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| This man must be denormalised |
To avoid cancer, let the State dictate your diet
This week, a Cancer Research UK study revealed that about 40 per cent of cancers could be prevented by changing the way we live. This caused a lot of headlines, but we have known for centuries that cancer is related to lifestyle. In the 16th century, Italian barber-surgeons observed that breast cancer occurred at an increased rate in nuns and concluded that the increased risk might be due to the nuns’ apparent virginity — or rather that they had no children.
An interesting example to give, because breast cancer is indeed very strongly associated with childlessness. If doctors were to suggest that women who wanted to avoid breast cancer have as many children as possible as young as possible, that would be very sound advice. Strangely, I didn't see any mention of this in the Cancer Research report, but I did see a great deal about the much weaker association with drinking alcohol, which makes me wonder if there is a tendency to focus on certain 'lifestyles' while sweeping over 'lifestyles' under the carpet.
Inevitably, it is not long before we get to the anti-smoking blueprint...
The fight against tobacco shows that public health cannot be left to the individual...
No, it shows that it has not been left to the individual. It easily could be. And, by the way, there is no such thing as public health. There is my health and your health and their health. There is no communal pot of health.
Twenty-five years ago, about half the population smoked. Now that figure is 20 per cent.
Twenty-five years ago it was 1986, if I'm not much mistaken. In 1986, 33% of the population smoked. Maybe "about half" and "about a third" count as the same thing in the 'evidence-based' world of public health.
That shift would not have happened without powerful government intervention that took on the tobacco companies (and ignored the lamentations of the pension funds). Changing lifestyles not only needed information campaigns; it required mandatory and gory warnings on packets, an ever-increasing vice tax on cigarettes, advertising bans and forcing smokers out of pubs and offices and on to the streets with their habit.
Hang on, I thought the smoking ban was about 'protecting' all those poor bar-workers from being 'exposed' to secondhand smoke? That was the line in 2005-06 when ASH were campaigning for it. We were explicitly told that it wasn't a witch-hunt against smokers.
But now the truth can be revealed, as if we hadn't already guessed. It was about "changing lifestyles" by "forcing smokers out of pubs and offices and on to the streets with their habit."
But now the truth can be revealed, as if we hadn't already guessed. It was about "changing lifestyles" by "forcing smokers out of pubs and offices and on to the streets with their habit."
Only with this “nannying” did the message begin to stick and the mindset and individual choices of the population begin to change.
Cobblers. The smoking rate began falling in the early 1950s and has been gradually declining ever since. The smoking ban, the graphic warnings and the denormalisation began in 2007 and the rate of decline has slowed or—by some estimates—halted in the years since.
We need the same strength of public campaigning to prevent the coming cancer epidemic caused by obesity. Already a quarter of Britons are overweight — and the figure is rising.
You mean 'obese', not 'overweight', right? They are two very different things, as a doctor might be expected to know. The obesity rate is close to a quarter, yes. But whether one looks at the number of people who are overweight or obese, it is straining the truth to say that that figure is "rising". It is too early to say that the rate is declining after the large rise of the late twentieth century, but certainly "flat-lining" would be the only honest assessment of the recent trend.
I'll warn you now, dear reader, that you may need a stiff drink for this next bit...
So should the State dictate how many sausage butties I have for breakfast? Should the Health Minister be e-mailing me about my five-a-day broccoli and bananas? Yes and yes.
Sorry, but is this a wind up? "The State" should dictate how many sausage butties I have for breakfast?
Because my “freedom” has repercussions, not just on my health but on the rest of us. Private lifestyle choices have a tremendous effect on the public purse.
It's interesting that Waxman capitalises the word 'State', but puts the word 'freedom' in scare quotes, is it not? Gives you an idea of the value he places on the two.
As for smokers and the obese having a "tremendous effect on the public purse", not according to the vast majority of economic studies of the subject, it doesn't. Unless by "tremendous effect on the public purse" you mean saving money in pensions, benefits and healthcare costs. The table below shows the net lifetime healthcare costs of smokers, the obese and the 'healthy-living'. The smokers cost 220,000 euros, the obese cost 250,000 euros and the 'healthy-living' cohort cost 281,000 euros. Make your case on the basis on naked paternalism, by all means, but do not make it on economic grounds.
Some will argue that this is an affront to personal freedom.
But the people with the least ability to make informed choices are the poor, who happen also to be more likely to smoke or be fat.
Because the poor are so stupid and uninformed that they need the übermenchen of the public health establishment to force them to do what's right for them, is that it? They couldn't possible be rational actors like everybody else, could they? Here's an idea—since the poor are irrational and ignorant, why don't we stop them voting and form a coalition of doctors to preside over us? Then you lot could send us food parcels and 14 units of alcohol a week. Would that be enough control for you? Probably not.
Y'know, back in 1994, the tobacco company RJ Reynolds published an advertisement titled 'Today it's cigarettes. Tomorrow?' accompanied with photos of people eating burgers and drinking alcohol and coffee.
The text reads, in part:
Let's understand exactly what they're trying to do. They're pursuing a new era of prohibition, and in the process are ignoring the individual rights of not just the 45 million Americans who smoke but non-smokers as well. But the most threatening aspect of their program is their intention to force their views on the whole country. If they are successful in their bid to abolish cigarettes will they pursue other targets? Will alcohol be next? Will caffeine and cholesterol "addicts' need to be protected from themselves? Will books, movies and music get the treatment?
Not many people took this warning seriously, partly because it came from an industry which had an obvious vested interest and partly because the scenario seemed so outlandish. Who in 1994 could seriously envisage a campaign to ban smoking in the movies?! Who could imagine that people who eat high fat foods would ever be classed as addicts?! In all likelihood, RJ Reynolds never fully believed it themselves.
Three years later, ASH published a paper that addressed the slippery slope issue in relation to the ban on tobacco advertising. It read, in part:
Not a precedent for wider restriction
A ban on the promotion of tobacco is occasionally portrayed as the harbinger of wider restrictions and an authoritarian 'nanny state'.
Often this is made into a reductio ad absurdem [sic] argument in which the government is portrayed as regulating everything. This is false: the case for action against tobacco is based on its unique characteristics and enormous toll of death and disease even when used as intended. No other product comes close to matching this.
Contrast that with Waxman's article today, riddled with factual errors though it is...
Not only do we need to ramp up the public health campaigns that encourage us to ditch the doughnuts. But we will have to go further and ban adverts for high-fat foods.
Sure we do, and the rest. A reductio ad absurdum argument, huh? Who looks absurd now?
