Wednesday, 5 May 2010

A package of cod psychology

Another cracking article over at Spiked, this time by Dr Michael Fitzpatrick, who reminds us that the Conservatives' public health policy is barely distinguishable from Labour's (ie. the nanny state writ large).

It is evident that Cameron’s choice has little to do with health, but is more a political selection arising out of prejudice against the sorts of people who engage in the sorts of activities that would be increasingly stigmatised under a new Tory government (as indeed they have been under New Labour).

Michael reiterates some of the arguments from his essential book The Tyranny of Health, questioning the validity of lifestyle modification in a nation of ever-increasing life expectancy. He then argues that even if such interventions can be considered morally justifiable, they simply do not achieve what they set out to do. Go read.


Anonymous said...

Interesting article, however he's no smoker's friend, is he? He refers to it a few times, with a subtle implication that it's not to be encouraged.

I thought his observation that AIDS was the first real public health campaign, where a particular normal behaviour (sex without a condom) was both immoral and potentially criminal, was particularly insightful.

However, I was disappointed that he spoke at length about how life expectancy continued to increase, despite all manner of gloomy predictions from "public health", yet he also made a point of saying that many people where (no doubt) saved as a result of a reduction in smoking rates.

However, he made no (absolutely, no) mention of the massive increase in life expectancy of the generations who smoked the most throughout the 20th century. Curious bias? I think so.

Indeed, anyone who has a logical bone in their body would look at the rock-solid, almost linear increase in life expectancy throughout the 20th century and ask themselve, "Hmm..if smoking is so deadly, why aren't there dips and accelerations, depending on whether smoking rates were 80%, 20%, 50%, or 30%? Why this continuous straight line upwards, regardless of the habits of the people?"

You know what the logical answer is? Smokers are increasing their life expectancy at the same rates as non-smokers. Drinkers are increasing their life expectancy at the same rate as non-drinkers. Fatties are increasing their life expectancies at the same rate as skinnies.

That doesn't mean that a 60-a-day, 10-pint-a-day, 20 stone bloke will live as long as a tee-totalling puritan. However, this is an extreme comparison from the absolute opposite ends of the spectrum. Most of us are not there.

Similarly, most smokers are not 100-per day smokers, anymore (although life expectancy rose, like King Canute's tides, throughout smoking's ebbs and floods).

Not only does Dr Fitzpatrick fail to address these peculiarities, but he also fails to distinguish between levels of smoking which used to prevail and that which is common today. Is there a less risky level of smoking? Of course there is! "The dose is the poison".

Drink two bottles of Scotland's best per day for a couple of decades and you won't see too many more. Run marathons or play rugby for 20 years or so, and you can kiss mobility (and freedom from pain in your doltage) goodbye.

Yet, despite the extreme emphasis on exercise, moderation, diet and various other self-flaggelations, life expectancy continues to grind upwards at its same, old pace - no faster, no slower.

It's a bit like global warming: all of a sudden, the populace realized that it wasn't warming at all - game over.

I would hope that at some stage, the populace realizes that all of this crap focus on lifestyle modifications is not changing the life expectancy curve at all, but is just making all of our lives more miserable, regulated and less fun.

Snowdon said...


Life expectancy is a poor indicator of specific health risks for specific diseases that can only affect a minority (however large that minority might be). Rising life expectancy in the last century was mainly due to huge reductions in infant mortality and infectious diseases. These have far more effect on overall life expectancy, partly because smoking related illnesses are diseases of middle- and old-age. The decline in smoking related mortality is masked by more powerful factors lifting overall life expectancy.

jonathan said...

When the effects of smoking are discussed, the mistake is often made of cofusing "smokers" with "smoking". It is often claimed that that smokers, on average, die 6 or even 10 years earlier than non-smokers. This is plausible because, on average, smokers are more likely to drink heavily, exercise little and enjoy a poor diet. Prof David Spiegelhalter of Cambridge University, on his life-expectancy calculator, gives equal weight to each of smoking, fruit and vegetables (may not stop cancer but still good for you in some way), exercise and alcohol. Notice that obesity does not figure as a separate indicator. However, if you are so fat you can't move, you won't be getting any exercise. For example, I'm 53 and the calculator subtracts 3 years off my expected future life-expectancy for each of the 4 bad behaviours. Life-expectancy is rising a couple of years each decade, so I don't think it has much to do with smoking dropping from one half to one quater of the population in the last 50 years.