Friday 9 December 2011

A nasty piece of work

This man must be denormalised
The endless slurry of stupidity in modern life makes it easy to become numbed to even the vilest viewpoints, but every now and again you encounter somebody whose worldview is so revolting that you wonder whether you can be of the same species. Such an individual is one Dr Jonathan Waxman who has an article in The Times (£) today under the headline...

To avoid cancer, let the State dictate your diet

Oh dearie, dearie me. Not a good start at all. However, writers don't get to pick their own headline, so let's give him a chance to explain himself.

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."

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. 

Jeez, d'ya think?

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?


George Speller said...

And the facist swine hides behind a paywall. Anybody got his email address?

Anonymous said...

Spot on Chris,this nazi needs to be publicly flogged in a comments section open to the public.

Anonymous said...


"The cost of sloth, gluttony, alcoholic intemperance, reckless driving, sexual frenzy, and smoking have now become a national, not an individual, responsibility, all justified as individual freedom," asserts Dr. John Knowles, the influential president of the Rockefeller Foundation.

"But one man's or woman's freedom in health is now another man's shackle in taxes and insurance premiums." Knowles sternly warns that "the cost of individual irresponsibility in health has become prohibitive." 110

110 Conference on Future Directions in Health Care: The Dimensions of Medicine, Sponsored by Blue Cross Association, Rockefeller Foundation, and University of California (San Francisco) Health Policy Program, New York, Dec. 1975

Rockefeller Medicine Men
Medicine and Capitalism in America

Carl V Phillips said...

Chris, Great post (as usual). One thing: Try to avoid looking like you are falling into the misuse of "reductio ad absurdum" that the extremists have adopted. RAA is a logical technique by which an assertion can be disproven by observing that a false statement follows from it. The nannyists, who clearly do not understand what the term refers to, are trying to use it -- as you implicitly note -- merely to evoke the English word "absurd".

The complete legitimate RAA argument here is someone saying "it is ethical for the government to interfere with individual choice when such interference protects them from health consequences or saves public money; therefore interference with tobacco use is ethical". The RAA argument that refutes that logic (which, it should be noted does not disprove the conclusion, but merely shows that that particular premise is not a basis for claiming the conclusion) is "that premise would mean that it is ethical for the government to dictate what we eat for breakfast, and since 99.9% of everyone agrees that this would not be within the ethical bounds of government, the premise must be false."

Notice that there is no element of "if we allow that premise, then these other things will happen" in there. RAA is not a prediction, it is a logical (ethical, etc.) thought experiment.

Anonymous said...

Ummmm, smokers,drinkers, and the obese are AT LEAST 50% of the adult population and they are responsible for ONLY 40% of the cancers????

The non-smokers, non-drinkers, and non-obese are LESS THAN 50% of the adult population and they are responsible for AT LEAST 60% of the cancers????

This fool has proved a point that is totally at odds with his claims!!!!

Gary K.

Anonymous said...

"Costs to Society"

In America, the antis claim there is a loss of $97 billion in productivity/wages due to smokers pre-mature deaths.

However; when a smoker dies,the company will just hire another worker to earn those wages and there is NO loss to society of wages earned.

Since there are many millions of un-employed, there is no shortage of people looking for work.

Gary K.

Anonymous said...

Antis also claim that smokers cost society $96 billion per year in health care costs.

Apparently they think that smokers get the money, put it jars, and bury the money somewhere.

Actually, the money goes right to another part of society and that is the health care providers.

There is NO net cost to cociety.

Gary K.

Ivan D said...

I have rarely read anything quite so arrogant, ill–informed and offensive.

Waxman is of course a medic and very much not a scientist despite his affiliation to Imperial College. He is founder and president of the Prostate Cancer charity which seems otherwise sensible enough but perhaps one to avoid donating to if it gives this man a veneer of respectability.

It should be pointed out that the “study” linking 43% of cancers to lifestyle changes is in fact a review of old data produced by CRUK and published by CRUK in a journal owned by CRUK. It is neither novel nor of a high academic standard. The authors seem to have a problem understanding causality and rely heavily on old data and dubious sources such as WCRF. What the CRUK study does show us is that, given enough time to torture the data, its epidemiologists should soon be able to claim that most cancers are lifestyle related.

This suggests that there is no point donating to CRUK as all its expensive laboratories can be made redundant by forcing us all to eat up our greens.

dearieme said...

I'd forgotten about CRUK. My wife stopped supporting them after noticing that their standards of propriety were not hers.

Leg-iron said...

So let's see.

The state forces me to hand over money to cover any health costs I might incur in the future.

Then, to make sure I never incur any health costs, they will control my life down to the tiniest detail.

However, even if I follow their directions to the letter and never incur a single cost, I still have to pay for it all.

There is only one solution to this.

The NHS has to go. All of it.

Anonymous said...

I am happy to go along with Waxman's recommendations, as long as he is happy for me to set up camps where I'll house him and his family along with other 'intellectuals' and anyone else who is like-minded, to do the work I decree. The real estate market is inefficient, after all - I suspect that Prof Waxman has a nice big house whereas others are homeless. Shouldn't the State intervene? How much room does one person need?

I shall feed them the necessary nutrients, like lab mice, to keep them alive and productive until they are too old or weak to be of further benefit. It is in everyone's interest that my workers are healthy. By checking for any congenital abnormalities, I'll decide who mates with whom, and when.

The demands upon my time will be great. It is therefore I who will live in the big house with the garden. And as exercise is so crucial to health, which is the only reason I am feeding Waxman his five-a-day and only the monthly bacon buttie, after he's finished curing cancer he can do the weeding for a few hours each day.

I'd rather have prostate cancer than live in Waxman's world. It's apparent that he might have a brain like Uranus but he's never picked up 1984.