Tuesday 29 May 2012

There's a storm coming

This story didn't get any media attention at all, but it should have, because it may turn out to be one of the most portentous moments of the year.

'Non-communicable diseases' is the hot buzzword in public health at the moment. They are the diseases you get if malaria, AIDS, typhoid etc. don't get you first. Thanks to mankind's virtual triumph over those nasty viruses, 'non-communicable diseases' are on the rise. This is good news, since they mostly kill us off in old age. As much as we might like to indulge in the narrative of people dying in their sleep from old age, the chances are they died of a disease—probably one that was respiratory or circulatory in nature.

It's not all good news, of course. Some of these diseases are preventable to some extent, or—more accurately—we can reduce the risk of getting them to some extent. Last year, a Cancer Research UK report claimed that 40 per cent of cancers could be avoided by (fairly dramatic) lifestyle changes. This is almost certainly an exaggeration, but even if true it remains the case that most cancers are unavoidable. Moreover, if you duck one non-communicable disease, there will be another one waiting for you a little further down the line (most cancer deaths involve people over the age of 75). So long as the population keeps ageing and the nasty viruses are kept at bay, there is little prospect of reducing mortality from non-communicable diseases as a category.

And yet, it seems that your government (wherever you live) has decided it can do just that.

NGOs applaud government leadership on non-communicable disease death reduction

After an intense week of lobbying by NGOs during the 65th World Health Assembly, governments are poised to agree to a historic target to reduce premature deaths from non-communicable diseases (NCDs - including cardiovascular diseases, diabetes, cancer and chronic respiratory diseases) by 25% by 2025. The target is expected to be endorsed by all 194 of the World Health Organization’s Member States on Saturday, 26 May.

The NCD Alliance, a global advocacy organization representing a network of more than 2,000 civil society organizations led a major lobbying campaign, and mobilized its network to ensure this target was secured.

"Intense lobbying by NGOs"—the epitaph of our times. How delightful it is that these organisations think that lobbying and legislation is a substitute for biology and medical science. Rejoice in the entirely arbitrary figure of 25%. Bask in the ludicrously short (12 and a half year) timeframe in which this miracle is to take place. If we take carbon targets as our guide—as these people evidently have—we can expect a further meeting in a couple of years when governments will sign an even tougher (but even more historic) target of 50%. Oh, what the hell, let's make it 100%. There will be no more death on this planet if we can just get career politicians to sign meaningless pieces of paper in five star hotels.

This would be a more impressive announcement if it was accompanied by the (admittedly unlikely) news that scientists have (a) found out what causes most cancers, and (b) have found a cure/vaccine, but they have not, nor does such a breakthrough seem imminent. Instead, what we have is a prohibitionist's charter...

In addition to adopting an overarching target, Member States have committed to reach a consensus, before the end of October, on additional targets on tobacco, blood pressure, salt reduction and physical activity; and to consider adding further on targets relating to alcohol, obesity, fat intake, cholesterol and health systems responses such as availability of essential medicines for NCDs.

Whatever targets these people have in mind, it is extremely unlikely—if not a mathematical impossibility—that even their full and total implementation would lead to the mortality reduction they are chasing occurring, let alone by 2025. What we have here is an impossible target that will be pursued with boundless ferocity at any cost.

If, as these lobbyists claim, 194 countries are about to sign this quasi-treaty, you can expect to hear much more about our 'legal obligations' to control eating, drinking, smoking and—the mind boggles—'physical activity' for many years to come. You may recall last year's charming article from Jonathan Waxman titled 'To avoid cancer, let the State dictate your diet' which was itself based on the claim that lifestyles cause 40 per cent of cancer. That is only the start and it is, of course, why the puritans, bureaucrats, nannies and headbangers of public health are so keen on the idea of 'non-communicable diseases', because it gives them what every trigger happy army general wants—a war without end.

(Thanks to Rob Lyons for letting me know about this story. When he e-mailed it to me I asked him what these people thought we should die of if not non-communicable diseases. "Boredom", he said. True that.)


Anonymous said...

How many times have I asked, "Who invented the phrase 'non-communicable disease'?

What a stroke of propaganda-speak! How do such ideas get through the court of 'public opinion'?

There is no such thing as a disease which is non-communicable. If an illness is not communicable, it is not a disease. Malaria is a disease because it is 'communicated' by mosquitos. Flu is a disease because it is 'communicated' by viruses. Heart failure is not a disease - it is the result of some problem within the body itself, almost always as a result of old age.

How have the zealots got away with another abuse of our language?

Anonymous said...


DISEASE: 1.a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment.

Ben said...

"reduce premature deaths from non-communicable diseases (NCDs - including cardiovascular diseases, diabetes, cancer and chronic respiratory diseases) by 25% by 2025"

Clearly a goal that can never be achieved, because there are no measurable parameters. To define 'premature' deaths, you would have to distinguish it from 'mature' deaths. As the average life span has continually increased over the past centuries, there will be continuous goalpost moving, making it impossible to reach the goal.
A game that can be played at infinitum, ensuring a never dwindling source of income for the WHO. An extremely clever business model!

Ben said...

Despite all the money poured into the WHO, they never attained their goal of eradicating malaria. Over 1 million people die every year of this disease, all of them extremely prematurely.
What a shame!

Anonymous said...

Public health, like all parasites burrowed its way into government a few decades ago.
The end game is near.
Governments of the present model will fall.
Taking the PH parasites down with them.
Indeed a storm is coming, a financial one.

dearieme said...

"Heart failure is not a disease": the cases caused by viruses (or other micro-organisms) should surely be classed in "communicable disease". Perhaps some (all?) cases of MS, and some cancers too. In fact, the class "non-communicable diseases" includes the class "diseases caused by micro-organisms that we haven't identified yet". Compare with peptic ulcers - they mostly turned out not to be caused by It's Your Own Fault For Not Coping With Stress, but by an infection.

Pete Snowdon said...

With regard to malaria, that is a classic case where well tried and proven methods of control are no longer allowed. Light dusting of homes in Africa with a fairly weak solution of DDT was a significant method of control for malaria until (I think) 1996. When its use was finally banned in that year a National Geographic graph (which I do not have access to now) showed a huge rise in malaria deaths from that year.

Of course the DDT ban itself was a reaction to a flawed but massively popular distortion by Rachel Carson in "Silent Spring". As usual it was impossible for people to understand that the sensible and controlled use of potentially dangerous chemicals can actually be a benefit in certain conditions.

As a result, since then millions have died and millions of pounds have been spent on the not as effective alternative of mosquito nets.

Pete Snowdon

timbone said...

There is something that crops up in my mind on a daily basis. It is something which has cropped up on a daily basis long before I was even a twinkle in someone's eye. It is something which has been possibly the cornerstone of all religious belief. Two words. EVERYTHING DECAYS

Anonymous said...

Just what were these 194 countries threatened with like no IMF or World bank bailouts per say. Like they did with the WHO FCTC treaty!

Or do they just bow to the Emperors at the UN and submit like vassals to the state!

Not a patriot of Independence among any of them!


Anonymous said...

Isn't the phrase 'non-communicable diseases' a contradiction in terms?

My point is that a person who has 'heart problems' may have those problems for any number of reasons. One, for example, might be genetic in origin. A weak heart muscle can hardly be described as 'a disease' any more that a weak leg muscle can be so described. But, of course, there are diseases which have the possible consequence of weakening the heart muscle. On the other hand, I do not discount the idea that there are diseases which a person might suffer which result from bacteria ordinarily resident in the human body.

Can anyone tell me of an actual disease which does not have a bacterial of viral origin?