Friday 29 June 2012

Five years of junk in one place

As the fifth anniversary of the English smoking ban approaches, there was always going to be a lot of bollocks talked about it, so it's nice of The Guardian to put all the fish in one barrel ready for shooting.

This could very well be the most factually inaccurate newspaper article of the year, based as it is on the scribblings of Stanton Glantz, Anna Gilmore and Jill Pell. Our credulous scribe begins as follows...

Five years after the smoking ban drove nicotine addicts out of pubs and into huddles on the pavements, the fug-filled restaurants and bars are little more than a hazy memory. But it is not just our clothes that smell better – evidence is accumulating to show that the UK population is in better health too.

Strap yourself in.

The ban did not, as opponents warned, drive people out of pubs and into their homes to smoke.

Since the smoking rate didn't go down and 11,000 pubs went bust, it would be interesting to know where the smokers are smoking now. Have they all decided to start smoking in their gardens?

Whatever their domestic smoking arrangements, there can be no argument that smokers were driven from pubs and that pubs have been literally decimated by the ban:

Ban Damage

ASH: Hopeless liars

Pub share prices

Pete Robinson unleashed

A final word on ban damage

The big worry was that an increase in smoking at home would harm children, who were not subjected to so much secondhand smoke in restaurants and pubs. But a study carried out in Scotland, published in the New England Journal of Medicine in 2010, suggested their health has improved. Fewer have been admitted to hospital with asthma attacks since the Scottish ban on 26 March 2006, more than a year before the English ban.

The researchers looked at more than 21,000 asthma admissions between 2000 and 2009 for children under 15 years. Before the legislation, admissions among preschoolers were rising by more than 9% a year, while for older children they were stable. After the ban, they dropped by 18.4% for preschool children and 20.8% for those aged five to 14.

Utter bilge from the pen of Jill Pell and easily debunked by looking at the actual hospital admissions data. If that isn't good enough for you, compare and contrast these two statements made three months apart in 2011:

Ms Haw cited a study by Glasgow University which showed a 15% reduction in the number of children with asthma being admitted to hospital in the three years after the ban came into force.

Asthma UK said the number of emergency admissions had remained unchanged for a decade - suggesting the asthma of many young people was still being badly managed... "there has been no noticeable change in the unacceptably high emergency hospital admissions for children and young people with asthma in the last decade."

The first statement is based on the work of Ms. Pell. The second is from an asthma charity and is based on actual hospital admissions. They both refer to the same country and the same time. Who do you believe? More details here.

The biggest health impact has been a drop in heart attack emergency admissions – the "Montana effect", which has since been identified in many other places that have brought in smoking bans. Helena, in Montana, brought in a smoking ban in June 2002, but it was scrapped that December. During those six months, however, researchers publishing in the British Medical Journal found a drop in heart attack admissions to hospital.

The Helena miracle? Is that zombie study still walking?! The BMJ's decision to publish Stanton Glantz's innumerate masterpiece of cherry-picking shames the journal forever more. Details here. There is also the small matter that, no matter how you juggle the figures, a reduction in heart attacks of 40%, or even 4%, is mathematically impossible.

Anna Gilmore and her colleagues, at Bath's school for health, analysed heart attack hospital admissions for England between July 2002 and September 2008 and found a small but significant drop of 2.4% after the July 2007 ban. It was the equivalent of 1,200 fewer heart attack patients, they said in their paper in the BMJ.

Anna Gilmore's study was pure junk science.

But overall, it is pretty clear that smoking bans have made a difference to heart health. A Cochrane review, which scrutinised the data from 10 studies from North America, Italy and Scotland, found a drop in hospital heart attack admissions in all of them and a drop in the numbers of deaths in two.

Garbage in, garbage out. The Scotland study ignored the actual hospital admissions and was debunked by the BBC five years ago in addition to being included in The Times' Top 10 Junk Stats of 2007 (now behind a paywall). The Italian study was beyond a joke. And the biggest study conducted in America found no association whatsoever between smoking bans and heart attack reductions.

I hope you enjoyed that walk down memory lane. Here's to the next five years!

Meanwhile, back on planet Earth, the police are still raiding pubs and arresting landladies to enforce that "popular" smoking ban of ours.

Thursday 28 June 2012

The Causeway Cannibal, Zombie Apocalypse and the same old pattern of misinformation

I'm sure you've heard about the case of Rudy Eugene, AKA the 'Causeway Cannibal' who, on May 26th, attacked a homeless man in the streets of Florida, biting off part of his face. Eugene, who was mysteriously naked at the time, was shot to death by policeman at the scene of the crime. This bizarre and horrific case was immediately blamed on Eugene's alleged use of 'bath salts', an amphetamine-like legal high that has become mildly popular in the last two years.

This story created two moral panics at once. Firstly, that the world is heading towards a Zombie Apocalypse, and secondly that 'bath salts' are sending people loopy around the world and that something must be done.

The Zombie Apocalypse nonsense is too silly to discuss. As Dan Gardner says in his excellent book Risk, when one extraordinary event has been reported, journalists are eager to cover similar stories—even if they really aren't that similar—thus creating the illusion of a wider trend and a mounting crisis.

If someone is killed by a shark, for instance, all other shark attacks and near-misses are also reported, thereby giving the impression that the original event was part of a spate of attacks (a shark apocalypse). In truth, the subsequent non-fatal bites and sightings would not normally have been reported at all. Similarly, a woman biting a bit of her husband's face during a fight or a man eating his dog would not normally be regarded as cannibalism, but the Causeway Cannibal story is still fresh in our minds so let's pretend it's all part of the same picture.

The 'bath salts' aspect also follows a tried-and-tested model which I outlined in The Art of Suppression. The typical scenario runs like this: someone dies or nearly dies; the police/family/friends claim that the legal high du jour was involved; politicians and the media clamour to have the drug banned; toxicological evidence subsequently shows that the victim had not taken the drug; the drug is banned anyway.

This sequence of events has been repeated with only the slightest variations over the last twenty years, most recently when mephedrone was blamed for the deaths of two lads in Scunthorpe. The drug—known in the media, but not to users, as 'miaow miaow'—was swiftly banned in the UK. Only later did the coroner's report find that they had not taken mephedrone at all. They had taken the similarly named—but very different—drug methadone.

But waiting a few weeks for toxicological reports to provide some actual evidence is not what prohibitionist politicians do. As the Sun Sentinel reported back in May...

It'll be weeks before anyone knows for sure whether Rudy Eugene was even on drugs — traditional or synthetic — when he mauled Ronald Poppo on the MacArthur Causeway last Saturday. But some South Florida cities aren't waiting for the coroner's report. Horrified by the attack, they are adding bath salts to their previously announced plans to ban the sale of synthetic marijuana...

A week later, in Canada...

The Canadian Government announced Tuesday it will issue a ban on the street drug known as "bath salts" following the gruesome face-eating attack in Miami, Florida.

In Britain, the Daily Mail gave the story repeated coverage, such as this from June 24th...

British dealers are supplying America with the drug behind wave of horrific cannibal attacks feared to be 'zombie apocalypse'

The drug being blamed for a spate of cannibal attacks in the U.S. is entering the country from the UK.

Horrific assaults in which users of a substance known as 'bath salts' have eaten victims' flesh have given rise to speculation that America is in the throes of a 'zombie apocalypse'.

Proof that the whole world has gone insane can be found in the last paragraph of that report...

The Center for Disease Control even felt it necessary to address these fears, saying: "CDC does not know of a virus or condition that would reanimate the dead (or one that would present zombie-like symptoms)".

And then yesterday in America...

The Zombie Apocalypse phenomenon has entered presidential politics as Sen. Rob Portman (R-Oh.), one of Mitt Romney’s potential picks for VP, introduced an amendment to a Senate FDA bill that would implement a federal ban on the substance, helping the bill pass (92-4) and sending it on its way to President Obama’s desk.

“This ban can’t come quickly enough,” Grassley said. “Just about every day, there’s a new tragedy related to bath salts. The sooner this poison is off the store shelves, the better. I hope the president will sign this measure into law very quickly.”

Ever since the gruesome Miami cannibalistic attack stunned the nation during Memorial Weekend, bath salts have become a concern for recession-hit communities across the country that have been terrorized by zombie-like synthetic drug users that seem to follow a now familiar pattern of stripping naked, growling and trying to bite or eat their victims. The latest casualty, a family dog which was eaten alive by a Waco, Texas, man allegedly high on the deadly substance.

From day one, I have been very sceptical about the claim that this man was on 'bath salts'. This is partly because I have seen this pattern of events before and partly because—as I have been repeatedly saying on Twitter for the last month—there was no evidence that he had ever taken the drug, let alone was under its influence at the time of the attack. There was not even circumstantial evidence, such as his girlfriend (who also seems to be slightly odd) or family saying that he had a taste for legal highs. Nothing.

And so it has proved today...

The medical examiner's toxicology report of the "causeway cannibal" is back. Surprisingly, no "bath salts" or other strong street drugs were in his system.

Only surprising if you believed the unsubstantiated rumours to begin with.

Police immediately said "bath salts," synthetic drugs sold at convenience stores, were to blame.

They did indeed, but why? According to the Daily Mail...

The results were released weeks after a Miami police union official had speculated that because Eugene's behavior had been so bizarre he was probably under the influence of bath salts.

That's it?! Speculation from a single policeman who lacks the imagination to attribute bizarre behaviour to anything other than legal highs?! That's the evidence upon which hundreds of news stories and several pieces of proposed legislation has been based?!

It is. There was never anything more to it than that.

In the typical prohibitionist scenario I outlined in The Art of Suppression, toxicological reports usually get a fraction of the column inches given to the original false rumours. Because the Causeway Cannibal case has been such a big story, in this instance the facts of the matter are now getting out there but, as Maia Szalavitz writes in Time, the damage has been done...

Despite the fact that Eugene had no synthetic drugs in his system, it’s likely that his case will still be used for years as an example of what bath salts can make people do. If our history of wrong-headed beliefs about drugs is any indication, the association between bath salts and dangerous behavior will stick simply because it surfaced early. Since bath salts just arrived on the illegal market and remain untested and mysterious to many people, they will cling in ignorance to the horror stories about them.

I make no claims for or against 'balt salts'. I've never taken it, nor do I feel any urge to do so. It may be the worst drug to ever hit the market, or it may be an unlikely panacea.

I do know this, however. The publicity given to this drug since the Florida attack has made it world famous and more people will take it as a result ("It's legal! You can buy it online!", as the newspapers repeatedly tell us.) Furthermore, the drug will now be banned in many jurisdictions (in Britain, where it is known as Ivory Wave, it was banned last year) and new drugs will immediately come on the market to replace it—just as 'bath salts' replaced mephedrone. We will know even less about these new substances than we did about 'bath salts', and the pattern of tragedy, rumour, misinformation and prohibition will be repeated again. And again.

As for the Causeway Cannibal, new information has been released which apparently no one thought relevant to mention earlier.

Mental illness has always been a possibility. WPLG in Miami has confirmed that Rudy Eugene was diagnosed with schizophrenia. After this new toxicology report, that becomes the likeliest reason behind this unexplainable attack.

It looks as if the truth has finally put its shoes on in the Causeway Cannibal case. We will learn our lesson this time?

Monday 25 June 2012

ASH's funding: Who's been lying?

I note from Taking Liberties that the government is preparing to give taxpayers' money to ASH for the 42nd successive year. I discussed ASH's 2008 funding application in Sock Puppets, saying:

Contrary to the DH’s claim that it does not fund external research, ASH promised to provide “policy development research, research and analysis for DH, and for other government departments”.

Contrary to ministerial assurances that “none of this funding is to be used for lobbying purposes”, ASH specifically pledged to use part of this Section 64 grant for “media advocacy and lobbying”.

It is worth putting a little flesh on this information since the implications are potentially scandalous. Department of Health guidelines are quite explicit in ruling out the provision of Section 64 grants for research, with only a few specific exemptions...

The Department’s policy is not to award grants if:

- the grant will support research – we define research as ‘creative work carried out systematically to increase knowledge’. There are some instances where the Department may award grants, including for development projects, information services, routine surveillance or data-collection activities.

With regards to lobbying, successive ministers have stated in parliament that DoH grants to ASH are not, and cannot, be used for lobbying. Here is Dawn Primarolo, then Minister for Public Health, speaking in 2008:

Action on Smoking and Health (ASH) received funding from the Department in the current financial year in accordance with the 'Section 64 General Scheme of Grants to voluntary and Community Organisations'. The standard conditions attached to these grants including audit procedures are published on the Department's website.

ASH has received this grant specifically to carry out a defined project entitled "Capitalising on Smokefree: the way forward". None of this funding is to be used for lobbying purposes.

And here is Anne Milton, the current Minister for Public Health, speaking in 2011:

Action on Smoking and Health (ASH) has received funding from the Department in the past, through the Department's ‘Section 64 General Scheme of Grants to voluntary and Community Organisations’. ASH received these grants specifically to carry out defined projects.

None of this funding was, or could be used, for lobbying purposes.

Seems pretty unambiguous, no? But...

ASH's Section 64 funding request of 2008 tells a rather different story. Thanks to a Freedom of Information request made by Richard Puddlecote, we can see that ASH explicitly told the Department of Health that their "methods for achieving our objectives" included...

"Media advocacy and lobbying" (point 2 below)


"Policy development research, research and analysis both for DH, and for other government departments" (point 4).

ASH were duly awarded £600,000 over three years, as they had asked for. This raises a couple of thorny questions which require answers.

Were ASH lying when they told the DoH that they would spend the money on lobbying and research? It seems most unlikely that they would do so.

If they weren't lying and in fact did use part of the money for lobbying and research, then successive government ministers have misled the House when they said that grants to ASH were not used for these purposes.

Were the ministers lying, or had they been lied to by ASH or the DoH? In either case, why were these grants awarded in the first place when the application made it clear that at least part of the money would be used in ways which broke Department of Health rules?

I think we should be told.

Friday 22 June 2012

The shocking rise of non-communicable diseases

This nice little graph from The Atlantic tells a big story. Note how the annual mortality rate has nearly halved in the last 110 years and how the infectious diseases have been replaced by 'non-communicable diseases', especially heart disease and cancer, but also diabetes and respiratory disease.

Earlier this month, I wrote about the coalition of NGOs who have persuaded the World Health Organisation to pledge to reduce premature deaths from non-communicable diseases by 25% by 2025.

On Saturday at the sixty-fifth World Health Assembly - a meeting of the 194 member countries of the World Health Organisation – ‘delegates approved the development of a global monitoring framework for the prevention and control of NCDs, including indicators and a set of global targets. Member States agreed to adopt a global target of a 25 per cent reduction in premature mortality from non-communicable diseases such as cardiovascular disease, cancer, diabetes and chronic respiratory diseases by 2025.’

As you can see from the graph above, such a promise is little different to pledging to reduce total mortality by a quarter within thirteen years. To state the obvious, that is not going to happen.

What do these people think we should die of? If you exclude the infectious diseases and the 'non-communicable diseases', there isn't a whole lot left. You'll note that 'dying in a perfect state of health' is not an option. Presumably they want us to either die in an accident or commit suicide.

Or maybe they're planning to reintroduce tuberculosis and pneumonia. As the graph shows, that's the only proven way to keep non-communicables diseases under control.

I will leave the last word to the estimable Dan Gardner...

A 21st century temperance manifesto

In Sock Puppets, I mentioned a lobby group called Active Europe which is funded by the European Commission and the Council of Europe. Also known as Active Sobriety Friendship and Peace, its vision is "a world free from alcohol". It is a direct descendant of the International Order of Good Templars, the nineteenth century temperance outfit, and it continues to preach the virtues of teetotallism.

These people want an EU-wide alcohol strategy and, judging by a meeting to be held next week, the EU agrees.

What might such a strategy involve? If Active Europe get their way, it will involve a very great deal. They have published a list of "demands" (their word) based on the increasingly popular concept of "passive drinking" which, as you will see, is not the only piece of rhetoric they have borrowed from the anti-smokers.

Active demands that:

Direct and indirect alcohol marketing should be prohibited all over Europe

I'm not sure what indirect advertising is. Point of sale perhaps?

Alcoholic beverages should be clearly marked with content labels and labels warning the consumers about the risks connected with alcohol consumption. The warning text should cover at least 40% of the label.

Gee, I wonder where they got that idea from?

Alcoholic beverages targeting young people should be banned

Alcopops? Cider? Rum and Coke?

Alcohol product packaging and labeling should not be allowed to create a misleading impression about the content of the beverage, about the effects of the alcoholic beverage and they must not appeal to minors

That sounds like a recipe for plain packaging.

Alcohol should neither be sold in multiple packages nor offered at quantity discounts

Fine. I'll buy it by the barrel then.

The media should be cautious about consequences of alcohol consumption and avoid glamorization of alcohol consumption and alcohol products.

State control of the media. Why not?

European countries should adopt the model of retail monopolies for selling alcoholic beverages

State control of the alcohol retail industry. Why not?

Municipalities and local authorities should reduce the density of outlets

Notice that they give no ideal number of outlets. This is classic temperance stuff. However many outlets there are, there should be fewer. However high alcohol duty is, it should be higher.

Speaking of which...

All countries should increase minimum taxes on alcohol

Of course they should. Without end.

Non alcoholic beverages should be always more available than alcoholic beverages

What does "more available" mean? Pubs should stock more soft drinks than alcoholic drinks?

Alcohol should not be sold in packages

Plain packaging again?

Minimum prices for alcoholic beverages be introduced in all countries

That would break EU law, but never mind. It hasn't stopped the English and the Scots having a go.

Producing and selling home-made alcoholic beverages should require a license

Seriously?! That wasn't the law even during Prohibition.

All traffic, on the streets and highways, in the air and on the seas should be alcohol free.

Just to remind you, we—as taxpayers—are paying for this group to spout this stuff.

The alcohol industry should not be included in policy making on the alcohol field

Following the anti-tobacco blueprint to the letter.

Research financed by the alcohol industry should be discredited and ignored in the policy making processes

Ha! It should "be discredited and ignored" purely because of the funding source. How very enlightened.

Alcohol consumption has the consequences that the user escapes from reality instead of solving the problem. Obviously this creates obstacles for human beings to participate in the democratic processes. This amounts to political harm because in a well-functioning society everybody is empowered and engaged and nobody is influenced by drugs.

Do you know what I think "creates obstacles for human beings to participate in the democratic processes"? Governments funding special interests groups to lobby it while the rest of civil society is left out in the cold, that's what.

This group of neo-prohibitionists not only receive large sums of money from the EU (they list no other funding source). They are classed as "stakeholders" and they regularly "engage" with EU decision-makers. This system of patronage is endemic in the EU and has been a growing problem in the UK in the last decade. Welcome to the post-democratic world of state-funded activists and phony consultations.

Everyone is entitled to their opinion. I just don't want to pay for it.

A word from a cynical career politician

Hands Off Our Packs have produced a quality video which gives a nod to Yes, Minister and mocks the vacuity of modern politics, the power of bureaucrats and the nonsense of plain packaging all at the same time. Enjoy.

The government's consultation about this is drawing closer. It ends on July 10th so if you haven't registered your displeasure, go to the HOOPS site and add your name to the list. If you want to respond in detail, you can go to the Department of Health website.

The DoH is spending vast sums of money promoting this policy, despite this 'impartial' public consultation being run by the, er, DoH. Speak up now or allow the government's sock puppets to speak for you.

Thursday 21 June 2012

It's official: Soda is new tobacco

Having spent years explaining that the anti-smoking crusade is merely Phase One in a wider assault on liberty, it seems my work may soon be at an end. As the EU prepares itself for a Framework Convention on Alcohol, an article has appeared in PLoS which removes any doubt about the slippery slope. Directly comparing the soda industry with the tobacco industry, a bunch of social scientists from—you guessed it—California bludgeon the reader over the head with the news that Coca-Cola and its customers are next in line for denormalisation and extortion.

The hook for their argument is the soda industry's 'corporate social responsibility' programmes, ie. various anti-obesity campaigns, multi-million dollar philanthropy and community involvement. The authors note that the tobacco industry has also given money to the community in this way and therefore, by this tenuous association, the soda industry is EVIL.

Many other businesses also have corporate social responsibility programmes, of course, but they don't get mentioned because it would spoil their already paper-thin argument. Instead, they focus on Pepsi's Refresh project and Coca-Cola's Live Positively campaign.

As exposés go, I've seen better.

They use educational campaigns such as “Balanced Living” or “Exercise is Medicine” to urge individual consumers to achieve healthy lifestyles;


... [they] support charitable projects, such as the $2 million Spark Your Park (also called Sprite Spark Parks) initiative to refurbish basketball courts and school athletic fields in underserved communities;

The swine! Their businesses should be closed down, their factories razed to the ground and salt poured on the land so nothing can ever grow there again.

...and develop initiatives to improve the company's own business practices, e.g. reducing its water consumption.

Disgraceful stuff, I'm sure you'll agree. Just like Big Tobacco, only worse...

Soda CSR differs from tobacco in its explicit appeals to youth and in the aggressive launch of comprehensive campaigns soon after soda was linked to obesity.

It seems to be an iron rule that when governments spend large sums of money on public health campaigns, the advertisements are "innovative" and "hard-hitting", whereas even the most modest industry advertising campaign is "aggressive". Elsewhere in this article you can read about how the soda industry "has aggressively lobbied against taxes" and is "explicitly and aggressively profit-seeking". I wonder who the real aggressors are—the businesses trying to defend themselves or the fanatics who would impose their beliefs on others using state force?

Even from these brief descriptions it appears that the soda CSR campaigns reinforce the idea that obesity is caused by customers' “bad” behavior

If by 'bad behaviour' you mean choosing to consume more calories than you burn off, then yes, obesity is caused by bad behaviour.

Such tactics redirect the responsibility for health outcomes from corporations onto its consumers...

Beyond having to comply with basic safety requirements, corporations are in no way responsible for your health. You are. Never in history have we had more choice about what we eat and drink. Even within the soda industry, there exists a huge range of low- and zero-calorie products for you to choose from. What you decide to eat and drink is entirely a matter for you. Few choices are more personal and less public.

...and externalize the negative effects of increased obesity to the public

That sentence makes no sense. The soda industry is in no way responsible for someone becoming obese, but even if it were, the effect could only ever be internal to that person.

The overall goal for the tobacco industry's CSR strategy has been to normalize its products and its corporate image, but it has struggled as public health advocates have denormalized tobacco use and challenged tobacco companies trying to rehabilitate their images. Historically, advocates countered such campaigns by stigmatizing smoking. Now, denormalization characterizes the corporation's activities as a disease vector, and highlights the disingenuous use of CSR.

...The soda industry appears to be improving upon Big Tobacco's CSR strategy by acting sooner.

Sooner before what? Before "advocates" denormalise soda drinking, stigmatise soda drinkers and portray the soda industry as a disease vector, presumably. Well, yes. And who can blame them? They have the advantage of having seen the anti-tobacco blueprint. They know what's coming. They know that "advocates" will not stop with warning labels and sin taxes. They know that "advocates" will never be satisfied until the targeted product is illegal. Damn right they need to act. It's a shame that this action is limited to setting up charitable trusts.

While soda companies may not face the level of social stigmatization or regulatory pressure that now confronts Big Tobacco, concern over soda and the obesity epidemic is growing.

You don't need to read too far between the lines to see that social stigmatisation is on the horizon.

Unlike tobacco, at the first signs of soda denormalization soda companies quickly launched comprehensive, well-funded, international CSR campaigns that take advantage of social media.

Soda denormalisation, eh? How quickly things progress. For the "advocates", of course, this denormalisation is both essential and urgent.

Without sustained denormalization of soda, it will be harder for public health advocates to see why partnering with industry may further the companies' goals more than their own.

So what next? Having set our sights on the soda industry, all we need is a bit of junk science to decorate the crusade.

Research on the health harms of sugary beverages can help advocates name these products as one of the “biggest culprits” behind the obesity crisis. Emerging science on the addictiveness and toxicity of sugar, especially when combined with the known addictive properties of caffeine found in many sugary beverages, should further heighten awareness of the product's public health threat similar to the understanding about the addictiveness of tobacco products.

And there you have it. Addiction, toxicity, 'public health' and an evil industry that is copying Big Tobacco. I think we can say that Phase Two has officially begun.

Wednesday 20 June 2012

Stay skinny with McDonald's

Some obese children yesterday

A "freelance dietician" and her colleagues from London Polytechnic have published a survey of school children's eating habits in BMJ Open and have inevitably used it to push their nasty little statist agenda.

Half of inner city school-kids in deprived areas may be consuming fast foods/drinks at least twice weekly

Yes. And. So. What?

Conclusions: This study revealed a very high frequency of fast food consumption among the schoolchildren. Taste, quick access and peer influence were major contributing factors. These schoolchildren are exposed to an obesogenic environment, and it is not surprising that in this situation, many of these children are already overweight and will likely become obese as adults.

They're "exposed" to fast food joints, the poor dears. It's not as if they seek these places out, is it? The study notes that 61 per cent of these kids get free school meals. Doesn't say much for Jamie's School Dinner Revolution.

“Clearly, actions need to be taken to either limit the ability of these children to access fast food outlets or to change the foods they purchased at these outlets (e.g. less calorie dense, with more fruit and vegetables, with less fat and salt).”

What?! What does 'limiting the ability of children to access fast food outlets' mean? Close down the restaurants? Tie the children up? As for changing the foods available to private customers by private restaurants, I refer you to the case of Arkell v. Pressdram.

No doubt this cowpat of a study will be receiving ample press coverage tomorrow, but one important aspect of it will equally doubtless go unmentioned (because it doesn't feature in the press release).

When the researchers weighed these children they found something rather interesting. Here are the average body mass index (BMI) figures for each group by frequency of visits to fast food outlets. Bear in mind that a 'healthy weight is 18.5 to 25:

Weekly visits        BMI

Every day:            17.8

4-6 times:              18.3

2-3 times:              19.6

Once:                    20.3

Less than once:     21.4

And, for those of you who like your statistics with a little visual stimulation, let's see how that looks on a graph.

As you can see, the kids who eat the most 'junk food' are the skinniest—indeed they are slightly underweight—whereas the kids who eat the least weigh the most. Bit of a hole in the theory there, no?

Interestingly, it was observed that there was a significant trend that those who with greater BMIs reported purchasing fast food less often.

That's more than 'interesting'. It is a crucially important observation if you are going to go around demanding that fast food restaurants be closed down and have their menus tampered with by bureaucrats on the pretext of fighting obesity. What you see above is a perfect inverse relationship between consumption and body mass.

Based on our observations, it appears that those who have higher BMIs are less likely to consume fast food as often.

That's one way of putting it. Another way of putting it would be to say that people who consume fast food more often have lower BMIs. If the relationship was the other way round, this study would be cited as proof that fast food causes obesity. But since the findings go in the opposite direction, no such cause-and-effect is claimed and the researchers instead imply that there is reverse causation (ie. fat people avoid fast food restaurants because they are fat).

This is hardly the first time such a result has been found...

...there was no significant association between increasing takeaway and fast food consumption and obesity as measured by BMI corrected for age and gender. This is not a new finding. For example, French and colleagues found no significant relationship between frequent consumption of fast food and being overweight in their analysis of a cohort of 11-18-year-old boys and girls. Similarly, Simmons et al found no correlation between increasing takeaway consumption and obesity measured by either BMI or waist circumference.

So what is all this guff in the abstract of the report—and in its press release—about the 'obesogenic environment' that requires urgent government action?

We're being played like a cheap fiddle, folks.

An anti-obesity campaigner yesterday

Is the nanny state caused by socialised healthcare?

Paul Hsieh, a medical doctor, has an article up at Forbes asking whether an overbearing nanny state is an inevitable consequence of socialised healthcare. Dr Hsieh is the co-founder of a group called Freedom and Individual Rights in Medicine, whose very existence the British Medical Association must consider utterly baffling ("What are these 'individual rights' of which you speak?"). He argues that once the costs of healthcare are collectivised, the state can use efficiency savings as a justification for legislating against any personal behaviour that might be unhealthy.

One of Bloomberg’s primary justifications for his regulations is that widespread obesity drives up health costs for everyone. Nor is he alone in making this argument. USA Today and National Public Radio both recently published stories linking rising obesity rates to rising health costs. First Lady Michelle Obama has made childhood obesity her signature cause, arguing that obesity-related health costs jeopardize American economic prosperity. Former GOP Senate majority leader Bill Frist supports taxing sugar products to reduce obesity and national health spending.

The recurring theme: The government must limit our freedoms to limit overall medical costs. But this issue can only arise in “universal” health systems where taxpayers must pay for everyone else’s medical expenses.

Hsieh gives many other examples of excessive government interference being justified on the pretext of saving money, but I think he is wrong in his basic assumption. These people may use socialised healthcare as an excuse for sin taxes and prohibitions, but that does not mean that socialised healthcare is at the root of their concerns.

It is, as I explain at length in The Wages of Sin Taxes, demonstrably untrue that 'unhealthy' pastimes increase net healthcare costs. The obesity time-bomb is largely mythical, but the pensions time-bomb is not. If saving money was the real concern, we would subsidise cigarettes, remove speed limits and tax green tea (or whatever foodstuff is supposed to protect us from cancer this week). Many people are aware of this. Some are not, but I doubt that one prohibitionist in a thousand would waver in his or her support for controls on eating, drinking and smoking even if they did understand the real economics of the matter.

They might use the 'cost to the abstainer' argument to further their agenda, but that is only a rhetorical device. Removing these costs would not appease the likes of Bloomberg. People have long fought wars in the name of religion, for example, but the appearance of avowedly atheist regimes in the twentieth century did not lead to the decline of war. There is a difference between a reason and an excuse.

As smoking bans move beyond 'public places' (most of which are in fact private) and into the outdoors and people's own homes and cars, it has become clear that such bans are not about 'protecting' nonsmokers. As the years go by, it will also become clear that the crusades against food, drink and alcohol are not about protecting the public purse, nor even about 'thinking of the children'.

Prohibitionists have always found ways to bypass the obstacles presented by a liberal society, usually by appealing to some nebulous harm to others. These arguments can be shown to be fallacious, often with ease, but the fact that they do not change their minds despite their arguments being utterly refuted indicates that they are not motivated by their putative concerns, but by a deeper desire to control.

At the moment, the 'cost to healthcare' argument is popular, partly because it allows almost unlimited scope for political action, but it is a mistake to think that those who espouse it would fall silent if socialised healthcare were to disappear. Indeed, as Hsieh shows, many parts of the USA are hotbeds of nanny statism despite having a far less collectivised healthcare system than other wealthy countries.

It is tempting to believe that the arguments made by prohibitionists are sincerely held and that their prohibitionism can be cured by either refuting their arguments or removing the source of their supposed concern. In truth, their arguments exist only to decorate and obscure their true motivations. When one is destroyed, another instantly emerges to support the exact same policy. Refuting these arguments is not entirely pointless since a genuinely open-minded observer might be within earshot, but one should never confuse what a prohibitionist says with what he believes.

Monday 18 June 2012

How very reassuring

The Department of Health has released a statement in response to fears that plain packaging will be rolled out to other products...

"We have no plans to introduce plain packaging for food," a Ministry spokeswoman told this publication. 

As anyone who is familiar with the jargon of politics knows, 'we have no plans' is very different from 'we will not'. However, as Food Production Daily points out, the DoH's comment is more revealing for what it did not say than for what it did. The statement was released in response to the following comment from Mike Ridgway, a representative of the British packaging industry...

“With legislation around minimum alcohol pricing in the pipeline, high profile debates about a “fat tax” and calls for cigarette style health warnings on alcohol and ‘junk food’; brand owners and manufacturers have to open their eyes to the very realistic threat of ‘plain’ packaging being introduced on a wide range of consumer products. Indeed the Parliamentary Select Committee for Health has already called for evidence on “plain packaging and marketing bans” in its scrutiny of the government’s alcohol strategy.”

Since Mr Ridgway repeatedly named alcohol as the next prime target after tobacco, it is rather disconcerting that the DoH chose only to mention food in its rebuttal. I would be tempted to not read too much into that were it not for the fact that the UK and Ireland are indeed both looking at plain packaging for alcohol.

Meanwhile in New Zealand, Prime Minister John Key has said that "we have the sovereign ability to control what's on our shelves and the way we present it." A strange thing for the leader of a nominally free market society to say, but somehow not so surprising.

Still, we mustn't worry about a slippery slope here. As anti-smoking campaigners keep reminding us, tobacco advertising has been banned for ten years and yet nobody is seriously considering banning alcohol advertising.

Oh wait, they are.

If you pop along to this conference you will get the chance the hear Gerard Hastings speak. Hastings works at the UK Centre for Tobacco Control Research but—would ya believe it?—is now applying lessons learnt in tobacco control to the field of alcohol control. We know what he wants because he was at the 'Learning from Each Other' anti-tobacco/anti-alcohol love-in last year.

Professor Gerard Hastings, director of the Institute for Social Marketing and the Centre for Tobacco Control Research at Stirling University, said: "I’m very gratified to hear the minister talking about a complete ban as I believe that’s the way forward."

So, definitely no slippery slope there then. We can all rest easy.

Tuesday 12 June 2012

Sock puppets

Quite by accident, I seem to have written something that resonates with the British public. I don't know how this happened—a stopped clock tells the right time twice a day and all that—and I'm sure it won't happen again, but my first full paper for the Institute of Economic Affairs was received very well when it was released yesterday. Even my recent adversary Peter Hitchens found some kind words to say about it...

I see Christopher Snowdon (my opponent in a recent drugs debate) has done some excellent work on the growing interdependence between government and charities. For all that we clashed quite bitterly over drugs, I think Mr Snowdon should be complimented on this.

The paper is Sock Puppets: How the government lobbies itself and why. It is a study of state-funded activism with a particular eye on those charities who lobby the government whilst in receipt of government money. 

I did several radio interviews yesterday and was repeatedly met with shock when I told them that 27,000 British charities rely on the state for more than three-quarters of their income. Perhaps I am not supposed to disclose such things, but even the researcher who sounded me out for the Today programme was surprised to hear that charities received any money at all from the state. In fact, the government gives charities around £13 billion a year—more than they receive in donations from individuals. With such an imbalance between private and public 'giving', the term 'voluntary sector' seems wholly inappropriate and that's before we even touch on the sector's rampant politicisation.

And yet the researcher's attitude was, I think, typical of the British public, who see charity in the terms described by the Devil's Kitchen:

People tend to think of charities as being... well... voluntary organisations, doing actual, physical good deeds in the community—whether that be running soup kitchens, cancer hospices or homeless shelters.

Today, alas, the truth is often very different...

But most of these organisations were indulging in little more than flat-out lobbying. And they were using our money to do it.

It is one thing for the government to outsource public services to private charities. It is quite another for politicians to give pressure groups large sums of money which are then used to campaign for legislation (and they do—one thing this report shows is that successive Health Ministers have, ahem, 'misled the house' when they said that ASH's grants were not being used for lobbying). We have seen several instances of this on this blog in recent times (eg. here and here) and that is only the tip of the iceberg. It has to stop. It is profoundly undemocratic and a grievous misuse of taxpayers' money. As I said a few days ago...

This is not the kind of activity that should be taking place in a free and open society. A country in which the government's putative critics are funded by the government has more than a whiff of totalitarianism about it. What kind of state pays people to campaign for or against the government? What kind of politician thinks it appropriate to use public money to fund activism?

Naturally, the grant-addicted charity sector has responded to the IEA paper with displeasure (see here and here), but their rebuttals only highlight their belief that they have a divine right to taxpayer loot merely because (in their opinion) their causes are worthy. The obvious retort to them is that the schemes of technocrats, bureaucrats and vested interests might not be worthy and that is why people prefer a representative democracy to the managed democracy that the sock-puppet system would leave us with.

A large part of the charitable sector is so used to being funded by the state that it simply cannot understand why anyone would regard such an arrangement as unseemly. The original meaning of charity seems to have been consigned to the past for much of the 'third sector'. Amongst the public, however, there is still a strong sense that charity is nothing if it is not freely given.

If this report does no more than alert people to the scale of government funding of quasi-charities, it will have done some good.

Download it here (it's free) and stick it on your laptop, iPad, Kindle or what have you and tell me what you think.

The report was covered by the Telegraph and the Daily Mail and there is also some nice mentions from Ed West at the Telegraph, Bishop Hill,  Phil TaylorGuido Fawkesthe TPA, the aforementioned Devil's Kitchen, as well as my IEA colleagues Ruth Porter and Mark Littlewood. I also wrote a couple of short pieces for the IEA and Conservative Home.

I was slightly sleepy on BBC Radio 4's Today programme (9 minutes in), but woke up for BBC Humberside (35 minutes in) and was bright and breezy for LBC (there's a podcast of some sort but it requires more effort than I can muster, which is a shame because it was the best one).

Sunday 10 June 2012

That non-existent slippery slope again

Simon Chapman, 2011:

"The tobacco industry and its stooges played the same slippery slope arguments over advertising bans, sports sponsorship bans and pack warnings . Ad bans started 35 years ago. No alcohol advertising ban and no momentum I’m aware of other than breaking the sport/alcohol nexus. So the slope ain’t very slippery folks …."

Deborah Arnott, 2012:

Thirdly, the “domino theory” i.e. that once a measure has been applied to tobacco it will be applied to other products is patently false. The same argument was used against the ban on tobacco advertising, but 9 years after the tobacco ban in the UK, alcohol advertising is still permitted with no sign of it being prohibited.

The Sunday Telegraph, today:

Doctors call for ban on TV adverts for alcohol

Thirty leading medical bodies and charities have called for a total ban on advertising for alcohol on television... If the demands of the alliance are met, they would have a major impact not just on TV advertising but also on sport sponsorship.

Fancy that!

Sir Ian Gilmore, chairman of the Alcohol Health Alliance (AHA), said extreme measures were required to "reset society's norms" and protect children from marketing messages which glamorise drinking and fuel excess consumption.

"Resetting society's norms" wouldn't be the same thing as denormalisation would it?

Broadcast regulations state that commercials for beer, wine and spirits cannot be aired during shows watched predominantly by children. However, many programmes which are popular with youngsters, such as sitcoms and soap operas, are free from restrictions because adults make up the majority of their audience.

This is the slippery slope in action. Campaigners play the 'think-of-the-children' card to get a ban during children's programmes and then return a little while later pretending to have suddenly noticed that children watch football matches, Coronation Street and The X Factor too. Ipso facto, we need a total advertising ban. It is exactly the same argument that was used about 'junk food' advertising back in February.

Their paper welcomes the Coalition's plans to introduce a minimum price per unit but says more should be done to protect children from alcohol marketing.

Does anyone seriously envisage a time when temperance groups do not think "more should be done"?

[Ian Gilmore] said: "Britain's attitude to drink has changed dramatically, so that it has become all-pervasive, always available and constantly marketed.

"In terms of consumption, we need to change the norms, to get back to where we were 20 or 30 years ago."

So, to get back to where we were 20 or 30 years ago we need to get rid of alcohol advertisements which were legal and less tightly regulated 20 or 30 years ago. The logic is escapable.

And where were we 20 or 30 years ago anyway? We were drinking very slightly less than we are now. By 2008, per capita alcohol consumption had risen by less than ten per cent since the mid-1980s. What a golden age of sobriety that must have been.

We also know that since 2008, alcohol consumption has continued to fall rather sharply. Data from the Office for National Statistics confirmed the same, unreported story last week:

There has been a long-term downward trend in the proportion of adults who reported drinking in the week prior to interview. In 1998 75 per cent of men and 59 per cent of women drank in the week prior to interview compared to 68 per cent of men and 54 per cent of women in 2010.

This decline, which began in 2004, took place at a time when licensing laws were relaxed and—as we are constantly told—alcohol was becoming ever more affordable. Temperance crusaders are not responding to a mounting crisis, they are pushing as far as they can go within the realms of the possible and will continue to do so regardless of whether drinking rates are going up, down or nowhere.

How do they gauge what is possible? By looking to their elder brothers and sisters in the tobacco control industry, of course. It is no coincidence that the Alcohol Health Alliance was formed shortly after the smoking ban came in and is patently modelled on the Smokefree Coalition which campaigned for that legislation (including warning about the "passive effects" of drinking). If you want to know what anti-alcohol policies are on the horizon, don't look at patterns of drinking or any other evidence. Just look back at what the anti-smokers were doing a few years ago.

Friday 8 June 2012

A series of interesting graphs

As the media hate good news, the story of the extraordinary decline in deaths from heart disease in the UK has not received as much attention as it deserves. The graph below is from the British Heart Foundation's Coronary Heart Disease Statistics 2010 edition and shows that the mortality rate is less than a third of what it was forty years ago. Since 1980, the decline has been remarkably consistent and it has even gone below the government's target (something of a rarity, as these targets tend to be arbitrary).

Talk of 'health inequalities' is very common at the NHS. The graph below shows a clear gap between different socio-economic classes, and yet it is worth noting that the richest people had a higher rate of heart disease mortality in 1995 than the poorest people in 2008. That is quite something.

How do we explain this incredible decline? The graphs below, which are from the same document, shed some light but, in my view, do not fully explain it. I post these here for my, and your, reference.

First up is smoking which saw the bulk of the decline between 1974 and 1990.

Secondly, there is fat consumption which did not really begin to fall until 1980.

The next graph is one to throw in the faces of those who lament the supposed decline of the British diet since the wholesome days of the 1950s. Per capita consumption of vegetables has changed very little since the war while fruit consumption has more than quadrupled. You have globalisation to thank for that.

The graph below shows high blood pressure. Interestingly, prevalence has changed very little since 1998 (when this graph begins) and so it does not correlate with heart disease mortality at all (nor do rates of obesity, which increased significantly between 1970 and 2000).

Then there are medical interventions. The first involves prescription medicines which have boomed in the last 15-20 years.

And then there are operations. This graph shows the number of percutaneous coronary interventions (better known as angioplasty) and heart bypass operations carried out. Both procedures are conducted far more often than they were in 1980.

Have I missed anything?

PS. Despite this decline, deaths from 'non-communicable diseases' have continued to rise, which kind of proves what I said in Spiked this week.

Thursday 7 June 2012

Is one cannabis joint the equivalent of twenty cigarettes?

OK, they didn't quite put it like that, but that is the message some people might take from the British Lung Foundation's latest press release.

New report reveals dangerous lack of public understanding of the health risks of cannabis

Risk of developing lung cancer is up to twenty times greater in a cannabis cigarette than in a tobacco cigarette – yet 88% of the public believe tobacco cigarettes pose the greater risk

The BBC dutifully reported that...

The British Lung Foundation carried out a survey of 1,000 adults and found a third wrongly believed cannabis did not harm health.

And 88% incorrectly thought tobacco cigarettes were more harmful than cannabis ones - when the risk of lung cancer is actually 20 times higher.

Let's be clear here. It is perfectly plausible that smoking cannabis could cause lung cancer and it is perfectly plausible that joints could be more hazardous than cigarettes. They are unfiltered, for one thing, and they tend to be drawn into the lungs for longer. They are often mixed with tobacco, but even when they aren't they contain 'thousands of chemicals' just as cigarettes do (and as any burnt material will do). Any heavy dose of smoke drawn regularly into the lungs over a period of years is likely to cause damage and thus raise the risk of cancer.

The difference is that, with the exception of serious Rastafarians, people tend not to smoke twenty spliffs a day for several decades, and that is the point at which cigarette smoking becomes a serious risk.

Could cannabis be so dangerous that it causes the same damage as chronic smoking in a few years? That is what the BHF are claiming. The organisation has previously claimed that three joints equate to a pack of cigarettes, but statistical inflation took it to just one in 2008. Today's news release was essentially a rehash of that figure which is based on this study from the European Respiratory Journal.

It's a fairly small case-control study involving 79 lung cancer patients. The only unusual aspect of it is that it looks at relatively young people (55 years old or less) who have a lower cancer risk than the elderly. It gives some quite typical findings in relation to cigarette smoking. 89% of the lung cancer cases were smokers. The overall relative risk of smoking was 6.7 (3.1-14.0) and there was a clear dose-response relationship going from 2.5 amongst the light smokers up to 23.9 for the heavy smokers. The key findings are shown below—click to enlarge.

Ho-hum. And, I must add, ho-hum to another finding that is briefly mentioned which, contrary to a wealth of propaganda which says different, is quite typical of epidemiological studies on the subject...

There was no significant association between lung cancer risk and passive smoking, diet, occupation, income, educational level and alcohol use after adjustment for age, sex, ethnicity, cigarette smoking and a family history of lung cancer.

For the pot smokers, the relative risk was just 1.2 (0.5-2.6), which is insignificant in both statistical and practical terms, but for the heaviest stoners the risk was 5.7 (1.3-20.4). This is statistically significant but, as the confidence interval suggests, not totally compelling.

The groups were divided by 'pack-years' and 'joint-years'. Pack-years are a standard measure in smoking studies which combine duration of smoking with daily smoking rates. One pack a day for a year is one pack-year, half a pack for two years is one pack year, two packs for a year is two pack-years and so on.

Joint-years is a less familiar concept, but it relates to one joint smoked a day for a year. Five joints a day for a year would be five pack years. You get the picture, I trust.

What about bongs and pipes?, I hear you cry. Fear not, for the researchers had that covered...

If subjects smoked cannabis in a form other than a joint, e.g. pipes or bongs, they were asked to estimate the number of cannabis joints to which that would equate.

I will allow you, dear reader, to be the judge of how accurate you think estimates made by cannabis smokers—not renowned for their vivid memory at the best of times, and reflecting on occasions when they were off their heads on bongs and pipes—are likely to be.

Anyway, the argument used by the BLF is that the heaviest pot smokers—those who smoke a joint a day for more than 10 years (or equivalent)—have a similar lung cancer risk (RR = 5.7) to people who smoke a pack of cigarettes a day for 14 to 24 years (RR = 6.1).

Actually, they don't quite put it like that but they should have, because it's a more solid way of looking at it than what they did, which was to try to show how much risk increased with each pack/joint-year. They say (as the original researchers do) that one pack-year of smoking increases risk by 7% and one joint-year increases risk by 8%. Ipso facto, 20 cigs = one spliff.

In doing this they ignore, as so many epidemiologists do, the fact that the dose makes the poison. "Risk of developing lung cancer is up to twenty times greater in a cannabis cigarette than in a tobacco cigarette" is a silly and scientifically insupportable thing to say because it suggests that there is one joint/cigarette with your name on it. A single cigarette/joint will not give you lung cancer. It is a cumulative effect and—not incidentally—you are more likely to get it from taking up cigarette smoking because, unlike cannabis, ciggies are addictive. There really isn't much evidence that a few pack-years of smoking significantly increases lung cancer risk, but after several decades the risk rises sharply every year. If you put it on a graph it would be more of a hockey-stick than a straight diagonal line.

The same is true of pot-smoking and the research they cite clearly shows this. There is no increase in lung cancer risk for people who have less than 10.5 joint-years. One joint-year does not increase risk by 8%. On the contrary, their own data show that the light/occasional smokers of marijuana have a statistically insignificant reduction in risk of 0.3 (0.1-1.7). Those who have up to 10.5 joint-years also have a statistically insignificant reduction in risk (of 0.5 (0.1-2.0)). After that it suddenly jumps to 5.7 (1.5-21.6), albeit with only 14 cases and 4 controls involved.

This illustrates the foolishness of trying to quantify risk by individual pack-years and joint-years, let alone by individual joints, which is what today's press release essentially tried to do.

A more sensible message would be—if this one study is correct (a big if)—that chronic ganja smoking raises lung cancer risk up to the level of someone who regularly smokes for two or three decades. Equally, however, the same research could be cited as proof that you can smoke seven spliffs a week for a decade and do yourself no harm. You pays yer money and you takes yer choice, but it is irresponsible to imply that cigarettes are a safer option, just as it is irresponsible to imply that shisha smokers would be better off smoking cigarettes.

One thing I would like to know—and here I appeal to the scientists who I know read this blog—is how the researchers attributed these people's lung cancer to marijuana when 89% of them smoked cigarettes?

Tuesday 5 June 2012

Christopher Hitchens on "the prohibitionist mentality"

I'm very grateful to Brad Rodu for sending me the transcript of a speech given by Christopher Hitchens in 2004. The topic was tobacco harm reduction, but Hitchens spoke more generally about the individual's rights in a free society. It's a fascinating document and I trust Dr Rodu will not mind me reproducing it below (it has not been published before). I was particularly interested in his views about prohibition and the war on drugs which were, as so often, the opposite of his brother's. He also takes on the 'think of the children' argument which, as he says, is a recipe for infantilising us all. Also of interest are his views on addiction and smoking bans, as well as his response to the seemingly inevitable question of being a tobacco industry 'shill'.

Tobacco at the Crossroads: A Debate on the Ethics of Reduced Harm Products, Southern Methodist University, Saturday October 23, 2004

Keynote Speaker: Christopher Hitchens

SMU Staff: It is my great pleasure and honor to introduce to you today a well-received author, columnist and lecturer who has been a long-time contributing editor to the Atlantic Monthly and Vanity Fair to name a few. He majored in philosophy, politics and economics while studying at Oxford University where he received his diploma in 1970. He has written numerous books as well as was a critic for Newsday, and on several television shows such as Hardball. He will also be publishing a book this month of essays entitled Love, Poverty and War. It is such a privilege to have him here today to share with us his views on these exciting topics. So would you help me in welcoming Mr. Christopher Hitchens?

Mr. Christopher Hitchens: Bless you. Thank you, Chelsea, for that handsome introduction, and thank you ladies and gentlemen for coming. It was a special delight for me to find on my way in that someone has gone to all the trouble to put the First Amendment in stone on the wall. I only have it in poster form on my office door at home so I do see it every day but I think it should be incised in a lapidary manner on the wall of every university in this country and other institutions of higher learning, and it certainly has a bearing on the subject we met to discuss today. I am in the happy position of just having just finished a small book about Thomas Jefferson. And that’s meant I’ve had to spend a great deal of time reading again about the debates that went into the writing of the United States Constitution and its wonderful Bill of Rights and Amendments. And probably everyone has at one point or another had to wonder how it is that a mysterious and rather beautiful phrase appears in the preamble to that constitution. Up until then, all English, American and European reformists and liberals trying to establish the right of self-government over arbitrary power, whether monarchal or religious, had said that they wanted to defend life, liberty and property. This was the trinity, if you like, of political and intellectual reform in that epoch.

There’s a twist of genius, an X factor you might say, in the great substitution in our great founding document for property – the pursuit of happiness. One way this has to translate, I think, for the modern American is that the citizen can in no way be the property of the state, and that everyone has the right to go to Hell in their own way. What is undecided and unstipulated in the constitution after all, we know, is left to the citizen to decide, not the government. As you know, in a little while we will be getting very specific about harm reduction and different aspects of it, and I know I’m going to have a very educated panel. So I thought I would cut and erase this by saying something more general, perhaps, about the cultural climate in which we met to discuss all this. And I just have a couple of anecdotes of my own, which I hope will be illustrative.

I know this sounds like the opening of a bad joke. It is not. I was in a bar in Kentucky the other day. I asked for a drink and the barman said that would be fine but he would need to see my ID. I was partly flattered and partly insulted. I said to him are you serious? He said I’m very serious. No ID, no drink. So I said well, you must be joking. And he said are you trying to make me look stupid? And I said no, only you can do that, but why is this? He said it was zero tolerance; everyone had to show an ID. And I said come on. Finally, he took pity on me and said do you know why this is? And I said yes, I would like that. He said, well, our whole chain has had to take this policy because we were recently sued by a 70-year-old man asked for a drink and wasn’t asked for an ID, and he sued on the grounds of age discrimination. In other words, if he had been 18 he would have had to show an ID but if he 70, he didn’t. What could be more discriminating than that? And I said, and you are telling me that the courts upheld that suit, aren’t you? He said, that’s right. That’s what they did. Yes. So that’s why we are doing this.

Well, my next item. I wrote a short book about Mother Theresa not long ago, and I called it – some people will think this bad taste – I called it The Missionary Position. It’s not bad taste at all. It’s about religion in India and that’s why I didn’t call it Sacred Cow, which might have been bad taste. But when it was made into a motion picture, a documentary, which it was, to my annoyance the company that made it called it Hell’s Angel, which I thought was definitely clutsy. But, anyway, that is highly irrelevant except I went to the University of Rochester, New York to show the film at a festival and there was quite a big protest outside by some devout people who thought I had been profane. And I walked through the crowd, and there was this gang being held back by a cordon yelling at me and waving. And they were kind of hairy and leathery and greasy. My penny hasn’t dropped. Perhaps yours has. And I went over and said, Gentlemen, was it me you were looking for? And they handed me a piece of paper. It was a writ I was served just there, and it was the Hell’s Angels Chapter of Upstate New York suing me for breach of copyright. And I said, was that it? And they said ya; you got the writ, read it. And they got on their bikes and rode away, and I thought it’s finally happened. Everyone in America is now a lawyer.

You see where I am going with this. Everywhere I go, whether I’m trying to be a critic, a lecturer or just trying to buy a drink between engagements or just have a sustaining cigarette, there is someone who knows better than me what’s good for me and who will bar my roads of pleasure, not just to the attainment of happiness but even as happiness as a pursuit and I’m beginning to resent it. And I’m hoping to evoke some of this resentment in you, too. You may find that you will become (?) by being forced to have an airbag in your car or a seatbelt or be unable to take a bicycle ride in some states without taking a helmet with you and putting it on. You won’t be able to take your children – I can’t any longer - in large parts of my hometown Washington, DC, to the swings because swings can be dangerous and if there aren’t enough warnings posted, a kid might fall off, burst into tears, and then someone would have a case against the makers of the swings. And this is beginning, as I say, to get me down just as it got me down being approached by legalized Hell’s Angels in Rochester, New York. 

Now there’s a man called Richard Carmona, whom you ought to know if you don’t, because he’s your Surgeon General. And he recently testified before Congress on the matter of harm reduction. If you have the packet, you can read what he says. There is a very interesting appendix to it and he wanted to say that there is no point in trying to make a better mousetrap, a less injurious cigarette or to (?) tobacco in a less harmful form; that would only be colluding with the racket that is big tobacco. It is not good for you to be told you have these options because there is someone who knows better than you about this, and for your own good will tell you that you can’t be told what your choices are because you might make the wrong one. This is the tone of voice, which I think one will want to resist.

If people can’t publicly advertise and campaign for and call attention to using their own money to give a wide range of money, then it is actually true that the First Amendment has been breached in more than one way – that should be self-evident – but what I object to most is the repeated use of the word kids in this propaganda. If you read the rest of the comment in this statement, I think he says kids several dozen times. There is a whole group called the Campaign for Tobacco-Free Kids, the address of this is to the children. I would prefer to say children because I think kids is a patronizing word for child, even a patronizing word for infant. But I noted the robotic way in which it is continually inserted into the argument. It seems to be that this robotic repetition is designed to do something rather, potentially at any rate, rather sinister; that is to say to infantilize the rest of us. We must all be treated as if we were all children who had to be protected from risk and harm. We are not allowed to grow up. The standard of safety of conduct of consumption must be regulated by the average child or kid to use the condescending term and not by the exercise of adult judgment by people who know that life consists of choices and that the freedom to make them consists of risks and that none of these freedoms would be available to us without the risk and danger that was undertaken in order to enshrine them, in this case happily in stone.

The direction I feel we are headed is this: the campaign to treat us all like children in matters of harm reduction and consumption of certain products is going to have all the glory and majesty and success as the war on drugs. That is where I think we are headed now. I think in almost every generation there is one superstition or barbarous practice or absurd, self-defeating policy that later people look back on and think what were they thinking; what was wrong with the human mentality in that epoch, witch burning, for example. The hunt for old ladies with cats as familiars with Satan and the public burning of same; it went on for a long time; slavery – that man could have property in man – that not even our Declaration of Independence or its first ten or so amendments had the nerve to undue – this was taken for granted; and the sale of alcohol, manufacture and consumption of alcohol illegal. Everybody knows that led or organized crime, to corruption, to violence, to every possible social ill, but at the time it seemed to be common sense. Those are the sorts of things we should be afraid of repeating, and I think most notably of all and the one we could do the most about and the swiftest – the prohibitionist mentality and prohibitionist legislation.

So, with that ladies and gentlemen, I hope I haven’t exhausted your patience, I look forward very much to getting real and specific with the panelists and as ever and as before, I’m very grateful for you coming. Thank you.

SMU Staff: Thank you, again, so much for your words, Mr. Hitchens. We are now going to invite the student representatives from each group to come forward and take a seat at our panel to ask more specific questions to Mr. Hitchens, and if we have time at the end we will also take questions from the floor. So would those students please come forward and take a seat up here.

Mr. Hitchens: I feel like a conductor without a baton, somehow. Who starts?

Audience Member: I guess one of the main concerns we had in our group was what was the FDA’s responsibility or what should it be in the regulation of the tobacco industry because if they do regulate it – nicotine is addictive – and if it is a drug and it is causing harmful things in the tobacco industry, how could they with their rules and regulations still allow it to be legal?

Mr. Hitchens: My position on this is simple. Humans have addictive streaks in their personality – most of them do - there will be something for everybody. I know that makes it sound like sex but its not meant to. Everybody does something. No one that I know has ever taken up cigarette smoking under the impression it is good for them. Most people, in fact, don’t even enjoy their first cigarette. I certainly didn’t. I remember where I was. It was actually that Methodist boarding school behind the bicycle sheds. But if you persist with it, it can be a great help to you; at least, it is to me. It helps me concentrate when I am writing. Nicotine has been shown to be good for short-term concentration. It also helps ward off Alzheimer’s disease, amazingly enough. I don’t see why it hasn’t got the right to publicize that. I don’t think there is any point in listing it as a narcotic, or supposing anyone that uses it is in need of any kind of treatment or advice from the government at all. I am a straight libertarian on this point. It is my business. I’m sure there will be a passive smoking question. Maybe I should wait until that comes. 

Audience Member: Excuse me, my question is this: AIDS and cancer we know the pharmaceutical companies are creating cures and research for creating cures for these types of illnesses or problems but our question is: is there any type of pill that will cure the addiction to smoking and should pharmaceutical companies take this initiative to enter into this field that could possibly turn into a billion dollar industry?

Mr. Hitchens: I don’t know if there is a type of pill. There are certainly various ways of kicking it if you want to. There are patches that give you nicotine but not into the lungs, as everyone knows. There are ways of using a lower intensity nicotine to chew or to snort snuff as well, which in some countries is legal but in a large number of European countries is not. In some places, as you know, it can’t even be advertised. No one I know who has succeeded in giving up has done it without the help of some kind of hypnosis, usual involving the use of another drug, but again, I don’t think it can be just swallowed. 

Audience Member: Should a victim of secondhand smoke be held responsible for being inflicted, or should those who created the secondhand smoke be held responsible? How do you pinpoint responsibility financially, the cost of inflicting upon someone else or yourself?

Mr. Hitchens: As you may know, there is a book by Jacob Solomon [sic - Sullum] who has been accused, I think falsely, of being a shill for big tobacco. He quite a clever libertarian author, also, saying that the science on secondhand smoking is junk, that there is no such thing as getting real disorders from anyone else’s smoke. And I believe, at any rate, that book deserves a better hearing than it has received. But I would rather not take my stand on that. I believe it is obviously noxious to some people. I know people who can’t bear to be around it and who become short of breath or get terrible headaches, for example. And that’s why I think it is perfectly right and defensible to ban cigarette smoking on, for example, airliners or anywhere else where people have to be or where they can’t escape it. But as you must have noticed, we have gotten to the point of prohibition and gone well beyond the protection of someone who doesn’t want to be exposed to smoke and its behavior modification for those who do. I’ll give you the easiest example of that, and for once I won’t use the example of a bar or restaurant. The Metro linertrain from Washington, DC to New York I used to take a lot and still do. It used to have a smoking car and it was the last car on the train. You didn’t have to go into it if you didn’t want to. It wasn’t on the way to anywhere. If you needed the men’s room or the ladies room or the club car or the restaurant car, you didn’t have to pass into this carriage but when you opened the door to that carriage you really felt like giving up, I’ve got to say. It was like the worst (?) in the history of the world. But, after bit you got used to it, and nobody likes a quitter, you know; we hung in there. Well, then it was decided we will take that car off the train. Now that’s just telling you if there is anything we can do to make your journey more miserable and less comfortable, please let us know. This has nothing to do with passive smoking it must be plain.

Audience Member: Do you think peer pressure is a factor in an individual’s decision to smoke, and if so do you believe there’s a problem with that and do you have any thoughts on stopping peer pressure from being that factor?

Mr. Hitchens: No, I know there is peer pressure because the people who are after me most to stop it are my children. And I try not to smoke around them in case the passive smoking does not turn out to be junk. I’m not going to use them as an experiment for that, obviously. So if I could have had the opportunity of rephrasing your question, I would say that peer pressure is probably the best kind because authoritarian pressure parental or pedagogic, very probably will be counter productive whereas a number of people give it up because they don’t identify with the sort of kids you who bring it on. 

Audience Member: Knowing that a product is addictive and that it is inevitably going to cause harm, how can you expect the people who do not engage in that act to pay for the things that will inevitably cause harm because smoking is addictive and nicotine is addictive?

Mr. Hitchens: Addiction I think, if I may say so, is moral rather than ethical judgment. It’s judgmental in that special extra sense. Human beings are addiction prone. Cravings of one sort or another will be satisfied. To call it an addiction is to borrow from the moralizing of the war on drugs where the addict is the object of either pity or hatred but it is presumed in some sense that he has lost control of his personal integrity. But I don’t think this is true at all so I don’t really accept the implied ethics of your question. And then I personally believe that if there weren’t access to alcohol and drugs there would be a great deal more suicide and a great deal more depression. I am absolutely certain of it, in fact. I don’t want to sound too utilitarian about this but if you are interested in the sharing of the greatest happiness in the greatest number and if you are interested in the moral, ethical and is seems also financial and provisional tradeoffs, then you’ve got to build them all in. And this argument so far has not done that, and I’m afraid your question doesn’t quite do it, if you don’t mind me saying so.

SMU Staff: We are now going to take a moment and thank you, panel, for your questions, and we are also going to give you, the audience, and an opportunity now to ask any questions you may have lingering.

Mr. Hitchens: I wouldn’t be hurt if there are questions, but I have to say I think the panelists you should applaud asked a fairly exhaustive amount of questions. Well done. But apparently not completely exhaustive. Boring repeat questions will be dealt with very strictly.

Audience Member: I was going to ask you what you would say to the few of us who are actually opposed to everything, smoking, drinking, drugs, all that.

Mr. Hitchens: What I’d say to you is how sorry I feel. You have no idea what you are missing. 

Audience Member: Mr. Hitchens, you have talked about that you get some benefits from smoking and I assume those are the benefits you get from the nicotine in the cigarettes and you are willing to trade that off for harm that comes from the tar and the carbon monoxide and the other things that are part of what is called the delivery system of getting nicotine from a cigarette rather than a patch. Our country also gets a lot of benefit from caffeine through drinking coffee. The rest of the stuff in the coffee doesn’t seem as harmful as the rest of the stuff in the cigarette smoke. And that is why I think there might be some distinction between the ethics regarding tobacco and caffeine. Would you not concede that if you could get those benefits from a way that wasn’t so harmful to yourself and other people that there would be nothing wrong with limiting nicotine intake that would not be so dangerous for the government or anybody else?

Mr. Hitchens: Well, you restate very well, if I may say so, the very ground that we were brought together to discuss today. What about it?

Audience Member: We haven’t discussed much.

Mr. Hitchens: No, but I was surprised there weren’t more questions about it, but I think because to most people it is self-evident, but it may be a dream that has been with us since Eden that if we could have all this without all that, which I think may be a sort of utopian illusion, myself. You know, the feeling that if only I could eat this and not get fat or never get fat or whatever, you know it is going to happen to everyone in the end. I have been down the road. I’ve had a look at this. No one comes out of this a winner I promise you. No one comes out ahead. It is taken care of but if you are just stopped somewhere, it can be a great insurance against boredom, and in my case against suicide. I think it helps short-term concentration and a great number of good writers wouldn’t have produced their good writing without it. John Paul Sartre, for example, who I think is a good writer, but he would have rather died than give up. He knew that was a choice. Well, how are you going to quantify being without his later work? I think it is worth the blathering of many Surgeon Generals myself.

Audience Member: Mr. Hitchens, thank you for being here today and being willing to take the opposite side of an issue. Credibility is very important, especially when you come before a group that is interested in ethics. It might help us to know where you are coming from with regards to financial remuneration. Are you supported or have you been supported by the tobacco industry to go out and take this position?

Mr. Hitchens: No, but I would happily receive money from them. I do this for a living and I have three children. I wouldn’t, unless the implication of what you say would be a matter of credibility was that I would say something that I don’t otherwise believe in order to attract money from a client desperate enough to solicit my services. I suppose I would have to think about taking offense if that’s what you meant, but I don’t believe that it was.

Audience Member: The question is not meant to be offensive. It is be appealing because you do stand before–

Mr. Hitchens: Full disclosure. You don’t have to explain what you mean, please, not to an audience of this intelligence. I feel sure, not yet, but if it is offered, I shant refuse it. I have written a number of articles, for example, defending smokers’ rights and tobacco manufacturers rights and never got a dime on the side for it so far. And I keep wondering why Johnny Walker Black doesn’t use me as an endorser because I keep mentioning the charms of the stuff. I do product placement quite often. And I feel out of full disclosure I should say what whiskey it is I drink. I haven’t even had a free bottle from them so far. But I don’t myself think there would be any shame in that unless someone was to say that I seem like a pushover or very easily bored but then I would have wasted my time with you wouldn’t I because I would have left you with the impression that I was that kind of chap. And if you can’t put yourself in the safekeeping of other people’s good opinion, then you have no self-respect to lose. Is this a present, because I’m not sure, and it isn’t.

SMU Staff: Thank you. We’d like to take one moment to thank you for your time, Mr. Hitchens, for your opinions, for your strong position, for taking the time to share with us. We have given you a little gift to you from us –

Mr. Hitchens: Oh, I am benefiting from it – thank you.

SMU Staff: So thank you ladies and gentlemen for one more round of applause.

Mr. Hitchens: Thank you ladies and gentlemen. Thank you very much for having me.