Sunday 21 September 2014

The conceit of 'public health'

Blog post of the week has to be Clive Bates' open letter to 'public health grandees'. It really is a must-read, so if you haven't yet, do read it now. I'd like to highlight a couple of sections: -

Vapers think you don’t understand this model – and you don’t care what the evidence says. You have shown no sign of understanding how this works – and keep seeing it as a tobacco industry plot (they were late to the party) or some sort of rogue medical product. Neither is true. But vapers rightly suspect you are careless with the truth: most public health organisations united to support a ban on snus in the European Union in 1992, again in 2001, and once again in the 2014 Tobacco Products Directive. This is despite indisputable evidence that snus, a very low risk way of taking recreational nicotine, has been highly positive for public health where it is permitted and used in Scandinavia – displacing smoking, diverting smoking onset, and supporting user-driven quitting. There is no scientific, ethical or legal case for banning it – but you supported it anyway. This is the same public health model as vaping, so it is no wonder they don’t trust you. Until you face up to the lethal error you have made on snus, you have not earned the right to a hearing on vaping. 

The evidence on snus just keeps on coming. Last month, there was this study in the International Journal of Drug Policy:

METHODS: This paper exploits a quasi-natural experiment to examine the net effect resulting from these opposing incentives. While two Scandinavian countries, Sweden and Finland, joined the European Union (EU) in 1995, Finland was subject to a pre-existing EU ban on oral tobacco products while Sweden received an exemption. A difference in differences framework is used to estimate the change in the smoking rate in Finland due to the implementation of the ban. A secondary analysis uses Finnish smoking data to test for a structural break in trend.

RESULTS: In the post-ban period, smoking was 3.47 percentage points higher in Finland relative to what it would have been in the absence of the ban.

CONCLUSION: The availability of snus, a less harmful alternative to smoking, appears to have had a positive impact (reduction) on the smoking rate. Offering acceptable alternatives to cigarettes is critical in reducing smoking prevalence.

This study got no media attention and was completely ignored by supposed anti-smoking campaigners. As usual.

Clive also says this about the prohibitionists' insistence that vaping activists are astro-turf groups:

You seem surprised to find there are people who get up and do something, and do it for nothing – you seem to assume someone must be paying if vapers do anything. I can see why you might think this: it rarely happens in your world or it is a distant memory from your more idealistic youth. There are no grass roots or unpaid individuals campaigning for the things you want in this field. You should think of these people more like the activist campaigners you know in drugs or HIV/AIDS. Many vapers are passionate about their experience: they have escaped the death trap of smoking – or are heading that way – and having feelings of pride, empowerment, agency and control, as well as immediate welfare and economic benefits, and a much better long term health prognosis. They want others to benefit from the experience and they really don’t want you to take it all away through clumsy or excessive regulation based on poor science, comprehensive misunderstanding or for ideological reasons. And they don’t want to be collateral damage in your war on Big Tobacco, which is of little relevance to them.

It is undeniable that public health rhetoric is jampacked with references to Big Tobacco, Big Alcohol and Big Food. See, for example, this speech from the Director of the WHO, or this speech (ostensibly about public health, but actually about 'transnational corporations'), or, indeed, the entire campaign for a soda tax in San Francisco.

Until quite recently, I assumed that the attempt to polarise every nanny state policy as being 'doctors versus industry' was a marketing ploy on the part of the prohibitionists. It plays well with the media and the dimwitted. I assumed that most of them—with the exception of some of the younger, more naive campaigners and some of the true nutters like Gerard Hastings—understood that millions of people sincerely disagree with them and that it was impossible that all these people could be working for industry.

The e-cigarette issue has made me change my mind. It seems that many - perhaps most - 'public health professionals' genuinely believe that ordinary vapers on Twitter are part of an astro-truf campaign that has been orchestrated by Big Tobacco. It blows the mind that there are educated people who could entertain such a paranoid world of make believe, but if they believe this then there can be no doubt that they also believe that all opposition to policies such as minimum pricing, smoking bans and soda taxes is 'astro-turfed'.

Part of this comes down to an extreme sense of self-righteousness, fostered by living in an echo chamber, that makes it difficult for zealots to see any point of view other than their own. Clive is too polite to mention one of the other reasons why 'public health' people are "surprised to find there are people who get up and do something, and do it for nothing", which is that they would never consider doing anything without being paid for it, preferably by the government. A grass roots, volunteer-run 'public health' group is an oxymoron.

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