The IQOS cometh

Today sees the UK launch of Philip Morris's heat-not-burn product, IQOS, and the Today programme carried an item on it which you can listen to here. Today went to PMI's Geneva headquarters to hear about the science behind it and also interviewed ASH's Deborah Arnott who did her usual moaning about industry but said that if IQOS helps smokers quit that was 'all well and good'.

She made the facile point was made that if PMI wanted to reduce harm they would stop selling cigarettes. The reality is that no harm would be reduced by one tobacco company ceasing production of cigarettes and if even if every tobacco company stopped selling them it is doubtful whether harm would be reduced by driving the market underground. But the more important point is that tobacco companies can only sell cigarettes because people want to buy them.

A more rational way of looking at it is to say that if smokers want to reduce harm, they would stop buying cigarettes. The fact that they don't suggests that they think smoking is worth the risk, or plan to give up at a later date, or have not found a suitable substitute.

That is where e-cigarettes, snus and new nicotine products such as IQOS come in. A couple of striking claims were made by PMI on the Today programme. Firstly, that IQOS delivers 90-95 per cent fewer harmful constituents than conventional smoking and, secondly, that 70 per cent of Japanese smokers who have tried it have switched to IQOS permanently. The other striking figure is that PMI have spent $3 billion on developing IQOS to date. In other words, they are taking this seriously. It is no harm reduction gimmick. 

If the degree of risk reduction can be independently confirmed and if the Japanese experience can be verified and replicated, this could be a significant development. Much depends on whether smokers know the product exists (no easy task given the UK's extreme ban on tobacco marketing) and whether they like it when they try it. As I discussed in Free Market Solutions in Health: The Case of Nicotine, there are unintended consequences from hyper-regulation that work against harm reduction.

We must wait and see, but UK smokers now have a chance to find out. PMI have opened an IQOS store in Soho. I'll be popping up there in a couple of weeks. I've tried the product before and although I switched to e-cigarettes a few years ago, I can see why smokers who have never fully embraced vaping—like my IEA colleague Mark Littlewood—like it.

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Last Orders podcast with Martin Durkin

There's a new Spiked Last Orders podcast available. This month's guest is the great Martin Durkin (director of Brexit: The Movie, Britain's Trillion Pound Horror Story and more).

We talk about booze curtains in Ireland, the shrinking of chocolate bars, the war on fizzy drinks and go off on other tangents. It's fun. Have a listen.

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Still no evidence of a slippery slope

As we all know, the idea that the anti-smoking movement is a precursor to nanny state regulation of what we eat and drink is an evil myth spread by the tobacco industry. As Simon Chapman, Deborah Arnott and many good, honest tobacco control experts have tirelessly explained, it is a baseless scare story. Tobacco is a unique product, etc.

Now that we've cleared all that up, let's take a look at what was said at the WHO's recent anti-tobacco conference by Dr Vera da Costa e Silva, the head of the Convention Secretariat on Tobacco Control...

We are also watched by sugar and alcohol products manufacturers, who see the tobacco control movement as a precursor to threats they now face from public health campaigns. These industries fear a united international community acting on behalf of consumers. In the coming days, I hope their fears will be fully justified as we take further steps to end the tobacco epidemic.

Oh.

As Johnny Rotten once said, do you ever get the feeling you're being cheated?

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Tobacco tokens

My IEA colleague Len Shackleton has dug up an interesting debate from 1957 about tobacco coupons for the elderly.

In 1947 Hugh Dalton, then Chancellor of the Exchequer, used the budget to raise tobacco duty very sharply, by nearly 50%. This was largely to save foreign exchange at a difficult time, and to raise revenue: at that time the health dangers of smoking were not widely accepted. Indeed, during the war that had just ended, those in the armed forces had been provided with ‘smokes’ as part of their ration.

Dalton’s measure was, technically, a ‘regressive’ tax, in that it hit the poor relatively harder than the rich. Unsurprisingly, voices were raised against this. In particular, politicians were concerned about pensioners. Many of them were habitual smokers and the new charges would be a significant chunk out of what were then pretty meagre state pensions.

Accordingly Dalton was persuaded to institute what now seems to us a bizarre process of subsidy. On application to the Post Office, and signing a declaration that the tobacco was for their own use, pensioners would receive ‘tobacco tokens’, enabling them to purchase tobacco at the pre-duty-hike price.

This subsidy continued for eleven years, during which the number of pensioner-smokers benefiting rose from 1.4 million to 2.6 million, with the cost to the Treasury rising year on year. Eventually Harold Macmillan’s government decided to bite the bullet and scrap tobacco tokens. It fell to the lot of Enoch Powell, then the Financial Secretary to the Treasury, to lead in Parliament. The debate was to be a stormy one. The government was accused of ‘penny pinching from the poorest of the poor’, imposing a ‘heavy blow and a great hardship’. Dalton, by then on the backbenches, claimed that his measure had ‘brought great comfort and satisfaction’ to millions. Powell was accused of ‘sniggering’ and ‘sneering’ as he listened to the highly emotional case being made to continue with the subsidy.

As Len says, this highlights how difficult it is for governments to withdraw hand-outs once they have begun. It is also an example of a government cushioning the blow of regressive taxation for political reasons and then taking away the cushion. Either way, the full parliamentary debate is worth a read for anyone interested in the history of smoking, as is Len's blog post.

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Sugar bath

After commissioning some pointless junk last week, Cancer Research UK lowered the bar again yesterday with some meaningless claims about sugary drinks.They say that teenagers drink a bathful of sugary drinks every year. Perhaps they should commission Sheffield Uni to find out how many bathfuls that is between now and 2035?

I've written about it for Spectator Health...

As any fool knows, height is measured in double-decker buses and land is measured in football pitches. If you are measuring a very large stretch of land it should be compared to Wales, or possibly Belgium, but there is no need to be more precise than that. It is a robust system of measurement has served Britain well for years, but how should we measure volumes of fluid?

If it is a large body of liquid, an Olympic-sized swimming pool is the proper unit. For smaller quantities, you should use the bath. Most people have a bath tub, and everybody knows it can hold a hold a lot of liquid, so if you want to describe a reasonably large quantity of fluid there is no need to mess around with fancy-pants jargon involving 'pints' and 'litres', you can just say 'enough to fill a bath'.

That was the approach of Cancer Research UK (CRUK) today when they informed us that 'Teenagers drink a bathtub of sugary drinks a year'. In a press release that the BBC grandly described as a 'study', CRUK took data from the National Diet and Nutrition Survey and estimated how many sugary drinks are consumed by 11 to 18 year olds. The answer, they say, is just under two-thirds of a can per day. That doesn't sound like a great deal - and it is significantly less than they were drinking five years ago - but it is more impressive when you multiple it by 365 and put it in a bath. So that's what they did

Do read it all.

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Garbage in, garbage out

The Sheffield modellers have been in action once again, this time making some wild speculations about alcohol consumption in twenty years time. Cancer Research UK commissioned this little job which, I'm sure, is exactly what people who run marathons and buy pink ribbons want their money to be spent on.

You can read the report here but I doubt your life will be improved by doing so. I don't think it's even designed to be read. It has no academic merit and has no value as a policy paper. Instead, it seems to have been designed to get some cheap headlines and promote the Sheffield crew's pet cause of minimum pricing (while also furthering the cause of putting cancer warnings on alcohol, which is crucial in turning booze into the new tobacco). The timing of the report is revealing. It is surely no coincidence that today was the deadline for the Scotch Whisky Association to lodge its appeal to the supreme court in the minimum pricing case (which it has done).

The problem with predicting the impact of alcohol consumption is that nobody has any idea whether drinking rates will rise or fall next year, let alone over the next 20 years. We don't know what the economy will do, we don't know how the demographics will change and we don't know how tastes will change. Any forecast is guesswork and although the Sheffield team draw up four different scenarios, they caution against taking their guesses too literally...

The scenarios were selected to include increases and decreases in future consumption of varying degrees and, in some cases, reflect plausible explanations for the recent falls in consumption. None of these scenarios should be interpreted as predictions of what will happen in the future. Instead, they should be seen as illustrative examples of how the future could look under different conditions

That didn't prevent the CR-UK press release being headlined with...

135,000 alcohol-related cancer deaths predicted by 2035

And the media naturally followed suit with headlines like this...

More than 135,000 UK drinkers 'will die of cancer caused by alcohol by the year 2035'

One of the red flags indicating that the report was designed for propaganda purposes is the time-span of this estimate. Disease and mortality rates are nearly always measured in annual terms. The 135,000 estimate is not an annual figure. It is the combined total for the next twenty years. The only plausible reason why somebody would use such an unusual measure is that they want to create a BIG NUMBER for the media.

The annual figure of 6,750 doesn't sound scary enough and, with more than half a million people dying in the UK each year, it isn't scary, particularly since most of the cancer deaths occur in old age and extreme old age. And so they have multiplied it by 20 for effect.

The decision to model four different scenarios is commendable, but it is weird that there is hardly any variation in their estimates regardless of whether they assume alcohol consumption rises, falls or stays the same. Their alcohol-related cancer mortality estimates are all within a tiny bound between 133,213 and 134,636. 

In their best case scenario, they think there will be an average of 6,661 deaths per annum. In the worst case scenario, there will be 6,732 deaths. If that's the difference, it hardly seems worth worrying about.

The real purpose of the report is to push minimum pricing, which they reckon will prevent 674 cancer deaths but, again, this is over a twenty year period. In other words, we can carry on as we are and have 134,636 deaths between now and 2035 or we can bring in a regressive policy which will cost billions of pounds and have 133,962 deaths. The difference is a rounding error and, given the serious flaws in the Sheffield model, it is doubtful that even this marginal effect would be seen in practice.

There is more than could be said about this, but it's not worth the effort. It's hack work. CR-UK got their publicity. The Sheffield crew got their money. Let's move on.

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Alcohol and prostate cancer - the wizard strikes again

Tim Stockwell has established himself as the man who can turn black into white in the neo-temperance movement.

There is a mass of evidence showing that moderate drinkers live longer than teetotallers but Stockwell managed to persuade the Chief Medical Officer that this evidence shouldn't be taken seriously.

Conversely, there is no evidence whatsoever to suggest that hiking the minimum price on alcohol reduced alcohol-related deaths in British Columbia. Stockwell's own department in the province put out data showing as much, and yet he was able to create a model which convinced the world that alcohol-related deaths fell by a third.

Is there no end to this wizard's talents? Apparently not, for he has now decided that drinking causes prostate cancer. The British government doesn't think it causes prostate cancer. The International Agency for Research on Cancer doesn't think it does. Plenty of researchers who have conducted meta-analyses don't think it does.

But Tim 'no safe level' Stockwell reckons it does, and he's done what he did with the health benefits of drinking; he's looked at the evidence, thrown out the studies he doesn't like, adjusted the figures to within an inch of their lives, and claimed to have found a link. And not just with drinking, but with moderate drinking. And it paid off with headlines like this:

Prostate cancer risk soars by a quarter if men drink just one or two beers 

As in his previous work on moderate drinking, the supposed presence of 'sick quitters' is Stockwell's excuse for conjuring with the data.

Part of the problem with most previous studies comes from what scientists call "abstainer bias," where former drinkers were lumped together with people who have never touched a drop.

This practice can disguise the association between alcohol intake and health problems like prostate cancer by making drinkers "look good" in comparison with a group containing unhealthy former drinkers.

This would be a legitimate concern if you were looking at the overall mortality of drinkers and non-drinkers, but in a study of prostate cancer it doesn't matter if ex-drinkers are classified as abstainers unless alcohol consumption causes that form of cancer. You would only need to adjust for it if drinking was a known risk factor, which it isn't, but Stockwell assumes it is. Having made that assumption, he not only adjusts for it, but also boots out 90 per cent of the literature...
 

The research team identified all 340 previously published studies on alcohol and prostate cancer and found 27 that attempted to measure the risk at different levels of consumption.

You can read his study here. After ripping up most of the studies because they don't meet his standards, he is left with a pitifully small association between drinking and prostate cancer of 1.08, ie. an 8% increase in lifetime risk.

He then makes a bunch of largely unspecified adjustments and is still left with an relative risk of 1.08, but he managed to get a dose-response relationship and somehow got his results for moderate drinkers to achieve statistical significance.

He was then able to triumphantly announce that moderate drinkers have an 8% greater risk of prostate cancer, rising to 18% for heavy drinkers. Both are too small to bother most men but they were enough for the docile media to talk about how a man's prostate cancer risk would 'soar by a quarter [sic]' after 'one or two beers'.

Stockwell's evidence is as shaky as it gets, and people who know a thing or two about prostate cancer are not convinced. You may recall Diabetes UK politely putting down Action on Sugar when they claimed that sugar consumption directly caused diabetes. Well, Prostate Cancer UK issued a similarly gentle, but clearly sceptical, response to Stockwell's propaganda in The Times...

Iain Frame, director of research at Prostate Cancer UK, said: “It is already well known that alcohol plays a role in development of some cancers. However, the impact is unclear when it comes to prostate cancer specifically. This systematic review comparing previous research looking at possible links between alcohol consumption and prostate cancer serves to highlight just how difficult it is to undertake studies which provide conclusive evidence as to the true impact of one item in the diet over any other.”

This measured response was enough to get another member of the temperance fantasy modelling community - a goon from the Sheffield Alcohol Research Group called Colin Angus - to launch an extraordinary outburst on a venerable cancer charity. In a now-deleted tweet, he said...

I see no way to interpret this remark other than to conclude that Angus thinks that Prostate Cancer UK are deliberately lying about - or covering up - the risks of prostate cancer because they have worked with a beer company. This is quite an allegation.

Follow-the-money squealing and anti-industry paranoia come so naturally to people in the 'public health' racket that they make such accusations almost instinctively but, even so, this is a scurrilous claim to make.

It really is all about money with these people isn't it? It's what Carl Phillips calls the mirror-image delusion. They can't imagine anybody saying something just because it's true, or doing something without being paid for it, and so they can't imagine anybody else doing it either.


UPDATE

Another one who thinks that if you're not raging against alcohol, you're promoting it...

Mark Petticrew is not some Twitter loony. Or rather he is not just a Twitter loony. He was a key figure in the Chief Medical Officer's review into the alcohol guidelines which commenced with him having a private meeting with Stockwell and announcing from the outset that there is no safe level of drinking.    

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COP7 - what happened?

The World Health Organisation's snappily tilted Framework Convention on Tobacco Control's Conference of the Parties 7 drew to a close on Friday. So what actually happened? You can read reports from people who went to the effort of trying to get in, like Dick Puddlecote, but even according to the official FCTC bulletin not much has changed.

The two big topics were always going to be plain packaging and e-cigarettes. The WHO is in favour of the former (despite the evidence) and broadly against the latter (also despite the evidence). They set out a (junk science) position paper in September which was very similar to their previous position. For all the expense and negative publicity of COP7, the meetings ended with the position being basically the same. They encourage countries to ban them, but if they don't get a ban they demand hyper-regulation.

According to the official bulletin...

Oof – that was quite a week. COP sessions are always intense and tiring, with moments when it seems like Parties will never be able to reach consensus.

But this time really was different, with agreement unusually difficult to find on a number of issues.

While we hope there will be a few last-minute miracles today on some agenda items, it is worth thinking about why the frustration level was higher than usual.

According to the bulletin, agreement was harder to find because ('without wishing to sound paranoid') the tobacco industry somehow managed to slow down discussions. Since everybody except invited delegates and sympathetic NGOs were kicked out of the conference on the first day, this does indeed sound paranoid. More likely is that different countries have taken different approaches to e-cigarettes, with some - including the UK - bothering to look at the evidence.

The bulletin doesn't even mention e-cigarettes. From what I've heard, there was an attempt to get a resolution supporting total prohibition but this was opposed by enough delegates to get the WHO to fall back on its previous position.

The bulletin does, however, find room to mention what's really important to these guys...

Speaking of money: early in the week, the United Kingdom announced a significant investment of development funds into FCTC implementation. One can only hope this decision will attract imitators from other countries; it is an early tangible sign that the inclusion of the FCTC in the Sustainable Development Goals will have real-world effects.

That's £15 million from unwitting British taxpayers going into the coffers of this exceptionally secretive, unaccountable and morally corrupt organisation. Let's hope someone from the Department of Health - Andrew Black, for example - is hauled up by a minister to explain this largesse. It's bad enough that we have to fund ASH, Healthy Futures, the Health Equality Group etc. without giving more money to this mob.

The WHO gave Andrew Black, Deborah Arnott and their tax-sponging mates a special award for this 'donation'. How lovely for them.


UPDATE

My thanks to a reader for pointing out that the bulletin is from the Framework Convention Alliance rather than the WHO themselves. You can read what the WHO have to say here, but it's not much. 

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Marijuana is being legalised, now legalise vaping

Never mind the presidential election. Today saw California, Nevada and Massachusetts join Alaska, Colorado, Oregon, and Washington in legalising marijuana (Arizona rejected it and results in Maine are still being counted). Close to a quarter of all Americans will soon have access to legal cannabis. This is progress.

Meanwhile, e-cigarettes continue to be prohibited in several countries - and the corrupt WHO is currently talking about bans in many more, if reports from Delhi are correct. Two of the prohibitionist countries are Australia and New Zealand. Today, three organisations from these countries produced a report recommending the legalisation of nicotine for e-cigarettes. It's a policy supported by three quarters of Australians and is no more than common sense.

You can read the report here. Here's the conclusion...

The Australian Taxpayers’ Alliance, MyChoice Australia and the New Zealand Taxpayers’ Union recommend that the sale of ENDS and safe quantities of nicotine e-liquids be legalised with appropriate regulations.

The organisations support the development of appropriate regulations which avoid the dangerous error of classifying ENDS similarly to combustible tobacco cigarettes. Were the latter error to occur, a huge opportunity to improve public health, and save thousands of lives, will be wasted. With this in mind, we propose the following regulatory approach.

The Australian Taxpayers Alliance, New Zealand Taxpayers Union and MyChice Australia jointly call for the following actions to optimise the potential of this new and disruptive harm reduction technology:

1. That the Therapeutic Goods Administration to make the right choice to exempt nicotine for the purpose, and that the NZ Ministry of Health changes laws and regulations to favour full retail availability (to adults) of appropriately regulated ENDS;

2. Governments in Australia and New Zealand not miss grasping a public health opportunity through treating vaping like smoking (such as in the are of excise tax); and

3. The introduction of appropriate regulation at federal level to allow adults to choose less harmful alternatives throughout Australia and New Zealand (harmonization of harm reduction).

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The WHO versus the media

No, it's not surprising that the media have been kicked out of the latest WHO tobacco conference, but it is an outrage that not a single delegate voted against the decision. We are not only paying for this jamboree as taxpayers but the UK delegation - which, once again, includes Deborah Arnott from the nominally private charity ASH and the Department of Health activist-bureaucrat Andrew Black - generously offered the WHO another £15 million of our money to spend on its prohibitionist crusade yesterday.

The Rebel tries to get some answers in the video below. Worth a watch.


And then, today, Drew Johnson from the Daily Caller was dragged out...


Far be it from me to give advice to the WHO, but wouldn't it be easier - and less embarrassing - to just let people in? The public, media and - heaven forfend! - industry could only observe what was going on if they were in the gallery. It's not like they can say anything or do anything. The full transcripts will be available in a few weeks anyway.

I've written about the decline of the WHO for the Spectator. Here's a snippet...

How do you deal with a man who likens himself to Hitler, describes the murder of children as ‘collateral damage’, slaughters thousands, and says he’s happy to slaughter three million more?

If the man is Rodrigo Duterte, president of the Philippines, and you are the head of the World Health Organisation’s anti-tobacco division, you will send your personal congratulations. Never mind that Duterte’s indiscriminate shoot-to-kill policy for drug users has brought him to the attention of the International Criminal Court. Duterte has recently introduced a smoking ban and that, it seems, is enough for him to be embraced by the public health community.

A total lack of perspective? Perhaps, but an inability to look beyond petty lifestyle regulation has become the WHO’s calling card. Take North Korea, for example. Amnesty International says that this totalitarian hellhole is ‘in a category of its own when it comes to human rights violations’, but when WHO director-general Margaret Chan visited the country in 2010, she commented favourably on its low rate of obesity.

When the Ebola epidemic began in October 2014, Chan issued a statement saying that she was ‘fully occupied with coordinating the international response to what is unquestionably the most severe acute public health emergency in modern times.’ This was not entirely true. In reality, she was at a WHO conference in Moscow denigrating e-cigarettes and praising Vladimir Putin for his commitment to public health. Malaysian Airlines Flight 17 had been shot down above Ukraine only two weeks earlier.

Rodrigo Duterte, Kim Jong-un and Vladimir Putin. Is there any politician too brutal for the WHO so long as they take a firm line on fizzy drinks and smoking in bars? As international organisations go, this lot make FIFA look like the Girl Guides.

Do read the rest.

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Local councils and vaping

Excellent work from the Freedom Association here. They've sent FOI requests to every local authority to find out what vaping rules they impose on their staff. Nearly all of them ban vaping indoors and a large number of them force vapers to stand in smoking shelters (at least they have smoking shelters, unlike the NHS).

No evidence is provided by any of the councils for the ban on indoor vaping; there is none. The tobacco precedent means that authorities think they can ban anything on a whim (see also: the EU ban on e-cigarette advertising).

Do read the report. It's terrifying how stupid and illiberal people are in local government.

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WHO tobacco conference begins in the traditional way

The WHO's biennial anti-smoking conference got underway today in a city that is so thick with smog that it has been compared to a gas chamber.

As is traditional, the WHO made a show of being transparent for a few hours before doing the inevitable...

DESPICABLE: Every country at the WHO anti-tobacco meeting voted unanimously to kick out the press & the public #cop7fctc #UndemocraticWHO

— Drew Johnson (@Drews_Views) November 7, 2016

#WHO just restricted their meetings. Media & public kicked out. Not a single country objected. They are making policy using our tax dollars. pic.twitter.com/fY8s5nvKKK

— Lauren Southern (@Lauren_Southern) November 7, 2016

If you're on Twitter, follow @YaelOss, @sfliberty, @Drews_Views, @FaithGoldy, @Dick_Puddlecote, @AdamCleave, @INNCOorg and the two accounts above for regular updates.

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Alcohol and smoking experts

The Spectator has created a guide to experts for the under-10s. I don't agree with every word of it, but the bits about the 'public health' racket are amusing...

Alcohol experts

Sometimes grown-ups like to have a drink with friends or when watching box-sets. This is dangerous and you should ask Mum and Dad to consult the Department of Health guidelines before drinking alcohol. These special rules are drawn up by experts at ‘the Institute of Alcohol Studies’ and ‘the Alcohol Health Alliance’ or ‘the Modern Temperance Movement’ for short.

Now that vicars are not very popular, the Department of Health provides moral guidance about the problems of alcohol. These experts have replaced the word ‘evil’ with the phrase ‘negative health outcomes’. This is not catchy and explains why most people still ignore them.

Smoking experts

Everybody knows that smoking is bad for your health. So why do some grown-ups still smoke? Experts have concluded that people who smoke have different brains. They are unable to think for themselves and easily tricked by shiny packets and glossy advertising.

Anti-smoking experts know that smokers need to be lectured, scared and made poorer to stop them smoking. Although lots of smokers have started vaping instead, experts are committed to their campaign. Next, they plan to stop the packets being shiny. Experts understand people’s brains and shiny things.

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Pharma's leading questions

I was e-mailed last week by a lobbyist working on behalf of the pharmaceutical industry, asking me to complete this survey. The whole thing is geared towards getting the respondent to support the hypothecation of tobacco taxes for health care and, by implication, higher tobacco taxes.

Take the survey and ask yourself two (rhetorical) questions. First, why would the makers of alternative nicotine products be keen to use the state to push up the price of traditional nicotine products? Second, do the leading questions in the survey comply with the best practices of opinion polling?

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Roger Scruton on the WHO

As the WHO's secretive COP7 shindig draws closer, there's a good article in the Wall Street Journal about the organisation's dogmatic opposition to tobacco harm reduction.

For those who don't know, the FCTC COP meetings are biennial conferences held by an unelected international organisation where policies which affect hundreds of millions of nicotine-users are discussed in near-total secrecy (journalists and the public are banned). The UK's delegation is usually made up of the unelected bureaucrat Andrew Black and the unelected boss of a fanatical anti-smoking sock-puppet pressure group, Deborah Arnott.

It seems likely that this year's conference will spend most of its time promoting a policy that has conspicuously failed to reduce tobacco sales where it has been tried (plain packaging) while denigrating the only significant innovation in smoking cessation to have emerged in decades (e-cigarettes).

Roger Scruton's little book on the WHO is worth reading to get the background on this. It was published by the IEA in 2000, long before e-cigarettes emerged, and I only recently got round to reading it, but it is very prescient. For example, he noted that...

There is a crucial lack of transparency in the arguments and proposals emanating from the WHO on the subject of tobacco, and a clear intention to impose its legislation come what may. Whatever the arguments, it may reasonably be doubted that a committee of unelected bureaucrats has the right to nanny us in such a way, and to impose regulations that ought to be the business of national governments

In a more philosophical vein, he remarks on the WHO's growing obsession with 'NCDs' (non-communicable diseases) over infectious diseases as follows:

• People must die, and it is not necessarily in their interests, or in the interests of the rest of us, for them to ‘strive officiously to stay alive’. It is more important, in general, that people should enjoy full, productive and happy lives, than that they should eke out their years to the point when nobody regrets their dying. Any measure of the health of a society which paid attention only to the average age at death would have left out most of what matters. Equally important are the strength, well-being and physical condition of the population during its active life.

• There is a vast difference in life-expectancy between people in developed and under-developed countries. Life expectancy for men in Japan is well over 80; in central Africa it is around 50, in the Indian sub-continent around 60, in Europe and North America between 75 and 80. In almost all parts of the world the life expectancy of women is significantly greater than that of men.

• There is also a threat in the under-developed countries from diseases that have proved to be curable elsewhere.

• There is a distinction to be made between communicable and non-communicable diseases, which must be taken into account in any allocation of resources. A communicable disease (such as TB or smallpox) threatens whole populations, and is therefore an immediate public problem. Non-communicable diseases (such as cancer or heart disease) become matters of public concern only when life-threatening communicable diseases have been held at bay.

• There is a further distinction to be made between diseases of old age, and diseases which threaten at every age, and which strike the old and the young indiscriminately. Diseases of old age tend to be non-communicable, like cancer and heart disease.

• Diseases which threaten the young tend to be communicable, like malaria, river-blindness or Aids.

• Finally, there is a distinction to be made between voluntary and involuntary risks to health. Some people are risk-averse, and place health at the top of their agenda, being unwilling to risk their health for any other good. They are not necessarily the happiest of people, and indeed hypochondria is a form of human misery, which not only fills the sufferer with fears but also cuts him off from human sympathy. Normal people are prepared to risk health for happiness. One of the largest causes of hospital treatment in the UK today is sporting accidents – rugby, football, cycling and horse-riding. Those who engage in these sports regard them as so fundamental to their well-being as to take the risk in their stride. It cannot be the function of a health bureaucracy to cure us of such self-imposed risks.

The WHO's juvenile anti-capitalism, which has since reached new heights under Margaret Chan, is also discussed:

Tobacco has been on the WHO’s agenda for some time, and this is hardly surprising, given the many health-scares with which it has been associated. Little by little, however, it has moved up the scale of priorities. Now, under the new regime of Dr Brundtland, it has taken on the role of Public Enemy No. 1. It is not difficult to see why. People are making money out of tobacco. The tobacco giants are multinational corporations in fierce competition with each other, who engage in all the practices – from stereotyping adverts, to the sponsorship of pursuits like Formula 1 racing – which make big business contemptible in the eyes of those who depend for their living only on hand-outs from the public purse. Tobacco fits perfectly into the costume of the unscrupulous capitalist, as this was tailored by Marx and Engels. Unlike malaria, therefore, tobacco is the kind of thing against which you can declare war.

Dr Brundtland has publicly intimated that cigarettes should be available if at all only on prescription, and she has seen in the anti-tobacco cause a way of imprinting on the WHO her own distinctive style of politics. And she shows us exactly what is dangerous in the structure of transnational institutions in the modern world: they have been given legislative or quasi-legislative powers without full accountability for their exercise. And they have been irresponsibly placed in the hands of career politicians: in other words, people who desire nothing so much as an opportunity to legislate, without the tedious business of consulting those who will bear the burden.

Legislation without consultation sums up the WHO's approach very well. And things have only got worse at the WHO in the 16 years since those words were written.

Scruton's book is well worth reading. You can download it here.

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