Michael Kelly:Public need protection from themselves

Hypocrites don’t usually advertise themselves. Yet, in Tuesday’s Scotsman a tobacco company took out a full page advert “exposing” the fact that the UK government did not appear to have the evidence, in terms of costs and benefits, to justify the introduction of plain packaging of tobacco products.

The revelation was in the form of an e-mail, obtained under Freedom of Information disclosure, from the UK’s Tobacco Policy unit to an equivalent body in Australia. Dated May 2010, it followed the announcement by the Australian government to ban fancy packaging for cigarettes. In the e-mail, a British civil servant discloses “there isn’t any hard evidence to show it [plain packaging] works” and ask if his counterpart has done any impact assessment before introducing the policy. Well, of course, the Australians did; and their research showed that stripping cigarettes packets of their colourful glamour would increase the noticeability, recall and impact of health warning messages, reduce the ability of packaging to mislead consumers to believe that some products may be less harmful than others and reduce the attractiveness of the tobacco product, for both adults and children. The conclusions are persuasive and are posted on the internet for all – including the tobacco companies – to read.

You can be sure that those companies were the first to pore over them. Tobacco companies spend vast budgets on marketing, advertising, product placement and sponsorship. They research the impact on consumers of the presentation of their deadly products, including the colour and design of their packaging. They know precisely what evidence there is for all policy matters affecting their industry. So, rather than trying to embarrass the hard-pressed Department of Health to squander money on needless market research, they should disclose the results of their own surveys into the reaction of consumers to the attractiveness or otherwise of different forms of branding.

The fact that they are opposing the introduction of plain packaging is, to any objective observer, proof enough that they know it will adversely affect sales, especially to younger people.

Again, how cynical to demand evidence on this relatively minor issues when for decades they have challenged, denigrated and now ignore the overwhelming medical research demonstrating the serious health risks of smoking. From the Fifties’ research that first linked smoking to cancer, they have resisted the mounting evidence of health risks – even to the extent of swearing that nicotine was not addictive.

The companies who consciously peddle these cylinders of mass destruction require greater scrutiny and control, particularly over their sales efforts in the developing world. The heartbreaking commercials run by Save the Children highlight how little of the West’s money is required to reduce infant mortality in Africa. How contradictory that those who survive will be subject to a lifetime of tobacco salesmanship. It is time for the international community to step in to end it. Moral considerations will not hold these companies back.

Indeed, the scandal over contaminated meat products casts serious doubt over the practices of a whole range of companies supplying consumer products. The deceit in the food chain here was discovered by a foreign watchdog, in Ireland. That experience surely suggested that much tighter UK government and European control must be established. There will be complaints about bureaucracy and authoritarian government, but public health weights heavier in the balance.

Not that it is simply industry that should be held to account. Citizens, too, must be sanctioned if they subject the public to serious health risks. Start with those foolish parents who, in the early 2000s, decided to accept the advice of one rogue researcher, Andrew Wakefield, over the medical profession and refused to vaccinate their babies against mumps, measles and rubella. More than 100,000 children were denied that protection. As a result, today the same parents are queuing in panic to rectify their mistake in view of an epidemic of 620-plus cases of measles in South Wales.

There is an irrefutable case to be made for requiring people to be vaccinated against diseases that threaten public health. Whether a democratic society would ever allow individuals to be held down against their will and have a needle stuck in them is questionable. But social and economic sanctions, like those applied in the United States could be introduced – benefits might be affected, choice of school or employment might be restricted. Society simply should not be prepared to indulge the misinformed fantasies of ignorant people.

Unfortunately, while UK and Scottish Government policies are clearly prepared to push the promotion of healthy lifestyle policies to the limit, the National Health Service – which administers many of these policies – does not always set the best example. The sight of a grossly overweight nurse fills me with disgust. However, for many overweight patients, she may serve as a comfort and a validation of their own bad diet. Workers across the health services should be required to be non-smokers and with an acceptable BMI. If necessary, legislation should be introduced to allow contracts of employment to be so written.

The long-term answer is education. But how long to educate a public eager to follow any scare story it comes across on the internet and unwilling to accept establishment advice based on good science? Fluoridation of the water supply triggered the same kind of hysterical opposition when the only effect it has – verified over decades – is to reduce caries in the mouths of the most deprived of our children.

That example should haves served as a warning that the public cannot distinguish between good science and bad research, cannot evaluate risk. They must sacrifice some of their civil rights for their own good and that of the community. They must also be protected from those companies which want to kill them for profit.