Saturday, 20 July 2013

Lancet blames tobacco for everything, others more realistic

Let's get The Lancet out of the way first.

Even its headline is ridiculous: 'Tobacco control: where economics trumps health'. Its opening line is: 'Tobacco makes a lot of people a lot of money.'

While I couldn't agree more that the profit motive is no friend to public health, both the headline and the opening suggest that tobacco is almost unique in providing its executives with the kind of livelihood that renders them entirely indifferent to the consequences of their activities for public health. As if tobacco production is the only economic activity that makes people money. As if the interests fighting tobacco control had no financial interests at stake. (The health versus wealth dichotomy, applied to tobacco and its opponents, is an entirely false one.)

Following this ignoble opening, The Lancet continues its loaded argument, pouring derision on the idea that the government should need any more evidence before bringing in plain packaging. Let's just accept that the medics are the good guys and attempts to bring down the smoking rate or introduce plain packaging are opposed only by cynics of malevolent intent. The article concludes by urging advanced countries to show less developed countries what can be done to fight tobacco when things are done properly. (It fails to showcase the tactics of Anna Soubry as an example to the politicians of less developed countries in how to pursue tobacco industry goals – I'll give it that.)

And I thought The Lancet was a reputable science paper.

The trouble with The Lancet is that its views are so out-of-the-box absurd. It recommends citing a 'mantra' (that tobacco production earns people money) when discussing tobacco, as if such a mantra were relevant to the harm that tobacco causes, especially given that much human activity generates money, and that the whole economic basis of the Western world rests on the ability to make money.

A little more perspective is gained from Junican's blog post from Wednesday, where he links to a discussion about how damaging tobacco is at the F2C blog, and also discusses both Eysenck's paper (which shows how it is actually impossible to quantify the risks of smoking because of the variability and coincidence of other factors) and a paper by Kitty Little (which observes how lung cancer correlates with both diesel emissions and static weather conditions).

So much for whether tobacco is responsible for all the ills in the world. Clearly it isn't.  As for the other thing that The Lancet was complaining about, namely tobacco industry influence on government policy, a Scotsman article from Joyce McMillan comes in with a different perspective on this that is more mature than some I have read in relation to the supposed influence of Tory campaign manager Lynton Crosby:
For behind the sound and fury of this row about lobbying, there lurked one of those elephants in the room that are becoming such a striking feature of Westminster politics; the fact that when it comes to influence-peddling at the upper levels of British government, lobbying has almost nothing to do with it. Lobbying is, after all, a perfectly legitimate activity; charities do it, campaigns do it, companies do it, and even trade unions do it, although usually with very little success.
When major commercial interests seriously want to change policy, though, the best-organised of them know that straightforward lobbying and argument is merely the tip of the iceberg. What’s needed, to achieve real results, is a cohort of politicians and public servants, at the highest possible level, who will support these companies’ positions as a matter of course; and that is achieved not so much by presenting them with arguments, as by co-opting and employing them, and making sure that a large part of their own present or future well-being is dependent on their continuing harmonious relationship with the industry in question.
I am not sure that any of this is deniable. The fact that it goes on even though the government in Scotland won't speak to the tobacco industry is proof that tobacco is not the only industry that seeks to influence policy. (If it doesn't happen in Scotland already, it will happen in an independent Scotland, simply because a Scottish government will be a target for anyone wanting to do business in Scotland.)

I don't see what is wrong with trying to inject realism into the debate. How can it serve tobacco control to continue this farcical ideology that tobacco, uniquely, makes people rich at others' expense and tobacco, uniquely, influences politicians in ways that are unethical?

And how crazy is it mainstream media fails to report on Soubry, a politician who breach parliamentary procedure in her zeal to pass tobacco legislation, because they are worried that a Conservative party employee who worked for Philip Morris might have  talked to the party leader?

Good grief.


What the.... said...

'Tobacco makes a lot of people a lot of money.

There’s quite a bit wrong with the Public Health position. The statement implies that the tobacco industry makes a lot of money. However, there are other groups that make far more money from tobacco. For example, the amount of tax on the retail price of tobacco is in the order of 85% in a number of countries. The government makes at least 10:1 the profit of tobacco companies. And the government doesn’t produce anything: It’s simply a bureaucracy raking in the loot. Then there are so-called Public Health groups that want their cut of the booty so that they can remain in comfortable employment and further “educate” the public. Then there are pharmaceutical companies that have positioned, through much manipulation, their products as the preferred method of treatment for smoking cessation. They price their next-to-useless and cheap-to-manufacture nicotine replacement products according to artificially highly-inflated tobacco prices. The bulk of this inflated price goes directly to pharmaceutical companies. This conduct of looting those who smoke can well be described as a racket.

Routinely overlooked by Public Health is that it, too, is part of an industry making a lot of money. The medical establishment and medically-dominated Public Health has become so large that it can well be described as the medical industrial complex. It dwarfs the tobacco industry. There is plenty of evidence that there is over-servicing, over-medicating, and other fraudulent practices within the medical industrial complex. But these are very rarely considered by participants in this industry. Rather, they have promoted themselves as benevolent, non-materialistic overseers of the public protecting it from “evil” money-making industries, e.g., tobacco. This is just another massive “con job” done on the public.

What the.... said...

Consider how the medical establishment/Public Health portrays itself in the “battle” against “evil” Big Tobacco:
Antismoking has been obscenely funded by the taxpayer and Pharma interests for the last few decades. The great “skill” of activists is in propaganda - how to make headlines, how to maintain a high media profile. There has essentially been no questioning of their conduct. They are used to getting their way. The more fanatics are accommodated, the more hysterical and inflammatory become their claims, and the more deranged, draconian, and inhumane become their demands. On the rare occasion that fanatics don’t get their way, they resort to “Plan B” which is occurring now concerning “plain packaging” – it’s all a tobacco industry “conspiracy”. “There’s that “evil” tobacco industry thwarting our wonderful work”, screech the fanatics.

This entire “us vs them” framework was also contrived by the fanatics decades ago. This mythological good vs evil drama was suggested by Chapman at the 1983 [antismoking]
World Conference on Smoking & Health. It was in the presentation of his paper, a manual on how to do propaganda, “The Lung Goodbye”:
“Such a list could be added to considerably, but most entries would be characterized by being somehow cast in a mythological good versus evil battle in an arena observed by mass numbers of people. The good (health/clean air/children) versus evil (cancer/uncaring, callous industry) dimension is the ineluctable bottom line in the whole issue and a rich reservoir for spawning a great deal of useful social drama, metaphor, and symbolic politics that is the stuff of ‘news value’ and which is almost always to the detriment of the industry.” p.11

It’s all for manipulative, theatrical effect and has been quite successful – for decades - on an essentially gullible political class, media, and public. The zealots and their financial partners must have regular belly laughs at how all too easy the brainwashing has been.

What the.... said...

The medical establishment also does much damage, medically.

Consider “iatrogenesis” which refers to any detrimental outcome produced by medical conduct (e.g., adverse drug reactions, medical errors, poor care of the bed-ridden resulting in infected bed sores). In America, from the very few studies that have been done, iatrogenic deaths are estimated at 750,000-1,000,000 per annum. It dwarfs the so-called tobacco “death toll” (400,000) and is approaching half of the total annual death toll in America (2,500,000). The medical establishment is by far the leading cause of preventable death and disability and associated costs.

Further, the iatrogenic toll is far more plausible, causally, than the tobacco “toll”. The tobacco “toll” is based on lifetime use, involving millions of “puffs”, that also brings into play a veritable plethora of other factors over a lifetime. It is also argued from the population level that has very poor extrapolation to the individual level, i.e., it is a “statistical death toll”. Conversely, the iatrogenic toll is argued from the individual level and then estimated for the population level. For iatrogenesis, causation is typically demonstrable at the individual level. For example, with adverse drug reactions (these are properly prescribed, FDA approved drugs), it may take just one or a few pills to produce cardiac arrest in some patients that can be fatal or leave permanent injury. The patient is stable and within an hour of taking a pill goes into atypical catastrophic failure. The temporality of many of these associations is not over a lifetime, but involves hours or days. Of the two – the iatrogenic or tobacco tolls – it is the former that should attract very serious scrutiny. But, as will be seen, it has been the other way around, or upside-down, indicating who is running the show.

What the.... said...

Concerning smoking, there have been thousands upon thousands of antismoking “studies” conducted/funded. Many do not break new ground but simply reinforce the agenda. World Conferences on Smoking and Health have been occurring since the 1960s. In the last few decades there are National Conferences on Smoking and Health. There are now even Conferences for Nonsmokers. Then there are Smoking Cessation Conferences run by the Pharma cartel peddling its useless/dangerous “smoking-cessation” wares. Additionally there are numerous antismoking lectures and colloquia and speeches and committees and campaigns. Specific institutes for the study of tobacco have been created as sub-centres of university Public Health Departments (which in turn are sub-centres of the medical faculty). There is a plethora of taxpayer/Pharma-funded antismoking organizations – referred to as “charities” - lobbying government for antismoking policies. There has been a frenzy of antismoking activity over the last three decades. A formidable, lucrative industry has been created that did not exist 30 years ago. And the bulk of it is all under medical direction. The medical establishment has wreaked social havoc, again, to tackle the tobacco “death toll”, and peddled essentially on the basis of the far smaller so-called tobacco “toll” in nonsmokers (SHS).

So we could then ask that if this has been the reaction to the tobacco “death toll”, then there must be an even greater industry addressing/correcting institution-wide iatrogenesis? In fact, there’s not. Compared with the many thousands of antismoking studies, there are but a handful (~ 20) concerning multi-source or institution-wide iatrogenesis, damning as they are. There are no conferences on iatrogenesis whatsoever. There are no specifically-created institutes addressing the issue. In fact, it attracts almost zero attention within the medical establishment itself. The medical administration doesn’t like talking about it or the public knowing about it. This is the same medical establishment that now wants to “fix-up” the world. Scrutinizing the medical establishment would reveal how unstable its framework is. It would mean a [reasonable] loss of profits and trust. While it tenaciously maintains the spotlight on its favorite social targets such as smoking, it avoids scrutiny like the plague. The contemporary medical establishment has been reduced to a production line, a medical industrial complex, where the tenets of the Hippocratic Oath (particularly the edict of "first do no harm") play little or no part. The medical establishment was out of control 30 years ago. It has since entered a sinister phase. And smokers are one of the first to notice the ugly side of the medical establishment in its world-fixing (eugenics) and financially-compromised aspirations.

What the.... said...

References for iatrogenesis:
“We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs [adverse drug reactions] and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death”.

Including more sources of iatrogenesis:

Doctors Are the Third Leading Cause of Death in the U.S.
Cause 250,000 Deaths Every Year
From Starfield, B. (2000) Is US Health Really The Best In The World? Journal of the American Medical Association, 284 (4), 483-485.

Including even more sources of iatrogenesis:

Null et al. (2003)
Cause 780,000-1,000,000 Deaths Every Year

“Global Trigger Tool” Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured

What the.... said...

Some recent reports from other countries:

NHS Scandal Report To Expose Thousands Of 'Excess' Deaths
At 14 Trusts

A critical lack of staff and training in some nursing homes means that many elderly people are being left to die unnecessarily or are in great pain without proper palliative care.

Physician reveals the 'hidden agenda' of medical school

The story that emerges from the last few decades is that the medical establishment in developed nations is dangerously out of control. And it’s not as if the above reports are anything new, and some of these reports only touch the tip of the iceberg. These sorts of reports emerge every few years. Nothing is typically done to address the problems, with more reports to emerge a few years down the track, etc. And the problem is set to worsen with the “boomers” coming into old age. Medical practice has been allowed to flourish into a medical industrial complex into which the patient is forced. There is a theme amongst medical practitioners of having the bedside manner and social graces of an oaf. They conduct themselves like “body mechanics” with a “god complex” – delusions of omniscience, infallibility, and benevolence. The medical establishment produces many detrimental outcomes, yet is highly self-serving and self-protecting, where one major constancy is the production of profit, seemingly at the expense of much else, even to the point of a culture of secrecy concerning highly significant iatrogenesis. The doctor/patient relationship has also taken a pounding. Particularly concerning smoking, many doctors adopt a dictatorial stance where patients should even be coerced into quitting. There is also a cruel theme emerging in the medical establishment – see nursing home abuses. And it doesn’t stop there. Is it also not cruel to force patients that want to smoke off the entire medical property – in any weather – to do so? And what about involuntary mental patients that want to smoke? They are restrained physically or chemically, or given multi-day solitary confinement, rather than allow them to have a cigarette – even outside.

There has been a terrible loss of compassion. Practitioners have become blinded by questionable ideological stances (e.g., antismoking) and profit pressures. There is a chilling inhumanity that has been allowed to flourish in the medical establishment.

What the.... said...

The issue of iatrogenesis is occasionally put to Michael Siegel. Here’s his response of only a few days ago:
“Sadly, the problem of medical errors and iatrogenic illness is one that has not received appropriate attention. You are correct that it causes a great deal of morbidity and mortality. Unfortunately, the medical and health care establishment has been quick to criticize others, but when it makes mistakes, it almost never acknowledges them. Many hospitals have opposed simple right-to-know laws that required them to report medical errors that are made. I experienced this on a personal level during my medical school training (I didn't make the mistake, I observed someone else doing so).”

What the.... said...

It should also be noted that all of the detrimental consequences of the antismoking crusade – e.g., irrational fear/hate, social division/isolation, bigotry, economic fallout, contraband market – are also iatrogenic.

Belinda said...

@What the ...

Thanks for your comments. These would read well in a single blog post, if you allow me to convert it.

What the.... said...

Belinda, please feel free; go right ahead.