Plain packaging kicked into the not very long grass?

I chanced on a tweet that sported this link, and the relevant paragraph is here, embedded in Amendments to the Children and Families Bill:

(1)   The Secretary of State may, if satisfied that doing so is in the interests of preventing harm to the health of children under the age of 18 or of promoting the health of children under the age of 18, make regulations specifying retail tobacco packaging requirements.

The relevant legislation, if this amendment is passed and the bill becomes law, will enable the Secretary of State to write up the regulations just like that. Another amendment to the Bill is to make it an offence to 'fail to prevent smoking in a private vehicle when children are present'.

It seems that there is something more than a little underhand to prepare for the legislation to be brought in without further parliamentary debate, as part of a bill that will be full of glowing language about how life is being made much better for children.

This is clearly the solution that junior health minister Anna Soubry was working to enable but I didn't expect to see it in writing quite so soon as this!

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.

House of Commons Scrutiny Committee questions Under Secretary of Public Health Soubry

Time for opposition parties to challenge government on the Tobacco Products Directive. So eager was Anna Soubry to get the Tobacco Products Directive in Europe through that she went to Luxembourg and took part in all the deliberations, without clearing any of her positions with the Scrutiny Committee. She requested a waiver from scrutiny from the relevant committees, which was allowed by the House of Lords committee(!) but disallowed by the House of Commons committee, which said that there was not sufficient time to debate.

She explains her reasoning for this debacle in the video below, in committee, where she has been called up to answer questions as to how she came to over-ride its scrutiny:

Ms Soubry states fairly bluntly that the legislative outcomes were far more important to her than anything else. Committee members don't seem very impressed with the low priority she places on following parliamentary procedures. They have her apology on record, but it looks as if investigations will be ongoing.

Not only did she give a national position on the Tobacco Products Directive without UK Members of Parliament being able to debate them, but she failed for the preceding six months to keep the committee advised of progress. She thereby contributed significantly to the fact that time ran out for proper scrutiny and debate.

This is open and unembarrassed abuse of process – Soubry says she feels the committee ought to be grateful to her setting out to create conditions whereby the UK government will be able to come back and introduce plain packaging. She somehow attempts to make the case that her abuse of the parliamentary process was designed to protect Westminster's sovereignty.

Will the UK opposition start asking pointed questions?

Perhaps it is time to start writing letters. This seems about the level of debate on tobacco legislation: Why Labour should keep asking Cameron the Lynton Crosby question (New Statesman).

Plain packs fallout

The announcement that the UK government has done a 'U-turn' on plain packaging has been met with a furore in the media. The essence of it seems to be that the UK government puts profit first every time and has clearly compromised its stance on health by listening to lobbyists in the tobacco industry and claiming that more evidence was needed on the effectiveness of plain packaging than Australia needed to implement it last year. Concern that the government expressed about 'jobs' has been translated in the minds of critics to simple 'greed'. The media has explained the government's decision by pointing at the tobacco-industry-linked lobbying activities of campaign manager Lynton Crosby.

I am writing this as someone with no love for Cameron's government and a thorough conviction that it will grab any excuse to make money at the expense of people's welfare. What stops me from joining in the furious response to the government's decision not to leap forward without further evidence from Australia is the conviction that tobacco control policies have little to do with health in the first place. The Cameron government inherited its commitment to tobacco control from the Blair/Brown days. In essence tobacco control involves top-down management of people's lifestyle choices and taking advantage of a massive power differential to influence these choices. It is not about health, but control – millions have been spent on tobacco control and smoking cessation without significant effects on smoking prevalence, and enormous damage has been caused to the hospitality sector especially in poorer districts with higher smoking levels, damaging the social fabric and creating increasing social isolation.

Tobacco control is supported at the highest international levels. This should suggest what is undeniable: big government attracts lobbyists, and the most powerful globally are pharmaceuticals and food because they have monopolised the markets that serve our daily needs. Lobbyists have created tobacco control, and little minnows like the tobacco industry are accused of lobbying in order to disrupt it. Pharmaceutical companies have a clear interest in the denormalisation of smoking: a theme pursued throughout this blog.

I am not suggesting that the tobacco industry should be able to write health policy – far from it. But the pendulum has swung too far the other way. In Thursday's debate in the Commons, Public Health Minister Anna Soubry declared that she would not allow tobacco industry to influence policy, a position supported in this document (pp. 4–5), which explains the significance of the Framework Convention on Tobacco Control.

One of the most highly taxed products in the UK is thus marginalised from lobbying on its own behalf, in areas of policy that are the most pertinent and in which it is the most knowledgeable. It is not that what the tobacco industry has to say about health is necessarily gospel truth – of course its influence must be balanced by other points of view.

However, the playing field is far from level. Look at the hysteria when the health lobby doesn't get its own way. It must have been that Lynton Crosby! The underlying presumption created by the Framework Convention on Tobacco Control and its allies is that the tobacco company is inherently untrustworthy and only out to make money and that those working for tobacco control are inherently trustworthy and incorruptible in spite of their financial interests in their work. (Isn't it funny how only one side is capable of being corrupted.)

This kind of innate bias in the proceedings is troubling – as troubling as if right and wrong had been decided in advance in the courts. No one has a monopoly on the truth, It becomes even more disturbing in the light of the excessive taxation on tobacco products. The government will talk to the tobacco company about its tax affairs, but on policy it prefers an arm's length approach.Taxation without proper representation is very bad form – especially exceptional taxation on a specific product.

Article 5.3 of the Framework Convention on Tobacco Control reflects this bias against the tobacco industry as it 'calls on parties to protect the development and implementation of public health policies from the vested interests of tobacco manufacturers'. This suggests that only tobacco manufacturers have interests that might conflict with public health, but almost every industry has an interest that might conflict with public health, including the pharmaceutical industry, on which many public health systems are based. Pharmaceutical industries have commercial imperatives and the industry itself is staggeringly big and influential, but we are expected to believe that because of the good that they do, they are incapable of deals with government that compromise public health.

I cautiously welcome the decision not to act on plain packaging, but there are huge problems with the discussion of tobacco and public health in general, so I'm not celebrating yet.