On those who find non-communicable diseases a greater priority than infectious ones

The story is here. I find it quite hard to understand how anyone can prioritise non-communicable diseases over most urgent health problems. They don't spread, unlike communicative diseases. Surely this must be an important consideration. Other health related issues at the seminar under discussion were hunger, water and armed conflict.

All of these provide more immediately life-threatening scenarios, not only for individuals but also for families and communities. I can't seem to use that phrase now without reflecting how it has been over-used by people discussing top-down social management policies but these things are real in the wider world. Water and food shortages and infrastructure damaged by warfare all present more dangers to lives, including young lives (those of breadwinners).

Non-communicative diseases do not endanger the lives around sufferers in the same unpredictable way as communicable diseases. I am not trying to diminish their seriousness for those afflicted but when thinking of aid budgets and whole populations it surely makes more sense to treat illnesses that can be passed on to others, and to resolve food and water problems before tackling non-communicative diseases.

An economist, Rachel Nugent, fails to convince laureates at the Copenhagen Consensus that NCDs should swallow up most of the hypothetical aid budget. Richard Smith of the BMJ gives her account of what happened, and has a dim view of the laureates' conclusions about the most important spending priorities:

They ranked “Bundled micronutrient interventions to fight hunger and improve education” top, and the next four priorities were all about countering infectious disease. Vaccination against hepatitis B (9), drugs for patients with heart attacks (10), and salt reduction (11) all, however, came in the top 16 that would be funded. The polypill came in at 19 and tobacco taxation, the top choice of Nugent’s team, at 22. 

Why they chose these 16 is not explained, but a sense that they thought of some people, particularly children, as more deserving seemed to be one explanation. It certainly wasn’t only the numbers that decided them, said Nugent. When you listen to them ask questions, she continued,  you realise that they aren’t that different from anybody else. They are driven by anecdote, and there is always a bias towards the status quo, which  favours action on infectious disease over NCD.

The idea that infectious diseases might require resources more urgently than infectious ones is written off as some kind of immature knee-jerk tabloid sensationalist response and a 'bias to the status quo'. And where did the idea of deserts have anything to do with it ... surely the point is to limit damage within communities and this means tackling health problems that are likely to spread quickly.

Another issue with non-communicable diseases is that they are usually blamed on lifestyle factors. As we can see from Morton Satin (comments on the BMJ piece) there is dispute about the information given to the laureates about salt consumption, and Nugent's proposal about tobacco tax certainly also has a dogmatic route. (She claims that there is historic evidence that raising taxes produced health dividends – even if there is truth in this claim, it doesn't mean it is replicable in perpetuity.)

The C3 website, of which Richard Smith is an unpaid trustee, shows its activities in relation to preventative health, for example the workplace page, which tells us that C3 has many corporate partners including Unilever. Unliver has a whole page dedicated to it at Corporate Watch, which mentions its bad environmental record as well as various exploitative practices, before going on to explain its strategy to campaign on healthy eating in order to offset criticism of its unhealthy food output. Mars is another corporate partner of C3 on occupational health, and local readers will remember how it disowned the practice of deep-frying Mars bars.

My acquaintance with C3 is less than 12 hours old. But I am suspicious of the emphasis on non-communicable diseases while other more deadly perils persist.

BMA urges conference to distance itself from pharmaceutical interests: whistling in the wind?

A startling cautionary note has come from the World Health Organisation, urging smoking prevention activists to bite off the hand that feeds their activities. If not that, to get a respectable distance from other relevant commercial interests in the field. Delivered at a pharmaceutical-industry sponsored conference, it remains to be seen how much difference the acknowledgement of a competing interest in the field will make.

Chris Snowdon has covered this issue, with some background.

Our own resident smoking cessation medication trade-fare cum training school, the UK National Smoking Cessation Conference, similarly relies on pharmaceutical sponsorship. Looking at the list of delegates am I the only one to be amazed how much money changes hands in the effort to stop people from smoking? Most if not all these people are salaried, many of them specialising in smoking cessation or 'health improvement'. By the time the conference takes place in June there will probably be over 600 of them on the delegate list, and of course many more who won't make it.

What gives government such a kick out of employing people to stop people from smoking ... from buying a product which gives them so much money. Tell me it's conscience, and I won't buy it.

It gets harder to believe that one can view pharmaceutical corporations as primarily interested in the good of our health. They will be the main beneficiaries of the Traditional Herbal Medicinal Products Directive, which aims to outlaw the sale of herbs as medicines (due to be implemented on 30 April this year), thus removing access to herbal remedies by people all over Europe – including remedies originating outside Europe. (You can sign a petition here.*) Europe also wants to remove access to smokeless tobacco and e-cigarettes, also on the grounds of their supposed risks to the public. This will leave the smoking cessation business to the pharmaceutical corporations.

What makes Europe step into line with the commercial imperatives of these hugely powerful pharmaceutical corporations? Is it credible that pharmaceutical interests will be acknowledged to be as commercially powerful as that of the tobacco interests, and therefore just as suspect?

Those who make a virtue of a level playing field when it comes to applying smoking bans don't apply a level playing field in the economic and political arenas. Pharmaceutical companies and tobacco companies are clearly rivals in the market for nicotine, but tobacco companies face a ban on advertising and sponsorship. This means that no one depends on them for income, including the media. Pharmaceutical companies on the other hand make drugs, and government needs their cooperation. Pharmaceutical companies are seen as a source of good health and high quality, prestigious employment. They tick all the right boxes.

CorporateWatch quotes The Guardian in its general overview of pharmaceuticals.

There were times not long ago that drug companies were merely the size of nations. Now, after a frenzied two-year period of pharmaceutical mega-mergers, they are behemoths, which outweigh entire continents. The combined worth of the world’s top five drug companies is twice the combined GNP of all sub-Saharan Africa and their influence on the rules of world trade is many times stronger because they can bring their wealth to bear directly on the levers of western power.

With so much influence (employing two lobbyists for every member of the US Congress), it isn't surprising that commercial interests outweigh those of public health:

The US government has shown many times how it backs up its pharmaceutical industry at the cost of ordinary people the world over, including its own citizens. In September 1999 the US government decided to grant US pharmaceutical corporations the patent rights over drugs invented with public funds – six HIV/Aids drugs, as well as anti-malarial treatments and other medicines of vital interest to developing countries. The government had the right to use the drugs in public health initiatives, but chose to protect the commercial interests of its industry instead. 

I think I won't hold my breath for smoking cessation specialists to stop depending on pharmaceutical influence.

Contracts in Smoking Cessation and the Tobacco Display Ban: good money after bad?

An international public relations firm, Weber Shandwick, has won a double contract with the Scottish Government. In case you thought enough money had been spent on smoking cessation, this company, with offices in 77 countries, will 'signpost and motivate adult smokers wishing to quit to contact Smokeline'. An absolutely indispensable frontline service, wouldn't you agree?

The credentials of Weber Shandwick to do this kind of work are clear – they've been doing it for years. For example, two years ago they discovered that 9 out of 10 New Year's quitters in Australia were back on the fags by June, in a report for Pfizer.

The other contract is to educate the public about the tobacco display ban (Tobacco and Primary Medical Services Act), which was voted into law in January and will be enacted in October 2011. This Act is currently the subject of court action after a legal challenge from Imperial Tobacco: a verdict is awaited.

Employing PR companies seems an expensive way to convince the public to do something it doesn't want to do, or to sell unpopular government policy to the public. I look forward to Weber Shandwick winning a contract to sell a comprehensive hospital smoking ban package. I wonder how the people in the relevant Scottish Government departments feel about having their work of explaining policies and making them more publicly acceptable handed to an outside contractor. As a member of the public I find my confidence in the Scottish Government eroded a little, but my confidence in their tobacco policy is not high to start with.

Corporate Watch has a useful section on PR companies and the lobbying industry.

Afterthought: I've added to the sidebar our response to the Scottish Government's recent consultation on display and pricing in respect of the tobacco display ban legislation, submitted last month.