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.

Stirling University 0, Philip Morris 1

Today the Independent newspaper reveals that Philip Morris has made a FOI request of Stirling University's Institute of Social Marketing involving data for research on the smoking habits of young people. 

In fact it is old news: the request has already been approved by the Scottish Information Commissioner in a decision dated June 2011 that criticised the University's conduct in the affair.

The tone of the Independent on this whole issue is almost hysterical. No less than three articles by science editor Steve Connor appear in today's edition:

Exclusive: Smoked out: tobacco giant's war on science

(a loaded way to describe a Freedom of Information request); 

Echoes of climate change battles are no accident

(in which tobacco and climate change are treated as identical issues); and

Hair-splitting, brazen denials and six decades of dirty tricks.

Good that you can rely on the press to be even-handed, especially when it calls itself the Independent? I have no objection to dirty tricks being reported, but the report implies that because tobacco companies have been caught in the past being less than economical with the truth their opponents in tobacco control studies have always been and will always be beyond reproach. 

As well as these three pieces we have another by Jean King at Cancer Research (which contributed to funding for the study at issue) : 'This industry should be kept away from young people.' Tobacco is just one thing that many people agree is not a product for young people's consumption. Is this a reason for a major newspaper not to ensure that both sides are properly interviewed in a report about a dispute?

The leader ('The uses and abuses of freedom') is at least slightly measured, and concludes:

Scientific research, which has a value in its own right, but potentially also a commercial and social value, could be seen as the university's exclusive property. If the university and the research, however, have taxpayer funding, should the findings not be more widely available? In the end, the Information Commissioner might have to weigh the arguments – and that might be no bad thing.

This brings us back to the fact that the decision appears to have been made already. I would have expected the writer of a leader to know this: have there been further developments since then? The University was given until 15 August to comply, and it isn't clear what has happened since then. 


Significantly, the studies are funded by the public, and their findings are expected to (at the very least) inform public policy. Gerard Hastings' pleas that the children interviewed during these studies did not expect their data to fall into the hands of tobacco companies suggest that he hasn't fully appreciated what public funding implies. As somebody comments under the article, he should not have given assurances to subjects that would run counter to his obligations under FOI.


Significantly BMJ editor Richard Smith has also agreed that Philip Morris should see the data collected at Stirling. I agree that Philip Morris should have access too, not least because the Institute of Social Marketing and Cancer Research UK are behind the studies. Their agenda is specifically anti-tobacco, and it is hard to imagine that their research can be other than policy-led. This gives Philip Morris a legitimate interest.


Edit: The Scotsman quotes the office of the Scottish Information Commissioner: 

In a statement, the office of Scotland's Information Commissioner, Kevin Dunion, said: "The commissioner has not ordered the university to release the information. He has found that the request was not vexatious, and ordered the university to make a substantive response to Philip Morris International. 

"A substantive response could include release of the information in part or whole, or a refusal to release information with an explanation of why, under the provisions of the FOI Act, the university believes this to be the correct course of action.

Bumpy ride for UN conference on non-communicative diseases

It should surprise nobody that a global conference on non-communicative diseases fails to get to the top of most people's priorities. Former editor of the British Medical Journal Richard Smith discusses the forthcoming UN summit on non-communicable diseases (September in New York) – admits to no little surprise that there seems to be limited enthusiasm for it and contemplates the merits of a global resolution on this issue that is unsupported by any funding.

The summit focuses on four risk factors: tobacco use, alcohol misuse, physical inactivity and inadequate diet. These are leading factors in cancers, cardiovascular disease, COPD and diabetes.

Lancet editor Richard Horton observed earlier this year that the non-communicable disease agenda lacks the urgency of other issues.

Although 80% of NCD deaths take place in low and middle-income countries, the fact is that for the 50 or so poorest countries in the world an unfinished litany of problems remains—infectious diseases, maternal and childhood illnesses, and unchecked population growth. NCDs come bottom of this list.

Richard Smith still seems to feel it is worth while keeping on the table as an issue for the NCD Alliance. But the NCD Alliance seems to be losing patience with the rest of the world:

A particular problem for the NCD Alliance, a quickly formed global body of organisations concerned about NCDs, is that the outcome document lacks clear targets, meaning that member states can easily slide away from doing anything. There are also disagreements over follow up and the need for partnerships. The alliance says that its time to “stop being polite.” They want outrage.

The issues that concern the NCD Alliance seem far too important to leave at the table of a hastily formed group of non-governmental organisations, that appears to think it should be an authority on global health issues ... an authority with teeth, that can enforce its will on member states. What can such an alliance actually do? Adequate food cannot be guaranteed by a non-governmental body without the willing cooperation of many other actors. Such a body can recommend good diet, but where malnutrition is a recognised issue it won't necessarily help matters to have yet another body declare that everyone needs a balanced diet.

All an international body can do is demand policy changes. Any other kind of intervention costs money.

What kind of policy changes will be advocated? Is this kind of scenario in less developed countries really going to be helpful or relevant?

Mr Smith seems a little surprised that NCDs don't get the attention from the general public that was given to AIDS. The global health agenda seems to have turned upside down since then.