Tobacco control aims to lead global fight against non-communicable diseases, claims evidence base of success

The World Lung Foundation, an advocacy group that endorses tobacco control, looks forward to the forthcoming global summit on non-communicative diseases (article from the European Society for Medical Oncology, or ESMO). This summit aims to consolidate further the aims of tobacco control, taking the rest of the agenda on tackling non-communicative diseases in its wake. An agenda proposed by the NCD Alliance in the Lancet proposes the following 'priority interventions', which are 'tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies' and a goal of a smoke-free world by 2040.

Is it not rather startling to find interventions in lifestyle factors at the heart of every one of these first five priorities except the one on drug development?

Discussing the events of a UN meeting earlier this week, Stephen Hamill of the World Lung Foundation says:

With so many issues on the table, there was a call to identify and prioritize cost-effective interventions with an evidence base of success. Tobacco control meets this criteria. Implementing the Framework Convention on Tobacco Control (FCTC), the world's only public health treaty, would save hundreds of millions of lives at very little cost. We heard numerous civil society groups testify that to combat NCDs, the UN Summit must accelerate implementation of the FCTC. As advocates, however, we should take nothing for granted, and we have hard work ahead to ensure that this remains an outcome of the Summit. [emphasis added]

What evidence base of success would that be? Smoking cessation rates are nothing to boast of. Evidence to support the tobacco display ban was 'inconclusive' (Christine Graham at col 19996). Arguments continue about the evidence that plain packaging will make any difference. A big fairy tale about a drop in heart attack admissions was used to boost the popularity of the smoking ban in Scotland, and elsewhere. Yet we are told that tobacco control has an evidence base of success. That looks like material for FOI if ever I saw it, but no doubt the World Lung Foundation is under no obligation to reveal anything.

On the basis of this 'success', civil society groups (whatever they are) now want more tobacco control on the agenda, including more steps taken to implement the FCTC.

Who knows what will come out of the forthcoming summit on non-communicable diseases next September, but it would appear that one result will be more commitments made by countries under pressure from international organisations that will bedevil democratic accountability to their electorates. This will effect laws on food content and alcohol regulation as well as tobacco. Policing global public health, with other environmental and genetic factors in ill health pushed down the priority list, promises to be a huge diversion of resources from vital health issues.

Wars on drugs and smoking don't work

First, Devil's Kitchen writes about Bob Ainsworth's call to consider the legalisation of drugs. I haven't read in much depth about the wider drugs situation, but I understand that since hard drugs were criminalised in the early 1970s, drug use has taken off exponentially, no doubt aggravated by huge escalations in unemployment in the following decade, and the chief beneficiaries have been the dealers. Big-time dealers are scary people: small-time dealers might get involved in order to send their sister to university or achieve some other benevolent outcome, and are probably the ones most likely to fall foul of the law.

Costs in treatment of drug addiction, and the chaos that ensues for many drug users and their families, are hard to quantify.

Despite the fact that drug use is now far worse than it was when drugs were legal, any suggestion that drugs should not be illegal is met with the objection that 'we can't condone drug use'. Same old, same old. The idea that prohibition actually works underlies this objection. It's exactly what hospital trusts say about smoking in hospital grounds, and is similarly irrelevant.

Overnight legalisation of all hard drugs may not be sensible, but ways must be found to prevent 'recreational' drugs being sourced through criminal gangs. Price mechanisms, for example, must be used with care: they keep getting it wrong with tobacco, assuming that large tax increases deter people from smoking, when they are as likely to fuel the market of contraband salesmen again. Whether the government will listen to sense is another issue. As DK points out, both coalition leaders were ready to take action when in opposition, but less eager now that they are in power – just as on the smoking issue.

Two posts from Chris Snowdon show the failure of the smoking ban to make any impact on the nation's health or its smoking rates. The Scottish 'heart attack miracle' not only clearly never occurred in the first place,  but there is no evidence of any sustained drop in heart events since 2006. The Irish are seen to smoke more heavily now than in 2004. Chris also shows in another post that a recent attempt to claim a similar heart attack miracle on the Isle of Man, using calculations based on a tiny population, is flawed and unreliable.

Prohibition doesn't work, and neither do smoking bans.