The autism epidemic: what the World Health Organisation could usefully do for developed countries

This post is really a bit of an aside. On an alternative health site I read this piece on autism and the research into its causes. I am no more an expert on autism than on smoking, but find it hard to be persuaded that autism is a genetic disorder.

It is important to point out that there seems to be no consensus about what autism is:

Autism is a complex disability resulting in brain damage, gastrointestinal damage, sleep disorders, food sensitivities, epilepsy, immune dysfunction, self destructive behaviour patterns, repetitive behaviour, communication deficits and unresponsiveness to other people. It was first written about in a case study in 1943 by Dr Leo Kanner, who described 11 children with a condition that had never before been observed.

Autism might be described as a range of problems and indeed autism is also termed 'autism spectrum disorders'. The Gaia health piece points to a recorded incidences of one autism per fifty children and compares it to a 1970 figure of one in 14,875 recorded in Wisconsin in 1970. This is a stupendous rise and it seems feeble to say that it can be accounted for by different or better diagnostic techniques.

I am not disputing for a minute that the medical profession has been all too willing to describe ordinary behaviour as a medical condition and profit from treating it, but that's not what is at issue here. However it is true that like other behavioural conditions there is no single medical test that can confirm autism, and no doubt agreement on the extent of autism would be easier if there was such a test.

Autism is controversially attributed to the combined MMR vaccine. The reason for this is the numbers of parents who have observed their children's reaction to taking the vaccine, and also the difference in the children's developmental progress before and after taking the vaccine. Reports describe how children usually between one and two years old have variously lost eye contact, vocabulary, motor skills, appetite and sociability, and otherwise regressed from up to two weeks following their shots. The phenomenon is known as late onset autism, and has aroused concern because the timescales appear in many, many cases to indicate that a specific event has created this regression, rather than that the child has simply failed to develop at all. Various kinds of ill health and discomfort accompany the regression, and occasionally a child dies.

Faced with official blank looks, denials and assurances that vaccines are safe (in spite of mercury being a major ingredient of preservatives in the vaccines) people all over the world have researched what has caused their children's devastating and exhausting condition, and they have compared notes. That is why they know that so many of them have experienced a common pattern.  Some accounts are here, recorded in a 214-page document (Parents' Voice), which is still open for further additions. Short accounts of parent's experiences, several accounts per page, make sad reading: how do parents deal with such injuries to their children?

Many of the parents concerned did not know there had ever been a link between MMR and autism. Now, thanks to the Dr Wakefield controversy and the efforts of other campaigners  the issue is alive, but the medical establishment has still not acknowledged a link between autism and MMR – as the Gaia health piece states, research funds have been diverted to exploring autism and genetics.

My take is as follows: the single measles vaccine in the UK should not have been scrapped; and the testimony of parents whose children have been made ill should be taken properly into consideration. Efforts should be made to count the cases of late onset autism, and to investigate links with vaccines. If it is true that late onset autism accounts for anything resembling the incidences reported in the Gaia piece, this indeed amounts to an epidemic. There is no natural reason that a non-infectious condition should affect 300 times more people than it did less than two generations ago.

The World Health Organisation, if it wants to pay attention to the needs of developed countries, should look on autism as a crisis that dwarfs the smoking issue.
WHO got it wrong when they made tobacco the subject of the made the first global multilateral treaty – the Framework Convention on Tobacco Control – as if there is no such thing as infectious disease or malnutrition any more. Tobacco is an easy target when they develop a prohibitionist model that sends prices up, especially during a period of international austerity when demand for tobacco is unlikely to weaken. It gives the WHO something to preach about without really having to address what makes people ill.

If its mission were truly health and looking after the children, it would investigate this awful phenomenon. But perhaps the relationship of the WHO with health is, shall we say, 'complicated', like that of the US Center for Disease Control:

According to the CDC, the origin of this epidemic is a mystery. However the agency regularly takes great pains to point out through various discredited studies that it is not caused by vaccines. It also maintains that this disorder, which it terms behavioural, is genetic in origin. While examining the veracity of these claims, it would be prudent to point out that the mandate of the CDC is to ensure that all children follow the vaccine schedule. It thus suffers from a conflict of interest when it says anything about vaccines, as even a hint that vaccines are unsafe goes against its mandate.

If medical authorities are too bound up with a pro-vaccine mandate, how can any research they undertake be credible? Can the World Health Organisation arrange for the credible investigation of this issue? Is the World Health Organisation an authority that can deal with epidemics like autism, or just a ladder of opportunity for bureaucrats?

Paradoxes of harm reduction

Michael Siegel has attacked robustly and deservedly a paper from the World Health Organization that recommends the banning of e-cigarettes (which it describes pompously as ENDS (electronic nicotine delivery systems, even though some are used without nicotine). The ground for banning them is that they 'resemble' smoking and so hinder the 'denormalisation' of smoking. Believers in tobacco harm reduction, including Michael Siegel, consider that e-cigarettes provide an alternative to smokers that gives them nicotine less hazardously, and that banning e-cigarettes will seriously hamper many people's efforts to stop smoking.

I share this position to the extent that clearly banning cigarettes will make it harder for many people to quit smoking if that is what they want to do. I can't get excited personally about quitting smoking as an objective. I smoke very occasionally, have never smoked heavily and never succeeded in getting addicted (seriously, an anti-smoker told me that I wasn't trying hard enough!). I feel that enough people do give up smoking to demonstrate that it is possible given the willpower and the right circumstances (hence am sceptical about the addiction narrative), but don't share the idea that everyone has to give up.

But for those people who do have this conviction that smokers must give up, it makes absolutely no sense to ban e-cigarettes, simply because of their physical resemblance to the 'real thing'. It leaves medicinal nicotine the only alternative available, and this is a choice that many people simply will not make. There is also abundant evidence of its abysmal success rate.

E-cigarettes are a new kid on the block, and represent unexpected competition in the nicotine market. The power and influence of pharmaceutical companies in supporting tobacco control could be a strong factor in the reluctance of groups like Action on Smoking and Health to embrace Tobacco Harm Reduction.

ASH Scotland appears to be sitting on the fence. But Deborah Arnott sees some of the merits of e-cigarettes, as she explains here. She warns that the end game of tobacco will not be possible unless smokers have a real alternative – and, in my view, she presents e-cigarettes as the only potential subtitute for smoked tobacco that can satisfy smokers. Her tone is: 'Like it or not, smokers will only take what they want'.

Her concerns are that e-cigarettes are not made by the right people. She fears that tobacco companies will buy them up only to stop making them. Those dastardly Chinese make sofas that burn you so they clearly can't be trusted. They have to be regulated to the hilt (and preferably made by someone who won't just phase them out). But they must be available.

It may not occur to Deborah Arnott that she has a conflict of interest to contend with:

Source (h/tip Jay)

I am not sure that aiming to destroy an industry sits well with an aim to reduce the harms from smoking. It is absurdly ambitious, with profound economic implications. Apart from anything else it is stretching a point to call this a charitable objective.

Ending nicotine addiction at all costs is also stupendously ambitious and may also not be beneficial to health (for instance a person may substitute a far more harmful addiction).

The whole crusade, ridiculously, specialises in a very limited area of health interest, and holds tobacco responsible for virtually everything that can go wrong with someone's health.

Unaccountably this anti-tobacco project has become a global monstrosity, with the result that the World Health Organisation creates its first (only?) multilateral global treaty around similar goals. So confused is the World Health Organisation about its myriad goals that it cannot bring itself to bless e-cigarettes, the most successful smoking cessation method to date, because they look so much like smoking cigarettes that they fear that the wrong message will go out to the public.

Stoptober and its fallacies

The UK has an abundance of wealth to spend on silly stunts like this one.



Dame Sally Davies (CMO) urges us to realise that apart from the financial cost to the country, the cost to individuals is the real issue that people should be thinking about. She tells us that 1,260 people a day are admitted to hospital with smoking-related diseases, It is tiresome to point out what has been said many times: that smoking-related diseases are not necessarily caused by smoking. Consider this graph from the World Health Organisation (h/tip Fredrik Eich at Alternative Analysis). Given the low rate of lung cancer deaths in Mexico compared with Scotland, it would seem that there many factors at play other than smoking.


(Legend reads: blue, approximate population in hundreds ages 70–74; orange, deaths from lung cancer ages 70–74.)

In explaining any respiratory problems resulting from air pollution, the burning of fossil fuels merits consideration, especially in the light of reports that UK levels of such emissions have broken European guidelines for years. Only Dame Sally Davies knows why smoking is such a focus of attention, rather than extraordinary levels of emissions, and why the medical establishment repeatedly refers to smoking as a 'preventable cause' of cancer, when considered on a population-wide basis it is not preventable (certainly not more than most other causes of cancer), nor is it necessarily an exceptionally significant cause of cancer or other 'smoking-related' diseases. Do the funders of studies on tobacco allow researchers to conclude that fossil fuel emissions are a factor in respiratory and heart health?

WHO anti-tobacco campaign contravenes its constitution

This is the constitution of the World Health Organization.

• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. [...]
• The achievement of any State in the promotion and protection of health is of value to all. [...]
• The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.

Just for starters. 'Complete physical, social and mental wellbeing' is arguably incompatible with a denormalization agenda policy towards the social act of smoking. Denormalizing smoking is (beyond argument) part of the World Health Organization's agenda (see WRPO Blue Ribbon Campaign at this link).

Article 5.3 of the Framework Convention on Tobacco and Health is arguably at odds with the statement that promoting and protecting health 'is of value to all'. Article 5.3 states that governments 'need to be alert to any efforts by the tobacco industry to undermine or subvert tobacco control efforts and the need to be informed of activities of the tobacco industry that have a negative impact on tobacco control efforts'. If public health is a matter of common public concern, there should be no call for sidelining people from the public policy process by reason of their employment. (Like this.) 

On 'medical, psyhological and related knowledge', I have found a paragraph on tobacco labelling, published by The Union. 

To date, several countries have stopped requiring quantitative emission information from packages and instead require descriptive information about toxic constituents in smoke and their effects on health. Preliminary research suggests that this information is more meaningful to consumers and less likely to result in misperceptions about the relative risk of different cigarette brands. Further work is required to examine what types of descriptive product information are most useful to consumers. The extent to which information about additives or design features (such as filter ventilation) might serve as effective consumer messaging is also unclear, mainly because these approaches have yet to be explored. Several suggestions of approaches to descriptive product information that may be effective are discussed in section 2.

The idea is that quantitative emission information misleads people into thinking that some brands of tobacco are less toxic than others. Customers could be persuaded to change brands rather than doing the right thing, namely quitting the habit. The received wisdom is that instead of being misled by quantitative emissions, customers should be given generalised information. In my view, this kind of information is already all over the packet. Ingredient information is just that. What customers do with it is entirely their business. It is proposed that instead of quantative information they are to be given just more health advice. This is not compatible with the provision of full information.

This post came from a remark by Greg Burrows on Facebook:

After reading the World Health Organisation's Constitution, I believe with their methods prescribed in tobacco control they are fundamentally in conflict with their own constitution in regard to this statement: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition."

The definition of social condition is the state in which a person finds themselves in a particular society.

I am not a lawyer but to my mind the whole emphasis or goal of WHO FCTC has been to force their version of what our (smokers) social condition is, whether we like it or not, this is against their constitution.

I agree entirely with Greg that the spirit of the WHO has been abandoned in the current public health drive directed at smoking. It seems to me that the constitution of the World Health Organization was written at a time before the organization was dominated by ambitious, globalist campaigns.

The philanthropy of Gates

The Gates Foundation is known for philanthropy, even in respect of a Cinderella cause like eradicating smoking.

It has achieved (with the help of other agencies including Unicef, Rotary, and the World Health Organisation) the eradication of polio in India.

Or has it? It depends who you read. So far unreported by the BBC,

... the real story is that while polio has statistically disappeared from India, there has been a huge spike in cases of non-polio acute flaccid paralysis (NPAFP)– the very types of crippling problems it was hoped would disappear with polio but which have instead flourished from a new cause. 

There were 47,500 cases of non-polio paralysis reported in 2011, the same year India was declared “polio-free,” according to Dr. Vashisht and Dr. Puliyel. Further, the available data shows that the incidents tracked back to areas were doses of the polio vaccine were frequently administered. The national rate of NPAFP [non-polio acute flaccid paralysis] in India is 25–35 times the international average.

India is a large country whose population exceeds one billion, but 47,500 is a considerable number of casualties, especially when there is a clear correlation with the vaccination.

The Gates Foundation and WHO have come under criticism for their claim that polio has been eradicated. The polio virus has been synthesized in a test tube and now the wide incidence of non-polio paralysis make the eradication of polio impossible for the foreseeable future. They are also rebuked for persuading India to invest in a vaccination programme costing $2.5 billion: donor support amounted to just $2 million.

Readers must decide for themselves. But it appears to me that Gates and the WHO have a mission to govern the globe under the guise of philanthropic intervention. Under this guise they can undermine local governance systems, divert local priorities, and cost communities dear in both health and cash terms. From where I am sitting it appears that a spike of 25 to 35 times the expected incidence of non-polio paralysis is too high a correlation to put down to chance, and points to a vaccine that is positively harmful and not fit for use.

To read official news reports, you would think polio eradication was a complete success story. But  not only does this episode not inspire confidence – it should be a public relations disaster, since it is expensive, worse than useless and undermines local decision making and priorities. Indignation is widespread: this piece   – Third World duped on polio eradication – is worth a look. The original study: 'Polio programme: let us declare victory and move on' by Drs Vashisht and Puliyel of St Stephens Hospital, Delhi, is here.

(And if I were a smoker who wanted to quit smoking I wouldn't go to Bill Gates for help either.)

Privatising the World Health Organisation

As expected, the Tobacco Control Blog ended last week's World Conference on Tobacco and Health in Singapore with a glowing appraisal of Director General's leadership of the conference, and spiritual leadership of the whole tobacco control movement.

Before the conference the Framework Convention Alliance was less optimistic that headway could be made against the tobacco industry's many empires. They are now excited about a huge donation promised by Michael Bloomberg ($220 million), which will enable them to focus efforts to implement the Framework Convention on Tobacco Control in less developed countries.

The Framework Convention on Tobacco Control is the only international treaty under the auspices of the World Health Organisation. Quite why tobacco control came to be the only health topic worthy of a global treaty is no doubt a matter of historical record.

A report in last month's Third World Resurgence by Tom Fawthrop discusses whether the WHO is 'under siege from the private sector', in part because of the high costs of its activities. It opens by pointing out that Bill Gates addressed the last meeting of member states, describing this as 'symbolic of the crisis facing the United Nations' World Health Organization'. I would add that Bloomberg's donation to the tobacco control cause last week was also symbolic. Gates represents the ultra-wealthy 'globalists', who seek to influence global health policy.

Fawthrop discusses whether Margaret Chan is sufficiently aware of potential conflicts of interest arising from big shots in the corporate world seeking involvement in this field. He lists the wide range of private interests attending the NCD summit last September, noting the concern from professional groups and NGOs at the level of private interest present. He also goes into the recent history, claiming that the World Health Organisation was sidelined in the 1980s by the World Bank, which imposed drastic health cuts as part of its Structural Adjustment Programmes (conditions for financial help), and privatised what was left.

WHO is still sidelined today, as the architects of global governance, the World Economic Forum, seeks 'a new governance paradigm': a complete rethink, in their words:

The model of development characterised by donors and recipients is dead ... In place we need to think about collective responsibility. A world where an increasing number of stakeholders should have a role in shaping and making policy is a given. Governance does not equal governments alone.

Doesn't it sound lovely? We're all in it together! But Fawthrop points out that the WEF does not include medical personnel, patients or the general public among its stakeholders.

It recommends the use of public–private partnerships to meet the provision of health needs. In my book that means that the public will have to pay for projects that will maximise benefit to the shareholders of private companies, and if that means public borrowing, then the general public pays interest, as well as paying for any services that are not free at the point of use. The private corporations win, the banks win and the public benefits only if it can afford to. Countries are quite capable of running a system like that without being supervised by a global 'health authority'.

I used to be starry eyed about the World Health Organisation, before I became aware of its role in tobacco control. But any global authority will become prey to corporations, because they represent business opportunities, and this is what health issues offer them. Without adequate checks to ensure that global health rather than shareholder profits will be the bottom line we might as well not have a global health authority at all.

Consulting mosquitos

Yet again the Dutch come under fire for their lax attitude to tobacco control, because they have rolled back the tobacco campaign and withdrawn the funding for smoking cessation campaigns.

Chief among the complaints of the anti-smoking campaigners is the attitude of Anne Mulder, Public Health spokesman for the Liberal Party. He admits that the health department 'does hold meetings with the tobacco lobby':

'It's a legal product, I think it's right I speak to everyone and that's what I'm doing. I don't have any problem speaking to the lobbyists. If you want to make policy you have to speak to people on all sides then make your own decision.'

The inevitable objection (see earlier example):

'If you want to control malaria you don't invite the mosquitoes to negotiate with you on these issues. This is so illogical. It is absolutely irresponsible what they're doing, it's not a health policy not at all.'

The mosquito is a very poor example to illustrate why relevant interests should not be consulted over policy. Politicians don't control malaria, nor do they prevent disease. They legislate on policy. If you want to control malaria as a medic, you go to war with the mosquito and if you need the support of the law then other considerations might become relevant. The fact that mosquitos cannot speak for themselves has absolutely no bearing on the propriety of consulting all relevant parties to issues on which laws are being passed. (Sheila Duffy also had a go a few months ago when she blogged,
 'Malaria kills people, but mosquitoes don’t have PR agencies and expensive promotions budgets,' a consideration that is absurd as well as irrelevant.)

In consulting with tobacco companies the Dutch are flouting Article 5.3 of the WHO's Framework Convention for Tobacco Control. This measure seeks to 'protect' health policy from tobacco industry influence – because the FCTC is the first global multilateral treaty of the World Health Organisation. It should worry people that the WHO believes tobacco should be the subject of its first multilateral treaty, or that the tobacco industry is the only one supposed to be a threat to national public health policies, and whose influence must be resisted.  (More here.)

Shisha feels weight of smoking ban

A shisha bar in Finsbury Park, north London, that permitted smoking in contravention of the law, has been shut down owing £6,000 in fines and costs.

An impassioned article about the fate of shisha bars following the ban was published by the BBC in July 2007. As usual in such cases consultation appears to have been minimal. An official guide describes how shisha bars and cafés are included in the smoking ban provisions that were enacted in 2007. 


The Edgeware Road Association, which produced the video below, hoped to gain exemption from the smoking ban on the grounds that it threatened local cultural expression. This bid has not been successful to date. 



People do attend shisha bars to smoke shisha. A hookah pipe is not something you take to work with you and shisha-smoking is far more context specific than tobacco smoking.  (It's also very pleasant – I tried it recently.) The context is social situations in public lounges and cafés where people enter knowing what's likely to happen – not unlike licensed premises, cafés and restaurants as we knew them before 2006. 


I've no idea whether shisha bars still hope for an exemption. Much as I sympathise with their situation and much as I accept that many people would find shisha smoke altogether more wholesome than tobacco smoke, it is not only shisha culture that's had a coach and horses driven through it by smoking ban legislation. All social venues have been affected, whether used for shisha or ordinary tobacco, many have been adversely affected and many destroyed. This is not a cause for special pleading, for saying 'their poison is worse than ours', it's a cause for working together and realising that no legislation that has the effect of closing down social venues can possibly be in the interests of public health.


Even it insists 'smoking poses a serious threat to non-smokers', depriving millions of people of their preferred social venues and businesses shows only contempt for other people's livelihoods and preferences. 


The smoking of shisha pipes is under threat the world over, because the WHO has declared shisha smoking to be a passive smoking risk. Its home is the Middle East. Any resistance to suppressing shisha smoking lounges must unite not only with local efforts against smoking bans but also international efforts against prohibition.
...
One scholar who has taken on the challenge has been Kamal Chaouachi, a Tunisian-born medical anthropologist. In his words:

In these conditions, the challenge was not less than becoming the unofficial "spokeperson" of the hundreds of millions of voice-less (wo)men in the street, particularly in Asia and Africa where hookahs have been around for centuries. These persons – who often cannot read English or challenge the materials published in biomedical journals – have often felt powerless after being hurt by the pseudo-scientific and technical language of world "waterpipe" experts suddenly interested in their daily life.

Dr Chaouachi attended and addressed the Second World Conference Against Prohibition organised by TICAP in 2010. I am not yet well acquainted with his work but dipping in has been informative. He insists, in common with many of us, that anti-smoking is an ideology:

"Throughout history, whenever an ideology is given a political machine, it becomes a vehicle for cruelty and destruction. Ideologies do not recognize individuals, gray areas, self-criticism or anything outside their narrow boundaries. For in service of the ultimate truth, all means and sacrifices are justified. Corporate interest, on the other hand, is a driving force in many conflicts and wars as well as global health and environmental problems. We see political ideologies or aggressive economic interests—or worse, both—at the heart of every current human or natural conflict. Our world today, alas, is shaped by greed and politics."

Emphasis in the original. (He quotes the words above from of a US funded anti-smoker – a man who is fighting against shisha, and has no sense of how aptly he describes the worst excesses of his own movement.)
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This can't help the place in Finsbury Park. It is unfortunate for them that they broke the law – but without effective opposition, not hard to see how such things happen. Authorities here are powerful, and nothing stops them attacking people whose dislike of the law leads them to defy it.

Australians won't pay tobacco levy

The World Health Organisation has proposed a tobacco levy known as the Solidarity Tobacco Campaign to be added by wealthier countries to support tobacco control efforts in developing countries.

This is the latest of a number of ideas, which have included levies raised on currency transactions and airline seats, in order to raise funds for tobacco control.

Article 26 of the Framework Convention for Tobacco Control provides for these fund-raising efforts.

Article 26 of the WHO FCTC expressly relates to the generation of funds "for the development and strengthening of multisectoral comprehensive tobacco control programmes" of developing countries. Furthermore, a study developed by the WHO Secretariat in accordance with Article 26.5(c) of the treaty and submitted to the Conference of the Parties (COP) to the WHO FCTC in 2006 indicated that tobacco taxation is a sustainable, stable means to generate funds for tobacco control and other public health initiatives. The COP gave “full support to the prioritization of resource mobilization for tobacco control at the national and international levels”.

It is interesting that they call this fund a 'solidarity' fund. Solidarity implies voluntarism. It's also interesting that they regard tobacco taxation in developed countries as 'sustainable', but perhaps paradoxical to want health programmes to rely for their funding on tobacco sales. They get off with it because it supports their goal to make tobacco as expensive as they possibly can.

The World Health Organisation seems to focus quite a bit of attention to getting money out of countries – a variable voluntary contribution is levied on all countries, poor as well as rich, and some of them seem to be having trouble keeping up with payments. In fact its financial difficulties are long-standing, and it cites financial difficulties as an impediment to tobacco control in poorer countries.

The World Health Organisation tries to persuade governments to tax tobacco heavily to fight tobacco-related harm in their own countries. In addition it wishes to encourage a solidarity fund, for helping other countries:  

Concerning international assistance for health, for decades, a key principle underlying provision of such assistance has been solidarity, whereby richer countries assist developing countries ...

It is heartening to see that Australia has rejected this suggestion. In spite of a heavily anti-smoking policy stance, it has stated that it will not be implementing an additional levy: it announced a $700,000 donation following the conference last month on non-communicable diseases. Perhaps it has begun to notice the insatiable nature of global tobacco control efforts:  

... The spread of some diseases across countries also requires collective action based on solidarity to address global public health needs. To further support global solidarity and strengthen health‐development investments, Member States could decide to contribute a part of their tobacco taxe revenues for international purposes.

Oh aye! 

In acknowledging the precarious state of Framework Convention finances the Framework Convention Alliance says this: 

FCTC Parties must now face the reality that existing international funding systems have failed tobacco control. And the world is paying the price – NCDs have been ranked as one of the most serious threats to global stability.

Ranked by whom? The World Economic Foundation, based in Geneva. (Aren't fuel and resource shortages more likely to cause instability?) The referenced work is called Global Risk Factors 2011 and no url is provided. This report, on the other hand, is entitled Global Risks 2011. It's hair-raising (discussing cyber security, resource security and WMDs among other issues), but gives no more than a passing nod at non-communicable diseases. 

Good for Australia – now drop the plain packaging proposal and put life back into perspective.

Pharmaceutical sponsorship in smoking cessation: Toronto conference, November

Back in April, the World Health Organisation warned health professionals working in tobacco control not to become too involved with pharmaceutical companies. But the horse had already escaped. The creation of a global smoking cessation industry was already in its late stages, and continues to develop apace.

Michael Siegel blogs today on the 7th National Conference on Tobacco or Health being held in Toronto in June with Pfizer as a major sponsor. There is a significant conflict of interest (private v. public), since Pfizer manufactures Champix among other smoking cessation medications. Accepting sponsorship from Pfizer will compromise the integrity of the conference.

In March Siegel wrote a piece about ISPTID: the International Society for the Prevention of Tobacco Induced Diseases, in which he remarked that this society had renounced pharmaceutical funding and declared itself free of all industrial ties (before the advice from WHO had been published in the BMJ). He urges other organisations in this field to follow suit: but it will take a wholesale change for many years before I would have any confidence that the slate was clean of pharmaceutical influence. We know, in addition to the pharma-funded events that Siegel lists, that the major UK conference (UK National Smoking Cessation Conference) relies on pharmaceutical sponsorship.

Grants from the Robert Wood Johnson Foundation (a trust part-funded by profits from Johnson & Johnson) can be seen here. The list of grants (using 'tobacco' as a search term) contains some 1,650 entries with over $100,000 awarded for most of them.

It is probable that if all conference organisers wanted to find a willing source of funds for smoking cessation events and they were not permitted to take on pharmaceutical funding, they would find few people willing to come forward, and even fewer with a specific interest in coming forward, year after year in several different locations in any given period.

Scotland bribes smokers to quit: the efficacy of medication

NHS Tayside is extending its programme that offers money to people who use NHS services in order to attempt to stop smoking, on a postcode lottery basis. It targets its efforts towards those in deprived areas whose postcode indicates that they are probably heavy smokers, in order to try and close the 'health inequality' gap. 


The Courier explains. The scheme (which pays £12.50 a week in supermarket vouchers) has allegedly reached a quit rate of 50 per cent after four weeks. (Only five readers have left comments on this story, and they don't seem very happy about the outlay on the scheme.) This stupendously high quit rate (compared with what is normally achieved – see Michael Siegel's review of a recent study) apparently justifies the roll-out of the scheme, known as quit4u, from Dundee into neighbouring towns. 


Interesting that arch anti-smoker (and plain packaging advocate) Simon Chapman doesn't buy the line that NRT works, or that expenditure on it is justified.

The pharmaceutical industry has a clear commercial interest in eroding public and professional confidence in unassisted smoking cessation, yet easily implemented ideas, such as graphic health warnings, are more effective than nicotine replacement therapy. 

Is Chapman biting the hand that feeds him? It is not hard to find pharmaceutical links with the anti-smoking industry. Indeed health professionals were cautioned about this close relationship only a few weeks ago, by the World Health Organisation. Some of Chapman's anti-smoking colleagues are puzzled by his line of argument. Many have taken issue with him.  Not only does he not believe in smoking cessation treatments, he believes that pharmaceutical interests exaggerate the difficulties of smoking cessation, and that anti-smoking campaigning should not attempt to make out that people can't quit without help. Two years ago he published a major study that made the following points:

• - Research shows that two-thirds to three-quarters of ex-smokers stop unaided. In contrast, the increasing medicalisation of smoking cessation implies that cessation need be pharmacologically or professionally mediated.
• - Most published papers of smoking cessation interventions are studies or reviews of assisted cessation; very few describe the cessation impact of policies or campaigns in which cessation is not assisted at the individual level.
• - Many assisted cessation studies, but few if any unassisted cessation studies, are funded by pharmaceutical companies manufacturing cessation products.
• - Health authorities should emphasise the positive message that the most successful method used by most ex-smokers is unassisted cessation.

The message still hasn't got through to Tayside. 


I would love to know how Chapman expects the anti-smoking bandwagon to get pharmaceutical industry support if he goes about dissing the effects of nicotine replacement therapy. Does he expect to extort the money from the tobacco industry? Only time will tell.

UK National Smoking Cessation Conference 2011: book of abstracts

Download here. You can study at your leisure abstracts of the presentations at this summer's smoking cessation trade fair – most of them, that is, except the one for the presentation by public health minister Anne Milton, which was not available at the time of going to press (see p. 50).

The subject areas are harm reduction; prisons, probation and mental health; payment by results; campaigns; tactics of the tobacco industry.

In the middle of the brochure there is (as one might expect) a helpful section called 'Information from our sponsors', starting with a full page of 'information' about Champix, followed by 'information' about other kinds of smoking cessation medications (can double your chance to quit), followed by 'information' about a helpful organisation called the National Centre for Smoking Cessation and Training, which does pretty much what it says on the tin. Out there in the real world we could call this 'information' advertising, indicating the clear possibility of a commercial interest in the success of the conference, but we wouldn't want anyone to think that the pharmaceutical interests in question had anything to gain from government-endorsed smoking cessation campaigns, surely? (shhh, don't tell the World Health Organisation!)

Ten-minute rule motion passed to ban smoking in cars: let's get some perspective

At Westminster today a Bill was approved that would ban smoking in cars carrying children. As a backbencher's  Bill it collected less than 150 votes, but it got media attention because of its subject matter including mainstream attention from the BBC and ITV (among others) and the blogosphere, where it attracted the attention of Big Brother Watch.

The argument goes that having protected adults from secondary smoke, we must now protect children. But legislation banning smoking in enclosed public places has existed in the Republic of Ireland since 2004. At this time they were beginning to think of introducing it to Scotland and legislation to do this was passed in 2005, around six years ago. In other words it has taken the great and the good over six years to come to the conclusion that what might hurt adults in areas they need not go, might also hurt children in areas where they have no choice about going.

The real issue is of course that they could almost get off with designating private businesses as 'public places', but public opinion had not caught up with the idea that you can interfere with the smoking habits in the undeniably private areas of the home and car. Having established the right of interference in quasi-public places, their courage (if you can call it that) is growing. It has nothing to do with the level of risk involved, or the vulnerability of those affected, and everything to do with a steady process of invading autonomy in businesses, then in family cars, then in family homes.

How can you say in July 2005: 'the risk of exposure is unacceptable. We'll ban it with effect from next March'? There are other ways of handling bans of risky commodities, that leave you in little doubt that the government actually believes there is a risk and isn't just trying to mess you about.

The risk itself? The UK has a poor record on clean air quality, and it is to be expected that the government will concentrate its 'air quality' efforts on the smoking issue. This typifies the focus on lifestyle issues now being taken by global bodies, including the World Health Organisation, which has recently been trying to ratchet up interest in non-communicable diseases. This effort is reflected in the media by stories such as Unhealthy lifestyles to kill 52 million yearly by 2030. Such stories may not reflect the intention of the World Health Organisation (who knows?), but this one says that 'most' chronic diseases are caused by 'unhealthy and ethically wanting lifestyles'.

It looks as if they intend to blame the poor for getting ill needlessly. But they still want to treat those conditions that the poor would not be getting if only they behaved themselves. Is someone making money out of this?

The framework confirms the industry’s crucial role in continued investment in R&D programmes to develop drugs for the prevention and treatment of non-communicable disease, with over 1,500 products in the pipeline currently. It also commits the industry to target its innovation towards the specific needs of the developing world. To this end, in addition to the framework, there will be a programme of research, to improve understanding of the specific needs of developing world populations. [emphasis added]

Yes, there might be some very lucrative contracts here ... prevention and treatment of conditions that are killing off people in vast quantities (conditions that the patients bring on themselves, let's not forget!). The paragraph quoted above reads almost like a business plan for pharmaceutical companies.

The truth of course is that while lifestyle factors may contribute to ill health and many non-communicable diseases, there is no certainty about how much. It is not known to what environmental and other hazards workers, urban dwellers or other groups are exposed ('developing countries' include most of the world's population and a vast variety of working and living conditions), and while it might sound catchy to say that lifestyle factors are a common cause in their sicknesses, it is also profoundly lazy. Public policy will become limited to warnings about lifestyle issues, rather than awareness training about environmental issues and hazards at the workplace, for example.  I hasten to add that I am guessing, but it looks like the World Health Organisation is taking a moralistic, judgemental and simplified approach to the issue of non-communicable diseases, rather than a scientific, measured one. And as we have already established, non-communicable diseases kill older people and people in wealthier parts of the world, more often than infants and young adult breadwinners. The 'paradigm shift' in the focus of pharmaceutical companies might be good for their balance sheets – will it result in improved conditions for people, or neglect for their most basic needs?

Public health minister Anne Milton presents at Smoking Cessation Conference

Public Health Minister Anne Milton recently presented Action on Smoking on Health with an award from the World Health Organisation at a recent meeting of the All-party Parliamentary Group on Smoking and Health.

This last week she is listed as presenting at the UK National Smoking Cessation Conference, in a piece entitled The future for tobacco control and smoking cessation in England: Our vision for the next 5 years. It's one of the few presentation that doesn't get its own summary page on the website, so we'll have to wait until all the presentations are made available in several weeks before finding out what she said.

So much for advice from the top to anti-smoking activists not to cosy up to drugs companies.

Scots licensed trade seek smoking ban review

Two weeks ago a meeting took place in Edinburgh between licensees from Scotland and counterparts from the Netherlands and Croatia. As described here, the Scottish Licensed Trade Association seeks amendments to the ban to allow indoor smoking to take place in specific circumstances.

He said: “No-one wants to go back to the old ways of smoke-filled pubs and people coming out of pubs smelling of smoke, but I think it is appropriate to see if there is a way we can be sympathetic to everyone.

“This might be through a certain amount of ventilation, and by allowing only certain types of operations to allow smoking. There are some smaller operators that don’t have an outdoor area and can’t do food and are one step away from closure."

With opponents like this in the picture, it seems unlikely that such polite requests will be heeded. The official anti-smoking position (from the World Health Organisation) is that no amount of ventilation will work. Unless the SLTA is firing off more powerful cylinders in private than it appears to be doing in public (and I really hope that they are), I might ask why anyone from Croatia or Holland was invited to speak to licensees. These countries operate under systems that allow smoking, and they have had to fight their corner in order to permit smoking on their premises.

The leader of the Scottish Beer & Pub Association, another trade body, on the other hand, observes politely that tobacco restrictions are going to increase rather than decrease under the new administration ... but hey, let's go with the flow!

Richard Horton talks up NCD agenda, Moscow, April 2011

Richard Horton winds up discussion of a disorganised and frustrating event by describing the unexpected charisma of Vladimir Putin, who addressed the first global ministerial conference on healthy lifestyles and non-communicable disease (NCD) control. He then makes an intriguing case for resources to be given to non-communicable disease control:

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.

Quite rightly so. Diseases that can't pass from one person to another, whose cause is usually multi-factorial and can't be isolated and analysed, come a long way down the pecking order of complaints that a world health authority should turn its hand to – especially when people are dying in ways that should be cheap and easy to prevent.

If we are to make any progress at all in getting NCDs noticed, we’ll have to show how their prevention and treatment can easily be integrated into existing health programmes that are already struggling in health systems starved of cash and capacity.

How can you prevent something when you don't know what causes it? How, also, can you do it at no cost?

Another big vertical initiative is not what countries want or need. This points to an uncomfortable truth—we in the health community have not made an effective business case for NCDs. Deaths alone are not enough. We need to show why NCDs matter—and they do—for economic stability as well as poverty reduction. The macroeconomic case for action is lacking: an urgent gap to fill between now and September.

 So what is the 'business case' for emphasising NCDs, when Horton himself admits they are at the bottom of the heap as far as poor people's priorities go?

My cynicism knows no bounds perhaps, but the Framework Convention Alliance's interest in this conference indicates that tobacco control can be found lurking. I just hope that their keenness to promote the cause of NCDs doesn't lead to people being pressurised to sack employees who smoke, or otherwise make their lives difficult. I'm also intrigued about exactly what the conferences imagine they can do cheaply and easily to prevent non-communicable diseases ... but since they wish to discuss them at inter-government level this September, perhaps it won't be long before we find out.

WHO demands general smoking ban in Germany

It is harder now for European authorities to claim that smoking bans are universally popular. Germany has failed to enforce its ban, Spain has protested vigorously, and Belgian café proprietors and customers have also protested about a ban due for implementation in food establishments on 1 July, three years earlier than planned. The Netherlands has also thrown off its ban for bars without employees.  


Demands not just for a full implementation of the ban in Germany but for the law to be enforced centrally instead of in its federal states have appeared, of all places, in the British Medical Journal.  I only have access to the abstract but already the Heidelberg branch of the World Health Organisation gets its say, claiming that the German people are exposed to dangerously high levels of smoke in their restaurants and pubs.


(Clearly he seems to be under a misapprehension that people are forced to allow smoking in pubs and that unwilling customers are forced to go into them.) 


People seem happy to tell priests to keep out of politics and stick to religion: not a view I would necessarily agree with – everybody should have a say in politics. I would only agree to limiting religious interference in politics if religion wanted to keep secular interests out of politics. Why don't people realise that health is the new religion? Why do people tolerate health officials who are so steeped in politics that they happily recommend interfering with German legislation in order to achieve their smoke-free agenda? 


The study is entitled 'Full smoking ban is needed in Germany as four out of five pubs flout regulations'. What size of budget is needed to report what is common knowledge: that people can smoke in German public houses? 


The Netherlands didn't get off scott-free either. Tobacco control has no respect for national boundaries. 

Mapping mortality and health care priorities

Thanks to Paul L. Bergen for this.

Worldmapper tells us much, as Paul indicates, but I think we can take it further still.

The World Health Organisation increasingly talks about non-communicable disease control (such as here), as a major new public health priority ... indeed an epidemic that threatens to derail countries from their development goals.

A first glance at Worldmapper's page on causes of death supports this view to an extent, as it shows (using figures from 2002) that non-communicable diseases killed over 33,500,000, as opposed to nearly 18,500,000 deaths in the 'often preventable illness' category.

If you click on Deaths from non-communicable illnesses, the map will show the distribution of mortality from these diseases using land area to reflect populations affected. You can scroll through these conditions one by one by clicking on the 'next map' link to the right. They are concentrated in Europe and North America, i.e. developed countries but also noticeably featuring India. If you go to the Other preventable illnesses page and scroll through the following maps, you see a much larger concentration in Africa. (India is badly affected by these too.)  The exception is polio, which affects USA and Europe more than Africa.

The one crucial piece of information not supplied by this group of maps is the age of death. The maps giving this information list by gender as well as aggregate figures, from infancy to 100+. It is quite clear that if you start here and click on the 'next map' link till you get to age 100, Europe is starting to outstrip Africa by the time you reach the 45-to-49 age group, and by 64-to-69, Africa is skimpy.

It should be clear from this that non-communicable diseases are diseases of older people more than the other group of diseases. This is of course a very broad brush, and India seems to get the worst of both worlds. But there is certainly a pattern.

In Paul L. Bergen's words:

When the FCTC targets regions like Africa and asks (demands) that health resources be used for tobacco control operations, the money that would make a difference if applied toward malaria (or countless other endemic diseases …see more maps on the site), that would save many lives, is funnelled off into satisfying political aims with little effect on mortality.

 I would have thought it was obvious in any case that communicable diseases present a far bigger general health threat than non-communicable diseases. These maps show that communicable diseases kill the young and economically active, and this should be what concerns the World Health Organisation – not non-communicable diseases.

It would be nice to get more up-to-date figures on these maps!

World Health Organisation honours Greek PM for unenforceable smoking ban

This is a popular story today. Greek PM Papandreou has picked up the World No Tobacco Day prize for his determination to implement a smoking ban.

The report linked above describes the smoking ban as 'politically unpopular'. The Associated Press report refers to Greece as 'a country where the new smoking ban is largely ignored'.

Mr Papandreou is accredited with 'political courage' for his insistence that the smoking ban will be a comprehensive law in spite of other austerity measures the government is taking, and in spite of opposition from Greek people. I am not sure that 'political courage' are words that describe the actions of a leader who follows a global health agenda at the expense of his people's livelihoods and against their wishes.

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.