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.