Abertay academic against nannying: Newsnight Scotland interview

Watch this televised interview between Dr Stuart Waiton, against nannying, and Dr Andrew Fraser and Laura Williamson in favour of what they term a caring society that is willing to help people reduce their smoking and drinking.

It's always interesting to see health medics, who claim a political consensus in favour of their view, weigh in on their opponents and characterise them as rather irresponsible, selfish individuals who believe in pleasing only themselves. They claim to care for the children and society at large more than these un-community-minded free-market maniacs.

From what I know of Dr Stuart Waiton, he is no more a free-market maniac than I am. He quite reasonably rejects the notion that the health professionals hold a monopoly of wisdom about people's decisions, and rightly derides their eagerness to help people make the 'right choices'. There is an assumption that the patrician middle class has all the right answers, and anyone who disagrees puts himself (or herself) automatically in the wrong.

The two pro-establishment doctors sow the seeds of their undoing by claiming that a quarter of Scots smoke (9.29), and that people in poorer districts benefited less from the smoking ban than people in more affluent districts (10.40). Both statements reiterate the failure of tobacco control to achieve its stated aims. The smoking rate has not changed significantly since the smoking ban was introduced, the same figures (one in four Scots smoke, smoking kills 13,000 a year) have been trotted out since the millenium: a rapidly escalating tobacco control budget has done nothing to reduce the smoking rate or the alleged death rate.

Dr Williamson goes to far as to say that '[Dr Waiton's] argument for a minimal state would be okay if everybody had the same degree of freedom', but social inequalities lead to health inequalities, which it is the government's duty to correct. 'People need help, and what the government is trying to do is create this level playing field.'

She argues in favour of a system which she must acknowledge is not working. She knows the smoking ban hasn't really helped narrow the health inequalities gap. Intervention is needed to prevent 'the chronic diseases that result from smoking, obesity, alcohol consumption'.

Missing from their argument is any glimmer of interest in the socio-economic condition of patients whose interests they claim to be helping. Dr Fraser says that people know the answers but don't make the right decisions, and yet stops himself short of saying 'We love coercion'. If it is part of their faith that economic wellbeing improves health outcomes, that is where their efforts at 'levelling the playing field' should be addressed, instead of working to create countless new offences, which adversely affect people's prospects when they fall foul of the law.

More importantly, where did this idea come from that chronic diseases result only from lifestyle choices? Is it that the mega corporations are too important to politicians for their activities to be attacked on the grounds of environmental and public health damage? Note that Dr Williamson refers only to the budgets of tobacco and alcohol industries: not about the budgets of any other kind of industry, although these other industries must be even more powerful if they can avoid the government and medical establishment's hit list. Everyone knows people who have died early in spite of doing all the right things with their health: non-smokers, non-drinkers, joggers, you name it. No one is safe. [Late edit: more on this here: How working kills smokers: 'There is no question that smoking contributes to poor health. But to claim that smoking is the primary cause of preventable death and disease is one of the greatest scams in modern history.' H/tip Freedom2Choose newsletter, April 2013.]

The doctors wind up stating that we should look to a fair Scotland where we care about each other and community. And on the face of it, what's not to like? Only that the politicians and the medical establishment do far too little to campaign against economic hardship, which they know to militate against 'healthy choices', and place too much emphasis on lifestyle factors when explaining how people get ill.

Plain packaging on the way, Westminster and/or Holyrood

Has Andrew Lansley, who has been weighing up whether to implement the display ban as passed into law, found an even stronger form of deterrence? The BBC announces that the Department of Health will consider requiring plain packaging for tobacco products, and that it will put together a White Paper on the subject (it also says the government 'will ask' shops to cover up displays from next year: the wording is too mild to suggest that any final decision has been made).

Compelling the sale of tobacco in plain packaging cannot fail to make counterfeiting easier and cheaper, but legislation requiring such a move has already been mooted in Australia. The Scottish Government has also expressed interest in this, but does not have the powers to pass legislation on packaging. An SNP spokesman said: “The SNP is favourably disposed to this idea, and if Westminster will not do it then the powers should be transferred to the Scottish Parliament".

It would seem that the SNP might not need the extra powers, if the Westminster government proceeds to bring in legislation. Is this a factor behind the Department of Health's interest in the idea: 'being in the lead in tobacco control'? (or do they wish to prevent the devolution of further powers?)

Within Scotland, the effectiveness of plain packaging as a deterrent to smoking is disputed. Enrico Bonadio of Abertay University predicts a price war, but Crawfood Moodie (of the Institute for Social Marketing – yes, them again!) believes that the deterrent effect will outweigh any price war. The tobacco industry has concerns over its right to a brand image, and warns of legal trouble in the event of any legislation.

Nothing would be less surprising than an aggressive policy of this kind in Scotland, where ASH Scotland rules supreme. The same cannot be said of England however, where even many Tories have felt grounds for hope that the Coalition would adopt a less 'nanny state' line of policy. Dick Puddlecote has been enjoying disabusing them of their hopes of a better future under the Coalition.

LiberalVision also comments: also disillusioned with its leaders over more central control and illiberal governance, in contrast with its promises. More criticism from the Scottish blogosphere would be welcome: surely not everyone in Scotland approves of this policy?