On the 15th July The Guardian published an article by you headlined “Big tobacco has got its way – now let’s find what big alcohol is up to.” This was a reference to the government’s decision not to introduce plain packaging for cigarettes and to drop minimum pricing for alcohol, which you later described as a “day of shame” for the government. You wrote: “Public health measures such as this deserve better than death by lobbyist.” Actually, they don’t. They were only given life by lobbyists in the first place, and their death by lobbyist – if that is what has happened – seems to me entirely appropriate.
I am not a smoker, and I hold no brief for the tobacco industry. Indeed my father, who was a heavy smoker, died from lung cancer just over 33 years ago. But he didn’t smoke because he enjoyed tobacco; he smoked because he enjoyed nicotine and the social rituals of smoking. The attempt to reduce harmful smoking by banning advertising and sponsorship, hiding tobacco displays and raising tobacco duty can only get us so far. Meanwhile a vast illicit trade in cigarettes that defies policing and denies further revenue to the Exchequer has sprung up. And plain packaging is clearly regarded by the public as a ban too far, which is why the government was so nervous about it.
So, Sarah, I have a question for you: how might we move beyond the bans and restrictions beloved of the public health lobby, and mount an effective public health campaign in relation to smoking? Well consider this: whilst you’ve been busily engaged in your efforts to infantilise adult decision-making, there has been a quiet smoking revolution going on. I’m referring to the development of electronic cigarettes. These work, as you know, by vaporising liquid nicotine which is then inhaled by the user from a cigarette-like tube. As the government’s chief medical officer, Dame Sally Davies put it: “Smokers are harmed by the deadly tar and toxins in tobacco smoke, not the nicotine.”
Some 1.3 million of the UK’s estimated nine million smokers now enjoy nicotine through the use of e-cigarettes, as do six million of the 40 million smokers in the United States. And this level of market penetration – 14 to 15% – has happened without fanfare, and, crucially, without the bossiness of socially-accredited experts nannying, nudging, hectoring, lecturing, legislating, regulating or taxing them into it! And what has been the response of the public health lobby to this development? At best it has been ambivalent, and at worst downright hostile. On the one hand they fear that e-cigarettes will ‘re-normalise’ smoking and act as a ‘gateway product’ to tobacco. On the other hand, if it is used as a treatment that will lead to total abstinence – well that’s alright then, provided it is controlled by doctors!
The intention now is to regulate e-cigarettes as a medicine. Now, I’m not against regulation to ensure purity and consistency of product, but as a medicine? The public health movement has always had a strong puritanical element to it. It’s OK to take something to relieve suffering, but not to experience pleasure.
As a high-profile advocate of public health, and an MP, I invite you to publicly endorse the e-cigarette revolution. Why don’t you ask the following question of the health minister in the Commons: “Minister, could you clarify that the use of e-cigarettes in public places, such as pubs and bars, is not illegal under the Smoking Regulations, and would you join with me in encouraging local authorities, who now have responsibility for public health, to contact local pubs and bars to encourage them to allow this practice? Many lives could be saved as a result.” Now, prove me wrong, but I somehow doubt that you will do either of these things. The electronic cigarette is a private sector solution to a public health problem – and I suspect that is the reason why many of your public health colleagues don’t like it. It’s so much easier to resort to stereotypes and invoke 19th century folk devils like ‘Big Tobacco’ and ‘Big Alcohol’ isn’t it?
Which brings me to the alcohol industry and minimum pricing. You refer in your Guardian article to the “clear evidence from Canada that minimum pricing works”. The Canadian research you refer to suggests that a 10% increase in minimum price resulted in a 32% drop in alcohol-related deaths in British Columbia. This is pure fantasy. The figures are based on a mathematical model not real mortality figures. Why did these partisan researchers not use the actual price and mortality statistics? Because they didn’t support the conclusions they wanted to reach. In fact actual alcohol-related deaths in British Columbia rose most years between 2002 and 2009, and no year saw a lower total than 2002. No wonder the UK Government remains sceptical about the ‘evidence’ for minimum pricing.
You also stated in your article that minimum pricing “wouldn’t raise the price of alcohol in the pub by a penny….” A minimum price of 45 pence wouldn’t raise pub prices, that’s true. But here’s what researchers at Sheffield University predicted if minimum pricing was introduced at this level: “Revenue to retailers is estimated to increase by £201.1 million in the off-trade and decrease by £62.2 million in the on-trade.” In other words, people have only so much discretionary income to spend on alcohol. A minimum price would mean they would buy less from the off-trade but spend more money buying it. This leaves less money for them to spend in pubs and bars whose income would fall by £62.2 million a year. So much for the proposition that minimum pricing will benefit pubs. For the avoidance of doubt Sarah, this report comes from the authors of the Sheffield Alcohol Pricing Model – which you quote as ‘evidence’ in support of minimum pricing.
The response of the public health lobby to the government’s decisions on plain packaging and minimum pricing has been a predictable outcry, combined with the resignations of high profile public health organisations, like Public Health England, from the government’s food responsibility deal.
We need to move beyond a concept of ‘public health’ that seeks to ban and restrict and towards one that enables and expands choice. I think the choice for public health lobbyists is a stark one Sarah. Support private sector solutions to public health problems by engaging with industry; or refuse to engage, defend your ideological purity and risk being marginalised as a hard-line sect. If you choose the latter course that really would be a “day of shame”.