Further to yesterday’s post, I had a brief contretemps with Robert Colvile, director of the centre right Centre for Policy Studies.
Incensed is too strong a word for it, but I wasn't impressed with his suggestion that 'the public health priority should be getting the 12% of the population who still smoke to quit'.
I therefore reposted it on X, adding:
Seriously, @rcolvile? You sound like Chief Medical Officer Chris Whitty (and that’s not a compliment)!
To which he responded:
I am a one-man hotbed of heretical opinions, apparently including 'smoking is bad for you'.
Nice try, Robert, but the issue (as I quickly pointed out) was not whether smoking is (potentially) bad for you but whether it should be ‘the public health priority’ to reduce smoking rates from 12 per cent to zero.
That’s what I and many other people object to because it ignores the fact that, while vaping may be far less harmful than smoking, many adults choose to smoke because they enjoy it, so why the hell should it be a public health priority to ‘encourage’ them all to quit?
Anyway, we had a brief exchange of views that ended as quickly as it began.
Interestingly, however, Robert's initial response (‘I am a one-man hotbed of heretical opinions, apparently including 'smoking is bad for you') drew an immediate and supportive comment from former Tory health minister Neil O'Brien MP, who tweeted:
Crazy madness, what next
How droll.
O’Brien is a former director of Policy Exchange, another centre right think tank, that under his leadership published a report entitled 'Cough Up: Balancing tobacco income and costs in society'.
Published in March 2010, it is summarised on the Policy Exchange website as follows:
Smoking is the single, largest preventable cause of serious ill health and kills tens of thousands of people in England every year. It is a popular myth that smoking is a net contributor to the economy – our research finds that every single cigarette smoked costs the country 6.5 pence. In order to balance income and costs, tobacco duty should be progressively increased until the full societal cost of smoking is met through taxation.
In particular, I love the certainly of the claim that ‘It is a popular myth that smoking is a net contributor to the economy’.
If you say so, but yet another centre right think tank - the Institute of Economic Affairs - disagrees. According to 'Smoking and the public purse' by Chris Snowdon and Mark Tovey (2017):
In the absence of smoking, the government would spend an extra £9.8 billion annually in pension, healthcare and other benefit payments (less taxes forgone). Duty paid on tobacco products is £9.5 billion a year. In total, the gross financial benefit to the government from smoking therefore amounts to £19.3 billion. Subtracting the £4.6 billion of costs (above) produces an overall net benefit of £14.7 billion per annum.
Either way, the cost benefits of smoking to society are clearly open to debate and there’s a strong argument that smoking does benefit the economy.
But back to X where Robert Colvile insisted that he was:
Not even calling for smoking to be banned (which I don't support). Just saying we should encourage smokers to switch to vaping if they possibly can, and do much more to educate them about the comparative risks. Hey ho.
Fair enough, but that's not what he said when he wrote 'the public health priority should be getting the 12% of the population who still smoke to quit'.
Frankly, the public health priority should be to inform consumers about the relative risks of smoking and vaping, then leave us alone to make our own choices.
Furthermore, public health campaigners and policy wonks like Robert Colvile should ask themselves the question, ‘Is this really a public health issue?’, because I don’t think it is.
Unless smoking is a significant risk to non-smokers, it's a private health issue.
Unfortunately some vaping advocates are on a mission, and they won’t be satisfied until every smoker has been ‘encouraged’ to switch to vapes.
It reminds me of the story about the little old lady being ‘helped’ to cross the road when she didn’t want to cross the road.
It has probably been passed down the generations for centuries, but it sums up the virtuous vaping advocate who thinks he (or she) knows best.
I’m sure they mean well, but when you combine that self-righteousness with the conviction of an evangelist, it becomes a problem.
Meanwhile another vaping advocate took me to task yesterday, arguing that I am wrong to refer to smoking as ‘potentially harmful’.
‘Everything,’ he noted, ‘is potentially harmful. This framing hugely downplays the extent of the risk involved in smoking. I would remove no-one’s right to smoke but I would foster better choices in nicotine consumption.’
It’s a fair point, but the issue is this. While I fully accept the serious health risks associated with smoking - which are indeed of a greater magnitude than many other activities - it is also the case that many smokers live long and healthy lives.
It is also a fact that most smoking-related illnesses are multifactorial, so pinning the blame on smoking is often the lazy option. (It’s also why so few death certificates give smoking as the cause of death.)
In my view, anyone who smokes is playing Russian roulette with their health, and common sense suggests the risks must be greater the more you smoke, but it’s still only ‘potentially harmful’.
Others would go further and say the risks are exaggerated, and I have some sympathy with that.
That said, as I’ve got older, several friends and contemporaries who smoke have suffered from smoking-related illnesses, so it would stupid to ignore that.
Overall, though, I’m not sure what my critic would have me do. ‘Smoking can be harmful’ or ‘potentially harmful’ is factually correct.
What more can I say without resorting to the same fear-mongering employed by many politicians and public health activists whose anti-smoking rhetoric often seems fuelled primarily by a visceral and ideological hatred of the tobacco industry.
As for fostering ‘better choices’, that’s very subjective. It may be better for someone’s physical health to switch from smoking to vaping, but some people (like David Hockney) smoke for their mental health.
But the truth of the matter is this. Many smokers who have tried vaping prefer smoking. They like the warmth, the taste and the smell of burning tobacco, not to mention the finite time it takes to smoke a cigarette.
Despite the health risks, they have concluded that smoking is the better choice for them. Given the risks it may be irrational to smoke, but that’s life. We’re all different and the choices we make are unique to us.
Some choices may be ‘better’ than others but never underestimate the self-righteous conviction of the vaping evangelist!
See also: The Pleasure of Smoking: The views of confirmed smokers (Centre for Substance Use Research)