"The NHS is becoming more like Big Brother every day"

According to the Telegraph today:

 The NHS will ban patients from surgery indefinitely unless they lose weight or quit smoking, under controversial plans drawn up in Hertfordshire.

... the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional.

The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral.

The MailOnline added:

Under the proposals, which were uncovered by the Health Service Journal, smokers must quit completely and doctors won't just take their word on it. They will be breathalysed to monitor levels of carbon monoxide in blood, to ensure they are telling the truth.

To be honest, I feel I've heard this story (or something very similar) several times before, which indeed I have. It's a story that comes round again and again, with minor variations.

This time however there seems to be more opposition. The Telegraph, for example, featured a long quote from Ian Eardley, senior vice president of the Royal College of Surgeons, who said it was wrong to bar NHS treatment to any group of patients:

"Singling out patients in this way goes against the principles of the NHS,” he said.

"This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases," he said.

"There is simply no justification for these policies, and we urge all clinical commissioning groups (CCGs) to urgently reverse these discriminatory measures."

The Telegraph also quoted Joyce Robins from Patient Concern who didn't mince her words:

"This is absolutely disgraceful - we all pay our taxes, and the NHS should be there when we need it; we did not agree to a two-tier system."

Eardley's comments were also featured by the Mail which concluded its report with a quote from me:

"Forcing smokers to take a breath test is not only heavy-handed, it's a gross intrusion of privacy.

"If adults choose to ignore advice to quit smoking that's a matter for them. They shouldn't be treated like criminals and denied treatment.

"The NHS is becoming more like Big Brother every day."


BCH: results of consultation on extending 'smokefree' zone to nearby streets

I suppose I ought to write about the outcome of a consultation conducted last year by Birmingham Children's Hospital (BCH).

You may remember it. I wrote about it here (Action alert – hospital wants to extend smoking ban to nearby streets) and here (Why 'smoke-free' consultation should be declared null and void) and invited readers to submit a response.

The consultation report has been sitting in my inbox for a few weeks. I'd like to say the outcome was a victory for those who opposed extending the hospital's 'smokefree' zone to neighbouring streets but I can't because there was a majority in favour.

That said, it was hardly a great win for BCH. I say that because it took a Freedom of Information request to get the hospital to reveal the existence of the report which wasn't on its website.

Nor had the results of the consultation been reported by the local media, which suggested two things. Either they hadn't been released or the results were insufficiently robust to merit any coverage.

Anyway, after submitting an FOI request in August I was sent a copy of the report (Proposal for a smoke-free zone around BCH: consultation responses) plus this brief summary:

  • Birmingham Children’s Hospital remains a smokefree site. There has been no recent change in this.
  • As outlined prior to last year’s consultation, any changes to ask people not to smoke around the hospital would need to be developed as a proposal with the local authority. At this stage, no formal proposal has been made. However, our consultation showed that the vast majority of respondents who actually use the hospital, live in Birmingham or use the streets around our site were in favour of a smokefree zone, and we therefore continue to explore ways of achieving this.

The 19-page report, dated November 8, 2016, is slightly more interesting. Here are three things I noted. One:

More smokers were strongly against the zone than were for it. Previous smokers were more evenly split between supporting and being against the zone. The majority of support came from non-smokers.

I'm sure this won't won't surprise anyone. It is however another example of what I call the 'tyranny of the majority' and it's a problem for smokers because non-smokers now outnumber smokers five to one and those who express an opinion in surveys like this are invariably anti-smoking.

My guess is that most non-smokers don't feel strongly about people smoking in the street, regardless of whether it's near a hospital, but that also means they're unlikely to be motivated to take part in a consultation on the subject.  

Inevitably therefore what we're up against is a hardcore of anti-smokers plus members of staff who I imagine were encouraged to submit a response that, lo and behold, supported their employers' proposed policy.

Two, people are generally reluctant to ask smokers to move on not because they think they are interfering in someone else's business and it has nothing to do with them but because they are frightened to do so.

Indeed the most extraordinary comment in the entire report reads:

Having been a police officer for 30 years I feel it would be dangerous to get into conflict with people who are smoking.

Goodness, if an experienced police officer is intimidated by the thought of asking someone to stub out a cigarette or move further away from the hospital to smoke you wouldn't back them to protect you from a knife-wielding terrorist, would you?

Three, the hospital wants to ban smoking and vaping in nearby streets. This is based on responses to the question 'Should the zone apply to e-cigarettes?' and the following key points:

  • Respondents in favour of the zone were largely for it applying to e-cigarettes.
  • Several respondents highlighted that a zone might discourage quit attempts using e-cigarettes, although no respondents indicated that they personally would be affected in this way.

What I deduce from this is that respondents opposed to the zone were largely against it applying to e-cigarettes (I know I was) but very few (if any) vapers bothered to submit a response, presumably because it was promoted as a consultation about smoking. (Forest gets a mention in the report but there's no reference to any vaping-related organisations.)

In other words, by declining to engage in a consultation on a "proposal for a smoke-free zone around BCH", the vaping advocacy community has effectively given the green light to a policy which, if implemented, will prohibit both smoking and vaping in neighbouring streets.

Here are the full recommendations:

1. Given the strong support from the significant majority of the public, families and staff who regularly use the area around the hospital, BCH strongly believes that the introduction of a smoke-free zone around the hospital site is a positive step.

2. BCH believes it will improve the experience of visitors, whilst also offering an opportunity to communicate a consistent and important public health message.

3. Based on consultation feedback, BCH believes that the zone should include vaping and e-cigarettes, maintaining consistency with the hospital site itself.

4. BCH will initially pursue the introduction of a voluntary zone, supported through signage that highlights the importance of the zone to children and families visiting the hospital.

5. BCH recognises the views of a number of people that they would like to see a more formal, enforceable zone introduced. BCH will ensure that any implementation of zone is appropriately monitored, and will support exploration of a stronger approach if a voluntary zone fails to address sufficiently the level of concern that the consultation has highlighted.

The good news is that nothing much appears to have happened since the report was produced in November last year.

According to the hospital, in response to my FOI, "any changes to ask people not to smoke around the hospital would need to be developed as a proposal with the local authority. At this stage, no formal proposal has been made."

It's hardly a positive result but in the circumstances it'll do.

Full report here.


Stoptober 2017 limps on and we're still waiting for the 2016 evaluation

We're just past the midway point for Stoptober 2017.

I only wrote about this 16 days ago so you may remember that in November last year I requested a report from Public Health England on the outcome of Stoptober 2016.

This was treated as a freedom of information request and I was told that "all strands of the evaluation will be finalised in early February (2017)."

February came and went and nothing was published.

In August I submitted a further FOI request asking for a "full evaluation of the outcome of Stoptober 2016".

PHE, as I wrote here, responded as follows:

We are releasing an evaluation document of Stoptober 2016 during Stoptober 2017; this will be available on the PHE website ... The original publication date was delayed.

The FOI response was dated September 22. This morning I checked the PHE website again and I still couldn't find the document they said was going to be published "during Stoptober 2017".

OK, I know Stoptober still has 15 days to go but doesn't it strike you as odd that the evaluation document for 2016 has been delayed this long and still hasn't been published?

As I've commented before, the budget for Stoptober 2017 is substantially more than it was last year (£1.08 million versus £390,000 in 2016) so how can Public Health England justify that sort of increase without an evaluation of the previous year's campaign?

We know that the number of smokers signing up to Stoptober fell significantly in 2015 compared to 2014. That, I suspect, is why PHE moved the goalposts and decided not to ask smokers to register in 2016 as they had done previously.

Now – and quite blatantly in my view – PHE has procrastinated for as long it can, perhaps in the hope we'd give up asking awkward questions about the success or otherwise of an event whose greatest legacy is giving one or two minor celebrities a small pay day and a number of well-remunerated PR and advertising agencies a substantially larger one.

Update: I rang PHE this morning to ask when, exactly, the evaluation document for Stoptober 2016 is to be published.

I was asked to put my question in writing – again – so shortly before lunch I sent this email :

Further to our phone conversation, see FOI response attached. It includes the statement, 'We are releasing an evaluation document of Stoptober 2016 during Stoptober 2017; this will be available on the PHE website.

We are now beyond the midway point in the Stoptober 2017 campaign and it would be helpful to know when exactly the evaluation document for Stoptober 2016 will be made available.

Please note that my original enquiry, which was treated as an FOI, was made on 3rd November 2016. I received a response that stated: 'It is expected that all strands of the evaluation will be finalised early February.'

Now, here we are, in October 2017, and to the best of my knowledge the evaluation document for Stoptober 2016 is still unavailable.

Therefore my very simple question (not to be treated as another FOI request!) is: 'Can PHE give a date for the publication of the Stoptober 2016 evaluation document and, if not, what is the reason for the continued delay?'

If I get a reply today I'll let you know. I'm not holding my breath.

Update: I have had a reply, to be fair, from a very helpful FOI officer. The long-awaited document is complete apparently and will be uploaded on to the PHE website in the next 14 days.

You have to hand it to government. The speed at which civil servants work is breathtaking.


ASH Scotland, Big Brother and the eradication of choice

Update on yesterday's post.

Following a report in the Sunday Times Scotland that featured calls for smoking to be banned in the home, with the emphasis on social housing, the Herald asked Forest to comment.

Here's our full response:

"Banning smoking in any home would be a gross invasion of people's privacy.

"Targeting social housing is particularly obnoxious because it penalises unfairly those who can't afford to buy their own home.

"Prohibiting smoking at home would be almost impossible to enforce but it could create a snooper's charter encouraging people to snitch on neighbours they don't like.

"What happens if someone is caught and prosecuted? The consequences, including possible eviction, are out of all proportion to the alleged offence.

"The puritanical health lobby needs to get a grip and realise there are far worse things in the world than smoking.

"If campaigners really want to reduce children's exposure to tobacco smoke at home they should lobby government to allow separate smoking rooms in pubs and clubs.

"Tobacco is a legal product and adults must to be allowed to smoke somewhere without constant harassment and discrimination."

A substantial part of that quote is featured in today's paper under the headline, 'Smokers fuming over plan to ban tenants from lighting up at home'. If and when the report goes online I'll add a link.

We subsequently sent a press release to other Scottish media with the result that Forest has also been quoted in the Daily Record and Scottish Daily Mail.

Interestingly the Record (which supports most anti-smoking legislation) has also published a leader urging caution:

For the estimated one in five adults left in Scotland who does smoke, where else can they light up but in their own homes?

A public health campaign on why it is wrong to expose children to second-hand smoke would be far more effective than Big Brother legislation that takes the power of the state into living rooms.

Smoking out of sight of kids makes sense – if smoking makes any sense at all – but there is no need to hound people out of their own houses to prove the point.

See Smoking ban in people's private homes is a step too far – but we must educate on dangers to kids' health (Daily Record).

Meanwhile the Herald quotes a Scottish Government spokesman who says:

"We have no plans to ban smoking in people's homes. We'll continue to explore other ways to support out ambition of creating a tobacco-free generation by 2034."

Ironically ASH Scotland is employing the 'choice' argument. Instead of joining calls for a blanket ban on smoking in the home (a policy that even the Record describes as 'Big Brother legislation'), CEO Sheila Duffy talks of giving tenants a "choice" of smoking or non-smoking accommodation.

"We would like people to have the choice to live in smoke free accommodation. At the moment there's not an option."

This is so disingenuous I don't know where to begin but it reminds me of those anti-smoking campaigners who, 20 years ago, said they wanted to give people a choice of smoking or non-smoking areas in pubs and restaurants.

I had no problem with that, nor did I have a problem with giving people a choice of smoking and non-smoking pubs.

Eventually however the same people who began by calling for choice demanded the eradication of smoking in every single pub and club in the country.

In fact, as soon as legislation was introduced everyone was denied choice – even belligerent anti-smokers – because if there's only one option the state has made the choice for us.

Imagine a one-party state where you can vote but there's only one party to vote for. There's a word for that.

Likewise, when tobacco control campaigners talk about "choice", what they mean is the complete opposite. In their mad, bad, authoritarian world, "choice" means no choice at all.

Everywhere – workplace, the home – has to be non-smoking in order to give non-smokers a "choice".

But what about the nine million people who smoke, one in six of the adult population? Should they be denied choice, even in their own homes?

Increasingly tobacco control campaigners are behaving like autocrats and dictators, bending even the language to suit their smoke-free agenda.

The good news is, when even the Daily Record recognises the danger ('This Big Brother legislation on lighting up would take the power of the state into living rooms.'), there's a glimmer of hope we can turn the tide against this aggressive, oppressive lobbying.

Update: You can read the Herald report here (Should smoking be banned in the home?). Rather chuffed that it features my full quote including:

"The puritanical health lobby needs to get a grip and realise there are far worse things in the world than smoking.

"Tobacco is a legal product and adults must to be allowed to smoke somewhere without constant harassment and discrimination."


Smoking in the home - let battle commence

Today's Sunday Times Scotland reports that:

Anti-smoking campaigners in Scotland are seeking to stop people lighting up at home as part of a drive to reduce the harmful health effects of inhaling secondhand tobacco smoke.

No-one should be surprised. Banning smoking in the home has been one of tobacco control's less than secret ambitions for years.

It took a while for them to admit it, of course. When they were campaigning to ban smoking in the workplace we were repeatedly assured there was no question of smoking being banned at home.

Then, in December 2011, ASH published a briefing note, 'Smoke drift in the home and workplace'. See ASH: how to ban smoking in the home (my title not theirs).

Since then tobacco control has been chipping away, getting people used to the idea. Earlier this year, encouraged by the ban on smoking in cars with children (the first time smoking had been banned in a private space, if you exclude private businesses) it was reported that:

Smoking could be banned in some new council homes in a bid to protect the health of children, a UK public health expert has said.

Under the proposals, tenants would be asked to sign an agreement not to light up inside their home.

President of the Faculty of Public Health, Prof John Middleton, says some councils and housing associations are already exploring the smoke-free housing idea.

Today's report in Scotland also focuses on social housing so the tactics are clear - first, discriminate against those who can't afford their own homes, then extend the ban to every private home and garden. (Have you never heard of a tiny bit of smoke drifting back in to the house? It's a serious health risk!!)

Children, inevitably, are the Trojan horse through which this and other prohibitionist policies are being slipped in.

Ban smoking in cars with children? Tick. Ban smoking in children's play areas? Tick.

Ban smoking in parks and beaches (to prevent children from being exposed to the sight of someone smoking)? Tick, tick, tick.

Now smoking in the home is under threat because, we are told, "hundreds of thousands of people in Scotland are still at risk from exposure to secondhand smoke in their homes."

I'd like to see hard evidence to justify this claim, not to mention the insinuation that people's health is at serious risk as a result. The level of risk is important. We're surrounded by chemicals and particles in the home. The dose is the poison and most of the time the dose is relatively benign. Same goes for tobacco smoke.

The Enstrom/Kabat report, which most readers of this blog will be familiar with, remains the largest ever study of the impact of secondhand smoke on non-smokers in the home.

The results and conclusions were unambiguous and in the absence of any study with a similar database or longevity must never be forgotten.

The study, published by the BMJ in May 2003, focused on "35,561 never smokers who had a spouse in the study with known smoking habits" and found that:

For participants followed from 1960 until 1998 the age adjusted relative risk (95% confidence interval) for never smokers married to ever smokers compared with never smokers married to never smokers was 0.94 (0.85 to 1.05) for coronary heart disease, 0.75 (0.42 to 1.35) for lung cancer, and 1.27 (0.78 to 2.08) for chronic obstructive pulmonary disease among 9619 men, and 1.01 (0.94 to 1.08), 0.99 (0.72 to 1.37), and 1.13 (0.80 to 1.58), respectively, among 25 942 women.

No significant associations were found for current or former exposure to environmental tobacco smoke before or after adjusting for seven confounders and before or after excluding participants with pre-existing disease. No significant associations were found during the shorter follow up periods of 1960-5, 1966-72, 1973-85, and 1973-98.

In plain English the authors concluded that:

The results do not support a causal relation between environmental tobacco smoke and tobacco related mortality, although they do not rule out a small effect. The association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed.

The report, as we know, provoked a huge outcry with tobacco control activists falling over themselves to dismiss the report and smear the authors by any means possible.

ASH's response, reported by the BBC, was particularly interesting:

"This could be very damaging as it will be used by industry lobbyists to argue against laws to ban smoking in public places and workplaces."

In other words, ignore the study, the largest and most authoritative of its kind, because it could derail our authoritarian plan to impose a smoking ban on every workplace in the country which is based on the claim - never proven - that passive smoking is a serious health risk.

Today few people seem willing to fight the 'passive' smoking myth but that's exactly what we have to do because it will be very hard to win this battle on the sole argument that people have a right to behave exactly as they want in their own homes. (Clearly this isn't true on a host of issues.)

What I find frightening is the way younger generations have been indoctrinated to believe all the propaganda about passive smoking. This isn't scientific so it isn't the first argument I use when discussing smoking in the home, but I do like to point out that if the scare stories about passive smoking are anywhere near true then it's amazing that the generation of children most exposed to tobacco smoke (the baby boom generation of the Fifties and Sixties) is living longer than ever before in human history.

Imagine that. A generation of children – at least 50 per of whom must have been regularly exposed to tobacco smoke in the home for much of their childhood – has largely survived to tell the tale.

I accept there have been medical advances during that time but if regular exposure to tobacco smoke is as dangerous as we're led to believe all the medical advances in the world wouldn't have kept the overwhelming majority of that generation living long into their eighties and, increasingly, their nineties.

Btw, the Sunday Times sent Forest an email at 8.30 last night inviting us to comment "within 30 minutes".

Normally that wouldn't be a problem but I was driving home from Derbyshire at the time and didn't see the email until 10.30, by which time it was too late to reply.

We will however be fighting this all the way. I hope you will too.


Nudge, nudge, wink, wink

It's not often that I disagree with Chris Snowdon but this is one of those occasions.

Earlier in the week it was announced that US economist Richard Thaler, 'one of the founding fathers of behavioural economics', had been awarded a Nobel Prize for Economics.

Thaler is better known to me and many other people as the author of Nudge.

One of Chris's arguments is that libertarian paternalism, which Nudge promotes, is more libertarian than paternalist.

Most of those who disagree with Nudge, he adds, haven't read the book.

Well, I have read the book (although I may not have finished it) and I'm not a fan.

I wish I'd kept my original copy because I read it on a long haul flight – before it lulled me to sleep – and I remember making copious notes in the margins.

The following comments then are less about the book and more about libertarian paternalism in general.

Libertarian paternalism, or nudging, is often defended on the grounds that it excludes prohibition.

That's true. The problem is, while the theory may be fine, in practice it is invariably embraced by those whose endgame is prohibition.

Thaler's policy, as expressed in his book, is far more benign than that but libertarian paternalism rarely ends with a nudge.

Instead it works like this. Policies are introduced that are designed to change people's behaviour by exposing them to 'healthier' choices as opposed to 'unhealthy' choices.

'Unhealthy' choices aren't banned but they're made less visible. It could for example mean the removal of confectionary around supermarket checkouts.

If people prove resistant to being nudged governments invariably decide to intervene. Nudging therefore is often no more than a stepping stone to regulations or legislation.

E-cigarettes are a classic example of how nudging should work. Smokers have a choice of smoking or vaping and so far 1.6 million people in Britain have chosen voluntarily to switch permanently to e-cigs. (In total 2.9 million now vape but 1.3 million are dual users.)

The problem is, the rate at which smokers are switching to e-cigarettes is slowing down, hence the suggestion that smoking should be banned outside pubs or even offices to "encourage" smokers to vape instead.

As far as I know Thaler doesn't recommend that type of policy but it's a small step from a benign nudge to a more forceful push.

The use of taxation to change people's behaviour is also a form of nudging. Again, this may not be a policy Thaler endorses but I've heard so many people defend punitive taxation on the grounds that it 'encourages' people to smoke less that nudging and taxation are effectively partners in crime.

By the same token a tax on sugar could be described as nudging. Or minimum pricing of alcohol. The list is endless. 'Libertarian paternalism' is an oxymoron and it's wrong to suggest otherwise.

The first time I heard the term was in 2007 when it was unveiled with a great flourish by Professor Julian Le Grand, a former adviser to Tony Blair. I wrote about it here:

Professor Le Grand said instead of requiring people to make healthy choices – by giving up smoking, taking more exercise and eating less salt – policies should be framed so the healthy option is automatic and people have to choose deliberately to depart from it.

Among his suggestions are a proposal for a smoking permit, which smokers would have to produce when buying cigarettes, an "exercise hour" to be provided by all large companies for their employees and a ban on salt in processed food.

The idea, dubbed "libertarian paternalism", reverses the traditional government approach that requires individuals to opt in to healthy schemes. Instead, they would have to opt out to make the unhealthy choice, by buying a smoking permit, choosing not to participate in the exercise hour or adding salt at the table.

By preserving individual choice, the approach could be defended against charges of a "nanny state," he said. "Some people say this is paternalism squared. But at a fundamental level, you are not being made to do anything. It is not like banning something, it is not prohibition. It is a softer form of paternalism."

Does that sound more libertarian than paternalist to you?

In 2008 I helped launch The Freedom Zone at the Conservative party conference and as part of that two-day event I organised a panel discussion called 'Libertarian Paternalism and the Nanny State'. I described it here:

Chaired by Claire Fox (Institute of Ideas), it featured rather a good panel - Tim Montgomerie (editor, Conservative Home and an influential figure in Conservative circles), Dr Eamonn Butler (director, Adam Smith Institute), Brian Monteith (The Free Society) and Shane Frith (director, Progressive Vision).

Tim was the lone voice in defence of libertarian paternalism (aka "nudging") and without him the meeting would not have worked half as well as it did. Eamonn expressed sympathy for the concept, but doubted that politicians could implement it without going too far. Brian talked of the "bully state" and Shane criticised the extent to which government intrudes into people's lives. A lively discussion, well chaired, in front of an appreciative audience.

Anyone who knows anything about centre right-wing politics knows that Tim Montgomerie, the founder and former editor of Conservative Home, is no libertarian. Far from it. In January 2010 for example he wrote an article that is no longer online but, again, I wrote about it here:

If you want to know where we're heading under the next Conservative government, there's a clue in this article by Tim Montgomerie, founder of ConservativeHome.

The title alone is fairly explicit: "We need a state that helps people who do the right thing". It all sounds very reasonable, doesn't it? The problem is, who decides what the "right" thing is? Politicians? Bureaucrats? The media? And what does Montgomerie mean by "help"?

At the Conservative party conference in Birmingham in 2008 Tim was a panellist at a fringe meeting organised by The Free Society. We called it "Libertarian Paternalism and the Nanny State" and it followed reports that David Cameron was in favour of a policy known as "nudging".

This, it seems, is the acceptable face of the nanny/bully state. Instead of forcing people to change their behaviour, they are encouraged or "nudged" in the "right" direction.

Montgomerie's article for ConHome was prompted by a speech David Cameron had given to Demos, a Blairite think tank, the previous day. The Conservative leader (he was yet to be prime minister) told his audience:

"I know this is tricky territory for a politician. We're not exactly paragons of virtue ourselves. But to those who think politics should stay away from issues of character and behaviour, I say this:

When there are more than 120,000 deaths each year related to obesity, smoking, alcohol and drug misuse. When millions of schoolchildren miss out on learning because their classmates are constantly disruptive. When British families are drowning in nearly one and a half trillion pounds worth of personal debt.

And then ask yourself: do any of these problems relate to personal choices that people make? Or are they all somehow soluble by top down government action, unrelated to what people actually choose to do? Can we hope to solve these problems if we just ignore character and behaviour?"

Commenting on Cameron's speech I wrote:

I don't disagree with the reference to disruptive schoolchildren. But what about obesity, smoking and alcohol which he describes as issues of "character and behaviour".

I am not denying that there are problem areas (for example, excessive drinking by some young people) that need to be addressed. But what is he implying? That people who smoke, drink or are overweight are guilty of bad character or poor behaviour?

Cameron and his associates will deny it, but this smacks of a moral crusade (more echoes of Tony Blair).

For me, libertarian paternalism not only has echoes of Tony Blair, it suggests the same self-righteousness that became a hallmark of both Blair and David Cameron.

Graphic warnings, the tobacco display ban and plain packaging are all nudges. Likewise minimum pricing of alcohol and a sugar tax.

No-one is banned from buying or consuming any of these products (unless it's Lucozade where the company has simply removed the 'unhealthy' product from sale and replaced it with a 'healthier' version giving consumers no choice or say in the matter) but the slippery slope is clear to see.

All these policies may be designed to nudge us to make 'better' choices. Sadly it doesn't stop there, does it?

See also Nudge and liberty (Velvet Glove Iron Fist).


Proof of purchase

Don't take my word for it. 

Further to Tuesday's post I have now purchased a ticket to attend the 2017 E-Cigarette Summit, and here's the evidence:

I'll post a full review after the event next month.


Cost of cigarettes up to €12 a pack as finance minister targets a "fairer" Ireland

It was Budget day in Ireland yesterday.

New Minister for Finance Paschal Donohoe surprised no-one when he announced that the price of a packet of 20 cigarettes would go up by 50c (same as last year), taking the average price to €12.

That's the sixth consecutive Budget excise duty on tobacco has been increased and it's helped confirm Ireland as the most expensive country in Europe to buy tobacco.

(The UK was the most expensive but with the pound weakening in relation to the euro Ireland has sneaked ahead again.)

Although the news was expected, John Mallon, Forest's man in Ireland, nevertheless found himself in demand. Within a couple of hours he gave interviews to TV3, RTE Radio 1, Newstalk and Today FM.

He was also on a panel of guests discussing the Budget on RTE television and was quoted by the Irish Examiner, Irish Independent, Irish Sun, Irish Daily Star, Cork Evening Echo and The Journal.

Here's our full response:

BUDGET 2018 – Campaigners say a further increase in tobacco duty announced today is “unfair” and “irresponsible” because it discriminates against the less well off and will fuel illicit trade.

John Mallon, spokesman for the smokers’ group Forest Ireland, said:

"Ireland is already the most expensive place in Europe to buy tobacco. Raising the price of cigarettes for the sixth consecutive budget is unfair because it disproportionately hurts those on lower incomes.

"Evidence shows that a hike in taxes fuels illicit trade. It’s no secret that Ireland has a serious problem with black market tobacco. Increasing the tax on tobacco is irresponsible because it will only make the situation worse."

He added: "Paschal Donohoe [Minister for Finance] talks of building a fairer Ireland. Raising tax on tobacco does nothing to achieve that aim. It robs law-abiding consumers of their hard-earned cash and enriches criminal gangs."

Needless to say John buys all his tobacco abroad and there will be thousands of smokers in the UK and Ireland who do exactly the same.

In fact it reminds me of a tweet the IEA's Mark Littlewood posted in the summer – see below. He won't be alone, I'm sure.

The loss of revenue to the British and Irish governments is immense yet they persist with a punitive taxation policy that not only costs money but edges more people towards poverty. I think that's immoral but the British and Irish governments seem to disagree.

Next month we'll find out if Philip Hammond intends to increase excise duty on tobacco for the second time this year. (The last increase was in March.)

If he does smokers will have a legitimate argument that they are being singled out for treatment that goes way beyond so-called nudging.

Talking of which, I have something to say about that too. Watch this space!