This blog is inspired listening to Mark Carney, former Director of the Bank of England give the BBC 2020 Reith Lecture named after John Reith, the first Director-General of the BBC.
Carney’s theme was how moral values have morphed into market values, a way of economic and financial thinking which ultimately led to the financial crash of 2008. Years of uninterrupted economic growth led bankers to believe they were masters of the universe, that markets were always right. Unlike say teachers and farmers who can directly see the impact of their work through the development of children and the growth of crops respectively, those in the financial world became entirely disconnected from the communities, small businesses, and families they ultimately served. They became fixated on the numbers appearing on their screens, it was all about ‘we win, you lose’ in the financial game. Such tunnel vision corroded any notion of trading ethics.
Adam Smith’s Wealth of Nations became regarded as the template for capitalism. But while Smith was a free marketeer, his work had moral underpinnings; after all, he was also the author of The Theory of Moral Sentiments which sought to explain how we develop our moral judgements. Carney’s point was this aspect of Smith’s economic thinking was lost in the dash for cash.
One should be careful talking about morality as it applies to public health. There is no place for moral judgements in delivering public health interventions. The international treaties make it clear that everyone has a right to good health with nobody left behind.
But Carney’s lecture led me to think about a read across to the direction of travel taken by the community of international tobacco control including the WHO, politicians, public health officials, policy makers, legislators, and campaigning NGOs. For years, all these groups have been engaged in honourable and praiseworthy public health and legal interventions to combat the worst impacts of smoking including taking on the tobacco companies who traditionally fought all attempts to restrict sales of their deadly products.
However, the approach of these same institutions to the advent of safer nicotine products is now undermining the central tenets of public health. They are moving from a ‘moral’ position of challenging the presence of cigarettes to a frankly ‘immoral’ prohibitionist position. The pointer on their moral compass has spun off its spindle.
Like the bankers in their rarefied financial bubble, opposition to tobacco harm reduction only demonstrates just how out of the touch these agencies are with the realities on the ground. The leaders of international tobacco control have taken an Olympian view of the smoking epidemic, cocooned in an elitist bubble of well-paid jobs and holding well-appointed meetings to which any dissenting voices are barred. Many I suspect, have no idea of the psychological and social role that cigarettes and similar products play in the lives of millions of smokers from different societies and communities, many among our most marginalised and disadvantaged citizens. That role is complex and goes far beyond the crude nicotine hit. But like the financial managers blinded by greed, too many in the tobacco control community cannot see beyond a belief in a big tobacco conspiracy to lure teenagers into a life of nicotine addiction.
Tobacco control strategies are having little impact on WHO estimates of those who will die from smoking by 2100. That part of the strategy aimed at helping smokers quit is the least successful in achieving its aims because, especially in LMIC, the political will is absent and the health systems inadequate. As Carney points out, the financial world’s remedy should markets ever fail or appear to be struggling is either more of the same or fewer restrictions. Within tobacco control, the response to a failing strategy is not only more of the same, but an equally catastrophic refusal to accept that another route out of trouble exists.
Mark Carney was told by a senior partner at the leading investment bank Goldman Sachs, that “if something doesn’t make sense, it doesn’t’ make sense”. Beneath this somewhat banal tautology, lies a greater wisdom. Within the world of high finance if somebody tries to sell you a flashy new product or suggests that a company’s value should be orders of magnitude higher than similar companies in that sector, this probably doesn’t make sense. If you ask for the rationale for these claims to be explained and it still doesn’t make sense – you run. But in 2007-08, instead of running away, financial institutions ran headlong into a dazzling light of fraudulent selling: toxic bundles of sub-prime mortgages were presented as some flashy new products promising excellent returns. Faith can guide life, but it clouds judgement. Belief turned to madness, momentum was everywhere, naked greed side-swiped any notion of financial probity. The world was brought to the edge of financial ruin, the effects of which are still with us today.
Readers will be aware of the mantra – people smoke for the nicotine but die from the tar. Why? Because any form of combusted tobacco releases a tsunami of toxins. Then along comes a new way of consuming the nicotine which millions of people want. But instead of killing them, this new way of consumption delivers a near 100% margin of relative safety over smoking. So why try and ban it? It doesn’t make sense. There is no evidence that young people are mainly attracted to experimenting with vaping because of flavours, but it is a primary reason encouraging smokers to switch. So why try and ban flavours? It doesn’t make sense. There is sparse evidence that vaping is a gateway to smoking or that regular vaping becomes prevalent among the majority of teenagers who experiment. So why try and ban it and in the process deny access to those who need these products? It doesn’t make sense. If you were serious about tackling the smoking epidemic, you would want to ensure acceptable alternatives are accessible to those you are trying to protect. So why tax them like cigarettes or make them inaccessible by demanding they can only be available as medicinal products? It doesn’t make sense.
Next November sees the 26th meeting of UN Conference of the Parties (COP) to the climate change agreement aiming to put right what has gone disastrously wrong. It is possible this will coincide with the 9th COP meeting of the WHO Framework Convention on Tobacco Control. Those attending COP9 should also consider putting the brakes on anti-tobacco harm reduction policies which otherwise will also have dire consequences for millions. We can no longer continue to burn tobacco any more than we can continue to burn fossil fuels.