Goethe said that daring ideas are like chess pieces moving forward. They may be beaten individually, but they can still be part of a winning game.
The idea to ban anyone born after the year 2000 from buying tobacco is certainly daring. In Civil Service parlance it would be called ‘brave’.
And it didn’t take long for the objections to come pouring in. It would create a huge age-checking process, said the critics, so that in a couple of decades time there would be people having to prove they were 34, and legally qualified to buy products that kill them, rather than 33, and not. It would be against European law. It’s arbitrary.
All of this may well be true. It’s interesting that debates at the BMA annual representative meeting can often focus very closely on wording, to ensure they are realistic and workable, while doctors can also, on occasion, put forward something breathtakingly ambitious.
But why not? There’s a war going on. In the 20th century, London research assistant in academic public health Tim Crocker-Buqué said tobacco claimed 100 million lives.
Tobacco is not an ordinary product, and this is not an ordinary public health crisis. Dr Crocker-Buqué described it as a ‘perfect storm’ of a substance that was both highly addictive and very harmful.
It is a cause for celebration that the percentage of smokers in the UK has fallen from 45 per cent in the 1970s to around 20 per cent now. Much credit must go to the tobacco control measures for which the BMA has progressively pushed over the last few decades – an advertising ban, smoke-free public places, raising the age of purchase.
But if 20 per cent of the population were sticking forks up their noses every day, it would still seem a bizarre and urgent situation, even if the numbers were slowly falling. Smoking kills 100,000 of its consumers in the UK every year.
So this is more than an attempt at tobacco control. It is about ‘denormalising’ tobacco, and making it every bit as strange and alien as the forks-up-nose routine.
It is about waking people up from the trance of addition, where the conscious brain knows the harm but the body craves the hit. It’s about rescuing the young Paul Darragh.
Dr Darragh recalled, as a junior doctor, delivering the news of an inoperable bronchial carcinoma to a patient – and then popping out for a cigarette. The irony was not lost on Dr Darragh, now an associate specialist in general medicine in Northern Ireland, but it took him five years and three attempts before he managed to stop.
For Dr Darragh it was the shock of new and pertinent evidence about the incidence of asthma in the children of smokers and the fact that his son has started wheezing that caused him to stop.
This too is about delivering a shock. It’s easy to say that there have been plenty of other shock tactics over the years, and there are still smokers smoking. But it’s also true that the braver and more radical the move, the greater impact it can have. Smoke-free public places were unimaginable, then supposedly unworkable. Now they are unremarkable. They have saved lives.
Lest anyone think this policy is a pure piece of idealism (and there is something about the year 2000 that reminds us when it was a source of dreams and idealism, not crummy building projects in east London) it has a rather smart in-built mechanism.
If it were to start next year (I know, I’m not saying it will), it would focus on the age group at which tobacco addiction can often begin, without penalising those unfortunate enough to have already began.
Interestingly, the BMA has, for the same years, had the even more ambitious target of a tobacco-free society by 2035. Perhaps some people regarded that as little more than a well-meaning aspiration, like world peace. We were serious, and this is about taking that target seriously.
But what about civil liberties? We could talk at length about balancing the rights of individuals with the right of the government to protect public health, and probably end up mentioning seat belts. But Stockport director of public health Stephen Watkins put it much more succinctly: ‘Addiction is the real affront to liberty.’
It’s less a restriction than a rescue. A daring, idealistic plan for a rescue, but in an emergency, is not every rescue plan worth considering?
Neil Hallows is BMA views and analysis editor
Good idea to ban all born after 2000 from smoking - but only if they are banned from drinking alcohol too.
Smoking kills the smoker only (ok maybe there is some evidence of a passive smoking effect as well) but drinking kills other innocent people too, clogs up A&E and is a huge drain on policing budgets. Anyone who has a blood alcohol level above the legal driving limit In a public place should be arrested and fined, regardless of whether or not they are in a vehicle or behaving badly.
I think it's worth trying to find out what the tax rakeoff for booze and fags is. Its absence may well affect income tax. There will be an increase in smuggling - well, you can work it all out. A slow, steady rise in taxation might help folk to reduce consumption; that would be the kindest route if government and the profession are resolute about this whole matter. The practicality of banning folk born after year 2000 would mean Identity Cards (I'm in favour anyway) to be issued, otherwise the policing job would be much harder - they've enough to cope with already.
I am getting a bit sick of the current generation of leaders of our profession busying themselves with racking up victories against easy scapegoats for liberal discontent in our society, and then patting themselves on the back afterwards for their "courage".
People - predominantly working class people - smoke as a coping strategy. They smoke as a way of coping with the chronic background anxiety of having to live in a society where, increasingly, they can't find a job, or where their current job doesn't pay the bills; where they have to eke out a miserable existence in constant fear of the landlord, debt collectors, drug dealers, and the police; and where they are demonised remorselessly by the media as being somehow responsible for their plight. Contrary to what too many smug upper-middle class consultants and GPs think, they are not stupid.
Real daring would be to take on the forces of corporate greed destroying our society and their criminal backers in the government and the media. Real courage would be to resist the authoritarian tendencies of relentless managerialisation in our profession, that are increasingly turning us from independent advocates for our patients into government agents whose job it is to continually hector working class people for their "poor lifestyle choices".
The way to stop people smoking, abusing alcohol, and taking drugs is to set about creating the sort of society where people feel safe and secure, the sort of society where people feel valued and want to contribute towards rather than escape from. To ignore the real problems facing our society in favour of an easy headline-grabbing career-enhancing attack on its most vulnerable members - young working class people - is not "brave", "daring", or "ambitious", it is cynical disgraceful cowardice.
Here here Anthony Molyneux!
Increase the length of filter tips by two millimetres every year.
And yet the BMA is opposed to the use of e-cigarettes, or, for preference, personal vaporisers (since the ones that look like cigarettes are no use at all really), which really could reduce the rate of smoking dramatically. According to ASH, there are 2.2M vapers in the UK and 700k of them have switched completely, pretty much over the last 3 years. Now how does that compare with the 'jewel in the crown' of the NHS, the Stop Smoking Service - oh yeah, 146,000 in 10 years. And at a cost of Â£840M. Let's just compare that to the cost to the NHS of vaping, um, that would be precisely Â£0. For 5 times as many people not using tobacco.
I'm not saying that the SSS isn't worth funding, it is, but only if they can recommend that people vape instead of using NRT and the other far more dangerous medications available. A 30% success rate without any support from SSS is pretty good, just what could it be like if SSS did support vaping across the country?
But no, the BMA is implacably opposed to vaping and vapers, and we are not at all happy about this.
Personally, I would hope that any doctor that opposed vaping would be struck off as a charlatan and a shill for the pharmaceutical industry, but that's certainly a vain hope.
Get your heads out of the sand BMA, stop suggesting stupid, impractical, and probably illegal legislation and get behind the use of personal vapourisers!
I have nothing at all to do with the BMA as I am a member of the public and not a GP etc.
However, I am pleased to hear that the BMA is doing something about smoking.
When I was working in a retail shop, everytime the Chancellor put cigarette prices up by coppers, the staff I worked with always moaned for a day or so then continued smoking without any worry over the sudden price change just as if they hadn't gone up at all.
I tested a lady I worked with and pretended that the Chancellor had put cigarettes up to Â£15 per pack to stop people from buying them and to help give up smoking.
Strange, but that lady actually got worried for the first year ever compared to other years when she knew that a few pence would not make any difference to her and said, "if that's the case, then I will most definitely have to stop buying them once and for all".
This just prooves that adding a few pence each year onto a pack of cigarettes is not doing anything to stop people smoking (infact, it forces people to go out and bulk - buy before the prices go up).
However, I believe that no person in the right mind would be happy to see a sudden charge of Â£10 or Â£15 added to any make pack of cigarettes, and this certainly is the answer to me, to stop people smoking.
Seperate to the above... I was waiting for a bus opposite Morrison's supermarket in Byker, Newcastle several months ago, and someone stated to a man that he is not supposed to smoke at a bus stop.
He objected and said "smokers must be allowed otherwise they wouldn't have smoking bins at bus stops", then he also stated and said "people must be allowed to smoke in Morrison's doorway too, otherwise they wouldn't be allowed to have smoking bins".
However, I have noticed that people are smoking in public places such as in shop doorways etc, because the council has installed a bin to put your cigarette out and maybe yes, it stops people from throwing their cigarette(s) on the ground, but this seems to be helping people to smoke by enticing them when they see these bins around.
I think these bins should only be placed in 'out of the way' areas and NOT where non-smokers have to be around smokers such as doorways and bus shelters etc.
I just thought you might be interested in reading my comment, although I do wish to stay anonymous.
The BMA is doing nothing at all about smoking, merely posturing, and proposing pointless legislation.
Would you expect the RMT, the NUM or countless other trade unions to do anything about smoking? So why expect the doctors' trade union to do something.
One thing they could do is to support harm reduction, by supporting the use of personal vaporisers (e-cigarettes), Snus, and other reduced harm smokeless tobacco products.
Unfortunately, the pharmaceutical companies wouldn't like that, as they make a fortune out of the NHS for smoking cessation treatment don't work, or are positively harmful. I'm not saying that the BMA is in the pay of the pharmaceutical industry, but I'm hard pressed to see another explanation for their opposition to what could be the biggest public health gain of the last 50 years at least.
Luckily the Royal College of Physicians takes a somewhat different stance. Hopefully public health bodies will listen to them rather than a jumped up trade union.
Oh dear! Here I was, all prepared to give up the evil weed when yet again some crackpot medic comes up with another proposal for rabidly authoritarian legislation. Now I may need to reconsider my decision to quit in order to protest against this paternalistic lunacy.
A physicians it 's your job to give us health advice. Stick to that and allow us to make our own decisions like adults.
Great info... Will share, it so deserves too!!!
So much info in so few words. Tostoly could learn a lot.
I think you hit a buslleye there fellas!
You've imepessrd us all with that posting!