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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
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