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Vilified for tackling tobacco

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7247.1482 (Published 27 May 2000) Cite this as: BMJ 2000;320:1482
  1. Annabel Ferriman
  1. BMJ

    An organisation dedicated to “imposing its will” on people across the world and “undermining property rights” met in Switzerland last week. It was criticised in the Wall Street Journal Europe as undermining individual choice and in the Scotsman as “leading to a version of 1984.” So what was the name of this sinister body? Was it the Mafia? Or the Freemasons? Or a new socialist terrorist organisation dedicated to the overthrow of the capitalist system? No. As it turns out, it was the World Health Assembly, which was meeting in Geneva.

    Why did the assembly (the annual general meeting of all the member states of the World Health Organization) provoke such ferocious criticism, prompting a leader in the Times, a long feature in the Wall Street Journal Europe, and a half page article in the Scotsman? Its crime, according to these distinguished newspapers, was that it had decided to “take on” the tobacco industry, instead of confining its activities to the legitimate task of combating malaria, tuberculosis, and other infectious diseases.

    It would be convenient to assume that the authors of these articles were all in the pay of the tobacco companies, but no such evidence exists. But it is still worth addressing the arguments of people who attack the WHO for taking on the tobacco industry, because the debate is bound to run and run.

    The main opponent of the World Health Assembly's actions is Roger Scruton, the libertarian writer and philosopher who was until recently a professor at Birkbeck College, London, and now makes his living as a writer and runs an experimental farm. Scruton has produced a paper for the Institute of Economic Affairs (a right wing British think tank), entitled “WHO, what and why,” which is cited in the Times leader and which is the basis of the Scotsman article. Moreover, many of his arguments are repeated in the Wall Street Journal piece.

    In his paper, he argues that transnational institutions are increasingly exercising their legislative powers, in order to bypass the constraints to which national legislatures are subject. The situation is made worse by the habit of conferring leadership of these institutions on former politicians, such as Dr Gro Harlem Brundtland, the former prime minister of Norway who is now the director general of the WHO. Such former politicians tend to be more responsive to the concerns of vocal but unrepresentative interest groups, Scruton claims.

    “The dangers of this are illustrated by the WHO's ‘Tobacco free’ initiative, and its current attempt, eagerly pursued by Dr Brundtland, to secure a draconian convention against the tobacco industry.” Scruton claims that the grounds for this are largely spurious and will lead to massive legislative and policing powers being given to unaccountable bureaucrats and to the trade in tobacco going underground.

    Although Scuton's arguments hang together logically (as befits a former philosophy don), some of the statements on which he bases his arguments do not stand up to close scrutiny. He claims, for example, that although smoking is a risk to health, “it is perhaps less of a risk than eating junk food.” What evidence is he using to reach such an outlandish conclusion? And when he claims that the numbers of deaths from smoking have been exaggerated, what statistics is he using to counter the powerful collection of figures produced by Richard Peto and others in such books as Mortality from Smoking in Developed Countries 1950-2000?

    He also claims that tobacco is of no relevance to people in developing countries, because smoking related disorders affect people only in later life, and average life expectancy in many such countries is only 45. Yet he fails to recognise that this life expectancy figure is low because of the high number of infant deaths, and that plenty of those people who survive into adulthood live quite long enough to be affected by the diseases of smoking, such as lung cancer, emphysema, and heart disease.

    He fails to address entirely Richard Peto's prediction that although smoking is likely to increase deaths in developed countries by only 50% in the next 25 years (from 2 million to 3 million a year), it is likely to increase deaths in developing countries by 700% (from 1 million to 7 million a year).

    Finally, his claim that the WHO is not accountable to national governments is flattened in one sentence by Dr David Nabarro, an executive director of the WHO, who replied to Scruton's polemic in a counter article in the Scotsman. In it, he said: “WHO is directly governed by its member states and Dr Brundtland is an elected—not appointed—official … The WHO secretariat is responding to its member states,” who said that they found it hard to regulate the tobacco industry. They found that tobacco companies could circumvent advertising restrictions, health regulations and taxation rules and exert tremendous pressure on governments, which are generally ill-equipped to deal with their wealthy marketing machines.

    The ironic aspect of the Times' attack on the WHO's “political correctness” is how reminiscent it is of its earlier opposition to public health measures. When Edwin Chadwick tried to introduce clean drinking water and better sanitation into 19th century England, a Times editorial in 1854 thundered: “We prefer to take our chance with cholera than be bullied into health.” Plus ça change.