Public Health

Smokers Are Not a Burden

There follows a guest post by John Staddon, Professor of Psychology, and Professor of Biology and Neurobiology, Emeritus at Duke University, which is an extract from Chapter 4 of his book Unlucky Strike: Private Health and the Science, Law and Politics of Smoking.

I have discussed the morality of smoking, its supposed lethality, its addictiveness and its effects on nonsmokers. The evidence shows that if smoking is a sin it is a pretty venial one; nor is smoking as lethal as its critics charge and many smokers imagine. The health effects of passive smoke are almost impossible to measure. The best attempts have failed to find significant effects. 

This chapter deals with the most serious policy-related charge against smoking: that it costs non-smokers money – smoking has a Public Cost.  Smoking-related disease is “a profound burden on our national health care system”, wrote Judge Kessler. As we’ve seen, the National Socialists agreed (all those lost Volkswagens). “Smoking imposes a huge economic burden on society – currently up to 15% of total healthcare costs in developed countries,” says an article in the BMJ in 2004.  The case seems unarguable. A substantial fraction of smokers die of smoking-related illnesses. Treating illness, especially if the treatment is protracted and often ineffective, as it is with COPD and many cancers, is always expensive. 

But “obvious” is not always “correct.” The smoking-costs-us folk seem to forget (brace yourself!) that we all die, even non-smokers. As the bumper sticker reminds us: “Eat right, exercise – die anyway.” The facts about the health-care cost of smoking are in fact the opposite of the common preconception. For the 24-50 age range, smokers cost a bit more, thereafter they cost quite a bit less because smokers die a bit earlier than non-smokers. Overall “smoking actually saved the Medicare program money, $2,800 per male smoker aged 24 and $600 per female”, concluded Sloan and colleagues from a database up to 2002. Data gathered since, which I discuss at more length in a moment, confirm this conclusion: smokers save society on health-care costs. Silberberg, using a different set of data, concludes similarly in the Appendix.

The Betrayal of Public Health During The Covid Pandemic

We’re publishing a new piece today by Dr. Alan Mordue, a retired Consultant in Public Health Medicine, who is alarmed and disappointed that longstanding and important principles of public health have been jettisoned in the pandemic. Alan worked as a Public Health Consultant in England and then in Scotland for 28 years, retiring in 2016. He has extensive experience of teaching and training in public health and was an Honorary Clinical Senior Lecturer at the University of Edinburgh for many years.

Here is the introduction, where Dr. Mordue highlights the difference between what the media often mean by a ‘public health expert’ and an actual trained and accredited Public Health Specialist.

During this Covid pandemic I have heard much in the media from ‘public health experts’ and ‘public health officials’, but rarely from colleagues in my own specialty – Public Health! This is very surprising since the specialty, which I practised for 28 years as a Consultant in England and Scotland before my retirement in 2016, usually leads the management of all outbreaks of infectious diseases in the U.K., and also has had the responsibility for leading the production of pandemic plans in the U.K.

But is there any difference between a Public Health (PH) official, expert and specialist? Certainly you wouldn’t think so listening to most broadcast media. Here are my definitions:

So these three groups are very different. Only one group has undertaken an in-depth specialist training and has theoretical and practical experience in outbreak control and management (as well as other areas of PH specialist practice). 

When a PH ‘expert’ expresses views in the media about the management of the Covid pandemic it is therefore essential to know a little about their background training and experience. Even if they have an exalted title like ‘professor’, their chair may be in anthropology or their main experience in nutrition or dentistry. This is not to dismiss the contributions of diverse disciplines – given the inevitable complexity of a national response to a pandemic we certainly need to draw upon a wide range of expertise. However, over the last 18 months I have kept asking myself whether PH Specialist knowledge, skills and experience have had sufficient influence during the Covid pandemic. I will attempt to answer my question by referring to some of the key principles of Public Health and considering whether they have been followed or not during the pandemic response.

Among other things, Dr. Mordue criticises the redefinition of ‘case’ in the pandemic, where for the first time a positive PCR test alone in the absence of clinical symptoms has been counted as a case of the disease, causing big problems with false positives and over-diagnosis.

Either symptoms or a positive test alone is insufficient, both must be present to be counted as a confirmed case. It follows that there is no such thing as an asymptomatic case.

This standard definition was not adopted at the start of the pandemic. Because of this we don’t know how many real cases of COVID-19 we have had or have currently – the numbers recorded include real cases of people with relevant symptoms and a positive PCR test for viral RNA, but also include people with no symptoms of COVID-19 and only a positive PCR test. This has been further complicated by mass population testing in the community and hospitals of those without COVID-19 symptoms, the use of high cycle thresholds in the PCR test, and inevitably large numbers of false positive tests.

The piece is worth reading in full.

We Cannot Afford to Censor Lockdown Sceptics – Professor Martin Kulldorff

We’re publishing an interview today with Martin Kulldorff, Professor of Medicine at Harvard Medical School and one of the three original signatories of the Great Barrington Declaration. Among other things, he warns of the dangers of censoring dissenting voices during a pandemic, following his own run-in with Twitter a couple of weeks ago.

The media has been very reluctant to report reliable scientific and public health information about the pandemic. Instead they have broadcast unverified information such as the model predictions from Imperial College, they have spread unwarranted fear that undermine people’s trust in public health and they have promoted naïve and inefficient counter measures such as lockdowns, masks and contact tracing.

While I wished that neither SAGE nor anyone else would argue against long-standing principles of public health, the media should not censor such information. During a pandemic, it is more important than ever that media can report freely. There are two major reasons for this: (i) While similar to existing coronaviruses, SARS-CoV-2 is a new virus that we are constantly learning more about and because of that, it takes time to reach scientific conclusions. With censorship it takes longer and we cannot afford that during a pandemic. (ii) In order to maintain trust in public health, it is important that any thoughts and ideas about the pandemic can be voiced, debated and either confirmed or debunked.

This is a great interview done by the same journalist who interviewed Jay Bhattacharya for Lockdown Sceptics last week.

Worth reading in full.