Wednesday 20 July 2016

The Problem With 'Public Health'

2016 is still proving to be the most busy and stressful year that I can ever remember (albeit in a good way), and I do still intend to refer to Rod Liddle's excellent speech at the Freedom Dinner last week at some point as promised, but I can't help but comment on this while I have some time.

Yesterday, by total chance, I managed to hear Martin Dockrell of Public Health England on radio 5 live speaking about the new guidelines his organisation has produced on vaping in the workplace. (You can listen to it here from 41:45 onwards).

In the humble opinion of your host here, it speaks volumes about the problems we face with both 'public health' and the public sector in general.

For example, the slot was introduced almost as a comedy piece by the vacant BBC presenter. Y'see, everyone knows those dirty smokers are to be condemned at every opportunity, don't they?
"Every now and then you get a story where you think, I think this might get the listeners going"
Got that listeners? Prepare to get your hackles up, Auntie Beeb is eagerly awaiting your outrage.

PHE's guidance was then presented as if they had encouraged businesses to give vapers more breaks from their workstations than those already hated smokers! The bloody nerve!

It comes from an implied premise by the BBC that - obviously - vaping is either already banned by any self-respecting business or is surely going to be soon - so that the only way one can be able to afford vapers "frequent interim top-ups" of nicotine is is by allowing staff to "step away from the desk" and do so.

The fact that vaping is not harmful to anyone and perfectly legal to be used indoors is completely avoided.

Now, Martin Dockrell (who many readers will recall that I've had issues with in the past) is, as I understand it, admirably supportive of e-cigs so should surely nip this nonsense in the bud, don't you think? Sadly not.

He spoke about how vapers should "not necessarily" be banned from vaping indoors and how some - only some - employers may feel that vapers should be allowed a "stealthy puff" every now and then (not in the BBC, of course, har-di-ha because they've banned them everywhere). He was thrown the old canard about people who like chocolate being given time away from their desk to enjoy their habit and replied that staff in every company have 8 hours a day to "chomp their chocolate" and that "nobody is made to go outside to chomp their chocolate".

Erm, wouldn't this be a perfect opportunity to say there is no reason vapers should be made to go outside to vape either? Just a thought.

But no, open goal after open goal was missed by Dockrell and the end result was as predictable as it was saddening. The listening public could only really come to the conclusion that vapers should be shoved outside like smokers, just in a different area.

So let's look at what the PHE guidelines actually said. They fudge a lot too but there are some unequivocal views in there once you cut through the 'public health'  tip-toeing.
International peer-reviewed evidence indicates that the risk to the health of bystanders from exposure to e-cigarette vapour is extremely low.
For extremely low, read 'non-existent'.
The evidence of harm from secondhand exposure to vapour is not sufficient to justify the prohibition of e-cigarettes. Managers of public places and workplaces should ensure that this evidence informs their risk assessments.
This should give people like Dockrell a green light to say something like - ooh, I dunno - there is no health or legislative reason that vaping should be banned in workplaces.
e-cigarette use is not covered by smokefree legislation and should not routinely be included in the requirements of an organisation’s smokefree policy
Yes, exactly that. Because it is not any kind of threat so should be up to each business to decide.

However - and this is extremely important - surely 'public health' should be giving a very clear message that using e-cigs in public is quite simply not a public health issue! Far be it for me to suggest things for PHE to say on media if they are asked but how about this clear and concise one?
Vaping indoors is legal, not at all harmful to anyone, and it's not any of our business what companies do. However, we'd like to say that if you ban these devices you're a bit of a dick unless you have extremely strong grounds to do so.
Isn't it funny that in alcohol policy we're told that nuanced advice has no place and so only "no safe level of alcohol consumption" will do, but with nicotine a simple message that there is nothing to worry about and we're going to butt out of your lives is far too simple so, erm, we're going to try to say something nuanced instead?

The upshot is, of course, that listeners were guided into believing that this was a call to give filthy smokers more breaks, which the BBC were happy to stoke by gleefully reading out "what a load of old tosh!" reactions from their listeners who they led by the nose to object before a word was spoken by Dockrell.

It's difficult to understand why people like Dockrell can't just clearly say "there is no problem with vaping at all" until you understand three core problems with 'public health' in this area.

1) As we saw with the McKee FOIs, PHE are operating in an environment where they are being attacked by hideous anti-vaping dinosaurs who have no care for health whatsoever and are backed up by a Chief Medical Officer who is a disgrace and not fit for purpose. Offering proper advice must be difficult so it could be argued that Dockrell is dancing on eggshells in media appearances like this.

2) When you have pandered to the selfish, bigoted and anti-social with the myth of secondhand smoke and its imaginary dangers based on laughable relative risk, how can you then come out and say that even negligible risk from vaping is perfectly fine? It kinda opens you up as a bunch of liars doesn't it? So we have the bizarre situation whereby the PHE guidelines talk about bans being justified on the basis of "nuisance", "distraction" or - as Dockrell mentioned in his 5 live piece - "comfort". Erm, wasn't it about the threat of death to bystanders? If you're consistent you'd say there is absolutely none with vaping. But then that doesn't keep the shekels rolling in does it? Which brings us to 3) ...

3) 'Public health' is not really about public health, it's about salaries. If PHE came out and said that they have no position about vaping indoors because it's not a public health danger, and that their only comment would be that it should be roundly supported, then how could they justify their share of the £500m per year they are shovelled?

This is not to knock PHE's laudable support of e-cigs but to condemn their limp and spineless defence of vaping indoors or outdoors. It's great being supportive but absolutely no fucking use if there is increasingly nowhere that they can be used where cigarettes aren't.

Dockrell mentioned a policy goal during his radio interview which I think he failed to deliver.
"We don't want policies that end up doing more harm than good"
Well, when the message taken by BBC listeners is that PHE guidelines are "a load of old tosh" then it's fair to say that this goal is not being achieved and, in fact, prejudiced bans on e-cig use are actually being legitimised.

I'll start to believe all the guff about how 'public health' believes in e-cigs when outdoor bans in sports stadia begin to disappear, not before.

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