In a recent pamphlet Ed Crane, President of the American think-tank, the Cato Institute, spotlighted the movement toward a "riskless" society as a major threat to both liberty and prosperity. "The idea of the antirisk people", he writes, "is that it's somehow old-fashioned to allow risk in our society, that it's the role of government in a truly modern society to eliminate risk."¹

The anti-risk mentality has manifest itself in public policy on many fronts, relating, in Mill's terminology , both to "self regarding" and "other regarding" issues. Ironically, even when concerns to the "other regarding" - and hence might seem justifiable on traditional liberal grounds - the mentality is flawed. As a growing number of scholarly critics² have pointed out, anti-risk policies invariably ignore the costs - and hence risks - of attempting to eliminate risk. The advocates of risk elimination are also obsessed with what can be measured, as opposed to that which cannot be measured. The classic example here, of course, are the figures for those proven to be detrimentally affected by3new medical drugs, against those potentially benefited.³

The case against the anti-risk mentality is manifold, involving economics and cost-bene6t analysis, as well as sociology and social psychology, and future FOREST publications will also be dealing with the issue from the perspectives of these disciplines. However, the principal objection to the anti-risk version of paternalism is, in my view, a moral one, and it is this sort of critique of the anti-smoking bureaucrats and campaigners that underlies Pau1 Anderton's arguments in this paper.

FOREST has never denied that there are health risks associated with smoking. But, as Paul Anderton argues, most of life's pleasures arc associated with risks of some sort. In the jargon of the economists, life itself is a process of "trade offs" between competing values and, indeed, the penalties that seem invariably to accompany all our pleasures. As I write this I am still suffering from, and undergoing treatment for, a foot injury sustained in January on my daily &127ve mile run. Even the pursuit of health and fitness - which I personally find very pleasurable - is not without its risks!

Although the anti-smoking movement would like to portray itself as the epitome of scientific rationality its writings are shot through with propagandistic bias and quasi-religious zeal. "Bad health", Mr. Anderton declares, "as the present day version of damnation, is the modern puritan's excuse to indulge interfering tendencies."

1. Edward II. Crane, America's Counter-Revolution, Cato's Letters No. 5, Cato Institute, Washington, D.C.,1988, p.11.

2. See Aaron Wildavshy, Searching for Safety, Transaction Books New York, 1988; Idem, Trial Without Error: Anticipation vs. Resiliance As Strategies For Risk Reduction, Centre for Independent Studies St. Leonards NSW Australia, 1985; Mary Douglas and Aaron Wildavsky, Risk and Culture: An Essay on the Selection of Technological and Environmental Dangers, University of California Press Berkeley 1982: Robert Goodman "Bubblebaths and Freedom", Nomos, May/June, 1985; John Adams, Risk and Freedom, Transport Publishing Projects, London,l985.

3. Sec Milton Friedman, "Frustrating Drug Advancement", in An Economist's Protest, Thomas Horton, Glen Ridge, New Jersey, 2nd edn,1975.

Chris R. Tame

Campaign Director July 1989

Smoking, Health Risks and Free Choice

Paul Anderton

Smoking affects health. This can be accepted as a fact of sorts, but it has become associated with some rather confused ideas. Many activities affect health one way or another, of course. It could hardly be otherwise, because as health is dependent on both behaviour and environment there is inevitably a never ending list of conditions and activities which will "affect health".

But some of these conditions and activities get a disproportionate amount of attention compared with others. Some diseases and ways of dying are, for various reasons, more disturbing than others. Cancer, fire, murder by criminals and terrorists. There might, in fact, be other equally or more serious actual causes, but they are relatively ignored.

I Fashions and Fads in Health Concern

The attention given to different aspects of death or ill-health is very much affected by pressure groups and what can only be described as fashion. In fact the preoccupation with health itself is a fairly new phenomenon. In the age of Victorian values, for instance, health was not as important as religious conformity and the acquisition of `grace' - i.e. being favoured by `God' usually as a reward for suffering voluntary discomfort of some sort. J. S. Mill's famous essay On Liberty was directed mainly against religious intolerance in Victorian society. Perhaps if he were writing today his main target would be health intolerance! The health and safety campaigners have replaced Mrs. Grundy - ill-health, or more accurately perhaps, indifference to it, has become a serious sin, in place of promiscuity and blasphemy.

But health is rarely an end in itself - it is a means to some other end. This other end is experiencing what can only be called `good feelings' of some sort or other, whether they are carnal or psychological in nature. The carnal good feelings are well known. Warmth and comfort, food, drink, various sexual activities. Also some others of a somewhat artificial nature such as sunbeds, sauna baths, massage parlours, and similar devices. A lot of psychological `good feelings' are, in fact, not so clearly recognised for what they are. The most readily acknowledged are those associated with the usual virtues such as respect from others, satisfaction at doing a good job, having well-behaved and successful children, being a winner rather than a loser. There are also others which are not usually so readily admitted to, but nevertheless pursued with considerable energy and dedication. Such as attracting attention, making others jealous or envious of one's successes, appearing important by interfering in other people's affairs, pretending to have certain solutions to `problems' when the available evidence only supports doubt, for instance.

Good health certainly contributes to the achievement and enjoyment of some of these `good feelings', though in most cases a high degree of it, such as is necessary for an athlete or SAS soldier, is not required. In a lot of cases there must be something of a trade-off between the achievement and maintenance of health and the experience of some of these desired (if not always desirable) aims. On the simplest level this is because such activities can take up so much time and leave one so exhausted physically or mentally that the opportunity for also indulging in healthy activity is inevitably sacrificed; in other cases because the habits required such as eating and drinking excessively, travelling through time zones, or being polite to people one dislikes, produce health damaging effects such as obesity and `stress'.

Then there are some borderline activities which are not classifiable as entirely carnal or psychological. They involve elements of both pleasure of some sort and danger either immediate or prospective. In certain cases the danger element can be quite considerable and some people even pay money to experience it. Hang gliding, cave diving, power boat racing, or mountaineering for instance. The attraction of such pursuits is mysterious to some non-participants, but to others the attraction is clear enough, even though they do not engage in such activities themselves because the expense is too great or the risk too high.

And there are practices and activities which are attractive or pleasurable in themselves but are also in some sense dangerous, though the danger may in fact be hidden or ignored. Smoking and drinking (alcohol) are the most conspicuous in this category, the dangers being mostly rather vague and well into the future. (To a small extent there are immediate risks, for instance fire caused by discarded cigarettes or fatal accident from inebriation.) The attraction of such activities can also be somewhat mysterious to non-indulgers and, possibly because of the considerable carnal element in the attractions, a strong temptation to disapproval and suppression by these non-indulgers.

In fact it has now been discovered that one, at least, of the attractions of tobacco is its stimulus suppression effect. This is because of the nicotine content which makes it easier to cope with over stimulation. It does this by reducing the brain's reaction to random and unexpected input and this can be demonstrated by electroencephalograph measurements on people subjected to unexpected stimuli, such as sudden loud noise, some of whom have nicotine in their bloodstream and some of whom have not.

If nicotine consumption is suddenly stopped there is likely to be a `rebound' effect on brain activity so that extra stimulation is experienced above that which was normal before tobacco use. This is one important reason why attempts at giving up smoking result in difficulties in concentration.

Logically, of course, the reason why people continue smoking in spite of discouragement of various kinds is simply that they perceive some benefit from smoking and consider the benefit worth the risk. This is in fact what is done in innumerable other situations, mostly without interference or organised pressure to decide on one course of action rather than another.

Probably the reason why the risks, possibly quite considerable ones, associated with some voluntary activities are regarded as acceptable, and even in some way attractive, is that these risks are perceived as somehow capable of being mastered by the skill and ingenuity of the participant. In fact the demonstration of this capacity by the participant to himself, and possibly the world at large, is one of the major attractions of dangerous sports and similar activities.

But most `health risks' are not perceived as in any way controllable or avoidable by any action on the part of participants except by not engaging in the supposedly unhealthy activity at all. Or so it is usually presented by health propagandists, though there are some exceptions. The effects of radiation are widely perceived as much more dangerous than they really are from an objective point of view. This is almost certainly because radiation has no effect on any senses and so cannot be avoided by individual action as just about all other dangers can. The impossibility of taking individual action to avoid radiation effects makes them especially worrying. The reaction of the government in this case is to play down the dangers, give advice on how to avoid them anyhow, and come preciously close to regarding anybody who does not believe the official propaganda as subversive or stupid. Nevertheless, it is surely sensible to be extra careful about dangers that one cannot even sense, let alone control.

The situation in regard to information about drink and smoking is just the reverse. The dangers are emphasised rather than minimized. No, advice is given about how to continue enjoyment at minimum risk, only propaganda not to start at all or stop completely. Those people who apparently do not take notice of this advice often seem to be regarded as either stupid or irresponsible, and are subjected to continually extended restrictions, if not always for their own good, then for that of `others'.

The evidence that smoking and drinking increase the chances of developing certain diseases is now well known and generally accepted. But the traditional comment of the dedicated indulger that he/she knows somebody or other who has smoked or imbibed alcohol for a very long time without noticeable ill-effects is also a valid and relevant observation. Evidently some people can, and do, escape the predicted consequences. As there are at present no definitive tests for separating those susceptible to ill-effects and those not, it is not entirely unreasonable for any individual to assume, or hope, that he/she is one of those fortunate enough to be able to indulge without significant danger. A lot of such people might well turn out in due course to be mistaken, but at the time they have to decide it is a matter of assessing the risk against the reward of many years of pleasure, or at any rate relief from over stimulation and anxiety. If the dangers were controllable then the situation would be exactly analogous to that for dangerous sports and occupations.

II Pleasures and Penalties: Minimizing Health Risks

Among the many purposes for which taxpayers' money is spent, projects to discover, if possible, any means of mitigating or avoiding the dangerous effects of pleasurable activities, have been conspicuously absent. Some deductions can, however, be made from information available but not publicised, at least not by government agencies or the tame media.

Alcohol has a marked effect on the liver, but the liver is capable of recovering quite remarkably if given the chance. So it would seem that some, at least, of the worst effects of heavy drinking could be avoided by bingeing intermittently rather than drinking continuously. Perhaps a similar effect would result from giving up smoking for a relatively short period of a month or so. Many people would find this fairly easy whereas they regard giving up permanently as impossible. But would it be beneficial? It is now believed by investigators that the polynuclear hydrocarbons contained in tobacco smoke can cause increased rates of cancer and cardiovascular disease by stimulating mutations in the DNA blueprint material of cells. As such effects, when they occur, are definitely related to both quantity and time of exposure, it is at least feasible that an extended interruption of smoking could provide a `fresh start'.

Recently more definite discoveries have been made about mitigating the undesired effects of smoking. Some nutrients have been found to interfere with the process by which the polynuclear hydrocarbons, which are a major constituent of tobacco tar, first bind onto DNA molecules. Selenium is very useful for this purpose along with zinc and the vitamins A, C, and E. In fact the American National Cancer Institute now recommends taking about 200 microgrammes of selenium per day as an anti-cancer measure for both smokers and non-smokers.

Acetaldehyde is contained in tobacco smoke and manufactured by the (Liver of alcohol drinkers. Biologically, acetaldehyde acts as a cross-linker in forming unnatural and undesirable chemical bonds between molecules of protein and nucleic acids. This contributes substantially to the formation of stiff and wrinkled skin, hardened arteries, and emphysema. It has recently been found (by Dr. Herbert Sprince) that the effects of acetaldehyde can be largely eliminated by a nutrient combination of vitamins B1 and C, together with the amino acid cysteine (the natural source of this is eggs, but if health scares about eggs, as well as those about drink and tobacco, are a discouragement to eating eggs, then pure cysteine can be obtained from health stores instead).

Possibly undesirable effects of nicotine can be alleviated to a large extent by vitamin B3. This is also known as niacin or nicotinic acid and is chemically closely related to nicotine itself. As well as stimulus blocking, nicotine can cause blood vessels to contract so tending to increase blood pressure, whereas B3 has the opposite effect. Nicotinic acid also tends to decrease the level of blood fats such as cholesterol which is an additional benefit not related to smoking.

Vitamin C is well known for its property of improving resistance to the common cold, but it has two other important effects for smokers. It helps in the elimination of the heavy metals, lead and polonium, and also arsenic which are found in cigarette smoke, arid counteracts the effects of carbon monoxide and nitrogen oxides. This is only a brief indication of how the unwanted effects of smoking can be mitigated.^l

Obviously, the longer one's life is, the more chance one has of experiencing `good feelings', but the number and quality of them are also important. When new information becomes available it is up to everybody to assess or reassess his choices and decisions. That applies in principle to any circumstances, not just those connected with health. If some activity, previously regarded as entirely pleasurable, turns out to be in some sense dangerous after all then the situation is changed somewhat, but the decision, in the light of new knowledge, is not necessarily to alter behaviour.

Whether enjoyment and satisfaction over a lifetime are increased or decreased by smoking is simply not known or enquired into. It could be that in reducing stress and over stimulation smoking increases the contentment and efficiency of some individuals. On the other hand, perhaps not - no definitive study seems to have been conducted, though if complete and unbiased knowledge of the situation were really sought after, it surely would have been.

It is perhaps interesting to note that some of the most surprising of the insistent smokers are people such as nurses and mothers of small children, who continue even when under 6nancial pressures, and obviously aware of the much publici&127. health risks. The reasons:s given are usually along the lines of "it's one thing I can do just for myself' or "it's the only little pleasure I can afford". Evidently smoking is a relief from the stress caused by having to attend, at short notice, to problems over which they have no immediate control - such as the demands of sick patients and young children. Without such relief would productivity or patience be diminished with a real but unaccountable cost to the rest of us? We just don't know, and there have been no efforts to find out.

But that behaviour should be altered is the implication behind the propaganda, both official, from the government, and quite commonly from supposedly independent sources, such as the popular media. This often results in some highly unscientific reasoning in the sense of unbalanced selection of evidence and neglect of alternative considerations.

III The Myth of Passive Smoking

But whatever the consequences for the person who actively chooses or persists in some supposedly harmful activity, it is generally accepted that other people should not suffer any harmful effects as well. It has been alleged that so-called `passive smoking' or inhaling smoke from other people's cigarettes, can result in nearby non-smokers inhaling the equivalent of one or so cigarettes per day. If this is the case then it would appear that the considerate smoker is the one who inhales deeply and does not `waste' his tobacco by letting it just burn away.

In reality the argument that passive smoking can constitute a significant danger in normal circumstances is very dubious indeed, although the anti-smokers have waged a skilful propaganda campaign which has persuaded many that this is so.

For public places, where there is frequent change of occupancy, there is really very little chance of non-smokers being `forced' to inhale any quantity of tobacco smoke sufficient to cause them a health problem. The irritation factor has also to be taken into account, of course. But this has to be considered in a lot of situations occurring in any civilisation. Loud talking, bad driving, garden fires on Sundays, drunken revels, bad manners in general, are all irritations of civilisation that it is hardly practicable to eliminate completely. A lot of minor irritations have to be accepted as part of the give and take of communal living - so long as they do not persist too long and that they seem to be in some sense important to whoever causes the irritation. I'll put up with your lawn mower if you don't mind my radio in the garden; you can park your car all day just in front of my window if you don't complain about my children playing football in the street. Most smoking in public places is really of this nature. Nobody spends much of their lifetime on railway stations or shopping precincts, for instance. For confined spaces such as public transport or restaurants the system of having specified areas for smoking is surely all that is required. Attempts to ban a11 smoking in public on the grounds that it is `harmful' to non-smokers look suspiciously like puritans and compulsive interferers seizing on yet another weak excuse to indulge themselves.

IV The Myth of Social Costs

The economic effect of supposedly unhealthy activities is another area of confusion. The idea is promoted that whatever costs are incurred are somehow borne by `society' rather than the individuals concerned. These supposed costs are the purely notional ones which result from the loss of productive earnings due to early death from diseases considered related to the unhealthy activity, and any costs of treatment. Related' can be rather widely interpreted, as we shall see, but for the present the exact meaning is not important.

Every death and illness has some costs associated with it. For illnesses the costs are those of treatment which can, in principle, be measured [though in fact National Health costing is usually either non-existent or very approximate], and so-called social costs such as the loss of productive work by the sick person and possibly the disruptive influence on associates and family of a long chronic illness. The estimates of these costs are highly unreliable, and it is in fact very difficult to see how they can be calculated on any objective basis. Whatever basis is used is likely to be strongly influenced by whatever case is supposed to be strengthened by the results eventually obtained.

On the other hand possible balancing factors can be ignored. Eventually, of course, everybody will encounter a terminal disease of some sort. Some are more expensive than others whenever they occur in life. If they occur late enough, they might well be considered simply one of the inevitable consequences of `old age'. For fuel cost subsidy propagandists, bronchitis in old people is an example of `cold related' disease. For anti-smoking propagandists it is a `smoking-related' disease. Much the same applies to emphysema. Heart disease can be `smoking-related', `drink-related', `stress-related' 'obesity-related', or `sedentary lifestyle-related'. Pay your publicist, take your choice.

For instance the slimmers' magazine Weight Watchers commented on the importance of diet for avoiding heart disease.

"It is the nation's single biggest disease, killing twice as many people as all types of cancer .... and it is no wonder that the annual cost to the NHS approaches 500 million .... More than 25 expert committees in Britain have sat and deliberated over what advice to issue to the public and according to the Coronary Prevention Group .... the main risk factors are:

1. Obesity

2. Lack of exercise

3. Unhealthy diet (cholesterol)

4. High blood pressure

5. Smoking

You will have read reams about smoking and have either given up or made your mind up on that one, but as all the other risk factors are to do with diet and weight and such matters are of crucial importance to readers of Weight Watchers magazine, we will look at each of them in turn .... ."³

Interesting, isn't t it, that for diet enthusiasts, smoking is bottom of the list of dangerous conditions and practices?

Evidently the same disease can be used several times over, according to what case is to be made. But surely the most sensible view for most diseases is that for people over some age, say 75 to 80, the disease which proved terminal was just the one that happened to be affecting the unfortunate person at the natural end of his/her life. There is a belief, widely held by statisticians and doctors who have studied causes of death by natural causes, as distinct from accidents, that the main determinant of time of death is simply inheritance. The expected life span is determined largely by one's genes in other words. This is perhaps part, at least, of the explanation of why some people can soldier on for years and years with serious diseases, much to the surprise of both doctors and relatives, whilst others succumb very soon after contracting the same disease.

Whether the recorded causes of death are entirely reliable is also open to some doubt. A death certificate has to indicate the primary cause and also any significant secondary or associated conditions that could have contributed to death. Not surprisingly 'old age' is not acceptable in either category! As with practically every profession, medicine is subject to waves of fashion and fancy, so any cases of doubt about causes of death are likely to be resolved by a choice from the list of diseases currently of particular 'concern'.

Even if some activities and lifestyles lead to earlier death for some of those who indulge in them than would be the case otherwise, the economic effect is not simply the cost of treatment, funeral expenses, and loss of possible production in future. There is also what cynics (or treasury economists) might call the 'positive side'. For one thing a lot of tax will have been collected from the purchase of the substances of indulgence [this is really just for smoking and drinking, if the cause of early death is obesity or some Sexually Transmitted Disease such as AIDS then there will have been hardly any tax yield]. For another, dying before the normal retirement age means that retirement pension is not paid which saves a great deal of taxpayers' money and also the cost of treating the notoriously expensive chronic diseases of old age such as dementia or arthritis.

So the overall economic cost of so-called dangerous indulgences or enjoyments is actually somewhat problematical. Doubt can legitimately start with the original statistics, and proceed to which costs and prospective savings are to be included.

But these calculations are merely a distraction. Or rather something of a smoke screen which hides the true implication behind them. This is that each individual is in some way a `unit' of production. Another worker in the ant-heap. A piece of government property whose purpose in life is to be defined in social rather than individual terms. In vigorously propagandising, and introducing legal restraints, against some forms of personal behaviour rather than others the government is implying that it has some sort of right, or even duly, to organise and order thc lives of its citizens. That is not what most of us think we are paying and employing it for. Rather it is to find out what people want and make the gaining of it easier - in so far as this is within the power of the government. If there is conflict between one aim and another - as there almost always is, which is why choice is meaningful - then only the individual experiencing such conflicting aims can balance them for himself and decide which alternative to adopt.

V Puritanical Motives in Health Campaigns

Another interesting aspect of public financing of both propaganda and treatment/research is the selection of disorders for this attention. As mentioned before, rheumatism and arthritis get very little attention beyond the minimum - pain relief pills and replacement joints (usually after a long wait). In contrast to smoking (or drinking) arthritis has absolutely no benefits. It makes sufferers almost permanently miserable and distressed rather than contented. It stops them working or makes them much less productive so reducing economic efficiency. As it is not fatal there are no savings from reduced pension payments; in fact the disablement it causes puts an additional strain on social and health services over and above the pension payments. But there is a stony silence from government and medical sources about how the condition can be avoided, supposing there is some information available. Does jogging, heavy manual work, or outdoor activities in general contribute to it, for instance, as some sufferers suspect? If there isn't any known way of reducing the risk of arthritis and rheumatism, then it is surely time for some urgent research starting from the fact that these conditions seem to be more prevalent in this country than in many others.

Such differing attitudes suggest that the reasons actually given for interfering with individual choices, rather than just providing information, are perhaps not the real ones. Both the selection of subject and the supposedly relevant evidence give rise to this suspicion. They are prime areas traditionally subject to invasion by puritans and others looking for any excuse to run other people's affairs. Bad health, as the present day version of damnation, is the modern puritan's excuse to indulge interfering tendencies.

But bad health and early death are a lot more tangible than the older horrors preached about, and therefore much more easily grasped and assessed by individuals for themselves. The usual channels of communication such as the ordinary, non-government financed, media and dissemination of information by word of mouth are really quite efficient. Such methods can obviously work quite effectively and quickly for some rather immediate dangers as the salmonella/hysteria incident has shown. But it seems we are not to be trusted to assess the more remote dangers for ourselves. These have to be emphasised and even exaggerated by publicity, government financed. This would seem rather odd if providing information was the only motive for such activity.

The accepted explanation is simply that the attractive or pleasurable aspects of the dangerous activities have to be counteracted. And it seems to be taken for granted that ordinary people are not capable of assessing the balance themselves. They have to be regarded as totally subject to irrational desire which forces them into decisions and behaviour from which they have to be protected `for their own good'. This is very strange in a democracy where everybody is asked, every few years, to decide on quite abstruse questions of economics, international relations and defense for instance.

In view of this inconsistency perhaps we should look for some other explanation. Thc most likely is in some of the alternative aims of life to carnal enjoyment. The exercise of influence and control over other people is certainly one of the most seductive. Various excuses are given for indulging it, ranging, as we have seen, from `doing good' to saving money. None of them stands up to even cursory analysis, except the protection of non- participants from undue interference or inconvenience. But they are nevertheless fascinating to anybody with a desire to indulge his/her desire for power and notoriety by organising and pressurising other people into decisions and behaviour which, left to themselves, they would not undertake. Such people are nearly always a nuisance, but given their head, can easily become a serious danger to freedom and the elementary enjoyment of life.

On the other hand the overweight person with a drink in one hand and a cigarette in the other, watching soap operas on `tele' (having sated his literary appetite on the Sun or Star), may not be perceived as the supreme example of human achievement. His unattractive, if apparently happy, condition will be attributed to the sins of smoking, drinking, foreign newspaper magnates, mind-rotting television, failure of education, or irresponsible advertising. Pay your propagandist and take your choice.

But whatever shortcomings and inadequacies such an example of untroubled humanity might appear to have, he at least seems to be enjoying himself in his own way and is not a nuisance. And that is much more than can be said of those who would improve him.

Notes

1. For a more detailed discussion see Durk Pearson and Sandy Shaw, Life Extension: A Practical Scientific Approach, Warner ßooks, New York,1983, pp. 239-258.

2. See P. N. Lee, et al. "Relationship of Passive Smoking to Risk of Lung Cancer and Other Smoking-Associated Diseases", British Journal of Cancer Vol. 54 No 1 July 1986. And see also Peter N. Lee, Misclassification of Smoking Habits and Passive Smoking: A Review of the Evidence, Springer-Verlag, Berlin/London, 1988. A very good survey of the literature on this issue ran he found in thc tobacco industry's Tobacco Advisory Council publication, Smoke and the Non-Smoker Scientific Aspects of Environmental Tobacco Smoke, TAC, London,1989.

3. March/April 1989, p. 71.

THE AUTHOR

Paul Anderson is a former school-teacher. He has also been a Conservative Candidate in council elections and is the author of a forthcoming book on drugs policy.

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