Public Health vs. The Nanny State?
October 26, 2000
Jacob Sullum, Thomas J. DiLorenzo
Introductory Remarks by David Theroux
Good evening ladies and gentlemen. My name is David Theroux and Im the president of The Independent Institute. Our program tonight is entitled, Public Health versus the Nanny State. And as you may know, our two speakers tonight are the journalist Jacob Sullum, and the economist, Thomas DiLorenzo.
For those of you who have not seen their respective books, Jacob is the author of the widely acclaimed book, For Your Own Good, which is this one here. And Toms most recent book, which is co-authored with Jim Bennett, is From Pathology to Politics.
I also want to point out that The Institute published a book called Taxing Choice a couple of years ago which is directly germane to our topic tonight. And one of the issues that is a major feature of the so-called Nanny State is the use of taxes as a predatory form to punish people or to drive them away from certain kinds of behavior. Other forms of the Nanny State, of course, include regulation, prohibition, lawsuits of different types, and so forth.
For those of you new to The Institute, hopefully, you got a packet when you registered, and youll find information about our books and upcoming events. In there youll find a flyer about tonights program.
It also mentions that our next policy forum, which will be held on November 15, is entitled Gun Control: Separating Fact from Myth. The program will feature the criminologist Gary Kleck, who is professor of criminology at Florida State University and the author of the acclaimed book, Targeting Guns: Firearms and Their Control. Gary comes from a liberal background. As a criminologist, he discovered that these policies are not exactly producing the ends that people thought, and that perhaps firearms used in a private manner are beneficial to those trying to protect themselves. The program will also feature David Kopel, research director of the Independence Institute in Colorado, and who is editor of the book, Guns: Who Should Have Them? So we hope that youll be able to join with us then.
Barely a day goes by without some news of the latest public health threat, or feeling of such a threat. Serious health hazards, were told, lurk around virtually every corner: in water supplies, in the air, the soil, beverages, food, marijuana, cellular phones, second-hand smoke, food irradiation, not to mention TV and movies, the Internet, video games and so on. And yet Americans today live longer than ever, and crime rates continue to drop.
People ranging from Jerry Falwell on the right, to Ralph Nader on the left, are major proponents of the Nanny State. Such views stem from the fears over, and opposition to, the peaceful practices and peaceful choices of consenting adults regarding all manner of things.
The crusades against smoking, hamburgers, alcohol, fossil fuels, as I mentioned video games, and much more; recently a whole series of things that pertain to topics like global warming and so forth, seem to reflect, as Mencken suggested a kind of crusade against the simple joys and conveniences of modern life.
For example, although public opinion supports the legalization of medical marijuana, and states and communities around the country continue to pass measures supporting such reforms, powerful interest groups and government agencies refuse to recognize these changes. However, this Fall there are seven states with measures pertaining to drug issues on the ballot, and most of them will probably pass. In fact, in total there are 204 measures up for election in 42 states this election year, and most of them pertain to some aspect of personal choice in the Nanny State.
Lets for instance consider some the restrictions on the average home today. Just recently the Consumer Product Safety Commission requested that baby bath seats be banned because this safety product allegedly instills a false sense of security in parents who may then leave their babies unattended and expose them to the risk of drowning.
Not only is there no evidence of any design flaw in any of these baby bath seats, but this purposed ban is being made because bath seats for babies are apparently considered too safe. Too safe in luring parents to be less attentive. In other words, increased safety is now just too risky for the public and must be stopped.
Furthermore if a ban on baby bath seats were made, it turns out that baby drownings would most likely increase since only nine children using bath seats drown per year, versus 41 who die annually from bathtub drownings without a bath seat involved. So should safer technologies then be limited by the Nanny State? Who benefits?
Many of you may also know of the absurdities of the ongoing federal restrictions on the size of toilets in the U.S. resulting in less water used per flush. However, since the effective use of such toilets requires on average more than one flushing, the total amount of water used has increased since the adoption of these toilets.
Also just recently implemented, the Department of Energys new energy and water standards for washing machines will increase the cost of front loading machines by $200, and top loaders by $800. To meet the new standards, manufacturers must start selling more efficient front loading machines, instead of the more popular top loaders, even though front loaders dont wash as well, cant be opened during the wash cycle, and take longer to do the job, using precious water of course.
Meanwhile, governments themselves massively subsidize energy use, water use, energy development, and electric power transmission and distribution resulting in enormous waste. Waste that cant even come close to washing machine use.
Is this kind of government policy really in the public interest? Or are markets and private decision-making providing the real answers? Are these dangers real? Immediate? And a legitimate threat for our ever expanding government regulation? Can we eliminate health risks without government controls?
How does politics distort perceptions about public health? Will Americans succumb to or will they rebel against the growing Nanny States neo-Puritanism and attack on individual choice and responsibility? Our speakers tonight will discuss many of these very timely and important issues.
Our first speaker is Jacob Sullum. Jacob is the senior editor at Reason Magazine, and a syndicated columnist for Creators Syndicate. Mr. Sullum received his bachelors degree in economics and psychology from Cornell University. Hes a fellow of the Knight Center for Specialized Journalism. Mr. Sullum is the recipient of the Keystone Press Award for Investigative Journalism, and won first prize in Felix Morley Memorial Journalism Competition.
In 1988, his article on pain treatment for Reason was a National Magazine Award finalist in the public interest category. His book that I mentioned before, For Your Own Good, was Amazon.coms number one public policy best seller in 1998.
Hes also been Articles editor for National Review, and a newspaper reporter for the News and Courier Evening Post in Charleston, South Carolina, and The Times Leader in Wilkes Barre, Pennsylvania. His many articles have also appeared in National Review, The Wall Street Journal, The New York Times, The Los Angeles Times, and elsewhere.
Jacob is currently working, incidentally, on a new book on the moral issues involved in drug policy and drug use. Im very pleased to present Jacob Sullum.
Thank you. In the Spring of 1998 when the tobacco companies said they would no longer cooperate with the effort to pass a federal anti-smoking bill, the Clinton Administration said it didnt really matter. We will get bipartisan legislation this year, Secretary of Health and Human Services Donna Shalala told NBC. Theres no question about it because its about public health.
As it turned out Shalala was a bit overconfident, but her prediction was certainly plausible given the way politicians usually behave when the term public health is bandied about. The incantation of that phrase is supposed to preempt all questions, and erase all doubts. It tells us to turn off our brains and trust experts like Shalala to think for us.
Given that expectation, it may seem rude to ask why exactly smoking is a matter of public health. Its certainly a matter of private health since it tends to shorten ones life. But lung cancer, heart disease and emphysema are not contagious, and smoking itself is a pattern of behavior, not an illness. It is something that people choose to do, not something that happens to them against their will.
If smoking is a matter of public health, and therefore subject to government control, then so is any behavior that might lead to disease or injury. And in fact, public health officials nowadays target a wide range of risky habits, including not just smoking, but drinking, overeating, failing to exercise, owning a gun, and riding a bicycle without a helmet. Even gambling, which has no obvious connection to morbidity and mortality, is a matter of interest to public health researchers. In short, there is no end to the interventions that could be justified in the name of public health as that concept is currently understood.
Although this sweeping approach is a relatively recent development, we can find [precursors] of it in the public health rhetoric of the 19th century. In the introduction to the first major American book on public health, U.S. Army Surgeon John S. Billings explained the fields concerns. Whatever can cause or help to cause, discomfort, pain, sickness, death, vice or crime, and whatever has a tendency to overt, destroy, or diminish such causes, are matters of interest to the sanitarian.
Despite this ambitious mandate, the public health movement of the 19th and early 20th centuries dealt primarily with the control of infectious diseases. This was accomplished through a variety of measures including improved sanitation, cleaner drinking water, eradication of mosquitoes and other disease carriers, isolation of contagious individuals, vaccination, and the use of antibiotics. Such methods were strikingly successful, dramatically reducing death rates from illnesses such as measles, scarlet fever, cholera, small pox, diphtheria, whooping cough, pneumonia, and tuberculosis.
Nowadays, public health textbooks discuss the control of communicable diseases mainly as history. The fields future and present lie elsewhere.
One textbook, Principals of Community Health, explains that the entire spectrum of social ailments, such as drug abuse, venereal disease, mental illness, suicide and accidents, includes problems appropriate to public health activity. The greatest potential for improving the health of the American people is to be found in what they do and dont do to and for themselves. Individual decisions about diet, exercise, stress and smoking are of critical importance.
Similarly, Introduction to Public Health, notes that the field, which once had a much narrower interest, now includes the social and behavioral aspects of life endangered by contemporary stresses, addictive diseases and emotional instability.
Public health used to mean keeping statistics, imposing quarantines, requiring vaccination of children, providing purified water, building sewer systems, inspecting restaurants, regulating emissions from factories and reviewing drugs for safety.
Nowadays it means, among other things, raising cigarette taxes, banning alcohol billboards, restricting gun ownership, forcing people to buckle their seat belts, and making illegal drug users choose between prison and treatment.
In the past, public health officials could argue that they were protecting people from external threats. Carriers of contagious diseases, fumes from the local glue factory, food poisoning, contaminated water, and dangerous quack remedies. By contrast the new enemies of public health come from within. The aim is to protect people from themselves rather than from each other. Americans no longer live in terror of small pox or cholera. Despite occasional outbreaks of infectious diseases such as rabies and tuberculosis, the fear of epidemics that was once an accepted part of life is virtually unknown today. The one major exception is AIDS, which is not readily transmitted and remains largely confined to a few high risk groups. For the most part Americans are dying of things that you cant catch: cancer, heart disease, trauma. Accordingly, public health specialists are focusing on those causes and the factors underlying them. Having vanquished most true epidemics, they have turned their attention to metaphorical epidemics of risky behavior.
The evolution of the U.S. Centers for Disease Control and Prevention is emblematic of this shift. Established during World War Ido you know that the CDC originally did? What its original mission was?it was a unit of the public heath service that was charged with fighting malaria in the South. Today, the CDC includes seven different centers, only one of which deals with its original mission, the control of infectious disease.
The CDCs growth can be seen as a classic example of bureaucratic empire building. More generally, it is easier to dismiss public healths ever-expanding agenda as a bid for funding, power, and status. Yet the fields practitioners argue, with evident sincerity, that they are simply adapting to changing patterns of morbidity and mortality. But in doing so, they are treating behavior as if it were a communicable disease, which obscures some important distinctions.
Behavior cannot be transmitted to other people against their will. People do not choose to be sick, but they do choose to engage in risky behavior. The choice implies that the behavior, unlike a viral or bacterial infection, has value. It also implies that it attempts to control the behavior will be resisted.
In 1979, the Surgeon General issued a report called Healthy People, in which he noted that formidable obstacles stand in the way of improved public health. Prominent among them, he said, are individual attitudes toward the changes necessary for better health. Though opinion polls note greater interest in healthier lifestyles, many people remain apathetic and unmotivated. Some consider activities to promote health moralistic rather than scientific. Sill others are wary of measures which they feel may infringe on personal liberties.
However, the scientific basis for suggested measures has grown so compelling, it is likely that such biases will begin to shift. In other words, people engage in risky behavior because they dont know any better. Once they realize the risk theyre taking, they will change their ways.
But what if they dont? In the case of smoking, self-styled defenders of public health seem genuinely puzzled by the fact that so many persist in this plainly irrational habit. They insist that people smoke not because they like it, but because they were tricked by advertising and enslaved by nicotine before they were old enough to know better.
Scott Balin, at the time Chairman of the Coalition on Smoking or Health once told me, There is no positive aspect to smoking. The product has no potential benefits. Its addictive so people dont have the choice or not to smoke. Hence smokers who acknowledge the risk of their habit, that cite countervailing rewards are dishonest or deluded, displaying the classic defense mechanisms of rationalization and denial.
The sociologist Ann Wortham, herself a smoker, says, Tobaccos opponents believe that if you smoke, you are in a state of false consciousness, because you are not aware of what is in your interests. Its the refusal to acknowledge peoples capacity to make choices. You just define them out of the discourse. Addiction says that they cant even talk about their own likes and dislikes. We can decide for them.
Now Ann Wortham is not the only one to be rebelling. Even after the public is informed about the relevant hazards, and assuming that their information is accurate; many people will continue to smoke, drink, take illegal drugs, eat fatty foods, buy guns, eschew seat belts and motorcycle helmets, and otherwise behave in ways frowned upon by the public health establishment.
This is not because they cant help themselves. Its because for the sake of pleasure, utility, or convenience, they are prepared to accept the risks. When public heath experts assume these decisions are wrong, they are treating adults like children. That tendency is apparent in the rhetoric of the anti-smoking movement. Although more than 90% of smokers are adults, the best-funded anti-smoking group in Washington these days is called theyou know it? Campaign for Tobacco-Free Kids.
During the 1998 debate over tobacco legislation it ran adsthese were on the New York Times op-ed page, maybe youve seen them elsewherewith a headline saying Everyday Without Action on Tobacco, 1,000 Kids Will Die Early.
Now I dont know about you, but I had to read that a couple of times, and it conjured up images of fifth graders dying from lung cancer, 12-year-olds keeling over with heart attacks in the cafeterias, and high school sophomores with emphysema wheezing as they climbed the stairs on the way to their next class.
As commissioner of the Food and Drug Administration, David Kessler also tried to infantilize smokers. Nicotine addiction, he said, is a pediatric disease that often begins at 12, 13 and 14 only to manifest itself at 16 and 17 when these children find they cannot quit. By then our children have lost their freedom and face the prospect of lives shortened by terrible disease.
Now this label, the pediatric disease label, also reflects the public health tendency to pathologize risky behavior, thereby obscuring the role of individual choice. From a public health perspective, smoking is not an activity or even a habit. It is the greatest community health hazard. The single most important preventable cause of death. The man-made plague. The global tobacco epidemic. It is something to be stamped out like polio or scarlet fever.
Treating risky behavior like a contagious disease invites endless meddling. The same arguments that are commonly used to justify the governments efforts to discourage smoking can easily be applied to overeating, for example. If smoking is a compulsive disease, so is obesity. It carries substantial health risks. People who are fat generally dont want to be. They find it difficult to lose weight, and when they do succeed they often relapse. When deprived of food, they suffer cravings, depression, anxiety, and withdrawal symptoms. [Laughter] Some can be quite serious. [Laughter]
Sure enough, the headline of a March, 1985 article in Science announced obesity declared a disease. The article summarized a report by a National Institutes of Health panel finding that the obese are prone to a wide variety of diseases including hypertension, adult onset diabetes, hypercholesterol anemia, hypertriglicerademia, heart disease, cancer, gallstones, arthritis, and gout. The panels chairman said, We found that there are multiple health hazards at what, to me, are surprising low levels of obesity. Obesity, therefore, is a disease.
So, you got that? If it causes a disease, it is a disease.
Now since then, the obesity epidemic has been trumpeted repeatedly on the front page of the New York Times. One of the first stories came in July, 1994. It was prompted by a study from the National Center for Health Statistics that found the share of American adults who are obeseand thats really fat for laymenincreased from a quarter to a third between 1980 and 1991.
The government is not doing enough, complained Phillip Lee, an assistant secretary in the Department of Health and Human Services. We dont have a coherent across the board policy.
A New York Times story that was published the next year reported on a New England Journal of Medicine study that found gaining as little as 11 to 18 pounds was associated with a higher risk of heart disease. Or the headline as the jump page put it, Even moderate weight gains can be deadly. How would you like reading that over your breakfast?
The study attributed 300,000 deaths a year to obesity, including one third of cancer deaths, and most deaths from cardiovascular disease. The lead researcher said, It wont be long before obesity surpasses cigarette smoking as a cause of death in this country.
Just this month you may have noticed The Times ran a series of lengthy front page articles reminding its readers that the fat epidemic is still with us and only getting worse.
You are probably part of this epidemic, by the way. Since most of us are fatter than the experts say we should be, according to a survey that was a done a few years ago, three-quarters of Americans exceed the weight range recommended for optimal health.
At the American Obesity Associations first annual conference held last year in Washington, excessive weight was described as a national emergency, a worldwide epidemic, and a ticking time bomb in the health care system. Surgeon General David Satcher called it a major public health problem that deserves much more attention than it receives.
What sort of attention, you might ask?
Well as early as June, 1975, in its forward plan for health, the U.S. Public Health Service was suggesting strong regulations to control the advertisement of food products, especially those of high sugar content of little nutritional value.
Today, like Kelly Brownell, who I love by the way, because he gives such great quotes, is a professor of psychology at Yale University and he directs the Center for Eating and Weight Disorders at Yale.
People like Brownell have taken up this call for censorship. A militant attitude is warranted here, he told the New Haven Register. Were infuriated at tobacco companies for enticing kids to smoke, so we dont want Joe Camel on billboards. Is it any different to have Ronald McDonald asking kids to eat foods that are bad for them?
Brownell has also suggested taxing foods based on their nutritional content. Foods with a high ratio of calories to nutrients would be taxed heavily. While fruits and vegetables might be subsidized.
In 1998, U.S. News and World Report included this proposal, which it called the Twinkie tax, on its list of 16 silver bullets, smart ideas to fix the world. And they were not joking.
That same year, The New Republic published an article by Hanna Rosen in which she chided alarmist commentators, like me, I guess, who had criticized the notion of using taxes to encourage better eating habits. Aside from Kelly Brownell and a couple of other academics, she said, Very few were people were taking that idea seriously. One of them, it turned out, was Hanna Rosen. Its too bad Brownell isnt more popular, she wrote. The rest of her article was devoted to explaining why a Twinkie tax was not such a crazy idea after all.
Now, a food tax; youve probably already perceived this problem. A tax on junk food would be paid by thin people as well as fat people. So it might be more fair and efficient to tax people for every pound over their ideal weight. [Laughter] Now this is a market- based system because it would make the obese realize the cost that they impose on society, and it would give them an incentive to slim down. If they didnt want to lose weight, that would be okay, they could just pay the tax.
Now if that idea strikes people as ridiculous, its not because the plan is impractical. In many states people have to bring their cars to an approved garage for a periodic emission testing. Theres no logistical reason why they could not be required to weigh in at an approved doctors office, say once a year, and report the results to the Internal Revenue Service for tax assessment.
Although feasible, the fat tax is ridiculous, because theres an odious intrusion by the state into matters that should remain private. Even if obesity is apt to shorten a persons life, most Americans would agree, I hope, thats his business. That is the fat persons business, not the governments.
Yet, many of the same people believe not only that the government should take an interest in whether a person smokes, but that it should apply pressure to make him stop, including fines, also known as taxes, taxes support nagging, and bans on smoking outside the home.
New York City Lung Surgeon William Keohane, a prominent critic of the tobacco industry, has explained the rationale for such policies. People who are making decisions for themselves, he said, Dont always come up with the right answer. [Laughter]
Now the dangers of basing government policy on that attitude are pretty clear. Especially given the broad concerns of the public health movement. According to the textbook, Public Health Administration and Practice, public health is dedicated to the common attainment of the highest levels of physical, mental, and social well-being and longevity consistent with available knowledge and resources at a given time and place.
Now if thats not broad enough for you, Principals of Community Health tells us that the most widely accepted definition of individual health is that of the World Health Organization. Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. A government empowered to maximize health, then, is a totalitarian government.
In response to such fears, the public health establishment argues that government intervention is justified because individual decisions about risk affect other people. Motorcyclists often contend that helmet laws infringe on personal liberties, noted Healthy People, the 1979 Surgeon Generals report. Opponents of mandatory helmet laws argue that since other people usually are not in danger, the individual motorcyclist should be allowed personal responsibility for risk. But the high cost of disabling and fatal injuries, the burden on families, and the demands on medical care resources are borne by society as a whole.
This line of reasoning, which is also used to justify taxes on tobacco and alcohol, implies that all resources, including not just taxpayer-funded welfare and health care, but private savings, insurance coverage, and charity are part of a common pool owned by society as a whole and guarded by the government.
As Robert Meenan, a professor at the University of California School of Medicine at San Francisco, noted in the New England Journal of Medicine a couple of decades ago, Virtually all aspects of lifestyle could be said to have an effect on the health or well being of society. And the decision reached that personal choices should be closely regulated.
Writing a few years go in the same journal, Faith Fitzgerald, Professor at the University of California at Davis Medical Center observed, Both health care providers and the common will now have a vested interest in certain forms of behavior previously considered a persons private business if the behavior impairs a personal health. Certain failures of self-care have become, in a sense, crimes against society because society has to pay for the consequences.
Most public health practitioners would presumably recoil at the full implications of the argument that government should override individual decisions affecting health, because such decisions have an impact on society as a whole. But former Surgeon General C. Everett Koop, who became famous as a foe of tobacco, and now is campaigning against obesity. (And I havent seen any pictures of him lately by the way, but he was pretty chunky when he was in office. I dont know if hes taken care of that or not. And I guess I can say hereIm not sure if this is too mean to sayKelly Brownell is pretty chunky too. I dont know if thats fair to bring that up, but its seems to be like an anti-smoking activist who smokes.)
Koop does not seem to be troubled by the implications of this approach. I think the government has a perfect right to influence personal behavior to the best of its ability if it is for the welfare of the individual, and the community as a whole, he writes. Koop thus implies that the government is authorized to judge the welfare of the individual, and he elevates the community as a whole above mere people.
Now, some defenders of the public health movement have given this a little more thought, and they explicitly recognized the aims of public health are fundamentally collectivist, and cannot be reconciled with the American tradition of limited government.
One public health professor gave a speech back in 1975, which summed up pretty well the obstacle posed by the tradition of limited government. He argued that the radical individualism inherent in the market model is the biggest obstacle to improving public health. The historic dream of public health that preventable death and disability ought to be minimized is a dream of social justice, he said. We are far from recognizing the principal that death and disability are collective problems and that all persons are entitled to health protection.
He rejected the ultimately arbitrary distinction between voluntary and involuntary hazards, and complained that the primary duty to avert disease and injury still rests with the individual. He called upon public health practitioners to challenge the powerful sway market justice holds over our imagination, granting fundamental freedom to all individuals to be left alone. Public health, in other words, is inconsistent with the right to be left alone. Of all the risk factors for disease or injury, it seems, freedom is the most pernicious. Thank you.
Thank you very much Jacob. Our next speaker is Thomas DiLorenzo. Tom is professor of economics in the Sellinger School of Business and Management at Loyola College in Maryland. He received his Ph.D. in economics from Virginia Polytechnic Institute and State University, and hes been on the faculties in the economics department at George Mason University, State University of New York at Buffalo, University of Tennessee at Chattanooga, and Washington University. And hes also adjunct fellow of the Center for the Study of American Business at Washington University.
Professor DiLorenzo has also been a judge of The Independent Institutes bi-annial Olive Garvey Essay Competition for college students, which awards fellowships to the top three judged entries. And we have a number of college students with us this evening. Any of you interested in possibly entering the program, wed be happy to give you further information.
Also as an aside, The Institute operates a student intern program for college students, so any of you interested in discussing that should speak with Carl Close at the back.
Including his book, From Pathology to Politics, Professor DiLorenzo is the author actually, I guess its eight books now, is that right?
Ive lost track. I think its nine actually.
Okay. Some of the others include, The Food and Drink Police, Americas Nannies, Official Lies, Public Health Profiteering, Busybodies and Petty Tyrants, Cancer Scam, Destroying Democracy, and we have copies of that upstairs. Also, Underground Government is upstairs I believe. Hidden Politics and Unhealthy Charities. He is also a contributing author to The Independent Institute book I mentioned earlier, Taxing Choice, which again, anyone interested in this issue, I strongly recommend you getting a copy.
His authored articles have appeared in many academic journals including The American Economic Review, The Independent Review, which is our journal, and I should mention that The Independent Review, an ongoing theme of the journal are topics pertaining to the Nanny State. His articles have also appeared in The Internal Review of Law of Economics, Economic Inquiry, and so forth. And hes been the author of many articles and publications like The Wall Street Journal, U.S.A. Today, Readers Digest, and The Washington Post. I am delighted to introduce Tom DiLorenzo.
Thanks David. My next book by the way, thats coming out in the Spring from Transaction Books is an exposé on C. Everett Koop, and where we point out that he was so fat a couple years ago, that his surgeon told him that he needed surgery on his knees. His surgeon told him to lose 40 pounds before he would do the surgery, because it would be unsafe for him to get back up on his feet if he was that heavy.
And hesGet Fit America is his new grouphes telling us, get fit, lose weight. And one of the things they did was they got the government to define down words the criteria of what it is to be obese, as Jacob mentioned.
I work in Baltimore, and The Baltimore Sun ran an article claiming that according to the new criteria, every single member of the Baltimore Orioles baseball team was clinically obese. Fat, or muscle being heavier than fat, if you get highly trained athletes like that, theyre clinically obese.
Well, anyway, I want to spend 20 minutes giving you an overview of our book, From Pathology to Politics. The beginning of the book starts out with a brief history of the public health profession. And Jacob mentioned some of the things I was planning on talking about, but thats good so Ill talk about something else.
But to drive the point home about where America was in terms of public health in the 19th century, during the Civil War, there was no knowledge of germs. Surgeons would cut off an arm, and wipe the saw off on a dirty rag, or wash it out in a creek and then operate on the next person. There was no understanding of these things. And in fact, of the 620,000 Americans who died in that war, more than half of them died from disease, not gunshot wounds and things like that.
And it was the late 19th century, early 20th century when antiseptic surgery was invented, pasteurization, the whole field of bacteriology, quarantines where important, filtered water supply, all these things came about.
And so the old public health profession focused on what economists call public goods, and Jacob did a very good job of describing that. And there was a dramatic decline in mortality rates as a result. The early leaders of the public health movement were surgeons, bacteriologists, chemists, sanitation engineers, that sort.
Today, theyre more likely to be political scientists or anthropologists, that kind of trainingpolitical activists. State and local governments all set up public health departments. Theres now a huge federal bureaucracya public health bureaucracy.
And the thing I would like to stress right now is that the old public health is very interesting. In the old days, they even opposed taxation of almost any kind. And if I could read just one example of this. Nowadays, they advocate almost any kind of new tax, but not so long ago they were opposed to new taxes. In 1949, the American Public Health Association issued a resolution that said, Present federal and state taxes on oleo margin seriously raise the retail price of this commodity, thus violating the principal that government should facilitate rather than hinder the provision of a satisfactory diet for all the people. And then it goes on and it says, If the Association condemns specific taxes on oleo margin and respectfully petitions the Congress and the various state legislatures to repeal these taxes. End quote.
And weve gone a long way since then because, as Ive said, its hard to find any tax that the public health establishment is not in favor of. And were pretty critical on what I call the public heath establishment.
But not all individual public health researchersthere are a lot of good researchers out there; John Graham at the Harvard School of Public Health does great work on benefit cost analysis of proposed regulations for exampleI think its fantastic work that he does.
But if I were criticizing the economics professionIm an economistone way to look at it is: Well, what does the American Economic Association do? What do they publish in their journal, The American Economic Review, because that really sets the tone for the direction the profession is going.
And so thats what we do to an extent in this book, is look at what the leaders of the American Public Health Association are doing, and what are they publishing in their journal, which sets the tone for their profession. Although, of course, there are a lot of professionals out there who dont necessarily go along with what theyre doing.
What we call a point of demarcation in the public health movement came in 1968 when the government issued something called the Kerner Report on the Root Causes of Poverty. I hate to use that phrase, root causes because its one of Janet Renos favorite phrases. It makes me sick whenever I say it, but Ill use it once. But the American Public Health Association embraced this as their cause, their new cause, this is what we are about now, they said, the Kerner Report.
And what is it that they were about? Well, its not individuals who get sick, its society that is sick. And so they took it upon themselves to adopt the stance that we need to fix society, thats what is sick, its not so much individuals that get sick. They also abandoned more or less the idea of individual responsibility in health matters, and they announced in 1968 that government holds the ultimate responsibility for the nations health.
And so it was social programs, not medical research, patient care, and education about healthy living that became the emphasis. There was de-emphasis on these later things: patient care, education and research, and emphasizing social programs. And as we go through in the book, you can hardly find any kind of government intervention that the American Public Health Association doesnt take on as its cause, or one of its causes. Ill give you a very brief example.
Just going over some of their recent publications, it calls for an international ban on landmines, cessation of nuclear testing, creation of government jobs programs, regulation of guns as a consumer product, targeting welfare more to the benefit of women (as though women live independently of men), prohibiting wine makers from advertising the well-established health benefits of moderate wine drinking, promoting unionism, banning certain types of alcohol advertising, and limiting the ability of teenagers to work after school. They condemn the Republican Partys Contract with America. They want to raise the minimum wage and the big thing is socialized medicine.
This is where the impetus for socialized medicine comes from; to a very large extent it is the public health movement. So, theyre also in love with Cuba and Castro. Many of their publications hold Cuba out as the ideal societynot only their health care system, but their society in general is held out in a lot of the publications of the American Public Health Associationas the ideal for some reason. I dont know, theyre in love with Cuba.
And so the direction that this profession is going in, at least the leadership of it, and the money, and the big money that is in it, is political advocacy rather than the treatment of illnesses and the eradication of disease.
One example Ill offer to illustrate the types of things we talk about in this book, is the Centers for Disease Control, which Jacob mentioned, has spent money on conferences to train people how to lobby for gun control laws. Not how to treat gunshot wounds, but how to lobby for gun control laws. Theres Dr. Katherine Kristoffel, who was an invited speaker at a CDC conference on gun control, and she announced, Guns are a virus that must be eradicated. So the CDC has defined gun ownership as a virus, and since theyre in the business of disease control, well, they have a legitimate purpose there in controlling this virus of gun ownership. Thats their reasoning. And thats how they rationalize using tax dollars to train lobbyists.
They also fund a lot of bogus research. And Ill tell you an anecdote, a personal story. A friend of mine, Miguel Ferria, whos a neurosurgeon in Georgia. He was the editor of the Medical Journal of Georgia for a while, and decided to publish debates on the issue of gun control. He surveyed the medical literature on gun control and gun injury and thought it was awfully one sided. So he invited some of the top scholars on both sides of the issue to write survey articles on pro and con of the effects of gun control in the Medical Journal of Georgia.
Well, once he did that, the Medical Society of Georgia held an emergency meeting and fired him as the editor. The Atlanta Journal and Constitution editorialized against him and attacked him personally. Accused him of being a tool of the gun manufacturers, and just pretty much tried to ruin him. And thats how the public health establishment deals with diversity of opinion, lets say, on such issues as gun control.
A lot of the bogus research that is funded by the governmentone example, and maybe I dont want to steal anybodys thunder for your next seminarbut if youre at all interested in the gun control issue, the next seminar youre having sounds fantastic. Im familiar with the work of both of those authors.
But one of the strongest proponents of gun control, who is funded by the government, is Arthur Killerman, who routinely refused to make his data available to anybody. And so he keeps publishing articles in these so called peer-reviewed journals that sound awfully counter-intuitive to a lot of people. And other researchers want to try to see if they can replicate his results, but they cant because he wont give his taxpayer-funded results to anybody to replicate the results.
And thats one of the cannons of the scientific method is that the studies arent really accepted unless they can be repeated in several different instances, maybe with different data sets and so forth. But he wont give his data up.
Political science. We have a section in the book on political science. We discuss many of the studies that study risks. Health risks that are so small, it would be impossible to ever verify or prove that health risks are something that is said to create a one in 10,000 chance of getting cancer, for example. To really do a serious study of that, to verify that and make it anything other than a mere conjecture, youd probably need a study of about 500 million subjects, and of course thats never going to happen.
And so you get all these so-called risks like living near electromagnetic fields that they know can never be proven, but try to alarm us over that. We need to give the government more power and more money to protect us from these things.
Theres a concept that is used called relative risk that is misused. And what relative iswe dont have a blackboard, but you dont mind if I write on the wall with a pen, do you? [Laughter]
Well, Ill just define it. Its the prevalence of exposure to some substance among a group of disease victims. Lets say we suspect milk causes cancer. So if you have 1,000 cancer victims, the prevalence of milk drinking among them, divided by the prevalence among a controlled groupmilk drinking of a controlled group out there. And they come up with these ratios that are called relative risk factors.
So lets say you happen to give milk drinkers that have twice the incidence of breast cancer than non-milk drinkers. Theyll say, Do you drink milk? Youre twice as likely to get breast cancer, for women, if you drink milk. And of course what theyre doing is theyre claiming that aI dont even know if I want to call it a correlation, but theres relative risk factorstheyre claiming theres causation here. Milk drinking causes cancer, when, of course, there are many, many things that cause cancer, and in fact, researchers dont really know what causes cancer.
If you read their own research, were pretty sure theres a link between smoking and cancer, but they dont really fully understand how cancer gets started yet. All the researchers will admit that. They dont really; if they did, they can cure it, so, in all likelihood.
But for example, whole milk, I mentioned that. There was one study on whole milk and lung cancer, a relative risk of 2.14. So if you drink milk, the media will report youre twice as likely to get lung cancer. Wearing a bra and breast cancer, relative risk of 12,500. That was an actual published study. Drinking tap water and miscarriages, 1.5. Yogurt and ovarian cancer, 2.0. These are all reported studies. Dont eat yogurt. Dont wear a bra, I guess. [Laughter]
Yeah, I think it was a team of 60 male researchers that published that. But it gets even goofier than that. I have a really good one for later.
And in a lot of these studies, actual exposure to a substance is not even measured. And in a lot of the second-hand smoke studies, a lot of the data are gathered by surveying the children of people who passed away from lung cancer, and asking the children, how often do you think youre late father, or your mother, was exposed to cigarette smoke in the house? So theyre not actual measurements of how often they were in fact exposed. Its surveys. And thats a little iffy. There are a lot of studies of so-called disease clusters.
Now theres no reason to believe that cancer or heart disease or anything else will be equally distributed among the population. And there are clusters of certain parts, certain cities, certain towns, certain parts of town, that have a bigger incidence of certain diseases. And so theres usually some alarming news report about this. If you live in this part of town, youre much more likely to get cancer or some dreaded disease. But if you widen the sample just a little bit, these clusters tend to disappear. And so this is playing games with statistics, which is a lot of what goes on here.
And Ill read to you the silliest example of political science that I ran across from the prestigious American Journal of Public Health, a peer-reviewed journal. If youre in this field, you publish in this journal, its the top journal in that field. And I have big stacks of these, and I just looked through all these articlesabout 10 years worth of the American Journal of Public Health when I was doing research on this.
Theres one article called Condom Breakage and Slippage During Heterosexual Intercourse: A French National Survey, which had 31 co-authors. Thirty-one co-authors. And they surveyed 4,820 men and women using univariate analysis when entered simultaneously in a logistic regression model. This is the language of it, this language of science. But here are the conclusion. After reading through all this dense scientific language, the conclusion is high frequency of intercourse was associated with condom breakage, but not slippage. Peer-reviewed journal. Then it goes on.
During the Clinton impeachment thing, all his paid hacks that were on cable television every night said that everybody lies about sex. Thats all they said for months, everybody knows everybody lies about sex. Well, the American public health profession apparently doesnt believe that. They didnt watch TV during the impeachment thing. Because there was another study in this peer-reviewed journal that said, Self reports of recent condom failure are believed to be reliable as are reports of recent sexual events in general. And that was another and of course this was used to say that, well, if we hand out condoms in schools, thats a good thing, it will work. It will reduce venereal disease and so forth. And so, it gets downright goofy.
One other example of the research agenda of the public health movement that Ill end with, my last example, is that nationalization of childcare, which is a very big thing in the public health movement. They have published many, many books about this.
And on the plane on the way out, I never travel without The Independent Review, by the way. I brought this with me. And I was reading one of the articles by old friend Jenny Roback [Morse] thats in here. And one sentence I underlined because its relevant to what I wanted to end up with. And that one sentence in here is the left would love to control every school board in the country and to replace parental care of children with a network of government-funded daycare centers, schools and health clinics.
Well, in one of the chapters entitled, Ponds and Mascots, we will talk about briefly anyway is the movement to nationalize childcare. And I guess here in California you have an experiment going on with thewhat is it, the Children and Families First Initiative? Who can be against that? Children and Families First sponsored bywhats that guys name? I know him as Meathead from All In The FamilyRob Reiner. Hes the head honcho of that. And they raised the tobacco tax, yet again, to fund this.
But the idea is to get children almost as soon as they come out of the womb, and put them in the care of the state with state-controlled, state-run daycare for all children, not just children of poor people, all children.
And in the chapter here, we talk about how Hillary Clinton and the Clinton administration ordered the United States Army; ordered them to proselytize and advertise the Armys daycare system to the civilian population and promote it as a model. The President ordered the Army to do this.
And they call it the Total Army Family because Army personnel have government run daycare, and the Clinton administration wanted this to be a model for the whole country; to have coercive mandatory government-run daycare for everybody. Thats their dream.
And its interesting that, as far as I can tell, the first place where this phrase, Total Army Family was used was in George Orwells book, 1984, its actually in there, in the book 1984.
And Allan Carlson, the political scientist, who we quote in here and has written quite a bit about this. I think Ill finish with this, hes looked at this for quite a long time, and what are they up to? Why do they want government control of daycare?
Well, heres what he says, Back in the 1930s the Swedish theorist Alva Murdall showed how radical feminism might be reconciled with a collectivist vision of the family. Woman must be employed alongside men in the same jobs. Marriage must be transformed from a social expectation into a mere choice. The cost of children should be subsidized by the state and the very young should be raised collectively.
Some commentators argue that the American Military Family programs are mere parallels to civilian benefit plans. But, in fact, a whole logic rests on this model of Scandinavian socialism. And I think that explains whats up here with the push toward this.
In conclusion, what the public health movement has become is an organized assault on individual responsibility. And as Friedrich Hayek once said, The cause of socialism can not succeed unless it destroys the idea of individual responsibility. If people believe in individual responsibility, they will not accept socialism. And I think the public health movement knows this, which is why they target individual responsibility so severely and want to destroy it, because they want to adopt socialism. And thats all I have to say for now. Thanks.
Thank you, Tom. As I mentioned, the Garvey Fellowship Program that Tom was a Garvey Fellow, was that in 1982 or so?
1984. I was only eight years old then.
Yes, thats right.
I was a child prodigy.
So thank you Tom. We have time for questions, so anyone who has questions, Carl has the mike and well just wait a second for him to get that together.
Audience Member #1
How much of the public health establishments grab for expanded power do you think is fueled by just petty empire-building and personal desire for power which can be sort ofwell, I always think of the old sawthat you have to have an enemy. Everybody has to have an enemy. And they got rid of things like smallpox and cholera and things like that. So they suddenly ran out of diseases and epidemics to prevent; so they go for more things. How much of that do you think is based on just desire for personal power and glory and the feeling of wanting to do something wonderful for the world as opposed to an actual real deep desire to control the world?
Whos that for?
Audience Member #1
Does that make sense? Either, whoever wants to.
It strikes me that most of the people who are involved either in the public health field or any one of these allied movements, like the anti-smoking movement or the anti-fat movement, most of these people are quite sincere. They believe theyre doing good, they believe theyre doing the Lords work. They are, in fact, usually puzzled that anybody would criticize them.
Audience Member #2
Theres no question that they also haveand not just an ideological interestbut in many cases a financial interest, a career interest in this field, but of course that could be said of most people. People want to believe what is good for them is good for the world. Thats a very natural sort of inclination. And its very easy to convince yourself that what youre doing plays well for you, is also good for other people.
And so we look at something like the tobacco settlement, where all of this money is pouring in to state treasuries as a result of the settlement of these lawsuits against the tobacco companies. And some portion of that, not as much as you might think, but some portion of that, is going into the anti-smoking movement to fund things like anti-smoking ads and research on tobacco-related illness, and so on. So you have this situation where the people who are pushing for these arrangements and pushing for this money are also benefiting from it.
But at the same time, its kind of ironic, because theyre put in a position where if they really succeeded and everybody stopped smoking, well theyd all be out of work, and none of this money would be coming in. So theyre in the situation where on the one hand they want to stop people from smoking, but on the other hand, its really not in their interest to do that. So, its very complicated, and I dont like to attack peoples motives. I think most of these people are quite sincere and there may be other issues of ego and financial reward that come into it, but Im sure theyve convinced themselves that what theyre doing is for the best.
Yes, first, kind of a generic question for both panelists. We have started way down a national slippery slope toward the Nanny State. And Id like any thoughts about how we can stop that. How can we actively change or reverse that movement?
And then a specific question for Jacob, dealing with this smoking. William Osteen threw out the EPA rulings about second-hand smoke, declared that the rulings were invalid, yet we have laws all over the country based on that ruling. Why is nothing being done to overturn those laws that restrict second-hand smoking?
Well, the slippery slope, thats a tough question. Maybe Ill relate it to the last question, is WashingtonIve lived and worked around there for quite a long time; Ive studied Washington and written many books about what goes on therethe culture of Washington is such that if you understand economics, youre an outcast. You make economic sense, youre an outcast. Theres a very strong and clearly designed attempt by the Washington establishment to eliminate economic logic from policy discussion.
I read The Washington Post every morning, and the hallmark of The Post is economic ignorance with uncritical acceptance of any and all government intervention schemes that are brought up.
And I think the same thing happens with public health. That one of the things Jacob and I talk about and write about on this issue have to do with the effects on freedom, the effects on the rule of law. Well, thats like economics in Washington. If you talk about these things, they will either laugh at you, ignore you, or conduct a campaign of character assassination against you. And so most people just shut up about it. Even if people are in the public health field, they dont want to be castigated or marginalized.
I recall when Bill Niskanen, the chairman of the Cato Institute, made the statement that much of what government does is unconstitutional when he was a member of the Presidents Council of Economic Advisors. And the front page of the Washington Post tried to smear him and destroy his reputation. You dont just say those things in polite company. And so its a big battle to get people to appreciate things such as the rule of law and individual liberty. And thats why The Independent Institute is here, and thats why we spend so much of our time addressing these issues. We try to go over the heads of the bureaucrats and otherwise educate the public.
Yeah, I would just add on that question that a big part of this is trying to get people who think about the principals underlying the public policy. And people tend not to think in that way. They tend to think in a very ad hoc way. This measure sounds good without thinking about how the principle that underlies that might be extended to other areas you might not like so much.
So thats obviously a big part of what we try to do. We try to get people to think of whats the next step down the slippery slope. And the principles do matter.
And even though the anti-smoking activist may be quite sincere when he says, I dont care about cheeseburgers, Im not going after fat people, other people will come after him and quite explicitly will say, Look, lets copy this model, the anti-smoking model. What did they do, and how were they successful? How can we get the government to get people off their asses and get some exercise and stop eating so much? And they see the analogy quite clearly. So its a matter of trying to get people to think about the idea and the line policies.
As to the other point, I think the odds of actually getting anti-smoking laws and smoking bans reversed are pretty small. There has been some attempt to introduce the Osteens decision in towns that are now considering passing these ordinances. Im not sure how effective that is.
I think in Princeton, which was considering an ordinance they tried to do that, it went out. In fact, this EPA report [the ordinance] had been relying on had been tossed out by the federal judge. So that may slow things down, and it may have an impact in certain towns, but in a place like California, where its an increasingly small minority that still smokes, and the smokers, the people who do smoke, are so cowed, that even they say, Lets ban smoking, if you believe the surveys. At least they tell people thats what they think when theyre interviewed.
Most people, I mean, this is the tyranny of the majority. Most people want the ban. Id just as soon not have smoke in bars, and Im sure the vast majority of people feel that way. Im not willing to force that solution, but most people, again, dont think about the principal involved, they just think, yeah, who the hell nobody wants smoke. Youre bothered if I smoke. So you get very large majorities who support laws like that, and then it becomes very hard to overturn them once they get used to the idea they have a right to this smoke-free environment.
The survey that Jacob is referring to, you may not have heard of, is a new survey that came out of people in bars. Their view is about the smoking ban in bars. The only problem with it is that, of course, most of the dedicated smokers are not going to those bars. And the people who are going to them dont care.
Plus a lot of their respondents were probably drunk in bars. That will be the next thing banned in bars.
How can you rely on no drinking in bars? Yeah.
Audience Member #3
I really enjoyed your talks, thank you very much. My name is Mark Folker. First time Ive been to one of these meetings, but I think Ill be attending some more of them.
My question is: How do you think this is all going to end? When you go into an attorneys office, you see rows and rows of books that contain all the rules that were all supposed to obey at all times. And those rows of books get ever longer and heavier with time. And I dont see that trend reversing.
Is your question addressed to one of the two?
Audience Member #3
Either or both. And my question is: How do you think this will end? When will this trend turn around, and how will it turn around, and are there examples from history of the trend of ever larger, more powerful governments sort of moderating and turning around without some sort of violent cataclysm or external force that comes in and causes a reversal of this kind of trend? Thanks.
Well, the collapse of Communism would be one example of that, I would think.
Audience Member #3
Has it really caused a deregulation [inaudible] freedom or destroyed [inaudible]?
Theres more freedom than there used to be certainly. You see it in many other areas, too. Usually things have to get so bad, and people get so fed up and disgusted that they force a revolt to happen. And Chile was the first country to adopt a social security system. They were also the first country to privatize it after it got so bad, so unproductive and drained so much capital from their economy.
And so, that seems to be the trend, that things have to get really bad to wake people up, because, I think, de Tocquevilles famous saying in Democracy in America, that under a democracy, people tend to be sort of more or less hypnotized like sheep being led to the slaughter. And their liberties are taken from them a little bit at a time, and over 50 years, theyre almost all gone, and at that point, tend to wake up at some point. And I can point to the examples of like Chilean privatization and other things, even here in the U.S.
Jacob, do you have anything to say?
No, Ill just say that in a sense its fortunate that most of these people are not very deep thinkers and are not consistent. Because if they were consistent, God help us. Its good that they havethey only have their own little issues they stick to for the most part, andbut then on the other hand, its hard for people to see the larger trends. When people get used to these interventions, things that at one time were very controversial, it was quite controversial to force people to buckle their seat belts not so long ago. Now I think almost every state has a law requiring that, and in some cases they havethey can actually stop you for not wearing a seat belt. In some cases its incidental to the stop.
Audience Member #4
Does the federal government bribe the states to make those laws?
Yes. Right. Its tied in to the CDC.
With the seatbelt law, yeah, yeah. You get funding if you
And things like smoking in bars. A ban on smoking in bars. That was astonishing just five years ago. And I wonder what your sense is, David, whether there really has there been a backlash in California against that? Or is that sort of petering out? I think initially there was a lot of disobedience, but it seems like
Audience Member #5
Theres only a lot of rebellion when its freezing and raining outside. When you have to go and stand out in the rain, huddling over in your winter jacket.
Well, the initial poll indicated
Audience Member #5
And somebody steals your beer. [Laughter]
What a trade off.
I think it is important to realize a lot of these policies that become universal because of federal policies that essentially induce people. And thats the way the seatbelt policies and also the helmet laws and all these others are adopted. But one thing I was just going to say real quickly is that, we went through Prohibition, we came out of Prohibition. Theres a movement, as I mentioned, for medical marijuana and things like that. Ironically, or not ironically depending on your perspective, many of people in favor of legalizing medical marijuana are also the ones pushing for smoking prohibition and vice versa too. So its as Jacob is saying, its a very diffused type of thing. Question right here, Carl.
Audience Member #6
Yes. For Jacob Sullum. You said that smoking is behavior and not a disease. And of course, the anti-smokers will immediately point out or claim that smoking related disease is communicated by a second-hand smoke. Now it takes me 1,500 to 2,000 words to refute that credibly. I was wondering if you had any better way of handling it?
Well, you know, I got very bogged down in the science behind this, which I intended just to touch on because I realized there really was some serious misrepresentation going on. That there is evidence, but the evidence has been represented being much stronger than it actually is. And thats interesting.
Audience Member #6
Its interesting how things get distorted. How people misread things. How researchers push their finding as far as they possibly can, and then reporters take them and run even further, and so on. And that whole phenomenon is very interesting and it has implications across a variety of public policy data.
But when it comes right down to it, it really ought not to matter, whether or not there is a lung cancer risk associated with exposure to second-hand smoke. If there is one, its very small. Its a trivial risk.
But assuming that there is, or assuming there isnt, doesnt matter, because the truth is people dont want to be around the stuff. Whether they think theres some tiny risk, theyre going to get lung cancer after being exposed to it for 30 years, or just because it makes them cough, and it makes then nauseated and gives them a headache and makes them sneeze, and whatever. They dont want to be around it, and this I think this obsessing over some hypothetical tiny risk of lung cancer is really just a way legitimizing that complaint, that people dont like it, they dont want to be around it.
And so the question is what you do about that? Clearly, a lot of people dont want to be around it, and the response has to be that then you choose to go places where smoking is banned, and create a demand. And then restaurants and bars and so forth will respond. And they were responding to that well before there were any laws requiring them to ban smoking.
But, in a free society, there should be a place where a guy can go and have a beer and smoke a cigarette if its okay with the owner of the bar. In California, if youre a smoker and all your employees are smokers, and all your customers are smokers, you still cant do that. You still cant have a place where they can drink and smoke a cigarette. And that I think should appall people. Its just astonishing that we cannot, in this society, have a place for that kind of disgusting appalling choice for people to make.
So thats the argument, I think, that needs to be put, because if you get into the science, then theres a lot of back and forth about it, and most of the people just sort of tune it out. The truth is that you just have to face up to the fact that there is a big demand out there for smoke-free environments. There are a lot of people who are annoyed by it. And the less theyre exposed to it, the more annoyed they get by it.
The fact that you very rarely encounter it nowadays, especially in a place like California, means that when you do encounter it, you get even more upset. So you have to do something about that complaint; address it in some way that people will find plausible and persuasive.
Dr. Gold would you come up here.
Dr. Lois Gold
Im Lois Gold and I work in the field of cancer prevention. Theres something in the loop thats wrong here. I cant put my finger on it. We all watched movies, those of us who are older; movie stars smoking, and we werent bothered by smoke in a bar. Its only when it became clear that it was a communicable disease, if you will, analogy, because of the second-hand smoke claims, people crossed the line from voluntary risk for a smoker to involuntary risk for a person in the bar who didnt smoke.
Once people accepted that data, then I think it became clear that it was the model of malaria or measles or something. So I think, in my mind, the second-hand smoke belief in its hazard for cancer or lung disease of any kind is whats pushed people to be in favor of that legislation. I think theyre afraid for their own selves, whereas, the smoker is increasingly viewed as a victim whos addicted.
Yeah, I think the response to the idea that this is a risk that is being imposed upon you involuntarily, that its not. That people can choose where they go and where they work and thats one of the factors you take into account. I understand, people may be genuinely worried about it, especially if theyve seen some of the more exaggerated claims.
Dr. Lois Gold
But it still seems to me thats not really the main issue. This is
Dr. Lois Gold
Oh, I think it is, because
I dont see a difference in kind between something that reallythat causeshas a potential to cause health damage in the long term and something that simply causes short term health effects that are unpleasant. Theres a difference in kind, maybe. I mean, a difference in degree, but not in kind.
Dr. Lois Gold
Well, the idea is you cant predict whats going to happen to you in the long term. If you had an acute effect youd know it, and you could leave the bar.
Yeah. But the question is: do people really believe that if they go to a bar a couple of times a week, theyre going to get lung cancer? Im not sure that people really believe that.
Dr. Lois Gold
I think they believe they have an increased risk. And in point of fact, in the field I work in, if youre going to ban DDT because of its presumed carcinogenic effect in humans, the data is zero. And for second-hand smoke theres at least a little epidemiological data. So theres a continuum there on the level of evidence.
I think the crucial point then comes back to the issue of voluntary exposure or involuntary. Consent is the issue. Thats the difference between second-hand smoke and say, pollution thats given off by a factory or dumped into a river. It is that people can choose whether or not they encounter it, and increasingly are choosing not to encounter it. So you have to come back to that in order to explain why it should be allowed in some places. But it should be up to the person.
No, Ive read quite a bit about the history of this whole thing. Maybe not as much as Jacob has, but there was a conscious decision by the anti-smoking movement. Because they recognize that most Americans were tolerant people, and theyll say, Well Ill just go to the no-smoking section if I dont like smoke. How can we overcome this, they said. So they said we have to convince people that second-hand smoke causes cancer.
Dr. Lois Gold
So they came to the conclusion, first, and then government funded all these studies, which as Jacob points out in the book, theyre on very, very weak scientific grounds. The point I would make thats made in book, Cancer Scam, is that whenever the government enters into a public policy debate, it has the ability to drown out all other voices, and this thought as research, and the PR about so called research is funded with tax dollars. And so I think thats how this came about, this belief on the part of the public that second-hand smoke is dangerous. Everybody knows that now, of course, the scientists havent proved it.
Dr. Lois Gold
Yes, we doubt the veracity of the data.
But its doubtful.
Dr. Lois Gold
But youre saying what Im trying to say.
But it was a public relations campaign funded by the government that persuaded the public that this is real, even though the research is real weak at best.
Well, I think, and I dont want to give the wrong impression, it played a very important role in propaganda, in the sense of saying, theyre not just killing themselves, this is a cost theyre imposing on you. The same way the argument about cost imposed on taxpayers because of publicly funded health care says its not just their business, theyre hurting you too; theyre hurting you in the pocket book. I think thats very powerful rhetorically, and when you get images like you do in California; have you seen this billboard, Im not sure if they have it up anymore, that shows the woman standing next to a man. They were nicely dressed, they looked like some from old movie. The man says, Mind if I smoke? And she says, Care if I die?
Thats pretty powerful. Thats sayingand by the way thats not saying that smokers are victimstheyre killers, theyre guilty of negligent homicide. That is quite powerful stuff. But when it comes right down to it, I do wonder. I mean, people certainly have been convinced that they have a right not to be exposed to this stuff, and there is some element of health risk involved. But it still seems to me that when youre encountering it, the remote, tiny risk of lung cancer is not the main thing on your mind. The main thing on your mind is: I want to get rid of this. And the health concern is a way of legitimizing that complaint and saying, not only do Iis this a desire of mine, this is a right.
Audience Member #7
I agree with what Jacob was saying. I got to sit in on several public policy meetings, and in Los Gatos in California, and just from what I was able to see, the peoplewho where already opposed to smoking prior to the idea that second-hand smoke does anythinglatched onto the idea of you could be killing me. They were just delighted that they could be killed by this. This was the bestordinarily victims arent quite so happy about these thingsbut they were very thrilled, and it allowed them to become even more shrill that nobody was shocked and horrified when this study came out. They were delighted, it was glorious and they could go up and wave it back and forth.
Do you have a question?
Audience Member #7
That wasI agree.
OK. This gentleman, and then that will be it.
Audience Member #8
Would either of you care to comment on the CDCs 40-year sponsorship of the infamous Tuskegee study of untreated syphilis in black men who were used like guinea pigs?
Im not that familiar with it. All I know is what I read in the newspapers about that.
Yeah it was
Yeah, I dont know about it in-depth, so I wouldnt want to comment.
Well, Im shocked that the government would use citizens as guinea pigs. [Laughter]
We incidentally have another book, since Im hawking books tonight, called Cutting Green Tape, which deals in part with the so-called issue of toxic torts by government. And if you want to see real tort damages that government are essentially kept completely immune from liability, start looking to those areas. And of course these agencies know this and thats why the Army or others pursue these kind of tests. Gentleman right here.
Audience Member #9
The guy with the mike gets to speak. Ill be very brief, and you make a comment on what Im about to say. I happen to be in the life insurance business, and we have people who are called actuaries and they study rates of death, and they do this for a living, and they have to be very, very accurate, because theyre projecting out many years in the future. Hundreds of millions and billions of dollars are riding on this. And I can tell you that if I take an application and write an application for anybody for a life insurance policy and that person tells me he or she smokes; right there I know that the rate is going to be at least 20% higher because the actuaries have already determined that the probability of that person dying is greater. So thats pretty much. But the second thing Id like to say is that I can then write an insurance policy on that persons spouse who lives with them, and if he or she says, no I dont smoke, there are no consequences. The actuaries have not imputed one single dime into the premium for the person who lives with them.
So you wanted to comment on?
Well, it just reflects both the weakness of the evidence and the very small magnitude of the risk theyre talking about. I mean, in the EPA report were talking about, you take a very tiny risk and you raise it by 19%, its still really tiny. And the risk of lung cancer in non-smokers is very, very small. If you take that risk and you raise it by 20%, or even raise it by 100%, its still really small. So in practical terms it doesnt amount to much, even if we assume that what the EPA says is valid.
The other gentleman.
Audience Member #10
Yeah, I have to confess that years ago I graduated from a school of public health. But I was rational enough to leave the field about 20 years ago when they gave up science. However, I still get the periodical publications from the school where theyre bragging on their current research, and of course, begging for funds. And the thing in the latest journal, I dont know if theyre bragging on their program on social epidemiology, I dont know if youve heard that one. But I read the article on it and it turns out that they discovered that poor people dont have as good a state of health as rich people do, which we knew 50 years ago. But their cure for it now, as economists youll love this, is to get rid of poverty, which is now a public health problem. And the reason that poor people are poor, of course, is because rich people are rich. Theres only so much wealth to go around, and if rich people [Laughter]and the bottom line is its public health responsibility of the wealthy, then, to pay for the health care of the poor. Do you care to comment on that?
Well, we address that in our book actually. I wrote about it in the context of a psychiatrist in Washington, DC, who Ive talked with a few times. Sally Satel is her name, and she went to the annual meeting of the American Public Health Association, and the keynote speaker was Jesse Jackson. And then the next days luncheon speaker was John Sweeney, the head of the AFL-CIO. And it was one big political rally, and she said there was almost no talk of health, science. It was all about how can we get Jesse Jacksons political agenda through. That was pretty much what it talked about.
Audience Member #10
And she wrote about this in The Wall Street Journal and she had a blizzard of letters from these characters that The Journal published criticizing her, and pretty much what they said was just what you said. Poor people have worse health than affluent people. Weve known that for a lot longer than 50 years, I would think. But their solution is a bigger welfare state. And she argued, Well, no thats not the solution. Look at what weve done, weve perpetuated poverty. And so we take that whole issue on in my book about how we agree with them that poor people do have less healthy lives. But its more capitalism they need, not more socialism. But the American Public Health Association promotes socialism, not just health care socialism, but just socialism in general. Higher taxes, more regulation, more redistribution of the wealth, and so theyll harm poor people. There will be less wealth for the poor. And its sort of vulgarized Marxian economics, the idea that youre poor because Im rich. But theyre mired in sort of a 1920s era socialist thinking.
Just as long as I got the mike, I have one other question. Do you think the public is anywhere near aware that our current public health polices are not based on science?
No, I dont think so.
Most of the public is what economists called rationally ignorant about these things.
I think though that you provided the missing link that explains why there was this article on gambling in the American Journal of Public Health. When I came across that it puzzled me, but clearly its because you gamble and you lose, you become poor, and then youre not healthy any longer.
You already had one question, but this will be the final question right here.
Not only that, but the casinos become rich.
Audience Member #11
Id be interested to know from both the speakers any examples they have of where the government regulations restrict your personal responsibility that you are grateful for? And if there are any such, how do you discriminate between when Nanny is useful and when shes not?
Im hard pressed to think of any, but that is a problem that, if people have come to accept, for example, the seatbelt law, or the tax on cigarettes, or restrictions on advertising alcoholic beverages, or what have you, those things can always be cited as precedence and are. Well, we have this, and weve had it for a long time, and nobody really condemns that, so why not?
Audience Member #11
And that is a problem, because if youre going to be consistent about it, you have all these conservatives rallying against the anti-smoking movement, but most of them are very gung-ho about the war on drugs. And I dont see the distinction there. Theyre talking about targeting one drug versus another. And they dont like the fact that tobacco is targeted, because theyre used to tobacco; they know people who smoke; theyre conservatives and they like what theyre used to. But in terms of health effects, certainly its worse than any illegal drug you can name. Not necessarily in terms of short-term intoxication, but in health risk.
No, but what regulations are you grateful for?
Yeah, I cant think of any. Thats if youre talking about regulations.
Audience Member #11
Well, suppose you were required to take a driver license to run a car? Isnt that a gross infringement on personal responsibility?
No. Your initial question had to do with denying personal responsibility, is that right?
Yeah, thats right.
Audience Member #11
Any regulation that in some sense infringes on the personal responsibility.
Well if youre talking about regulations that try to protect people from themselves, then I am hard pressed to think of any examples that I approve of. If youre talking about regulations that try to protect you from other people, there are a lot that I would approve of. A lot of laws that aim to protect you from other peoples
Audience Member #11
So thats your discrimination?
Yeah. Well, if its something that is a threat to other people, theres a third distinction and you have to talk to.
Audience Member #11
Well its often hard to distinguish.
Well, you have to talk more precisely about the nature of a threat, what constitutes a violation of somebodys rights in terms of rules of the road and things like that, somebody has to set the rules. The owner of the road is going to do it. In this case, it happens to be the government. If you had a private owner, they might very well have a different speed limit or different technical rules about whether you can turn right on red, or whatever. A lot of that is very arbitrary. But there has got to be some rules, and the owner of the road is going to set them.
A lot of it depends on whether you have a system based on contract, or one group imposes order on other people. And thats the classic debate going back to the Greeks. So the question is how does that relate to public health?
Well for a lot of these regulations, the first thing I always think of is: if we didnt have this regulation, and there is a real problem, how might it be dealt with alternatively? And we tend to think that, for example, if a government had always manufactured shoes, and monopolized the shoe industry, people would be saying, who would make the shoes if we privatized the shoe industry? Weve never had private shoes. No one will make shoes. If the government has been doing it for a long, long time, we tend to think theres no other way of doing it, of securing safety in various ways. And so I always think what private institutions or contracts would come that would protect us?
Zoning. Bernard Sagan wrote a book 25, 30 years ago, called, Land Use Without Zoning. Everyone thought you needed zoning to protect yourself from nuisances in your neighborhoods. And he found that Houston, where there was no zoning at all, had pretty much the same protections through private covenants that all the other cities had in America, but they did it voluntarily. Thats the way I would think about these things, what alternative means are there to improve safety? Not always what is the specific benefitthats what seen, the benefit of the government regulation. What you dont see is what might have happened in another alternative regime.
Okay, Ill have to cut it off there, Im afraid. I want to thank our speakers, in particular for their wonderful comments and for their books [From Pathology to Politics, For Your Own Good]. I want to thank all of you for joining with us. Again, if you havent gotten copies of either of the books, there are copies upstairs, and Im sure that either author would be happy to autograph any copies that you might get. We hope that youll join us for our next Independent Policy Forum. Thank you and good night.
The talk tonight will be transcribed and you can purchase copies of that, or audio tapes or videotapes.