The long-awaited UK consultation on plain packaging was announced by Health Secretary Andrew Lansley in April and will end next month. The Conservatives, who had strongly opposed both tobacco display bans and plain packaging while they were in opposition, have apparently, now that they are in government, discovered the ‘truth’ about plain packaging. Despite the Health Secretary’s claims of open mindedness and objectivity about plain packaging, pending the outcome of the consultation, it seems that he and his department have already concluded that the time is right for such a measure.
The best evidence for this is the flawed nature of the consultation process, which seems designed to produce the ‘desired’ result. Certainly it violates the government’s own principles about risk assessment and principled regulation. These principles demand that regulation be founded on clear evidence which demonstrates that any new regulation, such as plain packaging, is both necessary and will work, that regulations be proportionate and that the regulatory process be objective, open and transparent.
The consultation violates almost every one of these principles. To begin with, it is not objective. In particular, the choice of a partisan of plain packaging to head a review of the evidence supporting plain packaging makes a mockery of objectivity. For this reason alone the consultation should be abandoned. Both the government and the anti-tobacco lobby are quick to denounce any plain packaging research that is supported by the tobacco industry, on the grounds that the source of funding inevitably corrupts the results. But apparently this ‘principle’ does not apply to government funding of pro-plain pack advocates.
Obviously this does not follow. If the principle that the quality of research is compromised by the source of its funding is true for the tobacco industry, it also true for the anti-tobacco industry. Indeed, it is instructive that the consultation requires that ‘all respondents disclose whether they have any direct or indirect link to, or receive funding from, the tobacco industry.’ Respondents with direct or indirect funding links to the government or the public health community or to the anti-tobacco movement are not required to disclose these links, even though, on the logic of the requirement, their funding might as easily prejudice their response as a link to the tobacco industry.
But the consultation not only fails to meet the standard of objectivity, it also completely fails in its evidence base to provide any compelling evidence that plain packaging is necessary and that it will work - two key regulatory requirements.
Finally, the consultation fails the test of proportionality, the requirement that regulation is justified after balancing the gravity of the risk which the regulation addresses against the appropriateness of the proposed mitigation.
The problem with plain packaging and proportionality is that the evidence base for plain packaging fails to provide any compelling scientific evidence that tobacco packaging as opposed to tobacco smoking is a significant problem. The proponents of plain packaging assume that tobacco packaging is a problem because, well, it is a form of tobacco advertising and we all know that that is a problem. But, of course, we don’t know that at all. Indeed, recent work from Nobel Prize winner James Heckman of the University of Chicago along with studies by, for instance, Capella et al., have shown that tobacco advertising has a statistically insignificant effect on smoking initiation and tobacco consumption.
Indeed, this consultation once again points tobacco control in the wrong direction and works to prevent it from actually doing anything meaningful about preventing smoking in the UK. At its unexamined core is the fundamental assumption that plain packaging is largely about eliminating the last remaining bit of tobacco promotion. And this is crucial since, according to this account, tobacco advertising is one of the major, if not the major reason that kids begin to smoke and adults continue to smoke and fail to stop.
But what if this crucial assumption which underpins plain packaging and drives the debate is in fact wrong? The econometric evidence has long failed to support the claim that tobacco advertising drives smoking initiation and consumption. And in recent years the second-line defence of this claim - namely studies of adolescent recall about advertising exposure and smoking initiation - has been thoroughly discredited.
A growing body of evidence does show, however, that the root causes of smoking are best explained by the social determinants of health. According to this perspective, the root causes of smoking are not to be found in such things as advertising or indeed, tobacco packaging, but in economic, social and educational deprivation. In effect the poor in Britain and elsewhere smoke because they are poor; they are not poor because they smoke.
The flawed DOH consultation, however, with its wrong-headed focus on tobacco promotion and packaging, fails to address any of this. It therefore represents a policy failure of spectacular proportions, consigning both current and future smokers to a policy void which does nothing to prevent or stop them smoking. And that is something that is profoundly immoral.
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