So here is a provocative one: When there is money involved can we reasonably expect anyone, including specifically business and governments, to care about a population’s health? Is this surely not such an unpalatable nihilistic concept that we should all roundly dismiss as the musings of a few dark and lost souls. Well let’s take a look at some facts to see if its helps.
We will start with vaping
8 years ago, those who had invested any time in the concept and who exhibited some basic intelligence, seemed to generally conclude that it would be very difficult to create a product that was as harmful as smoking. So as long as smokers were the customers, then it seemed very likely that switching to vaping would improve your health outcome. As the years have passed, this theory has been shown to be objective fact, with academic research after academic research showing vaping to be at least 20 times safer than smoking. So perhaps we firstly put aside that vaping is implicated in the ‘lives for money’ thesis.
Smoking on the other side of the spectrum is the obvious and uncontested bogeyman.
We know that cigarette companies understand they sell products that take the lives of 1 in 2 of its customers, the self-denial stopped decades ago (but only really when international courts told them to accept the fact). No surprise here then that the theory seems to hold true. Tobacco companies knowingly peddle cigarettes, they kill the users in the millions each year and they make billions in profits. Indeed, tobacco business is one of the most stable and bankable corporate wealth generators the world has seen. No morals allowed in a tobacco business, clever individuals the board members of big tobacco no doubt, but no need to be proud of the product you make or sell, just need to find markets to sell the product into and the profits will keep rolling, indeed directly correlated to the amount of death generated.
Given what we know about tobacco, the finding of markets to sell these ridiculously dangerous products into should be extremely difficult one would expect. Hmm, not the case though. No country, and this is remarkable, not a single country, prohibits cigarettes. Indeed, the only unanimous aligning fact across the United Nations is that every country continues to allow the sale of this most harmful consumer product. Notwithstanding the recent tobacco purge by non-other than Turkmenistan (take a look, an unremitting totalitarian state, led by a fitness fanatic, but at least taking on the power of world tobacco by having bonfires of illegally imported cigarettes), governments around the world continue to avail cigarettes. In a society that turfs our old folk out of hospitals because we cannot cope with the stress to the NHS purse into a ‘care at home regime’ that lacks the ‘care’ element, surely our leaders should be trying to ease the pressures on our overloaded health care system by addressing the root causes. In the pantheon of society’s ‘self-generated’ ills, we can quickly skip, fizzy pop, fast food, alcohol etc to the lord and master of consumer product pestilence, which is smoking.
So why do our governments not just simply ban cigarettes and be done?
Ask this question directly of a politician and you will hear the most weasel of all weasel words. Behind the ‘…freedom of choice…’ smoke screen (no pun intended), however, what we see is a basic fiscal dilemma. What sets smoking apart from the majority of consumer goods that bring risk to the users are two matters: money and latency. Money firstly; the HMRC revenue in 2015 from smoking excise in the UK was approximately £10Bn and the cost of treating the health effects of smoking is estimated at somewhere up to £6Bn. [Factchecker.org] So unfortunately, we have a simple commercial negative incentive of approximately £4Bn in our fiscal Tax:Spend consideration. But of course, our government could see beyond the simple monetary aspects and put the health and wellbeing of its citizens at the heart of its legislation and agenda.
£4Bn in the scheme of things is a small number for the lives that could be saved. This is true, however when you consider the second factor of ‘latency’ you see why our governments are unwilling to take proactive measures to stop smoking once and for all. You see smoking is a ‘king size’ long burn issue (pun intended). The Oxford dictionary definition of latency is ‘…the state of existing but not yet manifest…’. Unfortunately, smoking generates a state of progressive ill-health that insidiously grows the risk in the person. In essence, the longer you are smoking the more risk you are exposed to. Simply put, this means that even if the government was to ban smoking today and forego £10bn of excise revenue in the expectation of a health improvement and NHS cost reduction, this would take a generation to flow through the health of the UK’s population. £10bn lost each year, yet the ill-health effects of 10 million smokers that would still need to be provided and cost for through our NHS. This is a £100bn plus shortfall and no government, even the most moral at heart, will commit to this level of overhead, even if it eventually saves millions of lives. Governments are slave to short term financial balancing. Unfortunately for our policy makers, smokers do not die on their first puff. They inhale millions of puffs across many years and grow slowly but surely their health consequences. So, our second consideration in our thesis unfortunately also illustrates, if the number is large enough, money trumps lives.
Step up the pharmaceutical industry
So, in tobacco companies and governments we see the unfortunate choice of lives or money. Both choose money; one for greed, the other because it is stuck in a financial black hole. So, we need to find a knight on a white charger who is incentivised to save lives. Step up the pharmaceutical industry. Selling stuff to cure people and make profits, true? Yes, to a point. Before we move on, we must firstly ensure we are seeing things clearly and not conflating the health care profession, by which we mean doctors and nurses etc, with the pharma industry. Our doctors and nurses are national treasures, they save lives and care for us and our families each day and every day, they are motivated by the essence of what is core to our human spirit. Our pharmaceutical industry is not the same. It operates to make profit and it makes money nearly as efficiently as the tobacco industry. Indeed, take a look at stock markets around the world and you will see top stock market indices stacked full of pharmaceutical and tobacco companies. We all get that ill health provides opportunity for these companies to make money, this is how the capitalist world works, it drives innovation, it creates investment incentives and we are better for this dynamic, just take a look at the USSR in the 1980s; right? This is indeed the rhetoric, however, what happens when this incentive is undermined by a much more profitable disincentive.
Unfortunately, smokers provide too much opportunity for pharmaceutical companies. Smokers probably care not to think too deeply about this, but even when we look at those who are motivated by money to improve health, the value of keeping a smoker alive but ‘ill’ until an untimely early death, is much more profitable than picking up the responsibility that tobacco companies and governments have been unwilling to accept by stopping production or banning the sale of tobacco, and develop ‘remedies’ to smokers’ addictions. It is hard to write these facts as they are unpalatable to write never mind read or accept, but a smoker is more valuable alive and ill than cured of tobacco addiction. The profit that could be made through an effective Nicotine Replacement Therapy (NRT) or other ‘medicines’ pales in to insignificance compared to the revenue opportunities a smoker provides. From initial presentation, early in a smoker’s life to address a chest infection that is taking longer to leave than normal, to the first diagnosis of high blood pressure that needs daily medication, to the chronic bronchitis and asthma that requires a salbutamol inhaler, to eventual more progressed deterioration such as cardiovascular disease and cancers, the life of a smoker is too valuable to pharmaceutical companies for them proactively to strive to address the root addiction. If you find this all too nasty to contemplate, consider this. The world’s pharma companies spend billions and billions each year on research and development. It took a Chinese pharmacist working in essentially his ‘shed’ to invent the e-cig. Ask ourselves why the pharmaceutical industry firstly did not have the wit to get there first and secondly why the same industry fights tirelessly across the planet to undermine vaping and lobby for government intervention to stall or recede the success of electronic cigarettes.
Wherever you look, it would seem that no one has the best interests of the smoker in their agendas. What we have is a rather sinister tacit alliance between the tobacco industry, worldwide governments and multinational pharma giants, all ensuring that the status quo is maintained whilst the health and the wealth is squeezed unremittingly from a billion souls.
Is it any wonder that vaping has no friends?
You see, vaping has gate-crashed an invitation only party. It has started to eat ever bigger proportions of the cake that was only supposed to be shared 3 ways. But unfortunately, it cannot be given an invite, because:
for every bite the vaping guest takes from the cake, the smaller every subsequent party cake becomes. It is only the vaping gate-crasher that is happy to see the cake eventually no longer be required when time is called on this blackest of all sadistic get togethers.
Whilst we may have sweated the party cake metaphor a little too hard there, it does tie together nicely the knot suggested by the article’s premise. So why is the vaping industry different? Well quite simply, whilst successful industry is a profitable industry, for vaping to be successful our agenda is to stop people smoking. For once we have a financial incentive that aligns with the best interest of the smoker. Too often the vaping industry is criticised for ‘exploitation’ of addiction. This is unfair. Of the four protagonists in the frame, it is only the vaping industry that is incentivised and responding to the best interest of the smoker. If in a generation, there are no more smokers left, it will not be because tobacco companies have decided to get a conscience and stop production, nor our governments to have found a sack full of cash to fill the black hole or the pharma industry putting health in front of profits, no, it will be because vaping has been successful despite the best efforts of the other three.