Follow-up on how medics doomed public health – case studies

by Carl V Phillips

Yesterday I posted a long essay, a history-of-science analysis that wove in news events and personal flashbacks (hey, what author doesn’t want to be Kurt Vonnegut or Thomas Pynchon?), about why the public health profession ended up being the hate-filled anti-humanitarian institution that it is today. You will recall that it was ultimately the medics, not the temperance nuts, who were responsible for the downfall of public health. Today a case study, and a bit of a second, that provide some further illustration and some comic relief (there is no other way to play it — it is too absurdly horrifying to present as other than comedy).

For a while now, third-rate hospitals have been trying to outdo each other in imposing draconian social-engineering policies regarding tobacco product use. It was reported that one of them recently upped their stupidity level to:

The hospital will no longer hire anyone who uses nicotine in any form — including e-cigarettes, nicotine patches and gums — making the controversial claim that the use of such products is as hazardous as smoking.

Note that I am not going to let Jon Kelvey, reporting in the Carroll County Times for McClatchy-Tribune Information Services, off the hook on this. “Controversial claim”? Would Kelvey write “…making the controversial claim that the world is flat and the entire Church in Rome exists as part of a millennia-old plot by the Illuminati to keep that a secret”? He might, I guess.

Of course, he was just the unthinking (no, I did not mean “unwitting”) agent of the real thought-criminal here, Leslie Simmons, president and CEO of Carroll Hospital Center:

“We look at them together. There is nicotine in tobacco,” Simmons said. “I am not suggesting you won’t find something out there that [will] differ, but our experts believe that nicotine is just as dangerous and causes just as much harm and needs to be dealt with.”

And here is Leslie on twitter:

Leslie Simmons - twitter

And, yes, I realize those two quotes from her are pretty much redundant.

Oh, but it gets better:

“Last year, we made the nicotine testing mandatory if you had our insurance. If you tested positive, we again offered cessation products,” she said. “This year, if you decided you didn’t want to quit, then a smoking surcharge was added biweekly for any associate covered under our insurance.”

Yes, if you tested positive for nicotine, they told you to quit and gave you a free 90-day supply of nicotine in order to help with that. Though when you used it they fined you, so I guess it was not really free.

Beginning Jan. 1, applicants for positions with Carroll Hospital Center will be tested for nicotine along with the usual pre-employment drug screen, according to Simmons. Those who fail will be offered a free 90-day supply of smoking cessation products, their choice of nicotine patches, gums or other products. “It is $750, for a 90-day supply, and we would provide that for free,” Simmons said. “We would encourage them to reapply and retest in 90 days. We are not trying to make this punitive; we are really trying to help people.”

$750 for a 90-day supply of nicotine. Only a hospital administrator who bills patients $25 for a tongue depressor would think that even made sense.

And, riiiight, it is not punishment and they are trying to help people. “We are just intentionally inflicting harm on people if they refuse to act the way we want them to. It is not like we are punishing them!” I do suspect this will really help some people, a few local people who do not really want a job but are looking to score some free NRT. I cannot see how it offers much help to anyone else.

Returning to the more serious points from yesterday, this is a great example of how medics and their sycophants in public health (and in this case, in hospital administration) do not see “people” as referring to human beings, but only to bodies. They are trying to help bodies and since the punishment is inflicted on the stupid or evil humans who are occupying those bodies, it is not really punishment (i.e., flogging would presumably be punishment in Leslie’s eye; telling someone he is worthless because he cannot get through the day without nicotine, and fining or refusing to hire him on top of that, is not).

Of course, they are not really helping bodies at all by denying them smoke-free tobacco products, telling them they might as well smoke. But that is a whole different problem. Yesterday I pointed out why you do not want medics and their hangers-on to be involved with ethical decisions. It is also seldom a good idea to allow them to assess science.

Speaking of ethics:

“I know there have been some questions about the legality, and of course, we would never do anything like this without having it thoroughly vetted,” Simmons said. “The federal government … classifies smoking as an activity, not an issue that is protected under the Americans with Disabilities Act, so we are perfectly within our rights to do that.”

Recall yesterday that I pointed out that the field called “medical ethics” is really about law, not ethics. Medical people are basically like tax accountants: things are either legal or illegal. If something is legal, then they go ahead and do it with no further consideration because it is “within our rights”. Ethics, to them, means: do whatever you can get away with legally, and so long as you stop there, no problem.

Further on what we should not let the medical people decide, here is the one third-party tweet that Leslie favorited:

Leslie Simmons - twitter favoriteMedics do not want to have to recognize pesky issues like the costs of what they do. They just want to be able to take whatever action they want and have the rest of society suck up the cost. (I also like how the “wet dream” reference ties this back nicely to John Ashton.)

Needless to say, these are not the type of people you want making social policy.

Fortunately they are not the ones who are supposed to be doing so, though they have far too much influence anyway. That role falls to the likes of Carroll County Commissioner Richard Rothschild, R-District 4:

“This breaches a firewall that is very dangerous. If we can prevent people from working because they smoke, there is nothing to stop them from preventing them from working because they are obese or because they drink alcohol,” Rothschild said. “Where do you draw the line?”

If the goal is protecting health and lowering insurance costs, Rothschild said, why not ban high-risk activities like skiing as well?

I suspect Rothschild was trying to impose some shame and contemplation on the hospital and other “public health” types who engage in punishing human beings in order to protect their bodies. But, of course, the answer to that from them is, “What line? We will get there.”

Now it turns out that skiing is actually remarkably low risk, given that it basically consists of intentionally falling down a steep hill, but there are many behaviors that are more medically costly than smoking, including a few that are far from rare, like motorcycling and other dangerous forms of transport. Depending on quantity and metabolic details, drinking and obesity are up there too. Of course, no one involved with this story seemed to have any clue that basically anything is as costly as smoke-free tobacco/nicotine use, since there is no measurable cost from that.

According to the hospital news release that announced the policy change, “Nicotine use causes a wide range of health problems, including heart disease and cancer, and is the leading cause of preventable deaths in the United States.”

Um, yeah. As one CASAA member put it in a chat about this, “I genuinely don’t think that if your hospital system started performing exorcisms, it could erode public confidence in your abilities any more”.

Of course, Leslie and her hospital are just a particularly comic version of a general trend here. In another example:

Patients sneaking a smoke or a chew at Salina Regional Health Center or any of the hospital’s other properties will be sent away. The hospital implemented new rules Aug. 4 that are meant to strengthen its policy regarding smoking and use of other tobacco products.

In a Thursday news release, the hospital warned that patients who violate the policy will be discharged and considered leaving against medical advice. A nurse will remove the intravenous tube if they have one; tests and treatments will cease and the patient will be instructed to call for a ride home.

Yes, if someone so much as takes a pouch of snus while in the hospital for, say, immobilization of a seriously broken leg, their tubes will be ripped out and treatment will stop. I wonder if this would be enough about the body for Leslie to recognize it as a punishment?

On top of that, they will be thrown out by the hospital, and yet declared to be leaving against the advice of the hospital. Oh, but don’t worry:

“Patients have had seven years to adjust to this, and we’re finally saying that we are going to hold to our values that we are a health care organization,” Moody said. “Our intent is to return you to a state of health.”

Yeah, patients have had seven years to adjust. I mean, while you were lying in a bed in this third-rate hospital for seven years, surely you must have had time to get over using tobacco. But if not, out the door you go with the hole from your ripped-out catheter still oozing blood and your ass hanging out of your hospital smock in the crisp autumn air. All to return you to a state of health, of course.

This might even be funnier than Leslie if it were not quite so horrifying.

Again, relating this back to the serious points from yesterday, there is clearly a race-to-the-bottom happening here. For decades there was a slow drift of “public health” and the nannying side of the medical industry toward the phenomena I described. It was a natural progression from “only bodily longevity and purity matter,” to “we disdain the people who are occupying those bodies and not properly pursuing our goals,” and then to “we hate the people who are both actively refusing to try to further our goals and are daring to criticize our goals.” But it was mostly slow motion. Things seem to have accelerated rapidly.

Hospitals are tripping over themselves trying to show the most hatred for tobacco product users (and we can be sure that drinkers are next, and then others). The “scholarly” (*giggle*) side of public health has done the same. Simon Chapman et al. have made a career out of stoking hatred for years, but in 2014 that is not enough anymore, so we need even viler people like John Ashton and his supporters.

My assessment is that this is reactionary. As a large portion of the population have started to push back against the “public health” special-interest and their pseudo-ethic — in no small part because of the political mobilization of vapers — the suppressed hatred has risen to the surface. Many who had kept it tamped down to the level of disdain for the plebs no longer do. Others are actively engaged in playground-style bullying (or perhaps in these days of anti-bullying efforts, more apt would be: street-gang or maximum security prison) of trying to impress those around them by being even more evil than the next guy. As with the gang analogy, there is cred to be earned by inflicting impressive amounts of harm on “the enemy” (or at least making your friends think you have done so — it is not like we really care what they say).

Of course, the Enemy, to them, consists of all those awful autonomous actors who for some reason occupying those bodies that it is their self-appointed duty to protect.

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21 responses to “Follow-up on how medics doomed public health – case studies

  1. Nicotine occurs naturally in some vegetables, like potatoes. Does this woman seek to ban potatoes as well? Also, the caffeine in coffee produces a very similar physical response as nicotine. So I take it coffee will be banned as well? And alcohol?

    • It is easy to set the cutpoint for the test to distinguish between nicotine at the nutrient level (or from environmental exposure — that is also low but nonzero) and use of nicotine as a drug. Indeed, I am not sure if the clinical tests are sensitive enough that the nutrient level is not BDL (anyone know)? As I noted, alcohol is next. Caffeine is not part of their crusade at this point (“my vice is fine; your similar vice is sin”), though presumably some fringe will emerge that goes after it if the trend continues.

  2. So you test positive for nicotine and after a 90 day course of NRT you get tested again… and it will show up negative?

    • I think then they give you some new NRT. Or fire you. Or fine you. Or maybe lock you in the dungeon. I am not sure they thought this through.

      • To imply that “public health” Nazis possess the capability of thought implies that they have a conscience.

        I think they’re the ones who are thoroughly addicted to hate and need more and more then psychologically project their own depravity upon others. They just can’t get enough of it. They are thoroughly hooked and risk the lives of millions.

        I feel a public intervention in order against them for WE ARE THE PUBLIC in “PUBLIC health“!

        — Mark B.

  3. If I get pulled over by the police and fail a sobriety test/breathalyzer, can I expect the officer to offer me a drink?

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  5. What are medics? I thought those were Armed Forces folks?

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  7. We have empowered idiots to control our lives.

  8. They are not alone in this, you know.
    Quote: “Policy on Non-Recruitment of Smokers: WHO has a smoke-free environment and does not recruit smokers or other tobacco users who do not indicate a willingness to stop smoking. This policy underscores the Organization’s commitment to promoting a tobacco-free environment.”
    http://www.who.int/employment/who_we_need/requirements/en/
    And that’s not new. I heard from this a few years ago.

  9. I thought I did a pretty good job of showing the hospital’s claims about nicotine to be unsupported by scientific evidence without editorializing, which is something we newspaper folks only get to do in the editorial section. Looking over the published story, it does look as if the original statement by the CDC spokesman was softened in the editorial process: I recall the statement being that there was zero evidence to support the claim that nicotine and tobacco were equivalent carcinogens.

    • Carl V Phillips

      Mr. Kelvey,

      Thank you for weighing in. I will freely admit that this was probably a bit unfair to you personally since you wrote one story but ended up serving as a lightening rod for all the criticism the press deserves for the behavior I described. We see over and over how the press simply transcribes blatant lies about tobacco by medics and other non-experts (or by people who know they are lying) even though it is easy to learn that they are false (such as by contacting CASAA for a comment). This, of course, is a frustration shared by the real experts in many areas that are rife with pseudo-scientific claims — Krugman refers to it as the “views differ on shape of the Earth” phenomenon.

      You did indeed include a bit of pushback, though it was a bit tepid (apparently weaker than you intended). But the problem is that it occupied the standard throwaway “find someone with a different opinion and phrase it generically” spot at the end of the article (which few people reach) rather than appearing immediately after the first appearance of each lie where it would have had a chance to actually prevent the naive reader from believing the lies. You quoted her making multiple emphatic statements that were totally false, and that calls for a clearer response. No editorializing is necessary — simply reporting what the real experts say on each point following her claim. The journalism “ethic” of reporting whatever scientific claim some random idiot makes as if it were authoritative is the problem here.

      Oh, and btw, the CDC is not going to be your best source for this. You managed to find someone who told the truth. But as evidenced by the request for anonymity when telling the truth, their official positions are wildly out of synch with the science also — it is a political operation, not a scientific one. They do not lie about the science quite as blatantly as the person you quoted in the article, but they do make every attempt to mislead people about the risks of low-risk tobacco products.

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  13. One would think the obviously unethical practice of refusing to hire people based on tobacco use would be limited to third rate hospitals ran by dictatorial extremists. Not so. As of Jan 1, 2015, The M.D. Anderson Cancer Center, arguably the top cancer hospital in the country, has instituted a “tobacco-free hiring” policy.

    https://www.mdanderson.org/about-md-anderson/careers/how-to-apply.html

    My sources tell me they test for cotinine, which captures all nicotine use. So if you’re a prospect with off the scale talent and skills, but like to use a little snus, or an e-cigarette, M.D. Anderson will refuse to hire you. Never mind the blatant social class discrimination this represents. M.D. Anderson thinks it can help end cancer by sending nicotine users somewhere else to work. To their credit, the psychologists I know there strongly objected to this policy (because they have at least some training in ethics) but were overruled by the medical leadership because their attorneys told them they were on solid legal grounds.

    Since the policy has been implemented they’ve conducted “studies” that show new employees barely object to the new requirements. This, coming from an organization that fancies itself a premier research institution.

    • Ok, so first-rate hospitals that do third-rate research.

      So the people who were the beneficiaries of the discrimination did not object to it? What a shock! If they actually do follow-up tests of employees, it would be great if someone organized a protest consisting of doing a little NRT before their drug tests.

      The good news about discrimination is that unless it is near-ubiquitous, some other employer can benefit from it by hiring the shunned. Worked out great for quite a while for those who would hire LGBT people. Unfortunately, the employees still suffer downward pressure on their wages as a result of the reduced options.

  14. To be consistent with their “no tobacco allowed” policy I’m sure they’ll get around to random testing of current employees, which is supported by the same arguments and is also “within their rights.” After all, if you’re going to cudgel people into proper behavior with the threat of denying employment, why not have faith in your convictions and do it for everyone? Difficult to see how they don’t eventually get there.

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