by Carl V Phillips
The title harkens to a major essay I wrote, which I believe is widely regarded as the best post in the history of this page. This post is nothing nearly so ambitious, being about a single point, illustrated by a couple of examples and one blog post. However, it shares the goal of drilling down to what is fundamentally wrong with the “public health” enterprise, and how no fiddling around the details of particular bits of research will do anything important to remedy it.
Most readers are aware that over the last few days there were two important victories against “public health” excesses in the UK. On Friday it was announced that fake charities (widely known as “sock puppets”), which really get approximately all of their funding from government, would no longer be able to spend government money lobbying the government. I link to Chris Snowdon for more details because, according to my understanding of this battle, he deserves more credit than anyone for making this happen. To summarize, yes it is true: These operations, which are government agencies in all but name (and in not being subject to freedom of information requests!), spend a large portion of their budgets lobbying for particular policies or for more funding. The sock puppets will still be supported by government — this was not a funding cut, despite the howls of protest — but they will just no longer be able to use taxpayer money to lobby the government. In a tweet to Chris, I wrote, “I assume avg people who even notice+understand react with ‘what? they could do that before??!’ Any read on if that is true?” (He agreed it was probably true, but was aware of no data on the point.)
In a separate occurrence, earlier last week it was announced that a particularly hated sock puppet, Smokefree South West, was defunded and will be shutting down. Recently that group had changed its name to “Public Health Action” in preparation for expanding their war on tobacco users to also include a war on alcohol users. Dick Puddlecote described this event in the context of the celebrations of it, and the complaints about those celebrations. And that is where this gets really interesting.
DP recounts some of the pushback against the celebrations of this rare victory against the ever-growing power of “public health” political groups, observing:
Apparently, it’s considered bad form in tobacco control circles for anyone to express such a view [delight at the defunding]. I’ve seen it variously described as “unpleasant“, “unnecessary“, and “spiteful” amongst other adjectives.
He continues with quotes chosen (presumably intentionally) from tobacco controllers who are considered by many to be moderates because they defend the use of e-cigarettes (so long as they are only used for smoking cessation, of course). His assessment:
I find the chutzpah being exhibited there quite staggering!
He goes on to explain how Smokefree South West and others like them have proudly demonized and otherwise hurt smokers and vapers, as well as the pub industry, without a hint that they considered this to be unfortunate. Indeed, in many cases they celebrated these effects as features of their policies, not unintentional collateral damage. He summed it up with,
Their own side – including those bemoaning the poor treatment of Smokefree South West above – often talk about this “war”, so if you position yourself to be at war with a group of people how can you possibly complain when the other side celebrates winning the odd skirmish?
Indeed.
The answer to that question is what is so horrifying about the public health movement. Here is what “public health” people need to understand, which they clearly do not:
You are special-interest political activists.
To break that down a bit: Political activism means that they are trying to reallocate resources and otherwise impose changes on society. There are always winners and losers when this happens. Special-interest means that some people agree with their goals and motives, but many others do not. To a large extent that phrase is redundant with “political activist”, but it is worth setting it out for emphasis. “Public health” people act as if what they doing is nothing more contentious than asking the government to fill a pothole. That is, they act as if the only downside to what they are doing is budgetary costs, and beyond that no one could possibly have a reason to object. They seem to genuinely believe this, despite overwhelming evidence to the contrary (e.g., people taking delight in their setbacks, to say nothing of an immense body of literature in which people openly express opposition to their special-interest goals).
Partisans on either side of, say, the abortion rights debate are not surprised when opponents celebrate their side’s setbacks. They do not even feign surprise. They understand that they are trying to impose a policy that many people do not like. The thoughtful individuals among them even fully understand why many dislike their views, even as they fight for what they personally believe. The same is true for almost all issue-specific political activists. But not “public health”.
Tobacco controllers and others like them in “public health” are often referred to as religious zealots. Most religious zealots understand that their efforts run contrary to the preferences of many others. Indeed, they often celebrate that opposition because it is a necessary part of their motivational mythology. The ugliest zealots among tobacco controllers do indeed fit this picture, expressing open hatred for their opponents, taking pleasure in others’ pain, and considering it good that they are themselves widely hated. At least they are honest about this (which is not to suggest that they are not evil). Presumably these honest hate-filled individuals expressed consternation about the setbacks experienced by their sock puppets, but were not surprised that the setbacks were celebrated. This makes the “moderates” in public health worse in a way, because they do not seem to get this. The comments DP quotes suggest that they are genuinely shocked when confronted with evidence that they are a special-interest political activist group.
Many of us with a practiced liberal worldview do not mind religious proselytizers who openly advocate their views, even though most are advocating for illiberal religions, so long as they stick to persuasion and do not use force in pursuit of their goals. Oh, and also so long as they do not (ahem!) try to brainwash our kids. But we have little patience for thoughtless believers who seem oblivious to the fact that most people disagree with their views, and so just obnoxiously act as if their views are self-evident, or who try to slip them into the background of our social fabric without acknowledging this is special-interest activism (“….Thank you, and God bless America.”). Of course many people object to even open and honest proselytizing, and very few of us think “pluralistic discourse, this is fine” when the proselytizers are blocking the sidewalk or ring our doorbell. In other words, even people who might respect the rights of those with a particular special-interest worldview, and even those who basically respect the worldview but disagree, usually prefer it stay out of their faces.
In any case, “public health” advocates do use force, do try to brainwash our kids, and do get in our faces in a big way. Thus opposition to them comes from both those who object to their specific worldly goals and from those who object to their authoritarian tactics. Add in a few more who object to the mere fact of a special-interest hijacking the power of government, to their abuse of science, and to their sheer arrogance, and it adds up to a lot of opposition. Some of these motives are why the ban on using government funding for lobbying is such a big triumph, even though it really does not address other objections.
“But…but…but…,” sputter the public health partisans, “…if we do not have government funding to lobby the government, then only other voices will be heard.” The first response to that is: Bullshit! You people have ridiculous amounts of influence over governments, far more than anyone else with an interest in the matter. You have enormous pools of money. The second response is to repeat:
You are special-interest political activists.
You have no better a claim on government support for your special interests than any of your opponents. Why should you get to use taxpayer resources to fight for your worldview rather than, say, the publicans who you are putting out of business? Indeed, a pretty good case could be made that if anyone needs to be subsidized, it is the actual primary stakeholders, the consumers, who (as with most issues) have almost no resources to fight for their preferences. The secondary stakeholders, business interests, can mobilize influence — though probably not nearly as much as “public health” can, even without the sock puppetry. But not the people who are actually affected by the policies. “Public health” people are not stakeholders at all. Having an opinion about the proper private actions of others does not make you a stakeholder, it makes you a busybody.
“But…but…but…,” continues the sputter, “…we are the ones who are fighting for what is right.”
Um, seriously?
Ok, they probably would never put it so succinctly, but that is basically what they are saying. The “moderates” in public health seem genuinely oblivious to the fact that everyone in political fights, other than those who are simply rent seeking, believes they are fighting for what is right. Indeed, often those who are rent seeking (like, say, the “public health” people) often genuinely believe they are also fighting for what is right for society as a whole. Sometimes that claim is fairly comical, as with billionaires who seem to genuinely believe that any policy that enriches them further is good for society (or as with, say, “public health” people), but it seems to be what they believe. But it is one thing to believe that your political preferences are what would make society better (which, obviously, most of us believe most of the time) and quite another to be oblivious to the fact that others disagree.
“But…but…but…,” sputter the more thoughtful of the public health partisans, “…most of the public agrees with us.” No, no they don’t. Claims to this effect stem from misunderstanding that surveys and similar barometers of vague public preferences will always show support for vague positive-sounding principles, even when there is little support for particular policies. (I said these were the more thoughtful “public health” people, not necessarily that they have the skills to understand survey research, even though it is at the heart of their field.)
If you ask people, “Should we take military action to protect us from terrorists and rogue states?”, the median voter will say “yes”. But if you ask, “Should we just keep launching missiles that kill more civilians than enemy combatants, and each of which costs more than the average citizen will earn in a lifetime?”, the support withers. If you add a bit of analysis of the impacts like, “…and that many experts conclude inspire far more people to become enemy combatants than they kill”, very little support remains.
(Indeed, it is worth noting that for American politics, the median voter’s responses to vague principles about domestic economic policy gives us, well, the median voter. But if you ask people questions about specific policies (e.g., “Should millionaires pay a lower percentage of their income in taxes than the average family?” or “Should a family, if their child gets very sick, be forced to lose all their assets and be in or near bankruptcy before the government will pay for the treatment?”), it turns out that the median voter is actually far to the left of our “socialist” POTUS, and is pretty close to the positions of Sanders or Warren.)
Similarly, if you ask, as if it were nothing more momentous than filling a pothole, “Should we try to protect people from secondhand smoke?”, the median voter will answer affirmatively. But if the question is, “Should we prevent pub owners and office managers from providing even limited smoking-allowed areas in addition to the mandatory smoke-free areas?”, support withers. If we add, “…even if this means driving pubs out of business and permanently ending the social lives of many of our older citizens” and, “oh, by the way, the claims about the health risk from secondhand smoke are highly exaggerated”, support is very thin. Presumably, in some populations, supporters might still be in the majority, but it is literally insane to believe there are not a lot of opponents, and unforgivably thoughtless (in both senses of the term) to not understand their motives.
Of course, it does not end with smoking. Support for, “Should we protect our children from evil marketing that threatens their health?” does not imply support for, “Should we impose plain packaging on products, even though there is not a scrap of evidence that this accomplishes anything?”, let alone for, “Should we lie to smokers about the benefits of switching to e-cigarettes because that might theoretically, maybe, perhaps prevent some children from trying them?” The response to, “Should the government do something about the obesity epidemic?” does not imply support for “Should the government punish people for buying sugar with a tax which will probably just burden poor people without affecting anyone’s behavior (and, oh by the way, there is no obesity epidemic)?”
But returning to the main point, even if the “public health” “moderates” based their life choices on a misperception that everyone shares their personal politics, there is simply no excuse for not figuring out the truth at some point. Those of you in public health, you do know you face widespread pushback, don’t you? You are supposed to be scientists, after all: Analyze the data, don’t complain that it exists. (Here are a couple of study questions that might help: When someone advocates for a particular public policy, is it because this would make society better, in his view of what is best for society, or worse? When normal decent people gleefully celebrate an opponent’s setback, is this because the opponent is a poor powerless voice in the wilderness, or because the opponent often succeeds in taking actions that they consider to be bad for society?”) I suspect that if you, dear “public health” people, think this through, you will figure out that…
You are special-interest political activists.
Finally, some of the objection to the recent celebrations seems to derive from the sentiment, “yes, there are some extremists in public health who do bad things, but don’t blame everyone within our special-interest for the actions of the few.” The first response to this is that those espousing that position, rather than the extremists, seem to constitute “the few” in public health. Second, when it is voiced in the context of Smokefree South West it is rather absurd — see DP’s post for a cataloguing of their actions and attitudes. But ultimately the response is: The world does not work that way; you do know that, don’t you? People who do not step up and get their own house in order cannot protest that they are getting swept up in complaints about what their house is doing.
I know that the response to that from some quarters will be that the “moderates” who espouse this position are trying to step up and impose moderation. But the reality is that they are moderates only within their small special-interest pond. On a scale of 1 to 10, within their special-interest pond, they may see themselves as the 9s, squaring off against the 1s, 2s, and 3s. But within the spectrum of the all the world’s views, they are merely the 2s and maybe a few 3s taking on the 1s. Their moderation is still an extreme special-interest position, even if it is not the extremist position.
Moreover, they are not exactly stepping up very vigorously. They do not question any of the fundamental tenets of “public health” like, say, whether it is acceptable to use government power to force people to change intimate personal choices that have trivial external impact. They do not insist that junk science is never acceptable, and admit that it flows freely throughout their house, but merely suggest it is bad in a few specific cases when it is deployed by the 1s. They never say “some people in our house are destructive and hateful liars who are beyond reform, and we denounce them”; it is more like “oopsie, it looks like he got this one little point wrong, so let’s all work together to try to fix the honest error.”
But ultimately, and I would suggest most importantly, they adamantly refuse to offer a hint of recognition of the fact that,
You are special-interest political activists.
[Update: An wonderful illustration of this appeared in on Twitter a few months after this was written:
Tobacco harm reduction, anti-THR lies, and related topics 
Excellent dissection Carl. As for the self proclaimed moderates, I would remind them of that old saying, “if you lie down with dogs, you will inevitably end up with fleas”. My sympathy for the position of those who support bullying, vilification, and demonisation of smokers, vapers, drinkers, (anyone who does not share the fanatical pursuit of body purity), etc etc, dried up a long time ago. I understand their position, but understanding in this case produces no sympathy or even empathy. Its gone way too far for that.
History repeats…….
I note that the anti-vaping lying propaganda from the California Department of Health is not publicly labeled as being from “An unsupervised department in the California Department of Health that the rest of the Department Disagrees With.” Therefore, even the vaccine division and the divisions trying to save lives threatened from meningitis in San Jose have effectively signed their own names and reputations onto those lies, and to the loss of the lives of the people who have already crossed the line between “not yet doomed from smoking” to “doomed” in the last year, that might have stepped back from that line in time without those lies.
This is an excellent analysis of the situation. Too bad the prohibitionists can’t see that they are “special-interest political activists.” I certainly hope your essay is disseminated far and wide. It deserves to be widely read–especially in the lobbies of Parliament.
Well said.
About a year and a half ago I took on the same subject with this:
My conclusions for action are now only a partially effective way to cast these specially privileged special interest political activists back into the special ring of Hell that they came from. I would add now that strong efforts to place severe restrictions on what and how they can spend their budgets, with clear focus on missions that require something more than a nod to the precautionary principle and cherry picked science is needed. A thorough and transparent review process that builds knowledge and stops accepting the policy designed crap that passes for science in the field is also required.
It isn’t just for the good of being able to get tobacco harm reduction moving forward to break the stalemate these SIG’s created locking in the money, power, and prestige for themselves. It is more to recover the mission of real public health. You know, the kind that makes sure the water supply changes aren’t going to poison an entire population of a city [like Flint] or work to abate the mosquito’s carrying the Zika virus instead of making absurd recommendations like “don’t get pregnant til we sort this out.”
Something that may trigger lots of animosity towards anti-tobacco lobbies will be the recently proposed (by The Department of Housing and Urban Development in the USA) smoking ban “in the one-point-two million units of public housing it oversees”. As quoted by various web sites I’ve read, this ban would extend to the inside of people’s apartments.
This is Big Brother in action, sniffing the living room of private citizens to catch evil ETS (second, third, fourth, etc hand smoke) creeping from the sofa. It is an outrageously intrusive and cruel form of regulation. It definitely has a social angle: it is rich well fed bureaucrats screwing up the privacy of underprivileged and likely older smokers. I cannot conceive such type of cruel ban passing without massive protest in (say) any Latin American country. What’s the matter with the civil society in the USA? Why there is no organized protest against this cruelty?
I think it is time to challenge this from the human rights perspective. At the very least, smokers who are senior citizens MUST be dispensed from having to smoke at freezing temperatures.
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This entire article puts into much more civilized words, what I loath about my job. Here it is 4 years later and if anything, it is getting worse. I did not get into public health to be a political activist. Watching my job shift from scientific health issues to the promotion of propaganda and social causes has left me feeling empty. Worse still, I watch as fewer and fewer public health experts join the ranks, to be filled with people who have no background in science, public health, medicine, or even the root of the issues at hand. And then we get into the power of government wielding the shield of “in the name of public health” to step beyond the scope of public health. It is why I am leaving it.