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There are 5 comments on Paternalism and Public Health

  1. I found this a fascinating argument, but ultimately one with which I did not agree. I think, when wondering about the backlash to public health information campaigns, it’s too easy to wonder if the problem was with how the information is presented. It then puts the onus on the recipient of the information to parse intent and expertise level of their interlocutor; to use the example you posited, the unknown variable is the bridge crosser, who is either reckless and irresponsible or wisely changes his plans. The warner’s course of action need never be questioned.

    In reality, I think the better question is not “should public health nudge” but “WHOM should public health nudge.” Should their targets be the consumer, who even if they are a Mills style rationalist are nonetheless inundated with choices and data? Or should the target be the producers of unhealthy choices, and the governments who blithely allow those choices onto the market in the pursuit of profit?

    A person whose charge is to ensure the safety of others can do far better with their time than stand at a bridge and translate signs. They can go directly to the bridge builders. And they should.

  2. Estoy de acuerdo en varios puntos considero que seria importante adoptar estrategias que permitan internalizar la información que recibe la población en general independientemente del nivel socio económico.

  3. I’m sorry to say that it seems your personal views on what it means to be free is formed by a mind looking at it through superiority sized glasses. AKA “I just know better than you.” It leaves you with a distorted view even if your hard-wiring says not so. The same happens with your perception of what a “nudge” is. The logic is convoluted. In fact, if one finds a need to explain it at any length it already raises a red flag. Because a real “nudge” is simple; it can be described in few words. A “nudge” would be advice and for the informed to then take it or leave it. In that sense, the analogy between what business does and what public health does fails to be an analogy at all. Business advertises products that a consumer can take or leave. Like a mother in-law it’s your job to just bite your lip and say nothing about the ultimate decision. “Nudges” like bans on certain foods by public health are a dictate that leaves one with no choice. You MUST obey. When not angry over this disagreement I find it rather fascinating that the distinction is unclear to members of Public Health. That, and their denials that they are content to stop at what I calle real nudges. The trans fat policy in NYC began with Bloomberg asking for voluntary compliance by restaurants. When not enough volunteered he turned it into law. So why wonder that public trust in Public Health is in jeopardy when even the acceptable nudges prove to be just the inch before you come for the mile?

  4. There is NO place in any free civilised country for ‘nanny statism’ or ‘paternalism’ whether ‘hard’, ‘soft’ or ‘nudging’! When ‘nudging’ fails to work ‘soft paternalism’ follows and when this fails to work ‘hard paternalism’ is inevitable. The end result will be a society of compliant drones, stagnation and loss of freedom for everyone.

    One fundamental flaw is that those who promote paternalism wrongly believe that they know everything about the subject or behaviour to be targeted and those who refuse to comply, or challenge their view, are stupid. Narcissism at its worst – however many ‘experts’ are quoted to support their case. It works on the flawed assumption that old science is bad science, current science is good science and future science will be no different to science today. The example of the unsafe bridge is a good example of how the flawed ‘public health’ mind works.

    Warning someone of an unknown danger is NOT ‘nudging’ or ‘soft paternalism’ it is common sense, in fact I would go as far as to say it is the duty of any human being to do so. Thereafter however it should be down to the individual to do their own risk assessment using the known facts, as they see them, to decide for themselves whether to take the risk or not. John Stewart Mill is absolutely right. Suggesting that you prevent them from crossing the bridge because you know better is similarly flawed. What if that person was a skilled mountaineer who could navigate the bridge safely, or a bridge designer who could expertly assess whether the bridge was or was not safe? Why not prevent NASA from sending people into space – they must be very stupid if they don’t know that this is an intrinsically dangerous practice – you must intervene for their own good eh? – No? – Why NOT? Thank goodness that these earlier paternalists were ignore when the great explorers, willingly and of their own volition, took the risk of falling of the edge of the world in their ships, when all the ‘experts’ told them that the earth was flat.

    The point is that paternalism is NOT progressive but debilitating and it hinders human development. Treating adults as children will result in them acting as children. The human race survives because people have been able to push the boundaries of risk rather than be restrained by mediocrity determined by the mediocre, the risk averse and the puritan. That is not likely to change despite the efforts of ‘public health’.

    Another major problem is that once ‘public health’ activists determine (deem) that X causes Y, based on the limited knowledge of the day, is that X becomes more important than Y and when the facts change there is a reluctance for ‘public health’ to adapt and accept that X may not cause Y after all.That in turn breeds rigid dogma. Thereafter it becomes more important to perpetuate the dogma than to benefit public health. The tobacco CONTROL issue is a perfect (and original) example. While smoking has been reducing as a result of earlier public health initiatives, so-called ‘smoke related’ illness continues to increase.

    Too many have reputations at stake and too much invested in the ‘smoking kills’ hypothesis to ever admit to being wrong. The result of course is that science is directed towards maintaining the dogma and suppressing opposing views, rather than to discover real causes and cures – public health actually suffers.

  5. Dean Galea ignores the many unscientific, unwarranted, counterproductive and disastrous laws and regulations that have been imposed by ideological extremists under the guise of “protecting public health” and especially “the children”.

    The epidemiologic evidence indicates that cigarette smoking kills 480,000 Americans annually, while smokeless tobacco products may cause several dozen oral cancer deaths.

    But in 1986, Congress enacted a law requiring all smokeless tobacco products (which are 99% less harmful than cigarettes, and have helped millions quit smoking) to contain three rotating warnings stating “This product is not a safe alternative to cigarettes.”, “This product may cause mouth cancer.”, and “This product may cause tooth loss and gum disease.” Proponents of that law grossly exaggerated the very low risks of smokeless tobacco, falsely claimed it was a “gateway” to cigarette smoking, and said the law’s purpose was to “protect children from the tobacco industry”

    Those warnings (repeated daily by public health agencies) have deceived 90% of Americans (including most doctors) to inaccurately believe smokeless tobacco is just as, or even more, harmful than cigarette smoking. More importantly, that law and those intentionally misleading warnings discouraged 45 million smokers from quitting smoking (by switching to far less harmful smokeless tobacco).

    During Galea’s term, New York City officials also banned the sale of many flavored smokeless tobacco products (but exempted far more harmful menthol cigarettes, which are smoked by half of teen smokers), also deceitfully claiming the purpose of the law was to protect children from Big Tobacco.

    From 2004-2009, Big Pharma funded Campaign for Tobacco Free Kids, American Cancer Society, American Lung Association, American Heart Association and dozens of other medical, healthcare and public health groups lobbied Congress along with Philip Morris to enact the Tobacco Control Act, which protected all deadly cigarettes (and Big Pharma’s nicotine products) from future market competition by all new very low risk smokefree tobacco/nicotine alternatives
    (by prohibiting FDA from banning cigarettes and from even banning cigarette sales to 18 year old high school students, while requiring a multi million dollar FDA approval process for all new smokefree products). The law also further protected cigarettes from all very low risk smokeless tobacco products (by banning truthful marketing claims saying smokeless is less harmful than cigarettes, and by requiring even larger false fear mongering warnings on all smokeless tobacco ads).

    Enacted in 2009, this law has done nothing to reduce cigarette smoking, but was falsely promoted to Americans by Big Pharma shills and tobacco control extremists under the deceitful guise of “protecting children from Big Tobacco”.

    That same year, those same groups and Sen. Lautenberg also urged the FDA to ban all nicotine vapor products (which were called e-cigarettes at the time) by falsely claiming that e-cigarettes were target marketed to kids, were addicting kids, were gateways to cigarette smoking, would renormalize cigarette smoking, were poisonous, and didn’t help smokers quit smoking.

    After US Customs seized e-cigarette shipments that were being imported to the US, two e-companies sued the FDA in federal court, which unanimously agreed the FDA had unlawfully imposed the e-cig ban when striking it down. For disclosure, I filed an amicus brief with the DC Court of Appeals opposing FDA’s unlawful e-cig ban, while Big Pharma funded CTFK, ACS, AHA, ALA, AAP and Legacy submitted amicus briefs defending FDA unlawful ban.

    But the same day FDA conceded it lost in court, the agency stated its intent to ban all nicotine vapor products again by imposing the Deeming Regulation, which it did in 2014, and whose final rule is now at the White House OMB/OIRA awaiting approval before issuance.

    The Deeming Regulation would further protect cigarette markets (and Big Pharma’s NRT and Chantix markets) by banning >99.9% of all nicotine vapor products in 2018, which would destroy 10,000 small vapor companies and eliminate about 50,000 jobs. But of course, Obama’s DHHS and those same Big Pharma funded groups have been aggressively lobbying for this regulation by once again falsely claiming it would “protect children from Big Tobacco”.

    But the scientific and empirical evidence consistently indicates that vapor products, like smokeless tobacco products, are about 99% less harmful than cigarettes. Even better, they’ve helped several million smokers quit smoking (by switching to vaping) during the past several years, as adult and teen smoking rates have dropped sharply to new record lows, and about 99% of all nicotine vapor products are consumed by smokers or by exsmokers who switched to vaping.
    Meanwhile, there is no evidence that nonsmoking youth have become hooked on vaping, and there’s no evidence vaping has ever served as a gateway to smoking for anyone (anywhere in the world).

    If the FDA’s Deeming Ban is approved by Obama, millions of vapers and tens of millions of cigarette smokers will be denied legal access to lifesaving vapor products. Many vapers may switch back to deadly cigarettes, but far more vapers will find their preferred vapor products on FDA’s newly created black and gray markets, which could quickly resemble black markets for alcohol during Prohibition in the 1920’s and for marijuana since the 1930’s.

    But those facts have stopped Obama’s DHHS, hundreds of its funding recipients and drug industry funded anti vaping tobacco controllers from repeating their disproved lies about vaping as they’ve also lobbied to enact hundreds of vaping bans (including in NYC, which was Michael Bloomberg’s swan song as Mayor in 2014).

    Perhaps Dean Galea wasn’t aware of these facts, or the false claims by many “progressive” public health officials and other extremists that natural gas fracking (which has significantly reduced carbon emissions in the US), hundreds of man-made chemicals, guns, coal mining, oil pipelines must all be banned because they threaten public health.

    As a longtime public health activist, I’m outraged that many left wing progressive ideologues have lied about the scientific evidence to scare the public and lobby for policy goals that harm public health and destroy companies and even economies under the false guise of “protecting public health”.

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