Professor Robert West

A reader has drawn my attention to some of the disturbing ideas that now seem to be prevalent among public health professionals. Here’s Professor Robert West of CRUK’s Health Behaviour Research Centre earlier this year, providing an overview of tobacco control policies, and running through “the full panoply of behaviour change policies”, ranging from education and persuasion through to regulation and ’empowerment’.

Persuasion continues to have a demonstrable role in the form of mass media campaigns directed at triggering quit attempts and promoting the use of effective methods of cessation. It may also play a role in ‘denormalisation’. Inducements have been used to limited effect in the form of quit-and-win competitions and, more recently, incentives to stop smoking during pregnancy.

Coercion, by raising price, is probably the method with the strongest track record, the price elasticity for consumption being estimated at –0.4 internationally. More draconian measuresmay one day be possible: we have found almost 50% support for a total ban on sales of tobacco in England…Tobacco control worldwide has used the full panoply of behaviour change policies with considerable effect in many countries. The precise blend that will be most effective in a given country will depend on the profile of that country with regard to current levels of awareness of harms, social norms and the willingness to accept more coercive measures. (emphases added)

Here, in the space of a few sentences, ideas of the ‘denormalisation’ of smoking, and the coercion of smokers using draconian measures, flow out effortlessly and undisguisedly. Smokers are to be educated or persuaded to give up smoking. And if that doesn’t work, then they will just have to be coerced. Or rather, coercion is just one method among others to make them stop smoking, and the one with ‘the strongest track record’.

Not the faintest wintery ray of moral scruple warms this review of smoking cessation methodology. There is no sense of smokers being free, autonomous human beings who are capable of making their own decisions about whether to smoke or not. No. They are in effect so many dumb animals, and all that is being discussed is the most effective way of herding them from one place to another.

Who is this Professor Robert West? Where did he come from? Well, he graduated with a degree in Psychology in 1977, and a doctorate in Psychology in 1982. Since then, he’s published 122 scientific papers, mostly about smoking and smoking cessation, at the rate of 10 papers a year, or about one paper a month. Here’s a gem from the start of a talk given in 2005:

“When smokers try to become ex-smokers the final link in the chain of events leading to relapse is that at some point their motivation to smoke a cigarette is greater than their motivation not to.”

Erm, isn’t that just an empty platitude? Isn’t that just a long way of stating the mindbendingly obvious?

Or how about this from one of his research papers, which asks: Do ex-smokers report feeling happier following cessation?

In a cross-sectional household survey of a randomly selected, representative sample, 879 ex-smokers were asked to indicate whether they felt happier now, less happy, or about the same compared with when they were smoking.

Results: The large majority of ex-smokers (69.3%, 95% CI = 66.2–72.3) reported feeling happier now than when they were smokers…

This is “science”? There’s something utterly risible about giving the statistical significance and confidence interval of this result. Because ‘happiness’ isn’t something that can be measured, like height or weight or duration. Asking someone how ‘happy’ they are is to ask for a subjective valuation of the most vague and diffuse kind. The figures produced have no significance whatsoever, and nobody can have any confidence in them either. At best all that might be said is that most ex-smokers were maybe glad they gave up smoking. Since such ex-smokers must have wanted to give up smoking, it’s hardly surprising if they were glad they succeeded The surprising thing is that they weren’t allglad of it.But then, in fairness, if you’re banging out research papers at the rate of one a month, they’re hardly likely to be rocket science, are they?He looks nice enough, doesn’t he? Smiling, slim, fit, blonde hair, good teeth. His personal website has a YouTube video of him jamming on guitar with his brother Jamie. Yet here’s someone who is cheerfully and openly discussing the denormalisation and coercion of smokers using draconian measures. What went wrong? What happened?

Most likely people Robert West form a closed, inward-looking culture in which antismokers only ever talk to other antismokers. In that sunless academic world, moving from conference to conference, it’s not too hard to imagine how a consensus view in favour of draconian smoker coercion and denormalisation gradually evolved, powered by platitudinous research. Stranger things have bloomed in such stagnant pools. In that smokefree and smokerfree world, it probably became all too easy to gradually come to regard smokers as so many stupid, dumb animals in need of motivation, possibly with cattle prods.

At least, you don’t get the feeling that Prof. West ever booked a room at the Pig and Whistle to explain to the smoking punters how they were to be denormalised and coerced, and to invite questions from the floor, old Ned standing up to ask if he’s still be able to meet up with his mates for a pint and a smoke at the pub like they always had, and to be told that No that wouldn’t be possible any more. It might have been a good way to find out whether they’d accept further draconian coercive measures. Would they mind being pilloried or flogged? Their noses slit? Molten lead poured down their throats? A show of hands, please.

But this is hardly likely to happen when smokers and their representatives are unwelcome even at public conferences about smoking, as Simon Clark today reports:

the consumer has effectively been barred from addressing Holyrood’s self-styled “Smoking Conference”.

Which isn’t much different from what happened to him last year at an EU conference on smoking:

I sensed, as soon as I entered the room and introduced myself (“Hello, I’m Simon Clark – from the smokers’ lobby group Forest”), that there could be trouble. The guy from Pfizer (yes, the pharmaceutical company) didn’t look pleased, and there were mutterings from some of the other delegates. (There were around 20 in all.)

No surprise then, when, as soon as the meeting began, and we had all formally identified ourselves, two or three hands shot up. As I suspected, some of my fellow delegates were none too happy that a representative of Forest was in the room. If I didn’t leave, said one, she would. Others nodded their heads in agreement.

If smokers aren’t going to be consulted in the EU and Holyrood, it’s hardly likely the punters at the Pig and Whistle are going to be consulted either. It’s no more likely to occur to Prof. West to ask smokers what they think than it is for him to walk out into a field and start talking to a herd of sheep.

And nor is it likely to have occured to Prof. West that he might one day find antismokers like himself in their turn denormalised and coerced, stripped of their titles and their jobs, and suppressed in the most savagely draconian manner.

P.S. See also:

Robert West undertakes research and consultancy for companies that develop and manufacture smoking cessation medications. He has a share of a patent for a novel nicotine delivery device. He is a trustee of QUIT. His research is funded mostly by Cancer Research UK.