Here, sit down. You’re looking a bit down. Like a man condemned to a long spell in prison. Dick Puddlecote must be prescient or something, to have more or less written your obituary just two or three days before you abruptly resigned as Chief Medical Officer. Or was it cause and effect? Y’know, post hoc ergo propter hoc. You can never tell these days what might be causing what.
I won’t go over the ground that Dick covered. But he didn’t touch on another triumph of yours, the online application system that resulted in 15,000 junior doctors not being able to find jobs. What a massive blow that must’ve been to your creaking health service. Well done!
The greatest triumph of all, of course, was the complete smoking ban in public places, which you spearheaded, at one point even threatening to resign if the government didn’t adopt a total ban. That ban hasn’t saved any lives at all. And it even had the added bonus of destroying a venerable traditional pub culture, shattering communities, and dividing friends. Well, not entirely. Your schemes for minimum prices for alcohol would probably have finished off the few stalwart drinkers left in Britain’s pubs.
What a catalogue of achievements in 60 years! Rumour was you’d soon be on your way next to Switzerland, and the headquarters of the WHO. But what’s there left to ban, when more or less everything that can be banned already has been banned or restricted? Tobacco. Alcohol. Salt. Sugar. Well, you know the list better than I do. All the names of those killers on that big sheet of paper of yours have each been crossed out now, like so many enemies eliminated. You must be asking yourself: what’s there left to be banned or restricted or taxed into oblivion? I’ll tell you what. It’s a whole new mission for you.
You look surprised. I thought you would be. So let me explain, Don. Do you mind if I call you Don?
You’ve heard of silicosis, haven’t you? That disease which causes nodular lesions in the upper lobes of the lungs, and whose acute form brings shortness of breath, fever, and the bluish skin known as cyanosis. It’s sometimes misdiagnosed as pulmonary edema, or pneumonia or tuberculosis. And with 15,000 fewer doctors in the NHS, it’ll probably soon get misdiagnosed as bronchitis, emphysema, lung cancer, and even swine flu as well.
Well, silicosis is caused by inhaling crystalline silica dust into the lungs. And what’s crystalline silica dust called when it’s at home? Sand.
And where do you find most sand? Beaches.
And what do lots of families do on glorious hot summer days? Why, they climb in their cars and they head for the beach, with their children in the back seat with spades and buckets and beach balls. And when they’re there what do they do but lie down nearly naked on the sand, sometimes face down? And what do their children do? They run around kicking up sand, or they sit in it building sandcastles.
I see your eyes are beginning to light up.
So here we have this killer substance, sand or CSD, which is known to cause silicosis and all the other diseases I mentioned, and we have this relatively new social custom of family trips to the beaches where this substance is most abundantly found. So here’s another opportunity to put ‘lifestyle medicine’ into practice yet again.
If you remember, not many years ago, smoking was regarded as a perfectly healthy activity. No longer. It’s been denormalised. Rather like drinking is now also being denormalised. Well here’s something else to be denormalised. Sand. Sand and everything associated with sand. Like sunbathing, and swimming, and paddling, and fishing, and beachcombing, and kicking around beach balls.
It’s going to be an uphill struggle to denormalise sand, I realise. But it was an uphill struggle to denormalise smoking. So it can be done. Sand is usually seen as clean and white and wave-washed. And sunbathing and swimming and kicking around beach balls is regarded as perhaps the prime example of living a healthy lifestyle. But with a long campaign the public attitudes can be changed. Stopping calling it ‘sand’ would be a start. ‘CSD’ is much better. It sounds more medical and scientific and, well, vaguely alarming. Another name should be given to ‘beaches’ as well. ‘CSD-contaminated sites’ is the best I’ve come up with so far. Then in carefully staged public campaigns you start to ramp up the dangers of inhaling CSD, and all the diseases that are likely to result 10 or 20 years later. And then you play the ace card: the children. You slowly ram it into parents’ heads that by taking their children to beaches they’re more or less sentencing them to an early death. There’d have to bans on advertisements for beach holidays in Bermuda and so on. The tourist trade will fight like mad against it, but we can handle them the same way we handled Big Tobacco: we call them evil. Merchants of death luring innocent people to their deaths in faraway places.
Of course there’ll have to be all the usual epidemiological studies done to demonstrate the danger of CSD. But that’s no problem. Modern epidemiologists are well versed in finding health threats in more or less anything you point them at. They’ll find a small risk of cancer, heart disease, emphysema, bronchitis, cholera, typhoid, rabies, polio, impetigo, and so on. You name it, they’ll find a small risk factor. And if they don’t find a risk factor the first time they look, they’ll almost certainly find one the 35th time they look. And all we’ll need is one study that shows an increased risk of, oh, 10% or 20% or so. I’m talking the same figures as environmental tobacco smoke, of course. But then you know all this, don’t you?
You’re beginning to look positively jolly, Donnie.
And here’s a bonus. As you know, it used to be smoking that got blamed for every disease under the sun. Yet while fewer and fewer people smoke, the incidence of lung cancer has kept on rising. Worse still, more and more people who’ve never smoked in their lives are developing lung cancer. What do we do when smoking has been eliminated and the last smoker has been taken behind a shed and shot? Blaming everything on smoking is going to look more and more implausible. And this is where sand, or CSD, comes in. New medical studies will show that sand was the real culprit. The studies haven’t been written yet, but that’s what they’ll show.
Of course there’ll have to be a few other threats associated with beaches other than the sand. But there are plenty of them. There’s always a small increased danger of drowning associated with visiting any beaches. And there’s an even smaller risk of being eaten by sharks. I’m working on an idea for a beach-denormalisation ad campaign based loosely on Jaws. Only in this version it’s not the Great White that’s the real danger, but the sand that all the holidaymakers are sitting on. Nice twist, eh?
And there’s another plus too. Remember all those non-smokers who complained that they had to shower after visiting smoke-filled bars. Well, a lot of people do exactly the same when they come back from the beach, because sand clings to wet skin for hours, and it gets everywhere. Especially up your crack. If you don’t wash it off, it eventually falls off into your clothes, into your bed, onto the floor. Secondhand CSD. At the moment most people don’t mind about going to beaches and showering afterwards. But once CSD has been identified as a health hazard they’re going to start complaining about having to shower. Just like with tobacco smoke which they never used to care about. And they’ll start wanting sand-free holidays, and maybe even sand-free beaches.
And of course the real bonanza is that you get to wreck what used to be a happy, carefree pastime – going to the beach -, and convert it into something ugly and dangerous and dirty. We’ll manage to close down another social activity that used to bring whole families together in shared enjoyment. And it’ll empty the beaches, little by little, just like pubs and bars have gradually emptied. Won’t that be wonderful?
And that’s the real point, isn’t it? It’s not about health. It never was. It was always about stopping people doing things that they enjoy doing. Things that they don’t really need to do. Like smoke cigarettes, and drink beer, and munch crisps and chocolates. This is about bringing back fear and guilt and shame. And government control.
And it’s all straight out of the tobacco denormalisation playbook. Just cross out ‘tobacco’ and replace it with ‘sand’. You won’t have to do anything else.
You’re looking positively ecstatic now, Donnie babe. A man reborn. No, don’t bother to thank me. It’s all in a day’s work. We look after our own here. Here in Hell.