One Size Fits All

Something Rose said a couple of days back:

I can’t help wondering if banishing smokers to the outside of hospitals led eventually to the neglect of other patients such as in Mid Staffordshire. After all, it requires an entirely different mindset to go from the tradition of caring for your patients to punishing them…

What was the change in mindset? What happened? Perhaps it was the arrival of Evidence Based Medicine?

Evidence-based medicine (EBM) is a form of medicine that emphasizes the use of evidence from well designed and conducted research in decision-making. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to populations (“evidence-based practice policies”). It has subsequently spread to describe an approach to decision making that is used at virtually every level of health care.

Medicine shifted from an individual, personally tailored, almost-intuitive, family-doctor approach (often based on years of personal experience) to a population-level, statistical approach. Out went the family doctors who knew their patients, and in came mathematical social engineers. And in the process, humanity vanished, and it vanished because the individual person got buried in the crowd. He became a statistic.

It’s like a move from wearing individually-tailored clothes to wearing one-size-fits-all, off-the-peg, mass-produced clothes. The tailor fitted his clothes to the person. But now the person is fitted to the clothes. In the past the individual person was paramount, but now the clothes are. In the past, if the clothes were too tight, they were adjusted to be comfortable. Now if the clothes are too tight, the individual has to slim to fit them.

And what applies to clothes also applies to shoes, houses, offices, cars, and in fact more or less everything.

And one result is that the clothes and shoes never quite fit. They’re always one size too big, or one size too small. They’re never comfortable.

And so, instead of being given clothes that actually fit us, we’re being squeezed to fit the available single-size clothes. And so we have to stop smoking, stop drinking, stop eating. The problem isn’t the clothes; the problem is us. We’re too fat or too thin, too tall or too short. We are always deficient in some way. And we need to be encouraged to change our ways (and our shapes), and if we don’t change we must be forced to change.

It may be something that would seem to be inherent in the mass production of anything. A manufacturer designs something – say, a car for example – and he designs all its component parts, and then produces 100,000 almost-identical cars from the identical component parts. These cars may be too big for some people, and too small for other people, but there’s nothing manufacturers can do about it, and the people will have to adapt to the car, not the car to the people.

But with new manufacturing techniques, like 3D printing, in principle it shouldn’t be necessary to have a one-size-fits-all product. Each and every car could be tailored to fit its future owner, just by scaling the whole car to fit. And so would clothes and shoes and everything else. Everything would be tailored to the individual again. And everything would fit the first time it was put on, or stepped into. The individual would become paramount again.

So when you wanted a new pair of trousers, your precise measurements would go to the 3D trouser printer, and would be used to cut the exact pattern needed to fit you, from cloth of the exact type and colour you selected, simply by changing the parameters fed into the trouser printer. And a single trouser printer or shoe printer would run off thousands of unique trousers or shoes every day, rather than one single-size, single-colour product.

And while everything is a bit uncomfortable now, everything will be comfortable then.

Someone, one of those Indian gurus, once said:

“When the shoe fits, the foot is forgotten.”

Just not yet, however.


About Frank Davis

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27 Responses to One Size Fits All

  1. harleyrider1978 says:

    Smoking ban has chance in Kentucky legislature

    You see, the entire country of Ireland went smoke free back in 2004. The 10-year anniversary of the law prompted a number of stories around the world.

    According to the Irish minister of tourism, the smoke-free law “absolutely” increased tourism.

    It is true that pubs closed over the past 10 years, but researchers attribute those closures to the recession and other economic factors, not the smoke-free legislation. There are over 7,500 pubs open today in Ireland. One for every 630 people!

    “Drinking and smoking” were part of the traditional culture of the past, but it turns out that many people would visit more, and stay longer, if the environment were healthier. It hasn’t been perfect, and many pubs invested in outdoor areas to accommodate the law, but the public policy results are compelling for our state.

    Ireland saw a 26 percent post-ban reduction in heart disease and a 32 percent decline in strokes. They estimate that the smoke free law has saved over 3,700 lives. The proportion of smokers dropped from 29 percent smoked in March 2004, to 21 percent in December 2013.

    Since Kentucky leads the nation in the number of smokers, cancer deaths and a host of other illnesses, people are paying attention.

    • harleyrider1978 says:

      Perhaps a few of you who know the Ireland stats better can put a can in this guys BS.

      Gannet banned me via IP……..

    • Smoking Lamp says:

      On the Push for a Kentucky ban see “Poll: NKY voters want state smoking restrictions,” . This is at and presents the tobacco control case for a ban. The Northern Kentucky Health Department presents results of a poll stating that 65% of those responding favored a smoke-free law. The article also includes a poll: “Should business owners be allowed to set a smoking policy, or should government? – See more at: .

      • Smoking Lamp says:

        Also the article provides link for Smoke Free Advocacy Day which is run by Smoke Free Kentucky at but does not provide a link to NKYChoice (even though they were interviewed in the piece). NKYChoice’s web site is .

        Clearly the media is favoring the tobacco control movement. I know this isn’t new, but it certainly is a concern in a democratic society that relies upon a free and open press. The tobacco control cult has a large press and influence budget. They even fund press outlets as seen in this disclosure statement “Disclosure: Smoke-Free Texas was a corporate sponsor of The Texas Tribune in 2011” which accompanied their article “As Statewide Smoking Ban Stalls, Cities Go It Alone,” . Imagine the outcry s “Big Tobacco” was substituted for “Big Tobacco Control.”

        • harleyrider1978 says:

          It is true that pubs closed over the past 10 years, but researchers attribute those closures to the recession and other economic factors, not the smoke-free legislation.

          This is the part that was brought up last year in that economic impact meeting my legislator contacted me about. They weren’t impressed. Dave Kuneman took Ellen Hahns Lexington ky economic study of smokefree law and ripped her a new one. I sent it and a few others to every legislator they could be reached.

          The legislature knew full well how it impacts especially when you read how Lexington boasts about doing RAIDS on venues who might be breaking the probitional laws.

          In a state that loves tobacco,whiskey and horse racing the word Prohibition is like outlawing the state itself.

          Most of the money in ky for smokefree anything is coming out of cincinatti thru a couple of groups. I don’t have their names right now but they were the ones who did that stupid poll that most people want a smokefree law. In fact they are the ones that pay for it year in and year out.

    • Supergran says:

      Frank, you’re right. One size fits all. I (like yourself) very rarely go to the Docs, but about 4 years ago became ill and had to go. They found I had high blood pressure. She put calculations in a “health calculator”?? and due to my age, weight, and the fact that I smoke, it was calculated that I needed cholesterol reducing medication. I took them for about a year and had such pain with cramps in both feet ALL night, which then spread to my hands, I had to tell her I couldnt take them. She looked on her pc and said “you havent got high cholesterol”. I said “why am I taking the medication then”? She said, its a programme which calculated what you MIGHT need???? Such shite. Even tho I stopped taking the meds, I have been plagued with the cramps ever since. Also, I read up on these statins and many many heart surgeons etc. say far too many prescribed. Millions and millions to people who dont even need them. Pathetic. Absolutely wrong. In fact, reading the bumff regarding statins, they can actually do HARM. I hate that I have to be beholden to a Doctor now, due to the BP (and a couple of other things) but still, I rarely go. Repeat prescriptions over years and years. Marvellous.

  2. Rose says:


    I found this paper this morning and you might find it very interesting. It certainly makes points I hadn’t previously considered in the debate about the established right to smoke and whether smoking bans should ever have happened at all.

    Is it the duty of a doctor to lobby for a smoking ban?
    John Catherwood, Lecturer in Applied Ethics – 2004

    A snippet.

    “In this debate the medical profession has failed to live up to the majority of the “Duties of a
    Doctor”, as laid out by the GMC. These include:

    treat every patient politely and considerately;

    respect patients’ dignity and privacy;

    listen to patients and respect their views;

    respect the rights of patients to be fully involved in decisions about their care;

    recognise the limits of your professional competence;

    make sure that your personal beliefs do not prejudice your patients’ care;

    avoid abusing your position as a doctor;

    and in all these matters you must never discriminate unfairly against your patients or
    colleagues. And you must always be prepared to justify your actions to them.”

    Fascinating reading.

    • Frank Davis says:

      It is quite interesting, although a bit too much arguing about rights for my taste:

      Demanding coercive legislation to limit the free actions and rights of others is not, even if it is supported by the majority, and even if it is supported by the medical profession. This last point was recognised by the proposals to allow private clubs to permit smoking, although it seems that the tyranny of democracy is being imposed by the anti smoking lobby.

      Of course the immorality of such coercion was never recognised in the proposal to close smoking rooms in workplaces, including hospitals. This is quite clearly not motivated by a desire to prevent harm to innocents, but by a quite unwarranted desire to interfere in the life choices of free citizens by applying the full force of the law against them…

      Perhaps worse still we are putting employers and private citizens in peril of fines or otherpunishment if they fail to impose this law – we are recruiting hospital managers and publicans as vigilantes under duress. They are unaccountable to the citizenry whose freedoms they abuse, but legally liable if they fail to curtail other people’s liberty. This is an attack on democracy and accountability, as well as an unwarranted imposition on those made liable for the law’s enforcement.

      None of these are particularly new observations. What’s interesting is that this is (or was) from a philosophy academic. These are the people one would expect to address such issues, and it’s remarkable how few of them ever do.

  3. margo says:

    Exactly right, Frank. I’ve been registered at my doctor’s for the last 20 years and he doesn’t know a single important thing about me (what did I do for a living? how do I spend my time? am I rich or poor?) because he’s never asked. Occasionally I see him in the street and he clearly doesn’t recognise me. To him I am a list of numbers and ticked boxes on his computer – BMI, cholesterol, blood pressure, smoker? drinker? flu jab? etc, etc. I don’t know anything about him, either. We’ve never had any real conversation – he makes it clear he doesn’t want one.

    • Rose says:

      My doctor is fabulous, I refer him to my notes so he can remember who I am as we only meet every 15 to twenty years. I first met him as a very young doctor, full of enthusiasm and luckily he still has it. We work out the diagnosis together, because as I have had to point out to doctors before, I have me on 24 hour observation.

    • woohoo02 says:

      Just before the birth of my daughter by my partner she had pains and saw the doctor, which consequently sent us to the main hospital with a letter, we opened the letter and found that my partner was an ex smoker, which came as a surprise as she had never smoked in her life, are doctors defrauding the government or not?

  4. Barry Homan says:

    I just glanced at the Hippocratic Oath. Someone on this forum should compose a Hypocritic Oath, to reflect the modern world we live in.

  5. harleyrider1978 says:

    Bootleg cigarettes, Prohibition and the death of Eric Garner

    by Walter Olson on December 6, 2014

    Eric Garner, asphyxiated during his arrest on Staten Island, had been repeatedly picked up by the NYPD for the crime of selling loose cigarettes. Washington Examiner:

    The crime of selling “loosies” was not considered a serious one in the past. Many corner stores in New York City once sold them quietly upon request. But former Mayor Michael Bloomberg’s cartoonish anti-tobacco crusade changed that and everything else. Smoking in public places was banned. Punitive taxes and a legal minimum price of $10.50 were imposed in an effort to push prices ever-upward, so that a brand-name pack of 20 cigarettes now costs as much as $14 in New York City.

    As a result, the illicit sale of loose and untaxed cigarettes became more commonplace.

    I noted at yesterday’s Repeal Day panel at Cato that according to figures last year, New York’s unusually high cigarette taxes had brought it an unusual distinction: an estimated 60 percent of consumption there is of smuggled or illegal cigarettes, much higher than any other state. Another way to think of it is that New York has moved closer to prohibition than to a legal market in tobacco. [earlier 2003 Cato study]

    In his history of Prohibition, Last Call, Daniel Okrent cites (among many other law enforcement misadventures) the fatal shooting of Jacob Hanson, secretary of an Elks lodge in Niagara Falls, New York, in a confrontation with alcohol agents — though Hanson had a clean record and was not carrying alcohol. At the time, many saw Hanson’s death as reflecting poorly on the Prohibition regime generally. For some reason, though, Senator Rand Paul (R-Ky.) has drawn fire from some quarters for making a parallel observation about Garner’s death. [BBC; note however that while Garner’s frictions with the local NYPD seem to owe much to his repeated cigarette arrests, the proximate event leading to his arrest seems to have been his attempt to break up a fight]

    Yale’s Stephen Carter: “On the opening day of law school, I always counsel my first-year students never to support a law they are not willing to kill to enforce.” [Bloomberg View via Ilya Somin]

  6. harleyrider1978 says:

    Gunman “Assassinates” 2 NYPD Officers in Brooklyn, Kills Self: Officials

    The killings come as the NYPD faces scathing criticism for their tactics, including the chokehold death of Eric Garner, a black man who died when white police officers attempted to arrest him for selling loose, untaxed cigarettes.

    Attorney General Eric Holder condemned the shooting deaths as senseless and “an unspeakable act of barbarism.”

    HOLDERS just as responsible as Gov Coumo and deblasio in the crackdown on bootlegging in their anti-smokng high taxes and prohibition movement

    • harleyrider1978 says:

      New Laws and Penalties for Cigarette and Other Tobacco Product Violations in New York City

      Whatare the penalties for acting as a retail dealer without a license? Unlicensed retail dealers will be subject to fines of up to $5,000 for the first violation, fines of up to $10,000 for a second or subsequent violation within three years and sealing of the store for the third violation within three years. Whendid this new definition of retail dealer take effect? January 18, 2014. Cigarette Tax Evasion Howdoes this law apply to cigarette tax evasion? Cigarette retail dealers are prohibited from: • Selling cigarettes to an unlicensed dealer or dealer whose license has been suspended or revoked. • Purchasing cigarettes from any person other than a manufacturer or licensed wholesale dealer. • Selling, offering, possessing or transporting altered or counterfeit cigarette tax stamps, imprints or impressions. • Hiding or concealing cigarettes that are in unstamped or unlawfully stamped packages, loose cigarettes not contained in a pack or tax stamps that are unattached, altered or counterfeit.
      Whatare the penalties for violations? • Up to $2,000 for a first violation.  • Up to $5,000 for a second (different day) violation and each subsequent violation within three years. • Revocation of license for second or subsequent (different day) violation within three years. • Sealing of premises for three violations within three years.
      New Laws and Penalties for Cigarette and Other Tobacco Product Violations in New York City What You Need toKnow
      • Retail dealers who violate this law will also be subject to pre-existing civil cigarette tax penalties of up to: –$100 for each 200 cigarettes (in excess of 1,000 cigarettes) in unstamped or unlawfully stamped packages in the possession of or under the control of that retailer. –$200 for each 200 cigarettes (in excess of 1,000 cigarettes) in unstamped or unlawfully stamped packages knowingly in the possession of or knowingly under the control of that retailer. –$200 for each 10 affixed or unaffixed false, counterfeit tax stamps, imprints or impressions, in excess of 100.
      Whendid the new law regarding cigarette tax evasion take effect? January 18, 2014. New Enforcement Authority Sealing Persistent Violators Whatdoes it mean to “seal” a store? Sealing is the forced closure of an establishment by padlocking or otherwise preventing access to the premises. Whencan a retail store be sealed? This law permits sealing a store that has repeatedly violated certain tobacco laws: • A retailer or wholesaler that operates without a license more than two timeswithin a three-yearperiod. • A retailer or wholesaler that violates the following laws three timeswithin a three-yearperiod: –Evasion of New York City cigarette taxes. –Sale of loose cigarettes or cigars. (Cigars priced at $3.01 or more may be sold individually, but cigars that are $3 or less must be sold in packs of at least four. Little cigars must be sold in packs of at least 20.) –Allowing an employee younger than 18 years old to sell, dispense or handle tobacco products without supervision by a store owner or employee who is at least 18 years old.
      New Laws and Penalties for Cigarette and Other Tobacco Product Violations in New York City What You Need toKnow
      WillI be notified before my business is sealed? Yes. After an administrative tribunal finds that a store should be sealed, an order to seal the store will be posted on the establishment at least 10 days before it is sealed. Howcan my establishment be unsealed? An establishment may be unsealed after the sealing period ordered by the commissioner (a maximum of 60 days) has ended, and all outstanding fines and costs have been paid. Whendid this law take effect? January 18, 2014. Seizure of Illegal Tobacco Products Whencan tobacco products be seized? Law enforcement personnel from the Department of Finance, including Sheriff’s Officers, can seize any flavored tobacco products offered for sale (except in tobacco bars) or any cigarettes possessed or offered for sale by unlicensed retailers or wholesalers. Finance law enforcement personnel had already been authorized to seize tobacco products for which the required taxes were not paid. Caninspectors seize flavored tobacco products? Yes. The sale of flavored tobacco products, other than menthol, mint or wintergreen is prohibited in New York City, except in tobacco bars. Whendid the new rules regarding seizure of tobacco products take effect? November 19, 2013. License Revocation and Suspension Whencan a license be revoked or suspended? A cigarette retail dealer’s license must be revoked when a store does any of the following two timesor more—on different days—within a three-yearperiod: • Selling cigarettes, other tobacco products or electronic cigarettes to individuals under 21 years old. • Selling non-tobacco shisha, pipes, rolling papers or smoking paraphernalia to individuals under 18 years old.
      New Laws and Penalties for Cigarette and Other Tobacco Product Violations in New York City What You Need toKnow
      • Selling loose cigarettes. • Selling cigars that cost $3 or less in packages of fewer than four cigars. • Selling little cigars in packages of fewer than 20. • Permitting an individual under 18 years old to handle or sell tobacco without being supervised by an individual who is at least 18 years old and on the premises. • Selling, possessing or hiding counterfeit tax stamps or cigarette packs without a valid New York City and State tax stamp. A cigarette retail dealer’s license must be suspended when a store sells or offers flavored tobacco products three timesor more within three years. A cigarette retail dealer’s license may also be suspended for the failure to pay any civil penalty related to the violation of cigarette or tobacco laws. Whendid the new rules regarding revocation and suspension take effect? January 18, 2014. Increased Fines Whatare the fines for violations of these laws? The table below explains the fines and penalties for various violations. Fine Structure for New York City Tobacco Retailers
      Violation Fines and Penalties Acting as a cigarette retail dealer without a license • Up to $5,000 for first violation • Up to $10,000 for second (different day) violation and each subsequent violation  • Sealing of premises for two violations within three years
      New Laws and Penalties for Cigarette and Other Tobacco Product Violations in New York City What You Need toKnow
      Violation Fines and Penalties Sale, possession or concealment of untaxed cigarettes or counterfeit stamps • Up to $2,000 for first violation  • Up to $5,000 for second (different day) violation and each subsequent violation within three years • Mandatory revocation of license for second or subsequent (different day) violation within three years • Sealing of premises for three violations within three years Plus the following civil cigarette tax penalties with respect to the possession: • Up to $100 for each 200 cigarettes in excess of 1,000 cigarettes in unstamped or unlawfully stamped packages in the possession or under the control of a retail dealer • Up to $200 for each 200 cigarettes in excess of 1,000 cigarettes in unstamped or unlawfully stamped packages in the knowing possession or under the knowing control of a retail dealer • Up to $200 for each 10 affixed or unaffixed false, altered or counterfeit tax stamps, imprints or impressions in excess of 100 in the possession or under the control of a retail dealer Sale of herbal cigarettes to minors At least $500 ($2,000 maximum) for each violation Sale of, or possession with intent to sell, flavored tobacco products • Up to $1,000 for first violation • Up to $2,000 for second violation within three years • Up to $5,000 for third and subsequent violations within three years • Mandatory suspension of license for up to one year for third violation on different day and all subsequent violations on different days within three years • Sealing of premises for three violations within three years Howcan I read this fact sheet in other languages or see the actual law? Visit and search “tobacco laws,” or call 311. Whatif I have questions or need more information? Call 311 and ask for information about Sensible Tobacco Enforcement.

    • beobrigitte says:

      The BBC is repeatedly reporting this tragic event; it even mentiones that the killer had left angry messages on social media, one of them being about the killing of Eric Garner.

      Perhaps New York’s citizen aren’t as happy as we are being told?

  7. harleyrider1978 says:

    Ken Moellman Tonight’s show is going to be action-packed. If you listen to just one this year, this is probably the one (and there’s only a couple more this year after it anyway). Police assassinated in New York. Smoking Nazis on the march. New Kentucky campaign regulations. Other local KY news. And your calls! Tonight at 7PM. Don’t miss it

  8. Some French bloke says:

    On topic: some excerpts from an interesting article about “the pitfalls of randomized controlled trials” (RCTs)

    More than one way to measure
    By Rebecca A. Clay
    American Psychological Association
    September 2010, Vol 41, No. 8

    “Because trial participants typically don’t represent the population as a whole, for example, results from RCTs may not apply more generally. And even if they did, it’s impossible to tell from an RCT which subset of participants actually benefited from the intervention being studied.”

    “Single-case experiments are another important source of evidence, says Alan E. Kazdin […] In contrast to RCTs, which involve many subjects and few observations, single-case designs involve many observations but often few subjects.”

    And the final paragraphs:
    “If you just do an assessment before some treatment and an assessment after treatment and compare the group that got it to the group that did not, you lose the richness of the change on a day-to-day, week-to-week, month-to-month basis,” says Kazdin, emphasizing that single-case designs are not mere case studies.

    For Kazdin, overreliance on RCTs means missing out on all sorts of valuable information. Think of the nation’s telescope program, he says. The Hubble telescope looks at visible light. Another telescope looks at X-rays. Another handles gamma rays.

    “The method that you use to study something can influence the results you get,” says Kazdin. “Because of that, you always want to use as many different methods as you can.”

  9. Some French bloke says:

    only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations

    With all its articles about smoking and the (literally) scores of diseases and conditions that have been linked to it heavily slanted in favor of antismoking ideology, no wonder Wikipedia would have us recognize the existence of an acceptable substitute for hard science in the form of the ‘gold standard’ of e.g. randomized controlled trials,
    Whatever the type of study we’re dealing with, be it cohort, prospective or randomized, the exact same biases are likely to creep in unhindered, the same confounding factors – including major ones – are likely to be simply ignored as in any old case/control study.
    Let’s hope Wikipedia will soon start telling the tale of how the prestige of genuine sciences has been hijacked by those with a strictly political agenda, of how defective methodology all too easily promotes deceptive logic, in turn resulting in conclusions that are just plain deceiful.

    For those doing research on antismoking ‘studies’ and also those health studies (Whitehall, MRFIT) where tobacco use appeared more like an independent variable, it might be useful to recall the address to Judith Hatton’s pamphlets that seem to have been mentioned here but once, back in August 2011:

  10. harleyrider1978 says:

    Brian Monteith: Giving fresh look to old politics

    Unpalatable as it may seem, the smoking ban shows that nothing makes a party look old like regulation no matter what, writes Brian Monteith

    As we approach the Christmas celebrations and the end of 2014, our politicians will no doubt be thinking what next year’s general election will bring; what it will mean for them, their parties and their policies. We even hear them talking on the radio and television, quoting the number of days until 7 May as if to heighten the event’s importance. But for the public, there remains an elephant in the room that has driven many voters to desert the establishment parties and contemplate voting for the UK Independence Party or the Greens – namely that the old parties are all the same.

    Those who voted Conservative in 2010 – and that was more than 400,000 voters in Scotland – might have thought they would get a different type of government, but on too many fronts the differences with Labour’s policies are marginal. Conservatives like to talk about tax cuts and Labour likes to talk about higher spending, but the comparisons are often exaggerated to attract votes and both policies look distinctly challenging at a time when deficit reduction has become the overriding economic target.

    Despite some attempts to reduce the size of the state in our economy, one aspect that remains the same for the establishment parties – which in Scotland includes the SNP – is their penchant for increasing the amount of regulations or laws that can result in a criminal prosecution. The growth in state intervention to socially engineer our behaviour, and the need to police the regulations used to achieve the desired outcomes, ensures that the number of new crimes rises inexorably.

    A day does not seem to go by without somebody somewhere suggesting a new ban and a politician responding with a supportive comment, the colour of the party label being of no importance. Using a freedom of information request, Lord Stoddart of Swindon, an independent Labour peer, has confirmed that since 2009, the number of criminal offences for which UK citizens can be convicted has increased by 1,785. Of those, 712 were created in the last year of the Labour government, and a further 1,073 by the coalition government between 2010 and 2013.


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    Politicians often justify their interventions by saying that they are applying evidence-based policy, but what if the evidence contradicts their assertions? Well they ignore it of course, or cherry-pick the parts that support their case. What if the policies – that, remember, can result in criminal proceedings – deliver perverse results, even making a situation worse? Do they repeal their laws, do they fess up and seek to reverse their damage? Rarely, and even then it normally requires a change in government (or at least the politician in charge). But what if there is a consensus between political parties, how, then, can evidence result in a policy change?

    For an example of this problem we need look no further than how governments of all colours have applied public health policies to control smoking, irrespective of the evidence that suggests they are not working and without any regard to the consequences for businesses.

    The evidence about adult smoking rates tells us that it has been in consistent long-term decline before various bans on the advertising, retail display and smoking in public places were introduced throughout the UK. Add these bans to the increased taxes and we should have expected an acceleration of that existing trend, but instead we are now seeing that in some groups the number of smokers is increasing, such as in Scotland where it has risen from 22.9 per cent in 2012 to 23.1 per cent in 2013. Rather than question why the policies have failed, we can expect demands for even stronger bans and yet more demonisation and persecution of smokers. A ban on smoking in cars will come, first where children are present (as passed in Ireland last week) but then in all cases – giving the pretext to ban smoking in our homes.

    The SNP has been in the vanguard of such public health policies and is very keen to introduce the type of intentionally ugly standardised packaging that has been adopted in Australia, ostensibly to discourage smoking by children (although already illegal). For the moment, the SNP is holding off from introducing legislation as it waits to see what the coalition government at Westminster decides to do. That decision has been expected for nearly two months and could yet come any time before the general election but, as we wait, the evidence coming out of Australia tells us that not only is the policy a failure, it is delivering the opposite of the desired effect.

    The Australian Institute for Health and Welfare has established that smoking rates of teens in the period 2010-2013 have increased by 36 per cent while, by mid-2014, illicit tobacco sales had risen by nearly 25 per cent to 14.3 per cent of consumption from 11.5 per cent in 2012. How can the UK government forge ahead with the policy in the face of such evidence – and how then could the SNP choose to do so if the UK government sees sense and holds off?

    The UK government cannot simply dismiss the evidence. If it does, then it is not applying “evidence-based policy” but being driven by public health ideology or sheer prejudice. A recent study by Chris Snowdon of the Institute of Economic Affairs demonstrated how the smoking ban had played a significant role in the closure of 6,000 pubs since 2006 – but is any mainstream politician advocating a relaxation of that ban?

    What comes in smoking ultimately follows in public health targets. Although it was strenuously denied at the time in Australia that the standardised packaging of tobacco could apply to alcohol and foods, no sooner had the packaging controls been introduced than activists targeted spirits and fast foods.

    When faced with political parties that all say the same, and especially when what those politicians say is in direct contradiction to the everyday experience of ordinary people, then new parties appear attractive. It is no mistake that Nigel Farage is regularly seen with a pint in one hand and having a legal smoke outside. When the old parties seem so attached to corporate business so the Greens can look refreshing to those that believe small is beautiful. Politicians should heed the evidence or be damned by it.

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