Lions Led By Donkeys

I don’t really have much contact with the medical profession, mercifully. I haven’t been to see a doctor for over 10 years. And when I did used to see them, it was almost always only to get the sleeping tablets that I’ve long since replaced with far more effective whisky.

The result is that I’m now observing the medical profession from a distance – through binoculars, as it were. And recalling my experience of them over the years.

And the odd thing, in my recollection, is that none of those that I encountered in one surgery or other were particularly antismoking. They would ask me just once whether I smoked, and thereafter never mention it again. I remember one – a rather attractive woman doctor who I always liked visiting (because, well,… she was rather attractive) – even telling me, 30 years or so ago, that the roll-ups I smoked didn’t really count as cigarettes, because it was the manufactured ones that were the real problem.

And yet it’s the medical profession that is very largely the source of antismoking fanaticism. There was the very first one I ever encountered, the grim and humourless Dr W (who remains for me the personification of the antismoking zealot). But there was also Dr Richard Doll, and Doctor George Godber, and Doctor Gro Harlem Brundtland, and now UK CMO Dr Sally Davies, and WHO Director General Dr Margaret Chan. There are plenty more of them.

And here’s what seems to me to be the principal difference between them: It is that all the doctors that I encountered in surgeries and hospitals were hands-on, practising doctors meeting patients face-to-face every day of their working lives. And all the antismoking zealots whose names I’ve just mentioned are or were administrators of one sort or other. They’re doctors who, at some point after becoming qualified as doctors, ceased practising medicine. Dr W became a district health officer. Doll became a researcher. Godber became a CMO like Sally Davies. And Brundtland became a politician as well as becoming another WHO director general like Chan.

Or, to put it another way, the practising doctors that I encountered were the front line troops at the cutting edge of some war, and the administrators were the general staff officers in their chateaux miles behind the lines, poring over their maps. Their experiences of the war were completely different. And so was their thinking. For the front line soldiers, the war was bullets singing past them, and shells exploding around them, men dying beside them. For the general staff, the bullets and shells and casualties appeared as numbers in reports and requisitions. And the maps over which they pored were models of battlefields over which they moved toy soldiers and guns and aircraft.

And, pursuing this analogy further, “lifestyle medicine” or “evidence-based medicine” are examples of medical strategic thinking about How To Win The War: You win it not by treating sick people, but by preventing them from getting sick in the first place (as a consequence of smoking cigarettes, drinking beer, and eating chocolate chip cookies). And these new medical strategies seem to have taken over the high echelons of the medical profession in much the same way as a sudden enthusiasm for cavalry or artillery – or whatever the latest weapon is – periodically overtakes military strategic thinking – and which the poor bloody infantry in the front lines never have the faintest clue about.

Furthermore, the war planners in their headquarters never have to actually practically implement their plans. It’s not them who will have to usher smokers out onto the streets outside Dorset hospitals. It’s not them who will have to tell smokers on park benches to put out their cigarettes. It’s not them who is going to have to tell grieving relatives that, no, you can’t smoke here. They get other people to do that.

And furthermore, these administrative doctors – the researchers and  CMOs and director generals – are often surrounded by people who come from outside the medical profession. Like Deborah Arnott or Linda Bauld or Stanton Glantz, most of whom probably wouldn’t be able to apply a sticking plaster to a bleeding cut, never mind operate to remove an inflamed appendix, and yet who feel able to lecture hospital administrators on the need to drive smokers out onto the streets.

And so I’m beginning to think that the medical profession consists of lions – the courageous front line soldiers – led by donkeys – the administrative general staff far behind the front lines. Which is how the historian Alan Clark described the British army in WW1.

And the same probably applies in other disciplines. In climate science, it would appear that models of reality – computer simulation models – have replaced reality in the minds of many climate scientists. And it has even become necessary for them to change reality – by adjusting temperature records, for example – to bring reality into line with the models.

But in the end it’s always the practical realists in the front lines who must necessarily win out over the dreamers and planners and theorists and modellers in their remote headquarters behind the front lines. For either the new strategy or new weapon actually works, or it doesn’t. And if it doesn’t work, it will eventually be discarded, even if some awful cost has to be paid before the lesson is learned.

Of relevance, (H/T Rose) is this report:

…figures uncovered by the Telegraph, show that the nine main health quangos are now employing 628 officials on salaries of at least £100,000.”

They include 93 taking home more than Theresa May’s £149,440 salary – up from 48 at their predecessor bodies three years earlier.

Among the highest paid is the NHS deputy medical director, earning around £225,000 a year.

and this one too:

“Dame Sally Davies CMO: £205,000 – £210,000”, well she can certainly afford the tax on a packet of cigarettes but she is not doing as well as Harpal Kumar CEO of Cancer Research UK who was getting £240,000 a year and that was back in 2015.

Of course the generals in their headquarters were always paid far more handsomely than the infantry in the trenches.

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About Frank Davis

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24 Responses to Lions Led By Donkeys

  1. Timothy Goodacre says:

    Nobody had better tell me to put out a cigarette in a park !

  2. Harleyrider1978 says:

    Classic class warfare is what they are practicing
    They sit in their campaign tower war rooms directing
    Laws and regs against even the troops in the field!

    But they seem more like hitler in the bunker ordering armies around that just no longer exist!

    The door is closing in on tobacco control
    You don’t push people into the street and expect people to still take you seriously or cut off treating them just because they don’t fit your definition of lifestyle design.

    • roobeedoo2 says:

      We’ve already been mostly pushed out into the street, though, Harley. The hospital grounds ban is the next ‘Big Push’.

      I recently watched Stanley Kubrick’s ‘Paths of Glory’ and it perfectly illustrate’s Frank’s analogy with WW1’s Front Line and comfortably behind the Line priorities and expectations of success.

  3. Vlad says:

    Brilliant article. I wonder, did you elaborate with the attractive GP on why she thought factory made cigarettes were the real problem, not rollies?

    • Frank Davis says:

      No, I didn’t. But I used to dream of elaborating with her…

      • Frank Davis says:

        In retrospect I suspect that she was referring to the original ‘cigarette hypothesis’ according to which it was these new-fangled, mass-produced cigarettes that were causing the epidemic of lung cancer. Pipes and cigars, which people had been smoking for centuries, were not thought the cause. And neither, presumably, were hand-rolled cigarettes.

        Now of course all forms of tobacco – including e-cigs which have no tobacco in them – are regarded as causing almost every single disease known to man.

        • Vlad says:

          To make a parallel with meat, I now think rollies, pipes, cigars – actual tobacco – are like barbecued meat whereas factory made cigs are more akin the heavy processed hot dogs or stuff like that where you don’t know exactly what’s in them, although they’re labelled meat products.

      • Supergran says:

        hehe, now now Frank!!

  4. Rose says:

    Good news. H/T Dick Puddlecote.

    It looks like there is a crack forming in the anti-salt movement.

    Eat MORE salt: Huge health advice U-turn as experts claim low intakes of sodium INCREASE risk of heart failure
    Mar 5, 2017

    “The professor, who stepped down from the role of president of the World Health Federation earlier this year, disagreed with current health advice given by Public Health England, which says to eat no more than six grams of salt per day.

    ‘It is futile to target such low intakes and, moreover, it may well be harmful. Studies show below about three grams of sodium per day there is increased mortality, heart attack and heart failure,’ he told the Sunday Express.”
    http://www.express.co.uk/life-style/health/775072/heart-attack-salt-intake-increase-doctor

    “However Alison Tedstone, chief nutritionist at Public Health England, which sets the recommended salt levels, insisted reducing salt consumption helps lower blood pressure, which reduces the risk of heart disease and stroke.
    She said: “We are still eating a third more than we should. That’s why industry needs to continue to reduce salt in everyday foods.”

    How does she know that? I do my own cooking and rarely use salt.
    I shall take the Professor’s advice.

    Commentary: Possible role of salt intake in the development of essential hypertension
    2005

    “Salt is one of the cornerstones on which the mammalian biochemical structure is built. Total exclusion of salt from the diet leads to disaster, namely death.”

    “Still, salt is considered by some authorities, to be toxic on a level comparable with alcohol and tobacco”

    “The modern salt saga started in 1904 with a paper by Ambard and Brochard3 who showed an association between salt intake and blood pressure in six patients. On the basis of these observations they created a salt–blood pressure hypothesis.
    Subsequently in 1907 the results were opposed by Lôwenstein and from then on the salt–blood pressure hypothesis has been the basis for a dispute between supporters of the hypothesis and sceptics.

    What we can learn from this is that the salt–blood pressure hypothesis and the controversy dates back to the first decade of the previous century, initially based on a few case histories”
    “In the following years Allan’s positive results were both confirmed and disproved by several authors, but during the late 1930s the use of salt restriction faded.”

    “In the introduction of his 1960 paper Dahl defines his position, namely that salt is deleterious. Salt is compared with fall-out, carcinogens and atherogenic factors, and later in the paper with tobacco, alcohol, and fat”
    http://ije.oxfordjournals.org/cgi/content/full/34/5/972

    SALT AND BLOOD PRESSURE:CONVENTIONAL WISDOM RECONSIDERED

    POLICY IMPLICATIONS
    One segment of the public health community—funded by the the National Heart Lung and Blood Institute and endorsed by many journals in the field has decided that salt is a public health menace.

    Therefore, salt consumption must be drastically curtailed. The force with which this conclusion is presented to the public is not in any reasonable balance with the strength of the evidence.
    Programs, once in place, develop a life of their own; the possibility of health benefits becomes probability, and probability becomes certainty. After all, the public is easily confused by complications,
    only professionals can weigh the evidence, and where is the harm in salt
    reduction?

    The harm is to public discourse. The appearance of scientific unanimity is a powerful political tool, especially when the evidence is weak.
    Dissent becomes a threat, which must be marginalized. If funding agencies and
    journals are unwilling to brook opposition, rational discussion is curtailed.
    There soon comes about the pretense of national policy based on scientific
    inquiry without the substance. In our view, salt is only one example of this
    phenomenon.”
    http://www.stat.berkeley.edu/~census/573.pdf

    • legiron says:

      The harm in salt reduction is called hyponatremia. I have heard of patients admitted to hospital with this, only to be put on a low salt diet… and a saline drip!

      Soon we’ll all be carrying a saline drip around.

      Well, I won’t be. I always have a few small salt packets with me in case I buy food from one of the places that don’t put out a salt cellar any more ;)

      • Rose says:

        I’m very bad at remembering to eat salt, so I had bread and dripping sprinkled with sea salt for lunch after reading the article.

      • prog says:

        Standard practice in this household to routinely add salt to tinned soup, beans etc. I suspect a lot more than was originally included before the nutters started interfering.

  5. Clicky says:

  6. smokingscot says:

    The photo may not appear, but I had to comment on the Rose’s find:

    “/content/dam/news/2017/02/21/PD16319241_Jeff-Gilbert_BMA-CONFERENCE-CHURCH-HOUSE-small_trans_NvBQzQNjv4BqZgEkZX3M936N5BQK4Va8RWtT0gK_6EfZT336f62EI5U.jpg”

    And it says:

    “Dr Jonathan Fielden, the highest paid chief at NHS England, is currently suspended after being arrested on suspicions of voyeurism”

    So I checked up on exactly what that means.

    “voyeurism
    noun
    the practice of gaining sexual pleasure from watching others when they are naked or engaged in sexual activity.

    or

    enjoyment from seeing the pain or distress of others.”

    I’d say the second description very neatly sums up most of the donkeys.

  7. smokingscot says:

    Darn it didn’t load.

  8. Pingback: Vapers Digest 6th March | Convicted Vapour

  9. Rose says:

    In other news.

    Cigarettes sold for £20 EACH in prisons where smoking has been banned
    6th March

    “Prisons are getting themselves into huge debt buy spending up to £20 each for cigarettes in prisons where smoking is banned.
    And small pouches of rolling tobacco are changing hands up a staggering £200.
    Desperate inmates are running up debts which have to be paid by relatives when they are freed.”

    “Prison reform groups also said they feared that the smoking ban would lead to an increase in tensions in jail. Peter Dawson, from the Prison Reform Trust, said a “sensible approach to smoking in prisons would leave prisoners with a choice – at least to smoke outside”.

    “If that is to be denied to them, there has to be proper support while people give up – not just smoking cessation aids, but increased vigilance for signs of distress that could easily turn into self-harm or worse,” he said”
    http://www.mirror.co.uk/news/uk-news/cigarettes-sold-20-each-prisons-9978330

  10. nisakiman says:

    The ‘salt is bad for you ‘ meme never gained any traction in Greece. When you order a meal in a restaurant there, they will throw a handful of salt over it, regardless of whether or not it is salty anyway. If you don’t like a lot of salt on your food, don’t go to Greece!

    • nisakiman says:

      A bit like the ‘smoking is bad for you’,really. That never made much headway either.

      I’m in Laos at the moment, and I’ve come across that rarest of beasts, the cigarette pack with no warning plastered all over the front, just a discreet little panel on the side of the pack.

      How refreshing.

      Delay in posting this, as I got collared by the waiter for a brief English lesson.

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