Risk, Morality and Liberties

risk IIOne of the things that tends to catch my eye is a controversy thought settled long ago that unexpectedly shows signs of life in the morgue. It’s like the Ogden Nash verse describing an after-hours ball in the natural history museum:

One fossil looked at me and winked.
It’s sort of fun to be extinct

The fossilised controversy that winked at me recently was a UK parliamentary report by an all-party select committee on science and technology on the topics of vaping, e-cigarettes and other new ways of delivering nicotine to the user. As the Guardian revealed in a comprehensive report, the committee concluded that:

the risk to smokers who continue with their habit far outweighs the uncertainty around the possible harms of vaping. Public Health England has said e-cigarettes are 95 per cent safer than smoking …

The MPs’ report says it is thought that 2.9 million people in the UK are using e-cigarettes to try to stop smoking and “tens of thousands” are successfully quitting each year thanks to vaping and that therefore “the committee is pressing the government to relax the regulations around e-cigarettes, which in many respects are controlled like ordinary cigarettes”.

The report covers a great deal more ground, and it’s already come under attack. That’s to be expected for what the Guardian describes as a “hard-hitting” document reliant on strong scientific evidence. But it survived the first onslaught more or less intact. And that means the great tobacco controversy—which had apparently been settled in favour of a policy of regulating and pricing all tobacco and nicotine products out of the market and into bankruptcy—is back in the public square again.

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It never really left, of course. How could it when billions of people smoke worldwide and the most prohibition-minded governments rely heavily on “sin” taxes for revenue? Treasuries want to regulate tobacco industries only almost to death. What happens is that the debate comes and goes as particular rationales for stricter or looser regulation rise and fall.

The original case for lax or non-existent regulation never really changes. It was stated by William Conor Magee, a nineteenth-century Anglican Archbishop of York, as “Better England free than England compulsorily sober”, though the “compulsorily” usually gets lost in quotation. This is an important principle, and a liberal one at that, but it requires a few modest qualifications to make it a reliable guide to the making of law and regulation.

First, people who want to drink or smoke or indulge in other mood-altering drugs must know the risks in advance. Stricter regulation of tobacco was introduced when the much higher risks of cancer from smoking were established. Second, they may inflict those risks on themselves but not on others. Cigarettes faced still more restrictions when the concept of “second-hand smoke” inhaled from other people’s cigarettes was established (and considerably exaggerated). Third, a willing and informed drug-user may even be prohibited from purchasing it if it poses an early and severe threat to health. (Threats to health several decades away don’t suffice here because that would allow regulation of too many aspects of our private lives—our consumption of cheese, for instance, as suggested in the movie Thanks for Smoking.) And, finally, if whatever threat the drug poses can be materially reduced by scientific innovation, then suppliers and users have a moral and prudential duty to innovate—and government has a duty to amend its regulations to take account of the innovation.

That last qualification is important on two counts. “Vaping” seems to be an example of such an innovation, as the parliamentary committee argues; and without that fourth qualification, the first three could be manipulated to extend regulation over large areas of our lives that (see below) should be left to our own judgments. We should have no illusions about bureaucrats, regulators, or even doctors. Most are doubtless actuated by concern for the public good; but some have medical or social obsessions, and others simply like ordering people around.

They need regulating—and watching. Thirty years ago governments discovered the fiscal argument that governments should tax and regulate more, since smokers get lung cancer and so impose heavy costs on the National Health Service for treating it. No sooner had the taxes been raised and the regulations extended than it was realised that, since smokers on average die younger, collect less in pensions, and inflict less in end-of-life care on the NHS, they benefit the Treasury even more than we knew before.

Understandably, no one likes to stress this argument, let alone advocate smoking as a cure for fiscal excess, except mean-minded people like me. That may be a pity because, despite being discredited, this justification enjoys a half-life in the occasional threats by doctors to refuse care to smokers unless they shake the habit.

If such threats can’t be justified by large-scale social cost-benefit analysis, what drives them? Self-righteous moralism or medical authoritarianism? In some cases, perhaps so. In others, however, it’s likely to be a simple concern for a patient standing in front of the doctor. Yet it is when smokers are in distress that they most want the comfort of a cigarette. In those circumstances is not vaping at least an effective placebo? And if so, does that not justify governments if they decide to relax official hostility?

That is what the select committee decided, and it seems to follow from trends in UK public policy over the last hundred years and more. As the late Christie Davies observed in his indispensable book The Strange Death of Moral Britain, there were two main trends in both government and private sector bureaucracies towards mood-altering drugs.

The first was to encourage an ethic of self-control and self-discipline in the population that would lead people to avoid those drugs that led to joblessness, criminality and general fecklessness, and to guide others to do the same. That was the method followed by the Victorians, and it had enormous success in vastly reducing social problems across the board from crime to illegitimacy. It was especially successful in weaning the British poor off laudanum, which was accomplished almost entirely by social influences exercised through churches, Sunday schools, the Salvation Army, and new social work agencies, often associated with churches and underpinned by a common Christian morality. Laudanum was eventually made illegal, but only after its use had fallen sharply because people felt ashamed of a habit that marked them out as shiftless.

The second policy trend, starting in the early twentieth century and gathering pace in the 1950s, was to remove moral stigma from drug policy, regard drug abuse as the product of social causes, root policy in the concept of minimising harm, and focus on treating it as an illness. Thus, as was well known in the 1950s, drug addicts would receive the drugs of which they were habitual users or addicts on NHS prescriptions.

Tobacco and other nicotine products had a unique position under the regimes of both moralism and causalism as Davies terms them. Tobacco was the main mood-altering drug of Respectable Britain. It was, as Davies puts it, the drug of the steady worker and the brave soldier. Until the statistics linking cancer to cigarettes appeared, there seemed no real reason to place serious regulatory obstacles between the smoker and his cigarettes. Cigarette consumption peaked in 1948.

Once the link was established, however, the now reigning causalist doctrine of minimising harm kicked in to dictate that government policy and social attitudes would promote tighter regulation (supported by a moralist anti-smoking campaign akin to the Victorian campaign against laudanum). And that was the situation until the parliamentary report emerged to advocate the liberalisation of vaping on grounds of minimising harm.

That does not quite end the matter, however. At the very moment when vaping reduces the risk of nicotine substantially, Britain and Western societies overall have become extraordinarily risk-averse. Students at US universities are given “trigger warnings” before hearing words or facts they might find disturbing, and darkened rest rooms to help them to recover afterwards. Health-and-safety in the UK has become a synonym for preventing volunteers from helping others threatened by natural disaster. And companies pay large sums in damages to customers who used their products in ways against which they were specifically warned on the packet. It’s a legal and moral environment that makes it very hard to cut regulation when there is any risk at all.

And it may be worse than the diseases against which it’s intended to guard. As George Orwell wrote in The Road to Wigan Pier:

All mechanical progress is towards greater and greater efficiency; ultimately, therefore, towards a world in which nothing goes wrong … But in a world from which physical danger had been banished … would physical courage be likely to survive? Could it survive? And why should physical strength survive in a world where there was never the need for physical labour? As for such qualities as loyalty, generosity, etc., in a world where nothing went wrong, they would be not only irrelevant but probably unimaginable. The truth is that many of the qualities we admire in human beings can only function in opposition to some kind of disaster, pain, or difficulty; but the tendency of mechanical progress is to make your environment safe and soft; and yet you are striving to keep yourself brave and hard.

If you live in a risk-free society, you will be increasingly reluctant to take risks. And as the Victorians knew, you will then leave your children a world in which the risks are far greater than those in a packet of e-cigarettes.

3 thoughts on “Risk, Morality and Liberties

  • en passant says:

    Some years ago I watched a BBC program on a new breed of extreme sports risk-takers. When asked why they did it the universal answer was that “Life is not worth living without taking risks. It is the thrill of beating the odds that makes life exhilarating.”

    Amen to that.

    Now I have to go as I have another physio session …

  • Keith Kennelly says:

    ‘You don’t really live until you face death … then facing death becoes additive and life becomes exhilarating.’

    ‘Then you also learn, there is no fear you cannot overcome.’

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