That smuggest of colleges, the Royal College of Physicians of London, already infamous for its part in the MMC/MTAS disaster, has of late been cozying up ever more closely to the Department of Health, and its chief pongo, Sir Liar Liar Pants on Fire Donaldsong. Earlier this week it moved still closer, issuing an right-on report damning callous smokers who kipper their kids.
The report, featuring a cover photo of a prole caught in the hideous act of kippering a bairn, contains shocking figures and urgent recommendations in bountiful supply. Passive smoking, it estimated, caused children over 300,000 UK GP consultations and almost 10,000 hospital admissions every year, at a cost to the NHS of about £23.3 million. An alarming list of childhood illness caused by passive smoking includes old favourites such as asthma and wheeze (22,000 extra cases) and middle ear disease (120,000 extra cases), as well as the reliable media magnets meningitis (200 extra cases) and cot-death (40 extra deaths).
The report’s authors resisted a temptation to call for an outright ban on smoking (or kids for that matter), choosing instead to go for a rolodex of recommendations that included headline calls for a ban on smoking in any vehicle, and in public places where children are present.
Now – what could be wrong with a medical Royal College adopting an anti-smoking position? On the face of it, nothing – and Dr No is whole-heartedly against kippering kids. But the College’s recommendations call for significant inroads into personal freedoms – all naturally in the unimpeachable best interests of hundreds of thousands of kids. At this point, Dr No’s bullshit counter started to crackle away. For, just as a smoker has an unmistakeable air of stale smoke about them, so this report has about it an air of zealotry. And where there’s zealotry, more often than not there is fudge.
And sure enough there is. The first fudge is that the figures, alarming as they are, are estimates. Estimates, when it comes to veracity, are often found wanting – as we have seen only too clearly in Donaldsong’s recent estimates of the number of swine ’flu cases. So, naturally, Dr No turned to the full report to review the soundness of the estimates.
Here Dr No encountered more fudge. Although the College has released the headline figures, it has hidden the full report behind a £20 price tag. Obscuration is always irksome, and provokes suspicions – why place a bar before research which the zealots would have us believe is vital to the health of our children?
Dr No, needless to say, has no intention of making a gratuitous contribution to RCP funds – all the more so since the research was adequately, even generously funded, a point he will return to shortly – and so he turned to what is available. And found yet more fudge.
The conclusions and recommendations provide nothing in the way of science to back up the estimates; instead, they contain an emollient letter of welcome from Donaldsong, and more repetition and expansion of the headline figures and recommendations – but no useful references or data.
The College also provides a set of PowerPoint slideshows to support its case. Here again there is plenty of rhetoric, and precious little research – although slide three of Hubbard’s slideshow does contain three interesting bullet points about generating – generating? – the numbers:
• need to make a number of assumptions (oh, really, so what are they then?)
• provides approximate figures (how approximate? Are these figures estimates, guesstimates – or just plucked from the air?)
• at all stages tend to err on side of caution (as in, presumably, the precautionary principle ie ramp up the estimates until the eyes start to water)
But most notably – no science, just more fudge. And so Dr No is none the wiser about apparent paradoxes in the College’s claims – for example, that passive smoking causes 22,000 extra cases of childhood asthma and wheeze a year, when other – apparently contradictory – publicly available data show less passive smoking is temporally associated with more asthma. Childhood asthma prevalence has increased 2-3 fold over the last half century, while adult smoking prevalence – and so childhood exposure to passive smoking – has more than halved over the same period.
In times past, the RCP busied itself with the business of becoming and being a physician. It is not unreasonable for it to have a position on the important public health challenges of the day, but lately it has greatly increased its public health activity, and extended its reach into areas that properly belong not to medics and academics, but to politics and politicians. To Dr No’s eyes it appears that, like the Pharisees of long ago, the College doth protest its perfection too much in the face of its new-found God, the DoH. Could it be that there is a cozy ring of finance that runs through the College, the researchers, and the Government?