Progressive Puritans

Puritanism Makes Faulty Health Policy

The puritanism within us is alive and well, says Matthew Hutson. That much is clear from a new, white-hot debate published in the Annual Review of Public Health. That debate is all about nicotine. But our ongoing obsession with the perils of sugar echoes many of the same themes – along with some important differences.

Nicotine: Best Available Evidence Isn’t Good Enough

The nicotine debate is about the potential for electronic cigarettes to reduce the harm to public health from tobacco products. Stan Glantz and David Bareham lay out a defensive position rooted in fear of the unknown. “Because e-cigarettes have only been on the market a few years, the long-term population health effects are not known,” they conclude.

Their view differs entirely from the view that David Abrams and colleagues present. Abrams et al point out that electronic cigarettes are “substantially less harmful than cigarettes.” They conclude that using electronic cigarettes for “harm minimization is an extraordinary opportunity to enhance the impact of tobacco control efforts.”

Between these two views, we see an unusual divergence in presentation of the evidence. Apparently, Glantz and Bareham are dismissing the best available evidence (here, here, here, and here). Nicotine inspires fear, even if the facts say it’s pretty safe.

Sugar: Best Available Evidence Demands Action

In a similar manner, sugar inspires fear. But the result is different in this case. Fear calls for embracing the best available evidence to take action and target sugar in policymaking. Presently, proposals for a sin tax on sugar are popular with public health advocates.

Too much sugar can clearly contribute to obesity. But as Kevin Hall recently described, it’s more than just sugar in the food supply that explains our excess of obesity. And furthermore, sugar consumption has been declining for nearly two decades now. Obesity continues to rise regardless. So it’s far from obvious that targeting sugar consumption, by itself, will have any impact on the prevalence of obesity.

Decision Making: Values or Evidence?

There’s a difficult truth behind all of this. Values drive decision making – sometimes more than the evidence does. In a best case scenario, facts contribute to help inform decisions. But values always come into play.

Thus, the thread of morality that connects sugar and nicotine is important. Puritanism sees these substances as vices. So we should not be surprised that policies to limit perceived vices can command vigorous support. But we may find that puritanism is tempting us with flawed health policies.

For further perspective on the tension between scientific facts and values, click here and here.

Progressive Puritans, photograph © Tomas / flickr

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January 12, 2018

One Response to “Puritanism Makes Faulty Health Policy”

  1. January 12, 2018 at 9:13 am, David Sweanor said:

    The moralism in play on such issues should raise its own issues of morality. Such as, with the inhalation of cigarette smoke currently causing around 20,000 global deaths daily, and it being beyond question that these deaths are almost entirely due to the smoke rather than the nicotine, what is the justification for picking up on the old cigarette lobby wheeze of ‘we need more research before acting’? It is beyond scientific plausibility that cigarettes don’t cause catastrophic levels of disease and that non-combustion alternatives are be massively less hazardous. At what point is it simply immoral not to act?