Thursday, November 18, 2010

Warning labels and the nanny-state

EVERY SENTIENT HUMAN BEING knows that smoking is unhealthy. Cigarettes have been nicknamed "coffin nails" since at least the 1880s, and more than two centuries earlier King James I was railing against smoking as "a custom loathsome to the eye, hateful to the nose, harmful to the brain, [and] dangerous to the lungs."

In the United States, federal law has required warnings on cigarette packages since 1966. In the years since then, smoking rates have been sliced in half -- from more than 42 percent Americans who were occasional smokers in the mid-'60s to less than 21 percent now. As for the hardcore who smoke daily, their numbers have dropped to just 12.7 percent, an all-time low. If ever any message reached its intended audience, it is the message that smoking is bad for your health. In fact, smokers tend to overestimate the danger from cigarettes: Surveys show, for example, that smokers put the chances of dying from lung cancer caused by smoking at 40 out of 100. The actual likelihood: between 7 and 13 out of 100.

Smoking's toxic reputation isn't the only thing that has depleted the ranks of American smokers. Cigarettes have never been as highly taxed as they are now, as widely banned, or as deeply stigmatized. Plainly, the last thing the federal government needs to be doing now is rolling out new rules for alerting consumers to the hazards of smoking. That, of course, is just what the feds are doing.

Last week the Food and Drug Administration announced that it will soon require tobacco warning labels to be much bigger -- beginning next fall, they will have to cover half the front and back of each cigarette pack -- and more graphic. Armed with new powers granted by Congress last year, the FDA has designed 36 possible labels, from which nine final choices will be selected.

The proposed warnings, reports The Washington Post, include one "containing an image of a man smoking through a tracheotomy hole in his throat; another depicting a body with a large scar running down the chest; and another showing a man who appears to be suffering a heart attack. Others have images of a corpse in a coffin and one with a toe tag in a morgue, diseased lungs and mouths, and a mother blowing smoke into a baby's face."

Apparently the theory behind such fulsome antismoking imagery is that while everyone knows tobacco is unhealthy, some people need to have their noses rubbed in that fact as pungently and unpleasantly as possible. I don't smoke and never have, and if one of my kids were tempted by cigarettes, I wouldn't hesitate to deploy the diseased-lung or dying-cancer-patient pictures to make sure they realized the potential stakes.

But when did it become the job of the federal government to treat American adults the way mothers and fathers treat children? Is the stomping out of bad personal habits a role we really want to entrust to the Department of Health and Human Services? Washington can't manage to curb its own foul behavior; why would we put it in charge of curbing ours? Few things in modern American life are as ubiquitous as the pressure to stay away from tobacco. Everyone gets the message, which is why the great majority of Americans no longer smokes. The dwindling few who do don't need to be nagged about it by the government of the United States of America.

There will always be some people who smoke, just as there will always be some people who drive recklessly or overeat or drink to excess. Should the manufacturer's sticker on every new car be required to include images of horrible collisions and mangled motorists? Should packages of high-calorie junk food depict rolls of flabby cellulite or a patient undergoing bypass surgery? Should beer and wine bottles be covered with grisly pictures of ruined livers or passed-out drunks?

"The natural progress of things," Jefferson said, "is for liberty to yield and government to gain ground." The nanny-state may make some decisions easier, but it is not compatible with a free society. It isn't Washington's function to wipe your nose just because your nose needs wiping. Of course the functionaries mean well. There always seem to be good reasons for giving them just a little more authority, for agreeing to surrender just a few more personal choices, for letting yourself be treated just a bit more condescendingly. But it comes at a price. Smoking is unhealthy, no question about it. The loss of freedom and self-respect are more hazardous by far.


New procedure to reduce blood pressure

One hopes not but this could be a case of treating the symptom rather than the disease

MELBOURNE scientists have made a major breakthrough in treating high blood pressure. A simple 45-minute procedure to control the condition should be available within a year.

Between 25-30 per cent of Australian adults suffer high blood pressure, which can lead to heart disease, stroke and kidney failure. Medication fails to control the condition in half of the 1.5 million Australian sufferers.

The new procedure, developed by Baker IDI Heart and Diabetes Institute, involves a catheter device that is inserted through the groin into the renal arteries. It emits radio waves to destroy nerves in the kidneys that play a crucial role in the elevation of blood pressure.

The device, called the Symplicity Catheter System, has already been approved for use by government medicines regulator the Therapeutic Goods Administration and may be used routinely within a year.

Principal investigator Prof Markus Schlaich said the trial involved 106 patients in Australia and Europe, with half having the procedure, known as renal denervation. Of those who had the procedure, 84 per cent experienced a significant - more than 10mmHg - drop in blood pressure, and while it was hoped the results were permanent, they had so far lasted two years. Studies have shown reducing blood pressure by as little as 5mmHg can reduce the risk of stroke by 30 per cent.

"The study also found the therapy was safe, with no serious device or procedure-related complications," Prof Schlaich said. "High blood pressure is the biggest killer worldwide, and half of those patients treated are not controlled, so this could have a tremendous impact."

Melbourne woman Gael Lander, 67, was the first person in the world to have the procedure done, at St Vincent's Hospital two years ago. Ms Lander, of Brighton, had suffered from difficult to control high blood pressure since her mid-30s, and it transformed her life. "Everything used to race, my pulse, my heart, but since the procedure it's like someone's taken their finger off the fast-forward button," she said. "I'm a lot calmer."

Both her parents suffered high blood pressure, and her father died of heart failure and her mother after a massive stroke, and she had felt she would go the same way. "But it's taken a lot of worry off me. I know that I'm not going to have a stroke ... it's given me peace of mind," Ms Lander said.

Scientists expect the procedure to be adopted around the world. The results of the trial are being presented to the American Heart Association today , and published in medical journal The Lancet.


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