An irregular, irreverent, post-modern account of the surreal, the ordinary, and the bizarre happenings on and around the Felia lavender farm in Crete

Tuesday, June 09, 2009

The Smoking Gun!

I was lucky to have an English teacher who taught me how to read. Not how to read the individual signs and letter and words and sentences but how to read what a text was saying and how it was saying it. I use this skill assiduously and just in case you weren't so lucky here is an exercise.

Smoking costs the NHS five times as much as previously thought, researchers have calculated.

So begins a report on the BBC today. And we immediately know the tone to come.

Treating disease directly caused by smoking produces medical bills of more than £5bn a year in the UK.

It continues. Two sentences in and we have a concrete number. And, surprise, surprise, it's a shockingly big one!

In 2005, smoking accounted for almost one in five of all deaths and a significant amount of disability, the Oxford University team said.

Shocked by the big absolute number we can now have some percentages or in this case a ratio and an unquantified  "significant amount". Percentages are always good but sometimes if you want to slip a guess through you need to hedge it with another, more precise number and "almost one in five" sounds pretty precise doesn't it?.

The British Heart Foundation who funded the research said tighter regulations were needed on the sale of tobacco.

And there's the punch line - because of these numbers we need ... No surprises there then. So there you have the entire content of the report - smoking causes problems that cost the NHS a  lot of money so we need to do something legislative about it.

Not content with that the report decides to push it's point home but this is where it starts to unravel if we read the text closely. And the very next line begins the process.

The figure of £5bn in 2005-06 equates to 5.5% of the entire NHS budget.

OK, so smoking accounts for 20% of all deaths but costs the NHS only one twentieth of its budget. Did you see what I did there? I rounded their 5.5% down to a twentieth and re-expressed their almost one in five to 20%. And I added a carefully placed only. What's next?

Previous estimates have put the burden of smoking on the NHS at £1.4bn to £1.7bn, the researchers reported in Tobacco Control.

This sentence says, we used to think it was a big number but look, it's actually huge! Next up lets have an emotive inset quote from someone who sounds important.
This is money being drained out of the NHS as a direct result of something we have the power to prevent - Betty McBride, British Heart Foundation.

Yeah, that's a good one -  "drained out"  - like it isn't doing anything good or useful. Oh no, this is pure waste. Betty might be from the Heart Foundation but she seems not to have one - at least not for smokers. And that ending is good - a little ominous, but strong - we (without saying who this we is) can prevent all of this waste.

The next few paragraphs are key. Essentially they will now tell us that this is not new research. That these are not real numbers but "calculations" arrived at by extrapolating an old set of numbers using a set of other, unrelated, but newer figures from the WHO. Watch carefully how they do it and pass it off as genuine research.

But these were based on data from 1991 and because such studies are complicated to carry out, it has not been updated.

For the latest analysis researchers took into account data from the World Health Organization study of what proportion of a disease is caused by risk factors such as smoking, NHS costs and UK deaths from smoking-related diseases.

They calculated that in 2005, smoking was responsible for 27% of deaths among men and around one in 10 among women, a figure that has not changed much in the past decade.

When looking at the costs to the NHS, they calculated that treating cancer caused by smoking costs 0.6bn a year and cardiovascular diseases cost 2.5bn a year.

Long-term lung conditions cost £1.4bn.

Did you see that trick? All of the numbers in those paragraphs were qualified with "calculated"  - right up until the final, big money number £1.4bn. That is given as an absolute. Interesting number that - £1.4bn - where have I seen that before? Oh yeah back up there when it was a previous estimate. Convenient. And now they are going to tell us that that number is an underestimate. And they are going to slip in the fact that the data that the report is based on are out of date.


This annual cost is still likely to be an underestimate, they say, because it does not include indirect costs, such as lost productivity and informal care, the costs of treating disease caused by passive smoking, or the full range of conditions associated with smoking.

However, the study is based on data collected before the ban on smoking in public places came into force.

And now we get to hear from the study leader. And he's a doctor! Not a mathematician or a statistician. or even an economist, you'll note, but a doctor.

Study leader Dr Steven Allender, said the increased costs were largely due to increasing expense of treatment on the NHS with better treatment and technologies.

"The story is not so much the five-fold increase but that £5bn is an enormous number regardless.

OK, so maybe he isn't a statistician but he recognises a big number when he's just made one up. That's right Steve, a five fold increase isn't much of a story but a big number? That's something that'll get you in the media. And please note that this increase is not the fault of the smokers but of the drugs and medical companies and the NHS itself. Time for another emotive inset - not money this time but dead people.
England - 90,000
Wales - 6,000
Northern Ireland 2,500
Scotland - 11,000

Set beside this horrific set of numbers (Note: no source for these number is cited.) we get the estimable Steve's studied prognostications.

"There's two different ways of looking at this - one is if nobody smoked we would save £5bn but the alternative view is this is an enormous health problem and should be moved back up the policy agenda."

I have no problem with the second view. OK it's not what's being proposed but it sure is what needs doing. What is actually being proposed is, as we have already learned, another set of moral legislation that passes itself off as health legislation. But the first point? So what are we saying here Steve? That the people who currently smoke wouldn't, if they gave up, ever impose on NHS funds? No Steve, they'd have to die for that to be the case. Whatever they do die from might be less expensive. But it might be more expensive - like a lingering death from Allzheimer's? Oops. But let's not go there. Let's just get on with beating the reader with big numbers.

Drawing on their previous work on other lifestyle issues, he added that smoking cost five times more than lack of physical activity, twice the cost of obesity and about the same as an unhealthy diet.

A separate paper published by the team in the Journal of Public Health found that alcohol consumption costs the UK NHS £3bn.

Not all their numbers either! Alcohol is cheaper than cigarettes!! But what about those last 3 figures? The comparative ones. What are they for? Well, I suppose they are all lifestyle choices but I detect some kind of overlap. I feel a Venn diagram coming on. But no. Let's just say that unhealthy diet costs the NHS the same amount as smoking does. Is that, as Betty McBride told us about smoking , money just being drained out of the NHS a s a direct result of something we have the power to prevent? Well, surprise surprise, here comes Betty again and apart from re-iterating her point she goes on to proclaim her final solution.

Betty McBride, policy and communications director at the British Heart Foundation, said: "This is money being drained out of the NHS as a direct result of something we have the power to prevent.

"Yet the true tragedy of this monstrous figure is the lives that are cut short or ruined as a result of smoking.

"This study shows exactly why we need the strongest possible measures to control the sale of tobacco."

And here comes the DoH to back her up.

A Department of Health spokesperson said: "The government has made great progress in cutting the number of people smoking by nearly 2.5 million over the last ten years but with 21% of adults still smoking in England, there is much work left to do.

"We will be publishing a new tobacco control strategy this year to ensure England can look forward to a tobacco-free future."

Some people might be looking forward to a tobacco-fre future but not me. And not a whole lot of other people either. Do we get a say in this? I think not!  Betty, Steve, and the spokesman from the DoH have settled all this with a few big, made up numbers. And now here comes the BBC house policy - right at the end they have to get a quote from a dissenting voice. Not a reputable doctor, or economist, or statistician but a spokesman for the smoker's lobby group (the implication is that he is not credible).

However, Simon Clark, from the smoker's lobby group Forest, said the figure in the report was a guesstimate, and should be treated with contempt.

Mr Clark said it was preposterous to suggest that the cost of smoking to the NHS had risen dramatically, as smoking rates had been falling for 50 years.

He said: "Even if it was true, smokers still contribute twice that amount to the Treasury in tobacco taxation and VAT.

"Far from being a burden on society, smokers make an enormous financial contribution."

And strangely enough he actually makes 3 sound points. Too bad that he has already been discredited as a crank.

Read the whole article as presented on the web here

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