Idiots abound. Premature death by lung cancer is a horrible way to die, but short of outlawing cigarettes, it’s a citizen’s right to shorten his odds.

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I have long been frustrated by just the sort of misuse of data you expose. It seems particularly rife in public health apparently because those responsible feel justified in using all available means, legitimate or not, in what they deem to be the overall public good. Few are willing to criticise on what might appear somewhat technical grounds, people claiming simply to want better public health.

A while ago I was particularly annoyed by those campaigning for no alcohol whatsoever to be tolerated in drivers' blood. They commissioned research by a leading University but then produced a report which misinterpreted the results for their own purpose. The University, to it's credit when essentially their customer and benefitting from undertaking such research, politely pointed out exactly what could and could not legitimately be said about the data obtained. Still these people insisted on using it in whatever way they thought could save lives. I then found that a number of those involved simply opposed consumption of alcohol in any circumstances.

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Good post. I have long been annoyed by this type of analysis. Those fanciful costs to smokers themselves seem to assume that people are slaves to society rather than independent agents.

Another bait and switch by public health economists/activists can be to use one lower discount rate for benefits and another higher discount rate for costs thereby biasing public expenditure decisions towards health at the expense of any other area of economic activity.

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Jeez, these people need to calm down - “have a ciggy and do your breathing” as we used to say to Grandma. I particularly like that “loss of tax revenue due to early death” line - gives one a true perspective of one’s value.

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Oct 13, 2023·edited Oct 13, 2023

I applaud your attempts to take a balanced look at your right to addiction, you're entirely right that people don't balance the sums as well as you have, but I really struggle with a cost estimate of the burden to the NHS of smoking related illnesses being £2.2bn.

This only counts directly attributed smoking admissions, 2%.

It does not include diseases caused by smoking. This NHS data ring fences about 25% of admissions as being likely smoking related.


Given the NHS budget in 2022 was £180bn, that means as much as £45bn of the NHS budget is involved in deal with the consequences to damage caused by smoking.

For sure this will be a sliding scale, with many borderline cases as to the true cause, but damage is cumulative, the straw the broke the camel's back, etc.

I have the same concern with social care costs being £1.3bn, of the £27bn total. Especially as <22% of those 65yrs+ ever use social care, and likely those most damaged by life, or unlucky with generic factors.


It concerns me that you didn't include any of this analysis in your piece?

Honest mistake, or conscious omission?

I think booze and fags have fueled the best nights out I've ever had. I think their consequences to health are a cost to society that we should all be happy to pay for us all to live life to the fullest. If we can replace these drugs with ones that do less damage, all the better.

But, we need to be honest with ourselves about the costs, not try to fabricate arguments that those doing so entirely pay their own way so we should be left alone to do so.

I also entirely agree that in terms of productive lives, we would all contribute more to GDP if we all got addicted to exercise in our teens rather than booze and fags. Societies are actually making this transition implicitly, natural selection is driving this to the top as countries compete to out perform each other.

I think it is probably healthy, and I don't see anything wrong with govts trying to encourage it.

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