Archive for the 'Public Health' Category

Is cancer research fradulent?

Received an out-of-the-blue email today drawing attention to a blog on alleged extensive fraud in medical research (especially cancer). Not sure what to make of it.

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Time to tax the fat?

Earlier this week I watched Tax the Fat on More4. The style of the “documentary”, by Giles Coren (apparently he is a Times columnist, and restaurant critic) was that of a very provocative polemic. But it’s a subject I’ve contemplated before myself.

Mr Coren began his film by making the economic case for tackling obesity: he pointed out that nearly a quarter of Britons are clinically obese, i.e. have a body mass index (BMI) of 30 or more; and went on to claim that they cost the NHS £3 billion a year in obesity treatment and further costs to the economy in being unable to work. Rather amusingly he also showed that fat people are a safety risk to the rest of us as they increase stopping distances in cars.

The programme then looked at taxing fat in goods and services but showed it was unworkable: a supermarket spokesperson started going on about ‘good fat’ and ‘bad fat’ showing how difficult it is to tax fatty foods, and then, somewhat farcically, there wasn’t much support amongst travellers at an airport for charging a ‘fat supplement’ on air fares…

The film’s conclusion, therefore, was that obesity must be tackled through direct taxation. Mr Coren proposed that obese people should pay an extra tax on their total tax liability: this extra tax would, in percentage terms, be the square root of their BMI. So, for example, someone who has a BMI of 36 would pay an extra 6% in tax on their entire taxable income.

Amusingly, whilst Mr Coren was unable to impress the Public Health Minister with his proposal he did manage to get a meeting with John Prescott, the Deputy Prime Minister. Ironically, the meeting was “over lunch” with Mr Prescott putting away quite a bit… Whilst the Deputy Prime Minister did take an interest he, rather understandably, said the government had enough on it’s plate with a smoking ban. (Perhaps it also dawned on him that he may have to pay it.)

I think fat people are an economic problem but I’m not sure Mr Coren’s tax proposal is viable. Firstly, the very point Mr Prescott raised: that poorer people are more likely to have unhealthy diets. I’m actually not sure if this is true, of it’s just a widespread belief. Assuming it is true, however, that doesn’t mean we can’t have a Fat Tax, just that the formula must not penalise the worst-off in society.

The larger problem is to what extent being obese is a lifestyle ‘choice’. Sure, smoking is addictive, but you volunteer to get addicted when you start smoking. With overeating I’m not sure that for some people it isn’t a medical condition. The last thing we want is doctors’ time being wasted by patients wanting to be signed off their Fat Tax liability.

But then again, private insurers charge more for healthcare if you make poor lifestyle choices (including being obese). Why should the NHS not do the same with National Insurance? It’s often said of the NHS that it is more a ‘national sickness service’ than a health service because of it’s lack of focus on preventative care. Supporting lifestyle choices through regular health screenings (and appropriate adjustments to NI contributions) does not seem that unreasonable.

Incidentally, the very next day after this documentary was shown was Prime Minister’s Questions in the House of Commons. There was a question about rationing of NHS treatment by Primary Care Trusts on the basis of BMI. The question was posed by John Hemming, the Liberal Democrat MP for Birmingham Yardley, who looks rather obese himself but, to his credit, happily declared his interest. Canny as always, the Prime Minister, didn’t even pretend to answer the question and I haven’t seen much concern reported. Such rationing of non-emergency treatment, if it is NHS policy, is rightly so, in my opinion. People who adopt unhealthy lifestyles and take no responsibility for correcting them should not have their resultant healthcare costs funded by the rest of us. Perhaps a Fat Tax isn’t that far away from being politically possible.