Intended for healthcare professionals

Editor's Choice

Vice versa

BMJ 2006; 332 doi: (Published 26 January 2006) Cite this as: BMJ 2006;332:0-f
  1. Fiona Godlee, editor (fgodlee{at}

    It may seem perverse to support the banning of one vice while calling for the legalisation of another. But in both cases, the rationale has little to do with morals and everything to do with improving public health.

    The first vice, smoking in enclosed public places, is thankfully likely to become a thing of the past in England, when UK members of parliament take part in a free vote on a ban next month. Last year's proposed compromise—to allow smoking in pubs that don't serve food—was widely criticised as unworkable and likely to increase health inequalities (p 194). A total ban now looks inevitable, bringing the United Kingdom in line with Bhutan, Cuba, Ireland, Italy, Malta, New Zealand, Norway, and several states in the United States.

    For the remaining doubters, however, a paper in this week's journal may bring them round (p 227). It suggests that no effective technical solution currently exists for reducing the effects of environmental tobacco smoke in public places, and that the tobacco industry cannot be trusted to advise us on such matters. Newly released internal documents from British American Tobacco (BAT) show that, although BAT was successfully promoting air filtration systems as a means of combating cigarette smoke (and therefore as an alternative to a total ban on smoking in public places), company executives knew that the filters were ineffective.

    The other vice at issue is prostitution, or being paid for sex. Many countries have now decriminalised prostitution, but so far only the Netherlands has put prostitutes on the same legal footing as other workers. The UK government's new strategy, published last week, tends more to the Swedish model, which criminalises men who pay for sex. In Sweden this seems to have reduced street prostitution but possibly by driving prostitutes “underground” or forcing clients to look to other countries. The UK strategy allows more than one prostitute to work in the same place, which should improve safety for individual sex workers. However, it stops well short of allowing licensed premises. This is a mistake. As Petra Boynton and Linda Cusick point out in an editorial this week (p 190), properly licensed premises would mean that the worst aspects of the sex trade—child prostitution, trafficking, and slavery and the exploitation of vulnerable people—could be tackled. Licensing premises would encourage sex workers' access to health and social care.

    Juliet, a prostitute based in London, also writing in this week's journal (p 245), believes that the UK government has “failed enormously.”She argues that neither having sex nor getting paid are inherently degrading, abusive, exploitative, or harmful. The problems, she says, are the associated coercion, drug dependency, and lack of choices, not prostitution itself. It is surely time for an end to the arguments of moral opprobrium and for some bolder steps towards legalisation if we are to improve public health and human rights.

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