Big tobacco, the new politics, and the threat to public healthBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2164 (Published 15 May 2019) Cite this as: BMJ 2019;365:l2164
All rapid responses
As for the strategies of big tobacco companies to foster their business, the political context described by Gornall  is somewhat concerning. However, it's quite interesting that links between politicians and lobbies could be traced in detail. In Italy, a “sunshine act” proposal to make financial links between health care professionals and Industry more transparent has been approved by the Chamber of Deputies and is currently being discussed by the Senate for definitive approval.
In the meantime, a couple of weeks ago the Italian Senate has been the stage of a conference on cardiovascular prevention, with the non-conditional support of Philip Morris, discussing among other things the potential benefits of heated tobacco products. Invited experts expressed their interest and support for these products, which can reduce health risks and may help smokers to shift from cigarettes.
We think that risk reduction strategies should be proposed when adequate support from evidence is available, which is not yet the case for heated tobacco products, as highlighted by WHO  and by Public Health England. This is especially important when such issues are brought to the attention of politicians in order to avoid the risks of undue lobbying.
1. Gornall J. Big tobacco, the new politics, and the threat to public health. BMJ 2019; 365:l2164 doi: 10.1136/bmj.l2164
Competing interests: No competing interests
BMJ 18 May 2019 “Investigation“ examines links between (Conservative) politicians and the Institute of Economic Affairs and in turn its “bullish libertarianism” and the denigration of the Nanny State.
The “Nanny State” as a term of abuse should be actively countered.
There are two elements to the Nanny state of relevance here -
1 Public Health interventions - eg immunisation and food hygiene standards
2 Public education on health matters
The first of these should be re-defined as the “caring state”.
The second as the “informative state”.
Information is needed to counter the advertising and marketing by what we should call “exploitative business”. It is of course the case that the Tobacco business has spent far more on advertising and promotion than any state-funded anti-smoking campaign.
The “caring state” is also needed to ensure that standards are maintained in the food business, where in eg meat supply we have seen criminal activity, and also needed to counter the use of nutritionally unsound ingredients – eg fructose syrup, added sugar added to prepared and processed foods by “greedy business”. The addition of nicotine and flavourings to cigarettes is big tobacco's greed-driven examples.
So let's stand up for Nanny
Incidentally I worked for the Nanny state for many years. It was and perhaps still is called the NHS
Competing interests: No competing interests
I for one would look forward to the day when the nanny state is off my back. There was never any groundswell of public opinion to ban smoking in pubs, and it led to 12,000 pubs closing, 10,000 Working Mens clubs closing and over 100,000 people losing their jobs.
It is a basic tenet of liberty that the individual is left alone and it is an affront to control them unless it is interfering with a third party.
Philosophically many of the draconian taxes on cigarettes and minimum pricing of alcohol are taxes on the poor. The poorest fifth of the country spends 22% of its net available income on tobacco. Why should poor people who like a can of lager in the evening pay more due to state dictat?
After the smoking ban started in 2007 smoking rates were 23% and then display bans, vending machine bans and plain packaging soon followed. The smoking rate in 2013 was 22%, hardly any change. Today it is nearer 17% due mainly to electronic cigarettes. In the late 1970s tobacco companies were designing safer alternatives, but were blocked or unsupported by governments. The American Surgeon-General Everett Koop said in 1984 that there was no need for these replacements as “America will be smoke-free by 2000.” How many millions of people could have been saved if these safer alternatives had been introduced?
Electronic cigarettes are an entirely free market and a real competitor to cigarettes. They are a product of free market capitalism, not something designed by government and hence effective.
I could not help laughing at Scotland, one year after minimum priced alcohol actually started drinking more. Again state interference has been totally unsuccessful.
In conclusion, the nanny state is not only authoritarian it is largely ineffective and a waste of scarce resources.
Competing interests: I regularly attend IEA events which have free refreshments. I have written two articles for the IEA that have been published on their blog, for which I received zero remuneration. I have never been paid, expensed, or received grace and favour from tobacco companies or their nominees. However, I have been paid and expensed by pharmaceutical companies who make nicotine replacement products.