To the Royal College of Physicians for their conference on Global Health. I was asked to speak about international trade and health so I chose as my title “Opium, tobacco and alcohol: the evolving legitimacy of international action”. My argument went as follows. We all agree that, in most cases, international trade brings great benefits. Each country does things where it has a competitive advantage. I enjoy mangoes but it would be a bit silly of me to try to grow a mango tree in my garden in north London (although with global warming you never can tell). Yet there is a down side. The problems arise when what are being moved around the world are not the usual “goods” but rather “bads”. Few people really think that flying tons of AK-47s into the Democratic Republic of Congo is a good idea (except of course those doing the flying and those supplying them from places like the Trans-Dneister republic – see Misha Glenny’s new book - McMafia: Crime Without Frontiers ). Similarly, landmines are now fairly universally regarded as a “bad”. But what is it that changes a “good” into a “bad”?
I began by looking at one of the best known examples. In the middle of the 19th century British forces went to war with China (twice) to protect our right to sell opium to China. China certainly didn’t want it – it realised that it was causing harm to its population and even threatened to retaliate by banning exports of rhubarb to Britain, in the hope that this would inflict widespread constipation. Yet it was the opium harvest that lay behind the economic success of now British Bengal. Over a century later we were still at it, as Christopher Bayly describes in his excellent book on the British withdrawal from SE Asia, as we imported massive amounts of opium to ensure that the Malayan population kept working even though there was no food. Yet now the Royal Navy patrols the high seas, interdicting cocaine smugglers in the Caribbean (and anywhere else it can find them). What turned us from a trafficker to a policeman?
The same sort of change is taking place with tobacco. Here we have a product that has killed more people than all the wars of the twentieth century yet we (or at least our political leaders) still treat the manufacturers and distributors in the same way as people who make things that actually benefit us. It really is remarkable. These people are peddling their deadly products to children all over the world in a way that is really no different to the traffickers who hand around school gates trying to hook kids on heroin. Yet while no-one would invite the drug traffickers to be photographed with our political leaders, there seems to be no barriers for tobacco company executives. In the past, when countries such as Thailand stood up to the USA and said that they didn’t want tobacco imports, the USA threatened trade sanctions. Imagine what would happen if Bolivia took the USA to the World Trade Organisation for blocking exports of cocaine (although, again, anything is possible).
Except, there are some signs of hope. The Framework Convention on Tobacco Control does make clear that tobacco is not just another product and that governments can put in place a range of measures to counteract the aggressive marketing of tobacco without being accused of erecting non-tariff barriers. So tobacco is steadily being transformed from a bad to a good.
What of alcohol? Obviously this is more difficult as moderate consumption is clearly good for you, providing you are at risk of heart disease (if you are under 40 you are just kidding yourself – the net effect is harmful, sorry). Yet the alcohol industry seems to be doing everything possible to move into the corner with the makers of “bads”. Recently (as I described in an editorial in the BMJ) when discussions on a European alcohol policy were taking place, the Brewers of Europe published a remarkable report purporting to show that there really was very little evidence that alcohol was at all harmful. They commissioned it from the Weinberg Group, a consulting firm that had previous tried to convince us that the health effects of smoking were exaggerated and that Agent Orange was not such a bad thing after all. Their report argued that that "there is not enough evidence to substantiate a link between alcohol advertising and consumption," raising the question of why the industry spends so much money promoting its products, and that "violence is a subjective term which is fairly nebulous and elastic," a view unlikely to be shared by someone scarred by a bottle wielded by a drunk. Clearly, if the alcohol industry continues with tactics such as this, it cannot be surprised if we begin to consider the need for concerted international action, building on the experiences with narcotics and tobacco.