Can’t have those nurses smoking; bad PR you see

The National Institute for Health and Care Excellence (not so NICE) wants hsopitals to ban smoking completely:

“We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances,” said Professor Mike Kelly, director of Nice’s centre for public health, which drew up the new guidance. It is a “contradiction” for the NHS, which spends £2.7bn a year treating smoking-related ilnesses, to let patients smoke and not do everything it can to wean them off their habit, he added.

It’s the smug classicism that puts the particularly rancid icing on this shit cake. There’s a place and time to get people to stop smoking and it’s not when they’re stressed out, tired and hurting in hospital. Removing smoking shelters from your hospital won’t stop people smoking, it just means that they smoke outside in the wind and rain. Sometimes there are worse problems than having people smoke, for example being a smug condscending prick who wants to take away what little pleasure people can get in hospital.

Reading this made me so angry because I’ve been there with Sandra when the VU hospital decided — over Christmas — to shut down their indoor smoking rooms because some cow took offence to them, so she had to trundle outside into the cold, in her wheelchair (or bed even) to get about the only bit of comfort she had during the two years she had to spent in hospital.

Mind you, it would get worse for the staff:

Under the proposals hospitals’ entire grounds would become non-smoking areas, smoking shelters would be banned and staff contracts would forbid them from “smoking during work hours or when recognisable as an employee, for example when in uniform or wearing identification or handling hospital business”.

This really is the enforcement of a priggish morality under the guise of health concerns, because why else would you be bothered by people smoking in uniform? NHS staff isn’t paid nearly enough to be this kind of role model.

Health care as a moral issue

Alex talks about medical surveillance technology and the assumptions driving it and how wrong they can be and in the process makes a point that can be applied more generally:

Now, there is obviously some truth to this. Giving up smoking is a really good idea, as is taking your damn pills. But it is also highly problematic. For one thing, it assumes that the problem is non-compliance. In that sense, it transfers your problem from the domain of reality – a physical problem to be solved – into the domain of morality – a statement about good and bad. Rather than being poor, stressed, addicted, etc, the problem is that you are wrong and a bad person. As a rule, this is normatively evil, and of course it only works if the problem is not actually a real problem.

I’ve seen this sort of reasoning play out, or at least this was what it looked like from the outside, in the hospital Sandra stayed in for most of the last two-three years of her life. Sandra was a smoker, had been for decades and while fully aware of the risks, she also was certain that this would not be the thing that killed her and of course she was right… For her, as for many other people, the short term benefits of having a quick fag were more important than the long term health consequences.

Now when she first went into hospital it still have a couple of smoking rooms on the premisses, where both staff (more of whom smoked than you’d expect) and patients could go to. Then one day, in the middle of winter these were closed down because some busybody in higher management decided they don’t belong in a hospital. So now all those patients had to trundle out in the cold to get their fix, which certainly for Sandra didn’t do much for her health.

It’s that sort of attitude where the health health health message has to be driven home, even to people who are in no state to quit smoking, who are dealing with much more immediate problems and need the stress release fags offer. No, people need to be harassed and bullied into doing the right thing, even when it’s inappropriate.

Make booze boring for a safer Britain: support CAMRA

Social anthropologist Kate Fox thinks the British are wrong in blaming alcohol for antisocial behaviour and that it’s in fact a cultural thing:

In high doses, alcohol impairs our reaction times, muscle control, co-ordination, short-term memory, perceptual field, cognitive abilities and ability to speak clearly. But it does not cause us selectively to break specific social rules. It does not cause us to say, “Oi, what you lookin’ at?” and start punching each other. Nor does it cause us to say, “Hey babe, fancy a shag?” and start groping each other.

[...]

We become more outspoken, more physically demonstrative, more flirtatious, and, given enough provocation, some (young males in particular) become aggressive. Quite specifically, those who most strongly believe that alcohol causes aggression are the most likely to become aggressive when they think that they have consumed alcohol.

Which means that any attempt to limit booze related antisocial behaviour that focuses on alcohol as the evil spirit motivating this is counterproductive:

The drinkaware website, for example, warns young people that a mere three pints of beer (ie a perfectly normal evening out) “can lead to anti-social, aggressive and violent behaviour”, that “you might start saying things you don’t mean and behaving out of character”, that alcohol is implicated in a high percentage of sexual offences and street crimes, and that the morning after “you may wonder what you did the night before”.

Instead, booze should be made into something a bit boring and stop being used as an excuse for people to be assholes:

I would like to see a complete change of focus, with all alcohol-education and awareness campaigns designed specifically to challenge these beliefs – to get across the message that a) alcohol does not cause disinhibition (aggressive, sexual or otherwise) and that b) even when you are drunk, you are in control of and have total responsibility for your actions and behaviour.

Alcohol education will have achieved its ultimate goal not when young people in this country are afraid of alcohol and avoid it because it is toxic and dangerous, but when they are frankly just a little bit bored by it, when they don’t need to be told not to binge-drink vodka shots, any more than they now need to be told not to swig down 15 double espressos in quick succession.

Which is why we should support CAMRA, the Campaign for Real Ale, because how much more boring can booze be than if it’s drunk by middle aged, science fiction reading bearded folkies?

Nicotine-Use Disorder .. Wait, what?

Found via Unspeak, from a draft proposal to the new Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association: nicotine use disorder:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period

Which is followed by a list of supposed symptoms of this, including gems like “Craving or a strong desire or urge to use a specific substance” and “there is a persistent desire or unsuccessful efforts to cut down or control substance use”. All the symptoms are on this “well, duh” level or generic to any sort of addiction, as if the proponents of this addition have just cut and pasted a list of symptoms in under various headers, as indeed somebody has.

Does it matter, this reclassifying of various addictions as “disorders”? I think so, as it’s both offensive and misleading to suggest that somebody who is addicted to cigarettes, booze or drugs is immediately suffering from a disorder. You may have problems, sure, but are they psychiatric problems? Or do you just, engage in behaviour psychiatrists have labeled as such, like homosexuality used to be until surprisingly recent? Attempting to solve such “disorders” with psychiatric methods is liable to cause more damage than do good, while the medicalisation of societal problems does nothing to address their root causes. You can’t solve everything with a little blue pill.

Dutch mayors call for legalised cannabis

Amsterdam coffeeshop

Only a few weeks ago it seemed the Dutch tolerance towards soft drugs would end soon, due to the increasing strength of the puritan movement in Dutch politics. Magic mushrooms are already banned, while the future of the coffeeshop seemed limited, due to cheese paring measures forced on city councils like the rule that no coffeeshop could be located within 500 metres of a school. Try and find a coffeeshop in Amsterdam that doesn’t…

Meanwhile the growing troubles caused by socalled drugs tourists from France, Germany and Belgium in border towns had already led several of those towns to close down their coffee shops altogether. The future therefore seemed bleak for the ordinary cannabis user in the Netherlands, who smokes it recreationally or to relief pains and nausea (for which it works quite well, as I’ve seen myself, better than many conventional pain killers or nausea relievers). Though the system had worked reasonably well for some three decades, making going to the coffee shop almost as normal as going down the local for a quick pint and a half, it had always been a stopgap, an attempt to regulate cannabis trade without legalising it, as that would be difficult to explain abroad. It was introduced as a measure to free police resources for the battle against hard drugs as well as to limit the dangers of cannabis users “graduating” towards harder drugs. As such it worked well, but there never was the intention on the part of the authorities to go any further towards legalisation. It was a policy they were forced into but never were comfortable with.

Tolerance as a policy, even had it had the full support of politicians and police, could never continue forever. The inherent contradictions of the policy, which made it semi-legal to buy and sell cannabis at a retail level, but illegal to sell wholesale, let alone grow it, would see to this. But because we could never make the choice of legalisation without incurring the wrath of France and America, nor end Tolerance altogether the situation did continue. The hobbyists and smalltime growers who had been the base of the cannabis culture in the Netherlands were driven out by organised crime causing huge problems for many city councils.

The way these criminals operate is to go to an impoverished neighbourhood in Rotterdam or Tilburg or someplace simular and get a front man to hire a house from the council or housing society. This is then turned into a full blown industrial cannabis nursery, powered by stolen electricity from the neighbours. They only need to keep the flat on for several months, until harvest time, then disappear and make a huge profit selling their harvest to the coffeeshops. Despite everything the councils do to combat this, there’s little risk for the real criminals themselves: they leave everything to their patsies.

So it’s no wonder that the mayors of some thirty cities, including Amsterdam, last Saturday called for an end to this situation, by regulating the “backdoor of the coffeeshop”. What they want is to legalise the growing of cannabis by putting it under state supervision and allowing coffeeshops to legally buy their supplies from these suppliers. This would end the involvement of organised gangs, regulate the awkward situation the coffeeshops themselves are in now where they’re forced to buy from criminals, not to mention provide amuch needed source of income for local councils. It’s a good idea, but at the moment it still seems unlikely the central government will take the councils on, as the governing parties are largely opposed to legalisation.

No more coffeeshops in 2010?

That’s what one criminology professor says in an interview (Dutch). Henk van de Bunt, who last year co-wrote a report on the growing of marijuana in the Netherlands and the growing interest organised crime has in it, says continuing foreing pressure as well as this growing criminalisation of softdrugs that will lead to the end of the Dutch tolerance for it. The problem is that while buying and selling softdrugs is tolerated (not legal, just not actively prosecuted), growing it and selling it wholesale isn’t. And while growing weed once was done by amateur and homegrowers, organised crime has gotten increasingly involved with it. It’s this creeping criminalisation that will be the death of the coffeeshop, according to van de Bunt.

Now there have always been predictions about the end of tolerance as long as this policy has existed, but this time this prediction might be more accurate than usual. In the past decade the Dutch police has become much more aggressive in combatting the growing marijuana, which has driven out the amateurs and hobbyists as they can’t take the risks anymore. Meanwhile political pressure, both on council and national level to limit tolerance has increased as well. A few weeks ago for example two councils near border with Belgium decided to close down all coffeeshops in their cities because of troubles caused by drugs tourism, while the current government has pledged to forbid coffeeshops from opening near schools.

This is all part of an unspoken campaign to end tolerance of softdrugs not be explicitely ending it, but by making it so unworkable that it has to be ended. By going after the homegrowers the police has encouraged the spread of organised crime into the cannabis trade, which makes the case for ending tolerance that much easier. You can’t argue that ending tolerance will drive the trade udnerground if much of it already is in the hands of the mob anyway. The other prong of this campaign is to put more and more “reasonable” restrictions and demands on coffeeshops, to make it harder to open one or keep one open, death by a thousand cuts. To completely end tolerance has not yet been politically viable, but the van de Bunt is right to think it’s not that far off anymore, thanks to this silent campaign.

A better solution would be to legalise softdrugs completely, both retail and wholesale and make the growth of them a state monopoly. Chances of that happening are not so good though…