Whatever your views on abortion, the fight over abortion in the Obama health plan illustrates perfectly why government should stay out of health care.

When the government subsidizes health care, anything you do with that money becomes the voters' business. And rather than allow for choice between different ways of doing things, the government typically imposes the preferences of the majority — or sometimes, a vocal minority — on everybody.

On Saturday, the House of Representatives passed their version of President Obama's health care overhaul. Among other things, the legislation would subsidize private health insurance for millions of Americans.

To appease pro-life Democrats, Speaker Nancy Pelosi (D-Calif.) allowed them to insert an amendment to prohibit taxpayer dollars from touching any health insurance plan that covers abortion. House Majority Whip Jim Clyburn (D-S.C.) says the bill would have come up 10 votes short without it.

The amendment incensed pro-choice Democrats. The bill's subsidies would be so pervasive that prohibiting the use of taxpayer dollars for abortion coverage would restrict access to such coverage even for women who don't use the subsidies. Rep. Diana DeGette (Colo.) says she and 40 other pro-choice Democrats "are not going to let this into law."

Democratic leaders are searching for a compromise, but there is no way to split the baby here. Either the government will force taxpayers to fund abortions, or the restrictions necessary to prevent taxpayer funding will reduce access to abortion coverage. There is no middle ground. Somebody has to lose. Welcome to government-run health care.

The same thing happens, in all areas of health care, whenever government foots the bill. Do you think chiropractic is nonsense? Too bad, the government forces you to pay for it through Medicare.

Faith healing seem like quackery too you? Sorry, Charlie. Medicare and Medicaid force you to pay for faith healers at prices "comparable with those of real health care providers," according to law professors David Hyman and Charles Silver.

The problem extends far beyond those trivial examples. The government uses price and exchange controls to pay health care providers. We call those controls Medicare's "fee-for-service payment system" in polite company. Yet the effects are anything but genteel.

Researchers believe Medicare's exchange controls encourage unnecessary services, which account for at least one third of its $430 billion budget, according to the Dartmouth Atlas. Those controls actually penalize doctors and hospitals that coordinate care, use electronic medical records, or try to reduce the estimated 100,000 annual deaths due to medical errors. Congress has "reformed" Medicare's exchange controls approximately once in the program's 43-year history, with a "payment system" that encourages an estimated $12 billion of avoidable hospitalizations per year.

President Obama's economic advisor Larry Summers sums it up: "Price and exchange controls inevitably create harmful economic distortions. Both the distortions and the economic damage get worse with time."

Should grandma want to escape Medicare's price and exchange controls — if she would rather see a doctor that operates under less-perverse financial incentives — too bad. If she would prefer a smaller network of doctors that provides safer, more convenient, coordinated care, she's out of luck. The choice of what kind of medicine she receives belongs to the majority, or a vocal minority.

To be fair, the Medicare Advantage program allows some seniors to escape the traditional Medicare program's price and exchange controls. But Medicare Advantage has its own perversities, thanks to a separate price-and-exchange-control scheme the government uses to pay participating insurers. And in keeping with the overall hypothesis, Democrats are trying to eliminate Medicare Advantage, anyway.

Pro-choice Democrats want to preserve access to private abortion coverage. Pro-life Democrats want to preserve the right to choose whether to fund abortions. Fair enough. But any vote for government subsidies is a vote against choice.

Get government out of health care, and you'll be able to make choices for yourself. Not before.

None of this was supposed to happen, of course. During the recent UK debate over banning tobacco displays, the government repeatedly assured parliamentarians that not only would such a ban not increase the already large UK illicit market (HMRC estimates that 26 percent of all cigarettes consumed in the UK are non-duty paid and some 70 percent of seized cigarettes are counterfeit), but it would result in a significant decline in smoking, particularly among young people.

But the evidence from across the Irish Sea shows that both of these claims are simply false.

There are several reasons why banning tobacco displays drives the illicit tobacco market. First, by putting all tobacco products under the counter, a display ban undermines the belief that tobacco is a legal, regulated product and that selling and consuming counterfeit and smuggled tobacco products are crimes. Surveys in Canada have found, for example, that a majority of Canadians who buy illicit cigarettes do not believe that they are committing a crime.

Second, display bans fuel the illicit tobacco market by making it more difficult for customers to distinguish between legal and illegal products, since all tobacco is hidden from view. Third, display bans make it easier for dishonest store keepers to mix illicit and untaxed tobacco products and legitimate taxed cigarettes and thus to pass off illicit products.

Fourth, display bans make it more difficult for enforcement agencies, already overtaxed, to identify illicit tobacco products since all tobacco products are hidden from view. Fifth, through blurring the distinction between above and below the counter products, between legal cigarettes and illegal cigarettes, a display ban makes it more likely that smokers will increasingly get their tobacco from illegal as opposed to the legal and regulated tobacco market.

But banning tobacco displays not only drives the illicit cigarette market; it also does nothing to reduce smoking. To return to Ireland again, a just-released EU survey found that 33 percent of the Irish population smoked, which is the highest rate in the last eleven years. Since 2007, tobacco taxes have increased and tobacco displays banned, but smoking prevalence has increased from 29 percent to 33 percent. Even more alarming is the fact that the largest cohort of smokers is now aged 16-30.

The same lack of effectiveness for draconian smoking measures, such as a public smoking ban, is found in England. The NHS recently released a study, 'Statistics on Smoking', which found that the public smoking ban had not resulted in a statistically significant decline in smoking. Indeed, certain groups, such as young males, are in fact smoking more than before the ban.

Part of the reason for these increases in smoking, particularly in the young, is that many smokers find these heavy-handed measures unacceptable. They are what psychologists call 'reactant', that is, they push back against regulation and assert their freedom through engaging in the very activity that the state is trying to prevent.

Hence, far from preventing smoking, measures like a display ban actually encourage it in those young people already most susceptible to begin smoking.

Therefore, in a UK with a tobacco display ban, we can expect to see not only more smokers, particularly young smokers, but also an enormous increase in illegal, unregulated, and untaxed cigarettes. That's quite the public health 'success'.

The truth about second-hand smoking is finally out.

Thanks to some unusual candour on the part of the anti-tobacco brigade in New York City, we now have official confirmation that banning smoking in public has absolutely nothing to do with protecting the health of non-smokers from second-hand smoke, but everything to do with stigmatising both smoking and smokers. Closer to home, new evidence from the National Health Service (NHS) shows that the public smoking ban in England has made absolutely no positive difference in smoking rates, despite claims made by its champions that it would.

In September, Dr Thomas Farley, New York City's Health Commissioner, proposed banning smoking at all of the city's parks and beaches (1). Dr Farley's rationale for the ban has nothing to do with the risks that outdoor smoking pose to non-smokers, but rather with preventing people, particularly children, from having to see anyone smoking in public. Farley says, 'We don't think children should have to watch someone smoking'. Farley also defends the extension of the smoking ban to outdoor areas by arguing that it is 'part of a broader strategy to further curb smoking rates'. New York mayor, Michael Bloomberg, confirmed earlier this month that he would implement Farley's proposal, arguing that the public is 'overwhelmingly in favour' (2).

Why have the champions of banning smoking everywhere, even in private accommodation, suddenly come clean about the driving force behind their crusade? The answer is that they have essentially won the war over public smoking. But why is this the case? The answer, sadly, is that for the past 15 to 20 years, the public has been bombarded with a carefully orchestrated government-funded anti-tobacco campaign to convince them — in contradiction of the scientific evidence — that smokers pose a deadly health risk to non-smokers, particularly children.

The scientific evidence has never supported the case against public smoking. The US Environmental Protection Agency's seminal early 1990s report on second-hand smoke was severely flawed. Its critique of second-hand smoke was only sustained through a careful exclusion of non-confirming evidence and a non-traditional application of the statistical test known as confidence limits. The report was subjected to a scathing analysis by a US federal court, which rejected its scientific claims about the dangers of second-hand smoke, a finding that even on appeal was not reversed (3).

Moreover, a scientific study conducted by the World Health Organisation's International Agency for Research on Cancer found that there was no statistically significant association between smoking in the workplace and social settings and lung cancer in non-smokers. Indeed, the majority of studies about second-hand smoke and lung cancer in non-smokers have found non-statistically significant associations both in workplace and domestic settings.

Of course, none of this startling lack of scientific evidence has moved beyond the scientific journals and into the public domain, which means that the debate about public smoking is a non-scientific debate. And this means that it can proceed on virtually any grounds, unchecked by the need for careful and verifiable scientific evidence. The anti-smoking movement has always known that the evidence about the risks of public smoking, or private smoking for that matter, to non-smokers was marginal, at best, and nonexistent, at worst. But this was fundamentally unimportant.

Preventing people from smoking in public was never about real health risks - that is, it was never about protecting non-smokers so much as it was about stigmatising smoking and smokers and making it difficult for them to smoke. So with the science of second-hand smoke now never discussed, the anti-tobacco movement feels confident in moving the argument forward and revealing the starkness of its real agenda.

There is no compelling evidence that second-hand smoke poses a health risk to anyone in open spaces like public parks and beaches, but that is beside the point. The new push seeks, first, to demonise smoking and, second, to exert a brazen paternalism in which it is made virtually impossible for smokers — for their own good, of course — to light up in any public space.

There are profound difficulties with both of these objectives. For one thing, where is the justification for banning unhealthy behaviours from the public square simply on the grounds that someone might see them? Or, indeed, what is the justification for banning unhealthy behaviours from public viewing full stop? This opens up substantial room for prohibiting an enormous range of other behaviours which are neither immoral nor illegal, but simply unhealthy.

For example, by parity of reasoning it could be argued that children should never have to see anyone eating unhealthy foods in public, or indeed see anyone who is fat in public. Surely, there must be some evidence that seeing someone engaged in unhealthy behaviour puts others at risk. But where is this evidence?

For another thing, there is the issue of whether such measures actually work. For example, the NHS recently released a study on the effectiveness of the public smoking ban (4). The fact is that certain groups, such as young males, are smoking more after the smoking ban than before it. So, not only are such bans not supported by science, they are also not supported by the evidence on their practical effect in changing behaviour.

Finally, any policy by which the government engages in stigmatising the legal behaviour of its adult citizens is repugnant in a democratic society. Fundamental to democratic government is the respect that it owes to its adult citizens' choices about legal behaviour and, more fundamentally, how they choose to live their lives. Paternalistic interventions, whether through stigmatising or other means, can only be justified in the rarest of instances.

What the evolution of the debate over public smoking shows is how little science has to do with the anti-tobacco crusade, how disingenuous that crusade is about its real motives and goals, how easily the crusade on tobacco can be extended to other causes (most notably the war on obesity), and how fundamentally dangerous it is to a society both free and democratic.

(1) New York Eyes 'No Smoking' Outdoors, Too, New York Times, 15 September 2009 (2) Mayor Bloomberg vows to snuff out smoking in parks, beaches, New York Daily News, 1 October 2009 (3) For more on the EPA study, see An epidemic of epidemiology, by Rob Lyons (4) See Statistics on smoking, NHS, 29 September 2009 [pdf]

TOBAL is short for "There Oughtta Be a Law." Here's the progression of symptoms: Wrenching anecdotes about the effects of some alleged new trend make national news. A panic takes root in the media. Earnest editorialists scrawl urgent pleas for action. Politicians grandstand. Soon enough, we have our new law or regulation. It doesn't matter if the law is enforceable or may have unintended consequences. Nor does it matter if the law will have any actual effect on the problem it was passed to address. In fact, it doesn't even matter if the problem actually exists. The mere feeling that it exists is sufficient.

And so it goes with the panic over texting while driving. I'm not going to defend the act of clumsily thumbing out an E-mail while guiding a 2-ton, gasoline-loaded missile down the highway at 70 miles per hour. That's foolish. Nor will I argue there's some right to drive while iPhone-ing tucked into a constitutional penumbra. I will argue that we need to get over the idea that we can solve every bad habit with a new law. We can't, and this issue illustrates why.

Let's start with the alleged problem. Obviously, we have more people texting behind the wheel today than we did in, say, 1985. And undeniably, those people pose a threat. But it's hard to find definitive empirical support for the idea that our highways are awash in BlackBerry-spilled blood. Since 1995, there's been an eightfold increase in cellphone subscribers in the United States, and we've increased the number of minutes spent on cellphones by a factor of 58.

What's happened to traffic fatalities in that time? They've dropped — slightly, but they've dropped. Overall reported accidents since 1997 have dropped, too, from 6.7 million to 6 million. Proponents of a ban on cellphones say those numbers should have dropped more. "We've spent billions on air bags, antilock brakes, better steering, safer cars and roads, but the number of fatalities has remained constant," safety researcher David Strayer told the New York Times in July. "Our return on investment for those billions is zero. And that's because we're using devices in our cars."

Strayer would have a point if he were looking at the right statistics. But we drive a lot more than we did in 1995. Deaths in proportion to passenger miles are a far better indicator of road safety than overall fatalities. In 1995, there were 1.72 deaths for every 100 million miles traveled. By 2007, the figure had dropped to 1.36, a 21 percent decline. That's hardly remaining constant. But let's assume that even those numbers would be lower were it not for texting drivers. It's still far from clear that banning texting will make us safer. There are countless other driver distractions

that we'd never think of banning, from having kids in the back seat, to eating or drinking while driving, to fumbling with the radio. Certainly, it's foolish to type out text messages behind the wheel, but what about merely reading from your phone?

Are you more impaired following MapQuest directions from your Palm Pre while driving than reading them from a sheet of paper? What if you're looking at a GPS navigation device that's only slightly larger than your cellphone? What if the GPS system is on your cellphone?

That brings us to the enforceability problem. Maryland just passed a texting ban, but state officials are flummoxed over how to enforce it. The law bans texting while driving but allows for reading texts, for precisely the reasons just mentioned. But how can a police officer positioned at the side of a highway tell if the driver of the car that just flew by was actually pushing buttons on his cellphone and not merely reading the display screen? Unless a motorist is blatantly typing away at eye level, a car would need to be moving slowly enough for an officer to see inside, focus on the phone, and observe the driver manipulating the buttons. Which is to say the car would probably need to be stopped — at which point it ceases to be a safety hazard.

But let's say you're OK with a ban on reading cellphone messages, too. How would you write that law? Would you prohibit so much as a glance in the general direction of a cellphone while driving? Should we mandate that cellphones be stored out of the driver's sight while the car isn't in park? What about other things that might distract him from the road, like navigation systems? Shiny objects? Pretty girls in the passenger seat? How would you prove a driver was looking at a cellphone and not something near it?

If you want to increase the penalties for reckless driving, go ahead. If cellphone records show a driver was browsing baseball scores at the time he caused an accident, increase his fines and punishment. That at least makes some sense. But don't pass useless laws that will be arbitrarily enforced simply because "we have to do something."

We've seen similar nonsense on display with the general use of cellphones while driving. Though several states have passed bans, all make exceptions for hands-free devices. But we know the level of impairment of drivers using hands-free devices is essentially the same as that of drivers holding a phone. These laws aren't about safety; they're about symbolism.

Here are two things these bans will do: They'll give police officers another reason to pull people over, and they'll bring in revenue for the municipalities that aggressively enforce them. I think both are arguments against a ban. You may disagree, but the one thing these bans aren't likely to do is make the roads much safer. And if they won't accomplish that, there's no reason to enact them.

But shed no tears for Chicago. As a 2006 report from Europe's leading tourism trade association concluded, there's "little evidence of any benefit to tourism from hosting an Olympic Games, and considerable evidence of damage." With a projected half-billion-dollar deficit next year, the Second City is better off without the Games.

We can't say the same for Obama's reputation after his in-person appeal failed to get his adopted hometown past the first round of voting. What new project can the president undertake to save face?

How about ... reforming college football? In a post-election 60 Minutes interview last November, Obama called for selecting the national champion via an eight-team playoff: "I'm going to throw my weight around a little bit. I think it's the right thing to do."

Perhaps those of us who oppose national health care and cap and trade shouldn't complain that the president seems so easily distracted. But you have to wonder: Does Obama think there's anything too frivolous to merit the president's attention?

Obama's failed Olympic gambit was dumb politics. But it's also bad policy for the president to involve himself in nonpresidential issues, reinforcing as it does an infantile and unhealthy view of presidential responsibility.

Obama didn't invent that view of the presidency, he inherited it. Over the course of the 20th century, the public, conditioned by the media's relentless focus on presidential action, came to view the chief executive as a national father-protector, with a purview far broader than the limited role the Constitution sets out for him.

Nor is Obama the first president to involve himself in minutia. In his 2004 State of the Union, for example, President George W. Bush urged major-league baseball and football to "get tough, and get rid of steroids now."

And Bush periodically played the role of national fitness coach, meeting with food company executives to hammer out "a coherent strategy to help folks all throughout our country cope with" childhood obesity.

Faithfully executing the laws, protecting the country from foreign attack — and helping Americans "cope" with their kids' Dorito cravings — the president's portfolio is vast indeed.

But Obama has forged new frontiers in triviality. He's the president of all things great and small: He calls for "a cure for cancer in our time" while also promising to stand behind the warranty on your new Ford Fusion.

With the two wars he's running and his ceaseless efforts to micromanage the U.S. economy, you'd think he'd have plenty to do. But in his televised speech to America's schoolchildren last month Obama took time out to urge students "to stand up for kids who are being teased" and "wash your hands a lot."

He just can't help himself. Six months into his presidency, the Politico reported, Obama had already "uttered more than half a million words in public." In one whirlwind week last month, the president made his third appearance on "60 Minutes," gave a major speech on the financial crisis the next day, and made a record five talk-show appearances the following Sunday. And on the eighth day, he did Letterman.

Obama's incontinent approach to presidential responsibility doesn't seem to be helping him politically, however. August was the toughest month of his young presidency, and it began with the ridiculous "beer summit," in which the president gratuitously injected himself into a disputed arrest by a local cop in Cambridge, Mass.

Given how much bloom has come off the rose since then, Obama's decision to stake some prestige on securing the Olympics is baffling. What was the point of getting himself into an irrelevant fight that he might well lose?

More importantly, why would Obama go out of his way to encourage the public's irrationally broad view of presidential responsibility? Isn't the president's job hard enough?

Obama has become the omnipresent omnipresident. But a man who is everywhere, promising to do everything, may end up accomplishing very little, and he's sure to disappoint.

Unfortunately, neither of these claims nor policies meets the standards of evidence-based policymaking. Both are, instead, products of advocacy-based 'research' carried out by anti-tobacco lobby groups.

In evidence-based policymaking, as in evidence-based clinical medicine, practices and decisions are based on rigorous, systematic reviews of 'best practice', that is, therapies and interventions that work the best in reducing morbidity and mortality. Evidence, and evidence alone, not theory or tradition, drives practice.

The empirical record about tobacco advertising's affect on young people is decidedly mixed. Large independent studies have failed to find a statistically significant connection between tobacco advertising, consumption, and youth smoking. Indeed, the two major UK government-commissioned studies on tobacco advertising and marketing failed to find a causal link between advertising and young people starting to smoke.

This lack of evidence is confirmed by the fact that countries that have had advertising bans for a quarter century or more have not experienced statistically significant declines in youth smoking. Consumption and prevalence data from 145 countries finds little evidence that the entire range of tobacco control measures, including advertising restrictions and bans, has a statistically significant effect on smoking prevalence in any country.

Yet, the government pushes ahead with increasingly draconian restrictions on tobacco advertising through legislation to ban the display of all tobacco products. Even though the Department of Health claims that there is substantial evidence to show that such bans will reduce youth smoking, this is not the case.

The evidence in support of tobacco display bans, just as for tobacco advertising bans, is embarrassingly thin. Most studies show that tobacco displays have no statistically significant effect on youth smoking.

The most frequently quoted studies actually found that seeing tobacco displays had no effect on youth intentions to smoke. None of the so-called evidence about tobacco displays provides compelling behavioural evidence that any young person started smoking after seeing tobacco displays.

The evidence from the experience of other countries who have tried display bans does not support the claim that they reduce youth smoking. The government has repeatedly claimed that Canada, where several provinces have banned tobacco displays, shows that such bans result in fewer tobacco sales and fewer youth smoking.

The government knew that this claim, and the evidence that it was based on, was not true. Recently released DoH correspondence shows that the government was told in a March 2009 email that removing tobacco displays in Canada 'has not caused a decline in tobacco sales or discourage[ed] kids from smoking'.

Yet, the anti-tobacco lobby continues to push for even more far-reaching tobacco control legislation. This past week, Action on Smoking & Health (Ash) trumpeted a new study about the influence of tobacco packages as proof that putting all tobacco products in plain packages was now required. Ash's Deborah Arnott told the BBC that: "This research shows that the only way of putting an end to this misleading marketing is to require all tobacco products to be sold in plain packaging."

What Arnott did not tell the BBC was that she and Martin Dockrell, Ash's campaign manager, were not only two of the authors of the very study they so fulsomely praised, but Ash, along with the DoH, paid for the study.

Considerable previous research has shown that plain packaging of cigarettes will do nothing to reduce youth smoking. A study from Canada's York University, which asked young people about what effect plain packaging would have on their smoking decisions, found that 90 percent of daily smokers said they would smoke more or the same if cigarettes were in plain packages.

What then of high taxes to discourage or prevent youth smoking?

The claim that high tobacco taxes will reduce smoking is an odd one since we have been taught that smoking is addictive. If smoking is addictive, logic dictates that smokers will be insensitive to price increases.

But the claim also runs counter to what most experts say about how young people smoke. Most young smokers are experimental smokers who do not buy their cigarettes, but instead get them from friends or family, which makes them much less sensitive to high tobacco prices.

Data from the US National Household Survey on Drug Abuse recently showed that over 85 percent of 12-18 year old smokers consume the three most expensive brands of cigarettes, a fact that is also difficult to square with the claim that young people are price sensitive.

A series of American longitudinal studies has found tax increases have a statistically insignificant effect on preventing young people smoking. Last year, in a study of tobacco control policies in 27 European countries, it was found that, for adolescents, price was unrelated to smoking prevalence.

Tax increases do succeed, however, in increasing the risk of smoking. Jerome Adda and Francesca of University College London found that a one percent increase in tobacco taxes increases smoking intensity by 0.4 percent, which leads the smoker to inhale more dangerous chemicals and causes cancer deeper in the lung.

The result of public health policymaking absent of evidence is tobacco policy that repeatedly fails to address youth smoking. While the government is entitled to its own opinion about the most effective ways to reduce smoking, it is not entitled to its own evidence.

The members of that ultimate federal board will themselves not have examined or seen the patient in question. For another example of the growing, tumultuous resistance to "Dr. Obama," particularly among seniors, there is a July 29 Washington Times editorial citing a line from a report written by a key adviser to Obama on cost-efficient health care, prominent bioethicist Dr. Ezekiel Emanuel (brother of White House Chief of Staff Rahm Emanuel).

Emanuel writes about rationing health care for older Americans that "allocation (of medical care) by age is not invidious discrimination." (The Lancet, January 2009) He calls this form of rationing — which is fundamental to Obamacare goals — "the complete lives system." You see, at 65 or older, you've had more life years than a 25-year-old. As such, the latter can be more deserving of cost-efficient health care than older folks.

No matter what Congress does when it returns from its recess, rationing is a basic part of Obama's eventual master health care plan. Here is what Obama said in an April 28 New York Times interview (quoted in Washington Times July 9 editorial) in which he describes a government end-of-life services guide for the citizenry as we get to a certain age, or are in a certain grave condition. Our government will undertake, he says, a "very difficult democratic conversation" about how "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care" costs.

This end-of-life consultation has been stripped from the Senate Finance Committee bill because of democracy-in-action town-hall outcries but remains in three House bills.

A specific end-of-life proposal is in draft Section 1233 of H.R. 3200, a House Democratic health care bill that is echoed in two others that also call for versions of "advance care planning consultation" every five years — or sooner if the patient is diagnosed with a progressive or terminal illness.

As the Washington Post's Charles Lane penetratingly explains (Undue influence," Aug. 8): the government would pay doctors to discuss with Medicare patients explanations of "living wills and durable powers of attorney … and (provide) a list of national and state-specific resources to assist consumers and their families" on making advance-care planning (read end-of-life) decisions.

Significantly, Lane adds that, "The doctor 'shall' (that's an order) explain that Medicare pays for hospice care (hint, hint)."

But the Obama administration claims these fateful consultations are "purely voluntary." In response, Lane — who learned a lot about reading between the lines while the Washington Post's Supreme Court reporter — advises us:

"To me, 'purely voluntary' means 'not unless the patient requests one.'"

But Obamas' doctors will initiate these chats. "Patients," notes Lane, "may refuse without penalty, but many will bow to white-coated authority."

And who will these doctors be? What criteria will such Obama advisers as Dr. Ezekiel Emanuel set for conductors of end-of-life services?

I was alerted to Lanes' crucial cautionary advice — for those of use who may be influenced to attend the Obamacare twilight consultations — by Wesley J. Smith, a continually invaluable reporter and analyst of, as he calls his most recent book, the "Culture of Death: The Assault on Medical Ethics in America" (Encounter Books).

As more Americans became increasingly troubled by this and other fearful elements of Dr. Obama's cost-efficient health care regimen, Smith adds this vital advice, no matter what legislation Obama finally signs into law:

"Remember that legislation itself is only half the problem with Obamacare. Whatever bill passes, hundreds of bureaucrats in the federal agencies will have years to promulgate scores of regulations to govern the details of the law.

"This is where the real mischief could be done because most regulatory actions are effectuated beneath the public radar. It is thus essential, as just one example, that any end-of-life counseling provision in the final bill be specified to be purely voluntary … and that the counseling be required by law to be neutral as to outcome. Otherwise, even if the legislation doesn't push in a specific direction — for instance, THE GOVERNMENT REFUSING TREATMENT — the regulations could." (Emphasis added.)

Who'll let us know what's really being decided about our lives — and what is set into law? To begin with, Charles Lane, Wesley Smith and others whom I'll cite and add to as this chilling climax of the Obama presidency comes closer.

Condemning the furor at town-hall meetings around the country as "un-American," Harry Reid and Nancy Pelosi are blind to truly participatory democracy — as many individual Americans believe they are fighting, quite literally, for their lives.

I wonder whether Obama would be so willing to promote such health care initiatives if, say, it were 60 years from now, when his children will — as some of the current bills seem to imply — have lived their fill of life years, and the health care resources will then be going to the younger Americans?

No one ever accused Palin of being a health policy expert, and many found her hyperbolic term "death panel" off-putting. But that should not distract voters from this reality: President Obama has proposed a new body that would enhance Medicare's ability to deny care to the elderly and disabled based on government bureaucrats' arbitrary valuations of those patients' lives.

It is right there in the legislation now before Congress, and it is called the Independent Medicare Advisory Council.

Medicare already has the statutory authority to reduce the amount it will spend on elderly and disabled patients, but largely cannot exercise that authority. Federal law says that Medicare may deny coverage for services that are not "reasonable and necessary," but gives no guidance on what "reasonable" and "necessary" mean. That effectively leaves the issue in the hands of the bureaucrats at the federal Centers for Medicare & Medicaid Services.

"In theory," writes Tufts Medical Center's Peter Neumann and colleagues, "the CMS could interpret Medicare's statutory authority to cover 'reasonable and necessary' services as a license to use cost-effectiveness analysis," i.e., to deny care. "To date," however, "this course has proved to be impossible."

Why? Political resistance from the medical industry (which prefers that Medicare pay for everything) and the Sarah Palins (who don't trust bureaucrats to make those decisions) prevent Medicare from using cost-effectiveness criteria. Former CMS chief Mark McClellan notes that a mixed record of judicial interpretations and some specific congressional actions, for example on broad coverage of cancer treatments, have tied Medicare's hands somewhat. But he agrees: "I do think that political pressures have limited the agency's ability to go further."

Enter the Obama administration, which submitted to Congress legislative language that would create IMAC and give it broad authority to recommend "reforms to the Medicare program." In effect, IMAC would enable Medicare to overcome the political resistance to government rationing.

Some facets of Medicare would be beyond the reach of IMAC's unelected bureaucrats — but not Medicare's interpretation of "reasonable and necessary." The stimulus bill and the House reform plan deny federal agencies conducting comparative-effectiveness research the power to "mandate coverage, reimbursement, or other policies for any public or private payer." Obama places no such restrictions on IMAC.

Unless Congress rejects IMAC's recommendations within 30 days, they would become law. The administration would have license to implement them "notwithstanding any provisions of this Act or any other provisions governing the Medicare program."

Palin was dead wrong about a separate proposal to have Medicare cover advance care planning. Paying doctors to help seniors sort out their preferences for end-of-life care is consumer-directed rationing, not bureaucratic rationing.

Yet that error hardly excuses the media's mishandling of Palin's "death panel" claim, particularly since Obama himself corroborates it. Obama's first pick to head his health reform efforts — former Senate Majority Tom Daschle — proposed an IMAC-like panel despite the fact that "doctors and patients might resent" the panel making decisions about "matters of life and death." Back in June, in response to a question about "subjective" end-of-life decisions, President Obama said, "I think we have to have rules." And who would make those rules? His IMAC proposal tells us.

Lest you think this too Orwellian to become reality, consider that this type of government rationing already happens in the United Kingdom. Britain's National Institute for Health and Clinical Excellence (or "NICE") generally refuses to cover medical treatments that cost more than $35,000 per year of life saved.

Whatever one thinks of Sarah Palin should not distract from this truth: President Obama proposes to let government bureaucrats decide who gets medical care and who does not.

The government's claims supposedly trump any opposition, on whatever grounds, to this measure. These claims include the following:

1. An objective appraisal of the evidence shows that tobacco advertising and displays lead young people to smoke;

2. Banning display bans will result in fewer youth smokers;

3. Banning tobacco displays in other countries has resulted in fewer youth smokers;

4. Banning tobacco displays will not result in significant costs to retailers.

But now that the Department of Health (DoH), in response to a freedom of information request, has made public much of its correspondence related to the proposed display ban, we know that most of these claims are, in fact, untrue. Further, we know that the DoH has repeatedly violated government policy on the management of risk, and repeatedly misled others about its violations.

Let's begin with the first claim, that the evidence, when objectively and transparently evaluated, shows that tobacco advertising in general, and tobacco displays as one form of advertising, lead young people to smoke.

The requirement that legislation about risks be based on transparent, objective and sound evidence is a key part of government policy on risk. For example, the Treasury's Orange Book on the Management of Risk (2004) requires that measures on risks must be based on 'openness and transparency' and extensive, sound evidence. Similarly, the Risk and Regulation Advisory Council (Tackling Public Risk: A Practical guide for Policy Makers) notes that, in dealing with risk policy, 'It is vital that risk is approached with an open mind and without preconception'.

Further, the House of Lords Select Committee on Economic Affairs' Report on Government Policy on the Management of Risk (2006) noted that 'the most important thing that government can do is to ensure that its own policy decisions [about risk] are soundly based on available evidence and not unduly influenced by transitory or exaggerated opinions, whether formed by the media or vested interests'.

So just who, then, in the DoH was responsible for conducting a wide-ranging, objective, and transparent review of the evidence about tobacco advertising and tobacco displays and their supposed effect on young people? It certainly wasn't regular civil servants with expertise on tobacco issues who approached the issue without a vested interest. Instead, according to an email sent on 23 March 2009 from the DoH to a Canadian equipment company, 4 Solutions Display, the review was a product of Cancer Research UK, a charity that has also acted as an advocacy group consistently calling for bans on tobacco displays.

That email from a DoH manager said: 'We're basing our policy primarily on the work of Cancer Research UK, who have provided a report showing how display drives cigarette smoking among young people in the UK.' Moreover, not only was the display ban based on the work of Cancer Research UK, but the organisation had a senior official working in the DoH two days a week when the display ban policy was being formulated.

In effect, the government's policy about tobacco displays is not the result of wide-ranging research, evaluated objectively and transparently, but rather was based on a single report produced by an advocacy group campaigning for a display ban, and helped along by a senior official from that group working inside the DoH. What's objective, evidence-based, comprehensive, or transparent about that?

This makes clear why the government has consistently neglected its own evidence about tobacco advertising and young people; namely, it was highly inconvenient to the policy put together with Cancer Research UK. For example, Eileen Goddard's Why Children Start Smoking was produced for the DoH in 1990 and, unlike the studies on tobacco advertising cited by Cancer Research UK, is a longitudinal study that followed the same young people over time during the crucial period when they became susceptible to smoking.

Goddard found that becoming a young smoker was not statistically associated with being aware of tobacco advertising or being able to name more brands of cigarettes. Indeed, most young people did not like tobacco advertisements.

It also shows how the government has misled the public about the evidence supporting this legislation. For example, David Taylor, chair of the All-Party Smoking and Health Group, asked the health secretary what research the DoH had commissioned and evaluated on the effects of tobacco displays on youth smoking. Public Health Minister Gillian Merron replied that the DoH had 'assessed the role of tobacco displays on smoking in young people based on a variety of research and evidence', which makes it appear that the government followed the requirements of risk assessment by examining all of the available evidence.

But, as the DoH's March email notes, the minister's comment is highly misleading since the policy is based not on a variety of research and evidence, but almost exclusively on the 'work of Cancer Research UK'.

What about the second claim that banning tobacco displays will result in fewer youth smokers? The government, both in the Lords and in the Commons, has relentlessly advanced this idea. For example, in its 2008 Consultation on the Future of Tobacco Control, the DoH suggested that one of the benefits of a display ban might be a 'three-percentage-point reduction in the number of regular smokers aged 11-15' that would yield 19,500 fewer smokers in 'each annual cohort'.

But we now know, based on the DoH's email correspondence, that this is simply statistical nonsense designed to hide the fact that the DoH could not confidently expect that removing tobacco displays would make any difference to youth smoking. In that same 23 March 2009 email, the DoH manager admits that 'I wouldn't expect to see a significant fall in youth uptake until displays had been removed for approx 10 years'.

If the DoH had bothered to look at the international evidence on the effects of tobacco advertising restrictions, it would have seen that countries that have had advertising bans for 25 years have not experienced statistically significant reductions in youth smoking. In short, the DoH, when not speaking to the Commons or the press, admits that its tobacco display ban will have no immediate effect on youth smoking for a decade, which essentially is to concede that it has absolutely no evidence that it will ever demonstratively work.

Closely aligned to the claim that banning displays will result in fewer young UK smokers is the argument that other countries that have instituted display bans have had declines in youth smoking. The government has repeatedly claimed that the experience of Canada, for example, where several provinces have banned tobacco displays, shows that such bans result in fewer tobacco sales and fewer youth smoking.

The government, however, knew all along that this was simply not true. For example, Canada's 4 Solutions Display told the DoH in a March 2009 email that removing tobacco displays 'has not caused a decline in tobacco sales or discouraging kids from smoking'. The DoH was informed that 'Tobacco sales…across Canada has not felt a negative impact at all since the dark market was legislated'. Indeed, the 'truth' is that display bans have 'hurt small business and they really are the ones who are feeling the pain of lost income stream'.

Moreover, the government's attempt to misrepresent the experience of Canada with display bans is decisively refuted not simply by the DoH's Canadian correspondence, but by the official evidence from Canada. The Canadian data suggest there are no statistically significant differences between those provinces with display bans and those without in terms of the prevalence of youth smoking.

Finally, what about the government's claim that banning displays will not result in significant costs to retailers? The government has repeatedly claimed that the cost for retailers to cover tobacco displays would be minimal. For example, Lord Darzi told the House of Lords in a letter that the costs for removing a typical 25-square-foot retail tobacco display would be £212, based on estimates received from a company (4 Solutions) involved in the Canadian display ban. But the DoH correspondence shows that Action on Smoking and Health (ASH), the most prominent anti-display organisation, was told directly by 4 Solutions that it was not correct.

On 28 April 2009, Phil Beder, vice president of 4 Solutions, emailed ASH's executive director Deborah Arnott to 'clarify some of the issues surrounding the display ban covers that are presently being explored by your organisation in the UK'. Beder makes it clear that 'The original amount of £200 as discussed with you is for a standard three-foot section known as the Gantry and does not include shipping, installation or specific changes to size or dimensions…For individual stores requiring this type of system the costs could be somewhat prohibitive due to the need for specific builds, warehousing and shipping separately to single locations'. He concludes: 'Single shop all-in cost estimates including all the above specifications is approx. £450' – more than double the figures given up by the DoH.

Just in case ASH did not understand these figures, Beder followed up with another email on 30 April to Arnott. He wrote: 'I want to reiterate that the last email I sent to you (April 28) was a complete clarification of all costs associated with covering of tobacco. I also want to make sure you are not making additional assumptions on costs to suit your internal needs. 4 Solutions Displays cannot produce, deliver and install for the minimal dollars you are publishing nor can any other covers for the retailer be represented for delivery in the fashion we are being quoted. We would ask that you remove 4 Solutions Displays from any of your promotional materials as the numbers are misrepresenting the actually [sic] costs to a wide base of retailers in the UK. I trust that your organisation will insure that the entire financial story is told to all and not choose a single number that doesn't represent the actual facts of the past inquires.'

Last month, the Commons' Innovation, Universities, Science and Skills Committee produced a report, Putting Science and Engineering at the Heart of Government Policy, criticising ministers who introduced legislation that they falsely claimed was based on an objective review of the evidence. As The Times (London) noted: 'Government departments should be exposed by their own scientific advisers when they base decisions on political considerations rather than the findings of research.'

What makes the DoH's conduct so reprehensible is not simply that it has consistently misrepresented the evidence about its proposed ban of tobacco displays – to Parliament, to the media and to the public. Far worse, the DoH has abandoned any pretence of objectively collecting and reviewing the evidence about whether such a policy would work, and what its costs would be, by effectively outsourcing this work to an advocacy organisation that already has a well-established position on the matter.

The entire process surrounding the proposed display ban is now so corrupted that the government's only honourable course is to acknowledge this display policy fiasco and withdraw the legislation.

President Barack Obama's nomination this month of Dr. Regina Benjamin as U.S. surgeon general brought down upon the White House a barrage of criticism from medical "experts" who claim Dr. Benjamin is setting a bad example because of her weight. For example, Dr. Sarah Reed, who religiously keeps her own Body Mass Index in the "underweight" category, was quoted in The Daily Telegraph saying: "Although her credentials speak for themselves, her weight cannot be overlooked. Shame on her!".

Is Dr. Benjamin too fat to handle the nation's health? There are three evidence-based public health reasons why worries about her weight are unwarranted.

First, there is little credible scientific evidence that supports the claims that having an overweight or obese BMI leads to an early death. For example, Katherine Flegal of the Centers for Disease Control and Prevention found that in the U.S. population there were more premature deaths among those with BMIs of less than 25 — the so-called normal weight — than those with BMIs in excess of 25.

In fact, the lowest death rates were in the "overweight" category — that is, those with BMIs from 25 to 29.9. Indeed, in this study, Americans who were overweight were those most likely to live the longest.

In the American Journal of Public Health, Professor Jerome Gronniger looked at weight and mortality for each BMI point, rather than simply comparing, as is usually done, mortality across broad categories, such as underweight, normal, overweight and obese. He found that men in the "normal" weight category exhibited a mortality rate as high as that of men in the moderately obese category (BMIs of 30 to 35); men in the "overweight" category clearly had the lowest mortality risk.

Moreover, a new study published in the American Journal of Clinical Nutrition that looked at alternative measures of obesity, such as percentage of body fat, skin fold thickness, waist circumference, and waist-hip ratio, found even less scientific support for the alleged fat-equals-early-death thesis. The authors report that for the intermediate level of each of the alternative measures of obesity, there was a negative link with mortality. In other words, those with a higher waist circumference or a higher percentage of body fat had lower mortality rates.

A second reason why Dr. Benjamin's weight is a non-issue is because in those studies that have found statistically significant associations between overweight/obesity and premature mortality, the risks are so modest as to be essentially negligible. For example, whereas the reported lung cancer risks for smokers are typically 10 to 20 times higher than for nonsmokers, the death risks for those who are overweight and obese are often closer to only 0.5 above those of normal weight.

Third, contrary to conventional wisdom, the association of overweight and obesity with higher risks for a variety of diseases, such as cancer, diabetes and heart disease is unproven. In part, this is because these diseases have multiple causes.

More strikingly, increases in overweight and obesity have been paralleled by falls in total cardiovascular mortality and mortality from coronary heart disease and stroke, as well as in the prevalence of hypertension and hypercholesterolemia, undermining claims that overweight and obesity lead to higher rates of morbidity.

The case against Dr. Benjamin's suitability as surgeon general is constructed out of an anti-obesity crusade that has been splashed across so many front pages for so long that no one asks whether it is based on evidence. The questionable science underpinning the criticism of Dr. Benjamin is a smoke screen for an artfully choreographed anti-fat prejudice that, according to the eating disorder statistics, has already taken white women, girls, boys and ethnic minorities as its victims.

The last demographic holdout against "fatism" is the African-American female, who on average is disproportionately heavy. And she is disproportionately comfortable with her weight. The fat police view this fact as simply unacceptable.

Hence, their attack on Dr. Benjamin, which they perceive as an opportunity to lance this particular demographic boil once and for all. Shame on them.

Despite a skeptical literature on the relationship between alcohol advertising and drinking initiation and consumption, there remain powerful public health campaigns to restrict or eliminate alcohol ads. Exhibit A: the British charity Alcohol Concern's declaration last week that alcohol should not be advertised on television before the 9pm watershed. According to Alcohol Concern's spokesman, 'Given the evidence with regard to… the influence of alcohol advertising on young people, it is appropriate that the current rules should be tightened'.

Alcohol Concern's pronouncement is the progeny of two books published a half century ago, journalist Vance Packard's million-selling The Hidden Persuaders and French demographer Sully Ledermann's Alcohol, Alcoholism, Alcoholization. These works shaped today's public health establishment consensus about the effects of alcohol advertising.

Packard asserted that advertising exerts a strong manipulative influence on consumption. Ledermann claimed that there is a fixed relationship between total alcohol consumption and the proportion of heavy drinkers; the only difference between heavy drinkers and the rest of the population being the amount of alcohol consumed. Hence, there is a causal relationship between consumption and misuse.

Between them, Packard and Ledermann provided the basis for the public health establishment's demand that alcohol advertising be either tightly regulated or completely banned. According to the public health view, increases in average alcohol consumption increase the number of problem drinkers and thus the amount of alcohol-related harm, including healthcare costs. Given that alcohol advertising both initiates new consumers and increases total consumption, it should be restricted or banned.

At the very least, this view asserts, exposure to advertising causes individuals to drink who might not otherwise drink and causes people to consume more alcohol than they otherwise would. Restricting or eliminating advertising is justifiable since it would reduce total consumption and with it aggregate alcohol harm.

Are the public health community's claims about alcohol advertising effects true, and are its demands for restrictions or complete bans on alcohol advertising, based as they are to a large degree on Packard and Ledermann, justified?

In order to test these claims, we examined the public health model of advertising's effects, experimental studies, studies of alcohol advertising exposure and recall, econometric studies of alcohol advertising, drinking initiation and consumption, and studies of alcohol advertising restrictions and bans.

The public health model is foundational to the view that advertising affects drinking choices. The empirical evidence for this model is weak and even taken on their own terms studies of alcohol advertising consistently fail to demonstrate that the drinking behaviour of an individual is the causal result of an alcohol advertisement.

Even if we were to allow that this effects model is strongly supported by the empirical evidence, which it is not, there are no studies of alcohol advertising that trace the effect of an advert from exposure to purchase behavior across a sample population in such a fashion to demonstrate that the advert actually caused the behavior. Without such a demonstration, it is impossible to conclude legitimately that alcohol advertising caused a behavior.

As for experimental studies, even allowing for the substantial issues around methodology, small sample sizes, and the appropriateness of drawing conclusions based on artificial settings, it is nonetheless clear that there is no support in the experimental literature for the claim that alcohol advertising causes initial alcohol use or increases alcohol consumption.

Some prominent regulation advocates, such as Professor Gerard Hastings, claim that newer studies provide evidence of the link between alcohol advertising and drinking behavior. Our analysis of 11 cross-sectional and longitudinal studies of advertising exposure and recall suggests otherwise.

Three problems undermine the findings of the alcohol advertising exposure and recall studies. First, and most importantly, none of the studies can justify a causal conclusion about the relationship between advertising and drinking initiation or consumption given their cross-sectional or longitudinal design.

Second, all have significant methodological issues, particularly with respect to warranting that they have in fact accurately measured alcohol advertising exposure, and also in terms of their reliance on unverified subject recall. Finally, the studies generally report data that is either not statistically significant or, if significant, is a weak relationship, or in fact contradicts their thesis.

Together, these studies present virtually no support for the claim that alcohol advertising causes young people to begin drinking. Collectively, these studies suggest that alcohol advertising either does not increase total alcohol consumption, or has an impact that is, in the case of beer advertising, so marginal as to be insignificant.

With respect to econometric studies, out of over 30 such studies over the past two decades, only a handful support the claim that alcohol advertising leads to drinking initiation or increases total consumption.

The imposition of alcohol advertising bans represents a reasonably direct way in which to test the Ledermann-derived public health hypothesis about both the effects of alcohol advertising and the corrective of advertising restrictions and bans. Although the evidence is not completely consistent and has, as we have noted, significant limitations in its ability to control for possible confounding factors, there is still very strong evidence that the imposition of bans has not reduced consumption.

Of 17 cross-sectional and longitudinal studies of the effects of advertising restrictions and bans on drinking initiation and consumption, only three find that such measures have a statistically significant effect on either initiation or consumption. There is strong evidence that restrictions have not reduced consumption and the evidence from jurisdictions that have removed bans shows that consumption has not increased when advertising has resumed.

Nor do such studies provide support for the claim that such restrictions on advertising reduce alcohol abuse or alcohol related-harms such as road fatalities or disease. Indeed, one study found that broadcast bans of spirits advertising resulted in both higher consumption levels and increased levels of traffic fatalities.

Moreover, where alcohol advertising bans have been lifted, there is no evidence that consumption has increased. This does not, of course, mean that advertising is ineffective, as many of these studies, both nationally and internationally, have demonstrated the expected advertising outcome of substitution effects and movements between brands and beverage categories.

Based on the empirical evidence, it is clear that the public health establishment's claims about the effects of alcohol advertising are incorrect. Indeed, the weight of the evidence substantially argues against its assertions about alcohol advertising initiating drinking and increasing consumption and alcohol-related harm. Consequently, there is no public policy justification for measures to restrict or completely ban alcohol advertising that is directed to legal consumers.

But what about warning labels on alcohol? Either instead of or in tandem with advertising restrictions, can they not be an effective deterrent against drinking? In short, no, they cannot.

The main evidence against the effectiveness of such warnings comes from the US. According to the proponents of warnings, they serve both to inform the public about the specific risks of drinking and reduce the drinking of specific groups most at risk, such as pregnant women, adolescents, and problem drinkers. But the research evidence suggests otherwise.

If the warning is to be effective it first has to be noticed. But US telephone surveys have found that only between 20 and 25 percent of respondents noticed the labels in the first six months after introduction, with only 16 percent recalling the content of the warning. Effective warnings, according to Kip Viscusi of Harvard University, must also provide new information. Yet an Ipsos-Reid survey in February 2005 found that 99 per cent of Canadian women of childbearing age knew that there were risks with drinking during pregnancy, suggesting that the proposed warnings would not be providing new information.

Equally unimpressive is the evidence for warnings affecting behavioral change. The US Surgeon General's warnings about the risks to pregnant women from drinking have been mandatory since 1989. A study of alcohol consumption by pregnant women reported by the US Centers for Disease Control noted that almost eight years after the implementation of the warning labels the number of women drinking during pregnancy had risen. As Dr Janet Hankin in a review of fetal alcohol prevention discovered, only the lighter drinkers who were less at risk of having children with fetal alcohol syndrome followed the warning. 'Among high-risk drinkers', Dr Hankin noted, 'the label law clearly has not affected drinking behaviour'.

A similar result has been noted with adolescents. David MacKinnon reported in the American Journal of Public Health that in a group of 16,661 high school students followed from 1989 to 1995, 'there was no beneficial change attributable to the warning in beliefs, alcohol consumption, or driving after drinking'. The World Health Organisation's 2003 study on alcohol noted that warnings failed to increase young people's perceptions of alcohol risks and had 'no direct impacts' on consumption. Studies have also found that heavy drinkers, while aware of the warnings (they see them more frequently), are more likely to consider them less believable and to discount them more than other drinkers.

This suggests that warnings may not only be ineffective, they might also be counterproductive in at least three senses. First, warnings appear to reduce at-risk drinkers' acceptance of the risks associated with their behaviour. The very act of warning actually works against itself.

The reasons for this are various. There is a natural tendency to avoid information that has negative self-implications. People are very good at avoiding processing information like warnings that they perceive as threatening. Through a process known as cognitive readjustment people tend to exempt themselves as subjects who ought to be concerned with the warning.

Then, too, there is the fact that large numbers of risk-takers display what psychologists call 'reactance', in which there is a high level of resistance to the demands of outside authority and control. For these individuals, a label represents an unreasonable attempt to shape their behaviour.

Second, as the WHO study and others have noted, warnings highlight risk and for those attracted to risk this serves to make alcohol more attractive than it might otherwise be. Finally, in pregnant women, research by Professor Ernest Abel, director of reproductive toxicology at Wayne State University, suggests that warnings might provoke stress in pregnant women that in turn may result in stress-related physiological changes that compromise the health of the fetus.

Even if the evidence of failure does not convince, perhaps the strong probability that alcohol warnings and advertising restrictions drive some people to drink might bury these pernicious regulatory instruments.

But how effective are these programs? Not very — so why is the CDC recommending pouring millions of dollars more into programs that are unlikely to have any significant impact on public health? Early tobacco control policy efforts that largely consisted of raising taxes were quite successful in reducing smoking. The effect of more recent tobacco-control policies is much more ambiguous.

Bans on tobacco use in various places have been implemented widely. Bans have been imposed on restaurants and bars in 27 states and Washington. Four other states have imposed bans in restaurants, but exempt bars. Several more states have passed bans that take effect in the near future. Proponents argue that bans lower smoking, although evidence on this is mixed.

"Anti-tobacco" programs are the latest measure used by governments to control tobacco use. These programs fund anti-smoking ads that run in newspapers, magazines and on TV, school programs to educate children about the hazards of smoking, cessation interventions (intensive counseling services and cessation medications) and grants for researchers to demonstrate effectiveness of tobacco-control programs. These programs hire many people and are very expensive.

The CDC provides recommendations for how much money states should spend on anti-tobacco programs. According to the CDC, careful research shows that its recommendations would prevent hundreds of thousands of premature tobacco-related deaths. But the data do not back the CDC's claims.

The CDC recommends that states should spend $15 to $20 per resident each year on anti-smoking programs. Only two states — Maine and Mississippi — have consistently met or exceeded that goal over the years 2000–2007. In contrast, three states — Michigan, Missouri and Tennessee — have spent nothing on anti-smoking programs. Georgia spent just over $2 million in 2008, barely 5 percent of what the CDC now recommends. Nationwide, states have spent a total of $5.3 billion (in inflation-adjusted 2005 dollars) over those years, an average of $18 per person. But all that money has failed to significantly reduce smoking. Nor have the states that spent more seen a more dramatic reduction in smoking than states that have spent less.

Statistical analysis that I've conducted shows that there is a very tenuous link between cigarette sales and state anti-tobacco spending. At best, spending large amounts of money on anti-tobacco programs seems to produce a trivial drop in cigarette sales — less than a pack a year per capita. States would be better advised to put these resources toward other public health policies that produce larger results.

What was the basis of the CDC spending recommendations? Was the agency truly trying to identify anti-smoking policies that work well and use public funds effectively, or did the CDC simply assume that, "If you spend it, they will quit smoking"? If it was the latter, then it is unfortunate for both taxpayers and public health.

The CDC is now arguing that state anti-tobacco programs are underfunded. Tobacco-control advocates — many of whom receive money through these programs — repeat the CDC under-funding claims when pleading their cases for spending increases. It will be truly unfortunate if states simply accept these claims and increase funding without investigating the programs' effectiveness. However difficult it is to look beyond noble intentions, appraisal of a program's effectiveness is vital — particularly in these tight fiscal times — if we truly want to improve public health effectively.

Fat celebrities are the latest victims of the UK public health establishment's attempt to socially engineer our cultural and political environment so that the public becomes less tolerant of obesity and those the government categorises as obese. Through such nanny-state paternalism, the government seeks to ensure that people behave in "appropriate" ways, as defined by itself and a coterie of public health bureaucrats and academics.

Professor Michael McMahon, author of this week's Nuffield Health report on the influence of fat celebrities on obese people's attitudes to weight, says fat stars are seen as role models, helping to make being overweight acceptable. Professor McMahon's anti-fat stance epitomises the public health establishment's increasing use of a "denormalization" campaign against fat people.

As employed by the government and the anti-obesity industry, denormalization is a made-up word that functions as both a noun and as a verb to describe both a state in which the obese are perceived to be abnormal, aberrant, even deviant, and a series of activities designed to achieve this end.

In practice, denormalization means that the government attempts to shame adults into changing their behaviour. For the government's denormalization campaign to succeed these adults must be stigmatised; that is, they will be placed apart from the rest of civilised society until and unless they learn to behave in the approved manner.

Denormalization pushes the obese from being a health hazard to being a moral hazard, nothing less than blots on the nation's moral landscape. The environmental approach to obesity epitomized by denormalization is spelled out by Dr Kawshi De Silva of the Problem Gambling Foundation of New Zealand, who states: "The perceptions and beliefs in society about obesity can profoundly influence behaviour change and resistance to it."

The prominent American journalist, Morton Kondracke, recently called for being fat, let alone obese, to be made as socially unacceptable as smoking. Earlier this year, a London Evening Standard columnist advocated the public ridicule of fat people eating chocolate. In some quarters, it is predicted that the language of denormalization will soon be the main ingredient in the obesity debate.

The anti-obesity movement has accepted the argument of those, such as Australian nutritionist Dr. Rosemary Stanton, who have argued that: "We need to learn from the successes in tobacco control in tackling the obesity epidemic." Clearly, the anti-obesity campaign has modelled its denormalization campaign on the politically, if not empirically, successful tobacco denormalization campaign. Hence, the anti-obesity lobby employs public policy tactics to denormalize the use of the food industry's products.

There are significant downsides to the obesity denormalization campaign. In a recent article, published in Health Promotion International, L MacLean et al express a well-founded concern regarding the stigmatization of obese people, particularly of children. While there is much written about stigma and how it is exacerbated, these researchers point out that few, if any, guidelines exist for public health managers and practitioners who may attempt to design and implement obesity prevention programmes that minimize stigma. They examine the stigmatization of obese people and the deeply negative consequences of this social process, and discuss how stigma is manifest in the provision of public health services.

Recently published research by CD Elliott published in the Journal of Canadian Studies is particularly insightful in demonstrating the obesity denormalization campaign's dangerous ambitions. Elliott is unequivocal in concluding that the obesity denormalization campaign is central to the connection between obesity and citizenship in contemporary Western society.

This particular piece of research examines how denormalization has connected one's physical body to that of one's citizenry. In tracing the evolving narrative, Elliott explains why denormalization campaigners believe that the ideal citizen is, literally and figuratively, a "fit" citizen.

The person with the larger body is quite simply categorised as a lesser citizen than his or her smaller countrymen. Elliott outlines the ways in which the fat body or "failed body project" is equally positioned to that of the "failed citizen." Elliott points out that the figurative concept of citizen fitness is often mistakenly conflated with the visible look of leanness.

Given that public health reports such as this week's from Nuffield Health officially classify the majority of adults as overweight or obese, the framing of the fat body as the failed citizen is, to put it mildly, of considerable significance to both policymakers and non-policymakers alike.

We may draw several general conclusions from the denormalization experience to date. First, the obesity denormalization campaign represents yet another failure to address particular social problems, such as eating disorders.

Second, the fact that the denormalization campaign has failed to work in the tobacco arena apparently means nothing to the public health establishment, which has confidently prescribed comparable denormalization campaigns for the food, gambling and drinks industries.

Third, these campaigns dehumanize whole categories of people, which is arguably the most damning conclusion possible. Whatever one may or may not think of smoking and of smokers themselves, one unavoidable truth is that the smoker's social status (or lack thereof) in the modern era foreshadowed the current, lowly social status of the fat person.

Fourth, the obesity denormalization campaign is also worrisome because it wastes large sums of taxpayer money to satisfy the new Puritanism's anti-obesity agenda.

A potentially greater worry, however, stems from the reality that this denormalization campaign represents a new and dangerous assault on our core democratic traditions of choice about risk and lifestyle. Like so much in the "war on obesity," denormalization is a very bad prescription for supposedly good public health.

Professor James Heckman, the Nobel Prize-winning economist, has devoted a decade to understanding what makes young people engage in risky behaviours, such as smoking and illegal drug use, and what can be done to prevent this.

Given that a UK House of Commons committee is currently debating how to prevent youth smoking through legislation that requires shopkeepers to hide all tobacco products from sight, it would be reasonable to assume that the committee would talk to Professor Heckman.

But it hasn't. And the reason the committee is not doing so speaks volumes about the debased state of public policy debate.

The basis of the UK government's legislation is the claim that one of the major reasons why young people smoke is that they see tobacco displays in shops. If you find this claim more than a little odd, you are not alone.

When the legislation was debated in the House of Lords, the government was unable to produce any credible and compelling scientific evidence that seeing tobacco displays in shops led anyone to smoke or that removing tobacco displays had led to a decline in youth smoking. Indeed, the international evidence from a variety of countries that had tried this 'silver bullet' to stop youth smoking showed that adolescent tobacco use had either increased following a display ban or stayed the same.

In an attempt to bolster their less than robust case, the government touted a study by professor Gerard Hastings, which argued that the more young people were aware of tobacco brands the more likely they were to 'intend' to smoke (notice, not smoke, but intend to smoke).

Regrettably, the Hastings study (which was not published in a peer-reviewed journal) has several defects. Since it wasn't a study establishing cause and effect, it could never counter the commonsense response that the reason young 'intending' smokers knew more tobacco brands is because they were young intending smokers. Their smoking led to their interest in brands, not the other way round.

It also failed to provide a demonstrated connection between increased awareness of tobacco brands and tobacco displays in shops, which is, after all, what the legislation is about. Finally, Hastings' research is contradicted by a host of other studies, including some cited by the government itself, which showed that tobacco brands are not important in the process of taking up smoking.

Where does this leave Heckman? The reason that Hastings addressed the Commons committee rather than Heckman is because Hastings' research supports the government's tobacco control policy, while Heckman's work exposes the government's nonsensical arguments.

Heckman does this in two ways. First, his work shows that studies like Hastings' and claims about shop displays causing young people to start smoking are instances of flawed science: they don't meet the rigorous standards necessary to establish the government's claim that 'tobacco displays cause young people to begin smoking'.

Heckman argues that the government and public health advocates consistently make both strong assertions about the supposed causes of youth smoking and push draconian policies like display bans based on simplistic and flawed statistical methods that would not pass muster in other areas of public policy. Their studies never show that the particular focus of a policy, such as tobacco displays, is the cause of a problem such as youth smoking.

Nor do they ever consider and control for the role of other factors in initiating youth smoking. Nor are the studies replicable by other researchers. As a result, public policies and enormous resources are being focused on alleged 'causal factors', such as tobacco displays, 'that have not been scientifically established but merely assumed to affect smoking initiation'.

As a result, public policies for dealing with youth smoking and drug use are put forward without any connection to the problem for which they are intended. This means that by their very nature they miss the mark and fail. For example, if tobacco displays don't cause young people to smoke, banning them won't do anything to prevent youth smoking. Such measures are nothing more than window dressing and they fail to come to terms with the root causes of what drives smoking.

Second, Heckman's work provides real answers to the question of what leads young people to start smoking and what can be done to prevent it.

In a series of recently published research studies, Heckman showed that two factors, both malleable — family environment and school environment — are crucial in the development of two skill sets: cognitive skills and non-cognitive skills, such as motivation, determination, self-esteem, and self-regulation.¹

These two skill sets are both strongly and consistently related to the probability of becoming a regular smoker by age 18. Moreover, the foundations for both of these skill sets are developed at an early age. In short, the higher one's cognitive and non-cognitive skills, the less likely it is that one will become a smoker.

Heckman's research finds considerable support in recent research on youth smoking in the UK. Several studies have found that youth smoking is strongly correlated with living in areas of high social and economic deprivation, failing schools and dysfunctional families — precisely the sorts of environments that fail to provide for the development of the cognitive and non-cognitive skills that Heckman finds so important.

The implications of Heckman's research for smoking policy are therefore enormous. Instead of focusing on things like tobacco displays that are unrelated to youth smoking, the essence of the government's tobacco strategy ought to be three-fold:

1. designing early childhood interventions to develop crucial cognitive and non-cognitive skills in those areas with the worst performing schools and the highest youth smoking rates (these tend to overlap);
2. removing the causes of social and economic deprivation in those with the highest youth smoking rates;
3. creating novel interventions to address the sources of family dysfunction in those areas with the highest youth smoking rates.

The great benefit of such a tobacco policy is that, in addition to dramatically reducing smoking, it would reap significant benefits in a host of other areas.

It's a real tragedy that the Commons isn't hearing from James Heckman on youth smoking. This isn't just because his analysis cuts through the government's cant and shows how unsupported its policies, such as a display ban, really are. Far more importantly, his enormous knowledge of what really does cause smoking may help prevent a generation of British kids from lighting up.

¹ See 'An Assessment of Causal Inference in Smoking Initiation Research and a Framework for Future Research, by James Heckman, in Economic Inquiry, January 2008.

The legislation that will be voted on shortly in the Senate was cooked up out of public sight by Philip Morris, Sen. Ted Kennedy, D-Mass, Rep. Henry Waxman, D-Los Angeles, and anti-tobacco lobbyists. During years of covert negotiation, Philip Morris outwitted this coalition of "useful idiots" at every turn. Philip Morris staffers even wrote large portions of the bill.

Philip Morris was ruthlessly successful in pursuing its interests, but the Useful Idiot Coalition consistently failed to further its own. That is why Food and Drug Administration regulation of tobacco serves Philip Morris' corporate interest, not the public interest.

There are significant, and numerous, problems with the FDA regulating tobacco, and virtually no benefits to public health. Kennedy, Waxman, and the public health establishment present their legislation as a masterful regulatory stroke that will end tobacco marketing, prevent kids from starting to smoke, make cigarettes less enjoyable to smoke and reduce adult smoking. But FDA regulation of tobacco will do none of these things.

The bill fails to correctly identify the reasons why young people begin to smoke and concentrates almost exclusively on restricting tobacco marketing, while leaving the other risk factors for adolescent smoking unaddressed. There is nothing in the proposed legislation that shows the FDA understands the well-documented connections between education, poverty and smoking status, connections that provide the key to helping adults stop smoking.

It will not provide Americans with scientifically accurate information about the risks of smoking. Instead of providing accurate information about the risks of low-tar cigarettes, the current legislation requires the FDA to ban the descriptor completely, leaving smokers without any information about how to understand the risks of smoking.

Moreover, in its requirements for graphic warnings, the current legislation commits to fear-based messages that are not only often inaccurate through their overstatement of the risks of smoking, but substantially ineffective in both preventing and reducing smoking.

The process of validating new reduced-risk products appears to be designed to prevent such products from ever reaching the marketplace, thus giving smokers the stark, and for many the impossible, choice of "quit smoking or die." Rather than making smoking safer for those who continue to smoke, it will deny smokers access to new products that might literally save their lives. That is hardly a sterling prescription for good public health.

Even if the idea of FDA regulation were good in theory, in practice several things, including the FDA's competence in tobacco policy and science, its public image, its fit with the tobacco file, its available resources and its overall current competence, argue strongly against giving it regulatory responsibility for the nation's tobacco policy.

Equally important is the fact that, based on past failures, most of the FDA's problems in terms of science, staff and administrative prowess appear to be largely beyond easy repair. Why, indeed, would anyone who cared about effective tobacco control policy want to hand over the responsibility for such policy to such an organization?

FDA regulation of tobacco need not be a public health tragedy, however. By bringing the crafting of tobacco policy out into the light of day, by taking it out of the hands of the special interests and, most importantly, by keeping it away from the FDA, there is every opportunity to begin to create a policy that not only serves the interests of nonsmokers and smokers, but a policy that might really work.

Constructive recommendations about the scope, administrative home and content of tobacco policy would stand in sharp contrast to what is currently being rushed through the Congress under the guise of serving the interests of the American public.

During the dramatic biblical parable of the sheep and goats, Jesus asserts our moral responsibility rather than debates our policy approach.

Matthew quotes Jesus as telling the sheep: "For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in." They ministered to Jesus by doing these things "for one of the least of these brothers of mine."

This duty cannot be subcontracted to government. The Bible demonstrates concentric rings of responsibility moving outward, starting with individuals who are enjoined to take care of themselves, rather than living off of others. Those who fail to care for their families are worse than unbelievers, Paul warns. The early church transferred money within and among faith communities. Finally, Paul says in Galatians, "let us do good to all people."

If the political authorities are to act, it should be because other institutions have failed to meet people's basic needs. Today, far more private than public programs serve the homeless. The Catholic and Protestant doctrines of subsidiarity and sphere sovereignty, respectively, recognize that government is to respect the roles of other social institutions.

Diversity of responses is particularly important in dealing with a problem as complicated as homelessness. Even the number of homeless is disputed.

The Department of Housing and Urban Development figures homelessness on any particular night (in or out of a shelter) ran 672,000 as of January 2007 — down about 10 percent from 2005. There were 84,000 homeless households, down 15 percent. Chronic homelessness ran 124,000, down 30 percent.

The drop is positive, though these numbers remain far too high, and may have turned up in the current economic imbroglio.

The reasons for homelessness run the gamut. Those in poverty long have had difficulty finding affordable housing.

Dubious mortgages, declining home prices and increasing unemployment are threatening many homeowners today. The rising tide of foreclosures puts entire families at risk.

Homelessness also often reflects personal crisis, such as family breakdown, substance abuse and/or mental illness. The deinstitutionalization movement, which sought to respect the dignity of those who had been forcibly medicated and hospitalized, left some people living on the streets. Alcohol or drug use often accentuated other problems.

The answer is not simply more money for more government programs, of which there are thousands nationwide. This enormous challenge can be best met by reflecting back on the biblical model. We need to simultaneously meet current needs, which often include illness and hunger, and reduce future problems.

First, individuals and families have a moral as well as practical imperative to behave responsibly. Americans need to relearn how to resist substance abuse, curb wasteful expenditures and save money. Borrowers and lenders alike should spend money wisely.

Second, family and friends, backed by churches and other social networks, should be the first line of defense to homelessness. The need may be as simple as temporary financial aid or an empty couch. Such informal assistance can soften the impact of unexpected hardship while preserving the dignity of those in need.

Third, private social programs are better than government initiatives in ministering to the whole person, rather than treating those in trouble as numbers and prescribing only a check or bed. Some of the neediest require proverbial "tough love" — compassion and discipline. It is important to keep people off the street and ensure that they won't face the same problem again. That often requires changes in behavior as well as circumstance.

Obviously, charities have been affected by the current economic slump. However, this provides an opportunity for advocacy by activists and preaching by religious leaders. Those concerned about the needy must remind all of us of our duty to help, especially in difficult times. Too whom much is given, much is expected, the Bible explains.

Fourth, local initiatives are most likely to be effective in meeting needs that vary dramatically by region. Unfortunately, the results of many of the federal welfare programs, including those directed at housing, ranging from rental vouchers to Section 8 to public housing, have been ugly. The government's safety net is best maintained by states and localities rather than by Washington.

Fifth, the many federal subsidy programs used to encourage homeownership — Federal Housing Administration, Community Reinvestment Act, Fannie Mae, Freddie Mac — are ground zero of today's housing crisis and should be curbed. Attempts to solve the current crisis by artificially reinflating home values risk rewarding improvident lenders and borrowers alike, delaying painful but necessary adjustments in the housing market, and creating conditions for repeat experience in the near future.

We should instead make housing less expensive. Through exclusionary zoning (including restrictions on multifamily housing and minimum-lot size and square-footage requirements) and outmoded building codes (which reflect union interests rather than safety concerns), government has limited the housing supply and increased housing costs. Palliatives like rent control only worsen the underlying problem; government should strip away barriers to affordable housing. Doing so would help reduce homelessness.

Good people in a good society take care of those in need. That includes the homeless. But just as the problem is complex, so is the solution. And we will do best if we respond first at a human rather than at a political level.

To the jaded, this latest piece of anti-tobacco legislation might appear to be just another instance of a quarter-century of bad tobacco policy, in which successive governments have attempted to address a particularly serious and complex public health problem through a series of gimmicky soundbite measures that do nothing to address the underlying reasons why young people smoke.

But this legislation is, in fact, something much worse. It is the first time that a government has legislated on tobacco not only without any compelling evidence that what it is proposing will work, but actually in opposition to what its own experts have demonstrated to be the case.

According to the advocates of a tobacco display ban, seeing cigarettes displayed in shops is one of the major reasons why children in the UK smoke. The trouble is that, as the legislation has progressed through the Lords, it has become increasingly apparent that this is not the case.

A major piece of evidence used by the government to support the claims behind the legislation is a study by a team of Australian researchers led by Melanie Wakefield. Wakefield exposed several hundred school children to one of three digitally manipulated photos of convenience shop points of sale. One photo showed cigarette advertising and tobacco packs, one photo showed only tobacco packs, and one photo showed no tobacco packs.

The results are striking, as they refute each of the key claims about the supposed effect of tobacco displays on children's intentions to smoke.

First, there were no statistically significant differences in the estimates of how many of their peers smoke between the children who saw the convenience shop with no cigarettes and those who saw the shop with cigarettes.

Second, there were no statistically significant differences in approval of smoking between those who saw the shop with no cigarettes and those who saw the shop with cigarettes.

Third, there were no significant differences in assigning favourable attributes to children who smoke between those who saw the convenience shops with no cigarettes and those who saw the shop with cigarettes.

Fourth, there were no statistically significant differences in their perceptions of the dangers of smoking between children viewing the shop with no cigarettes and those seeing the shop with cigarettes.

Finally, and most importantly, there were no statistically significant differences in the children's intention to smoke between those who saw the shop with no cigarettes and those who saw the shop with cigarettes.

This research is not produced by the tobacco industry. Wakefield works at Cancer Council Victoria. This is the government's best evidence supporting its claim that seeing tobacco displays in shops leads children to smoke.

But matters get even worse when one looks at the other evidence presented by the government to the Lords. For example, according to the government, the Department of Health, in its consultation on the future of tobacco control conducted last year, found that one of the reasons that tobacco displays lead to children smoking was that they were effectively tobacco advertising.

Here, again, the government's own evidence suggests that this is not the case.

First, in the government's own expert study, Wakefield, as well as others, distinguishes between tobacco advertising and marketing and tobacco product displays. If tobacco displays are not tobacco advertising, using claims about tobacco advertising to support banning tobacco displays fails to support the case for tobacco displays. Second, even if tobacco displays were tobacco advertising, the government's own expert evidence suggests that such advertising is not the cause of young people smoking.

For instance, the Department of Health in its consultation on the future of tobacco control lists four predictors of 'regular smoking among young people': age and gender; home environment; drug use and drinking alcohol; and truancy and exclusion from school. Tobacco advertising is not included.

Again, two major studies commissioned by the Department of Health itself contradict the claim that tobacco advertising, let alone tobacco displays, lead young people to start smoking.

The Goddard Report, a longitudinal study of the causes of youth smoking and one of the largest studies of adolescent smoking conducted in the UK, found that becoming a smoker was associated with seven risk factors: being a girl, having brothers or sisters who smoke, having parents who smoke, living with a single parent, having relatively less negative views about smoking, not intending to stay on in full-time education after 16, and thinking that one might be a smoker in the future.

Becoming a smoker was not statistically associated with being aware of tobacco advertising or being able to name more brands of cigarettes. Indeed, Goddard found that children overwhelmingly did not like tobacco advertisements.

The second study, by Clive Smee, carried out an extensive examination of advertising and adolescent smoking in the UK from 1960-1987. It found that advertising in any form did not have a statistically significant effect.

Both of these studies were done when tobacco advertising was virtually unrestricted in the UK. If full-flown tobacco advertising did not lead to adolescent smoking, it is unlikely that seeing cigarette packages in the shops will do so.

In a further effort to bolster the quickly unravelling case for display bans, the government has circulated a study by Gerard Hastings and colleagues from the Centre for Tobacco Control Research at the University of Stirling. Hastings claims, most recently in a letter to The Times (London) this week, that an increased awareness of tobacco brands, supposedly from tobacco displays, increases young people's susceptibility to becoming a smoker.

Yet Hastings claims are refuted, first by the fact that, according to a US Department of Health and Human Services study, interest in smoking and intention to smoke drives brand awareness rather than the other way around. Young people interested in smoking are interested in tobacco brands. Interest in tobacco brands does not lead to an interest in smoking. Clearly, Professor Hastings has confused the sequence.

Second, Hastings' claims are further refuted by the British experience in which there has been a significant decline in awareness of tobacco brands. Yet, according to the most recent statistics for England, there has been no decline in youth smoking. Indeed, there has been an increase in smoking among adolescent girls. If Hastings' claim about awareness of tobacco brands driving youth smoking were true, then one should expect a sharp decline in awareness to bring about a corresponding decline in smoking.

In a final attempt to make its case that display bans work, the government has argued in the Lords that banning tobacco displays in other countries has resulted in fewer young people smoking. But, once again, the government's own evidence shows that this is not the case. Studies from both Canada and Iceland fail to show that banning tobacco displays has had a statistically significant effect on youth smoking.

In Canada, for instance, there is no obvious difference in youth prevalence between provinces with and without tobacco display bans. Moreover, according to the UK government's own data, the highest prevalence is found in Saskatchewan, the first province to ban tobacco displays.

In Iceland, in 2001 when the display ban came into effect, smoking prevalence among adolescents rose by 3.1 per cent. During 2002, the first year after the display ban, adolescent smoking prevalence was the highest it had been for five years.

The evidence presented by the government in favour of banning shop displays of tobacco, far from showing why such a measure is justified, actually shows why this legislation will not work. The bottom line is that a tobacco display ban will not prevent a single British adolescent from beginning to smoke.

The two leaders need to jettison such competing fallacies. Drastic policy changes are needed to neutralize the mounting threat to the stability of our next-door neighbor and the security of our own country.

The only effective strategy is to defund the drug cartels, and the only way to do that is to eliminate the multi-billion-dollar profit caused by the drug trade's black-market status.

It is not surprising that supply-side antidrug initiatives have failed in Colombia and other countries and are now failing in Mexico. The global trade in illegal drugs is a vast enterprise estimated at $320 to $400 billion a year, with Mexico's share thought to be anywhere from $35 billion to $60 billion. The United States is the largest single retail market, but U.S. demand is not the only relevant factor. Indeed, the main areas of growth are in Eastern Europe, the former Soviet Union, and some portions of the Middle East and Latin America. The bottom line is that global demand for illegal drugs is robust and likely to remain so.

There is more than enough consumption to attract and sustain traffickers. Since the trade's illegality creates a huge black-market premium (depending on the drug, 90 percent or more of the retail price), the potential profits are enormous. Supply-side antidrug campaigns are not only a futile effort to defy the basic laws of economics, but they also cause serious problems of corruption and violence for a drug-source country like Mexico. The brutal reality is that prohibition simply drives commerce in a product underground and allows the most violence-prone elements to dominate the trade.

Governments around the world seem to be awakening to the problems caused by a prohibition strategy. The Netherlands and Portugal have adopted decriminalization policies for possession and use of small quantities of drugs. In the Western Hemisphere, the leaders of Argentina and Honduras advocate reforms, and sentiment for liberalization seems to be growing in Mexico. The Party of the Democratic Revolution (PRD), the country's largest opposition party, has called for drug decriminalization, and even President Calderón has proposed to decriminalize the possession of small amounts of street drugs.

But such reforms, while desirable, do not get to the causal root of the violence that accompanies the drug trade. Unless the production and sale of drugs is also legalized, the black-market premium will still exist and law-abiding businesses will still avoid the trade. In other words, drug commerce will remain in the hands of criminal elements that do not shrink from bribery, intimidation and murder.

Because of its proximity to the huge U.S. market, Mexico will continue to be a cockpit for drug-related violence. Continued adherence to prohibition means that the United States is creating the risk that the drug cartels may become powerful enough to destabilize its neighbor. Their impact on Mexico's government and society has already reached worrisome levels. Worst of all, the carnage does not respect Mexico's northern border.

When the United States and other countries ponder whether to continue drug prohibition, they need to consider all of the potential societal costs, both domestically and internationally. Drug abuse is certainly a major public-health problem, and its societal costs are considerable. But banning the drug trade creates economic distortions and an opportunity for the most unsavory elements to gain dominant positions. Prohibition leads inevitably to an orgy of corruption and violence. Those are even worse societal costs, and that reality is now becoming all too evident in Mexico.

Abandoning the prohibition model is the only effective way to stem the violence in Mexico and its spillover into the United States. If U.S. leaders are reluctant to embrace the radical course of legalizing all drugs, they should at least begin with legalizing marijuana. That step by itself would strike a significant blow against the cartels, since at least 55 percent of their revenues come from marijuana sales. Even most drug warriors concede that marijuana is the least harmful of the illegal drugs. And if production and sale of that substance (as well as possession and use) were legalized, there would be more than enough domestic sources. Who would bother to deal with the Mexican cartels when a local producer could supply the product, or in many cases, consumers could grow it in their own back yards?

In his town-hall session a few weeks ago, President Obama was asked if he thought marijuana should be legalized. He responded with a flippant, half-joking "no." That response was most unfortunate. One would think that Obama, given his own youthful drug use, would be more receptive to moving away from the mind-numbing conventional wisdom about keeping marijuana illegal. There are ample domestic-policy reasons for changing that strategy, but with the awful violence the drug cartels are causing in Mexico, we now have a national-security imperative as well to alter course.

Ending drug prohibition would defund the criminal trafficking organizations while enabling honest enterprises to enter the business and be content with normal profit margins. Legalization would weaken the cartels more than any other step we could possibly take. The current strategy risks Mexico becoming a chaotic narco-state, with all the alarming implications that development would have for America's own security.

The response to the Amethyst Initiative was predictable: Advocates of restricted access and zero tolerance decried the statement for not recognizing that the MLDA21 saves lives by preventing traffic deaths among 18- to 20-year-olds. The president of Mothers Against Drunk Driving, for example, accused the university heads of "not doing their homework" on the relationship between the drinking age and traffic fatalities.

In fact, the advocates of the MLDA21 are the ones who need a refresher course. In our recently completed research, we show that the MLDA21 has little or no life-saving effect.

To understand why, a bit of history is useful.

When the U.S. repealed the prohibition of alcohol in 1933, states were free to legalize, regulate or prohibit access to it as they saw fit. Most legalized but regulated it. In particular, 32 states adopted an MLDA of 21, while 16 chose an MLDA between 18 and 20. With few exceptions, these disparities persisted through the late 1960s.

Between 1970 and 1976, 30 states lowered their MLDA from 21 to 18. These changes coincided with other national efforts to enfranchise youth, exemplified by the 26th Amendment, which granted those 18+ the right to vote.

In 1984, however, Congress passed the Federal Underage Drinking Act (FUDAA), which withholds transportation funding from states that do not have an MLDA21. The justification given for the act was that higher MLDAs would result in fewer traffic fatalities.

By the end of 1988, after passage of the FUDAA, all states adopted an MLDA21. Several states had adopted an MLDA21 before the FUDAA, but the other states were less eager to change. Several passed MLDA21 legislation but set it up for repeal if the FUDAA were held unconstitutional. Others enacted "sunset provisions" in case federal sanctions expired. But when the Supreme Court upheld the FUDAA, states faced a strong incentive to maintain an MLDA21.

Our research compares traffic fatality rates in states before and after they changed their MLDA from 18 to 21. In contrast to all earlier work, however, we examined separately the impact in states that adopted an MLDA21 on their own and those that were coerced by the FUDAA.

The results are striking. Virtually all the life-saving impact of the MLDA21 comes from the few early-adopting states, not from the larger number that resulted from federal pressure. Further, any life-saving effect in those states that first raised the drinking age was only temporary, occurring largely in the first year or two after switching to the MLDA21.

Our results thus challenge both the value of the MLDA21 and the value of coercive federalism. While we find limited evidence that the MLDA21 saves lives when states adopted it of their own volition, we find no evidence it saves lives when the federal government compels this policy.

This makes sense if a higher MLDA works only when state governments can set a drinking age that responds to local attitudes and concerns — and when states are energized to enforce such laws. A policy imposed from on high, especially one that is readily evaded and opposed by a large fraction of the citizenry, is virtually guaranteed to fail.

The major implication of these results is that the drinking age does not produce its main claimed benefit. Moreover, it plausibly generates side effects, like binge drinking and disrespect for the law — the very behavior that events planned for this month's alcohol awareness theme are designed to deter.

If we are to truly tackle the dangers of youth drinking, we must admit that the National-21 experiment has failed. We welcome the surgeon general's recent call to action to reduce underage drinking, to the extent that it provides tips for families and educators to curb the dangers of alcohol abuse.

The federal government has taken alcohol policy out of these parties' hands, however, by imposing an ineffective policy on everyone. An awareness campaign can only do so much when the most significant impediment to change is not on college campuses but in Washington.

Have you heard of Santiago Meza Lopez? They call him "The Soupmaker." In January he confessed to Mexican authorities that he had dissolved over 300 dead human bodies in acid. There's a lot of money to be made in America's black market for drugs and Mexican suppliers are willing to kill a lot of people to control those markets and capture the gains. Conservative estimates put the death toll of the war between rival Mexican gangs at over 5,000 in the last year alone. When you kill so many people it's hard to know what to do with all of the rotting bodies. One way to handle the problem is to call in the Soupmaker. Six hundred American dollars per corpse.

Did you know that the United States of America, the Land of the Free, puts a larger portion of its population behind bars than any country on earth? Thanks in large part to the War on Drugs, Americans lock more of their own in cages than do the thuggish Russians or those "Islamofascist" Saudis. As it happens, American drug prohibition and sentencing policies hit poor black men the hardest, devastating already disadvantaged black families and communities—a tragic, mocking contrast to the achievement of Obama's election. Militarized police departments across the nation month after month kick down the wrong doors, terrify innocent families, shoot lawful citizens, and often kill the family dog.

So why is Obama laughing? To be fair, in 2004, Obama called the War on Drugs "a complete failure." And he's much saner about pot than most politicians. He has in the past called for decriminalization of marijuana and his Justice Department has promised the DEA will ease up on medical marijuana dispensaries that comply with state law (though the Feds just cracked down on a cannabis coop in San Francisco). Sure, Obama's got a lot on his hands these days. But his dismissive snicker reflects a sadly common nonchalance toward America's disastrous experiment in prohibition. This is a "war" that has not only failed utterly to shut down the market for drugs, but has, on the way, perpetuated the shameful American legacy of racial stratification, eroded the rights and safety of American citizens, and fomented a civil war on our southern border in which knock-on markets for assassins and corpse liquidation specialists flourish. To call this "complete failure" is to put on a happy face.

Barack Obama inhaled. "The point was to inhale," he once smartly observed. But Obama also knows how to get elected president. Sadly, at this point in history, it remains a political liability to have become intoxicated on certain safe but illegal and stigmatized substances, like marijuana. Obama has said his past drug use was a regrettable youthful indiscretion, and he might even believe it. But why regret it? He managed to become president, didn't he? It's easy to laugh off the folks who jammed the White House switchboard when we imagine them as pranking "stoners," and this picture of "the online audience" concedes the harmlessness of marijuana users while refusing to take them seriously. But why not imagine them as regular folks motivated by a love of liberty, justice, peace, and, sure, maybe a taste for grass? Why not imagine them as successful professionals, unlike Barack Obama only in political ambition?

Marijuana is neither evil nor dangerous. Scientists have proven its medical uses. It has spared millions from anguish. But the casual pleasure marijuana has delivered is orders of magnitude greater than the pain it has assuaged, and pleasure matters too. That's probably why Barack Obama smoked up the second and third times: because he liked it. That's why tens of millions of Americans regularly take a puff, despite the misconceived laws meant to save us from our own wickedness.

The Atlantic Monthly's Andrew Sullivan has been documenting on his blog the stories of typical, productive Americans—kids' football coaches, secretaries of the PTA—who smoke marijuana because they like to smoke marijuana, but who understandably fear emerging fully from the "cannabis closet." This is a profoundly necessary idea. If we're to begin to roll back our stupid and deadly drug war, the stigma of responsible drug use has got to end, and marijuana is the best place to start. The super-savvy Barack Obama managed to turn a buck by coming out of the cannabis (and cocaine) closet in a bestselling memoir. That's progress. But his admission came with the politicians' caveat of regret. We'll make real progress when solid, upstanding folk come out of the cannabis closet, heads held high.

So here we go. My name is Will Wilkinson. I smoke marijuana, and I like it.

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On July 1, 2001, a nationwide law in Portugal took effect that decriminalized all drugs, including cocaine and heroin. Under the new legal framework, all drugs were "decriminalized," not "legalized." Thus, drug possession for personal use and drug usage itself are still legally prohibited, but violations of those prohibitions are deemed to be exclusively administrative violations and are removed completely from the criminal realm. Drug trafficking continues to be prosecuted as a criminal offense.

While other states in the European Union have developed various forms of de facto decriminalization — whereby substances perceived to be less serious (such as cannabis) rarely lead to criminal prosecution — Portugal remains the only EU member state with a law explicitly declaring drugs to be "decriminalized." Because more than seven years have now elapsed since enactment of Portugal's decriminalization system, there are ample data enabling its effects to be assessed.

Notably, decriminalization has become increasingly popular in Portugal since 2001. Except for some far-right politicians, very few domestic political factions are agitating for a repeal of the 2001 law. And while there is a widespread perception that bureaucratic changes need to be made to Portugal's decriminalization framework to make it more efficient and effective, there is no real debate about whether drugs should once again be criminalized. More significantly, none of the nightmare scenarios touted by preenactment decriminalization opponents — from rampant increases in drug usage among the young to the transformation of Lisbon into a haven for "drug tourists" — has occurred.

The political consensus in favor of decriminalization is unsurprising in light of the relevant empirical data. Those data indicate that decriminalization has had no adverse effect on drug usage rates in Portugal, which, in numerous categories, are now among the lowest in the EU, particularly when compared with states with stringent criminalization regimes. Although postdecriminalization usage rates have remained roughly the same or even decreased slightly when compared with other EU states, drug-related pathologies — such as sexually transmitted diseases and deaths due to drug usage — have decreased dramatically. Drug policy experts attribute those positive trends to the enhanced ability of the Portuguese government to offer treatment programs to its citizens — enhancements made possible, for numerous reasons, by decriminalization.

This report will begin with an examination of the Portuguese decriminalization framework as set forth in law and in terms of how it functions in practice. Also examined is the political climate in Portugal both pre- and postdecriminalization with regard to drug policy, and the impetus that led that nation to adopt decriminalization.

The report then assesses Portuguese drug policy in the context of the EU's approach to drugs. The varying legal frameworks, as well as the overall trend toward liberalization, are examined to enable a meaningful comparative assessment between Portuguese data and data from other EU states.

The report also sets forth the data concerning drug-related trends in Portugal both pre- and postdecriminalization. The effects of decriminalization in Portugal are examined both in absolute terms and in comparisons with other states that continue to criminalize drugs, particularly within the EU.

The data show that, judged by virtually every metric, the Portuguese decriminalization framework has been a resounding success. Within this success lie self-evident lessons that should guide drug policy debates around the world.

Bush claimed to respect federalism, but his Justice Department repeatedly brought the heavy hand of the law down on desperately sick people who, with the approval of their state governments, used marijuana to ease their pain.

Calling off the raids was the right thing to do, and—for a liberal president vulnerable to the charge of being "soft on drugs"—a politically courageous move ("the Audacity of Dope"?).

Thousands of Americans use marijuana to treat glaucoma, cancer, and other diseases. The federal government has no business coming between them and their doctors. Cancer survivor Richard Brookhiser made that clear when he testified before Congress in 2006.

Brookhiser, a staid senior editor at National Review, hardly resembles the stereotypical pot smoker. But in 1992, he contracted a particularly virulent form of cancer and found that only marijuana would allow him to hold down enough food to survive the treatment.

"God forbid that anyone in this room should ever need chemotherapy," Brookhiser testified, but if you do, "Let me assure you that whatever you think now, or however you vote, if that moment comes to you, you will turn to marijuana. Extend that liberty to your fellow citizens."

In recent years, 13 states have done just that. After California passed the Compassionate Use Act in 1996, the Clinton administration commissioned a comprehensive study on medical marijuana.

That report came out 10 years ago this month, and it indicated that the drug had shown promise as a treatment "for symptoms such as pain relief, control of nausea, and vomiting." The scandal-scarred Clinton worried that his opponents might portray his administration as a klatch of licentious Baby Boomers, so he wasn't entirely happy with the report's result. His administration sued medical marijuana dispensaries, and tried to revoke the licenses of doctors who prescribed the drug.

President Bush was more aggressive still. In the case of Gonzales v. Raich, the Bush Justice Department insisted that, regardless of what California's voters had decided, it had every right to deny use of the drug to a woman with an inoperable brain tumor.

In the process, the Bush team undermined the core constitutional principle that federal power is limited. As Justice Clarence Thomas wrote in his Raich dissent, "If Congress can regulate this under the Commerce Clause, then it can regulate virtually anything—and the Federal Government is no longer one of limited and enumerated powers."

Holder made clear last Wednesday that the Obama administration won't pursue cases like Raich. That's good news, but the new policy doesn't go nearly far enough. There's no good reason to wage war against people who use marijuana as medicine, but neither is there any reason to prosecute recreational users. It's a disgrace that, in the 21st century, in a free country, we continue to send people to prison for using or selling the drug.

Survey data tell us that some 40 percent of Americans have tried pot. Any policy that suggests that 100 million Americans are criminals needs rethinking. Among them are a host of political elites who support the drug war, at least tacitly: Bill Clinton, Al Gore, Newt Gingrich, Sarah Palin, and Barack Obama himself.

Obama's no legalizer. But his early moves—including the appointment of a moderate as drug czar—suggest that he's much less hawkish than his predecessors. There are even some signs of new thinking on Capitol Hill.

Last year Reps. Barney Frank (D-MA) and Ron Paul (R-TX) cosponsored a bill to decriminalize possession of marijuana. Senator Jim Webb (D-VA) recently took to the pages of the Washington Post to lament the fact that the United States locks up more people per capita than any other country in the world—many of them nonviolent drug offenders.

We're still far away from calling an end to our foolish and destructive War on Drugs, but the debate finally seems to be headed in the right direction. The prospects for drug policy reform look better than they have for decades.