 Gwtodd, mae'n cael mhwael ar y tafn. Merhid, mae'r gweithio am y gallu ddweud eich gwasanaeth gweithio. First of all, I shall lie once again to thank your hands, Gwciiln, Fyddair o wonderful and magnificent hospitality. The Search For Truth is, of course, very gratifying, but to search for truth in the Carrier Princess Otar Felly, y ffordd hyn sylwedd y mae'n gweithio'r wrth gwrth. Rwy'n meddwl i'r bobl a dweud o gael sylweddau, ac wedi 음ydau ein byddfer hynny am hyn, mae'n meddwl i'r bobl gennym isgol yng Ngheirion, ynddun nhw'n edrych yn yma, ac mae hynny i'r bobl. Bydd y Prifysg twfynu gwneud yno i fod yn ei godieth i gael ychydigol yn unosu'n any vehicle, including in private cars. The justification for this proposal was, as follows, it's generally thought on the basis of epidemiological evidence that children brought up with parents who smoke are more likely to develop chest infections, chest additions such as bronchiolitis and to suffer from severe exacerbations of asthma if they suffer from asthma. Asthmatic children of smoking parents have to go to hospital more often and stay longer than asthmatic children of non-smoking parents. The risk of children suffering from other conditions such as Nibogir disease is 35% greater if parents smoke than if they don't and parents who smoke more than double the risk of a child suffering from bacteria and meningitis. So it seems obvious or intuitively obvious that smoking in a small and confined space such as a car is not likely to be good for children's health and indeed smoking in a car raises articulate contaminants of the air to more than 100 times the recommended levels. Now let me just here interpose a warning for general consumption as it were. When epidemiological evidence or information is relayed to the general public it's often in the following form that consumption of product X say doubles the risk of development of disease Y. The significance of this information for most people however crucially depends upon the absolute not the relative risks. The doubling of a risk of developing a disease that normally occurs one in five million people is not really worth worrying about and a small increase in the relative risk of developing a very common condition can be of significance in absolute numbers and only rarely I think of these things made played to the public in the reporting of epidemiological studies and there sometimes in fact quite often not made in the medical literature themselves these things are not made clear and this one suspects is because scientific research and public advocacy are not nearly as distinct as one might suppose that they are about that they ought to be. Well a couple of absolute figures for the risk of children of smoking by their parents might now be in order it's estimated that in Britain I'm talking about Britain I hope you'll forgive me for using British statistics it's estimated that there are 9500 extra hospital admissions a year because of asthma necessitated by the smoking of parents by parents of asthmatic children that however is one in a thousand children per year if you need to keep all these figures in mind the death it's estimated that 200 cases of bacterial meningitis a year are attributable to smoking by parents and the death rate from this disease is between 5 and 10% even when adequately treated and the permanent neurological damage is 10 to 20% of cases that is to say between 10 and 20 children a year die in between 20 and 40 a year suffer from permanent neurological damage for example deathless because of parental smoking. Now these figures translate to something between one in a million and one in 250,000 children I'm assuming here for the sake of argument that these figures are beyond reproach and that all relevant compounding variables have been controlled for. Now let's examine a few principles it seems to me that a person A is right to breathe smoke-free air in situations where they are obliged to breathe the same air as B trumps these right to smoke and for example prison in which I used to work a doctor attempted rightly in my view to accommodate prisoners who did not smoke in smoke-free cells when they shared cells of course it's there aren't very many non-smaking prisoners because the statistical association between smoking and criminality is very very strong it's much stronger than the connection between poverty and it's much stronger than the criminality and it's much stronger than that the connection with unemployment and it's very nearly as strong as the connection between criminality and tattooing. Well where children are concerned the right to smoke-free air seems even stronger they can't escape the environment into which they are born and parents obviously have a duty of care to their children not to expose them knowingly to risks where there are no benefits accruing to them that is to say the children from those risks but if we examine the particular prohibition with regard to private cars in the first place it doesn't seem that anyone has ever shown that smoking in cars is an independent risk factor for the development of any disease in children it might be and perhaps it is but intuitive likelihood is not the same as evidence much less of certainty so quite a stern prohibition is being proposed on the basis of knowledge that is more mutually complete and it's likely to remain incomplete for very obvious it's intrinsically difficult to disentangle the risk of smoke-breathing cars from smoke-breathing elsewhere including of course in homes and it's obvious that many private cars are driven without transporting children thus a blanket prohibition is proposed to alter the behaviour of only a portion of the population the alternative being a targeted prohibition that would be more onerous possibly and intrusive to enforce than a blanket one it is obvious also that prohibiting smoking in cars could be and would logically be but a first step to the prohibition of smoking in homes or at least in homes where there are young children and we should not disguise from ourselves the possibility that this would bring benefits as measured by admission of children to hospital for acute exacerbations of asthma for example but unfortunately benefits are rarely more broad without costs and some of these costs are tangible and some intangible and many are unforeseen in a letter to the times towards the end of 1939 for example and shortly before his own death the famous surgeon Wilfred Trotter pointed out that the blackout in Britain preparatory to German air bombing raids which so far had not occurred had resulted in an extra 600 fatal accidents on the roads of Britain 600 people died as a result of that that is to say the mere proportion of 600 people nowadays of course we can we can conduct home wars and bombing countries to smithereens with fewer casualties to ourselves that is and so there is progress now I'll pass over the tangible costs of prohibition of smoking in cars from economic ones to agitation in drivers for example causing more accidents it's obvious that a prohibition first in cars and then logically in homes represents an increase in state power or control over the individual the cost of this increase in control of loss of liberty can of course be measured in the same units as the benefits to children's health the chief benefits and harms of the prohibition are probably incremental and therefore people might disagree whether from a so-called rational point of view it is justified or not to prohibit smoking in cars and homes is there more rejoicing in heaven over one hospital admission avoided than over 99 smoking parents were allowed to continue well what's clear from reading the medical journals is that there is never or very rarely any sense of dilemma in them a ban would would produce x amount of health benefit and therefore it should be instituted the question of freedom does not even arise let alone other costs of course to a hammer all things are a male to doctors everyone is the permanent possibility of an illness just as John Stuart no define matter as the permanent possibility of sensation but James Oswell once said the world is not to be made a great hospital and that is what we are recently doing since illness is by definition something that one would wish to avoid anything that helps avoid illness is so fact justified unfortunately health is one of those undoubtedly desiderata that is affected by almost everything that a man does this is so even if one does not take seriously the world health organisation sinister and totalitarian definition of health the definition of health is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity this definition was written into the organization's founding constitution and has not been amended since 1948 it's still used and is often posted and i don't think it requires very much reflection to see that on such a definition of health there is scarcely any definition at any extension of tyranny that could not be justified on grounds of public health and of course there is a marked institutional in the tendency for public health authorities to act well in advance of the evidence for example in the two countries in which i live Britain and France there have been widespread publicity campaigns endorsed by the WHO which involves some kind of moral bullying to get people to eat five portions of vegetables and fruit a day this i hasn't to have is not for aesthetic reasons but to improve the health of the population as we know a meal is a medical it's a medical procedure among the justifications offered for the campaign that of course used up a considerable amount of resources derived or perhaps i should say extorted from taxpayers was that eating five portions of fruit and vegetables would reduce the risk of cancer and i will hear pass over the difficult and perhaps impossible question of whether mounting propaganda campaigns actually changes people's behaviour very much let alone in the desired direction well a recent very large study involving more than half a million people in Europe demonstrated that those who ate five portions a day had a reduced risk of developing cancer of between two and three percent not enough to be sure that the effect was caused by the difference in diet after all very few people differ only in the diet that they take and no other characteristics and such a large study couldn't control for that so we don't know whether eating five vegetables a day is good for you or not at least from the point of view of developing cancer however it's unlikely that this will have any effect whatever on the propaganda that is used for two reasons really the first is that it would involve an admission that that they were wrong and secondly the show must go on but really it will also go on because we feel that people who do not eat fruit and vegetables are often stupid and badly educated and have a calling taste diet has long been thought to be the greatest key to health the British physician for example George chain and i'm taking just one example who lived between 1671 and 1748 already recommended exactly what is recommended now that is to say exercise a diet rich in vegetables and moderation in all things and though it must be said that at one point he weighed more than 200 kilos and he personally would not move around un-aided the differences that chain sought to persuade or convince his readers and his patients rather than compel them and in fact he used his own bad example as a good example but we now live in an age when official coercion for our own good when the philosopher king is in firm alliance with the double entry bookkeeper and also in an age when intellectuals such as Richard Dawkins can seriously propagate the idea that to bring up a child in a religious belief is a form of child abuse akin to sexual and physical abuse which he thinks perhaps should be rooted out by a public in position while we that's the world we live in and government shepherds believe they have an infinite responsibility towards their flock and the flock believes it too in large part and there can be of course no responsibility without power anxiety is about the potential for the extension of tyranny over the population in the name of public health are actually quite old the times for example in about 1848 said in a very famous leader that we would prefer to take our chances with cholera than have the government dictate what water we should drink and another very important example of a smallpox vaccination in England and Wales during the 19th century in the first two or three decades of the 20th century probably come as a surprise to you to know that the anti-vaccination movement was one of the strongest and most durable social movements of the 19th century and it published mass circulation journals continuously for 50 or 60 years in response to the British government's attempt in the 1850s to make the vaccination of children compulsory and instituted fines for those parents who did not have their children vaccinated constantly the compulsion vaccination in the United States is still quite quite common the arguments of the vaccinate anti-vaccinators were composed of two main screens i have quite a large collection of anti-vaccination literature the first of these was that vaccination was as a matter of empirical fact either useless or harmful responsible responsible for spreading such diseases as syphilis and even leprosy and also that it was ineffective against smallpox well this is not a strand that i'm interested in here there was a second strand according to which even if compulsory vaccination were effective against smallpox it would still not be justified because it would make the state and not the parents of children the arbiter as to how they the children should be best looked after and that this was the beginning of a slippery slope interestingly this was a movement of this predominantly working class the working class was asking for protection from the state not protection of the state and i'll quote just one dissie from here the flavor of the kind thing that said men of england claim your freedom make a noble stand sweep the unjust war of tyrants from your native land strike the blood of vaccination claim your liberty sound the echo through the nation britans shall be free well in the event a something like a compromise was reached in 1898 according to which parents could opt out of having their children vaccinated if they could persuade a magistrate that they were conscientious objectives to vaccination was the model for conscientious vaccination conscientious objection during the first world war in any case as it happened smallpox declined as a serious health threat in western countries for a variety of reasons only one of the vaccination and the passion they went out of the whole proposition well immunisation against contagious diseases is an interesting case because for most such disease is somewhere between 80 and 90 percent of the population must be immune in order for there to develop what is called herd immunity that is to say the non-immunised that the non-immunised are protected against infection because an epidemic cannot take hold in the population well the success of immunisation campaigns in eradicating or controlling various contagious disease has in my view encouraged the epidemiologists and the public health doctors and governments have a sense and of course the discovery of the damaging effects of smoking also encouraged and they hope to repeat these trials for the common diseases which are currently great significance both in terms of morbidity and economically in western populations diseases such as hypertension coronary artery disease stroke type 2 diabetes osteoporosis and various forms of cancer which seem to be related to lifestyle in most such cases of course causation is rather less clear cut or well established than it was for infectious diseases or even the connection between smoking and various kinds of disease but nevertheless varying degrees measures of varying degrees of coerciveness are proposed to reduce the burdens of these conditions from the contents of food to denial of medical treatment to those whose lifestyle has brought on their own conditions well the locus stand out public health authorities to interfere in the lives of individuals of the general public derives in large part from the fact that while the risks are taken by the individuals the costs of consequent illness when it develops are borne by others in the form of either important insurance or of course in Britain by the state medical system in other words I smoke but you pay for the treatment of my cancer and the hope of many people from Britain I think is that eventually they will have an extremely expensive procedure which will more than pay back the amount of taxes that they have paid but of course it's not possible for everyone to get more out of the system that he has paid nevertheless that is the hope. Now it's again obvious that people who pay the taxation cannot be the administrators or controllers of it and a class of bureaucrats charged with reducing costs or sometimes making profits is charged with the administration and incidentally they are likely to transfer as much as possible of the money raised by taxation or insurance into their own personal funds and this is not a negligible thing a British former minister of health admitted shortly before the election that the increased amount of money spent on our state health system since 1997 had been very largely wasted and these are not small sums the British government deficit is currently running at 250 I get muddled up now a trillion here a trillion soon we'll be talking to your money I think it's 250 250 billion that's it 250 billion dollars without the extra expenditure on the health service it would have been 100 billion so in other words 40% of the deficit is caused not by the expenditure but by the extra expenditure quite comparison with 1997 well epidemiology you can see that in this situation epidemiologists who discover connection statistical or causal between illness and risk factors give the government ammunition with which they are able to interfere in the day to day life of the population which of course is always a very pleasant task for certain kinds of people so freedom to what is really wanted is freedom to indulge in the risky behaviour on the one hand and insistence that someone else pays the cost on the other and this is not likely to be compatible in the long run though in the short run they're likely to it is likely to promote risky behaviour especially as the risky behaviour is generally concentrated in the least economically productive and politically powerful sector of the population so the stage is set for dictatorial interference endless dictatorial interference in fact but this interference in a democratic age must be extended to everyone as because it's likely to be both bullying and ineffectual and the more ineffectual it is the more it must increase now I don't think this problem is going to be solved in the near future it seems to me likely that healthcare will it seems unlikely that healthcare will revert ever to a system in which there's made the third part of payment and therefore I think there's going to be bullying in the name of health for the foreseeable future well ladies and gentlemen I'm going to end with a one last plea epidemiology demonstrates that by far the largest cause of injury in the developed world is that sport in 1991 for example five percent of the british population was injured sufficiently badly to necessitate hospital treatment while indulging in sport and in fact in 1996 the british medical journal reported that there were 19 million sports injuries a year in england and wales more than 19 million sports injuries a year in england and wales that's about one or two per five two sports injuries per five for the population and if you take the population most at risk it's probably at least one a year and possibly two a year so let's have however no nonsense about the health benefits of sport because the question that's the wrong question the right question is whether sports have health benefits that are not available without the risks by some other means so ladies and gentlemen one last plea that is to say that we ban sport and criminalize it