Success in tobacco control will not happen without public health champions speaking freely and honestly to the public. As professor Gérard Dubois explains below, there is real danger these voices are being silenced.
As is happening in the UK, France is beginning to experience an abuse of the libel laws. In 2009, through my role as professor of public health at Amiens University Hospital, I stated on French TV that cigarettes kill two smokers a year for every tobacconist. As a result, I am being sued by the French tobacconists’ union. The irony is that in June 2009 I received a “Knowledge for the World” award from the Johns Hopkins Alumni Association for making the very same claim. (1) I also chair the Alliance Prévention Alcool, a charity established in June 2010 to federate the organizations that oppose dangerous and inconsistent policies. Indeed, this is a serious challenge in France. For example, in June 2009, the Government issued new laws to “improve” the healthcare system but it also allowed for advertising of alcohol on the internet – the favoured media of young people. This nearly nullified ‘Evin’s law’ issued in 1991 to ban or limit alcohol advertising in traditional media and during sports events.(2)
Since 2006, Dr Alain Braillon had been a senior tenured consultant in my unit at Amiens, until his surprise sacking last December when his position, as head of the regional body for the assessment of professional practices, was abolished by a few members voting through an unscheduled agenda item at the hospital board meeting. Known as a “high profile expert on public health”(4) he had been in charge of several regional programmes, such as hepatitis B prevention, smoking cessation in pregnancy and suicide prevention, that were all brutally terminated by the director of the Regional Health Administration. Braillon has also taken a high profile stand on many public health issues, not only the law which allowed the advertising of alcohol on the internet, but also the controversial practice of population screening of prostate cancer.(3) The chairman of the French Public Health society said “This is the first case of the sacking of a public health expert that I have heard of.”(4).
France’s National Management Centre of the Ministry of Health unfairly investigated Braillon’s case to confirm the sacking. There were several breaches of the Freedom of Information Act and no evidence was heard from either myself or Braillon. Nevertheless the majority of the members of its advisory body, the National Statutory Committee, advised against the sacking. However, the National Management Centre overturned this advice. This rollercoaster ride of overturning decisions is highly unusual – the coincidence is exceptional!
Earlier this year, the Health and Sport Minister Roselyne Bachelot said she was shocked when British American Tobacco announced it was dropping the price of a pack of 20 cigarettes in France from €5.50 to €5.30 for two of its brands, Rothmans and Lucky Strike. Her calls for a tax increase in order to prevent young people from smoking were ignored. The Elysée (The French White House) consistently supports the tobacco, alcohol and online gambling industries but ignores the best evidence to reduce the health burden on the French people.
From more background on this story please see Healthwatch, issue 79, Oct 2010.
1 One Wise Man Rewarded. Johns Hopkins Magazine, June 2008. See: http://www.jhu.edu/~jhumag/0608web/alumnews.html
2 Braillon A, Dubois G. Web-based intervention and alcohol: who is upside down? Alcohol Alcohol 2010;45 :103. See: http://alcalc.oxfordjournals.org/content/45/1/103.full?keytype=ref&ijkey=6PUMODWWj0O43
3 Braillon A, Dubois G, Zielinski O. Screening for prostate cancer: a public campaign, evidence-based-medicine and conflicting interests. Eur J Public Health 2009;19:222. See: http://eurpub.oxfordjournals.org/content/19/2/222.full?cited-by=yes&legid=eurpub;19/2/222
4 Benkimoun P. Doctor’s sacking is setback for French public health, supporters say. BMJ 2010; 340:c711. See: http://www.bmj.com/content/ 340/bmj.c711.full?sid=117b18ac-43ef-4f2f-9d0d-0dacba2b0919