Thursday, 17 November 2011

How to win a healthcare argument – The British Medical Association vs. the pro-smoking lobby

The British press was awash yesterday with commentary about the British Medical Association (BMA) suggestion that smoking should be banned in cars.

The main thrust of the BMA argument is a recent study which suggests that the levels of toxins from smoking cigarettes are 23 times higher in a car than in a smoky bar. The ‘smoking in vehicles’ briefing paper says children are particularly vulnerable to second-hand smoke, as they absorb more pollutants because of their size and have underdeveloped immune systems. BMA director of professional activities Vivienne Nathanson, BMA Director of professional activities said: ‘…We are calling on UK governments to take the bold and courageous step of banning smoking in private vehicles. The evidence for extending the smoke free legislation is compelling’

Up steps Forest (Freedom organisation for the right to enjoy smoking) - with their counter-argument coming head to head with the BMA spokespersons both on TV and radio. The discussions that ensued provide me with an excellent framework on how to win and argument (or not as the case may be)

Make sure that your factual case is strong:
The BMA have over half a century of proven studies that smoking causes life -threatening and life-limiting disease. A variety of scientific studies have also confirmed the effects of passive or secondary smoking for at least three decades. The study quoting the toxicity of smoke filled cars was undertaken by the British Lung Foundation. The Director of Forest, Simon Clarke’s ‘factual case’ is ‘The evidence is flimsy…. There is not a serious health risk to children’
BMA:1 Forest: 0

Pick your argument and make sure it’s winnable:
This is where I believe the BMA got it wrong yesterday. Children and pets – always a winner. Legislation to protect the vulnerable – can’t lose. Remove ‘civil liberties’ – much tougher game altogether. Forest were able to extrapolate the BMA’s suggestion about banning all smoking in cars, whether children are present or not and question how far the legislation would reach – suggesting that the government could then ban smoking in homes as well.
BMA:1 Forest:1

Stay calm and courteous:
The two BMA spokespeople remained professional and calm throughout. Simon Clarke from Forest often bordered on a rant.
BMA:2 Forest: 1

Never, ever say ‘with the greatest of respect’
A personal dislike of mine. Whenever that phrase is used, it means the exact opposite. If one of the opponents doesn’t agree with the other’s argument – say so. Alas, Mr Clarke – you committed this faux pas
BMA: 3 Forest: 1

Be careful not to counteract your own argument:
The BMA has a ream of strong factual evidence on the dangers of secondary smoking and the enhanced effect of smoke in an enclosed space such as a car. It is estimated that in the UK 4000 adults and 23 children a year die from the effects of secondary smoking. Forest used the statistic that there are 21% of the population and 8% of those smoked in cars with children present. In other words there are at least 1 million children currently at the enhanced risk of passive smoking in cars. Shocking figure – worthy of legislation surely. Own goal
BMA: 4 Forest: 1

Prepare for possible counter attack:
As Simon Clarke made the valid counter argument that the UK police have more than enough to do without trying to arrest smokers in their cars, the BMA countered with the fact that seat belt legislation was unpopular at the time of introduction but now is pretty much universally accepted in the UK with a resultant significant saving of lives. A draw on that point – one all.
BMA: 5 Forest: 2

Try not to let it get personal:
Forest are taking any attack on the right to smoke personally on behalf of the 12 million smokers in the UK, but in this argument – they managed to avoid attacking the doctors personally.
The BMA spokespeople were positively saintly in not criticising smokers directly.
BMA: 6 Forest: 3

Put your argument in context – always looking at the bigger picture:
Particularly important for healthcare issues. This is easy for the BMA – the good of the nation etc etc. Not so easy for Forest – sorry – no beneficial big picture argument available.
BMA: 7 Forest: 3

And finally…

Try to get the last word in:
I suspect that both Dr Vivienne Nathanson and Dr Dean Marshall have had excellent media training. In both the TV interview and radio debate – their final words were… ‘we are just trying to save lives’

Slam dunk, home run, century, win on penalties, serve an ace, whatever sporting metaphor you choose – that has to be the most powerful healthcare argument winner there is.

We are just trying to save lives


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