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Exhibit A from the United States. That 100 pattie burger looks tasty...

(Spotted on Marginal Revolution)

Exhibit B from the United Kingdom - wait a few seconds to be diverted.

Both sites for the epicureans amongst us, most certainly.

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I have come across a press release from Britain's National Health Service. The NHS is currently trying to prevent obese people from having hip replacement operations as they do not "deserve" to have such treatment, despite the little matter of their having been taxpayers like the rest of us.

"The NHS, like any proud creation of a socialist, inclusive Britain, has to operate under certain priorities. Indeed its founder, the great Soviet leader Nye Bevan, stated that socialism is about priorities. Well, there is no place and certainly no priority to treat people, who, by laziness, sloth and lack of intelligence, choose to make themselves ill or incapacitated. In fact ill people are a positive nuisance. It is the fit, able-bodied and alert people of Britain who deserve to be treated by the Greatest Health Service Devised by Mankind. No more obese people. No more smokers. No more drinkers. No more red meat eaters and chocolate fans. Such habits have no place in a socialist Britain. Let such vile habits wither away."

I am still trying to vouch for the authenticity of this release. Looks plausible to me.

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As Christmas is almost upon us, it is a pleasure to read a nice article by a doughty basher of nanny-state puritanism, Jacob Sullum. Sullum states what many of us probably instinctively know to be true - a bit of what you fancy is good for you. Dark chocolate (yeh!), red wine (yeh again!) and even red meat (thrice yeh!).

So in the interests of good health, I am now eyeing a bottle of fine Rhone red wine sitting on the rack in the kitchen.

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I have long gotten a laugh from Dilbert, the socially inept engineer comic created by Scott Adams. Usually, Dilbert is harmless, but occasionally he causes real damage. Last Sunday's cartoon, which features Dilbert's mother in an excessive shopping adventure that ends with organ harvesting struck me as rather amusing, but according to Scott Adams' blog, dozens of people failed to see the humour in it:

Recently I killed thousands more people. I don’t have exact numbers yet. The problem stems from my comic that ran on 11-20-05, implying that retail stores might harvest organs from bad customers and sell them on eBay. I’ve received dozens of letters (long ones!) from very angry people who assure me that the Dilbert comic will reduce the number of organ donors. The concern is that people will think their parts will end up on eBay and so they won’t be inspired to donate.

This would only have an impact on exceptionally dumb potential organ donors. But as you know, that’s a large block of the general population. Now I have to wonder how many people are smart enough to read an entire Dilbert comic and still dumb enough to think that the first person on the scene of an accident might be there just to harvest organs for eBay. It can’t be more than 1%. Let’s see, we estimate 150 million people read Dilbert, so 1% would be 1.5 million. And only 10% of them might have donated an organ anyway, so I’m probably killing 150,000 people.

It’s times like this when “oops” doesn’t seem sufficient.

I bet you did not know that cartoonists could be so dangerous. If you ever meet Scott Adams, approach with extreme caution.

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One of the concerns appearing on the radar is the impact of a flu pandemic upon Africa, where a rudimentary infrastructure for health is combined with the largest number of individuals with HIV and AIDs. A common mistake is to view this latter group as the most vulnerable to a flu pandemic, with a potentially catastrophic death rate.

Recent comments by Dr. Robert Webster, at an avian-influenza conference, organised by the Council for Foreign Relations, in New York, theorised that HIV positive patients and those suffering from cancer could act as incubators for the virus, leading to more virulent strains. However, there is evidence to support the view that immunologically compromised individuals will not facilitate the spread of the pandemic:

Stephen Wolinsky, chief of the infectious diseases division at the Feinberg School of Medicine, concurred that prolonged shedding of the virus was a definite problem but referred to a study published earlier this week that stated that immunodeficiency may in fact be a benefit in the face of avian influenza.

The study, published in the journal Respiratory Research, indicated that the young and healthy may be those most seriously affected by avian influenza, as the body's immuno-response was to produce a storm of cytokines that can lead to respiratory difficulties.

Wolinsky opined that, for Africa, the lack of access to doctors and hospitals may prove to be a greater concern in the fight against avian influenza than the continent's HIV/AIDS epidemic.

This region has been identified as a potential outbreak region for the pandemic. Farming practices that bring farmers into close proximity with poultry, are compounded by non-existent public health schemes and a large proportion of the population suffering from ill-health and malnutrition.

The H5N1 virus overstimulates the immune system, and many of its powerful effects are caused by what medical expert call a "cytokine storm", after the immune molecules excited by the disease.

It was the cytokine storm that overwhelmed so many victims of the 1918 flu pandemic. Aids patients may be spared that fate.

But equally possible, with their immune defences down, they could succumb easily to the disease.

"In that situation," said Laurie Garrett, "vast populations of HIV positive people could be obliterated by the pandemic flu."

Laurie Garrett, senior fellow for global health at the Council of Foreign Relations, was identifying the worst case scenario.

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Alexia Harriton, an Australian woman who is deaf, blind, physically and mentally disabled and requires round-the-clock care, is suing a doctor for allowing her to be born, with the full support by her mother. Never mind that rubella during pregnancy does not guarentee what happened to Ms. Harriton.

I have a better idea. If she is competent to sue the doctor, she is competent to tell the people giving her round-the-clock medical care to get lost and let nature take its course. Hell, she could tell one of them to leave a nice sharp knife or a cup of water and a bottle of sleeping pills within reach if she wants to expedite things and if she cannot manage that, well seeing as how her mother is so supportive...

Why should a doctor be liable for an 'act of God'? So he did not diagnose how thing would shake out correctly. Too bad, no one is perfect.

Seems to me that Alexia Harriton and her mother were born moral and emotional cripples too. Nature dealt them a seriously crap hand and that is truly tragic but it is no one's fault. It happens. Deal with it, but please, deal with it yourself. Think I am being a little harsh? Well I do not think so and I have my reasons.

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A study claims that the long-term effects of smoking tobacco can impair mental functions. My goodness, what other horrors can the dreaded weed be held responsible for? I don't smoke and dislike the pong of cigarette smoke in my clothes after visiting a pub, but is there no limit to the ways in which our blessed medical profession want to condemn smoking? The claim rings false to me (I am not a scientist mind so if this can be verified in a peer-reviewed journal, I'll stand corrected). There have been lots of brainy smokers over the years, surely.

I wonder how many members of Mensa have been smokers?

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Just as the NHS is the darling of the British people, it will come as no surprise that its failures are increasingly covered by the tabloids, who have found that the crisis in health provision is a concern to those who have to rely on the state through no fault of their own. High taxes and expensive private health care denies choice to the majority of the population.

One of the latest (and incredible) stories to emerge is a lack of mops in Victoria Infirmary in Glasgow:

PATIENTS spent two days in "grotty" wards - after a hospital ran out of mops.

Cleaners at the Victoria Infirmary in Glasgow were left stunned after bosses told them of the shortage. And it took two working days for the hospital to replace all the mops.

A source at the closure-threatened hospital said: "We knew things were bad here but this takes the biscuit. Cleaners went to work on Wednesday and were told there were no mops and nothing could be done about it

Only scenes such as these could be caused by a state monopoly of health:

After replacement mops arrived on Thursday, a source revealed that hospital staff celebrated.

The insider revealed: "People were dancing around the boxes, singing and chanting, 'We have mops.' " The source added: "No wonder our hospitals are riddled with MRSA superbugs and such like if they can't get something as simple as this right."

Only the NHS could ration health and mops!

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"Organic farming has been put forward as one of the major pillars of a new, more-sustainable human society that would be "kinder to the earth". Unfortunately, organic farming cannot deliver on that promise. In fact, organic farming is an imminent danger to the world's wildlife and hazard to the health of its own consumers."

Dennis Avery, quoted in Fearing Food, (page 3) by Roger Bate and Julian Morris.

Something for George Moonbat to ponder, I reckon.

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The pharmaceutical industry has been running an ad campaign in the United States saying that reimportation of drugs from Canada were allowed, those drugs might be counterfeit, unregulated and unsafe. This is simple propaganda and nothing more.

Pfizer's Chief Executive Officer Dr Hank McKinnell has come out and contradicted his industry's advertising. On page 69 of his new book, he says that: "Drugs from Canadian pharmacies are as safe as drugs from pharmacies in the United States." Pfizer vice-president Dr Peter Rost says that drug company lobbyists "know full well" that drug reimportation has "been done safely and cost-effectively... in Europe, for over twenty years... The German Federal Health Ministry has verified that not one single confirmed case of a counterfeit medicine has ever come through the parallel trade chain. The UK regulatory authority has described the level of pharmaceutical counterfeiting as 'virtually undetectable'."

They were not speaking on behalf of their employer.

Dr Rost's view is confirmed by Donald MacArthur of the European Association of Euro-Pharmaceutical Companies who in November 2003 testified at a US Senate committee. MacArthur said: "As far as can be ascertained there has never been a single, proven case of a counterfeit medicine leaving the parallel trade supply chain in Europe. Certainly, none has been reported in the two largest markets for incoming parallel trade - the UK and Germany; in the case of the latter, the government has recently verified this fact".

In the US, where reimportation is illegal, counterfeiting is on the rise. The ban on reimportation has led many people who cannot afford the cost of drugs from their local pharmacy to use online shops they have never heard of to illegally get cheap drugs. Some of these websites, which are marketed through spam e-mail, claim to be in Canada but are based in developing countries and fail to deliver anything or supply counterfeit drugs.

If the US wants to fight counterfeit drugs, it should follow the European model and let legitimate, properly-regulated businesses, which consumers can trust, safely and securely reimport pharmaceuticals. That way, the drugs get imported from legitimate wholesalers in Canada and Europe. Contrary to claims of pharma's lobbyists, it is America's ban on reimportation that promotes counterfeiting. The US government should adopt free trade in pharmaceuticals not just to reduce prices but to reduce counterfeiting, too.

Crossposted from the Globalisation Institute Blog.

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Last summer, I went on very public record with my opinon that the überhyped and screechingly hysterical 'obesity epidemic' was nothing but a crock of shit, cooked up (in this country at least) by grasping public sector vested interests and amplified by their MSM handmaidens.

While I will continue to do whatever is in my power to undermine this whole wicked, mendacious plot over here, I am pleased to note that there is also some serious fightback going on over on the gun-toting side of the Atlantic:

One would be forgiven for thinking CDC stands for Center for Damage Control. Just a year after its widely-publicized and exceedingly controversial announcement that excess weight kills 400,000 Americans annually, the agency is rumbling, bumbling, stumbling toward an explanation for a new study that says the real figure is just 26,000.

Unfortunately, trial lawyers who see dollar signs where the rest of us see dinner have seized on the CDC's 400,000 deaths number to justify their frivolous crusades.

Now word comes from experts within the CDC that excess weight is about one-fifteenth as dangerous as previously thought, and has a lower death toll than diseases like septicemia and nephritis. Each death is of course tragic. But has anyone heard of the septicemia "epidemic" or the nephritis "tsunami"?

It's said that a lie can travel halfway round the world while the truth is putting on its shoes. Well, the truth about obesity is finally lacing up. And that's bad news for trial lawyers pursuing obesity lawsuits against food and beverage companies as well as the self-appointed diet dictators seeking extra taxes on foods they don't like.

Not that that will stop them, mind. Truth has little currency when compared to the value of a well-forged career-path or the tantalising lure of brimming public coffers. (By the way, the link above is to the website of an American organisation called the 'Center for Consumer Freedom'. Not only do they appear to be on the side of the Angels but their website looks like an excellent activist resource that is well worth a bookmark).

Still, the backlash has to begin somewhere, somehow and debunking the fraudulently inflated statistics is an important part of that process. However, it is equally important to maintain the principle that, even if all the har'em-scar'em statistics were true (which they clearly are not) then the responsibility for and solution to the problem of obesity lies with the obese themselves and not with judicial system or the apparatus of tax-collection.

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Story here that says that far from being a bad thing, sitting outside in the sun for at least 15 minutes a day is good for you, latest medical findings suggest. It certainly is a bit of a change from the period, I well recall, in the 1990s, when it appeared to be the case that any exposure to sun was fraught with danger as a result of the supposed hole in the ozone layer. I recall the constant worries, fuelled in the press and elsewhere, about skin cancer and the dangers of overdoing the sunshine.

Sometimes you have to just laugh. Of course being exposed to the sun is good for you in moderation! Mankind was not meant to sit indoors or conceal every aspect of the body all the time. Anyone I know who spends the vast majority of his or her time indoors looks, well, unwell, in my opinion. I always make the effort to break out of my office at lunchtime to get what passes for sunshine in this damp country of ours. It is not rocket science.

Coming next: medical experts reveal that regular exercise, eating vegetables and playing sports can do you some good.

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The steady advances in cloning technology holds a great deal of hope the future of the species and the news from Korea and Britain has been pretty damn encouraging over the last few years. It now looks like we could be on the brink of being able to mass produce stem cells and that, boys and girls, could be the gateway to a new era of medical possibilities.

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“This is really the destruction of the National Health Service."

- Professor Vincent Marks of the University of Surrey on the Today programme this morning discussing the modest government announcement to allow more private involvement in the National Health Service.

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It takes some nerve to announce this on the day of a General Election. Mind you, I doubt very much that it would at all influence the outcome:

Patients should be refused treatment because of their age in some cases, government advisers have proposed.

Where age can affect the benefits or risks of treatment, discrimination is appropriate, the National Institute for Health and Clinical Excellence said.

Charities representing older people said the recommendations were outrageous and sent out mixed messages.

Wrong. The message is quite clear and will gradually become more acceptable. Within five years, people over 75 will be offered euthanasia when they get sick. Within 10 years it will be mandatory.

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The fine U.S. blogger and libertarian scholar, Tyler Cowen, who's blog Marginal Revolution is well worth a visit (as if I did not have enough things to read, aarrgghh, Ed) has started a specialist blog devoted to tracking developments and medical research surrounding avian flu. Tyler is clearly worried about the spread of new and more powerful viruses and the threat this poses to the health to millions of people around the world.

Rather interesting, I think, that the Internet, which helps to spread ideas with the speed of a virus, is now spawning blogs which are devoted to actual, existing viruses.

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Terri Schiavo died this morning.

I hope that her husband and family can find some peace, if not with each other, than at least within themselves.

Now that the emotional flash point of the debate is gone, I hope that we can have a more considered policy discussion over who should make medical decisions for non-decisional patients, and under what restrictions.

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Nobody is willing to take the position (at least in public) that a person should not be able to refuse medical care in person, on their own behalf. However, many of those now engaged in the struggle over end-of-life health care are, wittingly or not, arguing that some health care decisions should be removed from private hands and made by the state.

The current baseline rule is that your personal autonomy with respect to consenting to or refusing to consent to medical care is pretty much absolute (I am discussing medical care, not mental health care, which operates in a parallel universe on these issues). I note that there are some second-order restrictions on what kind of care is actually available to you, arising from various licensing and regulatory regimes, but leave those aside for now. You can refuse any and all kinds of care, ranging from the most extreme life support to the most mundane blood transfusion, and people do all the time, even when the refusal puts their life at risk.

Things get more complicated when you are unable to decide for yourself (or, what amounts to the same thing, unable to communicate your decision). Someone has to decide what care you will be given. Your ability to make such decisions in advance will, sooner or later, be outrun by the unforeseeable complexities and irreducible detail of your medical care. If nothing else, someone will have to interpret your written instructions and apply them to the messy clinical realities. At the end of the day, if you are not "decisional" you will have a surrogate decision-maker. That decision-maker will either be a private individual or the state.

The current system very rarely results in the state directly taking custody of a medical patient who is not decisional, and is very heavily biased toward leaving health care decisions in private hands, with a fairly limited "reserved" power in the state to hear disputes about who the private decision-maker should be. So far, so good.

Although reasonable people can disagree on whether, for example, Michael Schiavo should be Terri Schiavo's surrogate or one of her parents should be, this dispute is over the proper issue of which private party should make decisions. It is very difficult, I think, to argue that this issue hasn't been fairly and adequately processed by the courts.

However, we are seeing increasing pressure to restrict the decisions that the surrogate can make. This is where it gets tricky, because legal restrictions on the decisions that a private decision-maker can make mean that the state is making that decision. If there is a law on the books that prohibits your surrogate from consenting to experimental treatments, then the state is making the decision that you will not receive that treatment. If there is a law on the books that prohibits your surrogate from withdrawing a feeding tube, then the state is making the decision that you will be fed through a feeding tube.

The current mantra that "if there is any doubt, err on the side of life" is a TV-friendly sound-bite in the service of expanding the control that the state has over your medical care, because this "principle" removes from your surrogate the ability to make health care decisions, and is functionally equivalent to the state ordering that medical care be provided regardless of your wishes. For your own good, of course.

Similarly, the endless agitation for more appeals amounts to agitation for more state review and oversight of a nominally private decision. For your own good, naturally.

In short, to the extent any coherent public policy is being advanced by the people who want the feeding tube re-inserted into Ms. Schiavo, it is a public policy that shrinks the decision-making powers of private decision-makers, and necessarily transfers those decisions from private hands to those of the state.

The over-riding principle that is cited in favor of this transfer of power to the state is the protection of life. However, the protection of life is not an absolute trump card; indeed, when it comes to medical care, personal autonomy overrides protection of life; otherwise, the law would require that life-saving health care be provided to you over your objections.

Nobody is willing to take that step, so advocates for the transfer of power to the state are left in the position of arguing that some decisions that you can make for yourself should never be made by your surrogate, but should be made by the state instead. Those are the only two choices on offer - either the state makes decisions about your end-of-life medical care by prohibiting your surrogate from deciding, or your surrogate decision-maker does.

I think you know where my instincts are when faced with a choice between preserving the private sphere and expanding state control.

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On The Voice of Reason (slogan: "A penny saved is a government oversight"), there is a pretty clear headed little essay of what I think is most the reasonable position on this absurdly emotive case.

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For an excellent overview of the Schiavo case, written by someone with a better work ethic than me (she links to her sources, I just kind of remember their gist), go to Majikthise.

Out of the morass of purely case-specific issues in this case, perhaps the most legitimate policy argument raised by the Schiavo trainwreck has to do with the withdrawal of food and water.

Let's be clear on Schiavo's condition and treatment here: she is being fed and hydrated through a tube in her stomach. She is not feeding herself, and is presumably not capable of taking food and water orally, or the tube would never have been inserted. This kind of feeding and hydration is just as much a medical treatment as having a glucose or saline IV inserted into your arm.

No one attempts to deny that Terri (or anyone else) would be permitted to refuse this treatment for themselves; a law mandating that you receive a given medical treatment against your will would be widely regarded as an abomination.

Similarly, no one seems to be seriously arguing that if Terri were on a ventilator or some other form of artificial "life support", that her guardian should be permitted to withdraw the life support, even though there is no written evidence of what Terri's wishes were in that regard.

This leaves many of the folks who are now arguing for federal intervention into Terri Schiavo's medical treatment in the rather uncomfortable position admitting that (a) she could refuse to consent to being fed through a tube in her stomach, and (b) that her guardian could withdraw other forms of life support, but nonetheless that (c) her guardian cannot refuse consent to her being fed through a tube in her stomach.

Thus, the policy question being posed by this case seems to be whether a surrogate decisionmaker should be compelled by law to "consent" to their ward being fed through a tube in her stomach, unless he can produce written evidence that is what the patient would have wanted.

The case against such a legal mandate boils down to the argument that denying the right to consent or refuse consent to the surrogate is the same as denying it to the patient herself. Of course, the surrogate is not, in fact, the patient, and there may be legitimate boundaries placed on the decisions the guardian can make on behalf of their ward. The question is whether withdrawal of nutrition and hydration is outside of those boundaries, and if so why.

The case for a legal mandate that nutrition and hydration be given over the objections of the legal guardian rests comes down to the argument that, where there is any doubt as to what the patient would want, we should err on the side of keeping them alive. This argument, however, founders on a couple of points. Logically, it cannot be limited to nutrition and hydration, and thus requires that we keep all life support, no matter how extraordinary, in place. Further, it begs the question of how much certainty is enough. Even where a written living will exists, the question can be raised about whether the patient changed her mind.

Because we cold-hearted libertarians care about such things, Terri Schiavo's care is being paid for by taxpayer money through the Medicaid program. Even though her parents have noisily pledged to take all financial responsibility for her care, they have not yet done so, even though the trust fund established out of the proceeds of her malpractice case to pay for her care is nearly exhausted. The annual cost is probably around $80,000 per year.

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Various precincts of the US body politic are obsessed with Terri Schiavo, a young woman who has been at the center of an ongoing familial, legal, and now, sadly, political dogfight.

In very broad terms, Terri Schiavo is unable to make decisions for herself. She is apparently brain damaged, and has been in some degree of coma or "persistent vegetative state" for years. Her husband wants to withdraw artificial life support and let nature take its course. Her parents want her kept on life support indefinitely in the hopes that some day she will make some degree of recovery. As ever, you can find a medical expert to present just about any side of this that you want. This situation is, sadly, all too common.

The uproar around Terri Schiavo illustrates rather nicely the key distinction between libertarians and, well, everyone else. For libertarians, the critical question is "who decides?", based on their belief that you should be able to make your own decisions in life. Most other folks, it seems, don't care "who decides" nearly as much as they care about "what decision is made," and particularly, "whatever decision is made, it damn will better be one I approve of."

In Terri's case, this means that all sorts of folks who you think would know better than to invite the state to participate in medical decision-making are doing exactly that, because Terri's husband has made a decision that they do not approve of.

So, not only have we been treated the spectacle of the Governor of Florida, Jeb Bush, trying to elbow his way to Terri's bedside so he can dictate what care she will receive, we also have various Florida legislators trying to insert the State of Florida into the mix. Now the US Congress, apparently not satisfied with embarrassing itself* in its ongoing investigation into steroid use in major league baseball, is preparing to abuse its subpoena power to block the decision made by Terri's husband.

A fundamental principle of health care law, and one dear to the hearts of libertarians, is that you must give informed consent to any treatment before it is administered to you (with an exception in cases of emergency when you are unable to communicate, in which case the caregivers are allowed to assume you want life-saving treatment). A doctor who treats you without your consent has committed assault and battery. It is your right to refuse any treatment at all, even if it will mean your death, and so long as you are a competent adult no court or legislature can intervene to force treatment on you.

When the patient is not a decisional adult, someone who will make decisions on their behalf must be located. You can appoint your own surrogate decision-maker, via a health care power of attorney (which I strongly recommend). Some states have lists of "deemed" surrogate decision-makers on the statute books, such as spouses, parents, siblings, etc., in rank order so everyone knows who has authority in a given case. As a last resort, a court will appoint a guardian.

The whole process is focused on the proper issue of identifying "who will decide." Once the decision-maker is identified/appointed, they stand in the shoes of the patient. The state retains (or should retain) only the most limited role, to ensure that the decision-maker does not abuse their power. Clearly, the decision to withdraw life support is a decision that Terri Schiavo could make for herself. Indeed, my wife has told me that if she were in Terri's position, that is exactly what she would want. Her husband's decision to make it in her stead is by no means an abuse of his power as her surrogate decision-maker - such decisions are made routinely, every single day, across the country by people charged with the heavy burden of making health care decisions for someone else.

What we have in the Schaivo case, then, is the legally appointed and recognized decision-maker making a choice that is well within his purview. Multiple court reviews have concluded that he is the right person to make the call, and his decision should be honored. To this libertarian, that is the end of the matter, because the very essence of being a libertarian is respecting the decisions of others even when you might decide otherwise. To a broad spectrum of conservatives, however, the fact that medical decision-making should be private is of no concern when the decisions made are decisions they disagree with.

*While at the gym yesterday, I caught a few minutes of the steroid hearings. It was painfully embarassing to see the solons of American governance earnestly seeking noted idiot Jose Canseco's advice on public policy. A quick survey of the fellows in the locker room revealed that this latest Congressional exercise in nannying competent adults and chasing headlines is not being well-received by the public. The universal sentiment was, "Don't they have anything better to do?"

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Stephen Pollard, a former member of Britain's Young Conservatives who is now a New Labour guru, has an article in the Times called: My easy ride in the Senate seat.

Life after his easy ride is getting a little more tricky, with a savaging from Global Growth, the free-market NGO.

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The Centers for Disease Control released new life expectancy figures for the USA today. Average life expectancy is up to 77.6 years, up three tenths in a mere two years. Also remarkable is the rapidly closing gap between the life expectancies of men and women. It was a 7.8 year gap in 1978 and is now down to 5.3 years.

When I was in my twenties I told friends my life's goal was to go downhill skiing on Ganymede at age 120. If the technological exponential keeps going as I expect -- and I am 'lucky' enough not to draw the Ace of Spades -- I might just do it.

See you on the slopes!

For more information, see Space.com's Live Science article.

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Leon Trotsky's views on the role of arts were well known. He argued that art in all its forms existed to convey political messages to the masses and that any other use of the arts was bourgeois nonsense. The idea that it was acceptable for the arts exist to express the personal views of some artist or to simply 'entertain' in a non-political sense (not that anything is really non-political to a statist) was just preposterous to Trotsky. Thus if the state wished to advocate or depreciate something, it was the role of the arts to assist with that process. A modern day example of this would be, say, the relentless demonization of smoking.

Which brings us to the views of the Orwellian sounding Centre for Tobacco Control. This group of lobbyists is infuriated that their calls for smoking to be censored by the British Board of Film Classification (who were once simply known as the Film Censors) has been rejected.

The board's cautious mention of smoking for the first time falls far short of demands that smoking scenes, particularly in any film likely to be seen by children, should be banned in Britain and consigned to the cutting room floor. Professor Gerard Hastings, director of cancer research at the UK's Centre for Tobacco Control, said: "If the BBFC doesn't accept its moral responsibility, it might as well pack up and go home."

And so we discover that this lobby thinks is the 'moral responsibility' of the state to impose standards on entertainment to make them more in accordance with the wishes of our technocratic betters (them, of course). Not only do they wish to make it as difficult as possible for you to make your own non-coerced choices as to what stresses and chemicals you expose your body to, they wish to prevent you seeing images which do not conform to the message they wish to indoctrinate you with. I would be curious to know if Professor Hastings also supports forcing people to take favoured chemicals?

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Remember this?

The sun's rays, which are called ultraviolet A and ultraviolet B rays (UVA and UVB rays) damage your skin. This leads to early wrinkles, skin cancer and other skin problems.

Being in the sun often over time, even if you don't burn, can lead to skin cancer. A tan is the body's desperate attempt to protect itself from the sun's harmful rays.

Well, forget that. Now learn this:

Sunshine might stop certain cancers from growing, including skin cancers, according to two new studies.

One found it helped beat the deadly skin cancer malignant melanoma. The other found the sun helped with non-Hodgkin lymphoma.

Tobacco is also known to prevent cancer. So get out that sunbed and a packet of cigarettes now. It's for your own good.

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One of the unspoken benefits of globalisation is the use that professionals make of the new instruments and techniques that are publicised over the internet or through the wider dissemination of networks to newly emerging economies, such as India. However, as one example demonstrates, medical professionals in India read or learn about new developments from the West in their specialism but are unable to apply them because they are too expensive or the instruments cannot be imported or the patients are not rich enough to afford them. This is providing a spur to entrepreneurial and philanthropic activity.

Narayana Hrudayalaya is a medical foundation established in India by Mother Teresa's cardiologist, Davi Prasad Shetty. Acknowledging the dilemma faced by all professionals in poorer countries, Shetty aimed to pioneer low-cost cardiac surgery that would prove affordable, with charitable supplements and insurance for even the Bengali peasantry and textile workers inhabiting the countryside around Kolkata.

In an interview with New Scientist, Shetty understood that governments and international bureaucracies were a hindrance, not a benefit.

If there is one organisation that can be squarely blamed it is the WHO. Headquartered in Geneva, separated from reality, it runs its global activities with help from government representatives who are mostly bureaucrats. In the countries I travel to, bureaucrats are a class of people who are experts in nothing but authorities on everything. They are not best-suited to guide planning at the WHO. One of the WHO declarations was "Health for all by 2000". How can a global body make that kind of statement when a country like Zambia does not have an echo-Doppler, without which you cannot detect any heart problem, or when one cannot find a single functioning ECG machine in many African countries?

Apart from the WHO, I have stopped blaming the politicians and bureaucrats. We are better placed to bring about changes by being outsiders, not by being a part of the system. All that the government can do is to stop being an obstacle. If it decides to be a bystander, things will fall in place. My belief is that within ten years, the government healthcare systems in all Third World countries will fold up. The government will not be able to pay even salaries, never mind offering healthcare. In that situation, organisations like ours should come forward to take over and manage it in a professional manner.

Whilst Shetty describes himself as a social worker as a libertarian, he has recognised that governments cannot provide the resources to meet his objectives and that it is best if they stand aside or collapse. When the state is no longer a factor, the economics or healthcare starts to add up.

Yes, it's very different. In Western hospitals, about 60 per cent of the revenue is spent on salaries, while in government hospitals in India, 90 per cent goes on salaries. By contrast, in our hospital only 12 to 13 per cent is spent on salaries. That doesn't mean our doctors are being exploited. Since their output is ten times more, unit operating costs are very low. To earn a given salary in another hospital, a doctor would have to perform one operation a day. With us he might have to operate on five patients. We also work with zero inventory, so the burden lies with the supplier. And since we are the largest consumers of medical disposables, we procure them at a discount of 30 to 35 per cent.

Increasingly, for the pragmatists of the world, freedom provides the answers that the state is unable to.

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Peter Cuthbertson has some pretty clear views about those who would control us for 'our own good'

Any Brit who turns their television on to ITV or Channels 4 or 5 now will sooner or later see a vile new National Health Service advertisement, funded by their own tax money. Showing a young man running around bars and shopping centres spraying foul smells into the air and onto the clothes of others, it literally urges people that just as they would not tolerate anyone who does that, they should fight against the freedom of smokers to light up in bars and pubs. An obvious prelude to the government's campaign to stop restauranteurs and landlords from allowing smoking on their own property, it is no doubt hoped the advertisement will edge public opinion in the nannying direction.

It is difficult to fathom the petty, narrow mind of the sort of otherwise unemployable bureaucrat who came up with this one. But one comes to understand the idea of people feeling aliens in their own country when one sees such things. What a profoundly un-British little broadcast it was. What a sickening way to impose the morality of the elite's stateless global citizen onto a country whose famous tolerance and fair-mindedness is probably what left-liberal nannies feel necessitates such propaganda - sorry, such a campaign of public education - in the first place. One can only hope enough independently-minded people are emboldened by such spiteful nonsense to take stands on behalf of smoking, one of the few remaining mass activities that genuinely is not in some way anti-social, in an age where it seems few Britons can enjoy themselves in a group without being obnoxious to others.

Somehow worse than this, however, one sees explicit use of taxpayers' money to campaign for one side on politically controversial areas, over behaviour that is perfectly legal and normal. This is a precedent that should worry everybody.

In any reporting on a quasi-tyranny, the state's control and use of the media is usually cited to show that a country cannot be a genuine liberal democracy. Chile's slide into dictatorship in the early 1970s is exemplified by Salvador Allende's decision to eliminate criticism of his regime by nationalising the press. Today's Russia is now widely described with the euphemism 'managed democracy' to a considerable degree because so much of its television is under state control: the elections themselves are free, but the state-run television stations campaigned strongly for Vladimir Putin in advance of last March's Presidential election.

It's because the use by the state of the media to advertise its own virtues and ideals is so symbolic of a wider lack of freedom that it is such a good indicator of the health of a society. The state is effectively limitless in its power to take by taxation anything people earn and produce. When it also feels free to use that money to take political stands, often stands opposed by the very people who pay these taxes, that is a signal of an overmighty government, wherever it exists.

When the state, as distinct from any political party, takes on the role of encouraging people to have the correct views and oppose the right habits, the liberty of everyone is made immediately more precarious. There is a very great supply of petty nannies with a favoured cause, and altogether more dangerous authoritarians and social engineeers with their own pet projects, who would love to get their hands on the power the NHS is now abusing. Rest assured, they will find ways of doing so if the precedent now being set is not reversed.