If you lie down with dogs . . .

The US midterm elections have a nasty side, but so does another, less visible election, that for Director General of the World Health Organization. Thirteen candidates are vying for the position left vacant by the untimely death of Lee Jong-Wook in May. And the politicking is said to be fierce.

One visible evidence is a new campaign against the Mexican candidate, Julio Frenk. Frenk is a well-regarded public health advocate for the poor who has been endorsed by the editor of The Lancet, the noted British medical journal (other posts on the election here and here). At issue is the role Frenk played as Mexican Health Minister in negotiating with tobacco companies over cigarette taxes in exchange for $400 million for health and social programs for the poor. Anti-tobacco advocates, led by the Campaign for Tobacco-Free Kids, believe this raises questions about Frenk's fitness for the WHO job. It is WHO policy not to negotiate with the tobacco industry.

But not everyone agrees. No public health advocate likes to make deals with the tobacco industry, but some are more pragmatic than others:

"I saw this as a tactical move to advance the agenda," said Nils Daulaire, president of the Global Health Council, a Washington-based health advocacy group, in a telephone interview today. "The people who elect the director general live in the real world for the most part themselves, and this is what you have to do to make advances in public health."

When Frenk made the deal, Mexican President Vicente Fox had been rebuffed twice in attempts to raise taxes to fund health care, said Christopher Murray, a former WHO official who is now director of Harvard Initiative for Global Health. The tobacco money was necessary to raise the standard of living for Mexicans, he said.

"At the time, I thought it was absolutely the appropriate thing to do," he said in a telephone interview today. (Bloomberg)

So was it a Faustian Bargain or making lemonade from a lemon? We don't have enough information for a fair opinion about this. It does show, however, that there are even more hazards to tobacco than their murderous health effects. Getting too close to these guys is bad for one's reputation.

Which is as it should be.