Friday, 17 April 2015

Tim Stockwell: merchant of doubt

The campaign to pretend that moderate alcohol consumption isn't good for you continues this month in the pages of Addiction and it's no surprise to find Tim Stockwell taking up the cudgels. Stockwell is one of the world's leading neo-temperance activists, the author of the Canadian Minimum Pricing Miracle study, and is determined to return us to the days of Scientific Temperance Instruction when alcohol was deemed unsafe at any level.

The methods of these people are becoming clear. They find heterodox evidence, exaggerate its importance, ignore the wider literature and declare victory. They are particularly fond of using what Deborah Arnott once described as "literally a confidence trick: the appearance of confidence both creates confidence and demoralises the opposition." They behave as if the benefits of moderate consumption were a bizarre urban myth and sporadically declare that the conventional wisdom which, they claim, has long been teetering has finally collapsed.

Stockwell did this in 2012 and got delightfully smacked down by two scientists. He did it again in 2013 in an op-ed titled 'Another serious challenge to the hypothesis that moderate drinking is good for health?' Mike Daube did it a few months ago in the BMJ in an op-ed titled 'Alcohol’s evaporating health benefits' which said the consensus view was based on "outdated evidence and wishful thinking". And Stockwell is at in once more in Addiction this month with an op-ed titled 'Has the leaning tower of presumed health benefits from ‘moderate’ alcohol use finally collapsed?'

Perhaps they think that the scientific consensus can be defeated by opinion pieces in journals? Where exactly is their evidence? The study Stockwell was getting excited about in 2013 found that moderate drinkers had a 24-46 per cent lower rate of death from cardiovascular disease and that "never alcohol users also had a greater risk of death than lifetime light users". It included this graph showing a clear J-Curve.


The study that Mike Daube treated like a game-changer in February used a crude statistic trick to downplay clear evidence in its own data that drinkers had lower mortality rates than teetotallers. It's going to take more than this piffle for the deniers to overwhelm the mass of evidence supporting the alcohol J-Curve.

In a characteristic move, Stockwell brings up the old 'sick quitter' hypothesis (first mooted way back in 1988) and talks about possible confounding. He even cites a study from 2005 which raised this question, but he fails to cite any of the studies that have tested the hypothesis by excluding people who were (a) sick, and/or (b) quitters. These studies found that moderate alcohol consumption was still associated with lower rates of cardiovascular mortality and/or lower overall mortality—eg. here, here, here and here. Stockwell doesn't mention them. I wonder why.

The more you study these people's behaviour, the harder it is to make the obvious comparison. They ignore the majority of the evidence, they focus on outlying studies that support their argument and they persist in arguing about statistics long after the arguments have been resolved. These are the tactics that got the tobacco industry labelled 'merchants of doubt' in the twentieth century. And that is what neo-temperance activists are when it comes to the alcohol J-Curve in the twenty-first century.

Thursday, 16 April 2015

Party manifestos - the lifestyle issues

All the major political parties have now published their general election manifestos. As predicted, they are mostly lacking detail on issues of 'public health'—ie. lifestyle regulation—but such detail as there is suggests that the nanny state will be thriving for at least another five years. Here are the main points from each manifesto...


Conservatives

Non-specific on most lifestyle issues. They claim to be "helping people to stay healthy by ending the open display of tobacco in shops, introducing plain–packaged cigarettes and funding local authority public health budgets." There is no mention of any other anti-smoking policies, presumably because they're waiting for ASH to tell them what to do.

They say they're going to "take action to reduce childhood obesity and continue to promote clear food information" but don't say how. There is a similarly vague promise to "become smarter when it comes to crime prevention, dealing with the drivers of crime such as drugs and alcohol."

And that's about it. No mention of e-cigarettes, food, soft drinks or alcohol. However, they say they will "create a blanket ban on all new psychoactive substances, protecting young people from exposure to so-called ‘legal highs’." This is very naive. Legal highs are not imported or marketed as psychoactive substances, but as pond-cleaners, plant foods and so on. If it was as simple as bringing in a "blanket ban", the government would have done it years ago.

Verdict: Disconcertingly vague. A pig in a poke.

Labour

Labour says it will "take targeted action on those high strength, low cost alcohol products that fuel problem drinking" but does not say how. Tellingly, minimum pricing is not mentioned; Ed Miliband distanced himself from it several months ago.

They will also "will set maximum permitted levels of sugar, salt and fat in foods marketed substantially to children." This could be construed as mandatory product reformulation or as an advertising ban by the backdoor. Whatever the intention, there are lots of products that cannot be reformulated so say goodbye to commercials for chocolate bars, for example, before 9pm. A bit depends on how they define "marketed substantially to children", but this is terrible idea that will be bad for consumers, bad for broadcasters and won't do a thing to reduce obesity.

There is also a mention of "a levy on tobacco firms" which amounts to arbitrary looting. The Tories consulted on this idea recently and decided that there were too many unintended consequences. Also difficult to see how they are going to tax the profits of companies that are based in Switzerland.

On gambling, Labour says it will "give new powers for communities to shape their high streets, including power over payday lenders and the number of fixed-odds betting terminals." This sounds like the "healthy high streets" fascism I wrote about last month.

Other than that, no mention of any anti-smoking or temperance policies. In fact, the entire section on "prevention and public health" only lasts one paragraph. Like the Tories, they know it's not a vote winner.

Verdict: Pretty dire, but would probably have been even worse if they listed everything they had in mind.

Lib Dems

The Lib Dems plan to "Introduce Minimum Unit Pricing for alcohol, subject to the outcome of the legal challenge in Scotland". Like the Tories, they boast about "taking tobacco off display in shops and introducing standardised packaging", but don't seem to have come up with any other ridiculous anti-smoking policies other than introducing a "tax levy on tobacco companies" (subject to a consultation).

They also want to "Restrict the marketing of junk food to children, including restricting TV advertising before the 9pm watershed". There is no definition for 'junk food' so I assume they mean High in Fat, Salt and Sugar (HFSS) in which case say goodbye to commercials for bacon, cheese, cakes, biscuits, most soft drinks and numerous other food products before 9pm. This is just censorship. And they plan to "Encourage the traffic light labelling system for food products", although they can't mandate it because it is an EU competence.

Like Labour, they want to "Protect high streets and consumers by granting new powers to Local Authorities to reduce the proliferation of betting shops and substantially reducing the maximum stakes for Fixed Odds Betting Terminals."

The Lib Dems are the only party to explicitly mention e-cigarettes in their manifesto, saying that they will: "Carefully monitor the growing evidence base around electronic cigarettes, which appear to be a route by which many people are quitting tobacco, and ensure restrictions on marketing and use are proportionate and evidence-based. For example, we support restrictions on advertising which risks promoting tobacco or targets under 18s, such as those introduced in 2014, but would rule out a statutory ban on ‘vaping’ in public places."

Verdict: Typical Lib Dems. They might be democrats but they certainly ain't liberal.

UKIP

UKIP explicitly opposes minimum pricing and will "reverse plain packaging legislation for tobacco." They will also amend the smoking ban "to give pubs and clubs the choice to open smoking rooms provided they are properly ventilated and physically separated from non-smoking areas".

As a bonus, they plan to save half a billion pounds a year by "Clamping down on so-called ‘fake charities,’ or state-funded political activism." Excellent and very relevant since the nanny state enterprise is led by state-funded 'charities'.

These sensible policies are slightly offset by a promise to "update licensing laws" by limiting the maximum stake on fixed-odds betting terminals from £100 to £2.

As they intend to hold an EU referendum, the awful e-cigarette regulations in the Tobacco Products Directive won't apply if the public votes to leave (this also applies to the Tories if Cameron keeps his promise).

No mention of food or soft drinks, presumably because they plan to leave them alone.

Verdict: Liberal in the uncorrupted sense of the word.

Greens

Bonkers from beginning to end, the Green manifesto is an orgy of bans and taxes. A ban on the sale of foie gras, a ban on fracking, a ban on hunting any animal for sport, a ban on circus animals, a ban on keeping rabbits in cages etc., etc. The main lifestyle policies are as follows:

"Put a minimum price on alcohol of 50p per unit." Yawn.

"Reduce the alcohol limit for drivers to as close to zero as is practicable." Predictable for a party that hates motoring in any form (unless it's chauffeur driven).

Increase the tax on tobacco and alcohol by £1.4 billion per year (!), equating to a roughly 10 per cent annual rise. Idiotic and illiberal.

"Extend VAT at the standard rate to less healthy foods, including sugar, but spend the money raised on subsidising around one- third of the cost of fresh fruit and vegetables." They think this will suck another £6.7 billion out of people's pockets. Perhaps it will.

They don't mention fixed odds betting terminals. This must be an oversight since I'm sure they'd like to ban them too.

They do, however, say they want "an evidence-based approach to the step-by-step regulation, starting with cannabis, of the drugs currently banned under the Misuse of Drugs Act as well as ‘legal highs’, with a view to introducing a system that reduces harms and brings the market under state control as a potential tax revenue generator." So it's not all bad. Quite.

Verdict: The perfect party for people in 'public health'—bossy, socialist and authoritarian.

Wednesday, 15 April 2015

Hurrah! A stupid law is wrecking an industry!

Last December, the Scottish government lowered the drink-drive limit from 80mg to 50mg per 100ml of blood. As has been widely reported, this has led to a 30 per cent drop in pub sales and is another hammer blow to the pub trade courtesy of the 'public health' racket.

This is depressing news, unless you are a journalist at the Independent, in which case damage to the economy is an end in itself...

Scotland's new drink-driving law is so successful it's damaging the economy, according to Bank of Scotland report

Scotland’s tough new drink-driving law is proving so successful at stopping people from indulging that it is damaging financial growth, according to one of the country’s top economists.

Wow. Is that what it's come to? Apparently so, as the theme was further developed in a pisspoor article in Vice yesterday that was positively gleeful about the coup de grace being delivered to Scottish pubs...

Scotland's New Drunk-Driving Law Is So Effective It’s Damaging the Economy

A new Scottish drunk-driving law introduced in December is proving to be so effective that it is actively damaging the economy, according to a Bank of Scotland (BoS) report published yesterday. It's a report that raises a number of questions, the most pressing of those being: Yo, how much of the Scottish economy is built on the cornerstone of people drunk-driving?

To which the answer is: Yo, being drunk has got nothing to do with it. The point of drunk-driving laws is, quite obviously, to stop people driving whilst drunk. When the breathalyser replaced roadside sobriety tests, the limit was set at a level below which anybody could reasonably be described as drunk. Indeed, it erred on the side of caution so that it would be a safe level for a little old lady and a heavyweight boxer alike.

Scotland has decided to jettison that limit and make the limit effectively zero, as 'public health' campaigners demanded. This has not only scared people off drinking one pint during the day, but from drinking much in the evening in case they are tested the next morning. It is this effect on people's evening drinking habits that really motivates the neo-temperance lobby. For the teetotalitarians, the negative consequences are a feature, not a bug. It's got nothing to do with road safety. It is about making people drink less, full stop. As the Independent notes...

The new law, which came into force in December, reduced the legal alcohol limit for Scottish motorists from 80mg to 50mg in every 100ml of blood. Drivers have been warned that having “no alcohol at all” is the only way to ensure they stay within the limit – and to avoid planning car journeys for the morning after a night drinking.

The thing is, people who drive with 50-79mg of alcohol in their system are not drunk and therefore cannot be drunk-drivers. They were not drunk last year and they do not magically become drunk just because a bunch of worthless politicians suddenly moved the goalposts. It is no more a 'crackdown' on drunk-driving than raising to age of consent to 21 would be a crackdown on paedophilia. It's an irrelevance, a distraction, a gimmick.

Reducing the drink-drive limit is a classic example of legislating for the sake of it. Everyone disapproves of drunk-driving so Something Must Be Done. You could try to enforce the law as it stands or you could piddle around with a new law with socially and economically damaging consequences. No prizes for guessing which option the Scottish government went for. Why bother going after the small minority of inebriated motorists when you can hassle people who have a swift half after work or who had a few drinks the night before? When you can't govern, legislate.

What's interesting about the Independent and Vice articles is that they are rejoicing in people drinking less in pubs as if that were the measure of success. Results have been divorced from putative intentions. The aim of drunk-driving laws is not—or, at least, should not be—to arrest people who are perfectly fit to drive, nor is it to close pubs down. The aim is to reduce alcohol-related traffic accidents.

On that score, there is very little evidence that reducing the blood alcohol limit makes any difference at all. 'Public health' and temperance campaigners often complain that the UK's limit is higher than nearly every other European state. This is true. Only Malta and Switzerland have a limit of 80mg, so they—along with the UK—must have more alcohol-related traffic accidents, right?

Er, no. I can't find the figures for Malta but the WHO have data on what percentage of road accidents involve alcohol. As you can see below, the UK and Switzerland both do better than average.


Looking at the total number of deaths on the road (per 100,000 motor vehicles) Britain and Switzerland also do significantly better than average.


This is not to say that Scotland won't see a decline in traffic accidents. Perhaps it will. But if it does, it will probably be because the government has reduced the number of journeys people make and thereby reduced the amount of traffic on the roads, not because it has deterred people from drunk-driving.

Tuesday, 14 April 2015

Packaging doesn't make people start smoking - study

This study was published in the European Journal of Public Health a couple of weeks ago. You won't have seen it reported anywhere and no 'public health' campaigners have mentioned it on Twitter, for reasons that will become obvious.

It looks at the factors that influence young people's decisions to start smoking.

Respondents were allowed to select up to three among the following response options: ‘your friends smoked’; ‘your parents smoked’; ‘you liked the packaging of the cigarettes (or other tobacco products)’; ‘you liked the taste or smell of tobacco’; ‘you liked menthol cigarettes’; ‘you liked cigarettes with a specific sweet, fruity or spicy flavour’; and ‘cigarettes were affordable’. Respondents who indicated that they started smoking because their friends smoked were classified as having initiated smoking under the domain of ‘peer influence’ and those who mentioned that they started smoking because their parents smoked were classified as under the domain of ‘parental influence’. All other responses were grouped together as ‘tobacco product features’, as the numbers of respondents who indicated each one as an influence were small.

Small, indeed. In fact...

No significant association between design and marketing features of tobacco products and an early initiation of regular smoking was observed (OR = 1.04; 95%CI 0.83–1.31).

The researchers found "no significant within-group differences were observed for design and marketing features of tobacco products". The results are shown below.


'Tobacco product features' include not only the packaging, but also flavours such as menthol. As any smoker knows—and as this study confirms—these factors simply do not register as a cause for people to start smoking. Nevertheless, the EU is legislating to ban menthol and the UK is legislating for plain packaging.

The reason for that, folks, is that 'public health' is not an evidence-based enterprise.

Drinking in films and other stuff

The Institute of Ideas has asked various people to nominate one law for repeal. For me, the sheer vindictiveness of the smoking ban made it the obvious candidate. Read my brief article here.

Meanwhile, the censorious fanatics who want films to be given an adult rating if they depict smoking are, quite predictably, trying to do the same with drinking. Activist-quackademics at Bristol University have produced research claiming that 15 year olds who see lots of drinking on screen are 20 per cent more likely to have drunk alcohol. Ignoring the multiple confounding factors that could be behind this piddling little result, the study concludes...

“Adverse outcomes from alcohol use are a large societal public health problem and rating films according to alcohol content may reduce problem-related alcohol use and associated harm in young people.”

This is not the first attempt to use junk science to lobby for censorship. Ian Gilmore, along with the vapers' friend John Britton, had a go a few years ago. And Glantz has recently started naming and shaming actors who smoke in films (he really hates The Lord of the Rings). His claim that an adult rating for films that depict smoking would save a million lives is a leading contender for the most risible 'public health' claim in the world—in a very crowded field. Glantz's website is always good for a laugh.

Finally, are you familiar with the surreal genius of the NGO-taunting Live from Golgafrincham website? If not, you should be. They have a video for their new project Brain Zero. I could embed it here but it needs to be seen in context for it to make sense. Even then, it probably won't, but that's kind of the point.

Go visit.





Friday, 10 April 2015

Empty smokefree casinos

Americans for Nonsmokers' Rights—an organisation that has nothing to do with nonsmokers, if it ever did—yesterday tweeted this picture of a smokefree casino in an effort pour encourager les autres...


Notice anything about this photo? If you spotted that there are virtually no customers, give yourself a pat on the back, although you didn't need to see the photo to know that. You could have guessed it from the word 'smokefree'.

It's the same old story. What is true of casinos is true of pubs, bingo halls and anywhere else that has a clientele disproportionately made up of smokers. Kick out your best customers and—surprise, surprise—your business suffers. Whether you personally love smoking bans or loathe them, that's a simple fact you have to accept.

The evidence that the smoking ban has damaged the British pub industry is such a clear, observable fact that I don't think even ASH attempts to claim otherwise these days. As for casinos, the picture has been the same everywhere in the world, which is why some casinos have managed to cling onto smoking rooms even in some of the most fiercely anti-smoking countries, though not the UK.

Only a handful of ideologues, like Stanton Glantz, who long ago abandoned reality for the comforting universe of their own imagination hold onto the belief that smoking bans are good for casinos (see this study, for example, but notice also the rebuttal and correction.) Longtime readers will fondly recall Glantz's claim that there were fewer heart attacks in Colorado casinos after they were forced to ban smoking. He failed to mention that this was because three of the casinos closed down and there were fewer people to have heart attacks in the casinos that remained.

In the early days of smoking bans, it was vaguely credible to argue that new nonsmoking punters would replace the departing smokers, but the jury is well and truly in now. Witness the recent battle in Indiana, for instance:

“We can’t afford to lose any more of our customers,” says Jim Brown, chief operating officer of Centaur Gaming, which owns the state’s two horse track casinos, Indiana Grand and its sibling, Hoosier Park Racing and Casino in Anderson.

Brown worries about his industry while sitting at a table in the Shelbyville casino’s swank piano bar. It fronts a newly renovated steakhouse designed to appeal to a more upscale crowd than the casino’s brew pub, where patrons can engage in off-track betting.
There’s an empty ashtray on every table.
“Getting rid of smoking just isn’t something that resonates with our customers,” Brown said.
He points to Illinois, where gaming revenues dropped 20 percent when the state banned smoking in casinos in 2008.
The Federal Reserve Bank of St. Louis, which studied the decline, concluded that $400 million plunge in revenue in 2009 was directly linked to casinos forcing their customers to extinguish their smokes. The loss reverberated, with $200 million less in state tax revenues and another $14 million in lost dollars to local communities.

Even politicians now admit that smoking bans hurt casinos, although they try to put a happier spin on it.

Rep. Ed Clere, R-New Albany, chairman of the House Public Health Committee, said the estimated cost to the state of ending the casino exemption — about $200 million in lost tax revenue, according to the Legislative Services Agency — will be offset long-term by reduced health care costs.

Smoking bans wouldn't reduce health costs even if they saved lives, which they don't. All they do is needlessly put people out of work and stop customers satisfying their first choice preference. If bans generated more business for casinos, the owners would have introduced them long ago. In reality, they go out of their way to attract smokers, as they are doing in neighbouring Ohio...

At least three casinos have sought permission for regulators to add slot machines to designated smoking areas. To lure patrons in, they now advertise with the slogan: Smoke free or smoke freely.

A fair compromise that satisfies everybody but the zealots. And they're never satisfied anyway.

"I think we need to leave it to the casino industry right now to decide what’s best for their industry.”

That's the crux of it. Unless there they were victims of a phenomenal information failure, casino operators wouldn't fight smoking bans tooth and nail unless they knew it was going to hurt them. The fact that they have to be forced into it tells you everything you need to know.

Thursday, 9 April 2015

Standardise everthing!

There was a little article in The Morning Advertiser yesterday, telling publicans to focus on their glassware if they want to give their customers the optimal experience.

Pubs are now paying more attention to how a drink is served, and as a result customers are enjoying the benefit of more innovative glassware, according to Henry Stephenson, managing director at Stephensons Catering.

For instance, flutes etched at the bottom of the bowl are helping maintain the bubbles for Prosecco lovers, while wider-bowled flutes are being championed by wine experts because they give sparkling wines a better nose.

The article carries on in this vein for some time, with various tips for businesses in the nighttime economy. It's a niche topic, but the message is basically sound: help your customers to enjoy themselves, make life better.

I only mention it because for every action there is an equal and opposite reaction. For every business that tries to improve things, there is a 'public health professional' trying to wreck it. That brings us to Linda Bauld and friends who published this study in Alcohol and Alcoholism last year...

Our findings suggest that, far from being merely a functional vessel, the glass has come to be an integral part of marketing activity. The role of the glass as a marketing tool has been hinted at in previous research—a previous analysis of alcohol marketing strategies (Hastings et al., 2010) noted that Smirnoff recommended ʻchunky glasswareʼ as a means of implying greater alcoholic potency—but this is the first time the glass has been examined in detail from a critical marketing perspective. Like a cigarette, the glass is a particularly intimate form of marketing because it is held in the hand and is integral to the moment of consumption (Ford et al., 2013).

... glassware for alcohol could be re-designed to encourage safer drinking, for example by deploying shapes that convey a more accurate impression of volume, or by adding marks to indicate units of alcohol, as has been recently implemented by Heineken (Heineken UK, 2013); however, the possibility that unit marks may in some cases encourage consumption would need to be thoroughly investigated before recommending this for widescale adoption. It has been shown that a ban on traditional glassware in nightclubs can reduce injuries from alcohol-related disorder (Forsyth, 2008); the possibility that such a measure may also reduce brand appeal could be investigated. Echoing the move to plain packaging of cigarettes is the time approaching for a debate on standardized, non-branded, measure-marked glassware imprinted with large harm-reduction messages?

 They never sleep.