Thursday, 26 March 2015

Healthy high streets

The medical establishment's bid for world domination continued today, with the Royal Society for Public Health (whoever they are) demanding the right to decide which shops are allowed to open and where they should be allowed to position their goods. In the same way as Lord Darzi has a fascist desire to turn public parks into 'Beacons of Health', this mob wants to live out their Albert Speer fantasies in our town centres.

We believe that business has a responsibility to ensure that what they offer doesn’t undermine the public’s health

Do you? Is that what you think? Because I think it should be up to us what we buy and we can "undermine" our health if we damn well please.

And we want to ensure that local authorities have the powers they need in order to curtail those business practices which may undermine the public’s health and the great work that many public health teams are doing.

Eurgh. The totalitarian tendencies of the 'public health' lobby are on full display in this document. There is no aspect of life that they don't want dominated by lectures and harassment. For example...

On a healthy high street businesses would create opportunities for health optimisation. This could include signposting customers to health services, high street employees engaging customers in healthy conversations, health promotions in local shops, such as health shopping trolleys and outreach activities in pubs and bars, including smoking cessation or health checks.

"Engaging customers in healthy conversations"? What does that even mean? As for "outreach activities in pubs and bars", go on, I dare you.

The businesses on a healthy high street would not only enable basic needs, including access to affordable healthy food and affordable financial services, to be met...

"Affordable" thanks to a system of subsidies and price controls, no doubt. And behold, these zealots have made a little graphic listing the good and bad businesses...

Notice how pubs and bars have suddenly become "health promoting". The RSPH say this is because they "encourage social interaction". A more likely reason is that pubs have been so battered by taxes and the smoking ban that the 'public health' lobby no longer sees them as much of a threat and prefers to pretend to be on their side while they go after the off licences and supermarkets.

Notice also how payday lenders and bookmakers have found themselves on the list of unhealthy businesses, despite having nothing to do with health. This gives the game away that 'public health' itself has nothing to do with health, rather it is a classic middle class crusade against temptation and vice.

This is further confirmed by the RSPH's league table of Britain's healthiest and unhealthiest high streets, which have been plastered across the media today. The 'unhealthy' ones are mostly working class cities in the North and Midlands, whereas the 'healthy' ones are mainly nice southern market towns, like Cambridge and Salisbury, plus a few places north of Watford that Hampstead intellectuals occasionally visit, such as York.

Using a ridiculous methodology, they have decided that Preston has the country's least healthy high street and Shrewsbury, of all places, has the healthiest.

The obesity rate is Shrewsbury is 25.9%, well over the national average and considerably higher than the rate in Preston (20.8%). Just saying.

Naturally, all this bollocks is accompanied by demands for state intervention into all sorts of areas that are none of the state's business. These include:

1. Taxing bookies, payday loan shops, tanning salons and fast food outlets at a higher rate than other businesses to "discourage" them from opening.

2. "Introduction of cigarette-style health warnings" for payday loans, fast food and sunbeds. No slippery slope there, then.

3. "We call on the Government to introduce a ban on the positioning of unhealthy food items next to all checkouts and queuing areas."

4. "Ban the positioning of e-cigarettes next to all checkouts" on the basis that "these products contain nicotine, which is a highly addictive, potentially harmful chemical."

Above all, they want councils to be able to close down 'unhealthy' businesses and cap the number of premises run by any one industry at the (totally arbitrary) limit of five per cent.

At a time when high street shops are closing at the rate of 16 a day, the 'public health' lobby are just the people to finish them off. These obsessives must be resisted.

Tuesday, 24 March 2015

Where are John Dalli's supporters now?

Silvio Zammit is currently on trial in Malta as a part of the John Dalli corruption scandal. It's not easy to summarise such a long-running saga briefly, but these are the basic facts:

  • John Dalli, a Maltese politician, was the EU Health Commissioner until he was sacked by Manuel Barroso, then the president of the European Commission, in October 2012.

  • A close friend of Dalli named Silvio Zammit was caught on tape trying to solicit a €60m bribe from the snus company Swedish Match in return for Dalli overturning the EU ban on snus. Swedish Match recorded this conversation and immediately handed them over to the EU fraud office, OLAF.

  • Telephone records show that Zammit and Dalli had clusters of conversations on the same days that Zammit had conversations with Swedish Match.

In court last week, a new piece of evidence came to light:

Two new witnesses from the Cabinet of the former Commissioner testified that Dalli inquired about lifting the ban on snus in January and February 2012. This is new evidence of relevance, since Dalli had always maintained that the last time he took an interest in the snus issue was at the meeting on January 6, 2012 with Zammit and a lobbyist.

It doesn't look too good for Dalli, does it? Perhaps fearing that this new evidence has brought his own day in the dock a little closer, Dalli launched into one of his characteristically strange rants. He has called almost everybody involved in this investigation a liar, and now he is saying the same of the two new witnesses. Meanwhile, he has accused OLAF's head Giovanni Kessler of perjury and claims that the OLAF report is a "fraud". In his view, everybody but Zammit should be facing prosecution.

"I believe that the conclusion of these procedures should be judicial action against Kessler and against the employees of Swedish Match, Hildingsson, Gabrielsson and Delfosse who have concocted and implemented the setup against me. Not to mention politicians and functionaries in Brussels and in Malta who were privy to this fraud."

Dalli's conspiracy theories are the stuff of legend (Barroso has called them "incomprehensible"). He is, of course, unable to supply any motive for why the EU's corruption watchdog would hound an innocent man for three years, nor why Barroso would decide to sack him without good reason, nor why Swedish Match would invent a story that could not possibly benefit them. Nor has he come up with an explanation for the crucial and undeniable fact that his mate was recorded on tape promising to arrange something that only Dalli could deliver. For €60 million.

As Kessler said recently, isn't it telling that Dalli has turned on everybody except the man who got him in this trouble...

"What would you do if a former friend betrayed you and that cost you your career?” Giovanni Kessler asked. “He could have taken Mr Zammit to court for tarnishing his reputation... He could have accused him of trading in influence to his detriment. There is no question that Silvio Zammit has damaged Mr Dalli, greatly. Mr Dalli also has the right I think, to be a civil party in the criminal case. It would give Mr Dalli the right to have a lawyer in that case putting questions to Mr Zammit. He didn’t. Why?”

As the trial has gone on, the penny has started to drop even amongst Dalli's biggest supporters that their man might have been sacked with good reason. After hearing the evidence laid out in court, New Europe, a website which has been strongly pro-Dalli in its coverage to date, ended its report with a mea culpa.

At this point New Europe has to clarify that in extensively covering the Dalli case in the past, had no idea of the parallel games of Silvio Zammit and was not aware of all such details.

Our interventions stemmed from the fact that the OLAF report did not accuse directly Dalli but referred only to “circumstantial evidences” and verified that Dalli had not changed the Directive and did not take any bribe.

... Indeed, with the new facts unveiled in the Maltese Court, it is obvious that Jose Barroso whom we have strongly criticized, acted on moral grounds, ignoring the rules. Obviously he knew or suspected the truth, which we did not

New Europe are not the only ones with egg on their faces after falling to realise that Dalli was toxic. There are a whole bunch of NGOs and MEPs—not to mention Private Eyewho chose to believe Dalli's bonkers conspiracy theory because it fit their narrative of industry corruption. It was, however, clear from the start that it was Zammit who solicited the bribe and Swedish Match that blew the whistle. If anyone has been wrongly hounded, it's Giovanni Kessler who has been the subject of some extraordinary attacks by Green MEPs.

The Zammit case continues. Fortunately for Dalli's erstwhile cheerleaders, it is only being reported in the Maltese press. The last word should go to the Maltese journalist, Daphne Caruana Galizia, who has followed this story like a hawk from day one...

There is something very wrong with John Dalli, properly wrong, and if you think about it, this may well have been the case from the start.

Let justice be done, right Monika?

Background reading:

Dalli is damned

More Dalli and Snusgate

Private Eye's pisspoor Snusgate report

What's got into Private Eye?

John Dalli - the facts finally emerge

John Dalli does a lot for charity but doesn't like to talk about it

John Dalli's conspiracy theory

Monday, 23 March 2015

Nina Teicholz's Big Fat Surprise

Nina Teicholz's book The Big Fat Surprise received favourable reviews from the Economist and from former BMJ editor Richard Smith so I decided to read it. I wish I hadn't bothered. Teicholz's thesis in a nutshell is that we have been lied to for years about saturated fat, leading Americans to adopt a low-fat, high-carb diet that has made them obese and diabetic and probably given them cancer. She concludes that we should go back to eating lots of red meat and dairy products like people did in the good old days.

I became suspicious of this book almost immediately when the author nonchalantly dismisses America's increasingly sedentary lifestyle as a factor in the rise of obesity between 1970 and the present day, saying:

These eight words in a parenthetical aside is the only reference to physical activity in the book. It is unreferenced and untrue.

Suspecting that Teicholz might not be fully on top of her brief, I searched out a critique online and found a forensic fisking by Seth Yoder at The Science of Nutrition who makes a compelling case for viewing Tiecholz as a hopelessly biased, cherry-picking plagiarist. More of that in a moment, but first let's return to the basic premise that Americans used to eat lots of fat and now they don't.

Teicholz repeatedly claims that "Since the 1970s, we have successfully ...  reduced the amount of fat we eat from 43 percent to 33 percent of calories or less." Lord knows where she gets the 43 per cent figure from*, but she compounds the error by claiming that this shows that Americans have reduced their fat consumption by 25 per cent. Neither claim is true.

According to the Centers for Disease Control, in the USA between 1970 and 1994, average calorie intake rose in the USA for both men and women (in contrast to the UK) as a result of an increase in carbohydrate intake. As a result, fat as a percentage of total calories fell, from 36.9% to 32.8% for men and from 36.1% to 32.8% for women, but fat consumption fell little, if at all. Indeed, the CDC clearly states: "The decrease in the percentage of kcals from fat during 1971--1991 is attributed to an increase in total kcals consumed; absolute fat intake in grams increased."

As for saturated fat, the CDC notes that between 1970 and 2000, "the percentage of kcals from saturated fat decreased from 13.5% to 10.9% for men and from 13.0% to 11.0% for women." By my calculations, this means that the number of calories men consumed from saturated fat fell from 331 to 285 and the number consumed by women rose from 200 to 206. Hardly a dramatic change but, again, Teicholz refers only to the percentages. She does not mention that the decline for men was tiny, nor that there was no decline at all for women. Nor, indeed, does she mention that the percentage of saturated fat in the American diet is still higher than "less than 10%" recommended in the official recommendations. 

In other words, and contrary to Teicholz's endless assertions, Americans have not "dutifully" followed government guidelines, they do not have a low-fat diet and they certainly do not have a "near-vegetarian diet".

The "near-vegetarian diet" claim, which is made more than a dozen times in The Big Fat Surprise, is so patently ludicrous that one wonders why her editor didn't pull her up on it. Here's a chart of the world's biggest meat-eaters. Looking from the top down, it won't take you long to find the USA...

 On page 116, Teicholz shows US meat consumption since 1909...

So a "near-vegetarian diet" means eating more meat than nearly any other country and eating more meat than Americans have eaten since records began? Teicholz defends this bizarre claim by saying "about half is poultry" (it's actually more like a third if this graph is correct**) and then berates the US Department of Agriculture for stating, perfectly accurately, that meat consumption is at a "record high". She claims that this is "misleading because they lump together red meat and chicken into one category" (p. 116). Yeah, they do: the category of 'meat'. You know why? Because chicken is meat. But even if you think that chicken is a vegetable, it is still clear that Americans are eating more red meat—which Teicholz claims is "virtually banned" in the USA! (p. 5)—than they did for most of the twentieth century. (Her claim that Native Americans ate "a diet of predominantly meat, mainly from buffalo" is also very dubious.)

Since the premise is untrue, the conclusion she draws from it—that Americans suffer from obesity and diabetes because they've been living off celery and mung beans since the 1970s—must also be untrue. But between the premise and the conclusion we have the, er, meat of the argument which revolves around the evidence for the belief that saturated fat causes heart disease. This is fertile ground for a popular science book, which is why several popular science books have already been written about it, notably Gary Taubes' Good Calories, Bad Calories which has given Teicholz a great deal of inspiration, to say the least.

Saturated fat is no longer seen as the singular dietary villain that it once was. It seems clear that it raises levels of 'bad cholesterol' which, in turn, increases the risk of heart disease, but the risk may not be as great as was previously believed. The most recent Cochrane Review on the subject concluded:

The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

This is not enough for Teicholz, who wants the reader to believe that saturated fat is not a risk factor for anything and should instead be viewed as a disease prophylactic. To switch from one extreme to the other she has to take some astonishing liberties with the evidence. I'm not sufficiently interested in the topic to check Teicholz's references—no casual reader should have to—and so I would have been deceived time and again had it not been for the fact-checking of the aforementioned Seth Yoder. I recommend you read his two blog posts, even if you are not interested in reading Teicholz's book. It delivers a heavy blow to Teicholz's credibility and her lame response to him suggests that she knows she hasn't a leg to stand on. (She promised a point-by-point rebuttal by mid-March but that has yet to materialise.)

The Big Fat Surprise: A critical review part one

The Big Fat Surprise: A critical review part two

Seth has identified many examples of Teicholz borrowing from other people, but especially from Gary Taubes. She not only uses many of the same sources as Taubes (which is often fair enough), but she tends to take the exact same quotes and makes the exact same mistakes as Taubes does in a way that suggests she hasn't even read some of the original sources. For example...
BFS, page 112:
[W]hen Senator McGovern announced his Senate committee’s report, called Dietary Goals, at a press conference in 1977, he expressed a gloomy outlook about where the American diet was heading. “Our diets have changed radically within the past fifty years,” he explained, “with great and often harmful effects on our health.”

The problem here is that Teicholz cites the source of this quote as “Select Committee on Nutrition and Human Needs of the United States Senate, Dietary Goals for the United States (Washington, DC: US Government Printing Office, 1977); 1.” However, this quote does not appear on page 1. It appears on page XIII. Normally I would chalk this up to a simple citation error. The reason I mention it is because Taubes uses the same exact quote on page 10 of GCBC, and also mistakenly cites the source of the quote as being on page 1. I would argue (as I have done previously many times) that this is good evidence that Teicholz is simply lifting sentences from others and simply citing what they cite – likely without ever even seeing the source material.

The accusation of plagiarism does not reflect well on Teicholz, but they do not destroy her argument. However, Seth also gives numerous examples of highly selective quotation. For example...

After discussing the Ornish diet for a bit, Teicholz mentions a paper on page 145 that reviews the evidence for (very) low-fat diets:
Tufts University nutrition professor Alice Lichtenstein and a colleague reviewed the very low-fat diet for the AHA […] Lichtenstein concluded that very low-fat diets “are not beneficial and may be harmful.”
Teicholz both takes the quote out of context and mangles it somewhat. Here’s the actual quote (emphasis mine):
At this time, no health benefits and possible harmful effects can be predicted from adherence to very low fat diets in certain subgroups.
The “in certain subgroups” part is vital to the accuracy of the statement. You can’t just cut it out. And Dr. Lichtenstein’s conclusion is quite a bit more nuanced than Teicholz would have you believe. The paper is actually a very objective look at low-fat diets. It acknowledges that more research needs to be done on these diets in order for a definitive recommendation. Moreover, as alluded to above, it states that until more evidence comes in young children, the elderly, pregnant women, and those with eating disorders should probably avoid the diet. However, it also acknowledges that a low fat diet can be beneficial and there is evidence for that. Here’s an actual quote from the conclusion:
There is overwhelming evidence that reductions in saturated fat, dietary cholesterol, and weight offer the most effective dietary strategies for reducing total cholesterol, LDL-C levels, and cardiovascular risk.

Teicholz also makes statements that are not only unsupported by her own references, but which are often the polar opposite of what her sources say. For example...

 Page 317:
[I]n more than a few major studies, LDL-cholesterol levels were found to be completely uncorrelated with whether people had heart attacks or not.
Let’s take a look at these “major studies” she cites, shall we?

The first is by de Lorgeril et al. I won’t go into detail, but those in the intervention group had fewer heart attacks and also had lower LDL. From the text: “[T]he trend with time was a decrease in total and low density lipoprotein (LDL) cholesterol […]” Although it was not statistically significant, so we’ll give this one to Teicholz.

The second is not a study, but a short commentary by Despres. It argues that we should not focus exclusively on LDL, which is not the same as saying LDL is not correlated with anything.

The third is a statin trial that showed reducing LDL cholesterol also reduced coronary events. In other words, the opposite of Teicholz’s claim. Some choice quotes from the paper:
This trial provides evidence that the use of intensive atorvastatin therapy to reduce LDL cholesterol levels below 100 mg per deciliter is associated with substantial clinical benefit in patients with stable CHD.

Our findings indicate that the quantitative relationship between reduced LDL cholesterol levels and reduced CHD risk demonstrated in prior secondary-prevention trials of statins holds true even at very low levels of LDL cholesterol.
The fourth is a meta-analysis on statins and all-cause mortality. Basically irrelevant because it’s only slightly related to the claim of no relationship between LDL and heart attacks.

The fifth is by Castelli et al and is again pretty much the opposite of what Teicholz said. Want some more choice quotes?
There is a very regular increase of CHD prevalence rates with increasing LDL cholesterol level at each level of HDL cholesterol.

The inverse relationship between HDL cholesterol and CHD, when taken over the three levels of LDL cholesterol, is significant (P < 0.001) by a method of Mantel, as are the positive trends of CHD prevalence on LDL cholesterol level.

Cross-classification of triglyceride with LDL cholesterol level (fig. 3) leads to the conclusion that either lipid has a statistically significant association with CHD prevalence […]

In general, then, when contingency tables are constructed for the three lipids considered two at a time, HDL and LDL cholesterol emerge as consistently significant factors in CHD prevalence […]
Does Teicholz even read the studies she cites?

Moreover, the book is marred by a clear bias of interpretation which is obvious even to the casual reader. She is highly critical of observational epidemiology and one can hardly blame her. Nutritional epidemiology is so full of data-dredging, misreporting, researcher bias and vested interests that it is tempting to dismiss the whole field. That is pretty much what Tiecholz does most of the time. If she says correlation cannot prove causation once she must say it a hundred times.

But here's the thing. She only says it when the studies don't support her argument. She frequently cites observational studies—and even ecological studies—when they suit her and she does so without mentioning that they are observational studies and without the many caveats she gives when the evidence doesn't go her way. Every conceivable limitation is mentioned when she doesn't like a study's result, even if the limitation (or "flaw" as she would call it) is unlikely to have distorted the results. If you want to claim that saturated fat is bad for the ticker she'll accept nothing except randomised controlled trials (which she claims do not exist, despite the Cochrane Review mentioned above being based on nothing else). On the other hand, any old cross-sectional study will do when she is trying to prove that eating nothing but blubber is good for you.

There are other blatant double standards in this book. When a food company funds a study into trans fats, for example, she draws attention to it twice one paragraph (p. 238), but when the Atkins Foundation funds research into the Atkins diet it is a footnote (p. 310). When the IARC finds that emissions from frying oils probably cause cancer, she says that they "determined that emissions from frying oils at the temperature typically used in restaurants are 'probably' carcinogenic to humans" (p. 278), but when the World Cancer Research Fund finds that fruit and vegetables probably protect against various cancers, she says that they "found that 'in no case' was the evidence for the consumption of fruits and vegetables in the prevention of cancer 'judged to be convincing.'" (p. 143) (Both IARC and WCRF have a grading system, with 'probable' being just below 'convincing' or 'known'. In other words, the degree of certainty was the same in both instances.)

Reading this book wasn't a complete waste of time. The chapters of the Mediterranean Diet and trans fats are quite informative, although you sometimes need to read between the lines. There is a good story tucked away in The Big Fat Surprise but this is not the book to tell it. The human interest comes from the people who made saturated fat (and later trans fats) the nutritional bogeymen. In Teicholz's rendering, it is a story of "personal ambition and money" (p. 332) with the outsized egos of a handful of publicity-hungry scientists silencing opposing voices for decades. There may be a grain of truth in this, but her caricature of Ancel Keys is a transparent hatchet job and, having seen the way she mangles quotes from her written sources, I'm not sure I can even trust her with the quotes she got from her interviewees. This is my fundamental problem with the book. After seeing how she misrepresents the science, I can't trust her on anything else.

My reading of the evidence, which I don't think is terribly controversial, is this. Heavy consumption of saturated fat is a risk factor for heart disease and heavy consumption of red meat (and/or low consumption of fruit and veg) is a probable risk factor for some cancers, but neither risk is big enough to stop me eating what I like. Obesity has risen in the USA as a result of rising calorie consumption and declining physical activity and this, in turn, has caused a rise in diabetes. Trans fats are probably not as bad for you as the Center for Science in the Public Interest would have you believe, and were only banned because they were in the wrong place at the wrong time. The Mediterranean Diet was and is an poorly defined gimmick. Nutritional epidemiology is a bit of joke, filled with false positives and groupthink, but there is more to nutritional science than epidemiology.

If you want to write a book about self-censorship and junk science in the nutrition research industry, be my guest. If you want to write a book saying that saturated fat is not worth worrying about unless you are in a high-risk group, go ahead. But what you can't do is use partial and one-sided information to create what is essentially a conspiracy theory and then go way beyond any reasonable interpretation of the science to make statements like this...

...cheese is probably healthier than bread. (p. 325)

Every reliable indicator of good health is worsened by a low-fat diet. (p. 330)

...saturated fats, like all fats, do not make people fat. (p. 334)

Eat butter; drink milk whole, and feed it to the whole family. Stock up on creamy cheeses, offal, and sausage, and yes, bacon. None of these foods have been demonstrated to cause obesity, diabetes, or heart disease... Sugar, white flour, and other refined carbohydrates are almost certainly the main drivers of these diseases. (p. 335)

...a snack of full-fat cheese is better than fruit. (p. 335)

These statements are, of course, unreferenced and indefensible. Does she not realise that sweeping generalisations, exaggerations and evidence-free assertions are precisely what she accuses Ancel Keys et al. of committing? Does she not see the irony of specifically a handful of foods (white flour?!) for obesity, diabetes and heart disease, based on vastly less evidence than exists for the saturated fat hypothesis?

In the final analysis, The Big Fat Surprise is a glorified diet book that tells people what they want to hear. Its dietary advice is very dubious and arguably irresponsible, but caveat emptor and all that. What is really disappointing is that the likes of the Economist have been taken in by it.

* In the 13 pages of corrections she sent her publishers for the reprinted edition, Teicholz changed the 43% figure to 40%, although this is still inconsistent with the CDC's figures.

** Weirdly, Teicholz has changed this in the reprinted edition to say "more than half is poultry" which is even wronger.

Friday, 20 March 2015

50 words for lobbying

This may come as a surprise, but Action on Smoking and Health (ASH) - the UK's number one state-funded anti-smoking lobby group - is no longer allowed to lobby with the cash it gets from the government.

Ministers have been claiming since 2008 (if not earlier) that ASH's Department of Health grants can't be used for lobbying, but this lie was exposed when ASH's grant application form clearly showed that some of the money was to be used for "media advocacy and lobbying".

In recent years, the Department of Health seems to have tightened things up somewhat. For ASH's 2013-14 grant, DH put in a clause explicitly saying that the money wasn't to be used for "lobbying or campaigning purposes."

The grant is also not to be used for "organisational running costs", leaving the question of what an organisation like ASH is to do with the money when the whole reason for its existence is to lobby and campaign? The answer, it seems, is to spend it and then use as many euphemisms for lobbying and campaigning as they can when they report back to the Department of Health. The quotes below are what ASH told DH they had done with their £175,000 grant in 2013-14. (All these documents can be found here).

With local government organisations, supporting local councillors and senior officials to understand the need for effective local tobacco control and the opportunities that are available for improving local public health and wellbeing.

They're not lobbying. Oh no. They're merely "supporting" politicians to make them aware of the "opportunities that are available" and to "understand the need for effective local tobacco control". Do these opportunities involve things like plain packaging, higher taxes and so on? Alas, the report does not say.

In 2008, ASH promised to use DH grant for "media advocacy". It no longer does so, because media advocacy is obviously campaigning. Instead, it says it does things like this...

Media-related work to raise awareness of harm caused by tobacco use.

Has anybody ever seen or heard anyone from ASH give an interview that merely "raises awareness of harm caused by tobacco use"? I haven't. They always have a policy to promote—plain packs, the display ban, the vending machine ban, higher taxes etc.

Over the last 12 months ASH worked with the Smokefree Partnership and the European Public Health Association to ensure that European public health experts understood the UK position on the Tobacco Products Directive.

That sounds a bit like lobbying to me. And this sounds a lot like campaigning...

We encouraged Smokefree Action Coalition members to contact their MEPs in support of the UK government's position on the TPD in advance of the votes in plenary

How is any of within the letter of the law, let alone the spirit of the law?

I need to emphasise that this is not a general account of ASH's work in 2013/14. It is specifically about what they did with taxpayers' money.

There's more of the same in ASH's report for 2012/13, when the same restriction on lobbying and campaigning was spelled out in the grant agreement.

Nationally, ASH will:

Stimulate and disseminate further rapid research on plain packaging

I challenge you to find any ASH press releases about plain packaging in 2012/13 that doesn't call on the government to bring the policy in as a matter of urgency. The research is only ever the bait.

ASH can provide additional capacity, working with civil society colleagues at European level, to help ensure that positive policy developments are encouraged.

I bet they can, but remember: they're only encouraging "positive policy developments". Heaven forbid that anyone should think that advocacy.

We continue to provide the European Commission, and other public health organisations working in this area, with factual information and support on the policy areas under discussion

That also sounds like lobbying, but it's okay because ASH were only providing "factual information". I'm sure that information wasn't at all one-sided, nor was it presented in a way that might lead towards a favoured policy outcome.

ASH says it also does this with its grant...

Providing local opinion formers with the data and evidence base on the need for local tobacco control interventions to ensure that the priority given to tobacco control locally is adequate to deliver national ambitions

Which "tobacco control interventions" are ASH telling opinion formers about the "need" for, and doesn't that fall under the category of campaigning?

Building support for effective local implementation of legislation on vending machines from 2011, point of sale display from 2012 and niche tobacco products

Okay, these laws had all been passed by this time, but a government-funded pressure group using taxpayers' money to "build support" for government legislation definitely constitutes sockpuppetry. It is quite clear that ASH sees this as its job, and is happy to report back to DH that...

Media support was delivered on the implementation of the legislation prohibiting the sale of tobacco from vending machines in October 2011.

These, then, are the deliverables that ASH provides the government for its money. They don't lobby, oh no, they just give politicians "support on the policy areas under discussion" and make officials "aware" of "opportunities" so that they "understand" the "need for effective local tobacco control".

They don't campaign either. They just "deliver" media support for laws, "encourage" people to contact lawmakers, "disseminate" research, and provide "factual information" so that opinion formers understand "the need for local tobacco control interventions"

I'm glad we got that cleared up. I'm sure the Department of Health would be mortified if it thought that taxpayers' money was being used to lobby and campaign. Or would it?

Thursday, 19 March 2015

Slippery slope? Nah!

The new Tobacco Atlas, published by the World Lung Foundation and the American Cancer Society, was unveiled at the World Conference on Tobacco or Health this week.

There is a striking image on page 80.

No further questions, m'lud.


Spot the difference between the graphic in the Tobacco Atlas and the, er, "scare tactics" of Imperial Tobacco in 2011.

The plain packs cottage industry

Yawn. Another day, another Guardian article desperately trying to pretend that plain packaging wasn't a flop.

Comprehensive research shows a year [sic] after being introduced, Australia’s legislation is a success and has prompted smokers to think about quitting

This refers to a supplement from Tobacco Control magazine which brings together a number of studies on the subject, topped off with an editorial by "Mad" Gerard Hastings.

All the studies have something in common. See if you can spot what it is...

Australian adult smokers’ responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey
Melanie Wakefield, Kerri Coomber, Meghan Zacher, Sarah Durkin, Emily Brennan, Michelle Scollo

Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers
Sarah Durkin, Emily Brennan, Kerri Coomber, Meghan Zacher, Michelle Scollo, Melanie Wakefield

Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers
Emily Brennan, Sarah Durkin, Kerri Coomber, Meghan Zacher, Michelle Scollo, Melanie Wakefield

Has the introduction of plain packaging with larger graphic health warnings changed adolescents’ perceptions of cigarette packs and brands?
Victoria White, Tahlia Williams, Melanie Wakefield

Do larger graphic health warnings on standardised cigarette packs increase adolescents’ cognitive processing of consumer health information and beliefs about smoking-related harms?
Victoria White, Tahlia Williams, Agatha Faulkner, Melanie Wakefield

“You're made to feel like a dirty filthy smoker when you're not, cigar smoking is another thing all together.” Responses of Australian cigar and cigarillo smokers to plain packaging
Caroline L Miller, Kerry A Ettridge, Melanie A Wakefield

Changes in use of types of tobacco products by pack sizes and price segments, prices paid and consumption following the introduction of plain packaging in Australia
Michelle Scollo, Meghan Zacher, Kerri Coomber, Megan Bayly, Melanie Wakefield

Use of illicit tobacco following introduction of standardised packaging of tobacco products in Australia: results from a national cross-sectional survey
Michelle Scollo, Meghan Zacher, Kerri Coomber, Melanie Wakefield

The advertised price of cigarette packs in retail outlets across Australia before and after the implementation of plain packaging: a repeated measures observational study
Michelle Scollo, Megan Bayly, Melanie Wakefield

The supplement is padded out with four op-eds which continue the theme...

Plain packaging: a logical progression for tobacco control in one of the world's ‘darkest markets’
Michelle Scollo, Megan Bayly, Melanie Wakefield

Standardised packaging and new enlarged graphic health warnings for tobacco products in Australia—legislative requirements and implementation of the Tobacco Plain Packaging Act 2011 and the Competition and Consumer (Tobacco) Information Standard, 2011
Michelle Scollo, Kylie Lindorff, Kerri Coomber, Megan Bayly, Melanie Wakefield

Did the recommended retail price of tobacco products fall in Australia following the implementation of plain packaging?
Michelle Scollo, Megan Bayly, Melanie Wakefield

Personal pack display and active smoking at outdoor café strips: assessing the impact of plain packaging 1 year postimplementation
Meghan Zacher, Megan Bayly, Emily Brennan, Joanne Dono, Caroline Miller, Sarah Durkin, Michelle Scollo, Melanie Wakefield

Finally, there is a research letter. Guess who that's from?
Did smokers shift from small mixed businesses to discount outlets following the introduction of plain packaging in Australia? A national cross-sectional survey
Michelle Scollo, Kerri Coomber, Meghan Zacher, Melanie Wakefield

All this can be found in the special supplement that has been put together by, er, Melanie Wakefield and Michello Scollo.

It's a small world, the plain packaging research community isn't it? One might almost call it a closed shop of like-minded activist-researchers. Melanie Wakefield, in particular, has been fighting to get cigarettes in plain packs for over a decade. Lord knows how many research grants she has pulled in over the years, but she's going to look pretty silly if people notice it's not working, hence today's release.

The other thing the articles have in common is that none of them—not one—looks at adult smoking prevalence, underage smoking prevalence or cigarette sales since plain packaging was introduced. Most of them are not new—they are reprints or remakes of previous efforts—but none of them look at the one thing that plain packaging was designed to do—prevent young people taking up smoking.

After more than two years, that's pretty suspicious, but it's hardly surprising since the rate of underage smoking rose between 2010 and 2013 and tobacco sales rose in the first year of plain packaging. Faced with this dilemma, Wakefield et al. ignore peer-reviewed evidence that shows that plain packaging doesn't work in the real world in favour of rehashing their own tired old surveys and focus groups which boil down to asking people if they like looking at pictures of gangrenous feet ("they don't! Plain packaging works!"). Even then, the best they can manage is to say that plain packaging has "prompted smokers to think about quitting". Never mind the fact that they're not actually quitting.

It's pathetic, but it's enough to get a report in the Guardian. Mind you, that's also hardly surprising when you consider that the author of the Guardian article is freelance journalist Melissa Davey who we last came across in September when she ran a similarly credulous article about plain packaging. She is currently doing a Masters in 'public health' at the home of Melanie Wakefield and Simon Chapman, Sydney University.

A small world indeed.

Tuesday, 17 March 2015

Respect the professionals!

Today saw the start of the 16th World Conference on Tobacco Or Health (I know, I know. It should be "and". They're trying to make a point. Just ignore it.)

This year, the vast, taxpayer-funded shindig for tobacco control troughers professionals is being hosted in Abu Dhabi. And since no expense is too great for the champions of the people's health, the main residential hotel is the five star Hyatt Capital Gate.


Looks nice doesn't it? Obviously, the sun-drenched luxury of the place played no part in the decision to hold the conference there, as Simon Chapman explains...

There has never been a conference in the Middle East and with heavy smoking rates among men in particular, and generally immature tobacco control policies in place, a strong case weighed heavily in the voting for this weeks’ gathering.

Sure. It was those "immature" (read: tolerant) smoking policies that made the fearless crusaders nip over to the United Arab Emirates, presumably to lecture the locals about the dangers of shisha pipes.

However, tragically—and I am holding back the tears as I write this—things have gone a bit Pete Tong for dozens of delegates.

The three day conference started on the 17th and as I write, at least 38 registered delegates we know of [the conference website says 60 - CJS], many whose presentations had been accepted by the conference and some who were to chair sessions, are still waiting for their visas to be issued.  These are from Bangladesh (29), Iraq, Tunisia, Nigeria and Syria. They have a combined experience of over 200 years in tobacco control.

That actually only works out at 5 years experience each, but never mind that. Imagine the anguish of these poor folk pining for their spa conference.

Imagine no longer, for one of them has written to Simple Simon and he or she paints a picture of almost unbelievably sanctimonious entitlement.

I am writing to you in a situation when I am waiting at a friend’s house, packed up all my bags and posters for presentation and checking email every 6 secs...

This is seriously awful when I have prepared  my speech and I have not yet got the visa to fly. With my 12 years of  professional career I got opportunities to lead a number of  platforms on health and tobacco control. [lists his international experience]

However this experience has made my disappointment so terrific that I am truly faded [sic] up on choosing a country which doesn’t respect the professionals, experts and researchers who are leading people’s health and well-being issues in this region and worldwide."

Like the death of little Nell, it takes a heart of stone not to dissolve into tears of laughter. They should have gone to Moscow again.

I never knew the tobacco control movement could make me so happy.