Wednesday, 19 January 2022

Inside the UK's illicit tobacco business

Article in Vice about Britain's illegal tobacco problem.
 

Phil Mykytiuk has spent a decade mapping tobacco crime gangs in the north of England. He is new in post as a trading standards manager at Bolton Council in Greater Manchester but worked for 10 years on a tobacco enforcement team at nearby Rochdale Council.

.. The National Crime Agency said that while it supports partner agencies on tobacco enforcement, its focus is on prohibited commodities like drugs and firearms, with HMRC taking the lead on tobacco. 

Mykytiuk, though, believes the multiple layers of crime behind cheap, illegal tobacco are escaping scrutiny, allowing crime gangs – emboldened by the lack of deterrent – to expand their power base right under the noses of enforcement. Having witnessed Kurdish tobacco gang members invest heavily in property and high street businesses here in the UK, he’s now seeing evidence of them moving into cannabis farms.

“But forget drugs,” he says. “Drugs is yesterday. The big thing is tobacco. These gangs are becoming the most capable criminals in this country. Right now it's the biggest threat we’ve ever faced.”


As the article notes, official statistics indicate that the illicit market is large (17%) but has not grown in recent years. Maybe, maybe not. Official statistics are based on a vague estimate that is highly sensitive to the assumptions fed into the model. The government could sample litter to see how many packs were not sold legally in the UK. I suspect this would give a larger and more realistic estimate, but HMRC shows no interest in knowing what's really going on.
 
Tobacco taxes are crazily high these days and it's hard to imagine high rates of 'tax morale' among smokers. If anything, they might feel a moral duty to starve a government that discriminates against them of money.  



Tuesday, 18 January 2022

Uncomfortable truths about the costs of healthy living

There's a good article in the New Statesman raising some uncomfortable truths about healthcare spending and lifestyle regulation. It mentions some research I commissioned at the IEA a few years ago.

In Britain we talk often of the “cost” to the NHS of people who smoke or are obese – the health support service One Small Step, for example, points out that smoking costs the UK government £12.6bn a year, £2.5bn of which is spent on NHS smoking services. On the same page, however, it notes that “half of all life-long smokers die early, losing on average 10 years of their life”. Given how dramatically health, social care and pension expenditure increases as someone ages past retirement, those 10 lost years actually represent a saving for the taxpayer.

That is an immensely grisly – not to mention heartless – way to look at things. But if your argument is that those who cost more should pay more, it is vital to crunch the numbers. Despite the perception that certain lifestyle choices would save money as well as lives, a Dutch study from 2008 found that smokers and the obese were cheaper to care for over their lifetimes, while research from the Institute of Economic Affairs concludes that: “By dying early, overweight and obese people saved the government £3.228bn in pension, healthcare and benefit payments in England and Wales in 2014.”

The more you think about it, the darker it gets. It is a triumph of medical science that people are living longer and surviving conditions that would once have killed us: someone who three decades ago would have died of cancer at 70 can now have a life-saving operation and live another 15 years. That’s wonderful – but those 15 years of other age-related ailments and potential dementia have a price-tag attached, for the government purse as a whole and in terms of healthcare specifically. Figures from the Nuffield Trust in 2016 published in the Guardian show how health spending in the UK is skewed towards the over-65s: more than £7,000 a year was spent per person on those above the age of 85 compared to a national average of £2,069, with an 85-year-old man costing the NHS seven times more than a man in his thirties. Miraculous but expensive new drugs compound the challenge. The unpalatable truth is that, above a certain age, the most costly thing someone can do in terms of burden to the NHS is to keep living.

 
There is no 'obesity timebomb'. 'Unhealthy' lifestyles do not pose a threat to the NHS or any other health system. What we have in the UK and around the world is a pensions timebomb and an ageing population putting unprecedented pressure on health and social care. Nobody in politics or the media knows how to address this and so disfavoured minorities are used as scapegoats to take our minds off it. 
 
Worthless, economically illiterate estimates of the cost of certain lifestyles are regularly produced (such as this garbage from ASH last week), but for all the talk about 'negative externalities', the reality is that the main economic consequence of people living healthier lives is that everyone has to work for longer before they can retire. Way to go, healthists!


Monday, 17 January 2022

Dishonest arguments against vaping

It's 2022 and certain people are still arguing about e-cigarettes as if it's 2012. Even in 2012, we knew more about them than the European Respiratory Society (ERS) does today. In a head-to-head debate in the British Medical Journal, three members of the ERS take on Nicky Hopkinson, the chairman of Action on Smoking and Health, to discuss whether e-cigarettes should be available on prescription. 

It's a controversial question and there are reasonable arguments on both sides, but the medics from the ERS don't bother with reasonable arguments. Instead, they bluster and lie and act as if no research has been carried out since their organisation took an ideological position against vaping back in the day. Here's how they start off...

There is already enough nicotine addiction. 

 
That is a moral judgement and has nothing to do with health.
 

For decades, smoking rates in the UK have been declining, and few teenagers see themselves becoming smokers. This has been achieved without e-cigarettes, and the decline in smoking has not accelerated after the introduction of e-cigarettes.

 
This is a bare-faced lie. The smoking rate had barely moved in five years before e-cigarettes became popular in 2012. It then fell sharply. 
 
E-cigarettes as an aid to smoking cessation have not been endorsed by a single major respiratory or paediatric scientific society because their effectiveness in smoking cessation is unproved—and remarkably poorly studied.
 
The appeal to authority here is suspiciously narrow. There are not many respiratory societies and I wouldn't expect a 'paediatric scientific society' to have any particular expertise in this area. The authors neglect to mention the endorsement of e-cigarettes for smoking cessation by Public Health England, the Royal College of Physicians, Cancer Research UK, the French National Academy of Medicine and fifteen past presidents of the Society for Research on Nicotine and Tobacco, to name a few. 
 
As for being 'remarkably poorly studied', the authors are either dishonest or woefully uninformed. There have been many observational studies, a number of randomised controlled trials and several Cochrane reviews, all of which show that e-cigarettes work better than anything else, even for smokers who have no intention of quitting. This is tacitly acknowledged by the gormless authors in what follows...
 

In the most cited trial comparing e-cigarettes with medicinal nicotine products, e-cigarettes were found to be superior, showing a one year abstinence rate of 18%, compared with 10%. However, twice as many people in the “old fashioned” nicotine replacement groups were found to have quit nicotine completely, as people using e-cigarettes tend to continue vaping, whereas most people using medicinal nicotine products quit.

 
That's exactly what I did and it's just the way I like it, thanks. The important statistic is that nearly twice as many people quit smoking with e-cigarettes than without. Whether people continue vaping after quitting - or continue using nicotine gum, for that matter - is of trivial 'public health' interest.

There is also the phenomenon of “dual use”: smokers quit by using e-cigarettes and then restart smoking while they continue vaping. In the most cited trial, 40% of people assigned to e-cigarettes were still using them after a year, and more than half of these vapers were also smokers. 

 
This is the same randomised controlled trial mentioned in the previous paragraph and the authors are saying much the same thing in a different way. The fact remains that the smokers who were given e-cigarettes were 83% more likely to quit smoking. That is what should matter to a respiratory society.
 

(The University of Bath’s Tobacco Tactics group has noted that the tobacco industry loves dual use.)

 
Haha! Who cares what a Bloomberg-funded activist group thinks??
 

E-cigarettes are not “95% less harmful than cigarettes.” 

 
Indeed. It's probably closer to 99.9%.
 

This often quoted statement is indefensible because vaping has been associated with many cases of acute lung damage, events not seen in smokers.

 
You're not seriously going to blame the US's 2019 EVALI outbreak on e-cigarettes, are you? It has been proven beyond reasonable doubt that the lung damage was caused by the adulteration of black market THC cartridges. It had nothing to do with nicotine vaping.

Around 80% of these cases are related to cutting the liquids with cannabinoids—but 20% are not.

 
No. In around 80% of cases, the person admitted to consuming black market THC. The other 20% denied it because purchasing black market THC is illegal. 
 
Either that or normal e-cigarettes briefly produced exactly the same symptoms as EVALI among a handful of people in a few parts of the USA for a short period before the contaminated THC products disappeared from the market. Which seems more likely?
 

If the acute effects of vaping are worse than those of tobacco, how can anyone seriously state that the unknown long term effects are less harmful and expect to be believed?

 
What an insanely stupid thing to say. 

The whole article is equally idiotic. Read it here if you must. These chancers couldn't lie straight in bed.


Thursday, 13 January 2022

The grips of obsession

A brief follow up on Monday's post in which I discussed the 'public health' academic Mark Petticrew who is obsessed by the idea that alcohol awareness charities are covertly encouraging people to drink.


Absolute monomania.



Wednesday, 12 January 2022

The Philippines take an enlightened approach to vaping, prohibitionists in the mud

The Philippines have had enough of Mike Bloomberg sticking his nose and money into their business. The wrinkly prohibitionist was caught last year funding numerous 'public health' groups in the country and giving pay outs to the Philippines FDA - the agency that regulates e-cigarettes.

The legal status of e-cigarettes has been all over the place in the Philippines in recent years. As far I can tell, they were effectively banned by the nation's autocratic president in February 2020, but they have now been deregulated in a conscious bid to encourage smokers to switch to them. 

It's all a big turnaround for a country that has been given awards from Mike Bloomberg and the equally prohibitionist WHO in the past. The volte face may have been partly a reaction to having a foreign billionaire using his money to influence policy, but it is certainly a step in the right direction.  

In true 'scream test' fashion, it has annoyed all the right people, not least the fanatics at the Tobacco Control blog...

New laws often build upon and strengthen existing laws, but in the midst of a pandemic when health-protective measures should be prioritised, retrogressive bills seeking to loosen existing restrictions on heated tobacco products (HTPs) and electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) have advanced in Philippine Congress. 

 
Cry more.
 

Completely disregarding the existing laws that already set a regulatory regime for these products and the repeated and pointed opposition of medical organizations, these bills seek to make HTPs and ENDS/ENNDS more widely available by lowering the minimum age of access from 21 years to 18 years, allowing sales to non-smokers, allowing online marketing and sales, allowing multiple flavours that are attractive to teens, replacing the FDA with the industry-friendly Department of Trade and Industry as the regulatory agency for these harmful products, and limiting the placement of GHW [graphic health warning] to a single message on nicotine as an addictive substance.


Excellent. 
 

Under the guise of balanced regulation, HB 9007 and SB 2239 proponents claim that regulation of HTPs and ENDS/ENNDS should not be stricter than that for reportedly much more harmful cigarettes, as stipulated in RA 9211. 

 
It obviously shouldn't. And note the sly use of the word 'reportedly'.
 
For a more intelligent take, read this report from the Manila Bulletin...
 

The Philippines is poised to join the ranks of progressive countries like the United States, the United Kingdom and New Zealand which are seeing sharp declines in the number of smokers with the passage of the so-called vape bill in the Senate and the House of Representatives, two leading international experts on tobacco harm reduction said.


It is also worth watching the Philippines' video statement at last year's FCTC COP9, the WHO's biannual anti-nicotine conference. The tone is very polite, but the minister makes it clear that they're not going to take any more of the WHO's prohibitionist medicine.




Monday, 10 January 2022

Marginalised outgroup is marginalised, new study reveals

This study would be funny if the subject matter wasn't so grim.

Background

Smoking is often colloquially considered “social”. However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up. Methods

In this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean(SD) age 67(10) years. We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years, using ordinary least squares regression models.

Findings

At baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 – 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 – 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 – 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 – 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 – 0·356, to 0·297, 95%CI 0·140 – 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 – 0·270, to coef.=0·197, 95%CI 0·087 – 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 – 0·207), at 4-year follow-up) over time.


Who could have guessed that a concerted, state-led campaign of ostracism and demonisation in which the law was used to drive smokers out of all indoor venues and a large number of outdoor venues would have led to the outgroup being socially isolated? I for one am stunned.

The discussion section is amazing. 
 

These findings have important policy implications. Firstly, they further strengthen the justification for anti-smoking legislation

 
That's one interpretation, I guess.
 

Adding to other research on the health impacts of smoking, our results suggest that smoking is potentially detrimental to aspects of psychosocial health.

 
I mean, it might be, but a more obvious inference is that smoking bans are detrimental to aspects of psychosocial health, something the late Frank Davis spent the last thirteen years of his life 'banging on about'. A simple way to test the proposition would be to see whether smokers felt socially isolated in the decades before the government decided to make an example of them. I know of no evidence that they did. 
 
Or we could study people in the dwindling number of countries where smoking is not yet treated as being akin to paedophilia and see whether they have 'less frequent engagement with community and cultural activities'. I suspect not, but further research would be welcome.

That is not the kind of research the authors have in mind, however.

Although causality cannot be assumed, and further research is warranted, the idea held by some that smoking might be prosocial appears to be a misconception, with serious implications for health and wellbeing throughout the lifespan.


As I have said before, 'public health' activists are the kind of people who would put a brick through your window and then try to sell you double glazing. For years they have shed crocodile tears over tobacco sales leading to secondary poverty, as if it were not the direct result of the exorbitant taxation they campaigned for. Now they are claiming, in effect, that smoking causes loneliness. 

And don't expect self-awareness to emerge any time soon. Guess what their solution is?
 

These findings emphasise the intersection of two major public health priorities which requires further attention. In policy terms it provides a further basis to increase efforts to achieve Smokefree society.


That's right. More smoking bans.


Behold the merchants of doubt!

Public health epidemiologists have been dining out on the smoking-lung cancer link since the 1950s. They're not going to find anything as big as that again and the trophy cupboard has been fairly empty ever since. 

'Public health' activists have been dining out on the tobacco industry's 'merchants of doubt' campaign since the 1990s and are eager to tar every industry of which they disapprove with the same brush. 

The latest example of this is a study titled Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages written by our old friends Mark Petticrew, Nason Maani et al. You may recall that Petticrew has an obsession with the bland alcohol education charity DrinkAware which was set up by the government and is funded by the drinks industry. 
 
Petticrew is convinced that DrinkAware exists to downplay the risks of drinking and encourage pregnant women to get drunk. He and his colleagues have been knocking out studies trying to prove this at a rate of one or two a year for the last five years. I've covered some of them on this blog, mainly because I find them funny.
 
The latest study is no exception. The gist of it is that the tobacco industry circa 1950-1980 put forward 'alternative causation arguments' to cast doubt over the smoking-lung cancer association. Indeed they did. There was talk of sulphur in matches being the real problem. Hans Eysenck suggested that the personality traits which led people to smoke also happened to increase the risk of developing cancer.
 
This was all obviously nonsense and we can laugh about it now. Petticrew's theory is that the same thing is going on today with regards to sugary drinks and alcohol. To get to the bottom of this, he and his chums conducted an online survey - the gold standard for 'public health' research these days - and gauged people's reactions to a series of statements. 
 

They were subsequently presented with a short, anonymized, paragraph containing either an alternative causation argument about a particular harm obtained from one of the four industry-sponsored sources (randomly selected from examples from either the fossil fuels, smoking, alcohol, or sugar sweetened beverages industries), or information from an independent scientific or non-governmental agency. Respondents were then asked about their certainty about the risk of the specific harm from that product (certain it does increase risk, uncertain it increases risk, certain it doesn't increase risk).


The idea was to see whether the industry's filthy lies would outweigh the impartial truth in the mind's of ordinary folk. Alas, they did.
 

Overall, (i.e. grouping all industries together) industry-sponsored uncertainty messages significantly increased the odds of uncertainty, or false certainty, by 60%, compared to independent sources of information (Summary OR 1·60, 95% CI 1·28–1·99) (see Fig. 1 and Table 2).


It seems that about seven per cent of participants went from being certain to uncertain when presented with the 'industry text'. Weirdly, it seems that the biggest effect was found when people were presented with ancient statements from the tobacco industry, albeit from a lower (but still surprisingly high) base.

 

 
What kind of statements are we talking about? This is where it gets interesting. The authors don't include them in the study but they can be found in a ropey Word document in the supplementary material. For alcohol, the first statement from 'an independent scientific or non-governmental agency' is this...
 

"Alcohol is a Group 1 Carcinogen. Like Tobacco." (Balance North East) http://www.balancenortheast.co.uk/our-campaigns/alcohol-and-cancer/

Balance North East is an anti-alcohol pressure group entirely funded by the taxpayer. It is questionable whether it is 'independent' (from whom?) or 'non-governmental'. Either way, it has an incentive to portray alcohol in the worst possible light to drive support for its various campaigns, which include minimum pricing and advertising bans. 

The claim about alcohol being a Group 1 carcinogen is true, but IARC's classifications are notoriously confusing to the general public since they are based on the strength of evidence rather than the magnitude of the risk. Processed meat is also a Group 1 carcinogen, but it is nothing like tobacco. As Cancer Research UK explains...
 

While this may sound alarming, it’s important to remember that these groups show how confident IARC is that red and processed meat cause cancer, not how many cancer cases they cause, as we wrote when we covered a previous IARC decision on diesel emissions, and interviewed one of our experts in the causes of cancer.

As Professor David Phillips – a Cancer Research UK-funded carcinogen expert from King’s College London – explains, “IARC does ‘hazard identification’, not ‘risk assessment’.

“That sounds quite technical, but what it means is that IARC isn’t in the business of telling us how potent something is in causing cancer – only whether it does so or not”, he says.

To take an analogy, think of banana skins. They definitely can cause accidents, explains Phillips, but in practice this doesn’t happen very often (unless you work in a banana factory). And the sort of harm you can come to from slipping on a banana skin isn’t generally as severe as, say, being in a car accident.

But under a hazard identification system like IARC’s, ‘banana skins’ and ‘cars’ would come under the same category – they both definitely do cause accidents.

 
So the first supposed statement of fact from an impartial organisation related to alcohol is not from an impartial organisation and is likely to mislead the vast majority of people. In the study, Balance North East's claim is juxtaposed with the following statement from - you guessed it! - DrinkAware.

"It's important to put the risks from drinking alcohol into context. There are many other factors that increase the risk of developing breast cancer, some of which we can't control, like:
 - Age: you're more likely to develop it as you get older
- A family history of breast cancer
- Being tall
- A previous benign breast lump
 However, in addition to alcohol, other lifestyle factors such as being overweight and smoking are thought to increase your risk of developing breast cancer." (Drinkaware, UK)


Again, this is all true. Is it misleading? Aside from the fact that smoking isn't actually a risk factor for breast cancer, I wouldn't say so. In any case, it needs to be put in the context of an entire webpage and a downloadable fact sheet which makes it very clear that "drinking alcohol increases your risk of breast cancer". This is hardly 'merchants of doubt' territory. 

The next pairing of 'non-industry sponsored' and 'industry sponsored' texts is...  
 

"The Chief Medical Officers advise: Alcohol can cause cancer, including breast and colon cancers" (Warning msg from Hobin et al, 2020)

"Not all heavy drinkers get cancer as multiple risk factors are involved in the development of cancers including genetics and family history of cancer, age, environmental factors, and behavioural variables, as well as social determinants of health" (Drinkaware, UK) 


This is not actually from DrinkAware. It is from the Australian equivalent, DrinkWise. The same webpage says 'Excessive drinking can increase the risk of developing colon cancer' and 'Studies indicate a relationship between alcohol consumption and developing breast cancer'. Hardly the stuff of a hardcore denier.

It seems that Petticrew's beef is that DrinkAware and DrinkWise acknowledge that alcohol is not the only cause of cancer. This is obviously true. Alcohol causes only a small minority of cancers. If the aim is to educate the general public, the quotes from DrinkAware and DrinkWise are more informative than "Alcohol is a Group 1 Carcinogen. Like Tobacco."

Some may disagree, but everyone should be able to agree that these 'industry-sponsored' organisations are not putting forward an 'alternative causation argument'. An alternative causation argument would be something like this:
 

Some studies have found a link between alcohol and cancer, but correlation doesn't equal causation and the statistical association may be due to factors such as X, Y and Z.


That is what the tobacco industry and its supporters did in the twentieth century. It is not what DrinkAware are doing. Pointing out that not every drinker gets cancer and listing some other causes of cancer is not an alternative causation argument. It is the truth and it is quite useful since most people would like to know what risks they face in life.

The next pairing takes a quote from Alcohol Concern - a defunct anti-alcohol pressure group - and the International Alliance for Responsible Drinking, an industry-funded body. 
 

"For some cancers, any amount of alcohol increases the risk. For other types of cancer, the risk only increases after drinking two or three drinks per day – around 26 to 35 units per week.

Any amount of alcohol increases the risk of:
- Mouth cancer
- Upper throat and voice box cancer
- Food pipe (oesophagus) cancer
- Breast cancer" (quote from Alcohol Concern information on alcohol and cancer (now Alcohol Change https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-and-cancer)

“Breast cancer is the leading cancer among women, and is associated with a large number of individual risk factors. Research has shown that breast cancer risk is associated with family history and hormonal and reproductive factors. Increased risk has been reported with hormone replacement therapy, but varies by the type of breast cancer (ductal, lobular, or mixed). Similarly, risk associated with other reproductive factors, such as age at menarche or breastfeeding, have been shown to differ by cancer subtypes. According to IARC, cancer of the female breast is causally associated with the consumption of alcohol beverages." (IARD, global)


In this instance, the 'industry-sponsored' message is more factual than the 'non-industry' message. The idea that light drinking increases the risk of breast cancer is actually pretty shaky. The same is true of laryngeal ('throat box') cancer. Meanwhile, the IARD statement is factually correct. It's difficult to see what Petticrew's problem with a sentence like 'According to IARC, cancer of the female breast is causally associated with the consumption of alcohol beverages' could be. Presumably he is upset because they mention other risk factors. It is understandable that a temperance pressure group wouldn't want to mention other risk factors, but it hardly seems unreasonable to do so.

The authors then move on to drinking in pregnancy with examples such as this:

If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. (UK Chief Medical Officer Guidelines, UK) https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking

There is confusion about how much one can safely drink during pregnancy. We know very clearly that excessive amounts, either in isolated binge drinking or in prolonged drinking, are very harmful. What we don’t know for sure is the lowest possible level that you can drink safely. We therefore say, for that reason, the safest possible thing that you can do is to not drink at all during pregnancy or while you’re breastfeeding. (Drinkwise, Australia) 


It is certainly true that there is 'confusion about how much one can safely drink during pregnancy'. It is likely that there is a 'safe level' but it would be unethical to run a randomised controlled trial to establish what it is. In the absence of firm data, total abstinence is clearly the risk-free option. And that is exactly what DrinkWise recommends! Presumably Petticrew included this quote because it mentions uncertainty, but the uncertainty is very real. 

They then move on to sugary drinks.

“Children who consume higher amounts of sugary drinks have a 55% greater chance of being overweight or obese compared to those who consume less [sic] sugary drinks." (American Heart Assn: (https://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_474846.pdf)

"Obesity is a complex problem that is influenced by many factors, most importantly diet, exercise and genetics. … The key to living a healthy lifestyle is to incorporate a balanced, healthy diet that balances calories consumed and calories burned through activity and exercise." (American Beverage Institute, sourced from Lim et al, 2019)


The 'impartial' commentators here are citing one meta-analysis. Other meta-analyses have been published which find no such effect (see here and here). This suggests a large degree of genuine uncertainty. Meanwhile, the 'industry-sponsored' commentators make a statement of fact that is so uncontroversial I am at a loss to see why it is included by Petticrew et al. 

“Excessive consumption of sugar is one factor promoting overweight and obesity. In 2013, about 37% of men and 38% of women worldwide were overweight or obese. Excess weight increases the risk of non-communicable diseases, including some cancers”. (NCD Alliance https://ncdalliance.org/sites/default/files/resource_files/Curbing-Global-Sugar-Consumption.pdf)

"Obesity is complex and there can be many causes. These include eating more kilojoules than your body uses, inactivity, genetics, conveniences linked to modern living, and socio-economic factors. For many, too much energy or kilojoules consumed from any source, including sugars, contributes to weight gain. For sugars and obesity, the research continues to show no direct causal relationship, outside of the contribution to energy intake." (Sugar Nutrition Research Centre https://www.sugarnutritionresource.org/sugar-health/sugar-and-obesity)


I can't see much of a difference between these two statements. They are both factually correct and uncontroversial.

It would be tedious to give more examples. The most that can be said is that the 'industry-sponsored' messages sometimes have a slightly different emphasis than the messages from campaign groups. Specifically, the 'industry-sponsored' messages - or, more precisely, the messages that have been handpicked by Petticrew and friends - are more likely to mention other risk factors than the messages from 'non-industry sponsored' organisations. 

Even this is debatable. If you look at the NHS's webpage about breast cancer, it only briefly mentions alcohol at the bottom of its list of risk factors. It is the same list of risk factors given by DrinkAware in the quote above which is supposedly 'misinformation'. 

The study concludes with a little rant and a call to action.
 

The potency of this misinformation is of concern in part because exposure to it is widespread. Compared to the tobacco industry, which has now been prevented from many forms of public engagement, the fossil fuel, alcohol, and sugar sweetened beverage industries have far wider access to the public as conveyors of misinformation, including by funding charities with the express purpose of communicating on product harms to the general public, as well as to children and young people through schools.

 
He is talking about DrinkAware, of course. Did I mention that he is obsessed?  

By way of example, Drinkaware, an alcohol-industry-sponsored charity in the UK, whose misinformation is used in two of our examples, is named on most alcohol-related advertising labels, posters and adverts, and its website, from which the information used in this study was obtained, received over 10 million unique visitors in 2018 (DrinkAware. Impact Report, 2018). Just as “the dose makes the poison”, the impact of these messages is a function of both their potency, and their breadth of exposure.


DrinkAware need to take out a restraining order against this guy. 

Dialing the madness up to 11 in the conclusion, the authors suggest that charities such as DrinkAware should be banned from talking about health risks, presumably by law.
 

.. This evidence brings into question whether manufacturers of harmful products and charities with funding from such manufacturers should be permitted to communicate about health risks with the public. 

 
And there is a clue as to what their next studies are going to be about. 
 

.. Future research could focus on messages regarding other harmful products such as gambling or vaping.

 
Something to look forward to. 
 
And, in case you were worried, the researchers took their duty of care very seriously. No one was hurt as a result of this experiment.
 
At the end of the survey respondents were presented with accurate independent (non-industry) information, and a link to a trusted source (e.g., the relevant NHS England information or other independent source). Each respondent was exposed to misinformation from only one industry.
 
 That's a relief.