Friday, 17 August 2018

E-cigarette reform and fake outcry

The Science and Technology Select Committee have published their report about e-cigarettes and it is rather good. Like most sensible people, they acknowledge that the EU's Tobacco Products Directive has set the vaping market back and suggest that the government should abandon the pointless and petty vaping regulations in Article 20 after Brexit. They also suggest repealing the crazy ban on snus, encourage employers to permit vaping in the workplace and reject the idea of taxing vape juice.

As I said in Vaping Solutions last year, this is the lowest of the low-hanging fruit for Brexit. Never mind the libertarian arguments for a moment, the health arguments for repealing legislation that makes it more difficult for smokers to quit are difficult to quibble with.

That hasn't stopped the usual suspects from throwing their toys out of their pram, however. The Daily Mail covered the story on its front page today with a claim about a non-existent 'outcry'.

Inevitably, the 'outcry' comes from Simon 'caps lock' Capewell and Martin 'toad' McKee, two dinosaurs who pop up with their nonsense whenever e-cigarettes are in the news. The fanatical anti-vaping hack Sarah Knapton sought them out for her Telegraph article, in which McKee is quoted as saying:

“Those involved in tobacco control outside England will be amazed at these conclusions although not entirely surprised as the committee took oral evidence almost entirely from individuals who are strong supporters of e-cigarettes."

The committee took evidence from, amongst others, Deborah Arnott (Action on Smoking and Health), Hazel Cheeseman (Action on Smoking and Health), John Newton (Public Health England), Gillian Leng (National Institute for Health and Care Excellence), Steve Brine MP (public health minister), Tim Baxter (Department of Health), David Harrison (UK Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment), Jamie Brown (Deputy Director, Tobacco and Alcohol Research Group, University College London), Ian Hudson (Medicines and Healthcare products Regulatory Agency) and Heather Thomson (Nottinghamshire NHS).

If all these people are 'strong supporters of e-cigarettes' then maybe there's a lesson there for throwbacks like McKee?

In the same article, Capewell adds some bollocks about 'passive vaping' and claims that Big Tobacco is 'using e-cigarettes as a 'Trojan Horse' to normalise the act of smoking'. These two clowns will keep fighting to the bitter end but they are further from the mainstream than ever. History will be the judge of them and their 'outcry'.

I wrote about the need for e-cig reform in today's City AM. Click to enlarge.


UPDATE

Speaking of clowns, how's this for a stunted intellect?



Thursday, 16 August 2018

Six reasons to legalise cannabis

On June 30th, the IEA and Volteface hosted an event in London to talk about cannabis legalisation. Six speakers from different fields gave a brief summary of their reasons for wanting prohibition to end. Here they are...

Andrew Boff, London Assembly Member (Conservative):



Richard Hurley, features editor at the British Medical Journal:



Neil Woods, Law Enforcement Action Partnership and author of Drug Wars:



Liz McCulloch, head of policy at Volteface:



Greg de Hoedt, founder of the UK Cannabis Social Clubs:



And me...



Wednesday, 15 August 2018

A strange argument about obesity

George Monbiot has written an unfathomable article for the Guardian in which he blames the food industry for making people eat too much while admitting that people eat less than they used to.

I've written about it for Spectator Health.

Thursday, 9 August 2018

A very Canadian booze revolution

Doug Ford, the brother of the late, great Rob Ford, is now the Premier of Ontario and has set about a populist revolution by cutting the minimum price of beer from $1.25 to $1.00. This represents a near abolition of minimum pricing for beer since it is difficult to manufacture and sell a beer for $1.00, let alone for less than that.

And as if that weren't enough to drive the temperance lobby to despair...

In order to encourage producers to lower their prices, Ford said his government would launch the buck-a-beer challenge, which would offer promotional programs, in-store displays and advertising to those who sell their beer at the minimum price.

There was a time when politicians offered the public cheaper beer in exchange for their vote. Since they fell under the spell of the nanny state lobby, the likes of Nicola Sturgeon seem to think that voters will mistake more expensive alcohol for freedom. Ford is turning back the clock and although the 'buck a beer' pledge hasn't gone down well with some of the breweries, even the BBC admits that his booze reforms are popular with the public.

I'm grateful to my Spectator Health colleague Mathieu Vaillaincourt for sending me this report...

The Canadian province of Ontario was in the British press yesterday, as the recently elected Progressive Conservative government led by Doug Ford (who is the older brother of the late mayor of Toronto, Rob Ford) wants to find ways to lower the price of beer. This was done because of a promise he made in his manifesto during the last election campaign. Since Mr Ford's PC Party won a comfortable majority last June, he has a carte blanche to implement his manifesto as he wishes. The intended goal of this Ford government policy is to return to the era where a can of beer was one dollar. This is far cry from other jurisdictions in the western world who want to put a higher and higher minimum price on alcohol.

This Doug Ford policy is a huge reform in a province known for having very restrictive alcohol laws which are a relic from the prohibition era. Ontario is not Saudi Arabia or Utah, but it's really far more restrictive than what's considered normal in the United Kingdom, France or Belgium.

Before Ford's upcoming reforms, corner stores were unable to sell any kind of beer and wine. Only a few hand-picked supermarkets in a few cities in Ontario were able to sell beer and wine, and only for a couple of years now.

If you want to buy alcohol other than beer or wine in Ontario, you still need to to go to your local LCBO store and if you wanted a beer you were supposed - up until a few years ago - to go to the Beer Store which is a joint-venture between the government of Ontario and a couple of big beer companies. The LCBO looks like your average self-serve liquor store, but the Beer Store is a Soviet relic. It's a very foul, austere and smelly place where you must look through a catalogue and ask the attendant which beer you want which they then get out of the back of the store.

Akin to the United States or Australia, each province in Canada has its own laws regarding the sale of alcoholic beverages. For example, Quebec, because of a gallic influence and because prohibition was always very unpopular in this majority French-speaking province, has had a relatively liberal liquor law for decades now with beer and wine sold at almost every corner store.

But the situation in Canada generally is a far cry from most of Western Europe. Most provinces in Canada have state-owned monopolies who sell and control the trade of alcohol beverages. Only the province of Alberta has completely liberalised the retail selling of booze.

As a proof of what a hot potato the trans-provincial trade of liquor in Canadian politics is, a recent case in the Supreme Court of Canada (called the Comeau case) made it virtually illegal to export a large amount of alcohol between two Canadian provinces.

Just as his cannabis policy more liberal than the Ontario Liberal Party's (he will allow private stores to sell cannabis when it becomes legalised in a couple of months) Doug Ford, who is labelled a populist, is more liberal and less nanny-statist on alcohol than the Ontario Liberal Party itself.


Saturday, 4 August 2018

Kellogg's do a Lucozade with Coco Pops

Kellogg's Coco Pops have been reformulated with 30 per cent less sugar but - bizarrely - with only one fewer calorie per bowl. Isn't this supposed to be about obesity?

If Twitter is any guide, the consumer response has been overwhelmingly negative. The Telegraph reports on this latest round of Public Health England's reformulation fiasco, with a quote from yours truly:

Christopher Snowdon, director of lifestyle economics at the Institute of Economic Affairs, told The Telegraph: "Consumers are right to be upset about their food being reformulated to hit government targets. Public Health England thinks we won’t notice when sugar is removed for food and soft drinks but the experience with Ribena, Lucozade and now Coco Pops shows how wrong they are.

"Nobody voted for this crazy reformulation programme and yet this is only the beginning of the government’s plans for the wholesale desecration of the food supply. To add insult to injury, the new Coco Pops only have one less calorie per bowl than the original. The taste of food is being ruined and it is not even being made less fattening."

If Kellogg's think they can appease the government by taking sugar out of Coco Pops and replacing it with 'premium cocoa powder', they are forgetting about the target of reducing calories by 20 per cent that they are also expected to meet.

The entire food industry should stand up and tell Public Health England where to shove their targets. They would have the British public behind them.

Friday, 3 August 2018

Alcohol advice and the noble lie

This, from by Julian Baggini in the Guardian, is rather good....

Want the truth about alcohol? You won’t hear it from the government 

.. For some time, studies repeatedly produced graphs with a J-shaped curve, showing both abstinence and excessive consumption associated with the worst health outcomes, with moderate drinkers enjoying the best health. It was only in January 2016 that the Department of Health revised its guidelines and claimed the best evidence now suggested that there was no “safe” level of alcohol consumption and every glass increased cancer and heart disease risk.

These new guidelines have been contested, but whether they are right or wrong, the point is that for years people who looked at the data repeatedly found the J-shaped curve, but no official source ever recommended the lifestyle it pointed to: one of moderate drinking. Changes in evidence don’t change the general tenor of anti-alcohol advice, they merely change how forcibly the authorities dish it out.

Why should this be so? One reason is that we like to think in clean, clear categories of good and bad. With our puritanical Protestant history, alcohol has always fallen on the dark side of this divide. So when the truth turns out to be complicated, rather than accept this maturely, we refuse to acknowledge the good and carry on as though it were all bad.

This is doubtless true, and there is more religious influence in the 'public health' crusade against alcohol than most people realise, but the 'no safe level' rhetoric is taken directly from the anti-tobacco campaign. Whilst the government has never recommended moderate drinking to teetotallers, it has only recently shifted towards an implicit message of total abstinence. This is because they are copying the anti-smoking movement in both messaging and policy.

Aside from the pure moralising, a more understandable but no less erroneous reason for refusing to recommend any consumption of intoxicants is fear of the slippery slope. Even if 21 units of wine a week does turn out to be healthy, 21 bottles of wine is not. Similarly, drug use can slide into drug misuse. Give a green light to moderate drinking, so the fear goes, and heavy use is sure to follow.

This paternalism might be benign in intent but it is malign in effect. If it is to have any credibility, health advice must be consistent with the evidence, not gerrymandered to anticipate its potential misuse. Sadly, however, health advice almost always goes through the distorting filter of officials anticipating behaviour change.

Again, this is true. Health authorities do not trust the public with information. But simplistic and misleading advice is not just about influencing the behaviour of people. It is about influencing the behaviour of government. The minutes of one of the alcohol review meetings says that it is ‘important to bear in mind that, while guidelines might have limited influence on behaviour, they could be influential as a basis for government policies’

When I wrote about this in 2016, I concluded that: 'Influencing government policy is the real aim of the game. They don’t trust us to handle accurate information. As a result, we can no longer trust them to give us it.' That is pretty much the conclusion Baggini comes to...

Health advice too often follows the principle of the noble lie. Rather than being told the plain truth, we are told what the authorities believe will lead us to behave properly, when “properly” means not just in the way that is most prudent for ourselves, but what is seen to be morally appropriate. This means that whatever the truth about healthy drinking or drug-taking is, we can’t trust government health advice to provide it. When the best current scientific evidence meets moralising paternalism, it is truth that starts to bend.

 Do read his whole article.

Thursday, 2 August 2018

Alcohol and dementia - more dishonest reporting from the BBC

A study was published in the British Medical Journal today showing that moderate to moderately heavy drinkers have a lower risk of dementia than teetotallers. As always happens when epidemiology finds benefits from drinking, there has been a rush to cast doubt on the findings by talking about 'sick quitters', confounding variables, recall bias etc. These are valid caveats to make, but they are mostly generic criticisms that apply to all observational epidemiology. And yet these points are only raised when a study shows benefits from alcohol consumption. They are almost never raised when risks are reported.

An example of this is Tom Chivers' article for CNN but if you want an absolute classic of the genre, read the BBC's report. The headline sets out the anonymous author's stall straight away...

Alcohol and dementia - is moderate drinking safe?

There is no question that moderate drinking is 'safe' for dementia. The question is whether being teetotal is 'safe'. This study provides yet more evidence that it is not, but by reframing the question, the BBC moves the Overton Window and implies that there are only two possibilities for moderate drinkers: greater risk or no greater risk.

There is no doubt that alcohol abuse is bad for the brain - but could there be health benefits for moderate drinkers?

How do we know that alcohol 'abuse' is bad for the brain? Because that's what the epidemiology shows. When it comes to harm, the BBC is satisfied that epidemiological studies can provide sufficient proof. But when it comes to benefits, it requires an impossibly heavy burden of proof.

The research is contradictory and so the answer isn't straightforward.

The research is actually pretty consistent. A meta-analysis of 15 studies published in 2009 concluded that light and moderate drinkers were 28 per cent less likely to develop dementia. A further meta-analysis of 20 studies published last year concluded that...

Modest alcohol consumption (≤12.5 g/day) is associated with a reduced risk of dementia with 6 g/day of alcohol conferring a lower risk than other levels while excessive drinking (≥38 g/day) may instead elevate the risk.

Does the BBC discuss these evidence reviews or any of the studies in them? Does it heck. So why does the BBC reckon the science is unsettled?

Some research suggests that drinking one or two units of alcohol a day - particularly red wine - could be of benefit to brain health, but other scientists are more sceptical.

The link is to a BBC story about a study which found no evidence that resveratrol - an ingredient in red wine - prevents heart disease. It doesn't mention dementia at all because the study wasn't about dementia.

Another study found that, even in moderation, drinking alcohol could increase the risk of dementia.

The link is to another BBC story, this time reporting the findings of an unpublished study that was presented at a conference in San Francisco in 2012. It is telling that the BBC chose to report this at all, but it did so at length and with the headline 'Drinking alcohol, even in moderation, "a dementia risk"'.

The only peer-reviewed study by the named researcher on this subject was published in 2014. It found that old women who reduced the amount they drank were at increased risk of dementia. You won't be surprised to hear that the BBC did not cover the study when it was published.

The BBC's claim that the research is contradictory starts and ends with those two stories. That's it.

Another study has come out to add to the confusing picture of public health advice around drinking.

It's not confusing. There is a J-Curve of risk that has been shown repeatedly for dementia and several other diseases. The advice should be to drink moderately.

The British Medical Journal study found that a group of people who did not drink alcohol in middle age were more likely to develop dementia later on than people who drank moderately. 

You can read it here. It used the famous Whitehall II cohort of civil servants, following them up over a period of 23 years. It found familiar J-Curves across the board, with those who were teetotal throughout the period being 47 per cent more likely to develop dementia that light/moderate drinkers.


The authors try to argue that this vindicates the new drinking guidelines (14 units) that were set in 2016 after a rigged process. This is a strange interpretation. Although risk is at its lowest at around 14 units per week, it does not follow that drinking more than this is unsafe. Common sense and convention dictate that drinking becomes 'unsafe' when the risk exceeds that of a teetotaller's, not when it exceeds that of the lowest risk drinker. As the graphs above show, you have to drink much more than 14 units before your risk reaches that of a teetotaller's.

There is a big difference between a safe amount and an optimal amount. If we are going to tell drinkers to consume 14 units a week because that is where the optimal health benefits lie, we should also be telling non-drinkers to consume 14 units a week. Neither the BMJ nor the BBC are going to do that, however.

So should non-drinkers take up the habit for the sake of their health? The answer is almost certainly no.

Why? The BBC won't explain its reasoning. Instead it makes the usual generic criticisms about epidemiology which are conspicuous by their absence when it is reporting that, for example, half a glass of wine increases breast cancer risk.

First of all, it can only really say that more of the people observed who didn't drink in midlife went on to develop dementia - it cannot say that abstaining from drinking itself is causing dementia. 

Yes, correlation doesn't prove causation. This applies to literally every epidemiological study ever published.

And people in this group may have drunk heavily in the past or had to give up drinking for health reasons. 

Hello sick quitter hypothesis, my old friend. I'm here to obfuscate with you again. The non-drinkers in this study were not all necessarily lifelong teetotallers, but they were certainly long term teetotallers of at least 23 years standing. It is possible that some of them may have been heavy drinkers when they were young. Is there evidence that heavy drinking in youth followed by decades of abstinence increases the risk of dementia? I don't know of any and the BBC doesn't cite any. It just throws out the possibility to cast doubt on the findings.

The study only looked at whether people drank during a particular snapshot in time, so some of that group might already be in poor health.

That sentence doesn't make any sense whatsoever. It takes two separate issues - 'sick quitters' and misreporting of consumption - and garbles them together in a way that suggests that the author doesn't have the first idea what he or she is talking about. In any case, the study didn't look at what people drank in one 'snapshot in time'. The civil servants were asked how much they drank on eight occasions over the course of the study.

Misreporting is an issue for all epidemiological studies that are based on questionnaires but the real issue in alcohol epidemiology is under-reporting of consumption. Since we know that people greatly under-report the amount they drink, it is highly likely that the people who have the lowest dementia risk are consuming around 20 units, not 14 units. The BBC doesn't mention this.

There have been a number of studies in this area with conflicting results...

As discussed above, this is misleading at best. A study was published earlier this year which was reported to show that light drinking increases dementia risk but, as David Spiegelhalter explained, it actually confirmed the J-Curve.

...and this one doesn't provide enough evidence to suggest that anyone should go ahead and change their drinking habits.

Somehow I suspect that the message would be different if moderate drinkers were 47 per cent more likely to get dementia than non-drinkers, but never mind. They don't call the BBC 'Auntie' for nothing.