Saturday, 22 June 2019

Ten years of Velvet Glove, Iron Fist

Boisdale, 2009

As Simon Clark notes on his blog, today marks the tenth anniversary of the publication of my first book, Velvet Glove, Iron Fist: A History of Anti-Smoking. You can see some photos of the launch event, which was also FOREST's 30th birthday party, here.

I've been re-reading the last couple of chapters of the book to see how it stands up. What struck me was how many things that I thought were relatively recent developments were already underway by 2009. In my mind's eye, anti-obesity campaigners had started on fat and only turned on sugar in the last few years, but re-reading Velvet Glove I realised that chocolate and biscuits were already in their cross-hairs in the noughties. I had also forgotten that local councils were denying planning permission for takeway shops more than a decade ago.

Most of my predictions about the slippery slope have been confirmed by events. The war on perfume never gathered the momentum that I thought it might, although when I was in Toronto recently I was in a building that advertised itself as a 'scent-free zone'. 'Electrosensitivity' never really took off, perhaps because the ubiquity of smartphones and wi-fi made the cost of having this trendy diagnosis too high. Even the most high profile 'sufferer' - arch anti-smoker and former WHO Director-General Gro Harlem Brundtland - is now using a mobile phone.

Of course, there are some things that no sane person could have predicted, such as Thailand banning smoking in the home on the pretext of preventing domestic violence, but there isn't much I would change about the book if I could have my time over.

Having said that, I keep meaning to revise and expand Velvet Glove for a second edition. One day I will get around to it, but it is a big job. The rise of e-cigarettes, which began shortly after publication, probably requires a whole chapter of its own, and there are a whole slew of policies - plain packaging, display bans etc. - that were only a glint in the eyes of a fanatic in 2009.

The obvious endgame for the anti-smoking lobby has always been prohibition. By the time I get round to updating the book, tobacco prohibition may well underway. It would be the natural final chapter.

Beverly Hills recently got the ball rolling by announcing a ban on the sale of tobacco and vaping products. I was struck by the comments of Doug Blanke, Executive Director of the Public Health Law Center at the Mitchell Hamline School of Law in Saint Paul, Minnesota, which brought to mind Billy Sunday's hilariously over-optimistic speech about 'John Barleycorn' when alcohol Prohibition began...

“The tobacco epidemic is the greatest manmade catastrophe of all time: it’s on track to kill a billion smokers before the century is out.  But we may look back and say that this was the day that changed all that. Because with this bold action, Beverly Hills is showing the world an alternative path.  A path to zero tobacco deaths. To a world where we don’t just ‘control’ tobacco products, we phase them out completely. A world free of tobacco-related death and disease.”

In January, it will be exactly a century since Prohibition began. Are we destined to repeat the same mistake again? I suspect so. Once Beverly Hills has had the ban in place for a while there will be studies published claiming that it has been a glorious success. California will then follow, then whole countries. Who will be first? Thailand? Australia? Singapore?

As Laurent Huber, Executive Director of Action on Smoking and Health says:

“Beverly Hills is the first domino falling for tobacco sales, and other jurisdictions with no doubt soon follow their lead.”

Remember when all they wanted was non-smoking sections in restaurants? How things snowball.

Friday, 21 June 2019

The IEA is closer to power than it has been for decades

The Institute of Economic Affairs is 'closer to power than it has been for decades' and 'may now hold the key to No 10'.

So said a peer-reviewed article in the British Medical Journal recently, so it must be true.

As you can imagine, those of us who work for the IEA were delighted to see our awesome power and influence being recognised by a top journal. Unfortunately, the article was written by gutter freelancer Jonathan Gornall so we can't pretend that it's an entirely accurate representation.

I've written a response for the benefit of the peculiar subset of people who think that 'who funds you?' is an argument.

When the BBC reported last month that Arron Banks had given £450,000 to Nigel Farage, I tweeted ironically: “So now we know why Mr Farage keeps banging on about leaving the EU. He’s been funded by a notorious Eurosceptic”. As should be obvious, the joke here is that everybody knows that Nigel Farage has been campaigning to leave the EU for 25 years. He attracts funding from people who share their ambition. The idea that the relationship works the other way round, with Farage’s opinion of the EU being dictated by the views of his financial backers, is laughable and yet that is how the British Medical Journal seems to view the relationship between the IEA and our donors.

Do read the rest.

Wednesday, 19 June 2019

Scottish government spinning last year's alcohol statistics

The newspapers are full of 'good' news stories about minimum pricing today...

Scottish alcohol sales drop as minimum price kicks in (BBC)

Alcohol consumption in Scotland falls to 25-year low following minimum pricing introduction (Telegraph)

Minimum pricing policy for alcohol has sobering effect (Times)

Scottish alcohol sales at lowest level in 25 years after price controls (Guardian)

This seems to contradict previous reports of alcohol sales rising since minimum pricing, and the Scottish government is milking it for all it is worth. So what's the story?

The figures come from Scotland's annual MESAS study and look at the calendar year of 2018. Minimum pricing wasn't introduced until May 2018, so the figures do not show what happened after minimum pricing came in. They show what happened in a year in which minimum pricing was in force for eight months.

Nielsen data show that sales in Scotland went up by every measure - volume, value and units - in the first nine months of minimum pricing. A sharp decline in cider and perry sales was more than offset by a rise in sales in other categories, particularly spirits, lagers and fortified wine, leading to a two per cent increase in the number of units sold overall - a rise of 25 million units. (Unfortunately, these data are not available in full online.)

None of this is irreconcilable with the MESAS figures released today (which are also based on Nielsen data) for two reasons.

Firstly, as mentioned, the MESAS figure is for the whole year and it is quite possible that sales were lower than average in the four months before minimum pricing began.

Secondly, the MESAS figure is - quite properly - an estimate of per capita sales. Per capita figures are obviously affected by population growth. If there has been significant immigration, per capita sales could fall even while overall sales rise.

The MESAS authors say that they use the mid-year population estimates from National Records Scotland. Interestingly, however, those estimates show little population growth between 2017 and 2018. The population rose from 5,424,800 to 5,438,100, a rise of just 0.24 per cent. The more relevant comparison is the adult population but this, too, has only grown slightly, from 4,560,646 to 4,572,359 (0.26 per cent).

Notwithstanding the different time periods involved, the difference between the unit sales figures and the MESAS per capita figures remains unexplained. A set of monthly Nielsen figures covering 2017/18 and 2018/19 would clarify things, but I have yet to see this. (UPDATE: I've been reminded that the Nielsen figures do not include sales from Aldi and Lidl. MESAS estimates sales from these two shops, somehow. This could have an effect.)

In any case, it's worth looking at the trends in the MESAS report. If you only got your information from the BBC, you would think that sales plummeted in 2018 as a result of minimum pricing.

Scottish alcohol sales drop as minimum price kicks in

Scots bought less alcohol in 2018 than any year since records began in the early 1990s, according to a new report.

Hmm, sort of. Last year's MESAS report showed that alcohol consumption was 'at a level similar to that seen in 1994' in 2017, so this is hardly an historic moment. 

Leaving aside the fact that the figures don't actually show what happened after minimum pricing (let alone as a result of minimum pricing), the per capita estimates for 2018 don't show anything special.

Sales in the on-trade declined, as they have done for years (note the sharp decline in the years following the 2006 smoking ban) and sales in the off-trade dipped a bit. The off-trade decline was of the same magnitude of that seen between 2015 and 2016 and was less steep than that seen between 2011 and 2012. 

If you don't recall the BBC reporting those sales declines it's because they didn't, although they did report the rise between 2013 and 2014, perhaps because the Scottish government put out a press release saying that the figures 'reinforce [the] need for minimum unit pricing'. See how it works? 

When the 2016 figures were published, I said...

If a rise of 0.1 litres is enough to garner headlines, you'd think that a fall of 0.3 litres would be newsworthy, but you'd be wrong.

But that was then, this is now. Today, a fall of exactly 0.3 litres per head is suddenly highly newsworthy because it can be wrongly attributed to a policy that wasn't even in place for a large part of the year in question.

If minimum pricing hadn't been introduced last year, the drop in per capita consumption wouldn't have been reported at all, just as it wasn't when a drop of exactly the same size occurred in 2016. And with good reason: it is neither large nor unusual.

In conclusion, if you want to see what happened to alcohol sales after minimum pricing began, I humbly suggest you look at alcohol sales after minimum pricing began.

Tuesday, 18 June 2019

Prohibition doesn't prohibit - prison edition

The erstwhile legal high Spice was banned in the UK in 2016. At around the same time, a ban on smoking in English prisons began to be phased in. Scottish prisons followed suit in November 2018.

Action on Smoking and Health predicted that the smoking ban wouldn't lead to prison riots. It led to a lot of prison riots. Violence in prisons is now at an all-time high.

And now we discover that...

Prison staff are falling ill from spice drug fumes

More than a third of prison officers and nurses have felt ill as a result of inhaling second-hand smoke from the drug known as spice that is plaguing jails.

A survey of more than 1,600 members of prison staff found that 53 per cent had been exposed to psychoactive substances taken by prisoners; 39 per cent said that they had felt unwell from the effects of the drugs, with 97 per cent of those affected reporting symptoms including dizziness and confusion.

Great success! Is there any problem that prohibition can't exacerbate?

In May, a group of activist-academics in Scotland found that levels of tobacco smoke had fallen in Scotland, and said:

“This research confirms that exposure to second-hand smoke has been drastically reduced and, ultimately, this will have a positive impact on the health of prison staff and prisoners.”

Meanwhile, back in the real world:

Scotland’s jails are in the grip of a new drugs crisis with the number of prisoners needing medical attention rising five fold in the last three years.

More than 1,600 prisoners needed medical attention after using psychoactive substances – formerly known as legal highs – last year.

And the number of cases continues to increase – with 1,100 prisoners affected already this year.

Banning smoking in prisons has caused the problem to escalate, warders say, with inmates now using government-issued e-cigarette devices to inhale the drugs.

Perhaps the authorities will now ban e-cigarettes, thereby further increasing the risk of violence?

Prison officers say the situation across the country’s jails is already out of control.

One said: “We seen prisoners foaming at the mouth and rampaging around with their eyes bulging out of their heads.

“Others look as if they are zombies.

“They exhibit super-human strength and are just completely out of control – it’s like walking into a zombie apocalypse.

“They don’t feel pain. We’ve seen then inflicting terrible injuries on themselves and others.”

Spice and other drugs are substitutes for tobacco. Tobacco has a calming effect on people, but the simple and effective solution of repealing the ban, at least outdoors, will never be entertained because British lawmakers are in the grip of fanaticism.

And so the carnage will continue.

Monday, 17 June 2019

Critiques of the Lancet's 'no safe level' study

A study appeared in the Lancet last August which claimed to have virtually erased the J-Curve from alcohol epidemiology. The authors used an unconventional methodology, modelling aggregate data from whole countries rather than looking at risk to individuals, and came up with this:

According to their model, there is no reduction in mortality risk from moderate levels of alcohol consumption. It did not quite show that there is 'no safe level', despite the authors claiming that '[o]ur results show that the safest level of drinking is none', but it came close. It has since been cited by the Lancet and others as conclusive evidence that no amount of drinking is safe and that alcohol should be treated like cigarettes.

The methodology was too opaque to allow a full immediate critique, but David Spiegelhalter discussed it here and I wrote about it at the time. Among its flaws was the inclusion of tuberculosis as an alcohol-related disease (debatable in itself) which lifted the risks of drinking even in countries where TB is virtually nonexistent.

The Lancet has now published criticisms from three groups of scientists. You can read them here, here and here, along with the authors' reply here. The authors defend themselves by saying that their conclusion is broadly supported by two reviews by Tim Stockwell and another study published in The Lancet last year. In fact, the latter study found clear evidence of a J-Curve and Stockwell's one man crusade against the J-Curve is based on extreme cherry-picking and 'questionable statistical methods'. In the end, the authors say:

Debates concerning whether the safest level of consumption is zero or near zero are missing the point.

You see what they did there? That's what you call moving the Overton window. It's not actually a question of zero or near zero. It's a question of moderate consumption versus not so moderate consumption; 20-odd units a week versus 30-odd units a week. Either way, more than the UK government's evidence-free 'safe drinking' guideline of 14 units.

If you're interested in this issue, hit the links above.

Thursday, 13 June 2019

Last Orders for Jamie Oliver

I'm off to the Global Nicotine Forum until Saturday so I will leave you with the latest Last Orders podcast with me, Tom Slater and TV's Kate Andrews. It's a special Jamie Oliver schadenfreude edition. Look at our sad faces.

Tuesday, 11 June 2019

American idiots

I haven't written about vaping in the USA for a while because the debate over there is so incredibly stupid that it's senseless to try to intervene.

Take this, for example. Anti-smoking groups want to raise the age at which people can buy tobacco to 21 because, well, they like bans. The tobacco industry says that is in favour of this policy. That has discombobulated the tobakko kontrol movement because they put the infantile 'scream test' at the heart of their dogma (ie. "the louder tobacco companies scream, the more impact we know a measure will have"). By their logic, if the manufacturers of cigarettes support an anti-smoking policy, it can't work.

Bear in mind that the Americans ludicrously define e-cigarettes as tobacco products. The Tobacco 21 policy is really an attempt to crack down on vaping, not smoking - and on Juul in particular - so you see why some tobacco companies might look kindly on it.

Jeffrey Hardesty, research program manager at Johns Hopkins University’s Institute for Global Tobacco Control, says he’s skeptical of the tobacco industry’s sudden support for Tobacco 21, noting that it “does not make amends for decades of obituaries.”

Whatever. Policies should be judged by their merits. This one is illiberal, although given that the US government treats people under the age of 21 like children when it comes to alcohol, it is harder to argue against it than it would be in Britain.

But even still, he says the laws are a good idea at their core.

How many dark nights of the soul did he have before aligning himself with the evil tobacco barons, I wonder?

Hardesty agrees that Big Tobacco’s involvement “has the markings of corporate social responsibility.” Nonetheless, he says grouping vapes and traditional cigarettes under the same regulatory umbrella is a smart strategy for improving public health.

No, it's an exceptionally dumb strategy because they are substitute products, one of which is vastly safer than the other. Any regulation designed to deter use of the safest form of a product will have a similar effect to regulation designed to encourage the use of the most dangerous form of the product.

“If you’re only applying legislation to e-cigarettes…you could drive people back to a potentially more harmful product,” Hardesty says. 

Only applying them to e-cigarettes would be lunacy, even by American standards, but I don't think anyone is suggesting that. What is being suggested is that paternalistic regulation be commensurate with the relative risks.

It doesn't take much brain power to invert Hardesty's argument and conclude that if you only apply the regulation to tobacco cigarettes, you could drive smokers towards the least harmful product. This is Harm Reduction 101.