Wednesday, 8 February 2023

Worst science journalism of the week

From the Daily Mail...
EXCLUSIVE: Using snus or dipping tobacco may raise the risk of Type 2 diabetes by 30 PERCENT, study suggests

Using snus tobacco products may raise the risk of type 2 diabetes by up to 30 percent, a study has suggested.

... In the latest study, researchers in Sweden — where snus was invented and the product is popular — monitored nearly 37,000 people in the country for eight years.

This included 2,000 snus users who had never smoked a cigarette.

They found that these individuals were 29 percent more likely to develop type 2 diabetes compared to people who did not smoke cigarettes or take snus.

What the study actually says... 
In this study, no association between snus use and risk of T2D [Type 2 diabetes] in the entire study population, in the analysis adjusted for age, sex, and smoking or in a model adjusted for other confounders, was observed, which is in line with the results from several cross-sectional and case-control studies.
From the Daily Mail...

Dr Olga Titova, an epidemiologist at Uppsala University who led the research, suggested snus raised the risk of diabetes because it contained nicotine.

What the study actually says...
This study suggests that current and former smoking are associated with an increased risk of developing T2D in middle-aged and older participants. There was less evidence of an association of Swedish snus use with the risk of T2D, suggesting that compounds other than nicotine may have a larger adverse effect on the development of T2D.
I can handle sensationalist media coverage of epidemiological studies, but reporting the opposite of what a study found is a bit much, isn't it?

Tuesday, 7 February 2023

Does smoking cost Britain £173?!?

If you say that a certain activity costs society £10 billion a year, most people would assume that if that activity disappears, society will save £10 billion a year.

They might have different ideas of what ‘society’ means. Some will assume that the £10 billion is a cost to taxpayers while others will assume that some of the cost is borne by private individuals and businesses. But the majority will, quite reasonably, assume that the cost is to other people, i.e. those who do not participate in the activity.

And nearly everyone will assume that the £10 billion is money in the conventional sense of cash that can be exchanged for goods and services.

But when it comes to estimates from ‘public health’ campaigners about the cost of drinking/smoking/obesity, all these assumptions would be wrong. Most of the ‘costs’ are to the people engaged in the activity and they are not financial costs. Taxpayers would not pay less tax if they disappeared. In general, they would pay more.

Last month I mentioned an estimate of the ‘cost’ of gambling in the UK and said:

These studies have no merit as economic research. They are purely driven by advocacy. The hope is that the average person will wrongly assume that the costs are to taxpayers and agitate for change.

The main aim of these Big Numbers is to convince the public that heavily-taxed activities place a burden on society that exceeds the tax revenue, thereby justifying yet more taxes and prohibitions.

In the case of smoking, this has become more and more difficult. Smoking has been a net gain for the Treasury ever since King James I started taxing it heavily in the 1600s. Today, as the smoking rate dwindles and tobacco duty rises ever higher, anti-smoking campaigners have got their work cut out duping non-smokers into thinking otherwise.

Tobacco duty brings in about £12 billion a year. For years, groups like Action on Smoking and Health (ASH) used a figure of £13.74 billion as the ‘cost of smoking’. This came from a flimsy Policy Exchange report which included £5.4 billion as the cost of smoking breaks and £4.8 billion as the cost of lost productivity due to premature mortality. Neither of these are costs to the taxpayer. They are not even external costs, i.e. costs to non-smokers.

Last year, in a review commissioned by the Department of Health, Javed Khan came up with a figure of ‘around £17 billion’ as the ‘societal cost’ of smoking. This included ‘reduced employment levels’ (£5.69 billion) and ‘reduced wages for smokers’ (£6.04 billion). Again, these costs fall on smokers themselves and are not external costs. They are, in other words, none of the government’s business.

Last week, a report commissioned by Action on Smoking and Health (ASH) pulled out all the stops and announced that the cost of smoking to Britain was now - wait for it! - £173 billion. Go big or go home, eh?

This is so far adrift from earlier estimates that even the casual observer might start to smell a rat. The report was written by Howard Reed of Landman Economics who used to do work for the people who campaigned against fixed odds betting terminals. He has previously produced a report for ASH claiming that smoking leads to unemployment and low wages, based on the simple observation that smokers are more likely to be unemployed and earn low wages. It is well known that smoking is far more common in lower socio-economic groups, but it is an absurd leap of faith to assume that smoking is the cause of unemployment and low wages.

Reed nevertheless assumed causality and, in his new report, reckons that smoking-related unemployment and low wages cost society (i.e. smokers) £15 billion a year.

But that is nothing compared to the £123.7 billion he attributes to the ‘cost of early deaths due to smoking’. He doesn’t show his workings for this calculation - or any other - but it is a combination of all the hours that could have been worked if smokers didn’t die prematurely plus the intangible costs of their lost years of life.

The savvy reader will have noticed that all these ‘costs’ fall under the category of None Of The Government’s Damn Business. If I die at the age of 75 rather than 80, I will lose the intangible benefits of five years of life, but that is my problem. Similarly, if I retire five years early and lose five year’s income, that’s up to me.

The absurdity of portraying lost years of life as a societal cost - let alone as a financial cost - can be illustrated by the example of contraception. The contraceptive pill has prevented billions of years of life, but it is very difficult to argue that it has cost society trillions of pounds. A society doesn’t become richer just because more people live in it; that’s why we use per capita GDP as the measure of national output, not overall GDP.

Certainly there are intangible costs to dying prematurely, but these costs fall on the individual. Moreover, there are intangible benefits to smoking which reports like this never acknowledge. Since both the intangible costs and the intangible benefits fall squarely on the smoker, it is for the smoker to decide whether the costs outweigh the benefits. It is no one else’s business.

The ‘societal cost’ figure of £173 billion is designed to make it look as if it is everybody’s business, but it is so obviously suspect that ASH haven’t been using it in their PR. Instead, they have focused on a claim from the same report that smoking imposes a net cost on taxpayers of £9.5 billion.


This estimate doesn’t include the bogus lost output or the intangible costs. It is more relevant to policy and it takes into account the taxes smokers pay on their tobacco. But is it plausible?

The figure breaks down as follows…

Reed says that tobacco duty (plus VAT on the duty) rakes in £11.05 billion (it is actually more than £12 billion but never mind). The challenge is for him to find costs to the taxpayer that exceed this.

First, he conjures up £8.4 billion in welfare benefits handed out to smokers to compensate them for their higher levels of unemployment and lower rates of pay. This hinges on the conceit that smokers are paid less and are more likely to be unemployed because they smoke. Whilst it is possible to imagine a scenario in which this could be a factor for an individual (largely thanks to ‘public health’ groups demonising smoking), it is very unlikely to be a general rule. A toilet cleaner is not going to be paid more just because she quits smoking and someone on the dole is not going to get a job just because he quits smoking.

Secondly, Reed reckons that the government would make an extra £8.2 billion if all the money spent on tobacco was spent on something else. It is true that this money would not disappear. It would be spent on other goods and services and some of those goods and services would be taxed, albeit at a much lower rate than tobacco is.

There would also be a multiplier effect of some kind which Reed assumes would create more jobs than expenditure on tobacco does. He says that “employment in the tobacco industry in the UK is close to zero”, although a footnote says that 5,000 people work in the industry. He then claims that tobacco retail and distribution “supports relatively few jobs in the supply chain”, which will be news to people who work in convenience stores.

Based on previous work he did for ASH, Reed estimates that if smokers stopped smoking and spent the money on all the things nonsmokers spend their money on, it would create more jobs and the government would make/save an extra £8.2 billion in taxes/benefits. He doesn’t show his workings so it is difficult to say how credible the estimate is, but there are two things to bear in mind.

Firstly, the revealed preferences of smokers shows that they would rather spend part of their income on tobacco than on anything else.

Secondly, jobs are a cost not a benefit.

Societies get richer by having the same things made by fewer people. What is being proposed here is having other things made by more people. Whatever those other things are, they are of less value to smokers than tobacco.

Thirdly, there is £2.2 billion in healthcare costs and £1.3 billion in social care costs. Fair enough, but what would these costs be if no one smoked? That is the relevant question and there is lots of evidence built up over decades that the costs would be higher because there would be more (mostly old) people requiring healthcare. Reed is aware of this but explicitly ignores it, more or less admitting that it would spoil his party if he took it into account.

Sometimes it is argued that in cost benefit analyses of policies which result in a reduction in the number of premature deaths in the population (such as tobacco tax increases or tougher tobacco regulations), the additional end-of-life healthcare costs incurred by the people who live longer should be taken into account. In the 2010 version of this model we argued that, even if this were the case, it would be a mistake to include these costs in the cost-benefit analysis (CBA) because there is a fundamental methodological flaw in this approach.

Taken to its logical conclusion, the inclusion of end-of-life healthcare costs in CBAs of this type would lead to the perverse conclusion that policies which result in larger numbers of premature deaths in the population have a positive benefit to society because they reduce healthcare expenditure on elderly people.

Yes it would! Because that’s what would happen!

The whole point of this calculation is to estimate the impact of smoking on the public finances, but as soon as it becomes clear that the government would save money from the healthcare budget, Reed has to turn a blind eye because it would lead to a ‘perverse conclusion’, i.e. a conclusion that would not suit the agenda of the people who commissioned it.

Reed is not even consistent in this. Elsewhere, he estimates that smoking saves the government £260 million a year in reduced pension costs due to premature mortality. Why include these savings but not the health and social care savings? Both are equally macabre insofar as they rely on people dropping dead.

(£260 million is a massive underestimate, by the way. The government spends £110 billion a year on state pensions. It is ridiculous to pretend that it would only spend an extra 0.2% on them if no one had ever smoked. When Mark Tovey and I conducted our own study in 2017 we found that the government would be spending an extra £9.6 billion on pensions if no one smoked.)

But whilst he won’t include healthcare expenditure foregone as a result of premature mortality, Reed does include £476 million in tax revenue foregone as a result of premature mortality. In other words, he thinks it is fair to include the taxes a smoker would have paid if they had lived longer, but it is not reasonable to include the healthcare they would have used - healthcare that would have been paid for, at least in part, by those very taxes.

This is economically illiterate nonsense that doesn’t stack up even on its own terms. Perhaps that is unsurprising when you consider that an anti-smoking pressure group not only commissioned it but helped to set its parameters.

The Model was commissioned by, and developed in collaboration with, ASH.

But it doesn’t really matter how the figure is arrived at because almost no one will read the report. All that matters is that ASH have a Big Number to cite when it’s lobbying for the government to pick of the pockets of smokers.

Which is, of course, what they immediately started doing…

Cross-posted from the Snowdon Substack

A swift half with Marc Sidwell

A new episode of The Swift Half dropped last week. I spoke to author and commentator Marc Sidwell whose book, The Long March, I belatedly read recently. We discuss the changing nature of leftism and the increasing power held by a small bureaucratic class. Check it out.

Thursday, 2 February 2023

Public health comic investigates the Beano

There's a laughable investigation into the Beano's website, of all things, in the British Medical Journal today. The Beano has responded, saying that the authors had chosen “to cite selective examples out of context”.

If you're familiar with the world of 'public health' academia, this will be enough of a clue for you to guess that Mark Petticrew is one of the authors, and you would be right.

I've written about  it for the Spectator

One of the regular characters in Viz is an old woman called Meddlesome Ratbag who goes to great lengths to engineer situations in which she can be offended so she can complain to the authorities. I was reminded of her this morning when I read the British Medical Journal‘s investigation into the Beano. Yes, you did read that correctly. One of the world’s leading medical journals has been devoting its attention to a children’s comic.

It turns out the Beano has a popular website that has been visited by nearly 48 million kids since its launch in 2016, according to the investigators. It stands accused of mentioning the brand names of various sweets, treats and fast food companies. These products are not advertised on the website and no money has changed hands. The owners of the comic have clarified that on occasions when they work with companies, this is ‘always clearly marked’ on their website and ‘would never include’ brands deemed by the government to be ‘high in fat, sugar or salt’ (HFSS).

The Beano is nevertheless accused on ‘exposing children to HFSS content’ by acknowledging the existence of the likes of Skittles and Greggs. In an overwrought editorial accompanying the investigation, the BMJ says:

Todays innocent fun” is tomorrows health crisis.

Read the rest here.

Prohibition failing everywhere

After the fall of the Islamic State, Bhutan was left as the only country in the world where tobacco sales were banned. Prohibition did not go well (who could have predicted that?)

The Bhutanese government legalised tobacco in July 2021 as a response to the COVID-19 pandemic. This was not because the government recognised the potential of smoking to reduce infections, but because so many tobacco smugglers were coming over the border carrying the virus.

The Tobacco Control blog has finally accepted that Bhutan has no plan to bring prohibition back. This makes it sad.

Bhutan reverses sales ban on tobacco

In 2010, Bhutan was lauded globally for being the first country to ban tobacco sales and smoking in public places. The ban lasted for over a decade until the circumstances posed by the COVID-19 pandemic compelled policy makers to change course, legalising the sale of tobacco within the country.

The Bhutanese legislation essentially banned everything except bringing a bit of tobacco in from abroad for personal consumption.

Building on the nationwide sales ban in 2004, the Tobacco Control Act, 2010 imposed a comprehensive ban on all tobacco products in Bhutan. The law prohibited cultivation, manufacture, supply and sale of tobacco products; imposed bans on advertisements, promotion and sponsorship of tobacco products along with restrictions in films; declared smoke-free public places or zones; and also prescribed a labelling requirement for display of country of origin and health warnings on tobacco products. Tobacco consumption, however, was not banned. Import of tobacco products for personal consumption was permitted, but taxed. The law also levied a sales tax of 100% for imported tobacco products from India and an additional custom duty of 100% for tobacco products from other countries. The Tobacco Control Regulations, 2013 and the Tobacco Control (Amendment) Act, 2014 imposed limitations on the quantities that could be purchased for personal consumption and required declarations of importer’s identity. The law also prohibited the illegal sale of tobacco and the use tobacco products in public places, punishable under the Penal Code Act of Bhutan, 2004

Despite the existence of a robust legal and regulatory framework for tobacco control, smuggling and a black market for tobacco was rampant in Bhutan.

Incredible use of the word 'despite' there. Here in the real world, we would say 'because of'.

Tobacco use in Bhutan has not decreased significantly, with a tobacco use prevalence of 24.8% and 23.9% as per the STEPS 2014 and 2019 respectively.
'Not decreased significantly' is one way of putting it. Another way of putting it would be 'increased exponentially'. In 2003, Bhutan had a smoking rate of just one per cent!
So that's tobacco prohibition gone for now. Over to you, New Zealand!
These politicians banned alcohol – now poisonous hooch is killing thousands

The world’s largest prohibition experiment since the 1920s pushed liquor production underground. The consequences have been disastrous.

 You don't say.

Wednesday, 1 February 2023

Learning lessons from Scotland?

Zero Covid enthusiast Devi Sridhar is in the Guardian today telling the English to learn some lessons from the Scots if they want to reduce alcohol-related mortality. Scotland has a far the highest rate of alcohol-specific death, so I'm not sure anybody is knocking on Nicola Sturgeon's door begging for advice, but let's roll with it.

Over the past 15 years, its devolved government has attempted to reduce alcohol-related harm through a ban on multi-buy price promotions on alcohol, minimum unit pricing, reducing the drink-driving limit and restricting alcohol marketing on TV. And partly due to these efforts, alcohol harm fell in Scotland between 2003 and 2012, before plateauing. The emphasis in Scotland continues to be on high-risk groups.


She is right to say there was a fall in alcohol harm, as measured by alcohol-related deaths, between 2003 and 2012, although the rate is still far higher than in England. 


So which policies does she think achieved this? As you can see, she names four.

1. Ban on multi-buy discounts. 

Introduced in October 2011. When it was evaluated in 2014 it was found to have had no effect on alcohol consumption.

2. Minimum pricing. 

Introduced in May 2018, long after the decline in mortality. Regular readers will be aware that this policy died on its arse. All the evidence to date suggests it reduced alcohol consumption slightly but not among heavy drinkers who are consuming more. There is no evidence of health benefits and some suggestion of harm.

3. Reducing the drink drive limit. Introduced in 2014, after the fall in alcohol-related deaths. It has been evaluated twice. Both studies concluded that it had no effect.

Firstly, this study in 2018 found that lowering the limit "was not associated with a reduction in RTAs [road traffic accidents]" but it did damage the pub trade.

Secondly, this study in 2021 found that lowering the limit "had no effect on drink driving and road collisions".

4. Restricting alcohol marketing on TV. 

This hasn't happened and the Scottish government doesn't have the power to make it happen. It is a figment of her imagination.

So, we have four policy changes, one of which is imaginary. The three that are real didn't work and two of them took place after the period in question. Top work from a public health PhD!

Devi doesn't ask why heavy drinking went up so much in 2020 and 2021 despite overall drinking going down, but if she gave it some thought she might find some useful lessons for how to reduce alcohol-related deaths in the future. 

Tuesday, 31 January 2023

Scots buying more alcohol from England

Further to this morning's post about minimum pricing, Public Health Scotland put out another report today. Based on survey data, it found that the proportion of Scots who have bought alcohol in England to bring back to Scotland rose from 13% in 2021 to 19% in 2022.

The report downplays this somewhat...

In 2022, a majority of 81% of 1,014 respondents did not report ever purchasing alcohol from across the border with England in person. Only 5% (54 respondents) reported travelling for the sole purpose of buying alcohol to bring back to Scotland. A larger proportion of 19% (191 respondents) reported bringing alcohol back to Scotland that they had purchased on a visit for another purpose because it is cheaper there than in Scotland.

"Only" 5%?! If the survey is representative, that's well over 200,000 people going over the English border purely to buy booze to bring back to Scotland. Considering how far most Scots live from the border, that's an incredible statistic. Off licence owners in the north of England should drink a toast to Nicola Sturgeon.

A further 14% are taking the opportunity of travelling to England to bring back some relatively cheap alcohol. It shows how much minim pricing is hitting drinkers in the pocket.

I'd love to see the same stats for Wales, where England is a stone's throw away for large numbers of people. If the Public Health Scotland report is any guide, a lot of them will have been heading over the Severn Bridge to get to an English Asda. 

Among the minority of 10% of panel members in Scotland who reported living within 60 minutes’ travel from the border with England (n=102) it was more common to report buying alcohol across the border, with 22% having travelled for the sole purpose of buying alcohol and 27% having bought alcohol while travelling for another purpose.

The Scottish government's claim that minimum pricing has worked rests solely on alcohol sales dropping slightly in Scotland while they rose slightly in England. I wonder how much of that is due to cross-border shopping?