Friday, 22 October 2021

What most people think

I really enjoyed talking to the comedian Geoff Norcott on Wednesday about Covid centrism, First Defence, cigarettes and more. Have a listen to the podcast here.



Thursday, 21 October 2021

Child obesity experiment fails spectacularly



The 'public health' lobby is keen on the 'whole systems approach' to obesity. This is not to be confused with the equally useless 'whole population approach'. The latter involves using blunt policy tools to get everybody to reduce their consumption of salt, alcohol, sugar or whatever whereas the whole systems approach has never been properly defined but involves the whole of society working to reduce obesity in some way.


The strategy of throwing any old policy into the mix in the hope that some of them will work is known euphemistically in 'public health' as the 'whole systems approach'. It is often illustrated with meaningless graphics and is anti-scientific, illiberal nonsense. Essentially, it gives activists a licence to do whatever they want regardless of the consequences.

At best, this scatter-gun approach can involve various teachers, social workers, charities and 'public health' professionals working face-to-face with people to help them have a healthy diet and control their weight. The one and only success story is Amsterdam where child obesity supposedly fell (a bit) after a whole systems approach was introduced. In practice, it's all too expensive and time-consuming for most governments and 'public health' groups to get behind, but it putatively shows that the government can do something about obesity.

The whole systems approach has now been tested in a four year randomised control trial in Australia called WHO STOPS Childhood Obesity (Whole of Systems Trial of Prevention Strategies for Childhood Obesity. Roughly 3,000 kids were treated to a wide range of 'community-based interventions'...

Some key examples of actions were (1) a rural health service changing its beverage provision and cafe to be “green only,” in line with government healthy choices guidelines; (2) a local government area constructing a new footpath to allow schoolchildren to engage in active transport more easily to and from school; (3) implementing a junior sporting-association-wide water-only policy; (4) a local primary school constructing signs encouraging children to be dropped off at set points away from the school gate to allow them to walk to school; and (5) implementing a healthy beverage policy at family day care.

So how did it go? At first, quite well.

There was a significant interaction effect between trial group and time (P = 0.006) (Table 2). Within intervention communities, the prevalence of combined overweight and obesity was 35.5% in 2015, 31.5% in 2017...

But then things started to go not so well.

...and 40.4% in 2019.

Awks.

Prevalence within the control group remained stable at 34.3% in 2015 and 34.7% in 2019.

The control group started out with a slightly lower rate of overweight/obesity (34.3% vs. 35.5%) and ended the trial with a substantially lower rate (34.7% vs. 40.4%). Needless say, this was not what the researchers were hoping for, but they are keen to stress that the experiment was not a complete waste of time because...

Intake of takeaway food significantly improved in the intervention communities by 2019 relative to 2015 compared with control...

And...

There was a significant intervention effect on water consumption (interaction, P = 0.019) with an increased percentage of girls consuming more than five glasses of water per day in intervention communities between 2015 and 2017 (18.1% increase) and 2015 to 2019 (11.8% increase) compared with control communities.

The authors do not take this to its logical conclusion and deduce that cutting down on takeaways and increasing water consumption does not lead to weight loss. Instead, they conclude that:

WHO STOPS reduced obesity prevalence over 2 years and over 4 years helped a majority of children keep their takeaway intake low... 
Childhood obesity is demonstrably preventable, and community-based interventions are effective, feasible, and acceptable to government, industry, and the public.

This is obviously not what the study shows, but in 'public health' you can say whatever you want. A more accurate conclusion would be to say that if childhood obesity rates go up despite the whole community working intensely with kids for several years, the chances of broad brush policies like advertising bans having an effect are nil.

Have I mentioned before that 'public health' is not a results-driven business?


Tuesday, 19 October 2021

The public health lobby wants to introduce a ‘meat tax’. Don’t bet against it

Marco Springmann is in the pages of the Guardian again calling for a meat tax so here's what I wrote about him and his ideas the first time around.


First published by Spectator Health in November 2018

Once you accept that the modern ‘public health’ movement is just the latest incarnation of the puritanism that waxes and wanes throughout history, it is easy to predict its next target. If you further assume – and who can now deny it? – that nanny state campaigners follow a blueprint laid down by the anti-smoking lobby, it becomes easy to guess not only their future targets but also their methods.

And so, when I suggested in an interview a few years ago that the next vices to fall under the cross-hairs of ‘public health’ would be caffeine, gambling and red meat, it was not because I had psychic powers, nor because there were rumblings in the medical journals about these issues (there wasn’t). It was because they have been for centuries the classic targets of scolds and ascetics once they tire of fighting the demon drink and tobacco.

Coffee is too popular with the upper-middle classes to be done away with yet, but this year saw the start of a minor crusade against energy drinks. The imminent downfall of fixed-odds betting terminals represents the first real scalp for the anti-gamblers in decades, with gambling advertising lined up as the next dragon to slay.

Meat has had an easier ride. Until now. A study published today in PLoS One looks very much like the start of a concerted effort to clamp down on processed and red meat. The crusade is beginning, as such crusades usually do, with a push for a sin tax.

Like most of the influential policy-based evidence in ‘public health’ of recent years, the study rests on opaque computer modelling. It produces estimates of how many people are dying from the over-consumption of meat, how much this costs society and what size of tax is needed to balance out the costs. It then estimates how many lives will be extended by processed meat consumption falling in an era of higher prices.

The published paper does not provide enough information for the model to be meaningfully assessed by the reader, but one thing is clear: the numbers are unfeasibly large. The authors reckon that the global death toll from processed and red meat is 2,390,000 people a year. The link between processed meat and bowel cancer is reasonably robust by the debased standards of nutritional epidemiology and there may be an association between meat-eating and coronary heart disease and stroke. Even so, a figure of 2.4 million defies belief. The authors admit that the Lancet’s Global Burden of Disease reports estimated the true figure to be 900,000 in 2010 and 700,000 in 2013. That is enough of a discrepancy, but they do not mention the most recent edition of the report which put the figure at just 140,000. The estimate published today is therefore seventeen times larger than an estimate of the same risk factor published barely a year ago. How can anyone have confidence in this field of academia?

Their estimates for the UK are equally outlandish. They claim that processed and red meat causes 70,000 deaths a year in Britain. That’s one in nine! 70,000 deaths is far more than is said to be caused by obesity and ten times more than is caused by alcohol. If today’s estimate is correct – and let’s face it, it’s not – only smoking can rival it.

If you can swallow the idea that 2.4 million people are struck down by bacon butties and surf-and-turf every year, you might be inclined to believe the authors’ estimate that processed and red meat incurs a cost of $285 billion to the world’s healthcare systems each year. Taking this figure and adding in some unspecified assumptions about the cost to the environment of cattle emitting greenhouse gases, they decide that the price of processed meat should rise in rich countries by an average of 111 per cent to offset its negative effects.

Calculations of this sort are not unusual in economics. The standard way of dealing with negative externalities is to implement a Pigovian tax, thereby passing the external costs of consumption back to the user. To do that, you must first work out what the net external costs are. This is where people in ‘public health’ invariably go wrong, counting internal costs (such as lost productivity) as external costs and failing to subtract savings. People who live to a ripe old age tend to cost a lot of money, but a classic mistake in ‘public health’ studies of this kind is assuming that someone who avoids a diet-related disease will avoid every other disease and never trouble the health service again.

Today’s study is not detailed enough for us to tell whether the authors have made all of these mistakes but the sheer size of their estimates suggest they have. They reckon that the UK alone needs to tax meat-eaters to the tune of £2.9 billion a year. This, they say, will reduce consumption of processed meat by ten grams a day and save 6,100 lives. That is nearly half a million pounds for every hypothetical life.

Leaving aside the garbage-in, garbage-out methodology at the root of these numbers, it seems unlikely that a British government – even one that bans plastic straws and taxes fizzy drinks – will introduce a 78 per cent tax on processed meat any time soon, although that is what the authors recommend. It is even less likely that everybody in the world will go vegan, although that is what the lead author, Marco Springmann, told delegates needed to happen at the End of Meat conference last year.

And yet every nanny state policy sounds absurd until the public have been battered with soundbites, dodgy statistics and empty promises for a few years. Nobody who has witnessed the unstoppable rise of the ‘public health’ movement over the last two decades can dismiss the possibility of a meat tax being introduced in the foreseeable future, probably followed by an advertising ban and graphic warnings.

The odds shorten when you consider that it is not just the ‘public health’ lobby that wants it. There is now an unholy alliance between health campaigners, vegans, vegetarians and environmentalists on this issue. This is the next battleground of lifestyle regulation and only a fool would bet against the people who always win.


Monday, 18 October 2021

Minimum pricing isn't working

Promises, promises

More evidence from the minimum pricing evaluation has been published and it seems that the policy has failed to achieve one of its main aims. The infamous Sheffield model predicted that a 50p minimum price would lead to 3,500 fewer crimes in the first year. 

Charlie Peters has the details...

Supporters of Scotland’s regressive alcohol legislation took a hit this week when it was revealed that minimum unit pricing had only had a ‘minimal effect’ on drink-related crime.

A Manchester Metropolitan University study looked at Police Scotland data collected since 2015. It found that there were no statistically significant changes in alcohol-related crime, disorder and public-nuisance offences after 2018, when a minimum price of 50p per unit was introduced.

Saying it had a 'minimal effect' is flattering to the policy. There was no measurable impact at all.

"On the whole, the limited discernible impact of MUP on alcohol-related crime, disorder and public nuisance suggests that the reduction in off-trade alcohol sales that followed implementation is below that required to deliver a reduction in crime," Prof Bannister added.
"Or, if crime did reduce, it has done so at a scale that the evaluation could not identify".

You may recall that the same modellers predicted that lowering the drink drive limit would reduce road traffic fatalities by 6 per cent. It did nothing of the sort.

The rest of the real world evidence on minimum pricing is far from compelling. There was a fall in alcohol consumption after the policy was implemented, but it was not accompanied by any decline in alcohol-related A & E admissions, nor in alcohol-related hospital admissions. The number of alcohol-related deaths fell in 2019, but rose sharply in 2020 (as they did in England - at about the same rate). The policy has cost Scottish drinkers tens of millions of pounds.

Naturally, the state-funded pressure group Alcohol Focus Scotland is not taking this lying down. They ar demanding the floor price be raised to 65p.


Friday, 15 October 2021

Denominators

In my City AM column today, I start with Richard Doll's research into smoking before discussing vaccine efficacy and our current obsession with the number of Covid deaths. The common denominator is denominators.

In the late 1940s, Austin Bradford Hill and Richard Doll began interviewing hundreds of hospital patients, half of whom had lung cancer while the other half had various other diseases. Their research, published in 1950, showed that 99.7 per cent of the male lung cancer patients had a history of smoking. Out of 649 patients, only two were nonsmokers. In retrospect, it seems amazing that no one had spotted the link between smoking and lung cancer before, but it is less surprising when you consider that 94.8 per cent of the men who were not in hospital with lung cancer also had a history of smoking. 

This might not seem like such a big difference. The vast majority of the men in hospital had smoked tobacco, regardless of what they were being treated for. And yet a statistician can tell from the figures above that smokers were fourteen times more likely to get lung cancer than nonsmokers.





Thursday, 14 October 2021

A swift half with Tim Stanley

My guest in the latest episode of The Swift Half is the author and columnist Tim Stanley. He has a new book out about tradition and we discussed the principles of conservatism.




Thursday, 7 October 2021

Alcohol-related deaths fall by 23% (sort of)

The Office for Health Promotion has got off to a flying start by announcing a 23% fall in alcohol-related deaths in England. This was achieved by changing the methodology behind the estimate and it was a piece of work carried out by Public Health England, but I'll take it. 

During the pandemic, there has been a lot of confusion about how many people have died 'with Covid' as opposed to 'of Covid', despite us having the death certificates showing how many died with Covid as the underlying cause (which is about 90% of all Covid-related deaths). 

I wonder how many of the people arguing the toss about this realise how shaky the figures are for obesity, smoking and alcohol-related mortality. For these diseases, academics tend to the use the system of attributable fractions. Put simply, they work out how many people are exposed to a risk factor (eg. alcohol) and then work backwards from epidemiological studies which show the increase in risk to estimate what proportion of deaths are caused by the risk factor.

Death certificates are not involved when it comes to establishing causation. The academics just look at the number of deaths from, for example, heart disease and state that x% were caused by smoking, alcohol, obesity etc. 

And so we decide that 50% of drownings are due to alcohol, for example, and then see how many drownings take place each year. It's a rough and ready estimate that has the virtue of being cheap, but it is prone to all kinds of flaws and uncertainties. Observational epidemiology is not an exact science and it is very difficult to establish the baseline risk (ie. the risk to someone who has no obvious risk factors).

Every few years, the academics update their assumptions. That is what has just been done. They also update their estimates of exposure. Previously, PHE was using alcohol consumption data from 2005 when the good people of England were drinking more than they do today. 

The result is a substantial reduction in the apparent harm done by excessive drinking. The number of alcohol-related hospitalisations has fallen below one million for the first time in years (a figure that has been inflated by the inclusion of more secondary diagnoses) and alcohol-related mortality is 23% lower than previously estimated.


I emphasise excessive drinking because the authors acknowledge that there is little to be gained by getting the average drinker to reduce his consumption.

As alcohol can be so damaging to health, wellbeing and society, it’s obviously a positive thing that England’s overall consumption of alcohol has fallen. However, before we become complacent, we should consider in more detail the alcohol consumption patterns across the population. If we look beneath the population-level trend, we can see data on consumption to suggest that many of the people who have chosen to drink less (or not at all) are those who were not at greatest risk of harm. It appears that many heavier drinkers, who are at most risk, have not reduced their alcohol consumption and may even have increased it.

This is another blow to the single distribution theory of drinking and the whole population approach to alcohol.

The new estimates cover 2019 but do not yet extend to 2020 when we saw a big rise in alcohol-specific deaths despite a significant fall in consumption. This, too, shows that the whole population approach is misguided.