Sunday, 23 September 2018

The martyrdom of Aseem Malhotra

Aseem Malhotra's bid to become famous and sell his diet book protect the health of the nation has provided this blog with some hilarious content over the years, but he hits new heights of comedic gold in the Sunday Times today.

The low carb/LCHF movement to which Malhotra belongs is ultra-conspiratorial. Being essentially a cult based on magical thinking, it blames other people's failure to share their beliefs on a vast and growing network of corrupt scientists and government agencies. You might wonder what motivates so many scientists, dietitians and bureaucrats to hide the truth about killer carbs, thereby condemning millions of people to 'diabesity', but the answer is obvious: they're all in the pay of Big Food/Big Soda/Big Grain/Big Ag! Wake up sheeple.

Malhotra denounced the British Dietetic Association as Big Food puppets after they dissed his diet book. He has since added the British Heart Foundation and the American Heart Association to his list.

Now it's Public Health England's turn. In a barking mad op-ed for the Sunday Times, he claims that the quango is trying to silence him. 

For decades, powerful food companies have profited from promoting misleading health information and aggressively marketing junk food to children and the most vulnerable members of society. Public Health England is charged with help to protect and improve the nation’s health. My experience is that its officials undermine public debate and behave more like a front group for the processed food industry rather than an independent and trustworthy body that welcomes public debate.

Really?! To put it mildly, that is not my experience.

In an effort to combat the epidemic of health misinformation I co-wrote a book, The Pioppi Diet, which brings together the evidence on what individuals and policy-makers can do to rapidly improve health and reverse the twin epidemics of obesity and type 2 diabetes. I was pleasantly surprised when the deputy leader of the Labour Party, Tom Watson, contacted me a few months ago to let me know he had “relatively easily” lost 94lb and improved his health by specifically following the diet.

Good for him. By his own account, Watson 'basically stopped taking sugar, refined sugar, and then I started walking 10,000 steps a day and walking up staircases and when a bit more weight came off I started to jog and cycle.' You don't need to spend £8.99 on Malhotra's ludicrous book to know that a regime like that is going to lead to weight loss.

The most important message in the book — which recommends a Mediterranean-style diet low in refined carbohydrate — is how lifestyle changes are more powerful than any drug in preventing and treating heart disease; these also come without side effects.

A diet low in refined carbohydrate is not a Mediterranean diet and Malhotra's 'Pioppi diet' is not the diet of people who live in Pioppi. Malhotra's diet takes bits of the Mediterranean diet, removes the bread and pasta and adds in lashings of saturated fat and an assortment of his own bizarre LCHF recipes, such as boiled and eggs and soldiers with the soldiers replaced with bits of asparagus wrapped in bacon.

For inexplicable reasons, according to one prominent healthcare leader (who has asked not to be identified), Public Health England tried to “sabotage” the launch and press coverage of the book last year. I was told by one eminent doctor that he had been contacted by a senior official from the body and warned from attending the launch in London, to be held at the headquarters of Penguin Random House. To his credit, he did attend.

Another health leader, who heads a national charity, did not attend, and said he had been “poisoned” against the book. Andy Burnham, the mayor of Manchester and a former health secretary, endorsed the book and attended a launch in Manchester. His office also received a call from Public Health England, warning him against showing public support of the diet.

Assuming Malhotra isn't making this up to get attention (who knows?), it wouldn't be wholly surprising if one of PHE's many employees suggested to 'health leaders' that it might not be in their interests to be associated with a man whom even Action on Sugar regards as being 'completely mad' and who has a track record of embarrassing journals with his error-strewn articles. Public Health England has criticised Malhotra's version of the Atkins Diet in public. It stands to reason that they would also criticise it in private.

I was shocked by these attempts to try and undermine a healthy eating plan, to stifle debate and to damage my credibility.



Public Health England’s own recommendations for healthy eating — which are promoted by the Eatwell Plate, a diet guide backed by the Department of Health, which includes chocolate, crisps and cakes to eat “less often” — was drawn up in consultation with the food industry.

Firstly, the Eatwell Plate was replaced by the Eatwell Guide in 2016. You'd think a self-proclaimed expert would know that.

Secondly, I know of no evidence that the Eatwell Guide was drawn up 'in consultation with the food industry'. This claim seems to be based on a wafer-thin article by Malhotra's friend and fellow low carb zealot Zoe Harcombe. Harcombe claims that the Eatwell Guide 'was formulated by a group appointed by Public Health England, consisting primarily of members of the food and drink industry rather than independent experts.' She provides no evidence for this assertion. Public Health England says it commissioned experts from Oxford University to develop the Eatwell Guide. Indeed it did. Their work can be seen here. None of them report any relevant conflicts of interest.

Thirdly, you'd have to be on drugs to think that Public Health England encourages people to eat chocolate, crisps and cakes. Indeed, one of main differences between the old Eatwell Plate and the new Eatwell Guide is these foods were taken off the plate altogether because, as the British Nutrition Foundation explains...

Foods high in fat, salt and/or sugars, which previously featured in the purple section of the Eatwell plate, have been moved outside the main image.

This has been done to clarify consumer understanding of the role of these foods and drinks in the diet. They are not a necessary part of a healthy diet but such products can be included, although they should only be consumed infrequently and in small amounts.

Their inclusion in the guide may help consumers feel that moving towards such healthy guidelines is an achievable and realistic target.

The Eatwell Guide therefore recommends food that is entirely healthy, unless you are a low carb nutter who thinks that bread and rice cause diabetes. It doesn't say that sweet treats should never be consumed because that would be extreme and unrealistic, but it clearly doesn't endorse them.

Malhotra continues...

I have not seen any statements from the organisation’s health officials saying we should be eating less of the sort of ultra-processed food that now makes up half of the British diet. 

Has he been living in a cave for the last few years or does a high fat diet cause amnesia? How did he miss this, this and this, for example? Public Health England never stops haranguing people about sugar, snacks and processed food. 

Public Health England makes different dietary recommendations to the Pioppi diet. It recommends placing starchy carbohydrates, such as bread, pasta, rice and potatoes, at the base of the diet, and to reduce consumption of saturated fats.

Now we're getting down to brass tacks. Malhotra's problem with the Eatwell Guide isn't that it encourages people to eat 'ultra-processed food' (it doesn't) but that it encourages people to eat starchy carbohydrates, presumably because of the nefarious influence of Big Bread, Big Pasta, Big Rice and Big Potatoes.

The reason Public Health England - and every other health agency in the world - makes different dietary recommendations to the 'Pioppi diet' because the 'Pioppi Diet' is a load of unscientific, low carb toot created by an attention-seeking cardiologist whose slogan is 'fat is your friend'.

I have published evidence reviews showing no association between consumption of saturated fat and a heightened risk of cardiovascular disease, diabetes and death, but Public Health England doesn’t want to debate the issues.

Malhotra has never published anything resembling an evidence review. He writes comment pieces in which he references a few cherry-picked studies, such as this and this. That is not the same thing at all.

We want to trust government dietary guidelines, but Public Health England must give a clear commitment to systematic reviews of the evidence. It must stop engaging in dirty tricks to try and censor and silence those who want to engage in legitimate debate.

Far be it from me to defend Public Health England, but they have no more reason to engage in debate with a diet book salesman on the make than with any other random conspiracy theorist. They have already responded to his rubbish once, saying in 2016: 'In the face of all the evidence, calling for people to eat more fat, cut out carbs and ignore calories is irresponsible.'

What more is there to say? Scientific issues are not resolved by Public Health England debating with people. They are resolved through the accumulation of evidence in peer-reviewed journals. Malhotra has never conducted any primary research and has never published anything but op-eds in journals (usually the Z-list British Journal of Sports Medicine). It is quite possible to accept - as I do - that fears about saturated fat have been over-hyped without relying on a patently unreliable narrator like Malhotra to design a healthy diet.

Inevitably, Malhotra's response to PHE's criticism of his dietary theories was to accuse them of incompetence and corruption (see tweets below). It's his response to everything. Why would anyone want to engage in debate with such a person?

Friday, 21 September 2018

Drinkaware and the scream test

Public Health England's collaboration with Drinkaware for the 'two days off drinking' campaign is of little interest to the general public but has produced a hell of a squeal from 'public health'. Two weeks after the announcement, the hot takes are still coming. Here are a few of them...

The gist of these articles (they are all essentially the same) is that the government wouldn't work with the tobacco industry so they shouldn't work with the alcohol industry. This is the fabled slippery slope in action. By this logic, they shouldn't work with the food industry either, but they are working with the food industry - on labelling, reformulation and other things beside. They also work with the alcohol industry on drink driving, underage sales and much more. The wingnuts of the nanny state probably think that the industry wants people to drink drive because - as they keep claiming - their interests are irreconcilably at odds with those of 'public health'.

This is dogmatic nonsense and you have to be deep down the temperance rabbit hole not to laugh at it. Telling people to go teetotal for at least a couple of days a week isn't bad advice. It's not going eradicate liver disease but nor will the grab bag of nanny state interventions favoured by the people who have been spitting their dummies out of their pram for the last fortnight.

Alcohol Focus Scotland's Alison Douglas has often advised the public to have drink-free days in the past (see here and here, for example), but now that Drinkaware are saying it, she no longer thinks it is good advice. You couldn't ask for a better illustration of the fact that it's not about health for these people.

Or take this from a BMJ article with the hysterical headline 'Public Health England's capture by the alcohol industry' by the terrible trio of Ian Gilmore, Linda Bauld and John Britton...

The question that senior PHE managers do not seem to have asked themselves in the process of entering into this partnership, and certainly did not ask their alcohol leadership advisory board, is why the alcohol industry is happy to fund a campaign that ostensibly aims to reduce alcohol consumption. Had they done so they would have received the answer that the industry does so because it thinks the campaign will be ineffective or will divert attention from other more effective policies to reduce alcohol consumption that the industry fears more, such as minimum unit pricing.

Who needs evidence when you have sweeping assertions? "If they'd asked us, this is what we would have said, therefore it is the truth."

Like rain bringing worms to the surface, the PHE collaboration has drawn the worst people in 'public health' out to bat. Today, the Lancet published an equally woeful op-ed by the equally awful trio of Mark Petticrew, Martin McKee and Theresa Marteau, who say...

In its defence, PHE points to Drinkaware's independent governance. Drinkaware revised its governance after a critical evaluation, but its new model did not prevent Drinkaware and other industry bodies from disseminating messages that could mislead the public about the risk of cancer from alcohol consumption, using strategies similar to the tobacco and other industries.

Their evidence for this comes from an article Petticrew wrote last year which was full of errors (some people would call them lies) and totally misrepresented what Drinkaware say about alcohol and cancer. In a serious scientific discipline, the article would have been retracted.

Bhattacharya and colleagues report that in England about two-thirds of alcohol sales revenue comes from people drinking above guideline levels; if all drinkers followed recommended drinking guidelines, the industry would lose almost 40% of its revenue. The lead author of that study stated in a press release: “The government should recognise just how much the industry has to lose from effective alcohol policies, and be more wary of its attempts to derail meaningful action through lobbying and offers of voluntary partnership.”

Bhattacharya represents the Institute of Alcohol Studies (née the UK Temperance Alliance) and his study was economically illiterate garbage. His comments to the press, as with the conclusion of his study, were based on the fallacy that businesses chase revenue over profit.

This is what happens when you pride yourself on not having anything to do with the industry that makes the product about which you claim to be an expert. Knowing nothing, you can make up little fantasies in your head. That can work OK so long as you only associate with other conspiracy theorists, but take those ideas into the real world and people are likely to make fun of you.

And when even the people at Public Health England - Public Health fricking England - start to worry about your extremism, it's time to take a cold bath.

Thursday, 20 September 2018

Why are we giving the WHO so much cash?

From the Express...

British taxpayers 'should not subsidise scaremongering anti-vaping laws'

British taxpayers should no longer subsidise “scaremongering” anti-vaping laws advocated by the World Health Organisation, consumer champions said tonight.

It includes a quote from my good self...

Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs, said: “The WHO’s scaremongering stance on e-cigarettes is at odds with the British Government’s evidence-based position.

“The UK taxpayer is paying through the nose to support this prohibitionist organisation. So far, the Department of Health has been unable to turn our money into influence. It is now time to get tough. Unless the WHO withdraws its support for the prohibition of vaping, the government should withdraw its funding.”

The idea of defunding - or even threatening to defund - the World Health Organisation may trouble some people. After all, it has done great things. And yet its past achievements all involve communicable diseases whereas the 21st century WHO is obsessed with the first world problem of 'lifestyle-related' diseases which are neither as pressing nor as easily preventable - and which are certainly not preventable by clamping down on vaping.

It seems to me perfectly reasonable to threaten to withdraw funds from this organisation until it (a) gets back to its primary function of tackling contagious disease, (b) removes the dark cloud hanging over its transparency and financial affairs, and (c) embraces science on harm reduction.

The UK has the motive and method by which to do this. We pay a staggering amount to the WHO compared to other countries. Check out its list of donors here.

In the 'general fund', the typical amount donated by a reasonably-sized, rich country is $10-30 million. France gives $13 million. Italy gives $10 million. Switzerland gives $11 million. Sweden gives $27 million. Korea gives $26 million.

A handful of countries give more than that. Canada gives $34 million. Norway gives $41 million. Japan gives $47 million. Germany gives $90 million, but Germany is the third biggest donor.

The biggest donor is the USA with $401 million but the UK, which has a smaller population than Germany and a population that is barely a fifth of the USA, is second with £163 million.

We must hope that some of the general fund is spent treating the sick and preventing infectious disease in the world's poorest countries, but that is certainly not how the WHO's money for tobacco control is spent. It is all advocacy, conferencing and nice hotel rooms. The Secretariat of the WHO Framework Convention on Tobacco Control had an income of $5.1million in 2017. The split between countries is quite striking because there are only three of them: Australia, Panama and the United Kingdom. And guess who is paying for 72 per cent of it?

That's right: the British taxpayer - to the tune of $3,697,792.

Presumably this is the £15 million (to be spread over five years) gifted to the WHO Framework Convention on Tobacco Control by the Department of Health civil servant Andrew Black in 2016.

Shortly after this generous use of other people's money, Andrew Black got a job with the, er, WHO Framework Convention on Tobacco Control. Fancy that!

Leaving aside the happy coincidences of Andrew Black's well remunerated career, you'd think that £15 million to the WHO's anti-smoking programme, plus annual contributions of £163 million and several other commitments, would give Britain the kind of 'soft power' that would allow it to make modest demands such as getting the WHO to stop saying that prohibition is an acceptable response to vaping, wouldn't you?

But apparently not, because the WHO's current position on vaping is to recommended 'prohibition or restriction of the manufacture, importation, distribution, presentation, sale and use' of e-cigarettes. That's right: prohibition.

Until the WHO stops recommending fecking prohibition for an effective substitute for smoking, it's reasonable to stop giving it cash, right?

Wednesday, 19 September 2018

More drivel about non-communicable diseases

The World Health Organisation's war on non-communicable diseases (NCDs) has always been a quixotic project. When it set its ridiculous and unachievable targets in 2012, I suggested that it was an excuse for a 'prohibitionist’s charter'...

If 194 countries really have signed this quasi-treaty, you can expect to hear much more about our ‘legal obligations’ to control eating, drinking, smoking and - the mind boggles - ‘physical activity’ for many years to come. You may recall last year’s charming article from Jonathan Waxman in The Times titled ‘To avoid cancer, let the State dictate your diet’, which was itself based on the claim that lifestyles cause 40 per cent of cancer. That is only the start and it is, of course, why the puritans, bureaucrats, nannies and headbangers of public health are so keen on the idea of ‘non-communicable diseases’, because it gives them what every trigger-happy army general wants: a war without end.

It is the conceit that anyone, let alone the WHO, can 'beat NCDs' that most annoys me. The only alternatives to death from a non-communicable disease are death from a communicable disease, violence, overdose or suicide. Fifteen million people die from the one of the latter every year, mostly at a relatively young age, but it is those who die from a non-communicable disease, mostly at an older age, that concern the WHO.

I argued in Killjoys that the WHO should not be wasting its limited resources campaigning against diseases of old age in rich countries when people are dying from easily preventable infectious disease in the developing world. Some people hoped that appointing an African as Director-General of the WHO would put the organisation back on course, but instead he is ramping up the rhetoric. Take this ridiculous tweet, for example...

It's only a matter of time before he starts telling us how many jumbo jets this equates to. I enjoyed this response...

This is all part of the build up to a big WHO conference in New York next week which will see the 'NCD Alliance' call for taxes on sugary drinks to stop people dying in their beds at the age of 99. See my Spectator post from May for more on this surreal crusade.

Tuesday, 18 September 2018

The over-provision of 'public health' ignorance

From The Times...

Call to tackle the ‘retail clusters’ that help cause ill‑health in Glasgow

Not this nonsense again?! How many times are we going to have to go over this? Retailers go where the demand and footfall are. If there was 'over-provision', the shops would close down.

Many of Glasgow’s most deprived areas are populated by “health-damaging” retail clusters that offer easy access to alcohol, fast food, cigarettes and gambling.

The finding, by researchers from Glasgow and Edinburgh universities, has prompted calls for tighter regulation to reduce the density of unhealthy outlets.

That was the intention, of course. There is no academic justification for the publication of a study that shows, for the umpteenth time, that city centre high streets have more off licences and bookmakers than the leafy suburbs.

“Our local environment shapes what we have access to and what we can afford,” said Linda Bauld, professor of health policy at Stirling university.

“The density of fast food, gambling, tobacco and alcohol outlets in deprived areas is almost certainly contributing to the health gap between rich and poor. This density can be changed through local planning processes and also through regulation.”

The question that people like Bauld can never answer is why, if businesses can make people engage in certain activities by merely existing, do retailers not 'target' wealthy areas where people have more money to spend? What kind of capitalist would waste his coercive powers on people who have little disposable income?

Miles Briggs, the Conservative MSP and the party spokesman on public health, has called for “determined local authority action” to tackle the problem.

 Ah yes, the Conservatives.

Frank McAveety, the Labour former leader of Glasgow council, said: “Clearly there is overprovision in some working class areas, creating a fatal combination of bookies, fast food shops and off-licences. There has to be a fundamental look at the legislative framework around overprovision and where powers lie and can be applied.”

The only over-provision I can see is a surplus of economically illiterate 'public health' studies written by people who don't understand supply and demand.

And yet, right at the end of the article, we get this...

Laura Macdonald, a co-author of the study, hopes the findings will influence change...


...but said: “We cannot ascertain why outlets are colocated in deprived areas — it could reflect shopper convenience or because retailers purposely choose areas close to populations with greater demand for specific goods.”

Yes, Laura! And the truth shall set you free!

It is both, of course, and that is all there is to say.

Monday, 17 September 2018

Insufferable bastards

Public Health England had their annual conference last week with 1,600 delegates. It's probably best not to think about how much it cost the taxpayer.

Head honcho Duncan Selbie (salary: £220,000) kicked off proceedings with a speech in which he paid tribute to my Twitter #content. You can watch it below from 11 minutes 43 seconds...

The best of the quotes pertains to PHE being "insufferable bastards". Whilst I wish I had said this - and it does sound like the kind of thing I might say - I can't find any evidence that I did. And whilst I did indeed call Selbie an overpaid, parasitic quangocrat, this was in relation to his decision to stop everybody smoking by 2030 and not, as he claims, the recent advice to have two days off drinking a week. 

This suggests - not for the first time - that Big Dunc might not have full mastery of the facts. But there is no doubt that he is doing an outstanding job by his own criteria...

Friday, 14 September 2018

Snowdon and Delingpole

James Delingpole's excellent podcast is the only podcast I always listen to. If you haven't subscribed to it yet, you should do so. If you haven't, you can listen to the latest edition, featuring my good self, below...