Saturday 30 January 2010

Cooking the books on Alzheimer's

Study shows cigarette smoking a risk for Alzheimer’s disease

When all studies were considered together, the risk factor for developing AD from smoking was essentially neutral at a statistically insignificant 1.05.

So where did the dramatic headline come from? Step forward Dr. Stanton A. Glantz (for it is he), who has found an association after "controlling for study design, quality of the journals, time of publication, and tobacco industry affiliation of the authors." 

Blimey, that's a lot of controlling and sounds very subjective. Is the self-styled "anti-smoking lunatic" Glantz really the best man to be judging bias? When it comes to identifying 'tobacco industry affiliation' he generally seems to use the six degrees of separation theory.

If anyone has the study, I'd love to see it. Please e-mail me:

Friday 29 January 2010

Alcohol consumption falls again

The Office for National Statistics released the latest drinking figures yesterday. Encouraged by the ONS press release, most of the media have focused on a rise in alcohol-related deaths of 3.5%. As this is a fairly pedestrian rise, the gentlemen of the press have turned the clock back 16 years to take a long-view; hence headlines like Alcohol-related deaths in Britain rising fast (Reuters) and British boozing deaths double (The Sun).

From the latter:

According to the Office of National Statistics, 4,023 people were killed by booze in 1992, rising to 9,031 in 2008.

There have been very substantial changes to the way "alcohol-related" deaths have been defined since 1992, but let's not get sidetracked by that right now. Instead, let's look at the amount people are drinking. 2009 saw a rise in how much women drink, but there was a greater decline in 2008 so it's as you were for the ladies.

The stats for males, however, should objectively be the big news story. Alcohol consumption has declined at by far the greatest rate in recent history, as this graph indicates.

But even this graph does not tell the whole story. 2007 saw the ONS bring in a major change to the way they calculated alcohol consumption. They insisted that everyone was drinking stronger beverages from larger glasses. Overnight, the amount men drank rose by 45% for women and 23% for men. In effect, this statistical 'correction' created the whole 'binge-drinking epidemic'.

The massive spike you see in the graph above reflects the statistical change, not any real change in consumption. It's an apples an oranges comparison. Whatever you think of the idea of glasses getting bigger, they didn't suddenly become so in 2007. If you want to see the real trend you need to use the same method throughout. The graph below shows alcohol consumption under the original method.

As you can see, there has been a fairly continuous drop in consumption. The picture for women is less clear, but still a decline is evident.

For a long time, Britain's falling alcohol consumption has been a well-kept secret. It doesn't fit the narrative of boozy Britain and doesn't support the neo-prohibitionist's scare-mongering. It is now so obvious that consumption has fallen (under either method of calculation) that this truth is now being whispered. The BBC, for example, gives it a brief mention:

The trend to less consumption began in 2002...

Indeed it did. So much for the riding tide of alcohol abuse.

...and is unlikely to be reflected in figures on the alcohol deaths for some years.

Herein lies the problem. We have 13 years of falling consumption and yet deaths have doubled in the last 16. What will it take for patterns of death to start following patterns of consumption?

There is no answer to this because overall consumption is not a predictor of alcohol-related death. It's a red herring. If you want to know how many people are going to get liver cirrhosis or pancreatitis you need to know how many people are drinking at chronic levels. Fewer than 10,000 die from alcohol-related deaths, even after the definition has been broadened enormously. This is not a problem to be solved at the population level and consumption amongst the general population tells you almost nothing.

Policy-makers are so wedded to population-level solutions that this important point gets lost. It is quite possible to have serious alcohol-related disorder and death even as general consumption falls. So focused is the government on its ridiculous 28-unit-a-week minimum that it ignores those drinking over 100 units who are genuinely at risk.

As long as this continues, the many will be punished for the sins of the few while those at most risk will slip through the net.

Thursday 28 January 2010

Shock trials and smoking police

The German newspaper De Bild is today running a big story about the latest anti-smoking scheme from the European Union.

The EU has declared war against smokers! Brussels wants to eliminate cigarettes with a ‘smoking police’, ashtray bans and high-publicity legal processes against celebrities who enjoy a puff.

De Bild - Europe's best-selling newspaper - is the German equivalent of The Sun so take it with as many pinches of salt as you like, but it says the plans include:

• ‘Smoking police’: The EU states are being asked to set up a system for enforcing the smoking ban, including a system of prosecution. The use of inspectors and enforcement officials is recommended. They will also carry out random spot checks.

• Shock trials: The EU states will be encouraged to carry out sensationalist prosecutions designed to shock the public.

• Ashtray ban: It will be the responsibility of all companies and public services to ensure that there are no ashtrays in the building.

• Celebrities who smoke will also be targeted and exposed publicly as smoking offenders.

• The dossier even defines smoking as including the ownership or handling of a lit cigarette, regardless of whether or not the smoke is actively being inhaled.

Full story here.

Tuesday 26 January 2010

ASH accounts 2008/09

After some confusion, the Charity Commission has published Action on Smoking and Health (England)'s accounts. If you're a British taxpayer, you donate to ASH, so you might like to know what you get for your money...

The Department of Health has reduced its funding somewhat, while ASH International (John Banzhaf's outfit; part-funded by Pfizer) and its supporting charities (mainly the British Heart Foundation and Cancer Research UK) have kept the money pouring in.

Supporting charities: £436,295

Department of Health: £142,000

ASH International: £104,119

£682,414 (plus others = total income of £743,000)

All of the Department of Health's cash (£142,000) was spent on a shadowy project called 'Capitalising on Smokefree', which Taking Liberties and Alex Massie mentioned back in 2008. ASH have never published anything about this, and the suspicion is that it was a front for generating yes-votes for the government's public consultation on tobacco control. A question was asked in the House, to which the then Health Minister Dawn Primarolo (remember her?) replied:

ASH has received this grant specifically to carry out a defined project entitled "Capitalising on Smokefree: the way forward". None of this funding is to be used for lobbying purposes.

But according to the accounts:

This project provides an information base and communications to support further progress on tobacco control policy and smoking cessation following on from the smokefree policies introduced in the Health Act 2007.

The Department of Health made a section 64 Scheme grant of £142,000 to this project.

"Communications to support further progress on tobacco control policy" sounds an awful like lobbying to me. What do readers think? 

Other highlights:

Dr. Anna Gilmore has quit her position as an ASH trustee, apparently to find a heart miracle where we already know there isn't one.


Revealed that the annual cost of smoking to the NHS in England has soared from £1.7 billion a year in 1998 to £2.7 billion in 2008.

A pretty amazing statistic in a country where smoking prevalence has dropped significantly, but then they had to keep pace with their rivals in the temperance movement who are getting all the press right now:

It is estimated that the cost of alcohol related harm to the NHS in England is £2.7 billion in 2006/07 prices.


Following the successful implementation of the overwhelmingly popular and effective smokefree law in July 2007...

... ASH has been at the forefront of a new campaign for a national tobacco control plan.

Do you remember the Smokefree Action Coalition? The one that only wanted a smoking ban and then would go away because there wasn't a slippery slope and they just wanted to protect workers from secondhand smoke?

The first step was the re-launch of the Smokefree Action Coalition. Consisting of more than 30 organisations committed to tobacco control, the Coalition was formed originally to campaign for legislation to make enclosed public places and workplaces smokefree. 

And that's all they wanted, remember?

With that goal accomplished, members agreed agreed to change the objective of the Coalition to securing a comprehensive tobacco control strategy.



Reducing children's exposure to tobacco smoke needs to be a central element of the three-year review of the smokefree legislation, due in 2010.

Smoking bans in the home, here we come!


To maintain good relations with the three current key funders

Like ASH International, as funded by Pfizer, the makers of Nicorette and Chantix?

The Chancellor responded to ASH's call for an extension of the reduced rate of VAT on nicotine replacement therapy, which will now apply indefintely.

That's the one.


Prepare for the next Government

Good to see a bit of realism creeping in there. Whether the next government also capitulates to its every whim while funding it to lobby "support further progress on tobacco control policy" remains to be seen.

Friday 22 January 2010

The real history of binge-drinking

The BBC has struggled to find a way of promoting the temperance movement today, so it has resorted to a little quiz...

It's not actually a quiz about 'binge-drinking history'. It's a quiz about alcohol control with such leading questions as this:

If you want to swot up on the history of binge-drinking, I thoroughly recommend Virginia Berridge's article  'The normalisation of binge drinking? An historical and cross cultural investigation with implications for action' (available as a PDF). But if you can't be bothered, here's the first line which tells you gives you the gist:

Binge drinking is nothing new in British society and has not always attracted disapproval.

Binge drinking is, of course, what we used to call simply 'drinking'. Berridge shows how the use of the more scary-sounding 'binge-drinking' has spread in a short period of time, first by the media:

And then by politicians:

The time-lag between the term being used by The Times and it being used in Parliament indicates that the moral panic over binge-drinking is largely an invention of the media. In his article 'Binge drinking and moral panics: historical parallels?', Peter Borsay compares today's feeding frenzy with that of the early-18th century 'Gin Crisis', and concludes:

Both are driven by pressure groups and an expanding media industry, focus primarily on the role of women, are urban based, and are underpinned by public perceptions of government complacency and an element of xenophobia.

Both could be categorized as a form of 'moral panic', that is, an event constructed in the media that draws its power not primarily from its inherent features but from its capacity to mediate a package of wider social anxieties.

There is nothing new under the sun. It's just a pity there aren't a few more historians in Parliament. Or at the BBC for that matter.

Thursday 21 January 2010

Another obesity drug taken off the shelves

The National Obesity Forum, the 'independent charity' has taken another blow today, as the BBC reports:

Top obesity drug sibutramine being withdrawn

A leading obesity drug is being withdrawn from use in the UK amid fears it increases the risk of heart attacks and strokes.

Dr June Raine, of the MHRA, said: "Evidence suggests that there is an increased risk of non-fatal heart attacks and strokes with this medicine that outweigh the benefits of weight loss, which is modest and may not be sustained in the long term after stopping treatment."

This is a blow for the National Obesity Forum because they have previously defended sibutramine (AKA Reductil) against claims that it has fatal side-effects, as in this press release:

NOF continues to view sibutramine as a safe and effective treatment against rising tide of obesity

The National Obesity Forum (NOF) today confirmed its view on sibutramine (Reductil) as a safe and effective treatment option for medically obese patients and supported the Medicines Control Agency (MCA) statement that: "Patients currently treated with sibutramine can continue to take their medicines as usual."

And when the evidence mounted, NOF chairman David Haslam insisted that there was no need to ban it.

"This is information we need to take very seriously because we should not be prescribing it to the wrong people," the Daily Express quoted Dr David Haslam, chair of the National Obesity Forum, as saying.

He added: "Anything that lapses blood pressure control could have side-effects.

"Anyone who has had a heart attack or a stroke should stop taking it but those who haven't should be assured there are no danger signals for them."

This mirrors the situation in 2008 when the weight-loss drug Rimonabant AKA Acomplia was approved for NHS use, despite fears that it caused suicide, and despite it having already been banned in the USA. Even its manufacturers, Sanofi-Aventis, found that it doubled the risk of psychiatric disorders. The National Obesity Forum, on the other hand, warmly welcomed its approval:

"This is a very good drug, and there are very many people who have tried everything else, including other drugs, with little success, who might benefit from it." 

Once approved, it took only a few months for the European Medicines Agency to urge doctors not to prescribe it, citing safety fears, and it was taken off the shelves. Still the (new) NOF chairman was eager to defend it:

Dr Colin Waine, chairman of the National Obesity Forum, said: "My patients were doing very well on it, and they will now have to stop and come off it."

Why such eagerness to defend these drugs? Other public health spokesmen have condemned them or been luke warm at most. Could it have anything to do with the fact that the pharmaceutical industry gives it thousands of pounds a year?

Or is it because Big Pharma paid for its website?

Or is it that Big Pharma almost entirely funds its annual conference?

Dr Matt Capehorn, GP, founder of Rotherham Obesity Institute and trustee of NOF presented a Sanofi-Aventis sponsored lecture...

Prof Colin Waine, Chair of NOF presented a Roche sponsored lecture entitled: ‘Weighing Up The Burden of Obesity’...

Dr Terry Maguire, Queen’s University, Belfast presented a GSK sponsored lecture titled: ‘Supporting overweight and obese patients; What role can pharmacy play?’

Prof Dr Luc Van Gaal, Professor of Medicine, Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital delivered an insightful presentation, sponsored by Abbott...

Now, I have no problem with industry funded pressure groups or charities. God knows, the government funds enough astro-turf 'grass-roots groups' to push its policies and industry is, if anything, under-represented. But I don't believe I have ever read a media report involving the NOF which mentions the fact that they are overwhelmingly funded by Big Pharma. 

Surely, in the interests of transparency, this conflict of interest should be explained whenever they are encouraging the sale of drugs, especially when they may well be deadly.

Wednesday 20 January 2010

The politics of the playground

Like many a political leader before him, the Mayor of Santa Cruz is learning that when it comes to tobacco, nothing you do is ever good enough to satisfy the prohibitionists.

As reported previously, Santa Cruz recently enforced an outdoor smoking ban to go along with its many other anti-smoking laws. Santa Cruz resident Ethan Epstein describes how 'comprehensive' these bans are:

In this bastion of “tolerance,” smoking has been banned throughout all indoor public spaces, outdoor dining areas, parks, beaches, and downtown thoroughfares. My (exorbitantly overpriced) apartment building has imposed a smoking ban that even covers private residences. 

I don’t smoke, but my girlfriend does, and she is forced to shiver in the bitter – for California – cold when she wants to light up. That smell wafting into your apartment is not cigarette smoke: it’s illiberalism and intolerance.

And what does the American Lung Association in California (ALAC) do to reward Santa Cruz's slavish devotion to the anti-smoking cause? It awards the city a 'D' in its Tobacco Report Card.

Treating this arbitary rating system with absurd high seriousness, ALAC spokesman Paul Knepprath said the city was oh-so-close to getting a 'C'.

Paul Knepprath, vice president for advocacy and health initiatives with the American Lung Association in California, said although Santa Cruz city code identifies "smoke" as a public nuisance, the wording isn't strong enough.

Knepprath said if the code specifically referred to second-hand tobacco smoke, it would have meant an additional bonus point, which after the errors were fixed, would raise the overall grade.

"That's how close it was," he said.

In other words, Santa Cruz could have only got a 'C' if its politicians lied and said that smoking outdoors posed a health risk to nonsmokers. There is, of course, no evidence for this.

What makes all this funnier, is that the Mayor has taken the news very badly indeed and has started throwing his toys out the pram. He scribbled an angry letter to the ALAC, saying...

"This is ridiculous and, frankly, it does not motivate me to press my City Council colleagues to take further action to reduce smoking: quite the reverse."  

Quite the reverse? You mean you're going to take action to increase smoking just because the ALAC hurt your feelings?

"I feel we are being abused and that the rating system is clearly a fraud and meaningless."

And Mayor Rotkin was still throwing a hissy-fit when the press caught up with him...

"Frankly, it makes me so angry I don't ever want to talk to these people again," he said in an interview.

Is this the level of school-yard politics we've be reduced to? Draconian laws being introduced to impress the bigger boys and then petulant name-calling when they don't get the pat on the head they feel they deserve?

I don't claim to be an expert on local politics in America, but aren't politicians supposed to be acting in the interests of their electorate rather than trying to to earn gold stars from out-of-town single-issue campaigners? Rotkin's reaction makes it pretty clear that climbing up a league table comes ahead of serving his electorate.

Rotkin himself is a rum fellow. He teaches 'Community Studies' at the University of California ("yes, I think I will have fries with that"). This includes an Introduction to Marxism, which I'm sure he teaches in a balanced and reasoned way, as you would expect from someone who edited The Socialist Review for ten years, describes himself as a "Marxist-Feminist" and lists his interests as...

Marxist theory, capitalist system, community power structure, institutional analysis, and affirmative action.

According to Discover the Networks:

Rotkin's ideals are outlined in his 1991 PhD thesis (entitled Class, Populism, and Progressive Politics: Santa Cruz, California 1970 - 1982), which describes his stealth strategy to implement socialism in the United States. A chapter from this thesis, titled "A Three-Part Strategy for Democratic Socialism," currently serves as an assigned reading for his "Introduction to Marxism" course. 

Part one of this strategy is Grassroots Organizing, which means finding groups with grievances against society and helping them to "wrest concessions," as he phrased it in his thesis. Borrowing from Saul Alinsky's tactics, Rotkin advocates hiding his true socialist agenda from the people he helps while "preparing the ground" for subsequent stages.

I don't wish to offend the good people of Santa Cruz who have elected him as Mayor four times, but from where I'm sitting this man sounds like an asshole.

And it gets better. Mayor Rotkin - who, let's say again, has banned smoking outdoors - is a board member of the American Civil Liberties Union. Is this guy for real, or what?

It's interesting to note that Santa Cruz's recent outdoor bans were brought in to curry favour with the ALAC after getting a 'D' last year.

The city received a "D" for 2008, which partially prompted the council to pass the ban on smoking along Pacific Avenue, West Cliff Drive, the Santa Cruz Municipal Wharf and other public sites. The ordinance, which took effect in October, expanded earlier prohibitions against smoking in restaurants and in lines for movies and concerts.

All of which makes last year's debate over whether or not to bring in these bans look like a bit of a charade. Policy seems to be being dictated by unelected pressure groups rather than the council. The silver lining is that the ALAC seem to have gone too far this time and alienated the childish and self-absorbed politicians upon whom they rely. I predict Santa Cruz will be getting a 'C' sometime soon.

Thanks to Becky for the tip

Tuesday 19 January 2010

An honest conflict of interest statement

What represents a conflict of interest for those who write studies about tobacco control? Some people would think that being a professional 'secondhand smoke consultant', receiving money from the makers of nicotine replacement drugs or being a member of a hardcore anti-smoking group would be worth mentioning if the individual is working on research that might lead to legislation. 

In practise, such interests are rarely mentioned as potential sources of financial or emotional bias. Dr Kamal Chaouachi has taken a very different approach in his recent study published in Medical Hypotheses. Instead of simply saying 'no conflict of interest', Chaouachi has opted for full disclosure, including all those Big Pharma ties that others overlook. In doing so, he hints at what a full conflict of interest statement might look like if those working in tobacco control went to the same trouble. 

Sunday 17 January 2010

David Kessler: "Food is like cocaine"

This blog has mentioned John Banzhaf's graduation from anti-tobacco fanatic to anti-food fanatic before. I haven't yet documented David Kessler's same slide down the slippery slope.

When he was in charge of the Food and Drug Administration (FDA) in the 1990s, Kessler made concerted attempts to bring tobacco within his regulatory domain (see Velvet Glove, Iron Fist, pp. 189-93). At around that time RJ Reynolds Tobacco placed ads in US newspapers, asking 'Today it's cigarettes - will high fat foods be next?'

It seemed an absurd comparison at the time but, as we now know, an assault on food was the 'next logical step' and, again, Kessler is involved.

On Thursday, Kessler appeared on Channel 4's Big Fat Diet Show, attacking the 'food industry' for making food enjoyable. This is what he said...

"Back 30, 40 years ago, what was the most salient stimuli [sic] for many people? It was tobacco. It was cigarettes. That hi-jacked our brains.

Today, what's the most salient stimuli [sic] for millions of people? It's food! That's hi-jacking our brains."

And when you get rid of food, what will be the next most salient stimulus? Do we keep going until there are no stimuli at all?

The reason food 'hi-jacks our brains' is because our bodies send signals to tell us when we need to eat and, when we do, our brains need to tell us we enjoy it. It's pretty simple, and pretty important. Pleasure is not a bad thing in itself, you know. 

"We now know that fat and sugar can stimulate the brain's neural circuitry like amphetamine and cocaine."

What he's talking about is dopamine, which is released in the brain and creates the feeling of pleasure. Kessler refers to cocaine to make it sound as if fat and sugar are evil and unnatural. It's a cheap trick. 

In fact, dopamine is released by doing virtually anything we enjoy, including watching television, playing sport, eating any type of food (so long as you like the taste of it), sex, smoking, a good joke etc. etc. etc. 

If someone ever tells you that [fill in the blank] acts like a class A drug, just walk away, because they're just talking about dopamine and they're using scare tactics. 

The drug references don't stop there...

The food industry has optimised food to achieve the maximal bliss point. They've constructed food to get us to keep on eating. It's this momentary hit. It's this momentary rush. And then you try to chase it again. We always knew that drugs can hi-jack our brain. Now we know that fat, sugar and salt - when put together in the right combination - can do the same.

A momentary "hit" that you have to "chase". Get it? Food = drugs. Let's regulate it! Needless to say, Kessler thinks that fast food is addictive and is paving the way for it to be taxed. Do this sound familiar?

His argument is hokum, of course. A war against anything that causes dopamine to be released is, by definition, a war on pleasure. People like Kessler insisted that they were not embarking on such a puritanical crusade in the 1990s when the tobacco issue came to a head (and he was explicitly warned about the slippery slope then. See this letter.)

Easting food is pleasurable. It's an evolutionary response to a biological necessity. The 'food industry' have made food that people want to eat. Nothing more, nothing less. 

Don't consume more calories than you will burn off. It's very simple but it's still a personal choice.

You can see Kessler's performance here (30 minutes in). Thanks to JB for the tip.

Rumblings of sanity

"During times of universal deceit", said George Orwell, "telling the truth becomes a revolutionary act." 

The following stories appeared in the last week. All of them involve statements that are so transparently truthful that they are obvious to anyone who does not have a vested interest in saying otherwise. Consequently, in the early days of 2010, they are considered controversial.

Outdoor Smoking Bans Spread Without Science

WeHo News 

West Hollywood, California (January 11, 2010) - Half a dozen LA County municipalities have banned smoking near their outdoor dining facilities, with a few banning it from publicly-owned property - sidewalks, medians etc. - across their city entire.

All did so citing public health concerns, but none did so based on scientific evidence that second hand smoke (SHS) near an outdoor area poses a health risk, because no such peer reviewed study existed.

Smoking defended by Quebec doctor

A Quebec psychiatrist has sparked controversy with a new book that comes to the defence of smokers and even promotes some benefits of smoking.

The former president of the province’s Association of Psychiatrists said smoking can be helpful for those suffering from deep depression.

"Sometimes antidepressants aren’t enough — it is an individual approach for everyone," Bourque said in an interview with Radio-Canada.

Bourque said the concerns about the dangers of second-hand smoke are overblown.

"The idea that is promoted by the Quebec government, that second-hand smoke is more dangerous than the smoke inhaled by someone who is smoking, is completely off the rails," Bourque said.

'Shaming' smokers makes it harder to quit: study

Tom Blackwell, National Post

Years of anti-smoking laws and campaigns have amounted to a public shaming of smokers that could make it harder for them to quit, a group of UBC researchers argue in a new report.

Katherine Frohlich, a public-health expert at the University of Montreal, said studies by her research group found that poorer smokers feel the policies have discriminated against them by, for instance, restricting their social interaction and isolating them at home.

"We shouldn't dismiss the fact these interventions have been incredibly successful," she said. "[But] we have to take into consideration the fact that there are some pretty serious unintended consequences."

Friday 15 January 2010

Unbelievable ignorance

For my sins, I'm currently reading a book called All Consuming by one of Gordon Brown's former advisors, Neal Lawson. In a nutshell, the author attempts to exploit the recession to persuade readers to turn against the free market. 

The book is riddled with factual errors and outrageous statements, as you might expect. Here's one of each:

Even the new [railway stations] like Liverpool Street and St Pancras are just shopping malls attached to platforms and ticket offices. Everywhere and everything is an excuse to sell.

Victorians, on the other hand, made stations that were more sensual and authentic. It was a joy to be in them to sit and wait. Now there are so few seats that you have to buy a coffee just to sit down. 

The trains are not part of a grand public service but engines for private profit.

Er... not quite. The railways were very much "engines for private profit" in Victorian times, what with them being entirely run by private companies. Britain's rail network wasn't nationalised until 1948, when British Rail was created. They then proceeded to close down hundreds of miles of track, ripping down countless "sensual and authentic" Victorian stations in the process.

That, however, is merely an hors d'oeuvre for this piece of swivel-eyed lunacy:

Totalitarianism, the accusation levelled against Communism...

That's right, "levelled". As if the jury was still out.

... is a system of control that regulates every aspect of public and private life. Consumerism and Communism are two different versions of totalitarian societies: both offer a pseudo-vision of freedom but operate to systematically refine their dominance. 

Good grief. That could very easily be the most stupid thing I've ever read. 

Totalitarian Communism (is there any other kind?) involves secret police, murder, torture, mass starvation, no freedom of speech, no freedom of the press, no freedom of religion, a one party state, rationing, endless queueing and forced labour. Oh, and 100 million deaths.

Consumerism involves people sometimes buying things they don't really need.

I'll take the electric toothbrush over the Siberian concentration camp, if it's all the same to you.

Wednesday 13 January 2010

Costs and benefits of alcohol

Over at The Spectator, Alex Massie has been taking apart the notion that alcohol "costs" Scotland £3.65 billion. Meanwhile in England, the Conservative party has announced its alcohol strategy. As Taking Liberties reports, this strategy is based on the belief that alcohol "costs" the UK £20 billion a year.

As Alex says, these figures are based on little more than guesswork. The fact that the Scottish estimates, in particular, have risen dramatically in a few short years makes one suspect that they are based more on politics than mathematics.

We are victims of Government-Sponsored Study Inflation. In 2001 a study for the Scottish Executive argued that drink cost the country about £1bn a year; in 2004 another report estimated the cost at £1.1bn before, in 2007, yet another claimed that hangovers and bar-room brawls and liver disease and all the rest of it cost £2.25bn. Chicken-feed in comparison to this year's numbers. 

So here too we can suppose that you can do the sums any way you please and that, consequently, it probably helps to decide what you want the result to be before you begin the whole sorry process.

Some of the supposed costs are so intangible as to be unmeasurable. How, for example, is one to quantify the financial cost of "family breakdown" or "grief"? Of the £20 billion alcohol allegedly costs the UK, £4.7 billion - almost a quarter - comes from the "emotional impact suffered by victims of alcohol-related crime". But if we are to start putting a price on misery, what price do we put on joy? As Alex says:

The hundreds of millions of pounds it says are lost through "pain" and "grief" is nowhere balanced by the equally arbitrary figures once could concoct for all the (life-long!) joy and contentment alcohol brings. To say nothing of its positive impact on the birth-rate. (Happy, boozy pregnancies almost certainly outnumber booze-related premature deaths. This must be worth billions in the pro-drink column. These are the workers of the future!)

Factor in the social cohesion - to use a favourite piece of government-speak - provided by public houses and the happiness-inducing impact of a dram at home and it seems to me that the ruinous impact of drink has, unsurprisingly, been vastly over-stated.

If emotional costs are ultimately unmeasurable, we can certainly quantify the economic benefits. The £20 billion estimate is regularly mentioned by politicians, but the document that gave us that figure also gave us this little nugget, of which we hear almost nothing [PDF]:

The alcoholic drinks market is valued at more than £30bn per annum, with around one million jobs estimated to be linked to it. Excise duties on alcohol raise about £7bn per year and, like other sectors, the industry pays local and central taxes.

Even if we take the £20 billion "cost" seriously, it is immediately outweighed by the £30 billion we gain. To put it another way, if alcohol control policies succeed, for every £2 we save, we will lose £3. 

Faced with these hard economic facts, most public health professionals will huff and puff before saying that the issue is not about money, but about health. They would say that saving lives is more important than saving cash. Fair enough, and if they want to make that argument, they should do so, but let's not pretend that alcohol is a drain on the economy. It isn't and it never has been.

Tuesday 12 January 2010

The International Conference Against Prohibition rides again

The International Conference Against Prohibition (TICAP) will be holding its second annual event in The Hague, Netherlands on Monday 15th March 2010. The line-up is superb and it promises to be a very interesting day and, I dare say, an entertaining evening the night before.

Guest speakers include former 'Winston Man' David Goerlitz, who spoke out against the tobacco control movement last year (listen here) and Brian Monteith, whose book The Bully State I reviewed recently. 

Other speakers include Dr Patrick Basham of the Democracy Institute, whose work was also mentioned on this blog recently, as well as Dr Rein Vos - an expert on the ethics of health - and Dr Michael Marlow, who has recently written an article tilted Do Anti-Smoking Programs Work to Reduce Smoking?

Last but not least, Dr Kamal Chaouachi, the world's leading expert on the chemistry of hookah smoking, will be speaking.

Yours truly will be chairing the discussion and it would great to see some readers of this blog there. Further details are available here.

Monday 11 January 2010

Still no heart attack miracle in England

Today, Michael Siegel dissects another junk science study purporting to show that the introduction of a smoking ban led to a drop in heart attacks. And so it goes on in the world of tobacco control. 

Back in the real world, recently published NHS figures have shown us that, just as there was no big drop in heart attack admissions in the first year of England's smoking ban, so there was no drop in the second year of the ban.

This graph shows the number of emergency admissions for acute myocardial infarction (heart attacks) in English hospitals from April 1998 to March 2009:

Ho-hum. It's the same old story. The rate was falling gradually before the ban and it has fallen just as gradually since the ban. 

Whenever hospital data is publicly available, there is no sign of a heart miracle. Whenever the raw data is available only to a select group of epidemiologists, there is a 'dramatic' drop in heart attacks. When an epidemiologist announces a drop in heart attacks in a small town or region, it gets global news coverage. When evidence from an entire nation shows that a smoking ban had no effect on heart attacks, the news is confined to a handful of blogs.

The story is always the same, and I apologise for boring readers with one null study after another. But spare a thought for Dr Anna Gilmore, whose job it is to turn this mundane data into a newsworthy study showing that the smoking ban has saved thousands of lives. She may be working on it at this very moment. 

At some point this year, the media will be reporting a heart miracle in England, based on the very evidence I have shown above (or carefully selected parts of it). It sounds incredible, Orwellian even, but it will happen, and when it does none of the real figures will matter. None of the data carefully collected around the country and displayed on the HES England website will matter. The number of people who really got rushed to hospital with a heart attack in those years will be irrelevant.

If you want chapter and verse, I can tell you that the heart attack rate dropped by 3.84% and 3.79% before the ban, and by 3.75% and 2.61% after the ban. These figures are nowhere near big enough to guarantee news coverage. When the study appears it will probably show that heart attacks fell by at least 10%. We know this because that's what was reported before the study even began.

We live in post-evidential times. Whatever he who pays the fiddler wants to believe happened, is what happened. The real events are of no consequence. They are trees falling in an empty forest. 

Sunday 10 January 2010

Where are ASH's accounts?

Strange goings on at the Charity Commission, who have just published ASH (England)'s financial accounts. Or so it seems at first glance. In fact, they've published ASH Wales' accounts, stamped ASH (England)'s charity number on them and filed them under 'Action on Smoking and Health: Charity number 262667).' 

This looks to be a cock-up by the Commission, rather than funny business on the part of the anti-tobacco industry. More puzzling are the ASH Wales accounts themselves, which are missing pages 9 to 14. As it says on page 8: "The notes on 9 to 14 form an integral part of these financial statements." They certainly do. They show where the money came from. What's happened to them?

Another cock-up, perhaps. I've contacted the Commission about this and should have some news in the near future. In the meantime, how much money ASH and ASH Wales received from the makers of Nicorette and Chantix last year remains a mystery. Our only clue is a 'key achievement' listed in ASH Wales' accounts:

2. Successful funding bid to the Pfizer Foundation for the delivery of youth worker training.

ASH Wales' links with Big Pharma are no secret. They acknowledged the "financial and/or kind support of" Pfizer, Novartis, McNeil and GlaxoSmithKline in their annual report. The question is whether their English big sister is taking the filthy lucre. We should have the answer any day now.

Friday 8 January 2010

The battle royale

One of Simon Heffer's predictions for the decade ahead is that, by 2019, "alcohol will have been accorded the pariah status of tobacco". 

A more optimistic outcome is forecast by Patrick Basham who, on the BBC's World Service, predicts a "battle royale over the fate of the bully state" with the neo-prohibitionists coming out second best.

Bully staters don't want us to smoke cigarettes, gamble, drink alcohol or gain weight so they'll ratchet up the campaign to shame and coerce those who rejoice in the individual's right to pursue - dare I say it - pleasure.

Under the bully state, the real bully is nanny the policy nurse who dispenses regulatory cures for all manner of alleged social ills from smoking to simply having fun. 

Thankfully, there will be dramatic growth in people's unwillingness to be bullied out of, and into, certain habits.  This will create an opportunity for the first politician who stands in front of the bully state's regulatory march yelling "stop!"

By the end of the decade, most Americans - and, I strongly suspect, most Britains too - will be actively rebelling against their respective ministry of the domestic bully.

Will a politician spot the gap in the market for less state interference? I'm not sure. Ronald Reagan once said: "The nine most terrifying words in the English language are: 'I'm from the government and I'm here to help.'" It's hard to imagine any of the current crop acknowledging the limitations of government in this way, let alone mocking it. But then Reagan wasn't a career politician. He'd had a life outside politics and could see government from the perspective of an outsider.

One of the problems, I think, with the rise of the career politician is that it has created a distinct political class that is convinced that it is right and the public are wrong. Politicians are often accused of being out of touch. The political class know they are out of touch but carry on regardless because they believe they are inherently wiser than the electorate. They view going against public opinion as courageous - evidence of strong leadership - where once, perhaps, it would have been seen as an affront to democracy. As a consequence, politicians often appear to be at war with their own people. 

This has to be unsustainable. I hope Patrick is right when he predicts that someone will stand up and say "stop!" But that would require a politician prepared to sacrifice power and hand it back to the individual. At the moment, the political class have no doubt that they would use that power more wisely themselves. Until such a politician emerges, I expect to see more votes going to fringe parties.

Listen to all Basham's predictions here. You can read his latest publication, the impeccably argued and eminently rational Are Public Smoking Bans Necessary? here.

Thursday 7 January 2010

Just stop

Does anyone even take notice of these stories any more?

Mobile phone radiation 'protects' against Alzheimer's

After all the concern over possible damage to health from using mobile phones, scientists have found a potential benefit from radiation.

The researchers, led by Professor Gary Arendash, said that if the phone exposure was started when the Alzheimer's mice were young adults, before signs of memory impairment were apparent, their cognitive ability was protected.

That's from the BBC today, which links to this not unrelated story also from the BBC...

Mobile phones 'may trigger Alzheimer's'

Mobile phones damage key brain cells and could trigger the early onset of Alzheimer's disease, a study suggests.

Researchers in Sweden have found that radiation from mobile phone handsets damages areas of the brain associated with learning, memory and movement.

The study, which was carried out on rats, is the latest twist in the long-running debate over whether mobile phones are a health risk.

As I see it, there are three explanations for this:

1. Mobile phones give rats Alzheimer's, but protect mice from getting it, for reasons that are completely unknown and totally inexplicable.

2. Scientists had their fun trying to scare everybody about mobile phones then they first came out, but now nearly everybody's got one they've decided to make us feel scared if we haven't.

3. Thousands of foolish young people pour out of university every year clutching a degree in epidemiology and are desperate to produce 'findings' that will get them in the news.

The second story is a classic case in point. The study's author, no doubt pleased to be talking to the media, is a mass of contradictions.

Professor Salford said there was good reason to believe that mobile phones could have the same effect on humans.

"A rat's brain is very much the same as a human's. They have the same blood-brain barrier and neurons," he told BBC News Online.

"We have good reason to believe that what happens in rat's brains also happens in humans."

That sounds worrying. Your study has just found that mobile phones cause brain damage in rats.

Professor Salford said that there was also a chance exposure to mobile phone radiation could trigger Alzheimer's disease in some people.

"What we are saying is those neurons that are already prone to Alzheimer's disease may be stimulated earlier in life."

Now I'm really worried. This sounds plausible.

"However, this theory is hypothetical. We do not have evidence yet that the human brain is affected in this way."

That's okay then. What a relief.

Professor Salford said mobile phone users should not be alarmed by the findings.

Thank God for that. I was alarmed for a second.

"This is a negative finding and yes it doesn't seem to be particularly good."

That sounds bad.

"But this is one observation, in one laboratory with a small number of animals. This study will have to be repeated before we get alarmed."

Good. That's set my mind at rest. A bit.

"Nevertheless, it is strong enough to merit more research into this area."

(The scientist's timeless way of asking for another research grant.)

But he added: "Perhaps putting a mobile phone repeatedly to your head is something that might not be good in the long term."

How else are you supposed to use the bloody things? I thought it was only cigarettes that were "hazardous when used as the manufacturer intended."

"Maybe we should think about restricting our use of mobile phones."

Make your mind up. And is that "we" the people, or "we" the government?

That brief interview has everything - extreme caution combined with extreme scare-mongering, followed by a request for more money and a suggestion that we legislate on the back of evidence that even he isn't sure about. Evidence which has now been disproved. Or maybe not. Presumably, another study will come along saying something completely different.

Instead of paying these people to tell us whether such-and-such does/doesn't cause disease, let's just employ one bloke, put him in a room and give him a coin to toss. It would save us a fortune and he'd probably be right more often.

One day, someone will actually make a scientific breakthrough. Will anyone be listening?

Sunday 3 January 2010

Smoking in New York

Today's issue of The New York Times contains an article about the widespread flouting of Bloomberg's smoking ban. In short, if you you've got the money to go to a half-decent night-club, you're not going to have a problem smoking.

In November, called it “the worst kept secret in New York nightlife” that “smoking is now allowed in numerous nightspots, specifically just about any and every lounge and club with a doorman and a rope.”

It's not just New York, of course. I mentioned the growing disobedience of French smokers a few days ago. Until it changed hands recently, my local snooker club routinely turned a blind eye to smoking on the premises. Recently, I stayed in a pub (picked at random) when visiting relatives and found that the curtains closed and the ashtrays came out on the dot of 11pm every night. Similar anecdotal evidence is abundant.

So while it's not just a New York phenomenon, that city has had longer than most to get used to the legislation. The theory is that resistance to smoking bans should fade over time. Seven years after the smoking ban came in, it seems that the opposite is happening. That really should be no surprise - it's what's happened throughout history. 

Smoking bans were popular a century ago but were all repealed by the late 1920s, according to Christopher Snowdon, the author of Velvet Glove, Iron Fist: A History of Anti-Smoking. Most bans meet the same fate, Mr. Snowdon said: “They usually end with the same kind of passive resistance you see here.”

“It's just the fact that you have a habit that won’t go away,” he added.

New York has a long and chequered history of anti-smoking measures. Its first smoking ban was back in 1620 when it was still known as New Amsterdam. In the 1900s, it was the home of the Nonsmokers' Protective League. Before the First World War, it banned smoking on public transport and banned women from smoking in public buildings. The 2003 smoking ban was just the latest in a string of failed tobacco control measures. 

Today's New York Times article may lead to a crack-down on these night spots in the short-term. In the long term, history suggests that Bloomberg and his health department enforcers have their work cut out.

Saturday 2 January 2010

Barbecue winter

Mild winter forecast as part of 'El Nino' effect

Preliminary forecasts, which take into account the El Nino effect, predict that Britain will have a mild winter this year, with temperatures above the 38.6F (3.7C) average for December.

January 2, 2010

Britain facing one of the coldest winters in 100 years, experts predict

Britain is bracing itself for one of the coldest winters for a century with temperatures hitting minus 16 degrees Celsius, forecasters have warned.

They predicted no let up in the freezing snap until at least mid-January, with snow, ice and severe frosts dominating.

And the likelihood is that the second half of the month will be even colder.

Well done chaps. Keep up the good work.