Friday 30 April 2010

Fevered imaginations

On the same day that Australia takes the 'next logical step' of banning logos on cigarette packs, the colour red became the latest victim of anti-smoking hysteria.

Leading doctors are demanding an immediate government inquiry into “subliminal” tobacco advertising on Ferrari’s Formula One cars, and the company’s $1 billion relationship with the maker of Marlboro cigarettes.

The red, white and black bar code emblazoned on Ferrari’s racing cars and its drivers’ overalls is designed to remind viewers of a packet of Marlboro cigarettes, it is claimed.

Er, yes. It's uncanny isn't it?

Dr John Britton—a man who is happy to spout any old rubbish about secondhand smoke without checking the facts—is "stunned" by this audacious combination of white, black and red.

John Britton, a Fellow of the Royal College of Physicians and director of its tobacco advisory group, said: “The bar code looks like the bottom half of a packet of Marlboro cigarettes. I was stunned when I saw it. This is pushing at the limits."

The phrase "swivel-eyed obsessive" springs immediately to mind. Yes, these are the colours of Marlboro—albeit a completely different shade of red. They also happen to be the colours of this blog. They are, for that matter, the colours of my football team, and Middlesbrough even sounds a bit like Marlboro. Is there no end to this conspiracy?

Gerard Hastings, director of the Centre for Tobacco Control Research, said: “I think this is advertising. Why a bar code? What is their explanation?”

Why not a bar code? The Marlboro logo isn't a bar code. What is the connection? As the Ferrari spokesman has pointed out, if anyone has a claim to the colour red, it is the car maker.

"The premise that simply looking at a red Ferrari can be a more effective means of publicity than a cigarette advertisement seems incredible: how should one assess the choice made by other Formula 1 teams to race a car with a predominantly red livery or to link the image of a driver to a sports car of the same colour? Maybe these companies also want to advertise smoking!

"It should be pointed out that red has been the recognised colour for Italian racing cars since the very beginning of motor sport, at the start of the twentieth century: if there is an immediate association to be made, it is with our company rather than with our partner."

Once again, the increasingly nutty complaints of these groups says far more about their fevered imaginations than it does about the issue. They only serve to confirm what their critics have long said—that they are fanatics in the true sense of the word. Meanwhile, Philip Morris must be delighted to be receiving worldwide media coverage and countless mentions of their leading brand. All courtesy of the anti-smokers. Nice work, guys.

Wednesday 28 April 2010

The Spirit Level Delusion

Anyone who believes that the age of innocence belongs to the past should read some of the reviews devoted to The Spirit Level: Why more equal societies almost always do better (2009). The basic premise of the book should immediately raise suspicions. It is nothing short of a theory of everything, which finds a single factor responsible for almost every health and social problem in the Western world.

The natural response to someone who claims to have suddenly found a grand unifying theory of life is—or should be—profound scepticism. On this occasion, however, many readers and reviewers suspended disbelief (but not all of them). In some circles, the findings of The Spirit Level have become the conventional wisdom.

The reasons for this are two-fold. Firstly, the book appeared under the halo of science (statistics, in reality). Secondly, the theory of everything revolved around income inequality, and so appealed to many on the Left of politics. Put simply, the argument is that 'more equal' countries (principally the Scandinavian states) do better under almost any criteria you can think of than 'less equal' countries (principally the USA, UK and Portugal). The evidence for this is shown on a series of scatter graphs which are—prepare for an understatement—not always totally reliable (for an example, click here).

I hold no brief for extending inequality—I happen to be in the bottom 10% of earners myself—but if the argument for bigger government and higher taxes is to be made, it shouldn't be made on the junk economics and voodoo science of The Spirit Level.

Regular readers will know that I am interested in the misuse of statistics. That is what first attracted me to The Spirit Level. My new book—The Spirit Level Delusion: Fact-checking the Left's new theory of everything—tries to shine the light of reason onto some of the wilder claims made by the Left in the last decade, not just in The Spirit Level but in such books as Affluenza, Happiness, All Consuming and The Selfish Capitalist

So if you've ever heard that Cubans live longer than Americans, that Oscar winners live longer than other actors, that capitalism leads to mental illness, or that income inequality is the root of all evil, I hope you'll buy a copy. It will be available from the usual retailers (Amazon, Tower, Barnes & Noble etc.) shortly. I also have a limited number of copies here if anyone would like one a bit sooner. Postage and packing is free and overseas orders will be sent by air-mail.

UK and Europe (£)

North America (US$)

Solution Graphics

The Spirit Level Delusion:Fact-checking the Left's new theory of everything

by Christopher Snowdon (with a foreword by Patrick Basham)

Democracy Institute/Little Dice - published May 17 2010

Tuesday 27 April 2010

Why do anti-smoking groups oppose tobacco harm reduction?

This morning I gave a speech at the 21st International Harm Reduction Conference in Liverpool. The topic I chose was 'Why do anti-smoking groups oppose tobacco harm reduction?' This is what I said...

For five centuries, opposition to tobacco has been founded on moral and religious objections to vice, as well as concerns over health. Under morality, we might include the claim that smoking was ungodly and sinful, that it was decadent and depraved, and that it was a habit suited only to ‘Red Indians’, Jews, blacks, Turks, Spaniards, or whichever racial group was out of favour at the time.

Under health, we could include virtually every disease in the medical textbook. Even confining ourselves to early modern Europe, we find references to deafness, blindness, hysteria, dyspepsia, impotence, infertility, paralysis and brain damage. The evidence underpinning these fears was, for the greater part of tobacco’s history, anecdotal at best, but even from the earliest days those who opposed tobacco did so on grounds that often had nothing to do with health.

From around 1700, rather by accident, the aristocracy of England and France engaged in a spontaneous experiment in tobacco harm reduction. Snuff came into fashion and smoking began to die out, amongst the upper classes at least. This should have pacified tobacco’s opponents for three reasons. Snuff did not fill the air with smoke, it did not carry the risk of starting a fire and it did not appear to be injurious to health. And yet it did not pacify them. Snuff was attacked as a vice - and an addictive vice at that - just as pipes had been. In the United States, similar moral objections were raised against chewing tobacco.

Today, the issue of health has become the dominant feature of the antitobacco movement, but the moral, and even puritanical, element is never far from the surface. In their efforts to ban smoking outdoors, Action on Smoking and Health (US) said such a ban was justified to prevent smokers from setting a bad example to others and listed smoking alongside swearing, drinking, gambling and the wearing of “scanty attire” as examples of unacceptable activities. Although smoking al fresco could not seriously be viewed as harmful to the health of others, it was still seen as sinful and offensive to the eye.

Similarly, Americans for Nonsmokers’ Rights - in a press release titled Electronic Cigarettes are NOT a safe alternative! - criticised the e-cigarette specifically because it mimics the act of smoking and because it contains nicotine. Only pharmaceutical nicotine products escape criticism, partly because they are marketed as a medicinal cure for a ‘disease’ and partly because they administer nicotine without providing pleasure. This has led to a somewhat inconsistent view of nicotine, described as being perfectly safe in pharmaceutical products but highly toxic in e-cigarettes, snus and other tobacco products. The EPA describes it as “acutely toxic (Category 1) by all routes of exposure (oral, dermal and inhalation)” while the MHRA says thats “nicotine, while addictive, is actually a very safe drug.”

Although the amount of nicotine delivered is comparable in all cases, the drug’s reputation as poison or medicine depends on how it is delivered and who is manufacturing it. Three industries are currently fighting for the nicotine market: the tobacco industry, the pharmaceutical industry and the e-cigarette industry. Each have a financial motive for denigrating alternative nicotine products. In the case of the pharmaceutical industry, this financial motive is shared by the various anti-smoking groups it directly and indirectly subsidizes.

This three-sided nicotine war is without historical precedent. Efforts to suppress alternative and/or safer tobacco products have traditionally been the preserve of the tobacco industry and the anti-smoking lobby. Initial opposition to cigarettes in the late 19th century came primarily from makers of chewing tobacco, pipe tobacco and cigars. It was from them that groups like the Anti-Cigarette League borrowed rumours of cigarettes being made in leper colonies and spiked with opium.

Attempts to bring a safer cigarette to market in the 1970s - in particular, by Liggett and Myers - were partly thwarted by rival tobacco companies closing ranks on those who, by introducing a safer alternative, would be implicating all existing brands as dangerous. In this, the tobacco companies found themselves on the same side as the anti-smoking movement, albeit for different reasons. By 1980, the consensus view amongst public health professionals was that any attempt to produce safer tobacco products would slow the quit rate.

Dr Gio Gori’s Less Hazardous Cigarette project, which was brought to a halt at the end of the '70s, was the last attempt to find a technological solution to a problem that many felt should be solved by behaviour modification. Thereafter, the doctrine of total abstinence took hold. The prevailing view was that the more dangerous tobacco was (or was perceived to be), the more people would quit. It consciously withheld safer alternatives from the individual in a bid to accelerate the quit-rate in the population. Reflecting on the new doctrine, Dr Gori said: “The new policy was - smokers shouldn’t be helped, smokers should be eliminated.”

At a time when governments were giving free syringes to heroin and free condoms to children, the ‘quit-or-die’ approach to tobacco raised ethical questions, and was only possible by an almost evangelical faith in the smokefree world to come. Total abstinence had previously been seen as a pipe-dream, but as the anti-smoking movement gathered pace in the 1970s, activists and governments came to believe it was possible within a generation. This was in-keeping with earlier reform movements, which invariably set their eyes on prohibition sooner or later. Just as the American temperance movement set out with a message of moderation and ended with complete prohibition, so the Anti-Cigarette League of the early 20th century went from a campaign that solely targeted ‘coffin nails’ to fighting cigars, pipes and chewing tobacco (which were the ‘less hazardous’ alternatives of its day). The Anti-Cigarette League’s absolutist slogan ‘A Smokeless America by 1925’ bears an uncanny resemblance to the Surgeon General’s equally ambitious of 1986: ‘A Smoke-Free America by 2000 AD’. Both serve as reminders that bringing
about total abstinence is easier said than done.

Four decades later, the ‘quit or die’ approach survives. Its political legacy can be seen in Britain’s ban on Skoal Bandits in the 1980s and Australia and Canada’s recent ban on e-cigarettes. It can be seen in Finland’s pledge to ban any safer tobacco product that might appear in the future. It can be seen in the ban on snus that is enforced in every EU country bar Sweden. Its impact on the health of populations, however, can only be seen by comparing Sweden’s significantly lower smoking rate and lung cancer rate to its EU neighbours.

In summary, modern anti-smoking activists oppose tobacco harm reduction because, like earlier reformers, they tend to be idealists. Even those who set out as pragmatists are liable to becoming more zealous once they become emerged in a worthy cause. Few activist groups of any hue avoid ‘mission creep’ for long. For the anti-smoking movement, the allure of prohibition - the only logical conclusion to its cause - could not be long resisted. To the anti-tobacco campaigner, the appearance of new tobacco products, even if demonstrably safer, innately feels like a step backwards. Their prohibition, on the other hand, feels perfectly natural and, since most alternative nicotine devices are niche products with relatively few users, they can be nipped in the bud with minimal resistance.

Tobacco harm reduction does not offer a Utopia, nor does it promise to rid the world of an addictive vice that some find intolerable. Nor, for that matter, does it hold the promise of destroying the tobacco industry; which is the stated goal of the most fervent activists, who have long convinced themselves that getting rid of the industry will get rid of the problem.

The oft-repeated mantra that 'if something is good for the tobacco industry it must be bad for public health' has come to be seen as a truism, and not without reason, but this logic can only be taken so far. Even the tobacco industry's fiercest critics must concede that no business benefits from killing its customers. When it comes to tobacco harm reduction, we might reflect that seeing the issue as good versus evil is more suited to lovers of comic books than to those looking for real-life solutions. If the tobacco industry - or any industry - can come up with less hazardous products, it should be seen as part of the solution, rather than part of the problem.

The future offered by harm reduction is not as tidy or pure as the vision offered by the idealists. Convinced that a tobacco-free world is within reach, a world of reduced harm seems pitifully unambitious. History provides many examples of anti-smoking crusades built on similar idealism collapsing under the weight of their own hubris, and no examples to the contrary. If they are aware of this inauspicious track record at all, today's crusaders would, I fear, reply with those famous last words: “This time it will be different.”

Thursday 22 April 2010

War on the working class

This looks rather good...

This provocative Democracy Institute General Election report takes the Government and Opposition parties to task for their growing attacks on working class habits and lifestyles. The authors demonstrate the junk science behind the attacks and reveal the political elite’s real agenda – to denormalise ordinary tastes and preferences so normal behaviour becomes seen as aberrant behaviour. In challenging this elitist agenda, the authors defend the working man's (and woman's) fondness for a bet, a Big Mac, a drink, a smoke, and a tan.

Chair – Mark Littlewood, IEA 
Authors – Dr Patrick Basham & Dr John Luik 
5.45pm –7.30pm 
Thursday 29 April 2010 
Institute of Economic Affairs 
2 Lord North St 
(Door on Great Peter St) 
Westminster SW1P 3LB  

I'll be there. Details here.

Tuesday 20 April 2010

The other is in the Albert Hall

A patient lost a testicle during an operation because the surgeon cut it off by mistake, a General Medical Council (GMC) hearing has been told.

Dr Sulieman Al Hourani was only supposed to cut out a cyst, but removed the whole right testicle instead.

Sounds like a bit of a balls up. What happened?

Sarah Prichard, counsel for the GMC, said the mistake was made as a nurse helping the surgeon turned her back to get a stitch.

When she turned around the testicle had been removed.

Ms Prichard said: "Literally as the nurse turned away to get a transfixion stitch, the incident occurred and the testicle was removed.

"Such was the level of concern they immediately realised it could be a serious medical incident and took steps to complete the relevant documentation."

Emergency paperwork. Splendid. If it hadn't been for that split-second decision, the right forms may never have been filled out. 

They do a marvellous job.

Tilting at the sun

The crusade against tanning is picking up pace nicely. Taking their cue from the temperance and anti-smoking movements, the campaigners are waltzing effortlessly down a well-trodden path.

They've already picked a number:

"We believe that sunbeds are causing upwards of 100 deaths per year in the UK."

And they've made the all important association with smoking:

Sunbeds are as dangerous as smoking, the World Health Organisation has said.

They've successfully played the think-of-the-children card in Scotland and have managed to get a sin tax put on sunbeds in the USA.

So far, so good, but it wouldn't be a true swivel-eyed prohibitionist crusade without talk of addiction. The word addiction is now so over-used that it has lost all meaning. If it has any definition in 2010, an addiction is something people keep doing, even though pressure groups tell them they shouldn't. Anything that gives us a moment's pleasure in our otherwise miserable lives fits this bill and is, therefore, fair game to be taxed, banned or regulated out of existence.

To the healthists, anyone who lives their life as if they're here for a good time, not a long time, must be literally out of their minds. Just as opponents of communism in Kruschev's USSR were treated as psychiatric cases, those who do not heed the messages of public health must be driven by forces they cannot control. The very fact that they fail to conform is proof that they lack free will. Why would any free individual fail to act in their own interest?

And so, in January, we had this:

Teenagers are putting their health at risk by becoming sunbed addicts, MPs heard today as a bid was launched to ban under-18s from tanning salons...

Labour former minister Caroline Flint said some research had warned "young people got addicted to it because as soon as the tan went, they wanted to top it up".

Mrs Morgan said there were "many examples of young people becoming addicted and feeling that they can't manage unless they go continuously ... and it is extremely dangerous".

Dick Puddlecote will be pleased to see his blog mascot—the last liberal in Parliament—taking a stand:

But Tory Philip Davies (Shipley) questioned why she had opted for the "nuclear option" of a ban instead a system requiring youngsters to show proof of parental consent before using the machines.

You will notice that the references to addiction above are not exactly what you would call clinical—Caroline Flint's comment is particularly facile—but, never fear, here comes the science:

Tanning salons could be addictive

Using tanning salons could be addictive in a similar way to alcohol or drugs, a study has suggested.

People who frequently use indoor tanning facilities may suffer addictive behaviour, according to a report in the journal Archives of Dermatology. They are likely to be more prone to anxiety symptoms and substance use, it said.

Disclaimer: I've only read the abstract of this study, but I suspect I would agree with the chairman of the Sunbed Association, Gary Lipman, who said:

"I am not a scientist but I have read enough scientific studies over the years to be able to see immediately that this one has little if any scientific merit."

The 'study' is actually just a survey of 229 sunbed users in the northeast of America, taken between September and December (when there's very little sun).

Further questioning showed that students who met the criteria for addiction to sunbeds were more likely to show signs of anxiety and use drugs such as alcohol and marijuana.

This is just a guess, but I'll throw it out there. Is it not possible that people who like to have a tan are also people who have a more active night-life, which would involve alcohol and drugs? Conversely, is it not also possible that the pale, the pasty-faced, the health nuts and the hypochondriacs are less likely to have an active night-life? Just asking, like.

"Despite ongoing efforts to educate the public about the health risks associated with natural and non-solar UV radiation, recreational tanning continues to increase among young adults," [the researchers] warned.

Time to take off the velvet glove then, eh? Note the reference to natural UV radiation. Never forget that there is no difference between the natural and non-solar UV rays. A campaign against sunbeds is a campaign against the sun itself. The rays are the same, the risk is the same. If they could regulate sun-bathing, they would. In fact, the anti-tanning brigade have already said that the sun is addictive. This comes from 2005:

...beachgoers reported if they were annoyed when people asked them to stop tanning, if they could not make themselves cut down on sunbathing, felt guilty about their habit, and wanted to tan as soon as they woke up...

"Anecdotal observations about patients who seemed 'addicted to the sun' have been discussed in dermatology for years," the authors note. They point out that the sun helps release endorphins in the skin, and people may become addicted to the feeling they get after tanning.

All we need now is a report about passive tanning. Watch this space.

Friday 16 April 2010

Ignore the food police

As I mentioned on Wednesday, a common defence of arbitrary nutritional targets is that they can't do any harm. In Velvet Glove, Iron Fist, I gave the example of George Lundberg, former editor of the Journal of the American Medical Association, who published a junk science article which showed that eating fish halved the risk of coronary heart disease. When the study was exposed as garbage, he glibly replied: "People are told that eating fish once a week is not a bad thing. What harm can it do?" That, in a nutshell, is the problem with the public health crusade. The harm, surely, is to science and to the truth. You would hope the editor of a medical journal would appreciate that.

Sometimes, however, the harm is more tangible. In the case of dietary advice, it seems that parents have been giving their children the kind of meals that would be more appropriate to a food faddist on detox. From the BBC:

"Parents are aware of the importance of ensuring their child eats healthily to avoid obesity and health problems in later life, but this can sometimes lead to parents making requests that their child follows a strict diet, such as skimmed milk and low-fat foods," says [the National Day Nurseries Association's] chief executive Purnima Tanuku.

It is the madness of public health to paint some foods as good and some as evil. Against this background of fear, parents can hardly be blamed for avoiding 'evil' foods such as fat and carbohydrates while turning to trendy alternatives. But they really shouldn't...

"Children under five have specific needs, and should not have low-fat diets as their growing bodies need fat and carbohydrates."

Growing rapidly, this age-group needs a diet which is - proportional to their size - much higher in calories than that of an adult.

An obvious point, that. Children are not adults. They need calories and plenty of them. But while a small number of parents allow their children to grow fat, many other parents have gone in the opposite direction, giving their kids meals that are only suitable for an office worker on a diet. Just as the 'evil' foods are essential for children, the 'good' foods are nothing of the sort.

Studies have shown that children burn fat much faster than adults - and so skimmed milk and other low-fat dairy products should remain off the menu until they are much older.

"And parents really shouldn't feel too anxious about puddings - sponge and custard is a good dessert to offer, surprising as that may sound," says Jessica Williams, a paediatric dietician.

And don't listen to the vegans and quacks, give them some meat.

"There have also been problems with the messages about red meat. It's a shame some parents feel so worried about it as it really is the best source of iron, and iron deficiency anaemia among toddlers in particular is common."

And what about the totally arbitrary 5-a-day target?

"And while the five-a-day message must certainly still be there, a child's portion does need to be smaller so they have room for the other, more substantial items on their plates. They simply won't get the calories they need from fruit and vegetables, even in large quantities."

The risks of following public health dogma are very real. More real, indeed, than the hysteria about childhood obesity.

There are in fact concerns that the plight of the underweight child has been forgotten amid the intense focus on childhood obesity.

Studies have shown that being persistently underweight as a child can cause problems over a lifetime, from cognitive impairment to skeletal disorders.

"Poor nutritional status in toddlerhood can be linked to permanent cognitive damage and a child never reaching their full potential, as well as shorter stature in adulthood."

But isn't all this based on sound science?

"I think that we are in danger of overlooking these children in the obsession about obesity - and I am not convinced that we have good measures of bodyweight in small children in terms of later risk," says City University's Helen Crawley, director of the Caroline Walker Trust which promotes good diet. "We should be much more careful."

As is revealed time and again, the people who issue advice about diet make it up as they go along, often swayed by their own obsessions (primarily vegetarianism). No sooner has policy been based on one study when another study comes along and says the opposite. At the very least, there should be a recognition that the available data are a mass of contradictions and that the diet which has made us the longest-living people in history remains the best bet. 

Public health has become hopelessly corrupted by the idea that 'strong messages' need to be sent out. It willfully misleads people and then refuses to take the blame for pandering to people's neuroses. In the case of diet, that means demonising some types of food (salt, fat, carbohydrates, sugar) and glorifying others (wholemeal bread, skimmed milk, broccoli). It may not be their intention to terrify parents into feeding their kids rabbit food, but it is such an obvious consequence of their actions that it can barely be called unintended.

If you want to know what to feed your children, listen to your grandmother before you listen to anything from the zealots, quacks and food faddists who now dominate the public health movement.

Thursday 15 April 2010

Tony Blair: the smoking years

I'm reading Strange Days Indeed by Francis Wheen at the moment, from which...

I have an abiding memory from the late Seventies of my first encounter with a puppyish young barrister named Tony Blair, who turned up at the New Statesman offering a short article about a High Court judgment and then accompanied me to our local pub in High Holborn, where he bought a packet of fags and lit up. 

Cherie Booth later ordered him to kick the habit as a precondition for marrying her; in 2006, as prime minister, he avenged himself by banning smoking in all public buildings. Having a ciggy in a saloon bar is now as unthinkable as driving without a seatbelt.

Explains a lot.

Wednesday 14 April 2010

How public health targets are set

Helen Rumbelow at The Times has published an important article about the 5-a-day fruit and veg target which has recently been shown to have no effect on cancer risk. Rumbelow gives a fascinating insight into how these targets are plucked out of the air based on shoddy evidence (see also: drinking guidelines).

The key quotes from the article are:

“The world has gone mad with targets,” says Tim Lang, the first stop in my quest. I’d tried the Department of Health, and was told its five-a-day programme was announced in 2000, based on World Health Organisation advice about the role of diet in cancer, but that didn’t really tell the full story.

Lang, a professor of food policy at City University, remembers it differently. It was the late 1990s, the new Labour Government had come to power and set about instilling a target-driven culture in every aspect of British life.

Ain't that the truth?

“We all understand targets in the policy world. I remember being in the room when we were being briefed by Americans on five-a-day, which we adopted from them. They chose five partly as it was considered a nice round sum and partly because it seemed possible, given how low consumption of fruit and vegetables was.”

Because it seemed "possible"? Because it was a "nice round sum"? This is how worldwide health advice is formulated?

In 1991 the American Government adopted the five-a-day policy, as growing numbers of experts were stating that bad food was causing cancer. First and foremost among them was Britain’s esteemed Sir Richard Doll, the scientific hero who established the link between cigarettes and cancer. In 1981 he estimated that a third of cancer deaths in the West could have been avoided with a better diet.

And he happened to be wrong about this. This was recognised by impartial observers long ago.

“It was a pretty rough, arbitrary number, which is always the case with any target,” says Willett. 

OK, fair enough. There's no point arguing over whether they should have said 4 or 6 portions of fruit and veg a day, but where was the evidence for any of it?

But, he adds, the studies were fatally flawed.

“They were based on retrospective evidence — asking people about their diet after they had already got cancer, which can lead people to report differently. Also, the control groups were not perfectly random, the people who volunteer for that kind of thing are much more health-conscious individuals.”

And, as I have said before, these are the same problems you get with secondhand smoke studies. The studies are wide open to all sorts of confounding factors and biases.

Still, at least it wasn't a money-making exercise.... was it?

“It was Susan Foerster, the head nutritionist in California. She had the bright idea of promoting fruit and vegetable consumption in a state which was a big fruit and vegetable producer.”

Unbelievable. As the livid Counting Cats concludes:

The fuckers just made it up. Like booze units, drug bans, traffic calming, climate chaos, second-hand smoke, third-hand smoke… The evil little turdulently tinpot meddlesome ratbags they really are.

Of course, some people will say there was no harm done here. Eating fruit and veg is good for you, even if it doesn't protect from cancer. This is the last line of defence for all junk science.

And it's true, if you don't see anything wrong with spending millions of pounds on health campaigns based on fantasy figures. 

It's true if you think the public should be treated like ignorant savages who are incapable of making their own decisions. 

It's true if you only care about reaching arbitrary targets. 

It's true if you think that an obedient population is more desirable than a well-informed population. 

And if you believe all that, there may be a job for you in public health.

Tuesday 13 April 2010

Junk from Canada and a surprising admission

Public smoking bans seem to have paid off in fewer hospital admissions for heart and lung problems, a Canadian study suggests.

The study looked for any effects of Toronto's 2001 ban on smoking in restaurants, aimed at reducing exposure to second-hand smoke, which the researchers say is a major factor in preventable poor health and premature death.

In Monday's issue of the Canadian Medical Association Journal, the researchers reported the following changes since the ban took effect:
  • 17 per cent decrease in the heart attack hospitalization rate

Ah, the magical 17%! As reported by the infamous Jill Pell, and as reported by the still-more infamous Stanton Glantz. With such remarkable consistency, perhaps we should see it as evidence of a genuine effect? Alas, no, since Pell's fictitious 17% was for 10 months, Glantz's was for all sorts of time periods and this new study's was for 8 years. Quite the opposite of consistent, really.

Michael Siegel explains why there are "huge problems with this study." His critique is recommended reading for anyone who needs convincing that these studies—every single one of them—rely on appalling methodology and sleight of hand. In particular, Siegel points to some huge drops in heart attack admissions in the places without smoking bans, and shows how the researchers buried this evidence.

An editorial about the study appears in the journal, written by British public health demagogue Alan Maryon-Davis. Maryon-Davis is, I'm afraid, a classic busybody, who describes himself as a libertarian despite calling for extraordinarily illiberal policies in the name of health. His views aren't worth paying the $20 the Canadian Medical Journal wants for them, but according to CBC:

In a commentary that accompanies the study, Prof. Alan Maryon-Davis of Kings College London, United Kingdom, argued for comprehensive cost-benefit analyses to weigh the potential health benefits of anti-smoking legislation against infringements on personal liberty and effects on jobs and livelihoods.

What would be the point? We already know that tobacco control flatly denies that smoking bans cost jobs, and we know that they value public health over personal liberty. And if the 'benefits' of smoking bans include these ludicrous ecological studies, to which no serious epidemiologist would put their name, we can be sure it wouldn't be worth the paper it's written on. Why pay these people to conduct another rubber stamping exercise when, as with the so-called review of the UK smoking ban, the result is preordained?

A better idea would be to get some serious, unbiased statisticians to look at heart attack data from around the world and see if there is any real correlation with smoking bans. After they've shown that there is no correlation (as they surely will, if data from the UK, America, Australia, New Zealand and several other countries are any indication), let's launch an investigation into how a small cabal of quackademics have engaged in what amounts to scientific fraud. How about that, Alan?

Speaking of junk science, the CMAJ carries another smoking-related story which has been buried under the media coverage dedicated to the latest heart attack fairytale. Last month I attempted, not very successfully, to convince BBC Scotland that Prof John Britton was—for want of a better word—lying when he said that secondhand smoke in a car was 23 times more dense than in a smoky bar. In the CMAJ, Ross MacKenzie and Becky Freeman have now exposed that lie:

There is no evidence to support the claim that smoking in cars is 23 times more toxic than in other indoor environments, according to a report in the Canadian Medical Association Journal.

Ross MacKenzie and Becky Freeman, from the University of Sydney, have criticised the 'unsubstantiated' figure and plotted its path through both the mainstream press and scientific publications before become widely accepted as 'fact'.

Kim Barnhardt, of the Canadian Medical Association Journal, said: 'There is no evidence to support the fact that smoking in cars is 23 times more toxic than in other indoor environments.'

As I have mentioned before, this "fact" has no basis in science and originated from Chinese whispers and ASH press releases. If it has a source at all, it seems to be a news report in that esteemed medical journal Rocky Mountain News.

'Successful advocacy campaigns often require the translation of complex research findings into short and memorable media quotes,' the report states.

That's being very generous. The '23 times higher' is, quite simply, a lie and always has been so. It would be perfect material for More or Less or Ben Goldacre, but don't hold your breath. Goldacre, in particular, seems able to turn a blind eye to bad science if it's in the name of a 'good cause'.

Finally, a plea. I've read the new heart miracle study, but if anyone has Maryon-Davis' article or the car study, I'd be interested to read them in full: Thanks.

Socialist propaganda

Via Counting Cats, I've just seen the cover of the Labour manifesto. It's a bit retro, isn't it?

Sunday 11 April 2010

A brief rant about bottled water

For me, one of the most baffling developments of the past decade has been the rise of bottled water as a lifestyle commodity/fashion statement/comfort blanket. Not only have millions of seemingly sane individuals been persuaded to pay upwards of a pound for something that comes out of the tap for virtually nothing, they appear to believe that without constant access to H20, they might actually die of dehydration.

At what point did it become inconceivable for folk to attend meetings, take a short train journey or just walk down the street without a personal supply of water? 

Don't get me wrong here. If you've got a mile to cover on a hot August afternoon, I'll turn a blind eye—even if I'll wonder why you don't grab a Coke for the same price. But, in general, I can't help but see the ubiquitous water bottle as a 21st century substitute for the dummy or, to drag this blog back into familiar territory, the cigarette.

It's particularly strange, is it not, that environmentalists are so quiet about something so unnecessary, so wasteful of plastic and so expensive to transport? Could it be that environmentalists are the very type of people who are in search of the ill-defined, but modish, trinity of health, purity and detoxification which makes them suckers for the bottled water industry?

This is little more than a personal hobby-horse, I grant you, but as this article in The Guardian shows, I am not alone.

As I sat in the cafe later, necking a hard-won jug of free tapwater, I realised how odd our relationship with water has become. Sure we've persuaded restaurants to stop charging us for it but no fewer people seem to be wandering around like overgrown babies, clutching plastic sucky-bottles.


Anyone with the brains to read (outside the ad agencies that come up with this sort of rubbish) must by now be aware that the argument that water 'detoxes' is entirely spurious, that the 'two litres a day' myth is just that and that buying water shipped from places like Fiji - even if it can be 'greened' through some 'offsetting' sophistry - is as immoral as it is absurd. Yet somehow, we've programmed ourselves deeply. Stand, sometime, in the queue at the airport; the last few feet before the metal detector, where the travelling classes are having their bottles torn from their hands by stone-faced airport stormtroopers. Witness the genuine pain on their faces.

Yes! Yes!

It makes me want to throttle them all individually. It's bottled bloody water. You can survive without it until you get on the plane. You saw the security signs, you know that poor sod is only trying to stop someone blowing your holiday to smithereens over Staines, yet you act like you're being brutally deprived of a human right. You tut about waste as it's thrown into the blue bin as if it wasn't your own, vacuous credulity that made you give £1.50 to a multinational for it half an hour ago.

What I particularly like about this article is that—unusually, in an age when people think their opinions should be law—there is no call for higher taxes, or a ban on advertising, or a government-sponsored campaign to denormalise bottled water. Just a plea for sanity; a revolution in the head...

Our weapon should be ridicule. Next time you see someone with a bottle of water, be sure to point and laugh.

That's all that's required or, at least, is acceptable in a liberal democracy. If a campaign of ridicule doesn't work, then too bad for the writer of this fine article and too bad for me. I'm not saying bottled water should be banned. I'm not saying that we should burn effigies of people who drink bottled water (a new and real development for which words fail me, but Dick, Bella and Leggy have much to say). 

I'm just saying it's a bit daft. It's only my opinion and you're free to disagree. It's your life. Live it as you wish. I just reserve the right to call you a bit of a twat. That's all.

Thursday 8 April 2010

Carless in Heathrow

In 1985, a taxi driver—Richard Carless—refused to pick up a passenger from Heathrow airport because the man had just lit a pipe and intended to smoke it. The taxi driver had asthma. The passenger understood this and agreed to wait for the next cab. There is no suggestion that their conversation was anything but amicable. However, a passing traffic warden reported the taxi driver to the police who prosecuted him.

According to the Daily Mail:

Mr Carless said the man was happy to wait for the next taxi but a passing traffic warden spotted what happened and called the police.

What law this man had broken, I don't know. Is there some law saying that taxi drivers have to pick up everyone who hails them? Is it a condition of having a taxi license? Perhaps so. Whatever the case, it resulted in the taxi driver going to prison.

Richard Carless, 67, was locked up for seven days in July 1986 after turning down the passenger who wanted to light up in his car because he feared it would aggravate his asthma.

He refused to pay the £120 fine on a point of principle and was put behind bars.

The former taxi driver is now taking the case to the Court of Appeal, saying it ruined his life.

Once you get over the amusing idea of a former taxi driver being called Mr Carless, this story raises several issues. The obvious observation is to say how times have changed. Today, of course, the police would have prosecuted the taxi driver if he had allowed the man to get in his cab. He would be looking at a £2,500 fine for 'permitting smoking' in an enclosed place and could face, like Nick Hogan, a 6 month prison sentence. Indeed, only last week, two taxi drivers were prosecuted and fined for smoking in their cabs when nobody else was present.

If we look at the Daily Mail's comments section—not a senate of reason, admittedly—we find contrasting views. From this:

This is ridiculous. You people don't jail criminals yet you jail a man for refusing to carry a smoker. I can't stand smokers and I would have done the same as this man. Mr. Carless was right then and now.
- Latima, FL USA, 07/4/2010 13:45

To this:

oh the good old days! a time when we were responsible for our actions and not told how to live our lives by a nanny state
- IAND, LONDON, 7/4/2010 11:20

In the course of 24 years, we have gone from a system that effectively protects people's 'right' to smoke in a cab to one that prosecutes people for smoking in a cab (I can't quite believe that taxi drivers didn't have the right to designate their cabs as non-smoking in 1985, but anyway...)

People like the American above who "can't stand smokers" (not, you will note, smoking, but smokers) are no doubt delighted that the government's guns have turned 180 degrees and are now aimed at smokers. The chap from London clearly thinks that the old ways were the best. 

Both of them, I would argue, are wrong. The law in 1985 was an ass. Far from making us "responsible for our actions" it intervened unfairly and unnecessarily in a private negotiation between a taxi driver and a potential customer. The taxi driver's terms were not to the customer's liking—he had just got off a flight and wanted to smoke—and the customer was happy to wait for a driver who would accept his terms. No one was hurt, or even upset, by this negotiation.

Today, that pipe-smoker would still be able to find a taxi driver who would take him where he wanted to go, but the law does not allow it. That's because the law is still an ass. No one would be hurt—the driver might ask him to wind the window down—and everyone involved in the transaction would be happy. As in 1985, the only people who would be unhappy will be distant bureaucrats and, perhaps, the odd interfering traffic warden.

There are no victims or villains in any of these 'crimes'. By prosecuting individuals for victimless crimes, the state itself is the villain. You do not—or rather should not—have a right to demand entry into private property. That, I'm afraid, also applies to bed and breakfasts, since bigots have property rights as well. Richard Carless took a stand against an unjust law and that should be recognised. Nick Hogan also took a stand against an unjust law. From their completely different perspectives, they have both suffered at the hands of the government despite harming no one.

Issues like the story above polarise debate. It's easy for some nonsmokers to rejoice that the state is now going after smokers. Equally, some smokers might be nostalgic for the days when the state, however inadvertently, went after nonsmokers. Upon sober reflection, we might conclude that all our interests would be better served if the state didn't 'go after' any of us. 

All the good stuff

I wasn't blogging over Easter, but here's a bit of good reading if you haven't had the pleasure already...

At Spiked, Patrick Basham pulls apart the recent 'junk food is like heroin' garbage:

Proving that junk food is addictive is a crucial final step in the War on Obesity. As long as the debate over obesity is framed in terms of choice, autonomy, and responsibility, the advocates of aggressive and overwhelming state action will face considerable problems getting many of their policy proposals accepted.

Meanwhile, there's no sign of the medical establishment's God complex wearing off in Britain, where those nice people at the British Medical Association want to ban smoking in the homeLeg-Iron is mad as hell and he's not going to take it any more:

We smokers have attempted compromise at every turn. We have not demanded all the pubs back, we have asked for some. We have asked for private smoker's clubs, staffed by smokers, but have been refused. The ban is total. No compromise at all. And we are called 'selfish'.

We are also called many other names, any of which, if applied to one of the government's pet groups, would get the name-caller arrested. We smokers are expected to shut up and get out of the way because we are inferior.

I say 'enough'.

Frank Davis has also had enough:

Push smokers too far, and they'll fight back. Push antismokers too far, and they'll fight back too. In many ways we already have a civil war. We have a civil war that is being conducted by antismokers against smokers. At some point, when smoking was ubiquitous, the antismokers probably got pushed too far. And they set out to fight smoking with everything they had. It's an unrelenting war. It never stops. Antismokers are trying to completely wipe out smokers. And it's only a matter of time before smokers start fighting back, and set out to completely wipe out antismokers, because now they're being driven too far too.

On a very different note, Google have put a very rare anti-tobacco tract from 1854 on-line (for download as PDF). Titled O tempora! O mores! A word to the wise on the use of tobacco and snuff, it gives a good insight into anti-tobacco sentiment in the days before they pretended it was only about health. Full of tall tales and hyperbole, it's an excellent example of anti-tobaccoism from that era:

These practices are of so filthy and disgusting a nature, and attended by so many evils, producing such fearful results to man, not only in a physical but a moral point of view, that it remains one of the most intricate problems how such practices can ever be tolerated amongst thinking people, much less become popular, to an extent so inconceivable as to be justly considered a national evil... [and so on for 100 pages]

It's worth noting that the whole treatise is not just against smoking but against chewing tobacco and snuff. Stopping smoking has never been the only goal; it has always been the aim to eliminate all forms of tobacco. Today's equivalent to snuff is the e-cigarette and today's equivalent to the Victorian anti-tobacco nut is John Banzhaf, who claims to have got e-cigarettes banned in the USA:

The importation of e-cigarettes will be banned indefinitely as the result of a unanimous ruling by the U.S. Court of Appeals.

Dick Puddlecote warned e-cigarette users than ASH were not their friends some time ago. In 2010, as in 1854, it is a moral crusade for people like Banzhaf. Puddlecote reminds us, once again, that you can't pick and choose which liberties you defend:

You're either libertarian, or you're not. You can't pick and choose which liberties you wish to keep, and which are OK to be stamped on. Bending an inch to these people just boosts their power and leads, eventually, to something being attacked which you hold dear.

But, in any case—and as the tireless Michael Siegel points out—Banzhaf is lying again:

While it is true that the FDA seized two shipments of electronic cigarettes, it is not true that the Agency has placed a ban on the importation of electronic cigarettes. To the best of my knowledge, these products continue to be imported and sold throughout the country. The FDA has certainly threatened to take enforcement action, but it has stopped short of formally banning the importation of the product, and to my knowledge, is not stopping these products from entering the country.

Finally, an election has been called for May 6. As I wrote some time ago, it will be interesting to see if Gordon Brown mentions the smoking ban when defending his record. I hope my readers will keep me posted. Otherwise, I will try not comment on politics for the next four weeks. I tend to agree with Simon Heffer at the Daily Telegraph:

As the campaign proceeds, the spectacle of inadequates on our television screens – Harriet Harman trying not to appear deranged by fanaticism, George "Sharing the proceeds of growth" Osborne trying to pretend he understands economics, or almost anyone from the Lib Dem front bench (except Dr Cable) trying to be taken seriously – may drive people either into the arms of the minnows, or abroad on holiday until the ghastliness is over...

The tedium to come can be obviated by not turning on the television for a few weeks. Newspapers, believe me, will ensure the diet of politics is kept to the minimum: our readers are precious to us, and we wish neither to bore them with the self-importance of politicians nor to insult them by bombarding them with propaganda. Strong drink and martial music may be useful. That still leaves the problem of how Britain will ever be run properly, whether by a tribal introvert who wishes to suffocate us with his "values", or a PR spiv whose "big idea" is to appoint 5,000 commissars to assist the development of "communities". There will be more absurdity yet. "Democracy," wrote Carlyle, "which means despair of finding any Heroes to govern you!" How right you were, Tom, how right you were.

Wednesday 7 April 2010

Fruit and veg

The Journal of the National Cancer Institute has just published a very large study which finds that eating fruit and vegetables has, at the most, a very weak effect on cancer risk (see BBC report). This could be seen as yet another example of lifestyle epidemiology contradicting itself—only a few days ago a study reported that eating a fried breakfast was a good way of combatting obesity—but there are good reasons to take this particular paper seriously.

Firstly, it is a very large study, involving over 400,000 subjects. Secondly, it is a cohort (or prospective) study, ie. it follows people over a period of years rather than interviewing people who are already ill. In these two respects, it trumps most of the studies that have found lower cancer risk amongst those who eat their 'five-a-day'.

The JNCI study found a relative risk for those with a high intake of fruit and vegetables to be 0.97 (95% CI = 0.96 to 0.99), ie. a 3% reduction, and there are serious doubts over whether even this extremely modest reduction is genuine or the result of confounding factors. There are few areas of science where a 3% reduction would be taken seriously.

Walter Willett, a prominent figure in the epidemiology of diet, has written a frank editorial to accompany the study, calling the association "very weak" and noting that there is not a single type of cancer that is significantly reduced by eating fruit and veg (full free text). The history of how such a belief came about bears repeating:

During the 1990s, enthusiasm swelled for increasing consumption of fruits and vegetables with the expectation that this would substantially reduce the risk of many cancers. Potential reductions as large as 50% were suggested... 

However, the evidence for a large preventive effect of fruits and vegetables came primarily from case–control studies, which can be readily biased by differences in recall of past diet by patients with cancer and healthy control subjects...

In the late 1990s, the results of large prospective cohort studies of diet and cancer began to accrue, and these did not confirm the strong inverse associations found in most case–control studies. Furthermore, a series of analyses that pooled the data from prospective studies for specific cancer sites confirmed the weak and non-statistically significant associations.

There are clear parallels with the evidence for passive smoking and lung cancer here. In both cases, the largest risks were reported when research was in its infancy (eg. Hirayama, 1981) and most of the evidence came from case-control, rather than cohort, studies. As the years went on, the reported risks diminished, falling from over 2.0 (100% increase) to less than 0.3 (30%). 

Just as the World Cancer Research Fund used a meta-analysis of questionable studies in 2007 to condemn almost everything except fruit and vegetables are carcinogenic, so the EPA and SCOTH conducted meta-analyses based on shaky science to condemn secondhand smoke as carcinogenic.

In both cases, larger and more reliable studies found no risk. In the case of secondhand smoke, one of the most important null studies came from the World Health Organisation's  IARC with Paolo Boffetta as lead author (1998). It found no statistically significant association with lung cancer despite one of the largest sample groups every studied. In the case of fruit and vegetables, the lead author is, again, Paolo Boffetta, and he finds a significant, but very weak, association.

In 1998, the WHO went to the unprecedented lengths of issuing a press release to contradict one of its own studies, so important was passive smoking (and thereby, smoking bans) to the battle against active smoking. It will be interesting to see if there is any backlash against this new study. 

As it is a less heated area, possibly not. Willett concludes his editorial by calling for "heightened efforts to reduce smoking and obesity" which remain the key battlegrounds, but there are many food faddists and vegetarians who will not be happy to hear that their lifestyles are not as healthy as they believed. There will also be many epidemiologists who will (justifiably) feel their work has been discredited.

Ultimately, after a brief period of controversy, the IARC's secondhand smoke report was forgotten about and attention shifted back to the grab-bag of smaller studies which had been favorable to the passive smoking theory. This new study may meet the same fate; already the tiny association it reported is being taken as fact, with all the caveats and doubts ignored:

In any event, a reduced risk of 2.5% should not be dismissed out of hand, the World Cancer Research Fund argues.

"For the UK, this works out as about 7,000 cases a year, which is a significant number," says Dr Rachel Thompson from the charity, which in a major 1997 report said there was "convincing evidence" of the protective effect of fruit and vegetables.

In Velvet Glove, Iron Fist, I described the World Cancer Research Fund's report as "a veritable encyclopedia of weak associations and questionable meta-analyses" (p. 310). Today's JNCI study only reinforces that view. Whatever the truth about this particular issue, basing policy on statistical studies that change like the weather is a fool's errand. 

Tuesday 6 April 2010

Gimme a pack of low birth weights

From the Daily Telegraph:

Women who exercise during pregnancy produce 'lighter babies'

As Tim Worstall points out, haven't we been told that low birth weights are a bad thing ever since they were associated with smoking in pregnancy? So are we now going to stop these women exercising?

Dr Paul Hofman, from the University of Auckland in New Zealand, said: ''Our findings show that regular aerobic exercise alters the maternal environment in some way that has an impact on nutrient stimulation of fetal growth, resulting in a reduction in offspring birth weight.

''Given that large birth size is associated with an increased risk of obesity, a modest reduction in birth weight may have long-term health benefits for offspring by lowering this risk in later life."

I can't say with any confidence whether low birth weights are good, bad or indifferent, but a little consistency from the medics would be nice. It's hard to avoid the conclusion that 'lighter babies' are good/bad depending on whether the researcher is involved in the crusade against smoking or the war against obesity.

And if larger babies really do grow up to be fatter, doesn't that suggest that some people are just born fat and that the so-called 'obesogenic environment' has got nothing to do with it?

Incidentally, I remember reading somewhere (can't find it now) that the weight difference between smokers' and nonsmokers' babies was ridiculously small—something like 9 grammes. Do any of my learned readers have the figures?

Thursday 1 April 2010

NYC: First smoke, now salt

From The Guardian, the city that brought you the smoking ban is now bringing in the salt ban:

New York restaurant kitchens face threat of salt ban

City politician proposes £600 fines for restaurants that use salt in recipes

Over the past few years New York has gained a reputation for taking the health of its citizens seriously – or nannying them, depending on your point of view.

Now a member of the city's legislative assembly has gone a step further by introducing a bill that would ban the use of salt in restaurant kitchens.

Bill A10129 would forbid the city's chefs from using salt in any of their recipes. The ban's proposer, Felix Ortiz, a Democratic member from Brooklyn, says it would give consumers the choice about whether to add salt to their meal.

Restaurants trying to sneak a bit of sodium chloride on to the plate would be fined $1,000 (£600) every time they were caught.

Ha, ha! Gotcha. April fools!!!

Er, actually no. This is from The Guardian three weeks ago. I tried to think of an April's fool wind-up, I really did, but considering what I have to write about every day, it's impossible to come up with anything so ridiculous that it hasn't already happened, is happening or will happen.

If you want a real bit of tom-foolery, The Guardian and Tom Harris have got the goods. At least I think they're joking. It's hard to tell anymore.