Wednesday 29 September 2010

Smoke and a pancake?

This has not been reported by the BBC (as usual), but the Dutch are going to relax their smoking ban. The ban has never been popular, has been widely flouted and has been little enforced. After effective campaigning—for which Wiel Maessen deserves much credit—the country's many small bars have gained an exemption from the ban.

Owners of small pubs in the Netherlands have welcomed the lifting of a smoking ban imposed on the hospitality industry in 2008. The partial scrapping of the measure was announced on Tuesday.

The incoming rightwing government is responding to persistent complaints from one-man businesses who argued that the smoking ban was meant to guarantee staff a smoke-free working environment. Since they had no employees, their small pubs didn't need the smoking ban, the owners claimed.
The ban will remain in force, however, for pubs, restaurants and the like which are run with personnel.

Secretary Wiel Maessen of the 1250 small pubs' umbrella group KHO said "I lit an extra cigarette when I heard the news." He added that despite his satisfaction on behalf of his members, the fight would not be over until the ban was lifted for the entire sector.

All of which means that the Netherlands, like most other European countries, have rejected a total ban to avoid the devastating economic effects seen in the UK and Ireland. Which begs the question, why doesn't the UK's new liberal, regulation-hating, freedom-loving, pro-business government not even consider the possibility of the doing the same?

Tuesday 28 September 2010

You can't rip people off, that's our job!

Blackadder: How would you like to earn some money?

Comte de Frou-Frou: I would not like to earn it. I would like other people to earn it and give it to me. Just like in France in the good old days!

On a few occasions over the last decade, Action on Smoking Health have got upset about (alleged) price-fixing between tobacco companies. It happened in 2003:

"We ... hope that the OFT carry out a thorough probe and are not fobbed off by industry spin," said Amanda Sandford, of anti-smoking group Action on Smoking and Health. If the consumer is being ripped off then this should be exposed."

And again in 2008:

“The hypocrisy of the industry knows no bounds,” said Deborah Arnott, the director of Action on Smoking and Health. “While complaining bitterly about tax increases, these companies have been raising the price of cigarettes to fill their own coffers while hiding behind the screen of tax rises.”

Coming from people who call for higher cigarette prices at every opportunity—and who barely conceal their contempt for the consumer—this righteous anger might seem baffling. If raising the price of cigarettes reduces smoking, what does it matter whether it is the government or the industry that does it?

But that is to disregard two of the key components of the modern anti-smoking movement: fanatical hatred of the tobacco industry and an unquenchable thirst for money.

Readers will be no doubt be thrilled to hear that Prof. Anna Gilmore, the world's greatest scientific mind and a woman of unimpeachable integrity, has now started dabbling in economics. In an article published the impeccably peer-reviewed Tobacco Control magazine, Gilmore uses the concepts of market failure and barriers to entry as an excuse to curtail tobacco industry profits. The only problem is that she doesn't understand what market failure is and the barriers to entry are entirely the result of tobacco control's own policies (ie. banning advertising).

Like ASH, Gilmore wants higher cigarette prices, but not unless the state (and state-funded researchers in the anti-tobacco industry) get to keep the spoils. Here's a sample paragraph...

This situation benefits the tobacco industry while disadvantaging the consumer, and reducing potential benefits to population health and the public purse. The extreme profitability of cigarettes gives tobacco companies both the incentive and the resources to fight public health measures designed to reduce tobacco consumption, and an enormous interest in opposing anything that could disrupt the current cigarette-dominated nicotine market. The pricing power of these companies also creates significant economic rents for the tobacco companies which ought to be captured by the state and used for wider social benefits.

Where to begin with such guff? We could start by asking when tobacco control suddenly started worrying about smokers being "disadvantaged" by higher cigarette prices or anything else? We could ask exactly which "public health measure" has been successfully fought by the tobacco industry in recent years? And does not the industry have a right to defend itself, and its customers, against Gilmore and her ilk in any case? Who really has an "enormous interest in opposing anything that could disrupt the current cigarette-dominated nicotine market"? Was it the industry that banned snus in the EU? Is it the industry that is banning the e-cigarette around the world? Or is it the puritan wing of tobacco control aided and abetted by the pharmaceutical industry? And in what kind of society do profits from a legal industry get "captured by the state" for no reason other than that its opponents resent its wealth and wish to have it for themselves?

Carl V. Philips has written an excellent post about Gilmore's latest train-wreck of a study over at ep-ology ('Anna Gilmore adds junk economics to her junk epidemiology portfolio') so there's no need for me to say any more. Here's a sample...

So this is their “radical” idea? Putting a new label on basically what is already being done, perhaps with a bit of nationalization of the companies, and making the absurd claim that this has something to do with the economic theory of market failures?

The most charitable interpretation is that this is just an attempt to use junk science as an excuse for a preferred policy, to transfer corporate profits to the government (something that can be done any number of ways that would work better if that is what government decides to do).

Well, I suppose given Gilmore’s demonstrated abuse of epidemiology there was no reason to expect anything else.

Incidentally, Gilmore's is the second article to be published recently in Tobacco Control which discusses ways of forcing the tobacco industry to hand its money over to public health 'professionals'. The other wants a 'polluter pays' principle and is discussed on the seldom updated TC blog (check out the swivel-eyed contribution from James Repace in the comments)

Is the anti-smoking lobby getting worried about where the next billion dollars is coming from? In these difficult economic times, it's always possible that someone in government might find better things to spend money on than a clique of unaccountable zealots whose policies don't deliver what they promise and whose research methods fall somewhere between charlatan and comedian.

One alternative way of raising money never seems to occur to them, but I will throw it out there. As downwiththatsortofthing notes, support for anti-smoking policies is always 80%. So why not ask all those hundreds of millions of people who support the movement to chip in a few dollars each? Y'know, like legitimate grass-roots organisations and charities do. No? It wouldn't work, you say?

Coercion and extortion and it is then.

Which way will ASH go on snus?

That cradle of democracy, the European Union, is allowing citizens to sort of vote on the Tobacco Products Directive. There are only seven questions so it's worth making your voice heard.

The main issues are the legalisation of snus, regulation of e-cigarettes, graphic warnings, plain packaging and bans on vending machines and tobacco displays—all the things that tobacco controllers have been getting excited about over the past few years, basically.

The snus issue is particularly important (see question below—and note the possibility of banning all smokeless tobacco products!) Click to enlarge.

Of all the suggestions put forward in the EU document, repealing the ill-conceived and scientifically unjustifiable ban on snus is the only one which would have a positive impact on health. The only EU country currently allowed to sell snus is Sweden. Not coincidentally—since snus is 99% safe—Sweden also has the lowest rates of smoking-related diseases.

ASH (UK) will doubtless submit its views to the consultation, but which way will it go? In 2004, an ASH press release said:

ASH believes that there is no logic to the banning of snus, when cigarettes, which are far more deadly, are on general sale, but that snus should not simply be de-regulated.

That was six years ago, however, in the days before ASH developed a cosy financial relationship with pharmaceutical companies who also happen to make 99% safe oral nicotine products of their own. The "independent" anti-smoking charity has been quiet about snus in recent years.

ASH was originally set up, in part, to find ways of making tobacco consumption safer (an aim now wiped from their website). So will they act in the interests of public health or in the interests of the pharmaceutical industry?

You can respond to the online consultation here.

You can read the proposals here.

And everything else is here.

Meanwhile, GlaxoSmithKline has asked the US government to remove dissolvable tobacco products from the market. No conflict of interest there then.

Monday 27 September 2010

Collective delusions

One of the most entertaining parts of Tony Blair's autobiography is his account of Labour's lurch to the left in the 1980s. Blair admits that even he didn't think a Labour government was the best thing for the country in 1983, despite being a Labour candidate himself. He also recalls his bewilderment as activist upon activist declares that the country voted for Thatcher in 1979 because Labour wasn't left-wing enough.

The comparison with Labour today is striking, and few in the party seem able to learn the lessons from history. Two articles appeared today—one by me—involving the word 'delusion'. Over at Spiked, Brendan O'Neil marvels at Labour's cognitive dissonance.

After it ditched everything it once claimed to believe in, launched three disastrous wars, obliterated key freedoms, and went from viewing the working classes as potential voters to branding them a dumb, unhealthy blob in need of constant policing, you might think there is nothing left to admire in the Labour Party. But there is one thing. Its powers of self-delusion.

These are so strong, so unshakeable, that they cannot help but inspire a kind of bizarre, wide-eyed awe in anyone who beholds them. And they have been on full display following the election of Ed Miliband as the new Labour leader.

And at the Institute of Economics Affairs blog, I discuss Milliband Minor's wide-eyed faith in a certain piece of political junk science.

As Labour draws backs into its left-wing comfort zone, the easy answers being peddled in The Spirit Level will continue to hold a certain allure. Buttressed by soft science and sold under the guise of equality, the reheated policies of the Michael Foot era can almost appear new and exciting. In truth, reducing income inequality is easily achieved, if there is a will to do so and if one is prepared for the unintended consequences. There are no such easy answers for reviving the economy and tackling complex social problems.

The electorate understands this. Across Europe, the economic crisis has failed to provoke the backlash against capitalism that was predicted (and hoped for) in some quarters. Even in Sweden, voters have condemned the Social Democratic Party and its Spirit Level-loving leader to an unprecedented second successive electoral defeat. If he wants to avoid the same fate, Labour’s new leader will have to draw on more than populist paperbacks and wishful thinking.

Please take a look...

Interview with Scott Ballin

Earlier this month, at the 2010 CORESTA Congress, Scott Ballin (former chairman of the Coalition on Smoking and Health) and David Ashley (FDA's Director of the Office of Science at the Center for Tobacco Products) spoke about the future of tobacco in light of FDA regulation (see various Michael Siegel posts for back-story).

In the 1990s, Scott Ballin was a Chairman for the Coalition on Smoking and Health. For more than 10 years he served as the American Heart Association's Vice President and Legislative Counsel. Most recently he has served on the Steering Committee of the Alliance for Health Economic and Agriculture Development (AHEAD), an informal organization formed to work towards the enactment of recommendations contained in the Presidential Commission report Tobacco at a Crossroad, that included passage of effective but fair and workable FDA legislation.

I was there to hear his speech and was able to grab a quick interview with him in an Edinburgh bar later that day. His speech had welcomed a new era of co-operation between tobacco control and the tobacco industry to address the issue of harm reduction. This sentiment is, shall we say, far from universal in the anti-smoking movement and I began by asking him about comments he had made about elements of tobacco control drifting towards prohibition.

CS: You said that you've noticed in recent years that the anti-smoking movement is moving towards prohibition. When did you first notice this and how widespread is it?

SB: For many years the tobacco control community always said that they were not out to ban tobacco, but more and more recently, there have been statements made by a lot of people I've known a long time who believe that now that we have regulation we can go that next step and try to introduce prohibition of all tobacco. And there are some people out there who are even talking about prohibition of nicotine as a drug. I don't know how extensive that is, but it is there and people are raising the issue for the first time. Before, no one would ever talk about prohibition, or even suggest it.

CS: And they're still not talking about it explicitly in the media.

SB: Not in the media so much, but privately and on some of the websites people will talk about "we have a chance to get rid of tobacco now." Y'know, the next step is plain packaging. So there's this progression. As one person said, "We should drive the [tobacco] industry into the sea and tobacco will disappear." It's fine but I don't think people really understand what they're talking about.

As I said today, it's not the tobacco that kills you. It's what you do with it. It's how it's produced and cured and treated—what goes into it. And most importantly how it's used. You can burn it but there's a big difference between that and something that's not burned.

It is an agricultural plant and you can do a lot of different things with it, and I think that people have just refused to open their eyes to this whole new discussion about what tobacco is, what we need to be doing from the standpoint of science to make it even lower risk.

CS: So you would be firmly anti-prohibition?

SB: If people look back at my 30 year history and what I've said, I've never been a prohibitionist.

CS: Do you ever see a time when prohibition would be an appropriate response?

SB: I don't think so, no. When you get the risks of a product down... We have risks in society all the time, like in our foods. Maybe our foods will eventually become more risky than using a tobacco-based product, depending on what we do with the tobacco. We've got cholesterol and sodium and fat and the obesity problem.

So these things have to be put into perspective, but part of the problem with any movement is that it takes on a life of its own and it continues, and it continues, and it continues, and you've got to have an enemy in this day and age to be able to continue your fight. And the enemy is changing. This is not the tobacco industry of ten years ago or twenty years ago. They're becoming more pharmaceutical-like and the pharmaceutical companies are becoming more tobacco-like. It's fascinating to watch.

CS: So what would be your final goal in terms of regulation and law-making?

SB: My final goal, as it has been for the last thirty years, is to ensure that the American public is protected from dangerous products, particularly those who are underage, but that we are doing more to provide information to the public about products. That we are developing new products that are lower in risk. The same as we would do with the food industry or any other industry. This is finally happening with respect to tobacco and I would like to see a system by which the consumer—in a regulated system—has the ability to make some very sound decisions about what they do or don't do with a particular product.

If something's really dangerous they're going to move in off the market through either regulation, competition or consumer choice. If you give the consumer something that's 99% lower in risk—that's consumer-acceptable—we should be doing it.

CS: In terms of cigarettes specifically, is it possible that FDA regulation—which lists over 100 toxicants—could lead to making cigarettes that nobody would want to smoke?

SB: Well, it's possible but with the technology we have today... I mean, I'm of the opinion that there is no potentially safe cigarette. If you burn lettuce and smoke it, you're going to be subjected to all kinds of stuff that you normally would not be subjected to if you ate the lettuce. So there's a big difference here. As long as there's combustion and the ability to create all these toxins—whether it's tobacco or anything else—it's going to be much more difficult to try to reduce those toxins.

Whether that's all possible, I don't know. I don't think anybody knows. And that's what remains to be seen. But the need to develop non-combustible products that are consumer-acceptable is, to me, the most important thing today. We do know that there are significant reductions in risk. We do know that all those toxins are not there. And if we have to take out the TSNAs [tobacco specific nitrosamines] or the heavy metals or other things, that's technologically feasible. We can reduce the risks even further, and we should be focusing on that as an alternative.

Saturday 18 September 2010

What's the 'new smoking' this week?

It's been tanning, obesity, bottled water and soda in the past. So what's the new smoking this week?

You probably missed this story a few days ago (it was, after all, published in The Independent). On the front page it was flagged up as 'Is sitting the new smoking?' Inside it had the slightly less sensational headline 'How sitting can make you ill', and it's a classic of the genre.

You'd have to have been living under a stone for the last decade or so to have missed public health messages on smoking, drinking, healthy eating and exercise. Whether we act on them or not, many of us can reel off figures on weekly exercise and alcohol limits – as well as the exact contribution to our five-a-day half a kumquat provides – like well-loved stanzas of poetry.

And if a growing band of doctors and medical researchers have their way...

(Which they usually do.)

...government health advice will include another bullet point. Experts in cancer, heart disease and obesity are all calling for advice on "sensible sitting" to become, in future, part and parcel of public health drives.

...Dr Alpa Patel, of the American Cancer Society, thinks it is only a matter of time. "I think the research community is building a strong evidence base [on the dangers of sitting] that will likely influence public-health guidelines in the future," she says.

The 'strong evidence base' is, needless to say, one of stupefying banality.

If we sit down for eight hours a day, we are not spending any of that time walking, running or swimming.

I'll be damned.

Sitting implies an absence of exercise. 


In fact, as Dr Patel says, "sitting is one of the most passive things you can do." 

You don't say.

Pretty much anything burns more calories than just sitting down. 

There's plenty of more of this in the article, although I should warn those of you who don't have a scientific background that complex ideas of this kind appear throughout.

Public consultation backfires on ASH

From The Scotsman:

Figures seen by The Scotsman show almost 90 per cent of respondents who replied to a Scottish Government consultation request oppose the measure.

Hardly surprising, since there is no evidence that display bans work and ample evidence that they put an unnecessary burden on shopkeepers.

Public consultations of this kind are not necessarily accurate barometers of public opinion (to put it mildly). As we saw in England, the only thing they measure is how well organised ASH and the NHS are in getting their staff and supporters to click on a website or return a generic postcard. In this particular instance, it seems they were not at all well organised.

Out of the 305 respondents to the Scottish Government consultation, 269 - 88.2 per cent - opposed the measure with support mostly coming from NHS trusts and anti-smoking charities.

Which means only 36 people responded positively to the proposal. Considering ASH Scotland alone employs 16 people, that is pretty feeble.

The opposition compares to 84 per cent support for the same measure in England...

Quite a disparity, no? And if you have read The Dark Market (free download), you will know why that is. It's because...

...75 per cent of respondents to that consultation came from Department of Health funded bodies.

So why couldn't DH-funded bodies in Scotland manufacture consent so effectively? Probably because they know that the Scottish government does what it wants regardless of public opinion. Back in 2005, a survey showed that two-thirds of Scots believed that pubs should be allowed to accommodate smokers. Then Health Minister, Andy Kerr, responded with these timeless words:

"We are not running government by opinion poll."

And the display ban was passed in Scotland with cross-party support long before the result of this consultation was published. So, really, what was the point?

Thursday 16 September 2010

Jill Pell does it again

Readers will fondly remember Dr Jill Pell's notorious heart miracle study, which claimed that Scotland's smoking ban had slashed the heart attack rate by 17%, despite the NHS's hospital records showing nothing of the sort.

Now she has returned with a study of similar quality and integrity. This time the narrative—as reported in the worldwide press release (repeated verbatim by The Scotsman)—is as follows:

Child asthma admissions drop 18% per year since Scottish smoking ban

The rate of hospitalisations for children with asthma in Scotland has dropped by more than 18 per cent year-on-year since the introduction of the ban on smoking in public places in 2006, according to scientists.

In a study led by Professor Jill Pell in the Centre for Population Health Studies at the University of Glasgow, researchers analysed data on hospital admissions for asthma in Scotland from January 2000 through October 2009 among children younger than 15 years of age. 

As with Pell's last travesty, the study has been published in the allegedly peer-reviewed New England Journal of Medicine. The key graph is shown below (click to enlarge). The smoking ban (March 26 2006) is marked with a grey line.

From this graph, the unwitting reader might get the impression that childhood asthma rates were rising gently before the smoking ban, peaked in the first year of the ban and then went into a steep decline. That, indeed, is how the study has been reported.

Before the smoking ban came into force, admissions for asthma were increasing at a mean rate of 5.2 per cent a year. After the ban, admissions decreased by 18.2 per cent per year, relative to the rate on March 26, 2006.

But did they? The graph above purports to show the average daily rate of hospital admissions for childhood asthma. But it also shows the number of admissions in each year, so we can easily work out what the average daily rates were (taking into account leap years and the fact that the final 'year' (2009) actually ends in October.

2000: 2391/366 = 6.53 per day

2001: 2142/365 = 5.87 per day

2002: 2034/365 = 5.57 per day

2003: 1803/365 = 4.94 per day

2004: 2621/366 = 7.16 per day

2005: 2103/365 = 5.76 per day

2006: 2633/365 = 7.21 per day

2007: 2056/365 = 5.63 per day

2008: 2235/366 = 6.11 per day

2009: 1397/304 = 4.59 per day

Plotting all this on a graph, we can see that childhood asthma rates were not rising before the ban and the only evidence for even a vague drop since the ban comes from the incomplete ten-month 'year' of 2009—several years after the ban came in. And, again, we can see that the peak year for asthma hospitalisations came in 2006—the very year that the smoking ban came into effect, which—by the logic of the study—should have seen a large drop in admissions.

I am at a loss to explain how Pell transformed the mundane, patternless hospital admissions data into the graph published in the NEJM study. The data simply do not fit the chart. She says only that she applied "smoothing" to the graph, but that alone cannot explain the discrepancies (surely?).

There is no indication in the text that these particular figures have been adjusted. Nor is there reason to think that using calendar years—rather than April to March—makes much of a difference. ISD Scotland only provides data for three financial years (using these are more appropriate since the ban took place at the end of the financial year), but, again, these data show a peak in the first year of the smoking ban and no real decline thereafter:

Hospital admissions for asthma for childhood under 15 years old

2005/06: 2,182 (2.5 per 1,000 population)

2006/07: 2,603 (3.0 per 1,000 population)

2007/08: 2,061 (2.4 per 1,000 population)

All of which raises some big questions...

How has she managed to make it look like the peak in admissions came in 2000 when it came in 2006?

How has she managed to make it look as if rates fell continuously from 2007 when the rate rose in 2008?

How can she claim that "there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26 2006"? Over three years, that equates to a 45% decline, which is crazy and obviously didn't occur, so where does this figure come from?

How can she claim that rates were rising by 5.2% per year when the rate fell for four out of five years before the ban? How, indeed, can anyone look at this data and seriously claim that there was a "year-on-year" rise or decline at any stage over this period?

Accepting that the rate in 2009 was unusually low, how can this plausibly be attributed to a smoking ban which began years earlier? The first year of the ban saw the highest childhood asthma rate of the decade and the next two years were in line with the pre-ban average.

So, dear readers, it's over to you. Is this the worst piece of pro-smoking ban junk science yet, or is there a perfectly innocent explanation?

Monday 13 September 2010

Palm reading

From the once-great British Medical Journal comes another scientific breakthrough...

Firm handshake link to long life

The strength of your handshake could be a clue to how long you'll live, say scientists from University College London.

They matched older people's balance, grip strength and ability to get up from a chair with their risk of an earlier death.


The researchers found that death rates over the period of the studies were 67% higher in people with the weakest grip strength compared with the strongest.

A similar pattern was found in the other measures, with the slowest walkers almost three times more likely to die compared with the fastest.

Frail and weak people are more likely to die than strong and healthy people. Hold the front page.

Those slowest to rise from a chair had double the mortality rate compared with those quickest to their feet.

Even being able to balance on one leg appeared to be linked with a reduced risk of death.

People who can barely stand up are less healthy than those who can hop. Here's Tom with the weather.

And what are the practical applications of this doubtless well-funded piece of research?

Professor Avan Aihie Sayer, a geriatrician and co-author on the study based at Southampton University, said that she was now pushing for wider use of measures such as grip strength in hospitals as a way of spotting patients with greater problems.

That would be greeting patients by shaking their hand, wouldn't it? In these difficult economic times, it would certainly be cost-effective. And about a thousand years ago it might even have been a step forward as a method of diagnosis.

I haven't been in a hospital in a while, admittedly, but I was under the impression that we had slightly more sophisticated methods and technology these days—stethoscopes, X-rays, body-scans, blood tests etc. Or is all handshakes and leeches again these days?

Next week in the BMJ: New study shows that fiddles and butcher's dogs are fitter than the bed-ridden and terminally ill.

Saturday 11 September 2010

A final word on ban damage

Apologies for the light blogging which will, I'm afraid, continue well into next week. In the last post, I asked whether pubs are traditionally 'recession-proof'. The answer is, as Facebook would say, "it's complicated".

At the IEA blog, Dave Atherton has been looking at pub closures since 1980, and finds that the secular decline in pubs closures was 0.65% up until 2007. This data set includes three recessions.

In the UK recession of the early '80s, pubs closed at an unexceptional rate:

1981: 0.72%

1982: 1.02%

1983: 0.59%

In the early '90s recession, the rate was somewhat higher with a notable peak in 1991:

1990: 0.94%

1991: 2.05%

1992: 0.96%

In only three of the years did pub numbers grow (1995, 1998, 1999) and in the years leading up to the English and Welsh smoking ban, the rate of closures was remarkably pedestrian, hovering around the long-term average of 0.65%:

2004: 0.67%

2005: 0.68%

2006: 0.68%

But since the smoking ban, closures have reached record levels, with each year far exceeding the previous high of 1991:

2007: 2.42%

2008: 3.47%

2009: 2.47%

2010: 2.74%

This period does, of course, coincide with another economic downturn, but it's worth noting that although this recession was the deepest since the 1930s, it was only slightly worse than that of the early 1990s. GDP fell in the early '90s by 5.6%; it fell in the last recession by 6%. Clearly the recession cannot explain all, or even most, of the decline in pub closures. Equally clear is the fact that factors combine to cause pubs to fail. Pubs that could have survived recession, or higher rents, may have been unable to deal with the added burden of the smoking ban (and vice versa).

Based on the secular decline, Atherton estimates that 3 in 4 closures since 2007 were primarily caused by the ban. He may be right. The 2008 figure, in particular, is so much higher than any previous year that an effect from the ban is obvious to anyone with eyes to see. It's also notable that previous recessions saw a brief peak, while this one has seen four continuous years of record closures.

Sometimes the raw data speaks for itself. But imagine for a moment that the figures for 2007-10 held steady at around 0.65%. Then imagine someone claiming that the smoking ban had closed many pubs and did so by arguing that the closure rate would have been much lower if the ban hadn't been enacted. Few people would take them seriously, no? It would be an unprovable assertion made by someone who plainly had an axe to grind.

And yet, that is effectively what Anna Gilmore did earlier this year when England's heart attack rate fell at exactly the rate one would have expected based on the secular decline. And so, against all the evidence, the popular narrative persists:

Heart attacks drop at the same rate as usual = the smoking ban slashed heart attacks.

Pubs close at the highest rate on record = the smoking ban has not led to pub closures.

Welcome to the parallel universe inhabited by anti-smoking groups.

Monday 6 September 2010

Ban damage

Quantifying the damage of smoking bans to the pub industry has never been easy. As well as a long-term (post 1960s) trend towards people drinking at home, there are clearly other factors affecting the licensed trade, including higher rents and taxes. Few people seriously argue that the smoking ban has not had a negative effect on Britain's pub trade. The question is how much?

In England and Wales, the picture has been muddied by the economic downturn which began in the first year of the ban, leading to recession in year two. Our ability to assess ban damage has also not been helped by the difficulty in finding solid and specific data on pub closures. The British Beer and Pub Association has issued figures showing 39 pub closures a week, more recently rising to 52 pub closures. Measured against 2 or 4 pub closures a week before the ban, one would have to be rather blinkered to pretend that the smoking ban has not been a major factor (although some have tried), but they are still annual figures for the whole of Britain. We have not had the benefit of seeing quarterly figures for each part of the UK.

But now we do. As the Morning Advertiser reported on Friday, and Taking Liberties reports today, data from the CGA Database give us a much clearer idea of what has been happening. Analysed by CR Consulting for the Save Our Pubs and Clubs campaign, the report concludes:

The results demonstrate a very close statistical relationship between the introduction of the smoking bans and the acceleration of the decline of the British and Irish pubs. This relationship is considerably stronger than those that could be attributed to a change in the beer duty or the recession.

The strength of this report is that it looks at four countries which implemented bans at different times (Ireland: 2004, Scotland: 2006, England & Wales: 2007). Pub closures accelerated in all four countries from the middle of 2008, which obviously indicates an effect from the recession. Since there are multiple, combinative factors leading to pub closures, it may be that the recession was the final nail in the coffin for pubs already weakened by the smoking ban. Or it may not. The best way to tell would be to see how many pub closed in previous recessions. My understanding is that pubs are traditionally seen as recession-proof, but I have yet to find reliable data for this.

But if the smoking ban's impact on pubs in England and Wales is muddied by the following year's recession, the same cannot be said of Ireland and Scotland, whose respective bans were enforced four and a half years and two and a half years before the recession began.

What is striking about the figures from the CGA Database is that there is the same pattern of pub closures, regardless of implementation date and regardless of the wider economy. Large-scale pub closures began in Ireland, then in Scotland and finally in England and Wales, perfectly following the chronology of the smokefree legislation.

Furthermore, the rate of closures is remarkably similar across the four countries. Closures in year two of the smoking bans are within the narrow range of 4.1% and 5.6%. In year three, they range from 5.5% to 7.6%. And in year four, both Scotland and Ireland saw the closure rate rise to 11% (all % are based on percentage change since the smoking ban.

In the first year of a smoking ban, the damage is less pronounced. Pubs are unlikely to close straight away—most can at least make it through the first winter. The exception here is Ireland which saw a large number of closures straight away (7.3%). Since the Irish economy was positively booming in 2004/05, this cannot be attributed to the wider economy. It would be interesting to see data for previous years.

What this report shows is that England's rate of pub closures in 2008/09 (4.9%) was very similar Scotland's rate of closures in 2007/08 (4.6%). Likewise, Ireland's rate of closures in 2007/08 (11%) was virtually the same as Scotland's rate of closures in 2009/10 (11.1%).

In other words, each country is experiencing the same phenomenon to almost exactly the same degree but in different years. The only plausible explanation for this time-lag is the implementation of smoking bans. When you look at closure rates in the context of when each smoking ban was introduced, the data fits like a glove.

It also fits all the other evidence. It fits what publicans have been saying:

The readers' poll showed 77% of licensees think that trade has suffered as a result of the ban. Almost two thirds (63%) say business is worse than expected, and 72% predict a "challenging" or "very challenging" outlook for their business. Three out of five licensees said they had let staff go or reduced their hours. In addition, 73% want the ban lifted.

It fits what market analysts have been saying:

Pubs have sold 175 million fewer pints in the past year as a direct result of the smoking ban, according to market analysts AC Nielsen.

It fits what pubgoers have been saying:

There's no need for any fancy statistical analysis of trends over time. Just ask the customers.

It fits what the share prices of the Pubcos have been telling us:

You'll notice that the collapse of the share price began almost on the dot of July 1st 2007. Recession? No—that didn't start until October 2008, by which time the company had lost 75% of its value. Supermarket booze? 'Twas ever thus. Bad management? Perhaps, but the story is the same for all the pub companies.

It fits what economic theory predicts will happen when a externality is imposed on a business; it fits what the pub industry did predict would happen; it fits what has happened in other countries, in other states and in other cities.

The only thing it doesn't fit is the rhetoric of anti-smoking groups like ASH:

"Smoke-free polices are not only good for health, they are good for business. Evidence shows that in countries where smoke-free laws have been introduced, trade has generally increased."

Amanda Sandford, ASH, 2003

Lawsuit addiction

I read an interesting story in The Sunday Times yesterday. As it's behind a pay-wall, I'll have to rewrite it from memory:

Filing frivolous lawsuits is as addictive as cocaine and alcohol

Litigation could be just as addictive to lawyers as heroin or cocaine. Chemical processes triggered by the thrill of chasing ambulances give people the same cravings as do hard drugs, tobacco or alcohol, scientists have found.

Researchers discovered earlier this year that rats became addicted to money and attention in the same way that people became dependent on hard drugs. Now experiments with sub-humans have found that litigation does indeed lead to addiction-like cravings.

The latest research used brain-imaging techniques and genetic studies to prove that the same pathways are involved in response to getting your face on television and buying a new Ferrari as the ones activated by alcohol, tobacco and cocaine.

Dopamine is a brain chemical released in response to experiences that create feelings of wellbeing, including eating and sex. People get an initial high from suing one person, but the growing tendency to sue everybody in the world dampens the sensitivity of these receptors.

As a result, more and more money and attention is needed to achieve a pleasurable feeling of satisfaction, and the weight piles on.

A team led by Eric Stice, a clinical psychologist at the University of Oregon, studied a group of 26 obese lawyers. Eight of them gained an average of half a million dollars during the six-month study period, while the rest remained stable or slightly lost money.

Those who had won a lawsuit could not get a “hit” from their moment in the spotlight because their excessive media exposure in the past lowered their ability to respond to dopamine.

“There are very strong parallels between drug abuse and being a legal vulture,” said Stice, who will publish the results of the study in the Journal of Neuroscience. You see an initially elevated response in the reward circuitry; then it reduces. As people file more and more ridiculous lawsuits, their brains become desensitised to reality, and that produces weight gain.”

Paul Kenny, a neuropharmacologist at the Scripps Institute in Florida, said: “The notion of lawsuit addiction is still controversial, but the research is certainly going that way.” His study published this summer, showed that “pleasure sensors” — the dopamine D2 receptors — are dampened down in obese lawyers in exactly the same way as they are in human drug addicts.

One such case is John Banzhaf, professor of public interest law at George Washington University, who is planning action against himself, similar to the one he led against cigarette manufacturers. “We could not have done this even five years ago, but there is now strong evidence that my forty years of bingeing on money and media attention have produced the same changes in brain chemistry as alcohol, heroin and tobacco,” he said. "Dear God, what have I done with my life?"

I'm pretty sure that's what it said, although you can check the wording here.

Saturday 4 September 2010

But until then...

Apologies for the light blogging. Next week, I'll be looking at a report showing that the smoking ban has had a very damaging effect on the pub trade, some new insanity about thirdhand smoke from that priceless old crank Georg Matt and the baffling desire of British drinks industry to go like lambs towards the temperance slaughter-house.

Getting to the bottom of all this will take some time. Until then, let me point you towards a discussion of sustainability from the always entertaining Counting Cats:

Essentially what “The Good Life” shows is “sustainable” living is only sustainable if it ponces off genuinely sustainable living. Tom and Barbara couldn’t manage without Jerry and Margot. Moreover it demonstrates that such poncing about is only really doable for the middle-class and higher (I wonder if Prince Chuckles reads this?) and that living “sustainably” is essentially living as a parasite. And fundamentally that is what I mean by true decadence.

I read an interview a bit back with Brian May, the guitarist from Queen, and he mentioned parties in the ’70s where dwarfs were employed to wonder around with saucers on their heads with cocaine for the guests. Just the right height for a snort you see. Now that could be seen as decadence but is it really? Queen got up to such stunts because they were enormously successful. I mean they were packing out stadia and shifting vinyl at industrial rates. That’s sustainable in the genuine sense and it isn’t decadence because real decadence is adopting a business model that doesn’t actually bring home the corn without government subsidy.

I have railed here and elsewhere about the theft of the word “liberal” from us but “sustainable” is another they have stolen from us. Let’s talk about sustainable business. Sustainable doesn’t mean poncing off genuinely profitable business in order to worship Gaia in a cack-handed manner.

Wednesday 1 September 2010

A frank admission

From The Telegraph:

'People should smoke and drink more’, says Russian finance minister

Russia’s finance minister has told people to smoke and drink more, explaining that higher consumption would help lift tax revenues for spending on social services.

Speaking as the Russian government announces plan to raise duty on alcohol and cigarettes, Alexei Kudrin said that by smoking a pack, “you are giving more to help solve social problems such as boosting demographics, developing other social services and upholding birth rates”.

“People should understand: Those who drink, those who smoke are doing more to help the state,” he told the Interfax news agency.

It's rare to see this truism expressed so candidly, but the minister is only saying what every economist and historian already knows. He is well aware that raising the price of a pack of cigarettes from 85p to 95p will have little, if any, effect on smoking rates, and he doesn't bother pretending that tax rises are designed for anything other than raising money. Nor does he go along with the Western fallacy that drinkers and smokers are a drain on the economy.

The Russians are gloriously off-message when it comes to public health spin-doctoring, and who can blame them?