Thursday 24 February 2011

Deluded Debs deep in denial

Chronically deluded neo-prohibitionist Deborah Arnott has popped up in The Guardian whinging about an article which stated the obvious about smuggling (ie. higher taxes = more smuggling). Apparently basic economics do not exist on Planet ASH. The headline says it all:

It is a myth that high duties on tobacco lead to increased smuggling

It would be an insult to your intelligence, dear reader, if I explained why Arnott is talking rubbish. It is Tim Worstall's unreconstructed view that Ms Arnott should shut up and put the kettle on. I also recommend reading the disparaging comments beneath the article itself.

But all you really have to do is take a look at some of the stories reported on ASH's own website in recent weeks:

Two million illegal cigarettes seized in East Lancashire in two months

More than two million illegal cigarettes have been seized in the past two months in East Lancashire. Health chiefs disclosed the figure as they drew up a plan to reduce the harm that smoking and illicit tobacco has on the lives of people in the area. The tobacco, which is illegal because it has either been smuggled into the country or is counterfeit, is thought to be responsible for four times as many deaths as drugs.

Cigarettes seized in tobacco smuggling crackdown in Burton-on-Trent

More than 13,000 cigarettes were recovered from three shops by officers from HM Revenue and Customs (HMRC) in Burton-on-Trent, Staffordshire. Keith Morgan, Specialist Investigation Detection Manager for HMRC, said: “The people who sell these cigarettes are not concerned about where or how they are produced, or even who buys them, including young children and teenagers."

Warnings over sales of illegal cigarettes in South West

147 million packets of illegal cigarettes are smuggled into the South West each year, with an estimated street value of more than £104 million.

Smuggled cigarettes aimed at children

Trading standards officials in the North East are urging the public for help in stopping illegal tobacco after more than 600,000 packets of smuggled cigarettes were seized in the region. An appeal last year led to a surge in public tipoff’s about illegal cigarettes.

Richard Ferry, of the North-East Trading Standards Association, described the response as excellent and urged people to continue providing vital information. Ailsa Rutter, director of anti-smoking organisation Fresh, said: “The sellers have no morals. They will even sell single cigarettes called ‘lucies’ to children.”

Bootleg Russian cigarettes lined with Chinese asbestos

Smokers have been warned that some black market Russian cigarettes contain asbestos. Trading standards officials have revealed that many of the Jin Ling cigarettes contain industrial chemicals and asbestos-lined Chinese plasterboard. They come in yellow packs with the words Jin Ling and USA emblazoned across the front.

The brand has been described by the World Health Organization as ‘the most disturbing new development in the illegal tobacco trade anywhere in the world’.

Treasury counts cost of illicit tobacco smuggling

The sale of illicit and counterfeit cigarettes is estimated to cost the Treasury the equivalent of £10m a day in lost tax revenues. But it is not just government's coffers that are affected, small retailers such as newsagents are too.

Debbie Corris runs a tobacconists in Whitstable, and claims that cigarette smuggling has been hurting her business.

Officers seize 250,000 cigarettes at Newcastle airport

UK Border Agency officers at Newcastle Airport have intercepted more than a quarter of a million cigarettes that were being smuggled into the region.

South Yorkshire: Jail terms for cigarette smugglers

Four South Yorkshire crooks have been jailed for their part in a smuggling ring which helped the Italian Mafia flood Britain with black market cigarettes - while another escaped immediate custody.

Scotland: BBC exposes tobacco crime gangs in Scotland

A BBC investigation is set to expose the organised crime groups controlling Scotland's illegal tobacco trade. A BBC Scotland undercover team secretly filmed the supply chain. The illegal trade is estimated to cost the Treasury billions of pounds in lost taxes.

Northern Ireland: Customs seize 185,000 cigarettes

Ten kilograms of hand rolling tobacco and 185,000 counterfeit cigarettes have been seized in west Belfast. Two men from Belfast were arrested and cash and business records were also seized.

Birkenhead shopkeeper masterminded tobacco-packing scam

A shopkeeper who owned three stores in Birkenhead masterminded a huge tobacco-packaging scam to sell thousands of illegal cigarettes. HM Revenue and Customs (HMRC) raided his stores and seized £105,000 in cash.

Does Arnott really believe that there is no connection between sky-high tobacco taxes and the growth of a vast smuggling and counterfeiting industry which didn't exist until a few years ago? Since it is hard to believe that anyone could be so dense, I have to conclude—once again— that she is a liar.

An interesting website has just been launched by the Media Standards Trust called It allows punters to compare press releases to news articles and tells you precisely how lazy/ignorant/overworked the journalists are who produce your daily newspaper.

Just as an experiment I put 'ash press release' into Google and up popped this::

'New report finds major benefits to the health of the nation from increasing tobacco taxes'

(Friday 05 March 2010)

I then cut 'n' pasted the text of the press release into and, voila, I could see how much of that press release was blindly regurgitated by The Mirror and the BBC. In the case of The Mirror, it was 63% cut and 78% paste.

One limitation of the website is that you have to put in the text of the press release to compare it to the news reports, not the other way round. This is a bit of a bugger since the original press releases are not always easy to trace. Another limitation is that its archive seems to be limited to national newspapers. A quick google search found that the press release above was churned out by plenty of other local and regional newspapers.

Perhaps these problems will be ironed out as time goes on with the assistance of its users. If you have a source of press releases, do let them know. In the mean time, it could still be a useful little toy when you want to see how much of what you read is reheated PR guff.

Tuesday 22 February 2011

Nudge versus Shove

Last week the British Medical Journal ran an article about nudging. Regular readers may recall that I'm in favour of nudging as defined in Nudge, partly because if the British government was to genuinely follow its doctrine of 'libertarian paternalism', it would be compelled to repeal a large swath of intrusive and illiberal legislation.

After flirting with Nudge a couple of years ago, the penny has now dropped amongst public health pro's that their agenda of limiting choice, raising prices and restricting availability cannot be dressed up as a friendly nudge. To highlight this, they show a table of nudges versus shoves (or velvet gloves versus iron fists, if you prefer). [Click to zoom]

Most of the so-called nudges would actually require regulation. Pubs are not going to, for example, serve drinks in smaller glasses because there is no demand for it. Others, such as "reduce cues for smoking by keeping cigarettes, lighters and ashtrays out of sight" would be enforceable even if regulated. And still others, such as "designate sections of supermarket trolleys for fruit and vegetables" are just stupid. Still, it gives you an idea of what these people would do if they could.

As for the shoves (regulations), most of them are already in place. Minimum pricing, a ban on trans-fats and raising the minimum age of alcohol purchase are the only policies to which the government has not yet capitulated. The rest would have to go under any government that took Nudge seriously.

The authors would like to see "regulations to limit the availability of alcohol" and "pricing interventions" on food. Since the desire to make it more expensive and inconvenient to eat and drink is at odds with a free society the Nudge agenda—coupled with the fact that the evil Tories have adopted Nudge to some extent—the demagogues of public health have gone off the idea. Their reasoning is that a system that has never been tried has never been shown to work.

Evidence to support the effectiveness of nudging as a means to improve population health and reduce health inequalities is, however, weak.

That's a bit rich coming from people who are still clinging to the belief that...

...increasing the price of tobacco may be more effective in reducing smoking among adults on lower incomes and in manual occupations than among those with higher incomes

There is a vast amount of evidence taken over decades to show that people on low incomes are the least responsive to prices increases. And there is increasing evidence that taxes in places like Ireland, Britain and Canada have already reached the tipping point at which smuggling and contraband make further tax hikes counterproductive.

It looks as if the attack on individual rights will be dressed up as an attack on the straw men of the drinks/food/tobacco industries in the future. And why not? It's a tactic that's been working ever since the Prohibition Party targeted the largely fictitious 'liquor trust' in the 19th century.

Without regulation to limit the potent effects of unhealthy nudges in existing environments shaped largely by industry, nudging towards healthier behaviour may struggle to make much impression on the scale and distribution of behaviour change needed to improve population health to the level required to reduce the burden of chronic disease in the UK and beyond.

This sounds to me like a door slamming. Farewell Nudge, we barely knew thee.

Friday 18 February 2011

How thick do ASH think we are?

From Brand Republic:

ASH blames adspend freeze for failures to quit smoking

The number of people who successfully give up smoking has dropped by a third since the Government halted its anti-smoking advertising.

New Department of Health figures are the first to reveal the impact of the Coalition's decision to freeze adspend as part of the £6 billion of cuts it announced last May.

Between January and March last year, the Government spent £861,000 on its anti-smoking campaign and 124,792 people successfully quit the habit with the help of the NHS.

When the budget dropped to just £26,000 between April and June, the number who gave up fell to 85,749. There was a further drop in the next three months to 76,504, when no ads appeared - 38 per cent down on the first three months of the year.

There was a similar reduction of 34 per cent in the number of smokers who set a date for kicking the habit over the same period.

Martin Dockrell, the director of policy and research at Action on Smoking and Health, said: "It has been a false economy. Mass-media campaigns are very cost- effective in terms of life years gained. They quickly reduce the pressure on the NHS."

Look Martin, I know you don't credit the British public with much intelligence but we're not complete morons. The quit-rate peaked between January and March because giving up smoking has been the #1 New Years Resolution since Methuselah was a bairn.

This is so obvious that it barely merits confirmation, but just to be sure, let's check with the NHS:

With regard to monthly quit attempts made, numbers were highest in January (note: the start of the year is the most popular time for people to attempt to quit, e.g. New Year’s resolution), followed by March, then February.

Yup, thought so. The first quarter is the busiest time of the year for smoking cessation services with or without the government spending vast sums of money. And the reason the government spends the most money on smoking cessation in January is because that's when there's most demand for it. Inevitably, the quit rate tapers off in the second quarter and then again in the third quarter.

It's not rocket science and it happens every year.

If we look at the figures from 2009, we can see this quite clearly:

Number of successful quitters in 2009:  2010 figures in brackets (NHS England)

January-March 2009: 120,935 (124,792)

April-June: 89,358 (85,749)

July-September: 79,842 (76,504)

2009, you may recall, was a time when the government was spending money like a sailor on shore leave. Lo and behold, there was a big peak in the first three months of the year, then the numbers dropped in the second quarter and there was a further drop in the third quarter. In fact, we can see that the numbers "dropped by a third" between the first and third quarter, just as they did when not a single penny was spent advertising these services.

So what we have here is a natural experiment. Despite drastically reduced budgets—down to £0.00 in the third quarter of 2010—the quit rate was almost identical to what it had been when Gordon Brown was engaging in his scorched earth policy with the public finances.

This is good news for the taxpayer, because it tells us that we can save money on quit-smoking adverts without reducing the number of people quitting. So thank you Martin Dockrell for bringing this to our attention. All the government needs to do now is stop funding of ASH—whose policies have been consistently ineffective in reducing the smoking rate—and we can really start celebrating.

(I'm pleased to see that no newspaper has felt moved to cover this 'story'. Perhaps bullshit fatigue is finally setting in when it comes to ASH.)

Drinking league

This really isn't good enough.

Average amount drunk in UK is 16th highest worldwide

Yet again, this once great country fails to make the top 10. We're getting beaten by South Korea now, for goodness sake. The Czechs are making us look positively light-weight. I'm not looking at you, ladies. You've been pulling your weight. But men, especially those aged 16-24, what's happened? Where's your sense of pride? I'm not asking you to keep up with the Irish or the Russians. Let's be realistic. But at least keep pace with the Portuguese and the Slovenians.

This comes from The Telegraph's article about the latest piece of temperance advocacy from the World Health Organisation, which is inviting governments around the world to keep on taxing drinkers:

“One of the most effective is raising alcohol prices by raising taxes."

By how much? Is there no limit? Apparently not, as there is no suggestion in the report that taxes could ever be too high. Alcohol taxes are not immune to the laffer curve and there is a ton of evidence, gathered over centuries, that excessive alcohol taxes result in more dangerous drinking habits and home distilling of strong, unregulated booze. You only have to look at the figures in this very report to the difference between high and moderate tax countries:

Per capita consumption of pure alcohol (litres)


Recorded consumption: 6.70

Unrecorded consumption: 3.60 

United States

Recorded consumption: 8.44 

Unrecorded consumption: 1.00

I use the USA as a comparison because it's not as if they don't have a history of making moonshine when they need to.

"This has the added benefit of generating increased revenues."

If it was truly effective it would result in less consumption, not increased revenue. Touting alcohol taxes as a way of raising revenue rather gives the game away, does it not?

And, dear oh dear, the anti-obesity and anti-smoking factions aren't going to like this...

"Alcohol consumption is the world’s third largest risk factor for disease and disability; in middle-income countries, it is the greatest risk."

That rather depends on what you're measuring. The demon drink came rather lower down the list in a previous WHO report, which showed the number of deaths attributable to various risk factors.

This wasn't sufficiently newsworthy for the new report on alcohol, and since the WHO now seems to be a glorified pressure group, they did what campaigners do and picked the data that best suited their PR people.

This is the chart, showing the number of Disability-adjusted Life Years. Sure enough alcohol now beats both smoking and obesity, and comes top for middle-income countries (or, more precisely I think, middle income people).

The difference comes down to alcohol tending to kill people at a younger age (that's 'kill' in the broadest sense—over 40% of the claimed death toll is due to intentional and unintentional injuries, which can only be partially attributed to alcohol.)

There's nothing wrong with using 'years lost' rather than 'lives lost' to measure the impact of risk factors. In fact, I think it's a better measure, as children dying of starvation and AIDS is clearly a more important preventable death than a 90-year old dying of hypertension.

It does, however, demonstrate how statistics can be mined to suit the cause. It is now a three-way battle between the temperance lobby, the fat-fighters and the anti-smokers to keep their pet project in the public eye. This involves vying for position both with the claimed death toll and with the ever spiralling 'cost to society'. Tobacco has traditionally been the undisputed champion in this field. For instance:

Smoking Now Leading Cause of Death Worldwide

The use of tobacco is now the primary cause of death around the world. And the Director of the U.S. Centers for Disease Control says not enough countries are taking adequate steps to discourage it.

The World Health Organisation implies the same thing, but note the careful wording:

Tobacco use kills more than 5 million people per year. It is responsible for 1 in 10 adult deaths. Among the five greatest risk factors for mortality, it is the single most preventable cause of death.

You may also have read that obesity is the leading preventable cause of death, at least in America. (Less reliable sources may have even told you that obesity is the leading cause of preventable death worldwide.)

Research confirms obesity is now leading cause of preventable death in U.S.

America's persistent weight problem is now the country's leading cause of preventable death.

For years scientists and health care professionals have warned of the dangers of smoking, and tobacco use is still a major contributor to early mortality. But new research shows that it is is obesity that now causes even more fatal disease.

And now alcohol is well and truly in the race. But, as a point of fact, none of them are the world's leading cause of preventable death. As the data show, the leading cause of lives lost is high blood pressure and the leading cause of years lost is childhood malnutrition. We don't hear so much about these, but then they're not taxable, are they?

Thursday 17 February 2011

Irony bypass

On Monday, Spiked republished Joe Jackson's 'dog ban' spoof (mentioned in a previous post). The letters have started coming in from dog-lovers who take things literally...

Jackson’s rant about dogs is clearly the ramblings of a deranged weirdo. With any luck he’ll be trapped in a kennels soon and do us all a favour. I have never read so much drivel in my life.

Andy Gardiner, UK

‘Have you ever seen a leg amputated because of gangrene? It’s not funny.’ Funnily enough, I haven’t, but also in my neck of the hemisphere I’ve never heard about anyone getting gangrene from a dog bite. For that to happen there would need to be other exigent causal factors, which we couldn’t really blame on poor, dim-witted canines. I guess Jackson had something to get off his chest, but he’s either got his tongue in his cheek or he’s stretching the bounds (or is that hounds?) of rationality.

Andrew Cox, UK

Tuesday 15 February 2011

A sincere apology to drinkers from the BBC

From the BBC:

In recent years, along with all other media, we at the BBC may have implied that an unstoppable tide of rising alcohol consumption posed a threat to the very fabric of British society. Headlines such as Rising alcohol addiction costs 'could cripple the NHS'Alcohol abuse 'becoming epidemic and Alcohol abuse 'epidemic' warning may have given some readers the impression that there was there was some sort of epidemic of alcohol use.

It is also possible that news stories such as 'Licensing Act to cause mayhem' '24 hour drinking - are you mad?' and 'Please Gordon, reverse this crazy law' may have given some licence-fee payers the impression that the country was going to hell in a handcart thanks to round-the-clock bingeing.

Having finally got round to checking the facts, we now recognise that heavy drinking is falling, abstinence is rising, and young people are leading the drive towards healthier drinking. Contrary to what you may have heard every day for several years, alcohol consumption has been falling since 2002, with drinking by young men falling most dramatically—from 26 units a week in 1999 to 15 units in 2009. Even changing the way consumption is measured can't disguise the fact that drinking has been on the decline for a decade.

Furthermore, what we have been laughably referring to as '24 hour drinking' has resulted in the average pub opening for an extra 24 minutes a day, hardly enough time to have a swift half. We also recognise that 'binge-drinking' is a scare-mongering and virtually meaningless phrase popularised by the tabloid media and is unworthy of the world's most respected news organisation.

We would like to distance ourselves from everything we have ever said and point out that we did not write any of these stories ourselves. They came from press releases from seemingly disinterested and trustworthy parties such as Alcohol Concern and the Alliance House Foundation. At the time, we had no idea that an organisation that used to be called the UK Alliance for the Suppression of the Traffic in all Intoxicating Liquors could have any prohibitionist leanings.

We now acknowledge that these temperance types will say and do anything to further their goals. Why, only yesterday we presented wild guesstimates from Alcohol Concern about the supposedly escalating costs of treating drinkers as a legitimate news story. We now see that the only reason for this story's existence was to encourage more funding for Don Shenker and his colleagues. The person responsible for this has been dismissed and from now on we will only be asking representatives from the Portman Group to comments on our news stories.

Henceforth, instead of illustrating all drink-related articles with this picture of a fat lager-guzzling wreck...

...we will be using this:

We sincerely apologise for any confusion caused in the past and will work hard to regain your trust. Cheers!

Slightly adapted from this.

Energy drinks are next

I neglected to mention the banning of Four Loko when it happened back in November and I now regret it because it looks like it could be the start of another branch of prohibitionary madness.

In short, the FDA effectively outlawed the sale of drinks which contained caffeine and alcohol, of which the best known was Four Loko AKA 'blackout in a can'. This came after a series of scare stories new articles telling tales of students drinking too much, passing out, getting their stomachs pumped and all the other things that have definitely never happened before in the history of higher education ever.

These drinks are, or were, nothing more than alcohol combined with the kind of energy drinks that are available everywhere. Consequently, it took almost a second for drinkers across America to work out what they needed to do to get around the FDA ban. The gentleman below explains the cunning plan in 37 seconds.

So, having hyped up a scare that wasn't there and brought in a ban that won't work, the next logical step has to be extending the ban to paper over the cracks.

Jacob Sullum reports at Reason:

Mary Claire O'Brien, a professor at Wake Forest University School of Medicine who helped foment the moral panic that led the FDA to ban Four Loko and three other brands of caffeinated malt beverages last fall, says the fight against demonic drinks is far from over.

"These premixed alcoholic energy drinks are only a fraction of the true public health risk," she and co-author Amelia Arria, a researcher at the University of Maryland School of Public Health, warn in a recent Journal of the American Medical Association commentary. "Regular (nonalcoholic) energy drinks might pose just as great a threat to individual and public health and safety."

Notice that energy drinks are not just a threat to health, but are—miraculously—"just as great a threat" to health as when they were mixed with alcohol. If true, that would make the banning of Four Loko look pretty futile. It means that something must be done, dammit. It would also suggest that alcohol itself is not a health risk, or at least that it is no more dangerous than the energy drinks with which it is mixed. Those energy drinks are widely available and have no age restrictions. And that, of course, raises a very important question; one that doesn't get asked enough these days...

Fortunately, Pediatrics—the World's Worst Journal™—is on hand to fan that particular flame:*

Heavy caffeine consumption, such as drinking energy drinks, has been associated with even more serious consequences such as seizures, mania, stroke, and sudden death....

Children, especially those with cardiovascular, renal, or liver disease, seizures, diabetes, mood and behavioral disorders, or hyperthyroidism or those who take certain medications, may be at higher risk for adverse events from energy-drink consumption...

Unless research establishes energy-drink safety in children and adolescents, regulation, as with tobacco, alcohol, and prescription medications, is prudent.

As Sullum points out, Pediatrics equates heavy caffeine consumption with energy drinks, when by far the most common 'caffeine-delivery device' is the humble cup of coffee. No one is (yet) suggesting that coffee be treated as a controlled substance. As I mentioned in a recent post on the subject of red wine, I suspect that this is because middle-class public health professionals drink coffee but don't drink Red Bull, just as they will drink wine but won't drink Four Loko.

Since a can of Red Bull contains 80 milligrams of caffeine (comfortably below the recommended limit for children and adolescents) and a short coffee from Starbucks has 180 (far above it), the focus on energy drinks—which the authors suggest should be restricted like cigarettes, alcohol, or maybe Valium—is puzzling, especially since, by their own account, American teenagers typically do not consume very much caffeine. "In the United States," the article says, "adolescent caffeine intake averages 60 to 70 mg/day." But why let that stand in the way of a good panic?

Incidentally, the Pediatrics study itself is another belter. Masochists can read the whole thing here, but the methodology alone tells you that it's up to Pediatrics' usual standards of scientific excellence.

OBJECTIVE To review the effects, adverse consequences, and extent of energy-drink consumption among children, adolescents, and young adults.

METHODS We searched PubMed and Google using "energy drink," "sports drink," "guarana," "caffeine," "taurine," "ADHD," "diabetes," "children," "adolescents," "insulin," "eating disorders," and "poison control center" to identify articles related to energy drinks. Manufacturer Web sites were reviewed for product information.

How do they find these people? "Scientist wanted — must have internet access and own pyjamas."

Monday 14 February 2011

The Iowan heart mystery

Reported in Iowa's local press and elsewhere:

It's been two years since the Smoke Free Air Act went into effect in Iowa. It prohibits smoking inside all bars and restaurants. The University of Iowa says in the two years Iowa has been smoke free, Iowans reduced their risk of heart disease by staggering numbers.

"Hospital admissions related to heart disease is much less, including stroke after the Smoke Free Air Act," says Dr. Enrico Martin of the Iowa Heart Center.

Admissions have gone down 24%, according to the University of Iowa. In just months, heart attack cases are down 8%. Strokes are down 5%. It's all thanks to the simple action of moving smokers outside.

This would seem to be exactly the same story that was reported over a year ago:

A recent study from the UI and the Iowa Department of Public Health shows a 24 percent decrease in Iowa hospital admissions for coronary heart disease and a decrease in admissions for heart attacks and strokes since the state restricted smoking.

Why the second lease of life for this particular heart miracle?

Perhaps because the study in question has finally been published? No. It still hasn't been published in any journal, peer-reviewed or otherwise.

Perhaps because some real evidence has appeared bearing out these "staggering numbers"? No. As Michael Siegel showed last week, statistics for heart disease and stroke—which are available on the Iowa Department of Public Health website—show no correlation between the date of the smoking ban and declining rates of mortality from these diseases:

Overall, there has been no change in the heart attack death rate in Iowa since the smoking ban was implemented. This is in contrast to a 39% decline in the heart attack death rate in the eight years prior to the smoking ban.

What the State of Iowa's own data show is:

Heart disease mortality rate (per 100,000):

2007: 229
2008: 242.1
2009: 229.8

Major cardiovascular disease (number of deaths):

2007: 9,200
2008: 9,623
2009: 9,232

(The smoking ban commenced July 1 2008)

Insofar as this 'study' has been published at all, it was in a three-page quarterly newsletter printed by Johnson County Public Health back in October 2010. From this, we can see that the monthly admissions in the first year of the ban were compared to the average monthly admissions between 2005-08. This is not the best of methods since we can't see the long-term trend (which is usually downwards, but not necessarily).

As you can see from the graphs above (taken from the newsletter), the data for heart attacks do not provide compelling evidence of any post-ban effect. The rate fell by 8%, which is the same as the rate of decline for flu and pneumonia (which have yet to be linked to secondhand smoke). And since admissions for heart attack rose in the first six months after the ban, this looks more like random fluctuation than anything else.

The coronary heart disease data, on the other hand, suggest a remarkably steep decline which accelerated over time. As the newsletter pointed out, a comparison between June 2009 and June 2008 shows a 40% decline (the magic number of the Helena hypothesis).

There are more than a few puzzles here. Mortality figures are not to be confused with hospital admissions figures, but it's reasonable to expect a correlation between the two. There isn't here. It's also reasonable to expect a correlation between CHD data and heart attack data. Sure enough, there is a close correlation between CHD mortality and heart attack mortality in the official figures (table above), but not in the newsletter's admissions data.

The evidence is incomplete, but reports of a heart miracle in Iowa are inconsistent with the hospital data that is publicly available. Yet again.

Friday 11 February 2011

No red meat for Forest Green fans

I suspect I will not be the only blogger to be writing about this story today, but here goes:

Burger ban begins at Forest Green Rovers football club

Burgers and sausages have been banned from being sold to fans at Forest Green Rovers football club.

The move was introduced for players at the Blue Square Bet Premier club a few weeks ago but now the policy has been extended to the whole stadium.

What could possibly inspire this lurch towards health faddism?

The Gloucestershire club is owned by Dale Vince who is a vegan who runs green electricity company Ecotricity.

Say no more. Never let it be said that vegan eco-mentalists are the type to inflict their lifestyle choices upon the unwilling.

Free-range poultry and fish from sustainable stocks will continue to be served.

From which you might rightly infer that this is not just about hamburgers. There will be no sale of any red meat at the theatre of dreams that is Forest Green Rovers' football ground.

Communications director Tom Williams said: "Following discussions with the manager and on nutritional advice, it was decided to no longer feed our team red meat for health and performance reasons."

And how's that been working out for the players? Let's have a quick look at the league table...

Narrowly avoiding the drop in the nation's fifth division, Forest Green might want to get a second opinion on the nutritional advice they've been receiving. But since that advice has been coming less from "discussions with the manager" as from discussions with the club's tree-hugging chairman, a second opinion might be out of the question.

There are, of course, no "health and performance reasons" why football players shouldn't eat red meat and no Premiership manager enforces such a ban. So you have to ask who knows how to get the best out of their players—Alex Ferguson and Arsene Wenger, or the owner of a club currently making up the numbers in the Blue Square league.

"[It has now been] decided that this policy should be extended to the stadium, at least in part as a further step in establishing ourselves as a "green" organisation.

Mr Vince added that "if red meat was not good enough to feed our players, then it wasn't good enough for our staff, fans and visitors too".

Firstly, red meat is good enough to feed the players. Secondly, there's nothing green about refusing to use livestock that has been bred locally in favour of fish that has brought back to land using dirty great trawlers. And thirdly, even if we leave aside the futile, faddish and scientifically unenlightened dietary regime inflicted on the bemused journeymen who make up the Forest Green Rovers team, the spectators are not playing the game. There is no requirement that people watching sport have to measure up to any standard of athleticism. What other form of entertainment demands the audience adopt the lifestyles of the performers?

This is exactly the sort of garbage we heard when football clubs started unilaterally banning smoking everywhere in their stadiums (including at the bar)—this ridiculous fantasy that everyone involved in the sporting spectacle has to stay fit and healthy. They don't, they aren't, and if they were they'd be playing it instead of watching it.

He said: "At its worst it means once every two weeks watching a football game without being able to eat red meat.

"Anybody that [sic] really needs it can bring a ham sandwich or something if they wish - that's no problem."

Well, it will be a problem for you, Mr Vince, if everyone does bring their own food—and I dearly hope they will—because it will lose you a source of revenue on match day. But then, as the owner of a "green electricity company" which can only be kept afloat with massive government subsidies, the workings of real-world economics may yet be a mystery to you.

Tuesday 8 February 2011

A little light satire

Over at the Free Society, Joe Jackson has written an amusing article in praise of the, ahem, 'dog ban' of 2007.

Of course, I have nothing against dog addicts! I am a tolerant person. If they want to roll around in dog hair in their stinking homes, then good luck to them. Unless, of course, there are children present, in which case the dogs should be forcibly removed and shot. Likewise if the dog addict’s flat adjoins another. The same, naturally, goes for their cars.

Go read.

Monday 7 February 2011

New York conversation

What can I say about New York's latest smoking ban in 'public places' (how the definition of that changes)? I write about how these things are going to happen but when they do there doesn't seem to be anything left to say. It can't be justified on the basis of secondhand smoke, obviously, and very few people have tried to do so. In civil liberties terms it's beyond the pale. It probably can't be enforced, but we shall see. It's very sad, but New Yorkers knew what they were getting when they re-elected Bloomberg.

All this you know, so I'll just quote what other's have been saying.

Whoopi Goldberg's having none of it:

"I'm done with this (anti-smoking) because I feel I pay taxes here just like everybody else. There should be a designated place and I'm tired of being treated like some damn criminal. If they're really worried about the smell in the air, give us electric buses, give us electric cars, and then I'll understand!

"But you know, (give smokers) a little respect because I understand that not everyone wants to smoke, I get that, but you can't keep treating people like they don't matter."

And Goldberg has vowed to defy the ban and pay the $50 fines for smoking in the newly-banned areas until nicotine lovers are given specially-designated spots to puff away in public.

She adds, "I'm going to take the hit, I'm gonna write the cheque, do everything until you guys do what you need to do to stop this nasty smell of cars and all the other nasty stuff... I'm smoking my cigarette, I'm sick of this!"

She may not have to pay many fines, if Carl at Ep-ology's experience is anything to go by:

I was in New York a couple of days ago and enjoyed the juxtaposition of talk of the brand new law against outdoor smoking and hanging out with people who chose to defy even the indoor ban, demonstrating that there is really no problem getting away with that.

The Daily Mash gives us the satirical take:

New York is bidding to reverse its plummeting violent crime figures by not letting anybody smoke.

Mayor Michael Bloomberg extended the city's smoking ban to parks insisting outdoor tobacco fumes were preventing people from enjoying the exhaust emissions from more than 300 square miles of gridlocked traffic.

But tourism experts say the move will also resurrect the authentic New York atmosphere portrayed in much loved Hollywood classics such as Mean Streets, Bada Bing and Fuck You.

New York cabbie Tom Logan said: "Ordinarily I would recommend the cultural highlights and reasonably-priced restaurants in our fair city but after pulling a 12-hour shift without a smoke I'll probably just spray the entrance to the Waldorf with machine-gun fire and then drive this motherfucker straight off the Brooklyn Bridge."

New York's anti-smoking laws are some of the strictest in America, though there is a loophole in the legislation to allow the public smoking of crack.

Rob Lyons has a less-than-romanic view of the Land of the Free:

This is a country where you can be arrested for not crossing the road in a state-approved place or for having a drink when you're 20 years old. Bloomberg seems to be just tidying up a few loose ends.

But of particular interest to me was the editorial in the New York Times (h/t Carl Phillips). NYT editorials acted as something of a barometer of public opinion during the last great American Anti-Smoking Crusade (1899-1920).

As readers of Velvet Glove, Iron Fist will fondly recall, when the first rumblings of anti-cigarette fervour began in 1884, the NYT ran a xenophobic editorial attributing Spain's decline to the smoking of cigarettes and warned that "if this pernicious practice obtains among adult Americans the ruin of the Republic is close at hand."

But by the first decade of the next century, the newspaper was striking a more libertarian chord. When cigarettes were banned in Indiana, it called the ban "a scandalous an interference as can be conceived with constitutional freedom" and consistently defended the right to smoke.

If the NYT has written anything critical of the tobacco control lobby in my lifetime, I missed it. So perhaps—just perhaps—their latest editorial marked the moment when the NYT realised again that this is a prohibitionist crusade they're talking about:

No smoking at the crossroads of the world? The vortex of tourism that brings smokers and nonsmokers in great numbers? The site of the world’s most famous New Year’s Eve party, where who knows what goes on? All of this takes the mayor’s nannying too far, even for those of us who want to avoid the hazards of secondhand smoke...

Meanwhile, there is talk that the mayor and the City Council want even more, like banning smoking near doors of office buildings and apartments. They need to take a deep breath and remember that we tried prohibition 90 years ago. They called it a noble experiment. It turned into a civic disaster.

Friday 4 February 2011

Applied philosophy

Stanton Glantz:

"I'm 62 years old, and I tell people I didn't have a midlife crisis. I know a lot of people who reach 50 who sit around saying, 'What have I done?' I don't have that problem."

Bertrand Russell:

"The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts".

Thursday 3 February 2011

Up to his old tricks

Professor Glantz finds a way to help smokers cut down to one cigarette a day

In yesterday's post I discussed harm reduction and the prospect of having more people doing something which is not very harmful balanced against the prospect of having fewer people doing something that is very harmful. The basic argument comes down to this:

Whether or not you have a few more, a few less, or about the same number of people using nicotine products, if they are doing so using products which are 90%+ safer, the overall effect on public health can only be positive. If they are 90% safer, you would need more than ten previously uninterested people to start using these products for every smoker who uses them to quit. If they are 99% safer (and this is the more scientifically probable estimate), you would need more than 100 previously uninterested people to start using these products for every one smoker who uses them to quit. Common sense tells us that this is simply not going to happen and only a delusional fruitcake could possibly think otherwise.

Enter Stanton Glantz from the University of San Francisco: mechanical engineer, epidemiologist, cardiologist, economist, statistician and now soothsayer. Is there no beginning to this man's talents?

Stan thinks—nay, has shown in the peer-reviewed journal Tobacco Control—that if snus was "heavily and successfully promoted as healthier and more socially acceptable than cigarette use" it would lead to the number of people smoking cigarettes in the US leaping from 23.1% to 30.1%, with two-thirds of these smokers also being users of snus. Therefore, he reckons that:

Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level.

To arrive at this counterintuitive conclusion, the great man has to demonstrate two things.

  • The honest (or, as he puts it "aggressive") marketing of snus as healthier and more socially acceptable would lead to a huge surge in snus consumption, with half of all new users coming from people who otherwise would not use tobacco in any form
  • Snus is much more dangerous than scientists believe and is, in itself, a major health risk

To take the second of these propositions first, Glantz states that:

Smokeless use has been linked to oral cancer, oropharyngeal cancer, heart disease and pancreatic cancer.

This is technically true. Smokeless tobacco has, at one time or another been linked to all these diseases. But one by one these scares have been shown to be baseless. Only last week, a definitive study showed that smokeless tobacco does not cause pancreatic cancer. That study came too late to feature in Glantz's evaluation, of course, but claims about snus causing any of the other diseases were debunked years ago. There is some evidence that the types of chewing tobacco used in places like India and Africa may be associated with oral cancer and heart disease, but the 'snus causes oral cancer' myth lost all credibility a decade ago.

Levy et al report the results of an expert panel that estimated a 90% reduction in mortality risk when using low nitrosamine smokeless tobacco compared to cigarette smoking.

Not quite. That expert panel found that these products were 90-95% safer and that was at a time when snus was thought to be more dangerous than it is now.

What the panel did find was that 90% of Americans "held the belief that the cancer risk from using chewing tobacco was equal to that from cigarettes." This myth—promoted by alleged health campaigners for decades—has no doubt deterred untold numbers of tobacco users from switching to less hazardous alternatives. The expert panel said:

The risks of using LN-SLT products [that's low nitrosamine smokeless tobacco products like snus] therefore should not be portrayed as comparable with those of smoking cigarettes as has been the practice of some governmental and public health authorities in the past.

Which suggests support for giving consumers honest and accurate information about risk—what Glantz calls "aggressive marketing." Glantz continues:

Data from the multinational INTERHEART study, a large case-control study of acute myocardial infarction (AMI), indicate an association between chewing tobacco use and AMI (OR 2.23, 95% CI 1.41 to 3.52) that was 75% of the risk of smoking cigarettes (OR 2.95, CI 2.77 to 3.14) and that the risk of dual use was larger than smoking.

But the INTERHEART study wasn't a study of low nitrosamine products and, as its authors admitted, it was something of an outlier anyway. It was unusual in finding a statistical association with heart disease and truly extraordinary in finding such a high relative risk. One of the reasons for this was that it was dominated by studies of the aforementioned dodgy chewing tobaccos from the Third World. A slew of studies have shown that snus does not increase heart attack risk (although a question remains about whether it may be associated with a small increase in mortality risk for those who have heart attacks).

Another 2005 review of the health risks of smoking compared to snus found that the risk of heart disease associated with snus is about half that of smoking.

This refers to a study by Roth et al., who found nothing of the sort. What the study actually says is:

Of all the studies examined, the only study that showed snus users to be at elevated risk to any type of disease was Bolinder et al. (1994), which reported significant elevations for both cardiovascular disease and total mortality...

None of the three other studies of cardiovascular disease (Asplund et al., 2003; Hergens et al., 2005; Huhtasaari et al., 1992) reported elevated levels of cardiovascular disease among snus users compared to the levels in non-tobacco users...

Considering all these findings, the Bolinder et al. (1994) cardiovascular disease findings appear to be an anomaly.

Not quite the same thing as the risk of heart disease being "half that of smokers", is it? More like "exactly the same risk as nonsmokers." What Glantz is doing here is, to use the scientific term, lying and hoping no one checks his references. There are still some dear, naive souls who believe that the peer-review process weeds out blatant falsehoods like this. Bless 'em. This is Tobacco Control, for goodness sake. We should be thankful the peer-reviewers corrected Glantz's spelling and put the graphs the right way up.

That pretty much covers the attempt to make snus look like a major health hazard when it's not. The issue of estimating how many people would take up snus as a result of the "aggressive marketing" is a much simpler matter. Glantz picked some numbers out of the air and wrote them down with an air of breezy confidence.

He assumed that the "aggressive" approach to harm reduction would lead to a tenfold increase in snus use. That's not so unreasonable. Less reasonable is his assumption that half of the new users would be previously uninterested nonsmokers. And half of the smokers who started using snus would continue to smoke. And snus users have half the heart disease risk of smokers. And the effect of promoting snus would reduce the effect of smoking bans by 50%. In other words, whatever figures you've got, just half them. It's the scientific way.

Why pick those figures? Because if he picked different ones he'd end up showing that tobacco harm reduction saved lives, stupid. Somehow—I'm really not sure how— Glantz uses these wild, unfounded guesses to navigate his way to the following jaw-dropping conclusions:

  • The number of smokeless-only users will rise from 1.0% to 12.6%
  • The number of cigarette-only users will fall from 19.8% to 10.5%
  • The number of smokeless users who also smoke cigarettes will rise from 1.6% to 19.6%
  • Overall, the proportion of the American public who smoke cigarettes will rise from 23.2% to 30.1%.
  • Tobacco-related death and disease would increase by 26%

There is more to be said about this study but, seriously, did no one at Tobacco Control think that it was a tad improbable that the promotion of snus as a healthier and more socially acceptable alternative to cigarettes was likely to result in a dramatic increase in the number of people smoking cigarettes? Did no one involved in this study have any objection to using half-truths, wild estimates and outright lies to come to a nutcase conclusion that would never happen in a million years? Are there still that many drugs being taken in San Francisco?

Whichever way you look at it, when it comes to peddling junk, Stan is still the man to beat.

Wednesday 2 February 2011

Being realistic about harm reduction

This story from the Daily Mail raises one or two questions:

Free morning-after pill fails to cut teenage pregnancies

The drive to give free morning-after pills to teenage girls has failed to cut underage pregnancies.

Schemes to offer over-the-counter emergency birth control to girls under 16 have simply encouraged youngsters to have more unprotected sex, damning research found.

In doing so they have fuelled a rise in sexually transmitted diseases.

The study in question looks sound enough and (according to its authors) its findings are in line with the majority of other research on the same topic. But the fact that this story has not been widely reported outside of the right-of-centre newspapers in Britain suggests that some people are not comfortable hearing such news.

I don't have a strong view on whether or not the morning-after pill should be given to under-age kids, but having the government hand out free contraception to the under-16s obviously sends out a signal that is at odds with sex being illegal for the under-16s. Likewise, giving free needles to heroin addicts. But that's how harm reduction works—we don't approve, but we recognise that it goes on and we try to reduce the risks.

The point of this post is not to pontificate on the rights or wrongs of needle exchanges and free contraception to teenagers, but only to point out something that any honest person working in harm reduction will tell you: if the government facilitates an activity, it will be seen to have at least tacit approval and that activity is likely to become more common. Social stigma is an effective means of controlling behaviour. We've seen it with drink-driving and we've seen it with smoking. If you remove that stigma and give a nod and a wink that something's okay—by, for example, handing out the morning-after pill in schools—you can expect to see more of it.

This is pretty basic behavioural economics and the apparently controversial study above does nothing but prove an obvious point—harm reduction policies increase uptake. But it isn't uptake that is the problem. Liberal opinion is less worried about people taking drugs and having sex than by the unintended consequences of these activities. I feel the same way. The problem with the free contraceptive scheme isn't so much that it is increasing the frequency of underage sex, but that it seems to be increasing frequency of visits to the STD clinic while not reducing the frequency of visits to the maternity ward. It is having an unintended—albeit predictable—consequence while failing to deal with the real problem. (Arguably, the wrong contraceptives are being dished out. Condoms would be a better way of preventing unwanted babies and unwanted diseases, but perhaps that would be putting too much power and responsibility in the hands of teenage boys.)

Harm reduction policies should be judged by the overall effect on public health. If it was about morality and behaviour, we wouldn't be attempting harm reduction in the first place.

So it is with tobacco harm reduction. If people were given access to less hazardous products such as snus or e-cigarettes—and if this was accompanied with honest information about how much safer they were than combustible tobacco products—we should recognise that this will inevitably lead to some people trying these products who would not otherwise be attracted to nicotine. Quite obviously, more people would use snus if it was legalised than if it wasn't. But the number of people using tobacco/nicotine isn't the issue, unless we have some moral objection to people using a mild addictive drug. The issue is whether enough people quit the very hazardous product in favour of the less hazardous product to make it worthwhile from a public health perspective.

In the case of tobacco, the hazardous product (cigarettes) is so harmful that very few smokers would have to switch to make a net saving in lives lost. Conversely, the less hazardous alternatives (snus/e-cigarettes) are so very much less harmful that a vast number of previously uninterested nonsmokers would have to be drawn towards them before this gain was cancelled out.

In terms of overall prevalence, it is likely that the total number of nicotine users would remain steady or rise, when compared to a scenario in which safer products were illegal and smoking was made less and less socially acceptable (although considering the failure of anti-tobacco to reduce smoking prevalence in recent years despite using every trick in the book, even that prediction may be suspect).

Whether or not you have a few more, a few less, or about the same number of people using nicotine products, if they are doing so using products which are 90%+ safer, the overall effect on public health can only be positive. If they are 90% safer, you would need more than ten previously uninterested people to start using these products for every smoker who uses them to quit. If they are 99% safer (and this is the more scientifically probable estimate), you would need more than 100 previously uninterested people to start using these products for every one smoker who uses them to quit.  Common sense tells us that this is simply not going to happen and only a delusional fruitcake could possibly think otherwise.

Coming up tomorrow: I discuss Stanton Glantz's belief that encouraging harm reduction would lead to more people smoking and more people dying of tobacco-related deaths.

The Spirit Level Delusion: Chapter 10 available for download

The new chapter of The Spirit Level Delusion, containing updates and additional material is now available for free download.

See the IEA blog for details.

Tuesday 1 February 2011

A week's levelling

Over at Ep-ology, Carl Philips has turned his critical eye towards a subject close to my heart—the eye-watering, near-medieval pseudo-science of The Spirit Level.

Snowdon's book (and associated interviews and blog posts) do a thorough job of debunking Wilkinson & Pickett and showing that [The Spirit Level] is utter junk science. I am confident that no serious reader who was genuinely interested in learning the truth could read what he wrote and still believe that there was a legitimate debate about whether W&P's analysis was legitimate.

You might surmise from this that Dr Philips—like many serious academics—is less than convinced by the evidence presented for Wilkinson and Pickett's curious brand of 'scientific socialism'. And you'd be right. He's writing about one of the five new articles I put up on The Spirit Level Delusion website last week. These are excerpts from a new chapter of the book that will be available shortly as a free download.

I hadn't intended to write more on this subject but Wilkinson and Pickett (The Spirit Level's authors) forced my hand when they published a new edition of the book attacking their critics for being professional "merchants of doubt" who are making "foul attacks" on their work because they're "free market fundamentalists". (As opposed to being normal, educated people who thought that empirical claims were there to be tested.) This paranoid and borderline libellous fairy-tale demands rebuttal, as do their other distortions and inaccuracies.

Specifically, it needs to be said that...

I've exhausted everything I can say about The Spirit Level (for now at least). I've never had any illusions about how far people's minds can be changed through the use of mere facts, logic and evidence. Ultimately, the great majority of people believe what they want to believe and I'm mildly annoyed at having spent so much time writing about all this when there are so many good books out there still to read. Nevertheless, The Spirit Level remains a fascinating case study of how far the credulity of reasonably intelligent people can be stretched so long as they are told what they want to hear. For that reason alone, it should be of interest to anyone interested in today's intellectual environment.

I'll leave the last word to Carl, who makes some interesting points about trust and whose post—as with all his posts—should be read in full:

Of course, W&P made it easy for Snowdon to shatter their credibility by making it so brittle. They put the reader in the position of either believing they have unequivocal evidence for a "new theory of everything" (to quote from Snowdon's snarky subtitle), or concluding that they were just pulling a sales-job on the reader. If they had behaved like scientists – recognizing the best contrary evidence and being properly equivocal – rather than peddlers or evangelists, it would have been necessary to explore the merits of their argument to challenge their claims and credibility.

Still, it is useful to figure out how to debunk as easy a target as is The Spirit Level. We need to start with the challenge of winning one-sided debates before we can take on arguments that have some credibility.