Tuesday 30 August 2011

Liam Donaldson up to his old tricks

Liam Donaldson on the way to the bank

Remember Britain's former Chief Medical Officer Liam Donaldson? Under the last Labour government, this flabby old fear-mongerer epitomised everything that is wrong with the public health crusade. Evidence-free policy making, perpetual scare stories, junk statistics, sucking up to the pharmaceutical industry—Donaldson brought it all to a new level.

In addition to lying through his teeth in his attempts to bring in the smoking ban and minimum pricing of alcohol, Donaldson was consumed with the desire to do battle with a viral pandemic. In the search for his very own Moby Dick, the sweaty surgeon hyped up fears of first SARS, then bird flu and finally swine flu. Thanks to Donaldson, no country overreacted to this scare more than Britain and no country helped the pharmaceutical industry make more money, as I said in a post last year:

Donaldson described swine flu as the "biggest challenge [to the NHS] in a generation" and predicted that a third of the UK population would come down with the virus in the winter. In an act of near-insanity, the British government ordered 110 million doses of the swine flu vaccine Tamiflu, 50 million more than would be needed to treat every man, woman and child in the country. The Department of Health ordered 32 million face masks. The Home Office made plans to dig mass graves.

In the event—despite the coldest winter for 30 years—there were fewer deaths than in the average flu season. The final death toll was 450—0.7% of the 65,000 predicted in Donaldson's worst-case scenario. Of these 450 deaths, only 70 could be solely attributed to swine flu.

The big winners from the swine flu panic were the pharmaceutical companies who managed to offload vast quantities of anti-viral drugs that were not needed and will never be used. There is now a hefty body of evidence that shows that Big Pharma had a disproportionate and malign influence on the World Health Organisation while the 'crisis' unfolded.

Our investigation has identified key scientists involved in WHO pandemic planning who had declarable interests, some of whom are or have been funded by pharmaceutical firms that stood to gain from the guidance they were drafting. Yet these interests have never been publicly disclosed by WHO and, despite repeated requests from the BMJ/The Bureau, WHO has failed to provide any details about whether such conflicts were declared by the relevant experts and what, if anything, was done about them.

"There was no scientific basis for the WHO’s estimate of 2 billion for likely H1N1 cases, and we knew little about the benefits and harms of the vaccination. The WHO maintained this 2 billion estimate even after the winter season in Australia and New Zealand showed that only about one to two out of 1000 people were infected. Last but not least, it changed the very definition of a pandemic.”

The world was suckered by the WHO and the WHO was—to put it most charitably—suckered by Big Pharma. No country was conned more than Britain and at the heart of the British scare was Liam Donaldson. Having coaxed the government into wasting millions of pounds on unnecessary drugs, Donaldson retired last year, with the risible promise to come back to the job if swine flu re-emerged as the plague he always claimed it would be. It hasn't, of course, so has the discredited quack drifted into ignoble retirement?

Of course not...

Liam Donaldson Takes Up Role With Lobbying Firm APCO

The former chief medical officer for England has agreed to advise a global lobbying firm with a string of UK healthcare clients.

In the new role, Donaldson will provide strategic advice for clients such as the British Association of Pharmaceutical Wholesalers, Johnson & Johnson and Pfizer.

As Paul Flynn says, "the wages of error are bounteous". But, as if that wasn't enough, he's also got himself a job at the WHO.

WHO Director-General names Sir Liam Donaldson envoy for patient safety

WHO Director-General Margaret Chan has named Professor Sir Liam Donaldson as WHO Envoy for Patient Safety. In this role, Sir Liam, who served as England's Chief Medical Officer between 1998 and 2010, will help the Organization promote patient safety as a global public health priority.

What a cosy little club the WHO is. And Donaldson is showing no sign of toning down the scare-mongering in his new role.

"If you were admitted to hospital tomorrow in any country... your chances of being subjected to an error in your care would be something like 1 in 10. Your chances of dying due to an error in health care would be 1 in 300," Liam Donaldson, the WHO's newly appointed envoy for patient safety, told a news briefing.

This little statistic is a classic Donaldsonism, as Emergency Physicians Monthly has pointed out:

This guy was formerly England’s Chief Medical Officer for twelve years. England’s own parliament put out a report of England’s Health Committee in 2009 – while Donaldson was the CMO - showing that “around 3,500″ medical errors in the NHS each year involve the death of the patient.

Between 2009 and 2010, there were 14.5 million hospital admissions in England – at least according to the NHS’s “Hospital Episode Statistics” online. With one in 300 dying from an “error in health care” (according to Dr. Donaldson), then a total of roughly 48,300 patients in England would have died at the hands of us careless, lackadaisical, downright dangerous medical providers.

Same calendar year, but there is a big discrepancy between 3,500 patient deaths cited in the House of Commons report and 48,300 deaths cited by Professor Sir Liam Donaldson.

That discrepancy leaves me with three possible explanations.

First possibility: Those who created the statistics used in the Sixth Report of the Health Committee for the House of Commons were a bunch of incompetents and should all be beheaded. Remember, the report was created during Sir Liam Donaldson’s tenure as England’s Chief Medical Officer, so he is not without blame if this scenario holds true.

Second possibility: There was a MI5 cover up of nearly 45,000 deaths due to medical errors in England in 2009. Someone call Scotland Yard … and Geraldo Rivera.

Third possibility: Sir Liam Donaldson is blowing bubbles out his bum when citing statistics on behalf of the World Health Organization.

Liam Donaldson scaring the wits out of people with made-up statistics to enhance his own power and prestige? Nothing changes.

Monday 29 August 2011

At the movies with the prohibitionists

It's been quite a month for wowser propaganda, what with Facebook folly, obesity babble and multiple drinking delusions. With so much junk coming from their temperance and fat-fighting rivals, the anti-smoking wingnuts must be feeling quite left out. But, like a champion limbo dancer, when the bar is lowered, you can rely on Tobacco Control to lower it once more...

Films that 'encourage smoking' claim £338m in UK tax credits

Imperial College team says government is 'seriously undermining' anti-tobacco campaign

This 'news story'—reported in the Observeris a variation of a press release that was knocking around last week which gave us the SHOCKING news that some Hollywood films subsidised by the US government depict smoking—a deviant activity which only 1.4 billion people engage in. The message is that this is UNACCEPTABLE and that governments should not provide assistance to film-makers who wish to depict this foul and despicable practice (other foul and despicable practices are okay). Won't somebody please think of the children? etc.

Personally, I find it shocking that Hollywood films receive subsidies. I had assumed it was only the piss-poor, loss-making British efforts that demanded aid from the reluctant tax-payer.

The UK version of this non-story is even lamer than the original. Foreign film-makers working in Britain receive tax relief for whatever reason and some of the movies they make contain images of the most evil habit in the Universe and, therefore, makes kiddies start smoking.

The evidence that teenagers start smoking because they see people (usually villains and perverts) smoking on screen has been entirely created by Californian fruitcake Stanton Glantz, who hilariously insists that half of all smokers take up the habit because they see Gandalf smoking in The Lord of the Rings or something. Even Glantz's opposite number in Australia, the creepy sociologist Simon Chapman, has described this evidence as "epidemiological alchemy" and, as former editor of Tobacco Control, he knows all about that.

Needless to say, the Observer story stems from yet another smokefree movies study from Glantz:

"California's state film subsidy program is undermining its longstanding tobacco control efforts," said lead author Stanton Glantz, PhD, UCSF professor of medicine and director of the Smoke Free Movies Project based at UCSF. "These activities never made sense, but are even more remarkable at a time when health and education programs are being slashed."

"In addition to ending subsidies for films that promote smoking, modernizing the rating system to give smoking films an R rating will provide a market incentive for producers to keep smoking out of movies that they market to adolescents."

Glantz has moved on from his original goal of banning smoking in all but R-rated films, and now wants the government to withdraw financial support from films that depict smoking. Since film-makers want the lowest classification possible and also want subsidies, this is one way of stopping the movie industry from showing the world as it is, and instead make it look like the fantasy that people like Glantz have in their heads. Don't be fooled into thinking this is just about changing the classification system. The aim is to get rid of smoking from all movies. It is censorship, pure and simple.

Glantz's co-author for the latest of his rants on this subject is Christopher Millett—a sociologist who works in obesity prevention. He crunched the numbers with the great mechanical engineer and concluded...

"In the period we looked at, the government gave £48m a year in tax credits to American films that feature smoking, almost all of which were rated suitable for children and adolescents," said Christopher Millett, from the School of Public Health at Imperial College London. "By comparison, the government spent £23m a year on mass media anti-smoking campaigns."

Note the spurious comparison here, as if the government is spending twice as much promoting smoking as it is trying to prevent it—as if the brief appearance of some villain smoking a cigarette is an equal and opposite reaction to an anti-smoking commercial.

The good news is that Glantz's 'smokefree movies' ruse has so far fallen on stony ground. The WHO and the CDC have been happy to support his demands for censorship, but the film industry generally doesn't like being told what to do by single-issue fanatics and has ignored them (it would open the floodgates to obsessives of all kinds if it didn't). The government has also shown no interest in supporting the zealots and when Glantz got his knickers in a twist over Avatar last year, he made himself a laughing stock.

Excellent. Anything that reminds the public that they are dealing with censorship-loving screwballs who want to turn art into propaganda is to be encouraged so, please continue 'Dr' Glantz. It's delightful.

Saturday 27 August 2011

Obesity babble

Last night, the BBC News reported as fact that the obesity rate will nearly double to 40% by 2030. It was the considered view of "doctors and scientists" and therefore immune from doubt and criticism. Yesterday, I mentioned the last time "experts" tried to predict the future of obesity in Britain—and managed to get both the magnitude and the direction of the trend wrong.

In fact, I have yet to see an obesity forecast that has not been wildly off base. In 2009, for example, a study in the Journal of Epidemiology and Community Health tried to predict obesity rates in 2012. Not a huge challenge, you might think, to see three years in advance. The researchers concluded that:

If recent trends in adult obesity continue, about a third of all adults (almost 13 million individuals) would be obese by 2012.

To be fair, there's still four months left before we can call this a fail. All that needs to happen in the next four months is for ten percent of the population to suddenly become obese and we will have a winner.

"Off the mark" is probably the kindest way of describing the predictions made about the obesity "pandemic". Take this, from 2004, for example:

Rising obesity will condemn one in ten Britons to diabetes by 2010

At current rates, doctors predict six million British cases of the condition by 2010

One in ten Britons can expect to suffer from diabetes by 2010 as the full impact of the country’s soaring levels of obesity takes its toll on public health.

Doctors’ leaders gave warning yesterday that a diabetes epidemic was now inevitable as new figures revealed that the number of cases has gone up by more than one third in the past eight years.

The report, the first indicator of the repercussions of Britain’s obesity problem, shows that there are 1.8 million diabetics in Britain — up 400,000 cases since 1996. A further million people are estimated to be living with diabetes, but with the condition as yet undiagnosed.

While the Government has predicted a rise of up to three million cases by 2010, doctors said last night that it would be closer to double that level on current rates.

Both estimates turned out to be too high, but the government got much closer than the doctors. By 2010, there were 2.6 million cases.

The phrase "at current rates" is the key to all this. Although the BBC might treat "doctors and scientists" as if they were infallible, the forecast in the Lancet—which is "based on historical trends"—is rooted in the assumption that existing trends will continue at the same rate indefinitely. Actually, it is rather worse than that, because the forecasters have chosen to ignore the flattening out of obesity levels in the last decade and have instead based their figures on the increase between 1985 and 2002, as Nigel Hawkes has noticed:

The actual figures show that the trend from 2002 has actually been flat. For 2009 (not included on the graph, I notice) the proportion of all men who were obese was 22.1 per cent, the same as in 2002. That is far from the impression given.

Although the obesity rate has not risen at all in the last 9 years, the Lancet predicts that it will rise by more than 100% in the next 19 years. This strikes me as being a questionable assumption at best. But leaving the dubious methodology aside, obesity predictions rest on the observation that rates have increased over time and therefore obesity is effectively caused by time itself. That being so, obesity will continue to rise at a consistent and predictable rate each year. It sounds ridiculous when put in these terms—and it is—but that is fundamentally what the "science" of these projections rests on.

It is the same logic that led the banks to believe that property prices would to go up forever. It is the same logic that makes gamblers put large sums of money on "home bankers" (the best football teams playing lesser football teams at home). It is the logic that is superbly documented in Dan Gardner's recent book Future Babble, which shows that tossing a coin is a more reliable way of predicting the future than asking an expert.

One of the reasons expert predictions are so unsuccessful is that they see the future as an exaggerated version of the present. All too often, they do not really understand why the current trend is happening in the first place, but having observed it, they expect it to continue.

This is not a good way of seeing the future at the best of times, but it is particularly foolish when current trends are exceptional. After 9/11, many predicted that massive acts of terrorism would become regular events in the years to come. They didn't. When the economy had an exceptional boom, the experts called it a new paradigm. It wasn't. When the economy came out of recession, some predicted a double-dip recession. It didn't happen (or hasn't yet). The experts were reacting to what was freshest in their minds. They reacted to exceptional events and assumed that they were now the norm.

There is no doubt that the rise in obesity in the last half-century has been exceptional. It is possible that the rise might increase at the same rate and become still more exceptional, or it might rise a little bit, or it might flatten or fall (as the most recent figures from the UK and USA suggest).

The Lancet obesity experts do not take their logic to its natural conclusion and tell us when 100% of the population will be obese, but based on their trend line it will be shortly before the end of this century. If they told us that everybody will be obese by 2100, we would (I hope) find their prediction risible. But it would be an entirely fair prediction to make, based on the assumptions that underpin their current report.

This is not just an reductio ad absurdum argument. Researchers have done exactly that. Take this 2008 study published in the journal Obesity, for example:

If these trends continue, by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034.

Let us imagine how that work. No American athletes. No American anorexics. Everybody, including anti-obesity campaigners, public health researchers and the author of this study—assuming he lives that long—will be overweight or obese by 2048.

It sounds absurd. It is absurd. Only by the logic of "expert" obesity predictions does it make any sense, because those experts do not acknowledge that people are autonomous beings capable of changing, adapting and taking control of their own lives

And so, while we can't entirely rule out the possibility that the new obesity prediction will prove to be correct, all the previous forecasts have been wrong and so, "based on historical trends", if we were given to predictions, we might predict that this one will be wrong too.

Friday 26 August 2011

A million alcohol-related hospital admissions?

Last night, I was on BBC Five Live discussing the latest shock-horror alcohol admissions figures for UK hospitals (on the iPlayer from 51.00). Actually, as Mark Wadsworth noticed, there's nothing new about them. They were given to the media back in February, and then released officially in May and have now been revived in the Silly Season for no other reason than that the temperance lobby wanted to milk them one more time. Apparently it sells newspapers.

The big (old) news is that there were more than a million alcohol-related hospital admissions last year in the UK despite (and this is rarely mentioned) alcohol consumption having been in decline for the last eight years, and despite (this is never mentioned) Britain having the third highest alcohol taxes in the world. This is a doubling in admissions in less than a decade. A truly remarkable phenomenon, if true.

In my naïvité, I always imagined that it was doctors and nurses who decided whether a hospital admission was alcohol-related, but then I read this post at the always informative Straight Statistics, which explains that hospital admissions data are divided up according to various assumptions. For example, it is assumed that 20% of all stomach cancer admissions are alcohol-related, half of epilepsy admissions are alcohol-related and a quarter of admissions for extreme cold are alcohol-related.

These assumptions are based on individual epidemiological studies which may or may not reflect the true risks. Whether true or not, if a man goes to hospital complaining of hypertension, he will make up a quarter of an alcohol-related admission, even if he is a teetotaler. If he goes to hospital 8 times, he will have added two alcohol-related admissions to the statistics—remember, these are admissions, not different individuals. The system is called 'alcohol-attributable fractions' and you can read all about it here should you wish.

Having read many an epidemiological study, I am not convinced that this is the very best way to get a handle on alcohol-related harm. The NHS's figures have already been distorted improved beyond recognition in recent years. The methodology has changed, for one thing, as the Office of National Statistics acknowledges:

These figures use a new methodology reflecting a substantial change in the way the impact of alcohol on hospital admissions is calculated. Previously the calculation counted only admissions for reasons specifically related to alcohol. The new calculation, for which the methodology is described in the report, includes a proportion of the admissions for reasons that are not always related to alcohol, but can be in some instances (such as accidental injury).

The number of ailments that are categorised as 'alcohol-related' has jumped from 7 to 14 to 20 in the space of eight years:

Finished admission episodes are identified where an alcohol-related diagnosis is recorded in any of the 20 (14 from 2002/03 to 2006/07 and 7 prior to 2002/03) primary and secondary diagnosis fields in a Hospital Admission Statistics record.

As a consequence of these changes we are seeing an enormous rise in admissions that are 'partially attributable' to alcohol which would not have been considered alcohol-related in the past. And of these partially attributable admissions, the biggest growth has come from diseases of old age which are blamed on alcohol by the system of attributable fractions.

As the Portman Group has pointed out in a letter that probably won't be published, hospital admissions are rising in general, largely as a result of the ageing population. According to them, the proportion of hospital admissions that are 'alcohol-related' has risen from 1.32% to 1.34% in five years, which does not sound quite like the 'epidemic' you may have read about.

Take hypertension, for example. There are many hundreds of thousands of admissions for hypertensive disease every year. The system of attributable fractions assumes that 28% of them are due to alcohol (13% for women), and, as a result, the number of 'alcohol-related' hypertension admissions has risen from 136,000 to 383,900 since 2002. There are also a huge number of admissions for heart palpitations, of which 182,300 are blamed on alcohol (up from 87,000 in 2002).

I am not necessarily saying that these ailments were not caused by alcohol in some way, but these two conditions make up more than half of the million admissions that have filled the headlines. And those headlines are invariably accompanied with images of young people out on a Saturday night. The unmistakeable impression is that a million people are being rushed to hospital with alcohol poisoning or liver cirrhosis. They're not. The admissions that are wholly attributable to alcohol make up less than a quarter of the total.

I suppose images of people in their eighties repeatedly being admitted to hospital with heart problems wouldn't sell the temperance lobby's agenda so effectively, but it is these pensioners, rather than the teen bingers, who are the real face of this moral panic. Hospital admissions for heart failure, hypertension, stroke, stomach cancer etc. will almost certainly continue to rise in the future because of the ageing population. As a consequence, the number of partially attributable alcohol-related hospital admissions will also rise. It has to, because although the number of admissions change, the underlying assumptions do not.

(It should be mentioned that drinking has prevented many thousands of hospital admissions because of the protective effect of alcohol on the heart. The NHS figures cannot be expected to include these, but any honest anti-alcohol campaigner would calculate how many admissions have been saved and debit it from the total.)

However, beneath all this noise, there is evidence of a rise in genuine alcohol-related diseases. The number of deaths from alcoholic liver disease—a diagnosis that is less prone to statistical fiddling—has risen from just over 3,000 to just over 4,000 in the last decade. This is much less dramatic than the temperance lobby likes to claim (and the rate fell last year) but it is a rise and it is compatible with falling consumption because overall consumption is a poor predictor of chronic alcoholism.

And chronic alcoholism is the issue. Along with those who commit alcohol-related violence, it is the chronic alcoholics who are the real problems. They need help and support while the thugs need punishment. The broad population-based policies of the temperance movement will not address either issue. They are going down the same dead-end of denormalisation that the tobacco control mob have gone down. They will punish the many for the sins of the few while doing nothing for the minority of people who abuse alcohol in a damaging way. Like the imbeciles of the anti-smoking lobby, they are obsessed with an imaginary war with the drinks industry which will do nothing to reduce harm or save lives. If these people were only idiots they would be tolerable, but they are dangerous idiots because their broad brush policies ignore the real problems.

The new obesity pandemic, the same as the old obesity pandemic

And today's bollocks is...

Half of UK men could be obese by 2030

Health experts blame passive overeating for global pandemic, warning in the Lancet that governments must tackle obesity now

Ooh, it's like I Love the Noughties. It takes me back to those days when property prices were rising, the Kaiser Chiefs were in the charts, Tony Blair was still Prime Minister and everyone was worried about the obesity 'epidemic'.

Governments around the world need to make immediate and dramatic policy changes to reverse a pandemic of obesity which could affect an extra 11 million people in the UK over the next 20 years, public health scientists have warned.

Would they be the same public health scientists who predicted this in 2006?

England to have 13m obese by 2010

More than 12m adults and one million children will be obese by 2010 if no action is taken, a report by the Department of Health is predicting.

The report warns that, based on current trends, 33% of men and 28% of women will be obese by 2010.

At the time, male obesity rates were running at 23.1% and the female obesity rate was 24.8%.

So, what happened next?

Despite the government ignoring the anti-obesity lobby's urgent suggestions for traffic light labelling on food and suchlike, the latest figures show that obesity amongst men has fallen to 22% and the female obesity rate has fallen to 24%.

Given that the previous prediction could not have been more wrong—despite the modest task of forecasting just 4 years ahead—how likely do you think it is that the anti-obesity 'experts' can predict what will happen in 19 years?

As George W. Bush once tried to say, fool me once, shame on you. Fool me twice, shame on me.

Exclusive video footage of the Lancet obesity team in session

Thursday 25 August 2011

Does Facebook cause substance abuse?

Hot on the heels of Alcohol Concern's dodgy report about how Facebook causes binge-drinking comes a report from America's National Center on Addiction and Substance Abuse (CASA), the neo-prohibitionist lobby group set up by Joe Califano in the early 1990s (see Velvet Glove, Iron Fist for Califano's background).

As faithfully report by Fox News and others, the report concludes that:

Facebook Linked to Teenage Drinking, Drug Use

American teenagers of middle and high school age are more likely to smoke, drink and use drugs if they also spend time on social networking sites, according to a new study by the National Center on Addiction and Substance Abuse at Columbia University.

The study, released Wednesday found that teens spending any time at all on social networking sites were five times more likely to smoke cigarettes, three times more likely to drink and twice as likely to smoke marijuana.

Califano has wasted no time in blaming Facebook et al. for kids drinking, smoking and taking drugs:

“The relationship of social networking site images of kids drunk, passed out, or using drugs and of suggestive teen programming to increased teen risk of substance abuse offers grotesque confirmation of the adage that a picture is worth a thousand words.“

He has no doubt that correlation equals causation:

"This year’s survey reveals how the anything goes, free-for-all world of Internet expression, suggestive television programming and what-the-hell attitudes put teens at sharply increased risk of substance abuse.

"Especially troubling - and alarming - are that almost half of the teens who have seen pictures ... first saw such pictures when they were 13 years of age or younger. These facts alone should strike Facebook fear into the hearts of parents of young children."

And there are the inevitable policy demands:

"The time has come for those who operate and profit from social networking sites like Facebook to deploy their technological expertise to curb such images and to deny use of their sites to children and teens who post pictures of themselves and their friends drunk, passed out or using drugs. Continuing to provide the electronic vehicle for transmitting such images constitutes electronic child abuse.”

"Electronic child abuse" and "Facebook fear" are strong terms, so what is the evidence to back them up? The survey's findings were as follows:

Compared to teens who in a typical day do not spend any time on a social networking site, those who do are:
  • Five times likelier to use tobacco (10 percent vs. two percent).
  • Three times likelier to use alcohol (26 percent vs. nine percent).
  • Twice as likely to use marijuana (13 percent vs. seven percent).

The first thing to note is that 70% of the teenagers used a social networking site, and so the 'control group' (those who didn't) are not typical—they make up just 30% of the sample. This should lead us to ask the key question of why this minority of teenagers are not on Facebook, MySpace etc. in a 'typical day'? Maybe they don't have many or any friends. Maybe their parents won't let them have a computer or use social networking sites. Maybe they come from families who have strong moral or religious objections to using these sites. Perhaps they are strict Mormons or belong to the Plymouth brethren. Any or all of these factors would be consistent with non-Facebook users being non-drinkers, non-smokers and non-drug takers.

Teenagers use Facebook, in part, to socialise, organise nights out and share photos of those nights out. Those who are less interested in socialising will be less interested in using a social networking site, but they are also likely to be less interested in using the substances that act as a social glue for many teenagers (like it or not).

Before anyone gets upset, I am not suggesting that people who abstain from alcohol and tobacco (or Facebook) are friendless bores with no social lives. But I would contend that parents who won't let kids use social networking sites are more likely to keep from away from tobacco and alcohol.

Unlike Alcohol Concern—which blames the drinks industry for the phony Facebook menace—CASA thinks that social networking sites spread substance misuse by allowing users to post photos of nights out. This, it seems, warps the fragile little minds of American youth.

No wonder [Facebook users are more likely to use substances] – with what’s on Facebook and other social networking sites for teens to see:

  • Half of the teens who spend any time on social networking sites in a typical day have seen pictures of kids drunk, passed out, or using drugs on these sites.
  • Even 14 percent of those teens who spend no time on social networking sites in a typical day have seen pictures of kids drunk, passed out, or using drugs on these sites.

I have no idea what the second bullet point means. Perhaps Mark Zuckerberg has found a way of beaming Facebook directly into children's brains. But let's move on...

Compared to teens who have not seen such pictures, teens who have seen pictures of kids drunk, passed out, or using drugs on Facebook or other social networking sites are:

  • Three times likelier to use alcohol.
  • Four times likelier to use marijuana.

This is very likely to be true, but it tells us nothing more than that drinkers and pot-smokers tend to have friends who are drinkers and pot-smokers. It is merely confirmation that (a) like-minded people tend to associate with each other, and (b) lifestyle choices are influenced by one's peers.

Properly interpreted, this information is underwhelming to the point of banality. Teenagers saw their friends drunk, smoking and passed out before the age of Facebook, and will continue to do so if Califano succeeds in forcing the people at Facebook "to deploy their technological expertise to curb such images" (a massive infringement of free speech and free expression which should be opposed by all right-thinking people).

Joe Califano is 80 years old, so perhaps it is too much to expect him to understand that social networking sites do nothing more than extend social networks in the digital age. But even he should be able to spot the chasm between correlation and causation in this survey. After all, if Facebook really does double, triple and quintuple substance abuse, we should have seen a massive rise in drinking, smoking and drug-taking amongst American youth in recent years.

Here is how Facebook went from having virtually no users to having half a billion users in the space of six years.

Teenage use of Facebook has risen from practically zero to 70% since 2004. If social networking sites make kids five times more likely to smoke, we should see some effect on the national smoking prevalence figures. Instead...

For current cigarette use, the prevalence increased from 27.5% in 1991 to 36.4% in 1997, declined to 21.9% in 2003, and then declined more gradually, to 19.5% in 2009.

For current frequent cigarette use, the prevalence increased from 12.7% in 1991 to 16.8% in 1999, declined to 9.7% in 2003, and then declined more gradually, to 7.3% in 2009.

And if users of social networking sites are three times more likely to use alcohol, we should also see a significant rise. Instead...

Current alcohol use among high school students remained steady from 1991 to 1999 and then decreased from 50% in 1999 to 42% in 2009.

Of the three substances under discussion, only marijuana has seen a rise in use in recent years, and the rise has been fairly slight.

The mistake made by CASA (and let's be charitable and assume it was a mistake) is to assume that the teenagers who don't use Facebook are the 'normal' ones who have evaded infection by the social networking evil. From that false assumption comes the belief that if Facebook stopped allowing users to share their depraved photos, substance abuse by the site's users would drop to the same level as its non-users. But the figures show that the non-users are far from 'normal'. Only 2% of them smoke, only 9% of them drink and only 7% of them use pot. This would be considered exceptionally low in any generation, with or without Facebook.

The question is not what Facebook does to kids to make them drink, smoke and take soft drugs. The question is why do abstainers from these substances also abstain from Facebook. That is a more interesting question, but the answer would not help CASA's agenda so it goes unasked.

Tuesday 23 August 2011

Shisha, defiance and petitions

I was mildly amused to see this story about shisha smoking in The Guardian today, because the journalist had contacted me back in April and I'd passed her on to hookah expert Kamal Chaouachi. Four months later, I'd forgotten all about, but here is the resulting article...

Smoking shisha: how bad is it for you?

It is growing in popularity but some experts say a single shisha session is the same as smoking 200 cigarettes

Some readers might recall that back in 2009, the BBC reported that...

Shisha 'as harmful as cigarettes'

Smoking a shisha pipe is as bad for people as smoking tobacco, the Department of Health and the Tobacco Control Collaborating Centre has found.

This is nonsense, as Chaouachi explained at the time, but soon the myth had taken hold that...

Shisha is 100 times worse than cigarettes

And this game of Chinese whispers quickly evolved into...

Shisha 200 times worse than a cigarette

Presumably, then, anti-smoking advocates would recommend that shisha smokers take up a pack-a-day cigarette habit to reduce their risk by 90%?

Of course they wouldn't, because they know as well as everyone else that the "200 worse" statistic is garbage. It's not based on harm to health, but is purely a calculation of how much smoke is inhaled. Shisha smoke is, however, fundamentally different to cigarette smoke. For one thing, shisha works on the heat-not-burn principle and is filtered through water. As Chaouachi explained to The Guardian, the resulting smoke is chemically different:

Dr Kamal Chaouachi, a tobacco expert who teaches at Paris IX University and has researched shisha for 15 years, says comparing shisha with cigarettes "amounts to comparing oranges to apples".

According to Chaouachi, studies led by independent researchers at the Royal University of Saudi Arabia have shown that shisha smoke is 30 times less concentrated in chemicals than cigarette smoke, contradicting the WHO's warnings. "It is ludicrous and anti-scientific to claim that hookah or shisha smoke is 200 times more toxic than cigarette smoke," he says. "While about 5,000 chemicals have been identified so far in cigarette smoke, chemists and pharmacologists from Saudi Arabia only found 142 chemicals in shisha smoke. Also, a medical team in Pakistan found that shisha smoke can be much less carcinogenic and radioactive than cigarette smoke."

There is also an acknowledgement that the BBC's story back in 2009 was, well, bollocks:

In March, the BBC published a news story claiming that GPs in Leicester "are seeing an increase in teenagers with health problems linked to shisha pipe smoking". But Leicester PCT now says the story was erroneous; while it maintains the number of teenagers in the city smoking shisha is on the rise, it says GPs have not confirmed an increase in treating patients with health problems caused directly by shisha.

The BBC is just great at reporting on tobacco issues, isn't it?

By coincidence, I happened to be in Beirut when the journalist first contacted me about this story. There is a very great deal of shisha smoking in Lebanon and so I was intrigued to hear that the country has just introduced a smoking ban. But it sounds as if the Lebanese will deal with the ban in a civilised and practical way:

“I don’t think people will follow the law. We’re Lebanese,” she said, looking out of the window at the chaotic Hamra traffic. “Like the seatbelt and traffic light laws, people will find ways to get around the law.”

Like many Lebanese restaurateurs, Ahmadieh isn’t too concerned about the new smoking ban, one of a raft of new laws introduced after a long parliamentary break, as she doesn’t believe that it will be strictly enforced, but rather applied according to the acceptance of each bar, cafe or restaurant owner.

Good for them. Meanwhile in the USA:

Lawmakers banned from Michigan bars

In an act of solidarity, Michigan bar and restaurant owners have banned state lawmakers from their property.

Effective September 1, the group Private Property Rights in Michigan said in a release Monday that lawmakers will be persona non grata in over 500 Michigan licensed establishments, across the state.

PPRM said it believes, however, even more will take part.

The group says bar owners and workers have grown frustrated with the Ron Davis law; also known as the private property tobacco use ban. PPRM claims the ban has collectively cost the state an estimated $200 million dollars in lost revenue through losses in jobs, taxes, business closings and to the state lottery.

Note to the British pub industry: this is what a pair of balls looks like. Here's the list of the MPs who voted for the smoking ban. Why not grow a pair?

Finally, Anthony Worral Thompson has set up an e-petition asking for the smoking ban to be reviewed and amended. You may rightly be cynical about the government's exercises in direct democracy but if you don't show your support, they'll interpret it as support for the bully state. Go sign it.

Monday 22 August 2011

The BBC's drink problem

Yet more pitiful health reporting from the nation's state broadcaster:

Children aged four in Wales' A & Es for drink and drugs

Children as young as four have been treated in accident and emergency departments in Wales for the effects of alcohol, research shows.

What research would that be?

Figures obtained by BBC Wales suggest at least 1,200 children attend casualty each year because of drink and drugs.

As you will gather, this is not just some rewritten press release from the British Medical Association (BMA). Instead, the Beeb has decided to do some low-grade investigative journalism of its own.

Naturally, however, the BMA takes centre stage:

Dr Richard Lewis, Welsh secretary of the British Medical Association, said the issue was "increasingly worrying".

"I think it's pretty well recognised by health services and health professionals that there's an increasing problem with both alcohol and drug-related incidents with younger and younger people," said Dr Lewis.

"We see year-on-year increases with attendances at A & E departments, particularly for alcohol."

And that is where the BBC's figures come in, which they present in the chart below.

As you can see, alcohol-related hospital admissions for the 12-17 age group have increased from 605 to 833 in five years, thus giving partial support to the claim that...

Clive Wolfendale, chief executive of north Wales drug and alcohol agency Cais, said the problem of children regularly drinking to such extremes had taken off around five years ago.

But, as anyone with the slightest facility for critical thinking can see, there hasn't been a rise in admissions in the last five years. The only reason it looks like there has, is that the BBC wasn't able to get hold of the figures for Cardiff and Vale—which typically make up a quarter of the total—for 2006 and 2007. The national totals the BBC gives for those years cannot, therefore, be compared with the later years. No responsible statistician would think of comparing, or even showing, these totals, but this is the BBC and it's amateur night again.

For the three years which are comparable, there has been no significant change in admissions (818, 809 and 833), and in the four areas which do have full data, three of them saw a fall in admissions. And for the '11 and under' age group (shown on the Beeb's website), the numbers are very small but have not risen (14, 5, 10, 12 and 12 per annum). Oh, and the number of admissions for drugs has fallen.

What, then, is left of the idea that we are seeing "year-on-year increases with attendances at A & E departments" for "younger and younger people"? Nothing at all, and the BBC has the figures to prove it, if it was so inclined.

But it isn't inclined. Instead, it allows various temperance campaigners to make unfounded and unchallenged assertions. Like this, from the anti-alcohol 'charity' Cais (which receives 99.8% of its income from the government):

"Where kids go first for what might be described as a high is drink, rather than cannabis or opiates or ecstasy or legal highs. The substance of choice is alcohol," he said.

"The reasons for that are two-fold. First of all it's the cheapness and availability because, in real terms, it's cheaper that [sic] it's ever been."


Okay, one more time for the world. Alcohol is not cheaper in real terms than it has ever been. Alcohol is more expensive in real terms than it has ever been.

From the Office of National Statistics:

Between 1980 and 2008, the price of alcohol increased by 283.3%. After considering inflation (at 21.3%), alcohol prices increased by 19.3% over the period.

And this is how the price of a pint of bitter changed in the last century:

I wouldn't expect temperance groups to admit to the fact that alcohol has never been pricier, but I would have hoped that the BBC would know this by now—God knows, they write enough stories about alcohol. If they had interviewed someone from the other side of the debate, they would have been told this. But, in defiance of the most basic standards of journalism, they didn't bother to solicit opposing views, nor did they bother with simple fact-checking.

"The second reason [for alcohol's popularity] is the general thrust of marketing," he added.

"The drink companies are on social networking sites and there's still a lot of direct advertising going on through sports sponsorship and so on."

How seamlessly we move from Friday's scare du jour to Monday's nonsense. As I mentioned in the previous post, Alcohol Concern's moral panic about online drinks marketing is silly season stuff. Alcohol marketing has never been more strictly regulated. If you are going to claim that underage drinking is on the rise (which it isn't), you need also to show that alcohol marketing is on the rise (which it isn't), otherwise you do not even have correlation, let alone causation. The only reason this fake charity is harping on about price and advertising is that the temperance movement's current political objectives are to increase prices and ban advertising.

This is reprehensible reporting from the BBC once again. Having gone to the trouble of getting the hospital statistics for Wales, their reporter—Kevin Leonard—sees that alcohol-related admissions for young people have been static or falling, but nevertheless decides to report that admissions are rising (albeit through quotes from interested parties). None of the quotes are challenged and no opposing views are allowed to be aired.

This kind of propaganda is now so common at the BBC that it is becoming difficult to believe that there is not an agenda at work. Whilst the BBC is not (quite) the worst offender when it comes to bad reporting of health issues, its coverage of alcohol issues is consistently biased and, unlike the Daily Mail, it cannot make the excuse that it needs to resort to sensationalism to attract customers.

This rubbish virtually fisks itself, but the facts are now peripheral. A narrative has been set in place that cheap alcohol and rampant drinks advertising has led to an epidemic of drinking, and the truth is not going to get in the way. We have unprecedentedly high prices, less drinks advertising than ever and a ten-year decline in drinking rates, but none of it matters. The temperance movement has stuck to their line and the BBC is right behind them come hell or high water.

UPDATE: Dick Puddlecote has spotted a cracking quote from the author of this tripe, Kevin Leonard, extolling the benefits of the NCTJ journalism course that turned him from geography graduate to BBC reporter.

“Whatever job you end up doing - I work on the BBC News website in Cardiff - you'll never regret getting those key journalism skills hammered home on an NCTJ course.”

He should demand a refund.

Friday 19 August 2011

The paranoia of Alcohol Concern

Alcohol Concern has been using your tax money to produce a piss-poor report about how the evil drinks industry markets to kiddies on the internet.

Except they don't, really, and Alcohol Con can't produce any evidence to the contrary. Instead, they resort to saying that some drinks companies use Facebook and Twitter, and so do teenagers. Ipso facto, drinks companies must be banned from using Facebook and Twitter.

And yes, that is exactly what they're demanding:

Given their strong appeal to young people, official alcohol marketing should not be permitted on social networking sites.

The report is of the usual fake charity standard, containing shocking revelations like this:

Each of the most popular drinks brands amongst young people aged 11-17 in the UK, namely Fosters, WKD, Carling, Budweiser, Carlsberg, Bacardi and Smirnoff, have a dedicated website.

The monsters! The vile unfeeling monsters! And there is in-depth research like this:

Video websites such as YouTube have also meant that previously-aired alcohol television adverts, which may not satisfy today’s broadcasting codes, have gained a new lease of life; a search on YouTube of “Carling Black Label” and “Tetley’s Bitter” for example produces adverts for the brands from the 1980s and the early 1990s.

Look, this is the internet. On the internet you can find out how to make a bomb, you can discuss designer drugs, you can find more porn than you could watch in a life-time, you can download any movie, steal any song, write about anything and read about anything. It's unstoppable, uncontrollable and it is gloriously immune to censorship. If a fifteen year old wants to go onto Youtube and look at an old Carlsberg Black Label advert, that is the least of your worries.

None of this is evidence. It is banal Googling and it tells us nothing. To be fair, Alcohol Con has gone to the effort of assembling a focus group of 16 and 17 year olds to discuss the connection between alcohol and the internet. The results were unsurprising. They used Facebook to put up pictures of themselves on a night out and, as you might expect, some of these nights out involved drinking.

For the young people surveyed, alcohol consumption and Facebook usage were both intrinsic parts of their everyday lives. It is perhaps inevitable, therefore, that SNS users enjoyed documenting their own drinking experiences and reading about the drink-fuelled exploits of others.

Fair enough. They are slightly underage but no one is suggesting that young people should be banned from using Facebook in case they mention drinking. So how does the drinks industry and their insidious marketing come into this?

None of the respondents interviewed admitted to being aware of or visiting brand websites.

I see.

None of the young people consulted have previously accessed brand websites and were not inclined to do so in the future. Similarly, the majority of respondents did not visit alcohol brand sites on Facebook, and the minority who have come across such pages previously had devoted little time to them.

Right. And what about the alcohol industry's sneaky use of Facebook, which Alcohol Con's head honcho Don Shenker calls a "real danger"?

Just a very small minority of the young people consulted had seen alcohol companies advertising on Facebook, through pop-ups on the side of their homepage.

Wow, this is a real epidemic of stealth marketing, isn't it? And what about Youtube?

Just one respondent mentioned searching for ‘funny videos’ on YouTube and had watched official alcohol videos. He recalled having watched the ‘Good Call’ advert by Fosters and the Heineken ‘Walk-in-fridge’ advert, and commented that they were amusing.

None of these respondents, however, were aware of alcohol channels on YouTube.

By this time you may be thinking that Alcohol Concern's report—faithfully publicised by the Daily Mail and others—is, at best, a waste of time that proves the opposite of what they are saying in the press, but maybe the drinks companies have been using Twitter to attract underage customers? I've been looking through the Twitter archive of a number of drinks companies (most of them aren't even on it) and I haven't found a single tweet that could be considered even vaguely child-orientated.

But then I looked at Alcohol Concern's twitter feed and it seems that they have found an example of malevolent practice. On August 15, Smirnoff tweeted this:

To which Dong Shaker replied:

What?!? We are dealing with drooling obsessives here. People who see hidden meanings in everything. Paranoid people, in other words. Can we stop funding them now please?

Interestingly, when you search for "Alcohol Concern Facebook" on Google, the first site on the list is a group called 'Alcohol Concern: Bugger Off' which has a mission statement with which I can sympathise:

Just a little show of disdain towards those boring twats at alcohol concern who are railing against a pint of beer costing 99p in Wetherspoons.

Listen. I'm sorry that your dad or mum was a drinker. I'm sorry for whatever deeply egocentric reason you have for joining such a pointless group. I honestly feel for you. But whatever happened to you, it's not the fault of the rest of mankind. Get over it. Shit happens. It's a genetic failing of yours. Not my fault.

I like drinking.

A beer is a social glue. And at 99p, hard working people on lower wages might be able to enjoy a few more of a night. And Cheers!

Alcohol Concern. Go away. Shut up. Leave us alone. Stop ruining everything for people.

You dull twats.

Smirnoff has 17,629 followers while Alcohol Concern has 269 followers. Who exactly does this fake charity represent again?

Wednesday 17 August 2011

The medicalisation of pleasure

Some interesting news from Switzerland, where nicotine addiction is to be classified as a disease.

Following a Federal Court ruling, the Federal Health Office has concluded that nicotine addiction can be considered an illness. Basic compulsory insurance, which currently does not reimburse any anti-tobacco medication, will have to pay up.

On August 4 the Federal Court underlined that alcohol and heroin addiction could be considered an illness and that “under certain conditions” so could dependence on nicotine. In this case, insurance companies would have to reimburse medicines to treat smoking addiction.

This is intriguing for a number of reasons. Anti-smoking extremists generally oppose the idea that smoking/nicotine addiction is a disease/disability, because the diseased and the disabled have rights. Nicotine addiction is specifically excluded from disability laws in several countries to prevent smokers complaining about discrimination. Anti-smoking campaigners have to tread a fine line between saying that cigarettes are more addictive than heroin, on the one hand, and insisting that smoking is a matter of free choice that can be stopped at any time.

The pharmaceutical industry is not so bothered about maintaining this balancing act. Their lobbyists would like to entirely medicalise the issue in order to position their own products as the 'cure'. And it is they who have been the main drivers of the Swiss decision, as the headline of this story makes clear.

Tobacco ruling has a financial side

Indeed it does. Step forward, Pfizer...

The court partially agreed with drug maker Pfizer which wanted its Champix (or Chantrix) medication included in the list of medicines reimbursed by basic insurance.

'Reimbursement' has always been Big Pharma's aim. It is nice for them to be able to sell drugs like Champix or Nicorette to those who want to quit, but it is even nicer if the government (or insurance companies) buys their stock en masse and dishes them out to smokers as a matter of course.

This intention has been clear since 1999, when Glaxo, Novartis and Pharmacia became big-spending partners with the World Health Organisation to achieve a tobacco-free (note, not nicotine-free) world. In that year, Greg Deener, Glaxo's Director of Global Commercial Strategy, gave a speech which explained exactly what they wanted in return.

We want to support and be partners in tobacco control in a number of areas. We could use help in the area of reimbursement. Zyban was first launched in the US, but as yet there is minimal reimbursement for Zyban in the US. In the US, 42% of people on Medicaid smoke. Federally, Medicaid does not require reimbursement for smoking cessation because it is a lifestyle decision, in the same category as hair replacement... Reimbursement will increase quit attempts, make physicians more proactive.

Do you think he mentioned reimbursement enough? For the pharmaceutical industry to maximise its profits, the government must buy up their NRT products as if they were antibiotics, but for that to happen—as Deneer made clear—smoking cannot be seen as a "lifestyle decision", but as a disease.

This is a very iffy proposition, because smoking is not a disease, rather it is a risk factor for disease, as the insurance companies have pointed out.

For their part, health insurance companies have denounced the “negative message.”

“We only cover risk of illness and not prevention, which is not a risk. Prevention is down to individual responsibility and can’t be carried by everyone. This would be putting all types of behaviour under state control,” explained Yves Seydoux, spokesman for Groupe Mutuel.

But others have equated nicotine addiction with alcoholism, and there is a case to be made that if other addictions are considered diseases, then so should nicotine addiction.

Jacques de Haller, president of the Swiss Medical Association, does not quite agree. “From a medical point of view the two pathologies are different, but both are a dependency.”

“A smoker is addicted to tobacco which makes him lose his free will and can considerably shorten his life,” he said. In addition, there is “the real problem of passive tobacco addiction”.

I have literally no idea what "passive tobacco addiction" is supposed to mean. I wonder if even he knows. It seems that you can stick the word "passive" into any sentence and get people to nod their heads in solemn agreement.

Leaving that aside, it seems to me that the real problem here is that if you classify nicotine addiction as a disease, then industries that sell nicotine products are part of the problem, and that includes Big Pharma. As ineffective as they are, NRT products have a role as one of the options for people who want to quit smoking for the sake of their health. But if the problem is redefined as being nicotine addiction itself, they are clearly not a solution. It could even be argued that since NRT is much safer than smoked tobacco, the pharmaceutical products encourage people to stay addicted for longer. Put simply, nicotine products are not a cure for nicotine addiction.

But what else can Big Pharma do? They can't claim that their NRT products cure lung cancer and they can't claim they prevent smoking. If they are to be viewed as medicines, it can only be as a 'cure' to smoking, but smoking is a lifestyle choice and can only be viewed as an addiction if all nicotine use is classified as an addiction and, therefore, a disease.

It doesn't make a whole lot of sense, but that doesn't seem to have stopped the Swiss. This is a major achievement for Pfizer as it sets the scene for the full medicalisation of nicotine. And medicalisation leads to prohibition.

At the start of the last century, a man could go into a shop and buy virtually any stimulant, narcotic, drink or tobacco product he wished, including opium, morphine and cocaine. By the start of the twenty-first century, only a handful of drugs remained publicly available—specifically: caffeine, alcohol and nicotine, of which only alcohol is an intoxicant. The rest had undergone prohibition, but what we call prohibition was really medicalisation. The drugs never disappeared, nor were they intended to disappear. Instead, a system which allowed ordinary people to use mood-altering substances as they saw fit was replaced by a system in which the power to distribute drugs was confined to the pharmaceutical industry and the medical establishment. Even under alcohol Prohibition in the 1920s, doctors were permitted to sell booze.

This enhanced the power and prestige of the doctors, and increased the profits of the drug companies. That is not to say that prohibition was their doing—on the contrary, the pharmaceutical interests initially opposed drug prohibition—but if you ask cui bono?, that is your answer. The sweeping prohibitions of the last century have largely been the work of moral entrepreneurs and zealous reformers, but the effect has been to medicalise a whole range of pleasure-giving substances, of which only a handful remain. In the process, a whole new range of 'diseases', 'syndromes' and 'addictions' has been invented which allows pharmaceuticals to be prescribed to an ever-greater number of people.

If this trend continues, it would be natural for nicotine and alcohol to go the same way eventually. As David Nutt and others have pointed out, there is no scientific reason for these drugs to be legally available when other drugs are classified substances. Alcohol is under no threat of imminent prohibition as long as the American fiasco remains in the popular memory, but David Nutt is personally working on developing a synthetic alcohol substitute and the government's guidelines on 'safe drinking levels' are so low as to be essentially medicinal.

The campaign against tobacco is far more advanced and, again, it has been pushed along by moral entrepreneurs to the benefit of the pharmaceutical industry. More recently, as events in Switzerland show, the pharmaceutical industry has taken a more active role. The long-term goal might be to have a similar nicotine market to that which already exists with drugs, ie. people acquire the habit on the black market and seek 'treatment' (which is actually maintenance of addiction) from doctors who prescribe pharmaceutical substitutes.

Tobacco and alcohol survived the prohibitionist wave of the twentieth century by no more than historical accident. There is no reason to be expect them to be around forever.

Monday 15 August 2011

Planning for prohibition

Apologies for the week's absence. Last Tuesday was another bad day for the Voluntary Human Extinction Movement as it saw the birth of my daughter (pictured left), amongst many others. As you might imagine, this event has been taking up much of my time. But normal service will be resumed this week, starting with an article I wrote for The Free Society about the people who said it wasn't about prohibition making plans for prohibition.

The piece looks at a recent paper titled 'Daring to Dream' in which anti-smoking advocates look at "end-game strategies" to wipe tobacco from the face of the earth. What could possibly go wrong, eh?

It also looks at a study published in the International Journal of Drug Policy—called 'History of Bhutan's prohibition of cigarettes: Implications for neo-prohibitionists and their critics'—which looks at how tobacco prohibition has been going in Bhutan. The answer, of course, is not well.

There is, says its author, “a thriving black market and significant and increasing tobacco smuggling… 23.7% of students had used any tobacco products (not limited to cigarettes) in the last 30 days… tobacco use for adults has not ended or is even close to ending… cigarette prohibition is instrumental in encouraging smuggling and black markets… The results of this study provide an important lesson learned for health practitioners and advocates considering or advocating, albeit gradual, but total cigarette ban as a public policy.”

That’s right. Prohibition still doesn’t work.

Do pop over and have a read...

Sunday 7 August 2011

The heart miracle scam revisited

One of the more blatant scientific scams of recent years has been the heart miracle phenomenon, in which tobacco control campaigners create studies showing a dramatic fall in heart attacks after smoking bans. It began when Stanton Glantz of Americans for Nonsmokers' Right announced the 'Helena miracle' in 2003, claiming a 60% drop in heart attacks after the smoking ban in this small town in Montana (later revised to 40%). It continued through places like Bowling Green, Ohio (47%) and Pueblo, Colorado (41%).

These places are not exactly major conurbations, you may have noticed, and the numbers of heart attacks are so low—often single or double figures—that large fluctuations are common. When whole countries have been studied, advocates have been forced to resort to methodological jiggery-pokery (Scotland, 17%) and bald, unverifiable assertions (England, 2.4%).

Stanton Glantz has produced two meta-analyses in an attempt to shore up his hypothesis, claiming that heart attacks fall by 27%, and then 17%, after smoking bans are enacted.

But when the actual hospital admissions data are made available, they invariably fail to provide any evidence of an effect of smoking bans on the heart attack rate. The statistics from Denmark, Wales, Australia, England, ScotlandNew Zealand and the United States have all failed to support the smoking ban/heart miracle hypothesis.

What should we trust? The evidence from places like Bowling Green, Ohio or the evidence from the entire USA? It has been obvious from the very beginning that anti-smoking campaigners have been mining the data to find big drops in heart attacks that roughly coincide with smoking bans. A study recently presented to an American Heart Association conference illustrates how easy this cherry-picking can be.

The study's finding are very interesting. The researchers looked at 74 US cities and found that the heart miracle effect has now fallen to just 3% (0.97 (0.95-99)). When the sample was limited to cities where the smokefree law was "meaningful"—ie. where there was a full smoking ban, rather than just restrictions—the effect disappeared entirely (0.99 (0.96-1.02). (Meaning that cities with lax smoking bans saw a bigger fall in heart attacks than those with "meaningful" smoking bans. Once again, the evidence fails to fit the theory.)

A drawback of the study is that there is no indication of how much the heart attack rate was falling before the ban, nor do the researchers compare rates to those in the cities which didn't have a smoking ban. When the study is published—if it is—hopefully the researchers will use a control group and look at the long-term trend.

What we do know is that rates of heart disease are falling in the USA, as they are in the UK and Europe. Even if one picks the more generous 3% figure, a modest decline of this order is likely to be in line with the secular trend. In other words: the smoking bans didn't make any difference.

If you look at the cities which brought in full smoking bans, you can see there is a great deal of variation in the heart attack rate with some going up, some going down and some going nowhere.

The variation is so great that no honest statistician would claim that there is any trend to be found amongst the data. But notice that four of the cities showed a statistically significant reduction in heart attacks and that the reduction was quite strong (at around 25%-30%). Now put yourself in the shoes of the tobacco control advocate who wants to show that smoking bans have a major effect on the heart attack rate. Which city would you choose to write your paper about? Evanston or Flagstaff?

The question, I think, answers itself. This is how they have been doing it. This is how we end up with 'news stories' like this from the BBC in 2003:

Town slashes heart attacks

Banning smoking in public places could prevent hundreds of deaths from heart disease, according to a study in a small US town.

Heart attacks in Helena, Montana, fell dramatically when smoking in public places was banned for six months last year.

The number of admissions dropped to fewer than four a month - a fall of nearly 60%.

From "nearly 60%" to nearly zero in just 8 years. What a ridiculous fraud this whole thing has been and how pathetic that so many have fallen for it.

Thanks to Michael J. McFadden for the tip.

Monday 1 August 2011

Panorama's half-hour temperance commercial

This week's Panorama programme (BBC) can only be described as a half-hour advertisement for Britain's temperance movement. Its big 'scoop'—repeated by most newspapers and then inserted into the News at Ten—was that "nearly half" of the representatives on the government's Alcohol Working Group are from the drinks industry. Since the rest were all anti-alcohol lobbyists, that seems like a pretty balanced panel to me, but apparently it's a scandal.

Panorama managed to ignore the irony of complaining about an imbalance in the government's policy group while making a programme that was as one-sided as the Battle of France. All the usual faces were there—Ian Gilmore, Don Shenker, Vivienne Nathanson—and all singing from the same hymn sheet they have been using for the last few years. They want a total ban on advertising, minimum pricing and restricted availability of alcohol (meaning, specifically, a ban on supermarkets selling alcohol). I think we all know that by now.

Did we see what ordinary drinkers thought of this? Did we see any academics who might be able to put British drinking habits in context? Of course not. Instead we got a brief clip of a representative from the drinks industry and a lot of footage of chronic alcoholics in a Liverpool hospital.

The policies put forward by the temperance lobby in this programme are not trivial. Alcohol advertising, though greatly restricted, has always been permitted in this country and no government has ever set a minimum price for alcohol or, as far as I am aware, any other product. Minimum pricing represents a major change in the way the state intervenes between buyer and supplier—"we can't let you buy it at that price, it's too cheap for you". This policy will cost nearly all drinkers a significant sum of money, it's probably illegal, there's no evidence that it will do any good and it's a Pandora's box that can never be closed.

Exceptional policies like these require exceptional circumstances and Panorama spent thirty minutes telling the viewer that Britain is indeed in crisis. Enormous quantities are being drunk at exceptionally low prices, they said, therefore prices need to rise. Something must be done.

Pretty much every assumption in this narrative is wrong. Whether judged by the standard of other countries or by the standard of previous eras, this country is not in the grip of an alcohol epidemic.

For instance, let's look at how the UK ranks amongst other EU states for alcohol consumption. (As always, click to enlarge).

As you can see, we are firmly mid-table, perched between Portugal and Cyprus. We are a very long way behind Luxembourg, the Czech Republic and Estonia. Incidentally, note that Finland is up near the top despite having some of the highest alcohol taxes in the world.

And speaking of alcohol taxes, is it true that drink is under-taxed in Britain?

Absolutely not. Of all the EU countries, we have the second highest rate of duty on beer and wine and the third highest duty on spirits. The countries that come above us are Ireland and Finland, both of whom are amongst the biggest drinkers in the EU.

This tells us two important things that deserve more attention:

(1) high alcohol taxes are not very effective in reducing alcohol consumption
(2) British drinkers are already taxed exorbitantly on the alcohol we consume.

But aren't we drinking much more than we used to? Well, up to a point. This is the graph used in the Independent's report on the Panorama 'story' today.

Firstly, notice how drinking rates have been in decline for several years and are currently only a squeak ahead of what they were in 1980 (when, contrary to claims made on Panorama, alcohol was 20% cheaper in real terms).

Secondly, note the year in which this graph starts. Can you think of any reason why people didn't drink much in 1947, when rationing was still in place and the country was virtually bankrupt? Anything at all? Because according to David "I am not a prohibitionist" Nutt, it's because the drinks industry wasn't as powerful then:

Since the second world war the alcohol industry has become one of the most powerful and successful in the UK. Intake has grown steadily, each person on average drinking more than twice that consumed in 1945.

Far be it from me to contradict Professor Nutt, but I'm pretty sure there was unrestricted alcohol advertising and no minimum pricing in 1947. If we take a longer view and start the clock from a more typical time in history, a rather different picture emerges.

It's a shame this graph doesn't go even further back as there was a large fall in consumption from 1876 onwards, but this chart is enough to show us that people drank quite a bit more at the start of the last century before falling massively during the First World War, rising a little, collapsing again during the Great Depression and falling to another low in the austerity years. Unless my eyes deceive me, 1947 represented the lowest rate of alcohol consumption in British peacetime history. I wonder why the Independent and Prof. Nutt would pick this particular era as the start point?

Since 1947, alcohol consumption has gradually returned to normal levels. It can truthfully be said to have doubled, but it would be more informative to say that its returning to the historical average. Anyone who tells you that we're in the midst of a drinking epidemic because we're drinking twice as much as we did during the age of austerity is trying to sell you something. Specifically, they are trying to sell you deeply illiberal temperance policies under the cover of a moral panic which does not exist.