Wednesday 31 October 2012

Is that a fact?

The big lie has returned. From NPR:

When smoking is banned in bars and workplaces, the number of people who suffer heart attacks and die drops within months, according to two new studies.

They found benefits not only in saving lives, but in lowering the cost of medical care for heart attacks, stroke and other smoking-related illnesses. It's the best evidence yet demonstrating big, swift health improvements when secondhand smoke is banished.

"We should now accept this as fact," says Richard Hurt, a professor of medicine at the Mayo Clinic who led one of the studies. Tobacco industry arguments that secondhand smoke isn't a major risk factor for heart disease, he says, are "just nonsense," because the only risk factor that changed in those 18 months was secondhand smoke. People's cholesterol and blood pressure stayed the same, and obesity rates increased.

And the man who invented this fraudulent field of pseudoscience is on hand for a comment of his own:

"It's just a gigantic effect," says Stanton Glantz, director of the Center for Tobacco Control Research and Education at UCSF, and a leader on the study. "There's nothing else you can do that's going to have that big an effect that fast."

Forgive my scepticism, Stanton, it's just that every time hospital admissions data are publicly available, they show these 'heart miracle' studies to be castles made of sand.

The latest effort focuses on Olmstead County, Minnesota, where the heart attack rate fell by 33 per cent between 2001 and 2009. All the ingredients of a heart miracle scam are in place.

Yes, these—ahem—'findings' were published by press release a year ago.

Yes, it's another small locality.

Yes, there's no control group to compare it to.

Yes, the timeframe studied is peculiar (the smoking ban was enacted in 2007).

Yes, heart attack rates have been falling all around the world with or without smoking bans (in the UK, for example, the heart attack rate fell by 50 per cent between 2002 and 2010.)

And yes, once again, the hospital admissions data make a mockery of the claim that the smoking ban 'caused' the fall in heart attacks. As Michael Siegel showed yesterday, the heart attack 'plunged' by a similar rate in the rest of Minnesota. And today, he has found data which show that the heart attack mortality rate which was falling steeply before the ban and then rose after it. Oh dear.

Thus, it is clear that the observed 33% reduction in heart attacks in Olmsted County during the study period is not attributable to the smoking ban.

Note that even if one looks only at hospital admissions for heart attacks in Minnesota, there was a 23% decline in these admissions between 2001 and 2006 alone (the data is not provided by HCUP past 2006). However, if one extrapolates to the year 2009 based on the secular rate of decline in the 2001-2006 period, the estimated number of hospital admissions for heart attacks in 2009 represents a drop of 34% from 2001.

In other words, in the absence of a smoking ban, heart attack admissions in Olmsted County would have been expected to drop by 34%. In the presence of the smoking ban, heart attack rates dropped by 33%.

Thus, it appears that the observed decline in heart attacks in Olmsted County is roughly representative of the overall trend in heart attacks in the state as a whole. In this light, the present study hardly supports a conclusion that the Olmsted County smoking bans produced a 33% decline in heart attacks.

If these are "definitive" results, I'd hate to see what "tentative" results look like.

Quite. Frankly, this is getting boring. It's the same crude trick again and again. Stop it.

Monday 29 October 2012

First plain packs arrive in Oz

I'm grateful to an Australian reader for sending me photos of what the new 'plain' packaged cigarettes look like. The cigarettes below are the same brand, albeit different sized packs.

Note the near-meaningless lettering on the cigarettes themselves. The legislation forbids the stamp to have any relation to the brand—God knows why—and, as mentioned in the previous post, the loons are already complaining that this arbitrary rule is somehow being breached.

This is pretty underwhelming stuff. It beggars belief that millions of dollars have been spent battling for this makeover. Presumably somebody out there thinks that if the health warning has a yellow background, people will suddenly notice that smoking is not good for them?

Despite the protestations of the pro-plain pack campaigners, it seems quite obvious that the new packs are considerably easier to counterfeit. Nothing is embossed, only a few colours are used and the fonts are basic. The absence of branding on the cigarettes themselves mean that counterfeiters can stick the same batch of cigarettes in any box. I also see that the gold stripe at the filter has also been banned—that should save the black marketeers a few bucks. The whole plain pack ruse might as well be designed to help the illicit market. What fools these people are.

Meanwhile, to nobody's great surprise, plain packs are already giving retailers a headache.

Hughes IGA supermarket owner Michael Makas said he had sold a few of the new packets, which are required by law to be plain, except for health warnings and brand names. He said selling the new packets was already a "logistical nightmare" because his staff had problems distinguishing between brands.

Surely not!

7-Eleven worker Reece Cheng told The Age the plain packets create confusion for shop owners and customers alike.

"About 30 to 40 per cent of the cigarettes have already moved to the new packaging. It's very confusing I have to say because the new packaging is all the same. "Normally we memorise the whole display by the colours because people always ask for the colours."

This cannot be true, of course, for there is [cough] peer-reviewed evidence which proves that making dozens of cigarette brands virtually indistinguishable will make life easier for retailers. Like this, from the black-is-white quasi-journal Tobacco Control:

Conclusion: Rather than plain packaging requiring an additional 45 s per transaction, our results suggest that it will, if anything, modestly decrease transaction times and selection errors.

So that's that cleared up then (see Dick Puddlecote for more details about that particular piece of 'research'). Onwards and upwards!

Friday 26 October 2012

The idiots have won

Build a spaceship folks. The idiots have won.

Exhibit A

In New Zealand, anti-smoking groups have broadened the definition of 'advertising' to include any form of speech by the tobacco industry on any issue.

A tobacco giant is being accused of illegally advertising cigarettes under the guise of a "public awareness campaign".

The Health Ministry has received 14 complaints against British American Tobacco New Zealand's "agree/disagree" campaign opposing plain packaging.

Here's an example of one of BAT's anti-plain packs ads. It nicely parodies the intolerance and bossiness of public health cranks who think that industry should be literally silenced in any policy debate. What it quite obviously doesn't do—as any sane observer will confirm—is advertise cigarettes.

Apparently, one of the people who complained about this campaign said it was "an attack on the sovereignty of political discourse in New Zealand".

Words fail me.

Exhibit B

The World "Health" Organisation is urging countries to crack down on e-cigarettes because they, er, look a bit like cigarettes.

"ENDS [electronic cigarettes] are products resembling cigarettes and could therefore undermine the denormalization of tobacco use upheld by the WHO FCTC... Parties are therefore invited to consider that a ban of ENDS as already undertaken by some Parties would contribute to changing the social norms regarding the consumption of tobacco products."

E-cigarettes are quite simply the biggest breakthrough in smoking cessation ever. The WHO is a disgrace which has betrayed its mission in developing countries and is more interested in dictating "social norms" than they are in saving lives. The whole rotten organisation should be investigated and shut down.

Exhibit C

Australian anti-smoking fruitcakes—led, inevitably, by that twisted old narcissist Simon Chapman—have complained that cigarette companies are breaching plain packaging rules because....well, I really don't the video and see if you can work it out. It seems to come down to the fact that the tobacco industry is allowed to stamp a few letters on the cigarettes for purposes of identification (how very liberal!) and so they have.

In one instance, Benson & Hedges cigarettes are labelled with "LDN"; in another case Winfield cigarettes are stamped with "AUS".

Yes. So. What?

Under the plain packaging regulations, cigarettes are allowed to be branded with an alphanumeric code but it must not represent or in any way be related to the brand or variant of the cigarette.

Professor Simon Chapman from Sydney University says the potential breach does not surprise him.

"They're probably just testing the waters here to see what they can get away with in the early stages of the new legislation," he said.

Professor Chapman says tobacco companies will do anything to create a sense of "intrigue" about their products.

Ooh, sense the intrigue!

I would like to comment on this, I really would, but the nutters have finally gone beyond the point at which I can even understand their arguments. My nearest guess would be that they think people will be 'lured' into taking up the smoking habit by seeing the letters 'LDN' on a cigarette. That is so stark-staringly, fetch-the-tranquiliser-gun insane that I can only assume that there is another layer of wibble that I've missed. On the other hand, we're dealing with people who think a BAT anti-plain packs campaign is a form of cigarette marketing so all bets are off.

Truly, the lunatics have taken over the asylum.

Wednesday 24 October 2012

Dalli is damned

EU President Barroso has sent disgraced former Health Commissioner John Dalli a letter which seethes with contempt. Dalli has been making his case—and changing his story—in a variety of fringe media outlets since his resignation. In recent days, he has claimed—somewhat pathetically—that he never really resigned at all. Barroso points out that he very much did. He goes on to discuss Dalli's "equally incomprehensible" claims and asks him, probably in vain, to act with "integrity"—the implication here, I think, is that he is the victim of some sort of Big Tobacco conspiracy.

"Mr Dalli,

I received your letter of 21 October 2012.

I would like to inform you that I am unable to accept the statements and claims made in your letter.

During our meeting on 16 October 2012, you have yourself unambiguously declared your immediate resignation, before the Director General of the Legal Service and the Head of my Private Office. Under the Treaty, no written form is required for a declaration of resignation, and it is irrevocable.

As a consequence, no further question arises about the effectiveness of your resignation.

Your various complaints and accusations of illegal or incorrect conduct vis-à-vis you that you have advanced in several statements since 17 October 2012 are equally incomprehensible. In this respect, I would remind you that you have had in good time several opportunities to react to the issues raised with regard to the OLAF investigation.

Finally, in the light of certain statements and insinuations you have made in relation to the process of preparation of the revised directive on tobacco, I wish to remind you of your obligation, as a former Commissioner, to behave with integrity in accordance with Article 245 TFEU. As the OLAF investigation confirmed, the decision making process of the Commission in the tobacco file has not been affected and, as foreseen in its Work Programme, the Commission will proceed with this proposal."

Dalli is a dead man walking. It is hard to believe Barosso would send such a letter if he was not confident that the evidence existed to take him down.

Alternatively, of course, you can believe that the EU is a pro-tobacco institution and that a little-known Swedish smokeless tobacco industry somehow framed Dalli and then organised a break-in of various offices in Brussels for no apparent reason. It is fitting that anti-tobacco EU sock puppets (and George Monbiot) should make such tinfoil hat accusations without any evidence whatsoever. Long may they continue to do so, for the closer they get to this discredited and corrupt individual, the more they sully themselves.


I had my say about a weird week in tobacco control in Malta Today at the weekend. On a different note, there's an article about minimum pricing and my latest IEA report at the New Statesman.

More Dalli and Snusgate

In a tetchy interview with the Times of Malta, John Dalli lets slip a little more information about this bizarre affair. If I understand him correctly, he is now saying he resigned verbally but not in writing. He confirms that the Tobacco Products Directive was signed, sealed and delivered by March this year (and, therefore, any pretense of consultation since then has been a charade). And he confirms that he wanted to ban smokeless tobacco:

And I can tell you, it was not on the cards. In fact, in the final version, the ban on snus is still there.

In fact, to tell you the truth, we were also suggesting a ban on all smokeless tobacco but that was changed when we negotiated with the other services in the Commission.

So your position was to ban all smokeless tobacco and this was changed after resistance from the European Commission?

That’s right.

Perhaps the most interesting part is at the end of the interview when Dalli says that he has "hundreds of canvassers" like Silvio Zammit, the man who is alleged to have asked Swedish Match for €60 million to repeal the snus ban.

Silvio Zammit is a canvasser like many hundreds of canvassers that I have. That is the relationship with him. And with him I have the contact I have with other canvassers. When they need something and when they have some friend who needs something. It’s the usual political game in Malta.

However, Dalli seems to think that these hundreds of people are well-intentioned volunteers who arrange appointments between interest groups and the EU Health Commissioner out of the goodness of their hearts.

You described a money offer by the snus lobby to Mr Zammit for a meeting as a bribe.

That is what it is.

Wouldn’t these middlemen be demanding money for these services? Would they be doing it voluntarily?

I would not be such an evil mind as to think that for someone to set up a meeting he would take money. All I say is that it usually is a feeling of importance (that these canvassers seek).

So you think that money is not traded in these circumstances.

No. I mean that as far as I am concerned, whenever anybody held any meeting with me, money was never an issue. I don’t know of any instance or any sniff of a possibility that money was an issue.

That these people would make themselves available to these companies for a fee.


Isn’t fostering...

I am not fostering anything. People ask me to meet people as other Commissioners do, and this is, if you ask me, why they were up in arms because everybody does this. Everybody meets people in the Commission and so they should.

Dumb or just playing dumb? You decide.

Monday 22 October 2012

Drinking in the Shadow Economy

I've got a new report out today, published by the Institute of Economic Affairs. It looks at rates of unrecorded alcohol consumption in Europe and identifies the factors which fuel the black market.

As always with the IEA, the publication can be downloaded as a PDF for free (click here).

This is the press release:

The Treasury is losing as much as £1.2 billion every year to the illegal alcohol industry. A new report, Drinking in the Shadow Economy, demonstrates how illicit alcohol consumption is becoming a permanent and growing problem due to excessive taxation.

The damaging effects of counterfeit alcohol

Failing to deal with counterfeit and smuggled alcohol threatens not only public cash, but public health and public order. Counterfeit alcohol can contain potentially life threatening levels of dangerous chemicals, whilst alcohol smuggling is linked to other illegal activities such as drug dealing, violence and money-laundering. High taxes are encouraging the growth of the illicit alcohol market

It is evident that high taxes are causing this boom in the illicit alcohol market. As prices rise, consumers are increasingly turning to the more affordable options available in the shadow economy. Government policy might intend to improve people’s health, but it may be having the opposite effect.

With the number of seizures of counterfeit alcohol rising five times between 2008/09 and 2010/11, and growing reports of counterfeit spirits being sold by both licit and illicit retailers, it is crucial that the government reconsiders its strategy in dealing with alcohol pricing.

High alcohol taxes do not reduce alcohol consumption

Contrary to popular belief, making alcohol more expensive is not an effective way of reducing drinking rates or the problems associated with excessive alcohol consumption. Britain and Finland have some of the highest alcohol taxes in the world and yet the amount of drink consumed in these countries is the same as in places such as France and Spain, where alcohol is more affordable.

Commenting on the report, its author, fellow of the Institute of Economic Affairs Christopher Snowdon, said:

“The government’s focus on maximising tax revenues is short-sighted and dangerous. Aside from losing money by encouraging consumers to find cheaper illicit alternatives, public health and public order are also being put at risk by high prices. Policy-makers ought to take the threat of illicit alcohol production seriously when considering alcohol pricing in the future.”

"There is a clear relationship between the affordability of alcohol and the size of the black market. Politicians might view the illicit trade as a price worth paying for lower rates of alcohol consumption, but this research shows that the amount of drink consumed in high tax countries is exactly the same as in low tax countries."

“Minimum alcohol pricing might seem like a quick fix to tackle problem drinking, but it is likely to cause many more problems by pushing people towards the black market in alcohol."

Rowan Atkinson on free speech

A brilliantly funny man with some extremely sound views. The perfect video at the end of an immense weekend of free speech at the Battle of Ideas.

Read more about the campaign to reform Section 5 of the Public Order Act here.

Saturday 20 October 2012

More on Snusgate

Malta Today has more on the EU/Dalli/snusgate car crash. It is doubtful whether anything this man says can be trusted, but John Dalli claims to have been planning a truly prohibitionist Tobacco Products Directive:

"I finalised the directive on 25 February, which kept the snus ban and also proposed a ban on all smokeless tobacco."

So much for consulting EU citizens, who were overwhelmingly in favour of lifting the ban on snus. Dalli explains his reasoning, which naturally has nothing do with health and everything to do with politics.

"A court sentence [sic] already bans the sale of snus outside Sweden. Changing it would have been political suicide."

Political suicide? Strong words, but an interesting choice of words, since Patrik Hildingsson of Swedish Match recalls the attempt to solicit a bribe of €60 million!) as follows:

"The Maltese businessman expressed to us very clearly that he was speaking on behalf of Dalli. He had a manner and information that made us wary," Hildingsson said.

"He said it was, in principle, political suicide to lift the ban and therefore he wanted money for it, simply put, since the career (of the EU commissioner) would be over afterwards."

Sounds like the two men from Malta were, at the very least, of the same mind and using the same language.

Friday 19 October 2012

Friday quote

Taken from Petr Skrabanek's wonderful The Death of Humane Medicine (1994) (free download)

"I don't smoke nor drink.

I don't stay out late and don't sleep with girls.

My diet is healthy and I take regular exercise.

All this is going to change when I get out of prison."

Have a good weekend. I hope to see some of you at the Battle of Ideas.

Thursday 18 October 2012

Obey or pay

Once again, an editorial in a medical journal has left me virtually speechless, this time from the New England Medical Journal. In a recent Supreme Court ruling, Chief Justice John Roberts mentioned that the government has considerable power to tax “even in areas where it cannot directly regulate.” That comment was enough to give the maniacs of public health a whole raft of new authoritarian ideas. Brace yourself.

Roberts's opinion appears to invite more targeted, assertive interventions to promote public health. For example, instead of merely taxing tobacco sales, the federal government could require individuals to pay a tax penalty unless they declare that they haven't used tobacco products during the year.

It could give a tax credit to people who submit documentation that their body-mass index is in the normal range or has decreased during the year or to diabetic persons who document that their glycated hemoglobin levels are controlled.

It could tax individuals who fail to purchase gym memberships.

It could require taxpayers to complete an annual health improvement plan with their physician in order to obtain a tax credit, though that might be challenged under other parts of the Constitution.

Taxing people for not joining the gym? "Health fascism" doesn't sound like hyperbole any more.

Some interventions we've outlined would never survive the political process, given prevailing antitax sentiment.


But such sentiment may fade as the economy recovers or become less important if Democrats regain control of the House of Representatives.


Moreover, the Court decision affirms that Congress can facilitate passage of a tax by calling it something less controversial.

How about you call it a "fine"? That's the usual term for a financial punishment for not obeying the government. Or would calling something by its name be too "controversial" for you?

The Court has highlighted an opportunity for passing creative new public health laws, authorized by the taxing power; this opportunity now awaits its political moment.

It never ends, folks. It's us or them. I can only quote those great lines from CS Lewis which appear on the sidebar of this blog:

"It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."

Wednesday 17 October 2012

Plain pack campaigners tried to corrupt public consultation

Dick Puddlecote has found himself a cracking scoop thanks to the Freedom of Information Act. On August 10th this year, Deborah Arnott, director of ASH, wrote to Tabitha Brufal (Department of Health) about a round robin e-mail from the UK Centre for Tobacco Control Studies. This e-mail explicitly encouraged people to sign all the pro-plain pack petitions that were doing the rounds because "I would seriously doubt that there will be cross checking between charity petitions".

Click to enlarge:

This is serious stuff. As Dick says...

So a tobacco control industry employee was actively encouraging fraudulent submissions of signatures... this wasn't a couple of rogue part-time signature-gatherers perverting evidence, it was someone working on behalf of the campaign itself.

Do go read the whole post. I will just add two things. Firstly, this incitement to pervert a government consultation came from the (state-funded) UK Centre for Tobacco Control Studies, a body which masquerades as a scientific institution. It should be clear to anyone who is familiar with the UKCTCS's output that it is no more than a glorified lobby group. This e-mail confirms it.

Secondly, it could be argued that Arnott's e-mail demonstrates some degree of integrity within tobacco control. She rightly says that the UKCTCS e-mail was "inappropriate and ill-advised". It might therefore be said that Arnott acted to prevent the consultation being corrupted with multiple signatures. But let me remind you of the date of the e-mail: August 10th 2012. The same day that the consultation ended. Too little, too late.

Once again, the plain pack campaigners have shown themselves to be unscrupulous and corrupt. Why are paying for this mob?

Tuesday 16 October 2012

EU Commissioner resigns in snus scandal

I've waited a long time to use this graphic

Massive corruption scandals at the EU are two a penny, but this one is very interesting. The EU Health Commissioner John Dalli has resigned after the snus company Swedish Match complained that an acquaintance of Dalli's—"a Maltese entrepreneur"—had been soliciting a bribe from them in return for influencing the forthcoming decision about the EU snus ban.

I don't know any more than you at this stage, but this is what the EU press release says:

Commissioner John Dalli has today announced his resignation as a member of the Commission, with immediate effect.

Mr Dalli informed the President of the European Commission Jose Manuel Barroso of his decision following an investigation by OLAF, the EU's antifraud office, into a complaint made in May 2012 by the tobacco producer, Swedish Match. The company alleged that a Maltese entrepreneur had used his contacts with Mr Dalli to try to gain financial advantages from the company in return for seeking to influence a possible future legislative proposal on tobacco products, in particular on the EU export ban on snus . As soon as the Commission received the complaint it immediately requested OLAF to investigate.

The OLAF final report was sent to the Commission on 15 October. It found that the Maltese entrepreneur had approached the company using his contacts with Mr Dalli and sought to gain financial advantages in exchange for influence over a possible future legislative proposal on snus. No transaction was concluded between the company and the entrepreneur and no payment was made. The OLAF report did not find any conclusive evidence of the direct participation of Mr Dalli but did consider that he was aware of these events.

The OLAF report showed clearly that the European Commission's decision making process and the position of the services concerned has not been affected at all by the matters under investigation.

The final OLAF report and its recommendations are being sent by OLAF to the Attorney General of Malta. It will now be for the Maltese judiciary to decide how to follow up.

After the President informed Mr Dalli about the report received from OLAF, Mr Dalli decided to resign in order to be able to defend his reputation and that of the Commission. Mr Dalli categorically rejects these findings.

Dalli was the main man when it came to revising the Tobacco Products Directive which would look at the snus ban, as well as plain packaging, e-cigarettes, product modification and other new mini-prohibitions.

Interesting times.

See previous posts Nicotine Wars, A Little Snus CoverageTobacco Product Directive Leaked to the Press and Snus: More Prohibition? for a little background.

Smoke and submarines

A nice example of how to mislead with statistics at the quasi-journal Tobacco Control. It looks at smoking in US naval submarines which was banned on 31 December 2010 largely thanks to this study. Its conclusion is:

This study provides evidence that non-tobacco using submariners were exposed to SHS. Exposure was seen in all submarine classes and was not limited to personnel working in proximity to the smoking area. The existing policy was inadequate to protect non-smokers from exposure to SHS and required revision. As a result of a policy review, informed by this study, smoking below decks was banned aboard all US Navy submarines effective 31 December 2010.

Although policy-makers felt no need for the study to be published before they acted on it, it's worth seeing how robust the evidence was for a ban that had a pretty profound effect on submarine crew—nipping outside for a smoke not being an option. Prior to the ban, smoking was confined to ventilated rooms (the whole sub is ventilated, obviously) and a previous study had found that "passive smoke exposure appears to be minimum [sic]".

This new study looked at cotinine levels in urine. Cotinine is a (harmless) biomarker for nicotine and, although cotinine can be found elsewhere (such as in nightshade vegetables), it is a reasonable proxy for tobacco exposure. The study's headline figure is that cotinine levels doubled once the crew were in the submarine compared to their levels when in port.

Overall, deployed cotinine levels were 2.1 times the in port levels in non-tobacco using submariners

To be precise—for the devil is in the detail here—the average background level of urinary cotinine was 0.33 ng/ml and the average level found once in the submarine was 0.69 ng/ml. That is a doubling. No doubt about it. But is it of any clinical significance? Let's look at what typical urinary cotinine levels are in smokers and nonsmokers.

Wall (1988) found a level of 6.0 ng/ml in unexposed nonsmokers, rising to 9.2 ng/ml for 'exposed' nonsmokers. Thompson (1990) found a level of 4.4 ng/ml in nonsmokers who lived with nonsmokers and a level of 11.4 ng/ml for those who lived with smokers. Repace (2005) found levels of around 3 ng/ml for nonsmokers, rising to around 8 ng/ml after 6 hours in a smoky bar.

All these figure are considerably higher than both the 'unexposed' and 'exposed' members of submarine crews today, presumably because the background level of smoke exposure has fallen sharply in the last 25 years due to smoking bans and the decline in the number of smokers. Levels of urinary cotinine in 'exposed' submarine crew are a fraction of those found in 'unexposed'—and therefore, by implication, 'safe'—nonsmokers a few years ago.

But it is only when we compare these levels with those found in smokers that we really see the figures in context. Wall (1988) found levels of 646.8 ng/ml in smokers of 10 or fewer cigarettes per day. For heavier smokers, the level was 1,100.7 ng/ml. Thompson (1990) found an average level of 1,623 ng/ml in smokers. Holl found an average level of 2,671 ng/ml.

Put in this context, a "doubling" in "exposure" from 0.33 ng/ml to 0.69 ng/ml looks like the meaningless finding it is. I have attempted before to show cotinine levels in smokers and passive smokers in the form of a graph. Alas, you need very good eyesight to see the bar for passive smokers, such is it dwarfed by the bar for smokers (take the optical challenge here). If we take Thompson's figure as a median estimate, when in port, the submariners have cotinine levels that are 0.02% of a smoker's. When in the submarine, this rises to—wait for it—0.04%.

If 0.33 ng/ml is a safe level, why isn't 0.69 ng/ml? Both indicate 'smoke exposure' that is less than 1/2000th of that associated with being a smoker. The authors of the study feel no urge to explain why this should be a health concern. Instead they defer to a scientifically insupportable comment made by the last Surgeon General in a press conference.

This study did not attempt to quantify risk; as the US Surgeon General advises, there is no safe level of exposure to SHS.

There you have it. No need for biological mechanisms. No need for epidemiology. A ridiculous comment from a glorified GP is enough for us to assume that trace levels of a harmless biomarker represent risk. This is the natural, and quite predictable, outcome of the "no safe level" woo. Once again, anti-smoking fanatics are doing the hokey-cokey on the grave of science.

There is, however, a much more reasonable conclusion that could be drawn from this study. Submarines are the very definition of an enclosed space and yet they have ventilation systems that reduce secondhand smoke exposure to a level that is, for all practical purposes, zero.

So, if a submarine can do it, why can't a pub?

Monday 15 October 2012

Alcohol: affordability vs inflation

Temperance campaigners frequently talk about how alcohol has become more "affordable" in the UK since 1980. Many people—including a worrying number of journalists and politicians—infer from this that alcohol has become cheaper.

To give one of many examples, here's the West Lothian Tobacco, Alcohol and Drugs Partnership (emphasis in the original):

In Scotland and the UK, alcohol has become greatly cheaper to buy over the last 20 years, particularly in the off-sales sector.

No it hasn't. Britons have become wealthier. For the record, alcohol has become more 45% more affordable since 1980 while becoming 24% more expensive in inflation-adjusted terms. See Statistics on Alcohol: England, 2012...

The above is taken from an NHS document, so it is puzzling why the NHS makes mislading statements elsewhere, such as:

However, over the last 30 years, the UK has become wealthier and alcohol has become cheaper.

Words have meanings and it is important to get them right. Affordability has a distinct meaning—it is the real price divided by average income. Real price also has a clearly defined meaning—it is the average price adjusted for inflation.

It seems to be only alcohol that is consistently discussed in terms of affordability rather than actual price. We don't talk about eggs, houses or oil in terms of affordability. There is a weird implication in the discussion about alcohol affordability—that 1980 was in some way the natural or optimal year for booze pricing and that we should return to it.

There is also a peculiar reluctance to look at different income groups. It is well known that low income groups have seen their earnings rise at a slower rate than those on median incomes and at a much lower rate than top earners. The affordability of alcohol for those low income groups is therefore significantly lower than the average. This may explain why the counterfeit alcohol market is on the rise despite supposedly rising affordability.

Whatever the case may be, we need to get our facts straight. Alcohol has emphatically not got "cheaper" over time. On the contrary, successive sin taxes have made it more expensive.

Saturday 13 October 2012

Minimum pricing guesstimates

There's a very good post up at Liberal Vision by Chris Oakley discussing the ever-changing predictions about minimum pricing coming out off Sheffield University. I've recently read the whole Sheffield report and it really is full of the most ridiculous assumptions. Like Chris, I was particularly surprised to see that they assume heavy drinkers to be more sensitive to changes in alcohol prices than moderate drinkers.

The Sheffield team do acknowledge some quite significant discrepancies between their model and previous work. Faced with the fact that their methodology produces results inconsistent with other findings for price elasticity in heavier drinkers they do provide an analysis that is consistent with the literature…

“To enable more direct comparability with the estimates in the literature we have also generated elasticity estimates for total alcohol purchasing from the EFS, shown in Table 11. These are in broad agreement with the literature, showing that - at the highest level of aggregation – hazardous and harmful drinkers (combined elasticity of -0.21) are less price elastic than moderate drinkers (elasticity of -0.47).”

….but then ignore it.

“Note that these high-level estimates are provided for reference only and are not included in the model.”

This is an extremely important aspect of the whole exercise because if price elasticity is lower for people who are heavy consumers, the result of minimum pricing will not be a reduction in their consumption but a significant increase in the amount they spend with attendant social consequences for them and their dependants.

Eric Crampton touches on why they did this and why they're quit wrong in this post...

They note too that, when we look at own-price elasticity within product categories, hazardous and harmful drinkers are more price elastic than moderate drinkers: they're more likely to shift product categories. But that tells us zilch about what harmful drinkers do in response to a price increase for the entire product category; it would be misleading to use this kind of data to claim that harmful drinkers are the most price responsive. They're most price responsive when their preferred brand or product changes in price but they're also least responsive to aggregate changes in alcohol prices.

While we're on the subject of junk science, I was pleased to get a mention in this week's Economist re: The Spirit Level...

Since both the levels and the origins of inequality vary widely, it is hardly surprising that there is no established relationship between income gaps and financial crises. That does not mean inequality never aggravates macroeconomic instability, but unfortunately critics of inequality often exaggerate their claims. A case in point is “The Spirit Level”, a book by two British epidemiologists, Richard Wilkinson and Kate Pickett, published in 2009. They claimed that higher levels of inequality were associated with higher murder rates, lower life expectancy, more obesity and all manner of other ills. Their explanation was a medical one. Inequality literally gets “under your skin” because the stress of keeping up with the Joneses raises cortisol levels.

“The Spirit Level” caused a sensation when it was first published in Britain, probably because it reflected the post-crash Zeitgeist. Its conclusions, however, have been largely debunked. In a devastating critique, published by the Democracy Institute, Christopher Snowdon showed that Mr Wilkinson and Ms Pickett made highly selective use of statistics. Other, more careful studies show that although there is a strong relationship between individual income and health (richer people tend to be healthier and live longer than poorer ones), the link between countries’ income gaps and their citizens’ health is weak.

Now to get on train for four and half hours to get to Devon to debate happiness with Richard Layard. Should you be in the area tomorrow morning, do come along.

Friday 12 October 2012

Those evil corporations

An exciting new job vacancy has opened up at Bath University...

Corporations and public health: exploring the impacts of corporations on non-communicable diseases and public health policies

Arguably the greatest challenge for public health lies in reducing the contributions of tobacco use, unhealthy diet and harmful alcohol consumption to the rising global burden of non-communicable diseases. Tobacco, alcohol and food related diseases are essentially industrial epidemics.

No alcoholism or gout in pre-industrial times, then? No lung cancer is peasant societies? No "food related diseases" before capitalism (only malnutrition and starvation).

Adapting traditional public health constructs, the concept of industrial epidemic identifies the role of the host (the consumer), agent (the product), environment and, crucially, the disease vector (the corporation).

If a disease is non-communicable it cannot, by definition, have a disease vector. And if a disease is not communicable, no amount of sophistry and goalpost-shifting can disguise the fact that it is not a public health issue.

A disease that is spread by a commonly owned public source (eg. water, air) can properly be dealt with by public authorities. No one wishes to be unknowingly struck down by infection and since goods held in common ownership can only be improved by collective action, preventive measures are desirable and necessary.

However, non-infectious diseases that may or not come about as a result of private action are manifestly matters of private, not public, health. The attempt to compare private transactions between companies and consumers to germ theory is cute, but it is utterly spurious.

Although relatively well developed in the study of tobacco (in part due to the availability of internal tobacco industry documents following US litigation), analysis of the vector and its interaction with the environment has been less thoroughly researched in other areas of non-communicable disease. Nevertheless emerging work suggests a strong degree of policy coherence and learning, as well as collaboration, between alcohol, food and tobacco companies and other industries making products harmful to health and the environment. Despite this overlap, the policy responses to these different vectors vary widely. While Article 5.3 of the Framework Convention on Tobacco Control specifically seeks to prevent tobacco industry influence on policy and supply side regulations are now a key part of tobacco control, alcohol and food policies are more typically based on partnership and voluntarism and consequently focus more on individual behavior change and less on the role of industry in shaping consumption.

But not for much longer if these people get there way. Food and alcohol industries—and their customers—should be worried.

This fellowship provides an opportunity to shape a research agenda on the influence of corporations (particularly food and alcohol companies) on health and health policy, building on existing work on tobacco already underway at the university.

No slippery slope there, then.


Applicants should upload a CV and a two-page outline of their research plans over the next 3-5 years, showing how these complement and enhance existing research within the relevant priority area.

For informal enquiries, please contact Prof Anna Gilmore email:

What an opportunity to have a cosy chat with an over-promoted half-wit who thinks it is illegal for companies not to maximise profit and who can't tell basic economics from a hole in the ground. Who better to supervise a project about corporations? Good grief.

Is there any doubt about what Gilmore's new drone will conclude? "The tactics of the food and alcohol industries mirror those of the tobacco industry... blah, blah, blah..." (ie. they make products people want, market those products and sell them to willing customers—shut 'em down!)

I will leave you with the words of Christopher Hitchens, written nearly twenty years ago:

Much of this militant prohibitionism is fuelled by a stern sense that those who practice it are standing up to the big, ruthless corporations... I am, of course, as shocked as anyone else to find out that big corporations can behave unethically when it comes to research and marketing. But I have never met a smoker who began the habit under the impression it was good for the pipes, and neither have you. Anyway, try a simple thought experiment. Would great and courageous social reformers... relax their attitude one bit if I grew my own tobacco and rolled my own, handmade cigarettes? The question answers itself.

Thursday 11 October 2012

Talking prohibition with Conservatives

I came back from the Conservative Party Conference yesterday, having said a few words at Forest's Liberty Lounge event and watched Alex Deane, Deborah Arnott and others debating whether prohibition ever works (yes, that was the motion).

The latter event was really quite depressing. The actual motion was only seriously discussed by a couple of participants. A woman from the British Beer and Pub Association gave a perfectly sensible speech, including a reminder than alcohol consumption is falling and that the smoking ban has "devastated" British pubs, but it had nothing to do with prohibition. Deborah Arnott rolled up half an hour late (stuck on the M6—presumably her broomstick broke down) and hijacked the event to talk about plain packs (as she did last time I saw her speak).

Also in attendance was a doctor whose name escapes me who gave a rather non-descript speech in which she said she believed in a middle ground between prohibition and legalisation. As a simple matter of fact, there is no such middle ground. Prohibition means abolishing the industry (drinks industry, heroin industry, whatever). If she was referring to the miserable hypocrisy of decriminalisation, it should be noted that alcohol was decriminalised during American Prohibition, ie. it was not an offence to possess or consume it. It was only an offence to manufacture, distribute and sell alcohol. Anyone who claims to be against prohibition but is in favour of destroying the tobacco industry or abolishing the food industry doesn't know the meaning of the word.

The interesting parts of the debate involved Alex Deane's arguments with John Glen and the audience. Alex needed to do no more than reiterate John Stuart Mill's harm principle to be seen as a dangerous radical by the medical Tories and he induced gasps of horror when he said that there is nothing wrong with getting drunk. (Incidentally, if you really want to see binge-drinking, go to any of the party conferences. Politicians who are against cheap alcohol appear to have no problem with free alcohol #hypocrites.)

The medics resented Alex for bringing what they saw as fancy-pants philosophy into matters of public health, and yet the question of whether the state should act to deter people from consuming booze, tobacco and drugs is very much a philosophical one. Public health people usually wish to sidestep the intellectual debate. Perhaps this is because they feel they would lose it, but I am increasingly of the opinion that they cannot even get their heads around it. They simply reject the notion that there should be any limit to state regulation if their computer models tell them that it would "save lives". The idea that liberty has value in itself, or that it is rational for individuals to balance risk against benefits, is alien to them. The belief that longevity is the single aim towards which all government policy must be directed is taken as read. If they condemn Prohibition or the War on Drugs, it is only because they did not and do not 'work', not because they are a violation of people's rights. The implication is that prohibition would be the perfect solution if only there was sufficient enforcement and surveillance to make people obey.

The most disheartening moment came towards the end when Julia Manning, the head of 2020Health and a former Conservative Party candidate, spoke from the floor. I have said before that the temperance lobby is on a mission to reject the vast amount of evidence showing that moderate alcohol consumption is beneficial to health. It is also set on convincing people that even one drink is bad for you. That is exactly what Manning said: that every drink increases the risk of cancer and the health benefits of drinking are between zero and negligible. She even denied that alcohol consumption reduced mortality from cardiovascular diseases.

This was such an outrageous lie that even the folk who had sat quietly while Deborah Arnott told them that smoking bans slash heart attacks challenged her. Richard Peto's 1997 study was mentioned, but Manning glibly replied that this had been overtaken by more recent research. This, too, is a lie (for example, see the large meta-analysis in the BMJ last year). I guess if you are a Conservative and a doctor you can say whatever you like because you know best.

The reason I have predicted that the 'no safe level of alcohol' and 'alcohol has no medicinal benefit' claims will gather pace in the years ahead—despite plenty of evidence that they are lies—is because they were two of the core beliefs of the nineteenth century temperance movement. They were integral to the nonsense of Scientific Temperance Instruction and they helped clear the way for full Prohibition in the twentieth century. It is therefore fitting that this meeting of prohibitionists-in-denial concluded with two of the classic prohibitionist myths returning from the grave.

(To read more about the resurgence of these myths, see previous posts Towards Zero, David Nutt shows his true colours and Teetotallers die younger, don't let 'em fool you.)


Straight after pressing 'publish' I saw that Simon Clark has also written a post about the debate.

According to Manning (who was sitting in the audience) even one alcoholic drink increases the risk to our health. Chris Snowdon, sitting next to me, muttered, "That's what the prohibitionists in America used to say."

Do go read it.

Monday 8 October 2012

ASH: Having a go at the Chinese now

"...therefore e-cigarettes are dangerous."

Many moons ago, I went to a panel discussion about tobacco harm reduction. One of the speakers was Deborah Arnott. You can watch her presentation here. She begins by recalling her first day on the job at ASH.

My predecessor, Clive Bates, I remember very clearly one of the first things he said to me "tobacco harm reduction is the most important thing ASH should be doing". And I said "well, actually we're trying to get a ban on smoking in public places and that's going to take a lot of effort." He said "no, you've got to get onto harm reduction. It was going to take so long to do something about it." And he was absolutely right, I have to say.

Indeed he was, but what Arnott fails to mention is that from that day to this, her organisation has done absolutely nothing to advance the case for harm reduction and has done much to hinder it. They have conspicuously failed to use their substantial influence in Whitehall to push for the re-legalisation of snus and when they talk about it e-cigarettes, it is only to spread disinformation and scare stories.

No wonder Clive Bates has since described ASH Scotland's position on smokeless tobacco as "absolutely jaw-dropping in its idiocy". Deborah Arnott is very much a part of what he calls "the well paid and comfortably smug public health community". She is most certainly one of the "fussy, insular and instinctively authoritarian public health people" who are "killing by the million" by tacitly supporting the ridiculous EU ban on snus.

E-cigarettes have now been on the market for a decade and there is not a scintilla of evidence that they are hazardous in any way. Lacking evidence of harm, Arnott resorts to casual racism in her staggeringly feeble argument for guilt by association (from 17.45 mins) . E-cigarettes, you see, are made by the same sort of shifty Chinamen who once manufactured a dud batch of sofas...

"This is a marginal product. It's underdeveloped and undermarketed, and there are real concerns about the lack of safety and efficacy. And I think we're justified to be concerned. These are products made in China, a country where they manage to make leather sofas which gave people third degr... significant burns. [Shows slide] These are examples of the burns people got. And shops in this country are currently paying out £20 million over the burns caused by sofas made in China."

What?!?!? Is this the Chewbacca Defence or something?! The Chinese make everything. It's the workshop of the world. So one batch of sofas from one company were made badly. What is the connection with e-cigarettes? The two products could hardly be more different. The only connection is that they are both made by the same race of people, but surely Deborah Arnott can't be implying some sort of racial inferiority that leads to low quality products. That would be—I don't know, what's the word?—a little bit racist.

Lord knows ASH are no strangers to bigotry, but they normally confine their hate-mongering to smokers. As readers of The Art of Suppression will know, prohibitionists have always been peculiarly obsessed with the Chinese. Truly the apple doesn't fall far from the tree.

Sunday 7 October 2012

Are you smarter than a politician?

This is so pathetic it's not even funny. 97 British politicians were asked a basic, sub-GCSE question about probability.

If you spin a coin twice, what is the probability of getting two heads?

There are, of course, only four possibilities: heads then tails, tails then heads, heads twice or tails twice. Ergo, the probability of two heads is 25 per cent. Even if you don't know this off the top of your head, you can work it out in a matter of seconds.

So how did the leaders of the nation—the men and women charged with spending our money—fare?

As you can see from the chart above (taken from Mark Easton's blog), most of them got it wrong, with only two out of five getting it right. Seven per cent of them couldn't even muster a guess. Labour MPs were more than twice as useless as the Tories.

Good grief.

Saturday 6 October 2012

Who governs Britain?

The new health minister, Jeremy Hunt, is interviewed in The Times (£) today

Previous health secretaries have often ended up being accused of nannying the nation. Mr Hunt always finishes the five fruit a day that are left on his desk, prefers muesli to fry-ups and jogs every morning, but he’s not going to impose his health regime on anyone else. “I don’t want a fat tax, I also like my Coca-Cola and crisps.”

Sounds promising, but let's remember what previous health ministers have said...

Andrew Lansley on minimum pricing, December 2011:

The Scottish government backs the idea of a minimum charge per unit of alcohol, which could see a bottle of wine cost at least £4.50 and a pint of beer around 90p. Experts believe thousands of lives would be saved if "pocket-money prices" were outlawed.

But the Health Secretary says there are "big problems" with the idea, which would penalise the poor, fall foul of EU competition laws, and do little to tackle the kind of dangerous drinking seen in town and city centres on Friday and Saturday nights.

Mr Lansley told The Independent on Sunday: "Are we really saying that because a bottle of vodka isn't £8 but £12.50 they are not going to preload with a bottle of vodka for a night out when they are in clubs where they pay £5 for a drink? That is absurd. They are still going to do this binge drinking because that is a behaviour issue. We have got to do much more to focus on what this means."

...The Health Secretary conceded that higher prices for drink can reduce consumption but added: "It is more likely to have a bigger proportionate impact on responsible drinkers who happen to be low-income households."

Caroline Flint on the smoking ban, June 2005:

Reports suggesting the government would opt for an outright ban on smoking in public places were dismissed by health minister Caroline Flint this morning.

Interviewed on BBC Radio 4's Today programme, Ms Flint was asked about newspaper stories over the weekend suggesting the government might go for a total ban.

She replied: "Those stories were false, speculation, anonymous briefings. We are having this consultation based on the proposals in the white paper [ie. with exemptions for many pubs and clubs—CJS]. I don't know where the stories came from."

Good luck to Mr Hunt if he intends to fight against the fat tax, but this will mean fighting the people in his own department who wield the real power. People like Andrew Black, for example, who appears to be judge, jury and executioner on tobacco policy. Or DoH-funded groups like Balance North East, who present themselves as a civil society pressure group while actively lobbying the government for temperance legislation. Or the countless state-funded bodies that "provide the responses to consultations that the Government is looking for"—as Lansley said when his party was still in opposition.

At the Department of Health, it doesn't matter whether or not an elected politician "wants" something. The unelected make sure it happens anyway.

Wednesday 3 October 2012


A few weeks ago I mentioned the latest of Panorama's Boozy Britain episodes which made the startling claim that the lives of 50,000 pensioners will be saved by minimum pricing in its first decade. I expressed scepticism about this example of what I call bullshit inflation.

Forgive me if I sound jaded when I discuss these people's crystal balls, but it was only six months ago that a 50p minimum price was predicted to save 2,000 lives a year across the entire population. The government-funded sock puppet website says that it will save exactly 1,000 lives, again across the entire population. Suddenly saving 5,000 lives only amongst pensioners seems to be upping the ante somewhat, no?

All this was press released days before the episode aired and various newspapers covered the 'story' with headlines such as Minimum price for alcohol 'will save 50,000 pensioners'. The figure comes from the Sheffield University team who produce all these minimum pricing estimates.

It is garbage. Not just the usual 'this sounds like a bad guess' garbage, but full-on 'no amount of squirming can get us out of this, we're going to have to retract it and re-edit the programme' garbage. The figure is more than four times larger than their dubious methodology can allow—a difference of some 38,500 lives—and thanks to the efforts of one of Dick Puddlecote's readers, the Sheffield University team have confessed to "human error". Take this with as much salt as you like, but they claim that someone accidentally put the wrong figures into the computer when Panorama commissioned the research. Truly a case of garbage in, garbage out.

Read the whole story at Spiked and also see Dick Puddlecote and the Pub Curmudgeon.