The alcopop years

The BBC has a decent article about the moral panic about alcopops that started in the 1990s.

Two decades ago alcopops caused a wave of concern that led to increased taxes and new regulations for drinks makers. Was the panic justified?

The answer is "no, probably not." There is even a rare outing for some pertinent statistics...

Consumption of alcohol, having reached a peak in 2000, is declining in the UK. The number of people who never drink is rising. Alcohol sales are falling, with a drop of as much as 6-10% in the past 12 months, according to retail analyst Mintel.

Never forget those figures. Just imagine how much more frenzied the temperance lobby would be if they were going in the opposite direction (as they will, one day).

Bloomberg's soda ban is still illegal

Remember that happy day in March when the splendidly named Judge Tingling ruled that Michael "Skeletor" Bloomberg had no authority to prohibit New Yorkers from buying a pint of Coke? Mike sounded pretty cocky after that bloody nose.

"We think the judge is totally in error in the way he interpreted the law and we are very confident that we will win on appeal."

Alas, yesterday brought more bad news for the pocket dictator...

Another court ruling has taken the fizz out of New York City's ban on big, sugary sodas.

A New York appeals court on Tuesday ruled that the city Board of Health exceeded its legal authority and acted unconstitutionally when it tried to put a size limit on soft drinks served in city restaurants.

"The Board of Health overstepped the boundaries of its lawfully delegated authority," the court said in its decision.

The state Supreme Court Appellate Division, with its opinion, upheld an earlier ruling that stopped the ban from taking effect in March.

The ruling of the four judge panel was unanimous, but that hasn't stopped the demented billionaire from entertaining the same delusion as before.

"Today's decision is a temporary setback, and we plan to appeal this decision as we continue the fight against the obesity epidemic."

Poor old Bloomberg. He must hate living in America with that whole freedom thing they have over there.

Tobacco Products Directive? Nein Danke!

If I credited them with enough wit and guile, I could almost suspect that the architects of the Tobacco Products Directive put e-cigarettes into the legislation to draw attention away from all the other illiberal nonsense they've got planned.

At some point in 2015-16, millions of Europeans are going to pop into their local shop and find that their usual brand of cigarettes, or pouch of rolling tobacco, is no longer available. Those who smoke menthol and slims will be told that the EU decided to ban them back in 2013. The packs will be covered in giant warnings covering three-quarters of their surface. The exact size and dimensions of the packaging and the cigarettes will have been dictated in Brussels.

While the obesity warriors strive to make crisp packets and chocolate bars smaller, the Tobacco Products Directive aims to make packs of tobacco larger. While scientists recognise that Swedish snus is the world's least hazardous tobacco product, the EU will maintain its ban on it.

None of this can be justified either on health grounds or on grounds of market harmonisation. As Angela Harbutt notes in this article, no EU country has even considered banning menthol. Nor has any EU government mandated 75 per cent graphic warnings, or demanded that cigarettes be exactly 7.5mm in diameter, or implemented any of the other three-in-the-morning ideas that the berks of Brussels have come up with.

If you are a regular reader, you will know all this by now. You will be familiar with the barely believable exploits of incompetent and/or corrupt individuals like Anna Soubry, John Dalli, Linda MacAvan et al. Unfortunately, most people have not even heard of the Tobacco Products Directive because the media have almost universally decided not to report it. Most of the consumers who will be affected by this legislation will not know about it until after—probably long after—it has been passed. Many will not be aware of it until that day in 2015-16 when they find their product of choice is no longer legal. That is just the way the European Commission wants it. By then, people can tut and grumble all they like but there will be nothing they can do about it.

That day has not come yet, however, and I'm pleased to see that Forest is fighting the consumer's corner will its new campaign No ThankEU! which gives the facts about the legislation and allows people to register their opposition. Do go have a read, sign up, share and follow them on Twitter. The more noise that is made about the EU's bureaucratic power grab the better.

"The important but unglamorous task of treating citizens like adults"

This is a keeper. A Guardian editorial from 2004 on the subject of alcohol...

For an institution trying to shed a "nanny state" tag, the government is not having much luck. Yesterday's publication of an alcohol harm reduction strategy for England will only add weight to the nanny jibes, coming in the wake of a similar exercise involving junk food. The new alcohol strategy includes a wearingly familiar series of policy recommendations. But in this case the nanny image is undeserved. That is because alcohol abuse is one of the silent demons of modern life, costing billions of pounds and scaring thousands of lives every year.

The facts are as staggering as a double vodka before breakfast. Up to 1,000 suicides annually are linked to alcohol abuse. A third of all domestic violence incidents, 360,000 each year, are related to alcohol. There are 30,000 hospital admissions for dependence and 22,000 premature deaths annually. The social costs are just as staggering: divorce and homelessness are frequently linked to drinking problems. But this rarely attracts the moral outrage that surrounds many other evanescent panics.

The question is, does the damage to the country from alcohol justify further government intervention? The philosopher John Stuart Mill answered that question: "The limitation in number of beer and spirit-houses, for the express purpose of rendering them more difficult of access, and diminishing the occasions of temptation, not only exposes all to an inconvenience because there are some by whom the facility would be abused, but is suited only to a state of society in which the labouring classes are avowedly treated as children or savages".

Similarly, given that millions of people in the UK regularly consume alcohol without problems, any prohibitive increases in taxes will disproportionately fall on blameless moderate drinkers. But increased powers for the police and councils to revoke the licenses of flagrant abusers are justified, as is a tougher line on offenses resulting from drunkenness. Further than that, the government is left with the important but unglamorous task of treating its citizens like adults and engaging them in civilised debate.

Good to know that's it's the world that went mad, not me.

That plain packaging study

A few days ago, anti-smoking sociologist Simon Chapman sent out some tweets suggesting that there was compelling evidence for plain packaging on its way and he called on the British government to specify what kind of evidence would satisfy them.

I don't claim to speak for the government but I expect that the least they want to see is: (1) a sharp decline in smoking prevalence, particularly underage smoking prevalence; (2) no increase in illicit cigarette sale and production; (3) a successful and inexpensive settlement of the various intellectual property disputes/lawsuits.

The study Chapman referred to was published yesterday. It was a phone survey conducted by one of his mates and it didn't remotely address any of these issues. Its main finding—reflected in headlines such as Plain cigarette packs 'encourage smokers to quit'—was that people who smoked out of plain packs were more inclined to think about giving up smoking. According to the survey, 57.1% of those smoking from branded packs were "seriously considering quitting in the next 6 months", whereas this rose to 68.8% for those smoking from plain packs.

These numbers are pretty feeble. The British government is contemplating introducing plain packs on the basis that it might deter underage nonsmokers from taking up the habit. At best, this new study suggests plain packaging might make a handful of adult smokers say that they are thinking about giving up smoking. It is doubtful whether any government will cross the Rubicon of plain packaging on the basis that it might make an extra ten per cent of adult consumers express a vague aspiration.

The researchers did not bother to chase up these people six months later to see if they actually did quit. As with all previous policy-based evidence on plain packs, stated preferences are assumed to align with revealed preferences. They don't.

It wouldn't be surprising if there was a spike in smokers expressing an interest in quitting, although this is more likely to be due to the new warnings than the elimination of branding (the authors acknowledge that they can't distinguish the effect of the warnings from the effect of the plain pack). It is often the case that new warning labels catch smokers' eyes, but it is also well known that smokers soon get used to them and quickly ignore them. Indeed, there is evidence that the more graphic the warning, the less effect it has. That may be why graphic warnings "have not had a discernible impact on smoking prevalence".

I suspect that the government is more interested in whether people actually quit (or never start) than in whether Australia's vastly expensive experiment briefly makes a few smokers express an aspiration. In fact, the study's findings are even flimsier than they first appear for the following reason.

Unlike previous studies on the topic, this research has the benefit of surveying people in a real life situation. It was conducted in November and early December of last year when the supply of branded packs was dwindling or non-existent (it was illegal to sell branded packs from December 1st). As a consequence, some people were smoking from branded packs and others (the majority) were smoking from plain packs.

I was reminded of an e-mail I received from an Australian reader in late October. He sent me some photos of the new plain packs—I published some of them in this post—including a picture of the large collection he had stockpiled for his own consumption (below).

I'm sure my correspondent was not alone in stocking up on conventional packs in the weeks before the ban came in. It should be quite obvious that anyone who buys a six month supply of cigarettes is not intending to give up smoking and is unlikely to express such a desire in a survey.

The point is that many of the people who were smoking from branded packs in November and December were inherently more committed to smoking than those who weren't. Getting hold of branded packs was increasingly difficult in the last few weeks before the ban (which is why the majority were on plain packs by then). Some effort was required to obtain them. Those who were smoking from branded packs when they were interviewed in early December can only have been doing so because they had a stockpile.

This is no mere hunch. The difference in character between the plain and branded pack purchasers is shown in Table 2 of the study. Of those who had never tried to quit, only 54% were buying plain packs, but of those who had tried to quit at least once in their lifetime, 76% were buying plain packs. This is actually the strongest result of the lot (with an odds ratio of 2.61) and it clearly suggests reverse causation, ie. it isn't that branded packs made people less likely to express an interest in quitting, but that people who were less interested in quitting were seeking out branded packs. The authors acknowledge this point in the text and when they adjust their results to control for this confounding factor, most of the associations they report disappear (ie. they fail to achieve statistical significance).

Ultimately, we are interested in what people do, not what they say. Stated preferences are never more meaningless than in the field of smoking where around 97% unassisted quit attempts end in failure and there is strong social pressure to express anti-smoking sentiments. The weak findings of this study do not merit the news coverage they have received, nor the spin put on them by campaigners, as Bernard Keane notes at Crikey...

[Health Minister Tanya] Plibersek’s media release statement that the study shows plain packaging is “working to put people off smoking” appeared at least a little disingenuous, though it depends on what you mean by “putting people off”. By the time some in the media had finished with it, we had “packs helping smokers kick the habit” (the ABC) and “plain cigarette packaging works: study” (the supposedly more rigorous Conversation). Perhaps the reports might have better if journalists had the actual report to work from, rather than a press release from one side of the debate?   

The idea that this phone survey might be instructive, let alone decisive, is absurd. Incredibly, the author of this study was so keen to influence UK policy that she flew from Australia to England in April to share the findings of this study with the government. No complaints from the public health lobby about Australians lobbying politicians on that occasion! In the end, she failed to meet any MPs and had to settle for briefing tobacco controllers at the Department of Health, but it is interesting to note how blurred the distinction between researcher and campaigner is in tobacco control.

When the government says it wants evidence, it means it wants to see what happened. How difficult can this be for people to understand? A natural experiment is underway in Australia which the rest of the world can study. Let's see what the smoking prevalence and cigarette sales figures show. We don't have long to wait. The desperate rush of anti-smoking campaigners to 'prove' the policy works before the real data surfaces suggests that they know it hasn't.

Anna Soubry must go

You may have heard the news about Anna Soubry brazenly ignoring parliament and voting for the Tobacco Products Directive without submitting it to parliamentary scrutiny.

Or perhaps you have not. After all, it was not reported by any British media—although every paper heavily reported silly rumours about David Cameron's adviser, Lynton Crosby, as if Cameron worked for Crosby rather than the other way round.

The media have been almost as negligent in failing to tell the public that there is any such thing as a Tobacco Products Directive. Despite a pisspoor BBC radio show and the odd passing mention from political bloggers like Dan Hannan, the public remains largely unaware that menthol cigarettes are to be banned and that e-cigarette industry as we know it is to be destroyed.

The people have had no say in any of this. Nor, as it transpires, has parliament. As Dick Puddlecote, Devil's Kitchen and Taking Liberties reported last week, Anna Soubry (public health minister) and Andrew Black (Department of Health tobacco programme manager) have been severely reprimanded by parliament's scrutiny committee for capitulating to the European Commission with "unwarranted haste". Soubry and her DoH chums were in such a rush to get the Tobacco Products Directive (TPD) passed that they didn't bother with trifling considerations like consulting elected representatives. For six months she failed to respond to the scrutiny committee. She did as she pleased in Brussels, taking advice from the usual state-funded lobbyists and DoH officials.

By her own admission, the main reason Soubry overrode scrutiny was that she was worried that the TPD would stop Britain introducing plain packaging, or, as Devil's Kitchen puts it, she was concerned that the TPD "did not allow enough scope for the UK government to be even more fascist". She was also eager to rush the TPD through before the EU presidency passed from Ireland to Lithuania. This lowly minister, who has been in the job for less than a year and has been an MP for just three years, ignored parliamentary process and committed the UK to far-reaching legislation based on her own personal opinion.

You can watch Soubry make the nauseating and disingenuous argument that she bypassed parliament for the sake of parliamentary sovereignty here. Incredibly, you will see that she wasn't even aware that e-cigarettes were in the legislation. These are our lawmakers, or—in this instance—our lawmaker.

The problem with Anna Soubry is not that she is necessarily a bad person. In another role, she may have some merits (and I have defended her once before). She is, however, a politician and is the latest in an unbroken line of inexperienced MPs parachuted into the superfluous role of Minister for Public Health, a junior position created in the late 1990s. The list of previous occupants is a Who's Who? of where-are-they-now? non-entities such as Dawn Primarolo and Caroline Flint. Like those before her, Soubry wants to make a name for herself and 'public health' offers plenty of headline-grabbing opportunities to do so.

The Nero complex that afflicts ministers in this Mickey Mouse department is not the worst of it. The real problem is the tendency of politicians to go native when they spend any period of time with the bureaucrat-activists of the Department of Health—a department which has a long track record of behaving as a law until itself. They are surrounded and bombarded by single-issue fanatics, pocket dictators and junk scientists who have no regard for truth or democracy. It chews up feeble-minded politicians and spits them out.

In the case of Anna Soubry, we have a junior minister who is not only incompetent (I repeat that she was unaware that e-cigarettes were in the TPD) but is so self-righteous—so spellbound by her convictions and ambitions—that she feels she can disregard the elected parliament of her country. Even while delivering her forced and insincere apology to the scrutiny committee, she sticks to the Tony Blair line of martyrdom—that she did what she believed to be right. Like every starry-eyed true believer, she answers to a higher power. The normal rules of engagement do not apply to her.

There are still serious questions for her department to answer regarding the false briefing to The Guardian in March as well as the leaking of information to anti-smoking lobbyists in Australia last September. Even if Soubry was not directly involved in either of these events, her handling of the TPD shows that the Department of Health has turned another apple rotten. She should resign. 

Economics, politics, democracy and plain packs

The wailing and conspiracy theories that have followed the coalition government's decision to wait-and-see on plain packaging has been incredible and unprecedented. 'Public health' campaigners are not good losers, perhaps because they are not used to losing. Carl Phillips writes about The Lancet's tear-stained lament for this ridiculous policy, in which the once-great journal complains that economics has been put before health in the UK. As Carl points out, The Lancet doesn't know what economics is.

Preferences — not some contrived conspiracy — is why tobacco control continues to fail. The most charitable interpretation of the dismissal of real preferences (and there are many others that are rather less flattering still) is that they think health concerns should trump all other human wants: anything that might benefit health, no matter how trivially, should be done, no matter how great the costs it imposes on people.

This is an utterly absurd position. Those who exercise police powers to force such absurd priorities on others certainly do not behave that way in their own lives. Do you think that they never eat anything unhealthy and avoid leisure travel, to name just a couple of activities that create risk? You do not have to view yourself as a libertarian to believe that government should pay attention to economics (i.e., to what people want and to the actual costs and benefits of a policy) before acting.

But when this happens, and health concerns are not allowed to trump everything else, and the “public health” types whine that they are being trumped. They are not, of course. They are just being forced to put their personal preferences into the marketplace of ideas and political process, where it just might be that others’ personal preferences win the day.

Indeed. It is all very similar to the whining that ensued when Denmark ditched its fat tax. On that occasion, 'politics' rather than mere 'economics' was blamed, but in the mouths of 'public health' both words are euphemisms for 'democracy'. As I wrote in The Proof of the Pudding: Denmark's Fat Tax Fiasco...

In the post-ban rhetoric of fat tax campaigners, the possibility that politicians had simply responded to public opinion was seldom entertained. For them, it is axiomatic that the interests of industry are in irreconcilable conflict with the public interest. No explanation is required for why the industry should prefer selling ‘unhealthy’ food to ‘healthy’ food, nor is it necessary to explain why, if ‘Big Food’ wields so much political power, it was unable to prevent the tax being introduced in the first place. (The term ‘Big Food’, which until recently would only ever be used satirically, is clearly intended to draw parallels with ‘Big Tobacco’ and to imply great power.)

From the perspective of self-appointed public health experts, it is only they who act on evidence while everybody else is motivated by the mysterious and unpredictable force of “politics”. Alberto Alemanno wrote that “the circumstances surrounding the withdrawal of the tax suggest that politics rather that an evidence-based policy assessment justify the decision of the Danish government.” (Alemanno, 2012)

But politics covers a multitude of interests. Evidence of widespread unpopularity is a legitimate reason to ditch a policy in a liberal democracy. The fat tax never had the support of the majority of Danes and it became even less popular as time went on. The proportion of the population who disagreed with the statement “in general it’s a good idea to tax saturated fat” rose from 43 per cent in 2009 to 50 per cent in November 2011. By October 2012, 70 per cent of Danes considered the tax to be ‘bad’ or ‘very bad’ (Gade & Klarskov, 2012) and by the time it was scrapped, newspapers were routinely describing the tax as “infamous”, “maligned” and “hated”. The liberal newspaper Politiken's editorial about the tax's abolition was headlined ‘Obituary for the hated fat tax’. Mette Gjerskov, the minister for food, agriculture and fisheries said: “The fat tax is one of the most criticised policies we have had in a long time.”

The indifference of health campaigners towards public opinion came as a surprise to Stephen Dubner, co-author of Freakonomics, who attended a public health conference in the US in November 2012 at which fat taxes were praised.

“One objection that I was surprised no one raised: the simple fact that taxpayers might hate the tax and rebel against it to the point where it becomes politically and economically impossible.”

Some in public health wear this unpopularity as a badge of honour. “The fat tax may be unfair and unpopular but it will certainly make people sit up and take notice,” Tam Fry of the National Obesity Forum told Deutsche Welle when the tax came into effect. “It’s a shock treatment but a necessary one to cure an epidemic.” But shock treatment rarely goes down well with voters, especially when the economy is on the rocks. Concerns about job losses and the cost of living may not be paramount to public health campaigners, but it is quite understandable that the government would place these considerations ahead of what is likely to be, at best, a small reduction in the population’s waist line.

There is, then, good evidence that the fat tax was widely unpopular in Denmark. There is equally good evidence that the tax encouraged cross-border shopping and put an unreasonable burden on shoppers and food producers alike. There is circumstantial evidence that the impact on consumption patterns was so limited that any benefit to public health would have been negligible even if the tax had stayed in place for years. And it is almost certain that the fat tax was, by its very nature, regressive. None of this is of interest to the health campaigners. From their perspective, the only evidence that could justify revoking the tax would be if rates of obesity had unequivocally risen. Even if that had happened, their response would likely have been to demand a more punitive tax rate across a wider range of products. As health campaigners, they are entitled to take a narrow view, but politicians are not obliged to do likewise. The wider social and economic perspective is too important to be dismissed as mere “politics”.

Plain packaging and junk food

From some Australian newspaper...

It was introduced to cigarette packets last year, but could plain packaging also be the answer for junk food?

Plain packaging as an attempt to combat Australia's obesity epidemic is back on the agenda after food industry professionals debated the weighty issue on Tuesday at the Australian Institute of Food Science Technology Convention in Brisbane.

That is predictable. This, however, is just depressing...

Eating healthily is a big priority for Oliver Hort and his young family.

Mr Hort said while he thought a move to plain packaging would not combat obesity entirely, it would be a good start.

"Anything to get people's attention away from the lure of junk food is a good thing," Mr Hort said.

Really? Anything? Getting people's attention away from junk food is so important that no policy can be too extreme?

"I'd like my girls to be able to make healthy choices in the future."

They will be able to make healthy choices in the future, just as we can now. Whether they will be able to make (allegedly) unhealthy choices in the future is more questionable, given the prohibitionist trajectory of the antipodean nations. But since your daughters are very young (the only one pictured is one year old), the responsibility lies with you, Mr Hort.

Mr Hort said cartoon advertising on junk food made it harder for children to resist unhealthy snacks.

"When The Wiggles are printed on something, it makes children want it more," he said.

I don't know who The Wiggles are, but if Mr Hort is a typical Australian it seems that the Aussies have been getting the governments they deserve in recent years.

The emerging campaign for plain packaging for food must be rather frustrating for anti-smoking campaigners who are desperately trying to pretend that the policy will be confined to tobacco. They must wish they could muzzle their colleagues in 'obesity control' for a couple of years before moving onto the next logical step. Alas, they are too eager. As the president of the Institute of Food Science and Technology says:

"If our health system can't cope with the increasing incidence of lifestyle-related diseases, it's something we will have to consider as an option. The levels of intervention need to become stronger. Ultimately, it may come to plain packaging."

Then there is New Zealand's Janet Hoek, a past master at tobacco control junk science and a jackboot of all trades...

"It makes sense to examine the potential these policies [plain packaging and graphic warnings] could have in reducing consumption of foods associated with obesity".

And, inevitably, there is the "I believe in liberty, but..." politician (AKA the liebertarian or lib-BUT-arian)...

In February, Queensland Health Minister Lawrence Springborg told The Courier-Mail he was "anti-nanny state", but in relation to food regulation "there are some things where government cannot dismiss stepping in, and this is one of those".

Authoritarian public health charlatans, useless politicians and an infantilised electorate. What a mess it is Down Under, and Britain is only a couple of steps behind.

The Moral Statistician

The timeless words of Mark Twain...

The Moral Statistician (1865)

I don't want any of your statistics. I took your whole batch and lit my pipe with it.

I hate your kind of people. You are always ciphering out how much a man's health is injured, and how much his intellect is impaired, and how many pitiful dollars and cents he wastes in the course of ninety-two years' indulgence in the fatal practice of smoking; and in the equally fatal practice of drinking coffee; and in playing billiards occasionally; and in taking a glass of wine at dinner, etc., etc., etc. And you are always figuring out how many women have been burned to death because of the dangerous fashion of wearing expansive hoops, etc., etc., etc.

You never see but one side of the question. You are blind to the fact that most old men in America smoke and drink coffee, although, according to your theory, they ought to have died young; and that hearty old Englishmen drink wine and survive it, and portly old Dutchmen both drink and smoke freely, and yet grow older and fatter all the time.

And you never try to find out how much solid comfort, relaxation and enjoyment a man derives from smoking in the course of a lifetime, (and which is worth ten times the money he would save by letting it alone), nor the appalling aggregate of happiness lost in a lifetime by your kind of people from not smoking.

Of course you can save money by denying yourself all these little vicious enjoyments for fifty years, but then what can you do with it? — what use can you put it to? Money can't save your infinitesimal soul; all the use that money can be put to is to purchase comfort and enjoyment in this life—therefore, as you are an enemy to comfort and enjoyment, where is the use in accumulating cash? It won't do for you to say that you can use it to better purpose in furnishing a good table, and in charities, and in supporting tract societies, because you know yourself that you people who have no petty vices are never known to give away a cent, and that you stint yourselves so in the matter of food that you are always feeble and hungry.

And you never dare to laugh in the daytime for fear some poor wretch, seeing you in a good humor, will try to borrow a dollar of you; and in church you are always down on your knees when the contribution box comes around; and you always pay your debts in greenbacks, and never give the revenue officers a true statement of your income.

Now you know all these things yourself, don't you? Very well, then, what is the use of your stringing out your miserable lives to a lean and withered old age? What is the use of your saving money that is so utterly worthless to you? In a word, why don't you go off somewhere and die, and not be always trying to seduce people into becoming as "ornery" and unloveable as you are yourselves, by your ceaseless and villainous "moral statistics?"

Now I don't approve of dissipation, and I don't indulge in it, either, but I haven't a particle of confidence in a man who has no redeeming petty vices whatever, and so I don't want to hear from you any more. I think you are the very same man who read me a long lecture, last week, about the degrading vice of smoking cigars, and then came back, in my absence, with your vile, reprehensible fire-proof gloves on, and carried off my beautiful parlor stove.

Plain packaging officially ditched

You may have heard the news. I've written a blog post about it at the IEA Lifestyle Economics blog.

The Department of Health public consultation on plain packs has also been published. The BBC reports that "53% of those responding to the consultation were in favour of plain packaging while 43% had urged the government to take no action on the issue". This is not true. There were 666,233 responses, of which 2,444 (0.4 per cent) were detailed submissions. 53 per cent of those 2,444 submissions approved of the policy—unsurprising since many of them came from state-funded public health lobbyists. Indeed, it's a shock that this slender majority wasn't larger.

Of the 99.6 per cent of respondents who voiced their opinion through co-ordinated campaigns, nearly two-thirds opposed plain packaging. That, surely, is the relevant figure.

Free Market Solutions in Health: The Case of Nicotine

Today sees the publication of a new IEA report I've written titled Free Market Solutions in Health: The Case of Nicotine.

In it, I look at the issues around e-cigarettes, snus and the nicotine wars. In particular, I discuss the ways in which over-regulation and prohibition are harmful to health.

In light of the European Parliament voting to regulate 'nicotine-containing products' as medicines yesterday, these questions are more pertinent than ever.



Read more and download the report for free here.

 

The problem with evidence-based policy

There was a bit of chatter about evidence-based policy yesterday. My blog post addressed the lack of it when it came to smoking bans, this chap from Stirling University said it was all about power and Ryan Bourne said in City AM that it was 'the most meaningless phrase in politics today'.

Here's my problem with it. Let's say that the government decides it's going to paint every house in Britain red. It could gather lots of wonks and experts together to chew over the best way to go about it. It could carry out surveys to find which shade of red the public liked best. It could conduct impact assessments. It could commission economic research to ascertain what would be the most efficient way of painting all the houses. Should it use crimson? Should it use brushes or rollers? Should it use scaffolding or ladders? Which type of paint would be most durable? Would it be better to do the work in winter or summer?

All of these questions could have empirically sound answers. Those answers could be published in peer-reviewed journals. It might transpire that it would be best to work North to South starting in April using rollers and a colour known as Dusky Rouge. The work would be outsourced to private companies.

This programme would clearly be evidence-based. Countless conferences, numerous studies and thousands of experts would have been consulted to discover the most efficacious way of painting the entire British housing stock red. If, after all this, you expressed the view that the job would be better done using paint-brushes and Salsa Red, you would be shown a ream of data showing that you were wrong. You might even be labelled a denier.

But what if you don't want to have your house painted? Even if you did want your house painted, perhaps you'd rather do it yourself than have the government do it for you. And even if the majority of Britons preferred Dusky Rouge, maybe you prefer Salsa Red or, god forbid, a shade of blue or green?

In short, the evidence base has not got us any closer to proving that the state should be painting people's houses, it has only shown the government how to do it.

This is the problem with much of what passes for evidence-based policy. It bypasses the question of why by focusing on the question of how. The fundamental question of whether the state should be doing it in the first place is never seriously scrutinised.

Take the issue of minimum unit pricing, for example. This is a classic example of reformers insisting that they have strong—nay, 'overwhelming'—evidence that makes it imperative for the state to act. As it happens, the Sheffield model which forms the evidence base in this instance is a mass of dubious conjecture and optimistic guesses, but the soundness of the data is not the point here. It is not unreasonable to assume, all other things being equal, that higher prices will reduce consumption somewhat so let's forget about the unintended consequences for a moment and suppose that a 50p unit price will reduce alcohol consumption by two per cent.

If that is the case, then minimum pricing is an evidence-based way of reducing alcohol consumption. But so what? People like drinking alcohol and it has many benefits. Why, then, not set a maximum price of alcohol and increase alcohol consumption by five per cent?

The answer, I suppose, is that the government has decided that alcohol is a Bad Thing and that it would be better if consumption fell. Fine. That is their view. So why not make the minimum price 60p or 70p or, come to that, £5 or £10? What is the evidence base for setting this minimum price at 50p?

There is none, of course. They believe that £5 a unit would be an excessive infringement on people's wallets and liberties, just as those who campaign for 20 mph speed limits consider a 5 mph speed limit to be an excessive burden on motorists, despite the fact that the same 'evidence' they cite for 20 mph would show that a 5 mph limit would 'save' even more lives.

By taking the discussion to the logical extremes of a £5 minimum price and a 5 mph speed limit, we see that policy is not really based on objective evidence, but comes down to a subjective assessment of costs and benefits. If I say that I find a 50p minimum price and a 20 mph speed limit to be an excessive burden on drinkers and motorists respectively, what evidence can be produced to show that I am wrong? There is none because—like my opponents—I am expressing a personal view.

The belief that alcohol consumption should be lower is nothing more than a subjective opinion. Evidence doesn't come into it. If there was any real science behind the policy, the government would state that there is an optimal level of alcohol consumption of, say, seven litres per capita per annum. If any politician made such a claim, he would be asked to provide empirical evidence for why that particular figure had been chosen and he would have to admit that there isn't any. How could there be?

Likewise, the 50p a unit minimum is entirely arbitrary. There is no evidence to show that the minimum price shouldn't be 75p or 95p or 15p. There is no evidence showing that there should be a minimum price at all. Again, how could there be?

The 50p figure was picked because it was politically feasible, not because the evidence showed—let alone demanded—that 50p was either optimal or necessary. No amount of evidence can tell us what the optimum number of alcohol-related deaths is (even the staunchest temperance advocate accepts that zero is unrealistic), nor can it tell us whether the nation is drinking too much or too little.

When people say that minimum pricing is an 'evidence-based policy', what they mean is that they think alcohol consumption should be lower and that higher prices are likely to reduce consumption. That is not an 'evidence-based policy'. It is personal opinion combined with the law of demand. In this instance, as in many others, the fundamental assumptions behind the policy are not—and can never be—evidence-based.

'The real reason for public smoking bans'

Ronald Bayer, professor at sociomedical sciences at Columbia University's Mailman School of Public Health, has been talking to PBS about an article he's written entitled Banning Smoking In Parks And On Beaches: Science, Policy, And The Politics Of Denormalization.

I last came across Bayer in 2008 when he wrote a thoughtful article about denormalisation and the regressive nature of sin taxes (Stigma and the ethics of public health: Not can we but should we). He is in the dwindling minority of 'public health professionals' who actually studies aspects of public health (specifically AIDS), rather than lifestyle factors connected with non-communicable diseases. Even more unusually, he has some understanding of ethics.

In his PBS interview, he discusses the kind of junk science that I often mention on this blog. He will no doubt find himself being crossed off a lot of Christmas card lists when the anti-smoking lobby reads it.     

I noticed when my students of public health talked about illicit drugs like heroin or cocaine or marijuana, they adopted a libertarian point of view -- emphasizing how the government has no business intruding on people's choices and all those negative consequences. But when I raised the issue of tobacco, they all became in a way, authoritarian. "We have to limit smoking, we have to limit where people smoke, we have to protect people from themselves, we have to protect their children." I was struck by the difference.

It is strange, isn't it? I have a few theories for why this inconsistency/hypocrisy exists. It may be because these students have seen the damage wrought by the war on drugs but have not yet seen the damage that tobacco prohibition will bring. It may be that students like the idea of radical change and therefore find the idea of switching the legal status of these products on their head appealing. It may be that they have been so bombarded by anti-smoking messages from the day they were born that they think tobacco smoke is more dangerous that mustard gas. Or perhaps the Mickey Mouse field of public health attracts zealots and moral imbeciles. At least Peter Hitchens is consistent in wanting the whole lot banned, just as I am consistent in wanting the whole lot sold on the free market.

Bayer then discusses the current wave of draconian smoking bans that are sweeping into American from the Bay Area, including those in private homes, in parks and on beaches.

I discovered the evidence was really weak. The evidence of harm to non-smokers on the beach or in a park from someone smoking is virtually non-existent. The evidence that fish and birds are dying because of cigarette butts is virtually non-existent. And even the evidence that seeing someone in a park or beach will encourage kids to smoke is extremely weak.

So I said to myself, what's going on here? What's the public health impulse that's involved that leads to these bans if the evidence is so weak? Because everyone in public health believes that what we do should be evidence-based.

It's quite simple, Ronald. They're charlatans who will stop at nothing. Their 'evidence' is manufactured to order.

As I thought about it, it became very clear that what was involved wasn't that we were trying to protect non-smokers from sidestream smoke on parks and beaches. We weren't really concerned about birds and fish. There wasn't really evidence that we were going to protect kids by disallowing smoking in parks and beaches.

What was involved was that we really wanted to make it less and less possible for people to smoke...

Well, yeah. You don't need to be Miss Marple to work that out.

The question now is, how come public health officials can't come out straight and say the reason we're banning smoking on parks and beaches is we want to protect smokers? We want to get them to give it up, we want them to smoke less and we want to make it more difficult for people to begin smoking.

The answer, of course, is that civilised societies do not allow one group to inflict their preferences on another group merely because they think it would be 'for their own good'.

I think it's because public health officials don't want to be tarred with the brush of the "nanny state," of "Big Brother."

That's a large part of it, of course. More precisely, they don't want to be exposed as the authoritarian busybodies that they are. They could be honest about it and say "we don't like what you're doing so we're going to make your life as difficult as we can until you stop", but that would give the game away. They would have to admit to the world—and, more painfully, to themselves—that they are not 'liberals'. Their only alternative is to concoct the kind of ridiculous 'evidence' which people such as Michael Siegel have spent years debunking.

My concern is that when public health officials make claims that can't be backed by the evidence, they run the risk of people saying, "We can't trust you." I understand it is probably more effective to say the reason we're banning smoking in parks and beaches is that we're protecting you from sidestream smoke, or your kids from looking at something very bad for them or that we're protecting wildlife. That might be more effective way in the short run of getting these statutes or regulations passed and put into place.

But in the long run, I think, that if people begin to feel that they're being toyed with, that the evidence is not being presented in a straightforward way, it's going to backfire.

I wholeheartedly agree. This is why the rest of the scientific community should stop turning a blind eye to the junk science that is done in the name of tobacco control (and, increasingly, in the name of alcohol and obesity control) before the public health racket drags the reputation of all science into the gutter. You can't fool all the people all the time. What good has ever come from people deciding that it's acceptable to lie to achieve their aims?

Stand up for e-cigarettes on July 10th

The BBC has, not entirely predictably, produced a sensible article about e-cigarettes. It has the apt title of...

E-cigarettes: Is a smoking alternative being choked by regulation?

The article quotes a sardonic e-cigarette user explaining why he decided to start vaping.

"I had a big problem with death, a really big problem with dying," he says. "I wanted to avoid dying at all costs."

It is to the author's credit that he ignores the anti-nicotine extremists and instead interviews Robert West, who was one of the few anti-smoking campaigners to oppose the ban on snus in the 1980s, equating the prohibition with “banning coca leaves and allowing the promotion of crack” (see The Art of Suppression; p. 174). In the Beeb's article, he returns to the issue, saying:

"Most of us in the field think that snus has been a lifesaver," says Robert West, who points out that Sweden has the lowest rate of tobacco-related disease in Europe.

He also makes a reasonable point about the supposed lure of e-cigarettes to the young...

"If those young people are people who would have smoked but instead they're using e-cigarettes, then that's a huge public health gain. If they're people who would never have smoked but they've taken up e-cigarettes, frankly in public health terms it's not really an issue - it's like drinking coffee or something, there's no real risk associated with it.

"The real risk is if they start using e-cigarettes and this acts as a gateway into smoking. Now which of those things happens none of us knows at the moment."

As for the idea that e-cigarettes undo the work to de-glamorise tobacco smoking, West, who has done consultancy work for nicotine cessation medication, says the public health opportunity provided by e-cigarettes lies in their remaining trendy.

"The opportunity here is for something that's seen in a different light," he says.

"We never got communities of people really enthusing about nicotine patches or nicotine gum. You didn't get a sort of nicotine gum users' group, in which they'd rave about the gum and sort of say: 'This sort of gum's so much better, and I make my own gum,' and stuff like that."

Ninety per cent of e-cigarette users are also smoking, he says, indicating that the devices are being used as a quitting aid. Countries that have banned them are, in his view, "nuts".

But—and this is the main inspiration for this post—there is this...

Jonny Lavery and others are planning a trip to Brussels next week to protest against the draft European legislation, which they see as a threat to their hobby.

Indeed they are and indeed it is. Around lunchtime on July 10th, a group of protestors will be meeting in Brussels as MEPs vote on a dreadfully flawed Tobacco Products Directive which will place these revolutionary products—along with every recreational non-tobacco nicotine product that is yet to be invented—into the hands of the instinctively prohibitionist public health establishment. If you're in the area, you'll see them because they'll be carrying black balloons like this...

I'll be fighting the good fight in other ways next week so unfortunately I can only be there in spirit. If you can go, please do. The indefatigable David Dorn of Vapour Trails TV (who supplied the above photo) bought a load of Eurostar tickets from London to Brussels. I don't know if he has any left, but if you want to go you can ask him (https://twitter.com/Hifistud). And, as a final reminder, there are still a few seats left for the big IEA debate about all this on July 15th - details here.

John Dalli does a lot for charity but doesn't like to talk about it

The Bahamas: The home of charity

New revelations continue to emerge in John Dalli's car crash of a career. The sacked EU Health Commissioner now claims to be the victim of a conspiracy concocted by the New York Times, the European Commission, OLAF, the tobacco industry and the blogosphere. The motive behind this vast plot remains unclear, to say the least.

The Worst's Most Persecuted Man's undisclosed trips to the Bahamas by private jet are the latest pieces in the jigsaw, as the New York Times reported this week (the UK and European press continues to turn a blind eye).

Even while he was being investigated in the tobacco case last summer, he took at least two trips to the Bahamas as part of an effort to arrange the transfer of tens of millions of dollars.

Dalli has an explanation for this which you can take with as many pinches of salt as you wish...

In an interview on Friday, he said he was facilitating the transfer of a huge sum to a charitable project “to help people in Africa.”

This globe-trotting philanthropy is not something Dalli has mentioned before, including to fraud investigators OLAF. What are the details? Alas, Dalli will not say. Those Africans need their privacy.

Calling the project very personal and confidential, he would not discuss its details.

This secrecy appears to have extended to the Brussels village...

One European Commission official, speaking on the condition of anonymity because of the political sensitivity of the issue, said Mr. Dalli worked to conceal the trip from European officials by calling them to say he was spending that weekend in Malta with his family.

Nothing suspicious about any of that [cough].

On top of this, it has emerged that John Dalli lied to OLAF last year—a sackable offence in itself...

Former European Commissioner John Dalli had admitted to police in December that contrary to what he told OLAF investigators, his former canvasser Silvio Zammit had alerted him to the EU probe when they spoke on July 6.

It is worth reading the Times of Malta interview to see how Dalli reacted to the journalist mentioning this deception. Here's a snippet...

“How do you know what I told the police? Now you must tell me how you know this from the police?”Asked whether this was the case, Mr Dalli said: “No, No, I am asking you. I won’t speak to you anymore... you are telling me that the police told you... I am going to stop here..."

The spluttering evasiveness of an innocent man?

The go-to person for Dalligate news at the moment is Daphne Caruana Galizia. Today, she has uncovered more details of the Dalli family's involvement with the Bahamas. In July 2012, Dalli's daughter Claire Gauci Borda signed a one year contract to hire a villa in the Bahamas for Tyre Ltd., a company that is registered at her father's address. She and another daughter of Dallis, Louisa Dalli, had been directors of the company since March 2012.

Tyre Ltd. is “principally involved in the trading of precious metals such as copper and gold” and, as Galizia notes: "Nowhere in the financial statements or other documents filed at Companies House is there any indication of charity work or donations to charity. There is, on the other hand, a reference to the impact of the price of gold on the future operations of the company, while the revenue in the first year of trading came entirely from trade in copper."

As of July 2012, the company was in debt.

At that point, the company had €316,354 in liquidity (cash and bank) and had borrowings of €535,480 described as an advance from its shareholder (the only listed shareholder at this stage is Derrick Germaine).

Yet despite the company’s precarious financial situation, just six months after the date of those accounts, it rented a villa in the Bahamas at $8,000 a month for 12 months ($96,000) with utilities and other expenses over and above that.

When Tyre Ltd personnel left the villa unexpectedly just two months after they rented it, they left the Bahamas in a private jet hired from third parties, that departed from Nassau at 1am. John Dalli was with them. The jet flew to Halifax, where it refuelled, then on to Iceland, then Brussels, then Malta. The total cost of this air-trip is estimated at $80,000.

Five weeks ago, on May 30th 2013, both of Dalli's daughters resigned from the company and a Brit, Martin Zuch, became director. 

The situation at present is that Tyre Ltd’s shareholding is held in its entirety by Martin Zuch personally. Zuch and Monthonkan are the only two directors. Claire Gauci Borda is the company secretary. The registered address remains John Dalli’s apartment at Portomaso.

Martin Zuch is an evangelical Christian who is one of the people responsible for a charity called Give Hope International, which appears to be legitimate... Zuch was neither a director nor a shareholder of Tyre Ltd when the villa in the Bahamas was rented. He entered the equation in May this year with an effective registered date of 25 December 2012.

Curiouser and curiouser. So, to summarise, we have a trip to a notorious tax haven which Dalli did not tell OLAF or the European Commission about. We have Dalli's assurance that his undisclosed trip to the Bahamas was philanthropic but he is not prepared to give any details about it. We have half the Dalli family, including papa Dalli, involved in a company which had no apparent charitable aims until five weeks ago when the whole thing was suddenly turned over to someone who had never been involved before.

Galizia spells out the implications in the comments to her excellent piece...

Why would somebody raising money for children in Africa spend $80,000 on a jet out of charity funds? Why meet in the Bahamas at all, when one lives in England and the other lived in Brussels at the time? Why then, in particular, that it couldn't wait until Dalli's EU meeting was over, so that he had to fly halfway across the globe and back in 24 hours, at his great age?

You are talking here about an EU Commissioner prepared to take the risk of being fired from his post (doing what he did is grounds for being fired) and a scandal in the international press (which has finally broken), so you have to be looking at the risk-reward ratio.

Indeed. Sounds like something Private Eye should be investigating.

The obesity gravy train

It never ends.  From The Telegraph...

Ban school run to keep children fit, says health chief

Parents should be banned from dropping their children off at the school gate to help tackle childhood obesity, said new public health chief.

Professor John Ashton said children should be made to walk a quarter of a mile each day to keep them fit and prevent obesity.

I guess this is the 151st way in which "the nanny state is good for us", as Simon Chapman would say (the comments are worth reading. The article, not so much.)

And, also from The Telegraph...

'Unhealthy' multibuys targeted in new obesity crackdown

Supermarket multibuy promotions on fatty foods could be scrapped in a new obesity crackdown by the Government.

Minutes from a Department of Health working group reveal big retailers and food companies may also have to set aside a percetange of marketing spend for "healthier" products instead of promoting fizzy drinks, confectionery and crisps.

A new code could also be introduced to restrict the use of cartoon characters on food that is high in sugar and salt.

Tim Worstall has some firm words to describe these people. To be fair to the government, they have said that these were only proposals which they will not be running with. The 'public health' lobby, on the other hand, would go much further and are currently huddled together at a tax-sponging jamboree in Vienna to discuss "marketing controls, food prices, bans and subsidies".

Meanwhile, as obesity rates stubbornly refuse to rise, they are resorting to desperate measures to stoke the "epidemic"...

Health advisers have set a new, lower obesity measure threshold for British Asians... Until now, experts have said all UK adults should aim for a BMI of no more than 25 to be healthy. But NICE says that doesn't go far enough for certain ethnic groups. Its new guidelines say Asian people should aim for a BMI lower than 23.

Expect to see a surge in obesity next time the figures come out, along with urgent calls for a crack down. See how it works?