Thursday 31 October 2013

The fizzy drink tax crusade goes on

Despite the political and economic fiasco that was Denmark's fat tax, the public health racket is determined to bring in a tax on fizzy drinks. They had a go in January and had another (barely reported) stab at it during the party conferences. Now they've taken a leaf out of the Minimum Pricers' book by making a computer model. It's published in the British Medical Journal so will probably get a large amount of press coverage. (This is not the first attempt to model the effect of a fizzy drink tax. A 2011 effort produced results that, upon inspection, were utterly negligible.)

One of the co-authors is Mike Rayner, a man with the most interesting conflicting interest in science because he believes that he is literally doing the Lord's work by making the poor pay more for their cola. He and his colleagues modelled the effect of a 20 per cent tax on sugar-sweetened drinks on consumption and on obesity.

Their estimate for consumption looks reasonable enough. They use a price elasticity of -0.9, which is in line with previous economic estimates. In other words, a 10 per cent increase in price results in a 9 per cent reduction in consumption.

Their estimate of what effect this would have on obesity is, however, essentially a guess. One problem with these kind of models is that it is well known that increasing the price of one product leads to people buying similar, cheaper products (which might have more calories). The authors of the study shrug this off, saying that the substitute drinks "are probably less harmful for health." Since fruit juice contains more sugar and calories than many fizzy drinks, this is debatable.

All that aside, their projected reduction in obesity is just 1.3 per cent. They admit that this is "relatively modest". That's putting it mildly. It's a feeble outcome—virtually a rounding error—and yet they estimate that this will cost the British people £276 million per annum (tellingly, they say it will "raise £276 million"—from where, the ground?).

News of the cost-of-living crisis obviously hasn't reached the offices of the British Medical Association. As with minimum pricing, people on six figure salaries are telling people on four figure salaries that they're paying too little for their shopping.

Like most models, it's garbage-in, garbage-out. If you tell the computer that Policy X will reduce obesity/mortality/employment/hospitalisations, the computer will give you a reassuringly precise figure. It won't tell you if your assumptions are correct.

It's better to look at places that have actually introduced taxes on fizzy drinks, as Fletcher et al. did in their 2010 study in the Journal in Public Economics. They concluded that there was...

...a moderate reduction in soft drink consumption by children and adolescents. However, we show that this reduction in soda consumption is completely offset by increases in consumption of other high-calorie drinks.

That's the USA. We might also look at Denmark which announced that it would be abandoning its soda tax a few months ago. Why? Because...

A soda tax in Denmark didn't lead to people drinking fewer sugary beverages. Instead, they just headed next door to Germany, where sodas were cheaper.

No UK media reported that the Danes had abandoned the tax, nor that they have cut beer tax. Funny how the public health lobby told us that the eyes of the world were on Denmark when they introduced these sin taxes, but their eyes were averted when the taxes were abolished after delivering no health benefits and being tremendously unpopular. Sadly, Rayner's model does not factor in unpopularity.

This work has not considered public opinion, which may be critical when deciding whether a tax is adopted.

Let's hope so.


The BBC can't help itself. When I woke up, their headline read...

'Sugary drinks tax would have "modest" effect on obesity'

This is an accurate summary of the study, but apparently was not sufficiently persuasive enough for the public health lobby. I suspect a phone call or two may have been made because the headline now reads...

Sugary drinks tax "effective health measure"

This is not an accurate summary of the study. It is not even an accurate summary of the sentence from which it is taken from which says "we have shown it could be an effective public health measure" (my emphasis).

How craven, but how typical, of the BBC's online health team to throw a perfectly good headline down the memory hole for the sake of propaganda.

Wednesday 30 October 2013

Sweets in supermarkets

Look how fat and unhealthy they are. Something must be done.

David Cameron, 2008: "The era of big, bossy, state interference, top-down lever pulling is coming to an end."

How's that small government thing going in Britain, 2013?

Junk food at checkouts under fire as new health minister says she wants to stop parents being pestered by children

So politicians are going to stop children pestering their parents, are they? Good luck with that. How about we have politicians that stop pestering us?

Sweets could be banned from supermarket checkouts under a health drive being drawn up by the government.

New public health minister Jane Ellison signalled a fresh crackdown on tackling junk food promotion, after her predecessor Anna Soubry said ‘there is nothing wrong with sweets’.

Lord knows, Soubry was wrong about a lot of things, but she was right about that. I can scarcely believe that such a statement needs to be made but let's say it again: THERE IS NOTHING WRONG WITH SWEETS.

Now Ms Ellison has identified the issue as ‘an area for action’ and will tell the industry to cut promotions of unhealthy snacks.

Does she now? Then let me disabuse her of that fanciful notion. Where shops display sweets has nothing—absolutely nothing—to do with the government. Nor is it any of the government's business if parents buy their children sweets and nor is it 'an area for action' if children irritate their  parents.

Is that clear? Good. So put away your statute book, call off your dogs and stick the veiled threats of your Responsibility Deal where the sun don't shine, you meddlesome, bossy, interfering, top-down lever pulling, good-for-nothing statists.

Ms Ellisson has signalled that she will take action against junk food at checkouts. In response to a parliamentary question, she said: ‘There is evidence that the majority of food promoted at checkouts and in queuing areas is less healthy than elsewhere, and that foods sold at impulse purchase points such as checkouts experience uplifts in sales.'

Again—how else to put this?—that is none of your goddamn business. They are private companies selling ordinary products. It's not junk food, it's chocolate. And, I might add, sweets should be eaten by children because that's who they're for. Children eat sweets. Adults drink alcohol. That's how it works.

If you don't want to buy a chocolate bar at the check out, then don't buy one. If you don't want your children pestering you, then raise them properly. The only 'area for action' the government should be looking at is abolishing the role of Minister for Public Health with immediate effect so that no more ambitious, inexperience, clueless and illiberal politicians like Jane Ellison can make a name for themselves.

Tuesday 29 October 2013

One trillion dollars

"Why make trillions when we could make... billions?"

If you're serious about lifestyle regulation, you have to have a big number for the putative healthcare costs of Product X. The number mustn't account for the substitute diseases that people would get in the absence of Product X, nor should it include any savings or benefits that the product is responsible for. That would make the number lower or even negative, and the number must be big. In the US, the figure for smoking is said to be £96 billion. For obesity, it is said to be $190 billion.

And for sugar...

Sugar Linked To $1 Trillion In U.S. Healthcare Spending


Basically, the U.S. healthcare system spends about $1 trillion per year (and possibly more) fighting the effects of excess sugar consumption.

Yes, he's serious. So how does Dan Munro—for it is he—work that out?

He quotes from a recent Credit Suisse report...

“So 30% – 40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.” Credit Suisse Report – Sugar: Consumption At A Crossroads (PDF here)

At this level, the math clearly lacks scientific precision, but it does emphasize the huge burden associated with a single and truly ubiquitous substance – sugar. Assuming a U.S. National Healthcare Expenditure of $3 trillion per year – and further assuming we simply take 33% (the lower end of the Credit Suisse range), the calculation is easy.

Er, no. The calculation is easy if you look at the full quote from the report which gives the actual figures:

Obesity alone accounts for 20% (or USD 190 billion) of US national health expenditures and diabetes and metabolic syndrome account for a similar figure (though there might be some double-counting). So 30%–40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.

Note that the figures are given in the sentence that immediately precedes the quote Munro uses, so it is surprising that he missed them. It shows $190 billion for obesity and a "similar figure" for diabetes and metabolic syndrome. The high end estimate Credit Suisse are providing for all obesity, diabetes and metabolic syndrome is therefore $380 billion. It's impossible to say how much of this is attributable to the existence of sugar but it is clearly less than 100 per cent—nobody claims that sugar is the sole cause of obesity or diabetes.

Credit Suisse do not blame every case of these diseases on sugar—that would be silly. They merely say that these are the total costs of diseases for which excess sugar consumption is a risk factor. The sugar-related healthcare costs of obesity, diabetes and metabolic syndrome must be lower than $380 billion—probably much lower. Munro's claim that "the U.S. healthcare system spends about $1 trillion per year (and possibly more) fighting the effects of excess sugar consumption" cannot possibly be true.

It should be noted that Credit Suisse underestimate the US's total healthcare bill. $190 billion is obviously not 20 per cent of $3 trillion. Munro is right to say that healthcare costs are closer to $3 trillion than $1 trillion. That's a bit of a howler on their part (and strange, since they get it right in an earlier sentence), but Munro's decision to use their percentages while ignoring the dollars is much worse.

Monday 28 October 2013

The disease of public health and its cure

I've written a lengthy essay about the public health racket for Spiked. Here's a sample...

On the type of people who become 'public health professionals':

Today, if you are gripped by an urge to eradicate some bad habit or other, you no longer have to make a nuisance of yourself knocking door-to-door or waving a placard in some dismal town square. You can instead find yourself a job in the vast network of publicly funded health groups and transform yourself from crank to ‘advocate’.

On the longevity obsession:

This is not a health movement, but a longevity movement. It is true that almost every death is theoretically preventable, but only in the world of ‘public health’ is it seen necessary to move every mountain to prolong the lives of geriatrics. The concept of a “good innings” or “dying of old age” are anathema to them. When all the preventable causes of deaths have been controlled, we will be free to die from the only cause of mortality that their policies actively encourage: boredom.

On the bogus 'cost to society' excuse:

The uncomfortable truth is that ‘preventable deaths’ save the taxpayer a fortune in pensions, healthcare, prescriptions and nursing-home provision. This has been confirmed by so many studies that public-health campaigners can scarcely be unaware of it and yet they continue to appeal to financial prudence because it has a superficial plausibility and because it is all that stands between them and being told to mind their own business. On the rare occasions when they are challenged on the facts, the scoundrels sheepishly abandon their claims and accuse their opponents of boiling everything down to pounds, shillings and pence. Physician, heal thyself.

On the abnormality of public health demagogues:

‘Denormalisation’ is the name of the game. It began, inevitably, with smoking/smokers, but denormalising drinking and drinkers is now on the political agenda. Considering the profound impact such policies have in stigmatising the vulnerable, robbing the poor and trampling on ancient liberties, it is time to ask whether the assortment of neurotics and authoritarians that make up the modern ‘public health’ movement is best placed to decide what is normal.

John Stuart Mill’s opinion of the peculiar longevitists bears repeating: ‘It is not, naturally and generally, the happy who are most anxious either for prolongation of the present life or for a life hereafter; it is those who never have been happy. Those who have had their happiness can bear to part with existence, but it is hard to die without ever having lived.’

What the modern puritans call ‘health policy’ often involves profound questions of economics, law, ethics, constitutional rights and philosophy, of which they are largely, if not entirely, ignorant. These issues are too important to be trampled by monomaniacs who have not learnt the art of living.

Do go read it all.

Friday 25 October 2013

An evening in Dublin

Wednesday's debate in Dublin answered a few questions, even if they were not the questions we went there to ask. The debate was titled 'How to really stop people smoking' and it provided an opportunity to discuss harm reduction and to look at best practice around the world. 'Best practice' here means countries which have actually reduced their smoking rates dramatically, rather than countries like Ireland which make much of their aspiration to become 'smoke-free' despite the manifest failure and unintended consequences of the neo-prohibitionist approach.

The radio interviews I did to promote the event, as well as my conversations with Dubliners, suggested that this was a topic worth discussing. All are aware of the country's epic levels of tobacco smuggling and can see with their own eyes that smoking remains very common indeed. In my first radio appearance of the day, I debated with Dr John Crown. Like many medics, John Crown holds himself in high esteem. He is also a politician. The combination of these two occupations makes it virtually inevitable that he has an authoritarian streak a mile wide and believes that his lifestyle preferences should be mandatory. He is a prohibitionist, but like most modern prohibitionists he rejects the P word, insisting that he "only" wants a ban on the sale of tobacco "for profit". A little history would teach him that the Anti-Saloon League only wanted a ban on alcohol for profit—and that is precisely what they got. Consumption, domestic production and supply for medical and religious reasons remained legal.

Anti-smoking zealots only know two tunes. If it isn't "children, children, children" it is "industry, industry, industry". On this occasion, Crown goes for the latter, thankful that the IEA believes that tobacco companies' money is as good as anyone else when it comes to donations and harrumphing about 'Big Tobacco'. He does not, however, behave psychotically in the studio and shakes my hand afterwards as I tell him I'll see him later, for he is on the panel at the main event.

As night falls, however, Crown's mood also darkens. What follows is one of the most infantile displays I have seen since puberty. Arriving at the venue—the Royal College of Physicians Ireland—he refuses to shake anybody's hand or to be photographed, instead charging towards the chair of the debate, the former politician and current radio host Ivan Yates, with a string of complaints. Yates is the soul of Irish charm and endures the rant gracefully. Crown demands that he speak first and the chairman complies. Speaking first is no great advantage in a debate. It is better to hear all the other panellist's views and then have the last word, demolishing opponents' arguments as you go. Since Crown insists on going first, I assume he is going to vent spleen and walk out.

Vent spleen he does. Instead of addressing the question of whether Irish tobacco control legislation works, he gave a potted history of the worst aspects of the American tobacco industry circa 1950-85 and explained that smoking was really, really bad. He then argued that the tobacco industry has moved from disputing the smoking-cancer link to emphasising civil liberties. That is where the IEA comes in. Since it is unthinkable to him that anyone sincerely believes in self-ownership and personal freedom, he concludes—or at least strongly implies—that anyone who says that grown adults have the right to smoke or vape must do so for money. There is, he says, no debate to be had. Smoking is dreadful and anything that is done in the name of reducing its prevalence is righteous. He does not dwell on the fundamental question of whether these things actually do what the campaigners claim they will.

Crown then leaves the stage, not to exit the hall but to sit in the front row. He whips out an iPhone and iPad and conspicuously flicks through them as the other speakers take the microphone. I then realise that he has elected to go first not to win the debate but so that he didn't have to hear—and respond to—the other panellist's evidence. I speak next, asking why it was that a country that had passed every piece of 'evidence-based' tobacco control legislation in the book had "stubbornly high" smoking rates (as the Irish Cancer Society put it) and why "children start smoking in Ireland at a younger age than any other country in Europe" (as Barnado's puts it). I contrast the neo-prohibitionist model with the harm reduction model in a way that will be familiar to readers of this blog.

The man-child Crown continues to sulk in the front row, still immersed in his Apple products. Jeff Stier and Axel Klein follow, throwing further pearls upon the swine. Thereafter, Crown looks up from his technology only when fellow travellers in the audience chip in with empty rhetoric. They seem incapable of beginning any comment without resorting to clichés, as if a room of intelligent adults need reminding of the health risks of smoking. "Tobacco kills half of its life-long users" is a particular favourite, despite it being manifestly untrue of every tobacco product bar cigarettes. Kathleen O'Meara, head of advocacy (ie. lobbying) at the Irish Cancer Society, takes the microphone and goes into a diatribe. She arrived after the panellists had spoken and announces that she will be leaving after making her statement (statement, mind, not question). As good as her word, she then storms out. Like Crown, she has never been told that we are born with two ears and one mouth for a reason.

John Mallon—who has written a good account of the evening—lightens the mood by trying to speak to the health lobby as human beings. As a smoker, he is the hunted, but he remains polite and gracious in the face of the hunters and his affability sits in stark contrast to the purse-lipped, lemon-sucking zealots.

Rooted to his seat, but with microphone in hand, Crown pipes up a couple more times to say that he wants e-cigarettes available only on prescription. He then reveals an appalling ignorance of the epidemiological evidence regarding snus and cancer. It appears that he knows nothing about the product, perhaps unsurprisingly since Ireland banned it thirty years ago, but unforgivably for a man who claims authority on the subject.

And so the question presented was never answered. But the question of how Ireland has been lumbered with so much ill-considered and counter-productive legislation was answered in spades. One only needed to see Crown and O'Meara in action to understand that this is something akin to a religious cult, immune to reason and living evidence, that can only be sustained by endless ad hominems and by keeping their fingers firmly in their ears.

I'm now off to Exeter to debate whether we should scrap the BBC licence fee, presumably at the behest of my shadowy paymasters at ITV.

Wednesday 23 October 2013


I've written before about Ireland's high smoking rate, its massive smuggling problem and its reputation as tobacco control's jewel in the crown (the former apparently being no disqualification for the latter). Tonight I'll be making that argument in Dublin at an IEA debate. As a taster, I've written an article for the Irish Independent...

According to children's charity Barnado's, "children start smoking in Ireland at a younger age than any other country in Europe". After years of bans and price hikes, this should be seen as a clear admission of failure.

Irish tobacco control has overwhelmingly and demonstrably failed – there has been no significant reduction in the number of smokers, and cessation rates are 10 times worse than the OECD average.

Now, rather than acknowledging failure and trying a new approach, the Government is doubling down on the failed neo-prohibitionist approach. Health Minister James Reilly has said he wants to make Ireland tobacco-free by 2025, and has announced plans to introduce plain packaging for tobacco products.

Ireland's crusade against the tobacco giants has seen them lose focus on what really matters – effective harm reduction and lowering smoking rates.

If the objectives of tobacco control were to demonise and irritate smokers and 'wage war' on the tobacco industry, then Ireland could certainly claim some small victory. But when it comes to stopping people smoking, Ireland's tobacco control policies couldn't be any less successful if they were set by the tobacco industry itself.

Read the rest here.

I arrived in Dublin last night and have had several interesting conversations with taxi drivers about the smoking issue. The first driver was a smoker, as was his wife. Between them they spend €700 a month on cigarettes. They spend less when a friend brings them cigarettes in from abroad, which is often. When I mentioned that the smoking rate hadn't fallen as much as might have been expected, he immediately pointed the finger at the black market. Everybody here is acutely aware that Ireland has a big smuggling and counterfeiting problem, largely run by the IRA.

The second driver didn't smoke, but he drank. He always goes over the border to buy his alcohol, saving about €7 on each bottle of whisky.

The third driver hated smoking but he described the display ban and plain packaging as "idiocy - idiocy beyond belief" (a phrase I might borrow). The smoking ban had damaged pubs, he said, and he was surprised that anyone ever obeyed it in the first place.

Monday 21 October 2013

Plain packaging (phase two)

As so often, no comment is necessary...

Tobacco researchers have identified weaknesses in Australia's plain packaging law that they want eliminated when New Zealand writes its rules.

The Government is committed to plain packaging but has not yet revealed the legislation, which Associate Health Minister Tariana Turia has said she expects to be introduced to Parlianment this year.

Australia's rules last year imposed a standard dull brown colour and large pictorial health warnings but permitted brand names, such as Dunhill and Rothmans, and variant names.

Otago University marketing expert Professor Janet Hoek said this kind of sub-branding using evocative names like "infinite" could undermine the impact of plain packaging - the policy's aim was to reduce the appeal of tobacco and enhance perceptions of the harm it caused.

Allowing variant names was a loophole in the Australian law that should be rectified in New Zealand's version of plain packaging.

The usual ludicrous, hypothetical junk science follows. Regular readers may recall Janet Hoek—a scholar of English literature and marketing—from her earlier quackery. Like many of her ilk, she's not going to get off this money-making gravy train any time soon.

Thursday 17 October 2013

Plain packaging for food

And so it begins...

If the Government is serious about reversing the obesity epidemic, it must introduce tough new rules on the packaging of children's treats, Consumer NZ says.

The consumer advocacy group is calling for the control of marketing gimmicks on food packaging - particularly cartoon characters, free toys and on-packet puzzles targeting children

Here comes The Science...

American researchers have found children preferred the taste of McDonald's-branded food over that in plain packaging, even though both were identical

You can't say you weren't warned.

Wednesday 16 October 2013

Junk science of the week, possibly of the year

This is just sad.

Oreos can be as addictive to the brain as cocaine, the authors of a scientific study have claimed.

Really? Tell me more.

To arrive at the conclusion, Schroeder placed rats in a maze which had two routes to different treats.

In a moment you will see how apt the words "To arrive at the conclusion..." are.

One on side, they placed rice cakes and on the other they placed Oreos.

After the animals had explored the maze fully, they were then left to choose which treat they would prefer to stay at.

Speaking of his findings, Schroeder said: 'Just like humans, rats don’t seem to get much pleasure out of eating rice cakes.'

Yes, because there's more energy in chocolate biscuits than there is in rice cakes.

The results, which showed the rodents had a strong preference for the chocolate treat, were compared to those of an identical test involving drugs.

One on side of the maze, the rats would be given an injection of saline while on the other they were given a dose of cocaine or morphine.

According to Schroeder, the rats in the Oreo experiment spent as much time hanging around their Oreo zone in the food test as they did the cocaine zone in the drug test, showing similar levels of addiction.

Are you kidding me? Aside from the fact that "hanging around" is not a symptom of addiction, the experiment shows nothing more than that rats prefer being injected with cocaine to being injected with nothing and that they prefer energy-dense food to diet food.

If they'd have put cheese on one side and rice cakes on the other, the rats would have gone for the cheese. Would that mean that cheese is "as addictive as cocaine"? No. Because the two experiments have nothing in common except that the rats displayed an entirely predictable preference for X over Y. Or, more precisely, in one experiment the rats preferred X over Y and in the other experiment they preferred A over B. Only a fool or a knave would conclude from this that X=A.

Writing in a statement describing the study, to be presented at the Society for Neuroscience in San Diego next month, Schroeder added: 'Our research supports the theory that high-fat and high-sugar foods stimulate the brain in the same way that drugs do.'

Yeah, we know. They stimulate the brain's 'reward centres' and release pleasure-giving chemicals, blah, blah, blah. That's what they're supposed to do. The brain's reward centres are there to encourage us to consume energy and procreate. The fact that cocaine stimulates these areas artificially doesn't mean that it's somehow weird or wrong that food does. Lots of things we enjoy release dopamine. That's why we enjoy them. The doofus who conducted this ridiculous experiment even acknowledges this in this video.

"We looked at the pleasure centre of the brain which is stimulated any time we engage in a pleasurable activity, including eating. Drugs of abuse hijack that system and lead to addiction."

Exactly, they hijack a perfectly natural and normal biological system. But that doesn't mean that everything that stimulates the reward centres naturally is addictive or pernicious. A correct reading of the neurological science would say that cocaine stimulates the brain in the same way that food and sex does, but that doesn't sound as scary as "sugar stimulates the brain in the same way as class A drugs".

As a general rule of thumb, if someone tells you that cupcakes or smartphones are "as addictive as cocaine" on the basis that they produce dopamine in the brain, walk away. They're saying no more than that pleasurable activities stimulate the brain's pleasure centres, which is a banal tautology.

The findings are a problem for the general public, Honohan said.

“Even though we associate significant health hazards in taking drugs like cocaine and morphine, high-fat, high-sugar foods may present even more of a danger because of their accessibility and affordability,” she said.

Oh, just go away, you stupid, stupid people.


I've been asked on Twitter if this is a case of bad science reporting by the Daily Mail. In fact, the Mail has been faithful to the researchers' press release so we must assume that the basic description of the experiment is correct.

Tuesday 15 October 2013

E-reefer madness

The gateway theory is demonstrable nonsense. Snus hasn't been used as a gateway to smoking in Sweden and there is no evidence that e-cigarettes are being used as a gateway to smoking in the UK or anywhere else.

In the mind of John Banzhaf, however, e-cigarettes are a gateway to heroin. There have been a few articles about this recently, including this by Jacob Sullum (an article that appears to have been taken literally by some people), but Ban-ban-banzhaf's press release is by far the funniest. Strap yourself in as we revisit 1950s reefer madness.

Experts are also worried that, with some 10% of middle and high school students already using e-cigarettes to ingest the addictive drug nicotine, it's only a matter of time before they move up to using these new e-cigarette cartridges to get a marijuana high without the characteristic marijuana smell in their rooms, or on their clothing or breath, thus making it more difficult for parents or teachers to find out.

Yes, "it's only matter a time". Just as it's only a matter of time before smokers of tobacco become smokers of marijuana, right?

Both Forbes magazine and Medical Daily have reported how such use can easily lead to a heroin addiction.

Medical Daily is a website that will seemingly publish anything and the Forbes article was making fun of the idea.

Detective Lt. Kevin Smith, the head of the Narcotics Unit for the Nassau County PD, doesn't beat around the bush: "For young people, marijuana is a gateway. The next thing you know they’re doing acid, molly, even heroin. I don’t like it that people are giving it a pass."

Note that the detective has already made the leap of faith that e-cigarettes lead to marijuana use. "The next thing you know", they're on heroin. Never mind that about of third of the population has tried marijuana and less than one per cent has tried heroin.

Marianne Chai, a Manhattan-based addiction psychologist, said e-cigarettes make it harder for parents to look for the old signs that their teens are using drugs, presumably including marijuana leaves and buds, the sharp and distinctive odor of marijuana smoke, and other similar signs.

What about being stoned? Isn't that the main sign that someone's been using drugs? The red eyes, slowed speech and dopy grin?

Interestingly, as the Chicago Tribune points out in "HOW E-CIGARETTES LEAD TO HEROIN": "But [NBC] got scooped on this story by anti-smoking activist John Banzhaf, who more than three years ago added facilitation of cannabis consumption to his list of reasons for fearing and loathing e-cigarettes."

Bear in mind that this is a press release written by the rampant self-publicist, ambulance chaser and anti-nicotine fanatic John Banzhaf. The stuff he was writing three years ago is as nuts as the stuff he writes today. Along with a load of BS about 'thirdhand smoke', he warned of the perils of secondhand vaping. For example...

If you don’t want people sitting next to you – in a waiting room, restaurant, bar, or any other area where smoking is now prohibited – using one of these devices to get around smoking bans, and forcing you and your loved ones to inhale deadly nicotine – please help now!

This guy is such a plonker even the likes of Chapman and Glantz have nothing to do with him.

While most of the articles and experts have emphasized the danger marijuana e-cigarettes pose to kids – a kind of "candy cigarette on steroids" as Banzhaf puts it – he stresses the risk when adults are able to get high without being detected. "Imagine automobile or even truck drivers tooling down the road happily inhaling the active ingredient in marijuana. Even if a cop does stop them before they kill or injure someone, there's no telltale odor to create probable cause to even detain them, and no other signals such as the slurring of speech which can signal driving while intoxicated with alcohol," says Banzhaf.

You could say the same about people driving on cocaine, heroin or 'molly' (MDMA). Banzhaf seems to think that the presence of physical smoke is the key to cracking these cases and therefore preventing them. It really isn't.

Equally worrisome is the specter of workers operating dangerous factory machinery or construction equipment getting higher and higher as they work, with nobody able to detect it. 

Does this ever happen? Have there been a spate of workplace injuries and road accidents since the e-reefer madness erupted? Or are these, in fact, the wild speculations of a warped and idle mind?

Even in states where marijuana use has been decriminalized, nobody would want these totally unnecessary dangers to third parties, says Banzhaf.

Perhaps not, but then we're talking about a fantasy scenario that is based on totally unproven assumptions. In places which have legalised marijuana it is, I assume, still illegal to drive under the influence and it is still, I assume, against company policy to operate heavy machinery whilst stoned.

In places which have not legalised marijuana, it would be wholly consistent to ban the sale of e-cigarette fluid which contains THC—if, indeed, it exists. Banzhaf, by contrast, wants to ban the device rather than the fluid because he's not really interested in drug use, he just hates smokers, but doesn't want them to stop smoking.

Monday 14 October 2013

Aggressively Regressive

I've written a new report for the IEA about sin taxes and stealth taxes which has been covered here, here, here and here. It looks at the role of indirect taxes in Britain's much-discussed cost of living crisis and their impact on the poor in particular.

When it comes to green taxes, fuel taxes and 'sin taxes' on alcohol and tobacco, left-wingers are strangely indifferent to the undeniably regressive impact on the poor. It seems that they just don't care, or at least that they care less about the cost of living than they do about their pet causes of environmentalism and public health.

People in the bottom fifth of the income stream spend, on average, 11.4 per cent of their disposable income on sin taxes (not the products, just the tax!) and spend a further 10.3 per cent on VAT. If they smoke or drive a car, they pay significantly more.

It seems to me that a good first step to tackling poverty would be for the government to stop taking money from the poor—money which has often been given to them by the government in the first place.

I've written a short blog post about this for the IEA and you can download the report for free here.

Friday 11 October 2013

Big Pharma versus e-cigarettes

Big Pharma's massive lobbying effort in Brussels has received very little attention so it's a pleasant surprise to see that German television has lifted the lid an inch or two on the funding of the many alleged 'public health' groups that have been involved with the Tobacco Products Directive. The video is here (I can't embed it) and it is, of course, in German. A rough translation is below...

Introduction by presenter: Lobbyists – most people imagine them to be sinister folk running around in dark suits, carrying suitcases. But it’s not that simple. Basically lobbyists are people that fight for certain interests. One example: The EU parliament negotiated over a stricter tobacco directive. In the process, many, many lobbyists had been active in order to present their arguments. There have been representatives by the tobacco industry but also representatives of anti-tobacco campaigners. Does that mean “bad lobbyists” versus “good lobbyists”? Katharina von Tschurtschenthaler and Ekkehard Sieker say: There’s more than just the mere “black and white”…

Broadcast: We’re in the EU parliament. Those are the remainders of little goodies by the tobacco industry (camera shows cigarette samples). Plus countless cover letters by tobacco companies urging MEPs not to support this “wrong” Tobacco Directive. Working against these lobbyists there are anti-tobacco campaigning groups with more than 100 people of staff and million-Euro budgets.

Quote Florence Berteletti, director SmokeFree Partnership: “We at SmokeFree Partnership are only two people of staff. Those responsible for Tobacco Control in Brussels you can count on one hand”.

For her point of view, the bible story of David and Goliath needs to be referred to. On the one hand you have the giant Goliath, representing the evil: The big tobacco industry. One the other hand you have little David, representing the good. However: Is David really that weak? Let’s have a closer look at her organization the SmokeFree Partnership. These tobacco opponents receive funding by the pharma industry, it says in this handbook on patient groups published by the EU. Obviously the anti tobacco groups are not that weak at all.

(Camera shows Smoke-Free sign and consecutively logos of pharma companies)

Our little David has got some true giants as friends! Johnson & Johnson, Novartis, GSK, Pfizer – Well, big pharma!

However: What is their interest? Saving mankind from death of smoking, out of altruism? Or are we talking about clear economic interests? Maybe it’s all about this: This is an e-cigarette! (camera shows e-cig) Already a substitute to regular cigarettes for many people. A giant future market. The pharma industry wants e-cigarettes regulated just as strictly as many other nicotine surrogates such as nicotine chewing gums or patches.

The boss of the SmokeFree Partnership also wants this, arguing that this would be the only way to ensure the e-cigarettes helps smokers quit. Quote Florence Berteletti : “If they were on the market unregulated, who’s supposed to do the research on this?” Sounds reasonable at first listen.

Among MEPs, the SmokeFree Partnership has got a good reputation as independent anti-tobacco group. Is that justified?

Quote MEP Carl Schlyter (Green Party, Sweden): “According to my internet research I was not able to detect any connection to the pharma industry.”

Quote MEP Dagmar Roth-Behrendt (Social Democrats, Germany): “I cannot tell you how that organization is being funded. Actually we don’t really know that with several NGOs. However I support this organisation’s goals and I honestly I cannot imagine which industry association should have an interest in supporting them except for altruistic interests.”

A mere altruistic interest? The SmokeFree Partnership was been funded with at least €18,000 from pharma companies in 2012. But indirectly it’s quite a lot more than that. For example let’s go back to 2009, to the campaign “Tobacco Free Europe”, aiming directly at MEPs, showing the death toll of smokers. The campaign was co-organized by SmokeFreePartnership. Pfizer & Co. had funded this with €90,000 (camera shows leaflet indicating the fundings in a cake diagram).

However, our little David has got some further powerful friends, like the ERS. It’s the founding partner of SmokeFree Partnership. ERS organizes conventions on medical and pharma topics like the one in Barcelona in 2013, predominantly sponsored by the pharma industry. Doesn’t the pharma industry influence SmokeFree Partnership via the ERS?

Quote Florence Berteletti: “I am the director of the SmokeFree Partnership. If you have a question concerning the pharma industry and ERS, why don’t you approach ERS?”

But we’re already there. ERS and SmokeFree Partnership use the same mailbox and the same e-mail-address. And Ms Berteletti had been ERS staff member until recently. Is that independence?

Quote Florence Berteletti: “We are not funded financially by the pharma industry. We do not represent any of their interests.” Up until the end of our conversation, the SmokeFree Partnership insists on its independence. On the day prior to the parliamentary vote the SmokeFree Partnership sends this appeal to the MEPs (camera shows leaflet with shock pictures including small children), in cooperation with a new partner: the EFA. This organization received as much as €490,000 from the pharma industy, according to official EU documents.

And what did our weak David achieve now? Well, first of all some sort of stalemate. Since – as opposed to other media coverage – the EU parliament yesterday did NOT pass a final/ definite ruling on tobacco control and it is not sure yet who’ll be able to make the big business with e-cigarettes. David and Goliath enter the next round.

Outro by presenter: There may be dispute of details of a regulation. However it should by any means always be clear and transparent who’s arguing in whose name and for whose interests.

Wednesday 9 October 2013

David Cameron and packs of ten

From today's Prime Minister's Questions...

Jake Berry (Rossendale and Darwen) (Con): Does the Prime Minister believe that when the European Union forces my constituents to buy 20 cigarettes at a time, rather than their current 10, it will reduce the number they smoke?

The Prime Minister: It does not, on the face of it, sound a very sensible approach. I was not aware of the specific issue, so let me have a look at it and get back to my hon. Friend.

It seems that the Prime Minister was unaware of the big vote in Brussels yesterday. Perhaps he was unaware of the Tobacco Products Directive in general. It wouldn't be surprising if Anna Soubry failed to mention it to him since she behaved as if she was judge, jury and executioner in her time as Minister for Public Health. She failed to submit the legislation to parliamentary scrutiny and then came up with lame excuses which she later had to admit didn't stand up to, well, scrutiny.

Two points stand out. Firstly, it would have been nice to have had a public debate about this legislation before MPs read about it in the papers this morning. The media must take much of the blame here. If the Tobacco Products Directive is important enough to be front page news today, presumably readers would have been interested in hearing about it before it was a fait accompli. Y'know, when they could actually do something about it.

Secondly, the fact that the Prime Minister was unaware of what was contained in the Tobacco Products Directive rather undermines the idea that Lynton Crosby is constantly whispering in his ear about matters related to tobacco. Can we ditch that little conspiracy theory now?

Tuesday 8 October 2013

Tobacco Products Directive: the jury is in

It's D-Day for the EU's Tobacco Products Directive. Here are the main proposals that have emerged from two years of work from some of the finest minds in tobacco control, along with the logic behind them and the results of the EU parliament vote.

Banning flavourings

Kids hate the taste of tobacco but they love fruit. That's why you'll always find children in specialist tobacconists filling their briar pipes with fancy oriental tobacco. Everybody knows that kids start smoking cigarettes that taste of cherry, strawberry and licorice. That's why flavoured cigarettes make up a whopping 0.000001% of the market.

But there's one flavour kids love more than any other. Whether it's in cough pastilles or ointment for sports injuries, kids just can't enough of that mentholated taste. Gangs of teenagers know there's nothing more grown up and manly than having a white, menthol cigarette hanging out of their lips. No wonder the EU has decided to arbitrarily ban this particular segment of the cigarette market.

Vote in Parliament: Flavourings banned approved but the menthol ban won't come in until 2022.

Bigger graphic warnings

Graphic warnings have officially had a "negligible" effect on smoking behaviour and "have not had a discernible impact on smoking prevalence". Making them twice as large could make the effect twice as negligible. As always, the graphic images will focus only on the least plausible smoking-related diseases such as gangrene, blindness and that man from Uzbekistan who managed to get throat cancer on the outside of his throat. These images are bound to strike a chord with smokers. Who amongst us doesn't know someone who was struck blind after smoking too many cigarettes? Future graphic warnings will concentrate on images of syphilis, bearded babies and 9/11.

Vote in Parliament: Graphic warnings will take up 65% of the pack, not 75% as originally planned.

Banning packs of 10 and small pouches of rolling tobacco

No one likes to run out of tobacco and thanks to the EU you'll be less likely to in the future. Trying to cut down by buying a pack of ten? Don't bother. Buy a pack of twenty to make sure you've always got cigarettes in the house.

Vote in Parliament: Approved. (UPDATE: Or was it? It's reported here that the ban on packs of ten was only 'recommended' and Taking Liberties says that 20g pouches will still be available.)

Banning 'slims'

Women are more likely to smoke slim cigarettes and, as everyone knows, women aren't allowed to smoke therefore slim cigarettes should be banned. If women still insist on smoking, they should be made to inhale great big lungfuls of tobacco like blokes do. Fatter cigarettes, more tobacco—it's a great health policy.

Vote in Parliament: Rejected.

Regulating e-cigarettes as medicines

They're not tobacco products and they're not medicines, so let's regulate them as medicines in a Tobacco Products Directive! This will increase costs, reduce competition and limit the appeal of a much safer nicotine product. Great news for the EU-subsidised tobacco farmers.

Vote in Parliament: Rejected!

Monday 7 October 2013

Reasons to regulate e-cigarettes as consumer products

The medicalisation of e-cigarettes has been portrayed as a way of putting them ‘on an equal footing’ with NRT, but this ignores the pertinent fact that the pharmaceutical industry wanted their nicotine products to be authorised as medicines so that they could be marketed as drugs and sold to state-run health agencies. There is no other precedent for ‘nicotine delivery devices’ being viewed as medicines and there are no calls for the most widely sold ‘nicotine delivery devices’ - tobacco products - to undergo medical authorisation. The e-cigarette industry maintains that its products are not medicinal drugs, but are recreational consumer products which can be used an alternative to smoking. There is no compelling reason why products containing nicotine should be medicalised when products containing caffeine, alcohol or sugar are not. Normal consumer protection laws should suffice.

Like other governments that have dealt with e-cigarettes in a heavy-handed manner, the EU is endorsing the same neo-prohibitionist approach that led to the disastrous missed opportunity with Swedish snus. Other proposed regulations in the directive are reductio ad absurdum variants of orthodox tobacco control measures which, as the previous chapter showed, have little or no impact on smoking rates. These include mandating still larger graphic warnings, standardising the exact length and diameter of cigarettes and banning ‘characterising flavourings’. By tying itself up with such trivial issues, the EU is living up to its stereotype as a bureaucratic machine that produces unnecessary and petty regulation.

The most visible effect of a ban on ‘characterising flavourings’ will be to prohibit the sale of menthol cigarettes, but it will also result in a de facto ban on a wide range of snus brands in Sweden (which are usually flavoured) as well as most e-cigarette fluids. Here, as elsewhere, the Tobacco Products Directive is stacking the deck against harm reduction while introducing arbitrary regulations for the cigarette industry. The directive will require medical authorisation for most ‘nicotine-containing products’ and will require pre-authorisation for any new tobacco product. Moreover, it will prohibit any labelling that might suggest that one product is less harmful than another. In short, it will not only kill off the two most promising reduced harm products, but will prevent any new innovations from hitting the shelves in the future. The effect will be to slice up the European nicotine market, dividing the spoils between cigarette companies and the pharmaceutical industry.

Harm reduction for smokers would save many more lives than harm reduction for drug addicts and it would not require a penny of government spending. It only requires the government to step back and allow free market solutions to gain popularity. In practice, this means taxing and regulating e-cigarettes as ordinary consumer products to ensure basic standards of quality while allowing snus to be sold with appropriate and accurate labelling to inform customers of its risk profile relative to cigarettes.

The neo-prohibitionist approach to public health has raised barriers to entry and excluded new entrants, thereby making the nicotine market less competitive and less innovative. Meanwhile, the cigarette industry continues to be highly profitable as a heavily regulated oligopoly, as Dr Robert Branston, Deputy Director of the University’s Centre for Governance and Regulation, acknowledges: ‘The market has failed to curb cigarette manufacturers in terms of pricing power and profit, and tobacco control policies have unintentionally exacerbated the problem.’ 

Consumers suffer in uncompetitive markets from higher prices and limited choice. Neither of these are seen as problematic by anti-smoking campaigners who view higher cigarette prices as desirable, but a more serious problem arises when safer products are preemptively banned under the precautionary principle or cannot be brought to market due to advertising restrictions and heavy bureaucracy. As former ASH director Clive Bates puts it, ‘if you over-regulate a new, disruptive, low-risk alternative to the dominant and deadly cigarette, you simply protect the worst products from competition.’ Whether by accident or design, the beneficiary is the incumbent industry, rather than the consumer.

We argue that the interests of consumers are nearly always better advanced by the provision of accurate information and free choice than by prohibitions and restrictions on commercial speech. Markets can correct themselves more quickly than governments. Market failures can be corrected by free enterprise long before government failures are even acknowledged, let alone rectified. Transforming a free market into a ‘dark market’ carries significant risks which are well understood by students of Prohibition and the War on Drugs. Restrictions on product development and marketing in the nicotine industry have led to information failures which have led, in turn, to further failures of both government and the market. Buttressed by political grandstanding, corporate rent-seeking, rigid ideology and old-fashioned puritanism, the result has been a disaster for the only group of people whose interests are of direct relevance: smokers.

From Free Market Solutions in Health: The Case of Nicotine 

PS. With the big vote on the Tobacco Products Directive coming tomorrow, the public health racket has closed ranks, with editorials in support of medical regulation appearing in the BMJ and the Lancet, plus a pisspoor op-ed from statist trougher Martin McKee and a letter from the usual suspects in the Telegraph.

There is an amusing rebuttal to McKee here and Clive Bates picks apart Linda McCavan's lies here. The rapid responses to McKee are also worth reading. Expect a final flurry of propaganda from the medical establishment and the EU-funded press over the next 24 hours.

Sunday 6 October 2013

Harm reduction and its opponents

The arguments for and against harm reduction in the field of nicotine are much the same as those in the field of illegal drugs where governments have increasingly adopted needle exchanges, methadone programmes and safe consumption rooms to reduce drug-related mortality. In the field of drugs, harm reduction is widely considered to be a healthier and more humane approach than rigid prohibition. The biggest difference between harm reduction for narcotics and harm reduction for nicotine is that many more people die each year as a result of smoking than die as a result of drug use, albeit usually at an older age.

The other key difference is that narcotics are illegal whereas cigarettes are not. Accusations of institutional hypocrisy made against governments which facilitate the consumption of illicit drugs carry less weight in the case of tobacco harm reduction since cigarette smoking is legal. Advocates of e-cigarettes and snus cannot be accused of condoning smoking since both products are alternatives to smoking and the former does not even contain tobacco. At worst, they can be accused of condoning nicotine use, but nicotine does not cause disease and, as a drug, it is much closer to caffeine than to opiates. Tobacco harm reduction therefore forces campaigners to ask themselves if it disease they are fighting or if addictive pleasures and corporate profits are a greater concern.

The economist Thomas Sowell divides people into those who have the ‘tragic vision’ and those who have the ‘vision of the anointed’. The latter believe that the problems of mankind are created by institutions and that, through legislation, solutions can be found - in this instance, total worldwide abstinence. The former see mankind as inherently flawed and believe that there are rarely ‘solutions’, only trade-offs. There are those who believe that legislation, denormalisation and NRT can reduce the prevalence of tobacco use to less than 0.5 percent of the population within twenty years. Others look at the failure of similar efforts to suppress alcohol and drugs in the past and view the neo-prohibitionist approach as utopian, unrealistic and ultimately damaging to health.

Back of the envelope calculations of how many premature deaths could be prevented by a shift to alternative nicotine products are easy to produce. ‘If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes,’ writes John Britton of the Royal College of Physicians’ Tobacco Advisory Group, ‘we would save 5 million deaths in people who are alive today. It’s a massive potential public health prize.’ This assumes that every smoker will be happy to shift to the electronic devices, an unrealistic scenario, but significant health gains can be predicted whatever the level of uptake.

In a private letter written in 1984 when harm reduction was out of fashion and total abstinence was the order of the day, the renowned epidemiologist Richard Peto pondered the question of ‘how many cancer deaths would be likely to be caused each year if one-third of the British population become habitual tobacco suckers.’ This was a reference to snus, which was becoming the subject of controversy in Britain as a result of the Skoal Bandits furore. Peto acknowledged that the health risks associated with snus, if any, were unknown and would take many years to identify. He cautioned that ‘no matter what epidemiological studies you mount, you probably won’t get even a preliminary answer this century, so as a practical basis for action I suggest you assume that the adoption of Skoal Bandit-like products by a quarter or a half of the British population will cause about 1000 cancer deaths a year. In contrast, tobacco smoking currently causes about 100,000 British deaths a year!’ Peto based his prediction of a thousand cancer deaths on the assumption that snus had a similar risk profile to the kind of loose oral snuff used earlier in the century in the USA. It took many years before the epidemiological evidence showed no association between Swedish snus and mouth cancer. He was, however, correct in his basic assumptions which he outlined as follows:

‘- The risks are not zero - The risks can probably be reduced by immediately commissionable laboratory research; - The risks are much, much less than those of cigarette use.’ (Peto, 1984)

Writing about Skoal Bandits in the Lancet the following year, the addiction specialist Michael Russell came to a similar conclusion:

‘Our results suggest that this new product could help people trying to give up smoking. It might be cheaper than nicotine chewing gum and would not require a prescription. If all smokers in Britain switched to sachets about 50,000 premature deaths per year might eventually be saved at an annual cost of less than 1,000 deaths from mouth cancer.’ 

Speaking to Virginia Berridge in 1995, Russell recalled that such messages fell on stony ground in the 1980s. ‘I gave a talk fifteen years ago at a respectable conference in Edinburgh - if you could get people to switch to snuff you could prevent lung cancer and bronchitis - all for a small risk. People don’t like it if you raise these issues.’ Such arguments ‘carried little weight with a public health lobby which still regarded safer smoking (in whatever form) as a discredited strategy and abstention as the only aim,’ writes Berridge (Marketing Health, 2007: 271). ‘The scientific message might have been right, but it was coming from the wrong messengers at the wrong time.'

In the USA, the oral pathologist Brad Rodu was roundly condemned by anti-smoking campaigners when he published his book For Smokers Only: How Smokeless Tobacco Can Save Your Life (1995). Like Peto, he based his calculations on the risk profiles of the most carcinogenic smokeless products but nevertheless concluded that ‘if all 46 million smokers used smokeless tobacco instead, the United States would see, at worst, 6,000 deaths from smoking-related cancers, heart problems, and lung disease.’ (Rodu, 1995: 131) Despite the book’s title clearly indicating that Rodu was not condoning the use of smokeless tobacco by nonsmokers, he was accused of being ‘irresponsible’ and ‘naïve’ by public health activists who have ostracised him in the years since (For Your Own Good, Sullum: 78-80).

Arguments against safer products

Opposition to harm reduction is by no means universal in public health circles. A number of organisations, including the American Association of Public Health Physicians, Action on Smoking and Health, the American Council on Science and Health and the Royal College of Physicians have recommended that snus be re-legalised and e-cigarettes be encouraged. For others, however, stated concerns include the possibility that alternative nicotine products act as a ‘gateway’ to cigarette smoking, that some people will use less harmful products as well as cigarettes, and that snus and e-cigarettes allow smokers to ‘get around’ smoking bans.

Taking the objectives of modern public health at face value, one can consider the following theoretical process by which a less harmful product could negatively affect population health. It is possible that individuals who would not have taken up smoking because they think it is too dangerous might take up the less harmful product. If Product A is half as hazardous as Product B and the entire market shifts from B to A, then net harm will fall by half. If, however, Product A attracts so many new customers that the entire market doubles, the net effect would be zero. And if the market increases threefold, net harm would increase by 50 per cent.

How likely is it that a shift to safer nicotine products will increase net harm? Further research will quantify exactly how much safer e-cigarettes and snus are in comparison to conventional cigarettes, but there is little doubt that they are at least 90 per cent less hazardous and are probably in the region of 98-99.9 per cent less hazardous (Rodu, 2011; Cahn and Siegel, 2011). If so, the risk posed by these products is of a similar order to that of eating red meat, drinking alcohol in moderation, driving a car, sun-bathing or any of the other run-of-the-mill lifestyle choice.

Approximately twenty per cent of the UK population currently use nicotine, of whom the vast majority smoke cigarettes. The nicotine market cannot, therefore, increase by more than fivefold (100 per cent). If snus and e-cigarettes are 95 per cent less hazardous than cigarettes (a very conservative estimate), then there would have to be a more than twentyfold increase in the size of the nicotine market for net harm to rise above the current level. This is a mathematical impossibility.

Alternatively, it is possible that individuals might take up the less harmful nicotine product and then move on to cigarettes - the ‘gateway’ effect. There is, however, very little evidence that reduced harm products appeal to nonsmokers in the first place. In the case of e-cigarettes, ASH notes that ‘there is little evidence of use by those who have never smoked.’ Based on survey data, ASH found that ‘regular use of e-cigarettes is extremely rare’ amongst children. Only one per cent of 16-18 year olds - and zero per cent of 11-15 year olds - use an e-cigarette more than once a week and this tiny minority is made up of smokers and ex-smokers. ASH found no regular users of e-cigarettes amongst non-smoking teenagers:

‘Among young people who have never smoked 1% have “tried e- cigarettes once or twice”, 0% report continued e-cigarette use and 0% expect to try an e-cigarette soon... Frequent (more than weekly) use of e-cigarettes was confined almost entirely to ex-smokers and daily smokers.’ Far from acting as a gateway to smoking, all the evidence indicates that e-cigarettes are a gateway from smoking. Switching from vaping to smoking would require a conscious decision to take up a habit that is ten times more expensive and one hundred times worse for your health. The prohibition or over-regulation of these devices will close off a hypothetical gateway from e-cigarettes to tobacco, but it will also close off a very real gateway for people who want to go from tobacco to e-cigarettes, and that is the path most travelled.

Some have complained that e-cigarettes ‘normalise’ smoking. ‘We are especially concerned that e-cigarettes might reinforce the smoking habit as they are designed to closely mimic smoking actions’, says the British Medical Association. For this reason, the BMA has called for the smoking ban to be expanded to include e-cigarettes despite it being almost inconceivable that ‘passive vaping’ could pose any risk to bystanders. On the campus of the University of California, San Francisco, it is against the rules to carry, let alone use, an e-cigarette, even outdoors.

For all the talk of ‘denormalising’ tobacco use, smoking prevalence in most countries exceeds twenty per cent of the adult population. Smoking may not be universal, but it can hardly be described as abnormal or unusual. In 2010, cigarettes and rolling tobacco made up 94.9 per cent of the EU’s nicotine market. E-cigarettes and NRT held just 0.4 per cent each while smokeless tobacco held 0.6 per cent (Matrix Insight, 2012: 20). Whilst there is evidence that the ‘denormalisation’ approach can lead to lower smoking rates (Hammond et al., 2006), it remains doubtful whether e-cigarettes ‘normalise’ smoking in any meaningful way. As a device that has spread rapidly by word-of-mouth in recent years, it would be more accurate to say that e-cigarettes normalise harm reduction and smoking cessation. Moreover, there are social costs incurred by the denormalisation/stigmatisation approach which can be avoided by the more liberal harm reduction approach (Bayer and Stuber, 2006).

Once bitten, twice shy?

A further objection sometimes raised is that harm reduction has been tried before and failed. Low tar cigarettes and filter tips are now widely portrayed as tobacco industry ruses to trick consumers and delay tougher regulation. This ‘once bitten, twice shy’ argument requires some rewriting of history. Lowering tar yields and investigating the ‘safer cigarette’ had the support of many public health scientists, including some of those who first identified the link between cigarette smoking and disease, as well as successive Surgeon Generals and several Ministers for Health. The Federal Trade Commission recommended that tar yields be printed on cigarette packs in 1969 (Sullum: 69) and many governments officially advised smokers to switch to low tar brands in the 1980s and 1990s.

Moreover, the harm reduction efforts were not complete failures. There is ample evidence that the unfiltered high-tar cigarettes of the 1950s posed more of a health hazard than the filtered low-tar cigarettes of later decades (Hammond et al., 1976; Tang et al., 1995; Blizzard and Dwyer, 2001; Harris et al., 2004). The European Union has progressively lowered the maximum permissible levels of tar and nicotine in cigarettes, presumably because it believes lower yields to be less dangerous. Although the ‘safer smoking’ initiative of the twentieth century was a more collaborative effort between the tobacco industry and government than is often recognised, the industry was guilty of keeping its misgivings about ‘light’ cigarettes to itself and it clearly failed to produce a ‘tolerable risk’ cigarette. None of this has any bearing on the safety or efficacy of snus and e-cigarettes, however. ‘Once bitten, twice shy’ is fallacious reasoning.

Arguments made against tobacco harm reduction on health grounds are not compelling. Opposition to e-cigarettes and snus can only be properly understood in the context of the public health lobby’s longstanding goals of eradicating recreational nicotine use and destroying the tobacco industry. An underlying objection of anti-smoking campaigners to these products is that cigarette companies could survive and thrive by selling them. Several tobacco firms have started selling snus and Lorillard became the first tobacco company to acquire an e-cigarette firm in April 2012. British American Tobacco has created a startup company called Nicoventures to create products for ‘smokers who may not want to quit smoking but who want a safer alternative to cigarettes’ while Philip Morris has patented a nicotine aerosol product (Matrix Insight, 2012: 52) Many anti-smoking veterans would find it intolerable if ‘Big Tobacco’ became a player in harm reduction since they have long since cast the industry as a consummate enemy with whom they are engaged in a war of annihilation.

Meanwhile the pharmaceutical industry has an incentive to lobby against non-medicinal nicotine products and national governments have a financial incentive to perpetuate the smoking of highly-taxed cigarettes. The novelist Lionel Shriver, who kicked her smoking habit thanks to e-cigarettes, blames opposition to the devices on ‘kneejerk cultural prejudice, puritanical vindictiveness, corporate collusion, and the unconscionable greed of tax authorities that won’t be able to heap the same punitive, confiscatory, opportunistic duties on a product that doesn’t hurt anyone.’

Resistance to e-cigarettes - which contain no tobacco and are, for the most part, not made by ‘Big Tobacco’ - is consistent with the puritanism and prejudice Shriver alludes to. Moral indignation towards pleasure-giving ‘vices’ may well be a motivation for some of those working in the tobacco control industry. Bell and Keane (2012) note that objections to e-cigarettes have a moral dimension and that ‘it is not clear that further research into e-cigarettes will substantially alter current opinion. This is because their dangers stem not merely from the constituents of the products themselves, but the ideological challenge they pose to the binary categorisation of nicotine into not only remedial and harmful forms, but morally “good” and “bad” ones.’

As smokeless products, e-cigarettes and snus do not violate the anti-smoking lobby’s vision of a ‘smoke-free society’ - indeed, they are likely to bring it closer to fruition - but recreational nicotine use of this sort remains morally suspect to some of its members and was never part of the plan. The question now is whether ‘it is better to aim for complete exclusion or prohibition of nicotine use, or to accept the place of nicotine in society but to regulate to make nicotine products safe.’ (Britton et al., 2001: 14-15) It remains to be seen whether that plan is flexible enough to adapt to changing circumstances or if the abstinence-only ideology is too big a juggernaut to be turned around.

From Free Market Solutions in Health: The Case of Nicotine

Friday 4 October 2013

Plain packs: longer transaction times, more mistakes, higher costs

This week, new research came out of Australia showing the impact of plain packaging on businesses that sold tobacco. Roy Morgan Research surveyed 450 shopkeepers and unsurprisingly—but contrary to the promises of anti-smoking campaigners—found that the legislation has been a pain in the arse for both retailers and customers.

Overall, around two-thirds of small retailers rated plain packaging as having had a negative impact on their business (69%).

The majority of retailers indicated that their staff now have a heavier workload since the introduction of plain packaging (63%).

As the chart below shows, the majority of retailers found themselves spending more time selling cigarettes than before the legislation came in:

And, as the next chart shows, the majority of retailers reported giving customers the incorrect product more often since the legislation came in:

It's important to remember that the, ahem, peer-reviewed evidence from the anti-smoking lobby confidently predicted that plain packaging would reduce transaction times and reduce the number of mistakes made at the counter. Remember, also, that they confidently predicted that the display ban would not increase transaction times.

Consider what that means. They are saying that a newsagent will be able to identify and pick up a pack of cigarettes more easily if all the packs look the same and he has to slide a door open every time than if the cigarettes are clearly distinguishable and he can simply turn around and reach for them. This is what fundamentalism and junk science can do to a person—it can make them believe things that are obviously absurd. Needless to say, their evidence was policy-based garbage.

So, plain packs are bad for business—not because retailers sell less tobacco but because it takes them longer to sell what people want.

Still, it's not all bad news...

Two-thirds of the total sample reported that they now feel less favourable towards the government as a result of the plain packaging legislation (65%). This includes almost half who reported feeling much less favourable (46%).

And so they should.

Wednesday 2 October 2013

That Irish plain packs study

Last week I wrote about the latest plain packs study which is the same as all the other plain pack studies, ie. it's a survey that asks teenagers whether they think ugly packs look ugly.

I'm very grateful to a reader who has managed to prise this unpublished effort from the hands of the state-funded charities that commissioned it. I won't say it makes for fascinating reading, but there are some telling moments which undermine the already-weak claims made on its behalf.

As with other surveys of this kind, it is clear that the teenagers questioned are no fools. They understand why people of their age smoke better than the campaigners, and they know it is not because of the colour schemes on the packs. If asked whether they think the 'plain' packs look worse than existing packs, they say that they do. Anyone would. The question that campaigners have never come close to answering is whether making the packs look worse will put people off smoking. The experience with graphic warnings suggests that it won't—because it hasn't—and there are plenty of clues in the surveys themselves to confirm this.

For example, this new Irish study finds that brand awareness amongst both never-smokers and smoking "enthusiasts" (their word for occasional//social smokers) was low. Amongst the enthusiasts, brand recognition was "generally limited. Most tended to stick with initially trialled brands or whatever friends were purchasing." Amongst never-smokers, awareness was "limited to what family members or friends smoked." So much for the appeal of 'glitzy' packaging. Awareness of brands was only high amongst teens who were already regular, daily smokers, which is what you would expect from regular consumers of any product. There is no evidence here that brands play any part in smoking initiation.

It is clear that the brands that teens buy when they start smoking are those which are cheapest, nor those with the 'glitziest' packaging (the latter tend to be more expensive):

When it comes to choosing which cigarette brand to purchase, price is ultimately the deciding factor  for teens and most will automatically choose the cheapest irrespective of whether it is their first choice.

The teens rejected a number of 'glitzy' packs because they associated them with older people:

The gold of Superkings and Benson and Hedges was seen as giving the brands an old fashioned feel. The pale yellow and blue of Camel packs was deemed to cheapen the product

Whereas the cigarettes they actually smoked are not glitzy and are considered to be quite unattractive even by those who buy them: spending power means most have to settle for realistic, affordable choices rather than their desired luxury brands. Examples of brands that fall within this category include Mayfair and Amber Leaf tobacco. Both brands were the most widely smoked brands by the teens who took part in the focus groups. The packaging for both of these brands was generally considered to be cheap looking and poorer quality. Amber Leaf was described as old fashioned, with cheap looking on pack imagery, garish yellow colours and packaging style being the primary drivers of this impression. Mayfair packaging was considered plain and dull.

Not going very well, is it?

Moreover, the teenagers are pretty realistic about what will happen if plain packs come in:

Enthusiasts and regulars suggest that they will eventually become desensitised to the on pack messages and many claim they will just purchase tins/personalised boxes to carry their cigarettes in.    

And they have legitimate concerns about the illicit market—unsurprising considering that Ireland is Western Europe's capital of black market tobacco:

There was a general sense of mistrust that standardised packaging afforded shopkeepers/cigarette manufacturers greater potential to replace more expensive cigarettes with cheaper versions and use poorer quality tobacco.

"You could ask for a box of John Player Blue, but they could be giving you those fake cigarettes or Mayfair and you would never know" (Male,  Regular,  C2D)

You can see why the campaigners want to keep this survey under wraps. There are some pretty smart kids over there in Ireland who can see what's afoot. What a shame that anti-smoking zealots aren't as canny as teenagers.