No matter who you vote for, public health always gets in

There's always a loophole (via Nonjob)

Cynical old men in pubs like to say of politics that "no matter who you vote for, the government always gets in." Tautologically true though this is, it is equally true to say that the unelected 'public health' lobby is the permanent government of Britain. No matter which government gets in and no matter how much the government promises to leave people alone the demagogues of 'public health' always get their way.

Banning smoking in cars is a classic example. The elected government is against it, the deputy prime minister is against it, it's been rejected in the House of Commons and yet it is on the brink of becoming law thanks to the parliamentary opposition persuading unelected lords to tack it on to a different piece of legislation.

Dick Puddlecote has written a must-read post about the implications of the ban on smoking in your own car if under-18s are in it. As he says, it not only leaves the door wide open for bans on smoking in the home, but it also makes the police responsible for enforcing nanny state regulations for the first time in our history.

It's senseless to argue with people who say that this legislation isn't the thin end of the wedge. In this blog post's four year history, I have given enough examples of the slippery slope for all but the most willfully ignorant to see how it works. This week, it was grimly amusing to hear people denying that the slippery slope exists while citing the seat belt legislation as a precedent for banning smoking in cars. If they knew their history, they would know that their proposal was just the kind of thing MPs had in mind when they warned they warned of mission creep during the parliamentary debate on mandatory seat belts in 1979.

Those MPs were ignored in 1979, but they have ultimately been shown to have been right. At a time when campaigners claim that 'sugar is the new tobacco' and the head of the WHO rants about 'Big Soda', the time has come to stop arguing with people who pretend that precedents do not have predictable consequences which follow from the precedent being followed to its logical end. Sure enough, it took only a matter of hours before the question of extending the ban to e-cigarettes surfaced.

When I was at University, I remember a politics lecturer mentioning that the parliamentary debate on seat belts was one of the few examples of John Stuart Mill's harm principle being seriously discussed in the House of Commons. Rightly so, since it was one of the first times in recent history (along with the motorcycle helmet law) that the government legislated to save people from themselves. The rest is history. Since then we have seen a raft of increasingly intrusive paternalist laws introduced 'for our own good', with the seat belt legislation cited as a precedent. This was all predicted in 1979. Ivan Lawrence MP, for example, said...

Since I have been in the House I have seen the cogent arguments and the telling pleas of hon. Members on both sides of the House persuading and succeeding in persuading the House that it is only a very little piece more of liberty that we are withdrawing and for such great benefits and advantages. As a result we have far fewer of our freedoms now than was ever dreamed possible a few years ago. In the end we shall find that our liberties have all but disappeared. It might be possible to save more lives in Britain by this measure—and by countless other measures. But I do not see the virtue in saving more lives by legislation which will produce in the end a Britain where nobody wants to live.

Parliamentary debates like this are a thing of the past. Indeed, parliamentary debates about smoking will soon be a thing of the past if the Children and Families Bill goes through as it is. The real story of the week is not the ban on smoking in private cars, but the enabling act which has also been tacked onto the Bill. This enabling act allows any health secretary to do almost anything they like regarding tobacco without having to go to the trouble of having a debate and a vote.

This is the relevant part of the Lords' amendment...

Insert the following new Clause—

“Regulation of retail packaging etc of tobacco products

(1) The Secretary of State may make regulations under subsection (6) or (8) if the Secretary of State considers that the regulations may contribute at any time to reducing the risk of harm to, or promoting, the health or welfare of people under the age of 18.

(7) Regulations under subsection (6) may in particular impose prohibitions, requirements or limitations relating to—

(a) the markings on the retail packaging of tobacco products (including the use of branding, trademarks or logos);

(b) the appearance of such packaging;

(c) the materials used for such packaging;

(d) the texture of such packaging;

(e) the size of such packaging;

(f) the shape of such packaging;

(g) the means by which such packaging is opened;

(h) any other features of the retail packaging of tobacco products which could be used to distinguish between different brands of tobacco product;

(i) the number of individual tobacco products contained in an individual packet;

(j) the quantity of a tobacco product contained in an individual packet.

(8) The Secretary of State may by regulations make provision imposing prohibitions, requirements or limitations relating to—

(a) the markings on tobacco products (including the use of branding, trademarks or logos);

(b) the appearance of such products;

(c) the size of such products;

(d) the shape of such products;

(e) the flavour of such products;

(f) any other features of tobacco products which could be used to distinguish between different brands of tobacco product.

(9) The Secretary of State may by regulations—

(a) create offences which may be committed by persons who produce or supply tobacco products the retail packaging of which breaches prohibitions, requirements or limitations imposed by regulations under subsection (6)

This basically gives carte blanche to any health secretary to bring in plain packaging and create any number of new tobacco crimes at the drop of the hat. Knowing how quickly politicians go native when they start working at the Department of Health, this is a crank's charter and ASH knows it. As far as they are concerned, the amendment makes plain packaging a done deal.

Deborah Arnott, Chief Executive of Action on Smoking and Health, said:

“This is a great win for tobacco control and public health. We congratulate parliamentarians from all Parties and the crossbenches in the House of Lords and all those supporters, who worked so hard to make standardised tobacco packaging a reality. Everyone who cares about protecting the health of children and about reducing the toll of death and disease caused by smoking should welcome the outcome of today’s vote. We are absolutely delighted.”

And so they should be. They lost the argument, they lost the public consultation and they lost the political battle in the elected chamber, but they found a way of never having to go through the democratic process again. If this law goes through, all they will need to do in the future is flatter whichever inexperienced politician is trying to make a name for themselves as Minister for Public Health and they will be able to get away with murder. This is more than they could ever have hoped for and the media hasn't even noticed.


For more commentary on the extension of the smoking ban, see...

Charlotte Gore, Guardian, A ban on smoking in cars with children is an authoritarian step too far

Stephen Glover, Daily Mail, 'If we let the Nanny State hound parents who smoke in cars, I dread to think who it'll pick on next'

Longrider, An authoritarian step too far

And you can hear me talking about it on Five Live here (starts at 8.25).

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The iron fist

Via Taking Liberties, I see that the anti-smoking bampots have found a new target for their hysteria. From Tobacco Control...

Article 13 of the Framework Convention on Tobacco Control (FCTC) requires signatories to ‘undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship’. The FCTC defines advertising and promotion very broadly, as

"any form of commercial communication, recommendation or action with the aim, effect or likely effect of promoting a tobacco product or tobacco use either directly or indirectly."

The Implementation Guidelines for the FCTC specify that:

"…a comprehensive ban… applies to all forms of commercial communication, recommendation or action and all forms of contribution to any event, activity or individual with the aim, effect, or likely effect of promoting a tobacco product or tobacco use either directly or indirectly. (Italics as per original.)"

It is therefore of concern to see that Imperial Tobacco has launched a social media campaign around the ‘Smoke Spots’ website in the UK (http://www.smoke-spots.co.uk). The site's launch was announced on Imperial Tobacco's Twitter account in July 2013, describing Smoke Spots as a ‘website for smokers’ which enables consumers to ‘find bars, restaurants and clubs with smoking facilities as well as locate outlets selling tobacco’. Imperial Tobacco's Head of Consumer Marketing was quoted in a company press release to support the launch as saying: "‘With this great new initiative, we are giving our consumers the chance to interact and form an online community where they can share great smoking experiences with each other.’"

The goal of creating an online community where consumers can ‘share great smoking experiences’ would appear to be inconsistent with the FCTC's ban on directly or indirectly promoting tobacco use.

In short, they are saying that telling smokers which pubs have smoking areas is a form of tobacco advertising and is therefore illegal. Bear that in mind if anyone ever asks you if a pub has a beer garden. It could be a sting operation.

The launch video and photos of launch events on Smoke Spots’ Facebook page show the Smoke Spots team surprising smokers in London, rolling out a red carpet, with chairs, music, food and drink, all presumably encouraging smokers to sit down and enjoy their cigarettes, sometimes in front of a prominent banner: ‘Smoke Spots—You choose where you drink, why not where you smoke?’. It is difficult to interpret the creation of such an atmospheric and enjoyable ‘event’ in any other way than directly promoting smoking.

Jesus.

One of the difficulties in regulating promotion of tobacco online is that it is often hard to distinguish between pro-smoking posts created by individuals unrelated to tobacco companies and clandestine posts by agents of tobacco companies posing as consumers.

Silence them all! Censor! The FCTC says you can.

There are no words to adequately express how insane the anti-smoking movement has become. Fanatics have always been with us, but they have traditionally been restricted to expressing themselves in letters to regional newspapers written in green ink. Today, they are given their own journals.

There is no doubt that the FCTC's guidelines—and they are only guidelines—are very badly written, probably because they were created by anti-smoking campaigners rather than lawyers. Nevertheless, did anyone really intend there to be a prohibition on telling people where they can smoke? Was it really the intention to make "encouraging smokers to sit down and enjoy their cigarettes" a crime?

This is what the fruitloops do. They take vague and badly written rules and extend them beyond the bounds of sanity. Take Article 5.3 of the FCTC, for example. Article 5.3 simply says that tobacco industry should not have undue influence on public health policy making. Specifically, it says: “in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law”. This means, for example, that "any interaction with the tobacco industry on matters related to tobacco control or public health is accountable and transparent".

That's fair enough (and it should - but doesn't - apply to other industries, eg. Pharma), but the anti-smoking lobbyists have tried to gold plate it at every turn. They act as if Article 5.3 legally forbids any interaction between policy-makers and the tobacco industry, which it doesn't, and then extend the definition of tobacco industry to virtually everybody who is not in their tiny cult.

Sometimes they go even further. Take the case of Katsuhiko Honda, the former president of Japan Tobacco. That's former president, please note. He no longer works at the company, although he is said to be affiliated as a consultant. After leaving, he applied to work at the Japan Broadcasting Company (NHK), a television network. Cue outrage from anti-smoking loons:

The Japanese Government ratified the World Health Organization Framework Convention on Tobacco Control (FCTC) in 2004, and has an obligation to observe the treaty under Japanese Constitution article 98.2. Article 5.3 of the FCTC states: "Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law". The government should avoid the influence of tobacco industry to pursue its policy.

Appointment by the Japanese parliament of a former president and now consultant of JT as the CEO of NHK would be a fundamental breach of Japan’s obligations under the FCTC.

We stand together with our colleagues from around the world who have also expressed concern about the possible appointment. NHK is broadcast in more than ten languages globally; its reach and influence is international.

What the hell is wrong with these people? The dude was trying to get a job in television, not at the ministry of health. Incredibly, the antis seemed to have won this fight last summer, but the issue came up again in November when Mr Honda was invited to sit on its board of governors. Cue more wailing...

“This appointment is troubling for many reasons, work in tobacco control being just one. Nonetheless, the fact that this appointment violates Japan’s international obligations under the World Health Organization Framework Convention on Tobacco Control Article 5.3 seems very clear."

It really isn't "very clear". On the contrary, it murky, paranoid gibberish. These people seem to think that the FCTC gives them the right to silence their critics and ruin anyone who has ever worked in the tobacco industry. Their censorious authoritarianism knows no bounds. An iron fist, indeed.

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Cry me a river

In November, I mentioned that the Australian government has been pulling the funding rug from under various 'advocacy' (ie. political activist) fake charities and sock puppets. One of them is the Alcohol and Other Drugs Council, an organisation that was so dependent on taxpayers' money that when the government announced that it was defunding it, it immediately cancelled the annual conference it had been arranged for three days later.

When ADCA was set up in the 1960s, it may have done some legitimate work, but by 2013 it was just another loud mouthed, authoritarian, parasitic lobby group, as I have mentioned before...

A flick through their press releases find them accusing John Farrell, a politician, of being "beholden to booze barons" because he failed to ban discounted alcohol. "Mr O’Farrell and his henchmen are not fit to govern," they claim.

We find them writing a letter to the Prime Minister, calling for "a complete ban on alcohol advertising and sponsorship, a minimum price per alcohol unit, the requirement for one-third of alcohol labels to be reserved for health warnings, and increased alcohol taxes."

We find them cheering on the previous government's move to introduce plain packaging, saying that "no debate is needed about this legislation."

We find them saying that it is "incomprehensible" and "beyond belief" that Aldi supermarkets are allowed to sell alcohol.

Needless to say, they are not feeling quite so cocky now that the hunter has become the hunted. Indeed, they have sent a quite pathetic begging letter to the government, pleading for a reprieve...

“Defunding has essentially destroyed the organisation and with it, its representative role in the alcohol and other drugs sector. The tens of thousands of workers in the sector, ranging from researchers and academics, community organisations, treatment specialists through to carers and volunteers in rural and remote Australia are now denied a national voice…

ADCA believes that its situation should be part of the review of government expenditure by the Commission of Audit. ADCA further suggests that its funding should be restored until at least after completion of the audit, so that years of expertise and corporate knowledge are not lost…

The government’s decision will ultimately prove to be shortsighted and ill-considered. There is no clearer example of the need for an organisation like ADCA than the current situation in which Australia finds itself – a nation wallowing in alcohol with a failure of leadership to address the critical issues of price, accessibility and advertising of alcohol products.

Governments in turn rely on the threat of defunding – as has happened with ADCA – to ensure advocacy and policy groups “tame down” their rhetoric. They then wonder why there is uncertainty and instability within the sector, why service organisations and community groups fight an ongoing battle to recruit and retain staff, and why such organisations find it impossible to plan for the future.”

Even in their death throes, these vermin can't resist hyperbole about "a nation wallowing in alcohol with a failure of leadership". Clearly they have no desire to "tame down their rhetoric" so it's time to administer the coup de grace, Mr Abbott.

May the day come soon when we read similar tear-stained, panhandling pleas from the likes of Alcohol Concern, ASH, Fresh, D-MYST and Balance North East.

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Plain packaging for food

We all know that plain packaging is a one-off measure that will only ever apply to the 'unique' product of tobacco and definitely won't set off another avalanche of slippery slope legislation. We know this because esteemed professors such as Simon Chapman have told us so and it's not like he's ever wilfully misled us before, is it?

One of the supposed effects of plain packaging is that it makes some smokers think their cigarettes are of lower quality than they were before. This, indeed, has become one of the peer-reviewed pseduo-facts that has helped fill the void of empirical evidence since plain packaging came in in Australia.

So would anyone like to hazard a guess at why studies like this are now being conducted?

Pretty food packaging makes food taste better: study

A University of Calgary study suggests wrapping food up in a pretty package is as likely to influence a child's food choice as a brand name like McDonald's.

Prof. Charlene Elliott's study builds on one done by Stanford University a few years ago.

The Stanford study found that preschoolers thought foods wrapped in a McDonald’s wrapper tasted better than the identical food presented in a plain wrapper. Children in the study even preferred the taste of carrots wrapped in McDonald’s wrapping.

"It was a very provocative study," Elliott said. "It's hardly surprising that given the choice of something that was wrapped in something completely plain and something that was decorated, the preschoolers preferred the food in the decorated wrapping."

Elliott's study came to same conclusion as the Stanford study, ie. that plain packaging makes people think food tastes worse. Still, probably nothing to worry about, eh? Sounds like a harmless academic exercise with no conceivable policy implications. We all know that the slippery slope is a fallacy.

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Eric Joyce on charities

Eric Joyce—one of the few MPs I have time for—has written an excellent blog post about lobbying. The government is in the process of passing the Transparency of Lobbying, Non-party Campaigning and Trade Union Administration Bill (popularly known as the Gagging Bill) which will limit political campaigning at election time—unless you're a political party. This is an unnecessary infringement of free speech and has been widely condemned across the political spectrum.

Charities are generally against the Bill, but they are focused on exempting themselves from the legislation rather than scrapping it altogether. What's so special about them? That is the question Joyce asks...

There’s a lot to be said about a contentious bill like this, but for my own part I think it’s worth flagging something obvious yet that receives very little debate as far as I can see. It’s not a detail of the bill, but an unquestioned assumption made by the people and organisations opposed to it. This is that campaigns conducted by charities are imbued with a moral superiority compared to those conducted by for-profit organisations. This moral superiority extends from the apparent motivation of those engaged in charitable activities and should lead, according to those who oppose the principle of the relevant part of the bill, to charities being given special treatment when it comes to political campaigning.

He then explains that (a) charities often have financial incentives themselves, and (b) there is nothing wrong with working for a profit-making company.

I’d like to advance two quick arguments here; the first a pragmatic one, the second more ideological, I guess.

First, many charities work in conjunction with for-profit organisations. Google 'environmental charities,’ for example, and search for revenue sources. You’ll find that companies that make their money making and selling, say, wind turbines, often help to fund charities and campaigns that argue for policies that serve those companies’ interests. There’s nothing wrong with that, of course. Quite the opposite. We live in a democracy and everyone should have the chance to advance world views and arguments in the hope that they’ll influence public policy. What seems fairly clear from this, though, is that ‘charity’ lobbying per se cannot be easily and neatly separated from ‘commercial’ lobbying and ascribed a superior moral value.

Second, and perhaps more fundamentally, most of my constituents make a living through ‘for-profit’ enterprises. I mean, we do live in a market economy, right? There’s nothing dirty about working in the private sector, is there? Meanwhile, a lot of people who work in charitable or not-for profit sectors do so simply because that’s where they’ve happened to get a job. And charities, big ones notably, operate in highly competitive environments (watch the World Wildlife Fund chomping its way into the environmental NGO market, for example. And have you ever watched high street ‘chuggers’ writing down the bank account numbers of pensioners caught off-guard?). Like the private sector, some charities are rubbish and others have aims a lot of us would profoundly disagree with. It’s really very hard to see a moral distinction of an activity simply on the basis of whether it’s being done on the basis of projected profit or not.

The bottom line is that the charities who complain about being 'gagged' are happy to see their ideological opponents gagged.

Charities have been calling the lobbying bill ‘the gagging bill’ because they want to be free to influence public policy at election time in ways not open to for-profit organisations. That is, they want to be free to speak while gagging the private sector ‘lobbyists’. But isn’t t that a profoundly undemocratic notion in itself? Charities, private sector companies, even the government and local government sector themselves, are all lobbyists to the same greater or lesser extent. They all want their world view to prevail, and they all want influence over public policy.

I made similar arguments in the opening pages of Sock Puppets (free download).

Do go read the whole of Joyce's post.

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Poetry corner with Gerard Hastings

I've been reading a bit of The Marketing Matrix by Gerard Hastings. Regular readers will fondly recall Gerard as one of the University of Sterling's numerous left-wing academics who uses 'public health' to push his anti-capitalist agenda. Despite having no medical qualifications, he has his fingers in both the temperance and anti-smoking pies (he is the director of the Centre for Tobacco Control Research and co-authored the review of evidence for plain packaging). He wants e-cigarette advertising banned, which is hardly surprising since he seems to want all advertising banned.

I wasn't expecting much from Hastings' book, to be honest. I thought I had got the measure of the man from his socialist outbursts in the media. Sure enough, The Marketing Matrix is a sixth form polemic about how we're all so oppressed by the free market. But there is a marvellous and unexpected joy within these pages, for it includes some of Gerard's poetry.

Would you like to read one of his poems? Of course you would.

The Corporation

You wear my name upon your breast

Your body end to end

It's plain for all the world to see

You are my greatest friend

You are my greatest friend, you are my greatest friend

I am the Corporation and you are my greatest friend

You love my Golden Arches

You crave my stylish swoosh

The looks you give my logos

Would cause a stone to blush, cause a stone to blush

I am the Corporation and I'd cause a stone to blush

My slogans are your poetry

Though they'd make a poet scream

They give your life its meaning

And craft your hopes and dreams

Craft your hopes and dreams, craft your hopes and dreams

I am the Corporation and I craft your hopes and dreams

You let me recreate you

In my image, by the hand

Like masochistic cattle

You queue to get my brand

Queue to get my brand, queue to get my brand

I am the Corporation and you queue to get my brand

Now my work has just begun

I have ambitious goals

I've started with your heart

But soon I'll have your soul

Soon I'll have your soul, soon I'll have your soul

I am the Corporation and soon I'll have your soul

For I am the new Jehovah

You answer to my call

You kneel before the labels

And worship in my malls

Worship in my malls, worship in my malls

I am the Corporation and you worship in my malls

You wear my name upon your breast

Your body head to toe

Little do you understand

I am your greatest foe

I am your greatest foe, I am your greatest foe

I am the Corporation and I am your greatest foe

For I'll crush you in the end, crush you in the end

I am the Corporation and I'll crush you in the end

Isn't that a wonderful? Oh, to be sixteen again!

It's worth remembering when you see Hastings on the television—as he was last night—that these are the kind of thoughts that are running through his mind. Getting him involved in regulating industries is a fox/chicken coop situation and probably best avoided.

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As I was saying...

Further to yesterday's post, there's a brilliant take down of Monday's sugarphobic Dispatches programme by Rob Lyons at Spiked.

Normally, we at spiked have better things to do than point out all the egregious errors in a single television programme. But this episode of Dispatches did such a good job of scooping up all the current prejudices around sugar and health that it would be a shame not to.

Do read it.

On the subject of industry-funded science, about which the Disptaches programme was obsessed, an interesting study was published in PLoS this week. It looked at the reliability of animal research in relation to statins. The accompanying editorial starts by making the general point that "clinical trials sponsored by the pharmaceutical industry are likely to exaggerate benefit and minimise harms", but then concludes that industry-funded work in this instance is "likely to be performed and reported to a higher quality, and to be at lower risk of bias, than work sponsored by others."

The findings suggest that there is something different about industry-sponsored non-human animal research, perhaps reflecting higher standards than is the case elsewhere. Perhaps the academic community can learn something from our colleagues in the commercial sector.

The editorial suggests that industry has greater incentive to make sure the results are correct in the long run, whereas incentives are different for non-industry researchers...

In contrast, academic researchers are rewarded not for the marathon but for the sprint—for a high-impact publication describing a part of the jigsaw, not for the body of work that shows the whole picture. To them, substantial efficacy in a single study is, in some respects, an end rather than a beginning.

Bero and colleagues have made an important contribution; their findings suggest that academic researchers might learn good practice in the management, conduct, and reporting of non-human animal research from colleagues in industry, and reinforces the importance for readers of research reports to focus on methods and data rather than on abstracts and conclusions.

On a different note, I see that New Zealand's slippery slope is being coated in grease and covered in ball bearings. I honestly assumed that this was a spoof when I came across it via Eric Crampton. It is not.

The first symposium to focus on the health effects of sugary drinks will be held in Auckland next month.

‘Sugary Drink Free Pacific by 2030?’ is the theme of the symposium that will be hosted by the University of Auckland at the Faculty of Medical and Health Sciences in February.

As Eric says...

A couple years ago it was SmokeFreeNZ 2025. Now MoH seems to be putting money into a conference pushing an end to soft drinks by 2025. I wonder how long until they want plain packaging for Coke.

Unbelievable.

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Conflicts of interest

2014 has begun with a bang of ad hominems in public health. It's becoming increasingly clear that the intention is to silence any voices that do not agree with the narrow clique of self-styled 'public health professionals' and to use allegations of murky meetings with industry to intimidate politicians who do not comply.

Last year, we had the manufactured controversy about Lynton Crosby and plain packaging. This was a classic attempt to imply fire by creating steam and it has persisted despite there never being a shred of evidence to support it and despite any wrongdoing being explicitly denied by those involved.

Earlier this month we saw the BMJ hatchet job against anyone who has ever dared say anything against minimum pricing. This seemed to be directly inspired by the fake Crosby furore and was aimed at the same outcome—pressuring the government into a U-turn by implying improper access by business interests.

At the weekend, we saw a preemptive strike on the sugar front. The new and inexplicably influential Action on Sugar (formerly Consensus Action on Salt and Health - let's call them Action on Sugar and Salt (ASS) for now) is desperate for the WHO to halve its recommended daily sugar guidelines. There is virtually no evidence to support this idea. What little evidence exists is of "very low quality", as the NHS notes. Reducing the limit would be a purely political move. It would allow campaigners like ASS to claim that things are twice as bad as they thought.

In addition, the sugar nuts want the UK government to lower its own guidelines on sugar consumption. There is little chance that this will happen. As regular readers know, the garbage spewed out by ASS people like Aseem Malhotra may play well on the news, but it has very little relationship with science, and it is scientists—specifically the Scientific Advisory Committee on Nutrition—who will ultimately make the call. The sugar nuts know this and are preparing their own industry conspiracy theory for when the time comes.  

The Sunday Times—which has a habit of raising cranks to the status of experts when it comes to sugar—led the way by reporting that some members of the Scientific Advisory Committee on Nutrition had committed the original sin of being consultants for the food industry.

This was followed by a truly pathetic Channel 4 Dispatches documentary which was like the worst George Monbiot article made flesh. Titled 'Are You Addicted to Sugar?' (despite the only expert interviewed politely confirming that sugar is not addictive) the programme floundered in a sea of innuendos and follow-the-money smears before making the inevitable, spurious comparison with tobacco. I challenge anyone to watch it and not conclude that the scientist from the Scientific Advisory Committee on Nutrition is an honest and thoughtful man while the presenter is not. You can view it here.

A further attempt to close the circle is the growing campaign to prevent industry-funded research appearing in scientific journals. As with so many public health crusades, this began with tobacco and has quickly moved on to other fields. It's only been three months since the British Medical Journal announced that it would not be publishing any more research funded by 'big tobacco', but there are already demands that this ban be extended to the pharmaceutical industry. There are, inevitably, calls for the same to happen to the alcohol industry as well, and Monday's Dispatches also made insinuations against research funded by the sugar industry.

I haven't read such books as Ben Goldacre's Bad Pharma (and probably never will) so I won't comment on the alleged wrongdoings of the pharmaceutical industry, although I am sure they are many and varied. Ditto the tobacco industry, although I am unaware of any examples of scientific fraud funded by them in recent memory (the BMJ ban was said to be the result of unspecified historic sins).

As for the booze and sugar industries, their crimes appear to amount to nothing more than funding studies that tend to disagree with studies funded by their explicit enemies. The Dispatches documentary felt it was enough to say that studies funded by - ahem - 'Big Sugar' were more likely to show that sugar didn't cause [fill in the blank]. Similarly, a staggering piece of political propaganda published in PLoS last year claimed that the alcohol industry was inherently untrustworthy because it tended to disagree with 'public health' campaigners.

In neither case was any thought given to the possibility that there might be biases on the other side, let alone that the industry-funded researchers might be right and the state-funded studies wrong.

If industry-funded studies are in error, surely the best response is to expose the flaws and debunk the evidence. This is almost never done by those who blithely condemn them. Although I can readily believe that biases, not least funding biases, can lead to bad science, it must be shown to be bad science before the source of funding becomes interesting or relevant. In Dispatches, as in the BMJ hatchet job, the competing merits of the evidence were given no thought whatsoever—only the money.

By barring those who have vested interests from engaging in the scientific process, the medical journals implicitly accept that their much-vaunted peer-review process does not, in fact, prevent scientific fraud or spot quackery. It is an admission that the whole system is essentially based on trust. This was made clear in a BMJ podcast recorded at the time of the ban on tobacco-funded research, featuring Fiona Godlee, the BMJ's editor-in-chief:

"I think there's been a dawning realisation of the extent of the bias and research misconduct relating to some of the studies funded by the tobacco industry. And although people in the past might have relied on peer review and also on transparency statements around the fact that the research was funded - leaving the reader, really, to draw their own conclusions - what we do know is that biases and research misconduct are often very hard to detect, and also that the funding can influence the outcome of studies in ways that are invisible to the peer reviewer or the reader."

Godlee went on to discuss the problems of "Pharma-sponsored studies or any self-interested group", as if there were no "self-interested groups" lurking in the hallowed halls of the public health movement. The simple truth is that biases and misconduct that cannot be identified in the case of tobacco-funded research will not be picked up in other forms of research.

There are, to put it simply, biases everywhere. Some are ideological and some are financial, but it has always seemed to me that ideological biases are more pervasive and more dangerous than financial biases, not least because they do not have to be declared. Last night, for example, Mike Rayner tweeted this:

Conflict of interest? On the sugar payroll http://t.co/vNWhkUq9Pe via @FoodNavigator
— Mike Rayner (@MikeRayner) January 21, 2014

You may recall that Rayner believes that he is doing the Lord's work in campaigning for a fizzy drinks tax (about which he also conducts influential research) and so I tweeted back to him...

.@MikeRayner When you declare your conflict of interests, do you mention that you heard the voice of God telling you to bring in a soda tax?
— Christopher Snowdon (@cjsnowdon) January 21, 2014

My (unanswered) response was light-hearted, but it raises a serious point. If Rayner believes that "God is calling me to work towards the introduction of soft-drink taxes in this country", what are the chances of him changing his mind in the face of the evidence? What are the chances of him conducting research that is likely to challenge his belief?

Isn't divine intervention a greater bias than that of someone who receives a consultancy fee from a seller of lemonade? The recipient of a grant from Big Soda can always look elsewhere for work. What is the true believer to do?

A religious belief such as this might seem an extreme example, but other deeply held political, economic or moral ideologies can be just as strong.

I am not, of course, suggesting that researchers be required to list their beliefs as conflicts of interest, nor am I suggesting than Mike Rayner's published research has been corrupted by Big Christianity. The point is that there are biases on all sides of the fence and science exists for us to get beyond the biases to the truth. If you think that research is flawed, prove it. If you think that misconduct has taken place, prosecute it. But don't bar thousands of people from presenting evidence just because you don't like what you think they might say.


UPDATE

Just seen this blog post which makes a similar point. 

An ad hominem attack is typically utilized to compensate for weak evidence behind a proposition someone is trying to advance. It is an obnoxious distraction. The real need is for integrity in research, acknowledging all sources of bias, and addressing inevitable biases through scientific rigor, not ad hominem fallacies.

It’s hard to imagine a worse idea than discouraging public health and nutrition experts from offering their best advice to companies who make the food we eat. But ad hominem attacks on those who do so might have just that effect.

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Obesity charlatans

From the BBC...

Can anti-smoking tactics solve obesity crisis?

New guidelines from the National Obesity Forum suggest using "harder hitting" anti-obesity campaigns, akin to anti-tobacco campaigns, in the UK.

The National Obesity Forum is a tiny single-issue pressure group. It has no authority to produce "guidelines" or anything else. It is a pharma-funded lobby group that has managed to provoke the bovine British media into proclaiming that the obesity 'epidemic' is worse than expected.

As the excellent BBC Radio 4 programme More or Less pointed out yesterday, this is a lie. An egregious lie. A complete lie. A deliberate and premeditated lie. (It didn't use those words exactly.)

Asked by More or Less for evidence of a worsening obesity, Tam Fry, chief spokesman for the National Obesity Forum, said:

"We have no actual statistics and figures"

So why claim that 'obesity is worse than expected'?

"A little exaggeration forces the message home"

That's all it takes to make front page news in Britain in 2014—"a little exaggeration".

If there was any integrity left in the UK media, these charlatans would never be allowed on the air again. And yet their lies suit the BBC's longstanding agenda of making eating the new smoking and so it warrants a special article in the specious 'magazine' section. Even a pasting by More or Less—one of the few BBC shows that justifies the license fee—is not enough to halt the bandwagon.

The in-your-face smoking campaigns of the past, [president emeritus of the Hastings Institute, Dan Gilmore] says, effectively convinced people both that their actions bothered others and posed grave danger to themselves.

When it comes to obesity, he says, "the public has not as thoroughly been terrorised [sic]."

What a charming message. If only we could terrorise more people, what a wonderful world it would be.

Any smokers reading this will know exactly what fatties can expect in the years to come by way of stigmatisation and 'denormalisation' (or, if you prefer, terrorism). There's no point lingering on the blatant evidence of the slippery-slope in this article and its headline. If you can't see by now that the same hateful tactics used against smokers are being deployed against consumers of salt, sugar, fat and alcohol then I'm afraid that you are an idiot.

Whether idiot or not, please make sure you listen to the More or Less item in full. It is a voice of reason in a desert of hysteria. It's a shame that the BBC doesn't ask the More or Less team to fact-check every news story *before* they report it. Sadly, I doubt the BBC News crew care about the truth.

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Scraping for barrel for plain packaging evidence

Once Australia launched plain packaging and the rest of the world, er, didn't, it was only a matter of time before the avalanche of tenuous, policy-driven junk science descended. Two studies published this week add to the feeble literature without addressing the question of whether plain packaging is doing what it is supposed to do (ie. reduce the smoking rate and deter minors from starting).

Dick Puddlecote has written a pretty thorough critique of the first effort, the conclusion of which was that plain packs have inspired smokers in New South Wales to call the Quitline en masse. The authors make no attempt to disguise the fact that their study is designed to encourage gullible politicians in other countries to emulate Australia's folly...

We found a significant increase in the number of calls to Quitline coinciding with the introduction of mandatory plain packaging of tobacco after other known confounders had been taken into account. Australia has taken a lead on mandating plain packaging, now supported by evidence of an immediate impact of this legislation. This should encourage other countries that are preparing similar legislation.

The reality is much less impressive. The graph below shows the weekly number of calls to the Quitline before and after plain packaging:

Clearly, the number of calls to the Quitline vary considerably over time. There is a spike in mid-2012 (for reasons I can't explain) followed by a spike when plain packaging was rolled out, and another spike when tobacco taxes rose in 2013. Calls to quitlines frequently do rise temporarily when changes are made to packaging and pricing so this is no great surprise. Moreover, the Quitline number is prominently advertised on the new packs. Nevertheless, the plain packs spike is no greater than you would expect from a mere rotation of the warnings or a new anti-smoking campaign on TV. Bringing in plain packaging is a hell of a lot of effort to go to for such a brief and modest outcome.

A few hundred extra people calling a phone number (in a state with a population of seven million) is not particularly newsworthy. We know that quitlines of this sort are a wildly expensive and inefficient way of helping people to quit and that their success rate is woeful. There was a similar spike in 2006 when graphic warnings were introduced (see below), but we now know that the effect of graphic warnings on smoking rates is "negligible".

And look at the numbers involved in both these graphs! When graphic warnings were introduced, the number of weekly calls to the Quitline hit 3,000 and regularly stayed above the 1,000 mark. By the time plain packaging came about, numbers peaked at 800 and were lingering around the 400-500 mark both before and afterwards. (There was a small drop in the number of smokers between 2006 and 2012, and therefore fewer potential customers for the Quitline, but nowhere near enough to explain why so few people were calling the Quitline by the time plain packs came in.)

In short, graphic warnings—which have a negligible effect on smoking rates—inspired many more people to call the Quitline than did plain packaging. If plain packaging cannot replicate even that modest outcome, the chances of it having any meaningful impact on smoking rates are very small indeed.

The second study, published today in Addiction, is even weaker. In this effort, a team led by longstanding plain pack campaigner Melanie Wakefield, hung around outside bars spying on monitoring smokers before and after the legislation came into effect. Their conclusion is that smokers tend to hide their packs a bit more since plain packs came in. And I do mean a bit more...

The proportion of packs oriented face-up declined from 85.4% of fully-branded packs pre-PP to 73.6% of plain packs post-PP (IRR=0.87, 95% CI=0.79-0.95, p=.002).

It's always amusing to see confidence intervals inserted into crude surveys to give the appearance of scientific rigour, but it should be clear that the difference between 85% of smokers placing their packs face up against 74% is utterly trivial. (I hesitate to assume that the authors believe that people start smoking because they see the front of cigarette packs on tables in bars, but the sky is the limit when dealing with anti-smoking nuts.)

The authors claim that there was a 15% decline in the number of cigarette packs seen on tables outside bars after plain packs came in. Of course, if smokers are concealing their packs in pockets and bags, the authors can't always know whether they are smokers. This is a bit of a methodological problem, to say the least, but the press release nevertheless makes the following remarkable claim...

[The researchers] found that pack display on tables declined by 15% after plain packaging, which was mostly due to a 23% decline in the percentage of patrons who were observed smoking.

The first part of this sentence is roughly believable. It's possible that a few smokers would keep the new packs out of sight or put their cigarettes in cases (the researchers find a three-fold increase in the use of cigarette cases).

The second part—that the number of people smoking fell by 23%—is simply impossible to believe. If the smoking rate has fallen by 23% in Australia since plain packs came in, I will retract everything I've ever said about this ridiculous policy. But it hasn't. It doesn't seem to have dropped at all.

So, while it would make sense to see fewer cigarette packs lying around when there are fewer smokers present, that is all the researchers have observed. I can't explain why they saw fewer smokers in their second survey, but it sure as hell ain't because their numbers fell by 23% or even 2.3%. Something is badly at fault with the methodology here that renders the observations about the number of packs seen on tables meaningless.

All of this is irrelevant flim flam in any case. Surely enough time has passed for us to see some real data. Was there a big drop in the number of young people taking up smoking in 2013? Was there an unusually large decline in the overall smoking rate in 2013? These are the real questions but, via Mr Puddlecote, I see that these questions are being scrupulously avoided.

A global study out today has found that after decades of declining, Australia’s rate of smoking has plateaued, and even increased slightly among women. There are almost 3 million smokers in Australia and between them they puff on 21 billion — yes, billion — cigarettes a year.

That’s the most recent data available, and it goes up to the end of 2012. As to whether the world’s first laws mandating the plain packaging of cigarettes have worked (they started in December 2012), those who have the data won’t release it. It’s a public policy secret.

A barrage of policy-based pseudo-science is being used to obscure us from the facts of what has really happened in Australia. Eventually, the truth will out. In the meantime, if you want to get an idea of what the real impact of plain packs has been, consider this...

Victoria has declared war on illegal cigarettes, with fines quadrupled for any retailers caught selling dodgy smokes.

The unprecedented crackdown comes as authorities begin destroying a record haul of 71 tonnes of illegal tobacco and 80 million cigarettes, seized on arrival in Melbourne by ship.

Health Minister David Davis will today announce the huge rise in fines for retailers caught with chop chop, counterfeit or contraband tobacco or cigarettes.

The new penalties, expected to be in place later this year, will see individuals facing fines of $34,600 and businesses $173,200.

Now, why would the government need to be doing this if everything was fine and dandy in the brave new world of plain packaging?

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Private doubts about minimum pricing

"It's only a model"

There's an interesting article in the European Journal of Public Health in which academics, politicians, civil servants, campaigners and industry bods speak anonymously about minimum pricing. Specifically, they talk about the Sheffield minimum pricing model and its role in policy-making. It's clear that many of them realise that the Sheffield 'evidence' is only a model and that models are less reliable than traditional (ie. hard) evidence. These doubts were not always communicated to the public (to put it mildly) and campaigners/academics were torn between being frank about the state of the evidence and wanting to persuade politicians to take the policy forward.

Many interviewees expressed the view that modelling, while helpful, was imperfect and subordinate to other forms of academic knowledge. There, therefore, appears to be an important distinction made between what might be considered more conventional forms of evidence (such as trials and evaluations) from the type of econometric modelling exemplified by the Sheffield study. The somewhat ambiguous status of modelling studies led to active discussion among some actors more familiar with more frequently used forms of public health evidence, such as epidemiological studies and evaluations. On some occasions, this led to a tension for public health professionals between maintaining a commitment to being ‘evidence-based’ (as underpinned by studies of effectiveness of public health interventions) and their responsibility as public health advocates.

Do read the whole article if you have time. If not, here's a few choice quotes...

Academic: When politicians and journalists ask you for your opinions, ‘well maybe they really want to hear my opinions’ and I did get a bit carried away and felt that I had been unfaithful to my scientific training because I suddenly felt that I really did believe that minimum unit price was going to be a good thing. Whereas to be honest, we don’t know. We don’t know. We’ve got models. Sheffield modelling etc, all the taxation stuff but we don’t know. And we don’t know what’s gonna happen to the very heavy, heavily dependent drinkers. We actually don’t know and there may be some pluses and minuses.

Academic: (Laughs). Well I like the little platitude of ‘do you believe the weather forecast? That’s modelling’. You take data, you use it, you try to make your best guess based on the relationships and trends you can see. You try to make the best predictions from that. I’m in sympathy with people who say ‘it’s just modelling’. And therefore I think the only answer can come from running the experiment and the Scottish government has been very courageous to run the experiment.

Academic: I do sometimes think that perhaps a little too much certainty is place on the results of the modelling. So when you look at a lot of the discourse from supporters of minimum pricing in Scotland where they talk about the policy leading to X number of saved lives in year one or fewer admissions or whatever, you know, it’s worth kind of bearing in mind that there’s a huge amount of uncertainty around those estimates. I don’t expect ministers to say you know 40 fewer deaths plus or minus 35 but it would be nice to have some acknowledgement that this is based on model estimates without it coming over as this will definitely happen because I think it leaves you open to possible criticism if it doesn’t happen.

My own frustration with the minimum pricing debate was never about the Sheffield group building a model—which is a perfectly valid thing to do, whatever its flaws—but with the almost religious faith that campaigners, politicians and the media put in it. Its estimates were cited with ludicrous precision (eg. "a minimum unit price of alcohol of 50p will annually save 3,393 lives and reduce hospital admissions by 97,900") as if they were proven historical facts—as if there were no doubt. It's a relief to know that behind the scenes, there was a good deal of healthy scepticism.

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The thin end of the wedge? Yes.

The BBC has run a little article asking various people "how to curb obesity". Predictably enough, the British Medical Association wants to reach for the statute book:

Prof Sheila Hollins, chairwoman of the British Medical Association's Board of Science, says a complete ban on advertising junk food would make a real difference.

"Environmental factors, including the promotion of unhealthy food and poor infrastructure for active means of travel, have had a negative impact on people's eating habits and activity levels and have exacerbated the UK's obesity problem.

"With an alarming rise in the levels of obesity among children, the BMA is urging the government to introduce a complete ban on the advertising and marketing of unhealthy foodstuffs".

This is all very strange because I seem to recall them promising us that there would be no "slippery slope" that led from banning tobacco advertising to banning advertising of other products. In 1985, for example, the BMA published a pamphlet calling for a complete ban on tobacco advertising, which explicitly described the slippery slope argument as a "deception":

The 'thin end of the wedge...'?

A further deception is the industry's appeal: "Where will they stop?" The industry argues that if advertising is stopped because tobacco is dangerous, then advertising for cars, motor cycles, alcohol, sugar, aircraft travel and any other potentially dangerous product could also be banned.

All of these products can endanger health, but they are dangerous only when abused. Tobacco is the only advertised product which is hazardous when used as intended.

With the BMA now demanding a total advertising ban not only on alcohol but also on a whole range of food, the author of this document must be feeling like a bit of a chump today.

So who was this propagandising plonker writing for the BMA back in 1985? Step forward, veteran prohibitionist "Simple" Simon Chapman...

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More obesity babble

The Daily Mail: It's worse than you feared

The headline above, and many others like it, are a result of the National Obesity Forum launching National Obesity Awareness Week. They provide no data and no evidence to back up their claim that things are worse than expected. Indeed, the ridiculous projections could hardly be any worse, with the Foresight report predicting that half of British adults would be obese by 2050 and a Lancet report claiming that half of British adults would be obese by 2030. Both of these forecasts are based on absurd methodologies that would, if taken to their logical conclusion, predict that 120 per cent of British adults will be obese by 2150.

The fact of the matter is that the models these predictions are based on (why does it always come back to models?) have already started to fall apart in the few years since they were created as the obesity 'epidemic' conspicuously fails to get worse. As I told Spectator blogs earlier today:

‘We are not seeing an “exponential” rise in obesity, as the National Obesity Forum claims. On the contrary, obesity rose sharply in the 1980s and 1990s but has risen at a much slower pace since 2001 and childhood obesity is in decline. Obesity predictions are based on the bone-headed assumption that the late twentieth century rise will continue at the same rate indefinitely. Even if this were not a ridiculous methodology, any honest attempt to predict obesity rates would accept that the slower recent trend indicates that the likely scenario is better, not worse, than previously thought.’

The UK Health Forum has put out a press release saying something similar, albeit in more guarded terms. I recommend reading Rob Lyons' evidence-based demolition of this scare story at Spiked if you want to hear the truth. Don't trust the newspapers and certainly don't trust the National Obesity Forum.

(Read this old post for a brief history of appalling obesity predictions.)

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Stanton Glantz's testable hypothesis

Stan Glantz: "...and then you subtract the number you first thought of."

 
Dear old Stanton Glantz has written a post about what works in tobacco control in which he makes some very clear claims and predictions:

Smokefree workplaces reduce cigarette consumption by 29%.

Strong graphic warning labels would reduce smoking by 16%.

He provides policy-driven junk science peer-reviewed evidence for both of these claims, but the real test of science is whether it stands up in the real world. They don't have graphic warnings in the US (hence Stan saying they would reduce smoking), so he can cling onto the idea that they have a non-trivial effect on smoking rates (despite all the evidence from places that do have them that they don't).

However, we do have graphic warnings in the UK. We've had them since 2008. We've also had one of the world's most draconian smoking bans since 2007. So we can test the hypothesis. Not only do we have a policy that supposedly reduces cigarette consumption by 29%, we've also got a policy that supposedly reduces the smoking rate by 16%.

Stan has therefore given us a testable hypothesis. Let's do him a massive favour by ignoring the supposed effect of the smoking ban (because I don't have the cigarette consumption figures to hand) and instead focus on the graphic warnings. In 2007, the smoking rate was 21%. If graphic warnings reduce smoking rates by 16%, as the mechanical engineer claims, the smoking rate should have fallen to 17.6% by now.

But what actually happened? As I say, smoking prevalence rate in 2007 was 21% and had been falling at a rate of just under one percentage point per year since 2000. If it kept going at the same rate, it would be about 17% by 2011. Instead, we had a wave of anti-smoking measures, not just the smoking ban and the graphic warnings, but also the graphic adverts, the massive 'investment' in NRT-based smoking-cessation services and the age of legal purchase rising from 16 to 18. According to Glantz, just one of these measures (graphic warnings) would have been enough to make the smoking rate fall to approximately 17.6%.

In fact, the rate stayed at 21% in 2008. In 2009, it was still at 21%. In 2010, it fell to 20%. In 2011, when the most recent data were available, it was still 20% (data from the ONS).

In other words, the slew of anti-smoking policies introduced in the UK between 2007 and 2011 had much less effect than Glantz claims will result from just one of them. The decline in smoking prevalence in that time has been just one percentage point, which is less than one would expect from the long-term trend, ie. from doing nothing.

This flattening out of smoking prevalence might surprise someone who is steeped in anti-smoking dogma, but there is a very simple explanation. Smokers don't smoke because they like the packaging and haven't noticed the warnings. People who don't understand why people smoke will never be able to deter people from doing so. Whenever the predictions of the neo-prohibitionists can be tested against the facts in the real world, they are shown to have been a failure.

The reluctance of politicians to test the promises of anti-smoking campaigners by retrospectively assessing the results is the primary reason why this fraudulent bandwagon continues to roll on. Doubtless there are people in the USA who believe that graphic warnings will reduce the smoking rate by 16 per cent or some other unlikely proportion*, just as there are people in the UK who believe that plain packaging will reduce the smoking rate. It's the same old tune played on the same old fiddle. And what a fiddle the whole thing is.


UPDATE

Although not yet available to the general public, soon-to-be released data from the Office for National Statistics show that the smoking rate rose slightly in 2012, standing at 20.5%. In other words, smoking prevalence has fallen by just 0.5% since 2007. Great success!

If tobacco control was a results-driven business—or if politicians made the slightest effort to compare the promises made by anti-smoking campaigners with what actually happens to smoking rates—the whole racket would be broken up and the 'public health professionals' would be tarred and feathered.

(The graph above comes from Public Health England in a response to another consultation on plain packaging. That's right, the government is lobbying itself once again. Thanks to Tobacco Tacticss for the tip.)


* The study Glantz cites for the 16% claim is from the campaigners' comic Tobacco Control. The authors note that their estimate "is 33–53 times larger than FDA’s estimates of a 0.088 percentage point reduction". 0.088 percentage points is far too small to show up in the data. The authors claim that the FDA's estimate was "flawed".

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The Mail and e-cigarettes

The Mail on Sunday asks a sensible question:

Now doctors say e-cigarettes do help you quit - and could save millions of lives... so why are petty bureaucrats intent on banning them from public places?

 
Gee, I don't know. Maybe "petty bureaucrats" have been reading the Mail on Sunday and the Daily Mail?

3 September 2012
Electronic cigarettes 'could damage your lungs' as they cause less oxygen to be absorbed by the blood

30 December 2012
Electronic cigarettes 'DON'T help fight addiction and cause harm to health'

27 January 2013 
E-cigarettes 'can cause more harm than smoking', experts say (click on the link to read a classic Mail on Sunday apology)

26 August 2013
E-cigarettes contain chemicals that make some 'as harmful as normal tobacco'

6 September 2013
E-cigarette use by teenagers DOUBLES in a year as kids get hooked on 'safer' smoking

11 October 2013
New fears as wave of smokers are now using E-cigarettes to smoke marijuana in public

21 October 2013
Restaurants' dilemma as diners annoy non-smokers by firing up e-cigarettes at the table

27 November 2013
Children being encouraged to smoke e-cigarettes by 'celebrity culture and excessive online advertising'

After two years of scare-mongering, today's article suggests that the Mail newspapers may be coming to their senses. It ends by quoting a GP who says: "While doctors recognise the size of the health gain, most don't know a lot about them." To which, the Mail on Sunday adds:

One can only hope the policy-makers are quicker to catch up.

Quite so. Let's hope this isn't only a temporary conversion and that the Mail directs its endless anger towards the enemies of e-cigarettes from now on.

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Action on Sugar

This week saw Consensus Action on Salt and Health (CASH) morph into Action on Sugar. Perhaps this was a recognition that the panic over salt "has little basis in science" and the real money now lies in the anti-sugar crusade. In a few years they will be called Action on Cheese.

CASH's abrupt change of direction has meant that we have been able to watch campaigners switch between bandwagons in real time. The screenshot below shows the CASH website at that awkward halfway house between the salt shaker and the sugar bowl

Fortunately for Action on Sugar, their new enemy is also a white crystal so they can keep most of their images. All they need is a web designer to delete the word 'salt' and replace it with 'sugar'.

As I mentioned on Wednesday, Action on Sugar got proceedings underway with a frenzied media blitz that revolved around their claim that "sugar is the new tobacco". Within 24 hours, scientists were lining up to criticise this absurd hyperbole—calling it "nuts", "inaccurate" and "quite crazy"—but the damage had been done and Aseem Malhotra (for it is he) had got his smug little face on television countless times.

Malhotra is Action on Sugar's Science Director. Says it all, really. As Slipp Digby notes in a must-read post that fisks the group's erroneous claims, "appointing him as Science Director when he has no experience in the field and has published no research is a really bad idea."

It has been less than three years since Malhotra burst onto the scene. I had him down as a know-nothing wannabe celebrity on the make from his very first Observer articles. He made incredible schoolboy errors on very basic facts from the outset, although it is interesting to note that his early articles about Big Food did not mention sugar and his ideas appeared to have evolved by reading sensationalist anti-sugar books and becoming a disciple of Robert Lustig.

Lustig's theories focus on High Fructose Corn Syrup, which he thinks is the primary cause of obesity in the USA. This has no relevance to the UK because there is hardly any High Fructose Corn Syrup in the EU (as usual, Malhotra seems to be unaware of this fact). Lustig might have a point or he might not, but at least he is a scientist who has put forward a testable hypothesis. Malhotra is not a scientist, he is a medic, and whilst that is enough for him to play the 'trust me, I'm a doctor' card, he is a prime example of why trusting medics on issues that are outside their immediate field of competence ends in tears.

If you don't believe me, take a look at this interview with him on Sky News this week.



Let's leave aside his usual claim that sugar has "no nutritional value whatsoever". People don't drink Coca-Cola because they think it's nutritious, they drink it because they like it. Let's also leave aside his claim that "poor diet is responsible for more disease than smoking, alcohol and physical inactivity combined" because I've written about that little fib before.

Instead, let's look at this nugget:

"Even if you are of normal weight and you have excess sugar in your diet, and you exercise, you are still increasing your risk potentially of getting Type 2 diabetes".

What Malhotra has done here is mangle the results from a controversial and tentative study by Robert Lustig (there's a good discussion about it here) that found that sugar availability correlates with diabetes. That is not terribly surprising, perhaps, and it is even less surprising that obesity correlates with diabetes.

The obvious explanation for both these findings is that excessive sugar consumption can lead to obesity and obesity can lead to diabetes. However, Lustig suggests that sugar consumption may have an effect on diabetes that is independent of its effect on obesity. In other words, he hypothesises that sugar consumption adds to diabetes risk of being obese. Whilst that is not impossible, the evidence he has presented so far is far from compelling.  That's only my opinion, but it also happens to be the opinion of Diabetes UK, who put out a statement in response to Action on Sugar's media blitz.

“... it is important to be clear that we want to reduce sugar consumption because having too much can easily lead to weight gain, as is true with foods high in fat. So reducing the amount of sugar in our diets is not all that we need to do to reduce our risk of Type 2 diabetes.

"The evidence that sugar has a specific further role in causing Type 2 diabetes, other than by increasing our weight, is not clear. We look forward to the conclusions of the Scientific Advisory Committee on Nutrition, which is due to report this year.”

Malhotra presents Lustig's theory as if it were proven fact and then further embellishes it by asserting that slim, physically active people are at greater risk of developing diabetes if they consume sugar. This goes beyond even Lustig's theory and enters the realm of outright quackery.

And then there is this gob-smacking comment...

"Intrinsic sugars within food like fruit and vegetables: not a problem, that's glucose. But what added sugar has is fructose and that is completely unnecessary in your diet."

Malhotra has fallen for the naturalistic fallacy, implying that "intrinsic sugars" are healthy because they are "natural" whereas added sugars are not. In fact, there is no reason to think that 200 calories from a smoothie are any less fattening than 200 calories from a Coke.

More incredibly, Malhotra thinks that glucose is the main sugar in fruit. Of course it isn't. Fructose is the main "intrinsic" sugar in most fruit (and some vegetables), hence the word fructose.

This howler of Malhotra's is equivalent to a temperance campaigner thinking that beer is stronger than whisky. It is like an anti-smoking campaigner not knowing the difference between a pipe and a cigarette. It does not bode well for Action on Sugar that their Science Director doesn't have even a GCSE-level understanding of the subject about which he claims to be an expert.

I foresee entertaining times ahead.

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