Monday 13 January 2014

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.


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".


Vova said...

This is why 'public health' research is such an attractive and rewarding occupation. You can spout any old rubbish as long as it's the party line, and no matter how wrong you are you probably won't be called on it - if you are you can rely on your colleagues to rubbish the critic.

Anonymous said...

He's a bit chubby, isn't he. Someone should tax something he likes.. if only for the children.

Rursus said...

To tax something he likes: Witless!

As far as I know: His Bankaccount is more than "chubby".

FXR said...

The figures get much more damning when you move from statistical percentages in adult populations, to actual numbers of smokers.

Glanz and his bag of tricks disguised the truth by starting out talking about percentage of population and later moving to a percentage of adults, providing an illusion that smoking had declined significantly in response to taxation and smoking bans, when they actually remained pretty well unchanged.

No change in respect to total of smokers, within only one numeric perspective, is in fact progress on their part, because the population is not static, it is rising every year.

Holding the line on percentage of population however indicated more people were smoking in real numbers and for the anti-smoker movement that spells failure. Something not easily discussed with so many living in denial, that what they have been doing for the past half century, could be a waste of time and money. Which could have been used in more legitimate risk reductions. With no need to promote hatred or caste designations. in victim bashing ad campaigns [to protect all the big business interests at the table where smokers are forbidden to speak].

Risk reductions by the scientific method. Resulting from the only thing that will ever reduce a risk.

Cures. [something else lost in the fast shuffle]