Friday, 27 February 2015

WHO do they think they are?

Since it's Friday, let's have a bit of good news for a change...

Pressure mounts on WHO chief over Ebola

World Health Organization (WHO) chief Margaret Chan must resign over the group's inefficient response to the recent Ebola crisis, the largest global AIDS organization said.

In a scathing statement released this week, Los Angeles-based AIDS Healthcare Foundation (AHF) called for sweeping reforms to the WHO to better prevent and manage dangerous epidemics.

"In light of WHO's lack of leadership, decisive action and resolve to embrace responsibility for the protection of global public health in the Ebola crisis, the current Head of WHO should step down so that a proactive, reform-minded individual might take the lead and transform WHO into an efficient global instrument for rapidly addressing global health threats," AHF said.

You may recall that when the Ebola epidemic was at its height, Margaret Chan couldn't even give a speech about it because she was "fully occupied" in Moscow trying to get e-cigarettes banned. Instead, she put out a statement which strongly, and falsely, implied that she was busy dealing with Ebola.

Chan's holiday in Russia perfectly illustrates the problem with the WHO today. It is so obsessed with micromanaging the lifestyles of rich westerners that it is unable to carry out the job that it was set up to do, ie. tackle infectious disease in poor countries.

Hyperbole? Not really...

Cut music to 'an hour a day' - WHO

People should listen to music for no more than one hour a day to protect their hearing, the World Health Organization suggests.

And then there's the WHO's war on confectionery.

Sack her.

Sugar sales (still) falling

From the BBC:

Researchers from Action on Sugar are calling for strict limits on added sugars. 

They argue that as the body can generate energy from food such as fruits, vegetables, pasta and rice, there is no need for additional sugar beyond this.

That is the very essence of puritanism, right there. That people should be given—as Cromwell said—“not what they want but what is good for them.”

Meanwhile, Action on Sugar have been getting excited by this:

UK sugar sales drop by 14%

Sales dropped by £298m ($338m) in 2014 and coincided with findings that nearly half of British customers had shied away from sugar that week.

The anti-sugar cranks deny all the evidence that sugar sales have been falling for decades, so I don't know why they believe this latest piece of evidence.

I'm being disingenuous. They believe it because they can take the credit for it, having spent a year creating hysteria about sugar being the new tobacco.

A drop of 14% in a year is a pretty big deal and it tells you something very important. It tells you that if people want to reduce the amount of sugar they eat, they can easily do so. They don't need meddlesome legislation.

Thursday, 26 February 2015

Outdoor smoking bans (again)

That revolting individual, Lord Darzi, is calling for a ban on smoking outdoors again. In the British Medical Journal, Darzi and Simon Chapman are playing a game of good cop/bad cop, with the latter assuming the role of a half-decent human being by opposing the policy.

...some have invoked the virtues of shielding children from the sight of smoking as worthy evidence in this debate. They may concede that smoking in wide open spaces such as parks and beaches poses a near homeopathic level of risk to others, but they point to an indirect negative effect from the mere sight of smoking. This line of reasoning is pernicious and is redolent of totalitarian regimes in their penchants for repressing various liberties, communication, and cultural expression not sanctioned by the state. North Korea’s residents are routinely subjected to such fiats, but many of us would recoil at the use of such reasoning elsewhere.

Totalitarian is the word. The idea that individuals should pretend to be something they are not in order to fulfill the state's vision of a virtuous country is deeply sinister. That they should do on pain of arrest is frankly fascistic.

I have nothing to add to what I said about this last year so, if you're interested, read that.

It hardly needs to be said that smokers, like nonsmokers, have never volunteered to be role models for other people's children. The claim that adult activity should be criminalised if it can be witnessed by minors does not have to be taken to its logical extreme for it to be exposed as absurd and totalitarian. It is plainly not a serious argument. And yet, if I did feel the need to act as a role model to children, I would, first and foremost, impress upon them the importance of ignoring and despising unjust laws. I would hope to teach them that there is, in any society, a minority of bigots who resent liberal values and who will do whatever they can to impose their own lifestyles upon them. If flouting a draconian law will help a child realise that the state is not its friend, then I will cheerfully light a cigarette in any street or park.

Wednesday, 25 February 2015

The future of pubs (if CAMRA keeps winning)

I gave a speech at the Future Pubs conference yesterday. This is what I said...

I’ve been asked today to give you my predictions of what the pub industry might look like in 2020. There are, I think, two realistic possibilities. The mundane view is that the trade will be pretty similar to what it is now, but with even fewer pubs. I would expect to see the rate of closures to slow down, but under any realistic scenario I wouldn’t expect to see the number of pubs grow. In only 3 of the last 35 years has there been an increase in the number of pubs, and only a modest increase at that, and all three of those years were in the twentieth century. The recession has, I’m sure, played a part in the decimation of the pub trade in the last eight years, but that doesn’t mean that recovery will lead to the growth in the sector. For the last couple of generations, pubs have closed during recessions and they have continue to close, albeit in smaller numbers, during booms.

The mundane view may also be the optimistic view. A less optimistic view is that, if the pub preservation movement continues to win victories in parliament, the pub industry will be well on its way to something like nationalisation by 2020.

What I call the pub preservation movement is the alliance of groups like The Campaign for Real Ale (CAMRA), Save the Pub, Fair Deal for Your Local and the All Party Parliamentary Save the Pub Group. The best that can be said about these groups is, perhaps, that they mean well. It pains me to criticise them because, on the face of it, we have a lot in common. They like beer, they like pubs, they want to see the pub industry prosper and grow. So do I. The fundamental difference is that whereas they see the government as the solution to the trade’s problems, I see it as the cause.

The pub preservers’ faith in government has led to what is, in my view, one of the most self-defeating and counter-productive political agitation in living memory. If we one day discover that the Campaign for Real Ale has been secretly controlled by the temperance movement for years, would we really be surprised?

For years, the Great Satan was the big brewers. CAMRA lobbied for—and virtually wrote—the Beer Orders which smashed the tied house system. Quite predictably, PubCos arrived to take their place, and now it is the PubCos who are the Great Satan and the big brewers who have been partially rehabilitated in the public imagination as ‘family brewers’ who supported something called ‘community pubs’. This kind of historical revisionism and rose-tinted nostalgia is an abiding characteristic of the pub preservation movement.

I have no interest in defending the PubCos. In many cases, they have run their businesses badly - as evidenced by the colossal debt that most of them are in and the fact that they have been selling off large parts of their estate. They have been hopeless when it comes to defending the interests of their customers on issues like minimum pricing and the smoking ban. If I were a publican, I think I would prefer to run a freehouse.

However, this does not mean that I think PubCos are evil or are determined to demolish every pub in the country, which appears to be the view of the pub preservers. You need to assume fiendish motives to able to predict how a business will react to ill-thought out regulation and perverse incentives.

This is how I think events will unfold.

Phase one: Market rent only

Parliament has decided - rightly or wrongly - that it is unfair for PubCos to be monopsony sellers who charge tenants more than the market price for alcohol. Essentially, it has decided that the PubCo quasi-franchise model is exploitative. And so it is giving tenants the legal right to buy their alcohol from wherever they like. It is easy to predict that most tenants will take advantage of this and buy their beer on the open market. And it is also easy to predict how the PubCos will respond. They will make up for the loss of wet rent by increasing the dry rent.

Phase two: Rent assessment

But the pub preservers can see this coming and they are one step ahead. They have pushed the government into bringing in a system of arbitration to decide what the 'market rent' is. Of course, we know what the market rent is. It is whatever the tenant and landlord agree upon. CAMRA et al. don’t really mean ‘market rent’. They mean a ‘fair’ rent, as interpreted by themselves.

Incredibly, this rent must not only be ‘fair’ - whatever that means - but it must be set at a rate that leaves the PubCo tenant ‘no worse off’ than the equivalent free-of-tie tenant.

This is legislation that could only be drawn up by politicians who have never worked in business. It applies to a fictional world where people and buildings are homogenous, identical units, the value of which can be objectively calculated by a bureaucrat. It is fantasy economics. The idea that the government can adjust the price of one overhead so that one publican is no worse off than a completely different publican is ludicrous.

A surveyor could only make such an evaluation if there was an identical pub run by identical publican to use as a comparison and, of course, there never is. It is highly unlikely that there would be a free-of-tie pub that was even remotely comparable, but even if there was, the surveyor wouldn’t have access to the books to see how much its rent and overheads cost.

Aside from being inherently impractical, this system of rent assessment will lead to horrendous market distortions. Its absurdity was exposed when the government admitted that an adjudicator might demand a tenant be charged no rent at all in order to be made him ‘no worse off’ than a free-of-tie tenant. The message is 'run your pub worse than the pub over the road and you pay a lower rent. Run it into the ground and you pay no rent.' It is economic insanity.

In practice, we must hope that surveyors exhibit more common sense than politicians when they are called in to deal with rent disputes. What we can be sure of is there will be plenty of disputes. Inevitably, many tenants will choose to go free of tie and, equally inevitably, PubCos will increase the rent when they do. Faced with a higher rent, the tenant will realise that the Save the Pub group hasn’t given him a free lunch after all and will move on to phase two and demand a rent assessment. Why wouldn’t he? It’s the PubCos who have to pay for it.

And so either the adjudicator will agree with the PubCo that the rent should be higher, in which case the tenant will face much the same costs as before, or he will decide that the PubCo isn't allowed to charge what the PubCo feels it needs to charge, in which case the PubCo has a fairly easy decision to make. The government has decided that it is no longer in the pub business, it is in the commercial property business. So the PubCo decides it’s going to rent the property to somebody else, but not as a pub, or it decides to sell the property, in which case it may or may not be bought by someone who wants to run it as a pub.

The best case scenario for drinkers is that these pubs are bought by independent publicans who keep it as a going concern. One does not need to read between the lines too much to work out that CAMRA’s real agenda is to force PubCos into selling off their estates to rosy-cheeked landlords and their ample-bosomed wives who will stock a cask of Old Thumper behind the bar and sing All Around My Hat.

If this happens, I will be happy with the ends even if I don’t approve of the means, but there are good reasons to suspect that this is not what will happen at all.

When is the last time the vast majority of Britain’s pubs were in the hands of individual operators? Certainly not in the lifetime of anyone in this room, nor in your grandparents lifetime. The tied house system is centuries old. Since the Victorian era, pubs have predominantly been owned by either brewers or PubCos. It is highly doubtful whether there are enough aspiring publicans with sufficient capital to buy a pub, particularly when beer sales are going through the floor and it is well known that the licensed trade is struggling.

Phase three: Planning restrictions

If no would-be publican can raise the money to buy the pub, the PubCo is going to sell it off to developers who will turn it into a shop or a private dwelling. But the pub preservers are once again ahead of the pack and have foreseen this unintended consequence of government action and - guess what? - they see yet more government action as the solution. They want to stop pub buildings changing their use without planning permission. Unlike the rest of their policies, this one didn’t quite make it through parliament although a second-best option has been brought in and pubs are now busy getting themselves listed as Assets of Community Value.

Pubs will flock to have themselves listed as Assets of Community Value and many will succeed. [UPDATE: In today's news, every pub in Otley has applied.] Getting this protection against a change of use is easy enough to do since it is easier for the local community to support their local pub in the abstract than it is to actually spend money in it, which is, of course, what the pub really needs.

The intention of this change to planning laws is to keep pubs on the market for long enough for an investor to come in and buy them, but although there may be exceptions, this seems to be a solution looking for a problem.

I am not convinced that the pub trade’s biggest problem is a lack of boarded up pubs standing idle up and down the country. The problem is a lack of buyers which stems from a lack of demand for pubs as they currently exist. The most likely outcome of the change to the planning laws is that pubs will stand derelict for months or years until the local community finally accepts that it is never going to bought as a pub and it would be better for everyone if it was turned into a house or shop.

Phase four?

I don’t know how many pubs will have to stand derelict before the penny drops within the pub preservation movement that the problem is a lack of demand, not a lack of supply. Perhaps the penny will never drop. Perhaps the next step will be for CAMRA et al. to lobby the government to step in where the market has supposedly failed by buying up all these ‘community pubs’ - these Assets of Community Value - and running them itself.

This is not as far-fetched as it might sound (remember the Carlisle experiment?). It would be in keeping with the big government interventionism of the pub preservers and it is not a million miles away from the proposals of the left-wing think tank, the Institute for Public Policy Research, which envisages pubs as state-subsidised post offices/internet cafes/creches/community centres. In other words, as National Heritage sites which preserve the physical building but cannot preserve the spirit of the pub, or even retain its primary purpose of serving alcoholic beverages.

Government ownership is, perhaps, the logical conclusion of a series of policies that pile intervention upon intervention to make up for government failure. If you distort the market so much that there is no market left then the only people who will be daft enough to enter the market are politicians. This is what I mean when I say that by 2020 we could be on our way to some form of nationalisation if we continue down the path of intervention.

Demand, not supply

It seems to me that the pub preservation movement has got just about everything wrong. Not just wrong, but diametrically wrong. The problem is not that PubCos are preventing people from going to the pub by closing down their premises and driving their tenants out of business. In fact, rates of closure have been about the same in the non-managed sector as in the free-of-tie sector for years and the Save the Pub group has been frankly dishonest in its manipulation of statistics to disguise this inconvenient fact. Pubs have been closing in every sector because of a fundamental lack of demand that has been largely due to government intervention.

Since 2006, the number of pubs in this country has fallen by 10,000. I estimate that around 4,000 of these have closed as a result of long-term social changes that I won’t go into here, but about which you will be familiar. That leaves 6,000 closures that cannot be explained by the secular decline.

What has happened since 2006 that can explain this dramatic increase in pub closures? I put it to you that the most likely culprits are the smoking ban, the alcohol duty escalator and the recession. The recession is now at an end, but - as I said earlier - I’m not holding my breath for a new golden age for pubs. The recession was the final nail in the coffin for many pubs, but it was not the underlying cause of the trade’s decimation. That leaves the smoking ban and alcohol duty - the first of which is extremely draconian and uncompromising by international standards, the second of which is extremely high by international standards. Almost incredibly, British drinkers pay 40 per cent of the EU’s entire alcohol tax bill.

The government could put right these wrongs tomorrow if it was genuinely committed to the pub trade. It could, and should, halve alcohol duty. It could, and should, amend the smoking ban to allow publicans to permit smoking in at least one room of their pubs.

What chance of this happening? Very little, I suspect. But it is what you would do if you were serious about reviving demand for pubs. You would look at the reasons why demand dropped off a cliff after 2006 and rectify them.

Instead, we have to endure the nauseating sight of watching MPs who voted for the smoking ban crying crocodile tears over the demise of the pub and blaming anything, including immigration, other than themselves. Instead of a united coalition campaigning for a big cut in alcohol duty, we see many publicans - and, once again, CAMRA - getting into bed with the temperance lobby to support minimum pricing—a policy that will leave even less disposable income in people’s pockets and therefore leave them less to spend in the pub.

Lest we forget, this is the same CAMRA that urged publicans in 2007 to - I quote - “prepare for a boost in demand for real ales following the banning of smoking in all pubs in England”. Now CAMRA thinks that raising the price of a can of lager from 80p to a pound will make people rush to buy a pint in a pub for four pounds. It would be funny if it weren’t so serious to those of us who want a living, breathing, thriving pub industry, rather than the mere preservation of ‘community pubs’ (whatever they are).

This, then, is my conclusion. If you believe, against all evidence and experience, that more government is the solution, then you will continue to get more government and you will get it good and hard.

Tuesday, 24 February 2015

The long tentacles of temperance

There's a 'public health' conference in Edinburgh in October on the subject of alcohol. The conference is called 'Momentum for change: research and advocacy reducing alcohol harm'. The words 'advocacy' and 'change' make it fairly clear that it is another chance for activists to swap notes and plan political campaigns. As usual, this shindig is being financed by the unwitting taxpayer, in this instance via the Scottish government and the Scottish NHS.

There is nothing surprising about this. It is the depressingly predictable way that the sock puppet state operates. But it is worth looking at one aspect of it, for it is being organised by the Global Alcohol Policy Alliance and its chairman Derek Rutherford offers some welcoming words on its website.

Derek Rutherford may be the most important temperance/public health luminary you have never heard of. His career nicely illustrates the way that the temperance lobby has merged into the 'public health' movement. Rutherford is a religious teetotaller of the old school. In an interview published in Addiction in 2012, he explained:

"In my youth I had three loves: the temperance movement; the church, because I was also an active member of the Baptist Church in Easington; and the Labour Party. They were the three organizations that I was committed to and they all came together." 

Rutherford is a trustee—and chairman of the Advisory Board—at the Institute of Alcohol Studies (IAS). Despite its academic pretensions and dispassionate-sounding name, the IAS is a temperance wolf in sheep's clothing. It was created by the now-defunct UK Temperance Alliance in 1983, of which Rutherford was a prominent member. The UK Temperance Alliance was previously known as the UK Alliance, or, to give it its full name, the United Kingdom Alliance for the Suppression in the Traffic in All Intoxicating Beverages.

The UK Alliance was formed in the 1850s to campaign for the total prohibition of alcohol. Not only did it fail, but the failure of the 18th Amendment in the US made prohibition a dirty word for generations and so it adopted the more moderate word 'temperance' in 1942. When the word 'temperance' started to sound too puritanical, it became a sort of think tank.

During its glory days, the UK Alliance bought some nice real estate in Westminster—which is still called Alliance House—and the IAS lives of its rental income along with funding from the EU. The IAS is coy about its earlier incarnations, saying only that it has "moved on from some of its original viewpoints" but the financial accounts of the Alliance House Foundation—the charity which syphons the rent from Alliance House into the IAS—still gives its objective as being “To spread the principles of total abstinence from alcoholic drinks”. In all the years I've been paying attention, the IAS has never said a good word about alcohol in any context.

In his Addiction interview, Rutherford says that he has been a "temperance man" all his life. He says he joined the International Order of Good Templars (IOGT) in the 1930s when he was 9 years old. The IOGT was also formed in the 1850s to fight for prohibition and it has also morphed into a pretend public health group which now claims to work "solely from evidence based facts". In the 1970s, it modernised slightly by calling itself the International Organisation of Good Templars. Today, it is known simply as IOGT International. I can't find details of IOGT International's funding, but its Swedish branch, IOGT-NTO, which lobbies in Brussels, receives funding from the government.

In 1990, IOGT International formed the pan-European Active Sobriety Friendship (AKA Active Europe) for young people. I've written about their extreme temperance agenda before. Despite hardly bothering with the sheep's clothing they, too, get funding from the EU.

Rutherford makes an interesting observation about how the rise of 'public health' offered opportunities for temperance men that the disease model of alcoholism did not:

"...when I entered the mainstream alcohol field in my 20s it was dominated by the disease model, the view that alcoholism comes in people, not in bottles. The decline of this view and its replacement by the public health model really meant a return to the temperance perspective I acquired very early, which always accepted that the problem is actually all to do with alcohol, and that if consumption increases then so will the level of harm. Hence the importance the movement placed on factors such as price and availability..."

As a result of this convergence of policy interests, Rutherford was able to set up the Teachers' Advisory Council on Alcohol and Drug Education (TACADE) in the 1960s at a time when "the temperance movement had a bad image" despite being an officer at the UK Alliance. He then became Director of the National Council on Alcoholism, which started getting government funding in 1972 (even he calls its a "supposedly non-governmental organisation"). The National Council on Alcoholism was replaced by the (state-funded) Alcohol Concern in 1985, but Rutherford had already walked out three years earlier after a row with the NCA's new chairman who said that he had no time for "a bunch of Methodist teetotallers". Rutherford returned to the UK Alliance where he formed the Institute of Alcohol Studies "to fight the alcohol policy cause".

In 1990, whilst International Secretary of IOGT, he co-founded Eurocare AKA the European Alcohol Policy Allaince, a neo-temperance organisation that lobbies in Brussels and which—yet again—gets funding from the EU.

Today, as an elder statesman, he is the chair of the Global Alcohol Policy Alliance which is having its annual conference paid for by the taxpayer in Edinburgh. The Global Alcohol Policy Alliance was formed in 2000 by Derek Rutherford who says that the priority is to "make the most of the opportunities provided by the development of the WHO Global Alcohol Strategy and the focus on non-communicable diseases."

The long and prolific career of Derek Rutherford tells us two things about the modern anti-alcohol movement that are not widely appreciated.

Firstly, that it remains steeped in temperance. Most people think that the temperance movement is virtually dead and that 'public health' is a different beast which just happens to have the same objectives of raising taxes, restricting licensing and banning advertising. In fact, the old temperance groups are still very much alive. They have simply changed their names or set up new organisations to pursue the same goals. This is one reason why I use quote marks around 'public health'. I refuse to accept the rebranding of moralists, religious zealots and puritans.

Secondly, the neo-temperance movement is dependent on government money. With the exception of the IAS, which has an unusual funding model, all the groups named above get money from the state in some form or another, and even the IAS gets some money from the EU. This is not unusual in public health—the majority of public health advocates get their hand in the taxpayer's pocket somewhere down the line—but it is still remarkable that an unpopular cause like gospel temperance is being kept alive by the largesse of government. Without it, the temperance movement really would be moribund because, as Rutherford says, it has vanishingly little grass-roots support:

"...the greatest tragedy is that we have not been able to create a people’s movement. We have not been able to have the grass roots marching as they did in an earlier era... We have many more professionals working in the field, but there is no popular movement"

But who needs public support when you have full-time professionals and government grants?

Monday, 23 February 2015

Some good news about sock puppets

Eric Pickles deserves a standing ovation for his latest move to stop taxpayers' money being used for political lobbying/advocacy/campaigning. His department—DCLG—is introducing a new clause into its grant agreements, saying:

“The following costs are not Eligible Expenditure:- Payments that support activity intended to influence or attempt to influence Parliament, Government or political parties, or attempting to influence the awarding or renewal of contracts and grants, or attempting to influence legislative or regulatory action”

In short, this means that local authorities cannot spend money lobbying the government. Pickles says:

"We hope this can and will be rolled out more widely across the public sector."

Amen to that.

Read more—including the full text of his statement—at the IEA lifestyle blog.

The 99 per cent

When the UK government suddenly announced that it would be pushing ahead with plain packaging last month, some people wondered why it had not waited for the results of the public consultation to be published.

The consultation has now been published...

99% say no to plain packs

Westminster is facing increasing pressure to backtrack on proposals to introduce plain tobacco packaging after an overwhelming 99% of respondents to a public consultation were opposed to the legislation.

The results of the plain pack consultation, released last Wednesday, showed the government had received 137,000 responses on the issue.

This included 136,000 campaign responses from retailers, lobby groups and unions calling for MPs not to press ahead with standardised packs.

That's that mystery solved, then.

Friday, 20 February 2015

James Reilly: liar or simpleton?

James Reilly, arguably Ireland's most fanatical anti-tobacco crusader, displayed a staggering degree of ignorance (or dishonesty) when discussing snus in a parliamentary meeting this week. The video below shows the imbecile (or liar) claiming that people in Sweden cut their gums in order to use the world's safest tobacco product.

This, of course, is sheer nonsense, as journalist Dan MacGuill says on his blog...

In case you didn’t already know, using snus does NOT involve cutting your gums. That’s a complete fiction – passed on as fact by a trained doctor, to a committee responsible for performing due diligence on Ireland’s public health legislation.

But what’s even worse about this clip is what the minister does NOT say: Sweden has by far the EU’s lowest tobacco-related mortality rates among men.

And several studies (here and here) have concluded that this is precisely because snus is legally available and prevalent there, which is not the case elsewhere on the continent.

It's never easy to say with certainty whether people in the 'public health' racket are lying or merely incompetent. The same is often true of politicians. Since Reilly is in both camps, he could either be a massive fraud or a massive idiot. Or both.

On this occasion, if Reilly knew that what he was saying was a lie, he must have expected to be called out on it, so I'm going to give him the benefit of the doubt and call him an unbelievably ignorant thicko who doesn't know the first thing about the one subject to which he has dedicated his career, rather than a conscious deceiver and fraud.

Either way, he's not a fit person to be making laws, which explains why Ireland has some of the most idiotic and counter-productive tobacco control legislation in the world. Despite having the worst problem with black market tobacco in western Europe, they've recently announced plans to introduce plain packaging. Guess who was the driving force behind the policy?

Controlling the food supply

Following on from yesterday's post about The Lancet's obesity plan, here it is in infographic form. Click to enlarge.

This is Government with a very big G. It is state control of what can be made, what it looks like, how it is sold, where it is sold and what it is sold for. The only thing the government doesn't do is make and sell the food itself (except in schools).

It is no wonder that the 'public health' model of top-down control of people and industry tends to be more popular with parties of the left than those of the right, but it is surprising that so few people on the centre-right fully recognise the 'public health' movement as the socialist enterprise that it is. After all, it is not as The Lancet tries to hide its political views.

Thursday, 19 February 2015

Does The Lancet stand by its obesity prediction?

The Lancet is blathering on about obesity again, with a special edition that combines the magazine's repulsive statism with tedious managerialism.

Let's not forget that it's only been four years since The Lancet received blanket media coverage with some back-of-a-fag-packet, evidence-free scientific, peer-reviewed predictions about how obesity would escalate. Based on data that went up to 2007, it predicted "a rise in obesity prevalence in men from 26% to 41–48% and in women from 26% to 35–43% [by 2030]."

The latest figures show that the male obesity rate is 26% and the female obesity rate is 23.8%. Awkward.

As you can see from these graphs, rates of obesity for both men and women are well below even the low end of what the Lancet predicted.

Awkward, but hardly unusual. In 2006, we were told that 33 per cent of men and 28 per cent of women would be obese by 2010. In 2007, we were told by the supposedly authoritative Foresight committee that that 36 per cent of men and 28 per cent of women would be obese by 2015. Needless to say, these forecasts were hopelessly wrong, as obesity forecasts always are. Maybe it's time to start ignoring the soothsayers of 'public health'?

What the public thinks of 'public health'

As reported towards the end of last year, ComRes conducted a large opinion poll on behalf of the IEA, asking people about their attitude towards 'public health' policies. The findings make for very interesting reading and you can see them in full in a series of blog posts on the IEA lifestyle blog. Here's a very brief summary:

71 per cent of the British adults surveyed - and 81 per cent of those who gave an opinion - believed that it should be the individual’s responsibility to make their own lifestyle choices and that the government should not interfere. This echoes the results of a 2013 Ipsos MORI poll which found that only 30 per cent of British adults agreed that ‘It is the government’s responsibility to influence people’s behaviour to encourage healthy lifestyles’. This view was largely reflected by respondents’ opposition to economic measures, including taxes and incentives, being used to encourage healthy lifestyles.

Of those who expressed an opinion, 69 per cent felt that indirect taxes were too high and 59 per cent felt that pubs should be able to accommodate smokers in a private room. Of the new ‘public health’ policies mentioned in the survey, only health warnings enjoyed majority support, perhaps because they are not perceived to impinge on freedom or impose a cost on consumers and taxpayers.

All in all, our survey found the British public to be generally liberal (in the uncorrupted sense of the word) when it came to individual lifestyle choices. They tend to prefer free choice rather than government intervention, and there is little demand for new or higher taxes on alcohol, tobacco, food and soft drinks.

Read more in these three posts...

Part one: Attitudes towards sin taxes

Part two: Attitudes towards financial incentives, health warnings and the smoking ban

Part three: Attitudes towards the nanny state by voting intention

Why is childcare so expensive?

From the BBC:

All political parties are being urged to join forces to review the UK's childcare system as another report highlights rising childcare costs.

The Family and Childcare Trust's annual survey says the average cost of a part-time nursery place for a child under two has risen 33% since 2010.

Shocking stuff. But what lies at the heart of high childcare costs in Britain today?

A further element in the expansion of government into the pre-school years is a comprehensive system of regulation of childcare providers, which has brought them into an unprecedented state-determined curriculum for under-fives. This scheme has thirteen assessment scales, each of which has nine points against which children’s development must be measured. Providers of childcare are subject to Ofsted inspection in the same way as schools for older children.
The requirement to implement this ‘early years Foundation Stage’, together with a set of demanding regulations about premises, food safety and so forth, has meant that many informal providers of childcare have simply left the market. The number of registered childminders fell from nearly 100,000 when Labour came into power in 1997 to 57,000 in 2010.

Governments. Screwing things up since time immemorial.

Wednesday, 18 February 2015

Drinking in the big towns

A study appeared in BMC Public Health last month which attempted to keep the Total Consumption Model afloat. Put simply, the Total Consumption Model (AKA Single Distribution Theory) says that the amount of alcohol-related harm in a society is directly linked to per capita alcohol consumption and, therefore, the objective of public health should be to reduce per capita alcohol consumption. It's demonstrable nonsense, but the neo-temperance lobby likes it because it can be used to justify to Whole Population Approach.

The authors looked at alcohol consumption and alcohol-related deaths in various British regions and concluded that...

We have confirmed the ecological relationship between consumption and harm; alcohol-related mortality rates are generally higher in regions with higher per adult consumption.

This claim is based on the following graph which charts alcohol consumption (horizontal) against alcohol-related mortality (vertical):

There is supposed to be a correlation here, but it is clearly very weak. Indeed, the authors note that the correlation is "r =0.59, 95% confidence interval (CI) = -0.02 to 0.89" which means that it is statistically insignificant. It is a sign of how low standards have sunk in 'public health' that the authors do not even mention statistical significance, let alone concede that their correlation doesn't pass the test. Instead, they argue that the correlation would be stronger if it wasn't for the pesky South West dragging things down on the right-hand side. They then come up with some rather desperate excuses for why this region has a high rate of alcohol consumption but about the same rate of alcohol-related mortality as London, the place with the lowest alcohol consumption. Bizarrely, they say that tourism is a "likely explanation" (ie. people from other parts of the country drinking in the West country and going home to die of liver cirrhosis). Perhaps they think that Edinburgh doesn't get tourists, or that its tourists don't buy lots of whisky to drink and/or take home with them?

All this graph really shows is that alcohol consumption and related morality is low in London and high in central Scotland (Glasgow, Edinburgh etc.). There isn't a statistically significant correlation between the two variables and there isn't even a hint of a correlation if one only looks at England. But the authors are wedded to the Total Consumption Model, so they have to treat the South West as a paradox to be explained away.

I didn't bother to write about this study when it came out because it's just another piece of trash in the vast dustbin of policy-based evidence and I am but one man. However, it came to mind again last week when the Office for National Statistics published its latest data on drinking habits. Amongst the data was this chart showing the prevalence of teetotalism in each region.

As you can see, the South West has the lowest prevalence of teetotalism in Britain. So, whilst the region drinks more than any other on a per capita basis, it does not necessarily drink more or a per drinker basis, let alone on a per problem drinker basis.

In fact, we have no idea how many problem drinkers there are in any of these regions, nor do we know how much they drink. We do have some evidence about so-called 'binge-drinking' (defined as 8 units or more in any given day for men and 6 units for women). Here it is...

This chart shows that rates of binge-drinking are highest in Scotland, the North East and the North West. This tallies somewhat with the evidence in the BMC Public Health study insofar as it is these regions that have the highest rates of alcohol-related mortality.

It's not difficult to see how a high prevalence of binge-drinkers could result in a higher rate of alcohol consumption, but it is also not difficult to see how an area like the South West could have a high rate of per capita alcohol consumption without the rates of harm that would be expected from the simplistic Total Consumption Model. It is a region in which a large proportion of the population drinks, but drinks relatively moderately and—presumably—regularly.

To the authors of the BMC Public Health study, this may seem like an explanation of the South West 'paradox'. In fact, it is just one example of different populations behaving in different ways. There is no paradox and the South West is not the outlier.

The outlier is central Scotland because it is the only area that has conspicuously higher rates of alcohol-related mortality. Why is this? Perhaps partly because of the high rates of binge-drinking shown in the chart above. But, as the experience of the South West shows, it is not the consequence of its per capita alcohol consumption. Per capita alcohol consumption is the consequence of other factors. It could be the consequence of lots of people drinking a moderate amount or it could be the consequence of relatively few people drinking a great deal. Simply looking at per capita consumption tells you nothing about the underlying factors and, contrary to the Total Consumption Model, it can therefore predict nothing.

Tuesday, 17 February 2015

Sugar in breakfast cereals

From a typically outraged article in The Guardian:

Cereal offenders: why do sugar levels keep rising in our breakfast choices?

Despite the barrage of health warnings on the dangers of sugar, new breakfast products – such as drinks and biscuits – contain more of the white stuff than ever

The sugar on our collective breakfast tables is piling up at an alarming rate. Despite a barrage of health warnings on the white stuff, a report last month from Action on Sugar showed that one in five cereals now contains more sugar than three years ago, and some are 18% sweeter.

The Action on Sugar research is here (PDF). It looks at 49 breakfast cereals, of which 10 have a higher sugar content than they did in 2012. That's your "one in five cereals".

But it also found that 21 of the brands had a lower sugar content than it did in 2012. That's more than two in five. Levels were unchanged in the other 18.

Of the cereals that have the highest levels of sugar, more than half have less sugar in them than they did in 2012 while less than a quarter have more.

So the claim that "sugar levels keep rising" and that breakfast cereals contain "more of the white stuff than ever" doesn't really stack up, does it?

And if you don't want the ones that have more sugar, my advice is not to buy them.

Gulping down taxpayers' money

Yet another sockpuppet pressure group with a name designed around an acronym was launched this week. Give Up Loving Pop (GULP) "takes the fight to sugary drinks companies" and is aimed at spreading panic about soda.

GULP has a website full of scientifically dubious claims and has been on the road—and on the radio—to share these claims with the public. In addition, they encouraged the Daily Mail to rehash this story to turn it into this story.

It will come as no surprise if I tell you that UK taxpayers are footing the bill for all this. So much for the bonfire of the quangos. Under the coalition, state-funded public health front groups have proliferated, just as the public health budget has inexplicably risen. In addition to subsidising old timers like ASH and Alcohol Concern, taxpayers have had to pay for minimum pricing campaigns, plain packaging billboards, Dry January and the vast leviathan that is Public Health England.

And we're not just paying for GULP's roadshows and their nifty website. We also have to subsidise the PR industry...

It is, then, a highly polished job and all done with money that could have stayed in taxpayers' pockets or been spent on healthcare in the North West.

GULP illustrates the intricate depths of the sockpuppet state. Speaking on the radio yesterday, its boss, Robin Ireland, was introduced as being from a "charity" called the Health Inequalities Group. The charity actually trades as Heart of Mersey and is a hive of busybodies, including Simon "sugar is the new tobacco" Capewell, whose green ink Twitter feed speaks for itself. Robin himself "hates junk food, sugar and tobacco" so he fits in nicely.

Even by the standards of fake charities, the Health Inequalities Group's financial accounts are opaque, but it is clear that they get the vast majority of their £850,000 income from North West councils and Directors of Public Health. In 2013, the Health Inequalities Group set up another organisation called Food Active which says that sugar is "a key foundation food of capitalism" and campaigns for the usual fussbucketry, including sugar taxes. Food Active then set up GULP this year to campaign for more of the same.

These organisations are—to borrow a phrase from George Galloway—three cheeks of the same arse. The advantage of this duplication is that it creates a "swarm effect" of cheerleaders. Moreover, all three organisations can respond individually the government consultations (which is one of their most important roles).

Expect to hear much more from GULP in the future unless a future government decides to get to grips with the nationalisation of civil society and cuts the purse strings.

Monday, 16 February 2015

The skunk-psychosis link is another reason to legalise weed

The Lancet Psychiatry has published a study which finds that daily users of cannabis are three times more likely to develop schizophrenia than those who never use it. The cannabis legalisation lobby will no doubt be picking holes in the research, and I hope they do a better job than Suzi Gage in The Guardian who resorts to making generic criticisms of epidemiology and saying 'correlation isn't causation' (as she tends to do when she doesn't like the findings but can't spot a specific flaw).

I am a card-carrying member of the cannabis legalisation lobby myself, but I don't need to pretend that cannabis is without risk to defend my position. I can do so on moral and practical grounds. The moral (libertarian) argument is that it is not for the government to persecute people for taking drugs so long as users are reasonably well-informed about the risks. The pragmatic (free market) argument is that the social and economic costs of prohibition are greater than costs of regulated drug use.

My reading of the evidence is that cannabis probably is associated with psychosis and schizophrenia in some way and that questions about reverse causation and confounding have been largely answered (see here, here, here and here). The new Lancet study does not come as a surprise, but it is made more interesting by its analysis of what type of cannabis is associated with psychosis.

These are the main findings:

Three points stand out. Firstly, that there is no association between cannabis use and psychosis for those who started smoking the drug after the age of 15. Secondly, that only those who use cannabis very frequently are at higher risk. Thirdly, that it is only skunk marijuana—which is high in THC—that seems to increases risk.

The difference between hash and skunk consumption in the case and control groups is striking. 44 per cent of the control group had smoked hash, but only 14 per cent of the group with psychosis had done so, whereas only 19 per cent of the control group had smoked skunk while 53 per cent of the group with psychosis had done so.

Opponents of drug reform will use this study to support continued prohibition—the Home Office has already done so—but it is actually another reason to liberalise.

The purpose of legalisation is not to have a free-for-all but to have a regulated market. In my book The Art of Suppression, I set out a proposal for legalisation that would allow drugs to be sold in much the same way as alcohol and tobacco. It is a blueprint that paves the way for opium bars, head shops and the sale of regulated drugs in pharmacies and nightclubs, for example, but it does not see a place in the market for every drug that has emerged in the century of prohibition.

Alcohol is legal, but you cannot go into an off licence and buy a litre of pure ethanol. Similarly, a sound system of drug legalisation would allow the sale of opium, but not heroin. It would allow the sale of cocaine (or cocaine-based products), but not crack. And it would allow the sale of pre-rolled, manufactured spliffs but there would be limits on THC content that would effectively ban the sale of skunk.

Would this system eliminate demand for crack, heroin and skunk? Probably not—and certainly not overnight—but it would help to shift consumers away from the strongest and more harmful derivatives of drugs. Who bought moonshine after Prohibition was repealed?

The aim is to bring the market back to where it was before the war on drugs began—when consumers, not suppliers, called the shots. Prohibition shifts power from consumers to suppliers. The sale of strong spirits soared during Prohibition while beer sales fell. Why? Because beer was too bulky for bootleggers and spirits offered greater profits. Skunk, crack and heroin offer the same benefits to drug dealers. Being highly concentrated, they are less bulky and therefore easier to smuggle and carry. The strongest derivatives always prosper under prohibition, but they carry the greatest health risks.

So it is with cannabis. Skunk was developed under prohibition for prohibition. It cannot now be uninvented, but a system which allowed the general sale of lower-THC varieties (to adults) would undo much of the damage that prohibition has done in this, as in every other, market.

Sunday, 15 February 2015

"Bitter row" over plain packaging studies

The Observer reports a "bitter row" in which anti-smoking campaigners are demanding the University of Zurich withdraw two studies which looked at smoking prevalence before and after plain packaging in Australia. Both studies, which were funded by Philip Morris (PMI), failed to find any effect on smoking rates from the policy.

I mentioned this research, by Ashok Kaul and Michael Wolf, last year. Although The Observer says the working papers were "widely disseminated in the media", I don't recall them getting much coverage at all and they were conspicuously ignored by Cyril Chantler when he conducted his review.

Pascal Diethelm, an anti-smoking campaigner who unveiled a not-very-scientific graph when I saw him speak in November, claims that the research contains seven errors. “Taken individually," he says, "most of them are sufficient to invalidate the findings of the papers. Collectively, they are damning.”

Kaul and Wolf have hit back strongly at this allegation with two rebuttals. In the second and most detailed of these, they conclude:

The authors of the annex have set out to discredit our research by providing a list of seven (so-called) errors and a list of seven issues. But they have clearly failed in their mission. Although there are some (minor) points of debate, there is not a single “extremely serious” error in our two working papers, as we have explained in detail in this reply.

Instead, the authors of the annex (i) have shown a surprising lack of basic statistical knowledge and (ii) have made false statements about the content of our working papers. What they have achieved to discredit, therefore, is only themselves. Perhaps this serves to explain the anonymous nature of the annex.

We welcome a constructive debate based on substance and comporting to scientific stan- dards and decorum. We regret that the authors of the annex have repeatedly overstepped the limits of scientific debate (i) by misrepresenting our approaches, methods, and find- ings; (ii) by engaging in personal attacks; and (iii) by hiding behind the cloak of anonymity. Although we firmly believe that constructive criticism will further scientific discovery and support good policy-making, we cannot accept defamatory statements and unsubstantiated attacks both on our academic institutions and on us as individuals.

You can read the whole back-and-forth here if you have the knowledge and inclination. Most of the issues are of a technical nature and go over my head, but the first of the seven supposed 'errors' is straightforward and it seems clear to me that it is not an error at all, let alone one that "invalidates the findings of the papers".

Kaul and Wolf's anonymous critics argue that absence of evidence is not conclusive evidence of absence. They complain that PMI issued a press release which said that 'The plain packaging experiment in Australia has not deterred young smokers, professors from the Department of Economics at Zurich University and the University of Saarland found in a report released today'. They also complain that BAT said the studies show that 'there has been no change in the pre-existing trend in youth or adult smoking since the introduction of plain packaging'.

They argue that Kaul and Wolf did not prove conclusively that there was no effect on smoking rates, only that their studies failed to find an effect. This might seem a pedantic distinction—in casual conversation, this is exactly how we might refer to such evidence—but it is a fair point. However, Kaul and Wolf have always been careful to make this distinction and have never oversold the findings. Their studies are very cautiously worded and they never ruled out the possibility that plain packaging had an effect that were were unable to measure.

The complaint of Kaul and Wolf's critics is essentially that other people drew a firmer conclusion from their research, but that is an absurd justification for retraction. I don't recall any demands for retraction when this study was reported with headlines such as 'Australia’s plain cigarette packaging has not given a boost to the illicit tobacco trade' and 'Cigarette plain packaging fear campaign unfounded, Victoria study finds'.

To take a more recent example, the BMJ published a study on Tuesday that was widely reported as showing that 'Alcohol has no health benefits after all' (The Times). This is not what the authors of the study said, nor is it what the study showed, but nobody would suggest it should be retracted because of inaccurate reporting by third parties. If that were the criteria, the public health literature would be very thin indeed.

I'd be interested to read comments from any readers who have the statistical qualifications to make a judgement on the other points, but if the rest of the critique is of the same standard as this I doubt Kaul and Wolf have anything to worry about. The intention seems to be to throw a little mud so that readers of The Observer—which has never mentioned the studies until now—get the impression that they have been debunked.

Saturday, 14 February 2015

Inactivity and obesity

There was a surprisingly sensible article about obesity on the BBC website this week.

We are used to seeing reports warning of an "obesity time-bomb". But the extent of the problem is often exaggerated.

Figures for 2010-11, from the National Child Measurement Programme, suggest 9% of five- to six-year-olds are obese.

That equates to 2.7 children in each class of 30. In 1990, it was 1.5.

Does a 20-year increase of just over one child per class seem like an epidemic?

That's a good question.

Dietary advice changes almost continually: eat less fat, ban junk food, tax fizzy-pop.

The Local Government Association has proposed a tax on "unhealthy" foods to enable local authorities to help overweight and obese children.

But are we missing the point?

Yes. Yes we are. We are overlooking the fact that calorie consumption, including from sugars, has been declining for many years, but so too has physical activity.

Arguably, inactivity is a better predictor of ill health than obesity.

Figures from the Physical Activity Statistics 2015 - British Heart Foundation (BHF) published this January show less than a fifth of children say they move enough - a figure that's still falling.

Shockingly, the BHF's own direct assessment of activity, using accelerometers, showed that none of the 11- to 15-year-old girls and only 7% of boys they measured actually did enough exercise.

Indeed. And many other measures show a decline in physical activity, both at work and at home.

Read The Fat Lie (PDF) for more. One day the message might get through.

Friday, 13 February 2015

Down with this sort of thing

Dick Puddlecote has said everything that needs to be said about the latest risible plain packaging study so do read his post if you haven't already. It really is appalling that these hacks receive taxpayers' money to come up with such abject drivel.

Meanwhile, another survey has found that voters don't give two hoots about this daft policy...

Populus asked more than 2,000 members of the public, on a scale of 0 to 10 where 0 = not important at all and 10 = very important, the level of importance they attach to completing outstanding pieces of legislation facing the remainder of this parliament:

•  "controlling the UK's borders and reducing immigration" (8.14)
•  "tougher counter-terrorism and security laws" (8.08)
•  “stopping human trafficking" (7.92)
•  "improving access to affordable housing" (7.46)
•  "making it easier for employers to take on apprentices" (7.10)
•  "improving rail and train services" (6.43)
•  "regulating the future of the fracking sector" (6.10)
•  "introducing plain packaging for cigarettes" (3.51)

"Introducing plain packaging for cigarettes" was the lowest of any of the variables tested, with a mean importance rating of just 3.51. The closest variable, "regulating the future of the fracking sector", scored 6.10.

See the full results on the Forest website.

And, speaking of Forest, the splendid Simon Clark is organising a drinks reception at the Institute of Directors in London on February 24th, featuring some of the soundest people in the country taking the microphone to Stop the Nonsense. That's a week on Tuesday. It's an open invitation but you must RSVP - see here for details.

Down, boy! Down!

A theme is starting to emerge from the journalism of the BBC's pet 'public health' poodle at the BBC, Nick Triggle.

Here he is celebrating the vote on the ban on smoking in cars in February 2014...

And here he is celebrating the implementation of the ban on smoking in cars yesterday...

We all know that "Nick feels strongly about this", but isn't it a little unseemly for a BBC employee to be slavering over the 'next logical step' so openly?

Thursday, 12 February 2015

Sugar conspiracies and the sad demise of the British Medical Journal

Has the British Medical Journal been taken over by a coalition of its enemies? It seems to be on a mission to destroy its credibility this week. A day after it publishes a shonky study and a woeful editorial about moderate drinking, up pops self-styled 'investigative journalist' Jonathan Gornall again. Last year he was bitching about me and anybody else who opposes minimum pricing in some articles that were so bad the EU ripped up his cheque. This time he's taking on 'Big Food'.

Gornall's series of articles about minimum pricing were lame, shifty and intellectually dishonest, but his new series about sugar is just dull. A theme is emerging in his hatchet jobs. First, he takes a policy which is controversial with the public but which has legitimate arguments for and against. He then treats the policy as a no-brainer which could only possibly be opposed by vested interests. He then looks for any kind of funding from business to civil society and the public sector; if he cannot find any he implies that it exists. Finally, he pads out his articles with quotes from activists and presents their failure to persuade government to bring in the controversial policy as being the result of 'webs of influence'.

Last year it was minimum pricing with the Alcohol Health Alliance. This time it's food reformulation with Action on Sugar. Action on Sugar have only been around for a year and their plan to reduce sugar in the food supply by 40 per cent is an arbitrary, unrealistic fantasy, but that doesn't stop Gornall presenting it as if it would have been a fait accompli had it not been for the pesky food industry.

It is clear that this ad hominem addict is either desperate for material or is totally unfamiliar with the people he is writing about. Laughably, he puts Prof. Susan Jebb at the heart of his story on the pretext she is funded by Coca-Cola. In fact, she does not personally profit from the food industry at all. She is part of a long-standing collaboration between food companies and government scientists which has led to the kind of product reformulation that Action on Sugar wants.

More to the point, Jebb is a supporter of sugar taxes, bans on confectionery at supermarket tills, mandatory product reformulation and various other nanny state policies. I disagree with her views - and have said so - but it is quite obvious that those views are her own, not those of Coca-Cola and Mars.

Despite the best efforts of Gornall and Action on Sugar, the McCarthyism that increasingly surrounds alcohol has not yet engulfed food and a number of scientists - including Jebb herself - have taken Gornall to task for his tabloid muck-raking. It's worth reading all of them, but this is my favourite, from Catherine Collins of the British Dietetic Association...

“As a dietitian I rely on high quality human nutrition research to ensure dietary advice to patients is optimal. This information is mainly obtained from clinical trials published in peer-reviewed clinical journals.
“So it is disconcerting to read Jonathan Gornall’s exposure of the link between industry and researchers – not that the link exists, but that a journalist feels it necessary to impugn good collaborative studies between industry and independent nutrition researchers based at the MRC and in UK universities. Science should deal in hard evidence, not insinuation.
“Similar to last year’s exposé on the UK alcohol industry and funded research (‘Under the Influence’, BMJ 2013), Gornall applies his focus to the machinations of the sugar industry. His citations extend to a Penguin book, a CBC news story, ‘Action on Sugar’ press releases, and media features from an ardent anti-sugar author. These citations are used to counter the hundreds of peer-reviewed clinical papers crafted into the public health documents he cites from the Department of Health, Public Health England and SACN.
“Despite being qualified to interpret medical and nutrition research, I remain as confused as the public will be to what Gornall is trying to say. Is it that the lure of money moulds researchers into compliant, complicit BigSugar agents willing to pervert good science for dosh? Is it that despite being open and transparent about funding links, plus registering your study prospectively with ClinicalTrials US/ EU and subsequent research, peer review is still inadequate for objectivity if your funding came from BigSugar?
“From a dietitian’s perspective, I would predict that the reason BigSugar has collaborated with researchers such as Jebb, Prentice, Macdonald et al is to ensure their research is conducted with those most knowledgeable in that field of investigation.

“As a science communicator I think it’s important to separate correlation from causation.  As an UK registered Dietitian I’ll continue to use objectivity, impartiality and my grounded knowledge in clinical nutrition to determine the relative merits of publications, whatever their funding source.”

Well said. I also liked this, from Prof. Tom Sanders, Emeritus Professor of Nutrition and Dietetics, King’s College London:

“The implied alternative in the BMJ article is to have a committee made up of members who are not tainted by connection to the food industry. In my experience such individuals lack the required experience and expertise and are likely to be incompetent."

Wednesday, 11 February 2015

Don't worry, drinking is still good for you

The temperance lobby hates the fact that drinkers live longer than teetotallers. Their problem is that there is a mountain of evidence showing that non-drinkers are significantly more likely to suffer from cardiovascular disease, in particular, and have lower life expectancies. Richard Doll, the doyen of public health epidemiologists, found lower rates of mortality amongst moderate drinkers in 1994. He showed that the relationship between alcohol consumption and mortality has a J-curve, with risk higher for teetotallers, lower for moderate drinkers and then a rise for heavier drinkers.

Doll et al. 1994

Doll was not the first to show this relationship and he certainly wasn't the last. In 2011, for example, a large meta-analysis published in the BMJ showed lower rates of death from heart disease amongst moderate drinkers. A previous large meta-analysis in JAMA Internal Medicine found the same for overall mortality. I could list many more.

The standard argument against this is that some people give up drinking when they become unwell (the sick quitter hypothesis) and so a simple comparison between drinkers and non-drinkers is invalid. Epidemiologists have been aware of this potential pitfall for many years and they have tested the hypothesis by excluding ex-drinkers and studying only 'never-drinkers'. And guess what? They found that the protective effect of alcohol still exists. Richard Doll showed this in 2004. Rimm and Moats (2007) showed this. Holahan et al. (2010) showed this. See here for a summary. The zombie argument has been rebutted. Teetotallers die younger, on average, than moderate drinkers. Get over it.

When the nineteenth century temperance crusader Mary Hanchett Hunt began her quack campaign to portray alcohol as deadly in any quantity she only had to overturn a general belief that booze was healthy. Her modern intellectual decedents have a tougher job in that they need to overturn decades of strong epidemiological evidence. Today, the job began in earnest in the British Medical Journal, leading to headlines such as this, from The Times...

Alcohol has no health benefits after all

Alcohol has virtually no discernible health benefits and claims that a glass of wine is good for the heart have been exaggerated, a study has concluded.

Other headlines such as 'Alcohol "has no health benefits" and previous research flawed, study finds' (The Australian) and 'Aussie scientists bust the myth that a couple of drinks a day is good for you' (Daily Mail) will have gladdened the hearts of 'public health' folk around the world.

So too would the editorial that appears in the journal, written by Mike Daube, previously a director of ASH in the UK and now an opera-banning jackboot of all trades in Australia. In a brief op-ed, Daube uses the word 'industry' no fewer than 13 times and claims that the days of people believing that alcohol is good for you are over.

These apparent [health] benefits are now evaporating, helped along by an important contribution in this week’s issue... 

What conclusions should we draw from this emerging evidence, including Knott and colleagues’ new study? Firstly, in health as elsewhere, if something looks too good to be true, it should be treated with great caution. Secondly, health professionals should discourage suggestions that even low level alcohol use protects against cardiovascular disease and brings mortality benefits. Thirdly, health advice should come from health authorities, not from the alcohol industry, and, finally, the alcohol industry and its organisations should remove misleading references to health benefits from their information materials... 

The real mortality benefits will come from determined action at the political level, not outdated advice and wishful thinking.

So what does the study actually show? The authors pull data out of the Health Survey for England and compare mortality rates amongst non-drinkers and never-drinkers to drinkers of various different amounts of alcohol.

Here are the results for men and women compared to non-drinkers. They are split between those aged 50-64 and those aged 65 and over. They are also split between two models. Model 2 is perhaps the most important as it controls for various relevant factors whereas Model 1 only controls for age. (Click to engorge.)

As you can see, for both sexes the relative risk is below 1.0 for drinkers of any amount of alcohol, ie. their mortality risk of lower than that of non-drinkers. This reduction in risk is statistically significant in almost every case.

We then look at the results for men and women compared to people who have never drunk alcohol:

Here, again, the vast majority of the relative risks for drinkers are below 1.0, indicating a reduction in risk compared to the never-drinkers. Fewer of these findings are statistically significant, but that is the inevitable result of there being fewer people in the samples. This is particularly true of the men, amongst whom there are only 95 never-drinkers in the 65+ group, compared to 307 non-drinkers. (Amongst the women there is a more statistically useful 353 never-drinkers aged 65+).

So how does this debunk the theory that moderate drinking reduces all-cause mortality risk? Quite simply, it doesn't. Even if we only use never-drinkers as the reference point, all the indicators show a reduction in risk in the region of 0.5-0.9, ie. a 10 to 50 per cent reduction. This is not trivial. We are not talking about a reduction in risk from one rare disease, but in overall mortality. This study shows, for example, that a male never-drinker is twice as likely to die between the age of 50 and 64 than a man who drinks 15 to 20 units a week (or, rather, who says he drinks that amount—the quantities are self-reported and he probably drinks significantly more). This is kind of a big deal. Imagine that instead of 'never-drinkers' we were talking about 'people who eat trans fats' or 'people who live with a smoker'. The 'public health' response to such findings would be a little different, don't you think?

The claim being made in the newspapers today—inspired by Daube's editorial and a deeply misleading BMJ press release—is that only women over the age of 65 benefit from moderate alcohol consumption. Even if this was true, it would hardly be trivial. Women make up half the population and the vast majority of deaths occur in people over the age of 65. However, it is not true. There is no plausible reason why alcohol would be protective for a woman's body but not a man's, and the data in this study give us little reason to think it does.

The claim is based on the fact that most of the risk reductions in the latter two tables are not statistically significant, except for women aged 65 and over. But there is a simple reason for this which some cynical people would call a trick. A relatively small sample has been taken and then split into different age groups, sexes and consumption levels to create dozens of even smaller samples. This, combined with the fact that there are relatively few never-drinkers to use as a reference, makes it very difficult to generate statistically significant results from any individual group.

The small sizes of the subsets mean that relative risk would, in many cases, have to fall below 0.5 before the results reached significance. No one believes that moderate alcohol consumption has an effect of that magnitude. However, there is plenty of evidence showing that risk falls by around 10-40 per cent and all the findings from this study are in line with that, albeit lacking the numbers to achieve significance. In only one group—women aged 65 and over—are there sufficient numbers to allow a risk reduction of this size to achieve statistical significance and, sure enough, statistically significant reductions in mortality risk are shown for every group of these women drinking between 1 and 20 units a week.

Dividing your sample into so many groups that statistical significance becomes practically impossible is a way of setting yourself up to fail. Failing to find a significant reduction in risk for one gender in a small subset that you have created does not mean that there is no reduction in risk. It does not mean that larger studies which have found a reduction in risk are wrong and you are right.  

Virtually every single relative risk is below 1.0 in this study. If you combined the age groups, the reduction in mortality would reach significance. If you combined the genders, it would reach significance. If you combined the various different drinking levels and simply compared those who drank moderately with those who never drank, it would reach significance.

No reasonable person could conclude from this study that 'Alcohol has no health benefits after all', as Britain's erstwhile newspaper of record claims. On the contrary, it shows much the same as all the other evidence on this subject: that moderate drinkers live longer than both non-drinkers and never-drinkers.


David Spiegelhalter makes similar criticisms of the study here.