Thursday 30 April 2015

Dodgy graph of the week

Consensus Action on Salt's threw their toys out of the pram again yesterday in the BMJ. In short, they got a large reduction in salt levels through a voluntary agreement between government and industry, and are now attacking the government for not forcing food companies to reduce it even more.

Since the anti-salt crusade began in the 1990s, new evidence has appeared to show that a low-salt diet isn't actually that good for you (eg. here and here - and see here for a summary). The policy of population-wide salt reduction, as opposed to targeted interventions for high-risk groups, remains contentious, but Consensus Action on Salt claim that the UK's 15 per cent reduction in salt intake has prevented thousands of deaths from heart disease.

I don't know whether this is true or not, but the evidence they present in their BMJ article certainly does not persuade me. Here it is...

So salt intake fell between 2003 and 2011 and so did deaths from heart disease. What compelling evidence! How wonderfully liberated from historical context it is!

Let's take a look at heart disease mortality over the long term, shall we? (Data from the British Heart Foundation.)

Campaign to your heart's content, CASH, but please don't insult our intelligence.

Seizing the narrative

Last year, some researchers from Cardiff University stole headlines from the Office for National Statistics by publishing data of Accident and Emergency admissions on the day before the ONS released its data on violent crime. They claimed that the fall in violence was due to alcohol becoming less affordable, despite the fact that violent crime had been falling since 1995.

This year, they did the same thing again. I believe this is called 'seizing the narrative'. I written about it for the Spectator - do have a read.

Wednesday 29 April 2015

Are 35% of deaths due to a 'poor diet'?

Graham MacGregor, the chair of Action on Sugar, is in the BMJ today complaining that the government hasn't compelled food companies to reduce salt as much as he wants. (MacGregor is also the chair of Consensus Action on Salt. What a small world.) He begins with this claim...

Poor diet is now the biggest cause of death and ill health in the United Kingdom and worldwide.

This may or may not be true, but neither of the references he cites even mention the UK so we can't tell. The first is an op-ed by Marion Nestle about 'Big Food'. The second is a webpage about a study about the USA. Aren't peer reviewers supposed to spot these errors?

MacGregor's claim is modest compared to that of Aseem Malhotra and friends in their astonishing op-ed last week (see here for a reminder). They assert that:

According to the Lancet global burden of disease reports, poor diet now generates more disease than physical inactivity, alcohol and smoking combined.

This is a surprising claim to anyone who is familiar with the statistics. Although the authors name the Lancet report, they do not include it in their citations, perhaps because they would then feel obliged to name the page in which the study made the claim. No such page exists because the claim isn't in the study.

Nevertheless, the notion that "poor diet" is worse than smoking, drinking and physical inactivity combined soon told hold. A nifty graphic appeared on the Telegraph website and was soon doing the rounds on Twitter.

These figures are not mentioned in the Lancet report either, but the credit to Simon Capewell gives us a clue as to how they were arrived at. The 34.6 per cent figure for "poor diet" is wrong. Badly wrong.

Here's what Capewell did. He went to the Lancet report and looked at the graph that shows the percentage of disability-adjusted life years attributed to different factors. He added the diet-related factors together and came up with a big number.

I know that's what he did because the slide below comes from a presentation he gave in 2013.

(Incidentally, I doubt Malhotra and friends would be happy with the content of this slide presentation. It's all about how evil saturated fat is. It was, however, created before the Year Zero of 2014 when Action on Sugar was launched and Capewell declared that "sugar is the new tobacco".)

I can't be certain, but I would bet a few quid that this is the source of Malhotra's claim. When the press release for his study was being prepared, either he or Capewell simply subtracted the 5.4 per cent for alcohol to get the 34.6 per cent seen in the Telegraph graphic.

What's wrong with that? Well, pretty much everything. For a start, he's included every death from high blood pressure, high body-mass index and high cholesterol under "diet". These factors can be influenced by diet, to be sure, but there are many other causes. It is quite wrong to group them together in this way. (As for including alcohol use under "diet" in his original slide, this is unconventional, to say the least.)

Moreover, you simply can't add these figures together. One of the counter-intuitive aspects of epidemiology is that it creates attributable fractions for risk factors which, if added together, would suggest that there are many more deaths than there are people dying. If this seems peculiar, I sympathise, but that's how it is and researchers in the field are quite sanguine about it (Carl Phillips gives an explanation for the layman here). 

The authors of the Lancet report make this clear at the very start of the section on 'results', saying:

The effects of multiple risk factors are not a simple addition of the individual effects and are often smaller than their sums, especially for cardiovascular diseases, which are affected by several risk factors (eg, table 2). The sum of the individual effects of just the metabolic risk factors at the global level is 121% and the summation of all the risks is greater than 400%.

In other words, if you added all the risk factors in their report together (there are many), you would conclude that there are four times as many deaths as there actually are. You would be double-counting all over the place and that's why you don't do it.

But even if you did try to compare different risk factors, you wouldn't use Capewell's method. It is bizarre that he chose to work out the percentages from the graph above (presumably using a ruler!) when the exact figures are listed in Table 2 and Table 3. If you look at those figures, you'll see the following estimates for disability-adjusted life years:

Dietary risk factors and physical inactivity: 254,333,000

Alcohol use: 136,063,000

Tobacco smoking (including second-hand smoke): 156,838,000

Physical inactivity: 69,318,000

You only need to subtract the figure for physical inactivity from the figure for 'dietary risk factors and physical inactivity' to get the total DALYs attributed to a 'poor diet'. It is 185,015. This is much lower than the combined figure for alcohol, tobacco and inactivity, which is 362,219.

You can do the same with the figures for mortality in Table 2:

Dietary risk factors and physical inactivity: 12,503,370

Alcohol use: 4,860,168

Tobacco smoking (including second-hand smoke): 6,297,287

Physical inactivity: 3,183,940

Again, subtracting the inactivity total from the top total gives 9,319,430 for dietary risk factors. This is much less than the 14,341,395 for alcohol, tobacco and inactivity combined.

Adding alcohol, tobacco and inactivity together entails some of the problems of confounding discussed above, but these risk factors are more likely to independent of one another and therefore less problematic than bundling a bunch of dietary risk factors together (drinking doesn't cause lung cancer, smoking doesn't cause liver cirrhosis, etc.)

But if you start adding 'diet low in fruits' to 'diet low in fibre', for example, you begin the process of double, triple and quadruple counting. Sure enough, if you add together all the deaths from 'diet low in calcium', 'diet low in milk' and so on together, the total exceeds 18 million, which is fifty per cent more than the figure for all dietary risk factors and physical inactivity combined in the Lancet report itself. This is why—if I may labour the point—you don't do it.

To an epidemiologist, this really is a schoolboy error, but it is exactly what Capewell did. He compounded the error by adding in a huge numbers of deaths that are not diet-related and are not considered to be diet-related in the original report. This misinformation was then passed onto Malhotra and friends who used it in their op-ed, a graphic was created and a meme was born.

But if "poor diet"—which, by the way, at the global level usually means malnutrition rather than excessive sugar and salt consumption—does not cause 34.6 per cent of all disease, how much does it cause?

You don't need to crunch numbers or estimate percentages from graphs to work this out. All you need to do is go to page 2,253 of the Lancet report and you will see these words...

We have expanded the set of components of diet included from a combined category of fruits and vegetables in the 2000 comparative risk assessment to 15 components in GBD 2010; together these dietary risk factors account for a tenth of global disease burden.

So it's 10 per cent, not 34.6 per cent (and the researchers also say that "we stress that these results should still be interpreted with caution"). This is not a trivial difference, by any means. It amounts to claiming that a quarter of all deaths worldwide—some 14 million—are due to poor diet when they are not. And since more than 10 per cent of deaths are attributed to smoking, alcohol and physical inactivity, this means that the claim in the Malhotra op-ed is also wrong.

May I humbly suggest that the media start asking questions of these people and that peer reviewers start doing their job?

Tuesday 28 April 2015

More evidence on physical activity and obesity

Tim Olds has written a nice article about the bogus controversy about whether burning off calories helps people lose weight.

People don’t seem to be exercising more or less than they used to. Studies show little historical change in leisure time physical activity. But there have been big declines in occupational physical activity as workplaces have become automated and the service economy replaces manufacturing and farming.

A study looking at work-related physical activity over five decades showed declines of about 500 kilojoules a day in energy expended on the job by US workers. Another spanning 45 years suggests the time women spent on domestic chores required about 1,000 kilojoules less each day in 2010 than they did in 1965.

Declines in energy expenditure of this magnitude are more than enough to account for historical increases in fatness.

He even dares to tell the truth about calorie consumption...

In 2008, one of my graduate students, Jo Stevenson, systematically reviewed studies reporting the energy intake of children. She found 2,148 reports dating back to 1856, covering 425,905 mainly European, North American and Australian children.

There was a consistent decline in energy intake of school-aged kids from 1920 onwards, at the rate of about 2% to 3% per decade, flattening out in the late 1990s. By 2000, kids were eating about 20% less than they did in 1920. Even conservatively allowing for under-reporting by fatter kids and methodological differences, the decline was still of the order of 1% to 2% per decade. Unfortunately, this research wasn’t published so I can’t link it here.

The evidence that adults are eating more may also be very suspect. Data from the periodic National Health and Nutrition Examination Surveys (NHANES) in the United States are often used to indicate upward trends in energy intake. But Blair’s team has previously convincingly argued – in a peer-reviewed article published in a well-respected journal – that these trends are likely to be artefacts resulting from changes in research methodology, and that dietary data are inherently unreliable anyway.

So historically, the evidence is that it ain’t the meat it’s the motion.

It's not often that The Conversation publishes a sensible article so do read it.

Monday 27 April 2015

Exercise doesn't help people lose weight?!

I've started writing for the Spectator blog. My first post went live today and looks at The Dodgy Science Behind the Claim that Exercise Doesn't Help You Lose Weight. Please pay it a visit.

Price controls: the case of alcohol

Despite the prominence of the Institute of Economic Affairs in the British Medical Journal's smear campaign against opponents of minimum pricing, we've never actually published much about it.* There was a chapter in Jamie Whyte's award-winning monograph Quack Policy, but nobody at the BMJ seems to have read it. Apart from that, nothing.

Last week, however, the IEA published a whole book about price controls and it includes a chapter about minimum pricing by yours truly. In it, I discuss the Sheffield model and the Canadian experience, as well as the likely impact on consumers and the legality of the policy under EU law.

You can download Flaws and Ceiling: Price Controls and the Damage They Cause as a PDF for free here.

(* The author of that piece was the third-rate journalist Jonathan Gornall who, like a third-rate footballer, is now plying his trade in Abu Dhabi. When not stoking the flames of anti-semitism in the Middle East, Gornall continues to write piss-poor hatchet jobs for the BMJ. Having done minimum pricing and sugar, Gornall turned his attention to plain packaging last week with an article so lame that no media reported it. Yet another effort is on its way, apparently. He's already been in touch with us about it.)

Sunday 26 April 2015

Global Forum on Nicotine 2015

The second annual Global Forum on Nicotine kicks off in Warsaw, Poland on 5 June. I'll be there. Will you?

Speakers include Hon Lik (the inventor of e-cigarettes), Clive Bates, Konstantinos Farsalinos, Martin Dockrell, Ann McNeill, Derek Yach and many others.

Tickets, flights and hotels were all at a reasonable price when I booked them. Early bird discount available until the end of April. Register here.

Friday 24 April 2015

Irish vaping mystery solved

On Monday, I mentioned the Irish Cancer Society's claim that 5 per cent of smokers had used an e-cigarette before they started smoking. This, they say, is evidence of a possible 'gateway' effect—an effect that has not been seen in any other country. For the avoidance of doubt, this is what they say on their website:

A concerning fact highlighted by our research was that 5% of current smokers used e-cigarettes before they started smoking. 

I have now found the survey results and there is a simple, predictable explanation for this finding. It's ain't true.

The five per cent statistic actually doesn't refer to all smokers, but to smokers who had used or were using e-cigarettes. The relevant data is below.

56 per cent of the smokers had ever used e-cigarettes so we're actually talking about half of one twentieth of one fifth of the population. Actually, you can't even halve the five per cent figure because the e-cigarette users are not representative of smokers as a whole. They are younger, for a start. If more old smokers tried e-cigarettes, the percentage would decline further.

The research did not find that "5% of current smokers used e-cigarettes before they started smoking". It found that 5% of an unrepresentative subset of smokers who had ever used e-cigarettes said that they had used e-cigarettes before they started smoking. To state the obvious, it was not a survey of every smoker in Ireland and the numbers are tiny. Although the survey started out with 1,000 people, there were only 176 able to answer this question. Of those 176 people, only eight gave the answer that formed the basis of the Irish Cancer Society's claim.

Eight! You cannot draw conclusions from such a tiny sample. You can't even be sure that these respondents used an e-cigarette before they started smoking. When dealing with numbers this small, you can't discount people misreading the question, not reading the question or ticking boxes at random. But even if they answered correctly, you cannot infer—as the authors do above—that it is an indication that "e-cigarettes are a [sic] probably gateway to smoking for this cohort."

Contrast those eight people with the thirty people who used to smoke but now only use e-cigarettes. That's thirty people from a smaller sample of 86 current e-cigarette users, meaning that 35 per cent of e-cigarette users used to smoke but no longer do so. Is that not more consistent with the view that e-cigarettes are a gateway from smoking than a gateway to smoking?

And yet the Irish Cancer Society seems to have little interest in the people who quit smoking, a strange oversight for a health group. Instead, their press release led with the claim that 'Two in three e-cigarette users are also smoking tobacco'. This, of course, means that one in three are not still smoking tobacco. Can the pharmaceutical companies that sponsor the Irish Cancer Society claim the same about users of their nicotine products?

Tuesday 21 April 2015

Vaping in the USA: When the lie's so big

Not a day goes by without some outrageous lie being told about e-cigarettes in the USA. America is currently in a league of its own when it comes to vaping deceit and I simply don't have time to write about it all. Many readers will already be familiar with the $75 million crusade of misinformation in California and the false portrayal of a smoker as a vaper in an attempt to con people into believing that e-cigarettes will make your lungs collapse. It is also worth reading Carl Phillips' account of the recent farce involving the FDA who were asked to make the warning labels on Swedish snus bear some relationship to reality.

It all boggles the mind and I hope someone is taking names and numbers for the inevitable reckoning in a few years time when these frauds will, I hope, be held accountable for their actions. Though far from being the most blatant attempt to mislead, this infographic from the FDA is also worth flagging up.

Amongst the most prominent lies about e-cigarettes is that (a) they don't help people quit smoking, and (b) they encourage young people to start smoking. It is no longer good enough to repeat the "we just don't know" mantra of years gone by. We have plenty of evidence—more of which was published this week—for us to know that these are lies.

An interesting question, less easily resolved, is whether e-cigarettes help to prevent smoking by getting would-be smokers to vape instead. For the fanatics, any evidence that young non-smokers experiment with e-cigarettes—which some will, of course—is evidence of a fictitious 'gateway effect' or is a terrible thing because it gets youngsters 'hooked' on nicotine (which has hastily and falsely been redefined as the scariest ingredient in cigarettes, rather awkwardly for the pharmaceutical industry).

Circumstantial evidence is all we can hope for when looking at would-be smokers because we don't know they are. We know who the smokers are, however, and we know who the vapers are, so if vaping rises sharply and smoking falls sharply there is a good a priori case for assuming that the former led to the latter.

That is exactly what has happened in the USA in the last few years and the wingnuts of 'public health' hate it because it not only scotches their gateway hypothesis but it suggests a prophylactic benefit too. The unavoidable conclusion is that high school students are vaping instead of smoking and that this is a good thing if you are concerned about public health rather than 'public health'.

How has the FDA's Center for Tobacco Products responded? By redefining e-cigarettes as tobacco products, of course, thereby pretending that nothing has really changed...

Click to enlarge, but the key point is that cigarette smoking fell dramatically between 2013 and 2014 at the same time as e-cigarette use rose dramatically. The FDA merely says that "there was no decline in overall tobacco use by students". This bare-faced lie is based on the ridiculous premise that e-cigarettes are tobacco products.

Elsewhere in the infographic, they claim that "more than 4.6 million students reported being current tobacco users". No they didn't. If they had been asked "are you a current tobacco user?" most of them would have said no because, er, they're not. The FDA finds that 2.4 million of their "current tobacco users"—ie. most of them—are actually regular or occasional users of e-cigarettes.

A decline in smoking prevalence from 15.8 per cent to 9.2 per cent in just four years would be something to cheer about if your mission was to improve the health of the nation. It's quite clear that whatever priorities the Center for Tobacco Products has—and pointless regulation seems to be the main one—the health of the nation is not amongst them.

Monday 20 April 2015

Did 1 in 20 Irish smokers start out on e-cigarettes?

In my post about the Irish Cancer Society's promotion of Nicorette yesterday, I didn't mention one little factoid that will doubtless be parroted by anti-ecig zealots in the Emerald Isle for years to come, namely...

The study also showed that five per cent of people currently smoking started after using e-cigarettes and the potential for them to become a 'gateway' drug for cigarettes was also highlighted by the ICS as a cause for concern.

The Irish Cancer Society (ICS) provides no link to this mysterious study and it has not been published, so we have no clue as to what this claim is based on, but it sounds highly improbable, to say the least.

Estimates of how many smokers there are in Ireland differ wildly, from 29 per cent according to the EU and OECD to 19.5 per cent according to the Irish health department.  With an adult population of 3.8 million, there are between 730,000 and 1,000,000 smokers. Are we to believe that between 36,000 and 50,000 of them had never tried smoking until they tried an e-cigarette?

It would be amazing if no young people ever experimented with e-cigarettes, but research to date is pretty clear in finding no 'gateway effect'. In the UK last year, ASH said "there is no evidence from our research that e-cigarettes are acting as a gateway into smoking". Office for National Statistics data show that e-cigarettes are used almost exclusively by smokers and ex-smokers, and a study earlier this month also found no evidence of a gateway, with its lead researcher saying:

"There are some concerns at the moment that the growth of e-cigarettes may be helping to get a new generation of young people addicted to nicotine. At the moment, that doesn't seem to be the case. There doesn't seem to be too much reason to worry that that's actually happening."

And yet the ICS, citing some unpublished research, reckon that one in twenty smokers started out using e-cigarettes? It defies belief, particularly when you look at the demographics.

It's well known that the vast majority of smokers had their first cigarette before the age of 20. Since e-cigarettes have only been widely available for the last few years, nearly all the people who supposedly used them as a gateway to smoking must therefore be under the age of 25. That narrows the field considerably, as this graph—from the Irish Health Executive—shows:

If, as this graph says, 15 per cent of Irish smokers are under the age of 25, about a third of them (5 per cent) must have been vapers first if the ICS claim is true. I can't prove that this is a lie, but it sounds very much like one. There just aren't enough non-smoking vapers to make it credible. The ICS's own briefing paper on e-cigarettes says:

...there are approximately 134,000 e-cigarette users in Ireland. The vast majority of these are either current tobacco smokers or former tobacco smokers and there is little evidence that the devices are used by people who have never smoked tobacco.

This is borne out by a graph that the percentage of Irish non-smokers who are current users of e-cigarettes is, er, zero.

To be fair, use by non-smokers is not totally non-existent. Four per cent of them have 'tried once or twice'—a quick puff here or there perhaps—and one per cent had 'used in the past', but none of them are vapers in the sense of being regular users. How can e-cigarettes be a gateway when non-smokers aren't interested in them in the first place? What is supposed to be the narrative here? Do non-smokers try e-cigarettes 'once or twice' and then immediately abandon them and start smoking instead? They'd have to do so in massive numbers if the claim that five per cent of the country's entire smoking population—most of whom are over the age of 35, let alone 25—started out with them were true.

As I say, I can't categorically prove that this is a lie, but the fact that non-smokers hardly ever try e-cigarettes, that almost none of them start using e-cigarettes regularly, and that research from the rest of the world has found no evidence of a gateway effect makes it very hard to believe that tens of thousands of Irish people are so keen on vaping that they decide to take the much more expensive and unhealthy decision to start smoking tobacco. The five per cent claim reeks of BS, but that won't stop it being trotted out until the twelfth of never.

Saturday 18 April 2015

The Irish Cancer Society's hard sell

I see the Irish Cancer Society has just made its contribution to the global campaign of e-cigarette misinformation. From the Sunday World...

A study conducted by the Irish Cancer Society has cast doubt on how useful e-cigarettes are in helping smokers quit.

The survey, conducted in March, found that using e-cigarettes may in fact increase smokers dependence on nicotine as the lack of regulation is creating the potential for long-term use.

Why shouldn't people use them long term? What's it got to do with the Irish Cancer Society? But note, straight away, that it's regulation they want.

They studied 1,150 people and they found that e-cigarettes are now used by 210,000 people in Ireland but 2/3s of those using them also used other tobacco products at the same time.

So a third of them are not smoking and, since we know that the vast majority of e-cigarette users are smokers when they first try them, this fact is clearly good news for 'public health'. If e-cigarettes help 33 per cent of those who try them to achieve abstinence from tobacco then they are an order of magnitude more useful in smoking cessation than any nicotine products produced by Big Pharma. Why don't the pharmaceutical industry's products get this kind of sustained abuse from cancer charities?

"This survey clearly shows that right now e-cigarettes are not a quitting aid as some people are led to believe,” says Kathleen O’Meara, Head of Advocacy and Communications for the Irish Cancer Society (ICS).

The survey quite clearly does that e-cigarettes are a quitting aid for very many people. You'd have to be an innumerate moron not to be able to see that.

“E-cigarettes are becoming an increasingly popular choice for smokers looking for a healthier lifestyle and to save money. But there are better, more proven ways to quit smoking than choosing devices that still have no regulations in Ireland.”

 Is this a sales pitch?

Currently, e-cigarettes are not regulated as a medicinal product by the Department of Health, and the ICS have called on the Department to do so to bring it in line with other Nicotine Replacement Therapies.

That's the pharmaceutical industry's line because they want to stifle the competition with expensive and unnecessary regulation. It's not the line of many people who are involved in smoking cessation and know what they're talking about. Are you sure this isn't a sales pitch?

“Nicotine is addictive and giving up is tough. There are more effective treatments that have been proven to increase your chances of quitting up to four times. E-cigarettes are not one of them.”

Wait, this is a sales pitch. Why would the Irish Cancer Society be lobbying for the pharmaceutical industry? If there's one thing these guys hate it's a perceived conflict of interest, so surely they wouldn't ... they couldn't... Oh yes, they are...


As I said when Alcohol Concern started hawking drugs last year, the mentality is "it's not a conflict of interest when we do it". But the Irish Cancer Society's pitch is so transparent, so unsubtle, and so obviously taken not only from the pharmaceutical industry's playbook but literally from their advertisements, that no sentient reader can fail to see what's going on here.

America's conflict of interest with e-cigarettes

This well made video nicely explains why California (and other US states, for that matter) are so keen to clamp down on e-cigarettes. People talk a lot about conflicts of interest, but this is a real one.

Friday 17 April 2015

Tim Stockwell: merchant of doubt

The campaign to pretend that moderate alcohol consumption isn't good for you continues this month in the pages of Addiction and it's no surprise to find Tim Stockwell taking up the cudgels. Stockwell is one of the world's leading neo-temperance activists, the author of the Canadian Minimum Pricing Miracle study, and is determined to return us to the days of Scientific Temperance Instruction when alcohol was deemed unsafe at any level.

The methods of these people are becoming clear. They find heterodox evidence, exaggerate its importance, ignore the wider literature and declare victory. They are particularly fond of using what Deborah Arnott once described as "literally a confidence trick: the appearance of confidence both creates confidence and demoralises the opposition." They behave as if the benefits of moderate consumption were a bizarre urban myth and sporadically declare that the conventional wisdom which, they claim, has long been teetering has finally collapsed.

Stockwell did this in 2012 and got delightfully smacked down by two scientists. He did it again in 2013 in an op-ed titled 'Another serious challenge to the hypothesis that moderate drinking is good for health?' Mike Daube did it a few months ago in the BMJ in an op-ed titled 'Alcohol’s evaporating health benefits' which said the consensus view was based on "outdated evidence and wishful thinking". And Stockwell is at in once more in Addiction this month with an op-ed titled 'Has the leaning tower of presumed health benefits from ‘moderate’ alcohol use finally collapsed?'

Perhaps they think that the scientific consensus can be defeated by opinion pieces in journals? Where exactly is their evidence? The study Stockwell was getting excited about in 2013 found that moderate drinkers had a 24-46 per cent lower rate of death from cardiovascular disease and that "never alcohol users also had a greater risk of death than lifetime light users". It included this graph showing a clear J-Curve.

The study that Mike Daube treated like a game-changer in February used a crude statistic trick to downplay clear evidence in its own data that drinkers had lower mortality rates than teetotallers. It's going to take more than this piffle for the deniers to overwhelm the mass of evidence supporting the alcohol J-Curve.

In a characteristic move, Stockwell brings up the old 'sick quitter' hypothesis (first mooted way back in 1988) and talks about possible confounding. He even cites a study from 2005 which raised this question, but he fails to cite any of the studies that have tested the hypothesis by excluding people who were (a) sick, and/or (b) quitters. These studies found that moderate alcohol consumption was still associated with lower rates of cardiovascular mortality and/or lower overall mortality—eg. here, here, here and here. Stockwell doesn't mention them. I wonder why.

The more you study these people's behaviour, the harder it is to make the obvious comparison. They ignore the majority of the evidence, they focus on outlying studies that support their argument and they persist in arguing about statistics long after the arguments have been resolved. These are the tactics that got the tobacco industry labelled 'merchants of doubt' in the twentieth century. And that is what neo-temperance activists are when it comes to the alcohol J-Curve in the twenty-first century.

Thursday 16 April 2015

Party manifestos - the lifestyle issues

All the major political parties have now published their general election manifestos. As predicted, they are mostly lacking detail on issues of 'public health'—ie. lifestyle regulation—but such detail as there is suggests that the nanny state will be thriving for at least another five years. Here are the main points from each manifesto...


Non-specific on most lifestyle issues. They claim to be "helping people to stay healthy by ending the open display of tobacco in shops, introducing plain–packaged cigarettes and funding local authority public health budgets." There is no mention of any other anti-smoking policies, presumably because they're waiting for ASH to tell them what to do.

They say they're going to "take action to reduce childhood obesity and continue to promote clear food information" but don't say how. There is a similarly vague promise to "become smarter when it comes to crime prevention, dealing with the drivers of crime such as drugs and alcohol."

And that's about it. No mention of e-cigarettes, food, soft drinks or alcohol. However, they say they will "create a blanket ban on all new psychoactive substances, protecting young people from exposure to so-called ‘legal highs’." This is very naive. Legal highs are not imported or marketed as psychoactive substances, but as pond-cleaners, plant foods and so on. If it was as simple as bringing in a "blanket ban", the government would have done it years ago.

Verdict: Disconcertingly vague. A pig in a poke.


Labour says it will "take targeted action on those high strength, low cost alcohol products that fuel problem drinking" but does not say how. Tellingly, minimum pricing is not mentioned; Ed Miliband distanced himself from it several months ago.

They will also "will set maximum permitted levels of sugar, salt and fat in foods marketed substantially to children." This could be construed as mandatory product reformulation or as an advertising ban by the backdoor. Whatever the intention, there are lots of products that cannot be reformulated so say goodbye to commercials for chocolate bars, for example, before 9pm. A bit depends on how they define "marketed substantially to children", but this is terrible idea that will be bad for consumers, bad for broadcasters and won't do a thing to reduce obesity.

There is also a mention of "a levy on tobacco firms" which amounts to arbitrary looting. The Tories consulted on this idea recently and decided that there were too many unintended consequences. Also difficult to see how they are going to tax the profits of companies that are based in Switzerland.

On gambling, Labour says it will "give new powers for communities to shape their high streets, including power over payday lenders and the number of fixed-odds betting terminals." This sounds like the "healthy high streets" fascism I wrote about last month.

Other than that, no mention of any anti-smoking or temperance policies. In fact, the entire section on "prevention and public health" only lasts one paragraph. Like the Tories, they know it's not a vote winner.

Verdict: Pretty dire, but would probably have been even worse if they listed everything they had in mind.

Lib Dems

The Lib Dems plan to "Introduce Minimum Unit Pricing for alcohol, subject to the outcome of the legal challenge in Scotland". Like the Tories, they boast about "taking tobacco off display in shops and introducing standardised packaging", but don't seem to have come up with any other ridiculous anti-smoking policies other than introducing a "tax levy on tobacco companies" (subject to a consultation).

They also want to "Restrict the marketing of junk food to children, including restricting TV advertising before the 9pm watershed". There is no definition for 'junk food' so I assume they mean High in Fat, Salt and Sugar (HFSS) in which case say goodbye to commercials for bacon, cheese, cakes, biscuits, most soft drinks and numerous other food products before 9pm. This is just censorship. And they plan to "Encourage the traffic light labelling system for food products", although they can't mandate it because it is an EU competence.

Like Labour, they want to "Protect high streets and consumers by granting new powers to Local Authorities to reduce the proliferation of betting shops and substantially reducing the maximum stakes for Fixed Odds Betting Terminals."

The Lib Dems are the only party to explicitly mention e-cigarettes in their manifesto, saying that they will: "Carefully monitor the growing evidence base around electronic cigarettes, which appear to be a route by which many people are quitting tobacco, and ensure restrictions on marketing and use are proportionate and evidence-based. For example, we support restrictions on advertising which risks promoting tobacco or targets under 18s, such as those introduced in 2014, but would rule out a statutory ban on ‘vaping’ in public places."

Verdict: Typical Lib Dems. They might be democrats but they certainly ain't liberal.


UKIP explicitly opposes minimum pricing and will "reverse plain packaging legislation for tobacco." They will also amend the smoking ban "to give pubs and clubs the choice to open smoking rooms provided they are properly ventilated and physically separated from non-smoking areas".

As a bonus, they plan to save half a billion pounds a year by "Clamping down on so-called ‘fake charities,’ or state-funded political activism." Excellent and very relevant since the nanny state enterprise is led by state-funded 'charities'.

These sensible policies are slightly offset by a promise to "update licensing laws" by limiting the maximum stake on fixed-odds betting terminals from £100 to £2.

As they intend to hold an EU referendum, the awful e-cigarette regulations in the Tobacco Products Directive won't apply if the public votes to leave (this also applies to the Tories if Cameron keeps his promise).

No mention of food or soft drinks, presumably because they plan to leave them alone.

Verdict: Liberal in the uncorrupted sense of the word.


Bonkers from beginning to end, the Green manifesto is an orgy of bans and taxes. A ban on the sale of foie gras, a ban on fracking, a ban on hunting any animal for sport, a ban on circus animals, a ban on keeping rabbits in cages etc., etc. The main lifestyle policies are as follows:

"Put a minimum price on alcohol of 50p per unit." Yawn.

"Reduce the alcohol limit for drivers to as close to zero as is practicable." Predictable for a party that hates motoring in any form (unless it's chauffeur driven).

Increase the tax on tobacco and alcohol by £1.4 billion per year (!), equating to a roughly 10 per cent annual rise. Idiotic and illiberal.

"Extend VAT at the standard rate to less healthy foods, including sugar, but spend the money raised on subsidising around one- third of the cost of fresh fruit and vegetables." They think this will suck another £6.7 billion out of people's pockets. Perhaps it will.

They don't mention fixed odds betting terminals. This must be an oversight since I'm sure they'd like to ban them too.

They do, however, say they want "an evidence-based approach to the step-by-step regulation, starting with cannabis, of the drugs currently banned under the Misuse of Drugs Act as well as ‘legal highs’, with a view to introducing a system that reduces harms and brings the market under state control as a potential tax revenue generator." So it's not all bad. Quite.

Verdict: The perfect party for people in 'public health'—bossy, socialist and authoritarian.

Wednesday 15 April 2015

Hurrah! A stupid law is wrecking an industry!

Last December, the Scottish government lowered the drink-drive limit from 80mg to 50mg per 100ml of blood. As has been widely reported, this has led to a 30 per cent drop in pub sales and is another hammer blow to the pub trade courtesy of the 'public health' racket.

This is depressing news, unless you are a journalist at the Independent, in which case damage to the economy is an end in itself...

Scotland's new drink-driving law is so successful it's damaging the economy, according to Bank of Scotland report

Scotland’s tough new drink-driving law is proving so successful at stopping people from indulging that it is damaging financial growth, according to one of the country’s top economists.

Wow. Is that what it's come to? Apparently so, as the theme was further developed in a pisspoor article in Vice yesterday that was positively gleeful about the coup de grace being delivered to Scottish pubs...

Scotland's New Drunk-Driving Law Is So Effective It’s Damaging the Economy

A new Scottish drunk-driving law introduced in December is proving to be so effective that it is actively damaging the economy, according to a Bank of Scotland (BoS) report published yesterday. It's a report that raises a number of questions, the most pressing of those being: Yo, how much of the Scottish economy is built on the cornerstone of people drunk-driving?

To which the answer is: Yo, being drunk has got nothing to do with it. The point of drunk-driving laws is, quite obviously, to stop people driving whilst drunk. When the breathalyser replaced roadside sobriety tests, the limit was set at a level below which anybody could reasonably be described as drunk. Indeed, it erred on the side of caution so that it would be a safe level for a little old lady and a heavyweight boxer alike.

Scotland has decided to jettison that limit and make the limit effectively zero, as 'public health' campaigners demanded. This has not only scared people off drinking one pint during the day, but from drinking much in the evening in case they are tested the next morning. It is this effect on people's evening drinking habits that really motivates the neo-temperance lobby. For the teetotalitarians, the negative consequences are a feature, not a bug. It's got nothing to do with road safety. It is about making people drink less, full stop. As the Independent notes...

The new law, which came into force in December, reduced the legal alcohol limit for Scottish motorists from 80mg to 50mg in every 100ml of blood. Drivers have been warned that having “no alcohol at all” is the only way to ensure they stay within the limit – and to avoid planning car journeys for the morning after a night drinking.

The thing is, people who drive with 50-79mg of alcohol in their system are not drunk and therefore cannot be drunk-drivers. They were not drunk last year and they do not magically become drunk just because a bunch of worthless politicians suddenly moved the goalposts. It is no more a 'crackdown' on drunk-driving than raising to age of consent to 21 would be a crackdown on paedophilia. It's an irrelevance, a distraction, a gimmick.

Reducing the drink-drive limit is a classic example of legislating for the sake of it. Everyone disapproves of drunk-driving so Something Must Be Done. You could try to enforce the law as it stands or you could piddle around with a new law with socially and economically damaging consequences. No prizes for guessing which option the Scottish government went for. Why bother going after the small minority of inebriated motorists when you can hassle people who have a swift half after work or who had a few drinks the night before? When you can't govern, legislate.

What's interesting about the Independent and Vice articles is that they are rejoicing in people drinking less in pubs as if that were the measure of success. Results have been divorced from putative intentions. The aim of drunk-driving laws is not—or, at least, should not be—to arrest people who are perfectly fit to drive, nor is it to close pubs down. The aim is to reduce alcohol-related traffic accidents.

On that score, there is very little evidence that reducing the blood alcohol limit makes any difference at all. 'Public health' and temperance campaigners often complain that the UK's limit is higher than nearly every other European state. This is true. Only Malta and Switzerland have a limit of 80mg, so they—along with the UK—must have more alcohol-related traffic accidents, right?

Er, no. I can't find the figures for Malta but the WHO have data on what percentage of road accidents involve alcohol. As you can see below, the UK and Switzerland both do better than average.

Looking at the total number of deaths on the road (per 100,000 motor vehicles) Britain and Switzerland also do significantly better than average.

This is not to say that Scotland won't see a decline in traffic accidents. Perhaps it will. But if it does, it will probably be because the government has reduced the number of journeys people make and thereby reduced the amount of traffic on the roads, not because it has deterred people from drunk-driving.

Tuesday 14 April 2015

Packaging doesn't make people start smoking - study

This study was published in the European Journal of Public Health a couple of weeks ago. You won't have seen it reported anywhere and no 'public health' campaigners have mentioned it on Twitter, for reasons that will become obvious.

It looks at the factors that influence young people's decisions to start smoking.

Respondents were allowed to select up to three among the following response options: ‘your friends smoked’; ‘your parents smoked’; ‘you liked the packaging of the cigarettes (or other tobacco products)’; ‘you liked the taste or smell of tobacco’; ‘you liked menthol cigarettes’; ‘you liked cigarettes with a specific sweet, fruity or spicy flavour’; and ‘cigarettes were affordable’. Respondents who indicated that they started smoking because their friends smoked were classified as having initiated smoking under the domain of ‘peer influence’ and those who mentioned that they started smoking because their parents smoked were classified as under the domain of ‘parental influence’. All other responses were grouped together as ‘tobacco product features’, as the numbers of respondents who indicated each one as an influence were small.

Small, indeed. In fact...

No significant association between design and marketing features of tobacco products and an early initiation of regular smoking was observed (OR = 1.04; 95%CI 0.83–1.31).

The researchers found "no significant within-group differences were observed for design and marketing features of tobacco products". The results are shown below.

'Tobacco product features' include not only the packaging, but also flavours such as menthol. As any smoker knows—and as this study confirms—these factors simply do not register as a cause for people to start smoking. Nevertheless, the EU is legislating to ban menthol and the UK is legislating for plain packaging.

The reason for that, folks, is that 'public health' is not an evidence-based enterprise.

Drinking in films and other stuff

The Institute of Ideas has asked various people to nominate one law for repeal. For me, the sheer vindictiveness of the smoking ban made it the obvious candidate. Read my brief article here.

Meanwhile, the censorious fanatics who want films to be given an adult rating if they depict smoking are, quite predictably, trying to do the same with drinking. Activist-quackademics at Bristol University have produced research claiming that 15 year olds who see lots of drinking on screen are 20 per cent more likely to have drunk alcohol. Ignoring the multiple confounding factors that could be behind this piddling little result, the study concludes...

“Adverse outcomes from alcohol use are a large societal public health problem and rating films according to alcohol content may reduce problem-related alcohol use and associated harm in young people.”

This is not the first attempt to use junk science to lobby for censorship. Ian Gilmore, along with the vapers' friend John Britton, had a go a few years ago. And Glantz has recently started naming and shaming actors who smoke in films (he really hates The Lord of the Rings). His claim that an adult rating for films that depict smoking would save a million lives is a leading contender for the most risible 'public health' claim in the world—in a very crowded field. Glantz's website is always good for a laugh.

Finally, are you familiar with the surreal genius of the NGO-taunting Live from Golgafrincham website? If not, you should be. They have a video for their new project Brain Zero. I could embed it here but it needs to be seen in context for it to make sense. Even then, it probably won't, but that's kind of the point.

Go visit.

Friday 10 April 2015

Empty smokefree casinos

Americans for Nonsmokers' Rights—an organisation that has nothing to do with nonsmokers, if it ever did—yesterday tweeted this picture of a smokefree casino in an effort pour encourager les autres...

Notice anything about this photo? If you spotted that there are virtually no customers, give yourself a pat on the back, although you didn't need to see the photo to know that. You could have guessed it from the word 'smokefree'.

It's the same old story. What is true of casinos is true of pubs, bingo halls and anywhere else that has a clientele disproportionately made up of smokers. Kick out your best customers and—surprise, surprise—your business suffers. Whether you personally love smoking bans or loathe them, that's a simple fact you have to accept.

The evidence that the smoking ban has damaged the British pub industry is such a clear, observable fact that I don't think even ASH attempts to claim otherwise these days. As for casinos, the picture has been the same everywhere in the world, which is why some casinos have managed to cling onto smoking rooms even in some of the most fiercely anti-smoking countries, though not the UK.

Only a handful of ideologues, like Stanton Glantz, who long ago abandoned reality for the comforting universe of their own imagination hold onto the belief that smoking bans are good for casinos (see this study, for example, but notice also the rebuttal and correction.) Longtime readers will fondly recall Glantz's claim that there were fewer heart attacks in Colorado casinos after they were forced to ban smoking. He failed to mention that this was because three of the casinos closed down and there were fewer people to have heart attacks in the casinos that remained.

In the early days of smoking bans, it was vaguely credible to argue that new nonsmoking punters would replace the departing smokers, but the jury is well and truly in now. Witness the recent battle in Indiana, for instance:

“We can’t afford to lose any more of our customers,” says Jim Brown, chief operating officer of Centaur Gaming, which owns the state’s two horse track casinos, Indiana Grand and its sibling, Hoosier Park Racing and Casino in Anderson.

Brown worries about his industry while sitting at a table in the Shelbyville casino’s swank piano bar. It fronts a newly renovated steakhouse designed to appeal to a more upscale crowd than the casino’s brew pub, where patrons can engage in off-track betting.
There’s an empty ashtray on every table.
“Getting rid of smoking just isn’t something that resonates with our customers,” Brown said.
He points to Illinois, where gaming revenues dropped 20 percent when the state banned smoking in casinos in 2008.
The Federal Reserve Bank of St. Louis, which studied the decline, concluded that $400 million plunge in revenue in 2009 was directly linked to casinos forcing their customers to extinguish their smokes. The loss reverberated, with $200 million less in state tax revenues and another $14 million in lost dollars to local communities.

Even politicians now admit that smoking bans hurt casinos, although they try to put a happier spin on it.

Rep. Ed Clere, R-New Albany, chairman of the House Public Health Committee, said the estimated cost to the state of ending the casino exemption — about $200 million in lost tax revenue, according to the Legislative Services Agency — will be offset long-term by reduced health care costs.

Smoking bans wouldn't reduce health costs even if they saved lives, which they don't. All they do is needlessly put people out of work and stop customers satisfying their first choice preference. If bans generated more business for casinos, the owners would have introduced them long ago. In reality, they go out of their way to attract smokers, as they are doing in neighbouring Ohio...

At least three casinos have sought permission for regulators to add slot machines to designated smoking areas. To lure patrons in, they now advertise with the slogan: Smoke free or smoke freely.

A fair compromise that satisfies everybody but the zealots. And they're never satisfied anyway.

"I think we need to leave it to the casino industry right now to decide what’s best for their industry.”

That's the crux of it. Unless there they were victims of a phenomenal information failure, casino operators wouldn't fight smoking bans tooth and nail unless they knew it was going to hurt them. The fact that they have to be forced into it tells you everything you need to know.

Thursday 9 April 2015

Standardise everthing!

There was a little article in The Morning Advertiser yesterday, telling publicans to focus on their glassware if they want to give their customers the optimal experience.

Pubs are now paying more attention to how a drink is served, and as a result customers are enjoying the benefit of more innovative glassware, according to Henry Stephenson, managing director at Stephensons Catering.

For instance, flutes etched at the bottom of the bowl are helping maintain the bubbles for Prosecco lovers, while wider-bowled flutes are being championed by wine experts because they give sparkling wines a better nose.

The article carries on in this vein for some time, with various tips for businesses in the nighttime economy. It's a niche topic, but the message is basically sound: help your customers to enjoy themselves, make life better.

I only mention it because for every action there is an equal and opposite reaction. For every business that tries to improve things, there is a 'public health professional' trying to wreck it. That brings us to Linda Bauld and friends who published this study in Alcohol and Alcoholism last year...

Our findings suggest that, far from being merely a functional vessel, the glass has come to be an integral part of marketing activity. The role of the glass as a marketing tool has been hinted at in previous research—a previous analysis of alcohol marketing strategies (Hastings et al., 2010) noted that Smirnoff recommended ʻchunky glasswareʼ as a means of implying greater alcoholic potency—but this is the first time the glass has been examined in detail from a critical marketing perspective. Like a cigarette, the glass is a particularly intimate form of marketing because it is held in the hand and is integral to the moment of consumption (Ford et al., 2013).

... glassware for alcohol could be re-designed to encourage safer drinking, for example by deploying shapes that convey a more accurate impression of volume, or by adding marks to indicate units of alcohol, as has been recently implemented by Heineken (Heineken UK, 2013); however, the possibility that unit marks may in some cases encourage consumption would need to be thoroughly investigated before recommending this for widescale adoption. It has been shown that a ban on traditional glassware in nightclubs can reduce injuries from alcohol-related disorder (Forsyth, 2008); the possibility that such a measure may also reduce brand appeal could be investigated. Echoing the move to plain packaging of cigarettes is the time approaching for a debate on standardized, non-branded, measure-marked glassware imprinted with large harm-reduction messages?

 They never sleep.

Wednesday 8 April 2015

The weird belief that people follow dietary guidelines

A study was published in Nutrition last week in support of the strange fantasy that Americans became obese because they slavishly followed government dietary guidelines. This is the premise of Nina Teicholz's recent book The Big Fat Surprise (see here for my review). Teicholz is thanked for her "support" at the end of the new study.

The revisionist history is that, from the 1970s, the US government told its citizens to abstain from fats and stuff their faces with carbohydrates. Americans dutifully complied and became obese as a result, because fats are wonderful and carbs are dreadful.

The evidence for this hypothesis comes from dietary data from the US National Health and Nutrition Examination Study (NHANES) which the Nutrition study cites:

Consumption of fats has dropped from 45% to 34% with a corresponding increase in carbohydrate consumption from 39% to 51% of total caloric intake. In addition, from 1971 to 2011, average weight and body mass index have increased dramatically, with the percentage of overweight or obese Americans increasing from 42% in 1971 to 66% in 2011.

For Teicholz and her supporters, this is proof that fat consumption has fallen by 25 per cent since 1971. But this is like saying that the British population has declined because the UK has a smaller share of the world's population today than it did fifty year ago. It is, to be blunt, a lie. What actually happened is Americans kept eating the same amount of fat but started eating more of other foods, mainly carbohydrates, thereby increasing their overall calorie intake which, combined with more sedentary lifestyles, led to world-beating levels of obesity.

The inconvenient fact that the amount of fat consumed has not fallen for over forty years is acknowledged in the study itself:

Since 1971, the shift in macronutrient share from fat to carbohydrate is primarily due to an increase in absolute consumption of carbohydrate as opposed to a change in total fat consumption.

... Daily fat consumption fell to 83 g in 1971, and remained at approximately the same level through 2011. In contrast, carbohydrate consumption, although basically at from 1965 to 1971 in terms of total calories, has risen to 278 g/d since 1965, an increase of 30.6%.

It is true that the US government recommended that dietary fat should make up less than 35 per cent of energy consumed, but it should go without saying that they wanted this to happen by people reducing the amount of fat they ate, not by increasing the amount of everything else they ate.

Americans abided by neither the letter nor the spirit of the guidelines, and yet the authors make the silly claim that...

These patterns and changes in consumption are consistent with the hypothesis that Americans on average adhered to the government dietary recommendations regarding fat, saturated fat, cholesterol, and carbohydrate.

You can read the USDA dietary guidelines for 1980 here. They are perfectly sensible, but it is a stretch to claim that Americans have been faithfully following them.

For a start, it says "use less of all sugars" and "eat less of foods containing these sugars", something that Americans conspicuously failed to do over the next twenty years. The rise in sugar consumption—which USDA plainly did not endorse—is one of the major causes of the rise in carbohydrate consumption.

USDA explicitly told people not to eat more simple carbohydrates like sugar because "they provide calories but little else in the way of nutrients." Insofar as it told people to eat more complex carbohydrates, it said "If you limit your fat intake, you should increase your calories from carbohydrates to supply your body's energy needs." USDA recommended that Americans "substitute starches for fats and sugars". That's substitute, not complement.

On the subject of "maintaining an ideal weight", USDA recommended that Americans "increase physical activity", "eat less fat and fatty foods" and "eat less sugar and sweets". Americans did none of this. They reduced physical activity, ate the same amount of fatty foods and ate more sugar. Unsurprisingly, they did not maintain an ideal weight.

Insofar as Americans were aware of the guidelines at all, they clearly did not "dutifully" follow them. The only aspect of the guidelines which they came close to meeting, albeit by accident, was a reduction in fat consumption as a percentage of total calorie consumption, but since this was entirely an artifact of increased calorie consumption, it is not what the USDA desired or recommended.

In sum, American nutritional guidelines were neither extreme nor dangerous (as the revisionists would have you believe), but even if they had been, it wouldn't have made any difference since Americans ignored them.

(See Carbsane for more of the problems with this study.)

Tuesday 7 April 2015

Coffin dodgers

From The Telegraph...

Alarm over sudden drop in female life expectancy

Life expectancy for women has suffered a drop on a scale not seen for decades, as their lifestyles become more like those of men, official figures show. 

Surely that's good news for all those people who are worried about 'health inequalities'?

They are not talking about life expectancy at birth (which continues to rise), but life expectancy at a very advanced age.

It means the average woman aged 75 can expect to live 13.1 years; five weeks less than in 2011.
For a woman aged 85, average life expectancy is now 6.8 years - a fall of two and a half months, in two years.

So a 75 year woman can "only" expect to live until she's 88 and an 85 year old woman can "only" expect to live until she's 91. Am I alone in thinking that this is, if anything, too long?

Various people are claiming to be very concerned about this blip. The state-funded super-charity Age UK are blaming the "decline of state-funded social care" (ie. "give us more money") while the renowned Twitter troll John Ashton, still at the Faculty of Public Health after avoiding the sack, is blaming—you guessed it—"lifestyle factors".

Prof John Ashton, president of the UK Faculty of Public Health, said the fall in women’s life expectancy might reflect changes in the lifestyles of the baby boomer generation, which were taking their toll decades later.

“One of the issues we have seen is women living lifestyle’s [sic] becoming [sic] more like those of men over recent decades, with more smoking and drinking,” he said.

Because every single health issue is about smoking and drinking, isn't it? Even a FIVE WEEK decline in estimated life expectancy for people aged 85.

Where to begin? Firstly, someone who is 75 or 85 was born either before or during the Second World War and is therefore not a baby boomer.

Secondly, look at the graph that forms the basis of this mini-panic...

Ooh, look at the scary drop! Can you even see it? The graph is interactive on the Telegraph website and, as a result, you can see what the figures are. Taken together, they show that life expectancy for 65 year olds was 21 (2011), then 20.9 (2012), then 21 again (2013). For 75 year olds, it was 13.2, 13, 13.1 respectively. And for 85 year olds, it was 7, 6.8, 6.8.

In other words, there was no decline in the most recent year's data for any of the age groups, nor was the tiny decline seen between 2011 and 2013 for the 75 and 85 year age group "on a scale not seen for decades". The post-1980 trend shows many small ups and downs. Amongst the 85 year group, for example, life expectancy fell in 1982, 1985, 1988, 1991, 1993, 1995, 1999, 2003 and 2008.

It is, however, noticeable, that the trends in life expectancy get flatter as the cohort gets older. Life expectancy for 95 year olds, for example, has barely risen at all since 1980. This is because—whisper it!—they have reached the biological limits of human life. One day, we may see the trend for the other cohorts flatten out too, but it is far too early to say that this is already happening, even with the 85 year olds.

I have said before that the 'public health' movement is actually a longevity movement. It has cheerfully abandoned the concept of premature mortality in favour of a mindless body count. Longevity isn't a bad measure of utility if you're measuring it from birth, but it becomes preposterous when you start fretting about people who are already in their 80s and 90s.

The 'public health' lobby pile absurdity upon absurdity when they start blaming "lifestyle factors" on people living to be 91.6 when, if only they hadn't smoked or drank so much, they could have lived to be 91.8.

John Ashton wants us to believe that someone dying in their tenth decade of life is a preventable and premature death. Not only that, he wants us to believe that these great-great-grandmothers would have lived longer if they hadn't been heavy-smoking baby boomers [sic]. Even if this were true, what kind of warning is it supposed to be? Aren't these people supposed to have died decades earlier?

Perhaps I am giving Ashton too much credit for thinking his position through. More likely, he was phoned up over a bank holiday weekend about an issue of supposed public health and he gave the Pavlovian response of "smoking, drinking, blah, blah, blah" because that is all he, and his fellow nanny statists, knows how to do.

Monday 6 April 2015

The Dark Market revisited

The tobacco display ban came into full effect in the UK today, making it a crime for shopkeepers to show customers tobacco packaging. With an election looming, it is worth remembering that both the Conservatives and Lib Dems opposed this absurd policy in opposition before nodding it through once in power. This is because no matter who you vote for, public health always get in.

It is also remembering that the case for the display ban was based on a tissue of lies from ASH and the Department of Health, who worked together to drastically understate the cost of retailers. Their collaboration was laid bare in a series of e-mails released under the Freedom of Information Act. This scam received some media attention (eg. in The Guardian) and I later told the full story in a mini-report titled The Dark Market

It is a fine example of how the government and its sock puppets stitch up public consultations, manufacture evidence and mislead the electorate. If you haven't done so before, today is a good day to read The Dark Market.

Sunday 5 April 2015

Sunday sermon: A creeping persecution

Here's a video of the indefatigable Patrick Basham talking about the nanny state in Australia recently. Enjoy.

Saturday 4 April 2015

Debating the Alcohol Health Alliance

I was on Five Live earlier in the week debating with Ian Gilmore—sorry, Professor Sir Ian Gilmore—of the Alcohol Health Alliance. Gilmore wants to stop Guinness from sponsoring the Premier League. It's "morally wrong" apparently.

Gilmore doesn't seem to know anything about sport or advertising, but you can listen from 28 minutes here if you're interested.

Friday 3 April 2015

Swedish exceptionalism

Sweden's state-owned alcohol retail monopoly—Systembolaget—has put out an amusingly smug advertisement for itself.

If you can't be bothered to watch it, the message is "free markets—bad, state-owned monopolies—terrific". Presumably, the aim is to convince Swedes that they are better than everybody else because they can't buy a drink after 6pm and it costs a king's random when they do.

To be fair, off licences in Sweden have a good range of choice (as the advert proudly declares), but that is offset by the fact that there is no choice in off licences. If the state doesn't stock it, it is effectively illegal.

Systembolaget gives the government a way to exploit and patronise the public at the same time. It's a hangover from the Sweden's brush with prohibition and the subsequent Bratt System. As Swedes are aware that most countries don't treat their citizens like children in this way, there is always a danger that they might turn against the state-owned model. And so, as with any socialist system, the state has to resort to nationalistic propaganda.

h/t C.W.Norton

Thursday 2 April 2015

What will the manifestos bring?

FTI Consulting have published a briefing paper about what to expect from the General Election. On page 32 there is a section on 'lifestyle' that is worth reading.

Following the end of the duty “escalator” on beer, the cut in beer duty in the March Budget demonstrated once again that politicians believe lifestyle industries and products capture the electorate’s attention. Albeit nuanced by broader arguments around choice, health and public responsibility, these complex consumer issues will continue to be a feature of debates in the commons long into the next parliament.

The tobacco industry has been rocked by the last-gasp success of the campaign to standardise “plain” packaging, the consequences of which are yet to arise after its implementation. The debate is far from over, especially if the Conservatives form another government: questions about illicit trade and intellectual property remain unanswered and noises about costly and time-consuming lawsuits are rumbling. Tobacco companies have set their sights on other industry challenges too: the evolution of alternative tobacco and nicotine products such as Electronic Vaping product (EVps, commonly known as e-cigarettes) means that “big tobacco” faces continued uncertainty as to what their products will look like and how they can be sold in the near future.

Going into the election, support for the alcohol industry appears sweetened with a 1p reduction in beer duty and duty on cider and spirits such as scotch whisky cut by 2 per cent, “to back one of the UK’s biggest exports”, as Osborne outlined in the last Budget. Whilst currently unsuccessful, the argument for minimum unit pricing has not been permanently defeated, with a report emerging from the house of Lords recommending a trio of paternalistic measures: minimum pricing, a variable tax rate in line with alcoholic strength and new rules on alcohol labelling. These are particularly likely to be pursued in the event of a Labour victory at the polls.

Alcohol faces a local / national pincer movement; the Local Government association has called for the government to divert a fifth of the current total annual duty on alcohol to councils and has requested power for councils to take public health issues into consideration when deliberating licenses, and supporting licensing and trading standards departments to tackle the black market in alcohol.

Authorities like Newcastle and Ipswich are mooting the prospect of local control over late night levies or the strength of alcohol which can be sold in their areas. as with proposals for local control over gambling (the number of bookies in an area, and what’s available within them), such measures can grow, spreading out so that in the end the effect is the same, or similar to, a national ban, without the national debate that would have gone with it.

The government faces pressure to take action against fixed odds betting terminals (FoBTs) in efforts to tackle problem gambling. This is not as simple an argument as it may seem; whilst some argue that too many outlets offering FoBTs on a high street can lead to a degradation of the street appearance and impact on the local economy, the impact of shop-based terminals (with the employment they offer and rates they generate) versus internet gambling as a source of addiction and poverty is more complex. There’s a safety point at play too, since the ability to police the age of gamblers, verify that they’re not drunk, observe and identify problem gamblers and so forth is much easier when the provider of the opportunity to gamble can actually see the punter – which of course doesn’t happen when the gambling’s being done at home. The government has set out that the future of FoBTs is “unresolved”. With the industry being placed under continued scrutiny, it can be expected that the gambling industry’s future faces uncertainty, though the Treasury will be wary of legislation that reduces the income it receives from the already heavily taxed and regulated gambling industry.

Sugar and fat in food and drink are next in the firing line, with a coordinated campaign by health bodies having grown momentum over the course of this parliament. A tax on soft drinks and energy drinks has been debated by public health officials and opposed by industry, but the government has not yet committed to a review or any progress on the issue. The debate should not be dismissed given the focus public health research is placing on diet and sugar intake, and the repeated cycle shown throughout this parliament in all of the tobacco, gambling, alcohol and food and drink debates – that progress for the “nannying” side of the argument is never permanently beaten. seemingly, it’s just delayed.

This briefing covers many of the big issues, but there are others—mandatory food reformulation, outdoor smoking bans, and a multitude of advertising bans, for example. These (state-funded) campaigns will continue regardless of which party is in charge. The shrieking will get louder and the pseudo-academic 'evidence' will get more and more absurd.

Whether they succeed doesn't much depend on the make up of the next parliament either. The last five years have shown that you cannot expect a party with the word 'conservative' or 'liberal' to be either of those things, while Labour's crusade against e-cigarettes at the EU level shows that the socialists are as hostile to free markets and free choice as ever. So long as the public health parasites keep saying 'think of the children!' there will be a gormless or ambitious politician ready to grab a quick headline.

Whatever happens, don't expect to see it in the manifestos before the election. Being unpopular, 'public health' garbage tends not be the kind of thing politicians want to put to a vote. The Tories and Liberals brought in the tobacco display ban despite being opposed to it when Labour were in charge. Plain packaging wasn't in any of the parties' manifestos and Labour's 2005 manifesto explicitly promised that its smoking ban wouldn't include wet pubs and private members' clubs. In fact, the only major 'public health' policy in the 2010 manifestos was minimum pricing in the Liberal Democrats'—and that never happened.

It's almost as if you can't trust them, isn't it?