Review of 2016: nanny state edition

2016 was the most entertaining year I can remember. I doubt we shall see another one like it.

If 'post-truth' is the word of the year - and apparently it is - the nanny statists have been ahead of the curve for a long time and they excelled themselves again this year. Here are a few of the lowlights of 2016 in the world of so-called 'public health'...

January

An Australian surgeon takes the anti-sugar crusade to its logical conclusion by waging a war on fruit - ('it advertises itself by being brightly coloured, shiny, sweet and attracts the wild life'). This is not a spoof.

Corpulent anti-vaping toad Martin McKee is caught lying to the Chief Medical Officer. Soon afterwards, the Chief Medical Officer is lying to the public about the health effects of moderate drinking. This was the big 'public health' story of January - the unscientific lowering of the drinking guidelines, as discussed here, here and here.

As plain packaging begins to be endorsed by countries outside the antipodes, the vultures from the obesity and alcohol 'research community' naturally circled. Expect to see much more of this in 2017.

2016 was a particularly paternalistic year for The Times who had a constant bee in its bonnet about gambling and sugar. It started the year by putting its weight behind the sugar tax. You won't be surprised that I argued it was wrong to do so.

Sally Davies' portrait on the wall of the gents toilet in Shepherds, Westminster

 
February

Sally Davies calls on women to think about breast cancer every time they pour a glass of wine. I suggested that this was indicative of our Chief Medical Officer's unhealthy state of mind.

There was more shameless bollocks about heart attacks declining as a result of people not smoking in pubs.

America is a basket case on e-cigarettes. The lies coming from across the Atlantic were so bold and brassy they took you breath away.

Cancer Research UK comes up with some fantasy modelling (very much a feature of 2016) to push the sugar tax. See the Stats Guy's analysis of it.

Anti-smoking campaigners in Australia and around the world continue to lie and lie again about the damp squib of plain packaging. The official review of the policy - much delayed as activists desperately groped around for a hint of success - is quietly released and uses some laughable modelling to generate the desired result.

The Times gets its knickers in a twist about a non-existent gambling epidemic.

Inspired by anti-nicotine lunatic Stan Glantz, a deluded Californian takes Hollywood to court for showing smoking in films (the case was recently dismissed).

Television in 2016

March

The EU Nanny State Index is published for the first time. The UK comes third, just behind the temperance-minded Scandinavians.

Action on Sugar were all over the airwaves in 2016. One of their typically ludicrous pieces of research was covered in this post.

George Osborne masks some embarrassing financial news by announcing a sugar levy. The Office for Budget Responsibility immediately admit that it's going to cost the government £1 billion. Thanks Jamie! I wrote about the regressive sugar tax here.

Public Health England launch a useless, patronising website called How Are You [sic]. I shudder to think of the cost. (It was plugged again a few days ago with this scare story.) I wrote about it at the time for the Telegraph.

April

Our Brussels overlords raise the idea of taxing e-cigarettes and clamping down on drinkers. If only there was some way of getting out of this bossy institution...

The Lib Dems put together a plan for cannabis legalisation which sounded nearly as grim as prohibition.

Australia goes full wowser. Never go full wowser.

You're not helping, The Sun.

May

Aseem Malhotra and his low carb oddballs virtually destroy the National Obesity Forum. I optimistically write Malhotra's political obituary for Spectator Health.

Plain packaging starts to be rolled out. ASH spent years - and vast sums of our money - lobbying for this stupid policy. The unintended consequences of it belong to them.

The EU's new, destructive laws on e-cigarettes are also introduced. Somewhat belatedly, the House of Lords condemned them.

Yet another baseless prediction of sky-rocketing obesity rates is produced by partisan hackademics.

'Public health' lobbyists took time out from thinking of the children to thinking of the middle-aged in 2016. In this article, I looked at the supposed epidemic of middle-aged problem drinking.

June

Being overweight is conveniently redefined as being malnourished for propaganda purposes.

I dig up some historical documents to show how the war on e-cigarettes mirrors the war on snus in the 1980s. I also look at the early years of ASH.

As war continues to ravage Syria, the WHO takes an interest by calling on the country's government, such as it was, to introduce plain packaging for tobacco.

In an unusual moment of clarity, the UK Faculty of Public Health calls for the legalisation of drugs. I offer my suggestions of how this should be done. 

How California views vapers

July

David Cameron departs. He was probably the most nannying prime minister in living memory. He brought in a sugar tax, a tobacco display ban, a plastic bag tax and plain packaging. He wanted to introduce minimum pricing and goodness knows what else. I tentative suggest that Theresa May will be less bad.

St. Jamie of Essex invests in the processed, frozen food industry and Aseem Malhotra makes a fitness video.

After spending years telling us to avoid sunshine and red meat, the 'public health' industry tells us to take vitamin D tablets to tackle the resulting epidemic of rickets.

Rising tobacco taxes are quite obviously leading to more black market sales and lower tax revenues for the government.

Anything California can do, Scotland can do

 August

Despite a mounting campaign of doubt from the neo-temperance lobby, the evidence that moderate drinking is good for you continues to grow.

Taking its cue from England, the Scottish government gets a bunch of temperance crusaders to look at the drinking guidelines.

The UK government publishes its childhood obesity strategy. It's a massive win for the nanny statists which they portray as a defeat because it would have been even worse if Nanny Cameron had still been in charge. 

The Taxpayers Alliance publish its Nanny State Rich List, shining a light on the money being sucked up by this parasitic, non-productive industry.

Aussie anti-gambling ad meets The Terminator

September

With depressing predictability, various mendacious scumbags demand a ban on smoking outdoors.

For those with eyes to see, the truth about smoking ban/heart attack miracles was as plain as day.

After years of flat-lining smoking rates, vaping leads to a downturn. Anti-smoking fanatics try to take the credit. Meanwhile, the WHO remains doggedly opposed to e-cigarettes.

Branches of the NHS start talking seriously about denying treatment to taxpayers who are fat or smoke.

Stanton Glantz tries to replicate his trick of cherry-picking old tobacco industry documents to generate a conspiracy about Big Sugar - and makes an arse of himself.

In post-truth America, cigarette tar ('total aerosol residue') is the same as road tar (asphalt)

October

The Irish government - which is beyond help by this point - seriously considers putting curtains around alcohol in shops. An Australian temperance zealot can't believe his country didn't think of it first. 

Action on Sugar go berserk when they discover sugar in ice cream.

The SNP wins the penultimate round of the minimum pricing court battle, but since we're leaving the EU it doesn't really matter.

ASH reveal their economic illiteracy - or, some would say, dishonesty - by publishing a comically inept report telling retailers that it isn't worth their while to sell tobacco.

Similarly, the WHO publish a downright deceitful report claiming that sugar taxes work.

When yet another bunch of blinkered campaigners make a ludicrous obesity prediction I put my own money on the line if they are right. No one takes me up on the bet.

The Conservatives - the party of free markets and individual choice

November

Cancer Research makes the nation cringe again with a pitiful press release about bathfuls of fizzy drinks. They follow this up by chucking some money at the hacks at Sheffield University to produce a worthless figure about alcohol-related cancers to get further cheap media attention.

After a prostate cancer charity takes a sceptical view of neo-temperance claims about alcohol, 'public health' blowhards accuse it of lying for money.

The WHO's biennial tobacco control summit begins in the traditional way, with everybody apart from true believers being turfed out. The conference turned out to be a bit of a waste of time, but it allowed 'clean air' campaigners to have a holiday in smog-ridden Delhi - and UK taxpayers get to give another £15 million to tobakko kontrol efforts. As I said at Spectator Health, the WHO has lost the plot.

We tried to warn you

December

Public Health England produced a report on alcohol so riddled with inaccuracies, misrepresentations and deceit that it took me two lengthy posts to scratch the surface (part one and part two). As usual, half a dozen people from Sheffield University and a handful of temperance/anti-industry ideologues were responsible.

The PHE report was press released with a claim so bad it had to be retracted within hours, but the claim that replaced it was little better.

Fantasy modelling was taken to new lows by the anti-alcohol people in 2016, but Tobacco Control drove it through the bottom of the barrel when it turned a sharp increase in heart attacks (following the introduction of a smoking ban) into a sharp decrease.

The Times continues to harp on about problem gambling doubling, a claim that has been made several times in the last decade, despite no rise in the number of problem gamblers. I explain what's going on in this Spectator piece.


And that's it for 2016. See you in 2017. May you live in interesting times.


PS. You can still listen to the year's Last Orders podcasts with the following guests:

Claire Fox

Sam Bowman

Michael Fitzpatrick

Rob Lyons

Brendan O'Neill and James Allen

Timandra Harkness

Martin Durkin

And you can listen to the IEA's review of the year here.

How many smokers really want to quit?

Nanny state extremists are fond of claiming that 90 per cent of smokers want to quit. The odious Simon Chapman, for example, when campaigning for smokers to be licensed, wrote...

Some 90% of smokers regret having started smoking

And the Chief Executive of ASH Wales says...

'We know that the vast majority of people who smoke want to quit...'

Regular readers will not be surprised to hear that these claims are not wholly truthful. The latest edition of the Health Survey for England, published this month, gave smokers a number of statements, with which the following proportion agreed:


I really want to stop smoking and intend to in the next month: 7%

I really want to stop smoking and intend to in the next three months: 8% 

I really want to stop smoking but I don’t know when I will: 19%

I want to stop smoking and hope to soon: 16%

I want to stop smoking but haven’t thought about when: 10%

I think I should stop smoking but don’t really want to: 20%

I don’t want to stop smoking: 21%

Economists prefer revealed preferences to stated preferences for a good reason: talk is cheap. It would be the easiest thing in the world to tick a box in a survey expressing a desire to give up smoking. It is what you are supposed to say in the current climate, and it carries no cost.

Nevertheless, 41% said they did not want to give up smoking and a further 26% expressed only a vague aspiration to give up. 15% said they 'really wanted' to give up smoking and intended to actually do so in the foreseeable future. Good luck them, but let's not pretend that the 'vast majority' of smokers are locked into a miserable cycle of addiction and are desperate to quit. Even their (unreliable) stated preferences do not imply that.

Furthermore, if you look at the reasons why smokers say they want to quit, some of them have nothing to do with health. The price of tobacco is the most commonly cited reason after health concerns, but the cost of smoking is high because anti-smoking campaigners have successfully lobbied for tobacco duty to be raised with the specific intention of getting smokers to quit. It is an artificial inducement.

Other policies, such as smoking bans, have the same effect. They incline smokers towards quitting by making their lives difficult; they do not make smokers dislike smoking per se.

59 per cent of smokers in the Health Survey for England express some desire to quit. This is a slim majority, not a vast majority, and if we stripped out those who are merely expressing the politically correct opinion, or who only want to quit because anti-smoking campaigners have made their lives miserable, or who are expressing a second-order preference, it is safe to assume that the real figure is well below half.

Undeterred by the obvious problems of taking half-hearted stated preferences literally, ASH Scotland have recently come up with the ruse of talking about 'willing smokers'. Scotland's autocratic government has decided that the country must reduce its smoking rate below 5% by 2034. This seems unlikely, but the state-funded lobbyists at ASH Scotland have found a way to spin it...

The smoking rate currently stands at 21%, suggesting the tobacco-free goal might be some way off and will require some serious shifting to get us there. But, crucially, a consistent two-thirds of Scottish smokers say that they want to stop. This means that the actual willing adult smokers are just 7% of the population – and nearly 90% of the journey to this tobacco-free Scotland is helping those smokers who actively want to be free from their addiction. Who could argue with that?

The answer to that question is, of course, 'anyone with an IQ above room temperature'. It is rather like taking the population of a country and estimating the 'real' population by excluding everybody who says they would quite like to live somewhere else.

The ASH cranks even show a graph to demonstrate how close they are to their 5% goal if you treat the fact that smokers who say they want to quit are still smoking as a mere administrative detail.

If there has been a theme to the 'public health' racket in 2016, it has been wholesale substitution of fantasy for facts, models for reality, and so it is fitting to end the year with this little example.

Back on planet Earth, however, people do things because they enjoy them, and smokers no more appreciate being the target of vilification and extortion than any other minority. This week saw the publication of a report from the Centre for Substance Use Research looking at how 'confirmed smokers' feel about smoking. Based on a survey of over 600 smokers conducted by FOREST, it does not claim to take a representative sample, but it is a valuable reminder that smokers - including those who express a desire to quit - enjoy smoking. This shouldn't be surprising, but in the land of make believe that is 'public health' it is a radical, heretical idea.

You can read The Pleasure of Smoking: The Views of Confirmed Smokers here.

Hear ye, hear ye!

Blogging will be light over the next week or so for obvious festive reasons, but there are a couple of podcasts you might be interested in.

The IEA has released its first ever podcast, with myself, Mark Littlewood, Kate Andrews, Steph Lis and Madeleine Grant discussing the events of 2016. The IEA podcast isn't on iTunes yet, but you can listen online.

I also had an enjoyable chat with James Delingpole for his podcast. If you don't subscribe to it, I recommend you do - and catch up with his interview with Gary Bell, in particular. The online link is to our interview is here.

And if your lugholes need even more libertarian banter, don't forget the Spiked Last Orders podcast - the most recent episode with Martin Durkin is here.

Merry Christmas to you all!

Virtue signalling with other people's money

Bay Area idiots are celebrating this week because the California Public Employees’ Retirement System (CalPERS) has fully divested its shares in tobacco companies. The pension fund got rid of the shares it held directly back in 2000, but it is now getting rid of the shares it holds indirectly through outside investors.

King of the idiots, Stanton Glantz, takes up the story...

In 2000, motivated in part by the sea of litigation facing the tobacco industry, the huge California Public Employees Retirement System (CalPERS) voted to divest the tobacco stocks that it held directly. Perhaps because they were so small, it did not instruct its outside investment advisors to divest their tobacco holdings.

Since then, the tobacco companies have soldiered on despite paying out hundreds of billions of dollars in settlements and continue to sued, most notably in Quebec, Canada and Florida. Because nicotine is an addictive drug they have been able to raise prices faster than consumption has dropped and so continued to remain profitable. Indeed, tobacco stocks are at an all-time high.

At the same time, CalPERS’ tobacco holdings (through the outside investors) have grown to several hundred million dollars.

What Glantz neglects to mention is that it was thanks to people like him that CalPERS got rid of some of the 21st century's best performing shares in the first place. He believed that his regressive and illiberal tobacco control policies would lead to smoking being wiped out within the foreseeable future and Californian politicians were dumb enough to believe him.

It was an incredibly expensive mistake. Tobacco companies have done more than 'soldier on' since the year 2000. The shares that CalPERS sold are worth 900 per cent more than they were 16 years ago. The shares that the outside investment advisors kept hold of - which were 'so small' in 2000 - are now worth $547 million. The 2000 divestment is estimated to have cost the fund $3 billion.

That is why CalPERS held a vote on Monday. Some of its members have grown tired of losing money hand over first and wanted to get rid of the ban on tobacco stock. They lost the vote 9-3 and, to add insult to injury, economically illiterate fanatics like Glantz then persuaded them to get rid of their direct holdings as well.

Read more here: http://www.sacbee.com/news/business/article121830108.html#storylink=cpy

Despite the California Public Employees’ Retirement System’s anxiety about the pension fund’s current financial state, representatives of state workers urged the board to stay away from tobacco.

“I don’t want to go back to my retirees and tell them their retirement depends on companies that invest in disease and death,” said Terry Brennand of Service Employees International Union, which represents tens of thousands of state workers.

CalPERS also got an earful from the American Heart Association, American Cancer Society and others, citing the social and public health costs and arguing that CalPERS was in danger of sending potential smokers the wrong message. Cynthia Hallett of Americans for Nonsmokers’ Rights said CalPERS would risk its global “reputation for responsible investing” if it jumped back into tobacco stocks.

Only time will tell how costly this becomes for the under-funded pension pot and those who depend on it.

It should go without saying that there is no 'public health' benefit to tobacco divestment, just as there is no environmental benefit from fossil fuel divestment. It is an entirely self-defeating action designed to give zealots a warm, fuzzy feeling. At best, it has a microscopic, temporary effect on the share price, but it does not affect company profits one iota and could not conceivably have any effect on the smoking rate.

Board member J.J. Jelinic, on the other hand, opposed the motion to expand CalPERS’ anti-tobacco stance. “I am not aware of anyone who smokes or doesn’t smoke based on whether CalPERS invests or doesn’t invest, and if we’re not changing behavior, then what are we getting for the money we’re giving up?” Jelinic said.

Nothing. You get nothing for your 'reputation for responsible investing'. It is the sheerest virtue signalling and it comes at a cost, not to people like Glantz, who have a university pension, nor to out-of-town lobbyists from the American Heart Association. It is ordinary workers who pay.

Are we drinking 42% more than we did in 1980?

Public Health England had an awkward moment earlier this month when they press released their report on alcohol with the claim that people in Britain are drinking twice as much as they did in the early 1980s. When asked to give their source for this assertion, they removed it from their website and replaced it with this:

Between 1980 and 2008, there was a 42% increase in the sale of alcohol.

This statistic is also highly dubious. The only question is whether it is a flat-out lie or is merely grossly misleading. It appears in the report like this:

According to Her Majesty’s Revenue and Customs (HMRC) duty and tax receipts, alcohol sales in England and Wales have increased by around 42% from roughly 400 million litres in the early 1980s, peaking at 567 million litres in 2008 and have since declined (Figure 6) (45). 

You might expect reference 45 to be a link to the HMRC data. It is not. Instead, it is a reference to a BMJ article by two minimum pricing campaigners, Nick Sheron and Ian Gilmore, both of whom were co-authors of the PHE report.

(45) Sheron N, Gilmore I. Effect of policy, economics, and the changing alcohol marketplace on alcohol related deaths in England and Wales. BMJ. 2016;(1860):353. 

The article does indeed make the following claim...

'UK alcohol sales increased from around 400 million litres in the early 1980s, peaking at 567 million litres in 2008, an increase of around 42%...'

It cites three sources for this: the British Beer and Pub Association's Statistical Handbooks of 2009 and 2013, and this HMRC webpage.

The most recent HMRC dataset does not go back further than 1999 but there is an archive which contains some figures going back to 1980. In Table 6 of the 2013 edition, it can be seen that 567 million litres of pure alcohol were sold in 2007/08, just eclipsing the previous high of 566 million litres recorded in 2004/05.

All good so far. However, these particular figures only go as far back as 1986/87 when 431 million litres were sold. There are no figures for 1980 that I can see. It is quite possible that only 400 million litres were sold in one of the recession years of the early 1980s, but I can see no evidence of it in the HMRC source provided.

But on the very same page, HMRC shows the amount of alcohol bought per adult. This is the relevant figure since the population has grown substantially since the 1980s. The figures are as follows:

1986/87: 9.53 litres

1990/91: 10.01 litres

2000/01: 10.50 litres

2004/05: 11.73 litres

2007/08: 11.47 litres

2012/13: 9.65 litres

Put in their proper context, it is clear that the recent peak in alcohol consumption arrived in 2004/05, not 2007/08. This is significant because it is central to Sheron and Gilmore's argument that consumption was rising until the alcohol duty escalator was introduced in March 2008, and Public Health England use exactly the same argument to call for higher alcohol taxes. It wasn't rising.

It also shows that current rates of alcohol consumption are very similar to those of thirty years ago. This is in direct contradiction to the headlines that were inspired by Public Health England's report, such as 'Britons are drinking 42% more than they were 30 years ago' (Daily Mail).

Other than propaganda, there is no justification for picking 2008, rather than the most recent year, as the benchmark date, nor is there any justification for looking at total alcohol sales rather than per capita sales. It is true that a record 537 million litres of alcohol were sold in 2007/08. It may be true that only 400 million litres were sold in 1980. But neither of these statistics mean anything unless they are put in the context of the fastest population growth in recent times.

To repeat: the per capita figures are on exactly the same page of the HMRC spreadsheet as the total sales. It is inconceivable that Sheron and Gilmore did not see them.

As for the question of how much we are drinking compared to 1980, we must turn to the BBPA statistical handbooks cited in Sheron and Gilmore's BMJ article. The most recent edition I have to hand (2014) gives the following figures for alcohol consumption per adult:

1980: 9.4 litres
1990: 9.8 litres
2000: 10.4 litres
2010: 10.1 litres
2013: 9.4 litres

We are, therefore, drinking exactly the same as we did in 1980. In fact, the figure dipped again in 2014 so we are drinking less. (Note that the BBPA define an adult as anyone 15 or over whereas HMRC define it as anyone 16 or over, hence the slightly different figures. HMRC also used financial years rather than calendar years.)

There is no particular reason to compare 1980's figure to 2008 but, for the record, the BBPA recorded 10.8 litres per adult in 2008, a rise of 15 per cent on the 1980 total, not 42 per cent.

At best, Public Health England have used an inappropriate measure of alcohol consumption to mask the fact that alcohol consumption today is lower than it was in 1980.

A world of pure imagination

From the Telegraph...

'Health by stealth' sugar tax could slash rates of childhood obesity by 10 per cent

The planned sugar tax could slash obesity among young children by 10 per cent and create “health by stealth”, experts from Oxford University say.

This is about Mike Raynor doing the Lord's work by producing yet another computer model that makes happy predictions about the sugar tax. You can read it here. As always, the words 'garbage in, garbage out' spring to mind.

If you wish to take such models seriously, that is your look out. Regardless of whether obesity rates rise, fall or stay the same, campaigners will produce another model in a few years claiming that the rate of obesity in 2018 was lower than it would have been had there not been a tax. That, too, will be treated as fact by their supplicants in the media. It is impossible to prove that nanny state policies fail. The goal posts are always moved. Scientific claims in 'public health' are unfalsifiable, which is to that they are not scientific.

But this blog post is not about the merits of predictive models. I am more interested in the media's response. The sugar tax study has been reported in virtually every mainstream media outlet in the UK with such headlines as 'Sugar levy is set to slash child obesity rates by 10%' (Daily Mail) and 'Sugar tax "will stop 10% of child obesity"' (The Times).

Evidently, a drop in childhood obesity of 10 per cent would be such big news that even a forecast suggesting it might happen makes it into every newspaper in the land. The clear implication from today's reports is that a 10 per cent decline would be a big deal and the sugar tax is therefore an important policy.

And that is rather strange, because on Tuesday the government published the Health Survey for England which contains all the official figures for smoking, drinking and obesity for 2015 (it always lags one year behind). It contains figures showing that between 2014 and 2015 there was a statistically significant decline in childhood obesity from 17.1 per cent to 14.0 per cent - a drop of 18 per cent. Among the 2 to 10 year olds whom the latest sugar tax study focuses on, the rate dropped from 16 per cent to 13 per cent - a decline of 19 per cent.

Since the sugar tax study used figures for 2014 as its baseline, the rate of childhood obesity has already fallen below what it predicted. Do you feel any better for it? Do you think your taxes are now going to be lowered as a result of obesity-related healthcare costs dropping?

You'd think there would be room in the news cycle somewhere for actual data, but I saw these figures reported nowhere. Insofar as the media reported the health survey, it was with stories about how children were less likely to smoke and drink than ever before. Obesity was not mentioned. The closest the Guardian came to mentioning the drop in childhood obesity was to say that 'child obesity remains stubbornly high', which hardly tells the whole story.

There is an element of fluctuation in these figures from year to year due to the sample size, and there is some suggestion that the 2014 figure was an overestimate (see graph below), but they are real figures, at least. They are not from a computer model.

Even if you ignore year-on-year changes and look at the longer term, it is clear that child obesity has fallen by much more than 10 per cent since its peak in 2004 and is only a couple of points above what it was 20 years ago. Why isn't this fact a cause for celebration while speculation about a lesser effect from the sugar tax is? Why do predictions about obesity get so much more coverage than actual rates of obesity?
  

Speaking of predictions, it is only two months since the Guardian - channelling the Obesity Health Alliance - predicted that obesity among low income boys was 'set to soar' to 43% by 2020. I have put my own money up for grabs for anyone who wants to bet that it gets anywhere close to 43%. The new health survey reports a drop from 27% to 20% in 2015 so it's looking good for me. It's only a shame nobody took me up on it.

And let's not forget the model in the Foresight report. Published in 2007, it predicted that the male obesity rate would be 36 per cent by 2015. This prediction was treated as gospel for years afterwards but this week the 2015 figure was finally published: it is 26.9 per cent. (The female figure was 26.8 per cent, but the Foresight prediction was less crazy for women; it predicted it would be 28 per cent. At the time the report was published, the rate was 24 per cent for both sexes.) Needless to say, none of the media who reported the original forecast have informed their readers that it turned out to be wildly off base.

The next milestone is 2030 when half of the adult population is supposed to be obese. As always, I will bet with anybody that it gets nowhere near this.

Time and time again in 2016 I have written about the 'public health' racket withdrawing into a world of pure imagination. The models have become more important than reality, not only for making predictions but also for remaking history. Obesity predictions get far more coverage than changes to the actual rates of obesity. Predictions about what sugar taxes might do get far more coverage than evidence about they actually do in places where they have been tried (ie. nothing). Regression models miraculously transform sharp increases in heart attack deaths into sharp declines and purport to show that policies save lives in places where lives have patently not been saved.

It is all very strange and rather discomforting. There is a narrative in place and mere facts cannot shift it. Unless you dig deep into Excel spreadsheets on government websites, you will not even find out about the most basic facts. If you rely on 'public health' campaigners and the media, there is a spiralling epidemic of childhood obesity and a sugar tax is needed to tackle it. It scarcely matters that the first of these claims is based on modelling that turned out to be wrong and the second is based on modelling that will, in all likelihood, also turn out to be wrong.   

Meanwhile, back in the real world, childhood obesity has dropped by 20 per cent in the last decade in Britain without a sugar tax but has not dropped at all in Mexico where there is a sugar tax. Never mind though, lads. Back to the models.

Public Health England's alcohol report: part 2

Last week, I wrote about the Public Health England report on alcohol which was released to the media with a lie that had to be retracted and which contained many more lies within. The report was shamelessly biased towards nanny state intervention and this is hardly surprising since the 'expert advisory group' and peer review team included the likes of Katherine Brown (from the organisation formerly known as the UK Temperance Alliance), anti-alcohol fanatic Ian Gilmore (Alcohol Health Alliance), Petra Meier (Sheffield Fantasy Modelling Club), Tim Stockwell (minimum pricing campaigner), Peter Anderson (temperance stalwart) and Gerard Hastings (socialist lunatic).

I covered some of the more egregious lies in the previous post. This post is about some of the other tactics used to mislead the public.

Doubt is their product

In common with the Chief Medical Officer's report in January, the PHE document embraces every epidemiological study that finds an association between alcohol and harm but treats the health benefits with extreme scepticism.

And so, for example, when it comes to the harms of drinking, findings from observational studies are considered to provide strong evidence.

There is strong evidence for an association between alcohol consumption and cancer including cancers of the oral cavity and pharynx, oesophagus, female breast, colorectum, larynx, liver, stomach, pancreas, lung and gallbladder. For certain cancers, including breast cancer, any level of drinking increases your risk so there is no ‘safe’ level of drinking.

But when it comes to the evidence that moderate drinking is good for health, epidemiological papers are no longer described as observational studies or cohort studies but become mere 'health surveys' and the authors emphasise all the problems that are inherent to this type of evidence. In particular, they focus on the zombie argument about 'sick quitters'.

Health surveys typically ask about current drinking levels and the classification of ‘non-drinkers’ can include former drinkers, occasional drinkers and people who have never consumed alcohol. This group of ‘non- drinkers’ is not a reliable comparison group as it may include individuals who never started drinking for a variety of reasons which may make them more susceptible to poor health (eg a lifelong disability), and former drinkers who may have stopped drinking due to poor health.

I've written enough about the tired old canard of 'sick quitters' so here's what the Department of Health working group said about it 21 years ago...

A key issue previously complicating the epidemiological data has been the so called “sick quitter” hypothesis outlined by Professor A G Shaper. This identified a number of relevant issues, but in particular it attributed higher mortality in people who did not drink to the effect of those who had given up drinking because of ill health. In addition, Professor Shaper has suggested that abstainers may carry a greater burden of ill health than drinkers and consequently never take up drinking, or that abstainers are constitutionally predisposed to high risk of disease, in contrast with moderate drinkers who are similarly predisposed to low risk of disease. However, a number of studies since 1987 have controlled for these factors so that we believe Professor Shaper’s reservations cannot be considered as a major explanation of the cardio-protective effect. Other confounding factors such as tobacco use, obesity, diet and age have now been controlled for in enough studies to allow us, on the basis of expert testimony, to be confident that the basic protective effect for CHD by alcohol is scientifically valid.

And when it comes to the benefits - but not the risks - of drinking, we are reminded that people underestimate the amount they drink.

Furthermore, health surveys generally underestimate alcohol consumption due to the exclusion or poor representation of people who are hard to access, less able to participate or do not live in private households in addition to inaccuracies in respondents recalling and reporting their drinking behaviour and problems with measurement error as people try to convert their consumption into units of alcohol or standard drinks.

People certainly under-report how much they drink. In many cases people may be drinking twice as much as they say they do. This should be of great interest to those who read the epidemiological literature and yet PHE are only interested in it in relation to the health benefits. They do not discuss to obvious implications for health harm, namely that people can drink considerably more alcohol before they assume the risks that are reported in observational studies.

Under-reporting makes the (already dubious) claim about there being 'no safe level' still more questionable. It suggests that the women who have a slightly elevated risk of breast cancer from light drinking are not drinking so lightly after all. And yet this point is never made in the report, nor do we hear about the significant confounding variables that affect studies of breast cancer. All we hear about is the ancient 'sick quitter' hypothesis that has been repeatedly shown to not be the explanation for lower mortality rates among moderate drinkers.

There are also big questions about the biological mechanisms that could explain how drinking causes cancer, especially in parts of the body that do not come in direct contact with alcohol, but the authors do not dwell on these questions except when talking about the benefits. And so we get weasel words like these...

There are no biological processes which have been robustly evidenced to explain the J-shaped curve effect.

That depends on what you call robust evidence. PHE do not elaborate on this point, but it is clear that they demand a far greater burden of proof when the benefits of drinking are involved. In reality, there are plenty of highly plausible biological processes that can explain lower rates of heart disease among drinkers.

When the government commissioned a group of non-partisan experts to review the evidence in 1995, they first of all concluded...

The epidemiological evidence alone linking alcohol and CHD [coronary heart disease] now makes the existence of a protective effect appear very likely. The written and oral evidence received by the Group confirmed that most of the technical epidemiological criteria for a causal association are now fulfilled.

And they had plenty to say about the biological process by which the J-Curve occurred:

5.6 Though a model of causation has not yet been established definitely, most of the evidence reflects increasing acceptance of biological explanations. It is established that the major physical cause of CHD is a life long deposition of fatty tissue in coronary arteries (atheromatous plaque). In addition, local coronary artery spasm and an increased tendency to form blood clots generate the symptom of chest pain (angina). These factors can lead to an acute narrowing or blockage of a major coronary artery and a clinical heart attack, leading to serious illness or death.

5.7 Atheromatous plaques consist largely of cholesterol. Cholesterol is transported in blood combined with specific proteins (lipoproteins) which affect its metabolism. CHD is mainly linked with low density lipoproteins (LDL) which carry 70% of plasma cholesterol. However, some forms of high density lipoproteins (HDO remove cholesterol from the surface of blood vessels. Put most simply it is acknowledged that a high ratio of LDL to HDL is associated with an increased risk of CHD mortality. Physical activity appears to raise HDL cholesterol but does not change LDL cholesterol levels. Alcohol, more than any other dietary factor, raises HDL levels in the blood. In addition, however, alcohol lowers LDL blood levels, and it has been speculated that it is through these lipoprotein cholesterol pathways that alcohol inhibits the formation of coronary artery atheroma.

5.8 Alcohol also directly affects advantageously a number of mechanisms associated with blood clotting and thrombosis. It has been found to reduce platelet stickiness and aggregation, to reduce fibrinogen and to increase fibrinolysis. Again, it has been speculated that through these mechanisms alcohol consumption directly reduces the likelihood of coronary heart disease.

Favouring low quality evidence and opinion over facts

The same exaggerated scepticism can be found when the authors look at other areas where the evidence goes against their tax-and-ban approach to drinking. Instinctively opposed to any solution that involves business, they go out of their way to dismiss the government's work with the drinks industry. They make brief mention of a Department of Health evaluation which found that the Responsibility Deal (which involved drinks companies watering down their products) helped reduce the nation's alcohol consumption by nearly two billion units, which is the twice the target of the 'billion unit pledge'.

In 2013, a Department of Health report evaluated the RD and concluded that between 2011 and 2013 the number of units of alcohol in the market reduced by 1.9 billion (286).

But the authors move quickly to cast doubt on this...

Low quality evidence suggests public-private partnerships involving voluntary pledges to reduce the number of units in the market are ineffective, given that most industry activity to reduce the number of units occurred regardless of the pledge. Furthermore, this activity related to the launch and promotion of new products, potentially increasing the size of the market.

There are two claims in the above paragraph that are little more than bald assertions. The idea that the size of the market is increased by the launch of more products is fanciful and the authors give no serious evidence for it other than the fact that it is 'possible'...

Reducing the number of units in an existing product is different to launching a new low-strength product. The latter potentially increases the total number of alcohol products on the market. It is possible people will then drink more as a result of increased product variety rather than switching from high-strength to low-strength products.

Moreover, the claim that the drinks industry would have launched lower-strength products in the absence of a voluntary agreement to do so is pure speculation. The authors admit that the evidence for this is of 'low quality' but that doesn't stop them treating it as fact when they get to their conclusion:

In conclusion, most alcohol pledge signatories appear to have committed to actions that they would have undertaken anyway, regardless of the RD [responsibility deal].

Oh, OK then. If you say so.

Incidentally, Public Health England is currently 'working with' the food industry to reduce sugar and fat content from food. When this happens, do you suppose PHE will claim that the food industry would have done it anyway?

While the authors treat their own hunches as fact, they cast doubt on the most patently obvious home truths when they do not suit their purposes. They want higher taxes on alcohol, for example, but higher taxes lead to substitution effects and illicit trade. How do they respond?

Cross-border trade, illicit trade and home production are other important phenomena that governments need to take into account when implementing taxation as well as pricing policies. However, there is a lack of data on the changes in alcohol price and tax avoidance and the illicit trade (201).

There will always be a 'lack of data' up to a point, but there is a wealth of evidence that taxation is a key driver of the illicit alcohol market and of the shadow economy in general. To not mention this is to lie by omission.

The report lies by omission a great deal. It cites a study that found a link between advertising expenditure and alcohol consumption but does not mention studies that have failed to replicate this. It mentions France's near-total ban on alcohol advertising but rather than look at whether the ban reduced underage drinking (which was supposedly the intention), the authors switch to various theoretical models which claim such bans work.

A reliance of models, particularly from Sheffield University, is a feature of the whole report. This is because the real world refuses to bend to dogmatic temperance fantasies such as the whole population approach which the authors mention as a theory at the start of the report...

Population consumption theory links population level consumption with alcohol-related harm and contends that overall consumption is directly, and dose-related to the level of alcohol-related harm in a population. As the consumption of a population increases, so does alcohol-related harm and vice versa. Contemporary alcohol policy rests on this fundamental assumption (1,37,38).

At least they admit that it is only a theory. However, by the end of the report it is being treated as gospel...

Given that alcohol-related harm is dose-related, population-level alcohol consumption can be viewed as an approximation of population-level harm (45).

When I wrote a report about the total consumption model with John Duffy in 2014, some alcohol researchers assured me that it was not central to alcohol policy and no one took in 'public health' too the theory literally. Just saying.

Given the lack of evidence for so many of their beliefs, the authors turn to the opinions of their mates. On alcohol advertising and self-regulation, they resort to anti-industry fanatic Anna Gilmore as their source for the following claim...

These tactics are similar to the strategies used by the tobacco industry, particularly the use of obfuscating tactics such as misrepresenting research evidence and using third parties and front groups to lobby government.

This is the kind of inflammatory claim you expect from a pressure group, not a government agency, but Public Health England has blurred the lines between the two. 

When the authors want to donwplay the effectiveness of current alcohol warnings (because they are the product of a voluntary agreement), they say this:

There is a general consensus among experts that alcohol labels have been poorly implemented and this may, in part, explain the finding that labels are ineffective in changing drinking behaviour (304,307).

If the citations are any guide, the 'general consensus' is the result of two anti-alcohol campaigners agreeing with one another. Reference 304 was written by Robin Room. Reference 307 was written by Tim Stockwell. Stockwell's article isn't even from a peer-reviewed journal.

With this 'consensus' in place, the authors turn to expert opinion on what alcohol packaging should look like:

With regards to health warnings, expert opinion informed by the experience of tobacco, suggests alcohol warning labels should be designed and implemented as follows (314):

- develop research to identify ‘direct’ and ‘evidence-based’ health warnings
- increase the visibility of the warnings
- incorporate pictorial health warnings
- consider plain packaging for alcohol products

'Expert opinion' here refers to the views of a single researcher, a doctoral student in occupational psychology called Mohammed Al-hamdani (reference 314).

I hope you spotted the reference to plain packaging, by the way. Quelle surprise.

The abuse of All Party Parliamentary Groups: booze and gambling edition

This week saw the publication of a report by the All Party Parliamentary Group (APPG) on Alcohol Harm in association with the soon-to-be-merged Alcohol Concern. The report sought to whip up hysteria about Booze Britain in the face of sharply falling rates of alcohol consumption and binge-drinking.To do this, they shunned official statistics and produced a report based almost entirely on anonymous anecdotes presented at their 'inquiry', thereby leading to a laughably unhelpful reference section at the back...

The main 'fact' that emerged from the report was that more than 70 per cent of weekend A & E admissions are caused by alcohol.

Over 70% of all attendances at A&E departments are alcohol related at weekends https://t.co/Feu0NyuVEt   @AlcoholConcern @UK_AHA

— UK Health Forum (@UK_HF) December 7, 2016

This statistic was dutifully tweeted by all the usual suspects, despite it being a contemptible, demonstrable lie. It is attributed to 'Source 12' in the report but is, in fact, a gross misrepresentation of a study of A & E departments in Newcastle which found that less than 20 per cent of weekend A & E attendances involved alcohol. I wrote about it when it was first misreported. There is not a shred of truth to the APPG's claim.

The media presented the document as a 'parliamentary report' and many readers will have assumed it was equivalent to a select committee inquiry. In fact, any group of MPs with a bee in their collective bonnet can set up an all party group about whatever they want and produce reports saying anything. They have no authority and its members cannot be assumed to have any expertise. Hence the report came with the following disclaimer:

This is not an official publication of the House of Commons or the House of Lords. It has not been approved by either House or its committees.

The truth is that the APPG on Alcohol Harm is the parliamentary puppet group of Alcohol Concern, just like the APPG on Smoking and Health is the puppet group of Action on Smoking and Health (ASH). The latter was set up by ASH in the 1970s and ASH is still the secretariat, just as Alcohol Concern is the secretariat for the alcohol APPG.

All party groups were never supposed to become fronts for special interests but that is what they have become.

Today, another APPG turned up with the 'findings' from their 'inquiry'. This time it was fixed odds betting terminals (FOBTs) in the cross-hairs and the APPG came to exactly the same conclusion as the pressure group that trades under the name 'the Campaign for Fairer Gambling' but whose real name is Prime Table Games.

The Times reports...

Cut betting terminal stake to £2, MPs demand

A cross-party group of MPs will today demand stricter controls on betting machines that allow punters to lose £300 a minute on casino games.

The fixed odds betting terminals all-party parliamentary group will publish the findings of a six-month inquiry into the machines.

Its report says that there is a “prima facie” case to cut the maximum stake of £100 a spin. It also urges ministers to slow the speed with which punters can make bets from once every 20 seconds.

What is the APPG on Betting Terminals? It was set up in April 2016 and its secretariat is a public affairs consultancy called Interel. Only five MPs are listed as members.

The APPG's associate members include BACTA, the trade association of the amusement arcade industry who are in direct competition with betting shops.

They also include the aforementioned Campaign for Fairer Gambling is also a member. Otherwise known as Stop the FOBTs or Prime Table Games, it was founded by casino tycoon Derek Webb. Its main political goal for the last few years has been to reduce stakes on FOBTs to £2 thereby making them unplayable for most punters.

Another member is the Hippodrome Casino, a fine establishment in central London which is also in competition with those who offer blackjack and roulette on electronic gaming machines.

Another member is Novomatic UK, a manufacturer of gambling machines that compete with FOBTs.

With the exception of the Hippodrome, all of these associate members gave the APPG £3,000 each to get started.

In addition, Interel Consulting UK provide benefits in kind worth between £10,501 and £12,000, which conveniently falls just under the £12,500 contribution level at which an APPG 'must prepare annual income and expenditure statements identifying the support received and the purposes for which it was used', according to parliamentary rules.

And who are Interel? They are a new name to me but it so happens that Adrian Parkinson of the Campaign for Fairer Gambling was working as a consultant for Interel 'offering advice and knowledge on gambling-related issues' when they decided to help set up the APPG. What a small world. Interel's clients include BACTA, the Hippodrome casino and Novomatic.

No wonder the bookies declined the invitation to give evidence at the APPG's rinky-dink 'inquiry'. The Association of British Bookmakers' response was commendably forthright for an industry body:

“We see no value in providing evidence to a group when the outcome of its inquiry has been pre-determined, and it operates as little more than a kangaroo court.

“The All Party Group is a club of anti-betting shop MPs, funded by amusement arcades and casinos with commercial interest in attacking betting shops.”

APPGs are supposed to be clubs for MPs who share an interest in a topic. I do not see why they require any external funding or outside control. From time to time, MPs raise concerns about how these groups operate but nothing ever seems to change. On the contrary, the problem of vested interests using APPGs to give a cloak of parliamentary respectability to their cause only gets worse.

Merry Christmas from the temperance lobby

It's that time of the year when the miserable killjoys of the taxpayer-funded 'public health' racket start counting down the days until Dry January. In the meantime they have to tolerate people eating, drinking and enjoying themselves over Christmas and New Year.

It's a difficult few weeks for them but they keep their spirits up by watching gruesome drink driving adverts and saying stuff like this...

Health experts have said that the office Christmas party should be scrapped in favour of no-booze leisure treats for staff.

Research carried out by charity Alcohol Focus Scotland believe staff get-togethers over the festive period can be both dangerous and embarrassing, and have had support from Alcohol Concern and British Liver Trust.

They found that as many as 200,000 people per day show up to work nursing a hangover and can take the entire morning to recover after a staff party. Alcohol Focus Scotland also highlighted that many drivers could be dangerous to other road users during the commute to work. 

Ebeneezer Scrooge, eat your heart out. These people are a parody of lemon-sucking puritans.

Alison Douglas, chief executive of AFS, instead believes that staff members should take trips to places such as the theatre, panto or bowling alley.

She said: “The impact of alcohol in the workplace can range from sickness absence, hangovers, accidents and injuries and lost productivity. “Many workplaces decide to do different things to the traditional Christmas night out, choosing to go bowling or to a panto or Christmas show, so drinking is not the focus.” 

Imagine being Alison Douglas. Just imagine it. Can we stop funding her vile organisation please?

Problem gambling: doubling and doubling?

Consider these three claims:

In 2004, it was predicted that the number of problem gamblers in the UK would double to 750,000 if the Gambling Bill became law.

In 2013, it was reported that the number of problem gamblers had doubled in the previous six years and had reached 450,000.

Last month, it was reported that the number of problem gamblers had doubled in the last three years and had reached 336,000.



How does the number of problem gamblers keep doubling without it increasing? Let's take a look...


Back in 2004, when that nice Mr Blair was trying to liberalise the gambling market, a prediction was made...

Public Health Association chairman Geoff Rayner said the number of addicts could double if the plans went ahead... He highlighted research by The Henley Centre, a strategic marketing consultancy, which estimated the number of gamblers could double to 750,000 people.

You don't need to be Carol Vorderman to work out that there were approximately 375,000 problem gamblers in 2004.

Mr Blair got his liberalisation (or most of it) and we have had gambling advertising on TV and a somewhat more relaxed approach to casinos ever since. We have also seen the rise of fixed-odds betting terminals and online gambling, both of which were supposed to drag us to perdition.

What happened next? The popular narrative is that there was an epidemic of problem gambling. Take this, from the Independent in January 2013, for example...

A huge increase in gambling addicts will make Britain's obsession with online betting a £2bn business. New evidence reveals that the number of people in danger of becoming problem gamblers has reached nearly a million, while hardcore addicts have doubled in six years to almost 500,000.

What the Independent calls 'hardcore addicts', the British Gambling Prevalence Survey calls 'problem gamblers' and it is the number of problem gamblers that was estimated in the 2010 survey. The Independent was citing that survey, although they exaggerated the number. As they note later in the article, the survey's mid-point estimate was 450,000.

So not actually a doubling, but still a rise, right? Not necessarily. The only firm conclusion drawn in the 2010 British Gambling Prevalence Survey was that there were between 254,900 and 593,400 problem gamblers in the UK. The wide gap between the low and high ends of the estimate meant it was uncertain whether there had been any rise at all since the previous survey of 2007.

Nevertheless, a narrative had been set in motion that problem gambling had doubled and it was all the fault of online gambling/fixed odds betting terminals/advertising.

Last month, The Times reported (not for the first time) that the number of problem gamblers had doubled again.

The number of people with a severe gambling problem has almost doubled to 336,000 in the past three years, according to the Gambling Commission.

 
But hang on a moment. 336,000 is less than it was in 2004 when Geoff Rayner made his gloomy prediction - and the rate of problem gambling has supposedly doubled twice since then.

Fortunately, there is a simple explanation. There are not enough problem gamblers for surveys to estimate the number with any precision. Since 1999, when the first survey was conducted, the rate has ranged from 0.3 per cent to 0.9 per cent of the adult population. The high of 0.9 per cent was recorded in 2010 and the low of 0.3 per cent was recorded in 2013. There is no pattern, no trend, but there is random fluctuation.

So this is what happens: when the rate appears to go up, the media report it. When it appears to go down, they don't. The Independent compared the 2010 estimate to the 2007 estimate. The Times compared the 2016 estimate to the 2013 estimate. Nobody compared the 2013 estimate to the 2010 estimate, but if they had they could have claimed that the rate of problem gambling had more than halved.

None of it means anything. In practice, the estimates have such wide confidence intervals (or margins of error, if you like) that one year's data is statistically indistinguishable from another. Give or take a few fractions of a percentage point, the rate of problem gambling in Britain is 0.5 per cent and has been ever since we started trying to measure it.

£52 billion cost of alcohol? The garbage keeps coming

The Public Health England alcohol report is so bad it would be hard to make it worse but the Guardian has managed it...

Alcohol-related crime, lost output and ill health costs UK £52bn a year 

Treasury urged to set minimum pricing to reduce alcohol-related harm as research finds cost to taxpayer is twice old estimate

No doubt the government is being lobbied to bring in minimum pricing, but apart from that every word of this is untrue. There is no new research in the PHE report, there is no £52 billion estimate, and the cost of crime, lost output and ill health do not come close to that amount.

The review was undertaken by Public Health England (PHE) and leading academic and medical experts on alcohol. It found that the true cost of alcohol-related harm, which had usually been cited as £21bn a year across the UK, has been “generally underestimated”.

The overall economic burden is due to be between £27bn and £52bn in 2016 (1.3%-2.7% of GDP), the researchers said.

This a rough approximation of what the PHE report says but, as I explained yesterday, the PHE report is riddled with misinformation.

The authors do indeed say that estimates of the external costs of alcohol range from 1.3% and 2.7% of GDP. In fact, there are only two estimates that are ever cited, both of which are more than a decade old. The most commonly cited study is a 2001 report for the cabinet office by Rannia Leontaridi which is the source of the £21 billion figure. This equates to roughly 1.3 per cent of GDP and PHE reference it correctly.

Leontaridi's estimate is often portrayed as the cost of alcohol to the taxpayer, but - as she made clear clear in the text - it is actually a combination of costs to public services and costs to individuals, including drinkers themselves. Moreover, some of these are 'emotional' costs, ie. non-financial. For example, she includes £12 billion as the cost of alcohol-related crime but this includes £4.7 billion of ‘emotional impact’ costs, £1 billion of lost productivity, £2.5 billion of costs borne by victims and £1.5 billion spent in anticipation of crime (eg. insurance, security systems). None of these are costs to the taxpayer.

Leontaridi's study is fine so long as you understand what she's measuring. Unfortunately, it has been willfully misinterpreted for the last fifteen years.

The other estimate that is occasionally cited is £55 billion. This must be the figure PHE are citing when they talk about 2.7 per cent of GDP, but it is impossible to be certain because they give no reference for it. The PHE report is so inept that it wouldn't surprise me if the authors don't know where it comes from.

They can almost be forgiven their ignorance. The source is so obscure that I doubt even many alcohol researchers have ever read it. It comes from a 2006 rapid review by the National Social Marketing Centre. It's never been in the public domain but I got the NSMC to send me it when I was writing The Wages of Sin Taxes a few years ago and I have put it online today so you can see what I'm talking about.

It's a shame that the NSMC report isn't better known because it contains moments of unintentional hilarity. My favourite bit is when include the UK's entire annual expenditure on'sports & fitness related products' and 'fat and low calorie food' as costs of obesity.

It is difficult to determine the proportion of expenditure on sports and fitness and on diet foods that can be attributed to obesity or fear of obesity. However, overall fitness and in particular a desire to lose weight or maintain weight loss may be a driving factor in the decision to join a gym or purchase diet food.

In 1999, the total value of the market for sports & fitness related products in the UK was estimated at £6.3bn (FCO 1999). Adjusting for inflation and country, this equates to £6.31bn across England in 2005. The market for reduced fat and low calorie food was estimated at £5.2bn in 2000, with an estimated growth rate (in cash terms) of 17.4% between 2001 and 2003 (Mintel International Group Ltd 2003). This equates to an annual growth rate of 8.4%. Adjusting for country, this means the market for diet foods is estimated at £6.70bn for England in 2005. Thus total household expenditure on sports and fitness and diet foods is estimated at £13.1bn across England in 2005.

This gives you a flavour of the whole report. Any study that portrays £13 billion of sports equipment and Diet Coke as a cost of obesity should not be taken too seriously.

The NSMC's cost of alcohol estimate isn't much better. It arrived at a figure of £48-50 billion but at some point this was upwardly adjusted for inflation and has been cited as £55 billion ever since.

Included in the NSMC figure is £8 billion that drinkers spend on alcohol! Their rationale, such as it is, is this:

The cost of alcohol consumption in England is £32 billion, approximately one third of total household expenditure on food and drink and about 6% of total consumer spending. Drinking of more than the guideline levels accounts for about 25% of all alcohol consumption. Heavy drinking men consume 2.5 times the mean level of male alcohol and heavy drinking women consume 4.5 times the mean level of female consumption. This means that families with one or more heavy drinker are likely to spend a high proportion of disposable income on alcohol. Estimating these costs as 25% of expenditure on alcohol amounts to £8billion.

If that doesn't make any sense to you then are you are thinking clearly. There is no justification in economics in including any part of private expenditure on a product as being a societal cost. Private expenditure is always exceeded by private benefits. You can't count one without counting the other.

And why stop at 25% of alcohol expenditure? Why not go wild and include it all? (Sure enough, when they get to their estimate of the cost of smoking, they include 100% of expenditure on tobacco.)

For reasons that I cannot understand at all, they then add £3 billion to their estimate for the tax paid by drinkers on 'excess alcohol'. This is wrong for so many reasons. Firstly, it's a transfer, not a cost. Secondly, it's private expenditure by drinkers. Thirdly, it's a Pigouvian tax that offsets external costs, it doesn't add to them. Fourthly, it's double counting because the tax is already included in the £8 billion of expenditure they've already (inappropriately) included.

Most of the rest of the NSMC estimate consists of 'intangible' (ie. non-financial) of £16 billion and private costs to individuals, including the drinker (£23 billion) and the authors are upfront about the fact that the study is not of external costs.

We have taken as wide a societal perspective on costs as possible. The costs primarily fall on individuals/families, although these are more difficult to measure, sometimes because of lack of any contact with formal agencies. 

So there we have it. A ten year old rapid review which includes costs that shouldn't be included and which is explicitly not an estimate of negative externalities.

And yet this is how the Guardian presents it...

Doctors are urging Philip Hammond to raise the price of alcohol to tackle the “scourge” of drink-related harm after it emerged that crime, ill health and lost productivity cost up to £52bn a year, far more than previously thought.

Hmm.

The review was undertaken by Public Health England (PHE) and leading academic and medical experts on alcohol. It found that the true cost of alcohol-related harm, which had usually been cited as £21bn a year across the UK, has been “generally underestimated”.

No one who has read the NSMC publication would suggest that it underestimated anything. PHE's claim that cost-of-alcohol estimates are too low is based on a lie, as I said yesterday. The PHE report says:

Few studies report costs on the magnitude of harm to people other than the drinker, so the economic burden of alcohol consumption is generally underestimated.

This could not not be less true. I seriously doubt whether the authors have read either of the studies they are obliquely referring to. They count every legitimate cost 'people other than the drinker' and then pile on a bunch of ineligible costs to both drinkers and and non-drinkers to arrive at a greatly inflated figure. 

In any case, there is no new study and no new estimate. Insofar as the Guardian's £52 billion figure has a source (PHE do not use this figure), it does not say what the Guardian thinks it says.