Friday 29 September 2017

"Completely mad" - Action on Sugar on Aseem Malhotra

How crazy do you have to be to get kicked out of Action on Sugar? Let's find out.

I'm grateful to Blair Spowart for sharing some e-mails between Action on Sugar and Public Health England which he received under the Freedom of Information Act. If you recall how closely PHE works with the UK Temperance Alliance (AKA Institute of Alcohol Studies) you won't be surprised to hear that PHE and Action on Sugar have a cosy relationship and exchange many e-mails. PHE appear to be using them as outriders for their sugar reformulation programme and, for reasons that have never been adequately explained, Action on Sugar - a pressure group - are invited to the meetings between PHE and the food industry.

But the most amusing correspondence involves someone whose name has been redacted but is quite clearly Aseem Malhotra.

When AoS was launched in January 2014, Malhotra was the group's scientific director and he was the smug little face of the organisation. But his relationship with the group gradually faded and he has been written out of AoS's history.

As others have noted, Action on Sugar's claims were hysterical nonsense from the outset. It takes a special kind of pseudo-scientific bullshit to get excluded from such company but Malhotra managed it by going off the deep end. Despite being a cardiologist, he recommends that people eat lots of saturated fat and avoid statins. He also reckons that exercising doesn't help people lose weight.

AoS have never spoken publicly about their divorce from Malhotra, but the FOI e-mails reveal what they think of him. In March last year someone from Action on Sugar wrote to PHE's Alison Tedstone to reassure her that Malhotra had nothing to do with the group...

It's not clear what the trigger for these e-mails was. At the time, Malhotra was all over the media claiming that 'type 2 diabetes is a condition of carbohydrate intolerance' and getting in trouble for a flawed (and retracted) journal article about statins. But he was in the media for all sorts of reasons, none of which were scientifically robust, so it could have been anything.

Things got worse in May 2016 when Malhotra and his new low carb chums released a ridiculous report with the National Obesity Forum telling the public: ‘Eat fat to get slim, don’t fear fat, fat is your friend'. It was near-fatal for the National Obesity Forum's credibility. Various board members walked out and the organisation released a statement saying:

The rest of the Board of the NOF wish to make it completely and transparently clear that they were not given the opportunity to see the document, or give any input into it and some members opinions differ from those specifically presented in the document.

On May 23rd, with PHE openly describing Malhotra's advice as 'irresponsible', Action on Sugar contacted the agency again to confirm that they had nothing to do with him. They not only said that Malhotra's report was 'ridiculous' but also noted that he was 'completely mad' on the issue of statins. He or she expressed relief that Malhotra had 'at least given up saying that he is a Founder Member of Action on Sugar, which was completely untrue'.

In fact, Malhotra still describes himself as 'Founding member and advisor to campaign group Action on Sugar' on his hilarious website and it seems to me that Malhotra has a decent claim for saying he was a founding member. He was certainly a member when it was founded - indeed, he was its scientific director - but it is understandable that MacGregor and his AoS colleagues want to distance themselves from him. With his thirst for fame, he has gone too far even for his fellow zealots. It seems that Action on Sugar now agree with what I said about Malhotra way back in April 2012 when I first became aware of him and wrote a piece entitled 'Aseem Malhotra doesn't know what he's talking about'.

Four years later, on the very same day that AoS e-mailed PHE to call Malhotra 'mad', I asked on this blog 'Is this the end for Aseem Malhotra?' and predicted...

Within a year or two Malhotra will be earning his living selling diet books and delivering cherry-picked presentations to credulous low carb cultists on cruise ships. Mark my words. 

His diet book came out a few weeks ago. I'm not aware that he has done any work on a cruise ship yet, but he is on the low carb conference circuit so it can only be a matter of time.

Martin McKee is wrong about the EU

In the last 18 months, fat socialist toad Martin McKee has been too busy wetting his knickers about Brexit to fully concentrate on his vendetta against vapers, smokers and drinkers. Nothing focuses the mind like a gravy train coming to a halt.

If there is anyone in 'public health' who voted for Brexit, they've kept it quiet. The EU is a perfect fit for the nanny state racket. They are both unaccountable, undemocratic, elitist projects that enrich themselves on the money of their victims.

McKee has teamed up with the overtly political Lancet magazine ('journal' is too respectable a word for it these days) to make the case for a soft Brexit, ie. staying in the EU. I haven't read the article and have no intention of doing so, but I've seen the press release and that was enough.

The NHS has benefitted from €3.5 billion in funds from the European Investment Bank since 2001...

That's less than £200 million a year. The NHS budget is currently £125 billion a year. Elsewhere in the article, McKee says that the £650 million we spend on healthcare for Brits abroad 'is marginal compared to the NHS budget'. Indeed it is. In any case, we are the ones who pay for the €3.5 billion that we 'benefit' from because our net contribution to the EU is a not-at-all marginal £8.6 billion a year. You don't need to be Carol Vorderman to work out that we would have more money to spend on healthcare if we left the EU.

But the main thing that caught my eye was this...

In terms of public health, the loss of the EU’s structures for managing public health pose a range of threats. For example, the UK relies on EU law for its tobacco policies, and the authors warn that without these the UK could become a prime target for the tobacco industry post-Brexit. 

This may play well with Lancet readers but it is simply untrue. The UK does not 'rely' on the EU for its tobacco policies. On the contrary, the EU is generally less draconian than Britain when it comes to anti-smoking, anti-obesity and temperance policies. Let's take a look at the UK's main tobacco policies:

Smoking ban - nothing to do with the EU
Plain packaging - nothing to do with the EU
Display ban - nothing to do with the EU
Ban on tobacco vending machines - nothing to do with the EU
Graphic warnings - now EU law but introduced by the UK years earlier and now superseded by plain packaging (see above)
Ban on smoking in cars - nothing to do with the EU
Advertising ban - nothing to do with the EU although a partial ban is EU law

The only anti-smoking policy that Britain has because of EU law is the ban on packs of ten cigarettes. If you extend it to anti-tobacco policies you could also include the ban on snus, although that only happened because the UK banned it first.

The ban on ten packs is stupid and counter-productive. The ban on snus is even more so. In a few years, member states will also have to ban menthol cigarettes thanks to EU law but that is the sum total of tobacco laws that Britain have had to implement as a result of Brussels. We have brought everything else on ourselves.

It is fair to say that British politicians didn't have much of a say on either the ban on ten packs or the looming prohibition of menthol cigarettes. Most of them seemed to have no idea they had been agreed in Brussels, including the Prime Minister. Whether they want to keep these laws after Brexit will be a decision for them. It will be easy to do since the Children's Bill is an enabling act that gives the health minister power to regulate tobacco without going through parliament. But all the other laws will stay in place even if we repeal both Tobacco Products Directives because they did not emanate from the EU in the first place.

So McKee is simply wrong. As usual.

Tuesday 26 September 2017

Chickens coming home to roost

The chickens have come home to roost in Australia. After spending years dismissing the warning that banning cigarette branding and setting tobacco duty at ludicrous levels would lead to a surge in black market activity, politicians down under are having to face the music.

Recent months have seen stories like this:

Old Erowal Bay man charged over alleged tobacco smuggling

A 32-year-old Old Erowal Bay man has become the fifth individual to be arrested as part of an extensive Australian Border Force (ABF) investigation into a tobacco smuggling syndicate in Sydney.

... On June 8, ABF officers intercepted a container originating from Malaysia declared as boxes of paper cups, however officers will allege the boxes contained more than 4.5 million cigarettes.

And this...

Australian tobacco executive bashed and stabbed in attempted kidnap

The attempted kidnapping, bashing and stabbing of an international tobacco company manager outside his family home in Sydney suggests crime syndicates are hitting back at efforts to combat the booming illicit tobacco trade.

The attack appears to be an unprecedented escalation in the struggle between policing agencies and the syndicates driving the illicit tobacco trade. Evidence suggests the attack was linked to BAT's support of police inquiries.

Police and big tobacco companies believe the illegal trade is driven by the escalating cost of legal cigarettes, and is now worth more than $1 billion. Budget measures mean a legal pack of cigarettes will cost $40 by 2020, compared with as little as $10 for a smuggled packet.

The bashed BAT manager had been working closely with state and federal agencies investigating the illicit trade, which is a huge source of income for organised crime syndicates in Melbourne and Sydney.

And this...

The Australian Border Force (ABF) has reported that in its first two years of operations it has stopped more than 400 tonnes of illicit tobacco from reaching the black market in Australia.

The ABF estimated the total duty evaded on the illicit tobacco at more than $294 million.

In the same period it said more than 100 individuals had been charged with tobacco smuggling.

Assistant Commissioner at the ABF, Wayne Buchhorn pointed to the recent arrest of two Chinese nationals following the detection of more than 7.4 million cigarettes at the Sydney Container Examination Facility.

The pair had allegedly attempted to conceal the cigarettes inside table tops.

Mr Buchhorn said illicit tobacco could be sold at more than 60 times its offshore price.

“Illicit tobacco is an increasingly attractive market to organised criminal syndicates due to the lucrative profits that can be made in evaded tax,” Mr Buchhorn said.

 And, indeed, this...

An Australian Border Force official has been nabbed over an alleged international tobacco ring operating between Sydney and Dubai.

... The arrests follow dawn raids on Tuesday when more than 570 AFP officers swooped on homes and businesses across Sydney.

"Unfortunately, during this operation, we have uncovered some allegations of corrupt activity, which this syndicate exploited to try and get their drugs into the country," AFP Assistant Commissioner Neil Gaughan said on Thursday. 


Tobacco smuggling ring busted in Sydney

Five men face serious criminal charges over their alleged roles in a tobacco smuggling ring after NSW Police seized 6.2 million cigarettes.


Illegal $9m tobacco crop destroyed in Vic

The destruction of a $9 million illegal tobacco crop in rural Victoria shows illicit growers they can't hide from the law, the Australian Taxation Office says.

The five-hectare crop was found at a property near Cobram on the NSW border in Victoria's north last week and subsequently destroyed.

The five tonne crop of tobacco leaves had an estimated street value of $9 million.

... It was the fourth operation of its kind this year and the ninth in Australia since last July, with almost $48 million worth of tobacco destroyed in that time.


Man charged after police find 4.8 million illegal cigarettes in Melbourne warehouse

A man has been charged with possessing 4.8 million illegally imported cigarettes with a street value of $2.5 million.

Australian Border Force (ABF) officers raided a warehouse at Dandenong, in outer south-east Melbourne on Wednesday, after receiving information from the Australian Criminal Intelligence Commission.

ABF said they found more than 4.8 million cigarettes hidden among glass bottles, with a street value of $2.5 million.


Australian Border Force smash Adelaide, Melbourne tobacco smuggling syndicate

A SOUTH Australian woman has been arrested for allegedly importing more than nine tonnes of illicit tobacco into Melbourne and Adelaide.


ATO seizes illegal tobacco crop worth $5.8m

An illegal tobacco crop with a potential excise value of $5.8 million has been seized from a central Victorian property.

Fifteen acres of tobacco plants were seized at a property in Macorna, between Durham Ox and Kerang, following an ongoing investigation into illegally grown tobacco.

And this...

Australian Tax Office helps police uncover illegal tobacco crop worth over $11m near ACT border 

An illegal tobacco crop worth more than $11 million has been discovered during a search by police and tax office officials of a property just south of the ACT border.

As many as 92,000 tobacco plants and two tonnes of tobacco leaves, along with $15,000 in cash, a shotgun and ammunition, were discovered during the joint operation yesterday morning, after a tip of from a member of the public.

I could go on, but you get the picture. The 'industry scare stories' have become very real and the Aussie government has belatedly set up a senate inquiry to look at the matter.

If you like a bit of schadenfreude, this article from the Saturday Paper will be up your straße. The man leading the inquiry is the 'Liberal' MP Craig Kelly who describes himself as a 'fanatical nonsmoker'...

“I have grave concerns that we’re trying to attack this issue through taxation,” Kelly says. “Like many things we do in government, the unintended consequences can be worse than the problems we’re trying to overcome.”

The Gillard government introduced plain packaging in 2012 and dramatically escalated tobacco excise, implementing yearly rises of 12.5 per cent each September 1 for the next four years. The Turnbull government extended the annual excise hikes in this year’s budget until 2020.

But there is growing concern about the increasing availability of cheap, illegal cigarettes, and the possible impact on smoking rates.

No kidding.

“We’re creating all these law-enforcement issues and we’re basically going down the track of prohibition by price,” he tells The Saturday Paper.

By George, I think he's got it.

And yet the article contains so many of the same delusions and idiocies that have got Australia into this fix that it is difficult to see how they are going to find their way out. Firstly, there is the government's refusal to work with - and use the resources of - the people who know the most about tobacco...

The [tobacco] industry also wants to expand co-operation with law-enforcement agencies. But the degree to which that already occurs has attracted some criticism because of World Health Organisation guidelines that the tobacco industry not be allowed to influence governments.

Earlier this year, the three companies asked the Australian Competition and Consumer Commission for permission to work together – normally a breach of competition law – to withhold their products from retailers found to also be selling cheap illegal tobacco.

But the ACCC refused, saying they could already do so individually without permission, and allowing collusion could be seen as giving them a “quasi-regulatory role”. It said such permission might be inconsistent with the WHO guidelines and “could create community perception of a partnership between the Australian government (and government agencies) and the tobacco industry”.

Then there is the pig-headed refusal of anti-smoking groups to accept simple facts...

In its submission to the tobacco inquiry, Cancer Council Australia says increasing excise is “the single most effective method available for reducing tobacco consumption, increasing attempts to quit and reducing smoking prevalence, thereby reducing death and disease caused by smoking”.

“Cancer Council Australia is not aware of any evidence suggesting that increases in excise in Australia have led to an increase in the size of Australia’s illicit tobacco market.”

There is, of course, masses of evidence to show that high taxes and excessive regulation drive activity in the shadow economy and there is specific evidence from KPMG about the Australian tobacco market which the anti-smoking lobby ignores based on nothing but an ad hominem...

The council rejects the findings of a 2016 annual report that the three big players commissioned from KPMG UK, which estimated the Australian federal government is missing out on $1.61 billion in tax each year. The health sector says the report is discredited because the tobacco industry funded it.

That's not quite how discrediting evidence works, is it? But shouting 'industry!' is like saying a magic word in the 'public health' racket. Say it and inconvenient facts disappear.

Finally, there is open contempt shown towards smokers by politicians...

Despite his concerns, Kelly acknowledges price should still play a role.

“You have to have some price pressure,” he says. “You have to have the strongest possible law enforcement. You’ve got to make lepers of those that smoke… make their lives horrible.”

With that kind of hateful attitude, it is hardly surprising that Australian smokers want to minimise the amount of money they give politicians via extortionate tobacco taxes. Thanks to the policies of recent governments there are plenty of latter-day Al Capones who are prepared to help them do so.

Tuesday 19 September 2017

Europuppets still thriving

I'm off on holiday for a week so I shall leave you with this, from a recent 'public health' conference organised by the European Public Health Alliance.

As I have shown many times, we already do. Take the EPHA, for example, which is overwhelmingly funded by the unwitting taxpayer.

'Following the guidelines of the EU Civil Society Contact Group and Alliance for Lobbying Transparency and Ethics Regulation in the EU, EPHA has calculated that it spent an estimated €300,000 in 2013 on activities carried out with the objective of influencing the policy formulation and decision making processes of the European Institutions.'

You won't be surprised to hear that 'public interest lobbying' means campaigning for more taxes, more bans and higher prices.

It's bad enough that these vile people are fighting to make us poorer and restrict our freedom but knowing that they're doing it on our dime is too much.

Monday 18 September 2017

Glantz's 'expanding tobacco epidemic'

From Stan Glantz's wacky blog...

More evidence that the US permissive policy environment for e-cigs is expanding the tobacco epidemic

Hong-Jun Cho, Lauren Dutra, and I recently published “Differences in adolescent e-cigarette and cigarette prevalence in two policy environments: South Korea and the United States” in Nicotine and Tobacco Research. This paper compares changes in e-cigarette and cigarette use in South Korea and the United States between 2011 and 2015. Korea has maintained restrictive policies on e-cigarettes whereas the US has left them essentially unregulated (a situation that the FDA will continue until at least 2022).

We found that In Korea adolescent e-cigarette use remained stable at a low level, whereas in the United States e-cigarette use increased. Most important, combined e-cigarette plus cigarette use declined in Korea whereas it increased in the US. The restrictive policies in Korea likely contributed to lower overall tobacco product use. These results are evidence against the claims that the availability of e-cigarettes is preventing youth from taking up cigarettes. They also add to the case that a permissive e-cigarette policy environment is making the overall nicotine/tobacco epidemic worse.

Wow, really?! Vaping is expanding the 'tobacco epidemic' among youngsters in the US?

*reads the study*

Cigarette prevalence (past 30 day) decreased in Korea from 12.1% (11.6–12.7) to 7.8% (CI: 7.3–8.3) and in the United States from 11.1% (9.5–12.6) to 6.1% (5.1–7.3). Combined prevalence of cigarette and e-cigarette use (adjusting for dual users) decreased in Korea from 13.2% (12.7–13.8) to 8.5% (8.0–9.1) but increased in the United States from 11.3% (9.7–12.9) to 14.0% (12.4–15.7).

It turns out that South Korea only has 'lower overall tobacco product use' if you pretend that e-cigarettes are tobacco products. The 'increase' in tobacco product use in the US also only exists if you make the same mad assumption.

Back on Planet Earth, the adolescent smoking rate in South Korea remains higher than in the US. The rate has dropped sharply among American youth since vaping became popular. It has dropped less sharply in South Korea.

So it's more pitiful junk science from Glantz and co. As you were.

Tuesday 12 September 2017

Last Orders - new episode

After a long break, Tom Slater and I are back with a new Last Orders podcast discussing all things nanny state. Our special guest is Claire Fox and we discuss the plastic bag tax, loony anti-obesity proposals and ten years of the smoking ban.

Listen here.

And if you're in a podcasty frame of mind, you can listen to me take on anti-sugar fanatic Graham MacGregor in this week's Spectator podcast.

Thursday 7 September 2017

A shoddy attempt to turn Big Alcohol into Big Tobacco

If you were involved in the revision of the UK's alcohol guidelines, you are the last person in the world who should be criticising others for misrepresenting evidence. As I've explained before, the benefits of moderate drinking were subjected to the full 'merchants of doubt' treatment by the Chief Medical Officer's guidelines committee. They blatantly cherry-picked the evidence, relying heavily on the work of one sceptic (Tim Stockwell) while raising a bunch of zombie arguments that have long since been debunked in the literature.

But 'public health' knows no shame and so Mark Petticrew, the activist-academic who helped lead the evidence review - and who told his colleagues what the conclusion was going to be before it had got started - has popped up today with a diatribe dressed as a study, claiming that the drinks industry 'appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer.' 

His evidence for this comes from the tried and tested quack methodology of doing a Google search and, er, misrepresenting the evidence. Written with three colleagues - although I'll just say 'Petticrew' in this blog post for brevity - he breaks the industry's alleged misrepresentations into several categories.

He starts with what turns out to be his strongest evidence. Under 'Denying, disputing or selectively omitting the relationship between alcohol consumption and cancer', he quotes the International Alliance for Responsible Drinking (IARD) and some Canadian organisation who say:

‘Recent research suggests that light to moderate drinking is not significantly associated with an increased risk for total cancer in either men or women.’  International Alliance for Responsible Drinking

'Some studies show a link between alcohol and breast cancer among both pre-menopausal and post-menopausal women. However, no causal relationship has been shown between moderate drinking and breast cancer.’ Éduc’alcool (Quebec)

The first of these quotes, from IARD, cites a BMJ study from 2015. The study actually does show an increase in total cancer risk from moderate drinking for women, but not for men. The IARD quote is badly worded, at best, and is all the stranger because they go on to explain the results of the study correctly in the sentences that follow (Petticrew doesn't quote that bit). The risks are extremely low, amounting to an increased risk of between two to four per cent, but they are not completely absent.

However, there is evidence from other sources that moderate and light drinkers do not have a higher cancer risk. Only last month a large American cohort study found that overall cancer risk was 0.89 (0.82-0.97) for light drinkers and 0.95 (0.85-1.05) for moderate drinkers. This means that light drinkers were significantly less likely to die from cancer in the study period. Nevertheless, the source used by IARD does not accurately reflect the statement quoted by Petticrew so it's 1-0 to him.

The second quote depends on what evidence you consider sufficient for a 'causal relationship'. Epidemiology famously cannot prove causation, but most authorities consider the statistical association to be good enough to infer it in this instance. On that basis, the Quebec organisation could be said to be 'disputing' the evidence, albeit no more than Petticrew and his chums have been disputing the much greater weight of evidence about the benefits of moderate drinking.

This is as good as the study gets as an exposé of industry 'denial'. Everything else in it is drivel, as we shall see. For the most part, Petticrew excoriates the industry for saying things that are patently true.

Under 'Distortion: mentioning some risk of cancer, but obscuring, misrepresenting or obfuscating the nature or size of that risk', he writes

It is commonly stated by these organisations (12/20 SAPROs) that the risk of some common cancers only exists for ‘heavy’, ‘excessive’ or ‘binge’ drinking. For example,

‘Cancer risk associated with the consumption of alcohol is related to patterns of drinking, particularly heavy drinking over extended periods of time.’ Australia, Drinkwise

In what universe is this stating that risk 'only' exists for heavy drinkers? If Drinkwise had meant to say that, they would have done so. As it is, the use of the word 'particularly' clearly implies that there is risk, albeit less risk, for non-heavy drinkers.

Similar statements also appear on the IARD website, such as ‘In general, alcohol-associated cancers have been linked with heavy drinking’ [27].

The scientific evidence suggests that such statements are misleading (Table S1), because the increased risk of some common cancers, such as breast, oesophageal, laryngeal, mouth and throat cancers and cancers of the upper aerodigestive tract, starts at low levels of consumption, even though it is low at those low levels [7,8] (see also Table S3).

Like the Drinkwise quote above, the IARD statement is true. Cancer risk is clearly related to patterns of consumption and heavy drinkers have a greater risk than light drinkers. IARD's report Drinking and Cancer provides five academic references to support this.

It is an indisputable facts that some cancers, such as liver cancer and possibly pancreatic cancer, are only associated with alcohol if you're a heavy drinker. For those cancers which are linked to moderate consumption, risk is significantly greater for heavy drinkers. Neither of the sources quoted above suggest otherwise, and the IARD document explicitly discusses the cancers that are - or might be - linked to light/moderate consumption.

It should also be noted that in the press release for this 'study', Petticrew says:

'It's important to highlight that if people drink within the recommended guidelines they shouldn't be too concerned when it comes to cancer.'

If IARD had said that, he would doubtless condemn them for downplaying the risks or being 'misleading'.

He continues:

Other industry claims (from three organisations) relate to disputation of the mechanisms, or involve claims about the consistency of the evidence, as in these examples:

‘Recent studies indicate a dose-response relationship between alcohol consumption and breast cancer, although this relationship was not evident in some past studies.’ IARD [27].

‘All the studies show that the knowledge about the causes of breast cancer is still very incomplete and as scientists from the National Institute on Alcohol Abuse and Alcoholism in the USA recently pointed out, some other (possible confounding) factors have not been considered in the research relating the consumption of alcoholic beverages to breast cancer.’ Wine Information Council [28].

This is also a feature of SABMiller materials:

‘The mechanism by which alcohol consumption may cause breast cancer is not fully known.... The relationship... is undergoing vigorous research... If and how these two factors may interact and affect risk is not completely known.’

All of these are uncontroversial statements of fact and plenty of non-industry sources echo them.

Here is the American Cancer Society, for example:

Exactly how alcohol affects cancer risk isn’t completely understood. In fact, there might be several different ways it can raise risk, and this might depend on the type of cancer.

And here is Cancer Research UK:

According to Dr Ketan Patel, a Cancer Research UK expert on how alcohol causes cancer: “We don’t really know. We don’t fully understand why alcohol causes some cancers and not others.”

Petticrew says that statements like this are examples of the industry tactic of 'Claiming or implying that, as knowledge of the mechanism is incomplete, the evidence of a causal relationship is not trustworthy'. That's rich coming from him. The alcohol guidelines review repeatedly cast doubt on the benefits of moderate drinking by falsely claiming that there is a 'lack of well evidenced biological processes that could explain the effect' and then presenting this as proof that the benefits do not exist at all.

Petticrew pulls exactly the same trick in his little polemic when discussing non-Hodgkin lymphoma which has been inversely associated with alcohol consumption. Keen to dismiss any benefits from drinking, he quotes an authority saying that 'there is no immediately obvious mode of action that could explain the association.'

But there is a difference between what Petticrew does and what the industry and cancer charities quoted above are doing. They explicitly state that the risks are real but that the causal mechanisms are not fully understood. Petticrew, by contrast, is claiming or implying that, as knowledge of the mechanism is incomplete, the evidence of a causal relationship is not trustworthy.

Petticrew then mentions the Portman Group...

The Portman Group’s response to the consultation on the revised UK guidelines (issued in 2016) includes a section in which the evidence is disputed, referring to protective effects. It refers to the ‘increased risk of a small number of cancer types’ and states: ‘Different levels of alcohol consumption have a range of effects on cancer risk including no impact on the majority of cancers, and in some cases, an inverse relationship.’ [11]. As well as misrepresenting the evidence, this statement is misleading as it confuses the number of different ‘types’ of cancer, with the risk of specific cancers.

Again, everything the Portman Group says here is true. The press release that accompanies Petticrew's article correctly notes that alcohol 'accounts for about 4% of new cancer cases annually in the UK.' There are more than 100 different types of cancer and IARC has established that alcohol consumption could cause seven of them: 'cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver (hepatocellular carcinoma) and female breast.' They also noted that 'an association has been observed between alcohol consumption and cancer of the pancreas'. But that's it.

It is reasonable to describe seven out of 100 as a 'small number' and it is indisputable that alcohol has 'no impact on the majority of cancers'.

It is also true that an inverse relationship between alcohol consumption and a few forms of cancer, including renal cancer and non-Hodgkin lymphoma, has been repeatedly found in epidemiological studies. Petticrew asserts that there is a 'lack of evidence for protective effects of alcohol consumption on cancer'. An unbiased reader who reads the meta-analyses (see links in previous sentence) might conclude that he sets the bar of proof higher for evidence that shows benefits than for evidence that shows harm.

The Portman Group is neither 'misrepresenting' nor 'disputing' the evidence. Petticrew chooses not to quote from page 20 of Portman's consultation response in which they explicitly say:

'The relationship between alcohol consumption and increased risk of certain cancers is clear and we believe it is important consumers are aware of this.' 

Moreover, the sentence immediately before the one Petticrew quotes (beginning 'Different levels...') says:

'We fully accept the evidence on the links between alcohol and certain types of cancer.'

Under 'Distraction: focussing discussion away from the independent effects of alcohol in increasing the risk of common cancers', Petticrew cites the following examples of the industry saying things that are 'potentially misleading':

‘Not all heavy drinkers get cancer, as multiple risk factors are involved in the development of cancers including genetics and family history of cancer, age, environmental factors, and behavioural variables, as well as social determinants of health.’ Australia: Drinkwise [26].

‘Alcohol has been identified as a known human carcinogen by IARC, along with over 1,000 others, including solvents and chemical compounds, certain drugs, viral infection, solar radiation from exposure to sunlight, and processed meat.’ IARD [27].

‘For example, the fact that you are female is a risk factor in developing breast cancer. We also know breast cancer is age-related so you’re more likely to develop it as you get older and that you’re more prone to breast cancer if it is part of your family history. These are all factors beyond our control. We also know that risk is related to the ‘hormone environment’ that women experience during the course of early pregnancy, child birth and breastfeeding which all exert a protective effect.’ Drinkaware, UK [32].

These are mundane statements of fact. It seems that Petticrew won't be happy until the alcohol industry's only health message is 'IF YOU DRINK, YOU'LL DIE!!! GET AWAY!!!'

In fact, these 'industry messages' are not very different from that of the Committee on Carcinogenicity, who say:

Drinking alcohol has been shown to increase the risk (or chance) of getting some types of cancer. This does not mean that everyone who drinks alcohol will get cancer, but studies have shown that some cancers are more common in people who drink more alcohol.

The Drinkaware discussion of breast cancer is similar to what you will find on Cancer Research's webpage about breast cancer. Although Petticrew doesn't mention it, the quote he uses is from Professor Paul Wallace, an epidemiologist with an impressive CV in alcohol research, who is Drinkaware's Chief Medical Advisor. The full quote runs as follows:

Professor Wallace says it’s important to put this risk into context. There are many other factors which increase the risk of developing breast cancer. “I often sit down with my patients and explain that there are certain factors we can do nothing about,” he says. “For example, the fact that you are female is a risk factor in developing breast cancer. We also know breast cancer is age-related so you’re more likely to develop it as you get older and that you’re more prone to breast cancer if it is part of your family history. These are all factors beyond our control."

There is a lot that Petticrew could have quoted from that Drinkaware webpage but didn't, presumably because it wouldn't fit his narrative of an industry cover up. For example:

When asked to name the main health effects of drinking too much alcohol, many people will first say liver disease. Others will mention heart disease. Some will name mental health issues. Cancers are often low down on the list.

But they shouldn’t be – especially breast cancer.

It is clear from a number of large scale studies that there is a link between alcohol consumption and cancer. Globally, one in five (21.6%) of all alcohol-related deaths are due to cancer. Breast cancer is the most common cancer among women and second only to lung cancer as a cause of cancer death in women.

Professor Paul Wallace, Drinkaware’s Chief Medical Advisor, believes that more people should know that alcohol can increase women’s risk of getting breast cancer.

I challenge any reasonable person to read this - or, indeed, any Drinkaware literature - and claim that the organisation is trying to downplay or deny the risks of drinking. I was on a Drinkaware panel once. They are basically a temperance group. Only a lunatic could think otherwise.

Petticrew says that there are 'two particularly frequent areas of misinformation', namely breast cancer and colorectal cancer. As evidence, he goes back to the Portman Group...

The Portman Group’s response to the UK guidelines includes a section on breast cancer, in which the evidence is disputed. For example, it states that ‘studies associating moderate alcohol consumption are contradictory’.

Is the evidence 'disputed' by the Portman Group? No, it is not. Here is what the Portman Group actually said in their consultation response:

A percentage (6%) of all breast cancer cases in the UK is attributable to alcohol - the links between alcohol consumption and breast cancer are clear and it is right that consumers are made aware of the risks.

As for the studies being 'contradictory', there is some truth in this, but it is not the Portman Group saying it. The Portman Group were only quoting some (reputable) scientists who said:

'Since studies associating moderate alcohol consumption and breast cancer are contradictory, a woman and her physician should weigh the risks and benefits of moderate alcohol consumption.'

Petticrew misquotes this and wrongly attributes it to Portman, which is sloppy at best. In fact, the point being made by the Portman Group is that risks should be explained in a meaningful way. This is not controversial. Cancer Research UK have made an effort to explain breast cancer risk in absolute, rather than relative, terms. John Holmes made a similar point in a journal article this week.

Nevertheless, Petticrew repeats his false claim about Portman disputing the evidence, saying: disputing the evidence on increased breast cancer risk, the Portman Group document does not reference the IARC reviews, other systematic reviews, nor the Committee on Carcinogenicity review.

Not only is the initial claim a lie, but the claim about references is also a lie. The Portman Group document cites the Committee on Carcinogenicity reports several times and uses it as a source for a table which shows 60,000 breast cancer cases a year, of which Portman says alcohol causes 3,600 (see below).

This is a strange way of 'disputing the evidence'.

What is the point of all this flim-flam? Regular readers will have probably guessed. It's all part of creating a narrative of alcohol being the new tobacco and Big Booze being the new Big Tobacco. And he's good the headlines he wanted.

If you want to know why a 'public health' study has been written you have to head straight to the 'discussion' section where it all comes out...

The most obvious parallel is with the global tobacco industry’s decades-long campaign to mislead the public about the risk of cancer, which also used front organisations and CSR activities to mislead the public.

...These findings therefore have significant implications. They provide evidence that the AI [alcohol industry], like the tobacco industry, misleads the public and policy-makers about the cancer risks of their products. Our findings are also a reminder of the risk which accompanies giving to the AI the responsibility of informing the public about alcohol and health.

...some public health bodies, academics and practitioners liaise with the industry bodies included in this study, for example by acting as advisors or trustees, or by collaborating with them in implementation activities. Despite their undoubtedly good intentions, we suggest that it is unethical for them to lend their expertise and legitimacy to industry campaigns which mislead the public about alcohol-related harms.

The AI, unlike the tobacco industry, still has significant access in many countries to government health departments. It is also active in the international policy arena, with, for example, partner or stakeholder status at World Health Organization and United Nations meetings relevant to alcohol, on occasions when the tobacco industry is excluded. This study shows that the AI uses similar tactics to the tobacco industry, to the same ends: to protect its profits, to the detriment of public health.

There you have it. Petticrew is none-too-subtly telling academics to back away from the alcohol industry if they want to keep their reputations intact in the coming war on drink. He is also sending a signal to politicians that industry always lies while anti-alcohol campaigners, such as himself, are trustworthy. And he is telling governments to lock drinks companies out of the political process as has happened with tobacco under the Framework Convention on Tobacco Control.

Petticrew gets to this conclusion by saying things that are not true and denying things that are true. His study uses sleight of hand, evasion and downright misrepresentation to create a false narrative that falls apart as soon as you look at the primary sources. He does precisely what he accuses the industry of doing: selectively quoting from research in order to mislead, lying by omission, and making claims that cannot be supported by the weight of evidence.

For all of Petticrew's bluster, the drinks industry is dominated by massive, blue-chip companies with who would get sued if they lied about the harms of drinking. 'Public health' academics have no such incentive to stay honest.

Not for the first time, Petticrew has started with a conclusion and scrambled around for evidence to support it. When he failed to find any evidence, he wrote what he was going to write anyway. If the 'public health' movement had any integrity, the man would be a pariah.

Spectator - obesity edition

I've got an article in tomorrow's Spectator about the government's doomed attempts to control people's waistlines. It's online now...

James Cracknell, the athlete turned anti-obesity campaigner, was the subject of sniggering and derision in April when he said that North Korea and Cuba had got a ‘handle on obesity’. With impressive understatement, he attributed this to both countries being ‘quite controlling on behavioural trends’. It was a bad point poorly made, but in a roundabout way he drew attention to the major obstacles faced by those who want to reduce obesity rates in the rest of the world: freedom and affluence.

Do read it all and also have a listen to the Spectator podcast in which I debate the issue with Graham MacGregor (Action on Sugar/Salt) and Francesco Rubino (KCL).

Wednesday 6 September 2017

Spanish smoking ban miracle

It is with a heavy heart that I must inform you that someone's written another yet smoking ban miracle study.

This time it comes from Spain where a partial ban was introduced in 2006 followed by a 'comprehensive' ban in 2011. The authors look at these two dates and study two types of hospital admission (for asthma and COPD), thereby giving themselves four bites of the cherry to find a correlation.

They pooled a bunch of hospitals together and came up with this mess of inconsistent and contradictory results:

Can you see clear evidence of hospital admissions falling after either of the bans? Neither can I, but the authors claim that the following findings emerged:

The partial smoking ban was associated with a strong significant pooled immediate decline of 14.7% in COPD-related admission rates...



There was no subsequent effect of the comprehensive ban on COPD-related admission rates...


But for asthma, it was the other way round...

Asthma-related admission rates increased by 12.1% immediately after the partial ban...


...but decreased by 7.4% after the comprehensive ban.


This is pretty much the definition of a mixed result. Can you guess how it was written up in the abstract?

The partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men. 

If you guessed they would ignore the null and negative findings and focus only on the positive findings then give yourself a pat on the back. You know them too well.

Let's try to get our heads around this, shall we? The underlying assumption here is that smoking bans reduce hospital admissions by reducing exposure to secondhand smoke. If so, it seems that the partial ban was so successful in reducing secondhand smoke exposure that it reduced COPD admissions by 14.7 per cent. This is pretty bloody impressive when you consider that COPD is a chronic disease that takes decades to develop and which mostly affects smokers.

But despite the miraculous effect on COPD, the partial ban had the weird effect of increasing admissions for asthma by 12 per cent, although you can see from the graph above that there were about the same number of admissions after the 2011 ban as there had been in 2003 when there was no ban of any kind. And when it came to the comprehensive ban, asthma rates fell but COPD rates didn't.

Does any of this seem plausible? Does it make a lick of sense? I would suggest not.

It is sheer garbage. Manifestly so. The best result these jokers can produce is a fall in COPD admissions during a partial ban. That ban must have done a hell of a job of reducing secondhand smoke exposure, huh?

Well, no. Not according to the authors of the Tobacco Control Scale who celebrated the introduction of 2011's comprehensive ban by saying:

The 2005 so-called Spanish model (weak smokefree legislation in bars and restaurants), praised by the tobacco industry, is finally dead. In 2010 Spain adopted far reaching and comprehensive legislation on smokefree bars and restaurants.

The same authors had previously described the 2006 ban as 'weak and ineffective, and a study of it published in 2009 concluded that:

Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels.

And yet this 'weak and ineffective' legislation had a massive effect on COPD admissions whereas the 'comprehensive legislation' five years later did diddly-squat. The miracle becomes more confusing when you consider that the ban which reduced COPD admissions somehow increased the number of asthma admissions.

This data-dredging bilge makes no sense on any level. Even if you accept the authors' prior beliefs about secondhand smoke, it defies all logic. The authors don't even attempt to explain the contradictions and yet this utter drivel got published in a peer-reviewed journal, just like all its ludicrous predecessors got published in peer-reviewed journals. It is beyond a joke.

Tuesday 5 September 2017

Did the smoking ban make the number of childhood chest infections plummet?

From The Herald...

Smoking ban sees child chest infections plummet

Really? I may be jaded from years of bitter experience but I suspect that this claim is going to turn out to be bullshit.

Children needing hospital treatment due to chest infections may have dropped by as much as a fifth since anti-smoking laws were introduced, research suggests.

A study led by the University of Edinburgh and the Erasmus University Medical Centre in the Netherlands combined data from 41 papers in countries where tobacco control policies have been introduced.

The figures suggest rates of children requiring hospital care for severe chest infections have dropped by more than 18% since bans were introduced.

OK, so it's a meta-analysis and, as the BMJ says, it's looking at admissions for lower respiratory infections.

Hospital admissions of children with lower respiratory tract infections have fallen by 18.5% since the public smoking ban and 9.8% fewer children have attended hospital for severe asthma exacerbations, research published in the Lancet Public Health shows.

The BMJ implies that the findings are specific to Britain whereas they are sourced from various junk studies from various countries, but what applies to one country should apply to all and claims have been made in the past about childhood hospital admissions for lower respiratory infections falling by 13.8 per cent in England after the smoking ban was introduced.

So let's see if it's true shall we? Here's something you can do at home. It's called 'fact checking' and at one time journalists were rumoured to have done it.

Here is the NHS database of hospital admissions.

There you will find 'Emergency admissions for children with lower respiratory tract infections (LRTIs)'.

Click on that and you will get a spreadsheet showing the number of admissions in each financial year for the whole of England between 2003/04 and 2015/16. You can also get the standardised ratio figures.

Chart them on a graph and you will see this. Note that the smoking ban started in 2007.

As I suspected, then, it's bullshit.

Supermarket alcohol: a Giffen good?

The Institute of Temperance Studies - or whatever they call themselves now - published the results of a survey of publicans last week that showed that they want lower tax on pub booze and higher tax on supermarket booze. Fancy that!

It also showed support for minimum pricing. We have seen before that some of the more short-sighted PubCos are happy to get into bed with the temperance lobby on this issue because they think it will benefit them. I think they are mistaken. It would be a disastrous mistake in the long-term to hand the price mechanism to the state and there would be no short-term benefit. Indeed, there is likely to be a short-term cost, as I explain at Spectator Health today...

If the price of food in supermarkets rose by 50 per cent, no one would predict a surge in demand for expensive restaurants. On the contrary, higher supermarket prices would make consumers eat out less to save money for groceries. So it is with alcohol. Consumers are well aware that pub prices are higher than supermarket prices. If pubs were no more than an alternative location in which to buy alcohol, everybody would go to the supermarket and the pubs would be empty.

Pubgoers are buying much more than a drink. They are buying an experience, with ambience, company, service and entertainment. There is no doubt that some consumers would prefer to drink at home less and visit the pub more, but they are unable to do so because of high prices in the off-trade. But minimum pricing is not going to make a pint in a pub cheaper. It is just going to leave people who buy alcohol in supermarkets with less disposable income. Unless these people have a highly inelastic demand for pubs and a highly elastic demand for alcohol – a strange combination of preferences – they will need to cut expenditure elsewhere to maintain their alcohol intake. Buying fewer drinks in the on-trade is one way of doing this.

Monday 4 September 2017

Send ASH to prison

Mystic Debs does it again - from New Scientist

There is no better way of predicting the future than listening to what Action on Smoking and Health (ASH) have to say and preparing for the exact opposite. Whether they are claiming that high taxes don't cause smuggling, or that smoking bans are good for pubs, or that it makes economic sense for shopkeepers to stop selling cigarettes, the truth can invariably be found by turning their statements at an angle of 180 degrees.

So when prison officers saw this in 2015, they should have been reaching for the tear gas...

Deborah Arnott, chief executive of charity Action on Smoking and Health, said there was no evidence to support claims that depriving prisoners of tobacco could lead to riots.

In a New Scientist article headlined 'I don't predict a riot', Arnott said:

... every time the idea of a ban is raised in the media, the headlines inevitably focus on fears of unrest and riots, rather than the health and wellbeing of inmates and staff.

The hypothesis that depriving smokers of tobacco could destabilise prisons may sound plausible, but there is little evidence to back it up.

As always in 'public health', there is a big difference between what they call 'evidence' and what happens in the real world. There have been numerous prison riots caused by smoking bans, such as those in Quebec in 2008, Kentucky in 2009, Florida in 2013, Queensland in 2014,  Melbourne in 2015 and Victoria in 2015 (the last of these received global news coverage and occurred a month before Arnott's article was published).

Arnott claimed that...

Psychiatric premises, including high-security facilities such as Broadmoor, went completely smoke-free in 2008, without any trouble.

Even this is not true. The smoking ban in psychiatric facilities immediately caused a riot at Ashworth Hospital. And most psychiatric facilities still allow smoking outdoors, although ASH are sadistically working to close that 'loophole'

Over the next few months, a total smoking ban will be 'phased in' across the entire prison estate, indoors and out. They're starting with the Category B and C prisons before moving on to the more problematic high security prisons. Those who know the prison system say that a ban will face the biggest challenges in Category A prisons, but it turns out that banning smoking in Category B and C prisons is not a breeze either.

We want burn!' Rioting prisoners 'demand tobacco' at Birmingham prison with 'one wing lost' as anti-riot teams prepare to storm jail

This follows reports reports in July of a smoking-related riot at Drake Hall Women’s Prison and a nine-hour riot at a Category C prison in Cumbria last month.

These reports only scratch the surface of the trouble caused by banning smoking in prison. A prison riot has to be big before it gets reported in the national press (which usually means something has to be on fire) and sometimes the media will not mention the fact that the smoking ban was the cause - as the BBC's article about the Birmingham riot didn't.

And riots are only the most visible part of the problem. The rise in violence and the increased significance of tobacco as a prison currency are the more persistent problems that plague prisons after bans are introduced. As one prisoner says in this interesting article...

'You've got your violence that'll happen at the start, these riots, that'll die down. You've got your violence that'll come with making baccy contraband – that'll become a way of life.'

It seems to be that since Deborah Arnott and her ASH colleagues have been the main force lobbying for a ban on smoking in prisons, they should be sent into a few jails to explain to the prisoners why they believe it's for their own good. HMP Birmingham would be the ideal place to start.

PS. It appears from the letter below that the prison service did not conduct a risk assessment before introducing the ban (click to enlarge). I guess Arnott's glib assurances were sufficient.