Thursday, 18 October 2018

Taxpayer-funded pressure group wants higher taxes

The Public Health (Alcohol) Bill passed in Ireland two weeks ago. Temperance lobbyists around the world are drooling in anticipation because it includes many of their favourite neo-prohibitionist policies, notably minimum pricing, cancer warnings, severe advertising restrictions and a display ban of sorts.

For the sake of Irish consumers, I'd sooner this law hadn't been passed but the consolation is that I can watch these wrong-headed policies fail. I doubt that many small shops will bother with the booze burqa and the Irish government will spend years battling the EU over mandatory health warnings.

Irish nanny statists were hoping that Northern Ireland would bring in minimum pricing at the same time as the Republic, but there's no government in Northern Ireland so that won't be happening any time soon, and with the unit price set at €1 (88p)* there will be plenty of activity over that precious soft border.

Loyal readers will recall that the Public Health (Alcohol) Ireland Bill was sold to the public by Alcohol Action Ireland, which is almost entirely funded by taxpayers. In case the sockpuppetry wasn't obvious enough, they set up another group - the Alcohol Health Alliance - which was specifically and explicitly created ‘to support the Public Health (Alcohol) Bill’. In addition to writing submissions to government as ‘an independent [sic] voice for advocacy and policy change’ and promoting the legislation in the media, Alcohol Action Ireland set up a webpage which enabled its supporters to lobby their parliamentary representative with a standardised e-mail (‘I urge you to please support the implementation of the Public Health (Alcohol) Bill, in full’ etc.). In 2016, Ireland’s Department of Health gave Alcohol Action Ireland an additional €75,000 ‘to engage with the EU to build support for the Public Health (Alcohol) Bill’.

Government lobbying government doesn't get more blatant than this. The money given to these campaigners by government was, as one Irish politician noted 'a circular kind of transaction'.

Despite the British government's anti-sockpuppet grant standards, sockpuppetry remains rife in Britain too, especially in the local and devolved governments (where the clause doesn't apply). Take Balance Northeast, for instance. Wholly funded by the hard-pressed taxpayers in the north-east via 14 local authorities, they produced a press release today in advance of the Budget:

Strong support for higher alcohol taxes to help fund public services

New figures released today show that nearly half (49%) of North Easterners support increasing alcohol taxes if the money raised went into funding public services impacted by alcohol use, such as the NHS and police.

So less than half of North Easterners support increasing alcohol taxes even if they are told that the money will be hypothecated for the NHS and police, which it won't be. Not exactly a thumping mandate, but Balance commissioned the survey and had to make the best of it.

A better question might have been 'Would you support using more of the £13 billion drinkers pay in alcohol taxes to pay for alcohol-related services?' Or perhaps 'Would you support defunding temperance pressure groups like Balance Northeast to pay for alcohol-related services?'

Instead, drinkers and non-drinkers alike are forced to pay for parasitic organisations like Balance Northeast to lobby for still higher taxes. It really beggars belief that, after years of 'austerity' which have seen severe budget cuts in local government, local authorities are still squandering taxpayers' money on these people.

* An Irish unit is 10 grams of alcohol. The equivalent of a UK unit will be €0.80 (70p).

Wednesday, 17 October 2018

Too hot for TV

There's a fun Twitter account called @ClassicAds that shows old TV commercials, mostly from the 1980s. If you're British, over 40 and fancy a trip down memory lane, have a look at some of the adverts below.

They all have something in common. If they were made now, it would be against the law to show them before 9pm under the government's ridiculous childhood obesity strategy. Yes, even the ones for butter and orange juice. I dare say many of them breach some regulation or other as it is.

Nobody really knows how many kids were obese in the 1980s (nobody really knows how many are obese now), but the number was pretty small. Perhaps the government is - as John Stuart Mill might say - interfering wrongly and in the wrong place?

Monday, 15 October 2018

Minimum pricing and the reverse Midas touch of 'public health'

More evidence that the Sheffield minimum pricing model was flim flam...

This follows the release of data from the Retail Data Partnership which found the following trend in convenience stores:

Brian Eagle-Brown of The Retail Data Partnership (TRDP) gave an overview of convenience performance in recent months, noting that alcohol sales were up “across the board” since the implementation of MUP.

“What was unexpected is that the result of minimum pricing is not declining, but actually increasing alcohol sales. Gin sales are up 90% year on year,” he said.

And as a fun bonus:

In news that may further disappoint policy makers, sales of full sugar soft drinks also appear to have been largely unaffected by the introduction of the sugar tax.

Brian’s TRDP colleague James Loker said that there “had not been a massive impact” from the sugar tax, and that “essentially sugary drinks are doing as well as they always have, and in some cases actually better.”

TRDP data revealed that the drinks most disadvantaged by the tax were those that opted for a formula change, with Irn-Bru and Ribena suffering a sales downturn.

Oh dear, what a shame, never mind.

I'll just leave this here lest we forget...

Friday, 12 October 2018

Questions to which the answer is yes

The BBC asks are we are living in a nanny state? In the article, my classical liberal stance is described as ‘ultra-libertarian’ while a ‘conservative’ makes the Orwellian argument that bans give people more choice. It’s a pretty good illustration of how much the centre of gravity has moved in this debate over the years. Do have a read of it.

Meanwhile the government wants to regulate pizza toppings. Only an ultra-libertarian could disagree!

Thursday, 11 October 2018

The strange death of the liberal Netherlands

The Netherlands comes a respectable 24th out of 28th in the Nanny State Index (the fewer points, the freer the country). It's not quite as good as Germany on lifestyle liberty but it's definitely in the green zone. Its reputation as a liberal haven has been largely well earned.

That could soon change. I mentioned on Monday that the Dutch health minister, Paul Blokhuis, wants to fast-track plain packaging through the Dutch parliament. He also wants to introduce minimum pricing so that the price of a crate of beer doubles from €10 to €20. He wants to emulate the UK's food degradation programme and he wants to copy Chile's ban on the use of recognisable characters on food packaging.

As if that weren't enough, he wants to ban smoking on terraces, stop supermarkets selling cigarettes and include e-cigarettes in both the country's smoking ban and the plain packs legislation.

And he can do most of this without the need for primary legislation. Plain packaging is scheduled to be passed before the month is out. By this time next year, the Netherlands could jump from the bottom end of the Nanny State Index to the top.

What the hell's going on? To understand, you need to look at last year's election. As often happens under proportional representation, there was no outright winner and a four party coalition was required to govern. This turned into a complex and lengthy process. In the end, the largest party - the People's Party for Freedom and Democracy - formed a coalition with Democrats 66, Christian Democratic Appeal and the Christian Union.

Mr Blokhuis is from the Christian Union. They came eighth in the election with just 3.4 per cent of the vote. They only won five of the 150 seats available but since nobody wanted to deal with Geert Wilders' Party for Freedom, and the People's Party for Freedom and Democracy couldn't get on with the Greens, the Socialists or the Labour party, they somehow got into government.

The Christian Union is a socially conservative party rooted in the Protestant church. Unsurprisingly, they have a moralistic view of 'vice' and their price for going into coalition was that Blokhuis be made health minister so he could introduce a 'National Prevention Agreement' with a raft of nanny state measures.

None of the policies being proposed by the Christian Union are supported by credible evidence, but I doubt that will concern them. It's not about health. It's a moral crusade.

I don't know what the prospects are of stopping any of this. It doesn't sound like the kind of thing that is going to be popular with the average Dutch voter, which is why so few of them voted for Blokhuis's band of religious zealots in the first place. But it looks like the 'public health' racket has a new hero in the making.

Wednesday, 10 October 2018

They wouldn't let it lie

The anti-drink lobby

This is turning into my favourite story of the year and it just keeps getting funnier. From The Times...

Experts threaten public health body over link to drink industry

Hundreds of top academics have threatened to stop advising Public Health England unless it abandons plans to work with the alcohol industry.

Excellent. Shut the door on your way out.

This is all because PHE teamed up with Drinkaware to promote abstinence from alcohol on at least two days a week. Drinkaware is a charity set up by the government to promote responsible drinking. It gets most of its funding from alcohol companies and so, according to temperance dogma, is part of the 'alcohol industry'. And, according to 'public health' dogma, governments can't work with industries because they are evil.

The academics say they are “alarmed” that PHE is unconcerned by Drinkaware’s industry funding despite “clear-cut examples of inaccurate information on Drinkaware’s website.”

The claim that there is inaccurate information on the Drinkaware website is a lie based on a deeply dishonest piece of work by Mark Petticrew and a Twitter thread by Colin Angus, both of whom are signatories.

Other signatories include Petra Meier (Sheffield modeller), John Holmes (Sheffield modeller), Richard Horton (Marxist Lancet editor), Tim Lang (corn laws aficionado), Gerard Hastings ("the corporation will get you in the end"), David Miller (tinfoil hat wearer) and John Britton (anti-smoking fanatic). Even Kate Pickett, co-author of The Spirit Level, has signed it. It's a veritable Who's Who of quackademia.

John Holmes of the University of Sheffield, who organised the letter, said that while academics would not abandon PHE overnight, they would lessen co-operation if they felt they could no longer trust the agency.

A terrifying proposition! Alas, PHE supremo Duncan Selbie is having none of it...

Mr Selbie said yesterday: “Drinkaware is not the alcohol industry, rather an education charity with millions of unique visitors each year. We are taking this opportunity to ensure the advice it gives is evidenced, pragmatic and sensible. The health harms of alcohol require action. Public health has always involved controversy and we will not shy away from this."

The Times also gives them short shrift. They didn't publish the letter and instead put a story about the epidemic of teetotalism among the young on the front page. They also dedicated a leading editorial to slapping them down:

There is no good case for PHE to accede to the critics’ demands. The academics’ letter claims that “the reputational risk to the agency’s status as a provider of impartial, evidence-based advice is significant”. The critics also complain that the message on responsible drinking is part of a wider campaign on public health, and that it thereby links an industry-funded body with the notion of healthy lifestyles. Yet Drinkaware is not a front for the alcohol industry. It is an independent body whose funding comes from drinks companies rather than from the taxpayer. Provided that the relationship is transparent, it is benign and the joint campaign’s output can help Britain’s drinking culture for the public good.

The campaigning message is both sensible and realistic. The chief medical officer’s recommended upper limit for alcohol consumption is, for both sexes, 14 units a week, to limit the risk of cancer or liver damage. The campaign targets drinkers between the ages of 30 and 45 who typically drink wine, beer or spirits regularly above these medical guidelines. These recreational drinkers do not necessarily have an obvious problem of susceptibility to alcohol but they need to be aware of the risks to their health and wellbeing of regular, excessive consumption.

The very idea of a measurable “unit” of alcohol (about half a standard 175ml glass of red wine) may itself be unfamiliar to the public. Drinkaware has addressed the issue of public recognition, with mnemonics and slogans in pubs and by encouraging two “dry” days each week.

This is sound advice. Mr Selbie should not allow academics’ purist objections to the drinks industry to override his responsibility to work with it to develop a pragmatic approach to public education. Consumption of alcohol, which is pleasurable to many, is not in the same category as the use of tobacco products, which are intrinsically harmful and addictive. A successful drinks industry has social responsibilities. PHE is right to harness them in this initiative.

I strongly suspect that The Times is more in tune with public opinion than the people who signed the letter. The great thing about this story is that the 'public health' people just don't get it. It's obvious that PHE are not going to back down and there is no pressure from the public for them to do so. And yet they keep doubling down.

In their letter, they write...

“That PHE is seemingly not worried about such activity or believes that it is not vulnerable to industry influence is troubling” 

Do they really think that they are going to win over PHE by implying that they are gullible fools who are 'vulnerable to industry influence'? The egos of these people are the size of a planet. The more they scream and stamp their feet, the more obvious it becomes to PHE and the public that they are fanatics.

Normal people do not think that alcohol is as bad as tobacco. Normal people do not think that working with an industry-funded charity is unacceptable (or, indeed, working with industry - most people work for an industry). These beliefs are only considered normal in the 'public health' bubble. Expose them to sunlight and people are going to laugh at them.


I have sent a e-mail to Duncan Selbie in his darkest hour...


Tuesday, 9 October 2018

Stanton Glantz pays $150,000 to settle sexual harassment lawsuit

According to Planet of the Vapes, anti-smoking campaigner and alleged sex pest Stanton Glantz has settled his sexual harassment lawsuit out of court. In December last year, alleged sex pest Glantz denied claims that he had sexually harassed post-doctoral student Eunice Neeley. The alleged sex pest was also accused of taking her name off a paper she had worked on and making racist remarks. Another woman filed a similar lawsuit against the alleged sex pest in March.

It now seems that Stanton Glantz, an alleged sex pest, has settled out of court with Dr Neeley after paying her $150,000. You can read the whole document here. The other lawsuit is yet to be settled.

I recommend reading this Carl Phillips post about the academic fraud angle that has been overshadowed by the other allegations.

Monday, 8 October 2018

The World Health Organisation's week

Enjoying myself outside the conference venue

I was in Geneva for a couple of days last week to check out the WHO's Conference of the Parties meeting (COP8). Not that there was much to check out. As is traditional, the public and press were kicked out at Monday lunchtime and weren't allowed back in.

It wasn't clear what was being discussed inside. Even now, two days after it finished, it's not clear what was decided. Neither the Framework Convention on Tobacco Control (FCTC) website nor its Twitter feed suggested that anything substantial had been agreed.

The closing address contained some waffle about sustainability and the usual paranoia about industry. I heard rumours that they had decided to regulate heated tobacco products as if they were cigarettes but the only thing that has been publicly agreed is the creation of yet another anti-tobacco organisation - the Global Strategy to Accelerate Tobacco Control - to 'reinforce government policies and accelerate global action for more effective implementation of the tobacco control treaty'.

I thought that was what the FCTC's job? Never mind, it will keep the money rolling in. At one point last week, the Framework Control Alliance (yet another NGO sucking on the taxpayer's teat) told us exactly much this shindig was costing us...

And they were right. It is even worse than I thought - and we Brits are footing the bill for most of it.

I suspect that the WHO is doing journalists a favour by kicking them out after a few hours. At the end of the day, COP is a 'public health' conference and therefore bound to be about the most boring thing on Earth. I expect it's one tedious presentation after another while all the grubby deals take place in hotel rooms. If the public weren't booted out, they would soon leave of their own accord.

Hats off to my friends from INNCO who were in town all week, speaking to the public about vaping and harm reduction at the Broken Chair, the only place in Geneva where you're legally allowed to protest - and, even then, only if you have a permit. I caught up with them on Friday...

And then I popped down to the main venue for a quick photo...

On Friday evening I held a meeting at the Mon Repos Hotel down the road to find out what the hell was going on. Spoiler alert: no one really knew, but it was good to have a chat with a few people anyway. Thanks to Dick Puddlecote, who filmed it with my iPad, you can see some of the conversations. The indefatigable Simon Clark also said a few words but, alas, we ran out of memory space two minutes into his remarks.

So here's Kim D. Peterson of INNCO...

Heneage Mitchell of FactAsia...

And Aaron Biebert (director of A Billion Lives) who I was delighted to meet for the first time...

I expected this to be my last time at a COP but apparently it's going to be held in the Netherlands in 2020 so there's a chance I might go again, especially if it's in Amsterdam. Unfortunately, the Dutch government is already trying to get in the WHO's good books by announcing an extension of its smoking ban and putting plain packaging on the table. Plain packaging is, of course, just the kind of utterly ineffective virtue signalling that COP delegates can't get enough of.

So too is divestment from tobacco stock. I have often wondered whether people in the divestment campaign have any idea of how the stock market works. This quote from the FCTC confirms that they they doesn't.

The campaign also has also begun striking at the heart of tobacco profits. In January 2018, ABP, the biggest Dutch pension fund and the largest pension fund in Europe, announced it would stop investing in tobacco. This has resulted in 3 billion Euros less in investments from the finance sector going to tobacco companies, said Mr. Blokhuis.

Regular readers know that the 'public health' mob struggle with the distinction between profits and revenue. Now it seems that they don't know the difference between profit and the sale of secondhand shares on the stock market.

“We need to convince more financial companies that investing in tobacco is bad for business, bad for their profit margins,” said Mr. Blokhuis. “This would be the final knockout for the tobacco industry.”

I regret to inform you that Mr Bolkhuis is the State Secretary for Health, Welfare and Sport in the Netherlands.

The FCTC is still in Geneva because today saw the start of MOP1 (yes, really), which aims to 'Eliminate Illicit Trade in Tobacco Products'. That's right, eliminate. With this kind of expertise, how can they fail?

Oh, and needless to say, the FCTC didn't take the opportunity to retract its warm words about vaping prohibition during COP8. Rumour has it that the UK delegation barely said a word all week.

Tuesday, 2 October 2018

Good COP, Bad Cop

The WHO's big anti-nicotine conference is underway in Geneva. As mentioned in a previous post, I'll be in town on Friday with Dick Puddlecote and others to see if we can find out what the hell is going on.

If you're in town or can make it to Geneva, you are warmly invited to come to our Good COP event that will take place at the Mon Repos Hotel at 6pm. We'll have a little discussion and a lot of drinks.

In contrast to COP8, all are welcome so long as you RSVP. Let me know in the comments below, via Twitter (my DMs are open) or via e-mail.

Monday, 1 October 2018

A plea for sanity on e-cigarettes

As COP8 kicks off in Geneva, 70 scientists have signed a letter to the WHO calling on it to abandon its negative position on e-cigarettes.

Dear Dr. Adhanom Ghebreyesus,

Innovation in tobacco control: developing the FCTC to embrace tobacco harm reduction

We write to express our hope that WHO will assume a leadership role in promoting effective and fast-acting policies for regulating tobacco and nicotine.  In this letter, we propose that WHO and related stakeholders adopt a more positive approach to new technologies and innovations that have the potential to bring the epidemic of smoking-caused disease to a more rapid conclusion. 

In the field of tobacco control and public health, the world has changed significantly since the Framework Convention on Tobacco Control was signed in 2003.  It is impossible to ignore or dismiss the rise of Alternative Nicotine Delivery Systems (ANDS). These are established and new technologies that deliver nicotine to the user without combustion of tobacco leaf and inhalation of tobacco smoke. These technologies offer the prospect of significant and rapid public health gains through ‘tobacco harm reduction’.  Users who cannot or choose not to quit using nicotine have the option to switch from the highest risk products (primarily cigarettes) to products that are, beyond reasonable doubt, much lower risk than smoking products (e.g. pure nicotine products, low-toxicity smokeless tobacco products, vaping or heated tobacco products). We believe this strategy could make a substantial contribution to the Sustainable Development Goal to reduce premature deaths through non-communicable diseases (SDG Target 3.4).

The concept of tobacco harm reduction is coded into the definition of ‘tobacco control’ set out in the FCTC (Article 1.d), and we believe it now needs to be fully expressed in the FCTC and by the Parties in their approach to implementation.  To that end, we offer some guiding principles for your consideration for the development of the next phase of global tobacco control, starting from the next Conference of the Parties (COP-8, 1-6 October, Geneva).

Tobacco harm reduction is integral to tobacco control. Harm reduction is a widely practiced strategy in public health (e.g. HIV, drug use, sexual health) and should become an integral component of tobacco control – helping smokers to quit smoking or diverting them from ever starting, and, in either case greatly reducing their risk.

From a health perspective, the major distinction between nicotine products is whether they are combustible or non-combustible.  It is not whether they are tobacco or non-tobacco products or whether they are established or novel. Given the principal focus of the FCTC is management of health risks, this distinction should be integral to the design and implementation of the FCTC.
Tobacco harm reduction is supportive and synergistic with the ‘MPOWER’ policies that underpin the FCTC.  By providing more diverse options for users to respond to taxes or other measures, harm reduction can improve the effectiveness of conventional measures and mitigate the unintentional harmful consequences of such policies to continuing users, for example the impact of cigarette taxes on people who continue to smoke.

Stakeholders should give appropriate weight to the benefits and opportunities of tobacco harm reduction and not focus exclusively on unknown risks to health, especially when these are minor or improbable risks.  A lost opportunity for public health is a real harm to public health, and should be recognised as such.

Youth uptake of any tobacco or nicotine product demands a coherent and adaptable strategy focussed on reducing present and future harms to young people. Policies to address youth nicotine use should be based on an understanding of youth risk behaviours, the interactions between use of different products (for example, for some young smokers the potential displacement of smoking by low risk products may be beneficial), and due regard for the overall balance of harms and benefits to both adults and to youth arising from interventions.

Uncertainty about long-term effects should not be a reason for paralysis. It is true we will not have complete information about the impacts of new products until they have been used exclusively for several decades – and given the complex patterns of use, we may never. But we already have sufficient knowledge based on the physical and chemical processes involved, the toxicology of emissions and exposure markers to be confident these non-combustion products will be much less harmful than smoking. We also know with certainty that the incumbent product (cigarettes) is extremely harmful.

FCTC and its implementation should embrace “risk-proportionate regulation”.  This means that the stringency of regulation or taxation applied to product categories should reflect risk to health. For example, there should be high taxes on cigarettes, but low or no taxes on vaping products. It is reasonable to ban all advertising of combustible products, and to place controls on advertising for non-combustible products (to protect never-smoking youth in particular) but allow enough promotion so that smokers can still learn of alternatives and can be encouraged to switch.  This risk-proportionate approach should be adopted throughout the FCTC.

WHO and Parties to the FCTC should be aware of and careful to avoid the harmful unintended consequences of prohibitions or excessive regulation. If WHO-endorsed policies make non-combustible alternatives to smoking less easily accessible, less palatable or acceptable, more expensive, less consumer friendly or pharmacologically less effective, or inhibit innovation and development of new and improved products, then these policies can cause harm by perpetuating smoking.

The FCTC negotiations should become open to more stakeholders. There are many stakeholders, including consumers, the media and public health experts with pro-harm-reduction views, who should be part of the process. We are concerned that the FCTC has been excluding appropriately diverse perspectives and that its deliberations and decisions could be more robust and credible if its proceedings were more open.

We are concerned that WHO and the Convention Secretariat are not embracing these principles and in many cases are doing the opposite. We have seen the more detailed letter to you of 3 September by Abrams et al regarding prohibition and excessive regulation. We recommend that this letter be read carefully by everyone with an interest in the future of tobacco control.
We believe that it is time for tobacco control to embrace tobacco harm reduction. We hope that WHO and Parties to the FCTC will advance this agenda at the Eighth Conference of the Parties of the FCTC, starting today.

The authors of this letter confirm no conflicts of interest with respect to the tobacco industry and that no issues arise with respect to Article 5.3 of the FCTC.

Yours sincerely, 

  1. David B. Abrams, PhD
  2. Marion Adler, PhD
  3. Jasjit S Ahluwalia, MD, MPH, MS
  4. Sanjay Agrawal, MD, MBChB
  5. Philippe Arvers, MD, PhD
  6. Frank Baeyens, PhD
  7. Shamsul Bahri Mohd Tamrin
  8. Scott D. Ballin, JD
  9. Clive Bates, MA, MSc
  10. Robert Beaglehole, MD, DSc, FRSNZ
  11. Mihi Blair (Ngāti Whātua)
  12. Anne Borgne, MD
  13. Ron Borland, PhD
  14. Thomas H. Brandon, PhD
  15. John Britton, MD
  16. Dr Jamie Brown, PhD CPsychol
  17. Jean-Pierre Couteron
  18. Sharon Cox, PhD
  19. Kenneth Michael Cummings, PhD
  20. Lynne Dawkins, PhD
  21. Jean-Michel Delile, MD
  22. Allan C. Erickson
  23. Jean-François Etter, PhD
  24. Konstantinos Farsalinos, MD, MPH
  25. Prof. Antoine Flahault, MD, PhD 
  26. Jonathan Foulds, PhD
  27. Thomas J. Glynn, PhD
  28. Peter Hajek, PhD
  29. Wayne Hall, PhD
  30. Natasha A. Herrera
  31. Martin J Jarvis, DSc OBE
  32. Martin Juneau , MPs, MD, FRCPC
  33. Dr.Aparajeet Kar, MD
  34. Leon Kosmider, PhD, PharmD
  35. Lynn T. Kozlowski, PhD
  36. Hiroya Kumamaru, MD, PhD
  37. Christopher E. Lalonde, PhD
  38. Murray Laugesen QSO
  39. Jacques Le Houezec, PhD
  40. William Lowenstein, MD
  41. Karl E Lund, PhD
  42. Bernhard-Michael Mayer, PhD
  43. Olivia Maynard, PhD
  44. Andy McEwen, PhD
  45. Ann McNeill PhD
  46. Klim McPherson, PhD, FMedSci, Hon FRCP
  47. Colin Mendelsohn
  48. Robin Mermelstein, PhD
  49. Faares Mili, MD
  50. Thomas J. Miller
  51. Marcus Munafò, PhD
  52. Raymond Niaura, PhD
  53. Caitlin Notley, PhD
  54. David Nutt, DM, FRCP, FRCPsych, FMedSci, DLaws
  55. Konstantinos Poulas, PhD
  56. Philippe Presles, MD
  57. Lars M. Ramström, PhD
  58. Vaughan Rees, PhD
  59. Steven A. Schroeder, MD
  60. John R. Seffrin , PhD
  61. Lion Shahab, PhD
  62. Rajesh N. Sharan, Ph. D.
  63. Michael Siegel, MD, MPH
  64. Roberto A Sussman, PhD
  65. David Sweanor, JD
  66. Professor Umberto Tirelli MD 
  67. Natalie Walker, PhD
  68. Kenneth Warner, PhD
  69. Alex Wodak
  70. Naohito Yamaguchi, MD

Friday, 28 September 2018

The WHO's immortality delusion

Yesterday saw the WHO's High Level Meeting on NCDs (non-communicable diseases) take place in New York. The good news is that the accompanying Political Declaration did not mention sin taxes on soft drinks, alcohol or tobacco. This has annoyed lots of nanny state campaigners who have had to settle for publishing a bunch of glorified advice sheets (like this) which are not remotely binding.

The bad news is that the WHO is off its head. I've written about the patent insanity of pretending that non-communicable diseases can be wiped out before. You may have thought that I was exaggerating or straw-manning. I was not. If anything, it's worse than I thought. The #BeatNCDs wheeze isn't just the latest incarnation of middle class paternalism that puts the whims of first world political activists before the needs of the developing world. It is genuinely delusional.

For example, here is Director-General Tedros calling on the world's governments to eradicate all non-communicable diseases within 12 years. Oh, and 'solve' mental health.

And here he is explicitly stating that every last one of the 41 million deaths from non-communicable disease are preventable. Your granny who died in her sleep at the age of 95? A preventable death. That old boy who kicked the bucket at the age of 88? Preventable.

And here is the President of Zambia suggesting that it is pointless preventing people dying from horrific contagious diseases in childhood or in the prime of life because they'll only die from cancer or heart disease when they're 80.

This is truly bonkers stuff. What do they think people are going to die from if they succeed in preventing death from non-communicable disease? Is Tedros planning to unleash a global plague to end the scourge of NCDs?

This was not a health conference. It was a meeting of an ever-lasting life cult. And once they've finished in New York, many of the cultists will be heading to Geneva for their next religious service: the Framework Convention on Tobacco Control's eighth Conference of the Parties. Those guys really rack up the air miles.

Since the British taxpayer is paying for most of this, I'm going to head over there to see what we get for our money. I won't be allowed in - nobody from outside the tribe is - but Geneva is a small place so I should get to see some of the believers with my own eyes. On the agenda this year is censorship of the arts and banning all e-cigarette advertising, amongst many other things. It will be interesting to see whether the UK representatives, who will doubtless include ASH's Deborah Arnott, take a stand against the WHO's prohibitionist stance on vaping.

I'll be in Geneva from Thursday to Saturday and I know a few vaping activists and libertarians are also going to be showing up. If you're going to be in town, let me know. I have a little event planned for Friday evening. Drinks will be provided. Details to follow next week.

And feel free to use the graphic at the top of this post (lovingly designed by my wife) which I liked so much that I turned them into posters. Could come in handy...

Have a good weekend.

Wednesday, 26 September 2018

Finally, a successful alcohol policy

Something extraordinary has happened at NHS Walsall. It has seen a 54 per cent drop in alcohol-related Accident and Emergency admissions and a 68 per cent reduction in bed days as a result of taking action on the 'frequent flyers' who come to A & E time and time again.

The NHS Trust identified ten people who were visiting A &E a great deal. How many times do you think they were admitted to hospital in a six month period? Ten? Sixty? A hundred?

The answer - incredibly - is 499. On average, each of them was being admitted twice a week.

It's an incredible statistic but the same thing is happening up and down the country. A small number of people who have a problem with alcohol - often combined with problems with drugs and mental health - take up a vast amount of NHS time.

So the Trust decided to focus on prevention among this small minority. They identified 38 frequent flyers and co-ordinated different service providers to help them out. As Daniel Hodgkiss, patient safety manager at the trust, explains:

'We identified a small number of hospital patients with complex needs that were discharged only to return multiple times and which accounted for a very disproportionate number of admissions.
'This was due to a lack of cohesion between social care, mental health services, police and a range of other services. By bringing these agencies together to co-ordinate patient care, we were able to substantially reduce admissions.'

The results have been astounding. A & E attendances have been more than halved! If other NHS Trusts achieved a fraction of this, it would result in huge savings (it is estimated that the initiative has saved NHS Walsall £250,000).

And yet I haven't seen any mention of this remarkable success story in the timelines of the anti-alcohol pressure groups or the 'public health' academics who profess expertise on alcohol policy. They are too busy whining about the PHE/Drinkaware collaboration and campaigning for (illegal) cancer labels on wine bottles in Ireland.

Could it be that dealing with the minority while leaving the majority alone doesn't quite fit their dogmatic belief that 'population-wide interventions have the greatest potential for prevention'?

As my friend Dick Puddlecote always says, it's not about health.

Sunday, 23 September 2018

The martyrdom of Aseem Malhotra

Aseem Malhotra's bid to become famous and sell his diet book protect the health of the nation has provided this blog with some hilarious content over the years, but he hits new heights of comedic gold in the Sunday Times today.

The low carb/LCHF movement to which Malhotra belongs is ultra-conspiratorial. Being essentially a cult based on magical thinking, it blames other people's failure to share their beliefs on a vast and growing network of corrupt scientists and government agencies. You might wonder what motivates so many scientists, dietitians and bureaucrats to hide the truth about killer carbs, thereby condemning millions of people to 'diabesity', but the answer is obvious: they're all in the pay of Big Food/Big Soda/Big Grain/Big Ag! Wake up sheeple.

Malhotra denounced the British Dietetic Association as Big Food puppets after they dissed his diet book. He has since added the British Heart Foundation and the American Heart Association to his list.

Now it's Public Health England's turn. In a barking mad op-ed for the Sunday Times, he claims that the quango is trying to silence him. 

For decades, powerful food companies have profited from promoting misleading health information and aggressively marketing junk food to children and the most vulnerable members of society. Public Health England is charged with help to protect and improve the nation’s health. My experience is that its officials undermine public debate and behave more like a front group for the processed food industry rather than an independent and trustworthy body that welcomes public debate.

Really?! To put it mildly, that is not my experience.

In an effort to combat the epidemic of health misinformation I co-wrote a book, The Pioppi Diet, which brings together the evidence on what individuals and policy-makers can do to rapidly improve health and reverse the twin epidemics of obesity and type 2 diabetes. I was pleasantly surprised when the deputy leader of the Labour Party, Tom Watson, contacted me a few months ago to let me know he had “relatively easily” lost 94lb and improved his health by specifically following the diet.

Good for him. By his own account, Watson 'basically stopped taking sugar, refined sugar, and then I started walking 10,000 steps a day and walking up staircases and when a bit more weight came off I started to jog and cycle.' You don't need to spend £8.99 on Malhotra's ludicrous book to know that a regime like that is going to lead to weight loss.

The most important message in the book — which recommends a Mediterranean-style diet low in refined carbohydrate — is how lifestyle changes are more powerful than any drug in preventing and treating heart disease; these also come without side effects.

A diet low in refined carbohydrate is not a Mediterranean diet and Malhotra's 'Pioppi diet' is not the diet of people who live in Pioppi. Malhotra's diet takes bits of the Mediterranean diet, removes the bread and pasta and adds in lashings of saturated fat and an assortment of his own bizarre LCHF recipes, such as boiled and eggs and soldiers with the soldiers replaced with bits of asparagus wrapped in bacon.

For inexplicable reasons, according to one prominent healthcare leader (who has asked not to be identified), Public Health England tried to “sabotage” the launch and press coverage of the book last year. I was told by one eminent doctor that he had been contacted by a senior official from the body and warned from attending the launch in London, to be held at the headquarters of Penguin Random House. To his credit, he did attend.

Another health leader, who heads a national charity, did not attend, and said he had been “poisoned” against the book. Andy Burnham, the mayor of Manchester and a former health secretary, endorsed the book and attended a launch in Manchester. His office also received a call from Public Health England, warning him against showing public support of the diet.

Assuming Malhotra isn't making this up to get attention (who knows?), it wouldn't be wholly surprising if one of PHE's many employees suggested to 'health leaders' that it might not be in their interests to be associated with a man whom even Action on Sugar regards as being 'completely mad' and who has a track record of embarrassing journals with his error-strewn articles. Public Health England has criticised Malhotra's version of the Atkins Diet in public. It stands to reason that they would also criticise it in private.

I was shocked by these attempts to try and undermine a healthy eating plan, to stifle debate and to damage my credibility.



Public Health England’s own recommendations for healthy eating — which are promoted by the Eatwell Plate, a diet guide backed by the Department of Health, which includes chocolate, crisps and cakes to eat “less often” — was drawn up in consultation with the food industry.

Firstly, the Eatwell Plate was replaced by the Eatwell Guide in 2016. You'd think a self-proclaimed expert would know that.

Secondly, I know of no evidence that the Eatwell Guide was drawn up 'in consultation with the food industry'. This claim seems to be based on a wafer-thin article by Malhotra's friend and fellow low carb zealot Zoe Harcombe. Harcombe claims that the Eatwell Guide 'was formulated by a group appointed by Public Health England, consisting primarily of members of the food and drink industry rather than independent experts.' She provides no evidence for this assertion. Public Health England says it commissioned experts from Oxford University to develop the Eatwell Guide. Indeed it did. Their work can be seen here. None of them report any relevant conflicts of interest.

Thirdly, you'd have to be on drugs to think that Public Health England encourages people to eat chocolate, crisps and cakes. Indeed, one of main differences between the old Eatwell Plate and the new Eatwell Guide is these foods were taken off the plate altogether because, as the British Nutrition Foundation explains...

Foods high in fat, salt and/or sugars, which previously featured in the purple section of the Eatwell plate, have been moved outside the main image.

This has been done to clarify consumer understanding of the role of these foods and drinks in the diet. They are not a necessary part of a healthy diet but such products can be included, although they should only be consumed infrequently and in small amounts.

Their inclusion in the guide may help consumers feel that moving towards such healthy guidelines is an achievable and realistic target.

The Eatwell Guide therefore recommends food that is entirely healthy, unless you are a low carb nutter who thinks that bread and rice cause diabetes. It doesn't say that sweet treats should never be consumed because that would be extreme and unrealistic, but it clearly doesn't endorse them.

Malhotra continues...

I have not seen any statements from the organisation’s health officials saying we should be eating less of the sort of ultra-processed food that now makes up half of the British diet. 

Has he been living in a cave for the last few years or does a high fat diet cause amnesia? How did he miss this, this and this, for example? Public Health England never stops haranguing people about sugar, snacks and processed food. 

Public Health England makes different dietary recommendations to the Pioppi diet. It recommends placing starchy carbohydrates, such as bread, pasta, rice and potatoes, at the base of the diet, and to reduce consumption of saturated fats.

Now we're getting down to brass tacks. Malhotra's problem with the Eatwell Guide isn't that it encourages people to eat 'ultra-processed food' (it doesn't) but that it encourages people to eat starchy carbohydrates, presumably because of the nefarious influence of Big Bread, Big Pasta, Big Rice and Big Potatoes.

The reason Public Health England - and every other health agency in the world - makes different dietary recommendations to the 'Pioppi diet' because the 'Pioppi Diet' is a load of unscientific, low carb toot created by an attention-seeking cardiologist whose slogan is 'fat is your friend'.

I have published evidence reviews showing no association between consumption of saturated fat and a heightened risk of cardiovascular disease, diabetes and death, but Public Health England doesn’t want to debate the issues.

Malhotra has never published anything resembling an evidence review. He writes comment pieces in which he references a few cherry-picked studies, such as this and this. That is not the same thing at all.

We want to trust government dietary guidelines, but Public Health England must give a clear commitment to systematic reviews of the evidence. It must stop engaging in dirty tricks to try and censor and silence those who want to engage in legitimate debate.

Far be it from me to defend Public Health England, but they have no more reason to engage in debate with a diet book salesman on the make than with any other random conspiracy theorist. They have already responded to his rubbish once, saying in 2016: 'In the face of all the evidence, calling for people to eat more fat, cut out carbs and ignore calories is irresponsible.'

What more is there to say? Scientific issues are not resolved by Public Health England debating with people. They are resolved through the accumulation of evidence in peer-reviewed journals. Malhotra has never conducted any primary research and has never published anything but op-eds in journals (usually the Z-list British Journal of Sports Medicine). It is quite possible to accept - as I do - that fears about saturated fat have been over-hyped without relying on a patently unreliable narrator like Malhotra to design a healthy diet.

Inevitably, Malhotra's response to PHE's criticism of his dietary theories was to accuse them of incompetence and corruption (see tweets below). It's his response to everything. Why would anyone want to engage in debate with such a person?

Friday, 21 September 2018

Drinkaware and the scream test

Public Health England's collaboration with Drinkaware for the 'two days off drinking' campaign is of little interest to the general public but has produced a hell of a squeal from 'public health'. Two weeks after the announcement, the hot takes are still coming. Here are a few of them...

The gist of these articles (they are all essentially the same) is that the government wouldn't work with the tobacco industry so they shouldn't work with the alcohol industry. This is the fabled slippery slope in action. By this logic, they shouldn't work with the food industry either, but they are working with the food industry - on labelling, reformulation and other things beside. They also work with the alcohol industry on drink driving, underage sales and much more. The wingnuts of the nanny state probably think that the industry wants people to drink drive because - as they keep claiming - their interests are irreconcilably at odds with those of 'public health'.

This is dogmatic nonsense and you have to be deep down the temperance rabbit hole not to laugh at it. Telling people to go teetotal for at least a couple of days a week isn't bad advice. It's not going eradicate liver disease but nor will the grab bag of nanny state interventions favoured by the people who have been spitting their dummies out of their pram for the last fortnight.

Alcohol Focus Scotland's Alison Douglas has often advised the public to have drink-free days in the past (see here and here, for example), but now that Drinkaware are saying it, she no longer thinks it is good advice. You couldn't ask for a better illustration of the fact that it's not about health for these people.

Or take this from a BMJ article with the hysterical headline 'Public Health England's capture by the alcohol industry' by the terrible trio of Ian Gilmore, Linda Bauld and John Britton...

The question that senior PHE managers do not seem to have asked themselves in the process of entering into this partnership, and certainly did not ask their alcohol leadership advisory board, is why the alcohol industry is happy to fund a campaign that ostensibly aims to reduce alcohol consumption. Had they done so they would have received the answer that the industry does so because it thinks the campaign will be ineffective or will divert attention from other more effective policies to reduce alcohol consumption that the industry fears more, such as minimum unit pricing.

Who needs evidence when you have sweeping assertions? "If they'd asked us, this is what we would have said, therefore it is the truth."

Like rain bringing worms to the surface, the PHE collaboration has drawn the worst people in 'public health' out to bat. Today, the Lancet published an equally woeful op-ed by the equally awful trio of Mark Petticrew, Martin McKee and Theresa Marteau, who say...

In its defence, PHE points to Drinkaware's independent governance. Drinkaware revised its governance after a critical evaluation, but its new model did not prevent Drinkaware and other industry bodies from disseminating messages that could mislead the public about the risk of cancer from alcohol consumption, using strategies similar to the tobacco and other industries.

Their evidence for this comes from an article Petticrew wrote last year which was full of errors (some people would call them lies) and totally misrepresented what Drinkaware say about alcohol and cancer. In a serious scientific discipline, the article would have been retracted.

Bhattacharya and colleagues report that in England about two-thirds of alcohol sales revenue comes from people drinking above guideline levels; if all drinkers followed recommended drinking guidelines, the industry would lose almost 40% of its revenue. The lead author of that study stated in a press release: “The government should recognise just how much the industry has to lose from effective alcohol policies, and be more wary of its attempts to derail meaningful action through lobbying and offers of voluntary partnership.”

Bhattacharya represents the Institute of Alcohol Studies (née the UK Temperance Alliance) and his study was economically illiterate garbage. His comments to the press, as with the conclusion of his study, were based on the fallacy that businesses chase revenue over profit.

This is what happens when you pride yourself on not having anything to do with the industry that makes the product about which you claim to be an expert. Knowing nothing, you can make up little fantasies in your head. That can work OK so long as you only associate with other conspiracy theorists, but take those ideas into the real world and people are likely to make fun of you.

And when even the people at Public Health England - Public Health fricking England - start to worry about your extremism, it's time to take a cold bath.

Thursday, 20 September 2018

Why are we giving the WHO so much cash?

From the Express...

British taxpayers 'should not subsidise scaremongering anti-vaping laws'

British taxpayers should no longer subsidise “scaremongering” anti-vaping laws advocated by the World Health Organisation, consumer champions said tonight.

It includes a quote from my good self...

Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs, said: “The WHO’s scaremongering stance on e-cigarettes is at odds with the British Government’s evidence-based position.

“The UK taxpayer is paying through the nose to support this prohibitionist organisation. So far, the Department of Health has been unable to turn our money into influence. It is now time to get tough. Unless the WHO withdraws its support for the prohibition of vaping, the government should withdraw its funding.”

The idea of defunding - or even threatening to defund - the World Health Organisation may trouble some people. After all, it has done great things. And yet its past achievements all involve communicable diseases whereas the 21st century WHO is obsessed with the first world problem of 'lifestyle-related' diseases which are neither as pressing nor as easily preventable - and which are certainly not preventable by clamping down on vaping.

It seems to me perfectly reasonable to threaten to withdraw funds from this organisation until it (a) gets back to its primary function of tackling contagious disease, (b) removes the dark cloud hanging over its transparency and financial affairs, and (c) embraces science on harm reduction.

The UK has the motive and method by which to do this. We pay a staggering amount to the WHO compared to other countries. Check out its list of donors here.

In the 'general fund', the typical amount donated by a reasonably-sized, rich country is $10-30 million. France gives $13 million. Italy gives $10 million. Switzerland gives $11 million. Sweden gives $27 million. Korea gives $26 million.

A handful of countries give more than that. Canada gives $34 million. Norway gives $41 million. Japan gives $47 million. Germany gives $90 million, but Germany is the third biggest donor.

The biggest donor is the USA with $401 million but the UK, which has a smaller population than Germany and a population that is barely a fifth of the USA, is second with £163 million.

We must hope that some of the general fund is spent treating the sick and preventing infectious disease in the world's poorest countries, but that is certainly not how the WHO's money for tobacco control is spent. It is all advocacy, conferencing and nice hotel rooms. The Secretariat of the WHO Framework Convention on Tobacco Control had an income of $5.1million in 2017. The split between countries is quite striking because there are only three of them: Australia, Panama and the United Kingdom. And guess who is paying for 72 per cent of it?

That's right: the British taxpayer - to the tune of $3,697,792.

Presumably this is the £15 million (to be spread over five years) gifted to the WHO Framework Convention on Tobacco Control by the Department of Health civil servant Andrew Black in 2016.

Shortly after this generous use of other people's money, Andrew Black got a job with the, er, WHO Framework Convention on Tobacco Control. Fancy that!

Leaving aside the happy coincidences of Andrew Black's well remunerated career, you'd think that £15 million to the WHO's anti-smoking programme, plus annual contributions of £163 million and several other commitments, would give Britain the kind of 'soft power' that would allow it to make modest demands such as getting the WHO to stop saying that prohibition is an acceptable response to vaping, wouldn't you?

But apparently not, because the WHO's current position on vaping is to recommended 'prohibition or restriction of the manufacture, importation, distribution, presentation, sale and use' of e-cigarettes. That's right: prohibition.

Until the WHO stops recommending fecking prohibition for an effective substitute for smoking, it's reasonable to stop giving it cash, right?

Wednesday, 19 September 2018

More drivel about non-communicable diseases

The World Health Organisation's war on non-communicable diseases (NCDs) has always been a quixotic project. When it set its ridiculous and unachievable targets in 2012, I suggested that it was an excuse for a 'prohibitionist’s charter'...

If 194 countries really have signed this quasi-treaty, you can expect to hear much more about our ‘legal obligations’ to control eating, drinking, smoking and - the mind boggles - ‘physical activity’ for many years to come. You may recall last year’s charming article from Jonathan Waxman in The Times titled ‘To avoid cancer, let the State dictate your diet’, which was itself based on the claim that lifestyles cause 40 per cent of cancer. That is only the start and it is, of course, why the puritans, bureaucrats, nannies and headbangers of public health are so keen on the idea of ‘non-communicable diseases’, because it gives them what every trigger-happy army general wants: a war without end.

It is the conceit that anyone, let alone the WHO, can 'beat NCDs' that most annoys me. The only alternatives to death from a non-communicable disease are death from a communicable disease, violence, overdose or suicide. Fifteen million people die from the one of the latter every year, mostly at a relatively young age, but it is those who die from a non-communicable disease, mostly at an older age, that concern the WHO.

I argued in Killjoys that the WHO should not be wasting its limited resources campaigning against diseases of old age in rich countries when people are dying from easily preventable infectious disease in the developing world. Some people hoped that appointing an African as Director-General of the WHO would put the organisation back on course, but instead he is ramping up the rhetoric. Take this ridiculous tweet, for example...

It's only a matter of time before he starts telling us how many jumbo jets this equates to. I enjoyed this response...

This is all part of the build up to a big WHO conference in New York next week which will see the 'NCD Alliance' call for taxes on sugary drinks to stop people dying in their beds at the age of 99. See my Spectator post from May for more on this surreal crusade.

Tuesday, 18 September 2018

The over-provision of 'public health' ignorance

From The Times...

Call to tackle the ‘retail clusters’ that help cause ill‑health in Glasgow

Not this nonsense again?! How many times are we going to have to go over this? Retailers go where the demand and footfall are. If there was 'over-provision', the shops would close down.

Many of Glasgow’s most deprived areas are populated by “health-damaging” retail clusters that offer easy access to alcohol, fast food, cigarettes and gambling.

The finding, by researchers from Glasgow and Edinburgh universities, has prompted calls for tighter regulation to reduce the density of unhealthy outlets.

That was the intention, of course. There is no academic justification for the publication of a study that shows, for the umpteenth time, that city centre high streets have more off licences and bookmakers than the leafy suburbs.

“Our local environment shapes what we have access to and what we can afford,” said Linda Bauld, professor of health policy at Stirling university.

“The density of fast food, gambling, tobacco and alcohol outlets in deprived areas is almost certainly contributing to the health gap between rich and poor. This density can be changed through local planning processes and also through regulation.”

The question that people like Bauld can never answer is why, if businesses can make people engage in certain activities by merely existing, do retailers not 'target' wealthy areas where people have more money to spend? What kind of capitalist would waste his coercive powers on people who have little disposable income?

Miles Briggs, the Conservative MSP and the party spokesman on public health, has called for “determined local authority action” to tackle the problem.

 Ah yes, the Conservatives.

Frank McAveety, the Labour former leader of Glasgow council, said: “Clearly there is overprovision in some working class areas, creating a fatal combination of bookies, fast food shops and off-licences. There has to be a fundamental look at the legislative framework around overprovision and where powers lie and can be applied.”

The only over-provision I can see is a surplus of economically illiterate 'public health' studies written by people who don't understand supply and demand.

And yet, right at the end of the article, we get this...

Laura Macdonald, a co-author of the study, hopes the findings will influence change...


...but said: “We cannot ascertain why outlets are colocated in deprived areas — it could reflect shopper convenience or because retailers purposely choose areas close to populations with greater demand for specific goods.”

Yes, Laura! And the truth shall set you free!

It is both, of course, and that is all there is to say.