Wednesday 31 January 2018

Two steps back for tobacco harm reduction

Last week the FDA was advised to keep it a secret that iQOS is safer than smoking, and the European Court of Justice was advised to keep snus illegal. I've written an article for Spectator Health about the anti-science, freedom-hating prohibitionists responsible.

There seems to be a principal-agent problem when new nicotine products are assessed by people who are steeped in ‘public health’ dogma, especially when those products contain tobacco. Bates argues that ‘panel members have strong ‘virtue signalling’ incentives to oppose tobacco industry innovation, even if highly beneficial to people at greatest risk. They can enter the room, turn up the pedantry dial to maximum, sit back and relax, lob in the odd insincere question and vote down the claims, all the time faking an appearance of trying to do the right thing.’

And so we have two products which are manifestly less harmful than cigarettes, both of which have a track record of getting people to stop smoking. One is illegal in the EU. The other is illegal in the USA. Neither of them can be labelled as less harmful and neither can be marketed as a reduced-risk product. At best, the government prevents manufacturers from putting truthful statements on these products. At worst, it prevents them from selling them at all.

Do have a read.

Tuesday 30 January 2018

The anti-drink lobby's war on reality: Geordie Shore edition

Some more puritanism dressed up as academia for you, this time from Alcohol and Alcoholism...

Alcohol Content in the ‘Hyper-Reality’ MTV Show ‘Geordie Shore’

Three tax-spongers from the UK Centre for Tobacco and Alcohol Research (UKCTAS) watched an entire series of the Newcastle-based reality show Geordie Shore and were - as the stars of this show might say - 'proper radge' to find numerous depictions of alcohol use.

All categories of alcohol were present in all episodes. ‘Any alcohol’ content occurred in 78%, ‘actual alcohol use’ in 30%, ‘inferred alcohol use’ in 72%, and all ‘other’ alcohol references occurred in 59% of all coding intervals (ACIs), respectively. Brand appearances occurred in 23% of ACIs. The most frequently observed alcohol brand was Smirnoff which appeared in 43% of all brand appearances. Episodes categorized as suitable for viewing by adolescents below the legal drinking age of 18 years comprised of 61% of all brand appearances. 

Shocking stuff, I'm sure you'll agree.

Alcohol content, including branding, is highly prevalent in the MTV reality TV show ‘Geordie Shore’ Series 11. Current alcohol regulation is failing to protect young viewers from exposure to such content.

Note the focus on 'young viewers'. I am not familiar with Geordie Shore but from what I've heard it is not exactly a children's programme. It is broadcast on MTV at 10pm and Series 11 is rated 18 on DVD. When I looked at the official website I found a selection of video clips with titles such as 'WTF! Gaz and Abbie neck on in naked hot tub party', 'Chloe's boob flash and char confession' and 'Scott finger blasts Chloe'.

It is, however, the use of alcohol that troubles our trio of researchers. They watched all 425 minutes of Series 11 and kept a count of every example of 'actual use, implied use without actual use, paraphernalia without actual or implied use, and brand appearance (real or fictitious)'.

Imagine having that much time on your hands. Imagine being paid to do it (the funders for this crucial scientific research were British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council and the Department of Health).

The fruits of their labour can be seen below. As you can see, there is a fair bit of alcohol use and 'inferred alcohol use' in between the fighting, swearing and shagging in Geordie Shore.

I'm sure you're as keen as I am to know what inferred alcohol use, so here's a handy chart.

The authors then go through every permutation of their findings in autistic detail before announcing that...

The findings of this study demonstrate that the occurrence of alcohol content (verbal and imagery) and alcohol brand appearances is highly prevalent in ‘Geordie Shore: The Complete Eleventh Series’ (GS11).

I expect a fan of the show could have told us that without being given money by the British Heart Foundation, but now it's official.

Similarly, our previous research found alcohol, including branding, to be the prevalent in contemporary music videos...

The life of a 'public health' scientist, eh?

Only one question remains: 'SO WHAT?!' And the authors spend the rest of their article telling us why we should give a hoot.

The study also found that alcohol content and alcohol brand appearances occurred in all episodes of the series deemed suitable for viewing by young people below the age of 18 years. The legal drinking age in the UK is 18 years.

The age at which you can buy a drink is 18 years, yes. Watching somebody else have a drink, on the other hand, is not age-restricted - and only a lunatic would suggest it should be.

Just because you're not allowed to do something doesn't mean that you're not allowed to watch somebody else do it on television. This basic distinction seems to have gone over the heads of our friends at the UK Centre of Tobacco and Alcohol Research.

This is an important finding...

It really isn't.

...because the drinks industry should be adhering to its own self-regulatory codes of practice which aim to prevent exposure of their products to an underage audience.

The drinks industry doesn't produce Geordie Shore, though, does it? As far as we know, no alcohol company has any involvement with it.

However, the regulation of alcohol advertising in the UK has already been criticized for systematically failing by producers and agencies exploiting the ambiguities in the codes (Hastings et al., 2010).

Regardless of whether that's true - and if you're citing Gerard Hastings it probably isn't - Geordie Shore is not covered by alcohol advertising regulation because - guess what? - it's not advertising. It is a reality TV show about twenty-somethings in Newcastle and - guess what again? - the reality is that they drink.

The authors then list various companies' code of conduct for advertising as if it's got anything to do with the real or inferred use of alcohol in reality TV shows:

Anheuser-Busch InBev, the leading global brewer, produces and sells over 200 beer brands globally (AB InBev, 2015). It owns two brands that appeared in this study; Corona and Budweiser. They have a voluntary marketing code that states ‘we are dedicated to promoting smart consumption and reducing the harmful use of alcohol’ (AB InBev, 2016) The code does not apply to television programmes that use their products without express permission to do so, which may have occurred in GS11. Drinks distributer Diageo is the global leader in alcohol beverages (Diageo, 2017). It owns five alcohol brands recorded in the data: Smirnoff, Captain Morgan, Baileys, Tanqueray and Cîroc. Diageo state that marketing will only be placed ‘where 71.6% or more of the audience are expected to be older than the legal purchasing age’ (Diageo, 2016). Clearly this is not guaranteed in GS11. Heineken UK and Bacardi Limited, the owners of Grey Goose, make similar claims in their corporate responsibility policies (Grey Goose, 2015; Heineken, 2015).

All totally irrelevant to the matter at hand.

It is unclear whether the drinks manufacturers have paid for brand advertising in GS11, in which case several codes of practice have been clearly violated...

'It is unclear whether' translates as 'There is no evidence that', so I think we can dismiss that option and move on to the more likely conclusion:

...or if this is a form of de facto advertising where brands are unofficially advertised without the alcohol producer’s knowledge...

Bingo! Now we're getting somewhere. The participants drink alcohol in real life and so that's what the programme shows. which case it is surprising that the companies have not objected and demanded withdrawal of their products.

I guess they could request that the labels be covered up, but it would make them look like control freaks for no benefit to anybody. The viewer would still be exposed to 'inferred drinking' and 'on-screen drinking to excess, with related drunk and disorderly behaviour and sexual encounters', which is what the researchers are supposedly concerned about.

Finally, and as usual in 'public health' studies these days, the conclusion is devoted to a shopping list of new laws and regulations that the authors want to introduce.

...enforcing new policy measures to help protect adolescents from alcohol imagery in the media is essential. Given that 60% of GS11 episodes were awarded by the BBFC and age rating of 15 years, it appears that the existing age classification policy is not protecting young people from alcohol imagery and its potentially harmful effects. 

As mentioned above, you have to be 18 to buy the DVD of Geordie Shore. The authors are talking about the ratings of individual episodes, some of which are rated 15. This is enough for them to play the think-of-the-children card.

In any case, there is no age limit on exposure to 'alcohol imagery'. Alcohol advertisements can be shown at any time of day on British television, except during children's programmes. Geordie Shore is on at 10pm at night, as I mentioned above but the authors mention do not at all (they merely say it is on during 'primetime'.)

The BBFC should award reality television programmes, which include excessive alcohol content and which promote excessive drinking and/or brand placement, an age rating of 18+ years.

The BBFC will not give something an 18 rating just because it depicts heavy drinking. They are not nuts. They did not cave in to Mary Whitehouse and they are not going to cave in to a small band of anti-drink zealots. They have patiently explained why they are not going to start giving 18 ratings to films that depict smoking and much the same applies to drinking. We do not ban films that depict murder just because murder is banned. Similarly, we do not give adult ratings to programmes that depict drinking, smoking or gambling just because you have to be an adult to do these things yourself.

A fairly simple concept to grasp, I would have thought. Now be gone with you.

Sunday 28 January 2018

Nick Cohen's dystopia

Nick Cohen has gone on a health kick and thinks that his midlife crisis should form the basis of public policy. Previous victims of this delusion include Sarah Vine, David Aaronovitch and, a few days ago, Jenni Russell. After Cohen gave up drinking last year, he wrote a factually inaccurate article calling for more temperance laws. He is now running a half marathon and has decided that the British population must forced to do more exercise.

The results are fairly terrifying. His latest Observer column begins like this:

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

This is literally Orwellian, with the opening sentence evoking the famous line from 1984: 'If you want a vision of the future, imagine a boot stamping on a human face - forever.' And whilst you might expect Cohen to draw back from this explicit authoritarianism and say something along the lines of 'but that would not be reasonable' or 'only kidding!', his article continues in exactly the same vein. Towards the end, he reasserts:

When we imagine a healthier future we are also imagining a more authoritarian state. Individual choice will be constrained and wisdom of the crowd rejected.

If this is the deal on offer, many of us would say that you can stick your 'healthy future' and give us liberty. It is doubtful whether the choice is as binary as Cohen suggests: despite all the wailing about obesity, people's health continues to improve whereas none of Cohen's coercive policies have been shown to work - but he seems to believe what he says and he takes it as read that people should be prepared to sacrifice liberty for longevity. As I wrote in Killjoys, this is a core belief of the 'public health' lobby despite the fact that nobody makes such an extreme trade-off when left to their own devices.

His overarching justification for forcing lifestyle change upon the population is the usual excuse about poor diets and lack of exercise bankrupting the NHS (may peace be upon it). Anyone who knows the economics of longevity understands that this is piffle (have a read of Death and Taxes for a summary). But, having fallen for this popular myth, he then launches into his programme for change:

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. 

Roads are obviously not too narrow to take cars, so I can only assume that Cohen will extend cycle lanes to make them so. I assume this because...

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. 

This is an idea that can only be seriously entertained by someone who works from home in central London. How practical would it be to bring Britain's roads to a standstill in an effort to force people to walk?

Let's look at some statistics. 89 per cent of all journeys in Britain are taken by road and two-thirds of business/commuting trips are taken by car. Only 6 per cent of car journeys are under a mile and the majority of journeys under a mile are already taken on foot. Even if we leave aside the foul British weather, the weight of luggage and the need of vans and lorries to make deliveries, the distances involved are simply too long.

Incidentally, although I don't have the stats for this, life experience tells me that pedestrians at pelican crossings do not have to wait more than a minute to cross the road.

Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

Because everyone lives within a mile of their workplace and should just get on their bloody bike, eh Nick? Never mind all the people who live in the suburbs, small towns and countryside - who are, by the way, in the majority.

Cohen's logic suggests that closing down railways, bus routes and the tube would also be necessary to get Britain exercising and yet he does not mention any of these. Perhaps the idea of getting around London without the help of an engine is not as appealing as the vision of suburban drones marching to the office?

School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

What about those who arrive in a bus? Is motorised transport only acceptable if it is owned by the state?

No fast-food outlet would be allowed within a one-mile radius of a school. 

Effectively, this would mean no fast food outlets in Britain's towns and cities. Thanks to Dan Cookson, we know what an exclusion zone of 400 metres around schools - as proposed by Sadiq Khan - would look like.

Cohen is proposing an exclusion zone that is four times wider than this and that applies to all fast food outlets, not just the new ones. This would amount to a total ban on shops selling pizzas, hamburgers, fish & chips, kebabs etc. Cohen would probably be happy with that, but it sounds a tad heavy-handed.  

Agricultural subsidies for fat and sugar would be abolished. 

There are no subsidies for 'fat'. Fat is a component of most food products including meat, cheese and milk. In so far as there is a subsidy for sugar, it is part of the EU's farming regime of tariffs and subsidies which, on balance, makes sugar more expensive that it would otherwise be.

Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. 

I have no idea what he is talking about here. Is he suggesting that the government ban the farming of these crops? Or does he think that people will spontaneously stop consuming them when public transport is (further) subsidised? If so, why? There is no logical connection between the two, but the call to subsidise public transport confirms that it is private car ownership, not physical inactivity, that is really bugging Cohen.

Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

Food manufacturers don't pay excise taxes, consumers do.

It may seem a less practical measure but I would hope to see a vigorous challenge to the paradox of our culture’s celebration of thinness and athleticism in an overweight world. The idealisation of film stars and athletes raises impossible expectations. Because 99% of people do not have the genes – or the time and money for training – to even think of imitating them, we simply don’t try. A small blow could be struck if UK Sport were forced to stop sponsoring elite Olympic athletes and spend its millions on sports facilities for all instead.

Again, I have no idea what he's talking about it. Whilst I am extremely sympathetic to the idea of not paying people to participate in the jingoistic tedium of the Olympics, I fail to see how withdrawing the funding will make us any thinner. It is wibble.

Sugar and fat addiction, like all addictions, provide a temporary respite for the poor, the depressed and the disappointed. 

Sugar and fat addiction do not exist. Giving up something you enjoy and then missing it does not make you an addict.

Perhaps we should offer them better lives rather than snatch away the few comforts they enjoy. 

That would be nice wouldn't it? But you have no way of doing it and you're only going to make their lives worse by dishing out the kind bans and taxes as that evil billionaire Mike Bloomberg threatened us with this week.  

This sounds a stirring counter-argument. 

It's better than taxing the hell out of us, censoring the media, and making us walk for miles in freezing temperatures, yes.

But as any reader who has been an addict will know, addiction prevents you finding a better life.

People are not addicted to driving and there is no evidence that they have a latent demand for cycling, walking or tasteless food.

God knows, there are good reasons to mistrust experts re-engineering societies from above.

Given that the main 'expert' Cohen cites is a fanatic called Tim Lang who thinks that repealing the Corn Laws was a mistake and believes that making food more expensive is an admirable end in itself, this mistrust is justified.

But as with tobacco, freedom of choice in the food and car markets has left us with no choice but to trust them.

The vilification of 'car markets' is a new one to me, but it is no surprise to see tobacco being used, once again, as a precedent for controlling the lives of private citizens.

Cohen admits that many readers will regard his proposals as 'dystopian', and so they are. Nevertheless, I am glad that he has put them down on paper. His article is a fine reminder of what we are up against.

Friday 26 January 2018

Junk alcohol research of the week

Sometimes the junk science that comes out of the ‘public health’ lobby is so bad you just have to laugh. Take this study, for example, published yesterday in the apparently reputable Journal of Hepatology. As reported by the Irish Times, it found that ‘alcohol consumption even at very low levels early in life may significantly increase the risk of alcoholic liver disease in men’. It was even suggested that drinking guidelines should be lowered to accommodate this emerging evidence.

Alcoholic liver disease is a relatively rare condition that overwhelmingly affects very heavy drinkers. It would be surprising, to say the least, if ‘very low levels’ of drinking caused it.

And yet the media’s coverage of this study accurately reflected the claims made by its authors. They claim to have shown that ‘consumption of alcohol early in life is associated with an increased risk of developing severe liver disease in men’. They say that ‘men consuming as little as one to five grams [less than one unit] of alcohol per day had an increased risk of severe liver disease compared to abstainers, indicating that the increased risk of severe liver disease might be present even at very low doses of alcohol.’ Moreover, they declare – in the abstract of the study – that: ‘Current guidelines for safe alcohol intake in men might have to be revised.’

How did they arrive at these remarkable conclusions? First, they dug up some old documents from the Swedish army dating back to 1969-70 when conscription was still in force. These documents contain survey data from conscripts aged between 18 and 20, including estimates of how much they drank.

This gave the researchers the baseline figures for alcohol consumption. The men were then ‘followed for a mean period of 37.8 years’ to see what happened to them. This is a rather grand way of saying that the researchers looked at Sweden’s National Patient Register to see how many had developed alcoholic liver disease by 2009.

Of the 43,296 individuals who had provided drinking estimates in 1969/70, 383 had developed severe liver disease (0.9 per cent). When the researchers looked at their alcohol consumption, they found that those who drank the most were the most at risk and those who did not drink at all were the least at risk. Fair enough but, more surprisingly, they also found that those who only drank one or two units a day were at increased risk.

The authors describe these findings as ‘borderline statistical [sic] significant’. In fact, they are nowhere near being statistically significant, but we’ll leave that to one side. The more interesting question is this. In the 39 years between the men being recruited to the army and their medical records being examined, how often do you think the researchers asked them how much they drank?

Every six months? Once a year? Once every five years?

How about never? Because that’s how often they kept abreast of what these men were drinking. Not once. They have no idea how much their subjects’ drinking behaviour changed in the intervening years. All they know is that the people who were teetotal in 1970 were less likely to develop liver disease than the people who were drinkers in 1970. Hold the front page!

In no way does this study show, or even imply, that drinking at low levels causes liver cirrhosis. The authors’ suggestion that their study shows that ‘recommendations for safe alcohol consumption regarding the risk for development of severe liver disease in men might be set too high’ is an absurd non-sequitur.

Quite obviously, the men in this study did not continue drinking at the same level as their 19 year old selves for the rest of their lives. Some of the teetotallers became heavy drinkers (we know this because eleven of them developed alcoholic liver disease), some of the heavy drinkers became teetotallers, and some of the light drinkers became heavy drinkers. It is not drinking at ‘very low levels early in life’ that causes the damage. It is drinking at very high levels later in life. Without knowing anything about what these men were drinking after 1970, the study tells us precisely zero about the relationship between alcohol and liver disease, nor does it inform the discussion about what a ‘safe level’ of drinking is.

Why are journals publishing this pointless rubbish? Judging by the lead author’s comments to the press, the aim is not to tell us anything useful, but to put pressure on the Swedish government to follow the UK in lowering the drinking guidelines.
“If these results lead to lowering the cut-off levels for a ‘safe’ consumption of alcohol in men, and if men adhere to recommendations, we may see a reduced incidence of alcoholic liver disease in the future,” Dr Hagström said.
It would be strangely fitting if the Swedes lower their drinking guidelines based on junk science which claims that alcoholic liver disease is a threat to light drinkers. As the e-mails released under the Freedom of Information Act show, it was only by making this scientifically illiterate assumption that the UK’s Chief Medical Officer was able to lower the guidelines in 2016.

We can expect more studies of this kind in the next few years. The anti-drink lobby will not be happy until the official drinking guidelines are zero and they will go to any lengths to achieve it.

[Cross-posted at Spectator Health]

Tuesday 23 January 2018

Snus goes to court again

I was interviewed for the Europeans Podcast recently about the issue of snus. You can listen to it here (iTunes) or here (Android).

The interview was timely because we've just had news out of Norway where Sweden's experience of a mass cross-over from cigarettes to smokeless tobacco has been replicated.

More Norwegians use snus – a form of snuff particular to Nordic countries – instead of cigarettes for their nicotine fix, official figures showed for the first time on Thursday.

The preference for snus in Norway, is certain to revive debate over the health effects of the product, a moist powder tobacco that is popped under the lip.

Though its sale is illegal across the EU, it is manufactured and used in Sweden, which has an exemption, and Norway, which is not an EU member.

According to Norway’s statistics office SSB, 12% of Norwegians used snus daily in 2017, compared with 11% who smoked cigarettes every day.

Uber-tweeter Stephen Fry has also posted one of his occasional tweets on the subject:

On Thursday, the EU's ban on snus will be tested at the European Court of Justice. As I described in The Art of Suppression, the ECJ ruled that the ban was legal some years ago after the IARC rushed out a briefing which conflated snus with hazardous smokeless tobacco products from places like India. Since then, more epidemiology has shown snus's potential to help smokers quit and has found the product to be vastly less hazardous than cigarettes.

The case has been brought by Swedish Match and the New Nicotine Alliance. The latter has issued an update on its website:

The case was originally brought by Swedish Match. The New Nicotine Alliance asked to be joined to this case because it concerns the health of smokers in the European Union. It is not about markets and commerce, but about the right to be able to choose a safer alternative to smoking. For the NNA this case is about whether some 320,000 premature deaths from smoking can be saved in future years, as detailed by Dr Lars Ramström in his statement to the court.

The denial of access to lower risk snus leads to unnecessary deaths. The NNA believes that smokers have a right to safer nicotine products as alternatives to smoking and the right to make choices that help them avoid adverse health outcomes.

The core of the NNA’s case is that the ban on snus is both disproportionate and contrary to the right to health. There is no need for the ban, and the ban, if upheld, will continue to contribute to excess mortality from smoking in Europe.

This is the first time that a ‘right to health’ argument has been used to challenge a bad tobacco law: we argue that the Court needs to examine the compatibility of the Tobacco Products Directive with both the EU Charter of Fundamental Rights and the harm reduction obligation under the Framework Convention on Tobacco Control.

I have written before about how Brexit offers an opportunity to get rid of this ridiculous ban, but the ECJ case offers an opportunity for smokers across the EU to switch to snus.

Fingers crossed.

Monday 22 January 2018

A junk history of tobacco harm reduction

An article in Tobacco Control by a pair of professional anti-smokers from San Francisco asks why the US and UK have such different approaches to e-cigarettes and other reduced-risk nicotine products.

Major British health organisations support tobacco harm reduction for smokers struggling to quit. The USA, in contrast, classifies e-cigarettes as tobacco products and leaders are less supportive of tobacco harm reduction.

Historians have attributed this transatlantic difference to the tobacco industry’s long history of deception over ‘safer’ products resulting in scepticism towards tobacco harm reduction.

Have they? That's news to me. Elias and Ling cite three articles as proof, but only one of them was written by a historian and that was published in 2004, long before e-cigarettes hit the market. None of them makes the argument that Elias and Ling say they do.

But never mind because the rest of the article makes the argument - such as it is - anyway. They do this by going over the story of the Independent Scientific Committee on Smoking and Health (ISCSH) which conducted safer cigarette research with the tobacco industry in Britain in the 1970s. The story they tell has been mostly drawn from the excellent work of the historian Virginia Berridge. You can read a very short summary of the initiatives of the 1970s in Vaping Solutions, but the gist of it is that nothing really came of them because smokers tend to draw more deeply on low tar cigarettes and regulation prevented more imaginative safer cigarettes from succeeding in the market.

Elias and Ling go through the British experiments for several pages and then, finally, get to the point:

In the eyes of the broader British public health community, the ISCSH work was largely for naught. Yet in recent years, the Committee’s guiding logic and premises of risk reduction have enjoyed a reanimation among British public health organisations.

Hear that dog whistle? The message is 'once bitten, twice shy'. History is repeating. Beware!

British public health should mind past experience, in which industry-backed ‘safer cigarettes’ undermined public health.

Elias and Ling argue that efforts in the UK to make cigarettes safer were an industry-led distraction which caused the British government to shelve effective anti-smoking policies. By contrast, the USA got on with the job of clamping down on cigarettes and had no truck with tobacco harm reduction.

As if that weren't bad enough, it's all happening again. When will those limeys learn?

If the past is any guide, the promotion of tobacco harm reduction may serve the interests of tobacco companies more effectively than the public.

The problem with this narrative is that it's ahistorical nonsense from start to finish. It turns a blind eye to the inconvenient fact that America had its own industry-government working group that spent millions of dollars trying to make cigarettes safer. The US National Cancer Institute set up the Tobacco Working Group in 1968 (five years before ISCSH was formed) for this very purpose, but the only acknowledgement of this in the Tobacco Control article is one sentence in the discussion section:

Government and industry collaborations to develop a ‘safer cigarette’ were not unique to the UK. From 1968 to 1979, the US National Cancer Institute spent US$50million to sponsor the Tobacco Working Group (TWG).

Government-approved efforts to launch safer cigarettes in Britain and the US were effectively dead in the water by 1978 and 1979 respectively. The two countries did not have different experiences and, therefore, their different attitudes to tobacco harm reduction today cannot be explained by them.

Moreover, the USA did not choose tough anti-smoking measures over tobacco harm reduction, and the UK did not choose harm reduction over anti-smoking policies. From the 1980s to the present day, the UK has had higher tobacco taxes, more restrictive advertising laws and larger health warnings. It also managed to ban snus, the only viable reduced harm product that existed until e-cigarettes came on the scene.

Elias and Ling's little morality tale is a travesty of history and explains nothing. Britain's approach to tobacco harm reduction, and vaping in particular, doesn't require much explanation. From around 2012, lots of smokers spontaneously switched to vaping and the government ultimately decided that this was a good thing. 

Britain is not unique in this. Across the developed world, governments have recognised the benefits of vaping and have regulated e-cigarettes accordingly, ie. more lightly than cigarettes. The sale of e-cigarettes is now legal in every EU country, for example, albeit with some silly restraints from the EU. The USA is the outlier insofar as it has moved from a tolerant position to a more extremist one. It is this American exceptionalism that requires an explanation.

My explanation is that US policy has been influenced by people, such as those at Elias and Ling's Center for Tobacco Control Research and Education, who are more interested in fighting tobacco companies than in fighting smoking. There is also a stronger puritanical element in the US anti-smoking movement than there is in the UK, and America has a stronger history of prohibition. Furthermore, the pharmaceutical industry has more clout in the US than it does in the UK and funds anti-smoking groups to a much greater extent.

In both countries, the 'public health' lobby is divided between those who are genuinely interested in health and those who are, in effect, moral or political crusaders. In Britain, the former just about managed to gain the upper hand, despite opposition from the likes of Martin McKee and Simon Capewell. In the USA, the latter are in charge. They are all awful, illiberal people to varying degrees, but in America the very worst have risen to the top.

Friday 19 January 2018

Blame the government, not Brexit, for the biscuit rip off

McVitie's are reducing their packets of Digestive biscuits from 500g to 400g. This means consumers will be getting seven fewer biscuits in their pack. Parts of the media have been blaming Brexit for this and the company itself has pointed the finger at the weaker pound and rising cost of raw materials.

McVitie's is shrinking the size of a packet of Digestives because of price increases caused by the Brexit drop in the pound, it claims.

The company said the value of sterling has made ingredients more expensive and it did not want to damage the quality of the biscuits.

If these were the real reasons, the obvious thing to do would be to raise the price. If companies made their products smaller every time inflation rose, everything would be tiny.

But they are not the real reasons. When the ONS looked at the 'shrinkflation' of chocolate and confectionery last year, it found no evidence that the value of sterling or the price of raw materials were responsible:

Manufacturers’ costs may also be rising because of the recent fall in the value of the pound – leading some commentators to attribute shrinkflation to the UK’s decision to leave the European Union. But our analysis doesn’t show a noticeable change following the referendum that would point towards a Brexit effect. Furthermore, others (including Which?) had been observing these shrinking pack sizes long before the EU referendum, and several manufacturers have denied that this is a major factor.

The real blame lies with Public Health England and its sugar reduction scheme. PHE have set the food industry the target of reducing sugar in its products by 20 per cent by 2020. McVitie's said last year that it was 'confident' it could achieve this.

But how? Artificial sweeteners do not work well in biscuits. When PHE realised that genuine product reformulation was impractical, they told the companies that reducing portion size would count as sugar reduction. Indeed, they actively encourage them to reduce portion size.

Shrinking a pack of biscuits from 500g to 400g is a reduction of twenty per cent and so McVitie's can claim to have met its target. Last year it reduced the number of Jaffa Cakes in a packet from 12 to 10, which is nearly a twenty per cent reduction. There will be more to come.

The price of the new, smaller pack of Digestives is also going to be reduced, but not by as much. It will fall from £1.25 to £1.15, a drop of 8 per cent. The result is that Public Health England can say that their target has been met, McVitie's can make a bit more money and the consumer loses out. Meanwhile, people who don't want to leave the EU can brandish this as further evidence that Brexit is making us all poorer.

But it is fake news. It has nothing to do with Brexit. It is all about the government's ridiculous childhood obesity strategy. They call it 'health by stealth'. Doing it by stealth is bad enough, but denying that it is happening while lying about the reasons behind this rip-off is intolerable.

Wednesday 17 January 2018

Public Health England vs. the Evening Standard

In November, the Evening Standard published an article about the drinking guidelines scandal in which the methodology of Sheffield University's modelling was changed at the eleventh hour after their initial modelling implied that the guidelines should not be lowered. The methodological change had no scientific justification, as the Sheffield team told Public Health England at the time. Nevertheless, PHE ordered the change to be made (for a fee of £7,800) and the research came back with significantly lower implied guidelines.

This story was covered in the Sunday Times in late October and I published a full account on Spectator Health. The Evening Standard reiterated some of this in an article on November 3rd headlined 'Public Health England "tweaked" alcohol research to impose stricter guidelines, report reveals'.

I would link to the article but it was taken down within hours. I don't know if it was ever published in the newspaper. All I have are these screenshots that I took at the time.

Why was this article taken offline? I suspected that Public Health England might have had something to do with it so I sent a Freedom of Information request asking to see all correspondence between them and the Evening Standard at the time of the incident.

Sure enough, I got this e-mail chain starting on 2 November while the journalist was preparing the article...

From: PHE
Sent: 02 November 2017 13:48
To: standard
Subject: PHE response on alcohol guidelines story in Sun Times


As promised - our full statement in response to Sun Times:

PHE spokesperson:

“The UK Chief Medical Officers’ alcohol guidelines were based on a comprehensive analysis of the evidence and advice from the Guidelines Development Group of independent experts.

“As part of the secretariat to the group, we commissioned the analysis, as requested by the Guidelines Development Group, from Sheffield University. We categorically refute the claim that PHE in any way attempted to influence or pressure Sheffield University on their research work to inform the alcohol guidelines.”

I will forward our final response to the Spectator as soon as possible


The Spectator article was mine. PHE did indeed respond to it and I replied to their points in this article.

PHE then sent the Standard the response that Sheffield had sent the Sunday Times a few days earlier...

From: PHE
Sent: 02 November 2017 14:10
To: Stanfard
Subject: PHE response


Below is part of our response to the Spectator Re: Chris Snowden’s article, which gives a more detailed account from Sheffield Uni about the evidence requested from the expert group. The links provide the minutes of the expert groups (GDG) meetings.

Any queries on the expert group’s decision on the evidence are not for PHE to answer – as we were just part of the secretariat to the group along with DH.

Sheffield Uni press office can also provide you with their full response to the Sun Times.

As part of the secretariat to the group, we commissioned the analysis, as requested by the GDG, from Sheffield University. Any emails from PHE to Sheffield commissioning additional modelling and evidence were based on the GDG’s decisions and at their request, as is clearly shown by the publicly available minutes of their meetings.

This has been confirmed by Sheffield University’s Alcohol Research Group, which has said:

“Minutes from the subsequent GDG meeting on 21 January 2015 state that, after hearing Sheffield's presentation of their work, the GDG concluded: ‘A holistic, expert judgement on guideline levels would be needed, taking account of uncertainties and issues not fully modelled’. This demonstrates that the group recognised there was considerable scientific uncertainty present and that no single piece of evidence or modelling decision used in isolation would determine the final guideline.

“As noted in the Royal Statistical Society's consultation response: "This is a contested area of science with considerable uncertainties" (paragraph 1.1). The change to the base case analyses related to a point of scientific uncertainty. The Sheffield Alcohol Research Group were happy with the decision taken whereby the base case analysis was revised but the original modelling assumptions were retained as one of a series of sensitivity analyses.

“Those analyses explored major areas of uncertainty within the underlying evidence and their implications for the Guideline Development Group's work. The group considered those sensitivity analyses in detail and took them into account in their decision-making.”


From: Standard
Sent: 02 November 2017 14:11
Subject: RE: PHE response


Thanks so much for getting back to me.

All the best,


From: PHE
Date: 2 November 2017 at 14:21:39 GMT To: standard
Subject: RE: PHE response


Grateful if you could let me know if you do decide to write something



It must be said that neither PHE's response nor that of Sheffield's is entirely consistent with the e-mails sent at the time. PHE's defence throughout this whole affair has been to pass the buck to the guidelines committee. I made it clear from the start that the idea of changing the methodology came from the guidelines committee. However, it is a bit much for PHE to deny that they 'in any way attempted to influence or pressure Sheffield University'. Whether acting on behalf of the committee or not, PHE exerted strong pressure on the Sheffield team, and on page 28 of Sheffield's published report it clearly states:

‘At the request of the commissioners (Public Health England), this threshold effect removed for the base case analysis…’

As for the Sheffield team claiming that they 'were happy with the decision taken whereby the base case analysis was revised but the original modelling assumptions were retained as one of a series of sensitivity analyses', the e-mails suggest that they were anything but happy. When asked by PHE to change the methodology, they said:

Our view remains that it does not seem right to assign people drinking at very low levels a risk of acquiring alcoholic liver disease and similar conditions. Unless there are strong opposing views, we think it better to keep the threshold in the base case.

The Standard published the story on November 3rd and received this e-mail from PHE in response:

From: PHE
Sent: 03 November 2017 16:38
To: Standard
Subject: Complaint re: "Public Health England 'tweaked' alcohol research to impose stricter guidelines, report reveals"

Dear XXXX,

Not for publication

I am writing to complain about multiple inaccuracies and errors in Alexandra Richards’ article “Public Health England 'tweaked' alcohol research to impose stricter guidelines, report reveals” and the article’s serious and unsubstantiated claim that PHE made changes to research in order to impose different guidelines.

As I explained in my phone call earlier, this is a serious allegation that assigns intent to PHE as well as claiming that PHE altered evidence. In fact, as our on the record statement made very clear, PHE was not a decision making body and so it is doubly wrong to suggest that PHE altered evidence with an intended outcome.

PHE was acting as secretariat to the independent group of academics, the Guideline Development Group (GDG) which advised the Chief Medical Officer (CMO) on the evidence. It was this group of academics which decided to request additional analysis, a point which is made very clear in the minutes of their meetings which were published by the Department of Health as part of the consultation process some time ago (this evidence, and a link to where it can be found, is detailed here: documents_acc.pdf). I have attached the minutes of the relevant meeting.

I request that the article is taken down until corrected so that others do not repeat its many errors.

They are:

Public Health England 'tweaked' alcohol research to impose stricter guidelines, report reveals
Wrong. A group of independent academics, the Guidelines Development Group (GDG), were responsible for reviewing the evidence and submitting this to the CMO. They resolved at their meeting of 21 January 2015 to request additional modelling. It should also be noted that the final report included all analyses  

The government asked a leading alcohol research centre to tweak data in order to impose stricter regulations on drinking  
Wrong. As above, the decision to request additional research was made by the independent GDG. Secondly, this sentence alleges, without substantiation, that PHE’s intention was to impose stricter regulations. Finally, the CMO Guidelines are not regulations – as made clear on the government’s website: “These guidelines, produced by the 4 UK chief medical officers, provide the most up to date scientific information to help people make informed decisions about their own drinking.”

Public Health England called on scientists at the Sheffield Alcohol Research Group (SARG) to write into a report
It is wrong to say PHE ‘called on’, this implies lobbying or advocacy. As the published minutes of the GDG and our statement make clear, PHE passed on the GDG’s request in our role as part of the secretariat.

Christopher Snowden, who requested the FOI, discovered that there had actually been an earlier draft of the report
This ‘earlier draft’ is publicly available on the Department of Health’s website in the consultation pack (see link above).

In emails seen as part of the FOI request, PHE wrote to the SARG suggesting that the group “estimate risk urges without threshold effects for wholly alcohol-attributable chronic conditions" in the model.
It is wrong to say this was PHE’s suggestion. As the published minutes of the GDG and our statement make clear, PHE passed on the GDG’s request in our role as part of the secretariat.

When the Evening Standard contacted the PHE they said that they had been acting at the request of the Department of Health and that any requests to change the report came from them.
Not correct. PHE made clear (see attached emails) that decisions on the evidence were made by the independent experts of the GDG. They are independent of the Department of Health.

PHE added: “Any emails from PHE to Sheffield commissioning additional modelling and evidence were based on the GDG’s decisions and at their request, as is clearly shown by the publicly available minutes of their meetings”
Our full statement makes clear the GDG’s role: “The UK Chief Medical Officers’ alcohol guidelines were based on a comprehensive analysis of the evidence and advice from the Guidelines Development Group of independent experts. As part of the secretariat to the group, we commissioned the analysis, as requested by the Guidelines Development Group, from Sheffield University. We categorically refute the claim that PHE in any way attempted to influence or pressure Sheffield University on their research work to inform the alcohol guidelines.”

He said that after seeing the initial evidence, the Department of Health decided that the evidence was not “robust enough”
See above – it was not the Department of Health but the GDG which requested additional evidence.

They also said that they could not answer questions regarding the GDG’s decision on the evidence.
PHE actually said in a background email (attached), “Any queries on the expert group’s decision on the evidence are not for PHE to answer – as we were just part of the secretariat to the group along with DH.”

I do not speak for Sheffield University, but I would point out that others have run a fuller version of their statement, including a line which was not included in the Standard Online’s piece - “The Sheffield Alcohol Research Group were happy with the decision taken whereby the base case analysis was revised but the original modelling assumptions were retained as one of a series of sensitivity analyses” (see: 113).

Please confirm receipt and that this article will be corrected.



The article was not just 'taken down until corrected', as PHE requested. It was taken down for good. Without having the full article in front of me, it is difficult to say how accurate it was. Most newspaper articles are inaccurate to some extent, but I don't recall thinking that it was any worse than average.

Looking at PHE's list of complaints, they are right to say that the guidelines are not 'regulations' and they are right to make a distinction between the guidelines group and the Department of Health. These are sloppy mistakes that could have easily been corrected.

Other than that, the article is basically sound. It is simply a fact that it was PHE who commissioned the Sheffield report and it was they who asked them to make the changes. Whatever word you want to use - 'suggested', 'asked', 'called on' - PHE wrote the e-mails to Sheffield requesting the changes. They can argue that they were just middle men acting on behalf of the guidelines group (although Sheffield researchers were on that group and they seemed surprised that PHE was asking for the whole base case to be changed), but they were the ones who told Sheffield to change the methodology.

In any case, the Standard article included quotes from PHE explaining their position so that readers could make up their own minds. That is fair journalism and the Standard was spineless to take the article down.

It is telling that neither PHE nor Sheffield has mounted a defence of the methodological change itself. Sheffield points the finger at PHE and PHE points the finger at the guidelines group. The data were 'tweaked'. PHE do not deny that. The change made to the base case had no scientific justification and no scientist has tried to justify it.

PHE says that '[a]ny queries on the expert group’s decision on the evidence are not for PHE to answer'. So who is going to answer them? Anybody?

Tuesday 16 January 2018

Stop press: sugar tax = higher prices

Some people seem surprised that Coca-Cola are raising prices and reducing bottle sizes as a result of the sugar levy, despite that being the whole point of it.

I've written a short piece for Cap-X looking at the economics of this and whether Coke are price gouging. Do have a read.

Monday 15 January 2018

Alcohol and dementia

The front page of yesterday's Sunday Times carried the news that Public Health England intends to use its bizarre new calorie limits to bully restaurants and food manufacturers into downsizing and degrading their products.

Public Health England (PHE) has told fast-food chains and supermarket ready-meal makers to “calorie cap” their foods, cutting down lunches and dinners to 600 calories and breakfast to 400.

The plan, to put the whole of the UK on a diet, is due out in March.

This is as I predicted when the new guidelines of 400 calories for breakfast and 600 calories for lunch and dinner were announced a few weeks ago:

I suspect that there is an agenda at work here. The 400-600-600 'rule' will allow PHE and its army of scolds to name and shame every restaurant portion, takeaway and ready meal that contains more than the government-approved quantity of calories. Individual meals will be portrayed as hazardous per se and will become targets for advertising bans, taxes and reformulation. A whole Pandora's Box is being quite deliberately opened. 

The same Sunday Times article also suggested that the alcohol guidelines might be lowered yet again:

To add to the agony, it coincides with research showing that the UK’s alcohol rules are too lax, with even drinking one pint or glass of wine a day poisoning the brain and raising the risk of dementia.

It's unclear whether Public Health England tipped off the press about this study or whether the Sunday Times decided to combine two 'public health' stories. The idea that the government would change the drinking guidelines on the back of a single study that looks at single outcome is absurd, but you never know these days.

The study itself involved a group of people being given sort of online quiz to test their reaction times (details are not provided) and asked how much they drank. Non-drinkers were excluded. The authors report that 'cognitive performance declined as alcohol consumption increased beyond 10 g/day' (a UK unit is 8 grams) and their conclusion reads as follows:

Current advice from the UK Department of Health is for men and women to not consume more than 16 g of pure alcohol per day (two units) on average. Findings reported here suggest that daily alcohol consumption above one unit is may have an adverse cognitive impact. Recommendations should be sensitive to this, especially among middle-aged and older members of the population.

But, as David Spiegelhalter points out in this blog post, the data do not support the conclusion. Here is the graph showing response times in milliseconds (y-axis) and daily alcohol consumption (x-axis).

The first thing to note is that this is not a study of dementia and the differences in response times are pretty small. The second thing to note is that the scale of the x-axis is insane! The third thing to note is, as Spiegelhalter says, response times are not quickest at around 10 grams of alcohol a day. They are quickest at around 18 grams a day, ie. more than two units. Moreover, response times remain relatively low even for very heavy drinkers.

In reality, the main finding seems to be that light drinkers don't have very good cognitive skills (and therefore, in the world of newspapers, are more likely to suffer from dementia). This is clearly not what the researchers wanted to find.

The usual excuse given by those who don't want to admit that there are any benefits from drinking alcohol is the hoary old 'sick quitter' chestnut, but the authors can't use that here because they excluded non-drinkers from their analysis. And so they resort to a 'sick light drinker' hypothesis that they seem to have invented for convenience:

The ‘J’ shaped association reported here should be considered critically. To reduce the ‘sick quitter’ effect abstainers were omitted. However, participants who may have only reduced alcohol intake for health reasons rather than quit, remain in the analysis.

No evidence for this little theory is presented. As usual, negative effects of drinking are reported uncritically while positive effects are met with a wall of speculation, doubt and hypotheses that are unevidenced but unfalsifiable.

The reality is that this study supports previous studies (such as this) that find a U or J-curved relationship between alcohol consumption and cognitive ability, with abstainers and light drinkers doing worse than heavier consumers. Its authors were evidently displeased with their findings and so they misrepresented them, created a misleading graph and called for a change to government guidelines.

The media then covered the study with such headlines as Just ONE pint a day ‘poisons your brain and increases your risk of dementia’ and another lie from 'public health' had travelled the world before the truth could get its shoes on.

Saturday 13 January 2018

The editor of the Lancet is an idiot

One of the big questions about the 'public health' racket is whether its most prominent figures are conscious liars or mere idiots. I have to tell you, dear reader, that I sometimes suspect deliberate deceit.

Yesterday, I wrote about the absurd claim that 'liver disease is on a trajectory to become the biggest cause of death in England and Wales.' The claim appeared in the Lancet and was made by its editor, Richard Horton. The source for claim seems to be an article published in the same journal last month, although it does not actually support Horton's factoid.

The reality is that liver disease is responsible for less than two per cent of deaths in England and Wales and its 'trajectory', such as it is, is flat. Several people, including myself, have pointed out this error to Horton and he responded last night with a tweet that doubles down on the original claim.

There is no ambiguity in this tweet: 'Liver disease deaths are on a trajectory to overtake deaths from ischaemic heart disease' (which is currently the biggest cause of death) And yet the graphs he uses to prove this clearly do not show the number of deaths. They show the number of working-age years of life lost before the age of 65, which is a very different thing indeed.

If Horton is deliberately trying to deceive us here, he is doing so with the Trump tactics of repeating himself and never backing down. I don't think that's his style do I can only conclude that he doesn't understand his own evidence and is an idiot.

Friday 12 January 2018

Fake statistic of the day

There's going to be a PR stunt in Parliament on January 22nd when Dr Sarah Wollaston uses the health select committee to campaign for minimum pricing. Wollaston is in charge of the committee and has been advocating for this regressive policy for years. There's no word yet on who will be appearing at the 'inquiry', but I expect we will see the usual faces from the Sheffield fantasy modelling club plus the likes of the UK Temperance Alliance (AKA the Institute of Alcohol Studies).

The Lancet's Marxist editor, Richard Horton, has given some publicity to Wollaston's kangaroo court in this week's issue. In addition to making the absurd claim that '[t]he science supporting minimum unit pricing seems overwhelming', he says this:

Chaired by independent-minded Conservative Member of Parliament and former general practitioner, Sarah Wollaston, the committee will review evidence for and against minimum unit pricing at a moment when liver disease is on a trajectory to become the biggest cause of death in England and Wales.

Even by Horton's standards, this is nonsense on stilts. Liver disease is nowhere near being the top cause of death. Here are the figures from the Office for National Statistics for men in England and Wales. Liver disease is tenth on the list, causing half as many deaths as prostate cancer and an eighth as many deaths as heart disease.

For women, liver disease doesn't even make the top fifteen:

If we look at the age-standardised mortality figures from Public Health England, the story is much the same. Here are the men. You'll see the rate of liver disease right at the bottom in blue.

And here are the women. Once again, liver disease doesn't make the cut.

And - without wanting to labour the point - here are the proportion of all deaths in England attributed to each major 'killer'. Liver disease just about sneaks into the top ten for men with 1.9%, but not for women.

If you look at Public Health England's graph for men (above), you can see the trend in liver disease deaths. Although Horton claims that 'liver disease is on a trajectory to become the biggest cause of death', the graph shows that the trajectory is basically flat. This is also the case for alcohol-related diseases in general, which rose in the 1990s but have been broadly flat for more than a decade.

So what the hell is Horton talking about? It can be no slip of the pen because he has been repeating the claim on social media:

The source for the claim seems to be a study he published in the Lancet last month. The Independent reported this study with the headline 'Liver disease to become biggest killer by 2020 with alcohol and obesity to blame' but that's not what the study said.

The study was, in practice, a briefing for anti-alcohol lobbyists written by the usual neo-temperance suspects (Ian Gilmore, Petra Meier etc.). Nick Sheron was one of the authors and he gave a quote to the media when it was published. We have seen before that Sheron likes to ignore the size of the population when he does his calculations, and that trait is in evidence in the Lancet study which says:

Alcohol consumption in the UK, which peaked at around 5642000 hL (hectolitres) in 2008–09, decreased when the duty escalator was introduced to around 4843000 hL in 2013–04, and increased again to 5126000 hL in 2016–17 after the duty escalator was withdrawn.

Sheron and Gilmore used this sleight of hand in Public Health England's risible alcohol policy evidence review. The appropriate measure here is per capita alcohol consumption. Per capita alcohol consumption actually peaked in 2004 and has been falling ever since. Sheron likes to pretend that the decline began in 2008 because it enables him to link it to the alcohol duty escalator. As he says in the study:

These changes show how responsive population alcohol consumption is to small changes in taxation and further support the Commission’s recommendation for an increase in overall alcohol taxation.

Total cobblers. There was a bigger fall in consumption in the four years before the duty escalator was introduced than in the four years afterwards, but since this doesn't fit the temperance narrative they rewrite history.

They then say that...

Alcohol-related deaths in England and Wales decreased from a peak of 7312 in 2008, when the alcohol duty escalator was introduced, to 6999 by 2012, but increased to 7630 in 2016 after abolition of the alcohol duty escalator in 2013.

Again, the authors are using absolute numbers when they should be using death rates per 100,000 people. Reading their statement, you would get the impression that deaths peaked in 2008 and then fell before reaching new heights following the abolition of the alcohol duty escalator. But this, again, disregards population growth. The rate of deaths per 100,000 men in England was 15.5 in 2008 and was 14.5 in 2016. For women, the rate was 7.0 in 2008 and 6.8 in 2016. Rates in Wales were also lower for both sexes in 2016.

Sheron et al. create a false narrative of record levels of liver disease mortality which are rising rapidly (and which can only be reduced by raising prices). But even in this fantasy, it is obvious that the 7,630 alcohol-related deaths mentioned in the study (of which only a proportion involve liver disease) make up less than two per cent of the 500,000 deaths that occur each year in England and Wales.

In what parallel universe, therefore, is liver disease poised to become Britain's biggest killer? It turns out that this isn't what the Lancet study claims at all. It doesn't make any claims about the number of deaths. Instead, it looks at the much more specific issue of lost years of life. This makes liver disease appear more important because it is less of a disease of old age than dementia, heart disease and cancer.

But although Quality Adjusted Life Years (QALYs) are a conventional measure in public health, they do not make liver disease look significant enough for Sheron et al. and so they switch to the rather less conventional measure of lost years of working life before the age of 65. This helpfully disregards all the people who die after the age of 65 - ie. the vast majority of the British population - and results in this graph.

I can't vouch for the figures in this graph because they have been created by the authors of the study and are not available in any of the routine statistics that are published by the NHS or ONS. They could be rubbish, but even if we assume that they are correct, it is clear that the 'trajectory' has been flat for the last decade. If liver disease overtakes heart disease under Sheron's bespoke measure, it will be because the number of lost working-age years before the age of 65 from heart disease falls, not because the number of lost working-age years before the age of 65 from liver disease rises.

None of this has any bearing on the number of people dying from liver disease. Horton's claim that 'liver disease is on a trajectory to become the biggest cause of death in England and Wales' not merely untrue, it is a million miles from the truth. Liver disease is responsible for well under two per cent of all the deaths in England and Wales. Mortality rates have not been rising and they show no sign of rising.

Nevertheless, you can expect this fake statistic to be trotted out for years to come with the once respected Lancet journal cited as the source.

Thursday 11 January 2018

The Geneva Convention: COP8

The World Health Organisation's highly secretive Conference of the Parties (COP) for the Framework Convention on Tobacco Control is coming to Geneva this year.

Not so much coming to Geneva as staying in Geneva, as that is where the WHO is based. Two years ago, it was in highly polluted Delhi. Two years earlier, it had been in Putin's Moscow. The conference is renowned for locking its door to the public and kicking journalists out of the room. Despite being taxpayer-funded, taxpayers cannot even watch the sessions, let alone participate in them.

Transparency might be zero, but the decisions made at this conference can have a profound effect on nicotine consumers all over the world. The WHO is famously opposed to e-cigarettes and other safer nicotine devices. Many of the bans on the sale and use of e-cigarettes can be traced back to them.

Last year, the UK delegation consisted Andrew Black, an activist-bureaucrat from the Department of Health, and Deborah Arnott of the state-funded pressure group ASH. The WHO FCTC's approach to e-cigarettes and tobacco harm reduction is diametrically opposed to that of the British government, but that didn't stop Black and Arnott using the conference as an opportunity to announce that the Department of Health had decided to give the Framework Convention on Tobacco Control an extra £15 million. Soon afterwards, Andrew Black was given a job at the WHO on the FCTC Secretariat. What a small world!

Let's face it, the general public is not welcome at this shindig and ordinary consumers are not going to get in. Nevertheless, Geneva is a nice place to visit and is easy to get to. The dates are 1-6 October 2018. Why not pop it in your diary?

Wednesday 10 January 2018

Cancer warnings on alcohol are unjustified

As reported in the Guardian, the Alcohol Health Alliance is concerned that only ten per cent of Britons are aware of the link between drinking and cancer. They are demanding cigarette-style warnings on alcoholic beverages to remedy this. There are several reasons why this would not be a good idea.

The evidence that only one in ten people is aware of the alcohol-cancer link comes from a survey conducted in September 2017 which asked respondents to spontaneously name diseases that they associate with alcohol consumption. It might have been better to ask a question along the lines of ‘do you believe that drinking increases the risk of some cancers (yes/no)?’ If cancer risk was not front of mind when the respondents answered the survey, we should not be surprised. The cancers associated with drinking are mostly quite rare. The lifetime risk of dying from these diseases is mercifully small and, for people who drink moderately and do not smoke, the increased risk from alcohol consumption is trivial to non-existent.

The exception is breast cancer, which appears to be linked to drinking even at low levels – hence the Chief Medical Officer’s claim that there is no safe level of drinking – but the evidence for this has only appeared in recent years and there are reasons to be sceptical of it. Even if the statistical associations between moderate drinking and breast cancer are real and causal, the magnitude of risk is so small that it is unlikely to persuade many women to go teetotal.

Nevertheless, don’t people have the right to know about these risks? Don’t we free market liberals want informed consumers? Well, yes we do. The question is how we go about telling them. Britain is not California. We do not plaster cancer warnings on every product on the shelves. We do not demand health warnings on bacon, steak, french fries and ‘very hot drinks’, even though they have all been declared carcinogenic (or ‘probably carcinogenic’) by the International Agency for Research on Cancer.

Plenty of everyday products have been linked to cancer or can cause harm if abused. With the exception of cigarettes, we do not demand health warnings on them because the risks are not particularly great and there are plenty of other ways for people to get this information if they are interested. Indeed, there are ways for people to be given this information even if they are not interested. Public Health England spent a staggering £4.5 billion last year. The British taxpayer pays for an army of ‘public health professionals’. If they wanted to inform people about the cancer risks associated with drinking, they have the resources with which do so.

I am not against labelling per se. People have a right to know what they are buying and I am in favour of putting calorie counts on alcoholic drinks. But a functioning market does not require consumers to know every possible cost and benefit before they make a purchase, and it certainly doesn’t require every possible cost and benefit to be listed on the label.

Let’s be realistic about this. The Alcohol Health Alliance are not demanding cancer warnings on wine bottles because they want consumers to be fully informed. They want cigarette-style health warnings because they want to treat alcohol like cigarettes. They want every bottle and can to scream a message that ‘Alcohol causes cancer’ and ‘Drinking kills’ in order to deter people from buying the product. Moreover, they want these messages to be carried alongside graphic photographs of diseased livers.

This would not lead to the public being better informed. On the contrary, it would mislead people into thinking that the cancer risks associated with drinking were of the same magnitude as those associated with cigarettes.

What would an accurate health warning on alcohol look like? I tackled this question in my book, Killjoys:
The British public, we are told, are woefully ignorant about the link between alcohol and cancer, and labelling drinks with a cigarette-style cancer warning would be an effective way to spread the word. Perhaps it would, but the risks are so small in practice that such a system would either discredit scientific advice in the eyes of the public or alarm consumers to such an extent that they would make worse choices than if they remained ignorant. A truthful alcohol label would explain that associations have been found between alcohol consumption and several cancers, most of which are rare. It would explain risks in absolute, rather than relative, terms (e.g. ‘Heavy drinking increase your lifetime risk of developing disease X from Y per cent to Z per cent’). Finally, it would explain that moderate consumption of alcohol reduces the risk of heart disease, stroke and diabetes, and that premature death is less common among moderate drinkers than teetotallers, although heavy drinkers have a higher mortality rate than either.

Aside from the fact that this is too wordy to fit onto a bottle of wine, a label that explained the science adequately would make consumers better informed whereas a warning saying ‘alcohol causes cancer’ would lie by omission. A truthful label would probably have no effect on alcohol consumption other than possibly increasing it. It is questionable whether it is worth putting it on the bottle at all, particularly since the information is available from other sources for those who are interested. And yet it is only the verbose yet truthful label, not the crude cancer warning favoured by paternalists, that can be ethically justified if the aim is to inform rather than alarm.
The ‘public health’ lobby is not interested in educating people about the health effects of alcohol consumption. One only needs to look at its campaign of doubt and denial over the benefits of moderate drinking to see that. There is no more justification for putting health warnings on alcoholic drinks than there is for putting them on sausages.

Cross-posted from Spectator Health.