Monday, 11 November 2019

Hey buddy, have you got your eating licence?

Pearl Street Mall, a no smoking zone

Smoking was banned across Pearl Street Mall in Boulder, Colorado in 2013...

Where is the smoke-free zone?

The ordinance bans all smoking between 11th and 15th streets on the Pearl Street Mall, and on the lawn of the Boulder County Courthouse.

Are there designated smoking areas around the mall?

When considering a place to smoke, there are no specifically designated smoking areas. It's important to know that smoking is not allowed on the Pearl Street Mall, from 11th and 15th street, or on the Boulder County Courthouse property. The Colorado Clean Indoor Air Act and City of Boulder code also require people to be more than 15 feet away from entryways when smoking 

There was even a party to celebrate this progressive victory...

Kick-off Celebration Event

A celebration event will be held from 11:30 a.m. to 1:30 p.m. on Friday, April 12, on the 1300 block of the Pearl Street Mall, where county, city and Downtown Boulder Inc. (DBI) staff will be available to answer questions about the smoking ban, hand out mints and information, and provide free resources available for smoking cessation programs.

Those who campaigned for the ban did so in the name of 'public health' and cited the claim that heart attacks fell by 41 per cent in Pueblo, Colorado after the town banned smoking indoors in 2003. That claim is a lie and, in any case, has no relevance to Pearl Street Mall which is an outdoor space.

Quite a large outdoor space, in fact. The ban extends from 11th to 15th and covers about ten streets.

As the risks from secondhand smoke outdoors are nonexistent, the real intention of the ordinance was probably to 'change norms', 'send a message' and make it more difficult for people to smoke. I doubt that those who lobbied for it expected there to be many arrests. Indeed, when the ban was introduced, Molly Winter of the city's 'Department of Community Vitality' (!) insisted that 'Boulder is not taking a hard line in terms of enforcement.'

But if you make petty offences out of victimless crimes, you can expect the boys in blue to take them seriously. The woman in the video below was arrested for not only smoking but having a dog off the leash and littering (dropping a cigarette butt, perhaps?). Faced with such a dangerous criminal, the police weren't going to take any chances, so they tied her to a chair, stuck a bag over her head, tasered her while she was defenceless and locked her in solitary.

As a chaser, watch this video from the even more progressive State of California where it is illegal to eat food on a train platform for some reason. The gentleman below, who is a more demographically typical victim of police harassment, committed his heinous crime at 8 o'clock in the morning while on his way to work.

“You’re eating.” 
“So what?” 
“It’s against the law.” 

Dame Sally would be proud.

If you create stupid, unnecessary laws to police every aspect of people's lives, don't be surprised when the police start throwing their weight around. Many of the replies to the two tweets above express sentiments along the lines of 'rules are rules, if they hadn't disrespected the law they would have been OK'. I find that almost as troubling as the incidents themselves.

Here's an idea. Maybe eating and smoking in the open air shouldn't be a crime? Instead of giving uniformed thugs endless excuses to victimise the public, how about we make laws that are worthy of respect?

Friday, 8 November 2019

Last Orders with Toby Young

The new Last Orders podcast was recorded during a break at the Battle of Ideas with Toby Young. We discuss the miraculous appearance of the original Irn-Bru recipe, Dame Sally Davies' refusal to leave the stage and the Scottish government's exploitation of children.

Have a listen and don't forget to subscribe via the device of your choice.

Wednesday, 6 November 2019

Did Prohibition work?

Like most Times columnists, David Aaronovitch has a penchant for draconian government action that he can only hide behind his liberal facade for so long. It is most likely to surface when he is looking down his nose at other people's lifestyles, or feeling guilty about his own (see also Nick Cohen).

In a particularly deranged column three years ago, he demanded a ban on the sale of sweets to children, amongst other things...

Ban fast-food outlets from stations and airports. Ban the sale of confectionery and sugary drinks to the under-16s. Ban the sale of over-sugared products in supermarkets (as measured by a ratio of sugar to other nutrients). Ban the bringing into schools of unhealthy foods. Ban the presence in offices (like our own here at The Times) of vending machines that seem to sell mainly crisps and chocolate. Specify a weight-to-height ratio limit on air passengers wishing to avoid a surcharge.

This all seems outlandish and dictatorial at the moment. So too, back in the late 1980s, did the idea that you wouldn’t be allowed to smoke on planes.

No slippery slope, etc.

Last week he was back with an article that attempted, in all seriousness, to portray Prohibition as a success. It's a rarely heard point of view but not wholly unprecedented. People in 'public health' occasionally try to rewrite the history of 1920-33 to justify their own lurch towards prohibition, whether it be with tobacco, vaping or alcohol itself.

The basic argument is that alcohol consumption fell between 1920 and 1933. Well, duh. That is not contested. The reason that the 18th Amendment is the only one to have gone through the difficult process of repeal (requiring the consent of two-thirds of US states) is that there are more important things than per capita alcohol consumption. Murder, for one. Organised crime for another. Thousands of people being blinded, crippled, poisoned and killed for another. I addressed the silly, galaxy brain argument that 'prohibition worked, actually' in The Art of Suppression.

Aaronovitch doesn't bring anything new to the table and seems to have done very little research into the arguments he has microwaved, but let us quickly run through them.

Prohibition showed bans can be good for us

Outlawing alcohol 100 years ago led to a boom in bootlegging but it also had a striking effect on public health

.. Excessive alcohol consumption is linked to all kinds of adverse health conditions. The most obvious is alcoholic cirrhosis (or scarring) of the liver. In 1911 the death rate for cirrhosis among American men was nearly 30 per 100,000. By 1929 that had been reduced by more than 30 per cent. 

There was certainly a steep fall in the mortality rate from liver cirrhosis in the early twentieth century, but the bulk of it took place before Prohibition began in 1920. At no point was the rate 'nearly 30 per 100,000'.

What caused this precipitous decline? Plenty of states had gone dry by the time the US imposed national Prohibition so we can't discount the firm hand of government entirely, but the most likely candidate is the First World War. The same thing happened in Canada, France, Britain and, I dare say, a few other European countries too.

Forgive the mad y-axis, but you get the picture.

You can, if you are inclined, use these graphs as evidence that making alcohol hard to come by reduces alcohol-related mortality, but note that the UK saw liver cirrhosis deaths fall from 9 per 100,000 to 5 per 100,000 before the war began. You don't need rationing, let alone Prohibition, for outcomes to improve.

Registered admissions to mental hospitals for psychosis linked to alcohol more than halved. 

I'm not sure where he got this statistic, if anywhere. The US Census Bureau didn’t start collecting statistics on admissions to mental hospitals until 1923, so we can't compare with the pre-Prohibition era.

One historian has suggested that short-term stays in mental institutions in New York fell prior to prohibition, and then rose after it...

'In 1904, 27.8 percent of the nation's total patient population had been institutionalized for twelve months or less. This percentage fell to 12.7 by 1910, rising to 17.4 in 1923.'

 I don't think the evidence exists to support or debunk Aaronovitch's claim.

Even by 1933, when Volstead was revoked, alcohol consumption had gone down by a third since pre-prohibition. 

Yes. The best guess is that consumption went down by two-thirds when Prohibition began and then rose until it was only a third lower than it had been when alcohol was legal. Not too impressive, really.

The point shouldn't need underlining, but the fact that Prohibition was flouted by scofflaws (a word invented in the 1920s) on such a grand scale is evidence that Prohibition was not wanted. 

Whatever Mark Twain may have written, prohibition saved many, many lives.

Mark Twain died in 1910. Perhaps Aaronovitch is confusing him with one of the tens of millions of Americans who thought that Prohibition was a disaster.

But what about the extra crime and the corruption it caused? In fact there was no big increase in homicide or violent crime in the era of prohibition.

Er, yes there was. The homicide rate rose throughout the era of Prohibition and fell sharply as soon as it was repealed. The increase in crime and violence was well recognised at the time and was one of the main reasons Prohibition was repealed.

Incidentally, the suicide rate - which, unlike the homicide rate, had been falling before 1920 - also rose throughout Prohibition and fell afterwards.
He continues...

True, mobsters — who existed long before the ban — pitched into liquor smuggling, but when prohibition was over they just moved on to other things.

And how lucky they were that the USA had launched the war on drugs in the meantime, thanks to many of the same characters who had given it the war on alcohol. The more opportunities you give organised criminals, the more organised crime you're going to get.

In the meantime arrests for public disorderliness due to drink fell by half, as did recorded complaints of domestic abuse (almost invariably violence by a drunken man against his partner or family).

Domestic abuse (or ‘wife beating’) was made illegal in 1920 in all US states. Ramsey says that...

'.. the likelihood that a wife beater would be incarcerated at least briefly seems to have been high in the 1920s'. 

This doesn’t directly contradict Aaronovitch’s claim, but I can't find support for it in this detailed history of American domestic violence which is surprising if it is true – a halving of domestic violence rates in 10 years would be remarkable.

His factoid about drunk and disorderly arrests also seems dodgy:

'The Volstead Act, passed to enforce the Eighteenth Amendment, had an immediate impact on crime. According to a study of 30 major U.S. cities, the number of crimes increased 24 percent between 1920 and 1921. The study revealed that during that period more money was spent on police (11.4+ percent) and more people were arrested for violating Prohibition laws (102+ percent). But increased law enforcement efforts did not appear to reduce drinking: arrests for drunkenness and disorderly conduct increased 41 percent, and arrests of drunken drivers increased 81 percent.' 

He then notes, correctly, that Prohibition had some positive lasting effects. It changed saloon culture beyond recognition and normalised female drinking in bars, for instance.

Finally, though prohibition was abolished and the renascent drinks manufacturers blitzed the public with booze ads and the film-makers with glitzy party scenes, it has lingered on in reduced consumption, state bans and — as I discovered aged 60, ordering a cocktail in the Lower East Side — stringent age checks.

Maybe, but as Lisa McGirr shows in her book The War on Alcohol, it also revived the Ku Klux Klan, normalised police raids on private property, created the template for the FBI and led to the creation of the modern, heavy-handed American penal state. So, swings and roundabouts.

Aaoronvitch's motive for resurrecting the failed experiment of Prohibition is, as you might have guessed, to push some lesser restrictions on drinkers. He cites Public Health England's amateurish, error-strewn report on alcohol policy that was published at the fag end of 2016.

Although there has been a slight decline in alcohol consumption in England and Wales in the last decade, that followed an increase of more than 40 per cent between 1980 and 2008.

Per capita alcohol consumption is almost exactly where it was in 1980.

In June 2012 the Scottish government began to legislate for minimum alcohol pricing aimed at reducing consumption through incentives. Last year a BMJ study concluded that the effects of a 50p per unit minimum cost had reduced consumption by 1.2 units per week, and two units among the heaviest drinkers.

It wasn't last year. It was six weeks ago and the claims in the study bear no resemblance to the sales figures.

Enough of this. Be gone with you, David, and do some research next time.

Monday, 4 November 2019

Economic illiteracy in The Economist

The Economist published an article about alcohol two weeks ago...

A sober brawl  

Alcohol firms promote moderate drinking, but it would ruin them

The subheading is nonsense, based as it is on a risible study produced by the Sheffield alcohol team and the UK Temperance Alliance t/a the Institute of Alcohol Studies.

In Britain more than 100 producers and retailers have signed a “responsibility deal” and promised to “help people to drink within guidelines”, mostly by buying ads promoting moderation. However, if these campaigns were effective, they would ruin their sponsors’ finances. According to researchers from the Institute of Alcohol Studies, a think-tank, and the University of Sheffield, some two-fifths of alcohol consumed in Britain is in excess of the recommended weekly maximum of 14 units (about one glass of wine per day). Industry executives say they want the public to “drink less, but drink better”, meaning fewer, fancier tipples. But people would need to pay 22-98% more per drink to make up for the revenue loss that such a steep drop in consumption would cause.

The print edition makes things worse with this graphic...

I have written about this study before - see here and here. The authors show such a basic misunderstanding of economics that it should disqualify from from commenting on the alcohol business ever again.

In short, they assume that alcohol revenues would decline by 38 per cent (£13 billion) if everyone drank within the government's evidence-free guidelines. They then assume that the industry would have to raise £13 billion from somewhere to keep its head above water. The figures in the graphic above show what they reckon drinks would cost if the industry were to pass that £13 billion on to customers.

The whole premise of the study is ridiculous. If the industry sold less alcohol, it would have fewer costs. Unless it has very high fixed costs, most industries could withstand a 38 per cent decline in sales (look at the tobacco industry in Britain in recent years, for example). It might become less profitable, depending on whether consumers switched from low margin drinks to high margin drinks, but it would not be not 'ruin them'.

People in Britain drank half as much alcohol in the 1950s than they did fifty years earlier. Did this ruin the booze industry? No. Of course it didn't. Why would it?

It's disappointing to see The Economist falls for this obvious rubbish. I wrote a letter to the editor about it...

Your article about alcohol (October 19th, p. 93) suggested that the price of beer, wine and spirits would have to rise dramatically ‘to make up for revenue loss’ if everybody drank within the government’s guidelines. Revenue is irrelevant. Only a fraction of the amount spent on alcohol goes to the producers as profit. A third goes straight to the government in the form of alcohol duty and VAT, and a significant proportion goes to retailers. Much of the rest is spent on the product itself.

If fewer products were sold, the cost of production would fall. There is no reason to assume, as the study you cite does, that the industry would have to raise prices by £13 billion to compensate for sales falling by £13 billion. The viability of a business depends on profit, not revenue.

It wasn't published.

Friday, 1 November 2019

Britain's low rate of problem gambling

Last month I tweeted something based on an article in the Economist...

The statistics for Finland were challenged by one or two people, so I did my own research and found that the 3.3% figure comes from this study in the BMJ published last year...

In 2015, the overall prevalence of past-year problem gambling was 3.3%.

However, the latest official figures from Finland give a figure that is half of that...

When the severity of problem gambling was measured using the Problem and Pathological Gambling Measure (PPGM), 1.6 per cent were classified as having a gambling problem...

This is still considerably higher than in Britain where the rate of problem gambling has been hovering around 0.7% ever since it first started to be measured in 1999. In the most recent dataset, it was exactly 0.7%. The figure for Sweden, which until very recently also had a state monopoly on gambling, is reported to be 1.5%.

But there are different ways of measuring it. While the DSM and PGSI systems produce similar results in Britain, I am not familiar with the PPGM measure used in Finland.

Fortunately, I was able to find directly comparable figures in this thorough piece of work. It was published in 2012, so some of the figures will have changed somewhat in the meantime (indeed, the figure used for Britain is higher than it is now), but it is nonetheless illuminating. Using the same methodology for every jurisdiction, the authors found that...

Depending on the specific country and the survey year, the standardized past year rate of problem gambling ranges from 0.5% to 7.6%,with the average rate across all countries being 2.3%. In general, the lowest standardized prevalence rates of problem gambling tend to occur in Europe, with intermediate rates in North America and Australia, and the highest rates in Asia. More specifically, the lowest standardized prevalence rates occur in Denmark, the Netherlands, and Germany. Lower than average rates are seen in Great Britain, South Korea, Iceland, Hungary, Norway, France, and New Zealand. Average rates occur in Sweden, Switzerland, Canada, Australia, United States, Estonia, Finland, and Italy. Above average rates occur in Belgium and Northern Ireland. The highest rates are observed in Singapore, Macau, Hong Kong, and South Africa.

I'd be interested to see more up-to-date statistics, if they exist, but all of the above seems to point to the same conclusion: the rate of problem gambling is below the international average in the UK and is higher in countries like Finland, Sweden, the USA and Hong Kong where there is far more state control.

Despite the emergence of online gambling, fixed odds betting terminals and the relaxation of some laws under the 2005 Gambling Act, the rise in problem gambling that was predicted by many never materialised.

Whether you look at Britain in the last twenty years or compare countries, it is difficult to see any correlation between regulation and problem gambling.

To many foreigner visitors, the UK may seem like a bit of a free-for-all, with bookies on every high street (albeit not for long), fruit machines in most pubs, legal casinos, several lotteries, gambling advertising on television after 9pm, bingo halls, arcades and a lively online sector.

So what is the secret of Britain's low rate of problem gambling? My own theory is that it's because we are relaxed about letting children gamble for low stakes. This takes away the 'forbidden fruit' element and there's nothing like playing the blatantly rigged penny waterfalls as a child to teach you that the house always wins, it's just a bit of fun, and you shouldn't expect to make a living out of it.

Monday, 28 October 2019

Are moderate drinkers responsible for the majority of alcohol-related harm?

You can't understand modern 'public health' ideology without understanding the arguments made in Geoffrey Rose's Strategy of Preventive Medicine. It is from this book that we get the 'prevention paradox' and the idea that 'a large number of people exposed to a small risk may generate many more cases than a small number exposed to a high risk'.

If heavy exposure to Risk Factor X increases risk of Disease Y by 200%, and moderate exposure increases risk by 10%, a layman might decide to focus on those who are mostly heavily exposed because they are at greatest risk.

Not so fast, says the 'public health' expert. Only 1% of the population are heavily exposed whereas 60% of the population are moderately exposed (the other 39% avoiding exposure altogether). This means that moderate exposure accounts for more cases than does heavy exposure. Efforts should be focused on those who are moderately exposed.

This makes a certain amount of sense in the theoretical example above, but it is not a principle that can be universally applied. Rose tried to apply it to all sorts of risk factors and his successors have applied it to more, including gambling and salt consumption. 

Doctors tend to deal with people on the extremes: alcoholics, the morbidly obese, people with very high blood pressure, etc. Rose's version of preventive health focused on the (median) average person. There are a lot of people at or around the average and not so many at the extremes. His view that you save more lives if you focus on the apparently 'normal' than on the high-risk 'deviants' gave licence to the 'whole population approach' of government imposing broad-brush policies on everybody.

Leaving aside the negative consequences of these policies, the theory only works when the average person is at genuine risk. Take blood pressure, for example. The first graph in Rose's book shows the bell curve of systolic blood pressure. The y-axis is the percentage of population.

From this we can see that the median adult has a reading of around 130/80mmHg. On the right-hand tail of the distribution we can see the people who have high blood pressure.

In Rose's view, you would save more lives by lowering the blood pressure of people who had a reading of 120 or 130mmHg than by treating the people whose blood pressure exceeded 160mmHg. Why? Because there are so many more of them.

He complained that doctors only considered giving statins to people whose blood pressure exceeded 100mmHg - thus 'encouraging the belief that those who do not qualify for the high-risk group, because they are "normal", have no cause for concern.' (p. 47).

But is there cause for concern? What reason was there to think that the blood pressure of an average person was unhealthy? One of Rose's own graphs shows that the risk of heart disease does not increase until blood pressure exceeds 130mmHg.

Weirdly, Rose claims that this graph shows 'a continuum of associated risk which increases progressively over the whole observed range'. It does not. It shows that the baseline rise is about 6% and that risk only begins to increase from around 130mmHg.

Of course, there are occasions when being 'normal' or average is not healthy or, at least, not optimally healthy. Rose gives the example of average cholesterol levels in Finland, which are (or were) a lot higher than levels in Japan. The former is probably less healthy than the latter.

But it cannot be assumed that the average person everywhere is always at elevated risk, nor that their health would invariably benefit from doing less of whatever it is that carries risk to people on the extremes.

Take alcohol. The physical harms of alcohol overwhelmingly affect (a) people who get very drunk and suffer acute harms, and (b) people who drink a great deal for many years and suffer chronic harms.

The average drinker does neither. Even if we leave aside the J-Curve showing significant health benefits from moderate consumption, it is clear that alcohol consumption by the median drinker contributes only a very small part to alcohol-related ill health.

This is a challenge to Rose's theory and therefore to the whole population approach. This is awkward because it is in the field of alcohol that the whole population approach has been most warmly embraced. It is officially endorsed by the Scottish government and is at the heart of Ireland's Public Health (Alcohol) Act which will restrict advertising, introduce minimum pricing, put alcohol behind shutters, etc.

How can this be justified? Step forward Claire O'Dwyer and her colleagues from Ireland's Health Research Board. Last week they published a paper title 'Drinking patterns and the distribution of alcohol-related harms in Ireland: evidence for the prevention paradox' which includes a passage that is hilariously and shamelessly political, even by the standards of 'public health' activist-academia:

Policy implications
Research indicates that the most effective approaches to reducing alcohol consumption are those which target the entire population, such as increasing the price and reducing the availability of alcohol. In Ireland, the Public Health (Alcohol) Act (2018) has recently (October, 2018) been passed and will introduce a number of population-based strategies to reduce alcohol consumption, including a minimum unit price for alcohol sales and restrictions on advertising and marketing. This policy represents one of the most progressive alcohol policies in the world. It was fiercely contested by the alcohol industry and the interval between the publication of the Bill and the passage of the Act at 3 years was the longest ever in Ireland. None of the provisions in the Act have yet been implemented. The findings in this study demonstrate that alcohol-related harms in Ireland are distributed across the population, providing support for a population-based strategy to reducing alcohol consumption. The findings thus indicate a need for the rapid implementation of measures outlined in the Public Health (Alcohol) Act (2018).

Subtle, eh?

The study itself purports to show that most alcohol-related harms 'are accounted for by low- and moderate-risk drinkers' and not, as some might expect, heavy and dependent drinkers.

The authors surveyed 4,338 drinkers and asked them if they had suffered any harm in the last twelve months.

The eight harms covered were harm to finances, harm to health, harm to work or study, harm to friendships or social life, harm to home life or marriage, been in a physical fight, been in an accident, and stopped by the police. E.g., “Have you experienced harms to your finances in the last 12 months due to your own drinking?”

You will notice that only three of the eight relate to physical harm, including two (physical fights and accidents) which may not have necessarily resulted in any significant harm to health.

Indeed, even 'harm to health' does not necessarily imply significant harm to health. The journal that published the study, BMC Public Healthy, has open peer review so we can see that one reviewer asked the obvious question:

Question: how is 'harm to health' determined by the survey take? Does this refer to blacking out, or falling, or experiencing a hangover, or does this refer to receiving a clinical diagnosis, such as fatty liver disease?

The answer came back:

"Harm to health" was not further defined in the survey and was left up to participants’ interpretation.

So it could be anything from having a champagne cork fly in your face to being put in a wheelchair for life. It seems likely that most of these harms were relatively trivial because most accidents and illnesses are relatively trivial, but we have no way of knowing.

This runs the risk of producing apples and oranges comparisons. A dependent drinker developing acute pancreatitis counts for the same as a light drinker tripping over in a pub.

The results are below. Click to enlarge.

As the first and third columns show, dependent drinkers are much more likely to suffer 'harm' than the other drinkers. But only 6.9% of those surveyed were classified as dependent drinkers, so only a minority of the harmful incidents could be attributed to them (see the second and fourth columns).

The majority of incidents were accounted for by the other groups.

...these findings imply that most alcohol-related-harms are due to periods of acute intoxication, and because these occasions are most numerous among low and moderate drinkers, they account for the majority of alcohol-related harms.

There is sleight of hand at work here. The study does not look at moderate drinkers. It looks at moderate risk drinkers.

What is a moderate risk drinker? In this study, it is a non-dependent drinker who engages in Heavy Episodic Drinking (HED). Heavy drinking is immoderate by definition, I would have thought, and is defined here as the consumption of at least 60 grams of alcohol in one session (7.5 UK units, or about four pints of beer). The individuals could, of course, be drinking much more than that.

Moreover, they could be drinking much more than that very often. The survey asks how often the participant engages in HED. Regardless of whether they say  “everyday”, “5–6 times a week”, “4 times a week”, “3 times a week”, “twice a week”, “once a week”, “2–3 times a month” or “once a month”, they are lumped together (see the black bar in the charts above) and considered to be 'moderate-risk'.

Common sense tells you that somebody who gets drunk most days is at high risk of all the 'harms' mentioned in this study, not least because the 'harms' in question relate to the consequences of drunkenness rather than the long-term effects on health. Somebody who only gets drunk once a month is clearly at lower risk and might be considered a low- to moderate-risk drinker by a layman (although not necessarily by a 'public health' academic). In this study, they are all grouped together as Heavy Episodic Drinkers.

It seems almost inconceivable that the survey didn't ask people how many units of alcohol they consumed, but if the authors have this information they don't use it. Why not? Units per week is the measure of choice in 'public health' for classifying risk. Many of the heavy episodic drinkers will be drinking enough for them to be classified as hazardous drinkers (more than 14 units a week) or harmful drinkers (more than 35 units a week for a woman or 50 for a man). It would be very useful to have this information.

The most cynical explanation for the authors' reluctance to show us how much these people are drinking is probably the correct one. If the statistics were broken down into subgroups, we would likely see a close association between heavy consumption and harm. Instead, the authors devised a methodology which allows people to consume vast quantities of alcohol and still be classified as 'moderate-risk' so long as they don't meet the DSM-IV criteria for alcohol dependence.

The study has another peculiar feature. For each of the harms, respondents...

...were assigned a score of 0 (“never”) 1 (“yes, once”) or 2 (“yes, more than once”) on each of the eight questions depending on their response. Scores on each of the eight harm questions were summed to give each participant a total score of harms that ranged from 0 to 16.

It is not clear how these scores were used in the final analysis, if at all. The results section only shows how many people had suffered each 'harm' at least once in the last year. This means that incidence of harm by, say, a dependent drinker who is habitually arrested and hospitalised will be greatly underestimated.

The authors are aware of this issue, saying...

This score is likely to be an under-estimation of harms, as “more than once” could equate to a number greater than 2. 

But they justify it, saying...

However, the purpose of obtaining the total harm experienced by the survey population was not to provide a precise estimate of the number of alcohol-related harms in the population but was to estimate how the harms were distributed across each drinker type. Hence the scoring of the scale in this way was appropriate to the aim of the study.

Focusing on prevalence, rather than quantity, would be OK if the authors stuck to talking about prevalence. But they don't. On the contrary, they repeatedly insist that their findings show the proportion of incidents that are caused by each group. The abstract of the study says...

The majority of the harms in the population were accounted for by drinkers who were not dependent on alcohol... the majority of alcohol consumption and related harms in the Irish population are accounted for by low- and moderate-risk drinkers

This is wrong. The authors cannot make any claims about the number of harms. They can only make claims about the number of people involved.

This misrepresentation occurs again and again...

In line with previous findings on the prevention paradox, the majority of harms occurred to low-risk or moderate-risk drinkers...

...the majority of the harms were accounted for by people who engaged in HED...

...our findings indicate that the majority of harms in the Irish population were not accounted for by dependent drinkers...

The majority of alcohol-related harms in Ireland occurred among drinkers who engage in heavy episodic drinking.

When the study was picked up by the media, journalists naturally made the same mistake...

Binge drinking among low to moderate risk drinkers is responsible for most of the alcohol-related harm that occurs in Ireland.

None of these claims is supported by the study's results. The authors simply do not have the data to make such assertions. Under their methodology, a drinker who got into a fight at the Christmas party is responsible for the same amount of harm as an alcoholic who gets into fight every night.

This is a critical flaw because we know that a tiny minority of drinkers are responsible for a huge number of incidents. It should have been picked up in peer review, but neither of the reviewers even mentioned it.

In conclusion, let us return to the central claim of the study which I have already quoted above...

...these findings imply that most alcohol-related-harms are due to periods of acute intoxication, and because these occasions are most numerous among low and moderate drinkers, they account for the majority of alcohol-related harms.

It should now be clear that this is untrue for three reasons.

Firstly, the study barely examines the long-term health harms which are the cause of most alcohol-related mortality. At best, it shows that people who get drunk are more likely to be involved in situations that are associated with drunkenness than people who do not get drunk.

Secondly, the study does not look at 'low and moderate drinkers'. It looks at a poorly defined cohort of low and moderate risk drinkers, many of whom are neither moderate drinkers nor at moderate risk.

Thirdly, the authors can make no claims about 'most' or 'the majority' of alcohol-related harms because their study makes no attempt to quantify them.

So what does this study tell us about the prevention paradox? Nothing, because the prevention paradox is about death and disease, neither of which are measured here. Are moderate drinkers responsible for the majority of a broader range of harms? The data in this study is insufficient to tell us that either, but probably not.

Friday, 25 October 2019

Are cigarette filters useless?

Richard Kluger memorably equated twentieth century efforts to make a safer cigarette to breeding a one-fanged rattle-snake. It has become dogma in tobacco control that neither filters nor low-tar cigarettes make any difference to the risks of smoking. Low tar (or 'light') cigarettes, in particular, have been portrayed as a tobacco industry scam, with the role of government and public health scientists written out of the story.

Regulators send out mixed messages. The EU's Tobacco Products Directive bans companies from putting nicotine and tar yields on cigarette packs to prevent consumers getting the idea that lower yields are less dangerous. At the same, it banned companies from selling cigarettes with more than 15 mg of tar in them in 1993 and has since lowered the limit to 12 mg and then 10 mg, presumably because it thinks higher yields are more dangerous.

Now Martin McKee and his chums have called for filters to be banned entirely, the effect of which would be to greatly increase yields of both nicotine and tar. This is not a new idea. In Velvet Glove, Iron Fist, I wrote about anti-smoking fanatic John Slade who wished the government had banned cigarette innovation in 1950 so that 'the only cigarettes on the market would be unfiltered 70 mm smokes, and far fewer people would be smoking.'

McKee et al. make their argument on the basis of litter, but perhaps they share Slade's hope. If so, I'm not sure it will work. Smoking was never more popular than it was in 1950 and I would far rather smoke an unfiltered Lucky Strike than a modern 'light' cigarette. Most people today don't know what a decent cigarette tastes like.

McKee et al. assert that the benefits of filters are a 'myth', but the only sources they cite as evidence are an article from the New York Times Magazine and an article in the pseudo-journal Tobacco Control.

Studies looking at the issue are few and far between, so it is a weird coincidence that one was published on Monday in JAMA Internal Medicine. Awkwardly for McKee, it found that...

After adjustment, unfiltered cigarette smokers were nearly 40% (hazard ratio, 1.37; 95% CI, 1.10-1.17) more likely to develop lung cancer and nearly twice (hazard ratio, 1.96; 95%CI, 1.46-2.64) as likely to die of lung cancer compared with those who smoked filtered cigarettes. Additionally, all-cause mortality was nearly 30% (hazard ratio, 1.28; 95% CI, 1.09-1.50) higher.

.. This study confirms that smoking any type of cigarette conveys serious health risks. Within the context of this study, unfiltered cigarettes are the most dangerous, and individuals who smoke them should be targeted for aggressive tobacco treatment interventions. 

This is in line with previous epidemiological studies such as this and this. The idea that filters confer no benefit whatsoever is unproven, to put it mildly. But we already knew that McKee doesn't approve of harm reduction.

Thursday, 24 October 2019

Getting advertising wrong

Last week we saw Mark Petticrew and friends make fools of themselves claiming that the booze industry encourages pregnant women to drink. Today they're back with a study proving that they don't know the first thing about advertising. The study has not been covered by the media, which must have come as a disappointment, but you can read it here.

It is obvious from the first line that this is not a serious piece of research:

Alcohol advertising is an important influence on alcohol consumption, and the evidence supports the restriction of advertising and marketing as a cost-effective intervention for reducing alcohol harms.

Having begged the question, they trawl through case studies published by the Institute of Practitioners in Advertising, mostly from between 1981 and 2003, looking for evidence that alcohol advertising is aimed at increasing alcohol consumption.

In a way, of course, it is. The aim of a Stella Artois campaign is to sell more Stella Artois. The aim is not to increase beer sales per se, let alone alcohol sales in general.

It doesn't seem to matter how much evidence shows that advertising does not increase aggregate consumption, 'public health' people still insist that it does - because they think (wrongly) that it would justify a ban.

Overall, 30/39 (approximately 77%) of the case studies explicitly mentioned increasing or maintaining market share as an objective or use this as a measure of campaign effectiveness.

Yes, that's the whole point.

There is consistent evidence from these case studies to support the industry claim that growing or defending market share is an important advertising objective.

Aye, there is.

They then move onto the 'alcohol industry claim' that 'Advertising Does not, and Is not Intended to, Stimulate Consumption'. This is where they come unstuck.

If sales and volume sales can be taken as a proxy for consumption, then all of the 39 case studies present evidence that advertising affects this outcome.

Er, no. Each of the case studies is for a specific brand. A rise in market share for one brand does not imply a rise in overall consumption. It is much more likely to lead to a fall in market share for another brand. Indeed, the case studies offer a reminder of several brands that were once very familiar but are not anymore, eg. Boddington's, Hofmeister, Murphy's.

Here are the authors' first two examples of advertising being used (supposedly) to increase consumption...

“We did not want to just sell Magners in the warm summer months: we wanted it to be drunk throughout the year”.
(Magners Cider, 2008)
The same campaign also: “…amplified Magner’s relaxed timeless brand values and drove winter consumption".

But even Petticrew et al. seem able to grasp that Magner's was trying to get people to drink their cider in winter instead of drinking, say, lager, not in addition to drinking the same quantity of lager...

Arguably, these examples show attempts to increase market share, rather than overall consumption. 

No kidding. But just when you think they have seen the light...

Other examples are more likely to reflect increases in consumption, such as this example where Foster’s lager used a humour-based campaign. The evaluation describes how it
“…gave permission for a ‘drinking occasion’… Blokes were lapping up the ads, but most importantly, they were lapping up Foster’s lager too…as the ads ran, sales rose, and they have continued to do so”.
(Foster’s Lager, 2015)

This campaign did not aim to increase overall consumption, and nothing in the quote suggests otherwise.

As noted above, the fact that all campaigns had increasing sales as an objective and/or main outcome is also an indirect indicator of the intended effects on consumption.

As noted above, it is nothing of the sort. The authors seem unable to distinguish 'consumption of Brand X' with 'consumption of alcohol'. common way of measuring the effectiveness of the campaigns is in terms of willingness to purchase. The Grolsch lager campaign provides one example of this:
“The most concrete measure of increased consumer demand is rate of purchase. Grolsch’s rate has more than trebled since campaign launch…Put simply, consumers are demanding the brand more than ever”.
(Grolsch, 2003)

It would be tedious to repeat all the examples cited by the authors. Suffice to say, they are all like this. First, the authors claim that the company is trying to increase overall demand for alcohol, then they produce a quote that clearly shows the company is only interested in increasing market share.

When they take on the 'industry claim' that 'Any Observed Relationship between Advertising and Consumption is not Causal', they say...

...these case studies often have the stated aim of demonstrating a causal relationship. This is sometimes made explicit, as in these examples from the Campari and Archers Schnapps case studies:
“This case history will show the vital role that an integrated advertising strategy, in terms of planning input, media choice and creative content, played in that growth. It will seek to demonstrate a causal relationship between advertising and Campari sales performance…”
(Campari, 1981)

No doubt there was a causal relationship between the Campari advertising campaign and Campari sales performance, but that has got nothing to do with the question of whether the advertising campaign increased the number of units of alcohol sold. The distinction is blindingly obvious. Are the authors really too thick to see it or are they playing dumb? has been claimed that advertising benefits the consumer by keeping product prices down [47]. However, there is considerable evidence from these data that the opposite is the case, with advertising helping to maintain or increase prices.

Reference 47 is none other than the 2014 reprint of the IEA's Advertising in a Free Society, which I abridged and wrote the foreword to. It does indeed say that advertising tends to lower prices. Advertising is a major lever of competition and competition tends to lower prices. There is plenty of evidence for this (see page 8, for example).

But what is true in general terms is not necessarily true in every case. Premium brands are more expensive because they have a good reputation. That reputation is often built on advertising, as I explain in the foreword...

But what if it could be shown that the more expensive branded good is identical to the unbranded budget good by objective criteria? Would this not be proof that the company is playing on consumers’ vanity and anxiety to exploit them? Harris and Seldon argue that the question is meaningless be-cause a product has no objective value. Even if the branded good is distinguishable from the unbranded good only by the advertising that portrays it as being of higher class, the consumer is justified in buying it. If he values it more highly be-cause he associates it with glamour, good taste or ethical living then he is right to pay more for it. Harris and Seldon argue that ‘if a bath soap, a fountain-pen, or a carpet gives more pleasure when the consumer thinks it is used by a duchess or a television performer, then he is making a logical decision in buying it: he is being more sensible than his critics’

In the whole history of British marketing, one brand has used advertising to justify higher prices more blatantly than any other: Stella Artois. With the slogan 'reassuringly expensive', it turned a bog standard Belgian lager into a premium drink. It is therefore no surprise that Petticrew et al. use it as evidence...

Several case studies also describe the mechanisms by which higher prices are maintained, e.g.,

“The premium price ideally pays for the advertising which tells the consumer the product costs more in the first place”. (Stella Artois, 1993)

Nobody has ever claimed otherwise, but note the contradiction in their logic. If, as they claim, alcohol advertising leads to higher prices in general, they should be in favour of it because higher prices lead to less consumption. 

In reality, the aims of alcohol advertising vary with regards to price. Premium brands use advertising to justify higher prices while retail advertising tends to focus on lower prices. Mid-range brands simply do what most advertising does - remind people that they are still there.

In conclusion:

These data suggest that advertising both aims to change attitudes, expectancies and consumption behaviour, and is effective in doing so.

And so it is. That is the proper purpose of advertising. What is doesn't do is increase per capita alcohol consumption or rates of alcohol-related harm - and nothing in the study shows otherwise.

Irn-Bru's reverse ferret

Some fun news was reported yesterday. I have written about it for Spiked...

In July, still insisting that it ‘made the right decision to reduce the sugar in Irn-Bru and the vast majority of drinkers agree’, the company announced a profit warning. Its share price fell by 30 per cent in a day and has fallen further since.

How serendipitous, then, that Robin Barr – great-grandson of the eponymous AG – recently stumbled across a dusty book buried deep in the company’s archives which contains the original recipe written out in longhand. As luck would have it, the 1901 version of Irn-Bru contained even more sugar than the fabulously popular version that Barr took off the shelves last year.

Having made such a remarkable discovery, the company decided that it would be rude not to share this ‘authentic piece of Scottish history’ with the public. Irn-Bru 1901 will be available in the shops from 2 December, supposedly as a limited edition. Just in case you haven’t got the message, it will be explicitly marketed as ‘old and unimproved’. 

Do read it all.

Tuesday, 22 October 2019

Somebody should measure childhood obesity

The government has set up a National Food Strategy, led by Henry Dimbleby, and has launched a call for evidence which closes on Friday.

The National Food Strategy will examine activity across several departments of state, building on the flagship Agriculture Bill and Fisheries Bill currently before Parliament, the Industrial Strategy, the Childhood Obesity Plan and the upcoming Environment Bill.

With regards to the Childhood Obesity Plan, I have just submitted a proposal suggesting that maybe, just maybe, somebody should make an attempt to measure childhood obesity.

Here's what I wrote...

The NFS call for evidence mentions the government’s Childhood Obesity Plan. The Childhood Obesity Plan opens with the assertion that ‘more than one in three children are obese or overweight by the time they leave primary school’. The claim that more than a third of eleven year olds are overweight or obese is routinely made by the Department of Health, Public Health England and single-issue campaigners, and is used to justify a wide range of interventions in the food market.

This factoid is rarely challenged, but it should be. We have no idea what the rate of childhood obesity is in the UK because nobody has made a serious effort to measure it. All we can say with confidence is that it is far lower than the government claims. For reasons that have never been explained, the government refuses to use the clinical definition of childhood obesity (based on the BMI of the 98th percentile in 1990). The clinical definition sets an unrealistically low threshold and therefore allows many false positives, but the government’s definition (based on the BMI of the 95th percentile in 1990) allows the category to consist mostly of false positives. Most of the children who are classified as obese by the government’s definition would not be classified as such by a clinician - or, indeed, by a lay person.

If the UK government used the clinical definition, it would find that the rate of obesity among eleven year olds was well under five per cent. If a representative sample was examined by a clinician, the rate would likely be lower still. It is bizarre that so much time and money is directed at the problem of childhood obesity without any serious attempt to measure its prevalence. Politically, it is easy to see why campaigners prefer a large number to a smaller number, but this does not justify fiddling the figures.

The inflation of the childhood obesity figures leads to demonstrable absurdities. For instance, it is well understood that the risk of obesity rises with age. If taken at face value, the government’s statistics show that the prevalence of obesity among 13-15 year olds is 25 per cent, but falls sharply to 15 per cent for 16-24 year olds. Children do not suddenly lose weight when they leave school. The discrepancy is explained by adult obesity being measured objectively while childhood obesity is not.

Given the Department of Health’s apparent lack of interest in getting to the truth of this matter, it would be a suitable target for fresh thinking from the National Food Strategy. Creating realistic BMI charts to measure childhood obesity is an achievable and important goal.

It is extraordinary to consider that the definition of childhood obesity was made without any child ever being examined or diagnosed (instead, the rate of obesity among children was extrapolated from the rate of obesity among 18 year olds!). A more rational approach, which would cost a tiny fraction of Public Health England’s £4 billion budget, would involve clinicians examining children of various ages and recording the BMI of those who are at the lower end of the obese range, based on adiposity and visible excess weight. These records could then be used in perpetuity as thresholds for childhood obesity at different ages.

Aside from being truthful with the public, a realistic measure of childhood obesity would have two benefits. Firstly, it would allow policy to be targeted towards children who are genuinely obese, as opposed to statistically obese, by giving us accurate information about their profile (socio-economic characteristics, region, race, etc.).

Secondly, it would allow progress to be measured. At it stands, the government’s target of reducing childhood obesity by 50 per cent by 2030 can only be achieved if large numbers of healthy children lose weight. This is neither realistic nor desirable. Officially, the proportion of children who are obese has remained more or less unchanged since 1999. Thanks to the large number of false positives, it is impossible to tell from the official dataset whether the number of genuinely obese children has risen, fallen or remained the same. 

I have written about this at greater length (with links to sources) in these two articles:

Monday, 21 October 2019

The use of children in the sockpuppet state

It's our old friend, the slippery slope again.

Call to hide alcohol from view in shops, just like cigarettes

Shops should be required to screen alcohol from public view just like cigarettes, Edinburgh’s deputy council leader Cammy Day has said.

This can't be true, can it? After all, 'the “domino theory” i.e. that once a measure has been applied to tobacco it will be applied to other products is patently false'.

So why is it happening?

His call follows a report by the Children’s Parliament in which children as young as nine voiced concern about the high visibility of alcohol in everyday life.

I wrote about this cynical PR exercise last month:

So the Scottish government has a public consultation on alcohol on the way. The government funds its own anti-alcohol lobby groups, of which Alcohol Focus Scotland is one. It convenes a group of children who are, aparently, too young to be exposed to the sight of beer in shops but are old enough to make detailed policy proposals. And their policy proposals are going to be fed into the consultation as not only the views of the public but of the chiiiiiildren.

If this was happening in some benighted dictatorship overseas, we would not hesitate to mock it as the brazzen parody of democracy it is.

Regardless of what you think about this particular issue, this is not the way to make policy.

The Children’s Parliament report published last month called for alcohol to be made less visible in shops and on TV and the removal of adverts from billboards and an end to alcohol firms sponsoring events where children are present.

Wow, the young children have exactly the same view as the adults (from Alcohol Focus Scotland) who primed them. What are the chances?

Councillor Day said he had been shocked by the youngsters’ report. “This was young people aged 9-11 who have fears at that age about the impact of alcohol on their life.
“I’ve written to Ash Denham asking her to work with local government to review alcohol licensing and how we can make it safer for young people. If cigarettes are bad for you and we have them hidden behind a screens, why are we not doing the same for alcohol?”

Well, Councillor Day, the traditional answer from anti-smoking groups is that cigarettes are a unique product, the only consumer product that kills when used as directed by the manufacturer, etc. But that bit of rhetoric tends to be forgotten once the door has been wedged open and it becomes open season on any product that displeases the nanny statists.

The Scottish Government published an Alcohol Framework document last year which promised a consultation on potential measures, including mandatory restrictions on alcohol marketing, to protect children and young people.

And that is exactly why the Scottish Government funded the Children's Parliament to look at the issue, with a temperance group brought in to ensure the children said the right thing. They could hardly have been any more blatant about it.

A government spokeswoman said: “We are all too aware of the impact of alcohol advertising and agree that there is more we can do to protect children and young people from alcohol harm. A key part of this is restricting alcohol marketing which is why we will be consulting on options for mandatory restrictions in Scotland in Spring 2020.”

Thus, the circle is complete. Government decides on the policy. Government funds pressure group to lobby for the policy. Government convenes a bunch of kids to support the policy. Government tells the media that it is under pressure from concerned children to introduce the policy. The media play along with the charade.

Pretending to cave in to state-funded lobby groups has been the defining feature of the sockpuppet state for years, but exploiting children in this way is a new and sinister development.

Saturday, 19 October 2019

Last Orders with Martin Durkin

A new Last Orders podcast came out recently. I forgot to mention it here at the time, but here it is.

This month's guest is the wonderful film maker Martin Durkin. We talk about the US vape panic (again), the lies about minimum pricing and whether it's OK to spray smokers in the face with fire extinguishers.

Have a listen.

Friday, 18 October 2019

A year of cannabis legalisation

Yesterday was the first anniversary of cannabis re-legalisation in Canada. I made a short video for VolteFace (see below) with a few thoughts about what needs to be done to wipe out the black market. My view hasn't really changed since I wrote this because the statistics haven't really changed. At the last count, two-thirds of recreational cannabis was still being bought on the black market thanks to the high price and lack of availability of legal product.

Speaking of statistics, the available data do not strongly show any increase in the number of Canadians consuming cannabis. In the first three quarters of 2018, the prevalence rate was 14%, 15.6% and 15.2% respectively.

In the last quarter of 2018, when cannabis was legalised, the rate was 15.4%. In the first quarter of 2019 it was 17.5%, and in the second quarter it was 16.1%. The confidence intervals of these estimates are about 1.5% either way. All figures relate to use in the last three months.

At most, legalisation has led to a one percentage point increase in use, mainly thanks to people aged over 55. Use amongst 15-24 year olds has certainly not gone up.

The lack of competition and availability is confirmed in this Reuters report which I worth reading if you're interested in the topic. It seems that the cannabis companies are losing money hand over fist at the moment.

Thursday, 17 October 2019

Pubs hit hard by the smoking ban - new study

Taken from Closing Time

There's a nice study in Health Policy looking at the impact of the English smoking ban on alcohol sales. It is of particular interest because it provides data for smokers and nonsmokers in the on-trade and off-trade.

The results will come as no surprise to anyone who has watched the collapse of pub industry since 2007.

The data show that before the smoking ban, smokers spent nearly twice as much money in pubs as nonsmokers - and nearly 50 per cent more on alcohol overall.

After the ban, average weekly expenditure in pubs by smoking households fell by 45 per cent, from £10.06 to £5.68.

Was this made up for by nonsmokers flocking to smoke-free pubs, as anti-smoking campaigners - and the useful idiots at CAMRA - promised? Not a bit of it. Expenditure by nonsmoking households also fell, from £5.70 to £4.42 a week.

Spending on alcohol from the off-trade remained pretty similar for both groups.

The study's author, Rob Pryce, does a separate analysis comparing the post-ban period with the two years before the ban (rather than six years). The results are similar for smokers, but the decline in spend by nonsmokers is smaller.

Click to enlarge

Whichever way you look at it, the evidence is clear: pubs' best customers spent a lot less in them after they were banned from smoking. Who'd have thought?

... smoking households significantly reduced their on-premise expenditure following the smoking ban, and non-smoking households did not significantly change their expenditure...

Apologists for the smoking ban sometimes claim that it cannot have done so much damage to pubs because smokers were in the minority. It is true that only 21 per cent of UK adults were smokers when the ban came in, but they were spending a lot more money in pubs. As anyone who remembers those halcyon days will recall, there were plenty of pubs where at least half the regulars were smokers. In some pubs, it could be 80 per cent.

The idea that nonsmokers would make up for this lost business was always a cynical fantasy. Most nonsmokers didn't care about secondhand smoke and most of those who did were never going to become regular pubgoers anyway.

This study only confirms the bleeding obvious, but it is still nice to have some firm figures.

Wednesday, 16 October 2019

Does the alcohol industry encourage pregnant women to drink? Four idiots investigate.

It is with a heavy heart that I must inform that Mark Petticrew is at it again...

Alcohol industry 'puts pregnant women at risk', researchers say

Alcohol firms and bodies they fund are encouraging women to drink in pregnancy – putting their unborn child in danger – by publishing false and misleading information about the risks involved, new research claims.

The study is here. It is a follow-up to this discredited effort by Petticrew and three colleagues who claimed that the booze industry 'appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer.' Ironically, that study was based on some extensive misrepresentation, not to mention shameless cherry-picking and selective quotation.

Now he and three fellow cultists are back with a study that makes the unlikely claim that the alcohol industry is actively encouraging pregnant women to drink because (don't laugh)...

...women are a crucial part of the alcohol market, as has been pointed out in relation to alcohol consumption and breast cancer risk (Connor, 2017). Pregnancy, therefore, may represent a significant commercial threat...

Hmm. So what's the evidence that alcohol companies are encouraging pregnant women to drink?

Several alcohol industry–funded websites appear to emphasize the scientific uncertainties regarding safe levels of drinking.

There is a great deal of uncertainty about safe levels of drinking during pregnancy. A few years ago, the UK government amended its advice. Having previously advised woman to avoid alcohol in the first trimester, it now advises pregnant women 'to not to drink alcohol at all to keep risks to your baby to a minimum.'

This is the precautionary principle in action, however. It does not reflect any solid evidence showing risk to the baby from light drinking.

As a recent systematic review concluded...

This review demonstrates the paucity and poor quality of evidence addressing this important public health question... In conclusion, we found limited evidence for a causal role of light drinking in pregnancy, compared with abstaining, on most of the outcomes examined. Despite the distinction between light drinking and abstinence being the point of most tension and confusion for health professionals and pregnant women and contributing to inconsistent guidance and advice now and in the past, our extensive review shows that this specific question is not being researched thoroughly enough, if at all. In addition, there has been no evidence regarding possible benefits of light alcohol consumption versus absence.

And even Petticrew admits at the end of his new study that....

...we emphasize that there are indeed uncertainties and complexities in the area of alcohol and health, not the least in defining the benefits of risks and harms from “light” drinking

It is perfectly acceptable for the authors of the systematic review to 'emphasize the scientific uncertainties regarding safe levels of drinking', but when organisations that get funding from the alcohol industry do it, they are supposedly encouraging pregnant women to drink.

But do they even do that? This is the first example Petticrew cites to make his case:

The International Alliance for Responsible Drinking (IARD), an alcohol producers’ “responsible drinking” body, appears to emphasize uncertainty regarding “safe” limits by publishing a table that details “drinking guidelines for alcohol consumption by women who may become pregnant, are pregnant and are breastfeeding issued by government bodies in various countries.” The table shows national guidelines from Albania to Vietnam, with no accompanying explanation.

You can visit the webpage here. It is literally just a list of the advice given by various governments worldwide, presumably so people who live in those countries can find out what their government recommends. What kind of 'accompanying explanation' is required? Alas, Petticrew et al. don't tell us because they move on to their next killer example...

Lack of consensus is also highlighted by Brown-Forman, which references the “ongoing debate about whether there is a ‘safe’ level of consumption during pregnancy, or during certain time frames of a woman’s pregnancy.”

So what?

The word debate is commonly used elsewhere in alcohol and tobacco industry narratives to imply that scientific evidence is simply a matter of debate or opinion among scientists

Are you kidding me? 'Debate' is commonly used to describe a debate, of which there are many in science and none in the dogmatic world of 'public health' activism.

DrinkWise also states that there is “confusion about how much one can safely drink during pregnancy”—with the added apparent implication that such a safe level exists.

A fevered mind might infer that. Most people would not. I doubt anyone of sound mind could look at the DrinkWise webpage and see anything other than unequivocal advice to avoid alcohol when pregnant or when trying to conceive.

In any case, the statement above does not come directly from DrinkWise. They are quoting Alec Welsh, a professor of fetal-maternal medicine, who I dare say knows a bit more about the subject than Mark Petticrew and his 'public health' pals.

Some wording appears to imply that alcohol is safe—but has not yet been proven to be so. For example, Diageo’s DrinkiQ website states that “research has yet [emphasis added] to establish a ‘safe’ amount to drink during pregnancy,”.. The language in the first clause of this sentence implies that there is a completely safe limit, which simply has not yet been identified.


They then quote Quebec's Educ’alcool Canada...

"The scientific community believes [emphasis added] that abstaining from drinking is the safest choice.” This appears to be an example of industry “mixed messages.” The word believe (like the word debate) may also imply that that this message is based not on evidence but on ideology.

The evidence is clearly insufficient to say that the case either way is proven beyond doubt. This applies to all claims based on observational epidemiology, incidentally. Evidence is built up until the case is made beyond reasonable doubt, but that still requires interpretation and, yes, belief. Causation can never be proven in epidemiology, and in this instance we don't even have good correlations. That doesn't make it a matter of ideology - whatever that is supposed to mean - it makes it a matter of opinion. Or, if you will, belief.

We noted that on some websites the positioning of the information on the webpage appears to dilute its importance and/or present mixed messages. For example, on the Drinkaware website, the sections on pregnancy appear on the webpage titled “Health effects of alcohol.” The page has 45 sections, of which the last four are sections on pregnancy, breastfeeding, FAS, and fertility, requiring the user to scroll down approximately nine pages to access the information

This is desperate stuff. Firstly, who measures a single webpage in terms of pages? You scroll down to find what you need (try it).

Secondly, it is perfectly reasonable to put information that is only relevant to half the population for a fraction of their lifetime towards the bottom.

Thirdly, Drinkaware has a whole webpage dedicated to alcohol and pregnancy which comes up in the first page of listings when you Google 'alcohol pregnancy'. On that page you are told...

Not drinking alcohol is the safest approach

Drinking alcohol at any stage during pregnancy can cause harm to your baby and the more you drink, the greater the risk. This is why the low risk drinking guidelines advise pregnant women that the safest approach is to not drink alcohol at all during pregnancy.

If you’re pregnant or think you may become pregnant, you’re also advised not to drink.

This, apparently, is the alcohol industry [sic] encouraging pregnant women to drink. It's laughable.

Organisations affiliated with the drinks industry cannot win, no matter what they do. If they don't provide information, Petticrew accuses them of using a 'strategy' which is...

.. part of a wider set of industry tactics that includes manipulating the evidence base, lobbying, and constituency building (forming alliances with other sectors, organizations, or the public to give the impression of larger support for the industry’s position)

But if they do provide information, he says...

More generally, the alcohol industry involves itself in providing health information because it can then can portray itself as “part of the solution” and therefore play a greater role in the regulatory landscape. This echoes strategies adopted by the tobacco industry when it was faced with the growing, unequivocal evidence of the harms of smoking.

I really don't know how this rubbish gets published, even in a low quality journal.