Saturday 28 December 2019

Review of the year

2019 was the fifth year of the Banter Era and the last year of the decade (except in the eyes of wannabe pedants). Let's look back on some of the highs and lows in the world of pretend public health...


The Lancet launchs the hilarious EAT-Lancet diet, a near-vegan regime promoted by two billionaires who spent much of the year jetting around the world to save the planet. This was followed by a rant about 'Big Food' in the same journal by people who literally want to regulate food like tobacco.

Meanwhile, the New York City health departments explicitly equates fizzy drinks with cigarettes and Tom Watson says that Coco Pops are the new tobacco.

The Fixed Odds Betting Terminals All Party Parliamentary Group (APPG) becomes the Gambling Related Harm APPG and searches for new dragons to slay (so long as they don't involve the sectors of the gambling industry that are paying for it).

Philadelphia's soda tax, like all soda taxes, proves to be a flop.

Public Health England calls for a pudding tax because of course they do.


Politicians in Hawaii want to raise the smoking age to 100.

Fresh demands for plain packaging to be extended to food.

Banning fast food shops near school fails to work. Excuses abound.

Joy in heaven as one of the identikit, state-funded nanny state pressure groups gets defunded. The IEA publishes my latest report on the sock puppet phenomenon.


Woke food company Farmdrop amusingly falls victim to Transport for London's 'junk food' advertising ban.

On the tenth anniversary of The Spirit Level's publication, I look at how its hypothesis is standing up. Not well.

The government is intent on clamping down on 'junk food' without really knowing what it is.

Anti-smoking groups are still pretending that a levy on tobacco companies is anything other than yet another tax on smokers.

In a crowded field, Mark Petticrew was the year's number one junk social scientist. In March, he doubled down on his mad theory that the charity Drinkaware is downplaying the link between alcohol and breast cancer.

Steve Brine resigns as public health minister. The world shrugs.

The EU Health Commissioner wants medical regulation of e-cigarettes because of course he does.

Sugar taxes still haven't worked anywhere ever. 

A dismal piece of quackademia tries to equate drinking with smoking.

Dame Sally ended the year with another damehood

As the new restrictions on fixed odds betting terminals come into effect, it is announced that 2,300 bookmakers will close. And it is still early days.

A respectable newspaper reports the insane claim that the smoking ban reduced heart disease mortality by two-thirds.

Tobacco prohibitionists try a new line: allowing the sale of cigarettes is an infringement of human rights or something. Nurse!

Scottish drinkers respond to minimum pricing by buying more alcohol from shops.

When the government introduces a bottle deposit scheme you'll wish you'd have heeded my warning.

America's ludicrous Truth Initiative loses the plot over e-cigarettes.

I reveal that Transport for London has spent thousands of pounds making its own adverts comply with its stupid food advertising restrictions.

The new Nanny State Index is published.


Norway's new health minister seems pretty cool.

Beverly Hills bans the sale of cigarettes, citing concerns about 'thirdhand smoke'. 

Claims about the efficacy of the tobacco display ban fail to stack up.

Crazy unintended consequences in Australia's Northern Territory after minimum pricing is introduced.

The second anniversary of plain packaging passes without comment from anti-smoking groups for obvious reasons.

I nearly die laughing after Jamie Oliver's restaurant empire collapses.


The IPPR calls for plain packaging for food.

Panorama produces yet another one-sided programme about booze after Adrian Chiles is recruited by the temperance lobby.

The claim that alcohol consumption fell in Scotland after minimum pricing gets blanket coverage.

The news that alcohol-related deaths rose in Scotland after minimum pricing gets no coverage.

The British Medical Journal admits that the IEA is awesome.

I visit Canada with some MPs and Volte Face to see how cannabis legalisation is going (later discussed on this podcast).

Velvet Glove, Iron Fist (the book) turns ten. 


Conservative leadership Boris Johnson says an extension of the sugar tax would 'clobber those who can least afford it' and calls for a review of sin taxes in general. An advocate of the sugar tax posted a rebuttal which doesn't stand up.

AG Barr announces a profit warning after reformulated Irn-Bru fails to fly off the shelves.

Estonia and Latvia slash alcohol taxes after getting kicked in the coffers by the Laffer Curve.

At the fag end of the Theresa May era, the government decides that the UK will be 'tobacco-free' by 2030. Smokers are not consulted.

Cowgirl junk scientist Anna Gilmore returns to remind us of her economic illiteracy.

I was on Triggernometry talking about the war on drugs, the nanny state, etc. and I debated Tory nanny statist Dolly Theis on the IEA podcast.


Josie Appleton reveals the full scale of the food reformulation folly.

As part of the war on their own obsolescence, anti-smoking campaigners call for health warnings on individual cigarettes.

'Public health' policies still don't save money.


Velvet Glove, Iron Fist (the blog) turns ten.

The usual suspects model the imagined effects of a snack tax and call it evidence.

In a report that was "kindly supported" by the Institute of Alcohol Studies (neé UK Temperance Alliance), the Social Market Foundation calls for a reform of Britain's alcohol duty system, but not in a good way.

The evidence that sugar taxes don't work keeps coming. Meanwhile, it transpires that the cash from the UK sugar levy has been swallowed into general government expenditure. Who could have seen that coming?

Public Health England admits that its policies won't reduce childhood obesity.

The American vaping panic - the year's most shameful episode - begins in earnest. It will be months before US agencies admit the truth.

The Royal Society of Public Health ignores the evidence and calls for a ban on fast food outlets in the vicinity of schools.

India bans e-cigarettes and tobacco stocks rally.

After ignoring the rise in alcohol-related deaths in Scotland in 2018, the media fall for some blatant cherry-picking to promote minimum pricing. Meanwhile, the Scottish government resorts to child exploitation as it moves to the next phase of its temperance agenda.

Public Health England's sugar reduction scheme proves to be a flop.


American 'public health' agencies hit new lows in their anti-vaping campaign.

Former Chief Medical Officer Sally Davies calls for plain packaging for food. I bid farewell to her in this article.

Mark Petticrew returns again, this time claiming that Drinkaware is trying to get pregnant women to drink. Nurse!

A new study shows how badly hit pubs were by the smoking ban.

AG Barr release a new version of Irn-Bru which has even more sugar than the previous one.

Another Petticrew effort gets published, this time revealing his lack of understanding of advertising.

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


The UK continues to have a low rate of problem gambling.

The Economist, of all publications, falls for the Institute of Alcohol Studies' economic illiteracy. 

David Aaronovitch reckons Prohibition was a success. It wasn't.

Crazy laws against eating and smoking outdoors. Only in America?

The 'public health' gravy train rolls on, devouring taxpayers' cash as it goes.

Norway's sugar tax is good news for the Swedish economy.


The award for the year's worst reporting of a health story goes to the BBC.

Lancet authors don't take criticism of the preposterous EAT-Lancet diet well.

The Lancet shows that it will publish pretty much anything if it advances the editor's political agenda.

The hired guns of Sheffield's alcohol research group are hired by the Australian government to look at the drinking guidelines, with predictable results.

Junk science legend Stanton Glantz claims that a few years vaping causes diseases that require decades of smoking. It almost certainly doesn't.

Finally, I look back on a decade's 'public health' 'achievements'.

And don't forget you can still listen to every episode of the Last Orders podcast. This year our guests were Anthony WarnerGeoff NorcottAndrew DoyleBrendan O'NeillKate AndrewsTimandra HarknessJulia Hartley-BrewerMark LittlewoodMartin DurkinToby Young, and Rob Lyons.

Friday 27 December 2019

A conversation about the Nanny State on Tour

You can never listen to too many podcasts, can you? So here's another one from the IEA, this time with me asking Mark Tovey about his Nanny State on Tour report and the staggering (mis)use of foreign aid cash.

Monday 23 December 2019

A decade of 'public health' achievements

The Royal Society of Public Health has published its list of the top 20 'public health' achievements of the 21st century. Only three or four of them actually involve public health and the most important of them (HPV vaccination) only comes in at sixth.

It is estimated that the HPV vaccine will prevent over 100,000 cases of cancer in Britain in the next forty years, but according to the RSPH it is less important than the sugar tax. That tells you everything you need to know about the way this husk of a movement was taken over by puritans and anti-capitalist loony tunes.

Their top five are:

1. The 2007 smoking ban
The Guardian says the ban 'has been credited with causing a fall of more than 20% in heart attacks and other cardiac conditions in the first 10 years'. This is a reference to some pitiful nonsense from Public Health England. The main achievement of the smoking ban was to close thousands of pubs.

2. Sugar tax
The RSPH says that the sugar levy 'has so far encouraged product reformulation' and this, apparently, makes it a greater public health achievement than the Teenage Pregnancy Strategy and childhood flu vaccine. Low and zero sugar drinks made up more than half the market before the tax came in. The main effect of the tax was to remove several popular brands from the shelves, resulting in discontent from consumers who would have been quite happy to pay a bit more, and fewer sales for the companies that were dumb enough to play ball.

AG Barr's share price ends the year 30 per cent lower than it was at the start. There has been no impact on obesity.

3. Marmot review
A transparently political tract masquerading as health research.

4. Sure Start centres
Left-wingers have a strange preoccupation with these.

5. Minimum unit pricing in Scotland
It is, at the very best, too early to say whether this has had any positive impact, although it has certainly cost Scottish drinkers many millions of pounds. The RSPH nevertheless describes it as a 'a high profile example of a fiscal intervention that is effective in improving health outcomes'.

As the decade nears its end, it's worth looking back at what the 'public health' lobby set out to achieve in the 2010s. It is nearly ten years since the RSPH and Faculty of Public Health published their '12 Steps to Better Public Health', a list of priorities for the decade ahead. Depending on how you define it, around half of the proposals can be considered to be 'nanny state'.

The full list was as follows:
  1. A minimum price of 50p per unit of alcohol sold (achieved in Scotland, with Wales soon to follow)
  2. No junk food advertising in pre-watershed television (in the Childhood Obesity Plan but not introduced)
  3. Ban smoking in cars with children (became law in England in 2015)
  4. Chlamydia screening for university and college freshers
  5. 20 mph limit in built up areas (achieved in a few places, but if the experience of Brighton is anything to go by, it is rarely enforced or obeyed).
  6. A dedicated school nurse for every secondary school
  7. 25% increase in cycle lanes and cycle racks by 2015
  8. Compulsory and standardised front-of-pack labelling for all pre-packaged food (not compulsory and cannot be compulsory until we leave the EU. A voluntary agreement with the evil food industry covers most products, however.)
  9. Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
  10. Introduce presumed consent for organ donation (happened first in Wales and backfired, is due to start in England next spring)
  11. Free school meals for all children under 16
  12. Stop the use of transfats (no mandatory restrictions, but the stuff isn't used much anyway)

The interesting thing about this list isn't how few of the objectives were achieved but how many objectives were achieved that weren't on the list. Where is the sugar tax, for example, which RSPH now claims is one of the greatest 'public health' wins of the century? Where is the ban on the sale of energy drinks to minors that is now on the cards? Where is plain packaging for tobacco?

The fact is that the sugar tax and plain packaging seemed too mad to be politically possible at the start of 2010. It is not that the 'public health' lobby had not considered these policies; soda taxes had been much discussed in the USA and the idea of plain packaging first surfaced in the 1990s. It is that they hadn't found a health minister dumb enough to take them seriously.

That soon changed when Nicola Roxon got behind plain packaging in Australia and Denmark introduced its ill fated fat tax. Once they had evidence that somebody somewhere was prepared to treat these policies as serious proposals, they dropped everything and diverted their efforts towards lobbying for them. They were not important enough to be mentioned at the start of the decade. The try-anything, ban-anything activists of the 'public health' racket made them priorities because a win is a win and who cares about the consequences?

Saturday 21 December 2019

Fill your ears

A couple of podcasts for your consideration while you wrap your Christmas presents:

Live from Lord North Street 

End of year review. Mark Littlewood, TV's Kate Andrews and I pick our favourite moments, people and films of 2019 and make a prediction for 2020.

Last Orders

Spiked's monthly nanny state podcast with me, Tom Slater and special guest Rob Lyons. Contains one last rant about failed businessman Jamie Oliver. Available here and on iTunes.

Also, I've blogged for the IEA about why Danny Dorling's theory that 'austerity' has caused life expectancy to decline falls at the first hurdle (spoiler: life expectancy hasn't declined).

Tuesday 17 December 2019

Does vaping cause respiratory disease?

Junk science supremo Stanton Glantz returned this week, with his colleague Dharma Bhatta, to claim that vaping causes chronic obstructive pulmonary disease (COPD), chronic bronchitis and asthma. In a study published in the American Journal of Preventive Medicine and widely reported in the media, the duo use the publicly accessible PATH survey to look at rates of disease in a large American sample between 2013 and 2016.

All told, they reckon that vaping increases the risk of respiratory disease by around 30 per cent. In comments to the press, Glantz said:

“Based on what we know about the biological effects of e-cigarettes, my guess is that if we followed these people for 20 years, the e-cigarette effect would be similar [to the risks associated with smoking,]”

The study has two sets of results. Firstly, it looks at the prevalence of disease among vapers, former vapers and smokers in the first wave of 2013/14.

Secondly, it looks at the prevalence of new cases of disease between the first wave of 2013/14 and the second and third waves of 2014-16.

In each case, they find that the risk of respiratory disease is around 30 per cent higher for both vapers and ex-vapers (the risks are higher for smokers).

There are a number of problems with this. First and foremost, COPD and chronic bronchitis only develop in smokers after decades of daily cigarette use. Given that e-cigarettes had only been on the market for a few years in 2013, it is biologically implausible that vaping could cause the same effects.

The mechanism by which vaping could cause new cases of asthma is even more mysterious. Although asthma can be exacerbated by smoking, it isn't caused by smoking.

Glantz and Bhatta don't manage to find a statistically significant association between vaping and COPD but they do find an 82% increased risk of COPD among former vapers (1.82 (1.23, 2.69)). This is even more extraordinary. Since almost nobody was vaping before 2010, we are being asked to believe that there are people out there who vaped for a year or two, quit and then developed COPD as a result.

'As a result' is the key phrase. Glantz and Bhatta insist that there is direct causality at play; that their findings are independent of all other factors except e-cigarette use. They reject the obvious explanation - that vapers are nearly all smokers and ex-smokers and are therefore bound to be at greater risk of respiratory disease than the never-smokers/vapers to whom they are being compared.

Of the e-cigarette users in the first wave of 2013/14, 85.5% were also smokers and 13.9% were former smokers. Only 0.6% said that they had never smoked. The claim that vaping causes COPD and chronic bronchitis is therefore based on a group of vapers of whom 99.4% are current or former smokers!

If you wanted to study the effects of vaping independently of smoking, you would compare people who have vaped but never smoked with people who never vaped or smoked. Glantz and Bhatta have the data with which to do this, but they choose not to. Instead, they lump never-smokers, ex-smokers and current smokers together in a group called 'vapers' and then claim to have controlled for smoking.

It is debatable whether the dataset they use allows such adjustments to be made. It is not even clear whether 'controlling for combustible tobacco use' is realistically possible. Glantz and Bhatta do not explain how they went about doing it, so we are left in the position of having to trust them.

They have done nothing to deserve such blind faith. Last year, they produced a study based on the same dataset and claimed that vaping doubles the risk of having a heart attack. Thanks to Brad Rodu, we later discovered that a large number of the heart attacks took place before the individuals had ever used an e-cigarette. The study was such a shoddy piece of work that it gained some media attention and several academics have been trying to get it retracted.

And that's before we get onto Glantz's long career driving the tobacco control clown car and his fanatical opposition to e-cigarettes.

So no, I don't trust these two to control for a variable that runs through the dataset like a stick of rock and which is almost certainly the true cause of the statistical associations reported. It is extraordinarily unlikely that vaping for a few years could cause any of the diseases studied (if it did, their rates would have skyrocketed in recent years - they haven't).

I hate to quote John Britton, but he is on the money in his letter to the Times today...

He's right. It's trash. Ignore it.

Monday 16 December 2019

Sheffield's hired guns return to the scene of the crime

The Australian government last changed the drinking guidelines in 2009. Naturally, they were revised downwards - to two standard drinks per day. The Australians use a system of 'standard drinks', with each standard drink being one Australian unit of 10 grams. A UK unit is 8 grams, so the Aussie guidelines work out at 17.5 UK units a week.

The National Health and Medical Research Council was responsible for issuing the advice and it has spent the last couple of years looking at the guidelines once more. You'll never guess what conclusion they've come to...

Two standard alcoholic drinks a day no longer safe, health officials say

National Health and Medical Research Council updates guidelines for first time since 2009 and says adults should average no more than 1.4 drinks a day

It's all rather predictable, isn't it? The new guidelines work out at about 12 UK units a week, even lower than the discredited British guideline of 14 units.

So, whose research was responsible for this implausibly low limit? Step forward our old friends at the Sheffield Alcohol Research Group, who were awarded the contract of modelling the safe drinking level. This was a bold move on the part of the National Health and Medical Research Council given that the Sheffield team were caught red-handed changing their methodology to allow Public Health England to lower the guidelines, but the Australian 'public health' industry is no more capable of feeling shame than our own.

The National Health and Medical Research Council knew what they were buying when they handed over the money and the Sheffield mob has not let them down. The name of the game is to exaggerate the risks of moderate consumption and downplay the benefits. Introducing their new model, they say...

New evidence on alcohol-related health risks has emerged since 2009. In particular, there is increased evidence that even low levels of alcohol consumption can increase drinkers’ risk of experiencing some types of cancer. An increased number of studies are also finding evidence that previous research may have overestimated any potential benefits to cardiovascular health that may arise from lower levels of alcohol consumption.

Four studies are cited to support the claim that 'previous research may have overestimated any potential benefits to cardiovascular health'. Two of them are Mendelian Randomisation (MR) studies looking at people who have an unusual genetic variant which affects alcohol consumption and risk. The relevance of this to western populations is debatable, to say the least. A recent study argues that the MR studies are not the get-out-of-jail card the temperance lobby has been waiting for, and MR studies may yet threaten the flimsy link between moderate alcohol consumption and breast cancer.

The third study is one of Tim Stockwell's numerous attempts to demolish the J-Curve (which shows lower rates of mortality among moderate drinkers than among teetotallers) by excluding studies he doesn't like and adjusting the results of the rest. See here for more on Stockwell's one man crusade.

The fourth and final one is the 2018 Lancet study which was reported to have debunked the J-Curve with this graph...

In fact, the study's findings actually supported the J-Curve if you could be bothered to go to page 31 of the appendix and the look at the graphs which didn't cheekily exclude the nondrinkers.

That, then, is the new evidence that shows that 'previous research may have overestimated any potential benefits to cardiovascular health'. Risible, but we should expect nothing more at this point.

Since 2019, there have been dozens of new studies confirming the benefits of moderate drinking, such as this, this, this, this, this and this, but most of them go unmentioned in the Sheffield report. Of course they do.

For their new model, they use risk estimates 'from published systematic reviews and meta-analyses of the epidemiological research literature'. All but two of their cancer estimates come from the World Cancer Research Fund, an organisation that has a naive view of ultra-low epidemiology and therefore thinks that nearly everything causes cancer. For prostate cancer, Sheffield uses one of Tim Stockwell's dodgy meta-analyses, presumably because even the World Cancer Research Fund doesn't think there's enough evidence to link it to alcohol. For non-Hodgkin's Lymphoma, which is without question inversely associated with alcohol consumption, they have to settle for a proper meta-analysis.

For heart disease, they use the 2016 meta-analysis by Yang et al. which showed a significant reduction in risk for people who drank moderately - and, indeed, heavily. It found that 36 grams a day (more than 4 UK units) conferred the lowest risk of coronary artery disease, with drinkers at this level being 31% less likely to suffer from it. Even at 135 grams per day (17 units) there was no increase in risk.

The Yang study shows this is a graph that is ugly but unambiguous. Teetotallers are at significantly greater risk of heart disease.

Avid readers of this blog will recall that the trick used to lower the UK drinking guidelines in 2016 was ignoring threshold effects, ie. pretending that light and moderate drinkers are at risk of serious alcohol-related diseases such as alcoholic liver cirrhosis and pancreatitis.

This had a big effect on the final results because lots of people are light/moderate drinkers and the diseases in question are often fatal. The problem is that light/moderate drinkers are at no extra risk of developing these diseases. None whatsoever. The Sheffield team know this, and we know that they know it because they said so when Public Health England asked them to change their methodology at the time.

Quite rightly, they e-mailed PHE to say that 'it does not seem right to assign people drinking at very low levels a risk of acquiring alcoholic liver disease and similar conditions'. But they did it anyway because PHE told them to - and paid them £7,800 for their trouble.

Changing your methodology at the 11th hour - in a way that you know to be wrong - on the orders of your funder would end most scientists' careers, but the world of 'public health' is a little different. Rather than being kicked out of the academy, the Sheffield Alcohol Research Group has been awarded numerous grants, including this job in which they returned to the scene of the crime.

And they've done exactly the same thing...

In the base case model, we assume this consumption threshold is zero for both chronic and acute conditions (i.e. that risk increases with any level of alcohol consumption) in line with the work undertaken as part of the 2016 UK drinking guidelines review.

Of course they do. This allows them to produce risk curves for diseases which only affect people who drink a great deal of alcohol which look like this...

And this...

Artificially increasing the risk estimates for moderate drinking in this way allows the Sheffield crew to flatten out the start of the J-Curve and make moderate drinking look much more dangerous than it is (since the extra risks counter the few benefits that Sheffield admits moderate drinking has). The result? Fewer lives saved by the protective effects and more lives lost to serious alcohol-related diseases.

In their sensitivity analysis, they model a scenario in which moderate drinking has no protective effects at all, a ridiculously unrealistic proposition which they nonetheless imply might be true throughout the text.

Also in the sensitivity analysis, they model a scenario in which there are threshold effects for some diseases - which is nice of them given that it happens to be true - but they set the thresholds at a ludicrously low level (4 UK units for men and 3 UK units for women per week!). In other words, drinking more than two pints of beer a week puts you at increased risk of alcoholic liver cirrhosis. It doesn't, of course, but this is 'in lines [sic] with the previous UK analysis' so that's OK.

As a result of this tampering - and their decision to make heart disease 'the only condition where we adjust a literature-based risk function' - they produce an overall risk curve which should look something like this...

But which looks like this... 

Sheffield's model therefore suggests a 'safe drinking level' of under 15 standard drinks a week. This is similar to the model they produced for the UK. This is hardly surprisingly as it is essentially the same model with a few adjustments made for demographics and health status.

But we know the UK model is worthless, and even the Sheffield team don't believe one of its key assumptions, so why did the Australian public health industry pay them to make the same mistakes again?

Hmm, let me see...

The next step is a public consultation running until 24 February but that will doubtless be a rubber-stamping exercise. Regardless of the evidence, alcohol guidelines only go in one direction and, as I have long argued, will one day go to zero.

Tuesday 10 December 2019

Obesity in England: just the facts

The Health Survey for England was published last week, with the latest obesity statistics (for 2018). It didn't receive much media coverage, presumably because there wasn't anything particularly newsworthy in it, but here's a summary for those who are interested.

The rate of adult obesity was down slightly in 2018 - to 27.7% - after a jump in 2017 that always looked like a statistical blip (from 26.2% to 28.7%). Bear in mind that these are only estimates based on a sample and so there is a margin of error. Rates fluctuate from year to year, but on average there has been a rise of two or three percentage points in the last ten years.

The rate is higher among women (29.2%) than men (26.1%). This has been the case ever since the ONS starting tracking obesity in 1993, which makes it all the more peculiar that the consistently useless 'public health' predictions assume that the rate will be higher among men.

Speaking of predictions, it is that time of the year when we see how the Lancet's famous prediction of 2011 is working out. The journal reckoned that the male rate would be between 41% and 48% by 2030, prompting headlines like 'Half of UK men could be obese by 2030'. This looks as unlikely as ever.

By contrast, the number of men who are overweight has always been higher than the number of women who are overweight. The figure for 2018 is 67% and this hasn't really budged for 20 years, so it's safe to assume that the prediction of 80% of men being overweight by 2020 is not going to come to fruition.

Here's the rate of overweight (including obesity) for both sexes combined. It's not very exciting.

Regular readers will know that nobody bothers to measure childhood obesity properly in Britain, but the rate of what is wrongly called 'childhood obesity' was 15% in 2018. This is about the same as it was in the late 1990s and is less than it was in the mid-2000s.

You'll notice that the rate has fluctuated a lot in recent years. This is probably because the sample size was sharply reduced in 2011. Lazy, but why bother making a proper attempt to estimate something that is meaningless?

The most interesting statistics are those which rarely get mentioned. The rate of morbid obesity (ie. a BMI over 40) has been rising more quickly, albeit from a low base. At the start of the millennium, it was around 1.5%. By 2010, it was around 2.5%, and in 2017 it exceeded 3% for the first time.

In relative terms, the obesity rate has come close to doubling since 1993, but the morbid obesity rate has more than trebled. Women are twice as likely to be morbidly obese than men, with one in twenty of them being morbidly obese in middle age. 

So, in this millennium, we have seen a gradual rise in adult obesity, a sharper rise in morbid obesity, no rise in the number of people who are overweight, and a decline in the rate of what they call child obesity.

Sunday 8 December 2019

Can we attribute 36% of premature deaths to "socioeconomic inequality"?

The last issue of the Lancet before the election contains a study looking at the association between deprivation and health. It concluded that...

One in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge. 

On Twitter, the study's lead author went further, saying that a third of premature deaths could be avoided if society was 'fairer'...

The counterfactual is, apparently, a 'fair country'...

The study used the Index of Multiple Deprivation which splits England into 32,844 areas and gives them scores based on income, employment, crime, education, health, housing and the environment, with income and employment having the heaviest weightings (between them they make up 45 per cent of the final score). The authors stripped out the health bit and calculated the number of premature deaths in each area.

In line with common sense and virtually all previous research, they found that the most 'socially deprived' areas had the highest mortality while the least deprived areas had the lowest. (For the sake of simplicity, I'll use the words 'poorest' and 'richest' in this post to describe these areas. It's a bit more complicated than that, but not enough the affect my argument.)

There's nothing surprising about the correlation between health and wealth. The problem is in how the authors have presented their findings.

Firstly, they make causal claims based on crude correlations. When challenged about this on Twitter, the authors denied it, but the study is unambiguous. It is titled 'Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018' for a start, and the authors use the words 'attributable' and 'attributed' time and time again. For example...

35·6% (95% CI 35·3–35·9) of premature deaths were attributable to socioeconomic inequality

Inequalities in premature mortality are persistent despite reducing total mortality, and we estimate that one in three premature deaths can be attributed to socioeconomic position.  

Their evident belief that social deprivation is the cause of the excess mortality is underlined by their assertion that the deaths would be avoided if there was no social deprivation...

Every year tens of thousands of premature deaths in England alone could be avoided by closing socioeconomic inequalities in mortality.

The large proportion of premature deaths that could be avoided by eliminating socioeconomic differences in mortality is likely to exist across high-income countries, because inequalities in premature mortality are ubiquitous.  

The second problem is that they do not settle for merely claiming causation between excess mortality and social deprivation. They make the stronger claim that the excess mortality is caused by (sorry, 'attributed to') socioeconomic inequality. For example...

Years of life lost to inequality was calculated as the difference between the years lost due to death before age 75 years in each cohort and the corresponding least deprived cohort. 
This is a different proposition. There are some who believe that inequality per se lowers life expectancy (most notably, the authors of The Spirit Level). Under this hypothesis, the stress of living in an unequal society manifests itself in unhealthy behaviour and bad health outcomes. The evidence for this is weak, however, and the authors of the present study do not make that argument, nor does the study contain any data that could test that hypothesis.

Perhaps it is just sloppy language, but the difference between poverty causing premature deaths and inequality causing them is enormous. In the former case, premature deaths could be reduced by making people richer. In the latter case, premature deaths could be reduced by reducing the gap between rich and poor even if the poor do not get any richer (ie. by simply making the rich poorer). 

Thirdly, they use the the richest decile as their baseline, as shown below.

All the lower deciles have a higher rate of premature mortality than the richest decile, and the authors describe every death above this baseline as an 'excess death'.

That would be just about acceptable if this were an academic exercise to imagine what would happen if everybody in Britain lived in the richest parts of Britain, behaved like rich people and had the income of a rich person.

But it isn't. According to the lead author, the study tells us what would happen in a 'fairer society'. The clear implication, underlined in the study, is that most or all of these deaths could be avoided in practice.

The presumption is that there would no socioeconomic inequality in a 'fairer society'. The idea that fairness implies total equality of outcome is debatable, to put it mildly, but let's go with it for the sake of argument.

It is possible, in theory at least, to reduce most of the criteria in the Index of Multiple Deprivation to close to zero. We could - again, in theory - ensure that everybody has exactly the same income.

But there are simply not the resources available to ensure that everybody has a top income. The median income in the UK is £28,400. The mean income - which is what everybody would get (in theory) if we had full equality of outcome - is £34,200. Incomes in the top decile are around twice that. The country would need to be at least twice as rich for everybody to have the kind of income that the authors think is 'fair'.

This is obviously unrealistic, even if we accept the other wild assumptions in the study (such as people in rich areas having better health for no other reason than that they live in rich areas, and radical egalitarianism having no negative effect on the amount of wealth created). The authors' counterfactual is not a 'fair country' but a fantasy country. It is not a lack of political will that prevents every area of the country from being as wealthy as the richest areas. The problem is economic. With limited resources, you cannot raise nearly everybody up without bringing some people down.

It makes no sense to view the happy situation of the least 'socially deprived' as a state of nature which is only denied to other people because of inequality. If you used the poorer areas as the baseline, you could cite the lower mortality rates in the higher deciles as evidence that inequality saves thousands of lives (a point conceded by the lead author).

That would be provocative, fatuous and fairly pointless, but so is the conclusion of this study.

Friday 6 December 2019

Fake alcohol news

The BBC has still not corrected its story from Tuesday which falsely claimed that alcohol-related deaths are 'dropping in Scotland'. This fake news has been spread around the world by advocates of minimum pricing and will doubtless continue to do so. The BBC is, after all, a supposedly trusted source.


This is not an isolated example of the public being misled about what has happened in Scotland since minimum pricing was introduced. I've written a whole article about it for Spiked. Do have a read of it.

Thursday 5 December 2019

Nattering about the Nanny State on Newsnight

Courtesy of Dick

Last night, Newsnight got four people together to discuss the issues that they think are being overlooked in the election campaign. I was one of them and the topic I picked was (you guessed it) the nanny state, using the Nanny State Index as the hook.

As I wrote a couple of weeks ago, there is very little in the way of paternalistic 'public health' policies in most of the main parties' manifesto. They are almost entirely absent from the Tories' manifesto and Labour's pledges are pretty vague.

That could be a good thing if it means they don't plan to interfere, but recent history shows that politicians are happy to introduce nanny state policies regardless of whether they were in the manifesto or not. If I recall correctly, there was nothing about plain packaging or sugar taxes in the Conservative manifesto of 2010, and Labour's 2005 manifesto explicitly said it would exempt wet-led pubs from the smoking ban.

There's a clip from the show below and you can watch the whole thing here. It's the first item in the show.

Wednesday 4 December 2019

The BBC is lying about alcohol-related deaths

Perhaps it was too much to hope the media to report the news that alcohol-related deaths rose in Scotland last year while they fell in England and Wales, but I didn't expect the BBC to flat out lie about it.

Almost unbelievably, the BBC's story is headlined...

Alcohol death rates dropping in Scotland

What?! This is Pravda level stuff.

Death rates caused by alcohol have dropped in Scotland in the past 10 years, according to new figures. 

Yes, sort of. There was a big decline between 2006 and 2012. Since then, they have risen every year except 2017 and they rose again last year - the year in which minimum pricing began. 

It is fair to say that alcohol death rates dropped, albeit a while ago. It is not fair to say that they are 'dropping'. That is, by any reasonable standard, a lie.

Since the drop occurred between 2006 and 2012, nobody could possibly attribute it to a policy that was introduced in May 2018.

And yet, incredibly, that is what the BBC tries to do...

Charities said it gave cause for optimism that minimum unit pricing was working, but warned that further action was needed to curb alcohol harm. 

The charity in question is the state-funded pressure group Alcohol Focus Scotland which works hand in glove with the Scottish government. To be fair to them, their 'cause for optimism' is not the death count but the supposed decline in alcohol consumption (of just under 3 per cent) that occurred in 2018 (although sales figures from the off trade do not support this). Tying this quote to the mortality figures is an invention of the BBC's.

The charity has suggested the minimum price of alcohol could be increased and alcohol marketing restricted. 

Well, there's a surprise. Needless to say, no other viewpoint features in the article.

I don't often make a complaint to the BBC, but enough is enough. I encourage you to do the same.

I've screenshotted the offending passages on the off chance that somebody at the BBC has integrity and corrects it.

Meanwhile, here's the policy and advocacy director of the NCD Aliiance (and former head of the European Public Health Alliance) spreading fake news. This literally could not be less true.

Tuesday 3 December 2019

Alcohol-related deaths down in England, up in Scotland

More bad news for minimum pricing advocates today. The Office for National Statistics has published its first data set for alcohol-related mortality since minimum pricing was introduced in Scotland.

Regular readers will know that the number of alcohol-related deaths rose (by 16) in Scotland in 2018. Almost nobody else knows this because no media outlet bothered to report it, despite the figures being officially published in June.

The ONS confirms this rise, but its data also allow us to compare Scotland with the rest of Britain for the first time. If the number of deaths had risen sharply in England, it could have spared the temperance's lobby blushes somewhat, as they could have claimed that Scotland was only saved from a similarly dramatic rise by minimum pricing.

Alas for them, the number of deaths in England fell by 145. Wales also saw a decline. No figures are available for Northern Ireland.

Put another way, the alcohol-related death rate rose from 20.5 to 20.8 per 100,000 in Scotland, but fell from 11.1 to 10.7 per 100,000 in England and from 13.5 to 13.1 per 100,000 in Wales.

The usual caveat applies about the data showing the calendar year of 2018, rather than the full twelve months after minimum pricing - not that this bothered campaigners when they were hyping flawed consumption figures and cherry-picked mortality figures.

Still, it doesn't look good for the 'public health' lobby's favourite 'evidence-based' anti-alcohol policy. The Sheffield model famously predicted 58 fewer deaths in the first year.

Monday 2 December 2019

Shooting the medium - the Lancet versus #yes2meat

Remember the EAT-Lancet diet that was promoted at great expense by the billionaire couple Gunhild and Petter Stordalen in January? It called for people to restrict themselves to portions of meat, eggs and dairy that make a WWII ration look like a feast. And the 'public health' lobby wanted to use government coercion to make it happen.

The Stordalens have since split up and the World Health Organisation has distanced itself from their movement, but Richard Horton's Lancet remains committed.

Last week, the once-great journal published a 'study' in which academics from the Stockholm Resilience Centre (which is a 'scientific partner to the EAT Foundation') complained that people had been writing mean tweets. They are annoyed that the EAT-Lancet diet was rounded mocked and criticised just before and after the launch.

They say...

Although the report was positively received by established international media outlets such as The Guardian and The New York Times, it also led to highly polarised debates online including misinformation, conspiracy theories, and personal attacks along with the hashtag #yes2meat.

Who could have guessed that something that was received by the Guardian and the NYT would not be popular with the general public?!

To understand the effect of this controversy, we have collected and analysed a dataset of Twitter activity linked to EAT–Lancet and yes2meat with 4278 Twitter users and 8·5 million tweets. Our analysis confirms that a digital countermovement managed to organise rapidly, essentially dominating online discussions about the EAT–Lancet report in intriguing and worrying ways.

'Worrying', eh? So what happened?

Although #yes2meat, from the outset, was used to promote meat-based diets independently of the report, it rapidly became the term against the Commission that opponents organised around online. By actively promoting #yes2meat right before, during, and after the EAT–Lancet report launch, this counter movement was approximately ten times more likely to be negative about the report than positive or neutral. This scenario has resulted in the wide distribution of critical (and at times defamatory) articles on alternative media platforms. Hence, the EAT–Lancet report not only sparked the spread of a science-based message under the official hashtag #EATLancet, but also resulted in the formation of a new sceptical online community organising around a new hashtag #yes2meat. 

They provide a handy graphic to show how the pesky public came out in force to slam the new dietary regime.

There has been a lot of Twitter-based 'research' in 'public health' in recent years, particularly in the vaping space. Usually, the aim is to present normal members of the public as industry stooges or bots.

The authors of the present study don't attempt to do this. They have to admit that...

...this diffusion was not driven by automatically produced content through so-called social bots, but by a growing community of sceptical social media users.

The EAT-Lancet report was published at 11.30pm on January 16th (UK time). A press release was sent out two or three days earlier under embargo. I knew about it by January 14th so I'm sure plenty of other people did too.

Looking at the #yestomeat hashtag, the earliest relevant tweets are from January 14th.

The low carb, high fat (LCHF) community was particularly rattled by the study. I have written before about their zealous social media presence. Some of them are indeed inclined towards conspiracy theories, but since these theories mainly centre around the supposed influence of industry - particularly 'Big Food' - the Lancet is not well placed to complain. It was playing the same game at the time.

But just because you're paranoid doesn't mean that they're not after you. Those who pointed out that the EAT-Lancet project was a heavily funded attempt to push a near-vegan diet on the world had a point...

Having preempted the report, the #yes2meat hashtag went mildly viral, mainly among people who treat being a carnivore of a key part of their identity. Some of the tweets got hundreds of retweets, as you can see above. And whilst some of the tweets were of the tinfoil hat variety (this is Twitter after all), some of them linked to reasonable critiques...

Ultimately, what is the issue here? The EAT-Lancet report was designed to get maximum publicity. Sure enough, it was noticed by lots of people - many of whom found the whole thing preposterous and sinister. Some of them took to Twitter to criticise it. So what? Free speech, right?

The authors of the new Lancet study don't quite see it that way. What you and I might call robust criticism of a highly controversial proposal, they call 'content pollution'.

Scientists and journals face serious challenges in a rapidly changing media landscape that is susceptible to the intentional dissemination of misleading content. Health communication campaigns are clearly susceptible to polarisation, so-called content pollution, and disinformatin.

What evidence is there that there was intentional dissemination of misleading content? None is provided in the article.
The controversies online associated with the EAT–Lancet Commission, we believe, show how a rapidly changing media landscape and polarisationpose serious challenges to science communication on health and climate issues.

Or, to put it another way, the ability of journals such as the Lancet to exploit their fading reputations by publishing political tracts masquerading as scientific studies is being undermined by the great unwashed having a voice.

Scientists and scientific outlets such as The Lancet need to be continuously aware of, and act proactively, to avoid manipulation and misinformation about issues of fundamental importance for human health and the planet.

That rather begs the question, does it not? Some criticisms of the EAT-Lancet report were silly, but others were well founded and made in good faith. The Lancet can't be expected to engage with every critic, but it could try engaging with some of them. Instead, it arrogantly assumes that the problem is not with its own report but with social media for allowing people to express an alterntive view.