Friday 28 June 2019

State propaganda for minimum pricing

Not a single newspaper has covered the statistics published by the Scottish government on Wednesday showing a rise in alcohol-related deaths in 2018. Given the extensive coverage of the decline in alcohol consumption a week earlier, this is shameful bias.

In fact, only one article appeared this week about minimum pricing. It was written by Sarah Devine at the Scotsman and was published yesterday (and put online today). It makes for very strange reading.

Indications are that the introduction of the minimum unit pricing of alcohol has lowered consumption, and hopes are high that a correlative reduction in drink-related violence is on the way, writes Sarah Devine.

It has been little over a year since Scotland became the first country in the world to introduce minimum unit pricing (MUP), and the latest official figures show that the policy is clearly working.

As mentioned, the latest official figures actually show that alcohol-related deaths rose but this fact doesn't get a mention in Sarah's article.

MUP was first called for by Scottish Health Action on Alcohol Problems (SHAAP) in 2007 before being implemented by the Scottish Government in May last year to challenge cheap prices charged for alcoholic drinks in Scotland.

Numbers released by Holyrood this month show that there has been a 3 per cent fall in alcohol sales per adult in the country since then, while the volume of alcohol sold per adult in Scotland in 2018 reached its lowest level in 25 years.

SHAAP, which was established in 2006 by the Scottish Medical Royal Colleges and based within the Royal College of Physicians of Edinburgh, is a clinical group aimed at tackling the public health issue of alcohol-related harm to improve the health and wellbeing of people in Scotland through a range of evidence-based approaches. It is also working to change the public’s perception of alcohol and reduce its negative impact on young people.

This is starting to read like a press release from SHAAP.

Last month, SHAAP was named as the first sponsor of Scottish Women’s Football’s National Performance League and NPL Cup, the elite level for girls’ club football in Scotland and the body lauded its stance on not accepting alcohol sponsorship.

Since SHAAP began, the number of alcohol-related crimes has also decreased substantially.

Given that the number of alcohol-related crimes has fallen substantially in England over the same period, this is a pretty clear case of the post hoc fallacy.

SHAAP’s work is led by a steering group with representation from the Medical Royal Colleges and Faculties in Scotland as well as invited experts.

SHAAP this, SHAAP that. Where is the news? Where is the opposing viewpoint? Where are the death statistics?

One such member is Dr Christine Goodall, who co-founded the Scottish charity Medics Against Violence (MAV) two years after SHAAP began, and who welcomes this reduction in the number of violent crimes.

The rest of the article is a puff piece for Medics Against Violence.

Combined with minimum unit pricing, work on issues such as adverse childhood experiences and the reduction of the availability of alcohol in deprived areas, in line with the WHO approach, Goodall is hopeful that the number of violent and alcohol-related assaults will continue to fall.

This is like something out of Pravda and it is very odd. It only makes sense when you look again at the top of the page and see this...

'Promoted by' means sponsored by, ie. paid for. Note that SHAAP is based out of the Royal College of Physicians, as the article says.

It turns out that Sarah Devine has a history of writing articles favourable to this pressure group, such as this piece promoting sponsorship of women's football and this piece promoting a temperance conference...

I don't hold this against Sarah Devine. Journalism is a tough trade these days. The problem is that SHAAP is entirely funded by taxpayers, with 87 per cent of its income coming directly from the Scottish government.

It seems, therefore, that the Scottish government is indirectly paying for biased, positive coverage of one of its pet policies in a Scottish newspaper. If so, Scotland's sockpuppet state is worse than I thought.

San Francisco is broken beyond repair

Since the demise of the Islamic State, the task of over-turning the Enlightenment has fallen to California. And what a fine job it is doing in the fight against science and reason, condemning glyphosate by jury trial, putting cancer warnings on nearly everything and leading the world in thirdhand smoke research.

San Francisco is the epicentre of the Golden State's insanity. The city has recently plumbed new depths by announcing a ban on e-cigarette sales. Leaving aside the issue of personal freedom - which is irrelevant to people in the Bay Area - why would you ban the safest form of recreational nicotine device and leave the most dangerous on the shelves?

It's a question that a few people have asked and one of Stanton Glantz's cohorts, Lauren Lempert of the Center for Tobacco Control Research and Education, has the answer. Make sure you're sitting down before you read it.

"It's a fair question to ask why there are still legal cigarettes, which may be at least as dangerous, and possibly more dangerous [than vape products]," said Lempert. 
 "May be"??? "Possibly"??! What do they teach them at the Center for Tobacco Control Research and Education?
"But that doesn't mean you shouldn't at least address this immediate problem of e-cigarettes, and then if you want to move on from there and ban all tobacco products, then do that." 
Good grief. These people are fully deranged. 

The more pressing question for the city is whether it will lose any tax revenue from wiping out the vaping sector. But don't worry, they've looked into it...

Ted Egan, the city’s chief economist, said his office reviewed the legislation and found it would not have a material impact on the San Francisco economy because the money spent on vaping products would continue to be spent in the city on other nicotine products like cigarettes.
That's alright then!
Meanwhile, the guy who led the moral panic about vaping as commissioner of the FDA has just joined one of the world's leading manufacturers of pharmaceutical nicotine products. What a small world.

Thursday 27 June 2019

Theodore Dalrymple on the British Medical Journal

Theodore Dalrymple has written an excellent article about the state of the British Medical Journal, inspired by the BMJ's recent attack on the Institute of Economic Affairs. It's full of gems so read the whole thing, but here's a sample...

To most modern doctor-philosophers, everything, up to and including a meal, is either health-giving or health-harming, and it is the most important function of a government, under their expert direction, to promote the health and prevent the harmful. They are the Islamic fundamentalists of human welfare: their religion allows the healthy and forbids the unhealthy. They do not recognise any ambiguities. Vested interest for them arises only from the possibility of making a commercial profit: their own demand for control over ever more resources, or for ever more power to forbid, is purely and objectively for the good of humanity. As the BMJ puts it, concern has been “prompted” that the current Health Secretary might be “listening to the views of vested interests above those of the health community”. The “health community”—assumed to be of one mind, incidentally—has no vested interests, because its interests by definition cannot be vested. 

.. I am not so much concerned that the views expressed in this article should be expressed (everyone is entitled to his opinions) as that there is not likely to be much debate about them. One has the impression on reading the medical journals—the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association, the BMJ—that a kind of stifling pensée unique has overtaken or infected an important part of the medical world: a pensée unique from which it is increasingly harmful to a career to dissent.  

Wednesday 26 June 2019

Alcohol-related deaths rose in Scotland last year

Remember last week when statistics showed a fall in alcohol consumption in Scotland in 2018 and everybody pretended that minimum pricing was responsible for the decline?

You can hardly have missed the news. It was reported everywhere and it inspired the Irish prime minister to get moving with minimum pricing... 

Ireland will move quickly to implement a minimum price below which alcoholic drink cannot be sold, the Taoiseach has said.

Mr Varadkar said the recent data in Scotland – which brought in the measure in May of last year – showed it was working well. This encouraged the Irish Government to implement the measure already contained in an alcohol control law passed by the Dáil and Seanad.

However, as I explained at the time, it's difficult to read too much into the figures for the calendar year of 2018, for a few reasons. 

First, minimum pricing didn't begin until May, so for a third of the year alcohol was sold at the market price. The figures I have seen for off-trade sales in the post-MUP period (May 2018 to April 2019) show no decline.

Second, alcohol sales have fallen in nine of the last eleven years, including a 3.7% fall in 2011, a 4.2% fall in 2012, a 2.5% fall in 2013 and a 1.9% fall in 2016. There is nothing special or unusual about the 2.95% fall recorded in 2018.

Third, if you dig into the spreadsheets of the MESAS study, you'll see that the decline in the on-trade was almost identical to that in the off-trade (2.9% and 3.1% respectively). If minimum pricing was behind the decline, you would expect it to be driven by the off-trade since that is where the price rises were experienced.

None of this was allowed to intrude on the celebrations last week. We all had to pretend that 2018 was the post-MUP period and minimum pricing was responsible for whatever happened in it.

Today, the figures for alcohol-related deaths were published. This was the moment that Alison Douglas of Alcohol Focus Scotland had been looking forward to, as she said in April:

"Really importantly, we'll get the first data on alcohol specific deaths in Scotland because that's the first indicator of what's happening to harm. Lets not forget the whole policy here is about reducing alcohol related harm and consumption is the means to improving peoples heath and lives."

This time, however, there was no press release from NHS Scotland, no comment from the Scottish Health Minister and not a peep from any of the newspapers. Why not? Perhaps because the figures show a rise in the number of alcohol-related deaths in Scotland between 2017 and 2018, from 1,120 to 1,136 (1.4%). 

Let's remember that the sainted Sheffield Model predicted exactly 58 fewer alcohol-related deaths in the first year of minimum pricing.

But 2018 was not the first year of minimum pricing. It was year in which minimum pricing was in force for eight months, as today's report makes clear...

Minimum unit pricing for alcohol was implemented in Scotland on 1 May 2018, with a minimum price of 50p per unit. The 1% increase in the number of alcohol-specific deaths between 2017 and 2018 is not conclusive evidence on whether or not the policy is working because (for example) it is well within the range of the ‘random’ year-to-year fluctuations that have been seen in many previous years and, in any case, the figure for 2018 as a whole includes deaths which were registered in four months (January to April 2018) in which there was no minimum unit price for the sale of alcohol.

This applies equally to the alcohol consumption figures. The 2.95% decline in 2018 was 'well within the range of the ‘random’ year-to-year fluctuations that have been seen in many previous years'.

All I want here is a bit of consistency. If we're going to pretend that the calendar year of 2018 was the post-MUP period and use post hoc rationale, then minimum pricing drove down alcohol consumption while failing to reduce alcohol-related deaths. Today's statistics should have received at least as much attention as the sales figures did last week ('the whole policy here is about reducing alcohol related harm', after all).

Instead, today's figures have been released to the sound of crickets and tumbleweed.

Ever get the feeling you're being played?

Monday 24 June 2019

Did childhood obesity really fall in Leeds?

At the start of last month, there was a good news story from Leeds...
Leeds becomes first UK city to lower its childhood obesity rate 
Leeds has become the first city in the UK to report a drop in childhood obesity after introducing a programme to help parents set boundaries for their children and say no to sweets and junk food.

Only a few cities in the world, notably Amsterdam, have managed to cut child obesity. Like Amsterdam, the decline in Leeds is most marked among families living in the most deprived areas, where the problem is worst and hardest to tackle.

“The improvement in the most deprived children in Leeds is startling,” said Susan Jebb, a professor of diet and population health at Oxford University, whose team has analysed the city’s data. Over four years, obesity has dropped from 11.5% to 10.5% and the trajectory is steadily downwards. Among the more affluent families, there was also a decline from 6.8% to 6%. Overall the drop was from 9.4% to 8.8%.

Jebb seemed confident in the statistics:

“This is four years, not one rogue data point,” she said at the European Congress on Obesity in Glasgow where she presented the research, also published in the journal Paediatric Obesity.
“Everybody is going around saying Amsterdam is doing something amazing. Well, actually, Leeds is too.”
The news was covered by the BBC with a story headlined 'Has Leeds cracked the obesity problem?', and the Guardian ran an op-ed by the head of business development at the organisation that was credited with success: Henry (Health, Exercise, Nutrition for the Really Young). He said:

Since 2009, when Henry started working in Leeds, obesity rates at age five have fallen significantly (from 9.4% to 8.8%), while rates for cities with similar socio-demographic characteristics, and as a whole, have remained high.

I mentioned it on this blog at the time because it seemed promising. Alas, via ConscienHealth, I see that it has been debunked. As Eugene Milne, the director of Public Health for Newcastle, explains:

But what was missing from the news coverage and responses was the fact that there is now a fifth data point in the Fingertips data—for the period 2013/14-2017/18—and this shows the prevalence of obesity in Leeds to have risen again to 8.98%. This is because the single-year data for the city in 2017/18 showed a rise to a prevalence figure of 9.5% in the reception age group.

This true. If you look at the data, you'll see that the rate of 'obesity' among reception age children has been between 8.4% and 10.3% since 2006/07. Aside from a small spike between 2008 and 2010, there is no discernible trend. In 2017/18, the figure was 9.4%. Looking at other figures, it's not clear why anyone ever concluded that there was strong evidence of a decline.

This therefore looks like junk research in support of another cash-burning 'public health' initiative. It's another reason to be sceptical of the barrage of stories that appear in the press when the European Congress on Obesity is in town.

Saturday 22 June 2019

Ten years of Velvet Glove, Iron Fist

Boisdale, 2009

As Simon Clark notes on his blog, today marks the tenth anniversary of the publication of my first book, Velvet Glove, Iron Fist: A History of Anti-Smoking. You can see some photos of the launch event, which was also FOREST's 30th birthday party, here.

I've been re-reading the last couple of chapters of the book to see how it stands up. What struck me was how many things that I thought were relatively recent developments were already underway by 2009. In my mind's eye, anti-obesity campaigners had started on fat and only turned on sugar in the last few years, but re-reading Velvet Glove I realised that chocolate and biscuits were already in their cross-hairs in the noughties. I had also forgotten that local councils were denying planning permission for takeway shops more than a decade ago.

Most of my predictions about the slippery slope have been confirmed by events. The war on perfume never gathered the momentum that I thought it might, although when I was in Toronto recently I was in a building that advertised itself as a 'scent-free zone'. 'Electrosensitivity' never really took off, perhaps because the ubiquity of smartphones and wi-fi made the cost of having this trendy diagnosis too high. Even the most high profile 'sufferer' - arch anti-smoker and former WHO Director-General Gro Harlem Brundtland - is now using a mobile phone.

Of course, there are some things that no sane person could have predicted, such as Thailand banning smoking in the home on the pretext of preventing domestic violence, but there isn't much I would change about the book if I could have my time over.

Having said that, I keep meaning to revise and expand Velvet Glove for a second edition. One day I will get around to it, but it is a big job. The rise of e-cigarettes, which began shortly after publication, probably requires a whole chapter of its own, and there are a whole slew of policies - plain packaging, display bans etc. - that were only a glint in the eyes of a fanatic in 2009.

The obvious endgame for the anti-smoking lobby has always been prohibition. By the time I get round to updating the book, tobacco prohibition may well underway. It would be the natural final chapter.

Beverly Hills recently got the ball rolling by announcing a ban on the sale of tobacco and vaping products. I was struck by the comments of Doug Blanke, Executive Director of the Public Health Law Center at the Mitchell Hamline School of Law in Saint Paul, Minnesota, which brought to mind Billy Sunday's hilariously over-optimistic speech about 'John Barleycorn' when alcohol Prohibition began...

“The tobacco epidemic is the greatest manmade catastrophe of all time: it’s on track to kill a billion smokers before the century is out.  But we may look back and say that this was the day that changed all that. Because with this bold action, Beverly Hills is showing the world an alternative path.  A path to zero tobacco deaths. To a world where we don’t just ‘control’ tobacco products, we phase them out completely. A world free of tobacco-related death and disease.”

In January, it will be exactly a century since Prohibition began. Are we destined to repeat the same mistake again? I suspect so. Once Beverly Hills has had the ban in place for a while there will be studies published claiming that it has been a glorious success. California will then follow, then whole countries. Who will be first? Thailand? Australia? Singapore?

As Laurent Huber, Executive Director of Action on Smoking and Health says:

“Beverly Hills is the first domino falling for tobacco sales, and other jurisdictions with no doubt soon follow their lead.”

Remember when all they wanted was non-smoking sections in restaurants? How things snowball.

Friday 21 June 2019

The IEA is closer to power than it has been for decades

The Institute of Economic Affairs is 'closer to power than it has been for decades' and 'may now hold the key to No 10'.

So said a peer-reviewed article in the British Medical Journal recently, so it must be true.

As you can imagine, those of us who work for the IEA were delighted to see our awesome power and influence being recognised by a top journal. Unfortunately, the article was written by gutter freelancer Jonathan Gornall so we can't pretend that it's an entirely accurate representation.

I've written a response for the benefit of the peculiar subset of people who think that 'who funds you?' is an argument.

When the BBC reported last month that Arron Banks had given £450,000 to Nigel Farage, I tweeted ironically: “So now we know why Mr Farage keeps banging on about leaving the EU. He’s been funded by a notorious Eurosceptic”. As should be obvious, the joke here is that everybody knows that Nigel Farage has been campaigning to leave the EU for 25 years. He attracts funding from people who share their ambition. The idea that the relationship works the other way round, with Farage’s opinion of the EU being dictated by the views of his financial backers, is laughable and yet that is how the British Medical Journal seems to view the relationship between the IEA and our donors.

Do read the rest.

Wednesday 19 June 2019

Scottish government spinning last year's alcohol statistics

The newspapers are full of 'good' news stories about minimum pricing today...

Scottish alcohol sales drop as minimum price kicks in (BBC)

Alcohol consumption in Scotland falls to 25-year low following minimum pricing introduction (Telegraph)

Minimum pricing policy for alcohol has sobering effect (Times)

Scottish alcohol sales at lowest level in 25 years after price controls (Guardian)

This seems to contradict previous reports of alcohol sales rising since minimum pricing, and the Scottish government is milking it for all it is worth. So what's the story?

The figures come from Scotland's annual MESAS study and look at the calendar year of 2018. Minimum pricing wasn't introduced until May 2018, so the figures do not show what happened after minimum pricing came in. They show what happened in a year in which minimum pricing was in force for eight months.

Nielsen data show that sales in Scotland went up by every measure - volume, value and units - in the first nine months of minimum pricing. A sharp decline in cider and perry sales was more than offset by a rise in sales in other categories, particularly spirits, lagers and fortified wine, leading to a two per cent increase in the number of units sold overall - a rise of 25 million units. (Unfortunately, these data are not available in full online.)

None of this is irreconcilable with the MESAS figures released today (which are also based on Nielsen data) for two reasons.

Firstly, as mentioned, the MESAS figure is for the whole year and it is quite possible that sales were lower than average in the four months before minimum pricing began.

Secondly, the MESAS figure is - quite properly - an estimate of per capita sales. Per capita figures are obviously affected by population growth. If there has been significant immigration, per capita sales could fall even while overall sales rise.

The MESAS authors say that they use the mid-year population estimates from National Records Scotland. Interestingly, however, those estimates show little population growth between 2017 and 2018. The population rose from 5,424,800 to 5,438,100, a rise of just 0.24 per cent. The more relevant comparison is the adult population but this, too, has only grown slightly, from 4,560,646 to 4,572,359 (0.26 per cent).

Notwithstanding the different time periods involved, the difference between the unit sales figures and the MESAS per capita figures remains unexplained. A set of monthly Nielsen figures covering 2017/18 and 2018/19 would clarify things, but I have yet to see this. (UPDATE: I've been reminded that the Nielsen figures do not include sales from Aldi and Lidl. MESAS estimates sales from these two shops, somehow. This could have an effect.)

In any case, it's worth looking at the trends in the MESAS report. If you only got your information from the BBC, you would think that sales plummeted in 2018 as a result of minimum pricing.

Scottish alcohol sales drop as minimum price kicks in

Scots bought less alcohol in 2018 than any year since records began in the early 1990s, according to a new report.

Hmm, sort of. Last year's MESAS report showed that alcohol consumption was 'at a level similar to that seen in 1994' in 2017, so this is hardly an historic moment. 

Leaving aside the fact that the figures don't actually show what happened after minimum pricing (let alone as a result of minimum pricing), the per capita estimates for 2018 don't show anything special.

Sales in the on-trade declined, as they have done for years (note the sharp decline in the years following the 2006 smoking ban) and sales in the off-trade dipped a bit. The off-trade decline was of the same magnitude of that seen between 2015 and 2016 and was less steep than that seen between 2011 and 2012. 

If you don't recall the BBC reporting those sales declines it's because they didn't, although they did report the rise between 2013 and 2014, perhaps because the Scottish government put out a press release saying that the figures 'reinforce [the] need for minimum unit pricing'. See how it works? 

When the 2016 figures were published, I said...

If a rise of 0.1 litres is enough to garner headlines, you'd think that a fall of 0.3 litres would be newsworthy, but you'd be wrong.

But that was then, this is now. Today, a fall of exactly 0.3 litres per head is suddenly highly newsworthy because it can be wrongly attributed to a policy that wasn't even in place for a large part of the year in question.

If minimum pricing hadn't been introduced last year, the drop in per capita consumption wouldn't have been reported at all, just as it wasn't when a drop of exactly the same size occurred in 2016. And with good reason: it is neither large nor unusual.

In conclusion, if you want to see what happened to alcohol sales after minimum pricing began, I humbly suggest you look at alcohol sales after minimum pricing began.

Tuesday 18 June 2019

Prohibition doesn't prohibit - prison edition

The erstwhile legal high Spice was banned in the UK in 2016. At around the same time, a ban on smoking in English prisons began to be phased in. Scottish prisons followed suit in November 2018.

Action on Smoking and Health predicted that the smoking ban wouldn't lead to prison riots. It led to a lot of prison riots. Violence in prisons is now at an all-time high.

And now we discover that...

Prison staff are falling ill from spice drug fumes

More than a third of prison officers and nurses have felt ill as a result of inhaling second-hand smoke from the drug known as spice that is plaguing jails.

A survey of more than 1,600 members of prison staff found that 53 per cent had been exposed to psychoactive substances taken by prisoners; 39 per cent said that they had felt unwell from the effects of the drugs, with 97 per cent of those affected reporting symptoms including dizziness and confusion.

Great success! Is there any problem that prohibition can't exacerbate?

In May, a group of activist-academics in Scotland found that levels of tobacco smoke had fallen in Scotland, and said:

“This research confirms that exposure to second-hand smoke has been drastically reduced and, ultimately, this will have a positive impact on the health of prison staff and prisoners.”

Meanwhile, back in the real world:

Scotland’s jails are in the grip of a new drugs crisis with the number of prisoners needing medical attention rising five fold in the last three years.

More than 1,600 prisoners needed medical attention after using psychoactive substances – formerly known as legal highs – last year.

And the number of cases continues to increase – with 1,100 prisoners affected already this year.

Banning smoking in prisons has caused the problem to escalate, warders say, with inmates now using government-issued e-cigarette devices to inhale the drugs.

Perhaps the authorities will now ban e-cigarettes, thereby further increasing the risk of violence?

Prison officers say the situation across the country’s jails is already out of control.

One said: “We seen prisoners foaming at the mouth and rampaging around with their eyes bulging out of their heads.

“Others look as if they are zombies.

“They exhibit super-human strength and are just completely out of control – it’s like walking into a zombie apocalypse.

“They don’t feel pain. We’ve seen then inflicting terrible injuries on themselves and others.”

Spice and other drugs are substitutes for tobacco. Tobacco has a calming effect on people, but the simple and effective solution of repealing the ban, at least outdoors, will never be entertained because British lawmakers are in the grip of fanaticism.

And so the carnage will continue.

Monday 17 June 2019

Critiques of the Lancet's 'no safe level' study

A study appeared in the Lancet last August which claimed to have virtually erased the J-Curve from alcohol epidemiology. The authors used an unconventional methodology, modelling aggregate data from whole countries rather than looking at risk to individuals, and came up with this:

According to their model, there is no reduction in mortality risk from moderate levels of alcohol consumption. It did not quite show that there is 'no safe level', despite the authors claiming that '[o]ur results show that the safest level of drinking is none', but it came close. It has since been cited by the Lancet and others as conclusive evidence that no amount of drinking is safe and that alcohol should be treated like cigarettes.

The methodology was too opaque to allow a full immediate critique, but David Spiegelhalter discussed it here and I wrote about it at the time. Among its flaws was the inclusion of tuberculosis as an alcohol-related disease (debatable in itself) which lifted the risks of drinking even in countries where TB is virtually nonexistent.

The Lancet has now published criticisms from three groups of scientists. You can read them here, here and here, along with the authors' reply here. The authors defend themselves by saying that their conclusion is broadly supported by two reviews by Tim Stockwell and another study published in The Lancet last year. In fact, the latter study found clear evidence of a J-Curve and Stockwell's one man crusade against the J-Curve is based on extreme cherry-picking and 'questionable statistical methods'. In the end, the authors say:

Debates concerning whether the safest level of consumption is zero or near zero are missing the point.

You see what they did there? That's what you call moving the Overton window. It's not actually a question of zero or near zero. It's a question of moderate consumption versus not so moderate consumption; 20-odd units a week versus 30-odd units a week. Either way, more than the UK government's evidence-free 'safe drinking' guideline of 14 units.

If you're interested in this issue, hit the links above.

Thursday 13 June 2019

Last Orders for Jamie Oliver

I'm off to the Global Nicotine Forum until Saturday so I will leave you with the latest Last Orders podcast with me, Tom Slater and TV's Kate Andrews. It's a special Jamie Oliver schadenfreude edition. Look at our sad faces.

Tuesday 11 June 2019

American idiots

I haven't written about vaping in the USA for a while because the debate over there is so incredibly stupid that it's senseless to try to intervene.

Take this, for example. Anti-smoking groups want to raise the age at which people can buy tobacco to 21 because, well, they like bans. The tobacco industry says that is in favour of this policy. That has discombobulated the tobakko kontrol movement because they put the infantile 'scream test' at the heart of their dogma (ie. "the louder tobacco companies scream, the more impact we know a measure will have"). By their logic, if the manufacturers of cigarettes support an anti-smoking policy, it can't work.

Bear in mind that the Americans ludicrously define e-cigarettes as tobacco products. The Tobacco 21 policy is really an attempt to crack down on vaping, not smoking - and on Juul in particular - so you see why some tobacco companies might look kindly on it.

Jeffrey Hardesty, research program manager at Johns Hopkins University’s Institute for Global Tobacco Control, says he’s skeptical of the tobacco industry’s sudden support for Tobacco 21, noting that it “does not make amends for decades of obituaries.”

Whatever. Policies should be judged by their merits. This one is illiberal, although given that the US government treats people under the age of 21 like children when it comes to alcohol, it is harder to argue against it than it would be in Britain.

But even still, he says the laws are a good idea at their core.

How many dark nights of the soul did he have before aligning himself with the evil tobacco barons, I wonder?

Hardesty agrees that Big Tobacco’s involvement “has the markings of corporate social responsibility.” Nonetheless, he says grouping vapes and traditional cigarettes under the same regulatory umbrella is a smart strategy for improving public health.

No, it's an exceptionally dumb strategy because they are substitute products, one of which is vastly safer than the other. Any regulation designed to deter use of the safest form of a product will have a similar effect to regulation designed to encourage the use of the most dangerous form of the product.

“If you’re only applying legislation to e-cigarettes…you could drive people back to a potentially more harmful product,” Hardesty says. 

Only applying them to e-cigarettes would be lunacy, even by American standards, but I don't think anyone is suggesting that. What is being suggested is that paternalistic regulation be commensurate with the relative risks.

It doesn't take much brain power to invert Hardesty's argument and conclude that if you only apply the regulation to tobacco cigarettes, you could drive smokers towards the least harmful product. This is Harm Reduction 101.


Sunday 9 June 2019

Panorama and alcohol, a toxic combination

A few weeks ago I was asked by BBC Panorama to do an interview about alcohol. Panorama has an atrocious history of making one-sided, error-riddled programmes about booze which amount to temperance propaganda. However, the new episode is hosted by Adrian Chiles, who I have always quite liked and who made a half-decent documentary about his own drinking last year, so I thought there was a glimmer of hope of it being reasonably objective and I agreed to the interview.

That hope was quickly snuffed out when he gave a speech to the fanatics of the Alcohol Health Alliance a few days after we met and I have since been told that my interview won’t feature in the programme at all.

To end all doubt, Chiles has written an article for The Observer in which he implicitly blames the alcohol industry for him drinking above the guidelines and portrays those guidelines as evidence-based (which they are not).

Judging by the article - and my unaired interview - the Panorama show tomorrow will be mainly about labelling, with Chiles concluding that the booze industry is lying to its customers by not advertising the new, evidence-free guidelines on their products.

People should be able to drink what they like, but they should do so with complete information. And that’s something the industry seems intent on keeping from us.

Consider a pub, with its long row of beer taps. On some you will see the percentage of alcohol in the beer. But why doesn’t it tell you how many units of alcohol there are in a pint? For that matter, why doesn’t it also tell you how many calories there are?

This, I think, is fair enough and I said so when he asked me about it. I don’t think it would make much difference to how much people drink - let’s face it, Chiles was smashing the old guidelines so there’s no reason to think he would abide by the new ones - but I’m not against consumers having information.

Labelling on beer taps doesn’t strike me as a big enough issue to justify 30 minutes of primetime television, but it gets worse when he actively defends the new guidelines...

In 2016 our chief medical officers set the safe drinking guidelines at a new lower level – 14 units a week for both men and women. Three years later, on the vast majority of products we looked at for Panorama, most producers still aren’t seeing fit to mention this. 

Good. No company should put manifestly untrue information on its products.

Small wonder that fewer than one in five of us are aware of the crucial 14-unit figure, as it’s on hardly any packaging at all. In most cases, the old advice – 28 units for men and 21 for women – is all you’ll get.

That’s not what is shown on most alcohol packaging. The guidelines haven’t been 28 units for men and 21 units for women since the 1980s. Most alcohol bottles and cans show daily guidelines with a warning to not regularly exceed them. Fairly sound advice.

As regular readers know, the new 14 unit guideline for both sexes has no empirical evidence to support it and was created in a demonstrably corrupt process. If Panorama was interested in investigative journalism, rather than being a mouthpiece for special interest groups, this is the story it would cover. Instead...

As for the 14-unit weekly safe drinking guidance, for what it’s worth – unlike many in the alcohol business – I choose to believe the conclusions of countless studies by scientists all over the world.

Utter guff. Not a single epidemiological study supports the 14 unit limit whereas countless studies show that people can consume around 30 units a week and still have a lower risk of mortality than a teetotaller. The only evidence for 14 units is a modelling effort from the hired guns at Sheffield University whom Public Health England paid to change their methodology at the eleventh hour because their original modelling supported the previous guidelines. Chiles’ claim is the exact opposite of the truth.

One piece of junk science from Sheffield is not enough for Adrian, so he doubles down by claiming that...

...most of the industry’s profits have to come from the other 30% of us. We need to keep pretty hard at it for them. If we were all to drop our drinking to safe levels, those profits would be hit to the tune of well over £10bn.

This can only be a reference to a laughable study published last August which claimed that alcohol revenues (not profits) would fall by £13 billion if all drinkers consumed exactly 14 units a week each.

I wrote about this economically illiterate piece of garbage at the time (see here and here). In short, the UK booze industry doesn’t make anything approaching £10 billion of profit so it cannot possibly lose ‘well over £10bn’. (You’d hope that someone who used to present a TV show about business could have worked that out for himself.) The authors of the study confused revenues with profits and ignored production costs and taxation. It should never have been published. In any serious academic field, it wouldn’t have been.

I hope the fact-checking is going to be better in the show itself, but despite Panorama getting itself in hot water in 2012 when it took a dodgy alcohol statistic on trust (yes, it was those lads at Sheffield Uni again), I have a feeling that it won’t be.

Wednesday 5 June 2019

Plain packaging for food, part 94

The IPPR, a left-wing think tank, got a lot of media attention yesterday when they called for plain packaging of sweets, cakes, crisps etc. Their report is an intellectually thin document with multiple typos (they write a lot about confectionery but rarely spell it correctly) and none of the analysis that you might expect from a think tank.

If you're going to propose Soviet-style regulation of the food supply, you need to answer a few basic questions. What is the source of the problem you are trying to solve? What is the likelihood that your policies solve it? What are the costs? What are the benefits?

The IPPR doesn't even ask those questions. The policy conclusions seem to have been cobbled together down the pub, mainly borrowing ideas that have been tried (and failed) in tobacco control.

I doubt the IPPR is particularly interested in obesity, but it is interested in having a go at capitalism, so it makes sense for them to get into bed with the 'public health' lobby. It describes plain packaging for food as a “challenge to the power of corporate manufacturers”, so that's nice.

The plain packs stuff got the headlines but other policies proposed were equally bizarre and illiberal. They want to 'extend the smoking ban to all public places' which presumably means banning smoking outdoors. They want to raise the smoking age to 21. They want to not only prevent new fast food shops opening near schools but shut down existing fast food shops to meet their target of 'no fast food restaurants with [sic] 0.1 miles of schools in England.' And they want to extend the sugar tax to various foods which displease them.

Pretty grim stuff, but good clickbait for the IPPR and another vindication for those of us who warned that this would happen.

I've written about it for The Sun today...

Those of us who opposed the sugar levy warned that the nanny state zealots would soon demand similar taxes on a range of everyday food products.

Similarly, we opposed plain packaging for tobacco because it would create a slippery slope, with food, soft drinks and alcohol next in the firing line.

A report published by the Institute for Public Policy Research (IPPR) proved the naysayers correct.

Not only are they calling for plain packaging for sweets, crisps and fizzy drinks, the IPPR is calling for tobacco-style sin taxes on cakes and confectionery, plus an extensive advertising ban for anything that the Government considers to be high in fat, sugar or salt.

Some of the IPPR’s justifications for these Stalinist diktats border on the ­surreal.

They claim that plain packaging for so-called “junk food” will “level the playing field between confectionary [sic] products and fruit and vegetables”, as if children would be eating turnips rather than chocolate bars if it weren’t for colourful wrappers.

Do read it all.

The Sun's leader is pretty solid...