Friday, 25 September 2020

Talking drinking guidelines and related issues

I was chatting to the guys at the Consumer Choice Center about a few nanny state issues recently. Top of the agenda was the US review of the drinking guidelines which looks to have been captured by temperance interests, just as it was in the UK. Full interview below.




Wednesday, 23 September 2020

Little Hitlers


 
Josie Appleton is always worth reading and she's written an excellent report for FOREST about the anti-smoking authoritarianism of local council busybodies. She made Freedom of Information requests to over 200 councils and found a range of smoking bans for staff and residents, including:

49 councils ban cigarette breaks entirely, even if workers clock off
 
113 councils currently ban smoking outside council buildings with some requiring employees to leave the site entirely or stand up to 50 metres from a council building to light up
 
29% of councils who replied had some form of ban on smoking outdoors.

Ipswich Council says that it is not enough to stand outside a council car to smoke - you have to move away from the car.  Leeds Council says: 
 
‘Leeds City Council employees are role models for our local communities. Employees who are visibly smoking whilst carrying out their duties are not demonstrating behaviour that encourages local communities to stop smoking.’

There is much more of this kind of thing but, as in Josie's fabulous book Officious, the report is at its best when it explains what it all says about the authorities and what they think of us.
 
The new restrictions on outdoor smoking are no longer even nominally justified by concrete health risks posed by smokers to other people. Instead, they are part of a new political and moral framework, a smokefree ideology, that is taking hold at all levels of the state structure, particularly regional governments and local authorities. This programme is seeking an end to the sight and presence of smoking in public spaces, not only as a public health goal but as a political and moral good and a means of social transformation. Smokefree beaches, parks, homes and workplaces are being pursued by a state structure strapped for funding and bereft of social or moral ideals. To go smokefree becomes a way in which state authorities can make a positive statement about the improvement of public spaces or of social conditions locally. ‘Smokefree’ becomes the stand-in public good, the stand-in way in which state bodies might claim to have a vision or to affect improvements in society.

... What is occurring is that the absence of tobacco is recast as a state of political, social or personal realisation. Tobacco – and, more precisely, an individual’s choice to smoke tobacco - becomes the embodiment of political and social restriction, of everything that is holding people back or preventing them from realising their potential. Therefore, tobacco control becomes a project of social realisation - of liberating people from restriction and allowing them to realise themselves.

On the Orwellian use of language:

Council smoking policies tend to state that the authority has a ‘duty of care’ to protect the health of its employees and local residents. Leeds Council says, ‘Everyone has a right to smoke if they so wish. However, Leeds City Council has a duty of care to its employees’ - and proceeds to outline how it will seek to discourage employees from smoking. This is a change in the meaning of ‘duty of care’, a phrase that would have traditionally meant the provision of public sanitation, the protection of people from accidents at work, and so on. Now this duty of care becomes a right of state intervention - trying to change the lifestyle choices people make in their everyday lives.

On the improvement of the lower orders:

The approach to tackling ‘inequality’ of ‘vulnerable’ groups is not to transform their situation in a substantive fashion (such as providing employment or housing) but merely to restrict the activity of smoking. As justification it is pointed out that smoking is much higher in socially deprived groups. Yet this gets things the wrong way around. It is more the case that smoking helps people cope with difficult situations, such as poverty or mental illness, rather than poverty or mental illness is a consequence of smoking. Yet, increasingly, social inequality is recast as the consequence of a lifestyle habit and the restriction of a lifestyle habit is seen as the answer to social inequality. The passing down of social inequality through the generations (which occurs through educational and financial factors) is re-explained as a ‘cycle of disadvantage’ through the transmission of ‘smoking behaviours’. Therefore, smokefree homes are seen as a way of breaking this cycle of disadvantage and the transmission of inequality.
 
 And, of course, vaping has not escaped the attention of the pocket dictators...

Smoking is also portrayed as a form of visual pollution because it is imagined that the habit is transmitted in a viral manner: if someone sees someone else smoking they may be tempted to try it themselves, or relapse if they have successfully quit. Several councils (including Islington) request that workers do not smoke in view of children.

It is for this reason that all councils (aside from one, Hull) treat vaping as smoking and impose similar restrictions upon it. The fact that vaping is one of the primary aids to quitting smoking, and has minimal health risks, is ignored. Vaping is restricted in the same way as smoking because it looks like smoking, which means that it mimics the same visual offence.

You can download The Smokefree Ideology here.


Tuesday, 22 September 2020

Plain packaging doesn't work - new study

Another 'public health' win!

 
A study published in Nature Human Behaviour looks at Australia's experiment with plain packaging for tobacco and comes to a conclusion that will surprise few regular readers...
 

Here we examine the effectiveness of Australia’s plain packaging law, which coincided with a change in graphic and text health warnings, by using nationally indicative data 5 years post implementation. We measured the effect of the law on smoking prevalence, tobacco expenditure, expenditure intensity and quantity of tobacco consumed, using New Zealand as a control country in a difference-in-differences research design. We uncover a substitution effect that is robust to different specifications and control countries. In response to the policy, smokers switched from more expensive to cheaper cigarettes and reduced their overall tobacco expenditure and expenditure intensity. However, as smoking became less costly, smokers consumed more cigarettes.


D'oh! If only someone had predicted this way back in 2012...

Should we care if cigarette companies becomes less profitable and are only able to compete on price? If smokers buy cheaper cigarettes from the licit and illicit market, perhaps we should. Price is widely seen as the single most important factor in influencing cigarette consumption, and yet here is a policy that will reduce demand for the most expensive brands, that will encourage the industry to compete by lowering prices and which is likely to stimulate the black market. For the zealots of the anti-tobacco industry, anything that harms Big Tobacco’s profits is a good thing, but in this instance, what is bad for the tobacco industry is also likely to be bad for public health.
 
I was not the only one saying this, of course. It was obvious to everyone but the 'public health' fanatics.
 
This is not the first time a study written by authors sympathetic to plain packaging has found no positive impact. These authors have a policy proposal to paper over the cracks of the last failed policy.

To discourage such substitution and to help the policy achieve its intended outcomes, policymakers should consider implementing auxiliary measures, such as taxes or price floors.

I'm afraid they've already tried that, guys. A pack of twenty cigarettes costs $40 these days (£22 /US $30). That, too, has had predictable unintended consequences.

All this, combined with the ban on e-cigarettes, cements Australia's position as the clown country of tobacco control.


No, YOU lock down

I propose a solution to our current predicament at The Critic...
 

Since there is no end in sight, lockdown should now become an issue of individual choice. If you want a lockdown, you lock down. You stay at home. You get your shopping delivered. You wait it out. If you are a pensioner, you may be doing this already and you have your pension to keep you going. If you are of working age but have a health condition that puts you at high risk, you may already be on Disability Living Allowance. If not, and if you can’t work from home, we will put you on it for as long as you want to self-isolate. Heck, even if there’s nothing wrong with you and you’re just scared of getting the virus, we’ll let you claim Disability Living Allowance and you can lock yourself down. Your employer will be legally obliged to keep your job open for you for when you return. The government will offer interest-free loans to anybody who wants some extra money. You can pay it back when this is all over. For now, stay at home for as long as you like.

If you go for a walk, keep your distance from other people. Keep washing your hands. No one will come near you. If you live with other people, come to a collective decision about what you want to do. If you have children, take them out of school if you want. It’s going to be just like the real lockdown, but optional.

.. No one will be compelled to stay indoors. An 85-year-old diabetic who doesn’t want to spend a large chunk of the rest of her life in self-isolation would be as free as a twenty year old to go out and enjoy herself. Free societies allow their citizens to take informed risks. We are allowed to ride motorcycles and smoke cigarettes. We should be allowed to take the risk of getting the coronavirus by mixing with consenting adults who have made the same choice. If granny doesn’t want to take the risk, we are not going to impose it on her, but she will no longer be used as an excuse for mass quarantine.

 


Friday, 18 September 2020

Belarus, T-Cells and COVID-19

There are a couple of interesting articles in the BMJ this week about the old Miley Cyrus, including one involving a rare mention of Belarus. Sweden's relatively laissez-faire attitude towards Covid grabbed the world's attention but Belarus took an even less restrained approach. In Sweden, it's been the epidemiologists calling the shots. In Belarus, it's the dictator. But both have ended up being a sort of control group.

Belarus isn't the most open society, to put it mildly, and its data are questionable. Its daily Covid death count has been suspiciously consistent, nearly always between four and six. No doubt the numbers have been massaged, but Belarus is not such a closed society that word wouldn't get out if its health service was collapsing and people were dying left, right and centre - which is what the likes of Prof Neil Ferguson would have predicted given that it didn't come close to locking down.

According to the BMJ, Belarus has 'one of the lowest [COVID-19] death rates in Europe' and the author is forced to come up with a bunch of post hoc rationalisations for this. Just as the experts suddenly remembered that Sweden has a relatively low population density after the predicted catastrophe failed to materialise, we are now told that Belarus has a large hospital capacity, has done quite a bit of testing and doesn't get many foreign visitors. 

Perhaps so, but a better explanation for why the predictions of disaster haven't come to fruition in Belarus or Sweden lies in another BMJ article this week. It won't come as a surprise to 'armchair epidemiologists', but it's nice to see it in a major journal. 

The fact that only a minority of people, even in the hardest hit areas, display antibodies against SARS-CoV-2 has led most planners to assume the pandemic is far from over. In New York City, where just over a fifth of people surveyed had antibodies, the health department concluded that “as this remains below herd immunity thresholds, monitoring, testing, and contact tracing remain essential public health strategies.” “Whatever that number is, we’re nowhere near close to it,” said WHO’s Ryan in late July, referring to the herd immunity threshold.

But memory T cells are known for their ability to affect the clinical severity and susceptibility to future infection, and the T cell studies documenting pre-existing reactivity to SARS-CoV-2 in 20-50% of people suggest that antibodies are not the full story.

“Maybe we were a little naive to take measurements such as serology testing to look at how many people were infected with the virus,” the Karolinska Institute immunologist Marcus Buggert told The BMJ. “Maybe there is more immunity out there.”

 

T-cells and immunity from previous viruses are surely the most plausible explanations for why COVID-19 has infected and killed only a fraction of the number of people predicted in countries that didn't lock down. I'm glad the BMJ is now taking this seriously. It's time for SAGE and the politicians to do likewise.





Thursday, 17 September 2020

The thirdhand smoke grift


More essential public health research from California...

The COVID-19 pandemic has created a number of challenges...

Hasn't it!

...including that many are spending more time at home than ever before. 

Domestic violence, suicide, loneliness, isolation, depression. It is a major problem.

This is a significant problem for those with neighbors who smoke. 

Not so much that, to be honest.

Smoking continues to be a problem in multi-unit housing, and while stay-at-home orders have helped to reduce transmission of COVID-19, they have also increased exposure to secondhand smoke from neighbors. 

It's just one thing after another, isn't it! You think you've dealt with one problem and then a worse problem comes along. Such as, er, wisps of smoke somehow creeping through your walls.

But the problem is more than just secondhand smoke: long after secondhand smoke has cleared, the harmful chemicals in tobacco smoke and e-cigarette vapors remain as thirdhand smoke. The chemicals in thirdhand smoke stick to dust and household surfaces, and can built up over time creating significant reservoirs of thirdhand smoke. 

A nightmare scenario!

Like other household hazards such as lead and allergy-causing dust mites, thirdhand smoke can be incredibly difficult and expensive to completely remove. It can be particularly dangerous for children as they are closer to surfaces where dust gathers such as the floor, they are more likely to put objects or hands in their mouths, and they have weaker immune systems than adults. However, while thirdhand smoke may be difficult to eliminate completely, it is possible to reduce the risk. 

Why do I get the feeling I'm being sold a cleaning product? Is this a press release from Amway?

Potential thirdhand smoke cleaning methods were examined by a group of researchers led by Georg Matt of San Diego State University. The study, "Remediating Thirdhand Smoke Pollution in Multiunit Housing: Temporary Reductions and the Challenges of Persistent Reservoirs," will be published Sept. 15 in the journal Nicotine and Tobacco Research.

Yes, it's Georg Matt, the San Diego psychologist who has been trying to make 'thirdhand smoke' a thing for 16 years. I first wrote about him before I had this blog. How we laughed and yet he's managed to keep this grift going all that time. Last year, he became the director of the Thirdhand Smoke Resource Center, a state-funded (paid for by smokers) organisation that aims to “make the public more aware of thirdhand smoke”.

According to the press release, traces of nicotine that are measured in parts per billion are now "listed by the State of California as a hazardous chemical". What a world.

So what has this esteemed 'public health' researcher been doing during the pandemic?

Households were split into three groups: the first group received dry/damp cleaning (thorough vacuuming and dusting), followed by wet cleaning (professional carpet/furniture steaming and cleaning of all household linens) a month later. The second group received the opposite, and the third group received both cleaning types on the same day.

Nicotine contamination was immediately reduced in all three groups following cleaning. Regardless of cleaning method, nicotine contamination in all homes increased again during the three months following cleaning, showing that the positive effects of cleaning, while significant in some cases, are temporary.

Matt continued, "We would like to be able to tell residents that there is a simple way to remove this contamination permanently, but that is not what we found. What we can say, as a result of this study, is that there are two important steps you can take to reduce thirdhand smoke contamination and make your home safer."

First, keep household dust as low as possible. Frequent vacuuming of all soft furnishings and floors, and dusting/mopping of all hard surfaces, is the easiest, best way to reduce thirdhand smoke exposure through household dust. Second, keep surfaces that you touch often as clean as possible. Frequently wiping table tops, doors, cabinets, and chairs, and washing pillow cases, blankets, and drapery will help keep our families safe from exposure to thirdhand smoke while we are all staying at home more than ever before. 

Terrific stuff. I quite like the idea of the half-witted hypochondriacs of California obsessively scrubbing every surface of their home to get rid of trace levels of chemicals that are even less dangerous than the cleaning products they're using.

Imbeciles.

You can read the 'study' here if you want. I really can't be bothered.

Wednesday, 16 September 2020

Plain packaging for e-cigarettes?!?

The Netherlands is on the brink of introducing plain packaging for e-cigarettes. To my knowledge, the only other country to have gone down that path is Israel. Not many countries have introduced plain packaging for tobacco products, let alone vaping products, because it doesn't work. The Dutch government also plans to ban (non-tobacco) e-cigarette flavours.

This has come about because the political party that came eighth in the last Dutch election managed to seize control of the health department, as I reported in 2018.

To understand the strange death of the liberal Netherlands, you need to look at last year’s election. As often happens under proportional representation, there was no outright winner and a four party coalition was required to govern. This turned into a complex and lengthy process. In the end, the largest party – the People’s Party for Freedom and Democracy – formed a coalition with Democrats 66, Christian Democratic Appeal and the Christian Union.

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

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

The rationale given by the government for putting e-cigs and heated tobacco products in plain packaging is as follows:

The purpose of the draft decision is to create a basis for delegation to set requirements by ministerial regulation for the standard packaging of cigars and electronic vapor goods. In addition, this order will bring the decree into line with the amendments to be made to the law concerning heating appliances and a basis is created for laying down rules by ministerial regulation with regard to the indications on packaging of electronic heating appliances. The actual requirements will be set out in that ministerial regulation. Neutral packaging for cigars and electronic vapor goods and rules for markings on the packaging of tobacco heating appliances limit the attractiveness of smoking materials and raise awareness of the harmfulness of smoking. This protects young people and adults against (nicotine) addiction through the use of these products, with serious consequences for health and a high risk of premature death.

The obvious problem here is that e-cigarettes and non-combustible tobacco products are not 'smoking materials'. They are substitutes for smoking materials which help people stop smoking.

We now have a huge amount of evidence showing that nudging people away from e-cigarettes leads to more cigarette sales. We know that raising the price of vaping products leads to greater sales of cigarettes. We know that taxing e-cigarettes leads to increased rates of youth smoking. And we know that e-cig flavour bans lead to increased cigarette sales, as we have seen in San Francisco and more recently in the whole USA.

If plain packaging for tobacco products and discouraging e-cigarette use was a winning strategy, Australia would be leading the world in smoking cessation. It's had plain packaging since December 2012 and has always had a total ban on the sale of nicotine-containing vape juice. And yet its smoking rate has barely budged in recent years whereas the UK and USA has seen a rapid decline. The chart below shows the annual decline in the smoking rate since 2013.


Putting cigarettes and reduced risk products in the same packaging will send a signal to consumers that there is no benefit from switching. Banning flavours will make vaping less attractive to smokers who might otherwise switch.

The good news is that the Dutch government has put these terrible policies out to public consultation. There have been over 200 responses so far, including various submissions in English.

You can submit your own response here, but be quick. The consultation ends on Friday 18th September.

If you respond, be polite and don't assume that the people who read it will be familiar with the basics of tobacco harm reduction. Quite clearly, they are not.

The text on the website translates as...

Heated tobacco products and standard packaging for e-cigarettes and cigars
Respond to consultation

Below are one or more questions related to the consultation. You can give your response in the space below the question. It is also possible to add a document to your response, for example if you want to include background information. Do not include personal data in your response or the document that you attach to your response.

What is your opinion on the draft regulations?

Click 'Verder' to submit. Tick all the boxes. Use Google Translate if you struggle! Anonymous responses are not accepted.

Tuesday, 15 September 2020

Shameless sockpuppetry in Scotland

Holyrood, a magazine aimed at politicians in Scotland, has recently given us some nice examples of sockpuppetry in action.

On Friday, it published an article by Sheila Duffy calling on the government to further increase the vilification and extortion of smokers.

We need policy decisions that are bold, and we need to ensure that Scottish Government have the tools and power to make those decisions.

Sheila Duffy is the CEO of ASH Scotland, which gets most of its income from the Scottish government. The article was bought and paid for.

Sheila Duffy is the chief executive of ASH Scotland. This feature was sponsored by ASH Scotland.

On Tuesday, Holyrood ran a poorly written article by Alison Douglas calling for the minimum price of alcohol to be raised.

Personal choice versus the nanny state. That’s the way that public health prevention is characterised by opponents. But with one quarter of Scots regularly drinking more than recommended, surely there’s more to it?

Er, no. Not really.

Now is the time for the Scottish Government to review and raise the minimum unit price.

Alison Douglas is the CEO of Alcohol Focus Scotland, which gets most of its income from the Scottish government. The article was bought and paid for.

This piece was sponsored by Alcohol Focus Scotland

This is how the political elite speak to each another. The government gives lobbyists a stack of taxpayers' money which the lobbyists spend on sponsored editorial to call on the government to interfere in the lives of its citizens. If it sounds corrupt, it's because it is.

Incidentally, Douglas writes...

We also need to turn our attention to tackling how heavily marketed and easily available harmful products are. Children have told us they see alcohol all around them, all the time.  It’s time we stopped exposing them to alcohol marketing and protected their right to grow up healthy and happy, free from alcohol harm.

And which children told them that? The children of the Children's Parliament, a Scottish government initiative, paid for by the taxpayer, in which kids as young as nine were handed over to Alcohol Focus Scotland to be brainwashed for a few hours before being filmed for a low quality propaganda video. I wrote about it last September.

Drinking in lockdown - what's the story now?

This month saw the release of alcohol sales figures for the UK during lockdown. They told a dramatic story. In the 17 weeks to 11 July, the number of alcohol units sold fell by a whopping 35%.

The total volume of alcohol sold during lockdown (the 17 weeks to 11 July 2020) fell to 1.3bn litres, down from 2bn the previous year, data from Nielsen Scantrack and the CGA found, despite value sales through the major retailers rising £1.9bn over the same period.

Sales of booze at the supermarket during the four month period hit £7.7bn, it said, however with the on-trade remaining shut, the overall volume of alcohol bought in the UK was far lower than last year, despite the increase in value.

Nielsen’s senior client business partner Gemma Cooper pointed out that around 46% of booze sold in the UK was sold through the on-trade and although spend had undoubtedly shifted to the off-trade, it was not enough to make up for the shortfall.

Note that Nielsen tracks the off-trade and CGA tracks the on-trade, so both bases are covered in these figures, in contrast to the slightly hysterical reports during the lockdown about alcohol sales 'soaring' by 31% (based solely on the off-trade).

You wouldn't guess that the UK had just seen its biggest peacetime decline in alcohol consumption from reading the papers today.


This comes from the Royal College of Psychiatrists who want more funding for alcohol and drug treatment services. They claim that 'Public Health England’s latest data on the indirect effects of Covid-19 found that over 8.4 million people are now drinking at higher risk, up from just 4.8 million in February'.

This statistic has been repeated by the BBC and others, but it doesn't appear in the report published by the RCP today. It looks like something added to spice up the press release. If so, it certainly had the desired effect.

But is it true? The source seems to be this webpage from Public Health England. PHE's data show that the proportion of adults drinking above the guidelines has risen slightly, from 22.7% to 23.5%.



If we exclude the people drinking between 14 and 21 units - a safe level, in practice - the number has risen from 14.5% to 16.4%. There has also been a rise in the heaviest drinkers (50 units or more) from 7.5% to 9.2%, but also in the number of nondrinkers (34.8% to 39.6%).

None of these figures come close to the doubling claimed by the RCP. For that, we need to look at PHE's alternative drinking data which is based on the Alcohol Use Disorders Identification Test (AUDIT), a survey which looks at behaviour and psychology as well as consumption. A score of more than seven classes you as a 'hazardous drinking'.


Here, we can clearly see a near-doubling since February. Numbers tend to be low in February and it would have been better to compare April to June with the same period in 2019, but there is nevertheless an obvious spike in the second quarter of 2020.

If this is the RCP's source - and it makes sense that they would use a psychiatric survey rather than alcohol consumption figures alone - their estimate is about right.

What does this tell us? Firstly, it shows that lockdown was a boring and/or stressful time for many people and that we shouldn't repeat it. 

Secondly, it shows - once again - that the single distribution theory of alcohol use is wrong. According to this theory, also known as the Ledermann hypothesis, there is a distribution of alcohol consumption which moves left or right as a whole. If per capita consumption (which is what the mean average drinker consumes, by definition) increases, the whole curve moves to the right and the number of heavy drinkers at the tail increases and the heaviest drinkers consume even more alcohol. If it moves to the left, everybody drinks less.

Graph taken from here


This theory gives support to the Whole Population Approach which focuses on driving down per capita alcohol consumption by whatever means necessary. The Whole Population Approach was most explicitly outlined by Geoffrey Rose and it underpins the 'public health' lobby's agenda not only with regards to alcohol but also to sugar, salt, blood pressure and many other risk factors. It officially underpins the Scottish government's approach to alcohol.

Put simply, there are two key assumptions:

1. The number of heavy drinkers, and therefore the amount of alcohol-related harm, is directly linked to per capita alcohol consumption. When consumption goes up, harm goes up. When consumption goes down, harm goes down.

2. Per capita alcohol consumption is driven by price, availability and advertising. If prices go up, availability goes down and advertising is restricted, consumption will go down and, as per the assumption above, heavy drinking and alcohol-related harm will decline.

You only have to look at the UK in the last twenty years to see that this theory is wrong. Alcohol consumption has gone down significantly but alcohol-related deaths have stayed at about the same level. (The temperance lobby would also say that alcohol-related hospital admissions have risen sharply, but those figures are worthless.)

The pandemic has given us an exceptional natural experiment. Alcohol advertising, like most advertising, declined during lockdown. Availability declined enormously as ten of thousands of pubs, clubs and restaurants were shut down for three and a half months. Prices stayed much the same (although one could argue that the average price fell as a result of the temporary abolition of the more expensive on-trade).

What was the effect? Per capita consumption did indeed decline (by 35%), but the bell curve did not move as one organism. Some people stopped drinking completely, other people drank less and some people drank more. If the AUDIT survey is any guide, an unprecedented decline in per capita consumption was accompanied by an unprecedented rise in 'hazardous drinking'.

We shall have to wait to see if this led to an increase in actual harm (if it doesn't then perhaps we should reevaluate the definition of hazardous drinking), but things are not looking good for supporters of the Whole Population Approach.

And why would they? The amount of alcohol individuals consume is driven by personal choice and circumstances, not the retail environment. It was ever thus.

Friday, 11 September 2020

Any questions?

I'll be on Any Questions tonight? Brexit and COVID-19 are bound to come up. If you're not watching Watford vs. Middlesbrough down the pub, tune in. Radio 4. 8pm.

Thursday, 10 September 2020

Thank you, unhealthy commodity industries!

Last year, I wrote about SPECTRUM, one of the latest nanny state sockpuppets to be funded by the unwitting taxpayer. Given £5.9 million and a ludicrous acronym (it stands for Shaping Public hEalth poliCies To Reduce ineqUalities and harM - I'm not kidding), SPECTRUM promised to focus on 'the commercial determinants of health and health inequalities, considering alcohol, tobacco and unhealthy food'. It is a crony organisation and its list of 'co-investigators' is a Who's Who of the British 'public health' racket.

There has been a lot of water under the bridge since then. A genuine public health issue has emerged and the 'public health' establishment has been shown to be useless. Public Health England has been closed down but SPECTRUM's work - such as it is - goes on.

Its latest report is titled 'Signalling Virtue, Promoting Harm' and you could not ask for a more perfect illustration of the moral rot at the heart of the modern 'public health' movement. The authors have scoured the world for  examples of 'unhealthy commodity industries' doing good deeds during the pandemic and portray these charitable acts as evil because, er, reasons.

Most of the report could have been written by a PR agency on behalf of the industries involved. The authors simply catalogue donations and assistance from businesses that have made a practical difference to people's lives at a difficult time. They are so deep down the rabbit hole that they assume the reader will disapprove just because the business sells an 'unhealthy commodity' like, er, food or baby milk.

Here's a typical example:

In resource-poor settings, the COVID-19 pandemic provided an opportunity for unhealthy commodity industries to present themselves as providing essential support to underfunded public services. In Guatemala, McDonald’s delivered meals to health staff at a COVID-19 hospital, while Am Bev made a sizeable donation towards hospital equipment. The local distributor of PepsiCo –cbc– donated facemasks to Guatemalan customs officials and police. 

The swine!

If the report serves any useful purpose, it is to inform people about how much charitable work businesses have been doing during the pandemic. I didn't realise there was so much of it. For example...

AB InBev have committed to distribute 1.4 million litres of potable water to 240,000 people in São Paulo and Rio de Janeiro communities, as part of its ‘COVID-19 response for the people of Brazil’.

In Bolivia, the Coca-Cola Foundation donated $299,153 via UNDP to provide assistance to healthcare workers and vulnerable populations.

As part of its Give Meals, Give Hope project PepsiCo India and the PepsiCo Foundation have supported the WHO Collaborating Centre Foundation for innovative New Diagnostics (FIND) to procure and distribute 25,000 COVID-19 test kits in coordination with the Ministry of Health and Family Welfare.


They even give examples of medical staff explicitly thanking companies for their donations, but still we are supposed to disapprove.

Heineken Russia donated meals together with its energy drink – Solar Power – for doctors and nurses on night shift, while Red Bull Australia were thanked on social media by Lifeline Adelaide for the ‘surprise delivery [of energy drinks] to help keep our Crisis Supporters energised as they answer calls for support’.

The international donut company Krispy Kreme similarly leveraged COVID-19 in a marketing campaign purportedly ‘serving smiles’ by offering free donuts to healthcare and other frontline workers in New Zealand, the US and the UK. Staff at the Royal Free Hospital in London posted a thank you message on social media to which Krispy Kreme responded, citing #NHSheroes and suggesting the brand was responsible for #creatingsmiles and #servingsmiles. 


 
While those on the front line were happy to get a free donut, the zealots behind this report - most of whom are comfortably tenured at Edinburgh University - know better.

The leading transnational tobacco company Philip Morris International (PMI) donated 50 ventilators through its Greek subsidiary, Papastatos, to Intensive Care Units in Greece. Despite strong criticism of this “shameful publicity stunt”, the Health Minister Vassilis Kikilias thanked Papastratos for “its significant contribution to strengthening the national health system”. This attempt by PMI to subvert Article 5.3 of the FCTC, which requires Parties to denormalise tobacco industry philanthropy, is also evident in Germany where the Berlin Senate Department for Health accepted an offer to use the Philip Morris GmbH Neukölln production site as a temporary distribution and logistics center for PPE.

Good on them. It seems that SPECTRUM would rather COVID-19 victims went without ventilators than have them supplied by businesses of whom they disapprove. When dogma conflicts with saving lives, the 'public health' racket is always happy to side with the virus. (Incidentally, Article 5.3 does not say what the authors claim it says.)

At least cigarettes are a genuinely 'unhealthy commodity'. The same cannot be said of some of the authors' other targets.

Kraft Heinz Canada is similarly promoting its partnership with Food Banks Canada, via which it is reportedly providing 1 million meals to Canadians in need. This collaboration centres on Kraft Heinz Project Pantry, with the accompanying twitter campaign indicating that such meals include ultra-processed products such as Kraft Dinner macaroni cheese and peanut butter.

Oh God! Not macaroni cheese and peanut butter. Anything but that!

In similar vein, the distributors of Indomie Instant Noodles, Tolaram Group donated GHS1 million and a package of their products to the COVID-19 National Trust Fun, with their products being directed to vulnerable households during lockdown in support of the government’s food assistance program.

Noodles! The world's biggest killer!

As part of its Give Meals, Give Hope project PepsiCo India and the PepsiCo Foundation have supported the WHO Collaborating Centre Foundation for innovative New Diagnostics (FIND) to procure and distribute 25,000 COVID-19 test kits in coordination with the Ministry of Health and Family Welfare. A press release from FIND welcomed this initiative from PepsiCo India “to support the scale up of India’s COVID-19 testing capacity” with the Head of Country Operations, Sanjay Sarin, describing the initiative as “critical” to scale up COVID-19 testing capacity. In Paraguay, Coca Cola donated personal protective equipment to the National Institute of Respiratory Diseases, including 22,000 surgical masks, 5,000 N95 respirators, and 2,000 surgical gowns. The Ministry of Health described Coca Cola Paraguay as having a “desire to contribute to the strengthening of the health system and support the efforts of the National Government”. In Colombia, AB InBev have donated 30,000 protective face shields using recycled PET bottles, and South African Breweries (SAB) claims to have donated 100,000 face shields made from recycled beer crates to a sub-national health department.

While reading this stuff, you have keep reminding yourself that the authors think it is bad. Why do they think this?

The seemingly philanthropic work of alcohol companies in providing financial support and PPE to the hospitality sector is better viewed as lobbying and advocacy...

But it isn't though, is it? This is the Humpty Dumpty school of academia ("When I use a word, it means just what I choose it to mean").

This pattern of strategic consistency by unhealthy commodity industries in utilising the context of COVID-19 to advance long established goals, signalling virtue by visibly contributing to relief efforts while continuing to promote products and practices that harm health and fuel the NCD epidemic, is echoed in reports into corporate behaviours across other sectors.

Virtue signalling is expressing empathy and concern without doing anything about it. This is the opposite. Almost everything listed in the report - and I have quoted only a fraction of it - involved businesses bearing a cost and providing a tangible benefit. Whether they converted their factories to making hand sanitiser or made donations to hospitals or provided ventilators and PPE, they made a valuable contribution. Some of it undoubtedly saved lives.

And what contribution has the alleged public health organisation SPECTRUM made? None whatsoever, although it has wangled another £500,000 to do research on COVID-19 and the licensed trade (spoiler alert: it will conclude that closing pubs and nightclubs was a jolly good thing).

"What did you do when you worked in public health during the pandemic, mummy?"

"I wrote a crummy report criticising businesses for donating money and hospital equipment, son."

To state the obvious, taxpayers should not be paying for any of this garbage.

Friday, 4 September 2020

The many failings of 'public health' in the Covid era


I've written a report for the IEA looking back on all the failings of Public Health England and the World Health Organisation since COVID-19 emerged. You Had One Job identifies four or five key failings by each agency and offers some proposals for reform. One of them - closing down PHE - was announced while the report was being edited last month. I discuss what to do with the WHO in this article for Cap-X.

You can download the full report for free here.

I've also written about where 'public health' went wrong for Spiked today. One of the problems is that agencies like PHE and WHO don't believe they have one job. They want to get involved in everything.

We could tolerate ‘public health’ professionals banging on about complex socio-economic problems beyond their ken if they could do their day job. Covid-19 showed that they can’t. The WHO was a hapless dupe of the Chinese Communist Party in the crucial early stages, while Public Health England was just hapless. Like the broader ‘public health’ movement, these agencies had taken their eye off infectious diseases in favour of becoming glorified political campaigners. Endless conferences, studies, targets and position statements on everything from computer games to climate change were no use when push came to shove. 

Do read it all.

Thursday, 3 September 2020

The drinking guidelines fix is in

More drinking guideline news. In December, I reported that Australia's National Health and Medical Research Council had recruited none other than the Sheffield Alcohol Research Group to 'model' the risks and benefits of drinking at different levels. 
 

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.


Sure enough, the Sheffield crew cut and pasted the model they'd used after Public Health England paid them to make changes that they admitted had no scientific justification. These changes made moderate drinking look less beneficial to health than it is and supported the guidelines being dropped for men. The Aussies are set to do the same, having only last reduced the guidelines in 2009. 

As Joe Aston reports in Financial Review, we now know that the Sheffield team were commissioned without the contract being put out to tender and that the NHMRC broke the budget to pay them $269,010 for their troubles. 
 
Nice work if you can get it, especially when most academics would never work again if they had Sheffield's track record.
 
Meanwhile, anti-alcohol academics in the USA are in process of trying to get the guidelines for men halved, from two 'standard drinks' a day to one. This time the main player is Timothy Naimi who has worked with the notorious Tim Stockwell on a number of studies trying to downplay the benefits of moderate drinking. Naimi is the only academic on the panel with a track record of alcohol research and the Advisory Committee's draft report places heavy emphasis on a handful of studies that cast doubt on the benefits of moderate consumption.

In the USA, the tactic seems to be to focus on the optimal level of drinking rather than the safe level. This would be a profound and illogical shift away from how governments set guidelines for food and drink around the world, as I explain in the Washington Examiner:
 

Although the report acknowledges that men who consume two drinks a day tend to live longer than those who don’t drink at all, the authors say that there are even greater health benefits for men who consume one drink a day or less. The implication is that the guideline should be dropped to one drink a day.

The evidence for this is far from solid, but even if it were proven that one drink is better than two, it would point to an optimal level of drinking, rather simply a safe one. It would also require the government to tell non-drinkers to become light drinkers. And yet the committee argues quite vehemently that alcohol is inherently dangerous, and the U.S. will maintain its advice that those who do not drink alcohol should not begin to drink for any reason.

Convention and common-sense dictate that it is “safe” to drink alcohol at a level that does not increase mortality compared to not drinking alcohol at all. This is how alcohol guidelines have been set around the world for decades.

Safe levels of moderate alcohol consumption, consistent with the current U.S. definition, have been repeatedly confirmed by a wealth of epidemiological evidence. There is no scientific reason to change the U.S. guidelines. The proposal to do so is based on dogma, nothing more.




Friday, 28 August 2020

Last Orders with Rob Lyons

The new Last Orders episode is out, featuring me, Tom Slater and Roby Lyons. This month it's a special 'Everything's Coming Up Snowdon' edition in which we only discuss good news: Public Health England, Turkey Twizzlers, the end of prohibition in South Africa and the success of Sweden. 

Listen here.



Friday, 21 August 2020

Meaningless graphics

 

Last year I started curating a Twitter thread of meaningless, stupid and pointless graphics, mostly Powerpoint slides from 'public health' conferences. The thread has become difficult to follow so I'm putting them all here and will add to them from time to time.

Thanks to everyone who has submitted entries. Keep them coming.  

1. The umbrella of health (from the EAT-Lancet commission)

2. The Doughnut (plus added random statistics at the bottom). I am told that this graphic is highly revered in some circles. 

3. The Bicycle of Education

4. With great power comes 97% responsibility.

5. The Non-Communicable Disease Policy Cube

6. The Bicycle of Disease Prevention

7. Another one from EAT-Lancet. You could stare at this from now until the end of time and be none the wiser.

8. A simple guide to COVID-19 from Danny Dorling

9. The Sisyphus of Something

10. Food, brain, stomach.

11. God knows.

12. Evidences based research, medias and economical interest. This is from the World Health Organisation.

13. Obesity simplified.

14. Perhaps you had to be there.

15. Should have been bullet points.

 

16. Everything but the kitchen sink.

 

17. Something to do with industry being connected to policy makers.

18. Muh capitalism.

 

19. Muh corporations.

 20. The Eye of Possitopianism.

21. The teepee of innovation.

22. Formula for peaceful societies revealed.


23. Feeling sleepy.




Wednesday, 19 August 2020

RIP Public Health England. Where next for 'public health'?

You may probably heard the news that Public Health England is to be closed down. As you can imagine, I nearly died laughing. It is a rare example of the government acting on a recommendation from an IEA report before the report has been published (coming in September).

But what now? What comes next?

I offer a roadmap in this article for the Spectator.

In his farewell email to staff, PHE’s chief exec Duncan Selbie wrote that the ‘obvious next priority is to secure the right and best future for all those other responsibilities of PHE that are not about health protection’. PHE’s empire building created many well remunerated jobs. Those who are on the low-fat gravy train will be understandably reluctant to get off and will be lobbying hard for a new agency that is Public Health England in all but name. Having set up the National Institute for Health Protection, the government may be tempted to set up a twin organisation, perhaps called the National Institute for Health Improvement (although Nanny State England has more of a ring to it).

Politicians love creating new bureaucracies, but they should resist the urge.

 


Sunday, 16 August 2020

Political pygmies

The Scottish government is banning music in pubs on the flimsy grounds that people might raise their voice and spread the coronavirus. It is the latest in a series of petty measures from pygmy politicians. I discuss some other articles in this article for the Telegraph

 

None of these policies, not the ban on smoking outdoors, nor the ban on the sale of e-cigarettes, nor the restrictions on food sales, will have the slightest impact on Covid-19 (except, perhaps, negatively). The only thing they have in common is that political pygmies have always quite liked the sound of them.

Faced with a serious public health problem, unserious people have retreated to their comfort zone of trivial lifestyle regulation. They cannot change the record. They were not made for these times.

 

I also discuss a recent study that claimed vaping greatly increases the risk of contracting the virus.

 

Written by three Californian academics, one of whom is the founder and director of an anti-vaping organisation, the study produced the unlikely finding that e-cigarette users are five times more likely to test positive for Covid-19. There is, to put it mildly, no obvious biological mechanism for this and the explanations offered by the researchers were risible.

They suggested that vapers were at greater risk of contracting Covid-19 because they touch their mouth and face more (they don’t), or because vaping causes the same damage to lungs as smoking (it doesn’t), or because vapers share devices with one another (even the authors admit that this was unlikely to happen much under lockdown).

The study’s methodology left a lot to be desired. It was based entirely on an anonymous online survey of 13 to 24 year olds. None of the information could be verified and we do not know how the respondents were recruited. The number of self-reported vapers who self-reported a positive Covid-19 test was so small (50) that it would have been easy for anti-vaping activists to game the system with fake responses.

Moreover, the association between vaping and Covid-19 only existed for people who had used an e-cigarette in the past. Inexplicably, there was no such association for people who had used an e-cigarette in the past 30 days (nor, indeed, for people who smoked).


Do read it all.



Saturday, 8 August 2020

Smoking and COVID-19 - the evidence gets stronger

I've found it impossible to keep up with all the research on smoking and COVID-19 recently. The tireless @phil_w888 has now catalogued over 700 studies of COVID-19 patients that have data on smoking prevalence. 

In the last week, the largest observational study yet conducted found that smokers (in Mexico) were 23 per cent less likely to test positive for COVID-19. This is in line with the results of an ongoing meta-analysis by some researchers who would clearly prefer the hypothesis to be disproved but who nevertheless have found a 26 per cent reduction in infection risk for current smokers. 

A study published in the Lancet a couple of weeks ago looked at the factors associated with COVID-19 caseloads at the national level. It found that countries with higher rates of smoking tended to have lower rates of Covid infection.

And a newly published prospective study of nearly 20,000 Covid cases tells a familiar story. Your chances of ending up in intensive care with the virus are increased if you are male, non-white, from a low income area, obese ... or a nonsmoker. 

Note the telltale dose-response relationship. The heaviest smokers are an incredible 88 per cent less likely to end up in ICU with COVID-19.

The same rules apply to your chances of testing positive for COVID-19. Indeed, it seems increasingly clear that smokers are less likely to end up in intensive care with COVID-19 because they are less likely to catch it in the first place.

Factors such as obesity, deprivation and being BAME are now universally acknowledged as risks for COVID-19. The UK government, in particular, has gone to town on the obesity finding. 

The smoking finding, by contrast, continues to be ignored, although the evidence for a protective effect is about as a strong as the evidence for obesity being a risk factor. 

And yet the association with smoking is not even mentioned in the abstract of the latest study (above), nor is it mentioned in the abstract of the Lancet study. The authors of the latter describe it as an 'unexpected finding' which 'requires further investigation'. The authors of the other study describe it as a 'counterintuitive finding' , although they do acknowledge that it is 'consistent with very low rates of smoking seen in patients presenting with COVID-19 in Wuhan and similar data from the USA and with the findings of a more limited analysis of patients with COVID-19 in France.

They also propose several possible causal mechanisms: 

This may reflect a general immunomodulatory effect, a mechanism that is thought to explain the lower incidence of sarcoidosis, extrinsic allergic alveolitis and ulcerative colitis in current smokers. Alternatively, smoking may cause increased ACE2 mRNA expression in human lung much as ACE inhibitors or ARBs are believed to, suggesting a possible common protective mechanism for severe COVID-19 disease. Additional possible mechanisms include a direct protective effect of nicotinic receptor stimulation or an association of smoking with another protective factor. This finding arose when including smoking status as a confounder and should be interpreted cautiously. Further studies are required to verify the apparent protective association, determine whether it is independent of other risk factors, and investigate potential mechanisms. 

The 'public health' lobby has done a good job of ignoring these findings so far, but how long can it continue? With the world economy crippled by lockdowns and social distancing - not to mention the human cost of the virus - is it ethical for them to overlook a possible solution? That solution may not involve smoking per se. It is likely to merely involve harmless nicotine. 

These findings get stronger by the day and are extremely interesting, and yet I do not see much interest in them from the people who are supposed to be protecting our health. It could be a fatal oversight.

 

UPDATE

Imperial College's antibody testing study arrived at a familiar finding:


Those who were overweight or obese had higher prevalence than those with normal weight, and current smokers had a lower prevalence than non-smokers (3.2% vs. 5.2%(OR 0.64 [0.58,0.71])

That's a 36% lower risk.


Monday, 3 August 2020

Remain (Inside) vs. Leave (the House) - the faultline in British politics

It's not a novel observation to say that the debate about lockdown measures is a rerun of Brexi, with the same people lining up on each side. But why should that be? In this article for the Telegraph, I throw a few theories around...

On the face of it, the two issues have nothing in common. It may be that Brexiteers are less risk averse. No Deal Brexiteers, in particular, embrace risk almost by definition. Remainers, by contrast, feel safer with the status quo, and once lockdown became the status quo, any loosening of it felt like a risk.

Or it could be about settling old scores. Some pro-lockdown campaigners are more or less explicitly anti-Tory activists who oppose any relaxation so they can say ‘I told you so’ in the future when there is a second wave of (hello, ‘Independent SAGE’).

Others are still smarting from the referendum. I swear there are political journalists in this country who will go to their graves convinced that the biggest news story of 2020 was Dominic Cummings driving to Barnard Castle. It is difficult to imagine them getting quite so upset about a special adviser possibly committing a minor breach of a regulation if he had not run the Leave campaign. 

Similarly, it is hard to imagine Sir Ed Davey reporting someone to the police for going to the pub two weeks after travelling to America - and therefore possibly not having quite done the full fourteen day quarantine - if his name wasn’t Nigel Farage (or as Carole Cadwalladr dubbed him, in typically understated fashion, ‘Typhoid Nigel’). Farage’s response was to tell Davey, not unreasonably, to ‘get a life.’


Do read it all.


Saturday, 1 August 2020

Alcohol doesn't cause cancer?

There was much excitement in 'public health' circles last year when a study failed to find an association between moderate drinking and lower rates of heart disease. The study used conventional epidemiology and Mendelian Randomisation (MR) to look at a Chinese population in which a gene that is associated with alcohol avoidance is relatively common (it is very uncommon in the West). The authors found a protective effect for heart disease when they used epidemiology but not when they used MR. It was not the first MR study to come to this conclusion.

MR studies featured prominently in the Sheffield Alcohol Research Group's report for the Australian government last year (Australia has since lowered its drinking guidelines). They also feature prominently in the US Dietary Guideline Advisory Committee's report (the US is also pondering a lowering of the guidelines). You can see the appeal to the anti-alcohol lobby.

The hype around MR studies says that they are 'nature's RCTs' and can prove causation. Neither of these claims is true, at least as far as identifying behavioural risk factors is concerned. Observational epidemiology is far from perfect but MR studies have enormous problems of their own. Self-reported alcohol consumption data might not always entirely reliable, but MR often does not involve alcohol consumption being reported at all. It is merely assumed that people with certain genes will drink less than other people.

But just as someone whose genes make them more likely to smoke is not necessarily a smoker, someone who has genes that make them more prone to alcohol avoidance is not necessarily a non-drinker (or even a light drinker). A few genes have been identified, particularly in Asian populations, which make people react badly with alcohol, but this is no guarantee that they will not drink heavily. In situations and cultures in which drinking is expected - networking among Japanese businessmen, for example - any genetic predisposition towards light drinking or teetotallism may soon evaporate.

In a commentary in the European Journal of Epidemiology, Kenneth Mukamal and colleagues argue that MR “is subject to all of the limitations of instrumental variable analysis and to several limitations specific to its genetic underpinnings, including confounding, weak instrument bias, pleiotropy, adaptation, and failure of replication.” MR studies on alcohol consumption and cardiovascular disease, they write, “demonstrate that it must be treated with all of the circumspection that should accompany all forms of observational epidemiology”.

Two new MR studies were published recently, neither of which attracted much attention. In June, an MR study published in Cancer Genetics found no association between inferred alcohol consumption and breast cancer. It also found no association with ovarian cancer.

And then last week, an MR study published in PLOS Medicine failed to find an association between inferred alcohol consumption and any form of cancer except - using one of the two databases - lung cancer.

The PLOS study is particularly interesting because it also looks at smokers - or, more accurately, people with a genetic predisposition to smoking. If it hadn't found an association with lung cancer, it would have raised serious questions about MR's credibility in this area. Fortunately it did, but it only found a doubling in risk, whereas epidemiological studies suggest that risk increases by anything from five to fifty-fold depending on smoking intensity. The study also found associations with several other cancers, but the risk ratios were quite low. For most of the cancers studies, there was no statistically significant association.


The results for inferred smoking therefore point broadly in the right direction, but it seems that the risk has to be rather large for MR to show a statistically significant result.

The results for alcohol, however, would require the textbooks to be rewritten if they were true. The epidemiological evidence linking alcohol to several forms of cancer is nearly as strong as the evidence linking moderate drinking to lower rates of heart disease. Lung cancer isn't one of them, but that is the only cancer with which the MR study found a statistically significant elevation in risk, albeit in only one or the two datasets used.


What are we to conclude? That MR has 'proven' that moderate drinking does not reduce heart disease risk, but that drinking in general does not increase cancer risk? Or that MR studies are too crude to find the kind of associations identified by observational epidemiology - including the link with breast cancer which is the basis of the 'no safe level' meme?

If we are to allow MR studies to override epidemiological findings about alcohol, several babies will have to be thrown out with the bathwater.