Thursday 30 April 2020

The NHS blame game

On Monday, the BBC's Panorama attacked the government for failing to provide NHS workers with enough personal protective equipment. Perhaps the government has as a case to answer, but Panorama didn't produce evidence that it does. The shortcomings it identified involved the NHS and Public Health England, but apparently these organisations can never fail the public. They can only be failed by the government.

I've written about this for the IEA blog:

One of the programme’s main allegations was that “the government” took COVID-19 off the list of High Consequence Infectious Diseases (HCID) in March 2020, thereby allowing “the government” to weaken the guidelines on PPE use. This, it suggested, was because “the government” had failed to buy enough PPE to go round.

But the decision to take COVID-19 off the HCID list was not made by politicians. It was made by Public Health England and their equivalents in the rest of the UK, with the Advisory Committee on Dangerous Pathogens in agreement. The guidelines on PPE use by health workers may have been “weakened”, but the guidelines are set by Public Health England, not politicians. And the procurement of face masks, gloves and gowns is not the personal responsibility of Boris Johnson or Matt Hancock, but of officials in the NHS and Public Health England.

Far be it for me to defend the government, but in the absence of any evidence that politicians actively discouraged stockpiling of PPE, it seems to me that at least some of the blame for the shortage should be laid at the door of the people working in procurement at multi-billion pound organisations who are specifically tasked with stockpiling it. But no, let’s just blame “the government”.

Do read it all.

Wednesday 29 April 2020

Furlough political journalists

These are difficult times for political journalists. The days are moving slowly and there is hardly any news. A strategy was laid out publicly by scientists six weeks ago and, rightly or wrongly, the government has been following it ever since. The only things to report are the daily death tolls and the comments made at the daily briefings.

There isn't much Westminster gossip and there have been no scandals. This is a problem for political journalists. How can you report the twists and turns of a fast-moving situation when life is moving slowly?

One option is to manufacture something out of nothing. The story behind the front page of today's Telegraph provides a nice case study in fake news.

The headline claim is that the government has quietly watered down one of its five tests for coming out of lockdown.

The first four have either been met or are close to being met. The fifth hurdle, which ministers have always said is the most important, was described on official Government documents on Monday as a confidence that “any adjustments to the current measures will not risk a second peak of infections”.

On Tuesday the wording was changed to say the aim was to avoid a second peak “that overwhelms the NHS” - making it easier for ministers to say the test has been met.

The allegation is that the fifth test previously said that the government must be...

Confident that any adjustment to current measures will not risk a second peak of infections.

But that it now says that the government must be...

Confident that any adjustment to current measures will not risk a second peak of infections that will overwhelm the NHS.

The story appears to have come from a tweet from the Daily Mail's political editor last night:

This got a thousand retweets in no time and quickly became a Daily Mail article:

Is the government preparing to ditch lockdown? Ministers are accused of watering down 'five tests' for easing curbs as wording of key slide subtly changes overnight

Within a matter of minutes, the Mirror had copied the story:

Coronavirus: Number 10 denies quietly relaxing 5 tests for easing lockdown

Number 10 has denied quietly relaxing the five tests it has to meet before relaxing coronavirus lockdown measures.

The fifth of the five rules originally stated the lockdown could only be eased if the government can be “confident that any adjustments to the current measures will not risk a second peak of infections”.

But in a graphic newly produced for today’s daily coronavirus briefing, the wording had been changed.

It now reads: “Confident that any adjustments to the current measures will not risk a second peak of infections that overwhelms the NHS.”

It is simply not true that the fifth test 'originally stated the lockdown could only be eased if the government can be “confident that any adjustments to the current measures will not risk a second peak of infections”'.

The five tests were widely reported by the media when they were announced by Dominic Raab on April 16th. A simple Google search shows that nothing has changed. Here is Reuters on April 16th, for example:

'...we must be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelms the NHS.'

Exactly the same wording was quoted by the New York Times, the Guardian and the, er, Telegraph. Alok Sharma used almost identical wording in the press conference on April 17th.

"We need to be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelm the NHS."

On the Conservative Party website, the fifth test says:

We need to be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelm the NHS.

As it happens, I was looking at the five tests last week and used the Conservative Party website as my source. I remember the wording and know that it has not changed. The Wayback Machine confirms that it was exactly the same on 24th April.

Any of this can be checked in a matter of seconds. Today's story, such as it is, is based on slides presented at the daily briefings. On Tuesday, the slide included the reference to the NHS. The slide on Monday didn't.

If you look at the slides, you can see that there are several other changes which I have underlined in red. These have attracted no comment.

The bullet points in Monday's slide were slightly more succinct than those on Tuesday's. Tuesday's had a bit more detail, but all of the 'added' details were in five tests as originally announced.

There has been no change to any of the tests since they were first announced, but that hasn't stopped other newspapers spreading this obviously fake news.

Perhaps it's time to furlough political journalists, put them in self-isolation and bring them back when we're ready to start worrying about the Brexit 'drama' again?

Tuesday 28 April 2020

Behavioural economist of the week

According to behavioural economists, behavioural economists have special insights into how fallible human beings actually behave in the real world. This sets them apart from mere normal economists who make flawed predictions based on unrealistic assumptions about rationality and self-interest.

Because behavioural economists are so terrific, they are able to come up with policies that avoid unintended consequences and encourage optimal decision making.

Take, for example, Professor Eyal Winter, a behavioural economist and government advisor...

Pubs could limit Brits to three pints when the lockdown is lifted, a Government adviser has suggested.

Professor Eyal Winter suggested Brits were "starving" for pubs, and the Government would bring in a drink limit to help them stay safe.

... He suggested landlords could ration how much beer they serve to two or three pints. Customers would then be politely told to go home.

I am not a behavioural economist but I humbly suggest that landlords who have been brought to the brink of bankruptcy by having to shut their pubs for months will be in no mood to turn away punters just as they are getting going.

I further suggest that anyone who wants a fourth pint will head to the next pub and continue drinking.

Finally, I contend that forcing people go on a pub crawl when they were perfectly happy staying in their local will help, rather than hinder, the transmission of contagious disease.

Thank you for coming to my TED talk.

Pretend public health conference postponed due to real public health problem

The World Health Organisation's big, biennial anti-nicotine conference has a habit of being disrupted by genuine public health crises. In 2014, its secretive Framework Convention on Tobacco Control Conference of the Parties in Moscow started in the week that Ebola became a major epidemic. When they took the roadshow to New Delhi in 2016, the city was blighted by such heavy pollution that Britain's anti-smoking queen Deborah Arnott had a cough for weeks.

2018's conference in Geneva managed to avoid a plague of locusts, but the curse has returned this year...

In light of the COVID-19 global pandemic and its impact on the conduct of international global conferences and travel, the Bureaus elected by COP8 and MOP1, after consulting the host country, have decided that convening the Ninth Session of the Conference of the Parties to the WHO FCTC (COP9) and the Second Session of the Meeting of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products (MOP2), scheduled for November 2020, is no longer possible.

As a result, the Bureaus, in consultation with the host country and the Secretariat, decided during their Third Joint Meeting on 21 April 2020 to postpone the sessions of COP9 and MOP2 to the following dates:

COP9: 8–13 November 2021
MOP2: 15–17 November 2021.

The meetings will convene on those dates in The Hague, Netherlands. 

As these prohibitionist jamborees are mostly paid for by the British taxpayer, perhaps we will get a rebate this year?

There isn't much to add to Dick Puddlecote's analysis so go read that.

Monday 27 April 2020

What does the law say you can do under lockdown?

After five weeks, there is growing evidence of the lockdown being ignored. The recent sunny weather has no doubt played a part. Combined with a certain degree of lockdown fatigue and the reasonable assumption than the number of infections has been dropping, the last days of the full lockdown are likely to see less compliance than the first.

There is still some confusion about what is permissible. We have become used to seeing photos of seemingly over-zealous police officers hassling people on park benches, sunbathing or walking in the countryside. Are they enforcing the law as written or are they overstepping it?

In England, the legal basis for restricting people’s movement under the lockdown does not come from the Coronavirus Act, which was passed on 25 March, but from the Health Protection (Coronavirus, Restrictions) (England) Regulations which were brought into force the following day under the Public Health (Control of Disease) Act (1984).

The principal stipulation is that ‘no person may leave the place where they are living without reasonable excuse.’* The only 'reasonable excuses' explicitly mentioned in the regulations are:

  • Obtaining ‘basic necessities’, i.e. ‘food and medical supplies’ and ‘supplies for the essential upkeep, maintenance and functioning of the household’ (ibid.: 4).
  • Taking exercise alone or with members of the household (ibid.).
  • Seeking medical assistance.
  • Providing care or assistance.
  • Donating blood.
  • Travelling to work when ‘it is not reasonably possible’ to work from home.
  • Attending funerals.
  • Fulfilling a legal obligation, e.g. attending court.
  • Accessing critical public services.
  • Moving house ‘where reasonably necessary’.
  • Continuing existing arrangements between parents to access children.
  • Avoiding injury, illness or risk of harm.

The regulations also state that ‘no person may participate in a gathering in a public place of more than two people’ unless they are from the same household, except when:

  • attending a funeral.
  • it is essential for work purposes.
  • it is necessary to ‘facilitate a house move’.
  • providing care or assistance to a vulnerable person.
  • providing emergency assistance.
  • taking part in legal proceedings.

Breaching any of these rules can incur a fine of £60 which doubles for a second offence and doubles again for any subsequent offences up to a limit of £960.

The number of permissible activities is therefore very limited and the police have considerable latitude. There have been several instances of police officers going beyond the law, but in most cases, they have been enforcing laws that are unambiguously draconian.

In response to public concern and confusion, the Crown Prosecution Service has issued guidelines on what constitutes a reasonable excuse to leave the house. They do not supersede the legislation, but they do suggest that you won’t be prosecuted for taking a breather on a park bench in the middle of a long walk or driving a short distance to take exercise. Interestingly, the CPS has interpreted the rule that allows people to move house to mean that ‘individuals can move between households’, e.g. stay at a friend’s house, so long as they stay for days rather than hours. It is difficult to believe that this is quite what the legislators had in mind. 

Nevertheless, the current regulations are the most severe restrictions on the movement of individuals in modern British history. By law, they must be reviewed every 21 days, with the first review carried out on 16 April 2020.

We should not forget that the sole justification given by Boris Johnson for the lockdown when he announced it on television on 23 March was to prevent NHS services being overwhelmed by COVID-19 patients. There was no suggestion that the lockdown should remain in place until the virus was stamped out entirely, nor until other countries had eradicated it, nor until a vaccine had become available. Those who are concerned about the loss of civil liberties should be wary of any attempt to move the goalposts.

Eamonn Butler has some further thoughts.

* The law was amended on 22 April to say 'no person may leave or be outside of the place where they are living without reasonable excuse'. Visiting a 'a burial ground or garden of remembrance, to pay respects to a member of the person’s household, a family member or friend' was added to the list of reasonable excuses, as was obtaining or depositing money from banks, building societies, ATMs, etc.

Last Orders: lockdown edition

There's a new episode of the Last Orders podcast out. Our guest this month is Toby Young, who has set up Lockdown Sceptics. He explains why he wants the UK lockdown lifted sooner rather than later. We also discuss whether the WHO should be defunded and whether nicotine can help in the fight against COVID-19.

Listen here.

Saturday 25 April 2020

Live football in a plague year

The (genuine) magic of the Nicaraguan Premier League

Only a handful of the world's football leagues are still playing games. I've been expecting Sky Sports to snap up the TV rights for them, but they haven't. Perhaps they expect the likes of Belarus to announce a lockdown any day, but this doesn't look like happening. Belarus has been recording a death toll from COVID-19 that you can count on one hand for weeks now. Nicaragua and its surrounding countries seem to have been largely unscathed. Taiwan has weathered the storm and Tajikstan has claimed, albeit dubiously, to have had no deaths at all.

These are the countries you will have to take an interest in if you want to watch any live football in the foreseeable future, and it's not such a bad deal. The Belarusian Football Federation has spaced out its games on Saturday so you can watch three in a row and they have a high quality YouTube feed for them. The Taiwanese league also has a reliable YouTube feed and you can watch any of the games live at 9am every Sunday with English commentary. I can't comment on Tajikstan and Turkmenistan's leagues because I haven't tried to watch them. I'm not even sure it is possible to watch them, but they play their games at lunchtime (UK time) on Saturdays and Sundays.

The Taiwanese league kicked off last week with cardboard cut-outs replacing fans, and the Belarusian league is in its early days, with only six match days so far. The standard is fair to middling, but competitive. There is a certain bleakness to Belarus at the best of times and the matches are more thinly attended than usual, for obvious reasons, but if you like football, this is the kind of thing you'll like. It certainly beats the try-hard banter of Lineker, Wrighty and Shearer on what's left of Match of the Day.

In my limited experience, there are not too many upsets in the Belarus league. Vitebsk won at 4/1 last week, but they needed a penalty against nine men to do it. At 6/1, fourth placed Gorodeya look good value to beat tenth placed BATE today. In tomorrow's game, top placed Slutsk are cleary favourites to beat bottom placed Belshina.

The Nicaraguan league is the pick of the bunch for me. The government's response to coronavirus has been almost unbelievable, but the virus doesn't seem to have taken hold and the season is almost at an end. The stadiums are mostly sub-Conference level, but the standard is better than that implies and some of the scenery is fantastic. The punters are still showing up and making some noise.

The format is unusual, to say the least. There are ten teams in the top division and they effectively play two seasons a year: the Apertura and the Clausura. Teams that finish in the top two are guaranteed a place in the playoff semi-finals against whoever wins from a playoff between the teams that finish third, fourth, fifth and sixth. This means that the team that finishes sixth out of ten can still win the league.

That won't be happening in the Clausura this year, because the fifth and sixth placed teams got beat in the first round of play-offs on Wednesday. Tonight, top placed Manugua FC will be playing CD Walter Ferretti while second placed Real Esteli will be playing Diriangen. The matches are available on Betfair, Bet365 and (I presume) some other betting platforms. The live stream was pretty good last week. You have to have an account to watch it and I'm not sure if you have to have a bet on the game, but I would advise doing so anyway to make it more interesting. The downside is that the games, which are normally on at 10pm UK time, are on at 2am this weekend. If you are still up then, Real Esteli v Diriangen is the one to watch.


Belarus Premier League

1pm: Slavia v Minsk
3pm: Gorodeya v BATE
5pm: Dinamo Brest v Shakhtyor

Nicaraguan play-off semi-finals

2am: Manugua FC v CD Walter Ferretti
2am: Real Esteli v Diriangen

Taiwan Premier League

9am: Taichung Futuro v Tatung
9am: Tainan City v Taipei Red Lions
9am: Ming Chuan University v Taipower
9am: Hang Yuen v NTUPES

Belarus Premier League

12pm: Slutsk v Belshina
2pm: Torpedo BelAZ v Ruh Brest
4pm: Isloch v Vitebsk

Friday 24 April 2020

Two more studies show smokers at less risk from COVID-19

Some researchers in London have looked at the evidence on COVID-19 and smoking and created a rapid evidence review. They do a better job than Stanton Glantz did last week, but they make the same mistake of not splitting up the current smokers from the ex-smokers. There isn't really any evidence that ex-smokers are more resistant to the coronavirus and there is no reason to think they would be. The hypothesis is that nicotine confers a benefit, and ex-smokers aren't getting any nicotine.

If you bundle the ex-smokers together with the smokers, you muddy the picture. Sure enough, the UK review finds 'substantial uncertainty arising from the recording of smoking status on whether current and/or former smoking status is associated with SARS-CoV-2 infection, hospitalisation or mortality'.

Nevertheless, it alerted me to this study which I had not seen before. It looks at 3,789 US military veterans aged between 54 and 75 who have been tested for COVID-19, of whom 585 tested positive. Smokers were heavily under-represented with an odds ratio of 0.45 (95% CI 0.35-0.57), ie. they were 55 per cent less likely to test positive.

Further evidence was published yesterday by some French epidemiologists. Their study involved pupils, parents, siblings, teachers and non-teaching staff at a high school in an area of Northern France that has been badly hit by COVID-19. Of the 661 people tested for COVID-19 antibodies, 26 per cent of them tested positive, of whom 5.3 per cent were hospitalised and none died. These are important findings in themselves, but there are also figures on smoking prevalence which, once again, are rather striking.

Smoking was found to be associated with a lower risk of infection (7.2% versus 28.0% for smokers and non-smokers, respectively), and this association remained significant after adjustment for age (OR = 0.23; 95% CI = 0.09 –0.59) or occupation (OR = 0.27; 95% CI = 0.10 –0.71).

This suggests that smokers are 70-80 per cent less likely to test positive for COVID-19, in line with a previous study from France. The authors note that...

Earlier studies in China and the U.S. have documented a low proportion of smokers among COVID-19 patients (6% of 191 hospitalised patients in Wuhan, and 1% of 7162 patients in the U.S.). The protection associated with smoking in our study was very substantial (75% decrease in risk of infection), and deserves full attention. One possible explanation would be the downregulation of ACE2, the SARS-CoV-2 receptor, by nicotine.

Taken together with the rest of the evidence, the association between current smoking and lower COVID-19 risk is starting to look statistically and clinically meaningful. There are now two big questions.

Firstly, is it the nicotine or is it something else? Trials underway in France should help us answer that.

Secondly, are smokers/nicotine-users more likely to fight off the disease when they get it or are they less likely to get it in the first place? Data on hospital admissions can be used to support either hypothesis, but the two studies mentioned above suggest the latter.

There is more to come, I'm sure. Watch this space.

Thursday 23 April 2020

The banter hypothesis

Following yesterday's news I've written about the banter hypothesis for Spiked...

People scoffed when Emmanuel Macron exempted tobacco kiosks from France’s lockdown on the basis that they provide an essential service. Who’s coughing now?

Far be it from me to preempt the conclusions of the professor’s research, but let us consider for a moment the policy implications of nicotine being the only tried and tested prophylactic for Covid-19. We could issue Lucky Strikes on prescription. We could #ClapForOurCigarettes every Thursday evening. The case for closing down Public Health England would be stronger than ever. We could open the pubs, but only to smokers and vapers. We might allow a few non-smokers in to enjoy the possible benefits of passive exposure, but only if they stand two metres apart. There is everything to play for.

Do read it all.

Wednesday 22 April 2020

Does nicotine protect from COVID-19? French scientists investigate

Nothing could rescue the Banter Era from the clutches of the coronavirus pandemic like the news that nicotine is the cure. In recent weeks, I have watched with mounting interest as evidence comes from different countries, all showing the same thing: smokers are significantly under-represented in COVID-19 wards.

It started when Konstantin Farsalinos spotted the trend in a succession of Chinese studies. Things got more interesting when the CDC found remarkably few smokers among COVID-19 cases in the USA. This was followed by a large study of over 4,000 cases in New York which showed that people with a history of tobacco use were 29% less likely to be hospitalised with the disease (the reduction in risk was even higher among current smokers).

Then we had the study from France, in which less than five per cent of hospital cases were smokers. That study has now sparked some serious scientific interest, as the Guardian reports...

French researchers to test nicotine patches on coronavirus patients 

French researchers are planning to test nicotine patches on coronavirus patients and frontline health workers after a study suggested smokers may be much less at risk of contracting the virus.

The study at a major Paris hospital suggests a substance in tobacco – possibly nicotine – may be stopping patients who smoke from catching Covid-19. Clinical trials of nicotine patches are awaiting the approval of the country’s health authorities.

The study is being led by the renowned French neurobiologist Jean-Pierre Changeux who explains the biological mechanism he believes could be responsible here.

SARS-CoV-2 epidemics raises a considerable issue of public health at the planetary scale. There is a pressing urgency to find treatments based upon currently available scientific knowledge. Therefore, we tentatively propose a hypothesis which hopefully might ultimately help saving lives. Based on the current scientific literature and on new epidemiological data which reveal that current smoking status appears to be a protective factor against the infection by SARS-CoV-2 [1], we hypothesize that the nicotinic acetylcholine receptor (nAChR) plays a key role in the pathophysiology of Covid-19 infection and might represent a target for the prevention and control of Covid-19 infection.

The French media have more...

It all started from a study that has just been carried out by the hospital, and which concludes that smokers are less affected than others by the virus. From this observation in the field was born a hypothesis which seems solid, and has just been published by the Academy of Sciences. It should be verified soon by a clinical study: that it is not tobacco, but nicotine which would have preventive properties.

The study carried out at La Pitié follows several rather surprising observations on the ground. In recent weeks, several studies (which include "biases" that could make them unusable), seemed to show that there was a relatively low proportion of smokers among the sick. Prison populations or patients of psychiatric hospitals - populations that generally smoke a lot - seem to be little affected. All of this would suggest that smoking status is protection against the virus.

... For the record, the idea germinated from a happy coincidence. Through a mutual acquaintance, the Nobel Prize in Physics Serge Haroche, Professor Zahir Amoura met a month ago the world-renowned neurobiologist Jean-Pierre Changeux. A specialist of what are called nicotinic receptors, the scientist suggests that nicotine could prevent the virus from fixing itself, from penetrating into cells: it would thus prohibit its propagation and constitute a brake on the development of the disease, which would finally explain the under-representation of smokers among patients tested positive

Meanwhile, Public Health England maintains that smokers are 14 times more likely to develop severe COVID-19. Let's see who is closer to the truth.

Tuesday 21 April 2020

When in doubt, blame booze

Two stories in the media have had an interesting spin put on them.

Firstly, new figures show that violence-related casualty admissions fell by 6% in 2019 and have fallen by a remarkable 45% since 2010.

Fantastic news, but you can usually find some bad news if you dig deep enough and so the BBC has focused on a rise in admissions among people over the age of 50 and come up with this headline:

Alcohol fuels rise in assaults on over 50s, study suggests

The number of people in their 50s and 60s needing emergency hospital treatment after being assaulted is at its highest level for nine years.

But where does alcohol come into this? 

The authors of the study said although this was "difficult to explain" it was likely to reflect the "growing" levels of drinking among older people in England.

"Current cohorts of older people exhibited higher alcohol consumption levels in the past and may be continuing their relatively higher levels into older age," the study says.

"Since heavy binge drinking, and violence associated with it, were much more frequent three or four decades ago, it seems possible that this generational trait is also reflected in slowly increasing the risk of injury in violence."

In other words, there is no evidence that alcohol has 'fueled' a rise in admissions among this specific cohort. It's pure speculation.

Secondly, the Scottish Sun reports on the rise in non-COVID deaths in recent weeks. This has rightly been at the centre of the debate about the costs and benefits of the lockdown. With attendances at A & E plummeting, thousands of operations postponed and consultants seeing fewer people, people who are dangerously ill are not getting the care they need. 

It will be months, if ever, before we get to the bottom of what is going on, but our old friend Linda Bauld has already identified the suspect.

Coronavirus Scotland: Expert calls for booze BAN after shock spike in non-Covid-19 deaths during lockdown 

MINISTERS should limit or even ban booze sales after a shock rise in deaths not linked to Covid-19, a health expert claimed last night.

Professor Linda Bauld called on the Scottish Government to consider the drastic step after stats revealed more than 600 unexplained recent fatalities.

Shimmying over the word 'unexplained', Bauld gives her reasons for doing something that one suspects she has always wanted to do:

Prof Bauld, chair of public health at Edinburgh University’s prestigious Usher Institute, said tragedies linked to drink and drug abuse were likely to be a significant contributing factor to the figures.

She pointed to many support services for alcoholics and addicts being closed at present. And supermarket booze shelves being stripped bare suggests alcohol consumption has rocketed.

That's not how stockpiling works.

“Colleagues in drug and alcohol services in West Lothian tell me they are not able to see their clients in the usual way. They are not able to reach them.

“And unlike other countries such as South Africa and India that have banned the sale of alcohol, we’re still allowing it to be sold.”

South Africa and India, those world leaders in public policy.

Prof Bauld insisted a ban or limit on booze sales should still be considered.

She said: “It’s not too late to do that. It may seem a bit churlish and it won’t be very popular. But that is certainly one option.”

Go on. Try it. I dare you.

Cannabis legalisation saves lives - vaping edition

A study in JAMA finds that there were fewer deaths from last year's 'vaping-related lung disease epidemic' in US states where marijuana and THC are legal.

This is very unsurprising. Despite dogged efforts to blame e-cigarettes, which included making up a misleading name for the disease - E-cigarette or Vaping product-use Associated Lung Injury (EVALI) - it has been obvious for more than six months that the problem was caused by vitamin E acetate in black market THC oil.

If you can buy cannabis legally, you have less reason to buy THC cartridges on the black market and therefore less chance of dying from a disease caused by an unregulated product.

Sure enough, EVALI is associated with marijuana prohibition and not e-cigarette use.

The regressions imply that average EVALI case rates were lower in recreational marijuana states by 7.2 (95% CI, −11.8 to −2.6) cases per million population than in prohibition states (P = .003). There was no significant difference between EVALI case rates in prohibition and medical marijuana states (difference = 0.3; 95% CI, −5.3 to 5.8; P = .93). There was no association between the prevalence of e-cigarette use and EVALI case rates (difference = −1.3; 95% CI, −3.3 to 0.7; P = .20).

The authors of the study are strangely coy about aligning themselves with the obvious explanation.

The reason for this association is not yet clear. 

A bit of deductive reasoning will help.

One possible inference from our results is that the presence of legal markets for marijuana has helped mitigate or may be protective against EVALI.

D'ya think?

It is possible that in recreational states, people tend to purchase marijuana products at legal dispensaries, which may be less likely to sell the contaminated products that are thought to cause EVALI. 


Monday 20 April 2020

Your listening pleasure

Everyone's doing webinars these days, for obvious reasons. The IEA will be putting out videos seven days a week from today so keep an ear out for those.

I've just been listening to Jacob Grier talking about his excellent book, The Rediscovery of Tobacco: Smoking, Vaping, and the Creative Destruction of the Cigarette, in one of the Cigar Lovers' virtual seminars.

It's only available for a day or so so check it out quickly (you'll need to complete a quick and easy registration).

Also, I was discussing the week that was on Five Live last night. You can listen to Good Week, Bad Week here.

Friday 17 April 2020

Smoking and COVID-19 - the Glantz/Patanavanich meta-analysis

With the FDA admitting that there is no evidence that vaping exacerbates COVID-19 and the Norwegian Institute of Public Health taking smoking off its list of risk factors for the disease, I've been expecting a reaction from Stanton Glantz. I imagine it has been all hands to the pumps in San Francisco this week as the legacy 'public health' establishment plans its counter-attack.

It arrived last night when Glantz and a Thai colleague, Roengrudee Patanavanich, published a meta-analysis of sorts as a pre-print claiming that smoking more than doubles the risk of COVID-19 progressing in people who have the virus. It includes a telling sentence in the Methods section:

We will widely disseminate our findings working with the media and interested clinical and public health groups. 

I bet you will, Stan.

You can tell it has been produced in a hurry. The results section consists of two short paragraphs and the conclusion is just two sentences long.

It looks at twelve studies, ten from China and one each from South Korea and the USA. The large study from New York which found no association between smoking and COVID progression - and found that smokers are significantly less likely to be hospitalised with the disease - is conspicuous by its absence.

The headline claim is...

A total of 9,025 COVID-19 patients included in our meta-analysis, 878 of whom (9.7%) experienced disease progression and 495 with a history of smoking (5.5%). A total of 88 patients with a history of smoking (17.8%) experienced disease progression, compared with 9.3% of never smoking patients.

The meta-analysis showed an association between smoking and COVID-19 progression (OR 2.25, 95% CI 1.49-3.39, p=0.001)

It also claims that...

There was not significant heterogeneity among the studies 

You could have fooled me. The odds ratios in the studies range from 0.11 to 12.19, ie. a 89% reduction in risk to a twelve-fold increase! Clearly, some of these results are very wrong. Bunging them all together in a meta-analysis is not going to get you anywhere. Garbage in, garbage out.

As you can see from this graphic, only three of the studies (supposedly) produced statistically significant results. One of them is Liu et al., which only included five smokers and is the source of the wild claim that smoking increases the risk of coronavirus progression fourteen-fold. The others are Guan et al. and this webpage from the Centers for Disease Control. Glantz gives both of these a big weighting and large odds ratios, but neither of the figures he attributes to them come from the studies themselves.

Guan et al. showed some raw data for smokers and ex-smokers in Chinese coronavirus wards, but the authors did not comment on smoking as a risk factor, nor did they produce an odds ratio. Both current and former smokers are under-represented in their study (compared with smoking prevalence in China), but they do appear somewhat more likely to develop severe symptoms. The increased risk is more like 50%, however, whereas Glantz claims the study shows a trebling of risk.

If the Guan study implies some risk of COVID progression from smoking, the same cannot be said of the CDC study which Glantz gives the greatest weighting to. This has hospitalisation data for 6,354 COVID cases in the USA. Most of the cases in the meta-analysis therefore come from this one data set.

It found that only 1.3% of the COVID cases were current smokers, a striking statistic in itself. Of the 88 smokers for whom the CDC has hospitalisation data, 27 were hospitalised (30.7%) and five ended up in ICU (5.7%).

2.3% of the cases were former smokers. Of the 178 ex-smokers for whom the study has hospitalisation data, 78 were hospitalised (43.8%) and 33 ended up in ICU (18.5%).

The CDC doesn't give a specific figure for nonsmokers, but the overwhelming majority of cases had never smoked (or so they said) and the overall rate of hospitalisation was 34%. The overall proportion of cases that ended up in an intensive care unit (ICU) was 5.8%.

Former smokers therefore did worse than average, presumably because of underlying health conditions, and current smokers did better than average. Both groups were heavily under-represented among the cases as a whole: 14 per cent of Americans are current smokers and an even larger proportion are ex-smokers.

A major caveat is that we don't have hospitalisation status for three quarters of the total cases recorded by the CDC, and the CDC says itself that...

...for some underlying health conditions and risk factors, including neurologic disorders, chronic liver disease, being a current smoker, and pregnancy, few severe outcomes were reported; therefore, conclusions cannot be drawn about the risk for severe COVID-19 among persons in these groups.

Glantz pays no attention to that advice. Instead, he lumps ex-smokers in with current smokers and produces a relative risk of 2.60 (1.82-3.73). Again, this figure does not come from the CDC and it does not reflect the data in the CDC study which shows current smokers to be less likely to be hospitalised and slightly less likely to enter ICU. Glantz's odds ratio of 2.60 - ie. 160% greater risk - is due to the outcomes seen in ex-smokers, not smokers.

Glantz's gives so much weight to the imaginary results from these two studies that it hardly matters about the rest. Nevertheless, there are some bizarre interpretations of sketchy evidence. For example, the study from South Korea (Kim et al.) involved 28 COVID patients, of whom five were smokers. Six of the 28 patients were given supplementary oxygen in hospital, of whom two were smokers. From these crumbs of evidence, Glantz portrays the study as showing that smokers are more than three times likely to become critically ill if they contract COVID-19.

Dong et al. provides detailed case reports on eleven COVID patients in China. Only one patient had a history of smoking. The authors do not attempt any statistical analysis and it is impossible to derive any relative risks from the doctors' notes. Glantz nevertheless attempts to do, somehow conjuring up an odds ratio of 1.15.

In Zhang et al.'s study of 140 COVID patients in Wuhan, only two of the patients (1.4%) were current smokers. The smoking rate in China is 27 per cent and the authors comment on how few smokers appear in their sample, saying that 'the exact underlying causes of the lower incidence of COVID-19 in current smokers are still unknown'. For Glantz's purposes, the only thing that matters is that both of the smokers had severe symptoms, from which he derives an odds ratio of 3.04 (0.73-12.69) which, once again, does not feature in the study itself.

Despite only having two smokers in the sample, Zhang et al.'s study is given a relatively heavy weighting of 6.74% by Glantz, thereby amplifying its purported findings in the meta-analysis. By contrast, Huang et al.'s study published in the Lancet had three smokers, none of whom developed severe symptoms. Glantz gives that study a weighting of just 1.74%.

If you read the twelve studies, you will struggle to find much evidence for the counter-intuitive theory that smoking reduces the risk of serious COVID-19 complications, but nor is there good evidence that it increases the risk. There is a suggestion of increased risk in Guan et al. - and, at a push, in Shi et al. - but the authors of the studies do not draw that conclusion and it seems to be more of an issue for former smokers than current smokers (perhaps because they are older). Contrary to Glantz's claims, the CDC data do not support the hypothesis that smoking increases the risk of coronavirus complications, and the agency explicitly cautions against drawing such a conclusion.

The New York study of 4,103 patients is the best evidence yet that current smoking is irrelevant to the current viral pandemic, but that isn't in the meta-analysis. All the other studies have far too few smokers in them to draw any conclusions either way.

And it is the lack of smokers coming to the attention of health authorities with COVID-19 that is the most interesting thing. It is why Dr Farsilinos started researching this in the first place. Since most of the studies are based on hospital data, you have to be hospitalised to be studied - and smokers are strangely under-represented in coronavirus wards. Current smoking rates in all the studies in Glantz's meta-analysis are much lower than would be expected: 10 per cent in Yang et al., 6.7% in Wan et al., 3.9% in Mo et al., 7% in Huang et al., 9% in Dong et al., 1.9% in Guan et al., 6% in Zhou et al., 1.4% in Zhang et al. and in 6.4% in Liu et al. In Shi et al., only 8.2% of cases had any smoking history.

The highest smoking rate recorded in any of the studies is 18.5% in Kim et al.'s study from South Korea and that is still well below the national smoking rate. In the USA, the figure from the CDC is 1.3%. In New York, it is 6.7%.

Under-reporting of smoking status by patients is always an issue and it no doubt plays a part here, but is hard to believe that under-reporting alone can explain such remarkably low figures. If there is something about nicotine that helps people fend off the virus, or stop it progressing, it would be useful for the world to know. (It could also help explain why current smokers seem to do better than former smokers.)

There may be nothing in the theory, but there seem to be plausible biological mechanisms for it and serious people are giving it serious consideration. Stan Glantz is not a serious person and it was inevitable that he would respond to the suggestion that tobacco might be anything less than the root of all evil with yet another shabby piece of junk science.

Thursday 16 April 2020

Smoking is not a risk factor for COVID-19 - Norwegian Institute of Public Health

The evidence is mounting that smoking is not a risk factor for COVID-19 infection or COVID-19 progression.

The most solid evidence yet was published as a pre-print at the weekend. A study of 4,103 coronavirus patients in New York found that current and former smokers were not more likely to need intensive care for COVID-19 (0.89 (0.65-1.21)) and were significantly less likely to be hospitalised with the disease in the first place (0.71 (0.57-87)).

This is hardly the first time researchers have noticed smokers being under-represented in coronavirus wards. Previous evidence comes from multiple Chinese studies and data from France, Germany and the USA.

Public Health England's claim that smokers are 14 times more likely to suffer COVID-19 complications looks increasingly absurd, but its equivalent in Norway has shown that it is willing to change its mind when the facts change.

From Dagbladet (translated)...

Smokers removed from risk list
As of April 1, smoking has been cited as a risk factor for severe coronavirus. This point has now been removed from the Institute of Public Health's list.

The list lists risk factors that can lead to serious illness, including pneumonia and difficulty breathing.
'We have removed smoking from the list because this in itself does not stand out as a risk factor for serious progress of Covid-19 in available data from the outbreak. It is also not clear that, for example, COPD stands out for the time being', writes senior consultant Sara Watle at the Institute of Public Health by e-mail to Dagens Medisin.

FHI's list now shows that three groups are at increased risk of serious progress. This applies to elderly people over the age of 65, people with cardiovascular disease, including high blood pressure, and people with diabetes.

 Your move, PHE.

Vaping to COVID-19 - has public health lost its way?

I had a good chat with Brent Stafford at Regulation Watch last night about COVID-19, public health and vaping. Check it out.

Wednesday 15 April 2020

WHO's sorry now?

So Trump has gone and done it. He's defunded the World Health Organisation, for now at least. I've written about it for the Telegraph...

In an ideal world, other big donors such as the UK would threaten to withhold funding until they are given an assurance that the Director-General, Dr Tedros Adhanom Ghebreyesus, will resign and the agency will undergo a root and branch review. The WHO should promise to drop its obsessions with political correctness and the nanny state and return to its core mission of tackling infectious disease without fear or favour.

That may be too much to ask right now, but Trump’s decision has kept the spotlight on this rotten organisation and made reform more likely. As I wrote last week, there is no chance of the WHO mending its ways unless there is a credible threat of the money drying up.
No one is naive enough to think the president is motivated purely by a desire to see an international agency clean up its act. Trump’s mishandling of Covid-19 in January and February was in many respects worse than the WHO’s. The only thing he got right in that period was banning travel from China and Europe, a policy condemned by the WHO for creating ‘fear and stigma’.

Sometimes the right thing can happen for the wrong reasons. Whatever Trump’s motivations, the WHO is long overdue a kick up the backside and this is the right time to do it. The current pandemic will eventually subside and the public will go back to ignoring the agency. The time to act is when the eyes of the world are on it. 

Read it all if you have a subscription.

At 8pm UK time I'll be live on Regulator Watch talking about this development and many other issues. You should be able to watch below (if not, click here).

Tuesday 14 April 2020

An angry Liberal Democrat

A Lib Dem who rejoices under the name James Belchamber is very angry about the evidence I produced last week showing that minimum pricing in Scotland has been a bit of a flop. You may recall that I found official statistics showing that the number of alcohol-related hospital admissions rose in Scotland in the first year of minimum pricing, and Scotland fared no better than England and Wales with regards to alcohol-related mortality in 2018.

In a scurrilous, bug-eyed rant, Belchamber accuses the IEA of 'fake news', lying and the 'dissemination of disinformation' for bringing these facts to the public's attention.

In a “Briefing Paper” published last week the headline “fact” was that, since Scotland did not see a drop in alcohol-related deaths over what England experienced, the policy as a whole was a failure (as they “warned”). Of course there is no mention that regularly consuming alcohol kills you over decades (a fact well-known now even to people outside of the medical industry), and that this is a disingenuous and fallacious argument.

They know this. Nobody with an interest in the subject could not know this. So we can only reason that they are out to deceive.

For Belchamber, it is just common sense that minimum pricing wouldn't have any effect in the first year. S'obvious, innit?

Unfortunately for him and his argument, that has never been the view of the Scottish government nor of the Sheffield University team who made some very specific predictions about what would happen in the first year. If he had bothered to read the very first line of the abstract of my report, he would have seen what those predictions were:

Advocates of minimum pricing predicted that it would have an almost immediate impact in Scotland, with modelling forecasting 58 fewer deaths and 1,299 fewer hospital admissions in the first year.

There are plenty of reasons to expect a successful anti-alcohol policy to deliver health benefits in the first year. Many alcohol-related deaths are from acute causes and most of the chronic diseases can be prevented if people suddenly change their behaviour. That's why the Sheffield modellers forecast a large impact in the first twelve months.

And it's why the actual outcomes in the first year are highly relevant in any assessment of the policy.

Belchamber says that 'if the facts change, I will change my mind' and ends his blog post with the pious injunction that...

As Liberals, we should seek truth.

I have left a comment on his blog explaining that he has made a howler. He will no doubt be embarrassed to have based a scathing blog post around a fundamental misunderstanding of the facts, but as a truth-seeking Liberal I'm sure he will acknowledge this and rethink his support of a policy that will make the poor poorer.

Who are the WHO working for?

A hard-hitting video from the Australian Taxpayers Alliance about the corrupt and unaccountable World Health Organisation.

Monday 13 April 2020

Corona-bollocks - bumper bank holiday weekend edition

The corona-vultures continue to circle, crowbarring their obsessions into the COVID-19 conversation. Here's a round up from the last week.

1. The Royal College of Psychiatrists asserts, without a shred of evidence, that drinking more than 14 units a week increases the risk of COVID-19 complications:

Drinking alcohol might be a way of relaxing or taking your mind off the constant stream of news about COVID-19. But if you drink more than 14 units a week, it can negatively affect your health, including by making you more at risk from the effects of COVID-19.

The model used to justify the drinking guidelines was changed at the eleventh hour after the modellers negotiated an extra payment from Public Health England. The idea that 14 units a week reflects the threshold for mortality is garbage. The idea that the model correctly predicted the threshold for coronavirus complications is insane.

The RCP, bless them, add this much needed disclaimer:

The content in this resource is provided for general information only. It is not intended to, and does not, amount to advice which you should rely on.

You can say that again.

2. In America, certain people are trying to keep the previous 'epidemic' alive...

Clive Bates watched this webinar so you don't have to.

3. In South Africa, the crime rate has apparently gone down since alcohol was banned for the 21 day lockdown. A police general wants to make the prohibition permanent.

Police minister warns public against fake videos and pulls no punches when it comes to alcohol prohibition laws, saying they should remain in place even after lockdown.

Police Minister Bheki Cele has given the clearest indication yet that regulations prohibiting the sale and drinking of alcohol during the lockdown will not be relaxed, even remarking that he wished they were extended beyond this period.

It seems likely that forcing people to stay indoors all day long has helped cut the crime rate. Presumably the police's job would be made easier if we made that permanent too?

In any case, historians may recall that alcohol prohibition doesn't have a great record when it comes to cutting crime.

4. In Britain, the fuzz continue to enforce whatever they think the law should be. This is one of many examples...

To be clear...
5. Tobacco Control magazine has endorsed the prohibition of cigarettes for years - it is what they call the 'endgame' at the bottom of the slippery slope. You'll never guess what they think the lesson of COVID-19 is...

The tobacco cigarette pandemic is like COVID-19 in slow motion. The need to ‘flatten the curve’ is urgent. The fact that the tobacco epidemic curve is only partially flattened (in some countries) is widely accepted because the cigarette pandemic has been with us for so long, and the tobacco industry has been extraordinarily successful at conditioning the public and policymakers to accept it as a given. If governments had acted to protect the public from tobacco with a fraction of the effort (and financial investment) they have exerted to control this coronavirus, many millions of lives could have been saved, and underlying demand on health services significantly reduced. The world will emerge from the COVID-19 pandemic changed. Phasing out cigarette sales would be an enormous long-term gain for public health.

After all this time, they still haven't worked out the difference between voluntarily engaging in a risky but rewarding activity and being infected with a potentially fatal virus.

6. Finally, the death rate from COVID-19 is disproportionately high among black people in the USA. There are several possible reasons for this. They are more likely to live in big cities such as New York where the disease is rife, they are more likely to work in essential industries, and they are more likely to be morbidly obese (a major risk factor for coronavirus complications).

In the face of this crisis, the US Surgeon-General retreated into his comfort zone and told black Americans to... stop drinking and smoking.

During Friday's White House briefing, Surgeon General Jerome Adams told Americans of color to follow safety procedures during the COVID-19 coronavirus pandemic for "your Big Mama," including to "avoid alcohol, tobacco and drugs."

These comments led to Adams - who is black - being improbably accused of racism. The implication that black people drink, smoke and take drugs more than whites is certainly wrong, but the real problem is that there isn't really any evidence that these behaviours make people more likely to die from COVID-19.

It's another example of the legacy 'public health' establishment struggling to come to terms with a health problem that can't be addressed by hectoring people about their lifestyle. When you're dealing with a highly infectious virus, 'don't drink and don't smoke' isn't advice. It's a mantra.

Later, when pressed on whether he thought 'all Americans should avoid tobacco, alcohol and drug use at all times' the Surgeon General was happy to set the record straight.

'Absolutely. It's especially important for people who are at risk and with co-morbidities. But yes, all Americans. So thank you and I will clarify that. All Americans need to avoid these substances at all times.'

In other words, he had taken the opportunity presented by coronavirus to tell people to do what he thought they should be doing anyway. There's a lot of this around at the moment.

Thursday 9 April 2020

Minimum pricing had no impact on mortality

There has been all sorts of rubbish written about minimum pricing since it was introduced in Scotland in May 2018. Nicola Sturgeon has lied about in the Scottish Parliament. The BBC has gone to extraordinary lengths to spin the policy as a success. The public have been told that alcohol-related hospital admissions have gone down when they have gone up. We have seen the media fall for blatant cherry-picking. We have been told that rates of problem drinking have gone down when we don't have any evidence either way.

One of the few solid facts - that there were more alcohol-related deaths recorded in Scotland in 2018 than in 2017 - has been sidelined. Instead, the media have focused on a disputed, and relatively small, decline in alcohol sales as if that were an end in itself. Any port in a storm (fortified wine sales have definitely benefited from minimum pricing).

Figures from the calendar year of 2018 are of limited use because minimum pricing didn't begin until May 1st. Today, for the first time, I can reveal the monthly mortality figures for Scotland, England and Wales. They show that there was no difference between the change in annual death rates from alcohol-related causes, regardless of whether the country had minimum pricing in place. Both England/Wales and Scotland saw a decline between May and December of seven per cent (compared to the previous year).

This graph is published in a new briefing paper I have written for the IEA. It summarises all the evidence gathered to date on deaths, hospitalisations and sales, plus exclusive new data.

Importantly, it contains estimates of the costs to consumers. Among the more outlandish claims made by the Sheffield modellers was the idea that moderate and low income consumers would be barely affected by minimum pricing. They predicted that a low income moderate drinker would only pay an extra 4p a year! This was never realistic, not least because it was based on the minimum price being set at 45p and they defined a moderate drinker as someone consuming the equivalent of just two pints of lager a week, but it worked from a PR perspective because it quelled politicians' fears about the policy being regressive.

Based on data published in the appendix of a study last year, we can see that moderate and low income consumers have sharply increased their spending on alcohol. Not all of this is due to minimum pricing, but a comparison with their counterparts in England suggest that excess spending due to minimum pricing is around £50 to £60 a year. This is not chicken feed, especially when you're struggling to make ends meet.

I discuss the new findings in this video.

Download the report for free here.

Wednesday 8 April 2020

Defund the WHO

Donald Trump has threatened to defund the World Health Organisation. And rightly so, as I say in the Telegraph...

Donald Trump has his reasons for wanting to blame others for America’s devastating coronavirus outbreak, but he is right to threaten to defund the WHO. Money talks and the USA is the agency’s biggest single donor. If there is hope of reforming this rotten organisation, it will only happen if it sees the cash drying up.

Britain should follow America’s lead. We gave the WHO over $200 million in 2018, making us its second biggest contributor. On a per capita basis, we are comfortably its biggest donor. Since our largesse does not seem to have bought us any soft power with the WHO, it is time to stop asking nicely. Tedros must go and the agency must get back to its original mission. If it cannot be reformed, it should be replaced.

Do have a read if you have a subscription.

Tuesday 7 April 2020

Public Health England up to its old tricks

Anyone hoping for Public Health England to turn over a new leaf and be honest with people in the age of coronavirus is et to be disappointed. They put out this press release on Friday...

Smokers at greater risk of severe respiratory disease from COVID-19

Emerging evidence from China shows smokers with COVID-19 are 14 times more likely to develop severe respiratory disease.

This is a highly selective use of the evidence, as I explain in an article for Spectator USA...

An evidence review published three weeks ago found no association between smoking and the severity of COVID-19. This is a rapidly evolving field of research and the results may change over time, but evidence from the 13 studies published to date ‘does not support the argument that current smoking is a risk factor for hospitalization for COVID-19’. On the contrary, it ‘raises the hypothesis that nicotine may have beneficial effects on COVID-19.’

Taken as a whole, the evidence on smoking and COVID-19 does not point in the direction the ‘public health’ lobby would like it to. And so they have ignored it, focusing instead on a single study which reported a monstrously high 14-fold increase in risk for smokers who contract the disease. The study only looked at five smokers and is an obvious outlier, but it has been treated as definitive proof by activists around the world. Public Health England, which is under fire for its weak response to the pandemic, retreated to its comfort zone last week, telling smokers that they are ‘at greater risk of developing severe disease from the COVID-19 virus’ and that there ‘has never been a more important time to stop smoking.’ The only evidence cited by the agency was ‘a small but highly impactful survey from China’ which found that ‘smokers with COVID-19 are 14 times more likely to develop severe disease.’

The article looks at several examples of single-issue pressure groups making tenuous links between their pet causes and coronavirus. Do have a read.

Wednesday 1 April 2020

To mute is human, to block is divine

I hit an important benchmark today when I blocked my thousandth account on Twitter. A volley of deranged abuse after I tweeted an article by Toby Young helped me sprint over the line.

A thousand sounds like a lot, but it's a big world out there and most of us will only ever see a few pockets of it. Of the planet's seven billion people, there are bound to be many millions of bad faith actors, obsessives, bores, pile on merchants, psychopaths and borderline retards, but you don't realise quite how many morons there are until you get on social media.

Twitter has 145 million active daily users. If you assume that one per cent of them are scumbags - surely a massive underestimate - that is well over a million people with whom you want no contact. Even if you block several thousand people, you will barely scratch the surface.

But Twitter is also host to many of the world's funniest, cleverest and most creative people. It is indispensable for breaking news, expert opinion and knowledge you would never otherwise stumble upon. I have probably learned more from being on Twitter than from any other medium and it saddens me when people feel they have to delete the app for the sake of their sanity. Yes, it can be a cesspool, but not if you curate it properly.

Several of my friends believe that the best way to de-scum their timeline is through judicious use of the mute button. There are two arguments in favour of this.

Firstly, they think that an idiot will take being blocked as some sort of victory.

Secondly, they like the idea of someone tapping pointlessly away at their keyboard to produce a reply that will never be seen.

Both arguments are flawed. On the first point, I doubt many blockees take being blocked as an admission of defeat by the blocker. Even if they do, so what? The worst they can do is take a screenshot and tweet it to their 16 followers, saying 'lol, looks like someone doesn't beleive in free speech!'

The second point misunderstands how many people use Twitter. A tweet is a micro-blog and the replies are effectively the comment section. The person replying is not just interacting with you. They are interacting with other people who reply. The muted user is therefore not tapping pointlessly away. They are saying things that other people can read and you can't. They are continuing to pollute your little slice of the internet and every time you don't reply they are thinking that you don't have an answer to whatever pathetic zinger they imagine they have launched at you.

No, it has to be a block. Blocking also holds the possibility, however slight, that the individual might reflect on their conduct and try to be more civil in the future.

It's not about stopping people seeing your tweets; you should be happy for everyone to hear your views. It is about stopping the worst people fouling the air of your timeline and the timelines of those you engage with.

Your time is not limitless and you have to remember that you are on Twitter for your own benefit. You are not there to provide a free service to other people. You are not there to be harassed or insulted. You are not there to provide information to anyone who demands it, especially when they could easily find it themselves elsewhere on the internet.

Respectful disagreement is a good thing. Arguments are useful and it doesn't matter if they get heated once in a while. But there is nothing to be gained from engaging with people who are never going to change their mind and are intent on arguing aggressively about somebody about which you know something and they know nothing. You shouldn't be prepared to waste a nanosecond's screen time thumbing through idiotic responses from irredeemable nitwits.

If someone comes striding into your mentions with a comment that maliciously misrepresents what you said, questions your motives, or insults you, ask yourself two questions:

  • Will your life be any worse if you never hear from this person again?
  • If a stranger came up to you in a pub and said what this person has just said to you online, would you punch them in the face?

If the answers are no and yes respectively, get them out of your life forever.

You can do due diligence by looking at their profile. More often than not it will be full of retweets - Twitter flotsam rarely have anything original to say - and the retweets will usually be from the most needy, lowest common denominator Twitter personalities (David Schneider, Otto English, Owen Jones, etc.)

After a while you get a sixth sense for the type of person who is going to start out with a seemingly innocuous question but turn into a snarling demon within a couple of replies. The following first impressions prompt an instant block from me:

  • Communist or fascist iconography in profile. I don't see much of this but it's always creepy when I do. Anyone who publicly aligns themselves with regimes that killed millions of people is at least half-mad and should be avoided.
  • #FBPE in profile. Since February I have been blocking 'follow back, pro-EU' accounts on sight. I wish I'd done it sooner. It's not that I disagree with their europhilia, though I do, it is that they are so consistently thick and hysterical on every issue. They are so ovine that in my mind's eye, they are all the same person. Putting pro-EU hashtags (and black spiders) in your profile was sad enough when there was a chance of overturning the referendum result. Keeping them there two months after we've left is inexcusable.
  • 'Who funds you?' bots. This is a niche one for people who work for the IEA. We don't publish a list of all our donors, partly to protect them from the kind of lunatics who tweet 'who fnuds u?' fifty times a day. Long experience has taught me that these people are not actually interested in who funds the IEA. It is just a way of avoiding debate on substantive issues. I have also learned that the conversational skills of someone who tweets those three little words as their first interaction with you are not going to improve if you engage with them.
  • Malicious quote-tweeting. Commenting publicly on someone else's tweet is fine, but if it is  done purely to invite a pile on, block the fiend responsible. Admittedly there is a fine line, but you know it when you see it. Similarly, if you have deliberately not tagged in the person you're tweeting about (because you don't want to lead a pile on), it is very bad form for someone to try to stir things up by tagging them.
  • Profile pics that only show the user's eye. These are almost invariably men. Presumably they do it because they are ugly. Maybe they think it makes them look cool. It actually makes them look like serial killers. For reasons I can't explain, their opinions are nearly always appalling.

There are other red flags that do not necessarily deserve an instant block, but point that way if combined with other aggravating factors:

  • Red rose (🌹). Popular with Corbynistas in recent years. Not everybody who puts it in their profile is a wrong 'un, but many of them are incorrigible spreaders of fake news and are liable to go into a psychotic rant at the drop at the hat.
  • Football imagery in profile pic. I love football but using a footballer or football stadium as your main photo isn't really acceptable for anyone over the age of 15 (I'll tolerate it as a background or header image). Adults who go down this route on Twitter seem inclined towards witless and illiterate abuse. Supporters of one team in particular are worse than most, but I won't name the club.
  • Photo of the user (always a man) running or cycling. Usually, but not always, a sign that the user is an angry cyclist or a low carb diet bore.

As I was writing this, I received a tweet that nicely illustrates my point. This one is virtually a full house: #FBPE and spider in username, basic misunderstanding of a simple point, obvious spelling mistake and a bit of gratuitous abuse to finish it off.


Don't be like MrsMinx🕷#GTTO #FBPE. Be like Mike.