Friday, 22 October 2021

What most people think

I really enjoyed talking to the comedian Geoff Norcott on Wednesday about Covid centrism, First Defence, cigarettes and more. Have a listen to the podcast here.



Thursday, 21 October 2021

Child obesity experiment fails spectacularly



The 'public health' lobby is keen on the 'whole systems approach' to obesity. This is not to be confused with the equally useless 'whole population approach'. The latter involves using blunt policy tools to get everybody to reduce their consumption of salt, alcohol, sugar or whatever whereas the whole systems approach has never been properly defined but involves the whole of society working to reduce obesity in some way.


The strategy of throwing any old policy into the mix in the hope that some of them will work is known euphemistically in 'public health' as the 'whole systems approach'. It is often illustrated with meaningless graphics and is anti-scientific, illiberal nonsense. Essentially, it gives activists a licence to do whatever they want regardless of the consequences.

At best, this scatter-gun approach can involve various teachers, social workers, charities and 'public health' professionals working face-to-face with people to help them have a healthy diet and control their weight. The one and only success story is Amsterdam where child obesity supposedly fell (a bit) after a whole systems approach was introduced. In practice, it's all too expensive and time-consuming for most governments and 'public health' groups to get behind, but it putatively shows that the government can do something about obesity.

The whole systems approach has now been tested in a four year randomised control trial in Australia called WHO STOPS Childhood Obesity (Whole of Systems Trial of Prevention Strategies for Childhood Obesity. Roughly 3,000 kids were treated to a wide range of 'community-based interventions'...

Some key examples of actions were (1) a rural health service changing its beverage provision and cafe to be “green only,” in line with government healthy choices guidelines; (2) a local government area constructing a new footpath to allow schoolchildren to engage in active transport more easily to and from school; (3) implementing a junior sporting-association-wide water-only policy; (4) a local primary school constructing signs encouraging children to be dropped off at set points away from the school gate to allow them to walk to school; and (5) implementing a healthy beverage policy at family day care.

So how did it go? At first, quite well.

There was a significant interaction effect between trial group and time (P = 0.006) (Table 2). Within intervention communities, the prevalence of combined overweight and obesity was 35.5% in 2015, 31.5% in 2017...

But then things started to go not so well.

...and 40.4% in 2019.

Awks.

Prevalence within the control group remained stable at 34.3% in 2015 and 34.7% in 2019.

The control group started out with a slightly lower rate of overweight/obesity (34.3% vs. 35.5%) and ended the trial with a substantially lower rate (34.7% vs. 40.4%). Needless say, this was not what the researchers were hoping for, but they are keen to stress that the experiment was not a complete waste of time because...

Intake of takeaway food significantly improved in the intervention communities by 2019 relative to 2015 compared with control...

And...

There was a significant intervention effect on water consumption (interaction, P = 0.019) with an increased percentage of girls consuming more than five glasses of water per day in intervention communities between 2015 and 2017 (18.1% increase) and 2015 to 2019 (11.8% increase) compared with control communities.

The authors do not take this to its logical conclusion and deduce that cutting down on takeaways and increasing water consumption does not lead to weight loss. Instead, they conclude that:

WHO STOPS reduced obesity prevalence over 2 years and over 4 years helped a majority of children keep their takeaway intake low... 
Childhood obesity is demonstrably preventable, and community-based interventions are effective, feasible, and acceptable to government, industry, and the public.

This is obviously not what the study shows, but in 'public health' you can say whatever you want. A more accurate conclusion would be to say that if childhood obesity rates go up despite the whole community working intensely with kids for several years, the chances of broad brush policies like advertising bans having an effect are nil.

Have I mentioned before that 'public health' is not a results-driven business?


Tuesday, 19 October 2021

The public health lobby wants to introduce a ‘meat tax’. Don’t bet against it

Marco Springmann is in the pages of the Guardian again calling for a meat tax so here's what I wrote about him and his ideas the first time around.


First published by Spectator Health in November 2018

Once you accept that the modern ‘public health’ movement is just the latest incarnation of the puritanism that waxes and wanes throughout history, it is easy to predict its next target. If you further assume – and who can now deny it? – that nanny state campaigners follow a blueprint laid down by the anti-smoking lobby, it becomes easy to guess not only their future targets but also their methods.

And so, when I suggested in an interview a few years ago that the next vices to fall under the cross-hairs of ‘public health’ would be caffeine, gambling and red meat, it was not because I had psychic powers, nor because there were rumblings in the medical journals about these issues (there wasn’t). It was because they have been for centuries the classic targets of scolds and ascetics once they tire of fighting the demon drink and tobacco.

Coffee is too popular with the upper-middle classes to be done away with yet, but this year saw the start of a minor crusade against energy drinks. The imminent downfall of fixed-odds betting terminals represents the first real scalp for the anti-gamblers in decades, with gambling advertising lined up as the next dragon to slay.

Meat has had an easier ride. Until now. A study published today in PLoS One looks very much like the start of a concerted effort to clamp down on processed and red meat. The crusade is beginning, as such crusades usually do, with a push for a sin tax.

Like most of the influential policy-based evidence in ‘public health’ of recent years, the study rests on opaque computer modelling. It produces estimates of how many people are dying from the over-consumption of meat, how much this costs society and what size of tax is needed to balance out the costs. It then estimates how many lives will be extended by processed meat consumption falling in an era of higher prices.

The published paper does not provide enough information for the model to be meaningfully assessed by the reader, but one thing is clear: the numbers are unfeasibly large. The authors reckon that the global death toll from processed and red meat is 2,390,000 people a year. The link between processed meat and bowel cancer is reasonably robust by the debased standards of nutritional epidemiology and there may be an association between meat-eating and coronary heart disease and stroke. Even so, a figure of 2.4 million defies belief. The authors admit that the Lancet’s Global Burden of Disease reports estimated the true figure to be 900,000 in 2010 and 700,000 in 2013. That is enough of a discrepancy, but they do not mention the most recent edition of the report which put the figure at just 140,000. The estimate published today is therefore seventeen times larger than an estimate of the same risk factor published barely a year ago. How can anyone have confidence in this field of academia?

Their estimates for the UK are equally outlandish. They claim that processed and red meat causes 70,000 deaths a year in Britain. That’s one in nine! 70,000 deaths is far more than is said to be caused by obesity and ten times more than is caused by alcohol. If today’s estimate is correct – and let’s face it, it’s not – only smoking can rival it.

If you can swallow the idea that 2.4 million people are struck down by bacon butties and surf-and-turf every year, you might be inclined to believe the authors’ estimate that processed and red meat incurs a cost of $285 billion to the world’s healthcare systems each year. Taking this figure and adding in some unspecified assumptions about the cost to the environment of cattle emitting greenhouse gases, they decide that the price of processed meat should rise in rich countries by an average of 111 per cent to offset its negative effects.

Calculations of this sort are not unusual in economics. The standard way of dealing with negative externalities is to implement a Pigovian tax, thereby passing the external costs of consumption back to the user. To do that, you must first work out what the net external costs are. This is where people in ‘public health’ invariably go wrong, counting internal costs (such as lost productivity) as external costs and failing to subtract savings. People who live to a ripe old age tend to cost a lot of money, but a classic mistake in ‘public health’ studies of this kind is assuming that someone who avoids a diet-related disease will avoid every other disease and never trouble the health service again.

Today’s study is not detailed enough for us to tell whether the authors have made all of these mistakes but the sheer size of their estimates suggest they have. They reckon that the UK alone needs to tax meat-eaters to the tune of £2.9 billion a year. This, they say, will reduce consumption of processed meat by ten grams a day and save 6,100 lives. That is nearly half a million pounds for every hypothetical life.

Leaving aside the garbage-in, garbage-out methodology at the root of these numbers, it seems unlikely that a British government – even one that bans plastic straws and taxes fizzy drinks – will introduce a 78 per cent tax on processed meat any time soon, although that is what the authors recommend. It is even less likely that everybody in the world will go vegan, although that is what the lead author, Marco Springmann, told delegates needed to happen at the End of Meat conference last year.

And yet every nanny state policy sounds absurd until the public have been battered with soundbites, dodgy statistics and empty promises for a few years. Nobody who has witnessed the unstoppable rise of the ‘public health’ movement over the last two decades can dismiss the possibility of a meat tax being introduced in the foreseeable future, probably followed by an advertising ban and graphic warnings.

The odds shorten when you consider that it is not just the ‘public health’ lobby that wants it. There is now an unholy alliance between health campaigners, vegans, vegetarians and environmentalists on this issue. This is the next battleground of lifestyle regulation and only a fool would bet against the people who always win.


Monday, 18 October 2021

Minimum pricing isn't working

Promises, promises

More evidence from the minimum pricing evaluation has been published and it seems that the policy has failed to achieve one of its main aims. The infamous Sheffield model predicted that a 50p minimum price would lead to 3,500 fewer crimes in the first year. 

Charlie Peters has the details...

Supporters of Scotland’s regressive alcohol legislation took a hit this week when it was revealed that minimum unit pricing had only had a ‘minimal effect’ on drink-related crime.

A Manchester Metropolitan University study looked at Police Scotland data collected since 2015. It found that there were no statistically significant changes in alcohol-related crime, disorder and public-nuisance offences after 2018, when a minimum price of 50p per unit was introduced.

Saying it had a 'minimal effect' is flattering to the policy. There was no measurable impact at all.

"On the whole, the limited discernible impact of MUP on alcohol-related crime, disorder and public nuisance suggests that the reduction in off-trade alcohol sales that followed implementation is below that required to deliver a reduction in crime," Prof Bannister added.
"Or, if crime did reduce, it has done so at a scale that the evaluation could not identify".

You may recall that the same modellers predicted that lowering the drink drive limit would reduce road traffic fatalities by 6 per cent. It did nothing of the sort.

The rest of the real world evidence on minimum pricing is far from compelling. There was a fall in alcohol consumption after the policy was implemented, but it was not accompanied by any decline in alcohol-related A & E admissions, nor in alcohol-related hospital admissions. The number of alcohol-related deaths fell in 2019, but rose sharply in 2020 (as they did in England - at about the same rate). The policy has cost Scottish drinkers tens of millions of pounds.

Naturally, the state-funded pressure group Alcohol Focus Scotland is not taking this lying down. They ar demanding the floor price be raised to 65p.


Friday, 15 October 2021

Denominators

In my City AM column today, I start with Richard Doll's research into smoking before discussing vaccine efficacy and our current obsession with the number of Covid deaths. The common denominator is denominators.

In the late 1940s, Austin Bradford Hill and Richard Doll began interviewing hundreds of hospital patients, half of whom had lung cancer while the other half had various other diseases. Their research, published in 1950, showed that 99.7 per cent of the male lung cancer patients had a history of smoking. Out of 649 patients, only two were nonsmokers. In retrospect, it seems amazing that no one had spotted the link between smoking and lung cancer before, but it is less surprising when you consider that 94.8 per cent of the men who were not in hospital with lung cancer also had a history of smoking. 

This might not seem like such a big difference. The vast majority of the men in hospital had smoked tobacco, regardless of what they were being treated for. And yet a statistician can tell from the figures above that smokers were fourteen times more likely to get lung cancer than nonsmokers.





Thursday, 14 October 2021

A swift half with Tim Stanley

My guest in the latest episode of The Swift Half is the author and columnist Tim Stanley. He has a new book out about tradition and we discussed the principles of conservatism.




Thursday, 7 October 2021

Alcohol-related deaths fall by 23% (sort of)

The Office for Health Promotion has got off to a flying start by announcing a 23% fall in alcohol-related deaths in England. This was achieved by changing the methodology behind the estimate and it was a piece of work carried out by Public Health England, but I'll take it. 

During the pandemic, there has been a lot of confusion about how many people have died 'with Covid' as opposed to 'of Covid', despite us having the death certificates showing how many died with Covid as the underlying cause (which is about 90% of all Covid-related deaths). 

I wonder how many of the people arguing the toss about this realise how shaky the figures are for obesity, smoking and alcohol-related mortality. For these diseases, academics tend to the use the system of attributable fractions. Put simply, they work out how many people are exposed to a risk factor (eg. alcohol) and then work backwards from epidemiological studies which show the increase in risk to estimate what proportion of deaths are caused by the risk factor.

Death certificates are not involved when it comes to establishing causation. The academics just look at the number of deaths from, for example, heart disease and state that x% were caused by smoking, alcohol, obesity etc. 

And so we decide that 50% of drownings are due to alcohol, for example, and then see how many drownings take place each year. It's a rough and ready estimate that has the virtue of being cheap, but it is prone to all kinds of flaws and uncertainties. Observational epidemiology is not an exact science and it is very difficult to establish the baseline risk (ie. the risk to someone who has no obvious risk factors).

Every few years, the academics update their assumptions. That is what has just been done. They also update their estimates of exposure. Previously, PHE was using alcohol consumption data from 2005 when the good people of England were drinking more than they do today. 

The result is a substantial reduction in the apparent harm done by excessive drinking. The number of alcohol-related hospitalisations has fallen below one million for the first time in years (a figure that has been inflated by the inclusion of more secondary diagnoses) and alcohol-related mortality is 23% lower than previously estimated.


I emphasise excessive drinking because the authors acknowledge that there is little to be gained by getting the average drinker to reduce his consumption.

As alcohol can be so damaging to health, wellbeing and society, it’s obviously a positive thing that England’s overall consumption of alcohol has fallen. However, before we become complacent, we should consider in more detail the alcohol consumption patterns across the population. If we look beneath the population-level trend, we can see data on consumption to suggest that many of the people who have chosen to drink less (or not at all) are those who were not at greatest risk of harm. It appears that many heavier drinkers, who are at most risk, have not reduced their alcohol consumption and may even have increased it.

This is another blow to the single distribution theory of drinking and the whole population approach to alcohol.

The new estimates cover 2019 but do not yet extend to 2020 when we saw a big rise in alcohol-specific deaths despite a significant fall in consumption. This, too, shows that the whole population approach is misguided.


Monday, 4 October 2021

Anti-alcohol cranks call for academic censorship

The psychologist Mark Petticrew has got it into his head that the rather dull health information charity DrinkAware is covertly promoting binge-drinking and drinking while pregnant while also downplaying the risks of alcohol. He has been banging this drum for four years now, producing several studies based on cherry-picking and misrepresentation. Most recently, he resorted to trawling through DrinkAware's Twitter feed crying 'bias' whenever a tweet wasn't as overtly anti-alcohol as those sent by temperance groups. 

The mini-literature he has built up serves no purpose other than to sustain his theory that everything the alcohol industry touches (for it is they who fund DrinkAware) is evil. It is all rather pathetic, but nothing is too trivial to be turned into a peer-reviewed study in the world of 'public health'.

This little saga has reached a new low with two of Petticrew's fellow cultists publishing their own 'study' defending their mate and condemning DrinkAware for having the temerity to respond to his daft accusations. Drinkaware and two other organisations had responded to the first of his articles in the journal that published it, pointing out some of the many inaccuracies and sleight of hand. Incidentally, that article was titled 'How alcohol industry organisations mislead the public about alcohol and cancer' because this is gotcha journalism we're dealing with, not serious academia.

The new study is one of most petty pieces of navel-gazing I've ever come across in a journal. They looked at three of Petticrew's articles and eight of the responses from DrinkAware and the other 'social aspects organisations' (SAOs) he attacked. They then look at four replies from Petticrew and his colleagues.

Why? Essentially to adjudicate. They decide that Petticrew was basically right and the SAOs were basically wrong. Crucially, they enshrine their biased opinion in a peer-reviewed publication that campaigners can wave around.

To make this sound slightly more like an academic exercise and less like score-settling, they describe their methodology as follows:

The analysis began with the first author, who was not immersed in the scientific literature in question, identifying the series of claims and counterclaims before the second author applied his reading of the debates


The second author is Jim McCambridge, a bona fide fanatic who is obsessed with the alcohol industry and is about as far from a disinterested third party as can be imagined. 

The two authors go through the accusations and rebuttals as if they were having an argument on a message board, shouting 'straw man' at the SAOs and accusing them of not responding to the main point. 

...there is a refusal to engage with the arguments made by Petticrew et al.

.. This response largely ignores Petticrew et al.’s attention to context and audience

.. The responses by SAOs raise narrow questions of content accuracy, rather than engaging with the overall findings of the articles

And so on and so forth. It is rather tedious and childish.

It is only when you get to the discussion section that the purpose of the study becomes clear. Aside from establishing that their pal is right and his opponents are wrong, their real beef is with industry-funded organisations being allowed to respond in journals at all. 

We argue that these controversies are scientific in location only, being published in peer-reviewed journals.

.. The forum is important. These replies become scientific artefacts, legitimated by publication in the scientific literature, a resource to be used in subsequent disputes as we see in the later responses of both Drinkaware and Éduc’alcool. In the future, it will be possible to write, “previous papers by Petticrew and colleagues have been heavily criticized,” attaching several references to add credibility to such claims, just as Sim et al. (2019) use Larsen et al. (2018). 

It is not hard to see an element of projection here. This should have been a blog post, not a study. The only reason it has been published as a study is so it looks respectable and can be cited.  

It is key to remember here that whereas the audience for a genuine scientific controversy includes other scientists in the field, the audiences for a counterfeit scientific controversy are people outside the field (e.g., the public, policy makers, journalists). These audiences cannot be expected to possess the tacit knowledge, obtained by socialization in the research community, that would allow them to discriminate between sources and to identify genuine disputes between scientists. 

The responses from the SAOs were all published in the Journal on Studies of Alcohol and Drugs or in Drug and Alcohol Review. These are the journals Petticrew published his studies attacking the SAOs in the first place (which is obviously why the responses were published in them). The Journal on Studies of Alcohol and Drugs is where this study has been published. If the readers of these relatively obscure journals don't have the "tacit knowledge, obtained by socialization in the research community" then who does? 

The editor of this journal obviously doesn't think it is a 'counterfeit scientific controversy' and he probably doesn't want to get sued, which might have been the SAO's second option. So he gave the SAOs the right to reply. Given the severity of the accusations and the shaky grounds on which Petticrew made them, it was the least he could do.

The arrogance of the authors is extraordinary. How dare they decide what is real controversy and a fake one? Who are they to decide who has the ability to understand a simple back-and-forth in relation to studies that are so basic that none of them involved more than scrolling through a website?

The replies, printed in peer-reviewed journals, thus operate as public relations exercises given legitimacy by being located within the scientific literature

You can probably guess what comes next. That's right, it's a none-too-subtle call for censorship. 

It is appropriate for journals to consider why they publish this kind of content, which adds to the burden of doing work in this area, manufacturing doubt about (and distracting attention from) important scientific issues, in part by facilitating attacks on published research and researchers. These organizations can write what they like on their websites, but why should journals publish such harmful material?

"Harmful material"! These people are dangerous cranks. Write that up and turn it into a 'study'.


Saturday, 2 October 2021

Goodbye Public Health England, hello Office for Health Promotion and Disparities



Public Health England is no more. I had to give it one kicking for Spiked...

A whole book could be written about the bottomless incompetence and quixotic delusions of an organisation that swallowed £4 billion a year. This is an agency that decided not to bother testing people for Covid at airports during a pandemic because PHE higher-ups’ limited cognitive abilities led them to believe it wasn’t worth it. It paid academics to fiddle with its computer model to justify lowering the ‘safe’ level for alcohol consumption. It claimed that smokers were 14 times more likely to suffer a bad case of Covid just as evidence was emerging to show that smokers were significantly less likely to catch the virus. Even in the gambling report that turned out to be PHE’s swansong, you can sense the disappointment when it found no link between problem gambling and smoking or obesity.


Now on to the Office for Health Promotion and Disparities...


Friday, 1 October 2021

Conspiracy theorist sacked by Bristol University


David Miller has finally been sacked by Bristol University. Professor Miller runs two grubby conspiracy websites, SpinWatch and Powerbase, and seems to be rather obsessed with 'Zionists'. See how many times Powerbase's entry on 'neoconservatism' mentions Jews, for example.  

Miller had already been suspended by the Labour Party (and later quit) for accusing Keir Starmer of taking "Zionist money" and he has called Jewish students "pawns" of Israel. 

Less well known is Miller's involvement in the wingnut faction of 'public health'. His 'join the dots' paranoia and theories about 'webs of influence' align nicely with the fixations of people like Anna Gilmore at Bath University where Miller worked as a sociology professor for most of the 2010s. 

Despite having no qualifications in health, Miller was taken on as an 'investigator' at the UK Centre for Tobacco and Alcohol Studies alongside Petra Meier, Gerard Hastings and others. 

From 2012, Gilmore and Miller worked together as PhD supervisors for an EU-funded project that was literally called 'Web of Influence'. 

The student will conduct their research under the supervision of Professor David Miller and Professor Anna Gilmore. 
The Project

The successful applicant will assist with a research team working on a new research programme within a large-scale project funded by the European Commission, ALICE RAP. ALICE RAP aims to critically examine and analyse currently fragmented research and strengthen scientific evidence to inform a new dynamic platform for public and political dialogue and debate on current and alternative approaches to addictions.

The specific project titled the ‘Web of Influence’ focuses on the poorly understood role of economic actors in public policy formation. The project will examine the ‘web of influence’ of four ‘addictive industries’ (Food, Tobacco, Alcohol and Gambling).

As recently as last October, after he had been suspended by the Labour Party and long after the first accusations of antisemitism had been made against him, Miller sat on a panel discussing corporations, neoliberalism, etc. with Anna Gilmore and Mark Petticrew - both of whom will be familiar to regular readers of this blog - at the World Congress of Public Health. 



To my knowledge, none of Miller's old colleagues have gone as far down the rabbit hole as he has, but it is interesting that someone like him can get so far in 'public health' without his crank tendencies being noticed, is it not? 


One of Prof Miller's contributions to academia




How's that war on smoking going?

The Foundation for a Smoke-Free World has commissioned a report that gives a comprehensive overview of the state of tobacco harm reduction around the globe. It looks at its potential and its challenges. 

Encouraging smokers to switch away from cigarettes should be a no-brainer in public health, but things are going backwards in many parts of the world thanks to Bloomberg, the WHO and other malevolent entities who are misguided, at best.

You can download it here. Well worth a read. 














Thursday, 30 September 2021

You can't appease fanatics

Live With Littlewood was back last night, for the first time in a studio with an audience. One of the topics that came up was the Obesity Health Alliance's latest list of demands. This didn't get much attention from the media, which must have upset them, but it really shows what happens when you give fanatics an inch.


The Obesity Health Alliance claim that their long list of demands will 'turn the tide' of obesity. This is a tacit admission that all the policies they spent years campaigning for and which the government has introduced or will soon introduce - the sugar tax, the food advertising ban, reformulation, banning BOGOFs, keeping 'junk food' out of shop entrances and exits, etc. - will not reduce obesity. They are certainly not prepared to wait and find out.

You can read their report here if you must. Lowlights include the suggestion that children be banned from buying food high in salt, sugar or fat, that the advertising ban be extended to cinemas, radio and billboards, and that the ridiculous food reformulation scheme somehow becomes mandatory.

The proposal made by the UK Government in 2019 to restrict shops from selling energy drinks to under-16s is a new potential policy lever to restrict children from purchasing unhealthy food

Restrictions on advertising unhealthy products from categories that contribute to children’s excess sugar and calorie intake are due to be introduced in 2022 across the UK, subject to Parliamentary approval, with a 9pm watershed to be applied to all TV channels, regardless of audience size. These new restrictions should be implemented in full and extended to cover all other media where advertising can be time restricted, such as cinema and radio. 

A comprehensive approach to outdoor advertising (both traditional posters and digital billboards plus advertising on transport) is needed to bring it in line with the broadcast and digital environment. This should be achieved with a total restriction on unhealthy food and drink advertising, meaning only healthier products are advertised. 

They think there should a legal cap on the number of calories in snacks...

Make a specific, time-bound commitment to introduce regulation to mandate calorie limits on single-serve portions of HFSS products if 25% of the calorie reduction targets have not been achieved by the first report point (2022) in the ongoing calorie reduction programme.

A mandatory upper limit on calories per single portion of unhealthy foods would limit excessively large portion sizes, particularly in the OOH sector. 


They want to ban Tony the Tiger and stop companies making truthful statements about their products...

Introduce new regulations to limit the use of promotional techniques on unhealthy food and drink product packaging.

This should include the following:
• Restrictions on the use of cartoon, brand equity and licensed characters along with celebrities and sports stars.
• End the use of on-pack promotional offers including give-aways, and competition prizes.
• Restrictions on nutritional and health claims.

They want price controls... 

Explore and develop effective policies that address disproportionate pricing structures on HFSS products, to prevent multi-portion servings being sold for proportionately less than individual servings.
Since plans to introduce a ban on multi-buy promotions and location-based promotions were first announced in 2018, some large retailers have switched promotion strategies to focus on price reduction, rather than multi-buys [who could have seen that coming?! - CJS]. Further research is needed to understand if price-reduction strategies lead to increased purchasing in the same way as multi-buys, with further regulation needed if this is the case. 
 
And more taxes...

Introduce a fiscal lever on food and drink manufacturers to incentivise further reformulation of processed food, such as the sugar and salt reformulation tax proposed in the National Food Strategy.

Assess the potential and utility of fiscal stimulus mechanisms to support food businesses to shift towards the production, manufacture, and sale of healthier food and drink products.

The barriers to businesses shifting their business models towards those that favour healthier foods need to be addressed through fiscal policies, incentives and investment, with taxes on unhealthy ingredients in processed food being a clear, evidence- informed way to have a positive impact on outcomes related to obesity.

Lots of taxes...

A key fiscal tool that the Government has at its disposal is the use of taxes on unhealthy ingredients in processed food, with substantial evidence that taxation can have a positive impact on outcomes related to obesity. 

Building on the success of the SDIL, a direct levy payable by the food and drink industry is the most effective way to achieve reformulation and should be implemented by the UK Government as a priority. 

And bans on food outlets opening...

...restricting granting or renewal of licences for establishments selling unhealthy food and use of exclusion zones to limit fast-food takeaways around schools, parks and leisure centres

They also seem to think that some shops should be banned from selling sweets, crisps, etc. altogether.

The growth of portion sizes needs to be addressed in conjunction with many other changes to the food environment, including the ready availability of unhealthy foods at non-food retail outlets (such as garages, clothes retailers and charity shops). 

It is not enough to stop companies advertising 'less healthy' foods, the companies must be prevented from advertising at all if the 'public health' lobby thinks they are associated with these foods.

There is a need to extend advertising restrictions to the brands that are associated with predominantly unhealthy products, as well as to the individual unhealthy products themselves: under the forthcoming restrictions, brand advertising will be permitted so long as it does not include identifiable unhealthy products. This will require the development of a new methodology to determine whether brands are associated with HFSS products based on their product portfolios and sales

Naturally, this will require yet more bureaucracy paid for with all that sweet, sweet taxpayers' money.

The issues with the current self-regulatory system are not unique to unhealthy and food and drink advertising and addressing this is part of the UK Government’s wider online harms agenda. More broadly, there is a need to establish a new independent regulatory approach that includes the pre-approval of advertising of all types, monitor compliance and sanction non-compliance with fines.

These people want nothing short of state control of the food supply. They are quite mad, but the government capitulated to them last time so who is to say it won't capitulate again?


Tuesday, 28 September 2021

Smoking, COVID-19 and Mendelian Randomisation


It's been interesting to watch how the Guardian has been covering the research into smoking and COVID-19. Like many media outlets, they reported the news last spring that researchers had found an inverse association between smoking status and Covid-related hospitalisations and that work was underway to see if nicotine patches would help people recover from the disease. 

Since then there have been many more relevant studies published which the Guardian has ignored, possibly because they nearly all show that smokers are less likely to be infected with the virus than non-smokers

It has only revisited the topic twice. The first was when some researchers in San Francisco did some modelling and claimed that smokers (and vapers) were more 'medically vulnerable' to COVID-19. The second was when a study was retracted because of undisclosed 'links to the tobacco industry'.

In the meantime, there have been six editions of a comprehensive meta-analysis, the last of which looked at 87 studies and concluded that smokers are 33% less likely to be infected with the coronavirus, no more likely to be hospitalised with Covid than non-smokers and no more likely to die from Covid than non-smokers. 

The Guardian is not alone in ignoring all this research. Hardly anybody in the media has touched the issue for over a year. But the Guardian is back today with a new story...

Smokers up to 80% more likely to be admitted to hospital with Covid, study says

Smokers are 60%-80% more likely to be admitted to hospital with Covid-19 and also more likely to die from the disease, data suggests. 

 A study, which pooled observational and genetic data on smoking and Covid-19 to strengthen the evidence base, contradicts research published at the start of the pandemic suggesting that smoking might help to protect against the virus. This was later retracted after it was discovered that some of the paper’s authors had financial links to the tobacco industry.

The unwary reader might assume from this that only one study has suggested that 'smoking might help to protect against the virus' and that this study was retracted. This is untrue. Dozens of studies have come to that conclusion, including in top journals such as the NEJM, Nature and the Lancet, and the one that was retracted was not published 'at the start of the pandemic'. (It is also important to note that it was not retracted because there was anything wrong with it; only that the journal has a policy of not publishing research by anyone with 'links' to tobacco.)

The new study uses Mendelian Randomisation which looks at the health outcomes of people who have certain genes. In this instance, it looks at people who have a genetic propensity to smoke. Apparently these people were more likely to be hospitalised with Covid, although the authors acknowledge that a genetic propensity to smoke may also correlate with a more general propensity to take risks with one's health such as ignoring social distancing guidelines. 

Mendelian Randomisation can be a very useful tool, but it has so far been shown to be weak at best and misleading at worst when it comes to lifestyle-related diseases. The obvious problem is that people who have genes which give them a propensity to do something do not necessarily do it. This is a particular problem when it comes to smoking because people's propensity to smoke has been severely curtailed by decades of public education, stigmatisation, high taxes and so on. 

Consequently, MR studies have found a link between smoking and lung cancer, but the association is much smaller than that found in observational epidemiology. In MR studies, it barely doubles the risk whereas smoking increases the risk by a factor of 10 or 20 in reality. If you take these studies seriously, smoking doesn't increase the risk from most cancers at all and only mildly increases the risk from a few others. (I have written about this before.)

MR research into alcohol has also been near-useless. MR studies have been cited as evidence that moderate drinking doesn't reduce the risk of heart disease (in contrast to many dozens of epidemiological studies which show that it does), but it is an inconvenient fact that MR studies don't show any risk from drinking either. An MR study published last year failed to find any statistically significant link between drinking and any disease except, bizarrely, lung cancer.

The methods are simply too blunt to find anything other than the strongest associations (smoking and lung cancer being the obvious example). Advocates of MR in lifestyle research claim that it cuts out confounding factors, such as socio-economic status, but it has a much bigger problem in that it incorrectly identifies people as smokers or drinkers when they are not. 

“The study adds to our confidence that tobacco smoking does not protect against Covid-19, as their Mendelian randomisation analyses are less susceptible to confounding than previous observational studies,” wrote Dr Anthony Laverty and Prof Christopher Millett of Imperial College London in a linked editorial published in the journal Thorax.

This is activist-driven spin (we have encountered Christopher Millett before and the editorial in question openly calls for more 'tobacco control' policies). The obvious point is that if smokers were 60-80% more likely to be admitted to hospital with Covid, we would see evidence of it in the hospital admissions data. But we don't. Time and time again, we find that smokers are less likely to be admitted to hospital with Covid. 

MR studies take a bit of work for journalists to get their heads around and the studies themselves rarely provide enough information for the reader to see what is going on. In this instance, as with the moderate drinking issue, MR seems to have been wheeled out to contradict findings that are inconvenient for the 'public health' lobby rather than to provide illumination.

The study also contains some observational epidemiology. The number of smokers in this part of the study is suspiciously small. Only 3.3% of the sample confess to smoking (the national rate is 14%). This may reflect the demographics of the kind of people who sign up for these things, or it may reflect undisclosed smoking, or both. Whatever the reason, the researchers still found that smokers were less likely to be infected with Covid, with heavy smokers being half as likely to be infected. You have to go to the supplementary tables to discover this. The authors do not report it in the text.

The idea that smokers are more likely to suffer more from COVID-19 if they get it is, of course, very plausible. Nearly all the evidence shows that former smokers are more likely to be hospitalised with Covid, presumably because they are more likely to have pre-existing health conditions.

The question is whether smokers are less likely to catch the virus in the first place. And if they are, why? If they aren't, why do antibody tests of whole populations (before vaccination campaigns began) find that smokers are less likely to have antibodies, i.e. they are less likely to have been infected? 

Confounding factors cannot be blamed for this and a study which combines the MR method of assuming somebody is a smoker based on their genetic profile with an observational element based on a sample that is clearly not representative of the public at large and contains hardly any smokers does not give us a compelling answer. Nor, if this study is correct, does it explain why all the other studies are wrong. 


Friday, 17 September 2021

Idiotic sugar reduction scheme spreads to Europe

The UK's hopeless sugar reduction scheme is spreading to Europe thanks to the equally hopeless WHO. 

I've written about it for The Critic...

If you want to know what the new, outlook-looking, post-Brexit, global Britain is all about, the Department of Health dropped a clue this week. In a punch on the nose for embittered Remoaners, it announced that the UK “has been chosen by the World Health Organization (WHO) to lead a new Sugar and Calorie Reduction Network to take global action on sugar and calorie reduction.” In a press release, the Department of Health mentioned twice that the WHO’s EU region “covers around 50 countries” and has “a much wider reach than the European Commission’s remit.” In your face, Eurocrats!

The UK has been selected because of its “world-leading expertise in domestic sugar and calorie reduction”. The UK may be one of the fattest nations in Europe, but thanks to the nearly-dead Public Health England it “has seen good progress with its sugar reduction programme — with sugar reduced by 13 per cent in breakfast cereals, yogurts and fromage frais”. Swarthy foreigners are naturally eager to emulate this triumph and they kneel at our feet awaiting instruction. They, too, want to make chocolate bars slightly smaller and corn flakes less tasty.

“Today’s announcement puts into action the UK’s ‘Global Britain’ ambitions”, said the Department of Health, presumably with a straight face. The scheme will be run by the new Office for Health Improvement and Disparities which opens for business at the start of next month as the replacement for Public Health England. If there was any doubt that the Office for Health Improvement and Disparities would be Public Health England with new stationery, it has been confirmed by its embrace of this dog’s dinner of a policy.


Thursday, 16 September 2021

Lowering the drink-drive limit didn't work in Scotland

My City AM column today is about the way governments prefer legislating to governing...

In December 2014, Scotland introduced a new policy modifying its drink-drive limit, to reduce the number of alcohol-fuelled traffic accidents. The legal limit was slashed from 80 to 50mg per 100ml of blood. Now, seven years later, a study published in the Journal of Health Economics has looked at the impact of the policy. The results are perhaps surprising.


Do have a read.




Sunday, 12 September 2021

How a typo tricked the media: half a beer a week won’t harm your health

First published in Spectator Health in February 2017

Eggs were on faces yesterday after some astonishingly bad science reporting in sections of the media. In articles that have since been taken offline, the Telegraph and Mirror announced that half a pint of beer a week is sufficient to harden the arteries and cause heart disease. Given the almost homeopathic quantities of alcohol involved — not to mention the fact that moderate drinking is known to reduce heart disease risk — this was a rather surprising finding, but it had supposedly been published in the Journal of the American Heart Association and was therefore considered legit.

Alarm bells started ringing when the Telegraph came up with this eyebrow-raiser:

‘The UK study defined consistent long-term heavy drinking as equivalent to drinking one serving of alcoholic spirit, half a pint of beer or half a glass of wine per week.’

The idea that drinking half a pint of beer once every seven days constitutes ‘long-term heavy drinking’ is patently ludicrous. There are some strange ideas floating around in the world of ‘public health’ these days, but things are not quite that mad. You have to wonder how that sentence got written, let alone approved and printed, without somebody at the Telegraph saying ‘surely that can’t be right’?

The rest of the story hinged on this basic error. The study itself is pretty good. Its authors set out to see whether heavy drinking stiffens people’s arteries, because arterial stiffness is a predictor of cardiovascular disease. They used a database of civil servants stretching back to the 1980s and measured something called pulse wave velocity (PWV) to gauge the state of their arteries. The higher the number, the harder the arteries.

The authors note that previous research has found the relationship between PWV and alcohol consumption to be J-shaped, which is to say it is relatively high for non-drinkers, lower for moderate drinkers and high again for heavy drinkers. This is significant because the relationship between cardiovascular disease and alcohol consumption is also J-shaped, ie moderate drinkers have a lower risk than both those who abstain and those who drink heavily.

The authors set out to test this and succeeded. Defining heavy drinkers as anyone who consumed more than 14 units a week, and measuring in metres per second (m/s), they found PWV levels among men of 8.8 m/s for non-drinkers, 8.3 m/s for moderate drinkers and 8.7 m/s for heavy drinkers. Among women the readings were 8.6 m/s, 7.9 m/s and 8.3 m/s.

Over the years, the PWV levels rose, but it was the non-drinkers and ex-drinkers who saw their levels rise the most. By contrast, the authors note that ‘stable moderate drinkers have the lowest PWV values throughout the study period’.

This seems to confirm the J-curve, but how does it support the claim that drinking half a pint a week gives you heart disease? It doesn’t. The study found the exact opposite of what the Telegraph and Mirror claimed. It showed that moderate drinkers, including those who limit themselves to a swift half once a week (if such people exist), have a lower risk of heart disease than those who never drink at all. So how did the press get it so wrong?

If you are going to rely on reporting science by press release, you have to be confident in the press release. Unfortunately for the fourth estate, this one was a stinker. The study’s authors defined anyone who drank more than 112 grams of alcohol a week as a ‘heavy drinker’. There are eight grams of alcohol in a unit, therefore they were drinking more than 14 units, but when the press release tried to explain this, it all went wrong:

‘Consistent long-term, heavy drinking was defined in this UK study as more than 112 grams (3.9 ounces) of ethanol per week (roughly equivalent to one serving of alcoholic spirit, half a pint of beer, or half a glass of wine); consistent moderate drinking was 1-112 grams of ethanol per week.’

The first part is true and so is the last bit. It is the middle section that’s the problem. 112 grams is by no means ‘roughly equivalent to one serving of alcoholic spirit… [etc]’. It is 14 servings of alcoholic spirit. I can’t be sure how this error crept in. My hunch is that whoever wrote it meant to put ‘eight grams of ethanol is…’ just before ‘roughly equivalent…’, but failed to do so.

Whatever the reason for this slip, it was dutifully repeated by sections of the media and the bizarre notion that ‘long-term heavy drinking’ is defined as one unit a week was born. And since the study found that heavy drinkers have harder arteries, this turned into ‘Just half a pint of beer a week increases risk of heart disease — new study’ (you can read the now deleted Telegraph article here thanks to the Wayback Machine).

I hesitate to call anything a new low in health reporting but this is definitely in the same postcode as the nadir. I think there are two lessons that can be learned from it.

Firstly, if proof were needed that some reporters do not read the research they write about, this is it. It is glaringly obvious that the journalists in this instance did not give so much as a cursory glance to the abstract, let alone to the tables. This is worth bearing in mind next time you read a health report in a newspaper.

Second, it says something about the outlandish claims made by ‘public health’ academics that a journalist would find it perfectly believable that they have not only started to define ‘heavy drinking’ as one small drink a week, but that they view this as a potentially lethal dose.

Daft as this may seem, it has to be put in the context of previous assertions by the ‘public health’ lobby which have been accurately reported under such headlines as ‘Cancer risk of two beers a year’, and ‘No safe level of drinking, health chiefs warn’. If you spend your working hours reading press releases from people who think that roast potatoes and buttered toast are the new asbestos, it can’t be easy to separate fact from fantasy.

The Telegraph and Mirror did such a bad job of reporting this particular story that they made the rest of the media look like Pulitzer prize winners, but the truth is that everybody covered it pretty badly. The Sun ran with ‘Men who drink ONE pint a day are “increasing their risk of having heart disease or a stroke”‘ and the Daily Mail went with ‘How just one pint a day can increase the risk of heart disease by prematurely ageing the arteries’.

While both newspapers avoided the ‘half a pint a week’ booby trap, they used the lightest of ‘heavy drinkers’ as their example to make a claim that is not supported by the study. On average, the people in the study who drank more than 14 units a week had stiffer arteries than those who drank less, but averages can be misleading. There is nothing in the data to suggest that 14 units is the threshold at which risk increases. It could be 30 or 40 units for all we know.

More importantly, every newspaper ignored the crucial finding that the heavy drinkers only had an ‘increased risk of heart disease’ if you compared them to moderate drinkers. It was the non-drinkers – both ex-drinkers and lifelong teetotallers — who had the stiffest arteries of all.

This is biological evidence which supports the enormous quantity of epidemiological evidence showing the benefits of moderate drinking to the heart. It is the only reason anyone in academia would be interested in it and yet it is the one finding that went without mention yesterday. 
 
Off the back of a typo in a press release, a study which found that moderate drinking protects against heart disease turned into a story about tiny quantities of alcohol causing heart disease. It’s a good job nobody takes this stuff seriously any more otherwise the public could become confused.


Thursday, 9 September 2021

Disruptive innovation webinar - today

I'll be speaking at a webinar on vaping at 7pm UK time (2pm EST). I'll be mainly talking about how the UK became a success story for tobacco harm reduction by not doing too much. Click here to sign up.


There's a new report to accompany it, including a chapter by me about the British experience.


Wednesday, 8 September 2021

The envy of the world

I've got an article in the Daily Mail today about the NHS.

The reality is that it is not normal for a health service in a rich country to have a flu crisis every winter.

We expect to wait months for an operation and are pleasantly surprised if we wait less than several hours in A&E.

We are meant to be impressed by being able to see a GP today, even though we called yesterday. Services that would be substandard in many countries are regarded in Britain as normal, if not excellent.

The fact is that the NHS is a failing system. The UK has 2.5 hospital beds for every 1,000 people, close to half the EU average and less than a third of the number in Germany — or even Bulgaria.

We have 2.8 practising doctors for every thousand people, fewer than any EU country bar Poland and Cyprus and well below the EU average of 3.7 per 1,000.

The UK's cancer survival rates lag behind Italy and France, and more of us die from cancer than do Belgians, the Dutch, Germans, the Japanese and New Zealanders — all countries with a social health insurance system.

Rates of 'avoidable deaths' are even worse.

In 2014, a league table by the Commonwealth Fund found that Britain performed well on 'access', 'equity' and 'care process' but came second-last for 'health care outcomes'.

What does that mean? As the Left-wing Guardian newspaper put it, the 'only serious black mark against the NHS was its poor record on keeping people alive'.

Do have a read.



Tuesday, 7 September 2021

The gambling epidemic that never grows

First published by Spectator Health in February 2016

Doctors prescribe drugs to tackle Britain’s gambling epidemic’ was the top story on the Times‘s front page on Wednesday. ‘The growing toll of problem gambling in Britain,’ it said, ‘is now so serious that the NHS has started prescribing £10,000-a-year drugs for some of the worst addicts.’ The Times echoed calls from the Campaign for Fairer Gambling for a ‘crackdown on fixed-odds betting terminals (FOBTs), which have been dubbed the “crack cocaine” of gambling’.

There are several problems with this story. A few years ago, I dug into the claim that FOBTs were the ‘crack cocaine of gambling’ and found that virtually every form of gambling has been given this tag at one time or another. I tracked it back to Donald Trump in the 1980s who used it to describe a video bingo game called Keno which he saw as a threat to his casino business. Since then it has been used to attack video lottery terminals, slot machines, pokies, horse racing, lotteries, casinos, internet gaming and scratchcards.

When my research was published I had the vague hope that people would think twice before parroting the ‘crack cocaine’ claim about FOBTs in the future, but that was clearly in vain. Three years later, it is seemingly impossible for any newspaper to write about these machines without including this evidence-free metaphor.

Secondly, there is precious little evidence that there is a ‘growing toll of problem gambling in Britain’. The British Gambling Prevalence Survey is by far the most thorough body of research in this area. Sadly now disbanded, it produced three reports using two separate methodologies to measure problem gambling between 1999 and 2010. Under one methodology, it found that gambling prevalence was 0.6 per cent in 1999, 0.6 per cent in 2007 and 0.9 per cent in 2010. Under the other methodology, it found prevalence rates of 0.8 per cent in 1999, 0.5 per cent in 2007 and 0.7 per cent in 2010. This suggests little, if any, change in the first decade of this century despite the introduction of FOBTs and the liberalisation of much of the gambling industry.

The British Gambling Prevalence Survey has since been replaced by Health Surveys for England and Scotland. The latest English report, published in 2013, found a problem gambling prevalence of 0.5 per cent under one methodology and 0.4 per cent under the other. The latest Scottish report found a prevalence rate of 0.5 per cent under both measures. If there is an ‘epidemic’ of problem gambling, it has been missed by every reputable survey.

The Times ignores the latest prevalence studies and instead claims that there are 562,000 problem gamblers in Britain. This is based on the fact that ‘the last gambling prevalence survey in 2010 found there were 450,000 problem gamblers in the Britain [sic] but experts at GamCare say the number of addicts is likely to grow in proportion to the size of the industry’.

Leaving aside the dubious assumption behind this factoid, the industry is not growing. After adjusting for inflation, the British gambling sector has a lower Gross Gambling Yield (which essentially means revenue) than it did in 2008. Contrary to popular belief, the number of bookmakers has been falling i the long term and has expanded only fractionally in the short term. The number of bookies peaked in 1968 at 15,782 before falling to an all-time low of 8,732 in 2000. It has risen only very slightly in the years since. At the last count, there were 8,819 bookies in the UK, representing a one per cent rise on the fin de siècle nadir, significantly less than population growth and a far cry from the ‘dramatic proliferation’ claimed by opponents of gambling.

As for the situation getting so bad that the NHS is having to dish out drugs at a cost of £10,000 per person, the prescriptions (for naltrexone) are being handed out by the National Problem Gambling Clinic, a private organisation which is mainly funded by the Responsible Gambling Trust (which, in turn, is entirely funded by the gambling industry). According to the Responsible Gambling Trust, the drug does not cost £10,000 a year. It costs £68 for three months. When I asked them about it, they told me that the clinic has only prescribed it five times since April 2015.

These are not minor discrepancies. There is a world of difference between the publicly funded NHS dishing out £10,000-a-year drugs to the countless victims of Britain’s gambling epidemic and a predominantly privately funded clinic prescribing £272-a-year drugs to five people against a backdrop of problem gambling rates that have barely fluctuated since 1999. But when have facts ever got in the way of a moral panic?


UPDATE

Since this article was written the rate of problem gambling has remained at 0.5-0.7%. It has not fallen since fixed odds betting terminals were effectively banned. See A Safer Bet. The number of bookies has, however, collapsed to 6,735 and thousands of people have lost their jobs.





Friday, 3 September 2021

A swift half with Claire Fox

My guest on the Swift Half with Snowdon this week is Baroness Fox of Buckley. You may know her better as Claire Fox. 




Thursday, 2 September 2021

Nanny State Index - interview

I was on GB News last night talking about the Nanny State Index. It was nice to have a bit more time than usual to discuss it, although I had to bite my lip when Aseem Malhotra's name came up.


 



Wednesday, 1 September 2021

Richard Doll, smoking and moderate drinking

First published by Spectator Health in January 2016


Sally Davies, the Chief Medical Officer, recently described the belief that moderate alcohol consumption was good for the heart as an ‘old wives’ tale’. This was the culmination of a long-running campaign within a section of the public health lobby to cast doubt on the large body of evidence showing lower rates of heart disease and lower rates of mortality among moderate drinkers. A report from researchers at Sheffield University, released on the same day, claimed that the health benefits of drinking were ‘disputed’ and the subject of ‘substantial debate’.

It is difficult to imagine any amount of evidence persuading Sally Davies that moderate drinking is healthy. The protective effect of alcohol on the heart was first observed in 1926 and countless studies from all around the world have confirmed it in the 90 years since. It seems that Davies places a much greater burden of proof on scientists who find a positive effect from drinking than on those who find a negative effect. This can be illustrated by looking at two light bulb moments in the career of the legendary epidemiologist, Richard Doll.

In 1950, Doll, along with Austin Bradford Hill, published the first epidemiological study showing a link between cigarette smoking and lung cancer. Many people were sceptical and potential flaws were quickly flagged up. The study had been limited to hospital patients in and around London, the vast majority of whom were smokers. In response, Doll and Hill got back to work and published a further study in 1952 which expanded its geographic reach. It came to the same conclusion.

Doll then initiated a prospective study which tracked the health of smoking and non-smoking doctors around the UK. When the first full findings were published in 1956 they once again showed a clear link between smoking and lung cancer risk.

In the meantime, researchers from other parts of the world conducted similar epidemiological studies with similar results. Gradually, it came to be accepted that the relationship was causal — smoking caused lung cancer.

Scepticism did not disappear overnight but as the years went by it was increasingly confined to the vested interests of tobacco companies and to maverick scientists who put forward alternative theories which might explain the statistical association between smoking and ill health. For example, the great statistician Ronald Fisher suggested that the early stages of lung cancer gave people the urge to smoke. Implausible though they were, such theories were not rejected out of hand but were subject to rigorous empirical testing until they were found wanting.

By 1976, when Richard Doll and Richard Peto published another edition of the doctors’ study, there was a wealth of evidence to support ‘the smoking theory’ (as it had been known) and there was a broad scientific consensus that the relationship between cigarettes and cancer was causal and proven. Alternative explanations had been tested and debunked.

Some people still refused to believe it, but they were a dwindling minority. The sceptics now became ‘merchants of doubt’, cherry-picking individual studies that seemed to undermine the larger body of evidence and raising spurious objections that had already been addressed in the scientific literature. Some demanded an impossible burden of proof by calling for randomised control trials which could not possibly be conducted even if it were ethical (which it would not be). Others said they would not believe smoking caused lung cancer until the exact biological mechanism by which it did so was identified.

Then, in 1994, Doll (now Sir Richard Doll) identified another statistical association in the data from the doctors’ study. In a study published with Richard Peto, he found that all-cause mortality was lower among moderate drinkers than it was among non-drinkers and heavy drinkers. It was not the first time such an association had been observed but some people were doubtful — not about the risks of heavy drinking but about the apparent risks of not drinking. Alternative explanations were again put forward, notably the possibility that some non-drinkers may have been former drinkers who had put their health at risk and were therefore at greater risk of premature mortality. This came to be known as the ‘sick quitter’ hypothesis.

As he had done when conducting research into smoking, Doll addressed his critics by carrying out a new epidemiological study. He published an article in 1997 looking at the question of causality which rejected the hypothesis that the association was due to confounding factors. Then, a few months before his death in 2005, he published a study based on 23 years of data which replicated the results of his previous studies while disproving the sick quitter hypothesis by comparing lifelong non-drinkers with moderate drinkers. The latter had lower rates of heart disease and lower risk of premature mortality.

By this time, Doll concluded: ‘That the inverse relationship between ischemic heart disease and the consumption of small or moderate amounts of alcohol is, for the most part, causal should, I believe, now be regarded as proved’. A Department of Health working group appeared to agree, noting: ‘All the evidence we have received confirms that the relationship between all-cause mortality and alcohol consumption follows a J-shaped curve. Non-drinkers have higher all-cause mortality than light and moderate drinkers’.

Doll was not alone in this research. As with the smoking-lung cancer finding, he was supported by researchers from around the world whose studies came to the same conclusion: moderate drinking lowered the risk of all-cause mortality and of heart disease in particular. In 2006, a meta-analysis of 34 prospective studies concluded that men who drank up to four drinks a day and women who drank up to two drinks a day had a lower mortality risk than those who did not drink at all. The sick quitter hypothesis was repeatedly tested and found wanting. The protective effect on the heart was repeatedly shown to be real and not the result of unhealthy former drinks in the non-drinking group.

As before, a noisy minority continued to deny these findings. They insisted that the biological pathways were unproven, though plausible pathways had been identified. They made generic criticisms of epidemiology that could apply to any observational research, though they never made them of studies which showed negative effects from drinking. Above all, they treated the sick quitter hypothesis as an unanswered question, never acknowledging that it had been tested extensively.

Decades after the evidence on moderate alcohol consumption had first been identified, those who refused to accept it were embroiled in a campaign of doubt and denial similar to what Doll had witnessed in the mid-20th century, but this time the naysayers were on the inside of the public health establishment, albeit in its neo-temperance wing. For years, they chipped away at the science, repeating the same old criticisms, cherry-picking studies and demanding an impossible burden of proof from researchers. They received a sympathetic hearing from their public health colleagues who had long struggled with the nuanced message that heavy drinking was bad while moderate drinking was good. Preferring a simple, clear, strong message that alcohol was dangerous, they were similarly inclined to dismiss or downplay the epidemiology.

Taken as a whole, the evidence was too strong to overcome, but so long as the critics persisted the evidence would, by definition, be ‘disputed’ and there would still be a ‘debate’. That was the line taken by the authors of the Sheffield University report when the Chief Medical Officer commissioned fresh research for the new drinking guidelines. In the 20 years since the Department of Health’s working group had concluded that epidemiological studies ‘strongly indicate a direct causal relationship’ between moderate drinking and cardiovascular health, the evidence had grown and become stronger, but anyone reading the Sheffield report would have got the impression it was on the brink of falling apart. Anyone listening to the Chief Medical Officer on the Today programme would have assumed it had already fallen apart. ‘An old wives’ tale’, she said. And with that, the job was done.

Sunday, 29 August 2021

Last Orders with Mark Littlewood

I had a blast recording a new Last Orders episode on Friday with Tom Slater and Mark Littlewood. It's the first time the show has been recorded in person for about eighteen months.

We discussed the Extinction Rebellion cult, smoking and Zero Covid. Listen here.



Wednesday, 25 August 2021

A Swift Half with Stuart Ritchie

The latest Swift Half with Snowdon features Dr Stuart Ritchie, a psychologist at KCL and the author of Science Fictions. We discuss IQ, fraud in psychology and Covid 'sceptics'. 



Tuesday, 24 August 2021

The WHO's war on alcohol

Last year the World Health Organization launched a public consultation on its draft “Global Alcohol Strategy to Reduce the Harmful Use of Alcohol”. It is not obvious that the world needs an alcohol strategy, nor does it seem an obvious priority for the WHO in the middle of a pandemic. National governments are quite capable of deciding how alcoholic drinks are taxed and regulated without pressure from a UN agency. Some countries allow you to buy a beer at any time day or night. Others have total prohibition. The huge differences in the way in which governments treat alcohol make it an unlikely candidate for global regulation, but the World Health Organization is keen to leave its mark on the issue nonetheless. 

The WHO has had a Global Alcohol Strategy since 2010, but the draft of the new strategy represented a significant shift in emphasis. While the 2010 plan acknowledged the problems created by the illicit market, which makes up 25% of global alcohol supply and more than 50% in some countries, the working document barely mentioned it. And while the 2010 focused on alcohol-related harm, the working document treats mere consumption of alcohol as a problem in itself.

This went largely unreported in the media because the WHO gave journalists a better story when they said that more efforts should be made to prevent “women of childbearing age” from drinking. This was yet another public relations disaster from an agency that has careered between tragedy and farce under the leadership of Dr Tedros Adhanom Ghebreyesus. From making Robert Mugabe a “goodwill ambassador” in 2017 to allowing Covid-19 to spread rather than offend the Chinese, the WHO has had a bad few years.

After launching a public consultation on its alcohol plan, the WHO came back with a new draft last month in which the reference to childbearing women was wisely deleted. Elsewhere, however, the problems remain. The new draft is actually even worse because the authors have inserted an unjustifiable and wholly unrealistic target of reducing per capita alcohol consumption worldwide by 20 per cent by 2030.

There was no target for per capita alcohol consumption in the 2010 plan. There was a target in the WHO’s Global Non-Communicable Disease Action Plan of 2013 but that was to reduce the “harmful use of alcohol, as appropriate, within the national context” by 10 per cent. The new proposal of a 20 per cent reduction in per capita alcohol consumption cannot be justified on health grounds since consumption is not a measure of health, and it is patently unachievable in such a short space of time. There is no reason to believe that this target could be met even if every member state introduced the WHO’s so-called “best buys” (tax rises, advertising bans, etc.) tomorrow.

Where did this target come from? A clue may lie in last year’s consultation which was inundated with submissions from temperance organisations. Many of these submissions were very similar. Some were identical. One of the biggest organisations in this network is Movendi International which was, until recently, known as the International Order of Good Templars. It was formed in the 1850s to campaign for the total prohibition of alcoholic beverages, but has since taken a more incremental approach to building an alcohol-free world. In its submission, Movendi called on the WHO to set a target of a 30 per cent reduction in per capita consumption by 2030, saying: “We propose a bold and ambitious overall target of a 30% reduction of per capita alcohol consumption until 2030”.

This exact phrase was repeated word for word in the consultation responses of numerous other organisations, ranging from IOGT Iceland and Slovenia’s Institute for Research and Development to Cambodia’s Khmer Youth Association, Kenya’s Alcohol Control Policy Network and Tanzania’s Network Against Alcohol Abuse. Duplicate responses were particularly common from temperance and public health organisations in Asia and Africa.

Organisations which endorse total abstinence from alcohol will naturally support any measures to suppress consumption. They can be expected to propose the most extreme targets for reductions in alcohol consumption, regardless of how unrealistic they may be. But pressure groups rooted in the temperance movement have very little public support and it is concerning to see the preferential treatment given to them by the WHO. Movendi, for example, is listed as a “non-state actor in official relations” with the WHO. Its spokespeople regularly appear at WHO conferences and it has an official arrangement with the WHO to “draft advocacy materials linked to WHO’s activities”, “increase support for alcohol control initiatives” and to produce “technical sessions and webinars to discuss and promote WHO’s global public goods in the field of alcohol prevention and control with content reviewed and approved by WHO in line with its policies and guidelines”. Movendi has also previously agreed to “help explore new or innovative ways and means to secure adequate funding for the implementation of the WHO Global strategy to reduce the harmful use of alcohol”.

In light of the close relationship between the WHO and the global temperance movement, it is reasonable to ask whether the WHO has simply split the difference between the 30 per cent target for consumption proposed by groups such as Movendi and the 10 per cent target for harmful use already in place in the NCD Action Plan to arrive at a target of 20 per cent for consumption. It is difficult to see any other logic to the decision since there is no evidence that a 20 per cent reduction is attainable or optimal. It is a false compromise; the “golden mean fallacy” writ large.

Since there is no prospect of this target being met, the WHO is setting up member states to fail. When 2030 comes around and this arbitrary and unrealistic milestone has not been reached, we can expect the WHO and its temperance partners to demand even tougher action, perhaps including a legally binding Framework Convention on Alcohol Control (modelled on the Framework Convention on Tobacco Control) that has so far been firmly rejected by member states.

Whatever the reasons for the sudden insertion of this target into the Global Action Plan, it is quite unacceptable. Insofar as the WHO has a mandate for getting involved in alcohol policy, it is in relation to health harms, not consumption. There is no reason to assume that a reduction in per capita consumption will necessarily lead to a reduction in alcohol-related harm. As the latest draft of the Plan acknowledges, wealthier countries tend to have higher rates of consumption but do not have higher rates of heavy episodic drinking.

The focus on consumption allows the WHO to push ahead with the kind of crude, supply-side policies that are popular with western public health academics but which can only discourage the sale of legal alcohol. Meanwhile, they virtually ignore illicit alcohol which is a bigger problem in most low and middle income countries. In contrast to the WHO’s 2010 plan, the new draft says almost nothing about the social, economic and health harms of black market booze and does not acknowledge the risks of increasing demand for homemade and illicit products by suppressing demand for legal products.

A new public consultation has now been launched and will run until 3 September. No doubt the temperance lobby will complain that the draft is still not extreme enough, but the WHO should listen to more moderate voices before it embarks on a plan that is designed to fail and which will be wholly unacceptable to many member states.

Cross-posted from the IEA blog. See also Henry Hill's article about the WHO at CapX.