Sunday, 18 April 2021

Last Orders with Clare Fox

A new episode of Last Orders came out at the start of the month but I forget to mention it here. Our guest was Baroness Fox of Buckley. You may know her better as Clare Fox. 

We discussed vaccine passports, the controversy over pictures of Muhammed at Batley Grammar School and the nanny state post-Covid.

Have a listen.

Friday, 16 April 2021

Less drinking, more problems - the lockdown alcohol "paradox"

I was on the Irish radio station Today FM yesterday talking about alcohol policy and lockdown drinking habits. I was up against someone from the Alcohol Health Alliance, an organisation that was specifically set up by the state-funded pressure group Alcohol Action Ireland "to support the Public Health (Alcohol) Bill". Sockpuppetry doesn't get much more blatant than that.

The Public Health (Alcohol) Act, as it now is, includes a number of hardline temperance policies including various advertising bans, minimum pricing, and a retail display ban (the latter is the first in Europe and is know in Ireland as the 'Booze Burka'). 

Minimum pricing still hasn't been introduced because the government doesn't want even more drinkers flocking over the border for cheaper alcohol, so it's been waiting for Northern Ireland to introduce it first. They've been waiting a while and may have to wait a lot longer.

A report was published by the Health Research Board this week calling for various other temperance laws, taxes and regulations. It reported that alcohol consumption fell by 6 per cent last year, largely due to the pubs being closed most of the time. It also reported that the Irish are still drinking more than the 9.1 litres per capita that the government has set as its target. Don't ask me why the government has a target for this, nor why it picked such a specific figure.

That was the background of the interview. I pointed out that England also saw a fall in alcohol consumption during lockdown but that alcohol-related deaths spiked at the same time. My opponent from the Alcohol Health Alliance was so wedded to the whole population approach that he couldn't get his around that, but I wouldn't be surprised if Ireland doesn't see the same combination of lower consumption and more harm when its figures are published.

You can listen to the interview here.

Thursday, 15 April 2021

Calorie labels on alcohol

The government is considering mandating calorie labels on alcoholic beverages. This is an anti-obesity push rather than an anti-drinking initiative. It is an extension of the plan to force food outlets to put calorie counts on their food menus. 
That policy is unworkable for smaller establishments who frequently change their menu and has already been watered down by the government. It will now only apply to businesses that have more than 250 employees. The same caveat will apply to the alcohol labelling policy, so it will only be the big chains that have to put calorie information on their beer pumps and/or menus.
The British Beer and Pub Association is said to be 'furious' about this idea and Matt Kilcoyne of the Adam Smith Institute is also unhappy...
‘Brits backing their locals are well aware that too many pints makes beer belly more likely. We don’t need government enforced calorie counts to tell us something we already know.’

‘Ministers thinking up this madness should stop and drop the policy. Let the publicans and the punters do what they want in the pubs without Mr Hancock wagging his finger each time a pint is pulled.’

I can't really share this outrage and I'm not convinced that everybody does know how many calories there are in a glass of wine or a pint of beer. Perhaps the government should conduct a survey to find out if there is really an information deficit worth addressing?
I wrote about this kind of thing in Killjoys...

It is not paternalistic to require a seller to provide accurate information about his wares. Manufacturers and retailers usually know more about their products than do consumers, leading to information asymmetries. If they deliberately withhold important facts from consumers in order to make more sales it is arguably a form of fraud and is certainly a form of market failure. Free-market economists are therefore in favour of buyers being given the facts. Once equipped with adequate information, some people may decide not to buy, but that is not the economist’s intention. The aim is only to give the consumer sufficient information upon which to make his decisions. Information asymmetries due to consumer ignorance are a conventional market failure for which there is a simple solution: education. 

The state can have a hand in this by broadcasting information to the public, or mandating certain lessons in schools, or forcing manufacturers and retailers to impart certain facts to customers. Even John Stuart Mill approved of the use of coercion if a person was ignorant of the risks. In a much discussed analogy in On Liberty, Mill argues that it is right to stop a man crossing an unsafe bridge if there is no time to warn him of the danger, but that no one should intervene if he is aware of the risks. When there is ‘not a certainty, but only a danger of mischief ’, he wrote, ‘no one but the person himself can judge of the sufficiency of the motive which may prompt him to incur the risk’ and so the person should ‘be only warned of the danger; not forcibly prevented from exposing himself to it’. 
In a country where people are increasingly health conscious, calorie counts on alcohol don't strike me as any more controversial than putting the volume of alcohol on a beer pump. I can't say that I feel like Tim Martin is wagging his finger at me when I see the calorie counts in Wetherspoons' menus (although I was taken aback to see that their Full English Breakfast contains 1,200 calories).

The problem with mandatory calorie counts in restaurants is that it would be expensive for small businesses and would lead to pubs, cafés and restaurants restricting their range of food. There is no practical or libertarian objection to calorie counts on packaged food in shops, nor is there a problem with Starbucks and McDonalds putting calorie information on the board. It's useful information, not coercive paternalism.
Apparently, the government reckons it's going to cost the licensed trade £92 million to change their pumps and menus. That sounds a bit steep for a basic graphic design job. Perhaps the answer is to have a long lead-in time so labels and menus can be changed when they are due an update. 

I've yet to hear a good reason why calorie counts should be on food but not alcohol. Some say it could encourage eating disorders, but that applies to all calorie labelling and isn't sufficient reason to conceal important information. Some have said that hard liquor will become more appealing to weight-conscious drinkers, but if people's response to being given accurate information is to drink more vodka and less beer, that's their business.

As I see it, the only problem with the idea is that it will give the capricious 'public health' lobby a foot in the door to demand paternalistic and misleading health warnings in pubs. It's bad enough that the booze industry has capitulated to government pressure and put the fake drinking guidelines on bottles and cans. 

From Killjoys again...

An informative warning for alcohol might explain that 11 million British adults drink at a ‘risky’ level, according to government statistics, and that there are 9,000 alcohol-related deaths a year, meaning that risky drinkers have a roughly 0.08 per cent chance of dying of an alcohol-related cause each year. If given this information, most consumers might conclude that a ‘risky’ level of drinking is not very risky at all. For that reason, such warnings are never issued. Instead, the public is told that alcohol has been ‘linked to’ more than 60 diseases and that there is ‘no safe level of drinking’.

If tobacco regulation is any guide, future labelling in the name of ‘public health’ will not lead to consumers being better informed. Graphic health warnings are less about education than they are about shock and disgust. Studies have shown that pictorial warnings are less effective in transmitting facts than written warnings because they literally repel the consumer. Cass Sunstein supports graphic warnings as a way ‘to persuade, not merely inform’, but when the evidence was independently reviewed, it found that ‘the impact of picture health warnings was negligible’ among young people in the UK and had ‘no discernible impact on smoking prevalence’ in Canada. The obvious explanation for this is that ‘individuals are very well informed about the consequences of smoking, and therefore benefit little from further messaging'. Once again, we have a legitimate market failure (or potential market failure) which paternalists have failed to solve – and may have exacerbated – because their intention is not to inform but to deter.

The threat of the slippery slope is always there, but there is a fundamental difference between simple information and a 'warning'. We should embrace the former but rarely the latter. Unless you want to get rid of calorie counts and ingredient lists on food products and hide the strength of beer from pubgoers, I can see no logic in opposing simple, discreet calorie labelling on booze in chain pubs.

Monday, 12 April 2021

A swift half with Freddie Sayers

The second episode of The Swift Half came out last week and has proved remarkably popular. Freddie is the executive editor of Unherd and has been interviewing most of the major players on every side of the lockdown debate since last spring. Check it out.

I'll be interviewing the Sunday Times' Matthew Syed live at 6pm, also for the IEA but not for The Swift Half. Catch it here.

Tuesday, 6 April 2021

Another awkward study about smoking and COVID-19

A study in pre-print from Germany looks at a particularly deadly outbreak of COVID-19 in the county of Tirschenreuth in spring 2020. The researchers took blood samples from 4,203 residents to see who had antibodies (and therefore who had contracted COVID-19). All the participants filled in a questionnaire with various questions about their lifestyle, e.g. alcohol consumption, how much TV they watch, physical activity, etc. 
Overall, 8.6% of those tested had antibodies. To the surprise of the researchers - but perhaps not to regular readers of this blog - only one lifestyle factor was associated with having antibodies for SARS-CoV-2 - and it was a negative association.

We were also interested whether seropositivity was associated with factors capturing a less healthy lifestyle (low physical activity, current or ex-smoking, drinking alcohol, or increased body-mass-index as a marker for excess calorie intake). We found no association with any lifestyle factor, except for current smoking. Remarkably, the odds of being seropositive was substantially decreased for current smokers compared to never-smokers (OR=0.36, 95%-CI: 0.24-0.53), while there was no association for ex-smokers (Supplemental Table 8). This would correspond to a 2.8-fold increase in the odds of being seropositive among never-smokers or ex-smokers compared to current smokers (Figure 5).

The researchers went to great lengths to find an explanation for smokers having a third of the risk of getting COVID-19, preferably one which didn't involve smoking.

The finding that current smoking was associated with a smaller probability of being seropositive is counter-intuitive under a hypothesis that smoking was associated with a less healthy attitude and more risky behavior. 
We conducted several sensitivity analyses in the search for potential confounding effects: first, we found stable associations across age groups and sex (unadjusted OR of seropositivity for current smokers vs. ex-/never smokers = 0.43, 0.34, and 0.47 for age groups 14-39 (young), 40-59 (mid), 60+ (old), respectively; 0.32 for men and 0.51 for women) (Supplemental Table 9). 
Second, we considered the possibility that the association of current smoking with reduced probability of seropositivity was due to an impaired ability of smokers to raise antibodies based on a previous report [20,21]. However, among the 74 individuals reporting a positive SARS-CoV-2 PCR test, we observed only 5 individuals without antibodies and these included 1 current smoker and 4 never-smokers (20% smoker as in the full sample). 
Furthermore, the association persisted when restricting to individuals having reported a previous PCR test: current smoking was associated with a positive test report versus negative test report (among the n=501 tested: OR=0.35), which is in line with a hypothesis that current smoking was associated with a lower risk of infection (Supplemental Table 10). This finding was not compromised by a higher proportion of current smokers among those tested, as previously reported by others [22]: 21.0% of those tested and 20.2% of those not tested were smokers (OR=1.07 adjusted for age, sex). Of note, we observed more women than men tested (14.4% and 9.4%, respectively), but no difference across age groups (9.7%, 12.2%, 11.5%, for age 14-19, 20-69, 70+, respectively). 
Finally, we also found a significant dose-response between the number of daily smoked cigarettes and seropositivity among all participants (zero cigarettes for never and ex-smokers OR=0.50 per 10 cigs/day, 95%-CI: 0.37-0.65, modelling reported # cigarettes smoked daily in a linear fashion, adjusted for age and sex) and a similar association restricting to current smokers (OR=0.69 per 10cigs/day, 95%-CI: 0.43- 1.07, Supplemental Table 11). Allowing for non-linear dose-response supported this finding (Supplemental Figure 2). 
A reverse epidemiology effect could induce a bias here, when individuals being current smokers at the height of the outbreak included severely ill individuals (e.g. cancer, severe heart disease) that prevented individuals from going outside or primed individuals to be particularly careful avoiding infection. However, the smoking- associated severe diseases would affect more likely older individuals and are less likely among younger individuals; therefore, the stable effect estimates across age groups provide evidence against such bias that would fully explain the strong association across age groups. 
Another potential bias needs to be considered when smokers who were infected were less likely to participate in the study. However, most individuals have not known their seropositivity at the time of questionnaire completion and participation.

Having come up empty-handed, they are forced to concede that smokers really are significantly less likely to be infected, as many other studies have shown. 

Particularly important to discuss is the finding that current smoking compared to never smoking, but not ex-smoking, was associated with a decreased risk of being seropositive and for reported infection. The association is strong, stable across age groups and sex, and exhibited a dose-response-effect. While the sample size of smokers among individuals with reported PCR-test was limited, the stable risk estimates and the few individuals with reported infection not showing antibodies suggests that the finding was not due to a lack of antibody building, but due to lower infection probability.

But here comes the cope...

This does not allow for the conclusion that smoking per se was protective. 

It does though, doesn't it? 

While smoking is generally linked to a less healthy and more risky behavior, a behavior associated with smoking that guards against infection could result in the same observation, e.g. gathering socially more outside or less frequently.

Hmm. It's a stretch.
And finally...
Any conclusion that smoking was preventive for SARS-Cov-2 infection needs to be rigorously challenged and, if substantiated, conclusions made need to weigh in the adverse public health impact due to the severe other implications of smoking like lung cancer.
It goes without saying that all conclusions in science should be "rigorously challenged", but it is difficult to imagine quite so much rigour being called for if the study had found smokers to be at greater risk of infection.

Hat top to Phil for bringing this to my attention.

Saturday, 3 April 2021

Behavioural economics and flawed paternalism

I've been reading a very interesting paper by Charles J. Delmotte and Malte F. Dold who discuss the problem with using sin taxes to tackle so-called internalities. Paternalists argue that taxes are not only needed to address negative externalities - costs and harm to others - but negative internalities - ie. costs that people impose on their own future selves which they are not always fully aware of. Classic examples include teenagers taking up smoking without realising how addicted they are going to get and students taking on debt without realising how little their degree is going to be worth.
The latter example is a fairly recent problem largely created by government policy and it doesn't lend itself to sin taxes, but nicotine products, alcohol, food and cannabis do. 

Economists want resources to be distributed efficiently and this requires people to make rational choices. Behavioural economics has shown that people do not always make rational choices (although we already knew that). But much of the paternalist argument relies on the paternalist making assumptions about what people's 'true' preferences are and then showing that people do not always follow them. A lot of this is based on comparing stated preferences with revealed preferences. Delmotte and Dold give an example:

Consider for instance alcohol consumption: a hyperbolically discounting drinker might promise today not to drink at the party on Saturday but then she reverses that decision once Saturday has become today. In such a scenario, following a behavioral welfarist logic, sin taxes on alcohol would help as a commitment device to align individual choice with one’s ‘true’, long-term preferences.
I have always found this kind of reasoning problematic. It seems weird to assume that what people say they want in the future is their true preference, but the choices people actually make in the present are illegitimate. I discussed an example from the behavioural economics literature in Killjoys... 
In Inside the Nudge Unit, David Halpern (2015: 139) details the results of two behavioural experiments that appear to show ‘time-inconsistency’, with people making different decisions in the here and now than they would make for their future selves::

‘Around three-quarters of (Danish) workers chose fruit over chocolate when the prize was due to be delivered the following week, yet the majority instead chose chocolate when offered the choice at the point of delivery. Similarly, most people choose a healthy snack option over an unhealthy one for later in the day - especially if they have just eaten - but the reverse is true when asked immediately before the snack is available. The same appears to be true for other forms of consumption: most people choose a ‘highbrow’ movie (such as Schindler’s List) over a ‘lowbrow’ one (such as Four Weddings and a Funeral) when deciding what to watch next week, but the reverse when thinking about the evening.’

What should we conclude from this? Halpern says it shows that we are ‘trapped in our present’ and links it to hyperbolic discounting in which ‘the further into the future a cost or benefit, the disproportionately smaller it becomes relative to immediate costs and benefits’. So it does, but it also shows something else. People have a tendency to think - or hope - that they will have a different outlook in the future. If you have ever agreed, months in advance, to do something in which you are not very interested - such as going to a conference that is likely to be dreary - you will be familiar with this cognitive bias. Like an elephant in the distance, it seems very small when it is only a date in the diary. You think that you will be eager and ready when the day comes, but when it does you wonder why you ever agreed to it. This is a cognitive bias, but it tells us more about second-order preferences than it does about being ‘trapped in the present’. You wish you were the kind of person who enjoyed going to tedious conferences, eating healthy food and watching highbrow films. You hope that in the near future you might become that person. But you are not.

In the experiments above, the participants were given a straight choice. They did not have to pay for their food and films. There was nothing to sway them in the choice architecture, no nudging, no default option. Given that they opted for chocolate and Sleepless in Seattle, it would take a leap of faith to conclude that what they really wanted was celery and The Piano. Yes, they chose healthy food and highbrow films for their future selves, but putting something off until tomorrow is only one step removed from not doing it at all. At best, these experiments show that people know what an idealised version of themselves ought to do. Awkwardly, though, they also show what people really want to do.

Stated preferences are fairly worthless because people don't have to balance any costs or benefits. They are not making a real decision. We are all familiar with the experience of going to the pub with the intention of having just one pint and ending up having significantly more. It is not obvious that one pint is the welfare-maximising amount, nor is it obvious that your wellbeing would have been enhanced by being kicked out off the pub before you could have the second. 

It seems to me that there is nothing special about the stated preferences of your past self and that paternalists only hold these preferences in high regard because they tend to be less hedonistic than people's revealed preferences. Sin taxes designed to tackle negative internalities are also going to reduce positive internalities, AKA benefits.

Moreover, people's preferences change over time. That is the point Delmotte and Dold make in their paper and it has significant implications.   

The idea of dynamic preferences surfaces prominently in chapter three of On Liberty, entitled “On Individuality as one of the Elements of Well-Being.” Therein, Mill ([1859]2003, 124) states that “(h)uman nature is not a machine to be built after a model, and set to do exactly the work prescribed for it, but a tree, which requires to grow and develop itself on all sides.”4 Mill uses the metaphor of a tree to describe the transformational nature of human choice: over time, individuals develop into a more mature version of themselves. What is required for such a personal growth path, Mill argues in reference to Wilhelm von Humboldt, is the exposure to “experiments in living” ([1859]2003, 122). 

 According to Mill, a person obtains individuality – they develop their own preferences – when they have been exposed to a variety of situations, they have been free to think about who they want to be and discuss freely with others what matters to them. Importantly, this process of individuation has to be an active process in which individuals pursue what they perceive to be their own good, in their own way. In other words, active choices on behalf of the individual are necessary for processes of individuation which are, in turn, the prerequisite for individual well-being.

And so, in conclusion...
Rather than choosing taxes that target specific lifestyles, individuals with dynamic preferences have a common interest in rules that secure an important degree of freedom for future preference development. Moreover, as individuals cannot predict their future preferences, we argue that they will opt for a tax code that is neutral with regard to today’s and tomorrow’s preferences.

The study is paywalled but you can read a pre-print version here. 
Reading that paper nudged me towards this video of Mario Rizzo talking about the flaws of behavioural paternalism. It's worth a watch. I don't know who kicks things off with the introduction but I like his style too.

Thursday, 1 April 2021

The APPG on Vaping's report about the World Health Organisation

The All Party Parliamentary Group on Vaping has published its report on the WHO's secretive tobacco conferences, the latest of which is due to be held in the Netherlands in November. Known as COP meetings (conference of the parties), they have become a hotbed of anti-vaping agitation in recent years. The WHO encourages member states to impose the strongest regulation on e-cigarettes, preferably including prohibition. They made the wrong call early on and has been doubling down ever since...

Two leaked papers from WHO’s Eastern Mediterranean Regional Office (EMRO) suggest that the WHO is exploring whether to advocate that reduced risk products are treated in the same manner as cigarettes or to ban them outright.

This is not the approach of the British government and that is a problem because British taxpayers are largely paying for these events. Indeed, they are paying a great deal to the WHO in general. As the report notes, the UK is the WHO's biggest state donor and recently agreed to increase its funding by 30 per cent.
The COP meetings fly under the media radar because they are held in secret and involve lot of private horse-trading and log-rolling on issues that can often seem boring, but they deserve more attention. The APPG report is a useful piece of work which says everything that needs to be said, much of which is stated starkly.

The WHO continues to undermine a policy which has been proven to help people stop smoking. 
That is the long and short of it.
The UK is a major contributor to the WHO (77% of its budget in 201826), therefore the world-leading policies we employ in this country towards reduced risk products – and the personnel behind them - should be backed up by our COP delegation in The Hague in November and that the UK has every right to do so. It would be entirely in keeping with previously stated aspirations from the WHO towards harm reduction; fits with the articles of the FCTC; is consistent with the scientific evidence; endorses the UK’s leadership in this policy area and would advance public health on a global scale. 

That requires us to send the right people to the meetings. How the UK chooses its delegates remains shrouded in secrecy...
During oral evidence, APPG members were told by witnesses that the process for choosing the UK’s FCTC COP delegates was not transparent. The delegations are published, and names of those attending is disclosed, but the process should be more open and transparent to ensure confidence, particularly the process by which delegates are selected.  

So, who should we send?

The UK should send a balanced delegation of officials and experts that includes proponents of evidence-based policy and harm reduction to COP9. The delegation should include experts who have first-hand experience of seeing the impact and benefit of reduced risk products as they are best placed to advocate for risk proportionate regulation. The UK should specifically push for a delegation which involves consumers and those with first-hand experience of vaping and reduced risk nicotine delivery systems. The UK should consider withdrawing funding from the FCTC if the WHO continues to discourage this form of smoking cessation. 

What we need is someone who is not afraid to be unpopular. Those who support harm reduction are outnumbered at the COP meetings and it is easy for timid individuals to feel overwhelmed or to just want to fit in. We need advocates, not seat-fillers. 
If tobacco harm reduction measures are not being advocated for at the COP, it is because they are not being brought to the table. It is therefore imperative that the UK continue to lead the world on this issue, with policies that promote the use of tobacco harm reduction products, including electronic cigarettes and heat-not-burn technologies.

And, crucially, let's use some soft power... 

The UK is one of the principal financial contributors to the World Health Organisation and the FCTC. If the upcoming FCTC COP9 advocates for a position on vaping and reduced risk products which is contrary to domestic UK policy, the UK should consider its options in relation to future funding.

Amen to that.

Wednesday, 31 March 2021

Smokers told to cough up again

Apparently smokers still aren't paying enough tax. The government is looking into the idea of taxing tobacco companies to claw back the £40 million that cigarette litter supposedly costs to clean up each year.

This tax will inevitably be passed on to Britain's seven million smokers who already pay £11 billion a year in tobacco duty (including the VAT on the duty). Simple maths tells you that the average smoker is paying more than £1,500 a year in tobacco taxes alone. But it's never enough for the depraved fanatics at ASH who have suddenly become interested in littering.

The plans were welcomed by Action on Smoking and Health (Ash), the anti-smoking charity Deborah Arnott, its chief executive, said that the group was “delighted that ministers are working collaboratively to use environmental legislation to make tobacco manufacturers clear up the toxic waste caused by cigarette butts”.


Toxic waste, my foot. Arnott is only pretending to care about this because it gives her another excuse to extract money from some of the poorest people in the country.

The Times also asked me to comment...  

Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs, the think tank, said: “This tax will inevitably be passed on to smokers who already give the government £11 billion a year. Britain has some of the highest tobacco taxes in the world and they fall disproportionately on those with the lowest incomes.”

He added: “If the government was serious about cigarette litter, it would provide appropriate street bins.”

Monday, 29 March 2021

A new dawn or Public Health England 2.0?

So Public Health England's nanny state functions will be passed to a new agency called the Office for Health Promotion. We don't know how much it will cost or who will be running it. Is there any hope that it will be anything other than Public Health England Mark II? Probably not, but let's not rush to condemn it just yet.

I've written about this for the Telegraph...

The Office for Health Promotion presents an opportunity for a fresh start. There is an appetite among the public for health improvement, but the activist-driven sledgehammer approach of taxes and bans favoured by Public Health England has run its course. By setting up an agency for health protection and a separate agency for health improvement, the government is acknowledging the difference between public health issues, such as Covid-19, and personal health issues, such as obesity. The former can justify a certain degree of coercion. The latter cannot.

The new agency needs some fresh faces and fresh thinking. The government has so far said nothing about how much it will cost or who will be running it, but the appointment of Dr Jenny Harries as Chief Executive of the National Institute for Health Protection – which has already been renamed the Health Security Agency – does not bode well. Formerly a regional director for PHE, Harries personifies the UK’s disastrous response to Covid-19. Every call she made in the crucial early months of the pandemic was wrong and yet she is being rewarded with a plum job. They take care of their own in public health.  

There is a chance that the Office for Health Promotion will abandon the failed policies of the past and rely on persuasion rather than force. There is a chance that it will cut out the dead wood and employ some smart people from a range of disciplines. There is a chance that it will become an effective and efficient operation rather than another self-serving, tax-sponging bureaucracy.  

It is all very unlikely, but it is not beyond the realms of possibility. The decisions made by government in the coming weeks will be crucial. Does it want an Office for Health Promotion or Public Health England Mark II?


Sunday, 28 March 2021

The future of UK tobacco harm reduction

I'm chairing a panel (online, natch) about the future of tobacco harm reduction on Monday at 6pm GMT. Martin Cullip, Clive Bates and Mark Pawsey MP are my guests so it should be lively.

Details here. You can watch it here or in the screen below.

Saturday, 27 March 2021

Victory (part two)

It's been a bit of a good news week. On Monday, AG Barr announced that its "limited edition" full sugar version of Irn-Bru would be on the shelves permanently, and now we're hearing that the online ban on tasty food advertising is being dropped.

An online junk-food ads ban is to be axed as it would have almost no effect on obesity.

The proposal would cut a child’s annual calorie intake by just 700 — equivalent to four packets of crisps.

Even that claim is extremely dodgy. It's based on experiments in which young children are put in a room with a television, no parental supervision and an unlimited quantity of free food. Half of them are shown adverts for the free food and the researchers see if they eat more of it. They do - marginally - and this is then somehow extrapolated to online advertising. It's junk science

Following a review, Whitehall insiders say ministers now accept that a boycott would be “disproportionate” as it would cost businesses tens of millions.

As I've said from the outset, the policies in the obesity strategy came straight from the desks of nanny state fanatics and hadn't been thought through. It was left to bureaucrats in Whitehall to turn them into workable legislation. That proved largely impossible because the definition of 'junk food' is ludicrously broad and food companies need some way of communicating with their customers. Laws aimed at McDonald's were going to affect the bakery on the high street and the local wedding cake business.

The whole thing is now disintegrating on contact with reality. The policy of mandatory calorie counts in the out-of-home sector has been stripped back so it only affects large chains (as I said it would have to) and the round-the-clock digital advertising ban is going to be scrapped entirely. 

The next thing to be scrapped or watered down is going to have to be the ban on positioning so-called unhealthy food at the end of aisles, front of store and checkout. This is clearly impossible for smaller retailers and will be a big problem even for supermarkets. 
The watershed TV advertising ban should also go. It's going to cost broadcasters a fortune and leave us with wall-to-wall food adverts after 9pm. Let's just accept that teenagers can handle seeing adverts for ice cream.
If people want this kind of stuff they can vote Labour, Lib Dem or Green, but there needs to be at least one mainstream political party that doesn't want to launch an unprecedented and unevidenced assault on the food supply.

As the Sun says: 

What took the Government so long to scrap the ludicrous proposed ban on online ads for fast food?

The scientific evidence showed it would cut a child’s daily calories by about two . . . that’s a biscuit crumb.

All at a monstrous cost to businesses.

The Sun pointed this out last November. It shows the power of the nanny-state lobby that this mad idea wasn’t immediately laughed out of the room.

But we welcome No10 seeing the light now.

How about applying the same common sense to other failed measures?

Like the sugar tax, which won’t trim an ounce off anyone’s weight.

Then concentrate on the real solutions:

Better education on diet — and exercise.

Friday, 26 March 2021

"Well, well, if it isn't the consequences of my own actions"

It's been a while since we had a laugh at Simon Chapman on this blog. He used to bring us so much entertainment. Australia's leading vaping prohibitionist is still knocking about in his nursing home shouting at clouds. He's been recently complaining about a "tsunami" of black market e-cigarettes. This is not a problem we have in Britain for some reason.

Meanwhile, Australia's black market for real cigarettes continues to flourish. Industrial scale tobacco smuggling and vast illegal tobacco farms didn't exist Down Under until the government fell under the spell of Chapman and his buddies and made the legal product unaffordable and unattractive.
Here's a typical story from earlier this month.
Illicit tobacco crops worth more than $84m seized in raids near Murray River

Authorities say illicit tobacco crops seized and destroyed in raids on properties near the Murray River this month are among the biggest busts of their kind in Australia.

Officers from the multi-agency Illicit Tobacco Taskforce uncovered more than 40 hectares of the plant growing on properties either side of the Victoria-New South Wales border, near the regional centre of Swan Hill.

The tobacco's potential value was estimated at $84.3 million.

More than 183 tonnes of tobacco was found in the first of three raids on a property at Kyalite, in south-west NSW, which the Natural Resources Access Regulator also attended to investigate possible water theft.

183 tonnes!
And here's another from this month...

The Australian Border Force (ABF) led Illicit Tobacco Taskforce (ITTF) has disrupted the activities of two alleged organised crime syndicates involved in the importation and distribution of illicit tobacco throughout Victoria and Western Australia.

The first operation occurred on Wednesday and Thursday this week (10 & 11 March 2021) when ABF officers from the ITTF executed Customs Act 1901 search and seizure warrants at a number of residential and commercial properties in suburban Melbourne.

The targets allegedly belong to an organised crime syndicate that smuggles illicit molasses tobacco into Melbourne and distributes it throughout Victoria.

During the warrants approximately 1,000 kilograms of molasses tobacco was located and seized, along with jewellery and $100,000 in cash, alleged to be the proceeds of crime.

The estimated value of evaded duty for this amount of tobacco is more than $1.5 million dollars.

Somewhere there's an organised crime boss commissioning a gold statue of Simon Chapman. Where would they be without him?

Vaccine passports

No thanks
The government is running a public consultation on 'COVID-Status Certification' - vaccine passports to you and me. If it was hoping to grab the public's attention, it has succeeded. People have been talking about little else for the last two days.
It began with Boris Johnson rightly suggesting that pubs should be free to serve whoever they want, but the idea of the government banning people from going to the pub unless they can prove they haven't got the virus soon took hold. 
It's difficult to tell whether the government is seriously entertaining this or if it is media spin. Johnson's comments have been pretty vague so far and both Johnson and several ministers have previously ruled out the idea. On the other hand, the government is not exactly going out of its way to squash these rumours and we know from the last twelve months that the 'public health' zealots advising the government never miss an opportunity to stick the boot into the licensed trade.
It has been suggested that people prove they don't have the virus in one of three ways:
- An antibody test (for those who have previously had COVID-19)
- A certificate of vaccination
- A negative lateral flow test
Weirdly, it has been suggested that this won't happen in the short term, but will be ready for Christmas.
The arguments in favour of this idea are that a spike in cases is plausible once we reopen, particularly among the under-50s who have mostly not been vaccinated. 
Israel is pretty much back to normal but requires vaccine passports for various events (although not, I think, for merely going to a bar). 
Other countries are almost certainly going to require a vaccine passport if you want to go on holiday so you might as well get one. 
The vast majority of the British public look set to have the vaccine, so the people who lose out will be mostly anti-vax idiots and assorted smileys, and they can still take the lateral flow test. 
From the perspective of the pub trade, it's less costly to administer a status certification system than to mess around with social distancing measure.

The arguments against - which I find more compelling - are that the vaccines are remarkably effective and any spike in cases is going to have a low mortality impact and is not worth the cost and the blow to civil liberties. I haven't seen any cost estimates yet, but it is likely to be very expensive and time consuming.

It involves the government handling data and creating an app so it will almost certainly be a technological fiasco.

The system won't be up and running by 17 May when pubs are due to reopen. If there's going to be a 'third wave', it will probably happen in summer when large numbers of people are still not vaccinated. By Christmas, the whole thing should be over and COVID-19 should have an infection fatality rate equivalent to flu. So what's the point?

There is still very little evidence that pubs are significant venues of infection. There was no spike in cases when they reopened last July. Admittedly, this doesn't apply to nightclubs and other venues that could be required to demand certification.
Antibodies don't usually last very long in people who have had Covid-19. After a few months they get protection from T-cells which can be tested for but it is quite expensive. 
Antibody testing involves a blood test which seems a bit extreme when all you want to do is have a pint. The government has a record of all the people who have tested positive for Covid. That should suffice.

Although you are likely to need 'status certification' to go on holiday abroad, you only do that once a year. Taking a test every time you want to go to the pub is rather more onerous.

Putting up these barriers, even if only to a minority of customers, is going to deter people from going out. That is bad for them and for the businesses that rely on them. For all the talk about pubs this week, you'd think it was the 1930s when people went to the pub every day because they had nothing else to do. The reality is that pubs have been in decline for decades. Thousands of them close every year. Most of them are virtually empty until the evening. They are an expensive luxury, not a mainstay, for most people. Part of the reason for this is that people have nice homes to live in and get their friends round for a drink - which is exactly what they will do if the government literally treats them like lepers. This is economically and epidemiologically sub-optimal.
There is no obvious endpoint to it. The government and the public health establishment can't be trusted to relinquish its control. Quite a few of them have always liked the idea of identity cards and this is a step towards them.

It looks like young people won't get their first dose of the vaccine for at least a couple of months. The system is therefore inherently discriminatory against the young. Vaccine coverage among the under-40s would be nice to have, but the fatality rate among this age group is so low that it shouldn't unduly concern them or us whether they get a jab or not. Yes, they could possibly pass the virus on to older people, but the older people have been given a vaccine that gives them approximately 100 per cent protection against hospitalisation. Let's remember what Matt Hancock said only two months ago.

When Covid hospital cases fall and pressure on the NHS is lifted, he says, ‘That is the point at which we can look to lift the restrictions.’ So what about herd immunity, vaccinating so many people that the virus dies out? ‘The goal is not to ensure that we vaccinate the whole population before that point, it is to vaccinate those who are vulnerable. Then that’s the moment at which we can carefully start to lift the restrictions.’ But at that point the majority would remain unprotected. Would he — as Health Secretary — still say it’s time to abolish the restrictions? ‘Cry freedom,’ he replies.

Whatever you think of these arguments, they are all better than what the government seems to be thinking.
The Guardian confirms this:

A UK government source said: “If the argument on health grounds doesn’t really wash because young people think they’re going to be fine and their grandparents and parents have all taken it, the strongest nudge is: ‘You’re not going to be able to be as free as you’d like.’ Not being allowed into pubs may focus minds.”

If only people who talk about 'nudging' would read Nudge. The whole point of nudging is that it doesn't make people less free. A nudge would be telling people that 90% of their age group is going to get the vaccine, or perhaps warning them of the dangers of long Covid. Banning people from going out unless they have an injection is, quite obviously, a form of coercion.

The consultation ends of Monday. It's straight forward. You just e-mail with a comment. Keep it clean.

Thursday, 25 March 2021

Chris Whitty - back to the day job

Chris Whitty had barely got his feet under the desk at the Chief Medical Officer's office when COVID-19 came calling. This week he gave an online lecture to remind us what his day job is when he doesn't have a real public health issue to deal with. 
The subject was obesity and he took up where Sally Davies left off. He doesn't seem quite ready to call for a ban on people eating on trains, but he stuck to orthodox 'public health' line about the food 'environment' being the problem and the government being the answer. 
Have a read of his slides.

Chris Whitty is not a member of the public. He is a highly paid member of a state bureaucracy. The public 'engages with the food industry' by buying the food they like from a range of products unparalleled in human history. Chris Whitty and his cohorts engage with the food industry by threatening them, telling them how to make their products, raising prices and restricting what they can say to the public. 
Whitty et al. are part of a special interest group that knows woefully little about food production, human behaviour or economics. They seem to think there is a market failure, but cannot explain why. Their sledgehammer approach is going to create lots of problems and solve nothing.

I can't see exactly what is shown in the photo of Whitty's supermarket. Presumably it is the confectionery aisle (are those Easter eggs?). If this is how the CMO is portraying the food environment in Britain, it is frankly dishonest. 

Next slide please.

How can we emulate the success of Ethiopia and Bangladesh? That's the big question in 'public health' today. 

Incidentally, calorie availability - which is what this scatter plot actually shows - is not a great measure. According to the source data, the 'daily supply of calories' is higher in Norway than in the UK and it is above 3,400 in both countries. Even in Africa, it exceeds the 2,500 calories recommended for an adult male. I don't know about Norway but the average person in Britain consumes a lot less than 3,400 calories a day, and the amount has declined over the decades, even if you make big adjustments for under-reporting.

Next slide please.

This is just a list of everything the 'public health' lobby has been demanding in the last few years. Nearly all of it has been done or is in the process of becoming law under Boris Johnson's spineless government. 

Whenever Chris Whitty says that something is a "political question" or a "matter for politicians", all I hear is "we are going conjure up so much junk science and produce so many dodgy models that it will become politically impossible for the government to take anything other than the most authoritarian course of action." Regular readers will be familiar with this approach from 'public health', but more people have seen how it works in the past year.

Speaking of junk science...

Aside from the flimsiness of the correlation and the bizarre way the categories have been split up, anyone who says there is an association between the proximity of fast food outlets and obesity has not bothered to look at the evidence.
Next slide please.

Tuesday, 23 March 2021

Lockdown, one year on and still in

It's a microphone

I've made the case for speeding the lockdown roadmap for CapX. Let's have more focus on data and move those dates forward.
I was talking to the great Simon Evans about the anniversary of lockdown in the first episode of my new IEA chat show, The Swift Half With Snowdon. It is, as the title hints, half an hour long. It's early days for me as a sort of interviewer, so let me know what you think in the comments. More great guests to come.

Monday, 22 March 2021


Some happy news to cheer you up in these troubled times...

IRN-BRU bosses have revealed their 1901 recipe which is crammed with MORE sugar than the axed pre-sugar tax original is back for good.

AG Barr's confirmed the 'old and unimproved' recipe will return to shops permanently today.

We previously revealed the 1901 Bru from the firm's archives is packed with 10.6g of sugar per 100ml.

The original Irn-Bru — axed after a new sugary drinks tax — had 10.3g.

Fans hailed the 1901 version of the drink as 'glorious' during a limited run last year.


In effect, AG Barr's sugar reduction scheme has led to there being more sugar in Irn-Bru than there was before. Way to go, Public Health England!

For more on this elaborate reverse ferret, see my article from 2019.

Thursday, 18 March 2021

Keep on vaping

A new study from the UK provides yet more evidence that vaping helps people quit smoking. It found that smokers who used a disposable e-cigarette were three times more likely to quit and people who used a refillable e-cigarette were five times more likely to quit.

Compared with using no help, the odds of abstinence were increased by daily use of disposable/cartridge ECs (OR=3.31 (1.32, 8.26), p=.010) and daily use of refill/modular ECs (OR=5.47 (2.70, 11.11), p<.001). Odds were reduced by non‐daily use of disposable/cartridge ECs (OR=0.23 (0.08‐0.63), p=.005), and by use of disposable/cartridge ECs to quit and no longer using at follow‐up (OR=0.10 (0.16‐0.62), p<.013). Secondary Results were similar to the primary outcome; however, odds of abstinence were also increased by use of smoking cessation medication (OR=4.15 (1.79, 9.62), p=.001).

Two of the authors have commented to the press to underline the significance of their findings.
Dr Máirtín McDermott, Research Fellow at King's College London's National Addiction Centre and lead author of the study, said: "Our results show that when used daily, e-cigarettes help people to quit smoking, compared to no help at all. These findings are in line with previous research, showing that e-cigarettes are a more effective aid for quitting than nicotine replacement therapy and prescribed medication.

"It's important that we routinely measure how often people use e-cigarettes, as we've seen that more sporadic use at follow up -- specifically of refillable types -- was not associated with abstinence."

Dr Leonie Brose, Reader at King's College London's national Addiction Centre added: "Despite the World Health Organization's (WHO) cautious stance on e-cigarettes, studies like ours show they are still one of the most effective quitting aids available.

"The WHO is especially concerned about refillable e-cigarettes, as these could allow the user to add harmful substances or higher levels of nicotine. However, we've shown that refillable types in particular are a very effective quitting aid when used daily, and this evidence should be factored into any future guidance around their use."

The evidence keeps piling up - and that makes anti-vaping dinosaur Stanton Glantz angry. In a classic piece of cherry-picking, he has focused on the ineffectiveness of occasional vaping to shore up his flanks.
Glantz doesn't seem to have realised what a self-own this is. Remember folks - for the best results, vape regularly and vape often!

Wednesday, 17 March 2021

Vaping's image problem

A new Eurobarometer survey came out last month looking at attitudes towards vaping in the EU. It makes grim reading. Things are going backwards on every level.

I wrote about this for New Europe

The survey shows that among those who have little or no experience with vaping, only 20 per cent think e-cigarettes and heated tobacco products help smokers quit. Seventy per cent think they do not. The proportion of all respondents who believe that e-cigarettes are ‘harmful to the health of their users’ increased from 27 per cent in 2012 to 65 per cent in 2020. The survey does not ask what they mean by ‘harmful’ and no one claims that e-cigarettes are completely risk-free, but there are indications elsewhere that the average member of the public thinks the risks are much greater than they are. A study published last year found that 59 per cent of Europeans wrongly believe that vaping is as dangerous or more dangerous than smoking.

Things aren't much better in Britain. 

Even in England, where health agencies have largely embraced vaping, the number of smokers who think vaping is as dangerous or more dangerous than smoking rose from 36 per cent in 2014 to 53 per cent in 2020. Less than a third of them believe – correctly – that vaping is less harmful than smoking and 40 per cent of them wrongly believe that nicotine causes cancer. A recent report from Public Health England concluded that ‘perceptions of the harm caused by vaping compared with smoking are increasingly out of line with the evidence’.


And do tune in to the Epicenter webinar 'Harm Reduction or Humbug?' tomorrow at 1pm GMT where I'll be on a panel talking about it.

Tuesday, 16 March 2021

Last Orders with Nick Cater

There's an episode of Last Orders out. I can't say it's new because I forgot to mention it when it came out two weeks ago, but our guest is Nick Cater - once a Brit, now an Aussie - who wrote an excellent book titled The Lucky Culture which I'm told is a favourite of Boris Johnson's. It explains how Australia got taken over by the metropolitan left and is relevant to many other countries.

In the pod, we discuss Zero Covid, internet censorship and a few other things. Check it out.

Friday, 12 March 2021

Cash for honours at the W.H.O.

The World Health Organisation has given the UK an award. Public health minister Jo Churchill picked it up on a Zoom call on Wednesday and the Secretariat of the WHO Framework Convention on Tobacco Control made a little speech
We are very pleased that the United Kingdom has been awarded a 2020 United Nations Inter-Agency Task Force Award recognizing the UK’s role in the global prevention and control of noncommunicable diseases. 
How exciting. 

The award recognizes the UK’s commitment to tackling tobacco use in low- and middle-income countries – through the FCTC 2030 project. 

What, you might ask, has the UK been doing to tackle tobacco use is low- and middle-income countries? 
The answer is that it has been bunging the WHO a lot of money. Specifically, it has been handing millions to the people at the WHO Framework Convention on Tobacco Control (FCTC).

This project was established with generous official development assistance funding from the UK Government, and is today also funded by Australia and Norway.
Generous is the word. No country gives more to the FCTC in assessed contributions than the UK on a per capita basis (the biggest contributors in absolute terms are the WHO's mates in China), but these payments only scratch the surface. The UK also gives the FCTC bonus payments, such as the £15 million (to be spent over five years) dished out in 2016. The British civil servant involved in this transaction landed himself a plum job at the WHO shortly afterwards. What a small world!
The trouble is that the agenda of the WHO - and the FCTC specifically - is diametrically opposed to that of the British government. While the UK encourages smokers to switch the e-cigarettes, the WHO wants to ban them. With the possible exception of Mike Bloomberg - who was also bestowed with an honour after giving the WHO lots of money - the FCTC is the biggest threat to tobacco harm reduction on the planet. 

The UK government is using taxpayers' money to finance prohibitionists and what are we getting in return? A little wooden plaque. This has to stop.

On a related theme, I strongly encourage you to watch this excellent little film from Yorkshire Cancer Research about vaping. This is what real public health work looks like.

Thursday, 11 March 2021

The sugar tax evaluation

From the Independent....

Consumption of sugar from soft drinks fell in the year after sugar tax brought in

Consumption of sugar in soft drinks was falling long before anyone took the idea of a sugar tax seriously, as I pointed out in 2016.

However, the headline is not quite a statement of the obvious. It refers to a new study in the BMJ which looks at soft drink consumption between 2014 and 2019. It is part of the official evaluation which, in classic 'public health' fashion, is being conducted by academics who spent years cheer-leading for the policy. And it's costing the taxpayer £1.5 million.

The study's conclusion is - obviously - that the sugar tax was a success. The authors report no change in the number of drinks sold, but claim there was a 9.8% fall in sugar consumed in soft drinks after the tax was implemented. That's 29.5 grams a week per household.

Reasonably enough, the authors attribute this to manufacturers reducing the sugar content. They even try to reach out to the 'food [sic] industry' in the text.
... the overall reduction in sugar with no change in volume we report here might represent a valuable benefit for public health with little harm to the food industry. 
As artificial sweeteners are cheaper than sugar, that may be true. However, the data only go up to March 2019 and it's worth remembering that the summer of 2018 was unusually hot and therefore saw more drink sales than normal (a fact that has been mentioned in connection to minimum alcohol pricing which also began in spring 2018).
The SDIL [Soft Drinks Industry Levy] has also been found to have had no long term negative effects on the share value or turnover of UK soft drinks companies, suggesting that, contrary to industry predictions, public health can gain without negatively affecting the soft drinks sector.

Firstly, tell that to AG Barr whose share price has never recovered from its poorly received reformulation of Irn-Bru.  

Secondly, there hasn't really been any 'public health gain', has there? Obesity rates haven't declined and it is not clear whether calorie intake has declined either. Sugar consumption has been gradually falling for decades and yet people keep getting fatter. All the sugar tax did was ruin some erstwhile delicious drinks.

It's not even clear that the sugar tax had the effect that the authors are claiming. They compare the real world evidence with a counter-factual, which always has the potential for mischief but was inevitable given the strong downward trends in sugar consumption prior to the tax being introduced.
The study divides the timespan into three periods: 2014-16 (pre-announcement), 2016-18 (post-announcement) and 2018-19 (post implementation). Table 1 shows the volume of drinks and amount of sugar consumed in each phase.  

Sales of high-sugar drinks were clearly falling before the sugar tax was announced, let alone implemented. Did the rate of decline increase after the tax was implemented? At a push, you can just about see a small step-change.

But if you combine all the drinks (high, medium, low and zero sugar), you'll see that the average household was consuming 141.5g of sugar from them in the 2014-16, 109.5g in 2016-18 and 80.1g in 2018-19. In other words, there was a bigger decline (32g) between the two periods before the tax was implemented than between the post-announcement and post-implementation period (29.4g).
Curiously, the data behind the figure that has driven the headlines today - the 10% drop in sugar consumption - doesn't appear in the main text, but is tucked away in the supplementary material. It is quite underwhelming. At the risk of being accused of 'eye-balling' the data, there doesn't seem to be much going on here. As so often in these studies, it all depends on how much you trust the counterfactual.
It wouldn't be surprising if the sugar tax led to some reduction in the amount of sugar consumed in soft drinks, especially since several companies felt inspired to take the sugar out of their flagship brands. But in the decade leading up to 2014, the amount of sugar consumed in soft drinks had already dropped by 45% and it would drop further before George Osborne announced the sugar tax (as this study shows). 
Was it really worth all the fuss? The secular trend is far stronger than anything that can be attributed to the sugar levy. Call it fashion, education or persuasion, but people had greatly reduced their consumption of sugary drinks long before the 'public health' lobby barged in with their regressive tax. Previous reductions in sugary drink - and indeed sugar - consumption have not been accompanied by a decline in obesity rates and that seems unlikely to change regardless of whatever marginal effect the 'public health' lobby tries to take the credit for since 2018.