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.