Thursday 28 October 2021

The medicine isn't working. More medicine!

Another study in the official minimum pricing evaluation was published this week. Once again, it was bad news for advocates of the policy, although you have to read it properly to find that out. According to a note at the top the study (too brief to be called an abstract), it says...

This study found that implementation of minimum unit pricing at 50p per unit was unproblematic with no evidence of beneficial or harmful impacts on the outcomes evaluated.

But as the results section shows, there was, in fact, some evidence of a harmful impact...

The odds ratio for an alcohol-related emergency department attendance following minimum unit pricing was 1.14 (95% confidence interval 0.90 to 1.44; p = 0.272). In absolute terms, we estimated that minimum unit pricing was associated with 258 more alcohol-related emergency department visits (95% confidence interval –191 to 707) across Scotland than would have been the case had minimum unit pricing not been implemented.

To be fair, this association was not statistically significant, but we know that minimum pricing costs Scottish drinkers tens of millions of pounds a year. That is a harmful impact and it can only be justified - at a push - if it produces positive health outcomes. This is just the latest study showing that it has not done so. 

The study is a substantial piece of work, running to over 200 pages. It is the most thorough piece of research conducted on the real world impact of minimum pricing to date. The authors compared outcomes in Scottish emergency departments with those in the North of England. They also compared outcomes in sexual health clinics and interviewed various 'stakeholders'.

At best, they found no improvement north of the border. Indeed, things may have got comparatively worse since minimum pricing was introduced.

On average, Scotland had a higher proportion of alcohol-related attendance than England. Scotland had a stable trend, whereas there was a decreasing trend in England.

.. The proportion of ‘current alcohol drinkers’ was higher in Scotland than in England, with this difference significant across all three waves. 

...For drinkers’ consumption, there were slight increases for the odds of alcohol misuse (FAST score ≥ 3; OR 1.22, 95% CI 1.04 to 1.42) and alcohol purchase from on-licensed premises (OR 1.27, 95% CI 1.05 to 1.55).
.. For the availability, purchasing and consumption of alcohol, stakeholders expected to see reductions after MUP, notably for young people because they had limited disposable income. Such reductions were not generally observed. 

This is in addition to the study published last week which found no impact on crime from the introduction of minimum pricing.

Not going very well, is it?
The study was produced by people like Colin Drummond and Niamh Fitzgerald who have been agitating for minimum pricing for years and are not going to allow the total failure of the policy to derail them now.

In the plain English summary, they make a few excuses and - surprise, surprise - call for the minimum price to be increased. 

Our study may have suffered from a failure to include those most likely to consume low-cost alcohol. We think that the reason that we found no effect either way from minimum unit pricing could be that the minimum price was too low to make a difference, that people did not notice it or that too few people who buy low-cost alcohol were included in our study. According to the World Health Organization, the price needs to keep pace with cost increases; however, it was unchanged in Scotland since being agreed in 2012.

And in the conclusion of the abstract proper, they say:

The lack of effect observed in these settings in the short term, and the problem-free implementation, suggests that the price per unit set (£0.50) was acceptable, but may be too low.

This is now the fallback position of the anti-booze lobby: the medicine didn't work, we need more medicine. Never mind the fact that their precious modelling which 'proved' that minimum pricing was the single most effective way to tackle alcohol-related harm was based on a 50p unit and was being published long after 2012. 

Meanwhile, in the USA, cigarette sales have risen for the first time in twenty years after a relentless campaign against vaping. As CNN notes, at the very end of their report on this news...

Smokers are also switching back to traditional cigarettes from vaping devices in response to restrictions on e-cigarette flavors

Don't expect any contrition from the people who have been at the forefront of the war on vaping. As the editor of the Tobacco Control 'journal' says...

Efforts must be redoubled, comrades!

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