Thursday, 1 December 2022

FOBTs: What happened next?

New statistics from the Gambling Commission were published last week and they make for interesting reading. You may recall that the stake limit on fixed-odds betting terminals (FOBTs) was reduced to £2 in 2019, which amounted to a de facto ban since hardly anybody wants to play them with such a low stake.
Advocates of the reform said it would reduce gambling-related harm by making it more difficult for machine gamblers to lose large sums of money. There was also a suggestion that it would reduce the number of problem gamblers.
Opponents said that it would lead to the closure of thousands of betting shops and that problem gamblers would switch to other gambling machines and go online.
The pandemic has made it difficult to make a simple before-and-after comparison because physical gambling venues were closed for long periods between March 2020 and July 2021. The financial year 2020/21 was a write-off and 2021/22 was partially affected by a lockdown. Even 2019/20 was slightly affected, with venues closed for the last 10 days of that year.
Nevertheless, there is enough evidence for some obvious changes in the gambling market to be identified. The table below gives an overview of the sector (click to enlarge).

The FOBT reform was introduced in April 2019. Overall Gross Gambling Yield (which basically means revenue: stakes minus prizes) fell slightly in 2018/19 and fell again in 2019/20. Bookmakers were the big losers, with GGY falling from £3.3 billion to £2.4 billion in this period.
By contrast, online casino GGY rose from £2.9 billion to £3.2 billion and then shot above £4 billion in the first year of the pandemic. Online betting revenue rose by £300 million in the first year of the FOBT change, having fallen the previous year.

It's difficult to call cause and effect in an evolving market but this data is consistent with the prediction that online gambling would pick up some of the slack from the fall of the FOBTs.

In the betting shop sector, there is clear evidence of a massive switch from FOBTs (formally known as B2 machines) to high jackpot machines (B3 machines). In 2017/18, there were 33,685 B2 machines in bookies and just 31 B3 machines. By 2021/22, there were just seven (!) B2 machines and 24,339 B3 machines.

Over the same period, Gross Gambling Yield from B2 machines fell from £1.7 billion to £110,000 while GGY from B3 machines rose from £158 million to £1.1 billion. Overall gaming machine revenue declined by 42 per cent. It should be remembered that 2021/22 was affected by lockdown. Nevertheless, there is little doubt that betting shops are making significantly less from gambling machines than they were as a result of the disappearance of FOBTs.
The other striking change is the number of betting shop closures. 2,300 bookmakers have disappeared since the FOBT reform. There are now 6,219 betting shops in the UK, which is half as many as there were in 1980. And there are more to come if yesterday's announcement from the new owner of William Hill is anything to go by.

An unpublished report by KPMG commissioned by the bookies predicted that 4,500 betting shops would close if the FOBT stake was reduced to £2. So far, it has been around half of that, but it has been a hell of a lot more than the few hundred predicted by anti-gambling campaigner Matt Zarb-Cousin.

Incidentally, and contrary to the notion that gamblers in betting shops would switch to betting on the horses, revenue from horse-racing continued to fall in 2019/20 with turnover (i.e. the amount wagered) falling below £4 billion for the first time. 
I can't find figures for employment, but I believe 53,000 people were employed in the bookmaking industry in 2018. With a quarter of betting shops closing, a rough estimate would be that around 13,000 people have lost their jobs.

As for problem gambling, the Commission's latest figures give the following estimates:

Year to September 2018: 0.5%
Year to September 2019: 0.5%
Year to September 2020: 0.6%
Year to September 2021: 0.3%
Year to September 2022: 0.3%

On the face of it, the rate of problem gambling halved between 2020 and 2021. This is possible, but it seems very unlikely. While this decline doesn't exactly correlate with the timing of the FOBT reform, anti-gambling campaigners could say that it is consistent with the prediction that the number of problem gamblers would fall once the 'crack cocaine of gambling' was banished from Britain. I haven't heard any of them make that claim, presumably because they are now crusading against online gambling and don't want to give the impression that things have got better.

The Betting & Gaming Council, by contrast, have been shouting about the low prevalence figure. This is probably a mistake. The problem gambling rate has been estimated at between 0.3% and 0.9% ever since it started being recorded in 1999. There has never been a sustained rise or decline. The fluctuations from year to year are probably meaningless. Although the Gambling Commission surveys 4,000 people, there are so few problem gamblers that the confidence interval is enormous (+/- 1.5%!). In the latest survey of 4,018 people, only 11 of them were problem gamblers. 
As a consequence, none of the year-to-year changes are statistically significant. It is perfectly likely that the next survey will find a prevalence of 0.6%, in which case anti-gambling campaigners (and The Times) will claim that the number of problem gamblers has doubled. That, too, will almost certainly be nonsense.

In summary, the radical stake reduction on FOBTs was associated with gamblers in betting shops suddenly spending £1.1 billion on machines that most people have never heard of, but spending less on machines as a whole. There is a strong suggestion in the data that some FOBT spend was displaced online. A quarter of the UK's betting shops closed. British gamblers may be spending slightly less overall, but we will have to wait for the 2022/23 post-pandemic figures to be published before we can say that with any certainty.

Wednesday, 30 November 2022

Last Orders with Julia Hartley-Brewer

A new Last Orders dropped this week. We welcomed back friend of the show Julia Hartley-Brewer to discuss the world cup, free speech on campus and how to keep your house warm.

Listen here.

You can send your questions to and we’ll try to answer them in the next episode.

Great success! Mexico's sugar tax

There's some terrific cognitive dissonance in this article in Frontiers in Public Health. You may fondly recall the Mexican sugar tax which supposedly reduced sugary drink consumption by 6 per cent or 12 per cent, depending on who you get your news from (it actually reduced it by about 3 per cent). It was much talked about in the months before George Osborne inflicted a sugar tax on the UK.

Did this 'world-leading' policy lead to a reduction in obesity in Mexico? You might think so according to the authors of 'Childhood obesity in Mexico: Influencing factors and prevention strategies'. They say... 
... given that sugar-sweetened beverages are well understood as a casual factor of overweight and obesity, the year 2014 saw the implementation of a tax of one Mexican peso per liter on beverages with added sugars, as well as on food items with an energy content ≥275 calories per 100 g.

Alas, their figures tell us otherwise. 14.7% of Mexican kids were classed as obese in 2006 and there was "a sustained increase over the following survey years until reaching nearly 20.0% in 2021."

Yes, it's another big 'public health' win! The obesity rate amongst adults has also risen - from 32 per cent to 36 per cent since 2012. On the face of it, the widely lauded sugar tax of 2014 has made not a jot of difference to the thing it was supposed to tackle. 
It would be interesting to compare these figures to countries in central America which do not have sugar taxes, but idea of using a control might be a bit too 'sciency' for the authors who seem to have a pretty weak grasp of how to work with statistics. When they look for correlations between diet and obesity they say:

Snack foods, sweets and desserts, and sugar-sweetened beverages were not statistically significant contributors in the model (p = 0.112 and 0.098, respectively), but seem to show weak associations.

There is either an association or there isn't. Statistical significance exists to help us establish if they is a likely association. There isn't one here but the authors proceed to act as if there is.
The pseudo-panels of the study showed that those food groups considered as protective, such as fruits and vegetables, protected against overweight and obesity in school-age children. On the other hand, intake of snack foods, sweets and desserts, and sugar-sweetened beverages were associated with the presence of both outcomes.
No, they weren't.
They do it again with fibre.
We also found that greater fiber consumption was associated with lower overweight and obesity in school-age children, even when this association was not statistically significant.

How do this stuff get through peer review?
Although this association is inconclusive in the scientific literature, we suggest that a greater fiber content in food items indicates a lower caloric density, as well as a lower consumption rate and possibly a greater sense of satiety.
In other words, "we didn't find an association between fibre intake and obesity, and the rest of the literature is inconclusive, but here's what we reckon..."
Notably, when facing a problem of the magnitude of school-age child obesity, permanent government strategies and actions are required to ensure the containment, prevention, and management of this outcome in order to avoid serious consequences for long-term health and national development. To the present, various strategies have been implemented in Mexico, as well as in other countries around the world.
And none of them have worked.
Although these have been associated with some positive results, they are not public policy actions which demonstrate an overall effective impact.
That's one way to describe abject failure.
An example of this is the establishment of regulations on the sale and distribution of foods and drinks in the school environment dating back to 2010, and which were only put in place in 2012 and whose implementation was monitored only starting in 2015.
That didn't work either.
Other actions implemented on the national stage and not only targeting the school-age population include the 2014 tax of one Mexican peso on sugar-sweetened beverages, and one previous study found a reduction of 6% in buying of taxed beverages in 2014. Furthermore, from 2014 to 2015 changes were observed in the buying of taxed and non-taxed beverages, where buying of taxed beverages diminished by 5.5% in 2014 and 9.7% in 2015: an average reduction of 7.6% over the study period.

Did it lead to a reduction in obesity, or even a slowing of the increase of obesity, as was promised? As we have seen, it did not. 
Nonetheless, the tax is too small to expect the provocation of biological impacts such as a reduction in obesity.
Oh, so now you tell us. Didn't say that at the time, did you? If you'd said it wasn't going to reduce obesity, the government would have never implemented it. All the modelling, as recently as 2020(!), said it was going to reduce the weight of children. Now you tell us the tax was too small. 
Why is anyone still listening to these charlatans?

Tuesday, 29 November 2022

The SNP's mad plans for alcohol advertising

Nicola Sturgeon yesterday

The Scottish National Party has been fully captured by the temperance lobby. Minimum pricing has crashed and burned, but they are still listening to the alleged experts from the pressure groups whose wages they pay. Banning alcohol advertising was always next on the agenda for the Scottish temperance groups and the Scottish Government has produced a consultation document that reads like it was written by Carrie Nation.

Licensing solicitor Stephen McGowan has written all it in on his blog.

I have been reviewing and practising alcohol related law in Scotland over some years, in my role as a licensing lawyer representing the trade, and I have written on this topic widely. I have often been a “critical friend” of the Scottish Government, having sat on many working groups and bodies on licensing reform, and must also concede I have been withering in my analysis of the efficacy of some of the licensing law which the Parliament has produced. That being, said even I am amazed at just how far these new proposals go, and the absence of balance.

Indeed. The SNP don't even have the power to ban TV and digital advertising but they've included them in the consultation anyway to show how serious they are (and what they would do if Scotland was 'independent'). They say...

It is crucial that any potential restrictions to reduce the volume of alcohol marketing are as comprehensive as possible.”

And they are not kidding. The proposals not only include every form of advertising, but virtually every kind of sponsorship, brand-sharing, merchandise and even the display of alcoholic drinks in shops. Head over to Stephen's blog for the full story but here are the lowlights...

Event Sponsorship

This part of consultation starts by telling us there is no evidence at all as to whether sponsorship of “events”, by which they mean music, cultural events and so on (as opposed to sporting events) by alcohol has negative outcomes. Nevertheless, unhindered by any expressed desire to wish to proceed with probative and proportionate policy-making, they plough on and ask whether there should be a prohibition on alcohol sponsoring all events across Scotland. This, if enacted, would end alcohol sponsorship of musical or cultural festivals as well as local community led events. Heaven knows how you organise a beer festival.

Brand-sharing and merchandise

Not content with proposing a complete ban on all alcohol advertising in all public spaces, and the shuttering of shop-fronts, they go further, and suggest that there should be a ban on the sale of all alcohol-branded merchandise altogether. No more hats or mugs. No more t-shirts. No more craft brewery hoodies. In the context of this consultation, these have become “walking billboards“. The Scottish Government go further still, and present a case that even alcohol-free products should be banned as they are, in essence, “gateway” brands to expose people to the alcoholic variants, because of the use of the same names and logos:

This demonstrates the need to carefully consider restricting these other distinctive and identifiable elements associated with the alcohol brand, in addition to restricting use of the alcohol brand name.

... Perhaps the most incredible proposal within this consultation is the suggestion that there should be a complete ban on any and all promotion/advertising of alcohol in public places. This notion is suggested not, it would seem, as an intrinsic goal, but on the basis that it might be quite difficult to create a more nuanced law. Consider the following paragraph:

Given the difficulties around defining places as places children and young people frequent, as well as the likely impact of alcohol marketing on adults too, a prohibition of alcohol advertising in public spaces may be the best course of action.”

I find that to be a remarkable statement. Here we have the Government saying that, because it might be too complex to prohibit alcohol marketing under defined circumstances, they should just go ahead and ban it altogether. We are looking at the white-washing of the alcohol industry across the country.  

... Hard-working alcohol producers will be vexed, I would suggest, to see the following comment:

Without branding and other marketing strategies, alcohol products in each beverage sub-sector are essentially variations of the same thing“.

This is an overt effort to eradicate the diversity and personality of individual alcohol products; to reduce them to a denominator common to those who are so opposed to it; that is, to see alcohol only as a harmful commodity, a vice. This one sentence discounts centuries of craft, effort and enterprise. This one sentence discounts the joy in sampling one malt whisky over another and sharing that experience with a friend. These, of course, are positive traits and experiences, which explains their absence.

... They even take us into territory where alcohol must be seen in the same context as tobacco:

Where alcohol is displayed behind the checkout this could be required to be in a closed cupboard, like tobacco products.”

Yep, that was always the plan.
You can read and respond to the consultation here.

A swift half with David Zaruk

Some of you may be familiar with the Risk-Monger, David Zaruk. If not, you can make his acquaintance by watching this week's Swift Half. David has been battling anti-science NGOs in Brussels for many years. We talk about the precautionary principle, Glyphosate, neo-nics and why the Dutch government is closing down farms. Do have a watch.

Friday, 25 November 2022

Banning disposable vapes?

A motley collection of environmental and 'public health' groups have joined forces to get disposable vapes banned

Environmental groups have called for the sale of single-use e-cigarettes to be banned due their “rapidly escalating threat”.

In an open letter to environment secretary Thérèse Coffey and health secretary Steve Barclay, 18 environment and health groups, including Green Alliance and RSPCA, argue that disposable vapes are “unnecessary electrical items” that contain single use plastic, nicotine and batteries, all of which are “hazardous to the environment and wildlife when littered”.

They describe disposable vapes as single use plastics, which is a stretch given that they provide 300 puffs each. They also claim that the amount of lithium in their batteries equates to 1,200 electric cars per year. Maybe so, but there were seven million electric cars produced last year and that number is rising exponentially. Lithium usage in e-cigarettes is negligible by comparison.
Disposable vapes are not a 'health threat'. On the contrary, they are hugely important in helping smokers who want to quit. Reusable e-cigarettes are cheaper in the longterm and many people who start with disposables will switch to them later, but they require a larger financial commitment up front and are less simple to use. For smokers who are trying vaping for the first time, disposables are the most appealing option.
As I told City AM... 

Vaping has been incredibly effective in driving down smoking rates in Britain, but 28 per cent of smokers have still never tried an e-cigarette and the majority of those who have tried them have not become longterm users. If more smokers are going to switch to vaping, they need products that are simple, convenient and cheap.

Thursday, 24 November 2022

A big rise in gambling addiction?

There’s an eye-catching claim splashed over the front of The Times today under the headline ‘Big rise in gambling addiction’:

The health service will announce tomorrow that it has opened clinics in Southampton and Stoke, adding to a national network of five commissioned in 2019. Figures seen by The Times show that 599 patients have been referred to the service in the past six months, a 42 per cent increase on the same period last year and up 65 per cent from 2020-21.

The figures come from here. ‘Gambling addictions’ rising by 42 per cent in one year is so unlikely that it is worth asking whether these statistics accurately reflect what is going on.

Astute readers will recall the coronavirus pandemic of 2020-21 and wonder whether the accompanying restrictions, which included the total shutdown of face-to-face gambling support for months, may have led to the figures for these years being lower than they would otherwise have been. It seem almost certain that they did.

2019/20 would be a better baseline to compare the most recent years to, except that a lot of these clinics didn’t even exist for part or all of that year. This significant fact is hiding in plain sight in the paragraph quoted above:

The health service will announce tomorrow that it has opened clinics in Southampton and Stoke, adding to a national network of five commissioned in 2019.

The whole point of these clinics is to give problem gamblers somewhere to go for face-to-face support. When the NHS Northern Gambling Service was opened in September 2019, Dr Matthew Gaskell said:

“I’m delighted to be opening our new clinic in Manchester. This will help make our service more accessible to people in the North West of England where we know there are thousands who need our support.”

As intended, problem gamblers are using these relatively new facilities. When more clinics are opened in Southampton, Stoke and elsewhere, it will presumably lead to even more people attending a gambling clinic. It will disappointing if they don’t, but it will not be evidence of a ‘big rise in gambling addictions’, although perhaps The Times will portray it as such

The aforementioned Dr Gaskell is quoted by The Times

He said the patients referred to NHS addiction clinics were a “drop in the ocean” of those suffering mental health problems because of problem gambling.

Perhaps so, but it is an increasingly large drop in the ocean as the number of NHS clinics proliferates and word gets around that they exist.

If you want to know whether there has been a rise in problem gambling, you need to look at the problem gambling surveys which have been running since 1999. They show that the rate of problem gambling has been flat and low for over 20 years. According to the latest data

  • the overall headline problem gambling rate as measured by the short form PGSI is statistically stable at 0.3%.

In short, there is a fairly obvious ‘if you built it they will come’ aspect to this story. I suspect that journalists at The Times are smart enough to see this but have had their minds clouded by the paper’s editorial line which resembles a moral crusade (why else would this half-story be on the front page?)

The rest of the article pushes the sports betting angle, with Dr Gaskell making the pointed and remarkably convenient claim that his clinics are “filled with young men in football shirts“. He is not a man averse to hyperbole…

“People start gambling as soon as they wake up in the morning; they’re gambling in the shower, gambling while they’re driving to work. The NHS is picking up the tab.”

The mind boggles at the idea of gambling in the shower. As for the NHS picking up the tab, the government made over £3 billion from gambling duty revenue last year and the industry was willingly paying for gambling treatment services via GambleAware until the puritans at the NHS decided that it could no longer accept this tainted money and passed the bill to the taxpayer.

If ‘gambling addictions’ have really risen by 65 per cent in two years, you have to wonder what the point of ridding the country of fixed odds betting terminals was. Remember them? They were the root of all evil according to dozens of Times articles until April 2019 when they were effectively banned. There were the ‘crack cocaine of gambling’, no less.

How does The Times square its victory over the dreaded FOBTs with the spiralling rates of gambling addiction it is now reporting? Perhaps it is relying on its readers having short memories.


Cross-posted from the Snowdon Substack.

Friday, 18 November 2022

Vaping proven to be the best way to quit smoking, media look the other way

The media love stories about vaping so it is odd that only the Daily Mail covered the latest Cochrane Review when it was published yesterday. Cochrane Reviews are at the very top of the evidence pyramid and only include randomised controlled trials (RCTs). 

There is an argument that RCTs are not best way to measure the benefits of vaping for smoking cessation because smokers tend to switch to vaping organically, sometimes gradually, and often without intending to quit. Nevertheless, RCTs have still shown vaping to be more effective than nicotine patches and placebos. The last Cochrane Review in 2020 concluded that there was 'moderate-certainty' evidence that e-cigarettes are effective in helping smokers quit.

The new review upgrades that to 'high certainty'. 

We included 78 completed studies, representing 22,052 participants, of which 40 were RCTs. Seventeen of the 78 included studies were new to this review update. Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 50 at high risk overall (including all non‐randomized studies), and the remainder at unclear risk.

There was high certainty that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (RR 1.63, 95% CI 1.30 to 2.04; I2 = 10%; 6 studies, 2378 participants).

The previous review's statement about moderate certainty was the last straw for harm reduction deniers to cling to. The 2020 SCHEER report, which informs EU regulation, even claimed that there was only "weak evidence for the support of electronic cigarettes’ effectiveness in helping smokers to quit". 

Surely nobody can claim that now. 

It's just a shame the media took so little interest in this evidence. I'm sure it will be a different story next time an unpublished conference poster claims that vaping causes brain cancer based on a weird experiment on rainbow trout.

Thursday, 17 November 2022

Underage gambling: a shaggy dog story?

From BBC Wales... 
Gambling: Boy, 16, lost thousands after seeing advert

A 16-year-old boy lost thousands of pounds gambling in just a few weeks after seeing adverts at a football game, a support worker has said.

Nick Phillips, from Swansea, said the boy opened an account in his father's name an hour after a match.

Really? If he opened the account in his father's name, he must have used his father's debit card. How was he expecting to withdraw his winnings? Why didn't his father notice thousands of pounds coming out of his account?

As Matthew Rushton says, it seems more likely that his dad has a gambling problem and blamed it on his son to get a refund.
As for being triggered by seeing a gambling advertisement at a football match (more likely a gambling logo), had he never seen a gambling advert before? According to anti-gambling campaigners, people see a dozen gambling ads before breakfast. What was it about this advert that made it such a conveniently specific cause of his woes?
I'd like to know a lot more about this story, but all we get from the Beeb is the first two sentences slightly rearranged...

Mr Phillips helps those struggling with gambling in Swansea, said the boy's family have stopped going to football matches because they want to avoid putting their son at risk.

He said: "This poor lad has gone home an hour after the match and opened an account in his dad's name after seeing the gambling ad."

Strangely, there is no quote from the teenager or his father in this story. There is no indication that the journalist has spoken to either of them. There are no names and nobody to corroborate the story. The only source is Nick Phillips who does a bit more than 'help those struggling with gambling in Swansea'. He actively campaigns against gambling advertising in football and is a programme lead for The Big Step, an anti-gambling group that spun off from Gambling With Lives.   
Nothing wrong with that. Phillips is himself a former problem gambler. But what happened to the two-source rule of journalism? The BBC has reported this fishy tale on the basis of what is essentially hearsay.

The rest of the article is just a soapboax for anti-gambling campaigners like Carolyn Harris...

Carolyn Harris, MP for Swansea East, said legislation needed updating to keep up with technology.

She said: "If you think about the last Gambling Act in 2005, the first iPhone was invented in 2007, who could have foreseen how technology would come along in the way that it has."

Hard to imagine but in back in those days, if you wanted to place a bet online you had to go to the trouble of using a computer! And what does it have to do with advertising anyway?

Tuesday, 15 November 2022

Testing the total consumption model of alcohol

I have a new peer-reviewed study out in Economic Affairs ($) this month looking at the total consumption model theory as it pertains to alcohol. It builds on some of the research I did for Lockdown Lessons in Health Economics in which I showed that greatly reducing the availability and advertising of alcohol during the pandemic did not lead to fewer alcohol-related deaths (as 'public health' theory would predict). Instead there was a large increase in such deaths.

Put simply, 'public health' theory inspired by the neo-temperance movement that emerged in the 1970s says that drinking patterns in society move in concert, so if moderate drinkers drink less, heavy drinkers will drink less. They believe that if per capita consumption of alcohol declines, the amount of heavy drinking - and therefore alcohol-related mortality - will also decline.

This leads them to think that reducing per capita consumption should be the goal of policy. In short, they think the tail wags the dog. As I write in the article:
It is important to stress that the single distribution theory is not presented as a rough rule of thumb, but as an iron law. Skog (1985, p. 90) asserted that “when mean consumption increases, the consumption level of all kinds of drinkers increases”. Rose wrote in The Strategy of Preventive Medicine that “from the average alcohol intake of a population one can precisely predict the number of heavy drinkers” (2008, p. 121; emphasis added).

Adherents of the total consumption model do not believe merely that shifting the curve to the left is one way of reducing heavy drinking, but that it is the only way. As Cook and Skog (1995, p. 31) put it, “heavy drinkers will reduce their drinking if – but only if – the others cut back too”. Rose and Day (1990, p. 1034) argued that “to help the minority the “normal” majority must change”.
It's easy to test an iron law. If there are exceptions, it's not an iron law. And there are loads of exceptions to the total consumption theory. The aforementioned lockdown experience, when per capita consumption fell but deaths spiked, is just one of them.

Far from moving ‘in concert’, there is evidence of polarisation in drinking patterns in Iceland, Sweden and UK, with heavy drinkers consuming more and moderate drinkers consuming less (Bjarnason, 2006; Meier, 2010; Zeebari et al., 2017).

Further evidence can be found in the alcohol-specific mortality data, which can be used as a proxy for heavy drinking. In the UK, an 18 per cent decline in per capita alcohol consumption between 2004 and 2016 was not accompanied by a decline in alcohol-related deaths or hospitalisations (Whittaker et al., 2020, p. 1987). In the WHO European Region, per capita consumption declined between 1990 and 2014 but alcohol-attributable mortality rose (Hallgren et al., 2018). In the Australian state of Victoria between 1999 and 2007, there were “significant increases in alcohol-related harm” despite “relatively stable alcohol consumption levels” (Livingston et al., 2010, p. 368). In Norway and Ireland, rates of liver cirrhosis fell between 1980 and 2000 as per capita consumption rose (Bentzen & Smith, 2011).

I add to this evidence base by looking at patterns of consumption and harm in 174 countries between 2010 and 2019. There is no consistent pattern and 64 of the countries saw trends moving in the opposite direction to what would be predicted by neo-temperance theory.

In conclusion:

Taken together, the evidence leads us to a conclusion that is almost diametrically opposed to the public health orthodoxy, but is likely to strike the reader as no more than common sense. The amount of alcohol consumed by the average drinker does not affect the amount consumed by heavy drinkers. Unless the average consumer is drinking a dangerous amount, there is nothing to be gained from making her drink less. If efforts are to be made to tackle heavy drinking, they should be directed towards heavy drinkers rather than the general population.

Monday, 14 November 2022

Last Orders with Nick Gillespie

In the latest episode of Last Orders - which is now coming out every fortnight - Tom and I spoke to Nick Gillespie of Reason magazine about US politics, nicotine-free cigarettes and Twitter. Check it out here, subscribe on iTunes (or whatever) or listen below.

Friday, 11 November 2022

A swift half with Edward Chancellor

Remember The Price of Time, the book about interest rates that I reviewed last week? I managed to get  the author to do The Swift Half interview yesterday. Enjoy!

Thursday, 10 November 2022

Food fight

I spoke at the British Society of Lifestyle Medicine conference in September in front of a surprisingly large crowd of 800 at Spurs' ground in Tottenham. I didn't realise at the time but the Q & A was being filmed. The topic was sugar taxes and other government interventions involving diet.

I haven't watched it back but I recall it getting a bit heated when Tim Spector, who had just given a presentation telling us that everything we knew about food was wrong, insisted that governments were acting with perfect information when they interfere in the food supply.

Wednesday, 9 November 2022

Revolver deluxe by The Beatles - a review

I've reviewed the newly remixed and expanded Revolver for Quillette.

A few years ago, I ordered a pint of Stella Artois in Washington, DC. I used to drink Stella quite a lot back in the day, but had fallen out of love with it for reasons I couldn’t quite identify. I ordered it on this occasion because it was the only beer that looked familiar. And oh, what a sensation that first sip was! How the memories came flooding back! It was then that I appreciated something I already knew but had subconsciously ignored. Stella Artois had been reformulated in the UK for tax reasons. The ABV had dropped from 5.2 percent to 4.8 percent and later, monstrously, to 4.6 percent. This was done stealthily. We weren’t supposed to notice and in a sense I hadn’t. I had just gradually gone off it until I was reminded of how it was meant to be.

I mention this because something similar happened with the Beatles’ seventh studio album, Revolver. The music was great but the stereo mix created in 1966 was awful. The only people who owned stereos back then were nerds, and so the Beatles, like other bands, treated the stereo mix as an afterthought. In the mid-’60s, mixing for stereo meant chucking half the instruments in one channel and everything else in the other channel. The result was a thin and incohesive sound that the Fabs only started to improve upon with Sgt. Pepper the following year.

This was the mix that appeared on compact disc in the 1980s and it is the only mix most people under the age of 60 know. It is the 4.6 percent ABV version of Revolver and I hold it wholly responsible for the album’s steady slide down the Greatest Albums of All Time charts in the last 40 years. It hasn’t slipped down the list because bands have made better albums in the meantime. They obviously haven’t. The blame lies solely with that weedy, disjointed stereo mix, the deficiencies of which have only become more apparent as the album has aged.

It was with this trenchant view that I approached the new deluxe edition of Revolver with an unusual degree of excitement. Contrary to what you may have inferred from the previous paragraphs, I am not an audiophile. I can’t tell the difference between a remastered album and an original (in fact, I suspect the whole remastering thing may be a con to part gullible middle-aged men from their money). But I do like a remix, and Giles Martin’s subtle remixes of the Beatles’ 1967–70 classics were well worth the admission fee.

On Revolver, Martin has made use of technology developed by the FBI to isolate the voices of mafiosa on murky wire recordings. This has allowed him to tease apart instruments that have been glued together ever since they were “bounced down” on four-track 56 years ago. Martin has cleaned them up, placed them appropriately in the stereo mix and—boom!—Revolver is finally in 3D.


Tuesday, 8 November 2022

Burning our money to ASH

State-funded prohibitionist pressure group Action on Smoking and Health are advertising an unusual vacancy.
NHS Strategic Lead
This a senior role within public health charity Action on Smoking and Health (ASH) to engage the NHS in action to tackle smoking.

This leadership role will seek to engage NHS leaders across prevention and health inequalities programmes as part of helping to secure the Government’s vision of smokefree England by 2030. It will develop and galvanise a professional network involved in delivering support and develop tools and resources to support system change.
'Galvanising a professional network to support system change' is blob-speak for getting various arms of the state to lobby the government.

It's nice work if you can get it. The salary is advertised at £50,000 to £60,000. Tell me more! 

This a senior role within public health charity Action on Smoking and Health (ASH) to engage the NHS in action to tackle smoking. ASH is public health charity established by the Royal College of Physicians, working to end the harms from smoking. We campaign to secure evidence-based policy change and work with public sector and others to support policy implementation. This role is to deliver on an NHS England funded project.

So the supposedly cash-strapped NHS is paying ASH to employ someone to tell the NHS to take a tougher line on smoking, even though the NHS is one of the most anti-smoking institutions in the world and ASH claims that it doesn't use taxpayers' money to lobby?

I've said it before and I'll say it again: 'Public health' is a bare-faced racket.

Friday, 4 November 2022

Of interest

I've written a review of Edward Chancellor's important book about interest rates, The Price of Time, for The Critic.

By slashing interest rates to historic lows, central bankers turned off one of the most important signals in the economy. Since this often required pricing money, quantitative easing became the bedfellow of unnatural interest rates in the new economic orthodoxy. QE began as part of a desperate effort to save the banking system from collapse but, emboldened by the apparent lack of inflation it caused, central banks began using it for lesser crises. The Bank of England had fresh bouts of QE in 2012 to help it reach its inflation target — i.e., to raise inflation — and again in 2016 “to help the economy after the EU referendum”. When the Federal Reserve engaged in its third splurge of QE in 2012, the stated objective was to help the jobs market.

Throughout this period, interest rates were kept at rock bottom for fear of dampening economic growth. Society quickly became addicted to cheap money. House prices rose to absurd levels, made possible only by freakishly low mortgage rates. Corporations took on debt to carry out a string of mergers and buyouts which produced returns for shareholders without the businesses having to go to the trouble of becoming more productive. Zombie companies proliferated, making just enough money to avoid insolvency, but not enough to ever pay back their debts.

All of this was sustainable only if interest rates never returned to normal levels. That, in turn, required inflation to remain abnormally low forever. In other words, it was not sustainable at all. The longer it went on, the bigger the bang would be when the bubble burst.

It's not paywalled so have a read.

Thursday, 3 November 2022

You can't appease fanatics, part 3,881

Since the start of last month, it has been illegal in the clown country of Great Britain for supermarkets to put 'junk food' such as marmalade and pain au chocolat at the end of their aisles. This has led to shoppers being unable to find the things they want.

Rumour has it that the supermarkets are not entirely unhappy about this as it means people walk around the store more and pick up more items, but it has naturally meant that so-called junk food has to stocked in the aisles rather than at the end of them.

In a development that will no doubt shock you, it appears that the government's outright capitulation to their lunatic demands is not enough for Action on Sugar who think it is outrageous that sugary products are being stocked in the middle of aisles.

This isn't the first time I've seen the word 'loophole' used by public health cranks to describe something that was never intended to be covered by the legislation in question, but it is a particularly hilarious example.

Where do they think these products should be stocked??

The answer, of course, is nowhere.

Wednesday, 2 November 2022

The Alternative Smoke-Free 2030 Plan

The government is working on its Smoke-Free 2030 Plan. Earlier this year, Javed Khan proposed some frankly mental tax-and-ban policies fed to him by the prohibitionist wing of the 'public health' movement. My plan is more realistic, more humane and would be more effective. It includes a simple 12 point plan to encourage smokers to switch to safer alternatives, or at least letting them know that they exist!

Download it here.

And there's a little video...

Monday, 31 October 2022

A swift half with Paul North

Paul North is the director of the drug reform group Volteface. I talked to him face to face at home about the various ways in which cannabis is being legalised around the world. Check it out.

Thursday, 27 October 2022

What if we ditched the sugar tax?

I'm on the Food Matters Live podcast this week talking about whether the sugar tax worked and if it should be ditched. The other guest is Giles Yeo whom I like but with whom I don't always agree.

Check it out.

Wednesday, 26 October 2022

Junk science of the week

New science just dropped...
Labels encouraging responsible drinking struggle to get the message through

People view labels on alcoholic drinks encouraging responsible consumption as a ploy by the industry to be seen as caring and are unlikely to lead to people drinking less.

The lead author is Dr Emma Davies whose previous contributions to the scientific literature include  'Connecting through dance: Understanding conscious clubbing event experiences', 'Acceptability of alcohol-free dance in place of traditional alcohol-focused events' and 'Reflection and connection: UK Psychologists’ views and experiences of blogging'.
Her new research has been published in the British Journal of Health Psychology. It is a 'qualitative study' which basically means that it was a glorified focus group.

The new research asked 20 drinkers aged between 21 and 63 for their views on the effectiveness of these labels, and considered whether it is likely that labelling can contribute to reducing people’s alcohol consumption.

n = 20. Not a lot, is it?
All participants were shown three types of labels, one set promoting responsible drinking, one set with positive health messages (drinking less reduces risk) and one set with negative health messages (drinking more increases risk), and asked about their views on the labels and drinking more widely.

The interviews found that the participants viewed responsible drinking messages as a ploy by the alcohol industry to be seen as caring without taking tangible action, and there was little support for the use of labels.

This strikes me as a strangely politicised take. I don't believe that many drinkers are as obsessed by 'ploys' by 'the industry' as people in public health academia are. 
The study itself reports participants having remarkably similar views to a small clique of 'public health' campaigners.
Perceptions of the alcohol industry seemed to be very strongly linked to perceptions of the tobacco industry.
Participants commonly suggested that pictorial messaging analogous to graphic images on tobacco products would be more effective than the text warnings they were shown in the interviews
Several participants highlighted that the role of the industry in a capitalist neoliberal society is to make money rather than to provide health information, and thus, they felt that labelling was not an appropriate strategy for alcohol harm reduction.
Who among us hasn't highlighted the role of the alcohol industry in a capitalist neoliberal society recently? 
Who were these people?! According to the study...
Participants aged 18 or over were recruited opportunistically via an electronic university research noticeboard and social media from one geographical area in Southern England. 

There seems to have been no attempt to find a group of people who were representative of the general population. Five of them had post-graduate degrees, ten had undergraduate degrees, two were undergraduates at the time of the interview and three had A-levels. None of them were educated below A-level standard. This is hardly surprising given that the opportunity to participate in the focus group was advertised on a university notice board and through the researchers' social media feeds.
How many of them were acquaintances or students of the researchers? Alas, we are not told, but we are told that "many worked at the host institution" and the lead author often uses her Twitter feed to recruit participants for her 'qualitative research'.

Recruiting people in this way is very common in 'public health', but it creates a very obvious risk of sampling bias. Dr Davies has less than 2,000 followers and it is reasonable to assume that the majority of them broadly agree with what she tweets, which is mostly links to anti-alcohol research and gestures of support for various woke causes. If you advertise opportunities to take part in a survey or interview to a self-selecting group of followers, you are bound to end up with an echo chamber. 
What does these people's subjective opinions tell us about labelling, drinking behaviour or the alcohol industry? Absolutely nothing. She might as well have done a Twitter poll.

Monday, 24 October 2022

Russia 1985–1999: TraumaZone - a review

I've reviewed Adam Curtis's new documentary Russia 1985–1999: TraumaZone for Quillette.

What we see is a country where people have been degraded by poverty and tyranny for decades, ruled over by an elite whose power is slipping away. Russia is being looted from within and without. Violence and nihilism reign. Everything is decrepit. Nothing works. Nobody knows what they are doing and nobody is coming to their rescue.

Restricted to the occasional caption and subtitle, Curtis refrains from editorialising. This cannot have been easy for him. I can picture him in the studio desperately resisting the urge to add a little sermon, particularly in the last episode. I couldn’t help wondering what he would say if he did. What does he want us to take away from these miles of videotape? Is it that communism and capitalism are as bad as each other? Or that capitalism requires stronger institutions and less corruption than the former Soviet Union could offer? Is he saying that a gangster like Putin has been able to maintain power for so long because Russians are scarred by their experience of freedom? Or has he simply decided that he is, first and foremost, an archivist?


Wednesday, 19 October 2022

Last Orders with Rod Liddle

 We've got the perfect Last Orders guest on the show this month. Have a listen.

Monday, 17 October 2022

A swift half with Marewa Glover

After a hiatus of a few weeks, the Swift Half with Snowdon is back. I was delighted to chat to Dr Marewa Glover, a harm reduction advocate from New Zealand, who told me how authoritarian her country is becoming. Saint Jacinda is serious about banning cigarettes very soon and makes no secret of the fact that vaping is next.

Scary stuff. Check it out below. 

Wednesday, 12 October 2022

The smoke-free 2030 target

More Westminster rumours. 

This time it's reckoned that health secretary Therese Coffey is shelving the unpublished 'smoke-free' plan. Some say that she doesn't even know that the government has a target of making England 'smoke-free' by 2030 because she's been too distracted trying to run the health service.

Is this true? Who knows? But there shouldn't be target for how many people smoke in 2030 because it's none of the government's business. The target was only created by Theresa May to give her some sort of legacy. It wasn't even in the last Conservative manifesto.

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

A pack of cigarettes costs £13, you can’t smoke them anywhere except outdoors and in private dwellings, they haven’t been advertised for 20 years, they are hidden behind shutters in shops and have been in beige packaging with gruesome photographs since 2017. 

Everyone has got the message that smoking is bad for you and the government would rather you didn’t do it. Having exhausted every sensible idea to deter people from smoking – and several half-mad ones – we have surely reached the point at which the individual’s right to choose is respected. My body, my choice, as they say.

What is the argument for turning the screw on this beleaguered minority yet again? In a paternalistic editorial, the Times acknowledges there is ‘a balance to strike between individual freedom and public health’ but that ‘smoking reduction has long moved beyond this binary tension’ because there is ‘common consent that reducing smoking is the right thing to do’. In other words, the freedom of individuals no long matters once the rest of society disapproves of them. This is what John Stuart Mill meant when he talked about the tyranny of the majority. If your mind is clouded by a dislike of tobacco smoke, try substituting  ’free speech’ or ‘religious freedom’ to see what an ugly and dangerous sentiment this is.


Tuesday, 11 October 2022

How libertarian is the government?

Nick Timothy reckons that the British government is hooked on 'libertarian ideology'. He says this like it's a bad thing. I look at the evidence for this so far at Spiked today...

A libertarian government would have immediately abolished the Online Safety Bill, scrapped the sugar tax, repealed the smoking ban, privatised the NHS and legalised cannabis. None of this has happened and very little of it looks likely to happen. Instead, we have a colossally expensive energy price cap and rumours that random drug testing could be introduced in offices.


Friday, 7 October 2022

What is gambling-related harm?

In the ongoing process of turning gambling into a 'public health' issue, it is necessary to identify some harms to be addressed. This is not as easy as it sounds since gambling per se does not cause any harm to health. On the contrary, it can improve wellbeing, as Public Health England acknowledged in its evidence review:

‘The highest levels of gambling participation are reported by people who have better general psychological health and higher life satisfaction. And people who have poorer psychological health are less likely to report gambling participation.’

Moreover, whilst pathological gambling is a mental health problem by definition, it does not directly harm health. 
This week, the Gambling Commission drew up a list of 27 gambling-related harms. Some of them are relatively severe impacts associated with problem gambling, albeit indirectly, such as:
  • loss of sleep
  • feelings of stress and anxiety
  • incidence of self-harm 
  • needed assistance from mental health services or help with your physical health
  • had thoughts of taking your life or made an attempt to take your life.
  • divorce, ending or loss of a relationship
  • experiencing social isolation
  • experiencing violence or abuse (including physical, emotional and financial abuse)

Some of them are pretty trivial...
  • feeling like a failure
  • increased consumption of alcohol and tobacco 
And some of them are ridiculous. For example...
  • reduction or loss of spending on recreational expenses such as eating out, going to the cinema or other entertainment
What?! This 'harm' comes about when you spend your money on literally anything. If you go to the cinema, you will suffer a 'reduction or loss of spending on recreational expenses such as eating out'. In a world of finite resources any expenditure on X means less expenditure on Y. The question is whether you'd rather spend money on X than Y. 
The same principle applies to the following alleged 'harm'... 

  • spending less time with the people you care about
I suppose that if you go to the casino on your own, you are using time that could be spent with your children, but maybe you don't want to spend all your time with your children. The school system means parents spend less time with their children but no one would describe that as a harm (if anything, it's a benefit).

The implicit message here is that gambling - not just problem gambling, but gambling in general - is a waste of time and money. If we're going to start redefining opportunity costs as harms there will be no end to the 'public health' campaign against gambling. 'No safe level' here we come...

Wednesday, 5 October 2022

Smoking and drugs at the Tory conference

I was in Birmingham earlier this week for the Conservative Party conference. I was on two panels, one about drugs and the other about smoking. You can watch them below.

Tuesday, 20 September 2022

Snus is safe and e-cigarettes are miracle products

There were a couple of studies published last week that are worth bookmarking. They don't tell us anything we don't already know, but they contradict what a lot of people think they know.

The first looks at smokeless tobacco and oral cancer risk. It finds that the kind of smokeless tobacco widely used in Asia, such as gutkha, is strongly associated with oral cancer (partly because these products contain many other ingredients in addition to tobacco), but there is one notable exception.

Except snus, all SLT [smokeless tobacco] products sold in different WHO regions are strongly associated with OC [oral cancer] incidence.

Readers of The Art of Suppression may recall that snus was banned in the EU because it was assumed to have a similar risk profile to other smokeless products. It doesn't. Not even close.

The other study looks at a remarkable feature of vaping that I have mentioned before - its extraordinary ability to help people quit smoking even when they have no intention of doing so.

Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR]=8.58, 95% confidence interval [CI]:5.06-14.54).

... Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking.

The difference between a 6.8% quit rate and a 32.4% quit rate is enormous. The awesome power of vaping to get unmotivated smokers to quit deserves more attention, especially since only half of British smokers say they intend to quit.
Imagine being an anti-smoking campaigners and being opposed to e-cigarettes...

Friday, 16 September 2022

Axe the tax, Liz

More from me on reports that Liz Truss may be ditching Boris Johnson's obesity strategy and repealing the sugar tax...

In public health circles, it is considered terribly gauche to expect policies to work. You might think, for example, that a trailblazing intervention designed to reduce obesity would be considered a failure if obesity rates rise to record highs after it has been implemented. Not so with the sugar tax. Obesity among both children and adults has gone up since it was introduced in 2018, but the health lobby does not consider it to be a failure. Contrary to the evidence of your eyes, they say, it has actually been a success. The only failure is the failure of the government to do lots of other things in addition.

This is one of a number of ways in which ‘public health’ differs from medicine. If a patient’s health gets worse after being given some pills, doctors do not claim that the treatment has been a success and double the dose.


Wednesday, 14 September 2022

Dare to dream

Has the Tory party finally found a leader with sound convictions and the bottle to get things done? The early signs are encouraging. Today's Guardian front page laments that...

Liz Truss could scrap anti-obesity strategy in drive to cut red tape

Exclusive: Health officials ‘aghast’ as review launched of measures to deter people from eating junk food

... The review is so radical in scope that it may even look at whether the sugar tax, which began in 2018 and has helped make soft drinks much less unhealthy, should go too. Health experts have hailed the levy as a key initiative in the fight against dangerous obesity.


Civil servants being aghast is a good thing when they work for what used to be known as Public Health England. Everyone from the Institute for Government to the Soil Association is horrified by the idea of an ineffective, regressive tax being ditched.
I've written about this for Spiked...

The sugar tax has achieved the square root of diddly squat while extracting £1 billion from the pockets of hard-pressed consumers and ruining the taste of several cherished soft-drink brands. For a prime minister focused on deregulation, lowering taxes and the cost of living, getting rid of it is an obvious place to start.

If Truss does scrap the tax, she will inevitably face fierce resistance from ‘The Blob’. The usual state-funded pressure groups and media midwits are already up in arms at the mere suggestion, as are the activist-bureaucrats who run the Department of Health. Although the sugar tax has only existed for four years and patently has no value as a public-health measure, you would think Truss was considering a ban on penicillin from the hysteria in some quarters.

Useless and regressive, the sugar tax was – to quote Jamie Oliver – a ‘symbolic’ measure. Its repeal would be no less symbolic. It would show that after getting through four prime ministers in six years, the Conservative Party had finally landed on a leader who genuinely believes in free markets and personal freedom. It would show that the nanny-state lobby does not always have to win, that Britain is not condemned to ever-more restrictive lifestyle regulation and that there is an exit on the road to serfdom. If Truss picks this battle, she will have my sword, and I hope yours, too.