Thursday 29 December 2022

2022 in review

At Spiked, I started and ended the year by talking about how useless the COVID-19 models were. Having got that of my chest, it is now time for peace and reconciliation. Incredibly, some people were still calling for more restrictions as late as April 2022. They just couldn't let it go.

If you wanted to follow the evidence on smoking and COVID-19, this blog was almost the only place to go. I stopped counting studies when I got to 100. The great majority found smokers to be less likely to be infected, but when I discussed this at SpikedI got the Facebook red flag treatment again.

In January, more evidence emerged of vaping's extraordinary ability to get smokers off cigarettes even when they don't want to quit. This was followed by a compelling Cochrane Review later in the year. Australians, however, were drip-fed a diet of lies about e-cigarettes in a country where the tobacco black market has grown to an absurd extent, and the Netherlands decided it wasn't even able to tolerate something as harmless as nicotine pouches. One Aussie doctor became so misinformed he started giving his son cigarettes to wean him off the vapes!

Gamblers, the gambling industry and their foes awaited a White Paper that was never published. The anti-gambling coalition, which wrongly presented the issue as one of public health, touted a claim about the number of gambling-related suicides which Public Health England had made up in its last days. It didn't stack up. In November, the Times also made a claim about problem gambling that was obviously untrue. 

With regards to tobacco, fifteen years after the smoking ban began and a decade after I stopped smoking, I still thought it was a terrible mistake. I also argued that Theresa May should have consulted smokers before she promised that most of them would quit by 2030. Some of the ideas put forward by a member of the Blob to achieve this target were frankly insane.

On food, the government struggled to cope with the commitments made by a delirious Boris Johnson in 2020. A ban on placing tasty food in prominent positions in supermarkets came into effect in October (predictably, nanny statists immediately complained about imaginary 'loopholes'), but bans on BOGOFs and advertising were pushed back to 2023 and 2024 respectively. Unpopular though they were, the Conservatives could see that charging people more for food wasn't the smartest thing to during an inflation-driven cost of living crisis. Meanwhile, the Mayor of London made ridiculous claims about his ban on junk food advertising.

By July, the evidence that minimum pricing had died on its arse in Scotland had become overwhelming. Expect much high jinx when the SNP is required to prove it worked to bypass the sunset clause next year. And expect more junk science about alcohol advertising now that it is in the cross-hairs of the Scottish Government.

In crank's corner, George Monbiot was hoist by his own 'who funds you?' petard and James O'Brien worked on yet another conspiracy theory for his listeners at LBC. Aseem Malhotra continued his downward spiral and anti-vaxxers wilfully misunderstood every piece of Covid data.

In the summer, I wrote a series of columns for the Times in which I discussed the perils of low interest ratesthe risks of hiking corporation tax and why the energy price guarantee should be means tested. To no avail, clearly.

It was a busy year in politics with three Prime Ministers and goodness knows how many Chancellors. Liz Truss's brief tenure was a disaster for the Conservative Party and, briefly, for the pound, but the economy was broken before she got her hands on it and it is a myth that Trussonomics cost the country £30 billion. When Rishi Sunak took over, Jeremy Hunt preached austerity while borrowing like there was no tomorrow and doing nothing about inflation.

On a happier note, my pal Ronnie O'Sullivan won his seventh snooker World Championship and I wrote about how lucky we are to share a planet with him. I also reviewed the deluxe edition of the Beatles' Revolver and the solo career of Paul McCartney. On a less happy note, I reviewed a documentary about Russia (1985-1999).

I also reviewed some excellent books about The New Puritans and interest rates, plus a contrarian take on Prohibition.

And I interviewed lots of people for The Swift Half with Snowdon. Some of the most interesting discussions were with some of the less well known people, including Angela Knight (on energy), David Zaruk (on anti-science NGOs), Bill Hanage (on Covid), Marewa Glover (New Zealand authoritarianism) and Edward Chancellor (interest rates).

Thanks for all your comments, shares and visits in 2022. Have a great New Year's Eve and I'll see you on the other side.

Thursday 22 December 2022

A swift half with Bill Hanage

It was a pleasure to speak to Bill Hanage, professor of epidemiology at Harvard University, about COVID-19 for the Swift Half recently. We discussed what happened this time last year and what is going on in China. (Note that this was recorded just before the CCP effectively abandoned Zero Covid). 


Tuesday 20 December 2022

Knives out for nicotine pouches

In 1991, the Lancet published an editorial titled 'Nicotine use after the year 2000'. It makes for very interesting reading. Click to enlarge.

The gist of it is that if 'purified nicotine products' were available, they would have the potential to 'eventually replace tobacco on the open market'. 

Thus it seems logical to offer either a cleaner product or, better still, an acceptable source of more pure, less contaminated nicotine.

The editorial then mentions 'a highly innovative type of cigarette that heats rather than burns tobacco' which is 'a near-perfect low-tar cigarette'. This was the direct ancestor of IQOS but it never took off in the USA, partly because - as the Lancet notes - public health groups spoke out against it. 

It concludes:

There is no good reason why a switch from tobacco products to less harmful nicotine delivery systems should not be encouraged. Smoking-related deaths after the year 2000 would fall steadily and substantially of this can be achieved. There is no compelling objection to the recreational and even addictive use of nicotine provided it is not shown to be physically, psychologically, or socially harmful to the user or to others.

Three decades later and several 'purified nicotine products' exist which go beyond the wildest dreams of the editorial's author. Vaping is vastly safer than smoking and has proven itself in the marketplace. Nicotine pouches are even safer and have tremendous potential. Heated tobacco products like IQOS have proven themselves in several countries, most notably Japan.

Are public health groups jumping for joy? For the most part, they are not. For the most part, they are trying to get them banned.
The latest target is nicotine pouches. They are snus without the tobacco. Cellulose plus nicotine. They are about as 'pure' as you can get. It is virtually inconceivable that they pose a non-negligible threat to health, and yet a growing number of governments are trying to nip them in the bud. 

Since they don't contain any tobacco, nicotine pouches are unregulated in many countries. Their legal status in Germany is unclear. In Norway, they are banned unless they contain tobacco!

The Netherlands has been ruled by an unusually puritanical government for the last few years and is now trying to ban nicotine pouches outright. There is already a de facto ban but this is legally dubious since the government has been regulating them as food, which they clearly are not.

And so it wants to ban them under the Tobacco and Tobacco Products Act for good measure. The government's rationale is just terrible: anti-scientific and deeply illiberal.

Nicotine is in itself very harmful

No it isn't.

The RIVM has determined that nicotine pouches contain harmful amounts of nicotine.

No they don't. Define 'harmful'.
Nicotine is an acutely toxic substance that is rapidly absorbed by the body, whether administered through the skin, by mouth or when inhaled. Use of a large amount of nicotine can lead to acute nicotine poisoning, sometimes fatal. 

A large amount of a lot of things could prove fatal, but commercial nicotine products do not contain anywhere near enough nicotine for that to happen. If you're worried about the strength of nicotine pouches, feel free to regulate the level of nicotine.

The only regulation needed of these novel products is (a) age restrictions on sale, (b) limits on nicotine strength, and (c) normal product regulation of ingredients. Banning them outright (while leaving cigarettes on the market, of course) is totally unjustifiable on any public health or ethical grounds. 

The public health of young people in particular is at stake. The government believes that more children should grow up in a smoke and tobacco-free environment. In such an environment, young people are protected against tobacco smoke, nicotine addiction and the temptation to start smoking. This also means that they do not come into contact with nicotine products without tobacco.

This doesn't make any sense, even on its own terms. At best, it is shameless mission creep. The last line is tacked on out of nowhere. Of course nicotine pouches are consistent with a 'smoke and tobacco-free environment', just like nicotine patches are. This is just lazy 'think of the children' drivel that would create a society fit only for children if it was followed through to its logical conclusion.
Not only does the government want to ban the sale of these pouches. It wants to ban the use of them. I didn't know this until today, but apparently snus is already included in the Dutch smoking ban!

The use of snus is prohibited in places where smoking is prohibited. It is difficult for those who have to ensure that the smoking ban is observed to determine whether someone is using snus or a nicotine pouch. This also applies to the Dutch Food and Consumer Product Safety Authority (hereinafter: NVWA)  who must ensure that the smoking ban is enforced by the manager of that location. Bringing nicotine pouches under the smoking ban also improves the enforceability of the smoking ban on this point. Furthermore, it is not in line with the aim of a smoke-free generation that there are products on the market (that are not a smoking cessation medicine) that can be used to maintain a nicotine addiction in places where smoking is not allowed. This would defeat one of the purposes of introducing a smoking ban, which is to encourage smokers to stop smoking.

It is difficult to know where to begin with the stupidity of this paragraph. It is unsurprising that a ban on the use of a product that is kept under the top lip is almost impossible to enforce, but it is not obvious why banning another product that can be concealed just as easily will make the ban any easier to enforce. A more logical response would be to remove snus from the ban.

We all know that smoking bans were designed to make smokers' lives harder, but it's rare to hear a government say the quiet part out as loudly as it does here. The ostensible aim of 'smoke-free laws was to 'protect' staff from secondhand smoke. Similarly, the aim of a 'smoke-free generation' policy was to have a generation of people who don't smoke, not to have an entire nation of obedient citizens who don't use nicotine in any form. The goalposts are now overtly shifting. It's almost as if prohibitionists will take a mile if you give them an inch.

Moreover, from a practical health perspective, having safer nicotine products will advance the goal of having fewer people smoking, not hinder it. The government completely ignores this. None of its documents mention the potential for adult smokers to switch to pouches.

It is sheer puritanism and it will spread around the world unless this senseless authoritarian juggernaut is brought to a halt. The Dutch government is consulting on these proposals until 16 January. The consultation webpage is here in Dutch and here in English. I'll be giving them some comments. I hope you will too.

Monday 19 December 2022

A late contender for junk science of the year

I am calling for a total and complete shutdown of e-cigarette research from California until someone can figure out what the hell is going on.

Teenage drinking is a top public health concern, generating social costs of over $28 billion per year, including substantial external costs associated with alcohol-related traffic fatalities. At the same time, the high rate of electronic cigarette (“e-cigarette”) use among teenagers has become a public health concern, with state and local policymakers turning to e-cigarette taxes as a tool to curb consumption. This paper is the first to explore the spillover effects of e-cigarette taxes on teenage drinking and alcohol-related traffic fatalities. 

I bet it is! 

Using data from five nationally representative datasets (the state and national Youth Risk Behavior Surveys, the Behavioral Risk Factor Surveillance Survey, the National Survey on Drug Use and Health, and the Fatality Analysis Reporting System) spanning the period 2003-2019, and a difference-in-differences approach, we find that a one-dollar increase in e-cigarette taxes is associated with a 1-to-2 percentage-point reduction in the probability of teenage binge drinking, and a 0.4 to 0.6 decline in the number of alcohol-related traffic fatalities per 100,000 16-to-20-year-olds in a treated state-year.

The study, currently a working paper but no doubt destined for a top 'public health' journal, is titled 'Can Anti-Vaping Policies Curb Drinking Externalities? Evidence from E-Cigarette Taxation and Traffic Fatalities'. I would be fascinated to hear more about the proposed causal mechanism here, but not enough to pay $5.


Friday 16 December 2022

Take no one's word for it

I take it as a slight badge of honour that an article I wrote in the early days of Covid was flagged as fake news on Facebook. I wrote a follow up to the offending article for Spiked two weeks ago titled 'The great Covid and fags cover up'. Regular readers will know what I'm talking about. If you don't, hit the link.

An organisation called Logically is Facebook's official fact-checking partner.

When Logically rates a piece of content as false, Facebook will significantly reduce its distribution so that fewer people see it, apply a warning label to let people know that the content has been rated false, and notify people who try to share it.

They have now rated my new Spiked article as 'misleading' which is a rung above 'false' in their ladder of truthiness. Why is it misleading? According to the accompanying blog post...

The article includes links to Snowdon's blog, where he has compiled a list of studies (including those published by reputed medical journals such as Lancet and Nature), and claims that an overwhelming “87 percent” of the studies acknowledge that smokers are typically less likely to catch the virus and be hospitalized.

On reviewing the exhaustive list of studies that Snowdon refers to, Logically found that several of them are pre-prints rather than peer-reviewed published papers.

You don't need to dig too deeply to see that. I explicitly say a study is a pre-print in the few cases where that is the case. There are only four of them, two of which use the same UK Biobank data. Excluding them makes no difference to the overall picture. The vast majority of studies have found smokers at less risk of getting COVID-19 and hardly any of them have found the opposite.
The author himself says that he has not done a "systematic review" of all the studies that have been listed.
Quite true. It is a compilation of every relevant study that crosses my radar, although I have some expert help.

In his article, Snowdon argued that search results for COVID-19 and tobacco/smoking lead to WHO briefs and articles in publications such as the British Medical Journal (BMJ). He claims that these studies merely state that smokers are at greater risk without addressing the actual findings of the studies that suggest smokers had a reduced risk of contracting COVID-19.

Indeed I do. Anyone who does a casual search would come away thinking that there was little to no evidence of a protective effect. Worryingly, this is all the fact-checker seems to have done. He focuses on those very same out-of-date and inaccurate websites that come up at the top of the listings - in particular, a short opinion piece by Jonathan Grigg (or 'John Griggs', as the fact-checker calls him):

In an article published in The Lancet on August 16, 2022, Professor John Griggs, a respiratory and environmental medicine specialist, acknowledged that there were studies in the early stages of the pandemic that appeared to provide evidence that smoking might protect against COVID-19. However, he also noted that during those early stages of the pandemic, "scientific journals rightly responded to the SARS-CoV-2 pandemic by more rapidly publishing their COVID-19 research”.

Yes, but the point is that these studies kept coming out long after the early days of the pandemic and have been remarkably consistent. 

Prof. Griggs also cited a more detailed article published in The Lancet, which examined epidemiological studies of tobacco use and COVID-19, and found that the studies have produced conflicting results, meaning further research is needed before one can claim that smoking affects susceptibility to the virus. The article nonetheless concludes that "the evidence indicates that smokers are at greater risk of poor outcomes from COVID-19, including hospital admission and progression to severe disease than are non-smokers."

This is a reference to an article by the renowned anti-smoking academic Neal Benowitz and his colleagues. It looked at 51 relevant studies, none published after August 2021, and found the evidence to be 'conflicting'.
Firstly, given what the fact-checker says about systematic reviews above, let's bear in mind that Grigg notes that Benowitz's article is...
...not a formal systematic review and based largely on searches up to August 2021
So how does this collection of studies differ from mine, apart from being half the size (and also smaller than the meta-analysis I mentioned in the article but which the fact-checker does not address)?
We identified conflicting evidence for the effects of cigarette smoking on the incidence of SARS-CoV-2 infection (appendix pp 3–6). Specifically, we identified 12 multivariable and eight univariate or frequency-reporting studies that found a positive effect of cigarette smoking on SARS-CoV-2 infection rates, and 14 multivariable and 12 univariate or frequency-reporting studies that found a negative effect.

That does indeed sound like a highly conflicting literature, but is it? Dip into the appendix and you will see that many of the studies are either irrelevant or don't say what Benowitz claims. The criteria for my list is that the study must be an epidemiological study showing the relative risk for SARS-CoV-2 infection among current smokers. Benowitz reckons he found twelve studies using multivariate models which show that smokers are more likely to get COVID-19, but he is clearly using far more generous criteria because they include the following... 
Li et al. - an ecological study about vaping, not smoking.  
Yoshikawa et al. - an ecological looking at smoking rates in Japanese districts. 
Liu et al. - another weak ecological study.

Wang et al. - a study of hospitalisations, not infections.

Gaiha et al. is a new one to me. It found, rather implausibly, that smokers were more likely to get COVID-19 but only if they vaped as well. Past use of e-cigarettes - but not current use - was strongly associated with COVID-19 risk. Make of that what you will.

McQueenie et al. is another study using Biobank data (two pre-prints using this data are in my list). It found that current/former smokers (the study didn't distinguish between the two) were 26% more likely to test positive. 

Colaneri et al. clearly states that 'being a current smoker was negatively associated' with COVID-19 infection. Presumably, Benowitz's excuse for including in his list was that it found that former smokers (like other nonsmokers) were more likely to get it.
Chen et al., which is in my list, didn't find an association between smoking or vaping and Covid infection but did find an association between vaping and smoking (i.e. dual use). 
Didikoglu et al. is another Biobank study. This one found that people whose mothers smoked in pregnancy were more likely to test positive. It is unclear from the study whether the same was true of people who smoked themselves.
Ho et al. is yet another Biobank study. This one found that current/former smokers were 45% more likely to test positive for SARS-CoV-2 (1.45 (95% CI 1.19 to 1.79)).
How many times was the Biobank data dredged during the pandemic?! Prats-Uribe et al. is yet another study using this dataset. This one separated current smokers from former smokers and found that current smokers were 42% more likely to test positive (1.42 (95% CI, 1.21–1.66)).
Of these twelve studies, only two fit my criteria and one is already on it so I've amended the list to include Prats-Urbine et al.
Benowitz also claims to have four studies using univariate models which find smokers to be at greater risk of infection. They are...

Albiges et al. didn't look at infections, it looked at mortality risk. 

Li et al. is the same study mentioned above; an ecological study about vaping, not smoking.

Dev et al. found an association between smoking and infection but this disappeared after adjustment. I'm happy to include this study in the list as supporting the null hypothesis.

Similarly, Mostafa et al. found associations with both former and current smoking which disappeared after adjustment for confounding factors. I'll add this one as a null finding too.

Unless we think epidemiological findings are more robust before they are adjusted for exogenous variables, none of these studies support Benowitz's argument. And none of the 'frequency-reporting studies' are relevant at all (I won't list them but feel free to check them yourself).

Benowitz also cites five studies which, he says, support the null hypothesis, i.e. they find no association either way. They are...

Liu et al. did not look at infection although it did find that smoking was not associated with Covid mortality risk.

Zhu et al. looked at hospitalisations, not infections. 

Dadgari et al. is a study from Iran which does indeed support the null hypothesis. I'll add it to the list.

Dayem et al. is a study from England which doesn't give relative risks for smoking but does say that 'current smoking status appeared to have a protective effect in our cohort after adjusting for comorbidities, as has been observed by others'.

Finally, Benowitz lists 14 studies using multivariate analyysis which show a protective effect from smoking, plus six using univariate analysis. Some of them are on my list already and a few of them don't meet my criteria, but there are eight studies that I've missed. They are...

Ghinai et al. is a study of homeless people in Chicago which found that smokers were less likely to be infected (0.71; 95% CI, 0.60-0.85).

Gu et al. is a US study which found: 'Being a current smoker (self-reported in the latest EHR encounter) was associated with a reduced chance of having positive test results (OR, 0.31 [95% CI, 0.20-0.48]; P < .001).'

Vila-Córcoles et al. is a study from Spain which found smokers 57% less likely to be infected (0.43 (0.25-0.74)).

Fernandez-Fuertes et al., is a study from Spain involving HIV patients. It found that 'active tobacco smoking was the only factor independently associated with lower risk of SARS-Cov-2 infection [Incidence rate ratio: 0.29 (95% CI 0.16–0.55)'.

Green et al. is a study from Israel involving patients with bronchial asthma which found: 'A significantly higher proportion of smokers was observed in the COVID-19–negative group than in the COVID-19–positive group (4734 [13.45%] vs 103 [4.55%]; P < .001).'

Gu et al. is a study from Michigan which found that smokers were much less likely to test positive for COVID-19 (0.31 (0.20-0.48)).

Lombardi et al. is a seroprevalence survey of Italian healthcare workers which found smokers were 59% less likely to test positive (0.41 (0.27-0.61)).

Holuka et al. is a study from Luxembourg which found smokers half as likely to test positive for COVID-19 (0.50 (0.30–0.83)).

These eight, plus the four studies that reached different conclusions, mean that we have an extra twelve studies to add. So let's get rid of the four pre-prints, two of which use the Biobank data. If they were going to be published in journals, they probably would have been by now. I've also taken a couple of studies out of the list, like this one, which are interesting but don't quite fit my criteria. I kept the Mendelian Randomisation studies even though they don't really fit the criteria because they're virtually the only studies that find an increased infection risk from smoking.

The new list is here. It has a grand total of 105 epidemiological studies looking at the relative risk of SARS-CoV-2 infection among current smokers. 

Of the 105 studies, 90 find a statistically significant reduction in risk of infection from SARS-C0V-2 among current smokers.

Eight of them find no statistically significant association either way (although theyy are nearly all below 1.0).

Four of them find an increase in risk.

Three of them found mixed results.

I mean, I guess you could say that these studies are 'conflicting' but there's a pretty clear tendency in one direction, isn't there?

The fact-checker then goes to the next link in the search results and finds the WHO... 

The WHO, in an updated 2020 review, which excluded the non-peer-reviewed reports and pre-prints, found that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients. However, it could not quantify the risk to smokers of infection by SARS-CoV-2 or hospitalization for COVID-19. The brief said that more population studies are needed to address these questions

Even if we ignore the fact that the WHO is corrupt and incompetent, the important thing to note is that this was a '2020 review'. More population studies have been conducted in the last two and half years and they overwhelmingly point to a protective effect. Perhaps this explains why the WHO haven't updated their webpage?

The fact-check ends with the thoughts of some random doctor in India... 

Logically also contacted Dr. Satyanarayana Mysore, head of the pulmonology department at Manipal Hospitals in Bengaluru, to get more clarity on the matter. Dr Mysore dismissed the claim that smokers are less likely to catch COVID-19, and said that there are major limitations in the studies associating smoking with with reduced risk of getting COVID-19. He noted that WHO has listed smoking and chronic obstructive pulmonary disease (COPD) as major risk factors for COVID-19. He added that smoking does not protect anyone from COVID-19 and has the potential to harm.

I've never heard of this guy and I doubt you have either. He could be as reliable as Aseem Malhotra for all I know. What are the 'major limitations in the studies'? Are they any more serious than in other epidemiological studies? The fact-check asserts that the early studies in this area were 'riddled with various problems' and had 'several biases' but it doesn't say what they are. It doesn't include a single link, even to the article it is fact-checking.

There are some very good fact-checking websites out there. The good ones lay out the facts, link to the data and explain why the claim is right or wrong. They don't appeal to authority or expect you to take their word for it just because they've declared themselves to be fact-checkers. Nullius in verba and all that. 
But I suppose if you are only accountable to Facebook, you can say what you like.

Saturday 10 December 2022

Bad Data - a review

 I reviewed Bad Data, a book about statistics, for Quillette.

Last Orders with Charlie Peters

A new episode of Last Orders is out. Charlie Peters tells us about his forthcoming documentary about grooming gangs and we discuss Scotland's alcohol advertising proposals, online 'safety' and why this government never does anything useful.

Listen here.

Thursday 8 December 2022

Drinking down, drinking deaths up

The ONS published their alcohol-specific mortality data today and it's the same depressing picture as last year. Having risen sharply in the first year of Covid, deaths rose again in 2021, presumably for the same pandemic/lockdown-related reasons. 

Two things to note about this. 

Firstly, the trends in England and Wales are basically identical in the last two years despite Wales adopting minimum pricing in the spring of 2020. The death rate in Scotland, which has had minimum pricing since 2018, continues to be much, much higher than in either of those countries.

Secondly, per capita alcohol consumption was lower in 2020 and 2021 than it was in 2019 and yet the death rate is much higher. This runs directly contrary to the whole population theory which maintains that there is a fixed relationship between the two variables, as I discussed in Lockdown Lessons in Public Health earlier this year.

Without the benefit of an expensive, government-funded computer model, I predict that alcohol consumption will rise and the number of deaths will fall in 2022.

Wednesday 7 December 2022

Favourite albums and opium dens

I've been on a couple of podcasts recently talking about various things.

It was a pleasure to discuss my five favourite albums with Tom Cridland on The Greatest Music of All Time podcast. Have a listen to find out what they are.

It was also nice to sit down with Delia Burgess for her Growing Up podcast to discuss political philosophy and why we should bring back opium dens. 

I've put the links to Apple podcasts above but you can find whenever wherever you get your podcasts.

Tuesday 6 December 2022

New junk science about alcohol advertising

With Scotland eyeing up a ban on alcohol advertising, you can expect some dubious claims about the efficacy of advertising bans to appear in activist journals in the coming months. A low quality effort in Drug and Alcohol Review titled 'Effective alcohol policies and lifetime abstinence: An analysis of the International Alcohol Control policy index' gets the ball rolling. 

Its authors include Sally Casswell and Petra Meier. Casswell was a co-author of the neo-temperance bible Alcohol: No Ordinary Commodity (alcohol is not actually a commodity) and Meier is the president of the neo-temperance Kettil Bruun Society having previously been in charge of the team in Sheffield that did the dodgy - and now demonstrably wrong - modelling on minimum pricing. 
Alcohol: No Ordinary Commodity and the Kettil Bruun Society promote strict Scandinavian-style supply-side policy interventions targeting affordability, availability and advertising, despite a lack of evidence that clamping down on any of them reduces alcohol-related harm. 
A Cochrane Review found "a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions" and even Casswell and her colleagues could not put forward a compelling case for advertising bans, saying in a summary of their book that...

Imposing total or partial bans on advertising produce, at best, small effects in the short term on overall consumption in a population, in part because producers and sellers can simply transfer their promotional spending into allowed marketing approaches. The more comprehensive restrictions on exposure (e.g. in France) have not been evaluated… The extent to which effective restrictions would reduce consumption and related harm in younger age groups remains an open question.

The new study claims, in the abstract, that: 

Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention.
Its methodology is so lame that you wonder how it was ever published. They found 13 countries and gave them a score under the International Alcohol Control policy index which awards points for "availability restrictions, pricing policies, marketing restrictions and drink-driving prevention". 

They then looked at how these scores correlated with the lifetime abstinence from drinking. With regards to alcohol advertising, there was quite a strong correlation, as shown below.

As the authors say: 
Marketing restrictions showed relatively high correlations with lifetime abstinence among the policies included (r = 0.80) (Figure 1).

Well, yeah, if you only look at these thirteen countries, one of which is Turkey where 90 per cent of the population is Muslim. The rest of them are a random grab bag including England, Scotland, Vietnam, Mongolia, Chile and New Zealand. Even tiny St Kitts and Nevis is there, but there is no USA, China, France or Russia.

The authors concede that "we had a limited sample size" and that that this "might have limited the generalisability of our findings". No kidding! 

They also admit that...  

... this was a cross-sectional analysis which was open to reverse causation, so our findings should not be interpreted as causal. Settings where alcohol use is less common may facilitate the government’s development and implementation of more restrictive alcohol policies.

This is quite obviously true of Turkey and, to a lesser extent, is likely true of some of the other countries.

Why such a small and eccentric sample? Apparently, it was a limitation "based on researchers who obtained funding and were willing to participate in the IAC study." Feeble stuff. It sounds like they relied on having people in each country to tell them what the laws were like in them. 

If so, they still managed to make mistakes. I don't know what the rules are in Mongolia or St Kitts, but I do know that Scotland has a lower drink-driving limit than England, and yet England gets a higher score for that in this study. England also gets a higher score for 'pricing' despite Scotland having minimum pricing while England doesn't. I stand to be corrected, but I also don't think there are any differences in alcohol advertising legislation between England and Scotland, and yet Scotland gets a higher score.

What is the point of a study like this? At best, it is underpowered to draw any conclusion. At worst, it is cherry-picking. And the data is wrong anyway. 

Why are they even using lifetime abstinence from alcohol as the measure in the first place? Since when was this the goal of alcohol policy? That alone tells you a lot about where these people are coming from.


PS. Brian Monteith has written about the extremist Scottish proposals for the Scotsman

Enjoy your favoured alcoholic relief while you can – because our Yellow and Green political puritans are coming after your pursuit of alcoholic recreation. And they will not be satisfied with temperance, oh no, nothing short of prohibition in Scotland will eventually do.

Why do I make this surely exaggerated claim? Two reasons; first the SNP/Green Scottish Government showed its hand last month when it launched a consultation on banning alcohol advertising in Scotland, and secondly, we know the route map from the past and current treatment of tobacco by today’s neo-puritans – and the assault against advertising of alcohol products will be almost identical, other than be delivered at an even faster pace.

No paywall. Do read it all.

Monday 5 December 2022

COVID-19, smoking and nicotine

After finding 100 studies looking at smoking and COVID-19, I have written about it for Spiked.

There are arguably no practical applications from the knowledge that smoking (or nicotine) reduces the risk of SARS-CoV-2 infection. Nobody was ever going to recommend smoking as a preventive health strategy and nearly everybody has had Covid-19 now anyway. But the truth needs no justification to be heard and if they can get away with lying about this, what else are they lying about?


Saturday 3 December 2022

Australia reaches peak clownshow

Congratulations if you had 'doctor gives child cigarettes' on your Australian clown show bingo card. I would have never thought of it myself. Seems too much like satire. Nevertheless, here we are...

Jason* is a general practitioner used to treating those addicted to tobacco, but he is at a loss as to how to help his 14-year-old son quit vaping.
... “I’ve tried talking to my son, warning of the health impacts of vaping and nicotine, and I’ve tried shouting and all of that sort of thing to get him to stop,” Jason said.

“It doesn’t work, because nicotine is highly addictive. We tried giving him nicotine gum but it was a waste of time because the amount of nicotine in gum is so minimal compared to the amount you get from vaping that it did nothing for his cravings.”

Jason has resorted to giving his son two cigarettes a day to replace the vape. He knows tobacco is harmful and comes with significant health consequences, but is facing a quandary that is common to many health practitioners and parents when young people come to them and say they are addicted to vaping.


*Names have been changed to protect the identities of children.

I'll say it again because it takes a while for it to sink in: a doctor is giving his own child cigarettes to smoke. 
Such an insane outcome is only possible in a country that has completely lost its mind about vaping. E-cigarettes have always been illegal in Australia and its people have been fed a constant diet of lies about them. Somehow they are able to ignore real world evidence from places like New Zealand and indulge in the fantasy that vaping is a tobacco industry ploy to get kids hooked on cigarettes. Many Australians believe that vaping is more dangerous than smoking. When you see Aussie doctors spreading the most extraordinary lies about vaping, it almost makes sense that a GP would try using cigarettes to help his child stop vaping. How he will then help his child stop smoking is another question, but better the devil you know, eh? At least they've finally found an example of the 'gateway effect', albeit one facilitated by a doctor.
The article is from the Guardian and was written by Melissa Davey whom thicko prohibitionist Simon Chapman took under his wing several years ago. After doing a Masters in 'public health' with Chapman, she immediately became a journalist and has been pumping out anti-vaping propaganda ever since. We cannot entirely discount the possibility that "Jason" does not exist and the whole thing has been made up. The Australian government recently opened a public consultation on vaping and Davey is shilling for even tougher laws to try to bolster the failed policy of prohibition. But whether Jason exists or not - and it is easy to believe that he does - it is telling that there is not a word of condemnation in the article for the doctor who - let's say it one more time - is literally giving his teenage son cigarettes. In Australia, this is apparently a perfectly reasonable thing to do.

What has been going on in Australia with vaping in recent years has all the hallmarks of a classic outbreak of mass hysteria. Historically, such outbreaks reach a tipping point when the charlatans who are pulling the strings go too far and the scales fall from people's eyes. The villagers turn on the witch-finder, everyone feels rather ashamed of themselves and life soon returns to normal. 

When a GP is handing out cigarettes to his own 14 year old son, surely that point cannot be far off in Australia?

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.