Saturday, 30 April 2022

Saying farewell to Covid again

Every time I call time on the Covid pandemic another variant shows up so let's hope that doesn't happen now that I have written what I hope is my last article about it for the Spectator...
 

James O’Brien, LBC’s pied piper of mid-wits, told his listeners on 22 April that ‘646 people died yesterday’ of Covid-19. He acknowledged that official statistics showed that the infection rate was falling, but muttered conspiratorially that he was ‘a little bit confused about how we’re keeping a proper handle on the number of infections now given that most of us have stopped testing’.

If even Mr O’Brien, whose books include How To Be Right and How Not To Be Wrong, is still confused by Covid statistics after two years, what hope is there for those us who didn’t attend a top public school? Sure enough, Twitter was awash with people repeating the 646 deaths figure and rebutting claims about falling infection rates with the words ‘we’re not testing’.

Anyone with an internet connection and mild curiosity knows this to be nonsense. The number of people in the UK who have died with Covid-19 written on their death certificate has not exceeded 200 a day since January 2022 and has not exceeded 300 a day since February 2021. Under the alternative measure of ‘deaths within 28 days of a positive test’, the figure has only exceeded 300 twice in the last year, but that metric has become increasingly misleading since the highly infectious Omicron variant became dominant.

Even the death certificate figures overstate the scale of the problem. In previous waves, Covid-19 was the underlying cause of around 90 per cent of deaths when the disease was listed on the death certificate. In recent weeks it has fallen below 65 per cent.

There were not 646 Covid-related deaths on 21 April, nor anything close to it. Instead, there was a backlog of reported deaths following a bank holiday weekend. No deaths were reported on Good Friday, Saturday, Easter Sunday or Monday. If you still haven’t got the hang of this after all this time, you should probably keep your opinions to yourself.

 


Thursday, 28 April 2022

Pod chats

I did a couple of podcasts this week. I was back with TV funnyman Geoff Norcott for the third time (I think) talking about Musk, Le Pen, China and much more. If you haven't already subscribed to What Most People Think, check it out here.

And I was on the Adam Smith Institute's Pin Factory podcast discussing nanny state issues, including vaping, so-called junk food and more. You can listen to that here.


Wednesday, 27 April 2022

Kellogg's sues the government

'Junk food'
 

John Harvey Kellogg was a miserable, teetotal, anti-smoking puritan so it's richly ironic to see his company attacked by 21st century neo-puritans. And it's pleasing to finally see a bit of pushback...  
 
Food giant Kellogg's is taking the government to court over new rules that would prevent some cereals being prominently displayed in stores because of their high sugar content.
 
Excellent. 
 

In a statement, Kellogg's said it had "tried to have a reasonable conversation with government" over the issue without success... 


As they would have been dealing with the Department of Health, that doesn't surprise me.

... hence their legal challenge.
 
Their argument is that the nutritional content of a box of cereal doesn't reflect the nutritional content of a bowl of cereal.
 

Chris Silcock, Kellogg's UK Managing Director, said: "We believe the formula being used by the government to measure the nutritional value of breakfast cereals is wrong and not implemented legally. It measures cereals dry when they are almost always eaten with milk.

"All of this matters because, unless you take account of the nutritional elements added when cereal is eaten with milk, the full nutritional value of the meal is not measured."

 
I don't know what the chances of success are. I expect the government will say that it can define 'junk food' however it wants and since the existing definition isn't based on any evidence whatsoever, it doesn't have to be consistent, rational or even sane.
 
Nonetheless, it is nice to see the food industry showing a bit of backbone at last. If the court case achieves nothing else, it might wake people up to the fact that this ban - and the accompanying advertising ban - mostly affects products that no reasonable person would consider to be junk food. I notice that the BBC article doesn't use the term 'junk food' for once, although it always did so when the campaign was underway.

Popular brands such as Crunchy Nut Corn Flakes and Fruit and Fibre are classified as foods that are high in fat, sugar or salt in their dry form and so retailers may be prevented from displaying such products in prominent positions, harming sales.

 
'Public health' versus Kellogg's Fruit and Fibre is just the battle we need to highlight the absurdity of this crusade. Like Crunchy Nut Corn Flakes, it is an excellent source of fibre and iron. Milk is an excellent source of calcium, vitamins and protein. It is a good thing for children to be eating them. Idiotic nanny state campaigners ignore all this because they are obsessed with trivial quantities of sugar.
 
The BBC naturally quotes some crank from Graham 'Mad Dog' MacGregor's Obesity Health Alliance...
 

Caroline Cerny, from the Obesity Health Alliance, said: "This is a blatant attempt by a multinational food company to wriggle out of vital new regulations that will limit their ability to profit from marketing their unhealthy products.

 
I once saw a box of Fruit and Fibre at the end of a supermarket aisle and now I'm so obese I can't leave the house.

"It's shocking that a company like Kellogg's would sue the government over its plans to help people be healthier rather than investing in removing sugar from their cereals."

 
Everything's "shocking" to these wowsers, isn't it?
 
A Department of Health and Social Care spokesperson said: "Breakfast cereals contribute 7% - a significant amount - to the average daily free sugar intakes of children.
 
7% is not a significant amount in one meal and there's nothing wrong with a bit of sugar in the morning to give you some energy.

"Restricting the promotion and advertising of less healthy foods is an important part of the cross-government strategy to halve childhood obesity by 2030..."
 
How's that going, by the way, according to your own fake figures?
 

 
Sugar tax and food reformulation working well, then! No doubt the next raft of bans will emulate their success.


Monday, 25 April 2022

An innovation principle for new nicotine products

My colleague Victoria Hewson and I recently wrote a report about vaping in which we discussed the precautionary principle. The precautionary principle is often invoked as a justification for banning things. When it comes to reduced risk nicotine products, we argue that such an approach is reckless rather than cautious.
 
We have ample evidence that e-cigarettes are much safer than smoking and are attractive substitutes to cigarettes for smokers. A study published last week found that smokers in Germany are 78% more likely to quit smoking if they use e-cigarettes, for example. 
 
But we would not have any of this evidence if every country had acted like Australia and preemptively banned them. The lesson is that we need an innovation principle, not a precautionary principle.

We discuss what that should look like in our report Vaper Trails which you can download for free here.


Tuesday, 12 April 2022

Graphic warnings on alcohol

More thinly veiled activism from the University of Stirling...
 
Prominent health warnings on alcohol products make drinking “unappealing”, new study finds
 
Young adult drinkers are more likely to perceive alcohol products as “unappealing” and “socially unacceptable” if they display prominent health warnings, according to new research.
 
Straight away we have a problem. Health warnings are not intended to make products "unappealing", let alone "socially unacceptable". They are supposed to give people important information that they might not otherwise have access to. Once consumers are appropriately informed, they can do what they damn well like. Who the hell do these people think they are, trying to make alcohol socially unacceptable to adults??

The study itself is a typical piece of 'public health' guff, being based entirely on an online survey. Its authors include Crawford Moodie, who was responsible for a large amount of the junk science that led to plain packaging. Moodie's specialty is showing people ugly photos and asking them if they find them ugly, usually via an online survey. In the usual slippery slope manner, he has transferred his skills to anti-alcohol activism.
 
Each warning set included one general (‘Alcohol damages your health’) and two specific (‘Alcohol causes liver disease’, ‘Alcohol causes mouth cancer’) warnings. The specific warnings were selected as more than three-quarters of alcohol-specific deaths in the UK in 2020 were caused by alcoholic liver disease and past research suggests that it is more effective to specify the type of cancer, with alcohol-related mouth cancer prevalent in the UK.

For those in the pictorial warning condition, an appropriate image was chosen to reflect each warning: ‘Alcohol damages your health’ (image of blood pressure test); ‘Alcohol causes liver disease’ (image of person clutching their liver); ‘Alcohol causes mouth cancer’ (image of CT scanner in a hospital). For consistency, in each condition participants were shown an image of a bottle of Smirnoff Red Label No. 21 vodka. 

You can see the bottles below (click to enlarge).
 
 
After being shown a photo of a selection of these bottles online, participants were asked whether they agreed with such statements as 'These alcohol products would make me aware of the health risks of drinking' and 'I find these alcohol products off-putting'. They were also asked to rate the Smirnoff bottle from 1 = ‘Very Unappealing’ to 5 = ‘Very Appealing’.
 
Can you guess what the results were? Of course you can. Anybody could. The people who saw the bottles that had been vandalised with graphic health warnings said they found the product less appealing that the bottles that had been left alone.
 
After controlling for covariates, participants who viewed products with warnings were significantly more likely to perceive the products as unappealing and socially unacceptable than the control condition.

You don't say! 

Look, I'm sure this is only the start of a new gravy train for 'public health' researchers so let me save the taxpayer some money and explain upfront that you will get the same result, every time, for any warning on any product. We don't need any more studies telling us that if you make something less appealing, people will say it looks less appealing.

But we also know from long experience with tobacco that such sentiments do not translate to behavioural change in practice. We know this because it has been shown in randomised controlled trials and because graphic warnings made not a jot of difference in the first country to implement them. Sorry, but RCTs and real world evidence trump online surveys.


Sunday, 10 April 2022

Escaping Paternalism with Glen Whitman

It was my great pleasure to speak to one of my favourite economists, Glen Whitman, this week about nudge theory. His book Escaping Paternalism, which he wrote with Mario Rizzo, is a must read.

 



Friday, 8 April 2022

Anti-gambling fanatic asks government to ignore the facts

The English Football League (EFL) is worried about the government banning sponsorship by gambling companies - and with good reason. When the House of Lords select committee carried out its review in 2020, it concluded that:
 

It seems that the removal of sponsorship would not unduly harm Premier League clubs, but it would very probably have a serious effect on smaller clubs; some of those in the EFL might go out of business without this sponsorship if they cannot find alternatives. This would be highly regrettable, especially given the close link between some of these clubs and their local communities. The financial situation of some of them is currently particularly fragile because of the impact of the coronavirus pandemic on sport. 

 
Naturally, therefore, the Lords did not support a ban on sponsorship that would seriously damage the heart and soul of the national game.
 
Only kidding. Of course they supported a ban. They just thought it should be postponed for a bit.
 

We therefore think they should be given time, perhaps three years, to adapt to the new situation. They would not be allowed in that time to enter into new sponsorship contracts with gambling companies, but any existing contracts could continue until they terminate, and clubs would have time to seek alternative sources of sponsorship.


The committee did not cite a single piece of evidence to justify a ban on gambling sponsorship. They just decided that there was too much of it.

They did try to find some evidence that gambling advertising was a problem, but came up empty-handed.
 

It is generally assumed that the increase in advertising is one of the causes, perhaps the main cause, of gambling-related harms. There is certainly a correlation, but we have received no evidence nor been pointed to any research which proves that there is any causal link between gambling advertising and problem gambling. On the contrary, Mr Parker [CEO of the Advertising standards Authority] said: “The indicators do not accord with the view that the undoubted increase in gambling advertising and in accessibility to gambling services, through smartphones, is driving a significant increase in problem gambling.


All true and all rather awkward for the anti-gambling lobby.
 

Mr Parker added: “I worry about this, because it seems common-sensical that, if there is a big increase in the volume of advertising, all other things being equal, it ought to lead to an increase in problems. The data is not showing that ...” This concerns us too. Plainly the companies would not spend increasingly large sums on advertising if they did not believe that this would increase either the overall amount gambled, or the amount gambled with their company, or both, and it does indeed seem counter-intuitive that this should not also result in an increase in gambling-related harms.


This displays an appalling - but very common - ignorance about the purpose of advertising. Companies spend money on advertising all the time without the expectation or need to grow the market. They just need to grow their share of the market. 

If gambling companies advertised to get more people gambling, they've done a very poor job of it. The number of gamblers has fallen in the UK in the last ten years and the market has declined in real terms since 2015 (note that figures before 2015 are not comparable because most of the remote gaming market was offshore).



Moreover, the number of problem gamblers hasn't risen since records began in 1999. In the latest set of statistics from the Gambling Commission (not shown below because these graphs are from A Safer Bet published last year), the rate is just 0.3%.


These indisputable statistics are not a strong foundation for a moral panic. 
 
The EFL has tried to explain all this to the government and for its trouble has found itself on the wrong side of former casino mogul Derek Webb whose front group Clean Up Gambling commissioned a report to slag off them off.

For some reason the BBC thinks this is newsworthy.
 
'Flawed' EFL gambling evidence should be ignored - MP
 
"Flawed" evidence submitted to the government's gambling review by the English Football League should be ignored, according to an MP who chairs a parliamentary group for gambling reform.  
 
.. Labour MP and chair of the All Party Group for Gambling Related Harm Carolyn Harris said gambling minister Chris Philp should "choose to ignore" the research in the gambling review, for which a white paper is due to be published within weeks.

She would, wouldn't she? She's a fanatic and her All Party Group, which has traditionally acted as a vehicle for land-based gambling companies, is funded by Derek Webb. 
 

The EFL, which is sponsored by Sky Bet and whose clubs receive £40m a year from gambling companies, commissioned research, seen by the BBC, which said there was "no evidence" that sponsorship influences participation in betting.

 
That is true.
 

It also said that gambling participation in sport "had remained flat at about 9% of the population between 2010 and 2018" and over the same period "the rate of problem gambling in sports had halved from 6% to 3%". 

 
That is also true. 
 

Vita's critique, which was commissioned by campaign group Clean Up Gambling, said the research was "faulty" based on using two different types of survey to assess gambling participation and problem gambling rates.

One of those surveys, conducted by the NHS and which runs from 2012 to 2018, cautioned against combining its results from a previous version of the survey because different methods were used to collect data.

 
This is a pretty desperate cope. The British Gambling Prevalence Survey which ran from 1999 to 2010 used the same gold standard surveys that the NHS has used since 2012 (the PGSI and DSM-IV surveys). They are accepted around the world as being appropriate for diagnosing problem gambling at the population level. 
 
Even if you believe that the data before 2010 are not comparable to the data after 2010 (and they are), the data from 2012 to the present day is totally comparable and those figures also show no rise in problem gambling.

The EFL's research also said there was "no evidence that sponsorship of clubs or leagues by betting operators influences participation in betting, or being a Skybet customer".

But the influence to gamble or not was based only on fans whose team had a gambling sponsor on their shirts and whether their team played in the Sky Bet-sponsored EFL, disregarding any other sponsorship or advertising in football as a whole.

It also concluded that "not being a fan of football decreases the probability of being a bettor, and of being a Skybet customer".


Football fans are more likely to bet on sport than people who don't like football! Who'd a thunk it?

If Webb, Harris and the APPG had some credible evidence that gambling sponsorship turns people into problem gamblers - or even into mere gamblers - they should point us to it. Instead, they cite some self-commissioned 'report' from Vita - whoever they are - which doesn't seem to have been published anywhere (not even online) and tell the government to ignore the EFL's evidence, i.e. to ignore the facts.
 

Harris told The Sports Desk podcast: "A decent thing would be to withdraw [the EFL] evidence, but they're not going to do that. So you need to take it with a massive pinch of salt which I suspect [the government] do.

"[The minister] can ignore it, he can choose to ignore it or discard it. And I would like to think that he would, but we know he's overwhelmed with evidence at the moment. I don't think the gambling minister is entirely hoodwinked. I think he sees a lot of the content for his white paper as being flawed."

 
They seem a bit rattled.


Wednesday, 6 April 2022

So many awkward studies about smoking and COVID-19

If you check out my list of COVID-19/smoking studies you'll find more than 70 epidemiological studies looking at how smokers fare when faced with the virus. In short, the evidence overwhelmingly shows that they are much less likely to get infected. 

Almost the only exceptions are a handful of Mendelian Randomisation studies that can't distinguish between smokers and nonsmokers and instead assume that people with genes that are associated with a propensity to smoke are smokers. For various reasons, that is not a sound assumption after decades of anti-smoking education and legislation. When it comes to lifestyle risk factors, the blunt tools of MR are only any good if you don't want to find an association.

The largest epidemiological study of its kind was published in Nicotine and Tobacco Research a few days ago. It involved 2.4 million people in California and it found that smokers were not only less likely to get infected but were less likely to be hospitalised, admitted to intensive care and die as well. 
 

Current smoking was associated with lower adjusted rates of SARS-CoV-2 infection (aHR=0.64 95%CI:0.61-0.67), COVID-19-related hospitalization (aHR=0.48 95%CI:0.40-0.58), ICU admission (aHR=0.62 95%CI:0.42-0.87), and death (aHR=0.52 95%CI:0.27-0.89) than never-smoking.

 
Coming from a state that has taken anti-smoking regulation to almost fascistic lengths, this must have broken the authors' hearts. To be fair, they seem to take it quite well and acknowledge that the 'smoking paradox' hypothesis should probably now be considered a fact.
 

In what has been termed the “smoker’s paradox,” studies across the globe have generally found lower risk of SARS-CoV-2 infection for current versus never smoking, an inverse association between smoking prevalence and the prevalence of SARS-CoV-2 infection, and a lower than expected prevalence of current smoking among patients hospitalized with COVID-19.

... A national matched case-control study from Korea found that current (OR=0.33, 95%CI:0.28-0.38) and former smoking (OR=0.81, 95%CI:0.72-0.91) was associated with a lower odds of SARS- CoV-2 infection than never-smoking. Data from 38 European countries found that after covariate adjustment, smoking prevalence was inversely related to SARS-CoV-2 infection. Further evidence comes from a cohort study of an aircraft carrier crew exposed to SARS-CoV-2 while at sea. Current smoking was associated with a lower odds of SARS-CoV-2 infection (OR=0.64, 95%CI:0.49-0.84), with even lower odds for those smoking more heavily...


That was a particularly amusing finding and an interesting study.

Many researchers who find that smokers are at less risk of Covid are keen to downplay their findings. They sometimes ignore them in the text altogether But the authors of the Californian study seem more interested in testing the various explanations that have been put forward and their study does this rather well.

Our study has important strengths. First, it is now recognized that non-representative sampling (e.g., hospitalized patients, people tested for active infection, voluntary participants) in many observational studies of risk factors for COVID-19 can lead to collider bias distorting true associations between risk factors and outcomes. A unique strength of our study is the inclusion of a large defined cohort of patients at-risk for COVID-19 within a closed healthcare system followed from testing and infection to death. 

Since all patients were insured, results are unlikely due to variations in access to care. 

Our retrospective cohort study design properly estimates risk over time, making it more rigorous than convenience sample studies. 

Further, the semi-parametric Cox proportional hazards model flexibly allows the underlying baseline risk to vary over the study period, accounting for changes in risk/exposure as the pandemic unfolded. By assessing smoking status during standard care pre-pandemic, our smoking data do not reflect short-term changes resulting from infection (e.g., if smokers with severe COVID-19 consequently quit smoking and report former smoking status). The small percentage missing smoking status was excluded rather than included with never-smoking, reducing the likelihood of misclassification. 

 
As for the idea that smokers are more likely to get tested, we know from mass seroprevalence studies (in which everyone gets tested) that this doesn't explain the association, but the authors offer further evidence.
 

Prior studies have speculated that people who smoke may be more likely to get tested for COVID-19 when asymptomatic (e.g., due to Centers for Disease Control and Prevention [CDC] guidance characterizing them as at-risk) or due to smoking-related symptoms mimicking COVID-19 symptomatology (e.g., cough), increasing their percentage of negative tests. While we are unable to directly test this, it is reassuring that in our study, COVID testing prevalence was comparable by patient smoking status (24.7% current, 28.1% former, and 24.6% never- smoking) and with a similar number of tests, on average. 


This must be the first worthwhile study about smoking produced in California for about thirty years. Does it matter? It's not as if governments are going to start telling people to start smoking, and everyone's going to get COVID-19 sooner or later anyway.

I think it does matter and so the authors. Firstly, because the truth is important no matter how politically incorrect it may, but also because this information could turn out to be really useful.

Understanding whether smoking is associated with risk of SARS-CoV-2 infection and COVID-19 severity is critical for informing public health strategies to mitigate risk during future outbreaks and prioritize at-risk groups for vaccination outreach, boosters, and treatments as they become available.


It will also never stop being funny.


Tuesday, 5 April 2022

The sorry state of vaping research

Dozens of new studies about vaping are published every week and most of them are absolutely dismal. They start from a false premise, use biased terminology, treat 'EVALI' as if it was caused by conventional vaping, fail to distinguish the effect of vaping from the effect of prior smoking, treat correlation as causation, and employ poor methodologies to come up with a desired anti-vaping conclusion.

A new study titled 'Analysis of common methodological flaws in the highest cited e-cigarette epidemiology research' shows just what a sorry state the field is in, particularly the garbage that gets the most citations and is most attractive to journalists. 

Well done to the authors for doing this deep dive. Here is their conclusion:
 

Our critical appraisal reveals common, preventable flaws, the identification of which may provide guidance to researchers, reviewers, scientific editor, journalists, and policy makers. One striking result of the review is that a large portion of the high-ranking papers came out of US-dominated research institutions whose funders are unsupportive of a tobacco harm reduction agenda.

However, this does not mean there is a trove of good research out there that answers the big questions, but merely did not make the popularity cut. There is not. Notably, papers discussing the effect of vaping on smoking initiation shared common flaws. By contrast, papers addressing the effect of vaping on smoking cessation or reduction demonstrated a broader variety of flaws, yet common themes emerged. Our analysis of common flaws and limitations may guide future researchers to conduct more robust studies and, concomitantly, produce more reliable literature. There are countless sources of good building-block information that can be pieced together to provide knowledge. To provide useful information, research questions should be precise, contingent, nuanced and focused on quantifications that are motivated by externally defined questions. Such research necessitates proactive design, rather than utilizing already existing, but not fit-for-purpose, datasets.

 
Do read it all. No paywall.


Friday, 1 April 2022

Boris's BOGOF rip-off

The plan to ban buy-one-get-one-free (BOGOF) and 3 for 2 deals on so-called junk food just as the cost-of-living crisis peaks in the autumn increasingly looks like an act of political self-immolation. The idea was championed by Public Health England which was closed down for being incompetent and, as Jeremy Driver says, it was a classic example of "luxury politics, divorced from the material concerns of citizens"

This point is underlined by the Public Health England report which originally pushed the idea in 2015. It says...
 

There is also evidence that during the high inflationary period of 2008-2010, promotions were a useful coping strategy for shoppers to manage the worst effects of food and drink inflation. 

 
Inflation briefly hit 5% in that period. It currently exceeds 6% and is expected to exceed 8% by October when the ban is due to begin. 
 
The thinking seems to have been that it was OK to remove the "coping strategy" of price promotions so long as inflation was low. Well, it ain't low any more.
 

During this period as food and drink became relatively more expensive, behavioural data shows that many shoppers increasingly selected items offered on promotion to help them save money.


You don't say!
 

Promotions at this level do of course play a role in helping shoppers reduce the cost of the items that they choose to buy. Based on the breadth and depth of promotions we can calculate a “giveaway” figure which equates to a 16% or approximately £634 reduction on a typical household’s annual, take home food and drink bill. In other words if people bought the same quantity of food and drink with no promotions they would need to spend an additional £634 for the same items.


The actual cost of the policy is likely to be less than £634 per household because retailers have other ways of discounting prices, but multibuy deals save consumers money, in part, because they save retailers money and allow them to adopt the Pile 'Em High approach. Retailers get bigger discounts from wholesalers when they place bigger orders and multibuy deals also help them clear surplus stock. They are an engine of efficiency.
 
These deals particularly benefit families because families buy more food. Sure enough, families are more likely to take advantage of them.


The PHE report goes on to claim that these deals actually cost consumers money because they end up buying more products but their analysis is shaky and they don't seem to consider the possibility that people might want to buy more food. Or indeed need to.
 
The bottom line is that the ban was intended to make people buy less food by making it more expensive. Like minimum pricing, it is the cousin of the sin tax but unlike a sin tax it doesn't raise any money for the government. That means the government can abandon the idea at zero cost and save consumers money.

Surely this is a no-brainer?