Friday, 20 May 2022

Jamie Oliver addresses a small gathering in London

Contemptible multi-millionaire Jamie Oliver turned up to speak to the staff of his front group Biteback and a handful of journalists in Westminster today in a protest against affordable food. Waving a high-sugar, high-fat, high-calorie luxury dessert, the failed restaurateur demanded the government ban multibuy deals such as '3 for 2' and '50% extra free' on food that contains modest quantities of fat, sugar and salt. The government is doing this anyway, just a year later than over-the-hill chef would like.
 
 
I wrote about this issue for Spiked in the week, so I will leave Tom Harwood to summarise the day's events. I particularly enjoyed the last 15 seconds of this.



Wednesday, 18 May 2022

Do nanny state policies work at all?

Carl Phillips and Marewa Glover have produced a very interesting study assessing the efficacy of anti-smoking policies in the USA. With the exception of tax rises, they find very little evidence that any of them have made any measurable difference to smoking rates and that most, if not all, in the fall in smoking rates would have happened without any legislation. 
 
Why, then, have smoking rates been declining for decades? Their theory is that it began with the "information shock" of public health authorities, such as the Surgeon General, declaring smoking to be a major health risk in the 1960s. This led to an immediate decline in smoking rates which has echoed down the years through inter-generational effects. As they note, the most robust predictor of individual smoking initiation is parental smoking. When parents quit or never start smoking, their offspring are less likely to smoke.  

And so, by their calculations...
 

Results: About one-third of the observed prevalence decline through 2010 can be attributed solely to fewer parents smoking after the initial education shock. Combining peer-group cessation contagion explains well over one-half of the total historical prevalence reduction. Plausible additional echo effects could explain the entire historical reduction in smoking prevalence. 

Conclusions: Ongoing anti-smoking interventions are credited with ongoing reductions in smoking, but most, or perhaps all that credit really belongs to the initial education and its continuing echoes. Ensuring that people understand the health risks of smoking causes large and ongoing reductions. The effect of all other interventions (other than introducing appealing substitutes) is clearly modest, and quite possibly, approximately zero, after accounting for the echo effects.

 
I recommend reading the whole study, but the following section should give you the gist of what they mean by echo effects:
 

We know that choosing to smoke is socially contagious – the more people around someone who smokes, particularly their parents, the more likely they are to start smoking.1 Parental smoking is the most consistent strong predictor of whether a teenager (of a particular age, in a particular population) will start smoking. Smoking prevalence among siblings, peer groups, and the wider community affects uptake via overt and subconscious social signaling. All of these are taken as fact in the scientific literature and in Phillips et al tobacco control politics, where they are cited as motivation or points of leverage for interventions. But one important implication – that a downward shock or trend in smoking prevalence will, by itself, cause further downward trending for more than a generation – is generally ignored. 

Similarly, smoking cessation is a contagious behavior. This is particularly clear for switching to a lower-risk alternative, wherein the person quitting smoking demonstrates to their social contacts that the choice is appealing and educates them about the alternative. However, even if the choice of cessation method is not affected by social-contact education, the demonstration effect of quitting itself is still powerful. Seeing a friend quit smoking takes it from being an abstract possibility to a concrete example of success. In addition, simply having fewer people who smoke in one’s social circles encourages quitting. Each of these, and all of them together, creates a positive feed-forward effect from any smoking reduction. 

Thus, a one-time permanent downward shock in the popularity of smoking – like that caused by initial education about the harms from smoking – causes a long tail of transition to a new lower equilibrium, echoes of the initial shock. If many people quit smoking, then many more who would have started smoking had they come of age earlier will not do so and others will be motivated to quit over time. The subsequent cohorts coming of age not only will experience the effect of the downward shock, but also be subject to less social contagion. There will be a new equilibrium, but it will only be reached slowly, with a substantial portion of the effect taking more than a generation. This will happen with or without any further efforts to discourage smoking. Subsequent interventions could still have effects beyond the secular trend toward a new equilibrium, of course, but it makes no sense to try to quantify those effects without trying to estimate the background effects of the echoes alone.

 
Phillips and Glover stress that it cannot be proved either way whether the bulk of anti-smoking regulation has made a difference to smoking rates. They present a hypothesis and a series of models. But it is an intriguing hypothesis and I have often wondered to what extent the tobacco control lobby has been dining out on a decline in smoking rates that would have happened without them (and for many years did happen without them). 

That would certainly help explain why tobacco-style regulation fails to work when applied to other activities. These policies tend to focus on the Three As - affordability, advertising and availability - but whilst it is Econ 101 to note that higher prices tend to lead to lower consumption, albeit at the expense of consumers, the evidence for the other two As is remarkably thin on the ground. 

Take alcohol. A 2019 systematic review titled 'Do alcohol control policies work?' and written by two members of the South African Medical Research Council concluded that ‘[r]obust and well-reported research synthesis is deficient in the alcohol control field despite the availability of clear methodological guidance.’ The policies examined included restricting alcohol advertising and restricting on- and off-premise outlet density.

With regards to advertising, a Cochrane Review, which is usually considered definitive, found 'a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions'. 

Even the authors of Alcohol: No Ordinary Commodity, the bible of the secular temperance movement, were only able to make a limp case for advertising bans.

‘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.’


A systematic review published in 2012 tried very hard to find evidence to support orthodox, supply-side anti-alcohol policies. It was written by dyed-in-the-wool 'public health' activists, including Mark Petticrew and Martin McKee, but they really struggled to find what they wanted. 

On advertising, they found seven studies which 'provided inconclusive results for the influence of advertising on alcohol use'. 

There wasn't much evidence and a lot of it was of poor quality, but...

A study rated as ‘strong’ in the quality assessment found no significant association between exterior advertising in areas near schools and adolescent drinking.

 
The authors nevertheless concluded that...
 

In general, the findings of this review are consistent with reviews on wider alcohol availability (Popova et al., 2009), which have found that availability has a strong influence on alcohol use.


But this is mere editorialising. The evidence they discuss in the paper doesn't show that at all.

In general, the results of this review are similar to those found in previous reviews (Babor et al., 2003)—studies show mixed results but strongly indicate that greater exposure to advertising is associated with higher levels of alcohol use.


How can mixed results strongly show anything?

They also looked at availability - including licensing hours and outlet density - and again struggled to find evidence to support their priors. They found '21 studies on the influence of availability of alcohol from commercial sources on alcohol use', but, alas...

Overall the findings provided inconclusive results for the influence of availability on alcohol use, although some studies indicated that higher outlet density in a community may be associated with an increase in alcohol use.

With regards outlet density specifically:

For off-premise outlets (such as shops), eight studies found no significant association but there is some indication that a higher density of off-premise outlets may be associated with an increased likelihood of heavy drinking. For on-premise outlets (such as bars and restaurants), results were also mixed but there is some indication that a higher density of on-premise outlets may be associated with an increase in the likelihood of drinking and heavy drinking. 

 
'Some indication' and 'may be associated' are not phrases to fill policy-makers with confidence and are a far cry from the bald assertions of efficacy you hear from the likes of Alcohol Focus Scotland when they appear on television.

As for local changes to licensing regulations...

Four studies (with four effect estimates) looked at the influence of local licensing changes on alcohol use, which included banning alcohol sales and making changes to the hours, days and volumes of alcohol sales that were licensed. They indicate that licensing restrictions may reduce alcohol use, but the evidence is not very robust.


This, remember, is from a group of people who are absolutely committed to clamping down on the advertising and availability of alcohol, and who are putting the best possible spin on the evidence.

The story is much the same when you look at food/obesity. You don't see many randomised controlled trials in the nanny state wing of public health but we have one for the policy of food reformulation. And guess what? It doesn't work. 
 
Consumption of sugar-reduced products, as part of a blinded dietary exchange for an 8-week period, resulted in a significant reduction in sugar intake. Body weight did not change significantly, which we propose was due to energy compensation.

We also have a RCT for intensive anti-obesity interventions with children over a period of years and they don't seem to work either.

It is often claimed that limiting the number of fast food outlets will reduce obesity, but dozens of studies have looked at the association between proximity to fast food outlets and obesity. The vast majority suggest that there isn't one.

This week saw the publication of a systematic review of food advertising. Again, it was written by fervent interventionists and its lead author is the activist-academic Emma Boyland who is responsible for a fair chunk of the literature herself. She is now not only a professor but also an advisor to thee World Health Organisation.

 

 
You won't be surprised that she concludes that governments should restrict food advertising, but it is difficult much of a justification for this in her study.

Evidence on diet and product change was very limited. The certainty of evidence was very low for four outcomes (exposure, power, dietary intake, and product change) and low for two (purchasing and unintended consequences).

Shown in a graphic, the evidence can most charitably be described as 'mixed'.
 
 
Even the press release had to come clean:
 

Their research, published in JAMA Pediatrics, found that food marketing was associated with significant increases in food intake, choice, preference, and purchase requests. However, there was no clear evidence of relationships with purchasing, and little evidence on dental health or body weight outcomes.


If food marketing doesn't have an effect on 'body weight outcomes', there is, of course, no point in restricting it. Obesity and dental health are the only outcomes we're interested in.

None of the studies mentioned above are libertarian hit jobs or industry debunkings. On the contrary, they are written by teammates marking each others homework. The ideological bias and statistical chicanery of many 'public health' researchers will be well known to readers of this blog. If they can't produce persuasive evidence that their policies work, even when reviewed by like-minded friends, we must seriously consider the possibility that none of this stuff does what it is supposed to.


Trying to find common ground on food policy

Sky News have a show presented by Trevor Phillips which tries to find common ground between people who disagree. It is called, reasonably enough, Common Ground and I like the format. It's half an hour long so there is time to get deeper into issues than you get in a standard TV interview. 

Yesterday I was on the show with Thomasina Miers, a restaurateur and food campaigner, to discuss the BOGOF ban and obesity policy in general. She is not a fanatic like Graham 'Mad Dog' MacGregor nor is she a grifter like Aseem Malhotra. She's mostly interested in improving the nutritional quality of school meals, but she also supports things like the BOGOF ban, so we naturally disagreed.

I'm not sure how much common ground we found. Watch it and decide for yourself.



Tuesday, 17 May 2022

Bog off forever

The ban on volume price discounts, such as '3 for 2' deals, for HFSS food has been delayed by a year and will now come into force in October 2023. The advertising ban has also been delayed by a year and will come into force in January 2024. 

Both of them should be ditched for good, as I argue in Spiked today...
 

The scoundrels of ‘public health’ have persistently claimed that the ban only applies to ‘junk food’. Most of the media have gone along with this conceit, but ‘junk food’ is in the eye of the beholder and has no legal definition. In Britain, the category of HFSS (high in fat, sugar or salt) is used as its nearest equivalent, but this covers far more products than you might expect, including olive oil, raisins and walnuts. 

The absurdity of this came to light when Transport for London introduced a ban on ‘junk food’ advertising and ended up penalising an achingly ethical food-delivery company for showing butter in an advertisement. TfL even had to change its own maps of London to remove offending images of strawberries and cream (Wimbledon) and curries (Brick Lane).

In an effort to avoid a similar embarrassment, the government has decided to define ‘less healthy food’ however the hell it likes. Butter and bacon are no longer on the list, despite both being very high in fat and bacon being high in salt. Forced to name every category of HFSS food that will be covered by the ban individually, the Department of Health has revealed how far-reaching and arbitrary the law will be.

As you might expect, the list includes crisps, pizza and chocolate, but it also includes ‘products made from potato, other vegetables, grain or pulses’; ‘bagged savoury crackers, rice cakes or biscuits’; ‘pitta bread-based snacks, pretzels, poppadoms, salted popcorn, prawn crackers’; ‘ready-to-eat cereals, granola, muesli, porridge oats and other oat-based cereals, bars based on one or more of nuts, seeds or cereal’; ‘croissants, pains au chocolat and similar pastries, crumpets, pancakes, buns, teacakes, scones, waffles, Danish pastries and fruit loaves’; ‘roast potatoes, hash browns, crispy potato slices, potato croquettes’; and ‘fish fingers and fish cakes’.

It also includes shop-bought meal deals of the kind that are popular with millions of people every lunchtime. If any component of the meal deal is deemed to be HFSS – a bit of mayonnaise in the sandwich, some sugar in the drink or a pack of crisps on the side – you will have to buy the items separately at an inflated cost. 

The government’s Impact Assessment expects to see a ‘loss in consumer surplus for consumers who currently make extensive use of price promotions’. That’s one way of putting it. The BOGOF ban should never have made it past the ideas stage and should now be put out of its misery for good.

 



Sunday, 15 May 2022

Gambling as a 'public health' issue

Martin McKee and Mark Petticrew, two of the most inept 'public health' blowhards in Britain, have bumbled into the gambling debate with a letter in Lancet Psychiatry. McKee has form for talking rubbish about gambling, having been an opponent of the National Lottery way back in 1995. Neither he nor Petticrew have conducted any research into problem gambling, but they recognise that efforts to redefine gambling as a 'public health' issue offers them a new dragon to slay and new opportunities to write opinion pieces about industry websites masquerading as research (which is Petticrew's speciality).

The letter is a bit of a blancmange and it becomes clear straight away that they are out of their depth.
 

Gambling harms have traditionally been viewed through the lens of psychiatry, psychology, and the neurosciences, with a focus on the individual gambler. This approach reflects an international research agenda that originated with the gambling industry and organisations that it has supported for almost 40 years. The ways in which this literature serves to pathologise people identified as so-called problem gamblers...


The clinical term for 'so-called' problem gambling is pathological gambling. The clue's in the name. It is a psychological problem which can be successfully treated. One of Britain's most prominent anti-gambling campaigners was cured of his compulsive gambling through the use of cognitive behavioural therapy and medication. These things work. 

The approach of the modern, morally bankrupt 'public health' movement is to not get your hands dirty working with individuals but to treat everything as a power struggle with the world of business, and lobby for useless legislation. One of the current fads is for levies on industry which amount to self-serving shakedowns. That's what the anti-smokers want and it is what some anti-gamblers want too. 
 
The thing is that the gambling industry already provides a lot of money for treatment and prevention, and is prepared to offer more. Such is the moral righteousness of the anti-gambling mob that they would rather tax the general public than accept money from industry. I reported such a case involving the mental health director of the NHS back in February. Some of them seem to have convinced themselves that money from industry is somehow laundered if it comes via a levy instead.

McKee and Petticrew are even opposed to a levy because it would supposedly create a 'conflict of interest'.
 

Bowden-Jones and colleagues propose a 1% levy on industry earnings to fund independent research. Although this funding would be a clear improvement on the current unsatisfactory system, in which voluntary contributions from the industry are channelled through GambleAware (a charity that both raises industry-derived funds and commissions research), the suggested levy is not a panacea. Linking the available funding to the earnings of the industry would create an obvious conflict of interest, because those involved might hesitate if their actions were to curb profits. We do not understand why public funding for gambling research should not be from government revenues, as is the case with any other threat to health.


This doesn't make much sense. Firstly, a levy would contribute to government revenues. Secondly, by the logic of 'public health' at least, if the industry makes less money (and therefore pays less via the levy) then there must be less gambling-related harm. Thirdly, are they seriously suggesting that researchers will refrain from offering effective solutions because the money will dry up somewhat? That would take a pretty unscrupulous and immoral academic. I believe this is known in psychology as projection.

So what do they propose instead? Insofar as they have a plan, it involves leaving problem gamblers to their fate while 'public health' grandees make pompous speeches about the 'commercial determinants of health' which is code for nutty anti-capitalist activism.

We call for a transformational change in how we conceptualise gambling harms, based on a public health framework that moves away from the current individualistic focus on so-called problem gamblers, takes seriously the upstream drivers of harm (eg, harmful business practices, products, and policies), and prioritises prevention of all forms of gambling harms, with funding mechanisms that are consistent with these goals.

 
It would be bad news for everybody if these ideologues get their way, but they seem to have some support, such as this chap...

Nothing much to worry about there, you might think. Just some bloke on Twitter who wrongly believes that treatment doesn't work. 

But the bloke who thinks treatment doesn't work is the Clinical Lead & Consultant Psychologist for the NHS Northern Gambling Service. Presumably he'll be handing in his resignation in the morning.



Friday, 6 May 2022

Prohibition doesn't work - South African edition

Mark Petticrew and a few of his headbanging colleagues have written a little diatribe for the BMJ. The gist of it is that arguments and evidence they don't like are a form of 'pollution' and should be controlled as such. Or something like that. I don't recommend reading it as it is largely gibberish, but I was amused by this sentence...

Public health research and advocates were also framed as “nanny staters” or “prohibitionists”6 engaging in “class warfare.”7
 
The citation for the supposedly unfair claim that 'public health advocates' are prohibitionists is this article from Tobacco Control which literally calls for a total ban on the sale of cigarettes (the authors argue that if they call it 'abolition' rather than prohibition, they will throw the public off the scent).

Being prohibitionists, a number of people in the 'public health' racket got rather excited about the ban on tobacco and alcohol sales in South Africa during the 2020-21 lockdowns. They obviously saw it as a test case for their long term goals. 

The consequences of alcohol prohibition in South Africa were exactly what you might expect. Tobacco prohibition worked out in much the same way, as a new study has found:

South Africa temporarily banned the sale of tobacco as part of its COVID-19 response. Despite the ban, the sale of cigarettes did not cease; rather, it caused major disruption to the cigarette market. The ban inadvertently benefited manufacturers who were previously disproportionately involved in illicit activities; these manufacturers increased their market share even after the ban was lifted. The ban may have further entrenched South Africa's already large illicit market. Our results show that there are unintended consequences associated with a temporary ban on the sale of cigarettes.
 
You don't say!


Thursday, 5 May 2022

World Health Organisation admits its anti-obesity policies don't work

From The Times...
 

Britain is on track to be the fattest nation in Europe in a decade, with the rise in obesity driven by takeaway services such as Deliveroo and sedentary lifestyles, a World Health Organisation expert has warned.

By the early 2030s, 37 per cent of British men and women are expected to be obese, a report from global health chiefs says. The present figure is 28 per cent.

 
Regular readers will be aware that obesity predictions from the likes of the WHO are worthless. As I wrote in 2015... 
 
In 2006, a Department of Health report predicted that 28 per cent of women and 33 per cent of men would be obese by 2010. Although a prediction for just four years in advance sounds a modest task, 2010 came and went with obesity rates of 26 per cent for both sexes.

In 2007, the well-regarded Foresight report predicted that 'by 2015, 36% of males and 28% of females will be obese'. Figures for 2015 have not yet been published but the most recent data for England show rates of 26 per cent and 24 per cent respectively.

Undeterred by these failed efforts at clairvoyance, The Lancet published a report in 2011 which predicted that nearly half of all British men and 43 per cent of British women would be obese by 2030. It would take an extraordinary surge in prevalence for this to come to pass. Current rates are below The Lancet's lowest confidence interval and appear unlikely to catch up.

 
Leaving the WHO's prognostication skills to one side, the claim that UK obesity rates will rise from 28% to 37% in the next decade does not say much for the WHO's anti-obesity policies. By 2030, the tax on sugary drinks - which the WHO portrays as one of the 'best buys' for tackling obesity - will have been in place for 12 years. The food reformulation scheme - which is apparently so effective that it is being rolled across Europe by the WHO - will have been in place for 14 years. Heavy restrictions on the promotion and sale of so-called junk food will have been in place for 8 years. Mandatory calorie labelling will also have been in place for 8 years. A ban on advertising food that is deemed high in fat, sugar or salt on TV before 9pm and online any time will have been in place for 7 years.

The WHO would doubtless say that the government should do even more, but this not nothing, is it? Once the last of these policies is rolled out next year, Britain will have the most far-reaching anti-obesity legislation anywhere in the world. If this stuff worked, you would expect obesity rates to fall by at least a few percentage points. Instead, the WHO reckons they will rise by a third and Britain will overtake Turkey and Malta to become the fattest country in the WHO Europe region.

Hardly a glowing endorsement of their own policies, is it?


The impact of minimum pricing

I've summarised the results of my recent research into minimum pricing for Cap-X...
 

From an economist’s perspective, the unusual natural experiment of minimum pricing offers a chance to see how human beings respond to floor prices. The sale of wine stayed more or less unchanged, but the sale of fortified wine rose by 25%. Much of this came from a surge in the sale of the notorious tonic wine Buckfast which was never sold below 50p per unit to begin with. 

Spirits sales fell overall, but the sale of whisky rose by 11%. The Scotch Whisky Association, who delayed the introduction of minimum pricing through a series of legal challenges, must be wondering why they bothered.

Another interesting finding from our research is that consumers often shifted to significantly more expensive drinks after minimum pricing began. Perhaps this is not so surprising. Minimum pricing effectively wiped out the bottom end of the market and pushed consumers towards the mid-range. It encouraged many consumers to experiment with mainstream brands that they might not otherwise have bought, such as Famous Grouse whisky or Gordon’s gin. If you’re going to spend more money on alcohol, why not buy a brand you recognise? Mid-range brands have never competed purely on price and do not cluster around the 50p per unit price point. 


On a different note, I've written about Ronnie O'Sullivan for Spiked.


Wednesday, 4 May 2022

A swift half with Martin Durkin

The latest Swift Half with Snowdon features the excellent Martin Durkin. He makes all the best documentaries. Check it out.




Tuesday, 3 May 2022

The cost of minimum pricing

 

When minimum unit pricing was introduced in Scotland in May 2018 it became illegal to sell alcohol for less than 50p per unit. One of the SNP’s flagship policies, it aimed to reduce alcohol-related harms, including death and crime, by raising the price of the cheap, off-trade alcohol that is often associated with harmful drinking. Lacking the power to raise alcohol duty itself, the Scottish government turned to minimum pricing as a way of using the price mechanism to reduce consumption. It was assumed that reducing consumption would lead to a decline in the associated harms.

Even if it worked, this would clearly come at a cost to many drinkers. How much it would cost was contested, with advocates of the policy insistent that moderate drinkers would barely be affected. Although Public Health Scotland is currently evaluating minimum pricing, the financial impact on consumers has not yet been investigated. 

And so, in a study published by the Institute of Economic Affairs over the weekend, John Duffy, Mark Tovey and myself used off-trade sales figures to estimate the cost of minimum pricing to Scottish consumers in the four years since it was implemented. We believe it exceeds a quarter of a billion pounds. Our midpoint estimate is £270 million. That works out at £59.39 per adult or £71.12 per drinker.

Minimum pricing is currently being evaluated by MESAS for Public Health Scotland. So far, they have struggled to find any benefits from the policy. Looking at the data from the past four years, we were also unable to find any discernible impact on crime, absenteeism, unemployment, hospitalisations or deaths, all of which were projected to improve after the policy was implemented. Admittedly, some of the projected benefits were so small that they would be difficult to identify in aggregate data, but all of the key indicators have remained unchanged or worsened since minimum pricing began.

Read the full report here.



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.