Tuesday 31 January 2023

Scots buying more alcohol from England

Further to this morning's post about minimum pricing, Public Health Scotland put out another report today. Based on survey data, it found that the proportion of Scots who have bought alcohol in England to bring back to Scotland rose from 13% in 2021 to 19% in 2022.

The report downplays this somewhat...

In 2022, a majority of 81% of 1,014 respondents did not report ever purchasing alcohol from across the border with England in person. Only 5% (54 respondents) reported travelling for the sole purpose of buying alcohol to bring back to Scotland. A larger proportion of 19% (191 respondents) reported bringing alcohol back to Scotland that they had purchased on a visit for another purpose because it is cheaper there than in Scotland.

"Only" 5%?! If the survey is representative, that's well over 200,000 people going over the English border purely to buy booze to bring back to Scotland. Considering how far most Scots live from the border, that's an incredible statistic. Off licence owners in the north of England should drink a toast to Nicola Sturgeon.

A further 14% are taking the opportunity of travelling to England to bring back some relatively cheap alcohol. It shows how much minim pricing is hitting drinkers in the pocket.

I'd love to see the same stats for Wales, where England is a stone's throw away for large numbers of people. If the Public Health Scotland report is any guide, a lot of them will have been heading over the Severn Bridge to get to an English Asda. 

Among the minority of 10% of panel members in Scotland who reported living within 60 minutes’ travel from the border with England (n=102) it was more common to report buying alcohol across the border, with 22% having travelled for the sole purpose of buying alcohol and 27% having bought alcohol while travelling for another purpose.

The Scottish government's claim that minimum pricing has worked rests solely on alcohol sales dropping slightly in Scotland while they rose slightly in England. I wonder how much of that is due to cross-border shopping?

Minimum pricing had a negligible impact on the booze industry

Public Health Scotland has produced the latest part of its minimum pricing evaluation.

To appreciate the full chutzpah of this tweet, you need to know that Colin Angus is a stalwart of the Sheffield University team responsible for the dire modelling that persuaded the Scottish government to go ahead with minimum pricing. (Not that they needed much persuading - they were committed to the policy before there was any evidence for it.)
It's a bit rich for Angus to have a pop at people for making inaccurate predictions about this policy. You only need to scroll to the bottom of the BBC article to be reminded of how bad his own track record is. 

I'm not sure which 'opponents' he's referring to. Perhaps the Scotch Whisky Association? Among economists, the only question was whether minimum pricing would make more profits for the drinks industry. Economic theory suggested that they wouldn't, but it was always a possibility since people are not fully rational and competition is not always perfect.

In the IEA monograph Flaws and Ceilings (2015), I predicted that minimum pricing would increase revenues but have little overall effect on profits.

Drinkers who prefer to purchase budget brands with low production costs will have to buy mid-range brands which have higher production costs. The impact on industry profits is negligible; it is consumers who are denied their first choice preference who lose out.

This seems to have been borne out by today's report which combines sales data with interviews with industry 'stakeholders' and finds that there have been some winners and losers, but no clear trend for the industry in either a negative or positive direction.

Overall effects on retailer profits were felt to be small with increased margins compensating for decreased volumes, with the effects depending on the mix of alcoholic drinks sold pre-MUP.

This should not be surprising since the impact of overall sales volumes has been pretty marginal. A Public Health Scotland report published last November found that per-unit alcohol sales only fell by 1.1% in the first three years of minimum pricing. Scottish consumers are spending more money on drink and consuming nearly as much as they did before. Some heavier drinkers are consuming more.

I can't remember what the Sheffield mob predicted would happen to industry profits after minimum pricing. I don't think they modelled it, but if Colin Angus wants to take it as a win that the booze industry has done fine out of the policy, we should let him. He hasn't had many wins in his career as a soothsayer.

There's only a few months to go before minimum pricing has its fifth birthday and the sunset clause kicks in. After that, the Scottish government has twelve months to prove that it has worked. Objectively, it will be unable to do that because the evidence clearly indicates that it has been a flop, but this is politics so I'm sure they will find a way. I wouldn't be surprised if activist-academics pull a dodgy counterfactual out of their hat at the last minute and claim success, as has just happened with the sugar tax. In fact, I'd put money on it.

Friday 27 January 2023

'Public health' academics apply lipstick to a pig

Re-posted from my Substack...

Just before Britain’s sugar tax was introduced in April 2018, various advocates of the policy were handed £1.5 million of taxpayers’ money to evaluate it. Marking your own homework is considered perfectly normal in ‘public health’.

They had their work cut out because what the government classifies as child obesity (but actually isn’t) rose in 2018/19, rose again in 2019/20 and then rose dramatically in 2020/21; the latter doubtless being lockdown-related.

Clearly unable to claim that childhood obesity declined after the tax was introduced, the evaluation team settled for arguing that there was less sugar in soft drinks as a result of the tax.

On average, this is probably true, although much depends on how much you trust the counter-factuals above. The effect certainly wasn’t very large and sugar consumption from soft drinks had been dropping for many years anyway.

Since soft drinks only provide around 2% of the nation’s calories and there had been no decline in obesity in previous years when sugar consumption from soft drinks had been in freefall, it was unlikely that the sugar tax would have any measurable impact on obesity rates. This seemed to be confirmed by obesity rates for both children and adults being higher in every year since the tax was implemented.

Today, however, the evaluation team is claiming victory based on an extremely sketchy model. They created a counterfactual based on trends between 2013 and 2016 and then compared it to what actually happened. Child obesity didn’t actually decline among any groups. Even relative to the counterfactual, it didn’t decline among boys of reception age or girls of reception age. It didn’t decline among Year 6 boys either. But there was, supposedly, a 8% decline among Year 6 girls. This, again, was only a relative decline. Even among this subgroup of the population, rates of obesity actually rose.

Even the strongest association of the SDIL [Soft Drinks Industry Levy] among the most levy-responsive groups (e.g., year 6 girls) reflected only a dampening of the rate of increase in obesity prevalence compared to the counterfactual rather than a reversal in trends.

When the researchers produced a counterfactual based on data from 2013 to 2018 - when the tax was actually implemented - it found that obesity was higher than expected among reception age kids and about the same as expected among Year 6 kids. This finding is filed away in the supplementary material and the authors barely mention it.

The authors conclude that…

Our results suggest that the SDIL was associated with decreased prevalence of obesity in year 6 girls, with the greatest differences in those living in the most deprived areas.

And, inevitably…

Additional strategies beyond SSB taxation will be needed to reduce obesity prevalence overall, and particularly in older boys and younger children.

This study will doubtless be cited as evidence that the sugar tax ‘worked’, but it is extremely thin gruel. Apart from requiring some very obvious cherry-picking to find evidence of success, it requires us to believe that the mere announcement of the sugar in 2016 reduced obesity among one very specific demographic, while the introduction of the sugar tax did not.

The authors argue that the announcement of the sugar tax incentivised soft drink companies to reformulate their drinks. Indeed it did, but not straight away and not in huge numbers. Lucozade and Ribena took the sugar out in 2017 and Irn-Bru halved the sugar content in 2018. It seems unlikely that this would be enough to reduce obesity among 10-11 year old girls by 8%, especially since it mysteriously had no effect on anyone else.

The counterfactual for those girls is shown below in red. The real obesity figures are shown in blue. You can see that the trend in obesity was essentially flat from 2015 to 2018 - i.e. before the sugar tax - but the counterfactual keeps on rising. Voila! The gap between the two lines is your 8% reduction in obesity. The evidence for the sugar tax being even a partial success starts and ends with this chart.

Even if you have faith in the highly suspect counterfactual scenario, why on earth would the sugar tax drive a significant reduction in obesity among Year 6 girls but not Year 6 boys? The authors confess themselves to be baffled...

‘it is unclear why this might be the case, especially since boys were higher baseline consumers of SSBs [sugar sweetened beverages]’

So they take the opportunity to splutter something about their current policy objective, advertising bans.

One explanation is that there were factors (e.g., in food advertising and marketing) at work around the time of the announcement and implementation of the levy that worked against any associations of the SDIL among boys.

There is no evidence for this whatsoever.

And why would Year 6 children be affected and not reception age children? Apparently, it was never likely to benefit younger children…

This result is congruous with findings from a cohort of British children showing that SSB consumption at ages 5 or 7 are not related to adiposity at age 9 years

Now they tell us! I don’t remember Jamie Oliver saying that, do you?

The lack of impact on young children gives the authors an excuse to once again push for more action from government…

Fruit juices, which are not included in the levy, are thought to contribute similar amounts of sugar in young children’s diets as SSBs and may explain why the levy alone is not sufficient to reduce weight-related outcomes in reception age children. In addition to drinks, confectionery, biscuits, desserts, and cakes are also important high-added sugar items, which are regularly consumed by young children and could be a target of additional obesity reduction strategies.

With the case for sugary drink taxes now ‘proven’ in the fairytale world of ‘public health’ academia, taxes on ‘confectionery, biscuits, desserts, and cakes’ will no doubt be next. And when those taxes also patently fail to reduce obesity, we can expect a lavishly funded evaluation team to turn up wielding the carefully selected findings from another dodgy model to prove that those, too, have been a triumph.

To date, the sugar tax has cost consumers well over a billion pounds.

Tuesday 24 January 2023

Food reformulation folly - the zombie twitches

The food reformulation wheeze seemed to fade away once Public Health England was killed off, but state-funded charity Nesta resurrected it this week and wants it to be mandatory. 

I wrote about it for Cap-X...

Public Health England (PHE) is dead but its terrible ideas live on. In 2015, PHE initiated a ruse in which it planned to remove 20% of the sugar from most processed food. The target was set for 2020 and the agency started working with its ‘stakeholders’ in the food industry to achieve ‘health by stealth’. 

The idea was that the companies would slyly remove sugar from their trusted brands and consumers would lose weight without having to make any effort. It was assumed that we wouldn’t notice the taste of artificial sweeteners because we are creatures of habit. So long as the packaging looks the same, we will mindlessly consume the same brands in the same quantities as we always do.

It didn’t quite work out like that. The food industry had to break it to PHE that you can’t take the sugar out of a cake or chocolate bar without compromising the size and texture, not to mention the taste. Some products, such as boiled sweets, consist of almost nothing but sugar and cannot be reformulated. Jam has to contain a certain amount of sugar otherwise it cannot legally be sold as jam. In any case, people will not buy artificially sweetened cakes, biscuits, spreads and confectionery because they taste horrible.


Thursday 19 January 2023

Canada's clown world drinking guidelines

Canada is on the brink of making itself an international laughing stock by cutting its drinking guidelines from two drinks a day to two drinks a week. The previous guidelines were only set in 2011 so Canadian drinkers can be forgiven for being suspicious about this dramatic change. The evidence base has not significantly changed in the interim. The evidence for the health benefits of moderate drinking has continued to pile up. 

The only thing that has really changed is that neo-temperance zealots like Tim Stockwell have tightened their grip on alcohol research. Stockwell and his 'no safe level' pal Tim Naimi both live in Canada and are both authors of the report that has made the ludicrous new recommendations.

I have been saying for over a decade that the 'public health' plan is to get the guidelines down to zero so they can start regulating alcohol like tobacco. The evidence does not support this fundamentally ideological campaign and so the evidence has been dropped in favour of fantasy modelling and cherry-picking.

There is a continuum of risk associated with weekly alcohol use where the risk of harm is:

  • 0 drinks per week — Not drinking has benefits, such as better health, and better sleep.
  • 2 standard drinks or less per week You are likely to avoid alcohol-related consequences for yourself or others at this level.
"Likely"!? How about certain
  • 3–6 standard drinks per week — Your risk of developing several types of cancer, including breast and colon cancer, increases at this level.
The only source given for the claim about colon cancer is this meta-analysis which claimed that 10 grams of alcohol per day was associated with a seven per cent increase in colon cancer risk. This is a smaller risk than having a portion of red meat a day. It found no statistically significant increase in risk in studies which had data on what happens when people have one 'drink' a day.

A Canadian 'standard drink' contains 13.45 grams of alcohol. Three standard drinks equals 40 grams. Four standard drinks equals 53 grams. The meta-analysis has no data on people who drink so little, so the claim that colon cancer risk increases at three or more standard drinks is not supported even by the authors' own preferred source.

As for breast cancer, which can only affect half the population and is partly why most countries have different guidelines for men and women, the report cites this meta-analysis of 22 studies, 13 of which found no statistically significant association with drinking. It pooled the studies and reported a 10 per cent increase in risk for people drinking 10 grams of alcohol a day. As with the colon cancer study, this was the minimum quantity studied so it tells us nothing about Canadians who drink 3-5 standard drinks.

In terms of mortality, another meta-analysis found that light drinking was not positively associated with any form of cancer, including breast cancer, and was negatively associated with cancer in a couple of instances:

.. light drinking reduced the mortality of female stomach cancer (RR, 0.65; 95% CI, 0.44 to 0.98; n=1) and male lung cancer (RR, 0.79; 95% CI, 0.70 to 0.87; I2=0.0%; n=5). There was no significant association between light drinking and the mortality of oropharyngeal cancer, esophageal cancer, larynx cancer, colorectal cancer, liver cancer, female gallbladder cancer, pancreatic cancer, breast cancer, cervical cancer, prostate cancer, and hematologic malignancy.
As with all this evidence, we should remember that people under-report the amount of alcohol they consume by around 50 per cent, so when a study says 10 grams a day it probably refers to 20 grams a day. This is an important point that anti-alcohol researchers are well aware of but only mention when it suits them.
  • 7 standard drinks or more per week — Your risk of heart disease or stroke increases significantly at this level.
This is just a flat out lie. As countless studies have shown, heart disease and stroke risk is substantially reduced among light and moderate drinkers. For example, a meta-analysis of prospective cohort studies (which track people’s drinking habits and health status over a number of years and are the most reliable studies in observational epidemiology) found that drinkers were 25 per cent less likely to die from coronary heart disease than teetotallers. The evidence for strokes is similar.
This is main reason why life expectancy is longer for moderate drinkers and the relationship between alcohol consumption and mortality is J-shaped.

The authors of the Canadian report essentially ignore all this evidence and instead focus on a cherry-picked meta-analysis written by Stockwell, Naimi and pals which massively adjusted the figures to arrive at their desired conclusion. This is inexcusable.
  • Each additional standard drink radically increases the risk of alcohol-related consequences.
"Radically"! Be careful out there!
The whole thing's a joke and I suspect the public will see it as such. There is a legitimate debate about whether low levels of alcohol consumption slightly increase cancer risk, but this has to put within the context of the reduction in risk for cardiovascular disease. The fact remains that the positive effects of moderate drinking on heart disease and other conditions exceed and outweigh the negative effects on cancer risk
People want to know what the overall risks of light, moderate and heavy alcohol consumption are. This is what drinking guidelines should tell us. Focusing on small and unproven cancer risks at very low levels of consumption while ignoring the benefits is lying by omission. 

Wednesday 18 January 2023

Secondhand cake

“If nobody brought in cakes into the office, I would not eat cakes in the day, but because people do bring cakes in, I eat them.”

Who is this co-worker from hell? Who is this whining, snivelling infant demanding that the rest of the world forfeits their small pleasures because she has no self-control?

It is none other than the head of the Food Standards Agency, Susan Jebb, who is in The Times tomorrow comparing cakes to passive smoking.

The full quote reads:

“We all like to think we’re rational, intelligent, educated people who make informed choices the whole time and we undervalue the impact of the environment,” she said. “If nobody brought in cakes into the office, I would not eat cakes in the day, but because people do bring cakes in, I eat them. Now, OK, I have made a choice, but people were making a choice to go into a smoky pub.”

Indeed they were, Susan, before people like you took that choice away to such an extent that even a pub that put up a sign saying ‘SMOKERS ONLY’ on the door and employed no one but smokers would still forbidden from accommodating them.
I’ve made a few slippery slope arguments in my time - contrary to midwit opinion, they are often valid - but even I never imagined that a workplace smoking ban would evolve into a workplace cupcake ban. Talk about the thin end of the wedge!

While saying the two issues were not identical, Jebb argued that passive smoking inflicted harm on others “and exactly the same is true of food”.

To inflict something on someone implies that it is done without their consent. In that sense - and leaving aside the question of whether wisps of secondhand smoke are actually harmful - passive smoking doesn’t inflict harm on a person who knowingly goes to a smoky pub. The same is obviously true of someone who offers you a cake. If they held you down and physically shoved it down your throat, that would be a different matter, but surely that is already illegal under some law or other?
Since Jebb doesn’t want people to see cakes in the flesh, it no great surprise that she doesn’t want people to see them on television either.

Jebb told The Times that advertising of junk food was “undermining people’s free will” and insisted restrictions were “not about the nanny state”.

Jebb is a fanatic. As such, she thinks people are only exercising their free will if they make the health-maximising choice. If they do otherwise, it can only be the fault of some external pressure that needs taming by the state.
Needless to say, she has a teenage socialist’s view of advertising.

“Advertising means that the businesses with the most money have the biggest influence on people’s behaviour. That’s not fair.”

It’s s’unfair!
“At the moment we allow advertising for commercial gain…
Commercial gain!
…with no health controls on it whatsoever and we’ve ended up with a complete market failure because what you get advertised is chocolate and not cauliflower.”
Does she think there is a huge latent demand for cauliflower? Does she believe that a nationwide marketing campaign for it would lead to people snacking on cauliflower instead of chocolate? Economists would predict that such an advertising blitz would, at best, lead to vegetable eaters consuming slightly less swede and slightly more cauliflower, but let’s test it. Let the Food Standards Agency put some of its £143 million budget into advertising vegetables and see how it goes. My guess is that it will go about as well as all the other expensive media campaigns governments have wasted money on trying to get people to eat a more ascetic diet.

And yes, Susan, making it illegal for food companies to tell consumers about their products is ‘nanny state’. And no, what you’re describing is not a ‘market failure’.

Apparently, Jebb is on The Times Health Commission because of course she is. I must admit that I didn’t know she’s also been running the Food Standards Agency since 2021. I am familiar with her mainly as an activist-academic who keeps getting taxpayer-funded jobs, so I can’t say I’m shocked to hear that she’s ended up in charge of a bloated, Blair-era government agency that never needed to be created in the first place and has long since deviated from its original purpose to become a soapbox for the paternalist elite.

The descent of the Food Standards Agency is such an egregious example of mission creep that I used it to illustrate public choice theory when I wrote Sock Puppets

Public choice theory provides a plausible explanation for why governments fail to deliver what is expected of them, both in terms of public services (which are hampered by bureaucratic inefficiency) and legislation (which is hijacked by special interests). It explains why bureaucracies become ever more bloated and taxes rise ever higher, even under governments which come to power on a ticket of deregulation and smaller government. It explains why bureaucracies are so resistant to budget cuts and why it tends to be frontline services, rather than management, which bear the brunt of such cuts if and when they arrive. It explains why an organisation like the Food Standards Agency can go from having a tiny staff investigating restaurant poisonings to having a staff of 2,000, a budget of £135 million and a mission that has expanded to campaigning against salt, fat and eating crisps during football matches.

It is not obvious to me why the Food Standards Agency’s day job couldn’t be done by the likes of Trading Standards, but the question that really baffles me is why, after 13 years of nominally Conservative government, are people like Jebb still being appointed to run these quangos? Just as a matter of pure self-interest, why give money and status to people who are going to attack and undermine you? Why do the Tories make life so difficult for themselves? After all this time, why have they still not made the slightest attempt at a counter-revolutionary march through the institutions?

When the Conservatives once again find themselves languishing in opposition, I suspect that quite a few of them will ask themselves exactly that.

Tuesday 17 January 2023

Last Orders with Patrick Chrisys

The new episode of Last Orders dropped over the weekend. We had a particularly good laugh recording this one. Listen here or subscribe in iTunes or whatever.

Monday 16 January 2023

The supposed costs of gambling

OHID, the agency formerly known as Public Health England, last week released a series of reports about gambling which replace a similar set released by PHE in 2021. They now reckon that gambling costs the country between £1 billion and £1.8 billion a year. However, this is not a net cost and most of it is neither a financial cost nor an external cost.

I've took a look at the figures on my Substack.

As the crusade against gambling gathers pace in the UK it is becoming clear that there are two tactics being used to make it ‘the new tobacco’.

The first is to treat it as a ‘public health’ issue. ‘Public health’ activists/academics are always keen to find (a) new dragons to slay and (b) fresh pots of grant money. Once gambling is seen as a public health issue, the door is open to the kind of regulation that smokers, drinkers and, increasingly, eaters have been treated to over the years.

Unfortunately, ‘public health’ academics know even less about gambling than they do about the other issues upon which they pontificate. The articles they have started writing for medical journals in recent years spout the usual empty rhetoric about the ‘whole systems approach’ and dust down policies from tobacco control that don’t make any sense in the context of gambling. You can’t really put a sin tax on gambling, for instance, because people chose their own stakes and you certainly can’t put gambling in plain packaging, although that hasn’t stopped ‘public health’ chancers from suggesting it.

The second tactic is to pathologise and demonise gambling in general, rather than focus on problem gambling. This allows the ‘public health’ lobby to settle into the comfort of the ‘no safe level’ rhetoric it uses with tobacco and alcohol while justifying policies based on the ludicrous whole population approach. Rather than treating pathological gambling as a psychological disorder that affects a small number of people, gambling per se is to be treated as unhealthy.

Public Health England was all set to drive forward with this strategy. An early draft of a PHE press release in 2021 said:

‘Health leaders from organisations such as X and X are joining PHE in calling for a public health approach to gambling focusing on prevention, early intervention and treatment. This approach is similar to how we tackle tobacco consumption or unhealthy food consumption, and would require cross-government support’.

PHE was closed down for being incompetent shortly afterwards, but before it imploded it put on a series of reports on gambling, and its successor, the Office for Health Improvement and Disparities (OHID), has now produced some updates of them.
Do read it all and subscribe if you haven't already done so.

Wednesday 11 January 2023

Prohibitionists turn out to be prohibitionists

"No one's talking about banning smoking!"

If I had a penny for every time an anti-smoker said something to this effect when lobbying for their latest piece of tobacco control legislation I would be a wealthy man. They would affect to be mortally offended by the accusation of being a prohibitionist. 

But now that New Zealand is introducing actual prohibition, their only question is when their own country is going to do likewise. The Labour Party is already expressing an interest. They were lying all along, as I say in an article for Spiked...

Where are these people now that New Zealand is actually introducing prohibition? How do they feel about the political party that is tipped to form the next British government being keen to do likewise? Do they feel betrayed by politicians who have taken their ideas to illiberal extremes? Are they disappointed that their ‘think of the children’ rhetoric has got out of hand? Of course not. They’re laughing up their sleeves and congratulating themselves on gaslighting the public year after year. With the proverbial frog now boiling, they can do it all over again with vaping, gambling and alcohol, secure in the knowledge that they won’t be rumbled until it’s far too late.

I was on a panel at last year's Global Tobacco and Nicotine Forum in Washington D.C. making the case that the odds of tobacco prohibition were under-priced at that it  is more imminent than many people think. As I say in the Spiked article, all it takes is a glory-hunting health minister or a legacy-seeking prime minister. Tobacco Reporter recently published a summary of the discussion.

Snowdon started by noting that, despite the negative U.S. experience with alcohol, prohibition has always been the natural conclusion of the anti-smoking campaign. “Prohibition somewhere is probably more imminent than some people think,” he said, pointing to New Zealand’s recently announced policy of gradually raising the age at which consumers can buy tobacco until it covers the entire population and the United States’ plan to require tobacco companies to reduce the nicotine in their products to a level at which nobody would want to smoke. “Both are variations of prohibition,” said Snowdon, but neither country is calling it that, instead using euphemisms such as “tobacco-free generation” and “endgame.”

Read the rest here.

Tuesday 10 January 2023

Language policing in 'public health'

Much of academia is focused on policing the English language these days so it is not surprise to see the 'public health' lobby joining in. In the video below, Joanna Cohen, a wild-eyed woman from one of Mike Bloomberg's front groups, wants people to focus on "accuracy and consistency" when they talk about tobacco harm reduction.

She doesn't like people calling new products 'novel'. She doesn't like them being described as 'alternative' either, because it makes people think of 1990s rock bands, apparently. She doesn't like the term 'heat not burn' because "it suggests the product is safe", which is news to me. I expect she disapproves of the term 'tobacco harm reduction' too.

She especially doesn't like words that imply reduced harm because people might get the impression that they are safer than smoking and that would never do. 'Smokeless tobacco' is unacceptable for this reason, she reckons, and she doesn't like 'modified risk tobacco product' even though that is the FDA's legal term.

Ms Cohen, who has also written a piss poor article on the subject, wants people to simply use the words 'e-cigarettes' and 'heated tobacco products'. That's alright by me, but it would be nice if she and her pals in the American anti-smoking industry would meet us halfway and stop referring to e-cigarettes as "tobacco products". While they're at it, they could stop referring to an illness that has nothing to do with e-cigarettes as 'E-cigarette or Vaping use-Associated Lung Injury'.



PS. A messages at the end of the video notifies viewers that the tobacco control lobby reserves the right to change their terminology at any time.

Saturday 7 January 2023

Manufactured anti-gambling outrage

Britain's anti-gambling coalition is outraged again, according to its friends at the Guardian... 

The betting industry has threatened to redirect a quarter of the funds expected to go to a charity tackling harms caused by gambling, the Guardian understands.

The four largest members of the Betting and Gaming Council have in the past pledged to use GambleAware as the main commissioner of any money it gave to tackle problems caused by its activities.

But sources at GambleAware said the charity was informed in recent weeks by BGC that in future, 25% of funds would be kept back to distribute directly to projects chosen by Bet365, Flutter Entertainment, GVC Holdings and William Hill.

Like everything else these days, anti-gambling campaigners say this is another reason why there should be a statutory levy on the industry to provide a slush fund for anti-gambling activists and academics treatment services for problem gamblers.

The former Tory leader Iain Duncan Smith said: "The fact that the BGC are taking a unilateral decision to redirect 25% of future funds away from GambleAware to fund its own chosen causes could not set out more clearly why a statutory levy to fund research, education and treatment is absolutely essential."

“This racket of the gambling industry deciding when, how much and now where money is spent to deal with the harm it causes simply has to end.”

'Racket' isn't really the right word for companies choosing which charities to support, is it? A racket involves using intimidation to get people to give you money. Like the campaign for a statutory levy, for example. 

In any case, as the article explains, the industry promised to give GambleAware £100 million by March 2024 and it is actually going to give it £110 million. They never said they would continue spaffing money on it forever. They also say that GambleAware "refuses to publicly provide transparency" about how its funds are spent, although the Guardian fails to pursue that potentially interesting line of enquiry.

Why the sudden urge to defend GambleAware? Three years ago, we had a nearly identical story in the Guardian when the industry made the decision to give £100 million to GambleAware.

Betting firms’ surprise decision to redirect £100m of funds for tackling problem gambling proves the industry has too much influence on how the money is spent, politicians and leading addiction experts have warned.

... The companies appeared to have agreed to route the money via Action against Gambling Harms (AGH), a charity founded by the Conservative peer Lord Chadlington to identify suitable recipients and hand out grants.

But in an unexpected change of heart, industry trade body the Betting and Gaming Council (BGC) revealed this month that all of the cash will go to the GambleAware charity instead.

You wouldn't normally expect the Guardian to take the side of a Tory peer, but needs must when your only objective is bashing the gambling industry.  
As usual, the one-club golfers of the anti-gambling coalition took this as evidence that a statutory levy was required...

In an open letter to the culture minister, Oliver Dowden, and the health secretary, Matt Hancock, experts will say this week that the decision underlines why a statutory levy is needed.

Last year, the NHS severed links with GambleAware because its management were too righteous to touch its dirty money. As I said at the time, it was an outrageous decision that has cost taxpayers millions of pounds. But since the industry can no longer fund NHS treatment for gambling problems via GambleAware, you can see why they might want to fund treatment directly (if, indeed, that is what they are planning to do).
There are also signs that GambleAware has been losing the plot recently. Last year it commissioned a report from YouGov which claimed that the problem gambling rate was many times higher than any survey in Britain has ever found. 
I don't particularly care whether there is a statutory levy or not. The government already makes £3.3 billion a year in gambling revenue which is enough to give red carpet treatment to every problem gambler who wants help many times over. £100 million is chicken feed by comparison. 

But I do get tired of the industry being damned if they do and damned if they don't. The Guardian (and the Times) twists every gambling story to make it look like the industry is up to no good. When they reported the ridiculous YouGov story, the Guardian headline was 'Gambling addiction could be nine times higher than industry claims', as if it was the industry that produced problem gambling estimates.

There is a bizarre sentence in today's article...

GambleAware has been criticised for being too close to the industry, for example by focusing in [sic] education programmes on the idea of “problem gambling,” which some say is a key narrative pushed by industry to deflect from the addictive nature of products they promote.
The idea of "problem gambling"? Why the scare quotes? Why call it an idea? Why a narrative? Problem gambling is a recognised psychological disorder. It is, supposedly, the whole reason why the Guardian gets so worked up about this issue.

Or could it be - just possibly - that the Guardian and the campaigners who feed it stories simply disapprove of gambling in general? Surely not!

Friday 6 January 2023

The hazards of not drinking

The corrupt and incompetent WHO started the year with some of their 'no safe level' schtick in Lancet Public Health. It took thirteen of their parasitic representatives to produce a wafer-thin article which cites the rectally-sourced statistic that alcohol causes 740,000 cases of cancer every year.

Evidence does not indicate the existence of a particular threshold at which the carcinogenic effects of alcohol start to manifest in the human body. As such, no safe amount of alcohol consumption for cancers and health can be established. Alcohol consumers should be objectively informed about the risks of cancer and other health conditions associated with alcohol consumption.

The public would be 'objectively informed' if the (minuscule) absolute risk of developing cancer was explained to them and the overall benefits of moderate drinking frankly laid out. The authors mention the 'potential existence of a protective effect for cardiovascular diseases' (note the word 'potential'), but do not acknowledge that moderate drinkers are around 20 per cent less likely to die prematurely than teetotallers.

The Daily Mail covered the story and I gave them a quote:

Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs think-tank, criticised the paper.

He told MailOnline: 'In its efforts to demonise alcohol, the WHO speculates there to be “no safe level” of drinking for a few forms of cancer. 

'It admits that there is insufficient evidence to support this.

'There is, however, a huge amount of evidence built up over decades showing that moderate drinking significantly reduces the risk of heart disease, stroke, diabetes and dementia.'

He added: 'On average, moderate drinkers live longer than teetotallers, so if moderate drinking is risky enough to worry about, the risks of not drinking at all must be terrifying.'

Thursday 5 January 2023

Last Orders with Geoff Norcott

 We did a Last Orders episode before Christmas, welcoming back comedian Geoff Norcott. Listen here.

Wednesday 4 January 2023

Junk vaping study retracted

Last July I wrote about a study which claimed, very implausibly, that vapers not only had a higher risk of cancer than smokers but also got cancer at a younger age. The authors looked at data from the USA’s National Health and Nutrition Examination Survey (NHANES) between 2015 and 2018. They found 154,856 living participants, of whom 5% were e-cigarette users, 63.6% were nonsmokers and 31.4% were smokers. They then looked to see which of them had ever had cancer and concluded that...

Our regression analysis showed that e-cigarette users have 2.2 times higher risk of having cancer compared to non-smokers (odds ratio (OR): 2.2; 95% confidence interval (CI): 2.2 - 2.3; P < 0.0001). Similarly, traditional smokers have 1.96 higher odds of having cancer compared to non-smokers (OR: 1.96; 95% CI: 1.96 - 1.97; P < 0.0001).

This didn't pass the smell test and there was a fairly obvious reason why it was wrong. The average age of the smokers was 62 and the average age of the vapers was 25. So straight away we have an answer to the question of why vapers who got cancer developed it at a younger age than the smokers (and non-smokers, whose average age was 50). They are a much younger cohort.
What about the increased probability of having had cancer? Well, they didn't. As the authors admit in the abstract, 'The e-cigarette users have lower prevalence of cancer compared to traditional smoking (2.3% vs. 16.8%; P < 0.0001)'. They could have added that they had a lower rate than non-smokers too (9.5%). The claim that they had a 2.2 times higher risk of having had cancer comes from a regression analysis in which they had a (presumably cack-handed) go at adjusting for age (but not for former smoking, d'oh!). 
What was true was that, of those who had had cancer, vapers were more likely to have had certain types of cancer than smokers and non-smokers, but - tellingly - they were not smoking-related cancers. Vapers were much less likely to have had lung cancer, for example.
Instead, as I wrote...

The only cancers that were more common among the vapers - not in absolute terms, but as a proportion of cancers among the people who had ever had cancer - were cervical cancer, thyroid cancer, leukemia and one form of skin cancer. What these have in common is that they are either not ‘smoking-related’ (or not strongly associated with smoking) and have a tendency to affect younger people more than most cancers.

Of the people who had had cancer, it is hardly surprising that the younger cohort was less likely to have cancers which mainly afflict old people. It tells you nothing about vaping which, in practice, is an incidental third variable in this study. You might as well say that vapers are more likely to rent than to own a house outright. It would be true, but not useful.
Similarly, the headline claim - that vapers get cancer at an earlier age than smokers and non-smokers - is obviously due to the fact that the vapers in this study were much younger on average than the other groups. Unless you follow these people until the end of their lives, you can't conclude anything.
I ended my article by asking... 

Don’t these things get peer reviewed?

It seems that someone has finally reviewed it because it has now been retracted.

This retracts the article “Cancer Prevalence in E-Cigarette Us-ers: A Retrospective Cross-Sectional NHANES Study”, by Anusha Chidharla et al, published in Vol. 13, No. 1, 2022, p20-26, doi: https://doi.org/10.14740/wjon1438 [1]. After publication of this article, concerns have been raised regarding the article’s methodology, source data processing including statistical analysis, and reliability of conclusions, the authors failed to provide justified explanations and evidence for the inquires, subsequently this article has been retracted at the request of Editor-in-Chief.

Strangely, the article itself does not have a retraction notice on it. Hopefully it will soon.

Regular readers will know that this study is just one of dozens of pieces of scaremongering piffle about e-cigarettes that are published in journals every month. Fortunately, it didn't get much media attention, although crank-in-chief Stanton Glantz, who has also had an anti-vaping study retracted in the past, was all over it on his blog...
First epidemiological evidence linking e-cigs to cancer in people

E-cigarette advocates like to point out that because there is no combustion, e-cigarettes expose users to lower levels of many carcinogens (cancer-causing chemicals).  Even so, there are still some carcinogens in e-cigarette aerosol exposure to e-cigarette aerosol damages DNA and reduces repair in animal and human cells and causes cancer in animals.  Now there is also direct evidence that people who use e-cigarettes are at increased risk of some cancers.
Not any more there isn't, Stan. 
Faced with the uncomfortable fact that none of the (spurious) associations between vaping and cancer involved parts of the body which come into contact with vapour, the great professor appealed to the magical properties of e-cigarette fluid.

The interesting thing about this finding is that these are not the major smoking-induced cancers (lung and bladder).  This result reinforces the view than e-cigarettes are not simply cigarettes without some of the bad chemicals; they expose users to a different mix of toxic chemicals than cigarettes.

There are no prizes for guessing whether he's blogged about the retraction.

Tuesday 3 January 2023

Regional minimum pricing - the latest grift

Are the minimum pricing modellers going to brazen it out? With their predictions turning to dust in Scotland (and Wales), will they do the decent thing and apologise or will they carry on as if nothing has happened?

A study published late last year suggests that they will keep their eyes on the price (government grants) and hope that no one notices that everything they've ever forecast has been wrong.

Their new study looks at the prospect of regional minimum pricing. This is an acknowledgement that there is little appetite for a failed policy which pointlessly increases the cost of living in Westminster, but that there are regional sockpuppet groups such as Balance NorthEast that are still keen.

The authors make it clear that they have been working hand in glove with the sockpuppets (boom, boom!) and that their study is designed to give them ammunition.  

We involved a wide stakeholder group throughout the development, conduct and delivery of this project. The idea for the project arose directly from conversations with Directors of Public Health and public health advocacy organizations in the North West region of England. The research was designed to be directly relevant to their evidence needs: specifically, the need for local level evidence regarding alcohol consumption, related harms and the estimated effects of MUP. 

This stakeholder involvement directly influenced the project by making us reconsider (a) the outcomes to be modelled; as a consequence of stakeholder input we added crime, and (b) the nature and design of project outputs—input from stakeholders encouraged us to develop locally relevant dissemination resources that were more interactive and of a higher quality design than originally planned. These ‘evidence assets’ were designed to support the communication needs of public health stakeholders.

Regular readers will recall that Petra Meier initially got into this work because she spotted a gap in the market. Her team are now more or less openly guns for hire.

The idea of regional minimum pricing is interesting insofar as a government that was genuinely pursuing evidence-based policy could have trialled it in one region to see how it went. The obvious problem with this would be the ease with which people could travel to a different region to buy their drinks (as we have seen with soda taxes in the USA). But we now have Scotland and Wales as the real-world guinea pigs so it doesn't matter any more, and the modellers don't bother modelling the impact of out-of-region shopping anyway.

Instead, we get the usual conclusion that minimum pricing would reduce deaths, hospitalisations and crime, plus some lobbying-orientated guff about levelling up.

Because we estimate the greatest impacts on health to occur in the most deprived groups, MUP would reduce health inequalities within UTLAs as well as reducing inequality between UTLAs. This, and the fact that current rates of alcohol harm are highest in the North of England, suggests that both national and local MUP policies have the potential to contribute to the ‘levelling-up agenda’ of the current UK government, which aims to reduce geographical inequalities

Despite all the evidence that heavy drinkers are the least price sensitive consumers - including a study by one of the authors - the model continues to assume the opposite, claiming that high-risk drinkers would reduce their consumption reducing by 7.7% compared to 3.6% nationally. Evidence from Scotland clearly shows the opposite. Indeed, the most recent study found that the heaviest drinking men drank more after minimum pricing was introduced. This is one of the main reasons the models have always been wrong, as John Duffy and I explained a decade ago.

There is not the slightest acknowledgement from the authors that their methods have failed dismally in the past. They ignore the data from Scotland entirely. They are like Hitler in his bunker moving around imaginary armies as the Russians enter Berlin. Only in 'public health' could this stuff still be funded and published.

Speaking of funding, it goes without saying that the taxpayer foots the bill for this:

The main funding source for this study was the NIHR Public Health Research Board, project number 15/129/19.

And you might not be surprised to hear that, in addition to building her own state-funded empire, Petra S. Meier has her fingers in this pie too. 

P.S.M. is a member of the NIHR Public Health Research Funding Board (2016–present).

It is a racket.

Monday 2 January 2023

A small eternity with Jamie Oliver

Jamie Oliver was made guest editor of the Today programme over Christmas, as if the BBC didn't already give him a loud enough megaphone. I listened to all three hours so you don't have to, and wrote about it for the Spectator.

There are many annoying things about the celebrity chef Jamie Oliver, but none of them grates my gears as much as the media’s obsequiousness towards him. I suspect that his political campaigning is largely a self-serving gimmick to keep the Jamie Oliver brand in the public eye, but that is besides the point. The point is that he would be the first to describe himself an activist and yet he is never asked the questions that activists, let alone politicians, are asked. He gets the celebrity interview when he should be getting the political interview. He has never been hauled up on the facts. He has never been given a grilling. Hardened journalists become starstruck in the presence of a man who, in media circles if not in the country at large, is regarded as a national treasure.

Oliver has had such an easy ride from the BBC over the years that it was not much of a stretch to make him guest editor of the Today programme on Tuesday. The servility was no different from usual, it was just more concentrated. Three long hours of unfiltered Jamie Oliver lightened only by occasional stories about Covid-19 in China and snowstorms in the USA. For the duration, Radio 4’s news bulletins carried no fewer than three Oliver-related news items. Jamie Oliver wants free school meals extended! A pressure group wants mandatory limits on the sugar content of baby food! George Osborne wishes the government would hurry up and ban adverts for ‘junk food’! It was like normal episode of the Today programme but more so.

The rest is here.