Henry Dimbleby sent me his new book, Ravenous, last week. He must have known I would hate it and give it a bad review. He was right. Here's my review.
Thursday, 23 March 2023
Henry Dimblebly's Ravenous
Tuesday, 21 March 2023
Salvaging minimum pricing
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.
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Unusually, the media have given a better account of what the study shows than its authors did. The term ‘activist-academics’ might be a bit strong, but several of them have been advocating for minimum pricing for a decade (e.g. here and here). They are the core of the team that has been evaluating minimum pricing for Public Health Scotland for the last few years and have been unable to find much cause for celebration. MUP seems to have had no effect on A & E admissions or crime. There is ‘no clear evidence that MUP led to an overall reduction in alcohol consumption among people drinking at harmful levels. On the contrary, there is evidence that the heaviest drinking men, in particular, are drinking more.
It may or may not a ‘dodgy’ counterfactual, but today’s study is certainly based on a counterfactual. Nobody is claiming that the number of deaths actually fell by 13.4%. The claim is that the number of deaths is 13.4% lower than it would have been, if we assume the trend in Scotland would have been the same as in England.
“If changes happen in both countries, they cannot be caused by the policy which only affected Scotland, but Scotland-only changes are highly likely to be caused by Minimum Unit Pricing, given there were no other major alcohol-related changes that occurred in only one of the countries in the meantime.”
Nevertheless, it is clear that in 2019 - the first full year of minimum pricing - the alcohol-specific death rate went down by about 10 per cent in Scotland while it rose slightly in England. As I said when these figures were first published, this is ‘consistent with the view that minimum pricing reduces alcohol-related mortality’. But it is also consistent with normal year-to-year fluctuation. A fall of this magnitude is hardly unprecedented. The rate fell by 10 per cent in both 2007 and in 2009, and by 15 per cent in 2012. Nobody paid much attention to any of these declines because no one was looking for a policy to pin them on.
The authors of the Lancet study are able to give a more detailed view by showing the monthly figures, but the story remains much the same. The death rate was a little lower in 2019 than in the most of the previous few years. Interestingly, there were an unusually high number of alcohol-specific deaths in Scotland in the months leading up to MUP, for reasons unknown. This makes the subsequent decline look a little more dramatic.
Still, it’s not very dramatic, is it? If the authors hadn’t highlighted when MUP began, you would be hard pushed to put your finger on it.
The graphs showing alcohol-related hospital admissions are even less impressive (n.b. the sharp fall in spring 2020 was due to Covid)…
If you took this data to a health minister in another country and told them that this is what they could achieve if they introduced minimum pricing, I can’t imagine them getting too excited.
COVID-19 is considered an exogenous shock which makes evaluating MUP in 2020 and 2021 very difficult. The authors do not look at 2021 at all, saying only that ‘the increase in the rate in Scotland from 2020 to 2021 (4%) was lower than in England (7%).’ This is misleading. In percentage terms there was a slightly larger rise in England during the pandemic, but in absolute terms there were an extra 3.8 alcohol deaths per 100,000 in Scotland in 2021 compared to the pre-pandemic year of 2019 whereas there were only an extra 3.0 alcohol deaths per 100,000 in England.
Since MUP only affects the off-trade, one might expect MUP to have had a greater effect during lockdown when alcohol was only available from the off-trade, but there is no indication of this in the data.
I will leave it to statisticians to decide whether the model is dodgy. But if we accept that there is a temporal association, the question is about causation. To decide whether or not MUP ‘worked’, we need to look at the totality of the evidence. Is it plausible that a decline in alcohol sales of three per cent would lead to a 13 per cent reduction in deaths? (Even the three per cent reduction in sales is based on a counterfactual; the real figure is 1.1 per cent, and that doesn’t include cross-border sales.) Is it plausible that MUP would reduce the number of alcohol-related deaths without reducing the number of alcohol-related A & E admissions? Or the number of alcohol-related crimes, for that matter? The claim in this study doesn’t fit with the rest of the evidence.
We also have evidence from Wales which introduced MUP in March 2020, a few weeks before the first lockdown. Like the rest of the UK, and much of the world, Wales saw a sharp rise in alcohol-related deaths in 2020 and 2021. There is no indication that MUP softened this rise. In fact, the number of alcohol-related deaths in Wales went up at exactly the same rate between 2019 and 2021 as it did England in percentage terms (27 per cent) and by slightly more in absolute terms (an extra 3.2 deaths per 100,000 in Wales versus an extra 3.0 per 100,000 in England).
Our study reports on the final intended outcome and finds that this reduction in sales led to a 13% reduction in deaths and a 4% reduction in hospitalisations. The methods used suggest plausibility that these effects can be causally attributed to MUP.
The research was observational, so cannot prove conclusively that the significant fall in deaths was due to the minimum unit pricing policy.
The actual recorded number of alcohol-specific deaths in Scotland has generally been rising since 2012.
But they didn't quite see a difference in hospital admissions or in deaths partially due to alcohol, like liver cirrhosis.
And so this study is evidence for the effect of MUP, rather than proof.
Sunday, 19 March 2023
A swift half with Dan Malleck
You may have read that the Canadian government is under pressure to drop the drinking guidelines to two standard drinks per week (yes, week). Dan Malleck, Professor of Health Sciences at Brock University, has been one of the few people calling this out as temperance-driven nonsense. It was a pleasure to talk to him in the latest episode of The Swift Half.
Thursday, 16 March 2023
Sweet Jesus, not plain packaging again!
Objective To examine the association of fully branded and standardized e-cigarette packaging with interest in trying products among youths and adults in Great Britain.
...
Results This study included 2469 youths (1286 female youths [52.1%]; mean [SD] age, 15.0 [2.3] years) and 12 046 adults (6412 female [53.2%]; mean [SD] age, 49.9 [17.4] years). Youths had higher odds of reporting no interest among people their age in trying the e-cigarettes packaged in green (292 of 815 [35.8%]; adjusted odds ratio [AOR], 1.37; 95% CI, 1.10-1.71; P = .005) but not white (264 of 826 [32.0%]; AOR, 1.16; 95% CI, 0.93-1.44; P = .20) standardized packaging compared with the fully branded packaging (238 of 828 [28.7%]).
...
Conclusions and Relevance The findings of this survey study suggest that standardized packaging measures may reduce the appeal of e-cigarettes among youths without reducing their appeal among adults.
They showed a bunch of people some mocked up e-cigarette packaging, some of which was 'plain'/grotesque, and found that people preferred the normal packaging. Fancy that!
HMG should take note of this research @NeilDotObrien and commit to implementing standardised packaging for vapes to reduce the appeal to children while not discouraging use by adult smokers trying to quit as recommended by @JavedKhanCEO https://t.co/w44E8DDDNz
— ASH (@AshOrgUK) March 14, 2023
‘the suggestion is that smokers were influenced more by the prospect of standardised packs … than the actual adoption of standardised packaging.’
This is obviously bollocks and since the only study cited in the review that looked at cigarette sales found "no clear deviation in the ongoing downward trend", I'm going to go ahead and say that plain packaging didn't work.
... the “domino theory” i.e. that once a measure has been applied to tobacco it will be applied to other products is patently false. The same argument was used against the ban on tobacco advertising, but 9 years after the tobacco ban in the UK, alcohol advertising is still permitted with no sign of it being prohibited.
Putting vapes in plain packaging reduces their appeal to children and could even stop them taking up vaping in the first place, a major new study has found.https://t.co/mesvDivOrk
— ASH (@AshOrgUK) March 15, 2023
“In the UK, plain packaging requirements for cigarettes and hand-rolled tobacco have been in place since 2017 – and data suggest smoking rates have fallen as a result..."
... so there’s precedent for this type of intervention."
But while cigarettes look very similar across brands (meaning packaging is the main opportunity for branding), e-cigarette devices come in a wide range of shapes and colours which may still appeal to young people once the packaging is removed. So while standardising packaging may go some way towards reduce e-cigarettes’ appeal to youth, it’s likely to only be part of the puzzle.”
Wednesday, 15 March 2023
Open season on smokers
The tax on a packet of cigarettes will rise by about £1.30 today thanks to the tobacco duty escalator. If recent history is any guide, the Chancellor won't even mention it because smokers don't matter in Britain in 2023. They are second class citizens to be vilified while the state uses them as cash cows.
With the 'smoke-free 2030' target treated as if it were an eleventh commandment, rather than a feeble attempt by Theresa May to secure a legacy (and wasn't even in the last Tory manifesto), it's open season on smokers. I'll be speaking on a panel about this at the IEA next Thursday. Feel free to come along.
Is the ongoing war on smoking justified? Is there an alternative to creeping prohibition and infringing on an adult’s right to choose? And what are the implications for future generations if the state controls our lifestyle choices, be it smoking, eating or drinking?
Chaired by Simon Clark, director of the smokers’ rights group Forest, panellists are: Henry Hill, deputy editor of ConservativeHome; Reem Ibrahim, a final year student at the London School of Economics and communications officer at the IEA; Kara Kennedy, staff writer at The Spectator World and author of ‘An ode to smoking’; and Christopher Snowdon, head of lifestyle economics at the IEA.
The discussion starts at 19:00 and will be preceded by drinks from 18:15.
Spaces are limited and will be given on a first-come-first-serve basis.
Please RSVP to events@iea.org.uk or call 020 7799 8900
Monday, 13 March 2023
Obesity and personal responsibility
Nesta, the UK’s “innovation agency for social good”, spends a third of its considerable budget on tackling obesity, but treats the jab with suspicion, even though it can cause weight loss of 15%. The risks of “effective weight loss drugs” such as semaglutide, it wrote, was that it “might well deepen the emphasis in the public discourse on a ‘personal responsibility narrative’”, distracting from “the root cause – the food environment”.
This, again, is strange. Let us remember that obesity kills and semaglutide will save lives. Imagine greeting a new treatment for lung cancer with the concern that fewer people coughing their last in hospital might take the pressure off tobacco companies.
The arrival of effective weight loss drugs and increasingly personalised nutrition services to the market might well deepen the emphasis in the popular discourse on a ‘personal responsibility’ narrative.
Last Orders with Matt Ridley
In the new episode of Last Orders, we welcomed back Matt Ridley – co-author of Viral: The Search for the Origin of Covid-19 – to discuss why the authorities are coming around to the Covid lab-leak theory, what we’ve learned from the Lockdown Files, and the bizarre scandal over tobacco firms donating to charity.
Listen here.
On a different note, I have written about grammar schools for The Critic.
Thursday, 9 March 2023
Scotland's alcohol advertising bluff
I've responded to the Scottish government's public consultation on alcohol advertising (which closes today so if you want to give them a piece of your mind, hurry).
I found the consultation document to give a very misleading picture of what 'the science' says about alcohol advertising (and advertising in general). Perhaps this is not surprising since it leans heavily on a report from the neo-temperance group Alcohol Focus Scotland.
I've written about this on my Substack, so have a read (and subscribe!)
Wednesday, 8 March 2023
Nicotine Wars event tonight
I'll be speaking at this event this evening. It's at 6pm in the London School of Economics Centre Building on the 2nd floor, in room 2.05.
I don't think you need to be a student to attend and you can sign up here (it's free). We'll be having drinks at the Edgar Wallace afterwards, the pub with the biggest collection of cigarette advertisements in London and quite possibly the world.
New research commissioned by ASH Scotland for #NoSmokingDay reveals the real cost of smoking.
— ASH Scotland (@ASHScotland) March 8, 2023
Households with 2+ people who smoke in the most lowest income group of Scotland will spend 73.5% of their total income in 2023 on tobacco.
Read more here: https://t.co/ONhKn8hwaj pic.twitter.com/vvRpW04udx
Tuesday, 7 March 2023
The Transport for London food advertising con
4 years since unhealthy food was restricted from advertising on Londons tubes & buses 😊
— Children's Food Campaign (@Childrensfood) February 27, 2023
And we now know its led to households purchasing:
🙌1000 fewer calories per week
🤩20% less sugary productshttps://t.co/uHkfJQ3prU @LSHTM @stevencjcummins @UKSustain @sugarsmartuk
There's a nice article by Duane Mellor and Dan Green in the Journal of Human Nutrition and Dietetics (no paywall) looking at how weak scientific findings are exaggerated in press releases and misrepresented by the media.
The age old question is who is to blame when the media reports false claims - journalists, academics or the press office? Increasingly, it seems to me that it is the academics themselves. When press releases are misleading it's usually because the politically motivated academics have provided quotes that go beyond the findings of their research, and the research is often worthless anyway.
The first example of this type of report and accompanying news story relates to the advertising ban on foods high in fat, salt and sugar across the Transport for London estate, which came into effect in 2019. The latest evaluation exploring the effects of this work was a piece of modelling from researchers at the University of Sheffield and London School of Tropical Medicine and Hygiene.62 This work was based heavily on data which explored household food consumption in London (intervention area) against households in urban areas in the north of England.63
As with other examples discussed in this review, the premise of the work is not being questioned, as when designing public health intervention, evaluation is complex and modelling potential effects is important when making policy decisions. However, when reporting this type of research, inherent differences in food intake and choices between the north of England and London need to be considered as these residual confounders may explain the difference in energy (calorie) intake beyond any influence of advertising restrictions on public transport.
The assumptions and the low quality of evidence supporting the development of the model used to predict changing prevalence of higher weight are not well explained, especially when translated into press releases.64-66
What is perhaps of greater concern is that this was then used to predict the number of people living with obesity.62 Then through the institutional press releases,46, 48 these have been translated to actual fewer numbers of cases of people living with obesity and having developed type 2 diabetes and cardiovascular disease. This is concerning, as presenting modelled data as actual cases is not only overstating the value of the work, but when explained to the public,67 it can undermine public confidence in health messages. It is therefore recommended that when modelled data are presented, it needs to be clear that the data are modelled and not actually measured cases, therefore not ‘shown’ as one of the institutions involved in this work claimed.68
Friday, 3 March 2023
Martin McKee: still wrong about vaping after all these years
Sir, Sadly, the massive growth in e-cigarette use among adolescents comes as no surprise to those of us who warned that this would happen (“ ‘Harmless’ vapes are creating teenage addicts”, Mar 1). Unlike public health organisations worldwide, Public Health England (now the Office for Health Improvement and Disparities) has been promoting these products heavily, arguing that restricting the features that make them most attractive to young people, especially flavouring, would deter the adults they wanted to switch from cigarettes. Although no longer using the discredited “95 per cent safer than cigarettes” claim, it at least accepts that e-cigarettes are not risk-free but seem oblivious to the evidence linking their use to heart disease. We always knew that it would be a struggle to counter the efforts of the tobacco industry to get a new generation addicted to nicotine but, sadly, in England, those who should have been protecting these young people did not even try.
Professor Martin McKee
London School of Hygiene & Tropical Medicine
We did not find a significant difference in the cardiovascular risk of exclusive e-cigarette use compared with nonuse of cigarettes and e-cigarettes
We are aware that summarising the relative risks of vaping versus smoking across a range of different products and behaviours and assessed across multiple biomarkers can be simplistic and misinterpreted. Based on the reviewed evidence, we believe that the “at least 95% less harmful” estimate remains broadly accurate, at least over short term and medium term periods. However, it might now be more appropriate and unifying to summarise our findings using our other firm statement: that vaping poses only a small fraction of the risks of smoking.
Sir, Martin McKee (letter, Mar 2) is right that the recent increase in vaping by young people is a cause for concern but I disagree that this represents a failure of public health policy. Between 2011, when vaping entered the mainstream, and 2021 (the most recent available national data), UK smoking prevalence has fallen from 20.2 per cent to 13.3 per cent — a fall roughly 50 per cent larger than in either of the preceding two decades, and equivalent to about three million smokers. While many of these former smokers are still vaping, the facts that smoking kills half of all long-term smokers and that vaping is unquestionably far less harmful than smoking make this a massive public health gain. We need to ensure that existing laws protecting children from e-cigarette promotion and under-age sale are observed and enforced, but ought not lose sight of the reality that vaping has contributed to a record reduction in the UK’s biggest avoidable cause of premature death and disability.
John Britton
Emeritus professor of epidemiology, Nottingham University
A swift half with Maria Chaplia
In the Swift Half this week, I talk to the Ukrainian libertarian Maria Chaplia about the war with Russia.
If you enjoyed that you'll like the interview I did with Konstantin Kisin last year.