The long tentacles of temperance in Canada

You know your country is in trouble when the most sensible part of it is French, but that's the sad position Canada finds itself in. After the Canadian Center on Substance Use proposed the loony tunes drinking guideline of two drinks per week, there was much less mockery than there should have been. 

But this week the Quebec newspaper Le Devoir published an article (English translation here) taking a long overdue look at the people who led the review. Our old friend Tim Stockwell features heavily, as does his neo-temperance colleague Tim Naimi. It's no great surprise to hear that they've been working pro bono for the full on gospel temperance outfit that now goes by the name of Movendi.

 

The CCSA study, titled Canadian Landmarks on Alcohol and Health, was featured on the Movendi International website  less than 48 hours after publication, as are the work of some of its authors regularly. This nongovernmental organization — formerly known as the Independent Order of Good Templars, its website says  — actively promotes a completely alcohol-free life.

Researchers Tim Stockwell, Timothy Naimi and Adam Sherk state in CCSA's conflict of interest statement that they are "members of an independent group of scholars who volunteer their time to prepare research reports on various topics related to alcohol and health”. It is specified, in brackets, that this group is Movendi International.

Stockwell and Naimi even took a trip to northern Europe at Movendi's expense. The organization, based in Sweden, paid for their travel and accommodation costs. The two men also participated in the Movendi podcast, a production resolutely committed to raising awareness of the evils of alcohol consumption.

According to the statutes of the Independent Order of Good Templars, which date from 2006 and which are accessible on the Movendi website , its members must make a promise: "accept the obligation not to consume alcohol and not to non-therapeutic use of other addictive drugs, as well as fostering public acceptance of this principle”.

 

The worrying thing is not so much that people like Stockwell are pals with a nineteenth century prohibitionist organisation but that Movendi are official partners with the World Health Organisation. 

"I consider that there are issues of conflicts of interest," says Jean-Sébastien Fallu, associate professor at the School of Psychoeducation at the University of Montreal.

The addiction specialist is very critical of the CCSA report. According to him, the study makes generalizations about occasional drinkers and ignores the beneficial aspect for overall health that drinking with friends can represent. He believes that such recommendations can confuse the public and harm the work of stakeholders in the field.

“There are areas of research that are more subject to subjectivity, to politicization. The issue of substances, in general, is one. There is a lot of ideology. And the choices that were made [in the CCSA study] are ideological choices in many ways,” he adds.

 

In the McCarthyite world of 'public health' it would certainly be seen as a conflict of interest to have your expenses paid by a booze company. I don't see how having them paid for by a bunch of teetotal lobbyists is any different.

 

The article doesn't mention the Kettil Bruun Society, another organisation that keeps the flag of temperance flying. Tim Stockwell was its president back in 2005-07. Its current president is none other than Petra Meier of the notorious Sheffield Alcohol Research Group which provides supposedly unbiased modelling to governments on such policies as minimum pricing and tax rises, and was at the centre of the UK's drinking guidelines scandal.

 

Birds of a feather flock together, don't they?

The alcohol advertising bluff

‘Public health’ groups are insistent that banning alcohol advertising would reduce the number of alcohol-related deaths. Very insistent. Here are some quotes from Alcohol Focus Scotland (a state-funded pressure group) in a report cited by the Scottish government in its 2022 consultation on alcohol advertising regulation: 

 

Research has now established a causal connection between children and young people’s exposure to alcohol marketing and drinking (p. 7) 

There is a wealth of evidence that exposure to alcohol marketing is causally linked to consumption. (p. 34) 

There is conclusive evidence of a small but consistent association of advertising with consumption at a population level. (p. 34) 

Significantly, research published since the Network’s first report has now established a causal connection between children and young people’s exposure to alcohol marketing and drinking. (p. 41)

The evidence is clear that exposure to alcohol marketing is a cause of youth drinking. This is the conclusion reached by researchers applying the same methodology that established the causal link between tobacco and cancer. (p. 41)

 

Pretty unequivocal, isn’t it? There is not only a strong association between alcohol advertising and drinking/youth drinking but the association has been proven to be causal!

When I first saw this, I had read enough studies about alcohol advertising to know that this was, at best, an exaggeration and I knew enough about the social sciences to know that proving causality is virtually impossible, but I hadn’t read all the studies. So I decided to read all the studies and found that the evidence was even weaker than I thought.

I have summarised the literature in a report that was published by the IEA today titled Alcohol Advertising: What does the evidence show?

Put simply, there are four different types of evidence.

 

1. Studies looking at the impact of alcohol advertising restrictions/bans. There are not many of these but most of them don’t find an effect on alcohol consumption.

2. Survey-based public health studies. There are a lot of these and nearly all of them find some effect on some measure of consumption. However, they don’t measure exposure to alcohol advertising subjectively. They rely on people recalling how many adverts they’ve seen. This means they are wide open to recall bias which is a big problem because people who are interested in a product are more likely to pay attention when it is advertised. Advertisers also target demographics who are most likely to buy their product so there is an in-built bias.

3. Randomised controlled trials in which people watch a film or TV show interspersed with adverts for alcohol (or another product in the control group) and the researchers see if they reach for a drink. There have been about ten of these and they have provided very mixed results. A slight majority find no effect.

4. Studies looking at alcohol advertising expenditure and alcohol consumption. There are quite a few of these and nearly all of them find no effect. Unlike the public health studies, they have the advantage of measuring advertising subjectively.

 

The conclusion is, rather boringly, that the evidence mixed and conflicting. But one thing can be said for sure: banning alcohol adverts is not an evidence-based policy.

A Cochrane Review — considered the gold standard of scientific evidence — concluded in 2014 that: “There is currently a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions.” I can only concur.

As for the claim that there is a causal link between alcohol advertising and youth drinking, I wrote about that for The Critic.

 

This is bluffing on an epic scale. Thanks to the alchemy of academic publishing, once a couple of zealots get their opinion printed in a journal it becomes a fact to be recited forevermore by pressure groups.

 

Have a read.

The report has been covered by the Times, Daily Mail, Scotsman, Express, Independent, Herald, ITV and many others.

Sugar taxes don't work, let's have more of them!

 

From Food Navigator...

 

Action on Sugar pleads for industry action as global study connects soft drink consumption to teenage obesity

Teenagers’ overconsumption of soft drinks has been directly associated with the prevalence of overweight and obesity in a global study. Soft drink consumption contributes to at least 12% of the variations in overweight and obesity rates among adolescents across different countries.

 

Alas, there was apparently no room in the article to mention that the study was produced by the chairman of Action on Sugar, Graham 'Mad Dog' MacGregor and his colleagues.

In light of the study, conducted by the Wolfson Institute, Queen Mary University of London, Action on Sugar, another university division, cautions that there is a dire need to implement effective strategies such as the Soft Drinks Industry Levy to reduce the consumption of such beverages.

To see how "effective" sugar taxes are, one only needs to read MacGregor's study...

 

Approximately 17.2% (95% CI, 17.0%-17.5%) of all the school-going adolescents were overweight or obese, and the population-weighted prevalence of overweight and obesity among adolescent students in countries and regions with soft drink taxes was marginally higher compared with those in countries and regions without soft drink taxes (17.4% [95% CI, 17.1%-17.7%] vs 16.3% [95% CI, 15.9%-16.8%]; P = .05).

 

Great success!

 

It seems, however, that countries which tax sugary drinks have fewer people consuming them.

 

... in countries with soft drink taxes, the prevalence of daily soft drink consumption among school-going adolescents was lower than in countries without such taxes (30.2% vs 33.5%).

 

This obviously didn't lead to less obesity but the authors call on governments to tax sugary drinks anyway.

 

These findings suggest that governments, particularly those in low- and middle-income countries, should take actions such as levying taxes on soft drinks to lower soft drink consumption or to reduce the amount of sugar consumption from soft drinks, to help curb the rapid increase in obesity.

 

These taxes have never curbed the rapid increase in obesity anywhere but, as I've said many, many times, the nanny state racket is not a results-driven business.

It's that man again

 

Cooey!

The Sunday Telegraph ran an article titled ‘I’m a doctor – here’s how I would solve Britain’s obesity crisis’ yesterday. Unsurprisingly, it didn't involve people eating less and exercising more, nor did it mention the miracle weight loss jab. Instead, it featured three slightly different awful people giving their Big Government prescriptions. 

After the usual recitation of bogus facts ("obesity now affects two thirds of UK adults [actually 26%] at a cost of £6 billion to the NHS each year [actually a lot less]") we were treated to the views of three self-proclaimed experts, one of whom isn't even a doctor.

First up was David Halpern of Nudge Unit fame who is no longer even pretending to be following the rules of Nudge.

 

I head up the Behavioural Insights Team, also known as the Nudge unit, which was set up by the government in 2010 with the idea that nudging people towards better choices without regulation or force is the best way to spark change long term. (We are now fully owned by Nesta, a charity.) We suggested nudges, such as the sugar tax in 2014 (implemented in 2018), and placing high-calorie foods away from checkouts in supermarkets. We also backed junk food advertising bans and an end to buy-one-get-one-free deals on such products...

 

One of the golden rules of libertarian paternalism AKA nudging is that you can't change the costs and benefits. A tax is not a nudge. A ban is not a nudge.

 

To state the obvious: a BAN is not a NUDGE. The opposite in fact. So don't blame Bloomberg's ban on large soda cups on us.

— Richard H Thaler (@R_Thaler) May 31, 2012

 

What is the point of David Halpern if he doesn't have any actual nudges to promote? Friends, there is no point to him. He is just another paternalistic blowhard.

 

It is evident that information, exercise and willpower will not reduce levels of obesity.

 

They are, in fact, the only things that have ever worked. 

 

Next up is Kamila Hawthorne, the Chair of the Royal College of General Practitioners. 

 

Two thirds of adults are overweight or obese in Britain, and as doctors, we’re worried about what this means for the future of chronic diseases. We need to raise healthy food and healthy eating on the nation’s list of priorities, and to do this together.

 

And how do we do that?

That starts with GP services, who need more resources to be able to support their patients in losing weight to improve their health.

 

Of course.  More money for doctors. I should have guessed.

What I would really love is if they left my surgery and saw a public health campaign advertised on a bus, reiterating the benefits of weight loss, building on what we’re doing in consultations.

I often say to people that if they can make these changes for themselves, they can do more for their health than any doctor can.

 

So information and willpower do work? Someone tell the man from the nudge unit.

 

Finally, and with horrible inevitability, it's Dr Chris van Tulleken who is correctly described as an 'anti-upf [ultra-processed food] evangelist'.

 

We know that what drives weight gain and other diet-related diseases in this country is eating foods that are ultra-processed, high in fat, salt and sugar...

Do we?

 

...yet at the moment, children see marketing for all of the above everywhere they turn.

Children don't do the weekly shop, Chris.

CvT's suggestion, which he hilariously seems to think is original, is to "treat food companies like tobacco companies". Expanding on this idea on Twitter, he said that scientists who have worked with the food industry "shouldn’t have a voice when it comes to health". Alas, he didn't explain how these people will be silenced, nor what industry he thinks food scientists should be working in. 

 

Countries like Mexico, Colombia and Brazil are beginning to better label food – they don’t use our confusing traffic-light system, rather big black hexagons on unhealthy products, so you can spot them immediately. They also ban cartoon characters on packaging, to make them less appealing to children.

 

Let's check back in with these countries in a few years and see if their obesity rates have fallen, shall we? Or would that be a bit too evidence-based for a UPF evangelist?

 

As for traffic light labelling being too confusing, let's hope he doesn't drive. 

We need to avoid eating rubbish food from cradle to grave. At the moment, people don’t have a choice.

 

So says the man who had to force himself to eat ultra-processed food for an article to promote his over-priced book. It seems he had never eaten Coco Pops or many other widely marketed food products before, despite being in his 40s. Since conducting this pseudo-experiment on himself, he has gone back to avoiding ultra-processed food like the plague.

 

It would seem, therefore, that people do have a choice.

Obesity is not COVID-19

Former health secretary Andrew Lansley has been talking to the ghastly Times Health Commission and seems to think we should be prepared for lockdown-levels of coercion to tackle obesity.

 

Obesity will kill more people even than the pandemic did and look what behaviour change was required for that.

The behavioural scientists wouldn’t have believed that people would adapt their behaviour to the extent that they did. So people will adapt their behaviour, but they need to believe that it matters sufficiently and the dangers are sufficiently great.

 

Naturally, I disagree.

 

It is true that behavioural scientists didn’t think the British public would go along with lockdowns, but they were wrong for two reasons. Firstly, people were very concerned about catching a novel coronavirus, if not for themselves then because they didn’t want their elderly relatives to be infected. It is precisely because the virus was highly infectious that made one person catching it everybody else’s business. Catching SARS-CoV-2 was not a purely self-regarding act. This is what made it a genuine public health problem, unlike obesity which is a private health problem rebadged as a public health problem to trick people into thinking that government coercion is justified when it isn’t.

The second reason why people went along with lockdowns is that they did not have much choice. They were enforced by roaming police cars and CCTV cameras. There were roadblocks. Neighbourhood snitches peered out of their windows. Drones flew over the Peak District to “shame” ramblers. There was nothing voluntary about them, and it is safe to assume that the “behaviour change” Lansley has in mind to tackle obesity will not be voluntary either.

 

Read the rest at The Critic.

The ideology of 'public health'

A bunch of random go-dodgers wrote a report for the King's Fund recently. It was boilerplate 'public health' stuff with no new ideas, but it gave me a chance to point out that preventive health does not generally cut money and will not, except possibly in the short term, cut waiting times.

 

The health establishment has convinced itself that there would be less pressure on the NHS if people were healthier. This is widely believed and feels almost intuitive. As the Oxford Handbook of Health Economics drily notes, ‘it is frequently argued (but not by economists) that prevention will save expenditure on future treatment’. Economists are the exception because they have looked at the evidence and understand that while premature mortality can be prevented, mortality cannot. When people live longer they consume more healthcare, most of which is needed after retirement age, when they are taking more out of the tax pot than they put it.

 

And an accompanying blog post introduces the spectre of 'ideology', but only from one side.

He [Richard Murray] argues that the Government is unnecessarily frightened of introducing policies that will be more popular than politicians think.

‘… surely all this will play badly with the public? A toxic mix of nanny state and lecturing on `healthy’ behaviours? Putting aside those who for ideological reasons think individuals should be left to sort out their own health (which is ideological given all the evidence that simply providing evidence to people on health impacts does not change their behaviours), this isn’t true.’

The word ‘ideological’ is rarely used as a compliment and it is used twice here, although not to describe Murray’s own worldview. I suppose the belief that adults should be free to eat, drink and inhale whatever they want without interference from the state is an ideological position but it also happens to be a part of living in a free society and is a fundamental value of the Enlightenment. 

And if ‘providing evidence’ doesn’t change people’s behaviour, it is because people are aware of the risks and are quite happy to continue behaving as they do. If people were systematically misinformed about the hazards of alcohol, tobacco, fast food, etc. it could justify some form of government intervention, but that doesn’t seem to be the case. Murray is so blinded by his own ideology that he doesn’t see that this makes the case for nanny state policies weaker, not stronger.

 

Read the rest at Cap-X.

Freedom Day two years on

It feels like longer but it's been two years since all Covid restrictions were removed in England. Most of Europe continued with various restrictions for months afterwards and some went into lockdown the following winter. Say what you like about Boris Johnson, but he got those big calls right.

I publish the receipts at The Critic...

 

In a letter to the Lancet, a group of self-proclaimed experts condemned “Freedom Day” (as it was dubbed by the press) as “unethical and illogical”. The signatories, which included the perennial Zero Covid advocates Stephen Reichter, Susan Mitchie, Martin McKee and Gabriel Scally, wrote: “We believe the government is embarking on a dangerous and unethical experiment”. In the British Medical Journal, many of the same academics called the lifting of restrictions “a terrible mistake” and described the new focus on personal responsibility as “an abdication of the government’s fundamental duty to protect public health”.

“I can’t think of any realistic good scenario to come out of this strategy,” said Julian Tang, a clinical virologist at the University of Leicester. “I think it’s really a degree of how bad it’s going to be.” “Allowing infections to run amok in the country is a dangerous mistake”, said Stephen Griffin of Leeds University, while his Independent Sage colleague Christina Pagel said: “It feels really surreal (and not in a good way) to be living in a country that is actively trying to infect young adults and children with Covid.” Robert West, a nicotine addiction expert married to Susan Mitchie, said that telling people to behave responsibly was “like putting someone out on the road without having taught them to drive.”

In the Guardian, Polly Toynbee called it “calamitous health policy misjudgment.” In the same newspaper, Dr Rachel Clarke said that she was “disgusted” by “the government’s decision to pour petrol on Covid numbers.”

Labour leader Keir Starmer called it “a reckless free for all” and said that the government “urgently needs to change course [and] drop plans to lift all restrictions”. Liberal Democrat leader Ed Davey said Boris Johnson had “got it wrong” with his “gamble” and called for mask-wearing to remain mandatory.

European freedom

There's a nice article in the Telegraph about the Nanny State Index. Check it out. 

 

Since launching in 2016, the Nanny State Index has recorded a net increase in paternalistic regulation across the continent. “There have been individual acts of liberalisation, for example Finland legalising e-cigarettes and Norway repealing its sugar tax,” said Snowdon. “But overall, it’s less free.”

The article rightly points out that just because the law says you can't do something doesn't mean it doesn't happen. Turkey is a case in point.

 

Of all places, Turkey comes out as Europe’s most paternalistic nation, which is a surprise to the Istanbul-based writer Lisa Morrow, who scoffs at the mention of Turkey’s smoking ban. 

“Get on an inner-city minibus and the driver will be smoking, get in a taxi and the driver will be smoking, go out at night and there will be people smoking in bars,” she tells me over Skype. “It’s a joke.”   

Morrow, a former smoker, originally from Australia, grew so tired of inhaling second-hand smoke that she launched Clean Air Dining Istanbul, a Facebook directory of non-smoking restaurants in the city. “In two years, we’ve listed just two venues,” she laughs.  

Perhaps unsurprisingly, given its majority Muslim population, Turkey comes out as the strictest nation for rules around booze. And it has outlawed e-cigarettes, although vape refills are widely available on the black market.

“It’s complicated because Turkish people sort of like having someone telling them what to do, but they don’t follow rules unless they think they are useful,” adds Morrow, author of Istanbul 50 Unsung Places.

Last Orders with James Woudhuysen

 

There's a new Last Orders out. We discuss the absurdities of Transport for London's ban on 'junk food' advertising, the fear-mongering over problem gambling, and the deranged views of Just Stop Oil. 

Have a listen.

On the Substack...

 ... are two newish articles. One is about the latest absurd consequence of Sadiq Khan's ban on 'junk food'  advertising. The other is a one-stop shop for arguing with morons about the NHS.

Problem gambling clinics

With seven million people on NHS waiting lists, hundreds of excess deaths a week and a five day doctors’ strike to look forward to, the Chief Executive of NHS England, Amanda Pritchard, appeared on television at the weekend to talk about gambling.

To be fair, that is not all she talked about, but it was the only part of the interview that was clipped by NHS England for its Twitter account (and retweeted by Pritchard) so it must have been seen as particularly important. She announced that seven new gambling clinics will be opened to meet a “really significant increase in demand” for the treatment of problem gambling. This will bring the number of NHS gambling clinics in England up to 15. The first one was set up in London over a decade ago. Five more were commissioned in 2019 and two opened last year, in Southampton and Stoke. 

This is good news. There is solid evidence that treatment, especially cognitive behavioural therapy, works in tackling gambling disorders. The clinics need to be accessible and people need to know that they exist. In that sense, Pritchard was performing a public service by talking about them.

But the way she framed the issue left much to be desired.

 

Read the rest at The Critic.