A review of another awful year

I've cast my mind over 2023 for Spiked. I fear that we are losing and shall go on losing for some time.

 

It is difficult to tell whether the nation’s rapid descent into neurotic puritanism is being driven by the unhinged political class or by the hateful, purse-lipped, lemon-sucking actions of the public. Evidence for the latter came when a survey by More in Common revealed that one in five Britons wants to close the pubs and bring back the ‘rule of six’. Just under 30 per cent want to close nightclubs and 45 per cent want face masks to be mandatory on public transport. This survey was not carried out in December 2020, at the height of the pandemic, or even in December 2021. It was carried out this month. We must come to terms with the fact that a sizeable minority of our fellow citizens – people who walk past us in the street without giving any indication of the madness bubbling within – have decided that if they don’t personally do or like something, it should be banned.

 

Do read it all.

Corpulence, imbecility and tobacco

I have written about corpulence, imbecility and tobacco from the perspective of 1931 for The Critic.

 

I have before me The Home Doctor, a 391 page layman’s version of Black’s Medical Dictionary published in 1931. Under the heading of “corpulence” — a word it uses interchangeably with “obesity” — it identifies the causes as being a “luxurious, inactive, or sedentary life, with over-indulgence in sleep and absence of mental occupation”, but above all “over-feeding” especially with “fatty, sugary, and starchy elements”. 

The Home Doctor notes that “women are prone to become more corpulent than men”, a claim that is borne out by modern obesity statistics, although the difference between men and women is quite small. It also notes that “health cannot be long maintained under excessive obesity”, although “even a considerable measure of corpulence, however inconvenient, is not incompatible with a high degree of health and activity, and it is only when in great excess or rapidly increasing that it can be regarded as a morbid state.”

 

Have a read.

And if you're interested in that kind of thing, I have written about the 1982 film adaptation of Evil Under the Sun on my Substack.

Last Orders Christmas special

If you don't already subscribe, you may not know that the new Last Orders is out and it's an end-of-the-year round up with the nation's sweetheart Kate Andrews. You can listen here.

The madness of sales quotas

The latest political pygmy tactic to get people to buy things they don't want to buy is to force companies to sell them to them. It's not going to work, as I argue in The Critic.

 

The government has given up trying to persuade us that heat pumps and electric cars are better than the real thing. Subsidies haven’t worked so it is now time for mandatory quotas. From April next year, boiler manufacturers will be told how many heat pumps they have to sell and will be fined £3,000 for every unit they undershoot the target by.  60,000 heat pumps were installed last year, mostly in new builds. Under the laughably named Clean Heat Market Mechanism, the industry will have to install 60,000 heat pumps in existing homes in year one and the target will rise to 450,000 by year four. Companies such as Worcester Bosch, who know more about the home heating market than politicians do, say that this is totally unrealistic and, treating the fines as a cost of doing business, are increasing the price of their boilers accordingly. 

In January, the zero emission vehicle (ZEV) mandate will come into effect, compelling car manufacturers to ensure that at least 22 per cent of the vehicles they sell are electric. The target will rise every year until it hits 80 per cent in 2030. For every electric car they fail to sell, they will be fined £15,000. With electric vehicles currently making up 16 per cent of the market, there will be a lot of fines.

Say what you like about Soviet apparatchiks but at least they only had production quotas. They didn’t have sales quotas because even they couldn’t force people to buy things. People don’t want heat pumps because they are big and expensive and don’t keep you warm. They don’t want electric cars because they don’t have anywhere to charge them and the national charging infrastructure is inadequate. This may change in the future, but it isn’t going to change very soon.

Continued here.

Challenging obesity myths

I was on TalkTV the other day talking about obesity. The story brought together a couple of myths propagated by The Times (which, like TalkTV, is owned by News UK), including the idea that obesity-related hospital admissions have doubled in six years. 

I was interested to see that that the £98 billion of 'wider costs to society' claimed by The Times two weeks ago has already morphed into a £98 billion cost to the NHS. I only got one bite of cherry in this interview which I used to challenge both of these lies. I was up against a doctor who basically just said that obesity was unhealthy.

If I had had a chance to respond to his last point, I would have explained that a secondary diagnosis for obesity is not equivalent to obesity being a partial cause of the illness with which a person is admitted. As I wrote on my Substack... 

 

For example, if an obese woman goes to hospital to have a baby, that is not an obesity-related admission in the sense that it could have been avoided if she wasn’t obese, but it will be recorded as such if a medic thinks her obesity is relevant to her care. This is not a random example. Maternal care is, by some distance, the most common type of admission to have a secondary diagnosis of obesity recorded.

 

Total consumption theory in the mud

A new study from alcohol researchers at Toronto's Centre for Addiction and Mental Health looking at 14 countries in 2020-21 has an interesting story to tell about drinking during the pandemic.

 

Results: When compared to 2019, alcohol-specific mortality rates in 2020 increased by 7.7 % and 8.2 % for women and men, respectively. Increases in alcohol-specific mortality were seen in the majority of countries and continued in 2021. In contrast, alcohol sales declined by an average of 5.0%.  

Conclusion: Despite a drop in alcohol consumption, more people died due to alcohol-specific causes during the COVID-19 pandemic in Europe.

 

This is exactly the opposite of what you would see if there were any truth in the total consumption theory/single distribution theory/whole population approach beloved of the neo-temperance lobby and the Scottish government.  

According to NICE, who have bought into this self-serving dogma, "the number of people who drink a heavy or excessive amount in a given population is related to how much the whole population drinks on average. Thus, reducing the average drinking level, via population interventions, is likely to reduce the number of people with severe problems due to alcohol."

 

This has always been nonsense. Heavy drinkers don't care what average drinkers consume. Heavy drinking and per capita consumption are only connected insofar as heavy drinkers have a disproportionate impact on per capita consumption because they drink so much. The idea that "reducing the average drinking level" will, in and of itself, reduce heavy drinking and alcohol-related harm is absurd. As I argued in Lockdown Lessons in Health Economics, the UK's experience during Covid disproves the theory. In fact, the UK had been disproving the theory for 20 years before Covid came along. So have other countries.

It's a garbage theory used to justify meddling with moderate drinkers. It needs to die.

First sign of failure for minimum pricing in Ireland

A study evaluating minimum unit pricing (MUP) in Ireland has been published (the first, I think). It found a statistically significant increase in wholly alcohol-related presentations at an emergency department (ED) of a Dublin hospital, but you'd never guess it from the abstract.

Findings

Alcohol consumption was a factor in 19.4% of ED presentations and in 17.3% of hospital admissions across the entire study period. A reduction in overall alcohol-related ED presentations was noted in the period following MUP, although it is not possible to conclude a direct effect.

Conclusion

Alcohol-related harm places a significant strain on EDs and hospitals, and the impact of MUP on hospital burden in Ireland merits further evaluation. Effective measures at local and population levels are urgently required to address this burden.

 

MUP was introduced on 4 January 2022. The minimum price in Ireland is €1.00 per 10 g of alcohol, substantially more than the 50p per 8 g of alcohol in Scotland and Wales (Irish units are larger). 

 

The authors looked at data from the hospital in two weeks preceding the introduction of MUP (November and December 2021) and compared it with two weeks in March and April 2022. One of the researchers was in the hospital throughout and interviewed anyone who was there with an ailment that is deemed partially or wholly attributable to alcohol, asking them what they liked to drink and administering the Alcohol Use Disorders Identification Test (AUDIT) to see if they were dependent drinkers. 73% agreed to be interviewed.

 

The researchers found that presentations that were wholly attributable to alcohol trebled after MUP was introduced. This is not immediately obvious from the way they present the data because they prefer to look at percentages of alcohol-related presentations rather than the number of presentations, but as you can see below the number of 'acute wolly [sic!] related' presentations rose from 5 to 15 and the proportion of alcohol-related presentations that were wholly related to alcohol rose by 19.8 percentage points. Normally, this would be presented as a 200% increase.

 

 

This is obviously not what they were hoping for and so they left it out of the abstract, although they do not acknowledge it in the text:

 

In Period 1, there were 5 cases of alcohol intoxication, and in Period 2, there were 14 cases of alcohol intoxication and 1 case of alcohol withdrawal.

... Although there was a reduction in overall alcohol-related presentations, we observed a significant increase in acute wholly related presentations, and this subgroup represented individuals with alcohol dependence (Supplementary Table S7). The reason for an increase in acute wholly related presentations such as alcohol intoxication or poisoning during Period 2 is unclear, but it could be related to factors noted in the Scottish evaluation of MUP in which the introduction of MUP was associated with reduced household expenditure on food with increased availability of funds for alcohol or switching to consuming more spirits amongst persons with alcohol dependence.

 

Quite possibly. These are the kinds of thing sensible people warned about in advance, but they were ignored.

 

Still, at least they've got their reduction in alcohol-related presentations overall. So why are they so circumspect in the abstract, saying 'it is not possible to conclude a direct effect'?

I suspect it is because most of the partially attributable presentations were very unlikely to have been affected by minimum pricing, even in theory. A large chunk of them (4 out of 10) were not just 'partially related' but 'chronic'. Most chronic diseases are unlikely to be affected in such a short space of time by any public health intervention. And, as with the obesity data I discussed yesterday, these people were not necessarily in the ED because of drinking. Some of them probably didn't even drink. These are all simply diseases that can be caused by excessive alcohol consumption.

 

 

The same is true of the acute partially related presentations which mostly involve accidents. There were a lot of these both before and after MUP (it was an accident and emergency department, after all) but there were fewer after. Again, we don't know how many of these people had been drinking or whether they drank at all (the researchers do because they did on AUDIT test on most of them, but they don't tell us - interested readers may find something to explore in the Supplementary Table S7). They are just injuries that can be affected by alcohol. Presumably there are other factors, such as the weather. Maybe there are simply more people drinking in December than in March (the authors admit that their study "did not address potential seasonality of alcohol presentations").

The authors don't conclude that the minimum price should be higher, but prepare yourself for them to start saying that if a few more studies show that the policy has been a flop, as in Scotland. This is quite a small study and the statistical analysis is eccentric to say the least, but it's a nice example of 'public health' researchers burying the lede. If the aim of the policy had been to increase alcohol-related harm, they would have made it very clear that emergency department presentations that are directly caused by alcohol have risen 200% under minimum pricing - and you would have seen this study reported on the BBC. 

Dodgy obesity stats

The Times has become obsessed to the point of derangement about obesity and food. Its front page yesterday claimed that obesity-related hospital admissions have doubled in just six years. This statistic doesn't pass the smell test, as I explain on my Substack.

 

When statistics like this rise or fall dramatically in a short space of time, it is usually worth looking for a change in methodology. Sure enough, what we have here is a sharp rise in the number of people going to hospital with a secondary diagnosis of obesity. Back in 2009/10, only 142,219 admissions had obesity mentioned as a secondary diagnosis. By 2022/23, this had risen to 1,235,961. In the same period, the rate of obesity among adults has risen only slightly. A ten-fold rise in admissions isn’t very plausible, especially since admissions for which there was a primary diagnosis of obesity haven’t risen at all.

A secondary diagnosis of obesity doesn’t mean that your illness was caused by obesity, nor does it mean that you wouldn’t have got ill if you hadn’t been obese, as the statisticians who collate this data explain…

A secondary diagnosis of obesity does not necessarily indicate obesity as a contributing factor for the admission, but may instead indicate that obesity is a factor relevant to a patient’s episode of care.

For example, if an obese woman goes to hospital to have a baby, that is not an obesity-related admission in the sense that it could have been avoided if she wasn’t obese, but it will be recorded as such if a medic thinks her obesity is relevant to her care. This is not a random example. Maternal care is, by some distance, the most common type of admission to have a secondary diagnosis of obesity recorded.

 

Do read it all.

Prohibition and 'public health'

If Rishi Sunak goes ahead with his ruse of banning anyone born after a certain year from ever buying tobacco, the UK will be the only country in the world to have such a policy, but it will not be the only place in the world. I have only recently learnt this, but apparently there is a suburb of Boston where no one born in the 21st century can buy tobacco.

 

Politicians in Brookline, Massachusetts introduced the law under the cover of Covid in 2020 and it is currently being reviewed by the state’s Supreme Judicial Court. The Boston Globe has been covering the story...

 

Katharine Silbaugh, a Boston University law professor and one of the leading petitioners of Brookline’s bylaw, argued that nicotine and tobacco shouldn’t be regulated like alcohol or cannabis, which “whether we’re right or not, we believe at some age, they are safe enough to use.”

 

No, Katharine. You don't have age restrictions on alcohol and cannabis because they become safe enough to use when you're 21 (as the law is in the USA). It is because once you reach a certain age, you are old enough to make your own decisions. Once you are an adult, you can make your own trade-offs between risks and benefits, rather than have them made for you by some bossy law professor.

 

“It doesn’t make sense to have an age restriction that seems to indicate that you have become old enough to smoke,” she said. “You’re never old enough to smoke.”

 

This is what the anti-smoking lobby have believed all along, but have only had the stones to say out loud in recent years. Tobacco control has always been a prohibitionist movement. 'Public health' is a prohibitionist movement. You cannot trust them.

It is ironic that Silbaugh cites alcohol and cannabis as products that are more suitable to age restrictions than to prohibition. In the USA since the start of the 20th century, both products have been legal before being made illegal and then being made legal again. Americans can't seem to make their minds up about whether you are ever "old enough" to consume these products. Now it is tobacco's turn to undergo prohibition.

It is almost a cliché to say that prohibition doesn't work but it bears repeating. Take Australia, where nicotine vapes have always been illegal. For the last few years it has even been illegal to import them for your own use. Figures published last week by the Australian Bureau of Statistics show how well the ban has worked: 14.4% of Australian adults have used an e-cigarette. In the UK, where nicotine vapes have always been legal and public health agencies have actively encouraged smokers to switch to them, the figure happens to be exactly the same: 14.4% of British adults have used an e-cigarette.

The figures for young people are even more striking. Among Australians aged 18-24, 38% have ever used an e-cigarette. In the UK, 22% of 16-24 year olds have ever used an e-cigarette. The figures are not directly comparable because the UK figures include 16 and 17 year olds, but it is clear from the data that more young adults have tried vaping in Australia than they have in Britain.

There is nothing wrong with that, but it is a pretty remarkable fail for a country that not only prohibits the sale of nicotine vapes but whose government, media and public health establishment is hysterically opposed to them.

If the prohibitionists want a crumb of comfort, the rate of current use is slightly lower in Australia (4%) than in Britain (5.2%). So, er, well done.

Sugar tax study retracted

A study from 2021 which claimed that the sugar tax reduced sugar consumption from soft drinks by 10% was retracted last week. It appears the 13 authors made an enormous cock up and the 'real' figure is a trivially small 2.7%.

The media have paid no attention to this whatsoever so I wrote about it for The Critic...

 

This is not just any old bunch of researchers. They are conducting the official evaluation of the sugar tax and have been given £1.6 million of taxpayers’ money to do so. The same team has since produced a study claiming that the sugar tax reduced obesity among one group of girls but not among another group of girls and not among any boys (and obesity rates actually rose among all age groups), and a study claiming that it reduced tooth decay extractions among a subset of children who never drank many sugary drinks to begin with (I wrote about the latter last month). Almost unbelievably, they have a study in the pipeline that will claim that the sugar tax reduced childhood hospital admissions for asthma by more than 20 per cent!

The retraction casts further doubt on all these claims, partly because it raises serious questions about the team’s competence and partly because the reduction in sugar consumption attributed to the tax is now so tiny that any measurable difference in health outcomes is less plausible than ever.

 

Have a read.

Has the smoking rate stalled?

From the BBC...

 

Smoking decline stalls since Covid as more young people take up the habit - study

A decades-long decline in smoking in England has nearly ground to a halt since the pandemic, a study suggests.

The rate of decline slowed from 5.2% in the years before the pandemic to just 0.3% between April 2020 and August 2022, according to the research.

The lead researcher said it was likely more young people had taken up smoking and that urgent measures were needed.

 

Of course she did. The study is here. It was written before Rishi Sunak went crazy and announced a weird, sliding age-based prohibition, but the BBC is using it as a justification for it. 

 

Based on surveys with 101,960 adults representative of the population, researchers estimated 16.2% smoked in June 2017, falling to 15.1% by the start of the pandemic, in March 2020, but just 15% in August 2022, since when the the slower rate of decline has remained consistent.

 

She didn't actually do this research. She just used the figures from the Smoking Toolkit Study. Those figures show that the smoking rate was 15.4% in 2019 and was exactly 14.8% between 2020 and 2023. There was a marked rise in smoking rates among 16-21 years in 2020 which has since gone into decline (although not back to 2019 levels).

 

Researchers noted higher levels of stress and social isolation among younger adults during the pandemic.

 

Yep. We also saw a large rise in alcohol-related deaths and childhood 'obesity' in 2020.

Young adults may start smoking because they believed e-cigarettes were equally bad for them, Dr Jackson said.

 

Yes. That too. The EVALI panic took place in 2019 and people are hopelessly misinformed about the relative risks of vaping and smoking these days. 

 

There are certainly reasons to think that smoking might have had a mini-revival in recent years, but has it really?

The ONS survey - usually considered the best source - shows the smoking rate steadily ticking down every year.

Among 18-24 year olds, the rate dropped from 16% in 2019 to 14.7% in 2020 and had dropped to 11.6% by 2022.

Among 25-34 year olds, the rate dropped from 19% in 2019 to 18% in 2020 and had dropped to 16.3% by 2022.

Overall, the rate has been falling by roughly 0.5 percentage points every year since 2016, except 2020 when it was nearly flat (but still fell slightly). 

There is also the fact that tobacco sales have fallen. In 2019/20, 25.9 billion cigarettes were sold. By 2022/23, it was down to 20.3 billion. Rolling tobacco sales rose in 2020/21, presumably because people were unable to buy it abroad thanks to lockdowns and travel restrictions, but the total figure was still lower in 2022/23 than it had been in 2019/20.

I dare say there has been a shift to the black market, but a 20% drop in cigarette sales doesn't seem consistent with flat-lining smoking rates.

It is possible that the ONS is wrong, the Smoking Toolkit Study is right and the drop in sales is all down to the black market growing, but we must at least consider the possibility that the Smoking Toolkit is wrong. Its survey went online in April 2020 and has stayed online whereas I think the ONS survey went online but is now back to being done in person. We know how much difference switching from face-to-face to online can make.

Whatever the truth, the 'public health' mob will cite whichever statistics are most useful to them and those are the ones the BBC reported.

Prohibition 2.0 - the video

The video of the IEA's Prohibition 2.0 event is now available to watch. It was a really good discussion covering a lot of different aspects of Rishi Sunak's daft idea of gradually raising the smoking age. 

Mark Oates stepped in at the last minute and was typically erudite. 

Paul North from Volte-Face explained why prohibition doesn't work from the perspective of a drug reform activist and he had some interesting things to say about why so few people in drug reform have spoken out against this particular prohibition. 

And Craig Whittaker MP was a breath of fresh air, talking about how he was until recently a smoker before switching to heated tobacco (which will also be prohibited if the legislation goes ahead as planned).

If you weren't at the event, be sure to watch the video.

Meanwhile, the BBC continues to weep bitter tears over New Zealand turning its back on prohibition. In a ridiculously one-sided article published today, it takes a 'white saviour' approach to the Maoris - who smoke more than white New Zealanders - and pretends that they would have been the greatest beneficiaries of a ban. In fact, history shows that ethnic minorities suffer the most under prohibition.

Food junk round up

 There had been a glut of food-related junk in the news recently. I ponder some of them on my Substack.

Alcohol research - who funds it?

When I mention the vast amount of evidence showing that moderate drinking is good for your health, midwits will occasionally respond with the objection that non-drinkers are inherently less healthy or that the studies showing a protective effect are funded by the booze industry.

The 'sick quitter' hypothesis is a zombie argument that was debunked decades ago. The claim about industry funding is not really an argument. If the science is sound, it doesn't matter who funds the studies.

But, as a matter of fact, very few of the studies are funded by the alcohol industry. An article published this month in Addictive Behaviors gives us chapter and verse on this. Of the 713 primary studies on drinking and cardiovascular disease published between 1969 and 2019, only 8 per cent declared alcohol industry funding. In the last 15 years, there have been hardly any. (NB. The benefits of moderate drinking are mostly related to heart disease.)

 

One of the article's two authors is Jim McCambridge who has spent his whole career obsessing over the alcohol industry and would love to debunk the J-Curve. In the introduction, he describes the question of whether moderate drinking is good for the heart as "a major scientific controversy" (only in temperance circles) and even resurrects the sick quitter cope. You can tell from the text that has was disappointed not to find more industry funding, but that's just too bad. The facts are the facts.

 

Last chance to speak your brains

The public consultation on the government's Tobacco and Vapes Bill closes today at 11.59pm so make some noise. It won’t take you long. Answers are limited to 300 words and you don’t have to answer all the questions. You don’t even have to write anything. You can just tick the ‘disagree’ or ‘agree’ boxes. You can read my response here. Attention vapers: most of the questions involve you.

FOREST have done some polling and found that most people believe that you should be allowed to buy tobacco once you've turned 18. This is interesting because when people are asked if they support the Sunak prohibition, most of them say yes. 

These opinions are obviously mutually exclusive but I suspect most people have simply not thought it through. Smoking is a low salience issue these days and when people hear the government say "14 year olds will never be allowed to buy tobacco" all they can picture is a 14 year old. They don't picture 24 year olds and 34 year olds not being allowed to buy cigarettes in the future. 

No wonder the government is trying to rush this stupid policy through before the public have had the chance to give it some serious thought.

 

 

Paternalism in public health

I was pleased to appear on the Vaping Unplugged podcast recently. Have a watch/listen.

Don't forget the public consultation on the Tobacco and Vapes Bill closes at 11.59pm tomorrow. It includes many questions about new e-cigarette regulations so give the government a piece of your mind.