I hope you're coming to this year's Battle of Ideas. If you do, come along to the first ever Last Orders Live where me and Tom will be talking to some special guests about the stories of the day.
If you don't, you can always listen to the podcast later, but you won't have as much fun.
Tickets here. There's an early bird offer until next Monday.
It is time for the public to understand what the trade-offs are. They need to be told that yes, you can have all the stuff you say you want - nutrient neutrality, silent city centres, triple lock pensions, net zero, protectionism, bans on everything you don’t like, 20mph speed limits, high speed rail, state-run healthcare, more borrowing, more regulation, more tzars, more badgers, more wolves or whatever - but you are going to be poor.
Nobody wants to hear that and nobody is going to hear that, because politicians won’t level with the electorate. And so politicians will have to make the decision for them. They will have to be - I know this sounds crazy but hear me out - leaders.
It should be taken as read that local residents will oppose any development that they don’t directly profit from, that single issue pressure groups will oppose everything, and that opinion polls will always show support for luxury, high status policies unless the consequences are spelt out. But it seems fairly clear from opinion polls on voting intention in the last two years that lower prices, higher incomes and economic growth are the real priorities of the British public and that these should therefore be the priorities of the British government even though public opinion will be against the engines of economic growth in the short-term.
In the early 1990s, I had been a member of the EPA panel charged with evaluating the evidence for an association of passive smoking with lung cancer. It was clear that the leadership of the committee was intent on declaring that passive smoking caused lung cancer in non-smokers. I was the sole member of the 15-person panel to emphasize the limitations of the published studies—limitations that stemmed from the rudimentary questions used to characterize exposure. Many members of the committee voiced support for my comments, but in the end, the committee endorsed what was clearly a predetermined conclusion that exposure to secondhand smoke caused approximately 3,000 lung cancers per year among never-smokers in the United States.
... After several years of work, our paper was published by the BMJ on May 17th, 2003, addressing the same question Takeshi Hirayama had posed 22 years earlier in the same journal: whether living with a spouse who smokes increases the mortality risk of a spouse who never smoked. Based on our analysis of the American Cancer Society’s data on over 100,000 California residents, we concluded that non-smokers who lived with a smoker did not have elevated mortality and, therefore, the data did “not support a causal relation between environmental tobacco smoke and tobacco related mortality.”
The publication caused an immediate outpouring of vitriol and indignation, even before it was available online. Some critics targeted us with ad hominem attacks, as we disclosed that we received partial funding from the tobacco industry. Others claimed that there were serious flaws in our study. But few critics actually engaged with the detailed data contained in the paper’s 3,000 words and 10 tables. The focus was overwhelmingly on our conclusion—not on the data we analyzed and the methods we used. Neither of us had never experienced anything like the response to this paper. It appeared that simply raising doubts about passive smoking was beyond the bounds of acceptable inquiry.
Beneath the corporate jargon is an admission that the company’s ultra-low nicotine cigarettes are not selling as well as expected. Some analysts think it is a prelude to a federal bankruptcy filing. The company’s share price peaked at $77 in 2021 and is currently trading at $1.25.
It is not long since XXII was a darling of public health groups and the media. The Food and Drug Administration (FDA) did everything it could to help the company. It banned the vast majority of e-cigarettes and threatened to introduce nicotine limits in cigarettes that only XXII could comply with. It officially classified two of XXII’s very low nicotine cigarette brands — VLN King and VLN Menthol King — as “modified risk tobacco products”, thereby giving the company the unique privilege of being able to market their cigarettes with health claims. The FDA also bought 28 million of their cigarettes to use in research.
Is tobacco a unique product or not? Let's ask comedy professor Anna Gilmore.
Anna Gilmore, 2007:
'The International Monetary Fund encourages privatization of state-owned industries, including tobacco industries, to help address macroeconomic problems and promote economic growth; however, it fails to consider the unique nature of an industry whose product kills.'
'Tobacco is a unique product in that it kills half of its consumers. It is the only consumer product that is subject of a global treaty, the WHO Framework Convention on Tobacco Control (FCTC), with over 180 Parties including all but one OECD member. The FCTC is now embedded in the UN Sustainable Development Goals, enshrining the tenet that good governance in public health involves treating tobacco companies differently from the rest of industry.'
“For NCDs we should be able to move forward, we need to get beyond tobacco exceptionalism,” said Professor Anna Gilmore, Professor of Public Health and Director of the Tobacco Control Research Group at the University of Bath
New episode with my IEA colleague Marc. We discuss the implications of the trans ideology on free speech, plus a wolf update, Ted Cruz and craft beer.
TfL said the cheese ads – which were to be part of a campaign run by Workspace, the office provider and consultancy – could not go on the network because TfL uses “the Food Standards Agency’s model to define foods that are high in fat, sugar and salt.”
The founder of Cheese Geek, Edward Hancock, said the ban was “crazy” and said he couldn’t understand why fizzy drink ads were allowed on the network but not artisan cheeses.
Why?
— Edwina Currie (@Edwina_Currie) September 9, 2023
To prevent obesity.
But this is artisan cheese. Vintage cheddar. A bit expensive, but special. Hardly junk food.
Does anyone in @TfL know the difference..? https://t.co/Bt8JUZnKxs
(First publisher in Spectator Health in March 2019)
It’s only been a week since Sadiq Khan’s ill-conceived ban on ‘junk food’ advertising across London’s public transport network came into effect, but the unintended consequences are already coming to light.
As I explained last June, ‘junk food’ has no legal definition. Those who want to restrict food advertising clearly have American fast food chains in mind, but the government is not so arbitrary and capricious that it is going to put McDonald’s, Pizza Hut and KFC on a blacklist. That would not only be illegal, it would also make the thinly veiled snobbery behind the anti-obesity crusade awkwardly explicit.
The model was devised by our old friend Mike Rayner who literally believes that God told him to bring about a sugar tax in Britain. All the obvious stuff gets a black mark under Rayner’s model: pizza, crisps, biscuits, confectionery, milkshakes and sugary drinks. It also rules out lots of products that are not typically considered to be ‘junk’ but which can be expected to get caught up in a system that focuses on sugar, salt and fat: ice cream, clotted cream, jam, marmalade, honey, bacon, pretzels, salted peanuts, sweetened fruit juice, smoothies and most sausages.
But then there are the foods that hardly anyone would consider ‘junk’ but which still fail the test: cheese (including half-fat cheese), raisins, sultanas, soy sauce, mustard, most tinned fruit, most yoghurts, most breakfast cereals (including high fibre varieties), peanut butter, Marmite, mayonnaise (light and regular), tomato soup, most cereal bars, many pasta sauces, all butter, fat spreads and olive oil.
Having spent much of the last year warning of the unintended consequences of half-baked anti-obesity policies, I welcomed the jolt of schadenfraude I got from reading about Farmdrop’s battle with TfL. Farmdrop is the woke mirror image of the stereotypical fast food company. It bills itself as an ‘ethical grocer delivering delicious food direct from local farmers’ and specialises in organic produce.
If it is organic, it must be ‘healthy’, right? Not according to the Nutrient Profiling Model. Farmdrop’s wholesome advertisement showing a family admiring their latest delivery was rejected by TfL because it shows butter and bacon. Butter is high in saturated fat and calories. Bacon is high in saturated fat, calories and salt. Ergo, they are what disingenuous health campaigners describe as ‘junk food’.
If you think this is ludicrous, I don’t disagree, but rules is rules. I would have more sympathy for the people at Farmdrop if they hadn’t been enthusiasts for the ban right up until the moment they realised that it wasn’t just their competitors who were going to be clobbered.
In fact, they still support the ban. Like the party member screaming loyalty to Comrade Stalin as he is dragged off to the gulag, they assume that there must have been some mistake. In a charmingly bewildered blog post, Farmdrop say that ‘the ban is coming from the right place’ but that the ‘handling has been clumsy’. They ‘fully support the Mayor of London’s decision to prohibit junk food advertising on the transport network’ but are ‘concerned about how it’s being applied’.
Alas, they are not victims of an administrative error by an over-zealous jobsworth. The law is being applied as it was written, with HFSS food forbidden and non-HFSS food allowed. What is the alternative? There has been talk of TfL offering exemptions from the ban if the food in question is “not generally consumed by children” or if there are “exceptional grounds”. Neither seems to apply in this case, and if the authorities started making ad hoc exceptions on the basis of common sense, the whole house of cards would soon fall apart.
Farmdrop have their own definition of junk food, describing it as ‘calorific foods with little or no nutritional value’, but this only underlines how difficult it is to come to an objective judgement. If a food has no nutritional value, it is not food. Tellingly, they add: ‘We all know which foods we mean here.’ And so we do. We mean burgers that don’t come in a Rye Burger Bun topped with seeds (£1.75 for two). We mean mass-produced chocolate bars from Nestlé, not Belgian Dark Chocolate Tiffin (£3.50). What a shock it must be to discover that the authorities think that Organic Wyfe of Bath Cheese is just as fattening as the cheese on a Domino’s pizza and that Organic Dry Cured Streaky Bacon clogs the arteries just as much as the bacon served in a bap in a greasy spoon caff.
I said months ago that the public has been sold a pig in a poke by campaigners who talk about banning junk food advertising. The fact that a company like Farmdrop, which is in the food industry and regularly advertises on the tube, had no idea about the true scope of the law shows how far the wool has been pulled over our eyes. If a bland advertisement for ordinary food by a self-consciously virtuous business can fall foul of the law, anything can.
The chickens are coming home to roost. In the meantime, Londoners should reflect on the fact that they now live in a city where a photos of butter, raisins and ham are considered dangerous.
You can lead a horse to water but you can’t make it drink. The “public health” lobby is constantly undermined by the public. Generally speaking, people know what they want and they are going to get it, even if they have to spend slightly more money or walk around a supermarket a bit more.
You might be able to suppress the sales of a new variety of Magnum by banning adverts for it, but you won’t suppress the demand for ice cream. You could, I suppose, tax “unhealthy” food at the level at which cigarettes are taxed. That would no doubt have an effect, but no party is going to propose it because the public would hate it.
Any reasonably affluent and free society is going to have a lot of fat people in it. The government can’t make people exercise more and the tools it has to intervene in the food supply are, in practice, too trivial to make any difference. It will take many years of failure and huge sums of wasted money before politicians admit that this is one problem they cannot do much about.
TalkTV did a whole hour on gambling this week. It was presented by Jeremy Kyle, who used to have a gambling problem (he bet on the horses, I believe). I only got a minute or so to make my point and by the time I went on there had been so much nonsense talked it was difficult to know where to start.
I was on with someone from Jolyon Maugham's Good Law Project. God knows why they're sticking their oar in. Perhaps they're sick of losing lawsuits and want to join a battle they can win for once.
The clip below should start where I begin.
It was a joy to welcome back Simon Evans to the Last Orders podcast. We talked about the witch-hunting of Graham Linehan, the ridiculous regulation of takeaway pints, and the mad plan to reintroduce wolves to the English countryside.
Listen to the episode (and catch up on any you've missed) here.
Following yesterday's news, I was on BBC Radio Scotland this mornings discussing minimum pricing. Dr Alastair MacGilchrist, chairman of Scottish Health Action on Alcohol Problems, was on before me and Dr Sandesh Gulhane was on after me. It's worth listening to the whole thing. MacGilchrist still thinks minimum pricing worked despite alcohol-specific deaths hitting a 14 year high. Gulhane strongly disagrees, as any sane person would.
You can listen here. It was the first item on the show.
The original version of the Scottish Government press release stated that:
“In their final report of a series, researchers said that ‘robust, independent evaluation’ and the best available, wide-ranging evidence drawing on 40 independent research publications, showed that the MUP has been effective in its main goal of reducing alcohol harm with the reduction in deaths and hospital admissions specific to the timing of MUP implementation”.
This wording might suggest to many readers that most or all of the studies referred to examined the health impact of MUP. But the evaluation report explains that of the 40 papers included, only eight provided evidence on alcohol-related health outcomes. The remaining 32 examined other potential effects of the policy such as on alcohol consumption, social outcomes, compliance by retailers and product prices. Of the eight papers which studied health outcomes, one looked at deaths and hospitalisations and found a beneficial quantitative impact on these outcomes. Based on the other seven papers, the report concluded that there was “no consistent evidence that MUP impacted on other alcohol-related health outcomes such as ambulance callouts, emergency department attendances and prescribing of medication for alcohol dependence”.
The Scottish Government press release and the PHS ‘at a glance’ document both referred to the results of the PHS/Glasgow/Queensland study. However, information about the level of uncertainty associated with the reduction in hospitalisations and deaths was not included in either output, despite being emphasised in the study. For example, the figures are estimates based on statistical modelling and the reduction in hospital admissions was not found to be statistically significant.
Summarising technical data, especially for a public audience, is challenging. Press releases, factsheets, tweets and other communications require condensed information, but it still serves users best to include caveats about the uncertainty or limitations of statistical evidence. In this case, caveats did not carry through from the final PHS report to the press release and ‘at a glance’ document.
It’s been a bad few days for minimum unit pricing (MUP). At the weekend, the Sunday Times revealed that Scottish civil servants had put pressure on Public Health Scotland to sex up their evaluation of the policy back in June. Today, we heard that the Scottish government has re-written its June press release, watering down strong claims about the success of minimum pricing and deleting a whole paragraph. Today also saw the publication of figures showing that the number of alcohol-specific deaths has hit a 14 year high in Scotland.
I've written about this for the Spectator and have put some more thoughts on my Substack. I won't go over all the studies in the official evaluation that failed to find a benefit from minimum pricing but there is a good summary from the charity Favor here.
At The Critic, I've written an article I've been meaning to write for a while about misinformation about vaping. A recent suggestion from someone in the basketcase of Australia that vapes have Polonium-210 in them inspired me to get it written.
A study published last year found that if you lie to people on Twitter, some of them will believe you. The researchers showed 2,400 smokers some tweets about vaping, most of which were categorically untrue, and found that those who were exposed to misinformation were more likely to have a poorer understanding of the risks of e-cigarettes than those who were exposed to accurate information.
So far, so unsurprising. What was remarkable was the level of ignorance displayed by nearly everyone, regardless of what tweets they were shown. Of the people who were told that vaping is as harmful or more harmful than smoking, only 29 per cent believed that e-cigarettes contain fewer toxins than cigarettes. This is a pitifully low figure, but even among the people who were told that vaping is “completely harmless”, the figure was only 43 per cent. (In case it is not obvious — and apparently it isn’t — e-cigarettes contain far fewer toxins than cigarettes.)
No matter what messages they were shown, more than 60 per cent of the participants wrongly believed that e-cigarettes contain tar and the vast majority of them believed that vaping causes “popcorn lung”. Even among those who were told that vaping is completely harmless, 88 per cent thought that e-cigarettes cause popcorn lung.
British smokers were less ignorant than Americans, but they were still deeply confused. At the start of the study, only 11 per cent of the British smokers correctly believed that vaping doesn’t cause popcorn lung (compared with a pitiful 6 per cent of American smokers) and only 46 per cent of them understood that e-cigarettes don’t contain tar (among the Americans it was just 27 per cent). They would have been better off getting their opinions from a coin toss.
He simply asserts that: “The evidence is clear that we are eating more calories than ever and that trying to change our energy expenditure is not going to make a significant difference to weight.”
To support the second of these claims, he cites the Hadza hunter-gatherers of Tanzania. These people will be familiar to anyone who has read a book like this before, such as Henry Dimbleby’s Ravenous. A 2012 study found that their daily energy expenditure was not much different to that of your regular desk-bound Westerner, and yet none of them were obese. Van Tulleken admits that when the Hadza are not hunting or gathering, they rest a great deal but he incorporates this into his theory by inferring that “if we are active, our bodies compensate by using less energy on other things, so that our overall energy expenditure stays the same”. This is why he reckons that coal miners and athletes burn the same number of calories as the rest of us
His claim about coal miners rests on a study of miners in the USA and Turkey which, he says, found that they burned “2,100 and 2,800 calories per day — the same as the rest of us.” Alas, he completely misread the study. That is how much they burned at work. In the course of a whole day, they burned an average of 3,658 calories. Furthermore, the number of calories burned depended on how physically active they were, with the most active miners burning 4,414 calories a day:
Average energy expenditures according to activity levels were 3289.4 ± 356.64 kcal/d, 3910.0 ± 438.57 kcal/d, and 4413.8 ± 343.24 kcal/d (moderate, heavy, and above heavy activities; respectively).
This tells you all you need to know about the effect of physical activity on energy expenditure and it tells you a fair bit about the rigour of Chris van Tulleken’s research.
George Monbiot was once again calling for wolves to be reintroduced to the UK last week. This used to be a one man crusade but it seems to be becoming more mainstream.
Monbiot has been banging on about the benefits of wolves for twenty years. He accepts that wolves kill people from time to time, but says that depression also kills people and that ‘the excitement of knowing that they [man-eating predators] are out there somewhere’ could prevent depression and thereby save lives. One can only admire the creativity of this argument.
Monbiot’s opinion is enjoyably eccentric and I assumed that no one else shared it, but it seems like the tide is turning. For several days I have been receiving messages assuring me that wolves have been unfairly maligned in fairy tales and want nothing more than to co-exist peacefully with sheep, cats and children. They only occasionally attack people and certainly kill fewer humans than dogs/cows/cars. Their reintroduction to Yellowstone national park was a tremendous success and they are only a minor problem where they survive in several European countries. Why can’t wolves and lambs just get along?
It was great to welcome back comedian Leo Kearse on the Last Orders show last week. We discussed the censors at the Edinburgh Fringe, the junk science about ‘ultra-processed food’, and why middle-aged, privately educated liberals are ruining everything.
Listen here.
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.
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”.
"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.
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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)
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?
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.
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.
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.
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.
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.
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.
The report has been covered by the Times, Daily Mail, Scotsman, Express, Independent, Herald, ITV and many others.
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.
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.
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).
... 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%).
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.
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| 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.
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...
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
It is evident that information, exercise and willpower will not reduce levels of obesity.
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.
That starts with GP services, who need more resources to be able to support their patients in losing weight to improve their health.
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.
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...
...yet at the moment, children see marketing for all of the above everywhere they turn.
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.
We need to avoid eating rubbish food from cradle to grave. At the moment, people don’t have a choice.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.
Now, I never took the course to call myself a ‘public health professional’ but you’d think it would be best practice to copy the countries where smoking is going down and underage smoking is going down rapidly rather than the country where smoking is not going down and underage smoking is going up. But what do I know?
Notice that one defining characteristic is the pursuit of profit. Companies who make ultra-processed food want to maximise their profits, whereas other food companies feed us out of the goodness of their hearts. Adam Smith famously praised the benevolence of the butcher, the brewer and the baker!
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I sat down recently with my Tufton Street pals at the Taxpayers Alliance to talk about the Nanny State Index and the state of public health paternalism in Britain. Check it out.
Public Health Scotland have said that minimum pricing 'works'. Not a great surprise coming from a government public health agency when the government needs something to get one of its flagship policies through the sunset clause, but not consistent with PHS's own evaluation.
It was perhaps inevitable that a government-funded public health agency would find in minimum pricing’s favour. Minimum pricing is a flagship policy for the Scottish Government and the public health lobby is keen for it to be rolled out to other countries (Wales already has it, and it didn’t work there either). But it is a shabby end to an evaluation process that has cost a great deal of money and has been impressive in its breadth and depth. Taken together, the reports give a good impression of what has happened in Scotland under minimum pricing. Most of it is rigorous and impartial. Much of it supports the common sense criticisms of the policy made by sceptics before it was introduced. To make the case for minimum pricing, you would have to pretend that most of it doesn’t exist, and so that’s what Public Health Scotland have done.
The Health Secretary Steve Barclay is reported to be interested in learning from Australia’s experience with e-cigarette regulation. Quoted in The Times this week, he said: “I met a leading Australian figure this morning in terms of some of the lessons around the vaping industry in Australia, and how we can look at what has been done there and are there any lessons that we can share with each other.”
Britain does indeed have much to learn from Australia’s approach to vaping, in the same way as air crash investigators have much to learn from a black box. They say that every air crash makes air travel safer so long as the authorities understand what went wrong. On that basis, the world can benefit from studying the smouldering crater of Australia’s tobacco control policies.
The Online Safety Bill, ultra-processed food and a monkeypox update are all in the latest episode of Last Orders.
According to the Observer, it once owned “popular biscuits brands, including Lu biscuits, but sold its biscuit and cereal snack unit to Kraft Food in 2007”. It now boasts that “90 per cent of its UK portfolio of products by sales volume is not high in fat, sugar or salt (HFSS)”. The key phrase here is “by sales volume”. As the owner of two of the UK’s top selling mineral water brands, this is less impressive than it sounds.
The good people at Danone UK & Ireland may be sincere in their belief that Britain has “reached a point where meaningful intervention from the government is a necessary course of action.” But nobbling your competitors with taxes and bans looks rather like regulatory capture and corporate rent-seeking.
Wales introduced minimum pricing for alcohol in March 2020 but you don’t hear much about it. There has been an evaluation but it has tended to use surveys rather than empirical data. The evaluation team have done their best to paint minimum pricing in the best light, but you don’t need to read between the lines too much to see that the policy has hugely underperformed.
The proportion of people in Wales classified as increasing or higher risk drinkers rose from 33% in 2018 to 40% in 2020 to 45% in 2022.
