Alcohol, the Spirit Level and Simon Chapman being wrong again

Bit busy today. There's a new post up at the Spirit Level Delusion site if you're interested in that sort of thing.

As a follow up to some of last week's posts, the head of the NHS Statistics division has replied to the Straight Statistics critique of the alcohol-related hospital admissions. (See the comment section here.)

On behalf of the NHS Information Centre, I’d like to confirm that the figures in the press notice for alcohol related admissions in 2009/10 (1,057,000) and 2002/03 (510,800) are both calculated using the methodology introduced in 2009. They (and the remaining figures) in Table 4.1 of the report are comparable and show a large increase, subject to the various points of detail in the footnotes to that table.

Make of that what you will. The devil is in the "detail in the footnotes". The relevant table is on page 67 of this document.

And, a week after Simon Chapman memorably dismissed the idea of there being any smuggled tobacco in Australia, saying:

Smuggled tobacco is a major issue in nations with high corruption indexes and open borders. It has never been a major problem in Australia.

The Australian Daily Telegraph reports:

Sydney flooded with illegal cigarettes

SYDNEY is flooded with blackmarket cigarettes selling for as little as half the price of a genuine pack, but peddlers are avoiding punishment because it is tobacco companies who catch them.

Lies, all lies! You've got no proof!

The Daily Telegraph was able to purchase Chinese-made counterfeit cigarettes from outlets at Kings Cross and Warwick Farm.

Alright, I'll give you that. But, as Chapman says, there's never been a prosecution, therefore there is no problem.

British American Tobacco (BAT) conducts about 1000 undercover purchases each year and has taken legal action against more than 100 retailers in the past three years, effectively suing them for copyright infringements.

That doesn't count! There's never been a prosecution by the government.

In the year before Project Wickenby began, the Australian Taxation Office completed 53 tobacco prosecutions and had another 24 in progress.

Bugger.

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ASH: Still strangers to reality

The Independent has published a little puff-piece for ASH which has all the balance and thoughtfulness you would expect from an article which treats Deborah Arnott and Anna Gilmore as authorities. It's mainly about tobacco consumption in the third world but the real intent of the piece is to push plain packaging, as becomes clear in the final paragraphs. The logic is that industry arguments are always wrong and therefore they are wrong on plain packaging. Of all the examples the Independent could have used to decorate this fallacious argument, they concentrate on the damage done to the pub industry by the smoking ban. Or rather the lack of, because to ASH and their useful dupe at the Independent, this is a 'myth'.

A study from Action on Smoking and Health (ASH), out this week, scrutinises the credibility of economic arguments used by the industry to fight back against legislation. For example, when Christopher Ogden, chief executive of the Tobacco Manufacturers Association, said in 2010 that the smoking ban had severely threatened the pub and bingo industry because of lost jobs and livelihoods, the reality was a little different.

Really? Then the Independent obviously knows something that the country's biggest bingo operator doesn't.

Gala Coral, operator of Gala Bingo, says growth prior to the smoking ban was running at 10 per cent. "Since the ban, we have seen a very sharp fall in revenue and admissions," says Neil Goulden, chief executive of Gala Coral. "The smoking ban is entirely responsible for that, he adds."

So what's ASH's evidence?

Data from the Office for National Statistics shows a net increase in the number of people visiting pubs since the smoking ban.

No it doesn't. This is what the ONS survey reported:

Three-quarters (75 per cent) of drinkers who visited pubs said that the change had not affected how often they went to pubs. Respondents were as likely to say that they went to pubs more often now than before the restrictions (12 per cent) as they were to say that they went less often now (13 per cent).

The percentage of women who visited the pub about the same amount since the smoking
restrictions were introduced has decreased from 80 per cent in 2008 to 73 per cent in 2009.
Conversely [sic], the percentage of women who said they were less likely to go to the pub following the restrictions has increased from 9 per cent to 14 per cent over the same period.

The survey says nothing about how long people spend in the pub—much less, if beer sales are any indication. Self-reported evidence of this kind can be unreliable because respondents can use it as a chance to express their approval/disapproval of the ban, rather than tell us whether it's actually changed their behaviour. Nonetheless, this survey certainly doesn't suggest an increase in the number of pub visitors. And that's hardly surprising as you would have to be living on Neptune not to have heard that pubs have been closing at the fastest rate in British history. Pubs closing at the rate of 50 a week despite more people going to them sounds rather incongruous, does it not?

We can argue about the reasons for the great pub crash that began in 2007 until the cows come home, and it's clearly multi-factoral, but ASH are not prepared to settle for saying that they don't think the smoking ban has been the main cause. They have to go further and deny that pubs are in crisis at all. In fact, they think pubs are flourishing.

The next factoid in the Independent article is only ever used by ASH, so there can be no doubt that it was they who offered it to the clueless hack responsible for the article...

When England went smoke-free in 2007, the number of premises licensed for alcohol increased by 5 per cent, and it has continued to grow every year since.

It is indisputable that Britain has lost more than 6,000 pubs since the ban came into effect in 2007. (The figures are here.) And yet ASH try to imply that numbers have increased. Their figures don't relate to pubs, of course, but to alcohol licenses, and since the Licensing Act came into force in 2005, there has certainly been a big increase in the number of licenses handed out. This is partly because it's easier to get one, and partly because the law now obliges you to get one for even the smallest occasion. ASH might think it's jolly nice that there are more coffee shops and garden fetes that have alcohol licenses, but it's got nothing to do with the smoking ban or the pub industry.

This Canute-like refusal to face reality is only possible in the world of single-issue zealot. As I said last time I wrote about this subject, every fact supports the view that the smoking ban has seriously damaged the pub and bingo industries.

It fits what publicans have been saying:

The readers' poll showed 77% of licensees think that trade has suffered as a result of the ban. Almost two thirds (63%) say business is worse than expected, and 72% predict a "challenging" or "very challenging" outlook for their business. Three out of five licensees said they had let staff go or reduced their hours. In addition, 73% want the ban lifted.

It fits what market analysts have been saying:

Pubs have sold 175 million fewer pints in the past year as a direct result of the smoking ban, according to market analysts AC Nielsen.

It fits what pubgoers have been saying:

There's no need for any fancy statistical analysis of trends over time. Just ask the customers.

It fits what the share prices of the Pubcos have been telling us:

You'll notice that the collapse of the share price began almost on the dot of July 1st 2007. Recession? No—that didn't start until October 2008, by which time the company had lost 75% of its value. Supermarket booze? 'Twas ever thus. Bad management? Perhaps, but the story is the same for all the pub companies.

It fits what economic theory predicts will happen when a externality is imposed on a business; it fits what the pub industry did predict would happen; it fits what has happened in other countries, in other states and in other cities.

The only thing it doesn't fit is the rhetoric of anti-smoking groups like ASH:

"Smoke-free polices are not only good for health, they are good for business. Evidence shows that in countries where smoke-free laws have been introduced, trade has generally increased."

Amanda Sandford, ASH, 2003

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Drinking and deceit

Nigel Hawkes has a must-read post up at Straight Statistics about the latest chapter in Britain's bogus drinking epidemic. The headline news yesterday was that alcohol-related hospital admissions have topped a million, after doubling in the space of just six years.

The number of admissions reached 1,057,000 in 2009-10 compared with 945,500 in 2008-09 and 510,800 in 2002-03.

Such an enormous leap in the figures should set the alarm bells ringing. A doubling in admissions would be astonishing at any time, but when drinking has been on the decline, it simply defies belief.

But, as the NHS explained when last year's figures came out...

These figures use a new methodology reflecting a substantial change in the way the impact of alcohol on hospital admissions is calculated. Previously the calculation counted only admissions for reasons specifically related to alcohol. The new calculation, for which the methodology is described in the report, includes a proportion of the admissions for reasons that are not always related to alcohol, but can be in some instances (such as accidental injury).

The same note appears on the latest report, but—shamefully—not on the NHS press release that accompanied it. Consequently, it did not get a mention in the news.

Since 2002, the number of diagnostic fields (ie. the category of injury or ailment that people come to hospital to have treated) that are considered 'alcohol-related' has jumped from 7 to 14 and then from 14 to 20. (You can read all about this if you can read the tiny writing at the bottom of table 4.1 in the report).

The significance of this change cannot be overstated. The "proportion" of admissions that are not directly related to alcohol make up three-quarters of the total. It is not only meaningless to compare 2002 against 2009, it is questionable whether most of these cases can reasonably be called alcohol-related at all.

As Nigel Hawkes explains, the figures do not come from doctors and nurses classifying an admission as alcohol-related. Instead, they rely on aggregate data being divided up on a laptop according to a whole set of assumptions.

How is it that almost all the statistics related to alcohol can be moving in the right direction, yet the numbers of alcohol-related admissions keep going up at a dizzying rate?

It’s largely a function of methodology. Alcohol-related admissions are calculated in such a way that if you are unlucky enough, say, to be involved in a fire and admitted to hospital for the treatment of your burns, it will count as 0.38 of an alcohol-related admission – unless you happen to be under 15, when it won’t count at all.

If you drown, it counts as 0.34 of an alcohol-related admission – though most people unlucky enough to drown aren’t admitted to hospital. Getting chilled to the bone (accidental excessive cold) counts for 0.25 of an admission, intentional self-harm to 0.20 per cent of an admission.

These fractions apply whether or not there was any evidence you had been drinking before these disasters befell you.

The one measure that hasn't been twisted and changed is the number of alcohol-related deaths and, as Hawkes says, they fell.

Alcohol-related deaths – that is, those caused by conditions directly linked to alcohol – fell from 6,768 in 2008 to 6,584 in 2009. Much of the fall was attributable to a fall of nearly 250 in deaths from alcoholic liver disease.

That last figure is worth noting, since the claim that liver disease is rocketing is frequently made by temperance crusaders.

If Britain is suffering a drinking epidemic, it is a very peculiar epidemic indeed. It is one that has resulted in an enormous increase in hospital admissions despite a decline in both overall alcohol consumption and excessive drinking. According to the latest figures for 2008/09, it has also resulted in a 3% fall in alcohol-related mortality despite a 12% increase in alcohol-related admissions.

Over the same period, the way alcohol-related hospital admissions have been defined and recorded has changed time and again. It's not difficult to put two and two together here. Any responsible journalist would put the methodological change front and centre of any report.

The irony is that the BBC had, only the day before, exposed the fact that Alcohol Concern Cymru (the NHS-funded Welsh temperance group) had been creating alarm about drinking by inappropriately comparing two different sets of figures:

An alcohol charity claims there a "silent epidemic" of heavy drinking among elderly people in Wales.

AAC said the number of over 65s who said they had drunk more than the recommended maximum in the previous week rose from 22% (men) and 7% (women) in 2003/4 to 34% (men) and 17% (women) in 2009.

However, BBC Wales understands that as a result of changes in methodology adopted by the compilers of the Welsh Health Survey in 2006 the two sets of statistics are not comparable.

Quite right too. And yet, in their report yesterday, the Beeb made no mention of the fact that 2002's figures for hospital admissions cannot be compared with 2008's. Instead, it chose to focus on a press release from the NHS's astro-turf front group Alcohol Concern which predicts that admissions will rise to 1.5 million by 2015.

This is shoddy journalism but, in this instance, the NHS has been complicit in deceiving the media. As I mentioned, the NHS press release did not even hint at the change in methodology, nor did it mention the fall in mortality.

To give you an idea of how incompetent/dishonest (delete as applicable) the NHS has been in this matter, let's take the headline figure. That one million figure relates to admissions, not people. This is an important point because, as Hawkes says in his post, some people go into hospital with multiple admissions and most go in not at all. This is basic stuff, but how are hacks supposed to get this straight when the head of the NHS's statistics department is giving them misinformation?

Tim Straughan, chief executive of the NHS Information Centre, said: "Today's report shows the number of people admitted to hospital each year for alcohol related problems has topped 1 million for the first time."

This is frankly pathetic. The behaviour of the NHS and its spokesmen—not to mention Alcohol Concern—demonstrate once again that their desire to lobby for policies, notably minimum pricing, has made them incapable of issuing reliable and credible information. Time and time again, the British public are being deceived on the issue of drinking. Can we believe anything these people say?

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Nowhere left to hide?

The New England Journal of Medicine has published a comment piece about the future of tobacco control in the light of New York's outdoor smoking ban. I haven't written about the New York ban because, really, what is there to say? According to the BBC:

Smoking will be allowed on pavements outside parks, and car parks in public parks. One area the ban does not cover is "median strips" - known as the central reservation in the UK - the sliver of land in the middle of a large road.

It is possible, dear reader, that you consider this to be a reasonable and proportion piece of legislation. You may believe that allowing people to smoke in the middle of the road—but not on the road, and certainly not on the pavement—is a fair compromise which neatly balances the rights of nonsmokers with smokers.

But if you believe that, I doubt there is anything I can say that would bring you to your senses. There isn't anything to say about the health grounds for the ban, because they're aren't any. There's nothing to say about the scientific basis for the ban because none has been offered. It's a simple case of 'might is right'. Michael Bloomberg is a billionaire bully who should move to Bhutan and I feel sorry for New Yorkers, but it's not as if he's done it all himself. Take this guy, for example:

“I think in the future,” the city’s health commissioner, Thomas Farley, said at a public hearing, “we will look back on this time and say 'How could we have ever tolerated smoking in a park?'”

If that sentence doesn't make you shudder then, again, you're reading the wrong blog. Imagine a society in which smoking is not only banned in parks but in which people find it unbelievable that such a thing could have ever taken place. How many years of illiberalism, molly-coddling, fear-mongering and 're-education' would have to pass before people's minds became that narrow? If ever there was an argument for lighting up, drinking up and checking out early, Thomas Farley's vision of the future is it.

So what does the NEJM article have to say about all this? Well, actually it's pretty reasonable. It reminds us that smoking bans pre-dated the secondhand smoke studies and that, therefore, bans have never been purely about health. It suggests that one of the justifications for the NY ban—that smoking outdoors is the main source of litter—is based on a highly dubious measure which counts the number of individual items rather than overall volume. It accepts that outdoor smoking bans are primarily part of the denormalisation campaign and are ethically questionable. And it says, as this blog frequently says, that what we are witnessing is creeping prohibition.

Most health professionals agree that an outright prohibition on the sale of cigarettes would be unfeasible and would lead to unwanted consequences such as black markets and the crime that accompanies them.

Yet steadily winnowing the spaces in which smoking is legally allowed may be leading to a kind of de facto prohibition. Smoking bans imposed by states and municipalities have been accompanied by comparable measures in the private sector. Some employers and property owners prohibit smokers from congregating in building doorways; colleges and universities have banned smoking on their campuses; condominiums, apartments, and other multi-unit dwellings have passed requirements for smoke-free apartments. As the historian Allan Brandt has noted, smokers may soon have nowhere left to hide. Pressed by a city council member about where he believed people should be allowed to smoke in New York City, Farley responded, “I’m not prepared to answer that.”

Go read.

On a similar note, the Free Society and Privacy International are hosting a debate about smoking and civil liberties at the Institute of Economic Affairs next Wednesday. Details here.

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Does the Better Life Index support The Spirit Level?

Yesterday, the Organisation for Economic Co-operation and Development (OECD) published the Better Life Index. This project aims to measure the quality-of-life in countries using eleven criteria.

Since it was founded in 1961, the OECD has helped governments design better policies for better lives for their citizens. More recently, the OECD has been keenly involved in the debate on measuring well-being. Based on this experience, these 11 topics reflect what the OECD has identified as essential to well-being in terms of material living conditions (housing, income, jobs) and quality of life (community, education, environment, governance, health, life satisfaction, safety and work-life balance).

Having gone to all this trouble to create a reliable index of well-being, it's worth asking whether the OECD data supports The Spirit Level's hypothesis that "more equal societies almost always do better"?

No, it doesn't. The poorest country—Portugal—does worst, but the data points appear to be scattered randomly.

In fact, if we drill down into the data we can see that not only is well-being not better in "more equal" countries, but the OECD's figures do not support The Spirit Level's key argument—that "more equal" countries have stronger social support networks which lead to a healthier and happier population.

Quality of social support network:

Life expectancy:

Self-reported health:

Life satisfaction:

There is no association between inequality and any of these variables. Indeed, with the exception of self-reported health—which seems to show the opposite of what The Spirit Level says—the regression lines are about as straight as you could expect from a randomly assorted set of data.

Taken together, the OECD's Better Life Index appears to support the view of a previous effort by The Economist to devise a quality-of-life index, which concluded:

There is no evidence for an explanation sometimes proffered for the apparent paradox of increasing incomes and stagnant life-satisfaction scores: the idea that an increase in someone’s income causes envy and reduces the welfare and satisfaction of others. In our estimates, the level of income inequality had no impact on levels of life satisfaction. Life satisfaction is primarily determined by absolute, rather than relative, status (related to states of mind and aspirations).

(Note on data: The first graph shows an index of all the OECD's criteria with each given equal weight. Singapore and Hong Kong are not OECD members so they do not feature in the list. Their absence can only benefit The Spirit Level's case here because these unequal countries tend to perform well under most criteria. As per The Spirit Level, tax havens and countries without equality data are excluded. All other counties with wealth greater than Portugal are included. The OECD produces well-respected inequality figures but these are not used in The Spirit Level (perhaps because they show Japan to be quite unequal). I have used The Spirit Level's preferred inequality figures here and throughout The Spirit Level Delusion.)

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The glorious idiocy of Simon Chapman

Antipodean anti-smoker Simon Chapman has been receiving a well-deserved kicking over at Ep-ology for writing an opinion piece of weapons grade stupidity. Chappers has been getting all excited about plain packaging, so much so that he's started talking openly about prohibition and has even revived Julian Le Grand's much-mocked idea of smoking licenses. Chapman could learn from the Le Grand's experience on that one...

My e-mail inbox exploded. Mostly with pictures of Hitler, I have to say. People were very hostile to that sort of idea. So, although the nudge agenda, I think, does have possibilities I think care has to be taken that people don't feel that it's the nanny state, indeed the nanny state squared.

Of all the silly things Chapman has been saying recently, there has been one statement of such glorious idiocy that it almost turns full circle and becomes a sort of genius. In response to a report saying that 16% of tobacco in Australia is smuggled/counterfeit, Chapman says, with sarcastic self-satisfaction:

So while one in six smokers apparently know where they can repeatedly buy illegal tobacco, strangely, with more than a billion dollars supposedly being lost, the gormless Federal Police with all their intelligence and resources and impressive history of major smuggling busts cannot find any of these same retail outlets and prosecute.

It's a measure of Chapman's immense talent that he can solve the centuries old problem of smuggling in one throwaway sentence, but this is a true Eureka moment, is it not? If the public can get hold of illicit substances, so can the authorities. Like all the best ideas, the beauty lies in its simplicity. All the police have to do is go undercover, find out where people are getting illicit goods and then find out who supplied them to them, and so on until you get to the top of the chain. Then make a few arrests and—ta-da!—the problem is solved. If only the DEA and the FBI had thought of this 100 years ago, we could have made a success of Prohibition and the War on Drugs. I look forward to reading this guy's next webitorial when he will solve the Palestinian problem and the common cold.

But Chapman's real interest is the plain packaging ruse and the tobacco industry's response to it. It was widely reported by the piss-poor Australian press that BAT are planning to "flood Australia with cheap tobacco". In reality, the industry couldn't do such a thing even if it wanted to—well over 70% of the retail price is tax—and nor has it ever threatened to. What BAT did say was that higher prices and plain packaging encouraged illicit trade, and that the display ban and plain packaging meant that cigarette companies could only compete on price. Both of these statements are fairly obviously true and the effect of both is to encourage smokers to buy cheaper cigarettes. Since cigarette consumption is affected by price—although not as much as most products—this is an instance of alleged health campaigners shooting themselves in the foot. Lower prices mean more smokers, as they frequently say themselves.

This is not very complex economics and it is very different to BAT threatening to "flood Australia with cheap tobacco". Of course, boosting illicit trade is not the only reason the tobacco industry doesn't like plain packaging. The big companies, in particular, want to protect their brands. BAT have made this very clear by threatening to sue the Australian government for taking away their intellectual property. However, since most people don't care about their intellectual property, the industry has focused more on the illicit trade angle when arguing against plain packaging.

In the simple-minded world inhabited by the likes of Simon Chapman, the very fact that the industry opposes plain packaging is reason enough to go push ahead with it.

It’s now very plain the global tobacco industry sees the move as arguably the greatest single threat it has ever faced, and is spending millions to say that — really, honestly — plain packs just won’t work and will cause chaos throughout the economy.

I’ve done many interviews on this in the past year and even normally sceptical radio hosts quickly make the point that ordinary Australians are asking “well, if it won’t work, why are they so concerned and spending all this money?”

Far be it from me to question the intellect of radio hosts, let alone "ordinary Australians", but this line of enquiry rests on the assumption that the industry opposes plain packaging for the same reason the antis support it—because they believe it will bring down the smoking rate. But a few paragraphs later, Chapman shows that this isn't actually the case.

A leaked BAT internal training DVD from 2002 explains much about the industry’s real fears in plain packaging.

Profitability in the tobacco industry today rests largely on high-priced premium brands, which are able to attract higher retail prices purely on the strength of branding and pack image. If all packs will look the same, many smokers will wonder why they should shell out far more for a pack that looks the same as every other brand except for brand name and that internal tobacco industry research shows cannot be distinguished from cheaper brands in blinded smoking experiments. The illusion that premium brands are “better” will evaporate, and much profitability with it.

If this "leaked DVD" had revealed that the industry believed that the packaging of cigarettes leads nonsmokers to take up the habit, there might be a story here. In fact, what they say in private seems to be much the same as what they say in public. They're trying to protect their premium brands, and why not?

If smokers lose interest in the premium brands, they will smoke cheaper cigarettes. And if cheaper cigarettes lead to more smoking, plain packaging will lead, by way of unintended consequences, to more smoking. This is what the industry has been saying, and campaigners have scoffed, but Chapman now accepts this:

If smokers were to drift down to lower-priced brands, smoking rates could well rise, particularly among low-income groups and kids who are most price responsive.

Great success! A new problem is thus created for which Chapman has a predictably bone-headed solution:

The government could easily restore the price by increasing excise duty by 20% overnight as it did in April 2010 when first announcing plain packs and the tax rise

This, in turn, would lead to a further incentive to smugglers, although that doesn't bother Chapman because he doesn't believe smugglers exist. And so the cycle keeps on going. As one policy leads to a cock-up in one direction, a sticking plaster is applied that exacerbates the problem in another direction. What a shower they are.

Simon Chapman used to be the editor of Tobacco Control. Explains a lot, that.

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The Portuguese experience

From the International Harm Reduction Conference, this short video offers a succinct case for drug liberalisation. Portugal decriminalised drugs ten years ago and according to many people, this has successfully reduced both drug consumption and, more importantly, drug-related harm. (This, of course, has been contested).

The speaker is Joao Goulao, president of the Portuguese Drug Institute.

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