The fizzy drink tax crusade goes on

Despite the political and economic fiasco that was Denmark's fat tax, the public health racket is determined to bring in a tax on fizzy drinks. They had a go in January and had another (barely reported) stab at it during the party conferences. Now they've taken a leaf out of the Minimum Pricers' book by making a computer model. It's published in the British Medical Journal so will probably get a large amount of press coverage. (This is not the first attempt to model the effect of a fizzy drink tax. A 2011 effort produced results that, upon inspection, were utterly negligible.)

One of the co-authors is Mike Rayner, a man with the most interesting conflicting interest in science because he believes that he is literally doing the Lord's work by making the poor pay more for their cola. He and his colleagues modelled the effect of a 20 per cent tax on sugar-sweetened drinks on consumption and on obesity.

Their estimate for consumption looks reasonable enough. They use a price elasticity of -0.9, which is in line with previous economic estimates. In other words, a 10 per cent increase in price results in a 9 per cent reduction in consumption.

Their estimate of what effect this would have on obesity is, however, essentially a guess. One problem with these kind of models is that it is well known that increasing the price of one product leads to people buying similar, cheaper products (which might have more calories). The authors of the study shrug this off, saying that the substitute drinks "are probably less harmful for health." Since fruit juice contains more sugar and calories than many fizzy drinks, this is debatable.

All that aside, their projected reduction in obesity is just 1.3 per cent. They admit that this is "relatively modest". That's putting it mildly. It's a feeble outcome—virtually a rounding error—and yet they estimate that this will cost the British people £276 million per annum (tellingly, they say it will "raise £276 million"—from where, the ground?).

News of the cost-of-living crisis obviously hasn't reached the offices of the British Medical Association. As with minimum pricing, people on six figure salaries are telling people on four figure salaries that they're paying too little for their shopping.

Like most models, it's garbage-in, garbage-out. If you tell the computer that Policy X will reduce obesity/mortality/employment/hospitalisations, the computer will give you a reassuringly precise figure. It won't tell you if your assumptions are correct.

It's better to look at places that have actually introduced taxes on fizzy drinks, as Fletcher et al. did in their 2010 study in the Journal in Public Economics. They concluded that there was...

...a moderate reduction in soft drink consumption by children and adolescents. However, we show that this reduction in soda consumption is completely offset by increases in consumption of other high-calorie drinks.

That's the USA. We might also look at Denmark which announced that it would be abandoning its soda tax a few months ago. Why? Because...

A soda tax in Denmark didn't lead to people drinking fewer sugary beverages. Instead, they just headed next door to Germany, where sodas were cheaper.

No UK media reported that the Danes had abandoned the tax, nor that they have cut beer tax. Funny how the public health lobby told us that the eyes of the world were on Denmark when they introduced these sin taxes, but their eyes were averted when the taxes were abolished after delivering no health benefits and being tremendously unpopular. Sadly, Rayner's model does not factor in unpopularity.

This work has not considered public opinion, which may be critical when deciding whether a tax is adopted.

Let's hope so.


UPDATE

The BBC can't help itself. When I woke up, their headline read...

'Sugary drinks tax would have "modest" effect on obesity'

This is an accurate summary of the study, but apparently was not sufficiently persuasive enough for the public health lobby. I suspect a phone call or two may have been made because the headline now reads...

Sugary drinks tax "effective health measure"

This is not an accurate summary of the study. It is not even an accurate summary of the sentence from which it is taken from which says "we have shown it could be an effective public health measure" (my emphasis).

How craven, but how typical, of the BBC's online health team to throw a perfectly good headline down the memory hole for the sake of propaganda.

Share

Tweet

Sweets in supermarkets

Look how fat and unhealthy they are. Something must be done.

David Cameron, 2008: "The era of big, bossy, state interference, top-down lever pulling is coming to an end."

How's that small government thing going in Britain, 2013?

Junk food at checkouts under fire as new health minister says she wants to stop parents being pestered by children

So politicians are going to stop children pestering their parents, are they? Good luck with that. How about we have politicians that stop pestering us?

Sweets could be banned from supermarket checkouts under a health drive being drawn up by the government.

New public health minister Jane Ellison signalled a fresh crackdown on tackling junk food promotion, after her predecessor Anna Soubry said ‘there is nothing wrong with sweets’.

Lord knows, Soubry was wrong about a lot of things, but she was right about that. I can scarcely believe that such a statement needs to be made but let's say it again: THERE IS NOTHING WRONG WITH SWEETS.

Now Ms Ellison has identified the issue as ‘an area for action’ and will tell the industry to cut promotions of unhealthy snacks.

Does she now? Then let me disabuse her of that fanciful notion. Where shops display sweets has nothing—absolutely nothing—to do with the government. Nor is it any of the government's business if parents buy their children sweets and nor is it 'an area for action' if children irritate their  parents.

Is that clear? Good. So put away your statute book, call off your dogs and stick the veiled threats of your Responsibility Deal where the sun don't shine, you meddlesome, bossy, interfering, top-down lever pulling, good-for-nothing statists.

Ms Ellisson has signalled that she will take action against junk food at checkouts. In response to a parliamentary question, she said: ‘There is evidence that the majority of food promoted at checkouts and in queuing areas is less healthy than elsewhere, and that foods sold at impulse purchase points such as checkouts experience uplifts in sales.'

Again—how else to put this?—that is none of your goddamn business. They are private companies selling ordinary products. It's not junk food, it's chocolate. And, I might add, sweets should be eaten by children because that's who they're for. Children eat sweets. Adults drink alcohol. That's how it works.

If you don't want to buy a chocolate bar at the check out, then don't buy one. If you don't want your children pestering you, then raise them properly. The only 'area for action' the government should be looking at is abolishing the role of Minister for Public Health with immediate effect so that no more ambitious, inexperience, clueless and illiberal politicians like Jane Ellison can make a name for themselves.

Share

Tweet

One trillion dollars

"Why make trillions when we could make... billions?"

If you're serious about lifestyle regulation, you have to have a big number for the putative healthcare costs of Product X. The number mustn't account for the substitute diseases that people would get in the absence of Product X, nor should it include any savings or benefits that the product is responsible for. That would make the number lower or even negative, and the number must be big. In the US, the figure for smoking is said to be £96 billion. For obesity, it is said to be $190 billion.

And for sugar...

Sugar Linked To $1 Trillion In U.S. Healthcare Spending

Seriously?

Basically, the U.S. healthcare system spends about $1 trillion per year (and possibly more) fighting the effects of excess sugar consumption.

Yes, he's serious. So how does Dan Munro—for it is he—work that out?

He quotes from a recent Credit Suisse report...

“So 30% – 40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.” Credit Suisse Report – Sugar: Consumption At A Crossroads (PDF here)

At this level, the math clearly lacks scientific precision, but it does emphasize the huge burden associated with a single and truly ubiquitous substance – sugar. Assuming a U.S. National Healthcare Expenditure of $3 trillion per year – and further assuming we simply take 33% (the lower end of the Credit Suisse range), the calculation is easy.

Er, no. The calculation is easy if you look at the full quote from the report which gives the actual figures:

Obesity alone accounts for 20% (or USD 190 billion) of US national health expenditures and diabetes and metabolic syndrome account for a similar figure (though there might be some double-counting). So 30%–40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.

Note that the figures are given in the sentence that immediately precedes the quote Munro uses, so it is surprising that he missed them. It shows $190 billion for obesity and a "similar figure" for diabetes and metabolic syndrome. The high end estimate Credit Suisse are providing for all obesity, diabetes and metabolic syndrome is therefore $380 billion. It's impossible to say how much of this is attributable to the existence of sugar but it is clearly less than 100 per cent—nobody claims that sugar is the sole cause of obesity or diabetes.

Credit Suisse do not blame every case of these diseases on sugar—that would be silly. They merely say that these are the total costs of diseases for which excess sugar consumption is a risk factor. The sugar-related healthcare costs of obesity, diabetes and metabolic syndrome must be lower than $380 billion—probably much lower. Munro's claim that "the U.S. healthcare system spends about $1 trillion per year (and possibly more) fighting the effects of excess sugar consumption" cannot possibly be true.

It should be noted that Credit Suisse underestimate the US's total healthcare bill. $190 billion is obviously not 20 per cent of $3 trillion. Munro is right to say that healthcare costs are closer to $3 trillion than $1 trillion. That's a bit of a howler on their part (and strange, since they get it right in an earlier sentence), but Munro's decision to use their percentages while ignoring the dollars is much worse.

Share

Tweet

The disease of public health and its cure

I've written a lengthy essay about the public health racket for Spiked. Here's a sample...

On the type of people who become 'public health professionals':

Today, if you are gripped by an urge to eradicate some bad habit or other, you no longer have to make a nuisance of yourself knocking door-to-door or waving a placard in some dismal town square. You can instead find yourself a job in the vast network of publicly funded health groups and transform yourself from crank to ‘advocate’.

On the longevity obsession:

This is not a health movement, but a longevity movement. It is true that almost every death is theoretically preventable, but only in the world of ‘public health’ is it seen necessary to move every mountain to prolong the lives of geriatrics. The concept of a “good innings” or “dying of old age” are anathema to them. When all the preventable causes of deaths have been controlled, we will be free to die from the only cause of mortality that their policies actively encourage: boredom.

On the bogus 'cost to society' excuse:

The uncomfortable truth is that ‘preventable deaths’ save the taxpayer a fortune in pensions, healthcare, prescriptions and nursing-home provision. This has been confirmed by so many studies that public-health campaigners can scarcely be unaware of it and yet they continue to appeal to financial prudence because it has a superficial plausibility and because it is all that stands between them and being told to mind their own business. On the rare occasions when they are challenged on the facts, the scoundrels sheepishly abandon their claims and accuse their opponents of boiling everything down to pounds, shillings and pence. Physician, heal thyself.

On the abnormality of public health demagogues:

‘Denormalisation’ is the name of the game. It began, inevitably, with smoking/smokers, but denormalising drinking and drinkers is now on the political agenda. Considering the profound impact such policies have in stigmatising the vulnerable, robbing the poor and trampling on ancient liberties, it is time to ask whether the assortment of neurotics and authoritarians that make up the modern ‘public health’ movement is best placed to decide what is normal.

John Stuart Mill’s opinion of the peculiar longevitists bears repeating: ‘It is not, naturally and generally, the happy who are most anxious either for prolongation of the present life or for a life hereafter; it is those who never have been happy. Those who have had their happiness can bear to part with existence, but it is hard to die without ever having lived.’

What the modern puritans call ‘health policy’ often involves profound questions of economics, law, ethics, constitutional rights and philosophy, of which they are largely, if not entirely, ignorant. These issues are too important to be trampled by monomaniacs who have not learnt the art of living.

Do go read it all.

Share

Tweet

An evening in Dublin

Wednesday's debate in Dublin answered a few questions, even if they were not the questions we went there to ask. The debate was titled 'How to really stop people smoking' and it provided an opportunity to discuss harm reduction and to look at best practice around the world. 'Best practice' here means countries which have actually reduced their smoking rates dramatically, rather than countries like Ireland which make much of their aspiration to become 'smoke-free' despite the manifest failure and unintended consequences of the neo-prohibitionist approach.

The radio interviews I did to promote the event, as well as my conversations with Dubliners, suggested that this was a topic worth discussing. All are aware of the country's epic levels of tobacco smuggling and can see with their own eyes that smoking remains very common indeed. In my first radio appearance of the day, I debated with Dr John Crown. Like many medics, John Crown holds himself in high esteem. He is also a politician. The combination of these two occupations makes it virtually inevitable that he has an authoritarian streak a mile wide and believes that his lifestyle preferences should be mandatory. He is a prohibitionist, but like most modern prohibitionists he rejects the P word, insisting that he "only" wants a ban on the sale of tobacco "for profit". A little history would teach him that the Anti-Saloon League only wanted a ban on alcohol for profit—and that is precisely what they got. Consumption, domestic production and supply for medical and religious reasons remained legal.

Anti-smoking zealots only know two tunes. If it isn't "children, children, children" it is "industry, industry, industry". On this occasion, Crown goes for the latter, thankful that the IEA believes that tobacco companies' money is as good as anyone else when it comes to donations and harrumphing about 'Big Tobacco'. He does not, however, behave psychotically in the studio and shakes my hand afterwards as I tell him I'll see him later, for he is on the panel at the main event.

As night falls, however, Crown's mood also darkens. What follows is one of the most infantile displays I have seen since puberty. Arriving at the venue—the Royal College of Physicians Ireland—he refuses to shake anybody's hand or to be photographed, instead charging towards the chair of the debate, the former politician and current radio host Ivan Yates, with a string of complaints. Yates is the soul of Irish charm and endures the rant gracefully. Crown demands that he speak first and the chairman complies. Speaking first is no great advantage in a debate. It is better to hear all the other panellist's views and then have the last word, demolishing opponents' arguments as you go. Since Crown insists on going first, I assume he is going to vent spleen and walk out.

Vent spleen he does. Instead of addressing the question of whether Irish tobacco control legislation works, he gave a potted history of the worst aspects of the American tobacco industry circa 1950-85 and explained that smoking was really, really bad. He then argued that the tobacco industry has moved from disputing the smoking-cancer link to emphasising civil liberties. That is where the IEA comes in. Since it is unthinkable to him that anyone sincerely believes in self-ownership and personal freedom, he concludes—or at least strongly implies—that anyone who says that grown adults have the right to smoke or vape must do so for money. There is, he says, no debate to be had. Smoking is dreadful and anything that is done in the name of reducing its prevalence is righteous. He does not dwell on the fundamental question of whether these things actually do what the campaigners claim they will.

Crown then leaves the stage, not to exit the hall but to sit in the front row. He whips out an iPhone and iPad and conspicuously flicks through them as the other speakers take the microphone. I then realise that he has elected to go first not to win the debate but so that he didn't have to hear—and respond to—the other panellist's evidence. I speak next, asking why it was that a country that had passed every piece of 'evidence-based' tobacco control legislation in the book had "stubbornly high" smoking rates (as the Irish Cancer Society put it) and why "children start smoking in Ireland at a younger age than any other country in Europe" (as Barnado's puts it). I contrast the neo-prohibitionist model with the harm reduction model in a way that will be familiar to readers of this blog.

The man-child Crown continues to sulk in the front row, still immersed in his Apple products. Jeff Stier and Axel Klein follow, throwing further pearls upon the swine. Thereafter, Crown looks up from his technology only when fellow travellers in the audience chip in with empty rhetoric. They seem incapable of beginning any comment without resorting to clichés, as if a room of intelligent adults need reminding of the health risks of smoking. "Tobacco kills half of its life-long users" is a particular favourite, despite it being manifestly untrue of every tobacco product bar cigarettes. Kathleen O'Meara, head of advocacy (ie. lobbying) at the Irish Cancer Society, takes the microphone and goes into a diatribe. She arrived after the panellists had spoken and announces that she will be leaving after making her statement (statement, mind, not question). As good as her word, she then storms out. Like Crown, she has never been told that we are born with two ears and one mouth for a reason.

John Mallon—who has written a good account of the evening—lightens the mood by trying to speak to the health lobby as human beings. As a smoker, he is the hunted, but he remains polite and gracious in the face of the hunters and his affability sits in stark contrast to the purse-lipped, lemon-sucking zealots.

Rooted to his seat, but with microphone in hand, Crown pipes up a couple more times to say that he wants e-cigarettes available only on prescription. He then reveals an appalling ignorance of the epidemiological evidence regarding snus and cancer. It appears that he knows nothing about the product, perhaps unsurprisingly since Ireland banned it thirty years ago, but unforgivably for a man who claims authority on the subject.

And so the question presented was never answered. But the question of how Ireland has been lumbered with so much ill-considered and counter-productive legislation was answered in spades. One only needed to see Crown and O'Meara in action to understand that this is something akin to a religious cult, immune to reason and living evidence, that can only be sustained by endless ad hominems and by keeping their fingers firmly in their ears.

I'm now off to Exeter to debate whether we should scrap the BBC licence fee, presumably at the behest of my shadowy paymasters at ITV.

Share

Tweet

Dublin

I've written before about Ireland's high smoking rate, its massive smuggling problem and its reputation as tobacco control's jewel in the crown (the former apparently being no disqualification for the latter). Tonight I'll be making that argument in Dublin at an IEA debate. As a taster, I've written an article for the Irish Independent...

According to children's charity Barnado's, "children start smoking in Ireland at a younger age than any other country in Europe". After years of bans and price hikes, this should be seen as a clear admission of failure.

Irish tobacco control has overwhelmingly and demonstrably failed – there has been no significant reduction in the number of smokers, and cessation rates are 10 times worse than the OECD average.

Now, rather than acknowledging failure and trying a new approach, the Government is doubling down on the failed neo-prohibitionist approach. Health Minister James Reilly has said he wants to make Ireland tobacco-free by 2025, and has announced plans to introduce plain packaging for tobacco products.

Ireland's crusade against the tobacco giants has seen them lose focus on what really matters – effective harm reduction and lowering smoking rates.

If the objectives of tobacco control were to demonise and irritate smokers and 'wage war' on the tobacco industry, then Ireland could certainly claim some small victory. But when it comes to stopping people smoking, Ireland's tobacco control policies couldn't be any less successful if they were set by the tobacco industry itself.

Read the rest here.

I arrived in Dublin last night and have had several interesting conversations with taxi drivers about the smoking issue. The first driver was a smoker, as was his wife. Between them they spend €700 a month on cigarettes. They spend less when a friend brings them cigarettes in from abroad, which is often. When I mentioned that the smoking rate hadn't fallen as much as might have been expected, he immediately pointed the finger at the black market. Everybody here is acutely aware that Ireland has a big smuggling and counterfeiting problem, largely run by the IRA.

The second driver didn't smoke, but he drank. He always goes over the border to buy his alcohol, saving about €7 on each bottle of whisky.

The third driver hated smoking but he described the display ban and plain packaging as "idiocy - idiocy beyond belief" (a phrase I might borrow). The smoking ban had damaged pubs, he said, and he was surprised that anyone ever obeyed it in the first place.

Share

Tweet

Plain packaging (phase two)

As so often, no comment is necessary...

Tobacco researchers have identified weaknesses in Australia's plain packaging law that they want eliminated when New Zealand writes its rules.

The Government is committed to plain packaging but has not yet revealed the legislation, which Associate Health Minister Tariana Turia has said she expects to be introduced to Parlianment this year.

Australia's rules last year imposed a standard dull brown colour and large pictorial health warnings but permitted brand names, such as Dunhill and Rothmans, and variant names.

Otago University marketing expert Professor Janet Hoek said this kind of sub-branding using evocative names like "infinite" could undermine the impact of plain packaging - the policy's aim was to reduce the appeal of tobacco and enhance perceptions of the harm it caused.

Allowing variant names was a loophole in the Australian law that should be rectified in New Zealand's version of plain packaging.

The usual ludicrous, hypothetical junk science follows. Regular readers may recall Janet Hoek—a scholar of English literature and marketing—from her earlier quackery. Like many of her ilk, she's not going to get off this money-making gravy train any time soon.

Share

Tweet