Minimum pricing round up

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.

You can also read the UK Statistics Authority's reply to Dr Gulhane who complained about the Scottish government's misleading press release. 

 

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.

 

Despite this ticking off, MacGilchrist insisted that there was 'no doubt' that minimum pricing saved lives. His temperance colleagues have also steered well clear of 'caveats about the uncertainty or limitations of statistical evidence'. It's lucky for them that the UK Statistics Authority doesn't monitor tweets. 

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Minimum pricing in the mud

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.

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Vaping misinformation

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.

 

Do read the rest.

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Ultra-Processed People by Chris van Tulleken - a review

Ultra-Processed People was on sale at half price on Amazon recently so I took the plunge and read it. I have written a lengthy and not particularly glowing review for The Critic.

 

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.

  

Part one is here and part two is here.

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Wolves

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. 

I wrote about it for the Spectator...

 

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?

 

Do read it all.

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Last Orders with Leo Kearse

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.

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The long tentacles of temperance in Canada

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

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

 

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

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

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

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

 

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

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

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

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

 

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

 

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

 

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

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