The war on physician associates

Ever since interest rates soared to historic norms, many doctors have been struggling to afford the payments on their second yacht. With Rachel Reeves dishing out a 22 per cent pay rise to junior doctors, it was unsurprising when GPs recently voted for industrial action for the first time in 60 years. Not only is the average GP having to sit around chatting to people for a measly £88,000 a year, but — as they never tire of telling us — their surgeries are overstretched and they have to see too many patients. 

I’m being facetious, of course (or am I?) but everyone agrees that GPs spend too much time doing work below their pay grade — repeat prescriptions, dishing out paracetamol, dealing with cuts and bruises, malingerers, lonely old people, etc. — and yet the medical establishment is curiously resistant to any attempt to lighten their load. This week’s proposal from the Tony Blair Institute to replace some GP consultations with artificial intelligence was not met with rapturous applause from our medical overlords. In fact, they hated it. And yet if you speak to any family doctor privately, they will tell you that they spend too much time talking to people who have such trivial or routine ailments that a chimpanzee could diagnose and treat them. Patients, meanwhile, often see GPs as unnecessary gatekeepers to specialists and antibiotics. The solution is obvious: triage patients and send the low level cases to more junior personnel.

Read on at The Critic...

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Mindless ultra-processed waffle

A chef turned novelist by the name of Simon Wroe has written an article about ultra-processed food (UPF) for the Financial Times. It is abysmal but since it is typical of a mainstream newspaper op-ed on this topic, let’s take a look.

Head over to my (free) Substack...

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Tim Stockwell in the Sunday Telegraph

The Sunday Telegraph ran a good article at the weekend about Tim Stockwell's obsessive crusade against the health benefits of moderate drinking. It includes some quotes from me. Here's a taster...

 

But many of Dr Stockwell’s respected peers say it is far from settled science and have cast doubt on his research. They question his motives and accuse him of being a front for a worldwide temperance lobby that is secretly attempting to ban alcohol.

Dr Stockwell denies this. Speaking to The Telegraph, he in turn accused his detractors of being funded by the alcohol lobby and said his links to temperance societies were fleeting. He was the president of the Kettil Bruun Society (a think tank born out of what was the international temperance congresses) and he has been reimbursed for addressing temperance movements and admits attending their meetings, but, he says, not as a member.

... “I have attended a meeting funded by the Swedish Temperance Organisation and I’ve written material that they have published,” he said. “I’ve had connections with the International Order of Good Templars. I’ve attended some of their meetings, but I’m not a member.”

On a practical level, drinkers will almost certainly be unaware of the explosive row Dr Stockwell’s research has generated in academia. But there is a very high chance they will have read one of the many stories his work has generated, and potentially modified their behaviour, reluctantly popping the cork back into the wine bottle or leaving the beer unbought on the supermarket shelf.

Now experts warn that the anti-drinking lobby – a “neo-temperance movement” – has the US and UK’s drinking guidelines in its sights.

“Dr Stockwell has never conducted any primary research into this as far as I’m aware,” Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs, told The Telegraph. “He just keeps creating systematic reviews with the aim of trying to obscure the J-curve and the benefits of drinking. 

“You have what I think you can fairly describe as a neo-temperance movement operating quite effectively in Britain and around the world.

"A lot of these academics take the view that everybody needs to drink less. They’re very keen on being able to say there’s no safe level because then they could treat alcohol very similar to tobacco."

 

It's good to see the media digging a bit deeper into this.

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Alcohol, nicotine and dementia

The Lancet recently published a study looking at the risk factors for dementia. Based on observational epidemiology it included excessive alcohol consumption as a risk factor, but when it came to the protective effect of moderate drinking, observational epidemiology was suddenly not enough. We have been here before, of course, and I have written about this for The Critic...

 

They have no such quibbles about evidence that suggests heavy drinking causes dementia, of course. That evidence is actually much flakier — the aforementioned meta-analysis found “no consistent evidence to suggest that the amount of alcohol consumed in later life is associated with dementia risk” — but the Lancet authors conclude that drinking more than 21 units a week is a risk factor for dementia based on a study which found that people who drink until they pass out are twice as likely to suffer from dementia than moderate drinkers!

Heavy drinking probably does cause dementia, although you’d have to drink a lot more than 21 units a week, but the refusal to acknowledge that teetotallers are greater risk than most drinkers is pig-headed. Doctors are never going to recommend that non-drinkers start drinking. A medical journal that portrayed alcohol as in any way beneficial would be considered ideologically unsound in the current year. And so we are left with a soft Lysenkoism in which objective facts must be denied for the greater good. 

The same is even more true of nicotine, which is not mentioned at all in the Lancet study. The authors are keen to stress that epidemiological studies show that smokers are at greater risk of dementia (and, therefore, that smoking must cause dementia), but there is substantial evidence that nicotine confers all sorts of cognitive benefits that could be harnessed to tackle the disease. Research is occasionally commissioned to investigate this further, but there has been a distinct lack of urgency and any positive findings would be resisted by anti-vaping activists who portray nicotine as a “brain poison”.

 

Read it all.

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Tim Stockwell's cherry-picking goes into overdrive

He started with 3,248 relevant studies of which 3,125 were immediately discarded. This left 123 cohort studies to which he added 87 relatively recent cohort studies. By the time he had finished, he had whittled them down to just five - and then he had the nerve to published an article titled 'Why Do Only Some Cohort Studies Find Health Benefits From Low-Volume Alcohol Use?' The media lapped it up, as usual.

Yes, it's Tim Stockwell. Read all about it on my Substack.

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The fix is in

I wrote last year about some ‘experimental statistics’ from the Gambling Commission that suggested that there are far more problem gamblers in Britain than we thought there were. They appeared to show that 2.5 per cent of the UK population have a gambling problem whereas every official survey in the last 25 years has found the rate to be around 0.5 per cent. The experimental statistics are now official statistics and anti-gambling campaigners are claiming that they prove that “the harms caused by gambling have been massively underestimated”.

But do they? To save money, the government is switching from face-to-face surveys and telephone surveys to online surveys despite it being well established that “online surveys over-estimate gambling harm”. Until recently, people’s gambling habits were tracked as part of the Health Survey for England. People were randomly selected to take part in the survey and those who accepted were interviewed in their home. Since people feel it is their civic duty to take part in a national health survey, its participation rate was a respectable 50 per cent.

The new Gambling Survey for Great Britain is very different. Letters were randomly sent to 37,554 addresses asking the residents if they would like to take part in an online survey about gambling. If they didn’t respond, they were sent another letter telling them that they could do the survey by post if they preferred. Despite the inducement of a £10 fee, most people did not respond. Only 19 per cent of those who were sent the letter ended up taking part in the survey, mostly online.

When four out of five people refuse to take part in your survey, you no longer have a random sample of the population. Unlike the Health Survey for England, the Gambling Survey for Great Britain is explicitly badged as being about gambling. Who is this most likely to appeal to? People who gamble a lot. And people who gamble a lot are more likely to problem gamblers than people who don’t.

 

Can the Gambling Commission really convince the public that rates of problem gambling are eight times higher than they are? Probably.

 

Read the rest at The Critic.

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The Tobacco and Vapes Bill returns

Be afraid.

 

Labour wants to regulate flavours and branding, and may even be planning to tax vapes (another Sunak ruse). We know from other countries that such policies lead to more smoking and more cigarettes being sold. As mentioned above, the government also intends to include a wide range of reduced-risk tobacco products, including heated tobacco, in the generational ban.

The two parts of the Tobacco and Vapes Bill are therefore pulling in opposite directions. From one side, you have the clumsy hand of the state using a weird and sluggish version of prohibition to coerce people away from all tobacco products. From the other side, you have restrictions on vapes, pouches and other reduced-risk products which, if allowed to flourish, would make smoking obsolete long before 2080. It is possible that the government might still get the balance right — the King’s speech was short on detail — but until it does, I’m backing Sweden.

 

Read the rest at The Critic.

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