Regressive taxation

I'll be damned if I can find anything in the news to blog about today, so here's a link to a study that was tweeted by Ben Goldacre yesterday:

Smoking and Ill Health: Does Lay Epidemiology Explain the Failure of Smoking Cessation Programs Among Deprived Populations?

The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts.

Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved.

The study (from 2003) confirmed the fairly obvious observation that those on the lowest incomes are most resistant to anti-smoking campaigns. There is a strong social gradient to smoking prevalence which didn't exist fifty years ago.

Although not explored in this study, one result is that taxing cigarette is about the most regressive form of taxation imaginable. Anti-smoking campaigners argue that those on low incomes benefit disproportionately from higher tobacco duty because, since they are least able to afford it, they will be most likely to quit smoking. They say that "a disproportionately number of lives of the poor are likely to be saved by a cigarette tax." It's a nice piece of rhetoric and for most products it would hold true (price relative to income affects consumption).

But tobacco is not most products and this simple economic formula does not take into account why people smoke. The proof of the pudding is in the eating and history is a better guide than economics on this issue. Decades of experience have shown that raising tobacco duty widens both health inequalities and financial inequalities. And while smoking is obviously linked to poor health, so is poverty. 

Few politicians are eager to acknowledge, let alone address, this thorny issue. Tobacco duty raises around £13 billion a year in the UK.

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Peer review, The Spirit Level and the appeal to authority

Brendan O'Neil has written a great piece at Spiked on the subject of peer review (with a few quotes from me). The article was inspired by the ongoing debate about The Spirit Level, and its authors attempt to confine it to peer reviewed journals.

The irony is that the authors owe their success in spreading their political message to writing a book for the mass market. This book was not peer-reviewed (obviously - although it refers to peer-reviewed studies, as mine does), and many of the statements they have made in the mainstream media would never get past peer review. Having engaged with the real world, they seem keen to withdraw to the confines of academia at the first sign of trouble.

Since it was published last year, The Spirit Level – Kate Pickett and Richard Wilkinson’s book on why equal societies do better than unequal ones – has become a sparkplug for heated, testy debate. Not one, not two, but three pamphlet-length critiques of it have been published, while others have rushed to man the book’s intellectual barricades (‘This book’s inconvenient truths must be faced’, said a Guardian editorial).

Yet now Pickett and Wilkinson have imposed an extraordinary condition on future debate about their book. Because much of the criticism of The Spirit Level has consisted of ‘unsubstantiated claims made for political purposes’ (in their view), ‘all future debate should take place in peer-reviewed journals’, they decree.

Wow. In one fell swoop they have painted any criticism of their book that appears in non-peer-reviewed journals as somehow illegitimate. They snootily say that ‘none of [the] critiques are peer-reviewed’ and announce that from now on they’ll only engage in discussions that ‘take place in peer-reviewed journals’. So any peep of a critique that appears in a newspaper, a book published by a publishing house that doesn’t do peer review, a non-academic magazine, an online magazine, a blog or a radio show – never mind those criticisms aired in sweaty seminar rooms, bars or on park benches – is unworthy because it hasn’t been stamped with that modern-day mark of decency, that indicator of seriousness, that licence which proves you’re a Person Worth Listening To: the two magic words ‘Peer Reviewed.’

This is not to say that peer review isn't important. It is clearly better than the alternative. The problem, as Brendan says, is more to do with public perception and the inclination of some researchers to appeal to authority.

Being peer-reviewed no longer simply means that you wrote an academic report that was considered by other academics to be serious enough for publication – it means you possess the truth, Pure Knowledge, elevated insights that are not available to mere mortals who have not been PR’d...

To be peer-reviewed is to have the right to speak publicly on important matters – to be non-peer-reviewed makes you immediately untrustworthy, a bit of an intellectual charlatan, possibly even suspect in your motives.

The Spirit Level provides a useful example here. It owes much of its success to the simplicity of its evidence, but this simplicity—and the fact that all the data used are publicly available—makes it easy for anybody to check. It doesn't require a PhD in social epidemiology to take data from the United Nations website and plot it on a graph. And, as I show in my most recent book, the evidence simply doesn't stand up (and, if you want to appeal to authority, several distinguished professors have said the same thing).

Remember, we're not talking nuclear physics here. We're talking about the most basic statistical fact-checking of the most basic type of epidemiological study. If a scientist tells me there are black holes in the Universe I'm happy to take his word for it. If a social epidemiologist tells me that life expectancy is higher in Cuba than it is in America, I'm going to check it. And if she's wrong I'm going to say so.

As Brendan concludes:

It is ironic that Pickett and Wilkinson, so very keen on the idea of equality, don’t like the idea of an equal right to speak and critique. In this area of life, their attitude is: ‘If you’ve been peer-reviewed, let’s talk. If not? Screw you.’

Go read.


UPDATE

More Spirit Level-related discussion at The Taxpayers' Alliance. There is also an exhaustive list of links covering the debate of the last month on the right-hand side of The Spirit Level Delusion website.

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New Zealots

Having mentioned yesterday the anti-tobacco extremism in the Antipodes, it is timely that ASH (New Zealand) have popped up to make my point for me. New Zealand is one of the few places in the world where anti-smoking campaigners don't even bother pretending not to be prohibitionists, hence...

Smoking: Majority of NZers want sales banned

The majority of New Zealanders support an end to commercial tobacco sales by 2020, a UMR Research survey has found.

You can guess who commissioned this survey.

ASH spokesman Michael Colhoun said the results released today showed the public believed "enough is enough" and it was time for strong action to be taken on tobacco.

"The momentum has been built up over the past year, including the tobacco excise increase and I think we've reached a tipping point," said Mr Colhoun.

Now then. It is possible that the majority of New Zealanders do want smoking banned in the next 9 and a half years (although the comments to this article suggest that perhaps they don't). Admittedly, it would make New Zealand rather unusual since every survey since the 1960s has shown that only 30% or so of the population harbour such prohibitionist thoughts.

But even if there is now a Kiwi majority, I'm not convinced that this question is sufficiently robust to separate the hardcore from the merely confused:

The survey, for anti-smoking group Action on Smoking and Health (ASH), asked 750 respondents if they agreed or disagreed that "New Zealand should be a completely Smokefree nation by 2020. This means smoked tobacco would not be widely available for sale."

Fifty-nine percent of respondents "agreed" or "strongly agreed" with the statement, ASH said.

"Tobacco would not be widely available for sale"? What the hell does this mean? It wouldn't be widely available in playgrounds? It wouldn't be widely available in tobacconists? And didn't New Zealand become a 'smokefree nation' when it brought a smoking ban in back in 2004? Weren't they told, like we Brits were, that that was what 'going smokefree' meant?

To ASH, it seems, "not widely available" means completely illegal and "smokefree" means banning the sale, purchase and consumption of smoked tobacco. So if that's what they mean—and if that's how they're going to spin it in a press release—why don't they ask people if they want tobacco to be completely illegal? Could it be because they wouldn't get quite the same answer?


UPDATE

These people are deadly serious.

Mr Colhoun says while the crackdown on tobacco will be heavy; people who wish to grow their own tobacco can continue to do so.

“At the moment you can grow up to 15kg a year for personal use; people who want to put tobacco plants in their backyard – they can do that and we’ll never end that,” he says.

Of course not. Why, that would be excessive.

So there you have it—a cast-iron guarantee from ASH (New Zealand) who, 25 years ago, were calling for a smoking ban on domestic flights. Not on international flights obviously. Or in bars and restaurants. That would have been excessive.

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Over at Dick's

Dick Puddlecote and I probably share a fair bit of traffic, but if you don't get over there as often as you should, may I recommend some of his recent posts?


On the government (apparently) rejecting every single idea submitted on the Your Freedom website:

The country now belongs to civil servants, quangoes and fake charities - brain-dead politicians and a woefully incompetent press merely pass on their directives.

The circus was fun while it lasted though, wasn't it? Now get back to chomping on your bread.

75 Days Later




On the world's worst business idea:

First it was the smoking ban – now Cardiff could have its first ever alcohol-free pub.

A former bar manager says he wants to open Wales’ only dry pub to help curb binge-drinking in the capital.

Pub Industry Sounding a Retreat


And on being the frustrations of being a perpetual Cassandra:

The floodgates are wide open now. Anti-smoking lunatics have picked the lock and every single issue fruitcake is queueing up to dictate the way you live your life. What's more, they are very confident that - with the denormalisation of smokers as a guide - government, badgered by the joyless health-obsessed, will be happy to accommodate them.

The small matter of dictating to smokers has now become an avalanche of righteous ecstasy as every avenue of your life is now open to scrutiny and control.

Err, we did tell you so.

A Niemöller Avalanche

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Hobart paving

Tasmania's state capital Hobart has just introduced a smoking ban in public places. Nothing unusual about that, you might say, except this ban is a little more 'comprehensive' than most.

A controversial ban on smoking in Hobart's outdoor malls has been well received, the city's council says.

Hobart City Council in May passed a ban on smoking at three outdoor malls in central Hobart, which took effect on Sunday.

Smoking in Hobart's alfresco dining areas will be illegal from August next year.

I've been meaning to write about the extremism sweeping through the Antipodes for a while. As has been happening in California, local officials seem to be vying with each other to bring in the most draconian legislation.

The ban caused controversy when first announced, with retailers expressing concern it could affect business.

But the council said at the time it was proud to have some of the nation's most stringent anti-smoking laws.

Discussing the new ban, Hobart's Lord Mayor, Rob Valentine, summed up the old Velvet Glove/Iron Fist dichotomy in a few well chosen words. First came the good cop...

"It's been well received, but at the same time we're not trying to pounce on people," he told ABC Radio on Monday.

Mr Valentine said he hoped the council would not have to enforce the ban with fines.

"We're not really keen to go down the punitive measure trail because we think that people at the end of the day will support it.

"There are others that will see smokers and point to the no-smoking sign.

And then the bad cop...

"But if push comes to shove, there is a $200 fine."

Inevitably, campaigners now want to see an outdoor smoking ban across the state. Equally inevitably, they are citing that old favourite: the level playing field.

The Cancer Council's Darren Carr says a blanket ban "would put all councils and all restaurants on a level playing field".

In recent years Tasmania, like the rest of Australia, has become a world leader in tobacco control. It has an indoor smoking ban, a partial outdoor smoking ban, graphic warnings on packs, huge tax rises on cigarettes and a total ban on tobacco advertising.

So how are all these 'evidence-based' policies working out?

The Heart Foundation's chief executive Graeme Lynch says in 2001 approximately 24 per cent of Tasmanians smoked.

"And the latest ABS figures [show] that rate has actually risen to 24.9 per cent," he said.

Keep up the good work, chaps.

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Obesity, where is thy sting?

Much was written last week about Public Health Minister Anne Milton recommending doctors use the word 'fat' instead of 'obese'. Commentators like Richard Littlejohn and Harry Mount thought this was a splendid bit of straight-talking, whereas some doctors thought it could be offensive and insisted that society is to blame (ie. it isn't regulated enough).

Professor Lindsey Davies, president of the UK Faculty of Public Health, which represents public health professionals, warned against using 'fat' when dealing with patients.

"People don't want to be offensive. There is a lot of stigma to being a fat person."

She said health professionals started using the term obesity to encourage patients to think about the condition in a different way.

"Obesity is something that happens to people rather than something they are."

That last line hints at the gulf that exists between the government's focus on personal responsibility and the public health establishment's focus on changing the social environment, but that's an issue for another day.

What I don't buy is the idea that the word obese came into heavy use because it's a more sensitive term. I think I remember correctly when I say that until about five years ago, 'obesity' was not a widely used word in Britain. Like 'binge-drinking', it came into popular usage to make a problem sound worse.

When the diet wars began, being fat was not generally considered to be a terrible thing. Indeed, it had connotations of being jolly, robust and cuddly. By popularising the clinical term obesity—frequently using it to describe people who were merely overweight, and often with the prefix 'morbid'—the panic was ratcheted up. But like all over-used words, it has become familiar and lost its sting. And so we return to 'fat'.

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E-cigarettes look set to be banned

So it looks like they're going to ban e-cigarettes in the UK. The fools.

Michael Kitt at ecigarettedirect.co.uk has received a letter from a Trading Standards Officer who has (apparently) been told by the Medicines and Healthcare products Regulatory Agency (MHRA) that they  will be opting for what they always said was their preferred option and banning all nicotine products. There are are—of course—two major exceptions: the most hazardous nicotine products (smoked tobacco) will continue to be on sale, as will the least effective smoking cessation aids (pharmaceutical nicotine).

From the letter:

I have been in discussions with other Trading Standards authorities and have found out that the consultation is almost complete. The outcome will be that as of a date (yet to be announced) there will be a 21 days period and then these products will be outright banned in the UK, unless the traders apply for certification as a medical device from MHRA. This process could be complicated and costly so it is expected that many traders may cease trading.

What this means for vapers like Leg-Iron is that it's back to the cigarettes. The least harmful nicotine delivery device is to be withdrawn in favour of the most harmful. And in the boardrooms of Pfizer and Philip Morris there was much rejoicing.

How has it comes to this? As I said at the International Harm Reduction Conference back in April, I think it comes down to a combination of fanaticism and pharmaceutical pressure.

Americans for Nonsmokers’ Rights - in a press release titled Electronic Cigarettes are NOT a safe alternative! - criticised the e-cigarette specifically because it mimics the act of smoking and because it contains nicotine.

Only pharmaceutical nicotine products escape criticism, partly because they are marketed as a medicinal cure for a ‘disease’ and partly because they administer nicotine without providing pleasure.

This has led to a somewhat inconsistent view of nicotine, described as being perfectly safe in pharmaceutical products but highly toxic in e-cigarettes, snus and other tobacco products. The EPA describes it as “acutely toxic (Category 1) by all routes of exposure (oral, dermal and inhalation)” while the MHRA says thats “nicotine, while addictive, is actually a very safe drug.”

Five years ago, when I began researching Velvet Glove, Iron Fist, I was wary of making too many claims about the influence of the pharmaceutical lobby. Although Big Pharma (or, more accurately, the pharmaceutical companies who happen to make nicotine products) have funded the anti-smoking movement lavishly over the last twenty years, there were anti-smoking fanatics long before they got involved and, for the most part, the movement's prohibitionist agenda has remained unchanged. While it is important to be aware of the conflicts of interest, especially when nicotine replacement products (NRT) are being touted, people like John Banzhaf and Stanton Glantz were going to be saying the same things with or without Big Pharma's cash.

But I have been saying for some time that the anti-smoking movement's attitude towards the e-cigarette would be the litmus test of pharmaceutical influence. There is no doubt that Big Pharma is seriously worried about the e-cigarette's impact on their sales, as an industry report suggested:

E-Cigarettes Will Revolutionise the Face of Tobacco Smoking and Could Pose a Threat to the Smoking Cessation Market

In February, the Department of Health (of which MHRA is a part) went further than ever before in pushing pharmaceutical nicotine, not just as a smoking cessation aid but as a long-term substitute. Needless to say, this change of emphasis suits the makers of nicotine products just fine. 

In the e-cigarette, we have a product that is—at the very least—99% less harmful than cigarettes. In all probability, it is 100% safe (because, as MHRA say, nicotine is "a very safe drug"). Furthermore, there is considerable anecdotal evidence that e-cigarettes are more effective as smoking cessation aids than anything sold by Big Pharma. It is certainly reasonable to say that they require some regulation, if only to prevent contaminated or substandard products going on sale, but to ban them entirely is sheer madness. As Paul Bergen says over at Smokles:

There is good reason for some sort of standards for any widely used product. This is just a very bad way of going about it.

If cigarettes did not exist and e-cigarettes were some unique nicotine delivery device then this approach would not be entirely out of sorts. It would still be unusually demanding in its short time frame for compliance but the worry would center more around commercial concerns than concerns of health.

However we have been repeatedly reminded by national authorities that too many people are dying from smoking, implying that these same authorities think this is not a good thing, and also implying that they would support actions that would bring down those mortality figures.

Quite simply, the ban on e-cigarettes—like the ban on snus—is going to result in more people dying of smoking-related diseases. It is a victory only for those with a bone-headed prohibitionist mindset, it is a victory for the precautionary principle and it is a victory for big business. No organisation that supports the ban can seriously claim to be working in the interests of public health.

If and when this ban is confirmed, will we hear objections from ASH? After all, ASH claims to support harm reduction. There must be some amongst their number who joined the movement because they wanted to help people quit smoking and save lives. Will they speak out or will they keep quiet in deference to the companies who pay for their conferences?

H/T: Kate at Vapersnet.org 

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