NHS priorities

From the BBC...

Twenty-five different cancer treatments will no longer be funded by the NHS in England, health chiefs have announced.

NHS England announced the step after it emerged the £280m Cancer Drugs Fund - for drugs not routinely available - was to go £100m over budget in 2014/15.

Some drugs will be removed and others restricted - a move charities say could leave some without crucial treatments.

How interesting it is to see where the axe falls when the NHS needs to tighten its belt. While patients are being deprived of life-saving drugs, let's consider some of the things the NHS has been able to afford in these years of austerity...

Liverpool PCT could find £400,000 to help put up 20 mph signs in residential streets and could find a further £265,000 to fund a 'program of community engagement work on slower speeds'.

Public Health England, whose £600 million budget could fill the funding gap for cancer drugs six times over, found money to produce exciting new guidelines which recommended people heat their homes to 18 degrees Celsius (a radical departure from the previously recommended 21 degrees that we all used to abide by). PHE also called for health warnings to be put on till receipts if people bought 'too much' unhealthy food.

The NHS managed to scrape together £46 million to spend on essential front-line roles such as ‘play and communication worker’, ‘carbon manager’, ‘car park environmental officer’, 'arts in hospital co-ordinator', 'EU office director' and 'green label development co-ordinator'. Very necessary.

Public Health England found £500,000 to give pretend charity Alcohol Concern to promote Dry January, a campaign it had previously run without additional state support and which Cancer Research also runs in the same month. This was in addition to the £450,000 that Alcohol Concern also gets from the taxpayer.

NHS trusts around the country were able to find several million pounds to lobby for plain packaging with prime billboards such as this...

... and, of course, the NHS found the money to tell some of the country's most heavily taxed people how much they loved them and appreciated their hard earned money.

There was also plenty of money available to fund astroturf temperance groups like this and this.

And other lobbyists like this.

And this.

And not forgetting this.

Or this, this and this.

And there was just enough money to pay these muppets to go around city centres campaigning for a smoking ban in cars.

But after all that expenditure, there naturally wasn't enough money left for trivial distractions like healing the sick.

After all, people with cancer occasionally make a recovery without any treatment, whereas the nanny state would die tomorrow if it wasn't for taxpayers' money.

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Taxes on food and drink: Fair? Efficient? Effective?

I have an article about sin taxes in the latest edition of Cato Unbound. Over the course of January, other writers will challenge and debate the point I make. I, in turn, will respond. You can also make a contribution in the comments if you wish.

Extending “sin taxes’” to certain foods and soft drinks is increasingly seen as a practical response to obesity and obesity-related diseases. Several countries and most U.S. states have some form of tax on soda, candy, and/or fatty foods, but they have so far had little or no effect on population health. For a tax to be justified, it should be efficient, fair and effective, and that taxes on food and drink meet none of these criteria.

Read the whole article here.

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The prohibitionist's dilemma

There's a very revealing quote from the 'policy and advocacy director' (ie. chief lobbyist) at Queensland's Cancer Council in this story that Dick Puddlecote picked up. He's talking about e-cigarettes:

"This was a problem we didn't have a number of years ago. It's a real frustration for those of us working in public health because it wasn't even on the horizon a number of years back.

"It's something we're just better off without."

This tells you a lot about the mentality of the anti-smoking crusade. Consider the following scenario.

You are deeply concerned about the effect of smoking on health. You've spent your whole career trying to help people give up smoking. You dream of a 'smoke-free world'.

But it's a struggle. Smoking rates tend to be on the decline in wealthy countries, but they are falling very slowly. Globally, there are more people smoking than ever before and there will be more people smoking tomorrow.

No matter how many bans you introduce, a large minority of adults continues to smoke. Tax rises have had some effect on smoking prevalence but—although you would never say so openly—you are aware that these taxes are a major burden on the poor and are fueling a large and growing black market.

What's more, nearly everything has been tried. All the reasonable stuff—health warnings, anti-smoking ads, banning sales to minors—was introduced before you were born. Even the more extreme measures on the list have mostly been ticked off, which is why you've had to spend the last few years scraping the bottom of the barrel with this silly plain packaging campaign. But what comes next? It has to be prohibition of some sort, and you know that won't work.

At one time, many years ago, it seemed that nicotine patches and gum might offer a solution, but it has become clear that smokers don't really like them and their efficacy as stop-smoking aids is pretty negligible.

And then, out of nowhere, a product falls into your lap that smokers actually like and which helps smokers quit. Incredibly, even smokers who had no intention of quitting find themselves switching to it. There is no evidence that it causes cancer, heart disease or COPD and it doesn't create an odour that non-smokers would find objectionable.

You can't believe your luck. This is the kind of thing that people like Michael Russell hoped to discover in the 1980s: a device that delivers nicotine in a satisfying way without delivering the smoke and the toxins. At last! This changes everything! What an opportunity!

That's scenario number one.

In scenario number two, you are a journeyman public health advocate picking up a nice, steady wage from the government every month. You hold lots of meetings and you go to lots of conferences. You and your colleagues developed a plan of incremental prohibition in the early 1980s and you have it all mapped out.

The Plan was to ban tobacco advertising and then ban smoking in as many places as possible. You were going to raise taxes on tobacco until it became unaffordable for people on low and median incomes. Other ideas—display bans, graphic warnings, banning menthol cigarettes—could be incorporated if you could convince politicians that something should be done and these policies were something.

You would attack what you considered to be the source of problem—the tobacco industry—with plain packaging, windfall taxes, standardised cigarettes or whatever. Gradually, you would beat smokers and the industry down until both were so unpopular that you could push for the final goal of prohibition. Within twenty years (it was always twenty years away) the tobacco industry would be outlawed and there would be no more smoking. In the meantime, there was good money to be made getting research grants to prove that the various policies in The Plan would work.

And then something comes along that you didn't expect. A new product that gives smokers a way to enjoy nicotine without the health risks of smoking cigarettes. You didn't come up with the idea. The government didn't come up with the idea. It came from the private sector, and private businesses are making money out of it. Worse still, after a few years of monitoring the market, the tobacco industry buys up a few companies and now they're making money out of it.

Sure, lots of people are giving up smoking as a result, but not in a way that was part of The Plan. Where does this leave you? What will become of the public health professionals and all their peer-reviewed studies? What about the 'endgame'? What a problem!

So you bite your nails and say to yourself...

"This was a problem we didn't have a number of years ago. It's a real frustration for those of us working in public health because it wasn't even on the horizon a number of years back."

And then you pour yourself a glass of skimmed milk, slump into your armchair and say...

"It's something we're just better off without."

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Signature policies

From the International Business Times...

Islamic State's (formerly known as Isis) ban on cigarettes is one of its signature polices. It has imposed a strict set of Sharia laws barring the use of drugs, alcohol and cigarettes in the territories it has conquered across a swathe of Iraq and Syria.

IS has declared smoking "slow suicide" and demands that "every smoker should be aware that with every cigarette he smokes in a state of trance and vanity is disobeying God".

Via Frank Davis

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David Nutt's cunning plan

Our old friend David Nutt was talking a lot of sense about 'Ecstasy deaths' in the Guardian yesterday (I apply scare quotes because, as he points out, the recent spate of deaths were actually due to the consumption of the MDMA substitute PMA).

For libertarians, Nutt is a real curate's egg—sound when talking about drugs but hysterical, illiberal and wrong when talking about alcohol. For several years, there have been rumours of Nutt combining his twin interests by developing his own legal high which he will market as an anti-alcohol drug. In 2013, he was attacked by the prissy fake charity Alcohol Concern when he appealed for investors on BBC radio. It now seems that his product will soon be unveiled:

In an unlikely marriage, the compound was created by the drug designer behind mephedrone, a now widely banned substance that has caused at least one death and been implicated in 13 others in the UK. The man, who has asked to be referred to by his pseudonym, Dr Z, initially intended his creation to be sold as a legal high. But after having discussions with Nutt and trying it on himself, he now plans to gift the patent to Nutt's charitable research group DrugScience, in the hope it will be used as a "binge mitigation agent".

How it might finally be used will depend on the results of detailed testing – including how quickly it is absorbed and how it mixes with alcohol. But it might become something you'd take at the start of a night out, or perhaps even add to each drink.

Nutt and Dr Z have called the new drug "chaperon". Its less catchy name is MEAI or 5-methoxy-2-aminoindane. Structurally, it is closely related to two drugs you can buy as a legal high in some places – MDAI and MMAI. Both were invented by David Nichols from Purdue University in West Lafayette, Indiana, and have some of ecstasy's euphoric effects.

Nichols says chaperon also looks a bit like another drug, PMA, which is known to be highly toxic.

I admire Nutt's audacity, but does he really think that this drug will not be banned at the first opportunity? Along with hundreds of similar substances, the three drugs that it has been compared to—MDAI, MMAI and PMA—have all been banned, and the latter is genuinely dangerous.

As a harm reduction agent, it leaves a lot to be desired. It is well known that mixing drink with drugs significantly increases the risk of drug use and yet the whole point of this drug is that it is supposed to be mixed with drink. It also appears to be slow-acting ("more than 5 hours after the first dose, I feel intense but controlled euphoria. Now the idea of drinking alcohol seems repulsive") thus giving people more time to (a) drink and (b) take more pills because, as Nutt says of PMA, "they think they have been sold a weak lot and may take another dose to make up for this".

On the other hand, 'Chaperon' may have some positive features. According to the New Scientist reviewer, it is "a party drug without some of the side effects" and there is talk of "an antidote so you can drive home after a night out." These are nice features for a recreational drug to have, but it remains a recreational drug and Nutt cannot have failed to notice that the government would prefer people not to take recreational drugs.

Nutt's marketing strategy is to claim that Chaperon is a "binge-drinking mitigation agent" which turns people off alcohol, but the same could be said of amphetamines and many other drugs that have been banned for decades. Yes, drugs can be substitutes for drink as well as complements to drink, but Nutt's legal high is not as unique as he thinks it is and even if it were, it is very doubtful whether regulators would welcome another intoxicant on the market.

Nutt is betting the farm on the government being more concerned about binge-drinking than recreational drug use. I strongly suspect that he is wrong. He may be able to call in some favours from his former colleagues at the Advisory Council on the Misuse of Drugs, but having a business partner who sounds like a James Bond villain doesn't help matters. I watched a documentary about 'Dr Z' once. He makes minor changes to the chemical structure of drugs, tests them on himself and then puts them on the market and waits for them to be banned (they are always banned). He invented mephedrone (AKA 'miaow miaow'), a substance which created the biggest moral panic of the last ten years.

Nutt and Dr Z would make quite a pairing on Dragon's Den. "Good afternoon. I'm Professor Nutt. I was sacked by the government for being too pro-drugs and this is my business partner Dr Z, the anonymous inventor of dozens of banned substances. We're looking for £100,000 to kickstart our legal high binge-drinking mitigation business."

I genuinely wish Professor Nutt well with this project. If nothing else, the inevitable banning of Chaperon will draw attention to the the absurdity of Britain's drug laws. If it is an elaborate stunt then more power to his elbow, but if he sincerely thinks that he has found a business opportunity he needs to stop getting high on his own supply.

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Obesity and food outlets

So, this study came out last month...

A study by researchers at Leeds Beckett University has found there is no link between the food environment and childhood obesity.

The research study, led by Leeds Beckett childhood obesity expert Dr Claire Griffiths, measured the exposure of over 13,000 children in Leeds to supermarkets, takeaways and retail outlets in three relevant environments – their home, their school and their commuting route.  These environments were then used to estimate the association between the food environment and the child’s weight status.

Results from the study, published today in the International Journal of Behavioural Nutrition and Physical Activity, revealed that there was no evidence of an association between the number or type of food outlets and childhood obesity in any of these environments. Additionally, there was no evidence of an association between the proximity to the nearest food outlet from the home or school and childhood obesity.

This rather puts the dampeners on the availability hypothesis which the anti-obesity industry has borrowed from the temperance lobby. Local authorities up and down the country are busy preventing chip shops and McDonalds opening up in the name of 'public health'. You'd think local councillors would want to hear what the evidence says, and yet I can't find this study mentioned by any news source.

Contrast this media silence with the publicity that was aroused when a study found that inner kids were "exposed" to a terrifying number of fast food outlets (ignoring the fact that the kids who ate in them most often were less likely yo be obese). Or compare it to the publicity generated by a researcher who called for a "takeaway clampdown" (although even the BBC conceded that "research on schoolchildren indicated children in neighbourhoods with a lot of fast-food restaurants were slimmer").

It's not as if the Leeds research is the final word on the matter, but there is - to put it mildly - an imbalance in the way the 'obesogenic environment' theory is reported.

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Bad luck and cancer

The news that most cancers are due to bad luck, not lifestyle factors, genetics or the environment, is on the front page of several newspapers today. Here's a snippet from the Beeb:

Most types of cancer can be put down to bad luck rather than risk factors such as smoking, a study has suggested.

A US team were trying to explain why some tissues were millions of times more vulnerable to cancer than others.

The results, in the journal Science, showed two thirds of the cancer types analysed were caused just by chance mutations rather than lifestyle.

In some respects, it is surprising that this study has made such a big splash. It does not claim that all cancers are due to bad luck. On the contrary, it attributes a substantial minority to lifestyle factors such as smoking. Did people really think that most or all cancers are due to bad habits? Perhaps they did, but if the findings seem counterintuitive it is because of the lingering, primitive belief that ill health is the result of sinfulness and that those who develop cancer somehow deserve it—a belief that is eagerly fostered by the neo-puritans of 'public health'.

I got a sense of déja vu when I read this story as it seemed remarkably similar to a story that came out only last week.

Life choices 'behind more than four in 10 cancers'

More than four in 10 cancers - 600,000 in the UK alone - could be prevented if people led healthier lives, say experts.

Latest figures from Cancer Research UK show smoking is the biggest avoidable risk factor, followed by unhealthy diets.

This is really just another way of imparting the same information. 'Large minority of cancers caused by lifestyle factors' is no different to 'Most cancers not caused by lifestyle factors' except in its emphasis, as I said at the time.

@danmacdonald73 "Most cancers are due to bad luck, doctors admit. Eat, drink and be merry."
— Christopher Snowdon (@cjsnowdon) December 26, 2014

But the change in emphasis is very significant. The Boxing Day story was inspired on a Cancer Research UK press release whereas today's report is based on a study published in Science. Moreover, the CR-UK press release gives a much higher estimate of how many cancers are lifestyle related. It attributes more than 40 per cent to lifestyle factors (smoking, diet and drinking, mostly) whereas the new study finds that only a third of cancers are due to lifestyle factors, environmental factors and hereditary factors combined.

And whereas the Science study is a serious piece of research written by two oncologists and published in a peer-reviewed journal, the CR-UK press release was based on a back on the envelope estimate by CR-UK statisticians and appeared to have been designed primarily to give CR-UK an excuse to promote 'standardised' packaging and assure the public that 'we do not want to ban mince pies'.

It may be a coincidence, of course, but it makes you wonder whether CR-UK decided to put their figures out last week, with a heavy emphasis on things that can be banned, because they knew that the more circumspect Science study was coming out seven days later.

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