Thursday, 9 July 2015

Misunderstanding advertising

My latest post for Spectator Health is about 'public health' people hating advertising because they don't understand it.

In response to drinks companies saying that advertising doesn’t increase overall sales, Alcohol Action’s response is: ‘Alcohol sponsorship of sport works in terms of increasing sales and, as a result, alcohol consumption. If it didn’t, the alcohol industry simply would not spend so much money on it.’

To see how silly this claim is, forget about alcohol for a moment and consider products such as cat food and toilet paper. These products are advertised quite heavily despite there being an obvious ceiling on how much can be consumed. If someone were to say ‘Cat food advertising works in terms of increasing sales and, as a result, cat food consumption. If it didn’t, the pet industry simply would not spend so much money on it’, I hope you would question their sanity. It is quite obvious that Whiskas adverts are designed to lure Felix customers over to their brand. Their commercials could only increase overall consumption if they encouraged people to buy more cats, which is fairly unlikely.


Do have a read.

Food control

My goodness, aren't things snowballing?


Why not just give us ration cards?

Full story here.




Wednesday, 8 July 2015

When the levy breaks

Slipped away in George Osborne's budget today was some news on the tobacco levy. This is the looting that ASH wants the government to do in order to keep itself in business. Via the FT...

The impact of a tobacco levy on the tobacco market would be similar to a duty rise, with tobacco manufacturers and importers passing the levy onto consumer prices.

As tobacco duties have already increased this year and will continue to increase by more than inflation each year in this Parliament, the government has decided not to introduce a levy on tobacco manufacturers and importers

Feel free to contradict me in the comments, but my understanding of the issue is this:

ASH's original idea was to have a literal levy, like a windfall tax or the Master Settlement Agreement, in which companies would have a certain proportion of their profits taken from them by the government.

This was never practical because the British government has no authority to take profits from companies based abroad (eg. JTI and PMI) and the companies that are still based in UK (BAT and Imperial) would be sorely tempted to up sticks if such a levy came in.

In the last budget statement, the government noted that its public consultation had identified some problems with the idea of a levy. By the time I was debating this on the radio a few weeks ago, ASH seemed to have come to terms with the fact that it was impractical. Instead, they were arguing that an additional tax be placed on tobacco, the proceeds of which would be ear-marked for anti-smoking initiatives, ie. for them and their mates.

This amounts to no more than an additional sin tax on tobacco, with the usual negative impact on the poor and on the black market. Since tobacco duty is already due to rise above inflation, with the money going towards general government expenditure rather than prohibitionist pressure groups, the government has decided to call the whole thing off.

Good. Now the government needs to stop funding ASH entirely.

That dramatic proliferation in betting shops (slight return)

Three years ago I wrote a paper for the IEA about what I consider to be a moral panic about fixed odds betting terminals (FOBTs). In it, I showed that there has not been a "dramatic proliferation" of betting shops in the UK, whatever Harriot Harman might tell you.

The latest gambling industry statistics were published last week so I thought it was time to see how the bookmaking epidemic had spread since I wrote The Crack Cocaine of Gambling?


Answer: it hasn't.



Tuesday, 7 July 2015

Book Review: Citizen Coke

I wrote a book review for the latest issue of Economics Affairs which is paywalled and was heavily edited for space, so here is the full version. The book is Citizen Coke: The Making of Coca-Cola Capitalism by Bartow Elmore...


Bartow Elmore sees two themes running through the history of the Coca-Cola company. Firstly, the company does not really produce anything; it is a brand, a recipe and a trademark, not a manufacturer. Secondly, it has always depended on government action and political favours to prosper. Elmore argues that these are the traits of ‘Coca-Cola capitalism’, a distinct form of doing business which has since been emulated by other multi-nationals.

On the first point, the author does a convincing job of showing that Coca-Cola has traditionally focused on supplying syrup while leaving bottling, retailing, farming and processing to others. He echoes Naomi Klein’s recurrent complaint about global corporations such as Apple and Gap being mere ‘brands’ which outsource production to other countries. Although Elmore accepts that this has been a demonstrably successful business strategy - limiting risk and leaving the company less vulnerable to changes in government policy - he appears to disapprove, and yet he never fully explains why. The implication is that Coca-Cola somehow lacks authenticity (Elmore calls it ‘hollow’) because it ducks out of the noble task of production. Its preference for outsourcing tough jobs to third parties is portrayed as being almost cowardly, and there is a sense of moral outrage about early Coke retailers who, like McDonalds today, had to mix the syrup with their own water.

It is true that Coca-Cola’s suppliers, including the environmentalists’ bête noire Monsanto, have had their fingers burnt when Coke changed its buying arrangements. Coke’s switch from sugar to high fructose corn syrup (HFCS), for example, was bad news for the sugar industry. But frankly, who cares? Why should the reader empathise with one giant corporation and not another? Even if creative destruction was morally questionable - and it is not - there is no reason why Coca-Cola should pick its own coca or refine its own sugar (as Elmore implies it should). The real question is whether customers get a good deal from the company’s pursuit of efficiency and it seems they do. One of the more extraordinary facts in this book is that the price of a bottle of Coke in the USA remained at five cents from 1886 to 1950.

Elmore’s other main argument—that Coca-Cola’s success owes much to government policy—also contains more than a grain of truth, especially if one uses the author’s broad definition of ‘state aid’ to include access to municipal water supplies and waste disposal. Once again, the company’s success is portrayed as inauthentic and ill-gotten. Throughout the book, Elmore echoes Barack Obama’s notorious refrain ‘You didn’t build that.’ Who built the roads and railways that transport Coke around the US? The government. Who recycles the empty Coke cans? The government. Who provides the water for Coca-Cola’s plants? The government (mostly).

It could be argued that these are indirect benefits of infrastructure projects which would exist with or without a soft drink industry. So long as Coca-Cola pays its taxes and settles its water bills, it has every right to use them. But sometimes the state has acted in ways that directly benefit the company. Elmore makes much of the US army’s extensive distribution of Coke to soldiers in the Second World War and rightly notes that the price of HFCS is artificially low thanks to government subsidies. When expanding its empire abroad, Coca-Cola has often received preferential tax arrangements from governments which welcome new investment. All told, Elmore concludes, the ‘best thing for sleek Citizen Coke was big government’.

It is notable that Elmore rarely blames the government for creating these opportunities, let alone suggests that there is anything inherent about big government that makes such corporatism virtually inevitable. It would be surprising if Coca-Cola, in its long history, had not benefited from rent-seeking, subsidies and good fortune. On the other hand, there have also been instances when Coca-Cola has suffered at the hands of lawmakers—soda taxes and sugar tariffs, for example. Has Coca-Cola benefited from government action more than the average US corporation? Perhaps it has, but Citizen Coke offers little by way of comparison with other businesses.

Throughout the book, the reader is given the impression that the economy is a zero-sum game in which every shrewd business decision is a swindle, every middleman is an exploiter and every win for Coca-Cola is a defeat for everybody else. But whilst Coca-Cola has clearly profited from some government policies, Elmore does not distinguish between those which burden the public and those which benefit the public. It is doubtless true, for example, that the company benefited from the government’s decision to ship countless crates of Coke to American troops during the war, but it did so at the insistence of US army generals who felt that a steady supply of this most American of drinks would act as a boost to both morale and energy. Can we say with confidence that they were wrong? If Lieutenant Colonel John P. Neu, who is quoted in this book, believed that Coca-Cola was ‘vital to the maintenance of contentment and well being of the military personnel’ we should, perhaps, take his word for it.

Similarly, it is not unusual for local and national governments to offer tax breaks as an incentive for businesses to invest and create jobs. Free marketeers would prefer low taxes for all and an end to rent-seeking, but it is not kindheartedness that compels politicians to provide such inducements, rather it is the anticipation of future employment and taxation. What Elmore describes as state aid often amounts to no more than politicians deciding not to needlessly obstruct commerce. For example, Elmore discusses the negotiations around the Harrison Narcotics Tax Act in 1914. This portentous legislation effectively kickstarted the war on drugs by removing cocaine and opium from general sale. Famously, Coca-Cola had used traces of cocaine in its original recipe and, although these were removed in 1903, the drink still contained de-cocainised coca leaf extract. An early draft of the Harrison Act would have severely restricted imports of coca leaves, whether they contained cocaine or not. Successful lobbying by Coca-Cola led to the legislation being amended to allow trade in de-cocainised leaves to continue. As Elmore puts it, ‘the state had once again sweetened Coke’s supply situation.’

There is little doubt that this exemption owed much to private discussions in smoke-filled rooms. It is unlikely that a smaller company would have been able to bend the ear of lawmakers in this way. Nevertheless, Coca-Cola’s victory came at the expense of no one. The intention of the Harrison Act was to prevent the use of narcotics, not to reduce the appeal of one of the country’s most popular soft drinks. A ban on de-cocainised coca leaves would not have advanced the cause of drug prohibition by one inch. In this instance, at least, Coke’s lobbyists led to better lawmaking.

Unfortunately for readers hoping for an exposé, Coca-Cola’s closet contains very few skeletons and so, in the absence of shocking revelations, Elmore throws everything he can at the company. He repeats long-debunked health claims about caffeine and artificial sweeteners, even implying that Coca-Cola was unnecessarily threatening the health of its customers by using saccharine after it been approved by the Food and Drug Administration. He also gives a sympathetic and credulous hearing to the more extreme views about fructose, sugar ‘addiction’ and obesity, with fanatics such as Michael Jacobson and Kelly Brownell taking centre stage while mainstream scientists are ignored.

Ultimately, Elmore’s critique of ‘Coca-Cola capitalism’ boils down to environmental objections. He spends a great deal of time criticising Coke for using vast quantities of water, sometimes in places where water is relatively scarce. But water is a renewable resource and using it to make thirst-quenching drinks seems perfectly justifiable, particularly since much of the water is undrinkable until Coca-Cola treats it. (Elmore accepts that the company has often come to the aid of governments that are unable to maintain decent water quality, but he portrays these acts of charity as a ‘marketing technique’. At his most generous, he concedes that ‘not all of Coke’s [water-purification] projects were solely self-serving’.)

Readers who are shocked to hear that soft drink companies use a lot of water will find much to be outraged about in Citizen Coke. To these eyes, however, the workings of the Coca-Cola company are neither surprising, nor appalling, nor unique. Elmore’s attacks on ‘agri-business’ are generic criticisms of modern farming that could be levelled at any food or drink company and his complaints about the caffeine industry’s deforestation of South America might be valid, but they would be better directed at coffee drinkers.

Elmore is on stronger ground in his discussion of government recycling programmes which have been introduced, in part, as a consequence of soft drink companies switching from reusable glass bottles to disposable aluminium and plastics. From an environmental perspective, the abandonment of reusable glass bottles is difficult to defend. With a deposit of one or two cents, 96 per cent of bottles were being returned in 1948. The company then shifted to aluminium cans, of which only half are recycled. More recently, it has shifted to plastic bottles of which fewer than a third are recycled. The environmental impact is mitigated somewhat by the halving of fuel use that comes with one-way delivery, but the switch to disposables has imposed greater costs on the taxpayer in terms of litter-picking and recycling. Nevertheless, Coca-Cola is hardly unique in having moved away from reusable glass containers since the nineteenth century and it would take a thin skin to be scandalised by it.

The author’s tone is calm and his history is solid, albeit telling a story that has been covered many times before. It is disappointing to find that Elmore, with a PhD in history, thinks that ‘the 1800s’ ended in 1899 rather than 1809, but this is a common error and a minor complaint. Elmore deserves credit for not allowing Citizen Coke to turn into a rant, even if a rant might have been more entertaining. Instead of an out-and-out polemic, Elmore has written a straight history which nevertheless bubbles with enough pejoratives to leave the reader in little doubt about his muted contempt, not just for ‘Coca-Cola capitalism’, but for capitalism in general. This is a book in which Coke is not merely sold, it is “peddled”—and peddled by “Big Soda” at that. Successful executives are more often than not “cutthroat businessmen”. Business deals are “all about money”. People are “bombarded” by advertising, and this advertising is invariably “aggressive”. Et cetera.

But perhaps its biggest failing as an academic work (it began as a PhD thesis) is that it does not deliver on its promise to show how Coca-Cola paved the way for a new form of capitalism. His theory might be correct, but direct comparisons with other companies are needed if the reader is to be convinced. On more than one occasion, Elmore criticises Coca-Cola for cautiously watching its rivals before emulating them; hardly the behaviour of a pioneer. Moreover, Elmore never explains what the implications of ‘Coca-Cola capitalism’ are, beyond a few broad concerns about ‘sustainability’. The author could have gone in one of several directions with the material in this book to produce a more satisfying read. Had he pursued one its themes, an interesting book about crony capitalism could have emerged. Had he pursued another, he could have written a wider critique of capitalism in which Coca-Cola played a dominant, but not overwhelming, role. Instead, he has written a softly spoken hatchet job which ultimately lacks fizz.



Friday, 3 July 2015

Making sense of alcohol-related hospital admissions

The latest figures for alcohol-related hospital admissions were published last month and, over at the Alcohol Policy blog, James Morris lamented the fact that such announcements ‘no longer appear to generate significant media attention following changes to the reporting of the data’. This, he argues, is because the Department of Health prefers to use a narrow measure of ‘alcohol-related’ rather than the previous broad measure. The broad measure helped to push the number of alcohol-related hospital admissions over the (newsworthy) threshold of one million some time ago, but it was never credible. Here’s why.

The first thing to understand about alcohol-related hospital admissions is that there is no nurse on the door to judge whether your condition is due to drink. It is simply assumed that a certain proportion of each medical condition is caused by alcohol. So, for example, 15 per cent of breast cancer cases amongst women aged 45 to 54 are assumed to be caused by alcohol consumption, 23 per cent of hypertensive diseases amongst men aged 65 to 74 are assumed to be caused by alcohol, and so on, through every disease, injury and death that could possibly be due to drinking.

If this seems somewhat arbitrary, it is, but there is some science behind it. Alcohol really is a contributor to some chronic diseases and it is right that this be acknowledged in the data, however imperfectly. The problems only really arise when you start counting secondary diagnoses as alcohol-related. That is what the old ‘broad’ measure did.

Imagine that you have hypertension and you go to hospital because you have a virus. The virus is your primary diagnosis and your hypertension is your secondary diagnosis. The hypertension has nothing to do with your virus, but it is recorded in the data anyway. Although your visit to hospital was not alcohol-related in any meaningful way, hypertension is considered to be an alcohol-related condition and because you have it as your secondary diagnosis, your admission is officially alcohol-related. You have contributed to the alcohol stats without touching a drop.

Not only is this absurd, it also guarantees that the numbers will keep rising over time because the population is growing, people are getting older and, above all, clinicians are more likely to record a secondary diagnosis than they were in the past. If you ever wondered how alcohol-related hospital admissions could double in the space of a decade despite alcohol consumption falling, this is a large part of the reason.

Since many alcohol-related conditions are diseases of old age, it is a mathematical certainty that they will continue to generate more and more hospital admissions as the population expands and ages. A year-on-year increase in the number of admissions for alcohol-related pneumonia, for example, only really tells us that there has been a general rise in admissions for pneumonia. We have no idea what role alcohol played, it is just assumed that a set proportion of them were alcohol-related. We could all stop drinking tomorrow and the number of ‘alcohol-related’ admissions for heart disease and cancer would continue to rise for many years, or until the underlying assumptions were updated.

Nevertheless, even under the narrow measure, there has been a rise in admissions, from 253,000 to 333,000 since 2004, but this needs to be put in the context of a massive increase in the use of hospitals in general. In 2001, there were 12 million finished consultant episodes in English hospitals.

Last year there were 18 million. Alcohol is a factor in less than two per cent of them and most involve longterm conditions rather than acute intoxication. I mention this only because newspapers like to illustrate their stories about alcohol-related hospital admissions with photos of drunks on the pavement but, as the Office for National Statistics noted last week, only ‘950 (less than 1 per cent) of admissions were for the toxic effects of alcohol’.

In any case, the ‘public health’ lobby has no reason to worry about the Department of Health switching to a more accurate definition of an alcohol-related admission. The latest figures may not have made the front page this year, but the Mirror still reported that ‘Hospital admissions caused by alcohol have soared to one million a year’. The Express ran the news under the headline ‘Booze Britain: Drink-related hospital admissions double in a decade’. So long as the Office for National Statistics keeps publishing figures for the broad measure, we can expect them to continue being newspaper fodder for many years to come.

[Cross-posted from Spectator Health]

Wednesday, 1 July 2015

The anti-smoking lobby is burning our money

Harry Phibbs has written an important post about the little known issue of the Local Declaration on Tobacco Control (LDTC). This is an ASH initiative to get local authorities to sign up to an agreement to ostracise the tobacco industry in everything they do. Essentially, it is Article 5.3 of the Framework Convention on Tobacco Control gold-plated to a ludicrous degree.

Article 5.3 says, very simply...

In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.

Fair enough, perhaps, but ASH is not content with keeping the tobacco industry away from 'public health policies', it wants the government to have nothing to do with them even when local authorities and the industry have mutual interests, such as tackling counterfeit tobacco. And so they have gone around the local councils and got them to sign up to an agreement that includes a promise to...

Protect our tobacco control work from the commercial and vested interests of the tobacco industry by not accepting any partnerships, payments, gifts and services, monetary or in kind or research funding offered by the tobacco industry to officials or employees

This is Article 5.3 on steroids. Does it matter? Well, yes, it matters quite a bit because the tobacco industry has traditionally given local authorities rather a lot of financial support to tackle illicit tobacco, but because of ASH's ideological intransigence that money is now coming from taxpayers. As Phibbs says...

What is the practical relevance of such a gesture? Most significantly, it is preventing the industry from working with signatory councils (trading standards) on the issue of the illegal trade in tobacco products, which cost the Exchequer £2.1 billion in 2014 alone, imposed significant costs on retailers as a result of lost sales, and brought organised criminal gangs into local communities.

Several local authorities have rejected funding for sniffer dogs from tobacco manufacturers, which are used to locate illegal products. They have decided to fund this activity themselves and are redirecting funds from the public health budget in order to do so.

Okay, in this instance the money is coming from the public health budget so it probably would have been wasted anyway, but ASH's little treaty is also hindering the fight against tobacco smuggling...

There have been examples where the trading standards officers, believing that LGDTC stops them from dealing with the industry, have refused to work with the industry on counterfeit tobacco – this includes refusing local, on-the-ground, intelligence.

And it is not just illicit tobacco. Money is also been turned away to deal with littering...

Due to LGDTC, councils and the Keep Britain Tidy campaign will no longer work with the tobacco industry on anti-litter measures or campaigns such as making bins smoker friendly.

This is lunacy. If the industry wants to pay for these services, taxpayers should be thankful. Aside for tobacco smugglers, who benefits from councils rejecting contributions towards sniffer dogs? Where is the conflict of interest? When it comes to counterfeit tobacco, the only conflict is between the tobacco industry, who would like to see less of it, and the anti-smoking fanatics who want to pretend it doesn't exist.

Local councils have been sold a bill of goods by ASH about what they can and cannot do. I've been reading a document entitled 'Guidance for Trading Standards on engaging with the tobacco industry' which is endorsed by ASH and Public Health England. ASH has its own list of tips entitled 'Developing Policy on Contact with the Tobacco Industry'. Both of them offer highly misleading advice to local authorities based on a misrepresentation of Article 5.3. The first of them says:

This document articulates the legal obligations placed on public authorities by the Treaty and illustrates established best practice for those working in the sector.

The 'Treaty' has never been enshrined in law in Britain or the EU, so this is wibble from the outset. There are no 'legal obligations'. From a legal perspective, the FCTC is nothing more than a bunch of aspirations, but even if Article 5.3 was the law, it clearly refers to health policy, not trade policy, smuggling or waste disposal.

None of this stops ASH from making thinly veiled threats like this...

[Article 5.3] could be relied upon in legal proceedings brought by an individual or other non-state body against a public authority. An authority that does not act in compliance with the convention may be exposed to risk of judicial review. If a local authority decides to diverge from the guidelines it is suggested the reasons for doing so should be documented.

This is intimidation, plain and simple. It raises the spectre of lawsuits (that will never been filed) to coerce councils into taking an extreme position to suit ASH's comic book worldview.

The document goes on to say that local authorities should only deal with the industry if they need written confirmation that a counterfeit product is indeed counterfeit. If offers of money and support are made, the councils are told to run a mile. In a section about what to do if the industry 'approaches your local authority with offers to support to tackle illicit tobacco', the guidance reads:

Decline the offer citing conflict with the guidelines on the implementation of Article 5.3 and the Local Government Declaration if your local authority has signed it

The Local Government Declaration obviously has no legal standing, and nor do the guidelines about how Article 5.3 should be implemented which, being guidelines, are even less binding than Article 5.3 itself.

The document even makes this paranoid plea:

Let public health colleagues know about any approaches from the tobacco industry

Needless to say, all of this goes far beyond anything in Article 5.3, but with the bogus threat of legal action hovering over their heads, it is little wonder that local authorities have chosen to unnecessarily milk the taxpayer for bills that have traditionally been paid by industry. The result is worse local services where other budgets are depleted and a less effective response to organised crime.

Taxpayers are not only being forced to pay for ASH, they are being forced to pay for their collateral damage.