Wednesday, 16 October 2019

Does the alcohol industry encourage pregnant women to drink? Four idiots investigate.

It is with a heavy heart that I must inform that Mark Petticrew is at it again...

Alcohol industry 'puts pregnant women at risk', researchers say

Alcohol firms and bodies they fund are encouraging women to drink in pregnancy – putting their unborn child in danger – by publishing false and misleading information about the risks involved, new research claims.

The study is here. It is a follow-up to this discredited effort by Petticrew and three colleagues who claimed that the booze industry 'appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer.' Ironically, that study was based on some extensive misrepresentation, not to mention shameless cherry-picking and selective quotation.

Now he and three fellow cultists are back with a study that makes the unlikely claim that the alcohol industry is actively encouraging pregnant women to drink because (don't laugh)...

...women are a crucial part of the alcohol market, as has been pointed out in relation to alcohol consumption and breast cancer risk (Connor, 2017). Pregnancy, therefore, may represent a significant commercial threat...

Hmm. So what's the evidence that alcohol companies are encouraging pregnant women to drink?

Several alcohol industry–funded websites appear to emphasize the scientific uncertainties regarding safe levels of drinking.

There is a great deal of uncertainty about safe levels of drinking during pregnancy. A few years ago, the UK government amended its advice. Having previously advised woman to avoid alcohol in the first trimester, it now advises pregnant women 'to not to drink alcohol at all to keep risks to your baby to a minimum.'

This is the precautionary principle in action, however. It does not reflect any solid evidence showing risk to the baby from light drinking.

As a recent systematic review concluded...

This review demonstrates the paucity and poor quality of evidence addressing this important public health question... In conclusion, we found limited evidence for a causal role of light drinking in pregnancy, compared with abstaining, on most of the outcomes examined. Despite the distinction between light drinking and abstinence being the point of most tension and confusion for health professionals and pregnant women and contributing to inconsistent guidance and advice now and in the past, our extensive review shows that this specific question is not being researched thoroughly enough, if at all. In addition, there has been no evidence regarding possible benefits of light alcohol consumption versus absence.

And even Petticrew admits at the end of his new study that....

...we emphasize that there are indeed uncertainties and complexities in the area of alcohol and health, not the least in defining the benefits of risks and harms from “light” drinking

It is perfectly acceptable for the authors of the systematic review to 'emphasize the scientific uncertainties regarding safe levels of drinking', but when organisations that get funding from the alcohol industry do it, they are supposedly encouraging pregnant women to drink.

But do they even do that? This is the first example Petticrew cites to make his case:

The International Alliance for Responsible Drinking (IARD), an alcohol producers’ “responsible drinking” body, appears to emphasize uncertainty regarding “safe” limits by publishing a table that details “drinking guidelines for alcohol consumption by women who may become pregnant, are pregnant and are breastfeeding issued by government bodies in various countries.” The table shows national guidelines from Albania to Vietnam, with no accompanying explanation.

You can visit the webpage here. It is literally just a list of the advice given by various governments worldwide, presumably so people who live in those countries can find out what their government recommends. What kind of 'accompanying explanation' is required? Alas, Petticrew et al. don't tell us because they move on to their next killer example...

Lack of consensus is also highlighted by Brown-Forman, which references the “ongoing debate about whether there is a ‘safe’ level of consumption during pregnancy, or during certain time frames of a woman’s pregnancy.”

So what?

The word debate is commonly used elsewhere in alcohol and tobacco industry narratives to imply that scientific evidence is simply a matter of debate or opinion among scientists

Are you kidding me? 'Debate' is commonly used to describe a debate, of which there are many in science and none in the dogmatic world of 'public health' activism.

DrinkWise also states that there is “confusion about how much one can safely drink during pregnancy”—with the added apparent implication that such a safe level exists.

A fevered mind might infer that. Most people would not. I doubt anyone of sound mind could look at the DrinkWise webpage and see anything other than unequivocal advice to avoid alcohol when pregnant or when trying to conceive.

In any case, the statement above does not come directly from DrinkWise. They are quoting Alec Welsh, a professor of fetal-maternal medicine, who I dare say knows a bit more about the subject than Mark Petticrew and his 'public health' pals.

Some wording appears to imply that alcohol is safe—but has not yet been proven to be so. For example, Diageo’s DrinkiQ website states that “research has yet [emphasis added] to establish a ‘safe’ amount to drink during pregnancy,”.. The language in the first clause of this sentence implies that there is a completely safe limit, which simply has not yet been identified.

Wibble.

They then quote Quebec's Educ’alcool Canada...

"The scientific community believes [emphasis added] that abstaining from drinking is the safest choice.” This appears to be an example of industry “mixed messages.” The word believe (like the word debate) may also imply that that this message is based not on evidence but on ideology.

The evidence is clearly insufficient to say that the case either way is proven beyond doubt. This applies to all claims based on observational epidemiology, incidentally. Evidence is built up until the case is made beyond reasonable doubt, but that still requires interpretation and, yes, belief. Causation can never be proven in epidemiology, and in this instance we don't even have good correlations. That doesn't make it a matter of ideology - whatever that is supposed to mean - it makes it a matter of opinion. Or, if you will, belief.

We noted that on some websites the positioning of the information on the webpage appears to dilute its importance and/or present mixed messages. For example, on the Drinkaware website, the sections on pregnancy appear on the webpage titled “Health effects of alcohol.” The page has 45 sections, of which the last four are sections on pregnancy, breastfeeding, FAS, and fertility, requiring the user to scroll down approximately nine pages to access the information

This is desperate stuff. Firstly, who measures a single webpage in terms of pages? You scroll down to find what you need (try it).

Secondly, it is perfectly reasonable to put information that is only relevant to half the population for a fraction of their lifetime towards the bottom.

Thirdly, Drinkaware has a whole webpage dedicated to alcohol and pregnancy which comes up in the first page of listings when you Google 'alcohol pregnancy'. On that page you are told...

Not drinking alcohol is the safest approach

Drinking alcohol at any stage during pregnancy can cause harm to your baby and the more you drink, the greater the risk. This is why the low risk drinking guidelines advise pregnant women that the safest approach is to not drink alcohol at all during pregnancy.

If you’re pregnant or think you may become pregnant, you’re also advised not to drink.

This, apparently, is the alcohol industry [sic] encouraging pregnant women to drink. It's laughable.

Organisations affiliated with the drinks industry cannot win, no matter what they do. If they don't provide information, Petticrew accuses them of using a 'strategy' which is...

.. part of a wider set of industry tactics that includes manipulating the evidence base, lobbying, and constituency building (forming alliances with other sectors, organizations, or the public to give the impression of larger support for the industry’s position)

But if they do provide information, he says...

More generally, the alcohol industry involves itself in providing health information because it can then can portray itself as “part of the solution” and therefore play a greater role in the regulatory landscape. This echoes strategies adopted by the tobacco industry when it was faced with the growing, unequivocal evidence of the harms of smoking.

I really don't know how this rubbish gets published, even in a low quality journal.

The radicalisation of Dame Sally

Sally Davies stepped down as Chief Medical Officer last month, but she refuses to go away. In the last week alone she has called for a raft of extreme anti-food policies and a ban on flavoured e-cigarettes.

She was not always like this. As I argue in this article for Spiked, Davies' time in 'public health' is a cautionary tale of radicalisation.

Just when you thought she had gone away, Sally Davies is back – and louder than ever. When she finally stepped down as the UK’s chief medical officer last month, after a long farewell tour, I naively thought we had seen the back of her. But then that’s what I thought about John Major and Gary Barlow in the 1990s, so I should be used to disappointment by now. Some people just don’t know when they’re not wanted.
Dame Sally seemed to revel in her reputation as a bossy, nanny-state scold in her nine years as Britain’s ‘top doctor’. So it’s been a shock to discover that she was self-censoring all that time. Freed from the constraints of her £205,000-a-year government job, she is now able to say what she really thinks, and it’s scary stuff.

Last week, she called for a ban on eating and drinking on public transport (with a generous exemption for ‘fresh water’ and breastfeeding). This week, she jumped on America’s anti-vaping bandwagon and demanded a ban on flavoured e-cigarette fluids (ie, nearly all of them). At this rate, she will be proposing full rationing and mandatory marathons by Christmas.

Do read it all.


Tuesday, 15 October 2019

Dame Sally and plain packaging for food


Former Chief Medical Officer Sally Davies treated us to her mad parting shot last week with a report on childhood obesity. Most of the media coverage focused on the idea of banning eating and drinking on public transport (because it normalises snacking or something), but that was only one of a number of lunatic proposals.

Also included was...

Accelerate the [food] reformulation programme (PHE), If sufficient progress is not made, the government should apply either:

a. A fiscal lever or

b. Standardised packaging, (as for tobacco).

This is not the first time we have seen calls for plain packaging to be extended to food. In addition to several studies pushing the idea, the IPPR think tank wants plain packaging for all sweets, crisps and sugary drinks (as 'a challenge to the power of corporate manufacturers').

The idea also surfaced two weeks ago when the Food Ethics Council held an event called 'Food policy on trial: in the dock - plain packaging' in which four people debated whether to put 'unhealthy' food in 'standardised' packaging.

Whoever was on the 'jury' had a penchant for state intervention because they concluded that...

  • Much stronger regulation is needed on packaging and on food and drink claims, both in what is allowed and how strictly that is enforced. ‘Fake farms’ and cartoon animations shown on pack to market unhealthy products to children were two examples of where the jury agreed that bans were needed.
  • The jury called for honesty to become a central tenet of any food strategy. It proposed a citizens’ assembly [oh, God - CJS] to decide on which claims about food and drink should and should not be allowed, on packaging and more broadly. It also recommended incorporating that into the National Food Strategy (England) process.
  • There are problems with the idea of introducing plain packaging on worst-offending food and drink categories, not least setting boundaries about what should and should not be included. However, the threat of such a radical idea opens up the space for other interventions to be brought in.

The mere fact that plain packaging hasn't had any measurable impact on anything when tried on tobacco hasn't held this bandwagon back one inch. As I said of plain packaging when it was first mooted in the UK, when all you have is a hammer, everything looks like a nail.

Amusingly, one of the people speaking in favour of plain packaging for 'junk food' at the Food Ethics Council debate was Ben Pugh of Farmdrop. You may recall Farmdrop as the company that got caught out advertising cheese, jam and other everyday groceries that are classified as High in Fat, Sugar or Salt under the government's puritanical definition. It's great to see that his faith in Big Government hasn't been shaken!

By the way, did you see the cover of Sally Davies' report? It tells you a lot about how little grasp she (or whoever writes her nonsense) has of the evidence. The implication is that childhood obesity has risen because food has got bigger. It suggests that a bag of crisps weighed 100g in 1990 and weighs 150g today. The average pack of crisps actually weighs 25g today and weighed 30-35g in 1990. Sally Davies is comparing a modern multi-pack of crisps with, er, something.

The graph also shows childhood 'obesity' rising between 2006 and 2018, which it didn't, and the x-axis is totally mental, going up in increments of 16 years, 4 years, 5 years, and then 3 years.

Apart from that, rigorous stuff! Dame Sally was worth her £205,000 a year, wasn't she?.



Monday, 14 October 2019

The Lancet explained

I've just come across this press release from earlier in the year which helps explain how so much unscientific, non-medical, political dross gets published in the alleged medical journal the Lancet.

'Activist Editor' Richard Horton of The Lancet receives $100,000 Roux Prize

.. "Richard has been an activist editor, relentlessly taking on issues beyond the traditional scope of 'public health,' including the accountability of the medical profession, as well as human rights," said IHME Director Dr. Christopher Murray. "He has demonstrated an uncompromising commitment to advance health internationally, and his vision for a healthier, safer, and more just world has made Richard one of the world's most sought-after population health speakers."

One of those issues beyond "traditional public health" has been "planetary health," a discipline Horton argues transcends incorporating public health and the environment, and examines "the unity of life and the forces that shape those lives," according to an editorial published last year.

"Planetary health was intended as an inquiry into our total world. Our political systems and the headwinds those systems face," he wrote. "The failure of technocratic liberalism, along with the populism, xenophobia, racism, and nationalism left in its wake. The intensification of market capitalism and the state's desire to sweep away all obstacles to those markets."

Okay.

Monday, 7 October 2019

Smoking literature

I'm off on holiday for a few days so I'll leave you with a bit of reading material from my favourite single-issue pressure group, FOREST.

Josie Appleton is always worth reading. Her book Officious is a modern libertarian classic and her recent polemic 40 Years of Hurt is worthy of your attention.


Rob Lyons is also a doughty fighter for smokers' rights. His recent FOREST publication, Nicotine Wars, calls for unity between vapers and smokers. It is naive to think that the puritans will leave vaping alone once they've finished with smoking, as events in the USA have shown.


I've also been reading Jacob Grier's Rediscovery of Tobacco which is excellent. I'll review it properly in a few weeks.

Friday, 4 October 2019

Mysterious vaping illness - latest

It's been over a month and there is still no sign of the USA coming to its senses about the 'mysterious vaping-related disease'. The media reporting has been generally abysmal, but the response of politicians and health agencies has been nothing short of reprehensible.

Here is the latest advert from the Illinois Department of Public Health, for example...



From the very outset, all the evidence pointed to cannabis oil cartridges being the problem. A strong warning about these products, particularly the black market variety, might have prevented the outbreak of death and disease continuing. We're up to a thousand hospitalisations now.

It is clear that these products are everywhere. As the New York Times reported yesterday...

.. As health officials grapple with a public health crisis they are struggling to understand, police departments are in the midst of a swift crackdown on vaping products containing THC, the psychoactive ingredient in marijuana. In the Phoenix area, the authorities recently raided three homes over eight days, seizing hundreds of THC cartridges at each. In Wisconsin, detectives arrested two young brothers accused of running a large-scale THC cartridge assembly operation inside a condo. And in Nebraska, sheriff’s deputies found a stash of cartridges in a car parked at a truck stop. 

.. The effort to crack down on illicit vaping products has been laden with complications. The police say they have been stunned by the growth in popularity and variety of vaping devices. Enforcement can be difficult because vaping THC is not accompanied by the distinctive — and often incriminating — smell of marijuana. And police officers have had to learn the difference between vaping cartridges for THC, which are illegal for recreational use in most states, and devices for vaping nicotine, which are legally sold at many drugstores and gas stations.

If only the media learned the difference. Last week, Ben Camerillo was hospitalised with acute lung pain after suffering the 'mysterious vaping-related illness'. The television news reported that he has PTSD and used 'both THC and flavored vaping products'. The news item ended with the words 'if you are vaping you need to stop.'

But as Camerillo explains in the video below, he has only ever vaped cannabis/THC oil. He has never smoked and never used nicotine e-cigarettes.



Interestingly, he says that he bought THC carts from (legal) dispensaries, so the most sensible public health message is: avoid vaping cannabis oil while scientists figure out what exactly is going on.

Instead, mendacious politicians have been ordering vape shops to pull their flavoured vape fluids off the shelves, thereby greatly expanding the black market. Look at the state of this...



Also of interest is the video from TRT in which Robert West, Deborah Arnott and Sarah Jakes discuss the attempt by 'public health' dinosaurs like Simon Capewell and Martin McKee to import the US vape panic to the UK. A man who died nine years ago after switching from cigarettes to vaping is being held up as the UK's first and only 'vaping-related' death.

The Sunday Times recently claimed that there have been 200 cases of 'health problems linked to vaping' since 2014. But, as Arnott points out below (17 minutes), the MHRA is obliged to make a note of any complaint related to any of the products it regulates, of which only 74 have actually mentioned vaping. None of them has been proven.



Anti-vaping crusaders in the UK know that this is the chance they have been waiting for. We shall see if they have anything else up their sleeve.


Thursday, 3 October 2019

That teen vaping epidemic

All the data you need to debunk America's teen vaping panic is freely available on government websites. Martin Jarvis and colleagues have been looking at the National Youth Tobacco Survey and the number of high school students who regularly vape without having previously used tobacco is very small indeed.

Past-30-day e-cigarette use increased by 78% from 11.7% in 2017 to 20.8% in 2018. In both years, use was strongly associated with lifetime tobacco use history: it was seen in 8.4% of never tobacco users in 2018, in 29.0% of those who had tried a non-combustible, but never a combustible, product (OR 4.4 (CI 2.8-7.2) by comparison with never tobacco users), and in 71.0 % of those who had smoked more than 100 cigarettes in their lifetime (OR 26.8, CI 17.7-40.5)
Frequent use occurred in 0.1% of never tobacco users in 2017 and 1.0% in 2018. Findings from 2014 and 2015 showed that first product tried was overwhelmingly cigarettes among those with a substantial lifetime cigarette history. Among past-30-day e-cigarette users who had never tried tobacco products in 2018, 3.8% reported craving, 3.1% reported wanting to use within 30 minutes of waking, and 61.8% said they had used e-cigarettes on ≤10 days in their life.

They conclude:

We find a gaping chasm between the vision of an epidemic of e-cigarette use threatening to engulf a new generation in nicotine addiction and the reality of the evidence contained in the NYTS.

Meanwhile, cigarette used by this age group has just fallen to the lowest level on record.