Today sees the publication of the first Nanny State Index comparing lifestyle regulation across the EU. The UK comes third, ie. it is the third worst. Finland and Sweden are in the top two although I suspect that if they liberalise their e-cigarette laws (as seems likely), the UK could leapfrog them next year.
You can look at the data here.
And you can read what I have to say about it here.
Thursday, 31 March 2016
Tuesday, 29 March 2016
Mission creep, you say?
Tobacco Free Futures, which used to be Smokefree North West, are changing their name to Healthier Futures so they can get their snouts in the temperance and obesity troughs.
You may recall that Smokefree South West tried a similar trick when they changed their name to Public Health Action. You may also recall the UK Centre for Tobacco Studies turning itself into the UK Centre for Alcohol and Tobacco Studies.
How interesting to see activist groups turn from being predominantly about creating 'smokefree' places to making the country 'tobacco free' to laying into food and drink. No slippery slope, eh?
Taking Liberties says...
How hard can it be? All they have to do is say 'think of the children', make up some statistics, and demand tax and legislation. As 'Healthier Futures' says in its press release...
I'm sure they have.
Meanwhile, party is over for 'Public Health Action'. The government will finally stop showering them with taxpayers' money this summer. Judging by their website, they are now lobbyists for hire...
Hopefully, Tobacco Free Futures sudden name change is a sign that they, too, will soon be weaned off the taxpayer's teat.
You may recall that Smokefree South West tried a similar trick when they changed their name to Public Health Action. You may also recall the UK Centre for Tobacco Studies turning itself into the UK Centre for Alcohol and Tobacco Studies.
How interesting to see activist groups turn from being predominantly about creating 'smokefree' places to making the country 'tobacco free' to laying into food and drink. No slippery slope, eh?
Taking Liberties says...
What makes me laugh is the fact that people like Andrew Crossman and, before her, Fiona Andrews at Smokefree South West, are arrogant enough to think they can switch overnight from being 'experts' on tobacco to become 'experts' on obesity and alcohol as well.
How hard can it be? All they have to do is say 'think of the children', make up some statistics, and demand tax and legislation. As 'Healthier Futures' says in its press release...
Materials have been re-cycled where possible.
I'm sure they have.
Meanwhile, party is over for 'Public Health Action'. The government will finally stop showering them with taxpayers' money this summer. Judging by their website, they are now lobbyists for hire...
We offer evidence based, cost effective public health solutions.
Whether you need a behaviour change campaign, help raising awareness to a particular audience, or support in a specific area such as PR, brand identity or event management – we can deliver your objectives from start to finish.
Hopefully, Tobacco Free Futures sudden name change is a sign that they, too, will soon be weaned off the taxpayer's teat.
Monday, 28 March 2016
Nick Triggle: BBC propagandist
Nick 'feels strongly about this' Triggle has been doing a bit of bank holiday propaganda for the BBC health website today (see here, here and here for some previous offences). Theoretically, Triggle's regular editorial pulpit offers analysis of health news. In practice, it allows him to portray value judgements as facts while slavishly taking the 'public health' line on every policy demand.
His latest article is headlined 'Dawn of the nanny state?' Dawn? Where have you been for the last ten years, Nick? It must be at least the afternoon of the nanny state by now.
After correctly noting that the Conservatives are now the nanny state party, Triggle mentions the sugar tax and asserts that 'the mounting evidence on sugar has played its part in convincing them to act.' What evidence would that be? Alas, he doesn't say - because it doesn't exist.
And then there is this...
The reference to precision is the punchline here, but the whole sentence is a joke. The £11 billion figure is made up of estimates of the cost of smoking, obesity and alcohol. The alcohol estimate is £3.5 billion, which is about three times higher than any realistic cost estimate, but the real problem with the figure is that it is gross, not net. Sin taxes on alcohol and tobacco amount to roughly £25 billion per year.
Any serious attempt to estimate costs to the state must include revenues received by the state. It we look at net costs, it is clear that the 'lifestyles we lead' provide a huge financial windfall to the government.
Triggle then brings up another dodgy figure...
If the NHS needs its budget to be increased by a third every ten years, it is difficult to see how it can be sustained. The £30 billion figure was conjured up by Simon Stevens, the NHS CEO, when he was trying to squeeze more money out of George Osborne, but whatever the real figure may be, there is no doubt that the health service needs budget rises that cannot be explained by either inflation or population growth. It is delusional to imagine that the core driver of NHS costs is 'unhealthy lifestyles'. It is, in fact, the opposite: old age.
Policies to encourage healthier lifestyles may be justified on their own terms, but it is a fantasy that they will cut costs. They are far more likely to increase costs - to the NHS, but especially to the pensions and welfare system - by increasing the size of the elderly population. This is well understood by health economists as I explained in Death and Taxes last year...
The tendency of preventive health measures to incur costs rather than save them is well documented, but the general public are not well aware of this because single-issue campaigners constantly assert the opposite.
A worthwhile article could be written by somebody at the BBC to explain this. It would have the merit of being interesting, important and true. Instead, we get a stream of misinformation from hacks like Nick Triggle masquerading as analysis.
His latest article is headlined 'Dawn of the nanny state?' Dawn? Where have you been for the last ten years, Nick? It must be at least the afternoon of the nanny state by now.
After correctly noting that the Conservatives are now the nanny state party, Triggle mentions the sugar tax and asserts that 'the mounting evidence on sugar has played its part in convincing them to act.' What evidence would that be? Alas, he doesn't say - because it doesn't exist.
And then there is this...
The lifestyles we lead are costing the nation and, in particular, the NHS money. Some £11bn a year, to be precise.
The reference to precision is the punchline here, but the whole sentence is a joke. The £11 billion figure is made up of estimates of the cost of smoking, obesity and alcohol. The alcohol estimate is £3.5 billion, which is about three times higher than any realistic cost estimate, but the real problem with the figure is that it is gross, not net. Sin taxes on alcohol and tobacco amount to roughly £25 billion per year.
Any serious attempt to estimate costs to the state must include revenues received by the state. It we look at net costs, it is clear that the 'lifestyles we lead' provide a huge financial windfall to the government.
Triggle then brings up another dodgy figure...
Evidence suggests by 2020 there will be a black hole of £30bn. That is massive when you consider the NHS budget is currently just over £100bn... this is where, [the government] hopes, tackling unhealthy lifestyles come in.
If the NHS needs its budget to be increased by a third every ten years, it is difficult to see how it can be sustained. The £30 billion figure was conjured up by Simon Stevens, the NHS CEO, when he was trying to squeeze more money out of George Osborne, but whatever the real figure may be, there is no doubt that the health service needs budget rises that cannot be explained by either inflation or population growth. It is delusional to imagine that the core driver of NHS costs is 'unhealthy lifestyles'. It is, in fact, the opposite: old age.
Policies to encourage healthier lifestyles may be justified on their own terms, but it is a fantasy that they will cut costs. They are far more likely to increase costs - to the NHS, but especially to the pensions and welfare system - by increasing the size of the elderly population. This is well understood by health economists as I explained in Death and Taxes last year...
The old adage that ‘an ounce of prevention is worth a pound of cure’ may be true of health and wellbeing, but almost the exact opposite applies to financial costs. ‘Over the past four decades,’ writes Russell, ‘hundreds of studies have shown that prevention usually adds to medical spending.’
A study in the British Medical Journal concluded that the elimination of ‘coronary heart disease, cancer and chronic obstructive lung disease - the present targets of health promotion - would augment healthcare costs substantially’ because ‘lengthening life generally will increase healthcare needs, particularly long term nursing costs’. There are some exceptions to the rule that successful public health initiatives cost money, such as the prevention of accidents, childhood disease and lifelong disabilities, but most preventive measures to tackle diseases of old age merely lead to more chronic ailments and infirmity over a longer period of time and, ultimately, death from a substitute disease which is no cheaper - and often more expensive - to treat.
All of this runs contrary to the conventional wisdom. When the UK government cut the £3 billion public health budget by £200 million in 2015, the Faculty of Public Health claimed that it would cost the NHS ‘at least £1bn’ in the long run. This is most unlikely. As Jane Hall explains in the Oxford Handbook of Health Economics: ‘Although it is frequently argued (but not by economists) that prevention will save expenditure on future treatment, the current body of evidence demonstrates that it is more likely to generate additional health care costs.’
This cold economic fact seems to have passed many politicians and health campaigners by. Quoting Barack Obama, who claimed in 2008 that ‘Devoting more of our health-care funds to prevention will save tens of millions of dollars’, Rappange et al. (2010) replied that ‘although prevention may indeed increase the health of populations, these interventions, unfortunately, are, in general, unlikely to result in lower expenditures.’ They continued:
‘While preventive interventions may reduce illnesses and expenditures related to risk factors, especially when they successfully prolong life, they will increase illnesses and expenditures unrelated to those risk factors primarily in gained life years. The costs of these unrelated illnesses have been demonstrated to outweigh the savings on related illnesses for the important risk factors of smoking and obesity. In spite of this, the suggestion that prevention is cost saving remains persistent both in the academic field as well as in health-care policymaking. For many, it remains counterintuitive that a healthy lifestyle results in more rather than in less lifetime health-care expenditures. This is problematic as it may result in inefficient use of health-care resources based on overly optimistic assumptions regarding lower health-care expenditures due to prevention, and thus may cause disappointment (among policymakers) when prevention fails to meet these expectations.’
Bonneux et al (1998) put it still more bluntly, saying:
‘There is no evidence that healthcare costs are increasing because citizens live unhealthier lives. In fact, quite the contrary would seem to be the case.’
The tendency of preventive health measures to incur costs rather than save them is well documented, but the general public are not well aware of this because single-issue campaigners constantly assert the opposite.
A worthwhile article could be written by somebody at the BBC to explain this. It would have the merit of being interesting, important and true. Instead, we get a stream of misinformation from hacks like Nick Triggle masquerading as analysis.
Friday, 25 March 2016
Study claiming moderate drinking has no health benefits torn apart
 |
| Hello irony, my old friend, I'm here to facepalm with you again |
Tim 'merchant of doubt' Stockwell made yet another attempt to muddy the waters on the benefits of moderate drinking this week (for background on Stockwell's one man crusade, see here, here and here). Headlines like 'Evidence that alcohol lowers heart disease and extends life 'flawed and shaky at best'' are all part of his drip-drip campaign to undermine decades of scientific evidence.
Of course, it is possible that Stockwell is onto something and has found compelling new evidence to support the 'no safe limit' narrative.
Only kidding. Stockwell doesn't do much in the way of original research. His modus operandi is to trawl through the epidemiological evidence, chucking out studies that don't suit his theory (ie. most of them), hauling out zombie arguments and making generic criticisms of epidemiology.
His latest study is no different. You can read it here. He concludes:
Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.
The reference to 'public policy' indicates what Stockwell is really about. The fringe views of this activist-academic were highly instrumental in changing the UK's alcohol guidelines recently.
If you want a flavour of how Stockwell goes about his 'research' have a read of this unusually brutal critique of his latest study from a group of scientists who specialise in alcohol research.
Here are a few key passages...
“In this new paper, Stockwell et al have again biased their meta-analysis by ‘cherry picking’ a small number of studies for their meta-analysis – they discarded 2,575 studies and analysed only 87. The studies that they analysed related reported intake to disease, but they carefully avoided hundreds of validated studies that showed reduced disease among moderate drinkers."“Stockwell et al seem to have deliberately pretended that the many animal and human studies over the past four decades that have provided extensive evidence for the biological mechanisms supporting the findings that light to moderate alcohol consumption is cardioprotective do not exist.”“Science should serve the truth and to do it needs to take due account of all of the evidence, including controlled clinical trials in humans and animal models. What I find more disturbing in this paper is the lack of an overall vision, missing the opportunity (that is at the heart of the meta-analysis) to learn and build an overall view from the accumulation of collective scientific expertise. This setting, incompatible with the selection of convenience (cherry picking) leads unavoidably to repeat, with monotonic obstinacy, the same mistakes and the same misdeeds.”“We are all tired of having to counter the same self-serving polemics over and over again with unperturbed demeanor.”“Science happens when you examine a hypothesis and use experiments to contest it. Non-science is what happens when you believe a hypothesis and quote all the evidence you can to support it, while ignoring the rest."In the opinion of Forum members, the present paper markedly distorts the accumulated scientific evidence on alcohol and CVD. As stated by one Forum member, “The biased selection of studies that are included undermines the value of the paper, but more importantly promulgates misinformation in the name of appropriate scientific method. Failure to acknowledge the robust body of knowledge that supports the opposite conclusion, and disqualification of extensive animal and cell culture studies that offer plausible biologic explanation of observed benefits, is unconscionable.”The Forum concludes that the overwhelming body of observational scientific data, as well as an immense number of experimental studies, support the contention that, for most middle-aged and older men and women who choose to do so, the regular consumption of small amounts of an alcoholic beverage can be considered as one component of a “healthy lifestyle.” Such a habit has been shown to be associated with a lower risk of cardiovascular disease and of total mortality.
Ouch.
Thursday, 24 March 2016
Fruit cakes
The consumption of fruit juice should be considered a major health hazard! https://t.co/gNemORjdZS @SimonCapewell99 @pascalmeier74 #obesity— Dr Aseem Malhotra (@DrAseemMalhotra) March 24, 2016
The sugarphobia carries on. From The Guardian (and everywhere else)...
Fruit juices and smoothies contain 'unacceptably high' levels of sugar
A 'study' has been published in BMJ Open looking at the sugar content of fruit juice, ie. some nutters from Action on Sugar read the nutritional content on the side of the bottles and copied them into a table.
Shockingly, it transpires that pure fruit juice contains sugar! The caps-lock crusader, Simon Capewell, explained why the public should be aghast...
“These are marketed intensively to children as well as to parents,” said Prof Simon Capewell of the department of public health and policy at the University of Liverpool, one of the authors. “They are routinely packaged in garish colours. They routinely have cartoons and other sort of folksy animal creatures being used to market them."
No prizes for guessing where this is leading. Plain packaging for cranberry juice, anyone?
“There is often a health halo – some claim about vitamin C or ‘packed full of fruit’. There are no restrictions around the words industry can use in their marketing. They can claim or imply quite a lot."
Actually, there are quite a lot of restrictions on marketing. Advertising claims - unlike 'public health' claims - have to be 'legal, decent, truthful and honest'. For example, fruit juice makers can say that their products contain vitamin C and are packed with fruit because their products contain vitamin C and are packed with fruit. See how that works?
“I think it came as quite a surprise to us really that there is so much sugar hidden and that any of the most familiar brands had such a high level.”
Assuming Capewell's surprise is a genuine emotion rather than a rhetorical affectation, he has no business presenting himself as an expert. This guy is a public health professor and a member of a charity, Action on Sugar, that is entirely focused on this one ingredient. If he didn't know roughly how much sugar was 'hidden' in fruit juice, he is in the wrong job.
The researchers analysed 203 fruit juices, fruit drinks and smoothies stocked by seven major supermarkets – Tesco, Asda, Sainsbury’s, Marks and Spencer, Waitrose, the Co-op and Morrisons. They found almost half contained a child’s entire recommended daily intake of sugar, which is a maximum of 19g or nearly five teaspoons.
Obviously pure fruit juice does not contain 'teaspoons' of anything, but this seems to be the only way the public health loons can talk about sugar these days.
If you are scandalised by idea of fruit juice containing 'nearly five teaspoons' of sugar, brace yourself as I reveal how many 'teaspoons' of sugar are in the fruits themselves.
A banana contains four teaspoons of sugar!
An apple contains five teaspoons of sugar!
An pear contains four and a half teaspoons of sugar!
A bunch of grapes contains five teaspoons of sugar!
A slice of watermelon contains four and half teaspoons of sugar!
An orange contains four teaspoons of sugar!
Remember, each teaspoon of sugar contains 16 deadly calories! What's more, some of these fruits are packaged in 'garish colours'.
Now if you'll excuse me, I have a 'study' to submit to BMJ Open.
Wednesday, 23 March 2016
Let there be light (in the evening)
The clocks go forward this weekend. That is my annual cue to talk about what a marvellous thing British Summer Time is. This year, however, following a disagreement I had with Peter Hitchens in October (see below) and on the centenary of BST, I will making my case at the IEA where we hope to settle the issue once and for all. Tickets are free. If you are also free, come and join us.
Et cetera...
Discussion: Rage, rage against the dying of the light
In 1916, the clocks went forward by one hour and the tradition of British Summer Time (BST) began. Introduced as a war-time measure to increase economic productivity and reduce energy consumption, the issue still provokes controversy 100 years later.
On the centenary of daylight saving time, join us at the IEA to debate the motion: 'British Summer Time should be scrapped'.
Speaking for the motion we are pleased to welcome back the Mail on Sunday's Peter Hitchens who describes BST as "fanatical and dictatorial" and says the system amounts to "lying about the time". Opposing the motion will be the IEA's head of lifestyle economics, Christopher Snowdon, who describes BST as "glorious" and wants it to be rolled out across the year.
RSVP via email or on 0207 799 8900.
Peter Hitchens examines our mad habit of making the clocks lie every spring: http://t.co/tX34kwUW8v— Peter Hitchens (@ClarkeMicah) March 27, 2015
@cjsnowdon Mr Snowdon(why is this no surprise to me?) is a late riser, and I am an early riser. That's our choice, and....— Peter Hitchens (@ClarkeMicah) October 24, 2015
@clarkemicah Because lots of people are asleep at 6am but everybody is awake at 5pm.— Christopher Snowdon (@cjsnowdon) October 24, 2015
@clarkemicah If you had your way, the sun would rise at 3.40am in June and set at 8.20pm. Is that really what you want?— Christopher Snowdon (@cjsnowdon) October 24, 2015
.@cjsnowdon Trotsky could have said that, and may well have done so. Your real inspiration, if you did but know it.— Peter Hitchens (@ClarkeMicah) October 24, 2015
@clarkemicah The only people who will up to appreciate a 3.40am sunrise are those who are on drugs. You are doing their bidding :)— Christopher Snowdon (@cjsnowdon) October 24, 2015
.@cjsnowdon But may I quote you on your comical claim that there is no objective time?— Peter Hitchens (@ClarkeMicah) October 24, 2015
@cjsnowdon Just you be sure to acknowledge it on that distant day when I bring it up against you. Or you can back out now.— Peter Hitchens (@ClarkeMicah) October 24, 2015
.@cjsnowdon No, you're the one that will be late, having stayed in bed.— Peter Hitchens (@ClarkeMicah) October 24, 2015
Et cetera...
Tuesday, 22 March 2016
Jamie Oliver costs us another £1 billion
Most unintended consequences are quite predictable, but I hadn't thought of this one.
The Office for Budget Responsibility estimates that George Osborne's tax on fizzy drinks will increase inflation by a quarter of a per cent. This will have a more profound effect that you might think because it affects index-linked government debt.
The Guardian recently reported that the inflationary impact of the tax will require an additional £1 billion in debt interest payments. This sounds hard to believe and yet it is true. The OBR made precisely that forecast in its assessment of the Budget and yesterday confirmed it to Brook Whelan (from People Against Sugar Tax, for whom I am an unpaid advisor) by e-mail. This is what they said:
Osborne must have known about this massive dead-weight cost when he was contemplating the sugar tax and yet he proceeded with it anyway in an attempt to distract from other parts of the Budget (that went well!).
It beggars belief. Not only will the British public have to pay half a billion pounds a year for a regressive tax that campaigners now admit is largely 'symbolic', we also have to pay a billion pound set up charge! And inflation will rise, leading to increases in other index-linked payments.
Jamie Oliver should be tarred and feathered.
The Office for Budget Responsibility estimates that George Osborne's tax on fizzy drinks will increase inflation by a quarter of a per cent. This will have a more profound effect that you might think because it affects index-linked government debt.
The Guardian recently reported that the inflationary impact of the tax will require an additional £1 billion in debt interest payments. This sounds hard to believe and yet it is true. The OBR made precisely that forecast in its assessment of the Budget and yesterday confirmed it to Brook Whelan (from People Against Sugar Tax, for whom I am an unpaid advisor) by e-mail. This is what they said:
...the soft drinks industry levy feeds through to a price increase in 2018-19 in our forecast. This in turn increases the growth rate of the retail prices index (RPI) and this in turn is used as the measure by which index linked government debt.
So the increase in the RPI adds to the cost of debt interest. This is set out in para 1.34 bullet 5 in our Economic and fiscal outlook.
This is not the cost of implementation to firms and you are correct that this is solely the effect on the public finances.
Osborne must have known about this massive dead-weight cost when he was contemplating the sugar tax and yet he proceeded with it anyway in an attempt to distract from other parts of the Budget (that went well!).
It beggars belief. Not only will the British public have to pay half a billion pounds a year for a regressive tax that campaigners now admit is largely 'symbolic', we also have to pay a billion pound set up charge! And inflation will rise, leading to increases in other index-linked payments.
Jamie Oliver should be tarred and feathered.
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