The medicine isn't working. More medicine!

Another study in the official minimum pricing evaluation was published this week. Once again, it was bad news for advocates of the policy, although you have to read it properly to find that out. According to a note at the top the study (too brief to be called an abstract), it says...

This study found that implementation of minimum unit pricing at 50p per unit was unproblematic with no evidence of beneficial or harmful impacts on the outcomes evaluated.

But as the results section shows, there was, in fact, some evidence of a harmful impact...

The odds ratio for an alcohol-related emergency department attendance following minimum unit pricing was 1.14 (95% confidence interval 0.90 to 1.44; p = 0.272). In absolute terms, we estimated that minimum unit pricing was associated with 258 more alcohol-related emergency department visits (95% confidence interval –191 to 707) across Scotland than would have been the case had minimum unit pricing not been implemented.

To be fair, this association was not statistically significant, but we know that minimum pricing costs Scottish drinkers tens of millions of pounds a year. That is a harmful impact and it can only be justified - at a push - if it produces positive health outcomes. This is just the latest study showing that it has not done so. 

The study is a substantial piece of work, running to over 200 pages. It is the most thorough piece of research conducted on the real world impact of minimum pricing to date. The authors compared outcomes in Scottish emergency departments with those in the North of England. They also compared outcomes in sexual health clinics and interviewed various 'stakeholders'.

At best, they found no improvement north of the border. Indeed, things may have got comparatively worse since minimum pricing was introduced.

On average, Scotland had a higher proportion of alcohol-related attendance than England. Scotland had a stable trend, whereas there was a decreasing trend in England.

.. The proportion of ‘current alcohol drinkers’ was higher in Scotland than in England, with this difference significant across all three waves. 

...For drinkers’ consumption, there were slight increases for the odds of alcohol misuse (FAST score ≥ 3; OR 1.22, 95% CI 1.04 to 1.42) and alcohol purchase from on-licensed premises (OR 1.27, 95% CI 1.05 to 1.55).

.. For the availability, purchasing and consumption of alcohol, stakeholders expected to see reductions after MUP, notably for young people because they had limited disposable income. Such reductions were not generally observed. 

This is in addition to the study published last week which found no impact on crime from the introduction of minimum pricing.

Not going very well, is it?

 

The study was produced by people like Colin Drummond and Niamh Fitzgerald who have been agitating for minimum pricing for years and are not going to allow the total failure of the policy to derail them now.

 

Sign the e-petition to urge government to support alcohol minimum pricing. http://t.co/qdBSfNKXaZ

— Niamh Fitzgerald (@NiamhCreate) March 14, 2013

In the plain English summary, they make a few excuses and - surprise, surprise - call for the minimum price to be increased. 

Our study may have suffered from a failure to include those most likely to consume low-cost alcohol. We think that the reason that we found no effect either way from minimum unit pricing could be that the minimum price was too low to make a difference, that people did not notice it or that too few people who buy low-cost alcohol were included in our study. According to the World Health Organization, the price needs to keep pace with cost increases; however, it was unchanged in Scotland since being agreed in 2012.

And in the conclusion of the abstract proper, they say:

The lack of effect observed in these settings in the short term, and the problem-free implementation, suggests that the price per unit set (£0.50) was acceptable, but may be too low.

This is now the fallback position of the anti-booze lobby: the medicine didn't work, we need more medicine. Never mind the fact that their precious modelling which 'proved' that minimum pricing was the single most effective way to tackle alcohol-related harm was based on a 50p unit and was being published long after 2012. 

Meanwhile, in the USA, cigarette sales have risen for the first time in twenty years after a relentless campaign against vaping. As CNN notes, at the very end of their report on this news...

Smokers are also switching back to traditional cigarettes from vaping devices in response to restrictions on e-cigarette flavors

Don't expect any contrition from the people who have been at the forefront of the war on vaping. As the editor of the Tobacco Control 'journal' says...

Time to work harder for a cigarette #endgame: #Cigarette sales up in US for first time in 20 years: https://t.co/HDMr3Qx0Ew.

— Ruth Malone RN PhD (@MaloneRuth) October 28, 2021

Efforts must be redoubled, comrades!

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The government's obesity app

The government is going to start trialling a new obesity app in January. Taxpayers are going to be forced to pay people to eat vegetables and go for a walk. I'm against this, as I explain in the Spectator...

There is a good chance that the HeadsUp app will be another government IT disaster and will never be heard of again after the trial ends next summer, but it should never have been given the green light in the first place. Not only is it Orwellian for the state to track your footsteps and monitor your shopping and eating habits, it will create a two-tier society in which those who follow the often dubious advice from public health authorities will be subsidised by those who do not (or indeed cannot). Ludicrously, Health Secretary Sajid Javid is portraying this scheme as part of the ‘levelling up agenda’.

Do have a read.

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What most people think

I really enjoyed talking to the comedian Geoff Norcott on Wednesday about Covid centrism, First Defence, cigarettes and more. Have a listen to the podcast here.

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Child obesity experiment fails spectacularly

The 'public health' lobby is keen on the 'whole systems approach' to obesity. This is not to be confused with the equally useless 'whole population approach'. The latter involves using blunt policy tools to get everybody to reduce their consumption of salt, alcohol, sugar or whatever whereas the whole systems approach has never been properly defined but involves the whole of society working to reduce obesity in some way.

As I have said before...

The strategy of throwing any old policy into the mix in the hope that some of them will work is known euphemistically in 'public health' as the 'whole systems approach'. It is often illustrated with meaningless graphics and is anti-scientific, illiberal nonsense. Essentially, it gives activists a licence to do whatever they want regardless of the consequences.

At best, this scatter-gun approach can involve various teachers, social workers, charities and 'public health' professionals working face-to-face with people to help them have a healthy diet and control their weight. The one and only success story is Amsterdam where child obesity supposedly fell (a bit) after a whole systems approach was introduced. In practice, it's all too expensive and time-consuming for most governments and 'public health' groups to get behind, but it putatively shows that the government can do something about obesity.

The whole systems approach has now been tested in a four year randomised control trial in Australia called WHO STOPS Childhood Obesity (Whole of Systems Trial of Prevention Strategies for Childhood Obesity. Roughly 3,000 kids were treated to a wide range of 'community-based interventions'...

Some key examples of actions were (1) a rural health service changing its beverage provision and cafe to be “green only,” in line with government healthy choices guidelines; (2) a local government area constructing a new footpath to allow schoolchildren to engage in active transport more easily to and from school; (3) implementing a junior sporting-association-wide water-only policy; (4) a local primary school constructing signs encouraging children to be dropped off at set points away from the school gate to allow them to walk to school; and (5) implementing a healthy beverage policy at family day care.

So how did it go? At first, quite well.

There was a significant interaction effect between trial group and time (P = 0.006) (Table 2). Within intervention communities, the prevalence of combined overweight and obesity was 35.5% in 2015, 31.5% in 2017...

But then things started to go not so well.

...and 40.4% in 2019.

Awks.

Prevalence within the control group remained stable at 34.3% in 2015 and 34.7% in 2019.

The control group started out with a slightly lower rate of overweight/obesity (34.3% vs. 35.5%) and ended the trial with a substantially lower rate (34.7% vs. 40.4%). Needless say, this was not what the researchers were hoping for, but they are keen to stress that the experiment was not a complete waste of time because...

Intake of takeaway food significantly improved in the intervention communities by 2019 relative to 2015 compared with control...

And...

There was a significant intervention effect on water consumption (interaction, P = 0.019) with an increased percentage of girls consuming more than five glasses of water per day in intervention communities between 2015 and 2017 (18.1% increase) and 2015 to 2019 (11.8% increase) compared with control communities.

The authors do not take this to its logical conclusion and deduce that cutting down on takeaways and increasing water consumption does not lead to weight loss. Instead, they conclude that:

WHO STOPS reduced obesity prevalence over 2 years and over 4 years helped a majority of children keep their takeaway intake low... 

Childhood obesity is demonstrably preventable, and community-based interventions are effective, feasible, and acceptable to government, industry, and the public.

This is obviously not what the study shows, but in 'public health' you can say whatever you want. A more accurate conclusion would be to say that if childhood obesity rates go up despite the whole community working intensely with kids for several years, the chances of broad brush policies like advertising bans having an effect are nil.

Have I mentioned before that 'public health' is not a results-driven business?

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The public health lobby wants to introduce a ‘meat tax’. Don’t bet against it

Marco Springmann is in the pages of the Guardian again calling for a meat tax so here's what I wrote about him and his ideas the first time around.

First published by Spectator Health in November 2018

Once you accept that the modern ‘public health’ movement is just the latest incarnation of the puritanism that waxes and wanes throughout history, it is easy to predict its next target. If you further assume – and who can now deny it? – that nanny state campaigners follow a blueprint laid down by the anti-smoking lobby, it becomes easy to guess not only their future targets but also their methods.

And so, when I suggested in an interview a few years ago that the next vices to fall under the cross-hairs of ‘public health’ would be caffeine, gambling and red meat, it was not because I had psychic powers, nor because there were rumblings in the medical journals about these issues (there wasn’t). It was because they have been for centuries the classic targets of scolds and ascetics once they tire of fighting the demon drink and tobacco.

Coffee is too popular with the upper-middle classes to be done away with yet, but this year saw the start of a minor crusade against energy drinks. The imminent downfall of fixed-odds betting terminals represents the first real scalp for the anti-gamblers in decades, with gambling advertising lined up as the next dragon to slay.

Meat has had an easier ride. Until now. A study published today in PLoS One looks very much like the start of a concerted effort to clamp down on processed and red meat. The crusade is beginning, as such crusades usually do, with a push for a sin tax.

Like most of the influential policy-based evidence in ‘public health’ of recent years, the study rests on opaque computer modelling. It produces estimates of how many people are dying from the over-consumption of meat, how much this costs society and what size of tax is needed to balance out the costs. It then estimates how many lives will be extended by processed meat consumption falling in an era of higher prices.

The published paper does not provide enough information for the model to be meaningfully assessed by the reader, but one thing is clear: the numbers are unfeasibly large. The authors reckon that the global death toll from processed and red meat is 2,390,000 people a year. The link between processed meat and bowel cancer is reasonably robust by the debased standards of nutritional epidemiology and there may be an association between meat-eating and coronary heart disease and stroke. Even so, a figure of 2.4 million defies belief. The authors admit that the Lancet’s Global Burden of Disease reports estimated the true figure to be 900,000 in 2010 and 700,000 in 2013. That is enough of a discrepancy, but they do not mention the most recent edition of the report which put the figure at just 140,000. The estimate published today is therefore seventeen times larger than an estimate of the same risk factor published barely a year ago. How can anyone have confidence in this field of academia?

Their estimates for the UK are equally outlandish. They claim that processed and red meat causes 70,000 deaths a year in Britain. That’s one in nine! 70,000 deaths is far more than is said to be caused by obesity and ten times more than is caused by alcohol. If today’s estimate is correct – and let’s face it, it’s not – only smoking can rival it.

If you can swallow the idea that 2.4 million people are struck down by bacon butties and surf-and-turf every year, you might be inclined to believe the authors’ estimate that processed and red meat incurs a cost of $285 billion to the world’s healthcare systems each year. Taking this figure and adding in some unspecified assumptions about the cost to the environment of cattle emitting greenhouse gases, they decide that the price of processed meat should rise in rich countries by an average of 111 per cent to offset its negative effects.

Calculations of this sort are not unusual in economics. The standard way of dealing with negative externalities is to implement a Pigovian tax, thereby passing the external costs of consumption back to the user. To do that, you must first work out what the net external costs are. This is where people in ‘public health’ invariably go wrong, counting internal costs (such as lost productivity) as external costs and failing to subtract savings. People who live to a ripe old age tend to cost a lot of money, but a classic mistake in ‘public health’ studies of this kind is assuming that someone who avoids a diet-related disease will avoid every other disease and never trouble the health service again.

Today’s study is not detailed enough for us to tell whether the authors have made all of these mistakes but the sheer size of their estimates suggest they have. They reckon that the UK alone needs to tax meat-eaters to the tune of £2.9 billion a year. This, they say, will reduce consumption of processed meat by ten grams a day and save 6,100 lives. That is nearly half a million pounds for every hypothetical life.

Leaving aside the garbage-in, garbage-out methodology at the root of these numbers, it seems unlikely that a British government – even one that bans plastic straws and taxes fizzy drinks – will introduce a 78 per cent tax on processed meat any time soon, although that is what the authors recommend. It is even less likely that everybody in the world will go vegan, although that is what the lead author, Marco Springmann, told delegates needed to happen at the End of Meat conference last year.

And yet every nanny state policy sounds absurd until the public have been battered with soundbites, dodgy statistics and empty promises for a few years. Nobody who has witnessed the unstoppable rise of the ‘public health’ movement over the last two decades can dismiss the possibility of a meat tax being introduced in the foreseeable future, probably followed by an advertising ban and graphic warnings.

The odds shorten when you consider that it is not just the ‘public health’ lobby that wants it. There is now an unholy alliance between health campaigners, vegans, vegetarians and environmentalists on this issue. This is the next battleground of lifestyle regulation and only a fool would bet against the people who always win.

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Minimum pricing isn't working

Promises, promises

More evidence from the minimum pricing evaluation has been published and it seems that the policy has failed to achieve one of its main aims. The infamous Sheffield model predicted that a 50p minimum price would lead to 3,500 fewer crimes in the first year. 

Charlie Peters has the details...

Supporters of Scotland’s regressive alcohol legislation took a hit this week when it was revealed that minimum unit pricing had only had a ‘minimal effect’ on drink-related crime.

A Manchester Metropolitan University study looked at Police Scotland data collected since 2015. It found that there were no statistically significant changes in alcohol-related crime, disorder and public-nuisance offences after 2018, when a minimum price of 50p per unit was introduced.

Saying it had a 'minimal effect' is flattering to the policy. There was no measurable impact at all.

"On the whole, the limited discernible impact of MUP on alcohol-related crime, disorder and public nuisance suggests that the reduction in off-trade alcohol sales that followed implementation is below that required to deliver a reduction in crime," Prof Bannister added.

"Or, if crime did reduce, it has done so at a scale that the evaluation could not identify".

You may recall that the same modellers predicted that lowering the drink drive limit would reduce road traffic fatalities by 6 per cent. It did nothing of the sort.

The rest of the real world evidence on minimum pricing is far from compelling. There was a fall in alcohol consumption after the policy was implemented, but it was not accompanied by any decline in alcohol-related A & E admissions, nor in alcohol-related hospital admissions. The number of alcohol-related deaths fell in 2019, but rose sharply in 2020 (as they did in England - at about the same rate). The policy has cost Scottish drinkers tens of millions of pounds.

Naturally, the state-funded pressure group Alcohol Focus Scotland is not taking this lying down. They ar demanding the floor price be raised to 65p.

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Denominators

In my City AM column today, I start with Richard Doll's research into smoking before discussing vaccine efficacy and our current obsession with the number of Covid deaths. The common denominator is denominators.

In the late 1940s, Austin Bradford Hill and Richard Doll began interviewing hundreds of hospital patients, half of whom had lung cancer while the other half had various other diseases. Their research, published in 1950, showed that 99.7 per cent of the male lung cancer patients had a history of smoking. Out of 649 patients, only two were nonsmokers. In retrospect, it seems amazing that no one had spotted the link between smoking and lung cancer before, but it is less surprising when you consider that 94.8 per cent of the men who were not in hospital with lung cancer also had a history of smoking. 

This might not seem like such a big difference. The vast majority of the men in hospital had smoked tobacco, regardless of what they were being treated for. And yet a statistician can tell from the figures above that smokers were fourteen times more likely to get lung cancer than nonsmokers.

Have a read.

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