Tuesday, 2 September 2014

I rest my case

My main reason for going to Australia was to take part in a panel discussion titled 'The Grit in the Oyster' at the Centre for Independent Studies' Consilium conference on the Gold Coast. The purpose of the discussion was the talk 'in praise of contrary opinion'. You can read an edited version of my speech below (published in The Australian), before scrolling down for the punchline.

John Snow is a legend of public health. In the 1850s he investigated a cholera outbreak in London and noticed that the victims' houses were clustered around one particular water pump. He removed the pump's handle and the epidemic came to an end. This led him to conclude that cholera spread through contaminated water and not, as was widely believed, through the air. In one fell swoop, he had invented epidemiology and discovered germ theory.

A lesser known fact about Snow is that he was reviled by much of the medical establishment in his lifetime and germ theory was not accepted as fact until after his death. Wedded to the miasma theory of disease (which, put simply, says that disease is spread by bad smells), doctors were intent on closing down polluting industries in Britain's cities. These industries protested their innocence and found common cause with Snow, who used the issue to promote germ theory.

The editor of The Lancet, a leading medical journal, treated Snow with undisguised contempt. In so many words, he portrayed him as a crank and a hired gun of big business. "The theory of Dr. Snow tallies wonderfully with the views of [industry]", he wrote in a scathing and sarcastic editorial. Snow's theory, he said, was "a mockery of science" and a "wretched crudity". Appealing to the authority of the existing consensus, he said that the belief that cholera was a waterborne disease was not "in accordance with the experience of men who have studied the question without being blinded by theories".

The Lancet was right about Snow being a hired gun. He had received money from the threatened industries to give testimony to a parliamentary committee. But neither his links with business, nor the fact that the establishment disagreed with him, stopped Snow being right and the establishment being wrong. Although doctors eventually came round to Snow's way of thinking and now idolise him, the fact remains that Snow's heresy was not addressed by coolly assessing the evidence, but by appealing to authority, appealing to consensus and dismissing Snow as a tool of big business.

For all his troubles, Snow got an easy ride compared to those who step out of line in the field of public health today. Take Katherine Flegal, a statistician at the US Centers for Disease Control. Last year, she and her colleagues published a systematic review of 97 studies in the Journal of the American Medical Association which found that mild obesity produced no extra mortality risk and that being merely overweight resulted in a small reduction in mortality risk.

Despite being supported with a ream of data, the study was savaged by the public health lobby. Walter Willett, one of the world's most prominent anti-obesity campaigners said: “This study is really a pile of rubbish and no one should waste their time reading it.” A spokesman for the National Obesity Forum said “It’s a horrific message to put out at this particular time" and absurdly suggested that Flegal's "message" was that we can "eat ourselves to death with black forest gateaux.” Willett later organised a symposium in which speaker after speaker lined up to denounce Flegal and her work.

Or take James Enstrom, a vastly experienced and respected epidemiologist who had been working at UCLA since 1976. In 2003, he and a colleague published a study in the British Medical Journal that found no association between secondhand smoke and lung cancer. Many other studies had come to the same conclusion and Enstrom's research had no substantive flaws. Nevertheless, when anti-smoking campaigners heard about the findings, they breached the journal's embargo and hastily organised a press conference in which they slated the study (which they they not yet read) and described the study as "crap" and Enstrom as "a damn fool".

In 2005, Enstrom further blotted his copy book by conducting research on fine particulate matter which cast doubt on the scientific basis of new air pollution laws proposed by the Californian Environmental Protection Agency. Although Enstrom's findings have since been replicated in other studies, he was later sacked by UCLA because his research was "not aligned with the department’s mission”.

Or take the 2011 study by Brand-Miller and Barclay which claimed that sugar consumption had been falling in Australia while obesity had been rising. They and their study - titled 'The Australian Paradox' - have been viciously attacked by anti-sugar campaigners, with the usual accusations of being in the pay of industry. The researchers were eventually charged with scientific misconduct and have only recently been exonerated.

All of these examples involve scientists of good standing whose studies have been published in peer reviewed journals. It is hard to believe that any of them would have been attacked with such vigour had they not been dealing with red button issues that are of great importance to public health pressure groups.

In the 1850s, doctors were committed to make cities smell better. In the 2000s, they were committed to smoking bans. Today, they are committed to fighting obesity, with a particular focus on sugar.

To put it bluntly, the policies had already been decided. The campaigners want to send a clear, unambiguous message to the public while persuading politicians to act. Any research suggesting that a policy is misplaced or directed at the wrong target brings down a firestorm upon the heretical scientist, regardless of the quality of the research or the credentials of the researcher. In each case, the response from the establishment is visceral rather than rational. The implications of dogmatic groupthink and intimidation for the pursuit of sound science - and sound policy - are chilling.

The theme here is, I hope, pretty clear. I am arguing that the establishment often reacts to challenging evidence by resorting to ad hominem attacks (typically based on alleged funding from industry) and appeals to consensus (eg. 'the debate is over') rather than addressing the evidence directly.

With that in mind, let me explain that whilst in the antipodes I had a couple of days in New Zealand where I gave a talk to the NZ Food and Grocery Council about the abject failure of taxes on food to reduce obesity. This was largely based on the report I wrote about the rise and fall of the Danish fat tax for the IEA.

Four days after my visit, the Association of Salaried Medical Specialists came back with their rebuttal (to a speech they hadn't heard). The organisation carefully picked apart my arguments, proving beyond doubt that any loss of utility from such taxes would be more than offset by benefits. They demonstrated that indirect taxes on essentials were not, in fact, regressive. They showed that the money raised by sin taxes could not possibly be more effectively spent on anything else. They identified crucial flaws in all studies that have claimed that soda taxes have little or no impact on obesity. And they showed that the Danish fat tax had actually been a success.

I'm joking of course. What they actually did was release this...

Tired attempt to pass off venal campaign as debate

“The decision to bring British anti-tax spin doctor Christopher Snowdon [!?! - CJS] to New Zealand last week was just another tired disingenuous attempt to dress up a venal campaign as a genuine debate,” says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).

“Snowdon’s attacks on credible medical and social research have been well documented so it was disappointing but hardly a surprise to see him singing to the choir within the NZ Food & Grocery Council about the evils of taxing sugary soft drinks, etc. The Council obviously gives much greater priority to the food industry’s profits than the risk of poor health of New Zealanders.

“What is surprising is that the Food & Grocery Council obviously hasn’t realised the New Zealand public’s distaste for propaganda masquerading as evidence and genuine debate.”

As noted in media coverage http://www.stuff.co.nz/life-style/wellbeing/10443122/Anti-sugar-campaigners-wowsers, the Food & Grocery Council has been at the centre of ‘Dirty Politics’ allegations that it ran sponsored posts on the Whale Oil blog. Both Katherine Rich from the Council and Christopher Snowdon have been referred to in glowing terms on this blog. When Mr Snowden’s [sic] strongest supporters are the Cameron Slater ‘gang’, what more can one say. [I have been mentioned on the Whaleoil blog twice in its entire history - CJS]

“All of this raises questions about the real intent of these people and organisations. Issues like obesity are very important for New Zealand and any discussion of possible solutions, such as taxes on soft drinks, needs to be based on evidence rather than the commercial desires of opaque vested interests.”

Mr Powell says Snowdon’s arguments on diet and obesity have been comprehensively demolished over the years, including in video interviews and articles such as these: http://blogs.channel4.com/tom-clarke-on-science/obesity-crisis-sorting-fat-fiction/1221 and http://www.theguardian.com/society/2014/aug/30/child-poverty-link-malnutrition-rickets. [The first of these links is a video of me talking about obesity, but not sugar/soda/fat taxes. The second just says that the UK Faculty of Public Health supports a sugar tax - CJS.]

He also noted that despite numerous calls to do so, the organisation Christopher Snowdon works for, the UK Institute of Economic Affairs, has consistently failed to reveal its funders. This is despite evidence of its support from the tobacco industry which has been revealed in that industry’s internal documents: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60480-3/fulltext.

“Mr Snowden [sic] is little more than a front for vested business interests seeking to make profits by increasing poor health,” says Mr Powell. “We have enough ‘Dirty Politics’ in New Zealand already without being subjected to the bile of one of their English imports.”

That's more like it, guys! Who needs empirical evidence and logical deduction when you've got unsubstantiated smears, innuendo and personal abuse? Or, if you prefer, 'dirty politics'.

Viva public health!


PS. Whilst in Auckland, I was interviewed by the Sun Star Times. The article ('Anti-sugar campaigners "wowsers"') isn't too bad, but it included a mild attack from one of the sugar tax lobbyists. On this occasion, the man throwing brickbats was Tony Blakely. I was booked to debate with Blakely on television, but he bottled it at the last minute.

You can listen to me talking about the Grit in the Oyster on ABC Radio here. Quite a sensible discussion, this one.



All he wants is the world on a stick



From New Zealand's Whangarei Leader:

Council calls on govt to ban tobacco
A local councillor has spoken out candidly about his addiction to smoking in an attempt to get the country's Smokefree 2025 vision taken more seriously. 

The Smokefree 2025 'vision' (AKA the 'endgame') is so obviously a euphemism for prohibition that it's amazing that Kiwi campaigners pretend otherwise. It is therefore refreshing to hear a politician state clearly what the plan is. The reason, however, is mind-boggling.

Whangarei District Council has resolved to have the mayor write to Prime Minister John Key, calling for a ban on the sale of tobacco products on January 1, 2025.

The man behind the movement, councillor Brian McLachlan, has struggled to give up. He says he's had enough, and many other smokers feel the same.

Try an e-cigarette, Brian.

Oh, you can't. The anti-smoking lobby had them banned.

"Giving up is easy. It's the day after, and the day after that, that's the hard part," he says.

"As soon as you start smoking, addiction sets in with a craving that totally subverts your freedom to choose."

Only in the mad, mad world of Public Health is the criminalisation of a product consumed by one in five adults considered to be a pro-freedom move. Orwell would be proud.


"What I need, now, is simply not to have cigarettes available at the places where I go to fill up my car, buy my groceries or last-minute stuff at the dairy. Whether I can see the smokes or not, I know they're there, and I know I can get them."

It's all about ME!!!

"You can ban smoking from yet more places and push me to a place where I stand out in the rain and feel like some sort of second-class citizen. That may have solved your problem, but it hasn't solved mine. I still need a cigarette."

Oh, just have a cigarette then, you weird masochist.

McLachlan says he is not advocating for smoking to become illegal...

Drinking was never illegal in 1920s America but no one was in any doubt that they were living under Prohibition.

...and overseas tourists would still be able to bring in tobacco for personal use.

Ah, the Bhutanese model. That worked well.

Has New Zealand's public health racket spoken out against the draconian fantasies of this manchild?

Of course not.



Monday, 1 September 2014

Pig ignorant, two-bit columnist of the month

I'm now back from Australia. The lies, nonsense and gibberish have naturally continued in my absence, such as Robert Lustig doing a convincing impression of a raving fanatic and the latest ravings from Sarah Wollaston, which include this doozy...

[Wollaston] argued that if someone wants to lead an unhealthy lifestyle 'of course that's entirely up to them'.

But the government should intervene, with new regulations if necessary, to make it harder for people to buy junk food.

So not entirely up to them, then. See Tim Worstall for a fuller response to Wollaston's nonsense.

But there was one article of such stupendous idiocy - such hysterical, evidence-free garbage - that I cannot let it lie. Vapers are used to pointless, Polly Filler-esque columnists putting pen to paper before engaging their brains but this, from Rachel Lloyd in the Telegraph, belongs in a class of its own.

'I thought my e-cigarette was a miracle. Turns out, I was smoking the equivalent of 40-a-day'

When my local chemist told me to stop vaping immediately, or risk seriously damaging my health I thought he must be having a mad half hour.

Kindly Mr Patel has always struck me a cautious man. It seemed ridiculous that he was making such a fuss.

'Such a cautious man'. I suppose appearing to have a reckless, devil-may-care attitude is not a good move if you're dispensing potentially dangerous drugs, but anyway...

I just couldn’t grasp that something as innocuous as an e-cigarette, widely regarded as the safe alternative to real cigarettes – and commonly used by smokers to quit - could come with any lasting health risks.

There is no evidence that inhaling nicotine in a non-combustible form creates lasting health risks, whereas there is quite a bit of evidence that it doesn't

Now, I think differently and others are starting to, as well. This week, the World Health Organisation (WHO) recommended that e-cigarettes should be banned indoors, because they emit chemicals potentially as dangerous as cigarettes and have a potential passive smoking risk. 

The WHO provide no evidence that there is any evidence of harm from 'passive vaping'. That's because there isn't any. And no credible scientist believes that e-cigarettes are anywhere near as dangerous as tobacco cigarettes. That's because they're not.

Doctors are also calling for more research into the long-term effects.

They are indeed, and so they should, but requests for more evidence into a relatively new product are not evidence of harm to the user, let alone to non-users.

I took up vaping two years ago, during a particularly stressful period and soon found myself addicted - puffing away throughout the day.

Nicotine is addictive. Surely you knew that already?

It was the summer of 2012 when I first succumbed to the habit. My lovely stepfather died towards the end of July that year after a brief battle with cancer. His decline was swift it took us all by surprise and it was hard to see him in hospital without dashing outside for secret weeping breaks.

Meanwhile, my mother - always the rock of the family - was battling a rare and punishing neurological disorder known as Chronic Cluster Headache. Seemingly, overnight she went from perfect health to a hellish existence.

To add to the drama, I started hearing a permanent, high-pitched ring in my ears which I suspected might be psychosomatic but was nonetheless terrifying. I was subsequently diagnosed with tinnitus caused by partial hearing loss in my right ear.

Panic stricken, I wondered if I would ever get to sleep without swallowing copious amounts of sleeping pills.

So, the very last thing on my mind when my friend Jason offered me a drag on his e-cigarette one evening at the pub was whether it might be bad for my health.

Why is that, Rachel? Considering the circumstances, I would have thought that health issues would be at the forefront of your mind.

In fact, all things considered, I could easily have forgiven myself for smoking 20 Malboro Lights a day and weeping into my pillow each night in an orgy of self pity.

Yes, OK, we get it. It was the worst of times. However, you didn't start smoking 20 Marlboro Lights a day. You started vaping instead, which is much the safer option.

That said, I was never a committed smoker. Even back in my twenties my flirtation with nicotine was half-hearted. I was one of those annoying ‘social smokers’ who could be found in pubs ‘borrowing’ fags off bystanders to go with chilled, deliciously deep glasses of Chardonnay.

You do, indeed, sound like an annoying person.

Yet as I sucked on Jason’s e-cigarette (containing, he explained, a harmless amount of nicotine and "few other chemicals") I was struck by how lovely it felt to breathe so deeply. 

Jason's description of e-cigarettes, though vague, is basically correct. The enjoyment you got from the e-cigarette probably had less to do with the joy of breathing deeply than the joy of nicotine entering your blood supply.

When very stressed I tend to revert to tight, shallow breathing. Vaping encouraged me to expand my lungs properly - even if I was filling them up with mysterious substances.
The motion of vaping is soothing and instantly calming, without the guilt that accompanies conventional smoking.
I loved the way the tip of my e-cigarette lit up with each drag, mimicking the glow of a cigarette. When I exhaled a sheet of mist shot out of my mouth like a plume of diamond-coloured smoke.

Yes, yes, we've seen them.

Vaping instantly struck me as a hip, environmentally-friendly alternative to smoking. Why wasn’t everyone doing it?

The reason most people use them (which you have managed to ignore) is that they are cheaper and healthier than smoking. Not everybody wants to smoke and most people who vape aren't particularly interested in being 'hip' or 'environmentally-friendly'.

I loved being able to indulge myself in the office, at the cinema, over dinner and on the tube. And when I saw the rather decadent TV adverts for e-cigarettes, earlier this year, I smiled away sucking at the tip of my e-stick. I was already one of the initiated - and it felt good to be 'ahead of the curve'.

I think I hate you.

But as the months went by I began to question the extent of my vaping. I was spending at up to £30 a week on e-cigarettes

I spend less than £10. Presumably you were using a cigalike.

If I left home without it, I would fly into a panic and immediately prioritise finding a chemist.

Yes, you're definitely using a cigalike. By the way, they are available from many shops other than chemists. Or perhaps you haven't found a newsagent who strikes you as sufficiently 'cautious'.

I couldn’t function properly without my new prop and my dependence increased. It had seemed like a relatively harmless habit. Could vaping really be any more threatening to one’s health - and bank balance - than caffeine, or alcohol?

The available evidence suggests that vaping is about as harmful as caffeine (ie. not very much at all) and rather less harmful than alcohol.

Eventually, in June this year, I sought the advice of my chemist as to ‘cutting down’. Mostly, I wanted to save money.

Warning bells sounded as Mr Patel’s usually cheerful countenance clouded over and he told me stop 'smoking' my e-cigarette straight away.

I wouldn't trust the advice of anybody who uses the term 'smoking' about a product that doesn't involve smoke.

“But I thought the whole point was that they were safe?” I asked [not actually a question so shouldn't have a question mark - CJS], feeling like a child whose sweets were being confiscated. 

No, the whole point is that are safer.

“E-cigarettes contain nicotine," he told me, "which can lead [sic] circulation problems and heart disease. 

The existing evidence does not suggest that nicotine causes heart disease. Insofar as they might cause circulation problems, it would be as a result of a mild increase in the heart rate, as you would get from caffeine or the nicotine products that kindly, cheerful, cautious old Mr Patel happens to sell in his chemist.

"Some have also been found to emit formaldehyde, which is a carcinogenic.”

Formaldehyde can be found in apples, pears, bananas, beetroots, apricots, tomatoes, plums, beef, lamb, cabbage and many other natural foods. The dose makes the poison. It is far from clear whether the small amounts of formaldehyde in tobacco cigarettes cause cancer, let alone that much smaller amounts found in some e-cigarettes do so.

I was horrified, but worse was to come.

Horrified? You said earlier that you thought he was 'having a mad half hour', but never mind.

Two days later I scurried to my doctor for a second opinion. She asked exactly how much vapour I was consuming per hour.

“Up to forty inhalations an hour on a particularly stressful day,” I admitted.

According to her, I was inhaling the equivalent of 40 fags a day – at least in terms of nicotine. There was no doubt about it, I was a vape addict.

If your doctor thinks that a single breath of e-cigarette vapour equates to a whole cigarette then you should seek a third opinion. Or do some research. [UPDATE: As Geoffers points out in the comments, the doctor is referring to 'up to forty' inhalations per hour. My mistake. Even on a 'particularly stressful day', this is still not the equivalent of 40 cigarettes a day. 30 puffs of 18 mg/ml fluid is the nicotine equivalent of one cigarette. If awake for 15 hours, inhaling 40 inhalations an hour, the equivalent daily cigarette consumption would be one pack.]

My love affair with vaping began to unravel. I just couldn’t continue with the habit knowing the potential dangers.

What a dilemma! How to avoid the dangers of nicotine?

But giving up wasn't easy. It took several attempts to finally quit. In the end I switched to a nicotine patch and slowly weaned myself off for good. 

That's right, by taking nicotine in a different form. Lovely, safe nicotine from the pharmaceutical industry instead of horrible, killer e-cigarette nicotine.

If I’d known two years ago what I know now, I would never have started vaping.

With the greatest respect, you don't seem to know anything now. Your knowledge of e-cigarettes has actually gone backwards and you haven't made any effort to look at the significant body of research that exists. Assuming that Mr Patel and your doctor actually exist, you have been unfortunate in asking the opinion of two people who have also neglected to read the research. Nevertheless you could have done so yourself before writing pig ignorant rubbish in a national newspaper.

And I would strongly discourage anyone else from taking it up. Yet, even as I write, I can feel a insidious craving to vape – oh the bliss contained in that first puff of e-cigarette.

Talking about the 'bliss' of vaping might not be the best way to 'strongly discourage anyone else from taking it up', but that's your problem, I suppose.

But I will stand firm come what may...

Such valour! It's only a matter of time before this lady is awarded an award for courage. Her bravery in the face of almost insurmountable first world problems horror brings a tear to the eye.

...and would strongly encourage others to make themselves aware of the risks, too.

I would strongly encourage you, Rachel Lloyd, to make yourself aware of the risks. If you can't be bothered with PubMed, you can start with this list. Please don't write anything else about e-cigarettes until you can tell your arse from your elbow.

Wednesday, 20 August 2014

Oz/NZ

I'm on my way to Australia to attend the Consilium conference. I'll be on a panel speaking "in praise of contrary opinion". If you are in Sydney, we'll be reprising this discussion on the 25th in a public meeting.

On the 26th, I'll be on an excellent panel with Cassandra Wilkinson and Julie Novak to talk about government snooping and the march of puritanism. That event, organised by My Choice Australia, is also in Sydney and will, I hope, be followed by some binge-drinking.

I'll also be paying a flying visit to Auckland to talk about sin taxes at the New Zealand Food and Grocery Council, but that is, I think, restricted to members of that organisation.

I've had a few things to say about nanny state lunacy on the other side of world in recent years. The cancer of public health totalitarianism seems to be partially in remission in Australia since Gillard was kicked out, but it will be interesting to see things with my own eyes. It's been eight years since I visited either country.

I'll be back at the end of the month when normal service will be resumed on this blog.


Tuesday, 19 August 2014

The Fat Lie (plus Channel 4 News)


Yesterday, the IEA published my latest report—The Fat Liewhich presents some of the evidence mentioned previously on this blog related to calorie consumption and obesity. The following is a summary of some of the main points, but please read the whole report which can be downloaded free of charge here.



Obesity prevalence has increased sharply in Britain since the 1970s. Many public health campaigners portray Britain’s obesity ‘epidemic’ as being caused by the increased availability of high calorie foods, sugary drinks and larger servings in restaurants. This view has been reflected in television programmes such as The Men Who Made Us Fat (BBC), which focus on the supposed rise in calorie consumption while paying little attention to the other side of the equation: physical activity. Some campaigners explicitly dismiss physical activity as a factor. For example, Aseem Malhotra, science director of Action on Sugar, says that ‘it’s time to bust the myth of physical activity and obesity’.

Today, the IEA has released a briefing paper that demonstrates that this conventional wisdom has no basis in fact. If people are ‘being bombarded every day by the food industry to consume more and more food’, as some claim, then the industry has failed. Consumption of calories - and of sugar and fat - has fallen significantly while obesity rates have risen.

The Department for Environment, Food and Rural Affairs (DEFRA) has carried out annual surveys of the British diet since 1974. These surveys are based on diet diaries compiled by a cross-section of the public and are supported by till receipts (DEFRA, 2013). Shown in the graph below, these data indicate a significant decline in daily per capita calorie consumption in the last forty years, from 2,534 in 1974 to 1,990 in 2012. This represents a decline in energy consumption of 21.5 per cent.


This is corroborated by the National Diet and Nutrition Survey (NDNS) which began in the 1990s, the results of which can be compared to the Dietary and Nutritional Survey of British Adults which holds data for 1986/87. These surveys collect data for food and drink consumed inside and outside the home. Shown below, they indicate that average calorie consumption has fallen by 9.8 per cent for 19-64 year olds since 1986/87.


Both datasets also show a decline in per capita consumption of carbohydrates (including sugar) and fat (including saturated fat).

It is clear that average body weight has been rising for decades while average calorie consumption has been declining. Assuming that the laws of thermodynamics are correct, there can be only one explanation for this: Britons are, on average, burning fewer calories than we used to.

This should not be surprising. The transition from manual labour to office work saw jobs in agriculture decline from eleven to two per cent of employment in the twentieth century while manufacturing jobs declined from 28 to 14 per cent of employment. Britons are walking less (from 255 miles per year in 1976 to 179 miles in 2010) and cycling less (from 51 miles per year in 1976 to 42 miles in 2010). Only 18 per cent of adults report doing any moderate or vigorous physical activity at work while 63 per cent never climb stairs at work and 40 per cent spend no time walking at work.

Outside of work, 63 per cent report spending less than ten minutes a day walking and 53 per cent do no sports or exercise whatsoever. Add to this the ubiquity of labour-saving devices and it is clear that Britons today have less need, and fewer opportunities, for physical activity both in the workplace and at home.

Obesity features so often in the media that it is surprising that the data shown in this briefing paper are not better known. The myth that Britons are consuming more and more food has persisted for the following two reasons:

Firstly, there is a tendency to import narratives from the USA where, in contrast to the UK, calorie consumption rose in line with obesity rates for many years. This dual trend had come to an end by 1990, however, and the role of chronic physical inactivity is beginning to be acknowledged as the driver of rising obesity in the years since.

Secondly, the food supply is a more inviting target for health campaigners than the sedentary lifestyles of the general public. A war against ‘Big Food’ requires no stigmatisation of individuals (other than the individuals who work in the food industry) and there are a readymade set of policies available which have been tried and tested in the campaigns against tobacco and alcohol. Instigating such a war, however, requires the public to believe that food companies have acted unscrupulously by stuffing unwitting consumers full of calories, forcing large portions upon them and spiking their meals with sugar and fat. The data shown in this paper are clearly not helpful to that narrative.

Such is the sensitivity of the public health lobby to this sort of information that when two researchers published a paper showing that sugar consumption had been declining in Australia for thirty years while obesity had been rising, they were branded ‘a menace to public health’ and investigated for scientific misconduct. They have since been exonerated, but the title of their study - ‘The Australian Paradox’ - highlights how deeply rooted is the belief that obesity can only be the result of increased sugar and/or calorie consumption at the population level. As the evidence from the UK - and, in recent times, the USA - shows, it is no paradox at all.

Reposted from the Institute of Economic Affairs.

See also Tim Worstall and James Dellingpole on this topic.


POSTSCRIPT: CHANNEL 4 NEWS

I went on Channel 4 News to talk about this report (you can watch the interview here).  I confess to getting rather irritated half way through, which I regret because it doesn't go down well with viewers, but I had due cause. I had expected that whoever I was up against would say something along the lines of "OK, people are eating fewer calories but they're still eating too many calories considering their sedentary lifestyle". Then we could argue about policy. I wasn't expecting somebody to flat out deny that calorie consumption has fallen at all, let alone insist—without a shred of evidence—that it has actually risen.

That, however, is what Prof. Mike Lean of Glasgow University decided to do. He pointed out that nutritional evidence is self-reported and is therefore prone to misreporting. He also pointed out that obese people tend to misreport more than slim people. If he had read my report he would have known that this was not news to me. From page 17-18 (under the heading 'limitations'):

Measuring the diet of the nation is not an exact science. Researchers rely on individuals keeping track of what they eat over a period of several days and it is well known that people tend to under-report the amount of food they consume due to a desire to deceive or - more commonly - a tendency to forget (over-reporting is also possible, though less common). The alternative method of keeping till receipts to check what food has been purchased is also problematic because some food is thrown away.
Researchers are well aware of these issues and have ways of testing the degree of under-reporting, notably with urine tests using ‘doubly labelled water’ which show how much energy a person has expended (and, therefore, how much energy a person of steady weight has consumed). Nevertheless, it is believed that Britons throw away about 10-20 per cent of the food they buy and under- report how much they eat by around 20 to 40 per cent (WRAP, 2013; Macdiarmid and Blundell, 1998).
When studying dietary trends over time the question is not whether people under-report but the extent to which under-reporting has changed over the years, if at all. Women and the obese are most likely to under-report and whilst the proportion of women in the population has remained stable, the proportion of obese people has clearly increased. It is therefore possible that more obesity has led to more under-reporting, but it is very unlikely that the population has become so forgetful and dishonest that the large, steady and virtually uninterrupted decline in calorie consumption reported in successive studies can be explained by misreporting alone.

So there is no doubt that people misreport. The only question is whether they systematically misreport far, far more today than ten, twenty or thirty years ago. I can find no evidence that they do and the other sources of evidence, such as food purchases, do not suggest otherwise. As I say in the quote above, food purchase data are not perfect either, because people throw away some food, but it defies common sense to believe that people throw away less food today than they did during the three day week or the winter of discontent.

Having knocked the evidence, Lean then dismissed it completely. Indeed, he said that the reality is the polar opposite of what the evidence shows. It's a common tactic with some keyboard warriors and some of the weaker industry lobbyists—skim a paper, look for the limitations, and then claim that the mere acknowledgement of limitations renders the whole paper worthless. Having dismissed the evidence, insert your own subjective opinions as if they were fact. Never mind that the vast majority of epidemiological evidence—including virtually all evidence on nutrition and cancer—is based on self-reporting and, therefore, is subject to misreporting.

When asked for evidence of his own, he started to quote a study, albeit a barely relevant study, from the USA, thereby proving a point I made on page 24 of The Fat Lie when discussing the reasons why the myth of heavier eating has persisted:

Firstly, there is a tendency to import narratives from the USA where, in contrast to the UK, calorie consumption rose in line with obesity rates for many years.

But—what d'ya know?—the myth is falling apart in America too, as shown in the recent study published in the American Journal of Medicine which found that:

Our findings do not support the popular notion that the rise in obesity in the U.S. can be attributed primarily to sustained increases over time in the average daily caloric intake of Americans... Average daily caloric intake did not change significantly [between 1988 and 2010]. BMI and waist circumference trends were associated with physical activity level but not caloric intake.

Lean's policy of point blank refusal to accept any of the evidence from DEFRA, the British Heart Foundation, the Department of Health, the Institute of Fiscal Studies and the Office for National Statistics turned the discussion into a question of trust—who do you trust: the professor or the increasingly irate free market think tanker? Obviously, the average viewer has no inclination to dig into the data so is going to side with the professor.

British Heart Foundation, 'Coronary Heart Disease Statistics', 2012

Institute for Fiscal Studies, 'Gluttony in England?', 2013

Krishnan Guru-Murthy helped him out by ending the interview with the tiresome question of whether 'Big Food' funded the IEA report. They didn't, of course. Readers of my books, articles and blog posts over the last five years know which topics spark my interest and I'm lucky enough to be able to write about more or less anything I like within the field of public health policy at the IEA. I don't need any suggestions from commercial interests. As for whether 'Big Food' funds the IEA at all, I honestly don't know and I honestly don't care. I don't really know which companies even make up 'the food industry' but it must be a very broad church (I'm from a long line of farmers so I guess I have 'links' with 'the food industry'). The IEA has always had a policy of donor confidentiality so I wouldn't say who funds it even I knew, which I usually don't. But I'm quite happy to say, as I did in this interview, that people are welcome to assume that we are funded by x if that means that we can move on to talking about the issue at hand.

An appeal to authority and a little innuendo about funding goes a long way with the average couch potato—probably more so on Channel 4 News than on most programmes—so I don't doubt that Mike Lean won the debate in many people's eyes. Hey, ho. Hopefully some people read the report regardless.

Monday, 18 August 2014

The plain packs meta-lie (part two)

The second part of the current plain packaging meta-lie is that "customs and excise data shows [sic] a fall of 3.4% in tobacco sales by volume in the first year of standardised packaging" (Public Health England).

Public Health England gives this webpage from the Australian Department of Health as the source for the claim that sales fell by 3.4 per cent in the first year (ie. December 2012-November 2013). That page says that the treasury has "advised that tobacco clearances (including excise and customs duty) fell by 3.4% in 2013 relative to 2012", but it provides no source and there is no trace of the treasury making such a statement.

We might be tempted to take this claim on trust were it not for the fact that the government has produced detailed figures on tobacco sales. They are published by the Australian Bureau of Statistics and can be seen here (table 8).

These data show that seasonally adjusted tobacco sales in the last five years were as follows:

2009: $16,270,000,000

2010: $15,869,000,000

2011: $14,747,000,000

2012: $14,250,000,000

2013: $14,126,000,000

Conveniently, for the purposes of assessing the impact of plain packaging, the 'years' shown above refer to December to November (eg. 2013 is actually December 2012 to November 2013). Mapped on a graph, they look like this:


It should be obvious that plain packaging did not lead to an acceleration of the longterm decline in tobacco sales. On the contrary, it coincided with an unusually small decline. The year-on-year changes are as follows:

2009 to 2010: 2.5 per cent

2010 to 2011: 7.1 per cent

2011 to 2012: 3.4 per cent

2012 to 2013: 0.9 per cent

In case you think that the seasonal adjustment has somehow altered the trend, these are the year-on-year changes based on the unadjusted data:


2009 to 2010: 2.6 per cent

2010 to 2011: 7.0 per cent

2011 to 2012: 3.4 per cent

2012 to 2013: 1.3 per cent

Whichever of the two datasets you use, three things are clear. Firstly, tobacco sales did not fall by 3.4 per cent in the first year of plain packaging. Secondly, the decline in tobacco sales was considerably smaller in the first year of plain packaging than in the preceding years. Thirdly, a decline of 3.4 per cent would not have been unusual even if it had occurred in the first year of plain packaging (the average decline in the previous three periods was 4.3 per cent). But it didn't so it doesn't matter.

You may have noticed that both sets of figures show a 3.4 per cent decline in tobacco sales in the year before plain packaging came in, so perhaps that is the source of the error. I won't rule out deliberate deceit, but routine incompetence is a usually the best explanation for government misinformation. I can't say the same about those who spread this, and other, lies about the alleged impact of plain packaging. They are probably conscious, deliberate liars. They've been doing it for years.

The plain packs meta-lie (part one)

Friday, 15 August 2014

The plain packs meta-lie (part one)

In recent weeks the various dodgy claims made by plain packaging campaigners have coalesced into a single meta-lie which, I suspect, will now be repeated again and again.

The meta-lie has two components. Firstly, that Australia has seen the biggest ever decline in smoking prevalence since plain packaging was introduced. Secondly, that tobacco sales fell by 3.4 per cent in Australia in the first year of plain packaging (with the implication that this is an unusually large drop).

These claims have been repeated by Public Health England...

In Australia, official data is already demonstrating the impact. Its latest national triennial survey shows the fastest decline in smoking rates in over 20 years, and customs and excise data shows a fall of 3.4% in tobacco sales by volume in the first year of standardised packaging... According to the latest official national survey of tobacco use, the daily smoking rate fell markedly from 15.1% to 12.8% between 2010 and 2013 – a record 15.2% decline.

They are also being parroted by ASH Ireland today in the Irish Times...

Latest research results from Australia on its standardised packaging of tobacco products are very encouraging. Official data from its latest national survey show the fastest decline in smoking rates in over 20 years with an 11 per cent relative reduction in the prevalence of smoking. Customs and excise data in the same survey show a fall of 3.4 per cent in tobacco sales by volume in the first year of the legislation.

Let's take the claim about smoking prevalence first. This contains a lie within a lie. The figures that campaigners are referring to compare 2010 with 2013. Plain packaging was only introduced in December 2012 so anything that happened in two-thirds of that period cannot possibly be attributed to olive green fag packets. Moreover, there was a whopping 25 per cent tax hike on tobacco in 2010 which the government predicted would reduce the number of smokers "in the order of 2 to 3 per cent, or around 87,000 Australians."

Using two data points three years apart when plain packaging wasn't in place for most of the period in question is obviously a poor method of assessing the impact of the policy. We do have data that shows annual changes in smoking prevalence, but plain pack campaigners ignore it because it clearly doesn't support the claim they want to make.

Leaving all that aside, the claim about smoking prevalence doesn't stand up even on its own terms. The graph below shows smoking prevalence in Australia since 1995 (in three year increments).



Anyone whose job does not depend on not seeing things can see that there has been a steady, longterm decline in the smoking rate. Prevalence fell in every three year period and did so consistently and predictably within a narrow range of 0.9-2.4 percentage points.

The biggest decline in this period was not—as campaigners are claiming—between 2010 and 2013 (2.3%), but between 1998 and 2001 (2.4%). 2010-13 did not see the biggest decline in smoking rates since records began (as Martin Dockrell claimed on the radio recently). It was not even the biggest decline in the last fifteen years.

So why do they say it was? Simon Chapman seems to be the source of this particular bit of spin. He's keen to focus on the percentage differences between the percentages rather than look at the decline amongst the whole population. Therefore, he's looked at the percentage drop from 15.1% to 12.8% (which is 15.5%) and decided that this is the only number worth talking about. His method has the effect of downgrading what was genuinely the biggest decline in the time series that occurred between 1998 and 2001 (21.8% to 19.4% = 11.0%).

To see why this is a statistical trick, consider the graph below which shows a constant decline of 5 units from 50 to 0.


The decline is completely straight and linear, but if you measured it using Chapman's method you would get the impression that the decline speeds up rapidly and exponentially (see the percentage figures on the horizontal axis). In the early stages of the decline, the percentage drop is quite small (10%, 11.1% etc.), but as the numbers are diminished the same drop leads to much bigger declines in relative terms, ultimately ending in declines of 50% and 100%. Every step down represents the biggest ever decline up to that time even though the drop is always exactly the same.

Therefore, if the number of smokers is dwindling year-on-year (as it is in most Western countries) and there is a constant and steady decline in the smoking rate, it is a mathematical inevitably that you will keep seeing a record decline if you measure it as Chapman does even if the rate of decline of smoking in the population does not accelerate. Of course, the smoking rate does not fall by exactly the same amount every year so it is not a certainty that records will always be broken, but so long as the decline is roughly constant the probability of a record being broken rises as the numbers get smaller.

This is not the way the data are normally looked at, nor is it the way they should be looked at. Chapman resorts to this tactic because it helps disguise the simple fact that the smoking rate has been falling a steady but pedestrian pace for many years and has continued to fall at the same pace since 2010.

Plain packaging wasn't introduced in 2010 or 2011. It was introduced in December 2012, so the question of whether there was a record drop in the smoking rate between 2010 and 2013 is academic so far as that policy goes. Nevertheless, for the record, there wasn't.

To be continued...