Wednesday, 23 April 2014

Alcohol and violent crime

From the front page of The Times...

Shock drop in violent crime

Serious violent crime has halved in a decade as Britons cut down on binge-drinking and move towards a less macho culture, research has found.

This echoes a very similar story from the same newspaper last year...

Violent crime has fallen to its lowest level for 30 years and firearms offences are down for the eighth year in a row.

Indeed, the same story could have been told every year for the best part of two decades. The Office for National Statistics notes that violent crime peaked in 1995 and has been falling ever since. A similar trend has been seen in many developed countries and no one knows quite why.

Many theories have been put forward to explain why murder and violent crime started falling dramatically in the early 1990s. Some attribute it to the the rise of CCTV. Others say it is the result of higher incarceration rates. The Freakanomics authors link it to legalised abortion. Earlier this week, the BBC revived the intriguing idea that it is due to the decline of leaded petrol (although I suspect this is a classic correlation without causation). The Spirit Level authors try to link it to inequality (despite the fact that there is not even a correlation in that instance). And so on.

Today, the claim is that it is due to the decline in alcohol consumption...

Jonathan Shepherd, lead author of the study by the University of Cardiff’s Violence and Society Research Group, said: “Binge drinking has become less frequent, and the proportion of youths who don’t drink alcohol at all has risen sharply. Also, after decades in which alcohol has become more affordable, since 2008 it has become less affordable. For people most prone to involvement in violence, those aged 18 to 30, falls in disposable income are probably an important factor.”

It's always nice to see the press report the decline in alcohol consumption, which now amounts to an 18 per cent fall since 2004. The problem with the boozing/violence theory is that the ONS's figures show that the biggest fall in violent crime preceded the fall in drinking by ten years. Since then, the decline has been less impressive...

Between the 1995 and the 2001/02 surveys, the number of violent crime incidents fell, from 4.2 million in 1995 to 2.7 million in 2001/02. Since then there has been a general trend where the CSEW [Crime Survey for England and Wales] has seen a period of modest annual decreases (though often not large enough to be statistically significant year on year).

The ONS shows the rise and fall of violent crime in this graph...

It's also refreshing to hear - contrary to the usual hand-wringing - that alcohol has been getting less affordable in recent years, not that it will stop talk of 'pocket money prices' or silence those who want even higher taxes on booze. Changes in affordability are primarily the result of changes in incomes (alcohol is still more expensive in real terms), and incomes have fallen back to the levels of 2004 during the economic crisis.

Alcohol affordability has therefore also returned to the level of circa 2004. In the great scheme of things, this change is not huge. After a dip during the recession, affordability seems to have ticked upwards again more recently. As temperance campaigners would happily point out in any other context, alcohol is more affordable than it was when violent crime was much more common.

None of this really tallies with the alcohol consumption data, which show that per capita consumption started rising in the mid-1990s just as violent crime was starting to fall and started falling while alcohol was still becoming more affordable.

It wouldn't be surprising if alcohol consumption and violent crime were linked; a lot of violent crime is committed by drunks. And it is certainly true that recent years have seen a decline in both, but the correlation does not stand up if we go a few years further back.

The bigger picture shows that the decline in violence - which has been seen in other countries which have very different drinking patterns - preceded the decline in alcohol consumption by many years and was initially accompanied by a significant increase in alcohol consumption. The decline in violence was also accompanied by an increase in the affordability of alcohol until quite recently.

So whilst we cannot rule out a 'recession effect' on heavy drinking amongst some groups which might have had an impact on the prevalence of violent crime, it does not seem to have been - indeed, cannot have been - the cause of the long-term decline.

Tuesday, 22 April 2014

Toys out of the pram

The toys are out of the pram again in Scotland with the latest hissy fit from the temperance lobby.

A high-profile health group has criticised the Scottish government’s decision to include representatives of the alcohol industry on a Holyrood body examining licensing hours.

Evelyn Gillan, chief executive of Alcohol Focus Scotland, said that the Scottish government had dismissed concerns from public health bodies over the presence of representatives of the alcohol industry on the National Licensing Advisory Group (NLAG).

The 'representatives of the alcohol industry' are the Scottish Retail Consortium, the Scottish Licensed Trade Association and the Scottish Grocer's Federation, all of whom are entitled to have their voices heard on a matter that clearly affects them. By contrast, the 'high-profile health group' is Alcohol Focus Scotland, a government-funded sock puppet that represents no one at all.

The temperance nutters in Scotland, as elsewhere, have a 'no platform for industry scum' stance and have predictably stormed out...

The body was set up to explore ways for “improving the operation of the licensing regime”, but NLAG’s four public health representatives, including Dr Gillan, quit after the government failed to agree to proposals to restrict the role of the drinks industry on the group.

By 'restrict', they mean 'eliminate'. In the Stalinist world of public health, it is not enough to be invited to the party. Everybody else must be forced to leave.

This all started when the temperance groups demanded the industry groups be thrown off the panel last year...

The dispute dates back to November, when the four health experts wrote to Mary Cuthbert, a civil servant and NLAG chairwoman, calling for NLAG to be made up of licensing regulators, such as local authorities, rather than industry representatives.

The letter read: “In our view, it is not appropriate for the producers and retailers of alcohol to be involved in determining the conditions of their own regulation in the manner that the NLAG’s membership and work programme entails.”

This game of brinkmanship backfired when the government decided that the licensing group should be more than a forum for anti-alcohol agitators.

The quartet then wrote to Kenny MacAskill, the justice secretary, warning him that there was what they called an “obvious conflict of interest” in having industry representatives in NLAG, but Mr MacAskill said that the group’s diverse membership offered a “valuable fresh perspective”.

And so they quit. Adios, so long, close the door behind you, etc. We are used to 'public health' lobbyists going home and taking their ball with them when they don't have a 100 per cent majority in a meeting.

Except it's not their ball and they can't take it home. As with the Responsibility Deal, proceedings continue in their absence.

Rather generously, the government has told the unruly toddlers of public health that they "remain welcome to return to the group", an offer that would surely not be extended to the industry bodies if they had acted in the same petulant manner. Almost incredibly, Alcohol Focus Scotland has instead decided to attack the NLAG for not having any 'public health' groups on it.

Dr Gillan said: “We are very disappointed in the government’s attitude. This is now a predominately industry body, examining a public health issue. There are now no public health organisations involved on this body, so it is wrong to say NLAG incorporates a broad mix of views. The health perspective is missing.”

Er, that's because you all left, remember?

Plain packs - just the facts

I've written a concise paper about the issues facing the UK government with regards to plain packaging for the IEA.

The Chantler review was only ever intended to give the 'public health' perspective on this policy, but there are many other important aspects to consider. This paper looks at them all and suggests the government does likewise.

You can download it here (PDF) and there's a summary here.

Wednesday, 16 April 2014

The scream test

In the field of public health they have something called the 'scream test'. This says that you know that a policy will work if the industry involved kicks up a big fuss and complains. It is assumed that anything that annoys or damages the industry must be good for people's health.

As childish as this sounds, they really believe it...

One of the measures used by anti tobacco campaigners to determine the effectiveness of an innovation, action, legislation or reform is how loudly the tobacco industry “screams”.

If the tobacco industry complains loudly and long and lobbies all the politicians it can find then you know that you are winning. You know that whatever it is the anti-tobacco campaigners or governments have done is going to reduce sales of tobacco.

Although initially used with regards to tobacco, this theory has inevitably been applied to other industries that zealots dislike...

Tomorrow sees the start of Senate hearings on the alcopops tax. This tax passes the “Scream Test” with flying colours: its impact on sales could not be clearer from the way the distillers are opposing it. [The alcopop tax was another public health glorious failure, see here for details - CJS]

The scream test is one of the most pathetic and risible concepts in a field that abounds with idiocy. It has been much in evidence in the debate about plain packaging. Lacking serious evidence that plain packaging won't be another over-hyped cock up, campaigners have resorted to saying "hey, it must work otherwise the industry wouldn't be spending so much time opposing it, right guys?"

Here are just a few of the many uses of this fallacious argument...

“This absolutely passes the tobacco industry scream test. They have thrown major PR resources at it, major legal resources at it." (Sheila Duffy, ASH Scotland)

"Why would the tobacco industry and its allies be so vehemently opposed to plain packaging if they weren’t so frightened that plain packaging would work?" (Deborah Arnott, Director ASH England)

"If [plain packs] have no impact then Big Tobacco has nothing 2 fear. Go figure." (Simon Chapman, Australian brain donor)

But, as Chapman let slip two years ago, the reason the industry is opposed to plain packaging is the same reason any industry would 'scream' about it. A ban on branding hinders their ability to make more profit from premium brands. It is not about fears that smoking rates will fall - which is what the campaigners mean when talk about the policy 'working' - but about making profits in a declining market from selling more expensive brands. And, since the anti-smoking lobby is in favour of more expensive cigarettes, plain packaging is a counter-productive policy for both sides.

Chapman is not the only one who knows that the 'scream test' nonsense is a rhetorical trick. Tucked way in the transcripts of Cyril Chantler's interviews is the same admission from another anti-smoking sociologist, Luk Joossens.

"There is only reason why [cigarette companies] are campaigning so heavily against plain packaging: because they've made their gains with premium brands and they believe there will be shift to the cheaper brands and they will lose their profits."

Bear that in mind next time someone uses the scream test argument. As the man says, "there is only one reason why they are campaigning so heavily against plain packaging" and it is the fear of brand-switching.

If Breaking Bad was really set in Britain

Since the last season of Breaking Bad was broadcast, there's been an amusing cartoon doing the rounds suggesting that the concept wouldn't have worked in any country other than the US.

Although I hate to tarnish American liberals' rose-tinted view of socialised medicine, I would suggest that the conversation in Britain would go more like this:

"I'm afraid you have incurable lung cancer."

"Can you give me any drugs to prolong my life?"

"I'm afraid not. The NHS can't afford them. Lung cancer patients, in particular, are a low priority."

"Can I pay the NHS to give me these drugs?"

"I'm afraid not. That would be illegal. You can obtain them if you have private health care. Do you have private health care?"

"No. I can't afford it. A large part of my lifetime income has been spent on tax and national insurance to provide me with cradle-to-grave health care. I guess I'll have to start making crystal meth."

"There isn't enough latent demand for crystal meth in the UK to make it worthwhile."

"Damn it."

"You're going to die. There's a 70 per cent chance you'll be dead within a year. Unlike the US, which has the highest cancer survival rates in the world, rates in Britain are very low, particularly for lung cancer."

"Aw, man."

"It serves you right for smoking."

"I don't smoke."


Tuesday, 15 April 2014

An interview with Dr Ashok Kaul

Last week I mentioned that the only piece of real world evidence about underage smoking rates in Australia since plain packaging was introduced was not mentioned in the Chantler review. The research was carried out by the statisticians Dr Ashok Kaul and Dr Michael Wolf. It was presented to Chantler's team in a meeting in London last month and clearly indicates no increase in the rate of decline of smoking prevalence amongst 14-17 year olds in the thirteen months between December 2012 (when plain packs came in) and December 2013.

ASH director Deborah Arnott has since co-authored a letter to The Lancet in which she complains that 13 months is not long enough to see an effect (she doesn't explain why) and claims (wrongly - see below) that an implausibly large effect would be needed to show up as statistically significant.

I decided to e-mail one of the authors, Dr Kaul, to ask him what was going on and he generously agreed to answer a few questions on the record. Here they are...

You met with some of Chantler's team in March 2014 and explained your research in great detail. Why do you think it was not mentioned in his final report?

It is difficult to speculate about the reasons why our research was not explicitly referenced. The Chantler review team claims that our work was considered in reaching the conclusions of the review. We find this quite remarkable, though, since Sir Chantler apparently did not feel the need to reference the only paper on plain packaging based on real-world data in his report to support his findings. In particular, a neutral reader of the review would expect to find a complete reference list of original research to be able to draw his own conclusions.

In response to your research, some proponents of plain packaging have implicitly accused you of 'misrepresentation of the evidence'. In particular they criticise the 'small sample size'. How do you respond?

We not appreciate being implicitly accused of `misrepresentation of the evidence'. We have analyzed the data in a completely open and reproducible way. If anything, as detailed in the paper, there is a (slight) bias in our methodology in favor of finding a plain packaging effect. But we have not found any evidence of a plain packaging effect. What exactly does `misrepresentation' mean in this context? We agree that the sample sizes are relatively small, and state this explicitly in the paper. Currently, in our opinion, there is no better data set available.

How much of an immediate effect on smoking prevalence would be needed to pick up a statistically significant decline in this data set?

Despite the relatively small sample sizes, the power of our methodology against a meaningful immediate effect on smoking prevalence is not tiny. For example, the power against an immediate effect of reducing smoking prevalence by 0.5 percentage points (beyond the existing time trend) would have been around 0.65. This is quite large, actually. A power near 1.00 is never realistic; a typically number one aims for in controlled (!) experiments is 0.8. In a nutshell, our approach would detect a non-negigible effect of plain packaging on smoking prevalence of minors in Australia with a pretty high probability - despite the small sample size. Criticizing the 'small sample size' is therefore quite absurd.

Are you aware of any other empirical evidence on youth smoking since plain packaging was introduced in Australia?

We are not aware of any other piece of research based on real-world data on the effects of plain packing on youth smoking behavior in Australia. We are therefore quite disappointed that our work was not explicitly referenced in the Chantler review.

Some campaigners have said that they would not expect any short term effect from plain packaging on underage smoking. Do you have a view on this?

Some people expected a short-term effect, others did not. It is a legitimate and important research question to ask whether there is evidence for a short-term (lasting) effect of plain packaging. The empirical evidence so far does not support the conclusion of a short term effect. Of course, short-term effects are important for policy makers around the world who would like to chose their regulatory policies from a set of alternatives that have been proven to be effective - plain packaging is so far not part of this set.

Together with the fact that Chantler ignored the 0.3 per cent increase in cigarette sales since plain packaging came in - along with other empirical evidence - the decision to overlook the only real world figures on smoking prevalence seems rather strange, to say the least.

Monday, 14 April 2014

So now e-cigarettes are tobacco products AND medicines?!

Via Jo Lincoln
From the Financial Times...

Electronic cigarette users are set to be banished to the pavement alongside their tobacco-smoking cousins – and face similar hefty prices – if the World Health Organisation pushes ahead with plans to regulate e-cigarettes in the same way as normal tobacco.

Leaked documents seen by the Financial Times revealed that parts of the WHO are keen to classify the battery-powered devices as tobacco under the Framework Convention on Tobacco Control, a WHO treaty that obliges governments to curtail smoking rates across the globe.

The forces ranged against e-cigarette users are endless and become less accountable at every turn. We have already been faced by the MHRA, the Department of Health and the European Commission. Now comes the World Health Organisation, an unelected body with strong financial links to the pharmaceutical industry which holds its meetings on tobacco in notorious secrecy.

Why, you may ask, has the Department of Health been conniving to have e-cigarettes regulated as medical products while the WHO is conniving to regulate them as tobacco products? Aren't medicines at the opposite end of the spectrum to tobacco products?

Of course they are. It makes no sense at all until you consider that the WHO's Framework Convention on Tobacco Control can only be applied to tobacco whereas the MHRA only regulates medicines. Necessity is the mother of invention, hence the eager rush to pretend that e-cigarettes are something they not.

The WHO's excuse for classifying e-cigs as tobacco products is that the nicotine in them comes from tobacco. But the nicotine in patches and gum also comes from tobacco. And whilst it is possible to artificially synthesise nicotine without using tobacco, it is much more expensive and the resulting fluid would be exactly the same. It is a risible justification.

The fact remains that e-cigarettes are neither tobacco products nor medicines. They are consumer products and should be regulated as such. They have nothing to do with the MHRA or the WHO. They have nothing to do with the corrupt 'tobacco control' lobby that has objected to them from the start because never featured in the prohibitionist blueprint.

Quite how the British government is going to square e-cigarettes being both medicines and tobacco products is a question for another day. On the plus side, very few of the signatories of the Framework Convention on Tobacco Control have implemented all of the WHO's recommendations. It can be ignored with apparent impunity. On the down side, the UK is one of those countries.

As difficult as it was for vapers to make the EU see some sense on this issue, the hardest task is yet to come. The WHO is completely outside the democratic process and answers only to itself. There is a long road ahead.

For further reading head to City AM and Dick Puddlecote.