Friday, 23 January 2015

Will plain pack campaigners put their money where their mouth is?

I don't know if you heard, but Britain's government of nominally conservative and liberal politicians gave the green light to plain packaging this week. The vote in parliament will be a formality.

The surprise announcement on Wednesday night was the culmination of several years of intense campaigning which swallowed up millions of pounds of taxpayers' money and yet the idea remains as futile, silly and counterproductive as it was when I first wrote about it six years ago. More so, in fact, because we have since had real world evidence from Australia proving its ineffectiveness.

The campaign has gone on so long that I suspect the public will expect to see real results this time. It won't be like graphic warnings or the ban on cigarette vending machines, when legislation was pushed through quickly and then forgotten about. The public health lobby has an aversion to assessing its policies in retrospect for obvious reasons—most of them don't work. As I have said many times before, tobacco control is not a results-driven business, but the claims about plain packaging have been so hysterically overblown that I don't think the public will forget them overnight, no matter what fresh campaign is launched to take our minds off it.

We have been told, by none other than the corpulent 'public health' luminary Martin McKee, that the best way to tell if an anti-smoking policy is effective is to watch the markets.

We are also told that plain packaging is a bigger deal in the UK than it is in Australia. We have a larger population and we are regarded as more influential to copycat nations in the West than distant Oz. So how did the markets react to the seismic news this week?

Here's BAT's share price...

Here's Imperial Tobacco's share price...

And here's Philip Morris's share price...

ASH et al. have committed a lot of money to the idea of plain packaging in recent years, most of it belonging to taxpayers. Would they, I wonder, bet their own money on the policy working? Because the people who actually do have money in the game are calling their bluff.

Wednesday, 21 January 2015

Unsurprising quote of the week

The latest from our friends in the public health lobby...

"Our end game is to bring sugary fizzy drink consumption down to zero in 2025, similar to the end game for tobacco consumption."

See this post for a reminder of who these advocates of "stopping the availability of sugary drinks in New Zealand" are, and see Feminoptimal for further comment.

Tuesday, 20 January 2015

We're public health, we say what we want

This is a relatively minor lie by 'public health' standards, but telling nonetheless. Kevin Fenton is the director of health and wellbeing at Public Health England. Last week he informed his Twitter followers that...

The trouble is, if you check the source he cites, it doesn't say that at all. It says this:

For children aged ten years and under, the main sources of NMES [non-milk extrinsic sugars] were ‘non-alcoholic beverages’ (27-30%) and ‘cereals and cereal products’ (25-29%). For children aged 11 to 18 years, ‘non-alcoholic beverages’ was the largest contributor to NMES intake, providing 40%, mainly from soft drinks (30%). ‘Fruit juice’ contributed 10-14% to NMES intake in children across the age groups. ‘Sugar, preserves and confectionery’ contributed an additional 19-22% to intake for children.

The appendix shows the % of sugar that comes from fruit juice and soft drinks in detail (click to enlarge).

Call me a pedant if you must, but I've always been under the impression that a majority is any percentage above 50 per cent, and that figures like 27 per cent, 30 per cent and—if you count fruit juice as a 'sugary drink'—40 per cent are known as a 'minority'.

Never mind though, eh? Fenton only relieves the taxpayer of £175,000 a year to do this job.

For the record, here's what the other tireless public servants at this quango get paid..

Name Job title Professional qualifications How appointed Salary level
Duncan Selbie Chief Executive MSc Open competition £185,000 to £190,000

Lis Birrane Director of Communications NCTJ Proficiency Certificate PGDip Job matching £100,000 to £105,000
Michael Brodie Director of Finance and Commercial CPFA Open competition £105,000 to £110,000
Dr Paul Cosford Director for Health Protection and Medical Director MBBS MSc MRCPsych FFPHM Job matching £160,000 to £165,000
Dr Yvonne Doyle Regional Director MD MPH FRCPI FFPHM FFPHMI DCH Job matching £165,000 to £170,000
Professor Kevin Fenton Director of Health and Wellbeing MBBS MSc Dip GUM FFPH PHD Open competition £175,000 to £180,000
Richard Gleave Chief Operating Officer MSc Open competition £130,000 to £135,000
Dr Jenny Harries Regional Director MBChB MPH MBA PGDip PGCert FFPH FCMI Open competition £125,000 to £130,000
Professor Paul Johnstone Regional Director BM MSc MRCGP FFPH Job matching £180,000 to £185,000
Jonathan Marron Director of Strategy MBA Open competition £110,000 to £115,000
Dr Christine McCartney Director of Microbiology Services PhD MRCPath FRCPath Fixed term appointment £55,000 to £60,000
Stephen Morris Development Advisor None Secondment £120,000 to £125,000
Professor John Newton Chief Knowledge Officer MBBS MRCP MS Open competition £165,000 to £170,000
Dr Rashmi Shukla Regional Director BM FRCP FFPH Job matching £165,000 to £170,000
Alex Sienkiewicz Chief of Staff None Secondment £110,000 to £115,000
Tony Vickers-Byrne Director of Human Resources FCIPD DMS PGCE Masters in Workforce Planning Job matching £100,000 to £105,000
Sally Warren Director of Programmes None Open competition £80,000 to £85,000


Monday, 19 January 2015

Great extrapolations in wealth and obesity

"If current trends continue..."

Oxfam have been given lots of news coverage today thanks to a report which claims that the richest 1% will 'control' more than half the world's wealth by 2016.

The prediction is based on this graph (from page 2 of their report).

The weaknesses of this extrapolation should be obvious, although they seem to have eluded the BBC, The Guardian et al. Oxfam cherry-picked four years of data and drew a straight line extending out from them. And, just to be sure of getting the right result, they ignored the most recent year, presumably because it suggests that the trend is flattening out.

The idea that the 1%'s share of wealth rises in a straight and linear fashion (because of Global Capitalism - boo!) is a fiction. One only needs to look at the other graph on page 2 to see this.

Here we see that the 1%'s share of wealth was declining when the global economy was booming, rose after the financial crisis began and seems to now be levelling off. We also see that the 1%'s share of wealth is smaller than it was 15 years ago—a fact that Oxfam chooses not to mention, perhaps because it doesn't suit their claim that 'global wealth is increasingly being concentrated in the hands of a small wealthy elite.'

The 1%'s share of wealth may now be about to fall again, or it may stay flat, or it may rise. Without an understanding of why it fluctuates in the first place (which Oxfam, being economically illiterate, does not have), it would be foolish to speculate. But what you really should not do is cherry-pick a handful of years when the share of the 1% rose and assume that this trend will continue inexorably.

Seeing Oxfam's graph I was immediately reminded of the various obesity predictions which use the same cretionously stupid methodology. Take the ironically titled Foresight report of 2007, for instance. This highly influential report told us:

The extrapolation of current trends, which underpins the microsimulation, indicates that, by 2015, 36% of males and 28% of females will be obese. By 2025, these figures are estimated to rise to 47% and 36% respectively. By 2050, 60% of males and 50% of females could be obese.

To state the obvious, it is now 2015. Are 36 per cent of British men obese? Well, we can't say for absolute certain because there is a peculiarly large delay in getting these figures out, but the most recent data go up to 2012 and I doubt that I am leaving a hostage to fortune by confidently saying that they are not. Not even close.

The obesity rate for men in 2012 was 24.4 per cent, less than one percentage point higher than it was in 2007. This is the Foresight prediction plotted on a graph alongside the actual data.

You can see what the Foresight authors did here. Rather like Oxfam, they found a trend that suited them (ie. the 1990s), ignored the most recent data (they had figures going up to 2004 when they wrote the report) and extrapolated a straight line going ever-upwards.

It is a mystery why the Foresight authors thought that male obesity would be so much higher than female obesity by 2015. Female obesity was higher when they wrote their report and it remains so today (although, of course, lower than they predicted: 25.1 per cent—and falling—in 2012).

As with wealth inequality, there is no reason to think that rates of obesity will rise forever, let alone that they will rise in a straight line. But, as with Oxfam's report, the real aim of the Foresight report was not to produce a credible prediction, but to create alarming headlines such as 'Half of adults "will be obese by 2050"'.

The Foresight report's conspicuous failure to make a vaguely accurate prediction of what would happen in five years time should cast serious doubts on their predictions of what would happen in 35 years time. Nevertheless, the claim that half of adults will be obese by 2050 continues to be made by campaigners for various taxes and bans. In 2011, the BBC stated as fact that 40 per cent of adults will be obese by 2030, based on an equally spurious extrapolation in The Lancet.

It is also worth bearing in mind the fact that the Foresight predictions are the basis of many claims about the financial cost of obesity in the future. These cost estimates have already been shown to be highly inflated, but since the Foresight predictions of obesity prevalence have so far borne no resemblance to actual rates of obesity, they should be considered worthless.

Finally, if you are thinking to yourself that obesity rates would have risen to the heights predicted in 2007 had it not been for the valiant effort of public health campaigners, remember that these very campaigners have accused successive governments of failing to tackle the problem. None of the policies that these people have campaigned for have been enacted and, according to anti-obesity industry, the government's Responsibility Deal has been "utterly inadequate" and "will not work".

The inexorable rise of obesity predicted in 2007 has not been averted by 'public health' legislation. It was simply never going to happen.


My thanks to Rob who contacted by e-mail to tell me that the 2013 figures came out last month (see here). They show that male obesity rose to 26 per cent and female obesity fell to 23.8 per cent.

Taking both sexes together, the UK adult obesity rate was 24.9 per cent in 1913.

In 2007, it was exactly 24 per cent.

According to the Foresight report, it will be 32 per cent in 2015. If anyone would like to place a wager on this prediction coming true, I would be delighted to bet against you.

Here's the male obesity graph updated with the 2013 figure...

Friday, 16 January 2015

Fact-checking Action on Sugar

When Labour announced yesterday that they would be aiming their public health rifles at tobacco, alcohol and sugar—rather than the traditional trio of tobacco, alcohol and obesity—it was a major win for Action on Sugar. Despite being barely a year old, this pressure group enjoys blanket media coverage and easy access to politicians.

Last year, their representatives met with Jeremy Hunt to present their 'Childhood Obesity Action Plan'. They would certainly have delivered the same document to Labour health spokespeople like Luciana Berger.

I only got around to reading it yesterday and I wasn't expecting much, but it is conisderably worse than I feared. In fact, it is an absolute disgrace. Time and time again Action on Sugar make hyperbolic and downright false claims that cannot be supported by their own citations, let alone by the wider scientific literature. It is scary to think that there are people in power who take them seriously.

Here are some of the statements they make in this document, along with the references they cite.

Obesity in childhood is strongly linked to the constant availability and consumption of ultra-processed foods and sweetened soft drinks(1). 

Source (1) cited here is Dietary Determinants of Obesity by Susan Jebb. This study doesn't discuss availability at all, nor does it mention 'processed' or 'ultra-processed' foods. For that matter, it only mentions children on two occasions, both of which I quote below.

With regards to 'sweetened soft drinks', it says: 'Cohort studies show either no relationship or a positive association between sugar-rich drinks and weight gain or obesity in adults or children'. Hardly a 'strong link'.

With regards to sugar, it says: 'While some studies show a protective effect of a high proportion of carbohydrate, many others show no association, particularly for studies in children [nb. sugar is a carbohydrate]. The evidence relating to the intake of sugar per se to weight change in inconsistent'. Again, hardly a 'strong link'. Indeed, barely even a hint of a link.

Jebb concludes that the strongest link with obesity is not with sugar at all, but with fat, saying: 'The strongest evidence for an increased risk of obesity relates to diets that are high in dietary fat or low in fibre'. Not quite what Action on Sugar would have you believe, and yet they cite it anyway.

From the outset, then, Action on Sugar totally misrepresent what researchers are saying in their own footnotes. 

These calorie-dense foods have no nutritional value, and are laden not only with sugar, but saturated fat and salt, leading to raised cholesterol and blood pressure, which further increases the risk of cardiovascular disease.

It is unclear which foods they are talking about, but if they contain sugar and fat, they will have some nutritional value because - guess what - carbohydrates and fats are nutrients. You can just about argue that fizzy drinks contain 'empty calories' if you must, but you cannot say that food has no nutritional value just because you don't like the nutrients in it. If it is food, it has nutritional value by definition.

Sugar that is added by the food industry is a major hidden source of calories in many foods and is an unnecessary source of calories that contribute directly to type II diabetes(2) and dental caries(3).

Citation (2) is Dietary Sugars Intake and Cardiovascular Health by Rachel Johnson et al., published in Circulation in 2009. As the titles of the study and journal suggest, it is primarily about cardiovascular disease, not diabetes. In its eleven pages, it mentions diabetes just three times, most relevantly when the authors say that 'fructose consumption has been indirectly implicated in the epidemics of obesity and type 2 diabetes' (my emphasis).

They say indirectly because too much sugar, like too much of any food, can lead to obesity, and obesity is a risk factor for diabetes. This is very different to Action on Sugar's heterodox theory that sugar somehow causes diabetes 'directly' even in people who are not obese. The difference between 'contributing directly' and being 'indirectly implicated' is massive in this context.

Although fluoridation has a small impact, it merely delays the onset of caries, so that in the end all adults develop caries.

Not all adults develop caries [tooth decay] and prevalence of caries has been falling for several decades. As the graph below shows, it is difficult to assess the impact of fluoridation, but fluoridation isn't the main weapon against tooth decay. Toothpaste is.

They continue:

The constant availability, cheapness and overwhelming marketing of ultra-processed foods and soft drinks have changed the food environment in the last 20 years

Per capita sugar consumption has fallen in the last twenty years.

The current policies such as the Responsibility Deal, where the food industry has pledged to reduce calories but can then decide what they do, has not had any effect on calorie intake on a public health scale.

Calorie consumption has fallen in recent years, both for food eaten inside and outside the home. Whether this is due to the Responsibility Deal is another question.

Nevertheless the sweetened soft drink and food industries are starting to acknowledge their role in causing the obesity pandemic worldwide, and also realise that it is entirely their responsibility to reverse it.

Even the more hardened 'public health' campaigners acknowledge that personal responsibility plays at least some part in maintaining a healthy weight, both in eating and exercise habits. Claiming that 'Big Food' and 'Big Soda' are entirely responsible for making people slim - and, by association, have been entirely responsible for making people fat - is absurd.

Removing 100kcal from the diet has been predicted to prevent the development of obesity and type II diabetes(4).

Source (4) is a reference to the government's Healthy Lives, Health People policy paper (pp. 19-20). It says: 'A group of independent experts, chaired by Professor Ian MacDonald, has considered data on weight gain in England and advised that a reduction in energy intake of 100 calories per person per day on average would correct the energy imbalance at a national level and also lead to a moderate degree of weight loss' (my emphasis).

Once again, Action on Sugar totally misrepresent their source. The policy paper does says not claim that a reduction of 100 calories a day would 'prevent the development of obesity' and it does not even mention diabetes in this context.

It is widely accepted amongst the lay public and media that consuming more calories than we burn is the cause of the obesity epidemic, and thus the solution is to do more exercise. This is not correct. Obesity is due to eating too many calories, particularly food and soft drinks that give no feeling of satiety or fullness.

This is an astonishing repudiation of science. For a start, it directly contradicts what Susan Jebb wrote in the review cited by Action on Sugar earlier. She says explicitly, at the very start of her article, that 'One of the few incontrovertible facts about obesity is that weight is only gained when energy intake exceeds energy needs for a prolonged period... Obesity results not from a high absolute energy intake but from intake which exceeds energy needs, even as a small fraction of energy flux. It is thus the coupling between intake and expenditure that lies at the heart of the problem.'

Here we have Action on Sugar taking not just 'one of the few incontrovertible facts about obesity' but the first law of thermodynamics and turning them on their heads. These people will tell you—or, rather, tell your MP—that black is white. Almost everybody understands that calories out is just as important as calories in, and that exercise—whilst not the only solution to obesity—is certainly one of them. Public Health England, for example, says: 'The link between physical inactivity and obesity is well established.'

The authors of Action on Sugar's policy document do eventually admit that physical activity has some (unnamed) benefits, but can't resist following it with another lie...

Regular physical activity does have beneficial effects but there has been little change if any in our levels of physical activity in the past three decades, whilst levels of obesity has increased (12)(13)(14).

This time we have three studies cited so there must be lots of evidence that activity levels haven't declined in Britain in the past three decades, right?

Wrong. Source (12) is a study of Americans and so has no relevance.

Source (13) is a BMJ editorial discussing a study which found that various interventions have failed to increase the amount of exercise children are taking in the last few years. The editorial notes that the study did not look at sedentary time 'which is emerging as an important risk factor [for obesity] across the life course'.

Source (14) is a study of the energy expenditure of a hunter-gatherer tribe in Tanzania which found energy expenditure to be similar to that of a sample of Americans. As the NHS notes, although the study is of 'anthropological interest', it 'cannot answer the question of which is more important, a calorie-dense diet or lack of physical activity as a cause of obesity'. Naturally, the study says nothing about changes in activity levels in the UK in the last thirty years.

In fact, there is plenty of evidence that day-to-day physical activity has declined in recent decades. Public Health England says that 'People in the UK today are 24% less active than in 1961'. There is also plenty of evidence that physical activity is important in body weight regulation. This really should not have to be explained to an alleged health group.

A child eating a burger and chips, washed down with a sugary drink, followed by a bar of chocolate and crisps, would need to run half a marathon to burn off the calories consumed.

If a child 'burnt off' every calorie he consumed through exercise, he would very soon be dead. Even a completely sedentary human being needs calories to survive. A ten year old boy needs 2000 calories to maintain a normal weight. If he runs half marathons, he will need a good deal more.

...the biggest cause of death and disability in the UK is due to the food we eat, through its very high salt, sugar and fat content, and the lack of fruit and vegetables.

I'm sure the anti-smoking lobby and others would take issue with this claim. Only yesterday we were told that physical inactivity causes more deaths than obesity. Action on Sugar don't (or can't) provide a source for this claim, but I don't think it is too low a blow to point out that their science director, Aseem Malhotra, first came to my attention when he combined every death from heart disease, diabetes and cancer in the world and portrayed the total as being the number of deaths that are due to 'diet-related diseases'. I suspect he may have done something similar here.

I could give more examples, but I hope my point has been made. This lobby group has an extraordinarily cavalier attitude towards evidence. They don't so much twist the facts as make them up as they go.

Considering the folk at Action on Sugar have become the go-to people when the media want a soundbite about the white stuff, journalists really need to start doing some fact-checking. Just because someone has a 'Dr.' in front of their name doesn't mean they will necessarily tell you the truth.

When the scientific director of an organisation that claims to speak with authority about sugar asserts that High Fructose Corn Syrup—a product that is practically non-existent in the EU—is 'added to almost all processed food' in Britain, you should be wary.

When he claims that 'just one sugary drink, typical of a can of Cola, increases the risk of type 2 diabetes by 22%', you should be concerned.

And when this same sugar 'expert' promotes notorious quacks, ignores peer-reviewers, sparks investigations at medical journals with his questionable use of sources and doesn't even know that fruit contains fructose, it might be time to find somebody else to talk to.

Thursday, 15 January 2015

Labour officially declares war on 'alcohol, sugar and smoke'

The Labour party will announce its 'public health' policies for the general election later this morning. Judging by the press release, they will be much as we expected from the rumours of a 'nanny state crack down' last year.

Andy Burnham seems eager for Labour to shed its reputation for interfering into lifestyles - he says he is moving away from the 'finger-wagging approach' - and yet he can't help himself. He 'will pledge to take tougher action to protect children from commercial pressures and the harm caused by alcohol, sugar and smoke'. Alcohol, sugar and smoke - the three horsemen of the apocalypse in a society that is scared of its own shadow. And all done, of course, for the sake of the chiiiiildren.

Here are the four policies that have been shared ahead of the speech...

Plain packaging

Yawn. What is left to say about this ego-trip? Millions of pounds of public money have been spent promoting it in recent years and yet it remains what it has always been—a desperate scrape of the barrel designed by anti-smoking zealots to irritate the tobacco industry and stigmatise smokers.

People don't smoke because of the pack design and so there was never any chance that it would reduce tobacco consumption. Sure enough, when it was tried in Australia it didn't. Plain packaging remains on the agenda because everything else has been tried and politicians thinks it makes them look tough.

'Limits on the amount of sugar, fat and salt in food marketed substantially to children'

Lord knows how this is going to work. How, for example, do you reduce the amount of sugar in sweets? They are, essentially, all sugar. You could replace the sugar with sweeteners, but that will only the stir the hornet's nest of cancer paranoia about aspartame and saccharin. 

Famously, this piece of government über-intrusion could end up with Frosties being banned. And why? If you - as a parent - don't want your child eating Frosties, buy them Corn Flakes. If you don't want them drinking Coke, buy them Diet Coke. In almost every food category you can think of, there are low-calorie, low-fat and low-sugar options. The market has provided. This is not about 'making healthy choices easier', as politicians would have you believe. It is about making tasty choices illegal. 

And don't let the reference to children fool you. If the government decides a product is 'marketed substantially to children', it's going to have its recipe modified by government. Bearing in mind that Labour thinks a cigarette pack constitutes marketing to children, the sky's the limit.

'Improvements to food labelling to help people better understand what they are eating'

Calorie, sugar, fat and salt content is clearly shown on virtually every food product you'll buy in Britain, but this isn't enough for the public health racket. Informing people was never the real goal. The true intention is to warn, deter and frighten off. 

It seems that Burnham/Berger are going to work with the EU to get 'traffic light' labelling on food. This has never been tried before, but the unintended consequences are blindingly obvious to anyone who understands human nature: people will make a beeline for food that has red traffic lights on it because it will very quickly become apparent that they are a guarantee of tastiness.  

'Targeted action on high-strength, low-cost alcohol which fuels binge drinking and does most harm to health, with a range of options on both price and bottle-size being explored'

This is rather vague, to say the least, but you will note that minimum pricing is not explicitly mentioned. Two months ago, Ed Miliband announced that he wasn't in favour of minimum pricing so perhaps the Labour party has got the message that it is unpopular, regressive and illegal.

So what could they mean? Yet more taxes? Government-mandated small bottles? Banning white cider? We should soon find out.

See also: Labour targets Frosties and jelly babies in public health campaign (Telegraph)

Wednesday, 14 January 2015

Job done. Go away.

Ian Gilmore—the appropriately miserable face of the medical temperance movement in Britain—gave an interview last year which was published in BMC Medicine. In it, he said the following:

Of course, we do not want everybody to stop drinking. That is not the endgame. However, nonetheless, if we could just get the whole consumption curve shifted down by 10 or 20% - if we could get back to where we were in the UK, say, 30 to 40 years ago in our per capita consumption and we would see a huge benefit in health.

You get the feeling that Gilmore would say he wanted to see the 'whole consumption curve' go down by 10 to 20 per cent regardless of where it stood at any given time, but he gives a more specific target when he says that he wants consumption to go back to where it was '30 or 40 years ago'.

Gilmore doesn't seem to have kept up with the statistics. If he's happy with how much we were drinking '30 or 40 years ago' then he would surely be happy to split the difference and settle for where we were 35 years ago.

And it so happens that is exactly where we are. Per capita alcohol consumption for adults in 1980 was 9.4 litres. The latest available figures, for 2013, show per capita consumption to be...

[drum roll]

...9.4 litres.

And falling.

Two questions arise.

Firstly, where is the 'huge benefit in health'?

Secondly, now that Gilmore and his teetotal cronies have achieved their goal, will they go off, leave us alone and do something useful with their lives?

The answer, of course, is that there hasn't been a 'huge benefit in health' because basing policy on the 'whole consumption curve' is a fool's errand and they won't go away because they are prohibitionists who are in it for the long haul.