Thursday, 22 February 2018

Minimum pricing in Wales - the final PR push

I was on BBC Radio Wales this morning talking about minimum pricing (you can listen from 38 minutes in). This was prompted by the thrilling news that the people at Sheffield University who have spent the last ten year pushing minimum pricing are still in favour of it.

I gather that their latest government-commissioned report claims that 66 lives will be extended in Wales (population: 3 million) if drinkers respond to a 50p minimum price in the implausible ways that the Sheffield team assume. This is up from 53 in their previous report for reasons that are almost certainly not worth bothering with. Since there are around 1,500 alcohol-related deaths in Wales each year, it's doubtful whether such a small change can even be measured.

The media haven't shown much interest in the 66 theoretical lives that will be theoretically saved at a cost of millions of pounds to consumers. Instead they have focused on this statistic from the latest Sheffield publication:

75% of all alcohol consumed in Wales is drunk by the 22% of the adult population who are hazardous or harmful drinkers, according to a new report.

Within this – the 3% of the population who are harmful drinkers, account for 27% of all alcohol consumed.

This is just the Pareto Principle. It's no surprise to hear that most alcohol is drunk by people who drink the most. A fifth of Welsh adults don't drink at all so they obviously account for 0% of sales. 58% drink little (less than 14 units per week) and so account for relatively few sales. It says a lot about the decline in drinking in the UK that only 22% of Welsh adults consume more than 14 units a week and only 3 per cent are 'harmful drinkers' (defined as >35 units per week for women and >50 units per week for men.

As I discovered when I gave evidence in Cardiff - and as was confirmed in my interview today - the Welsh government has accepted that minimum pricing won't help the 'harmful drinkers' who have a dependency on alcohol, but they are hopeful of changing the ways of people like me who laugh in the face of the 14 units target.

It looks as if the Welsh government is going to go ahead with the policy because they're already starting to manage expectations. A spokesman says: 'Minimum unit pricing is not intended to work in isolation' and Alcohol Concern Wales says: 'Minimum pricing is one way to solve it but there's no cure.' It's a sure sign that an underwhelming 'public health' policy is on the way when campaigners start playing the 'no silver bullet' card.

Just before my interview on BBC Wales, listeners were treated to an audio clip of Sheffield University bullshit vendor Colin Angus turning the lies up to eleven. He said:

'Minimum unit pricing is a very well targeted policy because it very specifically affects the alcohol that's only purchased, really, by heavier drinkers.'

This is totally untrue. As the IFS and others have shown, 70 per cent of all off-trade sales will be affected and Angus's own report says that 22 per cent of the alcohol bought by moderate drinkers is currently bought at less than 50p.

Moderate drinking here is defined as 14 units a week or less. Under the previous definition of 21 units or less for men, minimum pricing would affect moderate consumers even more. This shows why the neo-temperance lobby were so keen to change the guidelines. It has a material and significant effect on the statistics, inflating the number of hazardous drinkers and reducing adverse effects of regressive policies on 'moderate' drinkers.

As regular readers will recall, the guidelines were changed largely as a result of another implausible model created by... the Sheffield Alcohol Research Group. That model initially supported a threshold of 21 units but the team made unjustifiable changes to their methodology at the eleventh hour in order to support a lowering of the limits after Public Health England told them to.

In any serious field of academia, being exposed as a gun for hire who is prepared to change your model if your funder writes you an additional cheque would be career-ending. It would surely be enough for the government contracts to dry up. In the world of 'public health', however, it is no barrier at all. In fact, it probably helps.

Tuesday, 20 February 2018

Talking Killjoys

I did a podcast with Cameron English recently which has been uploaded here. It's always a pleasure to talk to Cameron. He lives in California, God help him. Mainly we talked about my book Killjoys and the corruption of the 'public health' movement. Have a listen.

By the way, I am aware that the comment facility seems to have disappeared from this blog for the time being. I haven't disabled it, so if you have any idea why it's gone and how I can get it back, let me know via e-mail (scroll to the bottom). Cheers.

Monday, 19 February 2018

Another neo-temperance flop

Remember the great 'public health' initiative of removing high strength beer and cider from shops in Suffolk? These are the 'cheap' drinks that are supposedly targeted by minimum pricing (this is a shameless lie). Minimum pricing is going to effectively remove these drinks from sale - why buy them when you can get the same number of units from vodka for the same price? - but outlets in Ipswich removed them from sale back in 2012.

How did this 'Reduce the Strength' (RtS) scheme go? Well, it must have gone well because the Local Government Association has a briefing document telling councils that they should do likewise:

Suffolk – perhaps more than any other area – has led the way with tackling the consumption of high-strength, cheap alcohol... The campaign has proved incredibly successful. Ninety out of 138 off-licence premises have signed up, including big chains like Tesco, Sainsbury’s and Morrisons.

Note that the scheme is 'incredibly successful' because it had a large take-up, not because it reduced alcohol consumption or alcohol-related problems. It has been claimed that the number of street drinkers declined in Ipswich, but it seems more likely that these people (most, if not all, of whom are homeless) moved away rather than that they suddenly sobered up.

(As a brief digression, what are the chances of Scotland's homeless moving to England en masse in even greater numbers once minimum pricing is in place? Will anybody be studying this as part of the SNP's rinky dink evaluation?)

Since Ipswich councillors were primarily interested in shooing away street drinkers, they may consider the policy to be a success, but from a 'public health' perspective, the aim was to reduce alcohol consumption. Even if reducing overall consumption wasn't the explicit aim, consumption should decline if the number of the street drinkers and heavy drinkers declines because these people consume a non-trivial proportion of the booze sold. Aren't we told that 4 per cent of the population consume a third of all alcohol?

So did that happen? A new study published last week suggests that it did not. The authors got hold of sales data from the East of England Co-op which got rid of all its cheap high strength beer and cider (>7.5% ABV) from its 53 Suffolk branches in September 2012. Its Norfolk and Essex branches followed suit in September 2013.

The authors describe the roll out in Suffolk as Wave 1 (W1) and the roll out in Norfolk and Essex as Wave 2 (W2). Superstrength booze prior to removal made up 6.5% and 3.6% of total alcohol units sold in W1 and W2 respectively.

Let's see what happened when these drinks were removed...

Our analysis indicates that the impact of RtS on units of alcohol sold for beer/lager and cider was not significant in the two waves. More specifically, following RtS implementation, W1 stores experienced a non-significant increase (3.7%, 95% confidence intervals (CI): −11.2 to 21.0, P = 0.647) whereas W2 stores experienced a non-significant decrease (−6.8%, 95% CI: −20.5 to 9.4, P = 0.390).


The researchers missed a trick by not using Norfolk and Essex as the control group when W1 went into effect, but the results are interesting nonetheless. There was no significant change in the number of units sold and so far as the Co-op is concerned, unit sales went up in one area and down in the other.* As the authors say:

...the changes observed in the two waves were not consistent and so the overall findings showed no intervention attributable impact.

Although the results were non-significant in both places, the Suffolk experience is of most interest because it was there that the Reduce the Strength initiative extended to the most shops, and because Suffolk branches of the Co-op were selling more high strength products before the quasi-ban came into effect (6.5% of alcohol unit sales). It should therefore have seen the biggest decline in sales.

As the authors note, the RtS scheme did not make it impossible for people to buy high strength products in Suffolk. Not all retailers signed up. But the fact that alcohol sales rose in the Suffolk branches does not immediately suggest much switching to other shops. It seems that people in the area did not cut down their alcohol consumption, although some of them must have switched to different drinks.

This evidence goes against neo-temperance beliefs. The 'public health' lobby claims that some people drink too much because high strength booze is being sold at pocket money prices. The drinks taken off the shelves in Suffolk offer the cheapest units of alcohol money can buy in Britain. High strength beer and cider were still available in outlets like the Co-op after the RtS scheme began, but they were more expensive varieties, such as craft beer and scrumpy cider. Good, healthy, bourgeois rocket fuel, in other words.

The logic - and computer models - behind minimum pricing suggest that overall alcohol consumption should have declined as a result of high strength drinks becoming much more expensive, but that doesn't seem to have happened. The authors don't even seem to be very surprised by this. They've seen it all before. Under the heading 'What is already known about this topic', the authors write:

Evaluation of the Scottish Alcohol Act 2010 showed that banning alcohol multi-buy promotions did not reduce alcohol purchasing at the household level, and the introduction of the Alcohol Act was not associated with any changes in off-trade beer sales. 

I'd almost forgotten about the ban on multi-buys. Remember when that was an urgent 'public health' policy that was costing lives for every day politicians delayed? All water under the bridge now. It didn't work, but nobody's going to repeal it. Failure goes with the territory.

In 'public health', the only response to failure is to do more of the same but more vigorously. The authors of the study pounce on the fact that the RtS scheme was 'voluntary', as if it had been the retailers who had come up with the policy when it was actually the brainchild of Ipswich Borough Council, the Police, Suffolk County Council and the NHS. They conclude with a call for coercive, but unspecified, policies to do what this microcosm of minimum pricing couldn't...

Our findings suggest that voluntary RtS initiatives, have little or no impact on reducing alcohol availability and purchase amongst a broader population of customers. The research literature suggests that more effective regulatory public health interventions will be required to achieve substantial population health benefits in reducing alcohol consumption and alcohol-related harms.

Next time will be different, eh?

* Statistical significance is used in this instance to see whether the sales outcomes in Co-op shops reflects the change in sales cross the county.  

Friday, 16 February 2018

The sugar conspiracy debunked

There's been a lot of 'Big Whatever is the new Big Tobacco' rhetoric recently. It's all part of following the anti-smoking playbook which, oddly enough, involves accusing the food/alcohol/soda/gambling industry of following the tobacco industry playbook. It's all so meta, but it's an effective public relations exercise because ad hominem attacks work (read this fascinating study for proof).

The list of businesses that are accused of using 'tobacco industry tactics' is almost endless. Just in the last week, we have seen the booze industry, the baby food industry, the agrochemical industry, the food industry and Facebook all accused of using these mysterious tactics.

Most of the time, the tactics amount to no more than manufacturing a product and trying to sell it; in the final analysis, that is what the single-issue fanatics really object to. The 'tactics' can also often involve lobbying, or rather counter-lobbying as these companies are usually defending themselves from the unprovoked aggression. It is somehow seen as shocking that businesses affected by radical government action tries to have their say (see this 'scoop' from Ireland, for example).

If tobacco industry tactics have a unique meaning in the public's mind, they probably involve covering up evidence and sowing doubt. Of that, tobacco companies have undoubtedly been guilty in the past and the idea that other industries are selling us products that they know to be dangerous is a powerful narrative in these paranoid times. This is the fear to which Stanton Glantz appealed in 2016 when he switched his attention from smoking to sugar. And the global media fell for it. Here is the New York Times, for example...

The sugar industry paid scientists in the 1960s to play down the link between sugar and heart disease and promote saturated fat as the culprit instead, newly released historical documents show.

The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today’s dietary recommendations, may have been largely shaped by the sugar industry.

“They were able to derail the discussion about sugar for decades,” said Stanton Glantz, a professor of medicine at U.C.S.F. and an author of the JAMA Internal Medicine paper.

Glantz's claims were entirely based on an obscure evidence review written in the 1960s by three people, one of whom had undisclosed links to the sugar industry. In those days, researchers did not have to list their interests in journals and it was normal for nutritional scientist to work with the food industry (it still is). The review concluded that fat was a bigger risk factor for cardiovascular disease than sugar. This was an orthodox view then and is the orthodox view now. Glantz did not attempt to challenge this conclusion with empirical evidence. In his mind, one of the authors had received money from food companies so he must be lying.

If you have encountered the anti-carb/anti-sugar crowd on social media, you won't be surprised to hear that this narrative has gone down well. They have a penchant for conspiracy theories and ad hominems, and Gary Taubes has embraced it in his recent book The Case Against Sugar. Nina Teicholz, who borrows liberally from Taubes, created a version of history in The Big Fat Surprise in which John Yudkin's anti-sugar message was silenced by scientists and businesses who wanted people to consume carbohydrates.

There are all sorts of variations of this theory, but the basic theme is that good honest scientists always knew that sugar was the devil, but they were thwarted by devious proponents of the saturated fat hypothesis who shouted them down with the help of lavish funding from Big Carb.

I don't take sides in the fat versus sugar debate. For what it's worth, I think the claims of both factions are overblown. But the narrative presented by Glantz is historically illiterate nonsense and a new study published in Science takes it apart:

Building on a newly popular narrative holding that the low-fat campaign of the 1980s was not based on solid science, these allegations have suggested that if not for the machinations of the sugar industry and its cadre of sponsored researchers, the history of U.S. dietary policy might have unfolded very differently. In this article, we argue that the historical evidence does not support these claims.

Although we do not defend the sugar industry and cannot address every aspect of this history, we believe recent high-profile claims come from researchers who have overextended the analogy of the tobacco industry playbook and failed to assess historical actors by the norms and standards of their time.

Our analysis illustrates how conspiratorial narratives in science can distort the past in the service of contemporary causes and obscure genuine uncertainty that surrounds aspects of research, impairing efforts to formulate good evidence-informed policies. In the absence of very strong evidence, there is a serious danger in interpreting the inevitable twists and turns of research and policy as the product of malevolent playbooks and historical derailments. Like scientists, historians must focus on the evidence and follow the data where they lead.

The article is not behind a pay wall and I highly recommend it. Here are a few more choice cuts...

As we have shown, by the 1960s the paradigm that dietary fat was a likely risk factor for heart disease prevailed among a coalition of scientists closely linked with NIH and AHA and was based on extensive research. By contrast, the sugar theory was developed by a small number of researchers, was supported by limited evidence, and was not accepted by key authorities. Normal science is a social project in which a community of scientists develops consensus over theory. Heart disease epidemiology, in adopting a multifactorial model, could plausibly have accommodated sugar if the theory had withstood testing. But Yudkin's claims were seen as weak and antagonistic, and his signature finding could not be replicated. Moreover, sugar did not appear to meaningfully affect serum cholesterol—the only then-accepted lipid pathway to coronary disease.

As we have also shown, the sugar industry approached Hegsted only after learning of the results of his dairy industry-backed study suggesting that fat and not sugar was a factor in heart disease. “There was no, ‘We'll get money from them and make the results come out this way,’” recalled Lown, who worked in the department. “It didn't happen that way,” he said.

.. We do not claim the sugar industry had no influence on nutrition work at Harvard, nor on the field in general. But we believe that there is no good reason to conclude that SRF's sponsorship of a literature review meaningfully shaped the course of dietary science and policy. Moreover, we think it is an error to demonize, almost as a reflex, scientists and their research when there is evidence of private funding.

.. Our history also underscores the fallacy of emphasizing the machinations of one commodity sector when multiple food industries were deploying similar techniques of influence in the battle for market share. It is notable that during the low-fat era of the 1980s, when suspicion fell heavily on the meat and dairy industries, it was argued that, “The ‘fat lobby’ has not only influenced our nation's food and nutrition policies, it has determined those policies” [emphasis original]. Nearly 40 years later, at a moment when some have said “butter is back” and sugar is toxic, “Big Sugar” is the behemoth accorded these dramatic powers. Caught in the cross fire of these “diet wars” have been the reputations of historical nutrition scientists, whose statures have risen or fallen based on the extent of their contribution to current theories.

If the personal attacks on the authors of this study have not already begun, I'm sure it's only a matter of time.

Thursday, 15 February 2018

Childhood obesity figures are worthless

No news story about obesity in Britain is complete without the factoid about one in three children being overweight or obese. This statistic can easily be found on the Office for National Statistics website, but understanding the methodology behind it requires a little more digging.

I have hesitated to write about this for some time because I thought I must be missing something. I couldn't believe that such important statistics could be estimated in such a ridiculous way.

But they are, and the scale of child obesity in this country has been grossly inflated as a result. Read my article at Spectator Health and all will be explained.

There's more to say about this so I'll probably write a follow up piece. If you have questions or comments, leave them under the Spectator article and I'll try to respond.

Monday, 12 February 2018

John Stuart Mill spins in his grave

Robert H. Frank offered an unusual justification for clamping down on smokers in the New York Times last month. As it touches on some of the themes in Killjoys I want to discuss it.

One the main points in Killjoys is that paternalists are always looking for ways to disguise their paternalism. Even in these puritanical times, it is still not socially acceptable to ask the government to interfere in someone's private life just because you don't like what they're doing.

In the field of tobacco control, three justifications have been put forward which broadly fall under the category of 'protecting harm to others'.

The first is that anti-smoking policies prevent the tobacco industry harming smokers (by selling them cigarettes).

The second is that smokers put a cost on nonsmokers by developing expensive diseases.

The third is that smoking bans are necessary because secondhand smoke harms nonsmokers.

The tobacco control lobby has got a lot of mileage out of these arguments over the years despite none of them being very strong. The idea that anti-smokers are protecting people from industry ignores the fact that industry has no means of coercion. The economic literature shows that smokers do not have higher healthcare costs over a lifetime. And the epidemiological evidence on secondhand smoke is all over the place.

Crucially, though, the power of these arguments wanes as more and more anti-smoking policies are implemented. Campaigners can present an advertising ban, for example, as an 'anti-industry' measure, but it difficult to pretend that a ban on people smoking in their own home, or mandatory nicotine testing of employees, is an attack on the tobacco industry.

As tobacco taxes rise, the idea that smokers are not 'paying their way' becomes increasingly difficult to maintain. And claims about secondhand smoke lose their political significance once smoking has been banned in all enclosed public places.

Frank's article is an attempt to find a new justification for coercive anti-smoking policies in an era where the old excuses are losing their power. He starts by acknowledging that smoking in New York has been banned virtually everywhere, including in some outdoor spaces, and says...

Given the longstanding American hostility to social engineering, each of these steps faced heavy pushback. When called on to justify them, regulators have offered their traditional response: Restricting individual freedom is often the only way to prevent undue harm to innocent bystanders.

The specific harm cited has almost always been well-documented health hazards caused by secondhand smoke. This rationale is similar to the one for requiring catalytic converters on cars: We need them to prevent pollution that would otherwise cause undue harm to others.
But unless you work in a crowded bar with no ventilation, the health risks from secondhand smoke are small compared with those from being a smoker. For example, more than 85 percent of American deaths from lung cancer are attributable to smoking...

To digress briefly, this widely cited statistic is wrong. It may be true that 85 per cent of people with lung cancer are smokers, but that does not mean that 85 per cent of cases are caused by smoking. Half the population are smokers by the epidemiological definition (ie. have smoked more than 100 cigarettes in their life). Since non-smokers also get lung cancer, albeit in much smaller numbers, the proportion of lung cancer cases that are caused by smoking is more like 70 per cent. I can explain this in more detail in a future post if the logic is unclear.

...with fewer than one-third of the remainder linked to passive smoke exposure. Regulators may insist that their aim is not to protect smokers from themselves, but our regulations do vastly more to protect smokers (by inducing them to quit) than to protect bystanders.

This, of course, is the unspoken reason why smoking bans are introduced. They are not about barworkers or passive smoking, they are about making it difficult for smokers to smoke.

But they have run their course in places such as New York, and so a new justification is required...

In fact, smoking also harms bystanders in a more important way: Each person who becomes a smoker makes it more likely that others will become smokers as well. This additional effect outweighs the harm caused by secondhand smoke by enough to suggest that our efforts to discourage smoking, strict as they seem, may not be nearly strict enough.

He is arguing that smoking is, in effect, contagious.

By far the most powerful predictor of whether a person will smoke is the percentage of her closest friends who smoke. If the share of smokers in someone’s peer group rises to 30 percent from 20 percent, for example, the probability that she will smoke rises by about 25 percent. Whereas most of my teenage friends were smokers, relatively few of my sons’ friends were. In 2016, only about 19 percent of American men were smokers, and only about 14 percent of women.

This is a rather naive interpretation of the data. People will tend to associate with others who have similar interests and backgrounds. Drinkers will tend to spend time with drinkers, vegans will spend time with vegans, heavy metal fans will spend time with heavy metal fans. This is not contagion.

On the other hand, people do have an influence over their peers. If you were born in a different country, you would probably have different tastes in sport, music and food.

But you would still have free will - and this is the aspect that Frank overlooks. He gives an example of two peer groups, one with a smoking rate of 30%, the other with a smoking rate of 20%. Whatever the 'probability' of someone smoking in each group (which is somewhat tautologous anyway), the majority are still nonsmokers. Influence is not coercion.

Today’s environment is different mostly because of the taxes and other regulatory measures we have taken to discourage smoking. Well and good, but does anyone think that still having more than one smoker in six people is a desirable population ratio?

What is the desirable ratio? To Frank, it appears to be zero, but that is clearly not the desirable ratio for people who enjoy smoking. So who gets to decide? Someone like Frank, who doesn't smoke and who doesn't think other people should either, or the people who like smoking?

Why should anyone decide what percentage of the adult population smokes? Surely the 'desirable population ratio' is that everybody who likes smoking smokes and everybody who doesn't like it doesn't smoke. Whatever happened to 'life, liberty and the pursuit of happiness'?

Our stated rationale for discouraging smoking — to prevent harm caused by secondhand smoke — greatly understates the amount of harm that these actions prevent. When a regulation results in one smoker fewer, every friend of that person will have one smoker fewer in her peer group. Every member of every one of those peer groups will then become less likely to smoke. And that, in turn, will make others less likely to smoke, and so on.

Frank doesn't make any specific policy recommendations, but implications of his argument are sinister, bordering on totalitarian. It suggests that individuals should be forced to sacrifice their pleasures in case they unwittingly influence their friends into adopting the same way of life.

Most people don’t like being regulated, but even strict libertarians concede the legitimacy of regulations to prevent undue harm to others. As John Stuart Mill memorably wrote in “On Liberty”: “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.”
Causing someone to be more likely to smoke clearly inflicts substantial harm on that person. 

Not 'forcing' someone to do something. Not even 'causing' them to do something. But 'causing them to be more likely' to do something!

This is one of the grossest distortions of John Stuart Mill's harm principle that I have ever come across. It is inconceivable that Mill would have supported coercive legislation to force individuals to set a good example to those around them. Indeed, he explicitly rejected the idea and was clearly exasperated when the nineteenth century temperance movement made a similar argument about alcohol. In On Liberty, he described it as a 'monstrous' idea that would make 'all mankind a vested interest in each other’s moral, intellectual, and even physical perfection, to be defined by each claimant according to his own standard'. In practice, he wrote, it would mean ‘no right to any freedom whatever, except perhaps to that of holding opinions in secret’.

Today’s regulations to discourage smoking are strict, yes. But without violating libertarian sensibilities, we could adopt even stricter measures.

This is laughably untrue. It is hard to think of anything more likely to violate libertarian sensibilities than the idea that individuals must be coerced into changing their behaviour so that they can be a walking advertisement for a government-approved lifestyle.

Incidentally, I have encountered Frank's strange theories before in a different context. You can read about one of them from page 110 in my book Selfishness, Greed and Capitalism.

Thursday, 8 February 2018

Low alcohol drinks lead to more alcohol being drunk, claim cranks

In September 2016, a 'public health' academic named Milica Vasiljevic published a study in Tobacco Control claiming that e-cigarette advertising made children start smoking. This was a heroic over-interpretation of the meagre findings from her survey, but it went down well with the hard of thinking...

(Incidentally, a study published this week concluded that TV advertising of e-cigarettes reduces the number of smokers, so well done to the EU for banning it.)

Now Vasiljevic is back with a study about low-alcohol beverages, as the Daily Mail reports...

Low-alcohol booze ‘can you make you drink more’ as they are marketed for ‘lunchtime’ or ‘all occasions' 

They are seen as the sensible option to enjoy a tipple without going overboard.

But low-alcohol wine and beer may actually lead people to drink more, academics have warned.

Researchers at the University of Cambridge say lower strength drinks are being marketed as drinks for ‘lunchtime’ or ‘all occasions’, which may encourage people to choose them instead of soft drinks.

The study, published in BMC Public Health, is co-authored by Theresa 'beware of big glasses' Marteau and Mark 'muh, Big Alcohol' Petticrew, so it's guaranteed to be of poor quality, but nothing prepared me for quite how bad it was. At least Vasiljevic's e-cigarette study involved talking to children. Her new effort is based entirely on reading product descriptions on supermarket websites. The methodology section contains this small gem:

Disagreements were resolved by discussion until perfect agreement was achieved.

The study doesn't name the brands, but we can work out what some of them are by googling the marketing lines that are quoted. They include Gallo Summer Rose and Foster's Radler, a 5.5% wine and a 2% lager respectively, but they also include Erdinger Alkoholfrei which is an alcohol-free beer, as its name suggests (technically it has a maximum of 0.5% alcohol as it is not possible to remove every drop of alcohol from 'near-beer'). Its inclusion implies that the authors think that the promotion of 0.5% beers leads to 'risky drinking'.

Among the marketing messages that the authors reckon are designed to lure in vulnerable consumers are such scandalous slogans as ‘Perfect for all occasions from a lunchtime barbeque to an evening celebration’, ‘Perfect for nights in and social get-togethers’ and 'For all your trendy patio parties, picnic classics and the good old-fashioned night in with your pals’. They also highlight standard messages on wine labels such as ‘All occasions’, ‘Any occasion’ and ‘Any time’.

If that weren't enough, they also reveal that...

Low/er strength products were also more often marketed with information about their alcohol content.

I should hope so. If companies are going to produce low alcohol drinks, it is only fair that they warn consumers.

To our intrepid researchers, all this can only mean one thing:

Presenting low/er strength alcohol products as suitable for consumption on a wider range of occasions than regular strength products suggests they may be being marketed to replace soft drinks rather than alcohol products of regular strength.

OK. Let's take this in stages.

Firstly, someone searching for beer or wine on a supermarket website is probably not in the market for a soft drink.

Secondly, it is the government's explicit policy - having been lobbied by 'public health' - to reformulate products to make them healthier. Under the Department of Health's Responsibility Deal, the booze industry is committed to producing 'lower alcohol products' as part of the 'alcohol unit reduction' scheme.

Thirdly, the author's claim that low-alcohol drinks are aimed at people who would otherwise drink soft drinks is nothing more than an assertion. In so far as it is based on evidence, it stems from the feeble piece of trivia that none of the regular strength wines they looked up online mentioned lunch whereas 13% of the low-strength wines did.

Fourthly, it should be obvious that a low-strength wine/beer is a closer substitute to regular wine/beer than it is to a glass of water and, therefore, that increased sales of low-strength wine/beer will lead to less alcohol being consumed overall.

In fact, that is exactly what the Department of Health found in its review:

Between 2011 and 2013 the number of units of alcohol in the market has reduced by 1.9 billion. Of this it is estimated that 1.3 billion is due to reductions in the ABV of alcohol products...

But, as I have discussed before, 'public health' fanatics such as Mark Petticrew automatically assume that anything the industry does is suspect unless they are being forced to do it by law...

If it doesn't involve taxing the poor or creating criminal offences, Petticrew isn't interested, and so he invariably concludes that initiatives like the Responsibility Deal don't 'work' whereas heavy-handed and regressive policies do (even when the latter have obviously failed or haven't even been tried).

His findings are therefore highly predictable. Public Health Responsibility Deal on healthy eating? "Could be effective" but needs "food pricing strategies, restrictions on marketing .. and clear penalties". Responsibility Deal for alcohol? Not very effective, needs "law enforcement" to make "alcohol less available and more expensive." Voluntary agreements in general? Can be effective but only when there are "substantial disincentives for non-participation and sanctions for non-compliance", ie. when they are not voluntary. 

You get the picture. For Petticrew, the iron fist is always preferable to the velvet glove.

And so the authors conclude their pisspoor study of websites (sorry, I mean 'content analysis') by saying:

The present findings cast doubt on the industry contention that the development, promotion and marketing of low/er strength alcohol products may reduce alcohol consumption and associated harms. Rather, the present findings add to an existing literature that highlights how measures intended to benefit public health (in this case wider availability of low/er strength alcohol products) may benefit industry to the detriment of the health of the public.

This is pure editorialising. Their study shows nothing of the sort. It does not look at what people drink. It does not attempt to estimate, let alone observe, substitution patterns. It does not even look at how these drinks are marketed in the places that most people buy them in, ie. shops and supermarkets.

It is pure opinion and not a very good opinion at that. There is not a scintilla of evidence that low-alcohol beer and wine lead to greater alcohol consumption or 'the detriment of the health of the public'. On the contrary, evidence and common sense point in the opposite direction.

As with the e-cigarette study, the true believers of the anti-alcohol community love it. Perhaps that's who it's aimed at. A study by cranks for cranks...

This worthless garbage was funded by the supposedly cash-strapped Department of Health.

Tuesday, 6 February 2018

Public Health England

Public Health England have issued some mostly sensible advice about e-cigarettes in the hope of scotching some of the myths and junk science that has been pouring out of California for the last five years.

Dick and Clarky point out that PHE couldn't resist inserting some anti-smoking authoritarianism into their e-cigarette report. It is also somewhat amusing that they are calling for e-cigarettes to be given out by the NHS on prescription a day after it was announced that the only medically approved e-cigarette has been withdrawn from the market.

Nevertheless, the PHE report is worth reading and the authors should be given credit for trying to debunk some of the scare stories that threaten to bring the vaping revolution to a halt. My only concern is that the report won't be taken seriously by some because PHE has gained a reputation for talking nonsense (eg. here, here and here).

Speaking of which, I wrote this article about PHE and their mad schemes for the Spectator last week.

Unelected, unaccountable, and out of control, Public Health England has become a magnet for every crank, puritan, food faddist, temperance zealot, anti-capitalist and social justice warrior with a penchant for remaking the world in their own image. What do we get in return? Smaller portions, artificial sweeteners, higher prices, fewer choices and a stream of increasingly bizarre pronouncements from an agency that seems more interested in manipulating the population than in providing sound advice upon which we can make our own choices.

Do have a read.

Monday, 5 February 2018

Plain packaging in France: another non-event

Back in 2013, there was a flurry of studies published in the likes of Tobacco Control claiming a dramatic and immediate impact from plain packaging (which had been introduced at the end of 2012). One of them claimed that smokers were more likely to think about quitting if their packs were 'plain'. Another one claimed that there was a rise in the number of calls to quit-lines after plain packaging was introduced.

A whole cottage industry developed, with Melanie Wakefield at its centre, to look for evidence that plain packaging had an effect on smokers as soon as it was introduced. And yet, whatever smokers might have said in surveys, the hard fact of the matter is that cigarette sales rose in 2013 for the first time in years.

Rising cigarette consumption is hardly what you would expect to see if plain packaging had led to smokers quitting in droves, especially since there is also evidence of rising illicit tobacco consumption at the same time. And we now know from official statistics that the smoking rate did not decline between 2013 and 2016.

This would be very awkward for the tobacco control lobby if it was an evidence-based enterprise, but it isn't and so the WHO simply asserts that: 'Studies are conclusive: plain packaging of tobacco works'.
Since plain packaging was introduced in France and the UK, there have been a surprisingly few studies claiming an immediate impact of the policy. In fact, I haven't seen any. Maybe they are in the post, or maybe 'public health' academics don't want to leave more hostages to fortune.

However, we had a report from France last May claiming that cigarette sales had risen in the few first months of plain packaging, and in November the French health minister made a remarkably candid admission to parliament, saying 'the neutral package did not reduce the official sale of tobacco'.

We now have the tobacco sales figures from France which confirm that more cigarettes were sold in the first six months of 2017 than in either of the two previous years.

Cigarette sales fell slightly in the second half of the year and overall sales in 2017 were 44,614 million, compared to 44,926 million in 2016. This is a decline of 0.7%. To put that in context, the decline between 2015 and 2016 was 1.2%.

The best that can be said about plain packaging in France is that it did not lead to an actual rise in cigarette sales in its first year, but we should remember how unusual it is to see an annual sales increase in developed countries. The figures from France are consistent with the hypothesis that plain packaging has no more effect than doing nothing.

Anti-smoking campaigners seem to have more or less abandoned the claim that plain packaging has an effect on hard outcomes such as smoking prevalence and cigarette consumption in the short term. They have fallen back on the argument that the policy is part of a long-term strategy that will pay off after twenty years or so. This is convenient because it means that their claims are essentially unfalsifiable. Even after twenty years, it will not be possible to disentangle the putative effects of plain packaging from other factors and, if things go according to plan, most countries will have plain packaging by then anyway (assuming that cigarettes are even legal).

In the meantime, we are supposed to put out trust in those nice, honest anti-smoking people who reckon that plain packaging is the way to go. 

And yet, a supposedly game-changing policy like this should have some measurable effect within a year or two, surely? Throughout the campaign for plain packs in the UK, we were constantly told that 'more than 200,000 children start smoking every year' and that we need 'plain, standardised packs as soon as possible'. The obvious implication was that fewer people would smoke if plain packaging was introduced. But there is no evidence that this has happened in any country that has experimented with plain packaging and the same organisations are now campaigning for other policies with the same (bogus) figure:

“While we are glad to see developing policy such as plain cigarette packaging and increased taxation on tobacco, it is still worrying that more than 200,000 children and young people take up smoking..."

This is the modus operandi of the 'public health' lobby: campaign frantically for a supposedly essential policy, wear down politicians until they introduce it and then move on to another campaign as if nothing has happened.

And with plain packaging, nothing does happen. It's a total waste of time. France is now doing what Australia did after the failure of the policy became obvious by introducing massive increases in tobacco duty. No doubt this will have an impact on the sale of tobacco from legal retailers in France. Retailers in neighbouring Belgium and Spain, meanwhile, will be rubbing their hands with glee.

Friday, 2 February 2018

Public health versus 'public health'

Regular readers will know that I put the term 'public health' in speech marks when referring to the morally bankrupt crusade for lifestyle regulation that has co-opted the name.

I explained the distinction between public health and 'public health' in Killjoys:

The case for government action on public health issues is strongest when there is a threat to health that can only be countered by collective action. Collective action does not necessarily mean government action, but if the term ‘public health’ meant anything in Mill’s day, it meant tackling health risks in the shared environment which cannot be controlled by the individual, such as air pollution, or those involving people (or animals) who carry infectious diseases. Factories pumping coal smoke into a congested city and travellers coming home with Ebola pose a clear risk of unavoidable harm to others and are therefore a potential justification for coercion under the harm principle. It is not the scale of the risk nor the number of people affected that turns a health problem into a public health problem. It is the lack of consent from those who are put at risk and their inability to reduce the risk without collective action.

Since the 1970s, however, the scope of public health action has moved beyond hygiene and contagious disease to target self-regarding personal behaviour. As Richard A. Epstein explains, the modern ‘public health’ movement ‘treats any health issue as one of public health so long as it affects large numbers of individuals’. This has led to a focus on personal habits which are risk factors for non-communicable diseases, such as heart disease, diabetes and cancer. ‘Our public health problems are not, strictly speaking, public health questions at all’, write Gostin and Gostin. ‘They are questions of individual lifestyle’. In this view, ‘public health’ is the aggregated private health outcomes of the nation, and prevention involves modifying any factors that influence them. 

There is no shortage of genuine public health problems in the world, but 'public health' campaigners are not interested in them. Even if they were, the sociologists and psychologists of the 'public health' lobby don't have the medical knowledge to deal with diseases like AIDS, tuberculosis and malaria. Real public health problems do not respond to the advertising bans and price hikes.

Fortunately, there are organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria which are devoted to stopping poor people dying from contagious diseases. The Global Fund gets  most of its money from national governments but it also takes donations from foundations, individuals and businesses.

One of these businesses is Heineken, and the 'public health' lobby is not happy about it.

Health campaigners decry global HIV fund's deal with Heineken 

International health campaigners and alcohol concern groups called on a major global HIV and malaria fund on Thursday to end immediately a partnership it had signed with the Dutch brewer Heineken.

In an open letter to the director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an alliance of more than 2,000 health organizations voiced “deep concern” and said the deal would only help Heineken broaden its marketing reach.

“Transnational corporations producing and aggressively marketing alcohol rely on the harmful use of alcohol for their sales and profits,” the letter said.

That is a lie, of course. Alcohol companies would make sales and profits if everybody drank responsibility.

It accused companies such as Heineken of undermining and subverting evidence-based alcohol policy implementation “at the same time as they expand distribution networks and marketing to grow their market in low-and middle-income countries”.

Alas, there was no room in the letter for them to give examples of Heineken 'undermining and subverting evidence-based alcohol policy'. Perhaps they had Mark Petticrew's weird theories in mind?

If these people knew anything about the alcohol market in low income countries - and if they cared about people's health - they would welcome the expansion of 'distribution networks' for high quality, regulated drinks companies. In Africa and India, in particular, the market is dominated by moonshine, counterfeit alcohol and surrogate alcohol which regularly cause acute death. If people in these countries could access and afford a few bottles of Heineken, it would be a great improvement (unless you think that Heineken making more 'sales and profits' is a Bad Thing per se).

In any case, Heineken's donation to the Global Fund is going to have no effect on its distribution and marketing. It will be used to tackle AIDS, tuberculosis and malaria. The anti-drink lobby simply wants to turn companies like Heineken into pariahs for political reasons and will use any excuse that comes to hand.

When SABMiller made a donation to the same organisation in 2012, the imbecile Anna Gilmore and the sociologist Gary Fooks resorted to mental gymnastics as they groped around for reasons to oppose it:

In the current example involving SABMiller, the world’s second largest brewer by sales volume, a conflict of interest arises because of well-established links between alcohol use, violence (including sexual violence) and risky sexual behaviour, making alcohol a risk factor in the spread of HIV infection. Reducing alcohol use can therefore be seen as key to reducing HIV infection. Yet this inevitably conflicts with SABMiller’s underlying goal of maximizing profits from alcohol sales.

Imagine spending an hour inside these people's heads.

It is hard to think of a better illustration of the contrast between public health and 'public health'. On one hand, there are health workers trying to raise money to help prevent people dying from infectious diseases in the poorest countries in the world. On the other hand, we have social scientists in rich countries trying to stop this money being spent because it offends their idea of ideological purity. They really don't care how many people suffer for their dogma.

Thursday, 1 February 2018

The consequences of PHE's calorie propaganda

When Public Health England started lying about nutrition and setting fictitious limits on snacks and meals, I mentioned an obvious unintended consequence:

People will not come to any harm if they restrict their alcohol consumption to 14 units a week. They will come to harm if they consume 1,600 calories a day. This is totally unscientific and highly irresponsible advice (think of the anorexics, for example). PHE are no longer pretending to be a source of accurate advice. They are in the business of nudging, manipulation and deliberate deceit.

Now, via the BBC, I see that there has been a backlash, particularly from people who have experience of eating disorders. The video below is an absolute must see.

Wednesday, 31 January 2018

Two steps back for tobacco harm reduction

Last week the FDA was advised to keep it a secret that iQOS is safer than smoking, and the European Court of Justice was advised to keep snus illegal. I've written an article for Spectator Health about the anti-science, freedom-hating prohibitionists responsible.

There seems to be a principal-agent problem when new nicotine products are assessed by people who are steeped in ‘public health’ dogma, especially when those products contain tobacco. Bates argues that ‘panel members have strong ‘virtue signalling’ incentives to oppose tobacco industry innovation, even if highly beneficial to people at greatest risk. They can enter the room, turn up the pedantry dial to maximum, sit back and relax, lob in the odd insincere question and vote down the claims, all the time faking an appearance of trying to do the right thing.’

And so we have two products which are manifestly less harmful than cigarettes, both of which have a track record of getting people to stop smoking. One is illegal in the EU. The other is illegal in the USA. Neither of them can be labelled as less harmful and neither can be marketed as a reduced-risk product. At best, the government prevents manufacturers from putting truthful statements on these products. At worst, it prevents them from selling them at all.

Do have a read.

Tuesday, 30 January 2018

The anti-drink lobby's war on reality: Geordie Shore edition

Some more puritanism dressed up as academia for you, this time from Alcohol and Alcoholism...

Alcohol Content in the ‘Hyper-Reality’ MTV Show ‘Geordie Shore’

Three tax-spongers from the UK Centre for Tobacco and Alcohol Research (UKCTAS) watched an entire series of the Newcastle-based reality show Geordie Shore and were - as the stars of this show might say - 'proper radge' to find numerous depictions of alcohol use.

All categories of alcohol were present in all episodes. ‘Any alcohol’ content occurred in 78%, ‘actual alcohol use’ in 30%, ‘inferred alcohol use’ in 72%, and all ‘other’ alcohol references occurred in 59% of all coding intervals (ACIs), respectively. Brand appearances occurred in 23% of ACIs. The most frequently observed alcohol brand was Smirnoff which appeared in 43% of all brand appearances. Episodes categorized as suitable for viewing by adolescents below the legal drinking age of 18 years comprised of 61% of all brand appearances. 

Shocking stuff, I'm sure you'll agree.

Alcohol content, including branding, is highly prevalent in the MTV reality TV show ‘Geordie Shore’ Series 11. Current alcohol regulation is failing to protect young viewers from exposure to such content.

Note the focus on 'young viewers'. I am not familiar with Geordie Shore but from what I've heard it is not exactly a children's programme. It is broadcast on MTV at 10pm and Series 11 is rated 18 on DVD. When I looked at the official website I found a selection of video clips with titles such as 'WTF! Gaz and Abbie neck on in naked hot tub party', 'Chloe's boob flash and char confession' and 'Scott finger blasts Chloe'.

It is, however, the use of alcohol that troubles our trio of researchers. They watched all 425 minutes of Series 11 and kept a count of every example of 'actual use, implied use without actual use, paraphernalia without actual or implied use, and brand appearance (real or fictitious)'.

Imagine having that much time on your hands. Imagine being paid to do it (the funders for this crucial scientific research were British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council and the Department of Health).

The fruits of their labour can be seen below. As you can see, there is a fair bit of alcohol use and 'inferred alcohol use' in between the fighting, swearing and shagging in Geordie Shore.

I'm sure you're as keen as I am to know what inferred alcohol use, so here's a handy chart.

The authors then go through every permutation of their findings in autistic detail before announcing that...

The findings of this study demonstrate that the occurrence of alcohol content (verbal and imagery) and alcohol brand appearances is highly prevalent in ‘Geordie Shore: The Complete Eleventh Series’ (GS11).

I expect a fan of the show could have told us that without being given money by the British Heart Foundation, but now it's official.

Similarly, our previous research found alcohol, including branding, to be the prevalent in contemporary music videos...

The life of a 'public health' scientist, eh?

Only one question remains: 'SO WHAT?!' And the authors spend the rest of their article telling us why we should give a hoot.

The study also found that alcohol content and alcohol brand appearances occurred in all episodes of the series deemed suitable for viewing by young people below the age of 18 years. The legal drinking age in the UK is 18 years.

The age at which you can buy a drink is 18 years, yes. Watching somebody else have a drink, on the other hand, is not age-restricted - and only a lunatic would suggest it should be.

Just because you're not allowed to do something doesn't mean that you're not allowed to watch somebody else do it on television. This basic distinction seems to have gone over the heads of our friends at the UK Centre of Tobacco and Alcohol Research.

This is an important finding...

It really isn't.

...because the drinks industry should be adhering to its own self-regulatory codes of practice which aim to prevent exposure of their products to an underage audience.

The drinks industry doesn't produce Geordie Shore, though, does it? As far as we know, no alcohol company has any involvement with it.

However, the regulation of alcohol advertising in the UK has already been criticized for systematically failing by producers and agencies exploiting the ambiguities in the codes (Hastings et al., 2010).

Regardless of whether that's true - and if you're citing Gerard Hastings it probably isn't - Geordie Shore is not covered by alcohol advertising regulation because - guess what? - it's not advertising. It is a reality TV show about twenty-somethings in Newcastle and - guess what again? - the reality is that they drink.

The authors then list various companies' code of conduct for advertising as if it's got anything to do with the real or inferred use of alcohol in reality TV shows:

Anheuser-Busch InBev, the leading global brewer, produces and sells over 200 beer brands globally (AB InBev, 2015). It owns two brands that appeared in this study; Corona and Budweiser. They have a voluntary marketing code that states ‘we are dedicated to promoting smart consumption and reducing the harmful use of alcohol’ (AB InBev, 2016) The code does not apply to television programmes that use their products without express permission to do so, which may have occurred in GS11. Drinks distributer Diageo is the global leader in alcohol beverages (Diageo, 2017). It owns five alcohol brands recorded in the data: Smirnoff, Captain Morgan, Baileys, Tanqueray and Cîroc. Diageo state that marketing will only be placed ‘where 71.6% or more of the audience are expected to be older than the legal purchasing age’ (Diageo, 2016). Clearly this is not guaranteed in GS11. Heineken UK and Bacardi Limited, the owners of Grey Goose, make similar claims in their corporate responsibility policies (Grey Goose, 2015; Heineken, 2015).

All totally irrelevant to the matter at hand.

It is unclear whether the drinks manufacturers have paid for brand advertising in GS11, in which case several codes of practice have been clearly violated...

'It is unclear whether' translates as 'There is no evidence that', so I think we can dismiss that option and move on to the more likely conclusion:

...or if this is a form of de facto advertising where brands are unofficially advertised without the alcohol producer’s knowledge...

Bingo! Now we're getting somewhere. The participants drink alcohol in real life and so that's what the programme shows. which case it is surprising that the companies have not objected and demanded withdrawal of their products.

I guess they could request that the labels be covered up, but it would make them look like control freaks for no benefit to anybody. The viewer would still be exposed to 'inferred drinking' and 'on-screen drinking to excess, with related drunk and disorderly behaviour and sexual encounters', which is what the researchers are supposedly concerned about.

Finally, and as usual in 'public health' studies these days, the conclusion is devoted to a shopping list of new laws and regulations that the authors want to introduce.

...enforcing new policy measures to help protect adolescents from alcohol imagery in the media is essential. Given that 60% of GS11 episodes were awarded by the BBFC and age rating of 15 years, it appears that the existing age classification policy is not protecting young people from alcohol imagery and its potentially harmful effects. 

As mentioned above, you have to be 18 to buy the DVD of Geordie Shore. The authors are talking about the ratings of individual episodes, some of which are rated 15. This is enough for them to play the think-of-the-children card.

In any case, there is no age limit on exposure to 'alcohol imagery'. Alcohol advertisements can be shown at any time of day on British television, except during children's programmes. Geordie Shore is on at 10pm at night, as I mentioned above but the authors mention do not at all (they merely say it is on during 'primetime'.)

The BBFC should award reality television programmes, which include excessive alcohol content and which promote excessive drinking and/or brand placement, an age rating of 18+ years.

The BBFC will not give something an 18 rating just because it depicts heavy drinking. They are not nuts. They did not cave in to Mary Whitehouse and they are not going to cave in to a small band of anti-drink zealots. They have patiently explained why they are not going to start giving 18 ratings to films that depict smoking and much the same applies to drinking. We do not ban films that depict murder just because murder is banned. Similarly, we do not give adult ratings to programmes that depict drinking, smoking or gambling just because you have to be an adult to do these things yourself.

A fairly simple concept to grasp, I would have thought. Now be gone with you.

Sunday, 28 January 2018

Nick Cohen's dystopia

Nick Cohen has gone on a health kick and thinks that his midlife crisis should form the basis of public policy. Previous victims of this delusion include Sarah Vine, David Aaronovitch and, a few days ago, Jenni Russell. After Cohen gave up drinking last year, he wrote a factually inaccurate article calling for more temperance laws. He is now running a half marathon and has decided that the British population must forced to do more exercise.

The results are fairly terrifying. His latest Observer column begins like this:

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

This is literally Orwellian, with the opening sentence evoking the famous line from 1984: 'If you want a vision of the future, imagine a boot stamping on a human face - forever.' And whilst you might expect Cohen to draw back from this explicit authoritarianism and say something along the lines of 'but that would not be reasonable' or 'only kidding!', his article continues in exactly the same vein. Towards the end, he reasserts:

When we imagine a healthier future we are also imagining a more authoritarian state. Individual choice will be constrained and wisdom of the crowd rejected.

If this is the deal on offer, many of us would say that you can stick your 'healthy future' and give us liberty. It is doubtful whether the choice is as binary as Cohen suggests: despite all the wailing about obesity, people's health continues to improve whereas none of Cohen's coercive policies have been shown to work - but he seems to believe what he says and he takes it as read that people should be prepared to sacrifice liberty for longevity. As I wrote in Killjoys, this is a core belief of the 'public health' lobby despite the fact that nobody makes such an extreme trade-off when left to their own devices.

His overarching justification for forcing lifestyle change upon the population is the usual excuse about poor diets and lack of exercise bankrupting the NHS (may peace be upon it). Anyone who knows the economics of longevity understands that this is piffle (have a read of Death and Taxes for a summary). But, having fallen for this popular myth, he then launches into his programme for change:

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. 

Roads are obviously not too narrow to take cars, so I can only assume that Cohen will extend cycle lanes to make them so. I assume this because...

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. 

This is an idea that can only be seriously entertained by someone who works from home in central London. How practical would it be to bring Britain's roads to a standstill in an effort to force people to walk?

Let's look at some statistics. 89 per cent of all journeys in Britain are taken by road and two-thirds of business/commuting trips are taken by car. Only 6 per cent of car journeys are under a mile and the majority of journeys under a mile are already taken on foot. Even if we leave aside the foul British weather, the weight of luggage and the need of vans and lorries to make deliveries, the distances involved are simply too long.

Incidentally, although I don't have the stats for this, life experience tells me that pedestrians at pelican crossings do not have to wait more than a minute to cross the road.

Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

Because everyone lives within a mile of their workplace and should just get on their bloody bike, eh Nick? Never mind all the people who live in the suburbs, small towns and countryside - who are, by the way, in the majority.

Cohen's logic suggests that closing down railways, bus routes and the tube would also be necessary to get Britain exercising and yet he does not mention any of these. Perhaps the idea of getting around London without the help of an engine is not as appealing as the vision of suburban drones marching to the office?

School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

What about those who arrive in a bus? Is motorised transport only acceptable if it is owned by the state?

No fast-food outlet would be allowed within a one-mile radius of a school. 

Effectively, this would mean no fast food outlets in Britain's towns and cities. Thanks to Dan Cookson, we know what an exclusion zone of 400 metres around schools - as proposed by Sadiq Khan - would look like.

Cohen is proposing an exclusion zone that is four times wider than this and that applies to all fast food outlets, not just the new ones. This would amount to a total ban on shops selling pizzas, hamburgers, fish & chips, kebabs etc. Cohen would probably be happy with that, but it sounds a tad heavy-handed.  

Agricultural subsidies for fat and sugar would be abolished. 

There are no subsidies for 'fat'. Fat is a component of most food products including meat, cheese and milk. In so far as there is a subsidy for sugar, it is part of the EU's farming regime of tariffs and subsidies which, on balance, makes sugar more expensive that it would otherwise be.

Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. 

I have no idea what he is talking about here. Is he suggesting that the government ban the farming of these crops? Or does he think that people will spontaneously stop consuming them when public transport is (further) subsidised? If so, why? There is no logical connection between the two, but the call to subsidise public transport confirms that it is private car ownership, not physical inactivity, that is really bugging Cohen.

Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

Food manufacturers don't pay excise taxes, consumers do.

It may seem a less practical measure but I would hope to see a vigorous challenge to the paradox of our culture’s celebration of thinness and athleticism in an overweight world. The idealisation of film stars and athletes raises impossible expectations. Because 99% of people do not have the genes – or the time and money for training – to even think of imitating them, we simply don’t try. A small blow could be struck if UK Sport were forced to stop sponsoring elite Olympic athletes and spend its millions on sports facilities for all instead.

Again, I have no idea what he's talking about it. Whilst I am extremely sympathetic to the idea of not paying people to participate in the jingoistic tedium of the Olympics, I fail to see how withdrawing the funding will make us any thinner. It is wibble.

Sugar and fat addiction, like all addictions, provide a temporary respite for the poor, the depressed and the disappointed. 

Sugar and fat addiction do not exist. Giving up something you enjoy and then missing it does not make you an addict.

Perhaps we should offer them better lives rather than snatch away the few comforts they enjoy. 

That would be nice wouldn't it? But you have no way of doing it and you're only going to make their lives worse by dishing out the kind bans and taxes as that evil billionaire Mike Bloomberg threatened us with this week.  

This sounds a stirring counter-argument. 

It's better than taxing the hell out of us, censoring the media, and making us walk for miles in freezing temperatures, yes.

But as any reader who has been an addict will know, addiction prevents you finding a better life.

People are not addicted to driving and there is no evidence that they have a latent demand for cycling, walking or tasteless food.

God knows, there are good reasons to mistrust experts re-engineering societies from above.

Given that the main 'expert' Cohen cites is a fanatic called Tim Lang who thinks that repealing the Corn Laws was a mistake and believes that making food more expensive is an admirable end in itself, this mistrust is justified.

But as with tobacco, freedom of choice in the food and car markets has left us with no choice but to trust them.

The vilification of 'car markets' is a new one to me, but it is no surprise to see tobacco being used, once again, as a precedent for controlling the lives of private citizens.

Cohen admits that many readers will regard his proposals as 'dystopian', and so they are. Nevertheless, I am glad that he has put them down on paper. His article is a fine reminder of what we are up against.

Friday, 26 January 2018

Junk alcohol research of the week

Sometimes the junk science that comes out of the ‘public health’ lobby is so bad you just have to laugh. Take this study, for example, published yesterday in the apparently reputable Journal of Hepatology. As reported by the Irish Times, it found that ‘alcohol consumption even at very low levels early in life may significantly increase the risk of alcoholic liver disease in men’. It was even suggested that drinking guidelines should be lowered to accommodate this emerging evidence.
Alcoholic liver disease is a relatively rare condition that overwhelmingly affects very heavy drinkers. It would be surprising, to say the least, if ‘very low levels’ of drinking caused it.

And yet the media’s coverage of this study accurately reflected the claims made by its authors. They claim to have shown that ‘consumption of alcohol early in life is associated with an increased risk of developing severe liver disease in men’. They say that ‘men consuming as little as one to five grams [less than one unit] of alcohol per day had an increased risk of severe liver disease compared to abstainers, indicating that the increased risk of severe liver disease might be present even at very low doses of alcohol.’ Moreover, they declare – in the abstract of the study – that: ‘Current guidelines for safe alcohol intake in men might have to be revised.’

How did they arrive at these remarkable conclusions? First, they dug up some old documents from the Swedish army dating back to 1969-70 when conscription was still in force. These documents contain survey data from conscripts aged between 18 and 20, including estimates of how much they drank.

This gave the researchers the baseline figures for alcohol consumption. The men were then ‘followed for a mean period of 37.8 years’ to see what happened to them. This is a rather grand way of saying that the researchers looked at Sweden’s National Patient Register to see how many had developed alcoholic liver disease by 2009.

Of the 43,296 individuals who had provided drinking estimates in 1969/70, 383 had developed severe liver disease (0.9 per cent). When the researchers looked at their alcohol consumption, they found that those who drank the most were the most at risk and those who did not drink at all were the least at risk. Fair enough but, more surprisingly, they also found that those who only drank one or two units a day were at increased risk.

The authors describe these findings as ‘borderline statistical [sic] significant’. In fact, they are nowhere near being statistically significant, but we’ll leave that to one side. The more interesting question is this. In the 39 years between the men being recruited to the army and their medical records being examined, how often do you think the researchers asked them how much they drank?

Every six months? Once a year? Once every five years?

How about never? Because that’s how often they kept abreast of what these men were drinking. Not once. They have no idea how much their subjects’ drinking behaviour changed in the intervening years. All they know is that the people who were teetotal in 1970 were less likely to develop liver disease than the people who were drinkers in 1970. Hold the front page!

In no way does this study show, or even imply, that drinking at low levels causes liver cirrhosis. The authors’ suggestion that their study shows that ‘recommendations for safe alcohol consumption regarding the risk for development of severe liver disease in men might be set too high’ is an absurd non-sequitur.

Quite obviously, the men in this study did not continue drinking at the same level as their 19 year old selves for the rest of their lives. Some of the teetotallers became heavy drinkers (we know this because eleven of them developed alcoholic liver disease), some of the heavy drinkers became teetotallers, and some of the light drinkers became heavy drinkers. It is not drinking at ‘very low levels early in life’ that causes the damage. It is drinking at very high levels later in life. Without knowing anything about what these men were drinking after 1970, the study tells us precisely zero about the relationship between alcohol and liver disease, nor does it inform the discussion about what a ‘safe level’ of drinking is.

Why are journals publishing this pointless rubbish? Judging by the lead author’s comments to the press, the aim is not to tell us anything useful, but to put pressure on the Swedish government to follow the UK in lowering the drinking guidelines.
“If these results lead to lowering the cut-off levels for a ‘safe’ consumption of alcohol in men, and if men adhere to recommendations, we may see a reduced incidence of alcoholic liver disease in the future,” Dr Hagström said.
It would be strangely fitting if the Swedes lower their drinking guidelines based on junk science which claims that alcoholic liver disease is a threat to light drinkers. As the e-mails released under the Freedom of Information Act show, it was only by making this scientifically illiterate assumption that the UK’s Chief Medical Officer was able to lower the guidelines in 2016.

We can expect more studies of this kind in the next few years. The anti-drink lobby will not be happy until the official drinking guidelines are zero and they will go to any lengths to achieve it.

[Cross-posted at Spectator Health]