Tuesday, 30 September 2014

A late reply to Irish plain pack nonsense

Before I went to Australia last month, I wrote a letter to the Irish Times after they published a particularly silly article by Luke Clancy of ASH Ireland. They didn't published it (this is becoming a habit with Irish newspapers) so, very belatedly, here it is...

Nobody should be surprised that Professor Luke Clancy would claim (Irish Times, August 15) that plain packaging of cigarettes “works”, but to support his assertion he cites a number of statistics which should be taking their case to the United Nations Committee on Torture, such has been their mistreatment at the hands of the proponents of plain packaging.

In Professor Clancy’s rush to misquote one part of an official Australian Government report on smoking prevalence, he neglected to even mention another part of it. The less useful aspect, from his perspective, of the Australian household survey shows that the number of daily smokers in Australia between the ages of 12 and 17 – the very cohort that plain packaging is supposed to turn off cigarettes - has increased from 2.5 per cent to 3.7 per cent.

This is despite what Luke Clancy wrote last Friday: “All research to date shows packaging is central in attracting children to tobacco. When stripped of their alluring colours and logos and replaced with textual graphic and health warnings, the packages will transform the relationship between teenagers and tobacco.” The relationship has indeed been transformed. There are now thousands more teenagers having a relationship with tobacco, according to the Australian government.

It should be said that the Australian Institute of Health and Welfare study is carried out every three years with the latest covering 2010-2013. Since plain packs were only introduced in December 2012, campaigners have derived their conclusions about a policy that was only in effect for one third of the survey period. This is more than a little disingenuous, but if Professor Clancy is going to claim that plain packaging is responsible for the “fastest decline in smoking rates in over 20 years” (it’s not, but more on that below) then he equally has to accept that plain packaging is responsible for a rise in teen smoking.

Clancy also neglects to mention that there was a whopping 25 per cent tax hike on tobacco in 2010 which the government itself predicted would reduce the number of smokers "in the order of 2 to 3 per cent” or around 87,000 Australians.

The actual drop in overall smoking prevalence in the three years from 2010 to 2013 was 2.3 percentage points – perfectly consistent with the steady downward trend that has been in existence for many years and which seems to have been totally unaffected by plain packaging. This decline was not even the biggest decline in the last 15 years, let alone the last 20. There was a greater decline in smoking rates between 1998 and 2001 (of 2.4 percentage points).

Clancy disguises this by looking at percentage differences between the percentages rather than looking at the decline amongst the whole population. This is statistical trickery. As smoking rates get lower, it is a mathematical inevitably that an identical decline in the number of smokers will appear to have a larger effect in relative terms. For example, a two percentage point decline in a place where 50 per cent of the population smokes represents a relative decline of four percent, as Clancy defines it, whereas the same decline in a place where ten per cent of the population smokes would represent a 20 per cent decline. But the reduction in the number of smokers is the same in both examples.

Clancy also misrepresents Australian Bureau of Statistics’ data showing a decline in tobacco sales during the first year of plain packaging (December 2012-November 2013). Far from indicating a 3.4 per cent decline (which would not be unusual in any case) the data show that the fall in sales was much smaller (0.9 per cent) in the first year of plain packaging than it was the year before (3.4 per cent). For that matter, it was smaller than the year before that (7.1 per cent) and the year before that (2.5 per cent).

Incidentally, Professor Clancy wrote last week: “It has been reported that the Bill has gone to the EU, as is required practice and that it will be delayed by Europe. It is difficult to see why this is assumed and why is it [sic] reported as seemingly inevitable.” These two sentences illustrate just how out-of-touch Professor Clancy is. The reason that it was reported that the European delay is “inevitable” is that it is a fact. (Newspapers generally strive to report facts - the same cannot always be said of single issue campaigners).

The Bill was notified to Europe in mid-June and, if there were no objections, would have been back with the Irish government by mid-September. There have been a number of very strenuous objections from governments (administrations that haven’t been taken in by Professor Clancy’s distorted data) so the European Commission has doubled the standstill period for the legislation and told the Irish government it cannot proceed next month as it had planned.

It’s that simple Professor. Look it up.

And, for those who need visual stimulation, here's that plain packaging miracle (the "vaccine for lung cancer" - copyright Simon Chapman) in full...

That's right. It did bugger all.

Monday, 29 September 2014

Calorie consumption (part 2 of many)

In the previous post in this series, James left a comment asking "is it necessary to state so unequivocally that the problem is less exercise? I agree it's the most plausible explanation, but there could potentially be others."

My argument is that if, as seems to be the case, calorie consumption has fallen over time, increases in body weight must be due to fewer calories being expended and, therefore, that a reduction in physical activity is the most likely culprit. I appreciate that there are people who believe that a calorie is not a calorie and that changes in the diet could therefore be the issue. I tend to side with the traditional consensus view that a calorie is, in fact, a calorie, but even I wasn't so inclined, it so happens that the consumption the ingredients that some claim are uniquely fattening (notably saturated fat and sucrose) have also declined, so that line of argument seems like a dead end.

Physical inactivity is not the sole explanation for why people are expending fewer calories than they used to. It has been argued that central heating means that people burn off less energy through keeping warm. The decline of smoking has probably also had some effect; smokers weigh several kilograms less than nonsmokers on average.

There may be other factors that have affected metabolism over time, but physical inactivity remains the main contender for why obesity has risen. All sorts of evidence can be given on this count, only a little of which was documented in The Fat Lie. For example, I read an interesting post by Tim Olds at The Conversation this week:

In 1919, a young woman named E.M. Bedale started postgraduate research at University College London, an uncommon undertaking for a woman at that time. Her studies focused on energy balance in children, which led her to spend several years at a serendipitously eponymous school called Bedales in rural Hampshire.

During her two years at Bedales, Miss Bedale measured the energy expenditure and intake of the school’s students, using methods that are still considered to be gold standards today.

Her data provide a startling contrast to our time. Children from almost 100 years ago were 50% more active than kids today. They accumulated over four hours more of physical activity and sat for three hours less than today’s kids - every day.

Too historical for you? Not 'evidence-based' enough? Then how about this?

Or this...

In the 1960s, half the jobs in private industry in the United States required at least moderate-intensity physical activity, compared to less than 20% today.

Work in factories and farms has given way to office work, and that has amounted to over 400 kilojoules less each day that adults expend at work. This difference alone results in a weight increase of about 13 kilograms over 50 years, which pretty closely matches actual changes in weight.

And in the home...

In many ways, the whole ethos of ease now saturates our society, and efficiency is the hallmark of modernity.

Think about it this way - nobody is in the market for a labour-creating device. Sit-on mowers, leaf blowers, self-opening doors and automatic car windows, robot vacuum cleaners, sensor lighting, dishwashers and microwaves all yield daily microsavings in energy expenditure that add up to hundreds of kilojoules.

In 1900, the average American housewife spent an estimated 40 hours every week in food preparation. Today, that time is barely four hours — and it appears to have reached an absolute minimum.

When it comes to physical activity in one's leisure time, some interesting research was published this year in the American Journal of Medicine. I mentioned it briefly in The Fat Lie but some of the statistics are shocking and require another look. The graphic below shows the proportion of Americans who engage in no leisure activity whatsoever. Click to engorge.

Between 1988-94 and 2009-10, the proportion of men who did no leisure-time physical activity rose from 11.4% to 43.5%. Amongst women the rate rose from 19.1% to 51.7%. These are enormous changes in a relatively short period of time.

There's more to come but this blog post is long enough so I'll come back to it in the near future.

Thursday, 25 September 2014

Soda sock puppets

The soda tax campaign that is underway in Berkeley and San Francisco is asking voters to support paying an unnecessarily high price for a widely consumed product. This is not an easy sell, even for Californians, and so the campaign has tapped into the rampant anti-business mentality of the region by being entirely about 'beating Big Soda'.

The campaigners hope that Californians will be so angered by the thought of an industry making money that they will volunteer to give the government more of their own cash. And for the benefit of the dimmest voters, they've concocted the fairytale that a soda tax isn't a tax that people will have to pay—oh no!—it's merely a 'tax on industry'.

This is a tax on industry, not a sales tax on consumers or a tax on retailers. Distribution companies will pay the tax for the privilege of distributing sodas and other sugary beverages in Berkeley. It will be the companies’ choice whether or not to pass this tax to the people of Berkeley.

Seems legit...

In San Francisco, the pro-tax campaign is being run by a group called Choose Health SF. Their website is a real treat, including such phrases as "Coke and Pepsi are the real nannies" and "Ending hunger is about more than making sure people have enough calories."

Choose Health SF are obsessed with 'Big Soda'. They are particularly annoyed by the "misleading astroturf tactics of the American Beverage Association". This is a reference to the Coalition for an Affordable City, an organisation set up by the soft drink industry to campaign against "unfair beverage taxes".

Choose Health SF call the Coalition for an Affordable City a "local front group" for Big Soda. By contrast, their own campaign is about "real grassroots community coalition building". They call on Californians to "Join the soda tax grassroots movement." (To see the kind of people they've been building coalitions with, scroll to the bottom of this post).

So who are these grassroots campaigners who want the government to get more tax revenue? Choose Health SF's domain name was registered by Maggie Muir. Maggie Muir is a partner at Erwin and Muir, a public affairs agency that specialises in political campaigns. Erwin and Muir have been "hired by San Francisco lawmakers to lead the political committee in support of the soda tax".

Choose Health SF is, therefore, a classic astroturf group created and funded by the government to lobby for more government action. It is a state sock puppet

There will be some people who say that this is fair enough, it's one front group against another. I can't agree with that. If the soda industry wants to use its own money to campaign on an issue that is important to its customers (or any issue, for that matter), then it should do so. Most of its customers will be glad that it is taking a stand, but if there are those who don't support it, they are free to stop buying its products.

But for a government to use taxpayers' money to campaign for higher taxes under another name? No. The taxpayer has no ability to withhold his money from the campaign if they disagree the government's stance on the issue. He is, as Thomas Jefferson put it, forced to "furnish funds for the propagation of ideas he disbelieves and abhors".

Moreover, it is fairly obvious that the Coalition for an Affordable City campaign is funded by the soda industry. On every page of their website it says:

"Paid for by No on E: Stop Unfair Beverage Taxes, Coalition for an Affordable City, with major funding by American Beverage Association California PAC."

By contrast, the Choose Health SF website does not give even a hint that it is funded by the government. There is no 'About Us' page and Choose Health SF describes itself merely as "a political committee organizing to pass a local sugary beverage tax." There is nothing on the site to suggest that it is the work of a public affairs agency working on behalf of the government. Big Soda has to be upfront about its 'front groups', Big Government not so much.

We've seen various state-funded 'public health' agencies attempt the same trick in the UK in recent years (eg. here, here and here). I dunno, perhaps this sort of state-funded activism is par for the course in the USA? Erwin and Muir boast that they have "secured over half a billion dollars in financing for schools, roads, and parks improvements through 2/3rds voter approval", so maybe it is.

Whatever the case, voters in San Francisco need to be aware that the campaign for higher taxes has been orchestrated by the interest group that has the most to gain from them—the government.

Wednesday, 24 September 2014

Loot and plunder

So Ed Miliband has decided that tobacco companies make too much money and so he's going to help himself to some of it. Looting private industry on a whim is not the best way to convince companies that the UK is the best place to do business, but there you go. The other vultures of the parasitic state immediately began to circle...

This smacks of arbitrary and capricious government. And it will ultimately be paid for by the consumer, as one analyst told the Guardian...

“The obvious solution for companies is likely to be a pass-on of the cost through higher prices, so you would expect the consumer to ultimately bear the cost.”

Yep. But there is one thing that puzzles me about the way the media reported the story and it is this:

The fees, similar to those introduced by Barack Obama in 2009, are to be based on the firm’s market share.

Most newspapers echoed the claim that Obama did the same thing in 2009, but I can't work out what they're referring to. Obama introduced a major tax rise on tobacco in 2009, but that can't be it. Miliband's idea more closely resembles the Master Settlement Agreement, but that was a legal settlement and it happened way back in 1998 under Bill Clinton.

Can any readers explain? Or is this the Labour press office desperately trying to get the words 'Obama' an 'Miliband' into the same sentence?

Monday, 22 September 2014

Breathalysing clubbers

My thoughts at the Telegraph...

Sunday, 21 September 2014

The conceit of 'public health'

Blog post of the week has to be Clive Bates' open letter to 'public health grandees'. It really is a must-read, so if you haven't yet, do read it now. I'd like to highlight a couple of sections: -

Vapers think you don’t understand this model – and you don’t care what the evidence says. You have shown no sign of understanding how this works – and keep seeing it as a tobacco industry plot (they were late to the party) or some sort of rogue medical product. Neither is true. But vapers rightly suspect you are careless with the truth: most public health organisations united to support a ban on snus in the European Union in 1992, again in 2001, and once again in the 2014 Tobacco Products Directive. This is despite indisputable evidence that snus, a very low risk way of taking recreational nicotine, has been highly positive for public health where it is permitted and used in Scandinavia – displacing smoking, diverting smoking onset, and supporting user-driven quitting. There is no scientific, ethical or legal case for banning it – but you supported it anyway. This is the same public health model as vaping, so it is no wonder they don’t trust you. Until you face up to the lethal error you have made on snus, you have not earned the right to a hearing on vaping. 

The evidence on snus just keeps on coming. Last month, there was this study in the International Journal of Drug Policy:

METHODS: This paper exploits a quasi-natural experiment to examine the net effect resulting from these opposing incentives. While two Scandinavian countries, Sweden and Finland, joined the European Union (EU) in 1995, Finland was subject to a pre-existing EU ban on oral tobacco products while Sweden received an exemption. A difference in differences framework is used to estimate the change in the smoking rate in Finland due to the implementation of the ban. A secondary analysis uses Finnish smoking data to test for a structural break in trend.

RESULTS: In the post-ban period, smoking was 3.47 percentage points higher in Finland relative to what it would have been in the absence of the ban.

CONCLUSION: The availability of snus, a less harmful alternative to smoking, appears to have had a positive impact (reduction) on the smoking rate. Offering acceptable alternatives to cigarettes is critical in reducing smoking prevalence.

This study got no media attention and was completely ignored by supposed anti-smoking campaigners. As usual.

Clive also says this about the prohibitionists' insistence that vaping activists are astro-turf groups:

You seem surprised to find there are people who get up and do something, and do it for nothing – you seem to assume someone must be paying if vapers do anything. I can see why you might think this: it rarely happens in your world or it is a distant memory from your more idealistic youth. There are no grass roots or unpaid individuals campaigning for the things you want in this field. You should think of these people more like the activist campaigners you know in drugs or HIV/AIDS. Many vapers are passionate about their experience: they have escaped the death trap of smoking – or are heading that way – and having feelings of pride, empowerment, agency and control, as well as immediate welfare and economic benefits, and a much better long term health prognosis. They want others to benefit from the experience and they really don’t want you to take it all away through clumsy or excessive regulation based on poor science, comprehensive misunderstanding or for ideological reasons. And they don’t want to be collateral damage in your war on Big Tobacco, which is of little relevance to them.

It is undeniable that public health rhetoric is jampacked with references to Big Tobacco, Big Alcohol and Big Food. See, for example, this speech from the Director of the WHO, or this speech (ostensibly about public health, but actually about 'transnational corporations'), or, indeed, the entire campaign for a soda tax in San Francisco.

Until quite recently, I assumed that the attempt to polarise every nanny state policy as being 'doctors versus industry' was a marketing ploy on the part of the prohibitionists. It plays well with the media and the dimwitted. I assumed that most of them—with the exception of some of the younger, more naive campaigners and some of the true nutters like Gerard Hastings—understood that millions of people sincerely disagree with them and that it was impossible that all these people could be working for industry.

The e-cigarette issue has made me change my mind. It seems that many - perhaps most - 'public health professionals' genuinely believe that ordinary vapers on Twitter are part of an astro-truf campaign that has been orchestrated by Big Tobacco. It blows the mind that there are educated people who could entertain such a paranoid world of make believe, but if they believe this then there can be no doubt that they also believe that all opposition to policies such as minimum pricing, smoking bans and soda taxes is 'astro-turfed'.

Part of this comes down to an extreme sense of self-righteousness, fostered by living in an echo chamber, that makes it difficult for zealots to see any point of view other than their own. Clive is too polite to mention one of the other reasons why 'public health' people are "surprised to find there are people who get up and do something, and do it for nothing", which is that they would never consider doing anything without being paid for it, preferably by the government. A grass roots, volunteer-run 'public health' group is an oxymoron.

Thursday, 18 September 2014

Calorie consumption revisited (part 1 of many)

The Department for the Environment, Food and Rural Affairs (DEFRA) released new data on British food consumption today. Public health revisionists should look away now.

● Average energy intake based on all food and drink purchases has fallen 8.3% between 2001-02 and 2012.

● Energy intake from food and drink recorded as eating out fell 7.3% in 2012 and has fallen by 29% since 2001-02.

● There is a long term downward trend in energy intake since the early sixties (visible in all components of the chart). Combining year on year changes of estimates on like bases suggests that average energy intake per person is 31% lower in 2012 than in 1974.

● Despite decreasing energy intake, over-consumption of energy relative to our needs is a major factor in increasing levels of obesity

Taking the long view, DEFRA provides this graph. It goes back to 1940 and shows three (or, arguably, four) different datasets.

Initially, from 1940, the figures show per capita calorie consumption but exclude calories from alcohol, soft drinks, confectionery and food eaten outside the home. After rising after the war, the trend is downwards after the 1950s.

In 1992, calories from confectionery, soft drinks and alcohol were included, and, in 1994, calories consumed outside the home were also included. The addition of extra items naturally pushed the line higher up the graph, but in each case the trend continued downwards.

In 1948, 2,387 calories per capita were recorded, but this excludes alcohol, confectionery, soft drinks and eating out.

However, by 2012, despite all of the above now being included in the figures, recorded consumption was 2,209 calories per capita, which is to say it was lower than the 1948 figure.

Obesity prevalence is clearly much higher today than it was in 1948 and it seems clear to me—and should be clear to anybody who has the slightest understanding of the difference in the typical lifestyle of 1948 compared with today—that the primary reason for this is a big decline in physical activity, whether it be in the workplace, in the home or in personal transportation. 'Energy in' has gone down, but 'energy out' has gone down even more.

However, as we have seen previously, the nuclear option for who insist that obesity has risen because people are consuming more and more calories is to dismiss the DEFRA data—and all other data that show the same trend—out of hand on the basis that it is self-reported and therefore unreliable.

Aside from the fact that this is simply not true (there is plenty of evidence on household shopping that shows the same decline in calorie consumption), the 'we're eating more' claim is asserted without evidence and can be dismissed without evidence. Merely stating that people under-report what they eat, although true, is not enough to turn the graph upside down under any plausible scenario.

I have picked 1948 as a reference point here because it falls in a period covered by a British Medical Journal study that I briefly mentioned in The Fat Lie. Published in 1953, the study looked at calorie intake and weight changes amongst the British population during the years of rationing. It shows not only how much people were eating, but how much they needed to eat.

Comparison of the relation between the food-consumption levels and the body weight changes recorded in this paper and the calorie value of total supplies of food moving into civilian consumption (Ministry of Food, 1949, 1951a) shows that during 1944, when the calorie value of the total food supply was just over 3,000 per head per day, adult men and women gained weight; that during 1945, when the calorie value was over 2,900, weight was roughly constant; that during 1946 and the early part of 1947, when the calorie level fell below 2,900 and dissatisfaction over the food supply was voiced publicly, adults lost weight. In 1948, when the calorie level had again risen above 2,900, the trend of 1946 and 1947 was reversed.

The authors concluded that the government of the day's advice that an average British adult should consume 2,800 calories a day was 'probably too low'. They suggested that 2,900 calories a day was closer to what was needed to maintain a healthy weight. This was based on empirical data that showed that people tended to lose weight if they consumed less than that.

By contrast, today the government advises the average Briton to consume 2,250 calories a day to maintain a healthy weight. A diet that would be considered as the bare minimum, or even below the minimum, in the 1940s would be enough to make most modern Britons gain weight.

The very fact that government advice on calorie intake has changed so much over the years is, in itself, a stark recognition that we do not need to eat as many calories as we did decades ago. Why? Because we are considerably less physically active than we were decades ago, not only in the workplace, but also in the home.

Moreover, we do—on average—eat fewer calories than we did decades ago, or even a few years ago. You can argue that we are still eating too much (many people obviously are), but to pretend that we are as physically active as ever whilst eating more than ever is a complete inversion of the truth.