Friday, 24 March 2017

Tobacco Control fail

The 2016 Tobacco Control Scale (TCS) was published yesterday. The TCS pats governments on the back for capitulating to the whims of the anti-smoking lobby, regardless of whether the policies actually work.

Charting each country's score against smoking rates show that obedience to 'public health' diktats is no guarantee of lower smoking rates, even if forcing people to stop smoking were ethically justifiable - which it isn't. As with previous TCSs, there is no statistically significant association between tobacco control scores and smoking prevalence (the r-squared is 0.08, if you're statistically minded).


I've used smoking prevalence data from the OECD and the WHO circa 2015 for this graph. As I mentioned recently, Sweden's smoking rate has since fallen to nine per cent. The Swedes get a fairly mediocre score in the TCS because they don't ban all tobacco advertising, don't have a display ban, don't have plain packaging, don't have especially high tobacco taxes, don't spend much money on anti-smoking campaigns and don't have a 'comprehensive' smoking ban. Above all, they don't ban snus - and that is the reason they have the lowest smoking rate of any developed country. Naughty Swedes.

It says a lot about the tobacco control racket that Sweden gets the same score as Turkey. Turkey was the blue-eyed boy of the anti-smoking movement when the TCS was published in 2013. It introduced a draconian smoking ban in 2008 and has graphic warnings on cigarette packs covering 65% of the surface area. It bans nearly all tobacco advertising and it prohibits the sale of e-cigarettes.

In 2013, WHO director-general Margaret Chan delivered a speech in which she drooled over the fact that Turkey 'has some of the most stringent tobacco control measures in the world' and claimed that 'Turkey’s success in tobacco control has stunned many observers'. The WHO has a penchant for authoritarian regimes, but Chan was particularly awestruck by the Turks.

I am most pleased to mark World No Tobacco Day in Turkey, a country that is a model of success in tobacco control and an inspiration for the world...

Moreover this country was the first in the world to achieve all six MPOWER demand-reduction measures for tobacco control at the highest possible level of achievement. No other country in the world has done this...

I thank the Turkish government for collaborating so closely with WHO... Turkey is the only country in the world to receive three WHO awards for achievements in tobacco control...

It is a model for other countries to follow, and it is a source of great encouragement...

Thank you, Turkey, for being such a shining, and inspiring, model of success. Tobacco control works.

I could quote more of this hubris but you get the picture. Suffice to say, things did not go quite so well in the real world:

From 2008 to 2011, tobacco consumption in Turkey fell to less than 100 billion cigarettes per year. In 2015, the figure stood at 125 billion, including contraband cigarettes and loose tobacco, according to Elif Dagli from the Turkish Thorax Society’s Tobacco Control Working Group. The smoking rate rose from 39% to 42% among men, and from 12% to 13% among women. The real alarm, however, concerns the young. Compared to the 2003-2012 period, the consumption of cigarettes and other tobacco products in the 13-15 age group increased by 51% and 88%, respectively, Dagli said.

 Trebles all round!

Thursday, 23 March 2017

Moderate drinking: doubt, denial and whataboutery

Yet another study has shown that teetotallers have a significantly increased risk of cardiovascular death and death. The study was published in the British Medical Journal and involved nearly two million people, including 280,000 people who had never drunk alcohol. It was conducted by researchers at Cambridge University and University College, and the non-drinker category was split into never drinkers and former drinkers to prevent the usual squeals of 'sick quitter!' from the deniers in 'public health'. The table of results are at the bottom of this post.

I've written a full post about this for Spectator Health so please read that first, but here are a few additional thoughts.

The BMJ study is difficult to argue with, but the usual suspects have been out in force to sow as much doubt as they can. They have opted for a strategy that they would claim was ripped out of the 'Big Tobacco playbook' if other people did it. It takes three forms: outright denial, raising spurious methodological objections, and diverting attention to other issues.

Using examples from the last twelve hours, let me illustrate how this works.

Doubt

Ian Gilmore of the Alcohol Health Alliance, a long time foe of booze, went for the old trick of saying 'correlation is not causation' without explaining why we should not infer causation after 40 years of the same findings being produced. Doubt is his product.

Professor Sir Ian Gilmore, chairman of the Alcohol Health Alliance, said: “As the authors of the study say, it is not possible to draw firm conclusions from the study about cause and effect between moderate alcohol consumption and heart health."

As Gilmore knows, no epidemiological study is able to establish causation, but in the absence of any plausible explanation it seems reasonable to conclude that the effect is causal. Gilmore offers no alternative explanation and the BMJ study explicitly states that his beloved 'sick quitter' hypothesis does explain the results. Gilmore doesn't mention this in his press release. Instead he promotes the risible Chief Medical Officer's report that he and his buddies in the temperance lobby oversaw.

Denial

Outright denials came from the British Heart Foundation, of all people:

“This study suggests that sticking within alcohol guidelines may actually lower your risk of some heart conditions,” says Tracy Parker, of charity the British Heart Foundation, who was not involved in the study. “But it’s important to remember that the risks of drinking alcohol far outweigh any possible benefits. These findings are certainly no reason to start drinking alcohol if you don’t already.”

In fact, the BMJ study shows that participants who drank within the old UK guidelines were 24 per cent less likely to die and 31 per cent less likely to have coronary heart disease by the time the study ended. Let's not mince words, the BHF spokeswoman is lying here.

Whataboutery

James Nicholls of Alcohol Research UK, which is merging with Alcohol Concern, combined denial with whataboutery involving exercise and food.

“There are better ways to strengthen the heart such as exercise and good diet. All things being equal – and given the increased risk of suffering other health conditions linked to any amount of alcohol consumption – if you drink within the existing guidelines it is unlikely that alcohol will either lengthen or shorten your life.”

If a 24 per cent increased risk of mortality is unlikely to shorten your life then presumably a 34 per cent increase is not much to worry about either. A 34 per cent increased risk is what heavy drinkers have, according to this study. Perhaps we should put an end to alcohol research and do something more worthwhile? (To be entirely fair, the Guardian quoted the least true part of James's statement, the full version of which you can read here.)

Rosanna O'Connor of Public Health England went full throttle with the whataboutery:

“Those who don’t drink should not consider taking up drinking to improve their heart health, but are better off stopping smoking, getting regular physical activity and eating a healthy diet.”

Aside from the fact that large numbers of (mainly older) people are unable to be physically active, O'Connor presents a false choice between moderate alcohol consumption and other ways of staying healthy. In fact, research shows that people benefit from moderate drinking even if they already exercise, eat healthily and don't smoke. In other words, if you are a physically active non-smoker with a good diet you will be healthier if you drink moderately. Being teetotal is a risky behaviour no different from having a poor diet. An evidence-based health agency would treat it as such. If Public Health England hadn't just published a pile of dogmatic neo-temperance trash and called it an alcohol review, perhaps they would have admitted the truth today.

Incidentally, the BMJ study has been reported almost everywhere with the notable exception of the BBC. The BBC's health team is usually eager to cover alcohol news. Two days ago they reported a total non-story about the 20 year old fad of drinking alcohol with energy drinks. The Beeb has been keen to write stories about moderate drinking before, such as 'Cancer risk "even from light drinking"', 'Breast cancer link to small amounts of alcohol' and 'Red wine health benefits overhyped' so you would expect them to be interested in the largest study ever conducted on the effect of alcohol on the heart.

And yet they've completely ignored it. I can't think why.

Don't forget the Spectator post.





Tuesday, 21 March 2017

Fake dental news?

The dubious claims about tooth decay are coming thick and fast now. Only two months after the last dodgy press release about children having their teeth extracted in hospital (from the LGA), comes this from the Faculty of Dental Surgeons:

Hospitals in England are seeing thousands of very young children each year needing baby teeth removed. 

The Faculty of Dental Surgery at the Royal College of Surgeons, which compiled the data, blames tooth decay linked to sugary diets.

Figures show there were 9,206 extractions carried out on children aged four and younger between April 2015 and March 2016.

A decade ago, it was closer to 7,400 extractions.

This 26 per cent rise needs to be put in the context of a 16 per cent rise in the number of children aged under five in that period. Nevertheless, it is a rise and the Faculty of Dental Surgeons wasted no time in pinning the blame on sugar:

‘When you see the numbers tallied up like this it becomes abundantly clear that the sweet habits of our children are having a devastating effect,’ said Professor Nigel Hunt of the RCS Faculty of Dental Surgery.

And yet there is no credible evidence that children's teeth are getting worse. As I said in the Spectator last year...

We are no longer a nation of Austin Powers. ‘The dental health of the majority of British children has improved dramatically since the early 1970s,’ according to a 2005 study, which also noted that ‘levels of dental decay in UK children at five and 12 years are among the lowest in the world.’ A further study in 2011 also found that ‘since the 1970s, the oral health of the population, both children’s dental decay experience and the decline [in] adult tooth loss, has improved steadily and substantially’. This was confirmed in a report from the Faculty of Dental Surgery last year.

It is possible that the number of tooth extractions could have risen despite the overall trend getting better. Extractions are quite rare and there could be some groups in society who are not visiting the dentist or brushing their teeth. (The BBC mentions the worrying fact that '42% of children did not see a dentist in 2015-16'.) 

However, a few weeks after I wrote the Spectator article, Public Health England published the latest data from the Oral Health Survey of 5 Year Olds which told a very different story to the one we're being told today:

Tooth decay among 5 year olds continues significant decline

The oral health survey published today (Tuesday 10 May 2016) by Public Health England (PHE) reveals that less than 25% of the cohort suffers from tooth decay, a 20% drop since 2008.

Public Health England says:

The proportion of 5 year olds who have had teeth removed due to decay was 2.5%, compared to 3.5% in 2008 – about 2,000 fewer children.

And:

The survey also shows the average number of teeth affected by decay per child was 0.8, down from 1.1 in 2008. 

Moreover:

There has been a 9% increase in the proportion of children with no obvious decay since 2008.

Who to believe? Should we believe that tooth decay has fallen dramatically since the 1970s amongst every age group and that the number of under-5s who have had a tooth extracted has dropped from 3.5 per cent to 2.5 per cent since 2008? Or should we believe the opposite?

There are two reasons to take the more positive view. Firstly because it is backed up with a very large amount of evidence from academics, the Office for National Statistics, Public Health England and others. Secondly, because - at the time of writing - the Faculty of Dental Surgeons has not made its own evidence publicly available. 

Thursday, 16 March 2017

Smoking rate falls to 9% in Sweden thanks to snus

In Sweden, the smoking rate has fallen to a mere nine per cent, as the New Scientist reports, and snus is being given due credit. It's a good job the EU banned it everywhere else, eh?

I've written about this for Spectator Health. Do have a quick read.

Wednesday, 15 March 2017

Sugar statistics for everyone to ignore

Mike Gibney has dug out some sugar statistics from around the world to show, for the umpteenth time, that sugar consumption has not been rising during the obesity 'epidemic'.

The Food & Agricultural Organisation (FAO) of the UN measures the “disappearance” of sugar in countries worldwide which takes overall national production data, adds imports and subtracts both exports and non-human use. If used wisely and for time trends only, such data can be very valuable.

In Australia, such data shows a decline in per capita intake of sugar from 152 grams per day in 1980 to 127 in 2011. Using similar techniques, data from the Australian Bureau of Statistics shows a 17% reduction in apparent sugar consumption from 1961 to 2011 (139 to 115g/hd/d). Data from Australian National Nutrition Surveys, which are based on surveys of actual sugar intake at individual level, also show a decline in total sugar intake, from 115 grams per day in 1995 to 105 in 2012. Given that among the devils of sugar sources, those from beverages are considered as the Satanic level, it is interesting to note that such Satanic influences have also fallen over time.

No matter how defined (soft drinks, sugar sweetened beverages, sugary products, sodas plus juices etc.), the time-related decline of sugar intake in liquid form is still obvious. Data from industry sources were also made available to the authors and once again, no matter how defined, the same pattern of a decline in solid and liquid sugar intake is seen. For example, the % of children classified as “consumers “ of sugar-sweetened beverages declined from about 65% in 1995 to 25% in 2012. Energy from sugar-sweetened beverages plus juices in children fell from an average of 9.2 % of calories in 1995 to about 5.5% in 2012. All in all, there is not a shred of evidence from the either global overview or the Australian deep-dive into sugar intakes to suggest any rise whatsoever in sugar intakes.

Facts don't make any difference in this debate, of course. People believe whatever they want to believe and I sympathise with Mike's frustration:

Why therefore do we suffer the avalanche of data telling us about the poisonous nature of sugar and the wicked damage it is doing to the health of our children? In my view this is a consequence of our post truth era where post-truth is defined by The Oxford Dictionary as: ‘An adjective relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief’.

You see, sugar was extracted on the back of the global slave trade and is now used by corporate food giants to manipulate the food supply to make a tasteless mechanically derived ultra-processed foods into ones which are rendered hyper-palatable with copious levels of added sugars. Gurus from California with impeccable medical backgrounds have shown conclusively that sugar is toxic, the new tobacco in fact. Tax the damn thing and be done with it!

That’s the emotional argument. It wins out every time against the peer-reviewed data cited in this blog. As a life timer in nutrition I have come to accept this and other such misuse of nutritional data and its adaptation by populist experts and governmental departments.

Last week another study came out showing a decline in sugar consumption in Australia over the last thirty years. This is laughably called the 'Australian paradox' because (a) it is assumed that sugar consumption must have risen if obesity has risen, and (b) it is assumed that sugar consumption has risen in other countries.

Neither assumption is true, but that hasn't stopped one anti-sugar fanatic hounding those who prefer data to doctrine. Rory Robertson set up a green ink website several years ago attacking Jennie Brand-Miller and Alan Barclay after they published a study showing a fall in sugar consumption over several decades. He even managed to get Sydney University to investigate the pair, both of whom were cleared of any misconduct.

Robertson has since been threatened with being banned from Sydney University for allegedly acting in an 'aggres­sive and intimidating manner'. You won't be surprised to hear that Robertson gave up eating sugar, lost weight and is now something of a crusader. Thanks to his n=1 study, he seems to think that sugar is the sole cause of obesity.

I don't know what it is about giving up sugar that makes people so angry but I see a lot of it Twitter. Perhaps we will one day discover that carbs are good for mental health.

Friday, 10 March 2017

Scot puppets

The SNP has been building a whole own army of lobbyists to create the illusion of public demand for bans, taxes, minimum pricing and general lifestyle micromanagement. I mentioned Alcohol Focus Scotland and ASH Scotland last month. Inherited from previous governments, they consume £1.5 million of taxpayers' money every year between them.

While the UK government has taken action against state-funded political campaigning, the problem has been growing north of the border.

In the field of diet, the Scottish government set up Obesity Action Scotland in mid-2015. It features such familiar faces as Simon Capewell (Action on Sugar) and Sheila Duffy (ASH Scotland) and is entirely dedicated to political campaigning. It does the usual sockpuppety things like welcoming government consultations and lobbying for policies which even the government admits are 'unpopular'. I haven't been able to find out how much public money it is getting (perhaps a reader could find out?) but it mentions no other source of funding than the government so it is safe to assume that it is 100% sockpuppet.

Then there is Food Standards Scotland, an organisation created in 2015 which sounds like a Scottish equivalent of the Food Standards Agency but is actually yet another lobby group. Yesterday, they were lobbying for the sugar tax to be extended to all products that contain sugar and a 'calorie cap' on food eaten outside the home, whatever the hell that means.

Food Standards Scotland can always be relied on to send a warm response to government consultations on raising taxes and is always on hand to offer congratulations to politicians when they introduce nanny state policies while complaining that the policies do not go far enough.

None of this has got anything to do with food standards. It is about telling people what to eat because, according to the FSS, the question of what to have for lunch 'cannot be left to individuals alone'. To that end, FSS sends out regular press releases demanding 'urgent action' and 'radical measures' to raise prices, reduce flavour and restrict choice. It does so with an annual budget of £15 million.

And so the sham continues.




Thursday, 9 March 2017

The year of acrylamide

You may fondly recall the scare story about roast potatoes that made everybody roll their eyes back in January. The villain of the piece was acrylamide, a chemical that is created when carbohydrates are cooked. It is not just roast potatoes, but french fries, biscuits, toasts and many other food stuffs that can generate acrylamide. It can cause cancer in mice, but only at very high doses (‘as much as 1,000 to 10,000 times higher than the levels people might be exposed to in foods’, according to the American Cancer Society.)

Nevertheless, the Food Standards Agency tried to generate a bit of hysteria by warning about this supposedly new cancer threat. As I said at the time:

We simply do not know whether acrylamide in food causes cancer in humans. Even if it does, we do not know what a safe level of consumption is. The Food Standards Agency’s assumption that people would benefit from reducing their consumption of roast potatoes and toast is just that — an assumption. It is the precautionary principle on steroids. Further research would be welcome, but it is not the job of the FSA to pre-empt it. We have organisations like the International Agency for Research on Cancer (IARC) to weigh the evidence and assess risk. They found ‘inadequate evidence in humans for the carcinogenicity of acrylamide’. The FSA has gone way beyond its remit by issuing its scare story today.

It later transpired the European Commission is planning to regulate acrylamide in 2017 and a host of the usual pressure groups are campaigning for tough legislation, ie. excessive bans based on the precautionary principle regardless of costs. By accident or design, the FSA was clearing the path for the EU.

This week, two more pressure groups have added their voices to the mix...

Carcinogens found in British baby food and Belgian fries

Two new surveys have found high levels of acrylamide, a known carcinogen, in UK-made baby biscuits and Belgium’s favourite fast food.

...The Changing Markets Foundation and NGO SumOfUs, looked at 48 types of biscuits, including well-known brands like Little Dish and Ella’s Kitchen. The highest acrylamide levels were found in Little Dish biscuits, with levels almost 5 times higher than the European benchmark and 30 times higher than products with the lowest concentrations of acrylamide.

...In the meantime, Changing Markets and Brussels-area news service BRUZZ conducted a similar investigation last month (23 February) of Belgian fries sold in the capital. They found that 15% of the food business surveyed sell fries with high levels of acrylamide, exceeding the European benchmark of 600 µg/kg.

The highest acrylamide level found in the survey was 670 µg/kg, over six times higher than the lowest at 100 µg/kg, followed by two samples at 660 and 620 µg/kg.

I haven't seen either of these studies (if they are studies), but if the highest acrylamide level in french fries is only 10 per cent over the benchmark I doubt that it is much to worry about, since the benchmark is arbitrary in the first place (we don't know for sure that acrylamide causes cancer in humans at all, let alone at what level).

As I mentioned in January, the American Cancer Society, European Food Safety Authority and International Agency for Research on Cancer have all found insufficient evidence to declare that acrylamide, as typically found in food products, increase the risk of cancer. It is rather suspicious that non-scientific pressure groups are suddenly coming out of the woodwork with press releases like this just when the EU is looking to regulate.

The two organisations involved are hardly specialists in this area. Changing Markets specialises in 'campaigns that shift market share away from unsustainable products and companies' and when I visited SumofUs's website (slogan: 'people over profits') I was greeted with a pop-up telling me that 'SumOfUs exists to put bad corporations back in their place'. Apparently, their mission is to 'tame corporate beasts like Pepsi, Nestlé and Monsanto.'

Each to their own, obviously, but it is fair to say that identifying cancer risks is not these group's main area of interest or expertise. I suspect that we are going to see more activist science of this sort as the EU's decision gets closer.

Meanwhile, you might be interested in this paper on acrylamide from the American Council on Science and Health from 2003. The acrylamide scare might be new in Europe, but it has been going on in the USA ever since the chemical was discovered in food in 2002 (despite this, the FDA does not set legal limits on acrylamide in food).