Monday, 30 March 2015

Liberty and the nanny state

I was at the Liberty League annual conference yesterday, on a panel discussing threats to liberty. Brendan O'Neill spoke about censorship on campus (you can read his speech here). I was asked to talk about the 'nanny state'. This is roughly what I said...


It’s easy to see ‘nanny state’ issues as some of the less pressing threats to freedom today. Partly this is the result of the term nanny state itself, which sounds rather cuddly but is misleading because nannies generally have the interests of their clients at heart—something that can’t always be said about the modern public health movement. And partly it is because the public health lobby is often regarded as an arm of the medical community and people generally respect and trust doctors. This is also a misconception. The public health has very little to do with health and more to do with statism, snobbery and anti-capitalism.

I am going to argue that the public health lobby is, in fact, one of the most dangerous threats to liberty. Firstly because it is not just a looming or potential threat. The damage it does is very real and is growing by the day. Secondly, because unlike earlier moral crusades against food, alcohol and tobacco, it is heavily funded by the government and therefore has more power and influence. And thirdly because its entire modus operandi is to tax, control and ban—especially ban.

Earlier in the week you may have read about the public health group that ranked Britain’s high streets in order of their healthiness. This was the media hook upon which they hung a whole slew of policy demands which amounted to having the state decide which shops could open up, what they could sell and where they could position their products. They want differential taxation for 'unhealthy' businesses to encourage them to close. They want a cap on how many 'unhealthy' businesses can be allowed on a street. And they want these businesses to be run in a very specific way—for example, no e-cigarettes at the counter and no chocolate near the checkout.

What is an unhealthy business? According to this group, it’s things like tanning salons and fast food shops, but also - quite tellingly - payday loan shops and bookmakers. What have pawn shops and bookies got to do with health? Nothing, as far I can see, but their inclusion is a clue to the fact that the modern public health lobby has more in common with the middle class reform movements of the nineteenth century than it does with medicine.

What do you think this public health group mean when they talk about fast food outlets? Do they mean Leon? Pret a Manger? Yo Sushi? No, they mean kebab shops, McDonalds, chippies—the places they associate with the great unwashed. Why this obsession with minimum pricing? Because it will raise the price of the alcohol that poor people drink without affecting the price of craft beer and champagne. Why the relentless drive to turn smokers into second class citizens? Could it be because only 1 in 10 professionals smoke, whereas the rate is more like 1 in 3 amongst unskilled workers?

Policies such as plain packaging, minimum pricing, advertising bans and licensing controls are all direct attacks on economic freedom. The aim is for the state to control every lever of competition: price, availability, packaging and marketing. The current agitation from the likes of Action on Sugar is for the government to dictate how much of a given ingredient can legally be put into food products. The aim is for the state to decide what a product costs, what it look likes, what's in it and where it can be sold. The rate of tax on tobacco and alcohol is already so high that the government makes more profit than the manufacturers. This all amounts to a virtual nationalisation of industry without the state having to go to the trouble of manufacturing the product itself. No wonder the public health movement is full of antediluvian socialists, deep Greens and anti-capitalist throwbacks. It is not uncommon for public health demagogues to blame cancer and heart disease on free trade and so-called neo-liberalism.

But whilst the public health lobby is overtly anti-business and anti-market, this is largely a device by which they portray themselves as Davids in a David and Goliath battle. Their real target is the individual and it is the individual who ultimately pays the price of tax rises, advertising bans and prohibitions.

The attack on individual freedoms in quite blatant in the case of smoking bans. The totalitarian tendencies of those who want the state to restructure the high street to save the working class from temptation and vice were on open display last year when Lord Darzi called for a ban on smoking in London’s parks to turn them into what he called ‘Beacons of Health’. The justification for this Orwellian measure was that children should not have to see people smoking. This is the same mentality that drives the campaign to label films that depict smoking with an 18 certificate. As loopy as that campaign is, it is at least only trying to censor fiction, whereas Darzi wants to censor reality using the full apparatus of state force. The logic behind it is the that the individual must sacrifice his desires and unite behind the collectivist fantasy that Britain is a GOOD, CLEAN COUNTRY.

Some time ago, it was suggested that all adults be given photo IDs with which they could buy alcohol, but with the clever twist that it would not allow more than three drinks to be bought within 24 hours. This idea soon hit the buffers because its implementation was considered too expensive and impractical. But it was this, and not any ethical objection to stopping grown men and women living freely, that were raised. On the contrary, one prominent doctor said it was a jolly good idea, it was just a shame it was so impractical. It was the same when someone suggested making smokers buy a licence to purchase cigarettes a few years ago.

In short, the health lobby is not constrained by any concerns about liberty. The only thing holding it back is practicalities. In recent years, some anti-smoking campaigners have finally started to admit that the prohibition of tobacco is their ultimate goal. Others disagree, but only because it is not yet seen as feasible. But they all agree that prohibition is ideal in theory. The thought that people should be allowed to smoke regardless of whether prohibition is feasible probably doesn’t even cross their minds.

The same is true of most of those who want to legalise, or at least decriminalise, drugs. For libertarians, drug legalisation is a no-brainer and it has been gratifying to see more and more people coming over to our side of the argument in recent years. But very few people in the public health racket support legalisation because they believe that it’s none of the government’s business what people put into their mouths, lungs or veins. If drugs could be successfully suppressed they would support prohibition in a heartbeat. You only need to look around the world to see the bans on e-cigarettes, smokeless tobacco, alcopops and any number of other products and activities to see that the public health lobby will never be a principled ally against prohibition. On the contrary, it is the most potent source of prohibition, petty regulation and illiberalism that we face.

Sunday, 29 March 2015

Glorious Daylight Saving Time

As any fool knows, the world is run by people who get up early in the morning [citation needed] so it is surprising that Daylight Saving Time has lasted as long as it has. It is 99 years old in the UK but there are still those who object it, including farmers, Scottish highlanders and Peter Hitchens. The latter recently described this "mad annual ritual" as "lying about the time".

They will say that it is 9.00 a.m. when it is in fact 8.00.

Churches, shops cafes, railways, buses, TV stations and everyone else will join in the mass deception. You can stand aside if you like, but unless your life is totally private, you will (at the very least) inconvenience yourself.

Over the years, supporters of DST have made various empirical claims about energy conservation, road accidents and efficiency to defend their position. Opponents have countered with claims of their own. Some of these arguments are pertinent and can be debated sensibly. Others—such as saying that DST involves "lying about the time"—are preposterous, but they have a long pedigree.

There is a wonderful little book called Roads to Ruin by E.S. Turner (out of print these days, but secondhand copies are easy to find) which looks at fallacious and reactionary arguments made against sensible reforms in the 19th and early 20th centuries. The last chapter looks at Daylight Saving Time, a policy that many regarded as dangerously irresponsible and close to lunacy.

Amongst the dire warnings and hysterical objections made against moving the clocks forward were the following:

  • People wouldn't go to the theatre in broad daylight.
  • Cricket matches would finish too late for close-of-play results to appear in evening newspapers. 
  • It emulated the Germans.
  • Country squires would refuse to put their clocks forward. 
  • Few people would be awake at 2am to change their clocks.
  • It would encourage the working class to eat breakfast in the pub.
  • People would still wake up at the old time because they "know instinctively what hour it is."
  • Firework manufacturers would be put out of business (because firework displays would have to start at an inconveniently late hour).
  • It would harm the lighting industry.
  • People who used the sun to tell what time it was would be disadvantaged.
  • Likewise, people who used sun dials.
  • Businesses would "lose thousands of man-hours through workers forgetting to alter their clocks and arriving at their factories late."
  • It was "a plot to get the working classes out of bed earlier".

The commonest argument against DST, which is still heard today, is that if people want to see more daylight they should get up an hour earlier. There are two responses to this. The first is that it is more appropriate and practical to enjoy leisure time after work, not before it. The second is that the beauty of DST is that everyone can benefit from it, whether they wake up early or not.

Rather than complaining about people getting up too late, it could be argued that opponents of DST get up too early. Here's Peter Hitchens again...

If you are, like me, a habitual early riser who has been enjoying the steadily increasing amount of light in the early morning, the change will be an annoying nuisance. It was fully light around six. Now you will have to wait till seven o’clock for the same amount of light.

One man's meat is another man's poison. In my view, the fact that there is any sunlight, let alone full sunlight, at six o'clock in the morning while the night draws in before 7pm is proof of the need for DST. How many Britons are up and around to enjoy sunlight at 6am? Not many, I suspect, and for good reason.

A further objection is that supporters of DST believe that moving the clocks forward magically creates more hours of sunlight. Needless to say, we believe no such thing. It is just a question of whether you want more sunlight in the morning or more sunlight in the evening. Call me an old-fashioned utilitarian if you must (I'm not) but it seems fairer to have it when everybody is awake rather than when lots of people are asleep.

The campaign for DST was a one-man crusade by a man called William Willett (fun fact: he was the great, great grandfather of Coldplay's Chris Martin, who wrote a song called 'Clocks'). For the reasons given above, he was ignored and ridiculed for many years until a young(ish) Winston Churchill took the cause on as his own.

It is well known that Churchill was fond of a snooze. Willett, by contrast, was an early riser. As E.S. Turner recounts, he was...

...in the habit of rising on horseback at seven in the morning - 'the most joyous hour of the day' - in the woods near his Chislehurst home. On his rides he met no one, except the odd labourer, postman or chimney sweep. As the years passed he became obsessed with the absurdity of the nation lying slumbering behind shutters during the brightest, freshest, most wholesome hours, and in the evenings striving, by artificial light, to catch up with the pursuits they had been unable to overtake through their tardy rising. Mankind had wandered far from the natural hours of sleeping and waking and was trying to fit its life to an artificial pattern of clocks and timetables. Over the generations the urban populations had tended to sleep in later and later, thanks to the invention of gaslight, the increasing range of amusements and the natural indolence of man.

Did this revelation lead him to cajoling his fellow man into rising earlier? Did he try to turn the clock back on modernity? As you already know, he didn't. He decided to turn the clock forward and, as far as I'm concerned, hallowed be his name.

DST came into effect on 21 May 1916. Sadly, William Willett had died the previous year. Winston Churchill predicted that a statue would be built to his memory some day. He hasn't got one yet, but there is a memorial sundial in his honour near Chislehurst.


In 1968, Daylight Summer Time was rolled out throughout the year, but the usual coalition of milkmen, farmers and Scots successfully lobbied against it and Greenwich Mean Time returned in 1971. Since farmers can get up when they want and the Scots want independence, and since there are hardly any milkmen left, perhaps next year's centenary of DST would be a good time to try again?

Friday, 27 March 2015

More evidence on alcohol advertising

No matter how much evidence shows that advertising affects brand choice rather than total consumption, the public health racket will continue to say the exact opposite.

For example, Gerard Hastings recently appeared before a House of Lords committee to talk about alcohol regulation. Whilst there, he told this brazen whopper...

"All the evidence is that if marketing is encouraging you to consume a particular brand, it is also going to have an impact on category."

"All the evidence" does not say that. On the contrary, the overwhelming majority of the evidence shows that advertising for any established category, including alcohol, has little or no effect on overall consumption.

Yet another study confirmed this last week. Looking specifically at the alcohol market in the USA since 1971, the authors concluded:

This study has provided evidence of consumption changes across categories of alcohol beverages over the past 40-plus years with the preponderance of those changes significantly correlated to fluctuations in demography, taxation and income levels – not advertising. Despite other macro-level studies with consistent findings, the perception that advertising increases consumption exists. The findings here indicate that there is either no relationship or a weak one between advertising and aggregate category sales. Therefore, advertising restrictions or bans with the purpose of reducing consumption may not have the desired effect.

The authors note that there has been a 400% rise in alcohol ad spend in the last 40 years...


...and there has been a rise in consumer spending on alcohol...


...but there has been no commensurate rise in alcohol consumption...


And as the authors say, summarising the body of evidence of alcohol advertising...

...even though advertising appeared to not influence new consumers to drink alcohol, it has influenced existing consumers to switch brands or alcohol categories. Advertising has been a competitive marketing tool in the ongoing market share battles between individual brands to obtain increased sales at the expense of their competitors.
...In a market that is not expanding or is more mature, any sales gains by one brand will be at the expense of a competitor’s, thereby impacting a competing brand’s or category’s market share. Furthermore, advertising may be related to increases in consumption at the aggregate level, but only within a favourable social and economic climate such a expanding or growing market.

This is both common sense and evidence-based. As such, it will be ignored by the dogmatic denizens of pretend public health as they continue to rail against the reflected image of products they wish didn't exist at all.

Don't forget that you can download the new edition of Advertising in a Free Society (with a foreword by yours truly) here.

Thursday, 26 March 2015

Healthy high streets

The medical establishment's bid for world domination continued today, with the Royal Society for Public Health (whoever they are) demanding the right to decide which shops are allowed to open and where they should be allowed to position their goods. In the same way as Lord Darzi has a fascist desire to turn public parks into 'Beacons of Health', this mob wants to live out their Albert Speer fantasies in our town centres.

We believe that business has a responsibility to ensure that what they offer doesn’t undermine the public’s health

Do you? Is that what you think? Because I think it should be up to us what we buy and we can "undermine" our health if we damn well please.

And we want to ensure that local authorities have the powers they need in order to curtail those business practices which may undermine the public’s health and the great work that many public health teams are doing.

Eurgh. The totalitarian tendencies of the 'public health' lobby are on full display in this document. There is no aspect of life that they don't want dominated by lectures and harassment. For example...

On a healthy high street businesses would create opportunities for health optimisation. This could include signposting customers to health services, high street employees engaging customers in healthy conversations, health promotions in local shops, such as health shopping trolleys and outreach activities in pubs and bars, including smoking cessation or health checks.

"Engaging customers in healthy conversations"? What does that even mean? As for "outreach activities in pubs and bars", go on, I dare you.

The businesses on a healthy high street would not only enable basic needs, including access to affordable healthy food and affordable financial services, to be met...

"Affordable" thanks to a system of subsidies and price controls, no doubt. And behold, these zealots have made a little graphic listing the good and bad businesses...


Notice how pubs and bars have suddenly become "health promoting". The RSPH say this is because they "encourage social interaction". A more likely reason is that pubs have been so battered by taxes and the smoking ban that the 'public health' lobby no longer sees them as much of a threat and prefers to pretend to be on their side while they go after the off licences and supermarkets.

Notice also how payday lenders and bookmakers have found themselves on the list of unhealthy businesses, despite having nothing to do with health. This gives the game away that 'public health' itself has nothing to do with health, rather it is a classic middle class crusade against temptation and vice.

This is further confirmed by the RSPH's league table of Britain's healthiest and unhealthiest high streets, which have been plastered across the media today. The 'unhealthy' ones are mostly working class cities in the North and Midlands, whereas the 'healthy' ones are mainly nice southern market towns, like Cambridge and Salisbury, plus a few places north of Watford that Hampstead intellectuals occasionally visit, such as York.

Using a ridiculous methodology, they have decided that Preston has the country's least healthy high street and Shrewsbury, of all places, has the healthiest.

The obesity rate is Shrewsbury is 25.9%, well over the national average and considerably higher than the rate in Preston (20.8%). Just saying.

Naturally, all this bollocks is accompanied by demands for state intervention into all sorts of areas that are none of the state's business. These include:

1. Taxing bookies, payday loan shops, tanning salons and fast food outlets at a higher rate than other businesses to "discourage" them from opening.

2. "Introduction of cigarette-style health warnings" for payday loans, fast food and sunbeds. No slippery slope there, then.

3. "We call on the Government to introduce a ban on the positioning of unhealthy food items next to all checkouts and queuing areas."

4. "Ban the positioning of e-cigarettes next to all checkouts" on the basis that "these products contain nicotine, which is a highly addictive, potentially harmful chemical."

Above all, they want councils to be able to close down 'unhealthy' businesses and cap the number of premises run by any one industry at the (totally arbitrary) limit of five per cent.

At a time when high street shops are closing at the rate of 16 a day, the 'public health' lobby are just the people to finish them off. These obsessives must be resisted.

Tuesday, 24 March 2015

Where are John Dalli's supporters now?

Silvio Zammit is currently on trial in Malta as a part of the John Dalli corruption scandal. It's not easy to summarise such a long-running saga briefly, but these are the basic facts:

  • John Dalli, a Maltese politician, was the EU Health Commissioner until he was sacked by Manuel Barroso, then the president of the European Commission, in October 2012.

  • A close friend of Dalli named Silvio Zammit was caught on tape trying to solicit a €60m bribe from the snus company Swedish Match in return for Dalli overturning the EU ban on snus. Swedish Match recorded this conversation and immediately handed them over to the EU fraud office, OLAF.

  • Telephone records show that Zammit and Dalli had clusters of conversations on the same days that Zammit had conversations with Swedish Match.



In court last week, a new piece of evidence came to light:

Two new witnesses from the Cabinet of the former Commissioner testified that Dalli inquired about lifting the ban on snus in January and February 2012. This is new evidence of relevance, since Dalli had always maintained that the last time he took an interest in the snus issue was at the meeting on January 6, 2012 with Zammit and a lobbyist.

It doesn't look too good for Dalli, does it? Perhaps fearing that this new evidence has brought his own day in the dock a little closer, Dalli launched into one of his characteristically strange rants. He has called almost everybody involved in this investigation a liar, and now he is saying the same of the two new witnesses. Meanwhile, he has accused OLAF's head Giovanni Kessler of perjury and claims that the OLAF report is a "fraud". In his view, everybody but Zammit should be facing prosecution.

"I believe that the conclusion of these procedures should be judicial action against Kessler and against the employees of Swedish Match, Hildingsson, Gabrielsson and Delfosse who have concocted and implemented the setup against me. Not to mention politicians and functionaries in Brussels and in Malta who were privy to this fraud."

Dalli's conspiracy theories are the stuff of legend (Barroso has called them "incomprehensible"). He is, of course, unable to supply any motive for why the EU's corruption watchdog would hound an innocent man for three years, nor why Barroso would decide to sack him without good reason, nor why Swedish Match would invent a story that could not possibly benefit them. Nor has he come up with an explanation for the crucial and undeniable fact that his mate was recorded on tape promising to arrange something that only Dalli could deliver. For €60 million.

As Kessler said recently, isn't it telling that Dalli has turned on everybody except the man who got him in this trouble...

"What would you do if a former friend betrayed you and that cost you your career?” Giovanni Kessler asked. “He could have taken Mr Zammit to court for tarnishing his reputation... He could have accused him of trading in influence to his detriment. There is no question that Silvio Zammit has damaged Mr Dalli, greatly. Mr Dalli also has the right I think, to be a civil party in the criminal case. It would give Mr Dalli the right to have a lawyer in that case putting questions to Mr Zammit. He didn’t. Why?”


As the trial has gone on, the penny has started to drop even amongst Dalli's biggest supporters that their man might have been sacked with good reason. After hearing the evidence laid out in court, New Europe, a website which has been strongly pro-Dalli in its coverage to date, ended its report with a mea culpa.

At this point New Europe has to clarify that in extensively covering the Dalli case in the past, had no idea of the parallel games of Silvio Zammit and was not aware of all such details.

Our interventions stemmed from the fact that the OLAF report did not accuse directly Dalli but referred only to “circumstantial evidences” and verified that Dalli had not changed the Directive and did not take any bribe.

... Indeed, with the new facts unveiled in the Maltese Court, it is obvious that Jose Barroso whom we have strongly criticized, acted on moral grounds, ignoring the rules. Obviously he knew or suspected the truth, which we did not


New Europe are not the only ones with egg on their faces after falling to realise that Dalli was toxic. There are a whole bunch of NGOs and MEPs—not to mention Private Eyewho chose to believe Dalli's bonkers conspiracy theory because it fit their narrative of industry corruption. It was, however, clear from the start that it was Zammit who solicited the bribe and Swedish Match that blew the whistle. If anyone has been wrongly hounded, it's Giovanni Kessler who has been the subject of some extraordinary attacks by Green MEPs.

The Zammit case continues. Fortunately for Dalli's erstwhile cheerleaders, it is only being reported in the Maltese press. The last word should go to the Maltese journalist, Daphne Caruana Galizia, who has followed this story like a hawk from day one...

There is something very wrong with John Dalli, properly wrong, and if you think about it, this may well have been the case from the start.

Let justice be done, right Monika?


Background reading:

Dalli is damned

More Dalli and Snusgate

Private Eye's pisspoor Snusgate report

What's got into Private Eye?

John Dalli - the facts finally emerge

John Dalli does a lot for charity but doesn't like to talk about it

John Dalli's conspiracy theory



Monday, 23 March 2015

Nina Teicholz's Big Fat Surprise


Nina Teicholz's book The Big Fat Surprise received favourable reviews from the Economist and from former BMJ editor Richard Smith so I decided to read it. I wish I hadn't bothered. Teicholz's thesis in a nutshell is that we have been lied to for years about saturated fat, leading Americans to adopt a low-fat, high-carb diet that has made them obese and diabetic and probably given them cancer. She concludes that we should go back to eating lots of red meat and dairy products like people did in the good old days.

I became suspicious of this book almost immediately when the author nonchalantly dismisses America's increasingly sedentary lifestyle as a factor in the rise of obesity between 1970 and the present day, saying:


These eight words in a parenthetical aside is the only reference to physical activity in the book. It is unreferenced and untrue.

Suspecting that Teicholz might not be fully on top of her brief, I searched out a critique online and found a forensic fisking by Seth Yoder at The Science of Nutrition who makes a compelling case for viewing Tiecholz as a hopelessly biased, cherry-picking plagiarist. More of that in a moment, but first let's return to the basic premise that Americans used to eat lots of fat and now they don't.

Teicholz repeatedly claims that "Since the 1970s, we have successfully ...  reduced the amount of fat we eat from 43 percent to 33 percent of calories or less." Lord knows where she gets the 43 per cent figure from*, but she compounds the error by claiming that this shows that Americans have reduced their fat consumption by 25 per cent. Neither claim is true.

According to the Centers for Disease Control, in the USA between 1970 and 1994, average calorie intake rose in the USA for both men and women (in contrast to the UK) as a result of an increase in carbohydrate intake. As a result, fat as a percentage of total calories fell, from 36.9% to 32.8% for men and from 36.1% to 32.8% for women, but fat consumption fell little, if at all. Indeed, the CDC clearly states: "The decrease in the percentage of kcals from fat during 1971--1991 is attributed to an increase in total kcals consumed; absolute fat intake in grams increased."

As for saturated fat, the CDC notes that between 1970 and 2000, "the percentage of kcals from saturated fat decreased from 13.5% to 10.9% for men and from 13.0% to 11.0% for women." By my calculations, this means that the number of calories men consumed from saturated fat fell from 331 to 285 and the number consumed by women rose from 200 to 206. Hardly a dramatic change but, again, Teicholz refers only to the percentages. She does not mention that the decline for men was tiny, nor that there was no decline at all for women. Nor, indeed, does she mention that the percentage of saturated fat in the American diet is still higher than "less than 10%" recommended in the official recommendations. 

In other words, and contrary to Teicholz's endless assertions, Americans have not "dutifully" followed government guidelines, they do not have a low-fat diet and they certainly do not have a "near-vegetarian diet".

The "near-vegetarian diet" claim, which is made more than a dozen times in The Big Fat Surprise, is so patently ludicrous that one wonders why her editor didn't pull her up on it. Here's a chart of the world's biggest meat-eaters. Looking from the top down, it won't take you long to find the USA...


 On page 116, Teicholz shows US meat consumption since 1909...


So a "near-vegetarian diet" means eating more meat than nearly any other country and eating more meat than Americans have eaten since records began? Teicholz defends this bizarre claim by saying "about half is poultry" (it's actually more like a third if this graph is correct**) and then berates the US Department of Agriculture for stating, perfectly accurately, that meat consumption is at a "record high". She claims that this is "misleading because they lump together red meat and chicken into one category" (p. 116). Yeah, they do: the category of 'meat'. You know why? Because chicken is meat. But even if you think that chicken is a vegetable, it is still clear that Americans are eating more red meat—which Teicholz claims is "virtually banned" in the USA! (p. 5)—than they did for most of the twentieth century. (Her claim that Native Americans ate "a diet of predominantly meat, mainly from buffalo" is also very dubious.)

Since the premise is untrue, the conclusion she draws from it—that Americans suffer from obesity and diabetes because they've been living off celery and mung beans since the 1970s—must also be untrue. But between the premise and the conclusion we have the, er, meat of the argument which revolves around the evidence for the belief that saturated fat causes heart disease. This is fertile ground for a popular science book, which is why several popular science books have already been written about it, notably Gary Taubes' Good Calories, Bad Calories which has given Teicholz a great deal of inspiration, to say the least.

Saturated fat is no longer seen as the singular dietary villain that it once was. It seems clear that it raises levels of 'bad cholesterol' which, in turn, increases the risk of heart disease, but the risk may not be as great as was previously believed. The most recent Cochrane Review on the subject concluded:

The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

This is not enough for Teicholz, who wants the reader to believe that saturated fat is not a risk factor for anything and should instead be viewed as a disease prophylactic. To switch from one extreme to the other she has to take some astonishing liberties with the evidence. I'm not sufficiently interested in the topic to check Teicholz's references—no casual reader should have to—and so I would have been deceived time and again had it not been for the fact-checking of the aforementioned Seth Yoder. I recommend you read his two blog posts, even if you are not interested in reading Teicholz's book. It delivers a heavy blow to Teicholz's credibility and her lame response to him suggests that she knows she hasn't a leg to stand on. (She promised a point-by-point rebuttal by mid-March but that has yet to materialise.)

The Big Fat Surprise: A critical review part one

The Big Fat Surprise: A critical review part two

Seth has identified many examples of Teicholz borrowing from other people, but especially from Gary Taubes. She not only uses many of the same sources as Taubes (which is often fair enough), but she tends to take the exact same quotes and makes the exact same mistakes as Taubes does in a way that suggests she hasn't even read some of the original sources. For example...
 
BFS, page 112:
[W]hen Senator McGovern announced his Senate committee’s report, called Dietary Goals, at a press conference in 1977, he expressed a gloomy outlook about where the American diet was heading. “Our diets have changed radically within the past fifty years,” he explained, “with great and often harmful effects on our health.”

The problem here is that Teicholz cites the source of this quote as “Select Committee on Nutrition and Human Needs of the United States Senate, Dietary Goals for the United States (Washington, DC: US Government Printing Office, 1977); 1.” However, this quote does not appear on page 1. It appears on page XIII. Normally I would chalk this up to a simple citation error. The reason I mention it is because Taubes uses the same exact quote on page 10 of GCBC, and also mistakenly cites the source of the quote as being on page 1. I would argue (as I have done previously many times) that this is good evidence that Teicholz is simply lifting sentences from others and simply citing what they cite – likely without ever even seeing the source material.

The accusation of plagiarism does not reflect well on Teicholz, but they do not destroy her argument. However, Seth also gives numerous examples of highly selective quotation. For example...

After discussing the Ornish diet for a bit, Teicholz mentions a paper on page 145 that reviews the evidence for (very) low-fat diets:
Tufts University nutrition professor Alice Lichtenstein and a colleague reviewed the very low-fat diet for the AHA […] Lichtenstein concluded that very low-fat diets “are not beneficial and may be harmful.”
Teicholz both takes the quote out of context and mangles it somewhat. Here’s the actual quote (emphasis mine):
At this time, no health benefits and possible harmful effects can be predicted from adherence to very low fat diets in certain subgroups.
The “in certain subgroups” part is vital to the accuracy of the statement. You can’t just cut it out. And Dr. Lichtenstein’s conclusion is quite a bit more nuanced than Teicholz would have you believe. The paper is actually a very objective look at low-fat diets. It acknowledges that more research needs to be done on these diets in order for a definitive recommendation. Moreover, as alluded to above, it states that until more evidence comes in young children, the elderly, pregnant women, and those with eating disorders should probably avoid the diet. However, it also acknowledges that a low fat diet can be beneficial and there is evidence for that. Here’s an actual quote from the conclusion:
There is overwhelming evidence that reductions in saturated fat, dietary cholesterol, and weight offer the most effective dietary strategies for reducing total cholesterol, LDL-C levels, and cardiovascular risk.

Teicholz also makes statements that are not only unsupported by her own references, but which are often the polar opposite of what her sources say. For example...

 Page 317:
[I]n more than a few major studies, LDL-cholesterol levels were found to be completely uncorrelated with whether people had heart attacks or not.
Let’s take a look at these “major studies” she cites, shall we?

The first is by de Lorgeril et al. I won’t go into detail, but those in the intervention group had fewer heart attacks and also had lower LDL. From the text: “[T]he trend with time was a decrease in total and low density lipoprotein (LDL) cholesterol […]” Although it was not statistically significant, so we’ll give this one to Teicholz.

The second is not a study, but a short commentary by Despres. It argues that we should not focus exclusively on LDL, which is not the same as saying LDL is not correlated with anything.

The third is a statin trial that showed reducing LDL cholesterol also reduced coronary events. In other words, the opposite of Teicholz’s claim. Some choice quotes from the paper:
This trial provides evidence that the use of intensive atorvastatin therapy to reduce LDL cholesterol levels below 100 mg per deciliter is associated with substantial clinical benefit in patients with stable CHD.

Our findings indicate that the quantitative relationship between reduced LDL cholesterol levels and reduced CHD risk demonstrated in prior secondary-prevention trials of statins holds true even at very low levels of LDL cholesterol.
The fourth is a meta-analysis on statins and all-cause mortality. Basically irrelevant because it’s only slightly related to the claim of no relationship between LDL and heart attacks.

The fifth is by Castelli et al and is again pretty much the opposite of what Teicholz said. Want some more choice quotes?
There is a very regular increase of CHD prevalence rates with increasing LDL cholesterol level at each level of HDL cholesterol.

The inverse relationship between HDL cholesterol and CHD, when taken over the three levels of LDL cholesterol, is significant (P < 0.001) by a method of Mantel, as are the positive trends of CHD prevalence on LDL cholesterol level.

Cross-classification of triglyceride with LDL cholesterol level (fig. 3) leads to the conclusion that either lipid has a statistically significant association with CHD prevalence […]

In general, then, when contingency tables are constructed for the three lipids considered two at a time, HDL and LDL cholesterol emerge as consistently significant factors in CHD prevalence […]
Does Teicholz even read the studies she cites?

Moreover, the book is marred by a clear bias of interpretation which is obvious even to the casual reader. She is highly critical of observational epidemiology and one can hardly blame her. Nutritional epidemiology is so full of data-dredging, misreporting, researcher bias and vested interests that it is tempting to dismiss the whole field. That is pretty much what Tiecholz does most of the time. If she says correlation cannot prove causation once she must say it a hundred times.

But here's the thing. She only says it when the studies don't support her argument. She frequently cites observational studies—and even ecological studies—when they suit her and she does so without mentioning that they are observational studies and without the many caveats she gives when the evidence doesn't go her way. Every conceivable limitation is mentioned when she doesn't like a study's result, even if the limitation (or "flaw" as she would call it) is unlikely to have distorted the results. If you want to claim that saturated fat is bad for the ticker she'll accept nothing except randomised controlled trials (which she claims do not exist, despite the Cochrane Review mentioned above being based on nothing else). On the other hand, any old cross-sectional study will do when she is trying to prove that eating nothing but blubber is good for you.

There are other blatant double standards in this book. When a food company funds a study into trans fats, for example, she draws attention to it twice one paragraph (p. 238), but when the Atkins Foundation funds research into the Atkins diet it is a footnote (p. 310). When the IARC finds that emissions from frying oils probably cause cancer, she says that they "determined that emissions from frying oils at the temperature typically used in restaurants are 'probably' carcinogenic to humans" (p. 278), but when the World Cancer Research Fund finds that fruit and vegetables probably protect against various cancers, she says that they "found that 'in no case' was the evidence for the consumption of fruits and vegetables in the prevention of cancer 'judged to be convincing.'" (p. 143) (Both IARC and WCRF have a grading system, with 'probable' being just below 'convincing' or 'known'. In other words, the degree of certainty was the same in both instances.)

Reading this book wasn't a complete waste of time. The chapters of the Mediterranean Diet and trans fats are quite informative, although you sometimes need to read between the lines. There is a good story tucked away in The Big Fat Surprise but this is not the book to tell it. The human interest comes from the people who made saturated fat (and later trans fats) the nutritional bogeymen. In Teicholz's rendering, it is a story of "personal ambition and money" (p. 332) with the outsized egos of a handful of publicity-hungry scientists silencing opposing voices for decades. There may be a grain of truth in this, but her caricature of Ancel Keys is a transparent hatchet job and, having seen the way she mangles quotes from her written sources, I'm not sure I can even trust her with the quotes she got from her interviewees. This is my fundamental problem with the book. After seeing how she misrepresents the science, I can't trust her on anything else.

My reading of the evidence, which I don't think is terribly controversial, is this. Heavy consumption of saturated fat is a risk factor for heart disease and heavy consumption of red meat (and/or low consumption of fruit and veg) is a probable risk factor for some cancers, but neither risk is big enough to stop me eating what I like. Obesity has risen in the USA as a result of rising calorie consumption and declining physical activity and this, in turn, has caused a rise in diabetes. Trans fats are probably not as bad for you as the Center for Science in the Public Interest would have you believe, and were only banned because they were in the wrong place at the wrong time. The Mediterranean Diet was and is an poorly defined gimmick. Nutritional epidemiology is a bit of joke, filled with false positives and groupthink, but there is more to nutritional science than epidemiology.

If you want to write a book about self-censorship and junk science in the nutrition research industry, be my guest. If you want to write a book saying that saturated fat is not worth worrying about unless you are in a high-risk group, go ahead. But what you can't do is use partial and one-sided information to create what is essentially a conspiracy theory and then go way beyond any reasonable interpretation of the science to make statements like this...

...cheese is probably healthier than bread. (p. 325)

Every reliable indicator of good health is worsened by a low-fat diet. (p. 330)

...saturated fats, like all fats, do not make people fat. (p. 334)

Eat butter; drink milk whole, and feed it to the whole family. Stock up on creamy cheeses, offal, and sausage, and yes, bacon. None of these foods have been demonstrated to cause obesity, diabetes, or heart disease... Sugar, white flour, and other refined carbohydrates are almost certainly the main drivers of these diseases. (p. 335)

...a snack of full-fat cheese is better than fruit. (p. 335)

These statements are, of course, unreferenced and indefensible. Does she not realise that sweeping generalisations, exaggerations and evidence-free assertions are precisely what she accuses Ancel Keys et al. of committing? Does she not see the irony of specifically a handful of foods (white flour?!) for obesity, diabetes and heart disease, based on vastly less evidence than exists for the saturated fat hypothesis?

In the final analysis, The Big Fat Surprise is a glorified diet book that tells people what they want to hear. Its dietary advice is very dubious and arguably irresponsible, but caveat emptor and all that. What is really disappointing is that the likes of the Economist have been taken in by it.



* In the 13 pages of corrections she sent her publishers for the reprinted edition, Teicholz changed the 43% figure to 40%, although this is still inconsistent with the CDC's figures.

** Weirdly, Teicholz has changed this in the reprinted edition to say "more than half is poultry" which is even wronger.

Friday, 20 March 2015

50 words for lobbying

This may come as a surprise, but Action on Smoking and Health (ASH) - the UK's number one state-funded anti-smoking lobby group - is no longer allowed to lobby with the cash it gets from the government.

Ministers have been claiming since 2008 (if not earlier) that ASH's Department of Health grants can't be used for lobbying, but this lie was exposed when ASH's grant application form clearly showed that some of the money was to be used for "media advocacy and lobbying".


In recent years, the Department of Health seems to have tightened things up somewhat. For ASH's 2013-14 grant, DH put in a clause explicitly saying that the money wasn't to be used for "lobbying or campaigning purposes."


The grant is also not to be used for "organisational running costs", leaving the question of what an organisation like ASH is to do with the money when the whole reason for its existence is to lobby and campaign? The answer, it seems, is to spend it and then use as many euphemisms for lobbying and campaigning as they can when they report back to the Department of Health. The quotes below are what ASH told DH they had done with their £175,000 grant in 2013-14. (All these documents can be found here).

With local government organisations, supporting local councillors and senior officials to understand the need for effective local tobacco control and the opportunities that are available for improving local public health and wellbeing.

They're not lobbying. Oh no. They're merely "supporting" politicians to make them aware of the "opportunities that are available" and to "understand the need for effective local tobacco control". Do these opportunities involve things like plain packaging, higher taxes and so on? Alas, the report does not say.

In 2008, ASH promised to use DH grant for "media advocacy". It no longer does so, because media advocacy is obviously campaigning. Instead, it says it does things like this...

Media-related work to raise awareness of harm caused by tobacco use.

Has anybody ever seen or heard anyone from ASH give an interview that merely "raises awareness of harm caused by tobacco use"? I haven't. They always have a policy to promote—plain packs, the display ban, the vending machine ban, higher taxes etc.

Over the last 12 months ASH worked with the Smokefree Partnership and the European Public Health Association to ensure that European public health experts understood the UK position on the Tobacco Products Directive.

That sounds a bit like lobbying to me. And this sounds a lot like campaigning...

We encouraged Smokefree Action Coalition members to contact their MEPs in support of the UK government's position on the TPD in advance of the votes in plenary

How is any of within the letter of the law, let alone the spirit of the law?

I need to emphasise that this is not a general account of ASH's work in 2013/14. It is specifically about what they did with taxpayers' money.

There's more of the same in ASH's report for 2012/13, when the same restriction on lobbying and campaigning was spelled out in the grant agreement.

Nationally, ASH will:

Stimulate and disseminate further rapid research on plain packaging

I challenge you to find any ASH press releases about plain packaging in 2012/13 that doesn't call on the government to bring the policy in as a matter of urgency. The research is only ever the bait.

ASH can provide additional capacity, working with civil society colleagues at European level, to help ensure that positive policy developments are encouraged.

I bet they can, but remember: they're only encouraging "positive policy developments". Heaven forbid that anyone should think that advocacy.

We continue to provide the European Commission, and other public health organisations working in this area, with factual information and support on the policy areas under discussion

That also sounds like lobbying, but it's okay because ASH were only providing "factual information". I'm sure that information wasn't at all one-sided, nor was it presented in a way that might lead towards a favoured policy outcome.

ASH says it also does this with its grant...

Providing local opinion formers with the data and evidence base on the need for local tobacco control interventions to ensure that the priority given to tobacco control locally is adequate to deliver national ambitions

Which "tobacco control interventions" are ASH telling opinion formers about the "need" for, and doesn't that fall under the category of campaigning?

Building support for effective local implementation of legislation on vending machines from 2011, point of sale display from 2012 and niche tobacco products

Okay, these laws had all been passed by this time, but a government-funded pressure group using taxpayers' money to "build support" for government legislation definitely constitutes sockpuppetry. It is quite clear that ASH sees this as its job, and is happy to report back to DH that...

Media support was delivered on the implementation of the legislation prohibiting the sale of tobacco from vending machines in October 2011.

These, then, are the deliverables that ASH provides the government for its money. They don't lobby, oh no, they just give politicians "support on the policy areas under discussion" and make officials "aware" of "opportunities" so that they "understand" the "need for effective local tobacco control".

They don't campaign either. They just "deliver" media support for laws, "encourage" people to contact lawmakers, "disseminate" research, and provide "factual information" so that opinion formers understand "the need for local tobacco control interventions"

I'm glad we got that cleared up. I'm sure the Department of Health would be mortified if it thought that taxpayers' money was being used to lobby and campaign. Or would it?