Friday, 2 December 2016

PHE's alcohol review: part 1 - the lies

Public Health England (PHE) published their review of alcohol control policies today. It is a hodge-podge of wishful thinking, blinkered analysis and outright deception. As you might expect, it takes the 'public health' view that all human behaviour is dictated by advertising, affordability and availability, and that the correct response is therefore to tax and ban.

Alas, the world refuses to bend to neo-temperance dogma and so when observable evidence does not fit the narrative, PHE rely on modelling, modelling and more modelling, mostly from the prolific Sheffield University alcohol team, supplemented by opinions from a handful of anti-alcohol fanatics.

A blog post covering all the tricks used in the PHE report would be too long so I'm going to split it into several sections, starting today with some of the outright lies.

Part one: the lies

1. Lying about the price of alcohol

Over the last 30 years, the affordability of alcohol in the UK has steadily increased and alcohol is now 60% more affordable today than it was in 1980 (182). Relatively speaking, disposable incomes have increased and real-term alcohol prices have decreased.

The real-term price is the price adjusted for inflation. Since 1980, the price of alcohol has risen by 23 per cent more than the rate of inflation, therefore the real price of alcohol has increased, not decreased.

2. Lying about the effect of minimum pricing

Unlike tax increases, where the price increase may not necessarily be passed through to the point-of-sale, this policy ensures that a minimum price is paid by the consumer. In principle, this applies to all alcohol, however this policy typically affects the high-strength, cheap products that are predominantly sold in the off-trade.

Minimum pricing may have a greater effect on the price of high-strength, cheap products but it does not 'typically' affect them. Recent evidence from Scotland shows that, at 50p per unit, minimum pricing will affect half of all the alcohol sold in off licences, including two-thirds of the beer. That is not a targeted measure.

3. Lying about Canada

A 10% increase in average minimum price for all alcoholic beverages in British Columbia was associated with a 32% (95% confidence interval [CI]: ±25.7%) reduction in wholly alcohol-related deaths within nine months, a 9% reduction in acute alcohol-related hospital admissions and a 9% reduction in chronic alcohol-related hospital admissions two to three years after the policy was implemented.

Regular readers will know that this is flagrant lie. Alcohol-related deaths did not fall during this period and alcohol-related hospital admissions continued to rise.

The best that can be said about Public Health England here is that they didn't make this factoid up themselves but got it from the minimum pricing crusader Tim Stockwell.

4. Lying about advertising

Marketing is a commercial strategy with the goal of increasing sales of alcohol by increasing market size (new sales from consumers who would not have purchased or purchased less of a product) and market share (new sales from consumers who would have purchased rival products). 

The goal of advertising, whether for alcohol or anything else, is not necessarily to increase market size. In fact, that is seldom the goal and certainly not the effect. If it were, most advertising would be considered a failure. Beer sales have been in decline for many years, for example, but millions of pounds are spent advertising beer. The overwhelming goal of advertising for any established product is market share, not market share and market size, as PHE claim.

5. Lying about costs

The economic burden of alcohol use is substantial, with estimates placing the annual cost to be between 1.3% and 2.7% of annual GDP. Few studies report costs on the magnitude of harm to people other than the drinker, so the economic burden of alcohol consumption is generally underestimated. 

Bunkum. All the studies PHE refer to look at harm to other people (ie. negative externalities). Not only do they include negative externalities, but they inflate their figures by portraying many internal costs as external costs. It would be impossible to claim that the cost of alcohol is between 1.3% and 2.7% of annual GDP without including a vast range of alleged externalities.

The 1.3% actually comes from the most-cited English study which claimed the costs of alcohol were £21 billion per annum. That study explicitly set out to look only at negative externalities, including physical and financial harm to others. In practice, however, it included various internal costs such as lost productivity which should not have been included but which inflated the estimate. Either way, it is a lie to claim that it didn't 'report costs on the magnitude of harm to people other than the drinker'. On the contrary, it exaggerated them. 

6. Lying about costs again

Crucially, the financial burden which alcohol-related harm places on society is not reflected in its market price, with taxpayers picking up a larger amount of the overall cost of harm compared to the individual drinkers.

This may be sheer ignorance rather than a deliberate lie, but it is certainly untrue. By any measure, the costs to non-drinking taxpayers are far lower than the £10.4 billion drinkers in England pay in alcohol duty. The most charitable way to interpret PHE's statement is that the authors don't know the difference between societal/intangible costs and financial costs to the state.

7. Lying about alcohol consumption

This is a bonus lie that appeared in Public Health England's press release and in Duncan Selbie's weekly e-mail...

As a nation we are drinking twice as much as we did 40 years ago

No, we're not.

8. The big lie

The dishonesty in (7) points to a wider lie that runs through the whole PHE document. When looking at alcohol consumption over time it never refers to per capita consumption. Instead it talks about overall consumption. That might not seem very important, but the population of England and Wales has grown significantly in the last 40 years, with a large share of the increase taking place in the last ten years. The graph above shows alcohol consumption per capita, but PHE choose to show overall consumption like this...

Even if you ignore population growth and look at gross alcohol sales, PHE are still lying when they claim that we are drinking twice as much as we did 40 years ago, but there is a very specific reason why they have picked this inappropriate measure of consumption.

If you look at per capita consumption, the recent peak occurred in 2004, but if you look at overall consumption the peak occurred in 2008. This seemingly minor discrepancy has major implications for PHE's tax-and-ban approach to alcohol because if you accept that consumption started falling after 2004, there is no obvious explanation in the neo-temperance handbook. In 2005, incomes were still rising, alcohol was still becoming more 'affordable' and the licensing laws had just been relaxed. According to the beliefs of the 'public health' lobby, alcohol consumption should have kept rising.

But if you pretend that alcohol consumption was still rising during this period and only began to fall after 2008, you can claim that it was the result of alcohol becoming less affordable thanks to the alcohol duty escalator and the global economic downturn (both of which began in 2008). Nick Sheron and Ian Gilmore tried this trick out in a BMJ article earlier this year and it has now been embraced by PHE (unsurprisingly, since Sheron is one of the authors of the PHE report).

Measuring consumption by overall volume rather by per capita also has the effect of making the drop in consumption look smaller than it is. The decline per person in the last twelve years has been nearly 20 per cent, but by ignoring population growth PHE can portray the drop as being relatively insignificant. This gets them off the hook because it means they don't have to give an explanation for why alcohol-related hospital admissions and deaths have failed to decline (as they should under the total consumption model).

Despite the recent small declines in overall alcohol consumption, many indicators of alcohol-related harm continue to rise.

A twenty per cent reduction in drinking since 2004 is not as recent as PHE are claiming and it is certainly not small. I call that a lie.


Thursday, 1 December 2016

Brazilian smoking ban miracle

This execrable study didn't get any media attention and when I saw it tweeted by Tobacco Control magazine I didn't even bother reading the abstract, so bored am I of fraudulent smoking ban miracles.

Anyone who's followed these scams over the last twelve years knows what to expect. Typically, the activist-researchers take heart attack figures from before and after a smoking ban, create a counterfactual that suits their purpose and then claim that there were fewer heart attacks than there would have been without a smoking ban. It helps if heart attacks are already in decline (they often are).

That's why I didn't read the study. I thought I'd seen it all before. But my interest was piqued by Michael Siegel who blogged about it yesterday. The authors attempted the method described above but were faced with the awkward fact that the heart attack rate absolutely skyrocketed after Sao Paolo introduced its smoking ban in early August 2009.

The authors helpfully provide all the numbers in the study - for this a crime carried out in plain sight - and I have graphed them below. The red line shows the date of the smoking ban.

You can see the number of deaths from myocardial infarction decline after September, but you can see the same seasonal trend in previous years with a fall at the end of the year and a rise at the start of the next. Early in 2010, it rises sharply - much more sharply than in previous years - and stays high for the rest of the period covered. Unless the population of Sao Paulo increased by half at the start of 2010, this is not a decline in the heart attack rate.

Before the ban, the number of deaths hardly ever exceeded 600 per month and was often below 500. Within a few months of the ban, there were never fewer than 700 deaths per month.

In the bizarro world of Tobacco Control, this shows that the 'mortality rate for myocardial infarction reduced following the smoking ban in Sao Paulo'.

Things are not much better if you look at hospital admissions for heart attacks. There is a year-on-year increase almost every month after the smoking ban...

These inconvenient facts would have deterred lesser mortals, but our intrepid researchers pressed on regardless, making so many unexplained adjustments to the data that they were able to conclude their study as follows:

Mortality rate and hospital admission rate for myocardial infarction decreased after the comprehensive smoking ban law in Sao Paulo city.

And so history is re-written. It can join the growing list of 'public health' facts that are not facts, such as 'minimum pricing reduced alcohol-related deaths in British Colombia by a third' or 'Rotten teeth in toddlers are at crisis level’ or 'Sugar tax reduced soda sales by 12 per cent in Mexico'. Or, indeed, 'Scottish smoking ban reduced heart attacks by 17 per cent'.

It's not that these guys have failed to prove cause and effect. There is no effect to find a cause for. The campaigners have created their own fantasy land where the facts are whatever they want them to be and words mean whatever they want them to mean.

Wednesday, 30 November 2016

The IQOS cometh

Today sees the UK launch of Philip Morris's heat-not-burn product, IQOS, and the Today programme carried an item on it which you can listen to here. Today went to PMI's Geneva headquarters to hear about the science behind it and also interviewed ASH's Deborah Arnott who did her usual moaning about industry but said that if IQOS helps smokers quit that was 'all well and good'.

She made the facile point was made that if PMI wanted to reduce harm they would stop selling cigarettes. The reality is that no harm would be reduced by one tobacco company ceasing production of cigarettes and if even if every tobacco company stopped selling them it is doubtful whether harm would be reduced by driving the market underground. But the more important point is that tobacco companies can only sell cigarettes because people want to buy them.

A more rational way of looking at it is to say that if smokers want to reduce harm, they would stop buying cigarettes. The fact that they don't suggests that they think smoking is worth the risk, or plan to give up at a later date, or have not found a suitable substitute.

That is where e-cigarettes, snus and new nicotine products such as IQOS come in. A couple of striking claims were made by PMI on the Today programme. Firstly, that IQOS delivers 90-95 per cent fewer harmful constituents than conventional smoking and, secondly, that 70 per cent of Japanese smokers who have tried it have switched to IQOS permanently. The other striking figure is that PMI have spent $3 billion on developing IQOS to date. In other words, they are taking this seriously. It is no harm reduction gimmick. 

If the degree of risk reduction can be independently confirmed and if the Japanese experience can be verified and replicated, this could be a significant development. Much depends on whether smokers know the product exists (no easy task given the UK's extreme ban on tobacco marketing) and whether they like it when they try it. As I discussed in Free Market Solutions in Health: The Case of Nicotine, there are unintended consequences from hyper-regulation that work against harm reduction.

We must wait and see, but UK smokers now have a chance to find out. PMI have opened an IQOS store in Soho. I'll be popping up there in a couple of weeks. I've tried the product before and although I switched to e-cigarettes a few years ago, I can see why smokers who have never fully embraced vaping—like my IEA colleague Mark Littlewood—like it.

Tuesday, 29 November 2016

Last Orders podcast with Martin Durkin

There's a new Spiked Last Orders podcast available. This month's guest is the great Martin Durkin (director of Brexit: The Movie, Britain's Trillion Pound Horror Story and more).

We talk about booze curtains in Ireland, the shrinking of chocolate bars, the war on fizzy drinks and go off on other tangents. It's fun. Have a listen.

Monday, 28 November 2016

Still no evidence of a slippery slope

As we all know, the idea that the anti-smoking movement is a precursor to nanny state regulation of what we eat and drink is an evil myth spread by the tobacco industry. As Simon Chapman, Deborah Arnott and many good, honest tobacco control experts have tirelessly explained, it is a baseless scare story. Tobacco is a unique product, etc.

Now that we've cleared all that up, let's take a look at what was said at the WHO's recent anti-tobacco conference by Dr Vera da Costa e Silva, the head of the Convention Secretariat on Tobacco Control...

We are also watched by sugar and alcohol products manufacturers, who see the tobacco control movement as a precursor to threats they now face from public health campaigns. These industries fear a united international community acting on behalf of consumers. In the coming days, I hope their fears will be fully justified as we take further steps to end the tobacco epidemic.


As Johnny Rotten once said, do you ever get the feeling you're being cheated?

Tobacco tokens

My IEA colleague Len Shackleton has dug up an interesting debate from 1957 about tobacco coupons for the elderly.

In 1947 Hugh Dalton, then Chancellor of the Exchequer, used the budget to raise tobacco duty very sharply, by nearly 50%. This was largely to save foreign exchange at a difficult time, and to raise revenue: at that time the health dangers of smoking were not widely accepted. Indeed, during the war that had just ended, those in the armed forces had been provided with ‘smokes’ as part of their ration.

Dalton’s measure was, technically, a ‘regressive’ tax, in that it hit the poor relatively harder than the rich. Unsurprisingly, voices were raised against this. In particular, politicians were concerned about pensioners. Many of them were habitual smokers and the new charges would be a significant chunk out of what were then pretty meagre state pensions.

Accordingly Dalton was persuaded to institute what now seems to us a bizarre process of subsidy. On application to the Post Office, and signing a declaration that the tobacco was for their own use, pensioners would receive ‘tobacco tokens’, enabling them to purchase tobacco at the pre-duty-hike price.

This subsidy continued for eleven years, during which the number of pensioner-smokers benefiting rose from 1.4 million to 2.6 million, with the cost to the Treasury rising year on year. Eventually Harold Macmillan’s government decided to bite the bullet and scrap tobacco tokens. It fell to the lot of Enoch Powell, then the Financial Secretary to the Treasury, to lead in Parliament. The debate was to be a stormy one. The government was accused of ‘penny pinching from the poorest of the poor’, imposing a ‘heavy blow and a great hardship’. Dalton, by then on the backbenches, claimed that his measure had ‘brought great comfort and satisfaction’ to millions. Powell was accused of ‘sniggering’ and ‘sneering’ as he listened to the highly emotional case being made to continue with the subsidy.

As Len says, this highlights how difficult it is for governments to withdraw hand-outs once they have begun. It is also an example of a government cushioning the blow of regressive taxation for political reasons and then taking away the cushion. Either way, the full parliamentary debate is worth a read for anyone interested in the history of smoking, as is Len's blog post.

Wednesday, 23 November 2016

Sugar bath

After commissioning some pointless junk last week, Cancer Research UK lowered the bar again yesterday with some meaningless claims about sugary drinks.They say that teenagers drink a bathful of sugary drinks every year. Perhaps they should commission Sheffield Uni to find out how many bathfuls that is between now and 2035?

I've written about it for Spectator Health...

As any fool knows, height is measured in double-decker buses and land is measured in football pitches. If you are measuring a very large stretch of land it should be compared to Wales, or possibly Belgium, but there is no need to be more precise than that. It is a robust system of measurement has served Britain well for years, but how should we measure volumes of fluid?

If it is a large body of liquid, an Olympic-sized swimming pool is the proper unit. For smaller quantities, you should use the bath. Most people have a bath tub, and everybody knows it can hold a hold a lot of liquid, so if you want to describe a reasonably large quantity of fluid there is no need to mess around with fancy-pants jargon involving 'pints' and 'litres', you can just say 'enough to fill a bath'.

That was the approach of Cancer Research UK (CRUK) today when they informed us that 'Teenagers drink a bathtub of sugary drinks a year'. In a press release that the BBC grandly described as a 'study', CRUK took data from the National Diet and Nutrition Survey and estimated how many sugary drinks are consumed by 11 to 18 year olds. The answer, they say, is just under two-thirds of a can per day. That doesn't sound like a great deal - and it is significantly less than they were drinking five years ago - but it is more impressive when you multiple it by 365 and put it in a bath. So that's what they did