Thursday, 31 December 2015

Review of the year: the limitless stupidity of 2015

Will we look back on 2015 as the year when the pretend public health lobby jumped the shark and went too far? They certainly tested the credulity of the public like never before, but I suspect worse is to come in 2016. Worse is always to come.

Here are some lowlights from the past twelve months..

January

Nanny statists throw a wobbler when a study declares that most cancers are not due to 'lifestyle factors', despite having been happy a week earlier when Cancer Research said virtually the same thing with a different emphasis. (A counter-attack was swiftly put in motion which dominated headlines at the end of the year. Don't you love settled science?) Meanwhile, the NHS cut spending on cancer treatment so it could keep wasting money on faux public health, including on the fat salaries of their leading lights.

While alcohol consumption fell to where the temperance lobby claimed they wanted it to be and the anti-soda loons demanded the abolition of sugary drinks by 2025, ridiculous predictions about obesity continued to be made.

February

Tobakko kontrol invent a new Orwellian oxymoron for their assault on the outdoors: the 'voluntary ban'. Starting in Bristol, this pops up in various towns in 2015.

While David Nutt writes utter nonsense about alcohol, the pseudo-academic campaign to make people question the health benefits of drinking sinks to new lows in the BMJ.

The BMJ prints some conspiracy theories about the food industry courtesy of the world's worst investigative journalist (Jonathan Gornall). Meanwhile, the BBC's worst health journalist (Nick 'feels strongly about this' Triggle) continues to drool over the idea of tobacco prohibition.

The link between smoking skunk cannabis and psychosis gets more coverage but few point out that this is another reason why cannabis should be legalised.

The cranks at Action on Sugar claimed that 'sugar levels keep rising' in breakfast cereals despite their own evidence showing the opposite.

There were two pieces of good news this month. Firstly, ComRes conducted an opinion poll on behalf of the IEA which found that people were generally against the nanny state and in favour of personal responsibility. Secondly, the Department for Communities and Local Government announced an 'anti-sockpuppet clause' to stop local authorities squandering money on pressure groups. Nevertheless, February sees yet another 'public health' sockpuppet launched: Give Up Loving Pop (GULP - geddit?) is formed in the North West on the taxpayers' shilling.

The answer to everything

March

As that utter halfwit Aseem Malhotra begins his evidence-free campaign against physical activity (using increasingly bizarre claims), the Irish sockpuppet state goes into overdrive to campaign for anti-drinker policies that have since been adopted.

While plain packaging dies on its arse in Australia, desperate attempts are made to pretend it hasn't been a failure. With the inevitability of a man who loves gravy seeing a gravy train pass by, veteran anti-smoking twonk Stanton Glantz jumps on the anti-sugar bandwagon, claiming that 'Big Sugar' is the new 'Big Tobacco'. Major 'public health' organisations start publishing material that is indistinguishable from tobacco industry parodies from a few years earlier (for more, see here).

There was some good news in March, however. After years of being victimised by anti-science fanatics in California, James Enstrom won his case against unfair dismissal and a whole bunch of 'public health' troughers were prevented from going to their luxury conference.

Oh, sweet irony. A genuine graphic used by Aseem Malhotra

April

While Malhotra pushes his pitiful anti-exercise bullshit, the Scottish government achieves what every pretend public health policy aims to achieve by knackering an industry without benefiting anybody at all.

April was a big month for denialism. The campaign to undermine the mountain of evidence showing that drinking is good for you gathered pace in the pages of Addiction. In the USA, efforts to deny that increased vaping leads to less smoking reached ridiculous new heights, just as the Irish Cancer Society was trying to breathe new life into the obsolete 'gateway effect'.

Just because you're not obese doesn't mean you're not obese
May

As the government launched a stupid and unworkable ban on 'legal highs', Ben Goldacre confirmed that he was as prone to emotional biases as the people he once claimed to debunk by promoting an anti-vaping press release while ignoring all the evidence that supports vaping as a harm reduction strategy.

There were more bollocks obesity predictions, but there were also slivers of good news when the odious Royal Society for Public Health had to retract a press release which claimed that alcohol consumption was rising and there was a splendid spoof that showed how gullible the media are on matters of popular science. The IEA also published my review of so-called 24 hour drinking which was, I concluded, the best thing Labour ever did.


June

Despite assurances from the authorities that there wouldn't be a massive riot if an Australian prison banned smoking, a massive riot takes place after an Australian prison bans smoking (recently confirmed in an official review - Deborah Arnott still insists that there is 'no evidence' that smoking bans cause prison riots).

Elsewhere, the chairman of Action on Sugar confirms that he is an extremist lunatic and Jamie Oliver, the simpleton chef who hadn't been on telly for a while, suddenly becomes an anti-sugar warrior.

Meanwhile, I write an article for The Spectator about why the real cost to taxpayers is people living long and healthy lives. It is a subject I returned to at full length recently.


July

In a classic unintended consequence, Australian businesses reacted to a ban on smoking in outdoor dining areas by banning people from eating outside. The sugar tax campaign gathered momentum with a series of lies, including a whopper from those past masters at the British Meddling Association and a story about a non-existent tooth decay 'crisis' in the Sunday Times. A sober paper about sugar from myself and Rob Lyons was no match for the truly deranged ramblings of Action on Sugar's chairman, Graham MacGregor.

In other news, Brighton consulted on another 'voluntary ban' to go along with their voluntary sugar tax and a de facto voluntary speed limit. Subsequently abandoned, I had my say about it with Deborah Arnott on Sky News.

The good news of the month came when Tesco felt the wrath of the British public after falling for the rhetoric of the public health shysters and taking Ribena off the children's shelves. In the North West, a temperance sock-puppet was finally closed down.

Genuine public health ad. Not a satirical mock up.

August

While gullible Guardian idiot George Monbiot claimed that obesity was 'incurable' it became increasingly clear that higher tobacco taxes were bringing in less and less revenue. There was yet another smoking ban miracle study which, like all the others, was total pish. And The Lancet responded to a sensible, evidence-based report from Public Health England on e-cigarettes by smearing the authors.

In Australia, where another smoking ban caused another prison riot, conclusive evidence showed that tobacco sales rose in the first year of plain packaging, an awkward fact that was ignored by the media. The Aussies held a much needed enquiry into the nanny state which I gave evidence to via Skype.

August's moments of light relief both involved that charmless nerk Simon Chapman getting his comeuppance. First, a Senate Committee took him to task for his endless garbage and then he was forced to publish an apology to somebody he'd denigrated. By law, he can never take the apology down - it's here.

Spelling is not Nina Teicholz's strong suit. What is?

September

Jamie Oliver produced a piece of television propaganda that Kim Jong-Un would have rejected for being too crude and I calculated how much alcohol use really costs the taxpayer, getting some indirect coverage from the Daily Mash into the bargain.
 

October

The gospel temperance crowd got Scottish taxpayers to pay for their conference in Edinburgh (which looked mental). Sarah Wollaston held her ludicrous sugar show trials and Public Health England decided it was time for the government to take over the food supply.

The lunatics really took over the asylum in October. This was the month when bacon was as dangerous as plutonium and cheese was as addictive as heroin.
 
November

The anti-meat crusade began to take shape, the British Medical Journal jumped the shark and the ever-magical secondhand smoke started to go through walls


December

December saw the Chief Medical Officer equating being fat with terrorism. There was some blatant lying about A&E attendances, some early movement in the campaign for plain packaging of alcohol, maximum sock-puppetry from ASH and others, as well as the 2015 Sugar Summit and some hilarious bollocks about pets being made fat by thirdhand smoke. In happier news, minimum pricing took a pounding at the European Court of Justice and I published Death and Taxes with the IEA. 

What a time to be alive.

Finally, a few of my better scriblings of the year...

The Prohibitionist's Dilemma

The Ineffectiveness of Food and Soft Drink Taxes

Fact-checking Action on Sugar

The long tentacles of temperance 

Nina Teicholz's Big Fat Surprise

Reflecting on the election

Binge Britain has ended - get over it

Vapers deserve to be angry - they're under attack

Nanny state name-calling

Smokers are paying the price for plain packaging's failure

The EU's attack on e-cigarettes will bring a golden age of vaping to an end

The useful and the true

The reverse paranoia of 'public health'

A letter to the Telegraph

An interview with Christopher Snowdon

Wednesday, 30 December 2015

Quack claims about vaping, smoking and pets

Two articles today help bring a mad year to an end with some suitably dire science. The first will ensure that thousands of people keep smoking rather than switch to e-cigarettes, thanks to a widely reported quote from the lead researcher...

"I believe they [e-cigarettes] are no better than smoking regular cigarettes." 

No such conclusion can be drawn from the study itself which looked at what happens to human cells exposed to vapour extract in a petri dish. Cell damage took place but it is unclear what this means for vapers (if anything). As the press release says...

She [the lead author] notes that cells in the lab are not completely comparable to cells within a living person. The cells lines that scientists work with have been "immortalized because of certain cell changes," she says. So it could be that e-cigarette vapor has different effects than those seen in the lab.

Also, her team didn't seek to mimic the actual dose of vapor that an e-cigarette user would get. 

Moreover, there was no attempt to compare the effect with that of smoking but there is a clear indication in study's text that cigarette smoke is far more damaging...

Treatment media was replaced every three days with 1% e-cigarette extract. Because of the high toxicity of cigarette smoke extract, cigarette-treated samples of each cell-line could only be treated for 24 hours. 
 
You can read an excellent critique of this research here.

Elsewhere today, the Telegraph features this 'story' on its front page...

Pets at more risk from passive smoking than humans, find scientists 

For players of bullshit bingo, this article offers up a full house. Tiny sample size? Check. Unpublished research? Check. Data-dredging? Check. Mention of 'thirdhand smoke'? Check.

There are so many gems in the article, but this stands out...

The team said pets could even be at greater risk of health problems because of their low height and more likely to inhale ‘third hand’ smoke particles which are thought to be even more carcinogenic than ‘second hand smoke.’ 

Utter wibble. Insofar as 'thirdhand smoke' exists at all (it means residual staining from indoor smoking, ie. it is not smoke), there is no evidence of any carcinogenic effect whatsoever. Since smoke rises, having a 'low height' would actually make animals less likely to inhale secondhand smoke. This being so, the researchers resort to claiming that cats are at greater risk from licking supposed toxins off their fur.

“Furthermore as pets self-groom they will ingest the smoke particles from their fur – this is a big problem for cats as they are very fastidious and thorough about their self-grooming These factors mean that pets are probably exposed to greater amounts of passive smoke.” 

It's not smoke and the study does not measure harm at all. It's difficult to tell exactly what it does measure since 'the research is still ongoing and is expected to be published next year', but the study appears to have done nothing more than measure levels of nicotine in pets' fur and make absurd extrapolations from them. The hilarious claim that 'household cats are more susceptible to cancer than dogs when living with smokers' is based on nothing more than the observation that cats lick themselves more than dogs. The study didn't look at passive smoke and it didn't look at cancer. Hold the front page!

There is the small problem - unmentioned in any of the media coverage - that scientists have conspicuously failed to induce lung cancer in animals even when exposing them to vast quantities of tobacco smoke. They finally managed it in the late 1960s by using the patently unnatural method of giving dogs tracheotomies but the failure to induce cancer by putting animals in extremely smoky environments has generally been attributed to the stubborn insistence of animals to breathe through their nose (among other factors).

Lab experiments could be - and have been - conducted to put the claims made today to the test. We don't need silly assumptions and guesswork based on nicotine concentrations.

The unpublished research (involving 79 pets) also contains a humdinger that sums up the desperate state of things as 2015 draws to a close...

...dogs living with a smoker owner gained more weight after neutering than those in a non-smoking household. 

So passive smoking causes weight gain in dogs but only if they have been castrated! Never mind that smoking itself does not cause weight gain in humans - on the contrary, it is associated with lower body weight. Never mind, too, that there is no obvious reason why having working testicles should protect dogs from this counter-intuitive effect.

The study didn't even observe weight gain in the castrated, passive smoking mutts; the claim is based on the researchers finding that 'a gene that acts as a marker of cell damage was higher in dogs living in smoking homes than those that did not.'

In sum, we have researchers claiming that tobacco smoke, which is associated with weight loss when consumed in large quantities by humans, is associated with weight gain when consumed in trace quantities by dogs. Alas, there is no word yet on how it affects the girth of cats.

Professor Knottenbelt is hoping that the findings will help smokers understand the impact they have on their pets and give them an incentive to either stop smoking full stop or restrict the habit to outside the home. 

You don't say! 

Tuesday, 29 December 2015

Saying the unsayable

How to cope with an ageing population is one of the crucial economic questions of our time, but you would hardly guess it from the lack of attention it receives in the media.

From time to time we are reminded that there is a ticking demographic time bomb, but the full scale of the challenge is rarely acknowledged.

At the start of the last century, there were two million people aged over 65. Today, it  is more than ten million, and it is expected to rise to nearly twenty million by 2050.

The number of people aged 75 and over is expected to double in the next twenty years, from less than five million today to nearly nine million in 2035.

The economic implications are profound. The annual healthcare costs of a person aged 85 or over are five times higher than those of somebody in their early 60s, and ten times higher than somebody in their 40s.

The extent to which ageing has necessitated the spiralling budget of the NHS in recent decades is a matter of debate, but there is no doubt that it has been an important factor.

Significant though they are, healthcare costs are a relatively small part of the costs of ageing when compared to pensions and other old age welfare payments.

When the basic state pension was introduced after the Second World War, life expectancy was 68. It is now 81 and is expected to rise to 87 in the next fifteen years. It may not be long before people spend more years of life out of work than in work.

The Office for Budget Responsibility expects increased demand for healthcare, long-term care and state pensions – mostly caused by greater longevity – to gobble up an additional five per cent of GDP by 2065.

None of this is necessarily unsustainable given a strong economy, but as the number of workers dwindles relative to the number of dependants we will be set a challenge that no society has had to confront before.

Contrast the modest amount of coverage this serious issue attracts with the claims that are routinely made about obesity ‘bankrupting the NHS’ and smokers being a ‘drain on the taxpayer’. Last year, the NHS published a report which claimed that the very sustainability of the health service required ‘hard-hitting national action on obesity, smoking, alcohol and other major health risks’.

It would appear that we are a drain on the taxpayer if we live too long and a drain on the taxpayer if we die too early. But which is really more costly?

The economic evidence strongly suggests that old age requires much more expenditure than premature mortality. Diseases related to obesity and smoking are usually, though not always, cheaper to deal with than the chronic, non-fatal diseases of old age and they are also – to put it bluntly – lethally efficient.

If anyone is a ‘drain on the taxpayer’, it those who indulge in healthy lifestyles and live to a ripe old age. Every year in old age is spent taking more in services and benefits than is paid in tax.

People will argue, quite rightly, that old people have paid into the system all their lives and deserve their benefits in retirement, but that does not change the fact that the burden on working taxpayers rises as the elderly cohort expands.

The principal aim of healthy living is to extend life. It should be no surprise, then, that most preventive health measures end up costing more than they save.

Health economists have long argued that policies designed to extend life should be promoted on the basis that better health has intrinsic benefits rather than on spurious claims about saving money.

But when the government cut the UK’s £3 billion public health budget by £200 million earlier this year, the Faculty of Public Health claimed that it would cost the NHS ‘at least £1 billion’ in the long run.

This ‘stitch in time’ theory doesn’t stand up against the facts. As I show in Death and Taxes, a new report from the Institute of Economic Affairs, it is highly unlikely that efforts to deter physical inactivity, over-eating, smoking and drinking will save the taxpayer any money.

In fact if successful, they will almost certainly require greater public spending further down the line.

This is, of course, not an argument for encouraging worse health. But the pervasive fiction that the NHS’s financial problems would be solved if we all just ate our greens and cut down on the wine encourages unrealistic expectations about the ability of public health policy to cut costs, while making scapegoats of people whose healthcare costs are actually lower than those who lead ‘healthy lifestyles’.

The reality is that life expectancy has increased largely as a result of healthier lifestyles – better nutrition and lower smoking rates, for example -  and that this has led to significantly higher costs to government budgets.

The question of how to deal with the economic consequences of our grandparents in a system of state-run healthcare and welfare remains an important one. By contrast, the drinking and obesity ‘time bombs’ are paper tigers.


Cross-posted from Conservative Home

Wednesday, 23 December 2015

Questions raised by the minimum pricing saga

The European Court of Justice made it quite clear today that higher taxes are better than minimum pricing as a 'public health' policy. A bit of a Hobson's choice, admittedly, but if they are right it means that minimum pricing breaches EU trade law (see here for a brief explanation). Nevertheless, they have pushed the matter back to the UK (Scottish) courts to decide. 

The dreadful Nicola Sturgeon immediately said that she would fight on, so there is life in this issue for some time to come. Assuming that minimum pricing is dealt with in the Scottish courts, there are a number of questions. In no particular order...

1. To what extent can the Scots ignore the ECJ? It is, after all, the highest court in Europe. Surely it is there for more than friendly advice. And if the Scottish courts allow MUP, what happens when someone files a complaint to the ECJ about breach of trade law? Won't they have to make a judgement at some point, or is it entirely up to domestic courts how they define 'public health' and 'public morality'? If so, it's not much of a common market.

2. Why didn't the ECJ put the whole thing to bed once and for all? Its summary suggested that the domestic courts are better placed to decide whether minimum pricing is better than tax rises, but why should this be so? Minimum pricing is just a theory. The only evidence for it comes from a computer model (plus some truly awful studies from Canada where MUP as we know it is not in force). The ECJ could have assessed this evidence, such as it is, and come to a decision for the whole EU. Instead it has batted things back to Scotland and will presumably bat it back to any other member state that is daft enough to pursue MUP.

3. Speaking of daft member states, where does this leave Ireland? If the Irish government decides to bring in MUP tomorrow, what then? Does it have to wait for the Scots to make their minds up? Why should it? The Scottish decision won't be binding on any other country. Can the alcohol industry make the ECJ go through the whole process again, this time with Ireland as the focus? 

4. Will the Scottish case see academics taking the stand to defend their evidence? If so, bring it on. It would be wonderful to see Tim Stockwell trying to defend his execrable junk science. I suspect that a lawyer will ask more rigorous questions than the peer reviewers at The Lancet.

5. Will the SNP be able to drop the Whole Population Approach from its submission? The MUPpets made a blunder when they said that reducing everybody's alcohol consumption was one of the aims of minimum pricing. Not only is this the exact opposite of their other stated objective of targeting heavy drinkers, it allowed the ECJ to point out that alcohol duty rises would be a better way of doing it. The Scottish government must be wishing they'd never made this argument, but can they now pretend they never made it?

 



Tuesday, 22 December 2015

Lying about alcohol and A & E attendances

There is so much anti-booze hysteria today, but this stood out...

Three in four people in A&E at weekend are there because of alcohol

It refers to a study published in Emergency Medicine which is actually quite useful. It took two sets of data from two different years at the Newcastle upon Tyne Hospitals NHS Foundation Trust and estimated the proportion of A & E attendances that were alcohol-related.

The Telegraph reports that...

The alcohol-related attendance rate varied substantially from four per cent to 60 per cent on weekdays, but rose to 70 per cent at the weekend.

While focusing on the biggest number, the newspaper fails to mention the average. The study actually concluded that 'the prevalence rates of alcohol related attendances were 12% and 15% for the retrospective and prospective cohorts, respectively'.

Is 12-15 per cent a lot? Well, it's a damn sight lower than the 35 per cent estimate that underpins every single 'cost of alcohol' study the government has issued in the last fifteen years. As I explained in a recent IEA report, the 35 per cent figure is based on a long forgotten MORI survey from 2000. It was not based on any clinical evidence whatsoever. Studies like the one published today which bother to breath-test attendees typically arrive at a much lower estimate.

When I calculated the cost of alcohol to the public purse, I used an estimate that more closely reflects real evidence: 14 per cent. Given that a study in Newcastle—a notorious city for binge-drinking—has arrived at a similar estimate, I suspect that 14 per cent is still too high for the country as a whole. (Incidentally, none of the newspapers that covered this study bothered to mention that Newcastle was the city in question.)

Based on the figures, researchers calculated that it costs each emergency unit around £1 million a year just to treat drink related problems and injuries.

£1 million might seem a lot of money but to put it in context, the Newcastle upon Tyne Hospitals NHS Foundation Trust has an annual budget of £1,006,000,000. Alcohol-related A & E attendances therefore make up 0.1 per cent of its expenditure.

As for the idea that 'three in four people in A&E at weekend are there because of alcohol', this claim is made (more or less) in the text of the study...

On weekend days, over 70% of attendances were alcohol related...

But it is not borne out by the data. Table 2 of the study shows that alcohol-related attendances made up 17.4 per cent of Saturday's total in the retrospective study and 23.9 per cent of Saturday's total in the prospective study. For Sundays, the figures are 16.9 per cent and 19.7 per cent.

In other words, alcohol-related attendances make up less than 20 per cent of the weekend total, not 'three in four'. This is further confirmed by a graph showing the hourly rates at the weekend.


As you can see, the only time when attendances reach 70 per cent is between 2am and 4am when the total number of attendances are very low because most people are in bed. During the daytime, the figure is well below 10 per cent.

With a little scrutiny of the data, it becomes clear that 'On weekend days, over 70% of attendances were alcohol related' should read 'On weekend days, alcohol related attendances reached a peak of 70% at 3 am'. The sloppy wording of that sentence led the journal to issue a press release titled 'Almost three quarters of weekend emergency care caseload linked to booze' and the newspapers took it from there. It will not be long before this ridiculous factoid becomes the conventional wisdom.

You can't entirely blame journalists for this lie being spread (although it would be nice if health journalists could read academic studies). The lie is right there in the abstract and it was repeated in the press release. Incompetence or deliberate deceit? That, as ever, is the question.

Monday, 21 December 2015

Graphic warnings and plain packaging for alcohol

That old non-existent slippery slope again...

Methods: Ninety-two adults were exposed to four labelling conditions of bottles for a famous brand of each of wine, beer and hard liquor. Participants were randomly assigned to one of four labelling conditions: standard, text warning, text and image warning, or text and image warning on a plain bottle. Participants then expressed their product-based (i.e., evaluation of the products) and consumer-based (i.e., evaluation of potential consumers of the products) perceptions in relation to each label condition and were asked to recognize the correct health warning.

Results: As expected, participants perceived bottles with warnings less positively as compared to standard bottles in terms of product-based and consumer-based perceptions: plain bottles showed the most consistent statistically significant results, followed by text and image warnings, and then text warnings in pair-wise comparisons with the standard bottles. Some support for the impact of plain packaging on warning recognition was also found.

Conclusion: Unlike previous studies, this study reveals that health warnings, if similar to those on cigarette packs, can change consumer-based and product-based perceptions of alcohol products. The study reveals the importance of serious consideration of stringent alcohol warning policy research.

This is not the first name that gory images and plain packaging have been put forward as the 'next logical step' for Alcohol Control - see here, here, here and here. Things have now moved into the junk science stage in which the opinion of glorified focus groups is treated as empirical evidence. It won't be long before 'the evidence is overwhelming' and the government is accused of caving into the alcohol industry if it rejects the idea.

See how it works yet?

Sunday, 20 December 2015

The Dry January money pit

'Public health' campaigners love their conspiracy theories. Theirs is a world of shadowy figures and brown envelopes in which nothing is ever as it seems. Remember all that bullshit about how David Cameron wasn't going to bring in plain packaging because one of his advisers ran a public affairs agency that had a tobacco company on its books? Just as the glorious Soviet enterprise was undermined by capitalist 'wreckers', so too is the great public health enterprise.

A lot of these theories are so stupid that they cannot be said out loud, they can only be implied with vague references to 'vested interests' and 'putting the fox in charge of the hen house'. For example, I was amused to see this in the Daily Mail last week...

The NHS’s Dry January campaign is being run by a PR firm receiving millions from the drinks industry.

What? Dry January is officially an NHS project now, is it? Last I heard it was being run by Alcohol Concern, an ostensibly independent charity.

Officials are paying Freuds thousands of pounds to handle the marketing for the drive which urges Britons to give up alcohol next month. But the same firm also oversees the advertising for Diageo, the drinks giant behind brands including Guinness, Baileys and Smirnoff vodka.

Experts said it was nonsense for such an important public health campaign to be run by a firm with a clear ‘vested interest’. Controversially, Freuds also runs the PR for the NHS’s anti-obesity drive Change4Life – whilst also doing the advertising for Mars, KFC and Pepsi.

Consider what is being implied here. The suggestion—surely—is that this PR company is covertly undermining Dry January and Change4Life from within in order to please its industry clients. I can see no other reason why this should be considered controversial or newsworthy (there is, I suppose, the possibility that Freuds are undermining Diageo and Pepsi's advertising to please its government clients, but I doubt that possibility has even occurred to the 'experts').

Katherine Brown, Director of the Institute of Alcohol Studies [previously known as the UK Temperance Alliance - CJS] said: ‘The public have a right to independent public health information, delivered by experts who have no vested interests. It’s putting public health at risk.

‘Relying on organisations who receive funds from alcohol companies to offer up advice on how to reduce drinking is like putting a fox in charge of a hen house.’

Is it, Katherine? Is it really? Then perhaps you'd like to expand on that. Perhaps you'd like to explain exactly what it is you're accusing this company of. While you're at it, you could give us some evidence and examples?

She won't, of course. There is no evidence whatsoever for this wrecking theory and anybody who made the implicit message explicit would probably be sued for libel.

There is a genuine scandal here, but it has nothing to do with the temperance lobby's vague ad hominem slurs. The real scandal, as usual, is the misuse of taxpayers' money.

Public Health England, the Government agency responsible, would not disclose how much money it had paid the firm for either campaign.

But financial accounts show it is about £90,000 a month, just under £1 million a year.

I have no idea if these figures are correct, but if the true total is even a fraction of £1 million it is a disgrace. We know for certain that Public Health England spent half a million pounds on Dry January this year and, contrary to the first line of the Mail's report, Dry January is not an NHS project. It was created by Alcohol Concern as a fund-raising project and continues to be run by them.

We don't know how many people participated in Dry January this year. Alcohol Concern claimed it was two million but reduced this to 50,000 under questioning. In 2014, it was a mere 17,000. I will bet you a pound to a penny that they raised less from Dry January than Public Health England spent promoting it (it made £38,000 in 2013).

Meanwhile, Cancer Research runs the strikingly similar Dryathalon every January without any public subsidy and gets more people to sign up. The question is therefore not which PR agency Public Health England should be using but why they are spending our money on this superfluous and ineffective initiative at all.

Thursday, 17 December 2015

Death and taxes

I've got a new report out with the Institute of Economic Affairs. It's called Death and Taxes and it looks at the costs associated with the ageing population.

Here's the introduction:

The British population is getting older. At the start of the last century, there were two million people aged over 65. Today, there are more than ten million and this is expected to rise to nearly twenty million by 2050 (Cracknell 2007: 44). The number of people aged 75 and over is expected to reach nearly nine million by 2035, up from less than five million in 2010 (Rutherford 2012: 4).

Falling fertility rates and the baby boom have played a part in recent demographic change, but old people getting older as a result of medical advancements and healthier lifestyles has been the overwhelming driver of increased life expectancy in the last fifty years (Rechel et al., 2009: 2).

The financial impacts of an ageing society are profound. When the basic state pension was introduced after the Second World War, life expectancy was 68. It is now 81. It is expected to be 87 by 2030. Governments have long recognised that the working age population is under increasing pressure as the number of working taxpayers falls relative to the number of dependents. Longer lives necessitate greater expenditure on healthcare, social care and welfare.

If healthy lifestyles lead to longer lives and higher costs, it might be expected that unhealthy lifestyles lead to shorter lives and fewer costs. Nobody would advocate unhealthy lifestyles on the basis that they save money, but if the issue is reduced to cold financial facts this is a logical conclusion to draw. However, quite the opposite conclusion would be reached by reading the popular press and listening to public health campaigners. It is routinely claimed that groups with lower life expectancy, particularly smokers and the obese, are a ‘drain on the taxpayer’ because of the costs of treating smoking and obesity-related diseases. The clear implication is that expenditure on public services would be lower if there was less smoking and less obesity.

This argument is often made explicitly. In 2014, Simon Stevens, the Chief Executive of the NHS, warned that if ‘we keep piling on the pounds around the waistline, we’ll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat’ (NHS England 2014). A month later, the NHS published a five year plan which concluded that ‘the sustainability of the NHS’ requires ‘hard-hitting national action on obesity, smoking, alcohol and other major health risks’ (NHS 2014: 9-10).

There is no doubt that lifestyle-related illnesses require healthcare expenditure. The real question is whether these costs are higher than the longevity-related costs associated with ageing, not only to the NHS but to the government as a whole, including the social security system. The aim of this discussion paper is to find an answer to that question.

You can download it here and there's a blog post about it here.

Merry Christmas!

Wednesday, 16 December 2015

Obesity - the role of government

Thanks to the abject incompetence of Southern Trains/Network Rail, my train journey to London yesterday took 90 minutes longer than it should have done. As a result I had time to do something I rarely do these days and write a full speech for an obesity conference I was due to attend. The topic was 'The role of government - policy interventions'.

Unfortunately, the conference was yesterday and as a result of the aforementioned incompetence, I was not able to get there in time and the speech went undelivered. So here it is...

It is a principle of mainstream economics that governments should only intervene in markets if there is evidence of market failure. Possible market failures include monopoly, lack of competition, price fixing, negative externalities and consumer ignorance.

To be clear, the market has not failed just because some people are not eating what Jamie Oliver or Sally Davies thinks they should be eating. It has not failed just because some people have got fat. Since the food industry and retail industry are highly competitive and offer a very wide choice, there are only two plausible issues that might require the attention of the government.

Firstly, there could be negative externalities, but claims about obesity ‘costing’ society billions of pounds rely on largely intangible costs that affect the individual, not other people. It is far from clear that obese people incur higher healthcare costs over the course of a lifetime. Indeed, there is evidence that their costs are lower.

Secondly, there could be consumer ignorance. This can be addressed by the school system to some extent and through better labelling of food products. Food labelling in Britain is as thorough as it is anywhere in the world but there is scope for improvement. It is not always easy to tell how many calories are in the whole product, for example. Such issues would have to be dealt with by working with industry since food labelling is an EU matter.

That is the limit of justifiable government action to make the market function effectively. It must be stressed, however, that the likes of Action on Sugar don't want a well functioning market offering reasonably well informed consumers choice and low prices. They want to tell people what to eat, using force as much as possible and using taxes to punish those who don't want to comply.

This is very obvious if you look at their attitude towards fizzy drinks. On the face of it, this should be the last target of the food police. Action on Sugar and Public Health England say they want reformulation but soft drink companies were reformulating when most of these people were in short trousers. Coca-Cola alone has one reduced sugar brand and two zero sugar brands to accompany its main brand. These reformulated varieties are advertised as much, if not more, than the original brand. They are on the same shelves at the same price as the original brand.

So if, like me, you prefer to buy the original brand rather than the reformulated brands, it should be obvious that you are making a rational, informed choice in a free market. But this isn't good enough for the fanatics (nothing ever is). They stamp their feet and scream about Big Soda. They make hysterical comparisons between soft drinks to cigarettes. They protest against Coke sponsoring the London Eye. They demand a tax on soft drinks and, above all, demand that the amount of sugar in Coke be reduced so that nobody can buy a real can of Coke.

Moreover, they want to do the same thing with every other product that is made tasty with sugar. Not just sugar, in fact. They also want to see mandatory reductions in fat content and further reductions in salt content.

These are the demands of an extremist single-issue pressure group that knows that the lobbying game requires asking for more than you expect to get. What is depressing - nay pathetic - is that Public Health England has endorsed virtually all of their proposals - the sugar tax, the reformulation, using the law to force shops to display products where bureaucrats think they should be displayed, the advertising bans, et cetera.

All of these policies have something in common - a total lack of a track record in reducing obesity anywhere in the world.

If you wanted to reduce the obesity rate, the obvious thing to do is learn from countries which have much lower rates of obesity. Alternatively, you could look back in British history to a time when the obesity rate was trivially low, such as the 1960s, and learn from what we did then. But there is a strange refusal on the part of the anti-sugar campaigners to learn any such lessons, or even ask the question, presumably because the answers would disconcert them.

If you look at slimmer countries, you will find no real advertising restrictions, no reformulation and no taxes on food and drink. One of Europe's slimmest countries, Denmark, repealed its fat tax, abolished its soft drink tax and abandoned its sugar tax in the light of experience.

Similarly, if you look back fifty years to when the obesity rate was running at about one per cent, you will see that per capita sugar consumption was at least 20 per cent higher than it is today. There was, of course, no advertising ban, no reformulation and no tax on soft drinks. There was, however (according Public Health England), 24 per cent more physical activity.

In other words, the solutions put forward by Action on Sugar, and endorsed by Public Health England, do not follow from a diagnosis of the problem. They are the same old tax-and-ban policies borrowed from the anti-smoking lobby which in turn were borrowed from the temperance movement. They have since been borrowed by everyone from the anti-gambling lobby to the anti-meat lobby. The fact that each of these issues is totally different from the other does not seem to register with the campaigners. Something must be done, they say, and this is something, therefore it must be done.

That is not good enough. It is far from obvious that something must be done, but even if it must, this grab-bag of neo-prohibitionist measures is not it.

To the government, I say this. Do not be intimidated by the so-called public health lobby. Yes, they will go crying to the press if you do not capitulate to their every demand. They will say you have caved in to 'Big Food'. They will accuse you of ignoring their precious computer models. But if you give in today, they will come back tomorrow with an even longer list of demands and will complain just as loud. A Conservative government has no votes to win from the nanny state lobby and there is no point trying.

Revive the Responsibility Deal, by all means. Teach cooking in schools. Encourage physical activity. Make food labels crystal clear. But let's not have state control of the food supply.



Monday, 14 December 2015

The sockpuppet state at work

As reported by Simon Clark and picked up by The Sun (see below), the All Party Parliamentary Group on Smoking has been sending e-mails to the Department of Health at a rate of one e-mail every three days for the last five years.


This is appalling on a number of levels. ASH—an ostensibly private pressure group—is the secretariat of this APPG, ie. it is run by ASH. When ASH formed the APPG in the 1970s it gave it the more telling name of the All Party Parliamentary Group on Smoking and Health. The 'and health' bit was later dropped, but it remains ASH's presence within parliament.

All Party Groups are not forbidden from lobbying, but they were never intended to be pressure groups. They are supposed to be small societies for MPs who have common interests or expertise, not puppet pressure groups for external private interest groups. They are certainly not supposed to be lobbying at the astonishing rate that ASH's sockpuppet APPG has been doing. The 592 e-mails sent by the APPG in the last five years do not include e-mails sent by ASH itself, which may well number in their thousands (see The Dark Market for an idea of the scale of ASH's prolific e-mail output). Factor in the many other state-funded 'public health' groups that are active in this area and it becomes obvious that the government is being bombarded by prohibitionists on a daily basis.

ASH is still heavily funded by the Department of Health. How much longer are taxpayers going to be forced to pay these zealots to lobby their own bosses?

Friday, 11 December 2015

No, obesity is not like terrorism

Our hopeless Chief Medical Officer, Sally Davies, has been attracting attention by equating obesity with terrorism. I've written about it for the Spectator...

Davies' defenders might argue that obesity has killed more people than Isis, but this ignores the crucial difference between self-inflicted risk factors for diseases of old age and indiscriminate slaughter of innocents. Beheadings and bombings exist in a different moral universe to high blood pressure and diabetes. Being a couch potato is not equivalent to being burned alive. An 80 year old dying in hospital is not the same as a teenager being machine-gunned in the Bataclan. Only a moral cretin could fail to see the difference.

Do read the rest.

The report Davies is promoting is actually a serious piece of work (written by other people). It is only partially about obesity and doesn't advocate much in the way of nanny state policy. The BBC is only interested in taxing sugar at the moment so they got some quotes from her (presumably at the press conference) so that they could transform a reasonably sober article into a pro-sugar tax article. To see how activist-journalism works, compare the version of the BBC report that was published in the early hours with the final product.

Thursday, 10 December 2015

Dodgy graph of the week

An article in Bloomberg Business reports that the tobacco industry's latest court case against the British government is underway. The dispute is over plain packaging and intellectual property. The article mentions that the impact of plain packaging has been 'hotly disputed' but then shows a graph that seems to provide prima facie evidence that it was instrumental in bringing about an unusually large drop in the smoking rate.


Not only does the graph show an acceleration in the decline of smoking prevalence after plain packaging came in, but it also shows an even bigger decline after graphic warnings came in. Result! What more proof do you need?

The only problem is that it's total bollocks. The graph bears no relationship with reality. Smoking prevalence data in Australia is collected in the National Health Survey and published by the Australian Bureau of Statistics. The ABS happened to publish their latest smoking data this week and their graph looks very different:


Notice any large drop off in recent years? No. The ABS data shows the same gradual decline in the smoking rate that has been seen in nearly all wealthy countries in the past twenty years. Bloomberg's graph is irreconcilable with the ABS data, but I know which one I trust.

Eagle-eyed readers may have noticed an inconsistency in the ABS graph. There is a three year gap between the 2004/05 and 2007/08 data points and a three year gap between the 2011/12 and 2014/15 data points, but a four year gap between the 2007/08 and 2011/12 data points.

What happens when we plot the data to scale and combine the genders? Nothing much. In fact, you can thread a perfectly straight line between the data points.


Nice try Bloomberg, but there's still nothing to see here.



Tuesday, 8 December 2015

The 2015 Sugar Summit


Every now and then I have the perverse need to see 'public health' zealots in the flesh to confirm that they are as awful I remember them. They are always worse.

Yesterday I went along to the Sugar Summit or, to give it its full name, The Sugar Reduction Summit: Sugar, Sweetness and Obesity. The subtitle is important because the food faddists now take it for granted that the government should use force to remove (literally) half of the sugar from the food supply. The only question for these loons is whether it is okay to replace it with artificial sweeteners or whether sweet tastes per se should be driven out of the human experience.

Quite a few people were on the anti-sweetness side of the argument, a pretty clear sign that this is a moral crusade rather than a health campaign. Perhaps they think that they are sweet enough. If so, they are wrong.

Take Graham MacGregor, the chairman of Action on Sugar née Action on Salt. I have said before that he is the libertarian's best advocate because he is devoid of charm to such an extent that he is able to repel his own supporters. He hams it up a bit—one can imagine him playing Captain Hook in a pantomime—but there is no disguising the fact that he is a genuinely ghastly human being.

In his opening remarks, MacGregor described sugar, fat and salt and 'toxic substances'. He repeated the old canard about over-eating killing more people in Britain than anything else. He repeatedly compared food to tobacco. And he flatly asserted that the food industry is responsible for what people eat.

During questions, an academic from (I think) Maastricht University put it to MacGregor that the food industry only puts products on the market and that people are responsible for what they eat. This mild challenge was enough for MacGregor to blow a fuse. He informed the questioner that he 'has no conscience' and accused him of killing people with the food he was selling, despite the academic having preceded his question with an assurance that he has no relationship with the food industry.

Susan Jebb, a professor of nutrition whom we have encountered before, then said how disappointed she was to hear the distinguished (sic) MacGregor using 'loose words' and 'factual inaccuracies' (ie. lies) when slating the Responsibility Deal of which she was a part. I later saw them yelling at each other over coffee.

The Jebb-MacGregor clash is illustrative of how conferences like this move the Overton window. Jebb is an undoubted nanny statist who wants the government to control what people eat, but she is not quite as extreme as MacGregor. The main difference is that she thinks a lot can be achieved with 'voluntary' agreements whereas MacGregor wants mandatory targets backed up by law. In practice, the difference is trivial since 'voluntary' agreements are usually backed up by the threat of legislation. Nevertheless, the narrow difference between these two positions is where the 'debate' lies at such a conference. It is simply taken for granted that the state should make food significantly less tasty because a minority of people are too thick or lazy to get off the sofa.

The last session I attended featured the people shown below. On the right is Jason Halford, an obesity activist/researcher at the university of Liverpool. He chaired the entire conference and is particularly keen on advertising bans and food taxes. As you can probably see in the photo below, Halford is a fat man. He is almost certainly obese. I would not normally mention this, but when you have someone who wants the government to impose his solutions to obesity on the population it is relevant to note that he cannot impose a solution on himself.


Seated from the right is Ian Wright (Food and Drink Federation), Nick Southgate (a philosopher turned behavioural economist) and Gavin Partington (British Soft Drinks Association). Jack Winkler, one of the less swivel-eyed diet campaigners is obscured by a delegate's head but next to him is the Chief Policy Adviser of Which? magazine and a representative from the British Retail Consortium.

The last two were particularly disappointing. It appears that the British Retail Consortium are actively calling for the government to give them mandatory targets on sugar, fat and salt content. They want the fabled 'level playing field', an anti-competitive chimera that helps industry at the expense of consumers. Now that Big Retail support one of their key policies, will the 'public health' mob stop talking about the 'scream test'?

The British Retail Consortium have their self-interested reasons for attempting appeasement. They know that people will generally have to buy food from one of their members regardless of how degraded it is by government regulation. But what excuse do Which? have? They are supposed to be a consumer organisation protecting the public from being ripped off. They are supposed to believe in quality standards and choice and yet their policy adviser (why do they even have such a thing?) supports sin taxes, advertising bans and mandatory reformulation. A pox on them and a pox on everybody else who wants to tell us what to eat. My blood pressure can't take many more of these events.

Saturday, 5 December 2015

That sugar photo

You may have seen this photo doing the rounds on social media in recent months. It purports to show how much sugar is contained in each of these drinks:


I had grave doubts about this image from the first moment I saw it. 2015 was the year that everybody became aware that a can of Coke contains nine teaspoons of sugar. Quite obviously, there are more than nine teaspoons in the bag shown above. Indeed, there barely seems to be room for all that sugar in the can, let alone the other ingredients.

I never got round to testing this photo empirically, but I'm pleased to say that the good people at Merseyside Skeptics have. This is what it should look like:



Do have a read of the whole article.




Friday, 4 December 2015

The scandal of state-funded activism continues

Anyone expecting to see the pool of sockpuppet pressure groups dry up under a cost-cutting Conservative government is destined to be disappointed. It has been good to see Alcohol Concern finally lose its grant from central government, but the Welsh Assembly has made up the difference by lavishing taxpayers' cash on Alcohol Concern Cymru. A couple of other successes, such as the disappearance of Drinkwise Northwest, do not change the fact that the nanny state industry remains an overwhelmingly state-funded project. All the tobacco control lobbyists are still sucking on the taxpayers' teat and there are a growing number of state-funded 'non-governmental' organisations hassling consumers about what they eat.

2015 saw the creation of Obesity Action Scotland. How much taxpayers' cash it is swallowing is not yet clear, but there is no doubt that it is state-funded. Its steering group contains long-standing tax-spongers like Simon Capewell (Faculty of Public Health, Action on Sugar) and Sheila Duffy (ASH Scotland). As this government document makes clear, Obesity Action Scotland's job is to 'advocate' (ie. lobby) for political change, following the anti-smoking blueprint.

The Lancet series notes the current ineffectiveness of civil society action, partly because consumer power is constrained by the way in which industry shapes food preferences. For policies to be successful they need public engagement in stimulating their development and their implementation. Public health is seen as having an advocacy role and in creating coalitions of a broad range of organisations that have a shared goal. Several reports draw comparisons with work on tobacco, and the value of advocacy groups like ASH, and of international agreements like the Framework Convention on Tobacco Control. The SCOT (Scottish Coalition on Tobacco) is a relevant example here, hosted by ASH Scotland it draws together key third sector organisation and medical royal colleges. The new Obesity Action Scotland based at the Royal College of Physicians and Surgeons of Glasgow may have a role to play here. Greater public engagement and awareness should increase support for change- critical for change in the food industry.

One of Obesity Action Scotland's first actions was - surprise, surprise - to demand more taxation.

The Westminster government can't be blamed for taxpayers' money being wasted by the SNP, but it is certainly responsible for the biggest nanny state pressure group of them all, Public Health England. This vast quango was created by the coalition and its role as an 'advocacy' group was laid bare last year when the Health Select Committee complained that it had 'so far failed to set out a clear policy agenda'.

This was a strange complaint to make about an organisation whose first action was to demand minimum pricing for alcohol, but no one can say PHE has failed to set out a clear policy agenda this year. Its recent report on sugar concluded with a long list of political demands.

Not content with using its huge budget to push for policy change, PHE has also been setting up its own sockpuppet organisations to do likewise. I recently became aware of the UK Public Health Network. What is it? You may well ask. It grew out of yet another 'public health' conference (almost certainly state-funded) at which it was decided that...

...the public health profession should be clearer about the measures needed to improve the public’s health. The UK Public Health Network has been set up to help achieve this.

Their three priorities are drinking, smoking and diet—because there's a real gap in the market for groups demanding legislation on those issues, right? It's not enough that we already have the British Medical Association, the UK Faculty of Public Health, the Association of Directors of Public Health, the Royal Society of Public Health, the Royal College of Physicians, the Institute of Public Health, the UK Health Forum, the Society of Social Medicine, Action on Smoking, Action on Sugar, Consensus Action on Salt and Health, Alcohol Concern, the Institute of Alcohol Studies, Tobacco Free Futures, Smokefree North West, Smokefree SouthWest and the National Obesity Forum. No, let's have some more groups making identical demands. It all helps to create a 'swarm effect'.

I sent a Freedom of Information request to PHE in October asking how much money they had given this pointless organisation since its inception in October 2014. Last week I received a reply by post. As you can see, it decided that the UK Public Health Forum deserved £57,200 of our money just to get started.


I also asked for a copy of the grant or contract that led to this money being given. PHE has not provided it. Perhaps no such written agreement exists. It wouldn't surprise me to find that in the world of 'public health' cheques are written over a couple of drinks with no questions asked.

Somebody needs to bring this gravy train to a halt.

Wednesday, 2 December 2015

In denial

Why can't sugar tax supporters admit that their pet policy will hurt the poor more than the rich? That's the subject of my blog post for the IEA.

Do have a read.

Tuesday, 1 December 2015

Smokers are paying the price for plain packaging's failure

As Sinclair Davidson and Simon Clark have pointed out, plain packaging in Australia is three years old today. It did not lead to even the slightest dip in cigarette sales or smoking prevalence and so must be considered a failure. Not only did it fail, but efforts to pretend it hasn't failed are costing smokers dearly. Here's why.

Before plain packaging came in, the Labor party planned several tax rises of 12.5 per cent (plus GST) to be staggered over a couple of years, starting in December 2013. The Liberals stuck to these plans when they got into office.

These tax rises have helped to spare Labor's blushes. It is glaringly obvious from Australian Bureau of Statistics' data that the long-term decline in tobacco sales came to a grinding halt in the first year of plain packaging (the graph below shows the chain volume of tobacco sold each quarter in $ millions). Sales not only rose quarter-on-quarter throughout 2013 but sales in the first year of plain packaging were higher than in the previous year. The downward trend only resumed once the tax hikes began. 


The result is that smokers in Australia are being clobbered with hefty tax rises just to maintain the same downward trend that was taking place before the policy was introduced. This allows blowhards like Simon Chapman to claim that tobacco sales are at their lowest level for decades as a result of plain packaging when the truth is that nearly every rich country has seen tobacco sales fall to their lowest level for decades without plain packaging.

Britain, for one, has seen a much sharper fall in (legal) tobacco sales since Australia brought in plain packaging and, unlike Australia, it has seen a clear decline in the smoking rate.


Nothing is more important to Australian 'public health' campaigners than plain packaging being perceived as a success. Pride is at stake and there is a World Trade Organisation dispute in motion which requires the Australian government to show that the policy has achieved its public health objectives. Evidence for this is obviously in short supply, which explains why the government's post-implementation review has been repeatedly delayed despite being due for publication months ago.

In the meantime, smokers will continue to be clobbered with large tax hikes to maintain the illusion that plain packaging hasn't been a total waste of time and money (with predictable consequences for the black market). The Labor party has recently announced that it, if elected, it will continue to increase the tax by a further 12.5 per cent every year for four years.

As usual, the public are paying for the 'public health' lobby's folly. Expect to hear ASH shouting for tax rises even more loudly than usual once plain packaging is introduced to the UK.