Monday, 19 March 2018

Motivated reasoning - a case study

Last week, the IEA published my report Fast Food Outlets: What is the Evidence? As the title suggests, it is a review of the published evidence on the proximity and density of fast food outlets to obesity. It shows that only 20 per cent of the 74 studies conducted have found a positive association between fast food availability and body weight. Of the studies related to children, only 15 per cent have found a positive association.

This is no secret to those who are familiar with the evidence. Several previous evidence reviews have come to much the same conclusion.

Williams et al. (2014: 372) ‘did not find strong evidence at this time to justify policies related to regulating the food environments around schools’. Gordon-Larsen (2014) found that: ‘Studies of access to fast food and body weight generally showed null results’. Cobb et al. (2015) found that two-thirds of the associations between fast food availability and obesity in the literature were null, as did Mackenbach et al. (2014: 12) who took the methodological quality of the studies into account when conducting their review before concluding that ‘the overall evidence for an association between environmental factors and weight status is weak.’

Public Health England and its minions in local authorities have chosen to either ignore the academic literature or cherry-pick the few studies that appear to support 'zoning laws' (ie. banning new fast food outlets opening in certain areas). If they are not going to be honest about what the evidence says, it is up to people like me to shine a light on it.

This hasn't gone down well with a man called Greg Fell. Greg is Sheffield's Director of Public Health and is on £106,000 plus expenses and benefits (his predecessor was on an almost unbelievable £178,000). He is not some hikikomarxist living in his mum's basement. It is easy to forget that as you read his blog post.

Given the source, I’d guess it’s been funded by KFC, maybe the Colonel himself.

This is Fell's opening gambit. Going straight in with the ad hominem is what the bottom feeders on Twitter do and that is about Fell's level. It's his 'guess' that the IEA report was 'funded by KFC'. I can tell you categorically that it wasn't. The IEA doesn't do commissioned research and I've never heard of KFC, or any other fast food outlet, giving money to the IEA in all my years working for them. I can tell you with 100 per cent certainty that the first time anybody in the fast food industry, from the biggest burger chain to the smallest kebab shop, heard about this report was the day it was published.

But let's pretend for a moment that the IEA is mostly funded by McDonald's and that this particular report was commissioned by Pizza Hut. Hell, let's say it was written by Pizza Hut. Would its findings be any more or less true? Of course not. Leaving aside the fact that the report is only a summary of studies written by other people (mostly 'public health' people), the validity of a study's conclusions cannot be judged by the identity or motivations of its author. If it turns out to be a pack of lies then the motivations of the author might explain why, but these motivations do not automatically make it a pack of lies. This is basic critical thinking.

However, as I say, no such commercial interests were involved in this report so Fell's 'guess' is worthless. But that doesn't stop him putting it at the heart of his blog post's title:

The McKentucky-Hut review of fast food zoning evidence

It is worth noting how casually these people lie. Whether something is true or false seems wholly irrelevant to them. The only thing that matters is the effect that saying it will have on the reader.

Having indicated that evidence is not really his thing, Fell confirms it...

Bluntly, I can’t be bothered to go through it line my line. It seems of pretty poor quality academically speaking – a bit opaque re methods, selective quoting, flawed lines of argument. Of course maybe it doesn’t present to be an academic work, but it will still be presented as evidence to decision makers – who may or may not be able to pick through the flaws.

Not only is Fell not prepared to 'go through the it line by line' (ie. read it properly), he is apparently too busy to explain what the 'flaws' are. What are the 'flawed lines of argument'? What examples can he give of 'selective quoting'? Alas, he can't be bothered to provide a single example.

Or, more likely, he can't find any 'flaws' in a report that is mostly just a list of studies and a summary of their conclusions, but he has seen critiques of other people's work that use these phrases and thinks that he can poison the well by repeating him here. 

Some extracts of the studies reviewed are given. Obviously there’s no way of knowing whether the extract actually represents the conclusion of the original study.

I laughed out loud when I read this. Obviously there is a way of knowing whether the extract reflects the conclusion. You can read the study. To Fell, the idea of reading an academic study all the way through is not just alien, but completely unthinkable.

I don't expect readers to go through 74 studies to check that my conclusion is sound. I know better than anyone what a long and tedious process it is. On the other hand, if you're going to effectively accuse me of lying then the onus is on you to read the evidence and prove it.

What you don't do is say that you can't bothered to read the evidence while showing that you can be bothered to write a blog post implying that I'm making it all up. That would be true of any blogger, but it is doubly true of a Director of Public Health who should be familiar with the evidence anyway.

But who needs evidence anyway?

It is important we don’t become our own worst enemy in the pursuit of evidence.

As I said in a prior blog, Lack of evidence is frequently cited as barrier for not doing something. This is fine, but that must be considered in terms of counterfactual – what’s the evidence for the counterfactual or maintaining the status quo. Is doing noting an option. Establishing a level of burden of evidence proof in a complex system is different. Some say we need to move to a decision logic framework, not hypothesis testing – ie not a criminal burden of proof, but balance of probability and what is happening in the background.

But there is not a 'lack of evidence' in this area. There are 74 studies looking at this specific issue. There may be a lack of evidence to support the policies for which Fell advocates, but that is not remotely the same thing as a lack of evidence. If you have twenty well-conducted, peer-reviewed studies looking at mobile phone use, for example, and none of them found an association with autism, it would be dishonest to claim that there is a lack of evidence or that 'we just don't know'. We would conclude that mobile phone use does not cause autism. If one or two of them found a weak association, we would conclude that, on the balance of probabilities, mobile phone use does not cause autism.

It would obviously be wrong to claim that people who live near fast food outlets were more likely to be obese if no research had ever been conducted. But it is arguably even more wrong to make this claim after dozens of studies had been carried out all over the world for fifteen years and the majority of them had failed to find any such association.

There will always be those who are opposed to a policy proposition, sometimes on the basis of evidence, sometimes on pure ideological or commercial grounds.

Whether the Planning Authority should pay any attention to it is also debatable

The Authority might ask who sponsored the IEA to do this review, and why. 

Accusing someone of being 'ideological' is what Twitter bottom feeders do when ad hominems fall on stony ground. If the IEA presents evidence that free markets are the solution to a certain problem, an imbecile might respond by pointing out that the IEA is a free market think tank and therefore 'would say that, wouldn't they?' The appeal of this line of attack is the same as that of the ad hominem. It allows idiots to dismiss evidence without having to deal with its substance, or even read it.

In the lines quoted above, Fell commits both fallacies. He thereby concludes his blog post in the way he started it, with not a single substantive criticism of the research and with a claim about funding which is simply untrue.

I will leave the reader to judge who is being 'ideological' here but, as my colleague Kristian says, Fell's response is a wonderful example of a dull mind in motivated reasoning mode.

Friday, 16 March 2018

Last Orders returns

The Last Orders podcast is back! Join me, Tom Slater and Brendan O'Neill to discuss Public Health England's calorie crusade, minimum pricing and the absolute filth being propagated by Love Island and Geordie Shore.

LISTEN HERE or subscribe on iTunes.

PS. I was also on the Heartland podcast this week talking about the American Cancer Society's volte-face on e-cigarettes.

Thursday, 15 March 2018

Fast food outlets and obesity

I was on the radio last year with some woman from a 'public health' group who wanted fast food outlets banned around schools because there was 'overwhelming evidence' that proximity to these shops increased the risk of obesity.

It's a pretty good rule of thumb that if someone from the 'public health' racket claims that there is 'overwhelming evidence' of something then there is probably little or no evidence of it. So I looked into the literature, expecting to find a dozen studies or so. Instead I found 74 studies and this bit of fact-checking turned into a full blown project.

Today sees the publication of the resulting report: Fast Food Outlets and Obesity: What is the Evidence? You can download it for free but the basic conclusion is easy to summarise. There are far more studies showing no association between both the density and proximity of fast food outlets and obesity among both children and adults. In the case of children, null studies outnumber studies showing a positive association by more than four to one.

My report includes more studies than any previous evidence review in this area and its conclusion is the same as the six evidence reviews published by other researchers. The evidence that restricting fast food outlets will have any impact on obesity is extremely weak. If 'public health' was an evidence-based enterprise, it would have abandoned the idea years ago.

Do have a read of the report or read this short blog post about it.

Tuesday, 13 March 2018

The futility of divestment

I was in Edinburgh last week at a pensions and investment conference talking about the divestment movement. I have written about this idea before. It suggests that if you disapprove of an activity, you should sell your shares in the industry that facilitates it. In doing so you will achieve, er, absolutely nothing.

As I said at the conference, if you really dislike an industry you might not want to feel that you have to cheer it on because you have a stake in its success. Fair enough. But the divestment movement seems to think that selling off shares has some tangible effect on a company's activities. I see no mechanism by which a private investor selling a share in a fossil fuel company could have the slightest impact on the demand for fossil fuels or the amount of carbon dioxide emitted into the atmosphere. The same principle applies to tobacco, guns, alcohol, gambling, sugar or any other 'sin stock'.

If you only want to invest in 'ethical' companies and you are prepared to get potentially lower returns, that is up to you. What I object to is local authorities selling off high-yielding shares from their pensions portfolio for the sake of futile virtue-signalling. These losses ultimately have to make up by taxpayers. That is unethical.

I was on the panel with someone from Tobacco Free Portfolios. If you visit their website or watch their TED talk, you will notice that they do not offer a single reason why divesting from tobacco will have any impact on the number of cigarettes sold or the number of people who smoke. Action on Smoking and Health recently published a briefing paper encouraging local authorities to divest from tobacco. Nowhere in its eight pages is there any indication that divesting will do any good.

Given that there is no theoretical reason to assume that divesting has any effect on the supply or demand for the product in question, and given that proponents of divestment are unable to offer even a bad argument for it, you have to conclude that the whole thing is a pointless gesture.

The ASH document focuses on trying to persuade councils that tobacco stocks are not a good longterm prospect. The woman from Tobacco Free Portfolios made a similar argument. ASH are probably overestimating the efficacy of their anti-smoking policies, but it could nevertheless be true. Who knows?

Either way, that is an investment decision, not an ethical decision. If ASH knew for certain that BAT shares would be the best performing investment of the next decade, they would still encourage divestment. Claiming that tobacco shares - which have been extraordinarily lucrative in the past, despite increasing regulation - are going to head south is a way of wriggling out of giving a single tangible benefit of divestment.

In any case, why would we trust single issue pressure groups over the combined wisdom of investors? As somebody in the audience pointed out, future risks are priced into share prices. You don't have to be a strict believer in the efficient market hypothesis to see that share prices are a better guide to the value of a company than the value put on it by people who hate the company.

Let's remember that anti-smoking groups also claim that it is not in the interest of retailers to sell cigarettes and that tobacco farmers would make more money planting different crops. If either of these claims were true, you would expect retailers and farmers to have worked it out or themselves and changed their business model accordingly. It is hard to believe that organisations with an extreme prejudice against tobacco know more about the economics of the market than people who have got skin in the game.

You can watch the discussion below:

Monday, 12 March 2018

The scandal of 'public health' money being spent on health

A lot of the 'cuts' in the supposed era of austerity are imaginary. The education budget was ring-fenced from the outset and the NHS budget has risen year-on-year. Pensions have increased in line with the ludicrously generous triple lock. Between them, these three budgets make up the majority of government spending.

But one area where there really have been cuts is in central government grants to local authorities. Councils get most of their money from central government and these grants have fallen appreciably - and look set to continue falling.

Among these grants is the money they get from Public Health England. There has been a lot of chatter about 'public health' budgets being 'slashed' by the evil Tories and a lot of junk economics from those whose livelihoods depend on the gravy train continuing.

In January, born again teetotaller Nick Cohen wrote an overwrought piece for the Observer in which he bemoaned the cuts to 'public health' but failed to mention the size of the budget, perhaps because it is so enormous that people would be sanguine about a five per cent cut. In 2016/17, Public Health England's budget was £4.5 billion, of which £3.4 billion went to local authorities.

Moreover, the 'public health' budget for local authorities has risen over the years, from £2.8 billion in 2014/15, to £3 billion in 2015/16 and then to £3.4 billion. Bear these figures in mind when you hear that the 'public health' budget is going to be 'slashed' by £170 million in the next two years. In real terms, the budget will still be bigger than it was three years ago.

This gigantic stack of cash is ring-fenced for 'public health' which is great news for fat cat Directors of Public Health and the various parasitic 'stakeholders' that live off the 'health and wellbeing' industry. It is not so good for residents.

Many local councillors resent being forced to spend money on useless nanny state projects while budgets for genuine public services are cut. Hats off, then, to Northamptonshire City Council for this...

Northamptonshire County Council: £10m public health grant probe

A council dubbed the "worst-run in the country" is under investigation over allegations it used millions of pounds ring-fenced for public health to prop up other services.

Northamptonshire County Council is in talks with Public Health England about the possible "claw-back" of up to £10m.

It comes after the authority voted for almost £40m in budget cuts.

Conservative council leader Heather Smith said the money "may have been spent in adult social care".

She added: "It is debatable whether that was a public health need or not."

Social care may not be a 'public health' need, but it is a health need and I suspect that if local residents were asked if they wanted the money to be spent on helping the sick and infirm or spent on hassling people about their lifestyles, there would be a strong majority for the former.

The county council received more than £70m in funding from Public Health England over a two-year period.

It was meant to be used only for specific purposes, such as health education and smoking cessation services.


Mrs Smith said the money "may have been spent in adult social care, looking after people in some way or another".

Shocking stuff. We can't have 'public health' budgets spent on looking after people!

The fact is that Northamptonshire County Council is skint. Really skint. And yet, like other councils, it has been forced to employ an army of bureaucrats and busybodies to run fatuous, jargon-riddled projects which stretch the concept of 'public health' to breaking point by including things like 'financial wellbeing' and 'social wellbeing'. Its Public Health Director is on £155,000 a year and it has created a 'public health' mini-quango called First for Wellbeing (budget: £17 million) which does lots of 'fun activities' that are enjoyed by a tiny proportion of the local population.

It also parrots the usual inaccurate nanny state propaganda such as...

It might not seem like you are drinking too much, but even having just one or two drinks on most nights can do serious harm to your health, both physically and mentally.


Frequent exposure to other people’s smoke will almost put them at as much risk as an actual smoker!

You can see why councillors might think that 'looking after people in some way or another' is a better use of £10 million than continuing to pour it down this money pit. Northamptonshire County Council may be the 'worst-run in the country' but in this instance it is a beacon of hope that every other council should follow.

Saturday, 10 March 2018

The World Conference on Tobacco or Prohibition

No matter how low the bar of reason and integrity is set, the anti-smoking racket finds ways to limbo dance beneath it. This week, I have been following the #WCTOH2018 hashtag in awe. There is no shortage of charlatans and spivs in the anti-drink, anti-soda and anti-food cults, but for shameless hypocrisy and junk science, no one can touch the anti-smoking lobby.

WCTOH is the World Conference on Tobacco or Health. If memory serves, it has been taking place since 1967 and was a more or less serious science conference until around 1983 when the prohibitionists began to take over (see my book Velvet Glove, Iron Fist for details). It is now a playground for fanatics and tax spongers. Britain was well represented, with various activist-academics running up a quarter of a million pound bill for the taxpayer to pick up.

After a decade writing about this issue, I shouldn't be surprised by the pitiful standard of the rhetoric but it just keeps getting worse. Consumers are never mentioned except, perhaps, as victims of Big Tobacco. Ridiculous assertions abound, such as the claim that cigarette taxes were 'once thought regressive' but are no longer because, er, it doesn't help the cause to admit it.

As for the science behind reduced-harm claims of new products, the response of the tobacco control cult is to simply ignore it.

Perhaps my favourite non-argument of the week was a 'debunking' of the Nanny State Index (which I edit). The Index is only a league table of policies that 'public health' people lobby for so they should be proud if their country is at the top, but a Finnish 'public health' professional gave a whole presentation about it, including the killer argument that the Index is 'rubbish'. Alas, this was also the only argument.

How old are these people?

The most striking aspect of this year's event was how much of it was devoted to in-fighting and the preservation of funding. The Foundation for a Smoke-Free World, funded by Philip Morris, has a billion dollars of research funding which the tobakko kontrol establishment can't access because it would blacken their names in the eyes of their colleagues. This is driving them (even more) mad and a lot of energy has been expended turning their own friend Derek Yach into a non-person.

Then there are e-cigarettes. Tobacco control is explicitly morphing into nicotine control. The target is almost irrelevant. The key word is control and the emergence of a viable, low risk alternative for cigarettes is an existential threat to their racket. The same goes for snus. Naturally, therefore, the speakers at this (Pfizer-funded) conference are opposed to harm reduction and use classic merchant-of-doubt tactics to suppress them (or, in the case of snus in the EU, to keep it suppressed).

They are quite prepared to resort to blatant lies to this end...

Carl Phillips and Dick Puddlecote have covered some of the lowlights from this event so I won't go through them all, suffice to say that rank hypocrisy is a running theme, from demanding 'nothing about us without us' to complaining about the WHO shutting out civil society.

Shutting people out is what the WHO does, of course, as we shall doubtless see again in Geneva this October. This week, the corrupt WHO capitulated to demands from China to exclude delegates from Taiwan. Tobacco controllers who rightly described this as an outrage seem to have no problem with the press and public being kicked out of the COP meetings every two years, just as those who 'demand nothing about us without us' never ask smokers what they think about being under their 'control'.

That brings us to smoking, which is supposed to be reason for the conference's existence. After years of denial, the prohibitionists are finally owning up to being prohibitionists. There was even an official declaration.

You might think that the experience of alcohol prohibition and the war on drugs would make 'experts' wary of endorsing a ban on a product consumed by a billion people. But according to Tobacco Control's news editor, there is nothing to worry about:

If smokers had any doubts about what these people have in store for them, an official declaration at the world's foremost tobacco control conference to ban the sale of cigarettes should put an end to them.

Let's not mince words any more. These people are not the tobacco control lobby and they are certainly not public health professionals. They are prohibitionists and should only be described as such.

Thursday, 8 March 2018

What is the real rate of child obesity?

Since I started digging into the methodology used to estimate the rate of childhood obesity in Britain, I have been shocked by how shoddy it is. The figures that are routinely cited are quite simply a lie. They vastly exaggerate the number of kids who are obese.

In my previous post about this for the Spectator I said that the real rate is at least half of that claimed. That much should be obvious. A rate of 23 per cent among 11-15 year olds is extremely unlikely when the rate among 16-24 year olds is only eleven per cent.

In my new post, published today, I show some more credible evidence and argue that the true rate of obesity among children in this age group is closer to one in twenty, not one in five. Indeed, it could easily be one in fifty.

Do read it.

Tuesday, 6 March 2018

Food is the new tobacco

As reported by the Sun and a few of other newspapers, Public Health England is going ahead with its insane plan to withdraw a fifth of calories from the food supply. Not quite the whole food supply, as the quango has admitted that it can't take energy out of vegetables, but the targets apply to the following:

Egg products, potato products, meat products, processed meats, poultry, fish, meat alternatives, pies, pastries, sausages, burgers, pasta, rice, noodles, savoury biscuits, crackers, bread with additions (e.g. ciabatta with olives), cooking sauces, table sauces, dressings, crisps, savoury snacks, ready meals, takeaways, dips, hummus, coleslaw, pizza, ‘food-to-go’, sandwiches, composite salads and soups.

Biscuits, chocolate bars, confectionery etc. have already been covered by the sugar reduction plan and so are not included.

So much for only reformulating 'food that contributes most to intakes of children up to the age of 18 years', as PHE originally claimed when the 'childhood obesity' plan was devised. PHE bureaucrat Alison Tedstone now admits that everything is fair game:

“Our children don’t eat special children’s food,” she said. “We buy the same food for our entire family.”

As usual in 'public health', it's not really about children. It's about treating adults like children.

But PHE chief executive Duncan Selbie said the steps were as much about influencing the diets of adults.

"Britain needs to go on a diet."

But Britain doesn't need to go on a diet. Some people need to go on a diet, but 74 per cent of us are not obese and a fair proportion of 26 per cent do not want to go on a diet. Some of us need to eat more. And for the many millions of people who consume roughly the right number of calories, cutting energy content in food by 20 per cent is the equivalent of raising the price by 25 per cent. 

Meanwhile, PHE are sticking to their bizarre 400-600-600 rule; 400 calories for breakfast and 600 calories each for lunch and tea. This obviously adds up to 1,600, well below the 2,500 calories the agency maintains are needed by men every day, and so they advise us to consume an extra 900 calories in snacks, soft drinks and alcohol. Even nanny statist Susan Jebb raised her eyebrows at this:

While she welcomed raising calorie-awareness, she [Jebb] noted that the recommendation to eat a total of 1,600 calories for main meals was well below daily levels and assumed people were snacking. “Maybe it is better to have a slightly bigger meal and not to snack,” she said.

In December I wrote...

This seems to be a case of PHE deliberately giving people false information with the intention of tricking them into eating less, based on the assumption that we underestimate how much we eat, even to ourselves. The idea is that if you tell people to eat 1,600 calories, perhaps they will eat 2,300 calories.

...PHE are no longer pretending to be a source of accurate advice. They are in the business of nudging, manipulation and deliberate deceit.

This has now been confirmed by Alison Tedstone who told the Times...

She says people should stick to 1,600 calories a day for meals, leaving room for drinks and snacks. “This is not official calorie guidance; it’s a handy rule of thumb,” she said. Men are still advised to eat 2,500 calories a day and women 2,000 but after seeing that people did not admit to a third of what they ate Dr Tedstone said that the advice would help them to keep to the targets.

Woe betide anybody foolish enough to take the country's leading 'public health' agency at its word.

These people are dangerous idiots, but the food industry will have to go along with them because it has been none-too-subtly threatened with advertising bans, taxes and mandatory limits if it doesn't acquiesce.

As for consumers, the best we can hope for are smaller portions and a higher cost of living.

I have written about this for Spectator Health.

It is difficult to find the words to describe how demented this policy is. Imagine a Soviet commissar, drunk on power and vodka, who had been driven mad after contracting syphilis. Even he would not issue an edict like this. It is off the scale of anything the ‘public health’ lobby has tried before. It represents the final severing of the thread that once connected Public Health England to the real world.

Do have a read.

Monday, 5 March 2018

Jamie Oliver and 'middle-class logic'

Jamie Oliver is on the front of today's Times with some ill advised comments about fat people.

“When you get trapped in the disadvantaged cycle, the concept of middle-class logic doesn’t work. What you see is parents who aren’t even thinking about five fruit and veg a day, they’re thinking about enough food for the day,” he told The Times.

“Willpower is a very unique personal thing . . . We can’t judge our equivalent of logic on theirs because they’re in a different gear, almost in a different country."

Oliver believes everything he is told by his friends in organisations like Action on Sugar and then regurgitates their views to the media, not always very well. In this instance, he is talking about the socio-economic gradient of obesity and the idea is that people on low incomes are so stressed and cash-strapped that they can't help but stuff their faces with crisps and pizza. Victims of circumstance, they inevitably become obese.

Fortunately for them, there is a white knight - St Jamie of Essex - who will rescue them by taxing soft drinks and banning food discounts in supermarkets. The poor plebs are incapable of making decisions for themselves so the government must make their decisions for them.

You can see why the 'public health' lobby likes this argument. They are always looking for ways to sidestep the issue of choice and personal freedom. If being slim depends on having access to what Oliver calls 'middle-class logic', the case for state intervention appears stronger.

The problem with this analysis is not just that it is incredibly patronising but that it doesn't explain why so many rich people are obese and so many poor people are slim. For all the talk about the 'obesogenic' environment and lack of choice, the fact remains that the majority of us (74%) are not obese. Even in the 'most deprived' groups, 68% are not obese. It seems that a very large number of people from every social class is able to exercise willpower and 'logic'.

Indeed, obesity only has a socio-economic gradient among women. As the Health Survey for England shows, there is virtually no relationship between income and obesity for men.

Among women, the relationship is much stronger, but the obesity rate is still 20 per cent for the wealthiest women. If poverty-related factors are the cause of obesity, why are so many rich women obese and why do these factors seem to have no influence on men?

Even if the relationship between poverty and obesity were stronger, it would not necessarily imply a lack of willpower. People on low incomes are more likely to ignore government health advice on a number of issues and George Orwell nailed some of the reasons for this in The Road to Wigan Pier. The decision to prioritise taste and convenience over healthy is not irrational, per se.

More to the point, even if we accept the premise that obesity is caused by poverty, stress and unhappiness, Jamie Oliver is in no position to solve these problems. He is not going to improve the living conditions of working people. Instead, he is going to force his millionaire preferences on them and if they don’t comply, he is going to make them poorer, starting with his regressive sugar tax before moving on to banning food discounts.

This is a classic characteristic of middle class reform movements. They tackle symptoms rather than causes and ultimately punish the people they are supposed to be helping.

Friday, 2 March 2018

Jobs for the boys on the sugar levy evaluation

The sugar levy begins at the start of next month. Ribena is the latest kamikaze soft drink to be reformulated (ie. ruined) in an attempt to avoid the 8p per 330ml tax. The usual scenes are playing out on social media...

Will the tax-incentivised reformulation or the anticipated drop in consumption have any impact on obesity? Given that sugary sales in the UK have slumped by 45 per cent since 2003 without reducing obesity one iota, it is reasonable to predict that it won't. Moreover, as I mentioned yesterday, the latest evidence review found that:

We were unable to find evidence that any sugar tax actually implemented anywhere in the world has led to improvements in health.

But you never know, eh? Quite reasonably, the government has commissioned some research to evaluate the sugar levy. Less reasonably, it has given the commission to a bunch of people who have the double conflict of interest of having (a) campaigned for the policy, and (b) produced research predicting that it would work. In any serious area of science, this would disqualify them evaluating it but that is not how things work in 'public health'.

The first names on the team sheet to evaluate minimum pricing were the MUP supporters in Sheffield and Stirling. For the sugar tax, the job has also gone to nine people at the Centre for Diet and Activity Research (CEDAR). There are some very familiar faces.

The evaluation will be led by Martin White. There are signs that he may be predisposed to believing that the sugar tax will be a success...

"Studying a wide range of effects of the tax will help us be more certain about the true impacts of the tax. For example, if purchases of sugary drinks, their sugar content, tooth decay and childhood obesity all go down, and purchases of other types of drinks go up, this will increase our confidence that the tax has had a positive impact on health.

We anticipate the tax’s effects will go beyond health. For instance, a healthier population should be more economically productive. Or people drinking fewer sugary drinks might mean fewer jobs in the food industry. We will use economic models to predict the impacts of the tax on the whole UK economy.”

But we don't need to read between the lines to guess White's views. His Twitter feed makes no secret of his fondness for sugar taxes and other illiberal interventions.  

Among White's co-investigators in the evaluation is the Reverend Mike Rayner who wrote in 2012 - and I am not making this up...

In all of this I see a sacred dimension. You may not believe that I have heard God aright but I think God is calling me to work towards the introduction of soft-drink taxes in this country

In 2013, Rayner co-authored a study which claimed that a 20 per cent sugar tax would lead to a 15 per cent fall in sugary drink consumption which, in turn, would lead to a 1.3 per cent decline in obesity. These figures have been widely cited as evidence that the sugar levy will work despite the fact that there has been a much bigger fall in sugary drink consumption without a tax and yet there has been no decline in obesity.

Three other people on the evaluation team - Oliver Mytton, Adam Briggs and Peter Scarborough - were co-authors of that study. This is a glaring conflict of interest. Academics who have effectively staked their reputation on the sugar tax working are naturally going to be disinclined to say that it didn't.

It is not just that their model happened to conclude that the tax would work. They were active supporters of the sugar tax cause for years and celebrated when it was announced.

And then there is Harry Rutter, a dyed-in-the-wool nanny state zealot who sees everything in terms of 'public health' versus industry. He is, of course, very keen on sugar taxes...

The last two 'co-investigators' are Steven Cummins, Jean Adams and Richard Smith. Cummins and Adams were responsible for a risible study last year which used declining sales in Jamie Oliver's failing restaurants as evidence that the sugar levy would work. Adams also produced a study with Oliver Mytton (see above) which found that the sugar levy wasn't very popular and recommended that 'the public health community should seek to address outstanding public concerns in order to ensure successful and strong implementation'.

Of the nine people involved in the evaluation, Smith is the only one who does not have a track record of openly supporting the sugar tax, often with fanatical - and literally religious - zeal. The government might as well have asked Action on Sugar to evaluate the policy.

There are thousands of well qualified social scientists with no skin in the game who could have been hired to look at this. Instead, a group of glorified activists has been given £1.5 million of taxpayers' money to mark their own homework. 'Public health' is a shameless racket.

Thursday, 1 March 2018

"We were unable to find evidence that any sugar tax actually implemented anywhere in the world has led to improvements in health"

It cannot be said too often that sugar taxes have not reduced obesity anywhere in the world, and it is not for want of trying. Many places have experimented with taxes on sugary drinks, in particular, but the impact on calorie consumption has been trivial to non-existent. Naturally, therefore, they have had zero impact on obesity.

Most politicians don't care what the evidence says. Sugar taxes raise revenue and that is enough for them. If they want to portray sugar taxes as a health measure, they can always point to theoretical models created by sugar tax advocates which claim that a tax of 10 or 20 per cent will lead to x fewer cases of obesity.

But the real world evidence is clear. They don't work because consumers will tend to pay up or switch brands or switch to other sugary products. In any case, the proportion of calories they get from soft drinks is small to begin with.

The 'public health' lobby are bluffing. They tend to get away with claiming that there is 'overwhelming evidence' for policies which have weak or conflicting evidence behind them and, as we have seen with minimum pricing, politicians are often unable to distinguish between modelling from advocates and evidence from the real world. 

But in New Zealand, the government did bother to look at the evidence and commissioned the respected New Zealand Institute of Economic Research (NZIER) to review it. NZIER reviewed 47 studies and this is what they said:

The evidence that sugar taxes improve health is weak.


Our conclusion is that the evidence base gets weaker further along the chain of intervention logic. If taxes did not have economic costs, through deadweight losses and implementation costs, then even a slight causal link between a tax and an improvement in health outcomes might be justified. That, however, is not the case

NZIER's full report was published at the end of January and is worth reading. It is a sober and rational assessment. By contrast, the response from a leading Kiwi nanny statist, Boyd Swinburn, was a predictable rant about 'merchants of doubt'.

The 'public health' racket is in such a sorry state that ad hominem attacks have increasingly become its only weapon. Unable to find any ties between NZIER and Big Sugar, Swinburn resorts to the soft smear of complaining that a government-funded report written by impartial economists could be useful to those who oppose sugar taxes - and, in Swinburn's cartoon world, only nasty corporations oppose sugar taxes.

Science historians Naomi Oreskes and Eric Conway coined the term Merchants of Doubt in their expose of how Big Tobacco and Big Oil paid scientists and conservative think-tanks to dispute the scientific evidence on tobacco harm and climate change. Doubt in the evidence was the "product" they were marketing to avoid government actions which might threaten big business profits.

A health levy on sugary drinks, with the money going to prevention, is the new target. As expected, Big Food and Beverage and business interest groups are the leading merchants of doubt but conservative politicians and economists steeped in last century's economic theories are joining their ranks.

God knows what 'last century's economic theories' are. Perhaps he is referring to things like price elasticity, substitution effects and the concept of regressive taxation?

I'm tempted to fisk the whole of Swinburn's article, but what's the point? If you read it, you will see the double standards, sleight of hand and misdirection fly off the page. It is not exactly subtle.

But you may want to also read NZIER's Laurie Kubiak's response. The following is, I think, the key point:

The framework looks at why a tax on sugar taxes might be effective, by asking "by what process would a tax on fizzy drinks lead to improvements in health?" This is not a simple matter when it comes to sugar in drinks (as opposed, say, to tobacco), because there are many high-sugar substitutes to fizzy drinks that are not taxed in most countries. If a tax on drinks simply induces a switch to chocolate, for example, then health outcomes might remain unchanged.

We think that to be effective at improving health, a sugar tax must work across five steps: it must increase price, the increase in price must cause consumption to fall, reducing consumption must lead to a lower sugar and/or energy intake, the lower energy intake must result in lower physiological risk factors and lower physiological risk factors must improve health outcomes.

... We found that the evidence for effectiveness became weaker the more steps in the logic were included in the study. It is possible a sugar tax may lead to some reduced consumption of the taxed product in some contexts. However, we found no studies based on actual experience with sugar taxes that identified any resulting impact on obesity, diabetes or other health outcomes.

And the take-home message is, as always:

We were unable to find evidence that any sugar tax actually implemented anywhere in the world has led to improvements in health.

Wednesday, 28 February 2018

The affordability of alcohol

As the Daily Express reports, the Institute of Alcohol Studies (previously the UK Temperance Alliance) has issued some figures on the affordability of alcohol.

Good news! Supermarket beer almost 200 PER CENT more affordable than 30 years ago

Supermarket beer is almost 188 per cent more affordable today than it was 30 years ago, according to a study. Wine and spirits sold in supermarkets and off-licences are 131 per cent more affordable than in 1987 compared with 34 per cent cheaper in pubs, bars, hotels and restaurants - or “on-trade” venues - figures from the Institute of Alcohol Studies (IAS) show.

The Express's positive take on the figures was not shared by the IAS, nor by most of the other newspapers who reported it. It is all part of the campaign for minimum pricing in England. Chris 'No Further Action' Rennard will be asking a question about it in the House of Lords today and he has written a piece for Politics Home in which he repeats the figures above and concludes that '[g]reater affordability helps to fuel alcohol consumption'.

Rennard does not pause to wonder why, if the link between affordability and consumption is so strong, consumption is lower than it was thirty years ago (see below). Nor does he mention the fact that the sale of beer - which has supposedly become much more affordable - has fallen by a third since 1990.
The IAS's usual line on the price of alcohol prices is that it has got 60 per cent more affordable since 1980. This figure comes from the NHS and is true so far it goes. However, 'more affordable' is often misinterpreted as 'cheaper in real terms'. The Times makes that mistake today with its story 'Cheaper alcohol boosts calls for minimum prices'.

But affordability is more of a measure of rising incomes than falling prices. The NHS data shows that the retail price index has risen by 297 per cent since 1980, which is to say that prices have increased threefold, while the alcohol price index has risen by 377 per cent. Alcohol has therefore become more expensive in real terms.

And yet the proportion of household income spent on alcohol has fallen from three per cent in 1988 to 1.6 per cent in 2016. This is good news for everybody except the temperance lobby, but it is because incomes have roughly doubled in real terms since 1980, not because alcohol has got cheaper. Incomes have greatly outstripped inflation and, to a lesser extent, the rising price of alcohol, but alcohol has nevertheless become more expensive in real terms.

The IAS figures are interesting because they show the changes in prices in different parts of the market. This is the key graph. Click to enlarge.

The anonymous author of the IAS report does not explain where he or she got the alcohol price figures so I can't verify them (if you have them, please leave a comment). I have to say that I'm a little suspicious of the steepness of the rise in affordability after 2013, in particular, but assuming the data to be broadly correct, it suggests that off-trade beer, wine and spirits have become cheaper in real terms while the same drinks in the on-trade have become more expensive. They have all become more 'affordable', of course, but so has pretty much everything in the UK except housing and healthcare.

The IAS bang on about the alcohol duty escalator flattening the affordability index between 2008. Like Nick Sheron and Ian Gilmore, they portray this as some sort of magic bullet for alcohol harm. Sheron and Gilmore's trick is to pretend that alcohol consumption didn't start falling until the escalator began in 2008. The decline actually began in 2004.

The IAS's trick is to ignore the decline in average incomes during and after the recession. You can see exactly the same flattening in the graph above when the economy contracted in the early 1990s. As incomes fall, everything, including alcohol, becomes less affordable. The escalator had an added effect, of course, but it's not as if 2008-13 was the only time in the last thirty years that the government has increased alcohol duty.

It is good news for consumers that alcohol producers and retailers have become more efficient in the last thirty years. It's only a shame that the government has burdened the on-trade with so much regulation and taxation that it cannot do the same.

We expect things to become more affordable as we get richer. That is the whole point of getting richer. Only the most mean-spirited puritan would look back fondly on the days when households spent twice of much of their income on alcohol.

The temperance lobby does not care whether alcohol becomes less affordable because of recessions or because of taxes or because of minimum pricing. So long as people become poorer, they're happy.

Incidentally, Lord Rennard ends his article with this:

With each day that the Government equivocates on this [minimum pricing], 65 people die from alcohol-related causes. 

I am tired of campaigners using juxtapositions like this. Will minimum pricing stop 65 people dying from alcohol-related causes every week? No. So what is the relevance? Rennard claims that minimum pricing will prevent 525 alcohol-related deaths per year, a figure that is presumably plucked from one of the worthless Sheffield reports.

Let's imagine that the figure of 525 is a realistic expectation rather than a politically-driven fiction. That would reduce the number of daily deaths (which is also an exaggeration, by the way) to 63.4. Given how flaky the figures are to begin with, this is a rounding error.

If, God forbid, England introduces minimum pricing, there will be no winding down of the hysteria, no change in the rhetoric and no meaningful change in the figures that are bandied around. Rennard, or someone like him, will be back within weeks with some other illiberal policy that is urgently needed because: 'With each day that the government equivocates on this, 63.4 people die from alcohol-related causes.'

And so it never ends.

Monday, 26 February 2018

Another risible obesity prediction

Have you noticed that Cancer Research UK has been putting out a lot of politically motivated junk in the last couple of years? Remember the bathfull of cola nonsense? The trend began when they started working with anti-smoking activists like Linda Bauld, coincidentally enough.

Their latest piffle is an obesity forecast that doesn't make sense even if you accept their own stupid methodology. Every newspaper has lapped it up, as usual, and I've written about it for Spectator Health. Do have a read.

Sunday, 25 February 2018

The minimum pricing bait-and-switch.

Minimum pricing doesn't start in Scotland until May, but phase two of the campaign has already begun.

From the Sunday Times...

Minimum drink price of 50p ‘just for starters’

The cost of wine, spirits and beer in Scotland could rise by far more than the 50p minimum unit price (MUP) taking effect in May, after politicians and experts warned that the measure will not do enough to safeguard public health.

The temperance beast is never satiated. The battle over minimum pricing isn't about 50p units. It's about whether the price mechanism should be in the grubby hands of the 'public health' racket. Once the government has conceded the point that charging more for a unit of alcohol 'saves lives', there is no obvious reason not to raise it to 'save' more lives.

The junk Sheffield model claims that there would be more health benefits if the price was set at 60p, 70p or 80p. The higher it goes, the greater the supposed benefit.

The idea that a 50p minimum price is 'evidence-based' has always been absurd, and not just because the model itself is worthless. In what sense does the evidence dictate a 50p price rather than a 75p price or a £3 price? It doesn't and it can't. There is no evidence to tell us what the correct price is, but by the logic of 'public health' and the Sheffield model, it should always be higher.

As such, politicians can always be accused of allowing x number of people to die by failing to increase the unit price. Once this Pandora's Box has been opened, it cannot be closed.

The Royal Society of Edinburgh (RSE) has advised Nicola Sturgeon’s administration that the price now could be 64p, based on the consumer price index for alcoholic products in 2011-17. It wants ministers to consider a 60p rate, as proposed by Willie Rennie MSP, the Scottish Lib Dem leader — or even a 70p rate.

The RSE said: “A rise to a rate of 70p would reflect a greater degree of ambition, might also be supported, and would have a larger effect on the consumption of alcohol and on inequalities of outcomes."

Adjusted for inflation, 50p in 2011 is actually closer to 60p than 64p, let alone 70p, but it is true that 50p today is worth less today than it was then. If the intention is to get the putative benefits laid out in the Sheffield report of 2012, a case could be made for setting the price at 60p. But that is not what the public have been sold. The claim that minimum pricing has little or no effect on moderate drinkers and people on low incomes is a lie, but it is a lie based on modelling a 50p unit. At 60p or 70p, the impact is impossible to disguise.

When Sheffield's guns for hire started spinning minimum pricing as a policy that would have a negligible impact on moderate drinkers, they based their assumptions around a 45p unit price. That was in 2014 when nobody was seriously talking about a minimum price below 50p. They focused on the 45p scenario precisely because it was less damaging than 50p.

They have since abandoned the 45p ruse but all their subsequent claims, including the risible lie that minimum pricing 'very specifically affects the alcohol that's only purchased, really, by heavier drinkers', is based on a 50p unit.

Now we see that even 50p may have been unrealistic. The Scottish public has been sold a pig in a poke.

Some politicians and experts want radical action following research indicating that alcohol is 60% more affordable in the UK than it was in 1980, and that it is possible to exceed new lower-risk guidelines for alcohol of 14 units a week for less than £2.50.

Will they be happy when it is possible to exceed the new, fictitious guidelines for less than £7.50? Of course not. There is no theoretical limit to the unit price, but we can be sure that above-inflation rises will be demanded regardless of whether the policy is seen to have worked or not.

In theory, a £1 minimum price would be still more effective. A £3 price would be even better. The only reason nobody is calling for a £3 unit price is that it would raise the cost of living and create all sorts of unintended consequences.

But so will a 50p unit. The only difference is that politicians and medics would be personally affected by a £3 unit whereas they can afford it at 50p.

Thursday, 22 February 2018

Minimum pricing in Wales - the final PR push

I was on BBC Radio Wales this morning talking about minimum pricing (you can listen from 38 minutes in). This was prompted by the thrilling news that the people at Sheffield University who have spent the last ten year pushing minimum pricing are still in favour of it.

I gather that their latest government-commissioned report claims that 66 lives will be extended in Wales (population: 3 million) if drinkers respond to a 50p minimum price in the implausible ways that the Sheffield team assume. This is up from 53 in their previous report for reasons that are almost certainly not worth bothering with. Since there are around 1,500 alcohol-related deaths in Wales each year, it's doubtful whether such a small change can even be measured.

The media haven't shown much interest in the 66 theoretical lives that will be theoretically saved at a cost of millions of pounds to consumers. Instead they have focused on this statistic from the latest Sheffield publication:

75% of all alcohol consumed in Wales is drunk by the 22% of the adult population who are hazardous or harmful drinkers, according to a new report.

Within this – the 3% of the population who are harmful drinkers, account for 27% of all alcohol consumed.

This is just the Pareto Principle. It's no surprise to hear that most alcohol is drunk by people who drink the most. A fifth of Welsh adults don't drink at all so they obviously account for 0% of sales. 58% drink little (less than 14 units per week) and so account for relatively few sales. It says a lot about the decline in drinking in the UK that only 22% of Welsh adults consume more than 14 units a week and only 3 per cent are 'harmful drinkers' (defined as >35 units per week for women and >50 units per week for men.

As I discovered when I gave evidence in Cardiff - and as was confirmed in my interview today - the Welsh government has accepted that minimum pricing won't help the 'harmful drinkers' who have a dependency on alcohol, but they are hopeful of changing the ways of people like me who laugh in the face of the 14 units target.

It looks as if the Welsh government is going to go ahead with the policy because they're already starting to manage expectations. A spokesman says: 'Minimum unit pricing is not intended to work in isolation' and Alcohol Concern Wales says: 'Minimum pricing is one way to solve it but there's no cure.' It's a sure sign that an underwhelming 'public health' policy is on the way when campaigners start playing the 'no silver bullet' card.

Just before my interview on BBC Wales, listeners were treated to an audio clip of Sheffield University bullshit vendor Colin Angus turning the lies up to eleven. He said:

'Minimum unit pricing is a very well targeted policy because it very specifically affects the alcohol that's only purchased, really, by heavier drinkers.'

This is totally untrue. As the IFS and others have shown, 70 per cent of all off-trade sales will be affected and Angus's own report says that 22 per cent of the alcohol bought by moderate drinkers is currently bought at less than 50p.

Moderate drinking here is defined as 14 units a week or less. Under the previous definition of 21 units or less for men, minimum pricing would affect moderate consumers even more. This shows why the neo-temperance lobby were so keen to change the guidelines. It has a material and significant effect on the statistics, inflating the number of hazardous drinkers and reducing adverse effects of regressive policies on 'moderate' drinkers.

As regular readers will recall, the guidelines were changed largely as a result of another implausible model created by... the Sheffield Alcohol Research Group. That model initially supported a threshold of 21 units but the team made unjustifiable changes to their methodology at the eleventh hour in order to support a lowering of the limits after Public Health England told them to.

In any serious field of academia, being exposed as a gun for hire who is prepared to change your model if your funder writes you an additional cheque would be career-ending. It would surely be enough for the government contracts to dry up. In the world of 'public health', however, it is no barrier at all. In fact, it probably helps.

Tuesday, 20 February 2018

Talking Killjoys

I did a podcast with Cameron English recently which has been uploaded here. It's always a pleasure to talk to Cameron. He lives in California, God help him. Mainly we talked about my book Killjoys and the corruption of the 'public health' movement. Have a listen.

By the way, I am aware that the comment facility seems to have disappeared from this blog for the time being. I haven't disabled it, so if you have any idea why it's gone and how I can get it back, let me know via e-mail (scroll to the bottom). Cheers.

Monday, 19 February 2018

Another neo-temperance flop

Remember the great 'public health' initiative of removing high strength beer and cider from shops in Suffolk? These are the 'cheap' drinks that are supposedly targeted by minimum pricing (this is a shameless lie). Minimum pricing is going to effectively remove these drinks from sale - why buy them when you can get the same number of units from vodka for the same price? - but outlets in Ipswich removed them from sale back in 2012.

How did this 'Reduce the Strength' (RtS) scheme go? Well, it must have gone well because the Local Government Association has a briefing document telling councils that they should do likewise:

Suffolk – perhaps more than any other area – has led the way with tackling the consumption of high-strength, cheap alcohol... The campaign has proved incredibly successful. Ninety out of 138 off-licence premises have signed up, including big chains like Tesco, Sainsbury’s and Morrisons.

Note that the scheme is 'incredibly successful' because it had a large take-up, not because it reduced alcohol consumption or alcohol-related problems. It has been claimed that the number of street drinkers declined in Ipswich, but it seems more likely that these people (most, if not all, of whom are homeless) moved away rather than that they suddenly sobered up.

(As a brief digression, what are the chances of Scotland's homeless moving to England en masse in even greater numbers once minimum pricing is in place? Will anybody be studying this as part of the SNP's rinky dink evaluation?)

Since Ipswich councillors were primarily interested in shooing away street drinkers, they may consider the policy to be a success, but from a 'public health' perspective, the aim was to reduce alcohol consumption. Even if reducing overall consumption wasn't the explicit aim, consumption should decline if the number of the street drinkers and heavy drinkers declines because these people consume a non-trivial proportion of the booze sold. Aren't we told that 4 per cent of the population consume a third of all alcohol?

So did that happen? A new study published last week suggests that it did not. The authors got hold of sales data from the East of England Co-op which got rid of all its cheap high strength beer and cider (>7.5% ABV) from its 53 Suffolk branches in September 2012. Its Norfolk and Essex branches followed suit in September 2013.

The authors describe the roll out in Suffolk as Wave 1 (W1) and the roll out in Norfolk and Essex as Wave 2 (W2). Superstrength booze prior to removal made up 6.5% and 3.6% of total alcohol units sold in W1 and W2 respectively.

Let's see what happened when these drinks were removed...

Our analysis indicates that the impact of RtS on units of alcohol sold for beer/lager and cider was not significant in the two waves. More specifically, following RtS implementation, W1 stores experienced a non-significant increase (3.7%, 95% confidence intervals (CI): −11.2 to 21.0, P = 0.647) whereas W2 stores experienced a non-significant decrease (−6.8%, 95% CI: −20.5 to 9.4, P = 0.390).


The researchers missed a trick by not using Norfolk and Essex as the control group when W1 went into effect, but the results are interesting nonetheless. There was no significant change in the number of units sold and so far as the Co-op is concerned, unit sales went up in one area and down in the other.* As the authors say:

...the changes observed in the two waves were not consistent and so the overall findings showed no intervention attributable impact.

Although the results were non-significant in both places, the Suffolk experience is of most interest because it was there that the Reduce the Strength initiative extended to the most shops, and because Suffolk branches of the Co-op were selling more high strength products before the quasi-ban came into effect (6.5% of alcohol unit sales). It should therefore have seen the biggest decline in sales.

As the authors note, the RtS scheme did not make it impossible for people to buy high strength products in Suffolk. Not all retailers signed up. But the fact that alcohol sales rose in the Suffolk branches does not immediately suggest much switching to other shops. It seems that people in the area did not cut down their alcohol consumption, although some of them must have switched to different drinks.

This evidence goes against neo-temperance beliefs. The 'public health' lobby claims that some people drink too much because high strength booze is being sold at pocket money prices. The drinks taken off the shelves in Suffolk offer the cheapest units of alcohol money can buy in Britain. High strength beer and cider were still available in outlets like the Co-op after the RtS scheme began, but they were more expensive varieties, such as craft beer and scrumpy cider. Good, healthy, bourgeois rocket fuel, in other words.

The logic - and computer models - behind minimum pricing suggest that overall alcohol consumption should have declined as a result of high strength drinks becoming much more expensive, but that doesn't seem to have happened. The authors don't even seem to be very surprised by this. They've seen it all before. Under the heading 'What is already known about this topic', the authors write:

Evaluation of the Scottish Alcohol Act 2010 showed that banning alcohol multi-buy promotions did not reduce alcohol purchasing at the household level, and the introduction of the Alcohol Act was not associated with any changes in off-trade beer sales. 

I'd almost forgotten about the ban on multi-buys. Remember when that was an urgent 'public health' policy that was costing lives for every day politicians delayed? All water under the bridge now. It didn't work, but nobody's going to repeal it. Failure goes with the territory.

In 'public health', the only response to failure is to do more of the same but more vigorously. The authors of the study pounce on the fact that the RtS scheme was 'voluntary', as if it had been the retailers who had come up with the policy when it was actually the brainchild of Ipswich Borough Council, the Police, Suffolk County Council and the NHS. They conclude with a call for coercive, but unspecified, policies to do what this microcosm of minimum pricing couldn't...

Our findings suggest that voluntary RtS initiatives, have little or no impact on reducing alcohol availability and purchase amongst a broader population of customers. The research literature suggests that more effective regulatory public health interventions will be required to achieve substantial population health benefits in reducing alcohol consumption and alcohol-related harms.

Next time will be different, eh?

* Statistical significance is used in this instance to see whether the sales outcomes in Co-op shops reflects the change in sales cross the county.  

Friday, 16 February 2018

The sugar conspiracy debunked

There's been a lot of 'Big Whatever is the new Big Tobacco' rhetoric recently. It's all part of following the anti-smoking playbook which, oddly enough, involves accusing the food/alcohol/soda/gambling industry of following the tobacco industry playbook. It's all so meta, but it's an effective public relations exercise because ad hominem attacks work (read this fascinating study for proof).

The list of businesses that are accused of using 'tobacco industry tactics' is almost endless. Just in the last week, we have seen the booze industry, the baby food industry, the agrochemical industry, the food industry and Facebook all accused of using these mysterious tactics.

Most of the time, the tactics amount to no more than manufacturing a product and trying to sell it; in the final analysis, that is what the single-issue fanatics really object to. The 'tactics' can also often involve lobbying, or rather counter-lobbying as these companies are usually defending themselves from the unprovoked aggression. It is somehow seen as shocking that businesses affected by radical government action tries to have their say (see this 'scoop' from Ireland, for example).

If tobacco industry tactics have a unique meaning in the public's mind, they probably involve covering up evidence and sowing doubt. Of that, tobacco companies have undoubtedly been guilty in the past and the idea that other industries are selling us products that they know to be dangerous is a powerful narrative in these paranoid times. This is the fear to which Stanton Glantz appealed in 2016 when he switched his attention from smoking to sugar. And the global media fell for it. Here is the New York Times, for example...

The sugar industry paid scientists in the 1960s to play down the link between sugar and heart disease and promote saturated fat as the culprit instead, newly released historical documents show.

The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today’s dietary recommendations, may have been largely shaped by the sugar industry.

“They were able to derail the discussion about sugar for decades,” said Stanton Glantz, a professor of medicine at U.C.S.F. and an author of the JAMA Internal Medicine paper.

Glantz's claims were entirely based on an obscure evidence review written in the 1960s by three people, one of whom had undisclosed links to the sugar industry. In those days, researchers did not have to list their interests in journals and it was normal for nutritional scientist to work with the food industry (it still is). The review concluded that fat was a bigger risk factor for cardiovascular disease than sugar. This was an orthodox view then and is the orthodox view now. Glantz did not attempt to challenge this conclusion with empirical evidence. In his mind, one of the authors had received money from food companies so he must be lying.

If you have encountered the anti-carb/anti-sugar crowd on social media, you won't be surprised to hear that this narrative has gone down well. They have a penchant for conspiracy theories and ad hominems, and Gary Taubes has embraced it in his recent book The Case Against Sugar. Nina Teicholz, who borrows liberally from Taubes, created a version of history in The Big Fat Surprise in which John Yudkin's anti-sugar message was silenced by scientists and businesses who wanted people to consume carbohydrates.

There are all sorts of variations of this theory, but the basic theme is that good honest scientists always knew that sugar was the devil, but they were thwarted by devious proponents of the saturated fat hypothesis who shouted them down with the help of lavish funding from Big Carb.

I don't take sides in the fat versus sugar debate. For what it's worth, I think the claims of both factions are overblown. But the narrative presented by Glantz is historically illiterate nonsense and a new study published in Science takes it apart:

Building on a newly popular narrative holding that the low-fat campaign of the 1980s was not based on solid science, these allegations have suggested that if not for the machinations of the sugar industry and its cadre of sponsored researchers, the history of U.S. dietary policy might have unfolded very differently. In this article, we argue that the historical evidence does not support these claims.

Although we do not defend the sugar industry and cannot address every aspect of this history, we believe recent high-profile claims come from researchers who have overextended the analogy of the tobacco industry playbook and failed to assess historical actors by the norms and standards of their time.

Our analysis illustrates how conspiratorial narratives in science can distort the past in the service of contemporary causes and obscure genuine uncertainty that surrounds aspects of research, impairing efforts to formulate good evidence-informed policies. In the absence of very strong evidence, there is a serious danger in interpreting the inevitable twists and turns of research and policy as the product of malevolent playbooks and historical derailments. Like scientists, historians must focus on the evidence and follow the data where they lead.

The article is not behind a pay wall and I highly recommend it. Here are a few more choice cuts...

As we have shown, by the 1960s the paradigm that dietary fat was a likely risk factor for heart disease prevailed among a coalition of scientists closely linked with NIH and AHA and was based on extensive research. By contrast, the sugar theory was developed by a small number of researchers, was supported by limited evidence, and was not accepted by key authorities. Normal science is a social project in which a community of scientists develops consensus over theory. Heart disease epidemiology, in adopting a multifactorial model, could plausibly have accommodated sugar if the theory had withstood testing. But Yudkin's claims were seen as weak and antagonistic, and his signature finding could not be replicated. Moreover, sugar did not appear to meaningfully affect serum cholesterol—the only then-accepted lipid pathway to coronary disease.

As we have also shown, the sugar industry approached Hegsted only after learning of the results of his dairy industry-backed study suggesting that fat and not sugar was a factor in heart disease. “There was no, ‘We'll get money from them and make the results come out this way,’” recalled Lown, who worked in the department. “It didn't happen that way,” he said.

.. We do not claim the sugar industry had no influence on nutrition work at Harvard, nor on the field in general. But we believe that there is no good reason to conclude that SRF's sponsorship of a literature review meaningfully shaped the course of dietary science and policy. Moreover, we think it is an error to demonize, almost as a reflex, scientists and their research when there is evidence of private funding.

.. Our history also underscores the fallacy of emphasizing the machinations of one commodity sector when multiple food industries were deploying similar techniques of influence in the battle for market share. It is notable that during the low-fat era of the 1980s, when suspicion fell heavily on the meat and dairy industries, it was argued that, “The ‘fat lobby’ has not only influenced our nation's food and nutrition policies, it has determined those policies” [emphasis original]. Nearly 40 years later, at a moment when some have said “butter is back” and sugar is toxic, “Big Sugar” is the behemoth accorded these dramatic powers. Caught in the cross fire of these “diet wars” have been the reputations of historical nutrition scientists, whose statures have risen or fallen based on the extent of their contribution to current theories.

If the personal attacks on the authors of this study have not already begun, I'm sure it's only a matter of time.