Tuesday, 30 August 2016

A letter to the WHO

The WHO is having a consultation on what policy demands to put in the latest version of its delusional non-communicable disease action plan. I've just been reading the consultation document and was staggered to find (though I shouldn't be by now) that it is a wishlist of every juvenile anti-consumer nanny state policy you can shake a stick at.

The WHO is the FIFA of health so I very much doubt that any responses to their consultation will make them change their mind about anything but they are taking submissions (at appendix3@who.int) until close of play tomorrow so I decided to send them a quick e-mail anyway.

Dear Sir/Madam,

I have read your suggestions for Appendix 3 of the WHO Global NCD Action Plan and regret to see the WHO involving itself in policy areas in which it has insufficient knowledge and little authority. Is the WHO now merely a wing of the anti-capitalist movement?

In particular, I note the emphasis on banning intellectual property and branding (plain packaging), taxing sugary drinks and banning alcohol advertising. None of these policies have been shown to effectively tackle the associated problems but all have a detrimental effect on the operation of free markets. You may have no affection for markets - indeed, it is increasingly clear from the rhetoric of Margaret Chan that you do not - but many of us do. That is why some of the measures you want to recommend are unconstitutional or otherwise illegal. Why ask countries to do things that they cannot do, should not do and do not want to do? The public expects the WHO to be more than a glorified single issue pressure group.

There is zero evidence that plain packaging had any effect on tobacco sales in Australia, unless you count the unusual rise in sales observed in the first year of the policy as a direct effect of the legislation. There is zero evidence from anywhere in the world that taxes on sugary drinks have had the slightest effect on obesity. You asked Gerard Hastings to review the evidence on alcohol advertising and he told you that it was a driver of consumption. Hastings is well known to be an emotional and fanatical opponent of capitalism in general and advertising in particular. It is hard to think of anyone less qualified to give a sober judgement to an UN agency. Needless to say, his jaundiced view of alcohol advertising is not supported by economic studies.

I notice you also suggest bans on smoking outdoors. Again, there is not the slightest evidence that secondhand smoke outdoors poses a threat to anybody. Even if there were, it would not be any business of the WHO’s to tell people how to deal with it.

Finally, there is the question of resources. The WHO’s resources are limited and contagious diseases remain rampant in most parts of the world. A dollar spent campaigning for anti-market policies such as plain packaging and alcohol advertising bans is a dollar that could be spent preventing typhoid, cholera, HIV etc. NCDs kill people but it would take a moral cretin to view a death in old age from a lifestyle-related condition to be equivalent to a child dying of a communicable disease, not least because the former has consented to the risk and is not asking for your help. Until the latter have been adequately tackled, it is immoral to expend resources on the former.

The hard-working people who pay your wages expect you to be dealing with problems such as Zika and Ebola, not beer advertisements and the price of cola. If the WHO wishes to retain the good will it has attracted over decades of tackling infectious disease, it needs to drop the juvenile political campaigning and reform itself quickly.


Christopher Snowdon

Friday, 26 August 2016

Those new drinking guidelines in full

I've created a handy slide to summarise the Chief Medical Officer's new drinking guidelines...

Admittedly it doesn't cover everything in the report - there's some guff based around a fantasy computer model that bears no resemblance to real world data in there as well - but this is the only quote you'll need next time 'public health' activists say that we need more bans, taxes and regulations because X% of the population are drinking more than a certain amount.

Thursday, 25 August 2016

Alcohol guidelines in post-truth Britain

I've got an article at Spectator Health about a couple of new studies looking at moderate alcohol consumption that come to the usual conclusion.

Bearing in mind that [Sally] Davies claimed in January that whatever health benefits she grudgingly accepted only applied to old people, let’s look at the conclusion:
Our findings are generally consistent — especially for younger women — with an accumulating body of research demonstrating positive associations between moderate alcohol use and health, even after accounting for abstainer bias.
Looks like another two studies can be added to the massive body of evidence showing the same thing.

Smart people, those old wives.

A couple of hours after the article went live the government quietly released the official new alcohol guidelines (c/o the UK Temperance Alliance) which contains such gems as...

That the net benefits from small amounts of alcohol are less than previously thought (with substantial uncertainties around the level of protection) and are significant in only a limited part of the population. That is women over the age of 55, for whom the maximum benefit is gained when drinking around 5 units a week, with some beneficial effect up to around 14 units a week

Post-truth Britain indeed.

People Against Sugar Tax

A deranged Corbynista with a double digit Twitter following has spent five minutes on Google and written an ignorant and libellous blog post about a small pressure group called People Against Sugar Tax of which I was briefly on the advisory board.

The group was created a while ago by a guy called Brook Whelan with a strict policy of not accepting donations from industry. That is made clear on the website. Nevertheless, our left-wing friend has decided that the group is 'corporate astroturf' on the basis that Brook works in 'communications' (marketing, I believe) and the unpaid board members have links with the evil Conservative party. Alex Deane even defends vaping. Vaping!

This is pretty insulting given that Brook has spent a considerable amount of his own money fighting the sugar tax and so, at the risk of feeding the trolls, I still decided to leave a comment to correct the author. The author has refused to publish it, presumably because his reader would realise he's being hood-winked. Fortunately, I know enough about the far left's difficult relationship with free speech to have anticipated this, so I saved it as the time. So, in case you've come across People Against Sugar Tax and ever wondered, here's the deal...

My name has been removed from the website for the simple reason that I'm no longer involved with the group. I notice you have nothing to say about Brook Whelan - presumably because a look at his background would ruin your little conspiracy theory - but he founded and runs the organisation with the help of some volunteers.

When he set it up, Brook asked some people who knew about campaigning (eg. Alex) and some people who knew about the evidence (eg. me) to act as advisors. A reasonable thing to do, n'est pas? We agreed to do so, unpaid, because we agreed with his aims but after a while I realised that I was unable to dedicate sufficient extra-curricular time to the project and reluctantly dropped out.

Even if I had still been involved I fail to see how it would validate your libellous claim that the group is "corporate astroturf". Brook has been clear from day one that he would not accept a penny from industry or government. Indeed, he has sunk a considerable sum of his own money into the group. You owe him an apology.

I will continue to tweet about the sugar tax because I oppose it, as millions of other PEOPLE do. I hope Alex will continue to tweet about vaping, although what that has to do with the matter, God only knows.

If you're on Twitter, give them a follow.

Wednesday, 24 August 2016

Understanding the Basic Economics of Tobacco Harm Reduction

I'm delighted to have persuaded Carl Phillips to write a paper for the IEA about tobacco harm reduction. As many readers will know, Carl's knowledge and experience in this area is second to none and he is a rarity in the world of 'public health' in that he understands economics. As he said to City AM yesterday...

“Public health people are notoriously economically illiterate. Most of the nonsense in the policy discussion, on all sides, stems from ignoring economics,” said Phillips.

In his discussion paper Understanding the Basic Economics of Tobacco Harm Reduction, Carl looks at nicotine use from the perspective of welfare economics. This is how all other product use is normally looked at, but because most of the people involved in tobacco control have peculiar views, such as the belief that a billion people smoke as a result of some sort of demonic possession rather because they enjoy it, nicotine is usually excluded from conventional cost-benefit analysis.

'Public health' paternalists think that it's their job to assess costs and benefits for other people. However, being fanatics, they don't see any benefits from nicotine consumption and so, seeing only costs, assume that the optimal level of nicotine consumption is zero.

Using rigorous economic logic, Carl refutes that and concludes:

  • Substitution of a low risk product would be welfare-enhancing for most smokers. Some smokers will still prefer smoking to any available alternative, despite the much higher risk. But there are vanishingly few smokers for whom abstinence is a better choice than switching to a low-risk alternative. Thus there is no apparent ethical justification for anti-smoking measures that push for abstinence rather than switching.
  • The availability of low-risk tobacco / nicotine products will inevitably increase total consumption as compared to a world where cigarettes are the only option. This is the inevitable and rational effect of lowering the costs of a consumption choice. It is properly counted as an additional benefit, though it is widely derided as a cost. Public supporters of low-risk products who condition their support on those products not attracting any new users are either being naïve or cynically imposing conditions they know cannot be met.
  • For any remotely defensible goal, including minimising population health risk, the optimal level of excise tax on low-risk products is zero (assuming that is the lower bound; a subsidy would be better still). This is sometimes presented as if it were immediately evident from the comparative risk, but that is not actually a valid claim. However, simple economic analysis shows that it is the case.

You can download if for free here. Please do.

You can also read Carl's article for the City AM here.

Monday, 22 August 2016

That Canadian minimum pricing claim

From the Journal (Ireland), a pleasing rarity - a journalist who knows how to assess evidence. It all started with a clueless/lying politician...

"Minimum unit pricing has been proven to work, in British Columbia in Canada, for example. When they introduced it, they found, when they did the research that there were less deaths from…drinking, and there were less hospital admissions."

This is one of the most audacious lies I've ever come across in 'public health' and that is not a claim I make lightly. It started life in a ludicrous study from that old crank Tim Stockwell and has been repeated ad nauseum ever since.

The statement that alcohol-related deaths dropped by 32 per cent in British Colombia between 2002 and 2009 seems like a normative claim. It's not. There was never any drop in deaths and so Stockwell created a model that pretended there were. This is what 'public health' people do. They create a land of fantasy for themselves where their ridiculous policies work.

I have written about this farce of a study before, but the Journal has the most comprehensive take yet. Do read the whole thing, but here's a taster...

The first thing to note is that the number of alcohol-related deaths and hospital admissions generally went up in British Columbia during the period of 2002 to 2009.

As you can see, there were only two occasions when the number of deaths was lower than the year before, and the number of hospital admissions rose every year.

...It is doubly wrong to say that this happened “when they introduced [MUP]“. As we’ve explained, this study relates to increases in already-existing minimum prices.

...Remember that the study uses complex statistical models to estimate an association between a 1% increase in minimum prices, and a percent change in the number of deaths.

It’s not saying that prices actually went up by 1%, and these were the actual, observed ensuing increases and decreases in deaths.

If that’s a bit confusing, welcome to the world of statistical models.

It certainly is a bit confusing when 'public health' campaigners make up historical facts to suit their agenda, but it is hardly the first time. Models have their place in making predictions but using a model instead of using readily available data about a past event is, well, cheating.

Read it all here. There is also a pretty good overview of the sugar tax evidence from the same people here.

The silly, silly sugar levy

I've been looking carefully at the details of the proposed UK sugar levy and have written up my conclusions in a short IEA briefing paper. It is a truly perverse and counterproductive idea which will cost the government more than it yields and will have little effect in incentivising reformulation because the reformulation has already taken place.

Here's the executive summary...

In March 2016, George Osborne announced a ‘sugar levy’ on soft drink companies to start in April 2018. Under this policy, companies will be taxed on sales of medium and high sugar drinks (excluding fruit juice and milk-based drinks).

As an anti-obesity policy, the sugar levy seems arbitrary. Consumption of both sugar and sugary drinks has been falling for years while obesity has been rising. Soft drinks make only a small contribution to average calorie intake. Comparisons between European countries show no correlation between sugary drink consumption and obesity.

There is unambiguous evidence that ‘sin taxes’ of this sort take a greater share of income from the poor than from the rich. Since low income groups tend to buy larger quantities of SSBs, the impact of the sugar levy will be particularly regressive.

The Office for Budget Responsibility says the levy will increase inflation by a quarter of a per cent in 2018-19 thereby adding £1 billion to accrued interest payments on index-linked gilts. The inflationary effect will raise the cost of index-linked salaries, pensions and benefits by many millions of pounds. The levy will also require additional funding for enforcement and administration. For the first few years, at least, the sugar levy will be loss-making.

Hopes of extensive reformulation to reduce sugar content in the soft drink market are highly unrealistic. There is no more sugar to be removed from diet drinks and companies will not change the recipe of their popular original brands. Instead, the levy gives companies the perverse incentive to raise sugar levels up to the threshold of each tax bracket.

It is bizarre to introduce a tax when you know that it will incur billions of pounds of additional costs, and the stated objective of getting soft drinks companies to reduce the amount of sugar in their products is a pipe-dream.

50 per cent of the carbonated drinks market is already made up of low calorie brands. Regular Coke and Pepsi make up a further 24 per cent of the market - and they are not going to be altered. That leaves only a quarter of the existing market that could plausibly be reformulated but it includes such brands such as Irn-Bru and Dr Pepper which are unlikely to change (both have diet versions that sell modestly) as well as brands such as Lilt and Oasis which have already been reformulated to bring them below the lower-tier 5g/100ml sugar limit. For the latter category, the levy provides no incentive to reduce sugar levels further. On the contrary, since consumers tend to prefer the taste of sugar to the taste of artificial sweeteners, the levy gives manufacturers a perverse incentive to raise sugar levels in reduced-sugar drinks up to the limit of whichever tax bracket they are in.

I think the sugar tax is a bad idea on principle but it also happens to be a terrible idea in practice.

I've written more about this for Spectator Health.