Tuesday, 17 January 2017

Snooker and the smoking ban

Back in 2009, the BBC's Mark Easton tried to spin the mass closure of pubs in the wake of the smoking ban with an article titled 'Pubs aren't dying - they are evolving'. And so they were - evolving into flats, coffee shops and derelict ruins.

Britain has seen the biggest collapse in pub numbers for a century since it went 'smoke-free', but this can never be admitted by the BBC. Easton blamed 'publicans who are unable or unwilling to adapt to the 21st Century trading environment'. This is a common refrain from apologists for the ban. They portray landlords as being at fault for not turning their pubs into sandwich bars, crèches and community centres when all their customers really want is to drink, smoke and socialise.

Today, the BBC has published a story about the decline of town centre pubs which, as usual, ignores the elephant in the room.

Local Data Company figures, analysed by the BBC, show between 2011-16, the number of town centre bars, pubs and night clubs fell by about 2,000.

As is customary, an academic is wheeled out to blame the publicans...

"To halt the decline, pubs needs to develop their daytime offer."

But it not just pubs that are closing down:

Comedy clubs (-33%), snooker halls (-34%), internet cafes (-41%) and bingo halls (-22%) saw some of the biggest falls.

With the exception of internet cafes, which have become obsolete, these are all places people used to go for a drink and a smoke. Snooker clubs are of particular interest to me and they are in a bad way, as the BBC says:

Snooker clubs have seen a drop of about 35%. According to Sport England, the number of people who say they have played the game each week has dropped 43% from 64,400 in 2011, to 36,800 in 2016.

Jason Ferguson, chairman of the World Professional Billiards and Snooker Association, said the clubs were a victim of the decline in the licence trade, and were fighting - like most sports - to get people away from mobile phones and laptops.

"We're dealing with a completely different world now and there is an argument to say that a reinvention is required," he said.

"The traditional snooker club, which the sport had in the 1970s and 80s, is not working now but there are many that are thriving. The snooker clubs that are closing down are probably not inviting; there's a little doorway on a street where people don't go in."

I don't think it's the doorways that are the problem. If you want a better explanation, you need to ask Ronnie O'Sullivan who explained things more candidly in an interview last week:

“The grass-roots and amateur scene has almost disappeared, it started when the tobacco ban came in and clubs started folding."

And the truth shall set you free.

Brazilian heart miracle revised

Last month I wrote about the claim in Tobacco Control magazine that a smoking ban in Sao Paulo, Brazil had reduced the heart attack rate. Using the figures provided by the study's authors, I showed that the supposed decline was not obvious to the naked eye, to say the least.

This is their data on hospital admissions for myocardial infarction, with the smoking ban indicated by the red line...

And this is their data on mortality for myocardial infarction...

The first graph shows a notable rise from the pre-ban period but the second graph shows a dramatic increase. And yet the authors concluded:

We observed a reduction in mortality rate (−11.9% in the first 17 months after the law) and in hospital admission rate (−5.4% in the first 3 months after the law) for myocardial infarction after the implementation of the smoking ban law.

As usual in 'public health', the claim that something was 'observed' actually means that the data were fed into a model to produce the desired outcome, but what devilish model could have produced such a counter-intuitive conclusion? The authors say that only three variables were fed into the model: carbon monoxide levels, temperature and humidity.

Clive Bates left a comment on PubMed, suggesting that a more candid conclusion would read as follows:

RESULTS: We observed a substantial increase in mortality and hospital admissions for myocardial infarction after the implementation of the smoking ban law in Sao Paulo in August 2009. However, it is possible that other factors are responsible for this increase. After hand-picking a small number of possible confounding variables, and applying opaque statistical adjustments to account for their effect though without providing the data necessary for verification, we have been able to demonstrate that these increases could represent a modelled reduction in mortality attributable the smoking ban (−11.9% in the first 17 months after the law) and in hospital admission rate (−5.4% in the first 3 months after the law). 

 Last week, one of the authors responded with a partial explanation: incompetence.

After reviewing the entire paper, we noticed an error in data of the last column of Table 2. During the registration of information in Table 2, the last column mistakenly recorded incorrect monthly number of deaths for myocardial infarction. The correction will be done this week. Once this is an government data, it can be found in http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/obt10SP.def

Yesterday, a new version of the paper was quietly uploaded to the Tobacco Control website substituting this table...

...for the one that had previously been published:

And the new version includes this mea culpa:

Correction notice This article has been corrected since it was published Online First. The values in the final column of Table 2 have been updated. Data concerning monthly number of deaths for myocardial infarction was provided by Health Ministry through Mortality Information System and DATASUS. During the registration of information in table 2, the last column mistakenly recorded the sum of the number of stroke deaths with the number of stroke and infarction added, that is, unreal numbers. The correct numbers are now shown. The information can be obtained in http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/obt10SP.def. This information will not interfere with the rest of the analysis, because the analysis was done will the original data of deaths, not based in this table.

So they included all the stroke deaths alongside the heart attack deaths in 2010. A naive reader might expect this kind of thing to be picked up during peer review, but at Tobacco Control you'd be lucky if the reviewers notice a typo.

Assuming the new figures are correct, the graph of heart attack mortality should look like this:

This turns a startling rise into a more mundane continuation of the existing trend. If you can spot a 11.9% decline in the 17 months after the smoking ban then well done you. I can't. Nor do the figures for hospital admissions - which are correct, as far as we know - suggest that the smoking ban had any positive effect. The new figures for mortality mean the authors' claim is now deeply implausible rather than totally laughable.

Saturday, 14 January 2017

Dry January: spending £30 to make £1

The neo-temperance movement wants to turn January into a secular Lent for hypochondriacs. Now, if you want to stop drinking for a month, that's up to you, but I strongly object to having my tax money spent on the Dry January project, particularly since Cancer Research UK runs an identical campaign without state-funding (the 'Dryathalon').

And I object further when the government uses my money to pay for the fund-raising activities of the soon-to-be-defunct pressure group Alcohol Concern.

When Dry January was set up by Alcohol Concern in 2013, it was moderately successful and raised £38,000. Public Health England has since decided to throw our hard-earned money at it, giving Alcohol Concern £500,000 to spend on the 2015 event and £1,000,000 for last year.

What has been the return on this 'investment'? Alcohol Concern are a little cagey about it, but their Justgiving page suggests that donations haven't risen since the first Dry January was launched on a shoestring. Last year's effort brought in just £33,000.

Given the million pound investment, this is a net loss of £967,000. Dig deep, taxpayers!


The source of the £1 million figure is this article from December 2015. Public Health England's accounts for January 2015 suggest that £1 million is in the right ballpark.

Here's PHE's expenditure on Dry January in that month, excluding payments below £25,000. As you can see, the advertising industry did nicely out of it:

£211,946.14 - M4C Group: Press advertising
£32,251.20 - M & C Saatchi: Employer Toolkit Creative
£31,230 - M & C Saatchi: Radio advertising
£108,835.20 - M & C Saatchi: Fees and launch story development, including case study recruitment
£41,467.62 - Williams Lea Ltd.: Employers pack production
£47,927.38 - M4C Group: Radio advertising
£71,905.48 - M4C Group: Radio advertising
£47,949.62 - M4C Group: Radio advertising
£90,331.20 - M & C Saatchi:Above the line creative development
£40,200 - NHS Confederation: 'provision of services for NHS staff to participate in Dry January'
£52,660.20 - OgilvyOne: 'Behavioural Strategy and Registration Page Development'

That's £776,704 right there.

Wednesday, 11 January 2017

Recycled dental scaremongering

 From the Guardian...

Child 'sugar scourge': thousands having teeth removed in hospital

Experts say annual figures for England obtained by LGA show need for tougher curbs on sugar in children’s diets

More than 40,000 children and young people a year are having rotten teeth removed in hospital in further evidence of what doctors call the “costly scourge of sugar”.

New NHS figures obtained by the Local Government Association (LGA) show that 40,800 under-18s in England had at least one tooth taken out last year under general anaesthetic because of decay. Performing the procedures cost £35.6m.

If this story sounds familiar it is because it is virtually identical to this Guardian news report from last April which said:

The Local Government Association (LGA) says £35m was spent on extracting rotting teeth from under-18s in 2014-15, amounting to 40,970 procedures, compared with 32,457 in 2010-11.

That was based on 2014/15's figure. Today's report was based on 2015/16's figure. Note that the number of extractions has gone down (slightly) in the last year. The Guardian doesn't mention this, nor does it mention the fact that the government banned dentists from taking out more than one tooth in 2000 so all multiple extractions have to be taken out in hospital. The publication of new figures is news of sorts, but it's hard to believe the Guardian would treat it as such if the LGA hadn't made it all about sugar.

The LGA is yet another state-funded lobby group with a bee in its bonnet about sugar and a penchant for higher taxes, hence these attempts to alarm people about childhood teeth extractions without putting the figures in any context. I wrote about this last year but if the LGA can recycle material, so can I...

The LGA’s ‘community wellbeing spokeswoman’ says her figures prove that ‘we don’t just have a child obesity crisis, but a children’s oral health crisis too’.

But do we? We are no longer a nation of Austin Powers. ‘The dental health of the majority of British children has improved dramatically since the early 1970s,’ according to a 2005 study, which also noted that ‘levels of dental decay in UK children at five and 12 years are among the lowest in the world.’ A further study in 2011 also found that ‘since the 1970s, the oral health of the population, both children’s dental decay experience and the decline [in] adult tooth loss, has improved steadily and substantially’.
This was confirmed in a report from the Faculty of Dental Surgery last year.

The Office for National Statistics has run the Children’s Dental Health Survey since 1983 and the figures are striking. The number of 12-year-olds who exhibited clear signs of tooth decay fell from 81 per cent in 1983 to 28 per cent in 2013. One in three kids of this age had a cavity in 1983 but by 2013 this had fallen to one in nine. The survey does not look at younger children but in Scotland the prevalence of tooth decay among four-year-olds nearly halved between 1994 and 2014, from 62 per cent in 1994 to 32 per cent in 2014.

The rise in hospital admissions for childhood teeth extraction does not, therefore, reflect a general rise in childhood tooth decay. Quite the opposite. Nor does it reflect a rise in the consumption of sugar or sugary drinks (both have been falling).

There has been no rise in childhood or adult tooth decay as a result of fizzy drinks or anything else. On the contrary, there has been a dramatic decline in tooth decay across all age groups.

Yes, there are still too many kids with bad teeth but a sugar tax is not going to change that. However, there are things that local authorities could do but don't because it requires more than writing press releases. As I said last year...

The Faculty of Dental Surgery (FDS) has suggested that hospitals are being used as a last resort for children who have not been registered with a dentist or are ‘seeking dental treatment when the caries [ie cavity] is already at an advanced stage so must be referred to specialist services’. This is certainly plausible. Tooth decay is most common in inner cities and among low-income families. More could be done to encourage ‘hard to reach’ groups, including the foreign born, to take their kids to the dentist. The FDS would like to see a public campaign to this effect, along with education about the effect of sugar on teeth and the promotion of water fluoridation.

Local authorities could do any of this without having to lobby central government. Instead it is grabbing headlines with Jamie Oliver-style anti-obesity policies which are unlikely to make a dent in obesity rates and are even less suited to reducing rates of tooth decay. Sugar is an important cause of tooth decay, but it is the frequency of consumption that matters, not the overall intake. Saliva naturally removes sugar from teeth within 20 minutes. Drinking a can of pop or scoffing a bag of sweets once a day might not be advisable from an obesity perspective but it is trivial in relation to tooth decay. The problem comes when you make the bag of sweets (or the piece of fruit) last all day. Reducing sugar content in individual items, as the LGA wants to do, would make no difference because the issue is the frequency, not the volume.

The bottom line is that there has been a dramatic improvement in children’s teeth in recent decades as a result of tooth-brushing, fluoridation and dental check-ups. If more kids visited the dentist and brushed their teeth, rates of tooth decay would fall further. Local authorities would have to do some work to achieve this behavioural change but, unlike putting little pictures of teaspoons on lemonade bottles, it would actually work.

Tuesday, 10 January 2017

Bullshit inflation: sugar edition

A couple of items to catalogue in the are-you-sure-this-ain't-a-spoof? file. Firstly, a wonderful new website called Secondhand Sugars (they are insistent about the trademark).

Sugars can be harmful to children as early as in the womb. Secondhand Sugars™ are the sugars found in foods and beverages that babies in utero, infants, and children are exposed to involuntarily. The risks include obesity and related diseases like diabetes as well as cognitive and learning problems. Just as we protect children from dangerous secondhand smoke, we should prevent children from being exposed to secondhand sugars.

For God's sake, don't tell them about lactose.

You won't be surprised to hear that the founders of this important new piece of intellectual property hail from California.

So too does Gary Taubes who is busy hawking his new book with articles such as this in the ever-woeful Vox...

The case for eliminating sugar. All of it.

The sugar panic is undergoing an intense period of bullshit inflation at the moment with Taubes competing with articles such as 'Sugar is the "alcohol of the child", yet we let it dominate the breakfast table' by rival anti-carb author Robert Lustig. Taubes says he wrote his latest tome, in part, 'to help drive the policy discussions' but seems to understand that the noose is tightening around us all:

I don’t like the idea of regulation. If regulators feel the evidence is sufficient to go after my sugar, they might decide next week that [the evidence] exists to go after my pastrami. And I’m one of those people who happen to think pastrami is healthy.

Sorry Gary, but that's just the way it goes.

Thursday, 5 January 2017

The anti-science of the diet drink scare

First e-cigarettes, now diet drinks. It's not the unhealthy part of the product that the puritans have a problem with, it's the existence of the product. I fully expect to see a crusade against non-alcoholic beer if anyone ever starts drinking it.

I wrote about the recent claims that diet drinks are making the 'global obesity crisis' worse for Spectator Health...

The idea that zero-calorie products are a cause of obesity is absurd on its face and is unsupported by the evidence. It is not merely junk science, it is anti-science in that it implies that obesity is not caused by a surplus of energy but by some magical process involving bubbles and tin cans. It is front-page news because it is sensational, and it is sensational because it is not true.

Do have a read.

Tuesday, 3 January 2017

New year, same old sugar panic

Stop it

From the BBC (and everywhere else)...

Kids devouring too much 'breakfast sugar' warning

Children are packing in so much sugar at breakfast that half their daily allowance has already been eaten before school, Public Health England says.

There is no such thing as a sugar allowance. Rationing was abolished in the early 1950s. What we have is a recommendation - a recommendation that was arbitrarily and unscientifically halved recently because - I suspect - people were getting close to meeting it.

A survey of 200 parents with children aged four to 10 revealed the problem starts at breakfast. It found children were eating more than 11g of sugar or nearly three sugar cubes, on average, at breakfast alone.

Eleven grams of sugar is nothing. It's 44 calories. Britain is in a bad place if the consumption of 44 calories is front pages news.

Public Health England could make themselves useful by waging an educational campaign against the hysteria and scientific illiteracy of the anti-sugar/low carb/high fat cultists. With a bit of effort, it might avert the epidemic of eating disorders that is on its way if the current irrationality persists. Instead, it is effectively collaborating with the Action on Sugar cranks in order to promote its Change4Life app.

So let's look at the healthy breakfast alternatives suggested by Change4Life, five of which are given pride of place on Auntie Beeb's report of this non-story.

Of the two sweet dishes suggested, the blueberry and banana smoothie contains 15 grams of sugar and a serving of the porridge contains 20 grams of sugar. Even the baked tomatoes have 9 grams of sugar.

A touch of hypocrisy from Public Health England? Perhaps, but these dishes are not unhealthy. The amount of sugar in them is perfectly normal and appropriate. It would be very difficult to put together a palatable sweet dish for an adult or a child without 11 grams of sugar.

The survey also showed that 84% of parents thought they were giving their children a healthy start to the day.

For the most part, the parents are right. No child is going to come to harm by having 44 calories of sugar in their cereal bowl, on their toast or in their glass. Can everybody please get a grip?