Thursday, 27 July 2017

Another study shows that vaping helps people quit smoking

A study published in the BMJ today will have the usual anti-vaping fanatics howling at the moon. It found that vapers were much more likely to attempt to quit smoking than those who don't vape, and that they are 73 per cent more likely to succeed in quitting smoking when they do. It also finds a significant increase in smoking cessation in the USA that coincides with the rise of vaping.

Anti-vaping throwbacks will no doubt say that correlation does not equal causation, but the authors examine two possible alternative explanations for the decline in the smoking rate and find them wanting...

First, in 2009 there was an increase in federal tobacco tax. The national cigarette tax increased by 158%, resulting in an immediate reduction in cigarette uptake among US adolescents. In our study we found a small but statistically significant increase in quit attempts among US adults, from 39.9% in 2006-07 to 41.4% in 2010-11 (fig 2, top panel). However, the total cessation rate did not change: 4.5% for both surveys (fig 2, bottom panel). Thus the effect of the 2009 federal tax on quitting by adult smokers, if there was an immediate one, was no longer detectable by 2010-11. This lack of change in smoking cessation under such a dramatic tax increase accentuates the difficulty in improving quit rates at the population level. 

Second, since 2012 there have been annual, national media campaigns aimed at increasing quit rates among adult smokers. The TIPS from Former Smokers campaign used evocative television spots showing the serious health consequences of tobacco use. This campaign, running from nine to 20 weeks in any given year, reached a large segment of the smoking population. A national survey after the first round of the campaign found that 78% of smokers saw at least one media spot. By 2015, there had been four rounds of the campaign. Surveys found a statistically significant increase in quit attempts, and the cessation rate of those who made a quit attempt was estimated to be between 5.7% and 6.1%.

In the present study we found statistically significant increases in both quit attempt and cessation rates from 2010-11 to 2014-15. This period coincided with the TIPS campaign and the dramatic increase in e-cigarette use.

Could TIPS alone explain the increase? Given the reach of the first TIPS campaign, after four rounds it was expected to reach most US smokers by 2014-15. However, the majority of smokers did not appear to change their quitting behavior: smokers who did not use e-cigarettes were the majority (77%) in 2014-15. Neither their attempt rate nor the annual cessation rate was statistically different from that of all smokers in 2010-11 (fig 1). It was e-cigarette users in 2014-15 who showed a dramatically higher quit attempt rate and a higher cessation rate. 

The authors caution against attributing all of the difference in cessation rates to vaping because it is possible that those who are most committed to quitting are more likely to use e-cigarettes. However, this study is hardly the first to find a significantly higher rate of quitting among vapers and randomised controlled trials have found the same thing. Indeed, the quit rate among vapers in this study is more modest than has been found in most other studies, but it's published in the BMJ so is getting more attention.

The authors are from California so it is brave of them to publish a study that not only shows that vaping works but that the favoured policies of the tobacco control cabal don't. As a final dig in the ribs they conclude their study by saying:

We found that e-cigarette use was associated with an increased smoking cessation rate at the level of subgroup analysis and at the overall population level. It is remarkable, considering that this is the kind of data pattern that has been predicted but not observed at the population level for cessation medication, such as nicotine replacement therapy and varenicline.

They'll probably never work again.

Tuesday, 25 July 2017

Minimum pricing goes to court (again)

I've written a piece for Cap-X about the bollocks above, which was released on the day that the Supreme Court took a look at minimum pricing.

In the article I mention the fact that the job of evaluating minimum pricing has been given to the Sheffield Alcohol Research Group, which has been pushing the policy for the best part of a decade (see job spec below).

It's difficult to put into words quite how scandalous this is. Even if you thought that the Sheffield Alcohol Research Group's work was of high quality (which it isn't) and that they were impartial (which they aren't), the fact is that they have made their name producing research that purports to show that minimum pricing will be a roaring success. This gives them an inevitable and massive conflict of interest when it comes to evaluating it.

If they don't show that minimum pricing works, it will be an admission that their numerous reports - for which they have been amply remunerated by taxpayers - have been garbage. This would be enough to tempt a saint to massage the figures (and the Sheffield Alcohol Research Group are not saints). They are the last people you would turn to for an independent review. The fact that they have given the job is proof that the 'public health' racket is shamelessly and incorrigibly corrupt.

I'll bet you a pig to the pork scratching that when their evaluation is published in a few years' time, it concludes that minimum pricing has saved lives and worked even better than predicted, but that the unit price needs to be increased.

Anyway, do have a read of my Cap-X piece.

Monday, 24 July 2017

The 'mystery' of shrinking chocolate bars

The FT looks at the 'mystery' of shrinking chocolate bars...

After high-profile cases with the likes of newly gappy Toblerones, the UK stats office says that over 2,500 products were cut in size between January 2012 and June 2017, far outweighing the number of items that were boosted. The trend is most pronounced in sugary treats, where changing pack sizes have contributed 1.22 percentage points to their rate of inflation since 2012, the ONS says.

Manufacturers tend to blame price increases on higher costs for raw materials, but the ONS points out that sugar prices are around the lowest since records began in 1991, while cocoa prices have also tanked.

The FT also notes that the ONS discounts Brexit as the reason because:

'Our analysis doesn’t show a noticeable change following the referendum that would point towards a Brexit effect. Furthermore, others had been observing these shrinking pack sizes long before the EU referendum, and several manufacturers have denied that this is a major factor.'

Remarkably, both the ONS and the FT treat this as a genuine mystery rather than something that can be easily explained by the government sugar reduction scheme. There is plenty of evidence available in Public Health England documents such as Sugar reduction and wider reformulation: stakeholder engagement, Sugar reduction and wider reformulation meetings: November 2016, and Sugar reduction: Achieving the 20% that can explain why confectionery is shrinking.

As I said a couple of months ago:

The bottom line is that most people prefer the taste of sugar to that of artificial sweeteners, and many of the products in the firing line are inherently sweet. Products such as chocolate, confectionery and jam are not going to be magically reformulated with sweeteners. There is a dawning realisation at Public Health England that reducing portion sizes or having a calorie cap (which amount to much the same thing) are the only viable options.

While the achievement of the 20% reduction by 2020 is the overall focus of the programme, smaller gradual reductions can provide a useful contribution to reducing sugar and calorie consumption, and ultimately towards achieving the overall goal. This applies particularly in those products where sugar reduction per 100g can be more difficult, for example, in chocolate confectionery. Where this is the case, businesses are expected to employ additional mechanisms, such as reducing portion size, to achieve the total 20% reduction.

Here is what Public Health England are telling manufacturers:

Mystery solved.

Saturday, 22 July 2017

Only following orders

You've probably read about the five year old lemonade criminal of Tower Hamlets. She was selling lemonade outside her house on a sunny day, as children do, when four 'enforcement officers' charged her with trading without a licence and issued a £150 fine.

Tower Hamlets council have since cancelled the fine and apologised to the family, saying:

"We are very sorry that this has happened. We expect our enforcement officers to show common sense and to use their powers sensibly. This clearly did not happen."

The incident has been almost universally recognised as an extreme example of jobsworths mindlessly applying the letter of the law when they could use their discretion.

But there's always one...

You may call me a monster – but I'm glad that girl's lemonade stall got shut down

This article comes from the keyboard of one Duncan Hothersall who is the editor of Labour Hame (sic). Mr Hothersall seems to be a real person and his article does not appear to be a spoof. His argument is, in essence, that rulez is rulez and if you don't like them you should move to Somalia.

There are half a million cases of food poisoning each year in the UK, and one of the reasons we have stringent controls on who can sell food and drink, especially in unsealed containers, is to try to cut those figures down. And street stalls in general are regulated because we have a system of taxation, rights and responsibilities in this country which underpins our functioning society. Regulation is a social and economic good.

How many cases of food poisoning are caused by juvenile lemonade vendors - or sugary drinks in general - Mr Hothersall omits to mention. How much VAT is lost to the treasury as a result of five year old entrepreneurs is also left to our imagination, but we can safely assume that these numbers are very small indeed.

Nevertheless, it is not disputed that this infant was breaking the law. The question is whether the law is right and whether it was appropriately applied in this instance. The sweeping claim that 'regulation is a social and economic good' implies that a regulation must be good because it is a regulation. Presumably, then, Hothersall can think of no law that should be amended, repealed or applied with discretion.   

It’s also pretty unfair to criticise the hard-working public servants who acted in this case for doing the job they are no doubt underpaid to do. For the council to say “we expect our enforcement officers to show common sense” as they cancelled the fine is all very well, but I’m willing to bet they are given precious little leeway in their training when it comes to who gets fined and who doesn’t.

On what basis are we to assume that the enforcers are 'hard-working' and 'underpaid'? They may be, but we have no way of knowing. We do not even know who they are. What is an 'enforcement officer' anyway? As Josie Appleton says in her fantastic book Officious, the law used to be enforced by the police and we knew who they were. Today, we have an army of wardens, support officers, compliance officers and co-ordinators with varying degrees of authority (or none) whose only unifying feature is a high-vis jacket.

Whether you regard these people as underpaid depends on what value you think they bring to society, but there can be no assumption that they are all hard-working. Clearly they were not sleeping on the job in this instance, but if it took four of them to close down a child's lemonade stand we might question whether they were working at maximum efficiency.

For Hothersall, however, we do not need to know anything about the individuals. They work in the public sector and therefore must be hard-working and underpaid. It is unthinkable that anyone who works for the council could be paid too much.

“But these are decent folk being persecuted by a nanny state,” I hear you cry. And I stand impervious, I’m afraid. Because I’ve heard that line a lot recently and it’s beginning to grate.

I have not heard anybody claim that this is an example of the nanny state. The nanny state is about protecting adults from themselves. This case is not about that. There was no paternalistic intent in either the law or the application of the law. If it requires a label, it is the busybody state. 

If Mr Hothersall has been hearing a lot of complaints about the nanny state recently, it is because there is a sense that the state has become ever more intrusive. The complaint is not wrong just because it is 'beginning to grate' on him. A more enquiring mind might ask whether his fellow citizens have a point, but instead he changes the subject...

It’s the same argument used against speed cameras and parking fines. 

No, it isn't. These are not nanny state issues either and the complaint that Hothersall identifies (which is essentially 'bloody nanny state') is not actually an argument. If it were, he would have to find a counter-argument and that would be too much effort. Much easier to create a false equivalence between a motorist who moans about being fined and a five year old being punished for selling lemonade.

How often have you heard those caught out proclaim themselves as “law-abiding citizens” and bemoan the infringement of their freedom? 

Laws do infringe on freedom and they are intended to do so. The question is whether the infringement is justified by the wider benefits to others. A motorist might legitimately complain that a speed limit of, say, 20mph is unreasonable and is therefore an unnecessary infringement on freedom.

Just as Hothersall believes that the salaries of council workers can never be too high, he may also believe that speed limits can never be too low. Who knows what he thinks? It is possible that he gives these questions no thought at all since, despite writing for a political website, he seems to think that the nature of laws is not a matter for public comment. Regulation is good per se and every law in the land is perfect.

I have news for you: if you break the speed limit, or park illegally, or indeed break health and safety or trading regulations, you are not a law-abiding citizen. You’re actually the one who’s in the wrong.

If you break the law, you are not a law-abiding citizen by definition. That is undeniable. But whether you are in the wrong depends on whether the law is right. What if the law is an ass? What if agents of the state do not 'use their powers sensibly', as Tower Hamlets council put it?

Even if Hothersall cannot think of any laws he would like to change in Britain today, surely he can think of historical examples of good people breaking bad laws? Surely he can think of instances in which the letter of the law, rather than the spirit of the law, has been applied, thereby causing harm?

Most people - including the council - think that that is what happened in this case. Hothersall's insistence that we unquestioningly follow orders when the consequences are so farcically at odds with the intentions of the lawmakers and deviate so far from public opinion is slightly sinister.

A culture of entitlement, and a belief that rules are for other people but not us, is a disease gripping middle Britain.  

A culture of entitlement, he says. This is a five year old girl he's talking about. As they say on Merseyside, Mr Hothersall, give your head a wobble.

Friday, 21 July 2017

The case against The Case Against Sugar

Nobody does a forensic fact-checking like Seth Yoder at the Science of Nutrition blog. If you're interested in the low carb/high fat fad, his extensive reviews of Gary Taubes' Good Calories, Bad Calories and Nina Teicholz's The Big Fat Surprise are must-reads (you can also read my briefer review of the latter here).

Now he has gone through Taubes' latest book, The Case Against Sugar. As with the others, this has generally been well received by non-science reviewers and criticised by those who are familiar with nutritional science.

Do have a read of it.

Thursday, 20 July 2017

Snusgate: the movie

You may recall the scandal around the former EU health commissioner John Dalli who was sacked after being accused of being involved in an attempt to solicit a bribe from the snus company Swedish Match and subsequently exposed for some strange shenanigans in the Bahamas. Dalli was vigorously defended by 'public health' groups at the time and Private Eye made the ill-judged decision to take his side on a couple of occasions.

Dalli's defence is that he is the victim of an inexplicable conspiracy conjured up by José Manuel Barroso, the European Commission, OLAF, the tobacco industry and numerous others. The gist of the plot is that Barroso didn't want Dalli to regulate cigarettes and so conspired to replace him with a more pro-tobacco commissioner who would water down the Tobacco Products Directive (nb. Dalli's replacement is not remotely pro-tobacco and the TPD was not watered down).

On Monday night, BBC4 showed a documentary about Dalli which is well worth watching. The title and blurb for the programme (see above) are rather misleading. The 'mystery' involved smokeless tobacco, not cigarettes, and Dalli was not accused of being 'in the pocket of "big tobacco"', he was accused of trying to get in the pocket of a small tobacco company (and was reported to the authorities by the company).

I was expecting a pro-Dalli whitewash and the first 20 minutes seemed to confirm my fears. (Spoiler alert.) At first, the two Danish journalists are taken in by Dalli's protestations of innocence and are keen to blow the cover on a Big Tobacco conspiracy. But as they dig a little deeper and get to know more about the man, things take a turn.

Dalli shows them e-mails from a mystery correspondent named Maria who claims to have a dossier proving that Barroso took a bribe from the tobacco industry and put it in a Norwegian bank account. But this evidence never surfaces and we find that Maria does not exist.

They then go to Bahamas and find out about a con artist friend of Dalli's known as 'Ladybird'. They meet some American victims of a scam who point the finger at Dalli. When the journalists mention these new accusers to Dalli, he claims that they are also part of Barroso's conspiracy against him. Other accusers are said to have been 'brainwashed'.

By the end of the documentary, the journalists have concluded that 'Maria' is Dalli himself and that the man is, at the very least, half-mad. It's hard to disagree.

You can watch it on the iPlayer for another 27 days.

Wednesday, 19 July 2017

200,000 hypothetical children

When the plain packaging idiocy was first mooted in 2008, we were told:

More than 200,000 under-16s start smoking each year

In 2010, this statistic was officially endorsed (but not referenced) in the government's Tobacco Control Strategy:

Each year in England, an estimated 200,000 children and young people start smoking

And it was repeated many times, for example in this article about plain packaging in 2011:

Research has shown around 200,000 children and young people in England start smoking each year

In 2013, with the government still failing to commit to the idea, the BMA signed a letter to Jeremy Hunt demanding that the government introduce plain packaging, saying...

With over 200,000 children starting to smoke every year, there is no good reason for the UK to wait any longer.

The government eventually buckled to the fanatics and passed the legislation in 2015. Campaigners celebrated, saying:

“We are simply delighted that the House of Commons has spoken out to protect the 200,000 children taking up smoking every year in this country"

Every pack of tobacco is now in plain packaging and those 200,000 children are now 'protected' from seeing an irresistible logo, so I was interested to see the British Medical Association's statement responding to the new Tobacco Control Plan for England yesterday:

'While we are glad to see developing policy such as plain cigarette packaging and increased taxation on tobacco, it is still worrying that more than 200,000 children and young people take up smoking...'

So that's nine years of display bans, vending machine bans, tax rises and finally - the jewel in the crown - plain packaging, and the same number of children are taking up smoking as they did before? Is this a junk statistic or an admission of failure?