Velvet Glove, Iron Fist

Food is the new tobacco (part 94)

Sun, 06/05/2012 - 12:38
I doubt there are many readers who have not noticed that food is the new tobacco, but if you are still wavering, be sure to read this article from USA Today.

Since first lady Michelle Obama made childhood obesity her signature project almost two years ago, the issue has had the kind of highly visible national leadership that it previously lacked.

But that isn't enough, say public health leaders frustrated with the slow progress in stemming America's obesity epidemic.

Something more ambitious is needed, they argue — something more like the anti-tobacco movement.
The existence of this "domino effect" has recently been denied by our own dear Deborah Arnott (thereby providing Dick Puddlecote with many laughs - see here and here and here and here). So what does Dr. Stanton "not a medical doctor" Glantz have to say about it?

"When I look at what's going on with obesity, it reminds me of what was going on with tobacco in the '50s, '60s, and '70s, when there was a lot of emphasis on personal responsibility, voluntary self-regulation, and trying to make safe cigarettes," said Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.

That approach didn't work, and efforts to reduce smoking didn't really have much success until advocates shifted their emphasis from changing individual behavior to community-based activism and holding cigarette manufacturers accountable for harmful products, Glantz said.
Could this be the same Stanton Glantz who said in 2006: "The whole slippery slope argument is fallacious"? It is.

As public health experts committed to stemming obesity study the history of the anti-tobacco movement and look to it for guidance, it is helpful to consider some key similarities and differences between these issues.
Yes. Let's piece it together. Firstly, there's the "think of the children" angle...

Preventing harm to young people is a central goal of both anti-tobacco and anti-obesity campaigns. "First, let's protect our children," said David Ludwig, a child obesity expert at Harvard Medical School
Secondly, we'll need some denormalisation:

Smoking rates have been cut by more than half, intolerance of smoking in public places is widespread, and anti-smoking policies are in place at hospitals, workplaces and venues across the country. Koplan is convinced the same shift in social norms is called for — and achievable — when it comes to childhood obesity.
Then we need an equivalent of secondhand smoke:

The American public was alarmed when it learned that the cigarette smoke that non-smokers breathed in airplanes, bars and restaurants was dangerous, and that no amount of second-hand smoke was safe.

"The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people's intolerance of smoking and their willingness to see the government take action," said Michael Eriksen, director of the Institute of Public Health at Georgia State University.

There is no equivalent in the fight against obesity. "Your being obese does not affect me in the same direct way," Eriksen said.
Oh, but it does, squire. There is "passive obesity" and our old friend Robert Lustig is about to tell you about it.

The best argument might be that obesity consumes enormous health care resources, driving up the cost of medical care for everyone, suggested Robert Lustig, a professor of pediatrics and director of the Weight Assessment for Teen and Child Health Program at the University of California-San Francisco.
Finally, there is the essential prohibitionist trick of painting their crusade as being between "the people"—as represented by bossy, intolerant puritans and quacks—and Big Food/Big Tobacco.

"Some companies are making huge profits off obesity," said Stan Dorn, a senior fellow at the Urban Institute, a public policy research center in Washington, D.C., "and I worry that people who are focused on anti-obesity strategies aren't being tough enough on them."
However, there is an acknowledgement that there may be a few differences between the War on Food and the War on Tobacco.

"Tobacco we can get rid of entirely. We don't need it. It has no intrinsic value. But we have to eat to live and make terms with food as the enemy," said David Katz, director of Yale University's Prevention Research Center.
You've got to love the glib assertion that "we" can get rid of tobacco entirely, as if eradicating a plant that has grown for millions of years and is consumed by 1.2 billion people is a simple administrative matter—as if prohibition has such a glorious track record that the elimination of the world's second favourite drug is easy and imminent. But as much as I like that statement, I think I like the idea of food being "the enemy" even more. And that's not the only "enemy"...

Throughout most of history, humans lived in an environment where food was scarce and hard to get. As a result, we're primed, biologically, to eat food when it's available and "we're very good at storing calories and defending calories once we've got them," said Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine. "In some ways, you could say that our biology is our own worst enemy when it comes to being overweight or obese."
If food and biology are your enemies and Robert Lustig and Stanton Glantz are your friends, you're probably mixing in the wrong circles. Interesting times ahead...
Categories: Harm Reduction Feeds

Fake charity wants sweetie display ban

Fri, 04/05/2012 - 14:16
On the problems with tobacco display bans and plain packaging is that they are rooted in the idea that the very sight of a product constitutes advertising. This is very questionable logic, but it allows campaigners to demand that all tobacco branding be hidden from view.

As ever, what is good for the anti-smokers is good for single issue campaigners of any hue. It is logically inconsistent to remove tobacco from view while leaving other products - such as 'junk food' and alcohol - that cannot be advertised to children to remain on display.

This has not gone unnoticed by a fake charity called Sustain which is making moves in the direction of a sweetie display ban.

Our survey of 48 branches of fourteen national supermarkets and high street chains found that food was regularly displayed at the checkouts and in the queuing areas, and the vast majority of food promoted was unhealthy.

In many cases, the food was positioned to attract the attention of children – and was often within their reach – much to the annoyance of parents we asked.
One such wretched parent is quoted by the BBC:

Amanda Flint, a mother of four and supporter of the campaign, said: "Shopping with my kids is hard enough as it is. So to be subjected to rows of sweets and chocolates at the checkout is maddening. I want it to be easier to choose healthy options for my family."
You can surely guess where this is heading...

The history of campaigning on this issue suggests that retailers are unable or unwilling to stop voluntarily promoting junk food in their stores in this way. The Children’s Food Campaign is therefore calling for robust Government action to help parents and bring an end to this type of marketing of junk food to children.
Specifically, these state-funded activists want to see...

The Advertising Standards Authority should extend its remit to include in-store positioning of products and all point-of-sale marketing.

We call on the government to make removing unhealthy products from checkouts an integral part of its Responsibility Deal. 
It would be interesting to see what the ASA has to say about this. If the "positioning" of products is classed as advertising, it will give the government the power to dictate the layout of all shops—for the sake of the chiiildren, of course. And since the government has stupidly set the ball rolling by banning the advertising of so-called junk food to children, the only logical conclusion can be a ban on shops displaying sweets anywhere a child might see them—ie. everywhere—ultimately followed by plain packaging.

It is not the advertising of these products that the food faddists at Sustain find intolerable, but the products themselves. For them, a display ban at the point-of-sale would be step forward, but "the next logical step" would inevitably follow. And, in fairness to them, it is a perfectly logical and consistent progression now that the idiot politicians have decided that (a) children shouldn't see "unhealthy" food, and (b) it is appropriate for the state to intervene.

Let's get a few things straight before we continue down this slippery slope. Firstly, there is nothing—absolutely nothing—wrong with kids eating, letting alone seeing, sweets.

Secondly, there is no such thing as junk food. There may be junk diets, but food either has nutritional value or it does not. Sugar and salt are not only harmless, they are essential.

Thirdly, children generally don't buy their own food and if they have the sort of pathetic parents who buckle to "pester power", they are going to have bigger problems in life than being bought a bag of wine gums.

Fourthly, if you are the sort of parent who (as Sustain claim) finds the sight of sweets at the check-out annoying, may I suggest you fill in one of those comment forms the supermarkets so helpfully provide and do your shopping in a place that is more to your liking, preferably in a different hemisphere.

Fifthly, and most importantly, it is no business of the government how many sweets people eat or where a shopkeeper chooses to display them.

That is all.

Categories: Harm Reduction Feeds

Two debates

Thu, 03/05/2012 - 17:22
Liberal Democrat MP Stephen Williams has agreed to defend his government's plan to ban branded tobacco packaging at the Faculty of Arts, Bristol on May 10th (next Thursday). I'll be joined by Simon Clark (FOREST). I'm not sure who will be partnering Mr Williams. There is a Facebook page here if you're into that kind of thing, but you don't need to RSVP and tickets are free.

The following week, I'll be debating the War on Drugs with Peter Hitchens at the Institute of Economic Affairs, London. I think the War on Drugs is a Bad Thing. Peter doesn't think we've ever fought it in the first place. Should be fun. RSVP here.
Categories: Harm Reduction Feeds

Putting vegans in charge of the chicken coop

Tue, 01/05/2012 - 17:07
The news from Scotland is, as usual, not good...

Alcohol licences rejected after warning from NHS over health concerns 
A supermarket and two independent retailers have had their alcohol licence application rejected after objections from the local health board.
WHAT?!?

Sainsbury’s wanted to open a new store in the Cowgate, Edinburgh as part of the development of a site which was destroyed by a fire in 2002. NHS Lothian warned the Edinburgh Licensing Board that granting the licence went against the protection of public health.
Are you kidding me? What kind of moron would give bureaucrats from the NHS the power to reject planning applications?

The Scottish Government have recently given health boards the chance to object to new licences.
Oh, sweet devolution. This is local option for the twenty-first century—the preferred halfway house for would-be prohibitionists since time immemorial.

New guidelines were introduced in Edinburgh in February to prevent overprovision.
If only there was some other way to prevent over (or under) provision. If only we had some sort of mechanism whereby 'supply' fluctuated to meet 'demand'. In such a system, businesses would carry out research into whether there was sufficient demand for their services before investing and would go bust if their research was wrong. We could call this system a market.

NHS Lothian is not in the least bit interested in letting grown adults buy what they want, especially if those adults are working class. This is a case of middle class hypocrites clamping down on the plebs. You think I exaggerate? Read this...

Earlier this year, Tesco avoided a ban by arguing that residents of Roseburn are healthy and middle class. They were given the go-ahead for a new licensed shop after a lawyer argued the residents of upmarket Roseburn were “bottle of wine on the way home” drinkers.
Wow. Rarely is fear and loathing of the proletariat made more explicit than this.

To help crack down on lenient licensing, Police were also asked to supply the board with evidence which showed there had been 85 crimes within a 50m radius of the proposed store between last month and the previous March 2011.
Well, duh. It's a rundown area in need of regeneration, which would have been provided by building a supermarket, cleaning up the area and creating jobs. None of which will happen now because some unelected mandarins at the NHS find it morally objectionable that supermarkets sell alcohol.

A concerned resident in the Cowgate, Catriona Grant, submitted a public objection to the board.
Our "concerned resident" wouldn't be this Catriona Grant by any chance?

Catriona Mary Grant (born 1969) is a founder member and former co-chair of the Scottish Socialist Party and the party's equalities spokesperson.
Oh yes. That's her.




So let me get this straight. A perfectly respectable supermarket chain has been prevented from opening a new shop because a socialist "avenger" objects to the existence of supermarkets and a bunch of self-styled public health experts don't like working people buying alcohol. What other outcome can there be when you hand power over to this rabble of unelectable reactionaries?

Do hurry up with that referendum please Mr Salmond.
Categories: Harm Reduction Feeds

A slight difference of opinion

Tue, 01/05/2012 - 00:07
A radio debate on Voice of Russia between myself, Amanda Sandford (ASH), Amul Pandya (Hands Off Our Packs) and Mark Littlewood (Institute of Economic Affairs).

The interview was undeniably, though inadvertently, slanted towards the friends of liberty because the fifth guest—a Russian anti-smoking lobbyist—failed to make telephone contact. However, I doubt whether Sandford's feeble pro-plain arguments would have carried any weight had she had a dozen supporters behind the mic.


Categories: Harm Reduction Feeds

EU funding temperance groups. And the rest.

Mon, 30/04/2012 - 12:20
Last week saw a group called Active Sobriety Friendship Peace produce a press release calling on the European Commission to introduce a glut of temperance policies. They say that alcohol is a unique product, just like, er, tobacco and cite research from the neo-prohibitionist Institute of Alcohol Studies and Alcohol Concern. But while those two groups insist that they are not temperance societies, Active is not so shy...

Active- sobriety, friendship and peace is a non-governmental organisation gathering European youth temperance organisations working for a democratic diverse and peaceful world free from alcohol and other drugs where an individual can live up to her full potential. Active has more than 25 000 members in 26 European countries.
Who, I wonder, might be funding these politically correct, adolescent teetotallers as they lobby the European Commission to eradicate booze? Step forward, the European Commission and its €50,000 grant (click to enlarge)...




It's good to know that although the EU is nearly bankrupt, it can still find money to fund its pet lobbyists. Click here to see a small selection of the - ahem - "non-governmental" activist groups the EU is spending taxpayers' money on it, including the International Union of Socialist Youth, the Federation of Young European Greens, the International Falcon Movement-Socialist Educational International and the Young European Federalists (the latter has an online petition you can sign to demand a Federal Europe).

It comes to over €3 million. Money well spent for a thriving democracy, n'est pas?


Categories: Harm Reduction Feeds

Great logic

Fri, 27/04/2012 - 14:28
A couple of academics have thrown their lot in with the plain packaging campaigners, claiming that it would be a "costless experiment that provides valuable information on the effectiveness of plain packaging at almost zero public cost". On the subject of counterfeiting, they come up with this gem:

Likewise, the concern that there will be a substantial increase in unbranded or counterfeit cigarette supply is unfounded. What is more likely is that the introduction of plain packaging will make cigarette production far cheaper, therefore making the illegal market less profitable, and less cost effective.
It is surely undeniable that banning all branding will lead to a "substantial increase" in the supply of unbranded cigarettes. That is kind of the point, no?

As for counterfeiting, I'll have a glass of whatever these guys have been drinking. Let me get this straight - plain packaging will make cigarette production "far cheaper", but only for those who produce cigarettes in the legal market? For counterfeiters, however, the efficiency savings of only having to produce one pack design instead of 200 will miraculously not apply. Furthermore, these counter-feiters will be driven out of business because Big Tobacco will be so much more cost effective. I see...

Of course, the only way the legal market could beat the illicit market would be by driving down prices, since low prices are the USP of counterfeit goods, but this apparently will not happen in practice because the government will yet again put up taxes.

'The claim from the tobacco industry that plain packaging will potentially reduce cigarette prices, is likely to be correct,' says Professor Clarke. 'But this price decline can be readily offset by increases in the tobacco excise.'
In summary, then, plain packaging will make it cheaper and easier to manufacture cigarette packs, but not if you're a counterfeiter. The government will then increase cigarette prices which - despite the fact that the illicit trade exists solely because of artifically high prices in the first place - will mysteriously make illicit cigarettes less appealing and less profitable.

Anti-smoking economics - like normal economics but in reverse.
Categories: Harm Reduction Feeds

Tobacco company buys e-cig company

Thu, 26/04/2012 - 01:22
Lorillard, the American cigarette manufacturer, has bought the e-cigarette company Blu Ecigs for $135 million.

From their press release...
blu ecigs is extremely proud and excited to announce today our acquisition by one of the largest and oldest companies in America, Lorillard, Inc. Lorillard, through its Lorillard Tobacco Company subsidiary, is the third-largest manufacturer of cigarettes in the U.S and has a long and proud tradition that will compliment the passion of blu ecigs in the emerging electronic cigarette category.

“This is a very exciting move for me and my team. I am particularly excited about what this means for the brand and our customers. It gives us access to the tremendously experienced team and resources at Lorillard and will allow us to move to the next level on our expansion and product development."
Lorillard is best known as the US's biggest manufacturer of menthol cigarettes which the FDA has been attempting - but failing - to prohibit. In recent years, RJ Reynolds has bought the snus company Conwood (2006) and the NRT company Niconovum (2009). British American Tobacco has since set up a company which will sell a yet-to-be-announced reduced harm nicotine product (Nicoventures, 2011). This all suggests that Big Tabs hopes to shift the market towards low risk substitutes.

The Lorillard buy-out is good news, especially if they pump serious money into developing better products. I've said before that e-cigarettes can replicate the sensation of smoking very well but there's room for improvement when it comes to taste (at least to these lips, many thousands of people disagree). I fully expect e-cigarettes to come on leaps and bounds in the next few years unless they are suppressed by the prohibitionists.

Speaking of the devil, as I do, the down-side of this acquisition is that it will enable the pro-death wing of the anti-smoking movement to portray those of us who favour a market-driven shift towards low/zero-risk nicotine products as being stooges of Big Baccy. But since they do that already and always will, it's probably best to ignore their squealing and get on with doing what they have never done, ie. providing realistic alternatives for people who like nicotine but who want to quit smoking, while leaving the rest of us alone.
Categories: Harm Reduction Feeds

Does tobacco control actually 'work'?

Tue, 24/04/2012 - 12:20
I've got an article up at Spiked today asking whether the current anti-smoking orthodoxy, which I describe as neo-prohibitionist, is successful at actually getting people to stop smoking and improving health.

One obvious question is never asked - does this strategy of hyper-regulation and ‘denormalisation’ actually work? By one measure, the answer is a resounding ‘yes’. In 2006, the anti-smoking movement created a ‘Tobacco Control Scorecard’, a hit parade which Britain and Ireland have consistently topped thanks to uncompromising smoking bans, sky-high tobacco taxes and retail-display bans. Plain packaging should help the UK maintain the top spot next time the list is compiled.

 Trebles all round, then? Not quite. After declining steadily for years, Britain’s smoking rate has been flatlining since 2007, while Ireland’s eye-wateringly high cigarette prices have made the Emerald Isle the capital of black-market tobacco in Western Europe. If stigmatising smokers and annoying the tobacco industry is the aim of tobacco control, our two countries reign supreme, but if the goal is to improve public health we should take a lesson from the country that comes a mediocre ninth on the scorecard: Sweden.
Please do read the whole thing. There are also some very fine articles from Rob Lyons (on Jamie Oliver) and Patrick Basham (on plain packaging).
Categories: Harm Reduction Feeds

Comment from Clive Bates

Mon, 23/04/2012 - 15:31
A comment from former ASH director Clive Bates in a recent post deserves wider attention so I reproduce it here in full. Please click on the links.

I write as former director of ASH (the one based in London: I was director from 1997-2003. I am now no longer involved in public health and these are my personal views.

The public health community does know about smokeless tobacco and harm reduction, or it should know as it is their responsibility to understand what they are doing. There is plenty of evidence and sources available to those prepared to approach the issue with an open mind. In fact a debate has raged on this subject for some time and continues to this day - with many protagonists on both sides. The denial of evidence, warped logic, weird ethics and rejection of common sense has been extraordinary to behold. My concern now is that the EU is considering a new tobacco directive to replace the one that bans oral tobacco in the EU outside Sweden. Despite the reality that illiberal, self-defeating measure is deeply harming to health and civil liberties, as far as I can see no-one is lifting a finger to do anything about it. There is now the opportunity of the new directive to replace the ban with a regulated market in reduced-risk smokeless tobacco. 

Just so you can see that the public health community has never been united in its view on this, here are a few posts from me on smokeless tobacco and harm reduction:

Killing by the million: and that's just the health campaigners "If there is a reason to be a Euro-sceptic, then this is one of the strongest – deliberate denial of access to products that are much lower risk to people that are addicted to nicotine."

Saying stupid things with fake sophistication - a critique of ASH Scotland's position statement on smokeless tobacco: "jaw-dropping in its idiocy".

Mass killing machine making lots of money "One danger is that fussy, insular and instinctively authoritarian public health people will continue down the evidence-free path of blocking these developments and insist that for smokers it has to be ‘quit or die’. On the other hand, and more positively, tobacco companies may see smokeless products as a way of doing business with less death and disease and persuade regulators that they needs some regulatory tweaks to make it work – for example it is still impossible to tell smokers the truth about relative risks, and much public effort go in to obscuring it."

Useless scientific advice from the EU including a submission to the committee evaluating smokeless tobacco, and a more complete critique of what they were doing and how they were going about their work. 

The European Commission continues to rely on the work of this committee to justify its stance in favour of banning lower risk products, yet the terms of reference, the assessment and its interpretation were all thoroughly flawed and easily discredited.
Categories: Harm Reduction Feeds

Astro-turf group breaking the law in Liverpool?

Sun, 22/04/2012 - 16:07
An amusing headline from the Liverpool Daily Post...

Merseyside anti-smoking campaign criticised for giving away cigarettes
Considering how keen the anti-smoking movement is to keep people smoking and help the illicit trade, it was only a matter of time before they cut out the middle-man and started pushing cigarettes on people directly. In this instance, they were sending packs of fags out to politicians and journalists, apparently in the belief that they don't know what cigarette packs look like.

A Merseyside taxpayer-funded charity is promoting an anti-smoking campaign – by giving away free cigarettes.
This is a rare example of the media telling readers that plain packaging campaigners are, almost to a man, funded by the government. This is certainly outrageous, but for the Liverpool Daily Post, the outrage comes from what they have been spending their money on.

Tobacco Free Futures sent out the packs as part of its campaign about how packaging is alluring to children and can lead them to become hooked on smoking. The charity said it had only sent packs out to a small number of people in the media in the North West to try to highlight the dangers of smoking [how does that work then? - CJS] to “people with influence, including MPs”.

But the move has been slammed by leading city politicians, who are demanding answers of the city’s Primary Care Trust – and Westminster – as to why public money was being put into the pockets of big tobacco firms.
Since more than 80% of the cost of a pack of cigarettes is tax, this is more a case of taking from one pocket to put into another than it is of enriching Big Tobacco.

Why public money is going into the pockets of lobbyists in the first place would be a more pertinent question. As the article points out, this wing of the Department of Health has form when it comes to campaigning on the taxpayer's shilling.

The Liverpool PCT has been at the forefront of anti-smoking campaigning, even calling for films which featured smoking to be given an 18 certificate in local cinemas.
That much we knew. You may recall the astro-truf group D-MYST is based on Merseyside.

But there is a much bigger problem with all this that the article fails to mention. It is, I am quite sure, against the law to give unsolicited cigarettes to people. This means that Tobacco Free Futures are not just being profligate with your money, they are also engaged in a criminal activity.

Perhaps the Liverpool constabulary should be notified?
Categories: Harm Reduction Feeds

Snus: More prohibition?

Sat, 21/04/2012 - 13:31
It seems that the EU’s grudging toleration of Swedish snus use may be coming to an end. On Thursday, the Scandinavian press were reporting that the European Commission has announced its intention to ban a range of flavourings from tobacco products, such as sugar, licorice and menthol, which are needed to make most varieties of snus palatable.

Patrik Hildingsson, Communications Director at Swedish Match, the nation’s largest snus manufacturer, says the ban would “affect our entire portfolio, a number of flavours that have been available for more than 200 years”.

It is a sign of snus’s popularity that the possibility of a de facto ban led to a resurgence in Swedish Euroscepticis, with the hashtag #snusriot trending on Twitter and one tweeter writing: “I'm not a snus user, but the day the EU dictates what we Swedes put under our lips is the day I stand up to protest.” The Commission says that its ban on flavourings is aimed primarily at cigarettes, but it has not ruled out applying it to all tobacco products.

If so, the EU may have a fight on its hands, as Swedish MEP Christofer Fjellner told the Swedish newspaper Aftonbladet. “I expect that we, the Swedish representatives, will vote out the proposal – and that the Swedish Government will vote against the EU Council of Ministers.”

The Swedish government has long complained that the EU ban on snus lacks scientific foundation and should be overturned. Sweden now enjoys the lowest smoking rate and the lowest lung cancer rate in the whole of Europe, a fact that has not gone unnoticed by public health experts in Britain, including the Royal College of Physicians and the former director of Action on Smoking and Health, Clive Bates, who have questioned the wisdom of banning the least hazardous form of tobacco while cigarettes remain freely available.

The box below illustrates the 'Swedish Experience' nicely...



It had been hoped that the new Tobacco Product Directive, due to appear in 2013, would see the EU repeal the ban on snus, thereby allowing other countries to benefit from Sweden’s natural experiment in harm reduction. As Swedes prepare for a ‘snus riot’, it seems that the Commission is moving in the opposite direction.

Today, there are similar noises coming from Norway, which has seen benefits from snus use although these have been hampered by widespread ignorance amongst doctors and smokers about the health risks of snus (of which there are very few).

Norway May Ban Swedish Snuff in Five Years
National Council for tobacco prevention advocates a total ban on the increasingly popular form of tobacco, Snus (Swedish Snuff).

According to TV2's report, "National Council for Tobacco Prevention expects the number of diseases that are related to snuff will continue to increase", writes the Council in a report to Ministry of Health and Care.

The council advised that sales of snuss should be prohibited after 2017, just as it is now banned in all EU countries except Sweden.
This is all excellent news for cigarette companies, for whom flavoured cigarettes are a negligible segment of the market and whose business is threatened by people turning to the vastly less hazardous alternative of snus.

When anti-smoking groups start helping the cigarette industry, it might be time to stop and rethink the strategy.

Categories: Harm Reduction Feeds

Snus: they knew all along (part 2)

Wed, 18/04/2012 - 12:13
While doing some research recently, I came across a letter in a library archive written by Dr Richard Peto to Dr. B. MacGibbon. Peto was, and is, a highly respected epidemiologist who worked closely with Richard Doll on smoking and health.

The letter is dated 28th June 1984. Two months earlier, the Daily Mail had run a story about Skoal Bandits, an American form of snus made by US Tobacco Inc. who were due to build a factory in Scotland. Shortly thereafter, ASH's director David Simpson started a moral panic about this smokeless tobacco product which ultimately resulted in the EU ban on oral tobacco (1992). See Chapter 4 of The Art of Suppression for the full story.

I do not know who Dr. B. MacGibbon was or why Peto was writing to him, but Peto begins by recommending that some research into the saliva concentrations of snus users be conducted "fairly urgently". He continues...

I have given some further thought to the question of how many cancer deaths would be likely to be caused each year if one-third of the British population were to become habitual tobacco suckers.
Then, basing his figures on data from the US and UK...

This suggests that if about a quarter of the British population took to dipping 100 gms of tobacco a week, then in the long run “only” some 500-1000 excess deaths/year would result (see Appendix [which is a couple of studies, including the influential study by Deborah Winn looking at women in North Carolina - CJS]).

Maybe Skoal Bandits would be worse than SE US snuff, or maybe (especially if you take the advice in the first part of this letter! [ie. to carry out research "fairly urgently" - CJS]) they would be less hazardous. In any case, no matter what epidemiological studies you mount, you probably won’t get even a preliminary answer this century, so as a practical basis for action I suggest you assume that the adoption of Skoal Bandit-like products by a quarter or a half of the British population will cause about 1000 cancer deaths a year. In contrast, tobacco smoking currently causes about 100,000 British deaths a year!

This may be wrong – they could be carcinogenic, and the Asian experience with oral cancer suggests that they could be a lot more carcinogenic than I’ve estimated, but in any case you have most of what you need for political action, viz:

  • The risks are not zero
  • The risks can probably be reduced by immediately commissionable laboratory research;
  • The risks are much, much less than those of cigarette use.

The final thing you need is to know whether they will help avoid tobacco. No proof is possible, but it is noteworthy that among women in North Carolina, where both products have been widely available for decades,

  • The proportion of smokers among snuff-dippers is only one-third as great as that among non-dippers, and
  • Even among those dippers who smoke, mean cigarette consumption Is significantly lower than among non-dippers who smoke.

I suspect that, no matter what the risks might be, Skoal Bandits and allied products would be allowed to be sold [alas, this prediction was wrong - CJS]. Fortunately, however, the above arithmetic suggests that this may well do more good than harm. In any case, one should try to avoid producing a situation where the warnings or statements about Skoal Bandits etc. are so strong as to divert attention from the much more serious hazards of tobacco smoking.
He concludes by saying:
"The real message is that there is a hazard, but that it’s much less than that of smoking, and that a widespread shift to such products could probably save a lot of lives."
As I mentioned recently, Peto was not alone in seeing the harm reduction potential of snus. In 1985, the addiction expert M.A.H. Russell published a letter in the Lancet, estimating that 49,000 premature deaths would be prevented by a switch from cigarettes to Skoal Bandits. Unfortunately, and not for the last time, the voices of scientists were drowned out by those of activists who were itching for prohibition.
Categories: Harm Reduction Feeds

Temperance 2.0

Tue, 17/04/2012 - 14:20
There's another very good article at Points (the blog of the Alcohol and Drugs History Society) by Henry Yeomans, who wrote a wonderful article about the moral panic of binge-drinking a few years ago (referenced in this blog post).

Yeomans looks at the growth of "total consumption theory" which says that "the distinction of “responsible” and “irresponsible” drinking is fatuous, as the reduction of all forms of drinking is linked to decreases in harm".

It is true that there is often a correlation between high per capita alcohol consumption and high rates of alcohol-related harm, which leads some to call for supply-side measures that affect the whole population. This happens to be what the temperance movement has always believed and I entirely agree with Yeomans that we are seeing a return of traditional temperance, albeit not gospel temperance but medical temperance.

Although the current Government’s rhetoric is consistent with consequentialism, the growth of TCT and the imminence of minimum pricing suggest we are seeing a reversion back to the older, temperance-inspired faith in the inherently problematic nature of alcohol. Nowadays, this position tends to be justified in reference to medical, epidemiological, and demographic data, yet there is clear congruity with older discursive forces.

This can be seen in the general problematisation of all forms of drinking, which was initially advanced by Victorian temperance groups, as well as the historical lineage of certain groups. The Alcohol Health Alliance (AHA) has been the primary agency involved in the campaign for minimum pricing and it includes prohibitionist groups, such as the International Order of Good Templars and the Institute of Alcohol Studies, as well as medical organisations. The British temperance movement continues, therefore, to have some influence over the way in which alcohol is understood and regulated in England and Wales.
There is an obvious problem with total consumption theory in that alcoholics/problem drinkers/binge-drinkers consume a disproportionate amount of alcohol. A nation with a lot of "irresponsible" drinkers is likely to have a high per capita rate, but it does not follow that measures which reduce consumption amongst the moderate majority will reduce harm. On the contrary, policies which treat everybody as if they were at equal risk (as implied by the silly claim that there is "no safe alcohol limit") do not only punish the majority for the 'sins' of the minority, but they fail to give adequate support to those who are genuinely at risk.

Part of the problem, in my view, is that the neo-temperance movement bases now its strategy on the anti-smoking movement (the Alcohol Health Alliance appeared soon after the SmokeFree Coalition successfully lobbied for the smoking ban and blatantly emulates it), but while the anti-tobacconists can justifiably view any reduction in consumption and/or prevalence as progress, the situation with alcohol is more complex. However, complexity, moderation and harm reduction do not sit easily with moral entrepreneurship and so they are being jettisoned in favour of an approach that views alcohol as basically evil. I predict that the drinking guidelines will be reduced to zero in the next decade to 'send out a clear message'.

The temperance movement will, however, face the old problem that their policies are not very popular.

Naturally it is politically preferable for the Coalition to garner mass support for their policies, yet the political advantages may be eroded in the long term if apparently responsible drinkers find they have to either drink less or pay more. If the ‘responsible drinkers’ of Britain do indeed unite behind minimum pricing, they may soon find that they have more to lose than the social problems associated with binge drinking.
Do go read the whole thing.


UPDATE

I'm grateful to Yeomans for pointing me to this article from 2009 in which Andrew Lansley, like Gordon Brown, rejected minimum pricing, then being demanded by Liam Donaldson.

The shadow health secretary, Andrew Lansley, said: "Sir Liam Donaldson's report is a frank admission that the government's alcohol strategy has failed. The government's response to his report is another example of Labour's confusion and incoherence.

"If there was an ounce of leadership from Labour ministers on this issue there would be no need for Liam Donaldson to try his shock tactics to kick-start government policy."

He also made it clear that the Tories had no intention of putting the chief medical officer's proposal into practice.

He added: "There is clearly a need for action. But it is very important to recognise that to deal with this problem we need to deal with people's attitudes and not just the supply and price of alcohol.

"Our proposals, which include measures to tackle loss-leader promotions and higher taxes on high-alcohol drinks aimed at young people, would address this without penalising the majority of moderate drinkers. This would seem to be a much better route to go down than distorting the whole drinks market."
Categories: Harm Reduction Feeds

Dr Aseem Malhotra doesn't know what he's talking about

Sun, 15/04/2012 - 16:37
An article has appeared in the Observer under the byline of Aseem Malhotra. He is a medic and, not coincidentally, has a God complex and a shaky grasp on facts and figures. Like Liam Donaldson and many others before him, he seems to have tired of healing the sick and wishes instead to indulge his political ambitions without all the bother of having to get elected.

Malhotra has written several articles about so-called junk food, on the last occasion asking "For Big Tobacco, should we now read Big Food?" He appears to believe the absurd prediction that 90% of the population will be overweight or obese by 2050 (despite rates having been flat or declining for ten years), and has swallowed the idea that heart attacks fall dramatically after smoking bans are introduced (they don't). Today's article is headlined...

We must demonise junk food for the sake of our children
Calling for demonisation is not likely to get a warm reception round these parts, especially if the rationale boils down to 'think of the children'. Still, let's give him a chance.

A consultant psychiatrist friend, on his recent appointment to a new job, was so disgusted by the detrimental effect of the unchecked consumption of junk food on his patients' health that he successfully banned vending machines selling chocolates, fizzy drinks and crisps from the hospital grounds.
All in a day's work for your average medical busy-body, interfering in matters beyond their expertise (the guy is a psychiatrist, remember).

He wondered whether I – as a clinician – believed the consequences of eating junk food were as bad for our health as smoking cigarettes. "No, not as bad," I replied, "in many ways it's far worse!"
Oh, to be a fly on the wall when these two intellectual titans conversed. It must have been like a Pete and Dud sketch. ("You think hamburgers are worse than fags, Pete?" "Oh yes, Dud, I reckon they're far worse. Gotta be, haven't they?") If you're going to make a statement as stupid as that - dangerously stupid, in fact - you'd better have some pretty impressive evidence to back it up.

It is estimated that diet-related diseases are responsible for 35 million deaths worldwide, dwarfing smoking-related ones of 5 to 8 million.
Nice statistic. Shame it's rubbish. As the briefest Googling would have told him, 35 million is the total number of deaths caused by "obesity, cardiovascular diseases (CVD), cancer, and diabetes" worldwide, representing 60% of all deaths every year globally. In other words, he has combined the total number of deaths attributable to the diseases of old age and defined them as 'diet-related'. It is true that they can be diet related - just as they can be related to a number of other factors - but that hardly justifies presenting the bald statistic as if all these deaths could all be prevented by modifying diet, let alone drawing the conclusion that 'junk food' is more dangerous than smoking. Doing so suggests either appalling ignorance or a degree of mendacity.

As BenSix says..
CiF commentators passing off misunderstandings and received wisdom as fact is hardly new. Yet when a practicing doctor can make – unless I’ve made a ridiculous error – such a ridiculous error it drives home how lax the standards of epistemic rigour can be in today’s society.
Indeed. It is the old problem of the media assuming that someone knows what they're talking about just because they work in the medical industry. 
So what is the biggest culprit of the obesity epidemic and how do we combat it? According to Professor Robert Lustig, a child obesity expert at the University of San Francisco, it's sugar (including sweeteners) and processed carbohydrate.
If you ever find yourself reading an article in which Robert Lustig is cited as an authority, a good rule of thumb is to put it down and do something more productive with your time. This is not the first time Malhotra has cited Dr Lustig in an article and we have encountered him before. He is an anti-sugar crank and borderline conspiracy theorist who indulges in some of the strangest beliefs in the Bay Area - no mean achievement. He think that sugar-sweetened beverages have created "the biggest public health crisis in the history of the world" and seems to believe that bee stings are a sign from God that we shouldn't eat honey.

He describes sugar as being addictive and toxic...
Indeed he does. Because he doesn't understand what either of those words mean.

...and has called for a ban on the sale of sugary drinks to under-17s and a consumer tax on any substance with added sugar. This would be a good start.
And a start is all it would be, I'm sure. Presumably to be followed by minimum pricing of food and a display ban for sweets. The former was reported earlier today. The latter is hinted at here...

It horrifies me to see well-known high street brands getting away with the display of chocolates, crisps and fizzy drinks in prominent positions. It's perverse that institutions that represent health and wellbeing and treat the consequences of poor diet allow the sale of such products.
And it is perverse that newspapers which represent knowledge and information should pay people to misinform their readers, but that's life.

You will often hear two defences from big food corporations. The first: it's your choice what you eat
It is. It is the most basic of all freedoms.

...and the second: you need to exercise more.
If you're fat, you do.

In response to the second point, a study by Professor Boyd Swinburn, presented at the European Congress on Obesity in 2009, concluded that excess food intake explains weight gain.
Where would we be without professors, eh?

And so he goes on, mainly giving us a list of what he thinks should be compulsory or illegal. The only silver lining being the Guardian's choice of photo for this story, which suggests a certain mischievousness on the part of a sub-editor while illustrating the cognitive dissonance that surrounds the junk food scare.

Don't eat 'junk food' or you could end up as fat as these poor sods
Categories: Harm Reduction Feeds

Minimum pricing for food

Sun, 15/04/2012 - 01:55
Alone of all news networks, the BBC has chosen to turn a press release from the public health establishment into its top news story.



Nothing in this article is new or surprising. It is just another example of the anti-tobacco blueprint being extended to other areas of public life.

Just as it shouldn't be surprising to hear that the Department of Health is looking at plain packaging for alcohol (despite having not officially made its mind up about plain packaging of tobacco), it shouldn't be a shock to find that 'public health professionals' are excited by the idea of minimum pricing for food (despite the DoH having not yet officially made its mind up about minimum pricing for alcohol). That's right - minimum pricing for food...

The first phase of the campaign will try to find out what works. It will review evidence for diets, exercise, taxation, minimum pricing, changing advertising and food labelling, which medical procedures work and how children are educated.
How blatant do these people need to be for you to see that this is not just about tobacco? It's not even just about alcohol. Plain packaging for wine? Minimum pricing for burgers? This is not some libertarian paranoia about the slippery slope. This is actually happening. It is going on before your very eyes.

I don't want to say I told you so, but...
Categories: Harm Reduction Feeds

The binge-drinkers of Maidstone

Fri, 13/04/2012 - 00:33
From Kent Online:

Volunteers try to stop pre-loading

by Andy Gray
Poor old Andy. How the mighty have fallen.

Clubbers and pub goers could be breathalysed as they venture out in Maidstone in an attempt to measure levels of drunkenness.
Woah there! Nanny ruddy state or what?

But fear not. This is merely research...

Urban Blue Bus volunteers will carry hand-held intoximeters to determine the volume of so-called 'pre-fuelled' drinkers who load up with alcohol BEFORE a night out in town.

A recent study by Maidstone Town Centre Management indicated many revellers are well above the drink-drive limit before they even set foot in a pub.
And what, pray, is wrong with being over the drink-drive limit when you set off on foot?

At some point in the last decade, the drink-drive limit - which is quite deliberately set at a very low point indeed - became some sort of measure of drunkenness. We now regularly read about people being arrested for non-driving-related crimes, or - heaven forfend - autopsies of unfortunates, with the statement that they were three or four times over the drink-drive limit. But the whole point of the drink-drive limit is that it is set at a point at which the person is not drunk. Referring to it in multiples - as if it is a unit of drunkenness - doesn't tell us very much except that the person might have been drunk. When it comes to "revellers" on a Saturday night, it is self-evident that they will be over the drink-drive limit, but since they're not driving, so what?

Paul Alcock, manager of The Mall Chequers, said: "The plan is to find out how much people are pre-fuelling.

"The results will be used to warn of the dangers of drinking at home before going out."
The Mall Chequers is a shopping centre in Maidstone as far as I can work out, so what they have to do with people strolling around over the drink-drive limit, God only knows.

According to latest figures from the Local Alcohol Profiles for England, 17% of those aged 16 and over in Maidstone engage in binge drinking - this equates to roughly 21,000 people.
Andy Gray doesn't explain what period of time this refers to, but unless it is "every day", I would argue that it is very far from being an epidemic, or even a slight cause for concern. In fact, and assuming it refers to every week or every month, it is a frankly derisory rate of drunken levity which only confirms my view that people today do not drink very much most of the time and that this is a particular boring, conservative time to be alive, although I accept that this might not be anything new in Maidstone.

Mr Alcock said the intoximeter scheme, a joint initiative between Town Centre Management supported by police, will be up and running in the next four weeks.

The hand-held devices could be used to carry out 200 tests a night on some of the estimated 20,000 weekend visitors to Maidstone's 50 licensed pubs and clubs.
I hope and expect that the revellers of Kent will tell these police-funded "volunteers" exactly where to go when they wave the breathalyser- sorry, 'intoximeter' - in their face. Alcohol is alcohol whether it is drunk at home or drunk in one of Maidstone's no doubt salubrious licensed premises. There is nothing new or interesting about "pre-loading". I can say with certainty that it happened on an epic scale twenty years ago and I'm pretty confident that it went on twenty years before that.

"Post-loading" also occurs on a regular basis and, although you don't hear so much about that phenomenon, that is where the fun really begins. At both the pre- and post-loading stage, the alcohol is cheaper, there are no smoking restrictions and the company is better. The fights, property destruction and public disorder all happen at the mid-way stage, which is the bit the hospitality industry wish to portray as the safe and well-regulated part of the night. It's not and never has been. The pub and club industry's cynical attempt to cosy up to the temperance movement by pretending to be custodians of "sensible drinking" is the sheerest artifice. They whinge about people "pre-loading" on "cheap" supermarket booze, but their furrows of concern are not so deep that they will not cheerfully serve those same "binge-drinkers" when they stagger into town.

I did, however, enjoy the end of the article, which shows that common sense has not entirely departed these isles.

One of the group, Cllr Dave Naghi, was shocked to see drinkers relieving themselves at the side of the road.

"It was disgusting," he said.
'Twas always thus, but Cllr Naghi, bless him, is not your average 'ban it, tax it' local politician.

"We're going to get some toilets back in the High Street."
Thank you, Cllr Naghi. Sensible policies for a happier Britain.
Categories: Harm Reduction Feeds

Snus: they knew all along

Thu, 12/04/2012 - 00:28
Brad Rodu reports on a study recently published in Nicotine & Tobacco Research which shows that Norwegians who believe snus to be dangerous tend not to use it to give up smoking. Nothing surprising about that, of course. What is worrying is that 35% of those surveyed believed that using snus was as dangerous - or more dangerous - than smoking (in fact, it is over 95% safer). This is a troubling statistic, though perhaps unsurprising since many Norwegian doctors remain ignorant of the gulf in potential harm between cigarettes and snus.

The study, by Dr Karl Lund, also found that 32% of ex-smokers used snus to quit, whereas only 14% used pharmaceutical nicotine medication. From this, we can draw the conclusion that if smokers were not ignorant about snus's risk profile, many more Norwegians would be ex-smokers.

Still, at least the people of Norway - having wisely chosen to remain outside the EU - are able to buy snus if they want to. The same cannot be said of we Brits who helped to introduce the EU ban in the first place (see The Art of Suppression. You've read it by now, right?)

The harm reduction potential of snus in tobacco control can seem like a relatively new discovery. It is easy to believe that a clueless anti-smoking movement stamped the product out without realising the possibilities it had for smoking cessation. It was, after all, not until 2004 that Brad Rodu and Philip Cole published the study showing that 200,000 premature deaths could be prevented by adopting a Swedish culture of snus use.

This is not quite true. As early as 1985, the addiction expert M.A.H.Russell had tested snus (Skoal Bandits in fact) and wrote to The Lancet saying:

Our results suggest that this new product could help people trying to give up smoking. It might be cheaper than nicotine chewing gum and would not require a prescription. If all smokers in Britain switched to sachets about 50,000 premature deaths per year might eventually be saved at an annual cost of less than 1,000 deaths from mouth cancer.
This was at a time when snus was believed to cause mouth cancer, a belief that has been known to be false for over a decade. Nevertheless, Russell based his figures on the core principle of harm reduction and understood that 50,000 minus 1,000 still left 49,000, and that this was better than the prohibitionist, quit-or-die fairytales that were dominant in the tobacco control movement even then.

History will not look favourably on the dangerous idiots who banned snus in the EU - especially those who still support the prohibition now that the facts are clear. There were rational voices thirty years ago which went unheeded.

One of Russell's co-authors for the Lancet letter was Martin Jarvis. Today, Jarvis is a trustee of ASH. ASH is truculent, devious and unreliable on almost every matter on which they claim to have expertise. None of their pronouncements of the last fifteen years has not involved at least a half-lie, but their failure to speak out against the EU ban adds cowardice, hypocrisy and gross negligence to the charge sheet.
Categories: Harm Reduction Feeds

Osbourne's war on (real) charities

Wed, 11/04/2012 - 01:23
The government's latest attempt to make people of every political persuasion despise them is to dissuade the rich from giving to charity. The current situation, as the BBC describes it, is this...

When higher rate taxpayers donate money to charity, some of the tax can be reclaimed. Effectively they could pay no tax at all, if they choose to give away their income to charities.
This is a very good thing as it encourages charitable giving and the nebulous 'Big Society' that David Cameron claims to support.

But Mr Osborne announced in the Budget that from April 2013 the maximum amount that will be able to be reclaimed in tax relief - including on charitable giving - is £50,000 or 25% of the individual's income, whichever is the greater.
£50,000 is a pittance to some of these donors. You will probably recall that Warren Buffet and several other US billionaires gave away half their fortune to charity recently. Although Buffet has been known to complain that taxes are too low in America, it is notable that he chose not to give his money to the state, but to charities whom he thought - almost certainly correctly - would spend it more prudently.

One of the main reasons why Americans give much, much more to charity than any other country is that they enjoy tax benefits from doing so. But, as the Chief Executive of the Charities Aid Foundation points out, this is not a tax dodge. It is genuine philanthropy.

“This is not a ploy to save tax. Philanthropists who make large donations give away far, far more than they could ever claim in tax relief. That money goes to fund projects for the public good, such as medical research and help for the most vulnerable in society.
The killer line came from the "prime minister's spokesman" who delivered this doozy...

"In certain instances they may be giving to charities and those charities don't, in all cases, do a great deal of charitable work."
I certainly agree that there are plenty of charities who do not do a great deal of charitable work. Indeed, there are many charities that seem to do nothing but lobby for legislation, and, furthermore, these charities are funded by the government. That is an issue for the Charity Commission. If that Commission had not been snoozing under the stewardship of Suzi Leather for the last eight years, it might have encouraged some test cases against some of the many pressure groups masquerading as charities which have an undue influence on politics in contravention of charity law.

"We cannot be in a situation where very wealthy individuals are able to wipe out their bills by using these reliefs."
They're not profiting from it, asshole. Whomever they give their money to, donating funds to a third party is unambiguously an act of charity, whereas the state giving taxpayers' money to charity is an act of political patronage. These people are choosing to finance your precious Big Society rather than pay for the state's bureaucracy - a bureaucracy which gives £12 billion a year to charities in any case, including to such organisations as Action on Smoking and Health, the School Food Trust, the Equality Challenge Unit, Alcohol Concern and all the other fake charities that no one would donate to if they had a choice.

You want to remove tax status from organisations which do not do "a great deal of charitable work"? Fine. Start with the fake charity behemoth which Labour created and which you continue to feed. The third sector and the public sector are already inter-changeable much of the time. Let's deal with that rather than impoverishing real charities.
Categories: Harm Reduction Feeds

Sunset clause for minimum pricing?

Tue, 10/04/2012 - 12:48
From The Telegraph:

Drinks manufacturers plan to persuade the Government into agreeing a “sunset clause” on minimum unit pricing, which would force ministers to scrap the controversial alcohol policy if it was proven not to work.
Nice idea, but no dice. What could be more reasonable than assessing a law after a year or two to make sure it hasn't failed or back-fired? This is just the kind of thing that a government who claims to hate "unnecessary legislation" would support, notwithstanding that such a government wouldn't contemplate minimum pricing in the first place.

Strangely, we don't have much of a history of using sunset clauses in the UK, which is good news for our many anti-[fill in the blank] groups who might otherwise see their pet prohibitions put under scrutiny. Instead, they concentrate on the next ban and hope the public forgets the extravagant promises they made about the last ban.

I notice that no temperance groups are quoted in the Telegraph article. What can they say? If they support a sunset clause, the government might seriously consider it. If they oppose it, people might suspect that they have no faith in their ridiculous claims, eg. that a 40p minimum price will save 900 deaths a year.

There will be no sunset clause. There will only be calls for the minimum price to rise to 60p, 70p, 80p, and those demands will never end (see Scotland where a "leading public expert" reckons a 60p unit will save—guess what?—900 lives a year). The only hope is for the EU to rule it a breach of free trade. As with plain packaging, it will be for the courts to decide. Ain't it grand that the Conservative party—the party of the free market—are supporting policies which require arbitration from the European Union and the World Trade Organisation?
Categories: Harm Reduction Feeds