Christmas rant

Well, 2018 has been a tumultuous year by any standards. For the hospitality industry, I can’t remember a time when the threats and uncertainties were so formidable. As well as business rates, minimum wage hikes and a looming huge increase in fees from the PPL/PRS legalised protection racket, we have the huge uncertainties of Brexit and its impact on recruitment and staff shortages. Then there is the ever-present agitation from that other racket – so-called “public health”.

Regarding Brexit, I’m a libertarian by instinct as much as intellectual conviction but even I can see sometimes the sheep need a shepherd. If Mrs May’s deal falls, at the risk of being howled down by a demented mob shouting “it’s the will of the people”, I think Parliament needs to reassert its sovereignty and move an amendment to revoke Article 50. 

This Brexit madness has gone on far too long and it needs to stop. Indeed, if our elected representatives hadn’t abdicated responsibility and taken this decision themselves in the first place, we wouldn’t be in this position. Brexit on any analysis will have a hugely negative impact on the hospitality industry.

As far as copyright organisations are concerned, I’ve written about their antics before and I think it’s time the government reviewed intellectual property law and reconsidered at what point the repeated playing of a piece of music, with all the marketing benefits that has to the performer, publisher and record company, mean it is now in the public domain and the copyright owner can’t go on rent-seeking from it forever. 

Copyright organisations have gone beyond musical performances and we’ve now seen the development of the Motion Picture Licensing Company, which collects fees in relation to TV and movie broadcasts in licensed premises and hotels. The copyright racket is a classic Del Boy-type wheeze, using the law to exact a rent without adding economic value – it’s a case of rinse and repeat – the licensed trade is a big cake and everyone wants a slice.

 Where do I start with the public health racket? Its most emblematic policy, minimum unit pricing (MUP), came into force in Scotland in May and is already unravelling. Despite a 10% increase in alcohol prices across the board, we’ve seen a 15% increase in the value of alcohol sales in Scotland during the first six months of this policy. In volume terms, a 4% increase in the consumption of pure ethyl alcohol in the off-trade. Remember, MUP was meant to reduce consumption in its first year by 3.5% across the whole population and by 7% among problem drinkers?

Now the swivel-eyed temperance fanatics at Alcohol Focus Scotland and Sheffield Alcohol Research Group are saying while consumption may have gone up in Scotland it hasn’t risen as much as it has in England, where we don’t have MUP. So when they said consumption would go down, they really meant it would go up – just not as fast as elsewhere! 

You can almost hear the sound of goalposts being moved and ridiculous excuses being made – “the hot summer or the World Cup made Scots drink more”. Correct me if I’m wrong, but Scotland didn’t feature in the World Cup finals so are we supposed to believe Scots were knocking back more Buckfast while loudly proclaiming their support for the England team? Wouldn’t that be nice?!

I mustn’t leave out the sugar loons. The mass reformulation of our food supply at the behest of a public health lobby that sees business as vectors of disease and a conspiracy against the public goes on unchecked – and this under a Conservative government that is supposedly on the side of business.

With my attitude to Brexit I guess I must be an unrepentant member of the “liberal elite” stuck in my ways and in denial of populist democracy but, finally, here’s one that really got me ranting. David Runciman, professor of politics at Cambridge University, has complained the UK’s ageing population is creating a democratic deficit for the young. Is he advocating votes for 16-year-olds? Nope, that’s not radical enough. He wants voting rights for six-year-olds – “provided they can read”. I’m not making this up but if MPs continue to behave like six-year-olds, he may have a point. Merry Christmas!

LESS IS SOMETIMES MORE

It has been said that the first duty of a chancellor when delivering a budget is to contrive not to make things worse. It appears that on that measure at least Phillip Hammond has succeeded. So, for our sector we have seen a freeze on the duty levied on beer, cider and spirits, although the duty levied on wine will rise in line with RPI. My guess is the chancellor thought that wouldn’t upset the trade too much as most wine sold in this country is produced abroad, but it is a blow for British wine producers who’ve seen a bumper harvest this year due to the warm weather. Meanwhile, bowing to popular prejudice we will see a new duty band on ciders with an ABV of 6.9% to 7.5% from February 2019. This is designed to tackle the infamous strong white ciders frequently, though by no means exclusively, drunk by chaotic street drinkers. Given that these products have a market share of 0.27% it is hard to see this as anything more than political virtue signalling.

Predictably, health groups are unhappy at the duty freezes. They’ve been campaigning relentlessly for the return of the alcohol duty escalator and bemoaning the revenue ‘lost’ due to its abolition and previous duty freezes. Professor Sir Ian Gilmore, chairman of the Alcohol Health Alliance, described the duty freeze as “a missed opportunity” to use a duty increase to fund alcohol services. By his reckoning, duty freezes have cost the Treasury £4 billion in the last five years and will cost it a further £5 billion by 2023.

But is this calculation of lost revenue correct? It’s based on the assumption that increases in the duty rate will always lead to an increase in the duty take. The same assumption is often made about tax rates in general. And yet when the higher rate of income tax rate was reduced from 50% to 45% the tax-take from it rose from 25% of government tax revenue to 28%. This is an example of ‘Laffer’s Curve’. Art Laffer is the American economist who first observed that if a tax rose beyond a certain point it delivered diminishing returns. The art of setting tax and duty rates, from the government’s perspective, must be to maximise revenue without damaging the incentives to work or invest. Over-burdensome duty rates do both and have the effect of reducing demand for products and reducing the number of jobs the sector can sustain.

So, have previous duty freezes and the abolition of the duty escalator led to the loss of revenue that Gilmore cites? The fact is that in every year since the hated duty escalator was abolished alcohol duty has delivered more revenue to the Treasury, not less. Between 2013-14 and 2017-18 the revenue from alcohol duty rose from £10 billion to £11.5 billion – an increase of 15%. Health campaigners make the simple mistake of assuming the volume of alcohol sold would remain unchanged even if prices rose because of increases in duty and that’s where their calculation of lost revenue comes from. This is curious, not least because when they argue for minimum unit pricing they assume the opposite – that consumption will reduce significantly in response to raising prices.

In the run-up to the budget health campaigners argued that the pub trade hadn’t benefitted from the abolition of the duty escalator. They sought to drive a wedge between publicans and brewers. It is obvious that duty increases are not the only factor putting upwards pressure on the cost of running a pub, but they are a major factor. Between 2008 and 2013 – the duty escalator years – beer prices to the on-trade rose by 21%. Between 2013 to 2018 - in the five years since the duty escalator was scrapped – beer prices rose just over 11% (Source: HMRC). So, beer price rises to the on-trade have nearly halved since the duty escalator was abolished.

This benefits pubs and consumers and will help safeguard 3,000 jobs that would otherwise have been lost (Source: BBPA).

The announcement of rate relief for the next two years is also welcome, although not a substitute of the root-and-branch reform of business rates that is needed. Given the uncertainty around the outcome of the Brexit negotiations, this is probably as much as the chancellor could promise. So, if not three cheers for ‘Spreadsheet Phil’, we can perhaps offer one and a half cheers!

Supping with the devil

It’s an established dogma of the so-called public health movement that partnering with the alcohol industry to reduce harms is tantamount to supping with the devil. It’s not that they think you should use a long spoon, you shouldn’t even be at the meal. 

It was entirely predictable that when Public Health England (PHE) announced a partnership with Drinkaware to jointly campaign for “drink-free days” to reduce heavy drinking and promote moderate consumption, the usual anti-alcohol groups shrieked in horror.

This alarmist concern resulted in a letter sent to PHE by the Alcohol Health Alliance (AHA) signed by 50 anti-alcohol pressure groups and individuals. The concern arises from the fact Drinkaware is funded by the alcohol industry and therefore, in the view of the AHA, tainted by Big Alcohol. I defy anyone viewing the Drinkaware website to conclude it is an industry shill. The level of paranoia by these single-issue pressure groups verges on the pathological – “don’t fraternise with the enemy” is their credo!

Their view is that partnership working with the alcohol industry leads to the dilution of policies that really work and to the substitution of ineffective policies – such as education. So even though the PHE “low risk” drinking guidelines promote drinking no more than 14 units of alcohol a week interspersed by one or two alcohol-free days, and all these groups are signed up to that advice, if the alcohol industry supports it in conjunction with PHE it is tantamount to heresy. So much so professor Sir Ian Gilmore, chairman of the AHA and a key advisor to PHE, threatened to resign his post in protest. If you point a gun to your head and say: “Do as I say or I’ll shoot” you run the risk your bluff will be called, and it was. Professor Gilmore has resigned!

It seems to me if the AHA and its membership want to separate itself from the industry that produces the products they profess to be experts on, they will isolate themselves in an academic ivory tower and their policy prescriptions will lack any relevance to the real world in which they are enacted. This bone-headed, know-nothing approach does have one advantage, however, it enables them to make things up in their heads and ensure their own ideological purity by burying themselves deeply in the temperance rabbit hole. This immunises them from any kind of reasoned compromise with an industry they despise as comprised of capitalist bad guys engaged in a conspiracy against public health.

And, of course, the policies they describe as “best buys” for reducing alcohol-related harm are whole-population policies designed to reduce overall consumption through minimum unit pricing, tax rises and bans on advertising and promotions.

Contrast this with the pragmatic approach taken at Walsall NHS Trust. It recognised a disproportionate amount of time and NHS resources were being spent on a small number of “frequent flyers” – people with alcohol problems who turned up at A&E for treatment multiple times. They identified a cohort of just ten patients who were admitted 499 times between them in six months. On average, each patient was admitted twice a week.

Walsall NHS Trust identified 38 frequent flyers whose needs were complex and varied – alcoholism, mental health, family breakdown – and by taking a joined-up approach it was able to achieve a 54% drop in alcohol-related A&E admissions and a 68% reduction in bed days. Overall the trust saved more than £250,000.

Daniel Hodgkiss, patient safety manager at Walsall NHS Trust, said: “We identified a small number of hospital patients with complex needs that were discharged only to return multiple times, which accounted for a very disproportionate number of admissions.

“This was due to a lack of cohesion between social care, mental health services, police and a range of other services. By bringing these agencies together to co-ordinate patient care, we were able to substantially reduce admissions.”

This is the kind of pragmatic approach to alcohol-harm reduction we need to see. An approach that recognises the locus of alcohol-related harms lies with a minority of drinkers, the heaviest drinking 4%, who are people with complex needs and for whom drinking is a symptom as much as a cause of their problems. Why aren’t the AHA, Alcohol Concern and Alcohol Focus Scotland championing this approach instead of throwing their dummies out of the pram because PHE has, for once, adopted a sensible, partnership approach with the industry?

The big alcohol conspiracy theory

If I could affect one reform to our education system, it would be economics should become a mandatory subject in the National Curriculum. Two reasons – economics is by its very nature a libertarian subject, and, secondly, it would save me lots of time untangling misunderstandings that would never occur in the first place if people who ought to know better had replaced their ignorance of economics with some basic knowledge of it.

A recent study from the University of Sheffield alcohol research team and the Institute of Alcohol Studies is a case in point. This study purported to show the alcohol industry was economically dependent on heavy, harmful, dependent drinking. The study claims the heaviest drinking 4% of the population is responsible for 30% of all consumption and 23% of all industry revenue. The numbers break down as follows – those drinking above guideline levels are estimated to account for 68% of total alcohol sales revenue in 2013/14; 81% of off‐trade revenue and 60% of on‐trade revenue. This represents 77% of beer, 70% of cider, 66% of wine and 50% of spirits sales value.

If all consumers reduced their consumption to within guideline levels – 14 units a week – alcohol sales revenue would plummet from £35bn a year (2014 figures) to £22bn – a decline of 38%. To mitigate this loss, the authors say the alcohol industry would need to raise prices substantially, for example by £2.64 for a pint of on-trade beer or £12.25 for a 70cl bottle of off-trade spirits.

The sub-text of this is the industry’s claim to be in favour of moderate consumption is insincere because it’s so highly dependent on excessive consumption. The purpose of this study is to demonstrate if consumers drank “moderately”, defined as no more than 14 units a week, they would be faced with unrealistically high prices if the industry was to maintain its profits at the current level. So, the researchers calculate how much the industry would lose from people drinking less and then work out how much prices would need to rise for profits not to fall.

Here’s where their basic ignorance of economics kicks-in. They don’t look at profits or even at turnover. Instead they assume consumer spending equals industry income and then slice off 38% because this is what they estimate sales would fall by if everyone suddenly drank no more than 14 units a week. The howler that’s being committed here is £35bn is not the industry’s money. More than £10bn of it goes to the Treasury in alcohol duty and other taxes, and billions more go to off-sales retailers and to pubs, clubs and restaurants. And what is left, about £10bn, is not all profit. Most industries make a net margin of between 7% and 10% and so the loss to the alcohol industry’s profits would be only a fraction of what these researchers claim. And this is before we calculate the cost savings to the alcohol industry that would result from producing less product.

So does the alcohol industry stand to lose if heavy drinkers all became moderate drinkers? Insofar as heavy drinking is associated with early death, and moderate drinking with extended longevity, the answer is no. If people drinking 50 units or more a week (harmful drinkers) all became light drinkers consuming 14 units a week they would all live longer. The alcohol industry would get the same revenue from them but over a longer period. Since it is unlikely this state of affairs would happen overnight – that any move towards drinking less, but drinking higher quality products would be an evolution – it’s clear the alcohol industry has no conceivable economic interest in the premature death of its customers.

There is therefore no conflict of interest between the industry’s support for moderate consumption and industry profits. Indeed, brand owners do not want their brand values undermined by irresponsible use of their products.

A total of 21% of UK adults are teetotal while a further 58% drink at or below the low risk guideline of 14 units a week. That’s 79% of people who are at no risk, or next to no risk, from alcohol. The remaining 21% drink at or above 14 units, but only 4% above 50 units a week. The alcohol industry cannot possibly determine the distribution of its products between different consumer demographics – that is a consequence of millions of buying decisions made by consumers on a daily basis. What is equally clear is the industry has nothing to fear from its customers drinking moderately and living longer. Only temperance lobby researchers without even a basic understanding of economics seek to define the alcohol industry as a conspiracy against the public interest.

IF IT’S NOT IN THE MODEL – IT WON’T HAPPEN!

It has just been announced that the Welsh Assembly Bill to introduce minimum unit pricing (MUP) in Wales has been given Royal Assent. Predictably, the usual suspects – Alcohol Concern, Alcohol Focus Scotland and the Institute of Alcohol Studies are all crowing about this and calling for its immediate introduction in England. So, the Welsh Assembly government clearly aren’t interested in seeing how MUP works out in Scotland first – so much for “evidence-based policy”.

But there never was any real-world evidence for MUP, its supporters rely entirely on the discredited speculative numerology of the Sheffield Alcohol Pricing Model (SAPM). This purports to show how a minimum unit price at different levels will reduce consumption, and the benefits in terms of reduced alcohol-related harms of all kinds will cascade down in a sort of hierarchy.

But there were two things that SAPM neglected to model and that economists have identified as likely unintended consequences of this kind of government price intervention. One is market displacement; the other product substitution. Let me explain: market displacement is what happens when consumers wake up one morning and find a popular product has suddenly rocketed in price and they can no longer afford it. Consumers vote with their feet and seek a similar product in the black market.

This happened in Russia in 2010 when the government imposed a minimum price of 220 roubles for a half litre bottle of vodka. Consumption was displaced into the black market where people bought cheap and dangerous moonshine. In response, the Russian Government was forced to reduce the minimum price to 185 roubles in 2012 – approximately the price it was sold at before the government intervened. Consumer responses to government regulation completely neutered the minimum price policy. Will consumers do this in Scotland and Wales? Too early to tell, but anecdotally we know that Tesco’s car park in Carlisle is full of cars and vans with Scottish number plates! Some of these will no doubt rock-up on council estates in Glasgow and flog cheap English booze to price-conscious Scots.

But what of product substitution? Remember all those stories about cheap white cider being sold to vulnerable street drinkers and alcoholics with chaotic lives? MUP will solve all that by pricing these products out of reach of the poor. So, in Scotland a 3 litre bottle of Frosty Jack’s white cider made from apple concentrate and with an ABV of 7.5% was selling for £4.25 before MUP. OMG! Pocket money prices; alcohol cheaper than water – something must be done. Well, now it has been. A 3 litre bottle of Frosty Jack’s in Scotland now costs £11.25 – thanks to MUP - and sales have fallen off a cliff. So, problem solved then? Not quite.

If you’re the kind of drinker who necks a 3 litre bottle of strong white cider in one session it’s safe to say you’re not a cider connoisseur. To be blunt, you do it to get off your head – blotto! These people haven’t gone away; they haven’t all signed the pledge. They still want to get blotto but their tipple of choice is now priced out of reach. So, might they seek a substitute product? What else can get you off your head for the night? Well, a gram of the synthetic cannabinoid known as ‘Spice’ sells for just £6. A bag of heroin off the streets of Glasgow can be bought for as little as £8. If you want to understand the effects of Spice on the homeless, visit Piccadilly Gardens in Manchester and see for yourself. And deaths from heroin and other opioids are now at a record high.

So, what happens next? Answers on a postcard please. I simply ask: in what rational universe would we contrive for a bag of heroin to be nearly 30% cheaper and a gram of spice 46% cheaper than a 3 litre bottle of cider? Victory for public health! Vindication of the policy of minimum unit pricing!

Ah, but you see, these things weren’t in the Sheffield model – so can’t possibly happen – it’s been peer-reviewed you know! And the academics are quietly confident this will all work. This is what can happen when politicians who don’t understand how markets work throw a price regulation into the middle of a free market, and it enters culture. The unintended consequences kick-in. This is what can happen when activist academics, living in ivory towers, persuade dumb politicians that if only they can control the price mechanism they’ll be able to socially engineer the sober society and we’ll all live happier, healthier lives. Meanwhile, back in the real world, I just don’t think it’s that simple.

HEALTH SCARE OR HEALTH RISK – IT’S ALL IN THE PRESENTATION

Scarcely a week goes by without a headline-grabbing story about risks to our health that are associated with the enjoyment of food and drink we all thought was perfectly safe. And tabloid editor’s love these stories because anything that feeds public alarm sells papers. Usually the stories are based on epidemiology, which studies the incidence of disease in populations and the risk factors that correlate with them.

An example is a World Health Organisation report that classified processed meat such as bacon and sausages as carcinogens because the cooking process causes the production of acrylamide, which in large doses has been shown to cause cancer in mice. The tabloid headlines included “A bacon sandwich a day causes cancer”; “A bacon sandwich a day ‘increases the risk of colorectal cancer by 16%’ - experts say.”

A survey showed that nearly 50% of people in all age groups were aware of this conclusion and around a third of people said they were trying to cut down on consumption. And this was reflected in sales figures. In the four weeks after the publication of the WHO’s report and the headlines accompanying it, sales of packs of bacon in the UK fell by 8.5%, and this appears to have been a stepped change that hasn’t reversed itself. So, were the headlines justified, and what sense should we make of this and similar stories?

One of the most erudite commentators on how supposed risks are communicated to the public is Sir David Spiegelhalter, Professor for the Public Understanding of Risk at the University of Cambridge. He’s written extensively on how to spot the difference between a health risk and a health scare. He suggests that to understand the true scale of a risk, put it into the context of how the supposed risky behaviour would impact on a hundred people.

The bacon sandwich scare is a case in point. Spiegelhalter says that if a hundred people never eat a bacon sandwich, or otherwise consume bacon, ever, then nevertheless, six of them will develop colorectal cancer at some point in their lives. In the alternative, if a hundred people eat a bacon sandwich every day of their adult lives then seven of them will develop colorectal cancer. So, consider the logistics here: a hundred people, each eating a bacon sandwich a day, 365 days a year for, say 50 years, equates to the consumption of 1,825,000 bacon sandwiches! And this is the level of consumption needed to for one extra person in this group of a hundred to develop colorectal cancer. This is a health scare, not a real-world health risk.

For the alcophobes’ of public health, the lesson of this scare and the impact it had on sales of bacon, has not been lost. They recognise that attaching the words ‘cancer risk’ to the consumption of alcohol is a powerful means of scaring people into believing that big risks are involved even in relation to moderate consumption. In relation to breast cancer, which is what drives public health claims that “there is no safe level of drinking”, the lifetime risk of a female ‘never drinker’ developing breast cancer is just under 10%. For women who regularly drink moderate amounts of alcohol it elevates to just over 11%.

In round figures, if a hundred women never drink alcohol in the entire lives, nevertheless 10 of them will develop breast cancer at some point. In the alternative, if a hundred women drink two glasses of wine a day, then 11 of them will develop breast cancer at some point.  So, consider the logistics: if a hundred women each drink two 125ml glasses of wine a day, totalling three units of alcohol, every day for 50 years then that is 5,475,000 units of alcohol – which equates 608,333 75cl bottles of wine with an ABV of 12%! And this is the level of consumption needed for one extra person in this group to develop breast cancer. This is a health scare, not a real-world health risk.

The other thing that temperance lobby alcophobes’ understand is that in the public imagination cancer is always fatal. But 90% of breast cancer is not fatal and meta-analysis shows no link between moderate consumption of alcohol and breast cancer mortality, nor its recurrence (Gou et al 2013). A large study which followed up women with breast cancer correlated with better chances of survival if they were regular drinkers before diagnosis.  If they altered their drinking after diagnosis this had no link to their chance of dying from breast cancer, but an increase in drinking was associated with an overall increase in life expectancy, largely due to substantially fewer heart disease deaths among those who increased their alcohol consumption (Newcomb et al 2013).

So, much more needs to be done to promote public understanding of risk, otherwise the food and drink industry will continue to be subject to misleading scare stories from lazy journalists who fail to challenge the sensationalist claims of nanny-state health scolds.

Will cannabis kite go up in smoke?

The issue of legalising cannabis has been in the news in recent weeks. It began with the heart-rending story of a small boy having up to 50 epileptic seizures a day and his mother’s wish for him to receive medicinal cannabis oil which relieved his symptoms. The Home Secretary obliged with a temporary licence but made it clear there were no intentions to legalise cannabis for recreational use.

The only mainstream political party in the UK that supports the creation of a legal, licensed market for recreational cannabis is the Liberal Democrats. However, pressure for change is increasing, with Canada and nine US states legalising cannabis for “medicinal purposes” or full legalisation. Can change in the UK be far behind?

What are the arguments? Research indicates about three million UK adults regularly smoke cannabis – 7% of the adult population. The reputation of cannabis as a “soft drug” has become tarnished in recent years because the nature of cannabis itself has changed. Let me explain. Cannabis contains two chemical compounds – tetrahydrocannabinol (THC) and cannabidiol (CBD) – and it’s the THC that gets you stoned! But THC can also cause mental health problems in a small but significant number of users – particularly people with a history of mental illness. High doses of THC can cause psychotic episodes and paranoia. CBD, on the other hand, acts as a natural anti-psychotic medication and mitigates the chances of the mental health problems that can arise from THC use.

“Traditional cannabis” contained a balanced mix of THC and CBD but in the first decade of this century it was pushed out of the black market by sinsemilla – “skunk” – which has a high level of THC and very little CBD. Mental health referrals began to climb. Between 2006 and 2014 it is estimated the use of skunk declined 25% but THC-induced mental health referrals rose 50%. Skunk is a product of cannabis prohibition because it can be grown indoors using hydroponic equipment and doesn’t need to be smuggled-in across borders.

Those advocating legalisation argue we’ve failed to suppress the mass market for cannabis and a licensed, legal market would be a better way of managing use and reducing harm. However, this is not a simple or one-sided argument. If legalisation is to deliver better outcomes and eliminate the black market for skunk, the government would have to get the licensing model right.

How might this work? First, government would have to mandate a maximum level of THC (say 15%) and a minimum level of CBD to create a safer product. But the new, legal, “safer” cannabis would also have to be cheaper than black market skunk. There’s plenty of margin to play with as a gram of skunk currently sells for about £10 so there is a margin for producers, retailers and government, which would introduce a cannabis duty and levy VAT. It would also be necessary to ensure the product was easily available at chemists, off-licences and a network of cannabis cafes.

But let’s take a step back. If we enable a new, fully legal industry of intoxication and make cannabis safer to use, cheaper to buy and even easier to get hold of, what would happen to the level of demand? Again, research indicates a 10% reduction in price would trigger a 7% increase in consumption – at a time when it is falling. But it would be increased consumption of a safer product. Police time would be saved and government would gain perhaps £1bn a year in tax revenues.

Here’s where it gets complicated. THC-induced mental health problems didn’t start with skunk – they just got worse. So if consumption of legal cannabis remained the same, the incidence of mental health referrals would fall. If consumption significantly increased, the incidence of mental health referrals would still fall but the absolute number might rise.

You can see why this is a difficult issue for politicians. On the face of it, if we accept we can’t suppress a mass market in an open society and a failed policy of prohibition just lines the pockets of criminals, licensing sales of a quality-controlled product where we can control strength and ingredients and deliver a revenue stream for government seems a win-win situation. But think how the Daily Mail would spin this. Who would grow and produce cannabis products? The tobacco industry is best placed to do so. And who would retail them – bar or coffee chains? You can imagine the narrative of those opposed to change – Big Tobacco and Big Alcohol are behind this.

My own view is that, on balance, a licensing system offers a better chance of public protection and harm reduction than the status quo. But politically, I just don’t think this kite will fly in the UK.

Moving the goalposts

I am always intrigued to hear “public health” labelling any research paid for by the alcohol industry as “tainted by commercial interests”. What kind of naivety is it that causes people to believe money is the only source of corruption? Do these people think there’s an endless supply of benevolent millionaires willing to fund research into issues they have no opinion on? The fact is, funding has to come from somewhere and research should be judged on its own merits, regardless of who funds it. 

So it is regrettable, in my opinion, that a large-scale research project in the US into the health outcomes of moderate drinking has been abandoned because Big Alcohol was jointly funding this research along with a large dollop of public money. And who was objecting? The usual suspects – so-called “public health” bodies and taxpayer-funded temperance charities whose ideological bias taints their thinking and just about every piece of research they’ve ever produced. Is it a coincidence the voluminous research funded by the Institute of Alcohol Studies, for example, has failed to produce a single piece of work, ever, with anything positive to say about beverage alcohol? Yet this organisation regularly receives money from the World Health Organisation and the UN to fund its “scientific research”.

What methods do the Big Public Health ideologues use to pursue their objectives and skew research and public debate? Moving the goalposts is the preferred method of choice and there are numerous examples. In June 1998, 25 million Americans suddenly became overweight. Previously the official threshold for being overweight was a body mass index (BMI) of 27. Your average American at this time had a BMI of 26. On 17 July 1998, the government lowered the BMI threshold to 25 and almost one in ten adults in the US became part of a new obesity “epidemic” overnight. Subsequent research has proved a BMI of 27 is optimal for health, while so-called overweight people, as opposed to obese people, actually live longer than those of a supposed healthy weight. 

Then there is the drive to reduce sugar consumption. It’s all about “saving the children”. Children are currently consuming twice their daily recommended limit of five grams of sugar. However, three years ago the guideline was halved from ten grams to five and all of a sudden this moving of the goalposts doubled the number of kids at risk! But at risk of what? Five grams of sugar is roughly 100 calories. The recommended guideline for calorie consumption for a growing 11-year-old is 2,000 calories a day. Does it really matter whether 100 or 200 of those calories come from sugar as opposed to some other source?

In 2014, new drug Selincro was approved in the UK for treatment of “mild alcoholism”, a previously unknown medical condition that used to be called “moderate drinking”. Subsequent research has proved this drug to have no medical efficacy whatsoever when compared with the results of blind trials involving placebos. 

In the examples I have given above, if you want to find a “baddie” look no further than the pharmaceutical industry, which vigorously promotes diet pills and treatments for newly invented illnesses.

My favourite, of course, has to be the scientifically unjustified lowering of the low-risk alcohol guidelines in January 2016. This created hundreds of thousands of hazardous drinkers overnight and provided new impetus for the temperance lobby and its sock-puppet charities such as Alcohol Concern and Alcohol Focus Scotland – just when alcohol consumption, binge-drinking and under-age drinking were all declining and the percentage of teetotallers was growing – particularly among the young.

Does money corrupt research and policy-making? Not nearly as much as ideological bias

THE HAMMERS ARE OUT

The 1^st May 2018 was an historic day, we’re told. This was the date that minimum unit pricing (MUP) of alcohol came into force in Scotland. The SNP government spent the day congratulating itself for ensuring that Scotland was the first country in the world to introduce MUP, despite having spent years telling us that Canada had already introduced it, and its success there was part of the “evidence base” used to justify its introduction in Scotland. The other part of the “evidence” was the speculative numerology provided by the now-infamous Sheffield University alcohol pricing model.

That numerology produced some very specific predictions about what MUP at 50p per unit would achieve in Scotland. In the first year alone, it is supposed to achieve the following results:

·        60 fewer alcohol-related deaths

·        1300 fewer alcohol-related hospital admissions

·        3500 fewer alcohol-related crimes

·        A reduction of 3.5% in alcohol consumption per head

·        A reduction of 7% per head for “harmful drinkers”

So, 354 days to go and counting…

How will the achievement of these outcomes be measured? NHS Scotland is charged with overseeing this evaluation, but the anti-alcohol zealots from Sheffield and Stirling Universities will conduct much of the research. The academic reputation of the Sheffield University group depends on the real-world outcomes of MUP in Scotland vindicating the years of research and lobbying effort they’ve put in to this. The alcohol research departments at these universities have been lobbying for MUP since 2009, so I expect this to be little more than an exercise in the kids marking their own homework.

And hard on the heels of MUP in Scotland comes the announcement that the UK government will produce a new alcohol strategy, and they have commissioned Public Health England (PHE) to evaluate minimum pricing. PHE is little more than a four billion pound a year lobbying group which, since its inception in 2013, has been campaigning for MUP. If Big Alcohol produced research casting doubt on MUP it would immediately be called-out as a conflict of interest. But Big Temperance? They just get away with it.

What is heart-warming to see are the beginnings of the Scottish consumers’ revolt over MUP. Twitter is awash with images of Scottish consumers visiting supermarkets in Carlisle and Berwick on Tweed to buy slabs of beer not subject to minimum pricing. And online sales despatched from England are booming too – Amazon is reportedly doing a roaring trade! These sales appear to be for personal consumption, but how long will it be before White Van Man realises there’s a tidy profit to be made from giving Scottish consumers what their own government denies them?

There are elements of the on-trade in Scotland who think that the health lobby must be thrown some red meat, and if MUP appeases them that’s a price worth paying. But bullies always come back for more. Already health campaigners are calling for a ban on off-licence sales after 8 p.m., separate aisles for alcohol sales in supermarkets, banning new pubs and bars from opening in “stress areas” and the introduction of a Social Responsibility Levy to fund alcohol services. This levy is a tax that would be paid by all sections of the trade, not just supermarkets. Please remember the end-game here, which is to de-normalise alcohol use, reduce sales and availability from all sections of the trade, and achieve prohibition by stealth. It is not about tipping people out of the living room and into the tap room; it is most emphatically not about “helping pubs”.

When you look at the escalation of demands from the health lobby in Scotland just in the past week since the introduction of MUP, it’s clear that whether it works or not is almost beside the point. Minimum pricing is the thin end of the wedge, and now the hammers are out.

THE DEAD LICENSEES’ FUND

I support the recent call from Tim Page, chief executive of CAMRA, for industry trade bodies to do more to combat the tide of anti-alcohol propaganda from so-called “public health”. This often takes the form of research undertaken or funded by anti-alcohol charities, but how are these charities themselves funded?

In England the two main neo-prohibitionist charities are Alcohol Research UK (ARUK) and Alcohol Concern (AC). These two announced a merger in December 2016, and the shiny, new organisation that will combine supposedly objective alcohol research from ARUK with the anti-alcohol campaigning of AC will launch later this year. So, why is this merger happening?

AC lost funding from the UK government after it withdrew from the government’s voluntary alcohol responsibility deal in 2012. Since then they’ve survived on handouts from the Welsh Assembly government and the National Lottery fund, plus some money from big pharmaceutical companies that produce “treatments” for alcoholism, like Selincro. This wasn’t enough to sustain them, so a merger with ARUK, which has very similar charitable aims, provided a solution.

So, how is ARUK funded? ARUK’s research is paid for by the money earned from an investment fund that is managed for them by an asset management company called Investec. The investment fund was established in 1981 through the Licensing (Alcohol Education and Research) Act, following the winding up of the ‘Licensing Compensation Scheme’. This Scheme was effectively a tax levied on licensed premises that was established under the 1904 Licensing Act to provide compensation for the owners of licensed premises that were closed through no fault of their own, but where it was deemed that the density of licensed premises in an area was too high.

The Scheme was not popular. Temperance campaigners at the time called it “the Licensees’ Benevolent Fund” but the trade dubbed it “the Licensees’ Burial Fund.” It didn’t take long for the Scheme to fall into abeyance, but it was not until the 1981 Act that half of the residual funds were transferred to establish the Alcohol Education and Research Council.  In 2011, the AERC was wound up and the investment fund was transferred to a new charity, Alcohol Research UK - ARUK.

On their website ARUK say they “will not accept funds, in cash or in kind, from the alcohol industry.” But: “Alcohol Research UK may accept donations from people who were formerly but are no longer employed in the industry and do not have a significant residual financial stake in it (e.g. through shareholdings).”

In practice this means ARUK won’t accept money from companies or people involved in the alcohol industry unless they’re dead! Living off a “Dead Licensees’ Fund” is leeching of the first order. Now they’re joining forces with the preachers of AC. This union of Leechy and Preachy is a marriage of financial convenience between the closet prohibitionists of ARUK and Poundland prohibitionists of AC and it may yet turn out to be an uneasy alliance. I think government should act to take back ARUK’s funding from the compensation scheme and give it to the Licensed Trade Charity, which helps people who have retired from the licensed trade and have personal or family problems.

And talking of preachiness provides an ideal segway to Alcohol Focus Scotland (AFS), Scotland’s alcohol charity. This organisation exemplifies the kind of batshit-mental extreme anti-alcohol zealotry that arises when campaigning and research are glued together by the swivel-eyed moral certainty of true believers.

Having championed minimum unit pricing in Scotland on the basis that it will be “good for pubs”, they are now calling for pubs to be closed, or not opened in the first place. AFS funded research, published this week, that made fatuous correlations between the density of licensed premises and crime rates. It found that in areas with the most pubs, clubs and off-licences crime rates were four times higher and alcohol hospitalisation rates and deaths twice as high as in areas with a low density of premises. It would probably turn out that there was a similar correlation between high crime rates and the density of street lighting, since the high density of anything except sheep is more likely in urban areas, but don’t let that stand in the way of a good headline!  “Alcohol availability boosts crime rate” said the BBC news website.

Pause, sigh, breathe: we’ve been here before – this is a variant on the “availability drives consumption” argument that is constantly pushed by AFS, AC and ARUK. As the IEA’s director of lifestyle economics, Chris Snowdon, put it: “Suppliers respond to demand. If the ‘public health’ lobby could get this simple fact into their skulls they would be halfway towards understanding how the world works, and three-quarters of the way towards understanding that commercial activity is not a conspiracy against the public.”  

And who funds AFS? Yes, it’s the SNP government – to the tune of £500,000 a year of Scottish taxpayers’ money. These faux charities can’t get sufficient voluntary donations, so whether its live taxpayers or dead ones, we don’t really get a choice, do we? 

PURITANISM IS A VIRUS – AND IT’S SPREADING!

With minimum unit pricing (MUP) set to be introduced in Scotland in May, the puritans of the health lobby have been emboldened to push this policy out to the rest of the UK. The Welsh Assembly has been debating this issue in recent months and commissioned the Sheffield Alcohol Research Group (SARG) to produce a Welsh version of their model that depicts the effects of MUP at different price levels on consumption, harms and how many lives can be “saved” if MUP is introduced. The SARG research predict 66 lives will be saved a year in Wales if a 50p minimum price is introduced. This assumes that people will respond to the imposition of higher prices in ways that seem implausible to many. One of the persistent criticisms of the SARG model are the assumptions it makes about ‘price elasticities of demand’ – assumptions about how much people will reduce their consumption in response to an increase in price. There are approximately 1,500 alcohol-related deaths a year in Wales so it seems unlikely that it will be possible to measure whether this claim of 66 lives saved annually is fulfilled or not. The media has feigned shock at the claim that 75% of alcohol consumed in Wales is drunk by 22% of the population, who are defined as hazardous or harmful drinkers. And within that number are 3% who are the very heavy drinkers - accounting for 27% of alcohol consumed.  Why this should surprise anyone is beyond me – “Shock, horror – most alcohol is drunk by people who drink the most” is a “dog bites postman moment” and a statement of the blindingly obvious. Let’s put these figures into perspective. About 20% of Welsh adults don’t drink at all. 58% drink at or below the government’s low-risk guideline of 14 units a week (less than a pint of beer a day). So, that’s 78% at no risk or virtually no risk. Only 22% consume more than 14 units a week including 3% “harmful drinkers” – defined as drinking 50+ units a week for men, and 35+ units a week for women. Only in the oddball world of the activist academics of SARG is a person drinking a couple of pints a day classified as a “hazardous drinker”. The focus of harm-prevention really ought to be on the 3% of harmful drinkers, yet the Welsh Government has accepted that minimum pricing won’t help these drinkers, who most likely have an alcohol dependency. MUP is a policy which the Institute for Fiscal Studies has said will raise the price of 70% of off-trade sales. So MUP isn’t targeted at people at greatest risk, but at those who, by the standards recognised by most people, are light to moderate drinkers. MUP isn’t about targeting those most at risk, it’s about denormalising the use of alcohol and pricing it out of reach. The minimum price will only ever go up. Those reading this who are thinking: “Good, about time we bashed Tesco” need to realise three things: Firstly, that denormalising the use of alcohol will affect all sections of the trade. Secondly, making alcohol more expensive in the off-trade may reduce consumption a bit, but it will also reduce consumers’ discretionary spend overall and that is likely to mean less money to spend on going out. The notion that MUP will tip people out of the living room and into the tap room is a health lobby lie. Thirdly, now that the genie of minimum pricing is out of the bottle, how long will it be before government regulators – national or local - apply a higher MUP to the on-trade?

Talking of which: the government in the Isle of Man is now considering introducing MUP. Chief Constable Gary Roberts appeared at the opening of the triennial licensing courts, which sees licensees applying to renew their alcohol permits. Addressing the court, Mr Roberts said a new substance misuse strategy from the government looks likely to introduce a minimum price per unit for alcohol.

He told the licensing bench such a move would “save lives and help the on-licence trade regain its vibrancy.”

The same lies are being perpetrated by health lobby puritans wherever this “silver bullet” policy is proposed. It is always presented as a pub-friendly proposition, when in reality it is the thin end of the wedge. If even a rinky-dink assembly like the Tynwald can introduce this for the off-trade, what odds would you take for it being introduced by the UK Parliament for England – and then spreading to the on-trade, because a city council like Newcastle decides it’s needed to curtail binge drinking in the night-time economy.

For those who think I’m scare-mongering, I have three words: the smoking ban.

BIG TEMPERANCE VS BIG ALCOHOL

The recent announcement of a partnership between Dutch brewing giant Heineken and the Global Fund to Fight AIDS, Tuberculosis and Malaria has drawn a scream of protest from the alcophobe fanatics of Big Temperance. Heineken has agreed to aid the Global Fund by providing its experts on supply chain logistics, to better deliver medicines and health care products to people living in African countries to help the fight against these three major killer diseases.

This has prompted an Open Letter to the Global Fund from IOGT International and over 70 other alcohol health charities and NGOs, calling for the Fund to immediately end its partnership with Big Alcohol. IOGT International is the International Order of Good Templars by another name – an anti-alcohol group with its roots in the nineteenth century temperance movement. IOGT is also a dominant presence in the UK’s Alcohol Health Alliance and had members on the Public Health England committee that fiddled the revised low-risk alcohol drinking guidelines. These are the people leading the fight against Big Alcohol in Africa.

The crux of their argument is that alcohol (not just alcohol abuse) is a major cause of ill-health and that drinking it makes people disinhibited and therefore more likely to have unprotected sex, leading to more HIV/AIDS infections, so a big conflict of interest, they claim, between the Global Fund and Heineken. But this argument is a mere smokescreen for people who think it more important to stop the spread of alcohol use than the spread of AIDS, TB and malaria.

The Global Fund gets 95 per cent of its revenue from governments – taxpayers - around the world. Only 5 per cent comes from private donations, including companies. They administer a $4 billion annual budget. Any sensible person would welcome the help of a wealthy global brewer. To be sure, this is not entirely an act of selfless philanthropy, Heineken want to sell their products in Africa and to present themselves to African governments’ as good corporate citizens. But there is a powerful reason, from a health perspective, why Heineken and other global drinks’ producers should be encouraged to make their products more widely available in African countries, and at a price local people can afford. That reason can be summed up in one word: moonshine.

Anyone who knows anything about alcohol abuse in Africa will tell you that the problem is not the legal market for well-known brands, which many Africans can’t afford anyway, but the illegal market for moonshine. Every year, countless numbers of Africans risk their health and their lives drinking illegal alcohol. The illicit brewing market in Africa is worth an estimated $3.5bn a year. With names like “Kill me quick”, “The dog that bites” and “Goodbye Mum”, African moonshine has a frightening reputation.

Over the years, thousands of Africans have been killed, blinded or rendered sterile by drinking these lethal concoctions. In one of the worst recorded cases, 128 Kenyans died and a further 400 were harmed after drinking a particularly poisonous batch of illicit booze.

In Libya, where alcohol has been banned since early in Gaddafi’s rule, a bottle of Chivas Regal can cost more than $100, so Libyans drink a local concoction called “bokha”. There was recently a major health crisis related to poisoned bokha. Someone had added methanol to a batch and some 1,500 patients flooded into Tripoli’s hospitals within a few days.

The World Health Organisation says that about half of all the alcohol drunk in sub-Saharan Africa is produced illegally, with 85% of consumption in Kenya and 90% in Tanzania coming from the illicit market.

Barley, the essential ingredient in beer, is still not grown in many parts of Africa. High taxes and poor supply chains have also pushed up the price of legitimate goods. Toxic homebrew plugs the gap in the market. Africa's booming cottage industry is made up of clandestine breweries, where maize and sorghum is fermented, using water that itself is often filthy. The alcohol content is bolstered, using anything from embalming fluid to stolen jet fuel. The resulting grog may sell for as little as 20 US cents a glass. But for the poorest Africans, living on a couple of dollars a day, it is often the only way of blotting out their troubles.

This is the folly of trying to ban legal means of accessing properly produced, quality-controlled beverage alcohol products. All that happens is that the demand is met by illicit supply of poisonous concoctions that can kill or blind people on the spot.

And yet IOGT and its virtue-signalling fellow-travellers are worried about Africans knocking-back a pint of Heineken’s lager!

DRINKING BY NUMBERS

As the ‘public health’ hysteria over alcohol and the clamour for minimum pricing in England continues, it’s useful to get an overview of the issues by looking at some straight statistics. I increasingly think that the Office for National Statistics (ONS) is an oasis of calm objectivity in a sea of opinionated, emotionalised subjectivity emanating from alcophobic activists. So, I’ve been looking at stats published in 2017 by NHS England which are based mainly on ONS data and some from Public Health England.

What do these numbers tell us about alcohol use and abuse and its consequences? First, the much-vexed question of alcohol-related hospital admissions: there were 339 thousand such admissions in England, representing just 2.1% of all hospital admissions - which has changed little in the last 10 years. This statistic is a measure of the number of hospital admissions where an alcohol-related disease, injury or condition was the primary reason for the admission, or where it was a secondary diagnosis related to an external cause, e.g., an alcohol-fuelled fight. This is known as the “narrow measure” of alcohol-related hospital admissions; it is a record of “admission episodes” – not people admitted, which is a much lower figure.

The so-called “broad measure” records 1.1 million admissions, but includes primary diagnoses plus admissions where an alcohol-related condition was a secondary diagnosis, i.e., not the reason for the admission. The important distinction between the two measures is that the narrow measure is a count of actual admissions to hospital for an alcohol-related cause, whereas the broad measure includes that count, but provides further information about alcohol-related conditions that a patient may have had in addition to the reason for their admission. This provides an indication of the health burden that alcohol misuse has across the whole population. Newspaper headlines often confuse the two to create alarmist headlines.

So, 2.1% of hospital admissions caused by alcohol misuse isn’t a crisis, it isn’t growing like topsy, and it won’t bankrupt the NHS.

In 2015 there were 6,813 deaths that were related to the consumption of alcohol, 65% of which were for alcoholic liver disease (4,428). Alcoholic liver disease sufferers drink at the very top end of the harmful drinkers’ spectrum. Harmful drinkers are classified as men drinking over 50 units a week, or women drinking over 35 units a week. Most of those dying from alcoholic liver disease drink around 200 units of alcohol a week or more – the equivalent of a bottle of scotch a day. Every one of these deaths is an avoidable tragedy, but just over 25 million adults in England drink alcohol at least once a week, so harmful drinking and deaths from it arise from the product being abused by a very small minority.

The number of adults in England who report drinking alcohol in the previous week has fallen from 64% in 2006 to 57% in 2016 – a fall of nearly 11%. The UK ranks 19^th out of 31 countries in terms of annual alcohol consumption per head at just over 9 litres. 

THE ARCHITECTURE OF CHOICE

Old ideas are sometimes relaunched by employing a new language to disguise or mystify what they’re about. And so it is with puritanism. There’s no doubt that we’re seeing a resurgence of puritanism in a variety of disguised forms. The essence of puritanism is that pleasure is bad for you. Since many of our pleasures involve consuming things, this translates into consumption is bad for you. The locus of puritanical concern has, of course, been alcohol, and latterly processed foods with a high content of salt and sugar. And sugary drinks have also featured recently, with the introduction of a sugar tax looming many producers are reformulating their products – Irn Bru and Ribena seem to be getting a lot of attention on Twitter!

So, what’s behind this? What the New Puritans of Public Health want is to alter “the architecture of choice”, to nudge or coerce consumers into making ‘healthy choices’. The argument goes like this: people make free choices about whether to buy products in a market place, but are these choices really free? If products like alcohol, fizzy drinks and highly processed foods are everywhere available, then people are exercising their freedom to choose in an ‘intoxogenic’ and ‘obesogenic’ environment. In other words, free choice is exercised within a deterministic framework which the person making the choice cannot influence. And anyway, the argument goes, cunning marketing and advertising makes people buy things they don’t need by persuading them to want them!

I sometimes think that public health puritans live in a parallel universe. What they term the intoxogenic and obesogenic environment is merely the retail distribution system by another name. And since all of us are born into a society that existed before we did, and will exist after we’re gone, all choice is exercised within a deterministic framework.

So, how do public health puritans plan to alter the architecture of choice? Taking alcohol as an example, their measures include raising alcohol duty by more than inflation every year and introducing minimum unit pricing (MUP) – these are measures which reduce affordability, or “economic availability” as they often call it. In addition, they propose changes to the way in which the retail distribution system handles the product. This has been tried elsewhere, for example, in Australia you can’t buy alcohol from supermarkets, only from separate liquor stores. The same applies in Canada where most liquor stores are owned and operated by the government. Effectively the off-trade is a nationalised industry. In Scotland, where MUP will be introduced on the 1^st May, there are demands being made to have separate alcohol aisles and checkouts for alcohol in supermarkets.

All these attempts at reconstructing the architecture of choice either make people poorer by raising prices, or they make shopping a more inconvenient and miserable experience. The likely effect will be to drive such sales online. So, changing the architecture of choice really means taking choice away or making it more expensive and more inconvenient. All in the name of healthy choices.

At some point I think there will be a consumer rebellion against this. The Institute for Fiscal Studies estimates that MUP at 50p in Scotland will have a dramatic impact on prices. Some cider products will rise in price by as much as 90% and 70% of the alcohol units bought in the off-trade will see prices rise.

Will these price rises tip people out of the living room and into the tap room? The Scottish Licensed Trade Association certainly think so. They’ve been campaigning for government price intervention in the off-trade since the abolition of resale price maintenance in 1964. But it is simplistic to think that the price of alcohol is the only, or even the main thing that determines peoples’ decisions about whether to stay in or go out, and that the supermarket is the enemy of the on-trade. This is just crude Tesco-bashing and it ignores the fact that society has changed beyond recognition from the mid-1960s. Satellite TV, Netflix, computer games, the huge development of fast-food home delivery – all these things have transformed the home into a place to escape to, not from. It’s easy to get caught up in fighting yesterday’s battles whilst turning a blind eye to the complexities of the modern world.

I am aware of the problem of pre-loading, but I think this is more a product of later closing than cheap supermarket booze. And there is a new enemy on the horizon – one that threatens both sides of the trade: a puritanical public health lobby that is happy to drive a wedge between the on-trade and the off-trade. We can speculate whether MUP will or will not shift drinking back towards the pub and the bar, but we will know for certain whether this is the case in Scotland within the next 12 months.

STRAIGHT STATISTICS MATTER

In my last article I launched the CPL Nanny State Annual Awards for Fake News and Phoney Statistics. Several people contacted me and asked was this tongue-in-cheek, and did misleading statistics really matter, given the environment in which we live where information on social media sites like Twitter have a shelf-life attuned to the concentration span of a mouse. The answer is that whilst our awards night will be light-hearted and enjoyable, the impact of fake news and phoney statistics can be very serious indeed.

As an example, take the now-infamous quote from Professor Dame Sally Davies, England’s Chief Medical Officer of Health: “There is no safe level of alcohol consumption.” And to illustrate the point she asks women to consider: “Do I want that glass of wine or do I want to raise my own risk of breast cancer?” Notwithstanding the fact that she meant to say: “Do I want that glass of wine or do I want to avoid raising my risk of breast cancer?” it is the alarmist and misleading nature of the warning that is so damaging.

I am very sensitive to the emotional nature of anything connected with cancer, because it touches the lives of almost every family in the country, including my own. But let me explain why Professor Davies’ quotes are so misleading and why they raise women drinkers’ concerns unjustifiably.

Firstly, the implication is that one glass of wine a day will raise a female drinkers risk of breast cancer, and to most people that means raising their risk of dying from it because in the popular imagination cancer = death. The good news is that If you are a middle-aged woman you have just a 0.3% chance of contracting and then dying from breast cancer over the next decade. And this chance is the same whether you drink alcohol or not. There is slightly more chance that as a light-to-moderate drinker your eventual and inevitable death will be from breast cancer, but only because light-to-moderate drinkers are much less likely to die prematurely from heart disease, and you must die from something, eventually.

An analysis of various causes of death of middle-aged and elderly Americans (Thun et al 1997) found that, of the 251,420 women in the study, 0.3% of the non-drinkers and very light drinkers died from breast cancer, over the 10 years of the study’s duration. And the same percentage applied to the moderate to heavy drinkers. These were women drinking 1 to 4 standard drinks a day. In America a ‘standard drink’ is about 14 grams of undiluted alcohol, so approximately 1.4 units. So, a woman drinking 1 to 4 standard drinks is drinking between 1.4 to 5.6 units of alcohol a day and has the same chance of contracting and dying from breast cancer as that of a non-drinker.

In a smaller mortality study (35,000 women, Fuchs et al 1995) the chance of death from breast cancer during the 12-year follow-up period was 0.4%, and this was identical for non-to-light drinkers and moderate-to-heavy drinkers. And again, crucially, there was a much higher chance of death from cardiovascular disease among the non-drinkers.

Reading all this confused me somewhat. I was sure that there were numerous population studies that showed drinkers had a one percentile higher chance of getting breast cancer (from just under 10% lifetime risk to just over 10%), and there are, but these are studies of “incidence” (how many women are diagnosed) not studies of mortality (how many women die). So, women who drink alcohol have a slightly higher chance of being diagnosed with breast cancer, but if they are, they have slightly less chance of dying from it. That didn’t seem to make sense. So, I did a bit more research. It turns out that around 90% of women who are diagnosed with breast cancer don’t die from it, partly because medical science cures many of them, but also because many of the diagnoses are incorrect. Research also shows that women who drink alcohol are more likely to screen more for breast cancer than non-drinkers (Mu and Mukamal 2016), so you would expect them to be disproportionately represented in the diagnostic figures arising from screening activity. So, the link between drinking and the incidence of breast cancer is a statistical correlation, not a causal link – it is, in fact a self-fulfilling prophecy.

So, here’s what Professor Dame Sally Davies should have said: “When asking ‘do I want that glass of wine, or should I not drink at all’, women should balance a slightly elevated risk of getting breast cancer, which may be explained by the fact that drinkers are more likely to screen for it, with the actual elevated risk of cardiovascular disease associated with not drinking at all.”

This is why straight statistics matter.