Chasing unicorns

While training as a young economist, I had to grapple with such concepts as Gross Domestic Product (GDP), which I understood as a broad measure of the monetary value of the goods and services the country produces each year. Then there was the somewhat more difficult concept of “marginal utility”, which I just about know how to distinguish from butter! And then, being a grammar school boy lacking a classical education, my economics tutor taught me a Latin phrase: “Ceteris Paribus”, which means “if all else remains unchanged/equal” – or something like that. Ceteris Paribus provides a get-out-of-jail card for the failed predictions and forecasts of economists because things rarely remain unchanged, although sometimes it seems God put economists on this planet to make weather forecasters look good!

I understand social science is soft science – it’s not quantum physics – but at least economists are trying to measure something that can be objectively quantified or monetised. However, “public health” campaigners feel no such inhibitions. Recently published research funded by the Medical Research Council sought to quantify how even moderate drinking might reduce “quality of life” and put a monetary value on it – apparently drinking a bottle of wine a week costs £2,400 a year in lost quality of life, while one pint of beer a week equates to £610 a year in lost quality of life.

The research analysed the health, wealth and happiness of 141,000 British drinkers aged 37 to 73 and compared alcohol’s benefits, such as making people feel happy or sociable, with the higher risk of depression, insomnia and cognitive decline. 

But this is a curious comparison. In real life people make all kinds of trade-offs between short-term pleasures and long-term risks, usually on the basis the short-term pleasure is very real and very “now”, whereas the increase in risk is often very small and may or may not occur some time in the future. Or, to put it another way: “It won’t happen to me.” Usually, statistically, they are right. How can you compare the actuality of a benefit to the increased risk of a cost?

When scientists ignore the vast amount of scientific evidence that links moderate alcohol consumption to greater longevity – and less risk of heart disease and dementia compared with life-long abstainers – and abandon what can be sensibly quantified and try to monetise a concept as subjective as “quality of life”, you know they’ve abandoned science and are chasing unicorns.

They are not alone in this pseudo-scientific endeavour. The annual Halifax Quality Of Life survey has just been published and tells us Orkney is the best place to live in the UK. I like sheep, but not that much. The survey used to say various places in southern England were the most desirable places to live so Orkney’s rise to prominence is recent. About 22,000 people live in Orkney and its population is in long-term decline. Millions of people live in southern England and its population is growing. 

Pause for thought. GDP may be a rough and ready way of measuring how well the economy is performing but at least it’s measuring something objective. “Quality of life” is an entirely subjective concept and reflects the values of campaigners who use the cloak of science to mask their lifestyle activist intentions.

There are a lot of them doing it. There is the Genuine Progress Indicator, which measures income inequality and suggests if it is growing, a place is getting poorer. Some people will agree with this conclusion and some will disagree but it’s an implicit value judgement that tilts the science. Then there’s the Gross National Happiness Index, which was pioneered by the royal family of Bhutan – clearly experts in equitable development and cultural diversity. 

And isn’t it comforting to know The Lancet is getting in on the act? This formerly reputable medical journal has become a loony-left publication and a mouthpiece for some of the country’s worst lifestyle zealots. The Lancet Commission On Obesity recently published a 56-page report on how to solve the obesity crisis and save the planet – so no lack of ambition! The report is a diatribe against Big Food and declares we should all become vegans but, if we must eat meat or eggs, it should be in tiny amounts.

Their enemy is Big Food, which is a surrogate term for capitalism, and their remedy is more state control, higher taxes and more bans. Not only that, they’d like a hand-out from the taxpayer to fund their lobbying of the World Health Organisation to enshrine their puritanical intentions into a Global Treaty On Food.

Driving to work this morning I listened to the Queen song “Flash”, which featured in the film Flash Gordon. In the song the heroine breathlessly says: “Flash, I love you, but we’ve only got 14 hours to save the earth!” Isn’t this essentially the unifying theme of all these unicorn-chasers – moral salvation lies in abstaining from pleasure – and in the process you’ll improve your quality of life and save the planet. Isn’t that nice?

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.