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.

Nanny State Annual Awards for Fake News and Phoney Statistics

Nanny State Annual Awards for Fake News and Phoney Statistics 

I am pleased to announce the launch of the CPL Nanny State Annual Awards for Fake News and Phoney Statistics. The awards will go to the person or organisation that has perpetrated the most gratuitous porky or porkies, fake news or phoney statistics, in relation to public health. I invite readers to submit examples of fake news and phoney statistics – whether it be in relation to alcohol, sugar, obesity, carcinogenic burnt bacon – or any other claim made by nanny-statists that is designed to foment moral panic, frustrate modern life or otherwise deter us from doing anything pleasurable, on the dubious basis that it is better to die of boredom than anything else.

There will be three categories of award in relation to alcohol, sugar and obesity.

A few examples of fake news and phoney statistics from the past:

“There is no safe level of alcohol consumption.” And: “Do I want the glass of wine or do I want to raise my own risk of breast cancer?” Both quotes are from professor Dame Sally Davies, chief medical officer of health – even though she did get the wording a bit mixed up in the second quote, we know what she meant!

Another example would be chief nanny Dr Sarah Wollaston MP, chairman of the health and home affairs committee, who conducted a PR stunt in parliament on Monday (22 January), to campaign for minimum unit pricing (MUP), a policy she’s been championing for years. At the committee hearing she quoted the fake statistic: “The cost of alcohol is at least £21bn a year.”

At this hearing a couple of the usual suspects gave “evidence” – professor Sir Ian Gilmore from the Alcohol Health Alliance and professor Nick Sheron – both ardent alcophobes who support MUP. The usual lie that MUP won’t affect moderate drinkers was repeated – Gilmore stated its introduction at 50 pence a unit would cost moderate drinkers “just £1.72 a year”. To be fair, professor Sheron was nearer the mark when he estimated the cost at £60 to £150 a year!

Another recent example of fake news is the comment made by Richard Horton, the Marxist editor of the Lancet: “Liver disease is on a trajectory to become the biggest cause of death in England and Wales.” This fake fact is designed to scare us off drinking alcohol. In fact, the Office for National Statistics states liver disease is tenth on the list, causing half as many deaths as prostate cancer and an eighth as many deaths as heart disease.

But the best recent example of fake news in relation to alcohol came from – yes you guessed it – The Sun newspaper, which came up with this magnificent headline: “Boffins claim one pint a day can give you dementia.” As Chris Snowdon, director of lifestyle economics at the Institute of Economic Affairs, put it: “That public health lie went around the world before the truth even got its shoes on.”

The prize for all three categories will go to the perpetrator of the porky we select and will consist of a trophy and a bottle of cheap booze with the label removed and replaced with a health warning, and wrapped in plain packaging, of course.

All suggestions should be sent to me at paul.chase@cpltg.com by the end of February 2018 and should contain the quote and attribute it to the person or organisation being quoted. All quotes should be from 2017 and when we’ve picked the winners all contributors and their chosen porky perpetrators will all meet in a disreputable bar for an award ceremony and a night of responsible drinking.