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.

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.

Alcohol and cancer – again!

Barely a day goes by without some new “threat” to our health being announced by epidemiologists or other health campaigners. For these people, the meaning of life appears to be the elimination of anything enjoyable in order to achieve maximum longevity. Key to this is the elimination of “risk factors” from our diet and lifestyles. The key technique used to frighten us all into abstinence is to concentrate on cancer risks. Here an old trick is used – take a very small baseline risk and measure the increase to that risk that arises if you engage in “heavy” drinking. The effect of this is to give prominence and publicity to very large percentage increases in very small baseline risks.


The Alcohol Health Alliance (AHA) has taken to Twitter to publicise its message that alcohol = cancer = death. The Twitter headline reads: “Alcohol is linked with at least seven types of cancer” and then lists them on a handy infographic of the body as mouth and upper throat; larynx; oesophagus; breast; liver; and bowel cancers.


Of course, a “link” is not the same thing as a “cause” but they would like you to think it is. This scare-mongering is entirely consistent with a revision of the low-risk drinking guidelines on the basis there is “no safe level of consumption in respect of the epidemiological risk of developing cancers”, and “the cancer risks of drinking is a game-changer”. It is, of course, accepted that excessive consumption of alcohol is causally related to a small number of cancers – but the risk is dose-related.


Taking oral cancers as an example, what is the overall risk caused by drinking alcohol? According to Cancer Research UK, about 7,300 oral cancers are diagnosed in the UK a year. Of those, tobacco smoking was identified as the cause in 65% of cases. Alcohol consumption accounted for 30% of these –2,190 cases. In total, 30 million adults in the UK drink at least once a week. Of those, 2,190 of them develop an alcohol-related oral cancer – that is 0.007% of regular drinkers. And remember, these figures include very heavy drinkers as well as moderate and light drinkers – so don’t be panicked into abstention just yet.


Every such death is a tragedy but the actuarial risk is tiny. The proposition anything that raises the epidemiological risk of a cancer “isn’t safe” is therefore problematic. In everyday life people make trade-offs. They don’t ask “is this product or behaviour safe?” they ask “is it safe enough?” We do this all the time and not just in relation to food and drink. We don’t ask whether driving a motor vehicle is safe, we ask is it safe enough? In other words, do the benefits of driving justify me in taking the risks? When we are told tobacco-smoking results in the premature death of half of all smokers, that may deter people from starting or persuade existing smokers to quit. However, if you were told 0.021% of regular drinkers die from an oral cancer, would that put you off? It is this kind of epidemiological paranoia that leads health cranks to call for abstinence, and lowering of the lower-risk drinking guidelines is but a staging post on that journey.


However, what is missing from the AHA’s misleading messaging is any reference to the beneficial effects of moderate alcohol consumption. The life-prolonging effects of moderate alcohol consumption are on a firm scientific footing. Despite the AHA and its cronies’ science denial, Sir Richard Doll (the epidemiologist who discovered the link between tobacco smoking and cancer) has revealed there have been dozens of studies in the past 30 years that have vindicated the J-curve that illustrates the benefits of moderate drinking in terms of greater longevity for moderate drinkers compared with “never-drinkers”. If science indicates that alcohol conveys significant life advantages, why does the AHA act as though alcohol is evil?

MEDIA-DRIVEN MORAL PANICS

Cancer = Death. And sooner rather than later, or at least that’s the public’s perception. So any link between alcohol and cancer implies precisely that equation and is therefore guaranteed to generate headlines. So last week headlines in the I-online and Guardian newspapers that screamed “Alcohol directly causes seven kinds of cancer, says study”, and “Proof: drinking alcohol causes cancer” were designed to alarm public opinion and to feed into the ongoing ‘public health’ narrative that “there is no safe level of alcohol consumption”.

So, presumably, in order to justify these headlines there must be some new weighty piece of research that’s been published, or perhaps a meta-analysis of numerous other peoples’ research that give us, finally, irrefutable proof of this claim. But actually nothing of the sort! What the newspapers were referring to was an opinion piece by an academic named Jennie Connor, who works at the University of Otago, New Zealand, and that was published in the Journal ‘Addiction’. It consists of just over 3,700 words plus references.

Without wishing to be overly pedantic, it is not ‘alcohol’ but the drinking of alcohol, mostly in copious quantities, that causes a number of different cancers and there is nothing new in this claim nor is it, for the most part, disputed. The issue here is about which alcohol-related cancers require the drinker to really work at it by drinking to excess and which can be triggered by relatively low levels of consumption. The alcohol mortality statistics for England show that over 80 per cent of deaths from diseases caused by alcohol consumption are deaths from alcoholic liver disease (4,333 in 2014) and liver fibrosis/cirrhosis (1,520 in 2014). Bear in mind that some 28 million people in England drink alcohol on a weekly basis, so these drinkers are at the extreme end of consumption – often drinking in excess of a bottle of Scotch a day for many years.

The claim made in the article by Jennie Connor is that alcohol-attributable cancers make up 5.8 per cent of all cancer deaths worldwide. But if you look at the alcohol mortality statistics for England you will not find any recorded deaths from lip, oral cavity and pharynx cancer, oesophageal cancer, colorectal cancer or cancer of the larynx. As I said above, alcohol-related deaths are mostly caused by alcoholic liver disease or liver fibrosis/cirrhosis.  Curiously, there is no reference to deaths from alcohol-related breast cancer in the official figures, but studies estimate that about 94% of breast cancers are linked to causes other than alcohol, so separating out alcohol-related breast cancer let alone those cases that result in death is extremely speculative.

And this is the crux of the matter: at what point can we say that a statistical association between alcohol consumption and a disease becomes sufficiently well established to conclude that the relationship is causal? For what it’s worth, I think that Jennie Connor’s claim that the statistical association is strong enough for us to conclude that alcohol consumption causes cancers at seven sites is probably correct (oropharynx, larynx, oesophagus, liver, colon, rectum and female breast). But with the exception of the liver and a tiny minority of breast cancers these cancers are rare and rarely result in death.

The link between alcohol consumption and some rare cancers needs to be balanced by an appreciation of the clear proof that there are overall health protective effects from light to moderate drinking, particularly in relation to heart disease and stroke. I am of course talking here of the famous j-shaped curve that shows that regular, moderate drinkers live on average longer lives than either heavy drinkers or ‘never drinkers’, and are less likely than never drinkers to die of heart disease or a cancer. Jennie Connor, in her article, casts doubt on that hypothesis and space prevents me from going into detail on that, although I have done so in previous articles. Her scepticism of the j-curve hypothesis rather spoils what is otherwise a rational article that largely avoids bias.

My main criticism is of the media. Even supposedly ‘high-brow’ newspapers like the Independent and the Guardian cannot resist the temptation to get a wowser headline  by bigging-up an article that contains nothing new into a ‘study’, when it isn’t. This is how moral panics are started and sustained by a public media that creates and perpetuates myths which get repeated so often they become “well-known facts”. Are the media behaving cynically? Do they know they’re doing this? I am left with the thought that a man who tells a lie is merely hiding the truth; a man who tells a lie so often he’s convinced himself has forgotten where he’s put it.

THE SCREAM TEST

“I sense a huge disturbance in the force” said Obi-Wan Kenobe - immediately after the Empire had used the Death Star to destroy an entire planet. From the wailing and gnashing of teeth amongst health lobby cranks over the past couple of weeks you could be forgiven for thinking that something of similar consequence had happened. What could it be? Well, two things have really upset them: firstly the enactment, after a trial, of an anti-sock puppet regulation prohibiting charities from using taxpayers money, received from government, to lobby government; and secondly, the announcement that the government will not, after all, introduce a sugar tax.

Forgive me if I sound just a little smug, but the health racket has always applied something called the “scream test” to policies directed at our industry: if the policy makes Big Alcohol or Big Food scream, then it must be bad for “them” and good for “us”. There’s nothing like getting a dose of your own medicine boys!

So what has been the response to these measures? According to the Daily Telegraph campaigners have reacted with fury to reports that the government has rejected the proposal for a sugar tax of up to 20 percent, preferring instead to agreeing “voluntary measures” with industry to reduce sugar content of foods, but with the threat of a sugar tax if they don’t. Tam Fry, spokesman for the National Obesity Forum, said: “The decision must be reversed or it will be more proof that the Government is in the thrall of the food industry and the sugar barons will have won yet again.” And he continued: “NHS chiefs know full well that the combination of child and adult obesity could topple the UK’s most cherished institution.”

No it won’t Tam! Actually both adult and child obesity rates have stabilised recently and the whole moral panic over obesity is being kept going by projections about future obesity rates which are as unlikely to materialise as the previous ones. “This could be the end for the NHS” is the perennial cry of those who want to frighten us into state control of diet, or else the national religion will fall over.

And then there is the response of Graham MacGregor, chairman and founder of Action on Sugar. He’s so miffed he’s threatening to take his ball back and go and play for another country: “We won’t stop  and if the UK don’t want to stop doing it (sic), we will go to another country like Argentina or Chile which are much better organised in terms of public health and nutrition.” Really Graham, really? General Galtieri and General Pinochet must be turning in their graves!

And what of Nanny in Residence Sarah Wollaston MP, chair of the Commons Health Select Committee? Well, she’s not happy either. She’s been locked in a battle with Jeremy Hunt, the health secretary over the sugar tax and she’s even less pleased about government ending tax-payer funding of faux charities that use the money to lobby government. She fears that this will tip the balance even more in favour of Big Food and away from public health. Well, Sarah, quite a lot of people feel that the imbalance has been in the direction of so-called “public health” for far too long and that this is a much-needed correction.

The actual phrase that will be inserted into all new and renewed grant agreements reads: “The following costs are not Eligible Expenditure: Payments that support activity intended to influence or attempt to influence Parliament, Government or political parties, or attempting to influence the awarding or renewal of contracts and grants, or attempting to influence legislative or regulatory action”. And much credit goes to the Institute of Economic Affairs (IEA) and their director of lifestyle economics Chris Snowdon for researching and campaigning on this issue. Interestingly, those who don’t like the change are now referring to the IEA as a “neo-liberal” think-tank – conjuring-up images of George W. Bush and Dick Cheney, who are not on most peoples’ Christmas card list!

Of course, ‘public health’ can always point to the chief medical officer’s Revised Drinking Guidelines as a triumph can’t they? Well, no; these have been met with almost universal derision and a storm of criticism. Reportedly the Department of Health is distinctly rattled over the response to the new ‘low-risk’ guidelines and public support from ministers for Dame Sally Davies’s piece of science-denial has been conspicuous by its absence. And the “there is no safe level of drinking” mantra has quickly been followed by “there is no safe level of sun bathing” – in sunny February! And Dame Sally’s two pieces of advice: “When reaching for a glass of wine, do what I do and ask do I want this glass of wine or do I want to increase my risk of cancer?” and “Use six tea-spoons of sun cream” before going out into the sunshine. Oh dear!

All we need now is formal confirmation from the Scottish courts in a few weeks’ time that minimum pricing is dead and I shall throw a party!