Thursday, 2 October 2014

Whining doctors

I tend to write about 'public health' quacks on this blog rather than proper medics, but every now and again something like this crops up...

Ageing GPs 'may force practices to close'
Hundreds of GP practices are at risk of closure because of the ageing workforce, doctors' leaders say.
An analysis by the Royal College of GPs has identified 543 GP practices out of the 8,000 in England it believes could be forced to shut in the next year.

They all have over 90% of their doctors aged over 60 - the average retirement age is 59.

Firstly, boo-hoo for the poor doctors who retire at the average age of 59 while the rest of us work to 65 or later to pay for them and their massive pensions.

Secondly, workers get old and can be replaced without their businesses having to close down. It may well be true, as the BBC article says, that one in sixteen GP practices are staffed by older workers, but that does not mean that they 'risk closure'. That would only happen if the UK could not import GPs from abroad or was not training GPs at home. But we import many doctors from abroad and—as Nick Triggle (for it is he) admits in the article's final sentence—the number of doctors being trained in the UK is rising:

But the Department of Health said it was investing in new GPs. It said the number of GP training places was rising. Last year there were just over 2,700, but by 2016 it will hit 3,250 a year.

So this is just the usual scaremongering lobbying from a particularly plump vested interest. And, as always, it is about money:

RCGP chair Dr Maureen Baker said extra investment was needed just to keep the system afloat - never mind expanding it.
She said the amount spent on GPs as a proportion of the NHS budget had been falling in recent years, and needed to increase from the current "historic low" of just over 8% to 11% by 2017.

The amount spent on GPs as a proportion of the NHS budget is a red herring. The NHS budget increased threefold in real terms under Labour and is still increasing, albeit at a much slower rate since the recession. GPs' salaries also went up dramatically under Labour. The fact that anyone in the NHS has the nerve to complain about a lack of money after this staggering spending splurge is appalling, let alone doctors who have had their mouths stuffed with gold from day one.

No one should care about whether the amount spent on GPs has risen in proportion to the incredible largesse that has been enjoyed by the rest of the NHS. The only relevant statistic is whether the number of GPs has fallen relative to the UK population—and it has not. It is true that Britain has fewer GPs per 1,000 people than many other rich countries, but this has always been the case under the NHS and if that were to change it would have happened when Gordon Brown was throwing almost unbelievable amounts of taxpayers' cash into this money pit.

As is customary with this sort of special pleading, there is the usual claim that services are on the brink of collapse:

Comparing general practice to the "walls of a dam" that prevents the rest of the NHS being flooded, Dr Baker said: "So far much of the damage to the dam wall has been hidden from the public - they see the flooding downstream in A&E departments and in hospital pressures - but they haven't been aware that GPs, nurses and practice teams have been absorbing that pressure by trying to do more and more with less and less.

"But if we let that situation continue we will see whole chunks of the dam fall apart when practices have to shut their doors." 

Blah, blah and, furthermore, blah. I've been told that the NHS is on the brink of collapse my entire life. You only have to click on Google to see how often the NHS has supposedly been in this perilous situation. It's a bluff. It ain't gonna happen. It's a publicly funded state behemoth and cannot go bust. At worst, it will give some patients poor care and treatment, but it always has and it always will. Moreover, those patients who receive adequate care will continue to feel pathetically grateful for their 'free' healthcare that actually costs them over £2,000 a year.

Like all public services, the NHS should be on the brink of collapse. If it wasn't, it would be even less efficient than it is. But it will not, and cannot, actually collapse. It will continue to suck increasing amounts of money from taxpayers ad infinitum, much of which will continue to go to fat cat doctors, consultants, lobbyists, public health parasites and—above all—bureaucrats.

I don't know whether the current reforms of the NHS are a good or a bad thing, but I cannot remember a time when doctors' lobby groups weren't predicting the end of civilisation as we know it unless they were given more money. I would be less inclined to regard them as a reactionary, grasping, scaremongering special interest group if, at any point in living memory, they had ever seemed to be reasonably content to be engaged in well remunerated and secure employment (see also: teachers). The fact that large numbers of them also wish to restrict our freedom is incidental in this context, but it only adds to my conviction that they should shut up and get on with their job.

Wednesday, 1 October 2014

Winding up prohibitionists with the truth

Liberal Democrat Senator David Leyonhjelm has caused outrage in Australia by telling the truth about the economics of smoking. This is recommended viewing...

Here is some of what he said...

"Ladies and gentlemen, thank-you for smoking.

Australian smokers contribute significantly to the pile of money that – as I noted in this place recently – other people then spend.

As you well know there are many such big spenders in this parliament, as are many of the people who malign you.

They don't like your habit, but in my view they have an even filthier habit: spending your money – and other people's money – on things that are often even sillier than spending too much on cigarettes and booze.

Your generosity to the nation's treasury is truly staggering. The government collects around 8 billion dollars in tobacco excise each year. That's a lot of cash.

Last year, smokers imposed $318.4 million in net costs on Australia's healthcare system. Depending on rainfall, smokers also cost the taxpayer about $150 million a year in bushfire control.

If you do even basic arithmetic, these figures disclose that you wonderful, generous smokers pay 17 times as much as you cost.

... Because the revenues versus costs figure is so lopsided, those who would tell you how to live have tried to add 'social costs' to the healthcare costs I discussed earlier. 'Social costs' take in things like smokers' spending on tobacco, and the lost productivity represented by smokers' earlier mortality. These, allegedly, represent income foregone.

By that logic, deciding to work part time to increase your leisure time is a social cost, as is going on holiday.

Arguments like that suggest to me the anti-smoking lobby is running out of ideas.

But when powerful, well-funded lobby groups run out of ideas and arguments, unfortunately they don't fold up their lobbying tents and head home.

They keep lobbying, and we've now reached the point where, thanks to their efforts, the government is about to kill the goose that lays the golden egg, handing all the lovely tax money it extorts from you over to organised crime."

... Here's a little basic maths: if you spend $5,000 a year on tobacco, it's a bigger proportion of your income if you earn $30,000 per annum than if you earn $100,000 per annum.

In the trade, that's what's known as a 'regressive tax'. And if – along with South Park's Mr Mackey – we can agree that 'drugs are bad, mmmkay', it's probably also fair to say that 'regressive taxes are bad, mmmkay.'

Calling regressive taxes 'sin taxes' doesn't hide the scale of the problem. Smokers are typically poor, which makes this vast tax-take all the more perverse. It means, for example, that social planners who want to redistribute money from the rich to the poor need to increase both welfare payments and income tax rates to achieve their goals. When the 25 per cent excise increase was imposed, the Australian Customs and Border Protection Service noticed an increase in seizures of illicit tobacco.

In 2013, it rose to 183 tonnes, representing forgone customs duties of $150 million. Remember, that's the annual cost of putting out bushfires due to cigarettes.

And it's also entirely to be expected: tobacco can't even be commercially grown in Australia. Smokers of Australia, despite your generosity, I need to apologise on behalf of the short-sighted pickers of your pockets in this place.

Maybe they haven't studied any history, because if they did, they would learn that the regime controlling cigarettes is no longer one of 'legalise, regulate, and tax.' Instead, it now resembles two other regimes, regimes that were and are catastrophic failures. I'm thinking here of Prohibition and the War on Drugs."

Minimum pricing model wheeled out once more

The latest flurry of activity from Sheffield University's minimum pricing activists researchers appeared today. As ever, it made headline news at the BBC...

Minimum unit price '50 times more effective' than alcohol floor price

A minimum price is a floor price. If a BBC hack doesn't understand basic terminology, s/he is unlikely to be able to get to grips with a speculative and partisan estimate from a deeply flawed computer model.

The gist of the press release (there is also a study, but the study is more of an appendage to the press release than vice versa) is that the ban on alcohol being sold below cost price will have much less effect on alcohol consumption—and therefore, in the eyes of the activists researchers, alcohol-related harm—than a minimum unit price of 45p.

A few things need to be said about this...

1. The study, which has been published by the British Meddling Journal, is just the umpteenth reworking of tired old guesstimates about the possible effect of a 45p minimum price. Aside from the fact that no one is campaigning for a 45p minimum price any more (it is now 50-60p), the Sheffield model is based on absurd assumptions, such as the belief that heavy drinkers are more price sensitive than light drinkers, and it uses price elasticities that are at odds with almost everything that has ever been written about the demand for alcoholic beverages in the economics literature.

2. The claim that minimum pricing would be '50 times more effective' (ie. would reduce consumption by 50 times more) is also not new. The Sheffield activists researchers announced this factoid last year - in one of its many press releases - when the government announced the ban. They said:

The Sheffield modelling estimates that the impact of a 45p minimum price would be around 40 to 50 times larger than that of banning below-cost selling.

This factoid was eagerly taken up by their friends at the Institute of Alcohol Studies (formerly, and more appropriately, known as the UK Temperance Alliance), who issued their own release saying the same thing. Today's announcement is, therefore, a reworked version of a 16 month old, policy-driven press release that was based on a hastily cobbled-together figure.

3. The government only banned the sale of alcohol below cost price (actually below duty+VAT) because the 'public health' lobby spent years whipping up hysteria about supermarkets selling alcohol as a loss leader. Those of us who live in the real world knew that such a ban would have very little effect because we knew that hardly any alcohol is sold below cost price. It was a temperance lie from day one.

4. More recently—ie. since the government capitulated on below cost sales—the temperance lobby has turned its back on the loss-leader argument and has claimed instead that a ban "will have no effect at all on health". Claiming that minimum pricing will be fifty times more effective than something that will have "no effect at all" is the same as multiplying bugger all by fifty. The new(ish) Sheffield study actually reckons that a below-cost ban will save 14 lives a year, based on a reduction in per capita alcohol consumption of three units. This is because they make daft assumptions about per capita consumption and alcohol-related mortality having a direct, linear relationship. A more realistic estimate is that it will save about as many lives as a 45p minimum price, ie. none.

5. Since the Sheffield activists academics started modelling the impact of minimum pricing in 2008, per capita alcohol consumption has fallen much more sharply than they predicted would happen under their pet policy. They have yet to explain why all the glorious health outcomes that should have accompanied this decline have failed to reveal themselves.

6. The problem with minimum pricing is not that it will have more (or less) effect than a policy that no sane person thought would have any effect, but that it is deeply regressive, iniquitous and illegal. Resurrecting the corpse of the Sheffield computer model will not change that, nor will it alter the fact that the model itself is a waste of time, energy and taxpayers' money.

Tuesday, 30 September 2014

A late reply to Irish plain pack nonsense

Before I went to Australia last month, I wrote a letter to the Irish Times after they published a particularly silly article by Luke Clancy of ASH Ireland. They didn't published it (this is becoming a habit with Irish newspapers) so, very belatedly, here it is...

Nobody should be surprised that Professor Luke Clancy would claim (Irish Times, August 15) that plain packaging of cigarettes “works”, but to support his assertion he cites a number of statistics which should be taking their case to the United Nations Committee on Torture, such has been their mistreatment at the hands of the proponents of plain packaging.

In Professor Clancy’s rush to misquote one part of an official Australian Government report on smoking prevalence, he neglected to even mention another part of it. The less useful aspect, from his perspective, of the Australian household survey shows that the number of daily smokers in Australia between the ages of 12 and 17 – the very cohort that plain packaging is supposed to turn off cigarettes - has increased from 2.5 per cent to 3.7 per cent.

This is despite what Luke Clancy wrote last Friday: “All research to date shows packaging is central in attracting children to tobacco. When stripped of their alluring colours and logos and replaced with textual graphic and health warnings, the packages will transform the relationship between teenagers and tobacco.” The relationship has indeed been transformed. There are now thousands more teenagers having a relationship with tobacco, according to the Australian government.

It should be said that the Australian Institute of Health and Welfare study is carried out every three years with the latest covering 2010-2013. Since plain packs were only introduced in December 2012, campaigners have derived their conclusions about a policy that was only in effect for one third of the survey period. This is more than a little disingenuous, but if Professor Clancy is going to claim that plain packaging is responsible for the “fastest decline in smoking rates in over 20 years” (it’s not, but more on that below) then he equally has to accept that plain packaging is responsible for a rise in teen smoking.

Clancy also neglects to mention that there was a whopping 25 per cent tax hike on tobacco in 2010 which the government itself predicted would reduce the number of smokers "in the order of 2 to 3 per cent” or around 87,000 Australians.

The actual drop in overall smoking prevalence in the three years from 2010 to 2013 was 2.3 percentage points – perfectly consistent with the steady downward trend that has been in existence for many years and which seems to have been totally unaffected by plain packaging. This decline was not even the biggest decline in the last 15 years, let alone the last 20. There was a greater decline in smoking rates between 1998 and 2001 (of 2.4 percentage points).

Clancy disguises this by looking at percentage differences between the percentages rather than looking at the decline amongst the whole population. This is statistical trickery. As smoking rates get lower, it is a mathematical inevitably that an identical decline in the number of smokers will appear to have a larger effect in relative terms. For example, a two percentage point decline in a place where 50 per cent of the population smokes represents a relative decline of four percent, as Clancy defines it, whereas the same decline in a place where ten per cent of the population smokes would represent a 20 per cent decline. But the reduction in the number of smokers is the same in both examples.

Clancy also misrepresents Australian Bureau of Statistics’ data showing a decline in tobacco sales during the first year of plain packaging (December 2012-November 2013). Far from indicating a 3.4 per cent decline (which would not be unusual in any case) the data show that the fall in sales was much smaller (0.9 per cent) in the first year of plain packaging than it was the year before (3.4 per cent). For that matter, it was smaller than the year before that (7.1 per cent) and the year before that (2.5 per cent).

Incidentally, Professor Clancy wrote last week: “It has been reported that the Bill has gone to the EU, as is required practice and that it will be delayed by Europe. It is difficult to see why this is assumed and why is it [sic] reported as seemingly inevitable.” These two sentences illustrate just how out-of-touch Professor Clancy is. The reason that it was reported that the European delay is “inevitable” is that it is a fact. (Newspapers generally strive to report facts - the same cannot always be said of single issue campaigners).

The Bill was notified to Europe in mid-June and, if there were no objections, would have been back with the Irish government by mid-September. There have been a number of very strenuous objections from governments (administrations that haven’t been taken in by Professor Clancy’s distorted data) so the European Commission has doubled the standstill period for the legislation and told the Irish government it cannot proceed next month as it had planned.

It’s that simple Professor. Look it up.

And, for those who need visual stimulation, here's that plain packaging miracle (the "vaccine for lung cancer" - copyright Simon Chapman) in full...

That's right. It did bugger all.

Monday, 29 September 2014

Calorie consumption (part 2 of many)

In the previous post in this series, James left a comment asking "is it necessary to state so unequivocally that the problem is less exercise? I agree it's the most plausible explanation, but there could potentially be others."

My argument is that if, as seems to be the case, calorie consumption has fallen over time, increases in body weight must be due to fewer calories being expended and, therefore, that a reduction in physical activity is the most likely culprit. I appreciate that there are people who believe that a calorie is not a calorie and that changes in the diet could therefore be the issue. I tend to side with the traditional consensus view that a calorie is, in fact, a calorie, but even I wasn't so inclined, it so happens that the consumption the ingredients that some claim are uniquely fattening (notably saturated fat and sucrose) have also declined, so that line of argument seems like a dead end.

Physical inactivity is not the sole explanation for why people are expending fewer calories than they used to. It has been argued that central heating means that people burn off less energy through keeping warm. The decline of smoking has probably also had some effect; smokers weigh several kilograms less than nonsmokers on average.

There may be other factors that have affected metabolism over time, but physical inactivity remains the main contender for why obesity has risen. All sorts of evidence can be given on this count, only a little of which was documented in The Fat Lie. For example, I read an interesting post by Tim Olds at The Conversation this week:

In 1919, a young woman named E.M. Bedale started postgraduate research at University College London, an uncommon undertaking for a woman at that time. Her studies focused on energy balance in children, which led her to spend several years at a serendipitously eponymous school called Bedales in rural Hampshire.

During her two years at Bedales, Miss Bedale measured the energy expenditure and intake of the school’s students, using methods that are still considered to be gold standards today.

Her data provide a startling contrast to our time. Children from almost 100 years ago were 50% more active than kids today. They accumulated over four hours more of physical activity and sat for three hours less than today’s kids - every day.

Too historical for you? Not 'evidence-based' enough? Then how about this?

Or this...

In the 1960s, half the jobs in private industry in the United States required at least moderate-intensity physical activity, compared to less than 20% today.

Work in factories and farms has given way to office work, and that has amounted to over 400 kilojoules less each day that adults expend at work. This difference alone results in a weight increase of about 13 kilograms over 50 years, which pretty closely matches actual changes in weight.

And in the home...

In many ways, the whole ethos of ease now saturates our society, and efficiency is the hallmark of modernity.

Think about it this way - nobody is in the market for a labour-creating device. Sit-on mowers, leaf blowers, self-opening doors and automatic car windows, robot vacuum cleaners, sensor lighting, dishwashers and microwaves all yield daily microsavings in energy expenditure that add up to hundreds of kilojoules.

In 1900, the average American housewife spent an estimated 40 hours every week in food preparation. Today, that time is barely four hours — and it appears to have reached an absolute minimum.

When it comes to physical activity in one's leisure time, some interesting research was published this year in the American Journal of Medicine. I mentioned it briefly in The Fat Lie but some of the statistics are shocking and require another look. The graphic below shows the proportion of Americans who engage in no leisure activity whatsoever. Click to engorge.

Between 1988-94 and 2009-10, the proportion of men who did no leisure-time physical activity rose from 11.4% to 43.5%. Amongst women the rate rose from 19.1% to 51.7%. These are enormous changes in a relatively short period of time.

There's more to come but this blog post is long enough so I'll come back to it in the near future.

Thursday, 25 September 2014

Soda sock puppets

The soda tax campaign that is underway in Berkeley and San Francisco is asking voters to support paying an unnecessarily high price for a widely consumed product. This is not an easy sell, even for Californians, and so the campaign has tapped into the rampant anti-business mentality of the region by being entirely about 'beating Big Soda'.

The campaigners hope that Californians will be so angered by the thought of an industry making money that they will volunteer to give the government more of their own cash. And for the benefit of the dimmest voters, they've concocted the fairytale that a soda tax isn't a tax that people will have to pay—oh no!—it's merely a 'tax on industry'.

This is a tax on industry, not a sales tax on consumers or a tax on retailers. Distribution companies will pay the tax for the privilege of distributing sodas and other sugary beverages in Berkeley. It will be the companies’ choice whether or not to pass this tax to the people of Berkeley.

Seems legit...

In San Francisco, the pro-tax campaign is being run by a group called Choose Health SF. Their website is a real treat, including such phrases as "Coke and Pepsi are the real nannies" and "Ending hunger is about more than making sure people have enough calories."

Choose Health SF are obsessed with 'Big Soda'. They are particularly annoyed by the "misleading astroturf tactics of the American Beverage Association". This is a reference to the Coalition for an Affordable City, an organisation set up by the soft drink industry to campaign against "unfair beverage taxes".

Choose Health SF call the Coalition for an Affordable City a "local front group" for Big Soda. By contrast, their own campaign is about "real grassroots community coalition building". They call on Californians to "Join the soda tax grassroots movement." (To see the kind of people they've been building coalitions with, scroll to the bottom of this post).

So who are these grassroots campaigners who want the government to get more tax revenue? Choose Health SF's domain name was registered by Maggie Muir. Maggie Muir is a partner at Erwin and Muir, a public affairs agency that specialises in political campaigns. Erwin and Muir have been "hired by San Francisco lawmakers to lead the political committee in support of the soda tax".

Choose Health SF is, therefore, a classic astroturf group created and funded by the government to lobby for more government action. It is a state sock puppet

There will be some people who say that this is fair enough, it's one front group against another. I can't agree with that. If the soda industry wants to use its own money to campaign on an issue that is important to its customers (or any issue, for that matter), then it should do so. Most of its customers will be glad that it is taking a stand, but if there are those who don't support it, they are free to stop buying its products.

But for a government to use taxpayers' money to campaign for higher taxes under another name? No. The taxpayer has no ability to withhold his money from the campaign if they disagree the government's stance on the issue. He is, as Thomas Jefferson put it, forced to "furnish funds for the propagation of ideas he disbelieves and abhors".

Moreover, it is fairly obvious that the Coalition for an Affordable City campaign is funded by the soda industry. On every page of their website it says:

"Paid for by No on E: Stop Unfair Beverage Taxes, Coalition for an Affordable City, with major funding by American Beverage Association California PAC."

By contrast, the Choose Health SF website does not give even a hint that it is funded by the government. There is no 'About Us' page and Choose Health SF describes itself merely as "a political committee organizing to pass a local sugary beverage tax." There is nothing on the site to suggest that it is the work of a public affairs agency working on behalf of the government. Big Soda has to be upfront about its 'front groups', Big Government not so much.

We've seen various state-funded 'public health' agencies attempt the same trick in the UK in recent years (eg. here, here and here). I dunno, perhaps this sort of state-funded activism is par for the course in the USA? Erwin and Muir boast that they have "secured over half a billion dollars in financing for schools, roads, and parks improvements through 2/3rds voter approval", so maybe it is.

Whatever the case, voters in San Francisco need to be aware that the campaign for higher taxes has been orchestrated by the interest group that has the most to gain from them—the government.

Wednesday, 24 September 2014

Loot and plunder

So Ed Miliband has decided that tobacco companies make too much money and so he's going to help himself to some of it. Looting private industry on a whim is not the best way to convince companies that the UK is the best place to do business, but there you go. The other vultures of the parasitic state immediately began to circle...

This smacks of arbitrary and capricious government. And it will ultimately be paid for by the consumer, as one analyst told the Guardian...

“The obvious solution for companies is likely to be a pass-on of the cost through higher prices, so you would expect the consumer to ultimately bear the cost.”

Yep. But there is one thing that puzzles me about the way the media reported the story and it is this:

The fees, similar to those introduced by Barack Obama in 2009, are to be based on the firm’s market share.

Most newspapers echoed the claim that Obama did the same thing in 2009, but I can't work out what they're referring to. Obama introduced a major tax rise on tobacco in 2009, but that can't be it. Miliband's idea more closely resembles the Master Settlement Agreement, but that was a legal settlement and it happened way back in 1998 under Bill Clinton.

Can any readers explain? Or is this the Labour press office desperately trying to get the words 'Obama' an 'Miliband' into the same sentence?