Wednesday, 25 November 2015

Redefining freedom

I wrote a post for the Spectator yesterday about how the public health racket tries to redefine freedom. It was inspired by an Australian lobby group claiming that true freedom meant being ‘free from the fear that our children will be harassed by cigarette and alcohol advertising’.

It is a sure sign that a person is against freedom when they start trying to redefine it. Even politicians who espouse explicitly anti-liberal and anti-individualistic philosophies feel obliged to pay lip service to freedom from time to time. In The Doctrine of Fascism, for example, Mussolini wrote: ‘In our state the individual is not deprived of freedom. In fact, he has greater liberty than an isolated man, because the state protects him and he is part of the state.’

In this view, safety and freedom become one and the same, with true freedom coming from the state shielding its citizens from themselves. In Orwell’s Animal Farm, Squealer assures the animals that Napoleon ‘would be only too happy to let you make your decisions for yourselves. But sometimes you might make the wrong decisions, comrades, and then where should we be?’

I have mentioned before the Senate inquiry into the nanny state that is currently underway in Australia. If it does nothing else, it will at least start a dialogue about what it means to be free in a country where paternalism has been on steroids in recent years. Nobody wishes to be seen as being against freedom and yet the ‘public health’ lobby has an endless list of taxes, prohibitions and restrictions which implicitly assume that there is too much of it. The answer, as ever, is to redefine what liberty means.

Do read the rest...

Tuesday, 24 November 2015

Final thoughts on the Licensing Act

November 2005

November 2015. Plus ca change.

I've written a post for the IEA lifestyle blog about what happened after England and Wales relaxed their licensing laws ten years ago to the day. Go read that if you haven't already read Drinking, Fast and Slow.

I have one final observation to make, which is that the story of the last decade has posed a problem for the orthodoxies of the temperance/public health lobby. At the centre of their belief system is the Whole Population Approach (or Total Consumption Model) which says that reducing overall alcohol consumption invariably reduces alcohol-related health and social problems, even though those problems are caused by heavy and binge drinkers rather than the population as a whole. The theory, which was popularised by Geoffrey Rose, holds that the whole population changes its behaviour in tandem, so if moderate drinkers reduce their consumption, so will heavy consumers.

Because they are not targeting heavy consumers specifically, this means that any method of reducing per capita alcohol consumption should be effective. The three pillars of the 'public health' approach to alcohol are therefore remarkably similar to those of gospel temperance - ban advertising, restrict availability and increase price.

The fact that the increased availability that came with the Licensing Act coincided with a 20 per cent decline in alcohol consumption is therefore an inconvenient piece of information. Largely as a result of the British experience and other inconsistencies, even the WHO now accepts that the evidence linking availability to consumption is mixed.

Faced with this paradox, the pretend public health lobby could do what they often do and produce some black-is-white research claiming that all sorts of health and social problems related to alcohol are getting worse - indeed, the Institute of Alcohol Studies recently had a bash at doing this - but it would break their golden rule to admit that alcohol-related problems can increase while per capita consumption declines.

More suited to their hypothesis is the fact that alcohol-related violence and drink driving have declined while per capita consumption has declined. But it is clear that both of these trends began when alcohol consumption was rising between 1995 and 2004. Awkward.

Equally awkward is the effect of price. Alcohol became more affordable between 2004 and 2009 but then became less affordable as a result of falling real incomes and the alcohol duty escalator. And yet alcohol consumption fell at roughly the same rate in both periods. Temperance dogma says it should have risen and then fallen.

And then there are health outcomes. Alcohol-related hospital admissions have continued to rise, albeit at a slower pace than prior to 2005. Incidence of liver cirrhosis is still rising. They could claim that these increases are the result of the Licensing Act, but, again, they would have to explain why the fall in per capita consumption hasn't led to a decline in admissions.

Finally, there is alcohol-related mortality which has neither risen nor fallen since 2005. According to the Total Consumption Model, the kind of sharp decline in consumption seen in Britain in the last decade should have reduced mortality. Talk of a 'lag effect' is starting to sound a little desperate now that a decade has passed since consumption peaked. As Holmes et al. showed in 2012, the time lag between consumption falling and health outcomes improving is not supposed to take this long; much of it should be immediate.

In short, 'public health' dogma dictates that the Licensing Act should have led to more alcohol being consumed, more alcohol-related deaths and more alcohol-related crime. In fact, it has been associated with less alcohol being consumed, fewer alcohol-related crimes and the same number of alcohol-related deaths.

Time for a rethink?

Monday, 23 November 2015

Understanding the tobacco tax gap

HMRC published their latest estimates of the tobacco tax gap last month. This is the amount of tobacco smoked in Britain that is counterfeit or contraband.

The methodology of the tobacco tax gap is pretty crude. It amounts to this:

The estimate of the illicit market for tobacco is produced using a top-down methodology; that is total consumption is estimated, from which legitimate consumption is subtracted, the remainder being the illicit market.

In other words, they estimate how many smokers there are and multiply it by the estimate of how many cigarettes they each smoke. They then subtract the number of recorded sales - plus an estimate of how much is bought legally abroad - from the total and the figure that emerges is the amount of non-duty paid tobacco.

It's a cheap way of doing it (the better way - collecting discarded cigarette packs - is left to the tobacco industry) and it has been coming to increasingly unbelievable conclusions. The latest edition finds no increase in non-duty paid cigarettes in 2014/15 and a slight decline in non-duty paid rolling tobacco.

Since 2006/07, HMRC thinks the picture looks like this (albeit with wide confidence intervals)...

This suggests that the illicit trade is bigger than it was five years ago but smaller than it was before that. But is this realistic? HMRC's tobacco bulletin shows that there was a 28 per cent decline in (duty paid) cigarette sales between 2010/11 and 2014/15 (from 45.7 billion sticks to 32.7 billion sticks). That is a massive decline over a four year period. During the same period, (duty paid) rolling tobacco sales rose by only a little - from 6.2 to 6.7 million kilograms, the equivalent of half a billion sticks.

So we have legal cigarette sales falling by more than a quarter in the course of four years. What happened to smoking prevalence in that time? We don't have data for 2014/15 yet, but the ONS says that...

'Nearly one in five adults (19 per cent) aged 16 and over were smokers in 2013, a rate that although slightly less than 2012, has remained largely unchanged in recent years'

The smoking rate was 20 per cent in 2010. By 2013, it had dropped to 19 per cent. In other words, it fell by five per cent (in relative terms). If you factor in population growth, the number of smokers has declined by even less than five per cent. And yet cigarette sales fell by 21 per cent. A slight anomaly, no?

Given that legal cigarette sales have been falling at a far faster rate than has the smoking rate, how have HMRC avoided the obvious conclusion that more tobacco is being sold on the black market?

I wish I could answer that question. HMRC publish a methodological annex and I challenge anyone to read it without concluding that the whole thing is basically guesswork. A great deal depends on HMRC's assumptions, but these are rarely spelt out. As far as I can see, there are only two possibilities that could help explain why legal cigarette sales are plummeting while the smoking rate is not...

1. Smokers are smoking far fewer cigarettes
2. Smokers are buying more cigarettes on the black market

I haven't seen any evidence that smokers are smoking fewer cigarettes than they did five years ago - though they may be - and it is far from clear that HMRC have seen any such evidence either. They say they use data from the Opinions and Lifestyle Survey to estimate how many cigarettes smokers consume but I can't see any such estimate in it.

So, it's over to you, faithful reader. The number of smokers has barely dropped since 2008 and yet the number of cigarettes sold legally has dropped precipitously and the black market is - supposedly- roughly the same size. How do we square this circle?

Friday, 20 November 2015

Slides from a public health conference

It has been a theme of this blog in 2015 that commentary and satire is increasingly redundant when discussing the public health racket. All that is needed to discredit these lunatics is to repeat what they have said in their own words.

Take the Global Alcohol Policy Conference, for example. This taxpayer-funded event was held to give veteran temperance crusader Derek Rutherford a good send off and to pay homage to the Scottish National Party (which supports minimum pricing).

Most of the conference's Powerpoint presentations went online this week. I have only looked at a handful, but they drip with the kind of swivel-eyed extremism that can only come from living in an echo chamber. Anti-market, anti-individual and pro-government, the consumer is never counted as a stakeholder.

These people are obsessed with things they do not understand. Business, for one. Advertising, for another. They are obsessed not merely with the drinks industry, but with industry in general. And with so-called 'neoliberalism' (ie. anything that is not socialism).

Here are a few of the slides from the conference. As you read them, try to remember that they were put together by grown men, many of whom have letters after their name. They are academics. One of them has an OBE. These grown men doubtless spent hours preparing their presentations to ensure that the thoughts in their head were accurately and clearly transmitted to the audience. They were happy - proud, even - to stand by them in front of other educated, adult human beings. And now they want the general public to see them.

Gerard Hastings accuses a drinks company of 'grooming' teenagers.

It looks like a see-saw but is presumably meant to be a set of scales.
Oh no, free trade!
Hastings again.
A childish message amateurishly executed.

Hastings again.

This is how your taxes are spent. Good grief.

Monday, 16 November 2015

24 hour drinking - the debate

The tenth anniversary of so-called 24 hour drinking is nearly upon us. If you're in London tomorrow, do come and join us at the Institute of Economic Affairs for a debate about it. It should be lively, with the following speakers:

  • Christopher Snowdon, director of lifestyle economics at the Institute of Economic Affairs and author of Drinking, Fast and Slow
  • Jon Foster, Senior Research and Policy Officer, Institute of Alcohol Studies
  • Ian Graham, Central Licensing Unit, Metropolitan Police; Joint Chair of the National Police Chiefs Council Licensing group
  • Alan Miller, Chairman, The Night Time Industries Association
  • Stephanie Lis, Head of Communications, IEA (chair)
  • Brigid Simmonds, Chief Executive, British Beer & Pub Association

Click here for details. Please RSVP.

In the meantime, here is the video of the Maudsley debate on forcing psychiatric patients to stop smoking.

Friday, 13 November 2015

The magic of secondhand smoke

Here's another one to file under 'They Said It Would Never Happen'. The New York Times reports from the land of the free...

Smoking would be prohibited in public housing homes nationwide under a proposed federal rule announced on Thursday, a move that would affect nearly one million households and open the latest front in the long-running campaign to curb unwanted exposure to secondhand tobacco smoke.

The justification is hilarious, in a pathetic kind of way...

In moving to require the prohibitions across the country, federal officials say they are acting to protect residents from secondhand smoke, which can travel through walls and under doors

The claim that brick, plaster and cement are no match for wisps of smoke cannot be a misprint because it is repeated in a sycophantic New York Times op-ed titled 'They're coming for your cigarettes. But that's OK' (yes, it's OK, citizen, go back to sleep)...

The problem with your cigarette is that it sends secondhand smoke through your walls and doors and into your neighbors’ noses

The thing about smoke, as you cannot fail to have noticed, is that it rises due to being hotter than the air around it. You don't need to understand basic physics to know this, although it helps. Strike a match, light a candle, spark up a cigarette. Observing fire in any context demonstrates the same thing. The idea that smoke typically creeps 'under doors', down corridors, under more doors and 'into your neighbours' noses' should strike any journalist as being questionable, to say the least.

As for smoke travelling through walls, I really don't know where to begin. I'm not sure which is scarier, governments banning people from smoking in their own homes or the bizarre motivated reasoning that compels journalists to write things - in such a matter of fact way - that are not so. This is not even pseduo-science. It is anti-science.

Back in 2010, there was the guy who claimed that secondhand smoke travelled 'along plumbing and electrical lines', but he was manifestly a bit odd. This, by contrast, is the newspaper of record in the most powerful country on earth.

It's easy to laugh at the superstitions and crackpot beliefs that flourished before the Enlightenment. Increasingly, we have little to feel superior about.

Thursday, 12 November 2015

Why psychiatric patients should not be forced to quit smoking

I spoke at the Maudsley debate on banning smoking outdoors in psychiatric hospitals yesterday. This is more or less what I said...

I’ve never been in a psychiatric hospital and I don’t smoke any more. But it’s because I used to smoke that I know how enjoyable it is, what a comfort it can be, and how difficult it is to give up. Let’s be blunt about it - giving up smoking is a miserable experience. It makes you miserable even if you are fully committed and totally prepared for your quit attempt. Being forced to quit by somebody else when you least expect it must be worse. Being forced to quit when you have been taken from your home and put in unfamiliar new surroundings with total strangers must be almost unbearable. And forcing somebody through all that when they are suffering from a serious mental illness and are at the lowest point in their lives is, I will argue, vindictive and inhumane.

Why should they be put through this? According to the proposition it is because smoking is bad for their health. Smokers live shorter lives, on average, than nonsmokers. But this is true of all smokers, not just those who are suffering from mental health problems. Why, then, are they picking on them?
I think the answer is simple. It’s because they can - because they are easy targets. The medical establishment would happily ban us all from smoking if they could, but that prize is not yet in reach, and so they have turned their attention to those who are already under the government’s total control. 

In the recent BMJ head-to-head, the proposition said:

‘Some smokers with psychiatric disorders think that smoking can help them to manage their symptoms and relieve stress and don’t want to quit. We respect that view but point out that smoking has no positive effect’. 

The obviously contradicts the views of thousands of people with a mental illness who smoke, not to mention the billion or so smokers around the world who keep buying a product that supposedly has no positive effect. More to the point, it goes against the evidence that Simon and Deborah cite in their article - a 2013 report from the Royal College of Physicians which found, and I quote, that ‘nicotine can relieve symptoms of anxiety, depression, schizophrenia and ADHD’.  

Rather than attributing false consciousness to millions of people, let’s be honest and say that the problem with smoking is not that it has no positive effect, it is that it has negative effects. If smoking wasn’t bad for your health, most of you would be smokers, as you would have been if we were holding this debate in 1950. Most of you are not smokers because you are prepared to sacrifice the pleasure of smoking for the chance of better health in the future. You are making a personal trade off and psychiatric patients should be allowed to make their own trade off.

Their trade off may be different to yours, but then their circumstances are very different. It’s well known that people with mental illnesses are much more likely to smoke than the general population, with rates of up to 90% amongst people with schizophrenia. Although smoking rates have fallen in general over the years, there has not been much of a decline amongst people with mental illnesses. Perhaps the proposition think that people with mental illness are more susceptible to those colourful cigarette packs that we keep hearing about, but a more obvious conclusion to draw is that people with a mental illness get a greater benefit from smoking than the average person, and indeed there is good evidence that symptoms, particularly for schizophrenia, are alleviated by smoking. But even if smoking didn’t have particular neurobiological benefits for people with mental illnesses, it would still be a source of pleasure and comfort for them. It would still give them something to enjoy and look forward to during those long, traumatic days on the ward. And even if Simon and Deborah deny the benefits of smoking, I trust they do not deny that the existence of withdrawal symptoms which are strong enough to make 19 out of 20 quit attempts end in failure.

And so, added to the other problems that the patient suffers from, they will be forced to endure withdrawal in their new home - and never forget that this is now their home. Whether this results in the kind of violence seen repeatedly in prisons around the world when smoking bans have been introduced remains to be seen, but it will certainly lead to resentment, anger and a breakdown in trust between staff and patients before they’ve even got to know each other. The patient will know that there is a place outside where they could smoke and they will know that they are forbidden from doing so for no other reason than that their captors have decided that it’s for their own good. Not for the good of their mental health, which is the only reason they are there, but for their long term physical health - the benefits for which will be practically nil in any case because the majority of psychiatric patients resume smoking almost as soon as they are discharged.

In 2006, when the medical establishment was pushing for a ban on smoking inside psychiatric hospitals, the King’s Fund released a report supporting the ban, in which it said:

‘To those who are concerned that the proposed Health Bill infringes smokers’ rights, it is important to point out that the ban will prohibit only indoor smoking and that patients will still be able to smoke outdoors’.

How quickly we move on. How quickly these little assurances turn to dust. 

It also said:

‘The choice to smoke or to quit must ultimately be a private decision for the individual, and given that many psychiatric patients are detained compulsorily, it is right that proper consideration is given to the degree of choice that they will be able to exercise.’

That should be nothing more than an obvious truism. It is a choice for the individual. It is an abuse of power for medics to use the fact that they have custody of somebody to force them to act against their will and, in most instances, against their interests.
This is really quite simple. A psychiatric patient smoking outdoors is causing no harm to anybody. In a liberal society, that is the end of the story. A ban cannot be justified. Clearly there are people who don’t smoke, who hate smoking and apparently don’t understand anything about smoking, and they will always think that smokers are making the wrong choice, but that’s not their decision to make and it does not justify the use of coercion. Please show that you still want to live in a liberal and humane society by voting against this motion.


We lost by one vote. There should be a video of the event online soon.