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Minimum pricing – policy based evidence

November 28th, 2012 Posted in BBC, health, pseudo science by

Based on the output of the English media, one could be forgiven for not having noticed that Scottish ministers appear to have shelved minimum alcohol pricing ostensibly due to legal challenges. It will be unfortunate if minimum pricing is shelved solely on the basis of illegality because the lessons to be learned from the attempts to justify it via policy based evidence will then once again go unheeded.

We hear much talk of evidence based public health policy these days but what we actually get is “evidence” concocted to suit policy. The public health industry seems utterly incapable of delivering honest, objective, scientific evidence and the media contributes to the problem through lazy uncritical reporting combined with establishment bias. This was typified by the BBCs response to being caught out making wild claims about the number of lives minimum pricing would “save” amongst pensioners.  Rather than investigate the obviously questionable reliability of its source, the BBC simply accepted a lower but no more credible number.

The BBCs source was The University of Sheffield, which has now received involuntary taxpayer funding from two governments and a public broadcaster. On each occasion the motive has been the gathering of policy based evidence and it appears that neither the politicians nor the media appear to care how dubious the quality of that evidence is provided that it suits their purpose.

Petr Skrabanek in his 1994 work The Death of Humane Medicine cited Nobel laureate Irving Langmuir from 1953 when making a case against the “science” that underpins public health. He wrote that it “accepts evidence not according to its quality but according to its conformity with a foregone conclusion”. It seems that his wise observations have been ignored because the ersatz science that provides the “evidence” for policy interventions is nowadays more prevalent than ever. The University of Sheffield study provides a classic  example of this anti-science in which every supportive scrap of data, however poor in quality  is treated as “conclusive” or adding to a “growing body of evidence” and every contradictory piece as “flawed”, “controversial” or “in need of further research”.  Evidence at odds with the authors’ predetermined conclusions is often simply ignored. Take for example evidence statement 13:

“There is consistent evidence to suggest that alcohol consumption is associated with substantially increased risks of all-cause mortality even in people drinking lower than recommended limits, and especially among younger people. High levels of alcohol consumption have detrimental effects. The evidence is more equivocal, however, where it relates to establishing cut-off points for lower risk versus harmful levels of consumption. There is an ongoing controversy as to whether or not there are beneficial (cardio-protective) effects at low levels of alcohol consumption.”

This statement is an extremely misleading interpretation of the available evidence. There is no excuse for this form of words appearing in a document paid for by public funds and intended to guide politicians who are not versed in the subtleties of public health disingenuity. Hiding behind theoretical and contestable risk factors, the authors peddle the scientifically improbable but politically powerful concept of “no safe level” whilst ignoring a large body of evidence showing teetotallers to have lower life expectancy than moderate drinkers.  I could write extensively about the “controversy” they refer to but Christopher Snowdon already covered it in some detail.

Unfortunately this is not an isolated example in a production that goes to extraordinary lengths to provide policy based evidence.  The other “evidence” statements display a similar lack of objectivity and, despite using the Household Survey data provided by the ONS as a basis for much of their modelling, the authors ignore it when considering consumption at the population level.  They open their section on areas for possible future research (and of course more taxpayer funding) with the typically convoluted sentence:

Given the trends in consumption over the past ten years it is unlikely that a ‘do nothing’ policy would result in no change to the consumption of alcohol in the population.

It is hard to tell, but I think that they are trying to say that consumption is trending up so government MUST act. This is a remarkably inept statement to make in the middle of a trend that, according to the ONS has seen household consumption decline by 20% in a decade without any significant government intervention.

I find it hard to understand why politicians continue to pay homage to what Skrabanek described as healthism despite the huge flaws in the “evidence” that underpins it being repeatedly exposed. Perhaps Skrabanek gives some insight into the reasons when he writes:

Politicians find the facile rhetoric of healthism rewarding. It increases their popularity at no cost, and it enhances their power to control the population. It meets no resistance from the opposition, who promise to improve the ‘health of the nation’ even more.

Robin Fox, former editor of The Lancet describes Skrabanek as a “humorous man of immense culture and learning” in the Preface to The Death of Humane Medicine and despite not completely agreeing with Skrabanek’s pessimism, goes on to add that he “speaks many truths that we should heed”. I cannot help but feel that the world would be a better place if politicians, journalists and others did heed the words of this humorous, cultured medical man above the strident clamour of the health zealots. After all, without aggressive healthism there would be no need to insult our intelligence with pseudo-scientific policy based evidence and I sincerely doubt that the public would bemoan redundancies amongst the social “scientists”, non-practicing medics and psychologists who contribute to its socially divisive message. I doubt that these commenters on the BBC’s umpteenth plug for minimum pricing would mind at all:

For anyone who empathizes with Bauer and /or who is interested in a more liberal and less miserable future I recommend reading Skrabanek’s book which can be downloaded for free here.

By Chris Oakley. Chris’ previous posts on Liberal Vision include:  Alcohol is Old News – Minimum Pricing for Digestives is the “Next Logical Step” , Soviet Style Alcohol Suppression Campaign Called for By Public Health Activists , Alcohol Taxation: The truth, the whole truth and nothing but the truth Lies, damn lies, statistics &…

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