Liberal Vision

Soviet Style Alcohol Suppression Campaign Called for By Public Health Activists

As someone familiar with cutting edge science and those who work at the frontiers of medical research, I have always been struck by the backward totalitarian nature of public health. In a world in which hard science and enlightened medical opinion is positively buzzing about personalized medicine and the benefits of treating people as individuals, public health continues to push ideas that are more in keeping with early 20^th century totalitarian doctrine then 21^st century medicine.

ASH is of course one of the biggest culprits. Completely closed to the concept of constructive debate it spreads its misery through quasi-religious adherence to strict dogma and increasingly ridiculous attempts to claim that all opposition to its policies are the result of tobacco industry conspiracies. The similarities between the rhetoric of ASH and the propaganda of the former Soviet Union is quite uncanny at times but as far as I know, ASH has never actually advocated Soviet policies. I am sure that its employees would do if it suited the cause and involved more free money from the taxpayer but the opportunity seems not to have arisen.

However, the same can no longer be said for their cousins in the neo-prohibitionist movement who are now openly advocating that the UK government take its lead on alcohol policy from the Soviet Union. In an academically inept, blatantly political piece published in The Lancet, a group of liver doctors who in their conceit, believe themselves experts on the causes of alcohol abuse rather than its consequences, propose Gorbachev’s 1985 crackdown on alcohol in the Soviet Union as a template for alcohol control in the UK.

The Lancet article is a rework of last year’s effort in which the authors made the embarrassingly simplistic claim that the decline in French liver deaths was down to an alcohol advertising ban. Both were uncritically covered by the BBC whose representatives have assured me that they have no bias when it comes to public health despite the fact that they showcase minimum price campaigners however obscure on what feels like a daily basis.

This year Gilmore et al wax lyrical about Soviet Russia and how it achieved a 12% reduction in alcohol related mortality in just two years. The implication being that our government would see similar results if only it would do what the neo-prohibitionists ask of it. Minimum pricing is of course at the top of their list because  such a policy, although likely to be utterly ineffective in the form currently advocated, will give them a powerful lever with which to control the proletariat as they ratchet up future campaigns.

History sees Gorbachev as a heroic reformer in many senses, but he had no qualms in using the full power vested in him as an autocratic dictator to press home an aggressive anti-alcohol policy. Measures included:

• Closing  vodka distilleries
• Destroying  vineyards in the wine-producing republics of Moldavia, Armenia and Georgia
• Restricting the times during which shops and restaurants could sell alcohol
• Banning restaurants from selling hard liquor
• Raising the legal age for alcohol consumption from 18 to 21
• Effectively increasing prices by over 75%
• Creating a state sponsored temperance society that grew to 14 million members

His policies were as our neo-prohibitionist friends tell us immediately successful and he achieved a short term significant fall in alcohol related deaths. The price of vodka rose by 25% in 1985 alone and by a similar amount in the following year. The Lancet article unsurprisingly fails to mention the longer term consequences of the campaign.

Although Gorbachev did theoretically reduce legal alcohol consumption by 50% according to some estimates, the Russians have a long tradition of distilling their own firewater known as Samogon. The state crackdown:

• Stimulated the illegal alcohol industry
• Galvanized organized crime to take advantage of a burgeoning black market
• Led to an increase in deaths from poisoning caused by illicit alcohol.

By the third year of the campaign, despite severe custodial sentences being in force for home brewing, illegal Samogon was being consumed in larger volumes than legal alcohol, the policy was hugely unpopular, it was costing the government a fortune in lost revenue and it had significantly benefited organized crime. It was abandoned in October 1988.

The fall in alcohol related deaths seen in the early days of the campaign was rapidly reversed and increased above pre-legislation levels to peak in 1994.

Some will argue that had the Soviet Union persisted with its vigorous campaign, the fall in deaths during the first 18 months would have continued and the end would have justified all of the repression. So it is worth pointing out, bearing in mind the UK activist’s obsession with price, that the increase in alcohol related deaths in the early 90s took place against a background of high prices for legal alcohol that was a legacy of the Gorbachev campaign. Although some aspects of the campaign were reversed, the price stayed 75% above 1985 levels during the Russian mortality crisis of the early 90s.

Others, including some who claim to be liberal, will of course assert that the Soviets did not go far enough. Perhaps they never thought of putting vodka in olive drab bottles with massive pictures of diseased livers on them? You can be sure that Ian Gilmore has.

By Chris Oakley. Chris has previously posted on Liberal Vision:  Alcohol Taxation: The truth, the whole truth and nothing but the truth, A Liberal Tolerant nation? and  What hope is there for liberty if truth becomes the plaything of political lobbyists.

Our thanks to englishrussia.com for the poster.

Tags: alcohol, Gorbachev, prohibition, The Lancet

Alcohol taxation: the truth, the whole truth and nothing but the truth

“The truth, the whole truth and nothing but the truth” is what we swear to do when we testify in court and perhaps our world would be a better place if society encouraged that approach in public life. Sadly society doesn’t so it seems to be increasingly acceptable to tell half truths and even clever lies if they are “on message” or “advance the cause” and as a result our lives are increasingly governed by partial truths and spin.

Notable recent examples are activist’s persistent claims that social problems with alcohol are caused mainly by the “real price being less than it was 30 years ago” or “alcohol being cheaper than it has ever been”. The price /affordability confidence trick has been exposed before, but as the guilty include senior medics and the media still don’t seem to have worked it out yet, here is a step by step look at how the confidence trick of affordability indexes works. This requires no special expertise and the NHS /ONS statistics on alcohol are available to all.

Most people think of real price as the price of a product relative to all other products so using the term “real price” implies that alcohol is cheaper now than in the past taking into account inflation.

The reality is that alcohol has increased in price relative to RPI by 22.9% over the last 30 years according to the NHS as shown in Figure 1.

Figure 2 gives some insight into how health campaigners arrive at their claims. It shows the “affordability” of alcohol and we see that alcohol has indeed become more affordable over time. Some activists do recognize the difference between affordability and price but stop short of telling the whole truth by not mentioning what is driving affordability.

In the interest of the whole truth we need to provide context, which Figure 3 does by including the affordability of all goods using the same measure. Without context such indexes are deceptive.

Affordability indexes are simply price relative to RPI plotted against household income relative to inflation. The driver behind alcohol affordability is not “real”price but disposable household income which has risen significantly above inflation since 1980. As a result alcohol has become more affordable but less so than other RPI goods. The “real” affordability of alcohol relative to all RPI goods is shown in Figure 4.

Whilst we might expect the deception that confuses price and affordability from activists, it is worrying that Figure 2 is the only graph featured in the NHS Alcohol Statistics from which I derive all the data used here.

When household disposable income is corrected for baseline and inflation:

Affordability of alcohol = (Household disposable income / ((Alcohol Price Index/RPI)*100))*100

= (177.5 /122.9)*100 = 144

Affordability of all RPI goods = (Household disposable income / ((RPI/RPI) * 100))*100

= (177.5 /100)*100 = 177.5

So increases in alcohol taxation called for campaigners would not be a response to falling prices as they have claimed but an affluence tax.

Some might argue in favour of sin taxes based on relative affluence and a link between alcohol taxation and disposable income but activists are not campaigning on that basis. Backed by an uncritical media, activists have grabbed the attention of politicians by popularising the myth of ever increasing consumption driven by ever decreasing prices despite the ONS data pointing in the opposite direction.

We hear that more young people are damaging themselves with alcohol these days and who better to make the point than liver doctors who can be rightly considered experts in the consequences of alcohol abuse. However, they are not experts on the economics of our relationship with alcohol and it is conceit for them to assume expertise on the causes of what is a complex social problem.

Despite this, activists waste no opportunity to inflict their evangelical views on the nation. Here is the BBC reporting senior medic and activist Ian Gilmore

“Sir Ian told the BBC there had been a ‘very close link’ between the falling prices in real terms over the last 20 years and the amount Britons drank“

The ONS has only begun recording total (at home and outside the home) household consumption recently but based on the data since 2001 I beg to differ. Figure 5 shows the percentage change in consumption and the alcohol affordability index from a 2001 baseline. I see no “close link” using this data or any other consumption data.

As a father of two teenagers I am all too aware of the pitfalls faced by young people in our modern society. It would be helpful if we could rely on our political and medical establishments to guide us, but we cannot as they are clearly averse to telling the whole truth or even most of it unless it suits their agenda. It would be wonderful if any political party owned up to the lack of honesty in public life and did something about it. Or am I alone in expecting people with knighthoods to be honest?

By Chris Oakley. Chris has previously posted on Liberal Vision A Liberal Tolerant nation? and  What hope is there for liberty if truth becomes the plaything of political lobbyists.

Tags: alcohol taxation, Ian Gilmore, NHS Alcohol Statistics

What hope is there for liberty if truth becomes a plaything of militant lobbyists?

Tobacco was unfortunately very much in the news again recently with the BMA launching a campaign to ban smoking in cars probably as a prelude to what will then seem a more reasonable move to get it banned when children are present. I want to focus here not on the ban but on the methods being used by its advocates.

On Radio 4s Today programme Vivienne Nathanson of the BMA was questioned about her evidence:

Nathanson: Well, the evidence is, in fact, that the levels of toxins that can build up in a car do reach 23 times the levels in a smoky bar…

Interviewer: And that is—sorry to interrupt you—but that is peer-reviewed?

Nathanson: Yes, absolutely.

Interviewer: Everyone in the scientific community accepts that it’s true?

Nathanson: Absolutely.

The BMA has since issued a major correction and apology with the explanation that the mistake was caused by human error.  These things happen but as Head of Science and Ethics, Nathanson has a duty to check. I find her glib assertions regarding peer review and scientific consensus indefensible. It is hard to see how they could be made in error.

The same day over on Radio 5, a phone in caller queried the general evidence base for passive smoke harm and Deborah Arnott of ASH countered by emphasizing claims that heart attacks have been reduced by smoking bans:

“There’s very good evidence supported by the BMA, the Royal College of Physicians, the World Health Organisation, the Standing Committee on Tobacco & Health which reported to the Department of Health. The Coalition Government very recently conducted a review of smokefree legislation, and what we’ve seen is a significant decline in heart attacks following the implementation of the legislation. The evidence is incontrovertible.”

In response to criticism that a fall in heart attacks in England post the 2006 Health Act was part of an existing trend, she said:

“Yes, but the decline is greater than trend. And that’s in a peer-reviewed article published in a very reputable journal, and it’s been found not just in England, Scotland, but everywhere that smokefree legislation in public places has been brought in.”

The statistics on heart attack hospital admissions in the UK are freely available to all on line. Here is a link to the NHS data for Scotland.

Using the measure preferred by the tobacco control industry and the hospital admissions data from NHS statisticians (table AC5) we can calculate emergency admissions for heart attacks as follows:

12 months pre ban:             7905
0-12 months post ban:        7250        (-8.29%)
12-24 months post ban:      8913        (+12.75%)
24-36 months post ban:      7707        (-2.50%)

() = % change from pre ban baseline

The word Arnott used was incontrovertible, the claim is a 17% reduction and the intervention was presented by some supporters as certain to have an immediate major impact on public health. Taking all that into account we should see a consistent, trend independent effect in the public record but whichever table or measure we use it is impossible to objectively claim that such an effect exists.

I value sober analysis of NHS statistics more than I do articles authored by tobacco control activists, peer reviewed or otherwise. I am not alone in this view and it is unlikely that Arnott is unaware of the serious credibility issues facing all the studies that support her claim or indeed of the existence of other work that contradicts it. The evidence is very far from incontrovertible.

Arnott is a skilled professional propagandist who is all too aware that, whatever the actual truth; provided that she sounds convincing her version will be believed by enough otherwise ill-informed people to achieve her objective. An article here gives some insight into her personality and the nature of her campaign.

Arnott is correct in saying that there has been a peer reviewed publication in the BMJ that supports her claim.  It claims a 2.4% decrease in heart attacks due to the ban but fails to adequately explain how the result was arrived at. This approach is sadly increasingly common in medical journals. Bearing in mind Arnott’s comment on trends, it is notable that, according to the NHS, the overall decline in heart attacks for the 12 months post ban was 4.26% compared to a 5.19% decline 2 years before the ban. The post ban decline was in fact neither large nor significant. The BMJ paper was produced by a team led by Anna Gilmore.

Arnott is also correct in saying that there has been a review of the 2006 Health Act. It was written by Linda Bauld.

The authorship of both these papers throws up some very searching questions about ethics at the Department of Health. Surely in a society that allegedly values honesty and transparency we have a right to expect government to review policy and measure its efficacy using the most qualified, objective and unimpeachable resources available. Why then did the DH directly commission two not especially qualified people both of whom have a notable history of anti-tobacco activism? The results were hardly likely to be seen as either credible or objective.

ASH is largely funded by the Department of Health and appears to be in firm control of the government’s agenda.

How can we possibly have a free and liberal society if we allow the truth to become the property of pressure groups directly funded by government departments?  The principles at stake here radiate way beyond tobacco. We urgently need to reform the charity sector and I would suggest also the Department of Health.

Thanks to Chris Snowdon and Frank Davis for giving their time to transcribe the radio interviews.

Written by Chris Oakley.

Tags: Andrew Lansley, ASH, BMA, Deborah Arnott, Department of health, Smoking in cars, tobacco, Vivienne Nathanson

Our influence on NHS reform

In May we made a prediction for the great health reform debate:

“If as expected it concludes with some ‘minor concessions well spun’, no one will be pleased. A thousand authors will claim the credit. The Conservative backbenchers have already starting highlighting their own influence.”

This was unfair. The spinning has been magisterial, a master-class in repackaging that has silenced or baffled most critics, whilst leaving what were quite modest reforms largely unchanged… only masked in complexity and rhetoric where previously there was a dangerous level of clarity.

For example, Monitor, the health service regulator, previously, was to encourage competition.

Now it will only do that if patients benefit… which is no change at all… competition tends to keep providers in check to the benefit of patients… monopoly does the opposite.

It will encourage integration, collaboration, and choice… all of these things exist in competitive markets.

If any of these objectives collide, it is really very simple… they will be integrated, competitively… or the regulator will encourage parties to choose to collaborate…  unless that involves competition… in which case an integrated patient benefit test will apply… or Monitor will choose from several competing tests… some requiring collaboration from other regulators… unless those are rationalised in order to encourage integration… in which case it will be passed back to the Secretary of State to choose… or collaborate with his colleagues… or pause for a genuine listening exercise… or flip a coin…

The regulatory governance of the NHS is now at least as comprehensible as that of the Liberal Democrat Federal Party.

Never let it be said we are not reshaping Britain in our own image.

Alarming Clock-Up

Rumour reaches us that a senior member of the Cabinet has started referring to Nick Clegg’s pet phase as “the people Nick Clegg likes to call Alarm Clock Britain”. A helpful clarification, and touchingly loyal.

It is hard though to find commentators with a good thing to say about this phrase. Who after-all wishes to be associated with a thing that forces you out of bed.

Liberal Democrat activists tend to pause before commenting, usually adding, ‘well of course he means people who work’. To be entirely correct they should add ‘and are lower rate tax payers’… ‘with children’… and ‘get on with stuff’. Obviously… clear as mud…

No one is entirely sure who isn’t ‘Alarm-clock Britain’. Students before the new policy? Pensioners? The dead?

Much commentary then, of which a selection below, is incredulous.

“What the hell or rather who the hell is he talking about?”

“they mean pretty much the same group of people that Ed Miliband called “the squeezed middle”

“it’s a group he defines in the vaguest, most frustrating terms possible – almost as if he doesn’t really know what the hell he’s going on about.”

“I don’t know one single person who really resonates with the phrase.”

“‘Alarm clock Britain’ is the new political label for hard-working ordinary people. How patronising.”

The brave genius behind the phrase, is… no one:

“Lib Dem insiders the phrase has no single author, insisting it was a “team effort” among Mr Clegg’s aides and colleagues.”

A sure sign no one wishes to carry the can. As a result John Sharkey (ad-man) and Richard Reeves (wonk) often get fingered by the commentariat. How unfair.

There’s nothing new about political labels designed to capture a section of voters with whom politicians wish to associate.. “Mondeo Man”, “Worcester Women”, “Soccer Moms”… and so on.

 In marketing, such segment labels are useful short-hand for groups with common but complex characteristics.  

But they are only normally used inside campaigns. Devising a conscious strategy to sound like you’ve just emerged from a creative brainstorm with 10 year-olds high on fizzy pop, is quite novel.

However two months of non-stop abuse about this has not stopped the DPM putting it into his conference speech five times and using it as the headline for his Budget communication. He appears to have remarkable resilience to the sound of bells.

Any phrase that needs to be explained, every time it is used, is not a helpful short-hand.

Any phrase that makes Nick sound like a visitor from planet Alarm-Clock, in need of a Clegg-to-human translator, is unlikely to improve his reputation.

Anything so obviously flakey that didn’t get shot down in flames by his team or the MPs, suggests a degree of group-think is creeping into the bunker. That’s dangerous.

George W. Bush was always very good at getting himself out of his innumerate communication cock-ups with folksey charm. He would frankly admit his errors, shrug, and move on. He made his weakness for gaffes an endearing strength.  

Nick, or “Calamity Clegg” as his erstwhile leadership opponent used to call him, might do the same… “it sounded great when we threw it around the team, but on reflection…”

The alarm-clock is ringing Nick… are you listening?’