Liberal Vision

BMA: it it moves tax it, if it still moves ban it

In its latest attempt at extreme social engineering, the increasingly preposterous British Medical Association (the trade union for doctors and medical students) is today demanding a 20% tax on sugary drinks “to subsidise the cost of fruit and vegetables”.

What they don’t mention, but what Christopher Snowdon points out, is that:

“The BMA don’t mention that their soda tax will cost the public £1 billion a year, nor do they acknowledge that it would be deeply regressive. Indeed, they want to make it more even more regressive by taxing fizzy drinks (which are disproportionately purchased by people on low incomes) and use the money to subsidise fruit and vegetables (which are disproportionately purchased by people on high incomes). Nice.”

You may be surprised at that. Particularly when you consider that the BMA rejected a fat tax back in the summer of 2012 because:

“The idea of a fat tax on unhealthy food was rejected because it would have an unfair impact on people from a disadvantaged background.”

How is a tax on sugary drinks any different from a tax on fat? [Joined up  thinking ? I don’t think so]. But then again we should not be surprised at the lack of consistency in BMA proposals, or the absence of science-based thinking when it comes to its policies. This publicity-hungry, industry-hating trade union seems to have a policy of acting first and thinking afterwards.

This, after all, is the body that secretly awards its senior staff pay hikes of up to 137% – without bothering to inform its members. And a body that seems to have scant regard for the truth – with BMA spokespeople taking to the air to spout downright lies in support of their extreme views on ecigs and smoking.

That particular trait, of “massaging the facts” to suit the narrative, is displayed yet again today with its claims on sugar. As reported by Mr Snowdon:

“In the pages of The Guardian, their spokeswoman, Sheila Hollins, resorts to flat out lying…

“We know from experiences in other countries that taxation on unhealthy food and drinks can improve health outcomes, and the strongest evidence of effectiveness is for a tax on sugar-sweetened beverages.”

…..”[Mr Snowdon writes] the evidence on sugary drinks, in particular, is consistent in finding little, if any, change in patterns of consumption and no change at all in ‘health outcomes’, including obesity (see here and here for a summary).”

It is also the body that has consistently promoted a whole raft of policies which are potty at best and downright dangerous at worst. Here is a taster of some of its recent ludicrous proposals:

Ecigs – In December 2013 the BMA wrote to a number of football clubs urging them to end sponsorship deals with e-cigarette companies “smoking products” and to ban the use of e-cigarettes at their football grounds. [Err no e-cigs are not a “smoking product” – do at least get your facts right].

ECigs – The BMA has also been at the forefront of those demanding that all e-cigarettes are forced to be licensed medicinal product, and in the BMA’s 2014 annual meeting, it’s members called on governments to prohibit ‘vaping’ on e-cigarettes in public places where smoking is prohibited. [Hmm send them outside to smoke real cigarettes rather than vaping indoors – that will improve health [not].

Alcohol – In Jan 2015 the BMA demanded that politicians introduce a minimum unit price for alcohol. [Errm thought you were against regressive taxes? So middle classes can drink their French Chardonnay, but those on low incomes should be priced out of the market. This is prohibition for the working classes.]

Alcohol – In June 2015 the BMA called on all UK governments to introduce “clear and unambiguous” health warnings on alcohol. It also called on additional measures that “limit the affordability, availability and promotion of alcohol”. [Just to be clear will you restrict when I buy my alcohol from Ocado, or when they deliver it? Oh I forgot, you only wish to restrict those on low incomes from buying alcohol, not the middle classes with a credit card and an au pair at home to take delivery].

Alcohol – In June 1025 the Scottish BMA called on a ban on all alcohol advertising on television before 9pm “watershed”. [That might have worked in the 1970’s – but honestly.. in 2015?].

Alcohol – In July 2014 BMA in Northern Ireland called for a reduced hours of sale for alcohol. [Yep, let’s drive consumption out of pubs with responsible landlords and towards drinking in the home, because that is bound to work [not].

Smoking – In June 2015 – rather than vote FOR the legalisation of cannabis, the trade union voted for a BAN on the sale of all cigarettes to those born after 2000. Yes really, by 2030 you would” need ID to prove you were 31, not 30, to buy cigarettes”. [Well it was only a matter of time before they called for prohibition… Because that obviously works [not].

… that is to list but a few of BMA’s proposals. There are many more.

The BMA demand for a tax on sugar is yet another head-line grabbing, ill-thought through, plan, all too similar to those above: demonise industry; hit those on low incomes; tax where you can and ban where you can’t.  It is an archaic approach not fit for the 21st century.

It claims to want a comprehensive approach to “tackling obesity” and, it says, it sees  its role as “supporting the government and other stakeholders in taking action“. Sorry, but that claim rings hollow. You only have to read the foreword of the latest booklet to see the BMA’s primary objective – to end the relationship between Government and [one of the key stakeholders] industry.

“Addressing the commercial influences that have such a strong impact on diet will be key.”

“These range from the way unhealthy food and drink products are promoted and made widely available and affordable, to industry influence on the development of food and nutrition policies.”

“Without a stronger regulatory framework, commercial interests will continue to overshadow public health interests.”

“Many of these [measures] will not sit comfortably with the government’s approach to partnership working with industry.”

“My belief is that it is commercial interests that are excessively influencing people’s decisions about their diet.”

“How can we expect a child to develop normative behaviours about eating healthily when so many of the messages they are exposed to promote the opposite?

I don’t know which supermarket BMA bigwigs shop in, but when I go into a supermarket my problem is choice, not lack of it. Alongside normal coke I am offered Diet Coke [No sugar] “Coca Cola Zero” [No sugar] “Coca Cola Life” [Lower calorie sweetened using natural sources].. oh and “Caffeine Free” [also “lower calorie”]… and all with calorie content clearly shown on the tin.. if I care to look. I can also buy in a range of sizes from 150ml mini-cans, all the way up to 1.75 litre bottles, if I wish to limit portion size at any point.

And just in case that is not enough for you Coca Cola has, since 2012, reduced the average calories per litre in its sparkling drinks by 5.3% ; reduced the calorie and sugar content of Sprite, Dr Pepper, Fanta Fruit Twist and Glaceau Vitaminwater by more than 30% ; and increased its marketing budget in zero calorie colas by 52%. All as part of its “responsibility deal” with Government. I can also go to the Coca Cola calorie counter, where I see what exercise I can do to work of the calories in one can (11 minutes of squash or 32 minutes of pilates, (or if you prefer 19 minutes of stair climbing or 70 minutes of ironing) to work off 139 calorie can of normal Coca Cola.

Where is the praise from the BMA about how much has been achieved? How much of that would have been achieved if Government had opted to demonise the industry rather than working with it?

Moving away from all things fizzy, how much more could be achieved if this Government-industry relationship was extended to e-cigs and tobacco? Think of the public health advances that could be achieved if  Government worked with the tobacco industry on reduced risk products [such as PMI’s “heat not burn” products] rather than absurdly excluding them from an increasing number of conversations?

It is time for doctors to take back the BMA, sacking the self-serving fat cats at the top of this body, banging on like an old record about taxes and bans and little else. Surely they can see that the BMA is a fast-fossilizing dinosaur, desperately determined to remove all voices from the health debate except its own, regardless of the consequences. If they can’t see it, or won’t do anything about it, then public health is truly not safe in their hands.

Tags: alcohol, BMA, Cigarettes, Coca Cola, e-cigarettes, e-cigs, smoking, sugar tax

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

Ban the barmy BMA somebody please..

I feel a rant coming on.

The BMA has announced that we should “become the first country in the world to introduce a comprehensive ban on alcohol advertising, sponsorship and promotions in an attempt to curb the binge drinking culture”.

 Where do i start ? We have had a binge drinking culture since Mead was the drink of choice and good Saxon girls were told on their mothers knee to avoid marauding Scandinavians. I do not believe that was because there were huge advertising boards on the beaches of East Anglia recommending the local Saxon ale. And Lets be clear. We have some of one of the strictest alcohol advertising codes in Europe.

And what is all this about banning alcohol sponsorship? The BMA might want us to believe that because a football tournament is sponsored by Carling, the amount of lager we consume rises dramatically as a result – but it just doesn’t. People drink prior and post a football match because, for many, it’s part of the Saturday afternoon ritual. And a quaffing a pint of beer before a rugby game or a having a glass or two of chilled chablis on a Sunday afternoon watching the cricket, are all essentially British pastimes. Sport benefits massively from the injection of finance and support at every level of every game down to local pub footie and cricket teams. Banning sports sponsorship won’t change our behaviour at the game or at home so sod off and leave our sports alone. It’s tough enough right now without the doctors trade union getting involved.

What is really frightening is that IF these suggestions are taken up, how long before they realise that actually the ban on advertising alcohol did NOT stop the drinking levels in the UK after all . What next ? Will it seek to ban Eastenders, Coronation Street,& Emmerdale? All of which are set around pubs and have huge child/young adult audiences that are much more likely to affect attitudes than rather gorgeous adverts by Guinness or Stella Artois? And if we are banning all our soaps, how about the Archers (they drink quite a lot) and a good snatch of our dramas, re-runs of …well pretty much all our best comedy and American comedy come to that . We will be left with David Attenborough and Songs of Praise on the box and not much else.

I noted with interest that one of the BMA recommendations in the report (item 9) suggested introducing a “compulsory levy on the alcohol industry with which to fund an independent public health body to oversee alcohol related research, health promotion and policy advice. The levy should be set as a proportion of current expenditure on alcohol marketing, index linked in future years.” Yeah right……. think we all know who will get those cushy jobs.

The other recommendations are all about alcohol adverting , pricing and number of “outlets”. Yes, (sigh) another list of actions that penalise everyone because of the actions of some. If we as a society are serious about drinking the steps we could and should be taking are to make people face the consequences of their actions. Where are the suggestions that if you turn up drunk at A&E you pay for your treatment (no, I can see that the commissioners of this report would not want that task on their members shoulders); empower employers to dock pay if you cant turn up because of your hangover; impose serious actionable penalties for drunk and disorderly and enforce them. Better still if we can have sensible reports NOT written by those with a clear interest in perpetuating the NHS, then how about we have an independent report looking into serious alternatives to the NHS. I believe that making healthcare the responsibility of every individual will make people look after their livers much more effectively than curtailing glossy ads for beer or stopping Guinness supporting one of our national sports.  If I could ban anything right now i would ban the BMA – or at least put a warning on their reports stating their bias to the NHS status quo and their members.

Tags: ban on alcohol advertising, BMA, British Medical Association