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Public health demands: all fizz, no sparkle

By Angela Harbutt
July 16th, 2015 at 9:04 am | Comments Off on Public health demands: all fizz, no sparkle | Posted in Uncategorized

Hat tip: In case you missed it, do go read a brilliant analysis of Britain’s so-called “tooth decay crisis” by Christopher Snowdon.

As repnigel huntorted in the Sunday Times, according to Nigel Hunt, dean of the Royal College of Surgeons’ dental faculty, we are facing [yet another] health crisis, this time relating to child tooth decay. The basis of  theDean’s complaint is that some children are having to wait months before they can have teeth extracted under general anaesthetic in a hospital.  As Mr Snowdon says, “This is a disgrace”, but, he points out that this is not due to an epidemic of tooth decay, our oral health has been improving, not declining, in recent years:


“According to a report by the Royal College of Surgeons”….” ‘oral health has improved significantly since the 1970s’. Does that include children? You betcha. ‘The dental health of the majority of British children has improved dramatically since the early 1970s,’ according to a 2005 study, mainly because of ‘the widespread availability of fluoride containing toothpastes’. This was confirmed in a 2011 study which concluded that ‘since the 1970s, the oral health of the population, both children’s dental decay experience and the decline [in] adult tooth loss, has improved steadily and substantially.”

The problem, Snowdon suggests is not our willingness or ability to make kids brush their teeth, but rather the inability of the NHS to conduct the operations required. So the crisis, if there is one, is within the NHS.  Rather than accept that the problem lies there, and call for a review of health provision in the UK, or a demand to root out the inefficiencies of the state monolith, Dean calls for… wait for it… graphic photos of rotten teeth to be placed on sweets and fizzy drinks.

This of course echos the demands, issued earlier this week, by the doctors trade union, the British Medical Association, [BMA] to put a 20% tax on sweet drinks, because of the obesity crisis.

Serendipity that two medical groups demand action on fizzy drinks within days of each other? Or a coordinated effort to divert attention away from the failings of the NHS and point the finger at the preferred “evil” industry on which to pile up all the blame?

Or could it be a concerted attack on Government, currently considering “a range of measures to curb the nation’s intake of sugar“. If only the medical profession would apply such diligence and “joined up action” on the real NHS problems, rather than finding ever-new scape-goats.

Snowdon elegantly concludes:

“As Douglas Murray observed in The Spectator last month, victim-blaming has become the medical establishment’s default response to its own failures. The shrill demands for government action are a crude diversionary tactic. Can’t get the waiting lists down? Bring in a sugar tax! Unable to carry out minor operations? Put graphic warnings on Mars bars! It is a shameless distraction from the real issue, but when combined with the media’s gross misrepresentation of the facts and the political class’s thirst for legislation, it is a pretty effective one.”

Read Snowdon’s blog here.

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Why the 11th hour ASA u-turn?

By Angela Harbutt
July 30th, 2014 at 4:24 pm | 4 Comments | Posted in Quango

For those of you that don’t know, the Advertising Standards Authority (ASA) is a quasi-judicial authority, tasked with providing independent scrutiny of the marketing communications industry; specifically ensuring that advertising is not misleading, harmful or offensive.

The Chairman of the ASA is appointed by Advertising Standards Board of Finance (ASBOF) – who then appoints 12 Council members to preside over various cases put before them (frequently by members of the public complaining about advertisements they see). Council members are supposedly selected by the Chairman to reflect a diversity of background and experience. This of course only works if the Chairman does indeed appoint Council members who (a) genuinely reflect a wide range of views and experiences and (b) are completely impartial. The current Chairman is the beleaguered Lord Smith of Finsbury (out-going Chairman of the Environment Agency and former Labour Minister).

So what happens when the advertiser under investigation by the ASA is the Government, and too many of those on the ASA Council have various vested interests in keeping on side with government? Can the ASA realistically be relied upon to be blind status of the advertiser?

Perhaps not…

Back in January 2013 I submitted a complaint to the ASA regarding a Government “quit smoking” advert. The advert stated:

When you smoke the chemicals you inhale cause mutations in your body and mutations are how cancer starts. Every 15 cigarettes you smoke will cause a mutation.

I challenged the categorical statement that “every 15 cigarettes you smoke will cause a mutation”. The statement was based on an exploratory research paper which estimated that every 15 cigarettes smoked caused a mutation. It was based on a sample of one patient (yes one) whose smoking record was unknown and the paper did not take into account other factors that are known to affect mutation rates (e.g. ethnicity, age, environmental (background level of mutagenic chemicals) or lifestyle factors etc). No criticism of the study, it was fascinating insight into where genome research is heading. But the study did not provide evidence to back up the study. Nor did any other study. At best one other study (with a sample size of 21 patients – not much more than the average focus group) showed a range of estimated mutation rates, again with a long list of limitations attached to the estimates in this tiny sample.

Over the past 18 months the ASA has investigated the complaint thoroughly. As reported elsewhere, unsurprisingly, the ASA found on three separate occasions that the government advert was misleading and lacked substantiation. After the Department of Health had challenged the first two findings, the ASA brought in a cancer research expert to impartially review the evidence. Post review, it concluded, for a third time, that the advert was misleading and lacked substantiation. This recommendation was put to the ASA Council.

The ASA Council adjudication today however, overrules the findings of its own 18 month investigation, stating that the complaint is not upheld.  Given the consistency of the ASA rulings during the course of this investigation, why the dramatic last minute u-turn?

I can see only three possible reasons for the ASA Council adjudication.

Firstly the ASA Council were simply bamboozled by the science and talk of “peer-reviewed studies” (do people really not understand what that actually means?), lacking sufficient experience/ knowledge to differentiate between tiny incomplete exploratory studies producing estimates, and definitive studies providing robust evidence

Understandable perhaps, although you might have thought that if Council lacked the required experience it would have deferred to it’s own exhaustive investigation rather than overrule it.

Secondly, this quasi-judicial panel could not bring themselves to rule that government had misled the people, with all the ramifications for the long term future of the ASA (and/or themselves) that such a high-profile ruling might bring.

Or maybe it was ideological, and their views on smoking had a part to play. Perhaps they thought that no matter how unsubstantiated the government claim, the end justifies the means. To admit the government had lied on smoking (which it clearly did) would set back the cause for many years.

May be it was a bit of all of the above.

I do not know the ASA Council views on smoking, nor do I know if they actually had the competence to deal with the research data put before them, but I have do know something on the interests of some of the Council members.

Ray Gallagher, (according to the ASA website) has been advising the government “since 2006” as “broadcasting Specialist Adviser to the House of Commons Culture, Media and Sport Committee”.

Martin Narey is, according to his twitter account, also an advisor to Government, an appointment he is very pleased to have had recently renewed “I’m very pleased to be asked by Nicky Morgan to advise her on Adoption, Social Work Education and DCS support”. (You may also be interested to read his 2009 report on Social Mobility here – Page 68 states “Smokers in lower socio-economic groups consume more cigarettes than more affluent smokers and are more addicted. The strength of the addiction makes it harder for poorer people to quit…”).

Yet another Government advisor seated on the ASA Council is John Mayhead. The ASA website reports “Since 1999 he has been a non-exec at the Department for Transport and also chaired the Government Strategic Marketing Advisory Board which was responsible for the oversight of all Government marketing activity.”

You may be pleased to know that Hamish Pringle is not a Government advisor directly. Unfortunately he is Strategic Advisor at advertising agency 23Red. And guess which organisations feature prominently on 23Red’s client list … “Change for Life”, “Smokefree”, “Public Health England” and … “the Department of Health” (yes really).

He is not the only one whose clients include Government.

ASA Council member Anthony Earle Wilkes is the Managing Director of CETC Ltd, a specialist equal opportunity consultancy. His website states that he provides equality and training to organisations including regulatory authorities, local authorities and Government department & agencies. One wonders just how much the state accounts for his business income. Quite a bit one assumes given the nature of his business.

I could go on, but am waiting for the ASA to send me the “ASA Council Declaration of Interests” (curiously not on the ASA website) – and anyway I think you get the point.

I suppose it is possible that none of those listed above attended or, if they did attend, voted to over-rule the ASA executive on this Government advert – that information is not available to us. It is a regulatory body shrouded in mystery after all. We do not know who voted for and who against? We don’t know if it was a majority decision or unanimous? Or whether anyone abstained due to conflict of interest? All questions that cannot be answered.

And here is the problem, one that Arch Bishop Cranmer stated so well :

It is a question of impartiality, which matters profoundly in political processes where force and influence compete with manipulation and facts: if an organisation with quasi-judicial authority professes to be objective in its investigations, then its senior staff and officers must not only be impartial, they must also be seen to be impartial. There cannot be even the merest hint of a political agenda subverting that professed neutrality or corrupting the overriding commitment to fairness and justice.

Given the many Governmental connections past and present of those seated on the ASA Council, for Council to overrule the recommendations of its own investigation, with no explanation as to why, brings into question the very impartiality of the organisation – and therefore the whole process itself. Can people with such close links to Government really be relied upon to consider complaints against Government fairly? I think not.

At the very least you might expect the ASA adjudication to list members past and present links to Government at the end of the adjudication – for transparency sake at least.

An appeal on the ASA Council adjudication has been lodged with the ASA Independent Reviewer – Sir Hayden Phillips – who may decide to look at it and write a review. But even then his role appears to be only advisory – he can politely ask Council to reconsider its ruling – but it appears that this quasi-regulatory organisation cannot be forced to change its opinion, no matter how compelling the evidence: Given that Council members clearly believe they know better than their own staff, one assumes that they will also consider their views likewise superior to the Independent Reviewer.

This case has ramifications for us all. If the Government is not sanctioned for misleading the public in such a clear cut case, what else might it be allowed to say without fear of sanction? It does not bear thinking about. In the meantime we will wait to see what an appeal brings us – but what’s the betting it will this time next year before any decision is made?

DISCLAIMER: Across 2012 and 2013 Angela worked on the Forest campaign Handsoffourpacks opposing the introduction plain packaging of tobacco. She submitted the complaint to the ASA whilst working on that campaign.

READ ALSO: “At last, the ASA verdict on Forest complaint about DH “mutation” ad

UPDATE: For more information read “Spot the Difference: How the Advertising Standards Authority changed its tune

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New bounty on smokers helps GPs balance their books

By Guest
March 26th, 2013 at 9:41 am | 7 Comments | Posted in health

It is coming up to year end for GP practices and that of course means that they will all be diligently filling in reams of paperwork for the DH in order to secure maximum funding via the QOF. In the doctor’s business journal medeconomics Dr Gavin Jamie gives some top tips on how practices can maximise their points score.

According to Jamie:

It is that time of year when practices are polishing their data and preparing for the annual inspection on 31 March of their QOF achievement.

For many it is a matter of pride, and not simply financial necessity, to get the most points that they can. Here are my top tips.

The DH is now effectively offering GPs a bounty on every smoker they can identify and attempt to “reform”, so it is perhaps not surprising that third on his list of top tips for achieving the warm glow of satisfaction that only comes from a good dose of centralist bureaucracy is upping the practice’s smoking score.

TIP 3 Smoking

This has become more complicated with the need to offer smoking cessation advice or prescribe therapy to all smokers over age 15.

Due to the way that this is calculated, improved coding of people who have stopped smoking will enhance the advice indicator.

It really is worth making every contact count – even where patient just calls into reception or speaks to the practice by telephone.

If you are the sort of person who takes pride in this kind of exercise or if your practice just needs the money Dr Jamie recommends that you hassle people about their lifestyles at every possible opportunity.  I haven’t been anywhere near my practice because I am coming to hate the place. I wonder how many others feel the same and how long it will take for politicians to work out that this approach is counterproductive?

Surely even Dave can see that a system that encourages GPs to repeatedly annoy their patients is not a good thing. No doubt his DH advisors will claim to have “peer reviewed” evidence to the contrary and we can assume that it is the same advisors who tell him that minimum alcohol pricing will target alcoholics and that smoking bans have had dramatic immediate health effects. Surely at some point he will work out that these people are rather economical with the truth? Won’t he?

by Chris Oakley

This post is a followup to “The Department of Health is watching you!

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

By Guest
November 29th, 2011 at 10:26 am | 4 Comments | Posted in Government, health, Spin

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.

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Australia’s new plain packaging law for cigarettes may have got Andrew Lansley off the hook

By Editor
November 21st, 2011 at 8:48 pm | 2 Comments | Posted in freedom, Government, health, Nannying, Nudge Dredd


HAT TIP : Mark Littlewood (formerly of this parish) has posted an interesting article over on the Daily Mail today. It concerns tobacco plain packaging – but considers it from an angle we’ve not seen elsewhere. In it he suggests that the Australian government may have got Andrew Lansley at the Department of Health off the hook. How ?

“Well, he is a Cabinet minister in a government which claims to support deregulation….Fortunately, the Health Secretary does not need to marshal a whole series of arguments to rebut the case for plain packaging of tobacco (which would, in any event, be quite hard to do – as it is difficult to rebut a case based on no credible evidence whatsoever). He can cancel his promised consultation on the subject (originally anticipated to be launched in the next few weeks), thereby saving everybody a lot of time and effort. He can then sit back and wait for a couple of years and see what independent evidence suggests the impact to be in Australia, if the legal challenge from tobacco companies fails to reverse this intrusion into free expression.”

Click on the link above to read the whole article. It’s an interesting thought. Just how committed is this government to deregulation?

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