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Minimum pricing – policy based evidence

By Guest
November 28th, 2012 at 9:42 pm | Comments Off on Minimum pricing – policy based evidence | Posted in BBC, health, pseudo science

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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Minimum Pricing– autocratic, badly researched, regressive & unchallenged by liberals.

By Guest
October 12th, 2012 at 3:31 pm | 4 Comments | Posted in Policy, pseudo science

It seems that the increasingly weak case for minimum pricing for alcohol is being promoted mainly on the basis of “something must be done and this is the something makes us look best” by those to whom gesture politics is second nature. Sadly that category appears to include allegedly liberal democrats.

As someone who prefers to drink alcohol socially rather than at home I have to admit to having been intrigued and initially quite positive about the concept. It was only after reading most of the 500 plus pages of poorly explained, opaque gibberish produced by the University of Sheffield on the subject that I came to realise how bad an idea it actually is

The theory that has been heavily sold to the public by politicians and the public health industry, supported by the BBC , can be summarised as follows:

  • Alcohol is price elastic so increasing the price of alcohol reduces consumption and small acceptable changes produce big effects.
  • At risk groups including heavy drinkers, binge drinkers and young drinkers tend to consume lower cost products.
  • Increasing the price of lower cost products therefore targets “problem” drinkers
  • As only lower cost alcohol is affected the impact on moderate drinkers is minimal
  • It’s all good so people will support the idea.

The problem is that it isn’t this simple as I will attempt to illustrate using examples from the Sheffield Study. The Sheffield team admit that one weakness in their analysis is that there is very little UK data to work with. However, amongst the few studies that they cite are two that appear to undermine the price elasticity theory that is the basis for their model:

“Reviews of demand models from 1989 and 1990 in the United Kingdom found that the demand for beer, wine, and spirits was generally price-inelastic, with the demand for wines and distilled spirits being more responsive to prices than the demand for beer (Godfrey 1989 1990).”

It is logical that at some point, price affects behaviour but the idea that small changes will have big effects is extremely suspect unless you ignore common sense and evidence to the contrary:

“Chaloupka and Wechsler (1996) used a questionnaire approach to explore likely reactions to a tenfold increase in the tax on beer and found it would reduce binge drinking by young women by about 20%, but would have no effect on young men.”

They concluded:

“A substantial tax increase is thus required to achieve modest reductions in binge drinking by female students.”

 With respect to minimum pricing targeting “at risk” groups:

“Wagenaar (2008) found in his meta-analysis that price/tax also significantly affects heavy drinking (p<.01), but the magnitude of effect is smaller than effects on overall drinking.”

Manning et al (1995) derived a price elasticity response function with respect to drinking quantile, indicating that moderate drinkers are the most price elastic”

“One study found that modest increases in levels of taxes have no effect on the number of drinks consumed or on binge drinking (6 or more drinks on one occasion) (Gius, 2002)”

And from Gallet (2007)

“Moreover, if we are particularly concerned with teenage drinking, since we find that teens are least responsive to price, then perhaps the best approach to reducing teen alcohol consumption should involve alternatives to taxation, such as education campaigns.”

So there is some evidence from the Sheffield study suggesting that price increases do not target the groups the politicians say that they do and that it is somewhat speculative, without the benefit of hard evidence, to claim that because those groups currently consume a disproportionate amount of the cheapest alcohol that increasing bottom end prices will change their behaviour.

The Sheffield team do acknowledge some quite significant discrepancies between their model and previous work. Faced with the fact that their methodology produces results inconsistent with other findings for price elasticity in heavier drinkers they do provide an analysis that is consistent with the literature…

“To enable more direct comparability with the estimates in the literature we have also generated elasticity estimates for total alcohol purchasing from the EFS, shown in Table 11. These are in broad agreement with the literature, showing that  – at the highest level of aggregation – hazardous and harmful drinkers (combined elasticity of -0.21) are less price elastic than moderate drinkers (elasticity of -0.47).”

….but then ignore it.

 “Note that these high-level estimates are provided for reference only and are not included in the model.”

This is an extremely important aspect of the whole exercise because if price elasticity is lower for people who are heavy consumers, the result of minimum pricing will not be a reduction in their consumption but a significant increase in the amount they spend with attendant social consequences for them and their dependants.

The high level analysis suggests that heavy drinkers are less than half as likely to change their habits as a result of price increases but even that may be misleading because the Sheffield team lump “hazardous” and “harmful” drinkers together in the analysis placing a man who drinks a couple of pints each evening in the same category as one who consumes a bottle of brandy a day.

“Hazardous” and “harmful” together with “moderate” are entirely arbitrary non-evidence based definitions that are used in rather cavalier fashion throughout the Sheffield study and apparently in subsequent media interviews. According to the BBC:

“This would reduce levels of alcohol consumption by 10.3% among harmful drinkers – those who drink above the recommended limit of 4 units per day for men or 3 units per day for women”

It appears that either an error prone BBC journalist or the Sheffield team themselves have chosen to broaden the definition of “harmful” to include “hazardous” drinkers. It should be pointed out to those unfamiliar with bizarre WHO definitions that the inappropriately named “hazardous” group is defined by the absence of any symptoms /ill effects making it very different from the “harmful” group.

I believe that there is strong evidence to suggest that the neat analysis presented by politicians and the public health industry is extremely questionable and that the claims made for minimum pricing are based not on evidence but on speculation. Furthermore, I believe that there is credible evidence that minimum pricing is a regressive tax that will impact lower income consumers of alcohol at any level and will have potentially serious impact on families of heavier drinkers on low incomes.

The politicians have certainly failed to convince the public on this subject.  A perusal of comments on even left wing media such as the Guardian and BBC shows consistent public antipathy towards the idea. It is a heavy handed statist solution to what most people view as a social problem that is more in keeping with soviet style government than liberal democracy. I am not surprised that it is advocated by the Marxist public health industry and most ardently supported by those on the far left such as Nicola Sturgeon and Kevin Barron, but I am amazed and disappointed by the absence of either a social or classical liberal political challenge to an illiberal regressive law that like many similar interventions is doomed to failure and unforeseen negative consequences.

Dodgy expenses are not the only reason why people don’t trust politicians.

By Chris Oakley. Chris has previously posted on Liberal Vision:  Smokers-State Approved hate and Intolerance is UK policy,   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 , A Liberal Tolerant nation?What hope is there for liberty if truth becomes the plaything of political lobbyists , Public Health Success? & Lies, damn lies, statistics &….

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