Friday, 16 February 2018

The sugar conspiracy debunked

There's been a lot of 'Big Whatever is the new Big Tobacco' rhetoric recently. It's all part of following the anti-smoking playbook which, oddly enough, involves accusing the food/alcohol/soda/gambling industry of following the tobacco industry playbook. It's all so meta, but it's an effective public relations exercise because ad hominem attacks work (read this fascinating study for proof).

The list of businesses that are accused of using 'tobacco industry tactics' is almost endless. Just in the last week, we have seen the booze industry, the baby food industry, the agrochemical industry, the food industry and Facebook all accused of using these mysterious tactics.

Most of the time, the tactics amount to no more than manufacturing a product and trying to sell it; in the final analysis, that is what the single-issue fanatics really object to. The 'tactics' can also often involve lobbying, or rather counter-lobbying as these companies are usually defending themselves from the unprovoked aggression. It is somehow seen as shocking that businesses affected by radical government action tries to have their say (see this 'scoop' from Ireland, for example).

If tobacco industry tactics have a unique meaning in the public's mind, they probably involve covering up evidence and sowing doubt. Of that, tobacco companies have undoubtedly been guilty in the past and the idea that other industries are selling us products that they know to be dangerous is a powerful narrative in these paranoid times. This is the fear to which Stanton Glantz appealed in 2016 when he switched his attention from smoking to sugar. And the global media fell for it. Here is the New York Times, for example...

The sugar industry paid scientists in the 1960s to play down the link between sugar and heart disease and promote saturated fat as the culprit instead, newly released historical documents show.

The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today’s dietary recommendations, may have been largely shaped by the sugar industry.

“They were able to derail the discussion about sugar for decades,” said Stanton Glantz, a professor of medicine at U.C.S.F. and an author of the JAMA Internal Medicine paper.

Glantz's claims were entirely based on an obscure evidence review written in the 1960s by three people, one of whom had undisclosed links to the sugar industry. In those days, researchers did not have to list their interests in journals and it was normal for nutritional scientist to work with the food industry (it still is). The review concluded that fat was a bigger risk factor for cardiovascular disease than sugar. This was an orthodox view then and is the orthodox view now. Glantz did not attempt to challenge this conclusion with empirical evidence. In his mind, one of the authors had received money from food companies so he must be lying.

If you have encountered the anti-carb/anti-sugar crowd on social media, you won't be surprised to hear that this narrative has gone down well. They have a penchant for conspiracy theories and ad hominems, and Gary Taubes has embraced it in his recent book The Case Against Sugar. Nina Teicholz, who borrows liberally from Taubes, created a version of history in The Big Fat Surprise in which John Yudkin's anti-sugar message was silenced by scientists and businesses who wanted people to consume carbohydrates.

There are all sorts of variations of this theory, but the basic theme is that good honest scientists always knew that sugar was the devil, but they were thwarted by devious proponents of the saturated fat hypothesis who shouted them down with the help of lavish funding from Big Carb.

I don't take sides in the fat versus sugar debate. For what it's worth, I think the claims of both factions are overblown. But the narrative presented by Glantz is historically illiterate nonsense and a new study published in Science takes it apart:

Building on a newly popular narrative holding that the low-fat campaign of the 1980s was not based on solid science, these allegations have suggested that if not for the machinations of the sugar industry and its cadre of sponsored researchers, the history of U.S. dietary policy might have unfolded very differently. In this article, we argue that the historical evidence does not support these claims.

Although we do not defend the sugar industry and cannot address every aspect of this history, we believe recent high-profile claims come from researchers who have overextended the analogy of the tobacco industry playbook and failed to assess historical actors by the norms and standards of their time.

Our analysis illustrates how conspiratorial narratives in science can distort the past in the service of contemporary causes and obscure genuine uncertainty that surrounds aspects of research, impairing efforts to formulate good evidence-informed policies. In the absence of very strong evidence, there is a serious danger in interpreting the inevitable twists and turns of research and policy as the product of malevolent playbooks and historical derailments. Like scientists, historians must focus on the evidence and follow the data where they lead.

The article is not behind a pay wall and I highly recommend it. Here are a few more choice cuts...

As we have shown, by the 1960s the paradigm that dietary fat was a likely risk factor for heart disease prevailed among a coalition of scientists closely linked with NIH and AHA and was based on extensive research. By contrast, the sugar theory was developed by a small number of researchers, was supported by limited evidence, and was not accepted by key authorities. Normal science is a social project in which a community of scientists develops consensus over theory. Heart disease epidemiology, in adopting a multifactorial model, could plausibly have accommodated sugar if the theory had withstood testing. But Yudkin's claims were seen as weak and antagonistic, and his signature finding could not be replicated. Moreover, sugar did not appear to meaningfully affect serum cholesterol—the only then-accepted lipid pathway to coronary disease.

As we have also shown, the sugar industry approached Hegsted only after learning of the results of his dairy industry-backed study suggesting that fat and not sugar was a factor in heart disease. “There was no, ‘We'll get money from them and make the results come out this way,’” recalled Lown, who worked in the department. “It didn't happen that way,” he said.

.. We do not claim the sugar industry had no influence on nutrition work at Harvard, nor on the field in general. But we believe that there is no good reason to conclude that SRF's sponsorship of a literature review meaningfully shaped the course of dietary science and policy. Moreover, we think it is an error to demonize, almost as a reflex, scientists and their research when there is evidence of private funding.

.. Our history also underscores the fallacy of emphasizing the machinations of one commodity sector when multiple food industries were deploying similar techniques of influence in the battle for market share. It is notable that during the low-fat era of the 1980s, when suspicion fell heavily on the meat and dairy industries, it was argued that, “The ‘fat lobby’ has not only influenced our nation's food and nutrition policies, it has determined those policies” [emphasis original]. Nearly 40 years later, at a moment when some have said “butter is back” and sugar is toxic, “Big Sugar” is the behemoth accorded these dramatic powers. Caught in the cross fire of these “diet wars” have been the reputations of historical nutrition scientists, whose statures have risen or fallen based on the extent of their contribution to current theories.

If the personal attacks on the authors of this study have not already begun, I'm sure it's only a matter of time.

Thursday, 15 February 2018

Childhood obesity figures are worthless

No news story about obesity in Britain is complete without the factoid about one in three children being overweight or obese. This statistic can easily be found on the Office for National Statistics website, but understanding the methodology behind it requires a little more digging.

I have hesitated to write about this for some time because I thought I must be missing something. I couldn't believe that such important statistics could be estimated in such a ridiculous way.

But they are, and the scale of child obesity in this country has been grossly inflated as a result. Read my article at Spectator Health and all will be explained.

There's more to say about this so I'll probably write a follow up piece. If you have questions or comments, leave them under the Spectator article and I'll try to respond.

Monday, 12 February 2018

John Stuart Mill spins in his grave

Robert H. Frank offered an unusual justification for clamping down on smokers in the New York Times last month. As it touches on some of the themes in Killjoys I want to discuss it.

One the main points in Killjoys is that paternalists are always looking for ways to disguise their paternalism. Even in these puritanical times, it is still not socially acceptable to ask the government to interfere in someone's private life just because you don't like what they're doing.

In the field of tobacco control, three justifications have been put forward which broadly fall under the category of 'protecting harm to others'.

The first is that anti-smoking policies prevent the tobacco industry harming smokers (by selling them cigarettes).

The second is that smokers put a cost on nonsmokers by developing expensive diseases.

The third is that smoking bans are necessary because secondhand smoke harms nonsmokers.

The tobacco control lobby has got a lot of mileage out of these arguments over the years despite none of them being very strong. The idea that anti-smokers are protecting people from industry ignores the fact that industry has no means of coercion. The economic literature shows that smokers do not have higher healthcare costs over a lifetime. And the epidemiological evidence on secondhand smoke is all over the place.

Crucially, though, the power of these arguments wanes as more and more anti-smoking policies are implemented. Campaigners can present an advertising ban, for example, as an 'anti-industry' measure, but it difficult to pretend that a ban on people smoking in their own home, or mandatory nicotine testing of employees, is an attack on the tobacco industry.

As tobacco taxes rise, the idea that smokers are not 'paying their way' becomes increasingly difficult to maintain. And claims about secondhand smoke lose their political significance once smoking has been banned in all enclosed public places.

Frank's article is an attempt to find a new justification for coercive anti-smoking policies in an era where the old excuses are losing their power. He starts by acknowledging that smoking in New York has been banned virtually everywhere, including in some outdoor spaces, and says...

Given the longstanding American hostility to social engineering, each of these steps faced heavy pushback. When called on to justify them, regulators have offered their traditional response: Restricting individual freedom is often the only way to prevent undue harm to innocent bystanders.

The specific harm cited has almost always been well-documented health hazards caused by secondhand smoke. This rationale is similar to the one for requiring catalytic converters on cars: We need them to prevent pollution that would otherwise cause undue harm to others.
But unless you work in a crowded bar with no ventilation, the health risks from secondhand smoke are small compared with those from being a smoker. For example, more than 85 percent of American deaths from lung cancer are attributable to smoking...

To digress briefly, this widely cited statistic is wrong. It may be true that 85 per cent of people with lung cancer are smokers, but that does not mean that 85 per cent of cases are caused by smoking. Half the population are smokers by the epidemiological definition (ie. have smoked more than 100 cigarettes in their life). Since non-smokers also get lung cancer, albeit in much smaller numbers, the proportion of lung cancer cases that are caused by smoking is more like 70 per cent. I can explain this in more detail in a future post if the logic is unclear.

...with fewer than one-third of the remainder linked to passive smoke exposure. Regulators may insist that their aim is not to protect smokers from themselves, but our regulations do vastly more to protect smokers (by inducing them to quit) than to protect bystanders.

This, of course, is the unspoken reason why smoking bans are introduced. They are not about barworkers or passive smoking, they are about making it difficult for smokers to smoke.

But they have run their course in places such as New York, and so a new justification is required...

In fact, smoking also harms bystanders in a more important way: Each person who becomes a smoker makes it more likely that others will become smokers as well. This additional effect outweighs the harm caused by secondhand smoke by enough to suggest that our efforts to discourage smoking, strict as they seem, may not be nearly strict enough.

He is arguing that smoking is, in effect, contagious.

By far the most powerful predictor of whether a person will smoke is the percentage of her closest friends who smoke. If the share of smokers in someone’s peer group rises to 30 percent from 20 percent, for example, the probability that she will smoke rises by about 25 percent. Whereas most of my teenage friends were smokers, relatively few of my sons’ friends were. In 2016, only about 19 percent of American men were smokers, and only about 14 percent of women.

This is a rather naive interpretation of the data. People will tend to associate with others who have similar interests and backgrounds. Drinkers will tend to spend time with drinkers, vegans will spend time with vegans, heavy metal fans will spend time with heavy metal fans. This is not contagion.

On the other hand, people do have an influence over their peers. If you were born in a different country, you would probably have different tastes in sport, music and food.

But you would still have free will - and this is the aspect that Frank overlooks. He gives an example of two peer groups, one with a smoking rate of 30%, the other with a smoking rate of 20%. Whatever the 'probability' of someone smoking in each group (which is somewhat tautologous anyway), the majority are still nonsmokers. Influence is not coercion.

Today’s environment is different mostly because of the taxes and other regulatory measures we have taken to discourage smoking. Well and good, but does anyone think that still having more than one smoker in six people is a desirable population ratio?

What is the desirable ratio? To Frank, it appears to be zero, but that is clearly not the desirable ratio for people who enjoy smoking. So who gets to decide? Someone like Frank, who doesn't smoke and who doesn't think other people should either, or the people who like smoking?

Why should anyone decide what percentage of the adult population smokes? Surely the 'desirable population ratio' is that everybody who likes smoking smokes and everybody who doesn't like it doesn't smoke. Whatever happened to 'life, liberty and the pursuit of happiness'?

Our stated rationale for discouraging smoking — to prevent harm caused by secondhand smoke — greatly understates the amount of harm that these actions prevent. When a regulation results in one smoker fewer, every friend of that person will have one smoker fewer in her peer group. Every member of every one of those peer groups will then become less likely to smoke. And that, in turn, will make others less likely to smoke, and so on.

Frank doesn't make any specific policy recommendations, but implications of his argument are sinister, bordering on totalitarian. It suggests that individuals should be forced to sacrifice their pleasures in case they unwittingly influence their friends into adopting the same way of life.

Most people don’t like being regulated, but even strict libertarians concede the legitimacy of regulations to prevent undue harm to others. As John Stuart Mill memorably wrote in “On Liberty”: “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.”
Causing someone to be more likely to smoke clearly inflicts substantial harm on that person. 

Not 'forcing' someone to do something. Not even 'causing' them to do something. But 'causing them to be more likely' to do something!

This is one of the grossest distortions of John Stuart Mill's harm principle that I have ever come across. It is inconceivable that Mill would have supported coercive legislation to force individuals to set a good example to those around them. Indeed, he explicitly rejected the idea and was clearly exasperated when the nineteenth century temperance movement made a similar argument about alcohol. In On Liberty, he described it as a 'monstrous' idea that would make 'all mankind a vested interest in each other’s moral, intellectual, and even physical perfection, to be defined by each claimant according to his own standard'. In practice, he wrote, it would mean ‘no right to any freedom whatever, except perhaps to that of holding opinions in secret’.

Today’s regulations to discourage smoking are strict, yes. But without violating libertarian sensibilities, we could adopt even stricter measures.

This is laughably untrue. It is hard to think of anything more likely to violate libertarian sensibilities than the idea that individuals must be coerced into changing their behaviour so that they can be a walking advertisement for a government-approved lifestyle.

Incidentally, I have encountered Frank's strange theories before in a different context. You can read about one of them from page 110 in my book Selfishness, Greed and Capitalism.

Thursday, 8 February 2018

Low alcohol drinks lead to more alcohol being drunk, claim cranks

In September 2016, a 'public health' academic named Milica Vasiljevic published a study in Tobacco Control claiming that e-cigarette advertising made children start smoking. This was a heroic over-interpretation of the meagre findings from her survey, but it went down well with the hard of thinking...

(Incidentally, a study published this week concluded that TV advertising of e-cigarettes reduces the number of smokers, so well done to the EU for banning it.)

Now Vasiljevic is back with a study about low-alcohol beverages, as the Daily Mail reports...

Low-alcohol booze ‘can you make you drink more’ as they are marketed for ‘lunchtime’ or ‘all occasions' 

They are seen as the sensible option to enjoy a tipple without going overboard.

But low-alcohol wine and beer may actually lead people to drink more, academics have warned.

Researchers at the University of Cambridge say lower strength drinks are being marketed as drinks for ‘lunchtime’ or ‘all occasions’, which may encourage people to choose them instead of soft drinks.

The study, published in BMC Public Health, is co-authored by Theresa 'beware of big glasses' Marteau and Mark 'muh, Big Alcohol' Petticrew, so it's guaranteed to be of poor quality, but nothing prepared me for quite how bad it was. At least Vasiljevic's e-cigarette study involved talking to children. Her new effort is based entirely on reading product descriptions on supermarket websites. The methodology section contains this small gem:

Disagreements were resolved by discussion until perfect agreement was achieved.

The study doesn't name the brands, but we can work out what some of them are by googling the marketing lines that are quoted. They include Gallo Summer Rose and Foster's Radler, a 5.5% wine and a 2% lager respectively, but they also include Erdinger Alkoholfrei which is an alcohol-free beer, as its name suggests (technically it has a maximum of 0.5% alcohol as it is not possible to remove every drop of alcohol from 'near-beer'). Its inclusion implies that the authors think that the promotion of 0.5% beers leads to 'risky drinking'.

Among the marketing messages that the authors reckon are designed to lure in vulnerable consumers are such scandalous slogans as ‘Perfect for all occasions from a lunchtime barbeque to an evening celebration’, ‘Perfect for nights in and social get-togethers’ and 'For all your trendy patio parties, picnic classics and the good old-fashioned night in with your pals’. They also highlight standard messages on wine labels such as ‘All occasions’, ‘Any occasion’ and ‘Any time’.

If that weren't enough, they also reveal that...

Low/er strength products were also more often marketed with information about their alcohol content.

I should hope so. If companies are going to produce low alcohol drinks, it is only fair that they warn consumers.

To our intrepid researchers, all this can only mean one thing:

Presenting low/er strength alcohol products as suitable for consumption on a wider range of occasions than regular strength products suggests they may be being marketed to replace soft drinks rather than alcohol products of regular strength.

OK. Let's take this in stages.

Firstly, someone searching for beer or wine on a supermarket website is probably not in the market for a soft drink.

Secondly, it is the government's explicit policy - having been lobbied by 'public health' - to reformulate products to make them healthier. Under the Department of Health's Responsibility Deal, the booze industry is committed to producing 'lower alcohol products' as part of the 'alcohol unit reduction' scheme.

Thirdly, the author's claim that low-alcohol drinks are aimed at people who would otherwise drink soft drinks is nothing more than an assertion. In so far as it is based on evidence, it stems from the feeble piece of trivia that none of the regular strength wines they looked up online mentioned lunch whereas 13% of the low-strength wines did.

Fourthly, it should be obvious that a low-strength wine/beer is a closer substitute to regular wine/beer than it is to a glass of water and, therefore, that increased sales of low-strength wine/beer will lead to less alcohol being consumed overall.

In fact, that is exactly what the Department of Health found in its review:

Between 2011 and 2013 the number of units of alcohol in the market has reduced by 1.9 billion. Of this it is estimated that 1.3 billion is due to reductions in the ABV of alcohol products...

But, as I have discussed before, 'public health' fanatics such as Mark Petticrew automatically assume that anything the industry does is suspect unless they are being forced to do it by law...

If it doesn't involve taxing the poor or creating criminal offences, Petticrew isn't interested, and so he invariably concludes that initiatives like the Responsibility Deal don't 'work' whereas heavy-handed and regressive policies do (even when the latter have obviously failed or haven't even been tried).

His findings are therefore highly predictable. Public Health Responsibility Deal on healthy eating? "Could be effective" but needs "food pricing strategies, restrictions on marketing .. and clear penalties". Responsibility Deal for alcohol? Not very effective, needs "law enforcement" to make "alcohol less available and more expensive." Voluntary agreements in general? Can be effective but only when there are "substantial disincentives for non-participation and sanctions for non-compliance", ie. when they are not voluntary. 

You get the picture. For Petticrew, the iron fist is always preferable to the velvet glove.

And so the authors conclude their pisspoor study of websites (sorry, I mean 'content analysis') by saying:

The present findings cast doubt on the industry contention that the development, promotion and marketing of low/er strength alcohol products may reduce alcohol consumption and associated harms. Rather, the present findings add to an existing literature that highlights how measures intended to benefit public health (in this case wider availability of low/er strength alcohol products) may benefit industry to the detriment of the health of the public.

This is pure editorialising. Their study shows nothing of the sort. It does not look at what people drink. It does not attempt to estimate, let alone observe, substitution patterns. It does not even look at how these drinks are marketed in the places that most people buy them in, ie. shops and supermarkets.

It is pure opinion and not a very good opinion at that. There is not a scintilla of evidence that low-alcohol beer and wine lead to greater alcohol consumption or 'the detriment of the health of the public'. On the contrary, evidence and common sense point in the opposite direction.

As with the e-cigarette study, the true believers of the anti-alcohol community love it. Perhaps that's who it's aimed at. A study by cranks for cranks...

This worthless garbage was funded by the supposedly cash-strapped Department of Health.

Tuesday, 6 February 2018

Public Health England

Public Health England have issued some mostly sensible advice about e-cigarettes in the hope of scotching some of the myths and junk science that has been pouring out of California for the last five years.

Dick and Clarky point out that PHE couldn't resist inserting some anti-smoking authoritarianism into their e-cigarette report. It is also somewhat amusing that they are calling for e-cigarettes to be given out by the NHS on prescription a day after it was announced that the only medically approved e-cigarette has been withdrawn from the market.

Nevertheless, the PHE report is worth reading and the authors should be given credit for trying to debunk some of the scare stories that threaten to bring the vaping revolution to a halt. My only concern is that the report won't be taken seriously by some because PHE has gained a reputation for talking nonsense (eg. here, here and here).

Speaking of which, I wrote this article about PHE and their mad schemes for the Spectator last week.

Unelected, unaccountable, and out of control, Public Health England has become a magnet for every crank, puritan, food faddist, temperance zealot, anti-capitalist and social justice warrior with a penchant for remaking the world in their own image. What do we get in return? Smaller portions, artificial sweeteners, higher prices, fewer choices and a stream of increasingly bizarre pronouncements from an agency that seems more interested in manipulating the population than in providing sound advice upon which we can make our own choices.

Do have a read.

Monday, 5 February 2018

Plain packaging in France: another non-event

Back in 2013, there was a flurry of studies published in the likes of Tobacco Control claiming a dramatic and immediate impact from plain packaging (which had been introduced at the end of 2012). One of them claimed that smokers were more likely to think about quitting if their packs were 'plain'. Another one claimed that there was a rise in the number of calls to quit-lines after plain packaging was introduced.

A whole cottage industry developed, with Melanie Wakefield at its centre, to look for evidence that plain packaging had an effect on smokers as soon as it was introduced. And yet, whatever smokers might have said in surveys, the hard fact of the matter is that cigarette sales rose in 2013 for the first time in years.

Rising cigarette consumption is hardly what you would expect to see if plain packaging had led to smokers quitting in droves, especially since there is also evidence of rising illicit tobacco consumption at the same time. And we now know from official statistics that the smoking rate did not decline between 2013 and 2016.

This would be very awkward for the tobacco control lobby if it was an evidence-based enterprise, but it isn't and so the WHO simply asserts that: 'Studies are conclusive: plain packaging of tobacco works'.
Since plain packaging was introduced in France and the UK, there have been a surprisingly few studies claiming an immediate impact of the policy. In fact, I haven't seen any. Maybe they are in the post, or maybe 'public health' academics don't want to leave more hostages to fortune.

However, we had a report from France last May claiming that cigarette sales had risen in the few first months of plain packaging, and in November the French health minister made a remarkably candid admission to parliament, saying 'the neutral package did not reduce the official sale of tobacco'.

We now have the tobacco sales figures from France which confirm that more cigarettes were sold in the first six months of 2017 than in either of the two previous years.

Cigarette sales fell slightly in the second half of the year and overall sales in 2017 were 44,614 million, compared to 44,926 million in 2016. This is a decline of 0.7%. To put that in context, the decline between 2015 and 2016 was 1.2%.

The best that can be said about plain packaging in France is that it did not lead to an actual rise in cigarette sales in its first year, but we should remember how unusual it is to see an annual sales increase in developed countries. The figures from France are consistent with the hypothesis that plain packaging has no more effect than doing nothing.

Anti-smoking campaigners seem to have more or less abandoned the claim that plain packaging has an effect on hard outcomes such as smoking prevalence and cigarette consumption in the short term. They have fallen back on the argument that the policy is part of a long-term strategy that will pay off after twenty years or so. This is convenient because it means that their claims are essentially unfalsifiable. Even after twenty years, it will not be possible to disentangle the putative effects of plain packaging from other factors and, if things go according to plan, most countries will have plain packaging by then anyway (assuming that cigarettes are even legal).

In the meantime, we are supposed to put out trust in those nice, honest anti-smoking people who reckon that plain packaging is the way to go. 

And yet, a supposedly game-changing policy like this should have some measurable effect within a year or two, surely? Throughout the campaign for plain packs in the UK, we were constantly told that 'more than 200,000 children start smoking every year' and that we need 'plain, standardised packs as soon as possible'. The obvious implication was that fewer people would smoke if plain packaging was introduced. But there is no evidence that this has happened in any country that has experimented with plain packaging and the same organisations are now campaigning for other policies with the same (bogus) figure:

“While we are glad to see developing policy such as plain cigarette packaging and increased taxation on tobacco, it is still worrying that more than 200,000 children and young people take up smoking..."

This is the modus operandi of the 'public health' lobby: campaign frantically for a supposedly essential policy, wear down politicians until they introduce it and then move on to another campaign as if nothing has happened.

And with plain packaging, nothing does happen. It's a total waste of time. France is now doing what Australia did after the failure of the policy became obvious by introducing massive increases in tobacco duty. No doubt this will have an impact on the sale of tobacco from legal retailers in France. Retailers in neighbouring Belgium and Spain, meanwhile, will be rubbing their hands with glee.

Friday, 2 February 2018

Public health versus 'public health'

Regular readers will know that I put the term 'public health' in speech marks when referring to the morally bankrupt crusade for lifestyle regulation that has co-opted the name.

I explained the distinction between public health and 'public health' in Killjoys:

The case for government action on public health issues is strongest when there is a threat to health that can only be countered by collective action. Collective action does not necessarily mean government action, but if the term ‘public health’ meant anything in Mill’s day, it meant tackling health risks in the shared environment which cannot be controlled by the individual, such as air pollution, or those involving people (or animals) who carry infectious diseases. Factories pumping coal smoke into a congested city and travellers coming home with Ebola pose a clear risk of unavoidable harm to others and are therefore a potential justification for coercion under the harm principle. It is not the scale of the risk nor the number of people affected that turns a health problem into a public health problem. It is the lack of consent from those who are put at risk and their inability to reduce the risk without collective action.

Since the 1970s, however, the scope of public health action has moved beyond hygiene and contagious disease to target self-regarding personal behaviour. As Richard A. Epstein explains, the modern ‘public health’ movement ‘treats any health issue as one of public health so long as it affects large numbers of individuals’. This has led to a focus on personal habits which are risk factors for non-communicable diseases, such as heart disease, diabetes and cancer. ‘Our public health problems are not, strictly speaking, public health questions at all’, write Gostin and Gostin. ‘They are questions of individual lifestyle’. In this view, ‘public health’ is the aggregated private health outcomes of the nation, and prevention involves modifying any factors that influence them. 

There is no shortage of genuine public health problems in the world, but 'public health' campaigners are not interested in them. Even if they were, the sociologists and psychologists of the 'public health' lobby don't have the medical knowledge to deal with diseases like AIDS, tuberculosis and malaria. Real public health problems do not respond to the advertising bans and price hikes.

Fortunately, there are organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria which are devoted to stopping poor people dying from contagious diseases. The Global Fund gets  most of its money from national governments but it also takes donations from foundations, individuals and businesses.

One of these businesses is Heineken, and the 'public health' lobby is not happy about it.

Health campaigners decry global HIV fund's deal with Heineken 

International health campaigners and alcohol concern groups called on a major global HIV and malaria fund on Thursday to end immediately a partnership it had signed with the Dutch brewer Heineken.

In an open letter to the director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an alliance of more than 2,000 health organizations voiced “deep concern” and said the deal would only help Heineken broaden its marketing reach.

“Transnational corporations producing and aggressively marketing alcohol rely on the harmful use of alcohol for their sales and profits,” the letter said.

That is a lie, of course. Alcohol companies would make sales and profits if everybody drank responsibility.

It accused companies such as Heineken of undermining and subverting evidence-based alcohol policy implementation “at the same time as they expand distribution networks and marketing to grow their market in low-and middle-income countries”.

Alas, there was no room in the letter for them to give examples of Heineken 'undermining and subverting evidence-based alcohol policy'. Perhaps they had Mark Petticrew's weird theories in mind?

If these people knew anything about the alcohol market in low income countries - and if they cared about people's health - they would welcome the expansion of 'distribution networks' for high quality, regulated drinks companies. In Africa and India, in particular, the market is dominated by moonshine, counterfeit alcohol and surrogate alcohol which regularly cause acute death. If people in these countries could access and afford a few bottles of Heineken, it would be a great improvement (unless you think that Heineken making more 'sales and profits' is a Bad Thing per se).

In any case, Heineken's donation to the Global Fund is going to have no effect on its distribution and marketing. It will be used to tackle AIDS, tuberculosis and malaria. The anti-drink lobby simply wants to turn companies like Heineken into pariahs for political reasons and will use any excuse that comes to hand.

When SABMiller made a donation to the same organisation in 2012, the imbecile Anna Gilmore and the sociologist Gary Fooks resorted to mental gymnastics as they groped around for reasons to oppose it:

In the current example involving SABMiller, the world’s second largest brewer by sales volume, a conflict of interest arises because of well-established links between alcohol use, violence (including sexual violence) and risky sexual behaviour, making alcohol a risk factor in the spread of HIV infection. Reducing alcohol use can therefore be seen as key to reducing HIV infection. Yet this inevitably conflicts with SABMiller’s underlying goal of maximizing profits from alcohol sales.

Imagine spending an hour inside these people's heads.

It is hard to think of a better illustration of the contrast between public health and 'public health'. On one hand, there are health workers trying to raise money to help prevent people dying from infectious diseases in the poorest countries in the world. On the other hand, we have social scientists in rich countries trying to stop this money being spent because it offends their idea of ideological purity. They really don't care how many people suffer for their dogma.