Tired of winning

Three studies have shown that 'public health' policies don't work this week and it's only Tuesday

Henry Dimbleby and various van Tullekens were all over the media yesterday wanging on about how the government needs to do more in the way of ‘prevention’. Chris van Tulleken was once again comparing ‘ultra-processed food’ to tobacco (and saying we should treat them both the same) while Dimbers went into a peculiar rant on the Today programme about Kit Kat cereal, a product that he has done more than Nestlé to publicise.

As they see it, people are fat because the government has allowed them to be. If they - wise experts and thoroughly good chaps that they are - were in charge, they would simply stop people being fat. It’s all a matter of political choice and not listening to food industry lobbying. But ask them what they would actually do and it is clear that their policies would be wholly inadequate. Even their most draconian suggestions are unlikely to have more than a negligible impact on obesity rates.

I don’t really care how many people are fat. It’s none of my business. But I am interested in good policy-making and most ‘public health’ lifestyle regulation is astoundingly bad. It doesn’t succeed on any level. It’s only Tuesday and already we have had three glaring examples of ‘public health’ failure.

On Sunday, a new study evaluating minimum pricing in Scotland was published. It found that the policy had no effect on people drinking at harmful or hazardous levels.

The difference-in-difference estimation results reported in Table 2, do not demonstrate a statistically significantly discernible effect of MUP on the overall AUDIT-C alcohol consumption score, nor drinking at hazardous and harmful levels

This is consistent with the official evaluation which found ‘no clear evidence that MUP led to an overall reduction in alcohol consumption among people drinking at harmful levels’. It is also consistent with independent research which found no reduction in alcohol consumption among the heaviest 5% of drinkers (with some men drinking more) and with research showing there were no benefits for dependent drinkers.

So the policy cost consumers a fortune and failed. Can we get rid of it now?

Of course not. Say the line, Bart…

The results could suggest that a higher MUP may be required to better effect changes in drinking behaviours

Yesterday saw the evaluation of mandatory calorie labelling in pubs, fast food chains, cafés and restaurants published. The Impact Assessment said it would lead to people consuming 41 fewer calories in each out-of-home meal. The actual figure turned out to be zero, at best.

The results suggested that the introduction of the mandatory kcal labelling policy in England was not associated with a significant decrease in self-reported kcals purchased (B = 11.31, P = 0.564, 95% confidence interval (CI) −27.15 to 49.77) or consumed (B = 18.51, P = 0.279, 95% CI −15.01 to 38 52.03).

… At pre-implementation, a mean (M) of 1,007 kcals (standard deviation (s.d.) 630) and 909 kcal (s.d. 547) were purchased and consumed per customer, respectively. This was a smaller number of kcals compared with post-implementation (purchased M = 1,081 kcals, s.d. 650, consumed M = 983 kcals, s.d. 587).

But muh evidence-based policy!

Today saw an evaluation of Philadelphia’s soda tax published in JAMA Pediatrics. How many lives did this life-saving public health intervention save? Once again, the answer is zero.

In panel analysis of 136 078 youth, the tax was associated with a difference in zBMI change of −0.004 (95% CI, −0.009 to 0.001) between Philadelphia and the control and a 1.02 odds ratio (95% CI, 0.97-1.08) of BMIs in the 95th percentile or higher.

These results show that 2 years after implementation, the Philadelphia beverage tax was not associated with changes in youth zBMI or obesity prevalence.

This is a deeply unsurprising finding since sugar taxes have never reduced obesity anywhere in the world, including the UK. But that won’t stop people like Chris van Tulleken insisting that we should ‘build on the success’ of the sugar tax by taxing food.

I suspect that these people simply don’t care what policies are introduced or whether they work. They just enjoy sounding off and feeling righteous. They don’t see any real costs to the policies they propose and they don’t much care whether there are benefits. Given their influence (Dimbleby was the government’s ‘food tzar’ and van Tulleken, God help us, is doing the Royal Institution’s Christmas lecture this year) this makes them dangerous.