Friday, 17 November 2017

Plain packaging for alcohol (again)

The week's Lancet has an editorial about alcohol. It doesn't even bother to acknowledge the temperance lobby's victory in the minimum pricing court case. They are already moving on to the 'next logical step'.

Here are the closing sentences...

There is no excuse to ignore regulatory interventions for access, advertisements, and unit cost that are shown to reduce alcohol consumption. Like tobacco, the longer the delay in effective control, the more severe future interventions for alcohol will need to be. It is not unimaginable that bottles of Château Mouton Rothschild, which once bore the artwork of Salvador Dali and Pablo Picasso, might one day be required to have plain packaging and images of oesophageal cancer or a cirrhotic liver.

It only seems like yesterday when those of us who predicted this slippery slope were portrayed as paranoid libertarians who had fallen for a deceptive tobacco industry argument.

Freedom is indivisible and killjoys never sleep.

Europuppets defunded

A few years ago I wrote a report called Europuppets about the EU's exceptional largesse towards 'civil society' organisations of which it approves. Quite a few of them are in the business of punishing consumers under the pretext of 'public health', including the European Public Health Alliance (EPHA).

Over the years, EPHA has lobbied for minimum pricing, taxes on food and the Tobacco Products Directive, so I was delighted to hear that the European Commission is going to stop funding it next year.

In late October 2017, EPHA was informed that it had not been selected to receive an operating grant from the European Commission’s Health Programme, as from January 2018.

Such an occurrence has always been a possibility and the EPHA Board has undertaken contingency planning for several years. While this has some immediate implications for the organisation, the board and secretariat team are implementing plans to ensure EPHA’s long-term sustainability.

EU funding accounts for two-thirds of their income so hopefully their long-term sustainability is out of the question, unless Pharma steps in.

And the good news doesn't end there. The European Network for Smoking and Tobacco Prevention (ENSP) has been unsuccessful in applying for EU cash and the neo-prohibitionists at Eurocare have been defunded. The former relied on EU taxpayers for more than half of its budget so hopefully it will wither and die before it can bring about its 'tobacco endgame strategy'.

Not a bad start. The full list of unsuccessful grant applications can be read here. I don't recognise them all by the abbreviations so if you spot any gems, let me know in the comments.

Have a great weekend!

Thursday, 16 November 2017

Looking forward to minimum pricing

Now that the SNP are free to introduce minimum pricing, it's worth looking at what we're supposed to expect.

Back in 2009, when minimum pricing became a live issue, the Sheffield modellers predicted that a minimum price (of 40p in those days) would result in a drop in alcohol consumption of 2.7 per cent and a decline in alcohol-related deaths of 40 in the first year, rising to 210 per annum after ten years.

Given the 'public health' lobby's absolute obsession with this policy in the years since, we must assume that they regarded these as game-changing numbers. Imagine if alcohol consumption fell by 2.7 per cent! What a victory for health that would be.

We don't need to imagine because consumption fell by much more than that after 2009 without any notable policy change. In 2007, Scots were drinking 11.8 litres of alcohol a year. By 2016, this had fallen to 10.5 litres. This is a drop of 11 per cent - four times as great as the decline Sheffield said would occur if minimum pricing was introduced.

You probably haven't much about this, but if minimum pricing had been introduced in 2009 you would have never heard the end of it. Not only did alcohol consumption fall by 11 per cent, but the alcohol-related mortality rate fell from 34.6 per 100,000 to 30.0 per 100,000 for men and from 16.7 per 100,000 to 9.0 per 100,000 for women. This is a drop of 13% and 46% respectively.

It is interesting to see the decline in both drinking and alcohol-related deaths in Scotland in recent years and yet I do not see much interest in it from the denizens of 'public health', presumably because they can't take credit for it. 

Here are the alcohol-related deaths for men and women. Scotland is the top (light blue) line.

It's worth noting that the UK as a whole has seen a decline alcohol consumption of around 18 per cent since 2004 and yet Scotland is the only part of it to have seen a significant fall in alcohol-related deaths. This implies that the fall in alcohol consumption in Scotland has been driven by heavy drinkers consuming less whereas the fall in England, Wales and Northern Ireland has been driven by moderate drinkers consuming less and more people becoming teetotal.

Looking at the actual number of deaths below, you can see that mortality increased sharply between 1993 and 2003 before falling by about 20 per cent. It has not followed drinking trends perfectly, however. Note that there was a relatively large number of deaths in 2016 despite per capita consumption being at a twenty year low.

The latest Sheffield predictions for Scotland predict that a 50p unit price will reduce consumption by 3.5% and will reduce the number of deaths by 58 in the first year and by 102 per annum after ten years. This is what the SNP and its allies have been fighting for all this time. This is the promised land.

But despite all the wild celebrations from the neo-temperance lobby yesterday, these projected outcomes are so trivial that they would get lost in the noise of the data. If there is a 3 or 4 per cent downturn in per capita consumption in the first year of minimum pricing, you could plausibly attribute it to minimum pricing, but (a) it could just as easily be part of the longer term decline, and (b) so what?

The aim of the policy is to reduce alcohol-related deaths, but if minimum pricing did 'save' 58 lives, it would be impossible to tell from looking at the numbers because they fluctuate by more than that on a regular basis. Between 2015 and 2016, for example, they rose by 115 for no obvious reason. Between 2011 and 2012 they fell by 167.

Regardless of whether the figures rise, fall or stay the same over the next few years, it is inevitable that a regression model will be published - probably by the monopoly providers at Sheffield University - claiming that there were fewer deaths than there would have been in the absence of the policy. Such a regression model will be politically driven rubbish, but even if someone made a serious attempt to create a regression model, it would be impossible because they would not be able to project future trends. Why? Because they don't know the reason for the recent trend.

The stark reality is that the projected impact of minimum pricing, exaggerated though it almost certainly is, amounts to a rounding error too small to be seen with the naked eye. Even if it does everything its advocates claim it will, the impact of this supposedly world-leading policy will be too small to measure. The policy of doing nothing and selling alcohol at 'pocket money prices' in the last decade seems to have been vastly more successful than the most optimistic projections of Sheffield's activist-academics. 

Wednesday, 15 November 2017

Minimum pricing can now happen before Brexit

The UK Supreme Court has said that minimum pricing is legal under the ridiculous carve out that says that free trade doesn't matter if a policy is designed to protect ‘health and life’, ’public morality’, ‘public policy’ and ‘public security’ (ie. anything). The last reason to stay in the EU has disappeared.

It doesn't really matter for the UK because we're leaving but it's a shame for other EU countries. Now all we can do is see what happens. The clowns at Sheffield University have got the commission to evaluate the policy (quelle surprise) and they will obviously say that it's been a terrific success, but some serious people should be also be able to get hold of the data.

In the meantime, I've written a quick article for Spectator Health. Do have read of it.

Monday, 13 November 2017


Alcohol Awareness Week has returned for another year. It is a scheme dreamt up by the likes of Alcohol Concern to lobby for minimum pricing, tax rises and advertising bans while purporting to educate the public about drinking.

Thanks to the myriad lies of the neo-temperance movement, there is certainly room for education. Here are ten things that people deserve to know for starters...

1. The theory that underpins the neo-temperance lobby's 'whole population' approach is a demonstrably false and self-serving delusion.

2. The lowering of the drinking guidelines in the UK last year was orchestrated by a bunch of anti-alcohol zealots and relied on a model which was changed at the eleventh hour when the original model failed to support the change.

3. Moderate drinkers live longer than teetotallers, on average.

4. And that is not because of the 'sick quitter' effect.

5. Drinkers in Britain pay 40 per cent of all the alcohol duty collected in the EU.

6. Alcohol duty revenues in Britain far exceeds the costs drinking imposes on state services. Drinkers subsidise teetotallers to the tune of £8 billion a year.

7. Britain has never been a particularly heavy drinking country by the standards of other developed nations.

8. The claim that minimum pricing has worked in Canada is based entirely on one man's junk science.

9. Since 2004, per capita consumption of alcohol in the UK has fallen at its fastest rate since the 1930s and is now at the same level as in 1980.

10. Public Health England claimed last year that Britons are drinking twice as much as they were in 1980. This is because Public Health England doesn't know what it's talking about.

Sunday, 12 November 2017

Plain packaging - a gift to the black market

 From Retail Express...

The first counterfeit plain packs of tobacco in the UK have been uncovered by Retail Express and trading standards departments.

Following a tip-off, Retail Express was sold a plain pack counterfeit of a premium brand by a London newsagent for £10.50. The retailer took a legitimate pack out of the gantry and swapped it out with a fake pack, while processing the card transaction.

Doug Love, Hammersmith and Fulham Trading Standards officer warned: “The quality of the counterfeits is so good, unless you know what you are looking for it is incredibly difficult to spot.”

Evidence suggests the quality and prices of the plain pack counterfeits is creating a two-tier illicit trade, with cheap smuggled and counterfeit non-plain packs, and the new plain format illicit packs often passed through at RRP.

The article mentions that the first counterfeit plain packs were uncovered by Trading Standards in July, a mere two months after the new regulations came into full effect. They were found in the north-west and are now 'heading south'. 

If organised criminals want their products on the shop shelves, they've got to be in plain packs otherwise nobody's going to buy them at full price. The great thing about plain packaging - from their perspective - is that they only need to counterfeit one pack. After that, they just need to change the name on the front (all brand names have to be displayed in the same simple font by law) and they've got a full range of brands to sell. Happy days!

Another big 'public health' win. Well done to everybody involved.

Friday, 10 November 2017

Killjoys - out now

I'm delighted to announce the publication of my new book, Killjoys: A Critique of Paternalism. You can download the PDF for free. Hard copies and Kindle will be available from Amazon soon. If you want it sooner the IEA are sending out free copies to anyone who donates £10 or more this month (UK and Ireland only). Incidentally, we were going to send out free Killjoy lighters out as well but it turns out that there's a law against sending lighters in the post. I rest my case.

So what's it about? You can probably work it out from the title. It's about liberty and the limits of government intervention. I start with John Stuart Mill and the mainstream economists and move on to nudge theory, coercive paternalism and 'public health' paternalism. I look at the moral and economic arguments used by the 'public health' lobby to justify interfering in people's private lives and then look at the consequences of their interventions. Finally, I provide some suggestions about how a government that respected individual liberty would regulate risky lifestyle products and behaviours.

I've written a blog post about it for the IEA and Dick Puddlecote has kindly written a rapid response after picking up the book at the launch party on Wednesday night.

Download Killjoys.

Tuesday, 7 November 2017

Alcohol deaths and the folly of the whole population approach

It is often claimed that there is a direct correlation between per capita alcohol consumption and alcohol-related mortality. It is also claimed that this association is causal and that rates of alcohol-related death are directly tied to overall levels of consumption.

This theory, known as the total consumption model, is said to require a 'whole population' approach to alcohol policy aimed at reducing per capita consumption as an end in itself.

This view is explicitly endorsed by the World Health Organisation:

... lowering the population mean for alcohol consumption will also predictably reduce the number of people suffering from alcohol abuse.

And it is the official policy in Scotland and Ireland. As Alcohol Focus Scotland say (emphasis in the original):

The specific outcome of the Scottish Government’s alcohol strategy is to achieve a reduction in overall alcohol consumption.

If you want to know about the history of this idea, read the IEA paper John Duffy and I wrote a few years ago. In short, the theory is only supported by correlations seen in some countries between overall consumption and alcohol-related harm. Here is a graph from Finland, for example...

And here is the USA in a paper published in 1967...

These correlations are pretty tight. Notice that there is hardly any time lag. This is true even of chronic diseases such as alcoholic liver cirrhosis because, as Terris says...

In many cases the cirrhotic process can be halted and decompensation prevented by avoiding further use of alcohol. Conversely, resumption of heavy alcohol use after a period of abstinence can decompensate a previously injured liver in a relatively short period of time.

Based on these correlations, neo-temperance campaigners such as Alcohol Focus Scotland claim that alcohol-related problems can be addressed by reducing per capita consumption. But this is like trying to make a dog happy by wagging its tail.

The fact is that alcoholics drink a disproportionately large share of the nation's alcohol. If you have fewer alcoholics, per capita consumption will decline. This alone can explain the correlation between falling alcohol consumption and falling alcohol related mortality.

But there is no reason to think that reducing per capita consumption by getting moderate drinkers to drink less or by having more teetotallers is going to have any effect on the behaviour of alcoholics. And yet, by the logic of the whole population approach, anything that reduces per capita consumption will inevitably reduce alcohol-related mortality.

Conveniently for the 'public health' lobby, this approach allows them to avoid having to get their hands dirty dealing with people who have alcohol problems. Instead, they can tinker with the guidelines and lobby for tax rises and advertising bans, none of which are likely to have any impact on dependent drinkers. Alcoholism is a complex problem and their cretinously simple 'solutions' misdiagnose the problem and are therefore doomed to failure.

One only needs to look at the relationship between alcohol consumption and alcohol deaths in different countries to see that things are far more complex than the total consumption model assumes. Here is what happened in the USA after the study mentioned above was published...

Notice how the rise in cirrhosis peaked ten years before the rise in alcohol consumption. By the time alcohol consumption started falling in the mid 1980s, rates of cirrhosis had already fallen by around 20% from their mid-70s peak.

The United Kingdom is another example. Alcohol consumption peaked in 2004 and has since fallen by 18 per cent, as this graph from the IAS shows...
By the logic of the whole population approach, alcohol-related deaths should have fallen by roughly 18 per cent since 2004 but, as data published by the ONS today show, they simply haven't. The rate of alcohol-related mortality was 11.7 per 100,000 in 2016. In 2004, it was 11.5 per 100,000. Twelve years after the peak in alcohol consumption, mortality rates are essentially unchanged.

If you take the NHS's hospital admissions data at face value (which you shouldn't), there has also been a very large increase in the number of alcohol-related hospital admissions since 2004.

Leaving the hospital data to one side, the number of deaths is essentially the same as it was before consumption starting falling. As mentioned, this lack of association cannot be put down to a time lag. There is no time lag for acute alcohol-related harm (eg. drink driving deaths) and the time lag for alcohol-related diseases is remarkably short (within a few years, as most). It is not like smoking.

There has been no relationship between consumption and mortality in Britain since 2004. Death rates went down slightly and then went up slightly while consumption fell consistently.

The correlation that is sometimes observed between these two variables is not causal. Both consumption and mortality can be dictated by a third variable. That third variable is heavy drinking and/or alcoholism. But other things can affect per capita consumption and there is no reason to believe that per capita consumption (ie. other people's drinking) will affect alcoholism.

The story in Britain since 2004 seems to be that per capita consumption has fallen without levels of alcoholism falling. There are more teetotallers, young people are drinking much less, and non-heavy drinkers seem to be drinking less. Moreover, the fall in alcohol consumption has been largely driven by a fall in beer consumption. This is potentially significant because beer is less associated with alcoholism (when epidemiologists looked at the 'paradigmatic' data for the USA shown above, they found a somewhat more convincing association when they looked only at spirits).

All of this has caused per capita consumption to fall sharply, but unfortunately it has not led to a fall in the number of alcohol-related deaths. The most obvious explanation for this is that the small minority of people who are genuinely at risk of alcohol-related mortality has not got any smaller.

Targeted interventions, rather than policies aimed at the entire population, are what is required.

Monday, 6 November 2017

Self-serving sockpuppets

Who's fault is that, I wonder?

It should be a surprise to no one that the illicit trade in tobacco is booming after several years of above-inflation tax rises and the implementation of plain packaging. Shameless as ever, state-funded anti-smoking groups are attempting to exploit the failure of their policies to feather their own nests.

The graphic above comes from Fresh North-East (100% funded by the unwitting taxpayer) who have conducted a survey showing that the majority of underage smokers acquire their tobacco from illicit sources.

55% of children aged 14 and 15 who smoke say they buy illegal tobacco from sources like "tab houses" and shops - while 73% say they have been offered illegal tobacco.

Despite the survey finding that underage smokers are far more likely to be buying tobacco from 'private addresses' (ie. tab houses) than shops, Fresh are pushing for more regulation of the legal trade in the form of licensing. They want every shop that sells tobacco to apply for a licence to do so. Crucially, they want these shops to pay for the privilege. This is entirely unnecessary. Shopkeepers who sell illicit tobacco already face large fines and can lose their alcohol license if they sell tobacco to underage consumers.

The anti-smoking lobby wants tobacco licensing for two reasons only. First, to deter shops from selling tobacco at all (which, of course, would lead to even more illicit tobacco being sold). Second, to raise revenue for themselves.

The second of these reasons has not been made explicit until today, but Fresh have now come out and said it:

Fresh is calling on the Government to introduce a licensing system for tobacco manufacturers and retailers to provide funding for improved enforcement and other measures to reduce smoking prevalence

By this, they mean giving money to groups such as Fresh to lobby for measures to (supposedly) reduce smoking prevalence. 

The anti-smoking lobby in Britain now exists entirely for its own sake. All of its ridiculous policies have been tried and failed. It has nothing else to offer and it is now focused on keeping the money rolling in. Other than licensing, its only other policy proposal of any note is the unworkable idea of putting a windfall tax on tobacco companies. This, again, is designed to create a trough of money for ASH et al. to get their snouts into.

This is public choice theory in action. Groups such as Fresh have made themselves obsolete and the rise of e-cigarettes has set their obsolescence in stone. They are an irrelevance. The rise of black market tobacco - which they always denied would happen - is their legacy. They have done enough damage and their self-serving industry should be shut down.

Friday, 3 November 2017

Set vaping free

Disentangling ourselves from the EU after four decades will be fiendishly complicated but some elements of Brexit are refreshingly simple and uncontroversial. The recently enforced EU regulations on e-cigarettes are a case in point. Nobody seems to know what purpose is served by limiting vapers to tiny (10ml) bottles of fluid, limiting nicotine concentrations and banning advertising in most media - to name just a few of the new laws.

Recent years have seen a mass switchover from smoking to vaping that has been a boon for consumers, small businesses and 'public health'. Britain now has the second lowest smoking rate in Europe. This all happened under a free market for e-cigarettes which no longer exists thanks to over-eager bureaucrats in Brussels. Pointless EU regulations have restricted competition, raised prices and reduced consumer choice. The advertising restrictions are so severe that it is questionable whether the government's own stop smoking campaign, which promotes vaping, is legal.

Most British MEPs did not vote for these laws. The minister in charge, Anna Soubry, was not even aware that they had been passed. When they came into effect, they were condemned in the House of Lords and an Early Day Motion was proposed in the House of Commons calling for their repeal. Public Health England says that the EU's Tobacco Products Directive - which brought the regulations into force - 'certainly raises the barrier for bringing [e-cigarette] products to market ... and will undoubtedly constrain the market'.

It is difficult to find anyone in Britain who is prepared to defend the EU on this front. If we are not prepared to repeal these unnecessary and damaging regulations after Brexit, we won't repeal anything. This is the lowest of the low-hanging fruit and plucking it is a relatively simple matter, as I explain in a new IEA report published today (Vaping Solutions: An Easy Brexit Win).

The Tobacco Products Directive should have never included regulations for non-tobacco products such as e-cigarettes in the first place. The vaping market functioned better under the relatively laissez-faire regime that preceded it than it has since. The sooner it returns to its previous state, the better for the health, prosperity and liberty of the nation.

Download the report for free.

Cross-posted at the IEA blog

Thursday, 2 November 2017

Up is down in 'public health'

You may fondly recall Jill Pell, the anti-smoking campaigner who was responsible for the false claim that the rate of heart attacks fell by 17 per cent in Scotland after the smoking ban was introduced. Hospital admission statistics disprove this but that didn't stop the factoid spreading across the world. It has been cited as a fact in parliament several times.

Pell returned in 2010 with a risible attempt to prove that hospital admissions for childhood asthma fell by 18 per cent after the ban. Again, routine hospital statistics showed this to be complete nonsense.

Both studies somehow got published by the prestigious New England Journal of Medicine. Last week she returned again, this time in the rather less prestigious Tobacco Control, looking at hospital admissions for childhood respiratory tract infections (RTIs).

Awkwardly, it turns out that the number of admissions rose after the smoking ban, as this graph (from Pell's study) shows...

But this was only a minor inconvenience. In the past, Pell has managed to make it look as if admission rates were falling when they were essentially static, so it only required a bit more statistical jiggery-pokery to turn a rise into a decline. She probably enjoyed the challenge.

Here's what the data told her...

In our primary analysis, introduction of smoke-free legislation was associated with an immediate rise in acute RTI events (incidence rate ratio (IRR) 1.24, 95% CI 1.20 to 1.28) and an additional gradual increase over time (IRR 1.06 per year, 95% CI 1.05 to 1.06; table 2). This finding was consistent when upper and lower RTI events were considered separately.

Awks. At this point, Pell and her team could have decided not to publish (which, I strongly suspect, is what most 'public health' academics do when faced with such findings). Instead, they ploughed on.

We used advanced methods and followed a prespecified analytical approach—including a detailed statistical analysis plan—in an attempt to promote transparency. Despite this, our study yielded findings that were implausible and highly likely to be spurious.

Why would they be considered 'implausible'? Because...

Studies in other countries, including in the UK, previously identified consistent associations between comprehensive smoke-free legislation and subsequent reductions in paediatric RTI hospitalisations.

The problem here is that those studies are policy-based junk that directly contradict the evidence. Even if they weren't, respectable scientists don't change their conclusions to match those of other studies.

You know what is actually 'implausible'? The belief that a ban on smoking in workplaces, which mainly affected pubs, would have any effect of admissions to hospital by children under the age of 13 for a condition that is usually caused by a virus.

Building on the existing evidence base on the topic, we feel it is highly unlikely that smoke-free legislation was indeed responsible for a rise in paediatric RTI events, as our primary analyses seemed to suggest.

Nobody is arguing that the smoking ban caused RTI admissions to rise. The point is that, regardless of how Pell and her team 'feel', they did rise.

The amusing thing is that Pell et al. were clearly pleased with the rigour with which they approached this job...

Our study has a number of strengths. It was conducted according to a predefined protocol, including a detailed statistical analysis plan, which was developed a priori in an attempt to promote scientific transparency and reproducibility. We used over 10 million patient-years of high-quality data routinely collected over a 17-year period. Virtual universal availability of the CHI number minimises risks of incorrect data linkage across the datasets. We accounted for underlying temporal trends in RTI events as well as changes in population size and demographic structure. We applied a look-back period to reduce bias from RTI events occurring prior to the study period. Our modelling approach is widely applied in the evaluation of national public health interventions, including national smoke-free laws.

Then comes the punchline...

Given these strengths, the implausible findings are of considerable concern.

At which point, a sudden rethink was in order. But a further analysis still didn't come up with the goods...

In further post hoc analyses, the strength of association between timing of smoke-free legislation and acute RTI events was very similar when evaluated using a reg(S)ARIMA model of order autoregressive term multiplicative seasonal autoregressive term: IRR 1.15, 95%CI 1.02 to 1.28.

Ultimately, they resort to arguing that the smoking ban didn't cause the number of admissions to rise (which is something that nobody would seriously claim anyway)...

However, automatic break point detection suggested that the increase in acute RTI events started well before introduction of smoke-free legislation, that is, in November 2004. Using this break point rather than timing of smoke-free legislation in the primary negative binomial regression analysis indeed improved model performance as compared with the primary model. 


When timing of smoke-free legislation was then added to the model that included the November 2004 break point, smoke free legislation was associated with a gradual decrease in acute RTI events (IRR 0.91 per year, 95% CI 0.87 to 0.96), with no evidence of a ‘step’ change at that time.

God knows how they reached that last conclusion, but anyone who reads the abstract will see that the study shows that 'the legislation may in fact be protective', ie. that the smoking ban led to a reduction in the number of admissions for childhood respiratory infections.

I tempted to say that you couldn't make it up, but they did.

This is not the first time that 'public health' quackademics have turned a rise in hospital admissions into a decline (see the Brazilian miracle, for example), but it is the first time they have done it in such plain sight. Jill and her chums outline their methodology in detail, report their findings and then redo the whole thing because the findings go against their a priori assumptions. After redoing it, they arrive at exactly the opposite conclusion.

It is breathtaking. Is there any other field of science where researchers could do this so openly?

Monday, 30 October 2017

How Public Health England changed the drinking guidelines

Thanks to the Freedom of Information Act and this bundle of government documents, I have been able to see how Public Health England engineered the change to the drinking guidelines. Neither PHE nor the Sheffield University modellers come out of it well. If nothing else, it puts the lie to the notion that government-funded research is 'independent'.

Read the full story at Spectator Health. It's not pretty but it is important.

See also this report in yesterday's Sunday Times.

Thursday, 26 October 2017

Denying healthcare to smokers and fat people

I wrote this last week about the latest attempt by an NHS trust to defraud its customers...

In 1948, the minister for health, Aneurin Bevan, outlined the three guiding principles of the NHS: that it meets the needs of everybody, that it is free at the point of delivery and that it is based on clinical need, not ability to pay.

There was no footnote saying ‘…but only if you lead a state-approved lifestyle’. Bevan’s vision for the NHS could not have been clearer and yet a growing number of NHS trusts have been flying the kite of discrimination against smokers and the overweight. Hospital mandarins in North Yorkshire toyed with the idea of refusing surgery to incorrigible smokers and obese people last year. Clinical commissioning groups in Hertfordshire raised it again this week. Both sets of bureaucrats said that they would make an exemption for life-saving surgery, which was nice of them, but if patients are merely suffering from chronic pain, they will have to stop smoking and lose weight.

It is true that some operations will be more successful if the patient is slim and doesn’t smoke, although these benefits are not as great as some NHS bosses imply. But the risk is to the individual and it is the individual who is going under the knife. More importantly, it is the individual who has paid for the treatment.

The per capita cost of the NHS to every man, woman and child in Britain amounts to £2,000 per annum. If the average citizen had to write a cheque out for this amount every year, we might more fully appreciate the fact that the NHS is not a ‘free’ service that our masters can ration out to us if they approve of our lifestyles. It is an industry. We are the customers and those who work in it are our servants. Too many people at the top of the NHS hierarchy seem to have forgotten this. Increasingly, they see it as a tool of social control.

Some years ago, the NHS made a television advert which ended with the slogan ‘If you smoke, you stink’. It is difficult to imagine a private enterprise wilfully insulting a quarter of its clients in such a way. The demonisation of smokers and, more recently, fat people has given the NHS two groups of scapegoats to blame for its own shortcomings. We are routinely told that obesity threatens to bankrupt the NHS. This would be nonsense even if it were possible for the NHS to go bust, which it isn’t. The figures do not add up. Nor do the sums add up for smoking and drinking, neither of which are a ‘burden on the NHS’. Tax revenues from tobacco and alcohol amounted to £24 billion last year, vastly exceeding any associated costs to the health service.

If the NHS no longer wishes to treat smokers then it is only fair that they be given a refund, starting with all the tobacco duty they have paid over a lifetime. This alone would be enough for them to afford world class healthcare, with the added bonus that they would no longer have to pay for their own vilification.

Bevan understood that there is a basic social contract at the heart of the NHS. Because we are not allowed to opt out of paying for socialised medicine, doctors are not allowed to opt out of giving us it. No taxation without medication. If you’re going to start making patients go without treatment or pay privately just because they did not go everything they could to avoid their ailments, you might as well have a healthcare insurance system.

Such systems work well in the rest of Europe and I would not be opposed to borrowing a few ideas from places where health services produce better outcomes. The people who should really be concerned about the move towards NHS rationing are those who want to preserve ‘our NHS’ because they mistakenly believe that it is the envy of the world. Such a fundamentally political project cannot survive without consent. If it is going to start defrauding its customers - what else can you call refusing to deliver a service that has been paid for? - it is bound to lose public support.

If we set down this path, there is no obvious end to it. There are thousands of avoidable risk factors for diseases, accidents and injuries. Should we deny treatment to all those who fail to avoid them? Perhaps the NHS should simply adopt a policy of only treating healthy people. After all, if it wasn’t for the patients, the system would work perfectly.

Wednesday, 25 October 2017

Nationalising the pubs

At a conference in 2015, I suggested that the government had screwed over the pub trade in so many ways that it was only a matter of time before it had to be nationalised...

“Intervention upon intervention will lead to failure,” [Snowdon] said. “If we distort the market so much there will be no market left and the only people who can look after pubs will be politicians.”

“This is what I mean when I say that by 2020 we could be on our way to some kind of state-ownership of pubs; if they are regulated in such a way they are not able to be run by viable businesses.”

... The outspoken libertarian expressed his belief that politicians weren’t really concerned about the existence of the traditional British pub, saying if they were “genuinely committed” to the continued existence of the pub trade “they could and should halve alcohol duty and amend the smoking ban” and permit landlords to have one smoking room.

This was hyperbole. I was speaking partly in jest, but only partly. My colleague Kristian Niemietz also had his tongue in his cheek the other day when he looked forward to a socialist dystopia...

But the respected beer writer Phil Mellows has now made the case in earnest in Jacobin.

Recession, smoking bans, and changing lifestyles, plus an industry structure that has sucked profits towards major chains, mean that despite all the innovation, pubs at the heart of their communities have struggled to keep beating.

...Sometimes only the state is big and bold enough to save an industry. Given its record of success, it is long past time for the nationalization of pubs to return to the political agenda. It may sound far-fetched — but so, at one time, did Prime Minister Jeremy Corbyn.

The government certainly has experience in running loss-making industries. Thanks to the policies of successive governments, the pub trade is on the brink of becoming one of these.

Needless to say, I do not think that nationalisation is the answer. It would not address the industry's underlying problems and would lead to people who don't go to pubs having to subsidise those who do.

Industries come and go as people's tastes change, but there is nothing natural about the way demand for pubs has fallen in the last ten years. As I said in Closing Time, the industry has been crippled with high taxes and excessive regulation. Pubs do not need to be treated as charity cases. They do not need even more regulation and they certainly do not need state ownership. They just need to be given what the Australians call a fair go.

Tuesday, 24 October 2017

'Pretty neutral on the debate'

The Welsh Assembly formally announced its plan to put a minimum price on alcohol yesterday. A figure of 50p per unit was bandied around by the media but that has not been decided. Depending on what Scotland does, I suspect that it could be 60p (which is what the 'public health' racket have been demanding since 2009). Either way, the minimum price will go up and up.

We have been hearing the usual lies about how minimum pricing will have little effect on moderate drinkers. This is based - as always - on fantasy modelling from the Sheffield Alcohol Research Group who define a moderate drinker as someone who drinks 5.5 units a week (they do this by including all the light and occasional drinkers and then averaging out their reported intake - which is less than they actually drink anyway).

Figures in the BBC report show how implausible is the claim that only heavy drinkers will be affected. The majority of off-trade alcohol will become more expensive under a 50p unit.

Alcohol sold below 50p per unit makes up 72% of the beer sales in Welsh shops and supermarkets, 78% of the cider sales, 42% of the wine and 66% of the spirits.

So let's debunk the myth that minimum pricing will only affect the very cheapest, super-strong alcohol. It will affect most of us while effectively exempting the rich. If the policy is introduced in Wales, the prices will be noticeably higher than in England and a booming cross-border trade is inevitable. Perhaps the Welsh will blame the English when the policy is seen to fail.

There is still the small matter of EU law to get around first. The UK supreme court is expected to deliver its verdict by the end of the year. The BBC's (anonymous) reporter revealed his or her bias in this now-deleted paragraph..

The Supreme Court is expected to give its judgement within weeks to an attempt to block Scotland's minimum price legislation from being introduced.

However, if all goes well, ministers in Wales hope it would become law by summer 2018.

Speaking of the BBC, I was approached about going on BBC Breakfast yesterday to debate the policy. The programme is based in Salford and they prefer guests to be in the studio so I wasn't very surprised to get a text from their researcher saying that I wouldn't be needed because they'd 'got someone who is coming into Salford who is pretty neutral on the debate. They just look at the likely impact of various policies...'

However, I was extremely surprised when I found out that this 'neutral' policy analyst was none other than Colin Angus of the Sheffield Alcohol Research Group who is personally and professionally invested in minimum pricing and has been advocating for the policy for the best part of a decade. He is, to all intents and purposes, an activist. If you want to see how 'neutral' he is, here's a reminder of the time he started howling at the moon when the charity Prostate Cancer UK refused to believe some junk science from Tim Stockwell.

Aside from a brief video clip of an ex-alcoholic saying that minimum pricing would have had no effect of him, there was nobody to challenge Angus and so he was free to make the entirely false claim that minimum pricing in Canada led to a fall in alcohol-related deaths and hospital admissions (an easily debunked myth that can be traced back to Stockwell again). 

You can see his performance here but if you want to hear an actual debate about the policy, you can listen to me and someone from Alcohol Concern on BBC Wales yesterday here (from 37 minutes).

Friday, 20 October 2017

Money for old rope with Jolyon Maugham

Anti-Brexit campaigner Jolyon Maugham has been getting thousands of retweets with what he claims are secret government forecasts of what will happen if Britain leaves the EU without a deal and has to 'fall back' on WTO rules.

Maugham doesn't provide a link to the 'major newspaper' but the document he is talking about is probably the one referred to by the Independent and others back in March. Maugham has said that the document was produced 'shortly before the referendum'. It is almost certainly an early draft of the Treasury's notorious 'Project Fear' report that was published 18 months ago and is available online to anyone who wants to read it.

The Treasury also predicted an immediate recession if Britain voted to Leave. Obviously that didn't happen and the National Audit Office has admitted that some of the Treasury's assumptions were wrong. That doesn't make the rest of their predictions wrong, but it gives pause for thought.

So is it possible to get people excited about some predictions made 18 months ago when some of them have already been shown to be wrong? If your audience is one of diehard Remainers, the answer is yes, of course. Any scrap is hungrily devoured if it makes it look like as if the UK cannot become a normal, self-governing country.

Maugham's big 'headline' from his secret document is that every household will be £5,200 poorer under WTO rules.

Big news, eh? Except that is exactly what the Treasury publicly stated in May 2016, as you will see if you turn to page 122...

After 15 years, the UK is estimated to be between 5.4% and 9.5% of GDP better off inside the EU than adopting WTO rules. In 2015 terms, leaving the EU and relying on the WTO rules would mean a long-term loss of GDP of £5,200 a year for each household in the UK...

The net impact on receipts would be £20 billion a year in the central case of the EEA, £36 billion a year in the case of the negotiated bilateral agreement, and £45 billion a year in the case of the WTO.

But there's more...

This is highly debatable but, regardless of its merits, the same claim was made, almost word-for-word, on page 12 of the published report...

Relying solely on the WTO rules would result in a significant reduction in the openness of the UK economy to the outside world. It would be the alternative with the most negative long-term impact.

And on page 10...

WTO membership would amount to a significant closing of the UK’s access to global markets and would likely see the introduction of a much broader range of tariff and non-tariff barriers.

What other scoops has Maugham got for us?

Man! On page 98 of the published report, the Treasury mentions 'the food industry, worth almost £20 billion, over 370,000 jobs and selling almost 55% of exports to Europe'. It then gives exactly the same numbers that has got Maugham excited on page 96...

In 2014 for dairy products these tariffs averaged 36% with a very broad range of duties applied. This is significant because the EU accounted for 61% of UK agri-food exports in 2014, with EU member states accounting for 7 of the UK’s top 8 agricultural export markets.

The rest of Maugham's thread simply explains what WTO rules are and how could work, albeit with a bias towards pessimism. Everything in it has all been in the public domain for ages, mostly in the published report. For example...

This is discussed at greater length in the published report, particularly on pages 92 and 93, with the same conclusion. Woah!

Not exactly the Rosetta Stone, is it? It's kind of sad to see so many people getting hot and bothered about what is, at best, a shorter draft of a publicly available document. The idea that the Treasury had misgivings about leaving the EU but buried them in a secret report is ludicrous. The Treasury quite obviously wanted to remain and it published a 200 page report explaining why.

Some of the replies are hilarious.


Tuesday, 17 October 2017

Jamie Oliver's sugar tax 'success'

The evidence that taxing sugary drinks has any effect on obesity is - to put it mildly - poor. The great success story is supposed to be Mexico but we now know that per capita consumption of sugary drinks was essentially the same after that tax was introduced (in 2014) as it was before.

The other success story is supposed to be Berkeley, California, where sugary drink sales fell by 9.6 per cent after a soda tax was introduced in March 2015. But as I mentioned last week, you only have to read the study to see what really happened. Sales fell by 0.8 fluid ounces per transaction in Berkeley but they rose by 0.7 fluid ounces per transaction in neighbouring areas. People simply went out of town to do their shopping.

Since the quantities of sugary drinks consumed didn't change after the soda taxes were introduced in Mexico and Berkeley, it is inconceivable that they could have any effect on obesity. The authors of the Berkeley study (who include soda tax fanatic Barry Popkin) admitted that there was no statistically significant change in calorie intake from sugary drinks and that 'caloric intake of untaxed beverages (milk and other diary-based [sic] beverages) increased.'

Things are not looking good for advocates of these taxes, especially after the taxpayers' revolt in Chicago. An element of desperation is creeping in, hence this today...

Jamie Oliver’s 10p tax on sugary drinks sold in his Italian restaurants has resulted in a significant drop in sales, a study has found.

Jamie knows a thing or two about losing sales. He's been closing restaurants left, right and centre this year. However, the study looks at soft drink sales per customer so should not be affected by the general decline of Oliver's businesses. So what's the story?

A study of the effects of the levy, published in the Journal of Epidemiology & Community Health, has found that sales of sugar-sweetened drinks such as colas and lemonades fell by 11% in the first 12 weeks. At the end of six months, sales were 9.3% lower than they had been before the levy was introduced.

The price elasticity of sugary drinks is generally though to be around 0.8-1.2, meaning that a 10 per cent increase in price leads to a fall in demand of roughly 10 per cent. Jamie Oliver's drinks are so expensive - at £2.60 to £3.25 - that a 10p 'tax' only increases the price by 3.5 per cent.

A decline in sales of 9.3 per cent as a result of a 3.5 per cent price rise is implausible. It would imply a price elasticity of about 3.0, ie. three times higher than has been observed elsewhere.

To their credit, the researchers admit that this is not very likely...

Prof Steven Cummins of the department of social and environmental health research at the London School of Hygiene and Tropical Medicine, who carried out the study, acknowledged that the clientele of Oliver’s restaurants tended to be affluent, and that the price hike on a drink costing between £2.60 and £3.25 might not make a lot of difference to them.

“I don’t think the financial element of it is a massive disincentive,” he said. But he likened it to the plastic bag charge, which prompts people to think about having one.

It's worth remembering that Jamie introduced his 'tax' after presenting a ridiculous documentary on Channel 4 that portrayed sugary drinks as something akin to asbestos. This is likely to have had an effect on the kind of morons who admire the man and go to his restaurants. By the same token, it is likely that people who enjoy sugary drinks and don't want to be lectured by a fat-tongued Essex pea-brain would have been less likely to go to his restaurants after Oliver got on his high horse.

In other words, the people who visited his poxy restaurants after he introduced this gimmick were not necessarily the same people who visited before.

The drop in sales at six months of 9.3% was only in the restaurants that previously had higher levels of sales of sweetened drinks. There was a general drop in sales on non-alcoholic beverages, except for fruit juices, which went up. 

This is an important point. The most interesting thing about sugary drinks taxes is seeing what substitution effects take place. The Guardian doesn't give the figures, but the study says that there was a 22 per cent rise in the sale of fruit juice (which has about the same amount of sugar as a fizzy drink), although fruit juice orders from the children's menu fell. Sales of off-menu mixers went up slightly, but sales of diet cola and bottled water went down (by 6-7 per cent).

In fact, the sale of nearly every type of drink went down. It is not clear what, if anything, people were switching to. The authors don't have figures for alcohol sales for some reason, but the rise in the sale of mixers suggests that the sale of spirits may have increased. Alternatively, people could have switched to tap water. Either way, it left Oliver out of pocket.

He [Cummins] said he thought the effect was “entirely transferable” to other less expensive chains. “There is no reason why other restaurants couldn’t do exactly the same,” he said. 

Actually, there is a very good reason. Drink sales are an important revenue stream for restaurants and Oliver seems to have lost them overall. It speaks volumes about 'public health' researchers that Cummins doesn't think this would play a part in a restaurateur's planning.

This study doesn't tell us anything useful about the impact of sugary drink taxes as a government policy. I'll leave it to Kevin McConway, emeritus professor of applied statistics at the Open University, to have the last word:

“The menu was redesigned: it explained that the proceeds of the levy would go to the Children’s Health Fund, new drink products were introduced, and Jamie himself appeared in a television programme about sugar. So we certainly can’t be sure that the fall in consumption of sugary drinks was entirely, or even mainly, caused by the extra 10p.

“The researchers do provide some circumstantial evidence that the 10p played a role in the reduction in consumption, but they (rightly) make it clear that a study like this can’t prove what caused what. Actually, it doesn’t even establish that any of the specific changes at Jamie’s Italian restaurants had anything to do with the lower consumption – for instance, the researchers had no data from any other restaurants, and maybe consumption fell there as well"

“It’s interesting that, in this study, the consumption of fruit juice from the children’s menu fell as well – indeed it fell by rather more than the consumption of the sugar-sweetened drinks, while consumption of fruit juice from the main menu went up. Maybe the numbers of children going to the restaurants changed, relative to the numbers of adults – the researchers couldn’t tell because they had no data on whether customers were adults or children. Maybe things would have been clearer if they had had data over a full year after the change, rather than just from September to February.

Quite so.

Monday, 16 October 2017

Problem gambling figures misrepresented yet again

Back in May, I wondered why Phillip Blond had suddenly taken an interest in fixed odds betting terminals. It now transpires that his think tank, Respublica, had been commissioned by the Campaign for Fairer Gambling to write a report about them. It was published today and you won't be surprised to hear that it supports Derek Webb's longstanding goal to reduce the stakes to an unplayable £2.

I wouldn't bother mentioning it here if it weren't for the fact that it does what so many anti-FOBT campaigners do and lies about the problem gambling statistics... 

The latest available research has found that the number of problem gamblers has surged – from 280,000 in 2012 to 430,000 in 2015. 

Respublica provide two references for this: a Gambling Commission report about England and Scotland with statistics from 2012 and a Gambling Commission report about England, Scotland and Wales with statistics from 2015.

Respublica don't mention the fact that the latter report has an extra four million people in it (three million people live in Wales, plus UK population growth of around one million). In fact, they explicitly claim that both reports only look at England and Scotland. They then claim that there was a rising in problem gambling in these three years 'of over 50 per cent'.

This is implausible on the face of it and it is untrue. The 2012 report gives an estimate of the number of problem gamblers under the two usual measures: 

The confidence interval for the DSM-IV estimate was 0.3%–0.7%, for the PGSI estimate 0.2%–0.6% and for either screen 0.4%–0.9%.

And the 2015 report says:

The confidence interval for the DSM-IV estimate was 0.5% to 1.0%, for the PGSI estimate 0.4% to 0.9% and for either screen 0.6 % to 1.1%.

The figures from 2015 are higher, but there is not a statistically significant difference. All these estimates tell us is that there is a 95% probability that the real figure lies somewhere between the confidence intervals.

Even a naive reading of the stats does not imply a 50 per cent increase, however, and the Gambling Commission's most recent (absolute) number is 320,000 people, not 430,000 people.

If you look at the figures from 2010 you will see that they are higher than in either of the subsequent reports, being 0.7%-1.2% under the DSM-IV estimate and 0.5%-1.0% for the PGSI estimate. (The 2010 report didn't combine the two to come up with a third estimate.)

And the 2010 figures were slightly higher than the 2007 figures. So it goes. These estimates have wide confidence intervals and they fluctuate a bit but there is no visible trend in either direction. (See here for more details about this.)

There was not a significant increase between 2012 and 2015, just as there was not a significant decline between 2010 and 2015. Every problem gambling survey since 1999 has been consistent with the hypothesis that problem gambling prevalence has held steady at around 0.7%.

As I have said before, you can only pretend that there is a trend if you cherry-pick your reports and ignore the confidence intervals. That's why rates of problem gambling have appeared to be doubling and doubling in the last decade, if you believe the media, without the number of problem gamblers ever getting larger. 

There isn't much else in the Respublica report to discuss because it doesn't provide much in the way of evidence, but a dishonourable mention should go The Times for making this howler in its coverage...

In total about 1.5 million people play the machines, collectively losing more than £1.7 billion last year, almost £12,000 each on average.

£1.7 billion divided by 1.5 million people is £1,133, not £12,000. The Times is out by a factor of ten.

Thursday, 12 October 2017

Nudge and liberty

The behavioural economist Richard Thaler won the Nobel Prize this week. I was on the Moral Maze with Thaler back in 2010 and it was obvious that we were the only two people out of the eight on the show who had read his book. This wouldn't have mattered except that the show was all about nudging and Thaler had to listen to his ideas being totally misrepresented. I remember him saying to one panellist, 'you could not be wronger'.

People have been getting nudge wrong ever since and Thaler occasionally corrects them...

Some libertarians find nudging a bit sinister but most of them have never read the book either. Personally, I have always thought that libertarian paternalism was much more libertarian than paternalistic. The main criticism of nudging is not that it is authoritarianism but that it is quite trivial. In practice, there are not many problems that can be solved by nudging, particularly by government.

I've written about this in my forthcoming book, Killjoys, which will be published on November 10th and I've given CapX an excerpt which you can read here.

I'll say more about the book in a future post but here's the cover.

Wednesday, 11 October 2017

A great day in Chicago

In what is undoubtedly the feelgood story of the week, officials in Cook County, Illinois overwhelmingly voted to repeal their hated soda tax after just two months. Cook County is the home of Chicago, America's third largest city, so this is kind of a big deal, even if the UK media chooses to ignore it.

I've written about it here for Spectator Health, so do pop over and read my article, but let's take a moment here to savour the defeat of that evil old fossil Michael Bloomberg who has been bankrolling soda tax campaigns all around America (and beyond). He's not short of money but even a billionaire must smart from pouring millions of dollars down the drain, as he has in Chicago.

In 2016, Bloomberg handed over $1 million for ads to build support for the tax, and then donated another $2 million in August 2017.

In September, Bloomberg funnelled in another $3 million to the pro-tax cause.

And two weeks ago, in an extraordinary act of hubris, he handed out a $2.5 million grant to some 'public health' researchers at the University of Illinois to study the effects of the tax.

Bloomberg therefore spent at least $6 million campaigning for a soda tax that died on its arse after two months. He then spent another $2.5 million to study its non-existent impact. Evidently, Bloomberg's efforts to change the law in another city were not appreciated...

Funny as this all is, Bloomberg could be using his fortune to do some good in the world and heal the sick, but he chooses to spend it on campaigns to make fizzy drinks a bit more expensive which are a waste of time whether they succeed or not. At best, they will fail and we can have a good laugh at him. At worst, they succeed and the cost of living goes up. Meanwhile, there are important medical services that could spend the money usefully.

Anyway, do read my Spectator piece.

Tuesday, 10 October 2017

Fake obesity news

There are more worthless obesity predictions on the front page of The Guardian today...

In 2014, a third of men and women in the US were obese (34%). By 2025 that is predicted to be 41%. 

Really? Because in 2007 we were told that the obesity rate would have reached 41% two years ago...

More than three quarters of American adults will be overweight by 2015, a survey has found. A further 41 per cent will be obese if people continue to gain weight at the current rate, according to the study by Johns Hopkins University.

Still, I'm sure they'll be right this time, eh? I mean it's not as if the obesity rate is falling in America or anything, is it? Oh.

How about Britain? What do the ball-gazing experts of the World Obesity Federation reckon will happen here?

In the UK, more than a quarter of adults (27%) were obese in 2014 and that will rise to 34% by 2025.

Yeah? Well, it was supposed to have hit 32% two years ago according to the government's ill-titled Foresight report of 2007 which said...

The extrapolation of current trends, which underpins the microsimulation, indicates that, by 2015, 36% of males and 28% of females will be obese.

And the new prediction of 34% by 2025 is a bit of a climb down from the 41.5% predicted in Foresight...

By 2025, these figures are estimated to rise to 47% and 36% respectively.

As I have said before, I will happily take a bet with anybody that these predictions do not come true, which is to say that the real rate will be lower than the forecast. It always is because these 'microsimulations' are not serious attempts to plan for the future. They are quack statistics made up by spivs to draw attention to special interests (in this instance, it's World Obesity Day tomorrow).

Obesity forecasts are among the most useless trash in the whole 'public health' racket. Any journalists who give them credence should be ashamed of themselves.

A one-man anti-gambling torpedo

The Financial Times published an interview with Derek Webb recently. Webb is the multi-millionaire inventor of Three Card Poker who has put a small fortune into the Campaign for Fairer Gambling, an organisation he formed to attack fixed-odds betting terminals in betting shops.

He clearly feels that he has the wind in his sails because he's eyeing up his next target...

He adds he may broaden CFG’s focus to target online gambling next. “I want to fight where I can win,” says Mr Webb.

I'm told that he expressed a similar intention to go after the internet next at the Conservative conference last week.

Webb's growing addiction to attacking non-casino gambling sectors will come as no surprise to students of the slippery slope, but few people seem to understand just what a whirlwind of destruction he is unleashing.

Webb wants to reduce the stake on FOBTs to £2, knowing that this will make the machines unplayable for most punters. This will likely mean the end of FOBTs in bookies in Britain.

And that will mean the end of many bookies. FOBTs contribute around half of the average betting shop's revenue. They have no way of making that money from sports betting, which has largely gone online. If they lose half their revenue, there will be thousands of closures. The Association of British Bookmakers says 92 per cent of betting shops are at risk. Nobody knows how many, but it is not unlikely that most would go.

And that has severe repercussions for the horse-racing industry. Under a system set up in the 1960s, horse-racing gets 10.75 per cent of the profits from bets placed on races in bookmakers. This amounts to a subsidy of £60 million per annum but it will be much less if bookmakers go out of business.

As Lawrence Robinson, chair of the All-Party Parliamentary Group on Racing & Bloodstock, says:

If FOBTs go, bookmakers’ shops will go, and racing will lose out. 
The government has recently extended the levy to online betting, but online operators do not necessarily pay tax in Britain (to put it mildly) and it remains to be seen how many people bet on horse-racing without betting shops acting as its high street shop window. Horse-racing has been in decline for decades. This could be the final nail in the coffin for some racecourses.  

But it doesn't end there. If FOBTs go, the government will lose £400 million per annum in gambling revenue. To claw it back, the Chancellor is reported to be looking at taxing casinos more.

Formal proposals to be circulated among senior ministers to increase taxes on casinos, sources say.

That would put casinos under added financial pressure to go alongside all their other problems (as with FOBTs, casinos can't pass the costs onto customers via their table games because the odds are fixed).

And now Webb is going to go after online gambling too! From top to bottom, Britain's gambling industry is going to suffer more from one millionaire with a bee in his bonnet than from all the religious campaigners and moral guardians put together.