references for tonight’s Inside Health 19/3/13!/file/PartA.pdf!/file/PartA.pdf

8 Responses to “references for tonight’s Inside Health 19/3/13”

  1. Margaret McCartney
    margaretmccartney March 19, 2013 at 10:19 pm #

    the first: not sure how you see this as an argument against minimum alcohol pricing; it clearly states the harms of alcohol in the upper reaches of use;
    the second; it’s about the Sheffield work, I’m most interested in the data analysis from Canada; that’s the bulk of references here
    the third; the best trial would be an RCT and it is theoretically possible to do, but I suspect the will is not. I don’t think that this one trial of a complex intervention is enough to think that there is enough evidence to be reasonably sure of what’s going on; but I do think that when other evidence – from the same region, also Ontario, also Australia – is taken into account, there is enough to consider that minimum pricing probably does have a meaningful and useful effect. Additionally, death is not the only meaningful outcome from an intervention to prevent alcohol harm – eg multiple others are clinically important, eg foetal alcohol syndrome. Have a look at the Finnish study referenced above – for evidence of a converse effect.

  2. Dick Puddlecote March 19, 2013 at 11:54 pm #

    The first is an argument about the author.

    “we sense a desire by some in the field to apply tough standards on protective effects and more lenient standards on other effects, where sometimes the responses to very simple survey questions such as ‘Did your partner’s alcohol consumption contribute to your marriage problems?’ are accepted as causal evidence.”

    Isn’t Tim Stockwell a major plank of the argument for MUP? Wouldn’t you say that methodology like that casts his pronouncements in a bad light? He is, as I think you know, the prime source for the data analysis from Canada.

    Also, why do you glide past Sheffield so casually when our government used its ‘evidence’ heavily for the consultation?

  3. Margaret McCartney
    margaretmccartney March 20, 2013 at 7:35 am #

    1) don’t know much about the politics of who says hwat
    2) qualitative work is often important but should add to rather than be the entire evidence base
    3) because I went to the data that Sheffield reported on rather than just reading the report

    can you tell me, on twitter, you said that
    “@drmarkporter That’ll be the three line whip and threat of recriminations – it really is shockingly shoddy and contrived @mgtmccartney”
    who are you accusing of threatening/misleading/influencing me and with what?
    I am fascinated

  4. Mills March 20, 2013 at 5:18 pm #

    Why minimum unit pricing and not just an increased pro-rata tax on every unit of alcohol?

    The largest drinkers of alcohol are middle-aged and professional, so are unlikely to be affected by MUP.

  5. Dick Puddlecote March 20, 2013 at 9:52 pm #

    Margaret, it was a tongue in cheek comment about the very real public health mafia. Step out of line on certain matters at the wrong time and Global Link bans, personal and professional smears and slurs often ensue. Just ask Siegel, Enstrom, Kabat amongst many others in the second hand smoke debate.

    Public health is currently enraged about the possible (quite correct IMO) ditching of MUP. Anyone stepping out of line right now should expect a few stiff e-mails, I reckon.

    It’s why I have an extraordinarily low opinion of your colleagues and can’t trust a single word they say. I’m sure you are a decent person. I follow you simply because of that, and you prove it further by not blocking me the moment I challenge or debate, unlike dozens of your public health profession. I can name names if you like. 😉

    By the way, I have read all of Sheffield’s data too, and I still think it is the same old, same ole. Dangerous, shoddy, anti-social, selective, policy-led evidence designed (and paid for) to further an agenda. It’s why I was very disappointed to hear via Porter that you think it is sound. It’s not, and the fact that any institution can ever call it “targeted” is a joke that even a 13 year old could work out. Mills, above, highlights the problem in two short sentences, why can’t your acres of impenetrable, often inaccessible, links not see that too?

    (I think this is where you accuse me of being in the pay of big alcohol, even though I run a family transport business in the private sector) 😉

  6. Margaret McCartney
    margaretmccartney March 20, 2013 at 11:08 pm #

    well, since I’ve been talking about the problems of public health interventions like screening for the last decade, if I was going to find a horses’ head in my bed, I think it would have happened by now.
    I didn’t say the evidence was sound, but that it was pretty good, and is not just evidence from one place but many. I would prefer an RCT. We don’t have one. I think we could do one, but meantime, alcohol is doing harm that affects a small portion of people very badly (and their families, often) and we have some decent research which is pointing out a rational intervention.
    I would consider myself a libertarian, but before that comes the evidence. Is there evidence that this policy could benefit people currently being harmed by the most dangerous drug (Lancet 2010); yes, I think so. Is there evidence of people being harmed by it? No, I can’t find anything to support that.
    Some of the links are via passwords to full papers, but I think I’ve also given links to the abstracts.
    You haven’t replied about the inverse effect in Finland paper….

  7. Dick Puddlecote March 21, 2013 at 7:29 pm #

    Thanks again for the reply.

    On the PH mafia, I’m sure you have been challenging the consensus in many areas, but I suggest that lifestyle public health is a different beast. Firstly, it is populated by sociologists, psychologists and social scientists rather than the medical breed of ‘doctor’. Secondly, their grants tend to be reliant on passing the ‘next logical step’ of legislation to prove their importance (I’d say the world would carry on in much the same manner without them, they fail in just about everything they do). It is only their transparent manipulation of statistics and sometimes hysterical sound bites and, yes, bald-faced lies, that stop them being laughed out of Westminster.

    As far as your evidence of harm or not, the reason you have not seen evidence of people being harmed by MUP can be for two reasons. Firstly, the above mentioned collection of one-eyed agitprop pushers have only one aim, to get their latest wheeze through parliament by whatever means possible. Stockwell’s methods, above, is a perfect example of widespread practice – weak data is enthusiastically embraced if it supports, while strong data is discarded if it doesn’t (in fact, whole meta-studies have been conducted in this way many times, as was the systematic review for the MUP consultation). Secondly, and by the same principle, the medical profession in general quite understandably concentrate only on harms to health, and quantify it in number and cash terms. For example, QALYS and ‘costs’ to the NHS. Never do they quantify the cash and health benefits of enjoyment derived from unapproved products. I would argue that pleasure derived from alcoholic consumption can be valued at equal to, or more than, the total sales figure of the UK drinks industry (many tens of billions more than any costs thrown up by PH). If that debate was impartial and held in public, the public could make their own minds up, as could MPs. But, of course, the lifestyle PH industry know that would ruin their case so actively seek to silence opposition from tobacco, drinks, food, soda industries. Harm from derogation of activities which the public find enjoyable should be part of the debate, it is not at the moment, which conveniently helps prohibitionists to ignore the reduction in quality of life MUP would inevitably inflict on a vast majority of the the less well of who enjoy alcohol responsibly.

    Lastly, maybe I’m missing something, but the Finnish study relates to alcohol duty, not MUP. I fail to see how it is relevant to current plans. MUP is not targeted in any way, shape, or form. Duty can definitely be argued to be far more targeted, so one has to wonder why the big fuss over MUP which will hit the poor hardest whether they are abusing alcohol or not, no matter what statistical contortions Sheffield perform to ‘prove’ otherwise.