Friday, 18 February 2011

Drinking league

This really isn't good enough.

Average amount drunk in UK is 16th highest worldwide

Yet again, this once great country fails to make the top 10. We're getting beaten by South Korea now, for goodness sake. The Czechs are making us look positively light-weight. I'm not looking at you, ladies. You've been pulling your weight. But men, especially those aged 16-24, what's happened? Where's your sense of pride? I'm not asking you to keep up with the Irish or the Russians. Let's be realistic. But at least keep pace with the Portuguese and the Slovenians.

This comes from The Telegraph's article about the latest piece of temperance advocacy from the World Health Organisation, which is inviting governments around the world to keep on taxing drinkers:

“One of the most effective is raising alcohol prices by raising taxes."

By how much? Is there no limit? Apparently not, as there is no suggestion in the report that taxes could ever be too high. Alcohol taxes are not immune to the laffer curve and there is a ton of evidence, gathered over centuries, that excessive alcohol taxes result in more dangerous drinking habits and home distilling of strong, unregulated booze. You only have to look at the figures in this very report to the difference between high and moderate tax countries:

Per capita consumption of pure alcohol (litres)


Recorded consumption: 6.70

Unrecorded consumption: 3.60 

United States

Recorded consumption: 8.44 

Unrecorded consumption: 1.00

I use the USA as a comparison because it's not as if they don't have a history of making moonshine when they need to.

"This has the added benefit of generating increased revenues."

If it was truly effective it would result in less consumption, not increased revenue. Touting alcohol taxes as a way of raising revenue rather gives the game away, does it not?

And, dear oh dear, the anti-obesity and anti-smoking factions aren't going to like this...

"Alcohol consumption is the world’s third largest risk factor for disease and disability; in middle-income countries, it is the greatest risk."

That rather depends on what you're measuring. The demon drink came rather lower down the list in a previous WHO report, which showed the number of deaths attributable to various risk factors.

This wasn't sufficiently newsworthy for the new report on alcohol, and since the WHO now seems to be a glorified pressure group, they did what campaigners do and picked the data that best suited their PR people.

This is the chart, showing the number of Disability-adjusted Life Years. Sure enough alcohol now beats both smoking and obesity, and comes top for middle-income countries (or, more precisely I think, middle income people).

The difference comes down to alcohol tending to kill people at a younger age (that's 'kill' in the broadest sense—over 40% of the claimed death toll is due to intentional and unintentional injuries, which can only be partially attributed to alcohol.)

There's nothing wrong with using 'years lost' rather than 'lives lost' to measure the impact of risk factors. In fact, I think it's a better measure, as children dying of starvation and AIDS is clearly a more important preventable death than a 90-year old dying of hypertension.

It does, however, demonstrate how statistics can be mined to suit the cause. It is now a three-way battle between the temperance lobby, the fat-fighters and the anti-smokers to keep their pet project in the public eye. This involves vying for position both with the claimed death toll and with the ever spiralling 'cost to society'. Tobacco has traditionally been the undisputed champion in this field. For instance:

Smoking Now Leading Cause of Death Worldwide

The use of tobacco is now the primary cause of death around the world. And the Director of the U.S. Centers for Disease Control says not enough countries are taking adequate steps to discourage it.

The World Health Organisation implies the same thing, but note the careful wording:

Tobacco use kills more than 5 million people per year. It is responsible for 1 in 10 adult deaths. Among the five greatest risk factors for mortality, it is the single most preventable cause of death.

You may also have read that obesity is the leading preventable cause of death, at least in America. (Less reliable sources may have even told you that obesity is the leading cause of preventable death worldwide.)

Research confirms obesity is now leading cause of preventable death in U.S.

America's persistent weight problem is now the country's leading cause of preventable death.

For years scientists and health care professionals have warned of the dangers of smoking, and tobacco use is still a major contributor to early mortality. But new research shows that it is is obesity that now causes even more fatal disease.

And now alcohol is well and truly in the race. But, as a point of fact, none of them are the world's leading cause of preventable death. As the data show, the leading cause of lives lost is high blood pressure and the leading cause of years lost is childhood malnutrition. We don't hear so much about these, but then they're not taxable, are they?


Anonymous said...

But, as a point of fact, none of them are the world's leading cause of preventable death.

Chris, you may not be familiar with iatrogenesis, or iatrogenic effect. This refers to any detrimental consequences of medical activity. It usually refers to adverse drug reactions form properly administered drugs, medical errors (e.g., misdiagnosis, surgical errors), and the consequences of poor care (e.g., resulting infections in bed sores from poor care of the bed-ridden).

In the USA, the smoking “death toll” is estimated at 440,000 per annum. This estimate is based on lifelong risk of tobacco-use that also involves hundreds of other correlated risk factors. For all intents and purposes, it is a statistical death toll where underlying causation is highly questionable at the individual level: The causation is improperly argued from the population level to the individual level. The causation in iatrogenesis is far, far clearer. For example, a person can go into catastrophic failure leading to death/disability within minutes of being properly administered a drug. Causation at the individual level is typically clear. An estimate is then made of the population-level prevalence. In other words, the reasoning is from the individual to the population level rather than the other way around in the smoking “death toll”. The estimated iatrogenic death toll (population-level prevalence) in the USA is between 700,000 and 1,000,000. This is getting close to half of all deaths per annum. While the medical establishment may be of help to many along the way, there is a high probability that it will also kill you.

Of the two – the smoking “death toll” or the iatrogenic death toll – it is the latter that should be taken seriously because causation is properly definable at the individual level. Yet, while the smoking “death toll” is referred to incessantly, the iatrogenic death toll is rarely, if ever, referred to. While there are tens upon tens of thousands of questionable antismoking “studies”, there is only a handful on establishment-wide iatrogenesis. The medical establishment which makes up all of these charts and graphs, much of it statistical chicanery that it often uses to harass/persecute particular social groups, routinely omits its own very considerable death toll and spends very, very little time scrutinizing its own destructive activity. The medical establishment is by far the leading cause of preventable death and disability.


Anonymous said...

“We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs [adverse drug reactions] and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death”.

Including more sources of iatrogenesis:
Doctors Are the Third Leading Cause of Death in the U.S.
Cause 250,000 Deaths Every Year
From Starfield, B. (2000) Is US Health Really The Best In The World? Journal of the American Medical Association, 284 (4), 483-485.

Including even more sources of iatrogenesis:
Null et al. (2003)
Cause 780,000-1,000,000 Deaths Every Year


Anonymous said...

Adding in the destructiveness (also iatrogenic) of the aggressive promotion of eugenic ideology such as its antismoking campaign – promoting irrational belief, fear, and hatred (and all of the psychological, social, moral, economic, political, and physical ramifications thereof) – the contemporary medical establishment is a highly organized, highly self-protecting/promoting, mainstream, and dangerous entity in the world at this time. The Hippocratic Oath has been brutalized over the last number of decades. Taking the Oath for medical graduates is now optional. (There was a similar assault on the Hippocratic Oath in the German medical establishment in the years leading to the Nazi reign and in which reign medicos played a leading role) Removing allegiance to the Oath makes the medical establishment highly vulnerable to venturing into social domination and social engineering - again.