From the Annals Of Really Bad Science Journal

This is simply terrible:

Imposing a minimum unit price for alcohol leads to a dramatic fall in drink-related crime, including murders, sexual assaults and drink-driving, a new study shows.

Crimes perpetrated against people, including violent assaults, fell by 9.17% when the price of alcohol was increased by 10% over nine years in the Canadian province of British Columbia. Motoring offences linked to alcohol, such as killing or injuring someone with a vehicle and refusing to take a breath test, fell even more – by 18.8% – the study found.

An interesting finding but how good is the science?

Method:
A time-series cross-sectional panel study was conducted using mixed model regression analysis to explore associations between minimum alcohol prices, densities of liquor outlets, and crime outcomes across 89 local health areas of British Columbia between 2002 and 2010. Archival data on minimum alcohol prices, per capita alcohol outlet densities, and ecological demographic characteristics were related to measures of crimes against persons, alcohol-related traffic violations, and non–alcohol-related traffic violations. Analyses were adjusted for temporal and regional autocorrelation.

Results:
A 10% increase in provincial minimum alcohol prices was associated with an 18.81% (95% CI: ±17.99%, p < .05) reduction in alcohol-related traffic violations, a 9.17% (95% CI: ±5.95%, p < .01) reduction in crimes against persons, and a 9.39% (95% CI: ±3.80%, p .05). Densities of private liquor stores were not significantly associated with alcohol-involved traffic violations or crimes against persons, though they were with non–alcohol-related traffic violations.

So, they examined minimum alcohol prices and traffic violations in British Columbia. What did they not measure? Changes in traffic violations in Canadian society in general. In, perhaps, areas that did not have the rise in minimum pricing.

For all the ordure that it thrown at economists and their models these days at least this would never be published in an economics journal. Because the first reviewer, heck, even the editor pondering whether to send it out for review, would first ask, well, what was that general change so that we can measure the effects of this specific change against it?

Not that we’re about to do that detailed analysis, we’ll leave that to the excellent Chris Snowdon over at the IEA. But an indication from Canada’s 2010 crime statistics:

In 2010, police reported about 84,400 incidents of impaired driving (Table 4). The number of impaired driving offences reported by police can be influenced by many factors including legislative changes, enforcement practices (e.g. increased use of roadside checks) and changing attitudes on drinking and driving.

The 2010 rate of impaired driving was down 6% from the previous year, representing the first decrease in this offence since 2006 (Chart 14). The rate of impaired driving has been generally declining since peaking in 1981.

No, we don’t know but we’ve got at least a definite impression. Booze related driving incidents have been declining in general for 30 years. To the point that in the final year alone of this paper’s measurements they actually declined nationwide by 6%. And they’re trying to pin an 18% decline over a decade on a minimum price change that only happened in one province?

And they don’t compare the declines in that one province with other provinces?

This might be all sorts of things but it ain’t science, is it?

These people are insane

Yet more from the anti-smoking fanatics:

Smoking costs the NHS at least £2bn a year and a further £10.8bn in wider costs to society, including social-care costs of more than £1bn, says the document. With the public health budget now set to lose £200m a year, the group says that the tobacco industry should pay an annual levy to offset those costs and assist with the effort of stopping young people picking up the habit as well as helping smokers to quit.

Peter Kellner, chair of the report’s editorial board and president of YouGov, said: “The NHS is facing an acute funding shortage and any serious strategy to address this must tackle the causes of preventable ill health.

“The tobacco companies, which last year made over £1bn in profit, are responsible for the premature deaths of 80,000 people in England each year, and should be forced to pay for the harm they cause,” he said.

Sigh, the tobacco companies do not cause that harm. Smokers, voluntarily, cause that harm to themselves and pay taxes through the nose for having done so. And yes, this is a liberal issue. We get to ingest as we wish, we get to kill ourselves with our habits if we so wish because we are free people.

But what raises this to insanity is that the most successful smoking cessation product anyone has ever come out with is the e-cigarette, or vaping. And those very same public health bodies are behind the move to ban the use of such things in Wales. Our apologies, but that really is insane.

We look forward to the next two NHS efficiency reports

Lord Carter’s report that the NHS is not in fact as efficient as we would like that august organisation to be. This has led to the predictable cries from the left that it must be the nascent market in said NHS that is to blame:

The aim is, apparently to save up to £400 million for the NHS by making more effective buying decisions that will reduce the product range used by NHS hospitals from more than 500,000 items to just 10,000.

Three thoughts follow. The first is that it is very obvious that Lord Carter is saying that splitting the NHS into hundreds of trusts each making their own buying decisions is hopelessly inefficient, as was always obvious.

Second, he is saying that if you create an inefficient system where cooperation is not allowed because that is contrary to the dogmatically imposed idea that competition produces optimal outcomes you will end up with excess cost.

And third, he is saying that imposing centralisation on the system could save a great deal, as I argued on this blog only last week.

At which point we think we’d like to see proof of the contention.

NHS Scotland and NHS Wales work under very different levels of competition and market outsourcing than NHS England does. There are two possibilities in the Carter report. The first is that the 22 trusts chosen to be examined were from all three systems. At which point it should be possible to pull out the evidence that less market based systems are more efficient, as is alleged. Or, alternatively, the 22 trusts were only from NHS England in which case everyone is, no doubt eagerly, preparing for similar investigations, under the same terms, to be undertaken into NHS Wales and NHS Scotland so as to prove the contention.

For of course those making such a claim would actually like to have solid evidence of said claim, wouldn’t they? We’d not want to be deciding something of such public importance merely on the grounds of pure prejudice, would we?

Would we?

So, err, could anyone point us to those calls for or that store of comparative evidence? Because we can’t see them anywhere…..

Yes, we’ve said ‘competition’ and ‘NHS’ in the same sentence

There are certain ‘danger words’ you’re not supposed to use when talking about the NHS. These include ‘privatisation’ and ‘competition’. Usually it doesn’t really matter if you’re prescribing something or not; the mere use of the word leads to total destruction (i.e. a lot of yelling and inaccurate statistics thrown around about America).

Perhaps the usual absence of these words explains why the NHS continues to fall short in international rankings, and received a below-average DEA score from the OECD, even when compared to similar, publicly funded and run healthcare systems.

But a  new report from the Economic and Social Research Council has dared to mention the unmentionable – and as it turns out, competition is key to bettering public hospitals, from management practices to patient outcomes, including mortality rates:

The report The Impact of Competition on Management Quality: Evidence from Public Hospitals, building on ESRC-funded research, shows that hospital competition can improve healthcare by improving the quality of management practices. The research measured the management quality of 100 public hospitals through a management survey of clinicians and managers, and used data published by the government to assess the performance of NHS hospitals in England.

Key findings
• Hospital competition is useful for improving management practices and outcomes in healthcare.
• More hospital competition leads to improved hospital management and higher hospital performance in terms of quality, productivity and staff satisfaction.
• Management quality is linked to improved indicators of hospital performance including clinical quality, mortality rates and staff turnover rates.
• Hospitals with higher management scores also had shorter waiting times, lower MRSA infection rates and performed better financially.

This report will probably come as a surprise to many, but only because competition is not allowed to be part of the debate.

The DEA scores I mentioned above: when comparing publicly funded, publicly run systems, some countries actually do quite well. Norway and Italy have high DEA scores, and Poland ranks above average; but in all three cases, there is more choice among providers. (The OECD actually flags up how restricted choice is in the UK.)

I’m not crying ‘correlation equals causation’ here (Sam and Ben would kill me) – but this new research only adds to the evidence that competition in the healthcare sector – public or private – might not be such a terrible thing to bring up after all.

A blanket ban on psychoactive substances makes UK drugs policy even worse

It is a truth under-acknowledged that a drug user denied possession of their poison is in want of an alternative. The current ‘explosion‘ in varied and easily-accessible ‘legal highs’ (also know as ‘new psychoactive substances’) are a clear example of this.

In June 2008 33 tonnes of sassafras oil - a key ingredient in the production of MDMA – were seized in Cambodia; enough to produce an estimated 245 million ecstasy tablets. The following year real ecstasy pills ‘almost vanished‘ from Britain’s clubs. At the same time the purity of street cocaine had also been steadily falling, from over 60% in 2002 to 22% in 2009.

Enter mephedrone: a legal high with similar effects to MDMA but readily available and for less than a quarter of the price. As the quality of ecstasy plummeted (as shown by the blue line on this graph) and substituted with things like piperazines, (the orange line) mephedrone usage soared (purple line). The 2010 (self-selecting, online) Global Drug Survey found that 51% of regular clubbers had used mephedrone that year, and official figures from the 2010/11 British Crime Survey estimate that around 4.4% 16 to 24 year olds had tried it in the past year.

Similarly, law changes and clampdowns in India resulted in a UK ketamine drought, leading to dabblers (both knowingly and unknowingly) taking things like (the once legal, now Class B) methoxetamine. And indeed, the majority of legal highs on offer are ‘synthetic cannabinoids’ which claim to mimic the effect of cannabis. In all, it’s fairly safe to claim that were recreational drugs like ecstasy, cannabis and cocaine not so stringently prohibited, these ‘legal highs’ (about which we know very little) probably wouldn’t be knocking about.

Still, governments tend to be of the view that any use of drugs is simply objectively bad, so the above is rather a moot point. But what anxious states can do, of course, is ban new legal highs as they crop up. However, even this apparently obvious solution has a few problems— the first being that there seems to be a near-limitless supply of cheap, experimental compounds to bring to market. When mephedrone was made a Class B controlled substance in 2010, alternative legal highs such NRG-1 and ‘Benzo Fury’ started to appear. In fact, over 550 NPS have been controlled since 2009. Generally less is known about each concoction than the last, presenting potentially far greater health risks to users.

At the same time, restricting a drug under the Misuse of Drugs Act 1971 requires evidence of the harm they cause (not that harm levels always bear much relation to a drug’s legality), demanding actual research as opposed to sensationalist headlines. Even though temporary class drug orders were introduced in 2011 to speed up the process, a full-out ban still requires study, time and resources. Many have claimed the battle with the chemists in China  is one lawmakers are unlikely to win.

And so with all of this in mind, the Queen’s Speech on Wednesday confirmed that Conservatives will take the next rational step in drug enforcement, namely, to simply ban ALL OF THE THINGS.

In order to automatically outlaw anything which can make people’s heads go a bit funny, their proposed blanket ban (modelled on a similar Irish policy) will prohibit the trade of ‘any substance intended for human consumption that is capable of producing a psychoactive effect’, and will carry up to a 7-year prison sentence.

Somewhat ironically for a party so concerned with preserving the UK’s legal identity it wants to replace the Human Rights Act with a British Bill of Rights, this represents a break from centuries of British common law, under which we are free to do something unless the law expressly forbids it. This law enshrines the opposite. In fact, so heavy-handed and far-reaching is the definition of what it is prohibited to supply that special exemptions have to be granted for those everyday psychoactive drugs like caffeine, alcohol and tobacco. Whilst on first glance the ban might sound like sensible-enough tinkering at the edges of our already nonsensical drug policy, it really is rather sinister, setting a worrying precedent for the state to bestow upon citizens permission to behave in certain ways.

This law will probably (at least initially) wipe out the high street ‘head shops’ which the Daily Mail and Centre for Social Justice  are so concerned about. However, banning something has never yet simply made a drug disappear. An expert panel commissioned by the government to investigate legal highs acknowledged that a 50% increase in seizures of Class B drugs between 2011/12 and 2013/14 was driven by the continued sale of mephedrone and other once-legal highs like it. Usage has fallen from pre-ban levels, but so has its purity whilst the street price has doubled. Perhaps the most damning evidence, however, comes from the Home Office’s own report into different national drug control strategies, which failed to find “any obvious relationship between the toughness of a country’s enforcement against drug possession, and levels of drug use in that country”.

The best that can be hoped for with this ridiculous plan is that with the banning of absolutely everything, dealers stick to pushing the tried and tested (and what seems to be safer) stuff. Sadly, this doesn’t seem to be the case – mephedrone and and other legal and once-legal highs have been turning up in batches of drugs like MDMA and cocaine as adulterants, and even being passed off as the real things.  Funnily enough, the best chance of new psychoactive substances disappearing from use comes from a resurgence of super-strong ecstasy, thanks to the discovery of a way to make MDMA using less heavily-controlled ingredients.

The ASI has pointed out somanytimes. that the best way to reduce the harms associated with drug use is to decriminalise, license and tax recreational drugs. Sadly, it doesn’t look like the Conservatives will see sense in the course of this parliament.  However, at least the mischievous can entertain themselves with the prospect that home-grown opiates could soon be on the horizon thanks to genetically modified wheat. And what a moral panic-cum-legislative nightmare that will be…