Non magister sed mendax

Once again we’ve the, umm, interesting assertion that it’s sugar that is really causing the outbreak of obesity. That this is not true doesn’t seem to bother those pushing the tale. For here they are again:

Sugar and carbohydrates are the real culprits in the obesity epidemic – and the public has been falsely told that couch potato lifestyles are to blame, a new report has claimed.

Writing in the British Journal Of Sports Medicine, they said poor diet now generates more disease than physical inactivity, alcohol and smoking combined.

The editorial, by a group of cardiologists and sports experts, says that while obesity has rocketed in the past 30 years there has been little change in physical activity levels.

“This places the blame for our expanding waistlines directly on the type and amount of calories consumed,” they write.

Here is that editorial:

A recent report from the UK’s Academy of Medical Royal Colleges described ‘the miracle cure’ of performing 30 min of moderate exercise, five times a week, as more powerful than many drugs administered for chronic disease prevention and management.1 Regular physical activity reduces the risk of developing cardiovascular disease, type 2 diabetes, dementia and some cancers by at least 30%. However, physical activity does not promote weight loss.

In the past 30 years, as obesity has rocketed, there has been little change in physical activity levels in the Western population.2 This places the blame for our expanding waist lines directly on the type and amount of calories consumed.

So, what’s actually wrong with this analysis?

What’s wrong with it is that it’s simply factually wrong. As Chris Snowdon has been manfully pointing out all along, calorie intake in both the US and UK has been falling over the decades. As has, remarkably, sugar consumption. To the point that, for the UK today, average calorie consumption is lower than the minimum recommended during WWII rationing. Actually, today’s average consumption is below where our grandparents started to lose weight on such wartime rations. It simply cannot be an increase in consumption to blame as there’s not been an increase, there’s been a reduction.

Given that weight does work on calories input minus calories expended, this means that calorie expenditure must be down. But our magisters here are telling us of a study that shows that exercise levels have not fallen, might even have risen. So, what is happening here?

Quite simply, they are looking at formal exercise, not calorie expenditure. Perhaps more people do go for a shuffle around the block than used to. But that’s not going to outrun the effect of us all having central heating these days upon calorie expenditure.

It’s getting very difficult indeed to think that magister is the appropriate word here, our opinion is leaning ever more to the word mendax.

Universal healthcare and market-based systems aren’t mutually exclusive

An op-ed published last week in the New York Times laments Americans’ decline in support for government involvement in the redistribution of wealth – or, as the Times author Thomas Edsall calls it, ‘sharing’.

Edsall analyses a bunch of polls throughout the article, but what he finds troubling I find to be good common sense. For example, most Americans aren’t incredibly trusting of their government:

Even worse for Democrats, the Saez paper found that “information about inequality also makes respondents trust government less,” decreasing “by nearly twenty percent the share of respondents who ‘trust government’ most of the time:”

Smart thinking.

Furthermore, most Americans aren’t convinced that Obamacare is going to be the shining, efficient, cheaper, all-inclusive beacon of hope it was promised to be:

An earlier New York Times poll, conducted in December 2013, found that 52 percent of those surveyed believed that the Affordable Care Act would increase their medical costs; 14 percent said it would reduce costs. Thirty-six percent believed that Obamacare would worsen the quality of health care compared to 17 percent who thought it would improve it.

Also probably wise.

On the whole Edsall appears to understand people’s perceptions of government care (to my relief and his dismay) quite well – except for in one area.

Esdall claims the “most dramatic” change in public opinion has been people’s perception of the ‘right’ to healthcare. He cites the two Gallup polls in an attempt to claim that majority support for guaranteed access to health coverage has dropped radically over the past six years:

The erosion of the belief in health care as a government-protected right is perhaps the most dramatic reflection of these trends. In 2006, by a margin of more than two to one, 69-28, those surveyed by Gallup said that the federal government should guarantee health care coverage for all citizens of the United States. By late 2014, however, Gallup found that this percentage had fallen 24 points to 45 percent, while the percentage of respondents who said health care is not a federal responsibility nearly doubled to 52 percent.

But Esdall isn’t comparing apples with apples. The belief that in a developed society everyone should have access to basic healthcare provisions is not the same as believing that healthcare is a federal responsibility – especially in the United States.

The debate is not – and has not been for a long time – whether or not people should have access to healthcare, but rather how that care should be provided. What kind of delivery of healthcare will create the cheapest prices and best outcomes, and what safety net for those at the bottom will provide the most comprehensive care?

There is huge demand in the States for healthcare reform, and most people want this reform to focus on cheaper access to care. But that can be achieved without fully handing healthcare provision over to the federal government or adopting something that resembles the NHS.

Both the US and the UK should be looking to countries that rank highest for healthcare provisions internationally, which have almost all settled on systems where the central government funds healthcare but does not directly provide healthcare.  The Netherlands, Denmark, Switzerland, and Germany all have healthy relationships with private companies, ranging from insurance companies and charities, that provide better outcomes than those in the UK and in a cheaper, more efficient manner than in the US.

Support for universal access to healthcare and support for market mechanisms in healthcare are not mutually exclusive; there’s plenty of evidence to suggest a combination of the two creates the best healthcare systems in the world.

So, could the public health people please shut up?

Vaping, smoking, the great question is, is one a complement to the other (complement, meaning that more of one leads to more of the other) or a substitute (more of one leads to less of the other)?

Evidence:

Electronic cigarette use among U.S. middle and high school students tripled in 2014 while cigarette use fell to record lows, according to provocative new data that is likely to intensify debate over whether e-cigarettes are a boon or bane to public health.

No, that’s not provocative data, that’s conclusive data. A substitute not a complement.

Every public health advocate should now be pushing vaping. Anyone who claims to be such and is not is simply a Puritan.

By their actions shall ye know them.

Lies, damned lies, and electioneering statistics: privatising the NHS

Now the election campaign is in full swing, there has been a sharp rise in questionable statistics used in public discourse. This is distressing, as there is a risk people vote on the basis of misinformation. It seems that by using the same bogus assertions repeatedly, politicians of all stripes are able to eventually change the ‘facts’. The debate around the NHS has been the most dishonest.

“Reverse the tide of privatisation in our NHS”

There has NOT been a tide of privatisation in our NHS. Privatisation if the process of transferring ownership of an organisation from government to the private sector. No shares have been issued in the NHS, nor distributed as vouchers to citizens. The NHS remains publically owned and funded, resources have grown in terms of real cash and people, and services are free at the point of the use. They must still provide services to all, whilst a ‘privatised’ company could choose to only serve those who pay.

Outsourcing isn’t privatisation, and is slowing

The government has encouraged competitive tendering of services, and outsourcing has increased, but only from 4.4% under Labour to under 6% with the Coalition. The rate of outsourcing has actually slowed under the Coalition. Regardless, outsourcing isn’t privatisation, maintains free at the point of use access, and can result in better services.

What about Hinchingbrooke Hospital?

Hinchingbrooke Hospital is the closest example to privatisation, as it is now run (though not owned) by a private company. The tender process for the hospital happened in October 2009, under Labour, further exposing their hypocrisy. Regardless, its core assets are publicly owned, and it still delivers NHS services free at the point of use.

An honest debate would consider alternative models that would improve services 

As an aside, it’s worth noting that Hinchingbrooke has gone from one of the worst ranked hospitals, on the verge of shutdown, to one of the best for patient happiness and waiting times.

A proper discourse on health care would focus on ways to improve the quality. We should examine the merits of private (profit and non-profit) providers, rather than being blocked by ideological labelling. We should explore how alternative models that don’t reply on as much government management, like in Germany or Singapore, could deliver better services for all.

Private parts of the NHS say the NHS should not be privatised

Just a small note. There’s a letter in The Guardian insisting that the NHS should not be privatised in any form or manner. Hey, you know, election season. There’s some 100 or more signatories to it. Of whom 46 are listed as being GPs.

Yes, General Practitioner. That part of the NHS which has always been privately owned, run and managed, as contractors to the larger organisation.

46% of those shouting that there should not be private sector contracting to the NHS are themselves private sector contractors to the NHS.

It is, of course, possible that their own working experience leads them to believe that such contracting is a bad idea. In which case, of course, we should see the same people (including at least two past heads of the Royal College of General Practitioners) arguing that GP services must be nationalised and sharpish. We don’t, so that cannot be their argument.

Which leaves us really with only one possible explanation: a gargantuan ignorance of their own situation. And a general piece of advice to the wise: pay not much attention to the opinions of those who prove themselves, publicly, to be gargantuanly ignorant.