Monday 23 April 2012

Nanny ascendant

Kiwi healthists have been busy this past week.

Here's more from Doug Sellman on soft drink addiction (and other addictions):
People needed to find an activity pleasurable to want to repeat it. If they repeated it enough, it would become a habit, which could then become an addiction.
"As they're doing that there are genetic switches that change free will into a dehumanised state of drug craving and compulsion."
Christchurch-based researchers at the University of Otago developed a new list of 49 foods people should avoid and published their findings in the New Zealand Medical Journal earlier this year. The list is of the most addictive foods, Sellman said.
The foods were energy and calorie dense, high in fat and/or added sugars, prepared using a high fat cooking method such as frying or roasting, or low in essential nutrients.
They included muesli bars, ice cream, cakes, chocolate, doughnuts, jam, honey, pies and pastries. Energy drinks, cordial and fruit drinks also made the list. [EC: updated the link to one that works, emphasis added]
Sellman says those 49 foods are the most addictive. The list includes quiche, sausages, salami, and muesli. If I eat enough quiche, I could trigger genetic switches that will turn me into a dehumanised craver of quiche.* We really ought to remember how Sellman sets the bar on addiction whenever we read him about what has to be done about alcohol, tobacco, fatty foods, soft drinks, muesli, or pastries, or when he compares companies selling unhealthy food to drug dealers. Human agency disappears in his model pretty quickly.

Meanwhile, the anti-tobacco folks are pushing not just for plain packaging, discussed last week, but also for some seriously large excise tax increases. 3 News says the Ministry of Health is pushing for $100 per pack prices. And, helpfully, they've linked the OIA-released MoH advice to the Minister of Health.

The MoH document wasn't nearly as bad as I'd expected.** Instead, it looks like they've commissioned NZIER to do some work on what would actually be necessary to achieve the National-led coalition's goal of a tobacco-free New Zealand by 2025. Unsurprisingly, it'll take some pretty big policy changes: large tax increases, lots of anti-tobacco advertising, and potentially stronger alternative measures. I think at paragraph 6 they might be alluding to tobacco by prescription only when they say "At what point might it be preferable to consider alternative approaches, eg. a new regulatory regime that stringently controls tobacco as a highly toxic, hazardous substance and/or as an extremely addictive, harmful drug?"

At paragraph 54, MoH notes the potentially regressive nature of the excise increase but argues "although the tobacco tax is of itself regressive, increases in the tobacco tax are actually progressive." This might actually be true at the tax levels they're talking about. Marginal changes in tobacco excise are highly regressive; few people quit relative to the increase in tax paid by poor smokers who continue smoking. The O'Dea report said that even a 50% increase in tobacco prices would see 36,990 non-quitting Decile 1 households each spend an extra $928 per year while an estimated 4,110 quitting Decile 1 households would save $2,981; the poorest cohort then winds up spending a net extra $22 million in tobacco excise while decile 10 households spend a net extra $31 million. Excise hikes of the magnitudes being thrown around could conceivably wind up reducing total tobacco excise paid by low decile groups. But they would have other problems:
A leading academic says an extreme increase in the price of cigarettes could lead to black market dealing.
Speaking in response to a Ministry of Health discussion to raising the cost of a packet of cigarettes to $100 over the next eight years, Otago University health economics lecturer Des O'Dea said: "We all remember the days of prohibition in the United States and what that did to foster organised crime."
"While I don't think it would be anywhere near the scale of that, we could well see raids on retailers and a black market develop for cigarettes," he said.
I don't put a lot of weight on concerns that plain packaging legislation would lead to counterfeiting and smuggling; at least I'm not yet convinced of it. Is it really that hard currently to print fake labels for cigarette packets or to put anti-counterfeiting features into plain cigarette packs? But $100 packs of cigarettes have to yield a fair bit of home-grown tobacco outside of the excise regime and a fair bit of smuggling.***

Hopefully making it clear just what is needed to achieve the SmokeFree 2025 goal will have the government think again about the whole thing.

* I choose to avoid this risk, preferring the perilous whole milk and butter. I fear for Seamus though.

** I've read it twice, and I can't find a single reference to the "costs of smoking" number that MoH had been pushing a couple of years ago. Matthew Everett's the MoH contact person on the briefing document and is presumably the same Matthew Everett with whom I'd had fairly extensive discussion about the MoH's figure at the time. I'm glad to see that MoH doesn't seem to be pushing that figure any longer in its policy recommendations.

*** For both alcohol and tobacco, if anybody has ever seen estimates on the elasticity of informal supply through home production or smuggled goods with respect to excise changes, I'd love to see it. I worry that measured estimates of price elasticity of demand might overstate actual consumption decreases if there are reasonable shifts into illicit supply.


  1. If Prof Sellman wants to continue down this 'genetic switches turning off free will' track, then he needs to define his terms. What is free will? How do we know that non-addicts have free will? How do we know that non-addicts are using their free will?

    What is the State's role in compulsory use of my free will?

    1. "You can choose a ready guide in carbonated voice..."

  2. I find myself agreeing with Des O'Dea. The moment I saw this idea of $100 per pack pricing I just thought, blackmarket! Criminal gangs would just have another source of income and we would turn smokers into criminals when they smoke blackmarket cigs. But I would guess that many in the anti-smoking lobby do think smokers are criminals!

    1. I've asked NZIER whether their estimates had any elasticity of black market consumption with respect to legal product prices. I doubt they do; I'm not sure that those elasticity numbers exist.

    2. You can be sure the elasticity isn't zero. The experience with smuggling in Europe alone suggests that.

    3. A young man interviewed on the street on Campbell Live (I think) made a very salient point about $100 cigarettes. He said people still take cocaine, heroine and P even though they are very costly. He omitted to mention that those people also risk running foul of the law to continue their habit. Price increases or prohibition will not stop smoking completely. There will be some who respond to pricing pressures, but I imagine that most folk who were going to quit already have. I dare say the anti-tobacco lobby are well-meaning do-gooders at heart, but they seem unable to accept that a minority of people are going to continue wanting to smoke no matter what you try to do to stop them. And as long as their habit doesn't harm others they should be fully permitted to do so.

    4. If they were well-meaning harm-minimisers, snus and e-cigarettes would be encouraged, not discouraged.

    5. Possibly not, if you believe their view of harm minimisation equals zero consumption of tobacco, regardless of source or format. Gum and patches may contain nicotine, but snus is still a tobacco product. And e-cigarettes mimic the physical act of smoking a cigarette, so in their warped view of the world could be seen as not discouraging smoking. I agree with you 100% Eric, but I am trying to justify the seemingly unjustifiable position of the anti-tobacco folks. My real feeling is that there is a significant overlap between anti-tobacco and anti-globalisation people, and that they dislike cigarettes because they are made by big evil corporations like Philip Morris, etc.

    6. My counter thoughts are that there is a significant overlap between anti-tobacco and pro-globalisation people [World Government], and that they dislike tobacco because they are funded by big evil corporations like Pfizer, Johnson&Johnson &etc. ~ at one level down this is a corporate war for the nicotine market ~ at another, there's a sinister aspect.

  3. Oh no! I've become addicted to breathing! What should I do Prof Sellman?

    I fear I have become addled and dehumanized all at the same time... woe is me.

    At least I'm not a quiche eater... dodged that bullet.