Age-restricted fast foods?

Doug Sellman's latest prescription for reducing obesity:

Does the fast food industry need to be regulated?

Prof Sellman believes only New Zealand's law makers can forcibly change and control the booming fast food industry.

"Government regulation is the answer. It is the tobacco and alcohol industry story all over again.

"The price of freedom from government regulation is enslavement of large numbers of the population to these profit, rather than health-driven industries."

But Prof Sellman isn't optimistic the Government will do anything to effect meaningful change in the fast food industry.

"Unfortunately, we live in intense neo-liberal economic times when public health is given less value by governments to the GDP contribution of big business, while the harms are relatively discounted."

What can be done to combat the booming fast food industry?

Prof Sellman suggests the following measures:

• Dismantle the marketing
• Increase the price
• Reduce accessibility (density of outlets and hours of sale)
• Increase the age of purchase
• More incentives for people to leave their cars at home

Yup. Total neoliberal conspiracy that we don't have minimum purchase ages for food.

But remember, there are no slippery slopes from tobacco regulation to every other damned thing that Doug Sellman doesn't like.

Independent is an interesting word

I presented to the Ministerial Forum on Alcohol Advertising and Sponsorship a few months back with a brief submission on recent evidence on the effects of alcohol advertising on consumption behaviour.

One pretty compelling recent piece of evidence is Jon Nelson's recent meta-analysis, published in 2011. The abstract:

This paper presents a meta-analysis of prospective cohort (longitudinal) studies of alcohol marketing and adolescent drinking, which accounts for publication bias. The paper provides a summary of 12 primary studies of the marketing–drinking relationship. Each primary study surveyed a sample of youth to determine baseline drinking status and marketing exposure, and re-surveyed the youth to determine subsequent drinking outcomes. Logistic analyses provide estimates of the odds ratio for effects of baseline marketing variables on adolescent drinking at follow-up. Using meta-regression analysis, two samples are examined in this paper: 23 effect-size estimates for drinking onset (initiation); and 40 estimates for other drinking behaviours (frequency, amount, bingeing). Marketing variables include ads in mass media, promotion portrayals, brand recognition and subjective evaluations by survey respondents. Publication bias is assessed using funnel plots that account for ‘missing’ studies, bivariate regressions and multivariate meta-regressions that account for primary study heterogeneity, heteroskedasticity, data dependencies, publication bias and truncated samples. The empirical results are consistent with publication bias, omitted variable bias in some studies, and lack of a genuine effect, especially for mass media. The paper also discusses ‘dissemination bias’ in the use of research results by primary investigators and health policy interest groups.

So he picked the papers that use a baseline and exposure design and concluded that there's really nothing much there except for publication bias.

The panellists didn't seem particularly friendly or unfriendly. Tuari Potiki asked why economists' conclusions on this stuff vary so much from the public health folks who'd presented earlier in the day, and the general tone of the Forum members seemed to be "what additional restrictions should we place" rather than "do any potential restrictions do more good than harm", but maybe I misread them.

Well, the anti-alcohol advocates didn't think the Forum was independent enough so they've made their own forum.* They're calling it the Independent Expert Committee on Alcohol Advertising and Sponsorship.

Independent's an interesting word, since the IECAAS is being hosted by Alcohol Action NZ, Doug Sellman and Jennie Connor's anti-alcohol lobby group, and consists of Sellman, Connor, Janet Hoek, Mike Daube and others. They reckon the Ministerial Forum, including NZ Drug Foundation's Tuari Potiki, wasn't independent enough because the CEO of the Advertising Standards Authority is also on the Forum. Sellman et al are correct that the Forum members aren't experts in alcohol marketing, but I'm really unconvinced that that makes them less independent.

IECAAS writes:

To date IECAAS members have found no significant new research that would invalidate the recommendations made by the Law Commission in 2010. In fact the evidence supporting major reform appears to be strengthening. The recommendation to phase out alcohol advertising and sponsorship apart from objective written product information over five years is therefore as important today as it was when first reported to the government in 2010. The only difference is that New Zealand could have made several years of progress had the government responded.

I wonder how hard they've been looking. There's a reasonably important piece in the Journal of Economic Surveys that they've missed. And a few others.

* I can't stop imagining Bender setting up his own theme park. Except this one would be way less fun than Bender's.

Prohibitionist Electioneering

The usual bunch has issued a statement calling for more restrictions on alcohol. 

A four-point "call for action on alcohol", issued today, has been signed by the heads of general and specialist groups of doctors and nurses, academic researchers and the heads of the Anglican, Catholic, Methodist, Presbyterian and Salvation Army churches.

It calls on the incoming government after the September 20 election to implement Law Commission proposals from 2010 to raise alcohol taxes by 50 per cent, impose a minimum price for alcohol to stop price discounting, and phase out alcohol sponsorship and advertising except for "objective product information".

The 50 per cent tax hike would result in a 10 per cent increase in retail prices of alcoholic drinks. National Addiction Centre director Professor Doug Sellman, who organised the statement, said such a price increase would cut consumption by 5 per cent.

The Herald embeds their full statement, available here.

They open with a quote,

"If alcohol were a communicable disease, a national emergency would be declared." 

Later, they write,

The argument is often heard that policies to slow the supply of alcohol through increasing price or reducing physical availability diminish personal freedom and autonomy of "ordinary New Zealanders". It is time we moved from the self-interested and sometimes destructive "freedom to" (... drink as much as you want; supply alcohol to your children's friends; promote and sell alcohol anywhere any time) and consider the "freedom from" the harms caused by heavy drinking.

Those two together do get to the crux of things. The expansionist view of public health deems personal consumption decisions as akin to a communicable disease, puts no value on that individuals derive consumption benefits from alcohol, and largely ignores existing regulatory constraints including:

• If you're at a bar, and you're intoxicated, the bar can face pretty substantial penalties for continuing to serve you. Maybe you can drink "as much as you want" at home, but you can't do it in a licensed venue. I'm not sure what the prohibitionists will come up with to ban people from getting drunk at home, but I'd be surprised if they didn't come up with something. 
• The latest round of regulatory changes prohibited you from serving alcohol to your children's friends if they're minors unless you have a permission note from their parents. 
• You cannot promote alcohol in advertising on television outside of the watershed hours; you cannot sell alcohol outside of the permitted and constrained hours that vary from venue to venue and jurisdiction to jurisdiction. 

The market's already pretty heavily regulated. But all of those existing regulations, they never count for much. It's the next set of regulations that will make us the Shining City on the Hill. 

Back to their missive:

The 'sophisticated' alcohol culture promised twenty-five years ago by advocates of the liberalising Sale of Liquor Act 1989 has turned out to be an increasingly endemic heavy binge drinking culture in New Zealand [De Bonnaire et al 2005; Wells et al 2006]. The cost of alcohol harm is estimated to run into billions of dollars, money that would be much better spent on community benefits.

Ok. First off, here's the time path on per capita alcohol availability. Here's just how bad things have gotten since liberalisation in 1989. It's really terrible. You might want to cover your eyes and peek through the cracks in your fingers.

Can you see the huge per capita increase in alcohol consumption that came about because of liberalisation? It's there. Just squint a bit more.

Heavy drinking or binge drinking? The WHO reports [discussed here] that 5.6% of drinkers (4.5% of the population) consumed at least 6 standard drinks on at least one occasion in the last 30 days. So roughly one person in 20 had the equivalent of six 330 mL Tui, or just under two 500mL bottles of Epic's Hop Zombie Double IPA.* Even at that low a threshold, only one in twenty are drinking that much at least monthly. 

The WHO report lets us benchmark New Zealand internationally. Sure, there are other measures of everything within NZ, but the WHO figures at least run a common measure across different countries allowing for international comparisons. Why might international comparisons matter? 

Here are some of the countries lauded by Alcohol Action NZ. Quoting from them:

• Scotland’s parliament has legislated for a minimum price per standard unit of alcohol of 50p, to eliminate ultra-cheap products, although this is now being challenged in various courts by the alcohol industry.

• Finland, like other Scandinavian countries, has excise tax on alcohol about twice as high as New Zealand. [Note from Eric: the Productivity Commission noted New Zealand's particularly high alcohol prices. Yeah, the Scandanavians have high taxes, but we're hardly cheap.]

• The whole of the USA has a minimum drinking age for alcohol of 21 years.

• Ireland has off-licence trading hours of 10.30am - 10pm Monday – Saturday, 12.30 10pm on Sundays. California has a blanket closure of on-licences at 2am.

• The South African government has recently formulated legislation to ban all alcohol advertising and sponsorship, in even more stringent fashion than has existed in France for more than 20 years, although is now bracing itself for attack by the alcohol industry during the upcoming parliamentary process.

• Most countries of the world have a blood alcohol concentration (BAC) drink-driving limit of 0.05 or less, including Australia. Countries with a BAC of 0.02 or 0.03 include Sweden, Norway, Poland and Japan.

• Norway has resisted the influence of the European Union in maintaining strong regulation of alcohol in the face of trade agreements.

Ok. So Scotland, Finland, the US, Ireland, South Africa, France, Australia, Sweden, Norway, Poland and Japan are singled out as being super-awesome anti-alcohol campaigners. Let's check some outcomes.

First, let's look at age-standardised prevalence of alcohol use disorders. The WHO puts New Zealand at 3.4% prevalence, lower than all countries in the Western Pacific Region other than Brunei (1.7%), Japan (3.3%), Malaysia (2.3%), and Singapore (0.9%). See p. 320 of the appendix. Were New Zealand in Europe, we'd be much lower than average: we're lower than any European country other than Italy (1.2%), Malta (3.2%), Netherlands (1.3%), Romania (2.6%), Spain (1.4%), Tajikistan (0.8%), and Turkey (2.6%).

And how about those super-great campaigner countries? France (6.0%), Finland (7.7%), Ireland (7.3%), Sweden (9.9%), Norway (8.7%), Poland (8.7%), and Scotland (UK is 12.1%, no separate Scottish figure) all have worse rates of alcohol use disorders. Similarly, the USA (7.8%) and South Africa (5.4%) are worse than NZ. Only Japan (3.3%) is slightly below the NZ rate. If we fully replicated the experience of those countries with policies lauded by Alcohol Action NZ, we'd have worse rates of alcohol use disorders.   

Ok, maybe our problem isn't with alcohol use disorders. It's that nasty binge drinking. Let's look at at the prevalence of heavy episodic drinking in the WHO figures. The table at page 312 of the appendix puts NZ at 4.3%. Why is this lower than the 4.5% listed above? Because it's age-standardised: some differences in drinking across countries depend on demographic differences. Let's again compare NZ with our neighbours, with Europe, and with those countries whose policies are lauded by Alcohol Action NZ.

In the Western Pacific Region, Brunei (0.5%), Cambodia (1.2%), Kiribati (2.4%), Malaysia (0.3), the Philippines (1.6%), Singapore (4.2%) and Vietnam (1.3%) have lower rates; 13 countries including Australia, China, and Japan (18.4%!!) have higher rates.

In Europe, Turkey (0.2%), Tajikistan (1.0%), and Andorra (4.2%) have lower rates. Every single other country in Europe has higher rates of heavy episodic drinking. Every single one. 

Among those countries lauded by Alcohol Action, France (29.8%), Finland (35.9%), Ireland (36.5%), Sweden (24.3%), Norway (12.6%), Poland (5.4%), Scotland (UK figure of 27.1%), the USA (16.2%), South Africa (9.8%), and Japan (18.4%) ALL have higher rates of heavy episodic drinking. Every one of them. 

If we look at the WHO figures, it is utterly, utterly absurd to claim that New Zealand is some kind of binge drinking outlier. The Ministry of Health uses a different standard for potentially hazardous drinking and have higher figures; they also report that rates of hazardous drinking are declining, and especially among younger cohorts. MoH puts hazardous drinking rates at 19% of drinkers, with 80% of the population being drinkers. So 15.2% of the overall population. Even if we use that figure instead of the WHO one on heavy episodic drinking, we still get a lower rate than most of the countries lauded by Alcohol Action.

Fundamentally, how we stand relative to other countries shouldn't matter much: if a policy is cost-effective it should be implemented. But we have to define cost-effectiveness comprehensively, taking due account of the costs the policy imposes on individual consumption. And, that countries with lauded policies tend to have worse drinking outcomes than we do might just give us pause.

Previously:

• Seeing what you want to see: Minimum pricing edition
• More drinking stats
• Increasing alcohol excise is great, if you assume the right things
• On Stillman SHOREs: the effects of reducing NZ's alcohol purchase age
• Drinking time
• Drinking Ed
• More binge drinking reports
• Minimum pricing
• Minimum alcohol pricing and economic rents
• Markets hate profits: minimum pricing edition
• Petrol tax:speeding :: alcohol tax:binge drinking
• The Omniscience Constraint
• Public health and the regulatory state
• Minimum pricing
• Minimum prices and mortality risk
• Evidence and minimum pricing
• About that Canadian study...
• Alcohol minimum pricing
• A hopefully concluding note on the price elasticity of alcohol

* I only chose this one because I happened to have a bottle in my office supply.

More drinking stats

The WHO report on alcohol shows that Kiwis aren't that heavy of drinkers. Kiwiblog covered the highlights, so I hadn't hit it here. But there are a few things there yet worth noting.

First, the report tallies both official and unrecorded consumption, so the figures are a little bit higher than the official stats I tend to rely on here. The report doesn't explain particularly well how they record the unrecorded consumption. It doesn't matter a lot for New Zealand: they list average recorded consumption per capita aged 15+ at 9.3 litres, and unrecorded consumption at 1.6 litres, so the increase isn't that substantial. But here's the sum total of their description of the method, in Appendix IV:

An additional survey on unrecorded consumption was used to improve estimation of unrecorded consumption in some countries. In this survey, sent to 42 countries with at least 10% unrecorded consumption as part of the total consumption, the nominal group technique was used to solicit five expert judgements per country. In addition, a systematic search was conducted on all published literature (Rehm et al., 2014). The data obtained were analysed and fed back to the experts who used them to arrive at a final estimate.

So it sounds like expert guesses on consumption of home-made alcohol. It wouldn't surprise me if home production were increasing with excise, but does it seem plausible that home-brew has increased from an average of 0.5 litres [2003-2005] to an average of 1.6 litres [2008-2010] of pure alcohol per person aged 15+ in New Zealand? Say that 1% of us do any home brewing or home distillation: that would be 166 litres of home production per still or per brew kit. Seems high. If the beer is around .05, that's over three thousand litres per year per home brewer, if about 1% of the population are home brewing. Note that my 1% guess is based on a rough estimate of the number of people I know and the number of people I know who do any home brewing or distillation. Even if it's 10% of the population doing it, the numbers still seem implausibly high.

The Press notes that, per drinker rather than per capita, our consumption figures are higher, though they get the figure wrong: the WHO reports that we're at 13.7 litres pure alcohol per drinker. But they get this right:

But despite warnings about a binge-drinking culture, the figures show rates of "heavy episodic drinking" are well below many other countries.
Less than 6 per cent of the drinking population admitted to consuming at least six standard drinks on one occasion in the previous month.

Summarising from the WHO report:

• Per capita (aged 15+) consumption, in litres of pure alcohol, was 10.9 litres on average from 2008-2010. 
• Per drinker (aged 15+) consumption, in litres of pure alcohol, 2010, was 13.7 litres.
• 4.5% of the population aged 15+, and 5.6% of drinkers aged 15+, consumed at least 6 standard drinks on at least one occasion in the past thirty days. Six standard drinks (60 grams pure alcohol) is a six pack of 4% beer, 3 RTDs at 8%, or three-quarters of a bottle of wine. 

Sellman notes:

National Addiction Centre director Doug Sellman said the data showed the average New Zealander, of 15 years and over, was drinking about 16.5 standard drinks a week.

This suggested more than half were drinking in a risky manner, with health guidelines recommending no more than 15 standard drinks a week for men and 10 for women.

Alcohol consumption per head had increased by 13.5 per cent in New Zealand from 2005 to 2010, despite factors including a recession and an ageing population, he said. "This suggests the heavy drinking culture in New Zealand is being driven by strong factors which can overcome these."

These included "relentless" alcohol marketing, cheap availability, and a drinking age of 18, Sellman said. "As long as we have about 10 New Zealanders dying every week as a result of drunkenness, we deserve the unhealthy reputation of being a wild-south binge-drinking country."

I'll quibble a bit here. 10.9 litres does work out to 16.5 standard drinks per week on average, but consumption seems skewed: the median will be rather below the average in this kind of data, and especially where non-drinkers are included, so I'd be pretty reluctant to say that more than half are drinking in excess of health guidelines. I'd also be a bit nervous about relying on estimates that imply pretty substantial levels of home alcohol production based on "expert assessment" rather than inferred from things like distillation supply sales.

I also note that while total per capita consumption is up a bit from 2005 to 2010, it is substantially down on the 80s and early 90s, and consumption declined again after 2010.

If "relentless" alcohol marketing, cheap availability, and a drinking age of 18 are to blame for everything, why are youth drinking rates down? Why does the Productivity Commission note New Zealand's particularly high alcohol prices?

Again, here's the Ministry of Health's 2011/2012 survey findings:

• Since 2006/07, the level of hazardous drinking among past-year drinkers has significantly decreased for men (from 30% to 26%), but not among women (13% to 12%).

• People aged 18–24 years (particularly men) are at higher risk of hazardous drinking. Among past-year drinkers, about 44% of men and 26% of women aged 18–24 years have hazardous drinking patterns. However, the rate of hazardous drinking has decreased significantly in past-year drinkers aged 18–24 years from 2006/07 (49%) to 2011/12 (36%).

Emphasis added above. Prices haven't abated; marketing hasn't abated. The drinking age has stayed 18. But hazardous drinking has decreased, and has particularly decreased among youths aged 15-17. I'd summarised the broader stats here and here and here.

Update: Farrar seems right on our rank ordering: we're about the 96th heaviest drinkers when ranked on consumption per drinker. My spreadsheet gives me 97th, but the dataset had some strange country duplication. In 2003-2005, we were about 91st. So we're falling in the "heaviest drinker" league tables.

You need a common base to measure changes

Suppose I developed some new measure of how terrible journalistic reporting on health is. And by my new measure, fully 10% of newspaper articles on Stuff demonstrate a combination of complete innumeracy and absolute credulity. Suppose I then compared it to some prior, entirely different, measure of press innumeracy which listed only 6% of articles as being really bad in 2006.

Suppose I then sent the Sunday Star Times a press release about it and claimed that my new measure showed just how much worse things had gotten in the last few years. Think they'd print it?

Via ed.co.nz, Seamus, and Thomas Lumley, here's a Fairfax piece* the shocking rise in alcoholism:

One in 10 New Zealanders could now be considered "alcoholic" according to new diagnostic criteria - but the majority of those with a drinking problem are unlikely to recognise it because the issue is so common.

The new estimate of 400,000 "alcoholics" in New Zealand - around 10 per cent of our 4.4 million population - was tallied up by Professor Doug Sellman from the National Addiction Centre at the University of Otago.

It is significantly higher than the Ministry of Health's 2006 estimate which says 3 to 6 per cent of the population has an alcohol issue.

Sellman's figures are based on the new diagnostic criteria for "alcohol use disorder" recently published in the fifth edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association.

First off, alcohol use disorder isn't alcoholism. Lumley hit this one over the weekend, pointing to the statement from the President of the American Society for Addiction Medicine on the DSM-V:

DSM-5 has “Alcohol Use Disorder,” which comes in mild, moderate and severe flavors, suggesting the inadequate pyramid approach. There are 11 possible symptoms of the “use disorder,” of which two are necessary to achieve a mild specifier, four for moderate and six for severe. “Alcohol use disorder is defined by a cluster of behavioral and physical symptoms,” the authors of DSM-5 state. I have no problem with that except that some may confuse “alcohol use disorder” with addictive disease or with alcoholism

The article can serve as example.

But the bigger problem is that you just cannot cannot cannot identify changes in a measure if the base measurement has changed unless you do a lot of work to put the two measures on common footing. Suppose we changed how we measured inflation. We do that from time to time. When that happens, economists and statisticians have to do a lot of work building a linked index where you recalculate the old inflation observations on the new measurement so that you can have meaningful comparisons over time.

Suppose that the government put out a press release saying "Hey, by our new measure, wait times for surgery at hospital are half as long as they were under the old Labour government!". Surely surely the reporter would think to ask whether the change were due to the redefinition of the measure or whether it were due to anything real.

Anyway, by the new measure, as reported in the SST article, I count as having mild alcohol use disorder. I answered two of their 11 questions in the affirmative. Because I can spend a lot of time browsing at The Beer Cellar or over at Whisky Galore, I say yes to #3: "Spending a lot of time getting, using, or recovering from alcohol." It's all because of the "getting" part, but I'm being honest. It's an "or" question. I also say yes to #4, "Cravings and urges for alcohol". Reading articles like this give me strong cravings for strong drink. I answer "no" to all of the others, but that doesn't matter.

So, how did Sellman reckon 400,000? Surely it was something more than the guesstimate here presented.

"We know there are about 800,000 heavy drinkers in NZ [based on Ministry of Health figures] and it could very well be higher," Sellman said.

"A majority of heavy drinkers already are likely to meet one of them [the 11 disagnostic criteria], the acquired tolerance criterion, so that means they only need one more criterion to get there.

"So I'm suggesting that perhaps about a half of heavy drinkers are likely to have at least one more of the diagnostic criteria such as a recurrent problem associated with heavy drinking, which accounts for the 400,000 figure."

I hope it was the journalist inferring a trend based on this stuff rather than Sellman suggesting one. Yikes.

* I think this was initially in the Sunday Star Times, but it was also in The Press.

Who's to blame?

National list M.P. Aaron Gilmore didn't exactly cover himself in glory at Hamner Springs, allegedly calling a waiter a 'dickhead' for refusing to serve him additional wine, saying "Do you know who I am?!",* and reportedly threatening to have the Prime Minister get after the waiter, though Gilmore denies the latter accusation.

The Press on Saturday provided a couple of contrasting explanations. First, Joelle Dally provides a bit of Gilmore's history:

The Press can reveal Gilmore's colourful conduct started long before the Hanmer outburst.

In July 2012 Gilmore ruffled the feathers of Rongotai electorate bosses over his status at a regional party conference.

In 2011, when Gilmore went to speak to University of Canterbury students at a political speed-dating event, a student wrote to The Press about his conduct: "He showed up late, with no apologies to organisers or the candidate he shooed away to speak over. He spoke well past the time limit, and even described himself as ‘the most marginal MP in Parliament' . . . [He] talked over us and got aggressive to the point where I had to ask him if he would mind not yelling at me," she wrote.

Two years ago, the CV posted on Gilmore's Parliament web page was found to have incorrectly accredited him with being a member of Chartered Financial Analyst (CFA) Institute - a membership he had never had - as well as having a high-level finance-sector qualification he did not. He blamed the latter on the Parliamentary Service.

I don't know how much weight to put on any of those. I wasn't at the UC event, and it's always possible that another party's youth activist tried to put the knife in after the event [I have absolutely no clue]. I also don't know who's at fault for the errors on his Vita. The Herald also has tenants claiming Gilmore to be less than the world's greatest landlord.

You could read the list of problems and conclude that Gilmore has some personality problems, or it could be that once a pile-on starts, it becomes self-perpetuating. Imagine that anybody you'd ever annoyed got to contribute to a compilation list for the newspaper; I'm not sure that any of us would come out looking great. I don't know whether it's the former or the latter here, though the Hanmer display was hardly a great showing.

But Doug Sellman knows what's really to blame.

Don't blame Aaron Gilmore, blame the alcohol. Brainwashing alcohol displays in supermarkets made him (allegedly) surreptitiously record phone conversations with his tenants and mess up his vita, among other things. And trying to fit in with his mates is what had them dobbing him in to the press and apologising to waiters for him. 

I suspect that Big Alcohol is also behind the Novopay debacle, if you just squint your eyes enough.

* Whenever I hear of some minor celeb pulling the "Do you know who I am" trick, I can't help but imagine the dancing man from the Black Lodge in Twin Peaks, "Fire, Walk with me". He reveals his identity thus:

"Do you know who I am? I am The Arm, and I sound like this ... [Indian war whoop]".

The Arm was the one part of Bob that wasn't evil, so he cut it off; it then manifested as the dancing Man From Another Place. The dancing man wasn't evil, just a bit silly and sad. Like the people who shout "Do you know who I am?"

Some useful context

I'm sure it's only the confines of a short radio news blurb that had Radio New Zealand miss a bit of context in this story. The full text of the RNZ bulletin:

The Government is being urged to consider whether it is time to ban alcohol advertising and sponsorship of sport.

Kerry O'Brien, a behaviour studies expert at Monash University, told an alcohol marketing conference in Wellington on Thursday, that alcohol advertising is everywhere in both New Zealand and Australia.

He said sport is a major way in which the alcohol markets its product to young people and current advertising codes aren't protecting children.

Mr O'Brien said new research shows if adults receive alcohol sponsorship in their sports club, their children may also be influenced.

Ok, an expert addressing an alcohol marketing conference wants to ban advertising. What kind of conference? Alcohol marketing. Could be some industry thing, could be an academic thing, who knows. Sounds pretty neutral and impartial though.

Here's Alcohol Action New Zealand's blurb on their conference:

THE PERILS OF ALCOHOL MARKETING - Thursday 7th March 2013 at Te Papa, Wellington

The upcoming conference titled The Perils of Alcohol Marketing is shaping up really well, with excellent keynote speakers confirmed - Professor Sally Casswell, Massey University Auckland, Professor Janet Hoek, University of Otago, Dr Kerry O'Brien, Monash University, and Associate Professor Antonia Lyons, Massey University. This will be the first conference post the Alcohol Reform Bill and focusing on this fundamental commercial issue of alcohol marketing is very apt. The draft programme is available to view and download below.

We welcome abstracts for short presentations (3-5 minutes) that illustrate the most "evil" examples of alcohol marketing. Feel free to submit an abstract that focuses on one pertinent example or, alternatively, one that skims over multiple examples. Please see the call for papers application form below.

Don't miss this critical conference on alcohol marketing - New Zealand's most socially damaging drug. Register now by completing and returning the registration form below.

So a conference, titled "The Perils of Alcohol Marketing", and hosted by Doug Sellman's Alcohol Action New Zealand, specifically went out asking people to submit abstracts illustrating "the most "evil" examples of alcohol marketing" and had a keynote speaker who thinks alcohol marketing should be banned.

Here's the conference flier:

NZ continues to be one of the most unregulated societies in the OECD for the supply and sale of alcohol. Alcohol is our most socially damaging drug yet the global alcohol industry enjoys enormous freedom to market alcohol to New Zealanders - as if it were an ordinary commercial product. 

The Conference will feature: 

Stimulating and informative keynote presentations from experts on alcohol and alcohol
marketing: Prof Jennie Connor, Prof Janet Hoek, Prof Sally Casswell, and A/Prof Antonia
Lyons. Dr Kerry O’Brien from Australia’s Monash University is a special overseas guest.
A series of short presentations illustrating the most “evil” examples of alcohol marketing.
A political panel with representatives from the main parliamentary parties outlining their
respective party policy on how to deal with “The Perils of Alcohol Marketing”, in the light of the Law Commission’s recommendation to dismantle it over a five year period. 

The draft programme included:

• Otago's Jennie Connor on Alcohol Harms
• Otago's Janet Hoek asking whether responsible alcohol marketing is a "public health oxymoron?"
• SHORE's Sally Casswell asking "Where would alcohol companies be without alcohol marketing?" 

A bit of context can sometimes be of assistance. 

A hopefully concluding note on the price elasticity of alcohol

A condensed version of the letter I'd sent to the Press appeared in its letters section last week. My shortened letter:

In Monday's Press, Doug Sellman argued that differences in our interpretations of Chris Auld's study on the effects of minimum prices on consumption hinged on that the clause "relative to other drinks" was missing in one journalistic interpretation. This is hardly the case.

The Sellman press release said "A recent Canadian study has shown that a 10% increase in the minimum price of alcohol reduces its consumption by 16% relative to other drinks." As this statement was interposed between sentences noting the effectiveness of minimum prices in reducing consumption of alcoholic beverages, the reader could be forgiven for drawing the conclusion that the study Sellman cites finds that large a reduction in consumption of alcoholic beverages relative to non-alcoholic beverages. However, "other drinks" here did not mean that.
The sixteen percent estimate instead tells us what happens to, for example, beer consumption when the price of beer increases substantially and consumers then instead consume wine. It is highly misleading to present this as the expected effect of an across-the-board increase in prices.

It is especially misleading when the cited study did provide an estimate of the effects of minimum prices: a minimum price that lifts all prices by ten percent would decrease aggregate consumption of alcoholic drinks by only 3.4%. Indeed, Chris Auld, the economist responsible for the empirical analysis in the work cited by Sellman and Connor, writes in comment on my blog, and subsequently confirmed by email: "Eric, for the record, I agree with your interpretation, and I think Sellman and Connor's wording is very misleading." 

Doug Sellman and Jennie Connor's reply in Monday's paper this week:

"Dr Crampton continues his attack on us and does not admit that he made a mistake in quoting from an incorrect secondary source (Sept 11). But he does downgrade the charge from "screamingly wrong" to "very misleading", and if he were to take several more deep breaths he would realize we are essentially in agreement. We have said often over the past three years that there is no magic bullet to change the heavy drinking culture and the harm that results from it.

Although raising the price is probably the most effective and easily enacted measure the Government could put in place, it is not going to achieve the degree of change that is needed on its own.

However, the fact that a 10 per cent rise in minimum price results in a 3.4 per cent decrease in aggregate consumption should not be dismissed as trivial.

A reinforcing set of alcohol reforms, involving marketing, accessibility, purchase age and drink driving, in addition to raising alcohol prices, is likely to be required to bring about substantial change to the out-of-control and damaging state of alcohol use in New Zealand."

I continue to fail to see how there is any relevance in whether one includes "compared to other drinks". If they'd said "compared to other alcoholic drinks", then I'd have been perpetuating a misquoting. Recall that "other drinks" here means other categories of alcohol, not fruit juice. Keeping it in only clarifies things for those readers who knew that Auld et al meant "other alcoholic drinks" but sure doesn't help things for those who didn't know it.

Further, it's Chris Auld that said "very misleading". I'd said, and continue to say, "screamingly wrong". I was just space-constrained in the letters section.

If I had to guess what happened in the Sellman and Connor press release, I'd guess something like the following - I could pretty easily be wrong though and would happily take correction. Sellman and Connor both got mad that John Key said minimum pricing wouldn't do much to curb heavy drinkers' consumption, they ran a Google Scholar search to find some estimate they could use to beat him up with, gave the paper the most cursory skim to find a line they could use, and then ignored the rest of it. They might not have even noticed the 3.4% estimate further down the paper.

But even on this fairly benign story, there's just a shocking underling failure to put the number in context. Again, if you look at Wagenaar's meta-study, you just can't find a single estimate from any of the 100+ papers surveyed that puts alcohol demand as being relatively price elastic (ie absolute elasticity value  > 1.0); it's all degrees of inelasticity. And Sellman and Connor were happy to jump on a number saying alcohol's not just price elastic, it's really really price elastic. You simply cannot have any familiarity with this literature and expect that a price elasticity of -1.6 could possibly be right. It would be like claiming that acceleration due to Earth's gravity is fifty meters per second squared. You can't know anything about physics and think it plausible that acceleration due to gravity on Earth is fifty meters per second squared; you can't know anything about alcohol economics and think it plausible that the price elasticity of demand is -1.6. It's about that level of magnitude of wrong. And it's hardly "dismissing" the effects of gravity to point out that it's only really 9.8 meters per second squared either.

And this pair are the country's go-to experts on the evils of the booze.

Check your sources

Doug Sellman in the opinion section of today's Christchurch Press claims to have had his numbers right [not yet online]. Let's check the history here.

Here's Sellman and Connor's original press release:

Who is advising the Prime Minister on alcohol reform?

Mr Key announced today that he doesn’t believe that minimum pricing for alcohol will change the amount people drink.

“This is contrary to the scientific evidence base about alcohol pricing in general and minimum pricing in particular” said Prof Jennie Connor, medical spokeperson for Alcohol Action NZ.

“Mr Key states that what typically happens is people move down ‘the quality curve’ and still get access to alcohol. Where does this information come from? On the contrary, minimum pricing specifically targets the very cheapest alcohol options and is predicted to reduce average consumption by removing high-alcohol low-cost products from the market.”

“A recent Canadian study has shown that a 10% increase in the minimum price of alcohol reduces its consumption by 16% relative to other drinks”. [emphasis added]

“And these latest data are consistent with the scientific literature which indicates that increasing the price of alcohol has a positive impact on reducing heavy drinking”.

This is very clearly saying that there are very large price effects of increasing the cost of the lowest-priced alcohol. I had initially found the Newstalk ZB report and wondered whether she'd been misquoted, before finding the press release.

I wrote:

Connor has to have been misquoted here or the journalists left out a couple of subsequent clarifying sentences. The error is in the press release. Oh dear.

The link there is now deprecated, but the Scoop link still works.

In today's press, Sellman says that they had it right all along:

On July 3, 2012 we issued a press release recommending the government enacts a minimum price per standard drink of alcohol – to eliminate ultra-cheap drinks favoured by binge drinkers, young drinkers and heavy drinkers – and pointed to a Canadian study that showed ‘‘a 10 per cent increase in the minimum price of alcohol reduces its consumption by 16 per cent relative to other drinks’’. Our wording was based closely on the paper’s wording: “Longitudinal estimates suggest that a 10 per cent increase in the minimum price of an alcoholic beverage reduced its consumption relative to other beverages by 16.1 per cent (p0.001).”

Two days later Crampton wrote a damning critique of the press release on his personal blog, using the same arguments he later used in this Press article. However, it appears Crampton based his critique on a short Newstalk ZB news report of the press release, which quoted Jennie Connor saying, ‘‘studies show a 10 per cent increase in the minimum price of alcohol reduces consumption 16 per cent’’. Note: the reporter had cut off the words ‘‘relative to other drinks’’, which would indeed be wrong if she had said it.

Crampton’s blog piece, and his later Perspectives article, ridiculed the presumed mistake: ‘‘Can a 10 per cent increase in the minimum price of alcohol really reduce total alcohol consumption by 16 per cent?’’ he wrote. ‘‘No’’. But if he had taken the basic precaution of checking the primary source, our press release, he would have seen the words ‘‘relative to other drinks’’ and realised that we had not misquoted the Canadian study at all.

Thus Crampton’s main argument in the Press article was based on his own simple and avoidable mistake, which seems careless for a senior lecturer.

The problem isn't that the Newstalk piece left off the words "relative to other drinks" but that Sellman and Connor used that estimate as though it were relevant to average consumption and where "other drinks" would be interpreted as something other than other categories of alcoholic beverages.

Further, they might have noted that my post of 10 July quoted the press release accurately; my post of 5 July had cited the NewsTalk reporting.

If we look a bit further down the Auld paper, we see pretty clearly what Sellman and Connor had missed:

"The estimates indicate that a 10% increase in the minimum price of a given type of beverage reduced consumption of that type by about 16.1% relative to all other beverages, and a simultaneous 10% increase in the minimum prices of all types reduced total consumption by 3.4% (p<0.01 in both cases)."

Sellman and Connor were building a case in their press release that the Prime Minister was way off base in claiming that raising the minimum price would not have large effects on drinking. Whether "relative to other drinks" is included or not is irrelevant where the context suggests that "other drinks" means drinks other than alcohol.

And so I sent the letter below to the Press this morning:

Doug Sellman in Monday's Press claims to have had his numbers right all along. In his press release of 3 July, he and Jennie Connor wrote:

“Mr Key states that what typically happens is people move down ‘the quality curve’ and still get access to alcohol. Where does this information come from? On the contrary, minimum pricing specifically targets the very cheapest alcohol options and is predicted to reduce average consumption by removing high-alcohol low-cost products from the market.”

“A recent Canadian study has shown that a 10% increase in the minimum price of alcohol reduces its consumption by 16% relative to other drinks”.

The rather obvious interpretation of their release, which was highly critical of the Prime Minister's claim that minimum prices would not greatly affect consumption, was that we should expect a sixteen percent reduction in consumption of alcohol relative to other drinks were the minimum price of alcohol to rise by ten percent.

The paper on which their analysis was based does indeed have a quote that reads a lot like Sellman and Connor's. But, it refers to the effects you get if the price of one category of alcohol - like beer, wine, or spirits - rises relative to other categories of alcoholic drinks. It isn't talking about the consumption of alcohol as compared to fruit juice. This is obvious if we read the second clause of the sentence, where Auld and his coauthors write:

"The estimates indicate that a 10% increase in the minimum price of a given type of beverage reduced consumption of that type by about 16.1% relative to all other beverages, and a simultaneous 10% increase in the minimum prices of all types reduced total consumption by 3.4% (p<0.01 in both cases)."

In Monday's Press, Sellman claims not to have misquoted the Canadian study and that they had, all along, meant "relative to other drinks" to refer to other categories of alcohol. If so, it seems odd to have chosen that figure as being relevant to the argument they were building. It could be relevant if we were estimating the likely reduction in consumption of premixed "alco-pops" relative to other alcoholic beverages, but surely the total amount of alcohol consumed matters more than whether it is consumed in one type of alcoholic beverage rather than another. And, for total consumption, the 3.4% figure is the rather more relevant one.

I strongly encourage readers to read the paper on which Sellman's claims are based and to judge for themselves, rather than trusting either of us. An ungated version of it is available here: http://www.vsnews.fr/etudes/Does-Minimum-Pricing-Reduce-Alcohol-Consumption.pdf . Or, go to scholar.google.com and type "Does minimum pricing reduce alcohol consumption?" You will find that the authors there, like Sellman, favour minimum prices. I worry more about harms imposed on lower income moderate consumers of lower cost alcohol. How we weigh the tradeoff between reducing harms from heavy drinkers and reducing consumption benefits from poorer moderate drinkers is a fairly important discussion. But the case for a minimum price for alcohol ought not be based on an estimate of its effects that is roughly five times larger than that which can be supported by the evidence.

Alcohol purchase age

I caught a fun call from Christchurch Press reporter Joelle Dally yesterday afternoon. She noted that Doug Sellman disputed my figures and that Sellman claimed I was running a political campaign on the issue. Here are the stats I sent back to the reporter by email after a fire alarm on her side of the call cut the interview short. I must have gotten her email address wrong as none of them showed up in today's story. Anyway, here's what I'd sent:

Here are some of the stats to which I'd point. I'm sure that Professor Sellman would find reason to find a crisis in youth drinking in them, but I've a harder time seeing it.

First, I'll point to the figures from The Social Report that showed no increase in "potentially hazardous drinking" in the 15-24 age cohort from 1996/1997 to 2006/2007. Doug would be right that it could be the case that drinking within the "potentially hazardous" range could have changed, either becoming more or less intense, without showing any change in the proportion in that cohort. But it would seem odd if there were one cohort that were just getting worse and worse, without any changes in the proportion of people in that cohort. The Social Report also shows that there were some demographic shifts within the cohort of "potentially hazardous" drinkers: compared to 1996/1997, relatively more youths in that cohort are of European/Other background compared to Maori and Pacific.

Second, I'll point to ALAC's Youth Drinking Monitor. In 1998, before the purchase age change, about 25% of youths aged 14-18 were non-drinkers. That dropped to 14% shortly after the law change (2000).

But, if we look at more recent figures we find (Table 18) that 88% of 12-14 year olds are non-drinkers, 46% of 15-17 year olds are non-drinkers, and 11% of those aged 18-24 are non-drinkers.

Unfortunately, the age groupings make those a bit hard to compare. But look at those numbers and judge for yourself whether it seems plausible that we've had big increases in youth (age <18) access to alcohol since legalization.

The same pair of reports have 31% of youths 14-18 drinking heavily in 1998 (reported 5+ drinks at last occasion) and 30% of those aged 12-24 binge drinking now (4% of those 12-14, 27% of those 15-17, and 44% of those 18-24). Again, youth binge drinking is a problem. But it's harder to say that it's a problem that's worse now than it was prior to the change in the purchase age; the proportions seem pretty similar.

There should be a very strong burden of proof on those who would impose large costs on all kids aged 18-19 who drink responsibly - the gains of potential reductions in bad behaviour have to outweigh the costs we impose on those who aren't causing problems. Again, this can't rule out that maybe each and every one of those binge drinkers have gone from 5 drinks to 50 (or from 25 to 5).

And, as I'm sure Doug Sellman will have made insinuations about it anyway, I have done work for the Australian alcohol industry contrasting the methods used in estimating the social costs of alcohol with methods used in standard economic analysis. This work was conducted through a consultancy grant handled through the University of Canterbury's Research Office and subject to strict conditions around ethical conduct in research and around academic independence. Indeed, the University sent out press releases last year celebrating some of my work in this area; it's hardly been secret.

I have one other statement of pecuniary interest to make. If a split drinking age goes through, I'm going to make money on iPredict; if we go to either 18 or 20, I'm going to lose a lot. I'm a supporter of "Keep it 18", but I expect the split verdict to obtain unless they change the standing orders on how the vote proceeds.

Joelle didn't include those stats but did include a note from Sellman that the Law Commission had considered all this and still thought that there were problems in youth drinking. Look carefully at the Law Commission's review around youth drinking. Leave aside for now the general stuff about that it's bad that kids drink and look to how they treat evidence around the change in the alcohol purchase age in 1999. The Law Commission correctly notes that there was an increase in youth drinking in the year subsequent to the law change. But they don't say much about more recent trends.

At paragraph 16.15 they cite these bits of evidence on changes:

• The year following the law change had an increase in ED presentations by drunk kids
• But if you look at the reports I'm citing above, you find a blip upwards in bad stuff immediately following the law change, which subsequently reversed back to the status quo ex ante. So it wouldn't surprise me if there were an increase in ED presentations in the year subsequent. But if that has followed the same trend as youth binge drinking, it will have reversed.
• There was an increase in youth drink driving related problems subsequent to the purchase age change.
• But New Zealand reduced the drink driving limit to zero percent for kids and massively reduced those kinds of problems.
• "Our officers report bad stuff" reports from the police
• Evidence of increased binge drinking by kids through 2000 or 2002
• nothing about how that trend subsequently reversed back to status quo ex ante.

The rest of the LC's evidence on this question is around how bad youth drinking is in general, not about changes due to the purchase age. And while there's really good evidence from the United States that increasing the drinking age to 21 did a whole lot of good in reducing drink driving by kids, New Zealand seems to have achieved that goal with changes in the drink driving limit for kids. 

I'd also note Di Nardo and Lemieux's work on unintended consequences of the drinking age change in the US:

This paper analyzes the impact of increases in the minimum drinking age on the prevalence of alcohol and marijuana use among high school seniors. The empirical analysis is based on a large sample of students from 43 states over the years 1980 - 1989. We find that increases in the legal minimum drinking age did slightly reduce the prevalence of alcohol consumption. We also find, however, that increased legal minimum drinking ages had the unintended consequence of slightly increasing the prevalence of marijuana consumption. Estimates from a structural model suggest that this unintended consequence is attributable to standard substitution e ffects.

I stand by that there is not sufficient evidential base for imposing large costs on those moderate drinkers aged 18-20.

I also wasn't impressed with the quality of the Law Commission's work around alcohol taxation.

Alcohol stats

I wrote this for the op-ed section of Friday's Christchurch Press. I'm currently in Oz where I'll be talking about alcohol policy for the hospitality industry association liquor retailers conference and with a few journalists. So I'm posting this Wednesday and hoping that the piece did come out in Christchurch on Friday. Anyway, enjoy. [Update: here it is!]

---

It would be pretty easy for diligent Christchurch Press readers to conclude that alcohol is the worst scourge of humanity. Doug Sellman featured several times over the last fortnight warning us all of alcohol’s dangers; health reporter Georgina Stylianou wrote two articles on a new estimate of alcohol’s cost to the Canterbury health budget. And the University of Otago’s Professor Jennie Connor told us that minimum prices are remarkably effective in reducing alcohol consumption, pointing to a Canadian study “that showed a 10 per cent increase in the minimum price of alcohol reduced consumption by 16 per cent relative to other drinks.” Connor was quoted in a Mainlander feature on Doug Sellman explaining how Professor Sellman is not in fact a wowser; presumably it’s only free-spirited libertines who write op-eds in the New Zealand Herald worrying about how Woodstock commercials encourage boys “to have sex with their best mates’ mothers” and that advertisements “encouraging middle-aged women to get their teenage clothes back on and flirt with their son’s best mates” do not contribute to a healthy society.  (30 October 2009)

I do not particularly care what the jury decides on who is or is not a wowser. But I work with and care about the numbers around alcohol policy. And the impression most readers would get from the latest reporting in the Press is a bit at odds with, well, reality.

Let us begin perhaps with Jennie Connor’s citing of “a Canadian study” on the effects of minimum pricing. Can a ten percent increase in the minimum price of alcohol really reduce total alcohol consumption by sixteen percent? No. The number is so far out of line with the vast consensusof the literature that I got in touch with Chris Auld, one of the authors of what had to have been the study Connor had read, a piece in the May 2012 issue of Addiction. And my read of his study was right. If you increase the price of beer by ten percent, you could get a reduction in beer consumption of sixteen percent, but that’s because beer drinkers move over to other alcoholic drinks. Across-the-board increases in the minimum price of alcohol have far smaller effects: a ten percent price increase reduces aggregate consumption by only about 3.4 percent, as is made reasonably clear in Auld’s paper.

That the sixteen percent figure is screamingly wrong should have been obvious to anybody who is familiar with the literature. The largest estimate of the responsiveness of alcohol consumption to price measures in Wagenaar’s 2009 survey of 112 different studies suggested that a 10% price hike reduced consumption by 8.4%; Wagenaar concluded that 4.4% is the best consensus estimate. And for heavy drinkers, it was 2.8%. Auld’s 3.4% is then right where a reasonable person would have expected an estimate on the effects of minimum prices might fall. Sixteen percent – that’s right out.

The Auld study does come out in favour of minimum prices, but in conjunction with a decrease in alcohol excise taxes: it’s then a way of increasing the cost facing heavier drinkers while doing less harm to moderate drinkers if heavier drinkers drink cheaper alcohol. I worry more that the policy does disproportionate harm to moderate-drinking poorer people.

I was a bit more surprised to read of the new commissioned BERL report on the health costs of alcohol in Canterbury. Their prior work in the field, a 2009 study that included a measure of costs to the health system among other costs of alcohol, seemed to put a pretty heavy thumb on the scales in estimating the costs borne by the health system. My article in today’s issue of the New Zealand Medical Journal lists a few of those problems [note: link may only be active after lunchtime Friday, sorry]. While alcohol greatly increases the burden of disorders like liver cirrhosis, it also reduces the costs of cardiovascular disease. BERL here replicated work done in Australia by Collins and Lapsley (2008). But where Collins and Lapsley added up all the costs imposed by those disorders where alcohol makes things worse and subtracted from that total all the cost savings from those disorders where alcohol reduces costs, BERL simply erased any beneficial effects of alcohol for disorders including ischaemic heart disease, cholelithiasis, heart failure, stroke and hypertension.

As I had warned BERL against this kind of method when I served as discussant on their paper at the 2009 New Zealand Economic Association Meetings, I was curious whether they’d revised things. But, the new BERL paper wasn’t available. Two separate stories in the Christchurch Press, with lots of reaction quotes from doctors, were based on a paper that the reporter did not have and was not yet available for public critique. I received the paper Wednesday courtesy of the CDHB. And BERL, at footnote 14, reports they’ve done the same thing again: “The Collins and Lapsley fractions indicate some alcohol use may be beneficial for some conditions. We concentrate on harmful drug use, and assume zero fractions for such conditions.” So their measure of the costs of alcohol to the Canterbury health system relies on an assumption that there can be no health benefits from alcohol – an assumption that runs contrary to the weight of international evidence. Assuming one’s conclusions is hardly proper method.

Unfortunately, alcohol policy is one of those areas where a lot of people’s convictions about the right answer put a pretty strong lens on how they assess the literature. How often do you read that problem drinking among 15-24 year olds was no different in 2006/2007 than in 1996/1997 before the change in the alcohol purchase age? Or that per capita alcohol consumption is down substantially since 1991? Or that light drinkers have about a 14% reduction in their chance of dying from any cause than people who never drink,correcting for the host of other health-related behaviours that are usually given as reasons for ignoring the health benefits of moderate drinking?

Be skeptical of the moral crisis around alcohol.

A symposium, of sorts

The latest issue of the New Zealand Medical Journal features three papers on alcohol policy, including one from Matt Burgess, Brad Taylor and me, along with a commissioned editorial piece on the set. I have not yet had a chance to read the other two papers in the series but the editor of the journal kindly forwarded along a copy of the editorial piece late Thursday night.

Doug Sellman, lead author on the editorial piece, says about what I expected he would say about our work on alcohol.

Our piece in the NZMJ contrasts the standard economic approach to costs and benefits with that employed by BERL in their work. We worked through the different cost categories in the BERL report to illustrate the differences between a standard economic approach and the cost of illness method they used before spending a bit of time on the importance of marginal analysis rather than measuring total benefits and total costs of anything.

Sellman's piece, or at least the part of it criticising us rather than lauding the other two papers, begins with* a critique of our focus on external costs rather than costs borne by drinkers themselves; he pitches this as being responsible for the $4 billion difference in measured cost. I would note here that about a billion and a half of that $4 billion difference comes from BERL having double-counted intangible costs of statistical lives lost with forgone earnings. Even if your focus were entirely on total costs, there's a big chunk of that total figure that's just wrong.

I'm also not sure if he's amplifying for rhetorical effect, didn't understand the point, or whether we didn't phrase it clearly enough. But he writes:

The narrowness of the Crampton group’s approach is exemplified in the statement that “the only policy-relevant costs [of a fatal drink driver accident] are those imposed on emergency services in responding to the accident”. Equally the lost productivity through mortality reveals the dismal view from the world of this particular economic approach: early death is not seen as a cost because the economic unit (the deceased person) can simply be replaced.

In the case of drink driving accidents, we were very clear that deaths to those outside of the drinker's vehicle impose very large costs that are definitely deemed external and policy relevant. But if you were considering a single vehicle accident with a solo driver where nobody else was hurt and only the driver's own car was wrecked, then we would only count the costs to emergency services. There costs of deaths associated with that kind of crash remain very real, but if you want to count them, you have to also count the benefits enjoyed by those who took similar risk and didn't have an accident.

Similarly, Doug doesn't quite get why we discounted costs of forgone output. BERL used a measure of GDP per capita as forgone output rather than using the deceased worker's prior wages; that addition requires very strong assumptions around worker irreplaceability and capital-labour complementarity. But the main reasons we discounted lost output were first that it's double-counted with the intangible costs of lives lost, so it should be reduced even if you want to count private costs, and second because it's largely a cost borne by the drinker himself.

But here's my very favourite paragraph in the whole thing.

From a non-economist standpoint Crampton et al would appear to be the fundamentalists in this debate and their conclusions need to also be considered in the context of their receiving funds from an alcohol industry, which benefits from their conclusions. Further, it is important to note that “standard (neoclassical) economic approaches” are coming under increasing scrutiny and criticism, particularly following the recent global financial crisis, which was not predicted by “standard” economic models. New economic models based on better science and more rigorous mathematics are now progressing.5 [cite to Keen!]

I'm pretty sure that these can't all be true at once:

1. I'm a fundamentalist
2. I'm bought out by industry, saying whatever they want
3. We should throw out neoclassical economics because it yields conclusions like mine and the financial crisis too.

I suppose 1 and 3 could go together if I'm a fundamentalist economist. But the thing is, you can't really buy out a fundamentalist. A true zealot can be encouraged to spend more time on one area of work rather than another [and a consultancy contract that needs to get finished, earthquakes or not, does sharpen incentives on that front], but you can't buy a fundamentalist's conclusions. It's perhaps worth noting, again, that the net effect of industry funding on conclusions, when it comes to my analysis of the BERL study, was to substantially increase the measured external costs of alcohol use: thoroughly understanding the model on which the BERL study was based led us to find an error in our prior unfunded work - one not noted either by BERL or by Marsden Jacob in its $60k hatchet job on that prior piece.

* Actually, it begins with Doug making a trivial but risky error: he says that BERL produced its report for the Law Commission's review of the alcohol literature. I understand that the Law Commission, back in 2009, sent out a couple of threatening letters when they were characterised as having commissioned the BERL report. I doubt it'll happen here, because LC isn't being criticized (incorrectly) for having commissioned a shonky report. They didn't commission a shonky report; the Ministry of Health and ACC did. The Law Commission relied on a shonky report. That's different.

Evidence and minimum alcohol pricing

Otago's Jennie Connor and Alcohol Action NZ's Doug Sellman are angry again. This time, because Justice Minister Judith Collins cited some Masters' research done at Massey AUT showing that students surveyed said they'd not change their binge drinking habits if prices increased; they instead want the government to rely on international peer-reviewed evidence based on actual consumption patterns rather than on surveys.

And fair enough.

Fortunately, we have some evidence ready at hand. Byrnes et al, 2012, Drug and Alcohol Review. They use Australian household surveys from 2001, 2004 and 2007 to see how changes in alcohol prices affect the number of reported days of no, low, moderate, and high alcohol consumption; they find that while price increases do reduce consumption, they tend to reduce the number of days of low consumption while not changing the number of days of moderate and high alcohol consumption. This would be consistent with binge drinkers dropping the occasional beer or wine with dinner to save up for the big nights out. If policy is more worried about binge drinking than about light drinking, this might matter.

It's also mildly amusing that an Otago healthists complains about policy being based on surveys. I wonder what Connor would make of her Otago colleagues' call for banning smoking outside of bars on the basis of a survey of thirteen youths recruited in part via Facebook; the youths reported in focus groups that they'd be less likely to smoke if they couldn't smoke outside of bars. Maybe that one's ok because it's published in a journal rather than being a Masters Thesis.

Connor also notes that heavy drinkers tend to purchase cheaper alcohol relative to moderate drinkers.

“It has been established that hazardous drinkers spend less per unit of alcohol than others, and drinkers compensate for price increases by shifting to cheaper drinks. In the United States, the heaviest 10% of drinkers spend approximately $0.78 per drink compared with $4.75 per drink for the lightest 50% of drinkers.”

This only is a relevant comparison if the heaviest drinkers and lightest drinkers are drawn from the same parts of the income distribution. Suppose for sake of argument that heavier drinkers are more likely to be drawn from poorer parts of the income distribution and lighter drinkers from higher income parts of the distribution. If that's the case, we would want to compare the price paid by heavy and light drinkers correcting for any differences in income. If people with demographic characteristics similar to the heaviest 10% of drinkers but who are light drinkers spend $1 per drink (just a guess here), then minimum prices pushing above that hit both heavy drinkers and light drinkers of modest income. I know that consumption benefits from alcohol count for zero in the healthist world, but they ought to matter for policy.

At least they're not today claiming that a 10% increase in minimum prices reduce consumption by 16%...

If this isn't a wowser, I don't know what is

The Press has a puff piece letting Doug Sellman explain how he's not a wowser.

In short, 'wowser' suggested Christian women and other busybodies who wanted to get between a man and his drink. And not just drinking but many forms of pleasure. When Australian artist Norman Lindsay was attacked over his nude paintings in the 1930s, he said, "I am sick and tired of this wowseristic country". To this day, Lindsay's authorised online biography has "irate wowsers" in North America burning his paintings.

Closer to home and in our time, Doug Sellman has had "wowser" thrown at him a few times over the years. Along with other, less polite words. All because he has talked back to the alcohol industry.

Ok. This from the guy who got mad about the Woodstock mixed bourbon and cola drinks not just because of the booze, but also because they encouraged teenagers to have sex with their friends' mothers. Here's Sellman in an oped from the Herald not too long ago:

Mr Kerr is saying these young people and women need to be more responsible in the face of aggressive targeted marketing. But the industry he is defending is cynically trying to convert these people into heavy drinkers. Is that socially responsible?

Alcohol advertising on TV has recently reached a point that one wonders whether it can sink any lower. The latest Woodstock advert[*] aiming to get boys to drink bourbon sweetened by Coca-Cola in a product called Woodstock, associates a can of Woodstock, a "woody", with a penile erection and not unsubtly is encouraging them to have sex with their best mates' mothers.

The ad also seems to be encouraging middle-aged women to get their teenage clothes back on and flirt with their son's best mates. I presume some would defend these adverts as responsible business practice and contributing to a healthy society.

So Sellman isn't leading an old time Christian Temperance Union crusade against fun.  As the billboard says, Yeah Right.

Here's Sellman warning that alcohol is a Group 1 carcinogen, comparing it to plutonium, and ignoring that birth control pills are in the same darned category.

Here's Sellman pushing for taxes on soda.

Here's Sellman saying that muesli is addictive.

Further in the Press article, Sellman says it's all about the science:

As wowser and related insults show, alcohol reform is an emotive field where much is at stake - revenue streams included. Sellman wants to emphasise the science.

"It perhaps needs to be stated my colleagues and I are not basing our suggestions for alcohol law reform on our own opinions or life experience," he concludes. "They are based on the best international scientific evidence available at the current time."

The Press piece had earlier quoted the press release from Doug Sellman and Alcohol Action NZ colleague and U Otago Prof Jennie Connor that grievously exaggerated the findings from Chris Auld's paper on the effects of minimum pricing in Canada. Maybe that press release was "based" on the best international scientific evidence in the same way that a lot of stuff on TV is "based on a true story". Because it sure misrepresents what Auld actually found. Why should we trust anything he or Connor say about alcohol?

* I'd posted the ad here when Sellman first posted this op-ed about the moral decay of today's youths and their mothers.