Christopher Snowdon's Blog, page 2

Are problem gamblers four times more likely to attempt suicide?

As reported in the Independent ...  

Problem gamblers four times more at risk of suicide attempt by age 24 – study

 This is exactly how the press release that was e-mailed out yesterday was headlined although the online version has a slightly different wording... 

Pioneering research reveals problem gambling quadruples the risk of suicide among young people four years later

 Curiously, this claim does not appear in the study itself. Nor does the following claim from the press release... 

Lead author Olly Bastiani, PhD researcher at the University of Bristol Translational and Applied Research Group, said: “This study tracked people from birth, meaning we could look at the long term impacts of problem gambling, and could rule out alternative explanations that hinder previous studies, such as that people might be drawn to problem gambling as a way of escaping pre-existing suicidal feelings.”

 There is, in fact, no way for such a study to rule out other factors for an attempted suicide.  So what does the study really show? It is based on 15,645 people born in the 1990s in the Avon Longitudinal Study of Parents and Children. "Tracked from birth" is an exaggeration, but it does include survey evidence about whether they had ever attempted suicide at the ages of 16, 24 and 25, and it has survey evidence showing their PGSI (problem gambling) scores at the age of 20 and 24. A PGSI score of 8 or more out of 27 is the conventional threshold for problem gambling. The idea behind the study is to see whether suicide attempts are preceded by problem gambling, thereby strengthening the correlation and reducing the risk of erroneous reverse causation (i.e. that suicidal feelings lead to problem gambling). The researchers also control for other factors that could lead to suicide attempts, such as alcoholism. To cut a long story short, they find associations. They find that people who are problem gamblers aged 24 are 15% more likely to have made a suicide attempt in the last twelve months at the age of 25. They also find that people who are problem gamblers aged 20 are 20% more likely to have made a suicide attempt in the last twelve months at the age of 24. The latter finding is a relative risk of 1.20 and is after controlling for other factors.  Although it is not made clear in the study, the press release says that...  

The future suicidality link was most stark among 20-year-olds, where there was a 20% increase in suicide attempts for every increment on the PGSI meaning that those scoring eight and above experienced quadruple the rate of suicide attempts four years later. 

 This seems to be saying that someone who scores 1 out of 27 in the PGSI test is 20% more likely to kill themselves. That sounds unlikely. To get 1 out of 27, all you have to have done is "bet more than you can really afford to lose" or "gone back to try to win back money you had lost" in the last twelve months. It is hard to see how this could drive anyone to suicide. The researchers have then multiplied 20% by something to get a figure of 400% for people who are actually problem gamblers (i.e. score 8 or more). That suggests 20% x 20, but it is unclear where the 20 comes from. 20% x 8 seems more logical, but that only produces 160%. I confess that I am rather baffled by how they came up with the claim that "problem gambling quadruples the risk of suicide". None of this stuff is in the study, so we can only guess where it came from. Did the authors find an association between attempted suicide and low PGSI scores and draw a linear line upwards or did they find an association with high PGSI scores and draw a linear line backwards? One thing is for sure: there were not enough attempted suicides for them to confidently draw conclusions about people with low, moderate and high PGSI scores. The study seems to be 95% maths and 5% data, and the most important data is not presented. A lot of data simply doesn't exist and had to be "imputed" (i.e. guesstimated). Of the 15,645 people born into the study, 10,528 did not answer any questions about suicide attempts. That is 67%. Of the 4,331 people who answered the suicide questions, 2,616 (60%) did not answer the gambling questions. There were only 729 people who answered all the relevant questions and only 11 of them had attempted suicide in the past year. These are very small numbers of self-selecting people to be drawing bald conclusions about. Moreover, the authors chose not to control for several co-morbidities that seem relevant. They controlled for alcohol use disorders, socio-economic status and hyperactivity (all of which are strongly correlated with suicide attempts), but not illicit drug use or - surprisingly - mental health disorders. Although they give reasons for this, they acknowledge that it may be a weakness: 

Our selection of covariates was parsimonious. Other studies with greater power should include additional covariates such as depression, anxiety and illicit drug use to investigate whether these influence the relationship between PGSI and suicidality.

 The study itself is quite cautiously written and heavily caveated. At the end, the authors say: 

In conclusion, the present study found evidence of positive associations between harmful gambling and current and future suicide attempts among young UK adults, which was unlikely to be confounded by pre-existing suicidality. 

 That is a reasonable summary, as is the statement in the abstract that "this association may be more complex long-term, and increases in harmful gambling during adulthood may not be an important factor", but it is in contrast to the press release which claims the study was able to "rule out alternative explanations" (implying that all alternative explanations were ruled out, not just pre-existing suicidality). No such claim can be reasonably made. It is perfectly possible for someone who was neither a problem gambler nor suicidal at the age of 20 to have gone down a dark path by the age of 24 in which symptoms of problem gambling feature but are not terribly important.  It is fairly obvious that suicidal people typically have a number of different problems in their lives. A study published a few weeks ago found that problem gamblers in a Swedish hospital had a wide range of co-morbidities and were more likely than the average person to kill themselves, but that problem gambling per se  was not a risk factor for suicide. Despite the grandiose claim that the people in the new study have been tracked since birth, the authors do not have enough knowledge about their circumstances to be able to claim a causal link between "harmful gambling" and attempted suicide and, to be fair, they do not make such a claim explicitly in the study. The press release is a different beast, however. The press release seems designed to get the factoid that problem gamblers are four times more likely to attempt suicide into circulation. It also includes the red flag of a call to political action....  

Dr Newall said: “Gambling is a part of the government’s suicide prevention strategy, and these results help underscore the need for additional population-wide measures to prevent gambling harms, such as meaningful restrictions on gambling advertising.”

 The study has nothing to do with advertising or any other "population-wide measure". This is pure editorialising.  Incidentally, if we want to know what effect an advertising ban would have, we can look at what the problem gambling prevalence was in the first major gambling survey in 1999 - 8 years before gambling ads were legalised. The figure was 0.6%, statistically indistinguishable from the 0.4% reported in the most recent survey of this kind.  (Still more incidentally, the authors claim in the study that the "latest official Great Britain statistics have noted a significant increase in estimated prevalence rates for harmful gambling". This must be a reference to the new Gambling Commission online survey which gives a figure of 2.5%. The flaws of this survey are well understood, but even its supporters acknowledge that its figures can't be compared to figures from different surveys. The Gambling Commission has explicitly told people not to make such apples and oranges comparisons.) The claim that problem gambling is a major cause of suicide is central to the argument that gambling is a "public health" issue. The aforementioned Swedish study should put an end to the zombie claim that "up to" 496 suicides are linked to gambling every year in Britain (since it was an earlier version of the Swedish study that Public Health England used to make its foolish extrapolation), but there is a palpable urge on the part of anti-gambling campaigners and 'public health' academics to quantify something that probably cannot be quantified. Now that the gambling research field is awash with cash, expect to see much more of this. 

RIP Graham "mad dog" MacGregor

I was sadder than you might expect to read that Graham MacGregor has died, aged 84. The Telegraph focuses on his anti-salt advocacy, but you probably know him better for setting up Action on Sugar.

We sparred on TV and radio many times and I was always happy to let him talk because he was so zealous in his campaigning and so extreme in his demands that it could only put the median voter off. He was a fanatic and he didn't try to hide it. I don't mind that. I prefer a sincere crank to a fanatic who pretends to be a moderate. You knew where you were with Graham. Most of what he said was deranged and he told some outright lies, but he was upfront about his longterm goals, such as plain packaging for chocolate and halving the amount of sugar in all foods.

He was also, I think, an eccentric, and at least eccentrics are colourful. He said something to me once that gave me the strong impression that he was right-wing, which would certainly make him an eccentric in 'public health' circles. His accent and appearance were more military than medical, but he was a proper medical doctor and, as far I can tell, he never profited personally from Action on Sugar. 

In 2014, we both appeared on 'Alan's Ding Dong', a Partridge-esque feature of the Alan Titchmarsh Show, to debate the merits of a sugar tax in front of an audience of pensioners who had been bussed in from middle England. It went to a public vote in which the audience were invited to hold up a yellow paddle if they were opposed to the idea. As you can see from the photo below, you should never get between OAPs and their sugar.

I also remember MacGregor and fellow nanny statist Susan Jebb shouting at each other at the 2015 Sugar Summit. I couldn't hear exactly what was being said but it started after Jebb accused him of using "loose words" and "factual inaccuracies" on stage.

I only had a private conversation with him a couple of times, but when we were chatting before doing the Spectator podcast in 2017, he told me with some reluctance that he had agreed with every word of an article I had recently written (unfortunately I can't remember which one). When I asked him about the departure of Aseem Malhotra from Action on Sugar, MacGregor called him "bonkers" and was just getting into his stride when he stopped himself said "Anyway, I'm not going to talk about Aseem - especially to you!"

I met him again at a small conference held by the sugar industry in a London hotel. MacGregor was only required for a panel on public health late in the afternoon but he turned up for the whole thing and ended up listening to industry folk talking about things like fertilisers, the climate and other issues that affect sugar farmers. After a dry and detailed discussion of the global sugar market from an American speaker via videolink, MacGregor raised his hand to talk about how sugar taxes and food reformulation were sweeping the world and asked how the industry was going to cope with the inevitable downturn in sales. The American looked rather baffled and said that he was not projecting any decline in sugar consumption.

His legacy was mostly malign and a lot of what he said was objectively wrong, but I could never bring myself to hate the old boy. At least he was a character. RIP.

Drink driving and the bootleggers

I've written for the Morning Advertiser about the drink-drive limit after receiving a press release from a company called AlcoSense. You'll never guess what they sell... 

I received a press release the other day from an organisation called AlcoSense applauding the government for proposing a lower drink-drive limit. Labour will soon be consulting on whether to cut the limit from 80mg of alcohol per 100ml of blood to 50mg, bringing it in line with Scotland and the EU. AlcoSense says that this is “a welcome and overdue move”, although they would ideally like it to drop to the zero-tolerance level of just 20mg.

I had never heard of AlcoSense before. My first thought was that it must yet another neo-temperance lobby group funded by the government. In fact, it is a company that makes breathalysers. Its managing director, Hunter Abbott, says that “only” 37% of drivers are breathalysed after a collision. He thinks the figure should be 100%. He also thinks there should be more random breath testing. It is not hard to see why.  

 Free to read. 

 

Mario Rizzo on behavioural economics

I was delighted to share a stage with Prof Mario Rizzo, co-author of Escaping Paternalism and other fine works, at the IEA earlier this year. I never got around to posting the video, but here it is. Mario is an articulate critique of behavioural economics and "nudge" policies. I also mentioned his work on the slippery slope in my introduction, in particular The Camel's Nose is in the Tent which is well worth a read.

 

Gambling disorder does not cause suicide - study

Gambling with lies 

Loyal readers may recall that Public Health England misused a study of Swedish hospital patients to make the claim that 409 suicides a year are linked to problem gambling. The science was so shoddy that the claim was shelved by its successor, the Office for Health Improvement and Disparities, who then used the same study and made the same mistakes to claim that "up to 496" suicides are linked to gambling. Although government agencies have been careful to use terms like "linked to" and "associated with", campaigners and journalists have been less careful with their language.

 

But, as I mentioned last year, one of the authors of the Swedish study used the same dataset for her PhD thesis and concluded that gambling disorder was not an independent risk factor for suicide among the hospital patients. It turns out that people in hospital with a range of psychiatric problems suffer from a lot of issues associated with premature mortality and that you can't use an inherently high-risk group to extrapolate across the entire population of a different country. Who knew?

Along with the co-author of the original study, she has now published a new study which comes to the same conclusion: people with gambling disorder are more likely to commit suicide but this is because of various co-morbidities, not gambling disorder.   

Individuals with gambling disorder had an increase in levels of mortality and suicide mortality compared to age, gender and municipality-matched controls. However, gambling disorder itself was not at the 0.05 alpha-level statistically associated with neither suicide nor general mortality when controlling for somatic and psychiatric comorbidities, gender, age and socioeconomic status. Thus individuals with gambling disorder suffer from increased mortality and suicide mortality and reasons for these appear to be multifactorial motivating careful suicide risk assessment and screening for somatic comorbidities in individuals with gambling disorder.

 Or, to put it another way...  

In the regression model gambling disorder was not significantly associated with mortality, this was predicted by socioeconomic status, increasing age, low education level, somatic comorbidity, substance use disorder and previous intentional self-harm in men and for women by increasing age and somatic comorbidity. 

 Of course, this is only one study and one cohort of people. But it is the same cohort of people that PHE and OHID used to come up with their spurious statistics (and those spurious statistics were then used to come up with equally useless claims about the cost of gambling to the health service).  If you extrapolate the findings from this study, you get the result that no suicides are causally linked to problem gambling in the UK. Stick that on a t-shirt.

 

 

Horse racing strike

No horse racing today in Britain. Find out why at the Snowdon Substack.  

The subplot to all this is that the anti-gambling lobby have been working with the racing lobby to throw the rest of the gambling industry under the bus. The anti-gambling lobby in Britain is effectively Derek Webb and the various lobbyists and think tanks he funds or has funded, particularly Matt Zarb-Cousin (Clean Up Gambling), Will Prochaska (Coalition to End Gambling Ads) and the Social Market Foundation (SMF).

The SMF have called for remote gaming duty to rise to 50% (!) while Matt “not anti-gambling, just anti-FOBTs” Zarb-Cousin has called for online casinos to be taxed “into oblivion”. The SMF’s ‘concession’ to sports bookies is a 25% tax consisting 5% duty and 20% Horserace Betting Levy which amounts to the same as they pay now (15% duty plus 10% racing levy). This is because they know that horse racing is popular with the public and it gives them a way to “peel off and neutralise racing” - to quote Zarb-Cousin - while they hammer the rest of the remote gaming sector.

 

The endless "public health" playbook

Yawn.  

Food industry lobbying is leading Labour to drop public health plans, experts say

 How could they possibly know that? Lobbying is virtually impossible to measure and there is no way of knowing whether it is effective or not. The fact that politicians side with one special interest over another does not prove that it was the lobbying wot won it. And even if the lobbying was effective, it only means that the politicians were more persuaded by one set of arguments than another. So what? 

Labour has scrapped ambitious plans to tackle Britain’s growing toll of lifestyle-related illness after lobbying by food and alcohol firms, health experts have said.

Ministerial inaction on ill-health caused by bad diet, alcohol and smoking is so serious that the NHS could collapse as a result of conditions such as heart disease and diabetes, they warn.

 The NHS could collapse as the result of government not doing what these people want, could it? Actually collapse? Who are they anyway? 

The charge against ministers has been made by Sarah Woolnough and Jennifer Dixon, the chief executives of the influential King’s Fund and Health Foundation thinktanks.

 The King's Fund exists solely to pressure governments to pour more money down the bottomless pit of the NHS, as far as I can see. It never used to get involved in campaigning for illiberal lifestyle regulation, but it is now run by Sarah Woolnough who turned Cancer Research UK into a lobbying outfit, so that is sadly changing.   

"There is a long history of lobbying from the food, alcohol and tobacco industries weakening and delaying measures that would improve people’s health."

 It's a shame they're not as effective as the single-issue pressure groups that work night and day (or rather 9 to 5, except weekends and bank holidays) trying to relieve consumers of their freedom. 

They have said Labour are repeating the mistakes of previous governments by letting “vested interests” wield too much influence and water down planned policies.

 Plain packaging? The sugar tax? Banning disposable vapes? Which of these was "watered down"? Banning supermarkets from putting tasty food at the end of aisles? Banning everyone born after 2008 from ever buying cigarettes, cigars or Rizla? Where is the evidence of industries wielding too much influence when these were announced?    

“And once again long-promised restrictions on junk food advertising have been delayed while Labour’s proposals to extend smoking restrictions to outdoor areas of pubs and restaurants were squashed,” Woolnough and Dixon say in a joint blog.

 The "junk food" advertising ban has been delayed by three months because the legislation was so badly written it would have prevented McDonalds from advertising salads. It will now take effect in January 2026, but the industry has voluntarily agreed to stop advertising HFSS food in October anyway. Is that going to make the NHS collapse? 

“Minimum unit pricing for alcohol – successfully implemented in Scotland ..."

 

 – and a Clean Air Act, regularly promised by Labour in opposition, have both failed to materialise.”

 I don't think the latter has anything to so with "the food, alcohol and tobacco industries" while the former had more to do with Westminster politicians looking at the alcohol-specific death rate in Scotland and concluding that minimum pricing is a policy they can do without. 

Woolnough and Dixon single out the health secretary Wes Streeting’s threat to food firms in February 2024 that he would use a “steamroller” to force them to reformulate their products by putting less fat, salt and sugar in them. He has not acted on that pledge while in office, though, and instead published weaker plans intended to promote the take-up of more nutritious food.

 He's going to literally fine supermarkets if they don't sell people less sugar, salt and fat. Are you lot never satisfied? The answer, of course, is that they are not. They also want a ban on alcohol advertising (which wouldn't work). That, combined with an outdoor smoking ban, will supposedly be enough to stop the NHS collapsing. It's bollocks, obviously. Neither policy will have any measurable effect on the NHS workload and it is impossible for something that receives £200 billion a year to "collapse". What we need is for someone to deal with the NHS's horrendous productivity problem, but that would require a bit of effort rather than a finger-wagging blog post. Even if the government capitulated to this wish-list, the King's Fund and the rest of the nanny state blob would be back five minutes later with another list of "bold" and "brave" policies to save the NHS from collapse. They will make an unreasonable demand. The government will decide against it but do lots of other things they want. They will then accuse the government of succumbing to industry lobbying and the Guardian will write it up as a story. It's just so boring and predictable now.

The lesson of the last fifteen years is that the amount of screaming the government will be subjected to if it does nothing that 'public health' lobbyists want is identical to amount of screaming it is subjected to if it does most of what they want. They will accuse politicians of being in the pocket of various industries. They will accuse the Health Secretary of being weak. They will claim that the NHS is going to collapse. 

It is the same script regardless. The government gets no thanks for capitulating to them again and again. Their list of demands is endless and their autistic screeching is loud and constant regardless of what any government does. On tobacco and food, in particular, no government in the world has done more to appease these fanatics in the last two decades. It hasn't worked. The obvious lesson is that politicians should stop trying to appease them. The only thing that is likely to make them shut up is a government that makes is clear that it will not be giving into any further demands.

There is a hint in DHSC's response to this latest outburst that Streeting is losing patience with these people. 

The Department of Health and Social Care rejected the thinktank bosses’ criticisms. A spokesperson said: “We are legislating to make sure children today can never legally smoke, introducing a ban on high-caffeine energy drinks for children and new rules to make baby food better for families, preventing fast food shops from setting up outside schools, banning junk food adverts targeted at children, introducing supervised toothbrushing to prevent kids teeth from rotting, a Healthy Food Standard to make the healthy choice the easy choice, and investing an extra £200m in the public health grant after years of cuts.”

 "Yeah, but apart from that, what has the government ever done for us?"  
 

More reasons to doubt the official data on the illicit tobacco trade

I have written before about why HMRC's estimates of illicit tobacco sales are demonstrably wrong and greatly underestimate the size of the market. Aside from their figures being a mathematical impossibility and defying the evidence of one's eyes, there is a further reason to be suspicious of HMRC's claims.

HMRC reckons the manufactured cigarettes sold illegally in 2023/24 would be worth £800 million if sold at the normal retail price. But HMRC also tells us that cigarettes worth £697 million were seized by the authorities in 2023/24. 

If true, this means that the authorities are seizing nearly half (46%) of the cigarettes that are entering Britain before they can be sold. Who knew the British state could be so effective? It is much less effective at seizing cocaine (19%) or cannabis (26%) for example. If the figures are right, it isn't very good at tackling rolling tobacco either, having got hold of only £42 million's worth of it in 2023/24, a mere 2% of the supposed total.  

It doesn't pass the smell test, does it? The overwhelmingly more likely explanation fits with what anybody can see if they have their eyes open: the streets are awash with illicit whites and the authorities are - as ever - only intercepting a small fraction of it.  

Anti-capitalism and public health

A new IEA report from me - read it here.

And an article about it, also by me... 

Academics who see disease spreading every time money changes hands tend to take a dim view of the market economy. As anti-corporate rhetoric ballooned into a blanket indictment of capitalism, many of them decided that the solution must lie in overthrowing the existing economic system. They urge the public to regard “neo-liberal capitalism as the fundamental cause of health harms” and call for “a fundamental restructure of the global political and socio- economic system”. During the pandemic, a former WHO advisor hailed China’s draconian COVID lockdowns for curbing economic activity and claimed that “switching off capitalism not only protects us from the virus, it protects us from ourselves.” Richard Horton, editor of The Lancet, has told Socialist Worker that “we need a mass movement of resistance” against “neoliberalism”. A WHO report published last year blamed “deregulated forms of capitalism”, “trade liberalization” and “the promotion of free markets” for poor health, and concluded that “the importance of addressing that political economic system, and rethinking capitalism, cannot be ignored”.

 Read the rest at The Critic . 

 

 

Spiralling down

ASH are agitating for outdoor smoking bans again, this time with a dubious survey - see my Substack.

And the government is looking at copying Scotland and pointlessly dropping the drink-drive limit - see The Critic.

If you're interested in the Lucy Letby case, I've written about that for the Spectator.