Vishal Wilde 14/01/2015 Vishal Wilde 14/01/2015

Farage, ‘improper’ English and his inimical proposal

Attacking people who “cannot speak English properly” with suggestions of unemployment is just the tip of the iceberg of inimical and inhumane anti-foreign and anti-immigrant policies that threaten to lead Britain into socioeconomic retrogression. Farage also claims that “middle management” would be his target in making cuts in the NHS and, though this aspect is justified and welcome, the fact that it’s accompanied by the aforementioned divisive rhetoric reveals the discriminatory sentiment and true roots of his policy suggestions. Of course, this proposal would only affect the NHS but the danger is that when such sentiments are formally empowered in elections, it will inevitably lead to similar regulations being extended to other spheres and, therefore, also inhibit the private sector’s ability to recruit talented individuals. The Entrepreneurs Network released a report showing how we are already failing international graduate students and, therefore, British businesses: “Although nearly half, 42%, of international students intend to start up their own business following graduation, only 33% of these students, or 14% of the total, want to do so in the UK” – current immigration policy is already unfavourable toward beneficial, legal migration.

Mukand (2012) found that “the globalization of labour could dwarf those from foreign aid or even the liberalization of trade and capital flows. For example, a decision by developed countries to liberalize immigration restrictions by a mere 3% could result in an estimated output gain of more than $150 billion”; simply put, the proposed policy road UKIP is signalling with its anti-immigrant, anti-multicultural and xenophobic rhetoric is poor Economics that will, undoubtedly, make Britain poorer.

The attraction for many Europeans to come here, instead of elsewhere, is to learn English; the best way to learn a foreign language is to speak it and live where it is spoken. A major reason why India has been particularly successful in exporting services is the workforce’s inherent, multilingual capabilities. The only way Britain will be able to compete effectively, develop and exporting more is to have more multilingual people and this will inevitably require native speakers of foreign languages. A hostile environment toward bilingual and multilingual peoples will exacerbate the pre-existing shortage in both the private and public sector (the military, for example, is facing a particularly acute shortage). Furthermore, if people are discouraged from coming to Britain in the first place, it will significantly diminish our cultural capital.

Finally, don’t make the mistake of thinking that the upcoming UK elections are only really relevant for Britain. Just because our economy and our armed forces make up a far smaller proportion of world output and military strength than they did previously does not change the fact that this election’s outcome will have profound, global implications. The whole world is watching closely, as was the case with Scotland’s independence referendum.

Though both Britain and the USA are doing comparatively well (growth, unemployment and all that), Britain has the added attraction of having a welfare state that Europeans (amongst others) love and, therefore, this means that many look here. The increase in migration (both perceived and actual) reflects Britain having fared better (probably also contributed to it having done better) and, thus, people the world over look to British public policy; hence, as the voting public, we have essentially been called upon to be global leaders and good leaders lead by example.

Farage has carefully exploited anti-foreigner rhetoric and UKIP is our (albeit more civilised and less extremist) version of the extremist parties that have gained popularity during these hard times. When we vote anti-foreign, it will encourage those who look to us to reciprocate. Subsequently, trade restrictions and currency wars will intensify alongside a myriad of other protectionist policies and international hostilities (all of which happened in the run-up to WWII). We need to think carefully about the examples we set and the rhetoric we reward and, what's equally as important, the rhetoric we keep quiet about.

Tim Worstall 10/01/2015 Tim Worstall 10/01/2015

The joys of food rationing, the perils of obesity

Yes, we've again got someone telling us how lovely it was that the government decided what we could all eat:

Yet by most measures, food rationing was a good thing. The startling truth about this 75th anniversary of national privation is, that, as Driver insists, “for three prime reasons – scientific knowledge, efficient administration, and a newly discovered national sense of equity – Britain as a whole was more healthily fed during the 1940s than ever before (or since, some might add).” He published these prophetic words in 1983, when our current national obesity plague was just puppy fat. There is universal agreement that Britain was better nourished after the imposition of rationing than before it; last year we discovered that obesity is responsible for more than 12,000 cases of cancer every year.

What joy that the prodnoses should salivate over us all being told what to ingest, eh? Except, except, no one ever quite manages to grasp the point made by Chris Snowdon:

I have picked 1948 as a reference point here because it falls in a period covered by a British Medical Journal study that I briefly mentioned in The Fat Lie. Published in 1953, the study looked at calorie intake and weight changes amongst the British population during the years of rationing. It shows not only how much people were eating, but how much they needed to eat.

Comparison of the relation between the food-consumption levels and the body weight changes recorded in this paper and the calorie value of total supplies of food moving into civilian consumption (Ministry of Food, 1949, 1951a) shows that during 1944, when the calorie value of the total food supply was just over 3,000 per head per day, adult men and women gained weight; that during 1945, when the calorie value was over 2,900, weight was roughly constant; that during 1946 and the early part of 1947, when the calorie level fell below 2,900 and dissatisfaction over the food supply was voiced publicly, adults lost weight. In 1948, when the calorie level had again risen above 2,900, the trend of 1946 and 1947 was reversed.

The authors concluded that the government of the day's advice that an average British adult should consume 2,800 calories a day was 'probably too low'. They suggested that 2,900 calories a day was closer to what was needed to maintain a healthy weight. This was based on empirical data that showed that people tended to lose weight if they consumed less than that.

By contrast, today the government advises the average Briton to consume 2,250 calories a day to maintain a healthy weight. A diet that would be considered as the bare minimum, or even below the minimum, in the 1940s would be enough to make most modern Britons gain weight.

On average we all consume very much fewer calories than we did when rationing was in place. Thus it's not an increase in calorie consumption that is causing the rise in obesity. It just simply isn't. Indeed, if we all returned to that wartime diet we'd all gain substantial amounts of weight.

The entire thrust of bien pensant opinion (and not for the first time) is thus simply wrong. We might well consume too many calories for our current lifestyles but we don't consume more than we used to.

Kate Andrews 09/01/2015 Kate Andrews 09/01/2015

Hinchingbrooke Hospital isn't an example of bad privatisation; just an example of bad business

The first private healthcare provider to take over an NHS hospital just over three years ago is pulling out of its contract today, claiming it is “‘no longer sustainable under current terms’ because of rising demand and falling funding.” You can picture the foam forming around the mouths of hungry public-sector supporters and Burnhamites; in this ultimate battle to keep UK healthcare not only free at the point of use, but in public sector control, they’ve been craving a golden piece of evidence against the private-sector.

But Circle's contract termination isn't quite that.

Circle’s involvement with Hinchingbrooke Hospital is far from a traditional private sector model. Hinchingbrooke did not become a private hospital, but rather a privately managed hospital, that was still under the jurisdiction of NHS bureaucracy and, more importantly, dependent on public funds for its operations. Furthermore, there was nothing particularly competitive about the market, and while Circle did have an incentive to make some profit if it made a surplus, not much of its own money was at risk.

Circle’s contract with the government dictated that the hospital would be supported with public funds, give or take up to £5m worth of payments from Circle if public funds weren’t sufficient to provide necessary support for Hinchingbrooke.

Within a few years of taking over Hinchingbrooke Hospital, Circle Holdings took a failing hospital that “consistently ranked near the bottom of the 46 trusts for waiting times” – and that would have been shut down if it hadn’t been sold – and turned it into “one of the highest (ranked hospitals) for patient happiness”. Circle also corrected waiting time failures, leading the hospital to “(top) the list for short waiting times, seeing 98.2 per cent of patients within the required window”.

From ASI Fellow, Tim Evans:

Circle massively improved this hospital and the government should now do two things – 1. Recognise what a good job they have done and re-negotiate the contract to keep them on board - barring another company taking it over. 2. The government should announce that is wants more - not less - private and employee ownership of hospitals, clinics and other care facilities.

It is definitely the case that Circle brought to the table a much better management system and improved healthcare significantly for the hospital's patients. But these triumphs for both the hospital and its patients didn’t necessarily reflect a sensible business strategy. In fact, choosing to muddy the waters between public and private care under NHS supervision was a risky decision indeed.

From the ASI’s Dr Eamonn Butler:

I was very surprised that any private firm took on an NHS hospital. I spoke to private providers throughout the 90s and they all rejected the idea. An existing hospital comes with current buildings, equipment, procedures, personnel and above all culture. In schools a new head teacher can turn around a school, though there will be a lot of redundancies and redeployments along the way. In the NHS that is even more unthinkable, given the strength of the employee unions, including the doctors' trade unions, and the ease with which any changes can be dramatised as 'cuts'.

“Hinchingbrooke’s funding has been cut 10.1pc this financial year”, and having already spent £4.84m of the required £5m of its own funds, Circle claims it can no longer run the hospital in a successful, effective way.

It's always a bit risky to critique a Nobel Laureate but here goes....

There's no doubt that the work of Amartya Sen has enriched the human race. His studies of famine, as an example, have led to a general realisation that in the modern era they're not a result of insufficient food, they're a result of insufficient ability to purchase food that is extant (or to attract food from outside the area to the one of earth). The solution is therefore not to ship corn or wheat, but to ship money and simply give it to people. That this idea has so penetrated even the US government sufficiently that both the Bush and Obama Administrations have attempted to change the method of US famine relief in the face of the usual vested interests is evidence of quite how powerful the point is. However, this does not mean that Professor Sen is correct in all things. And this piece on universal health care shows us this:

The usual reason given for not attempting to provide universal healthcare in a country is poverty. The United States, which can certainly afford to provide healthcare at quite a high level for all Americans, is exceptional in terms of the popularity of the view that any kind of public establishment of universal healthcare must somehow involve unacceptable intrusions into private life. There is considerable political complexity in the resistance to UHC in the US, often led by medical business and fed by ideologues who want “the government to be out of our lives”, and also in the systematic cultivation of a deep suspicion of any kind of national health service, as is standard in Europe (“socialised medicine” is now a term of horror in the US).

The problem with this is that the US does have universal health care. What it does not have is universal health care insurance. And that's a vital distinction. We do not think that the US health care financing system is something that anyone should really be desiring to imitate. We most certainly don't suggest that the NHS, or any other of the European health care systems, should be rebuilt upon the American model. But it is the financing of the system, not the actual treatment, health care delivery, system that is the undesirable thing to copy.

Rock up to any emergency room in the US and you will be treated regardless of capacity to pay. Every county runs a health care system for the indigent and those otherwise unable to pay. Medicaid provides treatment to the poor. Everyone, but everyone, in the US has access to medical treatment. What they do not have access to is treatment without the possibility of having to pay for it out of pocket: and pay for it after the treatment has been given of course.

The importance of this distinction is that Sen is discussing how other countries, ones which don't in fact have universal health care, might move to having such. Great, excellent, a subject well worth discussing. It's also true that we wouldn't go around recommending the US system to those poor countries which currently don't have universal healthcare. But if we don't distinguish between healthcare and the method of financing access to it then we're going to get horribly confused as we try to design the appropriate systems.

Tim Worstall 04/01/2015 Tim Worstall 04/01/2015

Johann Hari is back and he's actually saying something sensible

But while Johann Hari is back and he is saying something sensible he's not, as so often, actually saying anything original. He's back with a book about drugs and the War on Drugs. This is not even remotely true:

Hari’s book turns out to be a page-turner, full of astonishing revelations. I had no idea that the war on drugs was single-handedly invented by a racist ex-prohibition agent, who needed to find a new problem big enough to protect his departmental budget. One of the first victims of his ambition was Billie Holiday, whose heroin addiction enraged him to the point where he hounded her to death. After he’d had the singer jailed for drugs, she was stripped of her performing licence, and as she unravelled into destitution and despair, his agents continued to harass her, even summoning a grand jury to indict her as she lay dying under police guard in a hospital bed.

That specific harrying of Billie Holiday might be, we don't know, but that's not the start of the War on Drugs by any means at all. As Chris Snowden has explained at book length the attempts to fight a War on Drugs begin long before Billie Holliday was being harrassed. Back to neat the turn into the Twentieth Century in fact.

However, this is true:

But something didn’t add up. “Every day, all over the world, hospital patients are given medical heroin, diamorphine, very often for long periods. And virtually none of them afterwards goes out and tries to score on the street. Which made me think, the issue here can’t just be the drug.”

Hari went to Vancouver to meet a psychology professor, Bruce Alexander, who had been similarly puzzled, so had replicated the original experiments. This time, instead of experimenting on solitary rats locked in empty cages, he offered the choice of clean or drugged water to rats kept in what he called Rat Park, a kind of rat heaven full of wheels and coloured balls and delicious food, and other rats to play and mate with. When these rats tried heroin, they weren’t very interested.

“They just didn’t like it. None of them overdosed. Even more strikingly, he then took rats that had become addicted in the isolated cages, and put them into Rat Park. And they almost immediately stopped using. What Alexander had found is that we’ve fundamentally misunderstood what addiction is. It isn’t a moral failing. It isn’t a disease. Addiction is an adaptation to your environment. It’s not you; it’s the cage you live in.”

It's not, however, remotely original. Much the same has been pointed out by Stanton Peele for some 40 years now. Most notably in pointing out that the vast majority of those American troops who used heroin in Vietnam came home and simply stopped using it, as various official reports have pointed out.

We'll have to wait for the book itself to see whether he properly attributes his sources, eh?

Tim Worstall 03/01/2015 Tim Worstall 03/01/2015

Lord Save Us from doctors making public policy

There's an old bon mot about preferring to be ruled by the first two thousand people in the Boston telephone book than the combined faculty of Harvard, experts that they are in their subjects. And so it is when we've got doctors trying to tell us what public policy should be rather than their sticking to their knitting and trying to treat the diseases that we become prey to:

Cancer is the best way to die because it gives people the chance to come to terms with their own mortality, the former editor of the British Medical Journal has claimed.

Dr Richard Smith, an honorary professor at the University of Warwick, said that a protracted death allowed time to say goodbye to loved ones, listen to favourite pieces or music or poetry and leave final messages.

He claimed that any pain of dying could be made bearable through ‘love, morphine, and whisky.’

Writing in a blog for the BMJ, Dr Smith admitted that his view was 'romantic', but said charities should stop spending billions trying to find a cure for the disease because it was clearly the best option for an ageing population.

It's entirely possible that going out on a wave of whisky and heroin (not a combination we would recommend if you're not planning on going out just yet and yes, gin is worse than whisky in this regard, off what ~~libertines~~ liberals like us know about) having said goodbye and enjoyed those last days is indeed the "best" way to go.

But we're afraid that it's still an insane thing for anyone to say that we should not try to cure cancer. The mistake is akin to that made by so many of the slower thinkers about market interactions. Sure, if there's only one single market interaction then as game theory tells us the incentive is to rip off the other party. But most market interactions are not one off transactions, they're simply a part of a number of iterations of the same transaction. In which case the incentive is to cooperate to mutual advantage.

Looking to cancer the assumption being made is that OK, once suffered from one should simply fold one's tent and steal away into that long dark night. Which is to entirely ignore the fact that as cancer treatments get better it's possible to have a series of iterations. That first, that skin cancer, say is treated and two decades later the luck of the draw brings on, say, colon cancer which may or may not be treatable. The whisky and heroin option taken at that first iteration would then have robbed one of that 20 years of life.

It's entirely possible that cancer is that "good death" but surviving one or two brushes with it before succumbing would be even better. So no, while we might well take a doctor's advice on how to treat a cancer we shouldn't be taking same on whether to investigate treatments or not. To do so would be to succumb to the views of the experts, something that pulling names randomly from the phone book would avoid.

Tim Worstall 29/12/2014 Tim Worstall 29/12/2014

The doctors are on the rampage again

We've a letter in the BMJ signed by some thousands of doctors over plain packaging of cigarettes:

The government is heading for an explosive new year showdown with doctors who fear it is in danger of giving cigarette companies a late Christmas present by pulling out of a major anti-tobacco initiative.

Nearly 4,000 health professionals, including the presidents of many of the leading royal colleges, have signed an open letter to the prime minister and the health secretary, published on Sunday on the British Medical Journal website, expressing alarm that plans to force cigarette manufacturers to sell their products in plain packs may not be introduced before the general election, as had been expected.

The number of doctors signing the letter – 3,728 – is five times greater than the number who recently signed an open letter supporting a ban on smoking in cars, a health initiative the government has confirmed it will introduce. The thousands of signatories underscore the strength of feeling about the issue within the medical community.

We've indicated here before our suspicion of the emergency with which this particular question is being addressed. The government says that it must follow EU rules about consultation, the doctors are saying damn that and do it now. But why now? Our suspicion is that they want it enacted into law before the evidence that it doesn't actually work becomes more widely appreciated:

Australian Bureau of Statistics' data show that there has been a secular decline in the chain volume of tobacco sales since the 1970s, but this began to go into reverse in the first year of plain packaging (see graph below). In three out four quarters in 2013, sales were higher than they had been in the last quarter before plain packaging was implemented. This unusual rise in tobacco sales only came to end in December 2013 when a large tax rise on tobacco (of 12.5 per cent) was implemented, thereby leading to a fall in the following quarter.

Screaming that we've a major problem that requires action is sometimes valid. Whether you think that plain packaging is such is up to you. But it does boggle the mind that so much effort is being given to the implementation of a policy that doesn't actually achieve its predicted result. It's rather like the similar public health campaign for minimum alcohol prices. They seem to have got the bit between their teeth and thus be completely incapable of seeing that they're proposing something that is just a terribly stupid way to try and achieve that stated goal.

What really worries here is that we're really quite sure that you've got to be reasonably bright to train as a doctor. So why is it that when it comes to these public health campaigns they all seem to have left their brains at home?

Tim Worstall 06/12/2014 Tim Worstall 06/12/2014

The latest argument for paid kidney donation

Apparently people receiving kidney transplants sometimes have to put up with pretty much any old dog end:

Almost 300 patients have been given kidneys previously turned down by other hospitals, with the majority not having been informed.

One in 11 kidneys transplanted from dead donors recently were used after at least three other units rejected them, official figures showed.

Doctors said a shortage of donors meant there was a need to use lower-quality “second-hand organs”. Critically ill patients are being forced to choose whether to hold out for a better organ that might never come.

Recipients were, however, not told that the organs had been turned down elsewhere. Patient leaders are calling for improvements to be made to enable patients to make informed choices. Patients are told what is wrong with the organs, but surgeons said it was irrelevant how many others had rejected them.

Kidneys have been offered on a “fast track” scheme after they had been rejected by five hospitals if the donor was brain dead, or three if the donor died after cardiac arrest since 2012.

This is not, to put it mildly, optimal. However, it is a useful illustration of the basic point about kidney transplantation. Which is that, very simply, not enough people die healthy enough to provide the kidneys needed for those who will die without a transplant. This is true whether we use an opt in system, an opt out one, even if we nationalised the cadavers of everyone in the country. We have to supplement that cadaveric supply with live donations.

At which point we'll make our now ritual point. There's only one country in the world with no shortage of kidneys for transplant. There's also only one country that allows direct compensation of live donors (under quite strict government and ethical control, of course). Iran is the only place that manages both. given that this does in fact work, does save lives, it's really something we ought to be doing ourselves. And, given that a transplant is vastly cheaper over time than continued dialysis it would save the NHS substantial sums if we did just bung a live donor £25k or so.

There really are some things that are just too important not to have markets in them.

Eamonn Butler 23/11/2014 Eamonn Butler 23/11/2014

This is not the right time for another pay claim by NHS unions

On Monday, NHS unions plan stoppages 'short of strike action'. It may not feel like it if your hospital treatment has been cancelled or you are lying in a ward with fewer nurses to look after you. The stoppages come after strikes back in October failed to move the government to raise its pay offer for NHS staff. A pay review body recommended a 1% increase for all NHS staff, but the government argues that this is unaffordable and unfair. After all, the 3% 'increment' rise puts more money into the hands of higher-paid NHS workers than lower-paid ones.And some 55% of NHS staff already get an annual 3% rise: so the government is saying that any extra cash for wages should go to the workers who do not get this. So it is proposing a 1% rise for the others, but not an extra 1% on top of the existing 3% increments.

Extending the 1% rise to all NHS workers, says the government, will cost around £300 million. Some 75% of hospitals' budgets is staff costs, so the extra cost that the union proposals would impose on them would mean cutbacks in staff – some 4,000 nurses lost this year, and another 10,000 next year. That could leave hospitals unsafe, risking another Mid-Staffordshire disaster.

Many members of the public would say that NHS staff should count themselves lucky. Average pay in the UK grew just 0.1% last year, and many businesses are hanging on by the skin of their teeth. But NHS pay has been rising since 2012. More than 5,000 nurses were recruited last year, and more midwives too. Public sector pay is generally higher than private sector pay for the same job, even before you count the more secure and higher public sector pensions. Lower paid workers, including those in the NHS, have been helped by the rise in the tax threshold to £10,000. Moreover, the £133 billion NHS budget – some 18% of public spending or over £2,000 per man, woman and child – is ring-fenced, so there is no chance of it falling – unlike the fortunes of most high-street businesses.

And if you want to know how bad things can really get, look at Portugal, which slashed its health budget 17%. Our public finances are not quite in that much of a mess, but things are still tight. The UK has economic growth of 3% but it is still fragile, and there are lots of things that could still spell disaster – a potential crisis in the eurozone, ebola, tension with Russia, you name it. The British government is 1.45trillion in debt, and adding to that debt by another £100 billion a year, despite creaming off 40% of the national income in taxes.

This just is not the right time for another pay claim. And certainly not for another Winter of Discontent (with images of ambulance crews dropping 'non-emergency' cases off in the snow to find their way home). The mind shivers. It is clear the government cannot budge, so why don't we all go back to work and try to get Britain out of this mess?

Tim Worstall 15/11/2014 Tim Worstall 15/11/2014

The Annals of Bad Research; public health edition

A quite delightful misinterpretation of a piece of public health research over at Salon:

States with lower HPV vaccination rates have higher cervical cancer rates Science confirms what we probably could have guessed

Well, no actually, Science would tell us that HPV vaccination rates would have no effect whatsoever on current rates of cervical cancer.

A new study presented at a conference for the American Association for Cancer Research found that states with the lowest rates of human papillomavirus (HPV) vaccination have the highest rates of cervical cancer and deaths from the disease. This is not surprising.

Well, actually, yes it is.

Low rates of HPV vaccination in Southern states have troubled medical professionals for some time.

Ah, yes, all those religious (and possibly even Republican!) Southerners not vaccinating their daughters.

What the paper itself actually says is that those places which have more preventive medicine have more preventive medicine. Vaccines are preventive medicine: as are things like Pap smears which can find potential cancers that can be treated before they become cancers.

But there's absolutely no causal connection at all between high vaccination rates and the subsequent lower cervical cancer rates. As science would tell us.

For cervical cancer takes 10-20 years to develop. And Gardasil, the first HPV vaccine, has only been on the market since 2006. To a reasonable approximation exactly no cases, yet, of cervical cancer have been prevented by the vaccine. It's also true that the likely age group to present with the cancer is women between 35 and 55. Absolutely none of whom will have had the vaccine as it is not offered to those who have already become sexually active (again, to a realistic level the number of those in that age group who were virgins in 2006 is going to be zero or darn close).

The vaccine itself is a wonderful idea and we thoroughly support everyone who will benefit from it getting it (and that includes men too, on the grounds that the tango does take two). However, let's not make up stories about it all. An 8 year old vaccine for a disease that takes 10-20 years to present will have had, as yet, absolutely no effect on the numbers presenting with that disease.

Some might think this not important but come along now, we've got it on good authority that comment is free but facts are sacred.

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