We would blame central heating ourselves

Science has discovered a mystery:

It may be the final straw that kicks off intergenerational war. Hard-pressed millennials already resent their parents’ generation for their free university education, generous pensions, higher employment rates and ownership of mansions they bought for £18.50.

Now it turns out baby boomers even had it easier when it came to dieting. A new study has found those consuming a given number of calories were 10% heavier in 2008 than 1971.

The difference, it turns out, is not down to Generation Y spending all its time sat on their well-padded nether regions playing computer games and sexting. Those with the same calorie intake and physical activity levels had an average body mass index 2.3kg/m⁲ higher in 2006 than in 1988. While average food and energy intake around the world has risen in recent decades, research has undermined the notion that weight gain is simply the result of people consuming more calories than they expend.

Well, actually, calorie intake in the UK has declined over that period. But this paper is specifically looking at the US:

Between 1971 and 2008, BMI, total caloric intake and carbohydrate intake increased 10–14%, and fat and protein intake decreased 5–9%. Between 1988 and 2006, frequency of leisure time physical activity increased 47–120%. However, for a given amount of caloric intake, macronutrient intake or leisure time physical activity, the predicted BMI was up to 2.3 kg/m2 higher in 2006 that in 1988 in the mutually adjusted model (P < 0.05).

If that were a British result we would immediately "blame" central heating. Something unusual in 1971 and near universal now. As an American result we're less certain.

Factors other than diet and physical activity may be contributing to the increase in BMI over time. Further research is necessary to identify these factors and to determine the mechanisms through which they affect body weight.

But that is the first thing we would go and look at. Given that we are, in fact, mammals. And that the major use of calories in mammals is the regulation of body temperature?

Rather than, say, blaming the food industry for advertising yummy things to us which we regard as the inevitable outcome of this current approach.

The best part of Britain's health care

This is a slightly strange thing for the Guardian to be trumpeting:

The UK is the best place in the world in which to die, according to a study comparing end-of-life care in 80 countries.

The integration of palliative care into the NHS, a strong hospice movement largely funded by the charitable sector, specialised staff and deep community engagement are among the reasons cited by the Economist Intelligence Unit (EIU).

Not that most of us tend to like thinking about it but yes, death is an inevitable part of any health care system. And here we've got an analysis of the one part of health care where Britain really is the world leader. Which is very interesting, of course it is, to know that we are still, at times, world beaters.

But what's even more interesting is that this one world beating part of the overall health care service is the one part of it not run by the NHS and not financed through taxation: that hospice movement. Which is rather food for thought about how we might look to organise, run and finance other parts of that health care system, isn't it?

Perhaps, even, the original decision to amalgamate all of the private, charitable, municipal health care systems into that tax funded NHS wasn't the quite the right thing to have done even?

So how much should the world's fifth largest economy pay toward drug development?

Depending upon exactly how you want to measure it the UK has around the fifth largest economy in the world. The creation of a new anti-cancer drug is of course a global (or at least rich world) public good. So, how much should that fifth richest society be asked to pay toward the creation of such a public good? Too much apparently:

The health secretary, Jeremy Hunt, has been challenged by a coalition of cancer patients, clinicians and campaigners to effectively tear up the patent on a breast cancer drug that has been dropped from the NHS because of its cost and allow the import or manufacture of a cheap generic copy.

The radical demand is reminiscent of what happened with Aids drugs in the early 2000s. The cocktail of antiretroviral medicines that now keeps millions of people with HIV alive was unaffordable in the developing world until a legal loophole was found enabling generics companies in India to make cheap copies.

The drug, Kadcyla, known generically as T-DM1, will not be available to new patients with advanced breast cancer from November on the NHS, although those already on it will be able to continue getting it.

It has been turned down for NHS use by the National Institute for Health and Care Excellence (Nice). Recently NHS England dropped it from the list that the Cancer Drugs Fund – set up to pay for drugs Nice rejected – is willing to reimburse.

The drug offers some 6 extra months of life to those with a particular form of breast cancer resistant to other treatments.

But here's the really important numbers. It costs some £70,000 for a course of it. It benefits perhaps 1,500 people a year. And the cost of development of a new anti-cancer drug is around and about $1 billion. That is, please do note, the cost of development. That doesn't cover manufacturing costs, marketing, training and the rest. Further, the few drugs that make it out of the development process have to also pay for all the ones that fail within it. Finally, note that this isn't about the profit driven nature of the industry. We can imagine alternative methods: say, governments pay for all drug development and testing. That wouldn't change those numbers: someone, somewhere, still has to pay for those costs.

So, that fifth largest economy in the world is being asked to pay some £100 million a year (recall, that's including all of the training, production, and marketing costs, not just the R&D) towards something that had an R&D cost of $1 billion.

Is that too much? Could be: but it doesn't seem wildly out of order either. The effective life of a patent is really only around 10 years (because of the time it takes to get approval) so it certainly wouldn't be appropriate for that fifth largest global economy to be paying £10 million a year for that global public good. Nor, obviously, £1 billion a year. So while there might be room to argue about this price it really doesn't look wildly disproportionate.

What we've really got here, with this call for the patent to be broken and then we can have puppies for all, is the economic equivalent of baying at the Moon. Because drugs cost a great deal to develop. Therefore, if the drug only benefits a small number of people it will be expensive to administer to each of that small number. It's simply a truism that a $1 billion cost amortised over few people has a high per capita cost. And that doesn't change whatever the financing method used in that development.

Now we've won, let's kill what works!

The victory of Jezzbollah and the Corbynistas appears to be turning politics in a French direction. That is, let's not worry about whether something works of not, let's check that it conforms with theory. And so it is with the various market reforms in the NHS. As Kristian Niemietz points out:

So when Corbyn used his acceptance speech to congratulate the Welsh government for ending the “internal market” in the Welsh NHS, declaring that this is “something we want to do in the rest of Britain”, he was not setting out a new policy stance – he was merely expressing a fait accompli. It was not Corbyn who exorcised the ghost of NHS reforms past. His party did that before he was even nominated. Which is strange, because these reforms were a qualified success story.

Quite so, one of the things in recent years was that NHS England had rather more of that market reform than NHS Scotland or NHS Wales did. Entirely unsurprising to people like us NHS England also did rather better over those years than NHS Wales or NHS Scotland. But for Jezzbollah and fellow travellers markets are inefficient: so they must go, whether they worked or not:

The Scottish and the Welsh NHS are the closest thing to a counterfactual, because they are still more or less run like the old (and, if the Corbynistas get their way, the future) English NHS. Even though they are, in per capita terms, better funded and generally better staffed than their English counterpart, their performance lags on most measures. Rates of mortality amenable to healthcare are higher than in England, waiting times are longer, and hospital infections are more prevalent.

Niemietz has a fuller paper exploring the subject at that link.

It's entirely possible for people to paint our own love of markets as being simply ideological. Enough people do that enough of the time that of course it's possible. But our commitment to them is actually practical. We're entirely happy to admit that there are times when competitive markets are not the solution. We do know our history and that time of competing private armies was called the Wars of the Roses and it's not generally held to be a happy time. But we do support markets when they work.

As they do in the provision of health care to the populace. Those parts of the NHS system that have been flirting with markets provide more and better health care than those that don't. We really do not see this as evidence that markets should be removed from the provision of health care. However French and conformant to theory our politics becomes.

Can we get this straight please? Obesity saves the NHS money

We have the public health crew on the rampage again:

Britain's junk food diet has become the leading cause of death and ill-health, ahead of smoking, according to a study published in The Lancet. The research shows that 40 per cent of NHS resources are spent dealing with ills caused by potentially preventable lifestyle factors such as unhealthy eating habits, obesity, alcohol and smoking.

We might think that since everyone pays for the NHS then everyone gets treated by the NHS. That fit person who survives to get dementia, that fattie that keels over at 40 are all deserving of the same treatment, no?

Overall, researchers found that life expectancy rose by 6.4 years between 1990 and 2013, increasing from 75.9 to 81.3 years.

And obviously something is going right. Leading to the thought that perhaps some of this is that as we don't die of other things these days then lifestyle diseases are all that's left to shuffle us off this mortal coil. But there's a vast mistake in this analysis as well:

Simon Stevens, the head of the NHS, has said the health service could be bankrupted by the strain of weight-related disease if current trends are not reversed. One in five children is obese by the time they leave primary school, and two in three adults are overweight or obese. In June, Mr Stevens said parents and society were doing something “terribly wrong” in how the next generation was being brought up, which would fuel a tide of diseases. He called for a change in the nation’s habits to turn around current trends. “Cutting down on junk food diets, couch potato lifestyles, cigarettes and booze could make Britain one of the healthiest places to live in the world, while saving taxpayers billions on future NHS costs,” Mr Stevens said.

Someone who is the head of the NHS, someone responsible for spending £120 billion or so of our money, really should understand this following point. Fatties, boozers and gaspers save the NHS money, not cost it. We've mentioned this before around here:

The researchers found that from age 20 to 56, obese people racked up the most expensive health costs. But because both the smokers and the obese people died sooner than the healthy group, it cost less to treat them in the long run.

On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.

Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.

The cost of care for obese people was $371,000, and for smokers, about $326,000.

Here is a paper on that very point.

Having us all slim, svelte, sober and pure of lung into our 90s would cost the NHS very much more money than the current level of topers, smokers and lardbuckets does.

There might well be very good reasons to advise people that the private costs of their behaviour, the years of life they will lose through their habits, might well not be worth it. But the public costs of their actions are the other way around from what is being assumed here.

And really, we do think that someone in charge of £120 billion of our money should know the difference between a positive and negative sign in front of an influence upon his budget. That's not, even in this day and age, too much to hope for, is it?

What good news as we face more First World Problems

This will no doubt set off the usual anguished whining among the usual suspects. But we regard this as cheering news, extremely cheering in fact:

Poor diet has emerged as the biggest contributor to early death around the world, according to new analysis from the leading authorities on the global disease, with red meat and sugar-sweetened beverages among the foods implicated in 21% of global deaths.

Smoking cigarettes still carries the highest risk factor of premature death in the UK, followed by high blood pressure and obesity. But the Institute of Health Metrics and Evaluation (IMHE) in the US says that a combination of dietary factors, from eating too few fruit and vegetables, nuts and whole grains to too much sodium and cholesterol, is taking a toll on health in the UK and across the globe.

We do rather doubt much of what we're told by these prodnoses who would control our diet. It was only last week that they were telling us that animal fats would murder us all in our beds and then after decades of saying so they've changed their minds. However, the good news is here:

Sub-Saharan Africa has a different pattern of risks from the rest of the world, with a toxic combination of childhood undernutrition, unsafe water and sanitation, unsafe sex, and alcohol use.

That is, where people are still in that absolute destitution of peasant poverty then people die from simply lack of food and sanitation. Whereas where people are not in that absolute destitution of peasant poverty they live long enough to die of something else. We regard this as an advance in human civilisation, whatever our beliefs about the accuracy of the diagnoses of those First World diseases.

For it's never going to be true that we can solve all the troubles of the world in one fell swoop: but that we do seem to be solving them, one by one, is reason for cheerfulness, no?

The Assisted Dying Bill should not have been euthanised

In light of the failure of the Assisted Dying Bill in the House of Commons today, I can't help but wonder why people are so against the idea of legalising euthanasia. Nobody's forcing you to die, so why should you be able to prevent other people from that choice? Many of the main arguments include having respect for the sanctity of life, a fear that the vulnerable will come under pressure from family or friends to use the service, and suggestions that better palliative care could negate the need for euthanasia. However, while these are all valid arguments, I do not subscribe to the thought that any of these reasons override the principal of autonomy.

The government simply should not be able to tell another individual when they should or should not be allowed to die. The bill itself had a number of pretty solid proposals to prevent any potential abuse of the system, specifically the approval of two doctors and a high court judge. In Oregon, where assisted suicide is legal, about a third of people who were prescribed the drugs necessary then decided not to take them and extend their life, illustrating that people take comfort in just being able to have the choice, although they may not necessarily take it. To take the autonomy argument even further, there are a lot of people who believe the choice to die in a clinic should be available for all people and not just the terminally ill, as we ultimately should own ourselves.

Another reason beyond autonomy as to why this bill should have passed, is compassion for those who are suffering and in pain, or even just having the ability to decide the terms on which you die, surrounded by friends and loved ones. British people are the second most frequent visitors of Dignitas in Switzerland, so there is clearly demand for legal euthanasia within the UK, yet the government's decision today has simply limited the ability of those who are less well off to make that decision. A trip to Dignitas can cost between €4,000 and €7,000, not including the cost of flights and accommodation for family members. That's something many people in the UK are not financially able to do; the legalisation of euthanasia in the UK would have made this fundamentally humane practice more accessible for people of all income levels.

Although it is estimated 1 in 5 people allow family circumstances to influence their decision, there is no reason why a person should not be allowed in their own right to not want to burden their family. Scott Alexander found that euthanasia does not disproportionately affect the elderly and that 99.8% of Dutch euthanisations were in cases where the pain was said to be “unbearable”, clearly showing that family pressure is not a primary reason behind euthanasia. The court and doctor checks suggested by the UK bill were part of a process to ensure external pressure is therefore not a reason behind the patient's decision. In addition, instances where euthanasia has been permitted for psychological reasons rather than terminal illness are minimal, with one case Belgium being the exception to this rule.

The percentage of deaths in Oregon caused by euthanasia last year was only 0.3%. The bill that failed today was not an act to encourage suicide or make it 'the norm', as it clearly is not in Oregon, but a logical and compassionate way to extend the freedoms of people in the UK. The government regulates enough already, the wishes of a terminally ill person should be one area free from their interference.

Another societal mass delusion, this time about sugar

Yes, yes, we know, we're all becoming gross lardybums because Big Food insists on feeding us masses of sugar. And there should be regulation, banning, taxation, anything, to save us from exploding as we gain ever more weight and fat as we gorge. We know this must be true because the nation's favourite cheeky chappie, Jamie Oliver, is telling us so:

If anything, Oliver’s proposed 20% tax on sugary drinks is a pretty modest gesture (it’s hardly the end of pudding as we know it – he’s not asking for anything to be banned), but still it attracts the frothing rage of libertarians and the resistance of industry lobbyists. Oliver’s been there before, of course. But the extra twist is that this row increasingly pits parents against everyone else.

The argument for taxing or otherwise regulating the white stuff is almost always framed as saving the kiddies from an untimely death (Oliver says he was inspired by seeing his own four bombarded with fizzy-drink ads while watching telly). But what separates this war on Big Sugar from his school dinners project, or even from sin taxes on age-restricted products like booze and fags, is that there’s no way of weaning children off sugar without also affecting adult diets. And many grown-ups respond to that with all the fury of toddlers denied a biscuit.

Yet the real problem here is that absolutely none of this diagnosis is actually true. we're not eating more than our forefathers did, we're not even eating more sugar than our forefathers did. We are, in fact, consuming less of both than our ancestors did, even that we did ourselves only a few years ago. As Chris Snowdon has pointed out:

All the evidence indicates that per capita consumption of sugar, salt, fat and calories has been falling in Britain for decades. Per capita sugar consumption has fallen by 16 per cent since 1992 and per capita calorie consumption has fallen by 21 per cent since 1974.

If calories consumed have been falling then it cannot be a rise in calories consumed that is making us all lardybuckets. If sugar consumption is down if cannot be sugar consumption which is making us all grossly fat. It must, obviously, be something else. That something else being that calories expended has fallen faster than calories consumed. Perhaps the largest influence on this has been the general introduction of full on central heating in recent decades. After all, we are mammals and the major energy use in mammals is the regulation of body temperatures.

One more little factoid on this: the current average UK diet has fewer calories than the minimum acceptable diet under WWII rationing. Quite seriously: we are gaining weight on fewer calories than our grandparents lost weight on.

And thus as a society we find ourselves in one of those madness and delusions of crowds events. These are not restricted to markets gone haywire, like the idea that American house prices could only ever rise, or that tech stocks could be day traded to a fortune. They can be rather more societal in nature: think witch burning or the much more recent Satanic abuse mythology. And we are now in the middle of another one about sugar.

It simply isn't true that we are eating more of it, nor that we are consuming more calories in general. Thus the solution to our generally getting fatter just isn't related to our consuming more of what we don't in fact consume more of.

So that's the end of minimum pricing on booze then

Ever since the idea was first put forward we, along with others, have been saying that minimum pricing for booze would fall afoul of the law. And we were right:

Nicola Sturgeon’s plans to fix a minimum price for alcohol has suffered a huge blow after the European court’s top lawyer ruled it would infringe EU law on free trade.

In a formal opinion on Sturgeon’s flagship policy, the advocate general to the European court of justice, Yves Bot, has said fixing a legal price for all alcoholic drinks could only be justified to protect public health if no other mechanism, such as tax increases, could be found.

Bot’s opinion is expected to mean a final defeat for the Scottish government’s efforts to be the first in Europe to introduce minimum pricing – supported by leading figures in the medical profession and the police, after several years of legal battles.

Over and above the obvious illegality of the proposal the thing we couldn't get our heads around was the mind gargling stupidity of the idea. We don't accept the idea that boozers don't cover their costs currently but imagine, for a moment, that we do. Why, as a solution, would you boost the profit margins of producers with a minimum price rather than raise the prices with more taxation? We have not been able to find anyone who can explain this to us.

All we're left with is the rather uncharitable opinion that some people wanted nice jobs as campaigners but wanted to make sure that they campaigned for something silly that quite obviously would never happen. Nothing, other than sheer raging stupidity, makes sense as an explanation to us.

Good grief, this is ridiculous

We're not sure that people understand what they're letting themselves in for here:

The vast majority of people believe alcohol abusers should pay for their own treatment rather than get it free on the NHS, a survey has found. More than half said the NHS should not fund treatment if the illness was a consequence of smoking and patients should be forced to pay for it themselves. The report questioned 4,000 UK adults about the cost of common procedures in the UK and whether it should be publicly funded.

Boozers, smokers and fatties save the NHS money: the costs of treating these various diseases unto death are lower than the lifetime costs of treating people who succumb to other diseases or even just old age. So the basic concept is wrong in itself.

However, there's another problem here. Which is that the health establishment, or at least the majority of the public health bit of it, is convinced that all diseases are caused by someone "doing something". In fact, if you tot up all the numbers, the people who have got cancer, or diabetes, or heart disease, from sugar, salt, smoking, boozing and donuts you end up with more people than there are people actually ill.

Meaning that if this principle were taken seriously, that you don't get NHS treatment for something you've done to yourself, there would be no free NHS treatment at all. Which would be fine for the bureaucracy of course, nirvana in fact: £120 billion a year without having to do anything. But it's not really the point of having an NHS, is it?