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.

Odoriferous statements

Prime Minister John Key said he didn't think minimum pricing would do much to curb heavy harmful drinking. Jennie Connor is quoted in a press release excoriating Key:

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".

"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". [emphasis added]

When I saw the release [HT: ed.co.nz], something seemed awfully odd about the bolded quote. What's the reference category, fruit juice? What's meant by "relative to other drinks"? So I dug around a bit for the work she's citing.

Connor is almost certainly referring to this Canadian study, which does argue in favour of minimum pricing. But compare their numbers with the bolded quote above.

The estimates indicate that a 10% increase in the minimum price of a given type of [alcoholic] beverage reduced consumption of that type by about 16.1% relative to all other  [alcoholic] 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). The first estimate may overestimate minimum price effects because it incorporates compensatory increases in consumption of all other beverages. The estimate of the effect of across-the-board changes in minimum prices on total consumption will be biased to the extent that the extra structure we imposed on the model is unrealistic.

Connor is citing the results from the own-price study as being the estimate of the effect of the across the board increase.

Doug Sellman, in the same press release, says

"The PM's statements reek of alcohol industry influence."

As for the bouquet emanating from the Connor/Sellman press release...