Bamboozled

Over the past 7 years, Nova Scotia has been at the leading edge of a movement attacking the use of alcohol, under the guise of a public health initiative. Unfortunately, the reports used in this attack are inaccurate at best and deceptive at worst. I have written about some of this in earlier entries. This entry will discuss the most prominent of these reports, and how Nova Scotians have been bamboozled by those responsible.

One of the first broadsides launched against alcohol in Nova Scotia was the 2007 report Changing the Culture of Alcohol Use in Nova Scotia,  produced by the then Department of Health Promotion and Protection. That report appeared on the Department’s website without much advance warning to anyone outside the Department – in my case I got a call about 40 minutes ahead of its release – and was never vetted through any of government’s central agencies or approved by Cabinet, because they never saw it either. I heard afterward that Barry Barnet, the Minister at the time, was the subject of some heat by other Ministers after the fact for not bringing such a policy to his colleagues first to see what they thought of it. While it was the cause of some concern at the time, it now appears mild compared to what followed.

The current cornerstone of the various anti-alcohol reports relied upon by the Public Health lobbyists in Nova Scotia is the infamous 2011 Alcohol Indicators Report. That report emerged in 2013 from what had become the Department of Health and Wellness, but unlike previous reports from that Department in its previous incarnation, thankfully was intercepted before it was broadly circulated. Nevertheless, a number of players in the anti-alcohol community apparently received a draft version and immediately began quoting it. When it made the rounds inside government in 2012, the obvious flaws and outright misstatements it contained caused many reviewers to have issues with it. While it may be no surprise that the NSLC took exception to many of its statements, others in government also were uneasy with its methodology and conclusions.

Those objections resulted in it being sent back to Health with instructions for them to clean it up. Things were quiet for a while, and it never resurfaced prior to the government changing in the fall of 2013. Not long after the new government took over, Jean Laroche of CBC somehow became aware of it and the Department agreed to release it to him in November. How Jean found out about this, I obviously do not know, but it would be interesting to find out. When I became aware of that impending release, I challenged communications staff at Health as to why that would happen since it had been rejected by government previously. I was told that they felt the previous embargo no longer applied given the change in government, and that they intended to release it. Minister Leo Glavine hinted in his comments at the time of Jean’s story appearing that it may have been suppressed initially for political reasons – something that seems highly unlikely with Maureen MacDonald in charge – and that he wanted it out. How he could reach such a conclusion one can only speculate.

The report made a bit of a splash when the CBC story initially ran, but likely most people never noticed it. That’s probably a good thing, considering some of the misleading statements the story contains, like “revenue from selling booze is easily eclipsed by how much is spent on alcohol-related health, hospital and police costs” and that it “shows Nova Scotians drinking more than most Canadians”. In actuality, we are 6th in total volume sold and 8th when that is adjusted for alcoholic strength, as shown in this table. Nova Scotia’s overall consumption per capita is in the lower half of all Canadian jurisdictions, and the volume sold continues to decline each year. The story also states that “Health minister Leo Glavine says there needs to be a cultural shift in how Nova Scotians treat booze”, which probably just means that the Minister had spoken to Dr. Strang and his colleagues at Health prior to speaking with the media. I can’t blame Jean for the story, as he was given the material he cites by the Department, so it is not surprising that he took it as fact.

Now that the report is out in the public domain, the anti-alcohol troops are constantly referring to it. So, let’s take a look at what it says. You might be surprised to find how much of what it contains is simply not true.

If there was ever a report crafted to lead to a conclusion, this is it. The authors used everything in their bag of tricks to present a misleading view of reality. They contend that per capita consumption of alcohol increased over a 20-year period ending in 2010, but don’t mention one important point. If they had used 1989 as their starting year, and not started the calculation at the time of the 1990 economic downturn, when sales slumped, the number would have actually gone down (and has in fact continued its decline in recent years, as the volume of alcohol sold in Nova Scotia has been in constant decline for the last 5 years). They contend that “unrecorded consumption” – duty free sales, home brewing, smuggled booze, etc. – would inflate these numbers even more, ignoring the fact that such has always been so and is not unique to that period. They also raise doubt about the figures used to calculate alcohol strength, but completely ignore light beer and lower-alcohol wine, which is an important segment of the market that has grown over the last two decades. By ignoring the reality that consumption has in fact dropped, they can then blame the ghost increase on the addition of agency stores and private wine stores during the period in question. If that isn’t creating a straw man, I don’t know what is. But it is but one piece of a larger puzzle that seems designed to purposely mislead the reader.

In Canada, there are three sources of national information on alcohol use: the Canadian Community Health Survey (CCHS), the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS), and the Canadian Addiction Survey (CAS) of 2004. CADUMS, sponsored by Health Canada, is conducted annually to assess alcohol and other drug use among Canadians age 15 years and older. It is specific to alcohol and other drugs, unlike the CCHS which covers a broad range of health indicators. CADUMS was launched in 2008 and derived from the 2004 CAS. Taken together, both the CADUMS and the CAS surveys highlight encouraging trends in Nova Scotia, including a decline in hazardous drinking. In fact, the report includes a number of statistical measures showing that alcohol-related harms are in continual decline. But don’t look for that to be highlighted in the report or mentioned by the anti-alcohol forces in Nova Scotia. In virtually every case they dismiss that information in favor of other measures that support a conclusion that things are getting worse.

A report created to reach a predetermined conclusion cannot let good news on this front  stand, given the objective of creating the illusion of a crisis. Therefore, the authors dismiss the CADUMS data and instead endorse the conclusions of the CCHS, which covers a much broader range of issues than just alcohol and drug use, ignoring that it is likely a less credible source when it comes to alcohol alone. This leads to one of the most troubling things about this report. When government departments issue health-related reports that are held up by doctors and Ministers as fact, the general public is inclined to believe them. The real question is why the doctors and public health professionals responsible stand behind what they must surely know is questionable information and misleading conclusions, especially when there is other information available to them that would put those conclusions into serious doubt. It is almost as if they believe the ends justify the means.

The report also weighs in on alcohol use by university students in Nova Scotia. The same pattern of questionable data is found here. Somewhat incredibly, there is no reliable recent data available on this, but the authors wouldn’t let that stop them from drawing some conclusions regardless. Therefore they used data comparing alcohol use among Atlantic-region university students – not Nova Scotia undergraduates alone, but also that from universities in New Brunswick, Newfoundland, and Prince Edward Island – with students from other Canadian regions, found in a survey that was conducted during March and April of 2004. That’s right – 2004, a decade ago. The data is ancient, not specific to Nova Scotia, and hardly relevant to a current study, but no matter – they use it to conclude that today’s Nova Scotia university students drink more than their counterparts. Incidentally, this same flawed conclusion was more recently repeated in a report issued by Students Nova Scotia, based upon this same old data. Such is the danger of this type of report – once issued, it becomes gospel, even if it is misleading. The same holds true regarding several other datasets cited in the report, where they include research done by others as fact without regard to its validity. My own opinion, based admittedly on anecdotal reports, is that I think there may well be a troubling degree of alcohol abuse among a segment of university students, and I find it odd that this obsolete data is all that is available.

The report (and the CBC story) repeats the well-worn statement that “the average age of first alcohol use among Nova Scotia students in grades 7, 9, 10 and 12 was 12.9 years in 2007.” There are two problems with this statement, the first of which is that the internal HPP study that came up with the number ignored the 30% of respondents who do not drink at all by leaving them out of the calculation. That’s a bit like saying 100% of Nova Scotians smoke, by ignoring all the nonsmokers surveyed. If the statement was altered to indicate a qualifier like “Among those who drink alcohol…” then it would be more credible, but that is never reported, despite it being brought to their attention on several occasions. Those responsible should know they are misleading their audience, but they do it anyway.

Meanwhile, CADUMS stated in 2008 an average age of 19.5 years for first alcohol use. The significant difference between that number and the HPP figure ought to be a red flag for the authors, but they ignore it. The NS report claims that “the Student Drug Use Survey age of first onset is likely a more accurate assessment of the current age of first alcohol consumption in Nova Scotia”. Why, though, we do not know since they don’t say why that is. One could say that it is conjecture and not based on evidence. One could also say that the lower number is also much more alarming and thus better for the agenda at hand. There is no acknowledgement of the possibility that the Nova Scotia Student Drug Use Survey could be biased as a result of young people seeking to state a lower age of onset because they feel it challenges social norms or is otherwise what those doing the survey want to hear. Nor does the Student Drug Use Survey provide any context at all for the question – first consumption of alcohol could include a small taste or sip at a religious ceremony, family dinner or holiday celebration. The implication it leads one to believe, though, is that your average 13 year-old is pounding back the booze. Not true.

The report then segues into attempting to quantify the amount of disease caused by alcohol. This is where things really begin to go off the rails. It starts by claiming that alcohol is an intoxicant directly linked to avoidable illness, injury, and death. While perhaps this could be accepted as a true statement on the surface, it is misleading since it is the harmful use of alcohol, and not alcohol consumption itself, which is linked with these things. Most people do not consume alcohol in a harmful manner, so the statement is misleading. Seems to me that we are seeing a pattern here.

The report then goes on to state that “The calculations in this report were made by applying the 2002 Nova Scotia-specific attributable fractions to disease conditions known to be related to alcohol…”, once again using data that is very old to support a conclusion. Not wishing to stop there, the authors compound their error by providing very specific numbers and rates with respect to alcohol-related hospitalizations, deaths, and crime. For example, on page 22 they claim an increase in alcohol-related deaths from 182 in 2002 to 231 in 2008. The precision of these numbers suggests a level of certainty and exactness which in reality does not exist. Nobody can say with any degree of certainty what such a number would be. Here’s the reason why.

To put it simply, most disease conditions that the report associates with alcohol can be contributed to by other risk factors, which creates a challenge in determining actual cause. It is misleading to point to one factor and isolate the number of deaths associated with that alone – because you are implying that the person would not have died if not for that. In the end, determination of the cause(s) of disease is usually not objective, and is instead a judgement call, which introduces a strong potential source of bias. At best, the figures included in the report relating to disease can only be considered notional estimates, not hard numbers, because of this effect. The number is somewhere between zero and “x”. But the result of including specific numbers in the report without qualifying statements is that the public and the media take these figures as fact, without any understanding of how they are derived and the very real limitations behind the numbers. Not surprisingly, the CBC story cited these numbers as fact. It is misleading and irresponsible to present data conveying a high impression of certainty when none exists, and not include the disclaimers which should be tied to these figures. I don’t blame the CBC for that omission. It should have been made much more clear in the report.

The other problem with this approach is highlighting one factor and making it the poster child for these problems. You could do it with any number of things. A similar study could be conducted to determine the death toll caused by cheeseburgers, or ice cream, or going to the beach. In the end, what does it mean? Life does not give you any way out in the end that does not result in dying. Elimination of any of these items does not change that. One could argue on a quality-of-life basis, but people make those choices every day. They do not always choose to do the thing that maximizes their chances of living to 100. The death toll number is meaningless, since the death toll for life is always 100%.

The report also makes a fairly obvious attempt to play down the benefits of moderate alcohol consumption. It states, “Some studies suggest that low levels of alcohol consumption may have specific health benefits for some groups including lowering the risk of coronary heart disease, ischemic stroke, and possibly blood pressure”. In fact, it is far more than a suggestion. Canada’s low risk drinking guidelines (LRDG), adopted by Health Ministers from all provinces and territories, are derived from evidence showing that at certain levels of alcohol consumption the benefits outweigh the risks. The point where the benefits and risks cancel out is the level of zero net risk, which is the basis for the LRDG’s recommended daily and weekly drinking limits. Whatever those benefits may be, this report makes no attempt to quantify them or include them in the analysis.

The report also includes the statement that “No pattern of drinking is without health risk…”, which is both meaningless and alarmist. Anything we do, from barbecuing dinner, crossing the street, taking a shower, or driving to work involves risk. It gets back to the cheeseburger example noted earlier. This statement also contradicts the basis for the low-risk drinking guidelines. I’ll go so far as to say it suggests a zero-consumption or Prohibitionist mindset at work on the part of the authors, all claims to the contrary notwithstanding.

But it then gets even worse. The involvement of alcohol as a cause of social harms is particularly difficult to estimate. It is certainly a contributor in some cases, and nobody can reasonably deny that. But trying to quantify those numbers with any precision in terms of financial cost to society as a whole introduces another entire set of problems. Nevertheless, the report attempts to do just that. It includes such unvalidated (I daresay, absurd) statements as “Police in Nova Scotia estimate that 90.0 percent of their work is related to drugs or alcohol” in an attempt to justify their conclusions. Setting aside for the moment the reality that there has never been any attempt by any society to make this a financially offsetting relationship – alcohol has, of course, been part of human existence for thousands of years, for both good and bad – the issues with this section are serious.

The report attempts to attribute direct and indirect costs to alcohol use in order to come up with a “costs of alcohol” figure, apparently based on a report done by economist Mike Foster for HPP in 2010, which, to my knowledge, has not been published. Any attempt to determine alcohol-related costs again raises the issue of causality – whether or not alcohol is a contributing factor to costs, and to what degree. Again, very precise numbers are provided, indicating a high degree of certainty, but without any discussion of the imprecise and subjective way in which these numbers are derived. Since the report is not available, nobody knows how those numbers were generated. We’re supposed to accept them as fact, and not just educated guesses or outright speculation.

Not only are the avoided costs associated with the health benefits of moderate alcohol consumption apparently not considered, neither are the significant other benefits derived from the alcohol industry in Nova Scotia. The economic benefits derived from the people working in our local breweries, wineries and distilleries, to the tourism revenue generated from our emerging wine region and those who supply it with grapes and other inputs, to those who work in our local bars and restaurants that serve alcohol, rate not a mention. These figures were quantified in an Economic Impact Study sponsored by the NSLC in 2012, and showed the industry as a whole generated $760 million in provincial revenues. It would have been nice of the authors to note this in some manner, but it was ignored.

Sadly, but perhaps not surprisingly, by ignoring all but direct government revenues derived from alcohol, while attributing very specific costs to areas that are not easily quantified, the report not only goes off the rails but then hurtles off the train trestle into the river below. It concludes that in 2006, fiscal revenue to the provincial government (mostly NSLC profits, with some other small tax and fee-related amounts added in) was $224.2 million, while direct social costs from alcohol – medical treatment, policing, corrections, and pretty much anything deemed by the authors to be attributed to the abuse of alcohol – were $242.9 million. Add indirect social costs from alcohol, mostly loss of productivity, estimated at $249.6 million, and the report shows it is an overall loser for the Province. This was where the objections to the cost/benefit analysis were raised at the time as being misleading, since you cannot compare only audited direct financial benefits with both direct and indirect cost estimates, especially when most of those costs are based on assumptions and notional calculations at best. There is also some question as to whether how much of the “loss of productivity” is a cost to the province at all, or if it is mostly an issue for the individual involved. The many issues with its contents and conclusions led to government directing that the report be put on ice until it was fixed. But it was never changed prior to being released to CBC in late 2013, and now the anti-alcohol lobbyists are quoting it as fact in their attempts to, among other things, have HRM pass a restrictive municipal alcohol policy.

Obviously, in my role at the time working for the NSLC, it was my job to raise our concerns with the report. But that doesn’t mean I was trying to deny reality. There are groups within society for whom alcohol is problematic, and efforts need to be made to help those people. The improper use of alcohol by young people, particularly those in university settings, is one that needs attention. I also understand that different reports can provide different results, and that there is no single right answer for a lot of things. But when you trumpet things that you have to know are incorrect or misleading, by issuing a report that lacks any sense of balance or objectivity, that crosses a line. Health & Wellness (and especially the previous HP&P) has for the last several years spent lots of time, effort, and taxpayer money trying to create an illusion of a larger problem. They provide funding to groups who are calling for sweeping changes to the way alcohol is sold and used in Nova Scotia, based upon the largely misleading conclusions found in this and other reports. They are using public money to lobby municipal politicians using very deceptive information. They are calling for significantly higher prices, advertising bans, reduced store hours, fewer outlets, and all sorts of other draconian measures that mimic what they previously did with tobacco. But alcohol is not tobacco, and unless you believe there needs to be a type of quasi-prohibition instituted in Nova Scotia, that is misguided. And that’s the sad thing about this entire exercise.

The 2011 Alcohol Indicators report was obviously produced at considerable expense and effort, and if properly directed it could have been a useful exercise. There are a few nuggets of useful information found in it, and the criticism of it I state should not be taken to conclude that there are no problems with the abuse of alcohol in this province. My criticism is primarily directed at those responsible for the anti-alcohol campaign in Nova Scotia over the last several years, and those who produce reports such as this using public funds. We are not awash in money in this province, and resources should be directed to help those in need of help, not to create issues that are largely an illusion. Public dollars should not, in my opinion, be used to support lobbying efforts by public employees that are at odds with government policy. Nor should those resources be knowingly used to promulgate incorrect, misleading, or outright deceptive conclusions. The fact that public health professionals are behind this is even more troubling. People tend to believe what they hear from such officials at face value. The health officials have to know that much of what they are saying is highly questionable, yet they continue to push an agenda that is at odds with what the public would want, at odds with government policy, and at odds with what the facts would suggest. It suggests a group that is out of control. It is, frankly, unconscionable. The ends do not justify the means. We are being bamboozled, and it needs to stop.

 

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