Feature Alcohol and Public Health

Under the influence: 2. How industry captured the science on minimum unit pricing

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.f7531 (Published 08 January 2014) Cite this as: BMJ 2014;348:f7531
  1. Jonathan Gornall, freelance journalist
  1. 1Colchester, Essex, UK
  1. jgornall{at}mac.com

Jonathan Gornall examines how the alcohol industry has worked to give scientific respectability to its views

When David Cameron unveiled the coalition government’s alcohol strategy in March 2012, the public health community celebrated what seemed to be a cast iron commitment to minimum unit pricing, underwritten by the determination of the prime minister to do “the right thing.”

All that remained was for the government to decide the level at which that minimum price should be set, and this was one of the objectives of the Home Office consultation on the strategy that started at the end of November 2012.

At that moment, the alcohol strategy “seemed like a triumph for health and commonsense,” recalled Professor Mark Bellis, then cochair of the Responsibility Deal Alcohol Network as a representative of the Faculty of Public Health. “People were bolstered—they thought that people were listening, that the evidence that was presented over many years was finally having an impact.”

But the celebration proved premature. The public health community had reckoned without the reach and influence of a drinks industry determined to defend its profits and ready to pull on every one of the many levers of influence at its disposal.

What health campaigners saw as a done deal, the alcohol industry viewed as anything but.

“I think the question that was being asked by the press and by people in the legislature [at that time] was not just about the price, it was about the principle of minimum pricing as well,” Nigel Fairbrass, SABMiller’s head of global communications told me. “I mean, I know the government indicated that it was just a price base question, but a lot of the people we spoke to, inside and outside parliament, were actually debating the principle.”

Role of think tanks

The opening public salvo of a concentrated lobbying offensive with the sole objective of killing off minimum unit pricing was a report published by the Adam Smith Institute on 26 November, two days before the consultation opened.

Such libertarian policy think tanks, for which free market economics are the answer to everything, are the natural allies of industries, such as alcohol and tobacco, that face regulatory pressure as a consequence of the health harms created by their products. The Adam Smith Institute is a self appointed opponent of “big government . . . regulating businesses [and] interfering with lifestyle choices” and has a long record of resisting regulation on behalf of the tobacco industry.

In a report entitled Minimal Evidence for Minimum Pricing, the institute declared that predictions based on the Sheffield alcohol policy model were “entirely speculative and do not deserve the exalted status they have been afforded in the policy debate.”1

The institute declines to identify its donors but insists that it received no money “from any individual, foundation, or business” associated with the alcohol industry.

What’s more, says Sam Bowman, research director at the institute, “If we did receive money from any alcohol industry source, it would have no influence on our policy positions whatsoever; nor does any money we get from any source. We believe in the rights of individuals to make choices for themselves, and alcohol regulation is one of the areas where those rights are threatened.” However, another area in which the institute perceives such rights to be threatened is tobacco regulation, and earlier this year it was revealed that it had received funding from the tobacco industry.2

The alcohol report was coauthored by Christopher Snowdon, a fellow of the institute and the author of various publications arguing that the alcohol and tobacco industries should be protected from regulatory intervention,3 4 5 6 and John Duffy, a statistician whose collaboration with the alcohol industry began in the 1990s. It was a relationship that coincided with the birth of the alcohol industry’s strategy of social responsibility, formulated as a defence against regulatory interference and grown to full effect in Andrew Lansley’s responsibility deal, and it earned Duffy grants from industry sources worth £690 000 (€820 000; $1.1m).

From 1990 to 1996 Duffy’s post as director of statistics at Edinburgh University’s alcohol research group was funded by a £500 000 grant from the industry’s Portman Group,7 a relationship that caused some controversy at the time.8

In 1993, in a paper that made no reference to his funding from the Portman Group, Duffy reviewed the use in alcohol control policy of population mean consumption as a determinant of the proportion of excessive drinkers and the level of alcohol related harms and concluded that “the statistical basis of this work is unsound.”9 It was a prescient piece of work, anticipating one of the alcohol industry’s main arguments against the introduction of minimum unit pricing. In other work during this period, he also challenged prevailing views on the amount of alcohol that should be considered harmful.10

In 1995, Duffy secured a grant of £190 000 from the Alcohol Education and Research Council (box) “for a project on development of standardised indices of alcohol consumption and harm” and he continued to cast doubt on prevailing wisdom in alcohol research. In one paper, he questioned the balance between the harmful and protective effects of alcohol consumption in middle aged men, concluding that “alcohol consumption is a net preventive factor against premature death in this population.”11

Alcohol Education and Research Council

The Alcohol Education and Research Council (AERC) was set up as a registered charity in 1981 by an act of parliament, using money left over from a redundant fund set aside by the industry in the early 20th century to compensate landlords who had lost their licences during a government cull of pubs, carried out “in the hope that this would reduce drunkenness and drunken offences.”

Its role included “the education of the public as to the causes and effects of, and means of preventing, excessive consumption of alcohol” and the development of “the capacity of people and organisations to address alcohol issues and also develop the evidence base linked to alcohol policy.”12

Members of the AERC were appointed by the secretary of state for whichever government department was hosting the organisation at the time—a role that was played variously by the Home Office, Department of Health, and Department for Culture, Media, and Sport. During the 1990s, when Duffy secured his grant, in addition to medical and other non-commercial representatives members of the AERC council included senior management representatives of alcohol organisations such as Fuller Smith and Turner, North British Distillery Company, International Distillers and Vintners UK, the Wine Development Board, and the Scotch Whisky Association’s alcohol research and education committee.

In 2011, the AERC was abolished and its assets and functions were taken over by Alcohol Research UK, a new charity. Whereas the AERC had, “on a couple of occasions,” received small amounts of funding from the Wine and Spirits Trade Association, the Scotch Whisky Association, and the Portman Group, said Dave Roberts, the new charity’s chief executive, there was “absolutely no chance that Alcohol Research UK would accept funds from such bodies today.”

Learning from tobacco

There is evidence that the alcohol industry was formulating a strategy of corporate responsibility to forestall looming regulation as much as 30 years ago. In 1984 a senior executive at Grand Metropolitan, a drinks giant which in 1997 would merge with Guinness to form Diageo, circulated a confidential strategy proposing a solution to seven “threats to the drinks industry.”

“Special interest groups,” he wrote, were “giving increasing voice to the problems of alcohol abuse” and demanding higher taxes, tougher action on drink-driving, restrictions on retail hours, funding for rehabilitation programmes, advertising and marketing restrictions, and health warning and ingredient labels on drinks. The industry, he said, should learn from the example of the tobacco companies, which had “reacted to not dissimilar threats in a passive, inadequate manner and, most of all, late.”

Grand Metropolitan’s position was that “alcohol in moderation is good for the consumer, in excess it is bad. [If] the media concentrate on the second part of this truism at the expense of the first, voters will come to believe that alcohol is bad and the drinks industry irresponsible.”

To avoid this, the executive wrote, the industry should consider either setting up an independent research body or funding a “Department of Alcohol Education within a British university.” In the meantime, the memo highlighted “an increasing enthusiasm for its education role by the [Alcohol Education and Research Council] and Grand Met’s wish to promote the AERC as the authoritative ‘central ground.’”

The author of the 1984 Grand Metropolitan memo was Tim Ambler, who today is one of eight senior fellows of the Adam Smith Institute. Between 1963 and 1991 Ambler, now a retired senior fellow of the marketing faculty at London Business School, worked for Grand Metropolitan and International Distillers and Vintners, which is now part of Diageo. Rising to the role of joint managing director, he was involved with the launch and development of brands including Baileys, Malibu, and Smirnoff vodka.13

Living in retirement in Norfolk, Ambler recalls the strategy memo he wrote but rejects the suggestion that it set the ground rules for the industry’s manipulation of public health policy. “Dead customers ring no tills,” he had written, adding “profit and social responsibility are entirely compatible”—an observation, he recalls, that “caused a bit of a flurry with my colleagues at the time.”

Ambler says he was surprised that the industry later “took such a hard line” against minimum unit pricing—and equally surprised at Cameron’s U turn. In 2011, in his role as an academic with London Business School, he says he had attended a meeting about minimum unit pricing with officials at the Cabinet Office and found “the room was full of people who were frankly prohibitionists. I spoke up a few times to say there was no case for them being rather excessively represented and got rather shouted down . . . At that time it looked like [minimum unit pricing] was definitely going through.”

In fact, the event was a seminar in February 2012 that had been organised by researchers from ALICE RAP, a European Commission financed research project set up to stimulate “a broad and productive debate on science based policy approaches to addictions.” The invitation-only meeting brought together members of the government's “nudge” team—officials from the Cabinet Office, Home Office, Treasury, and Department of Health—to consider some of the specific questions policy makers were facing as they considered options including taxation and minimum pricing. Ambler, who had been invited to speak, argued against a simple association between alcohol consumption and related harm.

The seminar was a “rare example” of the public health movement being granted access to UK policy makers, says Fleur Braddick, communications officer for the ALICE-RAP project, “and we had to be very insistent to organise it.”

As the consultation rolled on, however, it would become clear which side was really benefiting from excessive representation.

Concerted attack

The barrage of pseudoacademic shots from the far right continued. On 28 November Eamonn Butler, the director of the Adam Smith Institute, wrote a blog on the website of the Free Society (which describes itself as “an offshoot of the smokers’ lobby group Forest”), attacking minimum unit pricing as an illiberal policy, “pushed on politicians by pious interest groups who think they know how to run our lives better than we do.” Butler repeated the alcohol industry mantra: that minimum pricing would punish “the many for the sins of the few.”14

Two months later, the Centre for Economics and Business Research joined in, attacking minimum pricing as “a poor piece of policy that will do little to address the damage caused by alcohol misuse and much to exacerbate the financial challenge facing moderate drinkers on lower incomes.” As the report made clear, the work had been commissioned by SABMiller, one of the world’s leading brewers.15

Towards the end of January, just a few days before the end of the consultation, the Wine and Spirit Trade Association launched “Why should responsible drinkers pay more?”—a campaign that claimed to reveal “major public opposition to government’s plans to hike up alcohol prices” and urged members of the public to contact their MPs to voice opposition to minimum unit pricing. A commissioned poll found that most people “believed” that minimum pricing would not work in reducing alcohol harm—a meaningless conclusion reached, of course, without the benefit of the years of research conducted by Sheffield but doubtless of great value when it came to putting the wind up MPs.16

At the same time the Wine and Spirit Trade Association, following SABMiller’s lead, also published research it had commissioned from the Centre for Economics and Business Research, which cast doubt on “the capability of the Sheffield model to properly predict the relationships between alcohol-related harms and alcohol consumption.”17

It was not the first time the centre had joined forces with the drinks industry in an attempt to undermine the credibility of Sheffield’s work. In 2008 it was commissioned by SABMiller “to undertake a wide-ranging economic assessment of the impact of alcohol pricing policies, in particular minimum alcohol pricing.” One result of this brief was the 2009 report Minimum Alcohol Pricing: A Targeted Measure?18

Subsequently, the centre has produced reports for cigarette company Philip Morris, critical of the plans to introduce plain packaging for tobacco products in the UK and predicting up to 30 000 job losses and a loss to the Exchequer of up to £348m.19 20

Science is sidelined

John Holmes, a public health research fellow at the Sheffield Alcohol Research Group, says he has no problem with the industry and its supporters joining the debate. “We’re in a free market economy; they’re a player in that, and if you’re going to regulate the market they should have a say on it.” The frustration felt by him and his colleagues, he says, “is not that they are commenting, but the way they go about it. They are engaging with science but not with the scientific process—peer review, constructive discussion, balanced arguments, debate, critical appraisal of the totality of the evidence—so we’re just responding to the same points over and over again.”

For example, he says, the paper by the Adam Smith Institute comprised two essays and a technical section that was a “rehash” of an earlier critique of Sheffield’s work, commissioned from Duffy by the Scotch Whisky Association as part of its legal battle against the introduction of minimum unit pricing in Scotland. This paper has not been released for public consumption, but it is referred to in the list of documents referenced by the Scottish Whisky Association in its application for a judicial review of the Scottish government’s plan. It is dated October 2012, one month before the Adam Smith report appeared.21

Duffy referred to the statistical advice he had provided to the association in an article he wrote for Significance, a magazine published by the Royal Statistical Society.22

Sheffield, says Holmes, has faced “repetition of the claims and no real acknowledgement that we’ve responded to them and, we feel, have addressed several of their points and shown them to be inaccurate.”

He believes the industry and its mouthpieces are “not particularly interested in . . . engaging in any kind of debate about whether their arguments are accurate. It’s all about creating doubt about what we’re saying.”

Another organisation that has repeatedly mounted defences of the tobacco and alcohol industries is the Institute of Economic Affairs, whose assaults have included accusing the charity Alcohol Concern of using “dodgy surveys, junk science and misleading press releases.”23 24

In August 2013, the institute selected the work carried out on alcohol at Sheffield as a case study to illustrate “flawed ‘evidence-based’ policymaking,” in a report entitled Quack Policy. The author, Jamie Whyte, is a fellow of the Institute of Economic Affairs and also a senior fellow at the Adam Smith Institute.25

Ruth Porter, communications director for the Institute of Economic Affairs, says the organisation does not do “tied commission research for companies” but declined to say if any players in the alcohol industry had donated any part of the £830 000 given to the institute by supporters in 2012.

“We don’t receive government funding and, as I say, we don’t do commission tied research from companies,” she said. “All of our funding comes from voluntary donations and we respect the privacy of those who donate to us, and we don’t give out information about who funds us.”

However, in September this year SABMiller sponsored “Lessons from the recession,” a fringe panel event at the Conservative party conference held by the institute and chaired by Mark Littlewood, the institute’s director general.

That same month, the institute turned to the Free Society and Forest to sponsor “A Beer and a Fag with Farage,” a fringe event at the Conservative party conference in Manchester that played on Conservative fears that Nigel Farage’s UK Independence Party might become a serious contender for right wing Tory votes at the next general election.

The fringe event aside, SABMiller says it has not funded either the Institute for Economic Affairs or the Adam Smith Institute, but it has had a two year relationship with another think tank, Demos, which resulted in two reports on alcohol.

Published in 2011 and 2012, both reports argued that parental influence was the chief cause of harmful drinking, and, at the height of the consultation over minimum unit pricing, gave SABMiller a platform in the House of Commons from which to broadcast its message of corporate social responsibility.

Feeling the Effects was launched in Westminster on 11 December 2012 at an event sponsored by SABMiller and at which the speakers included the MP Andrew Griffiths, chair of the all party parliamentary beer group. The report, the product of “a two-year partnership between Demos and SABMiller which has focused on research into youth binge drinking in the United Kingdom,” concluded that “effective parenting is the best way to call time on Britain’s binge drinking.”26

A previous report by the project, Under the Influence, published in April 2011, was the subject of a seminar held in the House of Commons on 24 January 2012—towards the end of the consultation over minimum unit pricing.

The report was dismissive of the policy, which it said would “undoubtedly also cause some reduction in the frequency of binge drinking episodes among some groups [but] there is little evidence to show it would change the norms surrounding binge-drinking behaviour.” Instead, it recommended that retailers “consider a joint initiative as part of the Public Health Responsibility Deal, which sets a code of conduct for responsible alcohol sales.”27

Ralph Scott, head of editorial at Demos, said the think tank had had “complete editorial independence over the research, authorship, and dissemination of the reports . . . we are transparent about who funds us and which project they have funded. We explicitly publish references to the funders of each report in the inside back cover of all reports, always make this clear on press releases, and list our funders on the website.” It does not, however, “provide information on exact sums due to commercial sensitivity.”

Uneven debate

Public health researchers are at a tactical disadvantage when they go up against the material produced by such organisations, says Holmes.

“We can’t really change the narrative in any way—we don’t have that power—but bodies such as the Adam Smith Institute have this public megaphone which is disproportionate to the scientific merits of what they’re saying.”

There is, he says, an argument for science to adopt a more proactive approach, but the playing field is not a level one: “We publish our paper, and then we go quiet again until we’ve got something new to say. Whereas with lobbyists it’s more of a drip drip process— they’re constantly talking, meeting, putting their side across.”

Health lobbying groups, such as the Institute for Alcohol Studies, “are there to see that evidence is translated into policy, or at least used in policy decision making, and in theory they can engage in the same kind of lobbying. But in reality they don’t have access to the same resources, the same political connections. Even if science did want to do more, there are barriers: we don’t have the same access that industry does.”

With Andrew Lansley’s much derided Lobbying Bill paused in chaos amid accusations that it would not have prevented any of the lobbying scandals of the past few years and that it appears more concerned with hobbling charities and unions than big business,28 there is still no sign of Cameron’s promised lobbying register.29

However, one voluntary register already exists, operated by the Association of Professional Political Consultants, and it shows the extent to which the big players in the alcohol industry rely on political lobbyists to get their messages across: eight political consultancies represent the interests of nine alcohol organisations, including Diageo, Heineken, the Wine and Spirit Trade Association, SABMiller, and Portman Group.30

Such registers, however, can tell only a part of the story.

“We’ve done some work here that involved an interview study of different policy actors, including interviews with alcohol industry actors,31 32 and they were surprisingly forthcoming about what they did,” said Jim McCambridge, senior lecturer in behaviour change at the London School of Hygiene and Tropical Medicine.

“For them, lobbying on an issue by issue basis, trying hard to get a particular policy outcome, is undertaken sometimes, but that is not how lobbying is ordinarily done. It is really about building long term relationships with key policy actors so influence can be exerted in very subtle ways . . . and within these long term relationships what you see is quite astonishing levels of contact.”

An example of this technique in another industry came to light during the Leveson inquiry, when it emerged that during News Corporation’s controversial bid for BSkyB a company lobbyist had been in more than daily contact with a special adviser to Jeremy Hunt, the culture secretary, with the two exchanging hundreds of text messages in 2010 and 2011.33

But that was no one-off blurring of the lines. Equally shocking, as the next instalment of the BMJ’s investigation into the influence of the alcohol industry’s influence over public health policy reveals, is the extent to which the industry has managed to infiltrate parliament and government at the highest levels.

Notes

Cite this as: BMJ 2014;348:f7531

Footnotes

  • doi:10.1136/bmj.f7435
  • doi:10.1136/bmj.f7571
  • doi:10.1136/bmj.f7610
  • doi:10.1136/bmj.f7646
  • The BMJ received funding to conduct this investigation from ALICE RAP—a European research project cofinanced by the European Commission that aims to stimulate a broad and productive debate on science based policy approaches to addition.

  • Competing interests: I have read and understood the BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; externally peer reviewed.

References