The Idiotic Musings of Patrick Luciani on "Fat Taxes" and Obesity

I suppose I need to create a Patrick Luciani blog tag as this is now the third time I've been moved to write about one of his opinion pieces.

Once again he's come out swinging about "fat taxes" suggesting that it's ridiculous to think they'll be the answer to obesity.

I wholeheartedly agree. It is absolutely ridiculous to suggest that "fat taxes" will be the answer to obesity, and nobody other than Luciani is doing so. It's ridiculous because given the complexity Luciani himself ascribes to obesity, there will be no singular intervention that will have a remarkable impact. Complex problems tend not to have simple, singular solutions - it's the, "but that single sandbag won't stop the flood" argument, and truly, that's a breathtakingly stupid argument.

Clearly, the McKinsey Institute, in their report that Luciani cites, understands that single sandbags don't stand a chance, as they promote many sandbags, including soda taxes, in their levee building, obesity fighting, recommendations. Regarding soda taxes specifically, the McKinsey Institute concluded that in the UK alone, soda taxes would save nearly 500,000 disability-adjusted life years (DALYs) at less thane one fifth the cost per DALY when compared with the surgical option that Luciani cites as a presumably sounder choice.

Luciani also waxes on about the regressive nature of a soda tax, but as Andy Bellatti has pointed out, chronic diseases like type 2 diabetes are far more regressive, and really, is it useful or ingenuous to discuss fat taxes as "regressive" when the impact of a 10% soda tax on a person drinking even 1L of the stuff a day would clock in at roughly 8 additional daily cents?

Indeed, a soda tax is just one of many behaviour influencing sandbags, but that said it appears to be a pretty robust looking sandbag - at least in Mexico, but you wouldn't know that from Luciani's screed, because instead of reporting on the actual outcomes of Mexico's newly enacted sugar sweetened beverage tax, he chose instead to opine that by taxing soda the sale of beer in Mexico might rise. Of course had he reported on the actual preliminary Mexican SSB tax results, the data is incredibly positive, whereby in the first four months following the implementation of the tax, there was a 10% decrease in the purchase of sugar sweetened beverages along with a concomitant 13% increase in the purchase of plain water!

Lastly, unlike Luciani, I don't perseverate around obesity as the rationale for discouraging the consumption of sugar sweetened beverages as sodas are no less unhealthy for those without weight than for those with it.

There are genuine worries that Canada's health care system will be unable to cope with the costs of the rising tides of diet and weight related illnesses. Yet when faced with what for example the Canadian Diabetes Association has called, "an economic tsunami", Luciani's only 4 recommendations are for swimming lessons - portion control, parental education, surgery, and weight management programs - interventions that work on a case-by-case basis, and even then, require resources our current medical system simply doesn't possess, and while I'm happy to see those sandbags filled as best we're able, suggesting that they alone will stem the flood is plain idiocy. As that same McKinsey Report that Luciani very clearly cites,

"Education and personal responsibility are critical elements of any program aiming to reduce obesity, but they are not sufficient on their own. Other required interventions rely less on conscious choices by individuals and more on changes to the environment and societal norms. They include reducing default portion sizes, changing marketing practices, and restructuring urban and education environments to facilitate physical activities."

Honestly, I can't fathom Luciani's motivation for sticking to, and recycling, his incredibly, almost unfathomably stupid, guns. Why is anybody's guess. Post-purchase rationalization? Sunk costs? Overt conflict of interest? Or alternatively perhaps it's me and those McKinsey folks who have been drinking some pretty heavy duty Kool-Aid?

(Oh, and please click on Patrick Luciani's post tag down below and you can read more about his various strawmen. Here's hoping he's running out of papers willing to publish them.)

Patrick Luciani's Gigantic Soda-Loving Straw Man Rises to Fight Again

Sigh.

I've written about Mr. Luciani's arguments before. To boil them down to their very essence, he believes that obesity can and should be managed individually. That presumably with appropriate education and encouragement, obesity could be conquered.

This time Mr. Luciani is taking aim at the recent OMA call to action which included among other things, taxing energy dense and nutritionally bereft sugar sweetened beverages and junk food.

Now I'm all for differences of opinion, but what gets to me is when someone who clearly knows better, resorts to straw men, logical fallacy, fear mongering and data cherry picking to make their case.

His most recent piece starts out with these two lines,

"What makes us fat? According to Ontario’s doctors the culprits are junk food and sugary drinks. That’s why last month the Ontario Medical Association issued a list of policy recommendations that would treat junk foods on the same level as poisons."

Really? When I read the position piece by the OMA it was pretty clear to me that the OMA agrees with Mr. Luciani, that obesity is highly complex, but yes, dumbing down the OMA's report into a straw man from the get-go is a good way to bolster a crappy argument. And poisons?  Good grief.

He then stuffs in more straw by starting off his next paragraph with another misinformed and damning nugget,

"As much as the OMA hates to hear it, the causes of obesity are much more complicated than its report dares to admit."

Actually the OMA's all over that. They're not, as Mr. Luciani's now gigantic straw man suggests, hanging their hat on soda and junk food taxes and suggesting sodas and junk food are the simple cause and cure for what ails us, what they're doing is identifying specific interventional targets that may help as part of a much larger fight. Here's the OMA on what they actually think is needed,

"Just as no single intervention has been proven effective against the tobacco epidemic, no one or two isolated approaches to obesity prevention can hope to be effective. Ontario must set an aggressive course, with a comprehensive, multi-pronged suite of policies, in order to meet these challenges — and it must do so immediately."

Next Mr. Luciani cherry picks historian John Komolos (sic - his name is actually John Komlos) and states that according to Dr. Komlos, obesity rates have been rising steadily since the 1920s. Indeed, that's what Dr. Komlos' article concludes, but I can't imagine what it has to do with Mr. Luciani's current argument except to add more straw, especially given Dr. Komlos' own note in that same article (bolding mine),

"Of course, changes in dietary habits including the anchoring of a fast food culture in the social fabric reinforced and greatly exacerbated the trend toward increasing weight."

Moreover Dr. Komlos concludes his paper with this call to arms - one very much akin with the OMA's,

"The finding also implies that policies to attenuate or reverse the trend will have to reach deep into the social fabric and take into consideration that such socio-economic forces generally change at glacial pace."

Now Mr. Luciani launches into the thrust of his argument. That given obesity's incredible complexity, soda and junk food taxes are a useless initiative,

"This is further evidence that blaming junk foods or sugary drinks for the rise in weight over time is too simplistic. In light of those two factors, the OMA’s shame and blame policies don’t have a chance against the myriad causes of obesity."

As I've written before, this argument is the, "that single sandbag over there isn't going to stop the flood" argument; that clearly the complexity of obesity is such that soda and junk food taxes alone are unlikely to make a difference. Of course the OMA knows that which is why it's calling for, "a comprehensive, multi-pronged suite of policies", with soda and junk food taxes being included among them.

But here's his most insane bit of straw. He spends the bulk of his piece building up the argument that obesity's incredibly complex and that consequently simple interventions like taxes can't possibly help, and then he states that the solution despite incredible complexity, are doctors who will help society lose weight simply,

"by monitoring and advising their patients on weight control"

Honestly, the whole piece makes me wonder who Mr. Luciani is working for, as from my perspective, the incredible amount of straw and spin from such a reportedly intelligent man makes me wonder about the integrity of his motives for repeatedly writing such misguided misinformational missives.

Flooding 101: Sandbags Over Swimming Lessons

[Had penned this in response to a commentary published this past weekend in the Globe and Mail. While I'm disappointed the Globe didn't want to publish it to provide balance to an article that I feel inexcusably misinformed their readers, the good news is that I have my own publishing platform.

Before reading my piece, you may want to have a peek at Patrick Luciani's Pop a Few Myths About Obesity]

Pop a Few Myths Perpetuated by Patrick Luciani

It looks like Patrick Luciani has solved the complexity of public policy for all of us by dumbing down the discussion of a novel and harmless approach to decreasing the consumption of soda (the Draconian measure of (gasp) limiting vendors' cup sizes to a half litre but not limiting the number that can be purchased) into a straw man argument that suggests that given a limit on New York City cup sizes won’t in and of itself solve the obesity crisis, that it’s clearly a pointless and ridiculous endeavour.

That was easy! Forget about the fact that when building a levee against a flood pointing out the fact that a single sandbag isn’t going to do the trick is a purposely asinine argument for a flood control policy analyst to make. 

But before we get carried away talking about levees and swimming lessons, let’s dispense with the myths that Mr. Luciani uses to defend the consumption of sugar water as being non-contributory to health woes.

Myth 1: The recent decline in soft drink consumption is laudable

Mr. Luciani presents a 30% decrease in per-capita Canadian soft drink consumption as evidence that there’s no need for intervention. Presenting this data in a vacuum is not only unwise, but also disingenuous. There are many sugared beverages out there and while soft drink consumption may have fallen to a still staggering 82 litres per Canadian per year, presenting the fall positively belies the fact that during the time soda consumption has decreased there has been a tremendous concomitant surge in the consumption of sugar spiked energy drinks and sports drinks. In fact one recent report on global energy drink sales states that the average growth rate has been 10 percent per year for each of the past five years.

Myth 2: Cherry picked data is useful

While it’s true that the article that Mr. Luciani himself reports, “has its limitiations”, suggested that soft drink consumption wasn’t linked to obesity in children, that doesn’t change the fact that there are studies that reveal the opposite to be true including the meta-analysis conducted by Harvard’s David Ludwig and published in Lancet which revealed that for each additional soda a child drinks on a daily basis their risk of developing obesity rises by 60%. Nutritional epidemiology is indeed a very tricky business, but no doubt cherry picking articles and presenting a rare outlier as being sufficient to discredit cursorily mentioned contradictory prior studies does not further intelligent debate.

Myth 3: Taxing food and beverages will be difficult so we shouldn’t try

Mr. Luciani suggests that because it will be difficult to determine what should and should not be taxed, that we therefore shouldn’t consider taxes as a means to shift consumption patterns. I have some news for Mr. Luciani, our current Excise Tax Act already does exactly that by making very specific suggestions for the collection of food taxes, many of which certainly don’t seem to make much nutritional sense. For instance the Excise Tax Act specifically singles out club soda, salads, vegetable and fruit trays and small bottles of water as taxable when sold in retail stores. Certainly shifting the taxes that are already currently being collected on healthful items onto glasses of sugar water would be a painless first step to take. Moreover, the simple fact that singular interventions won’t impact upon the complexity that is obesity shouldn’t paralyze the implementation of singular interventions as just as obesity has no one cause, it will have no one cure.

Myth 4: The fact that the food industry has healthier choices means they’re the good guys

The fact a particular industry makes healthier products doesn’t indemnify their risky ones. Altria for instance makes both shredded wheat and Marlboro cigarettes and I’d imagine even Mr. Luciani would struggle to suggest interventions designed to decrease smoking weren’t worthwhile on that ridiculous basis.

The food industry has a fiduciary responsibility to profit, not to protect our health. It’s important too, especially in this current climate to remember that profits aren’t built solely on sales. Profits are also built on public perception and the ability to make the case that industry unfriendly legislative efforts are unnecessary because the food industry is part of the solution. Mr. Luciani suggests McDonald’s, Pepsi and Coca Cola are all “going healthy to stay ahead of the market”. I’d argue they’re going healthy to stay ahead of legislation and scrutiny and to cultivate champions like Mr. Luciani who may be more inclined not to care that Coca-Cola’s stated aim is to double its profits in a decade because it makes zero-calorie beverages as well as its perennial profit-making full sugared version that according to Coca-Cola themselves along with other sugared sodas is responsible for an astonishing 2.5-3% of the total calories currently being consumed by Canadians. Putting 3% into perspective, since 1970 average Canadian loss adjusted per capita calorie consumption has risen by roughly 500 calories a day. If we’re currently averaging the 3,372 calories reported by the Canadian Sugar Institute, the 101 calories of soda being consumed daily would account for 20% of the total calorie excess we’ve seen since 1970 and consequently is an obvious, logical and nutritionally responsible target for intervention, especially given the complete and utter lack of nutritive value in its consumption.

Myth 5: Because Canada’s Food Guide isn’t evidence based we can’t trust the government to make smart decisions

It’s easy to agree that Canada’s Food Guide fails to reflect our current understanding of the impact of diet on chronic disease, but the fact that the government has failed to create a truly evidence based food guide has absolutely nothing to do with whether or not interventions to reduce the consumption of sugar water would be beneficial to the health of Canadians of all weights, shapes and sizes.

Mr. Luciani is right to state that obesity is incredibly complex and consequently there will be no, “top-down simple solution”, but suggesting education alone will suffice? Does Mr. Luciani truly believe Canadians don’t know that drinking 82L of sugared soda a year isn’t a healthy plan? Our current environment is flooded with calories with a torrential current that relentlessly, forcefully and tirelessly pushes Canadians young and old to consume far too many of them. When faced with a flood a government’s first job ought to be building a levee, not Mr. Luciani’s recommended course of action - more swimming lessons. And indeed, no single sandbag will suffice, and there will even be sandbags that serve no purpose, but that doesn’t mean we shouldn’t be systematically stacking them.