Another voice has been added to the hue and cry for a minimum price for alcohol. Within days of Rubber Duck stepping down from his CMO post, the better to quack his favourite message, NICE, the National Institute for Health, Clinical and Anything Else Anybody Will Pay Us For Excellence, has jumped on the wagon. Voluminous guidance, published earlier this week, recommends a raft of measures that, NICE says, will ‘significantly decrease alcohol consumption’ if implemented. A top tip for government is to make alcohol ‘less affordable by introducing a minimum price per unit’. There was much talk of growing tides of unassailable evidence. Dr No began to fear he was now King Canute, alone on the beach, his once half full glass now half empty. Until, that is, he heard an interview on the Today programme. Suddenly the glass was half full again.
A Professor Mike Kelly, Chief Pongo of Public Health at NICE, and the man responsible for the report, was being interviewed by Wingnut. Wingnut was his usual Tiggerish self; the Prof was smooth, suave and very authoritative. “The evidence that we’ve reviewed, from across the world, indicates that minimum pricing is just about the most effective way of targeting problems drinkers” he assured us in a voice smoother than a thousand year old Malt. A distant tap-tap-tap echoed nails being hammered into white cider coffins.
Unfortunately for Mike, the BBC had also invited along a Gavin Partington, spokesperson for the Wine & Spirit Trade Association. Gavin showed himself from the off to be a high proof, spirited spokesperson. In double quick time, he was pulling the beer mats from under the Prof’s glass of fizzy water. There was, he said, no international evidence on minimum pricing, for the singularly persuasive reason that no country had introduced true minimum pricing. The Prof’s glass of fizzy water started to go flat. Challenged by Wingnut about the lack of evidence, the Prof let the cat out of the bag. The recommendation, it turned out, wasn’t based on international evidence after all, but on something quite quite different, something known as economic modelling.
Wingnut is in fact an economic super-computer cunningly disguised by the BBC to look and sound human. Economic modelling is the bread and butter, or rather the software, that makes him tick, and so, naturally enough, economic modelling was just fine for Wingnut. But Dr No is not an economic super-computer. Dr No, trapped in his non-economic, non-super-computer world, draws a distinction between evidence, derived as it is from verifiable real world data, where conclusions are properly bound to and by the original data, and modelling, economic or otherwise, which – all said and done – is nothing more or less than a clutch of souped-up Excel ‘what-if’ spreadsheets, where any number of internal assumptions may be made; and where what comes out depends on what goes in. Assumptions, of course, have form when it comes to cock-ups; and, as always, GIGO applies.
The difference, we might say, between NICE’s ‘evidence’, and real evidence, is between yesterday’s known weather and tomorrow’s forecast weather. Yesterday’s weather we know, because we saw it; tomorrow’s weather, even with the most sophisticated meteorological modelling, remains a forecast. It might – or might not – happen. We just don’t know – until tomorrow, when fact replaces forecast.
Dr No has nothing against forecasts. He makes regular use of any number of forecasts. But he never forgets that they are forecasts, not facts; and so Dr No does not take kindly to NICE pedalling forecasts as facts. He considers it at best disingenuous. Luckily he is not alone. One high profile researcher from ScHARR (the Sheffield outfit that did much of the research), a Dr Petra Meier, was recently called to give evidence to the Scottish Parliament – Scotland is set to be the guinea-pig in the minimum pricing trial – on the nature of ‘Econometric modelling as a decision-making tool’. Dr Meier was keen to put things into perspective. The model, she said, was a prediction, rather than a post-hoc observation; it was, she said, ‘like the weather forecast’.
Quite what the academic forecast now is for Dr Meier remains to be seen. But she is to congratulated for speaking plainly and clearly on the distinction between facts and forecasts. NICE, on the other hand, have jumped on the minimum pricing wagon, and presented a recommendation based not on facts, but on forecasts.
Barbeque summer, anyone?