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Public Health

Improving America’s Teeth

When was the last time you went to the dentist? If you’re now opening your calendar to check your last appointment, chances are it has been too long. There is no general rule on the regularity that will apply to all patients, not least because we all have different lifestyles. That said, if you are someone who consumes tobacco, drinks alcohol regularly, or if you are in doubt about whether your daily oral hygiene is up to standards, a good rule of thumb is to make a dentist appointment every six months.

For many Americans, the rudimentary costs of seeing a dentist for a routine checkup are manageable. Despite the fact that most dental plans cover 100% of the costs for preventive visits, many Americans appear to lack awareness of their benefits. Even though 80% Americans have access to dental benefits, nearly 35% of adults didn’t visit a dentist in 2019, according to the National Association of Dental Plans. For both the 20% of Americans who are either not employed or whose employer’s chosen insurance plan doesn’t cover dental care, and the existing insured patients, it would be important to increase competition through subscription models. My colleague Yaël Ossowski has explained the advantages of such subscriptions in the Boston Herald.

Improving America’s oral hygiene doesn’t just happen through the policy level of increasing competition or, as some argue, through getting the government more involved in the field of healthcare. First and foremost, oral hygiene happens at home through brushing and flossing. Unfortunately, that is where some Americans’ habits are falling short.

A 2021 study commissioned by the American Association of Endodontists showed that 21% of respondents failed to brush their teeth in the morning, 23% never floss, and 28% didn’t schedule a dental appointment the entire year. A 2016 analysis of 5,000 men and women had found that 32 percent of Americans never floss. This is all paired with headlines of less representative surveys showing that Americans mostly only brush once a day, if at all.

A factor that is underestimated by many is the effectiveness of chewing sugar-free gum. The American Dental Association says that while chewing sugar-free gum is no substitute for brushing your teeth, those gums sweetened by non-cavity-causing sweeteners such as aspartame, xylitol, sorbitol or mannitol can help prevent tooth decay. The saliva produced through chewing washes away food debris and neutralizes acids, and also carries with it more calcium and phosphate to help strengthen tooth enamel.

The European Food Safety Authority (EFSA), known for its cautious assessments of product claims, seconded the assessment that sugar-free gum improved tooth mineralization and thus has overall oral health benefits. It remains important to reiterate that sugar-free gum is in no way a substitute for regular oral hygiene; however, it is an adjunct to oral hygiene that makes it more than just a lifestyle but in fact, a wellness product.

Oral hygiene is an important factor in our daily lives. Tooth decay and lasting problems with teeth plague many Americans, burdening them with high dental costs. Both on a policy level and on an individual level, a lot remains to be done to improve the oral health of all citizens.

Originally published here

The looming GP shortage is real – multiple prescriptions for the same problem

When something aches or you feel bad, the first place to go or call is the General Practitioner (GP). The NHS designed GPs as the entry point for most health-related issues. The aim of this system is threefold: (1) to get patients quick access to a medical doctor in his or her vicinity, (2) to have the GP assess the problem and either treat the patient on-site or refer the patient to a specialist, and (3) to optimise more expensive specialists’ time by only seeing patients that need to see a more advanced doctor.

So far so good. But a recent study by the Health Foundation suggests that by the end of this decade around a quarter of needed GPs will have left the labour market without being replaced. The NHS GP shortage should be taken seriously: If this unfolds the more specialised parts of the NHS might get overrun by patients and a domino effect could occur bringing down the entire care system in England.

But just recruiting another 10,000 GPs without changing the current NHS GP system might be hard to realise. So let’s look at the reasons for the looming shortage and incentives that could get us out of this situation.

A massively centralised system such as the NHS will over and over again encounter shortages of capacity, human resources, and drugs given its top-down funding structure. The predominant compensation driver for GPs is how many patients are enlisted with their practice – morbidity, quality of care, and efficiency of care play merely minor roles.

A much more decentralised outpatient care system that champions private clinics and private insurance at competing rates will be much better suited to quickly react to looming shortages by individually adjusting the pay of staff and the compensation for clinics. Patients might want to pay more for seeking care nearby or pay extra for same-day appointments.

One of the fundamental problems with highly centralised and politicised systems is that often patients have to figure out which practice can actually still accept patients. In a more agile system, the money needs to follow the patient and not the patient the money (the allocated resources in the system).

The NHS is not the envy of the world, no matter how often English politicians repeat that phrase. Even social democracies such as Germany rely much more on private elements in their primary health systems than the UK does – Switzerland and the Netherlands are two great examples. Patients should be much more in charge of deciding how and where their health contributions should be spent.

One idea to make it more attractive for medical students to choose a career as GP is creating healthcare vouchers that cover the basic NHS package for GPs (around 160 GBP/year and patient) but allow patients to redeem their vouchers at non-NHS practices and pay the difference out of pocket if these are more expensive or have the difference reimbursed by supplementary insurance. This would allow GPs to increase their profit and at the same time allow patients to transfer resources allocated within the NHS to a practice of their choice.

Opening up medical education to private universities in order to bring up the annual output of graduates from medical schools should also be one driver for more doctors available. Education, as healthcare, is too centralised and hence bottlenecks are inevitable.

At the same time, we need to make it easy for medical professionals from other countries (EU and non-EU countries) to migrate to the UK and quickly (maybe even immediately) work as GPs or specialists. I personally heard from medical doctors who emigrated to the UK what bureaucratic and certification ordeal they had to go through in order to practise in England.

Let’s keep in mind that the talent pipeline from admitting a student to a medical college to having a GP is pretty much a decade. A quick change of the approach to primary care in England is needed if this problem should be successfully tackled.

Originally published here

The new Pandemic Resilience Index is out, what has changed since 2021?

Covid-19 pandemic took the world by storm. Most countries’ healthcare systems proved to be entirely unprepared for a health crisis of this scale. Some countries were able to react and adapt more swiftly than others. Pandemic Resilience Index (PRI), presented by the Consumer Choice Center back in 2021, ranked countries based on their resilience to Covid-19 and other similar crises. 

The PRI examined 40 countries by several factors: vaccination approval, its drive, and time lags that have put brakes on it, critical care bed capacity, and mass testing. Israel came in first, followed by UAE, while Australia, New Zealand, and Ukraine ended up at the very bottom. 

Recently, we updated the PRI. Compared to the initial results, the change in the ranking is primarily due to the booster vaccine rollout delays. 

This year, the UAE found itself at the top of the ranking, closely followed by Cyprus. UAE was a pioneer in booster rollout, having given booster shots to about 42% of its 10 million population. Unfortunately, not all countries were quick to react to new variants and the subsequent need for additional doses. Countries like Canada, New Zealand, Australia, and Ukraine took five months longer than the UAE – the first country to start the programme – to get booster rollout up and running. 

Ukraine and India are the only countries that hadn’t rolled out the booster programme by November 30, 2021 (The PRI 2022 uses November 30 2021 as a cutoff date). According to the Ukrainian first deputy health minister, they wanted to reach the target of having at least 50% of the population fully vaccinated, before allowing for boosters shot to be administered, a goal that is yet to be reached. At the moment, both countries have acknowledged the need for booster shots and rolled it out at the beginning of this year. 

Israel, ranked number one in the PRI 2021, was demoted to 5th place, mainly due to its delay with vaccine rollout, which started 75 days after the UAE. The UAE started administering booster shots to its residents back in May 2021, while on average other countries lagged 3 months behind. 

Cyprus reached the second place mainly due to its high testing rates. The daily covid test average per capita 128 times higher than in Brazil, for example.

Greece had the most significant percentage change in terms of daily testing. Most countries saw an increase in this aspect, except for Luxembourg and Sweden, where the change was negative. Ukraine, with the second-lowest number of daily covid tests, remains at the bottom. 

When it comes to vaccination rates, Brazil has seen the most impressive improvement in vaccination numbers since the Pandemic Resilience Index 2021 was published. The number of vaccinated people in Brazil increased from 2.4% to 63% by the end of November 2021.

Availability of booster shots is especially important as not only does it provide better protection, but more and more countries are putting expiration dates on vaccines. For example, to visit France, if it’s been more than nine months since your last vaccine shot, you have first to get a booster shot. Despite delays, all of the studied countries (except for Ukraine and India) had already started offering booster shots to their population before the emergence of the new Omicron variant. 

Despite the initial one-year-long shock that everyone experienced, with restrictions getting lifted, scrapping of vaccine passports in some countries and border reopenings, it seems we are finally getting back to everyday lives. While we hope we never have to deal with a pandemic of such size ever again, countries worldwide must learn a lesson from this horrid experience and have their healthcare systems better prepared for any upcoming threats. 

Oral health: household solutions for long-term benefits

As continuous lockdowns all over Europe require consumers to spend more time at home than ever before, many of them fall victim to complacency about exercise, and struggle to find focus in a working-from-home environment. Countless articles have already outlined tips for staying healthy while working in home offices. That said, there is a health tip consumers underestimate, and that is easier to put in practice than installing a Peloton next to your office desk: sugar-free gum.

The effects of sugar-free gum (SFG) have been analysed for a long time already. A 2011 study found that chewing gum reduces the desire for snacks by 10%, which makes a significant dent in cravings for those foods that are unhealthy. On top of the widely known added benefit of preventing tooth decay between regular dental hygiene, it has also been shown that chewing gum leads to increased cognitive performance and productivity. Given that consumers, as much as many others, currently spend their days on Zoom calls, chained to our desks, sugar-free gum has been one of many practical solutions that can help us snack less and be more focused. Sugar-free gum has also been mentioned as a tool for keeping anxiety induced by isolation during lockdowns at bay, and is prescribed by surgeons for post-surgery recovery.

Outside of the effect of staying more focused and not stuffing yourself with crisps, sugar-free gum also has benefits in the realm of oral hygiene and dental care. A recent King’s College London review analysed eight papers on the matter, in the attempt to answer the question: “What is the difference in the level of plaque quantity, in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG, who do not chew gum or who use alternatives such as probiotics or fluoride varnish?” The review, published in a special edition of Frontiers in Oral Health & Preventive Dentistry, found evidence that SFG reduces dental caries. 2021 research data has previously indicated that Streptococcus mutans, which are a significant contributor to tooth decay, are reduced by chewing.

These evidence indicators have led the UK’s National Health Service1 to address SFG in its guidance on oral health. As evidence becomes more conclusive on the benefits of SFG, consumers should look out for the product as more than just a sugar-free candy replacement, but more as a practical health addition. This could have benefits not merely for individual oral health, but also to overall public health: research published in the British Dental Journal (BDJ) has shown that if 12-year-olds across the UK regularly chewed sugar-free gum after eating or drinking, it could save the NHS £8.2 million, the equivalent of 364,000 dental check-ups.


  1. specifically the Department of Health and Social Care, the Welsh Government, the Department of Health Northern Ireland, Public Health England, NHS England and NHS Improvement and with the support of the British Association for the Study of Community Dentistry.

Reckoning with insurance for better patient choice in healthcare

A new Senate bill seeks to take the hassle of dealing with healthcare companies away from patients and into the hands of insurance companies. Although it falls short of the mark, this bill is a step in the right direction toward sensible healthcare reform in Pennsylvania.

Regardless of your job, your income, or where you live, we’ve all had at least one nightmare scenario when it comes to health insurance.

There are forms, claims, reimbursement requests, schedules, and negotiations. Doctors, dentists, and health practitioners understand the burden, and often have to face their own bureaucratic tests of will before focusing on their patients. The growth of healthcare administration costs emphasizes this. And that’s for people with private plans.

The price inflation that comes with the amping up of health insurance plans in our entire system — not to mention the role of government subsidies — is a well-known phenomenon. Insurance becomes involved in every rudimentary doctor visit or procedure, leading to bad incentives for health providers, employers, and insurance companies. This process involves a middleman in what should essentially be a simple medical contract between patient and practitioner. 

The answer, however, is not in abandoning free exchange in healthcare, as Medicare For All proponents would have us believe, but rather it is in reckoning with insurance to make our system more competitive and fair.

In Pennsylvania, one particular bill is addressing the process of making insurance more accountable and lowering patient costs and headaches.

This session, State Sen. Judy Ward has introduced SB850 that would enact assignment of benefits reform, compelling insurance companies to follow a patient’s wish to directly pay healthcare providers rather than leaving them with the paperwork and negotiation. This would simplify life for patients by requiring insurers to pay providers directly.

One would think this is standard practice, but especially for dental insurance, there are additional steps and vetting that often leave patients responsible for paying their dentists only after the insurance company has paid out the claim.

Though only a small reform, and leagues from where we need to be to have a truly free market in healthcare decoupled from our employers, this bill would make the entire process simpler and better empower patients and consumers.

Since the Affordable Care Act and large Medicare reforms at the federal level, assignment of benefits is recognized in most medical insurance markets, but not yet for dental patients.

These reforms are complicated by the often cumbersome terms of dental insurance contracts: only portions of care or procedures can be covered by insurance, there are caps on the amounts one can reimburse in a single year, and dentists must navigate these steps to accurately bill their patients without producing a shocking bill. This balanced billing approach is necessary for any medical professional who wants to stay in business.

The answer, however, is not in abandoning free exchange in healthcare … but rather it is in reckoning with insurance to make our system more competitive and fair. 

But the status quo often makes it more complicated than it otherwise would be.

That is why price transparency remains an important principle for these debates, and why legislators should continue ensuring patients have choice and access to the information they need.

There are dozens of easy reforms state legislatures could follow that would help improve care: fostering innovation, reducing bureaucracy, giving incentives to patients to use direct-to-consumer options, and more.

By continuing to promote competition and transparency, patients and consumers can benefit from better care and lower costs. It is only a small degree of change we need, but it beats the alternative.

Originally published here

Opinion: Learn from Britain — a junk food ad ban is a bad idea

The outdated playbook of trying to tax and ban things out of existence in a misguided effort to change people’s behaviour

Childhood obesity rates have nearly tripled in the last 30 years. Almost one in three Canadian children is overweight or obese, according to data from Statistics Canada. In an effort to tackle this growing problem, Health Canada has announced it is considering sweeping new legislation to restrict junk food advertising.

A similar plan was mooted but not adopted a few years back, but public health regulators now feel empowered to push this tired idea partly because the British government recently signed off on a new law banning television advertisements before nine in the evening for foods high in sugar. Health Canada says it is examining the British law and recommitting to implementing something similar in Canada.

The months the British government has spent dancing around this issue ought to be enough to ward off any right-thinking Canadian. The law it eventually came up with was a watered-down version of the original proposal, which would have banned all online advertising of anything the government considered “junk food.” Bakeries could have been committing a crime by posting pictures of cakes to Instagram.

The U.K. government now promises its new legislation will eliminate that possibility. But that doesn’t mean the ban is a useful public policy tool. First and foremost, ad bans simply do not work. The British government’s own analysis of its policy predicts it will remove a grand total of 1.7 calories from kids’ diets per day. That’s roughly the equivalent of 1/30th of an Oreo cookie.

It’s safe to assume the same policy would have similarly underwhelming results here in Canada. It won’t help reduce child obesity but it will make life more complicated for the country’s food industry. All this, just as the world enters a post-COVID economic recovery and countries like Britain and Canada need growth and investment more than ever.

The junk food ad ban was pushed through in the U.K. on the back of a sinister campaign weaponizing children’s voices. As the government wrapped up its public consultation on the proposal, it lauded a conveniently timed report supposedly highlighting the crying need for such a drastic policy intervention. The report — or “exposé,”’ as it was branded — was cooked up by Biteback 2030, a pressure group fronted by celebrity chefs and Dolce & Gabbana models. Absent hard evidence or coherent arguments for the centralization of decision-making on a matter as fundamental as what to have for dinner, it made its point by shamelessly putting interventionist politics into children’s mouths.

“I’m a 16-year-old boy,” read its introduction. “I feel like I’m being bombarded with junk food ads on my phone and on my computer. And I’m pretty sure this is getting worse.” Canadians who value free markets and individual liberties should be on the lookout for similar tactics from nanny-statists bent on drowning entire industries in red tape and consigning any notion of freedom of choice to the history books. It is incredibly paternalistic for the government to limit what advertisements adult consumers can see, as the ban would eliminate the targeted ads from all TV programming before nine p.m.

There is plenty Canada can do to fight obesity without resorting to blanket advertising bans, following the outdated playbook of trying to tax and ban things out of existence in a misguided effort to change people’s behaviour. The ban completely ignores the other half of the obesity equation, which is of course physical activity.

Obesity is a serious problem. It could even become the next pandemic. But as this junk food ad ban statement from Health Canada shows, powerful public health regulators are asleep at the wheel. They claim to be acting in Canadians’ best interest but they have nothing new to add to the policy debate.

Originally published here.

Health Canada coughs up counterintuitive vape policy

Ban on flavoured vape juice, nicotine limits will push smokers back to cigarettes

Just when it was thought to be safe to vape rather than smoke cigarettes, the Trudeau Liberals are unwittingly conspiring to resurrect the age-old sin of cigarette smoking.

They don’t think this will happen of course, but it will

On July 19, as per the federal Gazette, the Liberals of Prime Minister Justin Trudeau will announce new regulations to not only reduce the nicotine level in e-cigarette vaping products but ban flavoured vape liquids beyond tobacco and menthol/mint.

“Health Canada is pushing smokers back to smoking cigarettes and into the arms of ‘Big Tobacco’,” says Shai Bekman, president of DashVapes Inc., Canada’s largest independently owned e-cigarette company.

Ontario’s pre-emptive move to ban vape flavours will affect the big-name e-cigarette brands that sell primarily in convenience stores, such as Juul and Vype.

Both companies sell e-cigarette pods that come in flavours such as cucumber, mango, strawberry, and vanilla.

But what is Health Canada thinking?

According to various experts in sociological behaviour, and confirmed in many peer-reviewed articles, rather than reduce smoking, this will eventually drive vapers back to real cigarettes and, because of the severe 70-plus per cent tax on smokes, will also cause increased demand for contraband cigarettes.

After all, if you’re going to smoke, why pay a heavily taxed $20 a pack when a trip to the friendly smoke shack on any Mohawk reserve in Ontario and Quebec will get you a tax-free pack for as little as $4?

As David Clement, North American Affairs Manager with the Consumer Choice Centre recently wrote in the Financial Post, “our federal government is ignoring what is working abroad and is rejecting its usual governing principle of harm reduction.

“Curbing youth access to vape products is very important but banning flavours for adult smokers trying to quit tobacco is a huge mistake, one that could have deadly consequences,” said Clement.

“Approximately 1.5 million Canadians use vape products, most of them smokers trying to quit. Research on consumer purchasing patterns shows that 650,000 of those vape users currently rely on flavours that would be prohibited if the ban goes through.”

In May, also in the Financial Post, Fred O’Riordan, a former director-general at Revenue Canada, said “ the federal budget had something for everyone, including contraband traders.

“Their unexpected gift came in the form of a $4 per carton increase in excise duties on legally manufactured cigarettes, a sharp increase that may mark the end of one era — in which tax policy was an effective tool to control tobacco use — and the beginning of another.

”More smokers will switch to readily available and far cheaper contraband products,” he wrote.

“(This) will be bad for the health side of policy, especially for young people since illegal sellers do not ask for proof-of-age ID.”

The purpose of tobacco taxes, of course, is to raise revenues, but projections have been falling for years.

Last November, the Canada Revenue Agency estimated the 2014 loss in federal excise duty revenue from illegal cigarettes — the so-called “tax gap” — at about $483 million.

Lost provincial tax revenues would more than double that estimate. And those “latest” numbers are seven years old.

What’s needed is the ballsy move of reducing tobacco taxes enough to make buying contraband a non-thought. Ontario Premier Mike Harris did this and sin-tax tobacco revenues predictably went up.

And keep flavoured vapes — the mango, the vanilla and even the bubble-gum, all of which are also sold on reserves.

Health Canada has to stop being so counterintuitive.

It’s not working.

Originally published here.

Junk food ad bans don’t work

Recognised as a risk factor for severe COVID-19 cases, obesity will likely top the European policy agenda for the years to come.

The recent launch of the MEPs for Obesity and Health System Resilience intergroup combined with several surveys and events signals an increased interest in finding the most effective solution. However, the traceable tendency to use the WHO’s recommendations as a shortcut when it comes to lifestyle issues does more harm than good.

In November 2016, the WHO published a report calling on the European Member States to introduce restrictions on marketing of foods high in saturated fat, salt and/or free sugars to children, covering all media, including digital, to curb childhood obesity. 

Same year the “What about our kids?” campaign, led by Romanian MEP Daciana Octavia Sârbu and organised by 10 European health organisations, called for a change of the Audio-Visual Media Services Directive (AVMSD) to impose a watershed on junk food advertising at a time when the directive was undergoing a review. As a result, the updated directive did include a clause on the co-regulation and the fostering of self-regulation through codes of conduct regarding HFSS.

The WHO’s implicit impact is traceable across the board which, however, doesn’t add up to its legitimacy. The said report claims that there is unequivocal evidence that junk food ads impact children’s behaviour, but it doesn’t back it up with facts to show a causal link between the marketing of these foods and children’s obesity. What the report does though is demonise the marketing industry globally for intentionally targeting children.

The link between advertising – in particular TV ads – and childhood obesity is weak and most of the current conclusions are based on studies from decades ago. One such example is a trial conducted in Quebec over 40 years ago. As part of a 1982 study, five- to eight-year-old children who were staying at a low-income summer camp in Quebec underwent a two-week exposure to televised food and beverage messages. It was found that children who viewed candy commercials picked significantly more candy over fruit as snacks. Although there appears to be an established non-directional link between childhood obesity and television, and a plausible link with food ads, it is not sufficient to justify bans.

Junk food ad bans policies fail to recognise that childrens’ choices are heavily dependent on the environment where they grow up and behaviours that are treated as acceptable.  Therefore, if the parents live unhealthy lives then their children are much more likely to live unhealthy lives as well. 

To tackle obesity, we need to fundamentally change the societal narrative of what is healthy and what is not, and futile attempts to solve the problem through bans are not an effective way forward.

Education – both at school and home through model behaviours – and parental responsibility play a key role in fighting obesity. WHO’s junk food ad bans are a knee-jerk solution to a problem that requires a fundamental societal change.

Originally published here.

Taxing sugary drinks unlikely to cut Newfoundland and Labrador obesity rates

Newfoundland is creeping toward a fiscal cliff.

The province’s debt load is more than $12 billion, which is approximately $23,000 per resident. COVID-19 has obviously worsened that troubling trend, with this year’s budget deficit expected to reach $826 million.

Just this week legislators proposed a handful of tax hikes to help cover the gap, ranging from increasing personal income tax rates for the wealthier brackets, increasing taxes on cigarettes, and the outright silly concept of a “Pepsi tax.”

In one year’s time, the province will implement a tax on sugary drinks at a rate of 20 cents per litre, generating an estimated almost $9 million per year in revenue.

Finance Minister Siobhan Coady justified the tax, beyond the need for revenue, stating that the tax will “position Newfoundland and Labrador as a leader in Canada and will help avoid future demands on the health-care system.”

When described like that, a Pepsi tax sounds harmonious. Who doesn’t want to curb obesity and generate revenue?

Unfortunately for supporters of the tax, the evidence isn’t really there.

In one year’s time, the province will implement a tax on sugary drinks at a rate of 20 cents per litre, generating an estimated nearly $9 million per year in revenue.

Unfortunately for supporters of the tax, the evidence isn’t really there. In one year’s time, the province will implement a tax on sugary drinks at a rate of 20 cents per litre, generating an estimated nearly $9 million per year in revenue.

Regressive taxes

Consumption taxes like this are often highly regressive, meaning that low-income residents bear most of the burden, and are ultimately ineffective in achieving their public health goals.

Looking to Mexico provides a good case study on the efficacy of soft drink taxes. With one of the highest obesity rates in the world, Mexico enacted a soft drink tax, increasing prices by nearly 13 per cent, with the goal of reducing caloric intake. A time-series analysis of the impact of the tax showed that it reduced consumption of these drinks by only 3.8 per cent, which represents less than seven calories per day. Estimates from Canada also show the same. When PEI’s Green Party proposed a soft drink tax of 20 per cent per litre it was only estimated to reduce caloric intake from soft drinks by two per cent, which is approximately 2.5 calories per day.

While these taxes do in fact reduce consumption to some degree, the reductions are so small that they have virtually no impact on obesity rates. To make matters worse, taxes like this aren’t just ineffective in combating obesity, they are heavily regressive. Looking again at the data from Mexico, the tax they implemented was largely paid for by those with a low socioeconomic status.

In fact, a majority of the revenue, upwards of 63 per cent, was generated from families at, or below, the poverty line. If we take the province’s estimation of $9 million a year in revenue, it is reasonable to assume that $5.67 million of that revenue will be coming from the pockets of low-income Newfoundlanders.

In other jurisdictions south of the border, like Cook County Illinois, no soda tax has avoided the uncomfortable reality of being incredibly regressive, which is partly why they eventually abandoned the tax altogether.

Doubtful benefits

Newfoundlanders need to ask themselves, is it worth implementing a heavily regressive tax on low-income families to move the needle on obesity by a few calories a day? I’d argue that the negatives of the tax far outweigh the benefits, and that’s before business impacts enter the equation. This also happens to be the same conclusion found in New Zealand.

The New Zealand Institute of Economic Research, in a report to the Ministry of Health, stated that “We have yet to see any clear evidence that imposing a sugar tax would meet a comprehensive cost-benefit test.”

While both budget shortfalls and obesity are serious problems, a “Pepsi tax” isn’t a serious solution.

Originally published here.

Nicotine flavor ban: A lesson in why a bill should not become a law

A few years ago, a liberal law professor friend in New York asked me to help her with a lesson. I was tasked with coming up with a public health policy that students across a wide ideological spectrum could agree upon.

I suggested a policy promoting public health education explaining how vaccines work, as part of an educational campaign to support more widespread acceptance of essential vaccinations.

This proposal met some key criteria in that it was not intrusive, it was based on science as well as common-sense, was always timely and was consistent with broad-based public health goals.

The professor reported back that my topic led to a lively discussion about policy-making and was instructive about how to govern effectively, especially in politically polarized environments.

Now I’d like to propose another public health policy discussion that reasonable people with a wide range of ideologies should also agree upon, but this time, we’d evaluate a policy that should be widely rejected.

The same type of fundamental criteria apply. The proposal should be overly-intrusive, based on neither science or common-sense, particularly untimely, and inconsistent with broader public health policy goals.

A bill so ill-conceived is now being introduced by a member of the New York State Assembly who lives in my Upper West Side neighborhood. Assemblymember Linda B. Rosenthal is proposing to ban flavored nicotine pouches used by adult smokers to quit smoking.

These pouches fall into the category known as non-combustible alternative tobacco products. They contain nicotine derived from tobacco, but unlike other forms of oral tobacco such as chewing tobacco and Swedish-style moist snus, they don’t contain actual tobacco leaf. Nonetheless, they are still regulated as tobacco products and are subject to the strict regulatory process now being implemented by the Food and Drug Administration. 

Those rules include a requirement that a product be authorized for marketing only if the agency finds it to be “appropriate for the protection of public health.” And, of course, sales of any tobacco product to anyone under 21 are illegal under federal law.

A basic tenet of regulatory policy can be drawn from the restrictions the Supreme Court has placed on laws affecting constitutional rights, which is that a rule must be specifically and narrowly tailored to achieve a compelling government interest.

In the case of a proposed ban on flavors in nicotine pouches, the stated interest is to prevent youth use of a tobacco product. In that regard, it is quite compelling.

But the rule is certainly not at all tailored to achieve that purpose. The ban would apply to all flavored products, not to minors who would purchases it. 

In fact, because these are legally considered to be tobacco products, it is already illegal to sell these products to anyone under 21 in New York, as well as the rest of the country. So essentially the law is a ban on the sale of these products to adults.

Another way to evaluate such a proposal is to ask the questions, we asked in the academic setting:

  • Is the proposal intrusive?
  • Is it based on science as well as common-sense?
  • Is it timely?
  • Is it consistent with broad-based public health goals?

Such a ban would certainly be intrusive. It would prevent adult smokers from access to a significantly less harmful alternative to cigarettes. Flavors are essential In order for products such as these to be appealing to adult smokers an alternative to a cigarette. “Intrusive” is a rather gentle term when trying to describe a rule that would take ban access to a product that could save an addicted smoker’s life.

The proposal is also devoid of any science. Although the science is clear, youth should not use any nicotine containing products, a ban on the sale of lower-risk nicotine products to adults has no evidentiary basis and undermines the well-established public health principle of harm reduction. Remember, because sales of tobacco to those under 21 are already illegal, the only legal change this rule would cause is a ban on sales to adults. So common sense, together with our national history regarding prohibition, make it clear that Assemblymember Rosenthal’s proposal fails this test miserably as well.

As New York continues to grapple with public health challenges caused by the Coronavirus pandemic, including the tragic scandal related to the state’s handling of nursing homes during the pandemic, now seems like a strange time to introduce an intrusive and unscientific ban on a product which, even the bills’ supporters recognize, aren’t being used by youth, as were e-cigarettes.

In fact, the regulations on e-cigarettes have given fewer acceptable lower-risk alternatives to adult smokers who can’t or won’t stop using nicotine. So now would be a particularly dangerous time to ban the sale of flavored nicotine products to adults.  

Finally, the proposed ban is inconsistent with broader public health policy developed by Congress and now being implemented by the Food and Drug Administration.  The FDA has consistently explained that “tobacco products exist on a continuum of risk, with combustible cigarettes being the deadliest.”  The FDA is counting on lower-risk non-combustible products, authorized by the agency, to replace cigarettes for adults who need or want to use nicotine. A state ban on products the FDA is currently evaluating as a tool for tobacco harm reduction would undermine the difficult but promising regulatory process.

The pandemic has reminded us that the government has tremendous power over everyone’s lives, even in a freedom-loving democracy as ours. But there’s a line — there are standards as outlined above that can help us distinguish between rules which promote public health and those which, no matter how noble the stated intention, serve to undermine it.

Originally published here.

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