Christopher Snowdon's Blog

Some further thoughts on this at my Substack. 

Smokers would have to greatly overestimate the benefits of filters for a ban to provide a net benefit in public health terms, and I doubt they do. I expect most of them think they provide no protection at all. Most smokers have only ever known filtered cigarettes and they know that they are highly dangerous. In any case, making a product more dangerous in order to scare people off using it has got to be ethically questionable.

The anti-smoking lobby’s approach to this issue is all over the place. They were all in favour of the development of low tar cigarettes in the 1970s. They now say that was a mistake. Fair enough, but if it was a mistake why did they lobby for the EU to set limits on tar yields in the 1990s and then fight to lower those limits in the 2000s? They then successfully lobbied the EU to ban tobacco companies from putting the tar and nicotine content on packs because this information was (supposedly) misleading. Which is it? Either all cigarettes are as bad as each other, in which case get rid of the limits on tar and nicotine, or low tar cigarettes are safer than high tar cigarettes, in which case consumers should be informed.

Their current position seems to be that all cigarettes are as bad as each other and that filters should be banned because they give the opposite impression. If so, the EU’s limits on tar and nicotine serve no purpose and should be abolished. Indeed, they will have to be abolished if filters are banned because there is no such thing as a low-tar unfiltered cigarette. This is an issue that the authors of the Addiction article, who include ASH’s Hazel Cheeseman, never address. They can’t be dumb enough to think that the EU will accidentally ban cigarettes by banning filters and leaving the tar limits in place so they must think - if they have thought about it at all - that the EU will allow high tar cigarettes to be sold again. That would be fine with me. It’s just be a bit surprising that it’s also fine with an anti-smoking group.

 

Not a spoof
 Tobacco Control has published an hilarious article by a lawyer from ASH (USA) and a social scientist from Mike Bloomberg's Tobacco Control Research Group (Bath University). It is titled Tobacco control advocates as human rights defenders: a call for recognition. and is every bit as ridiculous as it sounds.   

Tobacco control advocacy is not without risks. Increasingly, advocates have spoken out about the threats, harassment and attacks they face when confronting powerful corporate interests.

 This "harassment" mostly consists being called things like 'nicotine Nazis', 'health fascists' and 'killjoys'. It turns out that if you stigmatise people, extort money from them through sin taxes and ruin their social lives, they will dislike you. Who knew? And yet, despite working tirelessly to make the lives of nicotine users miserable, I have never heard of any anti-smoking campaigner in the modern era being physically attacked by a smoker. When you think about it, that is quite remarkable.  

This commentary argues that tobacco control advocates should be recognised as human rights defenders (HRDs) under international frameworks.  

 Hahaha!  

The Office of the High Commissioner on Human Rights (OHCHR) defines HRDs as individuals who, individually or with others, act to promote or protect human rights in a peaceful manner.

 You know who isn't defined as a human rights defender? Ambulance-chasing lawyers and pointless academics who sit around on fat salaries thinking up ways to take away people's right to enjoy themselves. There are lots of names for people like that but 'human rights defender' is definitely not one of them. 

This definition is based on actions, not positions or titles. By this standard, tobacco control advocates—who work to protect and advance the right to health (and other rights) and challenge harmful corporate practices—clearly fall within the scope of HRDs.

 Anti-smoking lobbyists do not advance the right to health. Insofar as not smoking is synonymous with health, people can choose to do it or choose not to do it. Having the right to something does not mean that a person should be compelled by others to maximise it at the expense of everything else they hold dear. People have the right to a family life but that doesn't mean they should be forced to have children.  What difference would it make if we go along with this gaslighting and pretend that prohibitionists are champions of human rights? 

... much of the practical, frontline support for HRDs comes from civil society. For example, a civil society-led initiative based in Europe offers a variety of support mechanisms, including a hotline for urgent protection and visits in detention. 

 The initiative they are referring to has been supporting women living in Afghanistan under the Taliban and libertarians fighting political oppression in Georgia. Surely even the most deluded 'tobacco control' nutter can see that the plight of these people has nothing in common with single-issue campaigners being called nanny statists on Facebook?  

Tobacco control has always been about defending the right to health, life, and dignity. 

 No, it has always been a prohibitionist crusade run by neurotics, bigots and grifters. As the campaign against e-cigarettes and nicotine pouches shows, it was never really about health and it certainly isn't about dignity.   
 A moral crusade explicitly grounded in 'denormalisation' was never going to advance human dignity. 

Yet the advocates who lead this work often face threats without the recognition or protection afforded to other defenders of human rights. 

 The authors helpfully link to a website that might otherwise have escaped me. Paid for by two of Bloomberg's front groups, Courage Against Tobacco tells the heart-rending stories of brave of anti-smoking careerists who have suffered at the hands of the tobacco industry. The 'tobacco industry' is very broadly defined, including not just companies who make and sell tobacco products but also "all related corporate entities connected to tobacco manufacturing companies", "research institutions accepting tobacco funding", "third-party allies" and "lobbyists advancing industry positions". And, as if that were not enough, it also includes:  

Organizations promoting "reduced-harm" products while opposing evidence-based measures aligned with the WHO FCTCEntities that consistently advance tobacco industry policy positions 

 In other words, it includes literally everybody who disagrees with them. 

The website tells the story of a French anti-smoking campaigner who was "allegedly insulted online" by somebody from an organisation called 'Angry Tobacconists'. It tells the tale of ASH Scotland's Sheila Duffy being called a "health Nazi" by FOREST and of a former Detective Chief Inspector threatening to take her to court over something (the details are not clear). And we hear about some anti-smoking activist in southeast Asia who received a 36 page letter of complaint from somebody who is apparently vaguely connected to the tobacco industry.

It certainly puts the situation in Gaza and Ukraine into perspective, doesn't it? Nobody has ever suffered like a professional tobacco control lobbyist has suffered - and all to protect human rights! (i.e. their right to tell other people how to live their lives.) 

Recognising tobacco control advocates as HRDs is not symbolic—it is a necessary step to close a serious protection gap. It would align the field more explicitly with global justice efforts, unlock underused legal and institutional resources...

 And there we have it. Is that the sound of a cash register I can hear?  

... and send a clear message that defending health is defending human rights. As pressure from commercial actors intensifies, the global tobacco control community must act—not only to advance policy, but to safeguard those advancing it.

 These people are deluded beyond belief. Clive Bates puts it well in a rapid response... 

Tobacco control advocates are not defending human rights, but rather promoting controls and limitations on the rights of others. The threats to the safety of tobacco control activists are minimal in practice, but the threats to millions of others from adopting a prohibitionist, war-on-drugs posture towards safer forms of nicotine are significant.

 

 

I was spoke to Brent Stafford at Regulator Watch when I was at the Global Nicotine Forum in June. We discussed vaping, prohibition and why things will get worse before they get better. Here's the video.

 

Remember Joe Wicks, the chirpy gym bunny whose YouTube channel got children exercising during lockdown? He was quite famous in the spring of 2020 but was rather less famous five years later. In 2021, at the peak of its success, Joe Wicks Ltd. had £2,181,299 in the bank. By 2024, it had just £78,758. 

Whether the fading fame and fortune of Mr Wicks had anything to do with his decision to get onboard the bandwagon against ultra-processed food (UPF), we may never know, but it has certainly got him back on prime time TV. He has been on the breakfast sofa with Ed Balls and Susanna Reid, and viewers were treated to a whole hour of him on Channel 4 this week (Joe Wicks: Licensed to Kill). His promotional device is the “Killer” protein bar which he has created and is portraying as “the most dangerous health bar” ever. It supposedly causes cancer, stroke and heart disease — and yet it is legal! Why won’t the government do something?!

Inevitably, the documentary involves Wicks going on a poorly scripted “journey” to discover the truth about what is really going on in our food environment, blah, blah, blah. Equally inevitably, his tutelage leans heavily on the opinions of Chris van Tulleken who has recently been made a professor and is beginning to look as crazy as he sounds. For cinematic reasons, van Tulleken is portrayed as living in a dimly lit, underground laboratory surrounded by bottles of dangerous chemicals. The vibe is that of a strange but brilliant scientist who has accidentally unleashed the zombie apocalypse and is humanity’s only hope of ending it. Once Wicks gets to work manufacturing his unhealthy snack, van Tulleken occasionally surfaces with an intense stare, urging his youngish protégé to see it through to the end.

Read the rest at The Critic. 

Dewi Evans has sent a response to journalists following the broadcast of Conviction (AKA Lucy Letby: Murder or Mistake) which I reviewed last week. He says it's free to be shared so here it is for anyone who might be interested... 

Danny Bogado, Rosy Milner and the Channel 4 team took on a challenging documentary (Murder or Mistake, Channel 4, 29 September 2025). Producing a 2 hours' documentary from evidence that took Cheshire Police several years to collect and led to the longest criminal trial in English legal history is in itself remarkable. 

It was a privilege to be considered the chief prosecution witness in a trial that has led to the lifelong incarceration of England’s worst female killer. Her conviction would not have succeeded without Cheshire Police’s diligence and attention to detail, and the evidence of my fellow independent witnesses and the numerous nurses and doctors from the Countess of Chester Hospital. The evidence of all the witnesses was crucial. 

Lucy Letby’s new barrister has broken new ground in launching an appeal via press and media, providing of course a very selective version of events.Mark McDonald helpfully summarised 6 issues on his agenda; the rota, the experts, air embolus, insulin, the neonatal unit, and the media.Despite his natural thespian skills and his considerable bravado Mr McDonald and his supporters failed to offer any evidence not disclosed at Letby’s trial, or would stand scrutiny at a clinical or scientific presentation or the rigours of cross examination. 
The relevance, or not, of the rota, and Letby’s presence, has been flogged to death. Peter Elston, statistician and investment manager, just could not understand the difference between information that is statistically significant and that which is clinically significant. Statistics will point you in a certain direction. It does not prove that something took place. It’s why statistics did not play a part in the prosecution’s case. Presumably it’s why the Defence did not seek a statistical explanation either. 

Private Eye’s Dr Phil Hammondclaims credit for exposing the concerns regarding what became the Bristol Heart Scandal. He conveniently overlooks the fact that the same magazine took over 10 years to admit it got it wrong in relation to discredited medic Andrew Wakefield and his flawed MMR / autism claims. His claim that my diagnosis of air embolus was because I “couldn’t think of anything else” reflects his clinical limitations, not unexpected given he is best known as a comedian who writes forThe Eye.My diagnosis of air embolus was supported by my fellow independent witnesses, belatedly by the Chester paediatricians, and backed up by 18 publications. 

Shoo Lee may well be an eminent epidemiologist. His experience of air embolus is limited to reporting 3 cases from the 1980s. More tellingly he has no background of medicolegal matters because “I don’t do medico-legal cases. I don’t like them”. Bogado's programme did not have time to include my detailed critique of his 2 published papers.  If his most recent paper (published in December 2024) had been available before the trial its content would have been very useful - for the prosecution. His criticisms of my role, disclosed at the press conference, were all factually incorrect. Summaries from other members of the Panel were awash with errors, some of the weakest reports I have seen during my career.

Given the time constraints it was inevitable that the documentary concentrated on just a couple of cases. The timing of Baby C’s collapse created confusion. In my very first report (7 November 2017) I raised concerns regarding the event late on Saturday 13 June 2015 that led to his collapse and death. Over the next 5 years the dates seem to have become confused, leading to the prosecution alleging that the assault took place the previous day. I recognised the confusion at the Trial, reaffirming my original concern that the fatal assault was late on 13 June. I believe that Cheshire Police, the CPS, and the Prosecution team should set the record straight. 

Back in 2017, when I first raised concerns regarding Baby C’s demise, I was unaware of Letby’s presence on the unit, let alone that she was up close to Baby C at the time of his collapse. There is nothing in Baby C’s clinical records to confirm Lucy Letby’s presence. 

Baby O’s demise was given considerable attention, and we were presented with some extraordinary explanations from British Columbia based neonatologist Richard Taylor and the Brighton duo of Neil Aiton and Svilena Dimitrova. According to them Baby O’s death was due to a cannula inserted into the baby’s abdomen 20 - 30 minutes before he died. This fails to explain why the baby was moribund, sadly at death’s door, before the cannula was inserted. For good measure Aiton claimed that the ventilator pressures used to resuscitate the baby were too high. This does not explain why the baby required resuscitation in the first place. He had never required resuscitation following his birth, and his collapse took place when in Lucy Letby’s care. The Taylor, Aiton, Dimitrova hypothesis has been widely condemned by others, including a pathologist who gave his opinion on a recent Panorama programme. Their opinion should be confined to the Donald Trump School of Evidential Science. 

The controversy regarding insulin poisoning has been widely explored. Professor John Gregory recently endorsed (on the same Panorama programme) the opinion of his fellow paediatric endocrinologist Prof Peter Hindmarsh, stating that baby F and baby M were both poisoned with insulin. Insulin poisoning had been accepted by Letby’s Defence team at the trial, and indeed by Lucy Letby herself. 

Criticism of the neonatal unit building was reasonable, and the unit has long moved to more suitable premises. Alleging that the department was “failing” or unsatisfactory is unfair and unreasonable. Survival rates, the best quality control of any neonatal unit, were as good in Chester as the ONS [Office of National Statistics] figures for England & Wales, even for the smallest babies. The Thirlwall Inquiry confirmed that staffing was similar to other units in the North West of England. 

Mark McDonald and his team failed to show any new evidence that would justify another appeal. Unhelpfully for him, this week’s Law Society Gazette article by Bianca Castro (26 September) states: “Conviction did not uncover anything new, a potential problem if the CCRC [Criminal Cases Review Commission] are to refer the case back to the Court of Appeal.”  
The victims in the Letby Trial are the babies harmed and murdered by Lucy Letby, and their families. A campaign to release England’s worst female serial killer is beyond my understanding. It adds to the hurt and grief the families have suffered for the past decade. 

I wrote about the WHO for the Telegraph over the weekend. One of its Regional Directors has said that he wants to "erase" alcohol. In the article I discuss the malign influence of "Movendi" - the temperance group formerly known as the International Order of Good Templars - who are official partners of the WHO (fun fact: they are funded by the Swedish lottery). 

Movendi is one of the “civil society” groups that Dr Piukala described as “essential” in his speech this week. Drinkers everywhere should be worried about a gospel temperance society collaborating with the world’s biggest health agency, although the WHO has become so puritanical and dogmatic in recent years that it is hard to know which of them is more extreme.

They both want to denormalise alcohol through advertising bans, licensing restrictions and sin taxes. They both claim that drinking is harmful at any level. They both compare alcohol to tobacco and equate the alcohol industry with the tobacco industry. This is no small thing when WHO Europe explicitly says that its goal is to create a society that is not just “tobacco-free” but “nicotine-free”.

 More fool anyone who isn't worried about the direction of travel. The WHO didn't always want to eradicate tobacco. At one time, it would have accused anyone who suggested that it had prohibitionist intentions of being hysterical. They now explicitly want to eradicate not just tobacco but nicotine. If you don't think they would like to eradicate alcohol, even as a WHO Regional Director essentially says as much, then I am afraid that you are gullible. On the point of erasing nicotine, Clive Bates points out that the UN's snappily titled Political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being has been made worse since it was first drafted. In the first draft, there was "only one asinine reference to nicotine" (a reference to electronic nicotine delivery systems), but now member states are urged to focus on "nicotine control". 

This is supposed to be a statement about NCDs (i.e. cancer, cardiovascular disease, COPD, etc) finalised after a lengthy deliberative process. It is intended to focus on UN SDG Target 3.4, which aims to reduce mortality in adults aged 30-70 from major NCDs by one-third by 2030. The target that is likely to be missed by some distance. Yet, the text refers throughout to “tobacco and nicotine control” even though the primary driver of NCDs is not tobacco per se or nicotine, but smoke, including tobacco smoke.

  The good news is that the UN was forced to water down some of the messaging in the final draft. For example, member states were told to "Increase taxation on tobacco, alcohol and sugar-sweetened beverages" in the first draft, but in the final draft this has been changed to "Consider introducing or increasing taxes on tobacco and alcohol to support health objectives, in line with national circumstances". But its crusade against nicotine has been ramped up, with member states encouraged to: 

(a) significantly reduce tobacco and nicotine use by: (i) implementing health warnings on all tobacco and nicotine packages; (ii) restricting tobacco and nicotine advertising

 A nicotine-free world isn't going to happen. It is a pie in the sky prohibitionist fantasy. But, as I say in the Telegraph article, people can do a lot of damage reaching for Utopia.  The irony is that, even if you think that using state coercion to create a smoke-free world is an ethical objective, it is made much more difficult if you fight a parallel war against nicotine, firstly because you will be using scarce resources on multiple targets and secondly - most importantly - because people are more likely to stop smoking if they can use a safer form of nicotine.

The one-club golfers in 'public health' want plain packaging for vapes because of course they do. I've written about it for The Critic ... 

The epidemic of misinformation about the risks of vaping is one of the great public health disasters of the century and is all the more shameful for having been driven by people who have words “public health” in their job titles. The “popcorn lung” myth, the EVALI hoax and an endless series of tabloid scare stories — combined with the enduring misconception that nicotine causes cancer — have turned public understanding on its head. As the graph below shows, twice as many Britons think that vaping is as dangerous as smoking, if not worse, than correctly believe that it is far less harmful.

If vaccines or paracetamol were subjected to the same level of misinformation, public health professionals would be working frantically to move the public’s perceptions towards reality. Insanely, they are doing the opposite. The government’s Tobacco and Vapes Bill will give the health secretary Henry VIII powers to regulate vapes like cigarettes, thereby cementing the notion in the public’s mind that the health risks are comparable. The government is being cheered on by a motley assortment of fork-tongued “public health” academics and activists who pay lip service to the benefits of e-cigarettes while doing everything they can to suppress demand for them. 

A particularly egregious example of this was reported by the Independent this week. Members of the tiny, state-funded, prohibitionist pressure group Action on Smoking and Health have teamed up with researchers from King’s College to demand plain packaging for e-cigarettes. There is, of course, only one other product that comes in plain packaging: combustible tobacco. 

 Do read it all. As an aside, one of the authors of the study is Deborah Arnott who memorably claimed that 'the “domino theory” i.e. that once a measure has been applied to tobacco it will be applied to other products is patently false'. She was campaigning for plain packaging at the time.

 

 

 

 

A new law is going through Parliament to ban public officials from misleading the public. It sounds like a good idea, but it has the potential to spiral out of control very quickly. I've written about it for The Critic . 

The bear trap in the Public Office (Accountability) Bill is the unprecedented creation of a new criminal offence, punishable with up to two years in prison, of “misleading the public”. Section 11 of the Bill reads as follows:

A public authority or public official commits an offence if, in their capacity

as such an authority or official—

(a) they act with the intention of misleading the public or are reckless as

to whether their act will do so, and

(b) they know, or ought to know, that their act is seriously improper.

The reason journalists prefer to use cumbersome words such as “falsehood” and “untruth” rather than the more direct “lie” is that it is inherently difficult to prove that a person has deliberately fabricated something rather than made a simple mistake. The Bill attempts to swerve this problem by making it a crime to be “reckless” about misinformation, but this is so vague as to give lawyers a ludicrous degree of latitude. If the person knows – or “ought to know”! – that their untruth is “seriously improper”, they could face jail, but what is “seriously improper”? According to the Bill, it is anything that “a reasonable person would consider … to be seriously improper”. So that clears that up. It is also anything that “caused, or contributed to causing, harm to one or more other persons”. But what is “harm”? The Bill defines it as “physical harm, psychological harm (including distress) and economic loss”. This, again, seems rather broad.

On the face of it, this appears to mean that if any of the state’s six million employees says something untrue which someone else finds upsetting, they have committed a crime. Whether they are convicted will depend on a jury believing, firstly, that the individual knew that what they were saying was untrue — or were “reckless” in not checking whether it was true — and, secondly, that they knew that it would cause “psychological harm”. 

This example might seem a bit reductio ad absurdum, but assuming the worst is not a bad way to test legislation in the current year. Section 11 takes up barely a page of the 66 page Bill and leaves so much open to subjective judgement that it is impossible to predict how it will be used, but it is not difficult to see how it could be weaponised for political reasons. The most obvious targets will be politicians themselves. In the future, when you see an MP on Question Time claiming that Liz Truss crashed the economy or that the Tories spent £37 billion on an app, instead of complaining about it on Twitter, you can call the police, citing emotional distress.

 

 Taking a rare break from trying to free Lucy Letby, Private Eye's Phil Hammond has written a justified excoriation of the star turn at Reform UK's recent conference, Aseem Malhotra. I agree with most of it and I have said same much the same myself, but I was struck by this sentence... 

Malhotra is particularly dangerous because he talks sense in some areas (eg. lifestyle medicine) while spouting scaremongering conspiracies with no credible evidence base.

 When, exactly, did Malhotra ever talk sense about "lifestyle medicine" or anything else? When he said that saturated fat was good for you? When he said that exercising won't help you lose weight? When he said that Italians have a low carb diet?  Perhaps Hammond is thinking about the time when he claimed that sugar was the new tobacco, but that's not really based on "credible evidence", is it?  Or perhaps he's thinking about when he claimed - in a journal article that had to be corrected - that the food industry has been “buying the loyalty of bent scientists". Doesn't that sound like a scaremongering conspiracy theory? Maybe he's thinking about the time he said that people who have high cholesterol live longer than people who don't, and that Big Pharma doesn't want you to know that? Again, that sounds like a bit of a scaremongering conspiracy with no credible evidence base to me. You can go back as far as you want but you will not find Malhotra "talking sense" about anything. All that has happened is that he has swapped high status conspiracy theories for low status conspiracy theories.  What makes Malhotra dangerous is not that he talks sense but that he abuses the trust that people have in doctors by cherry-picking evidence to suit a particular narrative. He's been doing it from the start. That is why he was able to hide in plain sight among 'public health' campaigners for so long.

 

 

As reported in the Independent ...  

Problem gamblers four times more at risk of suicide attempt by age 24 – study

 This is exactly how the press release that was e-mailed out yesterday was headlined although the online version has a slightly different wording... 

Pioneering research reveals problem gambling quadruples the risk of suicide among young people four years later

 Curiously, this claim does not appear in the study itself. Nor does the following claim from the press release... 

Lead author Olly Bastiani, PhD researcher at the University of Bristol Translational and Applied Research Group, said: “This study tracked people from birth, meaning we could look at the long term impacts of problem gambling, and could rule out alternative explanations that hinder previous studies, such as that people might be drawn to problem gambling as a way of escaping pre-existing suicidal feelings.”

 There is, in fact, no way for such a study to rule out other factors for an attempted suicide.  So what does the study really show? It is based on 15,645 people born in the 1990s in the Avon Longitudinal Study of Parents and Children. "Tracked from birth" is an exaggeration, but it does include survey evidence about whether they had ever attempted suicide at the ages of 16, 24 and 25, and it has survey evidence showing their PGSI (problem gambling) scores at the age of 20 and 24. A PGSI score of 8 or more out of 27 is the conventional threshold for problem gambling. The idea behind the study is to see whether suicide attempts are preceded by problem gambling, thereby strengthening the correlation and reducing the risk of erroneous reverse causation (i.e. that suicidal feelings lead to problem gambling). The researchers also control for other factors that could lead to suicide attempts, such as alcoholism. To cut a long story short, they find associations. They find that people who are problem gamblers aged 24 are 15% more likely to have made a suicide attempt in the last twelve months at the age of 25. They also find that people who are problem gamblers aged 20 are 20% more likely to have made a suicide attempt in the last twelve months at the age of 24. The latter finding is a relative risk of 1.20 and is after controlling for other factors.  Although it is not made clear in the study, the press release says that...  

The future suicidality link was most stark among 20-year-olds, where there was a 20% increase in suicide attempts for every increment on the PGSI meaning that those scoring eight and above experienced quadruple the rate of suicide attempts four years later. 

 This seems to be saying that someone who scores 1 out of 27 in the PGSI test is 20% more likely to kill themselves. That sounds unlikely. To get 1 out of 27, all you have to have done is "bet more than you can really afford to lose" or "gone back to try to win back money you had lost" in the last twelve months. It is hard to see how this could drive anyone to suicide. The researchers have then multiplied 20% by something to get a figure of 400% for people who are actually problem gamblers (i.e. score 8 or more). That suggests 20% x 20, but it is unclear where the 20 comes from. 20% x 8 seems more logical, but that only produces 160%. I confess that I am rather baffled by how they came up with the claim that "problem gambling quadruples the risk of suicide". None of this stuff is in the study, so we can only guess where it came from. Did the authors find an association between attempted suicide and low PGSI scores and draw a linear line upwards or did they find an association with high PGSI scores and draw a linear line backwards? One thing is for sure: there were not enough attempted suicides for them to confidently draw conclusions about people with low, moderate and high PGSI scores. The study seems to be 95% maths and 5% data, and the most important data is not presented. A lot of data simply doesn't exist and had to be "imputed" (i.e. guesstimated). Of the 15,645 people born into the study, 10,528 did not answer any questions about suicide attempts. That is 67%. Of the 4,331 people who answered the suicide questions, 2,616 (60%) did not answer the gambling questions. There were only 729 people who answered all the relevant questions and only 11 of them had attempted suicide in the past year. These are very small numbers of self-selecting people to be drawing bald conclusions about. Moreover, the authors chose not to control for several co-morbidities that seem relevant. They controlled for alcohol use disorders, socio-economic status and hyperactivity (all of which are strongly correlated with suicide attempts), but not illicit drug use or - surprisingly - mental health disorders. Although they give reasons for this, they acknowledge that it may be a weakness: 

Our selection of covariates was parsimonious. Other studies with greater power should include additional covariates such as depression, anxiety and illicit drug use to investigate whether these influence the relationship between PGSI and suicidality.

 The study itself is quite cautiously written and heavily caveated. At the end, the authors say: 

In conclusion, the present study found evidence of positive associations between harmful gambling and current and future suicide attempts among young UK adults, which was unlikely to be confounded by pre-existing suicidality. 

 That is a reasonable summary, as is the statement in the abstract that "this association may be more complex long-term, and increases in harmful gambling during adulthood may not be an important factor", but it is in contrast to the press release which claims the study was able to "rule out alternative explanations" (implying that all alternative explanations were ruled out, not just pre-existing suicidality). No such claim can be reasonably made. It is perfectly possible for someone who was neither a problem gambler nor suicidal at the age of 20 to have gone down a dark path by the age of 24 in which symptoms of problem gambling feature but are not terribly important.  It is fairly obvious that suicidal people typically have a number of different problems in their lives. A study published a few weeks ago found that problem gamblers in a Swedish hospital had a wide range of co-morbidities and were more likely than the average person to kill themselves, but that problem gambling per se  was not a risk factor for suicide. Despite the grandiose claim that the people in the new study have been tracked since birth, the authors do not have enough knowledge about their circumstances to be able to claim a causal link between "harmful gambling" and attempted suicide and, to be fair, they do not make such a claim explicitly in the study. The press release is a different beast, however. The press release seems designed to get the factoid that problem gamblers are four times more likely to attempt suicide into circulation. It also includes the red flag of a call to political action....  

Dr Newall said: “Gambling is a part of the government’s suicide prevention strategy, and these results help underscore the need for additional population-wide measures to prevent gambling harms, such as meaningful restrictions on gambling advertising.”

 The study has nothing to do with advertising or any other "population-wide measure". This is pure editorialising.  Incidentally, if we want to know what effect an advertising ban would have, we can look at what the problem gambling prevalence was in the first major gambling survey in 1999 - 8 years before gambling ads were legalised. The figure was 0.6%, statistically indistinguishable from the 0.4% reported in the most recent survey of this kind.  (Still more incidentally, the authors claim in the study that the "latest official Great Britain statistics have noted a significant increase in estimated prevalence rates for harmful gambling". This must be a reference to the new Gambling Commission online survey which gives a figure of 2.5%. The flaws of this survey are well understood, but even its supporters acknowledge that its figures can't be compared to figures from different surveys. The Gambling Commission has explicitly told people not to make such apples and oranges comparisons.) The claim that problem gambling is a major cause of suicide is central to the argument that gambling is a "public health" issue. The aforementioned Swedish study should put an end to the zombie claim that "up to" 496 suicides are linked to gambling every year in Britain (since it was an earlier version of the Swedish study that Public Health England used to make its foolish extrapolation), but there is a palpable urge on the part of anti-gambling campaigners and 'public health' academics to quantify something that probably cannot be quantified. Now that the gambling research field is awash with cash, expect to see much more of this.