There was a moment in the early 1990s when deodorant advertisements started showing men spraying not only their armpits but also their chests. Even as a teenager who was very much in Lynx’s target market, this struck me as an unsubtle attempt to increase sales by getting people using more deodorant than was strictly necessary.

I don’t know if it worked, but such advertising tricks are unusual. In essence, most advertising says either “hello, we’re still here” or “you should try our product some time”. Advertising is quite a simple business and only two groups of people have an incentive to make it sound cleverer than it is: those who work in advertising and those who hate advertising, or at least hate certain things being advertised. 

If you advertise alcohol, you can’t get away with telling people to drink more, but that is what temperance campaigners think booze adverts do anyway, and so they want them banned.

…a large number of economic studies have found no correlation between expenditure on alcohol advertising and per capita consumption of alcohol

The question of whether alcohol advertising makes people drink more is one that can be answered with empirical evidence. I’ve been looking at all the studies for a report published by the IEA today. In short, a large number of economic studies have found no correlation between expenditure on alcohol advertising and per capita consumption of alcohol. Only a few researchers have looked at alcohol advertising bans, but most of them have found that they make no difference to how much people drink. Even when people are shown alcohol advertisements and offered drinks right there and then, sometimes for free, most studies do not find an effect. 

The only studies that typically find an association between alcohol advertising and alcohol consumption are those conducted by “public health” researchers which ask people to recall how much alcohol advertising they have seen in the last week or month. Heavier drinkers generally report seeing more adverts, although this is likely to be the result of ‘recall bias’. People who like a product are more likely to pay attention when it is advertised. In any case, advertising is not random. Advertisers target the demographics that are most likely to consume their products.

A Cochrane Review — considered the gold standard of scientific evidence — concluded in 2014 that: “There is currently a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions.” I can only concur.

The response of the “public health” lobby to empirical evidence that gives little support to their policy demands has been to ignore it and simply assert that booze advertising makes people drink themselves to death and must be banned. They repeat it again and again, as if to convince themselves as much as anyone else.

The gold-plated version of this self-serving delusion is the claim that alcohol advertising is not just associated with more drinking but is causally associated with it. The Institute of Alcohol Studies (the successor to the United Kingdom Temperance Alliance) repeated that claim this week.

Causality can rarely be proven in epidemiology and certainly can’t be inferred from the kind of social science that has barely been able to claim a correlation between advertising and consumption.

The idea that “alcohol marketing is causally linked to young people drinking” comes from an article published in 2020 by two American advocates of alcohol advertising bans, James Sargent and Thomas Babor. They reference a famous lecture from the great epidemiologist Austin Bradford Hill titled “The Environment and Disease: Association or Causation?” in which he set out nine criteria that should be assessed “before we cry causation”. Hill did not claim to be laying out iron laws, but his speech has stood the test of time because it appeals to common sense and sound judgement. Hill is best known for identifying the link between smoking and lung cancer which, by 1965, has been recognised as causal. He would be dismayed to see the state of “public health” research today. 

Let’s see how the evidence cited by advocates of alcohol advertising bans stacks up against Hill’s criteria…   

1. Strength of the association

Hill suggested that the nine- or ten-fold increase in lung cancer risk among smokers was large enough to imply causation whereas a doubling of risk would have been small enough to allow room for doubt. Associations between alcohol advertising and youth drinking, when they exist, rarely achieve a relative risk as high as 2.0 and never come close to 10.0. Even Sargent and Babor admit that such positive associations as exist are “modest”.

2. Consistency

The association between alcohol advertising and drinking at any age is anything but consistent. Even Sargent and Babor acknowledge that the evidence is “mixed”.

3. Specificity

There are many factors which influence the propensity of young people to drink. Insofar as advertising is one of them, no one would claim that it is a necessary or sufficient condition.

4. Temporality

For Hill, it was important to establish that the disease came after exposure to  the risk factor, rather than the other way round. Substituting “drinking” for “disease”, it is often difficult to establish this in some of the advertising studies. Reverse causation is clearly possible when studies rely on individuals recalling how much advertising they have seen. Some researchers have even claimed that owning alcohol-branded merchandise makes people drink more despite it being fairly obvious that the causation runs in  the opposite direction, i.e. heavier drinkers are more likely to own alcohol-branded merchandise.

5. Biological gradient

In epidemiology it is generally expected that there will be a dose-response relationship, with greater exposure to the risk factor leading to greater risk. Several studies have found an association between alcohol advertising and alcohol consumption that rises as exposure to advertising increases, but these studies suffer from the usual problem of recall bias which may also be on a gradient, with heavier drinkers more attentive to alcohol advertising than moderate drinkers. Studies which do not rely on self-reporting, such as this one and this one, found a conspicuous lack of a dose-response relationship.

At the national level, an increase in alcohol advertising does not lead to more alcohol being sold. In the USA, alcohol advertising expenditure rose by nearly 400 per cent in real terms between 1971 and 2012, but there was little change in per capita alcohol consumption. In Britain, alcohol advertising spend fell by 10.8 per cent in real terms between 1991 and 2001 but alcohol consumption rose by 15.8 per cent. Wine is not advertised much in Britain whereas beer and spirits are heavily advertised, and yet since 1970 there has been a huge rise in wine sales, a huge fall in beer sales and no change in spirits sales.

6. Plausibility

The broader economics literature indicates that once everybody knows about a product, advertising only affects brand share and has no impact on overall consumption. Since alcohol is a mature market, it is implausible that it would be an exception to this rule. As Tim Ambler says:

The understanding that total advertising does not affect total market size is not particular to alcohol; it is normal for other mature categories…

For some public health and temperance campaigners, however, it seems highly plausible that the promotion of a product will lead to greater consumption of it. They often say of alcohol advertising: “If it doesn’t work, why would the industry spend so much money on it?”. Their mistake is to see the alcohol industry as a monolithic entity rather than a group of rival businesses. The alcohol industry does not advertise. Alcohol companies advertise, and it is worth their while to spend money attracting other companies’ customers and keeping hold of their own. It is fallacious to argue that the mere existence of advertising proves the association.

7. Coherence

Hill noted that the epidemiological evidence on smoking and lung cancer emerged against a backdrop of rising lung cancer cases in countries where cigarette smoking had become popular. It was a known problem looking for an explanation. As mentioned above, there is no such temporal relationship between the amount of alcohol advertising and the amount of alcohol consumed in mature markets.  

8. Experiment

Randomised experiments have produced conflicting and unimpressive results, with most studies being consistent with the hypothesis that alcohol advertising has no effect on overall alcohol consumption.

9. Analogy

Alcohol advertising is analogous to the advertising of other well established products in mature markets. Evidence from the broader economics literature has been summarised in the New Palgrave Dictionary of Economics as follows: 

At the aggregate level, advertising tends to lag cyclical changes in total consumption slightly, not to lead those changes… Overall, advertising does not emerge from the empirical literature on consumer demand as an important determinant of consumer behaviour.

The flimsy findings from the public health literature clearly meet none of Hill’s criteria for causality and are at odds with the evidence from other disciplines, notably economics. That hasn’t stopped the ridiculous claim of causality being repeated by pressure groups like Alcohol Focus Scotland who said, in a report cited by the Scottish government in its 2022 consultation on alcohol advertising regulation: 

Research has now established a causal connection between children and young people’s exposure to alcohol marketing and drinking (p. 7) 

There is a wealth of evidence that exposure to alcohol marketing is causally linked to consumption. (p. 34) 

There is conclusive evidence of a small but consistent association of advertising with consumption at a population level. (p. 34) 

Significantly, research published since the Network’s first report has now established a causal connection between children and young people’s exposure to alcohol marketing and drinking. (p. 41)

The evidence is clear that exposure to alcohol marketing is a cause of youth drinking. This is the conclusion reached by researchers applying the same methodology that established the causal link between tobacco and cancer. (p. 41)

Austin Bradford Hill is a revered figure in science and this is not the first time lesser academics have tried to steal some valour by associating themselves with him. In 2017, the British Medical Journal published a study claiming that minimum unit pricing for alcohol — a policy that had never been tried anywhere — met Hill’s criteria. It is one of most absurd things I have ever read in an academic journal. 

This is bluffing on an epic scale. Thanks to the alchemy of academic publishing, once a couple of zealots get their opinion printed in a journal it becomes a fact to be recited forevermore by pressure groups. Hill must be spinning in his grave.