Gin Lane

doi:10.1136/bmj.39504.377755.43

BMJ 2008;336 (1 March), doi:10.1136/bmj.39504.377755.43

Editor's Choice

Gin Lane

Jane Smith, deputy editor, BMJ

In this week’s opening editorial Thomas Babor proposesthat countries are like people when it comes to alcohol: somecan handle their moderate drinking well, but some—likeBritain—develop "a pathological pattern of alcohol misuse"(doi: 10.1136/bmj.39496.556435.80).

Babor is writing about the BMA’s report on alcohol misuse,which came out last month (doi: 10.1136/bmj.39495.570185.C2)and provided newspapers with the opportunity to print imagesof young women handling their drink badly. Babor commends thereport for marshalling well the evidence for its suggested combinationof increased taxes, controlling access to alcohol, and encouragingearly intervention and treatment. Such measures, he suggests,might return the UK to its former status as a temperate nation.But temperance isn’t the only state historically associatedwith Britain: not for nothing is Hogarth’s Gin Lane oneof Britain’s iconic images.

What works in alcohol misuse, but at the individual level, isalso the subject of the Clinical Review on diagnosing and managingalcohol disorders by Andrew Parker and colleagues (doi: 10.1136/bmj.39483.457708.80).For people whose drinking has not yet become harmful, they emphasisesimple and non-judgmental screening questions and brief advice—againsimple and non-judgmental—from general practitioners andnurses in primary care and emergency settings.

Trish Groves has a simple suggestion too: why can’t halfbottles of wine be as available in Britain as they are elsewhere(doi: 10.1136/bmj.39503.505475.59)? "Selling half bottles won’tstop some drinkers from simply having two," she says, but itmight stop the middle aged middle classes from getting wasted.

In some ways "alcohol misuse" seems a relatively simple subjectto debate: alcohol causes known harms and there’s wideagreement (and evidence) on measures to minimise the harms andtreat them. Quality improvement is a more slippery subject.The ferocity of the letters responding to Chris Ham’seditorial on quality failures in the NHS prompted me to re-readwhat he had written. He was drawing on a Healthcare Commissionreport on lessons from recent quality failures in the NHS andwrote about the difficulties of establishing a "culture" ofsafety and of continuous improvement in the NHS, and he emphasisedthe need for leadership at all levels (doi: 10.1136/bmj.39486.406308.80).The common theme of our letter writers is that clinicians andtrusts don’t get a chance to show leadership because ofthe meddling of politicians—and indeed of policy and managementexperts such as Ham. This has led, says Chris Luke, to the emasculationand "proletarianisation" of the medical profession (doi: 10.1136/bmj.39500.453623.1F).

Yet this week’s journal also has an account of how continuousimprovement can be made to work, in the description by MuirGray and colleagues of how continuous improvement was builtinto the UK’s national breast cancer screening programme(doi: 10.1136/bmj.39470.643218.94). They emphasise the challenge:"The tasks are repetitive and potentially boring, the marginbetween success and failure is fine, consumer expectations keeprising, and the potential of errors to destroy public confidenceis great." And their answer? As nuanced as the problem, andthey tell the story well.

A prescription for amnesia: Chris Luke
BMJ 2008 336: 463. [Extract] [Full Text] [PDF]

Maximising benefit and minimising harm of screening: J A M Gray, J Patnick, and R G Blanks
BMJ 2008 336: 480-483. [Extract] [Full Text] [PDF]

Diagnosis and management of alcohol use disorders: Andrew J R Parker, E Jane Marshall, and David M Ball
BMJ 2008 336: 496-501. [Extract] [Full Text] [PDF]