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Rapid Responses: Rapid Responses published:
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Social problems and health problems
- Peter J Allmark (19 March 2004)
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Epidemiological studies underestimate alcohol risks
- Ellen C G Grant (19 March 2004)
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Complacency about alcohol equals lack of action.
- Peter R O'Loughlin, Beckenham. BR3 3AT Richard Smith (19 March 2004)
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A Societal Problem
- Graeme M. Cunningham,M.D.,FRCP(Glas,FRCPC (19 March 2004)
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A look from the third world
- Silvio Najt (21 March 2004)
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Alcohol misuse&Substance misuse are the major problems of the developed World.
- AK Al-Sheikhli (21 March 2004)
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very sad indeed
- Dr mohan devegowda (22 March 2004)
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"Courage mon Brave"
- Alex Thain (23 March 2004)
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Alcohol price raise and alcohol impaired driving prevention
- Ediriweera B.R., Desapriya (24 March 2004)
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Wrong question
- Wouter Havinga (5 April 2004)
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On complacency about alcohol
- Linda Hawes Clever (26 April 2004)
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Peter J Allmark, Senior Nursing Lecturer University of Sheffield S5 7AU
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Richard Smith asks why we are complacent about alcohol. One reason may be that health professionals are reluctant to extend their remit to social problems. Tony Blair's foreword to the government's strategy opens with a concern about "antisocial behaviour". It is the business of the police and related departments to deal with this, not health carers. If we focus solely on health then the problem becomes one of strategy. At least in principle this is relatively easy when one is dealing with smoking, a behaviour which unequivocally harms health. How, though, do we get across a message along the lines of, "some alcohol good, too much bad - but we don't know how much and it depends on whether you spread it out over the week"? What appears to be complacency may be justified caution. Competing interests: None declared |
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Ellen C G Grant, physisian and medical gynaecologist 20 Coome Ridings, Kingston-upon-Thames, Surrey, KT2 7JU, UK
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Editor- You ask why we are complacent about alcohol?1 Epidemiologists got the risks of taking progesterones and oestrogens wrong for decades. I think the claims that some alcohol is good for you, because of the J curve finding in epidemiological studies, has also been misleading. I cannot remember seeing a migraine patient who could tolerate red wine. As migraine patients are more likely to have zinc and magnesium deficiencies, they are also more likely to have impaired immunity and therefore, everything else being equal, they have more risk of premature illness and death. This leaves oral contraceptives, menopausal hormones and smoking as the main precipitants of migraine-clinic migraines.2 As highest risk individuals are self-excluded from drinking alcohol, the absurd conclusions from epidemiological studies, which usually measure nothing biochemically important, are that some alcohol is good for everyone. Alcohol is a cell poison and the effect of daily or binge alcohol intake is easily seen in sperm quality. IVF clinics regard a 50% reduction in sperm count, with 50% abnormal sperms, as "normal " enough to be used for assisted conceptions. Partners may be stimulated into superovulations, irrespective of severe antioxidant impairments such as low red blood selenium levels and copper or manganese deficiencies with superoxide dismutase dysfunction. This not only increases the risk implantaion failure or foetal abnormalities but also of ovarian cancer in the woman. Yesterday's news was that more 16 year-olds than ever before are taking oral contraceptives, smoking and drinking alcohol. If social manipulators wanted to give future children a high risk of autism, dyslexia or attention deficit disorder, this would be the way to go. 1. Smith R. Why are we complacent about alcohol. BMJ 2004;328: 2.Grant ECG. Oral contraceptives, smoking, migraine and food allergy. Lancet1978;2:582. Competing interests: None declared |
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Peter R O'Loughlin, Principal Partner The Eden Lodge Practice, Beckenham. BR3 3AT Richard Smith
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Richards Smith's article did not apart from the old suggestion of increasing the price, (why punish everyone for the actions of a minority?) offer any solutions. Further his comment that we have made progress with addressing smoking ignores the ineffective interventions that are currently available. In addressing the former I would suggest that for those who as the result of drinking alcohol engage in anti social behaviour, a statutory fine of £1000.00, yes one thousand pounds, to be deducted at source from their income would have a salutory, if not sobering effect. Subsequent incremental fines for repeat offenders, may prove more effective than 'Motivational Interviewing'or Cognitive Behaviour Therapy. If nothing else it would have a severe impact on their financial ability to drink to excess. Insofar as smoking is concerned, if one were to research the number of ex smokers who had been abstinent for a period of 12 months, then calculate the number of new and relapsed smokers, I suggest that the net result, on a national basis, in the reduction of smoking would be in the region of 4%. The hype issued by goverment influenced sources on the smoking statistics are in many cases based on those who have been abstinent for a period of two weeks. When on the various occassions I have asked these sources for the 3, 6 and 12 month figures, I am informed that 'they are not available'. Since I work in a private capacity, I suggest that if I were to attempt to claim success on such dubious statistics, I would lay myself open to charges of 'sharp practice'. I would also add that to seek to make comparisons between what is a non psycho active drug and the highly psycho effects of alcohol is pointless. Finally there is nothing new about drunkeness, or anti-social behaviour, it is simply more widespread as the result of ineffective interventions, again by goverment funded sources for those who concede they have a problem and are seeking help, together with ineffective punishments for those who lack both responsibility and respect for themselves, and are not in the least concerned about the impact of their behaviour on others. Competing interests: Substance abuse and addiction recovery interventions |
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Graeme M. Cunningham,M.D.,FRCP(Glas,FRCPC, Director,Addiction Division Homewoodhealth Centre,Ontario,Canada
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Dr.Smith's editorial suggests the only solution to excessive alcohol use is to raise the price of beverage alcohol and I agree somewhat.However,the acceptance of public intoxication in the U.K has always been passive and indeed often seen as humorous.If society took the same attitude to this as it does to second-hand smoke,smoking in enclosed spaces and drunk driving then perhaps consumption might moderate.Also Dr.Smith's candid admission of his alcohol use places him at the upper limit of the WHO level of safe alcohol use.Caveat emptor!. Competing interests: None declared |
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Silvio Najt, Private Parctice Buenos Aires, Argentina, 1414
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Our health authority recommends that drinking alcohol is good for the heart, in a place where like most of the third world places, has a severe incidence of alcoholism. One glass of red wine is good, then what about a bottle? probably better. Heart disease is a major burden but it wont go away just by adding more aggressions to our patients cells and tissues, how come alcohol is good? where is the hard data to prove this statement? Third world´s poor health situation is caused by smoking, poor eating habits (beer and wine are cheaper than milk), obesity, Chagas disease, malnutrition, lack of education opportunities, poverty, unemployment...but most of all because our bureaucrats repeat that all will improve by drinking a glass of red wine with every meal. Ain´t this a naïf and misleading message? Competing interests: None declared |
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AK Al-Sheikhli, Psychiatrist Medical Centre,Nuneaton,CV11 5HX,England.
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122th,March,2004 EDITOR-It was interesting to read the Editorial of Dr,Smith,Why we are complacent about alcohol?(BMJ 2004;328:0-g).My comment that, 1.Alcohol and substance misuse are both the main cause of the followings ,a.Psychological problems,like depressive illness, suicide and attempted suicide,drug related psychotic episodes,...etc. b.Physical problems,like cirrhosis of the liver,HIV/AIDS infection,Hepatitis B,C...,Cardiomyopathy,polyneuropathy,erectile dysfunction.etc. 3.Social problems,like marital problems and divorce.Sexual offences,motor offences and aggressive behaviour ..etc,even murder.Work problems and loss of jop..etc.Child &,mother battering. 2.Although raising the price might help in reducing the the number who abuse alcohol,but by reducing its avialibility also will help,beside to have an alternative for alcohol for social settings,like other types of soft drinks..etc. 3.If alcohol continue to be the main way to socialise,and if there are many pubs in any locality,how can we reduce the number of alcoholics.per capita consumption of alcohol depends on its avialibility, Thanking you, Yours sincerely, AK.Al-Sheikhli Competing interests: None declared |
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Dr mohan devegowda, GP solo clinic
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sir, Why are we complacent about alcohol i feel it is for following reasons. 1.Most of the doctors drink and we also patronise in meetings. 2.When a patient asks about alcohol we all try to educate about the quantity and what to drink and quote the royal society of psychiatry's prescription! 3. most of the income for the GOVT come from levying heavy taxes on alcohol. so it wil never work. mohan Competing interests: None declared |
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Alex Thain, GP Ardlarich Medical Practices, 15 Culdthel Road, Inverness , IV2 4AG
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Well done to our editor! If we are in any way insightful as Practitioners, politicians or policy makers, some honesty may serve as our most positive contribution to our function as (albeit unsolicited) role models. Honesty is a core belief for many many of our patients and helps us relate to them in a truly adult way. Of course, this should not excuse our tackling of alcohol problems within our own profession but it may serve to moderate the Calvanist impression which we appear to portray. Perhaps this is the truest confession of "conflict of interest"? Competing interests: None declared |
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Ediriweera B.R., Desapriya, Research Associate-Department of Pediatrics Centre for Community child Health Research, 4480 Oak Street Vancouver BC V6H 3V4
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Dr.Smith's editorial suggests the only solution to excessive alcohol use is to raise the price of beverage alcohol. In addition there are effective policies in controlling excessive alcohol consumption and related dangerous behavior and however they have become ineffective because the scientific standards we have set as legal limits are too permissive. Alcohol impaired driving is the most dangerous alcohol consumption and related behavior in the world. For more than a century, alcohol has been recognized as one of the principal risk factors for automobile crashes (1) The damage alcohol does to society is great. For example, nearly half of the roughly 35,000 fatal automobile accidents in the United States each year are alcohol-related, meaning that someone in the accident, usually a driver, is intoxicated. Currently, a Blood Alcohol Concentration Level (BAC) laws range from 0.08 to 0.10 mg% constitutes prima facie evidence in most countries for ‘Driving Under Influence of Alcohol.’ In UK, USA, Canada, South Africa and Sri Lanka the legal BAC limit is 0.08mg%. This standard is too permissive, as driving skills deteriorate and crash involvement risk increases beginning at 0.02%. Recent comprehensive review by Zador et al. (2) estimated that a driver’s risk of being in a fatal crash significantly increase of .02% in BAC. Scientific data provide clear evidence that important driving skills are impaired at very low BACs. Because in most of the countries the legal BAC limit is so high, it is often erroneously believed that one may drive up to a BAC of 0.8% overlooking the fact that driving is impaired at lower BAC. There are consequences attached to setting a BAC limit so high that a 72 kg man can drink four bottles of beer and still be under legal limit. In this sense high legal BAC limit may influence people to make bad estimates of their relative risk of injury or death while driving. It is emphasized that better drinking and driving policy designs and enforcement decisions need to be hinge on the scientific evidence (3). References: (1). National Institute on Drug Abuse. Consensus development panel. Drug concentrations and driving impairment. JAMA. 254: 2618–2621;1985. (2). Zador PL, Krawchuk SA, Voas RB. Alcohol-related relative risk of driver fatalities and driver involvement in fatal crashes in relation to driver age and gender: an update using 1996 data. Journal of Studies on Alcohol.61 (3):387-95; 2000 (3). Desapriya, E.B.R and Nobutada Iwase International policies on alcohol impaired driving: are legal blood alcohol concentration (BAC) limits in motorized countries compatible with the scientific evidence? Japanese Journal of alcohol and drug Dependence. 38(2):83-102; 2003. Competing interests: None declared |
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Wouter Havinga, Locum GP and life coach www.ISEEcoaching.com GL6 6JL
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Competing interests: www.ISEEcoaching.com |
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Linda Hawes Clever, President, RENEW USA
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I could tell the depth of Richard Smith's concern, because he did not offer solutions. Some solutions are indeed available! He might want to get material from the former Physician Leadership for National Drug Policy (David Lewis, MD; Center for Alcohol and Addiction Studies; Brown University; Box G-BH; Providence, RI 02912). Indeed, solutions for alcohol abuse are a whale of a lot better than any approach we’ve found so far to obesity! (Brain and genetic research looks promising regarding obesity, but therapies are years away at best.) Furthermore, treatment for alcohol troubles may well be more effective than treatment for tobacco dependency. In order to inject concern about alcohol disease into practitioners, policy makers, and parents, we need to publicize existing data: the effects of alcohol on fetuses, drunk driving statistics (not just deaths but maimings, including closed head injuries), the disproportional effect of alcohol on women (who have little treatment available because society denies the problem and who have far greater toxicity than men), the danger to teenagers, and last but not finally, family violence. At any rate, when alcohol abuse and alcoholism are considered from a medical standpoint and when people look at the numbers and the possibility for social and medical treatment, one can see that the picture is deeply troubling but not bleak. It’s worth some hope — and work — not despair. Competing interests: None declared |
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