Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
tacking alcohol misuse in the UK
- Mohammad A Javid (27 February 2008)
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Battle of the binge
- DAVID G SAMUEL (3 March 2008)
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A doctor who drinks responds
- Stephen Head (3 March 2008)
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Typical of this country's malaise
- peter j mahaffey (3 March 2008)
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Doctor do you know about alcohol unit?
- Abhay Kumar Das, Oliver J Corrado, Jacqueline A Smithson, Enoch Kyerematen, Robert M West (5 March 2008)
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recomendations are not enough
- Malcolm John Dickson (5 March 2008)
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Illiberal policy and evidence
- stephen black (19 March 2008)
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Promoting the use of alcohol
- Peter O'Loughlin (30 March 2008)
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Re: Promoting the use of alcohol
- Ellen CG Grant (1 April 2008)
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Mohammad A Javid, GP SA10 9BT
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This is a thoughtful editorial.However only a radical solution involving the collaboration of the individual, society and government would solve the problem.The harmful consequences of alcohol use are only too obvious. We need to develop a full educational and informational service with respect to the the benefits and harms of alcohol use;I freely admit there are some benefits of alcohol use but the harms far exceed any benefits-the risk/benefit ratio is highly unfavourable. The social acceptance and culture of alcohol use has to change.Just as the use of tobacco has come to be frowned upon so the use of alcohol must be seen to be socially unacceptable but the major stumbling block is that currently society is not prepared to give up alcohol consumption altogether. Alcohol should be seen as a very toxic drug with short and long term morbidity and mortality. The only solution is total non-use of alcohol by society as a whole;even so-called "social drinking" is far from safe-there are well- recognised negative effects on higher mental functioning;the recognition and response time to to a road hazard by drivers with no obvious external manifestations of alcohol intake are well known and accepted and the goal should be zero tolerance to alcohol use whilst driving;the next logical step is for society to recognise and accept the only answer to the problem is complete cessation of alcohol altogether which it appears society is not currently ready to do. We will never solve the problem unless there is this societal paradigm change. The promotion of alcohol must be banned;promotion of sport by the alcohol industry must be banned; the imposition of tax and duties by the government must cease so that there is no perverse incentive for the government to permit continued use of alcohol; and alcohol must be recognised as a drug with an unacceptable health risk profile. The question is:is society ready for an alcohol free world? Competing interests: None declared |
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DAVID G SAMUEL, 5TH YEAR MEDICAL STUDENT CF48 2AS
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As a future doctor I welcome the call from the BMA to increase the price of alcohol and to limit the amount of “special offers” being sold to the public in local supermarkets and bars and clubs. Happy hours, 4 shots for 5 pounds and buy one get one free deals only serve to fuel the craving to consume large amounts of alcohol in a short period of time for the least amount of money. Younger generations are targeted by these deals as students often live on tight budgets and live in the larger cities where bars compete against each other. Maybe a say forward would be to have a minimum price per unit for alcohol? Binge drinking results in young people engaging in harmful and risky behaviours such as fighting and unprotected sex. In addition people ignore their responsibilities and inflict both short and long term physical and mental damage to their bodies. However, controlling the prices and increasing the tax on alcohol is only one component of the remedy to the battle of the binge. We must work to change the attitude and culture surrounding alcohol consumption in the UK where it seen as something to enjoy in moderation, not part of some challenge to show how macho or brave you are in becoming paralytic. I also feel the penalties for shops, pubs and individuals who sell or purchase alcohol on behalf of youngsters must be harsher and more rigorously employed. The fear that breaking the laws will results in prosecution will serve as a deterrent. Each one of us has a responsibility to act as role models for future generations. Involving sports starts in anti binge drinking campaigns could prove as successful as anti racism campaigns in the past and would show that the stereotype image of manys stars fumbling from nightclubs is not always the case. Maybe it is time to introduce graphic television campaigns similar to cancer campaigns showing patients with terminal liver disease, cancer or other illnesses as a result of excessive alcohol consumption maybe a step too far but it would certainly open the eyes of the public to the hidden dangers of drink. I only hope that the work of the BMA and the government will serve to reverse the binge drinking epidemic otherwise I fear the NHS will be over run by chronic and acute alcohol related illness that will dehydrate its resources for ever! David Gwynfor Samuel
Competing interests: None declared |
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Stephen Head, General Practice Performer Middleton Lodge, New Ollerton, Newark, Notts. NG22 9JU.
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Whilst sharing the concerns about the burdon of alcohol abuse I would suspect the proposed solutions would not address all the issues. Also I am concerned at the copoorate hypocracy of a profession many of whom use alcohol to excess but still take a "Do as I say, not as I do" attitude to the rest of society. The "Limits" remain as an unvalidated criteria for excess drinking - please see the link. Many happy, healthy, successful people drink far more than that and either suffer no harm or make an informed decision to take a risk of such. If we are going to use financial means to address dangerous drinking another issues to consider is the demise of the English Public House - more close every year. Most dangerous drinking occurs in the home or on the street - bought from retail outlets. Drinkers are safer in a supervised environment. Like Post Offices, Pubs that close will create social costs. Part of the increased revenue from alcohol taxes should be charged against outsales and used to support supervised outlets, keeping the English pub alive. http://www.timesonline.co.uk/tol/life_and_style/food_and_drink/article2697975.ece Competing interests: None declared |
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peter j mahaffey, consultant plastic surgeon bedford hospital mk42 9dj
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Its depressing that even when the BMJ recruits an opinion (Thomas F Babor's editorial) on our alcohol problems from outside the UK, the barren response is the same as for so many of our pressing national issues . . . ban it, exclude it, repair it, or in this case tax it to the level of inaccessibility. Why are we becoming, in Britain, ever more incapable of looking at the roots of a problem, whether its social violence, failing education, C.diff infections on wards, paedophilia or many other ills, and trying to address those origins. From the point of view of doctors' opinions were'nt we always taught at medical school that prevention is better than cure? We are supposed to be participating in a European Community. Within that community, taxes on alcohol are by and large low because its citizens have a responsible approach to the drug. A few Nordic countries, notably Britain and Ireland, are exceptions. Our culture of "let's go out and get pissed", here widely admired even if secretly, is utterly alien to those of mainland Europe. What is the problem in attacking that culture and changing it if we sincerely believe that the problems of alcohol merit it? What is the problem with a sustained campaign in schools? What would be the problem in levying an immediate £100 fine on any instance of public drunken-ness where the blood level was found to be say over 250mg/100ml. I suggest that if there was the will to send out strong messages, then attitudes could be changed very rapidly indeed. Moreover, the present Government is not shy to engage in social engineering, so one must ask whether it is simply laziness that the roots of this particular problem are not addressed. The possibility of vested interests might a matter for further speculation. Competing interests: As a surgeon, I deal with the consequences of alcohol abuse daily |
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Abhay Kumar Das, Consultant Physician Pontefract General Infirmary, Friarwood Lane, Pontefract WF8 1PL, Oliver J Corrado, Jacqueline A Smithson, Enoch Kyerematen, Robert M West
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Alcohol measurement in unit was introduced in 1987. The UK Government first recommended safe weekly limit of drinking in 1992. Then it was changed to daily limit in 1995 to reduce binge drinking. In 2004 we conducted a questionnaire survey among adult outpatients in a teaching hospital in Yorkshire. Only 14% (38/276) knew the safe weekly limit although nearly half of the patients claimed (136) to be familiar with alcohol units. Then we conducted the same survey among doctors in Leeds teaching hospitals and General Practitioners(GPs) in Leeds the same year. Only 58% (258/445) of the doctors knew the correct limit. GPs knew better than hospital doctors (69% vs 45%). Over half (143) of the patients did not answer how many units of alchol does a 750ml (40%w/v) bottle of whisky contain, and many doctors got it wrong. It may sound simple 'a glass of wine contain one unit of alcohol', but it is true only when the strength is 9% and the capacity of the glass is 125 ml. Most wines are stronger than 12% and a glass of wine can be as big as 250 ml! Doctors ought to be fully conversant with alcohol units if they are to be in a position to educate their patients. Competing interests: None declared |
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Malcolm John Dickson, Consultant Obstetrician & Gynaecologist Rochdale Infirmary. OL12 0NB
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Whilst agreeing that the BMA’s recommendations are worthy, there is failure to address some underlying reasons as to why the nation consumes so much alcohol. The pace of life in the 21st centaury is frantic. We commute in cramped trains and on increasingly busy and gridlocked roads. We are swamped by a multitude of e-mails – most of which are worthless yet we have to sift through them all in case we miss the occasional golden nugget. In all strata of work, there are protocols to follow. These protocols are becoming more numerous and complicated and hard to keep abreast of. We have PIN’s to remember, codes to unlock our mobile phones, and passwords for computers, some requiring to be changed every 90 days, if you remember. In the business world, financial deals are made or broken by leverage. A huge profit can be converted into a huge loss by interest rates rising only by one quarter of one per cent The UK , a member of the G8 has some of the longest working hours in the world, and is trying to resist controls on this. These are some of the reasons that there is significant alcohol abuse in the United Kingdom. I believe that were the nation to have a more placid pace of life, rather than more recommendations and rules, alcohol consumption would be less Competing interests: None declared |
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stephen black, management consultant london sw1w 9sr
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Its hard to take an expert seriously when they strive to return us to a past that never existed ("...return the UK to its former status as a temperate nation"). But there are more solid reasons to question the policy recommended by Thomas Babor and the BMA. The first--and one which the medical establishment seems oblivious to --is the extent to which we can limit people's freedom in a liberal society. Even when people are harming themselves there has to be a limit on how much coercion sociaty can exert to prevent that harm. Recent debates about public health have strayed well over that line. The issue is particularly acute for alcohol as modest consumption is not harmful. Next, the BMA claims to have produced a report based on solid evidence. But this claim has to be taken with a large pinch of salt (something the BMA has not yet proposed restrictions on). Yes there is evidence that putting up the price lowers consumption. Yes there is evidence that restricting supply lowers consumption (prohibition lowers consumption a lot, but fails to eliminate it and has bad side effects). But the evidence also shows that consumption across countries is not much correlated with tax levels (otherwise france would a nation permanently inebriated). It also shows the futility of pushing tax too high (a footnote to consumption tables shows that some high tax, tight restriction scandanavian countries may have high volumes of illegal consumption on top of the official statistics). On top of that, the report ignores the recent experiment in england of freeing up licensing hours which, if the BMA were right, would have been a monumental disaster. If anything consumption has fallen since the new laws without any obvious net cost. Then there is the lack of evidence provided about what level of consumption is safe for an individual (government guidance was made up in the absence of evidence). The problem here is a conflict between the widely varying individual response to alcohol and the supposed need to issue clear and simple guidance. But the problem here is a result of the nanny state attitude where leaders believe they have to make our decisions for us. We can't be trusted to learn for ourselves as individuals how to cope with booze, so the government or the BMA must tell us what to do. Overly prohibitionist attitudes if anything encourage reckless behaviour in individuals. Making alcohol forbidden makes it more attractive to teenagers. Moving to the more liberal french attitude might actually reduce binge drinking in the long run. The whole of society should not be punished for the sins of a few. Whatever the short term gains of illiberal policies restricting the supply of alcohol, they will fail in the long run and will make our society a much less attractive place to live. Competing interests: Normally drinks more than the guidlines, but has given up for Lent |
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Peter O'Loughlin, Principal Eden Lodge PracticeBeckenham BR3 3AT
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Given the frequency with which the phrase ‘promote’, or ‘encourage sensible drinking’, appears in the Government’s alcohol strategy, including, the comment that ‘more needs to be done to promote sensible drinking,’ and similar comments which appear on almost every page of the document, one could be forgiven for thinking the Government intends to launch a promotion campaign for alcohol, rather than a strategy to create awareness of the highly addictive, psycho active, and hypnotic, nature of this legal drug. Widespread Public Health announcements of the latter, would be much more effective in helping moderate drinkers become aware of the risks they are taking, whenever they drink more than they intended, which as the document obliquely mentions, occurs without one being aware of it. Regrettably, the document fails to mention that the psycho active ingredients of alcohol, intentionally, or otherwise, actively contributes to the probability of such a situation occurring. The strategy does not appear to propose, to make widely known the fact, that ‘moderate’ drinkers, who occasionally drink heavily, are more likely to suffer an alcohol related injury than chronic heavy drinkers. Or the fact that those at highest risk are not the latter, but those who drink ‘sensibly’, or ‘moderately’, who sometimes binge drink. The clinical evidence and experimental research in support of my comments were published in the February 2006 issue of ‘Alcoholism’: Over an 18 month period, Researchers from the prestigious Alcohol Treatment Centre, Luasanne University Hospital, and the Swiss Institute for the Prevention of Alcohol and Drug Problems, screened almost nine thousand emergency department patients. Their conclusions not only confirm the above views and facts, the accuracy of the research is confirmed by Professor Linda Degutis, of Yale University. One wonders how, such large numbers, in a relatively small country, would extrapolate on a worldwide basis, or how many of the 180,000 hospital admissions for alcohol related problems in the UK, were in that category. It is puzzling why the Government’s proposals, claiming to increase the public awareness of the dangers of alcohol, make no mention of this important research, and therefore presumably has no intention of making it widely known to the public. Omitting such crucial research opens the door to speculation, as to whether the omission is deliberate, or whether the authors were unaware of it. In either case it would be helpful in preventing any wrong conclusions, if we could be reassured that representation from the Alcoholic drinks industry, had no influence over such a serious omission. Perhaps Caroline Flint, or Vernon Coaker, or both, who in their Ministerial Forward, so enthusiastically endorsed the concept of ‘promoting sensible or moderate drinking’, would care to enlighten us, as to why there is no mention of critical evidence that appears to contradict the views of the Government, and of course reassure us, that such an omission was not influenced by delegates from the Alcoholic drinks industry. Competing interests: Alcohol and Other Drug free recovery. |
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Ellen CG Grant, Physician and medical gynaecologist Kingston-upon-Thames, KT2 7JU
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Many doctors agree with Peter O’Laughlin that the Government’s advice promotes alcohol consumption. Clearly my efforts to explain why leading epidemiologists have misunderstood the meaning of famous “J” curve results have fallen on stony ground so far. I have already 43 responses mentioning alcohol (Advanced Search of rapid responses for author Grant, E and alcohol). Alcohol pickles cells and makes cell membranes rigid. Therefore alcohol can have no health benefits.1-5 Epidemiologists believe that people who drink small amounts of alcohol are healthier than non-drinkers. This ignores the reasons alcohol is avoided– such as dislike of the taste, unpleasant reactions including headaches or migraines or having being told by their doctors not to drink for health reasons. Oversensitivity is often due to deficiencies of essential nutrients and therefore an impaired immune system and more risk of illness. The alcohol industry must be very grateful to epidemiologists for encouraging the non stop promotion of alcohol drinking. The social attitude now seems to be - no party or celebration without alcohol, even for teenagers. Many women have drunk alcohol before they knew they were pregnant. As I wrote previously under the title, “No safe dose of alcohol for the fetus” - “It is time society grew up and put the health of future generations before profiteering and hedonism. It is really no fun bringing up unhealthy children”. 1 Grant ECG, Avoiding alcohol is good preconception care advice. http://bmj.com/cgi/eletters/330/7488/375#97208, 18 Feb 2005 2 Grant ECG. Epidemiological studies underestimate alcohol risks http://bmj.com/cgi/eletters/328/7441/0-g#53832, 19 Mar 2004 3 Grant ECG. Increases in atopy and increases in alcohol consumption in men http://bmj.com/cgi/eletters/330/7501/1187#104573, 21 Apr 2005 4 Grant ECG. Authorities should recommend abstinence from alcohol for pregnant women.http://bmj.com/cgi/eletters/330/7488/375#99803, 9 Mar 2005 5 Grant ECG. No safe dose of alcohol for the fetus http://bmj.com/cgi/eletters/330/7488/375#97081, 18 Feb 2005 Competing interests: None declared |
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