Learning about alcohol and from Nuremberg

BMJ 1997; 314 doi: (Published 08 February 1997) Cite this as: BMJ 1997;314:0

Alcohol flows through this BMJ as it has flowed through medicine for well over a thousand years. Minerva quotes from the physicians' health study from the United States and shows that the lowest relative risk of death in more than 22 000 male doctors was among those who drank 5-6 units of alcohol a week (p 452). The highest risk was among those drinking two or more units a day. The gap between risk and benefit is narrow, and, as always, the problem is to know where the pleasure and the benefits end and the dark side begins.

Traditionally we are more concerned with other people's drinking than with our own. In societal terms this means that we fret more about drinking among the young than among middle aged men, some of our heaviest drinkers. Kirsty Hughes and others from Glasgow have studied the use of “designer drinks”–fortified wines with sweet flavours and ciders that are filtered to remove colour and some flavours–and found that they appeal most to 14-15 year olds (p 414). The researchers also show that consumption of designer drinks is associated with heavier alcohol consumption and greater drunkenness than consumption of traditional drinks. Or, as one boy put it, “If you down Mad Dog [a designer drink] dead quick, you get steaming then you throw up but if you're in a pub you take your time.”

But are you, fair reader, drinking too much? You might answer the questions posed onp 423. A group from Verona have used this simple questionnaire in 482 patients in primary care and found that it is good for detecting not only those with formal alcohol disorders but also those with hazardous alcohol intake.

The BMJ issue that marked the 50th anniversary of the Nuremberg trials of the Nazi doctors sensitised many to the idea that we must be constantly on our guard to avoid slipping into unethical practices, and letters in response have some chilling stories to tell. E Ernst tells how he was sacked from the editorship of a medical journal for even mentioning Nazi medicine (p 439); J H Baron reminds us that Indiana had compulsory sterilisation before Germany (p 440); Hugh Thomson asks us to reflect on the links between Nazi medicine and abortion and euthanasia (p 439); and Margaret Hannah describes how as a student in Cambridge in 1981 she was shown a film made in a concentration camp in a physiology lecture (p 440). And on p 444 Peter Trigwell describes how the police in Britain today are using CS gas to restrain mentally ill people.

Finally, we carry the obituary of Ian Munro, editor of the Lancet from 1976-88, who probably did more than any other medical editor this century to draw doctors' attention to abuses of human rights (p 447).

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