Editor's Choice

Gin Lane

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39504.377755.43 (Published 28 February 2008) Cite this as: BMJ 2008;336:0
  1. Jane Smith, deputy editor, BMJ

In this week’s opening editorial Thomas Babor proposes that countries are like people when it comes to alcohol: some can handle their moderate drinking well, but some—like Britain—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 images of young women handling their drink badly. Babor commends the report for marshalling well the evidence for its suggested combination of increased taxes, controlling access to alcohol, and encouraging early 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 associated with Britain: not for nothing is Hogarth’s Gin Lane one of Britain’s iconic images.

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

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

In some ways “alcohol misuse” seems a relatively simple subject to debate: alcohol causes known harms and there’s wide agreement (and evidence) on measures to minimise the harms and treat them. Quality improvement is a more slippery subject. The ferocity of the letters responding to Chris Ham’s editorial on quality failures in the NHS prompted me to re-read what he had written. He was drawing on a Healthcare Commission report on lessons from recent quality failures in the NHS and wrote about the difficulties of establishing a “culture” of safety and of continuous improvement in the NHS, and he emphasised the need for leadership at all levels (doi: 10.1136/bmj.39486.406308.80). The common theme of our letter writers is that clinicians and trusts don’t get a chance to show leadership because of the meddling of politicians—and indeed of policy and management experts such as Ham. This has led, says Chris Luke, to the emasculation and “proletarianisation” of the medical profession (doi: 10.1136/bmj.39500.453623.1F).

Yet this week’s journal also has an account of how continuous improvement can be made to work, in the description by Muir Gray and colleagues of how continuous improvement was built into 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 margin between success and failure is fine, consumer expectations keep rising, and the potential of errors to destroy public confidence is great.” And their answer? As nuanced as the problem, and they tell the story well.

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