- Jane Smith, deputy editor, BMJ
Our patient journey this week is from a man who nearly ruined his marriage and the health of his wife through excessive drinking (doi:10.1136/bmj.d956). “Having been afraid of the effect on me if my wife found out about my drinking, I had never imagined the devastating effects on her. Suddenly I seemed to her a fraud.” With a supportive family and general practitioner, the anonymous writer seeks and gets help, and the story has a happy ending: “I prefer to be a steady non-drinker who takes the odd glass. It seems to be working.”
But not all such stories have a happy ending. In their editorial on the government’s plans to set a minimum price for alcohol in England, Cordelia Coltart and Ian Gilmore outline the costs of alcohol consumption: in the UK alone 30 000-40 000 deaths, close to a million hospital admissions, and costs of £20bn to £55bn (€24bn–€66bn, $32bn-$89bn) (doi:10.1136/bmj.d1063). That price affects alcohol consumption is well known, but Coltart and Gilmore criticise the timidity of the government’s proposals. “The price floor has been set so low that it will have no effect whatsoever on the health of the nation.” They suspect the drinks industry of exerting its influence.
So that makes the latest NICE guidance on diagnosing, assessing, and managing harmful drinking and alcohol dependence as necessary as ever (doi:10.1136/bmj.d700). Although most of the interventions have decent evidence behind them (information given in the version on bmj.com), the guideline writers point out that in the UK treatment services are fragmented and specialist alcohol services only patchily available. But the tools for identifying harmful drinking are widely available, and the article includes the AUDIT questionnaire on drinking patterns for use in primary care and non-specialist settings. But perhaps AUDIT should be even more accessible: the drinks industry could prove its social responsibility by printing it on beer mats and cocktail menus.
In the meantime research continues to pile up that suggests that light drinking protects against cardiovascular disease. In their systematic review and meta-analysis Paul Ronksley and colleagues update knowledge on the association of alcohol consumption and cardiovascular outcomes (doi:10.1136/bmj.d671). Drinkers (compared with non-drinkers) had lower risks of coronary heart disease and stroke and death from cardiovascular disease and stroke, with the lowest risks in those who drank less than two drinks a day. A further systematic review by the same group shows that moderate drinking (compared with no drinking) resulted in favourable changes in biomarkers associated with coronary heart disease (doi:10.1136/bmj.d636).
One of this year’s finalists in the BMJ Group Lifetime Achievement Award has also researched the effects of alcohol: Richard Peto’s studies in Russia into the effects of alcohol on mortality have led to greater controls on alcohol. He and the other two finalists, George Alleyne and John Wennberg, are the subject of a feature this week (doi:10.1136/bmj.d1062), the first of a series that will profile all the finalists for all 13 of the BMJ Group awards. The Lifetime Achievement Award is the only one where BMJ readers get to make the decision, so do cast your vote on bmj.com.
Cite this as: BMJ 2011;342:d1231