Alcohol

Doctors and the alcohol industry: an unhealthy mix?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1889 (Published 2 April 2013)
Cite this as: BMJ 2013;346:f1889

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26 April 2013

“In the view of WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.”(1)

This could seems hardly worth mentioning and one may want to ask WHO to give its view on the role of pedophiles in advisory committee on school curriculum for sex education.

In fact, sadly WHO is right and France is an enduringly example of wrong doing.

First, in 2006 the government used a law about agriculture to created a “Council for moderation and prevention” about alcohol consumption policies.(2) As two third of the members were pro alcohol, the main NGOs involved in alcohol treatment and prevention refused to participated to the Council.(2)

In 2009, the health minister, Roselyne Bachelot, issued a new public health law, ‘Hospital, patients, health and territories’, to improve the health-care system through regionalization. This did not preclude her to add an article to specifically allow advertising for alcohol on the internet, the most used medium by young people. She disregarded both medical associations’ claims and the results of a public poll, and almost nullified ‘Evin’s law’ issued in 1991 to ban or limit alcohol advertising in other media and during sports events.(3)

1 Chan M. Re: Doctors and the alcohol industry: an unhealthy mix? BMJ online 11 April 2013
Available at http://www.bmj.com/content/346/bmj.f1889?tab=responses Accessed 25 April 2013

2 ANPAA and eleven NGO. Council of moderation and prevention: associations for prevention and treatment of alcoholism and addiction will refuse to participate. Press release. 30 June 2006. Available at http://www.anpaa62.fr/docANPAA62/revuedepresseconseildemoderationetdepre... Accessed 25 April 2013

3 Braillon A, Dubois G. Alcohol control policy: evidence-based medicine versus evidence-based marketing. Addiction. 2011; 106(4):852-3

Competing interests: None declared

Alain Braillon, public health

Northern hospital, Amiens? France

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The International Center for Alcohol Policies (ICAP) welcomes public discourse on the very serious problem of harmful drinking worldwide, such as that exemplified by the recent article in BMJ and the April 11 comment from WHO Director-General Dr. Margaret Chan.

While there are divergent points of view on how best to address harmful drinking, there is a shared objective amongst all stakeholders: reducing harmful drinking worldwide. In pursuit of this objective, ICAP brings together research that supports effective, pragmatic, and feasible interventions against misuse of alcohol. We do this with full transparency about our industry funding source and our commitment to the inclusion of all relevant parties able to make a substantive contribution.

In their efforts to tackle the multi-faceted problem of alcohol misuse, which requires equally multi-faceted solutions, different stakeholders -- NGOs, public health experts, researchers, the private sector, and governments – have sought out ICAP’s expertise and its resources to develop policies and interventions. While our tools are available to all who request them or find them useful, ICAP does not directly involve itself in the governmental work of drafting national alcohol policies.

Competing interests: ICAP is a not-for-profit organization supported by leading producers of beverage alcohol.

Marcus Grant, President

International Center for Alcohol Policies (ICAP), 1519 New Hampshire Ave NW Washington DC 20036

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We are disappointed at Dr Chan’s negative reaction in the BMJ on 11 April to the Commitments of leading beer, wine and spirits producers, which are a sincere contribution to reducing harmful use of alcohol. The ‘Commitments’ were developed as a contribution to support WHO’s Strategy to Reduce Harmful Use of Alcohol as WHO, and Dr Chan personally, have encouraged the beverage alcohol industry to do more in this area.

We agree with Dr Chan that the development of national alcohol policies is the primary responsibility of national authorities. It is our experience that many governments do not agree with WHO’s view that the private sector has no role in policy formulation, as private sector companies from a range of sectors are often invited by governments to contribute their views and expertise to the policy development process.

It is increasingly recognised that effective responses to address serious societal issues require the involvement and mobilisation of a range of actors, including the private sector. The World Bank in its publication ‘The Growing Danger of Non-Communicable Diseases – Acting Now to Reverse Change’ (Sept 2011) for example, acknowledges this saying ‘NCD risk factors can rarely be modified through policies and interventions within the health sector alone. Rather, prevention measures that address these risk factors typically embrace a range of different sectors…………..along with civil society and the private sector’.

We welcome constructive debate on the most effective policy options to reduce the harmful use of alcohol, and believe in the merit of including a range of stakeholders in such policy discussions. Groups such as GAPA who seek to exclude those with views different from their own do a disservice to the very serious work of addressing harmful drinking worldwide and we encourage them to adopt a more inclusive approach.

Competing interests: None declared

Mark R Leverton, Director General

Global Alcohol Producers Group, 68 South Lambeth Rd, London SW8 1RL

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Letter in reply to BMJ feature on the alcohol industry

The World Health Organization agrees with many, but not all, points made in the BMJ feature on the alcohol industry and the accompanying editorial.1-2 References to the WHO Global Strategy to Reduce the Harmful Use of Alcohol require some clarification, particularly concerning claims that industry is simply doing “what WHO asked for in the strategy.” Not so.

The Global Strategy, which was unanimously endorsed by WHO member states in 2010, restricts the actions of “economic operators” in alcohol production and trade to their core roles as “developers, producers, distributors, marketers and sellers of alcoholic beverages.” The strategy stipulates that member states have a primary responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. The development of alcohol policies is the sole prerogative of national authorities. In the view of WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.

WHO is grateful to the many researchers and civil society organizations that keep careful watch over the behaviour of the alcohol industry. This behaviour includes direct industry drafting of national alcohol policies, or drafting through the International Center for Alcohol Policies and other entities or “public health consultants”, which it funds. As documented in recent reports, some of the most effective policy options to reduce the harmful use of alcohol, as defined by WHO, are conspicuously absent in these policies.3,4

WHO appreciates the Statement of Concern issued by the Global Alcohol Policy Alliance and has invited representatives of the statement’s authors to meet senior WHO management to explore these concerns in greater detail. Conflicts of interest are an inherent risk in any relationship between a public health agency, like WHO, and industry; conflict of interest safeguards are in place at WHO and have recently been strengthened. WHO intends to use these safeguards stringently in its interactions with the alcohol industry.

1Gornall, J. Doctors and the alcohol industry: an unhealthy mix? BMJ 2013;346:f1889 (2 April).
2Grove, T. Promises, promises BMJ 2013; 346: f2114 (3 April).
3Bakke, O, Endal, D. Alcohol policies out of context: drinks industry supplanting government role in alcohol policies in sub-Saharan Africa. Addiction 2010;105:22–28.
4Jernigan, DH. Global alcohol producers, science, and policy: the case of the International Center for Alcohol Policies. A J Publ Health 2012;102:80 – 89.

Dr Margaret Chan
Director-General
World Health Organization

Competing interests: None declared

margaret chan, Physician/Director-General

World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

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It is an over-simplification to say that the ‘ideological schism’ that divides the public health community is between those who are prepared to work alongside the industry in an effort to reduce harm, and those who are not. The public health and NGO community recognise that the alcohol industry is a stakeholder and can contribute to the reduction of harm in their role as producers and retailers of alcohol. Producing low strength products, labelling and server training are areas where it is legitimate for the industry to have a role. However, the alcohol industry seeks a role for itself in policy areas which extend far beyond their responsibilities as producers and retailers and in which they have no expertise. They are avid promoters of ‘partnerships’ because this provides an opportunity for them to influence the policy agenda in ways that favour their business interests at the expense of the public health interest [1].

Evidence clearly indicates that the most effective strategies involve the reduction of alcohol consumption at the population level {2}. Yet the global CMO of Diageo was quoted in a recent interview with Marketing Week saying “We need to tackle alcohol harm but population approaches don’t work.” [3}. In Scotland, the industry was enthusiastic about ‘partnership working’ when it resulted in alcohol awareness weeks and campaigns on responsible drinking. However, when the Scottish Government signalled its intention to introduce minimum pricing legislation with the full backing of the public health community and civil society, the industry immediately launched a lobbying campaign against the measure. When they were unable to prevent the successful passage of the legislation, they did what the tobacco industry has done for the last fifty years and mounted a legal challenge. During the passage of the minimum pricing legislation, industry representatives frequently called on the Scottish Government to "drop minimum pricing and work together in partnership with the industry to tackle alcohol problems."

Marcus Grant says the industry cannot increase taxation or limit availability as these are government actions. But that doesn’t stop the industry from consistently lobbying against such measures in different jurisdictions all over the world [2]. In reality, what partnership working means for the alcohol industry is steering discussion away from effective measures like controls on price and availability and ensuring that less effective measures are adopted.

If the alcohol industry is serious about reducing the harm that alcohol causes then they should cease all lobbying against those measures that the evidence indicates will be most effective in reducing harm. It is entirely reasonable for the public health and NGO community to insist on this as a pre-condition for any ‘partnership’ working.

[1] Babor T, Robaina K. Public health, academic medicine, and the alcohol industry’s corporate social responsibility activities. Am J Public Health 2013; 103 (2).
[2] Babor T, Caetano R, Casswell S,et al. Alcohol:no ordinary commodity – research and public policy. 2nd ed. Oxford. Oxford |University Press:2010.
[3} http:/www.marketingweek.co.uk/news/qa-with-diageos-global-cmo-andy-fennell/400 accessed 10/04/2013.
[4] Jernigan DH. Global alcohol producers, science and policy: the case of the International Center for Alcohol Policy. Am J Public Health 2012; 102 (1).

Competing interests: None declared

Evelyn Gillan, Chief Executive

AlcoholFocus Scotland, 166 Buchanan Street Glasgow

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The alcohol industry mirrors the tactics of big tobacco, keeping the focus on individuals. They frame alcohol as a personal freedom and choice, emphasizing individual pleasure and social interaction and blaming a small minority of drinkers for alcohol abuse and harm.

The public health community need to ensure that policy-makers at all levels understand the full impact of alcohol on society, highlighting the economic, social, personal and health costs and how alcohol harm is disproportionately distributed, particularly affecting vulnerable groups.

The alcohol industry is not interested in that discussion nor promoting science based effective measures to reduce harm done by alcohol.

Competing interests: None declared

Sven-Olov Carlsson, President

IOGT International, P.O. Box 12825 112 97 Stockholm, Sweden

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Many doctors [1] and law makers [2] come to grief through their own use of alcohol. People surrounded by drinking, like publicans, are at high risk of developing alcohol-related illness. A common feature of habit-forming drugs that alter brain systems detecting 'rewards' is the growing 'entrainment' of one behaviour (like binge drinking) with other behaviours or situations.[3] Of major concern in Public Mental Health is the community link between entrenched drinking habits and violence (e.g. recurring domestic violence [4]) or impulsive self-harm (especially suicide [5]). Commercial interests in sales of alcohol go far beyond just the distillers and brewers, or even the pubs and supermarkets, but entrain the wider hospitality, leisure and travel sectors of the UK economy. Around 2001 that inter-connected web of financial interests thwarted our Regional efforts in London to reduce alcohol-related harm, inspite of the Metropolitan Police and Public Health being united in seeking to reduce alcohol use linked with high-risk times and places. Today, foreign currency earnings from the export of Scottish whiskey or entertaining tourists here seem easily to outweigh Health factors in deciding public policy.

Over the last 30 years I have met decent individual brewers, hoteliers and off-licence managers. They were probably typical of their sectors. But in all that time, I cannot remember a single Industry-led initiative that actually reduced alcohol consumption or harm at a population level. Good publicans took up medical suggestions to use plastic beer glasses and transport managers took up police demands to stop passengers drinking on underground trains. Public Health can work with all local organisations to promote healthier communities.

But it is wise and honest for all parties to recognise the conflict of interest between the business of supplying a legal drug and reducing use of that unhealthy drug across the population.

[1] Stanton J, Caan W. How many doctors are sick ? BMJ 2003; 326: s97-s98.

[2] Caan W. Benefits and alcoholics. Feasibility study. BMJ 2009; 338: 1162.

[3] Caan W. Misfortunes never come singly. Perspectives in Public Health 2009; 129(5):210-211.

[4] Caan W. Alcohol and the family. Contemporary Social Science 2013; 8: 8-17.

[5] Caan W. Unemployment and suicide: is alcohol the missing link? Lancet 2009; 374: 1241-1242.

Competing interests: Founder member of a Special Interest Group for 'Alcohol & Violence', and teacher on alcohol & public health e.g. a seminar this week for FY2 trainees.

Woody Caan, Editor

Journal of Public Mental Health, Duxford, Cambridgeshire CB22 4PA

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