Why are we complacent about alcohol?

Twenty years ago I was a firebrand on firewater. I wrote rabid articles in the BMJ describing the dramatic range and extent of damage from alcohol and considering the options for responding. If the media wanted an anti-alcohol campaigner I was one of their first choices. I ranted and raved, and one unintended consequence was that I became friends with many wine writers and got to taste some exquisite vintage claret and 100 year old calvados. Now an old colleague in the battle against drink writes to ask me what went wrong. Why when things have got worse not better am I silent on the issue? The more important question, I think, is why are we as a society so complacent about alcohol. The two questions have similar answers.

The answers are topical because the British government has just produced its strategy for reducing harm from alcohol (p 659). It's the dampest of squibs. Any government that was serious about reducing alcohol problems would increase the price of alcohol. It's the one measure that will reliably reduce harm. And yet, as the Academy of Medical Sciences showed in its recent report (6 March, p 542), the price in Britain has fallen and consumption and damage have increased. Education, controlson advertising, and partnerships with the drinks industry are so much flim flam.

Why then are we all so complacent? One reason is that it's our favourite drug. Most people in England drink, and many of us—including prime ministers, journalists, judges, doctors, policy pundits, and medical journal editors—like to stack it away. Righteous indignation about ecstasy is easybecause we don't use it and don't want to.

For politicians there is the important problem of a million jobs, tax revenues, and exports. There are few votes in being serious about alcohol problems—and those there are have to do with drunks vomiting on people's lawns. And the political power of the drinks lobby is huge, far beyond that of a row of doctors wringing their hands. Hence, Tony Blair starts his foreword to a strategy toreduce harm by writing: “Millions of us enjoy drinking alcohol with few, if any, ill effects. Indeed, moderate drinking can bring some health benefits.” So, what's the problem, Tony? His first answer is “antisocial behaviour in towns and city centres.”

Another cause of complacency is that a little alcohol—and maybe even quite a lot—does seem to help you live longer. This fact leads to confusion over the message. Is it drink less, drink sensibly, drink like me? And what is sensible drinking? Is there something not sensible about my daily wine with dinner—and maybe Lagavulin later? I can't believe that: I'm not being sick over anybody.

Finally, it's too easy to be defeatist. Dozens of reports have produced no improvement. In contrast, we've made progress with smoking—because even those who smoke want to stop.