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Will the UK’s new alcohol guidelines change hearts, minds—and livers?

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i704 (Published 10 February 2016) Cite this as: BMJ 2016;352:i704

Rapid Response:

Drunk on risk: how the Chief Medical Officers’ alcohol guidelines are demonizing drink

Theresa M Marteau comments favourably on the new proposed guidelines from the Chief Medical Officers, which reduce the “safe” drinking level for men to 14 units and also state that there is no safe level of alcohol [1]. But this mixed message and others in the guidelines will only serve to confuse the public.

The first issue with the new guidance is the claim that “no alcohol is safe” [2]. Except for the strong-willed minority who will quit drinking entirely as a result of it, this warning is likely to be counterproductive as people might be happy to cut down but not to eliminate alcohol completely. Setting the unrealistic target of zero will result in people carrying on as before, or even indulging more because they think that there is no safe amount anyway, so they might as well have more and enjoy themselves, (There is a parallel here with overambitious new year resolutions of exercise.[3])

In addition, the "no amount is safe" message undermines the new recommended limit for men and the retention of the limit for women. Why should people attempt to adhere to the new limits rather than the old ones if they are also being told that the new recommended levels are not safe? Giving such a mixed message further increases the likelihood that the guidelines will not be taken seriously.

A closely related point is that the selection of the new limits seems to be based on arbitrary criteria: “The 14-unit limit has been chosen because at that point, your drinking leads to a 1% risk of dying from alcohol-related causes."[4] But this is essentially meaningless to members of the public. Why is a 1% risk deemed acceptable? Sally Davies, CMO for England, tried to explain things in terms the public can understand:

If you take 1,000 women, 110 will get breast cancer without drinking. Drink up to these guidelines and an extra 20 women will get cancer because of that drinking. Double the guideline limit and an extra 50 women per 1,000 will get cancer… That’s not scaremongering, that’s fact and it’s hard science.[5]

This might sound persuasive from a public health, population-based perspective, but in terms of appealing to the rationality of individuals it fails entirely. The risk of breast cancer without drinking is 1.1 in 10. The risk with drinking, according to the new guidelines, is 1.3 out of 10; drinking double the guidelines gives a risk of 1.6 in 10. This means that the absolute risk increase of drinking double the guidelines as opposed to not drinking is .5 in 10 – ie, 5%. Or to put it differently: among 1000 women who drink double the guideline amount, only 50 will get breast cancer because of it. So if every woman drank twice as much as recommended by the new guidelines, only 1 in 20 of them would get cancer as a result. If the public were told this message, most of them would probably assume that they will be one of the lucky 19, not the unlucky 1. The message phrased differently could be “you can drink twice what we recommend and there’s only a 5% chance that you’ll get cancer as a result – and in any case there’s a 10% chance you’ll get cancer regardless!”

Davies also stated that “My job as chief medical officer is to make sure we bring the science together to get experts to help us fashion the best low-risk guidelines.”[5] But good guidelines should give information on low, medium and high-risk and let people make their own choices. Focusing on the low-risk end risks people not paying any attention to the advice at all because it aims far too high. Furthermore, as the analysis above shows, drinking twice the guidelines would also keep the risk low – as would not drinking at all. It is scaremongering to say that there’s no safe amount when having a small or even moderate amount increases the risk only marginally.

Welcoming the new guidelines, Prof Sir Ian Gilmore, chair of the Alcohol Health Alliance has stated that "Only with accurate and transparent information are people able to make an informed choice about how much alcohol they consume."[4] But the right to know is useless if the facts aren’t explained properly. The new guidelines send a counterproductive mixed message that miscommunicates the risks of drinking to the public; the Chief Medical Officers appear to be drunk on risk, and demonizing drink.

1. UK Chief Medical Officer. Alcohol Guidelines Review: Summary of the proposed new guidelines. Section 6. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
2. UK Chief Medical Officer. Alcohol Guidelines Review: Summary of the proposed new guidelines. Section 17. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
3. Lehrer J. Blame It on the Brain. Wall Street Journal. Dec 26th, 2009.
4. Triggle N. Alcohol limits cut to reduce health risks 8th January 2016. http://www.bbc.co.uk/news/uk-35255384
5. Weaver M. New tough alcohol guidelines not scaremongering, says chief medical officer. Guardian, 8th January 2016. http://www.theguardian.com/society/2016/jan/08/tough-drinking-guidelines...

Competing interests: No competing interests

16 February 2016
David M Shaw
Senior Researcher
Institute for Biomedical Ethics, University of Basel
Bernoullistrasse 28, 4056 Basel, Switzerland