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Serial mischaracterizations of Alcohol Use Disorders in England.
Whose interests are served?
Kmietowicz could have critically assessed the recent data on alcohol from the Health and Social Care Information Centre.(1,2)
First, how to accept the statement “in 2014, there were 6,831 deaths which were related to the consumption of alcohol”? Not only did the UK Office for National Statistics state “in 2013 there were 8,416 alcohol-related deaths registered in the UK” but this figure was seriously challenged because France, for the same population, reports 49,000 alcohol-related deaths despite only a slightly higher adult per-capita consumption of pure alcohol (12 L in France vs 10 L in the UK).(3)
Second, why no concerns for social costs which include domestic violence to children and women?(4)
Third, why no calls for a comprehensive alcohol control policy with effective evidence-based actions (eg. price, labelling, advertisements …) but only a focus on ancillary measures such as the ‘”Dry January” initiative?(5)
Last, regarding treatment, why a sole interest in pharmaceutical assistance? Patients need a comprehensive treatment plan including psychosocial interventions: NICE recommends to “consider offering acamprosate or oral naltrexone in combination with an individual psychological intervention (cognitive behavioural therapies, behavioural therapies or social network and environment-based therapies)” which “should usually consist of one 60-minute session per week for 12 weeks.”(6) I note that nalmefene (launched in May 2013), was only prescribed 4,400 times in 2014-15 vs 139,000 for acamprosate and 52 ,000 for disulfiram. But that’s far too much.(7-12)
1 Kmietowicz Z. Drugs for treating alcohol dependence in England cost nearly £4m in 2014. BMJ 2016;354:i3670
3 Braillon A, Gilmore I, Williams R. Alcohol-related deaths: is misinformation hindering care improvement? Lancet 2015;385:1619-20
4 Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002 20;359:1423-9.
5 Iacobucci G. UK doctors call on government to introduce minimum pricing for alcohol. BMJ 2012;345:e7874
6 Pilling S, Yesufu-Udechuku A, Taylor C, Drummond C; Guideline Development Group. Diagnosis, assessment, and management of harmful drinking and alcohol dependence: summary of NICE guidance. BMJ 2011;342:d700.
7 Fitzgerald N, Angus K, Elders A, de Andrade M, Raistrick D, Heather N, McCambridge J. Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers. Addiction 2016. Online June 5. doi: 10.1111/add.13438.
8 Braillon A, Granger B. Nalmefene and alcohol dependence: a new approach or the same old unacceptable marketing? Subst Abuse Rehabil 2015 29;6:75-80.
9 Spence D. Bad medicine: nalmefene in alcohol misuse. BMJ 2014;348:g1531.
10 Braillon A. Nalmefene in alcohol misuse: junk evaluation by the European Medicines Agency. BMJ 2014 10;348:g2017.
11 Palpacuer C, Laviolle B, Boussageon R, Reymann JM, Bellissant E, Naudet F. Risks and benefits of nalmefene in the treatment of adult alcohol dependence: A systematic literature review and meta-analysis of published and unpublished double-blind randomized controlled trials. PLoS Med 2015;12:e1001924.
12 Stafford N. German evaluation says new drug for alcohol dependence is no better than old one. BMJ 2014;349:g7544.
Serial mischaracterizations of Alcohol Use Disorders in England. Whose interests are served?
Serial mischaracterizations of Alcohol Use Disorders in England.
Whose interests are served?
Kmietowicz could have critically assessed the recent data on alcohol from the Health and Social Care Information Centre.(1,2)
First, how to accept the statement “in 2014, there were 6,831 deaths which were related to the consumption of alcohol”? Not only did the UK Office for National Statistics state “in 2013 there were 8,416 alcohol-related deaths registered in the UK” but this figure was seriously challenged because France, for the same population, reports 49,000 alcohol-related deaths despite only a slightly higher adult per-capita consumption of pure alcohol (12 L in France vs 10 L in the UK).(3)
Second, why no concerns for social costs which include domestic violence to children and women?(4)
Third, why no calls for a comprehensive alcohol control policy with effective evidence-based actions (eg. price, labelling, advertisements …) but only a focus on ancillary measures such as the ‘”Dry January” initiative?(5)
Last, regarding treatment, why a sole interest in pharmaceutical assistance? Patients need a comprehensive treatment plan including psychosocial interventions: NICE recommends to “consider offering acamprosate or oral naltrexone in combination with an individual psychological intervention (cognitive behavioural therapies, behavioural therapies or social network and environment-based therapies)” which “should usually consist of one 60-minute session per week for 12 weeks.”(6) I note that nalmefene (launched in May 2013), was only prescribed 4,400 times in 2014-15 vs 139,000 for acamprosate and 52 ,000 for disulfiram. But that’s far too much.(7-12)
1 Kmietowicz Z. Drugs for treating alcohol dependence in England cost nearly £4m in 2014. BMJ 2016;354:i3670
2 Health and Social Care Information Centre. Statistics on alcohol, England. 30 Jun 2016.www.hscic.gov.uk/pubs/alcohol16.
3 Braillon A, Gilmore I, Williams R. Alcohol-related deaths: is misinformation hindering care improvement? Lancet 2015;385:1619-20
4 Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002 20;359:1423-9.
5 Iacobucci G. UK doctors call on government to introduce minimum pricing for alcohol. BMJ 2012;345:e7874
6 Pilling S, Yesufu-Udechuku A, Taylor C, Drummond C; Guideline Development Group. Diagnosis, assessment, and management of harmful drinking and alcohol dependence: summary of NICE guidance. BMJ 2011;342:d700.
7 Fitzgerald N, Angus K, Elders A, de Andrade M, Raistrick D, Heather N, McCambridge J. Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers. Addiction 2016. Online June 5. doi: 10.1111/add.13438.
8 Braillon A, Granger B. Nalmefene and alcohol dependence: a new approach or the same old unacceptable marketing? Subst Abuse Rehabil 2015 29;6:75-80.
9 Spence D. Bad medicine: nalmefene in alcohol misuse. BMJ 2014;348:g1531.
10 Braillon A. Nalmefene in alcohol misuse: junk evaluation by the European Medicines Agency. BMJ 2014 10;348:g2017.
11 Palpacuer C, Laviolle B, Boussageon R, Reymann JM, Bellissant E, Naudet F. Risks and benefits of nalmefene in the treatment of adult alcohol dependence: A systematic literature review and meta-analysis of published and unpublished double-blind randomized controlled trials. PLoS Med 2015;12:e1001924.
12 Stafford N. German evaluation says new drug for alcohol dependence is no better than old one. BMJ 2014;349:g7544.
Competing interests: No competing interests