Response to readers’ comments on ‘After the flood: twenty one principles to underpin a new approach to alcohol’

October 14, 2010

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My last blog on how to reduce the damage caused by alcohol consumption received more responses than any other to date. Work commitments have prevented me from responding until now – the below is a collated response to comments made by contributors. I have also updated the alcohol post with added references. This will be the last post at this URL: you can now find my blog at https://profdavidnutt.wordpress.com/.

 

Q1. “Most of your proscriptions won’t work – Drinking and violence have not markedly increased since 24 hour opening”

A: The data on drinking and associated violence is not as clearcut as that – Police say violence has increased
Q2. “Reducing the drink driving limit to 40mg/% will not reduce drink driving – both Finland and Sweden have a 20mg limit, and yet they both have higher levels of drink-driving than we do. In fact, Sweden has the highest proportion of deaths from drink-driving in the whole of Europe

A: However, as far as I am aware, wherever the limit has been lowered then lives are saved
Q3. “A lot of high alcohol content beers are brewed that way for taste rather than to get you drunk quicker, such as high hop content India Pale Ales and Imperial Pale Ales, doubly so for West-Coast style Double IPA’s. No one has yet figured out how to make an extremely hoppy beer with a low to moderate alcohol content that still tastes good”

A: I take your point, however, most of the high alcohol content larger/beers in the UK have less taste than the lower alcohol ones and are clearly being used by the young simply to get drunk.  Indeed, as I said, some of the ciders are not even brewed they are synthetic combinations of alcohol and flavouring

Q4. “Raising the drinking age to 21 only way makes sense is if you change the driving ages and age of majority along with it. Otherwise you end up with the same situation as in the US, where young people are not-quite full adults under the law”

A: Agreed – it’s a question of whether you want to save lives or not – but raising the age at which young people engage in risky activities, such as taking drugs, driving or sex, tends to reduce harmful outcomes

Q5. “We should to try and foster a healthy respect for alcohol (and by extension all drugs). They are something adults can enjoy without needing to use to excess. Make alcohol (or drug) impairment an aggravating factor in any and all criminal offences”

A: Agree with the education aspect [my point 16/17]. The aggravating crime idea is interesting – the opposite view tends to be taken currently  – I would be interested in a legal view

Q6.  “What are your stats on hospital admissions based on?”

A: Hospital Admissions linked to alcohol 65% increase over 5 years to 2008/9 (2010)
Data Dept. of Health
www.nwph.net/alcohol/lape
( lape =local alcohol profile England)

Q7. “Why should a 4% can of lager cost twice as much as a 2% can? I can see the logic of a progressive taxation, but this would make wine, that facet of the Mediterranean cafe culture we’re all supposed to emulate, prohibitively expensive”

A: In fact, taxing per unit would not greatly affect the price of wine because that’s what we do currently between different forms of alcohol – wine taxed more because of its stronger alcohol concentration

Q8. “Most things are cheaper relative to incomes than they were in the ’50s. This is a positive not a negative”

A: That why we need new policies to change the trend! Alcohol related harms have increased as prices have decreased due to higher consumption

Q9. “Scandinavia also has problems with drinking, so we shouldn’t emulate their policies”

A: It’s about the population risk – alcohol health damage is less in Sweden, I believe

Q10. “I’ve been to the pub with many ladies over the years, and I’ve often bought them large white wines in 250ml glasses. Not one has ever slumped into an alcoholic coma”

A: But all their livers will have been more harmed than if you had bought them a smaller glassful

Q11. “If organisations such as Carnage UK cause a problem, why not enforce existing laws first?”
A: They encourage harms – not necessary lawlessness – hence regulation simpler

Q12. “Alcohol free lager won’t work – the taste doesn’t compare to the regular stuff”

A: Untrue – I like it as do many other people who want beer/lager taste without impairment – and the quality is improving. Many experienced drinkers say they prefer the taste of alcohol-containing drinks because they are conditioned to them by the effects of the alcohol they contained. Indeed if alcohol free drinks were all that were available, I suspect most of us would be quite happy to drink them in preference to water or other alcohol-free alternatives

Q13. “We drink because this is a pressured, unhappy society in part because people think they can and it’s desirable to control the people”

A: Not true – in part we drink because we are subconsciously conditioned to drink by the alcohol in drinks

Q14. “Wouldn’t you see AIDs or Malaria as being more deserving of public funds? Doesn’t this show warped priorities?”

A: Alcohol kills more people per year in the UK than either of these

Q15. “I’m sure there are plenty of people who’d rather a line or two of coke than a pint of ‘ale’, but I suspect that’s not what you had in mind?”

A: Each to their own – assuming the choice is not driven by addiction

Q16. “How would banning of university-linked subsidised drinking be enforced in reality?”

A: Private organisations can do what they want but not with a taxpayer subsidy via the university

Q17. “Having a lower age for frontline combat troops than for drinkers, as in the US, is illogical”

A:  Agreed – a more sensible approach would be to raise the age for combat troops

Q18. “Alcohol is already more expensive in real terms (ie. price has exceeded inflation). I think what you mean is you want it to be make it as expensive as it was in the 1950s relative to income. No thanks.”

A: Correct, that’s what I suggest and why not? An average drinker would save much more in terms of reduced health and policing costs than they would lose in extra taxation

Q19. “Could you give a reference for Point 1: current estimates of damage from alcohol. £27bn is almost incredible!”

A: To clarify – that’s the overall cost of alcohol harms. The cost of alcohol related harm to NHS is  £2.7 billion at 2006/7 prices, cost to society is £17.7 to £21.5 billion, ref. (2008) Dept of Health www.direct.gov.uk/en/Nl1/newsroom/DG_170745

 Q20. “Education regarding the costs to the taxpayer seems to be lacking. If people knew how many hundreds or thousands of pounds it cost each of us… Maybe that could form a part of the warning notices”

A: Good idea

Q21. “Reducing the licensing hours just sends people home to drink what they want or makes them drink as much as possible within the time allotted”

A: Agreed – this would only work if other outlets also closed earlier or completely

Q22. “Minimum pricing would unfairly affect the poor”

A: Many of the poor are poor because they are addicted to alcohol and tobacco – tobacco price increases have helped reduce demand so why not for alcohol?

Q23. “Your desire to make another person’s decision whether to drink alcohol for them through taxation or other means can only come as a result that you believe you have made a better decision than that someone is capable of doing themselves”

A: Not  necessarily true because alcohol has a profound impact on people’s normal decision-making processes which is a major reason that it’s so misused and causes so much harm

Q24. “The decision whether or not to engage in any activity is one of cost vs. benefit. Your analysis looks only at the costs of alcohol, not the benefits”

A: Agreed, a cost-benefit analysis is required for all drugs legal and illegal
     

Q25. “The mortality of a teetotaller doesn’t meet that of a drinker until the drinker is taking 60 units a week. There is plenty of evidence that the occasional couple of beers or Glass or two of wine in the evening is not just harmless, but good for you”

A: This may be due to some teetotallers being ill. The health benefits of alcohol are not proven – see Academy of Medical Science. Calling Time: The Nation’s Drinking as a Major Health Issue: Academy of Medical Sciences; 2004.

Q.26 “Banning didn’t work in the US with prohibition, why should it work now?”

A: I didn’t mention banning  but in fact, it did reduce alcohol health harms dramatically, however, the increase in social harms from crime was deemed to offset the health benefits

Q27. “You can’t have researched alcohol consumption statistics. If you had, you’d know that there isn’t a problem. Okay so we have a few thousand binge drinkers, but we have laws to deal with them. They can be arrested for their behaviour. It’s always been thus”

A: Not true – 20% of all male and 12% of female deaths 18-40 in the UK are due to alcohol. Read the report by the House of Commons Health Committee: Alcohol. London: House of Commons; 2010. Report No.: HC 151-I

Q28. “I’m going to ask a very simple question: why do we care? If someone chooses to spend their life smoking, having a beer and hates taking exercise (that about sums me up) then let them. We should know of the dangers and then be allowed to get on with it”

A: We should care because the costs of not caring fall on us all

Q29. “I’ve heard that you have shares in GlaxoSmithKline, the friendly neighbourhood pharmaceutical multinational

A: No – I bought shares from the Wellcome Trust 20 years ago when they disposed of some of their assets to raise money for medical research. These were shares in Burrows-Wellcome that then became SKB and then GSK. I have since sold them to avoid people –such as the Guardian – assuming (incorrectly) that they might influence my thinking

Q30. “There’s no evidence to suggest increased hours of availability leads to greater alcohol misuse – l stats available from the NHS and ONS suggest that since licensing hours were liberalised, binge drinking, total alcohol consumption and alcohol related harm have all declined”

A: As previously discussed, the cost of alcohol related harm to NHS is £2.7 billion at 2006/7  prices,  cost to society £17.7 to £21.5 billion.  (2008) Dept of Health www.direct.gov.uk/en/Nl1/newsroom/DG_170745.
Hospital Admissions linked to alcohol subject to 65% increase over 5 years to 2008/9 (2010) Data Dept. of Health www.nwph.net/alcohol/lape ( lape =local alcohol profile England).
Per capita consumption of alcohol has doubled from 6.l per year in1960s to 11.5 per year in 2000, whilst price (relative to income ) halved since 1960s  Institute of Alcohol Studies (2008) “Alcohol: Tax, Price and Public Health”.  Institute of Alcohol Studies, www.ias.org.uk/resources/factsheets/tax.pdf

Q31. “The corresponding benefits of the drinks industry should be considered- such as the £8bn paid in duty by brewers every year, the £28bn contributed to the economy every year by the beer and pub industry (source: HMRC) and the general beneficial effect of a relaxing drink enjoyed by the vast majority of drinkers”

A: True – it’s a complex argument – I am not saying destroy the beer and pub industry – indeed some of my suggestions might strengthen it by diverting drinking away from supermarket sales and back to it

Q32. “What would you suggest as an alternative to alcohol? A synthetic, psychoactive drug, rather than a naturally occurring substance that we’ve been drinking for 10,000 years?”

A: See my other writings on this e.g. Nutt, D. 2006. Alcohol Alternatives: A Goal for Psychopharmacology? Journal of Psychopharmacology, 20: 318-320.
If alcohol was discovered today, its toxicity would make it illegal – saying this was maybe the main reason I was sacked last year!

Thank you for the numerous thoughtful commnts made – join me over at https://profdavidnutt.wordpress.com/ for more debate.

 

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9 Responses to “Response to readers’ comments on ‘After the flood: twenty one principles to underpin a new approach to alcohol’”

  1. Jackart Says:

    Your response does you credit. But the major objection to using price is that it punishes (it does…) the responsible drinker for crimes he does not commit. It’s therefore grossly illiberal.

    And using government statistics culled from reports from anti-alcohol monomaniacs?… naughty, naughty.

  2. PJH Says:

    I didn’t mention banning but in fact, it did reduce alcohol health harms dramatically,

    Except the harm to citizens who died during the prohibition, because the US Government thought it was a good idea to poison the alcohol that was still being drunk.

    http://www.slate.com/id/2245188/

    “The idea was to scare people into giving up illicit drinking. Instead, by the time Prohibition ended in 1933, the federal poisoning program, by some estimates, had killed at least 10,000 people.”

    http://www.naturalnews.com/029029_Prohibition_poisoning.html

    “In response [to previous poisons being easily extracted], the administration of President Calvin Coolidge ordered industry to add higher levels of more difficult-to-remove poisons to their alcohol, including acetone, benzene, cadmium, camphor, carbolic acid, chloroform, ether, formaldehyde, gasoline, iodine, kerosene, methyl alcohol, mercury salts, nicotine, quinine and zinc.”

    Or are you just counting the ‘non-fatal’ harm figures.

  3. John Says:

    I’ve got a suggestion for an alcohol alternative. Methylenedioxymethamphetamine.

  4. Sam Says:

    I’ve nothing to add really, and I didn’t ask a question in the previous post, but I’d like to thank you for taking the time to address the questions put to you.

    It seems to be mostly scientists who respond to criticism of articles they pen – probably because we’re used to having everything picked at from day one!

    I’m still undecided on this issue – heavy handed regulation smacks of nanny-stateism to me. At the same time there are huge issues around alcohol. I think one of the main problems is there is no legal alternatvie to alcohol so people are conditioned all their lives into thinking that the only safe (ha!) way of altering their state of mind is to get drunk. At the very least it’s the only acceptable way.

  5. James Phillips Says:

    Thank you for the response. However, this doesnt get around the fact that this punishes ordinary drinkers.

  6. Jonathan Says:

    Yesterday I saw articles in the media about your paper in the Lancet, claiming alcohol is more harmful than heroin. Unfortunately, my Athens login doesn’t give me access to the Lancet and I don’t like to go on what I see in the media.

    I wondered, when considering the harm caused by alcohol, does it take into account the fact that alcohol is currently legal and heroin etc. are not? Surely much of the problem caused by alcohol is because it is so widespread, and socially acceptable?

    I’m glad to see you are tacking the problem of alcohol. No review of drugs policy should exclude it or tobacco.

  7. Blanca Says:

    A brief comment:
    At half past seven the time I usually finish work, I cannot buy a book in my local bookstore (closes at 5), I will struggle to get a coffee in any local coffee shop (closes at 6:30), I cannot go to my local library (opens in the evenings only once a week). I can however, buy vodka in my local cheap booze place any day of the week (closes late) and have a pint in any pub. We are being manipulated by the alcohol industry, they have a huge interest of keeping alcohol available at any time, at a great cost for society. It’s time to do something about it!
    Thanks Prof. for showing us what science says (again)!!!

  8. Jonathan Says:

    Now I see the site has been updated to say the Lancet article is freely available, so thanks for that.

    Given that the findings of the paper are that alcohol is such a harmful drug, am I the only one who finds the programme for the conference ironic:

    Drinks reception 5.00pm – 7.00pm Drinks and canapés

    Are those all non-alcoholic drinks then? Surely the most important step towards reducing alcohol harm is eliminating the idea that alcohol is a necessary ingredient of social or business occasions. Scientists and experts should be able to meet to network and discuss their ideas without having to drink at the same time.

  9. empty1414 Says:

    If organisations such as Carnage UK cause a problem, why not enforce existing laws first?”
    This is my question. I see your answer but why? Could you tell me about reason, olease?
    Thank you!
    ___________________________
    http://www.vibramshoestore.com


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