Alcohol pricing and the Liver Trust scare

Drugs and Alcohol Today

ISSN: 1745-9265

Article publication date: 8 June 2012

394

Citation

Klein, A. (2012), "Alcohol pricing and the Liver Trust scare", Drugs and Alcohol Today, Vol. 12 No. 2. https://doi.org/10.1108/dat.2012.54412baa.001

Publisher

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Emerald Group Publishing Limited

Copyright © 2012, Emerald Group Publishing Limited


Alcohol pricing and the Liver Trust scare

Article Type: Editorial From: Drugs and Alcohol Today, Volume 12, Issue 2

Things are done differently in other countries, which makes it so attractive to both go away and then come back home. One obvious marker of difference is the way alcohol is handled. In Islamic countries, alcohol is so obviously absent from public life that the traveller is content to obtain his ethanol fix in the designated spaces of international hotels, or the discrete taverns that in many parts of the Middle East provide the indigenous Christian population with an economic niche. Many travellers prefer to forego it altogether. Far more complex to navigate is the web of regulations protecting public virtue in the USA. Tourists cracking open a half bottle of Californian rose to wash down a packed lunch during a long overland trip may find themselves kicked off the Greyhound. And allowing a thirsty teenager to sample the same drop of Zinfandel at a restaurant can get the family thrown out and the parents arrested.

In Spanish supermercados, on the other hand, eyes open wide at vintage Rioja selling for five euros the bottle and table wine from Valdepenas for one. Interestingly, it is still safe to walk back to the hotel even late into the night, and society seems to be functioning. For the UK traveller either experience is a welcome reminder of cultural difference. One could say that it supports the claims made by Barbour and colleagues, that alcohol is “no ordinary” commodity (Babor et al., 2010). So extraordinary in fact, that consumption is regulated by widely varying sets of strictures and permissions in different cultures. A reflection, perhaps, of the demons conjured by the uncorking of the bottle. Yet, the argument for different regimes can be extended across the entire restaurant menu. To see how differently culinary staples are treated across the world try asking for bacon sandwiches in the Islamic world, steak in India or dog roast in the UK. Culinary cultures are different, thank goodness, and food matters.

Cultural diversity, however, something that the authors of this influential publication take issue with. They claim that because alcohol is not ordinary, policies to regulate and control have to be standardised. Because of its extraordinary character policy should aim at eliminating cultural difference. But in matters of consumption (as in so many others), we argue vive le difference. When it comes to alcohol the first question should be why does it have to be classified in a separate category? Why, for instance is the international body working on alcohol the World Health Organisation and not the Food and Agricultural Organisation? Alcohol is nutritious, indeed, for centuries it has been a rich source of nutrients as well as an uncontaminated fluid. When combined with food, one of the cultural spectacles of Old Europe, it works for the mutual enhancement of eating and drinking. Though usually taken in liquid form when most foods are solid, the consistency of food lies on a continuum. In terms of mouth feel and body, a consommé is closer to a chardonnay than to loaf of bread. Even as subject of moral condemnation, there is considerable overlap. Prophets and preachers from Mohamed to the Temperance movement have railed against alcohol. But gluttony too is a deadly sin, and the assault obesity may well become the Temperance issue of the twenty-first century.

There are signs, however, that in the UK and increasingly across Europe the attitudes to alcohol are hardening. Not because the evidence base is building up that alcohol caused social problems are getting worse, but by dint of repetition. Driven by overlapping concerns over social unrest and the rising cost of healthcare provision, a view is crystallising that alcohol “excess” lies at the root of the problem. According to this arrival at truth by agreement, the problems lie in the ready affordability and availability of alcohol, the failure of the night-time economy and the insufficient rigor of government interventions.

According to the editorial position of DAAT there is no questions that Temperance advocates have good intentions - but the arguments do not stack up. Moreover, we argue that the proposed reforms will exacerbate social and medical problems. The importance of a realistic assessment of potential consequences, both intended and unintended, are particularly important for the discussion of policy issues that are motivated not by economic benefit but are pursued for the public good.

The argument that alcohol is underpriced has been put forward tenaciously. First supermarkets, a popular bête noire for their dominance in the retail sector, were chastised for selling alcohol cheaper than water. Particularly vulnerable to such temptation, it has been argued, are the poor. Supermarket discounters put oblivion within reach welfare recipients. A campaign targeted at the drinking habits of the middle classes followed. Wine consumption on the dinner party circuit, it was claimed, was paving the way for a public health disaster. Accordingly, it was the entire nation and not just pockets of the underclass that had to mend its ways. The uneven distribution of financial penalties on rich and poor can then be ignored. Now that the middle has been chastised and balance has been demonstrated, commentators can return to the main problem: alcoholic permissiveness among the poor and the young.

These are two population groups so impervious to the government light “nudge, nudge” approach that tougher measures are needed. According to a recent publication by McGregor (2012), this means minimum pricing, the banning of promotions (such as 3 for the price of 2), the introduction of separate counters for alcohol sales, and reduced trading hours. She praises the efforts of a far more interventionist government in Scotland, not normally a star performer in public health. Given the serious social implications of such policies, it is worth rephrasing what is proposed: economic discrimination, the further disadvantaging of the poor, social stigma for alcohol buyers and the return to binge buying. Is this the way forward towards an effective alcohol policy?

Some of her concern about alcohol-related problems is shared by MPs on the cross party Science and Technology Committee who have urged the government to try harder help people understand the unit system. “Alcohol guidelines are a crucial tool for government in its effort to combat excessive and problematic drinking”, said committee chair Andrew Miller MP. “It is vital that they are up to date and that people know how to use them. While we urge the UK health departments to re-evaluate the guidelines more thoroughly, the evidence we received suggests that the guidelines should not be increased and that people should be advised to take at least two drink-free days a week” (IAS, 2011).

We would go further and ask the government to make sure that it understands the unit system itself. As we have argued before, the measures borne in an era when the best way of distinguishing between the only two wines on the menu was by colour, do not help in the Bacchanalian emporium of the contemporary supermarket. As we learn from the committee’s report, the units themselves are arbitrary constructs (HOCSC, 2011). The standard unit used in the UK, for example, is 8 g of alcohol. In Ireland and Australia, it is 10, in Italy and Denmark 12, in Portugal 14 and in Japan 19.5. Such precise amounts of alcohol fit only loosely into rough descriptors like “a glass of wine” – what strength of wine, what glass? It could be said in response that precision is an aspiration for guidelines not a prerequisite. The intent is to moderate behaviour not deliver scientific standards of accuracy. But government intrudes into the nation’s drinking parlours at its peril. It cannot but err on the side of caution, in case people with low alcohol tolerance are tempted into risky drinking by official assurance that they are within safe limits. But by the same token, the drinking behavior of village pub regulars is now defined as hazardous and open to silent disapproval. There are evidently differences in physical tolerance and lifestyle. At the very least, government, risks its reputation for consistency.

Few things express the dilemma better than the oxymoronic title of the guidelines first published by the Health Education Council in 1984: “Sensible Drinking”. Reinforced by repetition, the nonsensical enters standard usage, and informs self-righteous lecturing from a moral vantage point. As the 1992 leaflet of the Health Education Council makes clear: “The government, does not wish to discourage the sensible consumption of alcohol, but is committed to reducing alcohol related harm”. But the point of drinking as with any substance use, is to escape the dictate of sensibility and to open up realms of consciousness that lie beyond the reaches of the sober mind. Indeed, it may be sensible to forego sensibility, at least temporarily. In antiquity the virtues of inebriation were recognised by the Persians who would discuss all important issues at least two times. Herodotus informs us that “If an important decision is to be made, they discuss the question when they are drunk, and the following day the master of the house where the discussion was held submits their decision for reconsideration when they are sober. Conversely, any decision they make when they are sober, is reconsidered afterwards when they are drunk” (Herodotus, 1996, Book 1, Chapter 133).

Trying to do the best may, as we know from the substance field, lead to problems beyond the anticipation of the most clairvoyant activist. The counsel for matters of lifestyle dependent health then is to minimize the interference of government, contain the arrant irresponsibility of business, and leave messaging to civil society. Many organisations form to celebrate or condemn the fruits of the vine in the hope that the consume citizen and taxpayer, benefit from maximum information, freedom of choice and the right to spend hard earned money as she pleases. Of course, the information that is provided should be of high levels of accuracy, but as we have already seen from out discussion of alcohol units, even governments are confused or at least inaccurate. It is unfair perhaps to demand higher standards of behaviour from non-governmental organisations, but when these are cloaked in professional excellence and the authority of practice one should expect nothing but the best.

It is deeply regrettable, therefore, to see one of the leading public bodies on alcohol education, the British Liver Trust, propagate harmful and inaccurate messages. The 2011 report contains many sensible and even mildly critical passages, such as the warning that the “The Government’s drug Strategy” raises concerns “about a drive towards a narrow focus on abstinence-orientated recovery models”.

It also recognises that “For some drinkers, such as those who drink at harmful,hazardous levels or are mild dependent, the best option may be to reduce alcohol consumption and for those who are more severely dependent, they may need to follow complete abstention from alcohol” (British Liver Trust, 2011). It is interesting that this argument is not made for people with problematic heroin or cocaine habits. Surely many clients presenting with illicit substances could also benefit from reduced consumption rather than being condemned to fail in the illusory pursuit of abstinence? The paper steps away from advocating “controlled drug use” but does insist on the benefits of “informed choice”. It claims that “alcohol policy will be most effective if it is based on giving patients an informed choice over the range of recommended and appropriate goals that will work best for their recovery pathway”.

Yet, at the same time the Trust itself is responsible for disseminating the most egregious misinformation reported in one national newspaper as “One month detox can do more harm than good” (Daily Mail, 2012). It came from eminent members of the medical establishment who were scornfully dismissive of the widespread custom among the drinkers of the land to keep the month of January alcohol free. According to the Southampton hepatologist Mark Wright “Detoxing for just one month in January is medically futile” (BBC, 2012). This is an extraordinary ex cathedra statement for which even a specialist should provide some kind of explanation. Is he saying that the human body does not self-repair, or that the period of abstinence does not provide welcome relief to an organ that has had considerable work to do over the preceding festive period? The attack on these popular methods of self-help is headed by the Liver Trust’s chief executive Andrew Langford, who dismisses the decision to say alcohol free for a month as “not the way to approach it”.

From the head of an organization that is dedicated to awareness raising and information distribution this is mindboggling. Having read the statements reported in different newspapers and websites I understand that both physicians were trying to say that people should drink less all around the year. But the message that came across was to discourage January abstainers altogether. Passed on by a series of Chinese whispers the story circulating through the country’s pubs now is: “don’t do a one month detox, it is bad for you”. There is no way of telling how many potential abstainers have been swayed by the medical advice from one of the leading agencies dedicated to health promotion, but we suggest that research be done. It is instructive, however, to report at least anecdotally that this sanctimonious approach, when combined with the top-down management of information and intervention has adverse effects on public health. As a consequence of the intervention of two public health advocates, however, we have the active discouragement of one of the most effective harm reduction measures in the alcohol field. When it comes to lifestyle related health, the punter will have to choose which information to follow and may be well advised to stay away from experts and within the tried and tested recommendations of folkmedicine. We hope, in the meantime, that government remains unswayed by the calls for price increases and does not seek to impose additional financial burdens on an already highly taxed population.

Axel Klein

References

Babor, T., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., Grube, J., Gruenewald, P., Hill, L., Holder, H., Homel, R., Österberg, E., Rehm, J., Room, R. and Rossow, I. (2010), Alcohol: No Ordinary Commodity – Research and Public Policy, Oxford University Press, Oxford

BBC (2012), BBC News Health, 1 January, available at: www.bbc.co.uk/news/health-16354472

British Liver Trust (2011), Reducing Alcohol Harm. British Liver Trust, London

Daily Mail, Month-long detox to get over alcohol-fuelled Christmas ‘can do more harm than good’ (2012), 3 January, available at: www.dailymail.co.uk/health/article-2080799/Liver-detox-Month-long-detox-alcohol-fuelled-Christmas-harm-good.html#ixzz1 nmd5a6Ld

Herodotus (1996), The Histories, Penguin, London

House of Commons Science and Technology Committee (2011), “Alcohol guidelines”, Eleventh Report, House of Commons, London. available at: www.publications.parliament.uk/pa/cm201012/cmselect/cmsctech/1536/153602.html

Institute of Alcohol Studies’ (2011), Cameron backs minimum pricing Butwill the Government?, Alcohol Alert, IAS, London. Web site: www.ias.org.uk/resources/publications/alcoholalert/alert201103/al201103_p14.html

McGregor, J. (2012), Drink and the City – Alcohol and Alcohol Problems in Urban UK Since the 1950s, Nottingham University Press, Nottingham

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