Wednesday, 18 May 2011

Queen declines a pint and Barrack O' Bama brings his own booze to Ireland. What's the problem?

The myth of moderation - can alcohol be good for you?

The Queen was poured a fresh pint on her tour of the Guinness factory today (18th May) but wisely set it to one side, to the apparent disappointment of the Duke of Edinburgh.  And when President Barrack O'Bama planned a visit to his ancestral home of Moneygall his advisers made the decision to bring a barrel of American beer to Ireland for him to drink.  They must have misunderstood the news that Ireland has a chronic alcohol problem.  It’s not a shortage Mr President, it’s a glut.  They can't have been reading the Irish Examiner which courageously reported (in a special 20-page supplement on 6th May and in many articles since) that our love affair with booze is by no means over despite the many unhappy consequences listed in the paper. For those that missed it, these include 70,000 crimes in 2010, 161,016 bed days in hospital in 2008, and 6.5 billion spent on drink between us in 2009.  This week a further report by UCD explores the unhappy link between suicide and alcohol at times of unemployment.  We really have a lot to worry about.

Don't do it, Sir.
So why was the The Examiner’s public service coverage seen as ‘courageous’? As TD Robert Dowds wrote in a letter published in the paper on 12th May:
As a new TD who called on the Government to seriously pursue a ban on the advertising of alcoholic drinks recently in Dáil Eireann, I must congratulate you on…a brave and challenging decision to publish such a supplement. Will the drinks industry ever advertise in the Irish Examiner again?
Selling the 'little of what you fancy' message

Well maybe they might. The trick with winning the hearts and minds of the public is not to overplay your hand. The alcohol industry has cleverly courted the role of educator in chief, largely through its 'charitable' wing  A role which, as the Joseph Rowntree Foundation reported:
enables the companies to dispel suspicions, appear caring and satisfy shareholders that it is dealing with the long-term potential threats to its business such as anti-industry campaigns and increased government regulation.
Sadly, The Examiner does seem to fit this description too, particularly in its avoidance of blame of the industry or a lax government, and the extraordinary column space given to two coroners who are distinctly off message, arguing ‘the benefits of a few pints’, the relaxation of drink- drive legislation and a ‘cost benefit analysis' of this whole death vs. profits debate about road safety. 

And there is synchronicity too between and The Examiner in the message that ‘moderation is good’. Thus The Examiner editorialises about “the harmful effects of alcohol misuse and the urgent need for self-education about the benefits of responsible and sensible drinking”.  What’s wrong with that you say?  Alcohol is good for you in small doses, fine in moderation and only a problem if you overdo it, right?  Well not if you know as much as neuro-psychopharmacologist Professor David Nutt who wrote in the Guardian last month that "There is no safe dose of alcohol”.
The myth of a safe level of drinking is a powerful claim. It is one that many health professionals appear to believe in and that the alcohol industry uses to defend its strategy of making the drug readily available at low prices. However, the claim is wrong and the supporting evidence flawed… Alcohol is a toxin that kills cells such as microorganisms, which is why we use it to preserve food and sterilise skin, needles etc. Alcohol kills humans too. The toxicity of alcohol is worsened because in order for it to be cleared from the body it has to be metabolised to acetaldehyde, an even more toxic substance. Any food or drink contaminated with the amount of acetaldehyde that a unit of alcohol produces would be immediately banned as having an unacceptable health risk.
Alcohol is a poison. The more you have, the more you poison yourself

But what of the endless research papers telling us that drinkers live longer than teetotalers, and that wine in particular protects your heart? Some are simple mis-associations linking the fact that rich people drink wine with the fact that they also live longer.  Yes they live longer, but it is because of the advantages of being rich rather than any benefits of drinking wine.  Poor people who drink die sooner, but they also die sooner than poor people who don't drink.  Further, an American University research team spent time looking at more than 50 studies that claimed that longevity matched moderate alcohol use.   They found a “systematic misclassification error”.   Research reports labelled as ‘abstainers’ those who in fact had a lifetime of drinking alcohol, but gave up often for health reasons in their last years and months.  The apparent benefits of drinking are due to a ‘reduction or termination of drinking in older people due to increased illness, disability, frailty and/or medication'.  Without this misclassification 'the studies judged to be error free found no significant all-cause or cardiac protection” after all. 

Or to quote Physician Ellen CG Grant "In my clinical experience over 50 years, in a society where alcohol drinking has been increasingly regarded as a social necessity, non-drinkers can have health reasons for avoiding alcohol... Migraine patients learn to avoid red wine because they immediately get a headache. Migraine patients are more likely to have strokes".

The conclusion that alcohol does not have any provable health benefits is consistent with the clear advice of the American Heart Foundation that:
How alcohol or wine affects cardiovascular risk merits further research, but right now the American Heart Association does not recommend drinking wine or any other form of alcohol to gain these potential benefits. The AHA does recommend that to reduce your risk you should talk to your doctor about lowering your cholesterol and blood pressure, controlling your weight, getting enough physical activity and following a healthy diet. There is no scientific proof that drinking wine or any other alcoholic beverage can replace these conventional measures.
So it’s poison, and the more you drink, the more you poison yourself. And it has no scientifically validated benefits, leaving the whole moderation argument looking very dubious.  In fact, as Bobby P Smyth, Clinical Senior Lecturer at the Department of Public Health & Primary Care, Trinity College Dublin wrote, the use of the term ‘moderation’ is itself dangerous because official definitions of it are inconsistent and misunderstood.
In the context of a discussion on alcohol, these words [moderate and moderation] are worse than useless. They are useless because there is no consensus among health professionals, let alone the general population, as to their meaning. International guidelines on low risk drinking are quite heterogeneous. Drinkers in general population samples have a poor and inconsistent understanding of what is meant by "moderate" drinking, with evidence that many people who experience significant alcohol related harm view their own drinking as moderate. In one Irish study of young adults it emerged that just over 50% met DSM-IV criteria for either alcohol dependence or alcohol abuse, yet most of this group viewed their drinking as moderate and nobody was willing to categorise their own drinking as "heavy".
So to return to President O'Bama and his barrel of beer. We don’t miss the insult Barrack, you don’t trust the Moneygall Inn to keep terrorists from climbing in the back-window and poisoning your pint. Well the joke is on you, Mr. President.  The beer you are bringing is already poisonous. Ha ha ha.  Good call Ma'am.

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