Thursday, 22 September 2011

Is the alcohol industry taking over the world?

A major survey of teenage drinking was published in June by the usually trusty and worthy Joseph Rowntree Foundation as part of its three year project on young people and alcohol.  It concludes with the astounding 'policy' advice that there is 'little benefit' in aiming to prevent young people from drinking alcohol. How did we get to this point?

'Doubt is their Product' is an excellent analysis by David Michaels of how the American tobacco (and asbestos) industry managed to stave off restrictions to sales and marketing that would naturally have followed from the alarming discovery that their product kills you.  The facts were known in the early part of the last century, a good 50 years before the courts and government took action.  Why were governments so slow to act?

As Michaels shows, the manufacturers created phony science to counter the good science.  As a tobacco company executive put it, they 'manufactured doubt' by flooding the market with 'studies' putting the emphasis away from the health disbenefits of tobacco and onto, for example, the genetic predisposition of some smokers to get cancer, or the social failings of addictive smokers, or the benefits of relaxing with a cigarette.  'The Orwellian strategy of dismissing research conducted by the scientific community as "junk science" and elevating science conducted by product defense specialists to "sound science" status also creates confusion about the very nature of scientific inquiry and undermines the public's confidence in science's ability to address public health and environmental concerns'.

Looking at the research flooding the journals it is clear that the alcohol industry, with the benefit of hindsight, is playing the same game, but better. The 'world's largest alcohol research organisation' the Foundation for Alcohol Research, for example, is funded by the alcohol industry to the tune of over 2,000,000 per year. It boasts the top alcohol manufacturers on its board, but also has a host of  academics from many leading universities rubbing shoulders with them.   Fine you say, but its output is very clearly stated: 'your donation will support our mission to discover the benefits and risks of alcohol consumption'.  And so it does. As the Public Library of Science editors wrote in May:
"The crisis of confidence that surrounds the behavior and practices of Big Tobacco and Big Pharma bias in funded research, unsupported claims of benefit, and inappropriate promotion and marketing, among others—should be enough to provoke in us all a high degree of skepticism with any industry involvement in health research and policy. But the evidence and critical voices highlighting the practices of the alcohol industry—a massive and growing US$150 billion global business—have not yet received adequate prominence in medical journals. Indeed, attention to and scientific research on the alcohol industry have not kept pace with the industry's ability to grow and evolve its markets and influence in the health arena"
“Powerful sway” of industry ahead of UN health summit

The influence doesn't end with research.  Big Alcohol is also infiltrating governments, and at very senior levels.  Astoundingly, the UK governments 'independent' health advisory panel on alcohol has been reconstituted in order to make way for a 50% alcohol industry representation (see the Guardian report on advisory panel 'heavily stacked' with industry insiders).  Worse, the British Medical Journal last month published details of how the world health agenda itself has been hijacked in advance of the world summit on non-communicable disease in New York this September.  The BMJ has evidence that alcohol industry representatives in several nations have used influence to change or delete aspects of the agenda.  'Indeed, draft documents show that effective, evidence-based measures on alcohol (controlling price, availability and marketing) are being deleted, and industry favoured measures (partnership working, community actions and health promotion) being substituted... with Japan, the EU, US and Canada resisting all language on taxation'.

Parents take the blame

Following the once-succcesful route taken by tobacco manufacturers, Big Alcohol has looked for scapegoats for the massive rise in alcoholism in the past decade, much of which is attracting negative publicity. In the UK and US and Australia the chosen soft targets are parents, deflecting attention away from the vacillations of government and a persistent failure to regulate an increasingly powerful industry. Led by the alcohol industry's 'responsibility' wing drinkaware in the UK, and the PDFA (outed as alcohol and pharamceutical industry funded) in the USA, a number of 'help' websites and 'research' papers have sprung up examining and advising on the role of parents who fail to manage teenage drinking. Of course parents have a role, and an important one, but the new 'research' serves to deflect or counter the many studies showing that the real drivers of our new drinking cultures are the massive advertising and marketing campaigns funded at enormous cost by the alcohol industry itself.  Western alcoholism is consequently flying under the radar as 'normal healthy drinking'.  As the JRF itself has noted in its pursuit of the cause of drinking cultures, 'international research, as well as research conducted in the UK, has led to debates regarding the emergence of a youth drinking culture which transcends gender, socio-economic differences, nationality and locality differences and is breaking away from traditional drinking cultures of older generations'.  Exactly - advertising and marketing reaches everyone.

Following on from the recent Drinkaware campaign advising 'when to talk to my children about alcohol' the Joseph Rowntree Foundation has published a series of studies into drinking amongst teens.  Its' September study of celebrity culture was preceeded in June 2011 by a 'major survey of early teen drinking patterns in England' conducted not by independent researchers but by the political census for hire group Ipsos MORI.  The report claims that
"For the first time in the UK, this study ranks what most influences young people’s drinking behaviour. It found that the behaviour of friends and family is a strong influential factor in determining a young person’s relationship with alcohol.... and are stronger influences than some other factors – such as individual well-being, celebrity figures and the media".
This would be valuable information if the report had evidence for this comparison, but it doesn't.   The study asked 5,700 teenagers to self-complete a survey which records their drinking habits, but doesn't attempt to assess or survey the effects of advertising and media.  It has many interesting findings - 'the odds of a teenager having ever had an alcoholic drink are greater if their parents allow their child to watch 18-rated films unsupervised...or if they have seen their parents drunk'.  Useful to know, but there is a slight of hand in concluding that the blame for our drinking culture must therefore fall solely on parents, and away from alcohol marketing and advertising. The report itself, effectively in an aside, acknowledges the power of marketing.
Young people are likely to say that adverts make alcohol look appealing and will encourage people to drink (Ipsos MORI, 2007). A review of seven international studies (Smith and Foxcroft, 2007) demonstrated an association between exposure to alcohol advertising and marketing and drinking behaviour in young people. Young people are influenced by television and magazine commercials, films, music videos and celebrities who explicitly or implicitly convey positive associations with alcohol (Christenson, et al., 2000; Roberts, et al., 1999, 2002).et al., 2000; Roberts, et al., 1999, 2002).
Having got that off their chest though, the surveyors ignore the whole issue of advertising and sponsorship until it comes to boldly making 'policy' recommendations.  Much like the Ipsos MORI report in 2007 which, against the findings of its own very loaded poll, claimed that there was 'no clear support for minmum pricing of alcohol in Scotland', the new report has no modesty about making strong recommendations not remotely supported by the survey itself.  Unlike the specific and tentative recommendations usual in research, this report confidently advises that 'there appears to be little benefit at this point in time in policy aiming to prevent young people from trying alcohol or encouraging an alcohol-free childhood'. Excuse me? Instead, it continues, policy should only target and 'set clear messages to parents, local policy-makers and front line services. National policy must focus on the strongest predictors that can be influenced - parental influence".  No minimum pricing, no regulation, no legislation.

So a study which has found that far too many teenagers drink far too much is letting the government and the alcohol industry completely off the hook.  In opposition to evidence-based recommendations worldwide from Alcohol Concern up to the World Health Organisation, the report  fails to recommend curbing sales, price, marketing or even drinking itself in favour of a few wise words to parents.  If you didn't know better, you might think it was written by the alcohol industry itself.

Demos shares the credits

No need to ask the same question of a remarkably similar study by the Demos think-tank 'focused on power and politics'. Publishing their report in August 2011 Demos trumpets unequivocally that 'poor parenting increases likelihood of binge drinking at ages 16 and 34'.  More than that, this study 'shows parenting style is one of the most important and statistically reliable influences on whether a child will drink responsibly in adolescence and adulthood'.  And policy implications?  “While levels of binge drinking have fallen for five years running, there is a minority of extreme, publically visible, drinkers. No matter how high minimum pricing on alcohol is, there will be a hardcore of binge drinkers who will find a way to pay for it'.   So again, no need for governments to act.  Its the parents and its the hardcore drinkers at fault, and nothing we can do about it.  No, what we should look to are “very practical measures like spreading the school summer holiday throughout the year which will go some way to preventing boredom and avoiding risky behaviour like under-age drinking.”

For goodness sake.

Two things undermine this very famiilar sounding report. Firstly the reliability of the data.  Demos claims to have reached its conclusion by categorising the families of 15,000 children into good and bad parents. How exactly, by looking through the window?  Not really. Actually they 'ran logistical regressions' on data from the 1970 British Cohort Study'.  No explanation of how.  Not what you might call good science.

And secondly, who actually paid for this logistical regression analysis of 40 year old data?  Step forward SABMiller.  'We're one of the world's leading brewers, operating across six continents, making a difference through beer'. 

I rest my case.

Wednesday, 14 September 2011

Booz in the Nooz

Live footage from Ireland's First Alcohol Free Comedy Club

'Ireland's First Alternative Alcohol Free Comedy Club was full to the rafters and a roaring success!' tweeted Dil Wickremasinghe, founder of Dublin's new club.  We had 'great acts, great audience & a great venue, plus a full house'.  Hosting Ireland's first alternative alcohol-free comedy club, Accents Lounge Dublin offered 'the most fun you can have with your clothes on' at the opening night, Monday 5th September.

As Dil writes about the new club, 'In addition to being Ireland’s first alcohol-free comedy club we hope to showcase the true diversity of new talent that often does not feature on the main stages. So not only are we going to help change the Irish drink culture but we are also going to break down barriers through humour – which incidentally was the reason why I got into comedy in the first place!"

The opening night featured comedian Steve Cummins, who has performed in every major venue throughout Ireland and at the Edinburgh festival.  He is also a regular contributor to Hot Press magazine and other publications.  Prior to turning professional, Steve worked with the homeless, juvenile offenders and adolescent gang members from the Projects in Chicago.  Be warned, 'some of what he says is contentious, some offensive but it’s nearly always funny. Except when he’s trying to be sexy. Then it’s borderline creepy'. 

Dil also blogs about the serious side of alcohol, a drug which has burrowed deep into the Irish culture.  'As a new comer to Ireland I wanted to learn about Irish culture but little did I know I had to learn about Irish drink culture as well! During the promotion of the gig we have come across polar opposite opinions about the concept of an alcohol-free comedy club. Some actually think it’s completely preposterous and will not work as I was told by one individual “this is Ireland, we need our drink to have a good time”.  Fortunately the many established alcohol free pubs, clubs and night -clubs of Dublin have already show that's not the case.

Back to the comedy.  The club meets on the first Monday of each month, and the second night is set for Monday 3rd October at 7.00 pm at  Accents Lounge at 23 Stephen Street Lower Dublin 2.  The first night 'even had people sitting on the floor' so 'be early or you might be disappointed'.


Thursday, 1 September 2011

Fetal Alcohol Spectrum Disorders: UK & Ireland's 'hidden disability'

Ireland and the UK are facing a major crisis with Fetal Alcohol Spectrum Disorders (FASD), a crisis fuelled by high rates of  drinking by mothers and a poor response by government.  To coincide with FASD Awareness Day on September 9th, a special conference on 'protecting the unborn baby from alcohol' takes place in the European Parliament.  As the organisers say, 'throughout pregnancy, even at low levels of exposure, alcohol interferes with the normal development and can seriously damage the unborn child.  Case studies across Europe show there are a substantial number of women who continue to drink during pregnancy, it ranges from 25% in Spain to 35%-50% in the Netherlands and even higher rates in the UK or Ireland at 79%'.

The more commonly known Fetal Alcohol Syndrome is a growing problem worldwide, affecting between 1 and 4 births per thousand.  But Fetal Alcohol Spectrum Disorders covers a wider range of problems associated with drinking during pregnancy.  Evidence Based Mental Health estimates that in Europe between 2–4% of all live births are affected.  'The majority of these children are described as having an alcohol-related neurodevelopmental disorder (ARND), manifesting in terms of problems with overactivity, inattention, behaviour or learning'.  The problems caused to babies and children by drinking during pregnancy are the leading known cause of intellectual learning disabilities. Not only are there physical signs and growth problems, but as FASD Ireland notes, there are 'central nervous system abnormalities such as poor fine motor skills, poor eye-hand coordination; hearing loss which is not related to injury or illness and poor gait when walking'. Alcohol Action Ireland also warns that 'more than three drinks a day increases the risk of miscarriage, 12 drinks a week increases the risk of premature birth and sudden high levels of drinking damage the developing brain'. 

The effects are long term and far reaching. The University of Pittsburgh 2010 study followed 592 people up to the age of sixteen. They found 'a range of behavioural problems' amongst those born to 'mothers who had at least one drink per day in the first trimester of pregnancy', and nearly '60 percent of the male affected patients' were found to have 'conduct disorder as adolescents'.  The narrow definition of FASD is clearly inadequate to describe the full scale of potential problems caused to infants by alcohol intake during pregnancy.

Counting the cost

Ireland is at crisis point with the problem.  As Fiona Gartland wrote in the Irish Times this week 'In a study in Dublin’s Coombe Hospital published in 2006, 82 per cent of women continued drinking while pregnant – almost eight times as many as women in the US, where FASDs are notifiable and drinks carry a warning label'.  This was confirmed in a British Journal of Midwifery study in 2009 which found that 'women in Ireland drink the most alcohol in pregnancy', and the government's own 2009 study which found that 26% of educated Irish women continued drinking while pregnant. Given that more women now drink in Ireland than ever before, with four in ten drinking to harmful levels and an increase of 29% in the proportion of Irish teenage girls hospitalised for alcohol related conditions, the problem of FASD must be reaching epidemic proportions.

Currently, according to Inclusion Ireland,  there are 'just under 27,000 people with intellectual disability registered on the National Intellectual Disability Database in Ireland. That is a prevalence rate of 7.38 per 1,000 of the total population'.  Of course there is no suggestion that these figures relate to FASD alone, but given the potential rise in FASD, is the total number of children with diabilites now set to rise?  And how is the country to cope given that 7,000,000 Euro in cuts to social welfare are expected in 2011 on top of the 6,000,000 Euro already cut in 2010?  To do the sums, the 2008 general survey revealed that Ireland has the highest birth rate in Europe with an average of 6.000 babies born every month.   If four out of ten women are drinking to excess, and 80% of those are still drinking during pregnancy, then potentially the well being of 1,920 babies per month is threatened. 

Government doesn't know

Astoundingly though, thanks to government policy, we don't actually know what the FASD figures for Ireland are.  Like many problems the government chooses to avoid rather than deal with, the issue is buried by a failure to register it.  Asked in the Dail this May about FASD, Dr. James Reilly Minister for Health confessed that
'although FAS is a specific diagnosis...only infectious diseases are notifiable under ...legislation. Therefore Foetal Alcohol Spectrum Disorder (FASD) does not fall within the scope of this legislation. There is no National Register for Foetal Alcohol Spectrum Disorder (FASD). Therefore, the numbers of cases of Foetal Alcohol Syndrome (FAS), Foetal Alcohol Spectrum Disorder (FASD) and Alcohol Related Neurodevelopmental Disorder (ARND) in Ireland are unknown'.

You would think this a matter for shame, or at least for a change in the legislation, but the Minister ducked out with the crumb that the Coombe Women’s Hospital, partnered by the HSE, is 'running a project' on FASD. Although a welcome move, the Coombe study has so far failed to identify many cases of FASD for two obvious reasons.  Firstly it relied on self reporting to assess drinking levels, and so 'only 2 in 1,000 admitted to be heavy drinkers'.  Secondly the babies were only studied for the few days or hours that they were in the hospital. As researcher Deirdre Murphy concedes, 'it is likely that some of the women were underestimating (or under reporting) the amount they drank. In general, fetal alcohol syndrome occurred less frequently than expected in this study, suggesting that it is either not recognized by medical staff, or only becomes apparent after the mother and baby have left the hospital'.  The Coombe project is clearly not even going to scratch the surface of the problem.

In the UK 'we are doing nothing'

The situation in Ireland's drinking neighbour the UK is similar. As the Guardian reported last year 'FASD have so far failed to register on the government's radar, suggesting a pressing need for more integrated working between health and social care. Dr Mary Mather, medical adviser to Tact's foetally affected children's service, says: "Here we are doing nothing, and we suspect we have a bigger problem than other countries because we have one of the highest rates of teenage pregnancy and binge drinking in Europe."

So, abandoned by politicians we must turn to the medical experts.  Dr Kieran O’Malley, consultant psychiatrist at Our Lady’s Hospital for Sick Children in Crumlin is an expert, having worked in the US and Canada and opened the first foetal alcohol clinic in Ireland in 2009. Speaking to the Irish Times he said that
'Because FASDs are not notifiable, there are problems with how cases are processed. The condition is hidden under a complex of ADHD and autistic spectrum or Asperger’s disorder to get services. Officially, there are no cases of FASDs in Ireland because they are not notifiable; it is a classic hidden disability. It seems we are 20 years behind North America with FASDs in Ireland, not dissimilar to how we dealt with child abuse. It is a socio-cultural issue. If a foetus is exposed to alcohol, it chemically increases its craving. I have seen six and seven year olds who steal cough medicines because they can smell it. They go to it like bees to honey"

FASD Ireland calls for action

Michele Savage, founder of support organisation FASD Ireland, also wants to see the disorders become notifiable.  Quoted in The Irish Times she says “If you don’t have the statistics, you don’t have epidemiology, and if you don’t have that, you don’t have services.  This is not about policing women’s pregnancy, but we wish women knew that if they are pregnant, alcohol won’t help their baby.”

No services, no plans

Legislation and services aside, even the simple policy of putting health warnings on bottles seems beyond the two governments at the moment.  It is effective.  As Ms. Savage says, 'since 1989, the US has had warning labels on alcohol and there has been a huge drop in alcohol consumption by pregnant women to 10-12 per cent'. The Irish drinks industry is apparently ready and willing to act according to drinks industry ireland.  Quoting the Acting Director of the Alcohol Beverage Federation of Ireland (ABFI), Kathryn D’Arcy it reports that  'the drinks industry had agreed this measure with the previous Government almost four years ago'.  However 'work on the legislative proposals is on hold at present to await the recommendations of the National Substance Misuse Strategy (NSMS) Steering Group'. 

Admittedly it must be hard to report on a problem that the government has decided does not exist.  There may not be much hope though, even if the labels are agreed. A voluntary code in the UK supervised by the alcohol industry's 'responsibility' wing the Portman Group aimed to put  'don't drink if you are pregnant' warning labels on all bottles and cans. It had the agreement of the industry, but after three years they had turned in what an independent assessment rated as only a 15% compliance.  Alcohol Concern's assessement of the same issue was an even more dismal 4%.  As David Norris recently said, quoting from Samuel Beckett, 'Ever failed. No matter. Try again. Fail again. Fail better'. The UK government have given the Portman Group a further two years to do just that.  The second attempt at labelling has until 2013 before the issue of a failure of self-regulation can be discussed.

Until then, with no sign of a government response, no official access to treatment and diminishing resources, Dr Malley's advice must stand. 'The truth is there are no safe amounts of alcohol in pregnancy'.


Link here for further info and research on FASD