Sunday, 5 February 2012

The best facts money can buy. Alcohol, evidence and Matt Cooper

Truth becomes a commodity when it can be measured in column inches in the newspapers, and those can be bought.  Bias in reporting, selling opinion as fact and rehashing research without questioning its authorship are all ways to flood the media with ideas that then occupy the space marked 'accepted fact'.  In the news this month are the case of the doctored research, amateurs presented as experts and experts presented as amateurs, and an industry funded 'study' quoted as fact.

"Anyone who doesn't take truth seriously in small matters cannot be trusted in large ones"
"The print media has to be careful in how it uses off-the-record, or unattributed sources" writes journalist Matt Cooper defending the established media against citizen 'keyboard warriors'.  But when Health Minister Roisin Shortall used hard evidence of alcohol harm and policy weaknesses to support what he calls her "approach" to policy change, Cooper implied that these were just her personal opinions.  "She believes that we drink too much alcohol in this country" he writes, and that the costs to society are just "decisions by individuals".  

Cooper, a usually tenacious and thorough journalist, boasts that his journalistic "experience...teaches the difference between a fact and opinion".  However he seemed reluctant to apply it when National Parents Council spokesperson Jackie O'Callaghan appeared on his programme The Last Word claiming to be an expert on alcohol.  When O'Callaghan said that children unfamiliar with drink at home are more likely to become alcoholics, Cooper failed to challenge it.  Worse, he also let it pass when she revealed that her evidence for this was that 'my daughter knows a boy at college who is always getting drunk"  As Clinical Associate Professor Dr. Bobby Smyth wrote, O'Callaghan "elaborated on her support for the myth that giving teenagers alcohol in the home magically teaches them to drink alcohol responsibly".

"Falsified data 145 times"
But academics are not always to be trusted either.  In December a leading researcher into the health benefits of red wine, turned out to have been fabricating the results.  Dr. Das, the director of the distinguished Cardiovascular Research Center at the University of Connecticut, "falsified and fabricated data at least 145 times, in some cases digitally manipulating images using PhotoShop" to persuade us that drinking wine will make us live longer.  With huge money invested in 'discovering' the health benefits of alcohol which is actually a poison, Das's deception may not be so surprising.  It does, however, lead us to be cautious until we have looked at the evidence and, critically, who is paying for it.

Which leads us back to Ireland where this week Anthony Foley of Dublin City University Business School released details of a new study widely reported across the media, which concludes that a major decline in average Irish alcohol consumption in the last ten years has been found" and that "average consumption increased in several OECD countries but declined in Ireland".

The most enthusiastic supporter of this study was Kathryn D'Arcy of the Alcohol Beverage Federation of Ireland.  “Contrary to popular opinion average consumption of alcohol in Ireland has declined dramatically in recent years" she claims, giving "a real opportunity to introduce targeted measures that will help those who misuse our products most” and make the planned regulation of the alcohol industry unnecessary.  For evidence she points to Foley's study.  However, he turns out not to be an expert in health or social trends but, as his DCU biography states, lectures on "indigenous export performance, enterprise development and service export performance".  Just the man for the job.  So who would ask an export specialist to inquire into alcohol use?  His previous clients include the Drinks Industry Group of Ireland and Licensing World. This new report, it turns out, "was commissioned for the Alcohol Beverage Federation of Ireland"

Isn't a report showing falling consumption of alcohol to be welcomed?
Foley's report is partially evidence-based, using OECD and Revenue Commissioners figures on alcohol consumption, but it does not produce any new evidence and is defined more by what it leaves out than by what it includes.  The figures it quotes show a sales peak in 2001, a decline in 2003 and a more or less flat line since. The sums seem to add up - overall recorded sales of alcohol per adult are down from 14.4 litres in 2001 to an estimated 12 litres in 2011.  

However, despite ABFI's claims, this still places Ireland well ahead of other OECD countries.  Australia and the UK recorded 10 litres per head in a comparable period.  And as Fiona Ryan of Alcohol Action Ireland has argued,
"the figure showing the first big decline in average consumption from 2003 to 2006 coincided with an increase in excise on alcohol products. This again establishes the link between pricing and consumption . . . Basically, we are drinking twice as much as we did in the 1960s. If we were all drinking to our maximum low-risk limits we would be drinking nine litres.”
The methodology of the DCU report also undermines some of ABFI's claims for it.  As discussed before on Gargle Nation, average ABV (Alcohol by Volume) levels used in studies are lower than those found in the the drinks themselves.  In Foley's report "cider is measured with a 5% alcohol content and wine with a 12.5 % alcohol content", but ciders are commonly 7% ABV and average wine alcohol content is now over 13.5%.  The study therefore falls short of a measure of the true amount of alcohol sold.
The Sun's cure for a hangover
Alcohol sold is not the same thing as alcohol consumed
The study also uses excise sales figures to measure consumption, but consumption is not the same thing as sales as the ABFI knows well.  Ireland is now unfortunately a nation with an established drinking culture and more than its share of alcoholics, so when price becomes an issue people will obtain alcohol by other means.  A Swedish university study from 2000 surveyed sources of alcohol as well as the quantity taken, and discovered that 2 out of every 8 litres consumed were from "un-recorded" sources.  Home-brewing is not difficult, and illegally manufactured alcohol is a growing business, for example.  In the UK the Guardian reports that "seizures of counterfeit alcohol by trading standards authorities have soared fivefold in two years, according to research which shows how criminal gangs are tapping into the demand for bargain booze". In Irish termsnon-recorded sales also include the huge cross-border sales from Northern Ireland amounting to over 189 million poundsworth of alcohol per year coming into the Republic.  Add to that people travelling from the UK with booze in their bags, and the Swedish findings will translate into a further 25% consumption than Foley is measuring, or closer to 14 litres per head.  

Judge by the results
Looking at sales figures is of course a reasonable pre-occupation  for the ABFI, but it is a distraction from an examination of the real concern of the Health Minster's at the moment, the cost in human health and work days lost due to excessive consumption of booze.  Mr. Foley concludes his study with the enigmatic statement that "from a health policy perspective, it is of interest to discover what effect, if any, the decline in average consumption over the past decade has had on the incidence of harmful consumption behaviour and on the consequences of alcohol misuse". The truth is consumption is still too high and things are getting worse.  Hospital admissions and deaths from alcohol have risen by 150 to 190% in the same period that Foley claims a fall in 'consumption', and this week the World Cancer Research Fund revealed that cancer in Ireland where people are "more likely to be overweight (and) to drink a lot" has "topped a list of 27 countries in the European Union with cases predicted to rise by 72%".

The DCU report does not address health issues properly, so when it points to what it calls a greater consumption of alcohol in Austria and France than in Ireland it misses another point which underpins the 2011 World Health Organisation study of drinking across the world.  The WHO assessed not only consumption but also risk from alcohol.  France and Austria do not have Ireland's major problem with teenage drinking or binge drinking, so the WHO gives France and Austria a low-risk rating for its drinking - Ireland was put in the risky category and is still there.  Nevertheless France has already lead the way with measures to limit marketing and sponsorship of alcohol which the ABFI is arguing are now unnecessary.  Unnecessary if your priority is selling alcohol, highly necessary if your priority is human health.

Triumphantly the ABFI concludes that "It is important that policymakers take these findings into account when formulating national alcohol policy, especially in regard to the upcoming National Substance Misuse Strategy Group report.”  I'm sure it is.


  1. Bias in reporting, selling opinion as fact and rehashing research without questioning its authorship can be found on both side of the alcohol policy debate.

    My particular favourite is this HSE report which “examines” 20 years of data, but focuses on a single year where an excise duty increase in spirits duty coincides with a drop in sales, while ignoring the upward trend for most of the time in question, which three successive excise increase failed to arrest.

    Can I ask you to comment on something without bias?

    I would first like to establish a few things I think we can agree on.

    1. Alcohol sales have been in decline since 2002. If you don’t trust the DCU report you reference, maybe you would prefer the recent Oireachtais report on the misuse of alcohol and other drugs: Page 23 tells the same story, just in less detail.

    2. Sales do not equal consumption. The figures in both reports do not include cross border sales, smuggled alcohol, home made alcohol etc. We will call this unrecorded consumption.

    3. The average price of retail alcohol has gone down since the removal of the groceries order, in 2006 opened the door to below cost selling by the supermarkets.

    4. The cost of retail alcohol is by far the major driver of unrecorded consumption. If the price of retail alcohol goes up, the incentive to resort to unrecorded alcohol also goes up. If the price of retail alcohol goes down, the incentive to seek cheaper alcohol is reduced.

    Now comes the logical conclusion I would like you to comment on.

    As the price of retail alcohol has gone down, we can only assume that unrecorded consumption has also gone down, as the incentive to seek cheaper alcohol is reduced. As recoded alcohol has also gone down, this means that consumption as a whole has gone down.

    Do you accept that average alcohol consumption per capita has gone down in recent years?

    1. Hi Sean, thanks for the question. I agree with your points, and probably (though of course we don't have the figures) the incentive to obtain alcohol outside of the pub or shop must rise and fall with the price in them. The revenue evidence shows that the average sales per capita has been steady since a fall in 2003, and it would be logical to assume that unrecorded figures are therefore steady or falling as booze becomes cheaper, as you argue.

      However, as a measure of consumption, alcohol related harm, health problems and the numbers seeking treatment for alcoholism has seen a dramatic rise over the same period. So we have to conclude that either a smaller but significant number are abusing alcohol a lot, or more likely the drinking culture that has been established has driven many from buying expensive booze at the top of the market in the pub to choose cheap and/or unrecorded booze at home just to keep getting a fix. It is surely a sign of the times that even the long-established culture of the Irish pub has seen such a massive decline in favour of cheaper cans and bottles at home.

  2. It is possible that more people on lower incomes are resorting to unrecorded alcohol, but if supermarket alcohol were as cheap as some people claim, that would hardly be necessary, would it?

    Another possibility is that the spike in alcohol related harm is due to people who were drinking heavily in the 90s and 2000s and are only now developing problems. It takes sustained abuse for most alcohol related medical conditions to bite. A case of peoples binge drinking chickens coming home to roost, as it were.

    Either way, it shows that price is not an effective way of changing the drinking habits of Irish people and they certainly do need to change.

    I have posted what, in my view, would be a better approach than trying to tax people better. I would value your input, if you can spare the time to read it:

  3. Hi Sean,

    I agree, the science only takes us so far in being certain of social trends. As you say, alcohol related harm now may be a legacy of the last decade, though teenagers presenting with problems have risen by 150% and throat cancer is now more common in the under 35s, so there are major changes afoot.

    Tobacco is a good comparison on marketing and price influencing culture - the ending of advertising and restrictions on availability, plus the smoking ban, have seen the numbers of smokers reduce drastically. - culture driven by policy. Unleaded petrol was another - it only really took off when it was made cheaper.

    Thanks for the link to your blog. I have had a look and will comment.

  4. Where did you get those figures from? I would be interested to see over what time frame the 150% rise took place and how the data was collected.

    If people are drinking less per capita but problems are on the rise, then it makes it even clearer that a policy aimed at reducing per capita consumption is not an effective way of combating alcohol related harm. We need to target problem drinking, not alcohol as a whole.

    I'm afraid that your information on tobacco is incorrect. The rates of smoking actually rose in the years immediately following the introduction of the smoking ban but they have begun to decline again since.

    When it comes to price, there is that pesky unrecorded consumption again. A quote from revenue in a report to government:

    "It is quite likely that price increases cause consumption of taxed cigarettes to decrease and the consumption of untaxed cigarettes to increase. The fall in taxed consumption is not due only to lower levels of smoking but also from smokers substituting to a lower cost alternative (untaxed cigarettes)."

    Just like with alcohol, if you artificially raise the increase the price, people find a way to get them for cheaper. I would say that education rather than price has been the thing responsible for people giving up cigarettes. There has been a lot of media time devoted to telling people how bad they are for you and people are giving up for that reason. This is certainly the reason I quit and I did so before the smoking ban came in.

    Smoking has also become less socially acceptable. Social pressure is a very powerful force and that is what I would like to see being used to bring problem drinking under control.

    Besides, we can clearly see that price inflation has not worked with alcohol. If it did, we would have seen a fall in sales during the price hikes of the past, not the steady rise we actually got between 1960 and 2002.

    You can't tax people better, but changing the social view of a particular activity can have the desired effect. It worked to reduce drink driving and smoking, why not drunkenness.

  5. The figures for teenage alcohol problems came from the HSE last year - here is the Examiner report

    The tobacco control office maps an overall trend in tobacco use downwards since 2002 to 23% last year.

    But I agree that price is not the only issue. Because tobacco and alcohol are highly addictive, once a market is created it will be self sustaining and resistant to a lowering of price. The need for education is clear, but at the moment the amount spent on education is a tiny fraction of that spent on sponsorship and marketing which are pushing far more succesfully in the opposite direction.

    Wouldn't you agree that a responsible policy would be to end sponsorship and advertising of alcohol in any forum that under 18's might see it.

  6. Dr Lyons said the hike was down to increased reporting but "it is also likely that it reflects a true increase in the number of people requiring treatment".

    So either it's actually a problem we are only beginning to see the true scale of, or it is on the increase. Either way, it happened in a time of decreasing alcohol sales, so a reduction in per capita sales did nothing to reduce alcohol related harm.

    Our government's plan is to reduce per capita sales and hope this reduces harm. Would you like to tell them it's not working or should I?

    Did you look at the smoking data you referenced? Always be careful of taking someone else's interpretation at face value. Confirmation bias is a big problem in these situations and the trend claimed since 2003 is really only a trend since 2008, if even that.
    The graph shows that smoking rose in 2004, then dipped in 2005, came back to 2003 levels in 2006, stayed more or less steady at that for most of 2007, with a dip at the end cancelled by a spike in 2008. The current downward trend is only there since 2008. This is not a downward trend due to the smoking ban and the very fact that it is so variable says to me that even the current trend might just be natural variability due to data collection methods and the people they have decided to ask.

    I hope that smoking is on the decline, but they can't claim a victory for the smoking ban here. Then again the smoking ban was never intended to tackle smoking as such, just passive smoking in pubs and restaurants and it has been very effective at that.

    A general "education" campaign is a bit wishy washy and can end up with conflicting messages. I have heard all sorts of scare stories about how x amount of alcohol causes an increase in y disease risk and people just lump it in with all of the other food scare stories they hear and continue on regardless. We need a campaign targeted at problem drinking.

    I don't mean medical advice about the number of units. People are aware of that and problem drinkers are accustomed to ignoring it. The disproving looks of your peers when you are falling down drunk are much more difficult to ignore.

    There is no way to prevent under 18's from seeing alcohol advertising. I have a 17 year old daughter and she does not go to bed at 9 nor is she limited to media controlled by the Irish government.

    I would also point out that any ban on alcohol advertising would take us further way from the practices common in societies where attitudes to alcohol are much better than ours. Targeting alcohol as a whole is a mistake. Alcohol is not the problem. Alcohol abuse is.

    What we can do is make sure that there is a message that drunkenness is not OK, along with adverts for alcohol and such a message should be targeted at the entire population, not just young people.

    The message should be that alcohol is fine. It is something people enjoy, but it deserves respect and if you drink too much, you are an embarrassment to yourself and those you are with.

    Our government takes in over a billion euro a year in direct taxation on alcohol but the only adverts I have seen actually putting forward the message that drunkenness is not OK are being paid for by the drinks industry. You may not like them, but they are the only ones actually doing something to change attitudes.

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