‘Corporate-borne disease’

(by peter)

Last week I attended a fascinating event at the Royal College of Physicians in which alcohol was described as, ‘a corporate-borne disease, like mosquitoes carry malaria’.

Clearly not my usual stomping ground.

This event was a book launch for the second edition of Alcohol: No Ordinary Commodity (Oxford University Press).

In essence, the book provides a compilation, review and analysis of the latest evidence-based research into alcohol. Its aim is to inform public policy makers and encourage a global approach to regulating alcohol far more tightly than it has been to date.

To give you an idea of the findings, which I elaborate on below, the notion that education is an effective means of regulating the detrimental effects of alcohol on society is largely rubbished in this study. Instead, the most effective measures are found to be taxation/raising pricing and regulating the physical availability of alcohol.

The event was presented by three of the book’s authors (there are 15 in total, all leading academics in the field of alcohol and addiction study). They were Griffith Edwards DM (National Addiction Centre, London), Thomas Babor, PhD, MPH (University of Conneticut) and Sally Casswell, PhD (Massey University, Auckland).

The opening address was made by Prof Edwards, a senior member of the authoring team. His fellow authors praised him as being one of the prime movers behind this book.

He described the book’s aim as, ‘simple: to provide an updated and reliable scientific base for alcohol policy’.

So far so good.

He then went on to note that the book’s previous edition was the object of an attempted smear campaign by the Portman Group, which he described as ‘a front organisation’ of the kind that ‘are very effective in influencing governments to deploy totally useless policies’.

In fact, much of Prof Edwards’ address was concerned with lambasting the book’s perceived detractors.

It was the first, but certainly not the last time during this presentation, that I found myself yearning for properly disinterested debate on this hugely important issue.

All too often it seems that both sides – supporters and detractors of the alcohol trade – are champing at the bit to bite chunks out of each other. This leaves policy makers as bemused piggies in the middle trying to legislate in a sensible and constructive manner in the midst of what is effectively a heated debate.

In saying this I fully realise that these eminent scientists would respond that they are the only truly disinterested parties in this debate, presenting evidence-based research that overwhelmingly supports the argument for tighter control of alcohol.

Yet I am also aware that analysis is almost never totally disinterested, however distinguished or scrupulous the authors may be.

The language at the book launch also tended to confirm this.

Clearly emotive terminology was frequently used. Prof Edwards’ very deliberate use of the term ‘front organisation’ implicitly evokes comparisons to illegal, underhand or generally suspect activity. Prof Babor talked of the ‘raging epidemic’ of alcohol disease in society. The quote about alcohol being a ‘corporate-borne disease’ akin to malaria-bearing mosquitoes was Prof Casswell’s.

This was demonization territory.

The introduction to the book contains, as far as I can see, just two half sentences on the positive side of alcohol. It is described, somewhat baldly, as ‘a means of socialization and enjoyment’ (p.11) as well as ‘a source of pleasure for many consumers’ (p. v).

Surely an attempt to engage with the bigger picture would have served this book, and its authors, well in their attempts to influence policy makers?

It seems this was not deemed a priority.

Thomas Babor noted how ‘alcohol insinuates [emotive terminology again] itself into society and the economy’ but that its ‘benefits come at an enormous cost to society’.

Later he noted that, in the UK, estimated costs (quoted by the British Medical Association) included £21bn per annum to individuals and families, £2.8bn to public health services/care, £2.1bn to other public services, and £7.3bn to employers in lost productivity.

He compared the alcohol problem to that of tobacco – a comparison also explicitly made by the other two presenters.

That tobacco has moved from being a socially accepted norm to a pariah product with such bracing rapidity should give every wine lover a wake-up call as to the potential implications of this comparison.

Babor noted the ‘compelling’ evidence that raising taxes or prices on alcohol, as well as controlling its availability, were effective manners of controlling consumption. He also, interestingly, commented on the finding that modifying the drinking environment can help – something the drinks trade has long argued, ie that properly training staff and enforcing existing legislation would help in the overall aim of countering problem drinking.

Sally Casswell took up the baton on the subject of education by saying, ‘people often start throwing things at me when I talk about this – they don’t like the conclusions’.

Those conclusions are that ‘the evidence base does not support the effectiveness of education’ for reducing alcohol consumption, with most initiatives rated by the book at ‘zero effectiveness’ (on an effective scale of 0-3).

The evidence suggests that, while education may improve awareness, it does little to change behaviour. The one important caveat to this is that, when education is backed up by properly enforced policy – such as in the case of drink-driving campaigns followed up by random breath testing – such policies may prove useful.

Education should thus only be used as part of a broader strategy, ran the conclusion.

Yet education was singled out as being one of the most frequently used interventions by governments on the basis, in Prof Casswell’s view, that ‘it’s the easiest and steps on the fewest toes’.

Alcohol marketing also comes under fire in the book, while France’s Loi Evin and general approach to alcohol control was widely praised by the presenters as one of the best approaches to date at a regional level.

Once again, the alcohol trade, and wine lovers, should take note of this scientific body of opinion.

There was much further discussion, including a concerning reference to Prohibition as ‘not just a bad thing’ (Griffith Edwards). But I was left with the following issues burning in my mind:

• The authors claim to have complete independence. Yet the book is sponsored by the Society for the Study of Addiction (SSA), with Griffith Edwards thanking them for their funding of logistical and travel expenses. This seems to present, if not a clear conflict of interest, then certainly a questionable position from the outset.

• No differentiation that I can see is made, or attempted to be made, between different types of alcohol. In other words, all alcohol is lumped together in one simplistic category and labelled accordingly. It seems self-evident, however, that there are clear distinctions to be made between, say, first-growth claret and super-strength white cider sold in three-litre blue plastic bottles. A responsible, and enlightening, exploration of this subject should engage with this reality.

• There are several areas of the study for which little evidence or research was available in this book. More research is thus needed to make the findings of a study such as this – which is effectively only as good as the research it compiles and analyses – more credible and far-reaching: this, at least, is one point on which both the alcohol industry and the scientists can agree. The only issue then becomes that independent funding is needed to prevent accusations of bias. This is, at best, an optimistic aim in the near future.

• Do any of the book’s authors enjoy a tipple of an evening? It may be a glib thought – and one that I yearned to ask the academics – but it does seem that the anti-alcohol argument tends towards the utterly joyless in its attempts to nullify the potential of alcohol, consumed in moderation, to be a health-giving, inspiring, joyful and profoundly civilising and civilised force for good in society. Of course there will be costs associated with one of the world’s most widely consumed legally available drugs – but a proper debate should recognise and deal with both sides of this reality.

As a final note, it was interesting to record that, at least as far as I could see, there was no or very little representation by the alcohol-centric press or media at the event.

Is it cynical to think that it was deliberate that the invitations to such press members went out just days before the event, which was scheduled at the end of July in near-prime holiday time?

Probably. But the thought still niggles.

None of this stopped me, however, from happily contributing to the coffers of anti-alcohol science by purchasing a copy of the book for the princely sum of £20.

It’s well worth a read.

My only regret was that I didn’t manage to stop for lunch and thus see whether a glass of nicely chilled rosé was available for that much-needed post-launch R&R…