barrycurtis

Patient: If I give up alcohol will I live longer?

Doctor: No, it will just seem that way.

We are confronted with a seeming paradox. On the one hand the government and medical authorities have been vociferously promoting "sensible" and "responsible" drinking for the past ten years. Meanwhile cases of diseases associated with heavy drinking such as liver cirrhosis have gone up in the same period. There was a 41% increase in the number of deaths from alcoholic liver disease between 1999 and 2005 whilst deaths from other diseases are falling year on year.

This paradox can be explained by two factors: 1) in this period, disillusionment with the political system and the total collapse in the perception of alternatives have rocketed. This gives rise to a sense of despair leading some people to turn to the bottle. 2) The more the government says don't do something, the more a fraction of the population will do it. This is the spirit of rebellion common to all generations.

If these two factors are correct, it seems that the more the authorities try to tackle 'binge drinking', the more adverse effect it will have. The way the problem ought to be dealt with is through the resocialisation of alcohol, i.e. bringing it back into ordinary life and discussing it sensibly. Alcohol is not a problem for the majority of people but the way the government approach it creates new problems.

According to statistics, over a quarter of the population regularly "binge drink". However scratch the surface and a different picture emerges. Binge drinking is defined as consuming more than 4 units of alcohol in a day (for a man, 3 for a woman). But given this definition, if you drink two pints of beer, you are a binge drinker. Clearly something is wrong with the calculation. It also seems to depend on where you do the drinking. In the UK, a "unit" of alcohol equates to 8 grams of ethanol whilst in Ireland, Austria, Poland and Spain, one unit is 10g. In Denmark, France, Italy or South Africa it is 12g, in Portugal and the US it is 14g, and a Japanese unit contains 19.75g. So whilst many countries advise the same upper limit of 21 units per week for men and 14 for women, this can mean different amounts of drink.

There is also a problem with the quantification of units. In 1979 the Royal College of Psychiatrists first indicated that a weekly consumption of more than 56 units of alcohol was the 'absolute upper limit'. In 1984 the Health Education Council suggested that weekly levels of between 21 and 36 units for men, and 14 and 24 units for women, would be 'unlikely to cause damage'. Then in the late 1980s a new consensus emerged setting the upper limits at 21 for men and 14 for women which has been the basis of most guidelines ever since. However these figures were arrived at arbitrarily, guessed at by working out a 'safe level' that was significantly lower than what heavy drinkers with diseases said they'd had. But a couple of points need bearing in mind: 1) the heavy drinkers with diseases were drinking heavily regularly over a long period of time. This does not parallel someone who say has 4 pints in a night, twice a week, even though mathematically he's exceeding his daily ration. It is wrong to compare the two individuals - one is obviously doing significant harm to himself whereas the other is merely enjoying himself. The latter should not be treated as a 'percentage' of the former, entailing a lower percentage of risk. The two individuals are not comparable. 2) The studies were based on personal testimony of how much the heavy drinkers had. But everyone knows they were likely to lie rather than confess to stupidity, thereby skewing the statistics on what is safe downwards.

Furthermore the figures used by the authoritative Royal College of Physicians in 1987 were "plucked out of thin air". According to Richard Smith, former editor of the British Medical Journal and member of the college's working party on alcohol, "the epidemiologist on the committee's line was that 'We don't really have any decent data whatsoever. It's impossible to say what's safe and what isn't'...the feeling was that we ought to come up with something. So those limits were really plucked out of the air. They weren't really based on any firm evidence at all. It was a sort of intelligent guess by a committee." Yet this "intelligent guess" is now taken as incontrovertible fact and is used as the scientific backing for the government's multimillion pound campaign against binge drinking.

Furthermore in the years since the 1987 "study", a host of new epidemiology has seen evidence to the contrary. In 2000, the World Health Organisation's International Guide for Monitoring Alcohol Consumption and Related Harm set out drinking ranges that qualified people as being at low, medium or high-risk of alcohol-related harm. For men, less than 35 weekly units was low-risk, 36-52.5 was medium risk and above 53 was high risk. Women were roughly half these figures. Meanwhile back in 1993, a study of 12,000 middle-aged male doctors led by Sir Richard Doll (the man who discovered the smoking-lung cancer link 40 years prior) found that the lowest mortality rates - lower even than teetotallers - were among those drinking between 20 and 30 units of alcohol each week. The level of drinking that produced the same risk of death as that faced by a teetotaller was 63 units a week, or a bottle of wine each day. In 1995 another study of 13,000 men and women found that drinking 50 units a week cut the risk of premature death by half.

However whilst it's important to reveal the evidence, one's case for drinking should not depend entirely on arguments about health. There's more to life than mere existence and so the case for drinking what you want should depend on how much you enjoy it. Just because a minority drink excessive amounts that cause adverse effects should not mean the right is curtailed for the rest of us. Drinking alcohol in its wonderful diversity of forms is a highly pleasurable activity which, in general, ought to have nothing to do with health. Unfortunately the obsession with "counting the units" and "knowing your limits" rather spoils the experience. Ironically the obsession with health turns a source of pleasure into a source of anxiety. If we add to the unit-counting phenomenon other social phenomena such as calculating your carbon footprint, counting your calories, or making sure you get your 5-a-day fruit and veg, it might seem that the elite are trying to turn us all into a bunch of worry-worts. If they had their way, we wouldn't even be able to drown our sorrows.

Finally it needs to be stated that the nation's health is not really the government's number one priority. In truth, the authorities use the fear of binge drinking as a tool of social control. The police now routinely round up the drinkers in the street on a Friday night, and we let this coercion go uncriticised because we think it's good for these people's health. Meanwhile General Practicioners are converted into agents of the state by government regulations that make them "advise patients to restrict their drinking to within the recommended daily levels". What this represents is the state creeping into your home, trying to control what you do behind closed doors. And it's not good for the doctor/patient relationship either as patients lie to evade official censure, and subsequently doctors mistrust them.

To conclude, we need to stop this obsession with counting units, and get back some common sense. When the government identify a quarter of the population as a problem, it is clear they're not interested in tackling a real problem but trying to find avenues and ways to control them. A quarter of the population aren't problem drinkers - they only appear so because the methodology is flawed, deliberately. Yes, a small minority do drink too much and will die prematurely, but targetting the whole of society in a campaign to reduce everyone's drinking is not the best way to tackle the problem and it creates unnecessary trouble. It's time the health zealots knew their limits.