Author: PeteBrown

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CAMRA and the neo-prohibitionists

A few of you have asked me where CAMRA is in the whole battle against the neo-prohibitionists, and whether they have issued any response to the HSC report.

So yesterday – after receiving a press release entitled ‘Pub Goers Set to Benefit from Abolition of Land Agreements Exclusion Order’ – I asked CAMRA’s press officer the question – had they issued any response to the HSC report or were they planning to?
CAMRA confirmed that they have not issued a press release, but have released the following quote to the media:
Iain Loe, CAMRA research manager, said “CAMRA welcomes the call by the Committee for the introduction of a minimum price per alcohol unit which will benefit community pubs by curbing the below cost selling of alcohol by supermarkets which can fuel pre-loading. We also welcome their suggestion that the Government should introduce a reduced rate of duty on beers below 2.8%.”
So there you have it. CAMRA supports minimum pricing – which we already knew – and has nothing to say about the rest of the report.
I’m not just going to indulge in knee-jerk CAMRA-bashing here. I’ll be asking CAMRA why they are not commenting more widely.
But in the meantime, what do you think? Is it CAMRA’s job to argue back against the HSC? Should they do so given that they claim to represent the interests of beer drinkers? Or is it too political? Is it outside their remit?
You can understand to an extent why drinks manufacturers are not arguing back – they would be hung out to dry by the media, treated (unfairly) with the same contempt as the cigarette companies who tried to argue that the link between smoking and lung cancer wasn’t proven.
But who SHOULD be fighting back? Someone has to. Surely it’s not just down to one or two independent journos and bloggers…
What do you think?

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Answering the neo-prohibitionists 7 of 10: “The best way to reduce the harmful effects of alcohol is to reduce overall consumption”

Here’s what the HSC Report says:


“There is a good deal of evidence to show that the number of heavy drinkers in a society is directly related to average consumption. Living in a culture which encourages drinking leads more people to drink to excess.”


“The most effective way to deal with alcohol related ill-health will be to reduce overall consumption.”

Two key points of rebuttal:

(i) The HSC’s own data contradicts this assertion

Alcohol consumption in the UK is declining. Binge drinking is declining. Alcohol-related crime is declining. So far, the correlation holds – albeit in the opposite direction to the one the HSC would like to convince you is true. And the key thing in all this – the availability of alcohol in the UK is increasing.

But alcohol related hospital admissions – even if we question how they are calculated – are still rising, as are deaths by liver cirrhosis (some of which are alcohol related, though not as many as the HSC would like to claim).

If availability of alcohol is increasing, but people are drinking less, and binge drinking less, but the number of people with alcohol related illnesses is rising, the relationship between overall consumption and alcohol abuse cannot be directly linear.

And the rising percentage of the UK population that is teetotal (estimates vary from 11% to 25%) suggests that in a time of declining overall consumption, light drinkers are dropping out of the market altogether rather than problem drinkers cutting down.

Other factors are at work here. There is something in modern society that is causing a minority to drink to excess even as the majority cut down on their drinking. We can all speculate on what those other factors might be, and I’ve done so elsewhere, but I want to keep this series of posts as factual as possible.

Whatever they may be though, these factors are being ignored by the anti-alcohol lobby and not given enough attention by health professionals, which is letting down people who need help. They don’t need to be told not to drink. They need help addressing what is making them turn to drink in the first place.

(ii) International comparison refutes this assertion

This keeps coming up in rebuttal to various points the anti-alcohol lobby makes, but seemingly it needs constant repetition. There are countries in Europe with higher per capita alcohol consumption than the UK, and fewer alcohol-related health problems than the UK.

And work done by Professor Dwight Heath emphatically refutes the notion that a culture that welcomes alcohol is a culture that encourages drinking to excess. Extensive scientific studies around the world (clue: you don’t just look at countries that have a problem. You look at countries that do and countries that don’t and you compare the two to see what’s different) has shown that in countries that are positive towards alcohol, it is integrated into normal society, drinkers are not stigmatised, and drinking is no big deal.

But in countries that are ambivalent towards alcohol, the stigma also brings with it a mystique. Alcohol is something errant, transgressive, consumed behind closed doors. On the one hand, it has a transgressive allure. On the other, people who drink feel they are already doing something wrong, and the line between moderate and excessive drinking is more blurred.

The most obvious proof of this point is Scandinavia: Sweden has more restrictive alcohol regulations than Denmark, and has a bigger problem with harmful drinking. In turn, Finland has more restrictive alcohol regulations than Sweden, and has a correspondingly bigger problem with alcohol drinking. There is a linear relationship not between overall consumption and harmful drinking, but between the social unacceptability of alcohol and problem drinking

The argument about families normalising alcohol with teenagers rather than letting them discover it with friends in an unsupervised, transgressive setting is a strand of this point. It has been dismissed by neo-prohibitionists as a “dangerous myth”. Unfortunately for them, it’s a myth that has a great deal of scientific research behind it.

In summary

When you look at the data objectively, there is no straight linear relationship between overall alcohol consumption and propensity to alcohol abuse.

The best way to reduce alcohol related ill-health is NOT to reduce overall consumption – it’s to identify what’s making a minority of people drink to harmful levels while the majority are drinking less.

And it’s to normalise alcohol consumption as part of a functional society – the opposite of what the neo-prohibitionists are trying to do.

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Answering the neo-prohibitionists, 6 of 10: “Alcohol abuse costs the country £55bn a year”

OK, this might be the longest one – but it gets much snappier after this, I promise.

(Caveat: like the previous post, in this one I can’t offer a ‘true’ figure. The intention is to raise reasonable doubt about the figures that have been quoted, and how they were arrived at.)

The BMA and the Health Select Committee cite not one, but two figures for the cost of alcohol to society. The first is £20 billion. The second is £55.1 billion.

£20bn or £55.1bn? So, er, which is it then?

The huge discrepancy doesn’t just mean one figure is more likely than the other – you can’t just say “let’s call it £20bn to be conservative then”. It means both figures are suspect.

Incredibly, the HSC Report seems happy to quite both calculations, simply stating in the Executive Summary, “In 2003 the PM’s Strategy Unit estimated the total cost of alcohol to society to be £20bn; another study in 2007 put the figure at 55bn,” as if the huge discrepancy between them is simply not an issue.

In any business I’ve worked in, if someone was asked to find the cost of something and came back with two different costs, one almost three times the other, with no recommendation as to which was right, questions would be asked about their ability to do their job.

But of course, by simply putting both figures out there with no comment whatsoever as to which might be the closest to the truth, the HSC allows the anti-alcohol lobby to simply quote the higher figure.

Think that’s paranoid?

In its coverage of the report on the day of its release, the BBC website simply says, “It is estimated alcohol abuse in England and Wales kills 40,000 people and costs the economy £55bn every year.”

It doesn’t dispute the figure. It doesn’t even mention the lower figure. And so the higher figure simply becomes fact.

(Rereading that, linking back to my previous post, see also how “alcohol consumption is probably a significant factor in 30 to 40,000 deaths per year” has magically become alcohol “kills 40,000 people” – a colossal misrepresentation of what the HSC Report actually says, even if we were to accept the report’s figures as accurate – which they aren’t.)

Let’s get out calculators out. Oh hang on, let’s just guess instead

The £20bn figure was calculated in 2004 by the Prime Minister’s Strategy Unit, and includes:

  • Healthcare ‘Up to’ £1.7bn
  • Alcohol-related crime and public disorder ‘Up to’ £7.3bn
  • Loss of productivity/profitability in workplace ‘Up to’ £6.4bn

The £55.1bn figures was calculated in 2007 by the National Social Marketing Centre (A Department of Health sponsored research company) and includes:

  • Cost to individuals and families/households (eg loss of income, informal care costs) £21bn
  • Public health services/care services £2.8bn
  • Cost to other public services (eg criminal justice system costs, education and social services costs) £2.1bn
  • Cost to employers (eg absenteeism) £7.3bn
  • Human costs (DALYs)[1] £21.9bn

The health care cost is at least taken from the studies quoted in the previous post, and needs no further discussion here. 

Loss of productivity in the workplace is also roughly comparable and consistent.

But look at the estimated cost of crime. In the lower figure, ‘crime and disorder’ costs come in at £7.3 billion. In the higher figure, ‘costs to other public services’ – which includes social services as well as costs to the criminal justice system – comes in at only a third of that figure, at £2.1bn. I’m sorry, but given that these figures are available to civil servants, such a huge discrepancy between the two casts doubt on the credibility of both reports.

If we look closer at the higher figure, £42.9 bn – 78% of the total – is made up of intangibles – cost to individuals and families, cost in terms of loss of life or healthy years – that would seem extremely difficult to put an accurate figure on. And that’s before we start to dispute the correlation/causation argument when alcohol is calculated as a factor in hospital admission, crime etc.

Alcohol and crime

I haven’t been able to look in detail at every element of these costs, but let’s take alcohol-related crime as one example.

The Reports claims that “Alcohol-related crime and anti-social behaviour have increased over the last 20 years.”

However, Home Office data shows that there has been a 41% fall in alcohol related violent incidents since 1995. This data may not be perfect – there’s a huge difference between crime that occurs, crime that’s reported, and crimes that are prosecuted. Critics argue – perhaps rightly – that the police are now deciding not to prosecute alcohol related crimes, but issuing cautions instead. However, home office data shows consistent decline in crimes reported, number of arrests/prosecutions, and number of cautions. The data has its issues. But if you’re going to use the data when it shows an increase, you also have to acknowledge when the same data shows a decrease. The HSC does not.

And then there’s that old correlation/causation argument again. The HSC says:

“Examples of offences which are often committed by people under the influence include physical and sexual assault, breach of the peace, criminal damage and other public order offences.”

Yes, those offences are also examples of offences committed by people not under the influence of alcohol. Your point is?

Hang on, there’s more:

“According to the British Crime Survey (BCS) 2005-06, 44 per cent of violent offenders in England and Wales were perceived by their victims to be under the influence of alcohol. This corresponds to a decrease in the number of violent incidents where the victim believed the offender or offenders to be under the influence of alcohol from 1,659,000 in 1995 to 1,029,000 in 2005/06. The offender was judged to be under the influence of alcohol in 54 per cent of incidents of stranger violence, 44 per cent of incidents of acquaintance violence and 21 per cent of incidents of mugging. Eighteen per cent of violent offenders between the age of 10 and 25 reported being under the influence of alcohol only, and three per cent under the influence of drugs and alcohol, at the time of the offence. Thirty-two per cent of young people surveyed reported being under the influence of alcohol when committing criminal damage offences and 27 per cent were under the influence of drugs and alcohol while being involved in vehicle related thefts.”

There’s so much to attack here:

‘perceived by their victims’ to be under the influence of alcohol? How can you tell? Can you be sure when you’re being attacked?

And you’re admitting that the number of such incidents fell by a third between 1995 and 2006, but don’t deem this worthy of comment?

18% of 10-25 year old violent offenders admitted being under the influence of alcohol – that seems pretty low, especially given the temptation to use intoxication as an excuse for your actions.

Overall, there are two levels of reasonable doubt here: firstly, the figures consist of people who seem to be drunk – at a time when it is hard to make such cognitive judgments – or people who claim they were drunk when committing a crime – which they may be likely to do in search of mitigation.

Secondly, there is no distinction between correlation and causation. Did this person commit this crime because they were drunk, as is being implied here? If that were true, then the more I drink the more violent and/or criminally minded I will become. This simply does not occur among the majority of us who are not criminally minded to begin with. And global studies show no direct correlation between alcohol consumption and crime.

What is the net cost?

If we want to produce an accurate figure for the cost of alcohol to society, we must surely look at the net cost. There is not a single accountant on the planet who would argue that looking at expense without looking at income provides an accurate financial picture.

Alcohol raises about £8bn in duty every year – more than offsetting the cost to the health service plus – in the NSMC version – the costs to other public services.

In total, the beer and pub industry alone is worth £28bn to the UK economy (source: HMRC). Before we even add in contributory factors from restaurants, bars, hotels, nightclubs and the economic value of wine and spirits, alcohol is a net contributor to the UK economy if its cost to the economy is close to the £20bn figure quoted. With the other figures, it surely exceeds the £55 billion figure too.

And what about intangibles?

If I suggested out of the blue that we should calculate a figure for the amount of happiness, joy and sociability created by alcohol, you might have some justification to accuse me of trying too hard, of over-egging the pudding. But to lapse into playground jargon for one second (it takes so much effort to stay rational) – they started it.

If we’re going to estimate a monetary value for the cost to workplaces of people being hungover, the cost to families of having to look after ill family members, the cost to individuals of the reduced quality of life from having an alcohol related illness – all of which are included in the £55bn figure – surely this needs to be counter-balanced by:

  • A valuation of the benefits of what the BMA itself admits is “the lower risk of coronary heart disease (CHD), ischaemic stroke and diabetes mellitus, [of moderate drinkers] compared to individuals who abstain from alcohol” 
  • A valuation of the benefits from what they refer to as the “feelings of relaxation and euphoria” that come with “no risk” moderate drinking – in other words, the pattern of drinking practiced by the majority of the population.

 [1] DALY calculates the cost of potential years of life lost due to premature death, including the equivalent of ‘healthy’ years of life lost die to poor health or disability. It’s calculated as ‘Years of Life Lost’ + ‘Years Lived With Disability’. So it now seems that a year of healthy life – like everything else in society – can now be judged in terms of its monetary worth.

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Some pretty ladies illustrate the problem

Everyone seemed to welcome the Myleene Klass post as a bit of light relief from my anti-neopro posts, so here’s a happy medium between the two, specially for Cooking Lager. Have a look at this poster, which is currently displayed on a crosstrack site at Finsbury Park Tube:

It’s safe to assume that these three ladies are not policewomen on duty, and should therefore not be wearing policewomen’s hats. But they are. That’s because they’re partying. They’re on a night out. They are cheeky – as well as the hats, one of them is sticking her tongue out at the camera. But that’s really all we can imply from the picture.
And what’s the caption? That’s right: ‘alcohol misuse in England is costing the NHS £2.7 billion a year’.
Simply because these women are having a good time on a night out, the implication is that they are ‘misusing’ alcohol. We’re used to the widely repeated images of women with their knickers round their ankles, or collapsed in the street, but now, you don’t even have to do that – simply by being young, happy and out with your friends, you look like someone who is ‘misusing’ alcohol.

Look again at the picture: they don’t look bleary-eyed. Their make-up is in good condition. They look quite sharp and alert. Their behaviour doesn’t look outrageous – they’re simply posing for a photo. They’re not doing anything anti-social. In fact quite the opposite, they look very friendly. They show no signs of intoxication whatsoever. Christ, it could be a teetotaller’s fancy dress party for all we know. But they’re still ‘misusing’ alcohol.
The tiny writing up in the corner says ‘representative image used’. In other words, this photo was probably posed by models. But these healthy, attractive, perfectly turned out models are quite clearly meant to ‘represent’ alcohol misuse.
And this isn’t an ad from a temperance or health group – it’s an ad for ITV news. It’s not attempting to define what constitutes alcohol misuse, merely reflect contemporary understanding of what alcohol misuse is, and who is doing the misusing.
The social demonisation of alcohol continues apace.

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Answering the neo prohibitionists, 5 of 10: “Alcohol related hospital admissions – and the cost of alcohol to the NHS – are soaring”

This is the longest, most detailed and technical post of the ten. If you’re not too interested in detailed liver cirrhosis stats, take a quick scan of the sub-heads then go to the summary. But I wanted to put all this out there for the record. Christ, it’s taken me long enough to work out – I don’t want it to go to waste. Firstly, another caveat: I have no desire to trivialise the burden alcohol abuse places upon the NHS – I know someone who used to work in casualty on a Friday night and she was deeply traumatized by what she had to deal with. I recognise that there’s an issue here. And for the record, I love the NHS – it’s one of the things that makes me proud to be British. I intend no disrespect to the people who have to clear up after drunks and stitch some of them back together. But there several points that need answering around the whole issue of the size of the burden alcohol supposedly places on the NHS. I can’t say what the true figures are in this – I don’t know. My intention here is merely to cast reasonable doubt on the figures that are quoted, and to suggest that the true cost of alcohol to the NHS is being overplayed. But I can’t say by how much.

(i) The difference between partial cause and total cause

Figures for alcohol-related hospital admissions are bandied about and roughly estimated by the people giving evidence to the report, and then taken as fact by the time the Report is published. In terms of official figures, what they don’t tell you is that when they are compiled, there’s a sharp difference between hospital admission and deaths that are considered wholly attributable to alcohol, and those where alcohol is a secondary or partial factor. And guess what? Only 25% of total ‘alcohol related’ hospital admissions are judged to be entirely due to alcohol.

In the rest, alcohol is one of several factors. In these situations, who is to say whether or not alcohol was the thing that tipped the balance or not? If someone is admitted with high blood pressure or heart attack and they drink heavily, smoke heavily and eat chips every meal, alcohol is part of an overall pattern that’s clearly rooted in a lifestyle. But their condition is still be counted as ‘alcohol related’ To get over this, NHS analysts have come up with a system of ‘attributable factors’, where you try to give each element in admissions and fatalities a percentage of the total cause, to get to an overall statistic. If I had a year to work on this, I might be able to figure out how this works. After spending half a day on it, I only hope someone else with a better statistical background than me can take up the challenge.

(ii) ‘Passive’ alcohol abuse: the difference between correlation and causation

(At this point I’d like to give huge props to Phil Mellows, a longstanding drinks industry journalist and fellow anti-neopro campaigner, who highlighted this point in a recent blog post here.) This question of partial versus total causes gets more complicated and inflammatory when we look at the secondary effects of alcohol abuse and how alcohol’s contribution to these is weighed. Here are three quotes from the Report: “The passive effects of alcohol misuse are catastrophic—rape, sexual assault, domestic and other violence, drunk driving and street disorder—alcohol affects thousands more innocent victims than passive smoking.” “Heavy drinkers are more than twice as likely to commit suicide as non-drinkers. Between 16 and 45% of suicides are thought to be linked to alcohol and 50% of those ‘presenting with self harm’ are regular excessive drinkers.” “Alcohol [is] a factor in 40% of domestic violence cases, 40% of child protection cases, and 74% of child mistreatment cases.” By stating these ‘facts’ without giving them any further analysis, the Report is implying that if you drink, you are more likely to be a rapist, a child abuser, a wifebeater, a suicide, and that the fact that you drink makes you so. As Phil pointed out when he addressed the rape issue, this is not only inaccurate, it is astonishingly offensive to drinkers. It willfully confuses causation (alcohol made them do it) with correlation (they happened to drink a lot and they also happened to do this). Let’s be careful here: I’m not disputing the fact that suicides, wifebeaters etc are more likely than average to be heavy drinkers. But there are no grounds whatsoever to say that alcohol consumption led directly to their appalling behaviour. I’m no psychologist, but based on both personal experience and common sense, I would suggest that in many cases, alcohol abuse and domestic violence/attempted suicide etc are both symptoms of a deeper underlying condition or issue. Sure, the alcohol doesn’t help. But when someone does something appalling and then says, “The drink made me do it,” they are denying personal responsibility for their actions and we tend to dismiss this as a lame excuse. The Report seems to buy it 100%. Added to this personal speculation, when you look at studies into the social effects of alcohol on a global, scientifically sound level, such as those carried out by Dwight Heath at Brown University, there is no direct causal link between violent and dysfunctional behaviour and alcohol consumption. If there were, the Czech Republic would have much worse rates of anti-social behaviour, drunk driving, domestic violence etc than the UK, because that population drinks significantly more than we do. But they don’t. Alcohol abuse is a symptom of something else – not a cause. We can demonstrate that this is true by looking at the body of the Select Committee Report itself, and the evidence given to it by the BMA. Here’s what the BMA says about the relationship between alcohol consumption and class: “Individuals in managerial and professional occupations are more likely to have drunk alcohol in the previous week, and to drink more frequently than those in routine and manual occupations.” And here’s what the Report says about the relationship between alcohol abuse and class: “People from lower socio-economic groups were more harmed by a given level of alcohol consumption. In the most deprived areas of the UK, men are 5 times more likely and women 3 times more likely to die an alcohol related death than those in the least deprived areas.” If alcohol is a cause of these problems, how can both statements possibly be true? If alcohol consumption was the cause of dysfunctional and anti-social behaviour, most people fighting on a Friday night, beating their wives or children or committing suicide would be managerial or professional people. They’re not. And if people from a lower social class are more likely to be harmed by a given level of alcohol consumption, then it is patently obvious that alcohol is not the issue – it’s something else that goes with being a member of that class. That’s logic that even a child could understand – but the Committee chooses not to.

(iii) The issue of liver disease, particularly liver cirrhosis

To be clear: it would be foolish to argue against the simple fact that alcohol misuse is one of the main causes of liver disease, and that figures for liver disease and liver cirrhosis in particular are increasing. Even in countries that don’t share the alleged link in the UK between heavy alcohol consumption and crime, violence, anti-social behaviour etc, those that are heavy consumers of alcohol tend to have higher rates of liver disease.But claims such as “The WHO has put alcohol as the third most frequent cause of death after hypertension and tobacco” cannot go unchallenged. It completely mixes up factors contributing to death with cause of death. Otherwise, what is ‘death by alcohol’ exactly? And are we honestly expected to believe that it causes more deaths than heart disease? Than cancer? Globally, are we expected to believe it causes more deaths than malnutrition or Malaria? Really?The truth is that 1.3% of deaths in England and Wales are due to alcohol consumption.But the Report argues that these are only deaths where alcohol is stated as a cause of death on the death certificate – and it’s fair to say it does play a contributory role in other deaths too. But the report then goes on to claim that alcohol consumption is “probably a significant factor in 30 to 40,000 deaths per year.” That ‘probably’ betrays the fact that there is no scientific calculation behind this figure. But naturally, the ‘probably’ and the ‘significant factor’ disappear by the time we get to press coverage, where alcohol is simply ‘responsible for 30-40,000 deaths per year’. But the biggest health-related story in the report is the shocking rise in deaths by liver disease in the UK over recent decades. Now that is undeniable, and obviously worrying. And given that cirrhosis is caused by long term alcohol abuse, I’m not disputing alcohol’s role in this, given that consumption was increasing over the 1970s, 80s and 90s. But we must acknowledge the link between current cirrhosis deaths and past alcohol consumption. But there are other factors contributing to liver disease that are being ignored. Firstly, there are various causes of liver cirrhosis. Here’s an estimated breakdown from a health consultancy in the US (I’ve been unable to find UK figures so far):


Liver cirrhosis can also be caused by fatty liver syndrome, which is the result of a bad diet. When the health lobby or the media choose to attack the obesity epidemic, they are very quick to point out that obesity can lead to liver disease, even cirrhosis. But they neglect to mention this when attacking alcohol. Why does this matter? Because in the UK, every single death by liver cirrhosis is counted as being caused by alcohol abuse – even if the person was a non-drinker! When calculating deaths from liver disease, the ONS states, “Very few of the deaths coded to these causes include a mention of alcohol on the death certificate. However they are included in the current ONS definition on the assumption that in England and Wales many of them were caused by alcohol, even if this was not explicitly stated,” and goes on to say “All liver disease deaths where alcohol is not mentioned (other than biliary cirrhosis) should contribute to the count of alcohol-related mortality.” So the ONS makes a calculation it knows to be wrong, in order to make up for the fact that across the board, alcohol-related deaths are under-reported. But then, the Royal College of Physicians inflates the resulting figure massively, also to account for under-reporting. The alcohol-related deaths that are not on death certificates are being – at least – double counted. The surge in liver cirrhosis correlates with increased alcohol consumption. But it also correlates with the obesity problem in the UK. I’m not arguing obesity is more of a cause than alcohol consumption. I’m arguing that it is a cause alongside alcohol consumption, as are “autoimmune inflammation of the liver, disorders of the drainage system of the liver (the biliary system), metabolic disorders of iron and copper (hemochromatosis and Wilson’s disease), and drugs such as pain-relievers such as acetaminophen and non-steroidal antiinflammatory drugs (NSAIDs), certain antibiotics, antidepressants, anti-cancer agents, and drugs used in controlling high blood pressure, high cholesterol , diabetes, and irregular heart rhythms”. Somewhere in these statistics, the Beer Widow’s Uncle George is being counted as having drunk himself to death, despite the fact that he died of liver cirrhosis after being a lifelong teetotaller.(This sounds like a bit like one of those arguments that smokers make to deny the link between smoking and lung cancer. I’m not trying to deny the link between drink and liver cirrhosis. But while we’re comparing the two, as far as I’m aware no one is trying to argue that 100% of lung cancer deaths are smoking related.) A final point on liver cirrhosis: one of the most disturbing charts from the Report, which has been extensively reproduced, shows cirrhosis rates soaring in the UK while they decline in several European countries. Two points on this:

  • The countries shown were chosen selectively: if you look at the data objectively, death from liver cirrhosis in the UK (6.5 per 100,000) is still considerably lower than in the USA (9.3 per 100,000) or the average for the whole of Continental Europe (10 per 100,000) (Source: the International centre for Alcohol Policies)
  • One of the countries that shows a steep fall in cirrhosis that’s almost a mirror image to the UK’s rise is Spain. Per capita alcohol consumption in Spain and the UK is roughly the same. Clearly then, the relationship between cirrhosis and alcohol consumption is not as linear and direct as is being claimed

(v) “The cost of alcohol to the NHS has doubled in recent years”

Radio 4’s More or Less programme demolished this one on January 8th. The claim from the NHS Confederation is that the cost of alcohol abuse to the NHS (however it is calculated, given all we’ve said) doubled between 2001 and 2006. As Radio 4 calculated: this is based on a report in 2001 that said the cost was £1.4-1.7 billion, and a second report in 2006 that claimed it was £2.7bn (so for a start, even from the very lowest base it’s not quite a doubling). If you adjust these figures for inflation – and take into account cost inflation inside the NHS, which is higher because of the amount of money pumped into the NHS in the early noughties, a figure of £1.4bn equals £2bn in 2006 prices – which would mean an increase in real terms from £2bn to £2.7bn. However, the people who compiled the 2006 numbers had better information, and claim that the 2001 figure was probably an underestimate. So if you take the upper limit of the 2001 estimate – £1.7bn – and adjust for inflation, you get £2.4bn, meaning a net increase of £0.3bn to get to that £2.7bn figure. Not a doubling at all then, but an increase of 12-13%. In addition, between the two periods the total percentage of the NHS’ budget spent on treating alcohol remained constant at 3%. Hardly ‘soaring’ then. Hardly a problem ‘raging out of control’.

In summary

Britain does have a health problem in which alcohol plays a part. But the Select Committee Report:

  • Confuses where alcohol is a partial or contributory factor with it being the primary cause
  • Confuses correlation (the presence of heavy drinking) with causation (heavy drinking being the main driver of the problem)
  • Quotes data selectively and partially
  • Wrongly implies that every single case of liver disease in the UK is alcohol related

And the true cost to the NHS is deliberately being deliberately exaggerated.

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Answering the neo prohibitionists, 4 of 10: “Alcohol is becoming cheaper/more affordable”

“While the consumption of alcohol has increased, taxation on spirits has declined in real terms and even more so as a fraction of average earnings.”

The Health Select Committee Report

Did you see what they did there?They start the sentence talking about alcohol, then switch to how taxation on spirits has declined, hoping you won’t spot the change in subject mid-sentence.The BMA adds:“Studies have also reported that price increases have the effect of reducing rates of alcohol problems including alcohol-related violence and crime… As part of a range of measures to reduce alcohol misuse, it is essential that the level of excise paid on all alcoholic beverages is increased at higher than inflation rates and that this increase is proportionate to the amount of alcohol in the product.”The implication here is that excise paid on alcohol is currently not being increased at a rate higher than inflation. The only problem with this is that if you don’t do that weasel thing by switching to talking about spirits, the price of alcohol is already increasing higher than inflation – and always has been:

The Report ignores this, and talks about how alcohol is becoming more affordable. How can this be true? Well, alcohol is becoming more affordable because average household income is increasing. Alcohol is becoming more affordable because everything is becoming more affordable.

But as alcohol prices have on average risen by 20% more than retail prices generally since 1980, alcohol is becoming more expensive versus other goods. As income increases, and the cost of high ticket items such as household electricals falls, people can afford to spend a greater proportion of their increased income on discretionary items such as drink – ‘affordability’ in this case is not directly linked with the price of alcohol. But should we still increase duty to offset this effect anyway? Well, how much duty increase do you want? Duty on beer increased tenfold between 1965 and 2007, and increased by 18% in 2008 alone. Duty on wine trebled between 1976 and 2007. It does seem utterly bizarre that duty has increased in reverse proportion to how strong drink is – beer has increased most, then wine, then spirits. Clearly that’s wrong and I support the Committee’s view that, relative to other drinks, duty on spirits should be increased. But affordability and price are being treated as the same thing – they’re not. By deliberately confusing ‘affordability’ (which is a function of rising disposable income) and price (which is a function of – well, price, but controlled chiefly by duty), you allow newspapers like the Telegraph to interpret these findings in the following syntax-strangled bullet point:

  • “69 – percentage alcohol is cheaper by than it was in 1980.”

This is a lie. Alcohol is NOT cheaper. It is already increasing by more than inflation, and in recent decades, it always has.

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Answering the neo prohibitionists, 3 of 10: “25% of the UK population is drinking at hazardous or harmful levels”

First, a disclaimer – I have no intention or desire to suggest that there is no such thing as a harmful level of alcohol consumption, or that some people in the UK drink to a level that presents a danger to themselves and/or others. We know that’s true. What I’m objecting to is the deliberate alarmism at the scale of the problem, and the attempt to define so many people as problem drinkers when the majority are patently not. OK, this is where we have to start getting a bit more technical and detailed. But to sum it up briefly: (i) The definition of hazardous drinkers is confused and essentially meaningless (ii) Even if you accept the definition (which you really shouldn’t) harmful and hazardous drinking are conflated by the report – and they’re quite different. (iii) Even when you take all that into account – ‘hazardous’ drinking as it’s defined – to the best we can measure it – is either static or declining.

(i) The definition of hazardous drinkers is confused and essentially meaningless

Let’s get harmful drinking out of the way first – it’s defined as “A pattern of drinking alcohol that causes harm to a person’s health or wellbeing. The harm may be physical, psychological or social.” When no harm is visible, the proxy used is drinking 50 units a week for men, 35 for women. Those limits may be high or low, but let’s accept them for now. The real problem is with ‘hazardous’ drinking. The Select Committee Report uses the BMA definition of harmful drinking: “A pattern of drinking alcohol that increases the risk of harmful consequences for the person. This term is used for males who regularly consume more than 21 units per week and females who regularly consume more than 14 units per week.” However, to arrive at their data, they then use ONS data. The question ONS asks if you’ve exceeded the daily recommendation (4 units for men, 3 for women) on any one day in the last week. The BMA has taken people who have exceeded the limit on one day, and claimed that these people regularly exceed the limit on most days – thus, if you drink 4+ units on a Friday, and are teetotal the rest of the week, you are counted as someone who drinks 4+ units most days. Even having done this, hidden in the body of the text, the BMA and the Report state that “In contrast to harmful use, hazardous drinking refers to patterns of use that are of public health significance despite the absence of any current disorder in the individual user.” (My italics) This is incredible – what they’re saying is that hazardous drinking is still hazardous, despite the absence of any ill effects of drinking in the individual. I can understand that while effects in the individual may be negligible, if you gross it up to a societal level you may see a statistical effect. But that is quite different from the overall implication that drinking at this level is likely to cause harm. Sorry, did I say implication? I meant assertion. Because after having quite specifically said that ‘hazardous drinking’ is defined as there being an “absence of any current disorder in the individual user”, the BMA then goes on to say: “The 2004 Alcohol Needs Assessment Research Project (ANARP) estimated that, for adults in England aged 16-64:

  • 38 per cent of men and 16 per cent of women have an alcohol use disorder, corresponding to 26 per cent overall (8.2 million people)
  • Of the 26 per cent with an alcohol use disorder, 23 per cent (7.1 million) consume alcohol at hazardous or harmful levels (32% of men and 15% of women)”

This terminology is then repeated throughout various documents. Yes, if you’re a hazardous drinker – that’s consuming more than 4 units a day for men and 3 for women remember, (equivalent to 1.5 pints of strong lager or one drop more than one large glass of wine) you now officially suffer from an ‘alcohol use disorder’ – even though their own definition of hazardous drinking specifies an absence of any disorder. The BMA also admits that: “The effects of alcohol on an individual are dependent on various factors including age, weight, type of drink, level of dehydration, previous exposure to alcohol, level and timing of food intake, and gender of the drinker.” Having acknowledged all this, they are still content to count anyone who drinks more than 4 units a day as a ‘hazardous drinker’ – irrespective of any of the above factors which, by their own admission, have an impact on the effect of alcohol. This definition of hazardous drinking is incoherent, self-contradictory, and makes profound errors in how the figure is calculated. And yet it libels a good proportion of 25% of the population as suffering from an ‘alcohol use disorder’.

(ii) Even if you accept the definition (which you really shouldn’t) harmful and hazardous drinking are conflated by the report – and they’re quite different.

The only thing to say here is that throughout most of its content, and as shown above, the Report refers to the two groups in one breath as ‘hazardous and harmful drinkers’. Having drawn a clear distinction between the definitions of the two groups, in terms of recommendations they are discussed as one – to the extent that ‘interventions’ are proposed for hazardous drinkers to warn them about their drinking! In fact, only 9% of the UK population are ‘harmful’ drinkers – surely it would be more useful to focus on them.

(iii) Even when you take all that into account – ‘hazardous’ drinking as it’s defined – to the best we can measure it – is either static or declining.

The report claims that “the latest ONS figures show that hazardous drinking had in fact increased between 2000–2008 from 24% to 28% in men, and from 15% to 17% in women. Remember what the ONS said about making comparisons like that? That’s right: “It should be noted, however, that changing the way in which alcohol consumption estimates are derived [in 2006] does not in itself reflect a real change in drinking among the adult population.” The Report here is quite deliberately and consciously ignoring the advice of the people who gathered the data it uses. Even if we were to pretend that the definition of hazardous drinking had any merit whatsoever, if look at that data in more detail:

Among men, even taking into account the revision upwards in 2006, ‘hazardous’ drinking is at worst static over the last ten years. If you were to disregard the recalculation, it would be falling. The fall is more pronounced for that ‘problem’ group, 16-24 year old men. It shows a decline – even a year-on-year decline – even taking into account the recalculation: The figure for women shows a marked increase, but this is clearly due to the recalculation of the units in a glass of wine:

It’ll be interesting to see what happens to this figure over the next few years – before the recalculation, levels are static.

So what’s the truth?

Well, according to the NHS, if we put aside the definitions of hazardous and harmful and look at some other data: “Among adults aged 16 to 74, 9% of men and 4% of women showed some signs of alcohol dependence. The prevalence of alcohol dependence is slightly lower for men than it was in 2000 when 11.5% of men showed some signs of dependence. There was no significant change for women between 2000 and 2007.” Alcohol dependence is a different measure. But I’d argue, given the above, that it’s a more useful one. It’s much lower than 25%. And overall, it’s declining.

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Don’t mess down the Rake

With thanks to my mate BLTP/Gargarin for bringing this to my attention, there was a story in the Guardian the other day about how former manufactured band singer, M&S pants model and all-round national treasure Myleene Klass has been cautioned by police after brandishing a kitchen knife at youths who were in her garden, peering through the windows, late at night.

Leaving aside the Daily Mail-lite debate on the wisdom of regarding such behaviour as criminal or not, Ms Klass is clearly quite tasty in more than one sense of the word.
The best bit about it though is that to illustrate the story the Guardian used a photo of Myleene they had on file. BLTP, eagle-eyed as ever, quickly spotted where the photo had been taken:
Want some, do yer?
The Rake does occasionally get a few twats in being raucous. And while the staff certainly don’t need any help in handling this kind of behaviour, if I was Glyn I’d be sticking up this press clipping as a deterrent to anyone who fancied creating a bit of bother. I for one would certainly obey anything Myleene said…

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Answering the neo prohibitionists, 2 of 10: “Binge Drinking in the UK is increasing”

The Health Select Committee Report says, “The last 50 years have seen several important changes in the sale of alcohol which have led to a great increase in binge drinking with all its harmful consequences.”
Every newspaper report on binge drinking refers to it as an “increasing” or “soaring” problem. If we were to commission a poll, I’m pretty sure the majority of the population would agree with the Select Committee Report when they refer to binge drinking as “a growing problem”.
Except it’s wrong to say binge drinking is increasing. Who says? Only the people who compile the data on binge drinking, that’s who.

(i) Unit consumption calculation has changed over time

The only way to estimate how much people are drinking is to ask them. The government recommended definition of a binge is more than twice the recommended daily consumption on any one day in the last week. Official figures for drinking are gathered as part of the General Household Survey – they ask how many beers or glasses of wine you’ve had, and work out your unit consumption from that.
Of course, if you ask people, they might well underestimate, so in 2006 the GHS recalculated the unit amount of what people claim they drink. Now, I don’t have a problem with this at all – over the last two decades we’ve started drinking more premium lager and premium ale, wine is becoming stronger on average, and when we say a ‘glass’ of wine we’re increasingly talking about a 250ml glass rather than a 175ml glass. I’ve looked in detail at how the calculation of unit consumption was revised, and I don’t have a problem with it.
The problem comes from the fact that the new calculation was not backdated. 2006 onwards is calculated in an entirely different way from years up to 2006. This means you cannot make comparisons over time. Of course, the calculation led to a one-off jump in claimed alcohol consumption if you look at it on a graph. But the Office of National Statistics – who did the calculation – says “It should be noted, however, that changing the way in which alcohol consumption estimates are derived does not in itself reflect a real change in drinking among the adult population.” Their words. Not mine.
Without the recalculation, there is a general downward trend.
The biggest leap in alcohol consumption is among older women – just as the ONS said it would be – because they’re most likely to drink the drinks that have been most affected by the change in methodology – glasses of wine.
So, to summarise: there’s not that much evidence of a surge in binge drinking rates. And where there is such evidence, according to the people who compile the statistics, it’s probably due to a change in methodology – not an increase in actual drinking.

(ii) Even ignoring that, there’s no evidence of a significant increase!

Data only goes up to 2006/7. It’s too early to see if the increase from 2006 to 2007 on overall figures is part of a trend or not – but even so, 25% versus 22% in 1998 is not much of an increase. And when we break the figures down by age, we see some interesting stuff:

16-24 year old drinkers are widely acknowledged to be the biggest problem group of binge drinkers. They’re the people we always see in any illustration of binge drinking, the people who are allegedly turning out town centres into no go areas for normal people, the villains starring in every episode of Bravo’s Binge Britain and every tabloid depiction of town centre carnage.
In this age group, even if we ignore the advice of the people who compile the figures and do a comparison over time anyway, binge drinking has fallen significantly over the decade.

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