Andrew Norfolk
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A collective shudder of dismay rattled wine glasses on middle-class dining tables this week when a report labelled some of Britain’s most affluent towns as sozzled dens of “hazardous drinking” iniquity.
Middle-class, middle-aged drinkers, according to a report commissioned by the Department of Health, had been consuming so much wine for so long that many were putting their health “at significant risk”.
Cue the sound of corks returning to half-drunk bottles across the land. Had the users known how safe drinking limits came into being, they might just have poured another glass.
When the report defined any man who drinks more than 21 units of alcohol a week, or woman who consumes more than 14, as a hazardous drinker, the authors were relying on limits that have been set in stone for the past 20 years.
Yet these guidelines have no basis in science. Rather, in the words of a member of the committee that drew them up, they were simply “plucked out of the air”.
The safe limits were introduced in 1987 after the Royal College of Physicians produced its first health report on alcohol misuse. In A Great and Growing Evil: The Medical Consequences of Alcohol Abuse, the college warned that a host of medical problems – including liver disease, strokes, heart disease, brain disease and infertility – were associated with excessive drinking. The report was the most significant study into alcohol-related disorders to date.
But Richard Smith, the former editor of the British Medical Journaland a member of the college’s working party on alcohol, told The Times yesterday that the figures were not based on any clear evidence. He remembers “rather vividly” what happened when the discussion came round to whether the group should recommend safe limits for men and women.
“David Barker was the epidemiologist on the committee and his line was that ‘We don’t really have any decent data whatsoever. It’s impossible to say what’s safe and what isn’t’.
“And other people said, ‘Well, that’s not much use. If somebody comes to see you and says ‘What can I safely drink?’, you can’t say ‘Well, we’ve no evidence. Come back in 20 years and we’ll let you know’. So 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.”
On that basis, a nation’s drinking destiny was determined. The Government accepted the recommendation and 20 years later Professor Mark Bellis, director of the North West Public Health Observatory, which produced this week’s study, felt able to say that anyone exceeding the limits was “drinking enough to put their health at significant risk”.
That a host of epidemiological studies had filled the intervening years with evidence to the contrary seemed not to matter one jot. Most significant, perhaps, was a study carried out by the World Health Organisation in 2000.
The WHO’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 chronic 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 low-risk below 17.5 units, medium between 18 and 35 and high above 36.
Seven years earlier, in 1993, a study of 12,000 middle-aged, male doctors led by Sir Richard Doll and a team at the Radcliffe Infirmary, Oxford, 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 roughly a bottle of wine a day.
By 1994, five studies had been published which showed that moderate amounts of alcohol gave some degree of protection against heart disease. A year later, scientists at the Institute for Preventive Medicine in Copenhagen, who studied 13,000 men and women over 12 years, found that drinking more than half a bottle of wine a day – 50 units a week – cut the risk of premature death by half.
So what is the truth? Clarity is not aided by the fact that different countries use different quantities of alcohol to define a unit.
In Britain one unit of alcohol is 8 grams of pure ethanol. In Australia and Spain it is 10 grams, in Italy 12, in America 14, and in Japan 19.75. Translate the respective countries’ levels into British units and you find that, for men, Britain’s supposed safe weekly limit of 21 is more than Poland (12.5), but less than Canada (23.75), America (24.5), South Africa and Denmark (31.5) and Australia (35).
Some countries say that women should drink less than men, but others, including Canada, the Netherlands and Spain, make no distinction.
Christopher Record, a liver-disease specialist at Newcastle University, suggested that “it doesn’t really matter what the limits are”. “What we do know is, the more you drink, the greater the risk. The trouble is that we all have different genes.Some people can drink considerably more than [the limits] and they won’t get into any trouble.”
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"the same risk of death as that faced by a teetotaller was 63 units a week, or roughly a bottle of wine a day." - lots of people who are now tee-total used to be very heavy drinkers, certainly more than half a bottle of wine a day. Did the study remove alcoholics from the "tee-total" category, or people who have a high risk of death from illness, take a lot of medication, and can't drink because of that?
Dan Beale, Cheltenham,
I like the way they can come up with this stuff out of thin air and drink is legal?
No wonder we hear so much rubbish when it comes to an illigal drug like Cannabis!
THINK people, THINK!
Andy T, England,
I get the impression that practically everything will potentially cause death before the effects of moderate drinking will with healthy people - and that seems to include being a teetotaller. It seems quite likely that the healthier moderate drinking portion of the population is therefore, in fact, more productive and to an older age than the miserable puritanical abstainers are - therefore paying more taxes too. So perhaps the anti-drinking lobby should just keep quiet. Informing on the detrimental effects of drinking and driving, or drinking while pregnant though is quite another matter.
Cirep G Nol, London,
I knew the figure was one they just made up: After 40 years of drinking all over the world and other experience, I know that everyone is different.
Peter Day, Doncaster, UK
a further wrinkle:
the overwhelming bulk of alcohol problems (liver "disease") are due to Vitamin B deficiency. supplement alcohol with Vit.B and cirrhosis does not occur.
the BMA a few years ago explicitly discussed this and the proposal to recommend that all british alcohol be supplemented with vitamin B. the evidence was overwhelming, and agreed unanimously to be so. yet they decided not to make the recommendation "as this would encourage alcoholism".
genuine alcoholics are not materially influenced by long-term health consequences when they seek refuge in a bottle. if they were, based on what the current received-wisdom is, they would not touch the stuff.
the dis-connected arrogance, bandwagon-ism, and sheer unprofessional irresponsibility of the BMA's position remains as breathtaking today as it was then.
Saltation, London,
Now we learn that levels of hazardous drinking in the UK were âplucked out of thin airâ we must wonder if the mindless mantra, âthere is no safe level of exposure to passive smokeâ came from the same place! For it is not only an insult to our intelligence (Am I in danger âcos I once smelt some smoke?) it is also thoroughly fraudulent.
The internationally respected and acclaimed British Doctorâs Study ran for 50 yrs and repeatedly reported that over 20 yrs of ACTIVE smoking produced no ill effect. Following the Welsh Assemblyâs triumphal and self congratulatory enactment of draconian anti smoking measures in July, I have repeatedly asked them to reconcile this finding with their near hysteria at the prospect of a little passive smoke. Although they do not dispute people may ACTIVELY smoke safely for 20 years, they stubbornly and ludicrously maintain there is âno safe levelâ of 2nd hand smoke!
Dai (Non smoker), Caerphilly/Hervey Bay, Wales/Aust
In the part of France that I live in they have a mid-day âmenu de jourâ in many restaurants that includes a quarter litre of wine per person. Many of these restaurants do not have quarter litre bottles so the quantity put on the table is rounded up to the size of the container available. The French diners drink what they want and leave the rest. A lot of the resident English and all nearly all holidaymakers make a point of finishing off all the wine that has been served. This points to a fundamental difference in the attitude of the English to alcohol to that of the âcafé cultureâ in Europe the Blairâs 24hour drinking reform was supposed to promote. Licensing laws were developed over the years that catered for the particular drinking habits of the British and it was a disaster waiting to happen to change them.
Not long ago our then oldest resident died at 106 and most of the local population seems to remain active well into their late 80âs. They all have a healthy regard to good food and drink with an emphasis on the social and woe betide anyone who tells them what is good or bad for them.
Many years ago the then vicar of the village in England in which I lived told me that excess in anything will be harmful but most things in moderation will invariably do you good.
David Huckett, Charante Maritime, France
Whilst the government is promoting lower levels of alcohol consumption their changes to licensing laws have not helped. Some, especially the young in this country will drink as long as they are allowed. The increased opening times have simply allowed them to drink for longer and moved the disruption caused from before midnight to constant drunken rampages in residential ares in the early hours of the morning. Some consistency would be greatly appreciated.
Eadger, London,
Great Britain is a wonderful country, but just as Americans have a problem with food, you British have a terrible problem with your culture of alcoholism. From the time I lived there I have observed that way too many good people spend too much time not only drinking, but talking about drinking, thinking about drinking, and just running one's life about when one is going to get the next drink. Bonding through drunkenness seems to be way too much a part of the shared culture. Drinking is fine if you control it--but way too many adults in Britain seem overly impressed with their ability to drink until they vomit, and that is just not healthy.
Alex, Lyndhurst, NJ
Christopher Record, a liver-disease specialist at Newcastle University, suggested that âit doesnât really matter what the limits areâ. âWhat we do know is, the more you drink, the greater the risk."
Surely much of the above suggests that, upto a point, the opposite is the case.
Cheers !!
Guy Johnson, Ipswich, Suffolk
These recommendations were based on the amount people told their doctors that they drank. Most people will tell their doctor that they drink(or smoke) less than they actually do. So these guidelines were purely based on annecdotal evidence given by patients who would not have wanted to tell the real truth about the amount they are drinking ,and therefore have no substance in reality. When I go to the recycling bins and see how many alcohol bottles are there , I wonder that anyone is still alive , if the safe alcohol levels were raelly valid.
Jane, Newcastle,
It seems to be a classic case of an elite who think that they can 'rule' others by way of their 'research' but really, in many instances, only enforcing their prejudices on others. !
Too many regulation, and too many bureaucrats, trying to rule the rest of us. The BBC also comes into this category.
John Charlesworth, Sleaford, Lincolnshire , UK
How many other so-called "health guidelines" such as this are based on such flimsy evidence? I seem to recall the advice of the medical profession varied acording to their own particular drinking or smoking habits and sitting in a consulting room with a doctor smoking heavily. I don't recall a drunk one, however, but every ailment under the sun seems to land at the door of smoking nowadays. Is it perhaps due to the decline in smoking that we now see attention turning to that other social pleasure, alcohol? How long until it, too, becomes a furtive habit, pursued behing closed doors in a solitary fashion before becoming illegal altogether. Think how much this might save our over-stretched health services though, allowing the money saved to be diverted to more deserving causes such as nuclear weapons, unnecessary wars, identity cards and all the other such obsessions of our political leaders nowadays.
Phil, Edinburgh,
I am well over pensionable age. I play 18 holes of golf at least four times a week. I am learning to ring church bells, not an easy thing to do. I have a load of other hobbies, one of which is settling down in the evening to share a couple of glasses of wine with my husband, who, I might add, is just as active as I am and a good deal older. This apparently dangerous habit has been going on for forty years. Moreover, if I am feeling feel a twinge or two, by the time the two glasses are consumed the twinges are gone and forgotten. So I say to all those bossy, interfering do-gooders, stop lecturing us!
Gay Sutton, Andover, Great Britain