If alcohol experts accept that public health campaigns are not working, then surely it is time to abandon them, writes GP Michael Fitzpatrick
One finding in a recent survey of more than 200 gastroenterologists, hepatologists, acute physicians and nurses engaged in treating alcohol-related harm has been widely reported. About 81% of these experts believe that, if alcohol was more expensive, consumption would decrease. Earlier this year the chief medical officer, Sir Liam Donaldson, proposed a minimum duty of 50p a unit alcohol in off-licences and supermarkets.
The other main finding of this survey, carried out by the Royal College of Physicians and the Royal College of Nursing, was generally ignored. But an even greater majority of the alcohol experts – 84% – believe that public health campaigns have been ineffective.
Yet medical authorities, politicians and commentators alike are reluctant to draw the obvious conclusion: if these campaigns, in which enormous resources have been invested over two decades, are not working, then they should be scrapped.
Instead, so powerful is the influence of wishful thinking in alcohol policy, the evidence of failure is always greeted with pious expressions of the need to try harder and the commitment of even more resources to the pursuit of the same failed policies.
Two key aspects of the policy of preventing alcohol-related ill-health are education in “sensible drinking” and “brief interventions” by GPs.
Since the 1980s, children in schools and adults in public places have been targeted with information about how to calculate units of alcohol in particular beverages and safe limits for men and women. Health promotion activists have sought to inform people about the damage alcohol can cause to their livers, their brains and their hearts. Yet the experts now acknowledge that all this has done little to deter an apparently inexorable rise in alcohol-related illness.
In fact, the failure of alcohol education policies should not be so surprising. For most people, whether they are teetotallers or drunks, or at some point on the wide spectrum in between, concerns about health are not a significant factor in their drinking behaviour. Heavy drinkers are well aware that alcohol does not have a beneficial effect on their health, but reminding them of this does not inhibit their consumption.
Turning to GPs
In recent years, drinkers have been encouraged to turn to their GPs and GPs have been encouraged to undertake “brief interventions” to discourage harmful drinking. This means interrogating patients about their alcohol intake and providing them with ‘information, advice and motivation” to reduce their consumption. By excluding serious drinkers, defining limited goals and providing only short-term follow-up, studies have been able to claim dramatic benefits. More sober assessments – such as those made by the experts surveyed above – suggest that benefits are modest and short-lived.
Raising prices may deter drinking – though it may also encourage illicit supplies. More importantly, shifting the discussion on to price may move the discussion of alcohol from the medical to the political realm, where it belongs. This would allow doctors to retreat from moralising propaganda (at which they are conspicuously inept) and return to treating their patients.
As political commentator HL Mencken wisely put it: “The role of doctors is not to make people virtuous but to save them from the consequences of their vices. The true physician does not preach repentance, he offers absolution.”
Michael Fitzpatrick is a GP practising in east London
This article is published in the 7 May issue of Community Care magazine under the heading It is no wonder that alcohol education programmes fail