When is an alcohol guideline not an alcohol guideline?
16/02/2016
I worry for Dame Sally Davies. The chief medical officer has revealed that every time she reaches for a glass of wine she thinks about cancer. This can’t be healthy.
It’s understandable that she’s so zealously taken on board her own recommendations on alcohol guidelines, which for the first time state that there is no safe level of consumption, but I’m not sure she’s properly understood them.
Recommended guidelines are, erm, recommended guidelines, not a strict rule. They are meant to encourage a relaxed and rational assessment of risk, not a cringing in fear whenever someone offers you a glass of pinot grigio.
It’s curious, too, that it’s specifically cancer Davies is worried about. Alcohol-related liver disease is a much bigger killer. But, of course, cancer is scarier.
She should also know that guidelines don’t have much effect on an individual’s decisions about how much to drink. Not even hers. As the public health lobby is constantly reminding the drinks industry, educating people is not enough.
This was confirmed by some reflections on the British Medical Journal’s website by one of the CMO’s advisors on the matter, Dr Theresa Marteau.
There is little evidence, she says, for “any effect of health-related guidelines on behaviour”. On the other hand, “they may shift public discourse on alcohol and the policies can reduce our consumption”.
See what they’ve done there?
I am, myself, sceptical about whether alcohol guidelines work. As I argued in the Off Licence News recently, it is extraordinarily difficult to apply them in actual drinking situations.
I did leave the door open a crack, though, by suggesting that they might play a role in arming doctors and other medical staff in their conversations with people whose drinking has become a problem for them.
We know that these conversations, or brief interventions as they’re called, can be effective in encouraging someone to reduce their consumption. But I suppose the length of time doctors are allowed with patients these days might make their interventions a little too brief.
So we are left with what I feared – that, whatever the strength of the science behind them, the guidelines are disingenuous. They are not meant to guide, but instead provide propaganda and headlines for cranking up the fear of the bottle and, in turn, persuading politicians to push ahead with the whole population policies that obsess certain sections of the health community.
Dame Sally Davies seems to be an early victim.