Monday, 6 January 2020

David Nutt on alcohol - wrong in every possible way

The 'public health' lobby have been eerily quiet since Christmas, which is odd because it is normally their peak time. So we will just have to settle for the publication of Tom Watson's new book and wait for David Nutt's book which he has previewed in the Daily Mail.

If the article is any guide, it's going to be a stinker. It's been a while since I read anything so densely packed with cherry-picking, false information and sloppy research.

Now a new decade has begun, everyone is making resolutions to go to the gym, stop smoking and eat less chocolate.

I haven't, so that claim is wrong straight away.

In the UK, we’re particularly keen on drinking — so keen that our alcohol consumption has nearly doubled since the Sixties.

Per capita alcohol consumption was at an historic low between 1930 and 1960. It then rose until 1980, although it was still lower than it had been before the First World War.

There was a further rise between 1995 and 2004, after which consumption dropped by 16 per cent. Per capita consumption today is at the same level as it was in 1980.

As for being 'particularly keen on drinking', alcohol consumption in the UK is lower than it is in most EU countries.

According to the Global Drug Survey, Britons get drunk an average of once a week, and one in ten of us are drunk on five or more days a week.

The Global Drug Survey is a non-random survey of illegal substance users. It doesn't tell you anything about the average Briton. 64 per cent of the respondents took cocaine, for goodness sake. Honestly, one in ten of us are drunk at least five times a week?! Does that sound remotely plausible?

(I'm amazed to find I haven't blogged about this before. I regularly use it - and the execrable news coverage of it - in my presentation about junk statistics.)

A staggering 10.8 million of us drink at levels that pose a risk to our health.

Only because the 'safe' drinking level was lowered for no good reason in a demonstrably crooked process.

Indeed, alcohol is now the leading cause of death for men aged between 16 and 54

No, it's suicide.

Alcohol is also the reason policing public drunkenness costs us more than £6 billion a year. It’s why the costs to the NHS are over £3 billion.

That depends how you measure it. The cost to the taxpayer is much lower than this and is far exceeded by revenues from alcohol duty of over £14 billion.

A couple of years ago, we discovered that just a single drink a day increases the risk of breast cancer.

The evidence that one drink a day raises the risk of breast cancer is actually rather weak. The graphic below shows the results from a meta-analysis of cohort studies looking at moderate/light drinking and breast cancer risk. Of the 25 studies, only six produced statistically significant results and the overall estimate was an increased risk of just nine per cent. There are significant doubts about causality.

Even light to moderate drinking raises your risk of developing an irregular heartbeat (cardiac arryhthmia), which can make you feel faint, short of breath and potentially lead to a stroke.

And yet people who drink moderately have a lower risk of stroke.

What’s frankly terrifying, though, is that a large 30-year study found evidence of faster cognitive decline in people who drank only up to seven units weekly, than in teetotallers.

I think Nutt must be referring to this study of hippocampal atrophy. However, this study used the same data set and found that people who drunk moderately had a lower risk of dementia. This meta-analysis of twenty epidemiological studies found the same thing. See what I mean about cherry-picking?

You may think you’ll be fine if you follow the UK chief medical officer’s advice to drink no more than 14 units a week. 

Not only do I think that I'll be fine. I know that I can drink more than that and live longer than a teetotaller.

And if you stick to these levels (roughly two pints of beer or two glasses of wine a day, spread out over three days a week, with days off in between), your risk of dying due to an alcohol-related condition is only around one per cent. 

It is around zero per cent.

One study concluded that having a couple of drinks on more than four days a week raises the risk of premature death by 20 per cent.

I can't guess which study this refers to, but I prefer to look at the totality of the evidence, and the evidence shows that abstinence kills.

And a recent report from the European Commission concluded that drinking any more than two units a year increases your risk of cancer, although the increased risk is very small. That’s just one pint of low-strength lager!

I think this is a reference to this rubbish which even Ian Gilmore described as 'speculative'. I can't imagine that there are enough people who drink one beer a year to build any kind of study around. It's pure scare-mongering. Nutt is clutching at straws.

In any case, why should I be worried about a very small risk of cancer when moderate drinking confers very large benefits to the heart?

The graphic below shows the results of a meta-analysis of 31 prospective cohort studies which found that drinkers are 25 per cent less likely to die from coronary heart disease than teetotallers. Note that - in contrast to the breast cancer studies - most show a statistically significant reduction in risk.

Naturally, Nutt dismisses any evidence that reflects well on drinking...

Hang on — what about all those studies that apparently showed benefits from drinking a daily glass or two of red wine? Sorry to disappoint, but a 2018 review of all the evidence — published in the leading medical journal, The Lancet — concluded that any partially protective effect on the heart is more than cancelled by negative effects, such as raised risk of cancer.

That study involved some opaque modelling to arrive at a conclusion that is not supported by any science. I wrote about it when it was published. It is a terribly flawed piece of work, as many others have pointed out (see here, here, here and here). Even if it were more robust, a single study doesn't refute hundreds of other studies.

Let me put it this way: If alcohol had been discovered in the past year or two, it would be illegal.

Probably, but that says more about the times we live in than it does about alcohol. In such a scenario, Nutt would presumably be seeking to legalise it, as he does with all other drugs.

The safe limit, if you applied current food-standards criteria, would be one glass of wine a year.


Would you take a new drug if you were told it would increase your risk of cancer, dementia and heart disease, or that it shortened your life? You wouldn’t touch it.

We would if we enjoyed it, and that is why billions of people drink alcohol. The fact that it lowers the risk of dementia and heart disease when consumed in moderation is just a bonus.

Yet over the past 50 years, alcohol has become entrenched in our lives. 

Past 50 years? Past few thousand, surely?

We drink for social bonding. We drink together to clinch business deals and come to agreements. We drink to celebrate the birth of a child, to commiserate with each other when someone dies. We drink because we’ve had a stressful day at the office, because we’re feeling anxious or just because it’s Friday.

Indeed we do. Great, isn't it? If we paid attention to Nutt's silly league table of drug harm, we would be taking, er, GHB and poppers instead. Something tells me that's not going to work.

Alcohol used to be a special purchase: you had to go to an off-licence or the pub — during limited hours — to buy it. Now it’s so easy to buy that many of us just chuck it into our supermarket trollies.

As already mentioned, alcohol consumption is at the same level today as it was 40 years ago.

We’re now the sick man of Europe. Take the drink-driving limit, for example, of 80mg blood alcohol. It hasn’t changed since 1967, thus leaving the UK with one of the highest drink-driving limits in the world. In most of Europe, the level is 50mg. Norway and Sweden, among others, have lowered it to just 20mg, which effectively allows for a dab of alcohol in a pudding.

Did Scotland reduce the number of road accidents when it reduced the drink-drive limit? No.

Is there any correlation between drink-drive limits and drink-driving accidents? No.

Some countries have gone much further, adopting successful policies to curb other damage caused by alcohol. The consequences in France are impressive.

The French introduced stringent advertising restrictions on alcohol in the early 1990s and put health warnings on the labels. The French still drink a lot more than the British and have one of the highest rates of alcohol consumption in the OECD.

Back when I was a medical student, it was rare to see someone in a UK hospital with alcoholic liver cirrhosis. But not in France, which is why we called it the French disease. Now, however, French cirrhosis rates are lower than the UK’s.

They are very slightly lower for women, but are still considerably higher for men. Overall, Nutt is wrong again.

So WHY haven’t we adopted any of these sensible policies?

Because advertising doesn't affect overall demand?

Because the Government makes so much money from taxes on alcohol. That is short-term thinking. The fact is that when you add in the costs of alcohol to society, there’s a net loss to the Exchequer.

Wrong yet again. Alcohol duty revenues cover the costs to government three times over.

These are: £3.5 billion annually on health; £6.5billion for policing drunkenness; £20 billion for lost productivity through hangovers. That comes to £30 billion.

Lost productivity is not a cost to the Exchequer. The £3.5 billion cost figure for health is an exaggeration. And the £6.5 billion cost for 'policing drunkenness' is simply made up.

Add in other factors such as alcohol-related costs to social care, the criminal justice system and the fire services, and the cost zooms to £55.1 billion.

Indeed, I’d argue that we need to go much further than France, starting by taxing drinks on the amount of alcohol they contain.

This is actually a good idea which I proposed in A Rational Approach to Alcohol Taxation. Nutt doesn't want to tax alcohol rationally, however. He just wants people to stop drinking (perhaps taking his synthetic substitute instead), and so he wants a tax rate much higher than the 9p per unit that can be justified by economics.

We should also cut the availability of super-cheap booze, and stop supermarkets using discounted offers on alcohol as loss leaders. On what planet does it make sense for a poison to be sold at less than the price of water?

This old canard again! Even if you ignore the tap in your kitchen, you can always buy water more cheaply than alcohol.

We should also repeal the licensing law so pubs once again shut up shop at 11pm...

And we should follow Scotland’s lead in introducing a minimum price per unit of 50p. At the time the law was passed last year, more than half of all alcohol was being sold below this price level — mostly to teenagers and alcoholics.

As far as I can tell, the claim about 'teenagers and alcoholics' is a Nutt invention, but it is true that minimum pricing has increased the price of most of the alcohol sold. It is not a targeted intervention.

There are already promising signs that the amount drunk in Scotland is decreasing.

It's been decreasing for years, and there are less promising signs about alcohol-related mortality, which rose in Scotland while it fell in England and Wales. Funny that Nutt doesn't mention that.

Come on, Boris, you know it makes sense. One of your predecessors, David Cameron, supported minimum unit pricing and set up a committee in 2010 to bring it about.

Nutt doesn't Boris very well if he thinks this is the way to persuade him. And that's fine with me.

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