I’m sure many readers will have sympathised with Kenneth Roy’s views on scare-mongering public health officials, though we should remember that much of the mongering is by his profession, who tend to emphasise the sensational and resist exploring the subtleties. But the subtleties are important for a balanced personal judgement to be made on risks and benefits. Take, for example, alcohol.
Most readers will have tried alcohol, the majority will probably be occasional or regular drinkers, and a few will have drunk to the point of causing themselves short-term or even long-term illness. The latter group will know that alcohol is a poison with easily understood adverse effects on the brain and liver. These effects are such as to cause loss of control and unconsciousness, something apparent to anyone venturing out into the popular parts of a city on Saturday night.
As a young hospital doctor I used to dread those evenings and nights on call at weekends when aggressive drunks came in with a variety of injuries and tried to assault the nurses and other patients. Clearly, alcohol is an acute poison and any attempt by public health officials to control excessive drinking and the consequent toll of injury to drinkers and others should be welcomed. Unit pricing of alcoholic drinks and education of the young in the dangers are cases in point.
Equally, most readers will be aware that alcohol is a chronic poison, that is, one that has cumulative effects on health, worsening in relation to the more that is taken. Again, if I may refer to my own experience, one of the most horrifying situations on a medical ward is admitting a patient with advanced liver disease, shaking and confused, then vomiting pints of blood as you struggle to get a tube down his or her throat to stop the bleeding. Not so dramatic perhaps, but unpleasant for all concerned is the slow decline into dementia or social incapability of the alcoholic. These long-term effects are becoming much more familiar to doctors now than they were in my younger days, thanks to the availability of cheap alcohol and a relaxation of public attitudes to drinking, especially by women who now have caught up with men in the alcohol-related disease statistics.
This therefore raises the question, what should we do about it? The libertarian might think, let them drink and take the consequences, but the consequences are taken not just by the drinker but by the family, the health service and police; they are far from cost free. The authoritarian would perhaps ban alcohol altogether, as in some Muslim countries. The responsible capitalist might urge a safe-drinking policy, while continuing to promote the product to young people. The poor public health official has a dilemma, because alcohol is widely treated by the population as a harmless medicine, taken for the relief of stress or the induction of euphoria. Could it be that the population has a point?
Perhaps the best known comment on this subject was by a German doctor/alchemist known as Paracelsus in the early 16th century, translated as: ‘Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy’. There is much truth in this early insight, as most of our medicines become deadly poisons if we take too much – aspirin, paracetamol, quinine, most heart drugs, and of course opium. The use of these poisons as medicines relates to small doses having effects that are beneficial. You might extend this thinking further to foods; fats, carbohydrates and protein are essential to life but excess of any of these may poison us, causing obesity, heart disease, diabetes and so on. Or to oxygen, the very molecule on which animal life depends; even oxygen in high concentration can fatally damage the lungs and so-called free oxygen radicals are not only essential to defending us against bacteria but also as the basis of inflammation can damage our own tissues and lead to disease.
Where does this leave us with alcohol? Well, most who drink it perceive some small benefits such as relaxation, a lightening of mood, and an increased confidence. A bit more and what happens depends on the environment; we may become overly friendly, troublesome or aggressive, or we may just fall asleep. Some who get to like these effects can become dependent on them to pursue their objectives in life and some may be unable to function without regular doses. This pathway to dependence and alcoholism is gradual and barely noticed by the individual, though friends may become aware of it. It affects the minority and there may well be genetic influences at work, so that a family history of alcohol problems is a worry.
There is some disagreement among health professionals on the best way to manage these sorts of problems. Some hope early detection and intensive management of those most at risk might be best, others (the majority) that general advice and regulatory action is more effective. If this is so, what should that advice be? If it were true that there are no health and societal benefits to alcohol use, abstinence would be advisable. However, there is a body of evidence that there are some health benefits from moderate drinking in terms of protection from heart disease, still the major killer of people in the UK, and this apparent protective effect is the basis of earlier advice from public health doctors on safe limits. In many studies of mortality (as opposed to risks of specific diseases such as breast cancer) the risk of premature death is high among heavy drinkers, gets progressively lower to a point when people are drinking a few units regularly, then rises somewhat among very light and non-drinkers.
Of course these are average figures and do not apply to every individual. For example, if your father died of an alcohol-related disease you would be wise to abstain. If you are pregnant, you should bear in mind that the developing foetal brain is very likely to be damaged if you drink, as alcohol goes easily across the placenta. If you are a woman you should not try to match your man’s drinking as in general you won’t metabolise it as well as he does – sorry. But if you have been drinking small amounts for years without problems, I don’t think you need do more than be careful and sensible. That means that in a week you should not drink more than about 15-20 units (not more than two bottles of 13.5% wine) and have two or three days of abstinence, avoid getting drunk (binging), and never lose count of how many you have had.
Actually, that is pretty much what the chief medical officers said, even though they did suggest that if you could abstain completely it wouldn’t do any harm, and that is almost certainly true. And remember, when health officials give advice, that’s what it is; you don’t have to take it but you would be wise to consider it as given in good faith.
By Anthony Seaton | 27 January 2016
