Strong public policy measures on alcohol would be more effective than clinical treatments, say experts
Three of Britain's leading experts in alcohol policy and treatments say that strong public policy measures on price and affordability of alcohol would be far more successful than clinical treatments or current Government initiatives in reducing alcohol-related harm. In the same way that doctors use evidence-based medicine to treat individual patients, they say the Government should use the overwhelming evidence we already have to implement stronger public policy measures on alcohol instead of persisting with measures that have little or no evidence of success.
Writing in the October edition of the BMJ Journal Gut, Dr Nick Sheron, of the University of Southampton, independent public health physician Dr Noel Olsen, and Professor Ian Gilmore, President of the Royal College of Physicians, say that despite advances in endoscopy, liver transplantation and critical care, survival figures for liver disease have not improved greatly over the last 30 years and remain at around 50 per cent overall. Because liver disease is a 'silent killer' with most people only experiencing symptoms once the disease is very advanced, doctors are faced with managing terminal cases, so death rates are high.
In their article 'An evidence-based alcohol policy', the experts contrast the limited capability of existing medical treatments and current Government initiatives with the likely success of stronger public policy measures. Strategies to reduce the overall alcohol intake of the population and specifically target heavy drinkers are more likely to be successful because they would prevent alcohol-related harm before it happens, rather than trying to treat it when it is too late. These policies would also reduce alcohol-related deaths in young people. The article quotes an EU Commission study that shows that 25 per cent of young male deaths and 10 per cent of female deaths in Europe are alcohol related.
The authors review the overwhelming evidence from the World Health Organisation (WHO), the Academy of Medical Sciences and the EU, all of whom conclude that the most effective means of reducing consumption and alcohol-related harm is to tackle the price of alcohol. They also show that increases in liver deaths since 1980 are very closely correlated with changes in the affordability of alcohol over the same time period. Price increases will result in a drop in consumption overall, but provide a 'double-whammy' as they impact most on the heavy drinker and the young.
The article states:
'The WHO conclusion is that increased taxation is the most effective tool, followed by restrictions on promotion and finally, by reducing the availability of alcohol. The alcohol industry and the Government have favoured an emphasis on education and information-based initiatives. There is no evidence that these approaches reduce alcohol-related harm although an evidence base is emerging in other public health areas, and in the longer term these measures may turn out to be effective. Information, advice and education campaigns may be important in changing attitudes and in preparing public opinion for the introduction of effective measures, but appear ineffective when used alone.'
The authors outline the series of policy measures called for by the UK Alcohol Health Alliance (UK AHA) and call for greater involvement from the hepatology and gastroenterology community to turn the tide of UK liver deaths.
Dr Nick Sheron, consultant physician and liver specialist at Southampton General Hospital, a clinical senior lecturer at the University of Southampton, and member of the Executive Group of the Alcohol Health Alliance UK, said: "We need to re-establish the delicate balance between the price people pay for alcohol and the harm that it causes - valuable lives are being wasted to preserve our love for cheap booze."
Dr Noel Olsen, independent public health physician and immediate past Chair of the Alcohol Education and Research Council, said: "Harmful drinking is a massive public health problem in the UK. The Government recognises that alcohol-related harm costs in excess of £20 billion a year. More effective government regulation of alcohol promotion, price and off licence sales are needed. The effect of lax regulation of corporate organisations is highly visible in banking, in our obesity-related food processing and marketing and in our alcohol marketing. It is time for Government to review its contribution to solving the problems."
Professor Ian Gilmore, President of the Royal College of Physicians and Chair of the UK Alcohol Health Alliance, said "The increasing toll of preventable deaths from liver disease stands out as a stark exception in a country where life expectancy is otherwise increasing. We are committed to working with Government and other UK agencies to tackle this, but urge that the evidence-based levers of price and availability are seized on as soon as possible."
Notes for editors
The paper can be viewed on the Gut website for those with a subscription: