By the editor, Apr 15 2017 01:33PM
We've come to accept regular lecturing by the Government on our health, rather as we now expect our newspapers to produce a steady crop of simplified and distorted medical science stories. Consequently, our visits to our GPs involve increasing questions about lifestyle choices, and such questions are liable to crop up in other, sometimes surprising, contexts, which may for example affect our ability to conduct our financial affairs as we wish. Woe betide us if our answers are significantly out of line with whaterver the state recommends - or worse, that we refuse to answer at all. And who knows what is done with the records of whatever we say? Yet it's rare now to hear complaints about "the nanny state": perhaps people have given up fighting it, or liberalism is so discredited now it's not considered worth fighting against at all.
A report last year on recommended maximum levels of alcohol did cause something of a stir because it lowered the limit for men to 14 units a week. As a few people in the media noted, this means that for those who enjoy a drink the message was essentially to become a teetotaller. And as a result, it's now become that much harder to keep a straight face when lying about our intake to the medical profession and other powers-that-be. Meanwhile, what if any advice do we take from such recommendations, and to what extent should we feel obliged to follow them?
It's quite often stated, alongiside such reports, that the "cost to the NHS" or similar is £X billions, hence justifying state action, and morally requiring us to adjust our lifestyles so as not to be a burden on others. But it's worth here bearing in mind the words of Humphrey Appleby in Yes Prime Minister, when given statistics of deaths from smoking and the cost to the NHS: "We have gone into that. It's been shown that, if those extra 100,000 people a year had lived to a ripe old age, they would have cost us even more in pensions and social security than they did in medical treatment." Were these figures accurate then, and are they accurate now? We might now add the additional, and burgeoning, cost of social care for the elderly. Meanwhile, smoking and other vices are heavily taxed. There is a strong case for suspecting Humphrey was right then, and would be right now. So where is the evidence and analysis to prove that there is in fact a net social cost of smoking, or any of the other demonised habits? Arguing the toss on this may seem a rather cynical and heartless exercise, but people and governments shouldn't get away with making accusations along the lines that one group of people are, by their lifestyle choices, costing everyone else a huge amount of money, if in fact this isn't true, or can't be proved either way.
But back to the report on alcohol. To be fair, this was measured, and appeared to be carefully produced and evidence-based. It made it clear that the recommended maximum limit was based on levels of risk, rather than some sort of cliff-edge of certainty, and acknowledged that risks to individuals would vary hugely depending on various other factors. Nevertheless, it's necessary to delve into the background material on which the report was based to get a proper understanding of what the recommended limit was based on. And it then becomes clear that there are some assumptions and conclusions that start to look questionable. The background report can be found here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545739/GDG_report-Jan2016.pdf.
The research included risk factors associated with diseases that are wholly attributable to alcohol, as would be expected - alcoholic liver disease, for example. But it also includes the risks of a much larger range of diseases, such as high blood pressure and a number of cancers, to which, it states, "it is clear that regular drinking contributes but for which conditions it is not possible to prove the role of alcohol in any individual case". Alarm bells ought to start ringing at this point: something is apparently "clear" and yet it's not possible to "prove" in any individual case. It sounds rather as though a link has been made in each case, based on theories and observations, without any defintive proof. We aren't told what evidence this is based on, but it is apparent that other medical warnings about the dangers of alcohol are based on connections to other risk factors, such as obesity. The idea being that it's likely that a person who drinks a lot is also (for example) overweight, and the latter condition causes a number of diseases. But of course some heavy drinkers aren't overweight, and provided they stay that way, that category of risk factors falls away.
Furthermore, the list of risks in the report includes the risk of accidents, whether direct accidental alcohol poisoning, or falls, car accidents, or other physical injuries. It's doubtful that many of those considering the recommended limit would have been aware of this. The person quietly sipping a few glasses wine or beer at home in the evening is extremely unlikely to poison themselves or walk into the path of a car or get into a fight. They'd be wise to take extra care walking up the stairs to bed, but that's hardly the sort of risk that a Government report needs to alert them to.
With all that in mind, we get to the figures. It's true that, if you do accept the analysis of the risks considered above, the report's conclusions show a marked increased risk of of drink-related deaths for those drinking significantly in excess of 14 units a week. Whereas the risk of drinking 14 units (spread over 5 days) is a 1% increased risk of mortality, the risk of drinking 49 units (spread over 5 days) is nearly 15%. But it's also important to put this in perspective. Although the report refers repeatedly and rather alarmingly to the "lifetime risk of death" from various causes, it is worth reminding ourselves of the rather obvious point that the risk of death occurring at some point in our lifetimes is 100%. This isn't a risk we can mitigate. Something will get us all in the end, whether drink-related or not. By "increased risk of mortality" we assume the report must mean an increased risk that the thing that kills us is attributable, wholly or partly, to alcohol. This may happen early in life, or later. Most of the diseases referred to in the report are likely to occur later in life. There is no analysis of how much longer you are likely to live if you take up the semi-teetotal approach. Nor is the report saying anything as dramatic as that it is 15 times more likely that you'll die early if you drink 49 units rather than 14 units a week.
So what this all means is that if you drink about 50 units a week - over 3 times the recommended limit - it's estimated there is a 15% chance that what happens to be the cause of your death will be linked in some way to alcohol. That includes the risk of accidents - most of which will be avoidable for sensible grown-ups - and includes a number of diseases that have been linked to alcohol, but for which there is no proof, and which may very well have other causes. The figures look precise, but hide a certain amount of guesswork. All that can be said definitively is that the more you drink, the more likely it is that your death will be drink-related, which is no more than common sense.
There's no analysis of what risks any displacement activity may have, whether this might be some other drug, literal or metaphorical, that helps us relax, or anything else. For a lot of people this might mean spending more time slumped in front of the TV, watching rubbish. There may be no evidence yet that this speeds up the onset of dementia, but it can't be long coming.
Most of us who like a drink know that it's capable of damaging us. Our bodies tend to warn us when we're having too much. We accept that there are risks involved in any event. It's helpful to know what specific diseases have been proved to be caused by alcohol, and what the risks and consequences are of getting them. But the weekly recommended maximum is a bit of nonsense. It's the sort of thing that Governments feel they have to do. And once this limit is out there, it becomes one of those myriad pointless farcical things that regulates our lives.