Have we really wasted 25 years promoting alcohol guidelines?

7. January 2013 11:33

Decisions made by various royal colleges some twenty-five years ago are coming back to haunt them.

Alcohol guidelines that recommended a weekly limit of 21 units for men and 14 for women were “plucked out of the air”, a doctor involved in the decision later admitted. The guidelines were not based on scientific evidence but political expediency. The medical profession needed some hard numbers that could sell to policy-makers; numbers that were neither too low nor too high. They had to set a credible target.

And the guidelines have, until recently, been a great success to the extent they have been accepted not only by doctors and governments but by the drinks industry, which uses them in its educational materials.

But there is little evidence that they have been adopted by drinkers, which you would think is the best way to judge their effect. People generally know about the limits and understand the concept of a unit, but unfortunately alcohol doesn’t come by the unit but by the glass, bottle and can. Even in the on-trade, where strict measures are poured, the number of units in a ‘glass of wine’ can vary wildly according not only to the size of the glass by the strength of the wine, which can be between 8% and 15% ABV.

It is, of course, impossible to keep track of unit as Sir Liam Donaldson admitted in a special report on Radio 4’s ‘You and Yours’ programme last week. He claimed, “[it is] not an easy thing for people to hold in their minds when they are going out to a bar or the pub.”

Sir Donaldson was Chief Medical Officer for England for twelve years until he left his post in 2010. During the time he never, to his knowledge, questioned the validity of unit guidelines. He told ‘You and Yours’ host Dr Michael Mosley that revisiting alcohol units and addressing the issue “more scientifically” was “one of the things on my list I didn’t get round to”.

Now the current CMO, Dame Sally Davies, is getting around to it. There has been speculation that her review will simply lower the recommended limits. But it now seems more likely that the whole idea of units and weekly and daily guidelines will be scrapped. There were hints on ‘You and Yours’ that drinking advice is better tailored to the individual, which would be progress as long as it isn’t confined to genetic factors.

Meanwhile, it looks as though we’ve wasted a quarter of a century on a futile exercise.

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Shakespeare’s Local – and Yours

17. December 2012 11:50

As I sit here in front of the screen, wondering what to drivel on about this week, Tony ‘Baldric’ Robinson is reading BBC Radio 4’s Book of the Week. It’s Shakespeare’s Local; Beer Writer of the Year Pete Brown’s history of a single pub, the George Inn in Southwark.

Multi-tasker that I am, I’m also going through the morning’s typically seasonal headlines:

‘Thousands of People At Risk Through Christmas Drinking’
‘When Social Drinking Becomes a Problem’
‘“Families Like Mine Pay More for Food to Subsidise Binge Drinking,” says David Cameron’

Whether or not there actually are any other families are like David Cameron’s it makes for cheerless reading, especially against the background of Brown’s effervescent narrative.

I’ve read the first couple of chapters myself and it is madcap stuff. Brown is off the leash, scuttling here and there, delving into each and every nook and cranny that takes his fancy, veering off at tangents, shuttling backwards and forwards in time. It’s a style that evokes a bustling, busy inn with all its comings and goings, its quirks and colourful customers.

Eyebrows have been raised over the idea of writing a whole book about a single pub, but when you’ve got six centuries to cover there’s plenty to work on. The book is an extraordinary celebration of our drinking culture, and it’s great that it is on the wireless. It should make sure Shakepeare’s Local is wrapped up under plenty of trees this Christmas…

Taking a step back, though, it’s curious that we can be so enthusiastic about pubs and so depressing about the consequences of going out and having a drink. There is much more to pubs than drinking, of course, but alcohol remains an essential part of the experience. The George Inn would certainly not have survived as long without it. A similar contradiction is revealed too in the way politicians express their devotion to the pub, but end up doing precious little to support it.

It’s that time of year when you’re allowed to hope that things will change, but until it does I encourage you to support your local over the festive season - and into the New Year - as Shakespeare supported his. There are still plenty of great pubs out there.
 
Have a merry one!

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Purging the Dogmas of Drink

10. December 2012 15:46

There are times, when following the hyperbole around drink in the mainstream media, I have to wonder whether it’s really me who is going mad. So it was good to visit the oasis of sanity that is the British Sociological Association Alcohol Study Group symposium, which took place in London at the weekend.

I’m not a sociologist. I don’t wear nearly enough corduroy. But they let me in, as they let in a whole kaleidoscope of perspectives on drink.

Most alcohol conferences focus almost exclusively on the pathological, negative aspects. But while the darker side of drink is certainly not ignored, here it’s mixed with lots of other stuff, giving a genuine sense of the complexity of the subject.

On Saturday there were presentations on the problematic marketing strategies of brewers in Nigeria, and another on a tale of addiction and recovery as told by a former professional footballer.

There was a whole session devoted to women’s drinking that opened up a debate around how they negotiate the impossible demands on them when they go out on the razzle. It was brilliant antidote to the kind of moralising nonsense and titillating pictures you get in the likes of the Daily Mail.

Another interesting paper looked at how alcohol policy is interpreted, talked about and recycled by drinkers themselves – and the awkward gap between policy and actual cultural change. And, for something completely different, a couple of architects revealed their thinking about what makes J D Wetherspoon pubs so successful.

The final session focused on research itself, the difficulties encountered when trying to get people to talk about their problematic drinking, and the work of Alcohol Research UK, which plays an important role as a body independent of both the industry and the public health lobby.

Then we went for a curry.

It was all a refreshing contrast to narrow arguments about minimum pricing - supposedly ‘not a silver bullet’ - but to hear people talk; you’d think it the only alcohol policy in town.

The discussions were sharp and critical, but with the aim of clarifying the subject rather than shoring up the bastions around the position you’re defending and shooting down anyone who disagrees.

Of course, we have to come to conclusions at some point otherwise we’d just be academic observers. But gatherings like this are a necessary to purge the dogmas that pervade the alcohol field; we need more like this please!

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Misapprehending minimum pricing

3. December 2012 11:40

James Morris of Alcohol Research UK put his finger on it on Twitter. To paraphrase, he said that minimum unit pricing is widely misunderstood because people are trying to think of it as working on an individual level.

“Actually MUP is about a small effect across a larger number of people,” known in public health circles, he adds, as the “prevention paradox”.

What this means is that rather than targeting alcohol policy at people who have a drink problem you deliberately take measures that affect the behaviour of most, or all, of the population. You see the results not in the better health of a particular group of defined individuals, but in the statistical improvement in health across the whole population.

The theory accepts that the majority of people will modify their behaviour, will buy less booze, even if their health isn’t at risk. By some mysterious mechanism, however, overall harms will be reduced.

It’s not surprising that this isn’t well understood. It’s counter-intuitive to say the least. And for me proof rests not only in the stats but in a satisfactory explanation of how you got to those results. I’ve yet to be convinced by any narrative about how minimum pricing will work.

You can see this problem in the way that the case for MUP has been fundamentally reframed for the benefit of politicians and the public they have to persuade.

In the beginning, which wasn’t that long ago, minimum pricing got its first mention in the UK in an appendix to a 2007 report by SHAAP (Scottish Health Action on Alcohol Problems). This report is specifically concerned with population-wide measures.

When Chief Medical Officer, Liam Donaldson, called for a 50p minimum unit price in 2009, the idea was rejected by the Labour government. The feeling was that it would penalise the majority for the benefit of the few. This was exactly what it was supposed to do.

But the advocates for MUP blinked, and started arguing that it was a measure targeted at heavier drinkers (though the Sheffield University researchers who modelled the effects have had to concede that dependent drinkers will be less likely to cut down).

Now the present government is claiming that minimum pricing will principally reduce ‘binge-drinking’ among young people.

Whether it will or not we don’t really know, but it certainly isn’t what minimum unit pricing was conceived to achieve.

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NHS drinking quiz provides food for thought

26. November 2012 09:01

To show a bit of willing in Alcohol Awareness Week, I took the NHS online myth-buster test, a true-or-false kind of quiz about misconceptions around drinking.

I only got two wrong. One was the fact that alcohol reduces the possibility of conception. I was foolishly factoring in the increased likelihood of intercourse. The other I reckon I’m right about, and the NHS has got it wrong.

It’s about whether eating before drinking makes you less likely to get drunk. I know you can’t always trust your own individual experience but in this case I’ve built up so much evidence over 40 years of going to the pub (including under-age, before you get your calculator out) that, well, it’s surely incontrovertible.

Scraping together the scraps of medical science I’ve picked up, I reasoned that food in the gut slows the absorption of alcohol through the stomach wall into the bloodstream, meaning that, as it’s metabolised out, at any one moment there’s less alcohol in your blood and you are, by an objective definition, less drunk.

But I still felt on shaky ground. How could I possibly know more than the NHS? Then a drugs and alcohol researcher I know tweeted me a link to a study he’d been involved in (as a human guinea-pig) which confirms that if you eat before you drink your performance impairment is significantly reduced. In other words, you’re less drunk.

As the NHS warns, if you drink enough, you’ll still get drunk. I don’t dispute it. But I know that if I drink, say, four pints on an empty stomach I’m going to feel quite squiffy. If I eat, most times I’ll feel OK, I’ve still had a good time, and my chances of falling under a bus are reduced.

That has to be a good thing. It’s practical harm reduction and we should be encouraging people to eat – which the NHS, to its credit, does in a footnote.

And changes in the pub industry mean that people are more likely to take solids on a night out. I remember when few pubs served food in the evenings. Now menus are designed so you can quite easily snack or dine to help you manage the effects of your drinking.

What the NHS is scared about is weakening the message that people should drink less. That’s true for some, but for most of us responsible drinking is a matter of reducing harm, not consumption.

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Alcohol Awareness Week: It’s time to talk about stigma

19. November 2012 11:36

Alcohol Awareness Week is underway, and this year’s theme is ‘It’s time to talk about drinking’. Do they mean me? Somehow I don’t think so. I never stop talking about it, writing about it, thinking about it. Now and then I even get a chance to drink the stuff.

I also rather suspect that most people talk about drinking quite a lot. Drinking is, after all, woven into the social fabric of our lives. What Alcohol Concern, which launched Alcohol Awareness Week last year, means is that it would like us to talk about drinking in certain ways, in:

“… conversations about the health risks, social problems, stigmas and taboos associated with talking about the dangers of alcohol.”

If there is a taboo about talking about the dangers of alcohol, it’s clearly one that Alcohol Concern has managed to wriggle out of. As have politicians of every stripe. Not to mention the mass media. It’s almost like the reverse of a taboo. It seems compulsory to mention it at every available opportunity.

It’s a gloomy subject, but my guess is that it crops up in pub chat, too, more than it used to, thanks to it being in the news so much. And I don’t just mean my pub chat. People don’t say, “oh here comes Phil, better think up something to say about the application of alcohol attributable fractions to liver disease”. At least I hope not.

But, dare I say it, Alcohol Concern does have a point. It’s hard for people with an alcohol problem to talk about it to their mates. It’s hard for them to turn down a drink. They don’t feel part of the crowd. There might even be something shameful about it.

For many, the easy way out is to not to go to the pub. But that would be a mistake. It only isolates them more.

This stigma is a major worry for drug and alcohol workers. It blocks the conversations and possible treatments that can help people with a problem.

When it comes to illicit drugs, of course, it’s worse because what they’re doing is deemed illegal. But it certainly exists for alcohol – and the sensational demonising of drink by politicians, the media, the medical profession and groups like Alcohol Concern risk deepening that stigma, making it harder, rather than easier, for people to talk.

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The evolution of the bouncer

12. November 2012 09:08

Nice to know that Tracy Bird, licensee of the Newman Arms in London’s West End, is liking her new door supervisor.

Bird, you might remember, had a recent run-in with Westminster Council over being made to serve customers more slowly and close her famous pie restaurant at weekends.

Westminster has backed down on those two, but the third requirement, to employ door staff, has stuck.

In fact, it’s brought positive benefits to the pub. Its reduced thefts and helped staff to keep order, by removing drunks, for instance. Some think the law against serving intoxicated customers is a dead letter, but any good licensee will want to remove them with a minimum of fuss.

The pub industry has changed a lot over the last decade, and the evolution of the bouncer into the door supervisor has been a largely unsung example of progress.

Of course, it would be lovely if pubs and bars didn’t need to have someone on the door. Bird herself was extremely reluctant to employ someone, understandably fearing it would undermine the traditional pub atmosphere of the Newman Arms.

Part of the reason for her initial aversion surely goes back to the old image of bouncers as underworld heavies who caused more trouble than they prevented. But in 2003 the regulation and certification of door staff by the Security Industry Authority transformed the situation.

The badge that new-age bouncers wear on their arms show they’re professionals who aren’t going to rough you up or sell you drugs. They might even have people skills. The old euphemism of ‘greeter’ now has a grain of truth to it.

So it was good news when the government decided not to chuck the SIA onto the ‘bonfire of the quangos’ as it originally intended. And qualifications for door staff have now been expanded to include physical intervention training.

That was a controversial area at one time, but the argument has been won that, realistically, the need for physical force is going to come up from time to time, and a professional door supervisor should know when and how it’s appropriate to use it.

So that’s all good. Except that I read the other day that the government is still aiming to phase out the SIA in its current form by this time next year and will launch a consultation shortly.

Worryingly, deregulation remains on the cards. And with it the possibility that all this good progress will be reversed. If we’re not careful, the bouncer could be bouncing back.

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They think it’s all over… but the beer duty debate was a hollow victory

5. November 2012 11:37

Watching the beer duty debate in Parliament last week was like going to a football match where only one of the teams had turned up. As Andrew Griffiths led his team opposing the duty escalator onto the pitch, somewhere down the motorway MPs who were in favour were playing whist in a broken-down coach.

It wasn’t a complete waste of time. There was some entertaining play on both political wings and it was a useful training exercise as all the arguments against the escalator were honed and finessed. The crowd on Twitter went wild.

There was a nervous moment when a spectator ran onto the pitch and tried to dribble the ball in the direction of Scotch whisky. But the referee, deputy speaker Dawn Primarolo, called him offside and sent him back to the stands.

Still, Griffiths’ side failed to score the goal they wanted – a review of the escalator. Somehow the opposition goalkeeper managed to get there, and after watching the three-hour build-up from between the posts Sajid Javid simply picked up the ball and took it home.

That’s democracy, I suppose. But it would be mean to say that nothing was achieved. Especially after the magnificent effort to get 100,000 signatures on the petition that forced the backbench debate.

The arguments made around the importance of pubs were particularly strong, and Javid said he’d “make sure the government does more to help the industry”. Although we’ve heard before how much they love pubs and all we get are Early Morning Restriction Orders and Late-Night Levys.

As for the punishing beer duty escalator, it looks like the government is happy to let it keep running, each year adding inflation plus 2% to tax. There is the deficit to worry about, of course, even though a shrinking beer market is cancelling out the gains to the Treasury.

And lurking behind the debate is the public health lobby. The inflation of alcohol’s cost to society makes drink an easy target for taxation. There is a good case to be made in favour of beer and pubs as positive contributions to responsible consumption, and that case was well made in Parliament last week. Yet not a single health minister was there to contradict it.

You might deduce from that they don’t have an argument. Or, more likely, they have no intention of changing their minds, fearful of the ‘wrong messages’ any curb on duty might send out.

But if they don’t turn up they can’t be challenged. Beware hollow victories.

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The trouble with Facebook, and the beauty of the pub

29. October 2012 15:13

I hate Facebook. Yet again I find myself threatening to leave it. I’m not sure exactly who I’m directing the threat at. Mark Zuckerberg probably wouldn’t know who I was if I walked up and punched him on the nose. Although that would be fun to try.

I hate Facebook for a whole number of reasons. The crappy design. The way it’s so hard to get it to do what you want it to do. The way it does things you don’t want it to do. Most of all, though, it’s the way it changes how people behave in each other’s – virtual - company.

I’ve been struggling to put my finger on it, but when people talk on Facebook it’s like they’re having a pub conversation without the conditions a pub creates that makes that conversation OK.

There’s an old saying about politics and religion being the only things you can’t talk about down the pub. This is completely wrong. The beauty of the pub is that you have the licence to talk about these subjects without the kind of comeback you might experience in other places.

A kind of social policing goes on among mates at the bar. If you’re getting out of order, overstepping a certain mark, someone will subtly steer you away from the danger or change the subject. It’s all quickly forgotten.

On Facebook, people will say the kind of things they might say down the pub but the effect is different. Facebook mimics the ephemeral lightness of pub chatter but because it’s written it’s taken more seriously and studied as an exact representation of that person’s beliefs and opinions. There’s no scope for irony or laughing something off. That’s what emoticons are for, of course, but they’re easy to miss.

Don’t get me wrong. I think social media’s great. I’m addicted to Twitter and find, for the most part, people on there are nice and polite and think before they tweet, as the recommendation goes. Probably the 140-character limit helps there.

Nor do I believe that social media is a substitute for going to the pub. More often than not it makes people want to carry on the conversation in the ‘real’ and can be the place that arrangements are made for a pub visit. Certainly go-ahead pubs have recognised social media’s potential for talking to their customers beyond the saloon bar walls and bonding their loyalty.

But for me, Facebook’s just not worth the hassle. I’ll see you down the pub.

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Job done on pubco-tenant relations? That takes the BISC-uit

22. October 2012 10:53

Does our government really care about pubs? It has certainly ramped up the rhetoric over the last few years, and as far as alcohol policy goes there has been a distinct shift in attention away from the on-trade and towards supermarkets. But sometimes you have to wonder.

Last week, pub trade weekly the Publican’s Morning Advertiser put in a routine request for an interview with Jo Swinson MP, the new minister responsible for the inquiry into the relationships between pub companies and their tenants. It was turned down on the grounds that the commitments made on the industry side have been “achieved”.

This makes no sense whatsoever. If the Business, Innovation & Skills Committee really had achieved its aims you’d think the government would be hammering on the door of the PMA, eager to talk about a historic breakthrough in self-regulation.

In reality, of course, we’ve a long way to go before everything in the beer garden is rosy.
Even then it would be nice to hear the minister’s views on what progress she thinks the past eight years of probing have achieved. She could have pointed to evidence that the pubcos are making more of an effort, though I’m not sure exactly how much of this can be credited to BISC.

It is commercial realities that have forced the over-weight pubcos to slim down and offer prospective tenants more flexible deals. The successive codes of practice that have come out of the BISC negotiations have indeed made it more difficult for them to put unsuitable people into their pubs – though they probably see that it makes commercial sense, too.

These are signs that the business model that got us into this mess is breaking down. Hopefully, the process will leave us with a healthier, if smaller, pub trade in which there is a fairer deal for tenants. But it would be foolish to declare the job done and stop worrying about it, which is exactly what the government seems to be doing.

I notice that Swinson’s brief covers employment relations, consumer and postal affairs and women and inequalities. With all that to do it’s hardly surprising she’s failed to get to grips with the complexities of the pub industry. (Where does it fall? Employment relations? Inequalities?) Goodness knows, I’ve been writing about it for nearly 30 years and I struggle to keep on top of it.

Meanwhile, the industry itself is probably pleased that it’s being left alone to get on with it, but at the same time suspicious that it’s because the government just doesn’t care. And nobody likes to be ignored.

 

 

 

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About the author

Phil Mellows

Phil Mellows is a freelance journalist and writer specialising in the UK pub industry and alcohol policy. For more information, and the Politics of Drinking blog, go to www.philmellows.com
You can also follow Phil on Twitter at www.twitter.com/philmellows

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