MEDIA-DRIVEN MORAL PANICS

Cancer = Death. And sooner rather than later, or at least that’s the public’s perception. So any link between alcohol and cancer implies precisely that equation and is therefore guaranteed to generate headlines. So last week headlines in the I-online and Guardian newspapers that screamed “Alcohol directly causes seven kinds of cancer, says study”, and “Proof: drinking alcohol causes cancer” were designed to alarm public opinion and to feed into the ongoing ‘public health’ narrative that “there is no safe level of alcohol consumption”.

So, presumably, in order to justify these headlines there must be some new weighty piece of research that’s been published, or perhaps a meta-analysis of numerous other peoples’ research that give us, finally, irrefutable proof of this claim. But actually nothing of the sort! What the newspapers were referring to was an opinion piece by an academic named Jennie Connor, who works at the University of Otago, New Zealand, and that was published in the Journal ‘Addiction’. It consists of just over 3,700 words plus references.

Without wishing to be overly pedantic, it is not ‘alcohol’ but the drinking of alcohol, mostly in copious quantities, that causes a number of different cancers and there is nothing new in this claim nor is it, for the most part, disputed. The issue here is about which alcohol-related cancers require the drinker to really work at it by drinking to excess and which can be triggered by relatively low levels of consumption. The alcohol mortality statistics for England show that over 80 per cent of deaths from diseases caused by alcohol consumption are deaths from alcoholic liver disease (4,333 in 2014) and liver fibrosis/cirrhosis (1,520 in 2014). Bear in mind that some 28 million people in England drink alcohol on a weekly basis, so these drinkers are at the extreme end of consumption – often drinking in excess of a bottle of Scotch a day for many years.

The claim made in the article by Jennie Connor is that alcohol-attributable cancers make up 5.8 per cent of all cancer deaths worldwide. But if you look at the alcohol mortality statistics for England you will not find any recorded deaths from lip, oral cavity and pharynx cancer, oesophageal cancer, colorectal cancer or cancer of the larynx. As I said above, alcohol-related deaths are mostly caused by alcoholic liver disease or liver fibrosis/cirrhosis.  Curiously, there is no reference to deaths from alcohol-related breast cancer in the official figures, but studies estimate that about 94% of breast cancers are linked to causes other than alcohol, so separating out alcohol-related breast cancer let alone those cases that result in death is extremely speculative.

And this is the crux of the matter: at what point can we say that a statistical association between alcohol consumption and a disease becomes sufficiently well established to conclude that the relationship is causal? For what it’s worth, I think that Jennie Connor’s claim that the statistical association is strong enough for us to conclude that alcohol consumption causes cancers at seven sites is probably correct (oropharynx, larynx, oesophagus, liver, colon, rectum and female breast). But with the exception of the liver and a tiny minority of breast cancers these cancers are rare and rarely result in death.

The link between alcohol consumption and some rare cancers needs to be balanced by an appreciation of the clear proof that there are overall health protective effects from light to moderate drinking, particularly in relation to heart disease and stroke. I am of course talking here of the famous j-shaped curve that shows that regular, moderate drinkers live on average longer lives than either heavy drinkers or ‘never drinkers’, and are less likely than never drinkers to die of heart disease or a cancer. Jennie Connor, in her article, casts doubt on that hypothesis and space prevents me from going into detail on that, although I have done so in previous articles. Her scepticism of the j-curve hypothesis rather spoils what is otherwise a rational article that largely avoids bias.

My main criticism is of the media. Even supposedly ‘high-brow’ newspapers like the Independent and the Guardian cannot resist the temptation to get a wowser headline  by bigging-up an article that contains nothing new into a ‘study’, when it isn’t. This is how moral panics are started and sustained by a public media that creates and perpetuates myths which get repeated so often they become “well-known facts”. Are the media behaving cynically? Do they know they’re doing this? I am left with the thought that a man who tells a lie is merely hiding the truth; a man who tells a lie so often he’s convinced himself has forgotten where he’s put it.

BALANCING THE PICTURE

It’s that time of year again when the latest statistics on alcohol and health are published and the usual attempts are made, by the usual suspects, to misinterpret them to keep the moral panic on alcohol going. The figure that made the newspaper headlines were of the “More than a million alcohol-related hospital admissions in 2015” variety. This particular statistic – it is 1.09 million to be precise – is actually the number of hospital admissions in England where the patient being admitted had a medical condition that was or might be related to alcohol, regardless of whether the diagnosis that led to admission was alcohol-related or not.

This 1.1 million figure (which, with little variation is quoted every year) is the most hotly contested alcohol statistic ever produced! It is actually a measure of the prevalence of alcohol-related medical conditions of all people admitted to hospital in a given year, regardless of whether the reason they were admitted in the first place was alcohol-related. The purpose of collecting alcohol disease statistics on all in-patients was to give the NHS a means of planning resources; to understand what alcohol-related illnesses might be coming down the pipeline, it was never intended to be represented as being a “count” of the number of hospital admissions related to alcohol, and to quote it as such, as much of the media and politicians consistently do, is a gross misrepresentation.

The truth about hospital admissions, where the primary or secondary diagnosis leading to admission is an alcohol-related condition, or has an alcohol-related external cause, is buried in the official HSCIC figures and is as follows:

	2013/14	2014/15	DIFFERENCE
Narrow Measure*:	152,120	144,270	-7,850
Broad measure**:	322,030	319,090	-2,940

* Narrow Measure: alcohol-related admissions where the primary diagnosis was for a condition wholly or partly attributable to alcohol.   

** Broad measure: alcohol-related admissions where the primary or secondary diagnosis was wholly or partly attributable to alcohol. 

It’s important to recognise that the numbers in the table above represent the number of alcohol-related hospital admission episodes, not the number of people admitted to hospital because of alcohol. Which brings me to ‘frequent flyers’. We know from Parliamentary answers that 54% of those admitted had been admitted two or three times in the year; and that 26% had been admitted four or more times. So how many people generated these alcohol-related hospital admissions? Let’s take the 2014/15 figures as an illustration:

Using the ‘broad measure’ we can see that there were 319,090 alcohol-related admissions in England in 2014/15, where the primary or secondary diagnosis was for an illness wholly or partly attributable to alcohol, or where there was an alcohol-related ‘external cause’ – such as an injury received during a drunken fight. If 54% of these admissions were of people admitted two or three times, then that equates to 86,154 people. If 26% of them were of people admitted four or five times then that equates to 20,740 people. Which leaves 63,819 people who were admitted only once. Add the three numbers up and it turns out that these 319,090 hospital admission episodes were generated by 170,713 people.

There are 1,880 hospitals in England which have an A&E department and where people can be admitted for overnight stays. Clearly alcohol-related hospital admissions will not be distributed evenly between them, but if we divide 319,090 admissions by 1,880 hospitals that is an average of around 170 admissions per hospital, per year – just over three a week – and these admissions are generated by just 90 people per hospital, per year or 1.7 people per hospital, per week.

How often do we read or hear it said that the burden of alcohol-related admissions will “bankrupt the NHS”? And yet the NHS as a whole deals with over a million patients every 36 hours! It is utterly disingenuous for the media and politicians to spout scaremongering statistics that grossly exaggerate the impact of alcohol on the NHS. For the health lobby this kind of statistical shenanigans is so ingrained that I doubt they even know they are doing it anymore. 

Paul Chase

AND NOW FOR SOMETHING COMPLETELY DIFFERENT!

In the wake of the EU referendum result, and the momentous political events that have followed over the past week, it seems almost banal to return to everyday stuff. I watched the results of the referendum over the course of the night and into the early hours – sleeping fitfully, but returning to the TV screen to see the unfolding picture. For me as a ‘remainer’ the nightmare was happening whilst I was awake! But the decision is made and I don’t intend to rehearse the issues of the campaign (you’ll be glad to hear). But I feel that more has changed than just our relationship with the EU.

I find myself returning to everyday normality, but with a strong Pythonesque sense of the surreal. Take the issue of minimum unit pricing (MUP): Readers may recall that the European Court of Justice (ECJ) published a judgment on this measure in December 2015. They kicked the decision back to the Scottish courts on the basis that MUP did break EU free movement of goods regulations, and taxation might be a better way for the Scottish government to achieve its health goals in relation to alcohol. The Scottish government now has to convince the Scottish Court of Sessions that there is no measure they could take that would be less trade-restrictive than MUP and which could achieve the same results. And of course the boys and girls from Sheffield University were on hand with a new mathematical model.

What strikes me as surreal is that in a couple of years’ time the UK will no longer be a member of the EU and therefore not covered by the jurisdiction of the ECJ. Except that Nicola Sturgeon would like, somehow, for Scotland to remain in the EU, even in advance of another Scottish independence referendum. But the UK is in until it is out – and both sides in the MUP case have stated they will appeal the Scottish court’s decision to the Supreme Court in London, should they lose. 

Will any of this matter in a couple of years’ time? We will have left and therefore Scotland can impose MUP if they want to and the EU won’t be able to do anything about it, right? Well, not quite. If Scotland, outside the EU, introduces MUP then the ECJ won’t be able to act, but the EU will be able to impose trade sanctions on, for example, exports of Scotch Whisky. Maybe a quota system, or a 15% surcharge. Of course we will have “got our sovereignty back” and we will “no longer be subject to the dictats of a foreign court” so that’s alright then. People should reflect on which is preferable: an orderly judicial process or a trade war – echoes of gunboat diplomacy and the whiff of cordite – we don’t have Lord Palmerston any more, but we do have, er…Boris. Oh, but we don’t – he’s just bottled it and declared he’s not standing for leader. He who wields the knife rarely wins the crown!

Another unwelcome development earlier this year was the publication of the new low-risk Alcohol Guidelines. The Guidelines proposed an upper limit of 14 units of alcohol a week for both men and women and a new mantra: “There is no safe level of alcohol consumption”. On Tuesday the 28^th June Byron Davies, Conservative MP for Gower, secured a debate in Westminster Hall on the alcohol consumption guidelines. The minister, Jane Ellison and her Labour counterpart Diane Abbott were both present and summed up the government’s and the opposition’s viewpoint respectively.

Byron Davies made an excellent speech, criticising the unrealistic level of ‘low-risk’ consumption; the way that decades of science that proved the health-protective effects of low and moderate consumption had been ignored by the Review; and the disproportionate influence of members of the temperance movement whose members served on the advisory committee that drew up the Guidelines. All good stuff.

But again, I found this more than a little surreal. Diane Abbott gave a speech in which she banged on about cancer and alcohol-related ill-health, completely missing the point of the whole debate. As far as she was concerned alcohol was A Bad Thing, and anything that was intended to reduce consumption was therefore A Good Thing. This prompted Andrew Griffiths MP for Burton to comment “Your speech is ridiculous.” But perhaps Diane Abbott had other things on her mind - like the disintegration of the  Shadow Cabinet and the coup underway against Jeremy Corbyn. It amazes me that in the wake of the political earthquake taking place in both the main political parties, Abbott can still find the energy for an anti-alcohol rant. 

I said at the beginning of this article that I thought something more had changed than just our relationship with the EU. I respect the considered views of those who want to leave, but I can’t help but feel that the whole tone of the debate has exposed a dark side to our political discourse. The upsurge of hate crimes comes to mind. Michael Gove commented on what experts had said about the economic consequences of Brexit:  “I think the country’s had enough of experts.” Perhaps he could give us an example of where anti-intellectualism has ever led to anything other than bigotry. Introducing the politics of identity into the Brexit debate was playing with fire. Fear of foreigners and an upsurge of racism have somehow slithered onto the agenda.

Perhaps the way to restore some sense of normality and stability is to retreat into the small stuff; the everyday stuff. I fear that prospect might be some way off.