Alcohol and cancer – again!

Barely a day goes by without some new “threat” to our health being announced by epidemiologists or other health campaigners. For these people, the meaning of life appears to be the elimination of anything enjoyable in order to achieve maximum longevity. Key to this is the elimination of “risk factors” from our diet and lifestyles. The key technique used to frighten us all into abstinence is to concentrate on cancer risks. Here an old trick is used – take a very small baseline risk and measure the increase to that risk that arises if you engage in “heavy” drinking. The effect of this is to give prominence and publicity to very large percentage increases in very small baseline risks.


The Alcohol Health Alliance (AHA) has taken to Twitter to publicise its message that alcohol = cancer = death. The Twitter headline reads: “Alcohol is linked with at least seven types of cancer” and then lists them on a handy infographic of the body as mouth and upper throat; larynx; oesophagus; breast; liver; and bowel cancers.


Of course, a “link” is not the same thing as a “cause” but they would like you to think it is. This scare-mongering is entirely consistent with a revision of the low-risk drinking guidelines on the basis there is “no safe level of consumption in respect of the epidemiological risk of developing cancers”, and “the cancer risks of drinking is a game-changer”. It is, of course, accepted that excessive consumption of alcohol is causally related to a small number of cancers – but the risk is dose-related.


Taking oral cancers as an example, what is the overall risk caused by drinking alcohol? According to Cancer Research UK, about 7,300 oral cancers are diagnosed in the UK a year. Of those, tobacco smoking was identified as the cause in 65% of cases. Alcohol consumption accounted for 30% of these –2,190 cases. In total, 30 million adults in the UK drink at least once a week. Of those, 2,190 of them develop an alcohol-related oral cancer – that is 0.007% of regular drinkers. And remember, these figures include very heavy drinkers as well as moderate and light drinkers – so don’t be panicked into abstention just yet.


Every such death is a tragedy but the actuarial risk is tiny. The proposition anything that raises the epidemiological risk of a cancer “isn’t safe” is therefore problematic. In everyday life people make trade-offs. They don’t ask “is this product or behaviour safe?” they ask “is it safe enough?” We do this all the time and not just in relation to food and drink. We don’t ask whether driving a motor vehicle is safe, we ask is it safe enough? In other words, do the benefits of driving justify me in taking the risks? When we are told tobacco-smoking results in the premature death of half of all smokers, that may deter people from starting or persuade existing smokers to quit. However, if you were told 0.021% of regular drinkers die from an oral cancer, would that put you off? It is this kind of epidemiological paranoia that leads health cranks to call for abstinence, and lowering of the lower-risk drinking guidelines is but a staging post on that journey.


However, what is missing from the AHA’s misleading messaging is any reference to the beneficial effects of moderate alcohol consumption. The life-prolonging effects of moderate alcohol consumption are on a firm scientific footing. Despite the AHA and its cronies’ science denial, Sir Richard Doll (the epidemiologist who discovered the link between tobacco smoking and cancer) has revealed there have been dozens of studies in the past 30 years that have vindicated the J-curve that illustrates the benefits of moderate drinking in terms of greater longevity for moderate drinkers compared with “never-drinkers”. If science indicates that alcohol conveys significant life advantages, why does the AHA act as though alcohol is evil?

LISTENING TO THE DRINKERS’ VOICE

Back in 2013 I discussed with industry trade bodies and leading drinks’ producers the possibility of starting a lobby group that would campaign against the constant litany of scare stories coming from the health lobby. Partly as a result of that discussion a group of drinks’ producers started the Alcohol Information Partnership (AIP) about 18 months’ ago. This organisation, headed-up by its Director General Dave Roberts, does a great job in answering the bogus statistics and one-sided research peddled by so-called ‘public health’.

The problem with AIP is that it is too easy for critics to dismiss it as the voice of Big Alcohol – which is manifestly true and AIP makes no bones about that fact. What has been missing from the alcohol-society debate is the authentic voice of the ordinary drinker. Until now.

A couple of weeks ago, a new organisation was launched called Drinkers’ Voice. This is a Campaign for Real Ale (CAMRA) initiative that aims to get the voice of the moderate drinking majority heard in this debate. CAMRA is in an ideal position to launch this initiative precisely because they are the biggest consumer group in Europe, are often highly critical of big brewers and cannot possibly be portrayed as drinks’ industry shills. The initiative has begun well and DV provided the media with a poll which highlighted that 70% of UK drinkers don’t take any notice of the CMOs revised drinking guidelines, because they’re not based on science and have no credibility with ordinary drinkers.

There have been articles on DV published in the Sun on Sunday, the Sunday Times and the Telegraph as well as a TV appearance by Amy O’Callaghan, DV’s spokesperson, on Sunday Live. DV will be a grassroots organisation with spokespeople in communities across the country who are passionate about their freedom of choice and their right to drink in a sociable and moderate way.

Creating a grassroots organisation of this kind is a bold move and CAMRA, and their chief executive Tim Page, are to be congratulated on taking the lead. To influence the wider alcohol policy debate we must influence the public opinion on which politicians’ ride. This is a fledgling organisation and it needs money. The decision has been made not to accept donations from the drinks’ industry, for obvious reasons. It is being crowd-funded by donation and if you would like to support Drinkers’ Voice as an individual you can donate via the following link:

https://drinkersvoice.org.uk/campaigns/donate/

This initiative is needed, and long overdue. Please get behind it. Further information about DV is available on their website www.drinkersvoice.org.uk

Drinkers' Voice

Back in 2013 I wrote a discussion paper titled “The Industry Perception – a Discussion”. In that paper, which I delivered to a group of trade body representatives and industry insiders, I made the following points – public and political perception of our industry is driven by individual experience of licensed premises, medical temperance campaigning, media distortion of issues and problems, and our failure to engage with the public in the alcohol and society debate.

And I indicated we were in this position because of a failure on two levels. Firstly, a failure to examine, analyse and deconstruct the medical temperance narrative, or to construct a counter-analysis regarding the causes of alcohol-related harms; and secondly a failure to recognise the serious nature of the resurgent temperance threat and lead a co-ordinated response to it.

The difficulty that others at the meeting pointed out to me is we, as an industry, are famously fragmented, so agreeing common positions on some of these issues was going to be difficult. There is no doubt since 2013 our trade bodies have recognised the serious threat posed by medical temperance and the constant litany of scare stories, dire warnings and phoney statistics that have accompanied their never-ending campaign to de-normalise the use of beverage alcohol. And there is now a coherent counter-narrative to medical temperance, which I have tried to play my own modest part in creating.

The difficulty in the past has been finding a suitable vehicle for expressing this narrative, particularly given the fact any drinks’ industry initiative would automatically be dissed as an attempt by “Big Alcohol” to promote its own agenda. What has been missing from the debate has been the voice of the ordinary drinker – until now.

Two weeks ago saw the launch of a new lobby group called Drinkers’ Voice. This is a Campaign for Real Ale (CAMRA) initiative designed to give the ordinary, moderate drinker a voice in the alcohol and society debate. CAMRA is in an ideal position to launch this initiative precisely because it is the biggest consumer group in Europe, is often highly critical of big brewers and cannot possibly be portrayed as drinks’ industry shills. The initiative has begun well and Drinkers’ Voice provided the media with a poll that highlighted 70% of UK drinkers don’t take any notice of the chief medical officer’s revised drinking guidelines, because they’re not based on science and have no credibility with ordinary drinkers.

There have been articles on Drinkers’ Voice published in the Sun on Sunday, the Sunday Times and the Telegraph as well as a television appearance by Amy O’Callaghan, Drinkers’ Voice’s spokesperson, on Sunday Live. Drinkers’ Voice will be a grassroots organisation with spokespeople in communities across the country that are passionate about their freedom of choice and their right to drink in a sociable and moderate way. As Drinkers’ Voice put it itself:

“We believe it is important that people understand the benefits of drinking alcohol as part of a healthy lifestyle. We want people to talk about how enjoying a drink with friends enhances their wellbeing, and how scientific evidence shows that moderate drinking can help heart and cognitive health.”

And then: “You’ll know that for too long this debate has been dominated by the anti-alcohol lobby, which has sought to de-normalise drinking and restrict people’s access to alcohol. As a result, we have seen the UK’s alcohol guidelines reduced last year without credible evidence to justify it. As the poll shows, this has widened the gap between government’s instruction and people who want to just enjoy a drink.”

Creating a grassroots organisation of this kind is a bold move and CAMRA, and its chief executive Tim Page, are to be congratulated on taking the lead. To influence the wider alcohol policy debate we must influence the public opinion on which politicians’ ride. This is a fledgling organisation and it needs money. The decision has been made not to accept donations from the drinks’ industry, for obvious reasons. It is being crowdfunded by donation and if you would like to support Drinkers’ Voice as an individual you can donate here.

This initiative is needed, and long overdue. Please get behind it. Further information about Drinkers’ Voice is available on its website.

ALCOHOL STATISTICS – A QUESTION OF CONTEXT AND REPORTING

The issue of alcohol-related harm and how it gets reported to the public is one that concerns me. We’re all very busy, so we tend to absorb headlines and not question the numbers or the conclusions based on them. That’s understandable when it comes to members of the public, but rather less so when applied to journalists writing stories. While the pursuit of a sensational headline may be what drives the tabloids, we ought to expect more from companies such as the Guardian and the Telegraph than the kind of lazy journalism we’ve seen recently.

What seems to drive so-called “public health” is the determination to relay simple messages repeatedly so they become “established fact” – things that “everybody knows”. The way in which they make claims about alcohol as a cause of cancer, and how that gets reported in the press is a case in point. The evidence of a link between drinking beverage alcohol and most cancers is extremely weak. Even where such a link has been established the numbers are usually vanishingly small. Here are some examples:

In England and Wales in 2014 there were 6,754 deaths from cancer of the oesophagus, of which just 26 – 0.4% – were recorded as having been caused by drinking alcohol. The biggest link between alcohol and cancer is in relation to liver cancer, but it is still extremely rare. There were 4,442 liver cancer deaths in 2014 of which 439 were alcohol-related – 9.9%. (Source: Office for National Statistics data).

The public often confuses alcohol-related liver cancer with alcoholic liver disease. The two are not the same. Alcoholic liver disease accounts for about 65% of deaths caused by excessive alcohol consumption. Contrary to what sensationalist headlines in the Guardian and the Telegraph said recently, in which it was claimed such deaths would “soar” in the next five years, the reality over the past five years is deaths from diseases caused by alcohol are stable. In 2011, there were 8,748 such deaths and in 2015, 8,758. The average is 8,597 per year. (Source: Office for National Statistics data).

If 65% of these deaths arise are from alcoholic liver disease, then that is about 5,588 deaths per year. Each of these deaths is an avoidable tragedy. But most of them were in men (65%); most were people aged 55 to 65 years old, and the average level of consumption was 200 units of alcohol per week – the equivalent of a bottle of scotch a day. So, the picture that emerges is one of a discrete group of alcoholics who are drinking vast quantities of alcohol over many years and dying prematurely. It is only when you understand these sorts of specifics you realise that whole population measures such as minimum pricing will not impact on the delinquent drinking behaviour of this minority of consumers.

Talking of delinquent behaviour – the latest drink-driving statistics have just been released. According to the Department for Transport (DfT) there were 1,170 serious injuries or fatalities in 2015 as a result of drink-driving. This is up from 1,070 in 2014 – an increase of 9.3%. But if you separate deaths from drink-driving from the combined figure they fell by 17% from 240 to 200. Confusingly the DfT defined the increase of 9.9% in the combined figure as statistically significant, but the decrease of 17% in fatalities as statistically insignificant, merely representing the “continuation of a period of stability”.

Predictably, campaigners are calling for a reduction in the drink-drive limit to bring England and Wales in line with Scotland, where the measure has had a devastating effect on pub businesses. The problem is not so much a dearth of accurate information, but the way in which lobby and research groups frame the dissemination of information and how it gets picked up and used in the media.

By Paul Chase

Compromise better than cliff edge in Brexit negotiations by Paul Chase

Will Brexit actually happen? New Liberal Democrat leader Sir Vince Cable doesn’t think so. Speaking on the Andrew Marr show, he said: “I’m beginning to think Brexit might not actually happen.” Tony Blair weighed in, expressing the view it would be stopped – and should be stopped. Are these opinions the wishful thinking of a bunch of “remoaners” or are they on to something?

Certainly in the cabinet there is a clear split between those around chancellor Philip Hammond who want a “soft Brexit” – putting the economy and jobs first – and those who want a “hard Brexit” and believe reducing immigration trumps all other issues. The issue of immigration control is one of huge significance for our sector because of our reliance on immigrant labour – and not just in London. Consider the following statistics:

– In the managed house sector, including pubs, bars, nightclubs and casual dining, 37% of the workforce are non-British nationals

– Across hospitality and tourism as a whole, 24% of the workforce is made up of non-British nationals, with 55% of those coming from outside the EU and where immigration controls are already in force, while 45% are from other EU countries where there are no restrictions on the right to work or live in the UK

– In London, non-British nationals make up 64% of the hospitality and tourism workforce, of which 46% come from other EU countries

I think there is a growing realisation among those who voted “leave” without knowing the destination that a hard Brexit would come at huge economic cost, and without a £350m-a-week bonus for the NHS.

What might a soft Brexit look like or might we decide, having glimpsed the destination, to stay in the EU after all? I think we will leave but it will be a gradual and nuanced affair. The talk of transitional arrangements, based on the difficulty of agreeing everything by March 2019, gives a steer regarding the direction of travel.

I suspect a transitional arrangement may look something like the “Norwegian model” – an “off-the-shelf” Brexit package based on the relationship Norway has with the EU. Its main elements are we would have tariff-free access to the single market for our goods and services but not be part of EU political institutions or subject to “ever closer union” or pressured into joining the single currency. We would not be part of the common agricultural policy or the common fisheries policy so would regain control of our territorial waters. We would still pay into the EU’s budget but probably about half the current rate. We would not be part of the Customs Union and therefore free to strike our own trade deals with the rest of the world.

What’s not to like? Crucially, the price to be paid for access to the single market would be more than just financial. We would have to abide by EU trade laws and be subject to European Court of Justice (ECJ) judgements; and we would have to agree to free movement of people – subject only to a temporary break clause in the event immigration was causing an acute social or economic problem. Being rule-takers but not rule-makers would mean we’d have no influence over how free trade within the single market might develop.

The points about the ECJ’s jurisdiction and free movement of people are the real sticking points. I suspect this will be sold to us as a transitional arrangement, with the final shape of the “leave deal” to be determined further down the line.

However, deadlines have a habit of slipping and one suspects a transitional arrangement scheduled to last two years could well be extended to three or four years, at which point the politicians would hope we’d all moved on and the transitional arrangement would quietly become permanent. This is shaping up to be that most British of arrangements – a compromise that satisfies neither side. However, it might just save our sector and others from an economic and recruitment cliff edge. Either way, I think a hard Brexit is dead unless the hardliners are bent on a strategy of keeping their hostage in Downing Street while trying to provoke a breakdown in negotiations and a walk-out of British officials from the talks. I, for one, favour a compromise rather than a cliff edge.

Illiberal anniversaries

We’ve just had the tenth anniversary of the ban on smoking in all enclosed public places, and much has been written about its effect on pubs. Also, in a couple of weeks’ time, the UK’s Supreme Court will consider the legality of the proposed introduction of minimum unit pricing (MUP) in Scotland. Here’s my take on both:

Firstly, as a lifelong non-smoker I personally much prefer smoke-free pubs. And if I were going to die in a ditch defending the right of individuals to make free choices, the right to set fire to a paper tube containing tobacco and inhale the smoke wouldn’t be my starting point. But it is nevertheless the case an awful lot of hypocrisy is attached to the reasons given for the smoking ban. This was never really about protecting people against second-hand smoke, and the statistical case for the ill-health effects of second-hand smoke was always pretty dubious in any event. This was about stopping people from smoking by criminalising their behaviour if they did so in certain circumstances. The alleged ill-health effects of second-hand smoke on the rest of us were never more than a fig leaf.

Has the smoking ban been bad for pubs? Most commentators agree it has. If they are correct then I am forced to conclude the ban was introduced on the basis of a false prospectus when the real reason for it was to force smokers to quit, and the impact that has had on the pub trade is regarded by anti-smokers as acceptable collateral damage. The fact the template for pursuing the smoking ban has now been replicated by those who are similarly opposed to alcohol leads me to suspect the two groups of people have much in common.

There was no decline in smoking after the smoking ban in 2007 and I would suggest the drop in smoking prevalence since 2012 is mostly attributable to vaping. The “public health” community is very divided on the issue of vaping because it finds it hard to accept a private sector solution to a public health problem – one that involves enabling people to enjoy nicotine in a safer way is preferable to simply banning something.

I think there are many reasons why pubs have closed over the past ten years – supermarket pricing, the shift towards home drinking and the growth of home entertainment, a fall in the number of young people who drink alcohol – to name but a few. Some have called for a review of the smoking ban and the reintroduction of ventilated smoking rooms in pubs. I think it would be a mistake to refight yesterday’s battles, particularly when there are plenty of battles we need to fight today. Reversing the smoking ban is a lost cause and we need to reserve our powder and shot for more immediate problems.

One such problem is the possibility of MUP being declared “legal” by the UK’s Supreme Court. The Court is due to consider this matter on 24-25 July, with a decision published probably in the autumn. I’ve written more on the subject of MUP than any other single issue, at least in part because its introduction has become such a totemic issue for the neo-temperance crackpots of so-called “public health”. I’m opposed to MUP because I believe it’s a bad policy that will penalise responsible drinkers, and will not impact on problem drinkers who are overwhelmingly located in in the moneyed middle classes, not because I think it is unlawful. If it turns out it does offend against EU competition law then as far as I’m concerned that would be very helpful.

A minimum price for a unit of alcohol was introduced in legislation passed by the Scottish Parliament in 2012. Since then it has been the subject of legal challenge by the Scotch Whisky Association and others who argue the measure acts as the equivalent of a quantitative restriction on EU trade, for example, by penalising efficient wine producers who are able to reflect their efficiencies in the price charged for their product. It would appear the European Court of Justice (ECJ), and indeed the Scottish courts accept this is the case, but argue for a “public health” exemption. The ECJ has stated it is ultimately for the domestic courts of any member state to decide whether MUP is a proportionate measure, the health benefits of which couldn’t be achieved by some other, less trade-restrictive measure, such as duty rises.

The Scottish inner Court of Sessions concluded it was a proportionate measure and it met the test set by the ECJ, and it is that decision that is now being appealed and the UK’s Supreme Court will rule on. My gut instinct is the appeal will fail and this will open the door for MUP in Scotland, where it is already law. Wales and Northern Ireland also want to introduce this measure and if they do it would be very difficult for England not to follow suit. I fear this is another anniversary we may be marking in the future, and not one that should be a cause for celebration by the trade.

AT WAR WITH THE MODERN WORLD

A report titled ‘Anytime, Anyplace, Anywhere’ was published in May this year by two neo-temperance research and lobby groups - the UK’s Institute of Alcohol Studies (IAS) and Australia’s Foundation for Alcohol Research and Education (FARE). If anyone was in any doubt that so-called ‘public health’ is a far-left socialist project opposed to consumer capitalism in all its forms, then take a look at this report and at the organisations that stand behind it.

The report is a comprehensive articulation of one of the three strands of neo-temperance, anti-alcohol strategy, namely, reducing the physical availability of beverage alcohol products – hence the title. The other two strands are affordability and advertising. IAS and FARE want to reduce all three as part of a whole population approach to alcohol harm reduction. I will give a detailed analysis of this report in Propel Quarterly, but here’s a taster:

The report comes up with 10 recommendations, all aimed at reducing alcohol consumption:

1.     Restrict trading hours for off-licence liquor.

2.     Restrict trading hours of on-licence venues to limit the availability of alcohol after midnight.

3.     Improve regulation of off-licence liquor sales by confining alcohol to specific areas within supermarkets to discourage impulse purchases and reduce alcohol sales.

4.     Enhance community involvement - provide residents with access to legal resources and advice to ensure that the community is able to engage with licensing systems.

5.     Clearly define licensing policy to minimise the cumulative harm associated with higher densities of liquor outlets.

6.     Place the onus on applicants to prove that their venue is in the public interest.

7.     Include and prioritise public health and/or harm minimisation objectives in liquor legislation.

8.     Enhance data sharing to facilitate more targeted policy interventions.

9.     Restrict the sale of high risk products in areas of concern.

10.  Deprioritise alcohol industry voluntary schemes.

Neo-temperance campaign groups like IAS and FARE believe that it’s the availability of alcohol that makes people drink it; that supply begets demand. The fact that such a proposition turns established economic theory on its head bothers them not one jot. You might think that the wish-list of a bunch or temperance cranks isn’t worth the effort of rebutting, but these are the same temperance cranks that hugely influenced the Chief Medical Officers’ of Health revised ‘low risk’ drinking guidelines. The IAS is very experienced at insinuating itself and its advocates into positions of influence.

They always play down their temperance aspirations and their broader ideology, but IAS is owned by a charity called Alliance House on whose board sits a variety of temperance organisations. Essentially the IAS is the research arm of the International Order of Good Templars (IOGT) and their offices are located at the same address in London. So, it’s worth looking at what IOGT believe if we are to understand the underlying motives of IAS.

IOGT believe that Big Alcohol is part of something they call the “corporate consumption complex”, which they define as: “an intricate web of organizations including the multination corporations manufacturing the goods of consumer capitalism, retail giants selling those products, trade associations doing the political lobbying as well as advertising and law firms supporting PR and political campaigns of these industries.”

And then this:

“Together with Big Tobacco, the food, pharmaceutical, firearms and automobile industries, the alcohol industry forms the so-called corporate consumption complex – a network of corporations, financial institutions, banks, trade associations, advertising, lobbying and legal firms that together promote “hyper consumption”.

“The corporate consumption complex has become the most powerful force to impact human health and the communities in which humans live. It is the primary modifiable cause of the biggest cause of premature mortality in the 21st century, Non-communicable diseases.”

So, there you have it - IAS and IOGT aren’t simply opposed to excessive consumption of alcohol and the health harms associated with that, they are opposed to the modern world! It’s all a conspiracy! They regard the pharmaceutical industry as part of this corporate consumption complex – as part of what causes non-communicable diseases. Have they heard of anti-biotics? And the automobile industry – get rid of cars! When you read through IOGT’s detailed analysis of what is wrong with modern society they are not just enemies of alcohol but are at odds with consumer capitalism – run by a bunch of bad-guys intent on putting profit before public health; apparently we all believe it is in our economic self-interest for our customers to die prematurely!

What is implied by their analysis is that the only way for us to live is to embrace a kind of woolly, agrarian communitarianism – back to the horse and cart, lots of brown rice and above all a life free of alcohol or any other intoxicant by means of which human beings might change their consciousness.

I think both our sector and government needs to be more aware of the ideology underpinning neo-temperance, and what it means for business and our society if these crackpots are successful in propagating their influence. Keep watching this space.

Paul Chase