Alcohol Consumption Guidelines

Debate between Alistair Carmichael and Lord Davies of Gower

Tuesday 28th June 2016 Westminster Hall

[Byron Davies]

I am grateful for that guidance, Sir Alan. The proposed new guidelines do not reflect the full international evidence base on alcohol and health, and actively downplay decades of epidemiological evidence that shows the protective effects of low to moderate drinking against cardiovascular disease, stroke, type 2 diabetes and cognitive—

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

Will the hon. Gentleman give way?

[Byron Davies]

If the right hon. Gentleman will forgive me, I really need to move on.

To quote a no less august body than the Harvard T.H. Chan School of Public Health in the United States:

“More than 100 prospective studies show an inverse association between moderate drinking and risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes. The effect is fairly consistent, corresponding to a 25 percent to 40 percent reduction in risk.”

The US Government’s National Institute on Alcohol Abuse and Alcoholism supports that position.

One crucial point is not scientific, but about responsibility. I am a proud Conservative. Therefore, like most sensible people, I believe that, by and large, people can make their own decisions about their lives. I am not advocating that people go out and smoke 100 cigarettes, drink heavily, eat mountains of butter or consume mounds of sugar. However, if people want to enjoy the company of their friends with a fine pint of British beer that has been brewed using British ingredients following a fine art that has been honed carefully over our history, who are we to stop them? The medical advice I have listed remains clear indeed.

Curtis Ellison is professor of medicine and public health at Boston University School of Medicine, and director of the International Scientific Forum on Alcohol Research. He says:

“Statements suggesting abstinence is better than light drinking in terms of health and mortality are erroneous and do not reflect current scientific literature, with well-conducted studies showing that mortality is lower for light-to-moderate drinkers than for lifetime abstainers.”

As a nation, we have always believed in the fundamental good sense of the British people and, although my confidence was shaken by last week’s events, we have allowed people to decide what is best for their own lives. The pub is a crucial part of the social and cultural fabric of the UK. There are few things that are as crucial a part of our identity and history as the casual, relaxed pub culture that Britain has enjoyed over hundreds of years. Indeed, the importance of the pub—casual and social drinking—to people’s mental and physical wellbeing is marked.

The Oxford University and CAMRA-instigated report, “Friends on Tap” acknowledges the benefits of pubs to wellbeing. By telling people there is no safe level of drinking, we could be denying millions the positive social effects of going to the pub and the positive effects on the community. The results from the pub surveys suggest that people who go to small community pubs have more close friends and feel that their communities are better integrated. Indeed, small community pubs are now vital in supporting community services.

Pub is The Hub has supported many pubs across the length and breadth of the UK to stay open, become community owned and offer vital services. The services on offer include internet lessons and provisions, restaurants, post offices and shops. The pubs have been transformed into a social hub and are providing services that are vital to communities’ very survival. I fear that alarmist advice threatens not only pubs but the threads with which our communities are weaved together.

To further support my case, the findings of Oxford University suggest that pubs in general, and local community pubs in particular, may have unseen social benefits. Pubs provide us with a venue in which we can serendipitously meet new and, in many cases, like-minded people. They offer an opportunity to broaden our network of acquaintances, which has advantages. There is a potential to translate acquaintances into new friendships and to widen our contact with a greater diversity of cultural groups by bringing us into contact with people from other walks of life and other cultures, whom one might never otherwise meet.

Pubs allow us to engage in conversation with, and get to know better, other members of our local communities. By extension, they allow us to mix, meet a wider range of community members, and interact with a greater diversity of social classes and cultures than would otherwise be the case if our social world was confined to work and home.

Closer to home and on the benefits of moderate alcohol consumption, Dr Richard Harding was a member of the Government’s 1995 inter-departmental working group on sensible drinking. In written evidence submitted to the Science and Technology Committee in 2012, he outlined the changes in available evidence since 1995, including the strengthening of the evidence base around the range of health benefits of moderate alcohol consumption. He said that the key findings are:

“Clear evidence that the frequency of drinking is as important as, or even more important than, the amount of alcohol consumed. All epidemiological studies show that the more frequent drinkers, including daily drinkers, have lower risks for many diseases than do individuals reporting less frequent drinking… Firmer evidence for the protective effect of moderate alcohol consumption for coronary heart disease, as well as further clarification of the mechanisms for the protective effect…Evidence for an approximately 30% reduction in risk for type 2 diabetes for moderate drinkers…Evidence that moderate drinkers have less osteoporosis and a lower risk of fractures in the elderly compared to abstainers…Evidence that light to moderate drinking is associated with a significantly reduced risk of dementia in older people…Increasing evidence that moderate drinking should be considered as an important constituent of a ‘healthy lifestyle’”.

Dr Alexander Jones of the University College London Institute of Cardiovascular Science says:

“There have been a couple of studies which showed that if they were randomised to either just eating a Mediterranean diet or eating a Mediterranean diet and drinking a glass of red wine a night, that those who drank a glass of red wine a night had better cardiac function over time.”

That international consensus is rejected at a stroke by the CMO’s proposed new guidelines in favour of a “no safe limits” narrative. The statement of no safe levels sends out confusing and contradictory messages to consumers and will serve only to generate public mistrust in the health service.

David Shaw, senior researcher at the Institute for Biomedical Ethics at the University of Basel says that

“the ‘no amount is safe’ message undermines the new recommended limit for men and the retention of the limit for women. Why should people attempt to adhere to the new limits rather than the old ones if they are also being told that the new recommended levels are not safe? Giving such a mixed message further increases the likelihood that the guidelines will not be taken seriously.”

Dr Augusto Di Castelnuovo, professor of statistics and epidemiology at the Institute for Cancer Research in Italy says:

“The new recommendation that there is no ‘safe’ alcohol limit is misleading: low to moderate consumption up to one-two units a day in women, up to two-three in men of any type of alcohol—with the possible exception of spirits—significantly reduces the risk of cardiovascular disease. Moderate drinking is associated with a modest excess risk of oral and pharyngeal, oesoph”—

I will forget that word—

“and breast cancers. But the balance between these two different effects is in favour of drinking in moderation.”

As well as concerns about the language of “no safe level”, considerable concern has been expressed about the communication to consumers of the level of risk associated with alcohol consumption. It is really important that we put risks in context so that consumers can make informed choices.

Ignorance of the international evidence has been heavily criticised by the Royal Statistical Society. In the key points in its response to the consultation, it states:

“We are concerned that, in their recent communications about alcohol guidelines, the Department of Health did not properly reflect the statistical evidence provided to the Expert Guideline Group, and this could lead to both a loss of reputation and reduced public trust in future health guidance…We are concerned that scepticism concerning the guideline process might apply to future pronouncements concerning arguably much greater health risks associated with inactivity, poor diet and obesity that, unlike alcohol consumption, are increasing problems. Once public trust has been lost, it is extremely difficult to win back, and you will have lost a key tool in managing future behavioural change.”

Those key points are on not just alcohol consumption but how we will view future medical advice from the Department of Health. The public must have confidence in our great institutions and be of the belief that they are serious and sober in their analysis while also realistic about people’s life choices and lifestyles.

We have worked so hard as a nation, with industry and Government working hand in hand to reduce serious problem drinking. Do not misunderstand me: I know there is some way to go on this matter and I am fully supportive of the efforts to curb problem drinking and tackle its health effects, but we must not remove industry from this process and we cannot let serious medical advice be tainted by alarmist and prescriptive guidelines that threaten to undermine the whole process we have embarked on.

Let me turn to the new CMO 14-unit weekly prescription for men and women, which would effectively make 2.5 million more of our male constituents problem drinkers overnight, classed as increasing risk from low risk by virtue of the fact that they might drink more than one pint a night in the pub. Immediately following this announcement, we saw The Guardian’s front page article asserting that as we now have in excess of 10.5 million people “drinking harmfully”, further regulatory interventions were needed. That was backed up by members of the Guidelines Development Group, including the chief executive of the Institute of Alcohol Studies. Job done—they moved the goalposts and scored straight away. But the established international precedent in 30 countries worldwide is that men and women are set different guidelines reflecting differences in alcohol metabolism due to body size and weight as well as the lower body water content and higher body fat content of women. Aside from the UK, there are only five other countries that recommend the same guidelines for men and women: Australia, the Netherlands, Albania, Guyana and Grenada.

Dr Erik Skovenborg from the Scandinavian Medical Alcohol Board and board member at the European Foundation for Alcohol Research said:

“I am surprised to see the same limits for weekly alcohol consumption for men and women, in spite of the well-established greater susceptibility of women. The danger is that the new guidelines will give women the false impression they are on a par with men in their ability to tolerate alcohol.”

The CMO told the Science and Technology Committee that the guidelines were primarily informed by new evidence on alcohol and cancer:

“the science has moved on...we know a lot more about the impact of alcohol on the development of cancer and on the risk of cancer”,

yet guidelines for women have remained the same, while guidelines for men have been reduced based on modelling of acute harms such as accidents and injuries. I simply cannot concur that that is sound medical advice on a number of levels.

Those of us who favour a partnership approach to these matters are very concerned that this triple lock—of proceeding with the language of “no safe level” in the face of international evidence to the contrary, of promoting the notion that men and women have equal tolerance levels to alcohol and of Britain needing to have the most stringent alcohol guidelines in the world, despite the positive recent developments in tackling alcohol harm—is a triple whammy that threatens to undermine the significant recent progress we have made, with industry and Government working together to tackle alcohol harm.