Alcohol is worse than cigarettes

Last week, Stacey Rhymes from Derby, who died from alcoholic liver disease at 24, appealed from the grave for steps to stop enticing vulnerable young people into addiction, when her mother released harrowing photographs of her daughter’s decline. Hers is the human face of a huge statistical problem – research published yesterday foresees more than 90,000 lives lost to alcohol over the next decade. As a practising gastroenterologist, I regularly see patients whose lives have been wrecked by alcohol. The media have focused on binge-drinking, but consumption has risen throughout society and brought an epidemic of alcoholic liver disease with it. A third of patients on our wards are alcoholics, and these days many are in their 20s and 30s, like Stacey, or even younger.

Thousands die from alcohol-related diseases every year. Moreover, compared to cigarettes, the effects of alcohol are worse because it destroys self-esteem and dignity before killing. This personal degradation and the accompanying family destruction does not generally occur with tobacco. Banning advertising of cigarettes has markedly reduced smoking and smoking-related illness. There is no reason for taking a different approach with alcohol.

While opponents may argue that this is anti-libertarian, they are in a minority. A YouGov Poll commissioned by the British Society of Gastroenterology showed 62% of the public think advertising of alcohol aimed at young people should be banned. They are right. In the past, death from alcoholic liver disease in France was more than 10 times higher than in the UK: now the relationship is reversed. In France most alcohol advertising is banned, with a marked decline in alcoholic problems, especially among young people. In the UK rising spending on advertising is mirrored in rising consumption among 11 to 15-year-olds.

Not surprisingly, the alcohol industry opposes restriction. In ads that try to deflect criticism, they point to the code that requires advertising not feature people who look under 25: no problem there, as these are much more attractive role models to teenagers. It’s clear that other requirements – that alcohol should not be suggested to enhance personal qualities like toughness or sexual activity – are not met by ads associating products with a cool lifestyle. The ads also commonly feature animals, humour and music: no wonder teenagers interpret these ads as suggesting that alcohol is a gateway to social and sexual success.

A charitable view is that the industry genuinely believes promotion is harmless. But I doubt many people believe this is anything other than sophistry in pursuit of profit. The view that alcoholism is only a problem for a minority is more likely to be sincere, but it is erroneous: excessive alcohol consumption and increasing alcoholic liver disease pervade all ages and sections of society. In our survey 52% of respondents drank above safe limits: it is the “sensible majority” that needs protection.

The point is, as with tobacco, the problem is too important to neglect. And of course advertising is not the only influence. Curbs on ads will have to be accompanied by restrictions on sponsorship and opening hours, minimum unit pricing, and a re-evaluation of the delusion that under-age drinking around the family table encourages responsible drinking. I would argue that every health district requires a named individual responsible for local awareness, early detection and effective support and treatment.

Any policy that treats alcohol differently to tobacco cannot be defended. At a time when the ad industry wants more trade and political parties want not to rock the boat, there are contrary pressures. But the problem is too serious for such considerations to hold sway.

By Chris Hawkey, 19 October 2009 Guardian

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