tag:blogger.com,1999:blog-125653241615635488.post5166778788945472251..comments2024-01-18T20:42:30.221+00:00Comments on Thinking to some purpose: In defence of alcohol guidelinesWill Haydockhttp://www.blogger.com/profile/00623145846257433457noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-125653241615635488.post-79215810160605191242016-01-20T22:02:59.406+00:002016-01-20T22:02:59.406+00:00A grown up debate would look very different from t...A grown up debate would look very different from the one we have now. <br />But it will never happen. Far too much self-interest and too many careers to protect, and being an absolutist crusader for any cause is a wonderful boost to the self-esteem. There is immense ego appeal in trying to protect The People.<br /><br />This alcohol debate is really about differing values and visions of perfect society. Always has been, always will be. Debates about MUP or drinking guidelines are just skirmishes in a longer war. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-83066927023939224002016-01-20T10:49:43.186+00:002016-01-20T10:49:43.186+00:00Again, this is really difficult, because one perso...Again, this is really difficult, because one person's 'problem inflation' is another person's effective lobbying. You could say the same thing about the NTA painting drug users as criminals (but getting huge increases in funding thanks to New Labour's 'tough on the causes of crime') or universities boasting about 'employability' and 'transferable skills' in order to prove their worth to the economy (but meanwhile undermining other arguments for education). There's a lot going on when people distinguish between alcoholism and dependency or even heavy sustained use (see my post on addiction from October). And harm to others is absolutely genuine; just ask the child, parent or partner of someone with substance use issues - and those issues don't have to be something that's neatly labelled 'alcoholism' or 'addiction'. But yes, I take your point about the difficulty of expanding the perceived problem. I'd yet again appeal for a grown up debate - and that means that people need to stop claiming that risks from alcohol are only confined to those at the very top end of the spectrum of consumption. There's no doubt I'm putting myself at (some) risk from my own consumption, for example, but equally that risk isn't certainty of health harm.Will Haydockhttps://www.blogger.com/profile/00623145846257433457noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-64822418639262683242016-01-20T10:32:47.075+00:002016-01-20T10:32:47.075+00:00I don't disagree with this. Certainly public ...I don't disagree with this. Certainly public education campaigns relating to drinking are often more about showing voters that government is 'doing something' rather than actually changing behaviour. And I don't doubt that some people will apply the risk guidelines in the way you're describing. But that's partly because thinking about risk isn't something that's straightforward and we tend to distort or simplify the arguments. I'd prefer to advocate for a clear, open debate than say we can't use reasonable words and analysis because someone might misrepresent them. That just feels like giving up.Will Haydockhttps://www.blogger.com/profile/00623145846257433457noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-848270971037820452016-01-20T10:28:25.919+00:002016-01-20T10:28:25.919+00:00I wouldn't deny that people bring their own ba...I wouldn't deny that people bring their own baggage to the agenda; that's why I mentioned my own position on alcohol, and I think that's always clear in my writing. However, these guidelines are (and can only be) about the medical risks associated with alcohol. It's up to the individual to balance those against their likely pleasures. I don't think the researchers are advocating or misrepresenting, but I'd agree that they're presenting just one element of the picture that a consumer might need. I'm sure the discussion will develop as well through the consultation and further discussions around the exact number and risk levels applied.Will Haydockhttps://www.blogger.com/profile/00623145846257433457noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-9259444670041590602016-01-20T04:11:09.483+00:002016-01-20T04:11:09.483+00:00It was Griffith Edwards who realised that the numb...It was Griffith Edwards who realised that the numbers of the UK's alcoholics did not matter politically speaking, so he created dependent drinkers. That was the start of 'problem inflation' of drinking.<br />The next wave is Harm to Others. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-2761378503643627832016-01-20T04:03:26.696+00:002016-01-20T04:03:26.696+00:00"..I still can't see why guidance is a ba..."..I still can't see why guidance is a bad thing" <br />But as Sally Casswell and others have pointed out, drinking guidelines don't change drinking behavior. <br />Modern guidelines created along public health thinking serve two purposes: a)governments feel some advice should be provided by them - looks uncaring otherwise; and b) the advice becomes re-interpreted by alcohol regulators (Police, licensing, NHS, etc) as limits, above which people are endangering themselves and so should be restricted in all sorts of ways, usually involving taxes, availability and marketing. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-14803972230227053532016-01-20T03:56:30.046+00:002016-01-20T03:56:30.046+00:00There is such a huge volume of epidemiology around...There is such a huge volume of epidemiology around alcohol that activist/researchers can pick out tons in supporting any conclusion they wish to end up making. <br /><br />And you can object to my term 'activist/researchers' but in my several years of experience, 95% of researchers who come into the field don't see any good reason for alcohol, and most of their work is designed for advocacy, not revealing new scientific knowledge. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-63666745288032173572016-01-19T17:33:37.580+00:002016-01-19T17:33:37.580+00:00To some extent I think you're right about the ...To some extent I think you're right about the guidelines, though I don't think people will exactly 'ignore' them so much as be unaware of them or their own levels of drinking.<br /><br />I've written about the danger of classifying more people as problematic drinkers, and I appreciate that, but that's not an argument against having guidelines in general and if these were to be challenged it would have to be on the actual methodology - though I still think it's interesting that the consultation isn't about the level. I wouldn't want to challenge the modelling, particularly, but I don't see why we shouldn't be thinking about what is an 'acceptable' level of risk, and what's the level that will communicate with people most powerfully.Will Haydockhttps://www.blogger.com/profile/00623145846257433457noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-892824017169030292016-01-19T17:29:12.009+00:002016-01-19T17:29:12.009+00:00I'd be interested in a careful rebuttal of the...I'd be interested in a careful rebuttal of the approach to risk functions used by the Sheffield group, for example the paragraph on Ischaemic heart disease p.27 of the Sheffield report. I'm not sure how they're biased - but if you can identify this from flaws in their risk modelling I'd happily be persuaded.Will Haydockhttps://www.blogger.com/profile/00623145846257433457noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-59814575764489248772016-01-19T17:25:31.124+00:002016-01-19T17:25:31.124+00:00I have to say I think this debate isn't so muc...I have to say I think this debate isn't so much about the science as the principle of guidelines. Most people attacking this would be challenging the guidelines regardless of the methodology or the precise number. I'd prefer it if they were up-front about that and could explain why giving a guideline is actually a bad idea.<br /><br />Winkler misses the point by talking about targets. There's plenty of problems with targets in managing organisations' performance, but these guidelines aren't targets to measure or drive Public Health or population 'performance'; there are already metrics for that on hospital admissions, treatment outcomes etc.<br /><br />Yes, I'd worry that this sort of guidance is only followed by those who need it least (and I've written about this already), but guidelines shouldn't be seen as the only intervention available and they contribute to a broader environment that helps shape discussions around alcohol.<br /><br />Personally, from my research I'd say government messages on alcohol (particularly 'binge' drinking) have been counterproductive because they give other drinkers a 'get-out' clause to con themselves about the risks of their own drinking. As I make very clear in this post, I don't have any problems with people drinking at higher levels than medical advice would recommend, but they shouldn't do so thinking that they're doing themselves good.<br /><br />On the J-curve issue, the risk functions are taken from existing research and show various shapes (see p.26 of the Sheffield report). But my whole point is that people are challenging the evidence when (a) they're not qualified to do this, having not read the material that's out there; and more fundamentally (b) this isn't actually why they object to the guidelines.<br /><br />What I'd like to see is some honesty and openness about why they're opposed (and Chris Hackley has given this, for example) - and some reason for me to agree with them. At the moment, I still can't see why guidance is a bad thing.Will Haydockhttps://www.blogger.com/profile/00623145846257433457noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-56940803364978426702016-01-19T12:59:52.676+00:002016-01-19T12:59:52.676+00:00Sally Davies and her no safe level/old wives' ...Sally Davies and her no safe level/old wives' tale rhetoric is indefensible. Even the RSS has written a letter condemning the evidence-free manner in which she and the DH went about their media operation. But badly behaved though she was, it's difficult to argue that people would be any better informed if they read the Sheffield report. I'll assume it's because you're a nice guy that you've omitted to mention that the rinky-dink J Curve in the Sheffield report - based on yet another theoretical model from the city of steel - bears no relationship to any J Curve based on observational studies, ie. what actually happens to people. When reality clashes so obviously with theory, it's better to side with reality.<br /><br />As for describing Sheffield's cherry-picking hatchet job on the health benefits of moderate drinking as a 'careful discussion', I think you need to have a lie down.<br /><br />I thought Winkler made a fair point about lowering the guidelines for alcohol, sugar etc. Aside from middle class hypochondriacs, people WILL ignore them. What he fails to appreciate - perhaps because he comes from an era when there was still an element of truth seeking in public health research - is that the guidelines are not designed for people to follow but for problem inflation. In this instance, to recruit another two million men into the dwindling ranks of 'hazardous drinkers'.Christopher Snowdonhttps://www.blogger.com/profile/15963753745009712865noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-69751726544832853142016-01-19T12:29:34.461+00:002016-01-19T12:29:34.461+00:00>>There’s careful discussion of this in the ...>>There’s careful discussion of this in the Sheffield model<br /><br />No, there's ill-informed and/or just biased consideration of this in the Sheffield work. But then again, they have form.Vovahttps://www.blogger.com/profile/01823050600809389492noreply@blogger.comtag:blogger.com,1999:blog-125653241615635488.post-35667252212028098952016-01-19T11:38:42.280+00:002016-01-19T11:38:42.280+00:00Most people will ignore the guidelines. The people...Most people will ignore the guidelines. The people least likely to ignore the guidelines will be people in public health who will now have a much greater pool of 'problem drinkers' now that the guidelines have been lowered. This will then lead to the inevitable call for more taxes and restrictions to be placed on people to combat the increase in 'problem drinking'.<br /><br />Maybe that's why people get upset, cause we know from experience how public health operate.Paul McNamarahttps://www.blogger.com/profile/08194656461253465493noreply@blogger.com