The great alcohol cover-up: how public health hid the truth about drinking

The text below is the basis of a talk given by Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs, at the Spectator annual health debate 2016. The debate was entitled: ‘Can we trust health advice?’

Before answering the question of whether we can trust health advice we must first ask: ‘Which health advice?’ It varies so much over time and between countries. In 1979, the government advised men to drink no more than 56 units of alcohol a week. This was later reduced to 36 units, then 28 units and then 21 units. Last month, the Chief Medical Officer reduced it once again, this time to 14 units. Upon announcing this, she also asserted that there is no safe level of drinking and that the health benefits of moderate alcohol consumption were ‘an old wives tale’.

Male drinking guidelines vary enormously around the world, from 52 units a week in Fiji to 35 units in Spain, all the way down to seven units in Guyana. There is no other country in the world that has the same guidelines as the UK. The day after Sally Davies released her report, the US National Institute on Alcohol Abuse and Alcoholism announced the results of its review of alcohol guidelines and maintained the recommendation for men of up to 25 units per week. This government organisation estimates that 26,000 deaths a year are prevented by moderate alcohol consumption thanks to reduced risk from heart disease, diabetes and stroke. In America, the guidelines for women are lower than they are for men, as they are in all but a handful of countries worldwide. Britain is now one of the few.

Therefore, in order to trust this latest piece of health advice from our Chief Medical Officer, we must believe not only that every previous Chief Medical Officer got it wrong but that every other country in the world has got it wrong. That requires a degree of patriotism that I am unable to summon up, particularly since the current advice bears no relationship whatsoever to the scientific evidence.

The graph represents the relationship between alcohol consumption and mortality. It is, I think, well known that the relationship is J-shaped. This particular J-curve is based on 34 prospective epidemiological studies which collect data on how much people drink and then follow them over a period of years with a view to seeing if they die and what they die of. As this graph shows, the risk of death declines substantially at low levels of alcohol consumption and then rises, but it does not reach the level of a teetotaller until the person is consuming somewhere between 40 and 60 grams of alcohol a day, which is to say between 35 and 50 units a week.

This J-shaped association was identified decades ago and has been repeatedly shown in studies from around the world. There are people in the temperance and ‘public health’ lobbies who do not want to accept the benefits of alcohol consumption. As a result, this epidemiological finding has been subject to more scrutiny than anything else in the field of alcohol research. It is precisely because it has been subjected to the greatest scrutiny that we know it to be robust.

It has been suggested, for example, that some of the teetotallers in these studies are former heavy drinkers who are inherently less healthy because of their old drinking habits. To test this, studies have been conducted to compare people who have never drunk with people who drink moderately, but the association remains — the teetotallers still tend not to live as long.

It has also been suggested that teetotallers lead unhealthy lives in other respects, thus confounding the results. However, it turns out that lifelong teetotallers tend to lead healthier lives than drinkers, being less likely to smoke and more likely to have a better diet, so that doesn’t stand up as an explanation either.

The only real pitfall in this kind of research is the problem of people under-reporting how much they drink. The amount of alcohol sold in the UK is about twice the amount that people claim to drink, so unless we throw away a huge amount of booze, it is certain that people either forget about how much they drink or they deliberately lie to researchers. In either case, we can assume that the people who say they consume two drinks a day are probably consuming three or four drinks, in which case the amount that you have to drink to assume the same level of risk as a non-drinker is even more than this graph suggests.

What is a safe level of drinking? Sally Davies says there isn’t one. In so doing she is encouraging the public to believe that the only safe level is zero. But that is not what the epidemiology shows at all. It would appear that you can drink significantly more than 14 units a week — or two units a day — and have a lower mortality risk than a teetotaller.

Why would she misrepresent the evidence? I think there are two reasons.

If I may illustrate by analogy, when I first started secondary school at the age of 11, the teachers told us that we would be expected to do three or four hours of homework a night. Even at the time, this struck me as being optimistic on their part. I doubt that any of us were so conscientious. Speaking personally, I recall half an hour being the average, perhaps up to an hour on occasion.

Looking back, I think the teachers knew that we wouldn’t do three or four hours. I think they would have been very happy if we did one or two hours. They were doing something that behavioural economists call ‘anchoring’ — putting an unrealistically high number in our minds in the hope that we would settle for a lower number, but that the number would still be higher than the number we would have come up with if left to our own devices. If they had said we should do an hour, we might have settled for 20 minutes. If they had said half an hour, we might have settled for ten minutes.

That, I suspect, is what health authorities are doing when they tell us to have no more than seven drinks a week, or to have no more than seven teaspoons of sugar a day. We will probably exceed those guidelines, but we might think twice about exceeding them by two or three times — and those are the kind of levels at which health could genuinely be impaired.

If that’s what they’re doing, I think it’s a problem. Manipulating school children into doing their homework is one thing. Lying to adults about scientific evidence is quite another. The health benefits of moderate alcohol consumption are not an ‘old wives’ tale’, as Davies claims. They are supported by a huge body of evidence, but she doesn’t want us to be able to handle nuanced information. In public health, things are either good or bad, and she wants to portray alcohol as bad, hence the need to downplay the benefits and the rhetoric about there being ‘no safe level’. It’s nonsense, but it is a clear message and that’s what counts.

Second, there is a distinct possibility that these guidelines are not really aimed at us at all. The number of people who exceed the weekly drinking guidelines has been falling for years. By lowering the recommendations for men, Sally Davies has pulled two million more hazardous drinkers out of her hat. Similarly, although most people exceed the old sugar guidelines, sugar consumption has been falling for years. Now that the guidelines have been halved, it is almost impossible not to exceed them. By moving the goalposts, the problem is inflated, panic ensues, and the political agenda of the ‘public health’ lobby, with all its taxes, bans and gruesome warnings, is given a shot in the arm.

There is a telling comment in the minutes of one of the meetings held to reassess the drinking guidelines. It says that it is ‘important to bear in mind that, while guidelines might have limited influence on behaviour, they could be influential as a basis for government policies’. Influencing government policy is the real aim of the game. They don’t trust us to handle accurate information. As a result, we can no longer trust them to give us it.

Victor Hugo's tempestuous artworks

EXHIBITION at the Hammer Museum

DIY

Lord Finchley tried to mend the Electric Light
Himself. It struck him dead: And serve him right!
It is the business of the wealthy man
To give employment to the artisan. 
- Hilaire Belloc

The Statues of Buckingham Palace

One day, old lion, we will stir ourselves,
shake off the bronze and be flesh.

The sash across my breast is blue I think, my hair
the dirty blonde of your pelt.

First we will look over our shoulders - I'll smile
shyly at the young men who've lounged a century

by the pool, then, without comment, you'll
roll your great shoulders and pad down onto the Mall.

I'll keep my hand warm in the rough tangle
of your mane. We walk past straight-backed generals

dusting the last of the black paint from their coats, while
the gentlemen of state adjust their breeches and steel

swords, clear their throats, and scramble down to the grass.
Along the Embankment we're joined by a few nervous
poets and the occasional nurse. The light is flat, Apollos
blink their olive eyes and begin to tune their lyres;

the muses and graces group with soft calls
to touch each other's pale new skins

with their fingertips. Mythical beasts lope beside us
and the Thames is full of mermaids in pearled scales.

We turn up towards Trafalgar Square, joined
by a Jesus or two, who have clambered

down from the fronts of churches. A little bemused, they rub
their palms and shiver. The military gentleman give them
overcoats,

clucking under their waxed moustaches. The Jesuses bob
their heads in thanks, feel in the pockets for tobacco.

Then everyone goes to watch as you and I, old lion, climb the
      steps
to the Gallery and whisper steeply at the key hole, waking the
      pictures.

Imogen Robertson (1973 - )

Thirst for beer

ARCHY INTERVIEWS A PHARAOH

By Don Marquis
From “archy and mehitabel,” 1927

boss i went
and interviewed the mummy
of the egyptian pharaoh
in the metropolitan museum
as you bade me to do

what ho
my regal leatherface
says i

greetings
little scatter footed
scarab
says he

kingly has been
says i
what was your ambition
when you had any

insignificant
and journalistic insect
says the royal crackling
in my tender prime
i was too dignified
to have anything as vulgar
as ambition
the ra ra boys
in the seti set
were too haughty
to be ambitious
we used to spend our time
feeding the ibises
and ordering
pyramids sent home to try on
but if i had my life
to live over again
i would give dignity
the regal razz
and hire myself out
to work in a brewery

old tan and tarry
says i
i detect in your speech
the overtones
of melancholy

yes i am sad
says the majestic mackerel
i am as sad
as the song
of a soudanese jackal
who is wailing for the blood red
moon he cannot reach and rip

on what are you brooding
with such a wistful
wishfulness
there in the silences
confide in me
my perial pretzel
says i

i brood on beer
my scampering whiffle snoot
on beer says he

my sympathies
are with your royal
dryness says i

my little pest
says he
you must be respectful
in the presence
of a mighty desolation
little archy
forty centuries of thirst
look down upon you

oh by isis
and by osiris
says the princely raisin
and by pish and phthush and phthah
by the sacred book perembru
and all the gods
that rule from the upper
cataract of the nile
to the delta of the duodenum
i am dry
i am as dry
as the next morning mouth
of a dissipated desert
as dry as the hoofs
of the camels of timbuctoo
little fussy face
i am as dry as the heart
of a sand storm
at high noon in hell
i have been lying here
and there
for four thousand years
with silicon in my esophagus
as gravel in my gizzard
thinking
thinking
thinking
of beer

divine drouth
says i
imperial fritter
continue to think
there is no law against
that in this country
old salt codfish
if you keep quiet about it
not yet

what country is this
asks the poor prune

my reverend juicelessness
this is a beerless country
says i

well well said the royal
desiccation
my political opponents back home
always maintained
that i would wind up in hell
and it seems they had the right dope

and with these hopeless words
the unfortunate residuum
gave a great cough of despair
and turned to dust and debris
right in my face
it being the only time
i ever actually saw anybody
put the cough
into sarcophagus

dear boss as i scurry about
i hear of a great many
tragedies in our midsts
personally i yearn
for some dear friend to pass over
and leave to me
a boot legacy
yours for the second coming
of gambrinus

archy

In the Author's Footsteps - by Adam Thorpe

David's hobby was a statement, of course; Gillian knew that. If anyone asked, Gillian would say he was a hiker, that hiking was his hobby. Really, what she wanted to say was that he was an awkward sod. 

Neither of them had ever had an affair. Their marriage, to outsiders, was rock-solid. They'd both spent their lives in adult education and Gillian was a lay preacher. Devout ecologists, they knew their birds. But if David's hobby got much worse, Gillian would have to up sticks. Or, with a bit of luck, he might get properly arrested and put away for a bit, instead of being cautioned, just an embarrassment in some local rag. That would shock him out of it.

The rot started, to Gillian's mind, when David took early retirement once the kids had flown. Ludlow was too quiet, after Bracknell. Lives of quiet desperation, as Pink Floyd had put it. Gillian played a lot of her ancient, vinyl numbers while David pored over old maps in the kitchen. She wondered how she had ended up like this. Distance Learning for the Open University. No colleagues. Rain spattering the picture window and David becoming an awkward sod. She had even started smoking again, and David had banned her to the garden. One morning there was a tussle, and Gillian threw one of those books at him. It missed, but landed with a splat and a few of the pages flew out and David smacked her across the face. Or would have done, if she hadn't ducked. 

Everything at sixes and sevens, as her mother would say. 

"Why can't you just hike normally, like everyone else?" she'd asked him, one day, when he was strapping on his horrible little snot-green knapsack with those chocolate stains, bound for Telford. 

"I am hiking normally. It's the world that isn't normal," he replied. 

"Change is totally normal," she said. "Look at us." 

"I can choose to live the life I want, Gillian," he said. 

"Well, at this rate you'll live it without me, soon." 

The climax came when he brought back yet another one of those books. He'd got enough of them, now, to cram three shelves. There were a couple of local second-hand bookshops nearby: one was neat and expensive with an ex-stockbroker behind the desk, the other chaotic and cheap with Mike and his unwashed beard staring at you from the shadows. If you were prepared to spend a whole morning truffling under his gaze, the cheap one could yield some treasures. Today it had yielded David's type of treasure. 

He waved it under Gillian's nose, ever so pleased with himself. She could smell the shop off his cagoule: pipe-smoke and bodily decay. 

"Found it," he said. "At last." 

"Don't tell me. The Himalayan Trail, 1914. Maybe I'll get rid of you for a few months and then you'll fall down some post-1914 crevasse." 

"Do you have to smoke in the kitchen?" 

"Bloody hell, David, you don't mind filling your lungs with it in the bookshop, do you?" 

He sat down, opening the book. 

"Wonderful," he murmured. "This is the crown jewel." 

"Looks just like all the others. Old and sad." 

"Buckinghamshire Footpaths by JHB Peel, published 1949." 

"Exactly. Just like all the others. Walking in Warwickshire, London's Countryside, See England First ..." 

He took out a reddish leaf that someone had pressed between the pages. 

"Fifty years old, this could be. Wych elm. Look. Tragic." 

It crumbled in his fingers like dried tobacco. 

"David, that's the last damn book or it's divorce." 

"I could say the same about your cigarette." 

She hesitated. She felt the smoke in her chest. 

"Alright. We'll do a deal. Fags versus those books." 

He looked at her over his glasses for a moment, then at the book open in front of him. 

"OK," he said. "I don't need any more. This is the ne plus ultra, this is." 

"Why?" 

"Listen." 

He put a bit more distance between the book and his glasses (another sign of age) and read. 

"Milton Keynes is a homely place. Fields encroach upon the dusty by-lane, and brim over the scattered cottages. There is nothing here of the conventional beauty spot, for indeed no one seems to have heard of the place, save the handful of its inhabitants; and these think so well of it they rarely leave it. I have known and loved Milton Keynes since I was a boy, but at no time in my legion pilgrimages thither have I met a stranger. The church at Milton Keynes, which is among the finest ..." 

"I think you've made your point. You're not going to do your thing at Milton Keynes, are you?" 

"Of course. A circular walk from Newport Pagnell via Milton Keynes, Woughton and the - I quote - 'delightful hamlets' of Little Woolstone and Willen, with a detour to Bradwell Abbey and then on to Great Linford, with its single-branch railway back to Newport Pagnell. In the author's footsteps." 

"Oh dear." 

"It's England," he said. "I've every right. Listen. The church is approached through a line of small trees, having a farm that reaches to the church wall itself, so that cows sometimes browse upon the backs of unsuspecting worshippers who have stopped to discuss the result of the Crimean War, or whatever else passes for news in this most blessed haven of pristine sanity." 

"Then you won't be wanted there, dearest. If it's a haven of sanity." 

David smiled. 

"The cows are concrete cows now, aren't they?" 

He almost made it to the end, too; he was only arrested while trying to enter the grounds of the Gyosei Japanese boarding school in Willen. 

"Willen is unspoiled because it is unknown," he shouted, waving the book about. "The cottages here wear an air of permanence; the oaks have a great girth; and old men are hale." 

The policemen had received about 100 calls relating to this bloke with his tatty green rucksack, and hauled him unceremoniously across the cycle way to the van. The fun had started when he'd crossed the M1 near Junction 14, where Mr Peel had admired the view of "innumerable drowsy villages cupped within the trees". A lorry had swerved onto the hard shoulder because David liked to think of the M1 as a phantom. He was surprised - disappointed, even - to find the village of Milton Keynes intact. The photographs of Milton Keynes in the book, showing thatched cottages humped like natural grass mounds off a dusty lane, with a church tower in the distance beyond grand elms, had nothing much to do with the clipped suburban verges and lawson cypresses of the present incarnation, but at least it wasn't under a Tesco storage depot as that ancient wood had been on the last hike.

"At the inn you will strike a footpath south-west to Woughton-on-the-Green." 

Days over old maps had established this footpath, as well as the inn. He crossed a few executive gardens and ended up inside the Asda superstore, where the route went up the Prepared Meals aisle. With the help of a compass, he followed the path with its primroses and snowdrops under oaks and elms (it was early spring) through the Chilled Foods section and on via a goods delivery bay into Dixons, which had a special offer on Toshiba laptops. He got into a bit of trouble in Top Shop, because the footpath curved into the back area where an off-duty cashier was snogging with a deputy manager. But he wasn't arrested: when he explained what he was doing, producing the book from his knapsack, they just thought he was a daftie. 

Bradwell Abbey was in the grounds of the City Discovery Centre, and he ate his picnic in peace. He had a spot of bother when the footpath, after crossing 20 mini-roundabouts, eight Redways and a multiplex car park, wound its delightful way through several offices and the gents toilets of Mercury Communications. They thought he was one of the Albanian field workers at first, until he opened his mouth. By now, he'd been tracked by a total of 243 CCTV tilt-and-zoom cameras - a brief, shadowy figure doing odd things: he was saved only by the difficulty of someone watching all 10,000 or so tapes that were on the go at any one time in the local CCTV centre. 

Once he'd climbed his way over the sea of parked cars and reached the nearest executive estate, he was again in the realm of private householder security. An alarm rang somewhere while he was crossing a neat lawn with a whirly-brick feature in the middle, and the cops picked him up as he was scaling the wall of the Gyosei Japanese boarding school a few minutes later. 

In fact, the alarm was in the form of a member of the Milton Keynes Development Corporation, who thought he was her estranged husband come back to do her harm. He did not resist the police, he only quoted Mr Peel, but they arrested him anyway. Reports of a trespasser had come in thick and fast over the last hour. Several people had phoned the police from their mobiles when he'd climbed on their cars, which had been in the line of the footpath. He'd even been roughed up by the owner of a Mazda MX-5 convertible, and lost his bobble hat. The police had got fed up: they were sick of alternative theatre at Milton Keynes, all these arty bods down from London littering the public space with their Lottery-aided wank, high on wacky backy or whatever. So they hauled him in. 

But they decided he was a genuine nut, going on about primroses and elms and meandering, drowsy streams. 

"I just want to get to Great Lindford," he kept saying, "down the winding English lane and its high-banked bend, the fields studded with hedgerows. Look!" 

And he'd flash the book at them, which they finally confiscated. 

"Jesus," said one of the coppers, "what are you on, mate? Bang him up for the night, will you?" 

When they let him go in the morning, he was not charged. Gillian stopped smoking and got very crotchety. David went quiet for a while and watched a lot of television. Gillian was almost relieved when he came back one day with Rambles through Middlesex, published in 1929. She went straight out and bought 10 packets of Marlboro. 

"At least he's not a drunk," she murmured to herself, as he plotted the next hike with his old maps, his finger cutting clean across the slumbering hamlet of Heath Row.

There was no possibility of taking a walk that day

The casual event that turns Jane Eyre towards a new future, in the book's very first line:

Rain confines Jane to the house - she takes the book to read - the fight with John - the Red Room - the apothecary's idea - Mrs Reed sends Jane to school - she becomes a teacher - the application for a post at Thornfield Hall.