Thinking about Drinking: A Year in the Life of an Alcohol Researcher at Stirling

Niamh was active in helping the media understand the implications of the 2016 new alcohol guidelines. In this blog post she discusses what happened as a result of the publication of the new guidelines and how the media portray the facts in their own way.

By Niamh Fitzgerald, Research Profile, @NiamhCreate

Journalists love a good alcohol story, especially at this time of year, and January 2016 gave them the ideal ammunition with the publication of new advice from the UK’s Chief Medical Officers (CMOs) designed to provide people with ‘accurate information and clear advice about alcohol and its health risks’.  For the first time, the guidance advised that ‘no level of regular drinking can be considered completely safe’ and advised the same limit for both men and women – not to regularly drink above 14 units of alcohol (about 1 and a half bottles of wine) per week, at the same time moving away from the previous daily limits.  The guidance was based on a lengthy process involving experts from around the UK including Prof. Gerard Hastings (from Stirling) and followed emerging evidence on the links between alcohol and cancer – kicking off a furore of media coverage.

Media coverage following the publication of the new guidelines

The Daily Mail led with the news that the guidelines would ‘put a stop to the belief that red wine is good for you in moderation’, while the Sun also focused on this ‘plonk lovers’ shock’ as the CMO’s ‘rubbished’ the supposed health benefits of wine.

Others focused on the cancer risk, with the Scotsman leading with ‘drinkers at risk of cancer from single glass of wine’; whereas the Telegraph headline was ‘health chiefs attacked for nanny state alcohol guidelines’.  It was a frantic week for colleagues and I at the Institute for Social Marketing (ISM) as we sought to capture all of the newspaper, television and radio coverage for future analysis.  As Lecturer in Alcohol Studies at ISM, and lead for teaching and public engagement on alcohol for the UK Centre for Tobacco and Alcohol Studies (UKCTAS), I was interviewed about the new guidelines on BBC News for their ‘Ask This’ feature, which takes questions from viewers.  I also had a comment piece published in The Scotsman.

Prescribed alcohol drug ‘Nalmefene’ was licensed despite insufficient evidence to prove its effectiveness

A study from the University of Stirling’s Institute of Social Marketing showed that a drug being used to treat alcohol problems in the UK was licensed for use, despite insufficient evidence to prove its effectiveness.

The drug nalmefene, marketed as Selincro®, was approved in Europe in February 2013 and was subsequently recommended by the UK National Institute for Health and Care Excellence (NICE).

Yet a team of scientists have found problems with the way clinical trials were conducted and analysed, making it impossible to know how much the drug actually helps to reduce drinking in patients dependent on alcohol.

Outlined in the journal Addiction, a group of experts analysed the published studies of nalmefene that formed the basis for the licensing and NICE decision. They concluded that evidence of its effectiveness was weak, and any possible effect on patients was small at around a one drink per day reduction on average.

Landmark report reviewing #alcohol policies across the UK! @NiamhCreate @VictimOfMaths @UK_AHA @A4UEvidence

UK Government’s alcohol policies are weaker than devolved nations!

The UK Government’s alcohol policies are weaker than those implemented by the devolved nations, a landmark report from the Universities of Stirling and Sheffield has found. Alcohol policies across the four UK nations vary widely in the extent to which they are grounded in scientific evidence, with political considerations appearing to have significant bearing, the research shows.

The report was commissioned by the Alliance for Useful Evidence and reviewed policies from the UK Government and devolved administrations against recommendations from Health First, the independent expert-devised UK alcohol strategy, in the first such audit of its kind.  Overall strategy, pricing, marketing and availability of alcohol were amongst the areas examined.

Scotland had the strongest approach overall, seeking to implement the most evidence-based policies, working to clear outcomes, and with a taskforce in place to monitor and evaluate the Scottish Government’s alcohol strategy.

By contrast, the UK Government did not support the most effective policies, made inconsistent use of evidence, and was the most engaged with the alcohol industry.

While Wales and Northern Ireland took strong positions in areas such as taxation and restrictions on young drivers, they have fewer legislative powers than the Scottish Parliament.

The report was co-authored by Dr Niamh Fitzgerald, at the University of Stirling and Colin Angus at the University of Sheffield.

Dr Niamh Fitzgerald, University of Stirling – Lecturer in Alcohol Studies

“Alcohol policy at UK Government level is in disarray, with it choosing to reduce taxation despite evidence that consumption and alcohol-related harms will increase as a result, putting even greater pressure on NHS and emergency services.

In contrast to the UK Government, the devolved administrations – especially Scotland – are taking steps to address the widespread harms due to alcohol, recognising that they are a ‘whole population’ issue. All four nations, however, engage in partnership with the alcohol industry, despite clear conflicts of interest and its history of failure to support those policies most likely to work.”

Colin Angus, University of Sheffield – Sheffield Alcohol Research Group

“A clear illustration of the gap in effective policy across the UK relates to the marketing of alcohol. The devolved administrations have indicated support for mandatory action on product labelling, but the UK government has favoured self-regulation which has proven ineffective, with over 40 percent of products on the shelf still failing to meet the industry’s own best practice guidelines.

On alcohol advertising, a reserved matter, the devolved administrations have called for stronger regulation to protect children, but this approach has been rejected by the former UK coalition government. The Scottish Government is currently updating its alcohol strategy while the other devolved nations continue to progress evidence-based policies to reduce alcohol harms. It may be that they will call for greater powers to go it alone in bringing in effective policy options, if Westminster is not prepared to act.”

Peter O’Neill, Alliance for Useful Evidence – Evidence Exchange Manager

“Devolution in the UK provides opportunities for exchange of evidence and learning about what works through experimentation with different policies across the four nations. This report calls on administrations to support such learning, by engaging openly and maturely with the alcohol policy evidence, being honest about reasons for policy decisions, and robustly evaluating policy initiatives. Unfortunately, the report also suggests that alcohol policy may sometimes be underpinned by ideology more than by evidence, and is likely to be less effective as a result.”

Four Nations: How Evidence-based are Alcohol Policies and Programmes Across the UK? has been presented to representatives of the four administrations as part of the work of the British-Irish Council, which meets later this month.

Just how useful are licensing laws for improving public health?

“Despite legal changes in Scotland, councils are struggling to use public health as an argument against new pubs and off-licences.  We need to reconsider the role of licensing in the context of other ways to achieve the same ends” Niamh Fitzgerald.

What is to be done?

A war chest, to fend off legal challenges, might bolster the law and encourage local authorities to use it more ambitiously.  But, perhaps, we should also re-examine the purpose and limitations of alcohol licensing.

In an era of increasing online sales and home-drinking, what can be realistically expected from action on licensing, even with more robust legislation?  Are there better ways to wield the big three weapons of price, availability and marketing?  Raising prices via minimum unit pricing may be a more reliable policy.  Or, if the goal is to reduce the presence of alcohol in our public spaces, diminishing its cultural symbolism, then restricting advertising on bus shelters, hoardings and on television after 10pm might be much more effective (and more achievable).  All these considerations call, perhaps, for a re-evaluation of the role we envisage for alcohol licensing in pursing improved public health.

Read more.

Dr Niamh Fitzgerald – Conversations about alcohol: making a difference to alcohol-related harm

The Evidence Exchange programme, an Alliance for Useful Evidence initiative, seeks to encourage the sharing and use of social policy evidence across the UK.

In this episode, Niamh discusses what is known about ABIs, how and where they work; her recent research on delivery of ABIs outside of primary healthcare, and pointers for practitioners.

One of the programme’s themes is the role of evidence in developing policy and interventions that reduce people’s risk of alcohol related harm, such as ABIs – Alcohol Brief Interventions. Dr Niamh Fitzgerald is an experienced ABI researcher and trainer across the UK. She works at the University of Stirling, developing alcohol teaching and public involvement for the UK Centre for Tobacco and Alcohol Studies.

There will be more discussion on this topic in a webinar on 26 May 2015, including learning from practice in Wales and England. Dr. Niamh Fitzgerald will also participate in the webinar.

For more from Iris FM click here.