A new group that aims to 'give the public a voice in the debate on moderate drinking' has launched as new research on the revised guidelines, drinking in pregnancy and cancer warnings hit the headlines.
Drinkers' Voice labels itself as a consumer organisation and says 'the anti-alcohol lobby has dominated the conversation on alcohol and your health, resulting in misleading statistics and scaremongering news headlines'. A poll commissioned by the organisation was reported as finding 70% of drinkers ignore the UK guidelines, though a new study out today suggests whilst 71% of drinkers were aware of them existing, just 8% knew what the actual recommended amounts were.
Of course, public health advocates may respond that this points to a need for more to be done to raise awareness and support informed decision making, such as through mandatory labelling. Previous research looking at Twitter responses has suggested drinkers are more evenly split over the guidelines, with similar figures also seen in a CAMRA commissioned YouGov poll.
Drinking in pregnancy... absence of evidence?
One recent such issue has been official guidance on drinking in pregnancy, which received fresh attention following a new review which identified a lack of evidence over the risks of low levels of alcohol use in pregnancy. News reports however included headlines such as 'Pregnant? It's OK to drink two glasses of wine a week says study'. Elsewhere efforts were made to point out that an absence of evidence is not the same as evidence of absence, thus the precautionary principle should be adopted: without clear evidence that low levels of alcohol pose no risk in pregnancy, the official guidelines should not imply it is risk free, and should continue to advise not drinking at all.
However, commentators on the report also pointed to the need for balance in health advice to pregnant women, or those trying to conceive. The precautionary principle can be advised without unduly alarming women who may have consumed small amounts of alcohol, or leading to a culture in which pregnancy is excessively ‘policed’. On the other hand, given the poor public understanding of units and serving sizes, there remains the risk that the 'low amounts' analysed in the report (up to four units per week) could be misinterpreted.
Cancer risks downplayed?
Another new piece of research which hit the headlines followed a study reporting that the alcohol industry misrepresents the link between drinking and cancer risks through strategies such as 'denying, distortion and distraction'. Led by Mark Petticrew of the London School of Hygiene and Tropical Medicine (LSHTM), information relating to cancer on the websites and documents of nearly 30 alcohol industry organisations was analysed. It suggests the most common strategy used by industry sources was presenting the relationship between alcohol and cancer as highly complex, therefore implying there is no evidence of a consistent or independent link. Other industry strategies were reported as denying that any relationship exists, or inaccurately claiming that there is no risk associated with light or ‘moderate’ drinking.
The issue of cancer risks and drinking has certainly been under significant focus in recent years with Cancer Research UK and other health groups campaigning specifically on raising awareness of the links. Indeed a significant part of the downward revision to the men's guideline was due to further evidence about cancer risks at low levels, prompting the CMO's infamous comments on contemplating cancer risks with every glass of wine. However, as John Holmes has previously argued, public health groups should exercise caution over 'no safe level' messages and be mindful of the implications in terms of public credibility. Meanwhile, regular opponent of the 'anti-alcohol lobby' Christopher Snowden attacked Petticrew's research, challenging any reasonable person to read 'any Drinkaware literature - and claim that the organisation is trying to downplay or deny the risks of drinking', even describing Drinkaware as 'basically a temperance group'.
Evidence, people and persuasion...
Alcohol policy debates are often mis-represented as consisting of two opposing homogeneous sides: ‘the alcohol industry’ and ‘public health’. In reality, the motives and activities of those involved are often complex and not diametrically opposed. Drinkers' Voice says its goal is to be a 'grassroots organisation' which will 'train up spokespeople across the country who can speak rationally about alcohol', though it has been established with support from the Campaign for Real Ale (CAMRA), and its board include a number of long-standing opponents of alcohol health and policy campaigning. As a drinking consumer group, it says it wants people to talk about the positives of moderate drinking', defined as 'what suits you, as long as your actions aren’t having a negative impact on you or others'.
Defining moderate drinking as something other than the low-risk guidelines returns to the issue of what and how drinking risks should be framed. In a new editorial on risk in addiction science, policy and debate, John Holmes and Harry Sumnall warn against simplifying risk in public health communications, and call for approaches that recognise the complexity of how risk is calculated and how individuals balance risk in their day-to-day lives. In particular, it is important to be clear about the relationship between relative and absolute risk levels. For example, cancer risks from low level of consumption remain low in absolute terms, so presenting large relative risk increases without that context can be misleading.
Attempts to capture the average 'drinker's voice' may well resonate with those who are opposed to, or feel threatened by, health messages that appear at odds with their own and other's experiences. Last year an industry funded body nameed the Alcohol Information Partnership was set up with similar goals of 'bringing balance back to the debate'. If Drinkers’ Voice though proves an authentic public success then it may serve as a reminder to health campaigners that advice needs to speak meaningfully to individual experience, values and what has been termed ‘lay epidemiology’.
Of course, Government has a responsibility to support citizens in making informed choices about decisions that may have real implications for their well-being. Scientific assessments of risk levels cannot base the evidence around what people wish it to be, but certainly there appears to be room for improving how the available evidence is communicated to the public at large.
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