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April 2019

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Editorial – April 2019

Welcome to the April 2019 edition of Alcohol Alert, the Institute of Alcohol Studies newsletter, covering the latest updates on UK alcohol policy matters.

This month, Scotland sees a decrease in cider sales since the introduction of minimum unit pricing. Other articles include: Spanish MRI study finds brain damage continues after alcohol cessation, while according to a Chinese study light to moderate drinking does not offer protection from stroke.

Please click on the article titles to read them, or alternatively download a PDF version of our newsletter by clicking on the cover image. We hope you enjoy this edition.

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COVER STORY – MUP sees off white cider in Scotland

Data suggests price policy has all but wiped out the bottom end of the market

Ale saw an 8.3% volume increase

16 April 2019 – Sales data suggests a decrease in cider sales in Scotland since the introduction of minimum unit pricing there last May. The decrease is particularly pronounced for cheap, white ciders, with 'IRI data for the 40 subsequent weeks to February 2019 [showing] value white cider down 73.3%... year on year.' Own label alcohol products of all kinds also saw decreasing sales.

Overall, volume sales are up. Nielsen data published in The Times shows that '203.5 million litres of alcohol was purchased from shops in Scotland over the 46 weeks to March 29, an increase of 1.8 million litres — the equivalent of four million cans of lager or 2.4 million bottles of wine — on the same period in 2017-18'.

Some products have seen a rise in sales in the same period, including the tonic wine Buckfast, which was not affected by the pricing policy. Ale saw a 8.3% volume increase in the 12 weeks before February. Premium and craft cider sales have also increased, seeing some cider manufacturers speaking out in support of the policy. Speaking to Drinks Retailing News (DRN), Westons's Head of Business, Darryl Hinksman, said: 'MUP has premiumised the category and taken units out of the Scottish cider market. It is killing off this bottom end. We think it’s a good thing.'

Independent and smaller retailers are also benefitting from the policy, as it has closed the price differential between them and supermarkets, who were previously able to undercut them. Mumtaz Ali, who owns an Edinburgh branch of Mace, told DRN: 'I am sure the independent sector for alcohol is up in general since MUP. It’s very encouraging. Even in spirits I can now sell the cheapest vodka in my store at the same price as you would find in a supermarket. It doesn’t seem to have put people off buying alcohol but I don’t think there has been a negative effect either. It gives us a better margin.'

Some commentators have suggested that the overall increase in volume sales immediately after the policy’s introduction run counter to the predictions made in modelling the policy from the University fo Sheffield. The Scottish Conservatives have been particularly vocal in their criticism of the policy. Speaking to The Times, spokesperson Annie Wells said: 'A year on, these figures are hardly moving in the right direction. Itʼs important we keep an eye on this and do not assume minimum pricing is going to work on its own. And if it continues to be ineffective, it will have to be revoked.' However their assertions overlook the fact that volume sales do not necessarily translate into increases in unit consumption – purchase patterns may have changed.

The policy remains supported by Scottish alcohol charities. Alcohol Focus Scotland Chief Executive Alison Douglas stated her confidence in the measure, and that evaluation of the policy would show 'minimum unit pricing delivers clear benefits'. Ultimately, it is important to note that robust and reliable analysis of the data takes time, and NHS Scotland won’t be publishing its official evaluation of the policy until the end of the year.

On the anniversary of MUP's implementation, IAS Policy Analyst Aveek Bhattacharya's assessment of the policy found that: natural volume sales rose initially over the summer in Scotland, and have been flat/fallen since; unit sales were flat/rose modestly over the summer, and may have fallen since; and alcohol sales growth has been higher in England than in Scotland, suggesting that MUP 'restrained alcohol consumption over a period when it would otherwise have risen and may yet bring about reductions in consumption'.

'Either way, if MUP had this effect on the heavier drinking population, it will have reduced health harms and saved lives,' he wrote. 'Over the coming months and years, as we get more transparent data and rigorous analysis, we will have a better idea.'

You can listen to Alcohol Focus Scotland Chair Alison Douglas explain what we can learn from the data released so far on the IAS SoundCloud page (also read the AFS explainer for more information on the policy).

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Alcohol brain damage persists into abstinence

Study finds white matter defects in alcohol use disorder, even in non-drinkers

03 April 2019 – A study of men with alcohol use disorders suggests an underlying process that evolves after cessation of alcohol use.

Diagnostic markers characterising brain damage induced by alcohol, are lacking, especially at the beginning of abstinence, which is a critical period due to the high rate of relapse that it presents. So researchers from the Institute of Neuroscience CSIC-UMH in Alicante, Spain, and the Central Institute of Mental Health of Mannheim in Germany, teamed up to analyse the variety of structural changes in the brain among those admitted to hospital with alcohol-related conditions, using magnetic resonance imaging (MRI) to determine how brain damage progresses during the first weeks of abstinence.

Neuroimaging of 90 volunteers interned for rehabilitation treatment in a German hospital revealed that six weeks after drinking cessation, changes in white matter structure persisted.

The work was published in JAMA Psychiatry (follow the link for the abstract).

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No stroke of luck for moderate drinkers

Moderate levels of alcohol consumption do not offer protective effect, finds large scale study

04 April 2019 – A comprehensive study published in The Lancet dispels the conventional belief that light-to-moderate drinking might have a protective effect against stroke, as well as other diseases and conditions.

A team of researchers from the University of Oxford, Peking University, and the Chinese Academy of Medical Sciences led a large collaborative study of over 500,000 men and women in China who were asked about their alcohol intake and followed for ten years, to observe the occurrence of conditions including heart attack and stroke from medical records. In over 160,000 of these adults the researchers measured two genetic variants that substantially reduce alcohol intake – only 2% of women and 33% men in the study said they consumed alcohol most weeks.

Among men, genetic epidemiological analyses defied conventional analyses in that there were no U-shaped associations with stroke risk and there was no evidence of any protective effects of moderate alcohol intake against stroke. Instead, stroke risk rose steadily for mean male alcohol intake up to 256 g per week.

From this, the team concluded that alcohol increases the risk of having a stroke by about one-third (35%) for every four additional drinks per day (280 g of alcohol a week), with no protective effects of light or moderate drinking. Even those who consumed one or two drinks a day were found to have an increased stroke risk of about 10–15%.

For women, the genetic variants that cause alcohol intolerance had little effect on blood pressure or stroke risk. Therefore women effectively became a control group, which in turn helped to confirm that alcohol, rather than genes, was the driving factor for stroke risk.

When it came to the effect of alcohol on heart attack risk, there was no clear evidence of any net protective effect of moderate alcohol consumption against acute myocardial infarction or total coronary heart disease for men. However, due to the limited number of cases analysed, the researchers said the effects were not clear cut, and so more data needed to be collected over the next few years.

The Chinese effect

By comparing the health outcomes of drinkers and non-drinkers according to their genetic profile, the team say they have been able to assess – with much more certainty than before – the direct effects of alcohol on stroke risk, distinct from any other factors.

They were able to do so with participants from China, rather than western Europe, where almost no one possesses those same genetic variants needed to conduct such a study.

Beyond this, the study did have some limitations. Participants’ alcohol intake was based on self-reporting. Most of the alcohol they consumed was spirits, whereas some claim that red wine contains separate characteristics that are beneficial for heart health.

However, the researchers expect the findings to apply to alcohol in other drinks. ‘Claims that wine and beer have magical protective effects is not borne out,’ said study author Professor Richard Peto, professor of medical statistics and epidemiology at the University of Oxford.

In addition to this David Spiegelhalter, Winton professor for the public understanding of risk at the University of Cambridge, who often comments on the issue of risk in relation to low alcohol consumption, was convinced by the new study’s findings. ’This is a very impressive study which shows that men who, by chance, have a combination of genes that put them off drinking alcohol have a lower risk of stroke compared with those without these genes,’ he said.

‘The fact that this is not true for Chinese women, who tend not to drink whatever their genes, suggests this effect is due to the alcohol rather than the genes themselves. I have always been reasonably convinced that moderate alcohol consumption was protective for cardiovascular disease, but now I am having my doubts.’

Ultimately, the researchers believe that the results of their study have important implications for the alcohol policy beyond China. Co-author Professor Liming Li, from Peking University, said in a press release: ‘Stroke is a major cause of death and disability. This large collaborative study has shown that stroke rates are increased by alcohol. This should help inform personal choices and public health strategies.’

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Lloyd’s of London calls time on drink

Blanket ban for insurance workers within institution

08 April 2019 – The City of London’s premier insurance house plans to extend its ban on drink to all workers within its jurisdiction.

This follows a ban on the 800-odd members of staff directly employed by the 331-year-old institution from drinking during working hours (9am – 5pm), enacted two years ago.

Beyond this, Lloyd’s is made up of thousands more people and independent operators – the organisation told BBC News there are about 40,000 pass holders who have access to the building.

They will be subject to changes including the replacement of the on-site bar into a coffee shop, and following a string of sexual and verbal misconduct claims revealed by Bloomberg, a new hotline for those who wish to report bad behaviour. Anyone found responsible for sexual harassment also risks being banned for life.

The organisation knows that banning booze won't stop bad behaviour. It is, however, seen as an important signal in what Lloyd's says is a ‘bigger action plan’ to improve the culture over time.

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WHO: Partnering with alcohol industry on public health is not okay

Abridged from the British Medical Journal

09 April 2019 – The World Health Organization will not engage with the alcohol industry when developing alcohol policy or implementing public health measures, its staff have been told, and any government seeking advice from a collaboration with industry should be warned of the dangers.

The message that partnering, collaborating, taking funding, and even talking with the alcohol industry on some subjects is not acceptable has been laid out in an internal note to WHO staff.

'The public health objectives of WHO in relation to alcohol should serve as the basis for any interaction with the alcohol industry,' says the email, seen by The BMJ.

'The nature of interaction between the WHO secretariat and the alcohol industry should be limited to a dialogue and exchange of information for achieving positive outcomes for public health. Interaction with the alcohol industry within a given framework should not lead to or imply "partnership," "collaboration," or any other similar type of engagement that could give the impression of a formal joint relationship, the reason being that such engagements would put at risk the integrity, credibility, and independence of WHO’s work.'

WHO stopped short of recommending that other organisations and governments should follow its policy.

Governments seeking advice from WHO on the appropriate level of engagement with the alcohol industry will be told that this decision is 'at the discretion of each member state,' although the potential risks of engagement should be pointed out, WHO staff have been told. These include conflict of interest and 'undue or improper influence' on public health work, especially in policies, norms, and standard setting.

Governments will also be warned that engagement may be used by the alcohol industry primarily to serve their interests with limited or no benefits for public health; could be conferred as an endorsement of the alcohol industry’s name, brand, product, views, or activity; and considered as 'a whitewashing of the alcohol industry’s image.'

Several governments and non-governmental organisations (NGOs) have been criticised for partnering with the alcohol industry.

The Global Fund to Fight HIV, Tuberculosis, and Malaria has been criticised for partnering with Heineken because of a conflict of interest with the fund’s objective to tackle the burden of HIV and AIDS and because it gives Heineken credibility in its marketing to consumers and legitimacy as a partner to governments.

Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, described WHO’s guidelines as ‘an excellent document’ which he hoped would be used as a template by other organisations and governments.

‘I hope that Public Health England reflects on this carefully considered guidance,’ he said.

 ‘I think it says all the right things and its definitions are useful. For example—reflecting on the recent debacle with Public Health England and Drinkaware—Drinkaware would quite clearly be included as a commercial actor,’ he added. ‘And it is strong on outlining the risks of improper influence, which are that engaging could be considered as conferring endorsement in the industry’s name and whitewashing alcohol’s image.’

 For the full article, visit The BMJ website.

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Flight of fancy – risky whisky ad banned

Base-jumping ad does not go down well with regulators

10 April 2019 – A whisky advert featuring a man leaping off a cliff has been banned for promoting ‘risky behaviour’.

The Macallan ad, which was broadcast in December 2018 on television, video-on-demand and Instagram, featured the man falling towards the ground before sprouting wings and flying away, ending with the text ‘The Macallan. Make the call’, accompanied by an image of the whisky product in a glass.

Six complainants challenged the ad on the grounds that it was irresponsible for linking alcohol with daring, toughness or irresponsible behaviour.

In its defence, brand owner Edrington Distillers Ltd argued that its first global advertising campaign was a ‘fantastical story’ which did not link alcohol with ‘bravery, daring or toughness’ – despite an opening scene in which the main character ran and jumped off a cliff – because no one consumes alcohol during the entire sequence.

In relation to the television version of the ad, Clearcast, the clearance body for adverts in the UK, explained that they had considered the daring and toughness Code rule when clearing the ad, and had decided that the treatment was fantastical enough to be acceptable. Clearcast also shared comments they had received from the agency about the content of the ad and their arguments as to why they thought it was acceptable.

In relation to the video-on-demand version, ITV believed the ad was imaginary, fanciful and dreamlike; inasmuch as it was both detached from reality and grotesque, as illustrated by the sprouting of feathers and formation of wings in the male character.

In relation to the social media version, Instagram said the ad did not violate their policies and they had not received any complaints about it.

However, the Advertising Standards Authority (ASA) responded that the actions of the main characters were reminiscent of the extreme sport of base-jumping, and that the act of jumping off the cliff was dangerous, potentially fatal and consisted of extreme risk-taking behaviour.

In conclusion, they noted: ‘Whilst we acknowledged that some elements of the ad were fantastical, such as the distance the man fell through the clouds, and the sprouting of wings which enabled him to fly away instead of hitting the ground, we considered, nevertheless, that the central message of the ad, which was explicitly highlighted through the tagline "Would you risk falling ... for the chance to fly?", was one of promoting risky or daring behaviour to reap possible rewards.

‘Although the character was not seen consuming alcohol at any point, we considered the ads made a clear association between an alcoholic product and potentially very dangerous, daring behaviour and concluded that they were irresponsible.’

The ASA judged the television ad to breach BCAP code rules 1.2 (Social responsibility) and 19.5 (Alcohol), and video-on-demand and Instagram ads to have breached CAP Code (Edition 12) rules 1.3 (Social responsibility) and 18.4 (Alcohol).

The ASA ruled that the ads must not appear again in their current form, and instructed Edrington Distillers Ltd to ensure in future their ads did not link alcohol with daring, toughness or irresponsible behaviour.

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Call for global 50% rise in alcohol tax

Task Force addresses enormous and growing health and economic burden of NCDs

13 April 2019 – A global health taskforce advised by Scottish First Minister Nicola Sturgeon has called for a 50% increase in tax on alcohol, the Times reports.

The group, led by Michael Bloomberg, former mayor of New York, said that millions of premature deaths could be prevented worldwide if unhealthy products were taxed more.

Other members of the group include Helen Clark, former prime minister of New Zealand; Dame Minouche Shafik, director of the London School of Economics; and Tabaré Vázquez, the president of Uruguay.

Direct powers over so-called sin taxes are reserved to Westminster but Scotland has pioneered other deterrents, including a smoking ban in public places and the introduction last May of minimum unit pricing for alcohol.

The latter followed a five-year legal battle with the Scotch Whisky Association, which argued that it breached EU and global trade law.

The Scottish government has said that the minimum price of 50p per unit will be reviewed next year, but analysis reported at the weekend showed that alcohol consumption has increased since the new law came into force.

Annie Wells, public health spokeswoman for the Scottish Conservatives, said the latest report took a ‘nanny state’ approach and showed a ‘complete lack of imagination, with the only idea a tax hike on hardworking people and the products the vast majority of people enjoy responsibly’.

But the report accused industries of using ‘false or misleading statements related to revenues, employment, illicit trade and impacts on the poor’ to fight changes, and urged governments to ‘rapidly and significantly’ raise taxes on tobacco, alcohol and sugary drinks.

‘If we want to improve global health, we need to tax the things that are killing us,’ Laurence Summers, chairman of the group, said.

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