‘Sensible drinking’ limits not ‘useless’ after all

It is customary for stories about alcohol to attract media attention in the run up to Christmas, but towards the end of 2007 one alcohol story received unusually wide coverage.

This was the allegation that first appeared in the Times that the original ‘safe drinking’ limits of a maximum of 21 units of alcohol per week for men and 14 for women, dating from 1987,“had no firm scientific basis whatsoever”.

The Times, in a report headed “Drink limits ‘useless’”, quoted Dr Richard Smith, a former editor of the British Medical Journal and a member of the Royal College of Physicians working party that proposed the limits, as saying that the limits had really been “plucked out of the air. They were not based on any firm evidence at all. It was a sort of intelligent guess by a committee.”

The fact that the very next day Dr Smith attempted to retract the statement, saying “The suggestion that the guidelines were ‘useless’ is not what I meant at all. That would be a very serious misinterpretation”, did not prevent the original story from fully going the rounds, being fastened upon with particular relish by commentators keen, for whatever reason, to challenge the credibility of the current official advice on alcohol and health. There were frequent references to the new Puritanism, health fascism, and dogooders attempting to meddle in other people’s lives.

Some blog spots featured the story with headlines such as “Anti-alcohol campaigners – I told you those lying b******ds were making it up”, and “Statistics, data and damned liars”. Rather more up-market publications also got in on the act. In a review in The Spectator of a book on largely bogus health scares, the reviewer took the opportunity to have a swipe at the drinking guidelines despite their not featuring in the book he was reviewing:

“For 20 years we were solemnly and repeatedly lectured that 21 alcoholic units a week for men and 14 units for women were the upper limits of what is safe to drink. A couple of months ago we discovered that these figures were, in the belated admission of their author, ‘plucked out of thin air’. But did anyone think to query the evidence at the time? No, we were taken in by the government-endorsed expert. The only wonder is that he has not been knighted.” (Spectator,2 January 2008,Graham Stewart,Review of Scared to Death: From BSE to Global Warming by Christopher Booker and Richard North)

The Times itself continued its attack by claiming that the current drinking guidelines disregard a host of epidemiological studies proving that large quantities of alcohol are good for us, and that consumption of more than 50 units a week cuts the risk of premature death by half.

However, if the author of the article had taken the trouble to read the 1995 Joint Publication of the Medical Royal Colleges, she would have found the very studies she claimed were being disregarded were included among the references.The publication was entitled 'Alcohol and the Heart in Perspective:Sensible Limits Reaffirmed’.

The innacuracies contained in the Times report are likely to have added to public confusion about what the ‘sensible drinking’ limits are or should be, and to have reinforced the suspicion, welcomed by some very influential participants in the alcohol debate, that the official guidelines have been discredited.

The latest promotion of the idea by some in the media that the UK drinking guidelines are not only too low but are arbitrary and unscientific coincided with the publication of a major scientific review of the drinking guidelines in Australia. Ironically, contrary to the whole implication of the media coverage in the UK, the review concludes that the current Australian drinking limits are too high and should be lowered. If this policy is adopted the new Australian limits will be lower than the British ones.

What are drinking guidelines?

Drinking guidelines are designed essentially to answer the question of at what level of regular consumption of alcohol the average adult is likely to experience a significantly raised risk of health damage.

The guidelines originally formulated by the medical Royal Colleges of Physicians, Psychiatrists and General Practitioners, and adopted by Government, all agreed on the graded nature of the relationship between alcohol consumption and risk. Consumption of 1-14 units of alcohol per week for women, 1-21 units for men, was defined as low risk. Consumption of 15-35 units per week for women, 22-50 units for men was defined as hazardous and consumption of more than 35 and 50 units per week for women and men respectively as definitely harmful.

In 1995, the official guidance was changed from weekly to daily limits – no more than 3-4 units per day for men, no more than 2-3 units per day for women, with the qualification that these maximum levels of consumption should not be reached every day of the week.

These guidelines are broadly similar to those provided in other countries. In Canada, for example, the advice is for women to drink no more than 9 drinks per week and men no more than 14 drinks per week. At first sight, these appear to be lower than the UK limits, but, allowing for the fact that Canadian units are larger than British ones, they are in fact comparable.

The similarities are not surprising, given that the guidelines are based on epidemiological evidence in relation to alcohol-related disease and mortality which is international in character. This evidence has grown substantially over the years and there is no truth to the claim in the Times that those setting the guidelines have disregarded evidence showing regular, heavy consumption of alcohol to be safe or even beneficial. In fact, the truth lies in the opposite direction, the more recent research suggesting that alcohol is, if anything,more dangerous than was previously believed. It has become clear, for example, that there is a significantly increased risk of some diseases at consumption levels below the 21/14 drinks per week level. It is significant that a recent, major British study of health and disease found that mortality risk increased above a consumption level of 14 drinks per week in both men and women. And in Australia, the new proposed guideline for low risk drinking is that neither men nor women should exceed 20 grammes of pure alcohol per day. This is equivalent to 2.5 standard UK drinks. The Australians define ‘low risk’ as the level of alcohol intake that, for healthy adults, will reduce the lifetime risk of death from an alcohol-related injury or disease to less than 1 in 100 (that is, one death for every 100 people who drink at that level).

Below: The graph presents some of the evidence, in this case mortality, that is taken into account when setting the guidelines. Some argue that this evidence suggests that the guidance is deficient, though hardly in the way implied by The Times. For in relation to the diseases shown, it can be seen that there is no clear threshold of consumption below which there is no risk at all.