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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Wednesday 22nd June 2011

There’s a tendency, I was going to write ‘in science’ but I think it’s more general than that, to take a flawed assumption and build an entire edifice on it with tentacles stretching into whole new areas. If this goes on long enough you can easily forget the weakness of the starting point of an argument. But, equally, we’ve become so used to hearing that something has been plucked out of the air (5 a day, 45 minutes, etc.) that we may assume something is flawed when, at its heart, it is not.

This week’s report from the Royal College of Psychiatrists  is about the whole topic of substance misuse in the older population but almost all of the media coverage has centred on its call for a reduction in the recommended ‘safe’ levels of alcohol consumption for the over 65s.

I’ll come back to the question of alcohol, but the areas of the report that are being ignored by the media are the more important. First of all, it’s about all substance misuse, so things like misuse of prescribed medication and, even, over the counter remedies is included because they can all contribute to health problems. The report’s thrust seems to be to alert doctors and other healthcare professionals to think about substance misuse when diagnosing older people because, for example, signs of mild cognitive impairment may not just be due to ‘a senior moment’.

But, even more important than this is the forward looking aspect of the report. People born in 1946 are, during 2011, passing the 65 years old change, as far as scientific research is concerned, from ‘adult’ to ‘older’. This means that in the near future the older population will begin to comprise those whose teenage years were spent in the late 60s onwards when substance use began to take off. These people may not bring with them any health legacy of their youthful indiscretions but they will bring a more relaxed attitude towards the use of psychoactive substances that could see the presently very small prevalence in the older 65s grow.

In terms of medical knowledge, now is the time to begin thinking about what to do with a problem that may be no more than ten or so years away. That is the main argument of the RCS’s report but, sadly, it is one that is being generally ignored. Not that it is surprising that it is being passed over. There is quite a bit of writing in the scientific literature about older people and substance misuse going back up to 20 years ago but this report is being treated as though older people giving themselves health problems through drink is a new phenomenon.

So, having tried to stress that the report is about much more than booze, I’ll turn to what it does say on that subject.

There’s a lot of misunderstanding about the recommended ‘safe’ levels of alcohol consumption. There are still reports, occasionally, that the limits were ‘plucked out of the air’ and have no scientific basis. The idea that these are ‘safe’ limits is, by the way, a media invention. They were first put forward as ‘sensible’ limits, a subtle but important difference. It is true that the first limits came about because of something called ‘a consensus statement’ issued by a working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners in 1992. In other words, the scientific evidence was not unequivocal, at the time, but the recommendations were a best guess based on the state of knowledge rather than the stab in the dark the limits are often said to be.

But, those who attack the recommended limits as being without foundation ignore the body of scientific work that has been undertaken since 1992 as researchers have sought to determine if the ‘consensus statement’ was a lucky guess or just a number plucked from the air. In fact, the overwhelming view of later research is that, as a ‘sensible’ limit, the 1992 figure, 21 units for men and 14 for women per week, was a useful measure.

Of course, people will always misunderstand advice and a perception arose that drinking nothing for six days followed up by a night out involving 21 units of alcohol was ‘safe’. So, in 1995, the Department of Health revised its advice to say that, within the weekly total, there should be a daily limit of 4 units per day for men and 3 units a day for women. Now, of course, all that does is complicate matters because people don’t see how it can be OK to drink 4 units a day but not to OK to drink over 21 units per week.

Because the media doesn’t think people can understand complexity and doesn’t want to waste time on education, you will almost always see the weekly limits specified, sometimes, in pieces that ridicule the idea that having your whole week’s ‘allowance’ in one night is within the limits.

The coverage of this new report implies that the idea of reduced ‘sensible’ limits for older people is new. In fact, the authors make it quite clear that they are echoing evidence based advice, from the USA in 2005, that older people (both men and women) should have no more than 1.5 units per day within a weekly total of 11 units. They also quote research, in 2009, suggesting that for older men over 4.5 units in one session should be considered to be binge drinking with 3 units as the equivalent for women.

So, the report is saying nothing new about alcohol limits for older people and, in fact, suggests that the lower figures should be ‘best practice’ for healthcare providers rather than coming out and calling for official guidance to be changed. All in all, another example of the difference between what a report says and what the media decides it would like it to have said.

But, it is wrong to suggest that this is a simple matter of conflict between science and the media. This report and the reporting of it give an interesting insight into the role of the press office in spreading less than correct information. Though, as above, the report cites the same weekly limit for older men and women, the press release from the RCS introduces the idea that, for women, the daily intake should be 1 unit with a weekly maximum of 7 units. So, though there is research that can be cited to justify the 11 units a week recommendation for men, the 7 units per week for women seems to have been plucked out of the air, possibly, because the press office didn’t want to have to deal with questions about why there was a lower daily recommendation based on gender but no difference in the weekly figure.

The misreporting by the media and the collusion of press offices in pointing out the ‘sexy’ parts of new work matter, not least because they allow people and, in particular, the alcohol industry to use the ‘Scientists, what do they know?’ argument to dismantle any attempt to get the problem of alcohol taken seriously.

Because, the unarguable fact is that alcohol is the second most harmful poison (plant-derived or otherwise) known to mankind with tobacco as the only substance producing more illness, suffering, early death and family and society problems.