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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Saturday 22nd October 2011

I’ve mentioned the NHS Choices Behind the Headlines website  before. I’ve used it to help me explain research on ‘Tabex’, the smoking cessation aid produced from Laburnum, Sunday 9th October, the possible role of colchicine, from Colchicum autumnale, the autumn crocus, in treating cancer Sunday 25th September and whether films showing smoking should be given an ‘18’ certificate Saturday 24th September.

It’s such a very well written and informative site that I’m willing to give it the benefit of the doubt when the authors resort to bad puns. A recent item about ‘fish pedicures’ couldn’t resist discussing the ‘scale’ of the problem and warning against being ‘reeled’ in by ‘fishy’ headlines.

Mostly, the site deals with very serious health matters and it has just produced a new report about one of the most serious; the effects of alcohol on health. The full 22-page report is available as a pdf that can be downloaded from here and I would strongly suggest that you read the full document for yourself.

The report looks at all the articles in Behind the Headlines related to alcohol written between July 2007 and July 2011. During that time, 75 studies were analysed along with how they were covered by a total of 242 news reports. By way of introducing its subject, the authors point out that the Daily Mail carried an item about how drinking alcohol every day could reduce the risk of heart disease just two days after carrying an item stating that a continuation of current drinking patterns would see an additional 250,000 deaths due to alcohol over 20 years.

It highlights the problems with delivering health messages to people. The first is that most people will get their health ‘education’ from the media rather than from the source of the information or from someone like NHS Choices. The second is that they may read just the headline and the first couple of paragraphs whereas the more balanced explanation of what a particular study actually shows is buried much further down the story. And the third is that people have become used to the idea that today something is good for you but, yesterday, it was bad.

That leads to a general distrust of health information where people decide that scientists don’t know what they are talking about and continue with a risky lifestyle when a reasoned examination of the issues makes it quite clear that science is in no doubt over the core of an issue.

There is a fourth thing, which is that health problems happen to other people. When I talk about smoking tobacco, I explain that, statistically, 50% of those who smoke regularly shorten their lives as a result but that, anecdotally, 100% of smokers believe themselves to be in the other 50%.

I should love to see a study done of just how much attention people pay to stories in the press about alcohol. My suspicion is that it would turn out that people pay more attention to, and retain more of the detail of, stories about the alleged benefits of alcohol than they do about its proven harms. Why read about the damage to health that alcohol can do when one ‘knows’ that one is not susceptible to that damage? Whereas reading about claims of reduced heart disease or similar provide a useful reinforcement for one’s existing behaviour.

If my suspicion is correct then reducing the number of stories that exaggerate or misrepresent a study showing some positive impact of alcohol would likely make little difference to the overall public perception of the health issues surrounding alcohol.

There is also a problem with the prominence a study achieves as a result of being featured in the press. The NHS Choices report gives two examples. In 2009, the Guardian reported that researchers had found that drinking ‘a glass or two’ of champagne produced benefits to the circulation that should reduce the risk of heart disease. But this was a trial involving only 15 subjects. Similarly, the Daily Mail reported that whilst one glass of wine was beneficial to cardiac health a second could increase risk based on a trial involving only 13 people.

The trouble with giving such small studies prominence is that the study results enter the public consciousness but not the limits of the study. Even today, many people will tell you, as indisputable fact, that coffee is a diuretic. Even doctors, when suggesting an increase of fluid intake, will often say not alcohol and not coffee or tea because caffeine is a diuretic.

But, that perception of caffeine comes from a 1928 study involving three subjects whose urination patterns were studied, for a few hours only, before and after drinking coffee. There were no controls i.e. no-one was asked to drink the same amount of liquid with no caffeine present so concluding that the need to wee after drinking a quantity of coffee was due to the caffeine is about as unscientific as it gets.

Also, today, there was a separate indication of the problems of reporting matters related to alcohol and health. UK government advice is that men should have no more than 4 units of alcohol a week and women 3. This has been, generally, multiplied up to give a weekly level of 28 units for men and 21 for women. But, the weekly advisory limits are 21 units for men and 14 for women, the assumption being that people will not drink every day.

Recently, the Royal College of Physicians, in written evidence to a House of Commons committee, stated that the limits suggested that people should have two or three alcohol free days per week. Today, the Daily Mail has reported that submission as if it gives new advice that contradicts previous government pronouncements when, in fact, as long ago as 2009, the potential for confusion from giving daily limits and weekly limits without making it clear that some days should be alcohol free was widely discussed.

The way this has been reported simply adds to that public perception that ‘scientists don’t know’ giving many people cover to continue high risk drinking.