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Mar 31, 2014

The reality behind Big Grog and other villains of the public health debate

The reality of the alcohol and beverage industry fits poorly with efforts to dismiss them as evil vectors of disease. The real data on health tells a different story.

Bernard Keane — Politics editor

Bernard Keane

Politics editor

Last week we saw how corporations are regarded as vectors of non-communicable diseases by key Australian public health lobbyists, thereby rendering the idea of consultation or communication with industry on health regulation as logical as communicating with a virus one seeks to eradicate. Before looking at some examples of how this is applied, it’s worth spending a little more time considering how accurate this Corporate Virology approach is. Last week we noted that Australian lifespans had continued to increase despite the apparently remorseless assault of alcohol, processed food, sugar and soft drink companies on the diets of Australians. Alcohol is particularly worth considering in this regard. Despite being dismissed as a clone of the tobacco industry by the public health lobby, there is extensive evidence for the health benefits of light to moderate alcohol consumption. The National Health and Medical Research Council’s 2001 alcohol guidelines contained considerable discussion of the “good evidence” that regular low-risk drinking protects against heart disease:
"Most studies of the effects of drinking measure these in relation to the amount people drink over time. Clear indications have emerged over recent years, however, that the pattern, as well as the level, of drinking is important in relation to both the risks and the benefits of alcohol. Essentially, the evidence suggests that low to moderate regular drinking, particularly when it occurs with meals, affords partial protection against heart disease and heart attack for people of middle age and older; while heavy drinking (both episodic and long-term) markedly increases the risk of heart attack."
However, the NHMRC watered down its comments on the benefits of moderate alcohol consumption when it overhauled the guidelines in 2009 (the guidelines that halved the recommended level of alcohol consumption per day for men to two standard drinks), citing studies that disputed the benefits of alcohol for cardiovascular disease and noting "the potential cardiovascular benefits from alcohol can also be gained from other means, such as exercise or modifying the diet". Another problem with the benefits of moderate alcohol consumption is that they are offset by the increased risks of various forms of cancer, such as mouth and oesophageal cancers and breast cancer in Caucasian women, that are known to be associated with alcohol consumption, as well as the consequences of heavy drinking.
"None of this fits with the 'Big Grog=Big Tobacco=Big Sugar=Corporate Virus' thesis ..."
The Boston University School of Medicine hosts an International Scientific Forum on Alcohol Research, which uses experts in a range of disciplines to conduct an ongoing review of alcohol-related research around the world. Studies reviewed by the forum in the last two years show increasing evidence of a wide range of benefits from low-to-moderate alcohol consumption in areas such as cardiovascular disease amongst people with diabetes, multiple sclerosis, arthritis, dementia and osteoperosis, as well as greater evidence of links between alcohol and skin cancer, gout and macular degeneration. It’s thus possible, as some studies have concluded, that in countries with relatively moderate alcohol consumption (like Australia, ranked 44th in the world in per capita consumption) the number of deaths attributable to alcohol consumption is exceeded by the number of deaths prevented by alcohol consumption rather than, as is assumed in costings of the impact of alcohol, alcohol-attributable deaths significantly outnumbering alcohol-preventable deaths. Two consistent themes of the ISFAR critiques are the J-shaped curve of the link between alcohol consumption and overall mortality, with light or moderate alcohol consumption being associated with lower overall mortality than abstention or heavy consumption, and the highly damaging effects of binge drinking compared to regular, moderate drinking -- as the NHMRC's 2001 guidelines suggested, the pattern as well as the level of drinking is important. The Corporate Virology approach thus becomes problematic when the alcohol industry itself, via initiatives like DrinkWise, promotes consumption of its product at exactly the level and in the manner that evidence suggests is most consistent with overall longevity (Drinkwise promotes the NHMRC guidelines on both moderate drinking and binge drinking). The beverage industry reflects different problems with the Corporate Virology thesis. Sugar is now the supervillain of the obesity debate, with the Public Health Association of Australia earlier this month welcoming a World Health Organisation recommendation that people halve their sugar intake and other public health groups calling for a "sugar tax" on soft drinks (the US has had a long-running debate over "soda taxes" which are common across many states). All that is ostensibly bad news for the soft drink industry. But the biggest problem for US soft drink manufacturers currently is trying to stop people abandoning low-sugar soft drinks like Diet Coke, Coke Zero and Diet Pepsi -- sales of which are falling much more rapidly than full-sugar products like Coke -- due to concerns about artificial sweeteners. One of the key vectors of the "obesity pandemic" is thus aggressively marketing low-sugar products (and that, incidentally, points to one of the problems of sugar taxes urged by public health groups: many overweight people already consume low-sugar beverages). None of this fits with the "Big Grog=Big Tobacco=Big Sugar=Corporate Virus" thesis advanced by some public health figures as a rationale for not dealing with the private sector -- preferring instead to tax and regulate what Australians consume.

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23 comments

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23 thoughts on “The reality behind Big Grog and other villains of the public health debate

  1. Shaniq'ua Shardonn'ay

    Oh – and drinking alcohol would have also been a good idea for many urban dwellers up until recently. Clean drinking water is a pretty new invention as well.

  2. john willoughby

    you are the Tamas Calderwood of piss drinking..

  3. Merve

    Shame that most of the ads seem to target young people and excessive drinking.

  4. Rosemary Stanton

    The claim that sugar is the super villain needs some explanation. Ever since Australia’s first Dietary Goals were formulated in 1979, the recommendations have been to avoid too much sugar, salt and saturated fat. There is no single way to eat badly and it’s simplistic to put it down to a single nutrient. After all, sugar comes with saturated fat in biscuits, cakes, pastries, confectionery and most desserts.

    The processed food industry in the US took the ‘reduce saturated fat’ message and produced plate-sized low fat chocolate cookies and literally hundreds of other junky foods with sugar and refined starches replacing fat. This was never in any official nutrition advice which was overwhelmingly to eat more vegetables, fruits and wholegrains.

    When 68% of men and 56% of Australian women are overweight or obese and when the average intake of junk foods contributes 36% of their kilojoules, consuming fewer junk foods (and hence less sugar, fat and alcohol) is not rocket science.

    You also seem to gloss over the increased risks of breast cancer for women with alcohol intake. Since breast cancer is far more common than mouth or oesophageal cancers, and since the risk for breast cancer comes with quite low intakes of alcohol and any increase in mouth and oesophageal cancers with alcohol requires much higher amounts, it seems strange that you put breast cancer behind the other two in your list.

  5. bloke99

    I’d be interested in rigorous studies of the mental health benefits of drinking. For many people it is a social activity that maintains and establishes all sorts of interpersonal connections. It can also be good for alleviating mental stresses. A more holistic view of the effects of alcohol on health might make moderate drinking seem better than many think it is.

  6. Northy

    Another one from Keane on this issue! Getting a little fixated it seems Bernard. I’m sorry to say but regulation of alcohol works. Have a look at the stunning early results of Sydney’s lockouts & early pub closures – a 50% drop in assaults (as we found out today). It is not surprising as all of the evidence and research pointed to this result. The head of St Vincent’s emergency said the hospital hasn’t had a single alcohol-related critical assault in 5 weekends. That was unheard of previously. Regulation of alcohol in Sydney city is saving lives; and it’s not like people can’t still go out and have a good night.

  7. JohnB

    Northy, I cannot recall Bernard supporting all-night binges or heading off to nightclubs preloaded with cask wine to keep the cost down.

    Like you, I support the so-called “Newcastle Solution” that has seen another publican fined today $5800 plus costs plus getting banned from holding a liquor licence for 12 months for serving underage and/or after hours customers. Unlike you, I don’t need a straw man argument to make my point. Why suggest that Bernard is against the Newcastle Solution?

    Three articles in the past six months do not demonstrate that Bernard is fixated on the topic of alcohol consumption.

    If only all contributors to this discussion relied on verifiable data, then Bernard would not need three articles in order to get his points across, which are (a) that the NH&MRC has failed to justify its tightening of certain recommendations, (b)that the negative effects of moderate consumption of alcohol are often over-rated by commentators and (c)that the Corporate Virus Theory accurately describes the alcohol industry.

    If Bernard is seeking a reasoned cry for adoption by the NH&MRC and others of rational policies, then he deserves to be applauded. Health policy, as Rosemary Stanton pointed out, is much more complex than declaring war on single factors such as sugar or alcohol marketing.

    That said, I missed the message from St Vincent’s Hospital. Thanks for mentioning it. We may still be getting more obese, but there is hope that society has identified a tool which works to reduce alcohol-induced violence.

  8. JohnB

    Oops!

    “…(c)that the Corporate Virus Theory accurately describes the alcohol industry” should read “(c)that the Corporate Virus Theory does not accurately describe the alcohol industry.

  9. AR

    BK still churning out his IPA job applications – he’ll have his own chapter in “Merchants of DO#ubt” any day now.

  10. AR

    ..would be “Merchants of Doubt” – anyone know how to change a keyboard from ameriakn layout?

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