A letter to the Irish Medical Times regarding its regular wine feature

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Dear Editor,

It’s encouraging for the health of your readers that we now have a growing number of doctors pro-alcohol writing in Irish Medical Times.

The fact that Dr Ruairi Hanley and Dr EP MacManus vigorously leapt to the defence of ’Giovanni Morelli’ following my ’Cono sur article was inappropriate’ letter indicates to me just how out of touch they are as to why ’advertising’ alcohol in IMT is inappropriate.

Gentlemen, just to let you know, I don’t believe in the ’nanny state’. I am not an advocate of the ’thou shall not’ mantra or muzzling the right to free speech. I try to empower people to make positive health choices in their lives every day ”” in a way that works for them. I developed and teach an ICGP-accredited brief intervention training programme that helps clinical staff address alcohol problems in an effective way with their patients.

Addressing alcohol misuse is indeed a multi-faceted problem. However, I fundamentally believe that no-one in the health services should either directly or subtlety promote/advertise alcohol in any form. I believe it is unethical for healthcare workers to do so ”” as alcohol promotion in any form undeniably contributes to its normalisation and societal acceptance, which in turn adds to the alcohol problem we have today, a problem that thousands of staff in the health services fight to reduce. Indeed, there is a strong argument for the omission of pro-alcohol-related articles in IMT when you consider the following:

1. Banning the advertising of alcohol has long been seen as an effective measure to help reduce alcohol consumption (IMT‘s Gary Culliton on May 1: ’The College of Psychiatrists of Ireland has issued a policy paper calling for a ban on all alcohol advertising and sponsorship in Ireland’). This concept has been backed up by all of Ireland’s leading physicians.

2. Most people do not drink ’responsibly’, as Dr Hanley incorrectly stated. Some 1,500,000 people in Ireland are drinking in a way that damages their health. That’s 50 per cent of the Irish population who drink. The problem is we all believe we drink ’responsibly’ or ’sensibly’ because the drinks industry uses moral language to portray alcohol consumption rather than using health terms. Don’t feel bad, Ruairi, they fooled you also.

You never hear the industry say, ’always stick to the low-risk weekly limits (11-14 units for females and 17-21 for males)’. So while we may be drinking ’responsibly’ by not assaulting our fellow man in Temple Bar on Saturday night, injuring ourselves or others through intoxication, rest assured one in two of us is drinking too much. And the facts back it up.

Alcohol misuse is the biggest drug problem in Ireland. Alcoholic liver disease has trebled here in the past 20 years, a disease which is developed primarily by habitual drinkers, not alcoholics, as Dr Hanley incorrectly pointed out. Additionally, 2,500 deaths each year in Ireland are caused by alcohol, while 35 per cent of male deaths aged 35-50 are as a result of alcohol. Are these ’sensible’ or ’responsible’ health outcomes for Irish drinkers? Dr Hanley also stated: “It would appear to some of our readers that we columnists should not be promoting the perfectly legal consumption of alcohol.” Tobacco, like alcohol, is also a legal product (drug). It kills 5,200 people each year in Ireland. Would you advertise cigarettes or cigars in IMT?

3. There appears to be a long history of alcohol-related problems amongst us healthcare professionals. Dr Michael Wilks, now Vice Chairman of the Sick Doctors Trust, a support organisation in the UK for doctors with drug and alcohol problems and their families, has commented: “The level of knowledge about how to deal with addiction in general practice is lamentable. The joke used to be that an alcoholic only drinks as much as his GP.” He further adds that the medical profession is in deep denial about the scale of its alcohol problem. “One of the issues about alcohol misuse is denial, so doctors are very, very ill indeed before they seek help, and usually that’s only when they have reached a crisis point and been arrested for a drink-driving offence, assault, or stealing to feed their habit.”

Evidence also indicates higher rates of suicide, depression, anxiety and substance misuse among health professionals than among other groups of workers. Additionally, in a Daily Mail investigation in 2012, an anonymous doctor described the medical profession as “hypocritical” in its attitudes to alcohol: “This dependence on alcohol for social interaction and relaxation should be worrying to all medical students and perhaps we should strive to live by example.” Curious to find out more, I asked Peter Anderson, Professor of Alcohol and Health, Oxford/ Maastricht Universities, to comment on the prevalence of alcohol misuse amongst healthcare professions. He told me that historically doctors had higher cirrhosis levels than that of the general population and echoed the ’joke’ made by Dr Wilks. He added that these cirrhosis levels had come down to comparable levels to the general population.

However, as healthcare professionals, should we not have lower cirrhosis levels than the general population? He also commented that drinking just two drinks per day containing alcohol increased the risk of mouth cancers by an astonishing 86 per cent. Eighty-six per cent from two drinks! He further added that: there is no consumption of alcohol that is considered safe; we should be leading by example regarding alcohol consumption; we should encourage colleagues to drink less (by not promoting alcohol consumption in IMT).

Sobering stuff indeed.

Therefore, in light of these points, should we not as healthcare workers advocate for the reduction of alcohol promotion across the board, including IMT? If we don’t, then who will? We should be the ones setting the examples for others to follow in relation to alcohol consumption ”” are we not looked upon as the experts, after all?

Perhaps your contributors would acknowledge that having a wine feature may not be so appropriate after all in IMT?

To conclude, I see my mate Gio quoted Marie Curie recently: “Great people talk about ideas, average people talk about things and small people talk about wine.” He then followed up by saying: “Well, that quote probably puts me in my place.” Enough said.

But rather than go back and forth about this for the next millennium, let’s settle it in a way to which all parties would surely agree? Ruairi, Gio and EP, how about a chat down in the local pub sipping four fresh, ice cold, tangy orange juices? Gentlemen, I’m buying.

Greg Conlon,

Health Promotion Officer,

Department of Preventive Medicine and Health Promotion, SVUH, Elm Park, Dublin 4.