I am delighted to have been able to spark off so much debate - although I
not sure whether it answers my original query, about the extent to which
the population/public health model continues to influence the health
policies of the US and other governments.
As I understand it, the target of reducing per capita alcohol consumption
by 25 per cent laid out by the US Department of Health and Human Services
in "Healthy People 2000" are likely to be achieved (more or less) yet the
government bodies that campaign against alcohol abuse insist that
alcohol-related problems are continuing to increase. Surely, according to
the public health model, a reduction in average alcohol consumption ought
to be associated with a reduction in alcohol-related harm? If not, I should
be very grateful if someone could take the trouble to explain to me why
not.
As regards the UK, when the Department of Health revised its "sensible
drinking" message in 1995, it stated that:
"There are difficulties in applying a whole population approach to alcohol
consumption, especially in the UK. The nature of the causal relationship
between average per capita consumption and alcohol misuse and problems is
still poorly understood and there does not appear to be any a priori reason
why the approach should apply universally. For example, it has been
possible to reduce the number of alcohol-related fatal road traffic
accidents without reducing the per capita consumption of the population as
a whole by getting the 'don't drink and drive' message widely accepted by
drivers. There is also the ethical problem of seeking to modify behaviour
which is in itself not harmful to the individual concerned to create a
climate which may influence some of those indulging in harmful to behaviour
to change. This is why current health promotion advice is couched in terms
of advising those drinking above the recommended levels to cut down, not of
trying to get everyone to reduce their drinking, and we believe this
approach should continue in the UK." (Department of Health, "Sensible
Drinking," 1995 section 9.4.)
The "recommended levels" mentioned above are between three and four "units"
a day for men and between two and three for women. (A UK "unit" is not the
same as a US "drink": the former contains 8 grams of ethanol, the latter
14.)
Regarding the funding of the Alcohol in Moderation conference at VINEXPO,
it did indeed come from the drinks industry but not specifically from wine
producers. I cannot speak officially for Alcohol in Moderation as I am not
a member of its editorial board, but I don't think they would complain if I
described it as a pro-drinks industry group which has set out its store to
argue for the benefits of moderate drinking. It also publishes a bi-monthly
newsletter carrying information about scientific research, government
policy, etc. This is supposed to be unprejudiced but is naturally skewed
towards information favourable to the industry, although nothing like to
the extent that the publications of, say, the Institute of Alcohol Studies
are skewed in the other direction.
The conference at VINEXPO was intended to further the group's objectives.
Thus, it looked at issues such as whether the scientific evidence suggested
that wine offered better protection against heart disease and other
illnesses than other forms of alcoholic drink and, if so, in what
quantities. Thomas Stuttaford, a British doctor who writes a daily column
in the London Times, argued that wine was better; Diederick Grobbee,
Professor of Clinical Epidemiology at the University of Utrecht, argued
that it was not. Jancis Robinson, who is the best-known British wine
writer, spoke about media attitudes to alcohol; Jacques Weill, former
Professor of Biochemistry at the Medical School of Tours, spoke about the
Ledermann theory; Dwight Heath (who is now a member of Alcohol in
Moderation's editorial board) spoke about the sort of things he usually
speaks about; I spoke, largely from a historical perspective, about the
counter-productive effects of what I argued were excessive controls on the
availability of alcohol (such as whether it is really a good idea to tell
every American under the age of 21 that (s)he is not allowed to drink).
No, we were not going to stand up for the public health/population model,
but the real aim of the conference, at least from my point of view, was to
try to introduce people who were not biochemists, doctors, historians or
sociologists to a subject of which they were largely unaware (the rationale
behind alcohol control policies) but in the consequences of which they were
deeply interested (being mostly involved in some aspect of the drinks
business or other). Of course we were going to put our own bias on that
information, but everyone knew where we were coming from. We had actually
hoped for rather more hostile questioning from the journalists who
attended, but obviously the speeches were so convincing that they had no
choice but to agree.
By the way, the red wine issue remains an open book. The public in America
jumped on it initially because Morley Safer (but not the scientists he
interviewed) referred specifically to red wine in the famous "Sixty
Minutes" programme on the French Paradox in 1991, and the wine industry
sought to take advantage (leading to a number of battles with the Bureau of
Alcohol, Tobacco and Firearms). Currently, quite a lot of research is being
published on the potential benefits of the antioxidants/flavonoids in red
wine but I do not think that anyone yet knows how they are used "in viro"
as opposed to "in vitro".
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