ALCOHOL

Alcohol abuse, its effects on society as well as habitual drinkers, has become a major topic of discussion in the British Society, even as the opinion-makers struggle to find ways to cope with systematic abuse and binge drinking.

TIME FOR A NEW APPROACH TO ALCOHOL

NICK EDWARDS

As an Accident and Emergency doctor, I see at first hand the effects that our booze culture is having on our health. And it scares me: self-induced illness costing the NHS a fortune, putting millions of patient’s health at risk ….. and taking my time away from looking after other patients. Some days I just despair. Last week was one of them.

In the same shift three teenagers were brought in before 9 pm dangerously drunk – the all drank vast quantities of beeer/wine/vodka/odd-coloured – surgery-alcohol-pop, before going out and then collapsed at various places outside the clubs they were on route to.

Ambulances were called and they were brought to my care. One was so drunk we had to suction out the vomit from her mouth to stop her choking to death. Another girl wet herself and then proceeded to vomit on the floor and hurl abuse at the staff. The third was so unconscious we ended up having to take over their breathing and taking them for a CT scan of their head to check that they hadn’t had a head injury. Why on why does this happen so regularly?

Alcohol induced fights

       Later on that evening there had been a punch up outside a night club – alcohol induced. Involved were two patients. Injuries were one facial bone fracture, one neck laceration from biting, two broken hands and a ruptured liver from being kicked in the stomach.

      Between them, the patients had a total of four operations, over 10 days in hospital- four of which were in intensive care and had a total of three A&E doctors, six surgeons, four anesthetists, six intensive care doctors, seventeen nurses, twelve operating department practitioners, three physiotherapists, three pharmacists and an occupational therapist involved in their care. It becomes obvious why alcohol is so expensive for the NHS.ass

     But it is not just your typical binge drinker tha causes problems. Last week a 68 year old retired solicitor came in. His partner had called an ambulance after he fell down the stairs. He had had his usual daily alcohol; four pints of Stella and a couple’ of whisky chasers not to mention a ‘few’ glasses of claret. He fractured his neck and skull and nearly died from internal bleeding. He had to put him to sleep, take him for an emergency scan and then to theatre and then to intensive care. He will survive but it is unlikely he will walk again. His care will be reassuring expensive for the tax payer.

      Chronic alcohol use

Then there are the effects of chronic alcohol use. A 45 year old man came in as he felt so terrible – so terrible that he had n’t been able to drink for two days – a very worrying sign. He had been drinking dialy since he had married. He a drank a bottle of wine with his meal each night and then before bed, a glass or two of whisky. He worked as an office manager, had two children and was very typical friendly next door neighbour.

           But he had given himself alcoholic hepatitis. His liver couldn’t cope any more with this level of alcohol and had gone into “shut-down”. Unless he stops drinking it won’t be long before this is a permanent state, liver cirrhosis develops and then he could become another sad statistic.

           Sometimes at work, you just despair and wonder why it is happening. Of all the drugs there are alcohol is the most dangerous – in the short term and long term. It is also the drug which cuases the most problems and costs the most for the NHS.

            Drinking glamourised

But all that has happened in the last few years is binge drinking has been glamourised and alcohol has been become easier to get and cheaper.

            So, what can society do? We need to de-glambourise alcohol – celebrities have a role to play as we know the influence they have. But we all need to be more responsible : teaching our children sensible limits and drinking responsibility ourselves. How many people reading think it is ok to drink a bottle of wine at night?  As my patient showed it is dangerous and you need to cut-down. Learn how much is safe to drink and stick to it otherwise you could end up in a similar state.

But the government needs to act. Self regulation of the alcohol industry has failed. We need a coordinate approach, which doesn’t damage the pub trade or affect the millions of people who sensibly enjoy a few pints a week.

            

             The health of our populations is more important than the share prices of a few drinks companies and supermarket.

            Here is my manifesto:

             We need a minimum alcohol price; supermarkets should be banned from selling crazily cheap alcohol. Not only would it cut alcohol consumption, but would help pubs as people will be less inclined to drink at home.

            Change Culture

We should encourage European style café culture and not a let’s get as drunk as possible as quickly as possible. Pubs should be forced to have adequate seats and tables and not be “vertical drinking” establishment. Redesigning of pubs has been shown to cut down massively on excess drinking. 24-hour drinking has not really increased alcohol drinking in A&E, it has spread it out throughout the night. I would be happy for 24 hour drinking to continue if real changes were made to drinking culture.

           

            Curb Promotions

Promotions which encourage excess drinking should be banned – drink as much as you can for a tenner, buy one get one free shots etc.

We should have a tax which is reflective on how strong the alcohol is and how likely it is to be drunk by underage teenagers. Overall tax should be increased on alcohol as this has shown an overall decrease in demand. It may not be popular but a few extra pence a week for the majority of sensible drinkers would save thousand of precious lives a year.

Clubs and pubs should be fined much more if they sell under age people and drunken people. The extra taxes should be hypothecated and not enter into general taxation pot. They should pay for alcohol withdrawal programmes and extra A&E staff for evenings when the consequence of alcohol hit us.

Don’t glamourise drinking

Finally, adverts glamourising alcohol should be banned and there should be explicit labels how much alcohol there is in drinks shown on the front of drinks.

            If any from drink industry does not believe me, then please join me on Saturday night in A & E. You will go home in despair, as I do most  nights and you will be persuaded that something needs to be done.

                               The write is a doctor who wrote the book “ In stitches, the highs and lows of life as an A & E doctor.” --- The Independent.

Source: The Tribune, February 18, 2012.

DRINKING

Binge-drinking can go the way of smoking

Steve Richards

Often in government in a policy surfaces from nowhere and comes to have more impact than those that attract a mountain of words in the media. Harold Wilson’s introduction of the Open University is one such example, his most life-enhancing policy as Prime Minister and one that got virtually no attention in advance, at least compared with his long forgotten pay policies.

Think also of the one measure implemented by Tony Blair that will have more positive impact on the NHS and people’s lives than all his reforms and increased investment, important though the higher spending was. Let us raise a glass to the smoking ban in public places, a policy hardly mentioned in all th books about the New Labour era and which attracted relatively little attention at the time of implementations, compared with, say a row between Gordon Brown and Blair over the wording of a speech on Europe. Of course, there were blazing disagreements over NHS reform, too, but the resulting policies, let alone those being considered by Andrew Lansley, don’t save any where near as much money or as many lives as the ban will eventually do.

`1

Smoking outdoors

Teenagers used to discover a love of smoking in pubs. They are not able to discover the love in such convivial circumstances any more. I see a few of them outside pubs in sub-zero temperatures. They take their drags as they freeze, almost bent over in physical pain. Some of them will give up. Some of those indoors will not start. They will save the NHS a fortune.

Foolish libertarians opposed the ban at the time, but even some of those accept now that the freedom for non-smokers to sit in public places without breathing in the equivalent of 20 Marlboros is also a liberty. The former Health Secretary, John Reid, was against the move on the grounds that it discriminated against the working-class people who enjoyed a smoke in their clubs. But Reid tended to make the wrong call. The smoking ban is here to stay. Let us raise another glass.

Smoking ban worked

 But let us not raise too many glasses. David Camron has identified his equivalent cause, highlighting the drinking culture in the UK as the “scandal of our society”. He estimates that the cost to the NHS us up Pound 3 billion. His remedies are to be unveiled next month, but he is apparently resolved to implement a “big bang” approach rather than opt for cautious incremental measures.

            Let us raise a glass of orange juice. He is right to identify the urgency of the situation and must therefore counter the still vibrant libertarian instincts of some of his advisers and colleagues. Perhaps it is an instinct he shares, too. Cameron opposed the smoking ban at first, although he has since acknowledged that the measure has worked.

          Some of his proposals might help ease the pressure on crazily overworked A & E wards in hospitals on Fridays and Saturdays, and a few other nights of the week, too. They include more police on patrol in A&E departments, and “booze buses” – vehicles staffed with paramedics to help intoxicated revelers. But the key is to reduce the amount of alcohol consumed. This is not easily achieved.

           

            On-the-spot fine

           

            When Blair proposed taking drunks to a cash machine in order to pay an on –the –spot fine, the poor old Home Office Minister at the time, Charles Carke had to pop up to explain that the idea was a “metaphor”. The more practical route is to make cheap drinks more expensive, either by statutory minimum pricing or much higher taxes. May be such a more penalizes moderate drinkers, but they will benefit from the lower level of disorder, and spare cash for the NHS.

            From within the Government, the libertarians twitch nervously at such a prospect. In his NHS reforms, Andrew Lansley had hoped to ensure that Health Secretary was no longer responsible for the NHS, so he is hardly going to enthuse about imposing a price on a bottle of cider. He is not alone in having faith in voluntary measures. If Cameron goes along this more cautious route, Britain will remain befuddled by booze.

             Voters’ permission

            Blair gave serious consideration to a “voluntary smoking ban”, a classic Third Way measure that would have achieved nothing.

            At a Downing Street seminar I attended towards the end of his rule, on the relationship between the state and health, he expressed what happened over the ban in a revealing way.

           “The voters gave us permission to impose the ban,” he said. Polls, focus groups and the rest of stifling evidence that paralyses leaders into not doing very much at all suggested that the ban would be popular.

             Using prices to determine behaviour is arguably more sensitive, but when that behaviour starts to improve, we will wonder why such controls were not used before.

            Preventive measures are the most effective route to saving the NHS money. Tackling obesity must be next. If Cameron succeeds with binge drinking, he will do more for nation’s health than he will with any of his other more publicized reforms.

                                                            - The Independent

Source: The Tribune, Saturday February 18, 2012.