The Pharmaceutical Journal
Vol 276 No 7384 p70
21 January 2006

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We must commit to public health and not be hypocritical about alcohol

By Terry Maguire

Proudly Siberian! What a strong advertising slogan. It has all the swagger and poise of a rough and rugged alpha-male suffering a testosterone overdose. I am referring, of course, to the advertising slogan for KGB Anti-hangover, the latest “remedy for those who have had too many” and sold in “all leading pharmacies and other outlets”. I can only suppose it is now official: I am not a leading pharmacy, since KGB antihangover is not on my shelves — and it will not be. KGB Hangover is, I think, the same as RU-21, which, we are told in the advertising copy, is a “safe and effective dietary supplement for consumers of alcohol”. Both were formulated by the KGB during the cold war “to keep Russian spies sober so they could drink their enemy targets under the table before stealing their secrets”. Well, it must be good then, but I am not sure the Medicines and Healthcare products Regulatory Agency would agree with the “safe and effective” bit — at least until the studies are done by someone other than the KGB.

Perhaps it is the ideal remedy for Charles Kennedy, the erstwhile leader of the Liberal Democrat Party. But then it is unfair taking a swipe at those down on their luck. Mr Kennedy, after all, is a victim. He suffers a debilitating medical condition: he is dependent on alcohol and that is no laughing matter. For a talented politician to fall from grace because of his inability to control his drinking is a tragedy but he is not the first and nor will he be the last. In December, Northern Ireland had, in the most mawkish fashion possible, the nearest thing it has had in recent times to a state funeral. It was for a man who, there is little doubt, was a football genius, but who, we must also remember lest we lose a grasp on reality, was a reckless alcoholic. It was this latter trait that took his talent, his relationships, his health and, finally, at the age of 59, his life.

We are such hypocrites when it comes to alcohol. Since 90 per cent of the population drink, we prefer to promote its positive traits only: the pleasure of drinking a fine claret, the relaxing properties of a gin and tonic, the anorak with his real ale. I am all for this. In moderation alcohol has positive health effects and, for the 50 per cent of drinkers on less than the weekly quota, this can be a good thing indeed. But alcohol has a dark side and this we try to ignore. Some 40 per cent of drinkers drink too much either by binge drinking (abuse) or regularly drinking above the recommended level (misuse). Some 5 per cent of the population are known to be dependent with another 5 per cent dependent but not admitting it. Taken together, misuse of, abuse of and dependence on alcohol creates a huge financial burden on our society amounting to some £20bn per year.

The medical and social consequences are bleaker still. Alcohol is involved in 60 per cent of assaults, 50 per cent of road traffic accidents, 50 per cent of domestic violence incidents and 47 per cent of serious injuries. Alcohol directly causes 5,000 deaths a year and makes a significant contribution to 3,000. Deaths occur mainly through stroke, cirrhosis of the liver, injuries and suicide.

For the alcoholics, from Charles Kennedy and George Best down to the guy lying prostrate at the corner of the street, the problem is clear-cut. However, for those bingeing at the weekends or finishing off a bottle of Marks & Spencer’s red every night at home, the danger remains that they will eventually move to an uncontrollable habit that may take years to resolve or will develop the cumulative health problems of long-term alcohol use. It is a complex and dangerous area.

Alcohol is like a bad smell we try to ignore. Many families who live with alcoholics like to keep it quiet. It is embarrassing;we do not like people to know about the weakness. Alcoholics are often entertaining people, so long as we do not have to live with them.

I had a wake-up call some years back. A telephone call on a Saturday afternoon had me at a police station picking up my 15-year old son. He was taken into custody drunk, unable to stand. It was a sobering life event, a time to look at my own alcohol intake. It was from me that my son got the idea drinking alcohol was safe and social.

As a student I was a social drinker but with the confines of a young family, drinking at home became the norm and this escalated. Close friends separated and this finally crystallised the issue for me. My friend’s alcohol intake proved problematic to his relationship; she could not cope, yet he refused to accept there was a problem.All the telltale signs were there, yet the emerging problem was ignored.

Yes, it is difficult to communicate an effective public health message about alcohol. There seems to be so many contradictions about the stuff. It is widely advertised and, in moderation, it is fine.Yet Government policy recommends no more than 28 units a week for men and 21 for women so why, you might ask, do we need 24-hour drinking laws?

There is hope. Brief interventions with patients about alcohol during routine GP consultations greatly reduce alcohol consumption according to Alcohol Concern. Many, it seems, just need to have an honest assessment about their intake from time to time.

I believe that pharmacists can add to what GPs are doing. Alcohol interacts with many drugs so we are ethically obliged to address the issue. But perhaps we could do something more. I agree that it is not easy and we seem reluctant to upset people.

Community pharmacy sways precariously between being a business and being a profession. Some are keen to be simply retailers, like our American colleagues; others wish to see a greater, more responsible role for the profession in public health. Some want both and I have termed this “professional schizophrenia”. I believe that in most cases we cannot have both.

Public health is the future so we need to commit to it. Stocking and selling hangover cures such as KGB Anti-hangover and RU21 is doing little for public health; it is, however, potentially dangerous if it promotes binge drinking. It is also dangerous to our reputation and our public standing in health care. And, lest somebody suggest I am a hypocrite for continuing to sell Resolve, I would point it has a product licence and is not promoted in such kitschy terms.