The Doctor’s Surgery

My definition of a moderate drinker is someone who drinks as much as I do; a heavy drinker drinks more than I do; and a miserable killjoy drinks less.

In other words, I consume exactly the right amount of alcohol, that happy mean between drunkenness and sobriety. Personally, I have not found teetotallers to be much fun, though no doubt there are exceptions.

A recent paper in the Lancet, however, wants to make teetotallers of us all. After immense statistical labours, which not one in a thousand doctors would be able to understand, the authors came to the conclusion that the only safe level of consumption is none. Their prose, the work of many hands, is not exactly a pleasure to read:

‘The present study aims to build upon pre-existing work and to address several limitations found in earlier research. First, the available studies have assessed the risk of alcohol use by relying on external meta-analyses, which do not control for confounding in the selection of the reference category within constituent studies. This approach is problematic because of the so-called sick quitter hypothesis, which emphasises the importance of reference category selection in correctly assessing risk among drinkers, along with other confounding study characteristics such as survival bias.’

In essence, the authors compared the consumption of alcohol per capita in a very large number of countries and correlated it with death rates from diseases known to be associated with or caused by alcohol. They found that there was no level of drinking that did not increase the chances of dying earlier than might otherwise have been expected.

I was reminded of a speed awareness course I attended after I had been caught speeding in Swindon. It was very good and I have been more careful to observe speed limits ever since; it provided clear evidence that the faster you drove, the more likely you were to kill or be killed. In fact, there was no completely safe speed at which to drive.

It follows from this that, if you want to avoid death by road accident, the only safe thing to do is never to leave your house. Only the other day, for instance, my wife was knocked over by our mechanical wheelbarrow when she accidentally put it into reverse; luckily, I was on hand to change gear and the sole damage was to some hollyhocks on to which the wheelbarrow had pushed her.

It is, I suppose, only natural that a medical journal should concern itself with health to the exclusion of all other considerations. As everything is a nail to a hammer, so every pleasure is a potential cause of illness to a medical journal. Even those things that are temporarily found to be health-giving, such as moderate drinking, are sooner or later found to be a serious threat to health. As Richard III said to his brother, ‘We are not safe, Clarence, we are not safe.’

What to me was astonishing in the paper in the Lancet was the willingness of the authors to prescribe policy to the entire world on the basis of very complex calculations that must by their very nature be uncertain, and will almost certainly be shown to be full of mistaken assumptions. Moreover, they commit what ought to be a criminal offence in medical authors, namely that of expressing risks only relatively and not absolutely. Even if it were true that moderate drinking raised the death rates from certain diseases by 50 per cent among 30-year-olds, this would be trivial because the death rates were so low in the first place.

We live in an age of advancing health totalitarianism.

‘To avoid death by road accident, the only safe thing to do is never leave home’