Act now to fight growing scourge of alcohol

ALCOHOL problems have been with us for centuries. But, with the increase in consumption resulting from a decrease in real price, the problem has become alarming.

There are innumerable effects on health, ranging from trauma and accidents to deaths from cancer, liver cirrhosis and even suicide. Equally grim are the social effects, including violence on children and family and the strong relation to crime. Extensive economic costs will result from inefficiency and accidents at work.

As a medical professor, I saw many such tragedies among my own patients, especially those with advanced tuberculosis, as well as among friends or colleagues.

I witnessed patients who had advanced relapsing disease – an illness that would not go away – because of their drinking. They suffered more as a result until we discovered their secret alcoholism and could treat that as well.

I also saw the devastating effects on people's mental health. Severe alcoholism often results in suicide, sometimes in people who have had very distinguished careers.

Alcoholic liver cirrhosis can lead to a very slow and painful death, and another consequence of alcohol abuse that I have seen.

And alcohol can also be at the root of child abuse in families, with terrible effects on the wives and youngsters involved.

In the early 1980s I chaired a committee on the subject for the Scottish Office. Our report produced an extensive review of the effects of alcohol. We also gave detailed suggestions on what should be done to combat the problem. These covered government action, action by medical professionals, local authorities, social workers, education, employers, trades unions and the courts.

The report made quite an impact at the time, both in Scotland and throughout the UK as a whole. The British Medical Journal declared: "Scotland leads the way on alcohol."

At least some of our recommendations were implemented, though there was little long-term effect. Indeed, the problems have become very much worse.

A vast amount of national and international evidence indicates a close inverse relation between total consumption and both types of ill-effect, including death from alcohol.

The decrease in real price is due to taxation not rising to match inflation. An increase in average personal income gives people more money to buy alcohol.

National and international research shows that one of the two major preventive measures is to increase alcohol taxation from year to year. The increase should always be greater than the combined increase in inflation and in the average rise in personal disposable income.

It may be claimed that rises in cost will particularly affect the poor, the young and pensioners. But these rises are designed to help them to avoid the tragedies of illness, social affliction and death.

The other major factor has proved to be availability. The greater the number of outlets and the longer the opening hours for buying alcohol, the worse the resultant problems. I understand that nowadays in Scotland about half the total alcohol is bought in supermarkets and off-licences. This enhances the grim problem in two ways. It increases the sources for purchase. Moreover, off-licences may use cheapening of alcohol, even as loss-makers, to attract customers – "three bottles for the price of two", etc.

Taxation is basically an undevolved UK responsibility. But we are informed by experts that the Scottish Government could legally put a minimum price on alcohol, provided it is done independently, ie not with the co-operation of the alcohol industry and its members. Health is a devolved subject. Health considerations can allow a government to overrule both European and UK competition law – as, indeed, has been done in the case of tobacco control.

The problems arising from binge culture in the young are causing widespread public concern. One proposal is to raise the age for legal purchase from the present 18 to 21. A number of the states in the US have done so. In those states there was a subsequent sharp decrease in deaths from road accidents not showing in the unaltered states.

I understand that federal government subsequently told the unaltered states that they would receive no further subsidies on their roads until they raised the age.

I would be in favour of raising the age for purchase to 21, both in-house and out-house. I hope public opinion will eventually overcome the objections of some politicians.

Meantime, I am greatly encouraged by the enlightened proposals for alcohol control of the Scottish Government and hope that the Parliament as a whole will come to support them.

I should add that, of course, I am not advocating prohibition. Personally, I have an occasional glass of wine, mostly with friends or adult family members.

Specialist whose work saved the lives of millions

SIR John Crofton made one of the most important discoveries the world has ever seen in the battle against infectious disease.

Born in Dublin in 1912, he started his medical training at Cambridge University and St Thomas's Hospital medical school in London, qualifying as a doctor in 1937.

He went on to work at St Thomas's Hospital before serving in the Royal Army Medical Corps from 1939-45, spending time in countries that included Eritrea and Germany.

Sir John's return saw him researching and lecturing in London, before he came to Scotland as professor of respiratory diseases and tuberculosis at Edinburgh University – a post he held from 1952-77.

TB cases in Britain numbered about 50,000 a year in the early 1950s, and he soon found himself treating hundreds of patients with the disease in Edinburgh's hospital wards.

In 1954 he led the team that discovered the first cure for TB – a cocktail of three antibiotics used simultaneously.

Doctors were astonished by the results, as the medication cured every patient treated.

Within six years the disease had been almost wiped out in Edinburgh and slowly the treatment was picked up around the world.

The same multi-drug approach is still used to combat TB, and Sir John's discovery has been credited with saving the lives of millions of people.

Sir John was president of the Royal College of Physicians of Edinburgh from 1973-76, and retired in 1977 – the same year he was knighted.

Since retirement he has continued working to improve people's health, travelling the globe to deliver speeches and give advice on combating TB and highlighting the effects of tobacco.

He was a founder of the anti-smoking group Action on Smoking and Health (ASH), of which his wife, Eileen, was director in Scotland.

More recently he helped launch Scottish Health Action on Alcohol Problems and he continues to take a keen interest in health issues.

Now aged 96, he is still called upon to give advice on the use of funding to improve health in the developing world, where diseases such as TB are a continuing problem.

IN NUMBERS

£2.25bn
estimated annual cost of alcohol abuse in Scotland

£820m
cost of alcohol misuse to the Scottish economy each year, including absence from work and unemployment

£405m
annual cost of alcohol-related ill-health to the NHS

40,000
alcohol-related discharges from hospitals in 2006-7, up almost 50 per cent in a decade

2,372
alcohol-related deaths in Scotland in 2005

30
people a year killed due to drink-driving

50%
of Scotland's prison population say they were drunk at the time of their offence

21
recommended maximum number of alcohol units per week for men

14
recommended weekly limit for women

30%
of divorce petitions cite excessive drinking

52%
increase in alcoholic liver disease in Scotland between 1998 and 2002