Going underground

A chilling subterannean production of Macbeth.

Rarely have I been more relieved to leave a theatre, and I mean that in the nicest possible way. Belt Up Theatre -- a group of young actors based in York -- have shrewdly commandeered a proper showstopper of a venue for their production of Macbeth: Clerkenwell's House of Detention.

In truth, the dismal catacombs would make even Clitheroe Players' "Charley's Aunt" a special and spooky experience. These vaults banged up the mad and the bad (including children) between 1617 and 1893, and, rather disturbingly, the underground cells sit right underneath a primary school playground. In the splendid tradition of mummers, jugglers and other unsavoury itinerants, Belt Up are not going down well with the locals, for whom the exposure of what lies beneath is somewhat less than welcome.

We begin the performance following the siren wail of the Weird Sisters through the underground black labyrinth. The cells and walkways are illuminated by the odd exposed light bulb, or by guttering candles. This candlelight softens features, but rather thrillingly makes the eyes of the homicidal Macbeth glitter. The audience stumble upon scenes, and are either explicitly welcomed as fellow kinsmen, courtiers and thanes, or made eavesdroppers and voyeurs. It does help to be pretty tall in this spying game, or at least to move briskly and single-mindedly between scenes to get to the front, and I was often left a couple of rows back, seeing only chinks of the action. There are compensatory times, however, when one is so close to the events as to be co-opted into them.

This immersive smudging between actor and spectator makes for some unexpected images, as we group, complicit, around filthy deeds in dark corners. On the night I saw the show there was a large party in attendance from the City of London School, and it was an arresting sight, to see all the shining schoolboy faces framed by the vault arches, or caught haplessly in the cross fire between two actors: Shakespearean extras to all intents and purposes. (They also proved uncannily good at taking off the witches' theme tune in the loos later.) Sometimes the freezing, clammy building itself accidentally enhances the performers' work: when Macbeth is channelling supernatural power by starting up the witches' caterwaul, a big drop of icy water fell on my forehead, right on cue.

Belt Up perform Macbeth with just four male actors, and all the doubling and shuffling around in the dark certainly doesn't make it the most transparent of productions. Rather, it was a mood piece, an opportunity to scry on a serial killer in the stygian gloom. In this, perhaps the House of Detention could have been exploited yet further: as we exited there were tantalizing vignettes of prisoners pacing up and down or pooled on the floor in rags, and perhaps more of these sidelong, atmospheric flashes might have served the actors better than their still-dutiful recitation of text.

Rather neatly Belt Up finish their piece with the witches' chant: "When shall we three meet again?" as though they and their diabolic power of suggestion would simply move on to the next susceptible individual. One emerges, shivering, into the daylight, though by now even the Farringdon tube station works and repairs now look like so many infernal engines.

This theatrical experience is truly dire -- but in the best way.

Davide Restivo at Wikimedia Commons
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Scientists have finally said it: alcohol causes cancer

Enough of "linked" and "attributable": a new paper concludes that alcohol directly causes seven types of cancer.

I don't blame you if you switch off completely at the words "causes cancer". If you pay attention to certain publications, everything from sunbeds, to fish, to not getting enough sun, can all cause cancer. But this time, it's worth listening.

The journal Addiction has published a paper that makes a simple, yet startling, claim: 

"Evidence can support the judgement that alcohol causes cancer of the oropharynx [part of the throat], larynx, oesophagus, liver, colon, rectum and [female] breast"

So what's especially significant about this? 

First, scientists, unlike journalists, are very wary of the word "causes". It's hard to ever prove that one action directly led to another, rather than that both happened to occur within the same scenario. And yet Jennie Connor, author of the paper and professor in the Preventive and Social Medicine department at the University of Otago, New Zealand, has taken the leap.

Second, alcohol not only causes cancer of one kind – the evidence supports the claim that it causes cancer at seven different sites in our bodies. There was weaker evidence that it may also cause skin, prostate and pancreatic cancer, while the link between mouth cancers and alcohol consumption was the strongest. 

What did we know about alcohol and cancer before?

Many, many studies have "linked" cancer to alcohol, or argued that some cases may be "attributable" to alcohol consumption. 

This paper loooks back over a decade's worth of research into alcohol and cancer, and Connor concludes that all this evidence, taken together, proves that alcohol "increases the incidence of [cancer] in the population".

However, as Connor notes in her paper, "alcohol’s causal role is perceived to be more complex than tobacco's", partly because we still don't know exactly how alcohol causes cancer at these sites. Yet she argues that the evidence alone is enough to prove the cause, even if we don't know exactly how the "biologial mechanisms" work. 

Does this mean that drinking = cancer, then?

No. A causal link doesn't mean one thing always leads to the other. Also, cancer in these seven sites was shown to have what's called a "dose-response" relationship, which means the more you drink, the more you increase your chances of cancer.

On the bright side, scientists have also found that if you stop drinking altogether, you can reduce your chances back down again.

Are moderate drinkers off the hook?

Nope. Rather devastatingly, Connor notes that moderate drinkers bear a "considerable" portion of the cancer risk, and that targeting only heavy drinkers with alcohol risk reduction campaigns would have "limited" impact. 

What does this mean for public health? 

This is the tricky bit. In the paper, Connor points out that, given what we know about lung cancer and tobacco, the general advice is simply not to smoke. Now, a strong link proven over years of research may suggest the same about drinking, an activity society views as a bit risky but generally harmless.

Yet in 2012, it's estimated that alcohol-attributable cancers killed half a million people, which made up 5.8 per cent of cancer deaths worldwide. As we better understand the links between the two, it's possible that this proportion may turn out to be a lot higher. 

As she was doing the research, Connor commented:

"We've grown up with thinking cancer is very mysterious, we don't know what causes it and it's frightening, so to think that something as ordinary as drinking is associated with cancer I think is quite difficult."

What do we do now?

Drink less. The one semi-silver lining in the study is that the quantity of alcohol you consume has a real bearing on your risk of developing these cancers. 

On a wider scale, it looks like we need to recalibrate society's perspective on drinking. Drug campaigners have long pointed out that alcohol, while legal, is one of the most toxic and harmful drugs available  an argument that this study will bolster.

In January, England's chief medical officer Sally Davies introduced some of the strictest guidelines on alcohol consumption in the world, and later shocked a parliamentary hearing by saying that drinking could cause breast cancer.

"I would like people to take their choice knowing the issues," she told the hearing, "And do as I do when I reach for my glass of wine and think... do I want to raise my risk of breast cancer?"

Now, it's beginning to look like she was ahead of the curve. 

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.