Surviving Black Wednesday - and checking out the Big Four

Nicky Woolf's first Edinburgh diary.

 

Wednesday, August 8. Day One.

Today, auspiciously for my arrival, is “black Wednesday”. This is the day when shows will statistically report their lowest audience figures. It's the first serious day of the festival, after shows have been offering two-for-one deals and press previews; cast members are getting serious, punters are just arriving and getting their bearings. Black Wednesday is the bottom of the mountain. If you can make it today, you can make it all the way – but a bad audience today will be very bad for morale. Black Wednesday, it is said, separates the men from the boys.

At the 2012 Edinburgh festival fringe, there are more than 257 performance spaces in the city, some of them grand old theatres, some of them tiny rooms above pubs or prefabricated huts in car parks, hosting more than 2700 shows or acts every day. During the festival the entire city – already one of the world's most beautiful, its ancient tenements crammed together in the lee of Arthur's Seat or in the shadow of the castle on its dramatic bluff – has an indescribable buzz about it. Excitement pours through its streets like honey. The Royal Mile is crammed with performers making their pitches to the innumerable groundling throng who seethe the cobbled streets.

The Festival is dominated by four big companies that each run clusters of theatres, bars and performance spaces. These are Assembly, Gilded Balloon, Pleasance and Underbelly. Pleasance, for example, takes over the University of Edinburgh Students' Union buildings and runs a total of 214 shows in 21 venues ranging from the 750-seat Pleasance Grand to the 46-seat Pleasance Hut

It's nearly ten when I step off the train, but before bed I pop out to check out some of my old haunts. My favourite place to hang out, and my first port of call, used to be the outdoor bar at the fifth of the so-called “big four”, C Venues. C is commonly thought of as a little smaller and less slick than the big four, a little less polished, and I have always found it to be a lot more fun. It is also more willing than the big four to take a chance on unknown or student companies or unusual concepts. “C venues,” a friend said to me unkindly, “will take anything.” His show is at the Pleasance, and there is certainly a pecking-order, though some individual companies transcend it.

C also had a lovely outdoor bar area called SoCo; but I am in for a shock. The area it used to occupy, on Cowgate, in the centre of the old town, is now a building site. Doors I used to go through are shut, and the building has a forlorn, empty look. The upstairs bar at C is still buzzing, but it's unusually hot for Edinburgh in August, and I want to be outside, so my next port of call is the Udderbelly, an outdoor garden and stage run by Underbelly venues that has been available London's South Bank. 

There, at the exclusive and exquisitely-decorated Abattoir bar, I have a nightcap and ask around for show recommendations before turning in. Tomorrow, for me, the festival begins.

Performers arrive at the Edinburgh Festival. Photo: Getty

Nicky Woolf is a writer for the Guardian based in the US. He tweets @NickyWoolf.

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.