Does minimum pricing work?

The PM will indicate support for the measure to reduce problem drinking. But does it make sense?

Anyone who's ever come home from a night out with an empty wallet will groan at the thought, but David Cameron is to indicate support for putting a minimum price on alcohol today. During a visit to a hospital in the north-east, he will say that excess consumption of alcohol is costing the NHS £2.7bn a year. This comes ahead of a government strategy on alcohol, due to be published soon after nearly a year of consultation with health professionals and the drinks industry.

If minimum prices are endorsed, it will mark a change in the government's policy. Cameron is instinctively opposed to further regulation, while the public health minister, Ann Milton, has queried whether it would be legal under European free trade legislation. Scotland, which has gone furthest on prices, is still testing the legality.

Of course, minimum prices will have the greatest impact on supermarkets and shops, where discount selling is more common than in pubs or bars. But is it an effective way to reduce dangerous drinking and alcohol-related problems?

Minimum prices would have most effect on the cheapest, strongest end of the spectrum, substantially upping the price of budget ciders (like the notorious, discontinued White Lightning). Some of these could more than double in price. For this reason, it has gained the support of a wide range of health campaigners: upping the prices of these drinks could target the most problematic drinkers.

Over at the BBC, Branwen Jeffreys explains some of the evidence cited by those in favour of the move:

Those who support a minimum price say there is strong evidence internationally that price is linked to consumption, and higher consumption is linked to higher harm. They point to Finland where in 2004 a dramatic cut in prices via taxes led within a year to an increase of 9% in consumption, according to official figures.

Most alcohol in Finland is sold through tightly controlled government-run shops. By 2005 alcohol-related problems were the most common cause of death among Finns of working age.

A 2008 model by the University of Sheffield suggested that a high enough minimum price could significantly reduce the impact and cost of alcohol to society. It found that problem drinkers seek out the cheapest ways to get drunk as they tend to be either young or those who drink a lot, and therefore would change their behaviour in response to price increases more than moderate drinkers would. (It has been strongly challenged by the drinks industry).

While the international examples may be compelling, it is worth pointing out that minimum prices have not yet been introduced in a country with a history of few limitations on the sale of alcohol. States in Canada which have used minimum pricing have a history of prohibition, and the Nordic countries have a tradition of selling alcohol through government-owned shops. That's why the example of Scotland will be watched closely.

On the other hand, some question the efficacy of minimum pricing on economic grounds. Tim Harford points out that it would up the profit margins of supermarkets -- and that in fact, if they decided a minimum price amongst themselves (rather than having one imposed by the government), they would be in breach of competition laws. He recommends increasing taxation further instead, as this would ensure that prices rise in proportion and would put the extra revenue in the hands of government rather than supermarkets. Rather paradoxically, minimum prices could make cheap alcohol a very lucrative product for supermarkets (because of the mark up).

Although the long-term benefits to society are difficult to prove conclusively, most people would agree that less cheap alcohol would have a positive effect. The evidence that alcohol consumption goes down when prices goes up is fairly strong. The best economic method of doing this remains to be seen.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear