An evidence-based alcohol policy is receding into the rear-view mirror

Minimum pricing takes a back seat to multibuy bans – and may not even work anyway.

Friday brought the news that the government is going to be stepping up it's alcohol strategy and moving beyond the previously discussed minimum pricing.

The Telegraph's James Kirkup wrote:

The Coalition’s alcohol strategy — expected to be launched next week — will propose that special deals which encourage shoppers to buy in bulk should be outlawed.

Most supermarkets offer significant discounts for customers buying bottles of wine by the dozen or half-dozen. Sainsbury’s and Waitrose, for example, regularly offer a 25 per cent discount for six bottles of wine.

Ministers believe such promotions give customers a financial incentive to purchase more alcohol than they intended to buy and should be banned.

The Telegraph takes umbrage with these plans, citing "fears that middle-class households will bear the brunt of measures supposedly aimed at troublemaking youths and other anti-social drinkers," and while that is a distasteful way to put it – "middle-class households" and "anti-social drinkers" are not, and never have been, mutually exclusive – it touches upon a problem with expanding the scheme in this way.

Minimum pricing has had its supporters and detractors in these pages. George Eaton pointed out that it would hit the poorest hardest, Samira Shackle argued that "the evidence that alcohol consumption goes down when prices goes up is fairly strong", and I explained why attempting to increase prices through the tax system alone was not likely to be effective. But the one thing which is universally agreed to be a benefit of the proposals is that it is blind to everything but price per unit. As a result, unlike the current duty laws – which impose different taxes on cider, beer, wine and spirits, even going so far as to distinguish "cider" from "high-strength cider" – it cannot help but applied most forcefully where it would have the most impact.

Clamping down on multi-buys, by contrast, may frequently lead to price rises which have very little impact at all on the amount drunk. It is hard to imagine a situation where someone picking up a four-for-three offer on bottles of Moët champagne is likely to become less of a problem drinker if that offer is scrapped.

While it's not the most pressing concern – regardless of what the Telegraph says – it does mark out the transition of this policy package from a "hard", evidence based, attempt to deal with problem drinking to a more populist attempt to make things look like they're changing without doing that much.

Today we find that it may be that even minimum pricing – the part of the alcohol policy which has the most support of the medical community – is a busted flush. A new report from the Institute of Economic Affairs (pdf) takes a cross-national comparison of the effects of alcohol price on consumption – and focuses strongly on illicit consumption, with rates of both smuggled and home-made alcohol consumption rising.

As you would expect, the more unaffordable alcohol is, the higher "unrecorded alcohol consumption" is estimated to be by the WHO, from around 3 litres per person in countries like Finland and Sweden, down to barely half a litre per person in France and Austria.

 

While the author, Christopher Snowdon, is keen to draw parallels with prohibition, citing John Stewart Mill's claim that "to tax stimulants for the sole purpose of making them more difficult to be obtained is a measure differing only in degree from their entire prohibition, and would be justifiable only if that were justifiable," it does seem that this "unrecorded alcohol consumption" is rarely as dangerous as bathtub gin. Although the stats are not presented, the more realistic inference – and Snowdon seems to agree, given his references to the geography of the countries involved – is that this unrecorded consumption consists mainly of cross-border sales, especially in richer countries. Not only is this not particularly dangerous, it isn't even really smuggling, given almost all of the countries in the study are within the EU and thus have no requirement to pay duty or declare personal imports.

While it may not be dangerous, this unrecorded consumption adds to the key finding of Snowdon's paper: the total absence of a cross-national correlation between affordability and consumption of alcohol.

Clearly, this all plays back into the debate around minimum pricing. Although Snowdon brings up the risk that minimum pricing encourages moonshine production, and so may even harm health, it's not really important to overreach in that manner.

The key problem for advocates of minimum pricing si that if alcohol price is as poorly correlated with consumption as the above chart shows, then raising it may not do much for public health at all – while still having a strong negative effect on the private purse.

There's still a lot to be said in this debate - not least because an IEA paper, no matter how good, struggles when pitted against a Lancet paper which concludes that (pdf):

Natural experiments in Europe consequent to economic treaties have shown that as alcohol taxes and prices were lowered, so sales, alcohol consumption, and alcohol-related harm have usually increased.

But the argument is far from settled. It may be better if the government just backs off on the whole plan for a while.

Rows of booze. Photograph: Getty Images

Alex Hern is a technology reporter for the Guardian. He was formerly staff writer at the New Statesman. You should follow Alex on Twitter.

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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