Friday, July 25, 2008

Smoking and drinking

A painter and decorator has been fined £30 for smoking in his own van because it was deemed to be a workplace. A passenger in his van, who had also just lit up, received a £30 fixed penalty notice as well. They are victimes of 'passive smoking' legislation

This particular report is in the Guardian, but it is in all today's newspapers. It happened in west Wales near Aberystwyth, which is about as alien a place that you can get in Britain, but that's mo excuse. The police had stopped the van on the suspicion that it was unroadworthy and you can imagine that he must have them a bit of cheek, but this is a prime example of the pettifogging bureaucracy that has crept over the country and the intrusive interference of the 'authorities' in the lives of the general public.

I imagine this decision will be thrown out on appeal, but it is yet another example of the police getting too big for their size twelves.

Now I have been a campaigner against tobacco. I pity those who were captured by the tobacco barons when they were young and have been addicted to the weed ever since. It is harder to stop smoking than to get off heroin. Most smokers want to stop and I am all for the health service giving them all the help they need. But in my working life I found it pretty easy to avoid passive smoke. Legislation that keeps smokers out of pubs seems to ignore the fact that people go there to drink, and that the alcohol is doing them more harm than the smoking.

I remember being confronted by a patient in my clinic with a raised MCV. The mean cell volume is a good warning sign of alcoholism and so it proved. He was a big fat man with a red face, cigarette stained fingers and beery breath. Aged about 45 he had married for a third time, on this occasion to a 23-year old who came in with him and with their baby. She clearly recognized his ill health and pleaded with me to make him better.

The cause of his problem was easy to diagnose: he drank too much and smoked too much. I told him that he would have to stop smoking and stop drinking. I spelled out all the consequences and agreed with the wisdom of the advice, though he couldn't see how he could manage to stop both at once. Brain-washed as I was about the evils of smoking, I suggested that he started with that and left the alcohol problem until later.

He didn't turn up to his next appointment a month later, but his wife did, or I should say his widow. She told me that he had died the previous week of gastric bleeding from esophageal varices. "Why didn't you get him to stop drinking first?" she screamed at me. I doubt that I could have done, but I should have taken his drinking history more seriously. I should have immediately investigated his liver.

Since then the problem has gone from bad to worse. Earlier this week we heard that there were more than 800,000 people admitted to hospital each year with alcohol-related illnesses and injuries in the UK — four times the official figure. When my daughter was a young doctor on the medical wards, alcohol was one of the major reasons for hospital admissions.

The night club business in Bournemouth has been booming, but I heard yesterday that the company that owns the night clubs is talking about going into liquidation. There are no fewer late night revellers spilling out onto the streets at 4 am, but the credit crunch has meant that rather than going out in the evening to drink the youngsters are going out drunk. Alcohol is so much cheaper at the supermarkets that the youngsters are drinking at home first and then going out. Supermarkets are using alcohol as a 'loss-leader' to draw in customers and don't seem to be much concerned that shoplifters are targeting the whisky counters.

Most countries have realized the necessity of limiting the sale of alcohol, but the drinks industry persuaded Tony Blair to make it more easily available. I wouldn't dare suggest that a sweetener went to Labor Party funds, but were one to be discovered I would not be surprised. The EU has made it impossible to restrict the importation of low-tax alcohol from France. Some individuals make a daily trip in a white van and return with it stuffed with alcohol, claiming that it is 'for personal use'. 'Booze cruises' are big money.

Cannabis has been in the news recently because of the risk of its inducing psychotic episodes, especially in young Afro-Caribbeans. Cocaine usage is rife among the fashionable party-goers and heroin addiction is a major cause of crime as addicts steal to feed their habit; but all these are minor players compared to alcohol. Over 2000 people a day admitted to hospital! We lose between 2000 and 3000 people are year to traffic accidents. In Iraq and Afghanistan together, fewer than 300 soldiers have died since hostilities began.

We should get our priorities right. Sales of alcohol should be restricted to those over-21, and it should not be on open display of supermarket shelves. I would prefer that sale of alcohol for consumption off the premises be confined to licensed premises with a barrier between customer and product and with very restricted hours of opening.

Most people like a drink and we certainly don't want to go back to prohibition, but that does not mean there should be so little restriction on the availability of alcohol. Liberty is fine, but the present drinking culture hurts not only the individual consumer, but his wife and children, his neighbor and almost everyone else in society. If you have a national health service, you have an interest in not paying for other people's recklessness.

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