Cheap Alcohol Is Killing Us

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Sir Liam Donaldson, Chief Medical Officer, today published his 2008 Annual Report, in which he called for society to recognise the effect of 'passive drinking' on society. He wants to see a shift in public opinion on alcohol similar to the move to smoke-free public places, so that being drunk is no longer an aim of drinking nor socially acceptable.

In his 2008 Annual Report, On the State of Public Health, England's Chief Medical Officer made recommendations to the Government to tackle alcohol harm, and particularly the collateral damage to society, family members, the NHS, and the economy.

Speaking at the launch, Sir Liam said: "England has a drink problem and the whole of society bears the burden. The passive effects of heavy drinking on innocent parties are easily underestimated and frequently ignored.

"The concept of passive drinking and the devastating collateral effect that alcohol can have on others must be addressed on a national scale. Cheap alcohol is killing us as never before. The quality of life of families and in cities and towns up and down the country is being eroded by the effects of excessive drinking."

Society's attitudes to passive smoking have shifted, culminating in the landmark smoke-free legislation introduced in July 2007. In comparison, whilst alcohol consumption has fallen in many European countries since 1970, England's consumption has increased by 40 per cent. The average UK adult consumes the equivalent (in units of alcohol) of 120 bottles of wine a year. Sir Liam calls for:

* A national consensus, prompted by government, that as a country we should substantially reduce alcohol consumption.

* Passive drinking to be acknowledged as a key issue. It should present a consolidated rationale for action and be the basis of national campaigns.

* Licensing laws should reflect the full impact of heavy drinking, making public health considerations central to licensing.

* A minimum pricing of 50p per unit to be introduced to reduce the consumption of alcohol and its associated harms.

If a 50 pence minimum price per unit policy was introduced this year, substantial effects would be seen immediately, with the full effect seen by 2019. Every year there would be 3,393 fewer deaths, 97,900 fewer hospital admissions, 45,800 fewer crimes, 296,900 fewer sick days, and a total benefit of over £1 billion. Research shows that the impact of price would be greater on heavy drinkers.

Sir Liam's Annual Report also addressed four other key areas of public health. Prostate cancer: What to do with the pussycats?

In England, one man is diagnosed with prostate cancer every 18 minutes and it is second only to lung cancer as the biggest male cancer. There are two common types of prostate cancer known as 'pussycats' and 'tigers'. The slow growing 'pussycats' can often have no symptoms and may not shorten life. The rapidly growing 'tigers' can spread quickly.

Treatment for prostate cancer often leaves men with significant complications, primarily incontinence and impotence. Identifying which tumours need radical treatment is difficult, and as yet there is no foolproof method. Widespread PSA testing (a blood marker of prostate cancer) is throwing up more and more men with early prostate cancer.

In his Report Sir Liam calls for:

* Increased efforts to identify whether patients have slow-growing 'pussycats' or aggressive 'tigers'.

* Adequate pre-test counselling to be carried out before PSA testing an asymptomatic man.

* Continued research into new treatments for localised prostate cancer which seek to minimise side effects without compromising survival.

Sir Liam said: "Men diagnosed with early, localised prostate cancer face an enormously difficult decision of whether to have radical treatment and risk the side effects or take the small chance that their cancer may progress and threaten their life. It is vital that men who are diagnosed with prostate cancer are truly informed of the risks and benefits of any treatment."

Pain: Breaking the barrier

Every year, 7.8 million people in the United Kingdom live with chronic pain. It is far more common now than it was 40 years ago, especially in women. A third of these patients reported inadequate control of pain, while only 14 per cent of people suffering pain have access to a pain specialist.

Chronic pain has a major impact on lives. It can prevent sufferers sleeping, impairs their ability to continue with work or normal family life, and young people with ongoing pain have more mental health and social problems than their peers.

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Sir Liam calls for:

* Training in chronic pain to be included in the curricula of all healthcare professionals.

* A national network of rapid-access pain clinics providing early assessment and treatment should be considered.

* For patients in hospital, a pain score should become part of the vital signs that are monitored routinely (like pulse, temperature and blood pressure).

* Consideration should be given to the inclusion of the assessment of pain and its associated disability in the Quality and Outcomes Framework for primary care.

Sir Liam said: "Chronic pain reduces the quality of life more than almost any other condition. The impact of pain on people's lives is significant, bringing emotional and financial burdens to patients and their loved ones. A major initiative to widen access to pain services is badly needed."

Antimicrobial resistance: Up against the ropes

Antibiotics have been successful at treating infectious disease and saving lives over the past 60 years. Inappropriate and unnecessary use has now reduced their effectiveness.

In some diseases, because of resistance, the last line of defence has been reached. Even though these drugs are becoming less effective, fewer pharmaceutical companies are developing new antibiotics because of the low profit yield.

Sir Liam calls for:

* Existing public education campaigns about responsible use of antibiotics to be raised in profile, in line with practice in some other European countries.

* Antibiotic packaging should carry a warning, reminding people of the need to take them responsibly and appropriately.

* No further classes of antibiotics should be made available without prescription unless there is careful consideration of the potential public health consequences.

* Novel ways to stimulate research and development of new antibiotics should be found.

Safer medical practice: Models, manikins and Polo mints

Skills in medicine have traditionally been learnt and practiced with real patients. Simulation training, both low and high tech, is becoming increasingly available to clinicians. Studies of simulation training for surgical skills have shown that surgeons trained in this way make fewer errors and carry out technically more advanced procedures. However, access to simulation training is limited in the NHS. Some simulators are sophisticated high-fidelity machines like the ones airline pilots train on. Yet some simulation can be very simple - practising putting up a drip on the arm of a manikin or picking up Polo mints with a delicate surgical instrument to enhance dexterity.

Sir Liam calls for:

* Simulation-based training should be integrated and funded within training programmes for clinicians at all stages.

* A national centre for simulation should be established to maintain and disseminate leading-edge methods and new developments.

* A skilled faculty of expert clinical facilitators should be developed to delivery high-quality simulation training.

* Each medical Royal College should identify a lead for simulation training. Sir Liam said:

"A surgeon trained on a simulator is twice as fast and twice as accurate as one who has not been. It reduces errors, making surgery much safer. How much better for a patient to know that the doctor has practised, refined and rehearsed their skills before taking the patient's life into their hands. Simulation works, and is important to medicine. The NHS must be able to provide it to make a difference to patients."

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