Friday, 31 August 2012

Towards zero

For the last couple of years I have been predicting that the time will come when the recommended drinking guidelines (colloquially known as "limits") will fall to zero. One day we will be told that the daily/weekly units system is too confusing for the plebs and that there is no safe level of alcohol consumption. The best advice, the experts will say, is to not drink at all.

Gradually, the evidence is being gathered for this zero tolerance line. Most recent was this, reported in the Independent:

Even light drinking increases cancer risk

New study indicates that it's not just heavy drinkers who need to worry about the health implications of alcohol

Just one alcoholic drink a day may increase the risk of cancer, according to a new study, which estimates that light drinking is responsible for 34,000 deaths a year worldwide.

This is based on a study—or, more likely, a meta-analysis—the results of which have been extrapolated. The relative risks that the 34,000 figure have been extrapolated from are things like this...

One drink a day increased the risk of cancer of the oesophagus by almost a third, according to the study being reported in the Annals of Oncology, which analysed data from more than 200 research projects. Low alcohol intake increased the risk of oral cavity and pharynx cancer by 17 per cent, and breast cancer in women by 5 per cent.

Let's leave aside the unlikelihood of questionnaire-based epidemiology being able to identify one risk to two decimal points (until relatively recently, if you'd have told an epidemiologist that x increases risk by 5% (ie. a relative risk of 1.05), he would have laughed in your face).

Instead, and for the sake of argument, let's assume that these risks are accurate. What do they mean for the individual? I have not been able to find the mortality rate for oesophageal cancer, but there were 1,975 deaths from cancer of the oral cavity & pharynx in England & Wales in 2010. Since there were 493,242 deaths altogether, we can say as a rough but useable estimate that the risk of dying from those diseases is about 0.4%.

In the same year, 10,290 women died from breast cancer, out of a total of 255,326 female deaths. The chance of a British woman dying from breast cancer is therefore roughly 4%.

The absolute risk of mortality from the former, and possibly the latter, cancer will be somewhat lower for teetotallers, but we shall be conservative and stick with the figures above as being the baseline risks.

If having a drink a day raises the individual's risk of dying from oral cavity & pharynx by 17%, then the absolute lifetime risk rises from 0.40% to 0.47%. If having a drink a day increases the risk of breast cancer by 5%, then the absolute lifetime risk rises from 4% to 4.2%.

I wonder if this information—if given in relevant, rather than relative terms, as I have above—would make anyone think it was worth living a life of self-denial in order to reduce their risk by a fraction of one percent. Considering that the lifetime risk of dying from all cancers combined is somewhere between a quarter and a third, I doubt it would.

Risks of this order simply have no practical relevance to human beings. The relative risks are so tiny—even if we assume them to be real—that it is irrational to worry about them. The only way they can be made to sound scary is by doing what the authors of this study have done, ie...

(a) only give relative risk and hope the public mistakes it for absolute risk (a common error)

(b) extrapolate your numbers across the largest population you can think of. In this instance, they've gone for the nuclear option of using the population of the entire world—this should always ring alarm bells

If you do both of these things, you can then use the old line about the risks not being very high, but that "in terms of public health" they are of great significance. This get-out clause is often to be found in the text of epidemiological studies when the findings are of negligible significance for a person's health, and we see it again here:

"Alcohol increases the risk of cancer even at low doses," say the researchers. "Given the high proportion of light drinkers in the population, and the high prevalence of these tumours, especially of breast cancer, even small increases in cancer risk are of great public health relevance."

No matter how many times this line gets used, it never gains any meaning. A risk that has no practical significance to an individual should be of equally little significance to public health. The public, after all, is no more than a collection of individuals. Spouting variations of "many a mickle makes a muckle" does not alter that fact. If the public health industry considers risks which are of no significance to people to be of great importance to them, it only shows how irrelevant the public health industry is to the lives of normal men and women.

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "This study adds to the evidence linking alcohol consumption to several types of cancer, and confirms that even light drinkers have a small but definite increase in the risk, particularly for those parts of the body, such as the throat and oesophagus, that come into direct contact with alcohol.

"People who wish to minimise their risk of cancer can help by cutting down on their drinking."

This thinly-veiled plea for abstinence is not justified by the scientific evidence. Only this week we have seen the latest in a long line of epidemiological research concluding that moderate drinking is very good for health, and not just for rare diseases. As Crampton mentions, a study in the European Heart Journal found a statistically significant reduction in the risk of total mortality of 22 per cent and a 42 per cent reduction in mortality from heart disease. It also looked at the "sick quitter" hypothesis so beloved of Ben Goldacre and David Nutt and found that it did not explain the results. There is now masses of evidence that there is a U-shaped curve for drinking and mortality, and especially heart disease (which is the single biggest cause of death in the UK).

That study did not get reported in the Independent and we continue to wait for a study to be published showing how many people are being "killed" worldwide through teetotalism. Don't hold your breath.




10 comments:

JohnB said...

The best advice, the experts will say, is to not drink at all.

Way ahead of you, Chris. The fraudsters “down under” are already “massaging” the public:

Alcohol as bad for you as asbestos and tobacco
http://www.heraldsun.com.au/news/more-news/booze-is-bad-for-you-research-shows/story-fn7x8me2-1226047953969

Alcohol linked to more cancers
http://au.news.yahoo.com/thewest/a/-/breaking/9291512/alcohol-linked-to-more-cancers/

Quit drinking to cut cancer risk
http://www.watoday.com.au/lifestyle/wellbeing/quit-drinking-to-cut-cancer-risk-20110501-1e38g.html

For example: “Australians should give up drinking alcohol entirely to reduce their risk of getting cancer, the Cancer Council recommended yesterday, in a warning it likened to the dawn of the anti-smoking movement.”

“Is that a slippery slope?”, I hear you ask. “Anti-smoking” and “tobacco” are routinely referred to as the precedent. But surely it couldn’t be a slippery slope which, according to the Tobacco Control Unintelligentsia (e.g., Crapman), doesn’t exist. It’s obviously all coincidental just like a contraband market just coincidentally pops-up out of thin air following extortionate taxes on tobacco.

Here’s another “coincidence”:
“The Cancer Council is advising Australians that alcoholic drinks are carcinogenic to humans, with no safe drinking levels”.

No safe level!! This obviously has nothing to do with no safe level of tobacco smoke, first or second hand.

Just a word on “no safe level”. This is one of the earliest formal references to “no safe level” of tobacco smoke.

Working Papers in Support of the 8th World Conference on Tobacco or Health: Building a Tobacco-Free World. March 30 - April 3, 1992
Buenos Aires, Argentina

The scientific evidence linking ETS to death and disease is clear and overwhelming : There is no safe level of exposure for the carcinogens found in tobacco smoke. Victims of ETS are called involuntary smokers or passive smokers . The only way to protect people from the dangers of ETS is to keep tobacco smoke out of our indoor air . The prevention of involuntary exposure to ETS should be a priority for tobacco control advocates worldwide. (p.79)
http://legacy.library.ucsf.edu/tid/hoc28a99

Just this one excerpt is loaded with inflammatory trash. Firstly, they’re referring to “clear and overwhelming” evidence nearly a year before the [fraudulent] EPA Report on ETS. Secondly, they’re already referring to “victims” of ETS. Thirdly, they are referring to “involuntary or passive smokers”. For some detail on the inflammatory myth of “passive smoking”, see comments section of
http://cfrankdavis.wordpress.com/2012/06/12/doctors-in-name-only/#comments

Fourthly, they’re already making the fraudulent claim of “no safe level of exposure for the carcinogens found in tobacco smoke”.

But the excerpt above contains an even more fundamental piece of information: BUILDING A TOBACCO-FREE WORLD. That’s clearly a social-engineering (eugenics) intent, very much in keeping with the Godber Blueprint. All of these inflammatory claims about ETS, this concoction, are only a contorted means to the contorted goal of a tobacco-free world.

So we can see the effect of a number of agenda-driven frauds. The Chapman Trick manipulates nonsmokers into the belief that secondhand smoke is a cocktail of vaporized poisons such as ant poison, toilet cleaner, embalming fluid, etc. “No safe level” simply accentuates the Chapman Trick. The myth of passive smoking promotes the idea in nonsmokers that SHS exposure is the equivalent of being forced to smoke (like smokers) this cocktail of “poisons” against their will. It’s understandable why there is a subgroup of gullible nonsmokers who react to SHS (even at a hundred yards) as if they are being exposed to a bio-weapon like, say, sarin gas, and demanding “protection”.


Carl V Phillips said...

Kudos for the significant figure remark.

We are not likely to see the article about how many people teetotaling kills (or better, "lack of adequate access to alcohol"!) come out soon unless we write it!. It would not be too hard. It would be nice to get a small grant from someone to support the effort, though.

harleyrider1978 said...

Chris this just sjowed up and is directly related to your Simon Chapman prohibition blog:

Millennium’ project finds support in Guernsey
Aug 31, 2012—Following a proposal put forward in the Australian state of Tasmania that a ban should be imposed on cigarette sales to anyone born after 2000, Guernsey, a British Crown dependency in the English Channel, is set to demonstrate “similarly bold measures”, according to a Guernsey Press story quoting the Guernsey Adolescent Smokefree Project chairman, Alun Williams.

Williams said that while there were no plans to impose such a ban, it showed that some jurisdictions had the confidence to take extreme action.

‘The proposal in Tasmania is an indicator of the seriousness with which countries across the world are beginning to tackle the tobacco epidemic,” he was quoted as saying.

http://tobaccoreporter.com/home.php?id=498&art=6227

harleyrider1978 said...

Carl Excellent work you do over at Epiology and if I ever hit the megamillions your grant desires are answered!

Junican said...

There was some health condition which, according to the Zealots, was costing the NHS enormous amounts of money. Unfortunately, I cannot remember what it was. It wasn't smoking, but it was something similarly general throughout the country. I calculated from the number of cases that the workload of every doctor in the country (were this condition eradicated) would be reduced by one patient per annum (or something similar). Question: How does that reduction in workload translate into cost savings?

The other thing which bothers me about statistics and epidemiology is how does a small increase in risk, spread over a whole population crystallise into a single individual 'catching' the disease?

harleyrider1978 said...

Debate 2.0: Should junk food be illegal?

http://ourworld.unu.edu/en/debate-2-0-should-junk-food-be-illegal/

karagiannis_dim said...

Again,since the road for the tobacco has opened,wait and see the avenue for the alcohol..

nisakiman said...

"...we continue to wait for a study to be published showing how many people are being "killed" worldwide through teetotalism."

And there lies the nub of the con being perpetrated globally by the zealots.

Were the MSM to publish "researchers have estimated" x thousands of deaths per year from not drinking alcohol, the report would be greeted with the scepticism it deserves, since it is patently nonsense. But when they say those estimated thousands of deaths are as a result of light drinking, or SHS, or whatever, it's taken seriously, despite being as nonsensical as the "not drinking" estimate.

It just goes to show how deeply the prohibitionist propaganda has penetrated the MSM, and by extension, the received orthodoxy.

Eric Crampton said...

Why should anyone much care about any of the individual disorders either worsened or ameliorated by alcohol unless you've a significant family history of something that could be made worse (bettered) by alcohol. Otherwise, total mortality really ought to be what matters.

C.A.G.E. said...

''The fraudsters “down under” are already “massaging” the public:''

They're past massaging at this point. The WHO has already declared that there is no safe level of alcohol!

From: http://www.euro.who.int/en/what-we-publish/information-for-the-media/sections/latest-press-releases/european-region-has-heaviest-drinking-in-the-world

''There is no safe level of drinking, and in many societies no difference in the risk for men and women.''

Iro