Early morning and a young lad, hooded, trainers, hugs his bottle as he staggers home. Last night it started early; cider, beer, and tonic wine. Blue bags on a Friday night. Party time in the park as teenage boys and girls huddle drunken in the dusk. Monday morning, at the surgery. Mother fraught and adolescent spite. School is bad, behaviour worse, out of control. “You must do something.”

Cans strewn around the room, thrown into the fireplace, crushed on the floor. Another on the wet formica table, collecting butts—an impromptu ashtray. And, all around the sweet rottenness of last nights drink. In the chair, an unshaven shadow of a man, yellowed fingers, greying shirt, mustard eyes and sallow skin, slurs rambling remnants of mixed up words. “He’s upsetting other residents.” The sheltered dwelling’s warden stands accusingly “You must do something.”

On the posh side of the river, a once elegant woman, curses and swears, blind drunk. Pearls swinging, familiar bottle, berates her husband sitting silently amongst the ornaments. Antique treasures, cheapest drink. Spirits with no care for class or age. His pleading look foretells those worn out words “You must do something.”

So, what do we do? A self-regulatory approach to alcohol marketing and health warning labels. The Royal College of Physicians disagrees. And so do I.

Domhnall Macaulay is primary care editor, BMJ