Richard Smith: Are alcohol companies doomed to cause harm?

Richard SmithTobacco companies clearly cause harm, and we will always need food companies. But what about alcohol companies? Can they produce net benefit?

 I’ve been pondering this question for three decades, but it’s a live issue for governments who must decide whether to include alcohol companies in programmes to reduce harm from alcohol and also for organisations, like some I belong to, which must decide whether to seek funding from them.

Not for a moment am I suggesting that alcohol companies want to cause harm. Come to that, I’m sure that tobacco companies don’t want to either—unfortunately for them it’s an inevitable consequence of their business. They either close down or cause harm.

Alcohol companies would like us all to be “responsible drinkers,” never getting drunk and never drinking enough to cause the multiple social, psychological, economic, and physical problems that can arise from alcohol. But it might well be that a country of responsible drinkers would drink much less than a country that has the usual compliment of heavy drinkers—in which case perhaps alcohol companies wouldn’t like it.

But this is irrelevant speculation. The sad truth for alcohol companies is that you can’t have responsible drinkers without heavy drinkers and drinkers who harm themselves and others. The distribution curve of how much people drink shifts left and right as the amount of alcohol consumed in a community goes up and down, but it’s very hard to change the shape of the curve. If you reduced the amount of alcohol in a community to the point where there were negligibly few heavy drinkers that community would be consuming very little alcohol, not enough to run a profitable alcohol company.

An equally uncomfortable truth for alcohol companies is that an increase of alcohol consumption of x in a community causes an increase in harm of considerably more than x, possibly even x².

So a crucial question is whether alcohol companies can make bigger profits (or at least the same profits) from selling less alcohol? Food companies can increase their profits while increasing their ratio of healthy to unhealthy products. Indeed, food companies recognise that their customers are increasingly interested in healthy foods. There is money to be made from producing healthier products.

It might be that alcohol companies could make more money if we all drank small amounts of Chateau Margaux and single malt whiskeys rather than large amounts of cheap cider and low grade vodka. But is that feasible? I fear not. I think that more profits means more alcohol sold and so more harm. This is the inconvenient truth for alcohol companies.

But there are other sorts of benefit from alcohol. The British government, for example, likes very much the jobs, exports, and tax that come from alcohol companies—and for the Treasury those immediate benefits must outweigh the costs of managing the harm from alcohol. It doesn’t seem acceptable, however, for a health organisation to align itself with an alcohol company on the grounds that economic benefits outweigh human harm.

What about the “fact” heavily promoted by alcohol companies that a “little of what you fancy” causes you to live longer. It’s a tricky epidemiological puzzle to tease out alcohol consumption, which is hard to measure in itself, from all the other factors that affect mortality, and I’m friendly with a group of highly capable epidemiologists who are very sceptical that low alcohol consumption leads to longer life.

Finally, there is the glow, the bonhomie that comes from alcohol. When I’ve finished this blog I will pour myself a glass of chilled cider. I’ll follow that up with several glasses of Cote du Rhone and possibly as it’s Tuesday finish with a shot of Lagavulin. This pattern of drinking will lead me to drink over my weekly limit and probably twice my daily limit, which defines me as a “binge drinker,” although I will fall sleep at about 10 rather than go out and pick a fight.

So my personal calculation is that the good of alcohol is outweighing the harm—but that’s because most of the good comes today and most of the harm tomorrow. If in a weeks time I’m in intensive care with liver failure or a stroke brought on by alcohol I’ll probably recalculate.

My conclusion? Governments might rationally hob knob with drink companies, and risk seeking individuals might see more good than harm in alcohol—but organisations promoting health in the broadest sense should stay away from alcohol companies.

Competing interest. RS drinks above the recommended alcohol limits although he was on the Royal College of Physicians working party that produced them. Some years back he told a Times journalist that the limits were “plucked out of the air.” Ever since then he is rung by journalists when there is a story about limits. Meanwhile, his brother, Arthur Smith, described in the Times as a “reformed alcoholic,” is being criticised by alcohol campaigners for putting on a Pissed up Chat Show at the Edinburgh Festival where all the guests must be drunk. Arthur nearly died of acute necrotising pancreatitis brought on by heavy drinking. Now he doesn’t drink.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.