News

Government and the alcohol industry are failing to provide drinkers with the information they need to make the right choices about alcohol – both for themselves and for their children.

New figures released show that only 16% people are aware of the weekly alcohol guidelines, 2 years after the guidelines were announced.

They also reveal that parents are not equipped with the right information to keep their children safe from alcohol harm, with fewer than 1 in 20 aware of the official advice on children’s drinking.

The figures come from the Alcohol Health Alliance UK (AHA), who surveyed the UK public on their attitudes to alcohol in September 2017.

The low-risk weekly drinking guideline for adults is 14 units a week – around 6 pints of 4% beer, or 6 medium glasses of wine. This guideline was announced by the UK’s Chief Medical Officers in January 2016.

For children, the official advice is that an alcohol-free childhood is best, due to evidence of a wide range of short term and long term harms linked to children’s drinking.

In England, the Chief Medical Officer says that if children do try alcohol, they should be at least 15 years old, and be in a supervised environment.

The recommendation that an alcohol-free childhood free is best is based on the fact that young people are physically unable to tolerate alcohol as well as adults, and young people who drink are more likely to engage in unsafe sex, try drugs, and fall behind in school.

In addition, the younger someone starts drinking, the more likely they are to develop a problem with alcohol when they are older.

This goes against the commonly held view that allowing children to drink at home at a young age will teach them to be responsible drinkers when they are adults. The AHA survey found that this view was common, with 6 in 10 people agreeing that children who drink at home will ‘know how to handle their drink when they’re older’, and that children who drink in moderation at home ‘are less likely to binge on their own.’

Whilst awareness of the alcohol guidelines for both adults and children is low, the AHA’s survey found that there is an appetite among the public for greater information on the risks linked with drinking, with high levels of support for the inclusion of warning messages on alcohol labels.

Eight out of 10 people want alcohol labels to include the weekly guidelines, and a warning that exceeding the guidelines can damage your health.

80% of people also want labels to include a warning that alcohol is linked with cancer. Alcohol is known to be linked with at least seven types of cancer, and has been classed as a class 1 carcinogen, along with tobacco, by the UN-linked International Agency for Research on Cancer. The alcohol industry has been found to mislead the public on this link, by denying or distracting away from it*, and industry bodies recently lobbied successfully in Canada to have a trial of cancer labels on alcohol products halted.

Commenting on the results of the AHA’s polling, Professor Sir Ian Gilmore, chair of the AHA, said that more should be done to ensure the guidelines for both adults and children are communicated to the public. He said:

‘It is really disappointing that only 16% of the public are aware of the alcohol guidelines for adults, and that fewer than 1 in 20 are aware of the advice around children’s drinking. The public have the right to know the Chief Medical Officers’ guidelines, so that they are empowered to make informed choices about their drinking. The same applies to parents, who want to do the right thing by their children and deserve to be informed of the Chief Medical Officers’ guidance on children and alcohol.

‘It is clear from our polling that the public want to be informed of the risks linked with alcohol, including the link with cancer, and that they want to see clear warning information on alcohol labels about the drinking guidelines and the risks of drinking at levels above these guidelines.

‘To this end, the government should introduce mandatory labelling of all alcoholic products, to ensure that the public and parents are fully informed about the risks.

‘In addition, the government should develop national information campaigns, informing the public and parents of the guidelines for both adults and children.’

Commenting on the survey’s findings around alcohol and cancer, Caroline Moye, Head of World Cancer Research Fund UK (WCRF UK), said:
‘AHA’s new research shows a clear public call for alcohol product labels to carry a warning about the link between alcohol and cancer, and the Government should put these warning labels in place. Government cannot leave the communication of cancer risks to the alcohol industry.

‘For anyone who drinks alcohol, we recommend they stay within the weekly guideline of 14 units a week, though abstaining from alcohol altogether will reduce their cancer risk even more. We have many tips for cutting down on alcohol, including drinking out of smaller glasses, diluting drinks such as swapping pints for a spritzer and aiming to keep at least a few days each week alcohol-free. People can get more information about our Cancer Prevention Recommendations at https://www.wcrf-uk.org/uk/preventing-cancer/cancer-prevention-recommendations.' 

The AHA’s polling was carried out in September 2017. 2,000 people across the UK (1,671 in England, 165 in Scotland, 110 in Wales and 54 in Northern Ireland) were surveyed on the AHA’s behalf by the national polling company OnePoll, and the results were then weighted to ensure they are nationally representative.

OnePoll works according to the Market Research Society’s code of conduct. This code helped ensure, for example, that none of the survey questions could be considered as leading.

Key statistics from the polling include:
- Only 16% of people are aware of the low-risk weekly drinking guideline of 14 units
- Only 3% of people are aware of the guidance that an alcohol-free childhood is best
- Only 10% of people mention cancer when asked which diseases and illnesses are linked to alcohol
- 81% believe the weekly guidelines should appear on alcohol labels
- 78% believe labels should include a warning that exceeding the guidelines can damage your health
- 77% of people support a cancer warning on alcohol product labels
- 73% believe labels should include calorie information
- 55% of people believe that ‘providing children with alcohol in a supervised situation will ensure that they know how to handle drinking when they’re older’.
- 57% of people believe that ‘children that drink alcohol in moderation with their own family are less likely to binge on their own’.
- 77% of people believe that the UK has an ‘unhealthy’ relationship with alcohol
- 52% think that the government is not doing enough to tackle the problems with alcohol in society

The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. 

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk  or on 0203 075 1726.

The BASL Annual Meeting 2017 was held between 20th to 22nd September on the Warwick University Campus with a splendid evening of dinner and jousting at Warwick Castle. Here we summarise some clinical highlights from the meeting.

In the Wednesday transplant section, Andrew Holt and Kerry Webb discussed individualisation of transplant assessment for patients with alcohol related liver disease, outlining guidelines which move away from the ‘six month rule’ of pre-transplantation abstinence and aim to provide uniformity of care amongst transplant units to avoid a perceived geographical variation in access to liver transplantation for this indication. The severe alcoholic hepatitis pilot was discussed by Ewen Forrest, who updated the group on the failure to recruit any patients to the pilot, but also stressed the lack of a robust statistical model to predict transplant need in this cohort.

In the field of stem cell transplantation, Fotis Sampaziotis presented his novel study demonstrating applicability of human derived stem cells to successfully populate a bioengineered mouse bile duct in vivo. Peter Friend delivered the Williams-Calne Lecture, which was a state of the art update on the current and future role of organ reperfusion preservation techniques in improving outcomes after liver transplant.

On Thursday morning, Ian Fellows’ erudite lecture highlighted the important role of sarcopenia in prognostication for patients with cirrhosis (perhaps best measured on the L3 slice of a non-contrast abdominal CT). He emphasised that patients with end stage chronic liver disease are invariably malnourished and require nutritional and dietetic support with high protein, high calorie supplementation ‘little and often’.

Tariq Iqbal presented data on a causal association between dysbiosis and liver disease in mouse models, thus highlighting potential novel therapeutic approaches in the field. Sotiris Mastoridis showed that exosomal MiRNA profiles may provide prognostic information in the field of acute liver failure. Gwilym Webb’s study of the epidemiological profile of autoimmune liver disease in the UK identified an interesting association between latitude and prevalence. Julia Verne presented the 2nd atlas of variation in risk factors and healthcare for liver disease in England. This forms an important reference document for all involved in hepatology service provision (https://fingertips.phe.org.uk/profile/atlas-of-variation).

Intrahepatic cholangiocarcinoma continues to confer a poor prognosis. Ali Yousuf presented a systematic review of the application of loco-regional therapies for inoperable disease. The SIRCCA trial is an international study comparing standard therapy versus selective internal radiation therapy (SIRT) for Inoperable disease and is open to recruitment in the UK.

George Mells, speaking on behalf of the UKPBC group, proposed a predictive model for identifying non-responders to ursodeoxycholic acid using pre-treatment parameters. The British Liver Trust Lecture given by Mary Ramsey outlined the economic and political hurdles which were overcome to provide the recently rolled out universal childhood hepatitis B vaccination programme in the UK. Tion Lim presented two cases of steroid resistant AIH which showed treatment response to interleukin-2 therapy that merits further evaluation in larger studies. The afternoon’s highlight was John O’ Grady’s Ralph Wright Lecture in which he emphasized the over-reliance on the p-value in the medical literature. He discussed the syndrome of “acute on chronic liver failure”, the contents of which he lays out in the October 2017 issue of Liver Transplantation.

Friday morning turned to case presentations. Lauren Johansen and Marianne Samyn presented the case of a young boy with juvenile PSC, highlighting the autoimmune element of the disease and the challenges of immune suppression management. Nowlan Selvapatt and Shahid Khan’s case led to a discussion of biomarker development in the field of cholangiocarcinoma and the need for larger studies in the field. Geoff Dusheiko and Shirin Demma expertly interweaved case and case discussion of a patient with active HDV, stressing the importance of universal HDV testing for patients with HBsAg seropositivity. Charlotte Grant and John Iredale discussed fibrosis regression in liver disease, exemplified by a case of recompensation after alcohol cessation and venesection in a patient with haemochromatosis and ARLD cirrhosis. Kris Bennett and Guru Aithal’s case led to a discussion of MRI in assessing for portal venous haemodynamics.

There were a number of noteworthy posters. Amongst these, Jayaswal showed that SVR12 is associated with reduction in liver fibroinflammation as assessed by MRI. Sherman demonstrated the potential value of combining ARFI and a “spleen-platelet/portal vein Doppler score” to predict clinically significant portal hypertension. Verne observed that the rate of cirrhosis related hospital admissions has more than doubled in the last ten years and that there was a high degree of variation in admission rates for paracentesis and oesophageal varices across different CCGs in England. Kamarajah showed that paired liver stiffness measurement compared favourably with paired liver biopsies in determining fibrosis progression for patients with NAFLD in Malaysia. Warburton demonstrated a complex biliary microbiome in “normal” human bile. Srivastava showed comparable liver transplant survival data between patients managed in a non-transplant and transplant liver centres in the UK. Delvincourt highlighted the role of self-expanding metal stents in the management of early post-transplant anastomotic biliary strictures. Campbell described the benefits of a shared palliative care liver pathway for the management of advanced liver disease in a hospice setting. Marra showed that 8-weeks of therapy with sofosbuvir/velpatasvir for patients with G3 HCV and advanced fibrosis achieved a 95% SVR.

Will Gelson
Consultant Hepatologist

Saqib Mumtaz
Hepatology Specialist Trainee

Specialist Clinical Fellow in Hepatology

Job Reference: 304-JSD-B079

Employer: University Hospital Birmingham NHS Foundation Trust - medical and dental

Department: Hepatology

Location: Birmingham

Salary: £50,500 - £68,680

Closing date 7th December 2017

For further information about this vacancy view on NHS Jobs by clicking > here. 

Responding to the UK Supreme Court judgment that minimum unit pricing is legal, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:

“We are delighted with the Supreme Court’s judgement that minimum unit pricing is legal and can be implemented in Scotland. The decision today represents a great victory for the health of the public.

“Five years ago the legislation introducing MUP passed through the Scottish Parliament without opposition. It has taken five years to implement for the simple reason that the Scottish Whisky Association and others chose to challenge it in the courts. In that time many families have needlessly suffered the pain and heartache of losing a loved one.

“This decision has implications far beyond Scotland. Wales, Northern Ireland and the Republic of Ireland are now clear to progress their own plans for minimum unit pricing.

“The spotlight should now fall on England, where cheap alcohol is also causing considerable damage. Over 23,000 people in England die every year from alcohol-related causes, many of them coming from the poorest and most vulnerable sections of society. We urge the Westminster Government to act now and introduce the measure in England. A failure to do so will needlessly cost more lives.”

Information on the AHA’s campaign for minimum unit pricing, along with facts and figures on the estimated impacts of MUP, is available on the AHA website: http://ahauk.org/campaigning-minimum-unit-price-alcohol/ . 

About the Alcohol Health Alliance UK
The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
- Highlight the rising levels of alcohol-related health harm
- Propose evidence-based solutions to reduce this harm
- Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk  or on 0203 075 1726.

The Medical Research Foundation have recently launched a funding opportunity focused on Viral Hepatitis research. Due to overwhelming demand the deadline has been extended for applications to Friday 10th November 2017.

This funding is aimed at Mid-Career researchers, who are making the transition to independence, and will support research that will increase the understanding of the disease mechanisms underlying viral hepatitis.

This competition is open to all UK researchers at eligible institutions (UK HEIs, Research Council research institutes, hospitals, and other independent research organisations). Applicants must hold a PhD, DPhil or MD and be in the process of, or be ready for, transition to research independence.

There is up to £1.6 million available in this competition and applicants may apply for up to £300,000 to support their research, over a maximum of a three year period.

The application process is now open and the deadline has been extended to Friday 10th November 2017.

More information can be found on the Medical Research Foundation website > here.