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

Due to the current BASL Surgery Representative stepping down BASL are seeking expressions of interest for this position.

The Surgery Representative will serve on the BASL Committee for a maximum term of 3 years and 2 years alternating and may be re-elected once. The representative is expected to attend BASL Committee meetings (face to face or teleconference) as well as the Annual Meeting in September.

Nomination Process
Please send nominations to the BASL Secretariat at judy.hawksworth@execbs.com by the deadline of 17:00 Tuesday 5th December 2017.

Candidates wishing to be considered for election must be a BASL member and will require one BASL member to propose them and a second BASL member to confirm their suitability for the role in writing.

If more than one candidate is nominated, the Secretariat will arrange for an election of all members. He/she will be elected by simple majority of those members voting. A member can be re-elected once to the post of Surgery Representative.

A personal statement, containing no more than approx. 300 words will be required from the candidates should an election need to take place.

The newly elected BASL Surgery Representative will take up their post straight away and will step down at the Annual Business Meeting of the Association during the BASL Annual Meeting in September 2020.

If you require any further information please contact judy.hawksworth@execbs.com .

‘Today’s budget represents a huge missed opportunity for the Government to tackle alcohol harm and protect our most vulnerable.

‘The freezes on alcohol duty the Chancellor has announced represent a real terms cut in duty, and a £1.2 billion tax giveaway to an alcohol industry which has already benefitted from successive duty cuts in previous budgets.

‘The planned increase in duty on some high-strength ciders appears like a small step in the right direction. However, in reality it will have minimal impact. A three-litre bottle of white cider at the newly proposed 6.8% ABV strength will contain more than 20 units of alcohol yet could still be sold for £3.50. This will do very little to protect dependent drinkers and children that consume these damaging products.

‘Furthermore, this measure will not come into effect until 2019 and in the meantime the price of high strength cider will fall because of today’s duty freeze.

‘This strengthens the case for minimum unit pricing of alcohol. With minimum pricing now judged to be legal by the Supreme Court and Scotland and Wales moving to implement the measure, it is important that England does not get left behind in terms of reducing alcohol-related harm.’

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 07748 757376.

Commenting on the editorial published in The Lancet Gastroenterology & Hepatology on the new definition of alcohol mortality proposed by Office for National Statistics (ONS), Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:

“We agree entirely with the concerns outlined in The Lancet Gastroenterology & Hepatology about the revised definition for alcohol deaths from the ONS.

“The new definition will mean that a high number of liver disease deaths where we know that alcohol is the cause will no longer be recorded as being linked to alcohol.

“This reduction will give the wrong impression to the public that alcohol deaths are going down, when in fact the burden of alcohol on our nation’s health and health service is growing, with alcohol-related hospital admissions going up, and liver disease rates on the rise.

“Medical experts across the country have warned that it is premature for the ONS to alter the definition in the way it has proposed. The reasons are technical, but it comes down to the fact that more research is needed on the exact link between alcohol and certain categories of liver disease deaths.

“We recommend that the ONS hits the pause button on the work it is doing to alter the definition of alcohol deaths, until the necessary research has been done. This research could be done quickly and cheaply, in a handful of liver centres across the country.”

The editorial is available by clicking > here.

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.