Minimum Unit Pricing for Alcohol

It is disappointing to see even limited medical support for legislation for putative public health benefits. There is an impression that some doctors are too keen to resort to legislation to enforce their views on the public when it is limitations in their medical communication skills that have failed to change behaviours.

Specifically, the apparent unqualified advocacy for minimum unit pricing for alcohol by Meier, Brennan, Angus and Holmes (2017) seems misguided in terms of principle and in terms of the evidence-base.

The principle of fairness is breached because minimum unit pricing for alcohol will cost individuals in lower socioeconomic groups proportionally more of their income than individuals in higher socioeconomic groups, i.e. the pricing is regressive, all other things being equal. Accordingly inequality of access will widen.

The evidence-base cited by Meier et al. (2017) draws extensively on their modelling which is open to many challenges particularly regarding the links of the models to the real world of individual behaviours and sociocultural contexts (Duffy & Snowdon, 2012; Griffith & Leicester, 2010). The observational studies from the Canadian provinces are not cited perhaps due to their weaknesses (Giesbrecht et al., 2016; Zhao et al., 2013).

Research into alcohol is fraught with controversies notably regarding research methodologies, protective versus harmful effects, price elasticity, inter alia (Gray, 2012; Roerecke & Rehm, 2012). If there is concern about harmful drinking by a minority of people of any age then the appropriate qualitative research should take place to investigate the reasons.

The editorial by Meier et al. (2017) would have been more persuasive if it had addressed policy initiatives aimed at promoting responsible alcohol consumption.

I conclude that the ruling on November 15th 2017 by the Supreme Court is regrettable in relation to all of the above points and because it will distract from the policy initiatives aimed at promoting responsible alcohol consumption in Scotland and in the other countries of the United Kingdom.

The Supreme Court’s ruling is also regrettable because it will enable the Welsh Assembly Government to divert attention from its failures in the management of the NHS in Wales.

Declaration: an abridged version of my comments on this subject was published as a rapid response in the British Medical Journal; see –

http://www.bmj.com/content/359/bmj.j5372/rapid-responses

References:

Duffy, J.C., & Snowdon, C. (2012). The Minimal Evidence for Minimal Pricing. The Fatal Flaws in the Sheffield Alcohol Pricing Model. England: Adam Smith Research Trust, ASI (Research) Ltd.

Giesbrecht, N., et al. (2016). Pricing of Alcohol in Canada: a Comparison of Provincial Policies and Harm-reduction Opportunities. Drug and Alcohol Review, 35, 289-297.

Gray, D. (2012). Is the Demand for Alcohol in Indigenous Australian Communities ‘Price Inelastic’? Drug and Alcohol Review, 31, 818-822.

Griffith, R., & Leicester, A. (2010). The Impact of Introducing a Minimum Price of Alcohol in Britain. England: Institute for Fiscal Studies.

Meier, P., Brennan, A., Angus, C., & Holmes, J. (2017). Minimum Unit Pricing for Alcohol Clears Final Legal Hurdle in Scotland. British Medical Journal, 359, 305.

Roerecke, M., & Rehm, J. (2012). The Cardioprotective Association of Average Alcohol Consumption and Ischaemic Heart Disease: a Systematic Review and Meta-analysis. Addiction, 107, 1246-1260.

Zhao, J., et al. (2013). The Relationship Between Minimum Alcohol Prices, Outlet Densities and Alcohol Attributable Deaths in British Columbia, 2002 to 2009. Addiction, 108, 1059-69.

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About Iain Robbe

I am a medical practitioner (MB, BS, 1980; MRCS, LRCP, 1980) registered with the General Medical Council of the United Kingdom without a licence to practise. I am active as a Clinical Medical Educationist participating in a number of projects with the universities of Dalhousie in Nova Scotia and Mount Allison in New Brunswick, inter alia, and separately with three of the veterinary schools in the UK. My focus is on teaching and research in professionalism, ethics, and communications, and particularly the influences of vernacular architecture on the creation of positive learning experiences in undergraduate and postgraduate medical education. I have the degree of Master in Public Health from the University of London (1985) and the degree of Master in Medical Education with distinction from the University of Wales (2001). The guiding principles in my practices are based on andragogy and humanism, and the prime ethical principle of autonomy for the individual and in population health. December 8th 2017

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