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One new drug a week: club drugs and novel psychoactive substances

By Meg Fluhart, @MegEliz_

This blog originally appeared on the Mental Elf blog on 24th October 2014

A recent report from the Faculty of Addictions at the Royal College of Psychiatrists has highlighted the changing face of drug abuse in the UK.

While drug abuse was previously dominated by crack, heroin, and ecstasy, an increasing number of people are being admitted to treatment for harm related to club drugs and novel psychoactive substances.

Club drugs are:

Psychoactive substances that are recreationally used in nightclubs, bars, festivals, music events, circuit and house parties.

Novel Psychoactive Substances (NPS) are synthesised to mimic traditional drugs and are marketed “not for human consumption” to avoid detection. They are sold under the guise of bath salts or other chemicals (Royal College of Psychiatrists, 2014).

The

Current problems

Serious harm

  • There is increasing evidence of risks and long-term effects of these drugs. For example:
    • GHB has a very small degree of dosing between euphoria and one resulting in coma or death (Club Drug Clinic, 2013)
    • Long term methamphetamine use may result in psychotic states
    • Ketamine can cause kidney and bladder problems
    • Mephedrone use can result in heart problems

New users, more drugs

  • Each year 1 million adults are estimated to use club drugs per year in the UK (National Treatment Agency for Substance Misuse, 2012), and this population of users has not just switched from crack and heroin but has emerged from a diverse population of students, ‘clubbers’ and LGBT communities
  • Additionally, the number of available drugs is growing, with a new NPS per week becoming available in Europe via the internet outlets (European Monitoring Centre for Drugs and Drug Addiction, 2012)

Unprepared services

  • Club drug and NPS users tend to not perceive current drug services as for them and are therefore more likely to receive treatment in alternative care facilities such as sexual or mental health clinics (National Treatment Agency for Substance Misuse, 2012)
  • Staff in these non-specialists centres have reported feeling unconfident in club drug and NPS assessment, intervention, and referrals
  • Furthermore, even specialist services have historically focused on crack and heroin related harm reduction and need further guidance and training to provide support to individuals with these emerging drug problems

The

Possible solutions

Widen the front door

  • Services need to encourage individuals to engage and seek treatment for club drugs and NPS-related problems, by understanding the population and drug specific problems they may come encounter with (e.g. gay men using mephedrone for sexual enhancement)

Support the front line

  • Information and clinical networks can be established in order to share information, develop knowledge, and keep on top of the rapidly emerging new drugs

‘Connect’ the front line

  • As club drug/NPS users are more apt to wind up in non-specialist treatment, it would be beneficial to integrate all different health centres into a clinical network. This would allow specialised centres to support non-specialist centres, as well as gather information across all different bases

Watch all horizons for harm

  • As many club drugs and novel psychoactive substances are new, little is known about the possible short and long term effects. Therefore healthcare centres from a range of clinical areas should be monitoring and recording club drug/NPS incidences (e.g. emergency/acute care, primary care, sexual health, and mental health services)

Promote research into club drugs and novel psychoactive substances

  • With the increase of new drugs on the market, funders should consider prioritising resources towards club drugs and novel psychoactive substances
  • Due the diverse population of users and context of club drugs, we cannot assume the same interventions that are established with crack and heroin will work with these drugs. Therefore, future research proposals should consider club drug/NPS treatment interventions

Empower users through education

  • A main priority should be to provide the public with high quality and comprehensive information on the risks of club drugs and novel psychoactive substances in order to prevent initiation
  • In addition, information on harm reduction must be provided, including advice on safe injection, warnings on increased sexual health risks when using, and material on support and recovery

The report calls for non-specialist staff

Summary

This faculty report has brought to attention the rising problem of club drugs and novel psychoactive substances in the UK, which are popular amongst students, clubbers, and the LGBT community.

The large number of users (estimated at 1 million people per year) has subsequently resulted in new drugs becoming rapidly available via online markets (National Treatment Agency for Substance Misuse, 2012; European Monitoring Centre for Drugs and Drug Addiction, 2012).

The report authors highlight several key points:

  1. Users of club drugs and novel psychoactive substances are likely to seek alternative treatment to traditional drug specialist centres. Therefore, it is important to train and educate staff in these non-specialist centres so they can confidently provide support and referrals to users
  2. All healthcare centres should work together to monitor and share information on club drug/NPS cases in order to monitor the possible side effects of these rapidly emerging new drugs
  3. Funding bodies should consider shifting the attention from traditional drug use (crack/heroin) to club drugs to determine whether different treatment interventions are needed

Should research funding be directed away from 'traditional' street drugs to these new club drugs and novel psychoactive substances?

Links

One new drug a week: Why novel psychoactive substances and club drugs need a different response from UK treatment providers (PDF). Royal College of Psychiatrists, 2 Sep 2014.

Club Drugs: Emerging Trends and Risks (PDF). National Treatment Agency for Substance Misuse, 2012.

Annual Report 2012 on the State of the Drugs Problem in Europe. European Monitoring Centre for Drugs and Drug Addiction, 2012.

GHB/GBL. Club Drug Clinic, 2013.

– See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/one-new-drug-a-week-club-drugs-and-novel-psychoactive-substances/#sthash.LrMnqRPK.dpuf

Smoking cessation in the emergency setting

By Olivia Maynard @OliviaMaynard17

This blog originally appeared on the Mental Elf site on 20th October 2014

shutterstock_198435872

The prevalence of smoking among patients in emergency departments (ED) is reported to be higher than in the general population, so encouraging smoking cessation in these settings has been recommended. However, 57% of ED staff believe that smoking cessation treatments are inappropriate for the ED setting, citing time constraints, lack of patient interest and treatment ineffectiveness as the main causes of these beliefs (Tong et al., 2010).

A systematic review published in the American Journal of Emergency Medicine (Pelletier et al., 2014), has recently analysed the most up to date research on the effectiveness, feasibility and appropriateness of smoking cessation interventions in ED settings.

The primary outcome measure was:

  • Self-reported and/or biomarker-assessed smoking cessation.

Secondary outcomes were:

  • All-cause mortality;
  • Cost per quit;
  • Patient satisfaction;
  • Practitioner time spent and non-practitioner time spent (these last two were considered together).

Methods

The authors included all original studies of smoking cessation interventions performed in either adult or paediatric ED settings that assessed at least one of the outcome measures outlined above.

One investigator conducted the literature search (on the Medline and CINAHL databases), identifying 17 articles which were then examined for sources of bias (such as lack of randomisation, non-blinding of participants or study personnel and incomplete outcome data reporting). Four studies were excluded due to a high or unclear risk of bias, leaving 13 studies to undergo full systematic review.

Although a meta-analysis of these studies was planned, their heterogeneity precluded this and therefore only a systematic review was conducted. All studies were also rated on a three point scale for quality, using 19 quality criteria questions.

This review looked at a range of

This review looked at a range of interventions for helping people to quit smoking in the emergency setting.

Results

Of the 13 studies, 11 were conducted in the USA, one in Germany and one in Turkey. Six studies used a single time-point follow-up for assessing smoking cessation, three had two follow-ups, three studies had three follow-ups and one had four follow-ups.

The smoking cessation interventions varied between studies and fell into six broad categories:

  1. Administration of self-help materials;
  2. Faxed referrals to other programmes;
  3. Brief advice;
  4. Counselling;
  5. Nicotine replacement therapy (NRT);
  6. Motivational interviewing-based interventions.

Eleven studies included at least two of these interventions and there was no consistent control group across the studies.

The main findings of the systematic review were as follows:

  • The overall quality of the studies was relatively poor:
    • Quality ratings ranged from 31 to 81% (where 100% refers to a study scoring top marks on all 19 quality criteria)
    • The average quality rating was 57% (SD = 15.1%).
    • Studies generally scored poorly on the documentation of participant retention and follow-up, justification of sample size and appropriate follow-up.
    • Data on all-cause mortality and cost per quit were absent or inadequate in the majority of studies and therefore these two secondary outcome measures were dropped from further consideration.
  • The majority of studies found no difference between intervention and control groups in terms of cessation rates (the primary outcome measure):
    • Twelve studies reported cessation rates and 10 of these reported no beneficial effect of the intervention.
    • Two studies reported a beneficial effect of smoking cessation intervention (Bock et al, 2008; Bernstein et al, 2013), however, this was only observed at three months in the first study and only one and three months, but not six months in the second study.
    • The authors of the systematic review note that these two studies used motivational interviewing-based techniques, and suggest that these techniques may be particularly effective. However, it is important to note that four other studies also used motivational interviewing, but did not find any beneficial effect.
    • Although the majority of these studies did not observe a beneficial effect of smoking cessation interventions, the authors note that many did find that overall smoking cessation rates (in both intervention and control arms) was higher than that reported among the general population in the USA (according to the 2010 National Health Interview Survey [NHIS]). This is a crude comparison however, as the 13 studies included in this review were conducted between 2000 and 2014, and were conducted in Turkey and Germany as well as the USA, whereas the NHIS survey was conducted in 2010 only in the USA.
  • Patient satisfaction was high, but was not often reported:
    • In the two studies reporting patient satisfaction, this was found to be 90% or above.
    • Both of these studies used motivational interviewing-based interventions and both considered paediatric patients or their parents, rather than adult patients receiving treatment for themselves.
  • Intervention time varied, but was not often reported:
    • A faxed referral was reported to take an average of 3 minutes, brief advice 5 minutes and motivational interviewing-based interventions 37 minutes.

MOst studies found no difference between intervention and control groups in terms of cessation rates.

Most studies found no difference between intervention and control groups in terms of cessation rates.

Conclusions and implications for practice

The authors of this systematic review conclude that:

ED-based cessation interventions may be effective, but the available data are somewhat limited and heterogeneous.

Only two of the 13 studies included in the review found any benefit of smoking cessation intervention in the ED settings, with both using motivational interviewing. This led the authors of this review to further conclude that:

Motivational interviewing may prove to be a promising strategy where feasible.

However, it is important to note that four of the six studies which used motivational interviewing did not find any beneficial effect of this intervention.

The authors recommend that:

ED providers ask about smoking status, provide brief motivational interviewing or brief advice to quit as time allows, and provide a pamphlet with information about the benefits of smoking cessation and information about the benefits of smoking cessation and information for verified smoking cessation programs to all patients.

The evidence supporting emergency based interventions for smoking cessation is limited and heterogeneous. Further research is required to determine whether smoking cessation interventions are more effective in encouraging cessation than simply visiting the ED alone, and if so, which interventions are most effective.

The evidence-base is not yet of sufficient quality for us to draw any conclusions about the best course of action for smoking cessation in emergency departments.

The evidence-base is not yet of sufficient quality for us to draw any conclusions about the best course of action for smoking cessation in emergency departments.

Limitations

  • The reviewers only searched two databases (Medline and CINAHL) so are likely to have missed studies published in journals not indexed on those databases.
  • The general quality of the studies included in the systematic review was weak to moderate, even after studies with high risk of bias were excluded. Future research should use rigorous designs with large sample sizes.
  • No studies investigated time-effectiveness, all-cause mortality, or cost per quit as outcomes and these factors should be considered in future research.
  • Only four studies pre-registered study information, meaning that the degree to which the remaining studies fully reported all study outcomes cannot be guaranteed.
  • Smoking cessation was assessed by the majority of studies using self-report, rather than through biometrically confirmed abstinence, potentially artificially increasing cessation success.
  • The lack of a standardised control group meant that study findings could not be pooled into a meta-analysis.
  • None of the studies included in this systematic review were conducted in the UK, with the focus on EDs in the USA.

The reviewers could have done more to find studies to include in their review.

The reviewers could have done more to find studies to include in their review.

Links

Pelletier JH, Strout TD, Baumann MR. A systematic review of smoking cessation interventions in the emergency setting. Am J Emerg Med. 2014 Jul;32(7):713-24. doi: 10.1016/j.ajem.2014.03.042. Epub 2014 Apr 2. [PubMed abstract]

Bernstein SL Bijur P, Cooperman N et al. Efficacy of an ED-cased multi-component intervention for smokers with substance use disorders. Journal of Substance Abuse Treatment, 2013; 44(1): 139-42.

Bock BC, Becker BM, Niaura RS et al. Smoking cessation among patients in an emergency chest pain observation unit; outcomes of the Chest Pain Smoking Study (CPSS). Nicotine and Tobacco Research, 2008; 10(10):1523-31. [PubMed abstract]

Quitting Smoking Among Adults – United States, 2001-2010. Centers for Disease Control and Prevention; 2011 [11/11/2011]

– See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/smoking-cessation-in-the-emergency-setting/#sthash.SCNL87pV.dpuf

The missing heritability problem

By Marcus Munafo

Missing heritability has been described as genetic “dark matter”In my last post I described the transition from candidate gene studies to genome-wide association studies, and argued that the corresponding change in the methods used, focusing on the whole genome rather than on a handful of genes of presumed biological relevance, has transformed our understanding of the genetic basis of complex traits. In this post I discuss the reasons why, despite this success, we still have not accounted for all the genetic influences we expect to find.

As I discussed previously, genome-wide association studies (GWAS) have been extremely successful in identifying genetic variants associated with a range of disease outcomes – countless replicable associations have emerged over the last few years. Nevertheless, despite this success, the proportion of variability in specific traits accounted for so far is much less than what twin, family and adoption studies would lead us to expect. The individual variants identified are associated with a very small proportion of variance in the trait of interest (typically 0.1% of less), so that together they still only account for a modest proportion. Twin, family and adoption studies would lead us to expect that 50% or more of the variance in many complex traits is attributable to genetic influences, but so far we have found only a small fraction of that total. This has become known as the “missing heritability” problem. Where are the other genes? Should we be seeking common genetic variants of smaller and smaller effect, in larger and larger studies? Or is there a role for rare variants (i.e., those which occur with a low frequency in a particular population, typically a minor allele frequency less than 5%), which may have a larger effect?

It is clear that some missing heritability will be accounted for by variants that have not yet been identified via GWAS. Most GWAS genotyping chips don’t capture rare variants very well, but evolutionary theory predicts that those mutations that strongly influence complex phenotypes will tend to occur at low frequencies. Under the evolutionary neutral model, variants with these large effects are predicted to be rare. However, under the same model, while rare variants of large effect constitute the majority of causal variants, they still only contribute a small proportion of phenotypicvariance in a population, because they are rare. On the other hand, common variants of small effect contribute a greater overall proportion of variance. There are new methods which use a less stringent threshold for including variants identified via GWAS – instead of only including those that reach “genomewide significance” (i.e., a P-value < 10-8 – see my earlier post), those which reach a much more modest level of statistical evidence (e.g., P < 0.5) are included. This much more inclusive approach has shown that when considered together, common genetic variants do in fact seem to account for a substantial proportion of expected heritability.

In other words, complex traits, such as most disease outcomes but also those behavioural traits of interest to psychologists, are highly polygenic – that is, they are influenced by a very large number of common genetic variants of very small effect. This, in turn, explains why we have yet to reliably identify specific genetic variants associated with many psychological and behavioural traits – while the latest GWAS of traits such as height and weight (the GIANT Consortium) includes data on over 250,000 individuals, there exists no such collection of data on most psychological and behavioural traits. This situation is changing though – a recent GWAS of educational attainment combined data on over 125,000 individuals, and three genetic loci were identified with genomewide significance, although these were associated with very small effects (as we would expect). Excitingly, these findings have recently been replicated. Another large GWAS, this time of schizophrenia, identified 108 loci associated with the disease, putting this psychiatric condition on a par with traits such as height and weight in terms of our understanding of the underlying genetics.

The success of the GWAS method is remarkable – the recent schizophrenia GWAS, for example, has provided a number of intriguing new biological targets for further study. It should only be a matter of time (and sample size) before we begin to identify variants associated with personality, cognitive ability and so on. Once we do, we will understand more about the biological basis for these traits, and finally begin to account for the missing heritability.

References:

Munafò, M.R., & Flint J. (2014). Schizophrenia: genesis of a complex disease. Nature, 511, 412-3.

Rietveld, C.A., et al. (2013). GWAS of 126,559 individuals identifies genetic variants associated with educational attainment. Science340, 1467-71.

@MarcusMunafo

@BristolTARG

This blog first appeared on The Inquisitive Mind site on 18th October 2014.

Alcohol minimum unit pricing: time to take action?

By Olivia Maynard @OliviaMaynard17

This blog originally appeared on the Mental Elf site on 3rd October 2014

The UK government’s minimum pricing policy for alcohol has been hotly debated over the last couple of years and this week a new study describing the potential benefit of minimum unit pricing over the governments’ current ban on below cost selling has started sparks flying once more.

In the paper, published on Wednesday in the British Medical Journal (BMJ), Brennan and colleagues (2014) use sophisticated modelling to compare the expected effects of the two policies on the following outcomes:

  • Alcohol consumption
  • Health harms, including deaths, illness, admissions to hospital, quality of life and costs to the NHS
  • Drinkers’ expenditure
  • Tax and duty revenues

However, before we get our teeth stuck into the study itself, what’s the difference between the two policies?

Minimum unit pricing is about setting a floor price (e.g. 45p) for a single unit of alcohol.

Minimum unit pricing is about setting a floor price (e.g. 45p) for a single unit of alcohol.

Minimum unit pricing (MUP)

  • A ‘unit’ of alcohol (roughly half a pint of low strength beer, a measure of spirits or half a regular sized glass of wine) would have to be sold at a set price, such as 45p
  • This policy was initially supported in 2012 by the UK government, but was later rejected
  • The Scottish government passed legislation to introduce MUP at 50p per unit in June 2012, but as yet this has not been introduced due to a legal challenge from the Scotch Whiskey Association which has now gone all the way to the European Court of Justice. The outcome of this legal challenge is not expected until late 2015
  • Canada, Russia and Uzbekistan have all introduced MUP

A ban on below cost selling (BBCS)

  • Alcoholic drinks must not be sold for less than the tax payable on the product
  • Under this policy, the price of alcohol does not necessarily increase with the strength of the alcohol and for drinks like high strength cider, a unit of alcohol can be sold for as little as 6p under this policy
  • The UK government favoured this policy over MUP in 2013 and introduced it in May 2014

The authors answer the following question in their study:

What would the differential potential impact of a BBCS versus a MUP policy of 40p, 45p or 50p if the policies were to be implemented in 2014-2015?

Despite once publicly supporting a minimum unit pricing of 40p. David Cameron's government has decided instead to put in place a ban on the sale of “below cost” drinks.

Despite once publicly supporting a minimum unit pricing of 40p. David Cameron’s government has decided instead to put in place a ban on the sale of “below cost” drinks.

Methods

As I said, the authors used some pretty sophisticated modelling techniques (using the Sheffield Alcohol Policy Model [version 2.5]) to answer their research question, but in brief, in order to work out the likely effects of these two alcohol policies, the following information was entered into the model:

  • Baseline data on:
    • Alcohol consumption for different population subgroups in England (split by sex, age, mean consumption level and income)
    • Prices paid for 10 different beverage types and quantity of each purchased, for the different subgroups
  • An estimate of the effect that price increases for these 10 beverages would have on consumption levels for the subgroups (given that different subgroups spend and drink different amounts of the 10 beverages)
  • The effects of this estimated change in consumption on death and disease rates at one and 10 years post implementation

Results

Given that harmful drinkers are a policy priority group, (consuming on average 58 units for females and 80 for males per week and spending £1,800 and £3,400 per year respectively), the authors focus in particular on the effects of the two policies on this group. Also, whilst MUP at 40p, 45p and 50p were all assessed, I will focus on MUP at 45p, as this is the level initially proposed by the UK government.

Proportion of the market affected by the policies

  • Under a BBCS, only 0.7% of all units of alcohol sold in the UK would see a price increase, whilst MUP would affect 23.2% of all units sold
  • MUP would disproportionately affect harmful drinkers, increasing the price of 30.5% of the units they purchase, as compared with only 12.5% of units purchased by moderate drinkers

Alcohol consumption

  • A BBCS was estimated to reduce the number of units consumed by harmful drinkers by only 3 units per year
  • By contrast, MUP was estimated to reduce this by 137 units; a 45-fold reduction as compared with a BBCS

Health harms, including deaths, admissions to hospital, quality of life and costs to the NHS

  • The estimated effects on the general population of the two policies after 10 years of implementation are shown below:
BBCS MUP
Annual reduction in number of deaths 14 624
Annual reduction in hospital admissions 500 23,700
Annual reduction in alcohol-related illness 300 12,500
Total number of quality adjusted life years gained 500 24,200
Total saving in healthcare costs £9.5 million £417.2 million
  • Based on these estimates, MUP will reduce deaths attributable to alcohol by 40 times more than BBCS
  • The majority of this harm reduction is likely to be among harmful drinkers, with 89% of the reduction in deaths after 10 years among this group

The study findings suggest that harmful drinkers would be helped most by minimum unit pricing

The study findings suggest that harmful drinkers would be helped most by minimum unit pricing.

Drinkers’ expenditure

  • Due to the high price elasticity of alcohol (higher prices mean people lower their consumption to a level which ensures they continue to spend the same amount) neither policy is expected to greatly affect spending

Tax and duty revenues

  • A BBCS is estimated to increase revenues in shops and supermarkets by 0.3% (£5.4m)
  • By contrast, MUP is estimated to result in a 5.6% (£201.1m) increase in revenues, although the effects on actual profits is unknown
  • The effects of the two policies on government tax revenue is small, as although VAT will rise (because this is charged as a percentage of product price and products will be sold at higher prices), alcohol duty revenue will fall (as this is related to the volume of alcohol sold)

Discussion

Professor Alan Brennan, professor of Health Economics and Decision Modelling at the University of Sheffield, who led the study said:

Despite some study limitations we found that a minimum unit price of 45p would be expected to have 40-50 times larger reductions in consumption and health harms.

The limitations Professor Brennan alludes to include the fact that certain assumptions about alcohol price elasticity and actual alcohol consumption and expenditure had to be made in order to run the model. However, the authors state that the sensitivity analyses they have conducted show that the relative scale of the impact of a BBCS versus MUP is robust to these assumptions and uncertainties and, if anything, the scale of the difference is likely to be conservative.

In the editorial accompanying the paper (Stockwell, 2014), Tim Stockwell, the director of the Centre for Addictions Research at the University of British Columbia, Canada, notes that one way to test whether the model is conservative is to compare the model’s predicted effects with actual reported effects in a country where MUP has been introduced. Indeed, when the model is applied to two Canadian provinces with MUP policies, the model underestimates the number of deaths by 2.3 times and the number of hospital admissions by almost 5 times.

It seems therefore that the model is robust enough to assess the effects of the two policies and if anything, underestimates the true likely effect of MUP. These data suggest that MUP would be a far more effective method of reducing consumption and preventing alcohol related harm than the BBCS implemented earlier this year in the UK.

Minimum unit pricing in Canada has been associated with significant reductions in alcohol related harm

Minimum unit pricing in Canada has been associated with significant reductions in alcohol related harm.

Implications for policy

  • The UK government introduced a BBCS in May 2014
  • The Scottish legal case will likely pave the way for alcohol pricing policies in other EU jurisdictions interested in introducing MUP, including the Republic of Ireland, Estonia and regional governments in the UK
  • Given the potential effectiveness of MUP as compared with a BBCS, the outcome of this legal case is likely to have important implications for public health across Europe

Response from government, industry and others

Perhaps unsurprisingly, this study has not found favour among the alcohol industry, with Miles Beale, Chief Executive of the Wine and Spirits Association arguing that the government should not be “punishing responsible drinkers through higher prices”, a statement which seems at odds with the study’s results which shows that MUP would specifically target harmful drinkers. Indeed, this is what makes MUP different from more indiscriminate policies, such as general price or tax increases, which would indeed punish moderate drinkers.

By contrast, Sir Ian Gilmore, chairman of the Alcohol Health Alliance, warmly received the results of the study and urged Westminster politicians to back the Scottish plans for MUP and “help push it through the European Court of Justice for the good of the public’s health.”

However, the response from the Department of Health was lukewarm, with a spokeswoman reiterating the fact that the government is “taking action to tackle cheap and harmful alcohol such as banning the lowest priced drinks” and noting that the government is “working with industry to promote responsible drinking.”

This close relationship between UK government and the alcohol industry is well documented and alcohol industry lobbying has been cited as the main reason for the government U-turn on MUP in 2013 (Gornall, 2014). Unlike tobacco control policies in the UK, which are protected from the tobacco industry and other commercial interests through a World Health Organisation framework (WHO FCTC, 2005), this is not the case for alcohol policies. John Holmes, a Public Health Research Fellow at the Sheffield Alcohol Research Group, and one of the authors of this study, has previously acknowledged that the alcohol industry should have some say in alcohol policies, but that he is also concerned that the industry is “not particularly interested in . . . engaging in any kind of debate about whether their arguments are accurate. It’s all about creating doubt about what we’re saying.”

Whether the alcohol industry will continue to cast doubt on this research and whether the government will choose to listen to the researchers or the industry, remains to be seen.

In late 2015, the European Court of Justice will decide if the Scottish parliament’s 2012 legislation can be passed, which will have a massive impact on public health in Europe.

In late 2015, the European Court of Justice will decide if the Scottish parliament’s 2012 legislation can be passed, which will have a massive impact on public health in Europe.

Links

Brennan A, Meng Y, Holmes J, Hill-McManus D, Meier PS. (2014). Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling studyBMJ, 349(g5452).

Gornall J. (2014). Under the influence: 1. False dawn for minimum unit pricingBMJ 2014;348:f7435.

Stockwell D. (2014). Editorial: Minimum unit pricing for alcoholBMJ, 349(g5617).

WHO FCTC. (2005). WHO Framework Convention on Tobacco Control (PDF). World Health Organisation.

Radu Bercan/Shutterstock.comPeter Fuchs/Shutterstock.com.

– See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/alcohol-minimum-unit-pricing-time-to-take-action/#sthash.hAkkpG2g.dpuf