“Let’s fix Britain’s drinking problem”



The former president of Brazil, Fernando Henrique Cardoso, said last week that the war on drugs had failed and that there was a need for a new global strategy concerning illegal drug use with a shift toward decriminalisation. Although progress is glacial, his sentiments do appear to reflect a growing change in attitudes, the most concrete example of which has been Portugal’s 2001 decriminalisation of all drugs, giving it the most relaxed drug laws in the European Union.

Portugal’s move has not led to nightmare scenarios of out-of-control drug use or “drug tourism” and has allowed Portuguese healthcare to more effectively offer treatment programmes to its citizens. Should Portugal’s move become a trend, a future UK government may be tempted to follow suit. However, before taking steps that may increase the ease with which currently illegal substances may be possessed and consumed, the will must be found to tackle our crisis of excess alcohol use, a drug that is already legal and widely available.

Many people use alcohol moderately and sensibly. However, millions of us do not. The harm alcohol causes is so broad that it is hard to adequately summarise it. The problems with health and public disorder are well documented, but more invisible is the toll it takes on relationships and mental health. It affects young and old; today an article in the Lancet identifies alcohol as a major factor in teenage mortality.

Despite this, the government’s attitude towards alcohol use has been predominantly soft-touch and we have seen a relaxation of licensing laws as well as local councils that appear to think nothing of allowing so many bars in certain high streets that they become a virtual no-go area to all but the most intoxicated. The large commercial concerns that produce and sell alcohol have been allowed to go about their business largely unchecked and alcohol use is widely encouraged by virtually unrestricted advertising and pricing practice. Also unhelpful is the socially corrosive veneration of alcohol-related culture that is displayed by some influential institutions, including student unions and some radio stations, whose shows regularly encourage people to relate stories of alcoholic excess.

Decisive action is needed towards curbing alcohol misuse. A report this week from the BMA calls for alcohol advertising to be banned and for the trend of music festival tie-ins to be similarly prohibited. A reduction in the density of licensed premises in town centres is also recommended.

Alcohol pricing must more accurately reflect its cost to society with the introduction of minimum prices for alcoholic drinks. More broadly, public opinion makers need to become aware of the effects of the attitudes they propagate and on this issue seek to lead rather than follow. There is cause to be optimistic: the realignment of attitudes toward drink-driving and smoking in public places shows that major shifts in policy and public perceptions on drug-related issues are possible and can take place relatively quickly.


The case for legalising all drugs is unanswerable 13 September 2009

It’s time for a U-turn on drugs 14 September 2009 about the report Zero Base Policy


Addendum 16 September 2009

New Scientist 15 September 2009 Blueprint for a better world: legalise drugs



Update 6 January 2019

Broken links fixed – I can’t see that things have moved on much in the past 10 years…

US healthcare reform in turmoil

I was out for dinner with a New Yorker friend of mine recently. She’s British, but she’d brought along an American friend and I happened to mention to him how much I was digging President Obama. Things deteriorated from there. “Obama is a socialist!” the heads of the rest of the table turned, as the conversation up until that point had been about interior furnishings.

“I don’t think that you appreciate what a socialist is” I replied. “You should try living in France; America doesn’t have a party of the left. All you’ve got is centre and right”. The conversation then moved onto healthcare, which was proposed as an example of where liberal economic theory fails to deliver. Our American friend was undeterred by this argument.

“It’s possible to get free healthcare in the United States” he opined. “People come into a hospital sick and get treatment, and once they’re in, the hospital can’t throw them out”

I’ve been thinking about this curry-fuelled conversation over the past few days whilst reading about Obama’s troubles in pushing healthcare reform, something he considers to be the most important aim of his presidency. To the European bystander, US healthcare would seem to be in desperate need of attention. Despite the United States being the world’s richest country, millions of its people do not have healthcare cover and anyone who’s seen Michael Moore’s film Sicko will know that even those with cover can find themselves severely financially compromised by the payments they are forced to make. The system costs more per head than anywhere else in the world, but yet is only rated 37th in comparison to other countries. The effects have been felt beyond that simply of the individual; the struggling General Motors sites the healthcare costs of its staff as a significant contribution toward its instability (link to Washington Post but no longer available).

Why then are some American right so vociferous in their opposition of reform? Meetings of members of Congress who are trying to promote Obama’s plans are frequently being disrupted and Congressman David Scott had a swastika painted outside his office. It seems that healthcare reform is being equated with increased state invention in the lives of citizens something that is, in the minds of some, directly comparable to fascism. Former Vice-Presidential candidate Sarah Palin – whom, for what it’s worth, I entirely loathe – is not shy of this imagery. She wrote on her blog, in a gross characterisation of the Obama proposals:

…the America I know and love is not one in which my parents or my baby with Down’s syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society’, whether they are worthy of healthcare. Such a system is downright evil.

Here and elsewhere the NHS has been getting caught in the crossfire.   Palin is presumably referring to NICE’s attempts to decide whether expensive drugs provide value for money.  Republican senator Chuck Grassley has also confidently said that, under the NHS, Senator Edward Kennedy would be left to die untreated for his brain tumour.

Misinformation must be blamed for the violent reaction to the possiblity of health care reform, but if I was an American I would be more concerned about the wider issues. If the society that the Americans have built is simply not coherent enough for people to wish to contribute toward the health of their fellow humans then it is in urgent need of reevaluation. Those without healthcare should not simply be the disparaged “them” of my dinner companion’s discourse. For universal healthcare to work “us” is the most important word.


I should point out that I do not consider myself to be “anti-American”.  An interesting read on the subject is The Eagle’s shadow: Why America fascinates and infuriates the world by Mark Hertsgaard.  Also BBC North American correspondent Justin Webb wrote this interesting piece for Radio 4’s From our own correspondent recently.

Independent: Is US healthcare so bad that it needs a lesson from Britain? – Q&A
Guardian: US Healthcare
Guardian: Debate over US healthcare reform takes an ugly turn
Guardian: ‘Evil and Orwellian’ – America’s right turns its fire on NHS
Guardian: This NHS row is paralysing progress – if you only read one of these links make is this one

BMJ Blogs: Is it unpatriotic to criticise the NHS?


Addendum Mark Mardell on From our own correspondent