The Sunday Times

June 26th, 2011

Look out, Dr Bully wants to snatch granny’s sip of sherry

When Jeanne Calment of Arles reached her 117th birthday in 1992, a local paper reported that she was being pressed by those in her nursing home to give up cigarettes — though she smoked only one or two a day — and port, which she loved. I was reminded of that hateful story last week, when the Royal College of Psychiatrists announced that people over 65 are drinking far more than is good for them, and that each day women should restrict themselves to a small glass of wine and men to less than a pint of average-strength pub beer.

Introducing this new “safe limit” in a ponderous report called Our Invisible Addicts, the college outlines a problem of substance abuse among the wrinkly and suggests old people who have half a bottle or so of wine with food, or regularly down more than a couple of pints at the pub, are binge drinkers: more than 4½ units for men and more than three units — two small glasses of wine — for women is bingeing. It recommends GPs screen everyone over 65 for excessive drinking and, if they persist in ignoring this new “safe limit”, treat them for addiction.

This is all heartlessly silly. One can only gasp at the mindset of the people who dreamt it up. For its lack of perspective, lack of human understanding, lack of common sense and lack of political realism, this must be up there with the pronouncements of the Archbishop of Canterbury.

No doubt there are geriatric problem drinkers. No doubt old people metabolise alcohol less efficiently than the young. No doubt booze interferes with pills. No doubt getting squiffy leads to geriatric accidents. No doubt there are old people who drown their loneliness in booze. But none of that justifies this puritanical mass bullying.

For one thing, the truth is that the number of elderly “hidden addicts” among us is actually tiny, according to the statistics cited in the report itself. What’s striking in the midst of the authors’ doom and gloom is the very high proportion of older people who do not drink much. NHS figures designed to show how many men drank more than four units of alcohol (two pints of weak beer) on at least one day a week showed that nearly 80% did not do so. Among older women, 90% did not drink more than three units of alcohol even one day a week.

In other words, most old people drink very little indeed, both by normal standards and by the standards of this interfering report.

Here are some of the things that I believe lie behind this mindset. First of all — and there must be some clever Greek word for it — people who are preoccupied with something have the mental habit of seeing that particular something everywhere they look, to the exclusion of other things, and so exaggerate it. It’s a professional deformity of experts. Strikingly, almost all of the distinguished people on the working party and editorial team that produced Our Invisible Addicts are experts in addiction. Perhaps it is too simple-minded to assume that such a team is likely to see addiction where others might not.

Then there is the constant phenomenon of unthinking egalitarianism — the one-size-fits-all mindset. It is everywhere. In this case, concerns about a tiny minority of problem heavy drinkers are imposed on the vast majority of responsible old people. Everyone must be cross-questioned by GPs, just because a few really need help.

And again, the safe limit for one person — whatever that may truly be — is simply not the safe limit for another. As the report carefully points out, old people metabolise alcohol differently from young people. What it ignores is the fact that individuals of any age metabolise everything differently from other individuals.

With alcohol, it must seem obvious even to the unobservant that one young woman, say, will feel tipsy after a single small drink, while another girl can drink big men under the table and wake up without a hangover. One chronic heavy drinker may die with a healthy liver, or surprise his doctors with one on an MRI scan. What is a safe amount of sherry for one granny would put another in A&E, and it is useless to generalise.

And the number of units now proposed in this report is so ludicrously low, in most people’s experience, that it will be widely ignored, thus completely destroying the point of the warning.

Underneath this mentality is a bullying, precautionary principle based on a mistrust of the public. As a result, the same excessively cautious diktats are applied to everybody. It shows a breathtaking contempt for the public, and at times for the evidence. Four years ago The Times revealed that the current recommended drinking limits for everyone (21 units a week for men and 14 for women) were simply “plucked out of the air” as an “intelligent guess”.

The recommendations were made in 1987, without any firm scientific basis, according to a member of the Royal College of Physicians working party that produced them. Richard Smith, a former editor of the British Medical Journal, said the committee’s epidemiologist confessed it was “impossible to say what’s safe and what isn’t”, because “we don’t really have any data whatsoever”.

Since then there has been some evidence that the recommended limits should be raised, but health ministers have chosen to ignore it. If they are doing so in the belief that this will keep costs down in the NHS, they are entirely wrong — old people drinking and smoking themselves to a relatively early death would go a long way to solving the national ageing problem.

But what’s worse than any of this muddle and prejudice is the heartlessness of the report. Old people will now be bullied about their modest drinking and shamed out of one of the great pleasures and consolations of old age. The report appears to be saying that anyone over 65 who drinks more than a dribble of alcohol needs medical help, but that is to mistake the symptom for the disease. The disease is ageing and the loneliness, failing health, anxiety, loss and pain that ageing flesh is heir to.

Since there is absolutely no hope at all that the state or the NHS can or will sort out these problems — it cannot begin to provide adequate psychiatric services or deal with serious poverty among the elderly — it is frivolous to talk of treatment.

If old people want to use alcohol as a palliative, who has the right to stop them? And what could be sillier than the mentality capable of telling a woman of 117, such as Jeanne Calment, that she must not smoke or drink because she might shorten her life?