Are we focussing on the right NHS costs?

[geoff956]

Originally Posted by Eoin (pronounced Owen)

While convincing people to drink less is doubtless a noble goal, the idea that it would overall save the NHS money is contentious. Alcohol raises £14.6Bn/year in taxes for the treasury. Alcohol costs the NHS around £2.7Bn/year. (1) While there must be other branches of Governments spending money on alcohol related problems (e.g. police/social work), I haven't seen any figures which make the cost to the taxpayer of alcohol come anywhere close to the revenue raised by it.

The costs to the treasury are of course much wider, and probably beyond calculation, e.g. police, & other emergency services, legal system, prison service, probation service, lost days from work, domestic disruption, divorce - it just goes on & on.

Originally Posted by Eoin
(1) [URL="http://www.bbc.co.uk/news/uk-11170814"

BBC News - Alcohol consumption 'continues to fall'

If this continues as a general trend I think we should all welcome it, but as you say the treasury is still raking in £14.6Bn/year from the amount we consume.

[George & Bill]

Our attitudes to narcotics are certainly out of kilter - it is odd how accepting we are of alcohol, or how taboo other narcotics have become, or some combination of those things.

But the thing is, OP, that humans have used perception-altering substances for much of their history. Most people are not addicted to these substances, and come to them in a position from which they can make a reasoned cost/benefit analysis - drinking a glass of wine may have a negative health impact, but it could also be enjoyable, and for many people latter will be sufficient for them to accept the former. Life is full of these calculations - we make them every time we travel, or play sport, or eat a cream cake. For most people, life is not about stopping any activity that has any negative health impact, but about balancing enjoyment today with health tomorrow. For most people, moderate alcohol consumption is compatible with this.

While I believe the current science does say that most alcohol consumption is a net negative health impact (benefits to the heart from a glass of wine a day are slightly outweighed by increased cancer risk), I think that drinking within recommended limits does not pose a risk to health that is any great than many other activities we do on a daily basis. The costs you have spoken of arise largely from a minority of people drinking too much, not from the majority drinking at all.

[geoff956]

Originally Posted by Gungnir

The point I was making is that your claim was that a bottle of spirits contains a lethal dose of alcohol, and that is not true. Yes it could be fatal, but so could eating 3 Mars bars if you're diabetic, or eating peanuts.

However you've digressed from your initial point, which is non-treatment of people with alcohol induced conditions and injuries (can't really forget about them), through the NHS. The issue is quite simple, once you consider an activity serious enough that you do not provide treatment due to inherent risk of damage, then where do you stop? Skydiving, skiing, horse riding, motor racing, motorcycles, rugby, football, golf, promiscuity even all have inherent risks of death, serious injury or illness (and the list isn't even close to exhaustive), clearly certain diets, and addictions are bad too, hell lets just put it out there, part of the reason the medical services are suffering is that they've been successful at increasing longevity, and enabling births that even 10 years ago would have died before childhood to survive with congenital defects that require continued treatments. So while alcohol is avoidable, so is most of what I've listed, and then there's the potential for making a judgment call on who receives treatment based on projected costs.

So if you consider alcohol related illness and injuries as not priority, why should it not also be argued that someone who's 85 with peripheral artery disease should be a priority? Or a newborn who is born with malfunctioning heart, liver or kidneys? Should we only treat those who through no fault of their own suffered some condition, disease or injury? Which leads to how is it decided what is or is not through no fault of their own?

Roy Castle died a number of years ago of lung cancer after being a non-smoker all his life, the opinion is that since he was an entertainer and working in bars, clubs, theaters where smoking used to be permitted he developed lung cancer because of exposure to environmental tobacco smoke. It could be argued that given by the late 50's the risks of active smoking were enough to cause people to begin to alter behaviors, and that being in a room full of cigarette smoke is tantamount to actively smoking, then his condition was indeed self-inflicted.

Now with all that said, it basically comes down to the question of, what level of personal control are you willing to cede to the government (in the form of the National Health Service) so that treatment cannot be denied? Ultimately that is the abstraction of question you're asking. Clearly you consider alcohol as one item you'd be willing to concede, but what about anything on my list in paragraph 2? All are known to cause death on occasion (although the treatment cost is likely to be significantly less than serious injury), and serious injury on occasion, and just regular injury too, and the costs are most commonly borne by the NHS.

A 'Lethal Dose' of alcohol is defined clinically as LD:50 which means a dose at which 50% of people would die. Having said that, it's only fair to say that other factors come in to play.
The weight of the person, and crucially, the time over which the alcohol is consumed both affect outcomes. Also the immunity (if any) already built up by the drinker. It is generally accepted that a 100lb
man or woman consuming 9-10 standard drinks in less than an hour would put them in the LD:50 range. On the other hand a 200lb man would have to consume around 5-6 drinks per hour over 4 hours to reach the LD:50.
Obviously there is no unconditional lethal dose and I imagine the same goes for many (if not all) other drugs. However, to get back to the point, a bottle of spirit would certainly contain enough alcohol to
meet this criteria.
The 3 mars bars may well kill a diabetic but as they would have no effect on the other 95.4% of the non diabetic population they could never be classified as a 'lethal dose'.

The remainder of your reply arises I think from a degree of ambiguity in my original post for which I apologise. I am not saying for one moment that treatment should be denied by the NHS. I was suggesting that perhaps we should concentrate (by education) on drink related problems generally - the results of which we often see in A & E departments. The saving of money hopefully to be made by less alcohol dominated A & E departments.