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NHS Choices: Behind the headlines   + / -  
last updated: Sat, 23 May 2015 02:08:05 GMT

 Fri, 22 May 2015 13:48:00 GMT Holidays and parties mean we may drink more than we think

"The amount of alcohol people in England drink has been underestimated by the equivalent of 12 million bottles of wine a week," BBC News reports.

It has long been known there is a big gap between the amount people say they drink in national surveys, like the Health Survey for England, and the amount of alcohol known to be sold in England.

In this new survey researchers set out on the assumption that while people may accurately report their standard drinking patterns from week to week, they may forget the drinking they do on special occasions, such as bank holidays, parties, weddings, wakes or big sporting events (which, for many England fans, is akin to a wake).

The study used a large phone interview to estimate the amount of extra drinking going on during these types of occasions. They found this accounted for an extra 12 million bottles of wine a week in England – just under a staggering eight and a half million litres, which is more than enough to fill three Olympic-size swimming pools.

The results seem plausible. As the scientists point out: "The impact of atypical and special occasion drinking is reflected in evening presentations to emergency units, which peak on weekends but also sports events, bank holidays, and even commemorative occasions such as Halloween."

If you are concerned about whether you may be drinking more than you should, you can download the Change4Life Drinks Tracker app, which is available for iOS and Android devices.

Where did the story come from?

The study was carried out by UK researchers from Cardiff University, Bangor University, Liverpool John Moores University, and the London School of Hygiene and Tropical Medicine. It was funded by Alcohol Research UK.
 
The study was published in the peer-reviewed medical journal BioMed Central. This is an open-access journal, so the study is free to read online or download as a PDF.

The UK media reported the story accurately.  

What kind of research was this?

This was a cross-sectional survey aiming to provide a more accurate picture of how much alcohol people in England drink.

The researchers say there is a big gap between the amount people report drinking in national surveys and the amount of alcohol being sold in England. So are we a nation of liars in denial about our drinking habits?

Rather than fibbing, the researchers suspected people might be being asked the wrong type of questions on alcohol surveys. You are usually asked what your average alcohol consumption is, say, over a week. People might not think to include special events in this estimate, such as drinking at a wedding or a birthday party, because they are not typical.

The scientists designed a large telephone interview study to see whether the special occasion drinking might make up the shortfall between estimates of typical drinking and alcohol sales. 

What did the research involve?

The team conducted a large-scale telephone survey between May 2013 and April 2014 of people aged 16 years or over living in England.

Respondents (n = 6,085) provided information on typical drinking (amounts per day, drinking frequency) and changes in consumption associated with routine atypical days (e.g. Friday nights) and special drinking periods (e.g. holidays) and events (e.g. weddings).

The team acknowledged it did not collect a representative sample of alcohol consumers and abstainers on a national basis, but instead used national population estimates and stratified drinking survey data to weight responses to match the English population.

The analysis looked to identify additional alcohol consumption associated with atypical or special occasion drinking by age, sex and typical drinking level. 

What were the basic results?

Accounting for atypical and special occasion drinking added more than 120 million units of alcohol per week (equivalent to 12 million bottles of wine) to population alcohol consumption in England.

The greatest impact was seen among 25- to 34-year-olds with the highest typical consumption, where atypical or special occasions added approximately 18 units a week (144g) for both sexes.

Those reporting the lowest typical consumption (≤1 unit/week) showed large relative increases in consumption (209.3%) with most drinking associated with special occasions.

In some demographics, adjusting for special occasions resulted in overall reductions in annual consumption – for example, women aged 65 to 74 years in the highest typical drinking category.

The Health Survey for England, a nationally representative survey, estimates alcohol consumption only accounted for 63.2% of sales. The new survey, including the special occasion drinking, accounted for 78.5%. 

How did the researchers interpret the results?

The research team concluded: "Typical drinking alone can be a poor proxy for actual alcohol consumption. Accounting for atypical/special occasion drinking fills 41.6% of the gap between surveyed consumption and national sales in England."

From a public health perspective they said: "These additional units are inevitably linked to increases in lifetime risk of alcohol-related disease and injury, particularly as special occasions often constitute heavy drinking episodes.

"Better population measures of celebratory, festival and holiday drinking are required in national surveys in order to adequately measure both alcohol consumption and the health harms associated with special occasion drinking." 

Conclusion

This large telephone survey sought to generate a more accurate estimate of England's alcohol consumption by taking account of atypical drinking days like Friday nights, holidays and events such as weddings.

It found atypical and special occasion drinking added more than 120 million units of alcohol a week (about 12 million bottles of wine) to population alcohol consumption in England

This accounted for some of the discrepancy between self-reported alcohol consumption and alcohol sales, but not all. The Health Survey for England, a nationally representative survey, estimates alcohol consumption only accounts for 63.2% of sales. The new survey improved this to 78.5%.

This begs the question, where is the other 21.5% going? There are many potential explanations for this. One is that people are pretty bad at estimating how much they drink, and generally underestimate it, for whatever reason, when asked.

An alternative, rather worrying, explanation is that a significant portion could be consumed by under-16s, who were excluded from the survey. And there could be people who just can't help downplaying the amount they drink, whether consciously or unconsciously, even to strangers on the telephone.

The research team highlighted a number of limitations of its own research. First, the survey did not attempt to generate a representative sample of alcohol consumers and abstainers on a national basis.

The scientists say their survey acts as a proof of concept, and a larger nationally representative survey is needed to test the usefulness of this methodology as a national alcohol monitoring tool. For example, participation rates were quite low (just 23.3% of those contacted) and the sample had more women, older people and people of white ethnicity than is true for England as a whole.

The estimates also might be imprecise. For example, the team didn't know if special drinking events were instead of or as well as the normal drinking days. In their analysis, they opted for a conservative measure by removing an average drinking day's consumption for each special event day reported.

The results make sense. As the scientists point out: "The impact of atypical and special occasion drinking is reflected in evening presentations to emergency units, which peak on weekends but also sports events, bank holidays, and even commemorative occasions such as Halloween."

If you find yourself regularly drinking more than the recommended daily limits (3-4 units for men, 2-3 units for women), you may have an alcohol misuse problem that may require treatment

Links To The Headlines

English drink 12 million bottles of wine a week more than estimated. BBC News, May 22 2015

Forgotten holidays and lost birthdays leave English drinking underestimated. The Guardian, May 22 2015

Drinkers in England consuming 12 million more bottles of wine a week than previously thought. The Independent, May 22 2015

English alcohol consumption 'hugely' underestimated, research suggests. The Daily Telegraph, May 22 2015

Links To Science

Bellis MA, Hughes K, Jones L, et al. Holidays, celebrations, and commiserations: measuring drinking during feasting and fasting to improve national and individual estimates of alcohol consumption. BMC Medicine. Published online May 22 2015

 Fri, 22 May 2015 12:00:00 GMT Quarter of sun-exposed skin samples had DNA mutations

A sobering BBC News headline greets sun worshippers on the eve of the spring bank holiday: "More than a quarter of a middle-aged person's skin may have already made the first steps towards cancer."

Sunlight is made up of ultraviolet (UV) radiation. Low levels of exposure to UV light are actually beneficial to health – sunlight helps our bodies produce vitamin D.

But prolonged exposure can change (mutate) the DNA in the cells. Over time the mutations accumulate, turning the skin cells cancerous, which can lead to either non-melanoma or melanoma skin cancer.

As part of a study into skin cancer, researchers analysed skin removed from the eyelids of four people aged 55 to 73 known to have a varying history of sun exposure (but not a history of cancer) to see what DNA mutations had built up.

To their surprise they found hundreds of normal cells showing DNA mutations linked to cancer, called "mutant clones", in every 1sq cm (0.1 sq in) of skin, and there were thousands of DNA mutations per cell.

The results were based on skin cells from the eyelids of just four people, so we don't yet know if the same would be found in other skin areas, or in other people, or what proportion of the mutated cells would eventually progress to skin cancer. 

Where did the story come from?

The study was carried out by researchers from The Wellcome Trust Sanger Institute in the UK, and was funded by The Wellcome Trust and the Medical Research Council.

It was published in the peer-reviewed journal, Science.

The BBC and the Daily Mail reported the story accurately and reiterated the best ways to lower your risk of getting skin cancer. 

What kind of research was this?

This was a genetics study looking at changes in the DNA of normal skin cells to see what proportions were linked to cancer.

Skin cancer is one of the most common forms of cancer. There are two main types of skin cancer:

  • non-melanoma skin cancer – where cancer slowly develops in the upper layers of the skin; there are more than 100,000 new cases of non-melanoma skin cancer every year in the UK
  • melanoma skin cancer – a more serious type of skin cancer; there are around 13,000 new cases of melanoma diagnosed each year in the UK and 2,000 deaths

Radiation from too much sun exposure causes damage to the DNA of skin cells. When certain combinations of mutations accumulate, the cell can become cancerous, multiplying and growing uncontrollably. 

Scientists know about lots of skin cancer mutations, but these tend to have been studied using samples of cancerous skin cells. Researchers don't know what combination of mutations is needed to transform healthy skin cells into cancer, or in what order.

Approaching the problem from a different direction, this team looked at healthy skin cells to see what mutations might be accumulating in a pre-cancerous stage. 

What did the research involve?

The scientists analysed the DNA of healthy eyelid skins cells removed from four people during plastic surgery (blepharoplasty). They looked for DNA mutations they knew were linked to cancer later on. The removed eyelid skin was reported to be normal and free of any obvious damage.

The team used eyelid skin because of its relatively high levels of sun exposure and because it is one of the few body sites to have normal skin removed.

They say this procedure is performed for age-related loss of elasticity of the underlying skin, which can cause eyelid drooping sometimes severe enough to disrupt vision, although the epidermis remains otherwise normal.

The skin sample donors were three women and one man, aged 55 to 73. Two had low sun exposure, one moderate and one high. Three were of western European origin and one was of south Asian origin. It was not clear how sun exposure was assessed.  

What were the basic results?

The researchers found a lot more cancer-related mutations in the normal cells than they were expecting. In all, their analysis pinpointed 3,760 mutations. The pattern of DNA mutations "closely matched" those expected for UV light exposure and that seen in skin cancers. 

DNA is made up of a code of letters known as base pairs. The team estimated people have around two to six mutations per million base pairs per skin cell. This, they said, was lower than the number of mutations usually found in skin cancer, but higher than found in other solid tumours.

Overall, they estimated around 25% of all skin cells carried a certain type of cancer-linked mutation called NOTCH mutations. While not enough to cause cancer on their own, if other mutations accumulate on top of the NOTCH mutations, they may cause cancer in the future. 

How did the researchers interpret the results?

Dr Peter Campbell, head of cancer genetics at Sanger, told the BBC News website: "The most surprising thing is just the scale; that a quarter to a third of cells had these cancerous mutations is way higher than we'd expect, but these cells are functioning normally."

He added: "It certainly changes my sun worshipping, but I don't think we should be terrified … It drives home the message that these mutations accumulate throughout life, and the best prevention is a lifetime of attention to the damage from sun exposure." 

Conclusion

This study estimated around 25% of normal skin cells have DNA mutations that could prime them to develop into skin cancer in the future. This was a lot higher than the scientists expected.

The genetic analysis of the study was robust, but used skin samples from just four people. This severely limits the generalisablity of the findings to the general population. For example, the results might be different for people of different ages, sun exposures and skin colours, so we don't know if this is true for most people.

Similarly, the researchers only used eyelid cells. There may be something unique about eyelid tissue that is linked to this higher than expected mutation rate. This may or may not be true for skin from other areas. At the moment, we don't know if the one in four estimate applies to other skin areas.

The good news is there are simple and effective ways of reducing your risk of skin cancer. The best way to prevent all types of skin cancer is to avoid overexposure to the sun and to keep an eye out for new or changing moles.

A few minutes in the sun can help maintain healthy levels of vitamin D, which is essential for healthy bones, but it's important to avoid getting sunburn. Wearing protective clothing such as sun hats, seeking shade, and wearing sun cream of at least SPF 30 are all advised.

Read more about how to enjoy the benefits of the sun without exposing your skin to damage

Links To The Headlines

Quarter of skin cells 'on road to cancer'. BBC News, May 22 2015

Skin cancer alert for the over-50s: Millions failing to heed advice over sun damage. Daily Mail, May 22 2015

Links To Science

Martincorena I, Roshan A, Gerstung M, et al. High burden and pervasive positive selection of somatic mutations in normal human skin. Science. Published online May 22 2015

 Thu, 21 May 2015 14:00:00 GMT Minor ailment scheme doesn't provide free Calpol for all

"Thousands discover Calpol has been free on NHS 'for years' as mum's Facebook post goes viral," the Daily Mirror reports.

This and other similar headlines were prompted by a post made on the social networking site Facebook. In the post, it was claimed that all medicines for children were available for free on the NHS as part of the minor ailment scheme.

"I was in Boots yesterday buying Calpol and happened to complain to the cashier how expensive it is. She told me, to my amazement, that if you register your details with them under the minor ailments scheme that all medicines for children are free – a scheme that has been going for eight years."

The post went viral, being "shared" and "liked" more than 100,000 times in the space of a few days.

But there are a number of inaccuracies both in the Facebook post and in the media's reporting of the story. 

What is the minor ailment scheme?

The minor ailment scheme is designed to enable people with minor health conditions to access medicines and advice they would otherwise visit their doctor for.

It allows patients to see a qualified health professional at a convenient and accessible location within their community, and means patients do not need to wait for a GP appointment or queue up for a valuable A&E slot with a non-urgent condition.

Childhood ailments that may be treated under the scheme include:

If the patient being treated is exempt from paying prescription charges – because they're under 16 or over 60, for example, or they have a prescription prepayment certificate (PPC) – you don't have to pay for the medicine. 

Important points about the minor ailment scheme

There are a number of important points that have not been made clear by the media:

  • The minor ailment scheme is not a national scheme. It is not possible to say exactly which medical conditions are covered because this will vary depending on the location and the particular service.
  • The scheme is designed to offer medication to meet an acute need. It is not an opportunity for parents to stock up on free children's medications – if a pharmacist thinks someone is trying to abuse the system, they can refuse any request for treatment at their discretion.
  • The pharmacist has no obligation to provide branded medication such as Calpol. If there is a cheaper generic version available that is known to be equally effective, it is likely that will be provided instead.
  • Claims that the scheme is secretive are incorrect. Information about the minor ailment scheme has been freely available on the NHS Choices website since 2008.

Read more about the services offered by pharmacies and how they can often save you a trip to the GP.

Links To The Headlines

Thousands discover Calpol has been free on NHS 'for years' as mum's Facebook post goes viral. Daily Mirror, May 20 2015

No need to cough up for Calpol - it's FREE on the NHS: Thousands discover they're entitled to various medications after mother's Facebook post goes viral. Daily Mail, May 20 2015

Calpol for FREE: Hundreds find they're entitled to free medication after mum's social post. Daily Express, May 20 2015

Did you know you can get Calpol for free? Metro, May 20 2015


 

 
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