Britain at risk of cirrhosis epidemic
By Maria Cheng, AP Medical Writer | August 7, 2007

LONDON --Last call at any British pub can be like a contact sport, with a crush of drunken customers suddenly heaving toward the bar in search of one last round.

It's a hallowed British tradition, and doctors say an increasingly dangerous one.

Britain's taste for binge drinking, driven by a pub culture in which a good night out means packing in as many pints as possible before the traditional 11 p.m. closing time, could lead to a liver disease epidemic within two decades unless Britons learn to drink more responsibly, experts warn.

"There's been a frightening increase in alcoholic liver disease in recent years," said Dr. Ian Gilmore, president of the Royal College of Physicians.

Deaths from cirrhosis in Britain increased dramatically over the past two decades, while they fell steadily everywhere else in the Western world, according to government statistics.

In England and Wales, 17.5 deaths of every 100,000 men were due to cirrhosis in 2002, up from 8.3 in 1987. And in Scotland, the increase was even more dramatic: 16.9 cirrhosis deaths per every 100,000 men in 1987 to 45.2 per 100,000 in 2002.

By comparison, the overall U.S. cirrhosis rate has fallen from 15 deaths per 100,000 in 1973 to nine per 100,000 in 2004. In the European Union, the rate in the early 1980s was about 20 per 100,000 deaths; by 2004, it had fallen to 13 per 100,000. Neither the U.S. nor the EU provided a breakdown between men and women.

"Deaths from cirrhosis (in Britain) are increasing out of proportion with anywhere else in the world," said Dr. Rajiv Jalan, a consultant hepatologist at London's University College Hospital.

Cheaper, more accessible alcohol are partly to blame.

Binge drinking in the European Union is highest in Ireland, Finland, Britain and Denmark, according to an EU survey published in March. The survey also found that almost one in five Europeans between the ages of 15 and 24 drink more than five alcoholic drinks in one sitting.

While other European countries also consume large amounts of alcohol, cultural differences might explain why the British pay such a high toll.

"We need to understand what drives our particular drinking culture," said Gilmore. "Here, it tends to be more binge drinking, which can be very dangerous."

Nearly one-third of 15- to 16-year-old British students reported having gone binge drinking at least three times during the last month, according to a 2003 European-wide alcohol survey. The legal drinking age in Britain is 18.

The British custom of buying rounds creates lots of social pressure to drink plenty: With everyone taking a turn at buying, being out with a dozen friends can mean downing at least a dozen pints.

And unlike other European countries such as France, Spain or Italy -- where alcohol is the accompaniment to a meal -- many Britons are unlikely to eat anything more substantial than a few packets of chips alongside their lagers.

While other major causes of death like cancer and heart disease are dropping, liver disease -- the fifth leading cause of death in Britain -- is rising steadily.

"What is happening in Britain is clearly an anomaly in Europe," said Gilmore.

Attempts to curb binge drinking, including 2005 legislation allowing round the clock alcohol sales, might have worsened the situation. At one London hospital, doctors noticed that since the alcohol licensing law changed, alcohol-related overnight trips to emergency rooms tripled. The law's effect, however, has been limited because most pubs did not to apply for an all-night license.

In the past decade, hospital admissions across Britain related to excessive drinking doubled. In 1995-1996, 89,000 people were admitted for alcohol-related conditions; by 2005-2006, the figure was 187,000 people.

And unlike the most of the rest of Europe, Britons are drinking more every year.

Total alcohol consumption in Britain doubled between 1960 and 2004, from about 1.5 gallons per person over 14 years old to 3 gallons per person. In contrast, other European countries, particularly in the south, recorded drops in consumption.

Cirrhosis used to mostly affect men in their 60s. Now, doctors treat patients of both genders in their 20s and 30s. Because symptoms can be nonspecific, including fatigue and sexual problems, many people may not realize they have liver problems until damage is irreversible.

Chronic alcoholism and the hepatitis C virus are the main causes of cirrhosis, but it can also be triggered by other hepatitis types, genetic diseases, other infections, autoimmune disorders, or a bad reactions to drugs.

Excessive alcohol intake kills healthy liver cells, leaving scar tissue that cannot regenerate itself. Once the liver starts to fail, a domino-like chain reaction in the body is set off, often leading to kidney, heart and circulatory failure.

"If the disease goes undiagnosed, you can go from being entirely well to being in the intensive care unit with multiple organ failure in six to eight weeks," Jalan said.

At a June meeting of the British Medical Association, doctors called for several measures to address the growing drinking problem in the country, including a ban on public drinking in the streets, higher alcohol taxes, and a lower threshold for drunk-driving.

The British government last year started an awareness campaign to alert young people to the dangers of binge drinking.

11 PM? Really?

Bars close at 4am in New York.

2:30 here, although on weeknights some close at midnight.

Heh. your state sucks.

But they re-open at midnight.

What gets me was the effort to reduce binge drinking by INCREASING the availability of alcohol with the allowance of all-night opening at bars. Which was followed by a dramatic increase in alcohol-related emergency room visits. Yet another attempt to reduce crime in the streets by making the sidewalks wider.

Well, it's odd that it's up for Britain and down for the US and EU.

But then again, that's why we have our drunken brits.

Could be worse. You could live here.

Dude, my presence alone would raise the state's average IQ 30 points.

Until recently, yeah. It was a pisser. There was a big fanfare when the licensing hours changed a few months back, although most publicans haven't really taken advantage of it.

They need to equip British bars with a puke ray. That'll clear out the booze hounds.

In a rare burst of seriosity, I'm going to say a fair bit about this.

Britain is a strange place, and I think there are a number of reasons for the increase in drinking, especially among young people in the last ten years or so. First, there is a strong legacy of Britain being a heavy drinking place. Take a look at what ya boy Shakespeare had to say about it in 'Othello':

IAGO
Some wine, ho!

Sings

And let me the canakin clink, clink;
And let me the canakin clink
A soldier's a man;
A life's but a span;
Why, then, let a soldier drink.
Some wine, boys!

CASSIO
'Fore God, an excellent song.

IAGO
I learned it in England, where, indeed, they are
most potent in potting: your Dane, your German, and
your swag-bellied Hollander--Drink, ho!--are nothing
to your English.

CASSIO
Is your Englishman so expert in his drinking?

IAGO
Why, he drinks you, with facility, your Dane dead
drunk; he sweats not to overthrow your Almain; he
gives your Hollander a vomit, ere the next pottle
can be filled.

So Shakey knew what the deal was even then. It's embedded in our culture. But why? Well, there is some element of truth to Britain being somewhat (still) often an emotionally-repressed place, even in comparison to the USA and especially in comparison to our European neighbours (always except the Irish from everything - sorry Darragh!) and drink allows us, as adults, to express love and affection for those with whom we are not having sex and to whom we are not related. A bit sad really, but that's the way it is. Forget all that Princess of our Hearts nonsense, that was an aberration.

Secondly, we are a largely secular society, with very few rites of passage. As a teacher I have become more and more concerned by young teenagers' attitudes to drink and their associations of alcohol and adulthood. That happened when Robbie and I were kids, definitely, but I think it's more widespread now because the drinks industry has spent the last 15 years coming up with more and more child-friendly 'alcopops' that don't have the conventional 'taste of alcohol' that used to put kids off. I'm often asked by kids "How many cans can you drink, Sir?". I don't tell them. We need to review how we introduce children into the culture of drinking. That said, I bet Stephane will know more than a few of his compatriots who drink to excess. Second and a halfly, we've got a lot of absolutely rubbish parents in this country, believe me on that one.

Thirdly, Drink has actually come down a lot in price (in real and relative terms) in the last few years. The entry into the European Union and the attendant 'booze cruises' have forced the drinks industry to do that. Simple economics.

Fourthly, I only really drink at weekends. Aye, I'm on holiday now and it's the summer, so I'll go out. The 'Drunken Brits' thing is mildly amusing, but I don't think we're pissed anywhere near as much of the times you may think.

Edit: Swearing removed. Didn't know where I was - sorry.

So only 94% of the time then?

I was thinking a little lower, Trev.

But still in the 90s, right?

75%. I'm not going any lower.

75%??! That's insane!

The Holtster wins a pint. Bang on.

Well, if you factor in all of them, that should be close to accurate.





Yeah, right!

75% is for teenagers there. It has to be!!

Don't look down your nose at us, ya Canadianite beatnik!