Just what the doctor ordered
Professor Ian Gilmore is no teetotaller — but as Graham Holter finds out, the Alcohol Health Alliance chairman is all for limiting the damaging excesses of the UK drinking culture
Professor Ian Gilmore insists: "It's not an attempt to put the drinks industry out of business. But if you'd like to join me in A&E on a Saturday night or on my liver ward, you will see the other side of the story."
Gilmore, who convened and chairs the Alcohol Health Alliance (AHA), is not a teetotaller (he refuses to be drawn on how much he actually drinks) and is dismayed at the idea that he is regarded with hostility by the drinks industry — an industry he believes should be taxed more heavily, regulated more rigorously, and more restrained in its marketing.
He's also got something to say about the sizes of glasses in pubs. As president of the Royal College of Physicians, Gilmore is one of the most influential medics in the country, yet he feels his profession is regularly out-gunned in the corridors of power by the drinks industry.
The AHA, formed last year, brings together some 25 organisations and charities with an interest in curbing alcohol misuse.
"It's not against alcohol in moderation," he says. "There has been attention given to the social aspects of alcohol misuse, but probably not enough to the health consequences.
"I don't have to tell you that charities such as ours have nothing like the resources of the supermarkets or the trade organisations, which are also better organised and have a very strong interest in these matters."
British Beer & Pub Association (BBPA) communications director Mark Hastings questions whether the AHA is really an entity at all. There is no secretariat, no website, no address. "It's not actually an organisation and it would be wrong to think of it as an organisation," he says.
"It has a number of different groups, some of which I suspect have competing interests, that sit under this broad banner."
Different members appear to have different ideas about how the AHA structures itself — there are conflicting responses on whether the group has met once, more than once, or has subcommittees. "I'm not going into the technicalities of how it's set up," Gilmore says. "It's not the business of the trade. But yes, we meet and also keep in touch electronically.
"We meet three or four times a year formally to share expertise and review priorities. Where we can agree priorities, we can speak with one voice, and sometimes one organisation leads on an issue."
Gilmore and the AHA started out by claiming alcohol was too affordable — so does he think the recent duty increases have improved the public's health?
"I think it's been very disappointing how the industry doesn't seem to be passing it on to the consumer, and in the supermarkets there's still very deep discounting," he says. "I don't know about the pub side, but we're not in the business of trying to close pubs — I think they have a very important social purpose. I'm personally concerned that the gap is widening between the on and off-trade."
Gilmore maintains that "we haven't called for higher tax", though the AHA's mission statement clearly contradicts this. "We've called for higher prices," he says, but it's hard to see what distinction he's making. "Taxation is an obvious method, but we need to look at all ways of doing it."
Asked to summarise his ideal world, Gilmore describes it as one "where there is no need for the AHA and we return to a culture where there's very little irresponsible drinking and very little irresponsible behaviour by the industry".
How realistic is that? "Well, you asked me what my ideal world would be. What I would like to see is a reduction in the health-related indices of alcohol misuse. There is some evidence that consumption might have levelled off in the past couple of years, but that does not seem to have been reflected in health gains.
"Whether that's because there's a lag between the two, or the figures on consumption are not accurate and are being distorted in some way by illegal imports, I don't know."
When Gilmore goes into a pub, what licensee-controlled problems does he observe? What more should pub managers do?
"It's certainly not an issue on which the alliance has formed a view. Personally, I would tend not to be in the sort of pubs that might irritate me. I would be in a country pub or a quiet pub in a small town, rather than a vertical-drinking establishment in the city, where there is much more heavy drinking.
"Giving people no option but a 250ml glass of wine isn't a place we want to be. I don't recall off the top of my head the percentage of on-licence outlets where that is the only choice, but it is a significant percentage. We want to see current standards about serving underage youths and people who are clearly intoxicated upheld much more rigorously. I know that there are improvements and so on, but I'm sure there is still room for improvement."
Gilmore won't take sides in the great on-trade versus off-trade social responsibility war, except to remark that "the widening gap between prices and the heavy discounting, particularly in off-licence trade, is one of the most worrying factors now".
His acknowledgement of the trade's efforts to behave more responsibly is perhaps unexpected, but neither is it particularly gushing. "I've seen considerable efforts, particularly from national organisations, to put the industry's house in order," he says, before the barb: "I can't comment on to what extent it's been a proactive, altruistic effort, and to what extent it was stimulated by the media and public opinion."
Gilmore's interaction with the trade is somewhat limited, though Hastings says the BBPA does attempt to make its case.
"I wouldn't describe the situation as being a gulf between us," he says. "I don't think anybody would disagree with the proposition that alcohol abuse is something that needs to be tackled. The disagreement is on the best mechanisms for achieving that.
"I'm sure there isn't universal disagreement on all the objectives. I don't see it as a fight in those terms. I think it's about engaging with these people and being clear about your own position, being clear about what the facts and evidence are, and having a dialogue with them.
"The AHA has some key objectives it is trying to pursue, and this industry wouldn't be very smart to think those issues are going to go away. If you take your foot off the pedal one bit, the agenda they are driving could seriously constrain the people of Britain.
"They think we're hugely effective in how we progress our case through the Government and the media. Their big beef with the industry is that we supposedly have an inside track and a lot of leverage with Government and opinion-formers.
"Of course, if you have the title 'doctor' or 'professor' and you're talking about health, in the public's eye you will have more credibility than a brewer or a distiller, and that's purely common sense.
"The other factor is that there is obviously a very strong patron-client relationship between the Department of Health (DoH) and the people who work on the front line — the doctors. They are in and out of each other's organisations on a regular basis; it's in the interests of the medical community to have a strong DoH behind it and it's in the interests of the DoH to have a strong and vocal medical community."
Not all doctors appreciate Gilmore's interventions. One of the most influential medical blogs, NHS Blog Doctor, written by the self-styled "Dr John Crippen", has been particularly scathing.
"I know that far too many people drink too much," Crippen posted in April. "I know that far too many people smoke too much.
"I do care. I am happy to provide advice on these and many other issues, if asked. I am happy to diagnose and help with any health problems that arise. I am happy for the Government to study medical research when formulating policy.
"I am not happy to issue diktats to public houses about the size of glasses. If the Government wants to issue such
