Health Viewpoint: Sushi and sake but no pickled brains: Their built-in protection against excessive drinking gives the Japanese a competitive edge, argues Colin Brewer

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PEOPLE buy Japanese cars because they are comparatively cheap and very reliable. For a while, we were not, as a nation, very keen on British-built cars. Even some of the more expensive ones were so unreliable that their owners often must have regretted the demise of the starting handle. Reliability seems to have improved lately, but our cars still do not do too well in the breakdown statistics.

We tend to assume that Japanese superiority in these matters is mainly the result of certain features of Japanese social and industrial organisation - thousands of workers singing corporate anthems at dawn and prepared to give their all for Toyota, as they were once prepared to give it for Hirohito.

There must be something in this idea, and it seems that it is not just in making cars that the Japanese excel. A study published a couple of years ago showed that Japanese surgeons did much better than their British counterparts at treating cancer of the oesophagus, and achieved it without the drama often prevalent in British operating theatres. Other research suggests that the average Japanese is marginally more intelligent (or, if you prefer, has a marginally more efficient brain) than the average European.

If Japanese brains really are more efficient, one reason may be that they spend less time than British brains under the influence of alcohol. This is because the Japanese have a fascinating, built-in genetic protection against excessive drinking.

Alcohol is initially broken down in our bodies by an enzyme to a substance called acetaldehyde, which is rather toxic stuff. If you give acetaldehyde to people, it makes them feel very unwell, but it is usually present only in very small amounts after drinking alcohol. This is because acetaldehyde is normally broken down very quickly by another enzyme, acetaldehyde hydrogenase (ALDH) and is eventually metabolised into carbon dioxide and water.

A very small proportion of Europeans have a deficiency of ALDH. This does not matter unless they drink alcohol, in which case they register high blood levels of acetaldehyde. However, between 40 and 60 per cent of Japanese have this deficiency. Their ALDH can cope with small amounts of alcohol, so that they can sip a little sake on social occasions, but more than that causes them to flush visibly, have palpitations and sometimes vomit - all symptoms of acetaldehyde toxicity. This is exactly what happens to people taking the anti-alcoholism drug antabuse, which works by inhibiting ALDH but does it much more effectively than Japanese genes. It produces a more severe reaction if alcohol is consumed. In other words, many Japanese have to treat drinking as if they were constantly taking a small dose of antabuse.

Research in Japan has come up with some interesting findings about the nation's drinking practices. First, those areas of the country with the highest proportion of ALDH-deficient inhabitants have the lowest per capita consumption of alcohol. Second, while about half of ordinary, non-alcoholic citizens are ALDH-deficient, only 2 per cent of Japanese alcoholics have the deficiency, so that this built-in antabuse really does protect the Japanese against alcohol abuse to a significant extent.

Because the deficiency is only partial, so is the protection, and some Japanese do manage to get drunk despite it - but at least they tend to get drunk in the evening, after work, rather than at lunchtime, during office hours. In contrast, it is not at all uncommon for British workers - including the executive variety - to have so much alcohol at lunchtime that their ability to do their job, whether it be making corporate decisions or seeing that widgets are screwed on properly, is seriously impaired.

Of course, alcohol and national drinking habits are only two factors among many. After all, the Germans and Swedes also produce some pretty reliable cars and neither is exactly a nation of teetotallers. Management styles, training, investment technology and quality control must also be very important. Yet anyone working with alcoholics sees many people who have been regularly intoxicated at work for months, or even years, before someone blows the whistle and forces them to confront the problem. Despite the denials of alcohol producers and advertisers, changes in the incidence of alcohol-related problems in a given country are strongly related to changes in overall or per capita alcohol consumption.

Not for nothing were the real duds that were produced in the worst days of the British motor industry called 'Friday night specials'. Friday is not just a day when people may feel like knocking off early; it is also a day when the sort of boozers who are not drunk every day of the week tend to prepare themselves for the fine old British custom of getting smashed out of their brains for the weekend. We enjoy many rights in Britain, but I do not think that the right to be intoxicated at work to the point of producing fifth- rate goods (and possibly putting their users at risk) should be one of them.

The author is a consultant psychiatrist.

(Photograph omitted)

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