GPs are now saying two drinks a night is too much – have they seen the state of 2016?

There may be GPs who are not yet aware that the NHS, being a little strapped for cash at the minute, isn’t madly keen to sanction expensive diagnostic tests for the well

Matthew Norman
Tuesday 20 December 2016 16:11 GMT
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GPs plan to crack down on what most people would consider to be moderate drinking
GPs plan to crack down on what most people would consider to be moderate drinking

In a year which began with David Bowie’s death and went precipitously downhill from there, this is hardly a contender for 2016’s most depressing headline. But were there an annual award for Most Eye-Rollingly Drivelling Fool Of A Headline, my nomination would be this, from today’s news: GPs Will Order Liver Scan If You Have Two Drinks A Night.

Apparently, the boys and girls at NICE (National Institute for Health and Care Excellence) – the sweethearts who deny terminal lung cancer sufferers immunotherapy that could give them extra years of more years of high quality life on purely cost grounds – want potential liver damage to be detected long before the emergence of such blatant symptoms as terrible itching and turning canary yellow.

The first cause of vexation with this notion that GPs will order scans for moderate drinkers is that they won’t. Not the ones I know, anyway. There may be GPs who are not yet aware that the NHS, being a little strapped for cash at the minute, isn’t madly keen to sanction expensive diagnostic tests for the well.

Are you consuming dangerous quantities of alcohol?

Better informed physicians might give a mild drinker a liver function blood test, which is cheap. But they won’t order a scan for somebody who, despite putting away a schooner of sherry before dinner and a small Bailey’s before bed, appears to be in sound health.

If you want to test this, go to the doctor and tell him or her you have a couple of beers each evening, and demand the liver scan which the folk at NICE think you require.

Most patients with alarming signs of illness – what we professional hypochondriacs call “red flag symptoms” – have to wait weeks or months for a scan, because hospitals have far too few scanners and not enough staff to operate those they have. The only medical response a GP who ordered a liver scan for a symptomless person would expect is a psychiatric referral for him or herself.

But even if there were ten million CT and MRI machines, and phalanxes of idle radiographers sitting idly about knitting and whining about scandalous NHS overstaffing, would it be wise for a GP to order a scan on the off chance that a mild drinking habit might one day compromise hepatic function?

The liver, as everyone knows, is the tough guy of the vital organs. Unlike Captain Scarlett, it isn’t indestructible. But it does, like Doctor Who, regenerate. Long before Carla Lane’s sitcom, the very first Liver Bird was the eagle sent by Zeus to punish the titan Prometheus for giving humanity the gift of fire. Every day, the eagle pecked out the poor sod’s liver. Every bleeding day the bugger grew back.

Despite limited access to computed tomography and magnetic resonance imagery, those prehistoric, myth-inventing Greeks had instinctive trust in the liver’s resilience. They were right. While two drinks a day will raise the risk of various cancers and other illnesses, we all have elderly friends and relatives who have drunk moderately and daily for decades without developing cirrhosis.

Yet this isn’t at heart (albeit there is a connection between excess alcohol consumption and coronary disease) a medical issue. It’s a philosophical one. What Ecclesiastes had to say about eating, drinking and being merry has stood the test of time. A couple of millennia after the New Testament was written, it remains the case that tomorrow we die.

The difference is that tomorrow tends to be much further away now than then, when 40 was a fine age – and in too many cases heartrendingly so. Obviously it is right to target wildly excessive alcohol intake, because that disables and kills the relatively young, and costs a fortune to treat. But why frighten moderate drinkers out of a nightly brace of drinks if the best outcome from that is eking out an apology for a life in senescent misery in a hideous care home, or as an NHS bed-blocking victim of the unpardonable failure to provide adequate social care?

The way to address serious alcohol abuse is through vastly increased taxation. And the way to deal with people who use small amounts to relax and make human existence that smidgeon less gruesome is to explain the risks, give them the odds, and let them decide.

If a couple of daily drinks make it 50-1 against cirrhosis, 12-1 against bladder cancer, and 4-6 on dying in a seemly, continent way before dependence and/or dementia strike, what brand of symptomless lunatic would give a cynical GP a wintry chuckle by demanding prophylactic testing that wouldn’t be available in far better funded health systems than ours? France probably has the best public health care in the world – and we can all guess what the French would say to the healthy drinker of three bottles of wine per week who demanded a scan on their liver.

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