Thinking sensibly

We have been given to believe that the health components of our drug and alcohol strategies are based on what the consensus of the clinical literature has to tell us. So it is somewhat suprising that the government has just announced that the advice to pregnant women is not to drink any alcohol at all. To date the advice has been that a couple of glasses of wine a week was fine. So what has changed? Nothing. According to the deputy Chief Medical Officer, this new advice was meant to send a 'strong signal' that women who drank more than the recommended limit were putting their babies at risk. But hang on, the new advice does not reiterate the current advice on sticking to the recommended limit, but urges women to abstain completely. So the government advice is confusing from the get-go. On top of which, the Royal College of Obstetricians and Gynaecologists intend to stick to their advice that in moderation, alcohol poses little or no threat for the unborn child. And presumably they should know. So if women weren't confused, chances are they are now.

But of course, they probably never were. Governments tend to assume that unless health messages are written in block captials using red crayon, the nation falls into an abyss of hand-wringing anxiety. Women (even when they are pregnant!) are perfectly capable of making sensible decisions about any lifestyle changes they feel are necessary.

Which is just as well because the clinical evidence of long-term damage to children related to maternal alcohol and drug use is highly contested. The media love to be able to trumpet the latest scare to put the fear of God into prospective parents. But those children in most danger are probably subject to a battery of maternal factors - diet, social status, housing as well as chronic drug and alcohol use. Clinical trials to isolate risk would be unethical so as The Times pointed out (25th May) taking the cautious approach on health advice is 'as much a matter of philosophy as science'.