Statement regarding claims of Drinkaware misleading the public

In their ‘Open letter from UK public health scientists to Public Health England regarding partnerships with the alcohol industry‘¹ published on 27 September 2018 by Dr John Holmes et al., the authors set out their opposition to Public Health England entering into partnerships with alcohol producers and retailers. Drinkaware, which as an educational charity is not part of and does not in any way speak for the industry, regards this as a matter entirely for Public Health England to decide. However, the letter also makes reference to so called ‘clear-cut examples of Drinkaware providing misleading information to the public’. The two references provided to support this claim are a blog post² authored by Dr Colin Angus and a comment³ published in The Lancet, written by Professors Mark Petticrew, Martin McKee and Therese M. Marteau.

As the Chair of Drinkaware’s Research and Impact Committee and the Director of the Committee’s programme we are both completely committed to Drinkaware’s policy of presenting the facts on the adverse effects of alcohol and to publishing its own research in peer reviewed journals. We are, therefore, deeply concerned by the claim in the letter that Drinkaware is providing misleading information to the public, and we profoundly disagree that the evidence provided justifies this.

In his blog, Dr Angus does not claim that Drinkaware is misleading the public, although he does state that the Drink Free Days campaign website provides ‘slightly odd’ feedback to drinkers who drink within the low risk drinking guidelines of up to a total of 14 units weekly, but more than the binge level (8 units for men and 6 units for women) on a single occasion. In fact, the feedback provided to such drinkers clearly states that ‘on the days you do drink, you are drinking at a level that is putting your health at risk’. We cannot see how, in any circumstances, this is misleading the public. We do acknowledge that the heading, referring to the overall risk level, was inappropriate and we have acted swiftly to amend it. We are grateful to Dr Angus for pointing this out, and always welcome experts and the general public letting us know when we can improve our content.

The comment piece in The Lancet by Petticrew et al. claims that ‘Drinkaware’s alcohol selfassessment tool on their website seems to endorse heavy drinking’. The basis for this claim is the following:

“For example, a 30-year-old man who drinks 7 units a day, every day - over three times the current guidelines for low-risk drinking - receives the advice: “If you continue drinking at this level and do not exceed the daily guidelines then you are drinking in a way that is unlikely to harm your health. Drinking consistently within these limits is called ‘lower risk’ rather than ‘safe’ because drinking alcohol is never completely safe”. This Drinkaware advice also refers to “daily” guidelines. The current guidelines are, however, weekly guidelines: “To keep health risks from alcohol to a low level it is safest not to drink more than 14 units a week on a regular basis.”

What, however, the authors fail to say is that the ‘self-assessment tool’ on the Drinkaware website is not a ‘Drinkaware tool’ but is in fact none other than the World Health Organisation’s 10-item Alcohol Use Disorders Identification Test, or AUDIT questionnaire, an internationally recognised and very widely-used tool for screening for harmful drinking. The feedback provided to the public is the feedback provided not by Drinkaware but by the WHO tool.

We have reviewed many instances where the WHO tool is accessible on other public facing websites (including NHS, Alcohol Concern, Patient.info, and others), and found that, for the scenario given above (a 30-year-old male, drinking 6 or 7 units per day every day), individuals would receive the same advice (as long as they report never to be ‘binge drinking’ – 8 units for men and 6 units for women on a single occasion – and never having experienced any symptoms of alcohol dependency or harm).

As a precautionary measure, to ensure no individual user is put at any risk, Drinkaware has now taken down the ‘self-assessment tool’ whilst we seek advice on how to best use it as an online tool. We note that the NHS has done so also. We assume that the other organisations using the WHO tool will in due course do the same.

We do acknowledge that the residual reference on the Drinkaware site to ‘daily guidelines’ was out of date and we corrected this immediately. The Drinkaware website is otherwise heavily populated by references to the CMOs' weekly low risk drinking guidelines.

We are not claiming that no mistakes can ever be found, or that no improvements can ever be made, with respect to our more than 900 web pages of information designed for the non-technical reader on the Drinkaware site any more than would be the case on any similar site containing very large volumes of information.

What we do absolutely reject, however, is the clear insinuation that any single mistake is somehow evidence of a deliberate policy on the part of Drinkaware to mislead the public. That is a grotesque distortion of the efforts which Drinkaware and its staff make to ensure that all our information is as accurate and complete as is humanly possible. Indeed, we regularly review and update all our information with oversight from an independent Medical Advisory Panel of senior medical experts. We question why the authors of the Lancet article did not point out precisely the same errors in a number of the other websites which we have reviewed, but which they apparently did not, or at least why they selected only Drinkaware for criticism.

Drinkaware is and remains proud of the information and tools we provide to the more than 9 million people who come to our website every year. We believe that our work is indeed helping to reduce the very serious harms caused by alcohol and we refuse to be misrepresented as to our aims, objectives and values.

Yours sincerely,

Dr Timothy Walker, Chair of the Drinkaware Research & Impact Committee and Trustee, Drinkaware.

Dr John Larsen, Director, Evidence & Impact, Drinkaware.

References

[1] Available from: https://docs.google.com/forms/d/e/1FAIpQLSdmYA2ahd_INy8ade6ObtgH3yHztF4yPnGyQFmcB4PFSyVEA/viewform [Accessed on October 2018]

[2] Angus (2018) ‘Tell me more, tell me more – what’s this industry-led public health initiative about’

[3] Petticrew et al. (2018) ‘Partnerships with the alcohol industry at the expense of public health’