Dr. Stephen Stewart:

I am a consultant gastroenterologist in the Mater hospital. We each see different societal demographics. There is a poor population around the Mater hospital area whom I see at my clinic. As has been said, society has changed. It has especially changed over the past 30 years in its approach to alcohol, which some would say should be welcomed. What we have discovered, however, is that women are drinking a lot more. When I was a registrar in the Mater hospital in the late 1990s, alcohol related liver disease was in the main associated with 60 to 65 year old men. It was very rarely associated with women. I then went to the UK for 11 years and after that returned to Ireland. In the intervening period, statistics for death from cirrhosis had doubled. More people were presenting with and dying from cirrhosis. The demographic of age had also changed such that the age at which people were being diagnosed with cirrhosis had reduced from 60 years to 30 years, 50% of whom were men and 50% women. This is not something that should be welcomed. It is a matter that must be addressed now.

The argument is made that minimum unit pricing will impact more on the poorer population. We do not want to make it more difficult for poorer people to be able to enjoy themselves. I will try to put some perspective on this. A person who drinks two bottles of wine a week at a cost of €5.50 per bottle will, following the introduction of minimum unit pricing, which will result in each bottle of wine costing €8.00, be spending €5 more a week on wine. While that increase is not a substantial amount, it will result in countless lives being saved. This is because the people on whom this will have the greatest impact is those who are drinking heavily. A person who is drinking ten bottles of wine a week will be faced with a increase of €25 in that regard. These are the people we are targeting. They are the ones we want to reduce their alcohol consumption. Minimum unit pricing on its own will not tackle this problem but it is the single most important and most immediate measure that will have an impact. In other words, a person could have cirrhosis but not be aware of it, but if they cut back on alcohol consumption, they will never find out they had it. However, if that person carries on drinking, they could die within a year. There will be an immediate improvement in that regard. What is more, if it is made more difficult for people to buy alcohol, people will drink less. Minimum unit pricing affects all demographics. From a personal perspective when I go on holidays to a place where alcohol is cheap, I drink more. How much a person earns is irrelevant. If alcohol is cheap, people drink more, and if it is expensive, they drink less. As such, minimum unit pricing impacts on all demographics.

If we do not tackle alcohol promotion that is targeted at 13 to 15 year olds, we will be storing up problems for the future. We need to change the culture. Italy and France were referred to. The culture around alcohol in those two countries has changed. It is not acceptable to be seen drunk in Italy. France has updated its legislation around promotion. That has led to a dramatic reduction in cirrhosis mortality there.

Unfortunately, education does not work and has proven not to work. It is not that it might not work, rather that it has been proven not to work. It is for this reason the drinks industry focuses on it. We need to forget about education for now and focus instead on the three things that are evidence-based. These are the things that will have an impact on my clinics. Education from parents to children was also mentioned. I am sure that if it were possible to legislate in that regard, the result would be a dramatic improvement. Recent evidence from the Young Scientist Exhibition showed that parental drinking has a huge impact on children. We do not have legislation which could assist immediately in this area, but it is important.

A recent study in this area scored the tightness of legislation in all European countries around alcohol. The tighter the legislation, the lower the cirrhosis mortality rate. We can be legislatively loose and accept higher cirrhosis mortality rates or we can be legislatively tighter and reduce those rates.

I will conclude with a story about a patient who attended my clinic a few months ago. The man concerned had bled from varices from cirrhosis and was found unconscious on the floor by his daughter. He was brought into the emergency department and resuscitated. We then treated his variceal bleeding and he survived. When I saw him six weeks later at my clinic, he told me he had given up drinking and would never drink again. When I responded that I was delighted to hear that and asked why he drank so much, his response was: "I didn't know it was bad for me." He then asked: "If it's so bad for me, how come it's so cheap, available at every corner shop and promoted so heavily?" That is something we all need to think about. That is the reason we are here today.