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Sobering idea The federal government recently adopted a plan to include warnings on alcohol – so where are they? Since the federal government made it mandatory for tobacco companies to include warnings on cigarette packages back in 1994, they ha

Sobering idea

The federal government recently adopted a plan to include warnings on alcohol – so where are they?

Since the federal government made it mandatory for tobacco companies to include warnings on cigarette packages back in 1994, they have become progressively more vivid – for lack of a better word – with each passing year. These days smokers and non-smokers have to look at pictures of mouth diseases, cancerous lungs, pregnant women, and eviscerated hearts, as well as pregnant women, children, and a bent cigarette that’s supposed to represent impotence.

It’s a good thing they don’t allow smoking in restaurants any more, because most people would probably lose their lunch.

Most people get the idea that smoking can kill you, and they either can’t stop or don’t care. In polls, most smokers say they would like to stop, and the government figures these graphic pictures are an extra nudge in the right direction.

Most smokers also agree with the need for warnings on packages, although most would probably object to the latest graphic approach if you were to poll them.

But love them or hate them, the labels may be working. Overall the number of smokers is declining in Canada, from almost a third of the adult population 15 years ago to less than a quarter – although some believe that subsequent tax cuts on tobacco products, spurred by bootlegging, probably slowed the rate of that decline and increased how much lower income people were smoking.

Now, with that campaign well in hand, Canada is preparing, supposedly, for its next labelling campaign – mandatory warning labels on alcohol containers.

On April 23, the House of Commons passed a Private Members’ Bill tabled by Judy Wasylycia-Leis, an NDP MP from Winnepeg North Centre, with 217 votes for and just 11 against. Presumably the other 75 representatives in the 301 member House were out on fact-finding missions that day.

According to Wasylycia-Leis, "The government should consider the advisability of requiring that no person shall sell an alcoholic beverage in Canada unless the container in which the beverage is sold carries the following visible and clearly printed label:

"WARNING; Drinking alcohol during pregnancy can cause birth defects."

She was referring to the prevalence of Fetal Alcohol Syndrome in Canada, which is present in approximately three out of every 1,000 births.

It wasn’t until 1973 that doctors introduced the term Fetal Alcohol Syndrome, although a causal link tying alcohol consumption to various birth defects had been suspected for centuries. According to Health Canada, the three major defects are: "Prenatal and/or postnatal growth restriction, characteristic facial features and central nervous system involvement (e.g. neurologic abnormalities, development delays, behavioural dysfunction and learning disabilities."

Alcohol consumption during the first trimester is more likely to lead to structural and anatomical defects, whereas consumption during the second and third trimester increases the risk of growth restriction and functional impairment. "Effects occur along a continuum of severity, with miscarriage, intrauterine growth restriction and Fetal Alcohol Syndrom being among the more severe. Less severe effects include certain cognitive or behavioural abnormalities. However, these abnormalities, particularly maladaptive disorders (attention deficits, poor judgement, lower comprehension and defiance) can persist into adulthood and impair the quality of life of the individual."

There is no national data on the prevalence of Fetal Alcohol Syndrome in Canada, although it is believed to be "one of the leading causes of preventable birth defects and development delay among Canadian children."

Of course, no two mothers are alike. The quantity of alcohol consumed, the frequency with which it is consumed, as well as the stage of pregnancy, the mothers’ ability to metabolize alcohol and the genetic makeup of the fetus are all factors in determining which children are affected and how badly.

For that reason, doctors recommend that mothers abstain completely during their entire pregnancy.

At the same time, however, they’re battling a long-held misconception that the odd drink may actually be good for an expecting mother, calming their nerves and helping them to cope with the discomfort. In addition, some mothers are ignorant, some had existing alcohol problems going into the pregnancy, and some just don’t seem to care. Hence the need for labelling.

It is unlikely that the extent of the labelling will stop with pregnancy. Groups opposed to drinking and driving have also suggested labelling in the past, and there is new evidence linking even moderate drinking to cancers and other diseases of the organs.

And Canadians drink a lot. Domestic consumption of beer, wine and spirits is in the neighbourhood of $13 billion annually, according to Statistics Canada, and per capita sales have increased for the last three years. Every Canadian, aged 15 and over, consumed an average of 103.6 litres of alcoholic beverages from March of 1999 to March of 2000 – that’s down from a high of 134 litres in 1976 and up from a low of 99.5 litres in 1997.

Compared to a country like Russia, or eastern European countries where alcohol consumption has doubled in recent years, we’re way behind the rest of the party.

A 1998 study of per capita pure alcohol consumption by the World Health Organization (WHO) put Canada in 30 th place, behind most of Europe, the U.S., Japan, and Australia and ahead of Central and South America, Mexico, Norway, China, South Africa and Iceland. A subsequent analysis of the statistics by the WHO found that alcohol was actually lowering life expectancies in many countries, with the principle causes of death being chronic liver disease and cirrhosis.

Recent American studies have also found evidence that heavy drinking increases your risk of contracting various cancers of the esophagus, pharynx, and mouth. As well, there is evidence to suggest that it also leads to liver, breast and colorectal cancers. Alcohol is also thought to be a factor in between two and four per cent of cancers.

It has been suggested that acetaldehyde, a byproduct of metabolizing alcohol, impairs a cell’s natural ability to repair its DNA, essentially opening the door for cancer. It may also increase the "expression" of oncogenes at a genetic level, triggering cancer promotion.

There is little evidence that alcohol itself is carcinogenic, although there is evidence that it has that effect when combined with other chemical substances, notably tobacco. People who smoke and drink have higher cancer rates than people who do one or the other.

Another theory is that alcohol affects our ability to absorb and process nutrients, which can lead to certain types of cancers. For example, alcohol can lead to reduced levels of iron, zinc, vitamin E and some of the B vitamins. As anyone who has ever contracted the flu after a weekend-long drinking binge knows, alcohol also impacts the effectiveness of our immune systems, making us more susceptible to disease.

Drinking and driving continues to have a large impact on the health of Canadians, killing more than a thousand Canadians every year and injuring thousands of others.

British Columbia is one of the worst provinces for offenders, on a per capita basis, according to Mothers Against Drunk Driving, with alcohol considered to be a factor in 41.9 per cent of the 475 driving fatalities in 1998. Overall, Ontario leads the way with 348 alcohol related driving deaths each year, representing 39.9 per cent of all driving deaths.

In Canada as a whole, alcohol was considered to be a factor is 38.2 per cent of the 3,260 driving deaths in 1998, representing 1,132 people or 3.1 deaths per day.

MADD has supported labels on alcohol containers in the past to warn people that alcohol will impair the skills necessary to operate a motor vehicle.

So where are these labels? It’s been six months since Parliament approved mandatory warning labels on alcohol, and nothing has happened.

Warning labels are already mandatory in the U.S., Mexico and India, and plans are moving ahead in England and Australia.

"It’s been disappointing," Wasylycia-Leis told the Winnepeg Sun on national Fetal Alcohol Syndrome Awareness Day on Sept. 9. "We know that it can make a difference.

"There’s no more legislative work to be done. It’s just a matter of doing it."

It will be up to Health Canada to implement Bill 155, although they’ve done nothing since it was passed in the spring.

The alcohol industry has also been silent on the issue, no doubt waiting to see how far the government is willing to go – alcohol labelling has been proposed for the past decade, and the issue has always fallen by the wayside.

It also isn’t clear how vivid the warnings will be.

Pictures of newborns with Fetal Alcohol Syndrome, cancers, cirrhosis, and car crashes aren’t going to go down all that smoothly.