Thursday, August 19, 2004

Quit pretending - that beer is a drug

VICTORIA - There's probably lots of good reasons to fret about a machine that lets you inhale your gin instead of drinking it.
But I can't shake the sense that the quick call for a ban is just another example of our reluctance to consider alcohol a drug.
Alcohol Without Liquid machines are already in a couple of British bars, where patrons pay $12 to pull on a face mask and inhale a vapour of oxygen and alcohol. Knock-offs are cropping up on EBay, and the machines are expected to make their U.S. debut soon.
Already, nervous hands are wringing. Critics complain the machines could lead to people getting drunk quickly (though the company says it takes about 20 minutes to inhale the equivalent of one drink). They observe rightly that impaired people would pass breathalyzer tests. And they wonder if users' brains - now protected by the time it takes to process drinks - could be damaged by a rush of alcohol.
Good concerns.
But on the other hand the machines offer some remarkable harm reduction benefits.
No calories, or the risk of obesity related diseases. No damage to the liver, or other internal organs.
That means getting drinkers to switch to vaporizers could prevent about 190 deaths a year in B.C. directly related to alcohol, and another 900 indirect deaths, just by reducing the physical damage.
That's not the way we think about alcohol. We don't see it as a drug, let alone a dangerous one, even though it will kill more people each year than heroin or cocaine overdoses.
Far be it from me to mock peoples' claims that they like the taste. I do too. And I've heard people talk convincingly of the special delight of the latest Okanagan merlot.
But I am prepared to wager that if you banned the sale of merlot - heck the sale of all red wine - in B.C., the overall consumption of alcohol would not fall by one litre. All those people who so loved red wine, or single malt scotch, or strawberry coolers, would find something else to drink if they weren't available.
Because ultimately all those bottles we buy are just the delivery system for the drug. The effects of alcohol - the relaxation, the buzz, whatever - really drive our consumption.
Look at those coolers and flavoured ciders, the hottest growing category of the last several years. We knocked back about 55,000,000 bottles in B.C. last year, some $93 million worth. They're tasty and everything, but not so tasty that we'd be grabbing them up at $2 a bottle if they didn't offer the mood-altering effects of alcohol.
B.C. liquor stores took in almost $2 billion last year. Some that was from tourists and visitors, I suppose, but then British Columbians were also travelling and drinking. The stores sold 347 million litres of beer, wine, vodka and the rest, enough to fill about 300 Olympic pools, and about 110 litres per adult.
Alcohol is by far the most widely used and available drug in our society - and the most heavily promoted to recruit new users.
It's also easily the most damaging, resulting in some 1,800 deaths each year and countless tragedies, from shattered families to lost jobs. Take alcohol out of the mix and our problem of backlogs in the courts would disappear, and our waiting lists for health care would shrink overnight.
Not to be preachy. I did my bit to help the Liquor Distribution Branch to those record sales last year. Sometimes a little mood-altering is just the ticket.
But the quick dismissive reaction to the alcohol vaporizer - gimmick that it may be - showed again our reluctance to acknowledge alcohol as another potentially addictive, potentially dangerous drug that we seek for its chemical effects on our brain.
And that's too bad. Alcohol has huge effects in our society. Our attitude towards it - and public policies - should be based on reality, not a polite pretence.
Footnote: Our biggest failure is not providing youth with accurate information about alcohol. A McCreary Centre Society survey of B.C. high students found 63 per cent of 15 year olds had tried alcohol. About 45 per cent of high school students who reported using alcohol also reported binge drinking within the last month. That's a massive public failure.

Wednesday, August 18, 2004

Tied poll shows NDP, Liberals face big challenges

VICTORIA - That whooshing sound you hear is Liberals heaving a sigh of relief about the latest Mustel Group poll.
Gordon Campbell and company were pretty confident last month's disastrous poll didn't reflect reality. That poll found the New Democrats had surged to 45 per cent, while the Liberals had skidded to a dismal 33 per cent.
But it still had to be a relief for Liberals to get the new numbers and see that they had climbed back to 40-per-cent support, just below the New Democrats at 42 per cent.
It's a sign of how tough things have got for the Liberals, elected with such huge support, that poll results that show them in second place are good news.
Pollster Evi Mustel says several things may have worked in the Liberals' favour. The economy is improving, and that is an important factor for many male voters, she says. (The Liberal rebound was almost entirely among men.)
And the last poll, which showed the Liberal plunge, came at the same time as the federal election. The provincial Liberals were criticized from all sides during the campaign. NDP leader Jack Layton blasted the government for tax and spending cuts; federal Liberal David Anderson blamed Campbell's unpopularity for the federal party's problems in B.C.
The good news for the Liberals is that the fallout has stopped.
The bad news is that given the minority government in Ottawa, the B.C. Liberals could once again be tangled up in federal politics as we near next May's provincial election. The Martin government will likely last longer than that, but with each passing month the advance campaigning for the inevitable vote will heat up.
Mustel also says the poll results may indicate that some voters are considering the possibility that the New Democrats might actually win, and shifting back to the Liberals. it's one thing to send a message by electing a strong opposition, they're deciding, and quite another to put the NDP back in office after their recent mismanagement.
Those are the fears NDP leader Carole James is supposed to be quelling, with mixed success so far. The party's poll standings represent a remarkable recovery, given that Mustel had them as low as 13 per cent in the months following the election.
But James has yet to make an impression on 50 per cent of voters, according to the poll. They have no opinion on the job she's doing as NDP leader.
James is generally doing OK with the people who have made up their minds - 57 per cent of decided voters approve of her performance, compared to 36 per cent for Campbell. (Sixty-four per cent think Campbell is doing a bad job.)
But doing OK isn't enough. As the election approaches she has to convince people the New Democrats can be trusted. So far, she's made relatively little progress in increasing the number of people who are confident in her ability.
It all makes for a very volatile situation, says Mustel. Asked for reasons for their choices, and voters are saying they aren't really keen on the party they say they support - they just dislike the other guys more. No party has a large committed core vote, and that means things could change very quickly.
There's one more piece of bad news for the Liberals in this poll. People were asked to pick the one issue they consider most critical, and almost 40 per cent picked health care. Government and the economy were the next closest issues, at 12 per cent each.
Health care hasn't been a strong issue for the Liberals. British Columbians are the least satisfied in Canada with their health care, and their satisfaction has decreased since the Liberals were elected.
The poll establishes one thing. The Liberals and the NDP both have their work cut out for before the election, now only nine months away.
Footnote: The Greens were at 11 per cent, down slightly from last month, Reform at three per cent, Social Credit at one per cent and Unity barely registered. The strength of all those parties and the success of a new unite-the-right movement could decide the election outcome in a number of close ridings.

Tuesday, August 17, 2004

Health care summit looking like a doomed effort

VICTORIA - Things are looking rocky for Paul Martin's big televised health care summit.
Premier Gordon Campbell and the rest of the premiers are heading to Toronto for one last strategy session before they meet with Martin.
The premiers want to firm up their proposal for a federally funded, national pharmacare plan. And they need to figure out how to handle Martin's counter-proposal for a reduction in wait times for surgery.
Martin's health care summit next month has at least got everyone's attention. But it has the potential to be a weird event, as all parties jockey for political advantage under the TV lights.
Martin says he wants to leave the meeting with a new plan for health care in Canada, a ridiculous objective, no matter how much work is done behind the scenes.
The public would be much better served if this became the first of a regular series of public first ministers' meetings on health care, perhaps once a month for six months. That would allow serious work on the kind of health care Canadians want, what and how they will pay, and positive changes that can be made.
There's no fix for health care, nothing that can be cobbled together in a few days that will make a lasting difference.
A national pharmacare program makes good sense. A single buyer - and single approving agency for new drugs - could negotiate more effectively with drug suppliers, and make the best decisions about which new drugs offer enough benefits to offset higher costs.
But so far, that's not what the provinces are mainly talking about. They're concern is shifting the current costs on to the federal government. For the public, that's a bookkeeping change. The same taxpayers pay, and the system isn't improved.
Martin's focus on reducing wait times for treatment in five key areas also makes good sense. Canadians judge the system by how long they must wait for care, and have watched with dismay as wait times increased.
Other jurisdictions have provided their citizens with wait time guarantees - a promise of treatment for major ailments within a set time. If the system can't deliver, the government pays for treatment outside the country or in the private sector.
But a deal on wait time limits or guidelines is not going to be reached in a few days in Ottawa. Health care is a provincial responsibility, and premiers will be understandably nervous in committing to wait time guidelines they can't meet.
And we are a long way from agreement on what sort of wait time guidelines we are prepared to adopt. In B.C., governments have decided that people should wait longer and longer for surgery. Wait lists in most areas climbed under the NDP, and climbed even more sharply under the Liberals. The median wait for a hip replacement has climbed 25 per cent since the election, for non-emergency heart surgery by 15 per cent. Our governments have had other priorities.
In the short term, reducing wait lists is about money, as Campbell showed this week. He announced $3 million more for heart surgery this week, a 5.5-per-cent increase. That's enough to cut the median wait by 20 per cent to 12 weeks, shorter than when the Liberals were elected. And it's a reminder of how relatively small amounts of money can make a large difference in reducing the wait for treatment.
Many Canadians have lost confidence in their governments' ability to manage health care, as this week's Ipsos poll revealed. When the premiers and prime minister sit down next month, those people want to see a commitment to long-term solutions.
Instead, they will see the leaders stumbling toward a meeting with hopelessly complex objectives. One of two outcomes is likely: the meeting will either break-up in recriminations and posturing; or another short-term deal involving extra money to maintain the status quo will be cobbled together.
Neither addresses the real health care issues.
Footnote: The Ipsos survey, done for the Canadian Medical Association, asked Canadians to grade the health care system. More than one in four gave federal and provincial governments failing grades for working together to make the system more accountable. Almost 30 per cent said the federal government wasn't funding health care adequately and 22 per cent said their provincial government wasn't spending enough.