The campaigner who exposed Public Health England for massaging evidence to push through a reduction in UK alcohol guidelines has told DRN he believes such skulduggery is “endemic”. In January 2016, the chief medical officer, Dame Sally Davies, cut drinking guidelines for men from 21 units a week to 14, bringing them in line with women, and declared there is no safe level of drinking. To justify this move she cited evidence from a Sheffield Alcohol Research Group report. The report’s authors essentially recommended a lowering of drinking guidelines based on an assessment of the potential harm of low-level consumption. 

However, campaigner Chris Snowdon used the Freedom of Information Act to obtain an email exchange between Public Health England and the academic advisers at SARG, and it shows the academics were in favour of keeping the guidelines as they were, but were asked to alter their model and produce a new draft of the report so the CMO could justify changing them. “Without this abrupt change at the 11th hour it would have been very difficult for the government to justify changing the drinking guidelines,” says Snowdon, who has gained plenty of column inches in The Times and The Spectator for his exposé.

The SARG team had already handed in two drafts to Public Health England of its report into drinking guidelines and expected the CMO to keep them at 14 units for women and 21 units for men. These “limits” had been criticised in the past, with Richard Smith, the former editor of the British Medical Journal who sat on the original guidelines panel, famously claiming they were “plucked out of the air”. SARG’s report was designed to give them some scientific credibility, even if only from a theoretical model, says Snowdon. 

Sensitivity analysis

However, his exposé shows that Public Health England was not satisfied with the first two drafts of SARG’s findings and asked it to conduct a “sensitivity analysis” to see if it could come up with different results. Snowdon believes SARG was confronted with the possibility that Public Health England wanted it to rip up its model and begin again from “a patently false premise” that would skew the findings towards an outcome preferable to their paymasters. Initially the team stood its ground and wrote back: “Our view remains it does not seem right to assign people drinking at very low levels a risk of acquiring alcoholic liver disease and similar conditions. Unless there are strong opposing views, we think it better to keep the threshold in the base case.”

The group subsequently agreed to amend the work. Snowdon says: “Although clearly unhappy with PHE’s proposal, the agency was SARG’s sole funder for this research and the team let it know that it would capitulate if PHE was insistent.

“This was all the encouragement PHE needed. It emailed back to say: ‘Thank you for your swift response. Could you provide costs/timing for changing the base case please?’ The following day, SARG replied with some quotes for the new work, but was clearly still keen to dissuade Public Health England from changing the base case. Its email to PHE gave the agency one last chance to change its mind. It reads, in full: ‘Please see attached a revised costing. As creating a new base case removes the need for a further sensitivity analysis on threshold effects, I have presented two options – a new base case OR a new sensitivity analysis.’

“But it was obvious that PHE was not interested in a mere sensitivity analysis. It wanted to change the headline findings and one of its employees wrote back on February 13 to announce that ‘I have now secured PHE funding to proceed with option two’. By February 19, SARG had received a letter of intent from PHE and had started work on the new model.

“Over the next few weeks, the Sheffield team complained about problems that emerged from its attempts to adjust the model to fit the new assumptions. It was doing something it had never done before. It is unlikely that it had even contemplated doing it before.”

The findings then changed dramatically based on the new criteria. “For male drinkers, some of the thresholds had nearly halved,” says Snowdon. “One suspects that this was music to the ears of PHE and the Guideline Development Group. The new figures not only seemed to justify the government’s existing recommendations for women but could be used as a reason to lower the guidelines for men. Nobody in the guidelines committee was likely to object to such a change. As I have previously described, the committee was packed to the gunwales with temperance campaigners.

“When reading the published report and considering the new guidelines, it should be remembered that they are built on an assumption that the Sheffield team told PHE ‘does not seem right’. When PHE commissioned SARG to produce the report [from a shortlist of one; nobody else applied] it was buying access to the computer model. Whatever the merits and flaws of that model, it had been used in alcohol research since 2008. But when it failed to produce the results needed to justify a change in the guidelines, PHE told SARG to programme it in a way that it had never been programmed before, using an assumption that had no scientific basis and about which the Sheffield team had obvious, well-founded reservations.

“These facts, which have only come to light as a result of Freedom of Information requests, give the lie to the idea that research funded by government is necessarily more neutral or independent than research funded by other means. SARG was clearly not allowed to use its own judgement. Instead, Public Health England and the guidelines group leant on the Sheffield team to get a report that was more to their liking than the document they were originally presented with.

Questions raised

“The more we learn about the process that generated the new guidelines, the more questions are raised about PHE. Far from being an honest broker in this story, the agency seems to have acted more like an activist group working towards a particular conclusion. Its relationship with the anti-drink lobby, which extends to holding its Alcohol Leadership Board meetings at the offices of a temperance group, is worryingly cosy for a state agency. Its decision to appoint leading anti-alcohol campaigners such as Ian Gilmore and Katherine Brown, both of the Alcohol Health Alliance, to the guidelines committee shows that it has become politicised.

“This bias was on display again at the start of this year when PHE published an error-strewn policy document which it released to the media with a headline claim that was so incorrect it had to be retracted. That report was put together by the same familiar faces who dominated the guidelines review process. The revision of those guidelines may seem a relatively minor achievement for the anti-drink lobby. You can ignore it, after all. But, as the minutes of one Guideline Development Group meeting say, it is ‘important to bear in mind that, while guidelines might have limited influence on behaviour, they could be influential as a basis for government policies’. That is why the guidelines are important and, I would suggest, it is why PHE went to such lengths to change them.”