Doctors Heal Thyself – Call for action against Alcohol.

http://health.india.com/diseases-conditions/national-doctors-day-2013-doctors-heal-thyself/

Op ed on Doctors Day in 2013

As per Wikipedia, “Doctor” originates from the Latin word of the same spelling and meaning. The word is originally an agentive noun of the Latin verb docēre ‘to teach’. Marcus Tullius Cicero said – In nothing do men more nearly approach the gods, than in giving health to men. In my editorial I have chosen to highlight the ubiquitous role of physicians by becoming positive role models. For centuries, doctors stand tall as fine role models for their students, patients, colleagues and in their community. At every point of contact with other human being, doctors are ambassadors of healthy lifestyle and a positive icon.   

In the early part of the 20th century, tobacco usage was very high amongst Indian physicians. It was common for physicians to smoke/chew tobacco while examining the patients, inside the hospital and in public. This was a reflection of high degree of acceptance for tobacco amongst physicians and society at large. Fortunately, with passing days, its usage is being increasingly looked down upon amongst doctors. It is increasingly difficult to spot a doctor smoking in public though it is still seen in certain parts of China, Russia and East Europe. However, rising use of Alcohol amongst doctors is an area of concern and the topic of my editorial on the eve of “Doctors Day”

The issue of Alcohol is similar to tobacco is several ways. Thanks to several decades of shrewd marketing, both continue as socially acceptable and profit making industry despite abundant evidence against them. There are about 2 billion people worldwide who consume alcohol and 76.3 million suffer from nearly 60 types of alcohol related diseases that leads to 1.8 million deaths. Alcohol is one of the leading risk factor for disease burden in low mortality developing countries and the third largest risk factor in developed countries. Alcohol is causally related to dependence syndrome, cancer,cirrhosis, pancreatitis, gastritis, polyneuropathy, hemorrhagic stroke, psychoses, epileptic seizures and other mental conditions. Alcohol consumption during pregnancy is related to various risks to the fetus.Alcohol drinkers have higher rates of sickness absence leading to lower productivity. Though alcohol is claimed to exert some beneficial effects, the recent WHO report concluded that “there are more life years lost due to alcohol consumption than deaths prevented”.

Having said that, it is estimated (though there is no data) that half of the doctors indulge in alcohol drinking beyond safe levels. A glimpse of such an indulgence can be witnessed by attending the gala dinner / banquet of the medical conferences. It is well known that the attendance in such session is nearly 100% while attendance of the academic sessions is strikingly dismal. Though the definition of the “moderate drinking” is mired in controversy, many doctors are comfortable convincing themselves that moderate drinking is safe. Most of them define their own “moderate” levels! Moderate drinking per day for men is 2 drinks in US, 3 drinks in Netherlands, 4 drinks in France! Women folk are supposed to drink one peg lesser than men in their country to be classified as moderate drinkers. The physician’s pro-alcohol attitude has also created a societal impression that encourages the vulnerable people to pick up the habit as a “tonic” and allows fearless continuation amongst those that are already habituated. Cochrane review clearly reported that a brief advice by physicians to reduce tobacco/alcohol is very effective. Conversely, a brief advice proclaiming safety of moderate drinking may have disastrous influence. It is interesting that a downbeat industry has gained so much of acceptance by suppressing mountain of evidence and succeeded in creating a positive impression amongst physicians. I am sure its consumption leads to actions that result in unintentional injuries or harm to patients. While there is a strict law to curb drinking and driving, we need to see more punitive actions for those doctors found “harming and not healing” under the influence of alcohol. Chronic alcohol addiction is bound to affect the psycho-motor abilities that are crucial to all physicians regardless of their specialty.

It is proven beyond doubt that non-communicable diseases are negatively impacting individuals, communities, and countries are undermining the achievement of the Millennium Development Goals. In September 2010, UN member states passed UN resolution, announcing that it will focus on common risk factors for vast majority of the non communicable diseases – tobacco, alcohol, unhealthy diet and physical inactivity. In this hour of public health crisis, it is only expected that medical community leads from the front. Firstly, they should not serve as proponents of drinking and secondly they should shun drinking at least in public.  Doctors serve as role models to society and their counseling on any such issue will be completely ineffective if the patient does not see the same advise being followed by the medical community.

Published by Chaturvedi Pankaj

Deputy Director, Center for Cancer Epidemiology, Tata Memorial Center, Mumbai. Professor, Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai

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