- The Washington Times - Sunday, August 19, 2007

LONDON (AP) — Last call at a British pub can be like a contact sport, with a crush of drunken customers suddenly heaving toward the bar in search of one last round.

It’s a hallowed British tradition, and doctors say an increasingly dangerous one.

Britain‘s taste for binge drinking, driven by a pub culture in which a good night out means packing in as many pints as possible before the traditional 11 p.m. closing time, could lead to a liver-disease epidemic within two decades unless Britons learn to drink more responsibly, authorities warned.

“There’s been a frightening increase in alcoholic liver disease in recent years,” said Dr. Ian Gilmore, president of the Royal College of Physicians.

Deaths from cirrhosis in Britain increased dramatically over the past two decades, while they fell steadily everywhere else in the Western world, according to government statistics.

In England and Wales, 17.5 deaths of every 100,000 men were due to cirrhosis in 2002, up from 8.3 in 1987. And in Scotland, the increase was even more dramatic: 16.9 cirrhosis deaths per every 100,000 men in 1987, up to 45.2 per 100,000 in 2002. In the U.S., every nine deaths per 100,000 in 2004 was attributable to cirrhosis.

“Deaths from cirrhosis [in Britain] are increasing out of proportion with anywhere else in the world,” said Dr. Rajiv Jalan, a consultant hepatologist at London’s University College Hospital.

Cheaper, more accessible alcohol is partly to blame.

Binge drinking in the European Union is highest in Ireland, Finland, Britain and Denmark, according to an EU survey published in March. The survey also found that almost one in five Europeans between the ages of 15 and 24 drink more than five alcoholic drinks in one sitting.

While other European countries also consume large amounts of alcohol, cultural differences might explain why the British pay such a high toll.

“We need to understand what drives our particular drinking culture,” said Dr. Gilmore. “Here, it tends to be more binge drinking, which can be very dangerous.”

Nearly one-third of 15- to 16-year-old British students reported having binge drank at least three times during the previous month, according to a 2003 Europe-wide alcohol survey. The legal drinking age in Britain is 18.

The British custom of buying rounds creates lots of social pressure to drink plenty: With everyone taking a turn at buying, being out with a dozen friends can mean downing at least a dozen pints.

And unlike other European countries such as France, Spain or Italy — where alcohol is the accompaniment to a meal — many Britons are unlikely to eat anything more substantial than a few bags of potato chips alongside their beers.

While other major causes of death like cancer and heart disease drop, liver disease — the fifth leading cause of death in Britain — is rising steadily.

“What is happening in Britain is clearly an anomaly in Europe,” said Dr. Gilmore.

Attempts to curb binge drinking, including 2005 legislation allowing round-the-clock alcohol sales, might have worsened the situation. At one London hospital, doctors noticed that since the alcohol-licensing law changed, alcohol-related overnight trips to emergency rooms tripled. The law’s effect, however, is limited because most pubs did not apply for an all-night license.

In the past decade, hospital admissions across Britain related to excessive drinking doubled. From 1995-1996, 89,000 people were admitted for alcohol-related conditions; between 2005-2006, that figure was 187,000 people.

And unlike most of Europe, Britons are drinking more every year.

Total alcohol consumption in Britain doubled between 1960 and 2004, from about 1.5 gallons per person over 14 years old to three gallons per person. In contrast, other European countries, particularly in the south, recorded drops in consumption.

Cirrhosis used to mostly affect men in their 60s. Now, doctors treat patients of both genders in their 20s and 30s. Because symptoms can be nonspecific, including fatigue and sexual problems, many people may not realize they have liver problems until damage is irreversible.

Chronic alcoholism and the hepatitis C virus are the main causes of cirrhosis, but it can also be triggered by other hepatitis types, genetic diseases, other infections, autoimmune disorders or a bad reaction to drugs.

Excessive alcohol intake kills healthy liver cells, leaving scar tissue that cannot regenerate itself. Once the liver starts to fail, a domino-like chain reaction in the body is set off, often leading to kidney, heart and circulatory failure.

“If the disease goes undiagnosed, you can go from being entirely well to being in the intensive care unit with multiple organ failure in six to eight weeks,” Dr. Jalan said.

At a June meeting of the British Medical Association, doctors called for several measures to address the growing drinking problem in the country, including a ban on public drinking in the streets, higher alcohol taxes and a lower threshold for drunk-driving.

The British government last year started an awareness campaign to alert young people to the dangers of binge drinking.

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