Something to think about.

As my family opened Christmas gifts, I was struck by the extent of consumer warnings on the packaging. The plastic bags were not a toy, and could suffocate a child. The tiny packages of desiccants were not to be consumed. Adult supervision required.

I remembered my coffee of the other day. Contents were hot, drink with care. So help me, the hammer at the hardware store probably has a warning to not hit yourself on the head with it.

16/365 - Caught in the headlights Andrés Þór via Compfight

Society is really into warnings. There’s a big sign on the electrical junction box on the curb. Slippery when wet. Objects may appear closer than they appear. No diving, shallow water. Warnings mandated on cigarette packages have grown from a discrete side label to an in your face colour display.

What kind of warning do you think this product requires? Current safe consumption guidelines are based on societal parameters, not medical ones.

Its characteristics are complex, its effects diverse.  It is clearly oncogenic, with a straight line relationship between amount consumed and oncogenicity: there is no safe level of consumption (Latino-Martel et al, 2011). Hepatotoxic. Associated with enteric bleeding. Cardiomyopathic, and neurotoxic. Implicated in up to 25% of completed suicides (Schreiber et al, 2012). Depression. Even vitamin deficiencies. Did I forget anything? I know, you know it. You know it all.

Do you think about your special curse? Do you know that? You’ve chosen it. You’ve put it on. It doesn’t come off. If you’re on holiday, in Mexico, no life guard of course, sitting around the pool with a hundred people doing the all inclusive thing… You’re a physician. That doesn’t stop. Sorry. Truth is ugly.

You know what this is. And I haven’t named it. It doesn’t carry a warning at all on the label in N. America, and in most countries. Shouldn’t we say something? As physicians? To our patients? To our MP’s? The only way cigarettes destroy families is when someone falls ill, or dies. This stuff commonly ruins families. Makes you hit your best friend. Your wife.

Medical students use too much of it. Doctors use too much of it. We are all taught the wisdom of the ages: the dose makes the poison (Paracelsus). Here the dose may be a whole lot lower than we thought.

We as physicians have a responsibility to tell it like it is, at least to our patients. Even if we don’t want to face it ourselves.



Some interesting reading:


Duke, A.A., Giancola, P.R., Morris, D.H., Holt, J.C., & Gunn, R.L. (2011). Alcohol dose and aggression: another reason why drinking more is a bad idea. J Stud Alcohol Drugs. 2011 Jan;72(1):34-43.

Gilber, B. (2011). Alcohol and aggression. Parkhurst exchange, July/Aug 2011, 45,60.

Latino-Martel, P., Arwidson, P., Ancellin, R., Druesne-Pecollo, N., Hercberg, S., Le Quellec-Nathan, M., Le-Luong, T., & Maraninchi, D. (2011). Alcohol consumption and cancer risk: revisiting guidelines for sensible drinking. CMAJ. 2011 Nov 8;183(16):1861-5. doi: 10.1503/cmaj.110363.

National Institute on Alcohol Abuse and Alcoholism

US Dept of Health and Human Services No. 22 PH 346 Oct 1993, updated Oct 2000

Schreiber, J., Culpepper, L., Fife, A. (2012, Mar. 20). Suicidal Behaviour in Adults. UpToDate. Retrieved Nov. 26, 2012, from