Wednesday, March 21, 2007

All the pleasure of drinking, without the pain - health - 15 July 2006 - New Scientist

All the pleasure of drinking, without the pain - health - 15 July 2006 - New Scientist

Why is it that when you step into a bar for a glass or two of cheer, you so often leave with five drinks' worth of impending doom? All you wanted was to loosen up, have some fun, unleash the gregarious you stuck somewhere in sobriety. Yet it is all too likely that this feel-good glow will be followed by a hard-luck chaser. Several drinks later, you stumble home, clumsy, belching and battling to stay awake. Your judgement's shot: you urinate in a doorway, stuff down two kebabs and narrowly escape getting killed on the road. At home, your partner declares you disgusting and, though you rant defiantly, you know it's true.

You toss and turn all night and in the morning wake tired, with a throbbing head and an uncanny certainty that you made an ass of yourself last night, though you can't remember the details. As you trudge off to work, a few brain cells lighter and with a slightly more withered heart and liver, you swear you won't do it again.

But you probably will. The simple fact is that alcohol makes people feel good. There are obvious downsides, but it also relaxes you, makes you happy, chatty and sociable.

What if you could have all that is good about alcohol, with none of the bad? What if you could enjoy a night of frivolous fun, then simply pop a pill for instant revival? Your sobriety restored, home you'd ride - or even drive - to a good night's sleep (or better) with no risk of a hangover. Or what if, before imbibing, you could swallow a tablet that would block the negative effects, such as memory loss? Better yet, imagine there was a substitute that could deliver relaxation and merriment without the nausea, disorientation or aggression. In fact, what if one day this dream drink could be so well-tailored that even a lifetime of indulgence would leave the liver, brain and heart unharmed?

It may sound too good to be true, but that day may not be as far off as you think. There's already a drug that can sober up a drunken rat in 2 minutes flat, and researchers are busy searching for compounds to do the same in humans. The memory preservative is not fantasy either, nor is the notion that with a little tinkering, pharmacologists could come up with a faux alcohol able to mimic the charms of booze with less of the sordidness.

Alcohol is one of the last great technological throwbacks. It is made today pretty much the way it was 4000 years ago. And it's crude stuff. Which makes you wonder: if we can take the calories out of food, the pregnancy out of sex and even the sex out of pregnancy, why not take the harm out of alcohol? "We know what alcohol does," says David Nutt, a psychopharmacologist and advocate of safer alcohol at the University of Bristol, UK. "Why not just make better drugs?"

The big problem with alcohol is that it kills people (see Diagram). And while there's an obvious way to stop this happening - drink less or not at all - for some reason, humans find this advice nigh on impossible to follow. According to the US Centers for Disease Control, 19,928 Americans died in 2002 from the direct effects of alcohol, including poisoning and alcohol-induced liver and heart disease. According to the UK Office for National Statistics, the comparable number for England and Wales in 2003 was 6580, and it's rising. Many more deaths are caused indirectly by alcohol: accidents, homicides and suicides, to name just three. If this harm could be mitigated by drugs, or if alcohol could somehow be replaced by safer substitutes, argues Nutt, many lives could be saved.


The reality is, though, that the biggest hurdles to safer alcohol may not be technical ones. Even if someone developed good alcohol blockers, booze substitutes or sobering-up pills, chances are they would end up gathering dust. Consider the sobering-up drug Ro15-4513. You may be surprised to hear that it was developed more than 20 years ago by pharmaceutical company Roche. Why have you never heard of it? Why can't you buy something similar over the counter?

When Roche researchers discovered that the compound could undo the behavioural effects of drunkenness, they were surprised and delighted. However, they later found out the drug has no effect on blood alcohol levels and consequently does nothing to prevent acute alcohol poisoning, which is probably caused by alcohol's effect on cell membranes throughout the body.
Sobriety pill

Roche was not keen on pursuing a simple sobriety tablet. It feared that, in the long run, such a pill might encourage drinking, rather than make it safer. Worse, they could envisage what might happen if someone used the drug, then caused an accident while driving home. They may have taken a sobering-up pill, but their blood alcohol level would still prove drunkenness. Roche's lawyers saw it as a legal nightmare, and the company dropped it.

There is another paradox. Psychoactive and addictive though it is, alcohol is regulated not as a drug but as a foodstuff. Any new substance purporting to counteract alcohol or replace it, on the other hand, would be regulated as a pharmaceutical. This creates potential barriers. For one thing, it might make alcohol blockers or substitutes harder to obtain than alcohol itself. It's hard to imagine ever getting to the point where such a drug or additive was being sold casually over the bar alongside beer, says Robin Room, director of alcohol policy research at Turning Point, an alcohol and drug research centre in Melbourne, Australia. What's more, he says, it's unlikely that anyone would want memory preservers badly enough to go and get a prescription.

Nutt suspects that only an intervention by government - announcing that it supports the making of safer alcohol, that they will tax it preferentially, or regulate it differently - is likely to make the difference. There are reasons for optimism on this front. New Scientist has learned that the UK government has asked the Academy of Medical Sciences to look at the case for safer alcohol and make recommendations.

Even with government backing, drug companies will be cautious. "The pharmaceutical industry does not position itself to be going into the recreational market," says Ragan. There are always risks when you take a drug, he points out. When you're treating a life-threatening disease such as alcohol addiction, they may be risks you are willing to take. But those risks are harder to justify in the merely sozzled.

Add to that the moral indignation that attaches to any suggestion that boozers should be allowed to drink more safely, and it looks like an uphill battle for safer alcohol. Many people in the alcohol addiction recovery field believe fervently that the only solution is outright abstention, and any drug of the type Nutt suggests would meet with stiff opposition. As an example, Room points to a drug called propylthiouracil. Normally prescribed for an overactive thyroid, it has also been shown to protect against cirrhosis of the liver in alcoholics, but is not widely used for that purpose. "My theory of why [it] has not become better established as a medication for reducing the harm to an alcoholic's liver," he says, "is the fear that it will allow the alcoholic to continue drinking."

But things change. Ragan recalls working in the pharmaceutical industry in the 1980s, when the idea of drugs to fight obesity was raised. "There was almost a riot," he says. Obesity, his colleagues felt, was a lifestyle problem. "So that's how far we've moved." Safer alcohol may not be coming to a pub near you just yet, but it's surely too good an idea to dismiss as idle bar-room speculation.

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