Under the Influence

I often attend gigs in Belfast, a thirty-five-minute drive from home. I say “drive” because there’s no public transport, so driving my car is the only feasible way to do it. (I can cycle to the nearest railway station in about twenty minutes or so, but the last trains back are around eleven-thirty, so that ‘s no good.)

When the music’s over and I’m coming home, it’s usually around one in the morning, or later, and there’s very little traffic on the roads. One thing that is conspicuous is that there is almost never any presence of police. That’s on main roads out of Belfast and on the M1 motorway: major highways. I’m sure that the coverage of minor roads is even more sparse.

What I’ve often thought is that if you were the sort of nutter who drives while under the influence of alcohol, the odds of getting caught and punished are tiny. Assuming you were sufficiently in control, or sufficiently lucky to avoid an accident, the probability is that you’d never have to pay for your crime.

That’s why I’m underwhelmed by the publication today of “The North Review of Drink and Drug Driving Law“. Sir Peter North makes 28 recommendations relating to drink-driving (and another 23 on drugs) none of which say “more enforcement of existing law”. The recommendation which most of the news media have picked up on is to reduce the legal limit of alcohol in blood from 80 mg/l to 50 mg/l in line with most other European countries.

If the police aren’t stopping and testing drivers, then the blood alcohol limit is completely irrelevant. Sure, make it 50 if it gives you a warm glow and the government can claim it’s “doing something” about the problem. Make it zero; why not? Or 1000 g/l if you like. It makes no difference.

Well, maybe a small difference, but maybe not. Evidence would be nice, so I turned to the brief section in the 238-page report dealing with research by the National Institute for Clinical Excellence. (Of course I had to read the whole report rather than depending on journalists to give me the significant points. I don’t have a high opinion of the main body of journalists. They’re lazy and incompetent.)

NICE didn’t actually do any research themselves, but studied relevant published reports from around the world, and in Sir Peter’s words found that “the adoption of a 50 mg/100 ml BAC [blood alcohol concentration] driving limit that occurred across 15 European countries reduced alcohol-related driving death rates by 11.5% among young people aged 18­-25.” So that’s good. But when the original scientists included a wider number of statistics, “there were no significant reductions in deaths or injuries among the broader population when these other factors, such as enforcement and infrastructure quality, were taken into account.”

“NICE considered that there was insufficient evidence to judge what level of effect might be sustained over time by lowering the BAC [blood alcohol concentration] limit, although certain studies indicate that there could be positive, long-term gains. “

“Review of the literature highlighted that there was only limited evidence on the pattern of drink driving in England and Wales (as measured by BAC levels  among the driving population). There was also a lack of UK evidence on how reducing the legal limit might change drink driving behaviour and the associated risk of casualties, particularly among those drinking above the current 80 mg/100 ml BAC limit.”

“Given the many uncertainties related to the data and the assumptions used in the modelling, the figures should be interpreted with considerable caution.”

Those are representative — I’m not cherry-picking those quotes to give a slanted picture of what the research said. You can see for yourself at http://northreview.independent.gov.uk/report. The best conclusion that you can draw from it is that a lowering of the limit might have an effect on drink-driving death rates, and yet the recommendation to lower the level is one of the most concrete made by Sir Peter.

He actually mentions the views of the NICE researchers on enforcement and publicity, but totally fails to draw any conclusions or make the obvious recommendations.

“The NICE review commented on the evidence available relating to public awareness and enforcement of BAC  [blood alcohol concentration] limit laws. NICE concluded that there is sufficiently strong evidence to indicate that publicity and visible, rapid enforcement is needed if BAC limit laws are to be effective. Drivers need to be aware of ­ and understand ­ the law. They also need to believe they are likely to be detected and punished for breaking the law. High quality review evidence also shows that mass-media campaigns can reduce alcohol-impaired driving and alcohol-related crashes.”

“Random breath testing is generally recognized as one of the most cost effective road safety measures. For example, a 2004 World Health Organization study reported that each dollar spent on random testing results in a cost saving of $19.74 Similarly, a New Zealand study found the cost-benefit ratio was 1:14 for random testing alone (i.e. for every $1 spent on random testing, the overall savings were measured to be $14), 1:19 for random testing coupled with a media campaign, and 1:26 for random testing with both a media campaign and “booze buses” (large, specially equipped vehicles used for evidentiary breath testing, which are typically very distinctive in order to attract the attention of nearby road users).”

In spite of including these extracts from the research, which clearly state the importance and effectiveness of enforcement and public awareness, there are no relevant recommendations. Perhaps the reason is implicit in what Sir Peter says in the introduction to his report: that lowering the  blood alcohol limit is a measure that would have public appeal. I can only guess that he thinks that spending money to save money, like the New Zealanders, would not be popular, so let’s go for the probably ineffective recommendations instead.

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