If we had been able to be more rational about the impacts of recreational drug use on society, it may have made more sense for the Government to have brought in strong regulations to curb the overuse of alcohol before it took steps to bring in strong regulations to curb the use of cigarettes. Why? Because the direct harm to others from the overuse of alcohol is greater than it is from the use of cigarettes.However, the history of New Zealand is likely to record in time how it was strong regulations around the supply and sale of cigarettes that preceded the same type of measures to curb heavy drinking, rather than the other way around.This edition of the NZMJ is being published on the eve of the final reading of a Government-ledAlcohol Reform Bill; a Bill that many believe does not go nearly far enough to have any significant impact on the current harmful drinking culture.It is timely that this edition contains two leading articles on alcohol harm, one addressing the harms to others from alcohol1 and another reporting on self-reported harms to the individual drinker.2 These two papers point to an enormous issue of alcohol-related harm across New Zealand and the need for urgent and effective alcohol reform at a population level.Given the intense public interest in the upcoming Alcohol Reform Bill, a third paper is also welcomed, because it provides a counterview on alcohol harms and costs. Crampton and colleagues3 discuss alcohol-related harm within a "standard economic approach" and conclude that cost estimates reflecting alcohol-related harm are often largely flawed and therefore of very limited use in informing alcohol policy.In the first paper, Connor and Casswell—two of New Zealand's foremost experts in alcohol policy and public health—have completed a tour de force in assembling the existing evidence of the harm of alcohol to others in New Zealand. They find this widely scattered body of information to be substantial in size and extent but not easily accessible or described in a usable fashion. The key findings are: There are no usable data on the harm to children of other people's drinking in New Zealand, including the presence of fetal alcohol spectrum disorder; Harm from others' drinking is higher than harm from one's own drinking, especially for women and young people; Up to a half of criminal offences involve someone who had been drinking; Self-reported violence involved a drinking perpetrator in about half of cases; About 40% of those injured and 25% of those killed in alcohol-related traffic crashes are not the drinker responsible; and About 1 in 8 unintentional residential fire deaths were victims of alcohol-related fires. Alcohol harm to children appears to be particularly poorly collected in New Zealand. For example, there are more than 12,000 care and protection notifications per year where children have been found to have been sexually, physically or emotionally abused or neglected but no reliable measure of the involvement of alcohol appears to be in place for routine use.Connor and Casswell argue that because of the severe limitations in the description of alcohol-related harm to others, policy responses are likely being compromised, in contrast to cigarette smoking where the effects of passive smoking have been instrumental in bringing about new strong reform.In the second paper Meiklejohn and colleagues report research on alcohol harm from a national postal survey. One in three New Zealand adult drinkers said they had been harmed by their own drinking in the past 12 months. Men, Māori, those living in a more deprived communities and the young are at increased risk of harm. The authors argue that the high prevalence of harm points to the need for effective population-based, rather than individually-based interventions as the necessary strategy to adopt and that interventions to reduce the availability and promotion of cheap alcohol have been shown to be the most effective.In the third paper, Crampton and colleagues primarily criticise the method used by another set of economists (from Business and Economic Research Limited [BERL]) who provided an economic analysis of social costs of alcohol for the New Zealand Law Commission's review of the liquor laws.4Crampton's group argues that about 80% of the stated costs should be discarded from the analysis because they do not conform to the "standard" (neoclassical) economic approach. The consequence of their recalculation is a substantial reduction in what they consider to be the true social cost of alcohol misuse in New Zealand: approximately $1 billion instead of $5 billion.One of the main assumptions is that harm to the individual from alcohol can be eliminated from their "standard" economic analysis because this is offset by the benefit of alcohol that was factored in by the individual to the decision they made at the time of buying and consuming the alcohol.Discussion of this "rational economic man" assumption is outside the scope of this editorial but it is of interest to note that public statements by representatives of BERL about the Crampton group's criticism of their method at the time included comments about the validity of this model of human cognition and behaviour. It is certainly worth pondering whether the consumption of a psychoactive substance which impairs judgement and diminishes impulse control is necessarily the best choice of behaviour to apply an assumption of rationality in human behaviour.The narrowness of the Crampton group's approach is exemplified in the statement that "the only policy-relevant costs [of a fatal drink driver accident] are those imposed on emergency services in responding to the accident". Equally the lost productivity through mortality reveals the dismal view from the world of this particular economic approach: early death is not seen as a cost because the economic unit (the deceased person) can simply be replaced.It is noteworthy that while Connor and Casswell describe a likely underestimate of the harm to others from alcohol, Crampton and colleagues would consider these further externalities to be legitimately included in their economic analysis.However, given the lack of attention to quantifying the extent of these alcohol-related harms to others, as identified by Connor and Casswell, it seems disingenuous for Crampton et al to then attempt to systematically minimise the total extent of harm by dismissing harm to oneself as economically irrelevant. This does not mean that we should avoid rigorous debate on the extent and nature of alcohol-related harm or the most appropriate measures use, but an ideological stance certainly appears unhelpful.The Crampton group position their critique of the BERL report as an economic versus a public health approach. Yet BERL is also a group of economists, not public health scientists.From a non-economist standpoint Crampton et al would appear to be the fundamentalists in this debate and their conclusions need to also be considered in the context of their receiving funds from an alcohol industry, which benefits from their conclusions. Further, it is important to note that "standard (neoclassical) economic approaches" are coming under increasing scrutiny and criticism, particularly following the recent global financial crisis, which was not predicted by "standard" economic models. New economic models based on better science and more rigorous mathematics are now progressing.5These developments are urgently needed in order to advance knowledge and improve quality of life. The complexity of the human drama needs the full spectrum of academic endeavour from the arts to the sciences, from rich novels to dry epidemiological papers in order to be adequately captured and understood.6 Somewhere between these two traditional domains sits economics, bravely attempting to understand and explain human complexity from the standpoint of the supply and consumption of goods and services; a critical perspective when considering alcohol harms.New economic models based on science, which more accurately reflect human nature and which can capture the full drama of human life, positive and negative, are required, to advance enlightened social policy in this emotionally charged and complex area of recreational drug use and costs to society.Parliament is about to debate a new Alcohol Reform Bill, which is the current government's response to the most comprehensive review of alcohol undertaken in New Zealand to date. Most of the strong reforms recommended by the Law Commission have not been included in the new Bill by the current government, particularly those addressing "unbridled commercialisation"7 by raising the price and dismantling the marketing of alcohol, as has worked for tobacco reform.As the evidence of alcohol harms accumulates, especially harm to others, we must continue to urge our elected representatives in government to enact effective legislation in order to help reduce these harms, rather than use outdated neoliberal economic models, which result in doing little more than watch from the sidelines.

If we had been able to be more rational about the impacts of recreational drug use on society, it may have made more sense for the Government to have brought in strong regulations to curb the overuse of alcohol before it took steps to bring in strong regulations to curb the use of cigarettes. Why? Because the direct harm to others from the overuse of alcohol is greater than it is from the use of cigarettes.However, the history of New Zealand is likely to record in time how it was strong regulations around the supply and sale of cigarettes that preceded the same type of measures to curb heavy drinking, rather than the other way around.This edition of the NZMJ is being published on the eve of the final reading of a Government-ledAlcohol Reform Bill; a Bill that many believe does not go nearly far enough to have any significant impact on the current harmful drinking culture.It is timely that this edition contains two leading articles on alcohol harm, one addressing the harms to others from alcohol1 and another reporting on self-reported harms to the individual drinker.2 These two papers point to an enormous issue of alcohol-related harm across New Zealand and the need for urgent and effective alcohol reform at a population level.Given the intense public interest in the upcoming Alcohol Reform Bill, a third paper is also welcomed, because it provides a counterview on alcohol harms and costs. Crampton and colleagues3 discuss alcohol-related harm within a "standard economic approach" and conclude that cost estimates reflecting alcohol-related harm are often largely flawed and therefore of very limited use in informing alcohol policy.In the first paper, Connor and Casswell—two of New Zealand's foremost experts in alcohol policy and public health—have completed a tour de force in assembling the existing evidence of the harm of alcohol to others in New Zealand. They find this widely scattered body of information to be substantial in size and extent but not easily accessible or described in a usable fashion. The key findings are: There are no usable data on the harm to children of other people's drinking in New Zealand, including the presence of fetal alcohol spectrum disorder; Harm from others' drinking is higher than harm from one's own drinking, especially for women and young people; Up to a half of criminal offences involve someone who had been drinking; Self-reported violence involved a drinking perpetrator in about half of cases; About 40% of those injured and 25% of those killed in alcohol-related traffic crashes are not the drinker responsible; and About 1 in 8 unintentional residential fire deaths were victims of alcohol-related fires. Alcohol harm to children appears to be particularly poorly collected in New Zealand. For example, there are more than 12,000 care and protection notifications per year where children have been found to have been sexually, physically or emotionally abused or neglected but no reliable measure of the involvement of alcohol appears to be in place for routine use.Connor and Casswell argue that because of the severe limitations in the description of alcohol-related harm to others, policy responses are likely being compromised, in contrast to cigarette smoking where the effects of passive smoking have been instrumental in bringing about new strong reform.In the second paper Meiklejohn and colleagues report research on alcohol harm from a national postal survey. One in three New Zealand adult drinkers said they had been harmed by their own drinking in the past 12 months. Men, Māori, those living in a more deprived communities and the young are at increased risk of harm. The authors argue that the high prevalence of harm points to the need for effective population-based, rather than individually-based interventions as the necessary strategy to adopt and that interventions to reduce the availability and promotion of cheap alcohol have been shown to be the most effective.In the third paper, Crampton and colleagues primarily criticise the method used by another set of economists (from Business and Economic Research Limited [BERL]) who provided an economic analysis of social costs of alcohol for the New Zealand Law Commission's review of the liquor laws.4Crampton's group argues that about 80% of the stated costs should be discarded from the analysis because they do not conform to the "standard" (neoclassical) economic approach. The consequence of their recalculation is a substantial reduction in what they consider to be the true social cost of alcohol misuse in New Zealand: approximately $1 billion instead of $5 billion.One of the main assumptions is that harm to the individual from alcohol can be eliminated from their "standard" economic analysis because this is offset by the benefit of alcohol that was factored in by the individual to the decision they made at the time of buying and consuming the alcohol.Discussion of this "rational economic man" assumption is outside the scope of this editorial but it is of interest to note that public statements by representatives of BERL about the Crampton group's criticism of their method at the time included comments about the validity of this model of human cognition and behaviour. It is certainly worth pondering whether the consumption of a psychoactive substance which impairs judgement and diminishes impulse control is necessarily the best choice of behaviour to apply an assumption of rationality in human behaviour.The narrowness of the Crampton group's approach is exemplified in the statement that "the only policy-relevant costs [of a fatal drink driver accident] are those imposed on emergency services in responding to the accident". Equally the lost productivity through mortality reveals the dismal view from the world of this particular economic approach: early death is not seen as a cost because the economic unit (the deceased person) can simply be replaced.It is noteworthy that while Connor and Casswell describe a likely underestimate of the harm to others from alcohol, Crampton and colleagues would consider these further externalities to be legitimately included in their economic analysis.However, given the lack of attention to quantifying the extent of these alcohol-related harms to others, as identified by Connor and Casswell, it seems disingenuous for Crampton et al to then attempt to systematically minimise the total extent of harm by dismissing harm to oneself as economically irrelevant. This does not mean that we should avoid rigorous debate on the extent and nature of alcohol-related harm or the most appropriate measures use, but an ideological stance certainly appears unhelpful.The Crampton group position their critique of the BERL report as an economic versus a public health approach. Yet BERL is also a group of economists, not public health scientists.From a non-economist standpoint Crampton et al would appear to be the fundamentalists in this debate and their conclusions need to also be considered in the context of their receiving funds from an alcohol industry, which benefits from their conclusions. Further, it is important to note that "standard (neoclassical) economic approaches" are coming under increasing scrutiny and criticism, particularly following the recent global financial crisis, which was not predicted by "standard" economic models. New economic models based on better science and more rigorous mathematics are now progressing.5These developments are urgently needed in order to advance knowledge and improve quality of life. The complexity of the human drama needs the full spectrum of academic endeavour from the arts to the sciences, from rich novels to dry epidemiological papers in order to be adequately captured and understood.6 Somewhere between these two traditional domains sits economics, bravely attempting to understand and explain human complexity from the standpoint of the supply and consumption of goods and services; a critical perspective when considering alcohol harms.New economic models based on science, which more accurately reflect human nature and which can capture the full drama of human life, positive and negative, are required, to advance enlightened social policy in this emotionally charged and complex area of recreational drug use and costs to society.Parliament is about to debate a new Alcohol Reform Bill, which is the current government's response to the most comprehensive review of alcohol undertaken in New Zealand to date. Most of the strong reforms recommended by the Law Commission have not been included in the new Bill by the current government, particularly those addressing "unbridled commercialisation"7 by raising the price and dismantling the marketing of alcohol, as has worked for tobacco reform.As the evidence of alcohol harms accumulates, especially harm to others, we must continue to urge our elected representatives in government to enact effective legislation in order to help reduce these harms, rather than use outdated neoliberal economic models, which result in doing little more than watch from the sidelines.