Concern is growing about the harms
that may arise from heavy drinkers mixing alcohol with so called energy
drinks to enable them to drink for longer and achieve higher levels of
intoxication.
On Friday and Saturday evenings, about 40% of people on
Australian city streets are heavily intoxicated (breath alcohol
concentrations (BAC) greater than 0.087 mg alcohol/100 ml) and nearly a
quarter of these drinkers will have consumed more than two energy
drinks. Data are lacking on energy drink use by alcohol drinkers in other countries but in samples, 73% of US college students and 85% of Italian college students reported consuming energy drinks mixed with alcohol in the past month.Epidemiological
studies show that drinkers who consume energy drinks are more likely to
record a higher breath alcohol concentration than those who do not. They are also more likely to report- drinking more alcohol.
- engaging in aggressive acts
- being injured
- symptoms of alcohol dependence
- having driven while drunk or been a passenger in a car with an alcohol impaired driver
- and having taken sexual advantage of, or having been taken advantage of, by another person
The
role that energy drinks may play in facilitating intoxication is
under-researched. Because of ethical concerns about people getting too
drunk and drinking too many energy drinks, much of the research in
laboratory settings has studied only the effects of combining low levels
of alcohol intoxication (BAC less than 0.1 mg alcohol/100 ml) with a
single energy drink (equivalent to a strong cup of coffee).
Some
researchers doing these studies have concluded that we should not be
concerned about the risks of combining alcohol and energy drinks. But
evidence from these studies does not convincingly refute the hypothesis
that more energy drinks consumed with more alcohol facilitates
intoxication and increases the risk of alcohol related injuries and
assaults.
Many of the researchers who draw reassuring
conclusions from this research have been funded by a major producer of
energy drinks. These researchers have presented their findings
at special sessions on alcohol and energy drinks at international
conferences where, because of limited disclosure requirements, audiences
may not be aware of the extent of their industry sponsorship. Many
conferences have no requirements that authors declare specific potential
conflicts of interest, although several have recently introduced
general requests, which rely on authors’ perceptions and have been found
inadequate for journal articles, leading to comprehensive requirements.
At
a 2012 Australasian Professional Society on Alcohol and Drugs
conference, for example, four out of five researchers who presented
research on alcohol and energy drinks had received financial support
from that major producer of energy drinks (for example, funds to attend international conferences or
for research). The four presenters who had received such support all
concluded that no evidence showed that the combination of energy drinks
and alcohol increased drinking or harm.The non-industry funded researcher also reported no significant
difference between alcohol and alcohol with energy drink sessions, but
went on to highlight that there is simply not enough evidence to answer
the key questions yet. I am not implying a causal relation here, simply an association. Only the presenters, who were the first authors of each paper, supplied declarations of competing interests.
These researchers were all critical of the epidemiological evidence to the contrary.
Yet they drew strong conclusions about their own studies despite
substantial limitations, most notably the lack of research into the
effects of real world levels of alcohol intoxication (greater than 0.1
mg alcohol/100 ml blood) and consuming typical amounts of energy drinks
(2-5 drinks).
Only the presenter who did not declare industry funding argued that we
needed more research to assess the associations between energy drinks
and harmful alcohol use in epidemiological studies.
There
are concerns about the role that this major producer of energy drinks is playing, especially in
supporting conference attendance of researchers whose findings and
conclusions are favourable. That major producer of energy drinks has, to my knowledge, been
supportive of some researchers, contacting them as soon as they hear of
their research and offering to check their protocols and supplied
placebos to studies whose protocols they approve. It has also funded
some research, such as the studies mentioned,
though none of these studies to my knowledge has experimentally
investigated the effects of more than a single 250 mL energy drink.
Energy drinks manufacturers should provide placebo versions of their
product to any researcher who asks, not just those whose protocols they
approve.
On a more ideological note, having four talks
out of five from industry funded researchers might inhibit our ability
to have a fruitful public health discussion. Having the same speakers
funded to attend conferences around the world by a company with strong
financial interests raises questions of propriety and the presentation
of research findings being used as a commercial marketing strategy.
It
is critical that the public can be confident in the findings of
research on these products. Conference organizers and journal editors
should require researchers working on energy drinks to declare whether
they have received research funding or unrestricted grants, financial
support to attend meetings or conferences (accommodation and speaking
fees), institutional or centre funding (including scholarships, purchase
of equipment, or endowments), and whether they have any applications
under consideration by alcohol or energy drink companies, or bodies
associated with these industries.
source : concerned researchers
No comments