COVID-19 and commerce complicate minimum unit pricing effects on health Authors' reply

We have read the recent study by Grant MA Wyper and colleagues,1Wyper GMA Mackay DF Fraser C et al.Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study.Lancet. 2023; 401: 1361-1370Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar which showed that the implementation of minimum unit pricing (MUP) for alcohol in Scotland resulted in a statistically significant reduction of 13·4% of deaths attributed to alcohol consumption. However, we have identified several concerns. We disagree with the finding of a relatively stable rate of deaths attributable to alcohol consumption from January, 2012, to October, 2020. First, there was a noticeable peak in deaths during October, 2017, and January, 2018, before the implementation of MUP, and another peak in deaths around April, 2020, due to the COVID-19 pandemic.1Wyper GMA Mackay DF Fraser C et al.Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study.Lancet. 2023; 401: 1361-1370Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Second, the study found that death from acute causes increased by 6·6% after the implementation of MUP.1Wyper GMA Mackay DF Fraser C et al.Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study.Lancet. 2023; 401: 1361-1370Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar These fluctuations in mortality indicate a strong confounding effect of the COVID-19 pandemic on the results. The abrupt rising peak of death attributable to alcohol consumption before the implementation of MUP is also intriguing. Alcohol consumption is a behaviour with diverse underlying pathologies. Interventions can have differential effects on individual risk groups, which might cause paradoxical increases in risk. Moreover, alcohol consumption in older people is linked to social engagement, but in contrast to social isolation, bereavement, or illness, which might require counselling.2Nadkarni A Weobong B Weiss HA et al.Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial.Lancet. 2017; 389: 186-195Summary Full Text Full Text PDF PubMed Google Scholar An inherent complex adaptive relationship between the health systems and commerce should be considered by policy makers when making decisions.3Theobald S Brandes N Gyapong M et al.Implementation research: new imperatives and opportunities in global health.Lancet. 2018; 392: 2214-2228Summary Full Text Full Text PDF PubMed Google Scholar One example of this relationship is tobacco advertising legislation,4Neuman M Bitton A Glantz S Tobacco industry strategies for influencing European Community tobacco advertising legislation.Lancet. 2002; 359: 1323-1330Summary Full Text Full Text PDF PubMed Scopus (108) Google Scholar which altered the accessibility and buying behaviour in the market.5Shirane R Smith K Ross H et al.Tobacco industry manipulation of tobacco excise and tobacco advertising policies in the Czech Republic: an analysis of tobacco industry documents.PLoS Med. 2012; 9e1001248 Crossref PubMed Scopus (31) Google Scholar We declare no competing interests.