Postscript: What happened next

After a couple of days of fairly intensive discussion the news inevitably moved on to other topics, but a fairly clear message had been sent to NICE that the media will rapidly pick up on any divergence from the advice of the Department of Health.

Since the argument was over draft guidelines it is worth revisiting the issue as on March 2008 when the final version of the guidelines were published.

It's worth doing a careful analysis of the exact wording of NICE's statements and
how it changed over time. First, NICE in their original guidelines in 2003 wrote:

Excess alcohol can harm your unborn baby. If you do drink while you are pregnant, it is better to limit yourself to one standard unit of alcohol a day (roughly the equivalent of a small glass of wine, a half pint of beer, cider or lager, or a single measure of spirits).

The controversial 2007 draft guidelines (pdf) did not change that message significantly:

Pregnant women should limit their alcohol intake to less than one standard drink (1.5 UK units or 12g of alcohol) per day and if possible avoid alcohol in the first 3 months of pregnancy.
Women should be informed that binge drinking (defined as more than 5 standard drinks on a single occasion) may be particularly harmful during pregnancy.

(NICE 2007 p.36)

Some of the stakeholders who reviewed the draft guidelines noticed that there is a difference in the advice which may confuse the public - this may have been as a result of the media coverage. In the consultations comments table (pdf), the British Dietetic Association writes:

We welcome a revision regarding alcohol, however there will be a confusion of messages to women as this does differ from the Department of Health advice.

(p.6)

To which NICE answers:

Thank you. Following stakeholder consultation the recommendation has now been amended slightly so as to remain in line with the evidence but with the “safe” level of alcohol intake expressed in terms similar to that used by the DoH so as to avoid causing confusion.

(ibid)

Since this is evidence that NICE have been made aware of the difference in tone between their advice and that of the DoH, and since they wrote that they would rephrase it to "avoid causing confusion", it is interesting to compare the final version of the guidelines as they appeared in March 2008 (pdf):

If you are pregnant or planning to become pregnant, you should try to
avoid alcohol completely in the first 3 months of pregnancy because
there may be an increased risk of miscarriage.
If you choose to drink while you are pregnant, you should drink
no more than 1 or 2 UK units of alcohol once or twice a week.
There is uncertainty about how much alcohol is safe to drink in
pregnancy, but at this low level there is no evidence of any harm to
the unborn baby.
You should not get drunk or binge drink (drinking more than 7.5 UK
units of alcohol on a single occasion) while you are pregnant because
this can harm your unborn baby.

The main difference that stands out is that the advice is now coupled with a slightly longer explanatory statement. Specifically, they included a sentence on the uncertainty about what the safe limit is - although they also include a reminder that there is also no evidence of harm at low levels either. The other main difference is that now the advice is "no more than 1 or 2 UK units once or twice a week", which is less than before (1.5 units per day), but certainly not advising abstinence (after the first trimester) as it has been demanded in several news stories, and as almost advised by the Department of Health. I say 'almost' because even the DoH, though it says you should avoid drinking any alcohol, still proceeds by stating that if you do choose to drink, limit yourself to a unit a day - which incidentally is almost twice as much over the week as NICE said is the limit.
So even though the new NICE guidelines do not advise abstinence, in a way they are stricter on the allowable limits than the DoH.

This minor tweak in the wording, with an added explanatory sentence on the uncertainty of the evidence of harm at low levels and a tightening of the acceptable limits, does not seem a major turnaround from the previous formulation.
However, this is how the NICE guidelines were presented in the press when the final version came out in March 2008:

FIRST the experts said you shouldn't drink. Then they said pregnant women could have a glass every so often. And after months of confusion, you might hope the health watchdog's latest advice on alcohol for expectant mothers would finally clear things up. But it seems nothing is that simple. In an ideal world, pregnant women would avoid drinking altogether, says the National Insitute for Health and Clinical Excellence. But since it believes some women will anyway, it warns them not to have more than one or two units once or twice a week.

Daily Mail, March 26, p.13

Broadsheets have similarly reported on the "change of heart" at NICE.

The NHS standards watchdog will today warn women not to drink any alcohol during the first three months of pregnancy, abandoning its own draft guidelines that were published last year. The new advice by the National Institute for Health and Clinical Excellence (Nice) also suggests that women should be much stricter about what they drink from the fourth month onwards: a small amount of alcohol is safe, but never more than one or two days a week.

The Guardian, March 26, p.2

The second quote in fact reveals that the abstinence that NICE is supposed to advocate is in fact only for the first trimester, not for the whole pregnancy. On that point however, there has not been a U-turn by NICE, because even the draft guidelines have insisted on no alcohol during the first three months (see above).

The tabloid as well as the broadsheet press reported the story as an NHS watchdog changing its tune and thereby confusing the public. That storyline seems to be wrong: NICE may have changed its guidelines, but not in the way that has been reported. There may be an element here of NICE deliberately exaggerating the changes they have made in face of the criticism they received when the draft came was made public.
However, even if they hadn't, the press reporting, at least from the Daily Mail, does not seem fair either. In October 2007 NICE was berated for not conforming their advice with the DoH, but now that the final version is out and they have listened to the concerns and changed the advice, the press has shifted the goalposts - instead of being satisfied that their critique has worked, the press now writes that "the experts confuse us because they keep changing their opinions".

One wonders whether the Daily Mail will ever allow NICE to win.

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