Letters CMAJ 348 CMAJ, February 22, 2011, 183(3) © 2011 Canadian Medical Association or its licensors Binge drinking The risky use of alcohol is greatly underappreciated by society as a sub- stantial source of harm to health and safety. A few points of clarification are required for the editorial by Flegel and colleagues. 1 The rates of binge drinking reported by the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) should be seen as conservative, given that sur- veys of this type underestimate alcohol sales by 60% to 70%. 2 When we com- pare what people tell us they drink with what is sold, we find that self-reported drinking accounts for only 30% to 40% of official sales. 3 In 2007, an expert working group released recommendations for a national alcohol strategy, which is the first national strategy developed for alcohol in Canada. 4 Many of the report’s 41 recommendations relate to the problem of binge drinking. The National Alcohol Strategy Advi- sory Committee has since been working to implement several of the recommen- dations in the National Alcohol Strat- egy, including developing a national consensus on low-risk drinking guide- lines and building capacity for alcohol screening and brief interventions in pri- mary care. More information is avail- able from the Canadian Centre on Sub- stance Abuse (CCSA) (613 235-4048). Although I agree that more research is needed to identify effective ap- proaches to reduce the rates of binge drinking, there is already very good evi- dence for some interventions, including screening and brief interventions. The crucial need is to find creative ways to roll out these proven interventions at the scale needed to affect consumption pat- terns at the population level. The economic burden of alcohol to Canadian society was estimated to be $14.6 billion in 2002, with direct costs accounting for $7.5 billion. A report soon to be published by CCSA shows that in most provincial and territorial jurisdictions, direct costs exceeded direct revenue from the sale of alcohol for fiscal year 2002–03. 5 Gerald B. Thomas Canadian Centre on Substance Abuse, Summerland, BC References 1. Flegel K, Macdonald N, Hébert PC. Binge drink- ing: all too prevalent and hazardous. CMAJ 2011; Jan. 17 [Epub ahead of print]. 2. Canada Health and Drug Use Monitoring Survey. Ottawa (ON): Health Canada. Available: www.hc-sc .gc.ca/hc-ps/drugs-drogues/stat/_2009/tables-tableaux -eng.php#t6. (accessed 2011 Jan. 6). 3. Stockwell T, Zhao J, Thomas G. Should alcohol policies aim to reduce total alcohol consumption? New analysis of Canadian drinking patterns. Addict Res Theory 2009;17:135-51. 4. Reducing alcohol-related harm in Canada: toward a culture of moderation. Recommendations for a national alcohol strategy. Available: www.ccsa.ca /2007%20CCSA%20Documents/ccsa-023876-2007 .pdf (accessed 2011 Jan. 20). 5. Rehm J, Baliunas D, Brochu S, et al. The costs of substance abuse in Canada 2002. Highlights. Ottawa (ON): Canadian Centre on Substance Abuse. Avail- able: www.ccsa.ca/Eng/Priorities/Research/Cost- Study/Pages/default.aspx (accessed 2011 Jan. 20). CMAJ 2011. DOI:10.1503/cmaj.111-2015 I believe there is an error in the editor- ial by Flegel and colleagues. 1 The edi- torial states: “Over the past five years, 8.8% of Canadians reported binge drinking [i.e., five or more per sitting for men, four or more for women],” cit- ing CADUMS. 2 I am very familiar with those data. According to the data, 19.2% of Canadians 15 years of age or older reported that they consumed four or more (women) or five or more (men) alcoholic drinks at least monthly over the past year; 7% reported doing so at least weekly over the past year. Christopher G. Davis PhD Carleton University and Canadian Centre on Substance Abuse, Ottawa, Ont. References 1. Flegel K, Macdonald N, Hébert PC. Binge drink- ing: all too prevalent and hazardous. CMAJ 2011; Jan. 17 [Epub ahead of print]. 2. Canada Health and Drug Use Monitoring Survey. Ottawa (ON): Health Canada. Available: www.hc-sc .gc.ca/hc-ps/drugs-drogues/stat/_2009/tables-tableaux -eng.php#t6. (accessed 2011 Jan. 6). CMAJ 2011. DOI:10.1503/cmaj.111-2017 Editor’s response Dr. Davis is not clear about where his cited rates are from. The citation for the 8.8% rate in the editorial is correct, according to Table 1 of the 2009 CAD- UMS report. 1 It derives from adding the percentage estimates in column 3 (the last two rows). The table we used was selected because we wanted to repre- sent the prevalence of people who engage in binge drinking on a regular basis of some frequency. If the suggestion is that the rates are rather higher, then our comments are so much the more compelling. Kenneth M. Flegel MDCM MSc Senior Associate Editor, CMAJ Reference 1. Canada Health and Drug Use Monitoring Survey. Ottawa (ON): Health Canada. Available: www.hc- sc.gc.ca/hc-ps/drugs-drogues/stat/_2009/tables- tableaux-eng.php#t6. (accessed 2011 Jan. 6). CMAJ 2011. DOI:10.1503/cmaj.111-2018 Restaurant industry opposes calorie content disclosure I was disappointed to read that the Cana- dian Restaurant and Foodservice Associ- ation (CRFA) remains opposed to menu labelling. 1 Since 2009, Ontario’s doctors have been calling on chain restaurants and school boards across the province to post calorie counts on menus and menu boards, and we continue to stand by that call. Although the CRFA is resistant to this important initiative, its US counter- part, the National Restaurant Association, has said, “The passage of this provision [menu labelling] is a win for consumers and restaurateurs, [and] we know the importance of providing consumers with the information they want and need.” 2 The Ontario Medical Association (OMA) report, Treatment of Childhood Overweight and Obesity, shows that 25% of children are overweight or obese, and 75% of obese children become obese adults. 3 Overall, the impact of overweight and obesity on health is esti- mated to cost Ontario $2.2 to $2.5 billion per year. Ontario’s doctors believe that menu labelling will have an impact on obesity rates, but it is not the only initia- tive that is needed to tackle the obesity epidemic. The OMA also wants to see an education campaign that teaches people