The Political Tug-of-War

The title of this post reflects the actions the Surgeon General is promoting. It's part of a long-term, well-thought-out, and well-funded campaign against consuming alcohol - any amount of alcohol. The campaign runs circles around anyone wanting to point out the other positive health science behind moderate consumption. But this report shouldn't be a surprise to anyone. 

In a  September 2019 blog post titled "Get Ready For Cancer Warnings on Wine Labels," I discussed the developing impact of the Cumulative Negative Health Message spread by neo-prohibitionists. Even then, there was a growing push to add enhanced cancer warning labels. By now, you've undoubtedly heard the latest iteration of this skirmish, but if not, let me get you up to speed.

On January 3rd, when many were resetting their circadian clocks back to work time after an extended holiday break, the outgoing Surgeon General released an advisory about alcohol consumption. 

The release comes at an interesting time - right before he leaves office and before his parent agency, the HHS, releases a critical scientific paper from their Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD). The forthcoming paper from the ICCPUD, a political event in and of itself, will help inform the committee approving the next edition of the alcohol section of the USDA Health Guidelines. 

As an aside, the ICCPUD is a horrible initialism. You were thinking it, and I just said it out loud.

The Findings

The key findings in the report are that alcohol consumption is the third leading preventable cause of cancer, after tobacco and obesity, and that there is a well-established, direct link between alcohol consumption and cancer risk for at least seven types of cancer, including cancers of the breast, colorectum, esophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx). 

The report further concludes that about 100,000 alcohol-related cancer cases and about 20,000 alcohol-related cancer deaths in the US annually are attributable to alcohol consumption, and cancer risk increases as alcohol consumption increases - which is information straight off the WHO website.

The anti-alcohol industry likes to obfuscate the science behind moderate consumption. They roll together those who consume alcohol moderately with those who drink alcohol irresponsibly, and from that angle, the math will say alcohol does cause cancer because the abuse of alcohol does significantly increase your risk. But if you separate the two, there is a long-held scientific view that wine extends average life spans and improves cardiovascular risk. The science regarding cancer risk for moderate consumption is quite different from what the Surgeon General is reporting.

What is the Surgeon General's solution to this issue?

He is calling for enhanced cancer warnings on all alcoholic beverages and a reassessment of the (USDA) guideline limits for alcohol consumption to account for cancer risk, and advising public health professionals and community groups to highlight alcohol consumption as a leading modifiable cancer risk factor and to expand education efforts to increase general awareness of the link between cancer and alcohol.

It's confusing to read that statement against the government report released by the NASM in December. That Government report said:  

"The committee concludes that compared with never consuming alcohol, moderate alcohol consumption is associated with lower all-cause mortality (moderate certainty). The committee determined that there was insufficient evidence to establish certainty for an association of moderate alcohol consumption with... cancers of the breast, colorectum, esophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx)." 

The Battleground

The part of the NASM statement that said moderate consumption is associated with lower all-cause mortality (longer life) is a throwback because that is the uncomfortable reality the anti-alcohol movement has been successfully marketing against since the 1990s, but they still haven't been able to fully erase the message.  

Living a longer life was an easy metric for the public to understand in the 1990s, but it was in opposition to the World Health Organization's goals. So, being unable to combat the scientific link between moderate consumption and longer life spans, the goalposts were moved to make cancer the threat, and they changed the measures away from lifespan to a new measure: DALYs (Disability-adjusted life years). 

The WHO says that "DALYs are calculated by adding together years of life lost due to premature mortality (YLLs) and years of healthy life lost due to disability (YLDs). One DALY represents the loss of one year of full health." There is a greater opportunity to shape a counterargument if you increase the assumptions needed to arrive at a finding. Reading through the definition, how many assumptions do you need to make to calculate the years of life lost due to premature mortality? Using DALYs, you can conclude that no amount of alcohol is safe.

Is This Report Important?

Advisories from the Surgeon General "are reserved for significant public health challenges that require the nation's immediate awareness and action." Translation: The Surgeon General believes this report is critical to digest and understand now. From this perspective, the Nation is late in understanding and addressing the ills of alcohol consumption. The report's suggestions are only recommendations, and from that perspective, the report is unimportant, as Congress has to agree to and approve the actions. 

But most mainstream news organizations have covered the report extensively over the weekend - paying little mind to the other side of the story. You can fully expect that neo-prohibitionists will cite this report as foundational proof that there is no safe amount of alcohol, and that is settled science. 

The battle is being played out, and the 'no safe amount' mantra is being recited repeatedly. If you say anything enough and nobody contradicts you, that message becomes truth. The alcoholic beverage industry is late in finding ways to bring out the other science on positive health impact that has been proven sound and contradicts the 'no safe amount' message.

The other impact of this report is that it could presage the tone of the upcoming release of the HHS and ICCPUD paper, which will influence the creation of the USDA Dietary Guidelines on alcohol consumption. We presently have the NASEM findings that moderate alcohol consumption leads to longer life, and in direct opposition to the Surgeon General's view, that they can't confirm the tie between the researched cancer findings and moderate alcohol consumption.

With the two reports likely coming to different conclusions, the committee charged with writing and updating the 2025 USDA Dietary Guideline on alcohol will either have to choose one message over the other or somehow combine conflicting report findings. Stay tuned for late in 2025 when the latest edition of the USDA Dietary Guidelines will be published.