There is a movement to get the U.S. Federal Tax and Trade Bureau (TTB) to expand its mandated health warning on beverage alcohol to include rotating messages linking alcohol consumption to cancer. The issue was covered in a post a few weeks ago. Now, we hear from two people–one pro and one con–concerning alcohol studies and warnings.

The warning pro position is represented by Thomas Gremillion, Director of Food Policy, Consumer Federation of America (CFA), a federation of more than 250 dues-paying non-profit member organizations, including well known groups like the Association of the Advancement of Retired People (AARP) and Consumer Reports. CFA also raises money sponsoring events like the National Food Policy Conference, the Consumer Lender Roundtable, and an annual awards dinner, and we receive some grant funding and cy pres awards, grants drawn from class action law suits.

The warning con position is represented by Jackson Shedelbower, the Communications Director, American Beverage Institute (ABI), a trade association representing America’s restaurant chains, hundreds of individual on-premise retailers as well as beer, wine and spirits producers.

Forbes: This interview is in the public interest. Thanks for participating. Each of you represent an advocacy group. How can you assure the public that advocacy is not the sole reason for the positions your organization takes?

CFA: “In short, representatives of our members participate through our board, and through committees that undertake a policy resolution process each year, to determine what positions are consistent with CFA’s mission. That mission, established in 1968, is to advance the consumer interest through research, advocacy, and education…CFA is proud to work to advance pro-consumer policies on a variety of issues before Congress, the White House, federal and state regulatory agencies, state legislatures, and the courts. We communicate and work with public officials to promote beneficial policies, oppose harmful ones, and ensure a balanced debate on issues important to consumers.”

ABI: “Simply because businesses sell alcohol products doesn’t make the information they release inherently deceptive. In fact, the industry wants and actively encourages people to use their products safely and responsibly. The industry has a legitimate interest in having balanced information provided about their products.”

Forbes: I will assume you agree that government regulation is necessary where alcohol is concerned, but do you think government has the right to play an active advocacy role?

CFA: “If by “an active advocacy role” you mean public education campaigns that help consumers understand the risks associated with drinking alcohol, absolutely. Indeed, the government plays this role already, through organizations like the Centers for Disease Control and Prevention’s (CDC’s) Alcohol and Public Health Program, and the National Institute on Alcohol Abuse and Alcoholism.

Those programs help to empower consumers to make informed choices about alcohol. However, our elected officials and public health authorities should do more. Drinking alcohol is the third most important cause of cancer that is within a person’s control, behind smoking and obesity. Yet surveys show that most consumers are not connecting the dots.”

ABI: “The government has a legitimate role in educating consumers about proven safety hazards. But when examining the comprehensive body of evidence, enjoying a drink over dinner does not fall into that category. The science connecting moderate alcohol consumption with broad negative health consequences is unsettled at best. While some oversight is necessary, government should not be in the business of micro-managing consumer behavior.”

Forbes: The World Health Organization (WHO) has taken an active advocacy role. Does your organization understand the exact aim of WHO when it comes to alcohol? Or can you explain what you believe or think WHO is advocating?

CFA: “I cannot speak for the WHO but the policies it mentions on its website—taxes on alcoholic beverages, restrictions on alcohol advertising, restrictions on the physical availability of retailed alcohol, drunk driving enforcement, addiction treatment—are all things that have been adopted in the United States and improved public health. Unfortunately, we are slipping in some of these areas. For example, Congress may soon vote on so-called “Craft Beverage” legislation that would cut billions in federal excise taxes, and include significant cuts for some publicly traded corporations. Another example is a slackening of restrictions on alcohol advertising, like the ban on liquor advertisements on television.”

ABI: “The industry has never supported consuming excessive amounts of alcohol daily. We actively discourage the behavior and support efforts by WHO to curb it. However, WHO often conflates the impacts of moderate drinking with alcohol abuse and frequently advocates for policies that target the former while doing little to address the latter.

Public safety campaigns should focus on reducing alcohol abuse, not discouraging moderate and responsible drinking.”

Forbes: Alcohol has been part of the human diet since at least the beginning of what we view as civilization (about 10,000 years ago). As far as we know, cancer has also been with humans throughout that time. Words matter: would you call the simultaneous existence of the two a link or a potential correlation or a risk factor? Explain your answer. 

CFA: “Alcohol is called a risk factor for cancer because the evidence shows that alcohol causes cancer. It is not simply correlated with it. Researchers have known this for a long time, thanks to animal and in vitro studies. The mechanisms behind the relationship are straightforward. When animals, including human beings, drink alcohol, the body breaks it down into a chemical called acetaldehyde. Acetaldehyde has been shown to be mutagenic, carcinogenic, and highly toxic in experiments with lab animals. More recent experiments, which take advantage of natural genetic variability within the population, show that exposure to acetaldehyde from drinking causes cancer. Alcohol also acts as a solvent, exposing cells to penetration from dietary or environmental carcinogens, and it raises estrogen levels, which can affect breast cancer risk. Indirectly, alcohol may increase cancer risk by contributing to obesity, or sleep deprivation…studies show that for some cancers, even moderate drinking appears to significantly increase cancer risk.”

ABI: “Given the available choices, I would say there is a potential correlation between moderate drinking and cancer. Alcohol abuse on the other hand is a risk factor.

Simultaneous existence has no relevance. Humans have consumed fruit for a large part of human history as well, but that doesn’t mean eating an apple causes cancer. We must rely upon the comprehensive body of science to inform us on the relationship between moderate drinking and health. The lion’s share of which links one or two drinks per day to modest health benefits. A handful of recent studies claiming otherwise shouldn’t instantly derail decades of research.”

Forbes: Is it possible that people used in alcohol and cancer studies have lifestyle habits which are not taken into consideration in the study but which can tip the scale one way or the other? For example, do they live near a toxic dump, did they ever have a heavy smoking habit, what is their genetic history as it relates to both cancer and alcoholism, and so on. Wouldn’t such information make a decided impact on the outcome of a study that tries to determine the relationship between consumption of alcohol and specific cancers?

CFA: “Epidemiological researchers have to wrestle with many confounding factors when they design their studies, and correlation does not prove causation. With respect to alcohol, however, more evidence suggests that the biases run in the opposite direction…many of the studies that have purported to show a link between “moderate” drinking and better health have confused lifetime “abstainers” with former alcoholics or problem drinkers, making “moderate” drinkers appear to be comparatively healthy. Or they have failed to account for “survival bias,” meaning they only consider the “moderate drinkers” that have survived up to the time of the study.”

ABI: “It’s challenging to conduct a study that accurately proves causation and many recent studies connecting as little as one daily drink to negative broad health consequences fall short of that standard. The studies often fail to control for confounding variables—including smoking habits, health history or even genetic factors—or employ flawed self-reported survey-based data.

The media frequently exacerbates the problem by reporting the findings of these flawed studies as undeniable fact…the amount of news coverage a study generates is not a barometer of credibility.”

Forbes: There’s no doubt that alcoholism is a major and destructive disease. But there have been numerous studies showing moderate alcohol consumption as potentially beneficial, studies claiming a different set of reasons for the benefits and studies disputing the premise entirely. How is the public supposed to determine the value of such confusing information?

CFA: “The financial incentives are kinder for researchers that can find benefits associated with moderate alcohol consumption. These studies also attract more attention from the media, for obvious reasons. The actual evidence of the health benefits associated with moderate drinking, however, is pretty weak…By contrast, the evidence showing that consuming alcohol causes cancer is overwhelming…”

ABI: “It is confusing…As with most things, the truth is probably somewhere in the middle. While moderate drinking should not be touted as medicine, a daily drink is not poison either.”

Forbes: Have your two organizations any common ground when it comes to the question of whether or not there is a definite link between alcohol consumption and cancer?

CFA: “I hope so. Alcohol clearly causes cancer, and denying that science is irresponsible. I suspect we may disagree on the extent to which the benefits of moderate drinking outweigh the increased cancer risk…We just want consumers to have the information they need to make an informed decision.”

ABI: “Both our organizations can agree about the serious consequences associated with alcohol abuse—liver cancer for example—and the active role public policy and regulation can play in curbing that dangerous behavior. Regarding the relationship of moderate drinking and a wide array of cancers—including breast and colorectal cancer—the science is unsettled at best and groups should be cautious about definitively labeling moderate drinking as a major cause.”

Forbes: Based on the information that exists, what do you think is the most reasonable thing or things people can do to prevent falling prey to the risk behind (or link between) alcohol and cancer? 

CFA: “…no public health organization recommends drinking alcohol if you do not already. If you do choose to drink, try not to drink excessively, which public health authorities define as more than one to two drinks per day for men and one drink per day for women (one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits). You might also try some of these strategies for cutting back on how much you drink.”

ABI: “As the industry has supported for decades, enjoy beverage alcohol responsibly and in moderation; know your limits. With regard to the science exploring the relationship between moderate alcohol consumption and health, never ignore new research, but always view it with a skeptical eye.

Original Outlet: Forbes
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