At a brewers’ conference this spring, an alcohol lobbyist fired a warning shot in what has become a multimillion-dollar global battle. Public-health officials “want to tell you that alcohol causes cancer,” Sarah Longwell, managing director of the American Beverage Institute, told the crowd. The industry, she said, was in danger of losing its “health halo.”
For decades, beer, wine and liquor producers have been helped by a notion, enshrined in a number of governments’ dietary advice, that a little alcohol can provide modest coronary and other health benefits.
Rapidly, that advice is shifting as health-policy officials around the world scrutinize their previous advice in the light of research pointing to possible cancer risks.
The change is pressuring the alcohol industry in some of its biggest markets, including the U.S., the U.K. and Russia. Its response is as expensive and sprawling as the threat it perceives, including attacking anti-alcohol advocates’ research and working with governments to formulate policy. Alcohol companies are also funding their own research, including a plan by four companies to contribute tens of millions dollars toward the cost of a rigorous study.
Said Beer Institute President Jim McGreevy, addressing executives at an April conference about the alcohol critics: “We can’t let them gain traction.”
In January, the U.K. weakened 20-year-old advice saying moderate drinking could benefit the heart, calling that benefit less than previously thought. It issued new guidelines saying alcohol raises the risk of certain cancers.
“There is no safe level of drinking,” U.K. Chief Medical Officer Sally Davies told a British television interviewer.
Also in January, the U.S. Department of Health and Human Services scrapped the part of its guidelines that said light drinking could lower the risk of heart disease for some people. Asked why, an HHS spokeswoman said more review was needed “to better understand health outcomes that may or may not be associated with moderate alcohol consumption.”
Meanwhile, South Korea, citing possible cancer risks, this year joined Australia in tightening maximum recommended alcohol consumption. A few years earlier, Russia restricted alcohol sales and raised beer and vodka taxes following a World Health Organization study describing various dangers it said drinking posed to health, such as leading to more accidents and infections. (Countries differ in what they consider moderate or light drinking.)
The threat to the alcohol industry isn’t as sharp as that faced by tobacco, which shrank due to rapidly changing public attitudes and government policy after it was determined that smoking causes lung cancer, heart disease and other ailments.
Nonetheless, governments’ alcohol advice matters, even if few would-be bar patrons ever consult it. It filters into policy on liquor taxes, retail-sales hours and advertising restrictions. More subtly, it can inform public attitudes toward drinking. Brewer Anheuser-Busch InBev NV now includes in its corporate risk statement that the WHO seeks to reduce what it calls the harmful use of alcohol by 10%.
Alcohol consumption fell in Australia after its government advised less drinking in 2009, dropping to 9.7 liters a person each year from 10.6. In Maryland, liquor, wine and beer sales all slipped after the state raised alcohol taxes in 2011. Alcohol sales in Russia tumbled more than 20% over several years when the government moved against drinking after the WHO report.
The near-consensus the industry enjoyed until recently—that light drinking can actually improve health in some ways—dates back to research four decades ago. A California cardiologist named Arthur Klatsky was trying to figure out what lifestyle factors might affect cardiovascular health. In what he says was a surprise, he discovered that light drinkers had fewer heart attacks than abstainers, as well as a lower statistical risk of dying from coronary heart disease.
It “changed the paradigm for studying the effects of alcohol,” according to the Alcoholic Beverage Medical Research Foundation, whose precursor organization at times funded Dr. Klatsky.
In 1995, the U.S. Department of Health and Human Services revised its alcohol guidance, eliminating the statements that alcohol had “no net health benefit” and that drinking “is not recommended.” Instead, HHS said moderate drinking was associated with a lower risk of coronary heart disease in some people.
“Science is on our side,” a beer executive told an industry conference the next year. Patti McKeithan of Miller advised convention-goers to start every meeting with legislators by saying that “alcohol can be part of a healthy diet,” according to documents in tobacco-litigation archives, where they can be found because Miller was owned by tobacco company Philip Morris at the time.
Now, newer research is once again shifting the consensus.
One of the first signs came when WHO officials set out nearly a decade ago to develop a new alcohol policy. They planned to focus on “global burden of disease,” assessing a broad range of possible effects, including indirect ones such as rates of accidents and certain infections.
“It was that sort of thing coming out of the WHO that made us fear for our lives,” said Mitch Ramsay, then an executive at SABMillerPLC.
His job was dealing with governments in parts of Africa, a region brewers looked to for growth. A negative WHO report risked new restrictions there.
Miller offered several African governments “a whole workshop about alcohol, and what are the policies and how should they be managed,” Mr. Ramsay said. It paid for an Australian health official to advise them, and Mr. Ramsay discussed ways to reduce problem drinking. He stressed that curbing beer sales would hurt the economy and that brewers have a right to sell alcohol in the countries.
“We intercepted” an alcohol policy in Malawi that would have raised taxes, Mr. Ramsay said. He said the country’s government asked for input on the policy, which was pushed by an NGO, and he argued that the tax, by making Miller lagers pricey, would tempt people to drink harmful homemade hooch.
Botswana initially moved ahead with a policy Mr. Ramsay wrote but then rolled it back and adopted a stringent alcohol tax. Formerly a cash cow for Miller, Botswana ceased to be.
Botswana’s health ministry confirmed Mr. Ramsay’s account. Malawi’s health ministry didn’t respond to questions.
In a 2010 report, the WHO labeled drinking harmful on a population-wide scale, “even when consideration is given to the modest protective effects, especially on coronary heart disease, of low consumption of alcohol for some people aged 40 years or older.”
It said “the harmful use of alcohol is a significant contributor” to some diseases, such as diabetes, and suggested that governments tax it to reduce consumption.
More recently, public-health officials have focused on research associating light drinking to a higher risk of certain forms of cancer.
Mark Bellis, a public-health official in Wales, said scientists’ newfound ability to isolate the effects of alcohol from other factors such as diet and exercise has revealed “overwhelming evidence detailing more or less linear relationships between cancer and alcohol.”
The U.K., in revising its guidelines early this year, said its review of research concluded that “the risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases” with any amount drunk on a regular basis.
“To link that with alcohol is a real game-changer,” said Linda Bauld, a health-policy professor at the University of Stirling in Scotland who helped get U.K. health officials to change their recommendations.
The new U.K. guidance didn’t deny benefits from alcohol for heart health but said these “are less and apply to a smaller group of the population than previously thought,” potentially reducing death risks only in women over 55.
Spirits maker Diageo PLC, facing a bill in Ireland that would introduce alcohol advertising bans, minimum pricing and warning labels, funded a moderation-focused group in Ireland called Stop Out-of-Control Drinking. The group became a focus of controversy after the spirits maker’s involvement was publicized. The Irish legislation remains under consideration.
In Scotland, Diageo supported a legal battle led by the Scotch Whisky Association and European wine producers that aims to block a law setting minimum prices on alcohol. The law awaits a final court ruling in Scotland.
In the U.S., Guy Smith, a former tobacco-industry executive who now works for Diageo, recently called a study of alcohol advertisements “junk science” that tarnished those behind it. Though the rebuke didn’t involve research on health implications of drinking, it sent a message to alcohol researchers that their work was open to being questioned.
“We push back when there are dumb studies,” Mr. Smith said.
Brewer AB InBev last year launched a program called Smart Drinking Goals that aims to address the WHO’s concerns by reducing the use of alcohol in six cities by 10% over 10 years. AB InBev recently introduced a nonalcoholic Budweiser in Canada and aims to have 20% of its volume come from no- or low-alcohol beer by 2025.
AB InBev and Diageo are joining with rivals Heineken NV and Pernod Ricard SA to contribute $55.4 million toward the cost of the first randomized trial assessing alcohol’s health effects. The study will be overseen by the U.S. National Institute of Alcohol Abuse and Alcoholism.
Researchers plan to enroll 8,000 subjects who are older than 50 and at risk for heart disease. Some will be randomly assigned to abstain from alcohol and the others to have one drink a day. The study will compare the incidence of heart attack, stroke and Type 2 diabetes in the groups after about six years. It isn’t designed to measure cancer risk.
The companies know “findings could go either way,” said a Pernod Ricard spokesman,Jack Shea, but they believe “it’s important to get a conclusive and definitive answer for public-health reasons for consumers and our business.”
At Boston University School of Medicine, two doctors have been dueling for years over these issues.
One, Tim Naimi, is part of a group of university researchers who receive government grants and publish frequently about the health effects of drinking. The other, Curtis Ellison, long had funding from alcohol-industry groups, though he says he stopped taking such funding in 2013 when a new medical-school dean objected.
In a March analysis of past research on alcohol and mortality, Dr. Naimi and his co-authors described what they called a flaw in some studies that found more heart disease in nondrinkers than in light drinkers. Some of the nondrinkers were people who used to drink but had quit because of illness, the analysis said. After correcting for that and other issues, they concluded that moderate drinking had no net health benefits.
Their analysis, in turn, drew criticism from Dr. Ellison, who has an office in the same BU building as Dr. Naimi. Dr. Ellison gained renown over two decades ago for work that gave alcohol, especially wine, credit for the “French paradox” of low heart-disease death rates despite diets high in saturated fat.
A group of researchers he is part of said the Naimi analysis failed to acknowledge studies finding alcohol beneficial, and criticized it for disqualifying animal studies that have shown that alcohol raised the protective form of cholesterol. The omission was “unconscionable,” said the Ellison group, the International Scientific Forum on Alcohol Research.
In 2014, the two had a tart public debate over the healthfulness of drinking. They haven’t had a discussion of alcohol since.