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Faced With Breast Cancer, Reporter Confronts Big Alcohol's Biggest Lie

The breast is among the most common sites for cancer in the United States. Alcohol use is among the most common behavioral risk factors for cancer in the United States. It should be simple to draw the line between these two facts, but, as writer Stephanie Mencimer reports for Mother Jones, decades of alcohol industry deception have left most Americans only dimly aware of that fact.

Mencimer’s piece, bluntly titled “Did Drinking Give Me Breast Cancer?”, tells a compelling tale of the author’s confrontation with her own tumor in the context of a health system that never quite got a grip on alcohol harm. She traces the complex history of the “healthy drinking” narrative, including 40 years of industry sponsored science intended to muddy the waters. She admits that she, too, bought into the wine lobby’s charming lie that red wine is good for you. As she points out, “people want to believe that a drink is good for them, and the science in this field is easy to manipulate to convince them.”

The article comes at a perfect time for the alcohol harm prevention community. As the academic community becomes embroiled in a series of corrupt practices at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Big Alcohol is frantically trying to fight off public health measures in Canada, Australia, and Europe to warn consumers that its products are carcinogenic. The latter fight is more than just token opposition from the industry. According to the 2018 Global Drugs Survey, 40% of respondents said that these cancer warnings would affect the amount they drink.

“We need every legislator and their staff to read this,” said Sara Cooley, Advocacy Manager of the California Alcohol Policy Alliance. “And every CAPA member, and potential ally. So incredibly comprehensive of our field, the issues, and the players.”

“Did Drinking Give Me Breast Cancer?” appears in the May/June 2018 issue of Mother Jones. Mencimer has continued to cover alcohol issues for the magazine’s online channels, including the recent Lancet study that showed links between drinking and all-cause mortality, and the trap behind the language of “moderate drinking”. This shift in the media narrative is promising for Americans trying to seize control of their health—but Big Alcohol still has many other magazines in which to sell cancerous half-truths.

READ MORE about the unfolding NIAAA scandal.

READ MORE about how Big Alcohol makes bucks off of breast cancer.

Researchers Warn: With Great Power Comes No Social Responsibility

Alcohol company initiatives to reduce alcohol harm actually serve to undermine public health.

Never trust a big bottle and a smile, say researchers Melissa Mialon and Jim McCambridge of the University of York. The pair recently published a review of 21 studies looking at the efforts Big Alcohol has made to paper over the harms that stem from its products. These efforts, collectively referred to as "corporate social responsibility" or CSR initiatives, turned out to be toothless when it comes to reducing alcohol harms. However, they were often extremely effective at product marketing and undercutting good public health policy.

CSR initiatives form the "friendly face" of many alcohol companies. The team identified several broad focuses, including the prevention of intoxicated driving, "responsible drinking" education, research support, and policy involvement. In each of these fields, the campaigns were inherently deceptive. For instance, research on industry intoxicated driving campaigns showed that "[less than] 1% of studied initiatives were based on any scientific evidence of effectiveness for reducing drink driving." Likewise, responsible drinking messages did not serve to curb over-consumption. Instead, they sent the message that the act of drinking is inherently normal and responsible.

Research and policy efforts were more nakedly intended to skew public health efforts away from evidence-based interventions. As an example, the paper identifies successful industry efforts to change health agency language away from "alcohol and other drugs" to "substance abuse". This simple language change takes alcohol from a substance of concern that is worth monitoring to one that is benign unless it is misused. CSRs also lend a veneer of responsibility to industry self-regulation, a consistently ineffective and two-faced strategy that nonetheless keeps the regulatory dogs at bay. Last, by focusing research and policy around individual misuse, research and policy CSRs place the responsibility for harm on the consumer. "This framing lies in direct conflict with a public health conceptualization of harmful drinking," the authors write, "and with the scientific evidence-base on how it may be reduced."

Social responsibility campaigns remain surprisingly understudied, a deficit that is quickly proving dangerous. As Big Alcohol's reach gets longer, the tools it uses to twist public understanding of alcohol get more robust. By exposing those tools, Mialon and McCambridge give the public health community a fighting chance to set it right.

(Mialon and McCambridge's paper, "Alcohol Industry Corporate Social Responsibility Initiative and Harmful Drinking: a Systematic Review," is available for free download from the European Journal of Public Health.)

READ MORE about the failures of industry self-regulation.

READ MORE about how Big Alcohol puts government researchers in its pocket.

READ MORE about the great lie of "responsible drinking".


CAPA Legislative Update: Last-Call Looms But Lawmakers Leery of Loopholes

Every legislative session, the California Alcohol Policy Alliance (CAPA)™ identifies key bills to support or oppose. These bills promise to profoundly change the alcohol regulatory landscape. An overview of the bills of interest is below. (Note that dead bills do not always stay that way—lawmakers will occasionally use legislative tricks such as "gut and amend" to reintroduce bills that failed on first pass. It is important to keep monitoring alcohol legislation even if you think things are winding down.)

Oppose

AB 2460—the Free Booze in Art Galleries Bill
DEAD
This bill would have allowed art galleries to serve beer and wine to patrons without needing a liquor license. Much like the Dry Bar Bill before it, it creates a class of venues that can serve alcohol without any oversight or service training. Anyone who has been to an art opening understands how easy it is for underage or intoxicated patrons to get served even with ostensible licensing requirements. This would have opened the floodgates. Fortunately, cool heads prevailed and the bill did not pass out of its house of origin.

AB 2738—the Palcohol Loophole Bill
DEAD
The sale of powdered alcohol, aka palcohol, was banned in California last year. The Palcohol Loophole bill created special classes of powdered alcohol that would be exempt from the ban. These classes would have rendered the palcohol ban void for all intents and purposes. This craven effort to undermine California's decision to keep distinctly dangerous products off shelves died when it failed to pass out of its house of origin.

SB 905—the 4 A.M. Bar Bill
SENATE APPROPRIATIONS SUSPENSE FILE
SB 905, Sen. Scott Wiener's efforts to skirt the rejection of last year's 4 A.M. bar bill, was passed by the Senate G.O. committee but placed in the suspense file in the Senate Appropriations committee. Unfortunately for California, the chairman of that committee is Senator Ricardo Lara, a co-author of the bill. CAPA expects the bill will be voted out of suspense, and is preparing to work with members of the State Assembly to stop it there. Allies and California residents concerned with the proliferation of violence and injury should TAKE ACTION now to oppose the bill.

Support

AB 2914—the No Boozy Cannabis Bill
ASSEMBLY APPROPRIATIONS AWAITING VOTE
Prop 64 legalized the sale of cannabis products to all adults in California, but contained language restricting efforts to combine alcohol and marijuana products. However, the language was vague enough that some nitpicking entrepreneurs have floated plans to mix the two drugs. The No Boozy Cannabis Bill clarifies and strengthens the law: no aspects of marijuana may be sold in alcohol, in the same store as alcohol, or proffered at the same event that alcohol is served. The bill has passed Assembly G.O. and awaits the vote in Assembly Appropriations.

CAPA and Alcohol Justice will continue to provide legislative updates over the course of the year. Please contact Alcohol Justice if you have any questions or wish to lend your voice to our bills of concern.

READ MORE about alcohol-related legislation in California.


“Healthy Drinking” FAQ: A Goldmine for Industry, a Minefield for Health

Talk about CTDOn March 17, 2018, a bombshell New York Times expose revealed systematic collusion between Big Alcohol and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIAAA, ostensibly an organization devoted to combating the harms of alcohol use, had sent staffers and hand-picked researchers to lobby industry groups for over $67 million to fund the Moderate Alcohol and Cardiovascular Health (MACH15) study. In exchange, the industry had the opportunity to vet all procedures and staff years before the study was even registered.

The solicitation process itself created enough issues surrounding ethics and bias to study to call for its immediate termination. But studies that can be used to promote the concept of “healthy drinking” are the alcohol industry’s holy grail, and a problem that public health practitioners must be ready to confront. Below are frequently asked questions about “healthy drinking” research.

  • Q: Is alcohol good for you?

    A: The short answer is no. Alcohol is a toxin with the potential to generate addiction. It is responsible for 88,000 deaths per year in the U.S. Drinking too much is tied to a range of harms, from cancer to diseases of the heart and liver, to car crashes and assaults.

    There are some studies that show that low levels of alcohol intake are associated with less heart disease and, more arguably, cognitive decline, but these benefits are debatable. What’s more, as drinking goes up, the benefits go away and alcohol instead worsens those conditions. A recent study showed that nothing caused more early-onset dementia than alcohol use.

  • Q: Why would anyone argue against these “pro-alcohol” findings?

    A: The public health community is wary of promoting these studies due in large part to selection bias. In short, when studying the effects of alcohol intake, researchers often compare drinkers and non-drinkers. However, non-drinkers often abstain for health reasons. This can make it seem like non-drinkers are less healthy because they do not drink when the truth is they do not drink because they are less healthy.

    Similarly, a recent “super ager” study reported alcohol use as a predictor of very old age. However, those individuals may simply have been robust enough to survive to a ripe old age as regular drinkers, while less hardy colleagues had already died before the study started!

    Another, larger reason to be wary of promoting these results comes from the fact that what may be good individual health can still be bad population health.

  • Q: What is the difference between individual and population health when it comes to drinking?

    A: Whether or not one drink a day is healthy for a single individual (and I’m not saying it is), if everybody in the United States were to drink one drink a day, there would definitely be additional incidences of harms. In particular, individuals who did not drink before being urged to by Big Alcohol and/or NIAAA would instantly increase their susceptibility to certain cancers, neurological issues, injuries, and life disruption. There is no guarantee that a teetotaler, once urged to start drinking, would have the same ease maintaining a one-per-day pace as the idealized low-level drinker. Creating a new heavy drinker would put that person at extreme risk.

    Any honest evaluation of whether “healthy drinking” exists needs to look at its effects on a randomized population over an extended period of time.

  • Q: Isn’t MACH15 meant to be exactly that kind of longitudinal study?

    A: While the MACH15 study is a longitudinal clinical trial, hence its expense and the industry’s eagerness to foot the bill, it is clearly meant to only look at the outcomes that might be improved by drinking. It is not designed to evaluate cancers, long-term cognitive declines, or gastrointestinal issues, much less emergent psychiatric or psychosocial problems. Laws and best practices protecting research participants means that outside investigators cannot get those answers themselves.

    Moreover, the selection bias is at work in MACH15 as well, since any participant who shows indications they might be vulnerable to harms from even low-level alcohol use is excluded. These exclusion criteria make for good research design, but also make it impossible for this trial to give an accurate idea of the population health impacts of drinking.

  • Q: Why not just use it to suggest drinking only to the healthiest people?

    A: The range of exclusion criteria the MACH15 researchers use are much wider than those given by your doctor during your average checkup. Since the study designers have openly declared they are trying to pave the way for doctors to recommend drinking to patients who do not drink, the study uses the population least likely to be harmed by drinking to put beers in everyone’s hands.

    Also bear in mind that the alcohol industry is not regulated by the FDA. A NIAAA decision to recommend drinking opens the door for Big Alcohol to make overblown health claims about their products. This would be like tobacco manufacturers using nicotine’s alleged ability to aid concentration as a reason to put cigarette machines (back) in college dormitories.

These are the reasons why Alcohol Justice cannot support the idea of healthy drinking, especially not as currently pushed aggressively by NIAAA and Big Alcohol. When it comes to picturing the health effects of long-term alcohol use, here is a great deal still to be filled in. Before we get there, we must refrain from making careless recommendations that could ruin lives.

TAKE ACTION to tell Congress to kill the deceptive MACH15 study.

READ MORE about NIAAA's backroom deals with Big Alcohol.

READ MORE about the industry's deceptive health claims.