The New Prohibition, Part 1

They're coming to rob the cork from your lunch

The U.S. Surgeon General’s advisory warning Americans of the link between alcohol consumption and cancer is the latest salvo in what I call The New Prohibition. This is a campaign by many in the public health sector and the media to move the discussion away from responsible, moderate consumption of wine and other adult beverages to total abstinence.

The New Prohibition has been looming for some time. You can see it in the World Health Organization’s statement a few years ago that “there is no safe level of alcohol consumption.” This line is echoed in news articles and statements by physicians, pundits and Puritans alike. The trolls in the comments section on my wine columns in The Washington Post picked up the refrain. The U.S. government is updating its dietary guidelines — one of the proposed changes would drop “moderate drinking” for an anti-alcohol stance.

The advisory by Surgeon General Vivek Murthy does not contain the phrase “no safe level,” but it does say increased cancer risk starts with the first drink. It will add a potent new voice to this anti-alcohol movement. Given the wide media coverage the advisory received — much more than another government study in December that tied moderate drinking to lower mortality rates — its impact may be felt for years to come.

I’m not an epidemiologist, so I won’t try to pick apart the studies in the endnotes in Dr. Murthy’s advisory. But as a professional communicator, I have some perspective on how the issue is being framed.

For generations, education about alcohol (by which I mean negative messaging) focused on responsible drinking: Don’t drink underage, don’t drink and drive, don’t make a fool of yourself in public. Know your limits. We’ve long known over-consumption can kill your liver and that alcohol addiction has social and public health consequences. But several studies have shown cardiovascular benefits, and the U.S. dietary guidelines even grudgingly acknowledged that moderate consumption might actually be beneficial.

Today the message is any consumption is harmful. That’s not a moderation message, it’s Prohibition.

“Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity, increasing risk for at least seven types of cancer,” Murthy’s press statement said. Which is it? Does it cause cancer, or increase the risk? Those aren’t the same, and the contradiction of absolute statements supported by less than absolute reasoning persists throughout the advisory.

Wouldn't it be terrible if I quoted some reliable statistics which prove that more people are driven insane through religious hysteria than by drinking alcohol.

— W.C. Fields

“In the U.S., there are about 100,000 alcohol-related cancer cases and about 20,000 alcohol-related cancer deaths annually,” the advisory says. That’s pretty definitive, and a Prohibitionist statement: Alcohol causes cancer. But in the same paragraph, the statement says, “An individual’s risk of developing cancer due to alcohol consumption is determined by a complex interaction of biological, environmental, social, and economic factors.” These include genetics, peer pressure and our individual risk tolerance.

So is my cancer caused by my wine, or the micro-plastics in my ultra-processed food? Could it be my diet? All the chocolate and coffee I consume for their heart benefits? Or maybe radiation from my smartphone, which is obviously causing my tinnitus and sleep apnea? All of the above?

The 22-page advisory gives a long list of studies and health organizations whose “rigorous research … has shown that alcohol consumption increases the risk of cancer for at least seven sites” in the body. The WHO says alcohol “can cause cancer;” another organization says “Convincing: Increases Risk;” and a 2016 U.S. Surgeon General report says “Even one drink per day may increase the risk of breast cancer.” The current version of the U.S. dietary guidelines says drinking “may increase the overall risk of death from various causes,” including cancer and cardiovascular disease.

This sounds like a pretty strong argument for moderation. But the advisory calls them “conclusive evidence that alcohol causes at least seven types of cancer …” and concludes “ … the causal relationship between alcohol consumption and cancer is firmly established …” These are Prohibitionist statements.

The rest of the advisory includes a fairly plain-language discussion of risk that may not sound all that alarming.

“Over the lifespan of a man, the absolute risk of developing any alcohol-related cancer increases from approximately 10.0% (about 10 out of every 100 individuals) for those who consume less than one drink per week to about 11.4% (about 11 out of every 100 individuals) for those who consume one drink daily on average to approximately 13.1% (about 13 out of every 100 individuals) for those who consume two drinks daily on average.”

Even in plain language, this is confusing. If I don’t drink (less than one drink a week), I apparently still have a 10-percent chance of getting one of these alcohol-related cancers. That chance goes up to 13 percent if I enjoy two drinks a day. There’s a big difference between less than one drink a week and 14 a week. Also, those 10 out of 100 non-drinkers who get one of these cancers are presumably included in the totals mentioned above and blamed on alcohol.

The Surgeon General’s advisory is a call for moderation, informing us of potential health risks of drinking alcohol by highlighting studies over the past four decades that concluded alcohol consumption increases our potential risk for various cancers.

However, the advisory contains categorial statements that alcohol causes cancer. These statements will be quoted by The New Prohibition in anti-alcohol arguments, proposals for higher taxes and other restrictions designed to make wine and other adult beverages less available and affordable.

We must carefully listen to the messaging, especially if Congress does consider changes to the alcohol warning labels. Notably, the advisory only recommends “an update [to the label] to include a cancer risk warning.” It doesn’t suggest specific wording. The simplest would amend “ … and may cause health problems” by adding, “… including cancer.” But given Congress’ legislative dysfunction these days, any changes could be slipped into a funding bill during closed-door negotiations to avert a government shutdown.

Tom Wark, one of the wine community’s fiercest voices in defense against The New Prohibition, warned in his Fermentation blog that the Surgeon General’s advisory is likely to become part of a Prohibitionist zeitgeist that may shape the discussion of wine and other alcohol beverages for generations. And he reminds us this negative zeitgeist may get another boost in coming months when the new dietary guidelines are issued.

Or to paraphrase W.C. Fields, someone’s trying to steal the cork from our lunch.