The New Prohibition, Part 2

The scary simplicity of "No Safe Level"

Last week, I wrote about The New Prohibition, my name for the rising tide of anti-alcohol messaging designed to shift the discussion of alcohol and health from responsible moderation to total abstinence. Today, I want to examine the key tenet of this movement — the mantra that “there is no safe level of alcohol” — from an unusual perspective.

For nearly 22 years, until I retired at the end of December, I was a Public Affairs Officer for the U.S. Nuclear Regulatory Commission. I never discussed my job in my wine writings, because it wasn’t relevant and I wanted to keep my worlds separate. But on this issue, my worlds overlap.

Health physics, the science of radiation protection, has a doctrine called the “linear no-threshold model,” or LNT. This assumes a linear relationship between radiation dose and health effects, with no threshold below which radiation exposure is safe. Therefore, any radiation exposure is considered harmful and increases your risk of getting cancer, and the effect is cumulative over time. LNT is the official policy of the U.S. government, including the NRC, and guides radiation protection regulations.

Health physicists agree that high doses of radiation are dangerous and can be fatal. But the LNT assumes that any radiation dose — every minute you stand in the sun, every X-ray you get, every airline flight you take — eventually adds up to cancer. I don’t know how this is proved — by the time you accumulate a lifetime dose equal to a fatal exposure, you’re probably old enough to die of any number of causes.

LNT is controversial. Many health physicists argue that small doses of radiation are less harmful and may even be beneficial (think of “getting some Vitamin D” on a sunny day for a basic example). There also is some evidence that the body recovers from mild radiation damage. On a graph, this theory (known as hormesis), would resemble the so-called J-curve of moderate alcohol consumption providing health benefits before hazards become pronounced with higher consumption, while the LNT model is a straight line, like the “no safe level of alcohol” argument.

With The New Prohibition, we are seeing the LNT model applied to alcohol consumption. We can all agree that alcohol is too-often abused and over-consumption has negative health effects, from mild (weight gain) to extreme (cancer). But what about the benefits of moderate consumption, from pleasure to potential benefits for cardiac health? The “no safe level” and LNT models oversimplify complex public health issues to create scary messages.

A new wine decanter (not) coming soon to the NRC’s employee store.

The key to radiation safety is to moderate your radiation exposure and keep your dose as low as possible. An argument for moderate drinking sounds similar: Consumed responsibly, beverage alcohol can be part of a healthy, enjoyable lifestyle. The difference, of course, is that we can’t avoid radiation, while we can abstain totally from alcohol. That’s what The New Prohibition wants.

“There is no safe level of alcohol” pins the extreme health effects on every sip of wine, beer or liquor we take. This isn’t “don’t drink and drive” or “know your limits,” which emphasize personal responsibility. This is “don’t drink.”

This may seem like semantics, and we may be tempted to brush off the latest Surgeon General advisory or government health study as “nothing new.” That would be a mistake. Messaging is where this fight will be won or lost, and our side is well on the way to losing it. “No safe level of alcohol” is already engrained in the talking points for any media story about alcohol and health. It’s short, definitive and easy to remember. It doesn’t get lost in nuance. The rebuttal too often starts with “Yes, but …” Before we can clear our throats to wax on about 8,000 years of history and culture and what Jesus did at the wedding or those other studies showing some cardiac benefits, “no safe level” strikes like a gavel delivering a verdict. Case closed.

“No safe level” may overstate the health impacts. It may even be wrong. But as slogans go, it’s effective.

Postscript: Last week, the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), part of the U.S. Department of Health and Human Services (HHS), released a draft report for public comment on its own study of alcohol intake and health. This committee, whose mission is to promote responsible alcohol use (as in, wait until you’re 21), concluded that “the risk of dying from alcohol use begins at low levels of average use,” and that “higher levels of alcohol consumption are linked with progressively higher mortality risk.”

The report, designed to inform the upcoming revision of the U.S. dietary guidelines, is controversial. Critics argue the ICCPUD overstepped its mandate by looking at overall health effects rather than just underage drinking. That’s inside the Beltway stuff. And while, like the Surgeon General advisory, a Command-F search turned up no use of the phrase “no safe level,” this report will add to the rising chorus of anti-alcohol voices.

(Image generated, somewhat reluctantly, by ChatGPT.)