Vivek Murthy could have chosen a lot of ways to spend his final weeks in office as U.S. Surgeon General. America faces numerous health issues. Six in 10 Americans suffer from a chronic disease, like type 2 diabetes or Alzheimer’s or heart disease. Mental health issues have been rising, particularly since the pandemic. A form of avian flu just killed an elderly man in Louisiana.
So I was surprised when Murthy chose to focus what might be his final health advisory on alcohol, calling for beverages to carry warnings stating that alcohol is a cancer risk. He also called for more public education on alcohol’s risks and for the U.S. Department of Agriculture and Department of Health and Human Services to revisit the alcohol consumption recommendations in the Dietary Guidelines for Americans.
It’s a curious move because Murthy’s advisory was largely symbolic. He can’t implement warning labels; only Congress can, and there is no evidence the House or Senate have any desire to do so. And Murthy will soon be out of office and unable to lobby for his proposals in an official role.
What’s more, Murthy undercut his own medical colleagues at HHS. Two weeks before his advisory, the National Academies of Science, Engineering and Medicine (NASEM) issued a report by a panel of 14 academics, including experts in public health, family medicine, epidemiology and biostatistics. As part of HHS’s review for the dietary guidelines, the panel and its staff conducted an extensive deep dive into the current relevant science on alcohol’s impact on health and found with “moderate certainty” that people who drink alcohol in moderation have lower all-cause mortality than those who don’t drink.
Murthy chose to ignore that in favor of a simplistic message: He focuses on alcohol as a cancer risk and ignores any health benefits. I guess I shouldn’t be surprised. If there is one trademark of the growing neoprohibitionist campaign, it is that simplistic slogans sell; nuanced science doesn’t. The most effective tactic for convincing the public that all alcohol is unsafe is to issue broad statements with no gray area, no doubts and no complexity.
Murthy decided one of his last acts should be to join the neoprohibitionist chorus.
Science is Never Simple
The one lesson public health authorities should have learned the hard way in recent years is that black-and-white health pronouncements are a bad idea. They make people believe that the answers are simple. When it comes to humans and health, they almost never are.
The NASEM report is not simple. The panel notes in their introduction that research on alcohol and health is complex because studies are limited to looking at correlation rather than causation and researchers often have to rely on people self-reporting how much they drink. The panel authors were careful to make clear how certain they are of each of their findings.
They found, with moderate certainty, “that compared with never consuming alcohol, moderate alcohol consumption is associated with lower all-cause mortality.” A big reason? “Consuming moderate amounts of alcohol is associated with a lower risk of [cardiovascular disease] mortality in both females and males.”
The panel also found with moderate certainty that moderate consumption of alcohol is associated with a higher risk of breast cancer. Yes, the evidence suggests that alcohol is one of several risks for cancer, along with diet, genetics, exercise and tobacco use. According to the most recent annual report of the American Association for Cancer Research, alcohol consumption is considered a factor in roughly 5.4 percent of cancers in the U.S. (Tobacco is a factor in 20 percent, and obesity is a factor in 7.6 percent.)
These findings reflect what the majority of peer-reviewed research has found in the past two decades. Moderate alcohol consumption—no more than two glasses per day—has been linked to lower rates of cardiovascular disease. It has also been linked to higher rates of certain cancers. But because cardiovascular diseases are still the number one cause of death in the United States—702,880 Americans died of heart disease and 165,393 died of stroke in 2022, per the Centers for Disease Control, compared to 608,371 deaths from all forms of cancer—moderate wine consumption is linked to a lower rate of mortality.
One thing remains clear: Heavy drinking and binge drinking are both unhealthy. Certain people develop dependency on alcohol and should avoid it.
Science Without the Scientific Method
Dr. Murthy's report is not interested in this whole, nuanced picture. The NASEM panel combed through years of studies. His advisory cites a single Australian study to provide its risk calculations. His advisory trumpets those cancer risks, implying that wine is similar to tobacco, without giving the whole health story. Never mind any possible health benefits for the heart. Never mind that for thousands of years, alcohol has fostered community and social benefits by bringing people together for food and conversation. (You would think that would be a welcome health benefit at a time when millions of people suffer from chronic loneliness and isolation.)
I guess I should not have been surprised by the timing of his advisory. Those who want to spread the idea that no level of alcohol is safe needed a forceful response to the NASEM report. The Surgeon General’s advisory will not be the only one. While the NASEM review is customary, this time around a second committee has been created under an HHS agency, the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD).
The six members of the committee are unusual participants in the dietary guidelines review process. These are not cardiologists or medical researchers, but substance abuse experts, many of whom have made their careers looking into alcoholism and how governments can reduce harmful drinking. Several work for organizations funded partially by advocates for temperance. Their report is expected this month. Based on their past public statements, I suspect their message will be simple.
Simple Answers
For decades, medical experts have tried to get across a complex message: Alcohol, drunk in moderation—say a glass or two per day, particularly if consumed with food—is low risk and can even offer some health benefits. Heavy drinking, or drinking nothing all week and then binging five or more drinks on Saturday night, is not healthy.
But nuance is hard. We want simple answers. Neoprohibitionists have a very simple one—no level of alcohol consumption is safe. That wine? It’s poison.
No matter how the dietary guidelines debate ends, the neoprohibitionists’ messaging will continue. They are modeling their efforts on anti-tobacco campaigns. They will push for warning labels that say no level of drinking is safe. They will push for bans on alcohol advertising. They will urge lawmakers to hike excise taxes to make wine less affordable. But most of all, they will continue to spread their simple message and convince people that a glass of Riesling is a risk.
Over the long term, I think they will regret their choice. History has shown that overly simplistic health pronouncements don’t age well. But for the time being, buckle up. The chorus is going to get loud.
