Two reports on the complex relationship between alcohol and our health have recently appeared. Both come from highly credible sources. While their purpose, methods, and data sources differ, their conclusions are remarkably consistent. Yet one has been sensationalised while the other has been ignored or disparaged.
The first report, from the National Academies of Sciences, Engineering, and Medicine, or NASEM, reviews recent evidence on specific questions posed by the US Department of Agriculture to inform new dietary guidelines. It finds that while there are many reasons for scientific uncertainty, moderate drinking is associated with a 16% reduction in all-cause mortality, a 22% reduction in cardiovascular mortality, and a 10% increase in the risk of breast cancer.
The second, an Advisory from the Surgeon General of the United States, provides greater detail on the relationship between alcohol consumption and cancer. As can be reasonably concluded from the NASEM report, the Advisory makes evident that far too many Americans die of alcohol-related cancers. As a physician, mental health policy expert, and winemaker, I welcome these reports, particularly Surgeon General Murthy’s focus on educating all Americans about the risks associated with drinking.
Sadly, some mainstream media have cast the resulting scientific nuance in war-like terms. The New York Times describes the discussion of scientific uncertainty as a battle, encouraging division over consensus. Both the Times and the Washington Post imply corrupt intent on the part of the National Academies to “placate the alcohol industry”. This approach tarnishes the reputation of one of the world’s most objective, apolitical, and authoritative scientific bodies, further eroding the public’s already fragile confidence in expertise, science, and objective journalism.
What to make of it all
Like many foods we consume — even meat, potatoes, and apple pie — alcohol has risks, especially when overdone. As the NASEM report suggests, moderate consumption of alcohol appears safe for most, but not all, adults. Following extensive reviews of the evidence, the report indicates that modestly increased risk for specific diseases, including some forms of cancer, may be outweighed by the evidence around decreased risk for all-cause and cardiovascular mortality.
Moreover, as the Surgeon General points out, the identified cancer risk is directly related to the amount of alcohol consumed. About 20% of American drinkers consume heavily or binge, behaviours that are unambiguously detrimental to health. The alcohol industry, health groups, and government should work collaboratively to reduce overconsumption, as well as related problems like addiction, binge and underage drinking, and drunk driving.
In addition to the actions, such as warning labels, that the Surgeon General suggests, there are several measures that the health care and public health communities should consider to minimize alcohol-related cancer risk. These include screening for alcohol metabolizer status, understanding the relationship between BRCA and other genetic factors and alcohol, and identifying lifestyle factors, such as diet, that may modify cancer risk.
Americans should always follow scientific evidence, whether formulating the Dietary Guidelines or in their own lives. Regardless of broad pronouncements, everyone has a unique genetic makeup and lifestyle that requires individualized consultation with a health professional to determine what is healthy for them regarding food and beverage consumption.
As the World Health Organization observes in its Constitution, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. For most people, enjoying a drink is a communal act of pleasure. Indeed, for at least 8,000 years, humanity has forged social bonds over food and wine. We should embrace these benefits while mitigating the risks.
Dr Tom Croghan is the co-owner, with his wife Polly Pittman, and winemaker at The Vineyards at Dodon in Davidsonville, Maryland. A physician and cellular immunologist he was, until December 2022, a Senior Fellow at Mathematica Policy Research, where his research and policy analysis focused on treating mental health conditions in primary care settings. He is a recipient of an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation and a Special Commendation from the Secretary of the Veterans Administration. He is also a board member of WineAmerica.

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