Cracks are continuing to appear in the WHO ‘zero-tolerance’ messaging about alcohol consumption.
A major criticism of the WHO advisory has now come in a post by Harvard Public Health whose title arguably defined the debate more concisely than anyone has previously managed: “Is alcohol good or bad for you? Yes.”
Alcohol raises and decreases cancer risks
“We have been researching the health effects of alcohol for a combined 60 years. Our work, and that of others, has shown that even modest alcohol consumption likely raises the risk for certain diseases, such as breast and esophageal cancer. And heavy drinking is unequivocally harmful to health. But after countless studies, the data do not justify sweeping statements about the effects of moderate alcohol consumption on human health.”
As an illustration of what the Harvard authors describe as the “need [for] the media to treat the subject with the nuance it requires”, they cite the UK ‘one million women’ study that found a link between moderate consumption of no more than one drink a day for women and increased incidence of breast cancer. Inconveniently for the zero-tolerance argument, analysis of the same study showed that rates of thyroid cancer, non-Hodgkin lymphoma, and renal cell carcinomas among the same group actually reduced.
"After countless studies, the data do not justify sweeping statements about the effects of moderate alcohol consumption on human health."
The authors question the methodology behind the WHO advice because too much of the research on which its based is ‘observational’. Looking at the quantities of alcohol consumed by large numbers of drinkers and abstainers ignores possible differences in the dietary, exercise and general lifestyle behaviour of non- moderate- and heavy drinkers. They draw attention to analysis by a Harvard researcher of over 300,000 drinkers. This “found that the same total amount of alcohol appeared to increase the chances of dying prematurely if consumed on fewer occasions during the week and outside of meals, but to decrease mortality if spaced out across the week and consumed with meals.”
Radio debate
Interestingly, in an even-handed BBC World Service Radio programme called “How Risky is Drinking Alcohol?” aired in August, Tim Stockwell PhD, whose reconsideration of the J-curve has been driving media messages about the dangers of alcohol, also acknowledged the weaknesses of observational data and said that more research is required. While saying he was “inclined towards” the zero tolerance messaging, he admitted that his meta-analysis doesn’t show that moderate consumption is harmful “because we haven’t been able to get rid of the bias” from the data. He also conceded that the risks are ‘tiny’ at low levels and “the difference between two drinks a day and no drinks” is not “significant”. People who drink two or three drinks a week across a lifetime were, he said, taking a “one-in-a-thousand” risk, and might shorten their lives by two or three days. He pointed out that the definition of ‘low’ and ‘moderate’ risk varies between countries and — surprisingly perhaps — distanced himself from the specific zero-tolerance messaging issued by the Canadian Institute for Substance Use Research where he is an emeritus professor.
Statistician disagrees
In the same programme, however, Sir David Spiegelhalter, Emeritus Professor of Statistics in the Centre for Mathematical Sciences at the University of Cambridge in the UK, took a far stronger stance. He sees no value in talking about what he later described – in an X/Twitter social media post – as “the pointless obsession with the possible overall risks of low levels of alcohol… If they are there at all (for which there is no good evidence), we know they are very small.
“We should never talk about ‘there’s a risk of something’,” he told the programme presenter. There are risks to everything we do, he said. We know the risks of moderate consumption are “very low indeed” and “very hard to estimate”. We just have to accept that “people drink for a reason. They drink because they enjoy it.”
"The risks are ‘tiny’ at low levels and “the difference between two drinks a day and no drinks” is not 'significant'”.
If the Harvard post and BBC programme provide ammunition for those wishing to counter the absolute nature of the WHO messaging, they also illustrate that this is not an argument that either side is going to ‘win’. Those who have criticised initiatives like Dry January and Sober October and/or who implicitly favour regular moderate wine consumption should also listen to the interviews with drinkers that were included in the BBC programme.
Unhelpful friends
A 44-year old British woman who was encouraged to give up alcohol by her fitness trainer during four months preparation for a marathon, described how much better she sleeps and feels now that she and her husband have reduced their consumption to far more occasional cocktails. Some of her friends, she says, have ‘disappointed’ her by being “almost angry at me and my husband for not drinking… and… made it difficult to do what we want to do.”
A male Australian interviewee contradicted the narrative that wine is not consumed in the same way as other forms of alcohol. Acknowledging that he “probably drinks a little bit more than is recommended” he said that his alcohol intake over the course of a single day might historically have involved seven or eight pints (over three and a half litres) of beer, half a bottle of vodka or two bottles of wine. Until now, he has alternated between this pattern of drinking, and total abstinence for up to four months at a time. Prompted by the programme, however, he said that he would now consider adopting the Australian government recommendation of 10 drinks per week when he finished his latest 117-day alcohol-free stretch.
One thing is clear. Whether professionals like it or not, alcohol, the way it is consumed, and the quantities involved, will continue to fascinate researchers, statisticians and the media for a very long time to come. And temperance campaigners and wine professionals will all find plenty of commentary with which to agree and disagree.
