How many Americans are going to stay away from work on Monday, February 13th? According to research reported by the Washington Post in 2019, some 17m are likely to call in sick with what is jokingly known as ‘Super Bowl Fever’. Others might describe this condition as a ’hangover’ after a boozy weekend centered around the most popular sporting contest in the US calendar. Assuming this figure is correct, immoderate alcohol consumption during and after that American Football game costs the US economy around $4bn a year.
This is a tiny drop in the US ocean if a report entitled “Excessive Drinking Is Draining the U.S. Economy” published by the Centers for Disease Control and Prevention is to be believed. According to its authors, “The cost of excessive alcohol use in the United States reached $249 billion in 2010, or about $2.05 per drink.”
That figure is 13 years old, but it is unlikely to have gone down. More recently, however, it is a publication from the other part of the North American continent that has attracted attention.
There is no safe level of alcohol
New advice from the Canadian Centre on Substance Use and Addiction clearly states that there are no innately safe amounts of alcohol anyone can consume. Even so-called moderate drinkers may be doing damage to their bodies that they, their families and quite possibly a broader community may have to pay for, if only in the form of taxes or insurance premiums.
Some people - a minority - will become alcoholics or, more likely, habituated and more dependent on a daily dose than they would care to admit.
Some - a larger number - will behave in ways they wouldn't otherwise have done, ranging from driving dangerously to hitting their partners or children.
Whatever the size of these minorities, no one can seriously deny the existence of alcoholism and drunken misbehaviour. After all, few of us can claim never to have witnessed it.
The health issue is trickier. Most non conspiracy-theorists readily accept World Health Organization data on all kinds of other stuff we all do and consume, and sensibly trust doctors’ advice on vaccination, exercise or weight loss. When WHO or government health ministries or NGOs publish reports on the dangers of alcohol, however, the mood changes.
Suddenly, for many in the wine industry along with libertarians and people who simply enjoy drinking wine, the men and women in white coats metamorphose into the enemy. They are apparently ‘neo prohibitionists’, driven by what the US National Association of Wine Retailers described as a “significant anti-alcohol agenda”.
Like climate change deniers, what one might call PoW – Protectors of Wine - look at multiple reports linking alcohol to cancer and reply “ah, but the studies don’t all agree” and point to the ones — the outliers — that suit their case.
They parrot the line that resveratrol in red wine protects people from heart disease without mentioning that, as Becca Yeamans-Irwin revealed for us a few weeks ago, to get any benefit, one would have to consume between 500 and 2,750 litres per day. They similarly like to say that resveratrol helps to counter Alzheimer’s, without paying attention to recent research by Topiwala et al involving the largest study of its kind that suggests that even a small daily glass of wine might increase the risk of both that disease and Parkinson’s.
It is, of course, very possible that people who drink wine in moderation are healthier than non-drinkers, but correlation does not guarantee causality. Wine consumption was only one of the dietary and behavioral factors that distinguished the long-lived Europeans after whom the French Paradox was named.
According to WHO, 4% of cancers diagnosed globally can be attributed to alcohol. This equates to 75,000 cases and 19,000 deaths in the US annually, out of a population of 332m. Canada believes it has 7,000 alcohol-related cancer deaths out of 38m - a far higher proportion.
One might say that 26,000 deaths out of a combined populace of 370m is a very small number – unless you happen to be one of those dead people, or someone close to them.
Right to know
If one in 25 road accidents involved a particular model of car, wouldn’t you want to know about it?
Or, to turn the tables, if you were a researcher who’d discovered that statistic wouldn’t you like the information to be out there so that people can make up their own minds?
After all, individuals with a strong family history of cancer might give the question greater consideration than children of long-lived chain-smokers for example.
For health researchers and authorities this is the nub of the argument. They believe that knowledge and understanding of the dangers associated with alcohol is insufficient. In January, the US National Cancer Institute published details of recent studies into what the public does and does not know. One found that, “93% of the US public were aware of the cancer risk associated with tobacco, compared with only 39% for alcohol”. Another revealed that “even among those who are aware, there’s a belief that it varies by the type of alcohol. For example, more participants were aware of the cancer risks from hard liquor and beer than about the risk from wine, with some participants believing wine lowers your cancer risk.”
93% of the US public were aware of the cancer risk associated with tobacco, compared with only 39% for alcohol.
Many in the wine world may celebrate this last finding; it shows that our messaging is getting through, but we’re peddling fake news. As the NCI points out “Alcoholic drinks contain ethanol, which is a known carcinogen, and there are several ways in which it may cause cancer. For example, ethanol can increase estrogen in the body, which increases the risk of breast cancer. The breakdown of ethanol in the body can also create high levels of acetaldehyde, which can damage DNA and cause liver, head and neck, and esophageal cancers. Because cancer risk increases with the amount of ethanol consumed, all alcoholic beverages pose a risk. However, public awareness of this risk is lower than for other carcinogens.”
Acknowledging this risk does not mean that everyone should give up alcohol or that readers of this column should stop producing, distributing, marketing or discussing or even recommending it in public. There are lots of pleasurable human activities that might have potentially life-altering consequences. We should no more accept a ban on alcohol than one on dating, skiing, driving or consuming a daily Big Mac and fries.
However, we should combine fighting any moves towards with prohibition with an acceptance that when doctors issue warnings they are only doing their job of trying to keep us healthy. In other words, we must stop treating the medical establishment as the enemy. And stop seeing the growing number of people who, for whatever reason, are deciding to be sober as any more peculiar than those who choose to be vegetarians.
The alternative is really not very attractive. It involves facing the charge of sounding like 1980s tobacco company shills, fossil fuel-funded climate change deniers or, still worse, US firearm lobbyists claiming that guns aren’t responsible for killing people.
Alcohol of almost every kind is wondrous stuff, to enjoy in a wide range of circumstances and moods, but like other sources of pleasure it can come at a cost, as many US workplaces are probably going to discover once again on Monday.