New limits for alcohol ignore benefits
Journalists love “headline numbers”, big round figures, especially millions and billions. They catch readers’ attention and seem impressive. But in January 2023 the lowly figure two (2) caught everyone’s attention; as in, two drinks a week. A health advisory board proposed that as a national guideline.
“Two? per week!?” You could almost hear local pub patrons cry. “You mean, per round?”
No, the Canadian Centre on Substance Use and Addiction (CCSA), a consultative body, issued a report, Canada’s Guidance on Alcohol and Health, recommending to Health Canada a new guideline of two drinks a week.
Alcohol guidelines in Canada haven’t been this tough. In 2012 the CCSA itself, in a brochure titled Canada’s Low-Risk Alcohol Drinking Guidelines, recommended “10 drinks a week for women, with no more than 2 drinks a day most days, and 15 drinks a week for men, with no more than 3 drinks a day most days”. (I carefully printed out that CCSA brochure before it disappears online.)
In the 1990s through the 2010s, a consensus around moderate drinking took root. One drink a day was seen as acceptable, even healthy.
In France, where we lived for more than a decade in the early 2000s, the government alcohol guidance matched the CCSA’s above, and was publicized on TV and in other media. Today France suggests a maximum of 10 standard drinks a week. The U.S. recommends no more than two drinks a day for men and one for women, while the U.K. suggests no more than 14 “units” of alcohol — around six glasses of wine or pints of beer — per week.
Major research supported this moderate-drinking consensus. In 2006, the Archives of Internal Medicine published an analysis based on 34 prospective studies incorporating a million people. It found that “1 to 2 drinks per day for women and 2 to 4 drinks per day for men are inversely associated with total mortality”.
Studies in the New England Journal of Medicine from 2015 found no overall cancer risk from low to moderate drinking.
Most dramatically, the Copenhagen Heart Study of 1995 singled out red wine as healthy. The New York Times headline read: “Danish Study Shows Wine Aiding Longevity”, and continued:
“Another large study has highlighted the potential benefits of alcohol to health and longevity. …. The 12-year study, conducted among more than 13,000 men and women ages 30 to 70 who participated in the Copenhagen Heart Study, revealed that those who drank wine daily were much less likely to die during the study period than those who drank beer or liquor or no alcohol at all.”
The public-health consensus seemed solid.
Reversal in trend
In recent years, this consensus has eroded. Attempts have been made to equate alcohol use with cigarettes and smoking — the latter a noxious practice that needs to be eradicated.
How did this happen? Anti-government folk blame regulators. Libertarians faulty “nanny-state” do-gooders. A better explanation has to do with people’s sense of risk.
The word “risk” comes back relentlessly in the CCSA report. Risk is of course a scary thing, and to note that almost every human activity involves risk does not resonate with someone whose loved one is abusing alcohol. This is a major social harm.
A better comparison than smoking’s dangers, however, are the risk factors that accompany driving. Traffic fatalities are inevitable and terrible, yet we still use cars. How do we decide what safety measures balance our convenience/efficiency/pleasure?
Imagine a traffic-safety panel suggesting that we drive at 70 kilometres per hour maximum. After all, there is more risk the faster you go. Driving at 80 km/h is generally riskier than driving at 70, and 100 km/h is riskier than both. And yet, here in Quebec and Ontario public opinion accepts 100 km/hour as the highway speed limit.
We have come to embrace seatbelts and airbags, but not drastic speed limits. The U.S. tried a 55-mph national limit for two decades, then repealed it. It wasn’t practical. There is a social trade-off in getting there faster. Traffic of all kinds was greatly slowed – deliveries, daily commuting, holiday trips, long-distance travel.
Such limits ignored other values in human life. This is similar to our social enjoyment of alcohol and its trade-offs with risk.
Pushback starts in media
The CCSA recommendation has generated strong pushback, online, in newspapers and on radio. The host of CBC’s Cross Country Checkup noted that their weekly Twitter question usually gets 25-50 replies; the alcohol topic generated 1,200 tweets.
A common complaint was “overreach” by public health officials.
Dan Malleck, a professor of health sciences at Brock University, published an op-ed in the Globe and Mail (“Canada’s drastic new alcohol guidelines demand a closer look”, Jan. 20), calling the CCSA’s report “alarmist and distorting.”
“The CCSA is basing its recommendations on a relatively narrow understanding of how alcohol functions”, wrote Malleck. No credit is given for its positive role in social life.
Malleck also faulted the CCSA for inflating very small risks. He notes that the CCSA says “consuming three and a half drinks a day increases your risk of developing larynx cancer by nearly 100 per cent, which sounds shocking”, until you learn that “larynx cancer, which is mostly related to smoking, was diagnosed in roughly 0.0197 per cent of Canadians in 2022.” A low risk that remains low.
A CCSA leader, Dr. Peter Butt, rejected criticism on CBC’s Checkup, adding that “he could not understand” how Globe editorswould publish Malleck. The CCSA wants to be treated as a neutral authority, immune from criticism.
Moreover, its report foresees “a cultural shift that, by and large, can only be orchestrated by governments.” —Whoa. A cultural shift … orchestrated by governments? What could go wrong? The word Prohibition comes to mind. Malleck, for one, sees a “new abstinence movement” hijacking public-health science.
Frankly, we need to sit down and talk this one through. Soberly.
Originally published in the Sherbrooke Record weekend supplement, January 2023.
