It has been reported in the press recently that the Department of Health is considering revising down the ‘lower-risk’ or ‘sensible drinking’ guidelines, on the basis of new evidence linking even very low levels of alcohol consumption to an increase in the risk of developing cancers – particularly breast cancer. The logic of the healthist argument is that there is no level of regular alcohol consumption, no matter how low, that doesn’t raise the epidemiological risk factor for a variety of cancers, and therefore there is no ‘safe level’ of alcohol consumption. It follows from this that the ‘lower-risk’ drinking guidelines should be reduced, as they have been recently in Canada and Australia. I believe that there is actually good evidence, from a health point of view, that we could safely raise the lower-risk guidelines. That’s right – raise them!
Let’s take a step back: firstly, if the overarching purpose of lower-risk drinking guidelines is to reduce levels of drinking and thereby levels of premature death by reducing the risks of developing fatal diseases, then surely what we should look at is the relationship between various levels of alcohol consumption and the risk of premature death from all causes, not just premature death from one cause – cancers. Here’s where we uncover some inconvenient truths for the health lobby. Research has established that people who drink moderate amounts of alcohol on a regular basis are less likely to die prematurely than people who never drink. And to be more specific, they are less likely to die prematurely from cancers or heart disease.
In the graph below we see the risk of all-cause mortality for ‘never drinkers’ represented by the horizontal straight line. If we look at the J-curves for men and women, represented by the solid black line and dotted black line respectively, we can see that risk of premature death from all causes declines at very low levels of consumption (less than one standard drink a day) and then starts to rise. But it only exceeds the risk for people who never drink when it exceeds four standard drinks a day for men and approximately 3 standard drinks a day for women. An American ‘standard drink’ equates to 1.7 units of alcohol.
The current UK lower-risk guidelines were plucked out of the air; they are not based on science. But we can now define a rational basis upon which to calculate such guidelines. It’s about relative risk: if people who drink moderate amounts of alcohol regularly have a lower level of all-cause mortality as compared with those who never drink, then the question we need to ask, when framing the lower-risk drinking guidelines, is: how many units of alcohol consumed per day would raise the risk of premature death from all causes above the risk level of those who never drink?
We do have an answer to this – represented in the J-curve graph. Research in the United States has shown that for men, two to four ‘standard drinks’ per day, and for women, one to three standard drinks per day, keeps the risk factor of premature death from all causes below that of ‘never drinkers’. In the United States a ‘standard drink’ is the equivalent of 12 fluid ounces of beer with an ABV of 5%. This translates into 1.7 British units of alcohol. So, two to four standard drinks a day represents between 3.4 and 6.8 units of alcohol consumption for men, and one to three standard drinks gives us a range of 1.7 to 5.1 units a day of alcohol consumption for women. The current UK guidelines are 3 to 4 units a day for men, and 2 to 3 units a day for women – hence my suggestion that the current guidelines err on the side of caution and could safely be raised.
But there is another question we need to ask about what the healthists have to say concerning safe levels and risk factors. If we are going to define alcohol as ‘unsafe’ because at any level of consumption it raises the risk of developing cancers, then what happens if we apply that principle to other drink and food products?
Let’s take tap water as an example. In the UK we put chlorine in our public water supply. Chlorine is a disinfectant that kills micro-organisms and thereby renders water safe to drink. The chlorination of public water supplies represented a massive step forward in public health and virtually eliminated cholera, typhoid and other water-borne diseases in advanced countries. But we know from research done in the 1970s and the 1990s that chlorine, when added to water, forms Trihalomethanes (THMs), one of which is chloroform. THMs increase the production of free radicals in the body and are highly carcinogenic (cancer causing). Specifically, they raise the risk factor for bladder, colon and breast cancers. THMs may also have an effect on pregnancy and the level of miscarriages and on the development of allergic reactions to certain foods.
There are numerous studies that establish this link between chlorinated water consumption and cancer. Here is just one example: a study published in the Journal of the National Cancer Institute in the United States found that “long term drinking of chlorinated water appears to increase a person’s risk of developing bladder cancer by as much as 80 percent.” I’m not trying to start a health scare here folks, because the absolute risk of developing bladder cancer is very low, so an 80 percent increase in a very low risk is still a very low risk. I’m merely pointing out that basing public health policy on epidemiological risk factors alone, does not provide the basis for evidence-based policy-making. Used selectively, as in the example of alcohol consumption and cancer risk factors, it is merely scaremongering and doesn’t deserve to be taken seriously. Department of Health, please take note.
But if we apply the principle that any elevation of cancer or other health risk factors renders food (as opposed to alcoholic drinks) unsafe, then we get to an even more untenable position. Consumption of red meat; of meat products such as bacon, sausages and burgers; consumption of convenience foods for microwave cooking, such as spag bol, because they contain added sugar and salt, and for the same reason consumption of fizzy drinks – all these foods raise disease risk factors. So what we are left with is fruit and veg – and nothing to drink! The healthist utopia is the creation of a teetotal, vegetarian society. And this is where you can begin to see that ‘public health’ as a movement is not about public health, but about state regulation of lifestyle. It is an ideology that seeks to use epidemiological research to pressure government to regulate the food and drinks’ industries in order to enforce mass product reformulation.
There are of course genuine concerns about the health effects of heavy alcohol consumption and about excessive consumption of foods rich in sugar, salt and saturated fats. But as long as we have free information and there is no market failure in terms of the provision of affordable healthy alternatives, there is no justification for government stepping in with large-scale regulation.