The viability of recommending moderate alcohol consumption as a step to reduce all-cause mortality was given a death blow yesterday by the release of a report by a National Academy of Sciences expert panel which concluded that low-dose (moderate) drinking increases the risk of breast cancer and may increase the risk of colon cancer as well.
The long-awaited report concluded that although moderate drinking appears to reduce all-cause mortality, primarily through a reduction in cardiovascular disease, it also increases breast cancer risk and there is some evidence that it increases colon cancer risk as well. The panel concluded that there was moderately strong evidence that low levels of alcohol consumption increase breast cancer risk and some evidence, although not strong, that low levels of alcohol consumption increase colon cancer.
A major purpose of the report is to inform the next Dietary Guidelines for Americans. The alcohol industry has a vested interest in the Dietary Guidelines including a recommendation of moderate drinking as part of a healthy diet. They funded an ill-fated clinical trial of the health effects of moderate drinking which was halted by NIH after an investigation revealed impropriety in the NIAAA's solicitation of funding directly from the industry, which violates NIH policy.
The Rest of the Story
This report is a death knell for the alcohol industry’s hopes of ever having moderate drinking recommended as part of a health diet. The report concluded that moderate drinking increases the risk of breast cancer and may also increase the risk of colon cancer. Even though the report suggests that moderate drinking may lower all-cause mortality, there is no way that physicians—or any public health body—can issue a recommendation for healthy people to take an action that knowingly increases their risk of cancer, which could be fatal.
A key principle of medicine is “to do no harm.” We do not recommend preventive measures that significantly increase the risk of one disease in order to prevent another disease. We cannot knowingly recommend that people consume a known, strong carcinogen as a method to reduce their risk of cardiovascular disease. There are other safe, effective, and proven ways to reduce cardiovascular risk without increasing your risk of cancer.
Recommending moderate alcohol consumption to reduce cardiovascular disease, in light of the findings of this report, would be unethical.
Imagine walking into a doctor's office and asking your doctor for recommendations about how to decrease your risk of cardiovascular disease. And the doctor says: "Boy have I got the carcinogen for you. Take this carcinogen once or twice a day, depending on your sex, and your cardiovascular risk will go down."
But this is precisely what would be happening if a physician--or a public health body such as the National Dietary Guidelines--recommended moderate alcohol use to reduce cardiovascular disease risk.
The only time when we can recommend that people take a medication or product that is effective in treating a disease but may have side effects by increasing the risk of another disease is when the patient already has the disease. And in those circumstances, the FDA is very careful about weighing the risk levels, the alternative treatments available, and the severity of the disease. We absolutely cannot recommend that healthy people take a medication or product that is effective in preventing a disease but increases the risk of another disease. In other words, medication or product side effects can potentially be tolerated for medical treatment. But they are unacceptable in medical prevention. The reason is that with prevention, the patient is healthy and to expose them to a higher risk of cancer would be doing harm. This violates a central tenet of medicine and public health.
Knowing that this report concludes that the link between moderate drinking and a potentially fatal cancer is real, there is no way that any public health body can possibly recommend moderate drinking as part of a dietary guideline. Given the findings of this report, doing so would be a serious breach of medicine and public health ethics.
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