No, Moderate Drinking Won’t Give You Cancer

As with his other work, the surgeon general’s report is light on facts, heavy on expanding government

By Allysia Finley. Excerpts:

"Two weeks earlier the National Academies of Sciences, Engineering and Medicine released a congressionally mandated review of the recent evidence on the health effects of moderate drinking, or up to one drink a day for women and two for men. Its more than 200 pages of findings run counter to Dr. Murthy’s 22-page report, though they got scant attention in the press.

The academies found insufficient evidence to support a link between moderate drinking and oral, pharyngeal, esophageal, laryngeal and other cancers. It did find a slightly higher risk of breast cancer with moderate drinking but also a lower risk of death generally and from cardiovascular disease specifically compared with never drinking."

"the report partially attributes only 17% of these estimated deaths to moderate drinking. Of the 609,820 cancer deaths in 2023, this would mean moderate drinking contributed to 3,400, or about 0.6%. Dr. Murthy’s claims about alcohol’s cancer risks are misleading"

See also Alcohol and Health: Cutting through the noise on drinking by Emily Oster. Excerpts:

"(What we do not know) Most other things. In particular, we do not (in my view) have good data on the relationship between alcohol and health at lower levels of drinking.

The reason for this gap is that alcohol consumption is associated with many other features of people, and nearly all of our analysis of the relationship between alcohol consumption and health is based on observational data. The people who drink alcohol are different from those who do not, and sussing out causality from that kind of data is just, simply, hard. And I will note: in this case, it’s not even obvious what the direction of the bias is. Light drinking tends to be associated with some positive health behaviors and some negative ones.

There is an enormous amount of scholarship about this link, using data of this type. The most comprehensive study of it was published in The Lancet in 2018. This is a truly extraordinary work of scholarship, as the authors combine virtually every study of the link between alcohol and long-term health and try to draw conclusions."

"it’s all from studies that individually have problems. One is sometimes given the sense that if you combine many studies, that somehow fixes these issues, but it doesn’t. Adding more studies increases the statistical precision of your estimates; it doesn’t fix the bias. If all the individual studies are biased, their average will be biased too."

"In all of this, there is a lot of “it could be” or “it might be.” But there is not much “it is.”

What would it take to know more about the subject? Basically, a randomized trial. A single well-designed, randomized trial of light drinking would be head and shoulders above the evidence we have. And not too long ago, someone designed one and started it! You can see information on The Moderate Alcohol and Cardiovascular Health Trial here.

The design of this trial seemed reasonable, but the funding was from alcohol manufacturers. This appeared problematic for a number of reasons, and the trial was shut down shortly after it started."

"Most of our evidence on the health impacts of light drinking is very poor and difficult to learn from."