'Big Alcohol' Deliberately Downplays Cancer Risk

Kristin Jenkins

September 18, 2017

Global alcohol producers are deliberately misleading the public and policymakers about cancer risks associated with alcohol, particularly breast and colorectal cancer, to protect profits at the expense of public health — just like Big Tobacco did, say researchers.

Qualitative analysis of all text related to cancer found on websites and in documents from 26 alcohol industry organizations shows that most of the information extensively misrepresents evidence about the association between alcohol and cancer, says Mark Petticrew, PhD, professor of public health evaluation in the Faculty of Public Health and Policy at London School of Hygiene and Tropical Medicine, United Kingdom, and colleagues.

A total of 24 organizational websites contain significant omissions and/or misrepresentations of the evidence linking alcohol to increased risk for many cancers, the study authors say in a report published online September 7 in Drug and Alcohol Review.

"It has often been assumed that, by and large, the AI [alcohol industry] unlike the tobacco industry, has tended not to deny the harms of alcohol," the investigators write. "Our analysis shows that, on the contrary, the global AI is currently actively disseminating misinformation about alcohol and cancer risk, particularly breast cancer.... The full scale and nature of these activities requires urgent investigation."

The study demonstrates that the alcohol industry and its communications partners or SAPROS (social aspects and public relations organizations) encourage "responsible drinking" using the three Ds: denial, distortion, and distraction. These strategies parallel those of the tobacco industry and allow alcohol producers to maintain "the illusion of rightness" with policymakers while eliminating any significant negative impact on consumption or profits, the study authors say.

"The most obvious parallel is with the global tobacco industry's decades-long campaign to mislead the public about the risk of cancer, which also used front organisations and CSR [corporate social responsibility] activities to mislead the public," the authors write."Our findings are also a reminder of the risk which accompanies giving to the AI the responsibility of informing the public about alcohol and health."

Even low levels of alcohol consumption are associated with an increased risk for at least seven types of cancer (oral cavity, pharynx, larynx, esophagus, liver, breast, and colorectal cancers), the investigators say, noting that the alcohol industry uses denial or omission to dispute this. Distortion tactics mention cancer but misrepresent the actual risk, and distraction is used to veer the message away from the independent effects of alcohol on common cancers, especially breast cancer and colorectal cancer.

Unlike the tobacco industry, large global producers of alcohol still have access to government health departments and retain partner or stakeholder status at World Health Organization meetings about international health issues relevant to alcohol, Dr Petticrew and colleagues say.

"The alcohol industry is involved in developing alcohol policy in many countries, and in disseminating health information to the public, including schoolchildren. Policymakers, academics, public health and other practitioners should reconsider the appropriateness of their relationships to these AI bodies."

When asked to comment, Tim Stockwell, PhD, director of the Centre for Addictions Research of British Columbia and professor in the Department of Psychology at the University of Victoria, British Columbia, Canada, agreed. "I echo comments by the authors that they have likely only examined the tip of the iceberg of undue alcohol industry influence on public information about alcohol and health," he told Medscape Medical News. "I'm personally not surprised by these findings as I have witnessed first hand efforts to deny, distort, or just downplay evidence for alcohol's negative impacts on health by senior representatives of alcohol industries in several countries, and also of international alcohol industry bodies."

An ever-expanding arsenal of social media and influencer strategies, such as funding "independent" think tanks and university research, and working to get a seat at national and international policy tables, has allowed the alcohol industry to exert "undue influence on public information about alcohol and health," said Dr Stockwell, who was not affiliated with the study.

"The net effect of these activities justifies the point of view that the alcohol industry itself is a threat to public health and safety. A shorthand would be to say when thinking about 'big alcohol,' think 'big tobacco' when viewing resources produced by drinks industry bodies," he suggested.

A better term is 'low-risk drinking' as this acknowledges the fact that even light drinking is a risk factor for cancer. Dr Tim Stockwell

There is no such thing as "responsible drinking" when it comes to the long-term health consequences associated with alcohol consumption, he added. "A better term is 'low-risk drinking' as this acknowledges the fact that even light drinking is a risk factor for cancer."

Information About Alcohol Consumption

For their analysis, the investigators identified all information on cancer and alcohol consumption from the Global Alcohol Producers website and its progress reports, from September through December 2016. They also looked at all health-related content in the CSR sections of 27 alcohol producers' websites. One website was inaccessible, so 26 underwent analysis.

They found that five alcohol industry organizations denied an association between alcohol and at least one type of cancer. Information provided by The International Alliance for Responsible Drinking (IARD), for example, states that "Recent research suggests that light to moderate drinking is not significantly associated with an increased risk for total cancer in either men or women." Similarly, Éduc'al- cool (Quebec, Canada) declared that "Some studies show a link between alcohol and breast cancer among both pre-menopausal and post-menopausal women. However, no causal relationship has been shown between moderate drinking and breast cancer."

To distort from the link between alcohol and cancer risk, 12 of 20 SAPROs claimed that the risk for some common cancers exists only for certain patterns of drinking behavior, such as prolonged heavy drinking or binge drinking. The website DrinkWise (Australia) states that: "Cancer risk associated with the consumption of alcohol is related to patterns of drinking, particularly heavy drinking over extended periods of time," for instance. The IARD website makes similar statements, such as "In general, alcohol-associated cancers have been linked with heavy drinking."

Eight of the SAPROS websites use distraction to focus discussion away from the independent effects of alcohol in increasing the risk for common cancers, the study shows. On its website "TalkingAlcohol.com," for example, SABMiller appears to imply that alcohol is associated only with less common forms of breast cancer: "Recent studies indicate that alcohol consumption may be more strongly linked to a certain less common form of breast cancer (lobular cancer), than it is to the most common type of breast cancer (ductal cancer)."

Some alcohol companies even go so far as to claim that alcohol consumption is protective against cancer, particularly in smokers. The SABMiller website states that moderate alcohol consumption can be linked to lower risk for bladder, kidney, ovarian, and prostate cancer, the researchers point out. In addition, IARD insists that "Among long-term smokers consumption of alcohol has been shown to be protective against colorectal adenomas."

The two most frequent areas of misinformation focus on breast cancer and colorectal cancer, the study authors point out. A total of 21 organizations present no or misleading information on breast cancer, and 22 present no or misleading information on colorectal cancer, they say.

While the breadth of the study strengthens its generalizability, its main weakness is the fact that it didn't examine other mechanisms of disseminating health information, such as through Twitter, or at meetings and in advertising campaigns. "It seems implausible however that industry would adopt different messaging regarding cancer through other outlets, though this is an important issue for further research," Dr Petticrew and colleagues write. "It is also possible that these industry sources misquote or present out of context, expert opinions or other commentary which they include."

Also needed is further analysis of citation bias through "cherry picking" of evidence by the alcohol industry, as is careful monitoring of information produced by new alcohol industry bodies, such as the Alcohol Information Partnership. Other industry websites, documents, social media, and other materials also must be examined "to assess the nature and extent of the distortion of evidence, and whether it extends to other health information—for example, in relation to cardiovascular disease. Comparative research across industries and with other areas of alcohol policy to examine industry distortion of evidence is also needed."

Explicit Health Warnings Needed

Dr Stockwell recommends that priority be given to limiting "the dangerous influence of alcohol industry groups on public communications about alcohol" by ending government funding and collaboration with industry front organizations. Alcohol industry groups should be required by law to provide explicit health warnings and public declarations of conflict of interest on any health information they provide, and clinicians should be extremely careful about where they get their information on alcohol, he says.

Alcohol in alcoholic beverages is recognized as carcinogenic and that there is no safe level. Dr Tim Stockwell

Prominent health messages should be placed on all alcohol containers, and these messages should include information on the multiple health risks associated with even moderate alcohol use, he added. "The notion that the alcohol in alcoholic beverages is recognized as carcinogenic and that there is no safe level should be part of that information," he told Medscape Medical News.

Clinicians must pay close attention to their sources of alcohol-related health information, accepting only impartial, independent sources that ideally are peer-reviewed and are not attached to any funding from commercial interest groups, Dr Stockwell advised. Clinicians also need to remain skeptical when "good news" is presented that downplays the risks or emphasizes the potential benefits of alcohol, and to be aware of their own "wishful thinking" when it comes to alcohol, he cautioned.

"There is a tendency within the medical profession to underestimate the health effects of alcohol, and there is indeed considerable evidence that the medical professions are often themselves at high risk of alcohol-related problems," he said.

The good news is that clinicians can play a vital role in addressing the impact of misleading messaging about alcohol and cancer risk. Evidence shows that patients are most likely to accept advice about their drinking behavior when it comes from a physician or other health professional, Dr Stockwell pointed out. "There is good evidence that even simple advice to reduce consumption can be effective, especially if this is followed up at future consultations," he said.

Advice about low risk or no drinking should be part of routine cancer treatment programs. Dr Tim Stockwell

Proactive measures, such as screening patients for behavioral risk factors (eg, alcohol consumption), are also key, particularly in patients with an increased risk for serious disease or those who have already been diagnosed. "There is evidence that alcohol consumption can increase the rate of growth of tumors and so advice about low risk or no drinking should be part of routine cancer treatment programs," Dr Stockwell noted.

The study authors and Dr Stockwell have disclosed no relevant financial relationships.

Drug Alcohol Rev. Published online September 7, 2017. Abstract

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