In one of his last official acts, Surgeon General Vivek Murthy has called on the nation to recognize the new risks associated with alcohol consumption. That could take many allies, several years, a label renewal and some lawyers.
On Friday, Murthy recommended an update to a decades-old generic surgeon’s warning printed on all alcohol packaging in the United States. He suggested the labels should look more eye-catching and warn users that drinking increases the risk of cancer.
By turning to alcohol as he ends his term as the nation’s top health educator, Murthy is placing a historically inert issue at the feet of a second Trump administration, including Robert F. Kennedy Jr., who has pledged to remove toxins from the nation’s health care system. to delete. food supply if confirmed as Minister of Health. Kennedy has said little about alcohol, but is concerned with long-term recovery; President-elect Donald Trump says he doesn’t drink because his brother died of alcohol addiction.
A new Congress will ultimately decide whether or not to consider Murthy’s request. In an accompanying report Released Friday, Murthy cites a growing body of research linking alcohol consumption to cancer, especially breast cancer in women. Although alcohol has been classified as a carcinogen by various health authorities for decades, much of the public is still unaware of its cancer-related dangers.
“The more alcohol consumed, the greater the risk of cancer,” Murthy writes in the report. “For certain cancers, such as breast, mouth and throat cancer, evidence shows that this risk may increase with around one or fewer drinks per day.”
Research shows that around 5% of cancer cases in adults over 30, and around 20,000 deaths per year, are due to alcohol consumption. A report from the National Academies of Science, Engineering and Medicine last month highlighted the link between even “moderate” alcohol consumption (one drink per day for women) and an increased risk of breast cancer. Other research has pointed to links between drinking and cancers of the oral cavity, pharynx, larynx, esophagus, liver and colorectum.
Will it stick in court?
Despite the toll — the Centers for Disease Control and Prevention estimates that 178,000 deaths are caused by excessive alcohol consumption each year — alcohol has not been a political priority.
The alcohol industry and its trade groups donate to both parties and race up and down the ballot. Many members of Congress also represent districts and states with alcohol manufacturers, distributors and retailers such as bars and restaurants. The alcohol lobby has a regular presence in Washington and has the financial backing of a giant industry to push favorable policies and quash unfriendly proposals.
(STAT has contacted major alcohol companies and trade associations for comment. The Distilled Spirits Council of the United States said in a statement: “The current health warning on alcohol products has long informed consumers of the potential risks of consuming alcohol. … it is the role of the federal government to determine any proposed changes to the warning statements based on the entire scientific research.”)
At the state and local level, alcohol industry representatives have opposed efforts to increase the price or reduce the availability of beverages. At the federal level, Trump cut alcohol taxes during his first term and Congress made them permanent. There appears to be little appetite to take on such a large industry, even as the new administration declares that it will “make America healthy again.”
The surgeon general’s urge, however, is different. It puts the science of alcohol and cancer on an important platform and has the potential to increase public awareness and build support for alcohol control regulation, experts say. State and local governments could even use Murthy’s advice as a legal basis for requiring alcohol cancer warnings at store checkouts or on billboards, said Thomas Gremillion, director of food policy at the Consumer Federation of America.
Murthy also recommended changing existing alcohol labels to make them “more visible, prominent and effective in raising awareness.” Researchers have criticized existing warnings as too boring, small and meek. They are easy to miss on many alcohol containers.
Congress has the power to redesign the warning labels by passing a law, or it could ask the Alcohol and Tobacco Tax and Trade Bureau to choose new wording and imagery, since TTB oversees alcohol labels.
“Every other day, consumers are confronted with alternating headlines claiming that alcohol is healthy or harmful. The science examining alcohol and health outcomes is complex, but the link between alcohol and cancer is one area where the evidence is clear,” said Eva Greenthal, senior policy scientist at the Center for Science in the Public Interest. Greenthal is an advocate who has pushed federal regulators to strengthen alcohol labeling and add nutritional information. Currently, only alcoholic products regulated by the Food and Drug Administration are required to list ingredients, calories and other nutritional information.
Bruce Scott, president of the American Medical Association, praised Murthy’s decision in a press release, saying, “For years, the AMA has said that alcohol consumption at any level, not just heavy drinking or addictive drinking, is a modifiable risk factor. for cancer. And yet, despite decades of compelling evidence of this link, too many in the public remain unaware of the risks of alcohol.”
Alcohol warning labels are among the policies recommended by the World Health Organization to reduce alcohol consumption in the population. For researchers, labels are among the best options for educating drinkers because they appear directly on the product – a “mini-billboard,” Stanford behavioral scientist Anna Grummon calls it. They could have similar effects as label warnings about unhealthy foods, as the FDA has done consideringor as warnings on tobacco products.
How well could they work?
Tobacco is a parallel in more ways than one. In 2020, the FDA ordered nearly a dozen different graphic warnings to be placed on cigarette packages and advertisements. Tobacco companies Philip Morris and RJ Reynolds sued the agency over the rule, and the battle dragged on for years, delaying its implementation. Alcohol companies can decide to question cancer warnings on First Amendment grounds, says Grummon, director of the Stanford Food Policy Lab.
Companies are given the same right as individuals to exercise freedom of expression, including by advertising products. As a result, public health rules must be carefully drafted.
This is where the Reynolds case is particularly relevant. In March, a 5th Circuit Court of Appeals judge upheld the FDA’s warning label regulation, overturning a lower court’s ruling. The labels will go into effect in the coming months, putting the U.S. on par with countries in Europe and elsewhere that already slap hard-to-miss images and language on cigarette packs. Reynolds was “an important signal that warning policies can deter lawsuits,” Grummon said.
Advocates often tout tobacco warning labels as a success story, but they admit that those warnings were accompanied by a powerful mix of smoking laws, tax increases and massive social changes that sharply reduced tobacco use in the U.S. after 1966. Alcohol is a completely different story. story. It is still a popular and widely used product, despite declining sales trends and minor shifts in public opinion. Alcohol is more affordable to the average worker today than it was decades ago, and more ubiquitous.
Compared to policies such as higher taxes and lower sales, the evidence behind alcohol warning labels is slim. It is still unclear how many warnings impact long-term alcohol consumption, and which consumers are most affected by the message. Some research suggests that warnings are effective in reaching people who drink heavily, but researchers don’t know exactly how receiving a warning affects drinking patterns.
“Consumers have the right to know about the risks of alcohol, regardless of whether they decide to change their drinking habits,” researcher Marissa Hall told STAT. Hall studies alcohol labels at the University of North Carolina’s Gillings School of Global Public Health.
In one of the few real-world experiments with warning labels, researchers in Canada’s Yukon Territory found that retail sales of alcohol per person fell 6% during the trial. Sales of alcoholic products with warning labels fell by 6.6% in the target area and increased more than in areas without labels. They found that sales remained lower even after the experiment ended and the labels returned to normal. (The study received a lot of media attention, which may have changed the results.)
More recent data published in the July Lancet Public Health, alcohol labels with a message about cancer risk increased participants’ knowledge of the link, and were rated the highest of six labels for impact and relevance. The study asked more than 19,000 people of drinking age in 14 European countries about their perception of different label messages. Cancer warnings with a picture of a patient were rated as less acceptable and made people avoid the labels.
In another recent one study Using more than 2,000 U.S. participants of drinking age, researchers tested which alcohol warning topics were most likely to reduce alcohol consumption. Of the sixteen topics, warnings about cancer were the most motivating for consumers.
Researchers say the most effective labels are large, colorful, eye-catching, and have varying messages to prevent consumers from becoming desensitized to them.
Whether or not Congress decides to adopt Murthy’s recommendation, how lawmakers implement a makeover — and how potential legal challenges determine its direction — will be critical. These factors will determine the extent to which a new warning changes public perception of the risks of alcohol, and whether drinkers change their ways.
STAT’s coverage of chronic health conditions is supported by a grant from Bloomberg Philanthropies. Us financial supporters are not involved in decisions about our journalism.