Alcohol should have cancer warnings, say researchers pushing to raise awareness | Hacker News Reader

Alcohol should have cancer warnings, say researchers pushing to raise awareness

cbc.ca

68 pointsbrimnes24 comments

If the medical community wants to gain my trust in their cancer judgements they can start by analyzing the cancer risks of the tens of thousands of chemicals that are used every day in our lives and to which we are exposed. PFAS, PFOS, insecticides, Purell (which is alcohol, does it cause cancer?), cleaning agents, food additives, tar coal oils, benzene in cigarette lighter butane and gasoline, plasticizers, skin lotions, fragrances, titanium dioxide (used in food, do you like eating metal catalysts?), and all the rest, separately and in combinations. All ignored for decades. If they can sequence DNA they can test all these substances for harm. Don't tell me it's too difficult, get cracking and you'll finish sooner. And now they want to convince me one particular chemical, widely used for millennia is the cause of a 50% increase in cancer risk? What's that 50% applied to? A 0.01% base risk? Where does all the base risk come from and is it greater than the risk from alcohol? Is it the combination of other chemicals and alcohol that raises cancer risk? Nuclear fallout from atomic bomb tests is still in everything across the world. Silica dust from Africa is in our air. Air pollution from ICE engines is everywhere, layered for decades in the soil along with the lead that used to be in gasoline. What's the risk from that? Why don't we have warning labels on gasoline pumps, and cars, and cities, and plastics? Should everyone be suing the USA, Russia, and China for above ground nuclear tests and the car makers and oil producers for polluting the air? There are unavoidable risks from radiation from space and the radiation in the soil and rock varies by locality so where you live may be a bigger determinant of cancer risk than what you drink. The medical research community just doesn't have much credibility when it comes to cancer causes. Particularly after the Surgeon General did nothing except a few press releases for decades about cigarettes. Stop doing all those useless, underpowered, non-blind, studies that even researchers don't trust and start putting some effort into finding cures and doing real research instead of only looking for drugs that have minor effect and are a burden on the economy. /rant

This is not a good take. If you care whether or not the list of chemicals you provided are cancerous, then you are free to study that yourself or support scientists that do study it. Just because a group of scientists chooses to study something you're not interested in doesn't mean that you can discount their work as "untrustworthy." Well you can, but it would be to your, and society's, detriment.

I think this is exactly the problem with the medical research community, they study what they choose to study, not what is important to study. This is a well known problem with research in general, researchers choose the easy problems and the profitable problems, while the hard problems get ignored for decades. Mapping DNA was considered too hard, until someone actually tried to do it, and now it's common. The research that is ignored (because it is thought too difficult, is too political, doesn't fit with researchers idea of morality, is not in the interest of big pharma, or would disrupt profitable empires) is what drives my lack of trust. In particular, the opinions described in this article seem like blatant victim blaming instead of any serious attempt to reduce harm from something that is never going to disappear from society given it's greater than ten thousand year history.

> ...they study what they choose to study, not what is important to study.

...

> In particular, the opinions described in this article seem like blatant victim blaming instead of any serious attempt to reduce harm from something that is never going to disappear from society given it's greater than ten thousand year history.

Isn't it good to challenge even established consumption, despite many not want wanting to, since such research has great potential to reduce harm?

Tobacco is a widely established product, yet because of research and education society is changing to reduce harm.

The article says nothing about how much harm would be reduced, it just states a vague 50% increase in cancer risk without stating what the baseline is and what that risk means in relation to all the other cancer risks. And there has apparently been no study of the harm that might be caused by reducing alcohol use. If alcohol use was reduced would fewer babies get born? Would people be less creative? Would there be less fun in the world? Would everyone concentrate more on being mean to each other to get ahead? Would the experience of life be even more frustrating? Anecdotal, but the meanest people I've ever met never drank. What is the harm of removing a "social lubricant"? Does it mean society runs less smoothly?

The people in the article are saying the public is not aware of the risk. But who is responsible for informing society of medical risks? The medical community! They say it's all the fault of the liquor industry, but they can give medical advice to all their patients and the liquor industry can do nothing about it. So why haven't they been informing everyone of this risk for decades? Almost everyone in the USA sees a doctor at some point, yet nobody has heard of this cancer risk? It seems to me they are to blame here for the lack of information. Yes, informing people of risks can be helpful. But it also has to be in context. Is driving a car a bigger risk than drinking? Then we should be putting warning labels on cars. Is air pollution a bigger risk than drinking? Then we should be warning people to move out of cities. Yet the medical community has ignored environmental concerns for decades. When was the last time a doctor recommended a standard test set to you to check your home environment for toxins? Never! I think these blindnesses on the part of medicine undermine trust in what they recommend.

I don't think it is research and education that changed society with respect to tobacco. Everyone knew the tobacco companies were lying. Plus the ill health effects of tobacco are obvious, people start coughing all the time. I think people themselves saw how their grandparents died and that is what changed them.

If the medical community wants to reduce harm by changing consumption they can start with better and more detailed advice on food, naming specific brands. For alcohol they could also say whether or not congeners have an effect on disease including cancer (is brandy different than vodka?) They could recommend replenishing B vitamins and rehydrating, study if that has an effect on cancer, which could be much simpler than stopping people from drinking. Yet you won't hear any such advice from a doctor. There has been an unspoken moral dimension to medicine for hundreds of years. Early research into reducing debilitating effects of alcohol was discouraged because "if we had a cure for alcohols bad effects people would be encouraged to drink more". They didn't study whether that was true, they just pronounced judgement. Doctors gave less pain killers to black people because they "believed" they had a higher pain tolerance, no studies involved. The flu, colds, and COVID-19 are spread by fomites they said, studies say they are spread by aerosols, and many in the medical community still don't believe aerosol spread is a problem (there are still recommendations for distancing rather than ventilation). There is a big dogma problem in medicine that is unacknowledged, it propagates unscientific beliefs from long ago. And when medicine fails I think it tends to blame the victim because of that dogma. This is playing out right now with obesity. Medicine says just eat less, it's a personal choice. But we're finding out it is not that simple. I think the same is true of alcohol. For example, there is not one word in this article about tapering drinking (because a sudden halt can cause harm). If they wanted to inform people of the risks to reduce harm why didn't they mention that risk? If this article causes people to quit drinking it may actually be doing harm by killing them.

Another aspect to this all is the apoliticalness of medicine. It has avoided confrontation with power for centuries. If power trumps medicine, what can you believe about what medicine says? This timidity was a survival characteristic, along the lines of do whatever the man with the spear says in the hope he'll let you save some of the people. The medical community has never overcome this even as society has changed. Fauci went along with Trump in the early days, rarely contradicting him, as an example. I think this has to change. Maybe this article is an outbreak of such courage. It seems long on condemnation and short on actual harm reduction though.

So here's some actual data:

https://pubmed.ncbi.nlm.nih.gov/16264180/

that says:

"The absolute rate of ER+ breast cancer (standardized to the age distribution of person-years experienced by all study participants using 5-year age categories) was 232 per 100,000 person-years among women in the highest category of alcohol intake, and 158 per 100,000 person-years among nondrinkers."

Sounds bad, a 50% increase in relative risk. Say most people live 80 years. So (158/100,000) * 80 = 0.1264 absolute risk. Do the same calculation for drinkers: (232/100,000) * 80 = 0.1856 The difference is 0.1856 - 0.1264 = 0.0592

So your absolute risk of getting breast cancer in your life is 12.64% if you are a woman and don't drink. If you drink that risk goes up 6%. The article doesn't say that, instead quoting only the relative risk increase of 50%. 50% sounds scary, does 6% sound so scary? Alcohol is one of the many risk factors for breast cancer, here's a list of all of the known ones:

https://www.breastcancer.org/risk/factors

Alcohol is lower on this list than radiation, being overweight, not experiencing pregnancy, not breastfeeding, and using hormone replacement therapy. Driving a car as a teenager is probably a bigger risk of death than getting breast cancer from drinking.

I'm all for meaningful harm reduction, but this article seems more like moral propaganda without a serious focus on all types of harm reduction for drinking or a statement of the absolute risk. I don't think a warning label would have much effect either, there is already a warning on alcohol that says "make cause health problems" and that is not stopping drinkers. If the label told the truth and said something like "drinking alcohol may cause a 6% increase in your risk of cancer, probably near the end of your life" would people pay much attention? Has anyone done a study to see if such a warning would have any impact at all or are these people just assuming it would have an effect? How many people ignore the California cancer warnings?

> When was the last time a doctor recommended a standard test set to you to check your home environment for toxins? Never!

Actually this happens pretty often with radon gas and mold tests. There are even regulations for testing when selling homes in some places.

Rules requiring better informing consumers doesn't seem too onerous to me.

True, but probably not something your doctor would tell you to do, and those tests don't even begin to address all the environmental factors that could be tested for that could affect health. One thought I've had is that everywhere in America with old industry should be tested for toxins, for example all of Eastern Massachusetts. In the old days bad stuff was just poured out in the woods and is probably still sitting there today. Waiting till it shows up as increased health problems in a particular geographic location doesn't seem proactive enough. Your doctor should ask for a PM2.5 count from your home, as well as a measure of organic volatiles, noise levels, allergens, CO2 levels, an air sample to put into a gas chromatograph, a soil sample to analyze, and more to know how your environment could be affecting your health. It wouldn't have be done often, but as a new patient it should be one of the first things done. Hell, even when geographically located disease is obvious like near the chemical refineries in Texas little is being done by the medical community and they certainly are not asking for environmental tests for industrial byproducts.

Rules requiring better informing citizens are good. I'd like the warnings to be proportional to the risk though, and I'd rather see the risks studied and reduced rather than just a warning meant to alter human behavior. Medical warnings often seem like EULA's, everyone pays no attention to them and clicks through. If there was instead a warning that described how to reduce risk, and where the worst risks are, and how to mitigate some of the risk, maybe people would pay more attention.

I'm curious, what do you do for a living? Do you not do what you choose to do, rather than what is of the most importance? Many people on HN work at Google, for instance. Is an ad-tech really the most important issue facing humanity? The "research community" isn't a single organization that is gate kept by a centrally planned authority. It's comprised of individuals and organizations of varying sizes, all operating independently. You are free to join the research community yourself and study the things you think are important. Most people I know don't choose their jobs based on what is most important, but rather what fits their lifestyle, what is most lucrative, etc. These people still do good work and are trustworthy.

Alcohol isn’t healthy, but other things aren’t either, so why warn for alcohol usage? Doesn’t sound like a good idea to me. Chances are that applies to all other things you mention, too.

Also, FTA: “moderate alcohol consumption has been linked to an approximate 30 to 50 per cent increased risk of breast cancer”. Even if the real number is only 5%, that doesn’t look like “only looking for drugs that have minor effect” to me.

The absolute number is probably closer to 5%, so yes there is an effect and it increases harm some. As you say I wanted to see them also mention the context in terms of how that harm stacks up against all the other causes of cancer and why this particular harm, which is fairly small, is worth singling out when there seems to be no issue with other harms of a similar magnitude. The "only looking for drugs that have minor effect" was more of a broadside rant, saying that a lot of medical research does indeed just look for marketable drugs and doesn't address root causes of disease. That is in part because grad students do a lot of the research and they need to graduate on time so they pick easier research problems. Certainly there is some good research going on, I've been involved in some medically related research myself on human behavior change using wearable devices. I guess what irks me here is that the article seems more like propaganda than a true assessment of harm and risk. The use of relative risk numbers rather than absolute risk, the alarm, the ignoring of other factors that are also relevant, and the lack of any showing that their solution would do any good. So they have come up with a solution that probably would only have minor effect, they haven't studied the impact of their solution and what harm it might cause, and their numbers are biased towards sensationalism. Maybe the minor effect would be worth it, but the USA government makes life and death decisions quite often where 5% is treated as a rounding factor so I'm not seeing a cause for alarm here. I can't see this as a reason to start a national campaign to reduce or eliminate all drinking either. What really irks me is that I don't think the NIH will fund much serious research into all the various aspects of alcohol, despite the widespread use. Instead they keep funding behavior change studies, all of which tend to show very minor success. It's similar to obesity, they say "just don't ingest it", but they ignore the addiction, the social aspects, the specific body effects, the biochemistry, and just are not looking to solve the basic problems, instead concentrating on trying to change behavior, which has not worked very well.

This the link for HN discussions that I've posted yesterday regarding the anomaly of much lower cancer rates among Middle Eastern people despite their high consumption of sugar compared to other countries such as European countries, USA and Australia[1]. You can download the presentation slides from the link as well in addition to the video. The research is not that scientific but I think it's a good start.

TLDR, less or no alcohol consumption is considered one of the main reasons for the anomaly in addition to fasting, etc. My first thought when I saw the video is that the main reason is the alcohol because majority of the population in Middle Eastern countries are Muslim and alcohol is strictly prohibited in Islam.

[1]Why Does the Middle East Have the Lowest Cancer Rates in the World:

https://news.ycombinator.com/item?id=29852556

Interesting that the article states repeatedly that there is zero safe level of alcohol when it comes to cancer.

A lot of food we eat contains small amount of alcohol, bread in particular. Vinegar, fruits and juices too. And generally, we are well equipped to deal with it, and it only starts to become problematic when we start to run out of the required enzymes and are left with the toxic byproducts that cause hangovers.

If the threshold is zero, it means that even "safe", easily metabolized alcohol is a problem and we should find correlations even between non-drinkers based on diet.

I previously read an article about alcohol and safety, which made a similar claim. The lowest level of alcohol consumption in their data was two drinks a day. They had no idea if there was a safe amount below that.

I'd assume it's a talking point that activists have adopted.

Probably they're not even considering quantities that are much less than a single drink.

When they say the threshold is zero they mean they haven't identified any specific amount below which there stops being any effect, but the effect is still dose dependent so the effect from incidental consumption is negligible and undetectable (except maybe statistically if there are large populations that are identical except for consuming or not consuming then).

This is in the context of debate over whether some harmful things like radiation or ingestion of heavy metals go linearly to zero or of there is a specific threshold below which they suddenly stop being harmful.

It doesn't mean that all quantities of alcohol are equally harmful.

> "Alcohol has been classified as a Group 1 carcinogen (carcinogenic to humans) for decades by the International Agency for Research on Cancer. It's right up there with tobacco and asbestos."

Other Group 1 carcinogens [0]:

- processed meat

- Salted fish, Chinese-style (?)

- solar radiation

- outdoor air pollution

- wood dust

- leather dust

A big problem with that CBC quote is that there is no way everything in Group 1 has the same (or even approximately the same) risk of causing cancer. How could eating cold cuts from a deli be equivalent to smoking a cigarette or inhaling mustard gas?

> The risk of dying from lung cancer before age 85 is 22.1% for a male smoker and 11.9% for a female smoker, in the absence of competing causes of death. The corresponding estimates for lifelong nonsmokers are a 1.1% probability of dying from lung cancer before age 85 for a man of European descent, and a 0.8% probability for a woman.[1]

*This* is the kind of smoking gun they should be showing; ~20% increase in the chance of dying from lung cancer for men who smoke. How much does alcohol increase chances of dying from cancer?

0 - https://en.wikipedia.org/wiki/IARC_group_1

1 - https://en.wikipedia.org/wiki/Health_effects_of_tobacco#Canc...

Looks like about 4% of all cases of cancer can be attributed to alcohol consumption:

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...

Not the leading cause, but significant, especially when considered along with the other health based harms.

Doesn't everything in California have a cancer warning? They're meaningless.

Money maker for lawyers. You get a fee if you find non-compliance.

As with most things. Follow the money.

Is more comprehensive labeling and related regulations a strategy for incumbents to further solidify their monopolies?

Seems like the industry wasn't a fan when the Yukon government tried warning labels: https://www.cbc.ca/news/canada/north/yukon-alcohol-warning-l...

Is there a scientific consensus on 0.1g-7g/week of alcohol causing cancer? I know there are studies that exclude former drinkers in the reference group that purport it, but it's not clear to me.

And I have not seen studies that show <7g/week of wine drinking causing cancer.

7g of wine at 15% would be ~1.15g of alcohol. This does fall in the range but we should pay attention to the specificity of being alcohol and not alcoholic beverage

No, it shouldn't! It's all about the dose. Drink too much water and you're dead!

Reply on news.ycombinator.com