Wednesday 10 January 2018

Cancer warnings on alcohol are unjustified

As reported in the Guardian, the Alcohol Health Alliance is concerned that only ten per cent of Britons are aware of the link between drinking and cancer. They are demanding cigarette-style warnings on alcoholic beverages to remedy this. There are several reasons why this would not be a good idea.

The evidence that only one in ten people is aware of the alcohol-cancer link comes from a survey conducted in September 2017 which asked respondents to spontaneously name diseases that they associate with alcohol consumption. It might have been better to ask a question along the lines of ‘do you believe that drinking increases the risk of some cancers (yes/no)?’ If cancer risk was not front of mind when the respondents answered the survey, we should not be surprised. The cancers associated with drinking are mostly quite rare. The lifetime risk of dying from these diseases is mercifully small and, for people who drink moderately and do not smoke, the increased risk from alcohol consumption is trivial to non-existent.

The exception is breast cancer, which appears to be linked to drinking even at low levels – hence the Chief Medical Officer’s claim that there is no safe level of drinking – but the evidence for this has only appeared in recent years and there are reasons to be sceptical of it. Even if the statistical associations between moderate drinking and breast cancer are real and causal, the magnitude of risk is so small that it is unlikely to persuade many women to go teetotal.

Nevertheless, don’t people have the right to know about these risks? Don’t we free market liberals want informed consumers? Well, yes we do. The question is how we go about telling them. Britain is not California. We do not plaster cancer warnings on every product on the shelves. We do not demand health warnings on bacon, steak, french fries and ‘very hot drinks’, even though they have all been declared carcinogenic (or ‘probably carcinogenic’) by the International Agency for Research on Cancer.

Plenty of everyday products have been linked to cancer or can cause harm if abused. With the exception of cigarettes, we do not demand health warnings on them because the risks are not particularly great and there are plenty of other ways for people to get this information if they are interested. Indeed, there are ways for people to be given this information even if they are not interested. Public Health England spent a staggering £4.5 billion last year. The British taxpayer pays for an army of ‘public health professionals’. If they wanted to inform people about the cancer risks associated with drinking, they have the resources with which do so.

I am not against labelling per se. People have a right to know what they are buying and I am in favour of putting calorie counts on alcoholic drinks. But a functioning market does not require consumers to know every possible cost and benefit before they make a purchase, and it certainly doesn’t require every possible cost and benefit to be listed on the label.

Let’s be realistic about this. The Alcohol Health Alliance are not demanding cancer warnings on wine bottles because they want consumers to be fully informed. They want cigarette-style health warnings because they want to treat alcohol like cigarettes. They want every bottle and can to scream a message that ‘Alcohol causes cancer’ and ‘Drinking kills’ in order to deter people from buying the product. Moreover, they want these messages to be carried alongside graphic photographs of diseased livers.

This would not lead to the public being better informed. On the contrary, it would mislead people into thinking that the cancer risks associated with drinking were of the same magnitude as those associated with cigarettes.

What would an accurate health warning on alcohol look like? I tackled this question in my book, Killjoys:
The British public, we are told, are woefully ignorant about the link between alcohol and cancer, and labelling drinks with a cigarette-style cancer warning would be an effective way to spread the word. Perhaps it would, but the risks are so small in practice that such a system would either discredit scientific advice in the eyes of the public or alarm consumers to such an extent that they would make worse choices than if they remained ignorant. A truthful alcohol label would explain that associations have been found between alcohol consumption and several cancers, most of which are rare. It would explain risks in absolute, rather than relative, terms (e.g. ‘Heavy drinking increase your lifetime risk of developing disease X from Y per cent to Z per cent’). Finally, it would explain that moderate consumption of alcohol reduces the risk of heart disease, stroke and diabetes, and that premature death is less common among moderate drinkers than teetotallers, although heavy drinkers have a higher mortality rate than either.

Aside from the fact that this is too wordy to fit onto a bottle of wine, a label that explained the science adequately would make consumers better informed whereas a warning saying ‘alcohol causes cancer’ would lie by omission. A truthful label would probably have no effect on alcohol consumption other than possibly increasing it. It is questionable whether it is worth putting it on the bottle at all, particularly since the information is available from other sources for those who are interested. And yet it is only the verbose yet truthful label, not the crude cancer warning favoured by paternalists, that can be ethically justified if the aim is to inform rather than alarm.
The ‘public health’ lobby is not interested in educating people about the health effects of alcohol consumption. One only needs to look at its campaign of doubt and denial over the benefits of moderate drinking to see that. There is no more justification for putting health warnings on alcoholic drinks than there is for putting them on sausages.

Cross-posted from Spectator Health.

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