Wednesday 16 October 2019

Does the alcohol industry encourage pregnant women to drink? Four idiots investigate.

It is with a heavy heart that I must inform that Mark Petticrew is at it again...

Alcohol industry 'puts pregnant women at risk', researchers say

Alcohol firms and bodies they fund are encouraging women to drink in pregnancy – putting their unborn child in danger – by publishing false and misleading information about the risks involved, new research claims.

The study is here. It is a follow-up to this discredited effort by Petticrew and three colleagues who claimed that the booze industry 'appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer.' Ironically, that study was based on some extensive misrepresentation, not to mention shameless cherry-picking and selective quotation.

Now he and three fellow cultists are back with a study that makes the unlikely claim that the alcohol industry is actively encouraging pregnant women to drink because (don't laugh)...

...women are a crucial part of the alcohol market, as has been pointed out in relation to alcohol consumption and breast cancer risk (Connor, 2017). Pregnancy, therefore, may represent a significant commercial threat...

Hmm. So what's the evidence that alcohol companies are encouraging pregnant women to drink?

Several alcohol industry–funded websites appear to emphasize the scientific uncertainties regarding safe levels of drinking.

There is a great deal of uncertainty about safe levels of drinking during pregnancy. A few years ago, the UK government amended its advice. Having previously advised woman to avoid alcohol in the first trimester, it now advises pregnant women 'to not to drink alcohol at all to keep risks to your baby to a minimum.'

This is the precautionary principle in action, however. It does not reflect any solid evidence showing risk to the baby from light drinking.

As a recent systematic review concluded...

This review demonstrates the paucity and poor quality of evidence addressing this important public health question... In conclusion, we found limited evidence for a causal role of light drinking in pregnancy, compared with abstaining, on most of the outcomes examined. Despite the distinction between light drinking and abstinence being the point of most tension and confusion for health professionals and pregnant women and contributing to inconsistent guidance and advice now and in the past, our extensive review shows that this specific question is not being researched thoroughly enough, if at all. In addition, there has been no evidence regarding possible benefits of light alcohol consumption versus absence.

And even Petticrew admits at the end of his new study that....

...we emphasize that there are indeed uncertainties and complexities in the area of alcohol and health, not the least in defining the benefits of risks and harms from “light” drinking

It is perfectly acceptable for the authors of the systematic review to 'emphasize the scientific uncertainties regarding safe levels of drinking', but when organisations that get funding from the alcohol industry do it, they are supposedly encouraging pregnant women to drink.

But do they even do that? This is the first example Petticrew cites to make his case:

The International Alliance for Responsible Drinking (IARD), an alcohol producers’ “responsible drinking” body, appears to emphasize uncertainty regarding “safe” limits by publishing a table that details “drinking guidelines for alcohol consumption by women who may become pregnant, are pregnant and are breastfeeding issued by government bodies in various countries.” The table shows national guidelines from Albania to Vietnam, with no accompanying explanation.

You can visit the webpage here. It is literally just a list of the advice given by various governments worldwide, presumably so people who live in those countries can find out what their government recommends. What kind of 'accompanying explanation' is required? Alas, Petticrew et al. don't tell us because they move on to their next killer example...

Lack of consensus is also highlighted by Brown-Forman, which references the “ongoing debate about whether there is a ‘safe’ level of consumption during pregnancy, or during certain time frames of a woman’s pregnancy.”

So what?

The word debate is commonly used elsewhere in alcohol and tobacco industry narratives to imply that scientific evidence is simply a matter of debate or opinion among scientists

Are you kidding me? 'Debate' is commonly used to describe a debate, of which there are many in science and none in the dogmatic world of 'public health' activism.

DrinkWise also states that there is “confusion about how much one can safely drink during pregnancy”—with the added apparent implication that such a safe level exists.

A fevered mind might infer that. Most people would not. I doubt anyone of sound mind could look at the DrinkWise webpage and see anything other than unequivocal advice to avoid alcohol when pregnant or when trying to conceive.

In any case, the statement above does not come directly from DrinkWise. They are quoting Alec Welsh, a professor of fetal-maternal medicine, who I dare say knows a bit more about the subject than Mark Petticrew and his 'public health' pals.

Some wording appears to imply that alcohol is safe—but has not yet been proven to be so. For example, Diageo’s DrinkiQ website states that “research has yet [emphasis added] to establish a ‘safe’ amount to drink during pregnancy,”.. The language in the first clause of this sentence implies that there is a completely safe limit, which simply has not yet been identified.


They then quote Quebec's Educ’alcool Canada...

"The scientific community believes [emphasis added] that abstaining from drinking is the safest choice.” This appears to be an example of industry “mixed messages.” The word believe (like the word debate) may also imply that that this message is based not on evidence but on ideology.

The evidence is clearly insufficient to say that the case either way is proven beyond doubt. This applies to all claims based on observational epidemiology, incidentally. Evidence is built up until the case is made beyond reasonable doubt, but that still requires interpretation and, yes, belief. Causation can never be proven in epidemiology, and in this instance we don't even have good correlations. That doesn't make it a matter of ideology - whatever that is supposed to mean - it makes it a matter of opinion. Or, if you will, belief.

We noted that on some websites the positioning of the information on the webpage appears to dilute its importance and/or present mixed messages. For example, on the Drinkaware website, the sections on pregnancy appear on the webpage titled “Health effects of alcohol.” The page has 45 sections, of which the last four are sections on pregnancy, breastfeeding, FAS, and fertility, requiring the user to scroll down approximately nine pages to access the information

This is desperate stuff. Firstly, who measures a single webpage in terms of pages? You scroll down to find what you need (try it).

Secondly, it is perfectly reasonable to put information that is only relevant to half the population for a fraction of their lifetime towards the bottom.

Thirdly, Drinkaware has a whole webpage dedicated to alcohol and pregnancy which comes up in the first page of listings when you Google 'alcohol pregnancy'. On that page you are told...

Not drinking alcohol is the safest approach

Drinking alcohol at any stage during pregnancy can cause harm to your baby and the more you drink, the greater the risk. This is why the low risk drinking guidelines advise pregnant women that the safest approach is to not drink alcohol at all during pregnancy.

If you’re pregnant or think you may become pregnant, you’re also advised not to drink.

This, apparently, is the alcohol industry [sic] encouraging pregnant women to drink. It's laughable.

Organisations affiliated with the drinks industry cannot win, no matter what they do. If they don't provide information, Petticrew accuses them of using a 'strategy' which is...

.. part of a wider set of industry tactics that includes manipulating the evidence base, lobbying, and constituency building (forming alliances with other sectors, organizations, or the public to give the impression of larger support for the industry’s position)

But if they do provide information, he says...

More generally, the alcohol industry involves itself in providing health information because it can then can portray itself as “part of the solution” and therefore play a greater role in the regulatory landscape. This echoes strategies adopted by the tobacco industry when it was faced with the growing, unequivocal evidence of the harms of smoking.

I really don't know how this rubbish gets published, even in a low quality journal.

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