Public Health Community, Heal Thyself

We owe a debt of gratitude to the public health movement. Without its research and advocacy, we would not have learned to stop the spread of diseases that once killed millions, like smallpox, measles, polio, whopping cough, and malaria. But for the last 40 years, public health as a movement has betrayed the trust it had earned as a result of these early successes.

Rather than protecting us from unseen and unwanted risks, certain public health advocates have turned to efforts to force us to live as they deem best. Worst of all, instead of relying on objective research to dictate strategies to prevent disease, they have turned science on its head: settling on policy prescriptions and then tailoring the science to justify their edicts. Nowhere, perhaps, is this corruption more unabashedly on display than in the debate over alcohol consumption.

Sometime in the last decade, certain public health advocates decided among themselves that because alcohol consumption raises certain health risks that all levels—even light and moderate—cannot be considered “safe.” The problem as Dr. Gary Murray, program director for the National Institute on Alcohol Abuse and Alcoholism (a division of the National Institutes of Health) put it in an email interview, is that “their interpretation, that there is no safe level of drinking is not supported by 50 years of epidemiology.”

Based on five decades of research and thousands of studies showing benefits associated with moderate alcohol consumption, the public generally believes alcohol can be consumed safely. To change this belief, the first thing that needs to change is the science. Enter Professor Mark Petticrew of the London School of Hygiene and Tropical Medicine.

In September, the journal Drug and Alcohol Review published a paper by Petticrew and his colleagues titled, “How alcohol industry organisations mislead the public about alcohol and cancer.” The purpose of this paper was twofold:

  • First, to enforce the idea that light and moderate drinking does significantly increase cancer risks; and
  • Second, to demonize the alcohol industry and anyone who fails to toe the “no safe level” doctrine as deceitful. 

The paper sought to determine the “comprehensiveness and accuracy” of the alcohol industry’s statements on cancer by collecting “all text relating to cancer” extracted from the websites of 26 industry organizations. After extracting individual sentences of text, the statements were sorted into one of three categories:

  1. Denial/omission (denying, omitting, or disputing evidence linking alcohol to cancer);  
  2. Distortion, (mentioning cancer but “misrepresenting” the risk); or
  3. Distraction (focusing the discussion away from the independent effects of alcohol on cancer).

Note that there is no category for accurate communications. That means that any statement selected by Petticrew et al would necessarily qualify as being some form of “misrepresentation.” Thus, the paper’s conclusion that the industry is engaged in significant misrepresentations isn’t surprising. By design, the study could find nothing else.

Had these authors honestly analyzed the documents, they would have found the companies communicating the exact messages they are accused of omitting.

For example, in one document from the International Alliance for Responsible Drinking (IARD), the company notes, “Recent research suggests that light to moderate drinking is not significantly associated with an increased risk for total cancer in either men or women.” According to Petticrew et al, this was classified as a denial because it misrepresents the evidence linking these lower levels of alcohol consumption to cancer. However, IARD did state that there’s some evidence linking lower levels of drinking to cancer in the very next sentence of that document, stating, “Among women, light drinking was found to increase the risk of all cancers by 2%, and moderate drinking by 4%, over the risk for non-drinkers. Among men, light drinkers had a 3% increase in risk over non-drinkers, while the risk for moderate drinkers was 4%.”

Similarly, DrinkWise, a nonprofit dedicated to reducing alcohol harm in Australia, was targeted for claiming that the risk of cancer from alcohol consumption “is related to patterns of drinking, particularly heavy drinking over extended periods of time.” According to Petticrew et al, this is “misleading,” because it implies that the risk applies only to heavy drinking. However, had that been what DrinkWise meant to imply, it wouldn’t have said the risk of cancer is “particularly” associated with heavy drinking, which necessarily means there is some risk with other patterns of drinking. Nor would DrinkWise have stated—again in the same document—that when it comes to alcohol consumption, “the more you cut down, the more you reduce your risk of cancer.”

In journalism, willfully distorting quotes is a gross violation of ethical standards. For example, I could take Petticrew’s own statement that “people [who] drink within the recommended guidelines shouldn’t be too concerned when it comes to cancer,” and forever argue that Petticrew believes there is no risk to light or moderate alcohol consumption. But I wouldn’t do that because, from the context of both this paper and other statements he has made, I know that is not the message Petticrew intends to communicate.

Even for those unfamiliar with research standards, this paper’s methodology should be highly suspect. As Murray noted, “these authors appear to have an opinion and are willing to bend the data to their will.” As such, it is not a piece of scientific inquiry, but a messaging document, part of a PR campaign designed by a handful of advocate-researchers on a mission. This is not science; it is propaganda.

That “mission” appears to have taken shape during meetings of Chief Medical Officers—researchers tasked with developing alcohol guidelines for the UK. It was here that Petticrew advised his colleagues to systematically ignore any evidence of health benefits associated with alcohol consumption, dismissing them as not “relevant in the context of an overall population message.” This message was decided upon in private meetings held between Petticrew and two other researchers. One of his collaborators, Jurgen Rehm, had previously advised governments to “treat alcohol like tobacco.”

Despite its obviously shoddy design, it is clear that Petticrew’s paper was an attempt to sell his message about any amount of alcohol causing cancer by comparing alcohol to tobacco—a product already widely feared. More specifically, he sought to parallel the alcohol industry to the reviled tobacco industry and its “decades-long campaign to mislead the public about the risk of cancer.”

Unfortunately, it worked. Gullible media outlets, all too willing to cut, paste, and publish sections of Petticrew’s press release, picked up on the not-so-subtle message, spreading his distortion of science, like an influenza pandemic and around the Internet.

Shoddy “research” like this threatens the entirety of the public health body. Not only does it suck up grant money that might have gone to actual scientific discoveries, it threatens the reputation of the entire field. It is up to serious public health professionals to address this.