Alcohol warning labels need updating, researchers say

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Sept. 1, 2022 – Warning labels on alcoholic beverages need to be updated to include details of potential harm to be more effective, say two US researchers.

Current labeling hasn’t changed in 30 years, only focusing on risks during pregnancy and using machines with a vague statement that alcohol “can cause health problems”.

That was “so understated that it borders on misleading,” say the researchers.

Science has advanced and there is now clear evidence of harm. Alcohol has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer and has been linked to an increased risk of many types of cancer. It has also been linked to a variety of diseases, from liver disease to pancreatitis to some types of heart disease.

But the public is largely unaware of the most serious health risks associated with drinking, they point out.

“We believe Americans deserve the opportunity to make informed decisions about their alcohol consumption,” said Anna H. Grummon, PhD, of the Harvard TH Chan School of Public Health in Boston, and Marissa G. Hall, PhD, of the University of North Carolina, Chapel Hill.

“The design and introduction of new alcohol warning labels should therefore be a research and policy priority,” they said.

The two researchers present their arguments in The New England Journal of Medicine.

“Alcohol consumption and its associated harms are reaching a critical juncture in the United States,” they said.

It now accounts for more than 140,000 deaths a year in the United States, according to the latest data from the CDC. The COVID-19 pandemic has made the problem worse, with a 25% increase in alcohol-related deaths in 2020.

New, well-designed alcohol warning labels are a sensible way to inform consumers and reduce alcohol-related harm, they suggest.

What makes a good warning sign?

Warnings are most effective when they’re prominently displayed, when they contain images of some kind, and when the content is rotated to avoid making a message “stale,” the researchers say. This has worked well for cigarette packs, where this type of warning has increased smoking cessation rates compared to smaller side-of-pack text-only warning labels.

There is also evidence that this type of labeling can work for alcohol. When big cancer risk warnings with pictures were temporarily posted on the front of alcohol containers in some stores in Canada’s Yukon, alcohol sales fell from 6% to 10%, they note.

But pressure from the alcohol industry led to changes at the Yukon Project, and while a general health warning remains in place, the label about an increased risk of cancer was removed.

The researchers say the alcohol industry is standing in the way of efforts to educate the public. The industry spends more than $1 billion each year to market their products in the United States

The authors warn that unless government gets involved, the alcohol industry has little reason to share the risks.

And some companies are even tying their products to health campaigns, like October’s sale of pink ribbon-themed alcoholic beverages, to encourage efforts to raise funds for breast cancer research, despite compelling evidence linking alcohol to a higher risk of breast cancer becomes.

Appeal to Congress for new labels

This isn’t the first call for a change in alcohol warning labels.

Last year, several medical groups petitioned Congress for a new cancer-specific warning label for all alcoholic beverages.

The petition was signed by the American Society of Clinical Oncology (ASCO), the American Institute for Cancer Research and Breast Cancer Prevention Partners along with the American Public Health Association, the Consumer Federation of America and the Center for Science in the Public Interest, Alcohol Justice and the US Alcohol Policy Alliance.

They are demanding a label that reads, “WARNING: According to the Surgeon General, consumption of alcoholic beverages can cause cancer, including breast and colon cancer.”

But that petition is still pending, said Melissa Maitin-Shepard, a policy expert at the American Institute for Cancer Research.

In addition, “the Institute is working to advocate through multiple channels for the addition of a cancer warning label to alcoholic beverages,” she said. “Given the strong evidence linking alcohol consumption to at least six types of cancer – and the low awareness of the alcohol-cancer link – there is a tremendous need to educate the public about the risk of alcohol and cancer.”

Noelle LoConte, MD, Associate Professor of Medicine at the University of Wisconsin, Madison, and lead author of ASCO’s Alcohol and Cancer Risk Statement, emphasized that alcohol is undoubtedly a carcinogen, causing about 5% of cancers worldwide, and also that its use has increased during the pandemic.

“Initiatives that raise awareness of this issue could help generate more public support for policies that limit access to alcohol, thereby reducing alcohol-related cancers,” she said. “In ASCO’s Alcohol and Cancer Statement, we recommend several key strategies to reduce high-risk alcohol use, including reducing youth access to alcohol, allowing communities to have better control over alcohol and outlet density, and increasing alcohol consumption Taxes on alcohol.”

But she also had a small criticism at one point in the New England Journal of Medicine Article. It shows an example chart listing stomach cancer as caused by alcohol.

“But to date, gastric cancer is not at IARC [International Agency for Research on Cancer] List of alcohol-related cancers,” she said. “I think that brings up a critical point, that these warnings must contain scientifically based facts.”

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