Last month, on World No Tobacco Day, federal Minister of Mental Health and Addictions Carolyn Bennett announced on Twitter that Canada would become the first country in the world to mandate that each individual cigarette sold carry a warning label, mirroring what consumers already see on the front of the pack. This would seem to be the end of the road in terms of warning labels for tobacco: there really isn’t much left to put a label on — unless someone can figure out a way to make exhaled cigarette smoke spell out “C-A-N-C-E-R.”

Unfortunately for consumers, this push doesn’t end with tobacco. There is a very active lobby for tobacco-style health warnings on alcohol, too. What started in Ireland is slowly spreading in Canada, with regional health authorities and groups like the Canadian Centre for Substance Use and Addiction (CCSA) advocating mandatory health warnings.

The issue here isn’t whether or not consumers should be given the facts about when drinking can be harmful to your health. The issue is whether they are presented in a truthful manner that realistically explains how drinking can cause negative health outcomes.

Those lobbying for enhanced warnings invariably quote the relative rather than absolute risk of drinking. For example: “Fourteen drinks a week for women increases the risk of breast cancer by 27 per cent.” Taken at face value that is a jarring figure, one that will likely spook some drinkers. To many people, it will sound as if drinking two drinks a day produces a 27 per cent chance of developing breast cancer.

But looking at that increase in absolute rather than relative terms, starting with the baseline risk for each illness, communicates a very different and much less shocking message. Using the CCSA’s own data, breast cancer is responsible for 17.3 premature deaths for every 100,000 Canadian women, which is a baseline of 1.7 one-hundredths of a per cent. A 27 per cent increase in that risk takes it to 22 premature deaths for every 100,000 women, or 2.2 one-hundredths of a per cent, which is still very small.

That extra risk — which is from drinking 14 drinks a week, remember — is similar to the breast cancer risk associated with taking birth control, as pointed out by Chris Snowdon from the Institute for Economic Affairs. Understandably, the researchers who studied that slight change in risk arising from use of the pill concluded that “Such risks need to be balanced against the benefits of using contraceptives during the childbearing years.” For hundreds of millions of women, avoiding an unwanted pregnancy evidently is more than worth the small change in breast cancer risk.

For men, the same relative risk versus absolute risk difference holds true. Take colorectal cancer, for example. It accounts for 13.9 premature deaths for every 100,000 men. According to the CCSA, men drinking 14 drinks per week increase their risk of colorectal cancer by 20 per cent. But again, when looking at absolute risk, 14 drinks per week shifts the baseline risk from 13.9 deaths per 100,000 to 16.7 — an increase of 2.8 deaths per 100,0000. In terms of percentages, the increase is 2.8 one-hundredths of a per cent.

Ironically, the CCSA’s report contains a piece of information that fundamentally undermines the “no safe use” narrative that it and other temperance groups are pushing. For men, consuming up to seven drinks per week actually reduces the risk of premature death from intracerebral hemorrhage, ischemic stroke and ischemic heart disease. This is important because ischemic heart disease is responsible for 47.5 premature deaths per 100,000 men. Seven drinks per week lowers the risk of premature death from ischemic heart disease by five per cent, moving that baseline figure down to 45.12, a decrease of 2.38 deaths per 100,000.

Heart disease is the largest premature killer of men among all 19 health issues evaluated in the CCSA report. It accounts for more premature deaths in Canada than liver cirrhosis, liver cancer, colorectal cancer, and oral cancer combined. Should the health benefits from reducing its deadliness not also be included on a health information label?

There are two different ways to inform consumers about the risks associated with drinking. One is with the largest, scariest number the data will sustain that while technically true doesn’t do much to educate consumers or encourage informed choices. The other is giving consumers the full depth of absolute risk information available. Better yet, we can communicate this information to consumers without following the tobacco playbook, which falsely equates smoking and drinking. Europe has already started this process, where beverage alcohol can have a QR code on the bottle that links to information about nutrition and alcohol risks and abuse. Given that the program is still new, we don’t have data on how frequently it is used, but it is a good step forwards for consumers wanting more information.

More information is generally a good thing for consumers, but only when that information isn’t misleading — which is what cancer warnings on bottles would be.

Originally published here

It is increasingly clear that the temperance lobby is increasing its influence both globally and domestically

Since last August, when the Canadian Centre for Substance Use and Abuse (CSSA) published its updated alcohol guidelines, telling Canadians that having more than two drinks per week is a problem, alcohol policy has been placed back under the microscope. It’s certainly important to discuss what Canada’s alcohol guidelines should be, and what is or is not considered low-risk drinking, but it would be wise to first put anti-alcohol lobby groups under the microscope before proceeding with any type of policy change.

It is increasingly clear that the temperance lobby, those who think drinking any amount of alcohol is unsafe, is increasing its influence both globally and domestically.

Internationally, the World Health Organization has moved from declaring the COVID-19 pandemic over to narrowing its sights on alcohol. The latest example of the WHO’s mission creep is its alcohol “guide for journalists,” which Christopher Snowden of the Institute for Economic Affairs has describedas “a catalogue of anti-drinking tropes, half-truths, and brazen lies.”

The guide starts off by stating that “no amount of alcohol is safe to drink.” But this “no safe amount” claim has been repeatedly debunked by peer-reviewed research that finds a “J-Curve” relationship between moderate drinking and all-cause mortality. Those who consume moderately, usually one to two drinks per day depending on the study, actually have a lower mortality rate than those who abstain entirely, with the risk then increasing after that one-to-two drink threshold. The J-curve has been found in peer-reviewed studies going back as far as 1986, and has been confirmed since in at least eight different studies. The J-curve is not reason to drink if you don’t, but it does undermine the premise of the WHO’s policy on alcohol consumption.

The WHO’s departure from evidence-based policy wouldn’t matter much to Canadians if those half-truths weren’t making their way into our politics, but they are. The CCSA’s new guidelines, built on many of the same false premises as the WHO’s, are gradually becoming what is considered the gold standard for alcohol policy.

Take, for example, B.C. Cancer’s new campaign in partnership with the province’s ministry of health. Focused on how drinking causes cancer, it cites the CCSA’s report, stating that it “provides evidence-based advice on alcohol.” But it doesn’t, so much so that the International Scientific Forum on Alcohol Research (ISFAR) called it “a pseudo-scientific amalgamation of selected studies of low scientific validity that fit their preconceived notions.”

And what are those preconceived notions? In sum: temperance, the idea that no one should ever drink, under any circumstances. In fact, the WHO officially partners with temperance lobby groups like Movendi, an international temperance group that preaches a zero-consumption approach to alcohol. Movendi was founded in the 1800s under the name “The Order of Good Templars,” but rebranded itself in 2020, likely because the old name sounded too fusty to be taken seriously. But fusty is what temperance is.

Unfortunately for those who drink responsibly, these groups are being taken more seriously both here and abroad. There is no question that alcohol, when misused, is dangerous. Alcohol policy should therefore always be on the table (as it were). But serious discussion about it should be based on accurate information.

Originally published here

Earlier this week, local Joplin businessman Jon Thomas Buck proposed that the Joplin City Council ban the sale and distribution of mini bottles of liquor.

Buck wants Joplin to follow the “nip ban” as adopted in the Boston area.

When asked about the proposal, Buck said, “We all know Joplin has struggled with issues related to litter and cleanliness in recent years. … One of the biggest culprits is the abundance of these small, single-serving bottles of alcohol. They are often consumed on the go and then discarded without a second thought, contributing to unsightly and unhealthy conditions in our city.”

But Joplin residents must ask themselves: Is this a good justification for banning what is essentially a small version of an otherwise legal product? The answer is no.

A mini-bottle ban is just another encroachment from the nanny state, this time aimed at adult consumers who prefer smaller bottles because they are convenient, ultimately punishing drinkers who want small serving sizes.

For public health, there is little evidence to suggest that prohibition of smaller-sized products works, certainly not from a harm reduction angle. If Joplin does go down the road of banning mini bottles, consumers will ultimately make one of two choices in response. The first is that they will buy these convenient bottles beyond Joplin’s city limits. This is obviously irritating for consumers and problematic for Joplin retailers as this motion tilts the scales against them.

The alternative to buying mini bottles elsewhere is, ironically, buying larger bottles of alcohol. It is hard to see how fewer alcohol-related incidents will arise from a policy that mandates consumers buy bottles of liquor 3 ounces or larger. Imagine trying to curb obesity by mandating that no meal can be fewer than 800 calories?

By stomping on convenience for consumers, Buck’s motion will actually end up nudging drinkers to larger bottles, and the possibility of more consumption and more alcohol-related incidents. This is a lose-lose scenario.

The second major critique of mini bottles is disposal. Because they are small, too many drinkers dispose of them by simply throwing them out on the street. Of course, this is unacceptable. There are laws against littering, and they need to be enforced. But surely the City Council can identify a problem that needs to be solved without deferring to prohibitionist policies? Other options, such as the expansion of trash bins on city streets or more by-law litter enforcement, should be exhausted before going down the route of a complete ban of a product consumers clearly love.

Those who support the ban highlight that because these bottles are small, they are virtually impossible to recycle. Some municipal websites across the United States explain that they often fall through the cracks of the sorting machines, and thus should be put in your trash bag as opposed to being recycled.

This is only true using dated machinery and recycling technology. Through chemical depolymerization, the repurposing of the bonds in plastics, virtually all plastic can be recycled. Take for example Alterra Energy in Ohio. Their advanced recycling plant takes in 40-50 tons of hard to recycle plastics (like mini bottles) and transforms them back into the building blocks for new plastic production, extending the life cycle of these hard to recycle plastics indefinitely.

Is Buck trying to reinvent the wheel of prohibition?

The prohibition of alcohol 100 years ago failed. The mindset of banning products that were deemed a nuisance caused more harm than good, which is why alcohol was then legalized.

Prohibition always promises results, but ends up creating a long list of negative second-order effects, many of which are worse than the initial issue of substance use.

Buck’s campaign to treat us all like children when it comes to the purchase of nips is going to have all the glory, majesty and success of previous prohibitions. The nip ban motion should be thrown in the trash can, along with your empty nips.

Originally published here

Early in March, Boston city councilor Ricardo Arroyo filed a motion to ban the sale and distribution of  mini bottles of liquor, aka nips.  Arroyo wants Boston to follow the nip ban as adopted in Newton, Chelsea, Falmouth, Wareham and Mashpee.

When asked about the proposal, Arroyo said the small bottles often end up as litter and that by banning these bottles Boston will experience fewer alcohol-related incidents.

But Bostonians must ask themselves: is this a good justification for banning what is essentially a small version of an otherwise legal product? The answer is no. The nip ban is just another encroachment from the nanny state, this time aimed at adult consumers who prefer nips because they are convenient, ultimately punishing drinkers who want small serving sizes.

For public health, there is little evidence to suggest that prohibition of smaller-sized products works, certainly not from a harm reduction angle. If Boston does go down the road of banning nips, consumers will ultimately make one of two choices in response. The first is that they will buy these convenient bottles beyond Boston’s city limits. This is obviously irritating for consumers, and problematic for Boston retailers as this motion tilts the scales against them.

The alternative to buying nips elsewhere is, ironically, buying larger bottles of alcohol. It is hard to see how fewer alcohol-related incidents will arise from a policy that mandates consumers buy bottles of liquor 3 ounces or larger. Imagine trying to curb obesity by mandating that no meal can be less than 800 calories?

By stomping on convenience for consumers, Arroyo’s motion will actually end up nudging drinkers to larger bottles, and the possibility of more consumption and more alcohol-related incidents. This is a lose-lose scenario.

The second major critique of nips is disposal. Because they are small, too many drinkers dispose of them by simply throwing them out on the street. Of course, this is unacceptable. There are laws against littering, and they need to be enforced. But surely the city council can identify a problem that needs to be solved, without deferring to prohibitionist policies? Other options, such as the expansion of trash bins on city streets, or more by-law litter enforcement, should be exhausted before going down the route of a complete ban of a product consumers clearly love.

Those who support the ban highlight that because these bottles are small, they are virtually impossible to recycle. Municipal websites across the state explain that they often fall through the cracks of the sorting machines, and thus should be put in your trash bag as opposed to being recycled.

This is only true using dated machinery and recycling technology. Through chemical depolymerization, the repurposing of the bonds in plastics, virtually all plastic can be recycled. Take for example Alterra Energy in Ohio. Their advanced recycling plant takes in 40-50 tons of hard to recycle plastics (like nips) and transforms them back into the building blocks for new plastic production, extending the life cycle of these hard to recycle plastics indefinitely.

Is Councilor Arroyo trying to reinvent the wheel of prohibition? The prohibition of alcohol 100 years ago failed. The mindset of banning products that were deemed a nuisance caused more harm than good, which is why alcohol was then legalized. The prohibition of cannabis in Massachusetts failed, as well.

Eventually legislators learned that the consequences of criminalizing cannabis were far worse than the harms associated with cannabis use. Prohibition always promises results, but ends up creating a long list of negative second-order effects, many of which are worse than the initial issue of substance use.

Councillor Arroyo’s campaign to treat us all like children when it comes to the purchase of nips is going to have all the success of previous prohibitions. The nip ban motion should be thrown in the trash can, along with your empty nips.

Originally published here