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