Who started the current WHO completely negative attitude towards alcohol?

I think that I have the answer to the title question, and that answer appalls me. The World Health Organization (WHO) used to accept the idea that small amounts of alcohol were not necessarily bad for you, and may actually have positive effects on some aspects of health. They no longer accept this — now, all amounts of alcohol are considered to be bad. Read on to see why they changed their minds.

I have written about this topic before, but I think that this is a very important one for the wine industry, as this seems to be one of the biggest global threats to that industry (along with local threats from neo-prohibitionists, etc), as also is global warming. This post is actually split into two halves, and will thus be continued next week.

As background, I've written several posts recently about wine and health:

• A scientist looks at alcohol and health, and is concerned
• Is consuming wine really as unhealthy as tobacco?
• Health and wine, and also Coca Wine
  

Previously

The reason for the previous positive attitude towards alcohol is summarized by Mark Hicken (Don’t let anti-alcohol grinches ruin your holidays):

The science related to safe levels of [alcohol] consumption has not changed. Hundreds of studies, and decades of scientific research, have consistently shown that those who drink in moderation live about as long (or even slightly longer) than those who don’t drink at all. The reality is that moderate drinking provides some cardiovascular benefits while slightly increasing the risk of certain cancers, some of which are very rare ... For most people, there is little or no effect on overall health and mortality.

This idea is usually pictured as a so-called J-curve, as shown above. It indicates that small amounts of alcohol (eg. one standard drink per day) actually reduce the risk of people dying (compared to zero alcohol), due to various medical causes. This particular picture is from: Giovanni de Gaetano and Simona Costanzo (2017) Alcohol and health: Praise of the J curves. Journal of the American College of Cardiology 70: 923–925.

Indeed, the Canadian Association for Responsible Drinkers hosts a whole web page covering this topic: Recent Studies on Alcohol + Health. It lists 12 science / medicine studies published from 2018—2023 confirming the health effects of moderate alcohol consumption. It also has links to pages containing both academic and medical commentary on the matter.

In spite of all of this, groups like the World Health Organization (WHO) would now have us believe that there is “no safe level of alcohol consumption and that alcohol causes cancer” (WHO shifts its alcohol narratives). Proactively, the WHO has suggested reducing consumption via global tax increases on “unhealthy products”, including wine (WHO demands tax increases on alcohol and sugar), as I recently discussed (WHO and the use of taxes to reduce alcohol consumption).

What caused WHO to change their tune?

The WHO makes it clear that their change of tune is based on accumulating medical evidence. This leads me to ask an obvious question: what is the first of the recent medical / scientific studies that made these new claims?

My research leads me to identify this published scientific paper, which appears to be a very important one of them, from 2018:

Alcohol use and burden for 195 countries and territories, 1990—2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (2018) 392: 1015–1035. (Max G Griswold seems to be the senior author, and Emmanuela Gakidou is the corresponding author.)

This paper is actually a summary of a more detailed report:

Global Burden of Diseases, Injuries and Risk Factors Study 2016. This was authored by the MGBD 2016 Alcohol Collaborators (517 people are listed as the collaborators).

The conclusion from the published 2018 paper is:

Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero.

Note that this is literally true, but that it is not all of the truth! Their Figure 5, as shown immediately above, is their revised version of the J-curve (as shown in the top figure). Note that the mortality curve does not drop below zero, which is the point that the authors are emphasizing. However, based on this graph, the authors could equally accurately have said that “the level of consumption that minimises health loss is one drink per day”. This is an act of omission, not commission — what they say is literally true, but it is only half of the story. That is why I am appalled!

An evaluation of the 2018 paper

Anyway, one can see why WHO might change their tack. The report is unambiguous, and actually concludes:

These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption ... In terms of reducing population-level alcohol use, WHO provides a set of best buys—policies that provide an individual year of healthy life at less than the cost of the average individual income. Governments should consider how these recommendations can be implemented within their local contexts and broader policy platforms, including excise taxes on alcohol, controlling the physical availability of alcohol and the hours of sale, and controlling alcohol advertising.

There is no doubt that the contributors have performed an impressive study. They have collated a massive amount of data, and developed some innovative ways to analyze that data, accounting for previous limitations. However, there is still one basic limitation in this type of work — the authors compiled data from pre-existing sources, rather than doing an experiment of their own. I will discuss this limitation in next week’s post.

Meanwhile, I noted above that previous studies found a positive effect on health of small amounts of alcohol (the so-called J-curve). When discussing these previous J-curves, the authors note:

Past findings subsequently suggested a persistent protective effect for some low or moderate levels of alcohol consumption on all-cause mortality. However, these studies were limited by small sample sizes, inadequate control for confounders, and non-optimal choices of a reference category for calculating relative risks. More recent research, which has used methodologies such as mendelian randomisation, pooling cohort studies, and multivariable adjusted meta-analyses, increasingly shows either a non-significant or no protective effect of drinking on all-cause mortality or cardiovascular outcomes. Our results on the weighted attributable risk are consistent with this body of work.

In estimating the weighted relative risk curve, we found that consuming zero (95% UI 0·0—0·8) standard drinks daily minimised the overall risk of all health loss (figure 5; shown above). The risk rose monotonically with increasing amounts of daily drinking. This weighted relative risk curve took into account the protective effects of alcohol use associated with ischaemic heart disease and diabetes in females. However, these protective effects were offset by the risks associated with cancers, which increased monotonically with consumption.

So, there you have it — the monotonic increase in mortality with increasing alcohol consumption is literally true, based on their data, but it is also true that lower levels of alcohol consumption have no notable difference in effects. The WHO have changed their mind for a very dubious reason. There is more to this topic, which I will cover in my next blog post.