Alcohol warning labels need an update, say researchers

September 1, 2022 – Warning labels on alcoholic beverages need to be updated to spell out details of potential harm to make them more effective, according to two US researchers.

Current labeling hasn’t changed for 30 years and focuses only on risks during pregnancy and machine use, with a vague statement that alcohol “may cause health problems”.

It’s “so underrated it borders on being misleading,” say the researchers.

The science has moved on and there is now strong evidence of harm. Alcohol has been classified by the International Agency for Research on Cancer as a Group 1 carcinogen and has been linked to a increased risk of many cancers. It has also been linked to a wide range of diseases, from liver disease to pancreatitis to certain types of heart disease.

Yet the public is mostly unaware of the most serious health risks associated with alcohol consumption, they point out.

“We believe that Americans deserve the opportunity to make informed decisions about their alcohol consumption,” said Anna H. Grummon, PhD, of 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 adoption of new alcohol warning labels should therefore be a research and policy priority,” they said.

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

“Alcohol consumption and associated harms are reaching a crisis point in the United States,” they pointed out.

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

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

What makes a good warning label?

Warning labels are most effective when displayed prominently, when they include images of a certain type, and when content is rotated to prevent a message from becoming “stale”, according to the researchers. This worked well for cigarette packs, where this type of warning increased quit rates, compared to smaller text warning labels on the side of the pack.

There is also evidence that this type of labeling can work for alcohol. When large cancer risk warnings including pictures were temporarily added to the front of liquor containers in some stores in Yukon, Canada, liquor sales dropped by 6% to 10%, point out- they.

But pressure from the alcohol industry has led to changes in the Yukon projectand although a general health warning remains, the increased cancer risk label has been removed.

Researchers say the alcohol industry is hampering public education efforts. The industry spends more than $1 billion each year to market its products in the United States

The authors warn that if the government does not get involved, the alcohol industry has little reason to share the risk.

And some companies are even linking their products to health campaigns, such as selling pink ribbon-themed alcoholic beverages in October to promote fundraising efforts for breast cancer research, despite compelling evidence linking the alcohol to a higher risk of breast cancer.

Call to Congress for new labels

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

Last year several medical groups petition 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, as well as the American Public Health Association, Consumer Federation of America, Center for Science in the Public Interest, Alcohol Justice and the US Alcohol Policy Alliance.

They are calling for a label that reads: “WARNING: Drinking alcoholic beverages can cause cancer, including breast and colon cancer, according to the Surgeon General.”

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

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

Noelle LoConte, MD, associate professor of medicine at the University of Wisconsin, Madison, and senior author of the ASCO Statement on Alcohol and Cancer Riskpointed out that there is no doubt that alcohol is a carcinogen, causing about 5% of cancers worldwide, and also that its consumption has increased during the pandemic.

“Initiatives that raise awareness of this problem could help generate more public support for policies that limit access to alcohol and thus reduce the number of alcohol-related cancers,” she said. “In the ASCO Statement on Alcohol and Cancer, we recommend several key strategies to reduce high-risk alcohol use, including limiting young people’s access to alcohol, giving municipalities more control on the density of alcohol outlets and outlets, and increase taxes on alcohol.”

But she also had a small criticism on one point of the New England Journal of Medicine article. It shows an example of a diagram that lists gastric cancer as being caused by alcohol.

“But to this day, gastric cancer is not on the IARC [International Agency for Research on Cancer] list of alcohol-associated cancers,” she said. “I think that brings up a critical point, which is that these warning labels need to contain scientifically established facts.”

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