Jamie Goode: How much of a threat is the New Prohibitionist Movement?

The current public health messaging around alcohol is a big problem for the wine industry. It’s becoming clear that in many countries, public health bodies are trying to make alcohol the new tobacco. The message being spread is that there is no safe level of alcohol consumption, and that people should be steered away from drinking at all. We can see where this is heading: increased taxation of alcohol, with reduced availability and limits on advertising. Neo-prohibitionists have booze in their crosshairs.

Doctors and scientists who work in public health have a strong motivation to change people’s behaviour. They see the damage that people do to themselves, and their mission is to reduce it. This creates an incentive to exaggerate the harms of certain behaviours: eating too much, eating the wrong things, smoking, drinking too much and living a sedentary lifestyle. If you are a government chief medical officer, your mandate is to reduce harm to health, and encourage the population to be healthier. You see the damage that excessive drinking does, so you want to discourage it. It’s much simpler to say that there’s no safe level of drinking and that it’s best to avoid alcohol altogether, rather than a more nuanced and accurate message (moderate consumption is good, high consumption is bad) that might be seen to encourage drinking.

One problem for the wine industry is that it’s very hard to fight the ‘no safe level’ messaging. It’s almost impossible for the drinks industry to respond with a message that for some people, moderate drinking isn’t just safe, but actually carries a health benefit. If wine producers claimed ‘drinking is good for you’ there would be an outcry. But this is what the science shows, and quite clearly, and as recently as a decade ago this wasn’t really contested. The reproducible finding that I’m talking about is the J-shaped curve. This is the shape of the line that results from plotting alcohol consumption against mortality. If we take non-drinkers as the baseline, then those who drink moderately live longer. Then as alcohol consumption goes up, risk of death goes up, and beyond a certain consumption level passes the abstainers and then rises to create the J shape. This J-shaped curve is the thorn in the side of public health people who really don’t want to admit that alcohol can be good for you. It also calls out the ‘no safe level’ message as being incorrect. It’s clearly safer to drink moderately than not at all.

One criticism of the J-shaped curve is that non-drinkers might be a poor baseline because some of them may have stopped drinking because of health reasons: the sick quitters. But this can be controlled for by using never-drinkers as the baseline, and the J shape is still there. Another might be that moderate drinkers as a group tend to have other behaviours that are protective: they might go to the gym more, or eat more healthily, or smoke less. These can also be controlled for, and still we have the J.

The reason for this curve is that alcohol seems to be protective against cardiovascular disease, while at the same time increasing risk of death by other means, such as cancers and accidents. Cardiovascular disease is a major killer, so its reduction by drinking lowers the risk of death more than it increases the risk of death by other means, up to a certain point. This is where the ‘no safe level’ claim is duplicitous. Yes, any level of drinking raises the risk of certain cancers, but it also lowers the risk of cardiovascular disease. And this is where we need to dissect out a more complicated message than public health people would like.

The question of safe consumption levels is complicated, because all the studies are done on self-report, so it’s likely that the safe level is higher than studies indicate (although, of course, we can’t be sure of this). This is where we run into the problem of risk assessment, something which people are bad at. We tend to be scared of things that are actually very safe (flying, for example) and not afraid of things that are very risky (like cycling or driving a car). Add to this, the confusion between relative risk and absolute risk. Both need to be known for us to make a sensible decision, but public health officials often just mention the relative risk.

Take shark attacks. They are very, very rare, so your absolute risk of dying from a shark attack is tiny. Perhaps 1 in 300 million. But if you take up surfing your relative risk of being munched by a shark might be 70%. This doesn’t mean that you are likely to be attacked by a shark, just that you are substantially more likely to be because you are frequently getting in the water. 70% sounds alarming but because the absolute risk is so tiny it’s still nothing to be too concerned about.

How should the wine industry, which sells a product that can damage peoples’ health, respond to attempts to restrict it, or shut it down? Let’s think about the car industry. Cars kill a lot of people every year. For most of us, the highest risk thing we do is get in a car. How does the car industry respond to criticism when it is making a product that kills and injures many every year? First of all, eliminating cars would cause the collapse of many societies, so entrenched are they as a means of transport. So that’s not on the table. Second, people are comfortable with the idea that there is a way that they can make their car travel safer, by driving more carefully, and governments have introduced laws about how to use the road and how fast to drive. Third, car manufacturers have had to improve safety standards of their vehicles. But still many people die on the roads.

The key issue here, though, is that there is an understanding that there may be no truly safe level of driving a car (you can’t legislate for the behaviour of others), but that this doesn’t mean that car driving is to be banned. People understand that here, the answer to mis-use isn’t dis-use, it’s correct use. Society isn’t working towards zero car use, but understands that cars have a place, they can be made safer, and that the current level of injury or death on the roads, while regrettable, is better than it used to be and could only be eliminated by steps that would cause huge societal problems that would eclipse the level of road accidents by a huge distance.

This is a subject that won’t go away. There is great peril for the wine industry in not contesting the untruthful claims that there is no safe level of alcohol consumption. But how it does so will require great wisdom.

Read about the recent Lifestyle, Diet, Wine & Health congress held in Toledo, Spain here.

Listen: Charles Parry, Director of the Mental Health, Alcohol, Substance Use & Tobacco Research Unit, SAMRC responds here.

• Jamie Goode is a London-based wine writer, lecturer, wine judge and book author. With a PhD in plant biology, he worked as a science editor, before starting wineanorak.com, one of the world’s most popular wine websites.