warning v. freedom

Murthy’s initiative

We flipped on the Beeber, aka BBC, which is about the only news we watch these days, primarily as their U.S. news airs as we enjoy an evening glass of wine or stout. Yesterday’s news included Surgeon General Vivek Murthy’s proposal on publishing alerts that alcohol contributes to the third highest preventable cause of cancer. The irony of hearing this report as we were having a single drink each did not escape me.

My husband mused he was surprised the Beeb dedicated such full coverage to the story. I asked if this wasn’t the same sort of revolutionary news paralleling the 1964 Surgeon General Report tying cigarettes to laryngeal and lung cancer? A decided minority of Americans witnessed the anxiety federal officials had about that announcement; they deliberately held off until a Saturday to release it. My husband thought momentarily, then nodded in agreement.

Cigarette consumption had been so encompassing in American life, with the tobacco a primary crop in the colonial and early independence eras. With widespread participation in World War II where government provided tobacco to those under arms that it seemed impossible to roll back the tide, use of the crop seemed absolutely ingrained in our society. In 1964, a third of women and more than half of men smoked, with income for tobacco companies amounting to $15 billion in salaries for two-thirds of a million people in some industry capacity.

The federal government’s role, defined in the Preamble to the Constitution, is to “provide for the general Welfare” among other responsibilities. The Johnson administration’s release of top quality scientific research cataloged in an 18 month Surgeon General study. The double blind studies and evidence initially received public skepticism and tobacco companies attempted for decades to disprove the harm, but ultimately increasingly detailed studies, cited repeatedly in lawsuits, led to a change in public perception. Ever so gradually the reality of tobacco’s causal effect on developing cancer took hold within public consciousness. Millions of smokers, with great difficulty or cold turkey, kicked their habit while millions more simply chose never to addict themselves to that weed.

Lung cancer, the effect of years’s smoking cigarettes, began declining as a cause of premature death in the United States. People still smoke and many of them still die but the numbers are markedly lower than before 1964, probably a strong justification for Murthy’s urging for similar warnings regarding alcohol’s link to cancer.

Telling the public it can take steps, albeit frequently unhappily, to prevent cancer is a big deal in this country as demands for personal freedom explode in seemingly any and all aspects of our lives. But it is far from a certain policy outcome these days.

The medical community began emphasizing within the past decade worrisome evidence of rising overall cancer rates for younger Americans. This coincides with greater awareness of female alcohol use climbing. Colorectal cancer, a noted concern with regard to booze, has increased as both drinking and consuming ever more voluminous quantities of ultra processed foods increased. Scientists readily acknowledge, like everything involving humans, that multiple variables are clearly at play but the statistics show strongly that new cancer cases for Americans 15-39 years of age—theoretically in their prime—started climbing steadily in the mid-1990s. Higher alcohol consumption as a significant contributing factor frequently comes up.

The Surgeon General’s clarion call yesterday proposed strong warnings on the alcohol effects of consumption on developing cancer. I cannot imagine the alcohol industry will sit back to accept these recommendations without protest. Nothing about the announcement indicated, as far as I saw, any attempt to prohibit either sales or consumption but the Surgeon General advocated this move as a public responsibility regarding the dangers alcohol poses for cancer. In the end, Murthy’s and the federal government leave the choice to consume in the hands of the public since the law does not limit alcohol consumption for anyone over the age of 21 in the country.

No consensus exists within the medical community on whether or if alcohol has a “safe” or a “dangerous” consumption level at all. Recommendations for women to consume no more a drink a day per week, two per day for men, have been in place for years. When I visited my own women’s health specialist two and a half years ago, she independently noted her substantial concern that young women are seriously impairing their future by underestimating the danger of higher than recommended consumption over several years (a conversation most women with daughters in their twenties, thirties, and forties probably recoil to hear).

But the United States remains a society where the limits on alcohol consumption result are solely age-dependent. We have staggered prohibitions on what I grew up calling “illegal drug” consumption, depending on the local laws on marijuana for medicinal or recreational use, but not “hard” drugs like cocaine, opium, or synthetic substances. Those latter substances seem to fall under the category of “addictive”, hence the federal system prohibits them. Additionally, anyone seeking a federal security clearance or works in certain critical industries like transportation cannot use marijuana regardless of the jurisdiction; in that case, federal policies overrule state decisions.

We tried to prohibit alcohol altogether in one of the most futile of national experiments a century ago. The 18th Amendment barred alcohol production, transport, sale or consumption between 1919 and the passage of a subsequent reversal of that policy under the 21st Amendment. During the intervening 14 years, crime and associated activity, blatant disregard for federal law, and virtually complete disregard for the constitutionally-driven regulatory process ensued. Al Capone may have been caught, as the old saw goes, on tax charges but the taxes and his business were all about booze. We learned, then abandoned any pretense, that Americans sought the government to regulate whether to imbibe. It was a lesson we have not forgotten. Yet, we now have considerably greater evidence that drinking increases premature cases of cancer, an otherwise largely age-driven disease in many cases.

Murthy is at the end of his tenure as Surgeon General as few, if anyone, serving under President Biden will serve in a subsequent administration under President-elect Trump. I have not seen any statements by the President-elect regarding a proposed replacement nor have I noted much from the nominated Health & Human Services Secretary, Mr. Robert Kennedy, Jr., on the link between booze and cancer. Mr. Trump lost a brother to alcoholism several years ago so he knows well the danger that illness poses but Murthy wants warnings specifically on alcohol and cancer, not chronic alcoholism.

The other aspect of this story that interests me is how the public will assess Murthy’s statement. In an era where pitifully few Americans grasp statistics and risk, how many will understand the increased risk they assume with alcohol consumption? Murthy’s proposed warning labels would be normative rather than statistical, I would assume. That takes the burden off seeing with some clarity exactly how much one’s danger increases. But, that means they are probably less likely to absorb the import of the warnings because it will be merely a caution rather than a warning for many.

Even more likely will be the past five years’ “COVID denying” undermining any sort of federal government role in health worries. Too many people think the federal system is politicized, which really means partisan, rather than dedicated to public health. In the same week Anne Arundel County published statistics that Whooping Cough, a nasty but not usually fatal respiratory illness especially common in infants and youth, cases are at a ten year high, Murthy’s suggestion will likely ignite claims of government overstep, if not out and out lies. The Anne Arundel statistic most likely results from the pronounced decrease in vaccinating for childhood diseases (and we have seen similar spikes in measles), but the widespread doubts about some Biden or Democratic policy undermines the importance of messages from independent medical research.

This is a country where personal freedom appears ever more central for many people, even when they endanger others. That is what personal choice, analysis, and risk tolerance can produce, or it can drive others to demand restrictions (as occurs with women’s health care, ironically). Vivek Murthy raised the alarm on alcohol creating greater risks of cancer. It will be our task to decide how we proceed societally with the data he has presented.

To answer my husband’s musing last night, more than nearly four dozen nations publish warnings about dangers of alcohol in health, although only South Korea and (by next year) Ireland deliberately mention the cancer link. Many other societies weigh broader benefits over individual rights, which may be why the British Broadcasting Service spent so much time on the topic. It will be interesting to see whether Murthy’s voice ultimately is one of leading us forward towards better outcomes or a final gasp of an administration departing into the shadows as it times out.

Murthy’s message certainly ought raise concerns for any of us who consume alcohol or have family members who do as cancer is horrible and too often victorious over all attempts to defeat it. This is not an abstract political question but a health matter over which we have some control, if we exercise it.

I welcome your thoughts on public health issues in our current environment. I am not a medical person but I do believe in individual rights and responsibilities so these questions fascinate me. Please chime in with your thoughts as they are relevant for any of our thinking.

I appreciate your time today or any day you read Actions. I also appreciate the subscribers who contribute to this work: thank each and every one of you.

We are purportedly receiving snowfall tomorrow into Monday. If you’ve never experienced a metro DC snowfall, you have no idea how entertaining these hours can be unless you really need eggs, toilet paper, or milk which become hard to find. The dawn gave way, however, to strong, cold winds.

Be well and be safe. FIN

Brianna Abbott, “The Mystery of What’s Causing Young People’s Cancer Leads to Gut”, WallStreetJournal.com, 3 January 2025, retrieved at https://www.wsj.com/health/healthcare/young-people-cancer-causes-gut-science-21375280?mod=healthcare_news_article_pos3

Otis W. Brawley, Thomas Glynn, Fadlo Khuri, Richard Wender, and John Seffrin, “Commentary: The First Surgeon General’s Report on Smoking and Health: The Fiftieth Anniverary”, AmericanCancerSocietyJournal, 64:1 (January/February 2014) retrieved at https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21210

Laura Cooper and Briana Abbott, “U.S. Surgeon General Calls for Cancer Warnings on Alcoholic Beverages”, WallStreetJournal.com, 3 January 2025, retrieved at https://www.wsj.com/health/alcohol-is-a-leading-preventable-cause-of-cancer-u-s-surgeon-general-warns-fa78b5c2?mod=healthcare_news_article_pos1

Siddhartha Mukherjee, Emperor of Maladies. New York: Scribner, 2010.

“Preamble to the Constitution”, TheConstitution. 1787. Retrieved at https://constitution.congress.gov/browse/essay/pre-1/ALDE_00001231/%5B'article',%20'1'%5D