SAVE THE DATE!

As 2024 ends, the US government has only published one out of two expected scientific reports investigating alcohol's impact on health and designed to inform federal drinking guidance. In mid-December, the National Academies of Sciences, Engineering and Medicine (NASEM) confirmed decades of research on the topic in a consensus report summarizing a year of work by a committee of 14 scientists. Moderate drinkers generally show a lower risk of death from any cause and from cardiovascular disease, but a higher risk of breast cancer when compared to people who have never drank, the extensive review of studies published in the last 5-15 years determined. A second expected report, from the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), which many suspect will take a harsher view of alcohol, has not yet been published. In its confirmation of scientific views held for decades, its matter-of-fact style and its even-handed descriptions of an admittedly "challenging" subject, the NASEM report seems somewhat unremarkable at first blush. It garnered relatively little mainstream media attention when it was published a couple of weeks ago. But in a year when so much public discussion of alcohol and health was overwrought with advocacy, much of it arguing for a complete overhaul of existing thinking, it is precisely those things that make the 250+-page tome all the more remarkable. Ref 1Different Doses, Different Outcomes; Societal Import, Impact Addressed Report authors took a balanced tone throughout, especially committee chair Ned Calonge in his preface setting up the complications of coming to definitive conclusions about alcohol's health effects. It specifically delineates between research showing clear harms from "higher doses," as well as "acute intoxication and habitual heavy drinking," and less clear impacts at "lower consumption levels." It also plainly acknowledges that "even the substantial evidence base noted above is challenged by threats of bias inherent in observational studies." Indeed, the report repeatedly recognizes the overarching issue of "abstainer bias" in many studies about alcohol.Calonge's preface also highlights further complexities with the field, including those that public health advocates commonly downplay or ignore. "There is variation due to drinking patterns, including binge drinking, and to different types of alcohol consumed such as wine, beer, and spirits." Note that both of those issues &mdash; drinking patterns and types of alcohol &mdash; were summarily dismissed by ICCPUD's panel of scientists in their proposed research protocol, stating they would ignore any study that attempted to address either.Yet it's the discussion of alcohol's societal import that may be the most surprising aspect of Calonge's introduction. "For many, drinking alcoholic beverages is part of daily life and in many social scenarios" and many drinks "provide flavors and sensations that people enjoy," he acknowledges. He then attempts to explain how the social aspects of drinking complicate the issue at hand: researching alcohol's impact on health, which we reprint here at length, as it summarizes a set of ideas rarely acknowledged. "Beyond physiology, though, there may be other impacts that are more difficult to measure, but may also be associated with health outcomes, such as social connectivity. Joining others to interact 'over a drink' in private and public settings is a common behavior that may well provide measurable social connectivity benefits. However, there are also potential harms related to alcohol and social connectivity."Extensive Process by 30+ Researchers in All Much of the report's heft can be attributed to its detailed explanations of the rigorous process the 14 committee members and many others went through to complete it. Recall, these experts were tasked with answering 8 research questions that had already been drafted and vetted for the 2020-2025 edition of the Dietary Guidelines for Americans (DGA). Each question covered a specific health outcome, focusing solely on the impacts of moderate drinking, or up to one drink per day for women and 2 for men (defining a drink as 14 grams or 0.6 oz of pure alcohol).After exploring all the research published on each topic over the last 5-15 years, the committee requested "systematic reviews" for 5 of the 8 health outcomes, to be completed by a separate government team of scientists at NASEM. (Research addressing three other questions about lactation was too "sparse" to warrant further attention.) Using those analyses of the research, the committee summarized the impacts of moderate drinking on each health outcome and ranked the certainty of those findings. Nothing in this report received a rating of "high certainty." As the authors acknowledged, such clarity is "unlikely&hellip;without a randomized controlled trial."But that wasn't the end of the process or the number of scientists who were a part of it. A panel of 10 other scientists with expertise in the field reviewed a draft of the report and posed questions to the committee. Notably, one of those researchers was Tim Stockwell, perhaps this year's most vocal advocate for revising drinking guidance globally (as many of his usual cohorts are serving on ICCPUD's panel of scientists). While this review panel didn't see the final report, two additional scientists "were responsible for making certain&hellip;that all review comments were carefully considered." In all, over 30 scientists outside and inside the US government worked on the report.Conclusions: Lower Risk of Death, CVD, Higher Risk of Breast Cancer Specific results of the committee's review may be the most important, but they are not particularly surprising to anyone following the field for very long. It concluded with "moderate certainty" that moderate drinkers have a lower risk of all-cause mortality than never drinkers. That's based on 8 studies that satisfied requirements for the review, out of a possible 27 studies published on the topic from 2019-2023. They suggest a 16% lower risk for moderate drinkers overall, with a small sample of studies providing additional info based on sex and age. However, there's "strong evidence that heavy drinking has adverse effects on" the leading causes of death, like heart disease, cancer, accidents and stroke, the committee wrote.A total of 19 studies over almost 15 years also suggest with "moderate certainty" that moderate drinkers experience lower risk of death from cardiovascular disease, compared to never drinkers. There's less certainty about reduced risk of nonfatal myocardial infarction and nonfatal stroke. On the other hand, the committee also concluded with "moderate certainty" that moderate drinking increases the risk of breast cancer, perhaps by around 10%. It made no conclusions about cancers at various points in the digestive tract (oral, laryngeal, pharyngeal, esophageal and colorectal). Research was too mixed or not deep enough to make clear determinations about weight gain or neurocognition, including dementia, Alzheimer's and cognitive decline.Lots of Open Questions How this report may or may not influence the drafting of the next edition of the DGA remains to be seen, of course. As is the potential impact of ICCPUD's report, if it is ever officially published. While it was promised before year end, the project has been behind schedule for some time, even before queries from Congress put pressure on the Biden administration to pull the plug. Of course, its contents may not remain secret, even if it is officially shelved (the NASEM report was published a day or two early after the press reported on a leaked edition).Given recent interest in publishing critiques of alcohol's impact on health, these two competing reports and the ongoing process toward the next DGA is only likely to feed the media frenzy. Then again, with the Trump administration coming in, questions abound about the future of the DGA as a whole, let alone the small piece of it that deals with alcohol. In short, we'll have plenty of fodder for these pages for some time.As always, thanks very much for your continued readership and support. Here's to continued opportunities to reflect on this unique beverage and its singular position in science and society. Let's raise a glass together in 2025. Happy New Year! Cheers,References1 National Academies of Sciences, Engineering, and Medicine, "Review of evidence on alcohol and health," The National Academies Press, Dec 2024

NASEM Report Walks Careful Line, Confirms Moderate Drinking Can Lower Risks for CVD, Death; Waiting on ICCPUD

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