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To close its series on alcohol, STAT News offered “12 ideas for tackling” what it continues to insist is an “epidemic.” And just like the outlet’s introductory pieces and its final two deep-dive articles, it begins by claiming that it’s all “the result of decades of policy decisions, industry influence, and cultural inertia.” But policy changes take up just 3 of its 12 recommendations. Instead, most of STAT’s proposals reflect the focus of the rest of its 7-part series: failings of the medical field and the American healthcare system. Price, Promotion and Packaging, Plus Pervasive Problems Outside Policy The three policy recommendations that make STAT’s cut should not surprise: “8. Align price of alcohol with inflation”; “10. Tighten marketing rules”; and “11. Improve alcohol labels.” It’s a classic trio of taxes, marketing restrictions and warning labels. But given the outlet’s emphasis on policy and public health perspectives, plus its fixation on industry lobbying, why do these recommendations all fall near the bottom of its list?Instead, the top two recommendations land squarely at the feet of doctors and the medical field, likely STAT’s primary audience. “1. Screen early and often,” the list begins, arguing that “medicine can do a better job of asking patients about any family history of alcohol misuse and conducting thorough screenings,” STAT argues. It next seeks “nudges,” or adding quick check-ins for both doctor and patients on digital health platforms. Packed into the middle of the list, STAT urges “more doctor training” on alcohol treatment and to “overhaul payment,” that is insurance coverage, especially for mental and behavioral health. The rest of the list addresses interactions between health institutions and government agencies, noting how available resources and research projects could also be applied to alcohol.Finally, despite the inclusion of policy recommendations designed to reduce drinking overall, not just harmful consumption, the authors also explicitly urge readers to “embrace harm reduction.” Authors suggest the benefits of pulling the consumption of heavy drinkers back toward moderation and argue specifically that “alcohol messaging could focus on helping a lot of people drink less, instead of trying to get a few people to go cold turkey,” the authors explain. Yet elsewhere in the series, the authors parrot critiques of the new dietary guidelines, which almost precisely echo the recommendation to “drink less.”Most of Series Focused on Health, Not Policy, Heavy Consumption, Not Moderation Like STAT’s recommendations, the majority of its reporting highlights problems within the medical profession and health systems, not government policy or industry activity. For instance, part 2 of the 7-part series dug into screenings. There’s no broadly used screening tool and “alcohol is still an awkward subject in the doctor’s office,” the outlet notes. Unsaid: collecting accurate information about both alcohol consumption and related health issues underpin many of the problems that plague alcohol research to this day.Screening also plays a crucial role in problems linked to drinking during pregnancy, subject of part 5. After decades of declines, self-reports of consumption at some point during pregnancy increased again, STAT reports. “There’s been a pushback for almost a decade now, it feels like, of young women just going, ‘Eh, phooey,’” one epidemiologist commented, in part driven by a Brown-based economist who questions scientific support for risks of light drinking, especially in the third trimester. Yet researchers told STAT that “while heavy or binge drinking are the strongest predictors of negative outcomes, there is no way for individuals to know how their fetus might be affected by lower amounts.”Throughout the STAT series, authors emphasize the risks of excessive, but not all drinking. By making comparisons to the attention paid to opioids, the authors are “not arguing” that “having a beer is anywhere near as dangerous as consuming fentanyl, a drug that can kill you in a single instance of use,” series co-author Lev Facher explained in interview segment on the outlet’s weekly interview series. Co-author Isabella Cueto argued that we don’t need a solid answer to questions about the risks of moderate drinking to recognize that heavy consumption “is causing a lot of harm,” which doesn’t get recognized because “people are so caught up on the low-to-moderate conversation,” in her view.What would be possible if more advocates also turned their attention to the harm caused by excessive consumption and the best solutions to address it? Could policy and funding address gaps in treatment for use disorders and imperfections with the abstinence-only approach of 12-step programs, explored in part 4? That approach doesn’t work for everybody, the authors explain, hence the “surging popularity of alternatives” that use medication or urge moderation. Still, many hospitals don’t have experienced addiction consultants on staff, “many insurers balk at paying for” proven drugs and treatment programs are often expensive with little-to-no oversight.Excessive, but not moderate consumption has also helped drive what part 3 calls “a new kind of liver crisis.” The newly defined diagnosis of MetALD, or metabolic dysfunction and alcohol-associated liver disease, is based on the combination of poor diet and heavy alcohol use, which compound each other to damage the liver. It’s already “nearly twice as common as alcohol-associated liver disease” on its own. But here too there are issues with screening and insurance coverage, although GLP-1 drugs may prove particularly helpful.Part of the concern is the impact on younger adults. “More young Americans are dying from liver disease than ever before, even as drinking rates dip to historic lows in those under 50,” the outlet summarizes. But it doesn’t recognize how the phenomenon upends the core contention that as use goes down, so does harm. Use is declining, yet more young people are experiencing liver disease earlier in their lives. And that points toward the need for more targeted approaches to identify and address that harm, not the population-level policies seeking to reduce consumption across the board. Cheers,

Most Change Needed in Medicine, Health; Most Harm from Heavy Drinking: STAT Pt 3

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