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Mar 31, 2014

The reality behind Big Grog and other villains of the public health debate

The reality of the alcohol and beverage industry fits poorly with efforts to dismiss them as evil vectors of disease. The real data on health tells a different story.

Last week we saw how corporations are regarded as vectors of non-communicable diseases by key Australian public health lobbyists, thereby rendering the idea of consultation or communication with industry on health regulation as logical as communicating with a virus one seeks to eradicate.

Before looking at some examples of how this is applied, it’s worth spending a little more time considering how accurate this Corporate Virology approach is. Last week we noted that Australian lifespans had continued to increase despite the apparently remorseless assault of alcohol, processed food, sugar and soft drink companies on the diets of Australians.

Alcohol is particularly worth considering in this regard. Despite being dismissed as a clone of the tobacco industry by the public health lobby, there is extensive evidence for the health benefits of light to moderate alcohol consumption. The National Health and Medical Research Council’s 2001 alcohol guidelines contained considerable discussion of the “good evidence” that regular low-risk drinking protects against heart disease:

“Most studies of the effects of drinking measure these in relation to the amount people drink over time. Clear indications have emerged over recent years, however, that the pattern, as well as the level, of drinking is important in relation to both the risks and the benefits of alcohol. Essentially, the evidence suggests that low to moderate regular drinking, particularly when it occurs with meals, affords partial protection against heart disease and heart attack for people of middle age and older; while heavy drinking (both episodic and long-term) markedly increases the risk of heart attack.”

However, the NHMRC watered down its comments on the benefits of moderate alcohol consumption when it overhauled the guidelines in 2009 (the guidelines that halved the recommended level of alcohol consumption per day for men to two standard drinks), citing studies that disputed the benefits of alcohol for cardiovascular disease and noting “the potential cardiovascular benefits from alcohol can also be gained from other means, such as exercise or modifying the diet”.

Another problem with the benefits of moderate alcohol consumption is that they are offset by the increased risks of various forms of cancer, such as mouth and oesophageal cancers and breast cancer in Caucasian women, that are known to be associated with alcohol consumption, as well as the consequences of heavy drinking.

“None of this fits with the ‘Big Grog=Big Tobacco=Big Sugar=Corporate Virus’ thesis …”

The Boston University School of Medicine hosts an International Scientific Forum on Alcohol Research, which uses experts in a range of disciplines to conduct an ongoing review of alcohol-related research around the world. Studies reviewed by the forum in the last two years show increasing evidence of a wide range of benefits from low-to-moderate alcohol consumption in areas such as cardiovascular disease amongst people with diabetes, multiple sclerosis, arthritis, dementia and osteoperosis, as well as greater evidence of links between alcohol and skin cancer, gout and macular degeneration.

It’s thus possible, as some studies have concluded, that in countries with relatively moderate alcohol consumption (like Australia, ranked 44th in the world in per capita consumption) the number of deaths attributable to alcohol consumption is exceeded by the number of deaths prevented by alcohol consumption rather than, as is assumed in costings of the impact of alcohol, alcohol-attributable deaths significantly outnumbering alcohol-preventable deaths.

Two consistent themes of the ISFAR critiques are the J-shaped curve of the link between alcohol consumption and overall mortality, with light or moderate alcohol consumption being associated with lower overall mortality than abstention or heavy consumption, and the highly damaging effects of binge drinking compared to regular, moderate drinking — as the NHMRC’s 2001 guidelines suggested, the pattern as well as the level of drinking is important.

The Corporate Virology approach thus becomes problematic when the alcohol industry itself, via initiatives like DrinkWise, promotes consumption of its product at exactly the level and in the manner that evidence suggests is most consistent with overall longevity (Drinkwise promotes the NHMRC guidelines on both moderate drinking and binge drinking).

The beverage industry reflects different problems with the Corporate Virology thesis. Sugar is now the supervillain of the obesity debate, with the Public Health Association of Australia earlier this month welcoming a World Health Organisation recommendation that people halve their sugar intake and other public health groups calling for a “sugar tax” on soft drinks (the US has had a long-running debate over “soda taxes” which are common across many states). All that is ostensibly bad news for the soft drink industry.

But the biggest problem for US soft drink manufacturers currently is trying to stop people abandoning low-sugar soft drinks like Diet Coke, Coke Zero and Diet Pepsi — sales of which are falling much more rapidly than full-sugar products like Coke — due to concerns about artificial sweeteners. One of the key vectors of the “obesity pandemic” is thus aggressively marketing low-sugar products (and that, incidentally, points to one of the problems of sugar taxes urged by public health groups: many overweight people already consume low-sugar beverages).

None of this fits with the “Big Grog=Big Tobacco=Big Sugar=Corporate Virus” thesis advanced by some public health figures as a rationale for not dealing with the private sector — preferring instead to tax and regulate what Australians consume.

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23 comments

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23 thoughts on “The reality behind Big Grog and other villains of the public health debate

  1. danger_monkey

    ” Last week we noted that Australian lifespans had continued to increase despite the apparently remorseless assault of alcohol, processed food, sugar and soft drink companies on the diets of Australians.”

    Yep, and you can pretty much chalk that up to the reduction of infant and child mortality – child death really drags the average life span down.

  2. Shaniq'ua Shardonn'ay

    I think part of the problem is that the ABS doesn’t release (or only releases some) of the data on cause of death by age group. That would facilitate the discussion that we need to have about disease and dying in old age vs what’s killing us in our prime (suicide).

  3. JohnB

    Very interesting and challenging. This is the health discussion we had to have, but will we? The gatekeepers are vigilant and strong.

  4. Electric Lardyland

    And just to add to what danger monkey just said: other confounding influences are things like; a huge increase in the understanding of many diseases, greatly enhanced medical technologies, a largely functional healthcare system, a large drop in tobacco smoking rates, and many Australians caring what they put in their bodies and getting plenty of exercise.

    So claiming that excess consumption of processed food, sugar, etc, doesn’t have a negative effect on health, because of overall mortality rates, is flawed logic.

  5. Electric Lardyland

    That being said, I have no problem with, more or less, moderate alcohol consumption. And the main problem that I have with excessive consumption, is the nasty hangovers and the wasted, brain-dead days after.

  6. Shaniq'ua Shardonn'ay

    @Electric Lardyland and @danger_monkey – If we look at the median age of death rather than the mean (or average) , the change in infant mortality rates would be cancelled out we are still living longer: (http://www.abs.gov.au/ausstats/abs@.nsf/mediareleasesbyCatalogue/2547281B0AB7F8F3CA257C1B000D7427?OpenDocument)

  7. R. Ambrose Raven

    Usual denialist denial. Obesity is one of the hardest conditions to treat as dietary restrictions often ultimately cannot be maintained.

    So, Big Obesity’s (the fast food industry’s) advertising and carefully planned manipulation of peoples’ behaviour is doing exactly what it intends; naturally its profits depend on perpetuating the promotion of ill-health. Limiting diet-induced chronic disease requires prosecution and control of fast food and drink promoters.

    So it matters that profit-seekers/Big Obesity appear to carefully design foods to become addictive, meaning in the physiology of reaction to high-glycaemic-index foods is the same as for consumption of addictive substances, such as heroin and cocaine. MRI scanning revealed intense activation of the nucleus accumbens, a critical brain area in the dopaminergic, mesolimbic system that mediates pleasure eating, reward and craving.

    Similar activation patterns have been found in people after consumption of addictive substances, such as heroin and cocaine.

    The reality of the alcohol and beverage industry fits very well with efforts to dismiss them as evil vectors of disease. The real data on health tells a exactly that story.

  8. Will

    I’m not fully supportive of Keane’s hostility to public health preventative groups, but this is a decent article which highlights some false alarmism and the problem of substitution effects. The latter issue is often poorly handled by the prevention crowd, often to the consternation of the actual researchers behind them doing the behavioural and epidemiological science. There is possibly some truth to Keane caricature of abstemious bike-riding prevention warriors, but the reality is they are compelled to observe advocacy silence on matters that can’t be given a full-voiced behavioural recommendation, even when that means worse outcomes in terms of harm minimisation. Keane mentions a good example of this artificial sweeteners, which you’ll note are mentioned nowhere in the recent Rethink Sugary drinks campaign, and electronic cigarettes is another area.

  9. Shaniq'ua Shardonn'ay

    “So it matters that profit-seekers/Big Obesity appear to carefully design foods to become addictive, meaning in the physiology of reaction to high-glycaemic-index foods is the same as for consumption of addictive substances, such as heroin and cocaine.”
    I just love it when people bring heroin and cocaine into it. It makes chocolate sound just so evil and nasty.
    I would have thought that from an evolutionary point of view the greedy ancestor who ate more than they needed and really got stuck into that Mammoth Fat would have a better chance of surviving the next famine than their peers. I think looking at Obesity as an evolutionary adjustment that no longer works now that food is abundantly available might be a good start.

  10. Altakoi

    Moderate consumption of alcohol is not the issue, although the possible health benefits are contested. However, saying the alcohol industry ‘promotes’ healthy alcohol consumption is complete rubbish unless one accepts that what one says is the sum of ones actions. This is the ‘guns don’t kill people, people kill people’ defence repackaged for a different problem. Sane people can own assault rifles, so there is no problem. What the alcohol industry also does is push for greater availability, lower prices – or at least an absence of taxes – the availability of products which are attractive to the young, and advertising which ‘promotes’ alcohol consumption in a positive light. Those are are its actions, and they speak far louder than a glossy ad campaign. Why is why they are willing to do a glossy ad campaign. Contrary to Bernard’s shakespearean protesting too much on this issue, no-one has accused the alcohol industry of doing anything other than acting primarily to maximise profits. Thats pretty much standard corporate behaviour, its not a conspiracy theory. What is being said is that the interests of profit, which is to increase sales, and health, which is to moderate consumption, are in conflict on a population level.