CCSA Report Medical Commentary
The following is a compilation of critical commentary on the CCSA Report from those in the medical community.
1. Bob Burns, a retired doctor from Nanaimo, B.C.
CBC, 25 January 2023
Just how risky is it to drink more alcohol than Canada's new guide advises?
"If it increases an already-low chance of a cancer, by 0.5, or one, or even five per cent, it would take thousands of cases to have any real significance. I believe that this is vital information to enable people to make informed choices,"
2. Dr. Richard Harding, a co-author of previous UK guidelines for alcohol consumption
Daily Mail, 09 October 2022
'Fifty years of epidemiological and clinical research points to substantial health benefits – not harms – of daily intakes of small amounts of alcohol,' he said. 'The plain fact is that, if people were to follow the recommendation to reduce their consumption to two small drinks or less a week, it is likely that they would be worse off in health terms.'
3. Martin Juneau, director of prevention at the Montreal Heart Institute
C2C Journal, 27 January 2023
Better Make it a Double: New Anti-Drinking Guidelines Seek Abstinence Through Fear, Part I
“As a cardiologist, I can tell you that there are hundreds of well-done studies that repeatedly show a J-Curve,” says Martin Juneau, the former director of prevention at the Montreal Heart Institute and Professor of Medicine at Université de Montréal. Juneau readily admits that alcohol is not beneficial for all heart conditions, including arterial fibrillation or high blood pressure. He also frets about his patients who over-indulge. “But,” he says, “if you want to prevent heart attacks, which is always the number one concern, then alcohol is protective.” He points to several data tables in the CCSA report that actually prove his point on heart health (see Tables 1-4, pages 25-28), despite the overall message being entirely contradictory.
Juneau echoes Malleck’s complaints about the CCSA’s focus on relative rather than absolute risks, calling the report’s deliberate choices in this regard “bad science.” Disputing the notion of a mortal threat arising from every drink taken, Juneau considers the health risks to be “very, very slight until you get to about 14 drinks per week. And after that, it takes off really quickly.” In other words, the real health concern from alcohol is binging, not moderate use. But if that’s the case, what explains the CCSA’s extraordinary effort at trying to convince Canadians that any amount of alcohol is deadly?
“In Canada, there is a certain a group of researchers, primarily based in Western Canada, who are very opposed to alcohol. I see a lot of moral ideology in their work,” Juneau states. Prodded for specifics, he mention the work of UVic’s Centre for Addictions Research of B.C. (now known as the Canadian Institute for Substance Use Research, or CISUR) and in particular Tim Stockwell, a psychologist at CISUR, as chief examples of this observed propensity to “always be on the side of no alcohol.” Stockwell and Jinhiu Zhao, also of CISUR, are the two Canadian co-authors of the 2017 study the CCSA used to dismiss the existence of the J-Curve. As for how this particular paper came to be chosen out of the thousands considered on coronary heart health, Juneau says, “I think they did a little cherry picking…I think they selected papers that confirmed their theory. There are studies that should be there, but aren’t.”
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Juneau’s wisdom on drinking, distilled from his three decades as a practicing cardiologist, is that red wine is better for your health than hard liquor. Drinking with dinner is ideal. Binging is always bad. He contrasts the Anglo-Saxon and Scandinavian approach to drinking heavily on weekends with Quebec’s more Mediterranean-style relationship with the grape that emphasizes small amounts daily in social settings. And he observes that most people are far more accepting of small risks than Temperance-minded scientists assume. Significantly, none of these concepts are to be found in the CCSA report. Rather it insists that all alcohol is identical, rigorously ignores any cultural or social component to how we drink and fixates on the puritanical belief that every drop you take brings you closer to death.
“The danger of research like this,” says Juneau, “is that it can make people feel guilty about doing something that is perfectly natural and has been enjoyed by humans for thousands of years. I say, if you drink, don’t panic.”
4. Dr. Meldon Kahan, addiction physician at Women’s College Hospital
Toronto Star, 29 January 2023
“When you make a blanket, unnuanced statement that (alcohol) increases your risk of cancer, that is really going to frighten people,” said Dr. Meldon Kahan, an addiction physician at Women’s College Hospital. “It also doesn’t put it into context. There’s a lot of things that have been shown to increase the risk of breast cancer, for example: red meat in the diet, deficiency of vitamin D, obesity, and by far the most important, our family history.”
For those diagnosed with cancer, these guidelines will cause tremendous guilt, said Kahan. And those who are drinking more than two drinks a week and doing just fine, they are just not going to listen.
“People don’t react well to being lectured to and to what feels like an attempt to frighten them.”
5. Dr. Harry Rakowski, academic Toronto cardiologist
National Post, 06 February 2023
Harry Rakowski: New drinking guidelines based on majorly flawed study
The CCSA recommendations, while developed by reputable scientists, were based on estimations of excess risk drawn from observational studies and systematic reviews of the literature. Almost 6,000 studies were reviewed and only 16 reports had adequate data to include in their mathematical risk modelling. Only three studies looked at cancer risk with data sufficient to influence a more restrictive change to guidance. Other studies focused on the risk during pregnancy, cardiovascular risk and societal issues.
The recommendations are based on pooled data from multiple studies that had somewhat similar methods. Only lower quality, that is to say observational studies were included, since higher quality trial data isn’t available. People typically self reported their level of alcohol consumption and it is reasonable to assume that many undercounted their consumption. Thus the data for risk for each additional drink a week may lack accuracy.
The major flaw in the study was the focus only on alcohol consumption as a risk factor, thus leading to a confirmation bias. If you only look at alcohol risk that is all you will find. There was no controlling for differences in variables known to affect cancer risk, such as diet, obesity, smoking, exercise and family history.
For example, if more alcohol consumption is associated with more smoking, something not adequately captured in the association study, it is more likely smoking is the major culprit for cancer risk. If people who drink alcohol also eat more processed meat, have a family history of disease and are obese, then these risk factors are the more likely cause of increased rates of colon cancer. If those who drink more do so due to greater stress and depression, they may have a greater degree of inflammation triggering illness.
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We all have to determine what risk level we want to live with. I think the previous recommendations for seven drinks a week for women and 14 for men are more reasonable than the new more restrictive CCSA ones. When we analyze risk we have to look at our own personal additive risks for alcohol consumption and consume with sensible moderation.
6. Eric Rimm, an epidemiologist at the Harvard T.H. Chan School of Public Health
USA TODAY, 17 February 2023
Is any amount of alcohol safe? It depends on your taste for risk.
On the flip side, there is some social benefit to relaxing and having a drink – as long as people can control their consumption, said Eric Rimm, an epidemiologist at the Harvard T.H. Chan School of Public Health.
"To have people feel scared and deny them that drink, I think we're doing them a disservice by freaking everybody out," he said.
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Rimm's work revolves around analyzing such data. He helped write the USDA Dietary Guidelines for Americans, which recommends that for those who choose to drink, men consume no more than two drinks a day on any drinking day and women no more than one.
He remains convinced, based on 40 years of research, that level is fine – and even healthy.
Yes, people will likely get more benefit from an hour of exercise than a glass of wine, but alcohol will somewhat reduce the risk of blood clots and improve glucose control, he said. That's why you bleed more if you nick yourself shaving the morning after having a drink or two.
That's also why he thinks it's probably better to drink small amounts five nights a week rather than just more on weekends – because it will keep alcohol's benefits consistent in the bloodstream.