[rapjr9]

I think this is exactly the problem with the medical research community, they study what they choose to study, not what is important to study. This is a well known problem with research in general, researchers choose the easy problems and the profitable problems, while the hard problems get ignored for decades. Mapping DNA was considered too hard, until someone actually tried to do it, and now it's common. The research that is ignored (because it is thought too difficult, is too political, doesn't fit with researchers idea of morality, is not in the interest of big pharma, or would disrupt profitable empires) is what drives my lack of trust. In particular, the opinions described in this article seem like blatant victim blaming instead of any serious attempt to reduce harm from something that is never going to disappear from society given it's greater than ten thousand year history.

[paulryanrogers]

> ...they study what they choose to study, not what is important to study.

...

> In particular, the opinions described in this article seem like blatant victim blaming instead of any serious attempt to reduce harm from something that is never going to disappear from society given it's greater than ten thousand year history.

Isn't it good to challenge even established consumption, despite many not want wanting to, since such research has great potential to reduce harm?

Tobacco is a widely established product, yet because of research and education society is changing to reduce harm.

[rapjr9]

The article says nothing about how much harm would be reduced, it just states a vague 50% increase in cancer risk without stating what the baseline is and what that risk means in relation to all the other cancer risks. And there has apparently been no study of the harm that might be caused by reducing alcohol use. If alcohol use was reduced would fewer babies get born? Would people be less creative? Would there be less fun in the world? Would everyone concentrate more on being mean to each other to get ahead? Would the experience of life be even more frustrating? Anecdotal, but the meanest people I've ever met never drank. What is the harm of removing a "social lubricant"? Does it mean society runs less smoothly?

The people in the article are saying the public is not aware of the risk. But who is responsible for informing society of medical risks? The medical community! They say it's all the fault of the liquor industry, but they can give medical advice to all their patients and the liquor industry can do nothing about it. So why haven't they been informing everyone of this risk for decades? Almost everyone in the USA sees a doctor at some point, yet nobody has heard of this cancer risk? It seems to me they are to blame here for the lack of information. Yes, informing people of risks can be helpful. But it also has to be in context. Is driving a car a bigger risk than drinking? Then we should be putting warning labels on cars. Is air pollution a bigger risk than drinking? Then we should be warning people to move out of cities. Yet the medical community has ignored environmental concerns for decades. When was the last time a doctor recommended a standard test set to you to check your home environment for toxins? Never! I think these blindnesses on the part of medicine undermine trust in what they recommend.

I don't think it is research and education that changed society with respect to tobacco. Everyone knew the tobacco companies were lying. Plus the ill health effects of tobacco are obvious, people start coughing all the time. I think people themselves saw how their grandparents died and that is what changed them.

If the medical community wants to reduce harm by changing consumption they can start with better and more detailed advice on food, naming specific brands. For alcohol they could also say whether or not congeners have an effect on disease including cancer (is brandy different than vodka?) They could recommend replenishing B vitamins and rehydrating, study if that has an effect on cancer, which could be much simpler than stopping people from drinking. Yet you won't hear any such advice from a doctor. There has been an unspoken moral dimension to medicine for hundreds of years. Early research into reducing debilitating effects of alcohol was discouraged because "if we had a cure for alcohols bad effects people would be encouraged to drink more". They didn't study whether that was true, they just pronounced judgement. Doctors gave less pain killers to black people because they "believed" they had a higher pain tolerance, no studies involved. The flu, colds, and COVID-19 are spread by fomites they said, studies say they are spread by aerosols, and many in the medical community still don't believe aerosol spread is a problem (there are still recommendations for distancing rather than ventilation). There is a big dogma problem in medicine that is unacknowledged, it propagates unscientific beliefs from long ago. And when medicine fails I think it tends to blame the victim because of that dogma. This is playing out right now with obesity. Medicine says just eat less, it's a personal choice. But we're finding out it is not that simple. I think the same is true of alcohol. For example, there is not one word in this article about tapering drinking (because a sudden halt can cause harm). If they wanted to inform people of the risks to reduce harm why didn't they mention that risk? If this article causes people to quit drinking it may actually be doing harm by killing them.

Another aspect to this all is the apoliticalness of medicine. It has avoided confrontation with power for centuries. If power trumps medicine, what can you believe about what medicine says? This timidity was a survival characteristic, along the lines of do whatever the man with the spear says in the hope he'll let you save some of the people. The medical community has never overcome this even as society has changed. Fauci went along with Trump in the early days, rarely contradicting him, as an example. I think this has to change. Maybe this article is an outbreak of such courage. It seems long on condemnation and short on actual harm reduction though.

So here's some actual data:

https://pubmed.ncbi.nlm.nih.gov/16264180/

that says:

"The absolute rate of ER+ breast cancer (standardized to the age distribution of person-years experienced by all study participants using 5-year age categories) was 232 per 100,000 person-years among women in the highest category of alcohol intake, and 158 per 100,000 person-years among nondrinkers."

Sounds bad, a 50% increase in relative risk. Say most people live 80 years. So (158/100,000) * 80 = 0.1264 absolute risk. Do the same calculation for drinkers: (232/100,000) * 80 = 0.1856 The difference is 0.1856 - 0.1264 = 0.0592

So your absolute risk of getting breast cancer in your life is 12.64% if you are a woman and don't drink. If you drink that risk goes up 6%. The article doesn't say that, instead quoting only the relative risk increase of 50%. 50% sounds scary, does 6% sound so scary? Alcohol is one of the many risk factors for breast cancer, here's a list of all of the known ones:

https://www.breastcancer.org/risk/factors

Alcohol is lower on this list than radiation, being overweight, not experiencing pregnancy, not breastfeeding, and using hormone replacement therapy. Driving a car as a teenager is probably a bigger risk of death than getting breast cancer from drinking.

I'm all for meaningful harm reduction, but this article seems more like moral propaganda without a serious focus on all types of harm reduction for drinking or a statement of the absolute risk. I don't think a warning label would have much effect either, there is already a warning on alcohol that says "make cause health problems" and that is not stopping drinkers. If the label told the truth and said something like "drinking alcohol may cause a 6% increase in your risk of cancer, probably near the end of your life" would people pay much attention? Has anyone done a study to see if such a warning would have any impact at all or are these people just assuming it would have an effect? How many people ignore the California cancer warnings?

[paulryanrogers]

> When was the last time a doctor recommended a standard test set to you to check your home environment for toxins? Never!

Actually this happens pretty often with radon gas and mold tests. There are even regulations for testing when selling homes in some places.

Rules requiring better informing consumers doesn't seem too onerous to me.

[rapjr9]

True, but probably not something your doctor would tell you to do, and those tests don't even begin to address all the environmental factors that could be tested for that could affect health. One thought I've had is that everywhere in America with old industry should be tested for toxins, for example all of Eastern Massachusetts. In the old days bad stuff was just poured out in the woods and is probably still sitting there today. Waiting till it shows up as increased health problems in a particular geographic location doesn't seem proactive enough. Your doctor should ask for a PM2.5 count from your home, as well as a measure of organic volatiles, noise levels, allergens, CO2 levels, an air sample to put into a gas chromatograph, a soil sample to analyze, and more to know how your environment could be affecting your health. It wouldn't have be done often, but as a new patient it should be one of the first things done. Hell, even when geographically located disease is obvious like near the chemical refineries in Texas little is being done by the medical community and they certainly are not asking for environmental tests for industrial byproducts.

Rules requiring better informing citizens are good. I'd like the warnings to be proportional to the risk though, and I'd rather see the risks studied and reduced rather than just a warning meant to alter human behavior. Medical warnings often seem like EULA's, everyone pays no attention to them and clicks through. If there was instead a warning that described how to reduce risk, and where the worst risks are, and how to mitigate some of the risk, maybe people would pay more attention.

[halpert]

I'm curious, what do you do for a living? Do you not do what you choose to do, rather than what is of the most importance? Many people on HN work at Google, for instance. Is an ad-tech really the most important issue facing humanity? The "research community" isn't a single organization that is gate kept by a centrally planned authority. It's comprised of individuals and organizations of varying sizes, all operating independently. You are free to join the research community yourself and study the things you think are important. Most people I know don't choose their jobs based on what is most important, but rather what fits their lifestyle, what is most lucrative, etc. These people still do good work and are trustworthy.