Will another warning save lives?

The U.S. Surgeon General wants to add “cancer” to the list of warnings labeled on alcoholic beverages, and someone needs to ask why.

To start with, the studies as to the association between alcohol consumption and cancer are unclear.

“Light to moderate drinking is associated with minimally increased risk of overall cancer. For men who have never smoked, risk of alcohol-related cancers is not appreciably increased for light and moderate drinking, up to two drinks per day,” Harvard University scientists reported in The BMJ, a peer-reviewed publication formerly known as The British Medical Journal, in 2015. “However, for women who have never smoked, risk of alcohol-related cancers, mainly breast cancer, increases even within the range of up to one alcoholic drink a day.”

Researchers in Spain followed up on this in 2021 with a study of “The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality,” which they subsequently published on the open-access website MDPI. The study was part of the ongoing European Prospective Investigation into Cancer and Nutrition (EPIC).

They reported finding that “dietary factors associated with higher cancer mortality risk included poor diet quality, consumption of alcohol and soft drinks including juice, and, to a lesser extent, intake of some fatty acids.”

So should the U.S. now also be putting cancer warning labels on juice packets and soda cans, the consumption of which is many times greater than that of alcohol?

The latest estimate from the National Institute on Alcohol Abuse and Alcoholism is that Americans, on average, consume about two and a half gallons of alcohol per year. This is just shy of 7 percent of the volume of the  37.1 gallons of sugar-sweetened beverages that a peer-reviewed study in Current Development in Nutrition calculated are consumed by Americans every year based on industry data.

Given this, wouldn’t it make more sense to start with a cancer warning on the drinks which now contain no warnings of anything at all? Alcoholic beverages are already labeled with a “GOVERNMENT WARNING:  1.) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.”

Is amending this to read that alcohol “may cause health problems, including cancer” really going to change anyone’s drinking habits?

Complicated picture

But wait, there’s more. There is a big scientific problem with the link between alcohol and cancer as highlighted in another study in the peer-reviewed British Journal of Sports Medicine in 2017.

That study found the link the other studies found between alcohol and cancer, but added that “stratified analyses showed that the association between alcohol intake and mortality risk was attenuated (all-cause) or nearly nullified (cancer) among individuals who met the physical activity recommendations.’

A follow-up study published in the peer-reviewed International Journal of Cancer in 2020 reported much the same thing. After looking at the medical records of almost 55,000 British adults over age 30, the researchers reporting there wrote that “increased (cancer) mortality risks were substantially attenuated when participants in these drinking groups exercised more than 7.5  Metabolic Equivalent task hours per week.”

It is here worth noting the medical definition of “attenuated: Weakened or thinned. Attenuated strains of disease-causing bacteria and viruses are often used as vaccines. The weakened strains are used as vaccines because they stimulate a protective immune response while causing no disease or only mild disease in the person receiving the vaccine.”

Read that however you care to read it, but note that the Cancer journal researchers added in their conclusions that “physical activity could be promoted as an adjunct risk minimization measure for alcohol-related cancer prevention.”

Credit is Surgeon General Dr. Vivek Murthy with good intentions in proposing a cancer warning for alcohol, but it’s hard to avoid wondering if he isn’t aiming at the wrong target.

There are good reasons in this case to ask whether the cancer relationship with alcoholic beverages is the alcohol or the increasingly sedentary lifestyles of Americans. The same question can also be fairly asked about the association between cancer and sugary drinks.

Maybe all these drinks should contain a warning that says “This beverage could cause cancer if you don’t get off your fat ass and move more.”

But both American politicians and the American medical community seem unwilling to talk bluntly about the very real problem of physical inactivity in this country even though it has been linked to not only cancer but to many other diseases and “all-cause mortality.”

A variety of studies, the latest of them published at the start of this month, have reported a dose-response relationship between physical activity (God forbid we call it “exercise” which many Americans seem to fear) and mortality.

The January study published in the Journal of Sport and Health Science reported that when human behaviors were actually tracked by smart watches or cell phones researchers found that “taking more steps per day was associated with a progressively lower risk for all-cause mortality of approximately 40 to 50 percent at 6000–8000 steps per day and 8000–10,000 steps per day in those greater than 60 years and less than 60 years, respectively.”

Those researchers also noted that their findings were exactly new.

“Numerous observational studies have shown that physical activity is associated with both longevity and a lower risk of developing non-communicable diseases, including cardiovascular diseases (CVDs), type 2 diabetes, and many types of cancers,” they wrote. “The beneficial effects of physical activity also extend to mental health conditions and some neurological disorders (e.g., more active individuals have a lower risk for depression) and for dementia and Alzheimer’s disease.”

Reporting in the peer-reviewed British Journal of Sports Medicine in November, researchers who did a “life-table analysis study calculated’ that “if all individuals (in the U.S.) were as active as the top 25 percent of the population, Americans over the age of 40 could live an extra 5.3 years on average. The greatest gain in lifetime per hour of walking was seen for individuals in the lowest activity quartile where an additional hour’s walk could add 376.3 min ( approximately 6.3 hours) of life expectancy.

And yet, an American medical profession overloaded with do-gooders and drug pushers seems unable to embrace the reality of the inactivity problem and accept a human evolutionary history that starts with Polypterus, the first fish to breathe air, and the amphibians, reptiles and mammals that evolved after leading to the eventual rise of homo sapiens who then spent hundreds of thousands of years constantly on the move in order to colonize the planet.

Drs. William Jennings Bryan

Maybe they don’t truly believe in evolution because many are the doctors who seem willing to ignore the evolutionary history of the human immune system, as was well illustrated during the pandemic. There is no archeological evidence of any of our ancestors developing anatomical features that filtered the air or discovering an ability to breathe through their skin like earthworms to protect themselves from airborne viruses.

Instead, homo sapiens evolved a sophisticated immune system that battled both infectious and non-infectious diseases starting with the skin and mucosa, progressing to the phagocytes in our bodies that can engulf pathogens and break them apart, and finally arriving at the cellular level where those T-cells everyone heard so much about during the pandemic go to work. 

All of these defenses are stronger in strong, healthy bodies than in weak, unhealthy bodies, and it is physical activity that strengthens bodies even if a huge number of Americans have either forgotten this or refuse to accept it.

It is not by accident that Americans suffer from epidemics of obesity and sloth. Nor is it by accident that American lifespans are falling behind those of the rest of the Western world because of these epidemics.

The pandemic gave the American medical community the perfect “teaching moment” to hammer home the importance of physical activity, and instead doctors joined in ordering Americans to cover their faces and get vaccinated, and in the process helped fuel yet another culture war in this country.

Masks might have saved some individuals, but there is little evidence masking had any effect at a population level. Sweden, which refused to order masking, had a death rate that was 58 percent of that in the U.S. despite Swedish officials admitting to a failure to act more aggressively to control the spread of the virus in nursing homes where the most vulnerable Swedes lived.

Older people were more vulnerable to Covid-19 because of immunosenescence, the natural decay of the immune system with age. Immunosenescence is, in turn, a process that can be slowed by physical activity or accelerated by a lack thereof, which has led to a medical recognition of a difference between chronological age and biological age.

“Researchers used to believe that life span was chiefly determined by genetics – meaning if your parents and grandparents lived long lives, you and your children would be much more likely to as well,” Mayo Clinic Dr. Francisco Lopez-Jimenez observed in a commentary for that organization’s website in July. “However, more recent research indicates that genetic factors account for only 15 percent to 25 percent of aging. As it turns out, graceful aging has a lot more to do with lifestyle than it does with hitting the genetic lottery.”

There is, he added, an important difference between how old someone is, known as chronological age, and the overall state of someone’s body, known as biological age.

Sadly, when it comes to biological age in America these days, many are older than their chronological age, often much older. A good number of these people ended up dead because of this during the pandemic of the old and unfit.

Somehow, the American medical community never got that messag and still hasn’t. When JAMA Network, a publication of the American Medical Association, in September, highlighted “Increasing Mortality Rates in the U.S. but Not From Covid-19,” Dr. Stephen Woolf, the author of the commentary below the headline, seemed mystified by what is going on.

“Whatever accounts for this trend appears to be uniquely American,” he wrote. “No other high-income country, except perhaps the United Kingdom, has experienced mortality increases as large as the U.S. The life expectancy gap between the U.S. and other countries widened greatly before the pandemic, and U.S. losses to COVID-19 were higher than in peer countries.

“Something systemic to the U.S. is limiting survival. Identifying the cause(s) and enacting social protection policies are urgent. A ‘moonshot’ effort by the research community to address the question is clearly warranted. Given the increases in mortality rates, the answer cannot come soon enough.”

But there’s no mysterious “something” going on. As the life-table researchers reported in November,  “if all individuals were as active as the top 25 percent of the population, Americans over the age of 40 could live an extra 5.3 years on average.”

This isn’t exactly new, either. President John F. Kennedy identified the problem 64 years ago.

“…No matter how vigorous the leadership of government, we can fully restore the physical soundness of our nation only if every American is willing to assume responsibility for his own fitness and the fitness of his children,” the then President-elect wrote in a commentary for Sports Illustrated magazine, then a dominate mainstream media source. “We do not live in a regimented society where men are forced to live their lives in the interest of the state. We are, all of us, as free to direct the activities of our bodies as we are to pursue the objects of our thought. But if we are to retain this freedom, for ourselves and for generations yet to come, then we must also be willing to work for the physical toughness on which the courage and intelligence and skill of man so largely depend.”

JFK’s commentary was aptly titled the “Soft American.” Today we have the “Soft, Fat and Horribly Out-of-Shape American,” but who would dare say that?

The current attitude in some corners is that being “soft” is not just fine, but is a change society should embrace. Thus we have entities like the San Fransisco “Department of Public Health,” hiring people like Virgie Tovar, author of “You Have the Right to Remain Fat,” as a “weight stigma and weight neutrality” consultant who says her job, according to the California Globe, is to promote her “biggest hope and belief that weight neutrality will be the future of public health.”

No one, it needs to be added, should be shamed, shunned or discriminated against because of their body size, but promoting the idea that obesity is healthy is simply not in the public interest given that it is fundamentally unhealthy.

Body weight is an indicator of “metabolic syndrome,” another American medical problem that has reached epidemic levels. 

Overweight in this country is a problem, and obesity is what the National Library of Medicine accurately describes as “a serious, chronic disease” that plays a role in determining the consequences of both what we eat and drink.

Against the backdrop of the many epidemics tied to the sedentary lifestyle that has become so common in this country, worrying about cancer from alcohol consumption seems a small thing.

And never mind the compounding, problematic issue that there are now so many products sporting labels of cancer danger that people are probably beginning to ignore the labels. California’s “Prop 65” cancer warnings have become so common that Consumer Reports was in 2022 moved to publish a story on “how to make sense of those warnings.”

It was headlined “Why California Thinks Your Couch Will Give You Cancer,” and advised that “as commerce moves increasingly online, California products are showing up everywhere now, and the warning labels along with them.”

Reports reporter Lauren Kirchner alsonoted that a 2016 paper from Harvard Kennedy School warned that Prop 65 “‘fails miserably at distinguishing between large and small risks; that is to say between wolves and puppies.’

“When warnings about small harms (puppies) are too plentiful, people become conditioned to ignore them. This can be dangerous when real dangers (wolves) arrive, but no one’s heeding the warnings anymore. Prop 65 labels indicate that a toxic chemical is present in a given product, but not how high the level of exposure is, and not how relatively dangerous the chemical is, compared with others. For these reasons, the authors write, ‘Proposition 65 warnings flunk the test of providing accurate or useful information to consumers.'”

So how much of a cancer danger is your beer or wine or shot of whisky? It’s hard to say for sure, but the evidence is pretty clear that it is significantly less dangerous than spending huge amounts of time sitting on your ass and little time engaged in physical activity.

Given an American Cancer Society study that concluded “prolonged leisure time sitting (defined as more than six hours per day) was associated with a 19 percent higher rate of death from all causes combined compared to sitting less than three hours per day” maybe all computer and TVs should now come with a warning label saying that “Sitting in front of this screen or others for more three hours per day substantially increases your risk of an early death. View at your own risk.”