Every year, the National Academies of Sciences, Engineering, and Medicine publishes influential reports on topics ranging from climate change to traffic safety to social media and adolescent health. The National Academies enjoys a fairly sterling reputation, with few questioning its self-described role of providing “independent, objective advice to inform policy with evidence, spark progress and innovation, and confront challenging issues for the benefit of society.” But as the Academies announces new appointments to an expert committee tasked with studying alcohol’s health effects, that reputation is coming into question.
This particular saga begins with the 2020 Dietary Guidelines for Americans (DGAs). Updated every five years, the DGAs have long included a recommendation that men who choose to drink alcohol should drink no more than two drinks per day. Women are advised to drink no more than one. This rather permissive stance reflects a prevailing view expressed in the 2010 DGAs that “moderate alcohol consumption is associated with a lower risk of cardiovascular disease.”
The problem with that advice is that the latest science casts doubt on those purported cardiovascular benefits and shows that virtually any alcohol has a negative effect on health. As the popular science podcaster Andrew Huberman sums it up, “even low-to-moderate alcohol consumption,” i.e. more than two drinks per week, “negatively impacts the brain and body in direct ways.” This advice is consistent with new Canadian guidelines warning that consumption of 3-6 drinks per week increases “your risk of developing several types of cancer, including breast and colon cancer.”
Needless to say, Big Alcohol does not like the new Canadian alcohol guidelines. Nor did they like the suggestion of the 2020 U.S. Dietary Guidelines Advisory Committee—the expert committee charged with updating the DGAs—that the recommended limits for men be reduced from two drinks per day to one. They persuaded 28 members of Congress to sign a letter to then USDA and HHS Secretaries Perdue and Azar, who subsequently issued new DGAs that maintained the recommended drink limits for men at two per day.
But the Big Alcohol lobbyists did not stop there. An obscure provision of the gargantuan 2023 Consolidated Appropriations Act, which Congress passed almost literally at the eleventh hour in December of 2022, sets aside $1.3M for the National Academies to conduct a study of alcohol and its health effects. In other words, Congress removed dietary advice related to alcohol from the DGA process, outsourcing it to the National Academies.
There are reasonable arguments for excluding alcohol from the DGA process. For one, alcohol is not a nutrient. On the other hand, the U.S. adult population consumes an average of almost 100 calories per day from alcoholic beverages, according to the CDC, and so alcohol contributes substantially to soaring obesity rates. The most important consideration, however, is that American consumers get objective, scientifically valid guidance on consumption. So the news that the National Academies would be studying alcohol rather than the Dietary Guidelines Advisory Committee did not ruffle a lot of feathers. Until the Academies announced the make-up of their expert panel last month.
The panel included two Harvard professors, Dr. Kenneth Mukamal and Dr. Eric Rimm, who have a history of alcohol industry funding. Following public outcry and within hours of a New York Times article reporting on the controversial appointments, the National Academies rescinded their appointments. Earlier this month, however, the Academies announced that it was appointing one of Rimm and Mukamal’s colleagues, Dr. Luc Djousse, who also has a checkered history of receiving and failing to disclose alcohol industry funding.
The Academies also announced another Harvard professor who has co-written papers with Dr. Mukamal, Dr. Carlos Camargo, who was chair of the alcohol committee for the 2005 Dietary Guidelines Advisory Committee. Those guidelines stated: “Alcohol may have beneficial effects when consumed in moderation. The lowest all-cause mortality occurs at an intake of one to two drinks per day. The lowest coronary heart disease mortality also occurs at an intake of one to two drinks per day.” If you are wondering whether that advice is at odds with the new Canadian guidelines and today’s scientific consensus, it is.
But it’s not just the presence of industry friendly voices on the National Academies committee that raises concerns, but also the omission of experts who have challenged their research, or published in fields critical to understanding alcohol’s health impacts. In particular, the twelve appointed experts do not include a cancer epidemiologist, and the only member who has specialized in alcohol-related harms is an expert in prenatal exposure to alcohol.
Why has the National Academies chosen these experts, and declined to appoint others nominated by public health groups? A review of the nominations submitted to the National Academies from outside groups, such as the Distilled Spirits Council, would shed some light on those considerations. However, when I asked the National Academies for that information, the reply was that “we don’t have an obligation under law or Academy policy to make any such comments public.” This is an important contrast with the DGA process. To be sure, industry influences the composition of the Dietary Guidelines Advisory Committee, but the public has visibility into who nominated which members. This National Academies alcohol committee is a black box.
Unfortunately, this is not the first time that this type of criticism has been leveled. A 2017 study found that six of the twenty members who wrote a 2016 report on genetically engineered crops had conflicts of interest that were not disclosed. And back in 2006, the Center for Science in the Public Interest looked at 320 different panel committee members and found that 18% had “direct conflicts of interest” defined as “a direct and recent connection to a company or industry with a financial stake in the study outcome.”
Tufts University professor Michael Siegal, whose blog is linked above, has called for a formal investigation into the formation of the National Academies’ alcohol panel, rightly pointing out that “in the absence of an investigation, the conclusions of this panel will be forever tainted and cannot be trusted or viewed as impartial.” The National Academies should not wait for public health and consumer advocates to force the issue. As a first step, the Academies should publish the correspondence it has received from industry and other stakeholders nominating the various experts on the committee. It should also remove Dr. Djousse and other members with conflicts of interest and add experts in relevant fields such as cancer epidemiology and addiction.