Alcohol, Canada, and the CCSA Report: The Devil’s in the Details

Alcohol is back in the news in Canada and the new report from The Canadian Centre on Substance Use and Addiction (CCSA) is making waves. The CCSA report updates their guidelines on safe alcohol consumption, and this is the first update in 11 years. The TL:DR on this one is that it significantly lowers the amount of alcohol advised to drink. 

How much lower?

The new report states that no amount of alcohol is truly safe, suggesting a maximum of two drinks a week for both men and women. This guidance is far more conservative then the original guidance, which previously advised up to 15 drinks a week for men and 10 for women. Furthermore, health experts are now pushing for cancer warning labels to be placed on all alcoholic beverages.

The report is 84 pages long, looks at 5915 reports, and concludes that there is no safe amount of alcohol. Furthermore, the report suggests that anything more than 2 standard drinks a week will dramatically increase your chances of cancer and of dying early. 

So, I looked at the report and went down to the results section to see what they actually say. The report lists 5915 sources for its report on the dangers of alcohol, and it goes into a lot of detail about how the study was conducted, adds some cool and scary charts, but if you want to save some time, scroll down to the top of page 20, the “2.1.2 Results” section. That’s where our old friend, the Devil, is hiding in the details.

Right at the top of the section, “In the end, a total of 16 systematic reviews fulfilled all the inclusion criteria for this project for all three research questions and were selected for inclusion in the mathematical modelling.

So, they tout 5915 articles, but only 16 of them are considered good enough to support your modelling. Okay, let’s continue.

So, in the end, three research questions are considered.

Research Question 1: Short-Term Risks and Benefits

Here’s the result of the first, “Twenty-nine systematic reviews on the short-term risks and benefits of alcohol were evaluated. Two systematic reviews were selected for inclusion in the mathematical modelling. One selected review focused on road injury (Taylor & Rehm, 2012) and the other on intentional and unintentional injuries (Taylor et al., 2010)”.

No surprise there, but under short term risks is one we’ve known about for years. You shouldn’t drink and drive. The second is that drunk people can be prone to violence or doing stupid things. Nothing about cancer here.

Research Question 2: Long-Term Risks and Benefits

This is the part about cancer and other diseases. As for long term risks (criteria number 2), only 14 reviews out of 154 were actually considered suitable for inclusion in the report. Here’s a direct quote from the report.

A total of 154 systematic reviews across eight categories of diseases associated with the long-term health risks and benefits of alcohol were evaluated. Fourteen reviews were selected for inclusion in the mathematical modelling.

Research Question 3: Pregnancy and Child Development Risks and

Benefits

Finally, let’s look at the last section on “pregnancy and child development risks”. Any guesses on how many of the reports were considered suitable for their model? Zero. Nothing. Nada. From the report…

Twenty-five systematic reviews focusing on the risks and benefits associated with alcohol consumption during pregnancy or breastfeeding for fetal, infant and child development were evaluated. None were selected for inclusion in the modelling because none met the mathematical modelling criteria.

Seriously, zero.

Look, I’m not saying that there aren’t risks associated with alcohol consumption. Any idiot can point to liver disease in heavy drinkers, or the dangers of drinking and driving, or the violence that sometimes accompanies bouts of heavy drinking. Also, and let’s be clear, some people such as alcoholics have a problem with alcohol and should never drink. None of that is new and none of those things are up for debate. 

It’s the report that bothers me and the attention that’s been garnered on something that seems, shall we say, a bit light. To sum up, of 5915 reports, only 17 were considered suitable to support their argument. That’s 3 tenths of one percent which isn’t even a statistically significant number. 

Furthermore, the big attention paid to this report only considers increased risks (absolute and relative) over and above risks that, for many, are already incredibly low for anything resembling moderate drinking.

Come back when you have more data.

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