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US agency changes alcohol advice after doctor complains

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3957 (Published 18 September 2018) Cite this as: BMJ 2018;362:k3957
  1. Owen Dyer
  1. Montreal

A Boston University epidemiologist and physician who complained to the director of the National Institutes of Health (NIH) about public advice on drinking and breast cancer risk has told The BMJ that he was pleasantly surprised to see the relevant web page change almost immediately to reflect his concerns.

Mike Siegel, professor of public health at Boston, wrote to Francis Collins, NIH director, criticising the advice offered on the main cancer web page of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which claimed that “drinking too much alcohol can increase your risk of developing certain cancers,” especially breast cancer.

This statement, Siegel argued, seemed to suggest that light to moderate drinking was safe, when research has shown that even one drink a day is associated with a statistically significant increase in risk for breast cancer. The NIAAA, he said, was “furthering the agenda of the alcohol industry.”

The BMJ contacted the NIH and the NIAAA the day after Siegel’s letter arrived and found that the advice had already been changed.1 John Bowersox, NIAAA spokesman, said, “We appreciate Dr Siegel pointing out an area that needed attention and have updated the information on this page accordingly . . . we have conferred with the National Cancer Institute and have updated the website to reflect the latest science.”

Siegel, after reviewing the changes, said, “They really have addressed it, I have to give them credit. This is a pretty definitive, and I would say adequate, response. To be completely honest, I’m quite shocked, as this is the first time this has happened to me.

“A number of times I’ve pointed out things, and it almost never gets fixed. What they wrote was very reasonable and very scientific—it’s nicely done.”

Concerns have been raised frequently this year about an excessively cosy relationship between the NIAAA and the alcohol industry. A planned NIAAA led major prospective trial called MACH 15, designed to compare moderate drinking with no drinking, was abandoned in June after emails seemed to show that NIAAA staff, in seeking funding from the alcohol industry, had held out the promise of results that would show health benefits from moderate drinking.2

Questions about the trial, and about the industry links of NIAAA’s director, George Koob, were the subject of congressional hearings in April. Collins, the recipient of Siegel’s letter, had told those hearings of his determination to stamp out “even subtle examples of cosy relationships.”

Collins commissioned a report, which found that the MACH 15 trial’s design was liable to show benefits from moderate drinking while missing harms. The report also reviewed claims that Koob had steered research funds away from studies that looked at the effects of alcohol advertising. New research into advertising had indeed stopped since he became director in 2014, the report found, although it drew no conclusions about motives.

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