There is an inherent and fundamental conflict of interest at the Health and Alcohol Information Center (CISA) in Brazil.
CISA is a social aspects and public relations organization funded by the alcohol industry that is located in São Paulo, Brazil, wrote Pinsky, Pantani, Messas, and Sanchez in the Journal of Studies on Alcohol and other Drugs in 2020.
CISA is one of the reference institutions in Brazil for the development of research into the consequences of alcohol, but it is funded by Ambev at least since 2005 and from Heineken since 2018.
Ambev, formally Companhia de Bebidas das Américas, is a Brazilian beer producer now controlled by global beer giant Anheuser-Busch InBev (AB InBev). Ambev was created on July 1, 1999, with the merger of two breweries, Brahma and Antarctica.
AB InBev is the world’s largest beer producer. This alcohol corporation has a track record of unethical business practices, such as buying science and other deceptive activities. Deception is AB InBev’s activity to hinder and obscure public recognition of the real effects of alcohol.
Heineken is the world’s second largest beer producer. Heineken has a track record of deploying unethical practices to maximize profits, just as AB InBev. Much of it has been covered by investigative journalist Olivier van Beemen in his book “Heineken in Africa”. From aggressive political activity, to tax avoidance schemes; from racism, exploitation of women, Human Rights abuses to unethical marketing; Heineken deploys a vast spectrum of unethical business practices, including deception and undermining independent science.
Exposing CISA’s conflict of interest – example of standard alcohol unit
The effects of Big Alcohol funding CISA appear in studies published by the center, which indicate a standard unit of alcohol as 40% higher than that considered by the World Health Organization (WHO).
The concept of standard unit is used in much of the research on alcohol use and harm and refers to the amount of pure alcohol present in a given quantity of alcoholic drink.
The WHO considers that the standard unit of alcohol has 10g of ethanol, the amount present in 285 ml of a beer with an alcohol content of 5%; in 100 ml of wine, or in 30 ml of distilled spirits. The standard dose used by CISA in its publications is 14g of pure alcohol, which would be a 350 ml can of beer, 150 ml of wine or 45 ml of spirits.
Most countries in the world that define a standard unit of alcohol follow the WHO and define it as 10g of ethanol.
The Intercept reports that the Brazilian Ministry of Health provides the following definition:
- A man who consumes alcohol in “low amounts” takes a maximum of 14 alcoholic drinks per week and no more than four on a single occasion.
- For women, there are up to seven doses per week, limited to three in one occasion.
- The department used a 2020 CISA survey as one of the bibliographic references in defining lines of care for disorders caused by alcohol use.
The table does not make it clear what standard dose the Ministry of Health is using. If it is 10g, defined by the WHO, a man who consumes 14 doses of alcohol per week would be consuming four liters of beer.
But, if the standard dose of CISA was applied, that same man could consume almost five liters of beer per week – and would still be in the group of people who consume “low amounts” of alcohol – it is one liter more than what is recommended by the WHO as lower risk amount of alcohol use.
CISA and Big Alcohol: Questionable science and absence of scientific legitimacy
According to researcher Zila Sanchez, head of the preventive medicine department at the Federal University of São Paulo, the influence of Ambev and Heineken directly interferes with the results of scientific research published by CISA. Together with other researchers, in 2020 she published an article exposing the conflicts of interest that exist at CISA.
The text highlights that it is part of the companies’ strategies to encourage research “without scientific rigor, resulting in inaccurate information about alcohol” and that favors the interests of the sector.
The data produced by CISA has a major conflict of interest. Even so, they are referenced by the media and official bodies and it is never said that they were generated by the alcohol industry”, explained Sanchez, as per The Intercept.Prof. Zila Sanchez, head, preventive medicine department, Federal University of São Paulo
The article also shows examples of “subtle disinformation” promoted by CISA. For example, CISA is promoting the idea that the alcohol industry can self-regulate effectively and contribute to reducing alcohol harm in this way.
Although it states on its website that Ambev and Heineken are “financial supporters”, Cisa does not disclose how much it received from the two beer giants.
Both beer producers steer CISA’s work through their seats on CISA’s “deliberative council” for at least two years, occupying prominent positions, as The Intercept reports.
- Currently, the presidency of the board is held by Carla Smith de Vasconcellos Crippa Prado, also vice-president of corporate relations at Ambev.
- The vice-president is Mauro Vitor Homem Silva, who is also responsible for the vice-president of sustainability and corporate affairs at Heineken.
The deliberative council supervises the work of CISA’s executive team, in addition to monitoring and guiding “the definition of objectives and social actions” and establishing “fundamental guidelines and general rules for organization, operation and administration”.
CISA has been operating for 19 years as a civil society organization of public interest. Cisa boasts of being independent and free from interference from its sponsors and partners.
Big Alcohol front groups such as CISA are source of alcohol policy misinformation in Brazil
CISA is effectively a lobbying and public relations front group directly funded by the alcohol industry. Yet, it masquerades as an independent, public interest non-governmental organization (NGO). It partners with universities and medical organizations and is the main source of information regarding alcohol issues for Brazilian people and the media.
CISA distributes their own non-peer reviewed publications, using unclear methodology to analyze public data from the national health information system, revising scientific literature, and replicating data from national surveys to support select recommendations and guidelines from the WHO.
An example of CISA’s misinformation campaign is visible in their 151 page report “Alcohol and Health for Brazilians: Panorama 2020.”
- This report pays almost no attention to the importance of WHO’s proven, effective best buy alcohol policy solutions (i.e. reducing physical availability, banning advertising, and increasing the alcohol price through taxation).
- Industry self-regulation is cited as an example of effective policy that is already in place in Brazil, despite strong evidence to the contrary.
- There is no disclosure of CISA’s conflict of interest with regard to their alcohol industry funding and connection.
- But the WHO is quoted more than 120 times throughout the document, which suggests a close alignment with the WHO’s objectives.
- There is no currently agreed upon measure with regard to the concentration of alcohol contained in a standard alcoholic beverage in Brazil. But the report defines it as falling within the higher end of the range worldwide (14 g of pure ethanol), which is then accompanied by blatantly misleading quotes pertaining to the beneficial effects of alcohol use.
Other evidence of CISA’s conflict of interest noted in the letter include:
- The construction of CISA’s executive board; it consists of both professors and health researchers from Brazilian universities as well as alcohol industry representatives;
- CISA’s founder and president is a professor in a medical school and the current coordinator of the municipal drug program for the city of São Paulo that is responsible for the local government’s decisions regarding drug policies, prevention, and treatment. At the same time, he is a member of the pilot initiative steering committee in Brasilia, an AB InBev program.
- During the COVID-19 pandemic in which the media regularly consults CISA’s members, the source of CISA’s funding is never disclosed, nor are the aggressive efforts of the alcohol industry to raise alcohol sales during this period.
The alcohol industry in Brazil continues to infiltrate and have access to the government and research in a way that is problematic and needs to be monitored and curtailed,” wrote Pinsky and colleagues, as per UNIAD.Ilana Pinsky, Daniela Pantani, Guilherme Messas and Zila M. Sanchez
CISA advice goes against scientific progress and development on low-risk alcohol guidelines around the world
The standard of 14 units of alcohol used by CISA and the Ministry of Health goes against the international trend of reducing the limit of what is considered lower risk alcohol use. For example, recently Canada began to advise that consuming more than two alcoholic drinks per week – considering that each one contains 10g of pure alcohol – already increases the likelihood of developing long-term illnesses, such as cancer.
Meanwhile, in Brazil, the standard dose of 14g promoted by CISA and their Big Alcohol funders is among the highest in the WHO overview. Most countries in the world that define a standard unit of alcohol follow the WHO and define it as 10g of ethanol. For example, in the United Kingdom, the standard dose is just 8g.
Movendi International provides a state-of-the-art resource page tracking developments regarding low-risk alcohol use guidelines around the world. The resource page contains more than 10 stories, including about Canada, Mexico, the United States, the United Kingdom, as well as all Nordic countries.
The Intercept cites doctor Alexandre Fonseca Santos, who in his doctorate is researching the public acceptability of alcohol policies. Dr Santos warns that the determination of risk ranges for alcohol use is purely scientific and should not be understood as a recommendation for safe alcohol use.
CISA promotes the benefits of alcohol
On its website CISA, promotes alcohol with stories such as: “Can light and moderate alcohol consumption reduce the risk of cardiovascular disease?” The answer to the question is in the subtitle – “study showed that people who consumed alcohol lightly and moderately had a reduced risk of developing heart disease caused by stress”.
The Intercept identified at least seven articles promoting alcohol and disregarding or misrepresenting latest scientific evidence. But CISA content, contested by several research and health entities around the world, is frequently reproduced by Brazilian media.
In January this year, the WHO released a scientific statement leaving no doubt about the myth of a safe amount of alcohol.
There are no studies that demonstrate that the potential beneficial effects of light and moderate alcohol use on cardiovascular disease and type 2 diabetes outweigh the cancer risk associated with these same levels of alcohol consumption for individual consumers.”Anderson BO, Berdzuli N, Ilbawi A, Kestel D, Kluge HP, Krech R, Mikkelsen B, Neufeld M, Poznyak V, Rekve D, Slama S, Tello J, Ferreira-Borges C. Health and cancer risks associated with low levels of alcohol consumption. Lancet Public Health. 2023 Jan;8(1):e6-e7. doi: 10.1016/S2468-2667(22)00317-6. PMID: 36603913.
In a response to the WHO statement, Movendi International President Kristina Sperkova shared her analysis of the WHO statement and provided six reasons why this new WHO publication is a game changer.
The World Heart Federation agrees. In a policy brief, the entity summarizes the best available evidence, coming to the conclusion that no reliable correlation was found between “moderate” alcohol consumption and a lower risk of heart disease. Studies that say otherwise would be based solely on observational research, which does not take into account factors such as pre-existing illnesses and history of alcohol use disorder and addiction.
Claims that “moderate” alcohol consumption, such as a glass of red wine a day, can offer protection against cardiovascular disease, says the text, “are, at best, misinformed and, at worst, an attempt by the alcohol industry to mislead the public about the danger of its product.”