The Arrogance of Power: Alcohol Industry Interference With Warning Label Research
In this issue, the Journal of Studies on Alcohol and Drugs publishes a set of interrelated articles that speak volumes about the potential role of alcohol warning labels in the prevention of alcohol-related morbidity and mortality. At a time when the alcohol industry and public health authorities are both moving toward the development of procedures that would advise consumers about the health hazards of alcohol consumption, alcohol scientists at Public Health Ontario and the Canadian Institute for Substance Use Research at the University of Victoria have been conducting groundbreaking studies that are sure to advance alcohol labeling policy, labeling research, and prevention theory.
In the first article, Zhao et al. (2020) describe an innovative analysis of the population-level impact of introducing evidence-informed alcohol warning labels in Whitehorse, Yukon, that included (a) a cancer warning, (b) low-risk drinking guidelines, and (c) standard drink messages. Compared with neighboring regions of Yukon and the Northwest Territories (which served as control sites), per capita sales of labeled products (the great majority of sales) declined in the intervention community by 6.6%, whereas sales of the many fewer unlabeled products increased by 6.9%. The results suggest an accumulating effect over time when highly visible labels with impactful messages are introduced in rotation.
Vallance et al. (2020a) assessed consumers’ baseline knowledge of alcohol-related health information by conducting surveys with 836 liquor store patrons. They found a low level of knowledge of alcohol–breast cancer risk (24.4%), limited ability to calculate a standard drink (28.9%), and low knowledge of daily (48.9%) and weekly (47.6%) low-risk drinking limits. Support for health warnings (55.4%) and standard unit of alcohol information (51.0%) was moderate. The authors conclude that despite the rather low level of alcohol-related health knowledge, there was moderate support for alcohol warning labels as a tool to raise awareness.
Hobin et al. (2020) tested the effects of the cancer warning labels on alcohol user’ recall and knowledge. Two to 4 months after application of the cancer labels, unprompted and prompted recall increased to a greater extent in the intervention versus comparison sites. Similar results were found 6 months after the intervention for all three outcomes.
Schoueri-Mychasiw et al. (2020) examined the impact of national low-risk alcohol use guideline labels. Awareness of the alcohol use guidelines increased from 30.7% pre- to 67.0% post-intervention and was 2.89 times greater in the intervention versus comparison site. This study showed that enhanced alcohol labels are noticed and may be an effective strategy for increasing awareness and knowledge of national drinking guidelines.
Another direction taken in this research program was precipitated quite unexpectedly when alcohol industry lobbyists pressured the Yukon government to temporarily shut down the research. Two articles address the influence of the alcohol industry itself.
In the first article, Vallance et al. (2020b) analyzed media coverage of alcohol warning labels with a cancer message in Canada, and compared the Yukon coverage with a related initiative in Ireland. The investigators found that 68.4% of media articles covering the Yukon study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of alcohol warning labels with a cancer message. Industry arguments opposing the warning labels were similar across both contexts, often containing statements from industry representatives distorting or denying the evidence that alcohol causes cancer.
Stockwell et al. (2020) explore three issues in the ongoing debate over alcohol warning labels: (a) a consumer’s right to know, (b) a government’s responsibility to inform, and (c) an industry’s power to thwart both consumer rights and government responsibility. These issues are discussed not only in the context of the Yukon labeling study but also in relation to recent industry interference in alcohol labeling policy in South Korea and Ireland.
The author discusses the pseudo-stakeholder countermarketing conducted by the alcohol industry often in the form of corporate social responsibility (CSR) projects under the assumption that companies can “do well” by “doing good.” The problem with the alcohol industry’s CSR activities from a public health perspective is that they tend to be more effective at promoting brand awareness than they are at doing any good for the health of their consumers. When the industry lobbies government officials to oppose cancer warning labels by claiming that they have already developed untested “guidance labels,” or when they threaten legal action to shut down a research project to test the impact of labels developed by independent experts, they are using their political power to make a statement that is not very conducive to real stakeholder marketing.
Three conclusions are highlighted by the author.
- Alcohol warning labels, when implemented in a clear and visible way, can not only communicate important health information to consumers but also discourage them from purchasing alcohol.
- Enhanced alcohol labels are noticed and may be an effective population-level strategy for increasing awareness and knowledge of cancer risks and national drinking guidelines, including the kinds of brief intervention messages that health professionals are now expected to communicate to their hazardous drinking patients.
- Additional cancer label intervention studies are needed to refine the messages and study their impact in research programs that are not compromised by industry interference.