The Consequences of the Surgeon General's Advisory on Alcohol and Cancer

What's on the horizen for wine and alcohol is something new and significant

Why the Surgeon General of the United States would choose to release such a wildly deceptive and incomplete assessment of the associations between cancer and alcohol consumption is unclear. The answer to that question, however, is for someone else to ferret out. What I want to explore today are the implications of this disastrous announcement that “Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States.”

It does not matter that the absolute risk of cancer associated with moderate alcohol consumption is minuscule. It does not matter that just a few weeks ago a study was released that shows all-cause mortality is lower among moderate alcohol consumers than abstainers. What matters is that “alcohol causes cancer” has been claimed and announced by the most important health official in America and the claim has been covered by every important and unimportant media outlet in the country.

The question to answer now is what will be the consequences?

Before I attempt to address that question, I want to remind readers that for a good long time, it was the release of new Federal Dietary Guidelines that worried many due to what appears to be a biased process and the real threat that the Guidelines would repeat the World Health Organizations’ claim that “there is no safe level of alcohol.” It’s worth noting that this event is still on the horizon.

Finally, before I jump in, I want to note that I am not going to take this space to list the various ways this declaration by the Surgeon General is dangerously overblown and provided without the critical context that would if offered, make Americans consider the real benefits of moderate consumption. I’ll leave that to other more qualified folks who will undoubtedly address the issue.

On Friday, U.S. Surgeon General Vice Admiral Vivek H. Murthy released “Alcohol and Cancer 2025: The U.S. Surgeon General’s Advisory”. It is exactly that. An “advisory”. There is nothing in it that compels legislation or federal action. It is a statement by the Surgeon General. Nothing more. However, because it comes from the highest health official in the federal government it comes with built-in authority. So authoritative is this Advisory that every media outlet in America including network newscasts, cable newscasts and every Internet-based media outlet covered it. The message in the advisory was simple and direct: “Alcohol Causes Cancer”. Not “excessive consumption”. Not long-term binge drinking of alcohol. Just “alcohol causes cancer.”

The primary recommendation by the Surgeon General is that this claim be publicized in a widespread manner so that Americans can take appropriate action. The Surgeon General has recommendations on how this ought to be done. I want to discuss those recommendations as well as the obvious consequences of a widespread acceptance of the idea that alcohol causes cancer.

THE RECOMMENDATION: Warning Labels
”The Surgeon General recommends an update to the Surgeon General’s warning label for alcohol-containing beverages to include a cancer risk warning.”

This recommendation sits on page 17 of the Surgeon General’s report on alcohol and cancer. If implemented by an act of Congress, we will see a declaration on every single bottle of wine that drinking the contents of the bottle will give you cancer. I can imagine a few things that would be more damaging to the wine industry, but not many.

Will Congress vote to put warning labels on wine and all other alcoholic beverages? There will certainly be an attempt, and a bill will likely be introduced. The response from the so-called “prevention” community will be fierce in their effort to get such labels placed on alcohol. There will be hearings. There will be much ink spilled.

Politico notes that it will be a heavy lift for Congress to overcome what will be a significant effort by alcohol industry lobbyists to stop any cancer labeling effort. Already the alcohol lobbyists have put in a significant effort concerning the dietary guidelines. As Politico writes:

“The alcohol industry fiercely opposes labeling as well as stricter guidance around consumption — the government currently recommends men consume no more than two drinks per day and women no more than one — and has cultivated support among lawmakers through an expensive lobbying and political operation.”

Politico estimates that the effort is “likely to fall flat”. We will see. I get nervous anytime Washington starts to take up alcohol issues because I don’t trust all the elements of the alcohol lobby not to attempt to gain an advantage through additional language that could either get into a bill on warning labels or see passage in lieu of warning labels.

Another encouraging comment comes from Senator Rand Paul of Kentucky who told Reuters the following:

“I can’t imagine that a Republican Congress would act like the nanny state and force labels on alcohol beverages saying that they may cause cancer,” he said. “It just seems completely inconsistent with freedom and everything that the party stands for.”

It’s important to keep in mind that anti-alcohol groups have been lobbying the TTB, the Surgeon General, and Congress to see cancer-related warning labels passed since 2020. This effort will now double in scope and they will have a powerful ally in their efforts.

Moreover, any legislation placing cancer-related warnings on wine labels would, if Congress passed such a thing, need to be signed by the President. President-elect Trump does not drink alcohol. His older brother was afflicted by alcoholism. President-elect Trump’s HHS nominee, Robert Kennedy, Jr., is a recovering alcoholic. And, the United States Trade Representative nominee Jameison Greer also is an abstainer.

Anyone contemplating the impact of a warning label that declares, “alcohol causes cancer” and who does not understand such a thing will decrease consumption among moderate drinkers simply isn’t taking this seriously. Of course, warning labels will do this. The claim is that such labels will simply expand knowledge of the link. But what is the point of expanding American’s knowledge of a link between alcohol consumption and cancer if not to deter consumption?

The current crop of warning labels on alcoholic beverages warn that drinking during pregnancy can harm the fetus and that drinking alcohol impairs one’s ability to drive and operate machinery. These labels were mandated by a Congressional Act in 1988 and first appeared on alcohol containers in 1989. Their impact was blunted when in November of 1991, “60 Minutes” broadcast a segment on the “French Paradox” that explored the seemingly contradictory relationship between the French diet, which is high in saturated fats, and their lower rates of heart disease compared to Americans. The report indicated that the French consumption of red wine was a key element in the French Diet that staved off heart disease. The impact on American’s drinking habits was enormous and immediate. Any impact of lowering the consumption of alcohol due to the new warning labels was more than blunted by the impact of the “60 Minutes” broadcast.

No such “French Paradox” revelation appears in the offing to blunt the impact of a warning label declaring “Alcohol Causes Cancer” and hoping for one is not a strategy to blunt what will be a considerable impact from the warnings. The impact of these kinds of warning labels will be felt over time as the idea that “Alcohol Causes Cancer” seeps into the American mind like a catchy commercial tune. No one has any reason to doubt that this announcement by the Surgeon General, the wall-to-wall media coverage, and any future warning labels will cause many Americans to rethink wine and alcohol consumption, leading to more abstainers or cutbacks in consumption.

THE OTHER SURGEON GENERAL RECOMMENDATIONS
In his Advisory, the Surgeon General has recommended more than warning labels. The following has also been recommended:

Reassess recommended limits for alcohol consumption to account for the latest evidence on alcohol consumption and cancer risk. (This is a call for the upcoming Dietary Guidelines to take account of the Surgeon General’s cancer claims and to adjust the guidelines accordingly.)

Strengthen and expand education efforts to increase general awareness that alcohol consumption causes cancer. (California has already mandated expanded “alcohol education” and the cancer claim will undoubtedly be included at every level of education. Anti Alcohol groups as well as organizations like the American Cancer Society will be lobbying state education boards, local school boards, and health professionals at higher education institutions to include condemnations of alcohol for its cancer-causing status. Grants will be issued to anti-alcohol groups to promote a no-drinking policy in various demographic groups.)

Inform patients in clinical settings about the link between alcohol consumption and increased cancer risk. (How many doctors will be caught NOT doing this after the Surgeon General declares it so?)

Promote the use of alcohol screening and provide brief intervention and referral to treatment as needed. (This recommendation is likely to be reiterated in statements by various federal, state, and independent health groups.)

Highlight alcohol consumption as a leading modifiable cancer risk factor and incorporate proven alcohol reduction strategies into population-level cancer prevention initiatives and plans. (This is a call for states to pass increased alcohol taxes, restrictions on access to alcohol, and advertising restrictions on alcohol in the name of preventing cancer. “Population-level Initiatives” is a euphemism for legislation.)

For individuals, be aware of the relationship between alcohol consumption and increased cancer risk when considering whether or how much to drink. Cancer risk increases as you drink more alcohol. (This is a call for those who drink moderately to drink less)

Every single one of these other recommendations will be implemented to one degree or another with the call for states to pass laws on taxes, access, and advertising the most difficult to implement. However, after the Surgeon General’s Advisory, the effort to restrict alcohol access and marketing and to raise taxes is much more likely.

EDUCATION
For several decades, alcohol has been portrayed in educational settings as something to avoid. Appropriately cited as something grammar through high schoolers should avoid, alcohol has been portrayed in these settings as adult beverages and holding the potential to be addictive, as well as detrimental to safe driving.

That’s going to change with the Surgeon General’s Advisory. If not by state mandates, then due to the influence of anti-alcohol prevention groups, educational settings will now be treating alcohol as cigarettes are treated. As the press release said in its second sentence, “Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity, increasing risk for at least seven types of cancer.”

The increased risk of cancer from moderate alcohol consumption is so much less than the increased risk of cancer from tobacco it’s akin to saying both lightning strikes and falling on your head cause headaches.

Education does not merely happen in schools. It happens in the media too. Think about how often you hear “two glasses a day for men and one glass a day for women” in conjunction with discussions of alcohol and health. These are the Federal Dietary Guidelines that have been in place for three decades. There are millions of such allusions to this recommendation across the Internet. Imagine each and every time this subject matter is discussed the “alcohol causes cancer” line is attached. The changes to websites are happening across the globe on thousands of websites as we speak.

Consider Artificial Intelligence. The same day the Surgeon General’s Advisory was released I asked Microsoft Copilot (MS’s AI) “What are the dangers of alcohol consumption?” It responded:

“Cancer: Increased risk of various cancers, including mouth, throat, liver, breast, and colon cancer.” It’s worth remembering that nearly every large language model AI is trained on data and information found on the Internet. The massive media coverage of the Surgeon General’s Advisory will now be part of these AI learning models.

Then there is social media. Today I surfed across X. I literally found 1000s of uncritical references to the new cancer and alcohol advisory. Half of them saluted the advisory: “It’s about Time”.

Harriette Van Spall is a Doctor of Cardiology at McMasters University. I read hundreds of tweets from Doctors that essentially took the same line: “Alcohol=bad, Alcohol causes cancer, We need warning labels.”

Due to the pressures that will immediately be put on educational institutions to condemn alcohol as causing cancer and due to the ubiquitous messaging in the media claiming alcohol causes cancer from the first sip, we are about to witness a sea change occurring over the next decade.

Within 10 years, “Alcohol causes cancer” will be among the top two or three things people know about alcohol (including wine). And this doesn’t even take into account any new Dietary Guidelines on alcohol that will soon be announced. The impact is lower consumption. The impact of lower consumption is fewer sales. The impact of fewer sales is fewer producers, wholesalers, and retailers. This is a simple equation.

LEGISLATION
Legislation is the result of 50% facts and 50% emotion. Where alcohol-related legislation is concerned, the the number one issue for any bill being considered is “health and safety”. Whether it’s direct shipping, distribution laws, hours of operation, advertising, taxes, or any other issue, this “health and safety” concern is the first and foremost concern put in front of legislators at any level of government. I have sat in and testified at numerous hearings across the country on alcohol-related legislation and not a single one was conducted without a member of the anti-alcohol prevention community in attendance arguing either against or for a bill based on the health and safety of alcohol. Further testimony will look exactly like this:

“When we know that even the first sip of alcohol can increase your risk of cancer, how can this Committee even consider for a moment not making alcohol less available. Higher taxes and reduced advertising will save the lives of our family, our friends and our children. We calculate that more than 1,000 cancer deaths will be prevented a year after this bill is signed into law. Your constituents are begging for help combatting this drug and those who push it. We support this bill and urge you to do the same.”

Or, consider a bill allowing consumers to have wine shipped to them from out-of-state wine stores:

“Members of the Committee, we know and the Surgeon General of the United States recently confirmed that alcohol causes cancer from the first sip. Allowiing even more access to alcohol via the direct shipment of wine from out-of-state vendors is the last things we need. We need stronger protections against this cancer causing substance. I represent mothers, fathers, siblings, children and thousands of your constituents who have suffered health related problems as a result of alcohol. We urge you to take steps to prevent cancer by opposing this dangerous legislation.”

This kind of rhetoric is very difficult for lawmakers to resist. And after today, even fewer will be able to do so. Today, free trade legislation became more difficult to pass and restrictions on access to alcohol, higher taxes on alcohol and restrictions on advertising alcohol just became easier to pass.

LITIGATION
Using the courts to loosen the restrictions on the sale and distribution of alcohol and to degrade the archaic three-tier system has been successful and important. But when judges hear cases, indeed, they are not always swayed by the dictates of the Constitution and Supreme Court precedent. They are also influenced by the zeitgeist; the culture; their fears and their beliefs.

The health and safety of a state’s residents is one of the remaining rationales for upholding restrictive and protectionist alcohol laws. However, it’s often difficult for the state to make the case that their discriminatory laws advance the health and safety of residents.

I’ve been involved in numerous cases that challenge discriminatory alcohol laws. I’ve helped craft litigation strategy and helped write briefs directed at Federal District Court judges, Appeals Court judges, and Supreme Court justices. In not a single case has the question of the extent to which discriminatory laws protect the health and safety of a state’s residents not come up. One argument I’ve never had to address is that a discriminatory state law helps prevent cancer. I will now face that claim in every single case I’m involved with.

How will a judge who lost a spouse to cancer react when told that the law that discriminates against out-of-state retailers who want to ship into a state just like in-state retailers do should be upheld because it reduces access to alcohol, which in turn reduces the risk of cancer to the state’s residents?

That judge will hear that the state already allows in-state retailers to ship wine to residents despite the cancer claims, which should indicate the law restricting out-of-state retailer shipping is only a matter of discrimination and protectionism and not a health or safety matter. But….but…Health…Safety…Cancer. Judges don’t always set aside emotion. Cancer is an emotional topic.

Yes, the new Advisory from the surgeon general will influence alcohol-related cases. I guarantee it.

But there is one even more insidious litigation consequence:

“In 2006, the American Cancer Society and other plaintiffs won a major court case against Big Tobacco. Judge Gladys Kessler found tobacco companies guilty of lying to the American public about the deadly effects of cigarettes and secondhand smoke. Tobacco companies are required to run an extensive television and newspaper advertising campaign, at their own expense, admitting the truth about their products.”
The American Cancer Society

Buckle Up. If there is not a lawsuit filed against “Big Alcohol” within two years of today, I’ll be shocked. If plaintiffs’ attorneys are not at this moment beginning to plan their briefs in advance of filing their lawsuit, I’d be shocked. The lawsuit is coming. “Big Alcohol has known for decades that alcohol causes cancer and did nothing to warn the public. They have perpetrated a fraud upon the public and they must pay,” is how the opening of their lawsuit will read.

Will it succeed? It hardly matters to Gallo, Diageo, A-B InBev, Constellation, and other members of the Big Alcohol club who will be sued by the coming litigation. The question is how will they respond. Big Tobacco settled.

THE CONSEQUENCES
The coming consequences of the Surgeon General’s Advisory that alcohol causes cancer are hard to overestimate. But let me lay them out.

1. Within 10 years we will see a demonstrable drop in wine consumption. My bet? 10-15%
2. Wine will become more expensive due to higher taxes
3. Wineries will be restricted in how they can advertise and promote their wines
4. Hundreds if not more wineries will go out of business due to reduced sales
5. Consolidation among wineries and wholesalers will be brisk
6. The number of independent fine wine retailers will fall everywhere.
7. Anyone under 18 years of age will grow up knowing first that alcohol causes cancer

This sounds dire. This sounds like an alarmist.

Let’s assume that within two months the Federal Dietary Guidelines are announced recommending much less consumption of alcohol, if any, and noting that alcohol is an important cause of death.

This kind of recommendation, combined with the announcement from the Surgeon General on alcohol and cancer, are without question the two most negative pronouncements on alcohol since the 18th Amendment outlawed the sale and consumption of alcohol more than 100 years ago. Nothing else even comes close.

Now, combine this with the fact that we are right in the middle of a retreat from alcohol consumption by younger Americans. Combine that with the fact that people are trading alcohol for cannabis in record numbers. Combine this with the fact that the World Health Organization, the most prestigious and influential health organization on the planet, is on the alcohol warpath and making headway.

I’m not being alarmist. And I’m not the only one who sees it.

“Shares of European and American spirits makers and brewers fell on Friday after the U.S. surgeon general called for cancer warnings on the labels of alcoholic drinks. Shares of Jack Daniel's parent Brown-Forman BFb.N slipped nearly 3% to $37.10 in early U.S. trading hours, hitting their lowest since April 2017, while Coors Light beer maker Molson Coors TAP.N fell 2.7%. Constellation Brands STZ.N, the maker of Corona beer, slipped 1.3%, while Boston Beer SAM.N was down 3% after falling as much as 6.4%.”

WHAT CAN BE DONE?
I don’t know.

This doesn’t feel like a fight against an overzealous lawmaker who thinks excise taxes should be increased by 1,000%—something that was easily beaten back in Oregon twice over the past few years. This feels like the rapid formation of a new zeitgeist; of a massive storm system moving in from the coast. It feels like it’s time to batten down the hatches and get the hell out of Dodge.

Industry lobbyists will either stop or delay some initiatives. Maybe warning labels won’t come immediately. Maybe excise taxes will only go up 10% here and there. Maybe advertising restrictions on wine will only apply to sports stadiums at first. But have you ever tried to stop a zeitgeist? Are some of you old enough to remember what happened to red wine sales immediately and for years after when “60 Minutes” declared the stuff was good for you and that you’d live like a Parisian if you just had your daily glasses? This feels like that.

And we haven’t even gotten the Dietary Guidelines yet.

The consequences will be felt over the long term. And anyone who doubts they will be considerable and be negative simply isn’t paying attention.