DECEMBER 1998 ∑ VOLUME 19∑ NUMBER 12
Big Alcohol Puts on a Front
On the surface, it looks like a government document destined for obscurity. But a recently released report written by representatives of both public health agencies and the alcohol industry is a first and a dramatic example of how much Big Alcohol has learned from the mistakes of Big Tobacco.
Rather than fight public health like the tobacco industry, the alcohol industry would prefer to "partner" with public health interests. It has notched an initial success with Working Papers, published by the U.S. federal health department's Center for Substance Abuse Prevention (CSAP) and the alcohol industry-funded International Center for Alcohol Policies (ICAP).
By co-sponsoring and distributing the paper internationally, ICAP makes its public debut after operating behind the scenes under the leadership of a former World Health Organization (WHO) prevention chief. By publishing it, CSAP reveals itself to be a chastened version of the substance abuse fighter that barely survived a defunding assault by the alcohol industry in Congress two years ago. Industry pressure forced open the door to cooperation and CSAP decided to switch rather than fight.
The document questions everything from binge drinking to a causal relationship between alcohol and crime in a format that for the most part presents both sides equally. The overall result is an alcohol policy "he said/she said." It concludes by obfuscating the scientific fact that alcohol is a drug -- a fact that CSAP once vigorously publicized to break through the denial that alcohol problems are significant, preventable and treatable.
"I know nothing about ICAP," says Dr. Percy Wootton, immediate past president of the American Medical Association (AMA). "But I have grave concerns."
Dr. Otis Bowen, the former governor of Indiana who as secretary of the Health and Human Services Department (HHS) ordered alcohol to be termed a drug a decade ago, shakes his head over the report.
"It's very difficult for me to get their point," he says. "Alcohol is a psychoactive substance that has addictive possibilities. Using alcohol is risk-taking behavior. The risks are still much greater than the pleasures and potential benefits to the heart."
Others in the public health community echo these concerns and refuse to work with an offspring of the alcohol industry that calls itself a public health agency.
"No public health agency would emphasize pleasure when talking about alcohol [as ICAP does]," says Dr. Philip Lee, former assistant secretary for health at HHS. "I don't expect these people [the alcohol industry] to behave in an ethical way. I expect them to use every device they can to promote the use of their product."
Alcohol problems in the United States alone cost society an estimated $148 billion a year, according to a government study released last May.
Pleasure took precedence over risk at ICAP's first international conference last summer in New York City. Called "Permission for Pleasure," the event brought the alcohol industry together with a smattering of health policy professionals, researchers who accept alcohol industry funding and some who shun it. The theme was summarized by one of the conference planners: "Happy people think happy thoughts. People who drink moderate quantities of alcohol think happy thoughts."
If this appeared simplistic, the consensus statement presented by ICAP's president for conference endorsement at the conclusion of three days was anything but. Among its recommendations were that governments should join with the alcohol industry and private foundations in researching the relationship between drinking, pleasure and good health; and that health policy should acknowledge the contribution of the pleasures of alcohol to quality of life. Noting that many health professionals boycotted the alcohol industry-sponsored conference, one scientist warned ICAP against publicizing alleged consensus between public health and the industry, and the prepared statement fizzled.
Despite rejection by the public health establishment of a partnership with the alcohol industry, ICAP's founder says the Center is on the right path.
"If we get it right, drinking can make life better," says ICAP President Marcus Grant. "I thought that maybe the first step toward getting it right was an international conference. ... If we're to get it right, public policy must look beyond containment and recognize the role of drinking and pleasure in good health. What's so remarkable is how well it fits in with our activities -- sitting, talking, sharing time with friends, celebrating."
Ask Grant how it feels to be considered a Benedict Arnold for going to work for Big Alcohol after a decade in substance abuse prevention for WHO, and he will correct the allusion. Actually, he says, some former colleagues called him Darth Vader.
"Many people felt shocked and let down when he went to work for the industry," says Dr. Peter Anderson, regional advisor to the alcohol, drugs and tobacco unit of WHO's Regional Office for Europe. "It seems counterproductive to turn over extensive skills gained in public health to the benefit of an industry that has a large responsibility in promoting the harm done by alcohol."
Grant says that he considers the move merely trading one public health agency for another. "ICAP's major source of funding happens to be 10 of the largest drinks companies, but our job is to promote public health goals," he says. "We've been approached by representatives of two governments -- Mexico and Australia -- that want us to help them rethink alcohol policy. We've done work for Chile and are working with public health specialists in India."
"I'm an advocate for the alcohol industry in the public health arena to exactly the same extent as I'm an advocate for public health in the industry arena," he says. "I believe that I've accomplished more for public health in the last few years than in the previous 10 ... just because the very structure of the United Nations held me back."
According to the alcohol industry publication Impact, Grant initiated the idea of a group "to build bridges" between the alcohol industry and public health following his appearance at the Impact annual marketing seminar five years ago in London.
ICAP was incorporated as a nonprofit in 1995 to "promote understanding of the role of alcohol in society and to influence alcohol policy issues internationally," according to Impact. Based in Washington, D.C., "ICAP realizes that influencing alcohol policy in the U.S. will inevitably go a long way toward influencing other nations." According to Grant, it has an annual budget of about $2 million and its sponsors pay equal dues.
The original 11 sponsoring alcohol companies included: Allied Domecq, Bacardi-Martini, Brown-Forman Beverages Worldwide, Coors Brewing Company, Foster's Brewing Group Ltd., Guinness, IDV, Heineken, Miller Brewing Co., Joseph E. Seagram & Sons and South African Breweries. Today, sponsors total 10 with the recent merger of Guinness and IDV's parent company Grand Metropolitan into Diageo -- the world's largest spirits company.
Some of these companies are known to public health advocates as pioneers in marketing alcohol to the poor, young and addicted in the Third World and as foes of public health prevention initiatives.
In Great Britain, Allied Domecq, Bacardi-Martini and Diageo are members of The Portman Group, which opposed England's lowering the permissible blood-alcohol level while driving as a drunk-driving prevention strategy. Two years ago, a British researcher blew the whistle on The Portman Group for offering money to academics to write anonymous reviews trashing a scientific study prepared for the World Health Organization, "Alcohol Policy and the Public Good," before it hit the streets.
In Europe, Seagram, Allied Lyons, Heineken and Diageo belong to The Amsterdam Group, which asked the European Community last May to let it take court action against France's regulations that ban the screening of sports featuring alcohol advertising.
"It's not my main job to police my sponsors," says Grant. "All I can do is bring these things to their attention and I have. What they do is their own affair. I'm insistent on making sure that to the extent I can influence these people, they go in the right direction ... but there are segments of these far-flung multinational companies that are difficult to reach. This can't be what drives me forward. … My main job is to try to move forward a public health agenda."
Absent from Grant's agenda is discussion of the impact of industry marketing and promotion on public health. Alcohol availability, advertising, product development and taxes are off the table; pleasure and education are on.
According to research by Thomas Greenfield at the Alcohol Research Group in Berkeley, California, drinking in hazardous amounts (more than five drinks at one occasion) accounts for 53 percent of all the alcohol consumed in the United States. Another 25 percent is consumed in at-risk amounts (three to four drinks at one occasion). Greenfield concludes that the heaviest drinking 10 percent of the U.S. population consumes 60 percent of the alcohol.
But ICAP disagrees with U.S. health guidelines on how many drinks constitute hazardous drinking. In its report on binge drinking, the organization points out that there is no global consensus on the definition of a binge. "Within certain cultural contexts, risky drinking behaviors such as bingeing may be normative and associated with specific occasions," states the report. "Perhaps it is time to move away from nebulous terms such as ‘binge' and towards a more clear distinction between responsible and reckless drinking behavior. ... Clearly, a binge is not always a binge."
To former U.S. Public Health Service Director Lee, this is obfuscation and "ridiculous."
Alan Lopez, former acting director of WHO's Program on Substance Abuse, questions the ethics of allowing a "very generous definition of what is heavy or hazardous drinking" and exaggerating the relative importance of cardioprotective effects of alcohol. "It might sell alcohol and make them look like concerned citizens, but is it really ethical and is it the appropriate public health context?" he asks.
Griffith Edwards, editor-in-chief of the research journal Addiction, offers a harsher assessment.
"ICAP's credibility was compromised by its funding. My policy is to avoid becoming engaged in debate with industry front organizations. In my view, ICAP is the same kind of animal as certain organizations that have been run by the tobacco industry."
That, says Grant, is an "ill-conceived perception." Not only is ICAP not a front organization for the alcohol industry; it is "a public health agency."
How much has it learned from Big Tobacco?
"Some of the board members may have individually thought that we should avoid the situation tobacco is in," says Grant, "but certainly it isn't something the board has discussed. That's a good question. It's a relevant question. I'm just not the right person to answer it."
-- Hillary Abramson