The International Agency for Research on Cancer (IARC) was set up by the World Heath Organisation (WHO) in 1965 to research the causes of cancer. Every institution has been hollowed out by activists in the sixty years since and it comes as little surprise that it is now getting involved in policy. In a study published this week in the theoretically reputable New England Journal of Medicine, IARC has judged literal prohibition to be evidence-based.
The article is titled “The IARC Perspective on the Effects of Policies on Reducing Alcohol Consumption” and yet it ends with the following caveat:
The views expressed in this article are those of the authors and do not necessarily represent the decisions, policy, or views of their affiliated institutions, including the International Agency for Research on Cancer or the World Health Organization.
If the views don’t reflect the views of IARC, in what sense is it an “IARC perspective”?
As it happens, only five of the 27 authors work for IARC. The rest are a grab bag of anti-alcohol academics, including three past presidents and the current vice-president of the neo-temperance Kettil Bruun Society. Britain is represented by Petra Meier of Glasgow University who is best known for using computer modelling to promote minimum pricing. Contrary to what we might call the “lived experience” of people in Scotland and Wales, the authors conclude that minimum pricing is effective.
And that’s not all that is effective. According to these IARC-adjacent academics, every policy they have been advocating for years has strong evidence of efficacy, with the possible exception of bans on price discounts. This includes everything from tax rises to a total ban on the sale of alcohol. Their definition of “effective” is a curious one. They are really only interested in whether a policy leads to a reduction in alcohol consumption because they assume that this will lead to a reduction in alcohol-related deaths. This is a quasi-religious belief that has often been confounded by reality and yet it remains so central to the “public health” approach to drinking that the authors only resort to looking at health outcomes if there is a “paucity of studies” looking at consumption. You might think the New England Journal of Medicine and IARC would be more interested in the number of people dying from alcohol than in the amount of alcohol sold and yet the authors explain that “proxy outcomes for alcohol consumption (e.g., death from cirrhosis) were [only] included if an association with alcohol consumption had been previously established.” Consumption is what they are interested in. Death and disease are mere proxies.
On this basis they can plausibly claim that tax rises are effective and they can have a go at portraying restrictive licensing laws as being evidence-based. Even minimum pricing reduced alcohol sales somewhat, albeit not among the people who are most likely to drink themselves to death. Alcohol advertising bans are a tougher challenge since the weight of evidence suggests that they do not reduce consumption, let alone harm, but the authors navigate this by focusing on just four studies and remarking on the “consistency of the evidence”, despite one of those studies explicitly stating that “advertising bans do not reduce alcohol demand” while one of the others, which looked at an advertising ban in British Columbia (B.C.), found “little support for the view that the B.C. advertising ban reduced alcohol consumption”. The authors carefully ignore the gold standard Cochrane Review which concluded that there is “a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions” and instead conclude that there is “sufficient evidence” that alcohol advertising bans reduce consumption.
And then the big one. Prohibition. If I were a “public health” academic seeking to assure the public that the nanny state is not getting out of control, I wouldn’t include actual prohibition in a list of “alcohol-policy interventions” for governments to consider. These academics, whose views may or may not reflect the views of IARC, have no such reservations. The evidence that prohibition “works” is, they say, very strong.
Because consistently large effects were observed in all studies across a range of settings, the Working Group concluded that there is sufficient evidence that bans on alcohol sales lead to a reduction in alcoholic beverage consumption.
This conclusion is based on evidence from nine studies, although the authors only cite two of them.
In one study, the 1920–1935 national prohibition of alcohol in the United States led to an initial 70% decrease in alcohol consumption, which eventually plateaued at a 30% to 40% decrease relative to pre-Prohibition levels.
US Prohibition ended in 1933, not 1935, but you can’t expect too much fact-checking from the world’s most prestigious medical journal. The study in question was written by two economists who are, to put it gently, no fans of prohibition. The point they were making in their study was that the reduction in alcohol consumption in the 1920s was pitifully small considering the severity of the law and the horrendous unintended consequences. One of them — Jeffrey Miron — has since published a study showing the relationship between prohibition and murder. The homicide rate rose in the US throughout Prohibition and peaked the year it ended, but the IARC-related academics do not mention this, presumably because murder is not a proxy for alcohol consumption. Nor are poisonings from moonshine, unemployment, corruption, crime or any of the other well documented consequences of prohibition.
If you ignore all the consequences apart from the impact on alcohol sales, you can argue that prohibition works, but why would anyone in their right mind do that? Why would a bunch of “public health” academics try to launder the reputation of a disastrous experiment in paternalistic over-regulation and why would a WHO agency put its name to it? It is a question worth pondering.
