It’s a common concern, and honestly, it’s tough to answer.

People want a clear number, a magic threshold, but it’s not simple.

The truth is that even small amounts of alcohol can increase your risk.

That’s right, even that glass of wine with dinner or that beer after work isn’t completely harmless.

Dr. Vivek Murthy, The Surgeon General of the U.S. Public Health Service, has been emphasizing it, and I echo that warning.

Alcohol and Cancer

Researchers have associated alcohol with at least seven cancer types: mouth, throat, larynx, esophagus, breast, liver, colon, and rectum.

In fact, in 2020 alone, over 740,000 cancer cases worldwide were attributed to alcohol consumption.

That’s a staggering number.

Even more concerning is that many people are unaware of this link.

A 2019 survey found that only 45 percent of Americans believe alcohol significantly impacts cancer risk. More on that finding in a bit.

Here’s the bottom line: the more you drink, especially regularly over time, the higher your risk.

And this applies to all types of alcohol — beer, wine, and liquor.

I know this isn’t what people want to hear.

We all enjoy a drink occasionally, but it’s crucial to be aware of the risks and make informed choices.

Even Small Alcohol Amounts Increase Cancer Risk

Even small amounts of alcohol can increase your cancer risk.

• What’s a standard drink? A standard drink has 14 grams of alcohol, like a 5-ounce glass of wine, a 12-ounce beer, or a 1.5-ounce shot of liquor.
• Less than one drink a week still has risks. Research shows that even this small amount can increase your risk of certain cancers.
• Lifetime risk: For women who have less than one drink a week, about 17 out of 100 will develop an alcohol-related cancer in their lifetime. This number includes cancers like breast cancer (about 11 out of 100 women), which alcohol’s effect on estrogen levels can influence. Men who have less than one alcoholic drink per week have about a 1 in 10 chance of developing alcohol-related cancer during their lifetime.

Any Alcohol Amount or Type Increases Cancer Risk

Any amount of alcohol consumption increases cancer risk.

The idea that a drink a day is good for you is outdated.

Current research shows that even one alcoholic beverage weekly increases your health risks.

What About One Drink Per Day?

Many of my Seattle friends and patients consume at least one standard drink daily.

You heard the risk increase for less than one alcoholic beverage per week.

What about daily?

Again, from the U.S. Surgeon General’s report:

For women, this means a 19 percent lifetime risk of developing an alcohol-related cancer.

For men, it means an 11 percent lifetime risk of developing an alcohol-related cancer.

Which Cancers Are Associated with Alcohol?

Alcohol consumption increases the risk of at least seven cancer types:

• Mouth
• Throat
• Voicebox
• Esophagus
• Breast
• Liver
• Colorectal

I’d like to make this information more practical by giving the absolute (rather than relative) risk increases for two drinks daily:

Five more women out of 100 will develop cancer secondary to drinking two alcoholic beverages daily. Three additional men out of 100 will develop cancer.

If you consume more than four drinks daily, you can add four more cancers to the list: Liver, stomach, gallbladder, and pancreas.

Less Than Half of Americans Are Knowledgeable

This pronouncement from Dr. Murthy disturbs me:

Less than one-half of Americans are aware that alcohol consumption increases cancer risk.

Here are the specifics:

Problems With My Analysis

It’s time for me to criticize Dr. Murthy’s analysis of the alcohol data.

The Surgeon General put out advice saying that even moderate drinking is linked to a series of cancers.

He implicates at least seven cancers.

Meta-analyses form the basis for much of my thinking.

Think of a meta-analysis as making a juice blend.

The quality of the juice depends entirely on the fruits you add.

Because alcohol consumption is self-reported, there are limitations:

• Accuracy: People might not accurately remember or report how much they drink.
• Bias: Reporting habits could differ based on race, socioeconomic status, and education level.
• “Non-drinker” category: The reasons people don’t drink vary widely, including health issues, past alcohol problems, or medical advice.

How I Approach Habits

I tend to consider several endpoints when I think about habits that may impact my health, including the following:

• What is my projected life expectancy? If it is six months, I might do things I wouldn’t do if I had decades.
• How well will I live (morbidity/ disability)? My quality of life (my health span) is enormously important.
• How much joy does the activity spark?
• What is the impact on those around me? If I were mean to others after drinking, it would (I hope) greatly influence my consumption.

Do you approach habits differently? Perhaps your belief system (religious or otherwise) has an influence?

For me, less is better.

But I don’t like the taste of alcohol in general (I don’t mind the occasional sake or hanjan (the latter is a Korean brand of soju, traditionally a rice-based spirit.

If I did drink, one word: Moderation.

Finally, if you have concerns, talk to your healthcare provider.

They can help you understand your risk factors and make the best decisions for your health.

Vivek H. Murthy

News about Vivek H. Murthy. Commentary and archival information about Vivek H. Murthy from The New York Times.

www.nytimes.com

The post How Much is Too Much? The Link Between Alcohol and Cancer appeared first on Medika Life.

Yes, I, too, am surprised. There is a side note, however: Reducing or quitting alcohol does lower oral cancer risk.

In this essay, I will offer the findings of the International Agency for Research on Cancer (IARC) working group.

Edgar Allan Poe had this to say:

“Fill with mingled cream and amber,
I will drain that glass again.
Such hilarious visions clamber
Through the chamber of my brain —
Quaintest thoughts — queerest fancies
Come to life and fade away;
What care I how time advances?
I am drinking ale today.”

Does eliminating alcohol have positive effects?

Cutting back on alcohol has several positive effects, according to a comprehensive review of 63 studies. When people reduce or quit drinking, it has several positive benefits, including the following:

• lowers the chances of ending up in the hospital
• injury risk reduction
• lower blood pressure
• weight loss
• recovery of ventricular heart function in alcoholic cardiomyopathy
• improvement of anxiety and depression symptoms
• improvement in mild liver disease
• lower psychosocial stress levels
• early mortality risk reduction

This lifestyle change can bring about improvements in both physical and mental health, leading to an overall better quality of life.

I wanted to include this section lest I come across as believing that alcohol is a benign drug.

Cutting back on alcohol

After reviewing dozens of studies, the International Agency for Research on Cancer (IARC) concluded this:

For most alcohol-related cancers, there is limited evidence to support a link between eliminating or reducing alcohol consumption and lower cancer risk.

More specifically, the IARC Working Group, which included 15 scientists from eight countries, reported “limited” evidence on this association for laryngeal, colorectal (CRC), and breast cancer, as well as “inadequate” evidence for pharyngeal (throat) and liver cancer.

The report did highlight two exceptions: Reducing or quitting alcohol was associated with a lower risk for both oral and esophageal cancer.

The IARC working group based this conclusion on large studies of long-term alcohol cessation in these cancer types.

My thoughts

I know of the perils of alcohol.

When it comes to cancer risk, however, the benefits of quitting or cutting back on alcohol remain much less clear, according to a new report from the cancer agency of the World Health Organization (WHO).

Apart from the latest IARC report, some separate studies have hinted that giving up or drinking less alcohol might lower the risk of certain types of cancer.

These studies independently suggest that making changes in alcohol consumption habits could have a positive impact on reducing the chances of developing specific cancers.

Even though there’s not a ton of evidence firmly connecting cutting down or quitting drinking to a lower risk of cancer, it’s well-established that the more you drink, the higher your chances of getting cancer become.

So, while the link between less alcohol and lower cancer risk isn’t super clear, there’s a solid connection between drinking more and increasing the cancer risk.

Actionables

A previous IARC analysis figured out that about four percent of newly diagnosed cancers around the world are linked to drinking alcohol.

The types of cancer most commonly associated with alcohol are esophagus, liver, and breast cancer.

The IARC goes so far as to classify alcohol as a group 1 carcinogen, which means there’s strong evidence proving that alcohol can cause cancer in humans.

According to guidelines from the American Cancer Society, the US Department of Agriculture, and the Department of Health and Human Services, women should have one drink or less per day, and men should stick to two drinks or less on any given day.

The post Quitting Alcohol Drops Your Cancer Risk, Right? Not So Fast. appeared first on Medika Life.

In the early days of the pandemic, two things shocked and dismayed me above other dim-witted responses to the virus: the CDC failing to promote early masking, and public health officials and politicians tripping over themselves to make alcohol more available than ever.

Liquor stores wouldn’t be closed, restaurants could deliver booze, or serve “to-go” alcohol with your take-out order.

The constant refrain I heard about why alcohol needed to be so ubiquitous was, “we will see hospitalizations from alcohol withdrawals go up and we can’t have these people crowding our soon-to-be overwhelmed hospitals.”

Guess what? Hospitalizations for alcohol withdrawal went up anyway.

Meanwhile, public parks, soccer fields, and other outdoor spaces were seen as a danger to public health and would need to be closed.

I can only assume these decisions were made with tax revenue and profits in mind over people’s health. After all, no one is collecting a fee to get into the local skate park.

People with years of experience and advanced degrees honestly looked around and thought outdoor spaces were a bigger risk than closing liquor stores to the public? Politicians here in America were obviously going to screw this up and make the wrong call, but public health officials should know better you would think, but then again, here in America many of them are political appointees with one eye on keeping their jobs.

I’m sympathetic to the businesses which relied on alcohol sales to try and stay afloat during that time, but better government policy should have ameliorated their financial suffering. Instead, we got a policy that purported to keep people out of the hospital but instead contributed to the deaths of more people than the virus was capable of killing.

Hell, if the CDC and governments kicked everyone outside for three weeks and made indoor spaces verboten this pandemic would have been over already, considering there is evidence that transmission rates outdoors are less than 1%.Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses: A Systematic ReviewRecommendations about methods to curb transmission of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)…academic.oup.com

Feel free to cram into your local beer & wine though, just don’t take your kids to the park.

Now studies are being published showing just how brain-dead these policies turned out to be.Alcohol-Related Deaths Spiked During the Pandemic, a Study ShowsThe deaths were up 25 percent in 2020 compared with 2019 as stressors accumulated and treatment was delayed, according…www.nytimes.com

Among adults younger than 65, alcohol-related deaths actually outnumbered deaths from Covid-19 in 2020; some 74,408 Americans ages 16 to 64 died of alcohol-related causes, while 74,075 individuals under 65 died of Covid. And the rate of increase for alcohol-related deaths in 2020–25 percent — outpaced the rate of increase of deaths from all causes, which was 16.6 percent.

Deadlier than COVID.

Then you factor in rises in obesity, suicide, narcotics deaths…and you get a fuller picture of just how utterly public health officials and governments failed to enact policies with an eye on harm reduction during the pandemic.

Drug overdose deaths also reached record levels during the first year of the pandemic, with more than 100,000 Americans dying of overdoses during the 12-month period that ended in April 2021, a nearly 30 percent increase over the previous year, according to reports issued in November. The number of deaths from opioids in which alcohol played a role also increased.

Young adults ages 25 to 44 experienced the greatest increases in alcohol-related deaths in 2020, rising nearly 40 percent over the previous year, according to the new report.

Of course, more papers will have to be published to replicate these findings, but I have a feeling these numbers are probably even higher than reported in this study.

My biggest concern is that when the next pandemic hits (COVID-23: Giraffe Flu? It’s never Tofu Flu, Toflu?) it’ll be like day one on the job and the same half-assed and wrongheaded approaches that didn’t work for COVID-19 will get an encore de failure.

The post Alcohol + Capitalism = Deadlier Than COVID appeared first on Medika Life.

David Sarabia had already sold two startups by age 26 and was sitting on enough money to never have to work another day in his life. He moved from Southern California to New York City and began to indulge in all the luxuries his newly minted millionaire status conveyed. Then it all went sideways, and his life quickly unraveled.

“I became a massive cocaine addict,” Sarabia said. “It started off just casual partying, but that escalated to pretty much anything I could get my hands on.”

At one particularly low point, Sarabia was homeless for three months, sleeping on public transportation to stay warm. Even with plenty of money in the bank, Sarabia said, he’d lost the will to live. “I’d given up,” he said.

He got back on his feet, sort of, and for the next three years lived as a “functional cocaine addict” until his best friend, Jay Greenwald, died after a night of partying. Finally, Sarabia checked himself into a rehab in Southern California — ostensibly a luxurious one, although Sarabia didn’t find it to be so.

Still, the place saved his life. The clinicians really cared, he recalled, although their efforts were hampered by clunky technology and poor management. He had the feeling that the owners were more interested in profits than in helping people recover.

Just days off cocaine, the tech entrepreneur was scribbling designs for his next startup idea: a digital platform that would make clinician paperwork easier, combined with a mobile app to guide patients through recovery. After he left treatment in 2017, Sarabia tapped his remaining wealth — about $400,000 — to fund an addiction tech company he named inRecovery.

With the nation’s opioid overdose epidemic hitting a record high of more than 100,000 deaths in 2021, effective ways to fight addiction and expand treatment access are desperately needed. Sarabia and other entrepreneurs in the realm they call addiction tech see a $42 billion U.S. market for their products and an addiction treatment field that is, in techspeak, ripe for disruption.

It has long been torn by opposing ideologies and approaches: medication-assisted treatment versus cold-turkey detox; residential treatment versus outpatient; abstinence versus harm reduction; peer support versus professional help. And most people who report struggling with substance use never manage to access treatment at all.

Tech is already offering help to some. Those who can pay out-of-pocket, or have treatment covered by an employer or insurer, can access one of a dozen addiction telemedicine startups that allow them to consult with a physician and have a medication like buprenorphine mailed directly to their home. Some of the virtual rehabs provide digital cognitive behavior treatment, with connected devices and even mail-in urine tests to monitor compliance with sobriety.

Plentiful apps offer peer support and coaching, and entrepreneurs are developing software for treatment centers that handle patient records, personalize the client’s time in rehab, and connect them to a network of peers.

But while the founders of for-profit companies may want to end suffering, said Fred Muench, clinical psychologist and president of the nonprofit Partnership to End Addiction, it all comes down to revenue.

Startup experts and clinicians working on the front lines of the drug and overdose epidemic doubt the flashy Silicon Valley technology will ever reach people in the throes of addiction who are unstably housed, financially challenged, and on the wrong side of the digital divide.

“The people who are really struggling, who really need access to substance use treatment, don’t have 5G and a smartphone,” said Dr. Aimee Moulin, a professor and behavioral health director for the Emergency Medicine Department at UC Davis Health. “I just worry that as we start to rely on these tech-heavy therapy options, we’re just creating a structure where we really leave behind the people who actually need the most help.”

The investors willing to feed millions of dollars on startups generally aren’t investing in efforts to expand treatment to the less privileged, Moulin said.

Besides, making money in the addiction tech business is tough, because addiction is a stubborn beast.

Conducting clinical trials to validate digital treatments is challenging because of users’ frequent lapses in medication adherence and follow-up, said Richard Hanbury, founder and CEO of Sana Health, a startup that uses audiovisual stimulation to relax the mind as an alternative to opioids.

There are thousands of private, nonprofit, and government-run programs and drug rehabilitation centers across the country. With so many bit players and disparate programs, startups face an uphill battle to land enough customers to generate significant revenue, he added.

After conducting a small study to ease anxiety for people detoxing off opioids, Hanbury postponed the next step, a larger study. To sell his product to the country’s sprawling array of addiction treatment providers, Hanbury decided, he would need to hire a much larger sales team than his budding company could afford.

Still, the immense need is feeding enthusiasm for addiction tech.

In San Francisco alone, more than twice as many people died from drug overdoses as from covid over the past two years. Employers, insurers, providers, families, and those suffering addiction themselves are all demanding better and affordable access to treatment, said Unity Stoakes, president and managing partner of StartUp Health.

The investment firm has launched a portfolio of seed-stage startups that aim to use technology to end addiction and the opioid epidemic. Stoakes hopes the wave of new treatment options will reduce the stigma of addiction and increase awareness and education. The emerging tools aren’t trying to remove human care for addiction, but rather “supercharge the doctor or the clinician,” he said.

While acknowledging that underserved populations are hard to reach, Stoakes said tech can expand access and enhance targeted efforts to help them. With enough startups experimenting with different types of treatment and delivery methods, hopefully one or more will succeed, he said.

Addiction telehealth startups have gained the most traction. Quit Genius, a virtual addiction treatment provider for alcohol, opioid, and nicotine dependence, raised $64 million from investors last summer, and in October, $118 million went to Workit Health, a virtual prescriber of medication-assisted treatment. Several other startups — Boulder Care, Groups Recover Together, Ophelia, Bicycle Health, and Wayspring, most of which have nearly identical telehealth and prescribing models — have landed sizable funding since the pandemic started.

Some of the startups already sell to self-insured employers, providers, and payers. Some market directly to consumers, while others are conducting clinical trials to get FDA approval they hope to parlay into steadier reimbursement. But that route involves a lot of competition, regulatory hurdles, and the need to convince payers that adding another treatment will drive down costs.

Sarabia’s in Recovery plans to use its software to help treatment centers run more efficiently and improve their patient outcomes. The startup is piloting an aftercare program, aimed at keeping patients connected to prevent relapse after treatment, with Caron Treatment Centers, a high-end nonprofit treatment provider based in Pennsylvania.

His long-term goal is to drive down costs enough to offer his service to county-run treatment centers in hopes of expanding care to the neediest. But for now, implementing the tech doesn’t come cheap, with treatment providers paying anywhere from $50,000 to $100,000 a year to license the software.

“Bottom line, for the treatment centers that don’t have consistent revenue, those on the lower end, they will probably not be able to afford something like this,” he said.

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