Last week, the US federal government updated its dietary guidelines for Americans including its recommendations on alcohol consumption. The update suggested that consuming less alcohol is better for “overall health” than drinking more but also removed specific numerical drink limits implying that moderation should be an individual assessment. At the same time, the US Congress House Oversight Committee released a report entitled “A Study Fraught With Bias” (the Congress Report) that was sharply critical of one of two study projects that aimed to shape the update including specific condemnation of Canada’s alcohol and health “model”.
The first US study had been authorized and funded by Congress and was known as the NASEM Study (National Academies of Science, Engineering, and Medicine). The second effort was known as the AIH Study (Alcohol Intake & Health) which was undertaken by the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD). The AIH Study was a competing effort which raised eyebrows from inception. It was not clear why or how it was authorized since ICCPUD’s mandate is underage drinking, not dietary guidance … and Congress had specifically authorized NASEM to provide the relevant advice. In addition, 3 of the 6 AIH Study Group members were academics working in Canada.
Felicity Carter provides an excellent analysis of the details of the studies and the political intrigue surrounding them here: It’s Not No Safe Level – But Not Moderation Either. From a high level, the new US dietary guidelines on alcohol seem reasonable (and acceptable to the wine industry) since they did not accept the “no safe level” arguments that have been put forward by anti-alcohol advocates recently.
From a Canadian policy perspective though, there is much of interest in the Congress Report since it directly criticizes the “Canadian model” of guidance for alcohol and health (by which they mean the 2023 CCSA Recommendations that have previously been commented upon in this blog). Specifically, and while parts of the Congress Report were partisan in nature, it made the following findings of fact:
- The AIH Study was “conducted in a manner inconsistent with federal law” and “is irretrievably flawed”. The six members of the AIH Study Group were determined to be “fraught with bias” since they were all “anti-alcohol advocates with beliefs predating the study that no amount of alcohol consumption is safe, contrary to several accepted studies in the field”.
- The three Canadian members of the AIH study group “were affiliated with creating the ‘Canadian model’ study that concluded that no amount of alcohol consumption was safe” (the 2023 CCSA Recommendations).
- The composition of the AIH study group was deliberately designed to reflect “the goal of the study: begin with a pre-determined conclusion that no amount of alcohol consumption is safe and recruit biased scientists to develop the research to support that conclusion.”
The three ‘Canadian’ members of the 6 person AIH Study Group were: Kevin Shield, Timothy Naimi, and Jurgen Rehm. The first two members (Shield and Naimi) were part of the group that produced the 2023 CCSA Recommendations, which included numerous references to the work of the third member (Rehm).
What is one to make of all of this … and particularly the direct rejection of the “Canadian model” and CCSA Recommendations? The first and most obvious observation is that the objectives and process for producing the US drinking guidelines is quite different from the objectives and process that Health Canada has used to inform its “Low Risk Drinking Guidelines”.
In the US, the drinking guidelines have formed part of the broader US Dietary Guidelines which are legally required to be created “based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared”. As such, Congress authorized NASEM to advise on alcohol consumption and assembled a broad panel of 14 medical and public health experts to consider the issues. The credentials of that panel are top-notch including representation from some of the leading universities and hospitals across the country (e.g. Harvard, Cornell, Brown, Stanford, Johns Hopkins). That group concluded with “moderate certainty” that those who drink in moderation have lower all-cause mortality than those who don’t. This was in stark contrast to the much smaller AIH Study Group who wrote in a draft that “the risk of dying from alcohol use begins at low levels of average use”.
In Canada, and in contrast, Health Canada commissioned the Canadian Centre on Substance Abuse and Addiction (CCSA) to provide recommendations for its standalone drinking guidelines which are not published as part of general recommendations for a healthy diet. I note that every single one of the purposes of the CCSA (which are set out in its governing statute) relate to addressing “alcohol and drug abuse”. None of their mandate relates to general dietary issues or to lifestyle or to exercise or toward normal alcohol consumption that is not related to “abuse”.
In other words, the CCSA is funded by government for, and devoted to, addressing issues of addiction and abuse. This is no doubt a noble cause and is important work. They would be exactly the right people to ask about consumption advice for those with a history of alcohol abuse problems. However, I don’t think that this process could be expected to provide reasonable consumption advice for the vast majority of Canadians who drink in moderation and do not “abuse” alcohol.
The second observation is to look at how the experts were chosen, the diversity of representation, and ask whether or not there was any bias that might influence their advice. Again, the US approach differs significantly from the Canadian one. As the Congress Report pointed out, the NASEM group was diverse and from highly respected institutions. In contrast, the AIH group was smaller and the Congress committee found that they had been picked precisely because they shared common anti-alcohol views and a “no safe level” perspective.
If we look back at the 2023 CCSA Recommendations, we can see that they were produced by a relatively large group of 22 panelists. While some are from well known Canadian universities, the majority are either addiction professionals or otherwise connected to addiction treatment. A few have spent their entire professional careers engaged in anti-alcohol advocacy (usually at taxpayers’ expense). As such, there was little apparent diversity in representation or viewpoints. Given the findings of the Congress Report, one must ask whether or not a similar thing happened in Canada as at the AIH Study Group: were panelists picked because they were “anti-alcohol advocates with beliefs predating the study that no amount of alcohol consumption is safe”?
If the above is correct, perhaps we can understand why the CCSA recommendations are so different from the US guidelines and why they were rejected by the Congress Report. If you ask a group of ‘experts’ who specialize in addiction and abuse what a safe level of drinking is … then they will likely respond “none” or that there is “no safe level” … because that is probably the right answer for an alcoholic or an addict. These ‘experts’ will have a perspective that is created by their professional experience. In that sense, the Congress Report might be right … they have a bias that is based on addiction and abuse. If you ask a different group of experts who specialize in general health the same question, you will likely get a very different answer … which is what happened at NASEM.
Significant policy questions remain for Canada. Which is the right approach to generate drinking guidelines? Do the findings of the Congress Report also imply that Canada’s “model” is “irretrievably flawed” and “fraught with bias”? It appears to me that many of the criticisms in the Congress Report are valid in respect of the Canadian “model”. Why is Health Canada asking the CCSA (an organization devoted to dealing with alcohol abuse) and a panel of addiction experts to generate drinking guidelines for normal folks who don’t abuse alcohol … which is most of us?
Canada appears to be experiencing a resurgence of Prohibition era thinking which is based on the assumption that any consumption of alcohol is likely to lead to extensive problems for everyone regardless of context. Indeed, the comical recommendation of the CCSA that drinking should be limited to 2 drinks per week creates a significant conflict of interest for them and for Health Canada: the threshold for “abuse” would be set so low that the CCSA can justify asking for even greater taxpayer funding since the entire drinking population would effectively become within their mandate.
This does not seem like an appropriate way to create government health policy … or to spend taxpayer dollars for the vast majority of Canadians. And, sadly, it may have taken a report of the U.S. Congress to point that out.







