Science
How Robert F. Kennedy Jr. went from outsider to Cabinet pick
He had written more than 20 books, drew healthy audiences speaking across America and attracted coverage from the country’s top newspapers and magazines. Still, by the height of the pandemic, Robert F. Kennedy Jr. said he felt muzzled.
Facebook and Instagram had banned posts by Children’s Health Defense, the Kennedy-founded organization that questions the value of vaccines. The social media sites noted that Kennedy’s group trafficked in medical misinformation, and a science research team labeled him a “superspreader” of bogus claims about COVID-19 vaccines.
But as 2024 loomed, the scion of America’s most famous Democratic family saw a way back into the public eye.
“I started thinking, ‘Well, the one place that they couldn’t censor me was if I was running for president,’ ” Kennedy told the New Yorker. As he prepared to announce his candidacy in 2023, he proclaimed, “The censors are permitting me to talk to Americans again!”
Indeed, a 16-month run for the White House and subsequent two months as a supporter of Republican nominee Donald Trump succeeded in keeping RFK Jr. close to the center of the public’s consciousness. It’s a prominent perch he’s likely to maintain if he succeeds in being confirmed as secretary of the Department of Health and Human Services.
Loyola Marymount University political scientist Michael A. Genovese said Trump’s designation of Kennedy for the Cabinet post demonstrates “the power of mutual opportunism.”
“RFK revives his failing career. Trump is linked to the glamour of the Kennedy name,” said Genovese, ticking off factors that may have informed Trump’s decision. “RFK gains some measure of respectability. Trump puts Kennedy in a Cabinet position he cares little about. RFK finds a way to stay in the glow of the spotlight. Trump gets an anti-science colleague to complement Trump’s anti-science sentiments.”
Kennedy’s halting ramble from Democratic Party fringe player to fervent MAGA ally did not shock anyone who has watched him closely in recent years. They recall how Kennedy visited Trump Tower shortly before Inauguration Day in 2017 and proclaimed that Trump would make him chair of a commission on vaccine safety and scientific integrity. The Trump administration position never materialized.
Campaigning for the White House this year, Kennedy criticized both major parties, though he saved his most spirited beat-downs for the Democrats. Part of the reason surely was that Democratic nominee Kamala Harris had spurned his overtures. It eventually became clear that Trump — as he had so many times before — was more than willing to strike a strategic alliance with a former adversary.
Kennedy, 70, came with a checkered personal history. Controversial — even bizarre — revelations dotted his presidential run. But several Trump appointees came with unsettling personal histories.
Kennedy, who declined to be interviewed for this article, has persevered over the course of a life frequently turned upside down by tragedy. He was 14 when his father and namesake was assassinated in 1968 at the Ambassador Hotel in Los Angeles. Not long after, he became addicted to heroin, a habit he did not kick until he was 29. Despite that, he graduated from Harvard and the University of Virginia law school.
His two strongest calling cards as a candidate appeared to be his family name and his career as an attorney who fought to clean up the environment. But both became overshadowed by his later preoccupations.
Kennedy spread the myths — refuted by science — that vaccines commonly injure children and cause autism. He outraged many in 2022 by comparing vaccine mandates to the totalitarianism of Nazi Germany.
When he announced last fall that he would continue his presidential run as an independent rather than as a Democrat, many in his family did not hesitate to heap on their disdain.
“Bobby might share the same name as our father, but he does not share the same values, vision or judgment,” three of the candidate’s sisters and one brother said in a joint statement. “We denounce his candidacy and believe it to be perilous for our country.”
This spring, nearly 50 of his former colleagues and leaders of the Natural Resources Defense Council Action Fund pilloried Kennedy.
“In nothing more than a vanity candidacy, RFK Jr. has chosen to play the role of election spoiler to the benefit of Donald Trump — the single worst environmental president our country has ever had,” the environmental leaders wrote in a broadside published in several newspapers.
Not unlike the man who would later offer him a Cabinet position, the candidate seemed impervious to criticism, positioning himself as someone who was delivering inconvenient truths to an unyielding establishment.
The candidate liked to quote his famous relatives, suggesting he was living by his father’s words: “Moral courage is a rarer commodity than bravery in battle or great intelligence. Yet it is the one essential, vital quality for those who seek to change a world that yields most painfully to change.”
Not long after the NRDC disowned him, Kennedy suffered another embarrassment. The New York Times reported on a 2012 deposition in which he described his concerns that he might have a brain tumor. A doctor, Kennedy said, had told him that his abnormal brain scans were likely “caused by a worm that got into my brain and ate a portion of it and then died.”
The revelation made him the butt of a slew of jokes on late-night TV, just as he was trying to assure voters of the seriousness of his candidacy.
Kennedy also took incoming fire from the right. “Kennedy is a Radical Left Democrat, and always will be!!!” Trump posted in April on his Truth Social platform. “It’s great for MAGA, but the Communists will make it very hard for him to get on the Ballot.”
Kennedy accused Trump of “a barely coherent barrage of wild and inaccurate claims.”
Into the summer, Kennedy continued to insist that the American people would eventually turn to him and away from the major party candidates. But while he wanted to talk about the evil of corporate and government elites, his past kept resurfacing in the media.
In July, Vanity Fair reported that a woman accused Kennedy of groping her decades earlier when she was the 23-year-old nanny of his children. Kennedy was married at the time.
After the story broke, the candidate texted an apology to the woman, while contending that he remembered nothing of the episode.
Not long after that, a video surfaced that raised questions about Kennedy’s long-term commitment to the race. In the recording, posted by his son on social media, the candidate is speaking by phone with Trump, who hints that he wants Kennedy to jump to his side.
“I would love you to do something,” Trump said, without offering further context. “And I think it’ll be so good for you and so big for you. And we’re going to win.” Kennedy’s response: “Yeah.”
Yet in public Kennedy insisted he offered a third way, unattached to the two major parties.
Then in August came a series of events that set the stage for Kennedy’s later emergence as a Cabinet pick. He weathered yet more embarrassing revelations, but also threw his backing behind Trump.
‘I like him a lot, I respect him a lot.’
— Donald Trump, on Robert F. Kennedy Jr. in August interview
A story in the New Yorker recounted an odd prank that Kennedy had pulled several years prior.
After finding a dead bear cub on a mountain roadside, according to his account, he loaded the carcass into his car and drove into New York City. Kennedy then deposited the body in Central Park, alongside a bicycle. The New Yorker reported: “A person with knowledge of the event said that Kennedy thought it would be funny to make it look as if the animal had been killed by an errant cyclist.”
Most of the attention from the story surrounded the dead bear, but it also revealed text messages in which Kennedy called Trump a “terrible human being” and “probably a sociopath.” But Kennedy judged that President Biden was “more dangerous to the Republic and the planet.”
Despite Kennedy’s assurances he was running to win, his campaign manager hinted in the profile that he might be willing to take a lesser role. She called the possibility of Kennedy as Trump’s secretary of Health and Human Services “incredibly interesting.”
Kennedy had reached out to Harris, too, CNN reported, expressing interest in a role in her administration. He was rebuffed.
“No one has any intention of negotiating with a MAGA-funded fringe candidate who has sought out a job with Donald Trump in exchange for an endorsement,” Democratic National Committee spokesperson Matt Corridoni told the cable network on Aug. 14.
It became apparent change was afoot six days later when Trump began to publicly flatter Kennedy, while the Democratic National Convention was in full swing and buoyed by Harris’ energetic candidacy.
“I like him a lot, I respect him a lot,” Trump told CNN. At a campaign event in Arizona, Trump called Kennedy “very smart.”
On Aug. 23, the day after the Democratic convention ended, the Kennedy heir endorsed the Republican, saying that, together, they were going to “Make America Healthy Again.” Trump’s handlers later rhapsodized at how a MAGA crowd in Glendale, Ariz., greeted Kennedy “like a rock star.”
The campaign knew it had a problem with some young female voters, particularly because Trump’s Supreme Court picks had eliminated federal protection of abortion access by overturning of Roe vs. Wade. But some of those same women were won over by Kennedy’s calls for improving healthcare and removing food additives that could harm children, said a senior campaign official who declined to be named. “A lot of that group of young moms loved what Bobby was saying,” said the advisor. “He moved that group for us.”
It’s impossible to know how many voters were moved by such feelings. Or how many were turned off by the continuing drumbeat of Kennedy oddities.
Just three days after Trump and Kennedy took the stage together for the first time, Kennedy faced another embarrassing headline. An old magazine article surfaced in which one of Kennedy’s daughters remembered her father’s strange encounter with a dead whale on Cape Cod.
Town & Country magazine reported that, many years earlier, Kennedy “ran down to the beach with a chainsaw, cut off the whale’s head, and then bungee-corded it to the roof of the family minivan for the five-hour haul back to Mount Kisco, New York.”
Again, late-night comics had fodder for Kennedy jokes. But, again, Kennedy weathered the storm and went on to campaign vigorously for his new ally.
Kennedy’s path to confirmation is uncertain. Although the incoming GOP majority in the Senate should clear the way, even some Republicans have said the former Democrat will have to answer questions about his vaccine stances and his desire to change how processed foods are made.
Kennedy proclaimed on X his readiness “to free the agencies from the smothering cloud of corporate capture so they can pursue their mission to make Americans once again the healthiest people on Earth.”
Though well short of the spot in the Oval Office once held by his uncle and coveted by his father, the Cabinet post would put Kennedy the closest he has ever been to the heart of a federal government that he previously pilloried only from the outside.
Science
After Fierce Lobbying, Treasury Sets Rules for Billions in Hydrogen Subsidies
The Biden administration on Friday made final its long-awaited plan to offer billions of dollars in tax credits to companies that make hydrogen, in the hopes of building up a new industry that might help fight climate change.
When burned, hydrogen mainly emits water vapor, and it could be used instead of fossil fuels to make steel or fertilizer or to power large trucks or ships.
But whether or not hydrogen is good for the climate depends on how it is made. Today, most hydrogen is produced from natural gas in a process that emits a lot of planet-warming carbon dioxide. The Biden administration wants to encourage companies to make so-called clean hydrogen by using wind, solar or other low-emission sources of electricity.
In 2022, Congress approved a lucrative tax credit for companies that make clean hydrogen. But the Treasury Department needed to issue rules to clarify what, exactly, companies had to do to claim that credit. The agency released proposed guidance in 2023 but many businesses have been waiting for the final rules before making investments.
The final guidelines that were released Friday followed months of intense lobbying from lawmakers, industry representatives and environmental groups and roughly 30,000 public comments. They include changes that make it somewhat easier for hydrogen producers to claim the tax credits, which could total tens of billions of dollars over the next decade.
“Clean hydrogen can play a critical role decarbonizing multiple sectors across our economy, from industry to transportation, from energy storage to much more,” said David Turk, the deputy secretary of energy. “The final rules announced today set us on a path to accelerate deployment.”
Initially, Treasury had imposed strict conditions on hydrogen subsidies: Companies could claim the tax credit if they used low-carbon electricity from newly built sources like wind or solar power to run a machine called an electrolyzer that can split water into hydrogen and oxygen. Starting in 2028, those electrolyzers would have to run during the same hours that the wind or solar farms were operating.
Without those conditions, researchers had warned, electrolyzers might draw vast amounts of power from existing electric grids and drive a spike in greenhouse gas emissions if coal- or gas-fired power plants had to run more often to meet the demand.
Yet many industry groups and lawmakers in Congress complained that the proposed rules were so stringent, they could throttle America’s nascent hydrogen industry before it even got going.
Among the concerns: The technology to match hydrogen production with hourly fluctuations in wind and solar power is still in its infancy. Owners of nuclear reactors also said that they had been left out.
So the final rules contain several significant tweaks:
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Hydrogen producers will get two extra years — until 2030 — before they are required to buy clean electricity on an hourly basis to match their output. Until then, they can use a looser annual standard and still claim the tax credit.
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In certain states that require utilities to use more low-carbon electricity each year, hydrogen producers will now have an easier time claiming the credit, on the theory that those laws will prevent a spike in emissions. For now, Treasury said, only California and Washington meet this criterion, but other states could qualify in the future.
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Under certain conditions, companies that own nuclear reactors that are set to be retired for economic reasons can now claim the credit to produce hydrogen if it would help the plants stay open. Existing reactors that are profitable would not be able to claim the credit.
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The final rules also lay out criteria under which companies could use methane gas from landfills, farms or coal mines to produce hydrogen — if, for instance, the methane would have otherwise been emitted into the atmosphere.
The guidelines “incorporate helpful feedback from companies planning investments,” said Wally Adeyemo, the deputy Treasury secretary.
Some hydrogen producers said that many, though not all, of their biggest concerns had been addressed in the final guidance, which runs nearly 400 pages.
“There’s a degree of relief that the rules are, on balance, an improvement from the original draft,” said Frank Wolak, chief executive of the Fuel Cell and Hydrogen Energy Association, a trade group. “But there’s a lot in the details that needs to be evaluated.”
The lack of clear guidance had been holding up investment, said Jacob Susman, chief executive of Ambient Fuels, a clean hydrogen developer that is planning roughly $3 billion in projects across the United States. “Now that we actually have something solid, we can get down to the business of building,” he said.
Environmentalists said that most of the safeguards in the original proposal to prevent emissions from surging had been kept in place.
“The extra flexibilities granted to the green hydrogen industry are not perfect from a climate perspective,” said Erik Kamrath at the Natural Resources Defense Council. “But the rule maintains key protections that minimize dangerous air and climate pollution from electrolytic hydrogen production.”
The Energy Department estimates that the use of cleaner forms of hydrogen could grow to 10 million tons per year by 2030, up from virtually nothing today.
But political uncertainty looms. A new Congress could repeal the tax credits, although hydrogen generally enjoys support from both Democrats and Republicans and a number of oil and gas companies have invested in hydrogen technologies. The Trump administration could also revise the rules around the credits, although that could take years.
Economics are another hurdle. Producing cleaner hydrogen still costs $3 to $11 per kilogram, according to data from BloombergNEF. By contrast, it costs about $1 to $2 per kilogram to make hydrogen from natural gas.
The new tax credit will be worth up to $3 per kilogram, which could bridge the gap in some cases but not all. Technology costs would have to decline sharply.
Even with hefty subsidies to produce hydrogen, it’s not clear that enough buyers will emerge. Around the world, hydrogen companies have canceled several major projects over the last few years because of lack of demand. Steel makers and electric utilities that might have interest in the fuel often balk at the costly equipment required to use it.
“These new rules will probably help, even if they don’t go as far as many in industry wanted,” said Aaron Bergman, a fellow at Resources for the Future, a nonpartisan Washington research organization. “But there’s still the challenge of finding the people to consume the hydrogen you produce.”
Science
Why the U.S. surgeon general wants cancer warning labels on alcoholic drinks
Alcoholic drinks are a leading cause of cancer and should carry a warning about that risk on their labels, the U.S. surgeon general said Friday.
Alcohol is a factor in nearly 100,000 newly diagnosed cancers each year and roughly 20,000 deaths from the disease, U.S. Surgeon General Vivek Murthy said in an advisory intended to focus the public’s attention on the health risk. By comparison, traffic accidents tied to drinking kill about 13,500 Americans each year.
“Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity,” the 22-page advisory said. “While scientific evidence for this connection has been growing over the past four decades, less than half of Americans recognize it as a risk factor for cancer.”
Labels on bottles and cans of alcoholic beverages already warn about drinking while pregnant. They also warn about drinking before driving or operating other machinery. In California, the voter-approved Proposition 65 also requires businesses that serve or sell alcoholic beverages to provide a warning about health risks, including cancer.
Any decision to update or expand the label would require congressional approval, an uncertain prospect. Murthy was appointed by President Biden, who has a little more than two weeks left in office. President-elect Donald Trump has picked Janette Nesheiwat, an executive at a New York-based chain of urgent care clinics, as his nominee for surgeon general.
Executives in the beer, wine and spirits industry said Friday that the scientific data linking alcohol to cancer are mixed.
Amanda Berger, senior vice president at the Distilled Spirits Council, noted that a recent report by the National Academies of Sciences, Engineering, and Medicine found that alcohol was associated with a higher risk of breast cancer but did not find such associations with other types of cancer.
That report also concluded that moderate alcohol consumption is associated with lower risks of all-cause mortality and cardiovascular disease, compared with never consuming alcohol.
“The current health warning on alcohol products has long informed consumers about the potential risks of the consumption of alcohol,” Berger said. “Many lifestyle choices carry potential risks, and it is the federal government’s role to determine any proposed changes to the warning statements based on the entire body of scientific research.”
The surgeon general’s advisory said that cancers of the colorectum, esophagus, liver, mouth, throat and larynx are all tied to drinking, as is breast cancer in women. The risk of developing breast, mouth or throat cancers may increase with less than one drink per day, it said.
Yet more than half of Americans are unaware that their drinking behavior affects their cancer risk. A survey by the American Institute for Cancer Research found that 89% of Americans recognized that smoking causes cancer and 53% knew that obesity was a risk factor, but only 45% realized that alcohol could cause cancer as well.
Nearly half of alcohol-related cancers in the U.S. are breast cancers in women, according to a study published by the American Cancer Society. About 1 in every 6 female breast cancers is due to alcohol, and the disease accounts for about 60% of all alcohol-related cancer deaths in women.
As a result, drinking is a bigger cancer risk for women than men. In 2019, about 54,330 women were diagnosed with a cancer that resulted from drinking, as were roughly 42,400 men. About 60% of alcohol-related cancer deaths in women are due to breast cancer, while liver cancer and colorectal cancer are responsible for about 54% of alcohol-related cancer deaths in men.
For women who consume less than one drink a week, the absolute risk of developing an alcohol-related cancer is 16.5%. Having one drink per day increases that risk to 19%, and having two drinks each day raises it to 21.8%, according to the advisory.
For men, drinking once a week is tied to a 10% absolute risk of an alcohol-related cancer. That risk rises to 11.4% by having one drink per day, and to 13.1% by having two drinks per day, the advisory says.
The World Health Organization’s International Agency for Research on Cancer says alcohol is a Group 1 carcinogen, putting it in the company of tobacco, asbestos and ultraviolet radiation. The U.S. National Toxicology Program declared in 2000 that alcohol causes cancer in humans, and organizations including the Centers for Disease Control and Prevention, the National Cancer Institute, the American Cancer Society and the American Assn. for Cancer Research agree that at least seven kinds of cancer are related to drinking.
There is also evidence to suggest that drinking contributes to skin, prostate, pancreatic and stomach cancers, though more research is needed, the surgeon general’s advisory says.
Scientists first linked alcohol consumption to certain cancers nearly 50 years ago, and the evidence showing that drinking is a risk factor for at least seven types of cancer has grown since then, the advisory says.
For instance, an observational study of 28 million people in 195 countries and territories found that the more alcohol a person consumed, the higher their risk of cancer. A study involving more than 1 million women found that those who had up to 1 drink per day were 10% more likely to get breast cancer compared with those who abstained. Likewise, a study with 36,000 people found that those who consumed about a drink per day were 40% more likely to develop mouth cancer than people who didn’t drink.
Laboratory experiments have shown how alcohol leads to cancer.
When alcohol is metabolized in the body, it breaks down into a chemical called acetaldehyde that can attach itself to DNA. The resulting damage can trigger the uncontrolled cell growth that leads to cancer.
Drinking also creates unstable molecules called reactive oxygen species that can interfere with DNA, proteins and essential fats. They also increase inflammation, which makes the body more hospitable to cancer.
There is also evidence that alcohol fuels breast cancers by affecting levels of estrogen and other hormones, and that other kinds of carcinogens — such as those found in tobacco smoke — are more easily absorbed in the body when they are dissolved in alcohol.
The companies selling alcoholic beverages say they have long urged consumers to drink the beverages safely.
“The U.S. beer industry has been a champion of responsible consumption for decades,” a spokesperson for the Beer Institute said Friday. “We encourage adults of legal drinking age to make choices that best fit their personal circumstances, and if they choose to drink, to consume alcohol beverages in moderation.”
Dr. Laura Catena, a winemaker and physician, said that she would “welcome any kind of alert or communication from the surgeon general about the cancer risks of heavy alcohol drinking,” but that it shouldn’t go beyond the established science.
The American Assn. for Cancer Research says alcohol use is responsible for 5.4% of all cancer cases in the U.S. That makes it a bigger risk factor than exposure to UV radiation, poor diet, and infections from pathogens like hepatitis and the human papillomavirus. (For comparison, 19.3% of U.S. cancers are attributable to smoking, according to the association.)
Studies suggest that people who cut back on alcohol or eliminate it can reduce their risk of these cancers by 8%, and reduce their overall cancer risk by 4%.
The Dietary Guidelines for Americans from the U.S. Departments of Agriculture and Health and Human Services say there is no health reason for nondrinkers to start consuming alcohol. Those who do drink can minimize their risk by limiting their intake to no more than one drink per day for women and no more than two drinks per day for men.
A 5-ounce glass of wine, 12-ounce bottle of beer or 1.5-ounce tumbler of distilled spirits count as a single drink.
The surgeon general’s advisory says about 83% of alcohol-related cancer deaths occur in people who exceed those limits. But that means 17% of deaths were in people who engaged in moderate drinking.
Science
U.S. Surgeon General Calls for Cancer Warnings on Alcohol
Alcohol is a leading preventable cause of cancer, and alcoholic beverages should carry a warning label as packs of cigarettes do, the U.S. surgeon general said on Friday.
It is the latest salvo in a fierce debate about the risks and benefits of moderate drinking as the influential U.S. Dietary Guidelines for Americans are about to be updated. For decades, moderate drinking was said to help prevent heart attacks and strokes.
That perception has been embedded in the dietary advice given to Americans. But growing research has linked drinking, sometimes even within the recommended limits, to various types of cancer.
Labels currently affixed to bottles and cans of alcoholic beverages warn about drinking while pregnant or before driving and operating other machinery, and about general “health risks.”
But alcohol directly contributes to 100,000 cancer cases and 20,000 related deaths each year, the surgeon general, Dr. Vivek Murthy, said.
He called for updating the labels to include a heightened risk of breast cancer, colon cancer and at least five other malignancies now linked by scientific studies to alcohol consumption.
“Many people out there assume that as long as they’re drinking at the limits or below the limits of current guidelines of one a day for women and two for men, that there is no risk to their health or well-being,” Dr. Murthy said in an interview.
“The data does not bear that out for cancer risk.”
Only Congress can mandate new warning labels of the sort Dr. Murthy recommended, and it’s not clear that the incoming administration would support the change.
Still, President-elect Donald J. Trump does not drink, and his choice to head the Health and Human Services Department, Robert F. Kennedy Jr., swore off alcohol and drugs decades ago, and says he regularly attends AA meetings.
There is no question that heavy consumption is harmful. But supporters of moderate drinking — including makers of wine, beer and spirits, and some physicians and scientists — argue that a little alcohol each day may reduce cardiovascular disease, the No. 1 killer in the United States.
Newer scientific studies have criticized the methodology of earlier studies, however, and have challenged that view, which was once a consensus.
While most cancer deaths occur at drinking levels that exceed the current recommended dietary guidelines, the risk for cancers of the breast, the mouth and the throat may rise with consumption of as little as one drink a day, or even less, Dr. Murthy said on Friday.
Overall, one of every six breast cancer cases is attributable to alcohol consumption, Dr. Murthy said. More recent studies have also linked moderate alcohol consumption to certain forms of heart disease, including atrial fibrillation, a heart arrhythmia.
Two scientific reviews will be used to inform the updated recommendations about alcohol consumption in the federal dietary guidelines.
Five years ago, the scientific report that informed the writing of the 2020-2025 dietary guidelines acknowledged that alcohol is a carcinogen and generally unhealthy and suggested “tightening guidelines” by capping the recommendation for men at one standard drink, or 14 grams of alcohol a day.
When the final guidelines were drafted, however, there was no change in the advice that moderate drinking of up to two drinks a day for men was acceptable.
But the government acknowledged emerging evidence indicating that “even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease.”
Since then, even more studies have linked alcoholic beverages to cancer. Yet any attempt to change the warning labels on alcoholic beverages is likely to face an uphill battle.
The current warning label has not been changed since it was adopted in 1988, even though the link between alcohol and breast cancer has been known for decades.
It was first mentioned in the 2000 U.S. Dietary Guidelines. In 2016, the surgeon general’s report on alcohol, drugs and health linked alcohol misuse to seven different types of cancer.
More recently, a scientific review of the research on moderate drinking, carried out under the auspices of the National Academies of Sciences, Engineering and Medicine, was commissioned by Congress.
That analysis found a link between alcohol consumption and a slight increase in breast cancer, but no clear link to any other cancers. The report also revived the theory that moderate drinking is linked to fewer heart attack and stroke deaths, and fewer deaths overall, compared with never drinking.
The World Health Organization says there is no safe limit for alcohol consumption, however, and 47 nations require warnings on alcoholic beverages. But cancer is rarely mentioned.
To date, only South Korea has a label warning about liver cancer, though manufacturers can choose alternative labels that don’t mention cancer. Ireland is currently slated to introduce labels that say there is a “direct link between alcohol and fatal cancers” in 2026.
The industry has a strong history of fighting warning labels that mention cancer, and alcohol-producing nations have also challenged warning labels under international trade law.
Industry opposition led to the premature termination of a federally funded Canadian study of the impact of warning labels that mentioned cancer.
The surgeon general’s advisory provided a brief overview of research studies and reviews published in the past two decades, including a global study of 195 countries and territories involving 28 million people.
They all found that higher levels of alcohol consumption were associated with a greater risk of cancer.
Other studies looked at specific cancers, like breast cancer and mouth cancer, finding the risks increased by 10 percent and 40 percent, respectively, for those who had just one drink a day, when compared with those who did not drink.
The report described the biological mechanisms by which alcohol is known to induce cancerous changes at the cellular level.
The most widely accepted theory is that inside the body, alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it, allowing a cell to start growing uncontrollably and creating a malignant tumor.
Animal experiments have shown that rodents whose drinking water was spiked with either ethanol, the alcohol used in alcoholic beverages, or with acetaldehyde developed large numbers of tumors all over their bodies.
Research has shown that alcohol generates oxidative stress, which increases inflammation and can damage DNA.
It also alters levels of hormones like estrogen, which can play a role in breast cancer development, and makes it easier for carcinogens like tobacco smoke particles to be absorbed into the body, increasing susceptibility to cancers of the mouth and the throat.
The surgeon general’s report also goes into detail about the increase in risk associated with drinking, differentiating between the increases in absolute risk and in relative risk.
For example, the absolute risk of breast cancer over a woman’s life span is about 11.3 percent (11 out of 100) for those who have less than a drink a week.
The risk increases to 13.1 percent (13 of 100 individuals) at one drink a day, and up to 15.3 percent (15 of 100) at two drinks per day.
For men, the absolute risk of developing an alcohol-related cancer increases from about 10 percent (10 of every 100 individuals) for those who consume less than one drink a week to 11.4 percent (11 per 100) for those who have a drink every day on average. It rises to 13 percent (13 of 100 individuals) for those who have two drinks a day on average.
Many Americans don’t know there is a link between alcohol and cancer.
Fewer than half of Americans identified alcohol use as a risk factor for cancer, compared with 89 percent who recognized tobacco as a carcinogen, according to a 2019 survey of U.S. adults aged 18 and older carried out by the American Institute for Cancer Research.
Yet alcohol consumption is the third leading preventable cause of cancer, after tobacco and obesity, according to the surgeon general’s report.
Dr. Murthy said it was important to know that the risk rises as alcohol consumption increases. But each individual’s risk of cancer is different, depending on family history, genetic makeup and environmental exposures.
“I wish we had a magic cutoff we could tell people is safe,” he said. “What we do know is that less is better when it comes to reducing your cancer risk.”
“If an individual drinks occasionally for special events, or if you’re drinking a drink or two a week, your risk is likely to be significantly less than if you’re drinking every day,” he added.
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