The strategies of alcohol industry SAPROs: Inaccurate information, misleading language and the use of confounders to downplay and misrepresent the risk of cancer.

Authors: Mark Petticrew, Nason Maani Hessari, Cécile Knai, Elisabete Weiderpass

We start by summarising our core findings, to contextualise the rest of our response. These are that alcohol industry social aspects/public relations organisations (SAPRO) dispute in different ways the risk of cancer from alcohol consumption, particularly breast cancer, and to some extent colorectal cancer [1]. When some risk is acknowledged, that risk is often presented in conjunction with a range of other potential confounders, thus undermining the evidence that there is an independent relationship. Smoking is sometimes used to imply that the risk is confined to smokers. Not all these strategies are used by all these (or other) SAPROs, all the time.
Several of the responses to our paper state that the relevant organisation does, in fact, include accurate information about cancer on their websites or documents, along with explicit statements about increased risk. We did not claim that all the information on these websites is inaccurate or misleading. In fact, in many cases accurate information is included, while at the same time inaccurate information is presented elsewhere. Thus, accurate information may be framed in such a way that it is simultaneously undermined. For example, Éduc’alcool’s publication ‘Alcohol and Women’ does have a clear statement about the risk of breast cancer, as they say in their letter. However this needs to be seen alongside their inaccurate statement (which we cited) that ‘no causal relationship has been shown between moderate drinking and breast cancer’. Presenting a mix of accurate and misleading or distracting information potentially sows doubt about the well-evidenced relationship between alcohol consumption and cancer.
One justification made by SAPROs for presenting information about a host of confounders is that it is their duty to present a complete picture about alcohol and health. We think that this is a weak justification for proffering a range of generic advice about unmodifiable confounders, hormone environments, genetic risks, ageing and so on. It is doubtful that the public turns to such websites for generic lifestyle information, or information about childbirth, or breastfeeding. The argument we made in the paper is that the inclusion of a wide range of potential confounders, and risk/protective factors, has similarities to well-documented tobacco industry strategies. These involved highlighting the complexity of the aetiology of lung cancer and coronary heart disease, thereby undermining the epidemiological evidence of a clear, independent relationship.

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