Most Americans still don’t know that alcohol can cause cancer — and the alcohol industry is working hard to make sure it stays that way.
For the past three years, the industry, aided by its allies in Congress and later the Trump administration, has sought to discredit and eventually bury a major analysis that offers new evidence of the link between drinking alcohol and getting sick and dying from various causes, including cancer.
It appears their campaign has succeeded. Three co-authors on the Alcohol Intake and Health Study, which was commissioned in early 2022 by the US Department of Health and Human Services under President Joe Biden, told Vox that they were informed last month that the Trump administration did not intend to publish the final draft of the study or its findings.
“The thing that the alcohol industry fears more than increased taxes is increased knowledge about the risks associated with drinking alcohol, particularly around cancer,” Mike Marshall, CEO of a group dedicated to reducing alcohol’s harms called the Alcohol Policy Alliance, who was not involved with the study, told me. “Like the tobacco industry, like the opioid industry, they are working hard to prevent the American people from gaining the knowledge that they need to make the best decisions for themselves.”
Why assert so much pressure? It makes sense if you look at the headwinds the alcohol industry faces. Americans today are drinking less. This year, Gallup recorded a historic low in the percentage of US adults who drink: 54 percent, down from 67 percent in 2022.
Though the vibes around alcohol are shifting, a lot of people still don’t fully understand alcohol’s health consequences. Surveys have found that while the percentage of Americans who know that alcohol is a carcinogen has been rising, it is still below 50 percent.
By the end of the year, the federal government will issue new dietary guidelines — something that happens every five years — which include recommended limits on alcohol consumption. The alcohol study’s results were intended to inform those guidelines.
“I was hopeful. … Look at all this evidence we have,” Priscilla Martinez, deputy scientific director of the Alcohol Research Group at the Public Health Institute and one of the co-authors, told me in an interview. “This is when the change is going to happen.”
But after the authors submitted their final report to Trump’s health department in March and never saw it again, Reuters reported in June, citing anonymous sources, that the new dietary guidelines would eliminate any specific recommended limits on alcohol consumption.
“I think it’s a shame,” said Katherine Keyes, an epidemiologist at Columbia University and another co-author. “Anyone who is a decision-making authority, you want them to have all of the information.”
It is another example of the Trump administration seeming to work against the best interest of public health — despite allying itself closely with Health Secretary Robert F. Kennedy Jr. and his Make America Healthy Again movement.
Kennedy and MAHA are fixated on harmful toxins and the corrupting influence of corporate interests. But neither Kennedy, who has been in addiction recovery himself for decades, nor the broader movement has seemed to make reducing alcohol consumption a priority. Instead, the Trump administration will not release a report that would actually show just how harmful to people’s health drinking alcohol can be, the latest in a series of decisions that could actually leave Americans less healthy.
Vox reached out to the White House and HHS to ask why the administration hasn’t published the study, but a spokesperson for the Substance Use and Mental Health Services Administration, the HHS subagency that oversaw the Alcohol Intake and Health Report, declined to address our questions directly.
“People are going to get sick who might have avoided getting sick, because they might have decreased their drinking,” Martinez said.
The Alcohol Intake and Health Study’s conclusions, explained
For this story, I spoke with three of the six authors of the study: Martinez, Keyes, and co-author Tim Naimi, an alcohol researcher affiliated with the University of Victoria and Boston University. They all emphasized that they had sought to conduct a study that would fairly represent America’s alcohol consumption. They not only reviewed a wide range of observational studies, but they also ran data through a statistical model based on the US population, specifically to estimate the mortality effects of alcohol for Americans.
Martinez said the thinking was: “We’ve got to make this relevant to Americans.”
They broke out their findings by different drinking levels — from one drink per day to three — and focused on health outcomes that have been proven to be associated with alcohol use. Their big-picture conclusion: Among the US population, the negative health effects of drinking alcohol start at low levels of consumption and begin to increase sharply the more a person drinks. A man drinking one drink per day has roughly a one in 1,000 chance of dying from any alcohol-related cause, whether an alcohol-associated cancer or liver disease or a drunk driving accident. Increase that to two drinks per day, and the odds increase to one in 25.
The general finding that the health risks from alcohol start at low levels of drinking and increase significantly for people who drink more is consistent with previous research, as I covered in a story earlier this year. Public health experts broadly agree that heavy drinking is bad for your health; the debate has been over moderate amounts of drinking. There is another issue that continues to complicate the debate: Lay people may have an inflated definition of what “moderate” drinking means compared to their doctor or a scientist, which could lead to people putting their health at risk even if they don’t think of themselves as heavy drinkers.
In that context, the report is a harrowing read: Alcohol use is associated with increased mortality for seven types of cancer — colorectal, breast cancer in women, liver, oral, pharynx, larynx, and esophagus. Risk for these cancers increases with any alcohol use and continues to grow with higher levels of use, the study’s authors concluded. Women experience a higher risk of an alcohol-attributable cancer per drink consumed than men. Men and women who die from an alcohol-attributable cause die 15 years earlier on average.
Amid all of the public discourse about alcohol and its health effects, here was a clear and authoritative summary of the evidence that would be most relevant to Americans. It was, its authors told me, consistent with the scientific consensus at this time.
“Nothing we’re saying is all that surprising or controversial to those of us who know the field,” Keyes said.
So, why has the US government buried the final draft of that report for the past six months? And why does it appear that the Trump administration will instead push the country’s dietary guidelines in the opposite direction?
A tale of two studies
Every five years, the federal government reviews the nation’s dietary guidelines and issues new ones that reflect the current best consensus among scientists about what we should eat, how much of it we should eat, and what we should avoid eating and drinking to lead a healthy life.
US officials always solicit expert opinion as they prepare a fresh set of dietary guidelines. The input is usually compiled into one massive report from a group of experts called the US Dietary Guidelines Advisory Committee and then submitted to the Department of Health and Human Services and the Department of Agriculture, the two agencies that produce the guidelines.
That was how the process went in 2020, and at that time, the subcommittee of researchers dedicated to alcohol (including Naimi) advised the government to reduce the recommended limit down to one drink per day for men, from two. The Trump administration ultimately decided not to follow the recommendation.
Ahead of drafting the new guidance for 2025, the Biden administration began considering in February 2022 whether to take a different approach to more thoroughly review alcohol’s health effects ahead of the 2025 dietary guidelines being developed and released. By April 2022, HHS had decided to launch a new review of the science on alcohol and health, called the Alcohol Intake and Health Study — the research Trump’s administration has yet to release — to be conducted by an outside expert panel. That analysis would be submitted to Congress as part of an annual report on underage drinking, and it would be shared with USDA and HHS to consider for the 2025 dietary guidelines.
It makes sense why the federal government would launch an effort like this. The negative health effects of alcohol have been getting more and more attention, and research continues to link drinking even in moderate amounts to cancer, liver disease, and mental health problems. The World Health Organization declared in 2023 that no amount of drinking could be considered safe. It was time to take a hard look at American drinking.
But almost immediately, controversy was already brewing around the Alcohol Intake and Health Study.
In December 2022, several months after HHS had decided to launch the Alcohol Intake and Health Study, Congress included a provision in a routine government spending bill: The National Academies of Sciences, Engineering, and Medicine should undertake its own study of alcohol’s health effects and submit that as the basis for the 2025 dietary guidelines. Two of the initial co-authors for that report were removed after objections over their reported connections to the alcohol industry. But at least one of the scholars who replaced them has also had their work supported by the industry.
When the experts who would produce the Alcohol Intake and Health Study were named in 2023, the alcohol industry began to circulate documents to lawmakers and other government officials claiming authors of the study were prejudiced against alcohol (all of the researchers had submitted conflict-of-interest paperwork ahead of joining the project). Naimi, in particular, has been labeled a “new prohibitionist” by Reason, a libertarian publication.
Keyes told me that she believed she had been criticized for, in effect, describing the findings of various alcohol-related studies.
“When I read criticism of my involvement in the committee, and it was described as a conflict of interest, the conflict was that I had accurately described scientific research in the media,” Keyes said.
Lawmakers on Capitol Hill waded into the fight. In March 2024, Congress tucked a provision into another omnibus spending bill that instructed HHS and USDA to consider the National Academies report when writing the alcohol guidelines. Representatives from states including Kentucky and California — where whiskey and wine are important cultural exports, respectively — sent letters to HHS in April 2024 and again that September, criticizing the Alcohol Intake and Health Study for being duplicative of the National Academies report — even though the former was commissioned by the government first. (HHS said at the time that it would not be duplicative but complementary.) The House Oversight Committee even sought to subpoena documents from the agency on the HHS report and the process that was producing it.
Both groups of researchers continued to assemble their reports as the public relations war raged. But when it came time to publish their findings, they had very different experiences.
Why hasn’t the final Alcohol Intake and Health Study been released?
A draft version of the Alcohol Intake and Health Study was posted on January 15, just days before Trump’s second inauguration and around the same time that then-Surgeon General Vivek Murthy recommended that alcohol come with cancer warning labels; you can still find it online here. This is the process for most government reports: The authors put together a draft, the initial findings are released for public comment, stakeholders submit their takes, and then the authors will take those comments into consideration and revise their report for its final publication.
But that didn’t happen with the Alcohol Intake and Health Study. After the public comment period, the authors made minor revisions — not to the findings themselves but to help translate its takeaways for non-experts. They sent that final report to the Trump administration in March.
And after that…nothing. The report never surfaced, and, according to the three co-authors I spoke with, they received no explanation for the radio silence.
Vox contacted HHS with a detailed list of questions about the Alcohol Intake and Health Study and why it hasn’t been released, as well as Kennedy’s general perspective on alcohol and health. The agency sent a brief comment in response:
“This information has been provided to HHS and USDA for consideration during the development of the 2025-2030 Guidelines,” an HHS spokesperson said.
Some of the authors still held out hope that the study would be included in the annual report on underage drinking that is required by federal law to be submitted to Congress and is expected later this year.
But then in August, those hopes were shattered: According to all three co-authors, they were told that the Trump administration did not intend to publish the study in any form and would not include it in the upcoming congressional report on underage drinking. (The authors are currently working, as they always planned to do, on publishing their findings in an independent academic journal.)
Then, at the beginning of September, Congress introduced a new government spending bill that would, among many other things, defund the interagency group responsible for launching the Alcohol Intake and Health Study in the first place during the Biden administration.
The National Academies report, on the other hand, has been released on time. Its findings, however, were controversial: It indicated that moderate levels of drinking could actually be beneficial to people, and even the links to cancer, despite ethanol being widely classified as a carcinogen, were limited. Some unaffiliated alcohol researchers have called their findings and their methodology into question.
Critics said the National Academies report was based on observational studies that can show a correlation between, for example, moderate drinking and cardiovascular health, but don’t prove a cause; the National Academies report’s authors acknowledged that limitation. As Naimi told me earlier this year, many moderate drinkers may have other attributes — such as higher incomes — that could explain their better health without accounting for alcohol. Critics of the National Academies report also said the authors had used overly restrictive criteria for which research to include, excluding many studies that have found harmful effects from alcohol use.
The Alcohol Intake and Health Study, on the other hand, focused on health outcomes for which there is a substantiated link to alcohol, included more studies, and modeled the available data to the US population.
The ball is now in the Trump administration’s court. Will it change the dietary guidelines as rumored and eliminate a specific recommended limit on alcohol consumption? The National Academies report would appear to set the stage for such a change, with its industry-preferred messaging that low levels of drinking could make people healthier.
And all the while, the Alcohol Intake and Health Study and a very different perspective on alcohol’s health effects remains locked in the administration’s proverbial basement.
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