Alcohol: The new-age nicotine

Dr Vivek Murthy, the then Surgeon General of the USA, made a public advisory in January 2025, stating that alcohol is a leading preventable cause of cancer. He also made a bold call for mandatory warning labels on alcoholic beverages to explicitly mention the risk of cancer. More than half a century ago, another landmark US Surgeon General report warned of the health hazards of smoking, which led to a global decline in tobacco use and fatefully transformed its image – from a fashionable chic to a bad habit.

The dangers of heavy and regular alcohol consumption have long been recognised in medicine and widely acknowledged in popular culture, supported by evidence as robust and well-established as that against smoking. However, the health effects of occasional alcohol use, in moderate and judicial doses, always enjoyed a different storyline.

Alcohol through time
In many cultures across the world, moderate alcohol consumption is well accepted and is a major accompaniment to food. The presumed health benefits and the connoisseurship around certain drinks like red wine have rendered a wide acceptance for moderate use, especially in the West. Alcohol consumption dates back to the dawn of civilisation, as old as the cultivation of rice and wheat. Some historical evidence even points to its use even before the beginning of agriculture. 

It may be a surprise to many hearing that alcohol is one of the only four substances that yield energy to the human body, alongside carbohydrates (glucose), protein, and fat. 

All four, when consumed in excess, are harmful to the body, but unlike the others, alcohol cannot be simply classified as a nutrient. Yet, as a natural product that the body can metabolise, alcohol has become an integral part of food cultures across the world.

Wining and dining cultures
On one of the trips to the Italian-speaking region of Switzerland, one of the authors had an interesting conversation with a nurse from an old-age home. Nurse Nancy described how the elderly residents started their mornings with a usual espresso and a cornetto, had pasta for lunch and dinner, and – quite casually – mentioned about their alcohol and wine habits.  

The inmates are offered a small amount of grappa (local spirit) with coffee for lunch, as well as red wine and grappa for dinner, which most of them consume happily. This reflects a deeply ingrained cultural norm in which moderate alcohol use is viewed not as indulgence, but as a time-honoured tradition.  

Similarly, beer is seen as a cultural staple in Germany, and surprisingly, it can be seen sold even in some hospitals. From wine in the Mediterranean and beer in Germany to rice wine in China and Japan, the cultural embrace of alcohol spans both East and West – except in certain Islamic countries, where its consumption is restricted or prohibited.

In India, too, wine, beer, and whiskey are increasingly becoming part of urban dining and celebrations. There is a noticeable trend among the younger generation, including women, toward occasional alcohol use.

Is alcohol considered more acceptable because its health risks are seen as milder than those of smoking?

Scientific evidence 
There’s a principle often quoted in medicine: “The difference between a medicine and a poison is the dose”. This applies to everything from basic nutrients like carbohydrates to even water. We need them in the right dose, and excess can be toxic or even lethal.  

Does this logic apply in the case of alcohol? Can there be a 'safe dose' – or better yet, a 'healthy dose'? That question is far from simple. When medicine meets habit and science collides with social norms, the answers become complicated. It can take decades of research to uncover the truth.

In the case of smoking, the evidence is well established. The risk of heart disease in young people who are even light smokers is nearly three times that of non-smokers, in addition to its well-known carcinogenic potential. In contrast, the case of alcohol is quite different and more complicated.

A number of previous studies have reported marginally better heart health among moderate drinkers compared to abstainers.  This finding, popularly known as the 'French Paradox,' suggested that the moderate consumption of wine might help explain why the French experienced fewer heart attacks despite their fat-rich diets. This apparent benefit from moderate drinking is thought to be a result of its stress-reducing effect in the brain. 

However, it remains unconfirmed whether this finding is genuinely accurate or merely influenced by artifacts – other unknown factors that affect health. In contrast to heart disease, the evidence linking alcohol to cancer is far more straightforward, prompting clear warnings from health authorities. Heavy alcohol consumption is a strong risk factor for various types of cancer.

More recent studies indicate that even moderate consumption may increase the risk of certain cancers. While these findings require further confirmation, experts currently agree that no amount of alcohol can be definitively said to offer health benefits based on existing evidence. The Surgeon General’s warning may feel like an overcorrection to some, especially in societies where social drinking is woven into the cultural fabric. 

While evidence of any harm from moderate and judicious alcohol use is still emerging, the evidence for any health benefits is slowly diminishing. Just as smoking transitioned from glam to grim, alcohol’s image too may shift in the years to come if more studies confirm these findings. 

Tailpiece  
The concluding part of this article was written while sitting in the quaint, laid-back French city of Marseille, having a healthy Mediterranean lunch of salads and pickled herring along with a glass of Chardonnay wine; well pleased about the ‘healthiness’ of the choices made, and not grabbing a greasy burger along with a tall glass of sugary cola. 

The million-dollar question is how long can you enjoy such an experience, assuming the beneficial effects of an occasional glass of wine or beer on heart health, and not worrying about the carcinogenic risks?  

(Social anthropologist and novelist Thomas Sajan and US-trained neurologist Titto Idicula, based in Norway, write on politics, culture, economy, and medicine)