The push for Medicare to cover weight-loss drugs: An explainer
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The largest U.S. insurer, Medicare, does not cover weight-loss drugs, making it tougher for older people to get access to promising new medications.
If you cover stories about drug costs in the U.S., it’s important to understand why Medicare’s Part D pharmacy program, which covers people aged 65 and older and people with certain disabilities, doesn’t cover weight-loss drugs today. It’s also important to consider what would happen if Medicare did start covering weight loss drugs. This explainer will give you a brief overview of the issues and then summarize some recent publications the benefits and costs of drugs like semaglutide and tirzepatide.
First, what are these new and newsy weight loss drugs?
Semaglutide is a medication used for both the treatment of type 2 diabetes and for long-term weight management in adults with obesity. It debuted in the United States in 2017 as an injectable diabetes drug called Ozempic, manufactured by Novo Nordisk. It’s part of a class of drugs that mimics the action of glucagon, a substance that the human body makes to aid digestion.
Glucagon-like peptide-1 (GLP-1) drugs like semaglutide help prompt the body to release insulin. But they also cause a minor delay in the pace of digestion, helping people feel sated after eating.
That second effect turned Ozempic into a widely used weight-loss drug, even before the Food and Drug Administration (FDA) gave its okay for this use. Doctors in the United States can prescribe medicines for uses beyond those approved by the FDA. This is known as off-label use.
In writing about her own experience in using the medicine to help her shed 40 pounds, Washington Post columnist Ruth Marcus in June noted that Novo Nordisk mentioned the potential for weight loss in its “ubiquitous cable ads (‘Oh-oh-oh, Ozempic!’)”
The American Society of Health-System Pharmacists has reported shortages of semaglutide due to demand, leaving some people with diabetes struggling to find supply of the medicine.
Novo Nordisk won Food and Drug Administration (FDA) approval in 2021 to market semaglutide as an injectable weight loss drug under the name Wegovy, but with a different dosing regimen than Ozempic. Rival Eli Lilly first won FDA approval of its similar GLP-1 diabetes drug, tirzepatide, in the United States in 2022 and sells it under the brand name Mounjaro.
In November of 2023, Eli Lilly won FDA approval to sell tirzepatide as a weight-loss drug, soon-to-be marketed under the brand name Zepbound. The company said it will set a monthly list price for a month’s supply of the drug at $1,059.87, which the company described as 20% discount to the cost of rival Novo Nordisk’s Wegovy. Wegovy has a list price of $1,349.02, according to the Novo Nordisk website.
Even when their insurance plans officially cover costs for weight loss drugs, consumers may face barriers in seeking that coverage for these drugs. Commercial health plans have in place prior authorization requirements to try to limit coverage of new weight-loss shots to those who qualify for these treatments. The Wegovy shot, for example, is intended for people whose weight reaches a certain benchmark for obesity or who are overweight and have a condition related to excess weight, such as diabetes, high blood pressure or high cholesterol.
State Medicaid programs, meanwhile, have taken approaches that vary by state. For example, the most populous U.S. state, California, provides some coverage to new weight-loss injections through its Medicaid program, but many others, including Texas, the No. 2 state in terms of population, do not, according to an online tool that Novo Nordisk created to help people check on coverage.
Medicare does cover semaglutide for treatment of diabetes, and the insurer reported $3 billion in 2021 spending on the drug under Medicare Part D. Congress last year gave Medicare new tools that might help it try to lower the cost of semaglutide.
Medicare is in the midst of implementing new authority it gained through the Inflation Reduction Act (IRA) of 2022 to negotiate with companies about the cost of certain medicines.
This legislation gave Medicare, for the first time, tools to directly negotiate with pharmaceutical companies on the cost of some medicines. Congress tailored this program to spare drug makers from negotiations for the first few years they put new medicines on the market, allowing them to recoup investment in these products.
Why doesn’t Medicare cover weight-loss drugs?
Congress created the Medicare Part D pharmacy program in 2003 to address a gap in coverage that had existed since the creation of Medicare in 1965. The program long covered the costs of drugs administered by doctors and those given in hospitals, but not the kinds of medicines people took on their own, like Wegovy shots.
In 2003, there seemed to be good reasons to leave weight-loss drugs out of the benefit, write Inmaculada Hernandez of the University of California, San Diego, and coauthors in their September 2023 editorial in the Journal of General Internal Medicine, “Medicare Part D Coverage of Anti-obesity Medications: a Call for Forward-Looking Policy Reform.”
When members of Congress worked on the Part D benefit, the drugs available on the market were known to have limited effectiveness and unpleasant side effects. And those members of Congress were aware of how a drug combination called fen-phen, once touted as a weight-loss miracle medicine, turned out in rare cases to cause fatal heart valve damage. In 1997, American Home Products, which later became Wyeth, took its fen-phen product off the market.
But today GLP-1 drugs like semaglutide appear to offer significant benefits, with far less risk and milder side effects, write Hernandez and coauthors.
“Other than budget impact, it is hard to find a reason to justify the historical statutory exclusion of weight loss drugs from coverage other than the stigma of the condition itself,” they write.
What’s happening today that could lead Medicare to start covering weight loss drugs?
Novo Nordisk and Eli Lilly both have hired lobbyists to try to persuade lawmakers to reverse this stance, according to Senate records. Pro tip: You can use the Senate’s lobbying disclosure database to track this and other issues. Type in the name of the company of interest and then read through the forms.
Some members of Congress already have been trying for years to strike the Medicare Part D restriction on weight-loss drugs. Over the past decade, senators Tom Carper (D-DE) and Bill Cassidy, MD, (R-LA) have repeatedly introduced bills that would do that. They introduced the current version, the Treat and Reduce Obesity Act of 2023, in July. It has the support of 10 other Republican senators and seven Democratic ones, as of Dec. 19. The companion House measure has the support of 41 Democrats and 23 Republicans in that chamber, which has 435 seats.
The influential nonprofit Institute for Clinical and Economic Review conducts in-depth analyses of drugs and medical treatments in the United States. ICER last year recommended passage of a law allowing Medicare Part D to cover weight-loss medications. ICER also called for broader coverage of weight-loss medications in state Medicaid programs. Insurers, including Medicare, consider ICER’s analyses in deciding whether to cover treatments.
While offering these calls for broader coverage as part of a broad assessment of obesity management, ICER also urged companies to reduce the costs of weight-loss medicines.
Most people with obesity can’t achieve sustained weight loss through diet and exercise alone, said David Rind, ICER’s chief medical officer in an August 2022 statement. The development of newer obesity treatments represents the achievement of a long-standing goal of medical research, but prices of these new products must be reasonable to allow broad access to them, he noted.
After an extensive process of reviewing studies, engaging in public debate and processing feedback, ICER concluded that semaglutide for weight loss should have an annual cost of $7,500 to $9,800, based on its potential benefits.
What does academic research say about the benefits and the potential costs of new obesity drugs?
Here are a couple of studies to consider when covering the ongoing story of weight-loss drug costs:
Medicare Part D Coverage of Antiobesity Medications — Challenges and Uncertainty Ahead
Khrysta Baig, Stacie B. Dusetzina, David D. Kim and Ashley A. Leech. New England Journal of Medicine, March 2023
In this Perspective piece, researchers at Vanderbilt University create a series of estimates about how much Medicare may have to spend annually on weight-loss drugs if the program eventually covers these drugs.
These include a high estimate — $268 billion — based on an extreme calculation, one reflecting the potential cost if virtually all people on Medicare who have obesity used semaglutide. In an announcement of the study on the Vanderbilt website, lead author Khrysta Baig described this as a “purely hypothetical scenario,” but one that “ underscores that at current prices, these medications cannot be the only way – or even the main way – we address obesity as a society.”
In a more conservative estimate, Bhaig and coauthors consider a case where only about 10% of those eligible for obesity treatment opted for semaglutide, which would result in $27 billion in new costs.
(To put these numbers in context, consider that the federal government now spends about $145 billion a year on the entire Part D program.)
It’s likely that all people enrolled in Part D would have to pay higher monthly premiums if Medicare were to cover weight-loss injections, Baig and coauthors write.
Baig and coauthors note that the recent ICER review of weight-loss drugs focused on patients younger than the Medicare population. The balance of benefits and risks associated with weight-loss drugs may be less favorable for older people than the younger ones, making it necessary to study further how these drugs work for people aged 65 and older, they write. For example, research has shown older adults with a high blood sugar level called prediabetes are less likely to develop diabetes than younger adults with this condition.
SELECTing Treatments for Cardiovascular Disease — Obesity in the Spotlight
Amit Khera and Tiffany M. Powell-Wiley. New England Journal of Medicine, Dec. 14, 2023
Semaglutide and Cardiovascular Outcomes in Patients Without Diabetes
A Michael Lincoff, et. al. New England Journal of Medicine, Dec. 14, 2023.
An editorial accompanies the publication of a semaglutide study that drew a lot of coverage in the media. The Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT) study was a randomized controlled trial, conducted by Novo Nordisk, which looked at rates of cardiovascular events in people who already had known heart risk and were overweight, but not diabetic. Patients were randomly assigned to receive a once-weekly dose of semaglutide (Wegovy) or a placebo.
In the study, the authors report that of the 8,803 patients who took Wegovy in the trial, 569 (6.5%) had a heart attack or another cardiovascular event, compared with 701 of the 8801 patients (8.0%) in the placebo group. The mean duration of exposure to semaglutide or placebo in the study was 34.2 months.
The study also reports a mean 9.4% reduction in body weight among patients taking Wegovy, while those on placebo had a mean loss of 0.88%.
The findings suggest Wegovy may be a welcome new treatment option for many people who have coronary disease and are overweight, but are not diabetic, write Khera and Powell-Wiley in their editorial.
But the duo, both of whom focus on disease prevention in their research, also call for more focus on the prevention and root causes of obesity and on the use of proven treatment approaches other than medication.
“Socioeconomic, environmental, and psychosocial factors contribute to incident obesity, and therefore equity-focused obesity prevention and treatment efforts must target multiple levels,” they write. “For instance, public policy targeting built environment features that limit healthy behaviors can be coupled with clinical care interventions that provide for social needs and access to treatments like semaglutide.”
Additional information:
The nonprofit KFF, formerly known as the Kaiser Family Foundation, has done recent reports looking at the potential for expanded coverage of semaglutide:
Medicaid Utilization and Spending on New Drugs Used for Weight Loss, Sept. 8, 2023
What Could New Anti-Obesity Drugs Mean for Medicare? May 18, 2023
And KFF held an Aug. 4 webinar, New Weight Loss Drugs Raise Issues of Coverage, Cost, Access and Equity, for which the recording is posted here.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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How To Eat To Lose Belly Fat (3 Stages)
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Belly fat is easier to gain than it is to lose, and it’s absolutely something that needs more attention in the kitchen than in the gym. Here’s one way of doing it:
By the numbers
First note: this video is by a man, and judging by the numbers mentioned, assumes that the viewer is also a man. An end goal of 10% body fat is a little on the low side for men, and would be dangerous for women. The magic 15% mark that he mentions as being a point where various metabolic things change, is more like 20% for women. All assuming normal hormones, of course, since it is hormones that direct this.
Healthy body fat percentages are (assuming normal hormones) in the range of 20–25% for women and 15–20% for men.
With that in mind…
The idea of this approach is to lose enough weight that your body gets rid of even the most awkward bits (e.g: visceral belly fat, which will often be the last to get used) before, if desired, then maintaining at a slightly higher body fat percentage.
- Stage 1: count calories (we don’t usually recommend this at 10almonds, but he does, so we’re reporting it here) and use your weight in pounds multiplied by 12 to give your daily calorie target. Make the majority of your diet foods that have a large volume:calorie ratio, such as fruits and vegetables, in order to feel full without overloading your metabolism. He has an interesting method of calculating a protein target; instead of the usual “1g/kg of body weight”, he says 1g per cm of height. Doing this consistently should get you to 15% body fat (so, 20%, for women).
- Stage 2: start counting fat intake too, and aim for 20–25% of your daily calories as fat. Continue, aside from that, with what you were doing in Stage 1. Doing this consistently should get you to 12% body fat (so, about 17%, for women). Being under the usual healthy level for a while should allow your body to start getting rid of visceral fat.
- Stage 3: track everything, levelling up your precision (no more “this little thing doesn’t count”), and planning ahead when it comes to social events etc. Doing this consistently should yet you to 10% body fat (so, about 15%, for women). This stage has a good chance of making most people miserable, so if that happens, consider the benefits of going back to the healthier 15% body fat (men) or 20% (women).
For more on all of this, enjoy:
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Visceral Belly Fat & How To Lose It ← without calorie-counting! We prefer this 😉
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The Seven Principles for Making Marriage Work – by Dr. John Gottman
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A lot of relationship advice can seem a little wishy-washy. Hardline clinical work, on the other hand, can seem removed from the complex reality of married life. Dr. Gottman, meanwhile, strikes a perfect balance.
He looks at huge datasets, and he listens to very many couples. He famously isolated four relational factors that predict divorce with 91% accuracy, his “Four Horsemen”:
- Criticism
- Contempt
- Defensiveness
- Stonewalling
He also, as the title of this book promises (and we get a chapter-by-chapter deep-dive on each of them) looks at “Seven principles for making marriage work”. They’re not one-word items, so including them here would take up the rest of our space, and this is a book review not a book summary. However…
Dr. Gottman’s seven principles are, much like his more famous “four horsemen”, deeply rooted in science, while also firmly grounded in the reality of individual couples. Essentially, by listening to very many couples talk about their relationships, and seeing how things panned out with each of them in the long-term, he was able to see what things kept on coming up each time in the couples that worked out. What did they do differently?
And, that’s the real meat of the book. Science yes, but lots of real-world case studies and examples, from couples that worked and couples that didn’t.
In so doing, he provides a roadmap for couples who are serious about making their marriage the best it can be.
Bottom line: this is a must-have book for couples in general, no matter how good or bad the relationship.
- For some it’ll be a matter of realising “You know what; this isn’t going to work”
- For others, it’ll be a matter of “Ah, relief, this is how we can resolve that!”
- For still yet others, it’ll be a matter of “We’re doing these things right; let’s keep them forefront in our minds and never get complacent!”
- And for everyone who is in a relationship or thinking of getting into one, it’s a top-tier manual.
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The Midlife Cyclist – by Phil Cavell
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Whether stationary cycling in your living room, or competing in the Tour de France, there’s a lot more to cycling than “push the pedals”—if you want to get good benefits and avoid injury, in any case.
This book explores the benefits of different kinds of cycling, the biomechanics of various body positions, and the physiology of different kinds of performance, and the impact these things have on everything from your joints to your heart to your telomeres.
The style is very much conversational, with science included, and a readiness to acknowledge in cases where the author is guessing or going with a hunch, rather than something being well-evidenced. This kind of honesty is always good to see, and it doesn’t detract from where the science is available and clear.
One downside for some readers will be that while Cavell does endeavour to cover sex differences in various aspects of how they relate to the anatomy and physiology (mostly: the physiology) of cycling, the book is written from a male perspective and the author clearly understands that side of things better. For other readers, of course, this will be a plus.
Bottom line: if you enjoy cycling, or you’re thinking of taking it up but it seems a bit daunting because what if you do it wrong and need a knee replacement in a few years or what if you hurt your spine or something, then this is the book to set your mind at ease, and put you on the right track.
Click here to check out The Midlife Cyclist, and enjoy the cycle of life!
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Hate salad or veggies? Just keep eating them. Here’s how our tastebuds adapt to what we eat
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Do you hate salad? It’s OK if you do, there are plenty of foods in the world, and lots of different ways to prepare them.
But given almost all of us don’t eat enough vegetables, even though most of us (81%) know eating more vegetables is a simple way to improve our health, you might want to try.
If this idea makes you miserable, fear not, with time and a little effort you can make friends with salad.
Why don’t I like salads?
It’s an unfortunate quirk of evolution that vegetables are so good for us but they aren’t all immediately tasty to all of us. We have evolved to enjoy the sweet or umami (savoury) taste of higher energy foods, because starvation is a more immediate risk than long-term health.
Vegetables aren’t particularly high energy but they are jam-packed with dietary fibre, vitamins and minerals, and health-promoting compounds called bioactives.
Those bioactives are part of the reason vegetables taste bitter. Plant bioactives, also called phytonutrients, are made by plants to protect themselves against environmental stress and predators. The very things that make plant foods bitter, are the things that make them good for us.
Unfortunately, bitter taste evolved to protect us from poisons, and possibly from over-eating one single plant food. So in a way, plant foods can taste like poison.
For some of us, this bitter sensing is particularly acute, and for others it isn’t so bad. This is partly due to our genes. Humans have at least 25 different receptors that detect bitterness, and we each have our own genetic combinations. So some people really, really taste some bitter compounds while others can barely detect them.
This means we don’t all have the same starting point when it comes to interacting with salads and veggies. So be patient with yourself. But the steps toward learning to like salads and veggies are the same regardless of your starting point.
It takes time
We can train our tastes because our genes and our receptors aren’t the end of the story. Repeat exposures to bitter foods can help us adapt over time. Repeat exposures help our brain learn that bitter vegetables aren’t posions.
And as we change what we eat, the enzymes and other proteins in our saliva change too. This changes how different compounds in food are broken down and detected by our taste buds. How exactly this works isn’t clear, but it’s similar to other behavioural cognitive training.
Add masking ingredients
The good news is we can use lots of great strategies to mask the bitterness of vegetables, and this positively reinforces our taste training.
Salt and fat can reduce the perception of bitterness, so adding seasoning and dressing can help make salads taste better instantly. You are probably thinking, “but don’t we need to reduce our salt and fat intake?” – yes, but you will get more nutritional bang-for-buck by reducing those in discretionary foods like cakes, biscuits, chips and desserts, not by trying to avoid them with your vegetables.
Adding heat with chillies or pepper can also help by acting as a decoy to the bitterness. Adding fruits to salads adds sweetness and juiciness, this can help improve the overall flavour and texture balance, increasing enjoyment.
Pairing foods you are learning to like with foods you already like can also help.
The options for salads are almost endless, if you don’t like the standard garden salad you were raised on, that’s OK, keep experimenting.
Experimenting with texture (for example chopping vegetables smaller or chunkier) can also help in finding your salad loves.
Challenge your biases
Challenging your biases can also help the salad situation. A phenomenon called the “unhealthy-tasty intuition” makes us assume tasty foods aren’t good for us, and that healthy foods will taste bad. Shaking that assumption off can help you enjoy your vegetables more.
When researchers labelled vegetables with taste-focused labels, priming subjects for an enjoyable taste, they were more likely to enjoy them compared to when they were told how healthy they were.
The bottom line
Vegetables are good for us, but we need to be patient and kind with ourselves when we start trying to eat more.
Try working with biology and brain, and not against them.
And hold back from judging yourself or other people if they don’t like the salads you do. We are all on a different point of our taste-training journey.
Emma Beckett, Senior Lecturer (Food Science and Human Nutrition), School of Environmental and Life Sciences, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The 7-Minute Morning Routine That Eliminates Stiffness
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The video title says “65+”, but honestly, if you are younger than that, and wait until you are 65 to attend to such things as mobility maintenance, then you’ll wish you’d started a long time previously!
So, today is always a good day to start, whatever your age.
A good way to start the day
The exercises do not, in fact, include the forwards bend depicted in the thumbnail. Rather, they are:
Exercise 1: toe wiggles (1 minute):
- while lying in bed, open and close your toes to improve foot mobility.
- this may seem silly and/or trivial, but it’s vital for overall mobility as foot health impacts daily movement, and your toes are responsible for a surprising amount when it comes to your posture, gait, etc.
Exercise 2: calf and hamstring stretch (1 minute):
- use a rolled-up towel (or similar non-stretchy long thing) to pull one foot towards you while straightening your leg.
- hold the stretch for 30 seconds per leg to relieve tightness in the calf or hamstring.
Exercise 3: knee flexion (1 minute):
- bend your knee as much as possible and pull your shin towards you.
- perform for 30 seconds per leg, gently easing into stiffness if necessary to improve knee mobility (i.e. if this is difficult at first).
Exercise 4: knee extension (1 minute):
- straighten one leg on the bed and press your knee down while pulling the toes up.
- hold for 5 seconds, repeat six times per leg, improving knee extension and strengthening the quads.
Exercise 5: hip flexion mobilization (1 minute):
- with your knees bent, pull one knee towards your chest and release in a rhythmic motion (see video for differences from #3)
- do 30 seconds per leg to improve hip mobility and loosen stiffness, especially beneficial for those with hip arthritis.
exercise 6: cat-cow stretch (1 minute):
- on all fours, alternate between arching your back (cat) and dipping it (cow).
- improves mobility in the neck, mid-back, and lower back.
exercise 7: shoulder and upper back stretch (1 minute):
- stand facing a wall, place your hands on the wall, and hinge at the hips to drop your torso between your arms.
- stretches lats, shoulders, and the upper back; do two 30-second holds..
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Is alcohol good or bad for you? Yes.
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This article originally appeared in Harvard Public Health magazine.
It’s hard to escape the message these days that every sip of wine, every swig of beer is bad for your health. The truth, however, is far more nuanced.
We have been researching the health effects of alcohol for a combined 60 years. Our work, and that of others, has shown that even modest alcohol consumption likely raises the risk for certain diseases, such as breast and esophageal cancer. And heavy drinking is unequivocally harmful to health. But after countless studies, the data do not justify sweeping statements about the effects of moderate alcohol consumption on human health.
Yet we continue to see reductive narratives, in the media and even in science journals, that alcohol in any amount is dangerous. Earlier this month, for instance, the media reported on a new study that found even small amounts of alcohol might be harmful. But the stories failed to give enough context or probe deeply enough to understand the study’s limitations—including that it cherry-picked subgroups of a larger study previously used by researchers, including one of us, who concluded that limited drinking in a recommended pattern correlated with lower mortality risk.
“We need more high-quality evidence to assess the health impacts of moderate alcohol consumption. And we need the media to treat the subject with the nuance it requires. Newer studies are not necessarily better than older research.”
Those who try to correct this simplistic view are disparaged as pawns of the industry, even when no financial conflicts of interest exist. Meanwhile, some authors of studies suggesting alcohol is unhealthy have received money from anti-alcohol organizations.
We believe it’s worth trying, again, to set the record straight. We need more high-quality evidence to assess the health impacts of moderate alcohol consumption. And we need the media to treat the subject with the nuance it requires. Newer studies are not necessarily better than older research.
It’s important to keep in mind that alcohol affects many body systems—not just the liver and the brain, as many people imagine. That means how alcohol affects health is not a single question but the sum of many individual questions: How does it affect the heart? The immune system? The gut? The bones?
As an example, a highly cited study of one million women in the United Kingdom found that moderate alcohol consumption—calculated as no more than one drink a day for a woman—increased overall cancer rates. That was an important finding. But the increase was driven nearly entirely by breast cancer. The same study showed that greater alcohol consumption was associated with lower rates of thyroid cancer, non-Hodgkin lymphoma, and renal cell carcinoma. That doesn’t mean drinking a lot of alcohol is good for you—but it does suggest that the science around alcohol and health is complex.
One major challenge in this field is the lack of large, long-term, high-quality studies. Moderate alcohol consumption has been studied in dozens of randomized controlled trials, but those trials have never tracked more than about 200 people for more than two years. Longer and larger experimental trials have been used to test full diets, like the Mediterranean diet, and are routinely conducted to test new pharmaceuticals (or new uses for existing medications), but they’ve never been done to analyze alcohol consumption.
Instead, much alcohol research is observational, meaning it follows large groups of drinkers and abstainers over time. But observational studies cannot prove cause-and-effect because moderate drinkers differ in many ways from non-drinkers and heavy drinkers—in diet, exercise, and smoking habits, for instance. Observational studies can still yield useful information, but they also require researchers to gather data about when and how the alcohol is consumed, since alcohol’s effect on health depends heavily on drinking patterns.
For example, in an analysis of over 300,000 drinkers in the U.K., one of us found that the same total amount of alcohol appeared to increase the chances of dying prematurely if consumed on fewer occasions during the week and outside of meals, but to decrease mortality if spaced out across the week and consumed with meals. Such nuance is rarely captured in broader conversations about alcohol research—or even in observational studies, as researchers don’t always ask about drinking patterns, focusing instead on total consumption. To get a clearer picture of the health effects of alcohol, researchers and journalists must be far more attuned to the nuances of this highly complex issue.
One way to improve our collective understanding of the issue is to look at both observational and experimental data together whenever possible. When the data from both types of studies point in the same direction, we can have more confidence in the conclusion. For example, randomized controlled trials show that alcohol consumption raises levels of sex steroid hormones in the blood. Observational trials suggest that alcohol consumption also raises the risk of specific subtypes of breast cancer that respond to these hormones. Together, that evidence is highly persuasive that alcohol increases the chances of breast cancer.
Similarly, in randomized trials, alcohol consumption lowers average blood sugar levels. In observational trials, it also appears to lower the risk of diabetes. Again, that evidence is persuasive in combination.
As these examples illustrate, drinking alcohol may raise the risk of some conditions but not others. What does that mean for individuals? Patients should work with their clinicians to understand their personal risks and make informed decisions about drinking.
Medicine and public health would benefit greatly if better data were available to offer more conclusive guidance about alcohol. But that would require a major investment. Large, long-term, gold-standard studies are expensive. To date, federal agencies like the National Institutes of Health have shown no interest in exclusively funding these studies on alcohol.
Alcohol manufacturers have previously expressed some willingness to finance the studies—similar to the way pharmaceutical companies finance most drug testing—but that has often led to criticism. This happened to us, even though external experts found our proposal scientifically sound. In 2018, the National Institutes of Health ended our trial to study the health effects of alcohol. The NIH found that officials at one of its institutes had solicited funding from alcohol manufacturers, violating federal policy.
It’s tempting to assume that because heavy alcohol consumption is very bad, lesser amounts must be at least a little bad. But the science isn’t there, in part because critics of the alcohol industry have deliberately engineered a state of ignorance. They have preemptively discredited any research, even indirectly, by the alcohol industry—even though medicine relies on industry financing to support the large, gold-standard studies that provide conclusive data about drugs and devices that hundreds of millions of Americans take or use daily.
Scientific evidence about drinking alcohol goes back nearly 100 years—and includes plenty of variability in alcohol’s health effects. In the 1980s and 1990s, for instance, alcohol in moderation, and especially red wine, was touted as healthful. Now the pendulum has swung so far in the opposite direction that contemporary narratives suggest every ounce of alcohol is dangerous. Until gold-standard experiments are performed, we won’t truly know. In the meantime, we must acknowledge the complexity of existing evidence—and take care not to reduce it to a single, misleading conclusion.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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