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Sinwan Basharat, Canada
The United States Surgeon General Dr Vivek Murthy, the country’s chief medical doctor, released a powerful report in January 2025, calling for alcoholic drinks in the country to include warning labels for cancer.[1] Similar to warning labels on cigarettes, he urged that the public must be made aware of the damaging effects of alcohol, particularly its link with at least seven leading cancers. His advisory comes on the heels of several guidelines and statements across the globe in recent years that similarly draw attention towards the fact that there is no safe amount of alcohol. The widespread use of alcohol, coupled with a lack of awareness among the public about the extent of its harms, is propelling a new wave of health authorities to strongly advocate that the narrative around alcohol must change.
Although the health risks of alcohol, especially when consumed in higher quantities, are generally well-understood among healthcare professionals, for many years there have been conflicting and confusing opinions about its moderate use. For instance, the Centers for Disease Control (CDC) and other agencies would suggest that consuming two or fewer drinks per day was considered moderate and not associated with major health risks.[2] It was not uncommon to hear the claim that a glass of wine a day could be good for a person’s heart. Such claims were backed by individual studies that suggested moderate use could be beneficial for certain cardiovascular outcomes. In contrast, studies also showed that moderate use could be associated with increased risks of other health conditions, such as liver diseases and certain cancers.[3] The mixed messaging and competing opinions understandably left people confused and overwhelmed about what the evidence truly showed.
What is undisputed, however, is that alcohol is one of the most prevalent and widely used substances across the world. More than 40% of the entire global population consumes alcohol, and in many countries, the rate is much higher.[4] In his latest advisory, the US Surgeon General reported that nearly three-quarters of Americans have at least one drink a week.[5] Alcohol is part and parcel of the culture in many societies. From dinners and celebrations to casual gatherings and moments of solitude, alcohol is glamorised and normalised as a seemingly indispensable part of modern life. Given its widespread prevalence, health authorities in recent years have tried to settle the uncertainties, develop a more conclusive review of the evidence, and present clear guidance about the effects of alcohol. For example, authors of one of the most comprehensive reviews in recent years from the Canadian Centre on Substance Use and Addiction stated:
‘To make more informed decisions about alcohol use, people living in Canada must be aware of important information about alcohol and health, assess their personal risk and consider reducing their alcohol use.’[6]
What’s New About the Latest Research
Research examining alcohol is primarily based on observational studies. These types of studies rely on self-reported data; they are not designed to adjust for other factors that can influence the results, and often only examine a few outcomes at a time, among other constraints. Individual observational studies are prone to greater biases, which generates uncertainty in the results. Although it occurs commonly, this type of research is not ideal for wider extrapolation and can be marred with misinterpretations if not nuanced carefully. To overcome these limitations and reduce biases in the research, health authorities are increasingly relying on a wider body of evidence, and pooling results from multiple studies (as well as multiple systematic reviews). In these reviews, researchers give greater weight to higher-quality studies, adopting stringent and consistent criteria to evaluate the evidence. For example, the Canadian review mentioned above identified 5,915 systematic reviews (compilation of many individual studies) but ultimately narrowed down the results to just 16 systematic reviews that they considered sufficient and of a high quality.[7] In this way, the latest research is more rigorous, more comprehensive, and is better suited for informing public policy.
What Does the Latest Evidence Show?
The results from this type of higher-grade research paint a stark picture of the profound effect alcohol has on individuals and society. Drinking alcohol is associated with a continuum of risk and cannot be described as having a threshold (safe or not safe level). The Canadian report states,
‘Science is evolving, and the recommendations about alcohol use need to change. Research shows that no amount of alcohol is good for your health. Drinking alcohol, even a small amount, is damaging to everyone regardless of age, sex, gender, ethnicity, tolerance for alcohol lifestyle.’[8]
The Canadian review details that for many health conditions, the risk of poor outcomes grows based on the amount a person consumes, and even a moderate amount is associated with increased risks for several cancers, liver disease, and violent behaviour. Moreover, there is strong evidence that a small amount of alcohol (one drink or less per day) is associated with the risk of several cancers.[9] The risk of cancer continues to grow with higher consumption – and always remains higher than not drinking. The US Surgeon General specifically emphasised in his report:
‘This body of scientific evidence demonstrates a causal relationship between alcohol use and increased risk for at least seven different types of cancer…The more alcohol consumed, the greater the risk of cancer.’[10]
Analysis shows how drinking small amounts of alcohol may provide some protective effects for a few specific conditions, such as ischemic stroke and diabetes.[11] The research contrasts previous claims that alcohol is beneficial for heart health, as a comprehensive assessment of the evidence shows that alcohol is a risk factor for other cardiovascular conditions, including high blood pressure and heart failure.[12] If there is a marginal benefit to heart health, it cannot be inferred to be all-encompassing. Moreover, the marginal benefit to a few health conditions pales in comparison to the net effect and overall increased risk on health outcomes.
New Evidence Highlights Wisdom of Islamic Teachings
It is widely known that Islam prohibits drinking alcohol, and it is a distinctive feature among major world religions. However, within its prohibition, it is a profound testament to the Holy Qur’an that alcohol is not described as completely devoid of any benefit. In fact, the Holy Qur’an gives a simple yet insightful rationale for why, despite having some benefits, alcohol is forbidden. It states,
‘They ask thee concerning wine and the game of hazard. Say: “In both there is great sin and also some advantages for men; but their sin is greater than their advantage.”’[13]
Islam forbids alcohol because it recognises that the net effect of alcohol leads to more harm. Proponents of alcohol may pick out a few individual studies that indicate some potential health benefits in a few specific conditions, but to truly assess its place in life, both the benefits and harms must be assessed comprehensively. To guide individuals, societies, and populations, Islam adopts a rational and systematic lens, similar to those adopted by the reviews cited, in order to explain why alcohol is prohibited. In the commentary to this verse, the Second Successor of the Promised Messiah (as), further explains this teaching of Islam. He writes,
‘The clause, ‘their sin is greater than their advantage’, embodies a very important principle. A thing should not be adopted simply because it contains some advantage, nor should a thing be condemned simply because it is harmful in certain respects. On the contrary, both sides should be carefully weighed, and a thing should be condemned only if its harm outweighs its advantage.
It is, in fact, a great characteristic of Islam that it never condemns a thing wholesale but frankly and freely admits even the smallest good that may be found in it. Islam prohibits certain things not because it considers them to be devoid of all good, for there is nothing in the world which is wholly bad, but because their evil outweighs their good. This is why, while prohibiting the use of intoxicants and games of chance because of their great harm, Islam has not failed to acknowledge the few advantages they possess.’[14]
The Need for a Narrative Shift
In the same light as Islamic teachings, evidence-based policy and public health guidance cannot be based on individual research studies and instead ought to rely on the wider body of evidence. Using this systematic approach, the latest evidence across international boundaries now consistently reports that the risk of alcohol on health is harmful to the overall health of individuals and society.[15,16,17,18] Moreover, reducing consumption and working towards abstinence is beneficial across the board.
Health authorities are leading an evidence-informed approach to change the discourse and change the narrative. The World Health Organization (WHO) – the foremost authority on international health – is especially leading a strong campaign to change the narrative. It wants people to recognise that the small benefits of alcohol that have been previously reported are substantially outweighed by alcohol’s strong associations with cancer and other diseases. Alcohol is a carcinogen, and more people should be aware of the significant risks it poses. Dr Carina Ferreira-Borges, a Unit Lead from the WHO, explains,
‘We cannot talk about a so-called safe level of alcohol use. It doesn’t matter how much you drink – the risk to the drinker’s health starts from the first drop of any alcoholic beverage.’[19]
Future of Public Policy on Alcohol
The world stands at a crossroads. On one hand, the evidence continues to mount that alcohol is extremely damaging to health and is associated with significant risks. On the other hand, people’s awareness about the risks has not significantly changed in the last 20 years.
Particularly after the COVID-19 pandemic, the rates of alcohol consumption are estimated to have increased.[20]
The WHO and others are advocating for increased awareness and consistent health guidance to better inform the public. Their recommendation to add warning labels to alcohol, like those on tobacco products, and cautioning people about its risks seems to be a step in the right direction. Whether it will go far enough to upend the pervasiveness and normalisation of alcohol in society remains to be established.[21] Centuries ago, Islam guided Muslims about the harms of alcohol based on rational principles. The teachings of Islam also went further than increasing awareness. Islam transformed attitudes and behaviours about alcohol towards complete abstinence, and this aversion strongly persists among the faithful. If 21st-century health policymakers desire to follow suit, they must similarly adopt Islam’s approach to solving one of the biggest health issues facing the world today.
About the Author: Sinwan Basharat is a researcher with a background in molecular genetics and epidemiology. He works for a research agency in Ottawa, Canada. He also serves as a Deputy Editor for the Science Section at The Review of Religions.
ENDNOTES
1. “Alcohol and Cancer Risk,” The U.S. Surgeon General’s Advisory, January 2025. Accessed: Jan. 23, 2025. https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf
2. “About Moderate Alcohol Use,” CDC, January 14, 2025. https://www.cdc.gov/alcohol/about-alcohol-use/moderate-alcohol-use.html. Accessed: Jan. 24, 2025. [Online]. Available: https://www.cdc.gov/alcohol/about-alcohol-use/moderate-alcohol-use.html
3. A. Iranpour and N. Nakhaee, “A Review of Alcohol-Related Harms: A Recent Update.,” Addiction & Health, vol. 11, no. 2, pp. 129–137, Apr. 2019, doi: 10.22122/ahj.v11i2.225.
4. D. Bryazka et al., “Population-Level Risks of Alcohol Consumption By Amount, Geography, Age, Sex, and Year: A Systematic Analysis for the Global Burden of Disease Study 2020,” The Lancet, vol. 400, no. 10347, pp. 185–235, Jul. 2022, doi: 10.1016/S0140-6736(22)00847-9.
5. “Alcohol and Cancer Risk,” The U.S. Surgeon General’s Advisory, January 2025. Accessed: Jan. 23, 2025. https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf
6. C. Paradis et al., “Canada’s Guidance on Alcohol and Health: Final Report (Canadian Centre on Substance Use and Addiction),” Ottawa, ON, January 2023.
7. Ibid.
8. Ibid.
9. H. Rumgay et al., “Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study,” Lancet Oncol, vol. 22, no. 8, pp. 1071–1080, Aug. 2021, doi: 10.1016/S1470-2045(21)00279-5.
10. “Alcohol and Cancer Risk,” The U.S. Surgeon General’s Advisory, January 2025. Accessed: Jan. 23, 2025. https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf
11. C. Paradis et al., “Canada’s Guidance on Alcohol and Health: Final Report (Canadian Centre on Substance Use and Addiction),” Ottawa, ON, January 2023.
12. Ibid.
13. The Holy Qur’an, 2:220.
14. Hazrat Mirza Bashiruddin Mahmud Ahmadra, The Holy Qur’an with English Translation and Commentary (Five Volume), vol. 1 (Farnham, Surrey: Islam International Publications Ltd., 2018).
15. “Alcohol and Cancer Risk,” The U.S. Surgeon General’s Advisory, January 2025. Accessed: Jan. 23, 2025. https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf
16. D. Bryazka et al., “Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020,” The Lancet, vol. 400, no. 10347, pp. 185–235, July 2022, doi: 10.1016/S0140-6736(22)00847-9.
17. C. Paradis et al., “Canada’s Guidance on Alcohol and Health: Final Report (Canadian Centre on Substance Use and Addiction),” Ottawa, ON, January 2023.
18. H. Rumgay et al., “Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study,” Lancet Oncol, vol. 22, no. 8, pp. 1071–1080, August 2021, doi: 10.1016/S1470-2045(21)00279-5.
19. WHO, “No Level of Alcohol Consumption is Safe for Our Health,” WHO News Release. Accessed: January 24, 2025. [Online]. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
20. OECD, “The effect of COVID-19 on alcohol consumption, and policy responses to prevent harmful alcohol consumption,” OECD Policy Responses to Coronavirus (COVID-19). Accessed: May 04, 2023. https://www.oecd.org/coronavirus/policy-responses/the-effect-of-covid-19-on-alcohol-consumption-and-policy-responses-to-prevent-harmful-alcohol-consumption-53890024/
21. A. M. E. Zuckermann et al., “The Effects of Alcohol Container Labels on Consumption Behaviour, Knowledge, and Support for Labelling: A Systematic Review,” Lancet Public Health, vol. 9, no. 7, pp. e481–e494, July 2024, doi: 10.1016/S2468-2667(24)00097-5.
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