The politics of drinking
            April 27, 2017

Drink and the meaning of cancer

It’s the fortieth anniversary of the publication of Illness as Metaphor, Susan Sontag’s extended essay comparing and contrasting the meanings carried by tuberculosis, in the 19th century, and cancer, in the late 20th and the ways I which they are discursively deployed for political purposes.

Since then we have made some progress in the understanding and treatment of cancer, but perhaps not as much as Sontag hoped. She envisaged a time when science, as it had with tuberculosis, identifies a single cause that could be dealt with efficiently, lessening our fear.

Instead we have the Daily Mail’s obsession with blaming everything from broccoli to bubble-baths (I’ve only looked at the Bs). The condition for this nonsense is medicine’s failure to come up with a convincing alternative.

Of course, we know some things. Everyone can name someone close who has smoked heavily for many years and has contracted lung cancer. On top of what the science says, you can see a connection.

It isn’t the same for alcohol. That there might be a link only struck me when a colleague of mine, a prodigious consumer of gin and soda water, died of throat cancer. For the rest of the heavy drinkers I’ve known, it’s been liver disease that’s got them.

My subjective impressions conform with most of the rest of the population who, to the shock and dismay of some public health campaigners, don’t realise drinking is a major cause of cancer. They also conform to the statistics. According to one paper “alcohol-attributable cancers at these sites make up 5.8% of all cancer deaths world-wide”.

(At this point, someone is going to ask me how many deaths I would find acceptable. This is not a serious question as there is no possible answer).

Nevertheless, that lack of awareness is now being addressed by a vigorous campaign. The previously mentioned paper, authored by New Zealand-based Jennie Connor and titled simply ‘Alcohol consumption as a cause of cancer’, in 2016 enjoyed more than 56,000 downloads from the Addiction journal website.

That was more than six times its closest competitor, a paper on e-cigs – not exactly an unsexy subject.

There is clearly something going on here, and this surge in interest in alcohol-as-carcinogen has already achieved a significant policy success. The new alcohol guidelines announced last year say that because of the cancer risk there is no safe level of drinking.

This was, of course, crystallised in the remarks of the chief medical officer herself, Dame Sally Davies, who exhorted the common people to do as she did and think of cancer every time a glass of wine approached her lips.

Davies has since admitted she “could have put it better”, but it conveys the ‘no safe level of drinking’ message pretty accurately I think – as utterly ridiculous. Even if it were true that the merest sip somehow gets those cancer cells going, it’s not a credible public health message – or is it?

Recent research in Australia suggests that advertising invoking the link between alcohol and cancer is most effective at getting people to think about their drinking.

The ad in question, angrily described as ‘immoral’ by my Twitter correspondent @ProfByron*, is really quite bizarre in that it shows a trickle of red wine coursing through the bloodstream and triggering cancer all over the place.

Yet, as Jennie Connor herself admits, we have scant understanding of the mechanisms by which ethanol might act on the body to produce cancer cells. With the exception of certain mouth and throat cancers the evidence is purely epidemiological, mathematical.

Sontag would have recognised what’s happening here. Even 40 years on, cancer remains mysterious and dangerous enough to stir deep fears. It is scarier than liver disease, which is a risk we can better grasp.

Heavily laden with otherness, cancer is also able to blame the host for its presence. Like the vampire, we must have invited it in.It is a uniquely powerful weapon and its aggressive deployment in the public health armoury against alcohol is a political act.

*Professor Byron Sharp has written a critique of Connor’s paper for the drinks industry’s Aim Digest.

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