Bioethics Forum Essay
The Medical Community is Due for an Alcohol Detox
Last month, while many people were partaking of Dry January, a U.S. Surgeon General advisory gave another reason for Americans to rethink their drink. The advisory on alcohol and cancer stated that alcohol consumption is the third leading preventable cause of cancer and recommended that alcohol labels be updated to include cancer warnings.
While the idea may seem foreign to many Americans, the fact that alcohol causes cancer has been known for many years. Alcohol was declared a carcinogen in 1988, and in 2020 nearly 750,000 cancer cases globally were attributed to alcohol. When it comes to cancer risk, the evidence is clear: there is no safe level of consumption. So why is it that today only 45% of Americans recognize alcohol use as a risk factor for cancer?
There are likely several reasons. For one, alcohol is extremely normalized in modern day culture. So much so that the phrase “drinking” usually means consuming alcohol as opposed to, say, water. Another is the powerful influence of alcohol industry organizations, which have been shown to downplay or distort alcohol’s role in causing cancer. In fact, many alcohol industry organizations promote the falsehood that alcohol in moderation has health benefits — a claim that has been debunked by leading global health organizations including the WHO and World Heart Federation.
As medical students, we are accustomed to guidelines that follow scientific evidence and medical practice that mirror them. Alcohol, however, seems to be an exception to the rule.
The concept of the medical community organizing smoking lounge sessions or social gatherings in high-radiation rooms or sponsoring creative workshops centered around asbestos and arsenic is utterly absurd. However, winding down after work at a bar or brewery is not only a trope of many medical TV shows but very much a reality in many medical settings; ironically, sometimes nicknamed “liver rounds.”
In medicine, getting a clear spinal tap for the first time is colloquially known as a “champagne tap” with supervising doctors traditionally gifting the performing resident a champagne bottle. At medical conferences, even oncology ones, alcohol is ubiquitous, with attendees frequently given drink tickets as part of their attendance fees. Medical students applying to residency programs are commonly invited to happy hours with current residents or program leadership, often hosted in alcohol-centric locations such as breweries and pubs.
Where alcohol’s well-documented harms are concerned, the medical community seems to have a blind spot. Not only does the community actively promote alcohol at events, but it also unintentionally excludes people who don’t drink alcohol, whether for health or moral reasons. As we wrote in our recent essay in the Hastings Center Report, the ubiquitous presence of alcohol at medical gatherings excludes or limits groups such as Muslims, Mormons, people with substance use disorders, pregnant individuals, and individuals from homes and communities damaged by alcohol.
Many such individuals may not feel comfortable attending alcohol-centric events. This leaves them to contemplate whether it is worth risking their faith, recovery, privacy, and/or moral safety in order to socialize, network, and advance their careers. Institutions that emphasize diversity and inclusion would benefit from reflecting on how promoting alcohol at their events misaligns with their stated values. As medical students we have seen firsthand how seemingly innocent medical student “wine nights,” bar trivia fundraisers, and conference cocktail hours have left many trainees feeling excluded from important social events and opportunities to network.
We believe that we are seeing a paradigm shift in how society thinks about alcohol. We may look back on the free flow of alcohol in the medical community today the way we regard how physicians used to smoke during teaching rounds in the hospital and even recommend specific cigarette brands. We believe there is ample knowledge not only of the medical harms of alcohol but also of its ethical implications—particularly how it can make some individuals feel excluded or unwelcome—to justify limiting its use as a social lubricant, especially in professional settings.
It’s time for the medical community to re-examine its relationship with alcohol — moving away from using it as a reward, a stress reliever, or a social crutch, and instead, finding healthier alternatives. For medical community events to be truly inclusive they must stop funding the service of alcohol and should implement policies against hosting events at alcohol-focused venues like bars, breweries, or wineries. While individuals of course have the freedom to consume alcohol if it is available, such as at a restaurant, medical organizations ought to refrain from endorsing or promoting its use.
In taking these steps, the medical community can set a proper example for our patients and allow people with moral or safety concerns to engage in community events without risking their recovery or compromising their faith. Professional ethics organizations would also do well to reassess their relationship with alcohol. While cultural norms will certainly take time to change, the medical community, which prides itself on being evidence-based, should be at the frontier of this change. After all, we did swear an oath to “first, do no harm.”
Luqman M. Ellythy is a fourth-year medical student at the Mayo Clinic Alix School of Medicine in Rochester, Minnesota. His research interests include bioethics, misinformation, street medicine and medical improvisation.
Elizabeth Farkouh is a fourth-year medical student at the Mayo Clinic Alix School of Medicine. She has conducted international research on the intersection of alcohol consumption, policies, messaging, and health outcomes, including suicide, cancer, and liver disease. @EbethFarkouh
For a different view, see: https://www.drvinayprasad.com/p/what-is-the-truth-about-alcohol-consumption