What would you do if I told you there is drug widely available without prescription that kills almost 500 Americans every day. This drug kills more people every year than the total of all infectious diseases. It is highly addictive and is made both in the U.S. and around the world, and has an unparalleled distribution network in plain sight.
Healthcare professionals are taught that any drug introduced in any developed country must meet certain standards before being approved. First, what is the drug for? Is it safe? Is it effective? What are the adverse effects? Does it have significant off-target effects? Is it cost-effective? What is its addictive profile? Are there significant drug-drug interactions? Are there people who should not receive the drug?
You would probably agree that these are indeed legitimate questions that should be answered before approving this drug for release to the public. You would also probably agree that this drug, given the facts in the first paragraph, should be prescribed very carefully by people who are aware of these concerns and issues.
Answering these questions is part of the reason why it takes so long and costs so much money to bring new drugs to market here in the U.S. It takes about 5-8 years and at least a $1 billion to do the heavy lifting before presenting the drug portfolio before the Food and Drug Administration. Despite what the AI companies and the political bureaucrats in Washington, DC, say, technology can not absolutely predict how a new compound will behave in a live human being. Doing it faster means taking shortcuts, and letting the public be the guinea pigs to “see what happens” just should not be the plan. The rigorous procedures focused on safety made the U.S. FDA the envy and gold standard of the world until recently.
Now, what if I told you that this drug has already been released to the public without any of the testing I mentioned above? Would you be surprised? Would you be outraged? Or would you just shrug your shoulders?
The drug is, of course, ethanol, and you know it as alcohol. I remember in my pharmacology training, the professor said for us to look at ethanol as a drug in development. What do we need to know? First, there is not a lot of therapeutic indications for its use, other than its recreational effects. It dulls sensations, fogs judgment, can create nausea, vomiting, gastric bleeding, gastritis, ulcers, dizziness and loss of consciousness. It can create encephalopathy, heart failure, arrhythmia, lability of blood pressure, pancreatic damage, liver scarring, liver failure, and liver cancer, and is associated with the development of numerous other malignancies.
The tolerability of an individual to alcohol varies by genetics and prior exposure. It certainly is addictive, as the myriad chapters of AA will attest. And learning to deal with root causes of alcohol addiction by awareness programs like AA, or use of some medications like naltrexone may help many suffering from alcohol addiction.
For millennia, as soon as humans learned to ferment, alcohol has destroyed lives, disrupted families and careers, and caused millions of deaths. An excellent report from STAT News on alcohol use caught my attention and prompted me to write this column. In the U.S. alone, alcohol is responsible for about 179,000 deaths annually. DUIs, especially from alcohol abuse, have caused much premature death and disability. But alcohol is the most prevalent behavioral altering substance in the U.S. and is not seen as a public health emergency. Indeed, the impact of alcohol on the behavior of our current FBI director and Defense Secretary and the past behavior of our Health and Human Services secretary do not seem to raise much concern.
Of course, alcohol is not necessary for erratic behavior or judgment lapses, as illustrated by the teetotaler president, whose older brother died at the age of 42 from illness induced by alcohol addiction and subsequently caused the president to avoid alcohol.
Yet alcohol remains central to American cultural and social life, mostly because the majority of people don’t have issues with the occasional drink. But we really cannot ignore the research that links excessive alcohol use, especially binge drinking, to the health issues raised earlier. And public health data have reported alcohol related emergency room visits almost doubling in the first two decades of this century. And the economic cost related to alcohol abuse exceeds $240 billion.
The healthcare system in this country is failing its citizens with regard to dealing with alcohol abuse, and that includes Democratic and Republican administrations. Various Surgeon General reports have highlighted alcohol’s links to psychosocial and hardcore medical issues, but other than small print warning labels, nothing has been done. The alcohol lobby wields a lot of influence.
Indeed, Robert F. Kennedy Jr., a recovering alcoholic and Trump’s Health and Human Services Secretary, has loosened drinking guidelines, and reduced efforts to understand and prevent alcohol addiction. Efforts to raise taxes and allow stricter regulation, strategies that worked to reduce tobacco addiction, have been successfully fought by the alcohol industry. And there has been a very successful diversion of public health attention to the opioid crisis, a topic I’ve previously covered here. Yet more people die from alcohol use than from opioids, and the combination is particularly lethal.
Tobacco use and obesity are well known preventable causes of cancer. And alcohol is right up there with them. This does not mean one has to stop drinking, but if we cut alcohol to one drink per day, it is estimated that we could eliminate almost 18,000 new cancers per year. Reducing alcohol intake is an important goal, since heavy alcoholic use or binge drinking remains problematic even though overall alcohol use in the general population is at historically low levels. And the majority of those who do drink in moderation don’t have any issues.
The MAHA movement should treat alcohol abuse the same way it has treated sugary drinks and ultra-processed foods. No one is seriously proposing prohibition of alcohol. It’s simply too integral to American culture. But being more educated about the impact of excessive alcohol use is something a responsible society should endorse, other than just adding a tagline at the end of an alcohol product advertisement.
Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.
This article originally appeared on Ventura County Star: An underreported drug crisis in America | Dr. Loh
Reporting by Dr. Irving Kent Loh, Second Opinion / Ventura County Star
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