Engs, Ruth C. [Ed.], Controversies in the Additions Field. David J. Piltman, Ph D. "CHAPTER 17: Health Warning Labels On Alcoholic Beverages."

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CHAPTER 17
Health Warning Labels On Alcoholic Beverages

David J. Piltman, Ph D

A controversial issue in the field of alcohol policy is the federal government requirement that health warning labels be placed on containers of all alcoholic beverages (distilled spirits, wine, and beer); this policy has seriously divided not only organizations but individuals who have worked together harmoniously over the last quarter of a century to bring greater public awareness to the serious problems of alcoholism and alcohol abuse in American society and to provide increased private and public funding for the prevention and treatment of this disease. The crux of the argument between the opponents and proponents of health waming labels is whether such action would raise the public's awareness of problems associated with alcohol use and would prevent the development of new cases of alcoholism, or whether such action is an exercise in futility since warning labels are simplistic and cosmetic reactions to a complex problem.

Historical Context of Warning Labels

As Mark Keller (1978) has pointed out, the idea of warning labels on containers of alcoholic beverages is far from being a new idea Keller cites the proposal of cautionary labels by a 1945 Massachusetts Legislative Special Commission to Study the Problems of Drunkenness which was as follows:

Directions for use: Use moderately and not on successive days. Eat well while dunking, and if necessary, supplement food by vitamin tablets while drinking. Warning: if this beverage is indulged in consistently and immoderately, it may cause intoxications (drunkenness), later neuralgia and paralysis (neuritis) and serious mental derangement such as delirium trernens and other curable and incurable mental diseases, as well as kidney and liver damage (Keller, 1978).

Such a label was rejected in Massachusetts.

Legislation was introduced in the 96th Congress (1978-81) by Senator Strom Thurmond of South

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Carolina to have containers of alcoholic beverages containing more than 24 percent alcohol (distilled spirits) labeled with a conspicuous warning that drinking may be injurious to one's health. Similar legislation has been introduced by Thurmond in previous sessions of the U.S. Congress and hearings were held by the Senate Alcoholism and Drug Abuse Subcommittee on his legislation in the previous session of the 95th Congress in 1978, but no legislation resulted from these hearings.

In early 1978, the Bureau of Alcohol, Tobacco, and Firearms (BATF) of the U.S. Department of Treasury asked for public comments on the issue of health warning labels on containers of alcoholic beverages in view of the increased attention being given to the fetal alcohol syndrome. The public comments were reviewed by a panel of three individuals from outside the government who reached no consensus on whether health warning labels would be effective or not. In early 1979, the BATE deferred any action on warning labels; instead they placed major responsibility for a massive educational campaign to alert the general population (especially women in the child-bearing ages and the medical and allied professionals) to the consequences of excessive and/or abusive drinking, on the alcohol beverage industry as well as the National Institute on Alcohol Abuse and Alcoholism (MAAA). Both private and governmental groups mounted massive educational campaigns in this area.

In a surprising development the U.S. Senate on May 7,1979, adopted an amendment co-sponsored by Senators Thurmond and Hatch of Utah to the renewal legislation (SB-440) for the NIAAA program authority to requite warning labels on containers of beverage alcohol containing more than 24 percent alcohol (distilled spirits) leaving wine and beer, both containing less than 24 percent alcohol content, exempt from this amendment. The Thurmond-Hatch amendment required the display of the statement: "Caution: Consumption of alcoholic beverages may be hazardous to your health" (Wall Street Journal, 1979).

In September 1979 the Senate Subcommittee on Alcoholism and DrugAbuse held hearings on the feasibility of health warning labels which supplemented/hose previously heldby the same Subcommittee in January 1978, then under the chairman ship of former Senator Hathaway. Senator Riegle stated on December 19, 1979, in the Senate that "there is an emerging consensus in the medical and alcoholism fields in support of warning labels. The consensus is not unanimous, but it is impressive nevertheless"(CongressionalRecord, 1979).

However, the House of Representatives' Subcommittee on Health and the Environment, under the chairmanship of Representative Henry Waxman, neither held hearings on this question nor was the health label

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amendment voted on when the House approved its version of SB-440, the renewal legislation for NIAAA authority.

A compromise was reached between the Senate and House on mandated health warning labels which in effect called for another study. The exact wording of the compromise which is embodied in the new Section 334 to the Comprehensive Alcohol Abuse and Alcoholism Prevention Treatment and Rehabilitation Act of 1970 was:

Throughout the 1980s demands for health warning labels on containers of alcoholic beverages by consumer, medical, public health, and new temperance advocates continued to escalate. Various cities, led by New York in 1983, and followed by others such as Philadelphia, Los Angeles, Columbus, etc., mandated retail establishments dispensing alcohol to require health warning posters. In 1987, California authorities, acting on the law required by their Proposition 65 initiative, labeled alcohol as a reproductive toxin; in 1988 warning posters noting this action were mandated throughout that state where alcoholic beverages were sold.

The health warning advocates moved to include more than fetal damage in their labels; they pressed that drink warnings should include references to alcohol's being a drug and other health problems that could result from the ingestion of alcoholic beverages. More specifically, in 1988, the proposed Thurmond-Conyers law would have required producers of alcoholic beverages to use five rotating warning labels. These were:

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WARNING: The Surgeon General has determined that the consumption of this product, which contains alcohol, during pregnancy can cause mental retardation and other birth defects.

WARNING: Drinking this product, which contains alcohol, impairs your ability to drive a car or operate heavy machinery.

WARNING: This product contains alcohol and is particularly hazard ous in combination with some drugs.

WARNING: The consumption of this product, which contains alcohol, can increase the risk of developing hypertension, liver disease, and cancer

WARNING: Alcohol is a drug which may be addictive.

In the mid- 1980s the alcohol beverage began to be a target of product liability suits for their alleged lack of informing consumers about the risks of addiction and health damage. Legal action was brought against Brown Forman and G. Heileman Brewing Company in Illinois in 1986 for alleged failure to warn that their products were addictive. Further suits involving alleged fetal damage by alcohol use were filed in Seattle, Washington. Probably, given their concern with the potential product liability awards, the alcohol beverage industry acquiesced to health warning labels on their products in 1988. Therefore, the Omnibus DrugAct of 1988 enacted by the U.S. Congress required that all containers of alcoholic beverages produced for domestic consumption carry the following warning labels effective November 19, 1989:

l. According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. 2. Consumption of alcoholic beverages impairs your ability to drive acar or operate machinery, and may cause health problems.

The controversy over warning labels and the best way to avoid fetal damage from excessive consumption of alcohol can be linked to broader concerns in the nation. In 1986, the U.S. Congress enacted the "Emergency Planning and Community Right to Know Act", which related to reporting requirements involving the emission of certain noxious chemicals into the atmosphere and the stockpiling of these dangerous chemicals (Insight, 1988). The "Right to Know" not only the ingredients but the risks of various products is a major aspect of the consumer movement. Moreover, given the fact that the American society is a health-centered one and the inability of medical science to determine a safe level of drinking during pregnancy leads inevitable to the recommendation by some in the new temperance movement of gender prohibition i.e., women in the childbearing years with the ability to conceive should abstain from alcoholic

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beverages since damage may occur to the fetus before the woman is aware she is pregnant.

Scientific Evidence of the Effectiveness of Health Warning Labels

There is not even one scientific study to support the point of view that health warning labels would raise the public's awareness of alcohol problems and alcoholism or that labels would have any effect on the drinking patterns of American citizens, which are deeply ingrained in the sociocultural fabric of the society. Furthermore, an overwhelming majority of Americans either abstain or are light or moderate drinkers. Only approximately six to seven percent of the adult population become alcoholic.

A warning label that excessive consumption of alcoholic beverages may damage your health comes at the end point of personal drinking decision-making—namely after the purchase of the alcoholic beverage. Do we scientifically know whether or not a label will be read by the purchaser? Also, how does a warning label affect the consumption of alcoholic beverages ordered in restaurants, taverns, and cocktail lounges where the health warning or posters are rarely in view? Or would governmental regulations later require that all glasses in which alcoholic beverages are served to customers mandate the printing of labels on them? Or would there have to be specified times when lights would be fumed up in the cocktail lounges, taverns, restaurants,etc., in order for the customers to read the labels on their glasses? Or would the server of alcoholic beverages in a commercial establishment have to give a verbal warning to the customer on the potential problems of alcohol use? Further, the economic costs of these new labeling procedures are being passed on to the consumers.

Use of All Products Carry Some Risk

The American Congress end the massive bureaucratic structure which it has created should be cognizant that almost all products may have some deleterious effects upon certain individuals. Salt is counter-indicated in cases of hypertension; thus the question becomes, should it carrying a warning label? Sugar is counter-indicated for diabetics; therefore should it carry a warning label? This list could be expanded ad nauseam to the point of absurdity. Unfortunately, in the rush by zealots to protect us from ourselves, there is real danger that there will be so many cautions and warnings about the possible negative consequences of products to certain categories of individuals that serious health hazards, where the danger is real to an overwhelming majority of the population, will be ignored by the

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customer. In short, health warning labels should be used only when the negative health consequences of the products are based on sound scientific studies such as is the case with cigarette smoking.

Conclusion

Despite these developments, a warning labels on containers of beverage alcohol is no more than a symbolic action without any substance, which would imply that America's alcoholism problem (which is probably less extensive than in the first half of the 19th century (Rorabaugh, 1976)) could be solved by simplistic and superficial devices that have never proved effective with any other major health problem. The furtherdamage is that warning labels may deceive some people into believing that concrete action is being taken by the government to reduce the health hazards of excessive drinking; in fact, health warning labels neither address the question of the multiple etiology of alcohol problems and alcoholism nor develop more effective primary prevention programs in this area.

We need to determine why some people drink to excess or have alcohol problems, and in most cases why humans have been drinking since the beginning of human history without the majority of them developing alcohol problems; these are the primary research questions to which our attention should be addressed, and we should not be deceived by simplistic answers (such as the Neo-Prohibitionist philosophy) to the complexities of alcohol problems.

More positive approaches to alcohol problems, but infinitely more expensive than cosmetic health warning labels on the agent alcohol, ate the educational efforts by private voluntary community agency structures, the alcohol beverage industry, the mass media, and governmental agencies at all levels to inform the public about beverage alcohol usage under varying conditions and at various dose levels.

REFERENCES

Congressional Record (1979). Senate, December 19, p. S19121. Insight (1988). May 23, p. 9.

Keller, M. (1978). "Letter to Senator Hathaway of Subcommittee on Alcoholism and Drug Abuse", January 28.

Rorabaugh, W.J. (1976). "Estimated U.S. Beverage Consumption, 1790-1869", Journal of Studies on Alcohol, 37 357-364.

Wall Street Journal ( 1979). May 8, p. 14.

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