摘要：In this article, I document strategies used by alcohol producers to influence national and global science and policy. Their strategies include producing scholarly publications with incomplete, distorted views of the science underlying alcohol policies; pressuring national and international governmental institutions; and encouraging collaboration of public health researchers with alcohol industry–funded organizations and researchers. I conclude with a call for an enhanced research agenda drawing on sources seldom used by public health research, more focused resourcing of global public health bodies such as the World Health Organization to counterbalance industry initiatives, development of technical assistance and other materials to assist countries with effective alcohol-control strategies, and further development of an ethical stance regarding collaboration with industries that profit from unhealthy consumption of their products. There Is Growing Recogni tion among public health authorities in the United States and globally that the harmful use of alcohol is a global public health issue of serious proportion. At the global level, the most recent estimates attribute to alcohol 4.6% of the global burden of disease and disability, roughly the same level as tobacco. Alcohol use is also responsible for 3.8% of global deaths. 1 In the United States, excessive alcohol use causes 79 000 deaths per year, according to the Centers for Disease Control and Prevention (CDC). 2 In the United Kingdom, the House of Commons Health Committee reported early in 2010 that alcohol consumption has nearly tripled since 1947, and deaths from liver cirrhosis had quintupled between 1970 and 2006. 3 In Russia, more than half of male deaths between the ages of 15 and 54 in the 1990s were caused by alcohol use. 4 In Brazil, nearly 18% of male disability-adjusted life years are attributable to alcohol use; the analogous statistic in Thailand matches that of the United States at 12%. 1 Although female mortality rates attributable to alcohol are lower, a review of the evidence from developing country settings concluded that, throughout the world, although men do more of the drinking, women disproportionately suffer the consequences, through impact on family budgets, domestic violence, and so on. 5 There is also a growing consensus about how to prevent and reduce alcohol problems. The World Health Organization (WHO) has sponsored periodic research reviews assessing the global research evidence regarding effective approaches. The most recent review, published in 2010, recommends the following interventions: minimum legal purchase age laws, government monopolies of retail sales, restrictions on hours or days of sale, outlet density restrictions, alcohol taxes, random breath testing and lower blood alcohol concentration limits for drivers, administrative suspension of driving licenses for exceeding those limits, graduated licensing for novice drivers, and brief interventions (preferably in primary care settings) for hazardous drinkers. 6 The CDC does systematic reviews for its Guide to Community Preventive Services . Its alcohol reviews have found restricting outlet density, maintaining limits on hours and days of sale, increasing alcohol taxes, and enhanced enforcement of laws banning sales to minors to be effective. 7 The Lancet in 2009 published a review of the most effective and cost-effective strategies. Raising the price of alcohol and banning advertising led the list in the latter category. 8 The WHO both at its headquarters and in its regional offices has begun to develop comprehensive strategies to address harmful use of alcohol. In Geneva, 2009 and 2010 witnessed an intensive period of research and consultation that resulted in the passage by the World Health Assembly of the first-ever Global Strategy to Reduce the Harmful Use of Alcohol. The strategy marks a commitment by the health ministers of 193 Member States to take action in 10 areas, including alcohol pricing, marketing, and physical availability. 9 The regional strategies in some cases endorse these even more strongly. For example, the Western Pacific Regional Strategy, recognizing that alcohol consumption in the region is increasing, calls for the establishment of alcohol taxation systems, the regulation or as appropriate banning of alcohol marketing, and regulation of times and places for sale of alcohol. 10 The African regional strategy observed that “adequate polices were few,” called for regulation of “the content and scale of alcohol marketing,” stated that “taxation should be increased,” and encouraged Member States to “restrict the times and places of sale.” 11 (p2–6) Leading global alcohol producers welcomed WHO's strategy, calling it “an important and constructive step forward in helping address alcohol issues around the world” and pledging to work constructively with WHO and Member States to help promote implementation of the strategy by supporting and contributing to feasible and effective policies that help reduce harmful drinking. 12 In contrast to leading tobacco companies, whose 1994 denial that nicotine was addictive “penetrated the smoke screen” of their relationship with public health and made clear that collaboration was not an option, 13 alcohol companies are on record as seeking a different route. I explored how industry-funded organizations have acted in the context of efforts to reduce alcohol-related harms. What strategies has industry employed in response to the public health initiatives? What has been the relationship of industry to public health evidence? I also examined the relationship of leading alcohol producers with public health science as exemplified in particular by the activities of their “alcohol policy think tank” (as the Global Alcohol Producers Group Web site refers to it), the International Center for Alcohol Policies (ICAP). Sources examined included the publications of the ICAP itself, tax filings in the United States by the ICAP, and comments of industry leaders about the ICAP and about alcohol policy found in searches for any of the words “alcohol,” “alcohol policy,” or “International Center” in the internal tobacco industry documents available from legal settlements at the University of California at San Francisco. Comparison of ICAP research and policy statements with findings from the WHO and other public health bodies and researchers showed how the industry has simultaneously cast itself as representing public health and ignored key findings of public health research regarding effective approaches to the prevention and reduction of alcohol-related problems.
