Neo-Prohibition: The Surgeon General’s Sobering Call to Action

“Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States – greater than the 13,500 alcohol-associated traffic crash fatalities per year in the U.S. – yet the majority of Americans are unaware of this risk.” 

- US Surgeon General Dr. Vivek Murthy

Is this the beginning of the new Prohibition, or is it simply a Surgeon General trying to establish a legacy of policy? In a search for answers, I turned to an opinion piece in STAT entitled The Surgeon General is right: America has a drinking problem, written by Dr. Luis Seija, who we might call a neo-Prohibitionist,

“Alcohol is not just another consumer product — it’s America’s favorite drug and its most dangerous.

… Prohibition, enacted in 1920, was a well-intentioned failure aimed at shielding Americans from the “scourge of drunkenness” and quickly became a cautionary tale of unintended consequences. … Prohibition failed not because alcohol wasn’t harmful, but because it underestimated the cultural power of alcohol and the need for public buy-in.

Where the temperance movement fell short, tobacco control succeeded, offering a blueprint for change. …. To rewrite alcohol’s narrative is to learn from both Prohibition’s failures and tobacco control’s victories: We need a cultural transformation that doesn’t alienate the public but rather invites them to reconsider alcohol’s place in our lives.”

Dr. Murthy’s Alcohol and Cancer Risk 2025 The US Surgeon General Advisory – “a public statement that calls the American people’s attention to an urgent public health issue … that require the nation’s immediate awareness and action,” is the first step in reframing alcohol as a health risk rather than social or moral ill. 

“Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity.”

After noting that 72% of US adults consume one or more drinks per week, he addresses the direct link between alcohol use and cancer, avoiding alcohol as an abused substance – Prohibitions’ moral argument.

“This body of scientific evidence demonstrates a causal relationship between alcohol use and increased risk for at least seven different types of cancer, including breast (in women), colorectum, esophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx). The more alcohol consumed, the greater the risk of cancer.” [emphasis added]

Dr. Bloom provides some detail here. For those familiar with the literature, alcohol is a, but not the cause of cancer. The best evidence for this comes from the cancers of the oral cavity, pharynx, and larynx – head and neck cancers where there is an acknowledged association between drinking and smoking. A meta-analysis of 27,000 participants in the International Head and Neck Cancer Epidemiology (INHANCE) consortium calculated the risk attributed to alcohol, tobacco, and the combination to the development of head and neck cancer. [1]

“4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined.”

It seems that alcohol is a relatively minor contributor to the onset of their cancer. In reframing alcohol as a health risk, Dr. Murthy pivots, focusing on the most prevalent alcohol-related cancer, breast cancer in women. The advisory devotes time to explaining the quantification of risk words and pictures. 

The graphic contains lots of numbers, drawing attention to those below the rising arrow and the four women figures. That 15% stands out, at least numerically. Still, the statistical reality is that for those women drinking at the limit currently recommended by our government, the risk of breast cancer increases by 2% and 4% from the baseline of less than a drink a week. 

An early study calculated the risk of breast cancer that can be solely attributable to alcohol at 2.1%; a prospective study of drinking and breast cancer did find a dose-related increase, but only in the women whose cancers were estrogen receptor-positive. Another study involving the prospective longitudinal Nurses' Health Study (NHS) of 121,000 women noted a statistically relevant dose association of alcohol with breast cancer. However, while concluding that breast cancer was associated with even low levels of alcohol consumption, at each level of drinking, even the highest, the risk attributed to alcohol alone was 1 to 2%

Dr. Murthy is correct in the linkage of alcohol and various cancers, but the overall impact of alcohol alone is smaller than any of the statistics cited. While the advisory provides some degree of context,

"An individual’s risk for developing cancer, including alcohol-related cancers, varies and is determined by a complex interaction of biological factors (e.g., genetics) and environmental factors (e.g., exposure to carcinogens)." 

What was served up by media headlines was calculated to grab attention rather than inform. That lack of factual information as to alcohol’s health impacts for the non-alcoholic casual drinker leads to Dr. Murthy’s second point based on a survey of Americans’ lack of knowledge of alcohol as a risk factor. 

“45% of Americans recognized alcohol use as a risk factor for cancer compared to 91% of Americans who recognized the risk of radiation exposure, 89% for tobacco use, 81% for asbestos exposure, and 53% for obesity.” As Dr. Seija, our neo-Prohibitionist, writes,

“The answer lies in a cultural chokehold that normalizes alcohol, protects its status, and blocks meaningful policy advancement. This isn’t because we lack evidence or effective solutions. Instead, it’s the stories we tell ourselves about alcohol, steeped in tradition and resistance to regulation, that undermine even the most promising of initiatives.”

A simple recitation of facts does not counter beliefs. The widely reported recommendation was to update the health warning labels on alcohol-containing beverages to reflect the risk of cancer. The Surgeon General’s complete recommendations, reframed by Dr. Seija, are already known,

“… raise taxes, limit availability, restrict marketing, enforce minimal legal drinking age, and fund prevention and treatment programs. To succeed, alcohol policy must be reframed to protect families and communities, not as government infringement. … Higher taxes, targeted education and awareness campaigns, and stricter marketing regulations aren’t just abstract ideas, they’re necessary steps to advance the betterment of public health.”

All of these actions require government intervention – the characterized as infringement is wholly cultural and political.  

Let's talk politics

Dr. Murthy has made the scientific case [2], but politics decides where that science gets applied or not. Will the Make America Healthy Again (MAHA) contingent provide the necessary government funding and intervention? Can Congress even agree to change the warning label on alcoholic beverages? 

The alcohol industry has faced a turndown in consumption for the last several years and has mobilized its free speech rights in extensive lobbying. As Politico reports, Anheuser-Busch, “the Distilled Spirits Council, and the Beer Institute — spent a combined $8,810,000 on lobbying” in the last year.

Here is a partial list of some of the political stakeholders. 

• President Trump, whose brother died from alcohol use disorder, does not drink. Nor does presumptive HHS Secretary Robert Kennedy Jr. attends daily AA meetings.
• The 100-member Congressional Wine Caucus, co-lead by Mike Thompson (D) representing California’s wine country and Dan Newhouse (R), a Washington grape grower, have asked HHS and the USDA to suspend a study on alcohol consumption that will “undergird the new dietary guidelines.” Additional questions about the study were raised by the House Oversight Committee, chaired by James Comer (R), whose Congressional district includes the Maker’s Mark Distillery.
• Representatives Stephanie Bice (R) and Susie Lee (D) chair the 21st Amendment Caucus, backed by the alcohol industry to encourage state-based alcohol regulation.
• According to Open Secrets, the alcohol industry “contributed nearly $24 million to political candidates and parties during the 2024 cycle.” That included Kamala Harris, Donald Trump, Robert Kennedy Jr, Representative Thompson, and House Speaker Mike Johnson
• Eric Trump owns the largest winery in Virginia.

Dr. Murthy’s advisory on alcohol and cancer risk may be grounded in science, but its future lies in the messy battlefield of lobbying, cultural inertia, and partisan priorities. While the Surgeon General’s call may echo past tobacco control successes, the alcohol industry’s deep pockets and political influence present formidable obstacles. Will this push for reform be the first sip of a new temperance era or another well-intentioned toast to nowhere?

[1] The risk is defined as the population-attributable risk or PAR

[2] The advisory cites five science studies involving alcohol

• International Agency for Research on Cancer (IARC) classifies alcohol as a Group 1 carcinogen
• US National Toxicology Program concluded that “Alcoholic Beverage Consumption” is known to be a human carcinogen
• The body of conclusive evidence that alcohol causes at least seven types of cancer is also agreed upon by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health’s National Cancer Institute (NCI)
• Alcohol misuse is associated with: “... cancers of the oral cavity, esophagus, larynx, pharynx, liver, colon, and rectum. Even one drink per day may increase the risk of breast cancer.”  - 2016 Surgeon General’s Report on Alcohol, Drugs, and Health
• "Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease. Alcohol has been found to increase the risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day)." - 2020-2025 Dietary Guidelines for Americans.

Pointedly, it does not mention a report from the National Academies of Sciences, Engineering, and Medicine, which noted an increased risk of breast cancer with moderate alcohol consumption, as well as finding that moderate drinking was associated with fewer deaths from cardiovascular disease. The NASEM study received the usual criticisms regarding researchers with financial ties to Big Alcohol and a lack of relevant research experience.