Memo to the U.S. Surgeon General: When it Comes to Alcohol and Pregnancy, the Dose Makes the Poison

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A quick search on Google or any Internet search machine for the topic "alcohol, pregnancy" will reveal that the precautionary principle is alive and well.

Websites from small pre-natal forums to the National March of Dimes sound dire warnings about the allegedly ill effect of drinking even a drop of alcohol --distilled spirits, beer, or wine -- just before or during pregnancy. The message communicated is this: even trace consumption of alcoholic beverages will increase the risk of birth defects -- some defects grossly obvious, some more subtle, taking the form of neurological impairment and learning disabilities.

This message has no basis in fact.

It is bad enough when private groups misrepresent the facts about alcohol and pregnancy, but it is absolutely unforgivable when the United States Surgeon General chimes in on the subject without data to back up his recommendations.

Last week he did just that. Dr. Richard H. Carmona warned that:

--"no amount of alcohol can be considered safe during pregnancy"

--"we do not know what, if any, amount of alcohol is safe"

--"a pregnant woman should not drink alcohol during pregnancy"

--"a pregnant woman who has already consumed alcohol during her pregnancy should stop in order to minimize further risk" (emphasis added)

There is no question that heavy consumption of alcohol during pregnancy can do irreparable harm to the unborn child. But is there evidence that an occasional drink -- a glass of wine with a meal -- poses a hazard? No, there is no such evidence, and Dr. Carmona knows that. He has chosen to embrace the "precautionary principle," which assumes that if there is even a hint of a possible problem, exposure to the substance in question should be avoided entirely -- even in the absence of hard data to back up such a recommendation.

Dr. Carmona has a history of misrepresenting and distorting health risks. For example, before the Subcommittee on Commerce, Trade, and Consumer Protection of the House Energy and Commerce Committees in June 2003, he claimed that there was no "scientific evidence to endorse any tobacco product, including smokeless tobacco, as a means of reducing the risk of cigarette smoking," noting there is no "evidence that the use of any tobacco product is a safer alternative to smoking."

And he was just plain wrong then as well.

Certainly we cannot designate smokeless tobacco as "safe" -- but it is very, very much less harmful to health than cigarette smoking. This should be obvious to the good doctor, given that smokeless tobacco, unlike cigarettes, is not associated with the deleterious systemic effects of cigarette smoking -- including lung cancer, heart disease, and chronic obstructive lung disease. If someone cannot give up tobacco entirely, there is no question that smokeless tobacco is a less harmful alternative.

Why is the Surgeon General misrepresenting facts about public health?

Because he wants to be politically correct. And tobacco is definitely not politically correct -- so all exposure to tobacco must be deemed equally harmful and thus rejected. False but definitely "p.c."

There is a parallel explanation for his p.c. posture in telling women not to have a drop of wine or anything else alcoholic during pregnancy. Again the precautionary principle pops up and takes over. Since pregnancy is a highly emotional topic, people with a personal interest in the topic are particularly vulnerable to advice of any kind, even that not backed up by science.

What possible downside could there be to telling a woman not to drink alcohol during pregnancy?

First, pregnant women are giving all sorts of "don'ts" during pregnancy. Don't drink. Don't smoke. But the risks of cigarette smoking (the overwhelming majority of people who smoke go through at least a pack a day) to the unborn child are truly spectacular. The risk of light-to-moderate drinking are purely hypothetical. How is a woman to know that the two risks are on totally different levels -- when the chief physician in the U.S. talks about them as equal threats?

Second, there are unanticipated consequences to dire warnings about small amounts of alcohol during pregnancy. A woman who has been drinking socially for years -- and finds herself pregnant -- may suffer anxiety unnecessarily. She may even consider terminating the pregnancy for fear of having already done damage to the fetus. Note the wording of the S.G.'s warning: "a pregnant woman who has already consumed alcohol during her pregnancy should stop in order to minimize further risk."

In other words, the Surgeon General is telling women that if they have consumed any alcohol before learning they were pregnant they have already caused harm to their unborn children but should stop so they do not do more harm. Given that there is no evidence whatsoever that this is true even for moderate drinking, this is simply an outrageous warning -- one which will surely terrify millions of moms-to-be.

The Surgeon General, with his position of authority, should use his office to communicate sound, scientifically based information about public health. On the topic of alcohol and pregnancy, he should have issued a statement based on facts, not hype, something along the lines of "Studies have indicated that significant consumption of alcohol during pregnancy poses substantial health risks to the unborn child. I recommend that women who are pregnant or planning on becoming pregnant abstain from alcohol or limit their consumption to a few glasses of wine, or its equivalent, per week."

Dr. Elizabeth M. Whelan is president of the American Council on Science and Health.