The Role of Society in Promoting or Deterring Alcohol Use and Addiction

of disclosing conflicts of interest. J Legal
Stud. 2005;34(1):1—25.

68. Hrynaszkiewicz I, Norton ML, Vickers
AJ, Altman DG. Preparing raw clinical data
for publication: guidance for journal edi-
tors, authors, and peer reviewers. BMJ.
2010;340:C181.

69. Hrynaszkiewicz I, Altman DG. To-
wards agreement on best practice for
publishing raw clinical trial data. Trials.
2009;10:17.

70. Vickers AJ. Whose data set is it
anyway? Sharing raw data from random-
ized trials. Trials. 2006;7:15.

71. Riley RD, Lambert PC, Abo-Zaid G.

Meta-analysis of individual participant

data: rationale, conduct, and reporting.

BMJ. 2010;340:c221.

72. National Institutes of Health. NIH

Grants Policy Statement, Part II: Terms and

Conditions of NIH Grant Awards, Subpart

A: General, Section 8: Administrative Re-

quirements, 8.2.3.1 Data Sharing Policy;

October 15, 2010. Available at: http://

grants.nih.gov/grants/policy/nihgps_

2010/nihgps_ch8.htm#_Toc271264950.

Accessed January 17, 2011.

73. Ross JS, Madigan D, Hill KP, Egilman
DS, Wang Y, Krumholz HM. Pooled
analysis of rofecoxib placebo-controlled
clinical trial data: lessons for postmarket
pharmaceutical safety surveillance. Arch
Intern Med. 2009;169(21):1976—1985.

74. Konstam MA, Weir MR, Reicin A,
et al. Cardiovascular thrombotic events in
controlled, clinical trials of rofecoxib.
Circulation. 2001;104(19):2280—2288.

75. Reicin AS, Shapiro D, Sperling RS,
Barr E, Yu Q. Comparison of cardiovas-
cular thrombotic events in patients with
osteoarthritis treated with rofecoxib ver-

sus nonselective nonsteroidal anti-inflam-
matory drugs (ibuprofen, diclofenac, and
nabumetone). Am J Cardiol. 2002;89(2):
204—209.

76. Weir MR, Sperling RS, Reicin A,
Gertz BJ. Selective COX-2 inhibition and
cardiovascular effects: a review of the
rofecoxib development program. Am
Heart J. 2003;146(4):591—604.

77. Godlee F, Clarke M. Why don’t we
have all the evidence on oseltamivir? BMJ.
2009;339:b5351.

Global Alcohol Producers, Science, and Policy: The Case
of the International Center for Alcohol Policies

In this article, I document

strategies used by alcohol

producers to influence na-

tional and global science

and policy.

Their strategies include

producing scholarly publica-

tions with incomplete, dis-

torted views of the science

underlying alcohol policies;

pressuring national and in-

ternational governmental in-

stitutions; and encouraging

collaboration of public health

researchers with alcohol in-

dustry–funded organizations

and researchers.

I conclude with a call for an

enhanced research agenda

drawing on sources seldom

used by public health re-

search,morefocusedresourc-

ing of global public health

bodies such as the World

Health Organization to coun-

terbalance industry initiatives,

development of technical as-

sistance 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 prod-

ucts. (Am J Public Health.

2012:80–89. doi:10.2105/

AJPH.2011.300269)

David H. Jernigan, PhD

THERE IS GROWING RECOGNI-

tion among public health au-
thorities 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. Alco-

hol 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 dis-

ability-adjusted life years are at-

tributable 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 dispro-

portionately suffer the conse-

quences, through impact on fam-

ily budgets, domestic violence,

and so on.5

There is also a growing con-

sensus about how to prevent and

reduce alcohol problems. The

World Health Organization

(WHO) has sponsored periodic

research reviews assessing the

global research evidence regard-

ing effective approaches. The

most recent review, published in

2010, recommends the following

interventions: minimum legal

purchase age laws, government

monopolies of retail sales, re-

strictions 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

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interventions (preferably in pri-
mary care settings) for hazardous
drinkers.6 The CDC does sys-
tematic reviews for its Guide
to Community Preventive Ser-
vices. Its alcohol reviews have
found restricting outlet density,
maintaining limits on hours and
days of sale, increasing alcohol
taxes, and enhanced enforce-
ment of laws banning sales to
minors to be effective.7 The
Lancet in 2009 published a re-
view 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 head-
quarters and in its regional offices
has begun to develop compre-
hensive strategies to address
harmful use of alcohol. In Ge-
neva, 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, mar-
keting, and physical availability.9

The regional strategies in some
cases endorse these even more
strongly. For example, the West-
ern Pacific Regional Strategy,
recognizing that alcohol con-
sumption in the region is increas-
ing, calls for the establishment of
alcohol taxation systems, the reg-
ulation or as appropriate banning
of alcohol marketing, and regula-
tion of times and places for sale of
alcohol.10 The African regional
strategy observed that ‘‘adequate
polices were few,’’ called for reg-
ulation 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 pro-
ducers welcomed WHO’s strategy,
calling it ‘‘an important and con-
structive step forward in helping
address alcohol issues around the
world’’ and pledging to

work constructively with WHO
and Member States to help pro-
mote implementation of the strat-
egy by supporting and contribut-
ing to feasible and effective
policies that help reduce harmful
drinking.12

In contrast to leading tobacco
companies, whose 1994 denial
that nicotine was addictive ‘‘pene-
trated the smoke screen’’ of their
relationship with public health
and made clear that collaboration
was not an option,13 alcohol com-
panies 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 alco-
hol producers with public health
science as exemplified in partic-
ular 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 exam-
ined 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 alco-
hol policy found in searches for
any of the words ‘‘alcohol,’’ ‘‘al-
cohol policy,’’ or ‘‘International
Center’’ in the internal tobacco in-
dustry 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 si-
multaneously cast itself as repre-
senting public health and ignored
key findings of public health re-
search regarding effective ap-
proaches to the prevention and
reduction of alcohol-related prob-
lems.

THE GLOBAL ALCOHOL
INDUSTRY

According to market research
estimates, the total alcoholic
drinks market was worth $979
billion in 2007, with the global
beer trade worth an estimated
$498 billion and the spirits trade
worth $216 billion.14-16 In gen-
eral, the high-income country
markets for alcohol are ‘‘mature,’’
and consumption in those coun-
tries is for the most part de-
creasing. By contrast, in the low-
and middle-income countries, al-
cohol consumption is increasing,
and these are the places the in-
dustry views as its best chance
for growth.5 This was exempli-
fied in the industry by statements
such as Seagram’s in its annual
report in 1996: ‘‘Our single big-
gest opportunity is global expan-
sion.’’17

Pursuing this opportunity has
led to unprecedented globaliza-
tion of the industry, to the point
where a relatively small number
of beer and distilled spirits com-
panies dominate global trade in
alcohol.18 Particularly in the case
of beer, the 1990s and early
2000s witnessed successive
waves of mergers and acquisi-
tions, resulting in the dominance
of the global beer trade by a small
number of companies, as mea-
sured by the concentration of

ownership in the trade, which
nearly tripled as the share of the
market held by the 10 largest
companies grew from 28% in
1979—1980 to 72% in 2008.

The global spirits industry has
also experienced rapid concentra-
tion. As shown in Table 2, in
recent years the 10 leading pro-
ducers have consistently con-
trolled more than 40% of sales (by
volume).

This growing concentration of
the beer and distilled spirits in-
dustries has created an unprece-
dented concentration of re-
sources at global and national
levels for participating in and
influencing policy debates re-
garding alcohol.

THE INTERNATIONAL
CENTER FOR ALCOHOL
POLICIES

To this end, in 1995, 10 of
the world’s largest distilled spirits
and beer marketers at that time
(Allied Domecq Spirits and Wine
[as of 2006 split up between
Pernod Ricard, Diageo, and
Beam Global Spirits and Wine],
Bacardi-Martini, Brown-Forman,
Coors Brewing Company, Guin-
ness PLC [now part of Diageo],
Heineken NV, International Dis-
tillers and Vintners [now part of
Diageo], Miller Brewing Com-
pany [now controlled by SAB-
Miller, a conglomerate formed by
joining Miller with South African
Breweries, with the Philip Morris
successor company Altria retain-
ing a 20% interest], Joseph E.
Seagram & Sons [whose spirits
brands were acquired primarily
by Pernod Ricard and Diageo in
2000], and South African Brew-
eries [now SABMiller]) banded
together to found the ICAP. One
of these companies, Miller Brew-
ing, was then controlled by to-
bacco giant Philip Morris. In the

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January 2012, Vol 102, No. 1 | American Journal of Public Health Jernigan | Peer Reviewed | Consequences of Industry Relationships | 81

1996 Philip Morris CEO briefing
book that came to light as one of
many internal tobacco industry
documents released after the
Master Settlement Agreement
between US state attorneys gen-
eral and tobacco companies,
there is a section explaining
Miller’s involvement in the ICAP
as follows:

As Miller continues to expand in-
ternationally, we will need a better
grasp on how different governments
may regulate our products . . . [this
is] the latest initiative in managing
worldwide issues, and assisting our
sales and marketing group in an
increasingly competitive market-
place.22(p6)

To lead the ICAP, the alcohol
industry turned to Marcus Grant,
a former member of the staff of
the WHO. As has been described
in greater detail elsewhere,23

Grant had come to the WHO in
1983 as the organization was
experiencing pressure from con-
servative, pro-business govern-
ments in the United States and
the United Kingdom, in part be-
cause of the WHO’s stance in
support of protests against the
marketing of infant formula in
developing countries. The US
government made it clear to
WHO leadership that it opposed
programs that were not in line
with the principles of private
enterprise. In the face of this
pressure, the WHO in 1983 can-
celled a major project investigat-
ing the marketing strategies of
alcohol transnational corpora-
tions, focusing particularly on
their plans to globalize the alco-
hol market. Grant began his work
for the WHO as a consultant, de-
veloping a report that would
downplay this project’s findings
regarding the impact of the
transfer of aggressive marketing
techniques perfected in devel-
oped countries to less-resourced
countries. He joined the WHO

staff and stayed until 1994, when
he resigned to become a consul-
tant to Seagram, Guinness, In-
ternational Distillers and Vint-
ners, and Hiram Walker (all of
which are now part of either
Diageo or Pernod Ricard).

This consultation led to the in-
ception of the ICAP. In a letter
announcing the formation of the
ICAP in 1995, Grant outlined 4
goals for the new organization: (1)
elaborating a more integrated
approach to alcohol policy, in-
volving all interested sectors; (2)
developing a common language
for promoting more effective di-
alogue; (3) encouraging initiatives
designed to meet the needs of
developing countries; and (4) pro-
moting responsible lifestyles (letter
from M. Grant to D. H. Jernigan,
April 7, 1995).

As ICAP activities would dem-
onstrate, these goals require some
translation. A subsequent ICAP
brochure described the first goal
as an effort to reassess ‘‘current
theories with a primary focus
on the differences between posi-
tive and negative patterns of
drinking.’’24 This emphasis on the
patterns of drinking (as opposed to
population levels of consumption)
and positive effects of alcohol use
would be a major ICAP focus in
its first decade, developed in a
1998 conference titled ‘‘Permis-
sion for Pleasure,’’ and a subse-
quent edited collection of essays
titled, Alcohol and Pleasure: A
Health Perspective.25 ‘‘Involving
all interested sectors’’ would in
practice mean pushing for and
engaging in active alcohol industry
involvement in public health poli-
cymaking regarding alcohol,
directing debate over alcohol pol-
icy into areas where the alcohol
industry could agree, and thus
focusing on education and identi-
fication and treatment of the
heaviest drinkers (among the least

effective and least cost-effective
approaches to alcohol problems8)
and staying away from population-
level strategies such as increased
taxes or restrictions on marketing
or physical availability. The sec-
ond goal would seek to remove
phrases troubling to the industry
such as ‘‘alcohol and other drugs’’
from the official lexicon (see sec-
tion, ‘‘Influencing Public Health
Decision-Makers at the Global
and National Levels’’). The third
would aim to protect the industry’s
ability to expand in areas where its
potential for growth was greatest,
by influencing and encouraging
weak alcohol policies in this re-
gion.26 The fourth goal would in
practice mean promoting drinking
and the drinker’s right to obtain
alcohol.

The actual work of the ICAP is
described through examination
of its voluminous output of sci-
entific conferences, book-length
collections of articles, issue re-
ports and briefing papers, and
other written products from
1998 to 2010. Additional infor-
mation about ICAP activities has
been gleaned from its reports to
the US Internal Revenue Service
on the annual forms that body
requires that every not-for-profit
organization submit to it on an
annual basis. Insights also come
from analyses others have done
of specific aspects of the ICAP’s
work.26—28

Becoming the Industry’s

Voice in Public Health

I believe that I have contributed
more to public health in my 5
years at ICAP than in double that
time in WHO.29(p2) (ICAP found-
ing director Marcus Grant, 2000)

Much of the ICAP’s activities
have focused on countering the
influence of the WHO and lead-
ing alcohol researchers by es-
sentially functioning like a WHO

unit on alcohol, with certain key
omissions. Building on Grant’s
decade of experience at the
WHO in creating and distribut-
ing edited collections of contri-
butions by scholars from around
the world, the ICAP would com-
mission and produce 10 such
book-length collections between
1998 and 2010, as well as 2
other monographs, 6 briefing
papers for consultation with the
WHO, 20 brief issue reports, 4
in-depth ICAP reviews of issues
in alcohol policy, 5 periodic re-
views of drinking and culture, 8
peer-reviewed journal articles
written by ICAP staff and paid
consultants, 1 special issue of
a journal devoted to alcohol and
harm reduction, and 22 charters,
working papers, progress reports,
and other brief policy statements
or guides to policy implementa-
tion. It also produced 4 policy
guides, 9 health briefing papers,
8 issue briefing papers, and 4
policy tool kits, ‘‘guides for
implementation of interventions
to reduce harmful drinking.’’
During the same period WHO
headquarters in Geneva put out
17 publications about alcohol.
Whereas the ICAP publications
all focused on some aspect of
drinking patterns and alcohol
policy, 4 WHO publications
looked at aspects of identification
and treatment of alcohol use
disorders, a topic to which the
ICAP has devoted little attention.

To produce its monographs,
the ICAP initially tried to recruit
current WHO staffers as writers,
reviewers, and advisors. Its pub-
lications mirrored some of the
publications being put out in
the same period by the WHO.
However, the WHO publica-
tions avoided inclusion of
works by industry representa-
tives, and ICAP publications were
often collaborations between

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academics and industry repre-
sentatives that would conclude
the opposite of what WHO pub-
lications were concluding. It per-
formed ‘‘literature reviews’’ that
were incomplete, not subject to
traditional peer review, and ei-
ther supportive of industry posi-
tions or emphasizing high levels
of disagreement among scientists.
Finally, it provided model na-
tional and global alcohol policies
based on the least effective strat-
egies, and offered technical assis-
tance in how to adopt and imple-
ment these policies.

These publications were distin-
guished not by what was in them,
which often included useful con-
tributions to various aspects of
alcohol studies, but by what was
not: they excluded or attempted
to refute evidence regarding the
most effective strategies to reduce
and prevent alcohol-related harm.
In replicating the work of the
WHO, the ICAP’s efforts to recruit
current WHO staffers working on
alcohol issues were unsuccessful,
so it relied on employees in other
sectors (such as the Department of

Mental Health, which at the time
was separate from the Program on
Substance Abuse), employees in
WHO regional offices, and retired
WHO officials. As Table 3 illus-
trates, 7 of the ICAP’s 10 book-
length collections included con-
tributors with ties to the WHO.
The ICAP also drew contributors
from well-respected institutions
such as Brown University, the
Canadian Centre on Substance
Abuse, the University of Sydney,
the University of the South Pa-
cific (Fiji), the National Council
Against Addiction (Mexico), the
Addiction Research Foundation
(Toronto, Canada), the University
of Zimbabwe, Johns Hopkins Uni-
versity, University College (Dub-
lin, Ireland), and the University of
Chile. Nine of the 10 edited col-
lections also included at least 1
chapter written by someone who
had previously been or was cur-
rently employed in strategic af-
fairs, corporate social responsibil-
ity, or a similar capacity for an
alcohol company.

Although the WHO was pro-
ducing fewer publications during

this period, several ICAP publi-
cations seemed to attempt to
counter or pre-empt similar WHO
publications. For instance, in
1994 the European office of the
WHO had sponsored a group of
17 scientists from 9 countries to
produce a comprehensive review
of the global research literature
on alcohol and public health.30

The book made a strong, evi-
dence-based argument for popu-
lation-level strategies such as ex-
cise tax increases and controls
over physical availability. The
ICAP’s first policy manifesto
appeared in 1998, and was titled
Drinking Patterns and Their Con-
sequences.31 It sought to reframe
the debate from societal mea-
sures to individual patterns of
drinking, which could be harmful
or beneficial. This reframing also
shifted the focus from the product
and the practices of the industry
to the behavior of individual
drinkers. The WHO also spon-
sored a group of 12 researchers––
6 from well-resourced and 6 from
less-resourced countries––to pro-
duce a book on alcohol and pub-
lic health in developing societies.5

The ICAP produced its own ed-
ited collection titled Alcohol and
Emerging Markets: Patterns,
Problems and Responses.32 The
WHO has devoted significant
resources in the past decade to
better measurement of alcohol’s
role in the global burden of
disease, and this has been
reflected in WHO33,34 as well
as in various other research
publications.1 Whereas WHO
estimates have placed alcohol’s
role in the global burden of
disease on a par with that of
tobacco, the ICAP, in a publica-
tion of its own titled Alcohol
Consumption and the Burden of
Disease,35 focused on the limita-
tions of the study, including
claiming (incorrectly) that the

estimates had failed to take into
account different patterns of
drinking. In fact, the WHO-
sponsored study developed and
tested a scale for classifying
country-level patterns of drink-
ing, and incorporated that mea-
sure into its calculations in
combination with measures of
population-level consumption
of alcohol.36—38

Two other ICAP publications
directly addressed the well-
documented public health strat-
egies of increasing alcohol taxes
and restricting physical avail-
ability. There is broad consensus
in the alcohol research field that
increasing alcohol excise taxes is
an effective tool for reducing
alcohol problems.39 The Na-
tional Research Council and In-
stitute of Medicine included tax
increases as part of its compre-
hensive program for reducing
underage drinking.40 A recent
meta-analysis combined data
from 112 studies of alcohol pri-
ces to conclude that, like sales of
other commodities, alcohol
sales increase when prices fall,
and decrease when prices (or
taxes) increase, and that tax in-
creases affect heavy as well as
other drinkers.41 Systematic re-
views of the literature by the
CDC42 as well as the interna-
tional group of researchers
sponsored by the WHO43 have
reached similar conclusions.
Despite this high level of agree-
ment among public health
scholars and organizations, the
ICAP report states that

[t]the effectiveness of taxation and
pricing policies as public health and
social tools for reducing consumption,
abuse and problems has been much
debated,44(p3)

and that ‘‘[t]here is evidence
that taxation does not effectively
target those who abuse alcohol
or who have risky drinking

TABLE 1—Concentration of Ownership in the Global Beer

Industry, 1979–1980 Versus 2008

Global Market Share, % (Ranking)

Corporation (Headquarters) 1979–1980 2008

AB/Inbev (Belgium) 6.5 (1; AB) 24.2 (1)

SABMiller (United Kingdom) 4.8 (2; Miller) 12.3 (2)

Heineken NV (Netherlands) 2.8 (4) 9.4 (3)

Carlsberg Breweries A/S (Denmark) 3.1 (3) 7.4 (4)

China Resources Enterprise Ltd (China)
a

4.2 (5)

Molson Coors Brewing Co (United States)
a

3.2 (6)

Tsingtao Brewery Co Ltd (China)
a

3.1 (7)

Grupo Modelo (Mexico) 1.3 (12) 3.1 (8)

Beijing Yanjing Beer Group (China) a 2.5 (9)

FEMSA (Mexico) 0.84 (20) 2.4 (10)

Total market share of top 10 companies 28.0 72.0

Source. 1979–1980 data from Cavanagh and Clairmonte
19

; 2008 data from Impact
Databank.

20

a
Did not exist or not in the top 30 in 1979–1980.

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January 2012, Vol 102, No. 1 | American Journal of Public Health Jernigan | Peer Reviewed | Consequences of Industry Relationships | 83

problems.’’44(p6) It concludes by
warning that ‘‘taxation is a blunt
tool and does not differentiate
between problematic and un-
problematic drinking pat-
terns.’’44(p11)

A CDC systematic review of the
literature on the relationship be-
tween physical availability of al-
cohol and health outcomes found

sufficient evidence of a positive
association between outlet density
and excessive alcohol consump-
tion and related harms to recom-
mend limiting alcohol outlet
density through the use of regula-
tory authority (e.g., licensing and
zoning) as a means of reducing or
controlling excessive alcohol con-
sumption and related
harms.45(p570)

Again, other reviews of the
global literature have corrobo-
rated this finding.6,46 The ICAP
review of the same literature
states that ‘‘a debate has been
developing around the effective-
ness of availability control mea-
sures,’’ claims that ‘‘[t]here is
evidence that efforts by those
desiring to circumvent existing
controls has fueled organized
crime’’ (with the cited source

being an article by a Diageo em-
ployee published in another
ICAP collection), and concludes
that

As research has increasingly dem-
onstrated, harmful outcomes of al-
cohol consumption are more closely
associated with particular drinking
patterns among specific groups, not
with overall consumption. As a re-
sult, gross-level measures such as
availability controls may not be
sufficient . . . .47(p9)

In the past 15 years, the WHO
has also embarked on a series of
exercises in global epidemio-
logic surveillance, which have
produced several survey-based
global status reports on alcohol,
alcohol policy, and alcohol and
youth.48—51 The ICAP in turn
partnered with and later adop-
ted as a subsidiary the London-
based Center for Information on
Beverage Alcohol, which has
produced tables on alcohol pol-
icies and related issues for vari-
ous ICAP reports. A close anal-
ysis of the methodology used to
produce the WHO alcohol poli-
cies report with that of the ICAP
on the same topic concluded
that

The ICAP report, in particular,
seems to present conclusions that
are inconsistent with its own data
or unwarranted because of faulty
survey methodology.28(p136)

The ICAP has also produced
a series of briefing papers, re-
views of alcohol policy issues
that claim to be surveys of the
research literature. Unlike sys-
tematic reviews, such as those
done by CDC’s Guide to Com-
munity Preventive Services,42,52

or meta-analyses, such as the tax
study described previously
drawing on 112 studies of alcohol
prices,41 the ICAP reviews pro-
vide no detail on the methods
used in identifying studies or
assessing their findings. The
ICAP papers focus on the dis-
agreements and inconclusiveness
of alcohol policy research. For
instance, the ICAP briefing paper
on health warning labels
on alcohol reflects ‘‘the equivocal
nature of the contemporary
HWL [health warning label]
debate.’’53(p6) The ICAP’s report
on alcohol and pregnancy con-
cludes that

many feel there is insufficient
evidence regarding moderate
consumption of alcohol during
pregnancy and the effect it
may have on a developing
fetus . . . .54(p1)

An ICAP report on estimating
costs associated with alcohol
consumption remarks that ‘‘some
economists argue that taxes
are not the most effective way
to discourage problem drin-
king.’’55(p5) Other reports reflect
the alcohol industry’s interest in
promoting alcohol consumption.
For instance, the ICAP report on
safe drinking levels concludes by
noting that ‘‘both the UK and the
US guidelines draw attention to
the health benefits of moderate
alcohol …