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"The simple message that's best supported by the evidence is that, if you drink, less is better when it comes to health," concludes an AP article published and much reprinted last week. The quote is from longtime alcohol researcher-advocate Dr Tim Naimi, whose significant presence in the piece may not be coincidental. Just a few weeks prior, he was disclosed as a member of a US government-supported 6-person panel embarking on new research that purportedly will be considered for the 2025-2030 edition of the US Dietary Guidelines. Recent disclosures about the panel, including its members, quickly followed a demand for more info by a Congressional oversight committee in early April. At the top of the list of doctors on the panel is Kevin Shield, a Canadian who regularly works with the World Health Organization (WHO) and the more geographically-focused, heavily aligned Pan American Health Organization (PAHO). He's among 3 Canadians on the US-based panel, in fact, joined by Naimi as well as long-time alcohol researcher Jurgen Rehm. Also aboard is Katherine Keyes of Columbia's school of public health (and therefore a colleague of prolific advocate-writer Ted Alcorn), Priscilla Martinez of CA's Alcohol Research Group and Adam Milam of the Mayo Clinic. Taken together, the group brings years of research&mdash;and advocacy&mdash;that's heavily critical of alcohol.At the same time that his participation on the panel was disclosed, Naimi and other alcohol-focused members of the public health community rounded the final bend toward the annual Alcohol Policy (AP) meeting next week. This year, a pre-conference "advocate institute," subtitled "how to be a David against Goliath," promises a full day of seminars ahead of the usual conference's focus on "moving from evidence to action." One of the conference's co-chairs, Naimi will present to would-be advocates in a seminar titled "Translating data into a narrative: when to talk about what." It follows break-out sessions like "Big Alcohol: how do we fight back?" and "Re-educating the press." Another member of the 6-person panel, Martinez is also scheduled to speak at next week's AP conference.Dietary Guidelines: Bedrock Policy, Seeking "Transparency" Few Americans may ever read the full Dietary Guidelines, an extensive resource published jointly by the Dept of Agriculture (USDA) and the Dept of Health and Human Services (HHS) every 5 years. But it sets the baseline for US alcohol policy. A major change in the guidelines can set the stage for further change and also impact US stances in global policy debates.Hence concern among industry leaders that if "'no safe level' gets in the guidelines," it's "a game changer," as Brewers Assn president/CEO Bob Pease commented during the recent NBWA Spring Legislative Conference. Echoing comments by DISCUS's science and health veep Amanda Berger, Beer Institute president/CEO Brian Crawford noted a "complete and total lack of transparency" thus far, urging that any revision must be "based on a preponderance of science." It "cannot be cherry-picked research where there is already a built-in thesis" or be "based on ideology." Similar concerns about the process and growing anti-alcohol sentiments later appeared on stage at the Craft Brewers Conference.What's Different? Alcohol Efforts Separated; Two Panels The development of the 2020 guidance for alcohol laid the groundwork for changes this time around. Last time, it was still led by the Dietary Guidelines Advisory Committee (DGAC), a group of scientists formed by both USDA and HHS to oversee the whole process. But scientists tapped by the 2020 DGAC researched and responded to just 1 of 8 alcohol-specific questions when initially recommending the guidelines for men be lowered from 2 to 1 drink per day. As a member of the committee, Dr Naimi voiced the loudest defense of that proposal. But it was ultimately rejected, recall.In 2022, around the same time folks at the HHS published its exhaustive list of questions for the 2025 DGAC (none reference alcohol, by the way), the department also received approval to initiate a separate study on alcohol and health, assigning it to the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD). A wide array of departments and agencies sit on ICCPUD, which was authorized in 2006 as part of the STOP Act and formally sits under the Substance use And Mental Health Services Administration (SAMHSA), part of HHS. To take up its alcohol study, ICCPUD formed a Scientific Review Panel. That's the 6-person panel above, though little was known about its makeup and activity until very recently.Meanwhile, in 2023, Congress appropriated $1.3 mil to the National Academies of Sciences, Engineering and Medicine (NASEM) to form another panel of scientists specifically tasked with answering all 8 of the previously vetted, but mostly unanswered questions. That appropriation was explicitly tied to the 2025 guidelines update. Proposed panel members were put to public comment, which recall came under fire from public health advocates late last year. That NASEM panel began meeting in January, using a protocol of open and closed meetings that mimics the usual process taken by DGAC.Congressional Pressure Produces Some Clarity "We are concerned that the process implemented by the Biden Administration for developing the Dietary Guidelines may not be fully in accordance with federal law," wrote a pair of Congress members to HHS Secretary Xavier Becerra in early April. After reminding of the regulatory authority and the 2023 appropriation to NASEM, chairs of the House Committee on Oversight and Accountability and its Subcommittee on Health Care and Financial Services, Reps James Comer and Lisa McClain, respectively, echoed industry concerns about ICCPUD's efforts."We are alarmed that HHS appears to be removing alcohol review from the DGAC and 'delegating' it to ICCPUD," they wrote. These reps feared that the ICCPUD panel's work "is duplicating&mdash;and may intend to undermine" the work of the NASEM panel. They sought not only a list of the ICCPUD panel's members, but also notes from meetings so far, documents showing how it was formed and anything "reflecting HHS and its subagencies' efforts to undermine, subvert, or displace NASEM's work." By contrast, the ICCPUD panel was subject to no such vetting, has held no public meetings and set its own protocol.Panel, Draft Protocol Revealed The very next day, the as yet unknown members of the ICCPUD scientific panel submitted their draft protocol for studying the "Health Impact of Alcohol Use in the United States" on a platform that prints in-process papers prior to peer review. That paper went live on the site 2 weeks later, by which time ICCPUD published its own explanation of the process on its website. However, that explanation has shifted since its initial publication, including how it presents the work's relationship to the 2025 Dietary Guidelines. Once more definitive, it now claims that the ICCPUD panel's findings, "in conjunction with the NASEM study findings," will be reported to Congress in 2025 and also "provided to HHS and USDA for consideration during the development of the 2025-2030 Dietary Guidelines for Americans."The timeline laid out by ICCPUD claims that the draft protocol will be submitted for public comment in April or May. It also suggests its 2025 Report to Congress will be submitted in Dec 2025, claiming that report will aid in developing new drinking guidance. But by that point, an update to the dietary guidelines should be close to final. At the NASEM panel's first public meeting in Jan, the associate director of ICCPUD, Robert Vincent, suggested the two panels were on "parallel" timelines, despite USDA scientists requesting findings from the NASEM panel by the end of this year. Then too, at the time, Vincent also suggested that NASEM's work would feed into ICCPUD's, contrary to current descriptions of the processes.More Questions, More Pressure, More Ties to Anti-Alcohol Advocates Lots of questions about the ICCPUD panel's process and its eventual impacts remain, including when its proposed protocol will be submitted for public comment and how folks will react to it. Pressure from Congress isn't letting up either. Rep Diana Harshbarger pressed Sec Becerra again about the decision to form the ICCPUD panel during a subcommittee hearing in mid-April, using some of the same critiques as her colleagues Comer and McClain."Guidance on moderate alcohol consumption for legal drinking age adults is entirely outside the mandate of ICCPUD," which again is focused on the prevention of underage drinking, she reminded. Sec Becerra didn't know why the decision had been made to use ICCPUD funds to study adult drinking, especially moderate consumption. Calling it a "good question," he asked for time to find the answer and follow-up with her.Also in mid-April, the pre-publication of the ICCPUD panel's proposed process further revealed a clear link to anti-alcohol advocates, though not the extent to which the groups may be collaborating. "We would like to thank Dr Alicia Sparks for her contributions to the protocol and her feedback on the revised protocol," the 6 panel members wrote in their acknowledgements on the paper, suggesting close work thus far. In addition to government-linked roles as a project director for both NIAAA's Alcohol Policy Information System and the STOP Act report to Congress, Sparks is chair of the US Alcohol Policy Alliance, presenter of the annual AP conference she co-organized with Naimi.The USAPA's stances on alcohol and the industry are far from neutral. "The power of the US Alcohol Industry is unprecedented," Sparks and the USAPA wrote in an invite to an NYC fundraiser in March. "At the local, state and federal level, Big Alcohol has even more power than Big Tobacco once did," the invite continues, claiming it "will be a tough fight, but now is our moment to take action: narratives around alcohol in the press and pop culture are changing." Lately, the group has ramped up focus on claims that alcohol "plays a primary role in perpetuating gun violence, domestic violence," as the invite reads, not just disease. Such claims would traditionally play no role in the development of dietary guidelines. But the ICCPUD panel's draft protocol suggests that this time, they might. We'll explore that potential in part two.Cheers,

A Tale of Two Panels: Deep Dive into Pending Dietary Guidelines, Part 1

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