Dr David Robert Grimes Profile picture
Sep 26, 2018 13 tweets 4 min read Twitter logo Read on Twitter
As a cancer researcher & science communicator, I have very mixed feelings on proposed #alcohol cancer labelling for drinks. I'll try here to elucidate why, and you can tell me whether you agree or not (1/n)
...so firstly, is alcohol a carcinogen? Almost undoubtedly, yes. IARC grade it a class 1 carcinogen, alongside asbestos, ionizing radiation, & smoking. We even know some mechanisms of damage. So labels should be a no-brainer, right? (2/n)
...well not quite. The real question isn't just whether something causes cancer (oxygen, processed meat, and sunlight are also Class 1 carcinogens for example) but how much it increases our risk of getting cancer. We need both bits of information to make a call (3/n)
...to understand that, we need to delve into the realm of risk. So a more pertinent question is "how much does drinking raise your cancer risk?" - and the answer to that is all to do with dose. Indeed, we see clear elevation in head & neck cancers in severe alcoholics (4/n)
...but the actual absolute risk increase for cancer due to alcohol is not especially high. There's a nice NYT article on it here, with this example for breast cancer risk.. (5/n) nytimes.com/2017/11/10/ups…
..on top of this is the thorny issue of co-morbidity; there is good evidence that smoking ALONGSIDE drinking does far more damage than drinking alone. So there is likely differences between drinking smokers & non-smokers hard to tease out of epidemiology (6/n)
.. so if available evidence suggests a clear link between alcohol & cancer, why then do I have mixed feelings on labels? Firstly because the absolute risk increase is small; it's not like smoking or sunbathing, where risk increases are massive. Will a warning confuse? (7/n)
..I would worry it would. IARC classifications already widely misunderstood; remember the furore over meat in 2015? Headlines like this stinker from Guardian were common. Just because two things can cause cancer doesn't make them equal risks (8/n)...
...yet that is precisely what is often taken from that. I know I've ranted on this before, & @edyong209 has this great piece on why IARC so frequently misunderstood. Re: alcohol cancer warnings, the pertinent question is how will these be understood (9/n) theatlantic.com/health/archive…
..and my concern is that without the appropriate context, they will be completely misinterpreted & cause more undue concern & public confusion than is appropriate. I would hope @SimonHarrisTD would consult w/ experts in public understanding of science to avoid this (10/n)
..to conclude, alcohol certainly ups our risk of certain cancers but it's important messaging is proportional to that risk, and not just done without due consideration of how it'll be perceived, and whether it'll help or hinder public understanding. (11/n)..
..I would hope this is kept in mind for final legislation. As this recent PLoS Medicine paper explores, the health consequences of alcohol are complex & simple messages misleading (12/12, n=12) journals.plos.org/plosmedicine/a…
Postscript: Chatting with @DrRobertOConnor & I do think it's important people know that alcohol is a carcinogen. But still in two-minds over whether this is the most pertinent thing to emphasize, given the greater psychological, physical, & social damage alcohol can do...

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More from @drg1985

Oct 9, 2018
Small thread on conspiracy theorists - it's tempting to dismiss such individuals as crackpots, but this misrepresents societal impact of what they do. Conspiracy theory is one of my research interests, so I thought it'd be useful to share some insights.. (1/n)
.. firstly, what do we mean by conspiratorial beliefs? These refer to narratives that postulate events in a given sphere are due to the machinations of some sinister cabal Stealing from one of my old papers, we might say.. (2/n)
... conspiratorial ideation is the tendancy to see conspiracies everywhere, and attribute events to conspiracy when there's no evidence to do so. Sometimes these people persist even when their assertions are readily debunked. But why? Let's explore! 3/n
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Aug 1, 2018
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..but it's EXTREMELY important to understand a screening test is NOT a diagnostic test. CC is not a diagnostic for cancer - it's a wide-net that looks for indicators in healthy people that might indicate an increased cancer risk in he future. It is *not* a cancer test. (3/n)
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Jul 27, 2018
Thread: Sweltering in this heatwave? Me too. And as this article makes clear, it's largely down to climate change. But here's how climate change 'skeptics' are going to try and play it - and how to not let them (1/n) theguardian.com/environment/20…
..the go argument of climate change 'skeptics' (more on that term later) is to argue that 'computer models' are basically toys with no predictive value, a blackbox that means nothing. They'll fixate on paragraphs like this. So why is that wrong? (2/n)
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Jan 17, 2018
Where to even start? This kind of nonsense is extremely damaging to patients with cancer & their families- and to medical professionals treating them. I'll try list the major points of contention here in a whistle-stop tour....
Firstly, medical professionals not recommending cannabis for cancer patients NOTHING to do with lack of med. knowledge - it's been studied to death (>10k studies , see my previous piece here: health.spectator.co.uk/the-rise-of-th… ) and the reality is that it has limited efficacy..
...cannabis does NOT cure cancer, and it isn't even especially effective for symptomatic relief. If it was, we'd use it. In reality, we only use it as a last resource BECAUSE it's not very effective, and can make things (such as nausea) worse for many patients. ...
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Sep 29, 2017
No, screw this - join me on a rant. The ketogenic brigade make these claims as their business model. So let's puncture it shall we?! (1/n)
..so what is the Warburg effect? The observation that cancer cells rely much more on inefficient glycolysis rather than healthy cells (2/n)
..in 1924, Warburg postulated that cancer was CAUSED by cells shifting their source of energy production from oxygen to glucose (3/n)
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