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It’s time to put cancer warning labels on alcohol, experts say

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The pressure on the government to put cancer warning labels on alcohol containers is growing, as experts say the majority of Canadians don’t know the risks that come with consuming even moderate amounts.

The latest catalyst is Canada’s new Guidance on Alcohol and Health, which updates the 2011 Low Risk Drinking Guidelines. The Canadian Centre on Substance Use and Addiction (CCSA), which released its final report today, points out that no amount of alcohol is safe and that consuming any more than two drinks a week is risky.

It’s a drastic shift from previous guidance, which recommended no more than 15 drinks for men and 10 drinks for women per week to reduce long-term health risks. The CCSA says the new advice reflects thousands of studies in the last decade that link even small amounts of alcohol to several types of cancer.

The new recommendations lay out a continuum of risk. Three-to-six drinks a week increases the risk of developing certain cancers, including colorectal and breast cancer, and more than seven drinks a week also increases your risk of heart disease and stroke. The danger goes up with every additional drink.

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“The last time we did the guidelines, it was in 2011,” said Catherine Paradis, the interim associate director, research, for the CCSA, who co-chaired the scientific expert panel that came up with the new guidance. “In 10 years there’s definitely been significant improvements in our understanding of mortality and morbidity associated with alcohol use. We have a much better understanding of the link between alcohol and cancer.”

According to the report, many Canadians are already in risky drinking territory, with 17 per cent of Canadians consuming three-to-six drinks a week, while 40 per cent drink more than six drinks a week.

Paradis says the panel spent the last two years combing through nearly 6,000 peer-reviewed studies, including research that now confirms alcohol use as a risk factor for an increasing number of diseases including at least seven types of cancers.

But despite the evidence, most Canadians are unaware or overlook the risk, says Paradis, and many still believe there are health benefits to drinking, though she says the most recent studies show that’s not true.

A blonde woman in glasses and a suit jacket smiles at the camera.
Catherine Paradis, the interim associate director, research, for the CCSA, who co-chaired the scientific expert panel that came up with the new guidance on alcohol, in pictured in Ottawa in October 2022. (Ousama Farag/CBC)

‘People need to be able to count their drinks’

Based on its findings, the CCSA is now calling for health warning labels that include the cancer risk on alcohol containers, and labels that inform people of how many standard drinks are in every container.

“Standard drink labels are necessary because people need to be able to count their drinks,” said Paradis.

“Labels about the health risk will provide people with that rationale as to why they should follow the guidance.”

The CCSA’s call for health warning labels, recently echoed by the World Health Organization, is based on research led by Canada. Erin Hobin, a senior scientist with Public Health Ontario, ran one of the only real-world experiments of cancer warning labels on alcohol in Yukon in 2017. The labels were placed on alcohol containers in two government-owned liquor stores for a month.

“What we learned from that study was that the cancer warning grabbed consumer attention,” said Hobin. “They read the cancer warning very closely. They thought about that message. They talked to their neighbours and their friends about that message, so there was real deep processing of that message.”

People not only talked about the warnings, Hobin said — they drank less, too.

A woman in a dark shirt stand in a lobby, facing the camera
Erin Hobin, a senior scientist with Public Health Ontario, ran one of the only real-world experiments of cancer warning labels on alcohol in Yukon in 2017. She’s pictured in Ottawa in October 2022. (Ousama Farag/CBC)

“Exposing people to cancer warnings on alcohol containers actually is associated with a reduction, a seven per cent reduction in per capita alcohol use compared to sites that were not exposed to the alcohol warning labels,” Hobin said, adding the study found increased awareness led to more consumer support for other alcohol policies like higher pricing.

The scientists behind the Yukon cancer label study say it was cut short because the alcohol industry intervened and the Yukon government couldn’t afford a potential legal battle. CBC’s, The National reached out to the industry to ask where they stand on cancer warning labels now.

Spirits Canada, Wine Growers Canada and Beer Canada responded with statements focusing on drinking responsibly and in moderation.

Wine Growers Canada added it doesn’t believe health warning labels are “the best way to effectively educate consumers on the responsible consumption of alcohol.” But Beer Canada says it remains “open to labelling suggestions that would be demonstrably helpful to consumers… to reduce harmful drinking.”

A legal duty to inform consumers

But experts say health warning labels should already be on alcohol containers, because the industry actually has a legal duty to clearly inform consumers of any risks — especially when those risks are not well known.

“They are not just critical, they are required under the law,” said Jacob Shelley, the director of the health ethics, law and policy lab at Western University. Shelley, who has worked on alcohol policy, says the obligation for manufacturers to inform consumers of any risks associated with their products is higher when a product is ingested.

A man in a red shirt stands in front of a book shelf
Jacob Shelley, the director of the health ethics, law and policy lab at Western University, says the alcohol industry has a legal duty to clearly inform consumers of any risks. (Jacob Shelley)

“It’s very frustrating, because there is a legal responsibility that’s not very difficult, and that the courts have actually identified, that when the product is ingested or consumed, that the duty to warn is actually increased because it poses an increased risk.”

Shelley says there’s a conflict on the alcohol industry’s side, which makes billions in profits every year, to provide cancer-warning labels.

“There’s money to be made by increasing consumption,” said Shelley.

Shelley says the normalization of alcohol in society may be contributing to a lack of political will to mandate health risk labeling, but he says government action is needed.

“We have governments regulating all sorts of products to ensure they’re safe, from baby cribs to cars, right? And so the government really ought to be more involved in requiring these types of labels, and can justify that requirement by saying that this is an obligation that manufacturers already have.”

CBC’s The National reached out to Health Canada, which partly funded the CCSA’s new drinking guidance. In an email, the agency said it recognizes “alcohol use presents a significant public health and safety issue that affects individuals and communities across Canada,” adding, “we look forward to receiving the updated guidance developed by the Canadian Centre on Substance Use and Addiction and reviewing any recommendations.”

Public support may be growing. According to the Canadian Cancer Society, a survey they led in February 2022 found that eight out of 10 Canadians support adding warning labels or health messaging on alcohol containers.

 

Is your drinking risky? Why there’s a big push for warning labels

There’s overwhelming evidence that alcohol causes cancer, and yet most people are unaware of the risks that come with drinking even a small amount. CBC’s Ioanna Roumeliotis breaks down the latest information and the growing push for mandatory warning labels.

‘I just didn’t know’

As efforts to educate Canadians about the risk grow, the political pressure is heating up, too.

“The thing that stands out most to me is the amount of people who have said, you know, I just didn’t know, I didn’t know that alcohol was a Class 1 carcinogen,” said Lisa Marie Barron, a New Democrat MP from Nanaimo, B.C.

“If they don’t have that information, how can they best make the decisions that fit them? I had somebody tell me, you know what, I might second guess that second drink.”

Barron forwarded a motion in the House of Commons last June calling for a national warning label strategy. Drinking has been glamorized, she says, but her past work in addictions exposed her to how harmful the effects can be. Ottawa, not the industry, should dictate what Canadians know, Barron said.

“Right now it’s left to the industry to decide what Canadians should or shouldn’t know on the bottles,” Barron said, adding her bill could help move the labelling conversation forward. “I’m trying to turn that around and say it’s federal responsibility to ensure that Canadians have this information, and here’s one tool for us to be able to get that moving forward.”

And the pressure is heating up on another political front too. Senator Patrick Brazeau, a non-affiliated senator from Quebec, introduced a bill in the senate last fall proposing an amendment to the Food and Drug Act to require what he calls “honest labelling.”

Brazeau says his own experience with addiction was a devastating lesson.

“I know that alcohol causes a lot of hurt,” he said, “and this is just my way of trying to give back.”

A man in a blue suit with long hair pulled back is pictured standing in an office
Sen. Patrick Brazeau is pictured in Ottawa in October 2022. He introduced a bill in the senate last fall proposing an amendment to the Food and Drug Act to require what he calls ‘honest labelling.’ (Ousama Farag/CBC)

It’s up to Ottawa to lead the charge for all Canadians, Brazeau said.

“If they’re serious about following science, well here’s the science. Alcohol causes at least seven types of cancer and now it’s up to the federal government to be bold. To take a strong stance and have the moral courage to say exactly that.”

Brazeau says no matter how much opposition he faces, he’s in it for the long-haul — whether it takes months, years or even a new government.

“I know that the industry is very powerful and they have a lot of resources,” he said.

“But you know this is not a fight against the industry, it’s a fight against cancer and this is a fight that I’m willing to take on.”

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WHO decision on COVID-19 emergency won't effect Canada's response: Tam – CP24

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OTTAWA – On Monday, exactly three years from the day he declared COVID-19 to be a global public health emergency, World Health Organization director-general Tedros Adhanom Ghebreyesus will decide whether to call it off.

But declaring an end to the “public health emergency of international concern” would not mean COVID-19 is no longer a threat. It will also not do much to change Canada’s approach.

“In Canada, we’re already doing what we need to do,” chief public health officer Dr. Theresa Tam said in her most recent COVID-19 update.

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She said the WHO discussion is important but COVID-19 monitoring and public health responses are not going to end. That includes continued surveillance of cases, particularly severe illness and death, and vaccination campaigns.

The WHO’s emergency committee, which was struck in 2020 when COVID-19 first emerged as a global health threat, voted Friday on whether to maintain the formal designation of a public health emergency.

Tedros will make the final call Monday based on the advice the committee gives him.

He warned earlier this week that he remains concerned about the impact of the virus, noting there were 170,000 deaths from COVID-19 reported around the world in the last two months.

“While I will not pre-empt the advice of the emergency committee, I remain very concerned by the situation in many countries and the rising number of deaths,” he said Jan. 24.

“While we are clearly in better shape than three years ago when this pandemic first hit, the global collective response is once again under strain.”

He is worried not enough health-care workers or seniors are up to date on vaccinations, that access to antivirals is limited and that health systems around the world remain fragile following three years of pandemic strain.

In Canada, there was a noticeable rise in cases, hospitalizations and deaths over Christmas and early in January but all are trending down again. Tam said there were no surges of the virus anywhere in Canada, though the latest variant of Omicron was being watched closely.

Federal surveillance data shows more than 30 people are still dying of COVID-19 every day, and hundreds of people are still hospitalized.

The formal designation of the global public health emergency was made on Jan. 30, 2020, when 99 per cent of confirmed COVID-19 cases were still restricted to China.

The decision was made to declare an emergency because human-to-human transmission was starting to occur outside China, and the hope was that by designating an emergency it could prompt a public health response that could still limit the impact of COVID-19.

That did not happen. On March 11, 2020, Tedros declared a global pandemic, practically begging countries to do more to slow it down.

The declaration of a pandemic meant that there was exponential growth in the spread of the virus.

By WHO terminology, a “public health emergency of international concern” is the highest formal declaration and the one which triggers a legally binding response among WHO member countries, including Canada.

It is what is done when a health threat is “serious, sudden, unusual or unexpected,” when it carries global public health implications and may require “immediately international action.”

A designation prompts the WHO director-general to issue recommendations for member countries including increased surveillance to identify new cases, isolating or quarantining infected people and their close contacts, travel measures such as border testing or closures, public health communications, investments in research and collaboration on treatments and vaccinations.

Dr. Sameer Elsayed, an infectious diseases physician and the director adult infectious diseases residency training at Western University in London, Ont., said to his mind the WHO should end the global emergency designation even though the pandemic itself is not over.

“I don’t know that we should continue to call it an emergency,” he said. “I hope they say that we’re going to bring it down a notch.”

Elsayed said for vulnerable populations, including the elderly and those with compromised immune systems, COVID-19 continues to pose a serious threat, but for most people there are far bigger threats, including suicide. He said with limited health resources, COVID-19 needs to be put in its proper place alongside other health issues.

Children, in particular, said Elsayed, are much more at risk from influenza and RSV than COVID-19 in wealthy countries, and from food insecurity and the lack of access to clean water in many developing nations.

Tam said regardless of what WHO decides, Canada won’t stop monitoring the evolution of the virus that causes COVID-19, including for new variants that may require adjustments to vaccines or other treatments.

She also said we must continue to monitor the ongoing developments in long COVID.

“We mustn’t, I think, let go of the gains that we’ve had in the last several years,” she said.

“I think whatever the decision is made by the director-general of WHO, I think we just need to keep going with what we’re doing now.”

This report by The Canadian Press was first published Jan. 27, 2023.

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COVID still a concern despite drop in flu, RSV cases: expert – CTV News

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As RSV and flu cases steadily decline in Canada, the World Health Organization (WHO) is set to announce on Monday whether it still considers COVID-19 a global health emergency.

Ahead of that announcement, one of Canada’s top infectious disease specialists warns that the WHO’s consensus won’t necessarily mean the virus is behind us.

“I think it’s important to point out that this is not about … whether COVID is gone or not,” said Dr. Lisa Barrett, an assistant professor in the Department of Microbiology and Immunology as well as the Department of Medicine in the Faculty of Medicine at Dalhousie University.

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“This is a real committee-based decision at the WHO level to decide in whether this is still a public health emergency of international concern,” she told CTV News Channel Sunday.

Barrett explained that this a matter of prioritizing access to resources and research, and not to determine an end point for COVID-19.

“So what this all means is that COVID is not done,” she said. “And the way it looks in different countries is different in many situations. That’s what they’re trying to decide at this point, not whether a pandemic is done or whether COVID is going away.”

WHO director-general Tedros Adhanom Ghebreyesus will make the official call on the status of COVID-19, based on the advice of his committee. Earlier this week, he warned that he remains concerned about the impact of the virus and mentioned that there were 170,000 COVID-related deaths reported around the world in the last two months.

The WHO update comes at a time when concerns over a combination of respiratory illnesses are easing. Canadian data shows that influenza hospitalizations are now dropping.

“We’re starting to see influenza, perhaps RSV, starting to come down somewhat,” Barrett said.

“There’s still a lot of debate about whether we’re catching many cases that are not important. But really, I think the big [question] from the last year as we start to see influenza and RSV maybe go down is, what’s the best way forward?”

Barrett noted that the FDA recommended a change to booster shot roll outs.

“They’re suggesting a once-a-year, similar to a flu shot. I think that’s the right approach at this point,” she said.

“I think the first thing we should remind Canadians is that if they are due for an additional dose in the vulnerable populations — older folks, people who have bad immune systems — please don’t think it’s too early to go out and get that last dose from the fall if you haven’t.”

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Where did B.C.’s beloved Nanaimo Bar come from?

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The Nanaimo bar. It’s a sweet treat made from chocolate, custard, coconut and walnuts. Love it or hate it, it’s uniquely British Columbian.

But where did this chocolatey delicacy come from?

To celebrate the launch of CBC’s new permanent Nanaimo bureauNorth by Northwest host Margaret Gallagher spoke to food historian Lenore Newman about the origins of the treat that shares the city’s name.

Newman says it can be traced back to three women in Nanaimo after the Second World War.

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Originally — and uncreatively — called chocolate slices, Newman says the “dainties” popped up around 1952, in, no surprise here, Nanaimo. The base layer, made of graham wafer crumbs, shows up earlier, but the square as we know it with the thick custard middle and chocolate on top appeared in a local hospital auxiliary cookbook in the early ’50s, Newman said.

 

A B.C. baker’s “ultimate” Nanaimo bars

 

CBC’s Midday talks to a woman who extended her recipe into a business selling aprons and tea towels in 1987.

It was first deemed the Nanaimo bar by Vancouver Sun columnist Edith Adams in 1953 when she wrote that the dessert came from Nanaimo.

This is important to note, Newman says, because other places such as Mississauga and England have tried to claim it as their own.

The bar was later featured in the Expo ’86 cookbook, giving it a little more notoriety.

“I think if it had been called the chocolate slice, it would have faded into the past, but the fact that it was called the Nanaimo bar kept it rolling forward,” Newman said.

 

A modern interpretation of Nanaimo Bar loved around the world

 

Samuel Hartono of Northern Bars shows the unique shippable design

The Nanaimo bar’s fame has been far-reaching; when Harry and Megan visited B.C. in 2020, their interest in the treats caused a media frenzy in the U.K. and the U.S., prompting questions of what the square was and where it came from.

The Daily Mail even printed a headline titled: Were Harry and Meghan Markle lured to Canada by chocolate treats?

And in 2021, British Columbians were nonplussed when the New York Times published a recipe and photo of a Nanaimo bar that was, quite frankly, all wrong.

That wasn’t the first time people were offended over Nanaimo bars. In 2019, a Canada Post stamp featuring the dessert showed far too much of the middle layer, prompting outrage from Nanaimo bar enthusiasts.

Famous, infamous

Any self-respecting British Columbian can confirm that these layers are just plain wrong. (Canada Post)

“I like to say it’s like the Kardashian of Canadian desserts in that it’s famous for being famous and sometimes infamous, and it’s amazing how much play it gets,” Newman said.

So, how do you make the perfect Nanaimo bar? Here’s a recipe from The Great Canadian Baking Show.

Ingredients

For the crust:

  • 1 cup graham wafer crumbs.
  • 3/4 cup unsweetened flaked coconut.
  • 1/2 cup finely chopped walnuts.
  • 1/3 cup cocoa.
  • 1/4 cup sugar.
  • 1/4 tsp salt.
  • 1/3 cup unsalted butter, melted.
  • 1 egg, beaten.
  • 1/2 tsp vanilla.

For the middle layer:

  • 1/3 cup unsalted butter, softened.
  • 2 tbsp custard powder.
  • 2 tbsp milk.
  • 1/2 tsp vanilla.
  • 1/8 tsp salt.
  • 2 cups icing sugar.

For the glaze:

  • 110 g semi-sweet chocolate, roughly chopped (about 3/4 cup).
  • 2 tbsp unsalted butter.

Instructions

Heat oven to 350°F. Line an eight-inch pan with parchment paper, with ends extending over the sides of the pan. Set aside.

Stir together graham crumbs, coconut, walnuts, cocoa, sugar and salt. Add butter, egg and vanilla, stirring to combine.  Press firmly into the prepared pan.

Bake until firm, about 10-12 minutes. Set aside to cool.

Meanwhile, prepare the middle layer. Mix butter and custard powder in a large bowl with a hand mixer. Add milk, vanilla and salt and mix to incorporate. Add icing sugar in two additions. Mix until light and fluffy. Spread over the bottom layer. Refrigerate for one hour.

While the crust and middle layer are in the refrigerator, stir chocolate and butter together in a medium heatproof bowl over a pot of simmering water until melted.

Spread chocolate glaze over the middle layer. Chill for 30 minutes. Remove from the pan with parchment edges and cut into 25 squares.

Store in an airtight container in the fridge.

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