America Is In Dire Need Of Drink Literacy

More on the Surgeon General's absurd recommendations for booze. Also: Is the Paper Plane the cocktail of 2025?

Can you say how many ounces this is?

It’s been five days since the U.S. Surgeon General called for warning labels on alcoholic beverages, and it still doesn’t seem any less ridiculous. I realize the drinks industry may have much bigger problems to worry about after the inauguration of the new administration on January 20th (ahem, tariffs anyone?). But this salvo from the neo-prohibitionists in the outgoing Biden administration feels like a childish, illogical, and unscientific misunderstanding of how drinking works.

Which is frankly par for the course in the ol’ US of A. Americans have always had a fraught relationship with alcohol. When it comes to drinking, we tend to think about things in black and white. Over the years, I’ve talked about a concept I’ll call “drinking literacy,” which other cultures seem to possess, but which we are sadly lacking in the U.S.

There’s a lot of talk about so-called “moderate drinking”—which is in fact defined by health advocates—but which has become increasingly difficult to navigate, and no health organization or government agency has really stepped up to help people define moderate drinking.

But before I get into all that, let me share a couple of reactions to last week’s news. Remember, the Surgeon General’s recommendation was specifically about alcohol and cancer risk. Nassim Nicolas Taleb, the essayist and mathematical statistician posted this on X (formerly Twitter) in response:

Debunking BS

Surgeon General declared ALL drinking=cancer. They can't read their own data!

Heavy drinkers, 7.2%, cause 75% of cancers.

Allora: Risk ratios are TINY for LIGHT drinkers, offset by a walk in the park listening to Rachmaninov. Cheers!

Taleb followed up with this post:

The relation between alcohol & cancer (& other ailments) is exaggerated.

~4% of cancer caused by alcohol, disproportionately from heavy drinkers, you can back-up that a light drinker has <1.02 risk factor.

[NONLINEARITY OF DOSE-RESPONSE]. Compensate by spending 3 more minutes in the gym.

Some "effects" are statistically ignorant (see graph for brain volume).

For those readers who don’t want to look at charts and graphs, here’s a salient, easy-to-understand commentary, sent via text message, from my friend Blair. We’d been discussing the Surgeon General’s announcement and he decided to read the study the decision was based on. Here was Blair’s take:

Just read that the alcohol-cancer study shows risk for women goes from 17% (less than 1 drink per week) to 22% (2 drinks per day) and increases for men 10% to 13%. Doesn’t seem a huge jump resulting from increasing your alcohol intake from <1 to 14 per week.

Blair is not a scientist. He’s just an intelligent, athletic person who eats healthy and is active and fit—and who looks at facts when assessing risks to his health. Let’s hope people like Blair are ultimately making the decisions on any alcohol warning labels.

Oh, and let’s remember a few other important numbers. According to the Surgeon General’s numbers, alcohol directly contributes to 100,000 cancer cases and 20,000 related deaths each year. That seems like a lot—though let’s remember that most of these cases involve heavy drinkers, as Taleb points out. But let’s look at an even bigger killer than cancer: heart disease, which accounts for one in every five deaths in the United States, or around 700,000 people.

There are plenty of studies—including one in December by the National Academies of Sciences, Engineering, and Medicine—suggesting that moderate drinking is linked to fewer heart attack and stroke deaths, and fewer deaths overall, compared with never drinking.

Drinking By The Numbers

Look, for more than three decades, we’ve had a well-established metric of moderate drinking in the U.S.: two standard drinks for a man and one standard drink for a woman, per day. The CDC and other health organizations also clearly define a standard drink: 5 ounces for a glass of wine at 12% abv; 12 ounces of beer at 5% abv, or 1.5 ounces of 80-proof spirits (40% abv).

The problem is, who truly consumes that? Some bars (and most book-club hosts) will pour you twice that much wine and call it a “glass.” A pint (16 ounces) of beer has become the standard pour at bars. Craft beers are generally much higher than 5 percent abv, many California red wines are over 15 percent abv, and many of the bourbons people love clock in at 100 proof or higher. How do people who actually want to manage their drinking—and manage their personal risk—compute all those numbers while sitting at a bar or wandering a liquor store?

Existing standard drink guidelines do not even begin to account for the complexity of alcohol by volume. How many craft beers do you drink that are under 5% abv? (Most IPAs are hovering around 7% these days.) How many wines—especially from California, Spain, Italy, and elsewhere—fall below 12% abv? How many cask-strength spirits that connoisseurs love fall below 80 proof? Does that cool tiki cocktail or giant margarita contain 1.5 ounces of 40% abv booze?

For years, I’ve ranted about both serving sizes and alcohol levels. In Boozehound (back in 2010!) I wrote: “We are facing an epidemic of cocktails served in inappropriately large glasses.” Years ago, a typical cocktail glass held about four or five ounces. Now, look at any drinkware retailer and you’ll be hard-pressed to find a glass under eight ounces, and most will be 10 or more. Crate and Barrel once told me that martini glasses in the 11-to-13-ounce range were their bestsellers. Wine glasses typically run 12 to 14 ounces, but some retailers’ bestsellers run more than 20 ounces—you could fit most of a bottle of your 15.5% abv California zinfandel into one glass.

Hell, speaking of a bottle of wine, how many people realize that a bottle of wine contains five standard drinks. Meaning if four men consume bottle of wine, they will all be under the recognized definition of moderate drinking.

Why do all these numbers matter? I’m glad you asked. It matters because just about every study on alcohol consumption and health risks relies on data that is…self-reported by individuals!

I certainly hope we can all see the potential flaws in studies that rely on self-reporting on people’s alcohol consumption? Setting aside that people’s memories are generally unreliable, there’s also the issue of people being reluctant to be honest because of social pressure or embarrassment. They don't want people to think they’re a drunk.

A man, for instance, could be considered a moderate drinker if he consumes three ounces of Jack Daniels per day. Which means he could consume 21 ounces, or 84% of a bottle of whiskey every week and still be considered a moderate drinker. But who would candidly admit to friends, family—or to their doctor—that they consume 84% of a bottle of whiskey every week?

So what to do? Will we ever have a study that gives clarity to the issue? Well, let’s all remember that, in 2018, the National Institutes of Health was set undergo a major research project that used a different methodology—studying 7,800 people around the world over ten years—and which was meant to prove, once and for all, that moderate alcohol consumption had health benefits.

So what happened? Well the New York Times (seemingly the favored mouthpiece of neo-prohibitionists) broke the news that much of the study’s $100 million budget came from five of the world’s largest alcoholic beverage manufacturers. Oops! After, that revelation, the NIH was forced to cancel the study.

And so we remain in our current public health purgatory over moderate drinking and its effects on health.

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Is The Paper Plane The Cocktail of 2025?

After all that health talk, I feel like I need to end this newsletter on a fun note, and with a drink. There’s been early chatter in food/drink media circles that the Paper Plane is a contender for “Cocktail of 2025.” Food52, in a post entitled “We’re Calling It: This Will Be the Cocktail of 2025” was first to the trendspotting:

2021 had the Espresso Martini. 2022, the Negroni Sbagliato. And now that 2025 is officially here, we can’t help but take our best guess at what food and drink trends are about to explode. If there’s one cocktail poised to soar in popularity this year, my crystal ball says it’s the Paper Plane.

…the Paper Plane is considered a modern classic. It’s an equal-parts riff on a bourbon sour, made with bourbon, Amaro Nonino, Aperol, and lemon juice, and already beloved by bartenders and cocktail-enthusiasts alike.

My first reaction was skepticism, but I’m seeing it on more and more menus. During the holidays, I went to a neighborhood party in the suburbs where I live—and what was the featured cocktail? The Paper Plane. So, based on limited experience to date, I’m going with Food52 on this one.

It makes sense. The Paper Plane is a riff on a Boulevardier, which is, of course, a riff on the Negroni—and people certainly love riffs on Negronis. Also, as I’ve reported on before, there’s definitely Aperol Spritz fatigue. Whatever the reason, here’s the recipe:

Paper Plane

• 1 ounce bourbon

• 1 ounce Aperol

• 1 ounce Amaro Nonino

• 1 ounce lemon juice

Combine liquid ingredients in a mixing glass. Add ice and stir vigorously, then strain into a cocktail glass. Garnish with paper airplane, or orange peel twist.

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