Despite an arsenal of drugs, many Americans are still unaware of their infections until it’s too late. A Biden initiative languishes without Congressional approval.In the 10 years since the drugmaker Gilead debuted a revolutionary treatment for hepatitis C, a wave of new therapies have been used to cure millions of people around the world of the blood-borne virus.Today, 15 countries, including Egypt, Canada and Australia, are on track to eliminate hepatitis C during this decade, according to the Center for Disease Analysis Foundation, a nonprofit. Each has pursued a dogged national screening and treatment campaign.But the arsenal of drugs, which have generated tens of billions of dollars for pharmaceutical companies, has not brought the United States any closer to eradicating the disease.Spread through the blood including IV drug use, hepatitis C causes liver inflammation, though people may not display symptoms for years. Only a fraction of Americans with the virus are aware of the infection, even as many develop the fatal disease.A course of medications lasting eight to 12 weeks is straightforward. But the most at-risk, including those who are incarcerated, uninsured or homeless, have difficulty navigating the American health system to get treatment.Of those diagnosed in the United States since 2013, just 34 percent have been cured, according to a recent analysis by the Centers for Disease Control and Prevention.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Fifteen words are roiling the global alcohol industry.Beginning in 2026, containers of beer, wine and liquor sold in Ireland will be required by law to bear a label in red capital letters with two warnings: “THERE IS A DIRECT LINK BETWEEN ALCOHOL AND FATAL CANCERS” and “DRINKING ALCOHOL CAUSES LIVER DISEASE.”The requirement, signed into law last year, is backed by decades of scientific research and goes much further than any country has thus far communicated the health risks of alcohol consumption. It has sparked fierce opposition from alcohol businesses worldwide, but it is also inspiring a push in some other countries to pursue similar measures.“It’s an important step,” said Dr. Timothy Naimi, the director of the Canadian Institute for Substance Use Research at the University of Victoria. “People who drink should have the right to know basic information about alcohol, just as they do for other food and beverage products.”In Thailand, the government is in the final stages of drafting a regulation requiring alcohol products to carry graphic images accompanied by text warnings such as “alcoholic beverages can cause cancer,” according to The Bangkok Post.A bill has been introduced in the Canadian Parliament that would require labels on all alcoholic beverages to communicate a “direct causal link between alcohol consumption and the development of fatal cancers.”Last week, the Alaska State Legislature held a committee hearing on a bill that would require businesses selling alcohol to post signs carrying a cancer warning.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Perfusion keeps a donated organ alive outside the body, giving surgeons extra time and increasing the number of transplants possible. On some level, the human liver in the operating room at Northwestern Memorial Hospital in Chicago was alive. Blood circulating through its tissues delivered oxygen and removed waste products, and the organ produced bile and proteins that are essential to the body.But the donor had died a day earlier, and the liver lay inside a boxy plastic device. The organ owed its vitality to this machine, which was preserving it for transplantation into a needy patient.“It’s a little bit science fiction,” said Dr. Daniel Borja-Cacho, a transplant surgeon at the hospital.Surgeons are experimenting with organs from genetically modified animals, hinting at a future when they could be a source for transplants. But the field is already undergoing a paradigm shift, driven by technologies in widespread use that allow clinicians to temporarily store organs outside the body.Perfusion, as its called, is changing every aspect of the organ transplant process, from the way surgeons operate, to the types of patients who can donate organs, to the outcomes for recipients.Most significantly, surgical programs that have adopted perfusion are transplanting more organs.Since 2020, Northwestern has had a 30 percent uptick in its volume of liver transplants. Nationally, the number of lung, liver and heart transplants each rose by more than 10 percent in 2023, one of the largest year-over-year increases in decades.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Single-use insulin pens changed Brian Brandell’s life.Growing up with Type 1 diabetes in the 1970s, he had to carry glass syringes and vials of insulin wherever he went. So in 1985, when Novo Nordisk debuted a disposable prefilled pen that combined several doses of medication with a syringe, Mr. Brandell readily adopted the new device.“They were a godsend,” he recalled.Brian Brandell, a biomedical engineer, is trying to do something about plastic waste from discarded single-use injector pens.Tojo Andrianarivo for The New York TimesBut more recently, he began weighing the effects of all the plastic in the pens he had thrown away over the years, and the potential harm to people and his surroundings.“I’m using this lifesaving product,” he said with frustration, “but in order for me to use it, I’ve got to be willing to damage the environment.”It’s no secret that the world has a plastic problem. The versatile, durable and cheap material is clogging the world’s oceans, leaching toxins into its biomes and contributing to climate change. Some countries have been drafting a treaty proposal that might ban select single-use products and set goals for reducing plastics production worldwide. But negotiations have snagged over opposition from the fossil fuel and chemical industries.Worldwide, the health care industry produced used more than 24 billion pounds of plastic in 2023, and is forecast to generate 38 billion pounds annually by 2028, according to BCC Research, a global market research firm.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Inhalers, EpiPens, home tests for flu or Covid, mouth guards. They accumulate in our homes, and recycling methods and advice can be tricky to pin down.Most of the plastic in your medicine cabinet is high-quality, medical grade — and devilishly difficult to safely dispose of, let alone recycle.The sorting equipment at standard recycling centers typically can’t handle small items, and wishfully including them only prolongs the sorting process that then increases the recyclers’ costs without salvaging the plastic. Some at-home medical products, like needles that have come into contact with bodily fluids, should not even be relegated to household trash.Governments and big pharmacy chains offer some guidance. For example, New York state’s Department of Environmental Conservation has a map of collection boxes for safely disposing of medications, and Walgreens and CVS Health have safe medication disposal kiosks at select locations. They also sell special containers for shipping used, discarded needles and medical waste to sites for safe disposal.But when it comes to recycling plastic devices, from asthma inhalers to insulin and allergy pens, people may find themselves ping-ponging around without a solution. Some states recommend inquiring with local pharmacies, which in turn recommend checking with municipal recycling facilities.“What we really need is an evolving, specialized recycling infrastructure alongside the big five — paper, glass, plastic, metal and cardboard,” said Mitch Ratcliffe, publisher of the website Earth911. “That conversation is really picking up steam in some particular categories, but not in medical equipment at all.”A few designers and companies are exploring alternatives that are more reusable or safer for the environment.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

JOHNSON CITY, Tenn. — On a quiet street corner, a sign marks the birthplace of a beverage behemoth: Here, in 1954, the Tri-City Beverage Corporation bottled its first case of Mountain Dew.The soda was originally uncolored and lemon-lime flavored, and its inventors used it as a mixer with bourbon. “Mountain dew” is also a nickname for moonshine, which farmers sometimes processed from leftover crops. Labels on early soda bottles promised it was “specially blended in the traditional hillbilly style.”It wasn’t until after PepsiCo bought the company in 1964 and eventually built a global youth-oriented brand, one marketed by extreme sports athletes, that the soft drink left its Appalachian roots behind.In a way, Mountain Dew came full-circle last year when PepsiCo turned the brand toward a new alcoholic beverage: Hard Mtn Dew. At a One Stop Wine and Spirits frequented by students from Eastern Tennessee State University, the new 24-ounce cans are prominently displayed. Although the brew bears little resemblance to its ancestor, its alcoholic content is “exactly what Mountain Dew is all about,” Charles Gordon Jr., owner of Tri-City Beverage, said.Hard Mtn Dew reflects a major change in the alcohol industry, which for the last century mainly produced drinks categorized as beer, wine or spirits. In recent years, those lines have blurred, and a fourth category of ready-to-drink beverages has emerged — hard seltzers and other flavored malt beverages, wine coolers and canned cocktails. Although these products differ in primary ingredients and how the alcohol is processed, all typically are flavored and packaged for casual consumption.This isn’t the first time a new type of alcoholic beverage exploded in popularity but some earlier fads were associated with single products like Zima, Smirnoff Ice or Four Loko. “It’s only really in the last three to four years that it’s become a major category,” Nadine Sarwat, a beverage analyst at Bernstein Research, said.Sales of hard seltzers and ready-to-drink canned cocktails were valued at nearly $10 billion in 2021 by the Grand View Research firm, which expects them to grow by double digits in coming years. And in a major shift, PepsiCo and Coca-Cola have debuted alcoholic products in the U.S. market. In February, Monster Beverage, a maker of energy drinks, began rolling out its first line of alcoholic drinks called The Beast Unleashed.But as alcohol-related deaths in America reach record highs, regulators and public health experts are voicing concern that the new class of drinks and the expanding industry could alter how people buy and drink alcohol. Some also expressed worry that the convenience of the new products could reverse the long-term decline in alcohol consumption by young people. And recent studies show that consuming even one alcoholic drink a day increases a person’s risk of cancer and heart disease.Coca-Cola and Monster Beverage declined repeated requests for comment, and PepsiCo referred questions about products bearing its brands to the independent companies that it had licensed to manufacture and market them.Pamela Trangenstein, a scientist with the alcohol research group at the Public Health Institute in California, recently supervised a study at college football games. She described a sea of empty White Claw hard seltzer cans covering the floor of a student section at one stadium.More on the Coronavirus PandemicLeaving Millions on the Table: Stop-and-go federal funding floods public health agencies with cash during crises but starves them of funds afterward. In Mississippi, the pandemic showed the pitfalls of that approach.New Drug’s Long Odds: A promising new treatment quashes all Covid variants, but regulatory hurdles and a lack of funding make it unlikely to reach the United States market anytime soon.Dangers Remain for Seniors: For older Americans, the Covid pandemic still poses significant threats. But they are increasingly left to protect themselves as the rest of the country abandons precautions.N.Y.C.’s Mandate: New York City will end its aggressive but contentious vaccine mandate for municipal workers, Mayor Eric Adams announced, signaling a key moment in the city’s long battle against the pandemic.“The carbonation and sugar content can make it taste like you aren’t drinking alcohol,” she said.The new product’s boozy content was “exactly what Mountain Dew is all about,” said Charles Gordon Jr., president and owner of Tri-City Beverage, which still makes Dr. Enuf soda but which sold Mountain Dew to PepsiCo in 1964.Mike Belleme for The New York TimesRecognition of Mountain Dew’s birthplace in Johnson City, Tenn.Mike Belleme for The New York TimesA tantalizing opportunityAmericans’ drinking habits have been shifting over time. The popular practice of avoiding calories and carbs has been driving down beer’s market share for years, said Bonnie Herzog, a Goldman Sachs managing director who analyzes the beverage industry. At the same time, alcohol companies are vying to win back people under 30, who are consuming less alcohol than previous generations at that age. And the coronavirus pandemic supercharged sales of portable products as consumers sought beverages they could drink at home.“Health and wellness, variety, convenience — that’s the appeal,” Ms. Herzog said.Hard Mtn Dew exemplifies these trends. It is sugar- and caffeine-free, and taps into consumers’ connection to a brand they’ve known for years. Although the new product is 5 percent alcohol by volume, a 24-ounce can contains the equivalent of two standard drinks. Fans who got an early taste seemed to like it. “I drank Hard Mountain Dew and felt like I was staring at God,” an online reviewer wrote.Major alcohol producers like Anheuser-Busch InBev and Diageo have invested heavily in this category, but the moment has also presented traditional soda makers with a tantalizing new market, Ms. Herzog said. In addition, manufacturers and distributors make a higher profit per case of alcoholic beverages than for nonalcoholic drinks, according to Kevin Asato, a beverage industry consultant.In 2018, Coca-Cola dipped a toe in the market when it introduced Lemon-Dou in Japan, the first hard drink among its brands since the 1980s. In 2020, the company paired with Molson Coors Brewing Co. to make Topo Chico Hard Seltzers. and last year, Coca-Cola entered into agreements to produce Fresca Mixed cocktails, Simply Spiked Lemonade and a canned Jack & Coke.On an earnings call on Feb. 14, James Quincey, chief executive of Coca-Cola, cited its “early alcohol experiments” like Jack & Coke, scheduled for sale in California at the end of next month, as a way for the company to be “a total beverage company — everywhere.”By licensing its soft drink brands to established alcohol makers for sale through existing distributors, Coca-Cola kept within the lanes of the regulatory firewalls that separate alcohol producers, distributors and retailers. This three-tier system has characterized the U.S. alcohol industry since the repeal of Prohibition and is intended to prevent a single company from vertically integrating and suppressing its competitors.PepsiCo, in contrast, has attached fewer of its brands to new alcoholic drinks — just Hard Mtn Dew and Lipton Hard Iced Tea, so far — but has shown greater willingness to disrupt the status quo.The company established a wholly owned subsidiary, Blue Cloud Distribution, to keep more control over sales and marketing, and a greater share of the profits. The venture involved hiring more than 250 employees, obtaining individual state licenses to distribute alcohol and a fleet of trucks.A fourth category of alcoholic beverage — seltzers, sodas and others — marks a trend that experts say may last for some time as demand continues to rise.Mike Belleme for The New York TimesAn artifact from the Mountain Dew Collection of the Reece Museum of East Tennessee State University in Johnson City. The beverage’s early marketing embraced the hillbilly image and included it in its branding.Photo illustration by Mike Belleme for The New York TimesTo comply with the three-tier system, PepsiCo licensed Mountain Dew’s brand to the Boston Beer Co. and provided it with Mountain Dew flavoring. That way, PepsiCo is independent from production and can instead control distribution.Not all states have approved of the arrangement. Last spring, regulators in Kentucky and Georgia denied Blue Cloud distributor licenses, ruling that Blue Cloud had blurred the lines between manufacturer and distributor. Indiana regulators denied Blue Cloud a comparable license last month.Jeff Birnbaum, a spokesman for Blue Cloud, pointed out that Hard Mtn Dew and Lipton Hard Iced Tea are both manufactured and marketed by separate companies, in accordance with the three-tier system.Local beer distributors have also tried to block the new competition. In October, beer wholesalers in Nevada and Virginia filed complaints with regulators asking them to revoke Blue Cloud’s licenses.And in December, independent beer distributors appealed to federal regulators, calling on the Treasury Department’s alcohol and tobacco tax bureau to investigate whether retailers were giving soft drink companies more favorable treatment of their alcoholic products. Soda companies routinely pay retailers so-called slotting fees for prominent placement of their products, but doing so for alcoholic beverages would violate the three-tier system, the distributors argued.They also provided photographs of what they called “inappropriate placement” of Hard Mtn Dew in stores, shown next to children’s juice boxes and toy cars.Mr. Birnbaum, a spokesman for Blue Cloud, said the company did not dictate to retailers how to display its drinks, but urged them to avoid confusing alcoholic and nonalcoholic products and to correct improper placement. He also noted Hard Mtn Dew was priced and packaged in line with other malt-based ready-to-drink alcohol beverages, and “boldly says on its label that it is for individuals 21 and older.”Mary Ryan, administrator of the alcohol tax and trade bureau, said her office had not received evidence of any violations. The bureau is accepting public comments until March 9 on whether it should revise regulations that assess the independence of retailers, among others.Ms. Sarwat, the beverage analyst, expressed doubt that the tactics employed by Blue Cloud and PepsiCo would lead to abandoning the three-tier regulatory system — but she didn’t dismiss their influence.“Any time Pepsi or Coke do anything, given how deep their pockets are, it is one to watch closely,” she said.The effects on healthExperts believe the new beverage types may represent an industry effort to boost drinking among young people, a group whose alcohol consumption has been falling for decadesMike Belleme for The New York TimesExcess drinking already kills more than 140,000 Americans each year, according to the latest estimates, far surpassing drug overdoses or firearm deaths.Alcohol experts take heart at the growing ranks of openly “sober-curious” young people, and beverage companies are trying to tap that group with a profusion of new nonalcoholic products, including zero-proof wines and nonalcoholic aperitivos. But some public health experts have expressed concerns that the widening variety of alcoholic drinks could reverse those trends.The long-term effects on drinking habits will not be known for years, according to Matt Rossheim, an associate professor at the University of North Texas Health Science Center. “In public health, it’s constantly this game of Whac-A-Mole, as industry is just so quick to innovate and launch things, and then it takes us years and years to figure out what happened,” he said.Of the few government surveys measuring drinking behaviors, none collect detailed data on the new alcoholic beverages, Marissa Esser, who leads the alcohol program at the Centers for Disease Control and Prevention, said.The Monitoring the Future survey, which measures substance use among eighth-, 10th- and 12th-grade U.S. students, will include questions about hard seltzers and ready-to-drink cocktails for the first time this fall.Because these types of drinks tend to be inexpensive, packaged in single-serve containers and sold in places like gas stations and convenience stores, they are likely to appeal to young people, Mr. Rossheim suggested.Industry executives acknowledged the marketing benefit that springboards off familiar brands. On an earnings call in November, Rodney Sacks, the chief executive of Monster Beverage, pointed out that the new line’s products featured “mean green,” “white haze,” “peach perfect” and “scary berries” — all “based on Monster’s well known and popular flavor profiles.”And women are a coveted consumer. Katherine Keyes, a professor of epidemiology at Columbia University, said the push into hard sodas appeared to target the female drinker, whose alcohol intake has been catching up to men’s in recent years. “A low-calorie, flavored alcohol beverage has been their tried-and-true approach to attracting a female market,” she said.Still, these options should not be marketed as healthy alternatives, experts said.“The harms from alcohol don’t mainly come from calories,” Bill Kerr, a senior scientist at the Public Health Institute’s alcohol research program, said. “They come from the alcohol.”

A recent study suggested the use of a decades-old medicine taken before imbibing could reduce the amount of alcohol consumed.Ever wake up regretting the last round of drinks from the previous night? There’s a medicine that might help.A recent study adds to the evidence that people who binge-drink may benefit from taking a dose of the medication naltrexone before consuming alcohol, a finding that may be welcomed now that alcohol-related deaths in the United States have surpassed 140,000 a year.Nearly half of American drinkers reported bingeing, defined as more than four drinks in a sitting for men and more than three for women, in the previous month, according to a U.S. government health survey.Some may view binge-drinking as harmless because the habit is widespread and a low percentage of binge drinkers are dependent on alcohol, according to experts.But it is considered a major risk factor for alcohol-related illness and injuries, and it heightens the possibility that an individual will develop an alcohol disorder.In the study, which was published in December in the American Journal of Psychiatry, 120 men who wanted to reduce bingeing but were not severely dependent on alcohol were given naltrexone to take whenever they felt a craving for alcohol or anticipated a period of heavy drinking.Naltrexone, which blocks endorphins and reduces the euphoria of intoxication, was approved in the United States for the treatment of alcohol dependence nearly 30 years ago. But it is typically prescribed for patients with more severe alcohol disorders to take daily to abstain from drinking.The new study’s targeted approach, in which patients were advised to take the pill one hour before they expected to drink, is less common, although studies going back decades have also demonstrated the effectiveness of the as-needed dosing method.The randomized control trial was double-blinded, so half of the men received naltrexone and half received a placebo, and neither the participants nor the scientists knew who had received which. Each week, participants also received counseling on how to reduce their alcohol use.By the end of the 12-week study, those given naltrexone reported bingeing less frequently and consuming less alcohol than those who had been given a placebo, a change that lasted for up to six months. The most commonly reported side effect of naltrexone was nausea, although it was generally mild and resolved itself as people adjusted to taking the drug.Glenn-Milo Santos, a professor at the University of California, San Francisco and the study’s lead author, said patients could discuss the treatment option with their clinicians, even if it was not suitable for all. “Increasing awareness that there are effective medicines that can help people with their alcohol use is important in and of itself,” he said.Taking naltrexone on an as-needed basis rather than as a daily dose may be more tolerable for some people because it allows their dopamine levels to recover in between uses. The approach could also let people feel more in control of their treatment. The practice is more widely embraced in Europe, where regulators in 2013 approved the medication nalmefene for similarly targeted dosing by people trying to drink less alcohol.Dr. Lorenzo Leggio, a physician-scientist at the National Institutes of Health, said the latest study was “very important” because, while alcohol treatments had traditionally been designed for people with severe addictions, far more people, like the study’s participants, had mild or moderate alcohol disorders.Last year, N.I.H. officials proposed rebranding these stages as “preaddiction” to underscore the need for early intervention, much as the diabetes field improved care by identifying and treating prediabetes.“If we attack the medical problem right away and early on, you cannot only treat the problem but prevent the development of the more severe forms of the disease,” Dr. Leggio said.The recent study enrolled exclusively gay and transgender men, groups in which there is a higher prevalence of binge-drinking, so the findings might not be applicable to all binge drinkers. The participants were recruited “via street outreach, recruitment fliers, sexual health clinics, needle exchanges, community organizations, bars, websites and social media,” according to the study, and additional participants in an unrelated study were also invited to join. Nearly everyone involved in the study reported having some college education and a regular health care provider.Dr. Henry Kranzler, a professor of psychiatry at the University of Pennsylvania who led earlier trials of targeted dosage of naltrexone, said the approach provided a “niche opportunity” because not all people found it easy to anticipate their cravings and to self-medicate in advance of them.“It takes a level of awareness that many people don’t have,” he said.Researchers agree that while there is no one-size-fits-all approach to treating alcohol disorders, naltrexone and other approved medications are vastly underused.Katie Witkiewitz, the director of the Center on Alcohol, Substance Use and Addictions at the University of New Mexico, said the drugs’ patents had expired, so cheap generic versions were available — but their original makers no longer advertise them.In a 2019 government health survey on alcohol and drug use, fewer than one in 10 people with an alcohol use disorder reported having received any treatment, and less than 2 percent of those individuals said they had been offered medication. Many physicians do not even know about the drugs.Ms. Witkiewitz said that two months ago she was supervising a patient she thought would benefit from naltrexone. But she said that the patient’s primary care doctor mistakenly believed that prescribing the medication required additional training in addiction medicine and refused to write a prescription.“There’s a real gap in the medical community,” she said.

A new study suggests a link between the large gatherings and a slightly higher number of transplants after traffic crashes.This summer, when half a million bikers clogged the streets of tiny Sturgis, S.D., for one of the country’s largest motorcycle rallies, there might have been a small unexpected benefit for nearby patients desperately awaiting organ transplants.Major motorcycle rallies are associated with increases in organ donors involved in motor vehicle crashes, according to a study published this week in JAMA Internal Medicine.The authors theorized this could be because of the numbers of motorcyclists attracted to the rallies, dangerously congested roads designed for far less traffic, or riskier behaviors such as riding while fatigued.Although they were careful to emphasize that policymakers should focus on reducing traffic deaths, the researchers wrote that they should also “anticipate and translate eligible deaths from these events into organ donations.”The lead author, Dr. David Cron, who is a surgery resident at Massachusetts General Hospital, said he got the idea for the study when a colleague described working at another facility near a major rally in New Hampshire. “They used to gear up for these events and increase staff in the emergency department and plan for an influx in motor vehicle-related trauma,” he recalled.Previous research has linked such rallies to increases in crashes and fatalities, but the new study found there were 21 percent more organ donors during major rallies than in the surrounding time periods, amounting to one additional donor for every two major motorcycle rallies.Dr. Cron and the article’s co-authors identified seven of the country’s largest annual motorcycle gatherings, including the one held in Sturgis, accounting for more than 100 separate rallies in a 16-year period. Then, the researchers analyzed data about organ donations and transplants from the Scientific Registry of Transplant Recipients, which divides the nation into eleven administrative regions.The researchers compared the number of people involved in motor-vehicle crashes who donated organs the week of a rally in one of those regions with the number of donors involved in crashes in four-week periods before and after the gathering.But the researchers were unable to determine whether the organ donors were people who died in motorcycle crashes or in other vehicles. Overall, motorcycle crash deaths account for a growing share of overall traffic deaths. According to the National Highway Traffic Safety Administration, there were 5,579 motorcycle fatalities in 2020, more than any previous year and nearly double the number from two decades ago.Laura Siminoff, a professor at Temple University and expert on organ donation who was not involved in the study, said it was “kind of obvious” that motorcycle rallies would be associated with greater numbers of fatal injuries. The more important implication, she said, was that hospitals and organ-procurement organizations were doing their jobs by facilitating donations from eligible patients.In the United States, motor vehicle crashes are among the most common circumstances leading to organ donations by deceased people, which can only take place under certain conditions. Deceased donors have typically suffered catastrophic brain injuries but their other organs are sufficiently healthy to transplant. About one in 30 people who die in motor vehicle crashes ultimately becomes an organ donor. (Last year, about 6,500 living people donated a kidney or part of their liver, too.)The researchers showed that the motorcycle rallies were not associated with upticks in the number of organ donors who died of strokes or drug overdoses, other circumstances that commonly allow for donations. During the weeks of the rallies, there were no observable changes in organ donation in non-neighboring regions, which made it less likely to be some unknown factor causing an increase in organ donation.Kevin Myer, president of LifeGift Organ Donation Center based in Houston, said most victims of fatal motorcycle crashes suffered significant injuries that rendered their organs unusable, which he suggested might have reduced the number of donations that otherwise would have been possible at the time of the rallies.Most states that previously required all motorcyclists to wear helmets have relaxed those laws. Of the states where the major motorcycle rallies in the study occurred, none have universal helmet laws, according to the Governor’s Highway Safety Association.“While I respect folks who love motorcycles and stuff like that, they really should wear their helmets,” Mr. Myer said.Although the apparent effect the rallies had on the number of transplants was small, there are scores of motorcycle rallies held across the county each year.Still, Dr. Cron said, “it’s just scratching the surface of the massive organ shortage.”Over 105,000 people are on the national waiting list for an organ transplant, and 17 die each day. Although over 90 percent of people have voiced support for organ donation, just half the population has registered to be an organ donor.

A C.D.C. study estimates that, over five years, one in eight deaths of people ages 20 to 64 occurred because of alcohol-related injuries or illness.An estimated one in eight deaths of Americans ages 20 to 64 in the years 2015-19 was the result of injuries or illness caused by excessive alcohol use, according to a new study from the Centers for Disease Control and Prevention.The study, published on Tuesday in the journal JAMA Network Open, assessed the effects of alcohol on people of working age, who accounted for nearly two-thirds of the country’s annual average of 140,000 alcohol-related deaths.The rates of excessive alcohol use and related deaths have most likely climbed since the period the C.D.C. researchers analyzed. After the onset of the pandemic, a variety of data showed Americans drank more frequently, and deaths due to a narrower set of causes attributable to alcohol rose 25 percent in 2020 over the previous year.Although alcohol takes a progressively heavier toll on older age groups, its effects are more noticeable in younger people who are less likely to die of other causes. Among those ages 20 to 49, one in five deaths was attributable to drinking, and for those ages 20 to 34, it was one in four, the study found.“This is really affecting adults in the prime of their life,” said Marissa Esser, who leads the C.D.C.’s alcohol program and was a co-author of the study. She said the large share of people dying in their working years meant excess drinking had an outsize effect on economic productivity.The researchers analyzed data from the nation’s vital records and identified deaths due to excessive alcohol use over the five-year period. Some causes of death, such as alcoholic liver disease, could be wholly attributable to excess drinking. For other causes of death, like cancers related to drinking or injuries where intoxication was a known risk factor, the researchers estimated the share of fatalities due to excessive alcohol use based on surveyed drinking behavior and sales in various populations. The data are only updated every few years because the calculations rely on multiple sources of data.If anything, the study underestimated the true number of deaths, Dr. Esser said, because the researchers did not include every cause of death in which alcohol played at least some role.Dr. Gordon Smith, a professor of epidemiology at the West Virginia University School of Public Health who was not involved with the study, said that even after decades of studying alcohol, he was taken aback by the sheer magnitude of its toll. “I knew it was a big problem, but I think it was important to see just how much of a problem it is,” he said.He credited the study’s authors for their methods of measuring the influence of excess drinking on various causes of death. “They’ve come up with probably the best estimates to date of the amount that alcohol contributes to these other conditions,” he said.Alcohol is a leading cause of preventable death in the United States, but it is often overshadowed by tobacco or opiates. And its effects on Americans’ health has been growing. Nearly a decade ago, a similar study found one in 10 deaths of working-age people was due to drinking, although researchers have changed the methodology, so a perfect apples-to-apples comparison is not possible.Katherine Keyes, a professor of epidemiology at Columbia University who was not involved in the latest study, said it painted a stark picture of the problem. “Where the science needs to go,” she said, “is what do we do about it?”She took a hopeful view of variations in alcohol’s effects that the study found across the states. In Mississippi, alcohol accounted for 9.3 percent of working-age deaths, whereas in New Mexico, it accounted for 21.7 percent, including one in three deaths of people ages 20 to 34, which Dr. Keyes called “horrifying.”But she said those differences were also indicative of the profound role that the surrounding environment has in any individual’s drinking habits. That suggests the most affected communities may be able to learn from others where drinking is less perilous, she said.There is ample opportunity to improve access to treatment services, experts say. Millions of Americans struggle with alcohol use disorders, but their medical providers do not typically counsel them to reduce excessive use or offer them medications that can blunt cravings.Dr. Esser said policymakers should take steps to make their communities safer. “Evidence-based strategies are out there and underused,” she said. The C.D.C.’s Community Preventive Services Task Force recommends a number of measures, including raising alcohol taxes and regulating the number and concentration of businesses that sell alcohol.Last year, Congress permanently reduced federal alcohol tax rates, and state alcohol taxes have generally not kept up with inflation. But in some hard-hit states, advocates have begun pushing back. In Oregon, there was a campaign to raise alcohol taxes, and lawmakers in New Mexico recently held hearings about doing so.

Alcohol taxes have been stagnant for years. But after the pandemic sent alcohol-related deaths soaring, activists in Oregon said higher taxes could save lives.Oregon is a drinker’s paradise. The state boasts more craft distilleries than Kentucky and is second only to California in the number of wineries. Some call Portland “beervana” for its bevy of breweries.But Oregon also has among the highest prevalence of problem drinking in the country. Last year, 2,153 residents died of causes attributed to alcohol, according to the Oregon Health Authority — more than twice the number of people killed by methamphetamines, heroin and fentanyl combined.Sonja Grove, a retiree in Portland whose adult son drank himself to death in April 2020, feels the toll is overlooked compared with those of other drugs. “Alcoholism has sort of taken a back seat.”In 2021, confronted by these conflicting trends, as the pandemic raged on, Oregon lawmakers made it easier to drink. They permanently legalized the sale of to-go cocktails, which the Distilled Spirits Council of the United States called a “lifeline,” and increased the number of cases that wineries could ship directly to consumers.Reginald Richardson, director of the state’s Alcohol and Drug Policy Commission, described the policies as incongruent. “We obviously want to create an environment that’s pro-business, that helps the state to develop, but we’ve got this other thing,” he said.That disconnect is typical: Before Covid lockdowns, no state permitted bars or restaurants to deliver liquor to customers at home, according to a trade association. Now, 28 have relaxed the rules.In contrast, policies that experts consider most effective at curbing excessive drinking have been ignored. For example, even as alcohol-related deaths soared to record highs in the last few years, alcohol taxes have fallen to the lowest rates in a generation.The Economics of AlcoholCeleste Noche for The New York TimesAmericans drank more during the pandemic, but national data on the change have only recently become available. Alcohol tax revenues collected by the U.S. Treasury Department rose by eight percent in the fiscal year that ended on Sept. 30, 2021, compared with the previous year, and remain well above pre-pandemic levels.Deaths caused by drinking also rose during the pandemic, spiking 25 percent in 2020 over the previous year. But the deaths — which have topped 140,000 nationwide — have been rising for decades in every state. Few places have seen a greater uptick than Oregon, where the rate of alcohol-induced deaths grew 2.5 times from 1999 to 2020, after adjusting for the state’s changing age distribution.Ms. Grove’s only son, Jonathon, had begun drinking excessively in college, she said, but managed to work as a pharmacy tech for years at Oregon Health Sciences University despite his worsening addiction. Cheap beer and white wine were his weaknesses. “He always thought that he wasn’t drinking hard alcohol, so he wasn’t really an alcoholic,” Ms. Grove said. He died in a cheap hotel, surrounded by empty cans and containers.Various studies in recent years have suggested that even moderate drinking poses a health risk, including to the heart. The Centers for Disease Control and Prevention recommends that men consume no more than two drinks a day and women no more than one.Dr. Eric Roth, chief of emergency medicine at Kaiser Permanente’s two hospitals in the Portland area, estimated that 10 percent to 30 percent of his patients had illnesses or injuries at least partly linked to drinking. “It’s always been a big problem,” he said, “and it’s getting to be an increasingly big problem.”To address substance abuse, Oregon has emphasized education and treatment to address substance use. A ballot measure passed in 2020 that decriminalized possession of small amounts of all drugs also diverted hundreds of millions of tax dollars from marijuana to recovery services, including for alcohol. This summer, Oregon sponsored a campaign to “Rethink the Drink.”Dr. Tim Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria, labeled educational campaigns a “fig leaf” and said that treatment, while helpful, was akin to parking an ambulance beneath a cliff rather than fencing the precipice to prevent people from falling. Measures to prevent excessive drinking are less costly and more effective, he said. “If you want to talk prevention, you’ve got to talk policies.”.The U.S. Community Preventive Services Task Force, an independent group of experts, has endorsed measures to deter excess drinking, including raising the price of alcohol. And alcohol has never been more affordable: As a share of average household income, a can of Budweiser in 2010 cost one-fifth of what it did in 1950 after adjusting for inflation, one study calculated, and the cheapest available liquor cost one-fifteenth the price.Sonja Grove’s son, Jon. Celeste Noche for The New York TimesOne way that governments can influence the price of alcohol is by taxing its producers or sellers, who pass the cost on to consumers. This is comparable to taxes on tobacco, which scores of studies show to be a powerful tool for reducing smoking. A large body of evidence shows that higher alcohol taxes are associated with less excessive drinking and lower rates of disease and injury deaths. After Illinois and Maryland raised alcohol taxes, the states reported reductions in binge drinking and car crashes involving intoxication.Alex Wagenaar, a professor emeritus at the University of Florida College of Medicine, said studies across diverse places and populations were consistent. “There’s just no question that the tax rate affects how much people drink, and the effect then ripples through to a really wide range of alcohol-related problems,” he said.But Oregon, which has no sales tax, has long curried favor with the wine and beer industries by keeping alcohol taxes low — less than 3 cents per glass of wine and not even a penny per a 12-ounce beer. For years, sporadic efforts to raise rates have sputtered.Max Williams, who as a state legislator between 1999 and 2003 pressed unsuccessfully for an increase, noted that wine taxes have not changed since 1983, nor have beer taxes since 1977. “I was a seventh grader at Cascade Junior High the last time that happened,” he said.Furthermore, leaving tax rates unchanged has the practical effect of reducing them. As in much of the country, Oregon sets alcohol taxes by the volume of the beverage rather than as a percentage of its price so when inflation pushes up prices, it effectively erodes the tax rate. Over the last 45 years, Oregon’s beer tax has lost 80 percent of its value.Christina LaRue, executive director of the Oregon Brewers Guild, acknowledged that the state’s tax rates were among the lowest in the country. But she questioned the evidence linking that fact with alcohol-related illnesses and injuries and whether local breweries were implicated.Both her parents drank heavily and died young, Ms. LaRue said, adding it made her an impassioned supporter of mental health services. She noted that her mother consumed cheap whiskey, not craft IPAs. “If a person has a drinking problem,” she said, “they’re going to find a way.”A Movement by the AfflictedCeleste Noche for The New York TimesLast year, Oregon Recovers, a nonprofit advocacy organization, renewed the push for a tax increase. Its executive director, Mike Marshall, an electoral strategist who has worked on campaigns for marriage equality and a race for governor, is 14 years sober.In contrast with Alcoholics Anonymous, which has a foundational tradition of avoiding politics, Oregon Recovers has proved an effective if polarizing force.The group approached State Representative Tawna Sanchez to sponsor the bill. Ms. Sanchez, who is Shoshone-Bannock and one of the few Native American members of the legislature, is open about her own struggle with drinking and said she was motivated in part to address addiction in her community.“The beer and wine industries have fought tooth and nail — and have won thus far — to keep their taxes from going up,” she said. “And I don’t think that’s fair to everyone else.”Mr. Marshall said the proposed increase — $0.21 on a 12-ounce beer and $0.40 on a glass of wine — was proportionate to Oregon’s alcohol problems, and the state’s Health Authority supported the bill. But the alcohol industry branded it as extreme, labeling it “a 2,700-percent increase” from the state’s rates.The bill never made it out of its first legislative committee.The Oregon Beverage Political Action Committee, which opposed the bill, has given more than $500,000 in campaign contributions to local politicians since 2020. Danelle Romain, its treasurer, said the measure’s demise was a bellwether for public support of such policies. “I don’t think Oregonians think alcohol is evil,” she said. “I just don’t think that message resonates.”Politics vs. Public HealthCeleste Noche for The New York TimesViews about alcohol policies do not necessarily cleave along familiar partisan lines. Mr. Williams was a Republican when he pushed for a tax increase, although he has since given up his party affiliation. “This is one of those issues that I think is way less politicized by party and more politicized by ideology,” he said.Since 2013, Democrats have held Oregon’s governor’s office and majorities in both legislative chambers. But the state’s prominent progressives do not connect the lax regulatory environment with alcohol’s widening harms.Last year, Senator Ron Wyden, Democrat of Oregon, and supporter of better mental health care, led successful efforts to permanently lower federal alcohol taxes. An industry group named him a “Beer Champion” of the year.Some experts say that the Biden administration has also favored alcohol producers over consumers. In February, the Treasury Department released a report on the market for beer, wine and spirits that mainly advanced recommendations for “boosting opportunity for small businesses.”David Jernigan, a professor at Boston University School of Public Health and an expert on alcohol, said the report “entirely ignored” public health in its push to reduce regulatory barriers and to foster more competition in alcohol production. “That’s all well and good for dish soap,” he said. “It has really different consequences for alcohol.”Major philanthropies have not invested significantly in initiatives aimed at reducing alcohol-related health risks and advocates are scarce. The U.S. Alcohol Policy Alliance is one of the only nonprofits focused on reducing alcohol-related harms nationwide and it is tiny. According to Nicole Holt, its chairperson, it has an annual budget of less than $50,000 and a single paid staff member. In the wake of the pandemic, the torrent of state laws deregulating alcohol sales occurred faster than the group could respond. “We have been on our heels,” she said.Efforts to raise alcohol taxes are rare. Since 2020, public health advocates in Hawaii have promoted a bill to increase rates there, but the measure did not gain traction this year. In New Mexico, where an attempt to raise alcohol taxes in 2017 failed, the issue has resurfaced.In Oregon, Mr. Marshall was not dissuaded by the long odds. “I am a gay man with a wedding band on my finger,” he said. “My life experience tells me it absolutely can happen.”Ms. Grove remains one of the group’s volunteers, although she took time off to undergo breast cancer treatment. “The chemo knocked me down, but you know, after you go through the death of a child, nothing can be as horrible as that,” she said.Ms. Sanchez, who now heads a legislative committee overseeing state budget policy, said she was not cowed either. Last year’s bill started a conversation that she feels compelled to pursue, especially because of her experience in recovery.“Should we continue to be anonymous about this?” she asked. “Should we continue to keep it all quiet? I think we need to start talking about it.”