We Don't Believe Alcohol's Good For You!

As soon as epidemiologists started following drinkers and abstainers, they found that drinkers had less heart disease and as a result lived longer.
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My recent post on the "hidden" benefits of alcohol -- hidden, because ... well, I'll get back to that -- elicited many comments, and many negative ones (along with the stupid ones -- you know, where someone says, "Sure alcohol is good for you," and writes like he's intoxicated). Rather than answer all these comments separately and piss people off individually, I thought I could piss everybody off more efficiently with this follow-up post.

"It's Rubbish! No such thing as moderate drinking habits."
This is an American temperance comment par excellence. Temperance advocates (and they were legion) argued that moderate drinking inevitably led to alcoholism (which they called chronic drunkenness or inebriation) in the same way that Alcoholics Anonymous today says alcohol effects the minority of drinkers who are alcoholics. As for what comprises moderation, the Dietary Guidelines for Americans says one to two drinks daily (for both women and men). The New England Journal of Medicine article I discussed offers the same figure, since the death rate was the lowest at 1-2 drinks daily for older Americans. However, even those who drank four or more drinks daily in that study had the same, or lower, mortality rates as long-term abstainers.

"These reports having been driving me crazy because after working as a nurse for over twenty years I know better. I have to wonder who is on these committees who issue these statements and who they are affiliated with. We know most of the government agencies and committees are staffed with flexians from industry. I tell women to limit their drinking to three drinks a week and men five drinks. When people start doing something that is addictive everyday, they are addicted to it."
This is a very important comment. It discounts the results on the unexamined (actually, counterfactual) assumption that this body of research (which is massive) was funded by the industry. My post states that the NEJM study was conducted by the American Cancer Society. The Dietary Guidelines are a government publication produced by the Departments of Agriculture and Health and Human Services. The chair of the Guidelines alcohol subcommittee is Eric Rimm, co-director of Harvard's Health Professionals Study, which has tracked health behavior and outcomes among doctors and nurses for decades.

But what is most significant about this post is its assumption that daily drinking must be addictive -- a very American outlook. In the United States today, 50 percent of 21 year old binge drink. This is truly astounding since only 70 percent of them drink; in other words, of 21-year-olds who drink, 70 percent regularly binge drink! If we dial back to the Monitoring the Future study of high school students, many 18-year-olds disapprove of adults drinking one to two drinks daily (the style that prolongs life) but not of having five or more drinks at one sitting on weekends -- the kind of drinking that leads to accidents and high death rates. So, in her labeling daily drinking addictive, this health professional commenter contributes to a binge mentality associated with higher drinking mortality.

"There are a lot of studies showing health benefits from moderate drinking. But recall there were many "studies" showing smoking to be beneficial back in the 50's and 60's. Tobacco companies had a lot to do with such studies and their results."
It is worth getting into the thinking behind this comment. The writer puts alcohol and cigarettes in the same category, which is warranted inasmuch as they are both commercially sold drug products capable of producing addiction. Moreover, growing up in America, many are tempted to think of them as equivalent items on some kind of morals scale -- i.e., a person who doesn't drink or smoke is better in some sense than one who does only one, or certainly both.

But the comment is wildly out of touch with the actual universe. The reason we know this? Because, at its base, epidemiological research is counting up outcomes for people who behave one way or another. As soon as researchers began tracking smokers and comparing them with nonsmokers, they found smokers got cancer AND heart disease more frequently and died earlier.*

What about drinkers? As soon as epidemiologists started following drinkers and abstainers, they found that drinkers had less heart disease and as a result lived longer. How do I know this? Because the Framingham Heart Study -- the first such community study of heart disease -- found this result in the early 1970s. But here's what is crucial to know. In 1974, Harvard investigator Carl Selzer noted this result -- but the National Institutes of Health, which funded the study, refused to allow Selzer to publish it (as he revealed belatedly, in 1997).

Why did this occur? Because the United States has a strong anti-alcohol bias -- like these commenters and much of the public health establishment. Drinking is bad, and they will never believe otherwise.

In regards to Framingham, let's dial forward some 30 years. In 2007, PBS produced a two-hour special, "The Hidden Epidemic: Heart Disease in America," devoted to the risk factors for heart disease discovered in the Framingham study. That abstinence from alcohol is among the major risk factors for heart disease seemingly could not be discussed. An excellent panel of five experts led by Larry King dealt with diet, sex, exercise, smoking -- just about everything that people do that impacts the health of their hearts. But alcohol was never mentioned.

Why not, do you think? Why wouldn't Larry ask the panelists about drinking and the heart, or why did none of them have the cojones to interrupt: "Larry, I really think we should discuss alcohol. Not smoking is the only behavior we have measured that reduces heart disease more -- including diet and exercise -- than does moderate drinking."

The ironic thing is that the major argument against the claim that regular drinking actually reduces heart disease and overall mortality is that drinkers may be healthier due to other factors, like higher incomes or other healthy behaviors. In the first place, research like the American Cancer Society study statistically control for extraneous lifestyle, economic, and other factors, so that social status can be eliminated as accounting for the drinking results. In addition, one Harvard Health Professionals study was limited to doctors who were all of normal weight, didn't smoke, exercised, and had good diets. In this otherwise healthy group, the same reduction in heart attacks was found among those who had one to two drinks daily.

But let's simply accept the "extraneous factors" critique at face value. What does it mean to say that moderate drinking is part of an overall healthy lifestyle that leads people to have less heart disease, live longer, and reduce their rates of dementia? It is certainly a different tune from the temperance chip so many Americans insist on replaying.

The three comments I included are all from frequent, popular commenters to a liberal Web publication whose readers one might think are more open than average Americans towards substance use. Obviously, this is not true of many HuffPost readers when it comes to alcohol. In the United States, the progressive movement was a primary impetus for Prohibition (think William Jennings Bryan), alongside the religious fundamentalism that is still so strong in our country. Together these remain powerful forces in the American outlook, which will always be uneasy with beverage alcohol, no matter what the data say.

* Of course, these assertions refer to group averages, which is why large samples must be studied. The most typical comment, both in favor of -- and opposition to -- my post, begins something like, "My grandfather..." This information is obviously important and relevant to the writer, but it is not epidemiology.

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