Is alcohol really 'good'?

Is alcohol really 'good'?

Scientists are still debating whether moderate drinking is as ‘healthy’ as sometimes it is projected to be.

By now, it is a familiar litany: Study after study suggests that alcohol in moderation may promote heart health and even ward off diabetes and dementia.

The evidence is so plentiful that some experts consider moderate drinking — about one drink a day for women, about two for men — a central component of a healthy lifestyle.
But what if it's all a big mistake?

For some scientists, the question will not go away. No study, these critics say, has ever proved a causal relationship between moderate drinking and lower risk of death -- only that the two often go together. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy.
"The moderate drinkers tend to do everything right — they exercise, they don't smoke, they eat right and they drink moderately," said Kaye Middleton Fillmore, a retired sociologist from the University of California, San Francisco, who has criticised the research. "It's very hard to disentangle all of that, and that's a real problem."

Some researchers say they are haunted by the mistakes made in studies about hormone replacement therapy, which was widely prescribed for years on the basis of observational studies similar to the kind done on alcohol. Questions have also been raised about the financial relationships that have sprung up between the alcoholic beverage industry and many academic centres, which have accepted industry money to pay for research, train students and promote their findings.
"The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a 'gold standard' kind of study -- the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country," said Dr. Tim Naimi, an epidemiologist with the centres for Disease Control and Prevention.

No single-bullet message
Even avid supporters of moderate drinking temper their recommendations with warnings about the dangers of alcohol, which has been tied to breast cancer and can lead to accidents even when consumed in small amounts, and is linked with liver disease, cancers, heart damage and strokes when consumed in larger amounts.

"It's very difficult to form a single-bullet message because one size doesn't fit all here, and the public health message has to be very conservative," said Dr. Arthur L. Klatsky, a cardiologist in Oakland, Calif., who wrote a landmark study in the early 1970s finding that members of the Kaiser Permanente health care plan who drank in moderation were less likely to be hospitalised for heart attacks than abstainers. (He has since received research grants financed by an alcohol industry foundation, though he notes that at least one of his studies found that alcohol increased the risk of hypertension.)

"People who would not be able to stop at one to two drinks a day shouldn't drink, and people with liver disease shouldn't drink," Klatsky said. On the other hand, "the man in his 50s or 60s who has a heart attack and decides to go clean and gives up his glass of wine at night — that person is better off being a moderate drinker."

Health organisations have phrased their recommendations gingerly. The American Heart Association says people should not start drinking to protect themselves from heart disease. The 2005 United States dietary guidelines say that "alcohol may have beneficial effects when consumed in moderation."

"With the exception of smoking and lung cancer, this is probably the most established association in the field of nutrition," said Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health.

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