ArticleIP_2516.txt

   
   
      
         
            Temperance Kills

            First, to prevent any
misunderstanding, the warning: Alcohol, when abused, is vicious, dangerous
stuff. Each year about 100,000 Americans die alcohol-related deaths. No one
should drink and drive or drink to excess. Some people--teen-agers, people on
contraindicated medications, pregnant women, and those who have trouble
controlling their consumption--should avoid alcohol, period. And all that you
know already.

            Here is
what you may not know--or may know only fuzzily. For most people of middle age
and beyond, one drink a day helps prevent heart disease and makes you less
likely to die prematurely. After one or (for men) two drinks, bad effects swamp
the good--dosage is everything! But on average the positive cardiovascular
effect of moderate drinking is not small, and it is not in dispute.
Epidemiologists figure that if all Americans became teetotalers tomorrow, about
80,000 more people might die each year of heart disease. So there are lives on
both sides of the equation.

            
One of those lives might, just as an example,
belong to my father. He is 69, has mild hypertension (controlled with
medication) and, but for the rare social occasion, doesn't drink. He has read
some news reports suggesting moderate alcohol use may yield benefits, but his
doctor has never mentioned such benefits, and my father has never given a
thought to changing his drinking habits. And, in the standard view of public
health officialdom, that is as it should be: People should not be encouraged to
drink, even in moderation, and alcohol should not be linked with better
health.

            The trouble is that moderate
drinking is linked with better health. We don't know exactly why; some
evidence suggests alcohol--of whatever sort, by the way, not just red
wine--stimulates "good" (HDL, for high density lipoprotein) cholesterol and may
help prevent blood clotting. But we do know the effects: On average, if you're
over about 40, a drink a day will reduce your chances of heart trouble.

            "Besides
the association between smoking and lung cancer, I think this is the most
consistent association I've seen in the literature," says Eric Rimm, a Harvard
epidemiologist. Research has shown heart benefits consistently since the 1970s
with, Rimm guesses, 70 or 80 studies of 30 to 35 countries by now. Not
surprisingly, he has a drink on most days.

            
Alcohol also causes harm, of course. It can
increase chances of breast cancer, cirrhosis, accidents, and so on. Heart
disease, however, is an enormous cause of death; improve those odds, and the
net effect is significantly to the good. Last December, the New England
Journal of Medicine reported the results of the biggest and probably best
mortality study yet conducted, one that followed almost half a million people
over nine years. It found that, after netting out all causes of death, moderate
drinkers over 30 were 20 percent less likely than nondrinkers to die
prematurely.

            But
there are a lot of people like my father out there: uninformed or vaguely
informed or not thinking about it. In 1995, a free market advocacy group called
the Competitive Enterprise Institute commissioned a survey asking people
whether they believed "that scientific evidence exists showing that moderate
consumption of alcohol, approximately one or two drinks per day, may reduce the
risk of heart disease for many people." Only 42 percent of those who responded
said they did, and a majority of those believed, wrongly, that the potential
benefits come only from wine.

            
The evidence on alcohol and health is now more
than 20 years old--so why the confusion? Two groups have a stake in getting the
word out, but one of them, the alcohol industry, is effectively forbidden to do
so. Every bottle of alcohol carries a
government warning label, and the Bureau
of Alcohol, Tobacco and Firearms has never permitted ads or labels to carry any
health claims, even mild ones. (For more on rejected health claims, click here.)

            Given that the government
restricts health claims even for innocuous foods such as orange juice and eggs,
it's reasonable to decide that booze merchants are the wrong people to entrust
with public education about drinking. That leaves only one other constituency
for getting the word out: the public health community. Its approach, however,
might charitably be called cautious--or, less charitably, embarrassed
mumbling.

            For
example, the authors of the aforementioned New England Journal study
characterized their finding of a 20 percent mortality reduction as "slight."
The accompanying editorial called it "small." I phoned Michael J. Thun, one of
the study's authors and an epidemiologist with the American Cancer Society, and
asked him whether a 20 percent mortality reduction is indeed small in the world
of epidemiology. "It's a sizable benefit in terms of prolonged survival," he
said. Why not say so? "Messages about alcohol don't come out the way you say
them when they're broadcast," he replied. "There's been a very long history in
society of problems with alcohol."

            
The British health authorities, in their 1995
guidelines ("Sensible Drinking"), say that people who drink very little or not
at all and are in an age group at high risk for heart disease should "consider
the possibility that light drinking might benefit their health." But American
authorities balk even at such a modest suggestion.

            And so
the U.S. official nutritional guidelines say just this about potential
benefits: "Current evidence suggests that moderate drinking is associated with
a lower risk for coronary heart disease in some individuals." They then go on
to recite a litany of risks (for the text, click here). Similarly,
the American Heart Association's official recommendation advises, "If you
drink, do so in moderation." It goes on to say heart disease is lower in
moderate drinkers but then warns of other dangers and cautions against
"guidelines to the general public" that encourage drinking (for the full text,
click here). See for yourself, but I think the message most people
would get from both sources is "Drinking isn't all bad, but eschew it
anyway."

            
Iasked Ronald Krauss--a doctor who, as the
immediate past chairman of the American Heart Association's nutrition
committee, helped write that statement--whether it was aggressive enough. "We
don't have much leeway around that 'one or two drinks a day,' " he said, and
what isn't known is whether encouraging moderate drinking will also encourage
excessive drinking.

            The
public health people understandably dread creating more drunks, more broken
marriages, more crime, more car wrecks. "When somebody calls you up saying,
'You're putting out a message to people to drink, and my daughter just got
killed last night because of some drunk,' that's the other side of the
equation," Thun says. "There are substantial numbers of people out there who
are looking for justification to drink more than they should."

            
Areal worry. But there are lives, again, on
both sides of the equation. The question, then, is what would happen if the
public health folks ran a campaign saying, for example, "Just One Drink" or
"Drink a Little--Not a Lot." Would people's drinking habits improve, or would
we create a nation of drunks--or what? The answer is: Nobody knows. What is
surprising, given the public health community's usual eagerness to save lives,
is that no one is trying to find out. It is simply assumed that too many people
will do the wrong thing.

            "People
have a very hard time with complicated messages," says Thun. No doubt some
people do. But is it really so hard to understand that a glass a day may help
save your life if you're of middle age or beyond, but that more than that is
dangerous? Presumably an avoidable heart attack is equally tragic whether the
cause is too much alcohol or too little. To continue today's policy of
muttering and changing the subject verges perilously on saying not just that
too much alcohol is bad for you but that ignorance is good for you.

            

               ENDNOTES
            

            

               Note 1
            

            By law,
the label on alcoholic beverages reads:

            GOVERNMENT WARNING: (1)
According to the Surgeon General, women should not drink alcoholic beverages
during pregnancy because of the risk of birth defects. (2) Consumption of
alcoholic beverages impairs your ability to drive a car or operate machinery,
and may cause health problems.

            
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               Note 2
            

            The law forbids "curative
and therapeutic claims" in alcohol marketing "if such statement is untrue in
any particular or tends to create a misleading impression." In practice, the
BATF interprets this to mean that any health claim must be fully balanced and
says it "considers it extremely unlikely that such a balanced claim would fit
on a normal alcoholic beverage label." The only health statement the bureau has
said it will accept is a four page government report, complete with 34
footnotes. (You can read that report by clicking here.)

            According to documents
obtained by the Competitive Enterprise Institute in its lawsuit to have the
current policy overturned, the statements that the bureau has barred include
the following: "Several medical authorities say that a glass or two of wine
enjoyed daily is not only a pleasant experience but can be beneficial to an
adult's health." "Having reviewed modern research on the benefits of modest
wine consumption, we believe that our wine, when enjoyed with wholesome food,
will promote health and enhance the pleasure of life."

            
Currently the wine industry is pushing--so far without success--for approval of
wine labels that read "To learn the health effects of moderate wine
consumption, send for the federal government's Dietary Guidelines for
Americans"--followed by the Agriculture Department's address and Web
site.

            
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               Note 3
            

            Excerpts
from the U.S. government's current (1995) dietary guidelines (click here
for the full text) include the following:

            Current evidence
suggests that moderate drinking is associated with a lower risk for coronary
heart disease in some individuals. However, higher levels of alcohol intake
raise the risk for high blood pressure, stroke, heart disease, certain cancers,
accidents, violence, suicides, birth defects, and overall mortality (deaths).
Too much alcohol may cause cirrhosis of the liver, inflammation of the
pancreas, and damage to the brain and heart. Heavy drinkers also are at risk of
malnutrition because alcohol contains calories that may substitute for those in
more nutritious foods.

            If you drink alcoholic
beverages, do so in moderation, with meals, and when consumption does not put
you or others at risk.

            Moderation
is defined as no more than one drink per day for women and no more than two
drinks per day for men. Count as a drink--

            --12
ounces of regular beer (150 calories)

            --5 ounces
of wine (100 calories)

            --1.5 ounces of
80-proof distilled spirits (100 calories)

            
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               Note 4
            

            Here is
the American Heart Association's recommendation on alcohol:

            If you drink, do so in
moderation. The incidence of heart disease in those who consume moderate
amounts of alcohol (an average of one to two drinks per day for men and one
drink per day for women) is lower than in nondrinkers. However, with increased
intake of alcohol, there are increased public health dangers, such as
alcoholism, high blood pressure, obesity, stroke, suicide, and accidents. In
light of these and other risks, the AHA believes it is not advisable to issue
guidelines to the general public that may lead some to increase their intake of
alcohol or start drinking if they do not already do so. It is best to consult
with your doctor for advice on consuming alcohol in moderation (no more than 2
drinks per day).

            
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               If you missed your
government warning, click here. And here,
again, is additional information on the BATF's onerous restrictions on health claims, the U.S. government's current
dietary guidelines dealing with alcohol,
and the American Heart Association's
recommendation on alcohol.