Food is not medicine? Hippocrates would beg to differ.
What are we trying to learn here? What we already know, that most things are fine in moderation? You could substitute alcohol for anything in these studies and get the same result--red meat, sugar, fat, carbs, diet coke, etc. If the goal is to eliminate everything that may affect your health negatively, including getting into a car, or talking on your cell phone or even stepping outside depending on where you live, then what exactly is the point of living in the first place?
7
Culturally, we seem to have a real bias in favor of alcohol. Studies can knock salt, fat, meat, and carbs. They can demonize tobacco. They can shame couch potatoes. But suggest that drinking isn't the best thing for you, and immediately someone springs to its defense. That's quite a lobby the alcoholic beverage industry has.
1
Kingsley Amis said that no pleasure is worth giving up for an extra few years in a geriatric home in Weston-Super-Mare.
I'll drink to that.
18
On the same point as this article, a while back we were told about a study which claimed that drinking scotch had been shown to be harmful to rats.
The unanimous response: "That's not a problem for us. It's those rats who had better stop drinking scotch."
4
The American war on pot helped screw things up. You want some "relief"? And you think beer is the best solution? I know dozens of retired people who light up, forget their pain and enjoy living. The years of stupid propaganda about how they are gonna go nuts and kill people or themselves just did not take apparently. Drunk or stoned? Honestly, there is no comparison. Differences in the hangover radically different too.
1
After a stressful day to come home to a glass of red wine and some good music helps put things in perspective. It is cheaper than a therapist and (thus far) high blood pressure medication.
13
Thank you for the following:
"But when we compile observational study on top of observational study, we become more likely to achieve statistical significance without improving clinical significance. In other words, very small differences are real, but that doesn’t mean those differences are critical."
A lot of people out there discuss this, but with your audience, I would love to see a blurb about what "statistical significance" is actually useful for (i.e., not much other than a sampling problem). The word carries such loaded and unwarranted meaning, I wish more influencers would discuss why in studies like this "statistically significant" results are often meaningless.
3
I've never seen a NYT article elicit such childlike giddiness in half of the commenters and bring out the holier then thou crowd for the other half.
8
I live in a city where the drinking age is 16. Seems to work.
4
My mother drank a few glasses of rose from time to time. So did my aunt. Mom lived to 87, my aunt to 93. I am 67 now, drink regularly but not disgustingly, I still work, and have good cardio-fitness. But my knee bothers me. And I had a tumor removed from my skull (benign) some 12 years ago.
I will continue to drink. The study missed the big picture. I bet that 32 ounce sodas and boxes of donuts do as much harm.
15
@Terry McKenna. rub some 3% CBD salve on that knee and have a drink for me.
9
Alcohol is a poison. That's why it makes us feel a buzz, or drunk. It sludges up the blood flow to the brain and it interferes with sleep, among other deleterious effects. I have no desire to drink poison.
3
@Brian
Please provide the results in animal studies (in vivo) that show significant blood sludging due to levels of alcohol from moderate social drinking to back up your contention. This was an very old finding (with high blood alcohol, actually) that has not been replicated. Like many "poisons", ethanol is a double-edged sword.
5
@Brian
Every medicine is a poison. Some hundred years before when your great nation was not yet existing a medicine named paracelsus found the dosage-poison relation. Aspirin kills you same as it saves you.
2. Havin travelled to the U.S recently I need to say nearly all of your food is "poison". Saturated and hardened fats, fat-lowered milk-products(harmful as well yes!), huge dosages of carbohydrates-hugh!;
burned meat...
you never had a burger with fries and chemically fixed mayonnaise on top with glutamate soaked "vegetables"??
alcoholic drinks maybe are not your kind of poison-
think twice dani-vienna
( me biased by close to daily,expansive wineconsumption;healthy, taxpaying neurologist- hated to poison myself with cheap american food)
16
I drink 1-2 glasses of wine or scotch a day. Maybe a beer now and again. I eat pate` and sausage.
I also walk to work. I hike. I read. I travel internationally. A lot.
I enjoy my life. If I shave off 5 years, I will have enjoyed myself.
What I'm not is worried I will get Tb. from my glass.
14
Carroll doesn't mention the Mendelian randomization studies, which are free of most confounders, especially the ones that plague other observational studies. They came to the same conclusions as the meta-analysis. At a recent workshop the lead author of one study told some of us of the results, before treating us to post-workshop drinks.
1
@Michael Weissman Now I really need a drink.
4
Yeah, yeah, yeah. And cigarettes used to be advertised as 'a healthful aid to digestion.' Alcohol is a neurotoxin. Might as well order some formaldehyde on the rocks. However, like so many, I still drink - the occasional beer. I don't think my usage will cause major or even minor health damage. At the same time, I know few moderate imbibers. Alcohol is a major contributor to illness and death, accounting for thousands in DUI deaths alone. It's a real problem, regardless of which current darling of a study suggests. And it's becoming more insidious as Mommies and Wine groups pop up, along with Yoga and Beer abominations. Even Disneyland is going to start serving alcohol! I guess the happiest place on earth isn't happy enough. Alcohol may have its place, but at the moment - it dominates. To the bad.
12
I would rather have a bottle in front of me
than
have a frontal lobotomy.
20
I disagree with Dr. Carroll. Food is medicine. That is, the right food, taken at the right time, in the right amount, for the right reason will heal the body.
Americans over-consume everything. If we have a situation where drinking Americans on average drink almost 2 drinks a day, it needs to be noted that this is on top of their bad diets, adding to the present risks overweight people already incur.
9
@4 Real I thought the same: food IS medicine. a healthy diet is an aide in keeping you healthy. Anyone who ever had a cold, or vomited or had tummy upset, or a headache, would understand respectively how, chicken soup/ bouillon or ginger ale makes you quickly feel better. A headache is sometimes helped by drinking a hot caffeinated cup of coffee.
1
Best. Article. Ever.
3
@jmf
Best. Comments. Ever.
3
You have to live a little!
I remember seeing a one frame cartoon, set in a doctor’s office. The patient was an old man, shriveled up and bent over. He resembled a prune! The doctor was writing in his chart when he said to this bent over patient;
“You know the 10 extra years you were going to get by living and eating healthy! Well...these are them!!!”
I’ve adopted the philosophy that says; “It’s not the years in your life that count, but rather the life in your years!!!
20
I live in Mormon country. Drinking alcohol is a no-no. In exchange for that many Mormons abuse drugs. Mainly in Utah itself. I am not in Utah, but in Nevada. Many Mormons, get this, are also addicted to Jello. Lime flavor. Utah has the highest Lime flavor Jello sales in the U.S.
What can be made of the two facts I submitted here? And how do they relate to health issues in the state of Utah?
7
@RudiWhen I was in high school, I used to crave - crave crave crave - Lime Kool-Aid following wrestling practice. I didn't grow up in Mormon country. But our wrestling mats were Lime green.
I don't know what to make of this either.
6
Alcohol is toxic? Don’t be such a buzzkill.
Who wants shots?!
2
@ubique me.
4
If I don't drink I could pass for normal.
3
All the words and rationalizations in the world won't fool your body.
1
Booze takes the stress away and replaces it with depression. I didn’t want to stop but when I did I stopped getting sad so much. Just like when I stopped smoking I didn’t get angry as much and blood stopped showing up in my toilet. But each individual needs to come to these conclusions on their own.
But remember this: quitting is a lot easier than they would have you believe because they don’t want to drink alone. It makes them look like they have a problem.
6
@R. Koreman I just drank a glass of an outrageous Alsacian Cremant. The vineyard are minutes from here. I'm not feeling particularly depressed and off to have a good laugh.
9
Can any research cover all the stupid decisions we make under the influence?
5
It'll get you in the end.
2
I am trying to think of something you can't have too much of. Love?
7
The NYT is just as guilty of publishing this garbage science. I am not surprised that the author neglected to mention the NYT article by Nicholas Bakalar saying that studies suggest that there is no safe amount of alcohol.
1
"... the levels that most agree are permissible."
Permissible by whom? Where does a responsible adult need to get permission in order to drink? Twitter?
7
Considering intake recommendations vary from country to country, the discussion of what defines “a drink” seems more based on American culture than health.
3
“Let food be thy medicine and medicine be thy food.” The very tenets of Hippocrates. Stating that food is not medicine in the article ignores a mountain of evidence to the contrary, based on scientific controlled group studies. Otherwise, I thought the article was interesting and somewhat thought provoking.
1
Based on nothing but observational data, most of the NYT's health writers have declared meat and animal fat anathema and forbidden their readers to eat these foods, at least in more than minute amounts, if we want to pursue good health and stay slim.
Now we're not supposed to care about alcohol causing health problems because that's "based on observational data," even though we also have direct research data and clinical data and personal experiences that say the same thing.
I need meat and animal fat for the proteins, vitamins, minerals, and omega-3s they contain. I never, ever need alcohol.
1
Sheeesh. I need a martini.
7
@JD
If it had an olive in it, it counts as a vegetable ;)
2
This is a good example of the flaws of "data mining."
There's a yawning gap between correlation and causality.
2
Thank you for this!
2
This article, like so many on the subject, fails to mention the social factor of drinking alcohol. Many families include members who are addicts for whom sobriety is an important goal. Even those close family members who do not struggle to maintain sobriety should maintain sobriety in solidarity with their loved ones to provide emotional support and a safe, drug-free environment in which to live. If a drinker finds that he or she is unwilling to do that, than the drinker should admit that they love alcohol more and assume appropriate distance for the sake of the family.
4
a couple of scotches or vodkas (2 a day)
won't kill any man. I enjoy my 2 drinks
and have no intention of depriving myself
of one of the few pleasures a late sixty
year old man can afford and savor without
either breaking the budget or feeling guilty.
contradictory studies are released every
year about eggs and exercise and even
orange juice, for goodness sake.the key
is moderation in everything, pleasure
included (and eagerly anticipated.)
26
In every news article I have seen about this study, and every comment I have read (not very many), there is a defense of light to moderate drinking, despite the fact that there is no evidence that the benefits outweigh the risks. The risks are real. They may be small, but they are probably not actually as small as Carol and others would like us to believe. People use analogies like dessert, but so far as I know, there is no study of any kind that concludes that light to moderate dessert eating is as risky as light to moderate alcohol consumption. Or, people talk about crossing the street. But that's different because you have to cross streets (and let's not forget that the act of walking is generally good for you). The bottom line is people love to drink and eat unhealthfully, and writers like Carol don't mind pandering to the masses to make a buck. Why the Times continues to rely on essays from a pediatrician who includes links to his controversial book about sinful eating in his food essays is beyond me.
12
@Dan Frazier
Dan , the great pleasures in life include good strong drink (read alcohol), great food (read rich, pleasurable), and stimulating company. I've been eating , drinking and carousing immoderately for over 50 years (I just turned 70 years of age) and it's brought me great joy and happiness and a wealth of deep and lasting relationships. Moderation in all things, Dan, including moderation.
26
The author is extremely short sided in considering just the health risks of drinking as a solitary activity. As a son of alcoholic parents, I know first hand the effects of drinking goes far beyond the risk of cancer or liver disease. My sisters and I were deeply affected by our parents decision to continue to drink. Drinking in families is not done in isolation and a drinker encourages others to drink more. Like second hand smoke, the effects of having a drink and the harm to others around them spreads as much as the smoke.
15
@John Pombrio true!
If your paper had reported on the Lancet study in the first place, perhaps it could have set a less sensationalistic tone. The main focus of the study wasn't the negligible health effects of moderate drinking; it was the damage caused by heavy drinking. A few newspapers seized on the click-baity "zero is healthiest" theme, and, once again, a conversation that should have been about policy to curb alcohol abuse became a quarrel over moderate drinking.
8
Drinking causes driving accidents. Wait. Then does drinking cause driving? Surely, it is do not drive when you drink, or drink when you drive.
3
As a sober alcoholic, I was always annoyed at being constantly reminded that just one glass of wine a day was good for the heart. I was therefore delighted by the news that my years of daily abstinence were actually more beneficial. I’ll continue to enjoy the many blessings of sobriety, this one included.
14
@Joe Stafford
I share your delight in abstinence as a sober alcoholic. The blessings of sobriety are so many, words are failing me to adequately describe. Just remembering that I am free of that daily burden now gives me a happy lift whenever I happen to think of it. If the grape is beneficial, I will take it as fresh fruit, not fermented.
3
The truth is obliterated by much data analysis. The rule - moderation in everything. Real truths -smoking and cancer and heat disease. No exercise - poor health. OvereTing - obesity. Weight and sugar - diabetes. An occasional drink / not so tragic. So many villains - eggs, butter, dairy ... Ut’s the processing and additives - not the basic foods - and wine!
2
Alcohol increases the chances of TB? Tuberculosis is a contagious disease. In areas where TB is rampant perhaps sharing a glass or being in a pub with someone who has TB may increase the chances of getting this disease but otherwise I find it bizarre that this illness was even considered, in the study unless lowered immunity is the culprit which would have to be in reasonably heavy drinkers I’m surprised drinking is not associated with ingrown toenails or hangnails.
8
Indeed, one of the merits of the study is that it aggregates data from vastly different countries and risk factors, but it is also its weakness. To name two instances, tuberculosis and traffic hazards are increased. However, if you live in a socio-economical setting where tuberculosis is not a problem, and you don't drive after consumption, the associated risk increases are negligible. Then remain, as discussed by the author, the complex question of cancer and metabolic impacts (as well as neuroprotection/neurotoxicity)
1
I have not gone into the depths of any of the studies aggregated here, but I suspect most of them base their conclusions on "statistically significant" results. That is a huge problem when dealing with large sets of data, and, in that context, means really nothing. If it is not an issue with sampling (like the original "student" of the Student's T test, then these "studies" don't mean a whole lot. Better to look at the science behind it and what chemical reactions with the body actually are. I'd refer anyone interested in the subject to economist Deirdre McCloskey's article (and voluminous other work on the subject) "The Loss Function Has Been Mislaid." She's said it too here as well:
http://www.deirdremccloskey.com/articles/stats/sig.php
Point is, statistical significance has nothing to do with substantive significance, and that is why no one really believes any of these "studies." And really never will. Unless a small sample is really your problem (which it usually is not) statistical significance tells you nothing.
3
4 in 100,000 is not a real risk. It *would* be a real risk if your sample was, say, 7 billion people studied. When the results are statistically insignificant, it is actively wrong to report them as though they were. It leads to people denying science since science "always says dumb, wrong things" when really those dumb, wrong things were never statistically significant in the first place. It leads to people ignoring studies that show real risks because "oh, well, everything is bad for you." Kudos for writing this article, but it does not go far enough. Articles with click-bait titles like "No amount of alcohol is safe" should be simply condemned as the poor journalism and the disservice to science that they are.
11
I am struck, and saddened, by the centrality of alcohol in one's enjoyment of life, as described in much of the commentary. It reminds me of compulsive or emotional eaters, or therapeutic drug users, whose afflictions generally do not receive the same level of public sympathy.
12
Good point. But it really is a cultural thing. You're not going to go to the land of the Lotus-Eaters and tell them lotus-eating is bad as their primary enjoyment. Same with alcohol in other cultures, tea and coffee in others (often the same, actually). The fact that I can't find good wine in Iran won't get me much sympathy there (though that is where it was invented according to what I've read recently) but the same comment in Napa produces the opposite effect -- meaning I'm just not trying hard enough (or at all). I dunno -- compulsive overeating was all the rage in some circles of ancient Rome.
2
I'm not a scientist or doctor but I suspect the next frontier really is people understanding their individual genetic makeup and then adjusting lifestyle, diet, drink accordingly. I'm a five foot four Caucasian man of eastern European descent. Sure, there are truisms. Too much alcohol is bad for anyone. But too much alcohol over a long period of time may impact me differently than someone else of different genetic make up and predispositions to certain illnesses. None of us currently have a real understanding of our own genetic story other than superficial characteristics. I suspect understanding our genetics on a cellular level, which seems inevitable, is going to make mysteries, such as alcohol consumption on the human body, less mysterious.
8
My grandparents pretty much does the opposite of what modern diet suggests. My grandma loves pork belly so she will eat that (full of fat) about 2, 3 times a week. She uses msg in everything. She drink a cup of water with a spoonful of sugar before she goes to sleep. She eats 5 meals a day. My grandpa drinks two class of sake everyday. However, the difference is that she cooks everything. She is always moving and cleaning. She doesn't over eat. Our meals are always including two vegetable and fruit everyday. We don't eat much snack (e.g. no chips or sugar or processed food). And of course everything back in the days is 'organic'. Both of them live to 100 years old. I really recommend everyone to read Michael Pollan's book it will change your opinion on 'nutrition suggestion'. Sorry for going off topic but its important we enjoy our life. I no longer change my life just because some study comes out.
13
I am waiting to see the study that says - "We compared health outcomes for drinkers, heavy, moderate, light - to health outcomes for non-drinkers ...but first - we made sure that none of our non-drinkers are recovering alcoholics or other people that have found it necessary to stop drinking for some kind of medical reasons. "
As a resident of the the USA - I have noticed that the people I know that do not drink -At All- fall into the general categories of: people on a medication that prohibits the use of recreational alcohol (think: several different anti-depressants) ; the previously mentioned alcoholics in recovery (who have typically messed their systems up before entering a recovery program)... and people who cheerfully describe themselves as 'religious fanatics' on the subject of alcohol. (Think: Observant Muslims, Baha'is, Mormons, and Seventh Day Adventist).
Unless the set of non-drinkers in the study consists only of life-long abstainers - the results are going to be of questionable value.
3
I gave up drinking alcohol at 60 for none of the above reasons. I did it because I think it is healthier, easier on my sleep, reduces calories, and it saves me money. I don't miss it and it doesn't bother me to be around people who do drink.
19
I am a healthy 55 year old. Two years ago I reduced my alcohol consumption from one or two glasses of beer a day to one or two a month. Reason: drinking that amount of beer was making me very sleepy, and being older, I didn’t need the calories. Without daily alcohol consumption I have a lot more energy in the evening, and I simply get more out of my free time. If I go out after work, I order coffee or sparkling water. If the people you hang out with are confident about their own alcohol consumption, they won’t worry about your sparkling water.
12
Add the people who heard, “it’s an acquired taste,” and thought there was no good reason to try to acquire a taste for something revolting.
3
So called meta-analyses combine the systematic errors of all the incorporated studies. By their very nature they have no independent control group or culling the data to remove either statistical or systematic errors.
They are not science. They are sociology. Take what you will from them with a grain of salt (but not too much; that might raise your blood pressure).
3
Many researchers think that the risk for heart disease does not go down with one or two drinks/day. The studies that concluded that lumped in alcoholics in recovery with those who never drink and - surprise - found more problems in that group. Drink as much as you want, but don't believe this nonsense about a little alcohol being good for the heart.
5
God, I've read so many studies that have reversed themselves on diet and drink that I pretty much gave up strictly following any study. Like many other behavioral patterns, moderation seems to be a reasonable choice when it comes to drinking. I don't smoke, exercise and enjoy a glass of wine most evenings. Sometimes, one glass will suffice, on occasion I'll have two glasses. After the first sip of wine I think similar thoughts: thank you God for this wine or there is a God and he loves me. At times, I do my simple wine detox and drink on alternate days. Yes, I do survive and I enjoy the diet Cranberry juice I drink in wine's stead. Sometimes I skip a few days. I must admit that after a few days without my evening glass of wine the pleasure of the first sip is that much more intense and a big smile breaks out on my face. Yes, I'm becoming a human being again.
16
@Richard
I liked your comment best and agreed wholeheartedly.
Too much of anything, even things generally regarded as healthful, like exercise and salad consumption, can be harmful if done excessively...that doesn't mean that I will irreversibly hurt myself if I work-out like a maniac for a week...I suppose the risk from drinking is higher, but you get my point... I think...anyway, who wants another Cabernet?
2
If only we could get rational analyses of studies such as this one, and written in such an approachable and understandable way, more frequently.
One thing the author emphasizes, which needs even more emphasis, is that it is utterly invalid to attempt to apply population statistics to any given individual. (Just as it is equally fallacious to generalize a single case study to a population.)
2
Know thyself. I battled severe reflux, trouble swallowing food, and narrowing of the esophagus for years and had to take daily anti-reflux medication. No doctor suggested a link to alcohol consumption. My blood pressure was always "high normal" bordering on need for medication. When I had my gall bladder removed I discovered from an ultra sound technician that my liver was enlarged. All this to say that the cumulative effects of drinking a lot when I was young and what I thought to be moderately in middle age was causing me health problems. I stopped drinking almost two years ago. Reflux issues are gone, blood pressure is normal, liver is getting a much-needed break.
15
Food is not medicine? What a thing to say! Tell it to Hipoocrates. Tell it to every single medical system the world over, except the modern western system, which has extremely high rates of chonic disease- mostly caused by it's standard vegetable-deficient diet. A statement made more ridiculous by reams of scientific data. Aye caramba.
A change in diet is proven to cure heasrt disease and diabetes just for instance. Just to keep it simple for now. Peace.
8
@bk: Food is not medicine; it's food. It's sustenance. No one is saying, including this author, that there are not differences between a healthy and unhealthy diet.
Ay, caramba indeed, but toward you, who is stretching the author's statement to an extreme only you can find.
6
Here's the timeline: Wine is bad for you. (study sponsored by the international whiskey association). Wine is good for you. (study sponsored by the international wine association). Wine is bad for you. (study sponsored by the international beer association). Wine is good for you...
10
This meta analysis couldn’t separate the effects of smoking, poverty or anything else other than gender, age and location and yet it’s given international headlines. That’s simply ridiculous.
The wide attention this “study” received is sensationalism at it’s best. Not only is such poor journalism bad for science and people’s understanding of science, it effects our politics, too. When journalists print every dumb utterance out of the mouth an imbecile, they help propagate the ideas. Please stop printing g click bait, the small amount of revenue isn’t worth the harm.
7
Wish I could give you 1000 recommends.
2
As I aged wines, whiskies other spirits became more affordable, and I expanded my consumption. My wife recently convinced me that the alcohol producers were playing us for profit, and I dropped down in consumption from the American average (2-3 drinks/day) to a couple of drinks over the weekend. I can't tell you how much better I feel.
14
Here in the UK the Medical director health was quoted as saying every woman who lifted a glass of wine to their lips should first think of the risk this is to their risk of breast cancer.
I am never smoker age 66 with no family history of breast cancer so my computed risk of breast cancer is greatly skewed towards my age. Even with adding in weight and alcohol consumption it is still no more then 3 in a hundred. If I use the questionnaire to make myself in the dangerous level of alcohol consumption the risk becomes 5 in a hundred. This can be interpreted as a nearly 100% increase in risk which sounds horrendous until you look at the level of absolute risk.
Media reporting of absolute risk is rarely if ever covered,probably because of the complexity of explaining it or more likely because it would not provide an interesting headline.
7
I'm just going to wait until the next peer-reviewed article that says drinking enhances our health.
9
If it’s just about relaxing, socializing and getting a little buzz, Cannabis in the form of edibles, drops or by vaping clearly is the healthier choice. That’s a proven, scientific fact.
5
I'm afraid Mr. Carroll is using his intellectual cunning to talk around the problem. The alcohol problem is not a statical problem, it is a scientific one. Alcohol is a poison to the human body. Period. If you want to roll the dice and see if you are number 914 or 915, sure go ahead, but why do I have to help pay for your health insurance?
3
cuz that's the way insurance works...
7
@Athos: Indeed. And I have yet to meet anyone who doesn't have one bad habit or another.
You can't lead an entirely risk free life, and the risks involved from light drinking certainly aren't worthy of even mentioning in the context of health insurance.
1
@Richard C
Just to clarify, many things are toxic to the body in large amounts (e.g., sugar (glucose) or even water!), but are not, or are even beneficial, in small or moderate amounts. To my knowledge there is no firm evidence that a limited amount of regularly consumed ethanol (alcohol) is a cellular "poison", actually. In such amounts it is readily handled by the liver and gut--i.e., metabolized by oxidizing enzymes to acetate, providing carbons for the mitochondria to make energy for cells. True, traces of an intermediate compound in the pathway (acetaldehyde) might get fixed onto cellular proteins for a time, but again this does not seem to be problematic, as it too eventually feeds into energy pathways. Chronic abusive ethanol consumption shifts into a toxic scenario however--another story.
1
I believe strongly in scence and the scientific method. Unfortunately, it is headline grabbing nonsense like this study which turns people off, even people like me. And, it is prima facie, nonsense. Alcohol has been a part of human culture since the first observation of fermentatation over 10,000 years ago. Our ancestors drank low alcohol beverages because water was dangerous.
Foolish as such “studies” and “meta research” can be, they feed public lack of faith in the scientific method.
I am sure that far more knowledgable people than I will defend this study and its results. But, when such studies violate common sense and historical reality, they undermine scientific credibilty on the ground.
In this Age of Darkness, science has been attacked by self serving and mendacious polemicists. Real science must be meticulous in the reporting to the public. Those of us who believe deeply in the scientific method need to be strong in our defense and wary of simple minded conclusiins
7
As long as the alcohol-related diseases don’t kill you before procreative age, the fact that our ancestors did it makes not a smidge of difference. It might well have killed them younger than they would have died otherwise.
1
Getting together, sharing feelings and ideas , over a glass of wine is an excellent way of communicating.
A glass of wine , beer etc might also be therapeutic in achieving relaxation after a stressful day .
Enjoying a drink is part of our social life and has been going on for centuries.
Moderation should be the rule .
Enjoy !
7
lots of us use a little heroin every day. not in excess but just to relax. i hate to think of what life would be like without my daily small shot of it. my mother used heroin everyday and lived to be 102.
ok. do these comments sound more ridiculous now?
6
@carr kleeb
Great point! Because a single glass of wine produced and bottled and regulated is the same as a dose of illegally obtained and unregulated heroin. *eyeroll*
7
@carr kleeb
May “sound” more ridiculous, but that’s due to widespread ignorance of heroin (and other drug use). More H users thannot - far more - use via the pattern u describe. And some live to 100. Believe it or not.
3
*sigh*
1
Nobody can argue that not drinking alcohol is a good thing. And, for sure, nobody can argue that drinking alcohol is a good thing. Finito.
7
@Michael No argument either way, but two observations: 1) I drank to excess for too many years, realized I couldn't handle alcohol, and it's no longer a part of my life. 2) My sister drank to excess until the day she died of cirrhosis. Talk about finito!
1
I keep wondering if the problems arise from the studies, or the reporting on the studies, or, uh, a nasty cocktail of both. Um, couldn't resist...
5
I understand why one would want to downplay the risks of alcohol consumption — and really, we all know the problems with making poor choices, not to mention driving while impaired. But the real deal is that the top 3 risk factors for cancer are smoking, alcohol consumption, and obesity. We know this. Consider yourself warned and reconsider your lifestyle choices.
5
The top risk factor for Cancer is age.
6
From Harrison's Principles of Internal Medicine 16th edition
"Drinking as few as 1.5 drinks per day increases a woman's risk of breast cancer 1.4 fold. For both genders four drinks per day increases the risk for oral and esophageal cancers approximately three fold and rectal cancers by a factor ofv1.5; seven or eight drinks per day enhances the risks of many cancers by a factor of five."
I don't drink because I do not like alcohol.
I make no statement about what others should do.
They can decide if the increased risk of cancer is worth the pleasure from alcohol.
That is their private choice.
I enjoy a good steak which can be unhealthy.
My choice.
Of course you must not drink and drive.
If you are in a traffic accident because you are impaired or drunk there should be no reduced liability.
4
Love it when someone actually looks at the quality of the science and puts that into perspective - extremely helpful!
7
Dr Carroll ==> Thank you for your careful analysis of this issue. Very few of the readers here, particularly those who read the popular health and lifestyle articles, have a deep understanding of what research papers actually mean in "real life".
And, special thanks for the bottom line:
The truth is we just don’t know.
That is the correct answer to far more questions than we are willing to admit to.
5
“sola dosis facit venenum” or “the dose makes the poison” is an adage attributed to Paracelsus, a German renaissance physician and alchemist. From Wikipedia “It means that a substance can produce the harmful effect associated with its toxic properties only if it reaches a susceptible biological system within the body in a high enough concentration”. In simpler terms, it means that even substances as innocuous and vital to life as water or oxygen in excessive amounts can kill you. And finally in this commenters my own words, all good and delightful things in moderation.
4
Lancet Remember what they said about the dangers of shots for children which they had to retract
2
It really seems that talking about drinking or not drinking is almost like talking about religion or politics. So full of tribalism. That's how the comments strike me.
12
Why do we need “better studies”? There isn’t very many people who drink too much who don’t know it. All studies will have some flaw to allow you to rationalize whatever you want to believe. We are going to continue to do what we want to do no matter what the new study says(and YOU know that to be true). As long as you aren’t driving, doesn’t matter to me what you chose to do.
6
Thank you. One of the most common intellectual mistakes, and one frequently committed by journalists, is to confuse existence of something with extent of something. This happens frequently in regard to science and quasi-science. This article clearly and succinctly shows the difference. Well done.
5
Oh please, stop saying that drinking is not bad for your health,
One out of every eight women will get breast cancer.
Alcohol is a very clear risk factor for breast cancer.
Alcohol causes cancer.
11
Increases risk, doesn’t cause
9
@Liza
Wow. I see a Nobel in your future!
6
Why is so hard for us to accept that alcohol is poison? Why do we keep insisting on moderation, when we should be discouraging young people from starting drinking? Getting sick and tired of this alcohol culture!
Another take-away that seems to be missed from the study is that two thirds of the world doesn’t drink.
23
Thank you for this article. Overreaching studies, distorted by sensational headlines and fed to an innumerate public, inevitably draw countering studies which are similarly reported and received. The public sees "scientists" who can't agree on anything, and they become cynical about expertise and easy to manipulate by... well, you know.
2
I agree with the final headline in this article, "We Need Better Studies." Far too many studies are reported in newspapers - NYT included - that are inconclusive in their findings, or are published way to early for their results to be genuinely meaningful. The public, however, assumes these studies have been replaced, reviewed, and have passed muster within the scientific community. In a way, publishing these incomplete pieces of research validates the cries of Fake News we hear about from The Great Pumpkin. In other words, they aren't doing anybody any favors. One study will say coffee is bad for you. Two weeks later another will say coffee is healthy. Breast feeding is good, breast feeding is bad. It gets rather confusing. So, please publish studies, but make sure they are juried, replicated, and properly presented. Don't go for the speed and the shock. Go for the depth and detail.
5
@Michael Kennedy
Everything is bad for you. Hasn't anyone noticed that everybody dies?
7
A professor of pediatrics that writes for The NYT and an Eco magazine! Not only is Mr. Carroll well-versed in medicine and statistics, he also has a realistic grasp of behavioral economics. Would love to see more of Mr. Carroll's take on the never-ending slew of daytime talk headlines related to health.
6
Perhaps the Donald should have a drink or two at the end of the day. It might clear up the cobwebs in his brain. Or take up marijuana to mellow out his tweets and spare us his anger and petulance.
24
@Karen K
Someone suggested, after the debacle of the Bush/Cheney administration with it's war of choice attitude, that if we are going to elect our presidents based on which one we'd rather have a beer with, we should make sure that the chosen candidate actually does drink beer. Would have worked to keep both Bush and the Great Pumpkin (thanks, Michael Kennedy) out of the White House.
4
Teetotalers, moderate drinkers, alcoholics-- one thing they all have in common is their defensiveness about how much they drink.
21
The doctor failed to mention the HUGE profits made off alcohol and the constant messages (via advertising) to drink. Our society is awash in alcohol and we, and our children, receive constant messages that drinking is a really fun activity. Alcohol producers spend billions on advertising each year and mostly targeting underage drinkers, binge drinkers, and alcoholics. A recent study by Columbia University estimated that alcohol consumption would drop by half if all people drank "in moderation" (whatever that means). The alcohol industry needs problem drinkers to make their huge profits. The World Health Organization has classified alcohol as a carcinogen. I wonder if the doctor advises people to smoke in moderation? Heck, I hear smoking really helps people lose weight!
16
Aaron's article is excellent-not so much for the denial of the benefits of meta-analysis, but for the wonderful array of opinions that Arron generated and have been shared in Comments. The scope of those factors that play a part in substance use: taste, escape, fun, making money (whether from making, selling, serving, rehabilitation, healthcare, legality, or burial) are highlighted. One of the comments really was potent-someone suggesting that the article was more about denial of a problem... I think Aaron and all his commentators have produced a very important document-let's think about why do we need to rubbish scientific observations?
2
What about all the studies how drinking red wine is good for you - good for the heart. Is that out the door now?
3
@anna anya chmielewski It's not the alcohol in the wine primarily I think responsible for the health benefits (though there was some confounding data about that too, I mean about health benefits from alcohol alone). But the compound (resveratol) in red wine that has been identified (in some studies) as being helpful against heart disease can be separated out. Alcohol by itself is a toxin. We ingest toxins all the time, and some may even give us a lot of pleasure, nothing wrong with that but we should be clear about what is what.
5
Mr Carroll's excellent article points out the usual limits of epidemiology, like residual confounding. I think we also have to consider under-reporting. I once had a GP ask me how much I drink. He turned to his resident and said you normally double that. People usually underestimate their alcohol consumption in part due to 'social desirabilty' and also because nobody really knows what a standard drink is. Both of these would be expected to overestimate the dose response between alcohol consumption and adverse health outcomes. Health authorities usually use the lower end of safety for their recommendations. For example, in pregnancy a bottle of light beer contains no more alcohol than is produced naturally in the GI tract. The slippery slope is that one drink leads to two and so forth, so it is easier to say have none. I suspect there are many children who were conceived under the influence of alcohol and spent many weeks exposed to alcohol until mom found out she was pregnant, and suffered no ill effects. Also, these reports fail to measure the social cohesion and happiness that alcohol can bring to most of the population.
I agree an RCT is needed and I would be happy to join as long as I am randomized to the moderate alcohol group.
2
@Tim 3.5 oz of still wine as a "drink" is way low. 5 or 6 is more realistic. Of course I love wine.
2
@Tim FYI, in a randomized study, you don't get to pick which group you get placed in: otherwise, it would no longer be a randomized study and all sorts of bias would results. For example, someone who drinks a lot might choose to pick the "heavy drinker" group to get free alcohol or conversely might pick the "teetotaler" group as a way to socially reinforce their attempts to quit alcohol. At the same time, it would be unethical for researchers to force someone to quit (alcohol withdrawal can lead to death) or to start consuming heavy quantities. Thus, it is highly unlikely an RCT of alcohol consumption would ever be done.
1
@TimothyCotter And a beer with only 3.5% alcohol is relatively unusual, too.
http://getdrunknotfat.com/alcohol-content-of-beer/#
1
Excellent, excellent article. I wish more in the news media would highlight the differences between statistical research resulting from studying clinical research and actual clinical research. Still, as some have essentially commented, the conclusion that a little alcohol is okay seems to be more a system of belief than an objective evaluation of fact. It is sort of like smoking cigarettes as opposed to smoking marijuana. I just don’t see how drawing the effluence of combustible material into your lungs cannot be harmful. Unless of course you have a belief system that says it’s not.
1
The risk of drinking and driving is built into American land use. There are many bars and drinking establishments which can only practically be reached by driving. These bars can tell people to designate a driver, but how many are willing to do that? And how many people come alone? If a bar is out of transit or taxi/TNC range, it’s asking for trouble. Drink Downtown!
Good article, countering our American tendency toward moral panics.
5
Thanks!
Studies that are not well thought through before they ever begin are always faulty. Simply taking the data previous faulty studies have accumulated and adding them all together will always brings about the 'answering data' the investigators were seeking to prove. In other words: If you think you have the answer all that remains is phrasing the question so that the obvious answer is the usual response.
@Susannah Allanic. This was not "a study." It was a meta-analysis of many studies, some more rigorously done than others. Looking at available data and doing a meta-analysis does not automatically "always bring ... about the 'answering data' the investigators were seeking.'" Those doing the meta-analysis are seldom the researchers involved in those earlier studies. Examining statistics of merged data for is just that. As long as everyone understands the limitations and what can be reasonably gleaned, there is no ethical or scientific problem. Problems arise when others try to squeeze more information out than is there, over-interpret the findings, or sensationalize it in a way to skew perceptions, especially in the press. No studies are perfect but more research may be helpful and a meta-analysis can give clues where to look next time. We all know a falling-down drunk when we see one and that drunkenness is harmful. Important questions are where is the line between moderate drinking and too much? How can that be measured? Who is most susceptible to alcohol related problems and when?
5
@Barbara Siegman
Duh...
The results always reflect the questions being asked and to whom, under what circumstances, have been asked.
If a compilation of studies are taken is that compilation all inclusive or focused?
Humans lie or if you would rather, they embellish. This is why we cannot and absolutely should not rely on any collection of what any groups of humans tell us regarding any question at all we might think to ask. For example: My Mother. I was present when she told the census taker that she was was 26 after she had just given my age at 16. I guarantee you she was not 10 years old when she gave birth to me. The census taker, however, wrote down 26 without hesitation.
Another incident was several years later, when I asked the admitting nurse about why she noted the patient's height at 73-inches and weight at 226 pounds? He had had bilateral above the knee amputations and was no where near 160 pounds. I walked in on another patient smoking in her armoire, and she swore up and down that she was checking for spiders.
The integrity of data collection is worthless is the survey is just a bunch of questions that interns and physical biology students are asking of patients.
Missing, drinking with someone vs. sitting on couch drinking water by yourself. Certainly socialization from drinking would increase longevity. Not to mention, meeting a life partner while drinking. How many people have met wives, husbands, girlfriends or boyfriends while drinking? All of which generally adds years to ones life.
5
One thing close readers of the New York Times can agree upon is its inclination to publish bogus studies and then contradict them with another bogus study. Remember the prostate and breast cancer recommendations from the government published in the last few years? Where articles in the Times rather intensely claimed you did not need to know if you had cancer based on their statistical study. Luckily most readers recognized this for the rubbish it was. An individual is just that an individual. The same goes for moderate drinkers. Framed by this so-called Meta Study as applied to any given individual no one has any idea what will turn out to be true. Though another commenters comparing western Europe to the middle east seems to throw this study in the garbage which is it what deserves. With the Times throwing this sort of rot around willy nilly is it any wonder people doubt science? I'm so glad we have Aaron E. Carroll to throw cold water on our modern day fabulist.
Thank you,
Mr. Carroll
@The Iconoclast. Studies often get misinterpreted and sometimes they are poorly done. That does not mean ignore everything. It means more people need to learn how to recognize what is valid and what is not. I agree, that whole "don't worry about diagnostic tests" was baloney. I am pretty sure insurance carriers were involved somehow.
3
Since one’s predilection for what might be harmful or not is subject to error therefore a person themselves cannot make an accurate assessment
My guess is if Aaron Carroll were not a drinker, this article would have a different bent. People can justify their drinking in all sorts of ways. I know I did when I was drinking. If he really admitted that alcohol is a carcinogen and toxic to our bodies this would have been written differently. I understand the fault of certain studies, however I find it shameful that a doctor is, in a sense, promoting drug use.
5
@Heather It's disturbing that you'd rather live in a world without drug use. Prohibitionist authoritarianism is a dangerous road- we will all die, no matter how healthy we attempt to be. The choice of what risks any person wishes to take upon themselves should be sacrosanct, and this doctor is recognizing that.
Life isn't all about how much we can produce, or how much social/human/financial capital we can accumulate. It's a lived experience, and humans have a right to experiment with that experience how they choose.
7
Back to basics, "Food IS medicine and Medicine IS food".
2
"For diabetes and heart disease, for instance, the risks actually go down with light or moderate drinking."
To draw a conclusion like this without looking at other variables is overly simplistic.
There are other studies, for instance, which conclude that people who enjoy one glass of wine with dinner several times a week, or even every night, tend to be people who are more highly educated, eat healthier diets, and exercise regularly. So the lessened risk of heart disease or diabetes may not be a result of the physiological effect of alcohol itself (though the relaxation it provides may contribute in disease prevention).
I'm just saying that other lifestyle choices of light to moderate drinkers need to be looked at too.
10
A reason not to drink: alcohol alters one’s conscious state. Why do it with alcohol when you can do it it by behavioral and verbal acts that are free of chemicals?
6
This statistical rehash of data that doesn’t account for this, that or the other is frankly useless. Couple that with vestiges of our prudish prohibition era morality and it’s hard to have a calm conversation about alcohol consumption.
Excessive consumption of sugar, ice cream, meat, even water can be deleterious to your health. (Water poisoning...really.) It seams the same is true for alcohol.
Duh.
1
Here’s the straight truth: Every one of us is going to die. The issue is not “if”, it is only “how”, and to a much less controllable extent, “when”. Put another way, “no one gets out of this life alive”. There was a report of one man who supposedly did so a long time ago, but that report is questionable for a lot of reasons. So, the existential question for all of us is this: how do you prefer to die? Do you prefer to die quickly and relatively painlessly, or slowly and painfully? My sense is that nearly everyone would choose “quickly and painlessly”, certainly within the culture of the United States. So, based on your desire of how you would choose to die, why would you take actions that reduce the probability that you will die the way you prefer?
In the “ecological context” of the United States at least, the most common ways to die quickly and relatively painlessly are heart attack or stroke with no intervention, accident, suicide, and certain drug overdoses. Accidents of course have a randomness to them that I think eliminates them as a selectable “how”.
So, alcohol. There is no right answer for an individual. To the extent that consuming alcoholic substances at a certain level gives you pleasure and does not decrease the probability that you will die in the way that you prefer, or perhaps even increases the probability of your death preference, then perhaps you do best by yourself by consuming it at that level. I think the same applies to many other substances.
6
@Joe Watters. I think the question is not only how one wants to die but how one wants to live.
4
@Barbara Siegman - Exactly. And I would like some wine between the cradle and the grave. I am not young and have enjoyed alcohol in moderation thus far. With the finish line in sight, I am happy to enjoy many things left to me - wine among them.
1
All these studies are indeed worthless. There are way too many variables in these types of studies to deduce any really logical conclusions. This one used old data not even designed for the purported purpose, which was probably all along to prove that alcohol is bad. The public is having these terrible studies foisted upon them in some horrible belief that these studies actually prove something. These studies need to be kept on ice until they can actually be verified in further studies that limit variability. Until then the public is not better informed at all by this nonsense, in fact it may harmed as indeed it has in past studies. No one should take any of this seriously.
2
@David Gifford Not worthless, but, like all studies, needs to be understood.
3
A serving of beer is 12 ounces of 3.5 ABV? Few beers clock in at such a low alcohol volume. Like saying a serving of soda is half a can. Yet another poor serving size guidance from "official"sources.
4
@Rachel
Quite right to scoff at 3.5 ABV.
Beers on the shelf now run the range up to 10 ABV and a few even beyond that, up to the legal limit of what may be called beer, which varies among states.
1
@Rachel
Without all the numbers I was taught that 1 shot of hard liquor, one glass of wine and one bottle or can of beer are roughly equivalent in amount of alcohol. People who drink many beers sometimes say they "only drink beer" with a straight face then consume 6 or 8 beers. Those people are kidding themselves. One beer, maybe two, is a different story.
2
In January 17, 1920 the Eighteenth Amendment of the United States Constitution effectively established the prohibition of alcoholic beverages in the United States by declaring the production, transport, and sale of alcohol illegal. However, Americans wanted to drink booze so the Twenty-first Amendment to the United States Constitution repealed the Eighteenth Amendment to the United States Constitution. The Twenty-first Amendment was ratified on December 5, 1933. It is unique among the 27 amendments of the U.S. Constitution for being the only one to repeal a prior amendment and to have been ratified by state ratifying conventions.
Supreme court legalizes recreational marijuana, and soon to follow recreational heroin and recreational cocaine.
Americans want more drugs and alcohol.
2
When my father returned from service in WWII, he went for a physical exam in connection with his new job (accountant). The doctor asked, "Do you smoke?"
Dad said, "Yes."
"Do you drink?"
Dad said, "Yes."
The doctor said, "Quit one"
Dad went home and threw away his cigarettes and happily drank his bourbon until he died, peacefully, at 86.
None of his children smoke.
We all drink...reasonably.
26
Food IS Medicine!
7
@aec, my recommendation button isn’t working for your comment, so here it is....
I bet alot of these alcohol apologists here are also ones to criticize marijuana. alcohol is poison while marijuana is medicine. give up the swill for some fine green and you'll be happier and healthier.
3
@Casey ... said the marijuana apologist.
@Casey What's an "alot"?
plus alcohol ruins the weed high!
2
I wish the NYTimes wouldn’t promote the authors book.
1
Another way to think about alcoholic beverages is that they have been on the NIH List of known carcinogens since 1999. See https://ntp.niehs.nih.gov/ntp/roc/content/listed_substances_508.pdf
So people should ask themselves: How much of a carcinogen should they allow the alcoholic beverage industry to put into their bodies?
5
I am an addictions psychiatrist. Many people don’t drink like they do in studies. According to the NIH 26% of adult drinkers in the US engaged in binge drinking monthly. About 20% of drinkers consume 90% of the alcohol in America. Choosing to drink is incredibly risky, with about 1 in 10 who start having a significant problem with alcohol at some point in their lives. No one plans to have a substance abuse disorder when they begin drinking 1-2 drinks a day, but millions worldwide suffer and die after starting out that way.
https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/al...
11
@Thomas This is the primary risk that should be concerned - approximately 1/10 people who start drinking will eventually become an addict to alcohol. For many, this is a pretty risky bet to take.
1
@RamS
Thomas actually said "having a significant problem with alcohol at some point in their lives". That's worlds away from addiction. This could be someone who starts drinking more heavily after a nasty divorce, and recovers from their use after they get distance from the event. This person would still have major problems with or without the alcohol- in fact, they may kill themselves without alternate recourse for their internal turmoil.
Have been reading these entertaining comments for a couple of days. I am finding it odd that so many commenters, both drinkers and anti-drinkers, assume that the primary goal of every drinker is to get a buzz on. I drink beer because I like the way it tastes. I like to try new beers, whether I will ever be able to drink them again, to see what they taste like. I don't particularly like feeling buzzed, and about the only time that happens is if I'm in a group "party" setting. I'm not pleased with myself when that happens, but don't beat myself up about it either. One reason I haven't become a recreational marijuana user is because the whole point of a joint or an edible is to alter mood. I'm not judging marijuana users, or those who drink to alter mood, but saying that having a beer or glass of wine because it tastes good is different. Too many commenters are missing that, thinking that all drinkers are self-medicating.
11
@Outdoor Greg
O Gang, that sound an awful lot like "I bought Playboy for the articles."
3
This article shows the clear societal prejudices FOR alcohol consumption. Sure the studies show booze is bad, but don't worry about the studies. But alcohol was classified as a Class 1 carcinogen in the 1980's, a fact that has been glossed over and/or hidden from the public for 40 years. Cannabis, however, you'll still hear is unsafe because it "hasn't been studied enough." (According to my latest discussion with my doctor.) Most drugs are viewed with suspicion and fear, but not alcohol. We decide as a society which drugs we will sell in the supermarket, (booze and cigarettes) and which we will lock people up for using. Sounds like a less-than-perfect approach to a major health issue.
14
Read about the history of the drug laws; they are pretty much all wrapped up with racism more than chemical risk to health (which is considerable with many drugs of course)...and alcohol has historically been the drug of upper class and whiter people.
This statistical study confirms the mountains of biochemical evidence that ethyl alcohol is a poison. On a cellular level there is no safe dose either. Why anyone could think there is a safe dose is rather mysterious given the molecule’s effect on living organisms. The molecular mechanisms have been worked out for the damage caused to the central nervous system, liver, heart and other muscle tissue and even the developing embryo. It would not be ethical to study whether alcohol is toxic or not anymore. The next studies should be done to try to mitigate the toxicity. I could certainly use a cure for a hangover.
6
Good essay, thanks. I'll have a small glass of good wine as a toast.
8
Aaron,
Your math is off.
In your example from the study in question you cite that out of 100,000 people who have one drink a day 918 will experience one of the 23 health problems. Then you mention 914 of non drinkers will as well. Saying that number knocks the 918 down to only 4 drinkers who got sick from drinking is false.
Those 914 people in the non drinking group don't belong to the 100,000 in the one drink a day group.
3
Thank you. But how many people are going to read the Upshot or the original study in the Lancent and truly understand the risk being presented in the study.
Most are going to read sensationalist coverage of this study.
The one area where most media really can improve is on how they cover scientific and health care studies, presenting an accurate interpretation of the findings and what they mean to an audience that is not well versed in statistics (itself a problem - stats should be taught in high school as a basic requirement of literacy).
3
I have read many of the commenters below who gave up alcohol due to a struggle with it. I commend that. However, many people engage in light drinking which causes little harm if managed right. Someone who can't drink moderately, shouldn't. If someone else can, then leave them to it! I don't know why there has to be a blanket solution to human behavior.
22
A bigger problem with this study, beyond the fact that it is observational and that it may suffer from confounding, is that it suffers from the ecological fallacy. What the entire population of a country on average does or experiences is not the same as the behavior and experience of individuals in it.
For example, in a country where some people drink a lot, some a little and some none, and there is some disease prevalence, ecological data cannot determine whether the individuals who drink a lot, a little or none are the ones with increased, or decreased risk of disease. The relationship might be different from what you might guess.
Large sample sizes - large numbers of people included in the study - do not help with that problem.
And associations, even where you do find them, do not necessarily mean causation. Considering Bradford-Hill "criteria" - they are not criteria - is not sufficient.
6
A case of "vast" conclusions based on "half-vast" data. Public health purveyors of these types of studies where results are driven by methodological weakness only make the public less likely to listen to ANY food-related health advice, even advice based on solid science. I think publishing this and then advertising the misleading main result to the exclusion of a more nuanced approach is professionally irresponsible. But, then, the Lancet has a history of publishing less-than-reputable science. E.g., they published the bogus study (1990s) connecting autism and vaccines (MMR - measles, mumps, rubella). Since then, researchers have spent thousands of hours and millions of dollars repudiating vaccine falsehoods initially promoted by a Lancet publication, so I am not overly surprised at them publishing this very poorly done study.
1
Reminds me of that scene in Sleeper where in the future the scientists laughed about how people used to think red meat and smoking were unhealthy! Just watched clip on YouTube. Even funnier is the line about buying stock in Polaroid - the Apple/Amazon of it's day.
3
Wonderful— now please take your astute observations to studies that have purported to rule out the benefits of taking vitamin supplements, but never take into account whether an individual tested as having a deficiency to begin with, the quality and dosage of the vitamin itself, an individual’s stomach acid level (for break-down/delivery of the dose) or perhaps IV supplementation to rule out digestive issues, and finally, incorporating an individual’s genome results into the equation — do they have SNPs related to the body not utilizing (for example) B12 correctly? THAT would be a vitamin study worth the paper on which it’s printed.
1
The joy that comes from sharing and enjoying a bottle of wine with family and friends cannot be overshadowed by scientific research.
Cheers!!!
15
I found it very interesting that the countries that drank least were NOT places I, or anyone I know, would want to live. Pakistan, Afghanistan, Saudi Arabia......Mortality rates in these places are no doubt higher than ours as well.
The places that drank most, I also noted, scored among the highest on the most recently published scale of happiness and satisfaction (Sweden, Norway....) There are many reasons for this besides alcohol consumption, of course. Universal health care, good schools, caring for the elderly.... And they have lower infant mortality and higher longevity. Just saying.....
30
Seems like these researchers can't see the forest for the trees. They appear to have overlooked the abundance of epidemiological studies indicating that moderate alcohol consumption (1 serving for women, 2 servings for men per day) is associated with increased longevity. This holds even after controlling for confounders such as socioeconomic status, past alcohol abuse and other factors.
4
Another account of this study that I read made the point that many of these alochol-related deaths were the rsult of drunk driving or other accidents in which excessive drinking was involved. Eliminating those deaths fro the analysis presumably would produce a less dire picture for light to moderate drinkers--or those who rely on designated drivers.
3
@Katherine - maybe a study on non-drivers' health and life expectancy would be useful.
2
This is bizarre. This is like saying "but if you ignore all the diabetics who had to get their feet amputated, it's not such a bad disease".
Those deaths did happen. And they were caused by alcohol. So why just not count them?
2
My aunt lived to be 102. She outlasted two bouts of cancer, and a stroke and finally passed of old age. She was an alcoholic for about one third of her life. Her sister, my mother, died at 69 and barely drank at all. She died of undiagnosed cervical cancer. These studies appear without and serve to make us distrust all similar studies expecting yet another with different results.
5
Thank you for teaching about meta-analysis and it's limitations. That's all the US preventative Task force uses when they make recommendations to HHS about what to cover during health provider encounters and how to proceed with that care. Sadly, far too much emphasis is placed on studies outside the US as well, even though it's well known that genetics and population culture (food, drink, etc.) skew results. However, I suspect the 'researchers' that published in the Lancet are really just looking for their next government grant vs. trying to sell newspapers.
Drink, within reason, and be merry. Who wants to live forever? Not I.
23
This article reads like a spouse trying to convince his partner that his drinking behaviour is perfectly normal and is no proof exists in this world to show otherwise.
"Another meta-analysis is unlikely to tell us anything new. " This is absurd. because information is not new does not mean we cant learn something new from looking at a much bigger picture.
As a nation (UK and USA) we have a very strange relationship with alcohol. It is not unusual to hear people defending theirs in a convoluted way and with little self awareness (nay; denial) but I am surprised to see it so blatant and unchallenged here in the NYT.
13
IMPORTANT FYI - they have never autopsied an alcoholic with atherosclerosis! Cheer up, folks with heart problems!
2
Here's the thing alcohol is a drug period. A highly addictive drug that has caused far more damage than all of the other "drugs" put together. Yet the media STILL treats alcohol as a friend while STILL playing the war on drugs game. So IF the Times continues to report on the evils of drugs they ought to always include alcohol since it's used with virtually every other drug. Or the Times could be the first responsible paper to hold big pharma and big pharma only for their shoddy addicting drugs.
8
As Woody Allen said, “You can live to a hundred if you give up everything that makes you want to live to be a hundred.”
14
I don’t like being around drinkers that consume more than what is healthy for them... which isn’t much!
They become terrible conversationalists and often appear more stupid than they realize.
But the worst thing about drinkers is to see them age faster as they jubilantly enjoy their alcohol lifestyle.
13
@Al
The truth is that most people are not as good at drinking responsibly as they think they are.
2
The most insidious harm from this study is undermining the public’s trust in quality research and expert testimony. There are just too many holes in this work - holes the general public can easily spot - leading to them wondering why anyone would trust or fund scientific research.
When scientists make sweeping generalizations, oversimplify and jump to conclusions we all lose.
2
“Too many people interpret [study results] individually, however, with panic-inducing results.” Americans are notoriously poor at risk analysis. Most believe science to be an alternate religion, and want firm ‘thou shalts’ and ‘thou shalt nots’. Studies like this will be misinterpreted and misapplied by those seeking absolutes.
1
As a public health researcher, I find it worrisome that news outlets like nytimes and others are so quick to dismiss high quality research. Is nytimes owned by the alcohol industry? The history of research on alcohol use is shocking - full of alcohol companies influencing government to prevent research from being done - which is why this study couldn't even be done in the US.
All of this should remind everyone of the way big tobacco shut down the message of harm. I'm disappointed to see the nytimes participating in discounting real research which shows measurable harm.
A quote from the study (which I actually read, you should too): "Globally, alcohol use was ranked as the seventh leading risk factor for premature death and disability in 2016." I'm sorry, that doesn't sound like nothing to me.
13
so, what do you suggest? forbidding alcohol? we tried that, remember?
life is an interesting dangerous activity, and always results on death. there is a sizable risk of premature death from any cause. in an effort to reduce that risk, government will now forbid life on all forms. bravo
3
@Worrisome
An Aaron Carroll figure will always appear in the NY Times to excuse the behavior of its subscribers. All this article is - and any and every other article on this, and all news websites - is a revenue generator. The red wine stock photo at the top of the article is also telling.
News is a business. Nothing more.
2
well balanced comment. happy to read this in a n american paper. even quality newspapers in europe already start the raid on alc
According to Wikipedia, one of the symptoms of alcoholism is antisocial personality disorder which is defined as "a personality disorder characterized by a long term pattern of disregard for, or violation of, the rights of others. A low moral sense or conscience is often apparent, as well as a history of crime, legal problems, or impulsive and aggressive behavior."
Aggressive behavior, I believe, persists even after alcoholics give up drinking. Think of all the health issues that might occur as a result of aggressive behavior, such as bar fights and antagonizing everyone you know in a million ways.
Do you know anyone who might be an aggressive drinker? Emergency room personnel consider aggression the primary presenting symptom of alcoholism.
Think about it this way: more than one drink a day is considered heavy drinking for a woman. Who is an alcoholic?
2
One should bear in mind the example of Winston Churchill, who gargled brandy every day of his life, put down untold gallons of champagne over a lifetime, and lived to a ripe old age. Alcohol, if you look at his career, didn’t slow him down at all.
2
Genes and wealth have much more to do with the negative effects of alcohol than “ how much”. Wealthy people in the fifties and sixties for the most part would all be considered alcoholic by today’s standards, in the fifties mom didn’t start out the day at aerobics classes, she started out the morning playing bridge with the girls at the club while having bloody Mary’s before lunch, it was all very acceptable and most of the ones I knew lived to ripe old ages. Today everyone is so overboard about health and “ sensitivity “ it makes one nauseous: on the other hand mommy today has no problem with daddy destroying millions of lives at his day job as a banker peddling CDOs or a techie blowing up old economies or creating worthless apps that make them rich. I’ll take the heavy drinking old business crowd any day.
5
I’ve been sober for 2 years now, was a drinker for 35 years. One thing that comes up over and over again is that alcoholics are consummate liars. Maybe the best liars in the world. We lie about how much we drink, when we drink, where we drink, etc. The basis of our recovery is coming face to face with the truth, and to stop lying to ourselves first, and to our families. And, ultimately, maybe, and that’s a big maybe, to the people studying us.
9
Thank you for publishing this assessment. I was so ticked off when I saw the headline on the BBC. The Lancet in choosing to publish this study was after click-bait.
Yup, if you have a couple drinks and drive, you have a higher likelihood of dying. That is then put in with the alcohol health risks? Not getting enough sleep can do this as well. The effect of moderate alcohol consumption on health is difficult to study and the role genetics plays will be a strong one. Try sorting that out....
1
I am going to go out on a limb here with my own theory - anybody who argues with this study is probably a drinker themselves and simply and clearly wants to defend their own drinking. I quit drinking 4 months ago, and if that study had come out while I was still drinking I would have done the same. I am a nutritioinst who also used to defend my clients drinkng as well - because how could I drink and tell them they shouldn't? Mr. Carroll if you are saying that all medical professionals look down upon drinking you are mistaken.
Alcohol is a toxin, it is poisonous to our bodies. It causes health issues, breast cancer in women, drivng accidents, blackouts. For me, it created a terrible habit, to the point where I didn't know what it meant to socialize, have a family gathering, relax or get through a stressful day without it. Everything in my life revolved around "having a glass of wine" and I justified it to the bitter end. Until I woke up and realized all this. I am not getting duped anymore by an industry who wants me to believe that life is only worth living with a drink in my hand.
31
I agree. Back in the old days, studies were published which showed that MDs who smoked were much less likely to counsel their patients about cessation. I think this article will be used by alcoholics to rationalize to themselves and their loved ones that they do not need to stop even when the doctor suggests so. I also agree with the other commenters that it is alarming how emotional people are about drinking: were this any other issue-- like the levels of chemicals emitted by microwaving/ diswashing plastic ware (which the Times did an article on recently) -- people would be writing about when/ how they switched to glass and steel. I have the rare drink but could easily give it up with no dent in the quality of my life.
5
Downplaying the obvious harm caused by alcohol is an absurd exercise in deception.
10
It would never occur to me for a moment to give up alcohol because of some study. I've drank most of a bottle wine every day for over fifty years and my body is still humming and my mind sharp as a hammer.
9
When I think of "sharp" tools, a hammer rarely comes to my mind.
22
I just stopped drinking alcohol. No biggie. I didn't like it that much anyway.
Did you know that additives to wine are not regulated?
7
My father, uncle and grandmother developed diabetes when they were about sixty years old. All of them enjoyed wine and all of them died from complications of being diabetic. I changed my diet and eliminated alcohol when I was fifty. Twenty years on and I am not diabetic. I may not have a longer life span than my father but I believe my quality of life as I age will be better. Staying healthy takes a conscious effort and it should start when you are young. It is troubling that we all consume more fats and sugars than we should.
4
@Lawrence DeMattei The scientific studies actually show that light to moderate drinking reduces the risk of diabetes.
4
@Robert
Was unaware of that study and it probably was done after the beginning of my abstinence. It is all about moderation, isn’t it? I always believed my risk was higher than others due to my extended family’s health history.
1
@Lawrence DeMattei -
FYI, if you want details on how much alcohol lowers diabetes rates, a recent compilation of 26 different studies can be found in “Association between alcohol consumption and the risk of incident type 2 diabetes: a systematic review and dose-response meta-analysis,” PMID 26843157.
A free pdf of this can be downloaded from: https://academic.oup.com/ajcn/article/103/3/818/4637587.
Their results: “Compared with the minimal category of alcohol consumption, light (RR: 0.83) and moderate (RR: 0.74) alcohol consumption was associated with a lower risk of T2D.”
A Relative Rate of 0.74 means that moderate drinkers ended up with 26% less diabetes than those who avoided alcohol. (Or see PMID 15864527.)
And if you do get diabetes, you shouldn’t stop drinking.
To see how to lower eventual coronary heart disease [CHD] in diabetics, Google “PMID 16463045” for a compilation of 6 studies:
“Risks of fatal and total coronary heart disease were significantly lower in all three categories of [diabetic] alcohol consumers (-6, 6-18, and 18+ g/day) than in non-consumers, with RRs ranging from 0.34 to 0.75.”
A relative CHD rate of 0.34? Wow. That is 200% MORE CHD in abstaining diabetics compared to those who drink more than 1.5 drinks per day.
See https://link.springer.com/content/pdf/10.1007%2Fs00125-005-0127-x.pdf
How does it work? Google “PMID 26458258” for a randomized controlled trial. And see PMID 21343206 for a compilation of 44 CVD biomarker RCT datasets.
1
I can't help but wonder if this study, published in a respected, peer reviewed journal, would garner such criticism, i.e., generalized, non-specific, not actually addressing the study itself, if it wasn't questioning such a popular pastime?
14
Alcohol kills brain cells. I personally need all I can get, particularly at 73. Some of the oldest continuous businesses on earth are breweries. Prohibition was impossible to enforce. I think there are numerous, excellent, healthy alternatives in modes of relaxation and drinks to imbibe. However anyone who enjoys alcohol will obviously be unpersuaded by my words. So much for making sense of human behavior.
6
@Curiouser -
Maybe if you pour alcohol on brain cells in a petri dish. Please provide data, not rogue assertions. In real life, light alcohol consumption is actually associated with significantly LESS old-age dementia decades hence.
From “Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies,” Eur J Epidemiol. 2017 Jan;32(1):31-42. PMID: 28097521:
“Eleven studies…were included. …
Modest alcohol consumption (≤12.5 g/day) is associated with a reduced risk of dementia with 6 g/day of alcohol conferring a lower risk than other levels while excessive drinking (≥38 g/day) may instead elevate the risk.”
And that meta-analysis did not include the new Whitehall II Study, “Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study,” BMJ. 2018 Aug 1;362:k2927. PMID 30068508.
“Participants: 9087 [London civil service] participants aged 35-55 years at study inception (1985/88).
Results: [After] a mean follow-up of 23 years. Abstinence in midlife was associated with a higher risk of dementia (hazard ratio 1.47) compared with consumption of 1-14 units/week.”
That means 47% MORE dementia 23 years later in the teetotalers compared to the light drinkers. 47%? Wow. See also PMID 30068510, 27184039, 19546653, & 24553426.
So, @Curiouser - Abstain at your own risk. (But then, there is no "making sense of human behavior"...)
3
No smoking, moderation in food and alcohol consumption and much exercise are important. These studies are not cause and effect. Remember when smoking was finally recognized as a cause of lung cancer and other lung diseases. The tobacco industry fought this tooth and nail as did the auto industry to make cars safer. The auto industry cited higher cost. Youth should be encouraged not to smoke and be moderate in drinking alcohol. The obesity crisis in America is of much greater concern to longevity, health cost and the quality of life.
3
The comments healthiness does not assess mental issues, merely body damage - it seems. Mind is even MORE important.
Also, the reference to drugs is another curveball. Before being an architect in the music industry as a sound engineer, I took the master tapes away when either drinks or drugs appeared. THE best bands had at that point given up both while working in the studio. They had found out the hard way that without clear head there was no clear results.
I lost my first girlfriend who had come to NY City at the age of 16 to drugs and every year one funeral with acquaintances, so I never had to try myself.
Then in architecture working with Masters, if one missed a nuance in a meeting - you were toast and potentially replaced quickly. So I instantly stopped even minor drinking and used exercise as means to lessen stress. I have to say that really has made an unmeasurable difference.
Having lived my youth in Scandinavia, one sees the damages of heavy drinking all too well.
1
I have been a constant wine drinker in my life, more in my youth and less now at 79. I am drinking now ca. 150ml or about a third of a pint at lunch every day. Always with eating.
I don't see any harm with it. To be true, I consider it a positive "health issue".
10
For each set of 100,000 people who have one drink a day per year, 918 can expect to experience one of the 23 alcohol-related problems in any year.
For each set of 100,000 people who smoke, about 30,000 will end up dying from it.
Context on relative risk is important.
13
@Jon You're comparing "in any year" to "lifetime" ?
1
A point I make that is a bit off topic is this: Food IS medicine if you eat to live rather than live to eat.
6
Alcohol is poison.
It kills thousands upon thousands in our country alone.
Why do supposedly civilized people allow this?
9
@Casey Jonesed I couldn't agree more. We are so focused on things that "other" people do - take opioids, smoke cigarettes - which only helps to support our own addictions. I stopped drinking four monts ago, by choice, and can't believe the wake up call I have had.
3
@Casey Jonesed
Civilized people have been drinking for at least 10,000 years. The discovery of beer making has been related to improved health and higher populations in tribal societies. Indeed, wine and beer making ARE attributes of civilized societies.
4
@Casey Jonesed Cars kill thousands too. Are you going to ban driving?
2
A clearly written, much needed, and helpful clarification. A number of additional consideration. "Risk," a mathematical concept, continuous in its interactive multi-dimensionality, is not a unidimensional, static. either/or state.Study designs, of whatever types, and their various data-analyzed, interpreted, presentations, rarely if ever consider ongoing, everpresent-operating realities: uncertainties. Unpredictabilities.Randomness. Lack of total control, notwithstanding the types, qualities and levels of timely or not timely efforts. In addition, all too often, little consideration is given to an "outcome's" being (1) caused by- and if this is replicable; (2) is associated with...(3) exists/occurs, for which there is no "reasonable" explanation. Which bring us to another issue: delineating between KNOWING, and its categories:
known; unknown, at a given time, because of gaps in information and necessary technology, and unknowable/not measureable; UNDERSTANDING and being able to effectively use what we know and understand. If indeed there is an actual need to do so, determined by...using meaniningful, and relevant, criteria. Which brings us to a most difficult issue, which is rarely noted in publications and other presentations. Who are the individual and systemic stakeholders raising and studying the "dangerous/not dangerous/beneficial" drinking issue and data? What are their agendas? Transparent, misleading as well as hidden ones! Lastly,are data the basis of most policies?
1
@s.einstein
Have you been drinking ?
;-)
5
I’m not worried in the slightest. I have a drink only occasionally. I drive and I’m a parent. So one drink is it when I’m out. Same goes at home when I entertain. It’s just my way.
I worry more about inheriting the diseases that have killed my family members.
10
@Nycgal you shouldnt be worried, you're not a drinker.
My grandpa drank beer and a shot of whiskey every day. He also ate a fairly traditional German-American diet that included a lot of sausage and cheeses. For a good chunk of his life, until he quit in his 60s, he smoked big green cigars. He lived to be 93 and died in his own home of a heart attack. I do not smoke, eat a pretty healthy diet, and drink much less than Grandpa. I think I'll be lucky to make 93.
10
People will continue to consume alcohol regardless of any study.
And people will drink too much will continue to drink too much.
I'm much more worried about a drunk driver killing me than I am about alcohol killing me.
But I'm lucky: I've always been a moderate in my consumption of "harmful" substances, which is probably primarily due to genetics.
6
My ancestors all came from Ireland, and many of them were drunks. I have siblings who are alcoholics. I drink quite a bit myself. I’m certain i am an alcoholic. I am lucky beyond belief, however, because my father never drank a drop. He spent his life working very, very hard to put his kids through the best colleges possible. He was ambitious and built a small fortune in real estate. I became an attorney at his urging, and my life has been very easy. I had the benefit of being raised by a sober father (and a sober mother) and I am only now, at 52, realizing the significance of this.
39
@M Genetics! As a nutrition geek, I do tend to see issues in converting glutamates (excitotoxins) to GABA (calming) in many people who have addictive personalities. Diet (grains and dairy) can also play a role.
Similarly one’s dopamine status (genetic tendency to not make enough, for example)plays a role in addictive behavior.
I’m a “one and done” drinker and am grateful to have absolutely no interest in imbibing too much— but so many of my friends self-medicate with alcohol. I wish we had healthier ways to help them treat these imbalances.
4
I wear a memory oximeter when I sleep, a practice I adopted two years ago after I started using a CPAP and wanted to monitor my blood oxygen levels. A few months ago, I started focusing for the first time on the pulse rate (PR) data in my oximeter reports and realized that consuming alcohol invariably negatively impacts my PR stats. Even if I drink just one glass of wine several hours before going to bed, my overnight lowest and highest and average PR (beats per minute, or bpm) as well as the low to high range are all significantly higher than if I don't drink, and ditto the number of "PR events" (defined as change in rate by at least 6 bpm, for a minimum duration of 8 seconds) I experience.
Alcohol is a toxin. The body's ability to detoxify alcohol no doubt depends on many factors that vary among individuals -- e.g., genetics, dose, and total toxic load. After I reviewed my two years of oximetry reports (which included notations about time and amount of alcohol consumption), it was crystal clear to me from the PR data that my body struggles to metabolize alcohol. I had my last alcoholic drink May 2, 2018 and haven't missed it since.
26
Thanks, Dr. Carroll, for this reality check.
As you say, even given their chosen analysis and spin, "Only 4 in 100,000 people who consume a drink a day may have a problem caused by the drinking, according to this study."
And even given their chosen analysis and spin, their dose-response curves indicate significantly decreased heart attacks and diabetes, on the order of 20% relative decreases, and these are what should concern most Americans, not tuberculosis.
It has become clear that the genetic risk of cardiovascular disease, our number 1 killer, varies by about 100% between extreme individuals, i.e. the least-lucky 20% of us have genes resulting in almost twice the CVD risk as the luckiest 20%. Those with the higher CVD genetic risk scores should be actively encouraged to take advantage of the CVD and diabetes benefits of moderate drinking.
3
The study has at least one more major limitation in addition to those already mentioned -- it assumes that ethanol is the only active ingredient in alcoholic drinks. Because the study only examined grams of alcohol in beer, wine, and other alcoholic drinks this is equivalent to assuming that all global alcoholic consumption was vodka drunk straight. No analyses of beer versus wine versus other drinks are presented. More seriously, the authors make no mention of this limitation in their abstract or conclusions or supplemental data, which the journal editors should have insisted on. My conclusion is that I will continue to drink wine because this giant study only proves that bad epidemiology gets too much press coverage.
2
The author says "For each set of 100,000 people who have one drink a day per year, 918 can expect to experience one of the 23 alcohol-related problems in any year"
In any year??? Lifetime incidence might be more to the point. No doubt neurotoxins are good for some people at some times, but not for most people most of the time. Not a very compelling critique.
6
Unfortunately, news media make it common practice to sell correlations as causalities. That's not only because it makes it more newsy, but because it's a common fallacy even for educated people, including scientists. I see lots of scientific papers that draw a conclusion of causality from statistical correlations. Must be about wanting to prove instead of test an intuition or hypothesis. The only way to prove causality is to split the subjects in half and treat each half differently. But such a plan would raise eyebrows in human ethics committees, so correlations is all we can have.
8
How can you trust a study like this when there are plenty of people who make it into their 90s and 100s claiming that a shot of whiskey or a glass of wine a day has helped them make that age? It is more likely a good gene pool and a little bit of old-fashioned luck.
10
I would be curious what the results are if auto accidents and smoking were not included. Since the results for one or two drinks seem only slightly worse than those for complete abstention, it would appear that anyone who drinks moderately, but doesn't drive after drinking or smoke has no additional risk.
7
With increasing sample size, smaller and smaller differences become statistically significant. That's why miniscule per-drink effects are alleged to be significant in this huge study. As the article correctly points out, the effects are nothing that any rational person needs to fret about
4
Is this a self-serving article for the author of 'The Bad Food Bible: How and why to eat sinfully,' where he promotes the moderate use of alcohol? Unclear. What is clear is how little western medicine knows about nutrition. "Food is not medicine," the author states unequivocally. Really? According to most ancient traditions, it pretty much is - and if we treated it that way, we would have a marked absence of illness and disease.
21
As Paracelsus, the Swiss physician of the Renaissance often considered the father of toxicology, said: "The dose makes the poison" (or in Latin, "Sola dosis facit venenum"). All things are poison if eaten, drunk, or absorbed to excess.
13
So Sir Winston Churchill, who lived to be 91, when asked by the King how he could “day drink” and still do his job, replied “practice.” He also chain smoked Cuban cigars.
DNA obviously has a lot to do with the nexus of alcohol consumption and resultant medical problems.
My mother is 95 and drinks like Churchill but never smoked.
Dad passed away at 90 and had martinis every evening after work followed by wine with dinner followed by a shot of straight gin watching TV with mom.
I don’t drink as much but I do drink a shot or two of spirits in the evening followed by a glass of wine. I also usually smoke a bowl of hash when available.
I think future studies should work in pot usage combined with drinking.
14
@winthropo muchacho I'd like to share a few cocktails with you. My aunt drinks 2 Manhattans every night and is 86 and still going strong. Pot combined with drinking - yes that would be me.
Don't knock observational studies completely. They're necessary when randomization is not a reasonable option. For example, randomizing people to drink lightly or moderately to test for the effects of one's health is an ethically terrible decision. This is why scientists implement observational studies with rigorous methodological designs to minimize/prevent the impact of confounding and bias on findings. There are also analytic methods to minimize these issues after the fact.
5
Wait a minute! This study does not actually prove that alcohol causes harm. It shows an association and from my reading, there was no effort to control for other variables. Most notably, smoking. The study does not control for smoking or for any other factors. If people who drink also smoke more, that could account for the effects seen. Same thing with poor nutrition, lack of exercise, socioeconomic status, and so on. The small health effects associated with modest amounts of alcohol may or may not actually be caused by the alcohol, we just don't know. It isn't a useful study for answering that question.
3
As an ex social drinker, alcohol was never an escape, just an occasional break. When I was upset about something, drinking was the last thing on my mind. I needed to address my issue(s) and I could not do it drunk.
Unfortunately most drink at emotional upset. I have no memory of my last imbibing. However, no hang overs, or embarrassments for things said plague me.
Drinking will have physical consequences just as anything done to excess will do. Just because one enjoys something does not mean you wear out it's welcome.
2
Gimme a drink please,
I’ll feel better and be fine,
No reward sans risk
1
It is the worst.
Processed drugs, same as processed food are the worst.
1
Many thanks for the actual statistics.
1
Everything in moderation, including moderation
7
Take everything in moderation--including moderation.
4
These comments show that very few people understood the main point of the article: with a large enough sample size, a minuscule biological difference (e.g. 4 out of 100,000) can attain statistical significance. In other words, it shows that one drink a day, on average, has essentially zero negative health consequences.
The media hype of the study and these comments are more indictments of the disgraceful state of science education in the US.
17
Thanks. I needed a good rationalization to continue my beer every other or every third day, in my retirement.
4
I've been experimenting with not drinking alcohol in any form for about six months. I enjoy a good bottle of beer, a nice red wine and especially a wee dram of single malt Scotch whisky. But when I imbibe, I also tend to nosh and that is reflected in my girth. My experiment of no alcohol also includes no meat or dairy and certainly no "snacks." The results have been remarkably good with weight slipping away. I'm pretty content with my diet but the question remains. Will I buy a bottle of single malt Scotch when autumn finally arrives? This article and the related research gives me no answers to my dilemma. I do know that I can't afford to carry that weight any longer, so perhaps I'll simply enjoy my lifestyle without meat, dairy, snacks OR alcohol... I keep reading that a whole food plant based diet is the healthiest for all of us. I have a sense this may be true. I certainly would welcome aging with grace and without heart disease or cancer. If alcohol mucks up the works it really is best left alone.
20
@CAG For me a plant-based diet contributed to very poor health, a zinc deficiency, and a weight gain of 15 lbs. I craved meat the entire time.
I gave it up after eight years. The 15 pounds immediately came off. It was a while longer before I learned I had a genetic mutation that made my copper/zinc balance something to which I had to pay attention. (Vegetarian diets are, by their very nature, very high in copper and low in zinc. High copper contributes to various health and weight issues).
I now do not eat any grains (including grain alcohol. Instead: wine, tequila, rum) or dairy. Those items were causing an inflammation reaction in my body and contributing to excess weight. If I ever try to “cheat,” the scale shows it the next morning. So maybe go grain-free (including rice & corn) for a couple weeks and see what happens as you continue to collect valuable information on how you are wired (maybe get your genome mapped as well). Good luck!
2
The defensiveness of many comments here suggests the rationalization of addiction. If the same study indicated no risk-free level of grape juice drinking it wouldn't elicit the same backlash. People drink because they want to, regardless of the risk, and the same is true for any psycho-active substance.
33
@Kevin I totally agree. This study could have said 99,000 out of 100,000 people die from alcohol every year and people will still drink. We are well aware of the dangers of smoking, drinking and driving, taking opioids for fun, etc and people really don't care. Including the author of this article who I can be certain drinks alcohol.
2
Live by Harris' rule: There is little you can do, in moderation, that stands to statistically lengthen or shorten your life expectancy by the amount of time it takes to do it. So carpe diem, if you like it, do it, if you don't, don't.
5
Drink up !
Enjoy.
Will no one rid us of these puritanical prudes, prohibitionists and priests ?
24
Look, people do lots of things that are bad for them. Their choice. But this article is really classic enabling. It has been known for years that a single drink of alcohol causes damage. That's why even at the height of the "drinking red wine is good for your heart" fad, not a single doctor actually prescribed a drink of alcohol a day to their patients. The exact biochemistry of the damage has been studied at the cellular level extensively. The mere fact that you can live with the damage into old age doesn't prove it doesn't exist. Just like the fact that there are people who had multiple horrific sunburns as kids yet never got skin cancer doesn't disprove the known fact that even a single sunburn does permanent damage at the cellular level. Drink if you want to. But accept the known risks, don't deny that they exist.
39
@JerseyGirl
Well said.
Actually, my concern is for the psychological impact of an intimate relationship with alcohol. I am not saying dont do it; just saying try to be aware of the real, life changing risks involved. I am not that the study or this article really address this. . .
4
Its way more than just hjow many drinks a day. We have longevity in our family-- and people who drank a lot of teh really hard stuff ...... and lived into their 90's-- and a few sthat were teetotalres and tragically died in middle age of other diseases.
6
Drinking alcoholic beverages is a risk easy to avoid.
4
@janye
Not easy for a good 10 percent of us.
Said like a true enabler. But seriously, remember that alcohol kills more people than all other drugs(except tobacco) combined.
9
@Steve - Hmmm? That may be because more people drink alcohol than use other more lethal drugs.
Out of 100,000 people who use alcohol in a year how many die?
I would think if we phrased it that way opioids, heroine, cocaine & cigarettes would be worse. Maybe even driving a motorcycle.
9
My mother was an alcoholic and she died of a heart attack - at age 95.
Winston Churchill enjoyed his brandy and he died at 90.
So the study doesn’t hold true for everyone.
14
@April Kane
But were they happy in their long-lived alcoholic stupour? Pretty sure Winston was not (Black dog depression)
1
Excess in anything - whether it’s alcohol, red meat, Facebook or sun exposure - has the potential to be harmful. The Buddhists have it right - moderation in all things. The problem is that many in the human race find moderation to be a very difficult thing to achieve.
14
Intellectually, we all know what not to do in order to have the best chances to be healthy: don't drink alcohol; don't smoke; don't be obese, and don't be sedentary. How many of the people posting on here deriding and chastising those who weigh the risks and choose to drink are themselves ignoring other health advice? It's not your call to judge someone else's choices. Nobody's perfect and nobody gets out of this life alive.
10
The emotional intensity of these comments, both pro and con alcohol use is surprising.
I am nearly 80 years old. I consume a glass of wine with midday and evening meals. This practice may shorten my life by a few days. I really don't care. Life without its little pleasures is hardly worth living.
136
@Joe Sneed
Woody Allen said it best,"if we do all the things that we can to live to 100, life is not worth living".
10
@DENOTE MORDANT
Woody = not a role model
2
@Joe Sneed
Sounds like you enjoy your vino, Joe--something to look forward to in the evening and that helps you relax. Note the definition of a drink in this article, a thimble-full of wine about. Which means you are probably well over the limit of what is considered a safe amount. Still, you are 80 years old and, judging from your comment, of sound mind. Therefore, thanks for lessening my own sense of guilt about enjoying in moderation nature's best relaxant.
2
The reputation regarding statistics is that they can be manipulated into any result desired. This is actually untrue if the models meet statistical standards and are conducted with scrupulous attention to all aspects of acquiring and analyzing data. Interpretation, however, requires attention to context.
Consider that one's parents living to a relatively old age is believed to confer some similar benefit to their offspring. Well, yes, but only 6 or 7 percent more often than not when all other factors affecting longevity are taken into account.
The same applies to statistics on the likely results of consuming alcoholic beverages. It's obvious from the comments that some start with their biases and react accordingly. The statistical reality is that moderate consumption has no significant affect one way or another...taking into account the multitude of variables that also affect health and longevity.
Those who live life in the grey reality of life will take in this entire article and carry on doing whatever they want. Those who see life in a more black and white way will make less nuanced choices because that's how they try to live day-to-day. The former are more likely to enjoy life than the latter, although we'd need statistical evidence to say for certain...or not.
Eclectic Pragmatism — http://eclectic-pragmatist.tumblr.com/
Eclectic Pragmatist — https://medium.com/eclectic-pragmatism
2
Alcohol may have adverse health outcomes even at low levels of consumption, but so do other items. I'll just mention one: soft drinks. It wasn't hard to find relevant studies. The effects look comparable, perhaps even greater.
https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/soft-drinks-...
"People who consume sugary drinks regularly—1 to 2 cans a day or more—have a 26% greater risk of developing type 2 diabetes than people who rarely have such drinks."
"A study that followed 40,000 men for two decades found that those who averaged one can of a sugary beverage per day had a 20% higher risk of having a heart attack or dying from a heart attack than men who rarely consumed sugary drinks. ... A related study in women found a similar sugary beverage–heart disease link."
If I am not going completely paleo, should I drink a Coke or a Coors?
4
@George B. A Coors has more calories than a Coke. Plus it contains alcohol.
@George B. Why do you think that not consuming sugary drinks has anything to do with eating a Paleo diet?
@JerseyGirl
Actually, a Coors and Coke or Pepsi have just about the same number of calories. 12 ounces of either have about 150 calories. Sorry.
Just to add to the "real world" message here.....there is virtually no chance of contracting tuberculosis in the United States unless you are already in poor health (which could be due to EXTREME EXCESS alcohol consumption, granted) and come into close contact with an actively infected person. There are very few patients in the US except among very marginalized populations (skid row, prison). It is the same in most OECD countries. TB is much more common in underdeveloped countries, however. Data on alcohol consumption and TB should not be aggregated between the two sets, with TB added to the "risks" in developed countries. The "average" is not the median in this case. Its apples and oranges.
5
While Americans are pretty much in agreement on how much drinking is too much drinking, the fact that most people don't measure their drinks means most people don't really know how much they drink.
As a retired addictions and mental health treatment program developer and counselor, I urge people to err on the side of less alcohol. Less will never harm anyone, but more can lead to anything from an auto accident to cirrhosis and pancreatitis.
I've had patients who suffered both, including a beautiful and smart young woman who died in her early 30s from pancreatitis due to her drinking. She didn't want to leave her 4 year old son for inpatient treatment that she needed. Instead, she left him forever, her own potential also unrealized.
A good study would be useful, but it takes only common sense to recognize that drinking less is the way to go.
9
The only study design that can prove the impact of drinking is controlled experimental design with random assignment. Non of the studies that is included in this meta analysis fulfill this condition and they should be ignored. Also, as the author discuss moderate drinking is beneficial to diabetes and heart problems the two biggest killers in the overweight people in the affluent western word.
3
Thank you for this article. Too many journalists, just like the public at large, are statistically innumerate, which leads to silly headlines like, "There Is No Safe Level of Drinking!"
This is the first piece I've seen that so carefully explains the study's claimed risks and the potential causal pitfalls. Kudos to Dr. Carroll and to the NYT for consistently delivering columns of this quality in TheUpShot.
And for those of you who claim that this article somehow sanctions heavy drinking, or drinking by all, or drinking in every context, please go back and read it again--but carefully this time.
14
I guess these comments are predictable. If you like to drink, phew. Unless I missed it there is little mention of the world wide cost of alcohol on health. Pretty staggering.
If this makes you feel better about having that drink I guess that's ok. Except I had a good friend die of liver damage and he is not alone in this fate.
Those people in commercials seem to be having so much fun, kind of like the ones that used to show smokers. The problem is it also is addicting and hard to know who is susceptible.
7
Of course drinking is not healthy. It is a risky behavior that can make life more bearable for some and a disaster for others. It is a good way to avoid old age in some cases or end up as a diamond jubilee alcoholic in others. I always enjoy it while doing it and hating it afterward. An excellent option for the suicidal person that wants life to last just a bit longer.
30
@Lillijag, like many other commenters, talk about "drinking" as if it were one thing, and assume we all know what they are talking about. When someone gives up "drinking" are they giving up consistently heavy drinking, binge drinking, or are they giving up a glass of wine with dinner? The article by Aaron Carroll made such distinctions, but many of the commenters do not, and this makes it difficult to interpret their comments, or to put them in appropriate context.
4
Climbing a mountain is dangerous to one's health. Eating a fatty steak twice a week is not safe for some. Driving down the freeway cold sober is often taking your life in harm's way. Walking down stairs in the dark when one is older is not safe. Eating a lot of potato chips, fast food, rich cheese and ice cream is a detriment to health. Slathering butter on toast is bad for some. Pick your poison people........we all have ours. There is no completely safe life.
11
I am reminded of this comment from the protagonist of the old PBS series “Rumpole of the Bailey” when he was questioned about his love of Claret wine: “No good vice is worth giving up for five extra years on the geriatric ward.”
226
@Gary Pahl
Life now IS what counts. But does drink always add quality to the here and now? Me thinks not . . .
I would rather die tomorrow having lived a full life today than live non-present life for a hundred years.
“I feel sorry for people that don't drink, because when they wake up in the morning, that is the best they are going to feel all day.”
“Alcohol may be man's worst enemy, but the bible says love your enemy.”
Two of my favorite quotes from a REAL ENTERTAINER---
Frank Sinatra
4
Frank Sinatra was an alcoholic and not a sober one. Who knows what his mornings were like? Sober alcoholics know how great it is to wake up without a hangover and how to live a life that is joyous and free of alcohol. Every sober day is a great day. No matter what happens, sober alcoholics don’t need to drink. I am sorry to see in these responses that so many non-alcoholics need to drink and will go to such lengths to defend it.
Well, I'll drink to that.
7
One thing not mentioned in this article is the psychological effects of drinking a fair amount of alcohol. Sure, you may not get cancer but you may act like a jerk to your wife and kids, yelling at them because your inhibitions are reduced. I have certainly seen this happen. Alcohol consumption impacts the people around you, as well as yourself.
22
I toast the author. There is nothing more to say.
57
I notice no one is rushing to deny that marijuana is a gateway drug, when new studies show it is alcohol that is the MAIN gateway drug and that marijuana is not one.
7
Might be dealing with statistical significance but not biological significance here.
3
@APS Which is why only science reporters should ever report on science. Much of the highly hyped hokum we read daily is because the reporters have no understanding of simple statistics. Kudos to Dr. Carroll for this article.
3
The best advice is not to develop a craving for alcohol. Developing a craving can happen easily, as many of us know. Having one drink a day can develop a desire to have this drink every single day, and perhaps to have a second drink. I might have this twice a week now, - usually a shot of Wild Turkey or Jameson's in my coffee, with ice cream. At earlier times in my life, I did have one drink a day, a beer, glass of wine, wine cooler, or a shot. But I discovered that even a small amount every day made me crave booze. So, I figured it is best to get to the point where you do not crave alcohol. My parents were doctors and heavy drinkers. I am a journalist, and a very light drinker. So far, I've outlived my father's age by two decades.
18
The author doesn’t refute the simple assertion of the study: the only safe level of alcohol consumption is zero.
Yes. The same is true of driving. But I have to drive. I don’t have to drink alcohol. And the act of driving itself doesn’t cause diseases. I am aware that auto emissions do. I’m speaking of the act of driving.
It’s also true that there could be a study on the effect of increased desert consumption. And 15 deserts would definitely have a detrimental health impact.
But does the author suggest, as a male, I should have 3.2 desserts per day? Is that average considered moderation?
I don’t think so. I choose to have no alcohol. But I beleive moderation would be much less than 3.2 per day. And definitely not daily consumption.
11
@Doug
I wonder what the safe consumption of social media is.
8
Thanks for this useful reinterpretation of the study. It seems to me that such information makes such a splash in the US because there is no nationalized health care system and people are thus held blameworthy if they become ill. Stories like this one are part of that national trend toward making people believe that they are responsible for staying healthy by avoiding any form of risk. Unless, of course, one lives in Flint, Michigan, in which case everyone just ignores the problem.
7
There are times I have 1 beer and have a nice conversation. There are other times I will destroy 5 or 6 craft IPA's and smoke a little MJ and if it's around a little bourbon. If I do that too much my blood pressure is high and I retain water and feel like a 65 year old who didn't ever exercise. If I stop for a few months all of the health numbers are back to normal.. Moderation is not 1 drink per day it's more like 2 drinks a week. Too much booze can really mess up your health and fast.
25
@fz1 I appreciate your honesty with yourself; too bad other comments here reflect a lack of the same.
1
I have quite a few friends (mostly white, affluent women living in suburbia, aged 30-45) who are absolutely obsessive about "chemicals" in their home/garden/food/cleaning products/etc because they vehemently believe these things cause cancer, autoimmune disorders, and a variety of other random illnesses. They eat only organic food, limit the amount of processed food, use "natural" cleaning products, no pesticides on their lawns, search for cosmetics with minimal ingredients, you get the idea. I think it's wonderful that they are so committed to "limiting exposures," because doing those things is probably a good idea, but heaven forbid you bring up their half a bottle of wine consumption every night, they will argue with you about how it's so beneficial despite it being a known carcinogen. I can't explain the cognitive dissonance.
81
@Genmed
This is absolutely a very important observation. The hypocrisy, judgemental attitudes and scientific illiteracy of the "organic" crowd is overwhelming at times.
4
@woodyrd Maybe. I happen to pay attention to eating organically. I also do not drink. At all.
1
@Genmed
Brilliant. And SO true!!! Alcohol is a deadly poison. A full glass of pure alcohol will KILL you. But somehow it's a health tonic when diluted? Madness. Everyone who has had a hangover has experienced what a terrible toxin alcohol is. The defenders of alcohol are addicts who are ashamed to admit it. I speak from experience. I quit 2 years ago, despite being a "normal" drinker. My happiness has increased immeasurably, as has my health. Thanks for great letter.
1
I haven’t read this study yet, but I’d sure be surprised if a paper published in Lancet didn’t adjust for obvious potentially confounding factors like smoking or socioeconomic status — and I suspect Dr. Carroll know this too.
4
@Diane O’Brien
Near the beginning of the article"
Observational data can be very confounded, meaning that unmeasured factors might be the actual cause of the harm. Perhaps people who drink also smoke tobacco. Perhaps people who drink are also poorer. Perhaps there are genetic differences, health differences or other factors that might be the real cause. There are techniques to analyze observational data in a more causal fashion, but none of them could be used here....
7
My father was an alcoholic for over 20 years, which was not usual for about a quarter of the government workers in D.C. Three martini lunches were not unusual for lunch during the Nixon years. Fortunately, after being warned he had one year to live, he went off alcohol cold turkey and died at age 85 having retired on a full government pension.
As a result, I rarely drink more than a glass of wine or a gin tonic on occasion, a few times a month and I am in excellent health at age 81. In my travels, however, I have found that older people in their 80's and 90's, do indeed drink two or three glasses of wine a day, usually with meals. The book "Blue Zones" describe the drinking and eating habits of old timers in different parts of the world. In my own experience I have found that red wine and garlic on a daily basis in many European countries, such as Greece and Italy, have contributed to longevity.
Personally, I'll take moderation regardless what the research says.
Just visit Europe, observe, and make your own decisions. The wine, food, and lifestyle are often superior to our own in the USA.
25
No surprise the New York Times rushes to assuage its tippling readers. How else could it, in good conscience, put out yet another article like "the ten best cabarnets to relax (inebriate) with this weekend."
Also no surprise that this comment section is full of anecdotes and justifications as to people's consumption of their favorite drug.
The continual normalization of drug consumption (vodka billboards on the highway?!) in our society is the main reason alcohol is the number one killer drug, surpassing that of opiates. That almost all victims of alcohol addiction started off as "normal" drinkers, just like all of you, is of course an inconvenient truth best left ignored.
Bottoms up! How else could you possibly "relax" but with ethanol?
29
Alcohol for many can be a gate-way drug - it can (does not always or even often open the door to other drugs). But this phenomenon does happen often enough to harm many, many people. The same is true for marijuana. Alcohol in many people is addictive, not in everyone. Alcohol is many people can result is violent behavior, it can result in reckless acts that otherwise people would not engage in.
It is also true that alcohol is a social lubricant, it results in people enjoying themselves and opening up and having more fun.
So it will be up to society to figure out this paradox. As a physician, I can attest to the idea (likely fact) that alcohol does more harm than good for society as a whole. And yes, for some individuals, it does enhance their lives..... Would those people be willing to live with a little less (not none) alcohol for the greater good?
The greater good is something we seem to care less and less about....
12
I am not a drinker. It seems to me that there are a lot of complicated motivations that are in play with habitual drinking. For drinkers, I would recommend first sorting out why you are drinking before you decide how many drinks a day you should have. The "why" is probably more than that you just enjoy a drink or two (or three or four).
6
We should view drinking alcohol the same way we should view going to war. Many call war just and beneficial and even call it necessary for peace. Well, these benefits might be plausible and might encourage us to turn to war to solve our problems, but we should state honestly that war is bad for human beings and bad for life.
Does our view of drinking alcohol oftentimes contain the same muted defense as our defense of going to war? We say we can benefit from drinking alcohol, and, yes, these benefits might be plausible and true; however, our reason should tell us that we are using something that harms us to gain benefits. Indeed, we may continue to laud drinking alcohol and laud going to war, but in each case we should state honestly that we are hoping to improve our lives by doing something that is inherently harmful.
The discussion surrounding whether or not one should drink alcohol is replete with the same lack of honesty that plagues any discussion of war. Few of us want to admit that we like engaging in an activity that is not good for any of us. Yes, we might defend the activity and even state that we want to engage in it, but we should be honest enough to mention that what we are doing is not good for us and not good for our neighbors.
So, let us drink and be merry, but let us do so in the knowledge that drinking is not good for us, just as war is not good for us.
2
Others are now noting that this enormous metastudy was poorly done. The flaws in considering motor vehicle accidents alone probably exceed the 4 harms per 100,000 subjects reported as the difference between no drinks (914 harms per 100,000) and one drink a week (918 harms per 100,000).
2
@Marvant Duhon,
I don't think the point here is that the study is poorly done. There are limitations to this study, for sure, which are limitations common to all meta-analyses of observational studies. I think what Dr. Carroll has a problem with are all the articles ABOUT this paper, that print "All Alcohol is Bad" without providing the context that 1. A drink per day is likely to only affect 4 out of every 100,000 people, and 2. This only should only apply to populations as a whole, there are a lot of individuals who will likely benefit from moderate alcohol consumption.
3
People are really weird about alcohol. If you want to drink, that's your business, but if I don't want to drink, that's also mine. Whenever I tell someone I don't drink because it doesn't do anything positive for me, they get offended, as if I have just told them their best friend is a jerk. To me, there is something deeply wrong with this.
Read up on the marketing of alcohol, an industry that spends more money on advertising than any other in the US. And they do it because it works.
If you can only have fun/relax/socialize with booze, that seems to mask a deeper life problem to me. As a former smoker, I could have said the exact same things about cigarettes people are now saying about alcohol, but if I called these "health benefits" you would rightly know I was full of it.
Don't fool yourself.
78
@rockstarkate
This is the only sensible comment that I've read.
Alcohol kills 90k people a year in America. Twice as many as opioids. Where is the outrage? The booze industry normalizes the single greatest killer in the history of mankind. Astonishing that anyone sees it differently.
The "deeper problem" for many of us is living in this country at this stage of its devolution.
I don't care how much alcohol you drink. Just don't get behind the wheel of a car after you've done so.
40
You can pry my wineglass from my cold, dead hands.
Seriously.
24
@Phyliss Dalmatian I'm sure someone will.
4
Drinking alcohol or not......we all die.
13
@Amy
Yes. So let's hasten the process.
Brilliant Amy!
From the article: "For each set of 100,000 people who have one drink a day per year, 918 can expect to experience one of the 23 alcohol-related problems in any year. Of those who drink nothing, 914 can expect to experience a problem. This means that 99,082 are unaffected, and 914 will have an issue no matter what."
I found this quote particularly interesting because it suggests the possibility that the authors of the study may not have complete understanding of statistics and probability. Let's examine one possible "problem" type, falling. Drinkers fall. But non-drinkers fall as well. If they're falling at what appears to be more or less at the same rate, you can't attribute the rate of falling to drinking alcohol because drinkers and non-drinkers are falling at the same rate. But the measurement of falling can be taken out of context and falls can be attributed to alcohol use when in fact falling by drinkers is at or near baseline rates. That would mean the Lancet study had a finding that could be interpreted as "statistical noise" and not a finding of a causal or even a predictive relationship.
5
I once heard that you increase your chances for success by decreasing your chances for failure.
8
This may already be here, but contrary to the author's point, as linked in the article, the ancient physician Hippocrates said, “Let food be thy medicine and medicine be thy food.”
4
Alcohol does nothing good for the body. It is toxic.
10
Numerous research studies beg to differ with you.
2
@Gary Pahl There is no research study anywhere that shows that any benefit to alcohol is not outweighed by the harm.
1
It is much easier to make measurements than to know exactly what you are measuring. - JWN Sullivan, Physicist c.1925
18
As a UK professor said..."there is no safe level of driving and we wouldn't advise people not to drive" and ...." come to think of it there is no safe level of living and we wouldn't advise people not to live"
But in this country alcohol is now comparatively inexpensive and more readily available than when I was young and I'm sure that's a factor in increased consumption with associated morbidity.
4
If you follow every single health guidance you may not live any longer but it will seem that way.
44
There is nothing more annoying than the childish comments like “Well pour me another glass of wine” on this article and other ones I’ve read in the NYT in the past. When confronted with study after study and when faults in the study that said a glass of wine a day or two beers a day for men shows health benefits. (Two beers a day? If that’s not an alcoholic I don’t know what is).
Americans need to examine their relationship with alcohol. Why is it even necessary?
6
I drink two beers a day often in the summer.
I am not an alcoholic.
23
You're right. You don't know.
4
@Nadir
Alcoholics drink a lot more than 2 beers daily.
2
Readers should know that alcohol is problematic in many ways.
It is:
* Addictive
* Blurs judgement and executive control functions of the brain beginning with the very first drink
* Carcinogenic See https://ntp.niehs.nih.gov/pubhealth/roc/index-1.html
* involved in about 10,000 vehicle deaths per year in the U.S.A.
10
As a nurse I'd rather see people smoke than drink. You can have 12 cigs a day and not hurt your wife, kids, job loss, healthcare costs etc....the society affects are much greater. Also why does alcohol have to be primary feature in visual media? Last week in a magazine was promoting kid time in the yard, yet front and center was a tub filled with wine bottles.....really.....can't play with your children w/o drinking! This is just one small example of the "over the top" of front and center alcohol promotion.
7
@Calleen Do you mean become an alcoholic instead of smoke, or drink occasionally instead of smoke? There are the risks of second-hand smoke, the economic loss from buying expensive cigarettes, the modern societal stigma of smoking in public, and the time spent taking smoke breaks can almost certainly slow down a career over a long period of time. And the healthcare costs for smokers must be huge! The occasional alcoholic drink is far less worse than smoking cigarettes, but alcoholism, is, of course, another story.
12
My father was a hard working, successful businessman, who enjoyed a strong drink(or several) in the evening his whole life. He lived to be 96 and was mentally sharp to the end. My brother died from alcoholism - he couldn't stop drinking despite a lot of therapy etc. I've seen the best and worst of alcohol in my own family. It is clearly a mixed bag.
Education about the hazards is the best program. We know prohibition doesn't work.
Some people say "I don't do drugs - I drink" - oblivious to the fact that alcohol is in fact a very dangerous drug. The beverage industry has cleverly avoided the drug label it certainly owns.
This needs to change.
We encourage alcohol drug use/abuse with billions of dollars in advertising, yet piously and ignorantly whine about drug use.
182
@Paul Shindler
Do we really know that prohibition doesn't work? It seems that the forces that pushed for prohibition have never left us, and that the lesson they took was that their approach didn't work. They have not tired of trying others.
So it seems this meta-study wasn't so much news as it was the endless filler required to feed the insatiable "beast" that the 24-hour news cycle has become? Got it.
5
What actually astounds me is the lengths that every news organization has gone to to attempt to minimize the findings of this study. We know that alcohol is simply bad for you, in any amount. Is drinking so important to us that we go through such mental gymnastics to avoid acknowledging the consequences?
15
Many people are injured or killed in auto accidents each year. No amount of driving can be considered safe to engage in.
1
How many of those accidents are caused by drunk driving?
7
How many of those accidents are caused by people who just can't put their cellphones away while they drive?
11
It seems detailed explanations and reasons to ignore a research study are only given when you’re not happy with the results.
Most research projects are imperfect. Yet there is plenty of sanctimony to go around despite flimsy evidence. Welcome to the club, alcohol lovers. Now it’s your turn to explain your choices.
3
Re. "If we want fresh knowledge, a big randomized controlled trial of light to moderate drinking may be needed. One was in the works recently, but it was shut down after The New York Times reported on ethical concerns about the way it was being pitched to and funded by industry." Ethical concerns were far from the only problem with the proposed study. It was also confined to a small segment of the population, excluded nondrinkers, and was looking only at cardiovascular risks, so results would not have included problems related to cancer, liver disease, accidental trauma, etc. In other words, it was a study skewed toward discovering positive findings associated with alcohol use (which of course is what the public would take from the reported results). Better designed prospective studies would include a wider age range and look at a broader range of outcomes that included some of the expected adverse consequences. But doubt there will be $$ to support them,
3
If results are so open to interpretation, then they have little meaning to the individual - and perhaps the decision should be made on other factors. It is also more than possible that there are differing effects for different groups. Europeans adapted to alcohol over centuries as cities made clean water impossible for most people. Introducing alcohol to other cultures harmed them greatly.
My goal is to improve my own time on this earth. 1-2 beers a night does that. They might have negative consequences, but I doubt it. For others, the regime could be toxic. You pay your money, and you take your chance.
2
@fred
I don't think one or two beers a night is going to hurt you, unless it makes you gain weight.
As soon as I read the Washington Post article about this study I said to myself, "I can't wait for Aaron Carroll to write an article giving us his measured, balanced, anti-alarmist take on this study." And you didn't disappoint, Dr. Carroll. You've sifted through the data to help us understand the statistical difference between absolute and relative risks for health behaviors. And yet again, you've shown us that we should always take these news-getting headlines with a grain of salt by looking more closely at the data. Great work as always, as I've come to expect from you.
For readers who like this measured approach to health news, you really should check out Dr. Carroll's YouTube channel, Healthcare Triage. I'm a fan.
30
I enjoy a single drink just about every night. My grandmother did and I picked up the ritual from her. She lived to 93. Of course this is anecdotal, and means nothing, a coincidence.
It seems reasonable to accept that drinking is not actually good for us. Yikes! Yes, but reasonable to conclude that its not. We drink because it makes us feel good. Common sense says lets not pretend otherwise. If we were really drinking to help heart disease we would take an aspirin each night instead and skip all the sugar, calories, other side effects, etc. I tire of drinkers and the various alcohol industries obfuscating this likelihood. It feels like a sloooow burn revelation, akin but slower than the tobacco industry's denials. Drinkers, though, as a group, are experts at denial, so this might take a while. Regardless, I'll still have my evening drink because...I like it! No other reason required.
42
"Moderate alcohol consumption is associated with certain improved risk factors for health (which this study confirms), but this is not the same as recommending that people drink."
Except that using the phrase "improved risk factors for health" ends up doing just that. In the 30 years since the "French paradox" idea took hold in America, the notion that alcohol was another food group and part of a healthy diet has absolutely become common. I don't think it's a matter of "staying calm" as much as sobering up to the facts, one of which is that those touted health benefits actually acrue to people with otherwise unhealthy habits; those already eating well and exercising are less likely to reap benefits.
5
@Blair:I agree with you. At some point people (experts as well as just plain people) decided alcohol was necessary for life. Not just a happy life, but, for living at all. Often it is said that at least 1 drink a day is needed to keep your sanity in this world. Nothing else will do. Gramma did it, so it must be true. Now some people are addicted to things that ARE necessary for life. They actually have a much harder time than any alcoholic. Take food. Can’t give it up, you will die. So, you must, with an iron hand control it. So, when talking to someone about alcohol, who asks ‘how do I know if I’m an alcoholic’. I say, ‘is it, to YOU, necessary for life.’ They always say ‘no’. Then I ask how often they drink, how much when they do, do they feel as if they must control it. I suggest they look into it. For NO it is not necessary for life. My folks had 1 half of the smallest brandy snifters I have ever seen with either Port or Sherry, each night before dinner. A ritual for them. Only an ounce, maybe 2. When my mother became ill they both gave it up without a thought. It was nice, a ritual, but not necessary. She smoked 2 packs a day of cigarettes. Had for 50 years (not what killed her). She knew she was addicted, but, they WERE necessary to her for her life. In the end she was afraid to use oxygen all the time as she needed. Afraid she’d get addicted. I say ‘if you must be addicted to something, to live life, make it oxygen’. Your family will miss you, if you don’t’.
This is a population-level study, but the results are being interpreted at an individual level.
4
Most issues the medical profession warns us of have to be taken seriously as we have no other reference point. Over time and especially recently with unending so called studies people are reeling to absorb it all. Try as the Medical profession may, their history of changing their guidelines and instructions is considerable. Blood pressure guidelines are a prime example. First 140 90 or less was okay now its dropped to 120/80 or less adding some millions to require drugs. Statins, and drugs to treat menopause are up in the air. The list with food stuffs is endless and confusing. Obviously there are Alcoholics who damage their health especially their liver. As a senior I only know if twice. Point being most people have common sense and enjoy social drinking or used as a relaxant. Every published drinking guide lines look at them there all over the map.
1
@Dan Green: To be truthful, if someone needs a relaxant give them a choice: alcohol, marijuana, opioids. They are all the same. Effect the same part of the brain. Saying one is better or worse is lying. All have the potential to kill you in nasty ways, some of which can take others with you, even strangers. If you need a relaxant, 1 find out why & if possible change it, if not, admit you are dealing with a mental illness & take the proper medication. Say anti-anxiety meds. Taken properly they don’t numb you, they just loosen that ball of pain in your gut.
For the medical profession. We demand new meds for all things regularly. We demand higher doses. So, they hurry their research to give us what we demand. Sometimes, with newer tests, newer research, they find that these drugs are NOT good. That the higher blood pressure isn’t good, but, most people won’t do what is necessary to lower it naturally (get a less stressful job for instance, or a divorce, or stop screaming at people who cut you off on the road). So, they need pills. Active Alcoholics kill not only themselves, they destroy their families, kill strangers, which in turn destroys other families. All ‘street drugs’ do that & alcohol is just the oldest. So, go to a used bookstore, buy a book on what’s good for you written in the 1700’s & do only those things. Nothing newer. No surgery, no antiseptics, no antibiotics, no repairing broken bones internally (surgery). Live that way. But, only eat foods available then.
1
Thank you for bringing some rationality to this discussion.
The study in question had so many flaws that it is questionable whether it means anything at all. As you say, we need a controlled study to get real information; studies of this kind just mislead those who don't understand the vast difference in significance between controlled and uncontrolled studies.
And we have as well to avoid confusing minor risks with substantial ones. We take a risk when we drive to the theater to see a movie, or go skiing, or play soccer. There is an immense difference in risk between having a beer while watching the game and binge drinking or alcoholism.
7
Re. "The study in question had so many flaws that it is questionable whether it means anything at all" - that's an overstatement. The results are supported by many individual studies. Dr. Carroll does a good job of parsing out the fact that the increased risks of 1-2 drinks a day are present, but very small, and will vary based on other individual factors (genetics, lifestyle risks, etc.). The study is a useful counterbalance to the widespread (but incorrect) notion that 1-2 drinks a day are indisputably good for you - a notion the alcohol industry was happy to promote.
7
@John P
It's just a meta analysis of observational studies, and as such not worth terribly much, as Dr. Carroll points out. There are too man confounders.
Furthermore, from what I've read (I haven't seen the original study), the effects of low levels of alcohol are just an extrapolation from population averages. If so, that's unwarranted as it presupposes linearity or a curve fit. That might be valid for something like the relationship between alcohol and oral cancer, say, but not for driving risk or cirrhosis.
Which isn't to say that the "two drinks a day are good for you" studies are any better. I wish the press would stop paying so much attention to observational studies or at least point out their inadequacy, because the public has been led wrong by them again and again.
2
I’m 85 years old and I can’t imagine what my life would’ve been like without alcohol. I’ve had ,and still have, more belly laughs and more fun with alcohol with friends and family over the years and that’s excellent for my mental health. I do not advocate “drinking to get drunk“ that college kids like. But hopefully that’s a short stage. Each person has to decide for themselves what their limits are. And if they can’t regulate themselves, then they need help.
68
If you are speaking in terms of “having to know one’s limits” about alcohol, then things have already gone too far! Maybe (maybe!) have a drink — if you don’t go beyond that, you don’t need to worry about “limits”!
@Mary Churchill
How sad that you ever needed alcohol to laugh with friends. I quit drinking 2 years ago and laugh a hundred times more now. No question my happiness has massively increased. We need to stop celebrating this legal drug that kills 90k people a year in this country alone. Nobody's laughing about the ruined lives and ruined marriages, that alcohol consistently creates. You can do what you want with your life, but please be honest about how awful alcohol is for this world.
Excellent article! Touched on all virtually every important aspect relating to the Lancet article in clear accessible language.
By personal choice, I’ve been a teetotaler for many years. But I don’t advise abstinence either, unless I perceive addictive use or health issues that alcohol may impact. The social benefits or sense of relaxation in moderation drinkers may well be worth 1 to 3 days lost longevity in an 80 year lifetime.
I would disagree we need more research on this issue, though. Every research report published concludes the need for more research.
12
When I saw the headlines for the study reported here, my reaction was "sigh.....another correlational study." And it was. Correlations are only one step above anecdotes in terms of providing useful data. They should be seen as hypotheses to examine, not results to report.
Thank you for this analysis Dr. Carroll. Unfortunately, it won't be broadcast as widely as was the original study.
Another culprit is the concept of statistical significance. With a large enough sample, insignificant differences can achieve statistical significance.
So, Dr. Carroll provided us with the remedy: proportions. In other words, what proportion of people who have one drink a day will experience harm? And further, comparisons are needed, such as the one provided about deserts. To understand the proportions regarding alcohol consumption comparisons are needed, such as what proportion of people who overeat by 500 calories per day experience harm? What proportion of people who drive over 50 miles/day experience harm? What proportion of people who exercise less than 30 minutes/day experience harm? What proportion of people who don't enough enough fiber each day experience harm?
Providing these kinds of data would be more useful than simply reporting the correlations from a meta-analysis.
20
Aaron Carroll's analysis should have been accompanied by a disclosure statement: does he or does he not drink alcohol himself? Because his assessment of these findings is surely influenced by his own views about alcohol, whether he likes it or not.
I disagree with Carroll's hedging on the study's significance. It is important and significant. Alcohol gives great pleasure, but with the very first sip, the risks begin. So many harmful behaviors and consequences are associated with alcohol consumption—irritability rising to anger, faltering coordination leading to accident, deterioration of useful inhibition leading to sexual indiscretion or sexual assault—and these behavioral risks on top of the accumulating evidence of alcohol's known effects on healthy organ and cell function.
By all means, enjoy your drink. But don't delude yourself about the consequences.
11
@Civres
I applaud you for stating that which I always state whenever we face information that is plausible but contrary to our desires. You write, "By all means, enjoy your drink. But don't delude yourself about the consequences."
Yes, alcohol is actually a poison, something that is toxic to our bodies and that causes the body great difficulty in metabolic functioning. Nevertheless, people enjoy drinking alcoholic beverages and even defend doing so by pointing to the so-called benefits of drinking a poison. That's fine; people may claim that they have enjoyed the benefits of drinking alcohol, but they should state in that same claim that they are aware of the contradiction that exists in finding any benefit in drinking something that can cause one's body harm.
It's the same way we should view war. Many call war just and beneficial and even call it necessary for peace. Well, these benefits might be plausible and might encourage us to turn to war to solve our problems, but we should state honestly that war is bad for human beings and bad for life.
1
@Civres
Sorry to contradict you, most people who are modest drinkers will stay modest drinkers all their lives. One should distinguish also between the forms of alkohol consumed. What should be analyzed is the social context, for instance:
Is drunken behavior accepted by society?
Is alcohol consumed only with food?
Is there a tradition of binge drinking?
As long as in statistics the only parameter considered is the number of drinks per week I can only say:
Garbage in, garbage out!
4
In the past, it was shown in studies that MDs who smoked were much less likely to counsel their patients to stop. I suspect it is the same story for alcohol.
The study doesn’t bother me in the least. Another glass of wine please!
6
Ethyl Alcohol is a solvent. It can't be good for an organic body.
5
Thank you for some common sense about drinking alcohol.
6
I think a study examining the role of alcohol in our lives would be more enlightening. It would explain why it’s so important to most people and why we won’t consider giving it up, or even cutting down on our intake. It is a toxin with pleasant effects. Most people know this and opt for the effect.
19
Interpreting research is not so simple. Unfortunately most of us don't have the skills to critically read research results and consequently might buy in to misinformation. Thanks for the article!
16
I think the problem is that these studies identify correlations, and most of us mere mortals confuse correlation with cause. We confuse “risk factor” with risky behavior, two very different things. Jumping from a plane is risky business, but getting out of bed in the morning is a risk factor for falling down the stairs. The issue is really more about information and risk management. You can’t manage risks you don’t know about. We routinely manage known risks - driving a car, crossing the road, running, kayaking, eating poutine or raw seafood. Take this study as another source of information, have a glass of wine, and relax.
10
If drinking wine increases one's risk of cancer, why don't we see more cancer in France and Italy where wine with dinner is the norm? Could there be factors such as fewer chemicals and more nutrition in the food and the conviviality around the table? Be wary of all or nothing headlines.
84
@Virginia Richter
Good points. Made me also think of my German ancestors, and todays Germans growing up drinking beer.Oh well I am old enough to remember " Doctors prefer Camels." Now of course smoking dope is okay.
3
There was a time in the 90s when '60 Minutes' ran an uplifting high on the benefits of red wine. Needless to say, the liquor store in the neighborhood was booming with 'yuppies' making rich cases to the happy vendors.
'Moderation' in America is a foreign word. Your risk may be different sounds correct, and a friend who shows little tolerance and possibly an allergic reaction for fortifying beverages, is lapping up this latest panic, much to my relief.
On a side note, recently there has been an excellent campaign. aimed at the health benefits of drinking more water and less sugary drinks. Let us keep up the momentum, if only for the sake of our children.
6
100% of people will experience medical problems during their lives unless they die prematurely by trauma. As my young nephew once observed, you can only escape death for so long. Living well is the brass ring, be one’s life long or short.
73
Thank you, Dr. Carroll, for pulling back the curtain on this study. Medical "news" is reported in a special way as if it were the Ten Commandments on tablets. Reporters, wanting to be published and wanting a bigger headline, often search for the sexiest way to interpret the data.
The biggest skew I found was the information which, while true, was peddled to doctors in practice. Drug companies were especially fond of relative risk reduction--"OMNIWHOMP reduced XXX 42% better than all all drugs"--and failed to put such data into more meaningful terms like ABSOLUTE risk reduction or calculating the NNT or NNH (number needed to treat or number needed to harm, an expression of the number of patients who would need to be treated by OMNIWHOMP to see this effect.
Just as bad but in a different way is direct-to-patient advertising, marketing which radically alters the patient visit when the patient's concern is OMNIWHOMP and not his health per se.
For me, I will continue a bedtime tipple with full acceptance of the additional 4 in 100,000 risk.
19
I was slightly less comforted by that tiny number when I twigged that it was the additional risk _per year_. Personally, I don't want to get through the next year without cancer or a stroke - I want to get through a few decades of being in the 99,000 or so who don't suffer. The additional risk is still small, but they're not so comfortingly teeny-tiny.
Alcohol is the third leading cause of preventable death in the United States. It killed 88,000 people last year. It’s negative effects are familial, even generational. For what it’s done to my family, I’d liken it to heroin or other opioids rather than dessert.
41
@Lauralee: it is just like all mood altering drugs. It’s just the oldest. If it had been kept as an antiseptic & never drunk think how many millions would be alive today. Many who never drank a drop, but, happened to be walking beside the road when a driver, drunk, went weaving by.
Thanks for a great dissection of the risks - but we shouldn’t berate the media too much for exaggerating the findings - the Lancet article itself says point blank about alcohol: “the level of consumption that minimises health loss is zero”.
7
@John Herring
Well said. "Acceptable male consumption of 3.2 drinks/day" notably when a "drink" over contains much more than 3.4 oz of wine. That consumption should pass as alcoholism. That correlates with abnormal rise in cholesterol/triglycerides, blood sugar, metabolic syndrome, hypertension. Forget the cancer risk, heart attack and stroke will get you before that, or divorce, auto accident, etc. The added benefit of cessation is a lower food and beverage cost/month.
3
@Jimd: And just think, you can actually taste the delicious food you otherwise stuff in your face to prove you aren’t a drunk, in a restaurant who’s food is horrible, but, who’s liquor is divine.
Since this was a meta analysis that rolled up several studies I can only believe it also incorporated the design flaws of those studies. In other words likely flawed.
These are the days of Code Orange; everyone needs a drink.
25
@D Priest: I don’t. The times they are atrocious. But, I’d rather face the end of the world sober than just wake up dead.
Comparing alcohol to dessert is disingenuous. One is a psychoactive drug and another is food. We could apply the same rationalization to cocaine or LSD using same logic. If alcohol were to be discovered only 50 years back it would definitely have been classified along with other drugs instead of with food. I haven’t heard of anyone getting addicted to donut and squandering all their hard earned money on it. Just because something is familiar to us doesn’t make it any less of a drug and is definitely much worse than substances like Marijuana.
5
Though sugar occurs in food, it also produces the same neural rewards as nicotine, cocaine, heroin and alcohol. Its excess consumption is pushed by soda and candy manufacturers, who are in fact major drug distributors.
26
@RG: Guess what alcohol metabolizes into? Sugar. I’d rather get mine unadulterated. Besides now it’s almost the only think I’m allowed to eat. No beef, pork, shellfish, tiny amounts of fish due to the ‘good’ in fish (could just take Omega 3 pills), no high end (fatty) dairy (butter, cream, ice cream, cheese). It is amazing how little is left. Oh, my health problem? One that in the past only Rich old fat men got. And I am none of those. Gout. Now a form of arthritis. Not just in big toes anymore either. I’m getting so sick of poultry I could scream. Oh don’t suggest I go vegetarian or vegan. MY gut won’t process many vegetables. Another problem. Oh, no eggs. If you are pining for ice cream, try what is now known as low fat ice cream, formerly known as ice milk in my youth, tastes better too. Sorry Ben, Sorry Jerry, won’t be visiting you anytime soon. See alcohol isn’t necessary for life, food is. Take 2/3rds away & you wonder if life IS worth living. Small stomach, always hungry now.
2
Winston Churchill abstained from NON-alcoholic drinks, but--alas--only lived until the age of 90.
44
@John Webb
Willie Nelson "there are more old drunks than old doctors".
15
So I guess I’d better have another round.
1
So an alcoholic, fully loaded, crashes his car into a teetotaler and lives and the teetotaler is dead. How does this affect the statistical outcome?
7
The National Highway Traffic Safety Administration counts that as an alcohol-related traffic fatality. That's how it affects the statistical outcome. It is also worth noting that if an impaired driver is sitting at a red light and is, without any fault, rear-ended by a driver who wasn't looking forward (texting?), that also counts towards the alcohol-related traffic incidents, as would a twenty-car pileup in a fogbank involving some impaired drivers.
I doubt that traffic accidents involving blameless impaired drivers are a significant component of the statistics, and it makes sense that NHTSA doesn't subjectively decide in each case whether alcohol caused the crash. Just saying this is how the NHTSA compiles its stats.
3
Terrific. Just when there is a microbrewery on every corner, and the countryside is filled with vineyards, they tell us that alcohol is bad for us. Every single drink. Just like cigarettes.
How are you supposed to make a living in this country? We can't all work in health care.
Oh, well, the sooner we die, the longer social security and Medicare will hold out. As someone said, the problem with living longer is all the added days are at the end.
I have spent time visiting in nursing homes. Most of those people are on an awful lot of drugs, and none of them are as much fun as alcohol. I think I will continue to go to that lovely winery near me, listen to music, and have a glass or two.
282
@MayCoble you have a great sense of humor!
1
“No safe level of ...” is a misused expression, especially is this study. While a drink a day might be in the noise level of all the other risks we deal with on a daily basis, for a known carcinogen like asbestos, a single exposure over a lifetime carries a significant threat of cancer above and beyond all other normal daily risks. So “no safe level of asbestos exposure” carries actionable significance, “no safe level of alcohol consumption “ points only to the quirks Of the statistical methods employed. Avoid all asbestos and you won’t get mesothelioma, stop drinking that one glass of wine a day and your life’s risk profile is unchanged.
24
I think this is at least the second time that you have written an article saying that drinking is not that bad for you.
I am a cancer survivor and I have been told by more than one oncologist that drinking is a serious risk factor for breast cancer and that if I want to reduce my risk of recurrence I should not drink at all.
Alcohol is a risk. If you have no other risk factors perhaps the increased risk due to alcohol is not something to worry about.
But to say that most people should not worry, is just not accurate.
I find it amazing that so many people are FREAKED out about not drinking.
If you can not easily give up alcohol, then you have a problem.
My suggestion, ask your doctor to discuss all of your health risk factors. If there are many that you can not control, family history and personal health history, then perhaps it makes sense to reduce all the risk factors you can control, i.e. alcohol.
64
@Liza
So you're willing to stop going to the beach because you might be washed away by a tsunami?
Life is full of risks. The question is which risks are substantial or not, and most of us don't want to live like monks just to avoid the minor ones.
12
@Liza
Yes, yes, yes!
You have written one of the few sensible letters here.
Alcohol is a killer. By FAR the most deadly drug on earth. 90k deaths a year in America alone! And as my doctor says: "No physician will ever recommend that you START drinking!"
What I see in articles like this, and the responses: people thrilled for an excuse to normalize an addiction that they are frankly ashamed of.
1
Always as we get on in years with every release of new findings that refute the earlier ones - it decreases the impact of what it means to us as individuals— unless of course there is new data or new methods of analysis that improve understanding.
That being said, in another context, there is something to the enjoyment of life with some fun and food with a toast of delicious wine or a brew that lightens our otherwise often depressing world.
As my nearly 80 year old mother-in-law said, “one day you have to stop fighting with yourself and all the advice, and just live well with enjoyment! The world could end tomorrow, and where would you be?”
There’s something to that... at least it got me thinking. I’m 64. She is nearly 80.
Things that make you go “hmmmm”. I’ll toast to that!
18
Hi from New Zealand, where we have some wonderful craft beers and wine. Drunk in moderation, and in good company, and with good food, I would have thought that the social contact and the craic do more to prolong and enrichen life. Isn't there a recent study (in Sardinia?) that indicated that close community was perhaps more important in longevity?
67
Thank you, Professor Carroll, for a well- reasoned analysis. However, one significant factor is often excluded from such articles; the quality of life rather than the quantity. I am 79 years old and I enjoy a bottle of two of beer daily. I love the taste, the stimulation and the conviviality of the company. I could abstain, live a few weeks longer but with a markedly reduced life quality of deprivation.
244
Cheers!
2
A good example of highly publicized conclusions based on known flaws of statistical methods with meta-analysis, especially without digging below the article title. Thanks Dr. Carroll.
15
The number of times I have heard "I know the data isn't good, but its the only data we have..." followed by the inevitable analysis and distribution of a report that we all could have done without...
6
Papers and news articles on the dangers of drink puzzle me. The Japanese, the French and Scandinavians are drinkers but they're healthier than the non-drinkers of the Middle East-- not as obese, live longer, etc. Why not see our diets (food and drink) as akin to portfolios? You should evaluate the performance of a portfolio as a whole, not judge it by particular stocks and bonds in it.
113
“The first sign of an emerging civilization is the prodigious use of alcohol.”
Words of wisdom lifted from a sign hanging in a long defunct San Francisco waterfront bar.
6
It’s the “moderate” part that some people have difficulty with.
11
Thank you for this clarification.
2
I am intrigued that no one, other than myself, seems to regard as peculiar the level of "one drink a day" as some kind of lower boundary. I quite enjoy a good beer, a good wine, and a good single-malt whisky. Very occasionally, I may also indulge in an actual cocktail. But I don't have any of them *every day*. Probably I average about twice a week. I am 70 years old and in excellent health.
9
For older women, more than 1 drink a day is too much. I often advise my patients to drink even less as many have health conditions and medications which are adversely impacted by alcohol.
1
I think this would be a fun time to evaluate our responses.
A large number of people will merely dismiss these reports.
But please take into consideration that alcoholics must all consider, at some
point if they are capable of becoming a person that never drinks alcohol again.
And those that fail will still be judged at this late date as suffering from a lack of will power.
Addiction is a disease, and a powerful one.
The more we treat it as a disease, the more successful we will become in treating it.
What if, on the end of this report, it was strongly advised that no one ever consumes alcohol again.
Could you become that person, on your own?
12
@Jann McCarthy
I could, but I'm fortunate to not have alcoholism to contend with. I have maybe one drink every couple months and use wine as a cooking ingredient. I'd miss it as a cooking ingredient more than as a drink.
I don't claim any virtue for this, just lucky genetics, but I do exist and for me it wouldn't be hard.
Alcoholism needs to be recognized as a chronic disease that the sufferer's need support to manage.
3
I think we need to take into account the quality of alcohol consumed—is it organic red wine, or liquor or beer made with pesticide-laden ingredients? And what is the person’s liver-burden to begin with? I bet these are significant considerations.
8
People really need to learn about statistics. Meta-analysis sounds impressive but the tone and tenor of the article in question don't actually deal with statistical usage of alcohol.
The statistical data I have found says that about 30% of the population regularly (perhaps daily) drinks at least one alcoholic beverage. Of that 30%, a sub-30% become addicted to alcohol or about 10% of the population will have an alcohol and/or drug abuse problem. As Carrroll noted, this study got headlines.
70% of the population rarely or never drinks alcohol. Personally, I'm good for a glass of wine at Christmas - does that really put me in jeopardy of an alcohol related injury or death?
We cannot minimize the devastation caused by substance abuse but we don't need a total ban on alcohol - actually we tried that and it did not work.
What we need to do is stop seeing substance abuse as a moral-failure. It is a disease for which we do not completely understand the cause. What is different about that 10% that have serious problems? That is where the focus of our efforts and studies need to be applied. Unfortunately, getting the government to fund research into the real causes of addiction runs into the folks who simply claim that it is a moral-failure and those people have to help themselves. That hasn't worked either.
24
If only 4 in 100,000 people who consume a drink a day may have a problem caused by the drinking, according to this study, how is it that you say in the same paragraph that for each set of 100,000 people who have one drink a day per year, 918 can expect to experience one of the 23 alcohol-related problems in any year?
Did you mean to say that 4 more people will have some problem from one drink per day over non-drinkers?
Of course, this is quantitative, not qualitative, comparison of problems.
4
You mean articles are written to attract attention and the headline does not always give the whole story???
15
If Disraeli were around today, I'm pretty sure his comment would be altered in the direction of "Lies, damned lies, statistics, models, and meta-analyses."
And Pope: "Drink deep, or taste not the Pierian spring; a little learning makes you a sophomore for eternity."
10
I disagree with the author. Food is Medicine. That's how our bodies operates... on the food we consume.
13
It's Groundhogs Day at the health desk once again.
1. First, we are told that something is really good for us in moderation.
2. Then, we receive news that it's really bad for us.
3. Finally, we are told that it's not that bad and that there are other factors at play.
4. Rinse & repeat.
We now have 3 articles to publish, read, and decipher boosting SEO and advertising revenue while just confusing the rest of us. Perfect.
12
so zero drinks has the best outcome, what's the point of life then?
14
@JA "To crush your enemies, see them driven before you and to hear the lamentations of their women"-Conan the Barbarian
10
Live longer than anyone else so you can lord it over them with your virtuousness. Who cares? Get a life, people.
1
Be handy to have a calculaor where you put in how many ounces of alcohol a day you drink and it estimates your increased risk. Better ounces of alcohol than “drinks” since “drinks” come in varying sizes and strengths.
1
These meta-studies remind me of Sophocles Oedipus at Collona:
“Not to be born at all
Is best, far best that can befall,
Next best, when born, with least delay
To trace the backward way.
For when youth passes with its giddy train,
Troubles on troubles follow, toils on toils,
Pain, pain forever pain;
And none escapes life's coils.
Envy, sedition, strife,
Carnage and war, make up the tale of life.”
Sure, when put that way, he's right. But that hasn't kept generation after generation, from time immemorial, from trying to have their own good time.
20
There is no safe number of times that you can cross the street. Each time you cross the street it increases the risk of being struck by a vehicle.
There are risks in everything we do. Our ability to judge relative risk gets lost in the noise.
88
Each time you cross a street you have a risk of being struck by a vehicle, but this risk does not go up each time you cross. Risk does not remember you crossed before. Under the same circumstances risk remains the same for each crossing.
60
@Oliver Herfort
But the more streets you cross the more risk you have. The total risk increases linearly. If I understood correctly this study suggests that drinking risks increase less than linearly. The 2nd drink causes less harm than the first. That is contrary to common belief, that the problem is binging.
3
@Marcelo I highly doubt it increases linearly, as the probability would eventually exceed 1. If p is the probability of crossing safely, the probability of crossing safely n times, assuming that each crossing doesn't affect the safety of the next, is p^n or p to the n-th power. The probability of being hit on the n+1 crossing than would be p^n * (1-p). I don't see any sign of linearity there, unless you think in log scale.
3
I’ve always been envious of those who are able to drink only the healthy amount of alcohol.
They are probably some of the luckiest people in the world but seem to be extremely difficult to find.
10
@Al Most drinkers do drink in moderation. But about 10% have real problems with drinking too much.
6
The Lancet study and others are important because they demonstrate that no alcohol is healthier than moderate alcohol. For many years it was widely stated that moderate drinkers are healthier (live longer) than non-drinkers. When former heavy drinkers who stopped drinking are taken into account, the supposed health advantage of moderate drinking disappears. So the risks from moderate alcohol consumption may be small, but they do exist. People may want to adjust their alcohol consumption accordingly.
18
@Benito, I'm not sure your capsule summary is correct. They do demonstrate that your risks from the "23 different alcohol-related health problems" is higher if you consume any alcohol. But what about your risks from all the non-alcohol-related health problems that weren't included? There have been publications suggesting that moderate alcohol consumption is preventive for some cancers and heart disease.
It's the overall risk of morbidity and mortality that should be considered, not the risk of isolated medical conditions.
15
@Benito: However, even if true that moderate alcohol consumption may be present, how do they compare with other behaviors that people have control over? Which would you be better off doing? moving from moderate alcohol consumption to no consumption or any of the following? Stop skiing, stop eating sugar, stop being inactive, stop smoking, stop doing mountain climbing, stop eating red meat, stop using marijuana, stop using opioids, stop being over weight, stop owning a gun, stop running marathons, stop hiking alone, stop texting while driving, stop road cycling, etc. etc.?
There is a relative risk to virtually all behaviors. How does the relative risk of moderate alcohol consumption compare with these, and all of the other hundreds of risky behaviors we engage in compare?
To focus on only one behavior (alcohol) may be an illustration of the answer to the old saying: How much is too much alcohol? Answer: More than I drink.
People who don't engage in certain types of risky behaviors often believe that others should not either. But they don't stop their own types nearly as easily as they say others. Or to quote Mark Twain: "Nothing needs changing so much as other peoples' habits."
2
Thanks for this analysis.
We need this with every new announcement that upends conventional wisdom, especially when it relates to medical decisions
It's not bad to remind people that alcohol can cause massive problems, medical, social and societal. Despite warnings as from the last announcement, we tend overall to downplay the amount of damage it causes. But if the message gets sensationalized- the norm in most media - it needlessly alarms some ( probably those who have no problem anyway) and generates a backlash.
19
The lancet meta-study is available to all without subscription:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310...
The graphs don't justify the dire warnings regarding low consumption of alcohol. Without knowledge of the quality and context of the studies used as a base, I see only a lot of statistical noise. Thank you Dr. Carroll for your voice of reason!
53
The real problem is that the study does not support the media's sensationalized conclusions. What was found was a correlation, not a causation.
21
These studies are a waist of time, money and news space. People are going to continue to drink; quantities and the groups that do or don't consume will vary as they have for centuries. It is enjoyable. I'm so tired of health scolds.
16
@TED338 But then you don't need to read this stuff and can keep puffin your smokes and sipping your whiskey. This is for people who care. There's plenty of them. This is no new prohibition.
2
As with all things, dose makes the poison.
If you were inclined to read the study and are capable of modifying your behavior as a result of it's findings, you probably don't have a problem and aren't at risk from ill health effects from the alcohol you consume.
That said, the vast majority of alcohol purchased is ingested by someone with a problem. They can't stop at the 1 per day or 1 per week level. We need less research in identifying a 'safe level' of consumption and more research into methods to help those with a drinking problem.
21
Frank Shorter drank two liters of beer the night before he won the gold medal in the marathon in Munich in 1972.
6
@Jim Noonan And I wonder how many more
to replenish and celebrate after. Those must have hit the spot. Looking back, the early '70s were great that way. Let's not forget Dock Ellis' 1970 no-hitter on acid.
5
Do the studies count highway deaths and the destruction of individual and families’ lives?
2
Yes. They assumed alcohol-related accidents at US rates. That was an aspect of the meta-analysis that this article suggested was open to question.
18
@Mike Indeed, the data (such as it is) suggests quite a lot of variation in alcohol-related accidents across the world, as well as considerable variation in how the data is collected - or created might be a better word. It is quite possible that the extrapolation of the US rate distorts the overall findings of the meta-analysis, though we don't know in which direction. We could note that some of the highest traffic accident rates - in general - are in countries such as Saudi Arabia, Iran and Iraq, where alcohol consumption is negligible. Perhaps oil is the culprit liquid?
3
This provides needed perspective, that initial reports in the press lack. The press, and the people who read it, should take a breath and put things in proportion, as this article does.
30
We, the US, rate at about 48th in the world regarding alcohol consumption. European countries dominate the top 20; all with longevity rates which exceed America, especially, Italy, France, and Spain; Germany also with their beer. In fact, the US cannot make the top ten healthiest countries, which are all European except for Canada. Appears as if beer and wine can be beneficial and that perhaps this study was a bit flawed.
86
@Lee Paxton
From my reading this analysis ignored longevity and looked only for the incidence of certain alcohol related diseases. So to the extent that moderate alcohol consumption has overall positive effects on longevity, as other studies have suggested, that would not be picked up in this study.
8
@Lee Paxton
The countries in Europe that you named have good health care for all. The United States doesn't.
98
@Lee Paxton Your scientific method is flawed. You ignore all factors other than alcohol consumption in explaining your assertion that Europeans are healthier than Americans.
5
Thank you for illuminating the limits of meta-analysis. Statistical significance is useful only insofar as the population being studied is representative of the populations about which generalizations are to be made. Some people, apparently with a genetic predisposition, fit the diagnostic criteria for alcohol dependence very soon after their first use. Others fit the criteria for years and then stop drinking ("natural recovery"). Thinking about alcoholism as a monolithic entity defies lived experience. Man's relationship with alcohol can be described along a wide spectrum of clinical presentations; from none to lethal. With a wide variation in clinical trajectories. Meta-analyses only muddy the waters when we know so little about the streams from which they come.
28
As a research scientist, I have to point out the politics of the study in question. If the authors had summarized, "there is a small risk with moderate alcohol intake, but a larger risk with consuming more than is recommended", how many newspapers, magazine, etc. would have printed the results? The quotes are truly wild-eyed by the article's authors and that makes it all the more "newsworthy". Then there is the money for the next grant for the next study-how much money might you receive if you put in that application, "we did a meta-analysis of data before and came up with pretty much what is generally believed about alcohol consumption"?
Also consider all the large observational studies with vitamins in the last few years that "proved" vitamin C, A, E, etc. would have profound effects on our health, only to have controlled studies show no effect.
Alcohol causes an increased risk of some cancers, has no effect on others, and prevents (that's right, "prevents") yet others and may or may not affect heart health. The jury is still out...which in science, in my experience, means it is a very close race between risk and benefit.
205
@David Hughes This relates to two known facts: (1) Sensational headlines sell papers (or drive clicks).
and,
(2) Most people are not scientifically trained, never studied statistics, and haven't a clue how to understand what they read in these areas.
I'm reasonably knowledgeable about science and discount sensational headlines where the study doesn't back up the headline. But I have a friend (a librarian who's otherwise quite intelligent but computer- and science-illiterate) who saw a story on how blue light from monitors at night causes sleep disorders by suppressing melatonin release and came to the conclusion that looking at computer screens makes people go blind. (It didn't occur to him that if this were true, the great majority of the population of the US would already be blind).
I wish I could suggest a solution to either of these problems, but that would require a restructuring of the education system or the news business, which isn't going to happen.
@David Hughes
You sound like a lobbyist for the alcohol industry. A drunk driver kills someone in America every 45 minutes.
http://www.unionleader.com/crime/belmont-man-was-drunk-when-he-caused-gi...
Here in New Hampshire, where I live, the state has no sales or income tax. The state makes money with a monopoly on liquor sales. We have state liquor stores right on the interstate highways. Drunk driving deaths and ghastly accidents are almost considered normal.
Most rapes, and many violent crimes are alcohol related, because of the very strong disinhibiting effect alcohol has on people when consumed in large quantities. The Catholic church uses the drug alcohol as a major part of it's theology -"this is my blood". There is probably a link between wine consumption and the ongoing pedophile priest horror shows. Medical problems from alcohol(liver and pancreas issues etc., etc.) cost us billions of dollars.
I enjoy a cold drink as much as the next person, but I'm also fully aware of the potential death and widespread "social wreckage" that accompanies alcohol abuse.
Denial is not a river in Egypt.
2
@David Hughes
"how many newspapers, magazine, etc. would have printed the results? "
As if it's the media that's the issue, not alcohol. The dumbing down of America continues at a record pace.
Well then... cheers!
55
I would love to see more columns like this! Most lay-people cannot sufficiently interpret peer-reviewed articles and, as Dr. Carroll lays out, we often see sensational headlines. Very few peer-reviewed publications are ever that exciting! Thank you for this piece and please consider doing this for every study you report on.
261
In 1988, WHO declared alcohol a group 1 cacinogen. There is no known safe dosage. Check that date. This is old news and did not prevent vast amounts of California farm land from being plowed under in favor wine grapes or vast amounts of new drinkers. Since we have the tariff our exports are less attractive...who is going to be drinking all this stuff? It’s just a meta study argument not to worry, is simply as unhelpful as the Trump tariffs.
The takeaway: study or no, you should be thoughful about what you put into your body.
9
@SW
The WHO declares anything and everything to be a carcinogen. This declaration tells us nothing about what _dose_ of alcohol might be a carcinogen, or how much the risk of cancer increases with x amount of alcohol.
18
@The Pooch
No safe dose=0
Agreed professor Carroll, everything in moderation, will not hurt you, we have known this probably since the Stone Age.
The issue though is abuse. It is tough to keep a vice in check whether it be wine, women or song.
12
@Paul
While I agree with you regarding moderation in all things, when will women stop being referred to as a “vice” or prize or reward for men.
35
@Paul
...also, the only negative impact of song that I am aware of is the drunken louts yodelling at the top of their lungs when leaving the bar around 2AM, which negatively affects my sleep. I am too polite to actually toss the boot that might negatively affect *their* health.
2
@Eileen Kennedy-thank you for your reply. It is just a saying. I could have said for women its diamonds, jewelry, hot fudge sundaes and men.
All these things are not vices, but people abuse them, then they become vices.
We don't need better studies - we need better journalism; especially in the United States of America.
In the US there is no culture, just the entertainment industry; there is no news, just infotainment.
The challenge for journalism in the US is that Americans stop paying attention to e.g. world affairs, as soon it gets more complicated than "them's the bad guys".
And then they go and elect the Commander-in-Chief of the greatest war-machine in the history of mankind.
125
Though the author reminds that excess in alcohol is not good for humans, the overall message is misleading about the risks of alcohol drinking.
Furthermore, it says nothing about all the additives found in liquors and wines, which add to the liver pathology.
Think about the marathon runners. During the preparatory time, 1/3/6 months, they are advised to abstain from alcohol completely in order to perform effectively.
Imagine how much could improve the quality of the daily life of youth and aged people limiting or cutting off completely alcohol drinking.
I know that the alcohol industry weighs billions of dollars and a lot of employment, but the health and good life of people should always prevail.
5
Your response is rich on words, scant on facts and data. Not everyone is or aspires to be a marathon runner. The message on alcohol is much more nuanced than you suggest and I think the author did an excellent job in identifying these nuances.
119
@renarapa
The only "marathon" running I do is to the liquor store when my beer fridge is empty. My daily consumption of 3.2 beers in no way hinders this particular athletic event.
JimF from Sewell
6
@renarapa
i am an "aged" person who ran marathons until his mid 40s. My wife or friends would always have a beer or two waiting for me at about mile 18. I did the same for my wife when she ran instead of me. Of course, we never stopped drinking during training.
Now in my 80s, with my wife close behind, I still average a half bottle of wine a night, with dinner. I refuse to lower my quality of life by stopping that consumption.
Cheers!
39
Food is medicine. Drinking depends on how the alcohol
influences how the alcohol or food affects their behavior.
The problem is what happens when people mix certain
foods with alcohol like cheese which can cause other
health issues.
1
We all live with myriads of risks until risk one day becomes certainty: death. But until then we are obsessed with any activity that can either delay or hasten the finality of being. This study should be considered as the final answer on the risks and benefits of alcohol consumption. One drink a day has some minor benefits and some minor risks.
I suggest we move on to other more important risky behaviors, such as sleep deprivation. For example lack of sleep most likely kills more people in car accidents than drunkenness. Lack of sleep impairs your ability to function at your job as much as a hangover. And good sleep is as at least as enjoyable as a glass of wine. Let’s focus on adequate sleep hygiene and improve millions of lives. Cheers.
110
Well written! And I think it's important to emphasize the ratio 4 in 100,000 found in one of the yet sentences in this article: "Only 4 in 100,000 people who consume a drink a day may have a problem caused by the drinking, according to this study"
79
At 89 years old I have been a drinker for about 74 years. The amount I drank was initially small due to lack of funds. Later I cold afford more and changed to wine as my main alcohol intake. Over the last quarter of a century I have averaged about 1 glass of red wine a day and an occasional Scottish malt whisky.
All this hazard that the study suggests is trivial compared with the enjoyment experienced. A much greater hazard I have to indulge in is crossing roads on foot.
395
Cheers on a life well lived! @irdac
14
@irdac
Yes, be careful and look both ways so you will be around longer to enjoy your wine.
2
@irdac
Your N.H.S. is not amused by alcohol abusers --
https://www.theguardian.com/society/2017/dec/29/were-not-the-national-ha...
Stone-cold fact -- the projected costs of alcohol abuse are equal to ~50% of the PPACA.
We enjoy a stiff drink, especially after a BoyNee lecture.
We also know that there is a cost for alcohol abuse and ignoring it will not make it go away.
2