A farmer in remote Sri Lanka, totally out of contact with the English-speaking media and the virtual world, is still more than 95% likely to report with conviction that using ‘non-excessive amounts’ of alcohol is good for his health and likely to lengthen his life. My guess is that the same holds for similar individuals in Venezuela, Vietnam or Vanuatu. How much should we credit national and international health agencies for this remarkable achievement in global public education – in the event that my guess is correct?

My guess is also that people are far less likely to hold with similar conviction that tobacco smoking causes heart disease or leads to premature death. And who should we blame – in the event that my guess is correct here too – for this failure of public education?

You may not think my guesses are accurate. I invite you to test with the next 10 people you meet how strongly they believe the reported benefits of alcohol use versus the harms of smoking and come to your own conclusions. You may find it quite enlightening to test whether the views of farmers (or accountants, teachers or others) differ from those of doctors.

Have we jumped prematurely to the conclusion that associations between better health outcomes in people consuming non-excessive amounts of alcohol – compared to abstainers – reflects a causal link? An article in the journal Addiction suggests that we have. The author, Hans-Olav Fekjaer, provides the most cogently argued case you will likely come across as to why this is so. Quite apart from other causality criteria that aren’t met in the ’alcohol health benefit’ case, he demonstrates the complete lack of plausibility of a biological mechanism underlying the diverse conditions allegedly prevented by alcohol, which include:

Alzheimer’s disease/dementia

Asthma

Colorectal cancer

Common cold

Coronary heart disease

Diabetes (type 2)

Gallstones

Hearing loss

Intermittent claudication

Liver cirrhosis

Low birth weight, prematurity

Lower urinary tract symptoms (in men)

Metabolic syndrome

Negative child development

Osteoporosis

Overweight

Psychiatric disorders

Renal cell cancer

Rheumatoid arthritis

Stroke (ischemic)

These are collectively reflected in better general health status and lower total mortality. No underlying mechanism put forward to explain these associations is more plausible than that they are the result of vector behavior (which may include skewing the alcohol research agenda, selective publication and other things). The second most plausible cause or contributor to the implausible list of ‘protections’ is the fact that abstainers, in the countries where such studies are conducted ad nauseam, are a tiny minority – statistically outside the normal population.

Why have people keen to prove that medicinal properties reside in alcohol not sponsored research on similar associations in countries where abstainers are not a tiny minority? Or is it likely that they may indeed have sponsored many such studies, which have somehow failed to meet the standards required for publication in indexed journals?

Hans-Olav Fekjaer would not find acceptance, in a scientific journal article, for speculation on such matters. But we should continue our own examination of likely underlying causes, as dispassionately as we can. It finally boils down to making an honest assessment of the probability and plausibility of each candidate for the title of  ’cause’ (or causes) underlying the observed associations.

For further reading:

Alcohol—a universal preventive agent? A critical analysis, Hans Olav Fekjær

Article first published online: 1 MAR 2013

DOI: 10.1111/add.12104

http://onlinelibrary.wiley.com/doi/10.1111/add.12104/full

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Speak Your Mind

  • Tord Steiro

    Dear Diyanath,

    Thank you for some good thinking, it stimulates further refelction on behalf of the reader. In particualr, two things comes to mind:

    1. The notion that limited alcohol consumption is good for health is perhaps as ancient as alcohol itself? It appears to be traditional knowledge in many a community off the beaten path, and a range of ancient written sources prescribe limited alcohol consumption as a cure to many diseases and conditions. But are these ancient ideas and traditions actually true? Fekjaer makes a compelling point about that!

    2. I have never really thought about the issue you mention regarding the point that alcohol is, supposedly, a magic mix effective against a whole range of very different conditions. Yes, your guess, that these results points to a better general condition rather than to a biolgical mechanism on behalf of alcohol, makes a lot fo sense. But can it be scientificalyl studied? Despite some pondering, that remains an open question.

    Other questions remains too: Omitted variables. the lates on that list may actually be coffee. Is there any correlation between consumtpion of coffee and consumption of alcohol? the answer is, we don’t know. But it may appear as if coffee has a rather different effect on health than what has been the accepted truth for decades. Being only one of many potentially omitted variables in the scientific litterature on the effect of alcohol on health, the risk that some omitted variable is behind the positive impact of moderate alcohol consumption is not unlikely.

    More information about coffee here: http://www.nejm.org/doi/full/10.1056/NEJMoa1112010#t=abstract