As always Chris these stealth temperance activist academics are more interested in convincing naive and gullible politicians and policy makers, than in developing rigorous policy-informing research. When that fails they go down the “it’s for the children” approach. Its the same with gambling , heading footballs, playing rugby and every other lifestyle risk these Webbian curtain twitchers want to protect us from. Re moderate drinking. Does anyone think miserable scolds like Whitty would’t benefit from a glass or two?
Just because someone advocates for policies aimed at reducing harm and promoting public health doesn't mean they're a miserable scold. In fact, it's often the most caring and compassionate individuals who recognize the need for evidence-based approaches to prevent suffering. Imagine defending the promotion of alcohol. Regarding Professor Whitty, let's not pretend that being drunk is going to magically cure his personality issues or make him any more likable. By the way, it's Weberian, not Webbian.
You claim that moderate drinking is associated with numerous health benefits, including lower blood pressure and reduced risk of heart disease. What about the numerous studies that have found no significant association between moderate drinking and improved cardiovascular outcomes? Or how about the one published in the Journal of the American College of Cardiology that found that moderate drinking actually increased the risk of cardiovascular events among women?
It's willfully irresponsible to give a rosy portrayal of moderate drinking as a panacea for mental health issues. Claiming that it can help alleviate symptoms of depression and anxiety, but failing to mention the research from Cambridge that found that heavy drinking was associated with increased risk of depression in young adults, regardless of their drinking frequency or quantity!
You also get very creative in your interpretation of statistics, claiming that moderate drinkers live longer than abstainers but do you mention the systematic review published in the British Medical Journal that found no significant difference in mortality rates between moderate drinkers and abstainers?
And what about the elephant in the room: the fact that your own drinking habits are questionable at best? Do you mention your well-documented love of fine wine, or how it might influence your opinions on moderation? Nope.
This is a masterclass in cherry-picking data and selective interpretation to support a preconceived notion about moderate drinking. One can only wonder the integrity of any research you have touched in your career.
The facts are clear: moderate drinking is not without its risks and negative consequences. No level of alcohol consumption is safe for our health.
If you post links to the studies, I will have a look at them but my conclusions are based on meta-analyses, i.e. the accumulated evidence, rather than individual studies. It is, in other words, the opposite of cherry-picking.
[1] Chou et al. (2015). Association between alcohol consumption and cardiovascular disease risk factors: A systematic review and meta-analysis of cohort studies. Journal of the American College of Cardiology, 65(11),1263-1272.
[2] Wood et al. (2017). Systematic review and meta-analysis of observational studies evaluating the relationship between moderate alcohol consumption and incident cardiovascular disease risk factors. Heart, 103(12), 934-943.
[3] Andreassen et al. (2018). Heavy drinking is associated with an increased risk of depression in young adults: A longitudinal study. Journal of Psychopharmacology, 32(11), 1181-1190.
[4] Chen et al. (2019). The association between heavy drinking and depression: A systematic review and meta-analysis. Depression and Anxiety, 36(10), 943-953.
[5] Gmel et al. (2018). Mortality among drinkers compared to abstainers: A systematic review and meta-analysis of cohort studies. British Medical Journal, 361:k2623.
[6] Lai et al. (2016). Alcohol consumption and mortality in men and women: A prospective cohort study. Addiction, 111(10), 1764-1775.
[7] World Health Organization. (2018). Q&A on the health effects of alcohol consumption.
[8] American Heart Association. (2020). Drinking too much alcohol can increase your risk for several cardiovascular diseases and conditions.
Here in Nova Scotia, our Head of Public Health loved those revised Canadian guidelines, the ones that said no amount of alcohol was safe and two drinks a week was the limit. He was pushing for family doctors to “screen” every patient at every visit for excess alcohol intake. At the time, I was the local head of family practice, and I told him that (a) we didn’t have the time to ask the same irrelevant questions at every visit (b) if we did ask the same questions at every visit, the patients would think we were either stupid or not listening, (c) patients routinely bend the truth when asked about “bad habits”, and (d) the question was a waste of time.
Why a waste of time? Because, in his view:
- if they didn’t drink, I was to counsel them not to start
- if they drank a little, I was to encourage them to stop and warn them against drinking more
- if they drank moderately, I was to encourage them to drink less and warn them against drinking more
-if the drank a lot, I was to encourage them to drink less and warn them against drinking more.
Bottom line was that, regardless of what they said, my response was going to be much the same. And, having gone through decades of telling smokers to cut down or quit, I knew exactly how ineffective my advice re drinking was going to be.
You don’t screen for anything unless there’s evidence to support the extent of the problem, it materially alters your management of the patient AND you have an effective intervention. For alcohol, we have none of the above.
I don't see any really good risk reporting on this whole topic. I think what most people would want to know if what are the increased risks if I drink a glass of wine a day...versus if I don't. Is this calculation anywhere?
I'm sure it has been calculated somewhere, but the calculation would depend on numerous untestable assumptions. What we need is a double blind randomised clinical trial with a follow-up of 20 years ... but that is not going to happen. Modest alcohol consumption has been a fixed item in many cultures for millenia. In fact, drinking beer used to be the only safe way to drink water. We humans, especially those with corresponding ethnicity, have been evolutionarily selected to benefit in terms of reproductive success through that behaviour. We could breed mice to be tolerant of alcohol consumption and then do the randomised clinical trial on the new breed of mice. Of course, reproductive success does not care very much for ensuring extreme longevity for many persons. It is better if only a few get very old (and consequently, very wise). For myself, I would prefer a shorter but happier life. And dying rapidly of a heart attack seems preferable to a long excruciating death by cancer. Problem: does moderate alcohol use increase the chance of cancer? Or of Alzheimers? Anyway: quality of life is just as important as quantity.
I agree with your perspective on moderate drinking but not with your characterization of Tim Stockwell. I had a lengthy email exchange with him this week for my own post on this topic and found him to be quite receptive to concerns about J-curve data etc. Also, I think that in his 2024 Studies on Alcohol & Drugs paper, and in an August 2024 JAMA Network paper led by Ortolá, you can see explanations for the happy side of the J-curve that go beyond sick-quitter/sick-abstainer proposals. I'm not persuaded, but I think there's enough triangulation with Mendelian randomization data, for all its weaknesses, to say that folks like Stockwell aren't being unreasonable about that side of the J.
If Kettil were alive he would probably disagree with the current politics of the eponymous society. He was a honest seeker of truth. He was my doctoral thesis adviser and a mentor. I have dedicated the 2nd ed. of my book PERFECT DRINKING AND ITS ENEMIES to him.
As always Chris these stealth temperance activist academics are more interested in convincing naive and gullible politicians and policy makers, than in developing rigorous policy-informing research. When that fails they go down the “it’s for the children” approach. Its the same with gambling , heading footballs, playing rugby and every other lifestyle risk these Webbian curtain twitchers want to protect us from. Re moderate drinking. Does anyone think miserable scolds like Whitty would’t benefit from a glass or two?
Just because someone advocates for policies aimed at reducing harm and promoting public health doesn't mean they're a miserable scold. In fact, it's often the most caring and compassionate individuals who recognize the need for evidence-based approaches to prevent suffering. Imagine defending the promotion of alcohol. Regarding Professor Whitty, let's not pretend that being drunk is going to magically cure his personality issues or make him any more likable. By the way, it's Weberian, not Webbian.
Christopher,
You claim that moderate drinking is associated with numerous health benefits, including lower blood pressure and reduced risk of heart disease. What about the numerous studies that have found no significant association between moderate drinking and improved cardiovascular outcomes? Or how about the one published in the Journal of the American College of Cardiology that found that moderate drinking actually increased the risk of cardiovascular events among women?
It's willfully irresponsible to give a rosy portrayal of moderate drinking as a panacea for mental health issues. Claiming that it can help alleviate symptoms of depression and anxiety, but failing to mention the research from Cambridge that found that heavy drinking was associated with increased risk of depression in young adults, regardless of their drinking frequency or quantity!
You also get very creative in your interpretation of statistics, claiming that moderate drinkers live longer than abstainers but do you mention the systematic review published in the British Medical Journal that found no significant difference in mortality rates between moderate drinkers and abstainers?
And what about the elephant in the room: the fact that your own drinking habits are questionable at best? Do you mention your well-documented love of fine wine, or how it might influence your opinions on moderation? Nope.
This is a masterclass in cherry-picking data and selective interpretation to support a preconceived notion about moderate drinking. One can only wonder the integrity of any research you have touched in your career.
The facts are clear: moderate drinking is not without its risks and negative consequences. No level of alcohol consumption is safe for our health.
If you post links to the studies, I will have a look at them but my conclusions are based on meta-analyses, i.e. the accumulated evidence, rather than individual studies. It is, in other words, the opposite of cherry-picking.
[1] Chou et al. (2015). Association between alcohol consumption and cardiovascular disease risk factors: A systematic review and meta-analysis of cohort studies. Journal of the American College of Cardiology, 65(11),1263-1272.
[2] Wood et al. (2017). Systematic review and meta-analysis of observational studies evaluating the relationship between moderate alcohol consumption and incident cardiovascular disease risk factors. Heart, 103(12), 934-943.
[3] Andreassen et al. (2018). Heavy drinking is associated with an increased risk of depression in young adults: A longitudinal study. Journal of Psychopharmacology, 32(11), 1181-1190.
[4] Chen et al. (2019). The association between heavy drinking and depression: A systematic review and meta-analysis. Depression and Anxiety, 36(10), 943-953.
[5] Gmel et al. (2018). Mortality among drinkers compared to abstainers: A systematic review and meta-analysis of cohort studies. British Medical Journal, 361:k2623.
[6] Lai et al. (2016). Alcohol consumption and mortality in men and women: A prospective cohort study. Addiction, 111(10), 1764-1775.
[7] World Health Organization. (2018). Q&A on the health effects of alcohol consumption.
[8] American Heart Association. (2020). Drinking too much alcohol can increase your risk for several cardiovascular diseases and conditions.
Here in Nova Scotia, our Head of Public Health loved those revised Canadian guidelines, the ones that said no amount of alcohol was safe and two drinks a week was the limit. He was pushing for family doctors to “screen” every patient at every visit for excess alcohol intake. At the time, I was the local head of family practice, and I told him that (a) we didn’t have the time to ask the same irrelevant questions at every visit (b) if we did ask the same questions at every visit, the patients would think we were either stupid or not listening, (c) patients routinely bend the truth when asked about “bad habits”, and (d) the question was a waste of time.
Why a waste of time? Because, in his view:
- if they didn’t drink, I was to counsel them not to start
- if they drank a little, I was to encourage them to stop and warn them against drinking more
- if they drank moderately, I was to encourage them to drink less and warn them against drinking more
-if the drank a lot, I was to encourage them to drink less and warn them against drinking more.
Bottom line was that, regardless of what they said, my response was going to be much the same. And, having gone through decades of telling smokers to cut down or quit, I knew exactly how ineffective my advice re drinking was going to be.
You don’t screen for anything unless there’s evidence to support the extent of the problem, it materially alters your management of the patient AND you have an effective intervention. For alcohol, we have none of the above.
I don't see any really good risk reporting on this whole topic. I think what most people would want to know if what are the increased risks if I drink a glass of wine a day...versus if I don't. Is this calculation anywhere?
I'm sure it has been calculated somewhere, but the calculation would depend on numerous untestable assumptions. What we need is a double blind randomised clinical trial with a follow-up of 20 years ... but that is not going to happen. Modest alcohol consumption has been a fixed item in many cultures for millenia. In fact, drinking beer used to be the only safe way to drink water. We humans, especially those with corresponding ethnicity, have been evolutionarily selected to benefit in terms of reproductive success through that behaviour. We could breed mice to be tolerant of alcohol consumption and then do the randomised clinical trial on the new breed of mice. Of course, reproductive success does not care very much for ensuring extreme longevity for many persons. It is better if only a few get very old (and consequently, very wise). For myself, I would prefer a shorter but happier life. And dying rapidly of a heart attack seems preferable to a long excruciating death by cancer. Problem: does moderate alcohol use increase the chance of cancer? Or of Alzheimers? Anyway: quality of life is just as important as quantity.
I agree with your perspective on moderate drinking but not with your characterization of Tim Stockwell. I had a lengthy email exchange with him this week for my own post on this topic and found him to be quite receptive to concerns about J-curve data etc. Also, I think that in his 2024 Studies on Alcohol & Drugs paper, and in an August 2024 JAMA Network paper led by Ortolá, you can see explanations for the happy side of the J-curve that go beyond sick-quitter/sick-abstainer proposals. I'm not persuaded, but I think there's enough triangulation with Mendelian randomization data, for all its weaknesses, to say that folks like Stockwell aren't being unreasonable about that side of the J.
Re: neo-temperance Kettil Bruun Society)....
If Kettil were alive he would probably disagree with the current politics of the eponymous society. He was a honest seeker of truth. He was my doctoral thesis adviser and a mentor. I have dedicated the 2nd ed. of my book PERFECT DRINKING AND ITS ENEMIES to him.
Is the purpose of life to live as long as possible and avoid any fun in case it takes a week or two off one's life? These people are extremists.