Alcohol and health

[Rahsaan]

originally posted by Ken Schramm:
... Humanity appears to be wed at the hip to intoxicants, primarily alcohol, and behind the scenes, someone is lobbying hard for amputation.

As is the case with so many issues in global culture/commerce/geopolitics today, our ability to factor ALL of the elements at play into our cost/benefit analysis is dramatically lacking.

Interesting points and I think all would agree that prohibition-style policies are destined to fail.

But, just because there are positive social and spiritual benefits to intoxicants - when used in moderation - doesn't mean we should let loose the full force of Capitalism to to push intoxicated indulgence. Some serious side effects to that path.

I assume you know the work of Carl Hart, who argues that all the negative effects of drugs that we see in the streets are less about the drugs and more about the individual problems that could be better addressed by other social and political programs. I.E. one can 'responsibly' use heroin with the right infrastructure.

I'm not sure how far to take that line of argumentation. But I do think we need to keep all these substances in perspective.

 

[Ken Schramm]

originally posted by Oswaldo Costa:
Maybe I am missing something about the logic, but you seem to be working back from scientific publications of magnitude to pile of money to vested interest, as if this causal chain was somehow suspicious. If the danger were to be legit, isn't this exactly what one would expect?

The worldwide alcohol business, like the tobacco, armaments and oil businesses, provide gigantic benefits to the economies of many countries, so it takes an equal belief in their deleterious effects to make governments go against them and their lobbies. Not something they would do lightly. What we should be suspicious of is, on the contrary, attempts to minimize the deleterious effects of these four industries. That said, it seems to me that each one of us should enjoy as much wine as their bloodwork permits within some reasonable safety margin, and not treat the issue as an all-or-nothing.

My point is that there is very rarely science for the sake of science. There is almost always science for the sake of some monetary agenda.

Here is a very apt example of this. I recently did a day long seminar about yeast and mead. This is a subject I have looked at pretty hard over the past 20 years. When I went to bone up on the science, I was pretty surprised to see how far it had progressed over the 8-10 years since I had prepared my past major presentation on honey fermentation. But the reason that the science on yeast metabolism had made so many strides is not beverage alcohol production, at all. In the worldwide alcohol business, >90% of what is produced does not go into our glasses, it goes into our fuel tanks. Efficiency and purity in that industrial production of ethanol is of huge monetary importance. You got money, you get science. You got no money, you stay uninformed, and you are left to collect the crumbs and hope they help. Mead has a similar interest in producing ethanol and almost only ethanol, and controlling the production of isopropanol and isobutanol and active amyl alcohol. Those were valuable crumbs; mead does not have the resources to generate that kind of knowledge on its own. FWIW, the things they are learning and working on developing are simultaneously incredible and frightening.

Physiologically, of course the danger of ethanol consumption is legit. But there is some money with a vested interest in making the point. Resources and intent are why the negative side is winning. Did we really need a Lancet article or WHO campaign to tell us these things? We have known for centuries that at high enough levels, alcohol is conclusively toxic.

But so are petroleum, and armaments. The dangers of those are legit, and while you can make the case that the science of climate change is confirming and trumpeting that, we rarely talk about the fact that there is no level of automotive travel without risk, and no level of pollution with any health benefits. Much less, any health benefits to the consumption of armaments. Yet there is no Lancet article or WHO campaign underway to get us to swear off these products. When the medical community does tell us that assault weapons and handguns are the biggest health threat to youth, the push back is swift and intense.

The larger issue is this: we know what alcohol takes away, but why are we not looking with similar scientific scrutiny at what alcohol has given us? We had alcohol dehydrogenase genes for millions of years before we even became Homo sapiens. From an evolutionary standpoint, there has to be some reason that we still do. It is becoming increasingly evident that culture and civilization may have arisen from the combination of human intelligence and the catalyzing influence of intoxicants. Casting them aside without understanding their role in our very firmament is something I think we need to consider very thoroughly. We have done a very poor job of reasoning through whether instead of being discarded, it might be far more beneficial if intoxicants were much more thoughtfully managed at an institutional level. Our first disastrous pass at prohibition should teach us that we need to look carefully at what it is that we really want, and what we can do as a culture to make it happen.

 

[MLipton]

Ken, I am largely sympathetic to your viewpoint, but i will push back against the nefarious suggestion of “vested interests” regarding health research. The NIH budget, while small in comparison to the defense budget, is quite large. Much of that money is disbursed on the basis of reviews from folks like me. We serve on study sections that provide peer review of proposals. Why would anyone propose to do a meta-study of 25 years worth of research into the health effects of alcohol? Because of the contradictory nature of much of those data. This is the skepticism that lies at the heart of valid scientific inquiry. And what they found were a number of systematic errors in many of the earlier studies that affected the analyses. Scientific progress is messy that way, as we saw recently with CDC advice re COVID and the seesawing value judgements about the health impact of various fats in our diet (saturated, polyunsaturated, omega-6, trans).

As Oswaldo noted, where we should get suspicious is when there isn’t active research about the health impacts of e.g. tobacco, sugar, gun violence or oil refinery effluents. In those cases, political forces have suppressed active research.

Mark Lipton

 

[georg lauer]

originally posted by Robert Dentice:
Ken it is such a good question. If you read the book I linked about there are so many studies that show the positive effects of moderate wine consumption that it would be very easy to contradict some of the negative ones but the negative side seems to be winning.

I think we need to discriminate between what is scientifically well supported versus what is made with that information. Regarding the former, it just seems that, as Mark pointed out, more and better evidence is supporting that the positive effects of moderate wine consumption do not exist in reality.
Where there is a real battle is when it comes to the question of how the data should inform policy and personal behavior. And that is where things have been so murky. For example, the recent recommendations about alcohol and cancer cite the estimate that 20,000 cancer deaths a year could be prevented with no or much reduced alcohol intake in the US alone. That is roughly 3% of the annual deaths from cancer, but this number is not based on stopping moderate consumption, but rather alcohol use in general, which includes the not exactly rare cases of regular excessive drinking, which we have long known leads to cancer of various kinds. So it is not hard to imagine that reducing from a level of 2 glasses on several days a week will have a risk reduction way under 1%. Meaning cancer risk will not be a reason for me to drop wine. I would also like to know how this compares for example to the environmental impacts living in a city versus the country side, but quantitative data on many of these factors are not well established. Few things are as obvious as smoking and cancer.

Now, the risk to our cognitive abilities in old age might be higher, so that is another one to consider, but it will be even harder to quantify.

 

[Ken Schramm]

originally posted by MLipton:
The NIH budget, while small in comparison to the defense budget, is quite large. Much of that money is disbursed on the basis of reviews from folks like me. We serve on study sections that provide peer review of proposals. Why would anyone propose to do a meta-study of 25 years worth of research into the health effects of alcohol? Because of the contradictory nature of much of those data. This is the skepticism that lies at the heart of valid scientific inquiry.
Mark Lipton

The NIH soiled itself by starting the MACH study with funding from the alcohol industry. I cannot find information on the actual funding sources of the Lancet article and the WHO piece. I don't know that the NIH was actually involved. If you have information that indicates such, I am all ears. Forgive me for being cynical, but I am as suspicious of the motives of the latter pieces as I am of the MACH study, which was so inappropriate that they dropped it like a hot potato.

I don't think that suggesting that there are vested interests in health research is "nefarious." I support
Bernie's efforts to afford Americans a much higher degree of transparency and accountability in that area.

 

[Oswaldo Costa]

Lots of interesting points to consider.

None of us wants to reduce consumption to zero, so it's a matter of finding a level that we believe to be reasonably safe, and that's going to be different for each.

I have no cardiovascular problems, but my folate levels are low, a potential side-effect of regular alcohol consumption that can make the liver grow in an effort to produce more folate. So, I have started to drink only until I notice that I am becoming tipsy and sleepy, because that'll be the sign that liver enzymes are no longer fully coping. My Rubicon. Those who, unlike me, become inspired and witty should perhaps not follow my lead. Those who become violent, definitely should.

By the way, next time y'all do your check-ups, do me a favor and ask your doctor to include folate (folic acid) in the blood test specs. If it's low, check out the study about its dangers cited in Good News.

 

[Robert Dentice]

originally posted by georg lauer:

originally posted by Robert Dentice:

I think we need to discriminate between what is scientifically well supported versus what is made with that information.

Of course. What happens with the media is they take a study or a few that support their bent and then promote only that angle. A great example is all the nonsense about how red wine is good for you because of resveratrol. If resveratrol is good for you the amount of wine one would need to drink to get a therapeutic dose would kill you! And we all know the silly games the general media plays with statistics to scare people. There are so many studies on alcohol and they are all over the place.

 

[Ken Schramm]

originally posted by Robert Dentice:

I encourage all of you to read this book:

Good News

It is heavily researched by a professional Medical journalist and cites over 300 medical studies.

Ordered.

originally posted by Rahsaan:

I assume you know the work of Carl Hart, who argues that all the negative effects of drugs that we see in the streets are less about the drugs and more about the individual problems that could be better addressed by other social and political programs. I.E. one can 'responsibly' use heroin with the right infrastructure.

I'm not sure how far to take that line of argumentation. But I do think we need to keep all these substances in perspective.

I have read a good bit on this, but I am not familiar with Carl Hart. Also ordered. Your point re: how far one can take an argument for "responsibly" using heroin is valid. I would suggest that the culture would be wise to find ways for users of intoxicants to be able to use them more responsibly, or perhaps even more accurately, less irresponsibly.

 

[georg lauer]

originally posted by Robert Dentice:

originally posted by georg lauer:

originally posted by Robert Dentice:

I think we need to discriminate between what is scientifically well supported versus what is made with that information.

Of course. What happens with the media is they take a study or a few that support their bent and then promote only that angle. A great example is all the nonsense about how red wine is good for you because of resveratrol. If resveratrol is good for you the amount of wine one would need to drink to get a therapeutic dose would kill you! And we all know the silly games the general media plays with statistics to scare people. There are so many studies on alcohol and they are all over the place.

While I do not dispute the problem with the media cherry picking, I don't think it is accurate that studies on alcohol are still all over the place. The issue remains complex, but these days the somewhat reliable studies come out decidedly more on the negative side.

 

[MLipton]

originally posted by Ken Schramm:

The NIH soiled itself by starting the MACH study with funding from the alcohol industry. I cannot find information on the actual funding sources of the Lancet article and the WHO piece. I don't know that the NIH was actually involved. If you have information that indicates such, I am all ears. Forgive me for being cynical, but I am as suspicious of the motives of the latter pieces as I am of the MACH study, which was so inappropriate that they dropped it like a hot potato.

I don't think that suggesting that there are vested interests in health research is "nefarious." I support
Bernie's efforts to afford Americans a much higher degree of transparency and accountability in that area.

Yes, that MACH study was a mess (WTF were they thinking getting funding from the alcohol industry for a study of moderate drinking?) but it’s worth noting that NIH’s own watchdog arm flagged it early on and pulled the plug. Regarding the Lancet article, if you’re thinking of Anderson et al (2023), that was all WHO — and their funding comes largely from governments with more from Bill and Melinda Gates Foundation.

Mark Lipton

 

[Tristan Welles]

originally posted by Robert Dentice:

originally posted by Tristan Welles:
I am waiting for the medical consensus to shift again before contemplating my response.

I encourage all of you to read this book:

Good News

It is heavily researched by a professional Medical journalist and cites over 300 medical studies.

Personally I have cut back mostly because I needed to lose some weight which I have done. I enjoy wine even more on the 3 or so days a week I drink.

Thanks!

My comment was made after the recent revelations regarding Eliezer Masliah's 'research'. With the minor, on-going crisis in the replication of studies, I'll just fall beck on taking more out of alcohol than it will ever take out of me.

 

[Christian Miller (CMM)]

originally posted by georg lauer:

originally posted by Robert Dentice:
Ken it is such a good question. If you read the book I linked about there are so many studies that show the positive effects of moderate wine consumption that it would be very easy to contradict some of the negative ones but the negative side seems to be winning.

I think we need to discriminate between what is scientifically well supported versus what is made with that information. Regarding the former, it just seems that, as Mark pointed out, more and better evidence is supporting that the positive effects of moderate wine consumption do not exist in reality.
Where there is a real battle is when it comes to the question of how the data should inform policy and personal behavior. And that is where things have been so murky. For example, the recent recommendations about alcohol and cancer cite the estimate that 20,000 cancer deaths a year could be prevented with no or much reduced alcohol intake in the US alone. That is roughly 3% of the annual deaths from cancer, but this number is not based on stopping moderate consumption, but rather alcohol use in general, which includes the not exactly rare cases of regular excessive drinking, which we have long known leads to cancer of various kinds. So it is not hard to imagine that reducing from a level of 2 glasses on several days a week will have a risk reduction way under 1%. Meaning cancer risk will not be a reason for me to drop wine. I would also like to know how this compares for example to the environmental impacts living in a city versus the country side, but quantitative data on many of these factors are not well established. Few things are as obvious as smoking and cancer.

Now, the risk to our cognitive abilities in old age might be higher, so that is another one to consider, but it will be even harder to quantify.

Thank you. What's missing almost entirely from the public conversation is context and proportion of risk.

There's also the problem of extrapolating from average results over a whole population. A 20% decline in alcohol consumption that was sourced from the 5% who are the heaviest drinkers in society would have enormous benefit. If it was sourced from the 30% of drinkers who consumed the least amount it probably wouldn't have much effect.

 

[Christian Miller (CMM)]

originally posted by MLipton:
Alcohol and healthAs your self-appointed health reporter, I wanted to see whether the recent revision of medical thinking on the impact of alcohol consumption on health (and the related redefinition of moderate drinking) has affected your wine consumption in any way. I am mindful of the old saw that there are more old wine drinkers than old doctors, but at the same time it is now clear that alcohol raises your risk for cancer, hypertension and fatty liver diseases. So, has this shift in thinking altered your consumption pattern in any way?

Mark Lipton

I've only been skimming the recent articles, but my impression is that there isn't a lot of new research on the cardiovascular benefits or lack thereof; just more meta-analyses purporting to be more rigorous, broader or controlling better for extraneous or confounding variables. At least one of them had a rather peculiar version of "more rigorous."

 

[Ken Schramm]

originally posted by Christian Miller (CMM):
Thank you. What's missing almost entirely from the public conversation is context and proportion of risk.

There's also the problem of extrapolating from average results over a whole population. A 20% decline in alcohol consumption that was sourced from the 5% who are the heaviest drinkers in society would have enormous benefit. If it was sourced from the 30% of drinkers who consumed the least amount it probably wouldn't have much effect.

Excellent point. Nuance is almost entirely absent from the Lancet and WHO discussions.

originally posted by Christian Miller (CMM):
I've only been skimming the recent articles, but my impression is that there isn't a lot of new research on the cardiovascular benefits or lack thereof; just more meta-analyses purporting to be more rigorous, broader or controlling better for extraneous or confounding variables. At least one of them had a rather peculiar version of "more rigorous."

Everything I have found has been meta-analysis. If the peculiar example of "More rigorous" involved the dismissal of studies which found smaller benefits, I concur.

originally posted by MLipton:
Regarding the Lancet article, if you’re thinking of Anderson et al (2023), that was all WHO — and their funding comes largely from governments with more from Bill and Melinda Gates Foundation.

Mark Lipton

I was looking at the 2018 Lancet article which asserted no health benefits whatsoever.

I've been digging into the sources of funding for various anti-alcohol non-profits and efforts like "Dry January". Some of what has been going on in the UK has been quite revealing. Makers of NA products funding anti-alcohol institutions and movements through non-profits seems a bit off to me.

 

[MLipton]

originally posted by Ken Schramm:

originally posted by MLipton:
Regarding the Lancet article, if you’re thinking of Anderson et al (2023), that was all WHO — and their funding comes largely from governments with more from Bill and Melinda Gates Foundation.

Mark Lipton

I was looking at the 2018 Lancet article which asserted no health benefits whatsoever.

OK. Yes, several comments: their reliance on DALYs is disingenuous, as alcohol is implicated in many acts of violence that certainly affect lifespan (this includes DWI events as well as other, more overt, violence). By their logic, none of us should drive or ride bicycles, or most likely leave the house at all, since the use of cars and bicycles are also associated with a decrease in lifespan. They do state in the article that "the estimated protective effects for ischaemic heart disease and diabetes in women are offset by monotonic associations with cancer," so they don't totally dismiss the studies that have shown benefits associated with moderate consumption.

I'll see what I can dig up about their funding sources.

Mark Lipton

 

[Jonathan Loesberg]

The funding will surely come from government agencies or groups concerned by alcohol. The second source would entail risk of bias in the researchers, though considerably less than research funded by cigarette, oil, liquor corporations and the like since their end is not profit. And, in either case, legitimate research is always available for outside review. I really think Ken's suggestions of an ominous, anti-alcohol conspiracy group is a bit much. His suggestion that meta-research (a form of review) has limited value, though, is worth considering.

 

[Yule Kim]

Do I believe alcohol has any health benefits? No.

Do I believe alcohol is increasing my risk of cancer and heart disease? Yes.

Will I continue drinking wine? Abso-fucking-lutely!

 

[robert ames]

originally posted by Yule Kim:
Do I believe alcohol has any health benefits? No.

Do I believe alcohol is increasing my risk of cancer and heart disease? Yes.

Will I continue drinking wine? Abso-fucking-lutely!

do i believe that alcohol has any social benefits? yep. any questions, watch babette's feast.

 

[Jonathan Loesberg]

Really, fabular fiction isn't a great basis for empirical conclusions. Art doesn't work that way. I'm with Yule on this issue.

 

[Yule Kim]

I mean, surfing, rock climbing, scuba diving, skiing, and recreational skydiving all increases your risk of death for no tangible benefit outside of making life a lot more interesting and fun. That shouldn't stop people from doing those activities.

You only live once. Mitigate the risk as much as you can, but don't let that stop you from enjoying the ride.