In a letter to Circulation, Stanton takes on the prestigious American Heart Association, which authored an advisory discounting the health benefits of wine. Stanton pointed out that, among the reasons cited for this dismissal of health benefits to drinking, was the spurious critique that heart benefits occur for all drinkers, and not just upper-SES ones with good health habits! He also noted the absence of references in the advisory to significant studies finding moderate drinkers, all other things being controlled, lived longer. In its response, the authors of the AHA advisory responded with a devious but popular non-sequitur—”we do not believe that physicians and other health care providers should advocate the use of wine or other alcoholic beverages as health promoting substances but rather should continue to advocate and address the importance of other lifestyle behaviors”—as though telling people to exercise and eat sensibly had been so successful that the advantages of moderate drinking for prolonging life can be safely ignored.
Circulation, 104, e73, 2001
Fellow, The Lindesmith Center-Drug Policy Foundation
The American Heart Association (AHA) advisory on “Wine and Your Heart”1functions more as a propaganda document than a scientific one. It discounts the null hypothesis, that wine has measurable beneficial effects for coronary disease (CHD), on two contradictory grounds: that wine is indistinguishable from other types of beverage alcohol that produce similar beneficial effects, and that alcohol in general does not produce such beneficial effects. Thus, the following statement, “Statistical modeling that includes potential cofounders [such as social and health behavior advantages in favor of wine drinkers] does not mitigate the beneficial effect of alcohol consumption on CHD” is somehow used as evidence against the reliability of the overall alcohol-CHD connection.
The fact that well-controlled studies find an alcohol-CHD benefit, of course, instead reinforces the advantages of moderate alcohol consumption. Although the advisory accepts that “higher [alcohol] intakes are associated with increased total mortality,” it nowhere states the converse, true statement—that moderate alcohol drinkers, particularly in higher risk categories, experience lower mortality rates than do lifetime abstainers. This result is obtained in prestigious, massive prospective studies such as the study administered by the American Cancer Society2 and the Physicians’ Health Study.3 So many studies showing mortality advantages for moderate drinkers have accumulated that reliable meta-analyses have been constructed from these individual studies.4 A part of this mortality advantage is the result of a similar U-shaped ischemic stroke function in relation to alcohol consumption, which the AHA advisory discounts without reviewing recent research.
The logic underlying this and similar attempts to undercut possible advantages from consuming alcohol is that alcohol is a dangerous substance to be avoided at virtually all costs—an aversion in most cases not displayed by the well-educated, middle-class health professionals who author these opinions. Indeed, a strong case can be made that an inability to accept the complex conclusion that some levels of drinking are healthy and others unhealthy (a realization that is centuries old, at least) is a sign of our society’s inability to articulate a sensible policy in regard to alcohol,5 even as alcohol remains the most commonly consumed psychoactive substance in the United States and the world.
- Goldberg IJ, Mosca L, Piano MR, et al. Wine and your heart. Circulation. 2001;103:472-475.
- Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337:1705-1714.
- Gaziano JM, Gaziano TA, Glynn RJ, et al. Light-to-moderate alcohol consumption and mortality in the Physicians’ Health Study enrollment cohort. J Am Coll Cardiol. 1999;35:96-105.
- White IR. The level of alcohol consumption at which all-cause mortality is least. J Clin Epidemiol. 1999;52:967-975.
- Peele S. The conflict between public health goals and the temperance mentality. Am J Pub Hlth. 1993;83:805-810.
*The author, in addition to writing frequently about alcohol problems and their treatment and about the healthy use of alcohol, has consulted with alcohol manufacturers on social and cultural issues related to alcohol consumption and on the benefits of moderate drinking. This letter was not reviewed, approved, or funded by any organization, and it represents only the views of only the author.