Mounting criticism of NIH's relationship with the alcohol industry | Hacker News Reader

Mounting criticism of NIH's relationship with the alcohol industry

arstechnica.com

168 pointslisper59 comments

As far as I can tell the harmful effects of alcohol are both grossly underestimated and severely overestimated. It’s the strangest contradiction.

I think as an addictive and potentially life destroying substance that promotes bad behavior our culture has a blind spot, or a kind of denial.

However the research suggesting that alcohol also decreases all cause mortality relative to abstinence, even when consumed heavily, seems pretty strong and not influenced by the factors referred to in this article. The link between alcohol intake and lower obesity also defies intuition.

The research is also hampered by the premise that it’s unethical to do a intervention study that has heavy alcohol use as one of the groups.

The whole thing seems like a misuse of research, to me. The effects of alcohol, both positive and negative, are mostly apparent to anyone who looks around.

Edit:spelling

the harmful effects of alcohol are both grossly underestimated and severely overestimated. It’s the strangest contradiction.

Makes me think of "If by whiskey"

As a Wisconsinite, I'm not sure I believe that there is a link between alcohol and lower obesity rates.

Is this after controlling for cheese and brat intake?

Racist

In my personal experience people of all races love cheese and brats from Wisconsin.

Minor point, but Dr. Jason Fung has a very interesting and, in my opinion, compelling explanation of obesity and weight gain. He argues that the main driver of obesity in the long term is insulin rather than total calories, and because alcohol doesn't significanlty raise insulin it doesn't contribute to obesity, despite the calories.

https://youtu.be/YpllomiDMX0

Alcohol itself may not raise insulin but what about the rest of your hard apple cider or miller lite?

Miller Lite has about 12 calories from carbohydrates, so not much. Roughly the same for most red wines. Not sure about cider because I don’t drink it, but in general most of the regularly consumed alcoholic drinks have a lot fewer carbohydrates than you’d think.

Do you mean to imply that premixed alcoholic beverages aren't regularly consumed?

I suppose you mean the wine beer and spirits that people regularly consume with a meal, or some such.

But also, there are plenty of people who regularly drink one or more premixed alcoholic beverages.

I should have said “many”, not “most”. I have no idea what percentage of people consume wine, beer, hard liquor or mixed drinks. Just pointing out that the carbohydrate content of red wine, lighter beers, and straight liquor is not as high as you would think.

Ok, no worries, thanks for clearing that up.

I would expect fairly similar rates between cider and wine, since the yeast are metabolizing the sugars.

Edit: stupid autocorrect

With cider, mead, and wine you want to watch out for back-sweetening. Since many consumers prefer a sweeter product, the finished product will have additional fruit juice, honey, or other sweeteners after suppressing additional fermentation. Beer isn't completely immune from it, either, but it's less common.

Most of the sugars present in the wort (or juice in the case of wine or cider) are consumed by the yeast who produce alcohol and carbon dioxide as waste products

Insulin is a driver for obesity, but its really secondary. The primary condition that precedes most metabolic syndrome complications is liver fat accumulation. When this happens, liver cells become insulin resistant and consequently start synthesizing glucose unnecessarily, which floods the bloodstream with excess glucose and subsequently drives insulin higher to sink it into peripheral tissues. Its been demonstrated over decades that the hyperglycemia of diabetes is caused by this liver synthesis of glucose, and not dietary factors.

Alcohol (ethanol) gets processed by the liver and enters the denovo lipogenesis pathway, becoming fat, which can accumulate in the liver if the lipid transporting machinery (LDL particles) are overwhelmed. This leads to Alcoholic Fatty Liver Disease (AFLD) and the "beer belly". Excess fructose consumption has been tied to Nonalcoholic Fatty Liver Disease (NAFLD) for many of the same reasons.

Some day we'll figure out why lipid droplet accumulation leads to insulin resistance. Some people think its tied to fuel selection and the evolved starvation response.

https://www.ncbi.nlm.nih.gov/pubmed/87483

First you say it's not primarily about insulin, then you say that excess of glucose drives up insulin, leading to fat deposits. It's the insulin that directly controls fat deposits at th cellular level, is it not? And you do not have to have insulin resistance in order to drive your insulin up - just eating a pile of pastries will do it. You probably know more than me, could you please clarify?

Alcohol does contribute to a fatty liver, though, which I think would then lower the glucose metabolism, which could also lead to more insulin being needed.

Beware of the longevity-promoting dogma that has been pushed by the alcohol industry. Some recent studies have shown that many prior studies have failed to account for the fact that many people who abstain from alcohol are in fact recovered alcoholics with a higher all-cause mortality. If you separate that group out, the health benefits are no longer observed.

https://www.statnews.com/2016/03/22/alcohol-longevity-benefi...

https://www.jsad.com/doi/10.15288/jsad.2016.77.185

In addition to that, many people who abstain do so for other health reasons. That is, they're not recovering alcoholics, but they have an unrelated health condition which causes them to abstain from alcohol, and that condition has a higher mortality rate than the general population.

Further the main study showing longevity benefits of red wine didn't control for wealth. Rich people live long and drink red wine, but they are not necessarily related.

Whatever longevity benefits alcohol would seem to have, they can probably be replicated with much safer foods, like say eating garlic or broccoli every day.

I keep thinking about this when I see the 'cured meats cause cancer' headlines.

Do they? I avoid them anyway, but what I wonder is: have the studied controlled for the possibility that people who tend to consume more bacon probably tend to consume more fried food in general and also fewer fruits and vegetables?

I've been meaning to look in to this, but perhaps somewhere can point me in the right direction or already knows???

The most damning evidence IMO is the promise, straight from the mouth of NIAAA director George Koob, to suppress future research that might be critical of the alcohol industry. Utterly disgraceful.

Koob's defense of that email -- that he was merely referring to research that is "not of the highest scientific quality" -- is pretty pathetic, given that Jernigan's and Siegel's work apparently met the NIAAA's past and present quality standards.

TBH, I find it difficult to see value in that particular line of research: it stands to reason that there would be a link between advertising and consumption in all age groups, so spending money to confirm that seems wasteful. Also, I haven't checked, but I'd be surprised if there hadn't already been some studies done on this.

Of course the reason some people are upset is because they would like to see restrictions on advertising, and were hoping another study would give them another argument in favor of such. But a positive result does not imply that such restrictions are necessary.

Yes, I'd be more concerned if they were suppressing studies that have to do with actual health effects.

It's funny how each time a scandal comes out in America, it's treated as if it's new and separate. The truth is that there is one solid pattern in every single American scandal, and that is corruption.

America is built on corruption, and is corrupt from head to toe.

Is corruption really uniquely American? Every country and institution that I've studied seems to suffer from corruption and my intuition is that corruption is a universal element of human behavior.

I think most countries are corrupt, but the amount that it's normalized in America is certainly unique. People in most countries act like corruption is a blight, here it's not even commented on.

There are countries where it's normal and expected to pay bribes to every governmental official you interact with, America the worst offender nor is not unique in any respect.

Consider how you would get yourself out of prison. In one of those countries, you pay the bribe. There's problems with that, but we know it's a bribe.

In America, we can't bribe our way out of prison, because the corruption is so much deeper than that. You get sent to prison because of corruption you can't even see:

- the prison guard union lobbied the state congress for tougher pot laws via "campaign donations" so that their members have jobs

- the local police chief needs to be "tough on crime" so that the mayor gets reelected, manifesting in "stop and frisk" laws

- the local police department arrested you so they could confiscate your vehicle, via DOJ-aided civil forfeiture laws

- the police department negotiated a higher salary for their members, so long as it was cost-neutral, so now they need to ticket poor people to make money, which is how you got pulled over.

That's the gist of it (I haven't even gotten to private prisons, Fox News, or the NRA)! And don't this this is a Republican problem either, Democrats have been pretty bad at this sort of thing for the last 30 years too.

Non moralist argument against the alcohol industry: most of the alcohol revenue comes from a very concentrated core of heavy drinkers who blow through the liver health guidelines and definitions of binge drinking. So the industry would suffer a massive shock if the relatively small group of people damaging their livers were to decide to stop doing so. This means that the industry relies on the intentional harming of a small group of people's bodies in order to survive.

Do you have any data on this? There are certainly heavy consumers but my (not data backed) feeling was that there's a fat tail - if there are thousands of high consumption binge drinkers then there are millions of casual "several drinks a week" drinkers that would dominate the actual dollars spent.

Also, unlike say internet bandwidth, there is actually a logistical limit to how much alcohol you could consume in a week, and it doesn't seem like it could be much more than 1 order of magnitude over the average casual consumer (3-4 drinks vs. 30-40 per week).

It shows up anywhere Zipf's Law shows up

http://academyofwinebusiness.com/wp-content/uploads/2010/05/...

https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think...

Moreover, I would expect that heavy drinkers to purchase much cheaper alcohol than one-glass-of-wine-at-a-restaurant drinkers.

Washington Post had an article and a chart on it. The top decile has 74 drinks per week, way more than the bottom 90% combined.

https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think...

Unbelievable. Thanks. The top decile actually consume over 75% of the alcohol (by number of drinks, probably less by dollars)

Whenever news like this comes out it makes me more cynical towards any sort of life sciences research that produces actionable health advice. Which is really a shame, because I want to be able to decide and participate in which activities are healthy!

You don't need ethical flags to be cynical about the state of general "X makes me healthy" research.

Most studies, even the squeaky clean ones (in terms of possible conflicts of interest), tend to suffer from persistent methodological flaws. P-hacking and small N are depressingly common. Actually establishing rigor in controlling only the independent variable is difficult (e.g., alcohol-is-good-for-you tends to be control poorly for the preexisting conditions of teetotalers versus non-teetotalers). There's also the "standard" biases of publication bias and the like.

That’s why logic is superior to many “scientific” studies.

It’s clear that the environment we evolved in lacked much alcohol, therefore studies showing alcohol is healthy should be taken with a grain of salt.

It’s clear that the environment we evolved in lacked much penicillin, therefore studies showing use of penicillin is healthy should be taken with a grain of salt.

To be clear, over usage of antibiotics is a MASSIVE health issue. Penicillin was an amazing discovery, but less than 100 years later we’re discovering antibiotic resistance and lifelong gut issues due to antibiotic usage.

How do you know that this is a massive health issue? What pure logic brought you to that conclusion?

Does the NIH provide most funding to university researchers working in health research?

It's the single largest source of such funding in the US (and I imagine in the world, too), yes. I don't know that it's >50% though, but it's certainly a large fraction. For example, it's budget is 4 times that of the NSF or CDC.

Yes, it's far and away the largest funder of health research in both the U.S. and the world, and NIH funding is the "gold standard" for things like tenure and promotion.

> The $100 million-dollar, 10-year study is now underway and will ultimately enroll 7,800 participants aged 50 or over at 16 sites worldwide. Half of the participants will abstain from hooch, while the rest will imbibe one serving a day. Scientists will track participants for an average of six years, looking at risks of heart attacks, strokes, diabetes, and death.

Wow, how do you recruit people for a study like that? It would hard to convince me either to completely abstain or to drink every single day for six years, much less to have one of those randomly chosen for me.

Does everything in America need to be healthy in order for it to be legal? Is that why the alcohol lobby so badly wants to prove that booze is good for us?

No, but "you should drink alcohol every day" and "you should not drink alcohol every day" makes a massive difference in how much alcohol you can sell.

If you use the "don't wire brush your grill" thread as your ruler anything that could possibly be harmful to consumers whether used properly or not should be illegal.

Our history of outright Prohibition might have something to do with it.

Depends on who is being hurt. Given the issue of drunk driving killing children, and given the current push to restrict rights to save children, I think informing the public of the number of children killed because of alcohol is important so that we can push for banning it (not a total ban, but a ban of the most dangerous stuff, which I will begin calling assault alcohol).

> given the current push to restrict rights to save children

What do you mean by that?

Admittingly based off of personal experience and limited to US culture, but I have seen/read a recent uptick in the number of people arguing we should restrict rights when those rights might lead to the death of children, including a number of decent sized rallies.

Sounds like a variant of the age old "think of the children" meme...

I think heavier taxes and more limits would be a better approach rather than a ban. Similar to smoking. In America we used to have to go to special stores only open certain hours. Alcohol is everywhere now, grocery stores, commercials, etc. Ideally there is a middle ground between prohibition and ubiquitous.

> In America we used to have to go to special stores only open certain hours

That was (and is) entirely state dependent.

I always thought it was kind of fascinating that dry counties "still" exist-

https://en.wikipedia.org/wiki/List_of_dry_communities_by_U.S...

One could argue that the current legalization and decriminalization of cannabis could not have occurred without the medical marijuana forerunners in the 90s, so there may be some merit to your argument.

On the other hand, I suspect the simple profit motive is much stronger. Headlines like “Study suggests one glass of red wine per day reduces heart disease risk” is music to a winery’s ears.

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