https://bmcmedicine.biomedcentral.com/articles/10.1186/s1291...
I can't help but feel bias against drinking has religious roots. This has been studied to death, and generally moderate drinking is shown to be beneficial, or at very least not harmful. But some folks are so opposed to that result they keep moving the goal posts.
That said, I have no specific criticism on the paper you refer to. It might be that the lower risk of heart disease is outweighed by an elevated risk for e.g. cancer? In that way both results can be true.
I don’t think it’s necessary to propose novel explanations for opposition to drinking. Alcohol has enormous negative effects on society and individuals. Nobody who has ever lived with an alcoholic is even remotely confused about this, but even those of us who have been lucky in that respect can easily observe large societal detriment. A staggering percentage of all violent crimes are committed by drunk people, most of us know someone who died in a drunk-driving related incident, and we’ve all been around drunk people who we found to be incredibly annoying (and often actually violent).
Opposition to drinking doesn’t require additional explanation.
There was a (ineffective and violent) prohibition on drinking a century ago. Some religions also have strong views against drinking. To ignore these societal influences on western culture and call it a novel explanation is a bit of a stretch.
Prohibition is widely regarded today as an obviously ridiculous blunder, but that's mostly revisionist and ahistorical.
German Lopez at Vox did a couple good pieces on what people get wrong about it:
* https://www.vox.com/2015/10/19/9566935/prohibition-myths-mis...
* https://www.vox.com/the-highlight/2019/6/5/18518005/prohibit...
There's also a bit of an asymmetry that makes weighing the pros and cons difficult. If 40 people enjoy a night at the bar, but one one of them goes home and beats their wife and another kills a family in a drunk-driving accident on the way home, do we just say, "well, 38 of the 40 peacefully enjoyed their evening, so it's mostly good." That looks like a horrific outcome, to me.
Unfortunately, an overly pedantic Supreme Court interpreted "intoxicating liquors" very broadly, resulting in a national ban that far exceeded the state and local legislation with which most people were accustomed and comfortable. It was the narrower definition only encompassing distilled liquor that the public knowingly gave their consent.
Obviously drunkenness is another issue altogether, but that's not what such studies examine in the first place, so that's a different discussion.
As for the benefits of wine in moderate drinkers, I remember reading a study which compared consumption of wine vs equal amounts of other types of alcohol, and concluded that the antioxidants and tannins in wine were the main carriers of that benefit, and if anything alcohol still had negative effects but simply the benefit from the other substances in wine overrode the harm caused by the moderate amounts of alcohol in wine.
Obviously since I don't remember the study to cite it, this makes it an anecdotal claim here, but ...
They didn't read in the Bible that alcohol was bad. They looked around at society and blamed a lot of its ills on problematic alcohol use.
Some background here: https://www.thegospelcoalition.org/article/9-things-you-shou...
Everybody gets this causal arrow strangely backwards. Alcohol causes people to sin; that's why Christians opposed its use. It's the negative effects of alcohol that led people to oppose its use, not "religion" per se (or even in any kind of explicit scriptural or liturgical sense).
That’s all I meant by “sin.” I only used the religious term because I was speaking from the viewpoint of the religious of the time. Didn’t mean anything by it other than ordinary misbehavior.
Perhaps, but P(A|B) is drastically different from P(B|A). In other words, what percentage of consumed drinks of alcohol are associated with a homicide?
Beyond that, could alcohol use be prevalent enough that alcohol could be implicated in 50% of everything? It's sort of like how "excessive speed" is a factor in most car accidents, but that's because posted speed limits are too low and everybody speeds at least sometimes.
I think of it as an "alcohol as a plaque solvent" model.
Careful. That result is not so clear-cut:
>> In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated. [Section Abstract/Results]
>> Pooled analysis of estimates relative to non-current drinkers showed a reduced mortality risk for an alcohol intake up to approximately 75 g/day. However, when studies with former drinkers in the reference group were excluded, the association was considerably weakened (see Additional file 1: Figure S9). In addition, among those studies using post-event alcohol measures, the result did not change substantively; a similar trend was seen in studies with multiple measures but failed to reach statistical significance, probably because of the low number of curves (n=2) in this subgroup (see Additional file 1: Figure S10). [Section Alcohol consumption and all-cause mortality among CVD patients]
Btw, "post-event" means that participants reported their results after they had their major cardiovascular event:
>> In addition, most of the included studies asked patients to report their average consumption since the occurrence of their primary events (post-event alcohol assessment), whereas three studies used alcohol intake in the year prior to primary events (pre-event), assuming drinking habits remained stable over time, even following events [14, 44, 45]. [Section Data extraction and quality assessment].
Is there any reason to believe the chemicals in alcoholic drinks would boost your health?
My intuition is it's behavioral or emotional in that maybe drinking a glass of wine a day is relaxing, maybe more likely to be drinking with friends?
Alcohol thins the blood, much like aspirin, which at small doses decreases all cause mortality.
Some types of alcohol, especially wine, are rich with antioxidants and flavonoids.
Alcohol may decrease stress and anxiety.
Alcohol is often consumed with friends and family, and we know socialization is correlated with better health.
Yes 100% on socialization that was my first intuition.
Can't we just reserve judgement here, and use some humbleness in the face of our ignorance to drive for a real RCT funded by the public?
Can we try to avoid the trap of becoming confidence-men?
For example: there are zero RCTs that prove to us cigarettes cause cancer. But we're still comfortable in saying cigarettes cause cancer.
It's entirely ridiculous to suggest we do a RCT and ask someone to smoke for 30 years to remove all doubt that cigarettes cause cancer. And who would pay for it? So all we have are mountains of data showing that cigarettes shorten lifespan.
The same is true here, but the opposite result. Doing a RCT on alcohol for decades will never happen. All we have are mountains of data showing either no harm or a small benefit on lifespan. So that should be our null hypothesis: that moderate drinking is either harmless or slightly beneficial.
About 80 to 90 percent of people who have lung cancer were smokers.
Only about 10 to 15 percent of smokers will develop lung cancer.
So it's not a guarantee. It increases the risk.
Just like alcohol (https://www.cancer.gov/about-cancer/causes-prevention/risk/a...)
The problem with doing RCT with alcohol and with smoking is that we're talking about lifestyle studies. You can't really do a study with the goal being "see if we can give this dude cancer during his lifetime".
And let's also remember that the study that people who drink moderately had longer lifespans just really notes correlation. It does not prove a causation.
Drinking is ubiquitous. Most people drink. Drinking is also a luxury. So if you're poor, you either drink a lot or very little. Because you either have a problem or you're too broke to afford it. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185179/)
Guess which income bracket engages in moderate drinking the most? That's right, the income bracket that also allows you to afford better health outcomes overall. So while it may be true that moderate drinking correlates with longer lifespans, it's a knock-on effect to the fact that being poor sucks.
The control part would be particularly difficult (unless maybe you gave everyone a real or sham nicotine patch? But then you can’t exclude some other benefit from straight nicotine itself).
One could control for all the confounders they want, but you still risk missing some that are unknown or undervalued.
Not only does that conclusion not follow from your premise (a logical fallacy), but it's an absurd suggestion as a process for deriving truth. Observational studies, at best, offer an insight into possible hypotheses, and should by no means be considered persuasive unless all interacting systems have been controlled for. In the case of ethanol, there are an enormous amount of interacting systems that need to be controlled for.
Your premise is also strictly false, as it's clear that not only is an RCT for ethanol consumption possible, but it was planned and partially in progress before it was terminated.
It's truly incredible to see the kind of language that you use here, how confident you are about your fallacious argument. I kindly request that you turn down your confident language. Science is a long and careful process of pushing back the fog of ignorance, and if you are serious about the search for truth you shouldn't use such confident language.
I think the most likely outcome is boring: moderate amounts of alcohol are moderately harmful, but not harmful enough to be immensely obvious and not harmful enough to outweigh the non-biological benefits some people extract from it.
Is this "no one reads the article anymore" again?
My complete layperson theory is that no amount of alcohol is "healthy" per-se: its negative effects are well known and documented, and almost assuredly outweigh the few dubious positive effects. Instead, the benefits of drinking small amounts of alcohol might be entirely tied to stress management. Stress kills. It absolutely ages people and leads to early death.
Having a wind-down ritual in the evening is probably the important bit. A glass of wine with dinner is a firm punctuation mark in a person's day. It signals that work is now over, and what's been left undone can be resumed tomorrow.
It's just a morality/cultural issue. They see people drinking & driving, excessively drinking and being violent, depicted IRL and in movies, and want to distance themselves from these bad types of people that drink alcohol.
Plenty of very secular countries have drink and smoke a lot (for communist countries, for example).
And of course, what those "studies to death" you mention have established is that alcohol is even nastier than suspected, causing birth defects and cancer like no comparable substance we consume, in addition to all the obvious negative health effects we all can see.
The supposed dip at the low end, for only a few of the nasty effects, is a counter-theory to distract from the (pink?) elephant in the room. And even that counter-theory has been discredited by mendelian randomization studies.
I think that has to be typical of a significant chunk of population. People on the wagon due to alcoholism exist but are likely to be a smaller group.
It boils down to: Self control is strongly correlated with good health