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Should Doctors Recommend Alcohol for Patients’ Health? Experts Debate

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Should doctors recommend alcohol as a way to reduce their risk of heart disease? At the recent Association for Medical Education and Research in Substance Abuse annual meeting, an expert in heart health and an expert in addiction and primary care medicine came up with sharply different answers.

R. Curtis Ellison, MD, Professor of Medicine and Public Health at the Boston University School of Medicine and a senior investigator in The Framingham Heart Study, argued in favor of recommending alcohol to benefit patients’ health. “Is light to moderate alcohol intake associated with beneficial health effects?” His answer is overwhelmingly yes, based on trials in humans and a huge amount of experimental data. He notes there have been many thousands of experimental studies (animals and humans) that support the premise that moderate alcohol and wine intake is associated with better health outcomes.

“While I am not recommending that everyone should drink, it is important that the public be given the truth. Middle-aged and older people should be aware that, unless contraindicated (by former abuse, pregnancy, religious beliefs, etc.), the regular consumption of a small amount of alcohol each day is associated with a lower risk of most of the diseases of aging, and with a longer lifespan,” Dr. Ellison said.

R. Curtis Ellison, MD

R. Curtis Ellison, MD

The important message to tell the public, he says, is explaining that drinking patterns make a big difference. “Fourteen drinks a week can mean two drinks a day, or all 14 drinks in one weekend—there’s a striking difference between the two,” he said.

What you drink also can make a difference, Dr. Ellison says. “Animal data and epidemiological data supports that wine drinkers do better, even when you control for eating and health habits.” He added studies have indicated that encouraging moderate drinking does not lead to increased abuse.

He quoted Dr. Philip Cole of the University of Alabama, who warns that public health experts are being paternalistic by not telling people the entire truth in the interest of trying to do what’s best for them. “It’s the concern that if we tell people one drink a day is good that they’ll go out and have two—there’s no evidence that’s happening,” Dr. Ellison said. “Let’s make sure we use education, not paternalism.”

Richard Saitz, MD, MPH, Professor of Medicine and Epidemiology at the Boston University Schools of Medicine and Public Health, says doctors should “absolutely not” promote alcohol consumption as a way for people to improve their health.

Public health officials have seen with prescription drugs, medical marijuana and now e-cigarettes, that if something is seen as sanctioned, teens will have the impression it’s safe, he said. “This can affect rates of addiction.”

“Any medical group will agree that in order to recommend a preventive intervention, you need the highest levels of evidence,” he said. “That would be multiple, large, randomized controlled trials showing that recommending alcohol to patients would improve outcomes, or at least that the benefits would outweigh the risks. We have no such study.”

In contrast, doctors started recommending low-dose aspirin for reducing the risk of heart disease only after many large controlled, randomized trials showed it was effective, Dr. Saitz noted.

Richard Saitz, MD, MPH

Richard Saitz, MD, MPH

The majority of studies suggesting a health benefit from alcohol ask people how much they drank last week, and then follow up 20 or 30 years later to see if they had a heart attack and died, he says. “We’d never accept that kind of evidence for a pharmaceutical product. There are numerous problems with these studies. We don’t really know the dose of alcohol, just what people who had been drinking tell you they remember they drank.”

People who regularly drink low amounts of alcohol also tend to have good health habits, Dr. Saitz observes. “They’re more likely to go to the dentist, get mammograms, have annual physician visits, exercise regularly, have better diets and have better psychological profiles—no one would say regularly drinking low amounts of alcohol causes any of this. The obvious conclusion is that people who drink low amounts of alcohol have many other healthy behaviors—there’s no way it would be possible to adjust statistically for so many of these other factors to separate out the effects of low-dose alcohol.”

Since so many people already drink, the patients who don’t drink are probably abstaining for various reasons, such as a family history of heavy drinking, medical problems that have made them stop drinking, religious objections, or not liking the taste, he said.

A major reason not to promote drinking is that alcohol has been classified as a carcinogen by the U.S. National Toxicology Program and the World Health Organization, Dr. Saitz pointed out. “You don’t want to increase the risk of cancer, even if it might prevent heart disease,” he said. According to the National Cancer Institute, even moderate drinking has been shown to increase the risk of breast cancer.

Excessive alcohol use is the third-leading preventable cause of death in the United States, according to the Centers for Disease Control and Prevention. “On a public health basis there’s no question alcohol causes more harm than good,” he says. “Many other things can be done for your health that are proven, that are not likely to be harmful for your health.”

8 Responses to this article

  1. jboside / December 13, 2013 at 1:43 pm

    Dr. Ellison said,“While I am not recommending that everyone should drink, it is important that the public be given the truth”. This stupid story has been released to the media on a quarterly basis for the past 30 years. The first thing a wine drinker says is wine is good for the heart. This alcohol industry quack is just puttin a spin on a old story.

  2. Jean / December 13, 2013 at 12:48 pm

    Absurd…. simply absurd. Doesn’t anyone use common sense anymore? In this day and age recommending any alcohol or other drug be used on a regular that is not prescribed for a particular concern can only end up backfiring in the long run. We all know how people scan and do “sight bites”, “sound bites” half listen, etc. etc with all the input these days. So any one in the addiction field surely knows that many (not all) people will see “alcohol healthy” and go with that. And to think that any medical/human services person would advocate any drug as healthy is downright absurd and unethical.

  3. Debra Rincon Lopez / December 13, 2013 at 12:42 pm

    This just makes patients think it is OKAY to be a DRUNK, even if it means KILLING THEMSELVES? They have a DOCTORS Permission after all? SO SICK I wished they never would have POSTED these FINDINGs. IF your an Alcoholic it’s not going to help you in any way, Just get you closer to DEATH FASTER! Debra Rincon Lopez. I have seen TOO MANY Tribal members in my Community & Family DIE Of ALCOHOL & DRUGS, I don’t want to see anymore!!!!

  4. JB / December 13, 2013 at 12:23 pm

    Two professionals from the same university. One using science, and the other giving sound bites similar to the ones the alcohol industry gives. Guess which one has received funding from the alcohol industry.

  5. Gail Chmielewski / December 13, 2013 at 1:11 pm

    I agree with Dr. Saitz, no, alcohol should not be encouraged for all the reasons he stated.

  6. Doug Moser / December 13, 2013 at 3:02 pm

    In/when truly providing individualized treatment, both doctors are right.

  7. Avatar of Steve
    Steve / January 4, 2014 at 4:43 pm

    Do you know Dr. Ellison receives alcohol industry funding, or are you just throwing out naked accusations because you don’t like his scientifically-based recommendations? You really should be careful before you accuse someone of being an industry mouth piece; if you are wrong you may find yourself being sued for defamation.

  8. Avatar of Beer causes Cancer
    Beer causes Cancer / April 1, 2014 at 10:04 pm

    The problem is that too many people are ignorant or blind to the facts that alcohol is the leading cause of auto fatalities for ages 16-20 according to NIH statistics. Beer is the leading cause of rapes and sexual assaults on college campuses and the leading cause of domestic abuse against women.

    Alcohol is the narcotic of choice for politicians, police officers and businessmen and should be criminalized and re-classified as a Schedule 1 Drug.

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