What if a pharmaceutical company invented a pill that resulted in a modest but significant reduction in the risk of heart disease in 90% of the population, but resulted massive increase in the risk of premature mortality in 10% of the population, easily shaving off 10-40 years in life expectancy in that 10%, depending on the severity of their reaction to the drug.
The company could find absolutely no way to tell the two populations apart prior to administering the pill. Most critically, once the 10% took the pill for a short period of time, they almost always ended up suffering the adverse effects.
Do you think the FDA would approve that pill? Do you think any sane doctor would prescribe that pill to his/her patients?
So absolutely, if you are sure you don't have any alcoholic tendencies (and if you have to ask, you aren't sure), then drink a glass or two of red wine a day (depending on your body mass). It will almost certainly improve your cardiovascular health.
But don't expect medical or public health professionals to go singing its praises from the rooftops to a partially at-risk population.
Are you really sure about that? Do you know Isotretinoin? You may want to do a little search about it. Look at the serious adverse effects and harms it cause [0].
Despite that, a huge numbers of doctors (in many countries around the world) do administer it. Why? Because it makes money for the pharmaceutical industry.
So the answer: Yes, the FDA will approve that magical pill.
Criticizing Isotretinoin can only come from someone who doesn't understand what big of a deal acne can be. That drug saves millions of human lives from suicide.
Millions of lives from suicide? Only ~800k people successfully commit suicide annually, and somehow many people survived quite bad acne before this drug.
I'm not saying severe acne or associated scaring can't cause mental health issues, but the list of side effects includes suicidal ideation, suicide, birth defects (it's a teratogen), depression (notably at the rate of between one in 1k and one in 10k), etc. This list [1] is quite extensive, and I'm glad I didn't have to sit on the fda council that decided this list of side effects was ok in a drug that, after all, just prevents some cosmetic scaring.
>Do you know Isotretinoin? You may want to do a little search about it
Yes, I know all about Isotretinoin. I took 3 courses of it as a teenager with severe, painful scarring acne. It improved my life a great deal, both from a health and social perspective.
If you know all about Isotretinoin, then we don't you speak to that instead of some perceived personal attack?
I think it's perfectly acceptable to assume someone may not know about something when it may heavily affect their argument and they haven't mentioned it.
I still think you are interpreting the statement as being far more condescending than it possibly is. You didn't mention it, it seemed relevant, so someone pointed it out, assumed you didn't know about it because you didn't mention it, and suggested you look it up.
I read it as trying to be informative, not condescending. More than a few upvotes on my response leads me to believe others interpreted it similarly. Maybe the subject is charged enough for you to create a bias for how you interpreted the response?
>Maybe the subject is charged enough for you to create a bias for how you interpreted the response?
Sure, it's possible. In fact, I'd say it's definite. I would never deny that I'm biased because of my life experiences with isotretinoin (which I knew as Accutane).
But by the same token, csomar is equally biased because of his/her negative life experiences with isotreninoin, as he mentions elsewhere [1].
And I don't know how else to interpret "You may want to do a little research" except as condescension. I guess if csomar is not a native English speaker, it's possible that's not how it was intended. But no native English speaker would write a statement like that without the desire to be arrogant, condescending and superior.
So the smart person will discount what we're both saying and do his/her own research, paying particular attention to published peer-reviewed research by neutral researchers.
But I think a thoughtful person with some numeric literacy will quickly see that the issue is not as black/white as csomar has painted it.
EDIT: I've already spent far too much time on this, so I can't respond to anymore replies. If someone makes a particularly good point against me, then I concede the argument.
And yet opiates are both approved by the FDA, and widely prescribed by doctors. As far as I know they carry a much higher addiction risk and increase mortality quite a bit more than alcohol does.
Benzos, amphetamines, SSRIs, etc etc. There are plenty of pills both approved and prescribed that have a worse effect and/or affect a higher percentage of people.
Opiates, benzos, and amphetamines are all highly controlled substances -- and most physicians only prescribe them long-term under very rare circumstances.
And actually, long-term opiate abuse is much less likely to result in organ failure and other chronic health conditions than alcohol is.
That's not the case with benzos or amphetamines, but I don't see anyone this side of Hunter S. Thomson arguing that more people should take amphetamines.
Finally, can you explain what you mean by "and/or affect a higher percentage of people"? You mean more people take SSRIs than abuse alcohol? I don't understand what you're suggesting.
Opioid[1] and Amphetamine[2] over-prescription is certainly not rare. Anecdotally, I know plenty of people that got sent home with a bottle of hydrocodone after dental surgery, which is not a rare case. There is an entire market based on prescribing these "highly controlled" substances to people who don't actually need them.[3][4][5]
While long term use of opiates isn't in itself harmful, long term abuse carries a high risk of overdose due to tolerance.
By "and/or affect a higher percentage of people", I mean that a higher percentage of people who take certain prescribed substances (like amphetamines or opioids) are at risk for addiction to those substances than those who drink alcohol.[6]
Edit: All of which is ultimately irrelevant, as your argument was "Do you think the FDA would approve that pill? Do you think any sane doctor would prescribe that pill to his/her patients?" and we both seem to agree that pills that have fewer benefits and just as bad if not worse consequences that your hypothetical drug are both approved by the FDA and prescribed by doctors.
Opiate abuse doesn't, but the bundled acetaminophen kills livers.
I think the previous posters' point was that becoming dependent on opiates happens more often than dependency on alcohol. I agree -- except in cases where there is genetic predisposition to alcoholism.
That depends entirely on body mass since the effect is dose dependent (one of the few things we understand well about the positive effects of alcohol).
The red wine thing is bullshit, as mentioned in the article. Wine and beer actually have problematic amounts of estrogen. If you're going to drink, quality clear spirits are best.
If there's anything special about red wine it's probably the small dose of salicylate. Might as well just take a baby aspirin if you buy into that.
I don't buy the idea that alcohol itself is particularly biologically medicinal; I think the benefits are entirely by way of psycho-social well being. At a simple biological level alcohol, at even pretty high amounts, is merely benign. That said, problems like fatty liver disease appear to be often be the result of the interaction between alcohol metabolism and stored polyunsaturated fats. So if you're going to drink a lot, eat a low PUFA diet.
> If you don’t distinguish binge drinking from daily moderate drinking, that would be due to Americans’ addiction-phobia, which causes them to interpret any daily drinking as addictive.
This is a quite common attitude in northern Europe as well, or at least in the Nordic countries. In Denmark it's highly suspicious to drink alcohol on a weekday (especially at lunch), unless it's a holiday, and will lead people to worry about alcoholism. But it's completely normal to have 6+ drinks on a weekend evening. Maybe even every weekend evening. You can binge-drink as much as you want, as long as it's only Fri-Sat (sometimes Thu). In fact it's even sort of expected; not doing so might raise suspicions that you're some kind of weird religious person (Mormon? Muslim?). Not sure how this arose, but it seems to be the cultural norm: 14 drinks/wk spread out as 1 each with lunch/dinner every day is seen as alcoholic, but the same 14 drinks/wk spread out as 7 each on Fri/Sat evenings is culturally normal. Whereas in southern Europe the opposite is more often true, at least traditionally, with weekend binge-drinking seen as more questionable than moderate daily drinking.
That's not what would make it a good predictor. The proper question is not what percentage of alcoholics drink every day, but what percentage of people who drink every day are alcoholics.
Plenty of alcoholics don't drink every day. It's a question of compulsive and uncontrolled drinking not simply the frequency of drinking. A collage student may destroy their health and social life though binge drinking while not being able to afford drinking every day.
Plenty of people with drinking problems don't drink every day - alcoholics, which I would define as people addicted to alcohol do. If a person is addicted to alcohol they will have pretty immediate adverse affects, i.e. the DTs, which include shaking, hallucinations and seizures pretty rapidly with no alcohol in their system.
Addiction often leads to physical dependence, but you can for example be a light smoker that's addicted to nicotine. However, you generally need to be a fairly heavy smoker before withdraw symptoms show up when you stop. On the other hand people without addiction to caffeine will often display withdrawal symptoms if they stop. This is vary common in people who enjoy soda or tea, but don't use it to stay adjust alertness.
> In fact, the evidence that abstinence from alcohol is a cause of heart disease and early death is irrefutable
I'm sorry, but the author drastically overstates the certainty of our current knowledge. Every single piece of evidence he marshals is a study, not an experiment, so who knows what the confounding factors are. And even worse, the studies necessarily depend on self-reported alcohol consumption, which, as any doctor knows, is basically just a bunch of lies.
There's a huge history of scientific consensuses being wrong, particularly surrounding health in the last 30 years. I think we should be cautious about jumping to conclusions of what these studies actually mean. That he calls his hypothesis "irrefutable" is downright appalling.
Yep, pure comedy. Here are the facts; alcohol is among the largest preventable causes of deaths, is connected to half of all violent crimes and about a third of car related deaths.
The problem with those "connected" results is that alcohol is very popular so a large fraction of any group has consummed alcohol recently. This is yet another example of the divergence of causation and correlation.
If it is actually responsible for preventable deaths, why are they not being prevented? Because they are probably very, very hard to actually prevent. Even prohibition did little to reduce death rates and we already arrest 1.5 million people in the US each year for driving under the influence. What would work? I suggest the prevention of these deaths will have little to do with alcohol and more to do with healthcare and perhaps automobile design.
France banned alcohol advertising; introduced minimum pricing and introduced stricter drink drive limits. They've seen reductions in deaths from cirrhosis.
England does not have minimum pricing[1]; does have alcohol advertising, and has seen significant increases in deaths from cirrhosis.
[1] this was a shoddy U-Turn, where evidence based choice was rejected based on lies pushed by the alcohol industry. Minimum unit pricing of 50 pence per unit would affect very few drinks. (One unit of alcohol is 10 ml of alcohol, so you multiply the amount of drink by the ABV then divide by 1000. 175 ml * 13.5 / 1000 is about 2.4 units.)
Sorry you don't understand - let me see if I can make it simpler for you. Your alias (readerrr) gives me some pause that this will be successful. :)
If something is preventable that means it can be prevented. Right? So why is it not be prevented? Understand? By this flawed logic aren't all murders and suicides also preventable? This "preventable" label is bullshit.
I suggest that the vast majority these "alcohol related deaths" cannot be prevented thought additional controls on alcohol. We tried prohibition - didn't help. We arrest 1.5 million people every year - still these death persist. Do you have some suggestions? I gave a few above.
I'm sorry, but when you see the huge drop from "none" to "less than daily" in men you know there has to be something else going on there that only happens to be correlated with alcohol consumption.
What if the people in the 'none' group can't drink because of a medical condition? Many medical conditions are already associated with shortened life spans, and alcohol often interferes with medication.
Including this page which should make things clear: alcohol consumption is just a placeholder for socioeconomic status, which everyone knows has a major effect on longevity.
The evidence definitely seems to be converging on non-drinking as less healthy than light or moderate drinking.
My question is, why does alcohol have these health benefits? Some earlier work pointed to resveratrol in wine, but there is a lot of doubt that's been cast on that hypothesis and the general benefits of alcohol seem to be agnostic regarding the particular form of beverage.
A whole pile of the studies are observational and not placebo-controlled, nor randomized.
Therefore, other factors beyond the consumption itself can't be ruled out, such as differences in education, religious beliefs, non-religious beliefs, open-mindedness, etc.
Trying to answer the question of why alcohol clinically has the effects that it does is a hard battle. The molecule has wide-ranging effects, it doesn't by any means hit any particular receptor. It goes wherever water goes in the body and disrupts every cell membrane in the body, among other effects.
And that's if the health benefits have anything to do with the clinical effects at all.
Associations don't imply causations. We don't know if gingivitis causes heart disease, nor do we know if heart disease causes gingivitis. Or maybe each has a minimal direct effect on the other (I'd never say none at all).
Likely, individuals that have/do things that prevent gingivitis, like affording a dentist, also have/do things that prevent heart disease, like affording blood pressure medications.
Rat experiments show that adding a small amount of alcohol to their drinking water makes them live longer. The reason is thought to be the alcohol helps kill off undesirable gut bacteria, which produce LPS endotoxins. Rats on antibiotics also live longer for the same reason.
I don't think gingivitis is caused by bacteria per se. Cavities and gingivitis manifest as a consequence of lousy overall health and problems such as mineral deficiencies, not a lack of listerine. The phrase "look a gift horse in the mouth" exists because lousy teeth indicate a bunch of other health problems. It's not about horse oral hygiene.
As far as I'm concerned, this thread should be about the fact the government and health care professionals are lying to us about the facts because they think they know best.
Whether the advice is best for society or not doesn't matter, they are lying to you. This concerns me a lot.
I call bullshit. There's nothing in the while article that proves drinking is healthy. The author heavily relies on the wrong logic of "correlation means causality".
For cigarettes, if you dial back what you consider moderation to say, maybe a cig or two socially every couple weeks, that would not likely be the thing that killed you. there are smokers like that, they just have a couple at a party, not very often. It's not something most people would do but there are some out there that do.
I'd say most cigar or pipe smokers I know are like this.
I think it's less common with cigarettes now for various reasons. The social stigma, the fact that they are much more convenient, and that they deliver their nicotine "hit" much faster, I would imagine makes them more addictive.
A reduced risk for Parkinson's disease (PD) among cigarette smokers has been observed consistently during the past 30 years. Recent evidence suggests that caffeine may also be protective. Findings are presented regarding associations of PD with smoking, caffeine intake, and alcohol consumption from a case-control study conducted in western Washington State in 1992–2000.
Being a cigarette smoker was observed to reduce risk of PD. This study does not tell us if it's the smoking itself that's causing this, or some other trait of cigarette smokers because the studies weren't randomized.
https://en.wikipedia.org/wiki/Stanton_Peele#Funding
This article makes it sound like there are no health concerns with regular drinking.