Scientific Perspectives - Dr. Rick Westermeyer,
M.D.
Many of you have heard or read that moderate alcohol may be beneficial to your health. Here is an example of a New York Times press release printed on December 11, 1997. "STUDY FINDS DRINK A DAY KEEPS THE GRIM REAPER AWAY". It stated that "researchers report that modest drinking is, on balance, healthful and alcohol's ill effects are offset by alcohol's benefit to the heart."
As a physician,
it was important to me to go to the scientific literature myself to examine
the evidence before I would start advising patients, as some doctors have,
that alcohol be used for medicinal purposes.
First, I obtained the original research paper printed in the New England Journal of Medicine, December 1997 and then I did a literature search of all the articles that have been published on alcohol in the last three years. What I found was quite surprising, considering all the popular press coverage of the beneficial and medicinal properties of alcohol. The largest and longest study to date was published in the New England Journal of medicine in December 1997 and was entitled "Alcohol Consumption and Mortality among Middle-aged and Elderly U.S. Adults". (Thun et al., NEJM 1997; 337: 1705-14).
It followed nearly 500,000 individuals for nine years and reported a 20% decrease in mortality for those aged 35 to 70 during the study period for those who consumed at least one alcoholic beverage per day as compared to non drinkers.They attributed nearly all of the lower death rates to medicinal effects of alcohol in protections against cardiovascular disease. From a purely medical point of view should physicians start recommending alcohol consumption to protect against heart disease and to promote good health? Many people have interpreted these findings to suggest moderate drinking of alcoholic beverages should be part of a healthy lifestyle.
After carefully studying the original research paper from the New England Journal of Medicine (NEJM) plus reviewing over fifty other alcohol related articles published in the medical literature in the last three years, the following seven points should be considered before using alcohol for medicinal purposes:
1) Alcohol is a well-established risk factor for numerous cancers. The NEJM study showed a 30% increase in breast cancer in women consuming as little as 1 drink per day. This added to the already known increased incidence of mouth, throat, esophagal, stomach, pancreatic and liver cancer associated with alcohol consumption. (Rosener L. "Alcohol consumption and the risk of breast cancer." Epidemiology Review 1993: 15:133-44). The only reason that an overall decreased mortality rate was shown in the alcohol drinking population was because many more people die from heart disease than cancer. How could any physician face a patient dying a slow, painful death from a cancer clearly linked to the alcohol that had previously been recommended as a way to decrease the chance of a heart attack by only 30% when other less risky preventative measures are available without causing cancer as a side effect?
2) By analyzing only those aged 35 to 70, the study did not accurately reflect the lifetime risk of alcohol consumption. Alcohol related injury is the number one cause of death in the 15 to 30 years old age group. (McGinnis, J.M. "Actual causes of death in the United States", Journal of the American Medical Association, 1993; 279:2207-12)
3) The mechanism by which alcohol gives cardiac protection may be harmful to other body systems. Alcohol appears to protect against heart attach in two ways. First, by raising the level of HDL cholesterol which reduces the build up of atherogenic plaque in the blood vessels, and secondly, by acting as a "blood thinner" which clots from forming in the already narrowed coronary arteries which is the initial event in most heart attacks. (Kannel, WB. "Serum cholesterol, lipoproteins, and the risk of coronary heart disease", The Framingham Study, Ann Int Medicine 1971: 38: 1224-32). Interfering with the delicate balance in the blood clotting mechanism may be a dangerous thing. A few years ago, it was noted that aspirin had blood thinning properties that prevented heart attacks. The initial reports were so impressive that thousands of physicians voluntarily started taking aspirin daily as a part of a study to look at the long term benefits. The research project was stopped prematurely when it was noted that the aspirin group was experiencing an unexpectedly high incidence of hemorrhagic stroke. While trying to prevent a heart attack by thinning the blood, some of these doctors died, or were permanently disabled by bleeding into their brains. Now most doctors only recommend aspirin to patients who have already had one heart attack. The reasoning being that the risk of a second heart attack is greater than the aspirin induced stroke and the potential benefit outweighs the risk. It clearly points out the danger of interfering, as alcohol does, with the delicate balance of the body in such areas of blood clotting. In addition, while preventing certain types of heart disease, alcohol has been clearly linked to cardiac arrhythmias and cardiomyopathy leading to congestive heart failure. (Cowie, M.R. "Alcohol and the heart" British Journal of Hospital Medicine, 1997; 57: 548-51).
4) The 30% decrease in the death rate from heart disease attributed to alcohol may be achieved and surpassed by other much less risky methods. Numerous studies have shown that simple lifestyle measures can reduce cardiac risk by 50 to 70% without any of the many harmful side effects documented with alcohol usage. (Miller, G.J. "Alcohol consumption: protection against coronary disease and risk to health." Int. Journal Epidemiology, 1990; 19:923-30)
5) The study's methodology and analysis bring into question the validity of the conclusions. It must be understood that all studies relating health risk and alcohol consumption rely on voluntary questionnaires being accurately completed. No one actually follows the patients around to document their consumption or verify their claims. One of the editors of the NEJM who wrote an editorial response pointed out that the study group reported their yearly alcohol consumption to be only half of US government per capita estimates based on industry production and sales. (Potter, J.D. "Hazards and benefits of alcohol". NEJM 1997: 337: 1763-64). He pointed out that either this study group did not reflect average American drinking habits, or they did not accurately complete their questionnaires. (A third possibility which he did not mention would be that one half the alcohol produced in this country gets poured down the drain or is used to kill slugs). Anyone who has ever worked with alcoholics knows they are often in denial regarding their drinking patterns and some may have inaccurately placed themselves in the non-drinking groups statistics which would have affected the validity of the conclusions. Additionally, the NEJM study excluded from their statistics without explanation 32,000 individuals who had cancer or cirrhosis at the start of the study. These diseased are known to be closely linked to alcohol consumption and their exclusion could markedly effect mortality rates.
by Dr. Rick Westermeyer, M.D.