Closing Remarks
Article Outline
What do we know today about the risks and benefits of moderate alcohol consumption? While all may not agree, I believe that, for most people for whom alcohol is not contraindicated by health, ethical, or religious reasons, there are “intelligent” ways of consuming alcohol that minimize the risks while providing health benefits. If consumed in “moderation” (when that term is defined to exclude binge or irresponsible drinking), alcohol can be considered as a component of a healthy lifestyle (along with not smoking, avoiding obesity, eating a healthy diet, and getting regular exercise). As our colleagues at Harvard have demonstrated, the risk of many of the diseases associated with aging can be reduced markedly by people following such a lifestyle 1, 2, 3.
The goal of this conference has been to get closer to the truth about moderate drinking. We have learned many ways in which we can improve our research techniques, especially ways of focusing more on the pattern of drinking among subjects in our studies. We should no longer define “moderate drinking” as a daily, weekly, or monthly average amount below a certain number of drinks or grams of alcohol. We must include in such a definition the drinking pattern, so that studies across cultures are more comparable. In addition, while drinking patterns are linked with health outcomes, they are also linked with a range of social outcomes. From the perspective of epidemiologic research, social outcomes are rarely taken into consideration in aggregate level estimates, such as the burden of disease attributable to alcohol. There is a real need to quantify social outcomes with standardized and comparable instruments and measures.
More research is needed in judging the applicability of short-term results from animal studies to the human condition, where the potential benefits generally relate to long-term use. Small-scale studies that measure specific biological end points in humans may therefore at times be a more reliable approach; consensus is needed, however, on what these measurable functions should be. Assessing the effects of alcohol on endothelial function has been suggested as one such measure that would provide important data in epidemiological studies.
We were not focusing on policy at this conference. And we realize that national guidelines depend on much more than the scientific data, and vary markedly according to the culture, the usual drinking patterns of the people in a particular country, and the behaviors that they are intended to change. However, we do have an abundant amount of epidemiologic and biological data that we can provide for physicians to use when dealing with individual patients, and such information should be both scientifically sound and balanced. As has been pointed out, advice for an individual can be quite different from general advice to a population. But the data are very clear: individuals without contraindications who decide that they want to consume alcohol can be told how to do so in the healthiest and least risky manner—by drinking small amounts on a regular basis.
As for our colleagues who are setting policy and guidelines regarding alcohol consumption, recall that Cole has pointed out that policy should be based not on paternalism (“We professionals know what is best”) but on education and the assumption that “informed people make healthful choices (4).” But, Cole adds, “health education should be education and not propaganda; it becomes the latter when only one side of an issue is presented to the public.” Some continue to be overly concerned that we must not share all the facts with the public, that if they hear that a little alcohol is good for their health, they will immediately think that a lot must be better! Specifying exactly how many drinks or grams or units of alcohol can be considered “moderate” can never work for all people. And many at this conference have emphasized that people are not stupid, that they know the difference between moderate and excessive drinking. The Greek playwright Euboulos, more than 2000 years ago, provided a good definition. “For sensible men I prepare only three kraters: one for health, the second for love and pleasure, and the third for sleep. After the third one is drained, wise men go home (5)”.
We are all concerned about the problems with alcohol abuse, especially among young people. The skills of epidemiologists would be usefully directed at assessing interventions intended to decrease such misuse of alcohol. More work is needed to determine which populations should be targeted with various interventions, what these interventions should be, and whether they work.
We have heard the strong moderating effects that culture can have on problems associated with alcohol abuse, on making excessive drinking socially unacceptable. Regardless of what some say, cultures can be changed, as evidenced by the example of the United States where smoking cigarettes in most indoor places has become unacceptable—a dramatic cultural change that took place over only a couple of decades. Similarly, with regard to drinking, in recent years many countries have been successful in markedly reducing the frequency of drunk driving. However, we have not been successful at all in reducing the heavy drinking and drunkenness that are becoming common in many of our cultures, particularly among young people. Many at this conference have emphasized the need for further, and better, research on how to deal with such problems of abusive drinking.
No one is advising that everyone should drink for their health, and there is little support for encouraging alcohol consumption for the prevention of coronary heart disease in areas of the developing world where risk of the disease is relatively low. However, I trust that the material presented and discussed at this conference will provide others with up-to-date and balanced information that will allow us all to judge better the risks and benefits associated with moderate alcohol consumption.
The Chairman of the Symposium and Guest Editor of this supplement wishes to acknowledge the tremendous intellectual and logistical support for the conference and for the publication of this supplement by Marjana Martinic, PhD, Vice President for Public Health, and her research assistant Yaw Nyame, BSE, of the International Center for Alcohol Policies, Washington, DC. Further, he acknowledges the valuable input into the conference and the editing of the supplement by Yuqing Zhang, MD, ScD, Professor of Medicine, Boston University School of Medicine, Boston, MA.
We are grateful for the time, effort, and intellectual input of all of the participants at the symposium. In addition to the first authors of the papers included in this supplement, we wish to acknowledge other scientists, listed below, who were present and made important contributions to the symposium:
Ricardo Brown, PhD, National Institute on Alcohol Abuse & Alcoholism, Bethesda, MD
Monica Gourovitch, PhD, Distilled Spirits Council of the United States, Washington, DC
Murray A. Mittleman, DrPH, Harvard School of Public Health, Boston, MA
Solomon Rataemane, MD, University of Limpopo/MEDUNSA, Pretoria, South Africa
Enrico Tempesta, MD, Osservatorio Permanente sui Giovani e l'Alcool, Roma, Italy
S. Goya Wannamethee, PhD, Royal Free & University Hospital Medical School, London, UK
References
- Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. JAMA. 1998;279:359–364
- . Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16–22
- Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790–797
- . The moral bases for public health interventions. Epidemiology. 1995;6:78–83
- Available at: www.users.globalnet.co.uk/∼loxias/symposium.htm.
PII: S1047-2797(07)00029-4
doi:10.1016/j.annepidem.2007.01.027
© 2007 Elsevier Inc. All rights reserved.
