You may not know it, but scientists have been arguing over whether moderate drinking confers health benefits. For the past few decades, scores of studies, most funded by the alcohol industry, have claimed that a daily glass or two of your favorite beverage confers modest cardiovascular protection, making moderate drinking healthier than abstinence. The media love these findings, so Americans tend to accept, as an article of faith, that a tipple a day keeps the doctor away.
In 2015, an article in the British Medical Journal explained that those studies were riddled with bias and industry influence. For example, in one study, researchers put all the moderate drinkers in one group. They put all the non-drinkers in another group. Then they compared the health of the two groups. Très scientifique, non? No, actually, because in those “non-drinkers” groups were both lifetime abstainers and reformed drunks. [1]
Including people already damaged by heavy alcohol consumption as part of the “non-drinker” group mainly confirms that moderate drinking is healthier than excessive drinking, which I don’t believe anyone disputes, with the possible exception of Keith Richards.
In addition to experimental design so bad it would be rejected from a fifth-grade science fair, the “moderate drinking is good for you” case has been hurt by a recent series of studies, some of which say “no, it’s not,” and some of which say, “in fact, it’s bad for you.” Moderate alcohol consumption has now been linked with more than 200 health problems, including all the big ones.
Enter Kenneth J. Mukamal, who’s heading up a $100 million study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to settle the question once and for all. For six years, he and his teams will follow 7,800 adults over age 50 with higher-than-average risk of cardiovascular disease. Half will drink fourteen grams of alcohol per day (in whatever beverage they like), and half will abstain. They’ll be checked to correlate alcohol consumption with heart disease, stroke, diabetes, and blood glucose.
Poring over Dr. Mukamal’s abstract with my non-specialist eyes regularly glazing over, I managed to spot a few striking details. Here’s one. “Epidemiological studies have consistently found that alcohol intake within recommended limits is associated with lower risk of coronary heart disease, ischemic stroke, and diabetes.”
Now that’s what I call a very loose definition of “consistently.” It’s mainly Dr. Mukamal’s own research that has “consistently” found health benefits, which makes me nervous about his impartiality, but, heck, let’s give the good doctor the benefit of the doubt and trust that he will thoroughly test his assumptions and follow where the evidence leads. Let’s trust that he will ignore that most of his funding comes from the alcohol industry, which desperately wants its product to be viewed as a unique boon to health, sort of like exercise or meditation in tasty liquid form. If we impute to him the best of faith, we still have to ask: how likely is his experiment to produce useful data?
The experiment is, in his words, “a worldwide, six-year, balanced-design randomized trial.” Sounds rigorous. Sounds fair-minded. But one element that gives me pause is “randomized.” When a trial is randomized, subjects are assigned to the control group or the test group by pure chance, not according to their habits or preferences. Where will Dr. Mukamal find 7,800 adults so indifferent to drinking and so enamored of science that they will submit to being eeny-meeny-miney-mo’d into either abstinence or a daily tipple for six years!
Imagine you’re a non-drinker assigned to the drinker’s group. You’re not too happy about it, but okay, you’ll do it for science. You start drinking a beer every evening. After about a month, you notice that your pants are getting a little tight. You suspect the beer. You fire up your calculator and discover that, even if you switch to rum and diet coke, you will consume an additional 219,000 calories over the six years of the experiment. Growing alarmed, you do more math. Using the classic calorie-to-pound-of-fat conversion formula, you discover to your horror that, unless you cut down on your food intake, you stand to gain almost sixty-three pounds over the six years of the experiment. How many avocados will you give up before you start skipping drinks?
On the other side, say you’re a daily drinker who now has to abstain for six years. Six years of barbecues and baseball games and poker nights and New Year’s Eves and St. Patrick’s Days. Six years of parties with a can of warm Mountain Dew in your clenched hand and—do I even need to go on with this example?
If you think about it from the experimental subject’s point of view, a randomized study of such duration seems destined to fail. Maybe even designed to fail? Unless subjects are outfitted with a bracelet that tests ethanol in their perspiration every hour—and compensated handsomely for wearing the cumbersome (and potentially shaming)[2] device— how will compliance ever be strong enough to support any conclusions at all?
My answer: it won’t. What we will get with this very expensive study are two groups that behave very much alike. Some of the “drinkers” will skip drinks. Some of the “abstainers” will drink. Their health outcomes will likely be very similar, and Dr. Mukamal will conclude that there’s no benefit, but also no harm, in drinking fourteen grams of alcohol every day.
Is this the ringing endorsement that the alcohol industry hopes to see? Not really. Their lobbyists have long relied on the “good for you” research to get all kinds of political consideration and positive press, so “no harm” will be a step down. But, with recent studies tending to show that even a little alcohol isn’t completely safe, “no harm” is still a win. More importantly, it’s a win that will last a generation. After NIAAA spends $100 million on a long-term world-wide study, everyone will be satisfied that the verdict is in and that, in modest amounts, alcohol is as safe as water. There won’t be any more energy (or funding) for a better-designed study for a long, long time.
The alcohol industry is thinking ahead, which is why they’re funding the study. They’ve learned from the mistakes of the tobacco industry that there’s a time to insist your product is good for consumers and a time to be happy with a reputation of “no harm.” This study will institutionalize the latter, and that’s worth a whole lot more than $100 million to an industry that pulls in $1 trillion annually. Besides, many people who get their news from social media won’t find out about Dr. Mukamal’s study and will still maintain that two drinks a day are good for you because they’ve heard it so often, including from their doctors.
Oh, and let me predict that, in addition to taking six years to complete, the study will require a l-o-n-g time to crunch the numbers. In the meantime, the industry will be able to say, “We’re so sure alcohol is good for you that we’re putting up gazillions of our own dollars to subject our product to an absolutely fair and impartial test! Actually, they’ll get Dr. Mukamal to say it for them, just like he did to the New York Times last summer.[3]
One last point: when you really think about what the NIAAA is supposed to do (hint: look at the name), it’s hard to justify pouring such vast resources into a study of people drinking (or not drinking) fourteen grams of alcohol a day. Fourteen grams an hour, sure; that puts the AAA back in NIAAA. But Dr. Mukamal’s study looks to me like it wandered into the wrong Institute by mistake but stuck around because people started feeding it.
Oh well, I look forward to following the experiment. Hey, maybe I should volunteer for the “non-drinking” group and see if they sign me up! That would tell us a lot!
[1] For this and other examples, see Chikritz, T. et al, “Has the leaning tower of presumed health benefits from ‘moderate’ drinking finally collapsed?” Addiction 110 (May 2015), 726-27.
[2] In my state, wearing a “transdermal detection bracelet” advertises that you have been arrested twice or more for drunk driving.
[3] Roni Caryn Rabin, “Is Alcohol Good for You? An Industry Backed Study Seeks Answers,” New York Times, July 3, 2017. Despite Dr. Mukamal’s assurances, the reporter makes clear how much influence the alcohol industry has in this research and how skeptical we should be of it. I recommend the article strongly.