Download Plenary Debate – Ellison 2013

“Should We Recommend Alcohol for
its Health Benefits?”
R. Curtis Ellison, MD
Professor of Medicine & Public Health
Section of Preventive Medicine & Epidemiology
Boston University School of Medicine
YES!
NO!
IT DEPENDS!
The International Scientific Forum
on Alcohol Research
I serve as the Scientific Co-Director of a Forum
made up of an international group of 40
scientists doing research on alcohol and health
and committed to balanced and well-researched
data on the subject.
The Forum publishes critiques of emerging reports
on alcohol & health through its Boston
University web-site (www.bu.edu/alcoholforum).
Members, International Scientific Forum on Alcohol Research
USA
Luc Djoussé, MD, DSc, Dept. of Medicine, Division of Aging, Brigham & Women’s Hospital and Harvard Medical
School, Boston, MA
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine,
Boston, MA
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA
Tedd Goldfinger, DO, FACC, Desert Cardiology of Tucson Heart Center, Dept. of Cardiology, University of Arizona
School of Medicine, Tucson, Arizona
Lynn Gretkowski, MD, Obstetrics/Gynecology, Mountainview, CA, Stanford University, Stanford, CA, USA
Dwight Heath, PhD, Dept. of Anthropology, Brown University, Providence, RI, USA
Imke Janssen, PhD, Department of Preventive Medicine, Rush University Medical Centre, Chicago, IL
Arthur Klatsky, MD, Dept. of Cardiology, Kaiser Permanente Medical Center, Oakland, CA
Lynda Powell, MEd, PhD, Chair, Dept of Preventive Medicine, Rush University Medical School, Chicago, IL
Andrew L. Waterhouse, PhD, Marvin Sands Professor, Department of Viticulture and Enology, University of
California, Davis; Davis, CA
Yuqing Zhang, MD, DSc, Epidemiology, Boston University School of Medicine, Boston, MA
Members, International Scientific Forum on Alcohol Research
Europe
Alberto Bertelli, MD, PhD, Institute of Human Anatomy, University of Milan, Italy
Giorgio Calabrese, MD, Docente di Dietetica e Nutrizione, Umana Università Cattolica del S. Cuore, Piacenza, Italy
Maria Isabel Covas, DPharm, PhD, Cardiovascular Risk and Nutrition Research Group, Institut Municipal
d´Investigació Mèdica, Barcelona, Spain
Alan Crozier, PhD, Plant Biochemistry and Human Nutrition, University of Glasgow, Scotland, UK
Giovanni de Gaetano, MD, PhD, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico
Mediterraneo NEUROMED, Pozzilli, Italy
Alun Evans, MD, Centre for Public Health, The Queen's University of Belfast, Belfast, UK
Oliver James, MD, Head of Medicine, University of Newcastle, UK
Ulrich Keil, MD, PhD, Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
Rosa M. Lamuela-Raventos, PhD, Department of Nutrition and Food Science, University of Barcelona, Spain
Dominique Lanzmann-Petithory,MD, PhD, Nutrition/Cardiology, Praticien Hospitalier Hôpital Emile Roux,
Paris, France
Rosa M. Lamuela-Raventos, PhD, Department of Nutrition and Food Science, University of Barcelona, Spain
Fulvio Mattivi, PhD, Head of the Department Good Quality and Nutrition, Research and Innovation Centre,
Foundazione Edmund Mach, in San Michele all’Adige, Italy
Jean-Marc Orgogozo, MD, Professor of Neurology and Head of the Neurology Divisions, the University Hospital of
Bordeaux, Pessac, France
Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark
Jan Snel, PhD, Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Holland
Jeremy P E Spencer, Reader in Biochemistry, The University of Reading, UK
Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway
Pierre-Louis Teissedre, PhD, Faculty of Oenology - ISVV, University Victor Segalen Bordeaux 2, Bordeaux, France
Dag S. Thelle, MD, PhD, Senior Professor of Cardiovascular Epidemiology and Prevention, University of
Gothenburg, Sweden; Senior Professor of Quantitative Medicine at the University of Oslo, Norway
Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy
David Vauzour, PhD, Senior Research Associate, Department of Nutrition, Norwich Medical School, University of
East Anglia, Norwich, UK
Members, International Scientific Forum on Alcohol Research
Australia, New Zealand, South Africa
Dee Blackhurst, PhD, Lipid Laboratory, University of Cape Town Health Sciences Faculty, Cape Town, South Africa
Maritha J. Kotze, PhD, Human Genetics, Dept of Pathology, University of Stellenbosch, Tygerberg, South Africa
Arduino A. Mangoni, PhD, Strategic Professor of Clinical Pharmacology and Senior Consultant in Clinical
Pharmacology and Internal Medicine, Department of Clinical Pharmacology, Flinders University, Bedford
Park, SA; Australia
Ross McCormick PhD, MSC, MBChB, Associate Dean, Faculty of Medical and Health Sciences, The University of
Auckland, Auckland, New Zealand
Ian Puddey, MD, Dean, Faculty of Medicine, Dentistry & Health Sciences, University of Western Australia,
Nedlands, Australia
Creina Stockley, PhD, MBA, Clinical Pharmacology, Health and Regulatory Information Manager, Australian Wine
Research Institute, Glen Osmond, South Australia, Australia
Gordon Troup, MSc, DSc, School of Physics, Monash University, Victoria, Australia
David Van Velden, MD, Dept. of Pathology, Stellenbosch University, Stellenbosch, South Africa
Potential Conflict of Interest
Partial expenses for operating the Forum are from
unrestricted donations to Boston University from
associations and companies in the beverage industry
(including NY Wine & Grape Foundation, Diageo,
Brown-Forman)
As donors have no input into the papers reviewed by
the Forum or the opinions published, the IRB at
Boston University has deemed that these do not
constitute a conflict of interest.
“Should We Recommend Alcohol for its Health Benefits?”
Among the factors that we must consider:
1.
Is excessive alcohol intake associated with
adverse health effects?
2.
Is light-to-moderate alcohol intake associated
with beneficial health effects? Is it the cause?
3.
Does the pattern of drinking affect the net health
effects? (speed of intake, with food, regular vs binge)
4.
Does the type of beverage affect the net health effects?
5.
Is the public often faced with biased, exaggerated
statements about alcohol? What are proper guidelines?
Types of Scientific Evidence
Case reports
Ecologic data (comparing populations without
individual data)
Case-control studies
Prospective cohort studies
(may be
population-based, must deal with confounders)
Experimental data
Human clinical trials (for intermediary outcomes,
for disease outcomes)
Potential Confounding in
Observational Studies
There is often clustering of healthy lifestyle factors
We must deal with such potentially confounding variables:
Age
Sex
Cigarette smoking
Education, occupation, and income
Diet, physical activity, level of obesity
Previous alcohol use
Adjust for many of these factors through stratification and
multivariable analysis techniques.
Research on Alcohol and
Cardiovascular Disease
Prospective epidemiologic studies for
many decades, even when fully
controlled for known confounding,
have been amazingly consistent:
moderate drinkers are at lower
risk of CHD than are abstainers.
Alcohol & CHD: Meta-analysis
Corrao et al, 2000
Alcohol Consumption and CHD Mortality:
Review & Meta-analysis. Ronksley et al. BMJ 2011
Reviewed 84 well-done prospective
epidemiologic studies; > 1 million subjects.
Estimated effects of alcohol intake on
mortality from coronary heart disease
Effects of Alcohol on Cardiovascular Disease
(Ronksley et al, 2011)
■
This meta-analysis showed risk reductions for
moderate alcohol drinkers of
25% for CHD mortality
29% for incident coronary heart disease
25% for cardiovascular disease mortality
13 % for all-cause mortality.
Alcohol & Mortality, adjusting for
SES and a Propensity Score (Lee et al, 2009)
12,519 subjects, Health & Retirement Study
With demographic adjustments, moderate
drinkers ( ≤ 1 drink/day vs non-drinkers) had a
RR for mortality of 0.50.
With full adjustments for SES, RF, behavioral
factors and a propensity score for moderate
drinking, RR was 0.62 (CI 0.48-0.80).
Net Effect of Moderate Alcohol
Intake on Mortality
(Konnopka et al, 2009)
Considered "moderate" up to 40 grams/day
(more than 3 drinks/day) for men and up to
20 g/day (about 1 1/2 drinks/day) for women;
included binge drinkers.
Deaths "avoided" by moderate alcohol use
were about twice as high (n=29,818) as the
number "caused" by moderate drinking
(n=14,457)
Deaths Attributable to “Moderate” Alcohol Intake
(weekly mean <40 g/d for men, < 20 g/day for women)
(Rehm et al, Ann Epidem, 2007)
Deaths Attributable to “Moderate” Alcohol Intake
(when “binge drinkers” excluded)
(Rehm et al, Ann Epidem, 2007)
Mechanisms of Effect of
Alcohol/Polyphenols on CVD
Blood lipids (esp. HDL-cholesterol)
Coagulation, fibrinolysis
Arterial endothelium
Genes (alcohol and/or polyphenols)
Ventricular function
Inflammation
Glucose metabolism
Mechanisms of Effect of Alcohol on
Cardiovascular Disease
(Collins et al, Alcoholism: Clin Exp Res, 2009)
“Healthy Lifestyle” for Prevention
of Diseases of Ageing
Don’t smoke
Stay lean (avoid becoming obese)
Exercise regularly
Eat a diet low in animal fat, with lots of
fiber (fruits & vegetables) and whole grains
Unless contraindicated, consume ½ - 2
drinks of an alcoholic beverage daily
from Stampfer, Hu, Chiuve, et al
Effects of Alcohol on Risk of MI
by Other Lifestyle Factors
(1. non-smoking, 2. not obese, 3. active, 4. good diet)
Least healthy (0-1 factors)=▲; Moderate (2-3 factors)=□; Healthy (4 factors)=◊
(Mukamal et al, Arch Intern Med 2006;166:21
Risk of Diabetes by Alcohol & Lifestyle Factors
Joosten et al, Am J Clin Nutr 2010
Healthy lifestyle factors: (1) BMI <25, (2) physically
active, (3) non-smoker, (4) high adherence to Dash diet
No. of Healthy Factors
None or 1
2 to 3
3 or 4
__________Hazard Ratio, adjusted______
Moderate
Abstainer
Drinker*
p-trend
3.90
1.98
< 0.001
2.68
1.21
0.002
1.00
0.56
0.02
*“Moderate drinker” = 5 - 14.9 g/d for women, 5 - 29.9 g/d for men
But what about experiments and
human clinical trials on alcohol &
health?
Daily-moderate versus weekend-binge alcohol
in mice. Liu et al. Atherosclerosis 2011
Daily-moderate versus weekend-binge alcohol
in mice. Liu et al. Atherosclerosis 2011
Meta-analysis of Interventional Studies of
Alcohol and Coronary Heart Disease
Brien SE, Ronksley PE, Turner BJ, Mukamal KJ.
Effect of alcohol consumption on biological
markers associated with risk of coronary
heart disease: systematic review and metaanalysis of interventional studies.
Published in BMJ 2011;342:d636
Human Interventional Studies on Mechanisms of
Effects of Alcohol on CV Risk (Brien et al, 2011)
Wine Increases the Number and Functional Capacity
of Circulating Endothelial Progenitor Cells by
Enhancing Nitric Oxide Bioavailability
A Clinical Trial of 80 Healthy Adults
Huang et al, Arteriosclerosis Thrombis & Vasc Biol, 2010
“The intake of red wine significantly enhanced circulating
endothelial progenitor cell levels and improved their
functions by modifying nitric oxide bioavailability.”
Omega-3 Fatty Acids:
An Untapped Resource
for Improving Health
R. Curtis Ellison, MD
Professor of Medicine & Public Health
Director, Institute on Lifestyle & Health
Boston University School of Medicine
Boston, MA,
Molecular Mechanisms for Increased Fibrinolysis
(Booyse et al, 2007)
Effects of Moderate Drinking
on All-cause Mortality
All-Cause Mortality, by Alcohol
Consumption
Alcohol and Mortality
(With repeated assessments of ETOH)
The Zutphen Study (Streppel et al , 2009)
Men followed for up to 40 years, until
death in the vast majority, with repeated
assessments of alcohol intake
Up to 20 g/day of alcohol (vs none) was
associated with 25-30% lower rates of
cardiovascular and all-cause mortality
Total Mortality, by Alcohol Consumption
Di Castelnuovo et al, Arch Int Med, 2006
Effects of Alcohol on All-cause
Mortality by Type of Beverage
Survival after Age 50, by Long-Term
Alcohol Consumption (Streppel et al, 2009)
Alcoholic Beverages and Incidence of
Dementia: 34-Year Follow-up Mehlig et al, 2008
Wine drinkers
Wine only
Spirits drinkers
HR
0.6
0.3
1.5
95% CI
0.4, 0.8
0.1, 0.8
1.0, 2.2
Conclusion: wine and spirits displayed opposing
associations with dementia.
Effects of Pattern of Drinking on
Cardiovascular & All-cause
Mortality
Does drinking pattern modify the effect of
alcohol on risk of CHD? A meta-analysis.
Bagnardi et al, 2008
Effects of Changes in Alcohol
Consumption and Health
Outcomes
Changes in Alcohol Intake & Subsequent
Risk of Diabetes
Health Professionals Study, n = 38,031 subjects
Joosten et al¸ Diabetes 2011
For initial non-drinkers, a 7.5 g/d increase = 22% decrease in risk
Baseline
>0-4.9 g/d
5-29.9 g/d
≥ 30 g/d
Intake 4 yrs Later_____
>0-4.9 g/d 5-29.9g/d ≥30g/d
1.00
0.75
0.35
1.09
0.74
0.59
0.78
0.67
0.50
p-trend
< 0.001
< 0.001
0.08
Changes in Alcohol Intake & All-Cause Mortality
Among Women with Invasive Breast Cancer
Newcomb et al, J Clin Oncology, 2013
(7, 780 deaths in 23,000 women with breast cancer)
Change in alcohol
Never drinker
Drinker
No change
Decreased
Increased
Changes in All-Cause Mortality
HR
95% CI
1.0
-0.86
1.03
0.76
0.71-1.03
0.85-1.25
0.60-0.97
Effects of Moderate Drinking on
The Diseases of Ageing
CV Diseases (↓ heart disease, stroke, CHF, vascular dis.)
Metabolic Diseases (↓ diabetes, MS, osteoporosis)
Cognitive Disorders (↓ Alzheimer’s, dementia)
Obesity (emerging data suggest ↓ weight gain)
Cancer (Abuse ↑ UADT cancers; moderate alcohol ↓ kidney
cancer & lymphoma, slight ↑ breast & colon cancer risk)
Total mortality (↓ among moderate drinkers)
Conclusion
Data over many decades (observational studies,
animal experiments, & human intervention
trials) have consistently shown that
Moderate drinking, especially of wine, is
associated with a lower risk of CVD and most
of the other diseases of ageing.
Cumulative Outcomes, WHI
Manson et al, JAMA 2013
Allcardiovascular
cardiovascular
endpoints
All
endpoints
Cardiovascular
deaths
Cardiovascular
deaths
Allcancers
cancers
All
All-cause mortality
All-cause mortality
The Ultimate Clinical Trial on Alcohol & Health
Recruit 50,000 normal, healthy 60 year-old people who are occasional
drinkers with no previous hx of misuse & not confirmed abstainers
Evaluate them in a run-in period, with incentives to remain for 20-25 years
Provide them with a blinded beverage (either containing alcohol or no alcohol)
Assure that they drink a certain amount (perhaps 12 grams/alcohol) every
evening, avoiding all other alcoholic beverages (except perhaps for
religious services, weddings, and funerals)
Closely monitor compliance (blood tests, bottle counts, etc.) ; use intensive
incentives to assure continued participation
Arrange follow up for 20-25 years to see which group ages better and lives
longer
(Unlike pharmaceutical trials, must not fund this study with grants from
interested parties)
Alcohol and Cancer in Women
(Allen et al, 2009)
Effects of Smoking & Alcohol on
Risk of Upper Aero-digestive Cancers
Szymańska et al, 2011
Effects on Risk
– Smoking, not heavy drinking
++
– Heavy drinking and smoking
++++
– Heavy drinking, not smoking
+/-
Alcohol, HRT, & Breast Cancer
California Teachers, n=40,000. Horn-Ross et al, 2012
Brooks PJ, Zakhari S. Moderate alcohol
consumption and breast cancer in women: From
epidemiology to mechanisms and interventions.
:
Alcohol Clin Exp Res – October 2012
• Pointed out complexity in evaluating the
association of alcohol and breast cancer
•
• Cited importance that the pattern of drinking,
short duration of follow up, under-reporting of
alcohol intake, etc., could have on results.
Risk of All-Cancer Deaths Among
Lifetime Abstainers and Current Drinkers
National Health Interview Survey, > 300,000 subjects, 8,362 cancer deaths
Breslow et al, Am J Epidemiol 2011
Lifetime Abstainer
No.
RR of Cancer Death
1,958
1.0
Light drinker
1,669
0.87
0.80, 0.94
Moderate drinker*
1,091
0.96
0.87, 1.06
622
1.27
1.14, 1.43
Heavier drinker
95% CI
--
*“moderate” = >3 – 7 dr/wk women, >3-14 dr/wk men)
Environmental Effects on
Cancer Risk in the UK
Parkin et al, Br J Cancer, 2011
An analysis estimated the proportion of cancer risk
associated with environmental factors.
Smoking (attributed in 19.4% of cases) was the
largest factor associated with cancer risk.
Diet and obesity were the next most common;
alcohol was attributed in 4% of cases.
Research on Overall Cancer Risk
(EPIC, Schutze et al, 2013)
While heavy alcohol intake increases upper aerodigestive cancer, overall only 3 out of 10,000 cancers
in women & 3 out of 1,000 cancers in men are related
to moderate alcohol consumption.
reduce
the
incidence
of
cancer.
These
data
support
current
political
efforts
to
reduce
or
to
abstain
from
alcohol
consumption
to
The authors do not add that for moderate drinking,
the net effect is a reduction in total mortality, or
greater survival.
Bias in Reports on Alcohol & Health
An analysis by the Framingham Study in
1974, after 24 years of follow up in men,
found that there were “4 major risk factors:”
● High blood cholesterol
● High blood pressure
● Cigarette smoking
● Abstinence from alcohol!
CHD Mortality in the Framingham
Heart Study, by Alcohol Intake (1974)
(Percent deaths over 24 years in Men)
Alcohol consumption, drinks/day
None
< 0.5
0.5-1.0 1.1-2.0 2.1-5.9 6.0+
Non-Smokers
16.3
14.8
14.6
7.8
5.7
7.4
Heavy Smokers
28.3
16.0
14.4
14.0
13.1
12.5
Response of Officials at NIH
“Refer to only 3 major risk factors, and
remove all references to alcohol.
With all the abuse in this country, we
must not say alcohol prevents CHD.”
“If you must comment on alcohol, say it
has no effect.”
Seltzer CC. “Conflicts of Interest and Political Science,” J Clin Epidem 1997
Comments from an “Alcohol Expert”
October, 2013
“Deaths from alcohol dwarf any small number of
people who may derive benefit from low-dose alcohol.
“Among all people who start drinking, 5 – 10 times as
many die from it as are benefited by it.”
Total Mortality, by Alcohol Consumption
Di Castelnuovo et al, 2006
Does Heavy Drinking by Adults Respond to Higher
Alcohol Prices and Taxes? A Survey and Assessment
(JP Nelson, Dept of Economics, Pennsylvania State Univ, 2013)
Higher alcohol prices and taxes are frequently proposed as
policy tool to deal with abusive consumption
a
A review of 19 individual-based studies that examine price
responses by heavy-drinking adults finds only 2 studies with a
significant negative price response among heavy drinkers.
Many studies show that moderate-drinking adults have significant
and substantial price/tax elasticities
The Impact of a Large Reduction in Alcohol Prices in
Finland on Mortality
Herttua et al, Int J Epidemiol, 2010
Markedly lowering the price of alcohol in Finland increased
the number of alcohol-related deaths by 14-40% = 0 to 2.9 excess
deaths each month, by age group
Lowering the price decreased by up to 24% the number of
deaths from cardiovascular disease = 0 to 24.8 excess deaths each
month, by age group
For all-cause mortality, 42 to 69 fewer monthly deaths
The Moral Bases for Public Health Interventions.
(Cole P, Epidemiology 1995;6:78–83)
“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.”
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.’’
Lionel Tiger on Alcohol Guidelines
“We have seen the rise of what he calls ‘concernocrats,’
people who are motivated by well-meaning concern for
the welfare of others and are prepared, therefore, to exert
their power over the behavior and disposition of others.
‘‘It is a very tempting thing for well-meaning people to
make statements about other people’s health and welfare
because the population is primed for quasi-religious
advice from the druids, the priests who advise us.”
Lionel Tiger on Alcohol Guidelines
“Those of us in the comment business need to be
extremely careful about what we say, not because
people may drink too much, or too little, but because
we may nominate ourselves as ‘gurus’ of everyone’s
destiny and inspect their behaviors too carefully.”
Alcohol & Health
Responses of Jackrabbit Johanssen, a crosscountry skier aged 101, on his advice for a
long and healthy life:
“Don’t smoke,
Get lots of exercise,
Don’t drink too much.”
Alcohol & Health
Responses of Jackrabbit Johanssen, a crosscountry skier aged 101, on his advice for a
long and healthy life:
“Don’t smoke,
Get lots of exercise,
Don’t drink too much.
Then, again, don’t drink too little either”
Current Challenges
For middle-aged and older adults who
have no contraindications to alcohol we
can encourage regular, moderate
drinking as a component of a healthy
lifestyle.
Make drunkenness socially unacceptable
Effects of Physical Activity
on HDL-Cholesterol
(NHLBI Family Heart Study; Ellison et al, 2004)
Effects of Alcohol Intake
on HDL-Cholesterol
(NHLBI Family Heart Study; Ellison et al, 1998)
Alcohol Intake & CHD Mortality
Among Non-Diabetics & Diabetics
Physicians’ Health Study, Ajani et al, 2000
Frequency of Alcohol Intake
Non-Diabetics
None
Monthly
Weekly
Daily
1.0
1.02
0.82
0.61
1.0
1.11
0.67
0.42
(n=717)
Diabetics
(n=133)
Moderate Alcohol Use and Cognitive Function
(A Mendelian Randomization Design Study)
March 2012
Headlines
• Mendelian randomization is the “Gold
Standard” for studying alcohol and disease
• Moderate alcohol use is unlikely to lower
risk of dementia
Moderate Alcohol Use and Cognitive Function
(A Mendelian Randomization Design Study)
March 2012
Comments
• Mendelian randomization based only on
ALDH2 (but explains < 3% of alcohol intake)
• Ignored patterns of drinking, environmental
factors affecting alcohol use
Summary of Mechanisms of Red Wine Effects
(Chiva-Blanch et al, 2013)
www.bu.edu/alcohol-forum
Alcohol and Obesity
2011-2013
Sayon-Orea et al reviewed publications on alcohol and
obesity. They concluded: “It is possible that heavy
drinkers may increase their risk of obesity.
“Light-to-moderate alcohol intake, especially wine
intake, may be more likely to protect against weight
gain, whereas consumption of spirits has been
positively associated with weight gain.”
Alcohol & Body Mass Index
(by quintiles of frequency of drinking)
Breslow RA et al – Am J Epidemiol 2005
Daily-moderate versus weekend-binge alcohol
& body weight in mice.
Liu et al, Atherosclerosis 2011
Mechanisms of Effect of Resveratrol on
Cardiovascular Disease (Collins et al, 2009)
The International Scientific Forum
on Alcohol Research
The Forum was established in 2010, to provide critical and
balanced reviews of emerging papers related to alcohol
and health, published on www.bu.edu/alcohol-forum
The Forum consists of an international group of 40 invited
physicians and scientists who are specialists in their fields
and volunteer their services
The Intenational Scientific Forum
on Alcohol Research
The Institute on Lifestyle & Health at Boston University
serves as the scientific center of the Forum; the Institute is
supported completely by donations
Since 2010, more than 120 critiques have been published by
the Forum on its web-site (www.bu.edu/alcohol-forum).
Brief summaries of each critique are distributed widely by a
team in the UK headed by Helena Conibear
Early-Adult Vs. Later-Adult Alcohol Intake:
Framingham Study
(drinks/week)
Later
Early
None
None
>0-7
>7-21
>21
Total
531
464
11
1
1,007
>0-7
931
3,157
559
38
4,685
>7-21
60
401
693
107
1,261
>21
25
28
123
174
350
Total
1,547
4,050
1,386
320
7,303
Mechanisms of Alcohol Effect on CVD in
Men (Rimm & Moats, Ann Epidemiol 2007)
Mechanisms of Alcohol Effect on CVD in
Women (Rimm & Moats, Ann Epidemiol 2007)
Alcohol, Wine, and Health
Recent Findings (Lee et al, 2009)
Alcohol & Cardiovascular Disease
Ecologic studies, such as those describing the
“French Paradox,” compare populations in the
aggregate, but do not contain individual data.
May generate hypotheses, not test them.
For the latter, clinical trials are best; but we often
have to rely on prospective epidemiologic
studies that are adequately adjusted for
confounders.
Quotation from
Abraham Lincoln
"It has long been recognized that the
problems with alcohol relate not to
the use of a bad thing, but to the
abuse of a good thing."
Lincoln A. Talk to Washington Temperance
Society of Springfield, Illinois, February 22, 1842
Coronary Atherosclerosis, by
Type of Alcohol Consumed
(Rabbits)
Type of Beverage
% of Coronaries with lesions
Water
Beer
Whiskey
White wine
Red wine
100%
100
83
67
40
Klurfeld & Kritchevsky, 1981
Effect of Alcohol Intake on
Stent Restenosis
Niroomand et al - Heart 2004
50
%
40
30
<50g/wk
>50g/wk
20
10
0
Restenosis
Repeat Angioplasty
In Determining Alcohol Policy,
We Must Avoid Publications With
Bias: An inclination, a propensity, a predisposition,
(towards); prejudice
Ignorance: Lack of knowledge (general or particular)
Pseudoscience: Pretended or spurious science; a
collection of beliefs about the world mistakenly
regarded as being based on scientific method or as
having the status of scientific truth
Misinformation: Wrong or misleading information
Sin Taxes: Do Heterogenous Responses
Undercut Their Value?
Ayyagari et al, National Burerau of Econommic Research, 2009
“Only a subgroup responds significantly to price.
Importantly, the unresponsive group drinks more
heavily, suggesting that a higher price could fail to
curb drinking by those most likely to cause negative
externalities.
“In contrast, those least likely to impose costs on
others are more responsive, thus suffering greater
deadweight loss yet with less prevention of negative
externalities.”