Opinion: Alcohol & Health

Q&A with R. Curtis Ellison, MD and Director of the Institute on Lifestyle & Health

What is the nature of the work you do at the Institute on Lifestyle & Health?

Our key activity at the Institute is the continuing surveillance of scientific literature on alcohol and health. Our investigators evaluate a large number of emerging reports to judge the quality of the data presented in the publications, consider the impact new findings may have on previous scientific research, and prepare regular appraisals of selected reports in formats for scientists and for the public.

Our chief goal is to make it possible for the Institute to serve as a balanced, scientifically sound, and unbiased source of information on alcohol and health, making up-to-date information readily available to all who are interested.

What are some of the topics addressed by the Institute in its most recent evaluations of scientific literature on alcohol and health?

In 2008, we issued critiques of more than 60 reports on recent research. Of those, we selected several important topics for inclusion in our annual report. Those topics included Maternal Alcohol Consumption During Pregnancy, Health Effects of Alcohol Consumption Over the Lifespan, Effects of Pattern of Alcohol Consumption, and Misrepresentations of Results from Papers on Alcohol and Health. If anyone is interested in seeing a copy of our report, they should e-mail me at [email protected].

Alcohol and Pregnancy is the subject of one of The Issue Forum’s Briefs. What did you address in your critique on research about this topic?

We examined a systematic review of studies on the effects of prenatal binge drinking (Henderson et al1 ), a large study on women and light drinking during pregnancy,2 an investigation of the association between maternal alcohol intake and stillbirth,3 and a study on the association between prenatal alcohol exposure and childhood conduct problems.4 I am including the citations, which can also be found in our Annual Report.

Overall, we found that reports continue to suggest that higher intake of alcohol during pregnancy may affect the fetus, and could lead to developmental or other problems in the child. On the other hand, these recent publications show little or no effects of occasional or light drinking by the mother during pregnancy. They also demonstrate how other socio-economic factors of the mother (e.g., low income or education, smoking, marijuana or cocaine use, young age at first child) may have large effects on the health of the fetus and child—factors which must be adjusted for when evaluating the potential effects of alcohol during pregnancy. We concluded that while drinking during pregnancy should not be encouraged, there is little evidence to suggest that an occasional drink by the mother is associated with harm.

You also mentioned the effects of patterns on alcohol consumption. What were your conclusions in your critique of recent literature on this topic?

As people familiar with the literature know, many studies have shown that the potential health benefits of moderate drinking occur almost exclusively among regular, moderate drinkers, and are not seen among binge drinkers. We examined a meta-analysis on patterns of drinking and coronary heart disease which was published by the Journal of Epidemiology and Community Health.5 The study supported the contention that, in comparison with not consuming alcohol, regular drinking is associated with lower risk of coronary heart disease—while irregular heavy consumption, or binge drinking, may increase the risk.

In our commentary, we noted that an increasing number of scientific publications are beginning to provide data not only on the average amount of alcohol consumed by subjects but on their pattern of drinking. The data almost invariably shows that the moderate consumption of alcohol on a regular basis (at least several times per week) is associated with maximal benefits, and that most adverse effects from “moderate drinking” is among subjects reporting episodes of heavy consumption, often referred to as binge drinking. We also noted that studies which suggest that a considerable amount of harm occurs even among “moderate drinkers” often fail to separate the binge drinkers (who may average the same amount over the week or month but consume it all on one or two days of the week) from the regular drinkers who do not binge drink.

Finally, we have a more general question about the literature, and the fact that results from some scientific studies often seem to be in conflict with other studies. As we have developed Issue Briefs, this has been one of our challenges in attempting to compile broad-minded overviews of research result on various issues. Why, in your view, is there such disparity?

I have some strong opinions about this. One of the key functions of our Institute is to try and help other scientists, the public, and governmental agencies have a scientifically sound and balanced view on the adverse as well as beneficial health aspects of moderate alcohol consumption. We have had examples of “political science” for more than three decades in which agencies or other groups tend to misrepresent the science to suit their political views.

Just one example: In 1972 the National Institutes of Health blocked the publication of a major report from the Framingham Heart Study that showed markedly lower rates of death from coronary heart disease among moderate drinkers than among abstainers. The National Institutes of Health (NIH) argued that “an article that openly encourages undertaking drinking with the implication of prevention of coronary heart disease would be scientifically misleading and socially undesirable in view of the major health problem of alcoholism that already exists in the country.”6 Luckily, shortly thereafter many other scientists published papers showing less heart disease among moderate drinkers, a finding confirmed since then by hundreds of scientific studies.

It is important that attempts to reduce and prevent alcohol abuse should be highly focused; we should “not throw out the baby with the bathwater,” so to speak. I don’t agree with approaches that may achieve slightly lower rates of abuse at the cost of markedly reducing benefits among the majority of people who consume alcohol in a healthful fashion. We should just tell the truth to the public: excessive drinking and binge drinking are bad for your health, and for society; on the other hand, regular light-to-moderate consumption by middle-aged and elderly adults is generally associated with health benefits. As Abraham Lincoln said in an address to a Temperence Society meeting in 1842, “It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but the abuse of a good thing.”7

*The Institute on Lifestyle & Health is supported in part by funds from Boston University School of Medicine, by unrestricted donations from companies in the alcohol beverage industry, including Brown-Forman, and by the National Institutes of Health.

Footnotes Less
  • 1. Henderson J, Kesmodel U, Gray R. Systematic review of the fetal effects of prenatal binge-drinking. J Epidemiol Community Health 2007;61:1069–1073. See: http://jech.bmj.com/cgi/content/abstract/61/12/1069.
  • 2. Kelly Y, Sacker A, Gray R, Kelly J, Wolke D, Quigley MA. Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age? Int J Epidemiol 2008;1–12. doi:10.1093/ije/dyn230. See: http://ije.oxfordjournals.org/cgi/content/abstract/dyn230v1.
  • 3. Aliyu MH, Wilson RE, Zoorob R, Chakrabarty S, Alio AP, Kirby RS, Salihu HM. Alcohol consumption during pregnancy and the risk of early stillbirth among singletons. Alcohol 2008;42:369-374. See: http://www.ncbi.nlm.nih.gov/pubmed/18562153.
  • 4. D’Onofrio BM, Van Hulle CA, Waldman ID, Rodgers JL, Rathouz PJ, Lahey BB. Causal inferences regarding prenatal alcohol exposure and childhood externalizing problems. Arch Gen Psychiatry 2007;64:1296-1304. See: http://ije.oxfordjournals.org/cgi/content/full/dyn230v1.
  • 5. Bagnardi V, Zatonski W, Scotti L, La Vecchia C, Corrao G. Does drinking pattern modify the effect of alcohol on the risk of coronary heart disease? Evidence from a meta-analysis. J Epidemiol Community Health 2008;62:615-619. See: http://jech.bmj.com/cgi/content/abstract/62/7/615.
  • 6. As quoted by Seltzer (Seltzer CS. “Conflicts of Interest” and “Political Science,” J Clin Epidemiol 1997;50:627-629).
  • 7. Lincoln A. Talk to Washington Temperance Society of Springfield, Illinois, February 22, 1842, as published in http://www.druglibrary.org/schaffer/lincoln.htm.

Alcohol and Violence

Research shows that higher rates of drinking, heavy drinking, and alcohol abuse are reported by violent offenders than the general population. Psychopharmacological effects—the way chemicals interact with an individual’s brain and affect thinking and behavior - physiological factors - individual brain chemistry - and other influencers provide explanations of behavioral patterns involving alcohol and violence.

Alcohol Addiction During Pregnancy Presents Need for Care and Compassion

We'd love to hear your thoughts

No Comments

Leave a comment 

Your email address will not be published.

* = Required field

Must be of legal drinking age to participate in the discussion.

Invalid date entered.