Where's the Proof?

By Christine Gorman Sunday, Jan. 19, 2003
    • PHOTODISC

    Cheers: The lemon may be healthy, but the rest?

    If there is one health story that journalists love to report, it's the one about the health benefits of moderate alcohol consumption. You can practically hear the editors chuckling "Ha! Here's a vice that's good for you!" No doubt part of their interest stems from the fact that some writers and editors are known to enjoy a drink or two. For the record, I often have a glass of red wine with dinner. But the truth of the matter is that the research on the health benefits of alcohol generally gets a heck of a lot more play than it deserves.

    For starters, this is an old story. Indications that a touch of the grape may do the heart some good go back at least 30 years, although each new shot of positive evidence still gets lots of attention. Two weeks ago, a big study in the New England Journal of Medicine showed that a particular pattern of drinking — rather than the absolute amount or the type of alcohol consumed — seems to have the best health effects. The investigators concluded that men who consistently drink a small amount of beer, wine or spirits three or more days a week suffer fewer heart attacks than those who drink less frequently. But you probably didn't hear or read anything about another large study, which came out a week later, that found that the beneficial effects of moderate drinking do not, for complex reasons, always seem to apply to African Americans.


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    Here's another twist that doesn't usually get emphasized: although the data supporting the health benefits of moderate alcohol consumption are strong, they are almost entirely from epidemiological studies, not the large, randomized, placebo-controlled trials that are the gold standard of science. Epidemiological studies are very good at identifying possible trends and associations, but they are not designed to prove cause and effect. That's not necessarily a problem. No one has ever done a randomized trial of smoking, yet it clearly causes cancer. On the other hand, it was on the basis of good epidemiological evidence that doctors believed for years that long-term use of estrogen and progestin would significantly protect women from heart disease. When the theory was put to the test with a randomized, controlled trial, however, it turned out to be dead wrong.

    Even if moderate drinking does confer health benefits, which it probably does, they are rather modest — certainly not stronger than the effect of small daily doses of aspirin on heart health. Indeed, according to Dr. Ira Goldberg, a preventive-medicine expert at the Columbia University College of Physicians and Surgeons in New York City, the effect may be more in line with the apparent cardioprotective benefit of eating a modest portion of nuts each day. Nuts, of course, aren't as sexy as alcohol.

    They're also unlikely to impair your judgment behind the wheel or send you on the road to rehab. Simply put, alcohol is not for everyone. "It's a lot more important to stress the benefits of a healthy diet and regular physical activity," says Eric Rimm, one of the co-authors of the New England Journal study. If you are one of those people who is able to drink responsibly, you can enjoy alcohol without turning it into some kind of medical excuse. But if, for whatever reason, you don't drink, there's no need to start. There are plenty of other ways to take care of your heart.

    Questions for Christine? Email her at gorman@time.com