Should Physicians Recommend Alcohol
to Their Patients? Yes
by Dr. Stanton Peele
Whenever I have visited a physician over the last decade, the following
scenario has been replayed: We discuss my cholesterol levels (total, LDL
and HDL). We review dietary guidelines and other medical
recommendations. Then I say, "Don't forget to remind me to drink a glass
or two of wine daily." Invariably, the doctor demurs: "That hasn't been
proven to protect you against atherosclerosis."
My doctors, all of whom I have respected and liked, are wrong. Evidence
has established beyond question that alcohol reduces coronary artery
disease, America's major killer. This result has been found in the
Harvard Physician and Nurse studies and in studies by Kaiser Permanente
and the American Cancer Society (ACS). Indeed, the evidence that alcohol
reduces coronary artery disease and mortality is better than the
evidence for the statin drugs, the most potent cholesterol-reducing
Drinking to excess does increase mortality from several sources, such as
cancer, cirrhosis and accidents. But a series of studies in the 1990s
including those conducted in conjunction with Kaiser, ACS and
Harvard in the U.S., Britain and Denmark, have found that
moderate drinking reduces overall mortality.
Nonetheless, many people object to the idea that doctors should inform
their patients that moderate drinking may prolong life. They fear that
such advice will justify the excessive drinking some patients already
engage in, or they worry that encouragement from doctors will push
people who cannot handle alcohol to drink.
The view that people are so stupid or malleable that they will become
alcohol abusers because doctors tell them moderate drinking is good for
them is demeaning and self-defeating. If people can't regulate their own
diets, drinking and exercise, then doctors should avoid giving patients
any information about their health behavior, no matter how potentially
Not only can people handle such information on lifestyle, it offers the
primary and best way to attack heart disease. Of course, doctors may
also prescribe medications. These medications rarely solve underlying
problems, however; and they often cause adverse side effects that
counterbalance their positive effects. Because they are not a cure,
courses of medication, once begun, are rarely discontinued.
People are the best regulators of their own behaviors. Even those who
drink excessively often benefit when doctors provide straightforward,
accurate information. Clinical trials conducted by the World Health
Organization around the world showed that so-called brief interventions,
in which medical personnel advised heavy drinkers to reduce their
drinking, are the most successful therapy for problem drinking.
But far more Americans drink less, not more, than would be most
healthful for them. To fail to inform these patients about the benefits
of moderate drinking is both counterproductive and dishonest. Physicians
may ask, "How much alcohol do you drink," "Is there any reason that you
don't drink (or that you drink so little)," and (to those without
religious objections, previous drinking problems, etc.), "Do you know
that one or two glasses of wine or beer a day can be good for your
health if you can safely consume them?"
Here are the data about alcohol and mortality:
- In 1995 Charles Fuchs and his colleagues at Harvard found that women
who drank up to two drinks a day lived longer than abstainers. Subjects
were 85,700 nurses.
- In 1995, Morten Gr�nb�k and colleagues found that wine drinkers
survived longer than abstainers, with those drinking three to five
glasses daily having the lowest death rate. Subjects were 20,000 Danes.
- In 1994, Richard Doll and his colleagues found that men who drank up
to two drinks daily lived significantly longer than abstainers. Subjects
were 12,300 British doctors.
- In 1992 Il Suh and colleagues found a 40 percent reduction in
coronary mortality among men drinking three and more drinks daily. The
11,700 male subjects were in the upper 10 to 15 percent of risk for
coronary heart disease based on their cholesterol, blood pressure and
smoking status. Alcohol's enhancement of high density lipoproteins was
identified as the protective factor.
- In 1990, Paolo Boffetta and Lawrence Garfinkel found that men who
drank occasionally up to two drinks daily outlived
abstainers. Subjects were over a quarter of a million volunteers
enrolled by the American Cancer Society.
- In 1990, Arthur Klatsky and his colleagues found that those who
drank one or two drinks daily had the lowest overall mortality rate.
Subjects were 85,000 Kaiser Permanente patients of both genders and all
These data from large prospective studies of people of both
sexes, different occupations, several nations and varying risk profiles
all point to alcohol's life-sustaining effects. This phenomenon
is now so well accepted that the U.S. dietary guidelines released in
January 1996 recognize that moderate drinking can be beneficial.
The levels of drinking at which alcohol lowers death rates are still
open to dispute. The new U.S. guidelines indicate that men should not
drink more than two drinks per day and women should not exceed one per
day. But the British government has set its limits for "sensible
drinking" at three to four drinks for men and two to three drinks for
women. That abstemiousness increases the risk of death, however, can no
longer be doubted. Moreover, alcohol operates at least as effectively as
pharmaceuticals to reduce the risk of death for those at high risk for
At one point, researchers questioned whether people who had quit
drinking due to previous health problems inflated the mortality rate
among abstainers. But this position can no longer be maintained. The
research described above separates drinkers who have quit drinking and
who have preexisting health problems from other nondrinkers. The
benefits of drinking persist with these individuals omitted.
At some point, ranging from three to six drinks daily, the negative
effects of drinking for cancer, cirrhosis and accidents catch up to and
surpass alcohol's beneficial cardiac impact. Moreover, women under 50
who have relatively low rates of heart disease and relatively
high rates of breast cancer mortality may not benefit from
That is, unless they have one or more cardiac risk factors. Even younger
women with such risk factors benefit from light to moderate drinking.
And, we must remember, most American women and men have such risk
factors. (Fuchs et al. found about three quarters of the nurses in the
Harvard study had at least one.) Remember, over all ages, American women
are ten times as likely to die of heart disease (40 percent) as of
breast cancer (4 percent).
Why, then, do Americans physicians, public health workers,
educators and political leaders refuse to recognize alcohol's
benefits? We might also ask why the United States banned the
manufacture, sale and transportation of alcoholic beverages from 1920 to
1933. It is probably too obvious to mention that alcohol has never been
banned or prohibition even seriously discussed in France,
Italy, Spain and a number of other European nations.
What is it about America and some other nations that prevents them from
considering that alcohol may be good for people? These so-called
"temperance" nations see alcohol in a highly negative light. This is
true even though nations with higher alcohol consumption have lower
death rates from coronary heart disease (see Table 1). Oddly,
"temperance" nations despite concentrating on alcohol problem
prevention and treatment actually have more drinking problems
than those in which alcohol is socially accepted and integrated.
This occurs even though temperance nations drink less alcohol. But they
drink a higher percentage of their alcohol in the form of spirits. This
drinking is more likely to take place in concentrated bursts among men
at sporting events or in drinking establishments. This style of drinking
contrasts with that in wine-drinking nations, which encourage socialized
drinking among family members of both genders and all ages at meals and
other social gatherings. These cultures do not teach people that alcohol
is an addictive drug. Rather, moderate drinking is modeled for children
and taught to them in the home. Furthermore, these cultures accept that
drinking may be good for you. We should, too.
Stanton Peele, Ph.D., is an alcoholism and addiction expert from
Morristown, N. J.