Alcohol as a panacea

No, there’s no real proof that moderate alcohol use is good for health. Maybe moderation is good for health.

Everyone “knows” that two glasses of red wine a day are good for your health. But, as Will Rogers said, it’s not what you don’t know that hurts you: it’s what you know that ain’t so. A paper by Hans Olav Fekjær and commentaries by Jurgen Rehm and Sven Andréasson, all in the latest issue of Addiction, review the evidence.

Yes, moderate drinkers have better health, on many dimensions, than non-drinkers and heavy drinkers. That’s the problem: too many dimensions, with too little biological mechanism. The logical thought is that people who drink in moderation probably have, on average, better health habits in other respects than those who don’t drink at all, since by definition they’ve avoided taking their alcohol use to excess while the abstainers either haven’t run that risk or have found that they can’t drink just a little. It’s also the case that, in Western cultures, drinking is normal while non-drinking is somewhat deviant. The fact that in India, where drinking isn’t a social norm, drinking isn’t associated with better cardiovascular health seems to me to seriously weaken the case for a causal connection in other societies.

Why the “Moderate drinking is good for what ails ya” theory has found such ready acceptance, while a comparable finding about moderate cannabis use and academic performance was ignored, is left as an exercise for the reader.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

17 thoughts on “Alcohol as a panacea”

  1. If my health was better I’d drink a lot more often. As it is, a beer once in a while is all I can do.

  2. Potential explanatory mechanisms:

    1). Moderate drinkers are more relaxed, with the resultant multi-dimensional benefits to health from lower stress levels (note that the greater level of relaxation could come from the booze itself or from the fact that, in this culture, if you drink moderately you are more likely to be taking more of your meals with friends and family vs. sitting alone)
    2). Alcohol has a broad anti-inflammatory effect (in small doses)
    3). People who have a couple of glasses of wine a day or a couple of beers are less likely to have an incremental couple of Diet Cokes, and the soda will kill you real good.
    4). The Almighty seems to like wine (well, if you’re a Jew or a Christian you’d come to that conclusion. A Muslim… not so much.).

  3. The fact that in India, where drinking isn’t a social norm, drinking isn’t associated with better cardiovascular health seems to me to seriously weaken the case for a causal connection in other societies.

    Since it isn’t a norm, those who do indeed cross …err drink the Rubicon might not be model consumers of alcohol or good stewards of other dimensions of health. Most of the people I know who drink take up whiskey, vodka et al. Beer/Wine isn’t the staple beverage. Most of them don’t binge but they aren’t < 21 units/week type either.

  4. I don’t know about any of these scientific fact doodads, but I can say with a fair degree of certainty that, in the main, a life that includes wine beats a life that doesn’t.

    1. @Herschel,
      I understand, but to each their own. I would change your sentence to;
      “I don’t know about any of these scientific fact doodads, but I can say with a fair degree of certainty that, in the main, a life that includes cannabis beats a life that doesn’t.”

  5. In India the consumption of meat is much less than in US. Heck, in the rest of the world the consumption of meat is less than in the US.
    My philosophy on wine drinking, it must be good for me because I like it.
    If you drink, drink organic. It tastes better, no hangover and it really isn’t much more expensive. Grapes are the most pesticide and chemical doused food product in agriculture. And then there’s all the crap they add to “enhance” (make) the flavor, preservatives, who knows what. Saw a TV special the other night about the hype vs. reality of the wine industry. Film of drums of powder being dumped into the vats of the oh so natural wine. With organic at least you know that alcohol is the poison you’re killing yourself with.

  6. I have a suboptimal liver and am taking two medications that advise against alcohol use, so I’ve gone from a few drinks a week to no drinks at all. I feel about the same, but I have more money and am hoping for better test results next time round.

  7. My bottom line on this issue is that no one should start drinking red wine just because of health benefits, but if you enjoy it there’s no need to stop.

  8. This weakens my confidence in my prior belief (that alcohol almost certainly reduces the risk of heart disease by a clinically significant amount and very likely reduces all-cause mortality similarly). However, I’d be more influenced if this had been published in a cardiology journal rather than Addiction. Given their familiarity with the negative health effect of alcohol abuse and the ability of heavy drinkers to characterize 8 drinks a night as “moderate,” I suspect that addiction specialists have a bias toward minimizing the possible health benefits of (truly) moderate drinking.

    1. As they should! Moreover, whenever you hear about a health benefit associated with a product you have to realize that whatever research is out there is most likely (1) funded (with inherent or unconscious bias in design) or (2) slightly or even not so slightly misrepresented in translation, by the product’s manufacturer. Whatever the benefits of drinking red wine to the health of drinkers, drinking red wine certainly benefits the financial health of those who sell the product. This pattern is so marked I think you almost have to take it as a given that claims like this are likely to be wildly exaggerated until proven otherwise.

  9. Specificity of effect is a central issue here. The authors are concerned about the spectrum of diseases influenced favorably by moderate alcohol use and consider that they are too diverse biologically to be accounted for by any effects from ethanol itself. The effects are hypothesized to be non-specific (moderate drinking is a marker of a balanced lifestyle).

    The dependence of the protective effect of alcohol on setting (whether it is a behavioral norm in the society in which the alcohol/health association is studied) is equally important, if not more important. In countries whose norms involve abstinence from alcohol, the protective effects are apparently not observed.

    Compare and contrast alcohol and smoking. Tobacco also is associated with a very wide spectrum of disease ( However, SFAIK, there have been no studies showing that smoking sometimes increases and sometimes decreases the risk of low birth weight, or heart disease, or emphysema, depending on the social norms of the country in which it is studied. Cigarettes increase risk of a wide spectrum of diseases, which could raise concerns about a non-specific effect of their consumption. If it were shown that the relationships depended on where the studies were done, that would be a game changer. But smoking is bad for you even if you live in a country in which it is common. The original studies of smoking and cancer were done at a time when a majority of adults in the UK and the US smoked, and the estimate of risk has not had to be greatly revised as the years have passed and the norms of those societies have changed.

  10. I second Barbara; drink it if you enjoy it. My theory of the red wine/better health connection: if you can afford two glasses of wine a day, you can afford to go to the doctor, even without Obamacare.

  11. India also has one of the highest ages for loss of virginity.

    It’s no coincidence.

    I know Kleiman is on a minor crusade against alcohol, but young people the world over know that it is highly conducive to sexual activity, which needless to say is one of the highest pleasures mankind is afforded.

  12. I have long enjoyed a couple of glasses of red wine a day, partly on the basis’ of my physician’s recommendation. The confluence of pleasure and good health habits has been welcome. However, I am nothing if not rational and evidence-oriented. Now that I know that the health benefits are illusory, I hereby pledge before the RBC to do the only sensible thing. I vow henceforward to moderate significantly the enjoyment I derive from my daily two glasses of wine.

  13. You are on the side of the angels here, Professor Kleiman.

    Look, I think there’s two honest positions in the drug war. There’s Professor Kleiman’s, which is that society should make decisions about what substances should be legal and how they should be regulated based on cost-benefit analyses based on definite harm. And there’s mine, which is that Prohibition proved that the freedom to intoxicate yourself is really valuable, even though it can cause a massive amount of social harm. Essentially, that being free to run risks is more important than preventing all preventable harm.

    And where we agree is that alcohol is just far more dangerous than marijuana, and that if you were really going to do the cost-benefit thing we’d concentrate our fire there.

    The problem is that neither honest position has anything to do with what has actually happened with our drug policy. Instead, drugs that are popular with the majority get legalized and exempted from criticism, and drugs that are not popular with the majority get criminalized and stigmatized. For a lot of Americans, the problem with Prohibition was that it imprisoned white people, while the War on Drugs is fine because it imprisons other people. Alcohol is good, pot is bad, because “those people” use pot, and costs and benefits have nothing to do with it.

    Thankfully, the worm is turning a bit on marijuana, but unfortunately for Mark it’s turning closer towards my position than his.

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