Dialogue: Health message leads to wishful drinking

The alcohol industry, by overstating the health benefits
of its products, may be encouraging the wrong people to drink more, writes SALLY JACKMAN*.

Numerous studies over the past couple of decades have associated low to moderate alcohol consumption with reduced coronary heart disease in middle-aged and older people.

The palatable message that drinking is good for you provides a quirky and popular story for journalists. For the alcohol industry it is the sort of publicity you cannot buy.

But much of the information coming from these sources is selective, and some is misleading. The misconception that drinking conveys large, universal health benefits may be encouraging the wrong people to drink more.

Heavier drinking has increased, according to surveys carried out over the 1990s by Auckland University. Simplistic messages about the health benefits associated with drinking may be contributing to the problem. The same surveys showed an increase in the number of people citing health benefits as a reason for having increased their drinking.

Misconceptions about the health benefits associated with drinking are perpetuated by comments like those made to the Tax Review 2001 recently. A submission from the Beer Wine and Spirits Council, the Distilled Spirits Association and the Wine Institute claimed that, "the vast majority of adult New Zealanders gain substantial health benefits from the consumption of beer, wines and spirits."

Professor Rod Jackson, one of New Zealand's leading experts in this area, says it is only in men over the age of about 40-45 and women over 50-55 that the benefits of alcohol consumption outweigh the harms. In people younger than this, the more you drink the greater your risk of death.

This is because the benefits associated with low to moderate alcohol consumption are largely due to a reduction in the risk of coronary heart disease. This disease affects far more middle-aged and older people than younger people.

The degree to which the relative risk of coronary disease is reduced in low to moderate drinkers varies from study to study, says Professor Jackson, but is in the region of a quarter to a third.

Different studies also show different optimal levels of drinking. The greatest benefit appears to be in the range of one to two standard drinks a day for women and one to four for men. Within this range, drinking more does not increase the level of benefit. Drinking at the lower end of the range carries the same benefit as drinking at the higher end of the range.

Health professionals who adopt a cautious approach to alcohol consumption are sometimes decried as finger-wagging social engineers. A recent article in the Herald by wine writer Joelle Thomson is a good example.

The article is stiff with indignation at health researchers who wilfully ignore the "irrefutable" evidence concerning the benefits of drinking. She roundly criticises the authors of an American study for recommending that pregnant women avoid alcohol. The study found that the children of women who drank during pregnancy exhibited more behavioural problems than those of women who did not.

Thomson writes off the recommendation for pregnant women not to drink as being "morally motivated, based on cultures whose main experience with alcoholic beverages is binge drinking".

The advice to pregnant women not to drink is not "off the wall". It represents a considered interpretation of the evidence.

In the same article she quotes a Danish study which found that the relative risk of dying among those who consumed regular, moderate amounts of wine was nearly halved compared with non-drinkers and that this property was not shared by beer or spirits.

In the interests of balance, she might have added that a subsequent Danish study found that wine drinkers had healthier diets compared with people who drank other alcoholic beverages. This raises the question of whether the wine or the good diet made the difference.

Studies throughout the world looking at the benefits associated with different types of alcoholic beverage have come up with variable results. But most reviews of the evidence conclude that it does not matter which drink you choose - the benefits are associated with alcohol generally. Variations in results probably relate to the drinking patterns associated with different drinks and different countries.

This highlights an issue rarely acknowledged by those involved with promoting alcohol. The relationship between moderate alcohol consumption and health is complex and there is still much to learn. There are still questions about the extent to which alcohol is responsible for the effect.

What impact do lifestyle factors and drinking patterns have on study results? What are the optimal drinking levels and what public health messages should be derived from the information available?

All of these issues are debated. The range of opinions that exists among the medical community reflects this and should not simply be written off as a divergence of ethical beliefs.

The public needs balanced, accurate information that allows for informed choices about drinking. This is unlikely to come from an industry whose aim is to promote alcohol consumption. The industry says it encourages moderation. Nonetheless, it relies on heavy drinkers for its profit margin. A decrease in heavy drinking would see the industry's profits fall.

One response would be to encourage non-drinkers to take up drinking. At face value this might not seem a bad idea. However, the most widely accepted medical advice is that non-drinkers should not take up drinking in order to reduce their risk of coronary heart disease.

People often have personal, cultural, religious or health reasons not to drink. They can reduce their risk of coronary disease in other ways, such as improving their diet, getting more exercise or giving up smoking. None of these strategies carries the same risks as taking up drinking.

Simplistic interpretations of the evidence such as the industry advice to the Tax Review are not helpful. They may lead to people becoming relaxed about their increased drinking. Wishful thinkers might ignore warnings about the health risks associated with alcohol, like increased risk of cancer and injury.

An aggregate increase in drinking is likely to create more problems than it solves.

* Sally Jackman is executive director of the Drug Foundation.