It sometimes seems, when working through the dozens of research
papers devoted to alcohol each week, that there can be few stones
left unturned in the field of alcohol and its effect on human
health and behaviour. Some 60 studies have now reflected Arthur
Klatskys J shaped curve - greeted with disbelief initially in
1974- which showed that those who drink between 12 and 30g of
alcohol a day live longer than abstainers and heavy drinkers.
Several papers reviewed this quarter reveal that we still have
much to learn: The New England Journal of Medicine calls for a
study, with clinical trials, on the efficacy of alcohol in lowering
the risk of heart attack among patients who already suffer from
cardiovascular disease. This accompanied a paper Should alcohol
be used as a medication.
A chapter by Merton Sandler on migraine, Wine a Scientific Exploration,
reveals that although it is indisputable that migraines exist,
dietary links, for example to red wine are controversial, unproven
and presumed by some as a conditioned reflex. In fact we have
little idea of the effect of alcohol on the brain at all. To use
Baroness Susan Greenfields words, the process of fermentation
has been practised since the early agricultural civilisations.
But even now, no-one really knows how alcohol exerts the effect
Why do individuals respond to alcohol differently? Why do a minority
(2% of women and 6% of men in the UK) become dependent on alcohol,
how much is a genetic predisposition?
How does alcohol actually give us pleasure?
Other questions which arise surround questions such as cirrhosis.
Why does cirrhosis only affect 10% of alcoholics and how strong
is the link between obesity and cirrhosis? Obese heavy drinkers
are now being shown to be at much greater risk. Professor Oliver
James called obesity the epidemic of the 21st century with strong
increased risk of fatty liver as well as type 11 diabetes at the
IMAG conference last year.
What is a binge? In many studies it is defined as consuming more
than six units of alcohol in an evening. This can be as little
as two good glasses of wine at 13%, which if consumed over a convivial
dinner certainly does not constitute a binge. Dr. Elisabeth Wheelan
highlights this problem in her commentary on the JAMA adult excessive
drinking research which courted much controversy in the US.
AIM and the WSAs joint conference on self regulation and social
responsibility offered some firm solutions regarding the role
of the industry and the government in tackling key issues such
as underage drinking, anti social behaviour, binge drinking and
drink-driving. The lack of accurate statistics were highlighted
many times however due to several factors: The lack of an international
definition of a unit means studies from around the world cannot
be accurately compared and contrasted. A unit varies from 8g in
Britain to 19.75g in Japan and 12g in the US. Even definitions
of light or moderate drinking vary between studies, making meaningful
comparisons between data difficult.
The cost of alcohol misuse to industry and the cost to the health
service offered another dilemma - it can be argued that cost benefits
should be factored in too. 65 million people in Europe have late
onset diabetes for example as Creina Stockley paper explores on
page 12, moderate drinking by the obese (constituting 20% of the
Australian adult population) reduces the risk of developing type
2 diabetes considerably, plus reduces the risk of cardiovascular
disease in those with type 11 diabetes, let alone those without.
So, it seems, we have much to learn, or to clarify at least, if
alcohols effect is to be properly understood, either on the body
or in a social context.