Page last updated: Tuesday, November 18, 2008
Should alcohol be used as a medication?
The New England Journal of Medicine suggested in an editorial that there is a need for a study explicitly designed to evaluate the efficacy of alcohol in lowering the risk of heart attack among patients who already suffer from cardiovascular disease. The suggestion will be controversial, particularly among doctors who believe that even the most cautious advocacy of the health benefits of moderate alcohol consumption might encourage more people to drink at dangerous levels. Others feel that despite the harms associated with alcohol misuse, the possible health benefits of the chemical should not be rejected.

The editorial observes that epidemiological data such as that coming from the US health professionals study are complemented by the findings indicating possible ways in which the beneficial effects are actually achieved. These include the increase in the level of high-density lipoprotein cholesterol ("good cholesterol") in the bloodstream of moderate drinkers and changes in the capacity of the blood to break down clots. ‘Would it ,therefore, be prudent based on these 2 types of evidence to set up a formal trial to evaluate the efficacy of alcohol, just as new drugs are assessed in clinical trials? A group of people would need to be divided into two halves, one scheduled to receive alcohol and the second not. Over the ensuing years the occurrence of cardiovascular disease in the two sub groups could be compared’.Doctors would be in a much stronger position to advise their patients to use alcohol, if the benefits had been confirmed by rigours clinical trials. Addressing the dilemma, the New England Journal of Medicine argues that few doctors would use a therapy that might reduce the heart attack rate by 25-50% as it "would result in thousands of additional deaths per year due to cancer, motor vehicle deaths and liver disease". A clinical trial among healthy individuals being "unlikely" it feels.

In the case of individuals with established coronary disease the journal reaches a different conclusion. It argues, "It may be time to randomly assign patients who already have cardiovascular disease, and who are receiving appropriate therapies, to an alcoholic beverage treatment study. In such patients the side effects of alcohol may be acceptable. We would then obtain data demonstrating whether or not alcohol is safe and effective when administered with other effective medications. At that point, one could advise patients with cardiovascular disease on the use of alcoholic beverages as a medical therapy."

Source. To Drink or Not to Drink? New England Journal of Medicine (2003), 348, 163-4,Goldberg, I.J., Division of Preventive Medicine and Nutrition, Columbia University College of physicians and Surgeons, New York, USA.

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