Attempting to correct discredited statistics they released a year ago, researchers from Columbia University’s National Center on Addiction and Substance Abuse analysed three sets of data from 1999. Information was obtained from national data sets, including 1999 versions of the National Household Survey of Drug Abuse, the Youth Risk Behaviour Survey (YRBS), the Behaviour Risk Factor Surveillance System (BRFSS), 2000 US Census, and national data on consumption and consumer expenditures for alcohol, published by Adams Business Research.

Data on a total of 217,192 persons aged 12 years or older were available from the data sources. The main outcome measures were amount of alcohol consumption as a proportion of total alcohol consumed and proportion of consumer expenditures on alcohol among underage (12 -20 years) and adult excessive (21 years +) drinkers.

The proportion of 12 to 20 year olds who drink was estimated to be 50.0% and underage drinking amounted to 19.7 percent of alcohol consumed that year, to a value of $22.5 billion. The proportion of adults aged 21 or older who drink was estimated to be 52.8% and the estimated total number of drinks consumed per month was 4.21 billion. Consumer expenditure on alcohol in the United States in 1999 was $116.2 billion; of that, $34.4 billion was attributed to adult excessive drinking. The authors therefore conclude that underage drinkers and adult excessive drinkers are responsible for 50.1% of alcohol consumption and 48.9% of consumer expenditure.

The researchers defined excessive drinking as more than two drinks daily. "These analyses show that it is not in the alcohol industry’s financial interest to voluntarily enact strategies to reduce underage or adult excessive drinking," states the report. The Columbia center is an advocacy group led by Joseph Califano Jr., a former U.S. secretary of health, education and welfare under President Carter, who has been an outspoken critic of the alcohol industry.

The group issued a report last year saying that young people ages 12 through 20 consume 25% of the nation’s alcohol, a figure based on the 1998 National Household Survey of Drug Abuse. Critics questioned the statistics, and Califano’s group acknowledged it failed to adjust its figures to reflect teens’ percentage of the nation’s population. The government agency that conducts the household survey, the Substance Abuse and Mental Health Services Administration, has estimated the percentage of alcohol consumed by youngsters at 11.4 percent.

A spokesperson for DISCUS noted that the authors of the original paper had combined data from three separate sets of results to obtain their findings, which "grossly overestimate the size of the underage drinking problem. .... we agree that underage drinking is a problem, but inflating those figures is not going to make that problem better. In fact, it’s going to make it worse, by giving teens the idea that their peers are drinking more than they really are".

Distilled Spirits Council representatives also took issue with the study authors’ definition of excessive drinking as more than two drinks each day. This definition stems from US Dietary Guidelines, which describe moderate drinking as one or less drink each day for women and two or less drinks each day for men. ‘While the Dietary Guidelines represent useful "benchmarks" for moderate drinking, they do not define excessive drinking’ state DISCUS.

In the editorial accompanying the study, Drs. Glen R. Hanson of the National Institute on Drug Abuse and Ting-Kai Li of the National Institute on Alcohol Abuse and Alcoholism say that whether or not a person is drinking too much depends on metabolism, body mass and how recently an individual ate. Hanson and Li add that doctors use different definitions to screen for alcohol disorders, diagnosing the problem in men who drink 14 drinks each week and four on a particular day, and seven drinks weekly and three on one day among women.

In response to these criticisms, Susan E. Foster of Columbia University told Reuters Health that she and her colleagues asked people from federal agencies to review the methods used in the current study before it was published. Before any study appears in a medical journal, she noted, it is also subjected to a process of peer review.

Commentary by R. Curtis Ellison

The authors do comment on what the effect of using different database measures of amount consumed would do to their estimates; for example, using estimated consumption by underage subjects from other databases would decrease the share of alcohol consumed by underage drinkers to 11.4% (using NHSDA) or increase the proportion to 20.8% (using BRFSS for adults and YRBS for the young), rather than the 19.7% reported in their main results. While there are arguments on both sides regarding the datasets chosen for the analyses, the data indicate that a sizeable proportion (probably somewhere between 11 and 21%) of alcohol consumed in the US is done by underage subjects. However, the methods used do not present data that are directly applicable to individuals. The standard deviations are very large and the average for each group is undoubtedly strongly affected by skewness of the data in the distributions of drinking frequency, amount, and expenditures related to alcohol; the analyses appear to be driven by a few people with very large consumption of alcohol. Thus, we cannot blame the A typical 12-20 year old for excessive drinking, as the data probably reflect more the extremes of a few. All of the inflammatory language about the evils of teenage drinking (damage the brain; interfere with mental and social development; etc.) relate to excessive consumption, and surely apply to a small proportion of heavy drinkers, not the average young person in the US.

There is a further problem with the estimates for adults. Instead of dividing subjects into groups according to usual categories of consumption such as <2.0, 2.0-3.9, 4.0-5.9, 6+ drinks/day (for which large epidemiologic studies have estimates of the effects of such drinking on rates of diseases and mortality), the authors choose groups where the range of consumption is apparently very wide (ranges not reported, only that the averages are 3.3 and 12.7 drinks per day for the two Aexcessive@ groups). Thus, it is not possible for the reader to know where the subjects in these groups fall in terms of net effects on health or mortality.

The main problem with this paper is that it is more of a harangue against drinking than a scientific treatise. Throughout the paper, there is no mention of the health effects of moderate drinking, only the adverse effects that are almost exclusively associated with inappropriate drinking. Many statements, such as, ‘Despite these limitations, the public health implications of these findings are staggering’ and ‘The human costs are incalculable’ would be more appropriate in the National Inquirer than in JAMA. The authors have completely ignored the public health implications of moderate alcohol use in preventing cardiovascular and many other leading causes of death. Further, statements such as ‘These analyses show that it is not in the alcohol industry’s financial interest to voluntarily enact strategies to reduce underage or adult excessive drinking’ and other attacks on the industry do not mention numerous campaigns by industry associations or beverage companies urging moderation.

R. Curtis Ellison M.D. is Professor of Medicine and Public Health at Boston University School of Medicine and a member of the AIM Council.

Commentary by Dr. Elizabeth Whelan

The authors present data that suggest American teenagers are drinking early and often and – when the stats on teens are combined with some unknown number of heavy-drinking adults – account for more than 50% of all alcohol sales annually. The authors go on to claim that half the teenagers who drink consume nearly fifty drinks a month and that "excessive drinkers" are also likely to be users of illegal drugs. They conclude by noting that the solution to the problem they have characterized is, in part, higher taxes on alcohol products.

The study comes from the National Center on Addiction and Substance Abuse, which is headed by Joseph A. Califano, Jr., who was Secretary of Health, Education, and Welfare under President Jimmy Carter. The source of the study alone should have been a red flag for the editors at JAMA: last year, the same group released a study, which later had to be withdrawn, that carelessly doubled the estimate of how much of the nation’s alcohol was drunk by teens. In l994, the same authors were caught up in another misrepresentation of data, claiming that 28% of adults on welfare were impaired by drugs or alcohol, when the actual government estimate was more in the order of 4.5%.

And as if that were not enough to put the JAMA editors on notice, the new study had glaring inconsistencies and non-sequiturs:

The JAMA authors defined "excessive drinking" as anything over one drink per day for women and two for men. Think about that. Let’s say you have a gin and tonic before dinner and two glasses of wine with your meal. You are, according to Mr. Califano, drinking "excessively." Clearly, for a healthy adult who is not planning on driving, that level is anything but excessive.

Stating that those who drink "excessively" i.e. any more than one or two drinks daily, are likely to be users of illicit drugs defies pure common sense. If they were to argue that those who consume over a fifth of distilled spirits a day are more likely to use drugs, well, maybe.

In considering drinking patterns, the authors regarded the twelve to nineteen age range as a homogeneous aggregate – as if comparing a twelve-year-old girl who drinks two beers a day with a nineteen-year-old college junior who consumes two mugs daily were reasonable.

The researchers, in estimating who drank 50% of the nation’s booze, lumped together two groups to reach that number: "teenagers and people who drink too much." What could possibly cause them to think of such a heterogeneous group as having some common base? As the points enumerated above suggest, there is too much variation within these categories of drinkers to treat all of them as though they were alcoholics – though CASA is right in some sense that all teenage drinking is a problem, in so far as underage drinking is illegal.

Clearly alcohol abuse and misuse is a serious problem in the US generally and particularly among American teens, and on college campuses. A study like this one, however, diverts attention from sensible solutions by wildly exaggerating the problem and shifting the focus from problem drinkers to nearly all those who consume alcoholic beverages. Surely the best way to focus attention on the l0% of Americans who do misuse alcohol is not raising taxes.

Why should the 90% of drinkers who use alcohol in a safe and health-promoting matter be forced to pay more for a pleasurable, life-enhancing product — one which in moderation dramatically reduces the risk of heart disease?

The publication by JAMA of this flawed Califano study raises serious questions about the credibility of this prestigious journal – and puts the spotlight on the inherent dangers of using the pages of a scientific journal to promulgate biased views – in this case, anti-alcohol propaganda.

Elizabeth Whelan, Sc.D., M.P.H., is President of the American Council on Science and Health and a member of the AIM Council.