Will Alcohol Just Plain Kill You?

In the CNN article, they list alcohol as the leading cause of death for people between the ages of 15 and 49.  But those people weren’t keeling over from heart attacks or cancer, they were running off the road. How often is alcohol mentioned in relation to an accident or injury? We all know this, it’s not a surprise. If somebody lights himself on fire or falls down a well, we know to ask if he’d been drinking. Somebody gets in a fight? Alcohol is probably involved. So yes, I absolutely would agree that alcohol is a major problem for the health of otherwise healthy people if we’re looking at their risk of accidental injury leading to death. Let me know if any of you take issue with this assumption.

What was striking about the Lancet’s assessment of alcohol risks is the overwhelming risk for men as opposed to women. Men drinking had three times the risk of dying between 15 and 49 as women. Road accidents and self-harm were leading causes of death, though they also included tuberculosis as an alcohol related death. That seems a little squirrelly to me, a little over eager to lay deaths at alcohol’s door. For comparison, I could say poverty is by far the leading cause of death worldwide, and I’d be right, but a little squirrelly (definitely an overlooked medical research term).

When you get beyond the initial patina of science, these researchers just go ape all over alcohol. Check out this quote from the full article: “does not need to assume zero exposure, the authors present tangible evidence for low-risk drinking recommendations. The level of consumption that minimises an individual’s risk is 0 g of ethanol per week, largely driven by the fact that the estimated protective effects for ischaemic heart disease and diabetes in women are offset by monotonic associations with cancer.” If you just read that and went, “Huh?” that is exactly the right reaction. They just did medicalese for, “Don’t freakin’ drink, OK? Just don’t!”

Remember second-hand smoke? These researchers want us to calculate in second-hand drinking as a possible harm. “Furthermore, the harmful impact of alcohol extends beyond health into families, crime and disorder, and the workplace. Evidence demonstrating the range and magnitude of the harm of alcohol to those other than the drinker is increasingly emerging.” Again, there is no way I’m going to argue, with my family history, that alcohol abuse doesn’t affect families. But calculating that into a person’s health is an entirely new way to consider the health impacts of alcohol. If your parents smoked, they exposed you to second-hand smoke. If they drank, they exposed you to second-hand alcohol? See where I’m having a little trouble? I’m not saying they’re wrong, I’m just seeing a whole new way of deciding health risks emerging from this study.

Given that presentation, it should come as no surprise that,“The conclusions of the study are clear and unambiguous: alcohol is a colossal global health issue and small reductions in health-related harms at low levels of alcohol intake are outweighed by the increased risk of other health-related harms, including cancer.” We’ll get to that cancer piece in a bit, but let me note that the adjective colossal isn’t usually used in medical journal articles. Colossal compared to what? Poverty? Malnutrition? War? Genocide? Lack of drinking water? I have to say all of those are more likely to kill you than a few drinks. So while I understand where they’re coming from, I wish the researchers had just let the data speak for itself. Once you start interpreting it, your biases start showing up and I already know these researchers hate the vine.

Instead of stopping with a conclusion, these researchers also give us a solution. “The solutions are straightforward: increasing taxation creates income for hard-pressed health ministries, and reducing the exposure of children and adolescents to alcohol marketing has no downsides. The outlook is promising: the UK has just embarked on a huge controlled natural experiment with a progressive evidence-based alcohol strategy in place in Scotland, and with similar measures planned in Northern Ireland and Wales, with England as the placebo control.” Now, the way I read that is that the English parliament just raised taxes through the roof on the Scots, the Welsh, and the poor Northern Irish while keeping their own pub tabs low. It sound pretty darn retro, and honestly a bit colonial.

But shouldn’t we ban the demon alcohol altogether? Oh, wait, we tried that. It was this thing called prohibition, and it didn’t work. But…what if we tried it on a worldwide scale? That seems to be the goal of this particular study. Here’s what the conservative Cato Institute says about prohibition and its inevitable failure due to market forces. And here’s what the Harvard Gazette says about the failure of prohibition because of vigilante justice by conservatives.

Regardless of who you believe, not ever drinking didn’t work as a solution. Taxing alcohol, as the study suggests, does seem to lower the misbehavior associated with alcohol in the U.S.. But these behaviors continue, just at a slightly lower rate.

What will be interesting is looking at the effect of marijuana use vs. alcohol use as the price of marijuana dips below the price of beer in states legalizing marijuana. There are many assumptions about the relative effect of marijuana on violent behavior and driving behaviors that we will see played out in that particular social experiment. What information we do have seems to support the idea that marijuana use replaces some opioid use, making marijuana an odd ally in the opioid epidemic.

Oh, but I promised to look at the data concerning to most of us who don’t drink like we’re fishes. What does alcohol do to our cancer risk? How much damage does a drink a day do? Having looked at the appendix for the study, which is truly awe inspiring in its completeness (remember, data charts for every country in the world), it’s pretty clear that drinking isn’t good for you. But how bad for you is it? Rather than arguing over whether or not you should include different cancers in the analysis of harms from drinking, let’s use the study’s own graph. Here’s the graph they published looking at the worldwide, overall risk from drinking for all health causes and risks.

Weighted relative risk of alcohol for all attributable causes, by standard drinks consumed per day. 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext#seccestitle200

Now, I don’t pretend to be an expert on graph reading. But if you look at that graph, it looks to me like one drink a day isn’t comparable to four drinks a day. And four drinks a day is still way better than 14. If I were looking at this graph, I would say it doesn’t really matter if you have one drink a day. But I’m sure I’ve just irritated everyone by shrugging. Basically, a little drinking won’t hurt you, and it might help to not stress about it (I suspect that’s the whole point of having a drink anyway). On the other hand, if you’ve been forcing down that glass of bitter wine every morning for your health, you can stop now.