Modern epidemiology took off in the 1950s and ’60s, when public-health researchers in the United States and Britain began long-term studies tracking a wide variety of health factors in thousands of people over decades and surveying them about their behavior to try to identify risks. What they found when they looked at alcohol consumption in particular was puzzling: People who reported being moderate drinkers tended to have a lower risk of mortality and many specific health problems than abstainers did. Did this mean that a certain amount of alcohol offered a “protective” effect? And if so, how much? In 1992, an influential study in The Lancet observed that the French had a much lower risk of death from coronary heart disease than people in other developed countries, even though they all consumed high levels of saturated fat. The reason, the authors proposed, was partly that the French drank significantly more wine.
The notion that alcohol may improve heart health has persisted ever since, even as further research has revealed that it can cause cancer and other health problems and increase the risk of injury and death. But equally plausible counterhypotheses also emerged to explain why teetotalers fared worse than moderate drinkers. For instance, people might abstain from alcohol because they are already in poor health, and most studies can’t distinguish between people who have never had a drink and those who drank heavily earlier in their lives and then quit. Indeed, over the years, compared with abstinence, moderate drinking has been associated with conditions it couldn’t logically protect against: a lower risk of deafness, hip fractures, the common cold and even alcoholic liver cirrhosis. All of which advances a conclusion that health determines drinking rather than the other way around. If that’s the case, and abstainers are predisposed toward ill health, then comparing drinkers to them will underestimate any negative effects that alcohol has. “This problem of the reference group in alcohol epidemiology affects everything,” says Tim Stockwell, director of the Canadian Institute for Substance Use Research at the University of Victoria in British Columbia. “It’s urgent to establish, What is the comparison point? All we know is that risk goes up the more you drink for all of these conditions.” But without a reliable comparison group, it is impossible to say precisely how dire those risks are.
The authors of the recent study in The Lancet endeavored to address this problem, at least in part, by removing former drinkers from their reference group, leaving only never-drinkers. To do so, they spent two years searching for every epidemiological study of alcohol ever done that met certain criteria and then extracting the original data. They marked those that already excluded former drinkers, which they thought would make the comparison group more accurate; to those that didn’t, they applied a mathematical model that would control for differences between their comparison group and that of the preferred studies.
The results — which are broken down by age, sex, 195 geographical locations and 23 health problems previously associated with alcohol — show that over all, compared with having zero drinks per day, having one drink per day increases the risk of developing most of those health problems. They include infections like tuberculosis, chronic conditions like diabetes, eight kinds of cancer, accidents and self-harm. (The more you drank, the higher those risks became.) This suggests that, on the whole, the benefits of abstaining actually outweigh the loss of any health improvements moderate drinking has to offer. The results, however, also show that a serving of alcohol every day slightly lowers the risk of certain types of heart disease — especially in developed countries, where people are much more likely to live long enough to get it. So, theoretically, if you are a daily drinker who survives the increased risk of accidents or cancers that are more likely to strike young to middle-aged people, by 80, when heart disease becomes a major cause of death, your moderate drinking could prolong your life. Then again, it might be your innate biological resilience that kept you healthy enough to drink. The data still can’t say.