I for one wish that they'd just do the study properly. Sure, it's now tainted beyond all belief, but it's such a societally important question that it's rather amazing we don't have a good answer to the question of how bad (or otherwise) light to moderate drinking is for you. Such a huge chunk of the population does it!
If we look at another societal thing that historically a huge chunk of the population did -- smoking -- it was known that it kills you, horribly, but it took taken more than sixty to eighty years for the public to get that message, and now society is slowly adjusting [at least in Europe] with real public benefits. If an effect is present with alcohol, even a small one, the integrated effect would be massive and it's a very scientifically valid question to ask.
Alcohol is really interesting -- people under report how much they drink, and how much they under report is a function both of the amount of booze, and the covariates that affect life expectancy like education (Prof Raymond Caroll at Texas A&M has an excellent book on this -- there's a method to correct for it by bootstrapping called SIMEX -- e.g. applied in [1], in which a sample of about 3000 adolescents and young adults around the age of 20 shows that binge drinking "may not be causally related to deficiencies in working memory, response inhibition or emotion recognition"). The paucity and conflicting of evidence probably means that the effect size is small, but the error bars are huge and as the article says, the covariates are many. It's just a shame that we can't have nice things because of the bent actions of a few.
This is completely anecdotal, but Whoop data could be used to uncover what moderate drinking does to you as people are self reporting their habits daily.
It is common knowledge in the Whoop community that any amount of alcohol will impact your recovery score(a in house metric combined of HRV, amount sleep gotten, amount sleep needed, recent activity strain, & more) for near 72 hours.
Came here to say this. Seeing the horrible toll that even a small amount of drinking does is a powerful motivator. Even with just Fitbit, RHR was a clear signal. WHOOP makes it clearer.
Biofeedback is underrated. I have foregone many drinks out of concern for my heart health, which otherwise would be invisible.
Whoop's recovery score, in my experience, is highly correlated with mental performance, not just physical. The only market to athletes, which is horrible because I wish there was a model that would make sense to give to my parents. You have to really want that data to pay $30/month.
> If we look at another societal thing that historically a huge chunk of the population did -- smoking -- it was known that it kills you, horribly, but it took taken more than sixty to eighty years for the public to get that message, and now society is slowly adjusting [at least in Europe] with real public benefits. If an effect is present with alcohol, even a small one, the integrated effect would be massive and it's a very scientifically valid question to ask.
But it's not if an effect is present: we do in fact know that alcohol consumption causes cancer. The link is well-established. What is surprising is that most people aren't aware that this link exists. IIRC the number of Americans aware of the link is something like 30%. According to this (https://www.theguardian.com/society/2018/jan/08/only-one-10-...) only 1 in 10 Britons is aware. (I assume even fewer people are aware that processed meat causes cancer.)
I understand what you're saying, of course, given that there might be some benefits that outweigh the risks when you calculate overall mortality. However, speaking personally, I think I would rather die of heart disease than cancer. In fact, compared to death by cancer, a heart attack sounds like a blessing (of course I'm aware there are other, slower and also nasty ways to go that are related to heart disease — but still). The main issue being, of course, that at least a slow death gives you some time to say goodbye and arrange your affairs. Still: I'd rather go quick and clean.
It's a morbid subject, but after recently reading The Emperor Of All Maladies, a masterful "biography" of cancer, this has been on my mind quite a bit. I love to drink, but I'm wondering if it's worth it.
You don't have to die of cancer. If you got it, and you're sure it's terminal, there's really not much need to wait, there are ways.
I'm still an alcoholic. I may drink less than before, but it's the only drug that affects GABA receptors that I can reliably get. If doctors won't help me, well, it's the only thing that keeps me sane lol.
I used to be careful with drugs, now I try everything I can get my hands on and note the results. It became sort of a hobby of mine.
Still remember the time I was fading in and out of consciousness from phenylethylamine and alcohol (wack interaction, do not recommend), the absolute despair that 7+ grams of pure GABA puts me into, and the time I passed out and pissed myself on too much Imipramine+L-DOPA+Valerian extract.
Ah, if only I could get the good stuff that works for my actual problems, but apparently prescriptions are not for subhuman citizens like me.
If I die, I die. If I become disabled/impaired, I die. Harder than it sounds, but I'm gonna test the limits.
Have you given kava a try? I reduced my alcohol consumption significantly to only rare occasions, and have recently found that kava serves as a nice substitute. The effects aren't as pronounced and you don't get the impaired judgement/reduced cognition, but I consider that a plus.
Most of Europe is actually rather backwards in terms of smoking prevalence and culture, compared to other western countries like US / Canada / Australia / NZ.
I don't know if it's improving but the current state is pretty shocking if you're used to seeing better.
Can't remember the last time I saw someone smoking in Australia. Maybe staff outside a hospital while walking to my office, but even that would be over a week ago.
Alcohol though has a very strong influence, unfortunately.
But we do know. The article mentions those mendelian randomization studies. They give us plenty of evidence that the proposed study would hurt those who were randomly told to drink more than they otherwise would - even if they just drank as much as the study's designers wanted.
And that's a big assumption. Alcohol is addictive. How many times do you hear of people drinking a lot less than they planned to on a night out?
Indeed, this extremely obvious fact is why there hasn't been an RCT for alcohol before. It's not that the idea hasn't occurred to anyone, it's that would-be reseachers have thought "no way would we get that past an ethics committee".
So what has changed? Well, it looks like this Mukamal guy lives in an extremely friendly regulatory climate. They're so friendly, in fact, that they go out of their way to shoo him in as their researcher, seek funding from the alcohol industry, and try to conceal the whole thing! If there's any group that might be willing to overlook the extremely obvious ethics issues of running a RCT telling people to drink, looks like it's the NIAAA!
How many people would be under more stress, have less relationships without alcohol? It absolutely works as social grease, loosens up nerves and is a very nice way of calming down.
I know so much in modern culture is about this weird asceticism, removing anything tasteful, fun, stupid and optimize for longevity - but what's the point to live in total boredom?
I think few people would deny that there are some benefits for some people from alcoholic beverages, but can we really say, with all honesty, that its benefits outweigh its harms?
Like most addictive substances, the negative health benefits don't manifest themselves immediately, but often after years or decades, and those who haven't suffered claim all the benefits while the harms loom on the horizon. They change their tune later in life...sometimes.
As for the other harms, such as the amplification of violence, the loss of mental faculties – that same "social greasing" is the removal of inhibitions, including those that prevent people from committing certain crimes or harm against other people. How many alcohol-fueled rages would it take to make the equation flip for someone?
If the argument is that it is fine as long as it is done responsibly, how do we police that?
Will alcohol always be around? Of course. It's something that cannot be avoided, even in societies that have banned it for one reason or another. But to welcome it with all its complications, just because one enjoys it, and closing a blind eye to the harms, is imprudent.
And is alcohol truly a good solution as a self-medicant? I think you are spinning that as a net positive, but I highly doubt this is a professional's opinion on that matter, such as a therapist or a doctor.
Finally, to equate a negative view of alcohol as "...removing anything tasteful, fun, stupid..." and "...total boredom..." – to be honest, this is reducto ad absurdium, isn't it? If nothing is fun if there's no alcohol, then I think there's a different problem.
Two studies [1],[2] suggest 40% and 25% of certain violent crimes have alcohol involved.It may be difficult to know whether these crimes would have happened without alcohol anyway. Nevertheless, even a slight reduction would certainly be appreciated by the victims and society.
And what about inventing other means of social grease?
[1] https://bjs.ojp.gov/content/pub/pdf/ac.pdf
[2] https://pubs.niaaa.nih.gov/publications/10report/chap01c.pdf
I think 'social grease' is a good term. Grease is multipurpose: alcohol serves to lubricate a social setting, abd removes the inhibitions that can prevent people from letting their guards down and opening themselves up. In different contexts, however, it can cause one to easily fall into darker emotional patterns, resort to violence, or lead to someone being taken advantage of.
We will never be rid of alcohol, in my opinion. It's too simple and effective, and too deeply engrained in our society. What we can do is work to better educate and support society so that alcohol can exist in a safer atmosphere. Addicts don't get addicted just due to chemical means: there are deep social implications.
I think few people would deny that there are some harms for some people from alcoholic beverages, but can we really say, with all honesty, that alcohol has no benefits, or that its harms outweigh its benefits for all intake amounts?
Should we police responsible consumption more than we currently do? Perhaps, it's worth discussing for sure.
Will alcohol always be around? Of course. It's something that cannot be avoided, even in societies that have banned it for one reason or another. But to reject it with all its benefits, just because it has harms, and closing a blind eye to the good, is imprudent.
And is alcohol truly always a _bad_ solution as a self-medicant? I think you are spinning that as a net negative, but I highly doubt this is professional consensus on the matter, such as among therapists or doctors.
Finally, I don't think there's anything wrong with making boring/stressful stuff less boring/stressful, sometimes you just gotta do boring/stressful stuff
Well said. I’ve been noticing that most such things in life are double-edged swords. Alcohol, Instagram, whatever. There is much wisdom in the “middle path”, applicable to much of life. Avoid the sharp edges of the blade, be in the flat middle.
I don’t think anyone would ever dispute the mental health benefits, though many people also lose their minds when drinking to excess. The purpose of these studies is to provide guidance to healthcare providers, so they can better assess the risk of their patients drinking habits.
The two drink a day meme is something I knew was totally bullshit, but could never really prove. Two of my uncles (one died recently) believed that meme and happily torched both their mental and physical health by drinking to excess. Their healthcare providers didn’t say anything either, until it was much too late, at which point the damage had become very obvious.
I dispute the "mental health benefits". Alcohol progressively disables parts of the brain. It literally the opposite of a mental health benefit. In fact, it will make problems like depression significantly worse.
I believe that the idea that people are to blame for their alcohol problems is totally false and basically a conspiracy by the alcohol advertising industry. The problem is alcohol, not the people consuming it. It naturally induces almost every person to want to drink more alcohol while inhibiting their ability to make good decisions such as about continuing to drink.
This is true for all problems people face. Ultimately, the genetic lottery predetermines a wide berth of our experience. Our environment determines the rest. If society wants to change behavior it finds deviant or unhealthy, its main tools are science-based interventions and leveraging its ability to manipulate the context within which people live.
The perennial issue is finding and designing the right levers to get the results that are wanted. Prohibition didn't work, moralistic pressure doesn't work, education doesn't work. The right incentives need to be discovered, and I think an acceptance that humans have a need for changing their state of mind will lead closer to answers.
For some people it acts as a social lubricant. For others, usually people with particular difficulties or stresses in their lives, it acts as an amplifier for some of the worst things people can do. A lot of those people also claim they only use it as a social lubricant.
Maybe if we could eliminate all the things that make people drink to extreme excess, or drink when it's dangerous, this would be a fun little quirk of the human species but as it is a huge amount of harm is correlated with heavy drinking and I think if you've only ever seen and understood the good side you are a very very lucky person.
It's not even a social lubricant! The social lubricant is actually approaching the people and talking with them. All the alcohol does is makes you less scared/restrained of doing that (and less scared/restrained in general, yeah).
Well, I can personally confirm that you can just as well train yourself to consciously overcome this specific restraint which is also a rather useful skill in itself. Sure, it takes work and effort but all things that don't "come to you naturally" require that.
And if where talking about cases of actual psychic illness, carefully chosen prescription drugs even when imperfect always beat self-treatment with alcohol.
Pretty tangential, but I think for the first time in history, much of the human population has incentive to optimize for longevity.
We seem to be on the cusp of solving aging and dying problems to a massive degree.
200 years ago we knew nothing, in another 50 we might know all we need to achieve immunity to aging.
I would bet my net worth that we figure that out in the next 1,000.
Anyway I still don't optimize for longevity, but I think it makes sense, at least.
I also enjoy that alcohol connects across millenia. Lately I've been trying some things from a Slavic brewery, they brew some ancient mead recipes. One was unchanged since about 1300, according to the label. That's pretty cool. If you want to check it out, the one I have now is a honey apple wine called Ribe Mjod. Same company.
Extra tangential: For a lot of human history, many of the elite _thought_ they were close to achieving immortality through unlocking the elixir of life, and that it could be discovered in the next few years.
That elixir has changed names, but the concept is still around.
Except that this time the elixir isn't powered by magic or fairy tales.
Aging is just another biological process. It's controlled by genetics and environment like everything else, and can be manipulated using similar principles.
It seems likely (thinking of CRISPR and similar inventions) the rudimentary tools for controlling aging are coming of age. I believe biological immortality is closer than we think.
Sorry to burst your bubble, but aging is not "just another biological process". It isn't even biological... everything ages and decays, even inorganic matter. Even rocks decay into clay.
Living biological processes by their nature resist decay, but that's an uphill battle... eventually entropy wins. Errors and waste products accumulate, materials become brittle and fragile, with every year lived the probability of dying before the next increases.
Can we help our biology to become more efficient at maintenance and repair? Probably, but not all that much. We are already very long lived. The only complex terrestrial beings that live longer do so by living very slowly... in terms of subjective time experienced, maybe they don't live any longer at all.
I posit that you've just found the name or class of elixir of our times. I'm not denying that life expectancy can be increased due to advances in science, healthcare, medicine, and lifestyle changes. But there's a difference between extending by a few years or even decades every century or so and immortality. We will discover other aspects that become limiting factors. Aging as "just another biological process" is a drastic oversimplification in my opinion and I think the more accurate statement is our understanding of aging has grown, but I doubt it's complete.
Something I've thought a lot about: in most fields of study, modern scholars revere the 'old masters' that came centuries before for their genius: think Newton, DaVinci, Socrates, Galileo.
However, in medicine, most doctors will tell you that the doctors from 200+ years ago were idiots that did more harm than good.
Why is that? Is modern medicine too hubristic? Were the doctors of ages old really that dumb? Is this a trend that will repeat itself in 200 years?
The first doctor discovered washing hands improved outcomes ~174 years ago & was initially dismissed[1]. It was later confirmed a couple of decades later when germ theory & bactereology[2] was born. Our understanding of how to have successful organ transplants only really took off in the past ~80 years as doctors started to better understand rejection. At the same time, in the 20th century, we got all sorts of new scanners & equipment to visualize the internals of the human body that we've never had before. Finally, the 20th & 21st centuries brought along revolutions in computing, genomics, & pharmacology.
So yes, 200 years ago doctors knew a great deal far less than today. I'm sure a doctor 200 years in the future looking back on today will feel similarly. There's still so much we don't know & there's a lot of guesswork involved. I wouldn't say they were idiots but the outcomes were certainly not at levels we'd accept today (just as the outcomes today won't be acceptable 200 years from now).
FWIW, the same is true in other disciplines. The 20th century marked a rapid exponential curve in learning. No one really studies any of the masters you note except for maybe Newton & Galileo. The former because the kinematics equations are actually extremely good approximations for Einstein's equations (& also his work on light and lenses remains accurate and foundational to this day). The latter as a warning of the dangers of putting ideology ahead of science and scientific thinking. Galileo's heliocentric model isn't actually used today except as a way to teach kids about the solar system because it's really simple & is good enough at that level (his work on gravity was an important influence for Newton's ideas on the topic).
High school science still (afaik) teaches the Bohr model [1] of the atom, because it works well enough for that level. This also leads to a great moment the next year when the teacher leads off with something along the lines of "Remember the Bohr model? Well, forget it: it's wrong." Fun that this causes some students to be outraged, but it's also a great lesson in the scientific method - or at least my (excellent) science teacher used it for that and it made a lasting impact on me.
I'm still annoyed whenever I think back at that, at being taught something that was wrong as if it was true. It costs nothing to say, "We're going to learn a model of the atom - the reality is more complex but this will work for now."
The way it is often done just creates trust issues for people who really care about accuracy...
The reason that moderate drinkers (i.e. 1-2 doses/day) appear to enjoy less risk of disease than the abstainers, is that the group of the abstainers includes people that used to drink but stopped to (e.g. they were alcholics and sobered up or they got sick and had to stop because of it) which still have hugely elevated risk profiles. When you account for that, the dip vanishes.
We now know that isn't true, especially not for heart disease. This study, as one example, separated out "never drinkers" from "former drinkers" to address this bias and found drinking to still be beneficial.
I can't help but feel bias against drinking has religious roots. This has been studied to death, and generally moderate drinking is shown to be beneficial, or at very least not harmful. But some folks are so opposed to that result they keep moving the goal posts.
On the individual level the science is still murky, but we do know that people from cultures that have a glass of wine in the evening tend to be healthier and live longer that those who don't. That said, I don't necessarily think the magic is in the antioxidants in wine, nor do I think it has something to do with the cardiovascular effects of having alcohol in the bloodstream.
My complete layperson theory is that no amount of alcohol is "healthy" per-se: its negative effects are well known and documented, and almost assuredly outweigh the few dubious positive effects. Instead, the benefits of drinking small amounts of alcohol might be entirely tied to stress management. Stress kills. It absolutely ages people and leads to early death.
Having a wind-down ritual in the evening is probably the important bit. A glass of wine with dinner is a firm punctuation mark in a person's day. It signals that work is now over, and what's been left undone can be resumed tomorrow.
That's exactly how I appreciate a beer after work every couple of days. A personal ritual to relax, taste a different - if possible craft - beer, and unplug from work. One small bottle (35 cl) is enough to make me happy ;)
>> This study, as one example, separated out "never drinkers" from "former drinkers" to address this bias and found drinking to still be beneficial.
Careful. That result is not so clear-cut:
>> In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated. [Section Abstract/Results]
>> Pooled analysis of estimates relative to non-current drinkers showed a reduced mortality risk for an alcohol intake up to approximately 75 g/day. However, when studies with former drinkers in the reference group were excluded, the association was considerably weakened (see Additional file 1: Figure S9). In addition, among those studies using post-event alcohol measures, the result did not change substantively; a similar trend was seen in studies with multiple measures but failed to reach statistical significance, probably because of the low number of curves (n=2) in this subgroup (see Additional file 1: Figure S10). [Section Alcohol consumption and all-cause mortality among CVD patients]
Btw, "post-event" means that participants reported their results after they had their major cardiovascular event:
>> In addition, most of the included studies asked patients to report their average consumption since the occurrence of their primary events (post-event alcohol assessment), whereas three studies used alcohol intake in the year prior to primary events (pre-event), assuming drinking habits remained stable over time, even following events [14, 44, 45]. [Section Data extraction and quality assessment].
Why is everyone so confident with their conclusions without RCTs? This article points out how deeply complicated ethanol consumption is with our biochemical systems. Without RCTs we really can't measure the overall effect of ethanol without quantifying the effects of ethanol on each of those systems.
Can't we just reserve judgement here, and use some humbleness in the face of our ignorance to drive for a real RCT funded by the public?
Can we try to avoid the trap of becoming confidence-men?
This is an impossible ask and exactly what I mean about moving the goalposts.
For example: there are zero RCTs that prove to us cigarettes cause cancer. But we're still comfortable in saying cigarettes cause cancer.
It's entirely ridiculous to suggest we do a RCT and ask someone to smoke for 30 years to remove all doubt that cigarettes cause cancer. And who would pay for it? So all we have are mountains of data showing that cigarettes shorten lifespan.
The same is true here, but the opposite result. Doing a RCT on alcohol for decades will never happen. All we have are mountains of data showing either no harm or a small benefit on lifespan. So that should be our null hypothesis: that moderate drinking is either harmless or slightly beneficial.
The problem with doing RCT with alcohol and with smoking is that we're talking about lifestyle studies. You can't really do a study with the goal being "see if we can give this dude cancer during his lifetime".
And let's also remember that the study that people who drink moderately had longer lifespans just really notes correlation. It does not prove a causation.
Drinking is ubiquitous. Most people drink. Drinking is also a luxury. So if you're poor, you either drink a lot or very little. Because you either have a problem or you're too broke to afford it. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185179/)
Guess which income bracket engages in moderate drinking the most? That's right, the income bracket that also allows you to afford better health outcomes overall. So while it may be true that moderate drinking correlates with longer lifespans, it's a knock-on effect to the fact that being poor sucks.
The issue is, the difficulty of doing an randomized study doesn’t nullify the benefits of randomization (a big one being eliminating confounding variables, for which there can be a lot for who decides to take up an addiction and why).
The control part would be particularly difficult (unless maybe you gave everyone a real or sham nicotine patch? But then you can’t exclude some other benefit from straight nicotine itself).
One could control for all the confounders they want, but you still risk missing some that are unknown or undervalued.
So your argument here is that it is ridiculous to suggest that an RCT is possible in this circumstance, so we should therefore accept observational studies which derive correlations as truth.
Not only does that conclusion not follow from your premise (a logical fallacy), but it's an absurd suggestion as a process for deriving truth. Observational studies, at best, offer an insight into possible hypotheses, and should by no means be considered persuasive unless all interacting systems have been controlled for. In the case of ethanol, there are an enormous amount of interacting systems that need to be controlled for.
Your premise is also strictly false, as it's clear that not only is an RCT for ethanol consumption possible, but it was planned and partially in progress before it was terminated.
It's truly incredible to see the kind of language that you use here, how confident you are about your fallacious argument. I kindly request that you turn down your confident language. Science is a long and careful process of pushing back the fog of ignorance, and if you are serious about the search for truth you shouldn't use such confident language.
Because only people with a high enough conviction of benefits of moderate drinking are commenting here and arguing for. However I have no idea how they do become so strongly convinced in that, given the low quality of the data that exists, the general reproducibility crisis in bio-sciences, precedent of complete compromise of a large study, things like https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-..., the argument that if moderate amounts of ethanol were beneficial we would have just evolved to synthesize it, etc.
I think the most likely outcome is boring: moderate amounts of alcohol are moderately harmful, but not harmful enough to be immensely obvious and not harmful enough to outweigh the non-biological benefits some people extract from it.
I don't think it's necessarily about religion. I have nonreligious, very sciency type friends who are simply opposed to drinking. Even after I show them the studies, they do as you describe, move goalposts and desperately try to justify their beliefs in some type of science.
It's just a morality/cultural issue. They see people drinking & driving, excessively drinking and being violent, depicted IRL and in movies, and want to distance themselves from these bad types of people that drink alcohol.
Not sure how you've reached the "religious" conclusion. With the glaring exception of Islam, alcohol plays a central role in most religions.
Obviously drunkenness is another issue altogether, but that's not what such studies examine in the first place, so that's a different discussion.
As for the benefits of wine in moderate drinkers, I remember reading a study which compared consumption of wine vs equal amounts of other types of alcohol, and concluded that the antioxidants and tannins in wine were the main carriers of that benefit, and if anything alcohol still had negative effects but simply the benefit from the other substances in wine overrode the harm caused by the moderate amounts of alcohol in wine.
Obviously since I don't remember the study to cite it, this makes it an anecdotal claim here, but ...
Everybody gets this causal arrow strangely backwards. Alcohol causes people to sin; that's why Christians opposed its use. It's the negative effects of alcohol that led people to oppose its use, not "religion" per se (or even in any kind of explicit scriptural or liturgical sense).
Given that "sin" is a purely religious concept, and that one's culture around alcohol has a pretty big effect on whether alcohol is associated with misbehavior (there are lots of people and places for whom alcohol does not cause "sin"), it's totally fair to say that alcohol bans were at least partially religiously motivated.
I don’t think either of your premises are true, but it’s my fault for using the word “sin.” Alcohol is implicated in something like 50% of all homicides. There’s no culture where that behavior is tolerated and prohibition of murder isn’t a religious concept.
That’s all I meant by “sin.” I only used the religious term because I was speaking from the viewpoint of the religious of the time. Didn’t mean anything by it other than ordinary misbehavior.
Alcohol is implicated in something like 50% of all homicides.
Perhaps, but P(A|B) is drastically different from P(B|A). In other words, what percentage of consumed drinks of alcohol are associated with a homicide?
Beyond that, could alcohol use be prevalent enough that alcohol could be implicated in 50% of everything? It's sort of like how "excessive speed" is a factor in most car accidents, but that's because posted speed limits are too low and everybody speeds at least sometimes.
The New England Journal of Medicine study that came out in the early 2000s (I don't have a citation for you) concluded the opposite: It's the alcohol that kept the arteries clear. Their study was motivated by the observation that the cadavers med students work on are typically homeless or strongly disadvantaged alcoholics. The bodies were often disease-ravaged, but their blood vessels were in very good shape.
I think of it as an "alcohol as a plaque solvent" model.
Another way to see it is that if you starve and don't eat well and try to store as sugar in your liver (but you can't because the liver has exit the room) you don't have much remaining fat in any part of your body, including the blood vessels.
> I can't help but feel bias against drinking has religious roots.
I don’t think it’s necessary to propose novel explanations for opposition to drinking. Alcohol has enormous negative effects on society and individuals. Nobody who has ever lived with an alcoholic is even remotely confused about this, but even those of us who have been lucky in that respect can easily observe large societal detriment. A staggering percentage of all violent crimes are committed by drunk people, most of us know someone who died in a drunk-driving related incident, and we’ve all been around drunk people who we found to be incredibly annoying (and often actually violent).
Opposition to drinking doesn’t require additional explanation.
The majority of drinking is done in a pro-social manner, and you're missing a large part of the picture when you say "Alcohol has enormous negative effects on society and individuals" as if it's a blanket negative impact. I agree that it does have a substantial negative component of course.
There was a (ineffective and violent) prohibition on drinking a century ago. Some religions also have strong views against drinking. To ignore these societal influences on western culture and call it a novel explanation is a bit of a stretch.
This is a bit of a non sequitur. The benefits of drinking are obvious! And, yes, religions and political parties have opposed alcohol...because the harmful effects are equally obvious. The causal arrow runs that direction. There was indeed a prohibition on drinking a century ago, spearheaded mostly by women who were tired of their husbands beating them when drunk.
Prohibition is widely regarded today as an obviously ridiculous blunder, but that's mostly revisionist and ahistorical.
German Lopez at Vox did a couple good pieces on what people get wrong about it:
There's also a bit of an asymmetry that makes weighing the pros and cons difficult. If 40 people enjoy a night at the bar, but one one of them goes home and beats their wife and another kills a family in a drunk-driving accident on the way home, do we just say, "well, 38 of the 40 peacefully enjoyed their evening, so it's mostly good." That looks like a horrific outcome, to me.
A critical fact that destroys modern narratives about the supposedly naive rationales behind Prohibition is that the 18th Amendment was only supposed to apply to what we now call hard liquor, not to beer and wine. Indeed, much of the country already had similar or identical legislation yet beer and wine was perfectly legal in most (all?) of those localities. The Federal prohibition was simply for national consistency with a public policy that was well tested.
Unfortunately, an overly pedantic Supreme Court interpreted "intoxicating liquors" very broadly, resulting in a national ban that far exceeded the state and local legislation with which most people were accustomed and comfortable. It was the narrower definition only encompassing distilled liquor that the public knowingly gave their consent.
This isn't quite accurate either. It was the Volstead Act - an act of Congress - that defined the breadth of the ban (i.e. what constitutes intoxicating liquors). The Supreme Court did uphold the legality of the Volstead Act.
Noted. Thank you. And for more context, the Volstead Act passed with supermajorities in Congress, enshrining a war-time prohibition (based on war-time powers) that was already in effect. So there were indeed some very strong political dynamics pushing for strict alcohol prohibition, but arguably not enough alone to get from inception to a constitutionally enumerated power. Perhaps the better lesson is that there is no simple narrative.
Thank you. I have not heard of thinning blood that is interesting! Kind of on that topic I have read a lot about inflammation casual relationship to lots of problems. As I'm getting older in my sport I take a lot more Ibuprofen than I used too ;) maybe going daily isn't such a bad idea?
Yes 100% on socialization that was my first intuition.
Do you really think the bias against drinking (that might or might not have religious roots) is stronger than the massive bias that comes from the vast majority of people enjoying alcohol a lot?
Of course we 'know' nothing for sure - which is a truism that applies both to the original comment and to yours... but my point is that you should rarely be convinced by a single study.
That said, I have no specific criticism on the paper you refer to. It might be that the lower risk of heart disease is outweighed by an elevated risk for e.g. cancer? In that way both results can be true.
"Religious roots", hah. The Catholic church was opposed to teetotallism, as were lots of conservative denominations. Modern Teetotalism started as a secular movement out of dismay at the visible damage of alcohol use, just like socialism started out of outrage against industrial labour exploitation, and the sanitation movement started out of literal physical disgust at foul smells. The common thread wasn't religion, but progressivism: seeing society change immensely around them due to technological process, they believed (far more than we do today, ironically) that society could and should be consciously reformed.
And of course, what those "studies to death" you mention have established is that alcohol is even nastier than suspected, causing birth defects and cancer like no comparable substance we consume, in addition to all the obvious negative health effects we all can see.
The supposed dip at the low end, for only a few of the nasty effects, is a counter-theory to distract from the (pink?) elephant in the room. And even that counter-theory has been discredited by mendelian randomization studies.
Feels somewhat disingenuous to combine the data for men and women, not sure about that discrepancy between surveys either: https://i.imgur.com/BVJvRx6.png
I'd expect 1-2 drinks a day to be pretty far up there in the distribution where 0 (abstention) is the minimum. There'd be a spike at 0, then a drop, and then a gently sloping upward curve, maybe flattening to a local minimum somewhere lower than 1-2 drinks per day before climbing again. I'd be in there somewhere. I drink occasionally, but orders of magnitude less than 1-2 drinks per day. More like go to a user group 1x or 2x a month and have a drink or two there, or maybe lift a few with buddies after work with similar frequency. With that stuff curtailed by the pandemic, it drops to near 0. That's not abstention, it just doesn't come up.
I think that has to be typical of a significant chunk of population. People on the wagon due to alcoholism exist but are likely to be a smaller group.
> In principle, firewalled research could be the solution. Supplement companies could pay to have tests done by independent researchers. Consumers would have a quality signal for what products to trust, and the companies that make good stuff would make more money.
The UK tried something like this for building materials - unfortunately, it doesn't seem to work very well.
To achieve certain standards of fire resistance, manufacturers could choose from a range of independent test houses, who would conduct the relevant fire performance tests at the manufacturers' expense.
Except it turns out, manufacturers don't want to go to difficult, argumentative test labs. They choose the friendly test lab, that knows how to treat its paying customers. The lab that will advise them on how to pass the test, that will leave them unsupervised as they add defeat devices to the test rig, and that will remove problematic photos from the test report.
The result? Loads of our tower blocks are clad in flammable insulation and ACM panels - including one where 72 people died in a single fire.
I think the difference between the testing for materials you describe, and the firewalled research OP wants is an intermediate institution.
Here it was the NIH, it should always be an independent organization. The money is committed to the institution before the institution decides who gets the job.
I agree. I love reading articles like this because it forces me to question what I think is the right perspective rather than just digest whatever perspective the author is feeding me.
I don't know why more journalists don't write like this. Is it just that people prefer being told what the right and wrong opinion to have is? Or is it simply because most journalists care more about reporting their opinion than trying to fairly represent both sides of the story in question? I guess it could be argued some opinions are so clearly wrong that they don't deserve the benefit of the doubt, but even then there is often a lot more nuance than is typically reported.
> Or is it simply because most journalists care more about reporting their opinion
I mean... this piece actually has much more opinion in it than "journalism" is "supposed" to, doesn't it? It's an opinion piece, not a piece of journalism, although he does a bit of research for it.
So I find it a bit confusing to ask for "more journalists" to write like this, while also saying you think most journalists care more about reporting their opinion than OP... OP actually centers it's opinion pretty directly, no? Mostly I think this piece is doing something that is not what journalism is even expected to do at all.
But to be sure the distinction between "journalism" and "opinion" is pretty confusing and blurry these days (because opinion rather than journalism both gets more clicks and is cheaper!). I'm not sure the solution to problems with journalism lies in asking journalists to write journalism more like an opinion piece, even a very well-written opinion piece!
See that's the thing, I think we've painted journalism as existing on some imaginary spectrum of "just the facts ma'am" which is good, and "editorializing with an agenda" which is bad.
But by far my favorite pieces of journalism are dripping with opinion and character and full of bias. The X factor that makes the result, to me way less biased than most journalism, is that they are introspective of their own biases, display empathy toward everyone involved, argue in good faith for everyone involved, and draws their own conclusion from the results of their imaginary argument with their crew of alter-egos.
It takes something special (and a lot of practice) to argue for someone you disagree with in such a way that that someone would say you did a good job.
I'd like to claim a difference between reporting your opinion and convincing people of your opinion. All the Pope has to do is to report his opinion, and people are interested in it as such. A lot of big newspaper opinion writers do the same, because a certain class just wants to know what their media outlet thinks, rather than why they think it, which can be skimmed or skipped. A good journalist, IMO, makes the premises of their arguments clear, and then makes the best case for the opposition (which often involves trying to weaken one's own premises.) Then, finally, explains why the best versions of the opposition arguments are probably wrong. This, even if it fails to convince, never fails to educate.
what "problems with journalism" are you referring to? All journalism is opinion; even if they just dumped raw datasets in a newspaper, that would have its own biases.
If you ask me, the main issues with modern journalism are the poor command of written English and a lack of depth/context. Neither of those seem to apply here.
In the mid 2000s NIH was flat funded, and lots of alcohol research went out the window. I worked at a place that did alcohol research at large (mostly mitochondria/liver systems biology stuff). Mostly the idea from funders was that alcoholism is not a disease, and funding should be moved to more pressing things like cancer/diabetes. I would say half the surviving labs moved on to metabolic issues in disease, and the other half did translational medicine based on their research. This was a huge blow, caused a few retirements and closing of several labs. I had to lay off a couple of my friends (technicians).
It is surprising the alcohol industry is going to such huge lengths, and I can't remember ever hearing of such things. It would be a huge blow to your credibility at the time I was in science.
I do enjoy the author trying to look at both sides at the end.
There are a number of substances that act like alcohol in the brain, but which are not fundamentally antithetical to animal cellular biochemistry the way ethanol is. Most-all GABA-A agonist drugs fall into this class.
I've always been curious how harmful these drugs would be under a profile of long-term recreational abuse, when contrasted with alcohol. I have a sense that you'd be far better off being addicted to such drugs, than you would being an alcoholic. Similar to how vaping, no matter its absolute health consequences, could still be beneficial relative to smoking tobacco, if that would be your alternative.
Maybe if we could figure out how to make an aqueous GABA-A agonist with a really high LD50, we could see the development of a "synthahol" in our lifetimes?
You’re hung up on GABA, but it has little to do with alcohol other than being part of the physiology of physical dependence.
LD50 for benzos is already “really high” - that is not an issue. Alcohol affects other neurotransmitter pathways other than GABA. That isn’t even the one responsible for the psychological dependence. So a GABA-A agonist with a high LD50 exists in multiple (benzos), but it’s not an alcohol substitute. There is a reason why these medications are used for acute withdrawal, but are not used for treating dependence.
Also, being addicted to benzos is far more debilitating than the “vaping” equivalent - this has been well studied since they had their heyday in the 70s. They’re quite harmful for chronic use except in very limited circumstances.
Maybe synthahol might be a thing - I mean you’re probably closer with something like ecstasy - but a GABA agonist isn’t it.
Benzodiazepines (Xanax, Valium, etc.) are basically that - GABAergics with very high LD50. They're positive allosteric modulators, rather than direct agonists, but the pharmacological action is similar. But benzos wouldn't be a good alcohol substitute - they're often described as less "fun" than alcohol by people who use them recreationally, they're more prone to delusions of sobriety (possibly because it's missing the other non-GABA effects of alcohol that help us gauge drunkenness), can be very addictive, and there's some link between long term benzo use and modest elevation of cancer risk, especially brain cancer.
I still found benzos "fun" but they definitely made me more sleepy and chilled out than alcohol. The disinhibition is still there which is where I suppose the "fun" comes from. The memory loss was far more extreme for me than alcohol though, which eventually made me stop taking them.
David Nutt shares your hypothesis and is working on such a substance [1].
I agree with you that something like chronic Diazepam abuse is probably less harmful to the body than a similar alcohol habit - but I'm skeptical (but hopeful) one could design an effective, recreationally-useful GABA-ergic drug that didn't come with the baseline shift and rebound anxiety (and in the limit, seizure/death) usually associated.
You can already choose to abuse pills in contrast to alcohol, and it's generally not very pretty either.
I'm pretty sure Dr Nutt was/is trying to market a synthanol product, which even had an "antidote" to get you sober again quickly.
Realistically his chance of any nation (especially a western one) legalising such a thing is very slim indeed, at least in the medium term. Which is a real shame, as alcohol causes huge harm to society.
We have plenty 'safe' GABA-A agonist, the issue is alcohol's greatest risk and greatest hard is dependence. The health effects in non-addiction scenarios are not related to its function as a GABA-A agonist but rather the specific metabolism of ethanol produces toxic metabolites.
The withdrawal from any type of GABA antagonist/PAM type drug can be lethal. The acute and long term side effects of ethanol discourage abuse.
Also acute overdoses of the safe benzo/Z-drugs are strange & alarming since you can put yourself into a 24-48 hour coma but recover pretty quickly.
You’re hung up on GABA, but it has little to do with alcohol other than being part of the physiology of physical dependence.
LD50 for benzos is already “really high” - that is not an issue. Alcohol affects other neurotransmitter pathways other than GABA. That isn’t even the one responsible for the psychological dependence. So a GABA-A agonist with a high LD50 exists in multiple (benzos), but it’s not an alcohol substitute. There is a reason why these medications are used for acute withdrawal, but are not used for treating dependence.
Also, being addicted to benzos is far more debilitating than the “vaping” equivalent. They’re quite harmful for chronic use except in very limited circumstances.
Maybe synthahol might be a thing - I mean you’re probably closer with something like ecstasy - but a GABA agonist isn’t it.
I've never tried it, but I heard a lot of folks take GHB as an alternative to alcohol, and that it has the same effects, but without the hangover. I also heard you have to be really careful with dosing, as you only need a very small amount of the stuff.
Be careful with that. The hangover provides a negative feedback that keeps the vast majority of (any)-alcohol consumers from becoming addicted. Now leave that out and see what happens.
Note: Alcohol hangover is not the same as the immediate withdrawal symptoms of other drugs that let‘s you crave for taking another hit shot whatever. It‘s caused by the myriad of trash by-products in metabolizing ethanol, not for the lack of alcohol. (and for certain alcohols additional also tannins, aroma substances and similar - think of whiskey and cheap wine)
And, I suppose, more simply, the diabetus! Pickles * beer^2 * burger * fries = (sugar * fat)^2 = pike of insulin over several hours * abundance of bad fats that the liver is supposed to absorb. I do realize not every alcohol binging happens in this form, but it’s the classic modern/hipster form. Any such behavior, even without alcohol, would turn the liver upside down.
This seems like a great writeup, but I'm a little skeeved by the genericness of the website it's on and the fact that absolutely no information about the author which might let me discern their intentions, biases, prior viewpoints, etc. is available that I can find.
Does anyone know anything more about the person who writes at this site?
(I know, I know, it doesn't matter who they are if their arguments are good. I'm just at the point where I pretty much have to assume bad faith until proven good faith when faced with any new source of online information.)
Compared to other fields of science, medicine feels still in its Stone Age. I’m not even sure it’s science at all. We see all kinds of medical papers and news articles everyday that claim health benefits of doing/eating something. But then the other day we see other kinds of papers or news articles that claim exactly the opposite thing. I stopped long ago putting too much trust in them. They are usually just their “opinions”.
Superbly written article, covering so much of the nuance involved in medical science. Easily one of the best links I've ever come across on Hacker News.
I'm reading this interesting book on the global history of prohibition that challenges a lot of traditional narratives. [1] One novel thing in the air at the time was the rise of social science and scientific thinking. Before the early 20th century, there wasn't much hard data on how alcohol led to bad health and safety outcomes. Some of this research probably went too far (equating all alcohol to poison). But new awareness of the real dangers (and lack of evidence for many folk remedies of alcohol like warming you up) had a big impact in convincing people and governments to get on the temperance bandwagon.
I would like to give a word of warning for people who would like to enjoy alcohol all their life: try to avoid kindling at all cost.
If you, like most professionals, consume alcohol for social clout and for fun, this is extremely crucial.
Once you develop kindling (sneaks up on you), even a few beers can trigger almost life threatening withdrawals, so your option is to not drink any, or drink yourself to death. There is no middle way.
For those interested, check out the cripplingalcoholism subreddit on reddit. Tons of first hand experience there. You have been warned. Kindling is a pandoras box of all kind of regrets and there is no way to reverse it apart from abstaining from alcohol for 10+ years.
For those (like myself) who are unfamiliar with "kindling", it appears to mean an effect where subsequent withdrawals are progressively worse than the first one.
Each time you binge drink a few consecutive nights/days you body has to adjust to the sedative weaning off.
For the first 100 or 1000 or 5000 times it's OK. Then you start showing physical symptoms. Little anxiety. Headache. Light sweats.
Once this starts (showing physical symptoms) you can never binge again without them showing up. And each time they get worse. Progresses to morning shakes, seizures, even death in extreme cases. All from binges you happily came out of as a teenager.
It sounds a lot like the ancient astronomers couching their studies in something like bringing glory to god for his masterful clockwork or the like. See Copernicus in On the Shoulders of Giants. Really eye opening how many rhetorical back-flips they did even as they introduced the sun-centered solar system that they personally believed in.
OP seems to push the idea that we could have trusted this study, even if it was funded by industry and run by a professor with cushy ties to that industry.
Did you not read the whole article? The author explains why his defense of this study and the players involved is wrong, and why they are "furious about every aspect of this story"
I did. I had trouble editing my comment. In the end, they do propose that it would have been valuable to continue with the study, and others like it, provided many changes were made:
```Sixth, in the final review, the NIH made no attempt at cost/benefit analysis. Their final report is a fair summary of the problems with the trial. But it doesn’t consider the information that was lost by cancellation, or the fact that that there was little cost to taxpayers. (Though Collins’ letter to Senator Grassley reveals the NIH did pay around $4 million out of pocket.) Could a different principal investigator be put in charge? Could the study design be modified to address the concerns? Could the monitoring bodies have been strengthened so people could trust the results? Maybe the trial was unsalvageable, but it’s telling that the NIH didn’t bother to make that argument.```
This seems like a success story for government science :
1. A shady dude and his business colleagues try to shoe-horn in a preconceived conclusion into a large RCT and co-opt the NIH brand for authenticity.
2. They have some initial success but once enrollment starts a variety of red-flags are raised and the whole thing is canned before any results are produced or large amounts of money spent.
3. Shady dues reputation is ruined, people are fired, and new safe guards are in place.
I don't disagree with the article at all, I think it's conclusions are probably largely right.
But it's hard to take seriously when the very first figure has a logarithmic y-axis without any callout in the discussion, exaggerating the appearance of the negative effects.
If the prohibitionists and the distillers can agree on protocols to collect and publish data, to the point they're both willing to fund it; then yes that certainly seems worth doing and then everyone gets to argue about that data set for the next century.
Isn't there another reading of this story that goes "NYT spikes cool thing for quick sensation?" File it with "Slate Star Codex" and other examples of predatory reporting there.
The first NYT article was problematic and more of an editorial, however the second follow up article did expose real issues with the "firewall" that deserved to be brought to light.
alcohol suppresses the immune system, making infection more likely. TB is also correlated with homelessness, poverty, incarceration, and addiction to other drugs, which all have obvious relations to heavy drinking, and TB treatments are generally hard on the liver, making prognosis worse and progress from exposure to disease more likely for heavy drinkers.
"TB is also correlated with homelessness, poverty, incarceration..."
This was along the lines of what I was thinking. I just found it odd that the others seemed to be direct and this one is a second order (or higher) impact.
can someone explain the term blankface used in the article? I read the link that was supposed to be explaining the term but I actually didn't get it...
A lot of people really love the “social lubricant” phenomenon. If you’re one of those people, ask yourself, does it seem reasonable to rely on a substance for something as simple as communication?
There are lots of ways to have find. If you need alcohol to have fun, it shows how little you know about having fun. Get a bike, or a wood chisel, or a chess board (snip a few million other ways to have fun)
Lot's of activities, that people under alcohol, consider fun are pretty repulsive for sober mind.
Go to clubs fully sober, the music is too loud, people are obnoxious, its not probably pleasant experience.
So alcohol users can develope whole different requirements for fun and if they quit, the world seems so depressive, because their habits and friends are still from that alcohol world.
Anything can be responsible or dangerous. Woodworking can be bad. I had relatives who would go down to the garage or basement and aggressively push wood through tablesaws to vent off steam. They didn't have all their fingers.
Autistic individuals appear to have more aluminum (specifically in their brains, maybe?) than others. But this is only correlation, not causation (and, so far as I know, not proven even as correlation).
If the correlation is correct, it remains to be determined whether the aluminum causes autism, or whether autists absorb aluminum as a consequence of their autism.
No idea on the detoxes. Just a lot of self reporting of high aluminum levels in both mother and child.
Because aluminum is associated with so many neurological issues and autism comes with consistent gut issues, there’s a thought that some type of gut issues could be causing higher levels of absorption of aluminum from the environment when your body would normally filter most of it out.
The biggest issue is that it’s compelling enough to warrant a study.
> this is an industry entirely devoted to selling an addictive substance that kills, by WHO estimates[1], three million people per year. Something like 75% of alcohol is sold to raging alcoholics[2].
I always love hearing about all the things that are more fatal than covid, directly under our control, and otherwise completely tolerated by society. Not that we shouldn't respond to Covid, but that we should probably have proportionate responses to such other things...
In the mid 2000s NIH was flat funded, and lots of alcohol research went out the window. I worked at a place that did alcohol research at large (mostly mitochondria/liver systems biology stuff). Mostly the idea from funders was that alcoholism is not a disease, and funding should be moved to more pressing things like cancer/diabetes. I would say half the surviving labs moved on to metabolic issues in disease, and the other half did translational medicine based on their research. This was a huge blow, caused a few retirements and closing of several labs. I had to lay off a couple of my friends (technicians).
It is surprising the alcohol industry is going to such huge lengths, and I can't remember ever hearing of such things. It would be a huge blow to your credibility at the time I was in science.
Does anyone actually know anyone who drinks more than 2 drinks every day? The only people I knew like that were homeless, and I was more concerned about other issues with them, than the drinking (which was more of a symptom than a cause, imo).
Am I naive for thinking that everyone knows that Alcohol is not good for them? Funding research into it seems like a waste of money, since I also believe that people should be 100% free to ingest whatever they want. You can't ban alcohol, its too easy to make. I barely drink, but its undeniably important to our culture.
e: Apparently I am quite naive. My crowd is more likely to have cannabis addictions than alcohol.
It's pretty easy to go over two units in a day if you drink casually and aren't paying attention. Checking a handy online chart, 2 units of red wine is 70% of an US measuring cup - 167ml. So if you thought a "cup" (as in measuring cup) of wine was fine, you'd be over 2.
A bottle of 5% beer is defined as 1.7 units, therefore a bottle of 6.5% or 7% craft beer would be well over 2 units.
Most of the beers I like are 7.5%, except stouts which are 10-12%. They also come in large 16oz cans. Two of these is almost 4 drinks. "Craft beer enthusiast" can start to approach heavy drinker very quickly.
I often socialize with a Belgian guy, and he will choose similarly strong Belgian beers, but will almost always split the bottle with someone else. I think that can would probably be split three ways — it is equivalent to 2½ to 3 reasonable glasses of wine.
Sometimes that means drinking less, but it might also mean each person tries a wider selection of beers.
(A deleted comment asked for a "European" view, and I should make clear this is not a unified European view. That's impossible, as drinking culture varies massively between countries, by drink, culture, law and tax.)
473ml*0.12 = 57ml of alcohol (!) - so almost 6 10ml units in a single can??? so two of those 12% stouts would be 11.4 units!
Ouch... Yeah. Maybe switch to one of them as a special treat once in a while. :)
Your numbers are off. Based on your link, a 12oz 5% beer is one drink so a 16oz 7.5% is 2 drinks (1.5 * 4/3) and thus two of those is exactly 4 drinks.
In England, pubs usually sell "small", "medium" or "large" glasses of wine, which are 125mL, 150mL and 250mL. ([1] for good evidence for this, that you can buy measures for it. There's also a law [2].)
But the comparisons in this discussion are all confused, as the first person wrote "US measuring cup" but used UK alcohol "units" (which are 10mL = 6g), but the US "standard drink" contains 11g = 18mL alcohol.
UK units are nicer to calculate, as an example 150mL glass of 13% wine contains 150 × 13 ÷ 1000 → 1.95 "units" alcohol (19.5mL).
But the US standard drink is probably nearer to what people actually consider one drink. The UK site shows that typical drinks are nearer 2-3 units [3].
Yeah, sorry, I was trying to use the "measuring cup" for familiar reference purposes. The 10 ml of alcohol measure in the UK (with 1-2 units being the "safe" range) definitely seems a lot clearer and easier to approximate if your drink has an ABV % to me than the "standard drink which is all over the place:
https://en.wikipedia.org/wiki/Standard_drink
"For example, in the United States, a standard drink contains about 14 grams of alcohol."
"Different countries define standard drinks differently. For example, in Australia, a standard drink contains 10 grams of alcohol,[4] but in Japan, one "unit" contains approximately 20 grams."
But, ok, yeah, I'm sorry. I'd perked up and replied to parent because the "2 standard unit 20ml limit" as "safe" seems to show up in a bunch of studies, and interpreted "2 drinks" as that.
But if he meant US standard drink that would be a 1.7*2 units (or 2 5% beer bottles), which is a bit harder to hit (but also firmly in unhealthy territory).
That said, as another person noted, you can blow through that with a high ABV craft beer really easily (or an overly full glass of wine).
It's a very large glass of wine, yes. That said, I've been in restaurants with large wine glasses that generously fill them.
I guess if you're paying by the bottle who cares. Ensures more consumption?
And, was more noting how people could deceive themselves. I just fetched one of the large wine glasses from the kitchen. Filled but well below the rim (maybe a couple of cm below) it was 2 cups of water (so 6 units!) - I emptied out the water and filled it with 1 cup of water (so well over the 2 units) the glass was less than half full. Visually looked about a third of the way up the glass due to the curve.
Yes I do. And they don't think it is a health problem at all. Even working in tech in downtown SF, there would be happy hours all the time and free-flowing booze. I told myself I was a "social drinker" but found myself at 2-4 drinks every single workday. So Monday is a python meet-up with drinks. Tuesday is someone's birthday and also Taco Tuesday so we all go out for tacos and drinks. Wednesday is some alumni event downtown with drinks. Thursday is my non-work friends' "Thirsty Thursday" drinks. Friday is the unofficial company-sponsored happy hour where the managers bring out Whisky at 3-4pm.
All of a sudden, I was on the road to alcoholism, just by trying to fit in and be a little more extroverted. And the booze certainly helps someone who is anxious and introverted do exactly that.
I sure do. There was a time in my life where I was getting properly drunk every single night for years and held down a programming job the whole time (and I still do!). I know several colleagues who drink far more
than two drinks a day and are all productive and well liked at their jobs (all ate in their late-30s to mid-60s).
Sometimes people spend years trying to find the right prescription drug to quiet their daemons (with awful side-effects along the way) but oh so often, good ol’ over-the-counter alcohol JustWorks.
in the beginning of the pandemic i was drinking probably half a bottle of wine a night which is probably ~3 glasses. the stress of everything, being stuck at home with 3 young children, etc. took actually a while to kick the habit. now i just have a few friday night and over the weekend. but during that time i still went to work and was my normal dad self, just after the kids went to be drank a bit. i think you can do some moderate drinking without being homeless although i do feel much healthier now that i don't drink much during the week
Quite a few people average one or two normal-person-defined "drinks" of alcohol per day. However, one normal-person drink of alcohol is very probably two or more scientists'/regulators' "drinks", because those are—for reasons I can't fathom unless the intent is to mislead people to believe their drinking is healthier than it is—so tiny that very few people would consider them one entire serving.
The short answer is 1 in 5 people in the US drink more than 2 drinks per day on average.
I know many people who fall in the second from the top decile of drinking (i.e. between 2 and 10 drinks a day). Some of the people who I think are in this group are probably actually in the top decile (above 10 drinks a day) and conceal the real quantities they consume
Let me put it this way, 75% of alcohol is sold to people who drink more than 10 drinks per day and this group comprises 10% of the US (the top decile of drinking.) Given the numbers it is pretty clear that a strong majority of this group is not homeless.
Eastern European here, but I spent most of my adult life in the UK. Almost every person I know drinks a few beers or shots a day. 2-3 on a normal, uneventful day, and a about 5-8 drinks when meeting up with family/friends etc, and 10-20+ drinks on a night out.
None of them show physical symptoms yet, all highly functioning people, but I suspect that is mostly due to their youth (20-40).
I personally went teetotaler about a year ago. Drinking is loads of fun and I miss it, but I appreciate a steady mood now way more than the ups and downs of alcohol induced euphoria, then potential anxiety etc.
> Am I naive for thinking that everyone knows that Alcohol is not good for them?
I think people definitely understand that heavy drinking (e.g. more than 2 drinks per day) is bad for you. The question is really about the impact of moderate drinking (1-2 drinks) where the science is unsettled, and people have differing opinions. Answering this was the goal if this particular study.
I really feel like moderate drinking is a poor standard invented by the industry to prevent loss of sales due to science, and ultimately an oxymoron not unlike safe cigarette, clean coal.
Though alcohol is out of the drinker's system within 24 hours, what that drink does to their system takes a month to play out. Yet someone who has had strictly 1-2 drinks a day for decades is somehow a moderate drinker? If a drinker hasn't gone a single month without a drink since their junior year of high school, I believe the more accurate label is alcoholic.
After I graduated from College in 2020, I humbled myself and got a job at Ralphs so that I could make rent payments. I worked at one across from a major park in Los Angeles so I just happened to get to know a lot of homeless people.
I was in engineering school so many of my friends at the same intellectual caliber were more interested in robots than partying, but even the more enthusiastic drinkers would only drink that much if we were partying.
I have known people who believe that "moderate drinking" is actually beneficial to health - something that has been shown to be untrue when controlling for socio-economic factors.
I believe people should be free to chose to drink too, but alcohol is truly in the "culture", like you said. Very few clearly harmful activities like that are part of any culture and that is what makes it important for us to educate society about this. I believe that alcohol should come with the same level of warning as cigarettes do, but the society is not there yet.
There was a meta-study a year and a half ago. It seemed to indicate that the supposed beneficial effects could be explained by moderate drinkers tending to exercise more and generally make sound health decisions. The study seemed to indicate that the safe number of drinks is one or two PER WEEK. It seems that zero is the number of safe drinks per day.
Such a strong belief that moderate drinking is beneficial.. "It gets the heart running". How to explain that it's not beneficial? How to show a study and have people believe in said study? Which study did you refer to?
I haven't personally managed (or even tried) to convince anybody because people feel personally attacked when their preferences are questioned, especially when these people believe themselves to be "scientifically-minded". I think everybody has to discover this on their own.
I'm not and have never been an alcoholic. But I have have family members that are (or rather were, before they died from it) and often felt that it's something that I could easily slip into myself if I didn't make a conscious effort to avoid all non-social drinking. So alcoholism is something I have spent some time researching.
> Does anyone actually know anyone who drinks more than 2 drinks every day? The only people I knew like that were homeless
My uncle died a couple years ago. He was a functional alcoholic and workaholic for almost his whole life, until his age caught up with him and he couldn't work anymore. Then he just became an alcoholic. He was a multi-millionaire when he died, so he could have afforded the help if he wanted it and could have admitted to anyone (not least of all himself) that he had a problem.
Alcohol itself is not a problem. Alcohol ADDICTION is a very serious problem that does not get anywhere near the attention and seriousness that it should.
> Am I naive for thinking that everyone knows that Alcohol is not good for them?
Yes. And of those who know, many simply don't care and value the buzz more than the health downsides. Or feel helpless to stop due to the grip of addition. Or are so far gone that they secretly hope for an early death.
> You also can't ban alcohol.
I agree that a flat-out alcohol ban would be a failure. It was already tried and not only did it not work and caused all kinds of strife, it essentially gave rise to organized crime. If it was tried today, it would look identical to the War on Drugs which did nothing to help society, lined the pockets for various government organizations, contractors, and politicians, and filled prisons with non-violent offenders.
> I barely drink, but its undeniably important to our culture.
I'll agree that it is "important" in the sense that it is omnipresent in many people's daily lives. Even if I don't drink regularly, many friends, families, and neighbors do. People drink on the TV shows I watch. Co-workers make jokes about how many beers it takes to debug a particular program. People I know die directly or indirectly from it.
But is it a necessary part of any culture? Absolutely not. And just to be clear, I'm not arguing for a ban or any other method, but when I ask myself whether the world would be better off without mass alcohol consumption, the answer is an unequivocal yes.
> Am I naive for thinking that everyone knows that Alcohol is not good for them?
Yes, extremely. Aside from the fact that I know plenty of people in my extended family who drink more than 2 drinks per day, the vast majority of my family clings to the "a drink a day is better for you than none".
I’d highly recommend you actually do the calculation of what a “standard drink” is. You might be surprised. In my garage fridge is a pint sized can of alcoholic Kombucha at 7% ABV. Higher than most beers, for sure, but not unusual for some craft beers in my experience. Back of the envelope calculations has that at 1.8 standard drinks, very close to the limit.
I've always wondered about this too. Seems like it would be cost prohibitive if nothing else.
During one stretch of my life where I was really stressed out I was having 2-3 glasses of wine a night for about 3 straight months. Aside from that, I can't imagine having more than a glass or two of something every week or so.
You mean for cost-prohibitive homeless people? For people with decent incomes, 3-5 drinks a day is easily affordable. Beer is < $1.00/drink[0] and Trader Joe's sells bottles of wine for $2.00[1].
A single coffee costs $4 before tip most places I've visited in Austin.
A bottle of wine contains about 6 servings, so if you buy $6 wine, that's around a dollar a serving, $60/month is not cost prohibitive for many people.
My local beverage store has lots of wine choices < $5, many have pretty good reviews (4+ stars out of 5)
Though if you're looking for the best bang for the buck, they have a 1.75l vodka for $8.99 - at 40 servings per bottle, that's about 50 cents a day for 2 servings a day.
Plenty of people. Once you start paying attention, you see many many casual alcoholics. I'm not sure why you're being downvoted because it's a common misconception as others have pointed out how much constitutes a drink and how much we're actually drinking.
People don't know that alcohol is one of the strongest poisons we use. Kills about 260 people per day in the US. Please fight for the health of your friends.
Joking aside, the dose makes the poison. On a society level, alcohol is a problem, but on a personal level, it is still unclear how much of an effect moderate drinking has, and in which direction it goes, that's the topic of the article.
If you want a strong poison most of us use, take acetaminophen. More than 12g and it can kill you by liver failure. It is the leading cause of acute poisoning, and yet, it is very safe at normal doses (1gx3/day).
I'm a light drinker (a beer a month range, and months without).
That said, I'm interested in the moderate drinking results.
Some alcohol intake is perhaps self medication for other issues - ie, stress etc. Perhaps there is a small positive there - though a larger positive would be to try and solve root causes?
Not - HN has gotten a bit downvote heavy these days - don't take it too seriously.
> Apparently I am quite naive. My crowd is more likely to have cannabis addictions than alcohol.
Where are you located? My impression --- which I'd like to see better evidence for --- is that in the US, heavier drinking is more prevalent in higher social classes on the East Coast than the West Coast.
I can think of half a dozen people who drink more than 2 a day. Heavy drinking is very common in the UK and Europe, Scandinavia especially in my experience. I stopped drinking a year ago because I was in the habit of having 4 and conversations like this convinced me I was killing myself.
I'm 5'11", 235lbs - I could stand to lose a little weight, but I've got a lot of muscle mass. I can drink a standard 12-oz 5% beer with a meal and not even notice the alcohol.
I can do that at lunch and dinner and not be noticeably intoxicated at all.
If we look at another societal thing that historically a huge chunk of the population did -- smoking -- it was known that it kills you, horribly, but it took taken more than sixty to eighty years for the public to get that message, and now society is slowly adjusting [at least in Europe] with real public benefits. If an effect is present with alcohol, even a small one, the integrated effect would be massive and it's a very scientifically valid question to ask.
Alcohol is really interesting -- people under report how much they drink, and how much they under report is a function both of the amount of booze, and the covariates that affect life expectancy like education (Prof Raymond Caroll at Texas A&M has an excellent book on this -- there's a method to correct for it by bootstrapping called SIMEX -- e.g. applied in [1], in which a sample of about 3000 adolescents and young adults around the age of 20 shows that binge drinking "may not be causally related to deficiencies in working memory, response inhibition or emotion recognition"). The paucity and conflicting of evidence probably means that the effect size is small, but the error bars are huge and as the article says, the covariates are many. It's just a shame that we can't have nice things because of the bent actions of a few.
[1] https://onlinelibrary.wiley.com/doi/full/10.1111/add.15100?c...