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Sep 02, 2014

I no drinkee for drinkee; I drinkee for drunkee

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By Dr. B. M. Hegde, India [ Published Date: May 12, 2006 ]

Dr. B. M. Hegde MD, FRCP, FRCPE, FRCPG, FRCPI, FACC, FAMS, is presently the Chairman of State Health Society, Govt. of Bihar, India, Visiting Prof. Cardiology at The Middlesex Hospital Medical School - University of London, Affiliate Prof. of Human Health - Northern Colorado University, Visiting Prof. Indian Institute of Advanced Studies - Shimla,  Retd.  Vice Chancellor, MAHE University - Manipal. Prof Hedge regularly gives talks on AIR, Doordarshan, BBC and Zee TV, London. 

"The wise is he who does not indulge in alcohol and has controlled his senses. He does not fall a victim to physical or mental illness." -- Charaka- Chikista 24: 206.

Alcohol is a powerful addicting drug which has multitude of actions inside the human system; there is hardly any human organ that alcohol does not damage. The medical profession, following the pseudo-science of linear laws, has been advising the gullible public, over the last few decades, that drinking a small amount of alcohol, red wine in particular, is, in fact, good for positive health and specially for the heart because alcohol helps reduce the incidence of heart attacks. Aided and abetted by the alcohol lobby this myth has disseminated far and wide. Even the common man on the street is aware of the "good" that alcohol does for the system. The illiterate masses get attracted to alcohol through so many other means used by the arrack lobby in India. Among the intellectuals drinking is a status symbol. But with all the contradictory claims made these days about the health benefits of low-fat diets, the harm of hormone replacements and the dangers of pain relievers, at least we still know that a drink or two a day is good for the heart. Well, maybe not.

Time was when the prestigious medical journals, including the British Heart Journal, went as far as to advise everyone to start drinking in moderation to fight the deadly enemy of mankind, heart diseases. "Time has come for doctors now to go to society to tell healthy people to take to alcohol in moderation to reduce the load of heart attacks" wrote an editorial in the British Heart Journal in the early 1980s! Every now and then there appears a significant controlled study that highlights the virtues of moderate drinking. The whole story is that "while the profession is not sure of the dangers of small amounts of alcohol in the long run, we have enough evidence to refute the myth that small amounts are good for the system." In fact, this was the opinion of the team of two Swedish researchers, appointed by the WHO, to go into this myth years ago. Unfortunately, that report never saw the light of the day in print and is still collecting dust in the Copenhagen press of the WHO, thanks to the powerful alcohol lobby!

The Dutch have come down heavily on the alcohol lobby in their country. From the land of the Heineken beer the news is not very good for the alcohol lobby. The government has declared that selling alcohol to children below the age of 18 years is illegal. Even advertising alcohol directly or indirectly in any media is an offence punishable with a fine equivalent of Indian Rupees two and half lacs. Alcohol advertising hoardings should not be near schools or be seen from any school or approach to a school. In all children’s parties where children below 18 gather, alcohol should not be served. In the Netherlands this is very good news. I hope other countries have the guts to do just that. There is even a ban on MTV shows in that country advertising alcohol indirectly!

The greatest myth in this field has been the advertisements, mainly through the medical lobby, that drinking a small quantity is good for health, that too it lessens the risk of a heart attack! I have been consistently writing that this is a not just a myth but a large fraud on the public, abetted and aided by a section of the powerful medical lobby. I was being hated for that; even my own colleagues used to laugh at me behind my back. I was an object of ridicule in all parties in Mangalore. One of my friends and a colleague was once heard remarking that "if a patient sees BMHegde, he will be asked to stop drinking; whereas I would want him to start drinking to help his heart. BMHegde is doing injustice to his patients!"

Another long-term cohort study published in the prestigious medical journal Heart (2000; 83: 394-399) clearly sets at rest any doubt people might have in this field. This study showed, after a very long observation lasting for decades, that those who drink a small amount and those who abstain have no difference in the rate of heart attacks and other heart diseases. However, the study clearly showed that those with heart disease, especially those who have had a heart attack in the past, are at a greater risk if they drink alcohol. The risk of another heart attack, as also other complications, is significantly higher in those who drink moderately or even heavily. Please note this is the same journal in its previous avatar as the British Heart Journal advocated drinking for all.


There seems to be a change of heart lately.  A special advisory panel of the American Heart Association issued a formal statement, published in January, 2001 issue of Circulation, urging doctors not to recommend alcohol to their patients as a means of reducing the risk of heart disease. Researchers at UCSF went through more than 30 years of studies that seem to show health benefits from moderate alcohol consumption, and concluded in March 2006 that nearly all contained a fundamental error that skewed the results. That error may have led to an erroneous conclusion that moderate drinkers were healthier than lifelong abstainers. Without the error, the analysis shows, the health outcomes for moderate drinkers and non-drinkers were about the same.

In a sensible book Science Without Sense (published by the CATO Institute in Washington DC 1999) the author, an American, Steven Milloy says "epidemiology is where the gold rush is and if a researcher wants to make it big faster he has to get in there. There are two basic types of studies-cohort and case control. Avoid cohort studies. They are time consuming and the results may take about twenty years. By then the funding may not be there and your career would take a long time to improve. Case control studies, on the contrary, are faster, the money is there still and the CV gets bloated fast with new publications. You simply scrounge up a group you can look at in retrospect. It is like Monday morning quarterbacking, only better. At the end of this game, you can adjust the score almost anyway you want."

Most of the studies that the newspapers publish in thick letters saying coffee does this or smoking protects or even alcohol protects against heart attacks come from such case controls. While it is true that we have no hard data to say that a small quantity of alcohol might damage the system, we have no data at all to say that small quantity of alcohol helps the heart or, for that matter, any organ of the human system. Even a teaspoon of alcohol raises the systolic blood pressure temporarily. That may or may not have long term effects. Similarly every teaspoon of alcohol damages and kills a few hundred of the cerebellar cells, the ones needed for balancing your body. (The unsteady gait of the chronically drunk is the result of the cumulative damage to the cerebellum). 

"This reopens the debate about the validity of the findings of a protective effect for moderate drinkers, and it suggests that studies in the future be better designed to take this potential error into account,'' said Kaye Fillmore, a sociologist at the UCSF School of Nursing. Ever since 1979, when The Lancet published an article claiming moderate drinking had a heart protective effect, the conventional wisdom both in the medical world and the laity was that a pint of beer or two glasses of wine a day are good for the heart. Since then there have been many attempts to sell this idea. There was once a headline in the New York Times in 1984 which read; "Heavy alcoholics do not get heart attacks......" Framingham study. Would you be surprised if I told you that a year later it was seen that the alcohol sales in the US doubled! At this point in time some researchers wanted to get to the root of this story only find that the total report read as follows. "Very heavy alcoholics do not get heart attacks as they do not normally live beyond twenty five years and die before that due to liver damage or other alcohol related diseases." This recent reexamination of all the data over the last four decades has led to a totally opposite conclusion.

When one starts with small amounts initially, it invariably leads to more drinking as the title (Chinese adage) tells. Most deaths resulting from over consumption include car crashes, suicides, homicides, alcohol poisoning, acute pancreatitis, liver cirrhosis and a whole range of cancers. Then there is the whole range of family disruptions that have great social impact. There seems to be no justification for the medical fraternity to patronize alcohol now that the "scientific truth" is out and the lie has been nailed. Ayurveda had the best advice for all, times to come.

"Don't think there are no crocodiles because the water is calm."-- Malayan Proverb.

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