So a drink a day won't keep the oncologist away?

Thoughts on the surgeon general's recent warning

A few weeks ago, Dr Vivek Murthy released a report suggesting that alcohol manufacturers should be required to add a warning label to their products giving people a head’s up about an increased risk of cancer. While the surgeon general’s plea would need congressional approval, numerous media organizations and social media voices have been all over the topic.

Given that I follow many health professionals online, the general feeling: of course alcohol doesn’t have health benefits. The persistent myth that wine is good for your heart has long been disputed, brain worm that it is.

My algorithm concluded: take a risk if you want, but know the risks.

Thing is: is it that clear-cut?

Such an answer is behind my scope of expertise. But one nuanced article by The Atlantic staff writer Derek Thompson (whose first book I wrote about in 2017) stood out.

Thompson opens by recognizing that “booze isn’t medicine,” though he enjoys a glass (or two, on occasion) of wine while cooking dinner and an ice-cold pilsner on a hot summer day. He notes that three or four drinks a night has long been implicated in a host of diseases.

Knowing people who drink that heavily, I’ve found that such people already know the risks. Thompson, like many on social media, are really discussing moderation.

After spending weeks reading studies and meta-analyses and catching everyone up on the French paradox (wine is heart healthy!), Thompson invokes an aspect I haven’t seen discussed: the social determinants of health.

Moderate drinkers tend to be richer, healthier, and more social, while nondrinkers are a motley group that includes people who have never had alcohol (who tend to be poorer), people who quit drinking alcohol because they’re sick, and even recovering alcoholics. In short, many moderate drinkers are healthy for reasons that have nothing to do with drinking, and many nondrinkers are less healthy for reasons that have nothing to do with alcohol abstention.

He notes that around the same time as Murthy’s report was published, a meta-analyses conducted by National Academies of Sciences, Engineering, and Medicine found that moderate drinking is “associated with a longer life.”

---

Clarity Lab EP2 out now: How to Read a Study with Dr Rohin Francis

---

This reminds me of a principle covered in Calling Bullshit: The Art of Skepticism in a Data-Driven World: if it sounds too good or too bad to be true, it probably is.

For nondrinkers or health professionals skeptical of alcohol having any benefits, the meta-analyses likely sounds like bullshit. Moderate drinkers probably feel the same about Murthy’s warning.

Thompson then introduces another concept key in understanding the dilemma: relative versus absolute risk. He uses the analogy of a swimming pool. Having one increases the relative risk of drowning, yet the absolute risk is still very low.

Placed in context, the “every drink reduces your life by five minutes” meme going around is less scary than designed. As Thompson frames it:

The surgeon general reports that moderate drinking (say, one drink a night) increases the relative risk of breast cancer by 10 percent, but that merely raises the absolute lifetime risk of getting breast cancer from about 11 percent to about 13 percent. Assuming that the math is sound, I think that’s a good thing to know. But if you pass this information along to a friend, I think you can forgive them for saying: Sorry, I like my chardonnay more than I like your two percentage points with a low confidence interval.

I land where Thompson does. In fact, I apparently drink less than he does. I don’t drink during the week, save the special dinner with friends. When I do drink, it’s usually a beer at dinner with my wife, on the weekend. Sometimes I shoot pool with a buddy on Friday nights, and that results in two beers.

Some people are genetically disposed towards alcohol addiction. I’m thankful that’s not me. The reason I don’t drink more than two beers (and usually stop at one) is that alcohol makes me tired. I’m amazed by people who get more wired and awake the more they drink. I just want to lie down and listen to music or pass out. Given that I wake up at 5 am every morning, and begin my day with 45-75 minutes of exercise, I’m grateful for my genetic disposition. Too much alcohol wrecks me; the trade-off isn’t worth it.

But the trade-off in the other direction isn’t necessarily worth it either. Maybe it’s my own bias seeping in, but I take Murthy’s well-meaning report with a pinch of salt. I spend my days tracking wellness influencers peddling pseudoscience, and the amount of fear-mongering that goes on in these networks—red dye 3 is horrible! GMOs will kill you! Gluten is the devil! Eat raw meat! Eat vegan for the planet and your health!—is more indicative of their sales funnel, chemophobia, and a horrible relationship with food (and often, their own eating disorders) than the reality of moderation.

Plus, as Thompson concludes, there’s a social component to alcohol that’s been part of the human condition as long as human history records (and likely longer). In a nation obsessed with individualism, it’s not surprising that wellness folk again put the onus of health purely on the single person.

Unsurprising, but also completely short-sighted.

That some Americans are trading the blurry haze of intoxication for the crystal clarity of sobriety is a blessing for their minds and guts. But in some cases, they may be trading an ancient drug of socialization for the novel intoxicants of isolation.