Debate Rekindled on the Two-Drinks-a-Day Road to Heart Health

By Kristen Bole No one really wants to hear that alcohol isn't good for us after all, which could be why scientists worldwide have convened on paper this month to debate a UCSF researcher's study that debunks the popular notion. UCSF School of Nursing Adjunct Professor Kaye Fillmore, PhD, led an international team on a meta-analytic study that found a common error in most significant studies connecting moderate alcohol consumption to healthy hearts. The study was published last year in Addiction Research and Theory, a bimonthly medical journal in England. Now, eight independent scientists have filed their responses to the Fillmore study in the March 29 issue of Addiction Research and Theory, with further response from Fillmore, creating what journal editor Derek Heim said "may well constitute the most complete critical discussion of the protective effect [of alcohol] to date." Three of those researchers donned their boxing gloves, taking issue with Fillmore's inclusions, exclusions or conclusions in the research, including which studies were considered flawed or were chosen for the analysis. Yet the majority agreed that most previous studies had included the same error. The error, according to the 2006 study, was in counting among "abstainers" the people who had given up alcohol for health reasons. That inclusion skewed the health profile of the abstainer group, Fillmore said, making moderate alcohol drinkers look healthier. The story generated huge interest, not only among media mavens, but also in the halls of the alcohol industry, which has supported past research substantiating the heart-health link. "It's probably the most ferocious debate in medical epidemiology right now, because we really hit the alcohol industry below the belt," said Fillmore, who admitted she personally enjoys a drink, but said she does it for pleasure, not for her heart. "This was a tremendous threat to the industry." Other researchers on Fillmore's team included William Kerr, PhD, Alcohol Research Group, USA; Tim Stockwell, PhD, University of Victoria, Canada; Tanya Chikritzhs, PhD, Curtin University, Australia; and Alan Bostrom, PhD, University of California, San Francisco. One of the authors currently contesting the Fillmore study, Arthur Klatsky, MD, from the Division of Research at the Kaiser Permanente Medical Care Program, cited his own eight-year study of 128,934 Kaiser patients. The study, which Klatsky had led, was included by the Fillmore study in the group that contained flaws. While Klatsky contested inclusion in the flawed group, citing precise questions in his study that had separated ex-drinkers from lifelong abstainers, his conclusion actually bolstered Fillmore's case. His study, Klatsky wrote, found that ex-drinkers do have increased risk and should be separated from lifelong abstainers. Infrequent drinkers (those who have less than one drink per month), he said, were shown to have the same risk as abstainers. Fillmore, whose team also published a response to the responses in the current journal, said her original paper drew international recognition precisely because so many physicians have started prescribing alcohol to prevent heart disease. That's especially true in developing countries, where medications aren't readily available to most people, but where alcohol - commercial or homemade - is both ubiquitous and cheap. "The bottom line is, nobody knows what alcohol's effect is on our hearts, because these studies are so difficult to construct to eliminate error," Fillmore said. "We do know that it is associated with a huge number of other killers, from cirrhosis to cancer to car accidents." Her hope is that governments and physicians alike will at least think twice about prescribing the two- or three-drinks-a-day "medicine," especially for those on medications that might interact with alcohol. "That's just dangerous. And for older people, whose tolerance to alcohol has decreased, you're going to have a lot of broken hips from falls, or car accidents," she said. "Why risk that, when it would be just as easy to tell them to take an aspirin a day?" Related Links: International Study Questions Health Benefits of Moderate Drinking UCSF News Release, March 30, 2006 UCSF Study Disputes Recent Reports that Alcohol-abstainers Are at Greater Risk of Mortality UCSF News Release, January 31, 1998 Faculty Profile: Kaye Middleton Fillmore, PhD UCSF School of Nursing Addiction Research and Therapy (Note: March 29 issue not freely available online)