Alcoholic denial: the government's prejudice against alcohol is a hangover from Prohibition.

The government's prejudice against alcohol is a hangover from Prohibition.

Dr. Peele is a fellow at the Lindesmith Center, a drug-policy think tank in New York, and a consultant for the industry-funded International Center for Alcohol Policies in Washington.

In 1972, Harvard epidemiologist Carl Seltzer examined data from the Framingham Heart Study and found that drinkers were less liable to heart disease than abstainers. As it turned out, the Framingham project was the first of many studies to identify moderate alcohol consumption as a prophylactic against heart disease. But the National Institutes of Health, which funded the research, refused to let Seltzer publish a paper about this result. An NIH official said, "An article which openly invites the encouragement of undertaking drinking with the implication of prevention of coronary heart disease would be scientifically misleading and socially undesirable in view of the major health problem of alcoholism that already exists in the country."

This episode, which Seltzer recounts in the May 1997 Journal of Clinical Epidemiology, illustrates the Federal Government's long-standing prejudice against alcohol. A quarter of a century after the NIH put the kibosh on Seltzer's paper, the connection between alcohol consumption and a reduced risk of heart disease is well established. More than fifty epidemiological studies have looked for a link, and almost all have confirmed the relationship found in the Framingham data. The research indicates that the risk of heart disease for moderate drinkers is 40 to 80 per cent the risk faced by abstainers.

About a dozen prominent sources of research data -- including the American Cancer Society, Kaiser Permanente, and the Harvard Nurses Study -- have established that moderate drinking significantly prolongs life. (The risk of coronary heart disease remains lower even for heavy drinkers, but other causes of death begin to weigh in at high drinking levels, causing a net increase in mortality.) The Harvard Physicians Health Study found a reduction in overall mortality of more than 20 per cent for men who had about one drink a day. The government's National Health and Nutrition Examination Survey estimated that drinking moderately (up to two drinks a day) prolongs the lives of white males by an average of 3 to 4 per cent. For women, the benefits of alcohol appear clearly only after menopause, about age fifty. But the life-prolonging benefits of light to moderate drinking persist for senior citizens, as was established by a 1992 study reported in the Journal of the American Geriatric Society.

With evidence like this accumulating, at some point the government had to take notice. But the process has been achingly slow. Every five years, the Federal Government releases its Nutrition and Your Health: Dietary Guidelines for Americans. In 1990, the Guidelines continued to exclude positive information about alcohol, asserting that "drinking has no net health benefit." This position had become impossible to maintain by the time the 1995 report (released in January 1996) was written. And so a slight nod was given to alcohol's benefits: "Current evidence suggests that moderate drinking is associated with a lower risk for coronary heart disease in some individuals." The Guidelines also noted, "Alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history." These simple statements were more than balanced by warnings about the risks associated with higher levels of alcohol intake and about the people who should not drink (adolescents, pregnant women, drivers, those taking prescription or over-the-counter medications).

The U.S. document differed in significant ways from one produced concurrently in Britain, entitled Sensible Drinking. The British version identified somewhat higher levels of healthy drinking (e.g., about twice as much alcohol as the one-drink daily limit for women in the U.S. Guidelines). The British guide, unlike the American one, discussed the overall impact of drinking on life expectancy as well as the likelihood that drinking by premenopausal women reduces the risk of heart disease later in life. It did not offer a blanket warning against drinking by pregnant women -- a warning that is hard to justify, since there is no evidence that light to moderate drinking causes birth defects.

Even so, the niggardly acknowledgments of alcohol's benefits in the U.S. Guidelines were hard won, as interviews with the report's scientific advisors revealed. One of them, New York University nutritionist Marion Nestle, said the changes represented "a triumph of science and reason over politics." Almost immediately after the report was published, anti-alcohol interest groups such as the Marin Institute began a campaign to reverse the statement about alcohol when the pamphlet is reissued in 2000.

Not surprisingly, the role of alcohol in preventing heart disease is still not widely known. A 1995 poll by the Competitive Enterprise Institute found that only 42 per cent of Americans were aware of medical evidence that moderate drinking reduces the risk of heart disease. Efforts by manufacturers to increase the public's awareness have been stymied by the Bureau of Alcohol, Tobacco, and Firearms. Federal regulations concerning the marketing of beer, wine, and liquor ban any statement about "curative or therapeutic effects if such statement is untrue in any particular or tends to create a misleading impression." The BATF has interpreted this rule as forbidding "all therapeutic claims, regardless of their truthfulness." It argues that such claims are inherently misleading, given the "harmful societal effects arising from the consumption of alcohol" and the danger to "those who for psychological or physical reasons are adversely affected thereby."

Since 1989, federal law has required that every container of beer, wine, and liquor sold in the United States bear warnings from the surgeon general about the hazards of drinking. For years importers and manufacturers have suggested balancing these somber statements with information about the culture, history, and possible health benefits of alcohol. The BATF has rejected every one of these requests. In May 1995, the Competitive Enterprise Institute petitioned the BATF to allow alcoholic beverages to carry health statements in addition to the mandated warnings, offering as one suggestion, "There is significant evidence that moderate consumption of alcoholic beverages may reduce the risk of heart disease."

In October 1996, having received no response, the CEI filed suit in the U.S. District Court for the District of Columbia, demanding that the BATF act on its petition. In January 1997, just before it was required to respond to the suit, the agency denied the CEI's petition. The CEI amended its complaint, seeking a declaration that the BATF's denial was invalid on First Amendment and statutory grounds. Recent Supreme Court rulings upholding the right of liquor stores to advertise prices and the right of brewers to tell customers the alcohol content of their beer bode well for the CEI's challenge.

Meanwhile, the Wine Institute filed its own request in June 1996, seeking permission for a label saying, "To learn about the health benefits of moderate wine consumption, write for the Federal Government's Dietary Guidelines for Americans." The BATF countered by requiring that the word benefits be replaced by effects, but as of this writing it has not granted the Wine Institute's petition.

The Federal Government's reluctance to admit that there might be a good side to drinking reflects a culture strongly influenced by the ideology of the temperance movement, which depicted alcohol as a demonic substance with no redeeming value. More than sixty years after the end of Prohibition, it is time for the government to acknowledge that alcohol has benefits -- social, psychological, and physical -- as well as hazards. Surely this is a truth with which the American people can be trusted.