Wine and poses.

It was the crowning moment of American Wine Appreciation Week. On February 25, a 42-person delegation from the Wine Institute met with President Bill Clinton just outside the East Room of the White House. The group of California winemakers had come to lobby against possible "sin" taxes on alcohol meant to help pay for the administration's health care reforms.

With flash bulbs popping, Wine Institute President John A. De Luca told the 46-year-old Clinton about recent medical research revealing potential health benefits from moderate alcohol consumption. Clinton interrupted, noting appreciatively that he had "reached the age that when all this health data comes out, I want to take another glass of wine .... "Before Clinton could even finish his sentence, the group erupted in applause. The president grinned, beating his chest, thump, thump, thump, like a healthy heart.

Several days later, the president sat for an interview with MTV News correspondent Tabitha Soren. Again, Clinton deflected talk of new taxes on alcohol by touting the benefits of drinking. "At least if you use it in moderation, there's no evidence that it causes harm," said the president, who drinks infrequently. "And there's some evidence," he continued, "that wine, for example, is good for your heart if you use it in moderation ."

From the breweries of St. Louis to the wine cellars of Sonoma, the sound of popping corks and clinking glasses should have been deafening. After years of bad news about sagging consumption and inhibiting regulations, the $82-billion-a-year alcoholic beverage industry had reason to rejoice: A health-conscious president had endorsed--or come very close to recommending- drinking in moderation.

You might have expected Clinton's comments to provoke some protest. Each year, the federal and state governments spend millions combating alcoholism, alcohol abuse, and drunk driving. An average of 300 people die each day from alcohol-related causes. Alcoholism and related problems cost the nation between $86 and $116 billion a year. So the president's remarks about drinking might have been news.

The lack of outcry reflects the stunning success of the alcohol industry's shrewd campaign in recent years to repackage booze as health food. It is the ultimate rehab story: The slumping industry capitalized on legitimate research suggesting that small amounts of alcohol may protect a regular drinker from coronary artery disease and even have a prolonging effect on life. That message isn't wrong--it's merely a fraction of the truth. This is also the tale of a complex health issue involving perilous tradeoffs that has been oversimplified, sometimes recklessly, by a self-interested industry and an over-eager news media.

1,000 pints of lite

The eighties were not banner years for the alcohol industry. Average annual wine, beer, and liquor consumption fell from a high in 1980 of 42.8 gallons per adult to 38.9 gallons in 1989. Per capita annual consumption of ethanol--the substance that makes you drunk--dropped during that period from 2.76 gallons to 2.43 gallons. By 1984, all 50 states had raised their legal drinking age from 18 to 21. Four years later, Congress mandated warning labels on alcoholic beverages. And the number of drinking Americans shrank. Today, a third of the population consumes 90 percent of all alcoholic beverages, while another third does not imbibe at all.

Faced with this dropping consumption the industry needed help. So it began exploiting an angle as old as wine itself: toasting your health.

The alcohol industry turned to a slew of studies dating back to the early seventies suggesting that moderate drinkers face a 25 to 50 percent lower risk of coronary artery disease or heart attack than nondrinkers. Wine (red or white) appears to be the best "medicine," but spirits and beer also seem to have a protective effect. Apparently, ethanol is what does it. The exact mechanism is unknown, but there are several theories: Moderate drinking may lower "bad" LDL cholesterol levels in the blood while raising "good" HDL cholesterol levels. Alcohol may decrease the stickiness of platelets in the blood that clog and block arteries. It may increase coronary blood flow and estrogen levels.

"We don't have any drugs that are as good as alcohol," says Dr. David N. Whirten of the University of California at San Francisco Medical School, who worked briefly as a wine industry consultant. "There's nothing else that comes close" in reducing the risk of heart disease, he adds. "A little alcohol is good for you, a lot of it is bad," says Dr. R. Curtis Ellison, an epidemiologist at the Boston University School of Medicine, who has received funding from the industry. In a 1990 issue of Epidemiology, Ellison wrote a controversial editorial suggesting that American men who want to reduce their risk of heart disease (and who do not have a bleeding tendency and are not at increased risk of alcohol abuse) "might consider the advantages of washing down [their] aspirin with a glass of cabernet."

Over the past few years, the good news about booze spread fast. In Mademoiselle, Dr. Elizabeth M. Whelan, president of the American Council on Science and Health, noted that around two-and-a-half ounces of 80-percent proof alcohol a day can cut a woman's risk of dying of heart disease by 50 percent. Since the health benefits of aerobic exercise are well documented, Whelan, whose organization has received funding from the industry, was quoted saying "the best way to prevent a heart attack may be to run from bar to bar."

Supermarket tabloids caught on. In the Sun, a blowout on beer took top billing on the front page. Beer was described as a "magic elixir that fights "safer than water," the Sun article stated: "Beer is a treasure house of essential vitamins and minerals, and contains ingredients that fight cancer, high blood pressure, cardiovascular diseases, kidney stones and arthritis ."

By February 1992, most Americans had gotten the message. According to a Gallup poll, after two years of decline, consumers appeared to be returning to drinking levels not seen since the mid-eighties. The poll also showed that 58 percent of Americans were aware of research linking moderate drinking to lower rates of heart disease.

Most of Gallup's 1,001 interviewees said they were not moved to drink by the news about alcohol and health, but consider what happened in November 1991 after "60 Minutes" aired a Morley Safer report on the so-called "French Paradox." The segment, produced by John Tiffin, examined possible explanations--including the consumption of red wine--for why the French, despite theft fatty pates, rich sauces, and buttery pastries, have a lower rate of heart disease than Americans. It was 12-minutes-and-45-seconds, some say, that saved the alcohol industry.

"So why is it," Safer began, "that the French, who eat 30 percent more fat than we do, suffer fewer heart attacks, even though they smoke more and exercise less? All you have to do is look at the numbers. If you're a middle-aged American man, your chances of dying of a heart attack are three times greater than a Frenchman of the same age."

A well-known wine lover, Safer cited a number of dietary factors to explain the paradox. The most important of all, he suggested, was wine. Per person annual wine consumption in the U.S. (around 2.05 gallons) ranks among the lowest of any wine-producing nation. French per person annual consumption (around 19.55 gallons) is the world's highest. "There has been for years the belief by doctors in many countries that alcohol, in particular red wine, reduces the risk of heart disease," Safer said, adding, "Now it's been all but confirmed." For balance, Ellison of Boston University was interviewed, describing the health benefits of moderate drinking while soberly noting that "we're all very much aware of the tremendous problem of alcohol abuse." But the magic moment--the enduring image--of the "60 Minutes" piece was when Safer hoisted a glass of red wine and looked into the camera: "So the answer to the fiddle, the explanation of the paradox, may lie in this inviting glass ."

"60 Minutes" was the highest rated program on television that week, with an estimated 33.7 million people tuned in. And the next day, people began buying and drinking... heavily. On American Airlines, for instance, requests for red wine increased so dramatically that most flights couldn't stock enough bottles. In the month after the report, red wine sales in supermarkets jumped 44 percent over the same period in the previous year, amounting to a 524,000 gallon increase (equal to 2.6 million bottles). In July 1992, "60 Minutes" rebroadcast "The French Paradox" segment. Sure enough, red wine sales shot up 49 percent over the previous year. All told, red wine sales increased approximately 39 percent in the year following the initial broadcast.

For his efforts, Safer was honored in France with a special "communication" prize from LVMH Moet Hennessy-Louis Vuitton, the champagne, liquor, and luxury goods giant. There was even a report that a new wine would be named Safer Red. Asked about the frenzied reaction to his report, Safer claimed he was "a little uneasy ... at the enthusiastic way the wine trade seized on the piece. Fortunately, most of the promotion was very seemly."

Not exactly. Despite a federal law which prohibits any representation that wine has "curative or therapeutic effects ," many vintners did everything they could to capitalize on the report. Food and Wines from France, the French quasi-government operation that promotes Gallic products overseas, placed full-page ads in a number of newspapers. The ad noted that the French passion for fatty foods "seems to be counteracted by their drinking of French red wine. Yes, French red wine." It went on: "Moderate consumption of French red wine--one to three glasses per day with your meals--flushes away these platelets, clearing the arteries!"

Across the country, posters appeared almost overnight in wine shops, saying "YOU SAW IT ON TV. RED WINE reduces the risk of heart disease by as much as 50%! ... DRINK RED WINE! TO YOUR HEALTH!" Beringer Vineyards of St. Helena, California, tried to sell wine with neck hangers--little bottle tags--that quoted the 60 Minutes program. Geyser Peak Winery of Geyserville, California, ran an ad that said: "As age enhances wine, wine enhances age." The Bureau of Alcohol, Tobacco, and Firearms (BATF) squashed the ad since it made an explicit therapeutic claim. Today, BATF, the Food and Drug Administration, and the Federal Trade Commission are preparing guidelines for alcoholic beverage industry advertising on the health issue. And the industry waits.

Wining and dying

So what's the problem with all this?

For starters, from all the press coverage, you might think the French eat all the wrong things and get away with it. Not true. In fact, heart disease is France's number one killer, accounting for 30 percent of all deaths. While alcohol may play some role, nutrition experts say there could be plenty of other dietary reasons for France's proportionately lower heart disease rate. The French, for instance, consume more vegetables, grains, and beans (high in healthy fibers) than Americans do.

In fairness, "60 Minutes" did mention other explanations for the "French Paradox." But the program left the clear impression that wine was the magic potion consumed by absolutely everyone-even kids. In fact, over the last decade, the number of French non-drinkers grew from 38.7 percent in 1980 to a majority of 50.7 percent in 1990. What's more, the French aren't exactly regular drinkers: according to a 1990 industry survey, only 28 percent of Frenchmen and 11 percent of Frenchwomen who drink wine do so every day.

"'60 Minutes' told the facts, but they didn't tell the whole truth," says Lawrence Lindner, executive editor of the Tufts University Diet & Nutrition Letter. Lindner notes that French men are three times more likely than their American counterparts to die of cancer of the esophagus and more than twice as likely to die of stomach cancer. Both cancers are linked to drinking. The French also die of cirrhosis and chronic liver disease at almost twice the rate of Americans. Of course, coronary artery disease is a far greater killer than these other illnesses, but Lindner believes drinkers should know the possible tradeoffs. 60 Minutes, he says, neglected to report that the French are at higher risk of dying in accidents (almost five times greater in the case of women) and suicides. Finally, France has a higher rate of alcohol abuse than the U.S.

It's also not entirely clear that it's the alcohol in wine that helps the heart. Purple grape juice, for instance, contains more resveratrol--a compound in wine thought to lower cholesterol levels in blood--than many wines. And according to a recent University of California at Davis study, these non-alcoholic compounds (known as phenolics) may have an important anti-oxidant effect in the body that prevents narrowing of the arteries and the formation of blood clots. So non-alcoholic wine, grapes, grape juice, and raisins may be every bit as good for your ticker as a glass of Burgundy.

Second, there's the vexing problem of defining moderate drinking. With alcohol, one person's moderation may be another's disaster--the poison is in the dose. And a "moderate" amount is not easy to specify. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has tried: "Moderate drinking may be defined as drinking that does not generally cause problems, either for the drinker or for society." That's as helpful as the National Cancer Institute advising that too much sun is "sun that is too much for you."

Figuring out what does constitute moderate drinking can be treacherous. "There are tradeoffs involved in each decision about drinking," says Dr. Enoch Gordis, director of the NIAAA. "Reducing the risk of developing coronary artery disease, for example, may be offset by the risk of developing another alcoholrelated condition." Despite President Clinton's comments on MTV, even small amounts of alcohol can cause harm. "Research shows," an NIAAA "Alcohol Alert" bulletin says, "that adverse consequences may occur at relatively low levels of consumption." Moderate consumption, for instance, increases the risk of strokes caused by bleeding (although it reduces the risk of strokes caused by blocked blood vessels). Driving skills can be impaired at 0.05 percent blood alcohol concentration (BAC) or lower, with rapid deterioration as the concentration rises. (A man weighing 140 pounds might attain the BAC level of 0.05 percent after two drinks.) Alcohol may interact harmfully with more than 100 prescription and over-the-counter medications. Moderate drinking may be related, if only remotely, to female breast cancer, and may be a risk factor in birth defects.

So what's the bottom line? From much of the media coverage and the industry's promotional efforts, non-drinkers might be encouraged to start drinking--when regular exercise, quitting smoking, losing weight, and stress management are clearer paths to better health. And those who already drink too much might rationalize their habit or addiction. What's more, people might easily misinterpret the news and continue eating unhealthy foods while trying to cancel the risk with beer or wine.

Sour grapes

The repackaging of alcohol as a health food also raises questions about the industry's motives. Naturally, industry spokesmen make the compelling argument that consumers should be given all the facts and make up their own minds about moderate drinking. "The bottom line is, do you trust the American people to handle this information?" says John De Luca of the Wine Institute. "Do you trust them with anything positive about moderate alcohol consumption?"

Though it's hard to argue with such logic, many believe there is a fundamental cynicism to the "moderate" or "responsible" drinking approach. "It's extremely subtle and very clever," says Dr. Ernest P. Noble, director of UCLA's Alcohol Research Center. "These are emotionally appealing but ambiguous phrases. They can mean almost anything one wants them to mean. They provide no guidance to the consumer as to who should drink, and when, where, and how much to drink." In fact, a study in the November 1992 issue of The Milbank Quarterly, a health care policy journal, found that recent moderate drinking campaigns undermine important public health messages and may encourage consumption. Studying the beer industry's "responsible" campaigns, the journal noted that "brewers have used vague slogans and other advertising strategies that fail to define 'moderate' drinking and have overlooked the fact that certain people should avoid alcohol consumption altogether." Even Dr. Arthur L. Klatsky, an Oakland cardiologist and pioneering alcohol-inmoderation researcher, says "it cannot be stated that alcohol generally is 'good for the heart' or 'bad for the heart.' Specific conditions and individual factors related to the risks of drinking must be considered for each person."

Only cranks and killjoys could quibble with the industry's position that well-informed consumers should make their own choices. It's when the industry starts prescribing alcohol that one has to wonder. Since higher excise taxes on alcohol tend to reduce consumption, the Beer Institute has argued that responsible drinking should not be discouraged at all because of the net health benefit to society. "There's probably more benefit from drinking moderately than there is a detriment from the abuse of our product," says Raymond J. McGrath, president of the Beer Institute, the industry's trade association. "We believe there's a net benefit to society which can be quantified."

While the Beer Institute tallies its numbers, the grim picture of alcohol abuse in this country is already well known. As many as 10.5 million Americans show signs of alcoholism or alcohol dependence and another 7.2 million show persistently heavy drinking patterns associated with impaired health or social functioning, according to the National Council on Alcoholism and Drug Dependence. More than 100,000 people die each year because of the misuse of alcohol. An estimated 35 percent of all hospital beds are occupied by people who are there because of alcohol-related problems. An alcohol-related family problem strikes one of every four American homes. Two out of every five people in the U.S. will be in an alcohol-related crash in their lifetimes. Alcohol is closely connected to the four leading causes of accidental death in the U.S.: auto crashes (about half are alcohol-related); falls; drownings (38%); and fires and burns.

And the list goes on. Sure, it might have been a swell party if we could all tipple our way to a longer, fitter life. But the Marin Institute for the Prevention of Alcohol and Other Drug Problems sums up the situation succinctly: "If you don't drink, there is no health reason to start."