SPH’s Bicknell Lecture: To Drink or Not to Drink?

Timothy Naimi, a MED and SPH associate professor (from left), Richard Saitz, a MED and SPH professor, R. Curtis Ellison, a MED professor, and Lionel Tiger, an anthropologist from Rutgers University, debated whether alcohol consumption should be encouraged as part of a healthy lifestyle at the 2014 Bicknell Lecture September 18. Photo by Cydney Scott

Over the past 30 years, more than 100 studies have shown positive cardiovascular effects from moderate alcohol consumption, defined as one or two drinks a day.

But whether those studies warrant a larger public health message encouraging moderate drinking is a subject of intense debate in scientific circles. Proponents say physicians and others should portray light consumption as potentially protective, while also acknowledging the risks. Critics say the supposed benefits of moderate drinking have been overblown and are based on flimsy science.

The debate surfaced again last week when four well-known researchers squared off on the topic at the annual William J. Bicknell Lecture in Public Health, organized by the School of Public Health. This year’s lecture was titled Should Alcohol Consumption Be Encouraged as Part of a Healthy Lifestyle? The consensus of the researchers? Definitely don’t drink too much.

But could there be a downside to drinking too little?

“Anything that we can do to lower the risk of a stroke, diabetes, dementia, or osteoporosis can make a contribution to public health,” said R. Curtis Ellison, a School of Medicine professor of medicine and public health and codirector of the Institute on Lifestyle and Health, who advocates moderate alcohol consumption as part of a healthy lifestyle.

That view drew a sharp response from addiction researcher Richard Saitz (CAS’87, MED’87), an SPH professor and chair of the community health sciences department and a MED professor of medicine.

“Alcohol is a pharmaceutical intervention that is also a carcinogen. We generally don’t recommend such substances in any doses,” said Saitz. “Are there harms of low doses of alcohol? Yes.”

Both sides came armed with research. In the academic version of a bar brawl, Ellison took the first shot, referencing dozens of studies showing that moderate drinking reduced the risk of heart disease and other cardiac ailments and was associated with lower overall mortality.

Saitz fired back with studies showing a link between moderate drinking and elevated risks of some cancers, including breast cancer, while criticizing as “hopelessly confounded,” “implausible,” and “flawed” the studies Ellison cited.

Joining Ellison to tout the benefits of moderate drinking was Lionel Tiger, the Charles Darwin Professor Emeritus in the department of anthropology at Rutgers University and author of several books on social evolution, including The Pursuit of Pleasure. Tiger argued that drinking has been part of American culture since the Pilgrims came to Plymouth and should be seen as a “facilitating mechanism” for socialization and stress reduction.

“Yes, the epidemiological studies are fine,” Tiger said, acknowledging scientific support for both sides. “But at the same time, you have to…embrace moderate consumption as a way of recognizing that, for most people, living is not easy.”

Drinking to cope is “a self-delusion, no doubt—but for whatever reason, it makes people feel that things are a little easier,” he said.

But Saitz and Timothy Naimi, a MED and SPH associate professor, said any social or health benefits associated with moderate drinking are outweighed by the potential risks. They noted that about half of all drinkers in the United States exceed the suggested limits of consumption in the US Dietary Guidelines—one drink a day for women and two drinks a day for men.

“We can’t pretend that everyone would drink moderately were alcohol promoted as part of a healthy lifestyle,” Naimi said. “Even if we assume cardiovascular benefits from low-dose drinking, alcohol causes more deaths and lost life than it prevents.”

Excessive alcohol consumption is linked with serious health problems such as cirrhosis of the liver, inflammation of the pancreas, and damage to the heart and brain. Heavy consumption also increases the risk of motor vehicle accidents, high blood pressure, stroke, violence, and suicide, studies have shown.

“Any benefit of light drinking is lost with one heavy-drinking episode,” Saitz argued.

Naimi said a new set of genetic-based studies has challenged the concept that moderate drinking has a “cardio-protective” effect. Until there is definitive research proving a link—without confounding factors—the public health community would be wrong to promote alcohol as a “health tonic,” he said.

Ellison, who is scientific codirector of the International Scientific Forum on Alcohol Research, said he advocates a “balanced view” of moderate drinking. He is best known for his research on the so-called French Paradox, in which he and others cited red wine consumption as a reason the French have low rates of coronary heart disease. After a 1991 60 Minutes segment on that topic he appeared in, red wine sales in the United States climbed by 40 percent.

“I think the message is, don’t drink too much—but don’t drink too little, either,” Ellison said. “Telling the truth about alcohol” is not going to cause people to abuse it.

But Naimi and Saitz said that promoting the supposed benefits of moderate drinking is fraught with problems, among them that different people might interpret “moderate” in vastly different ways. They also disputed Tiger’s view of alcohol as a social elixir.

“Remember that alcohol is tremendously socially disruptive,” Naimi said.

Saitz was more blunt: “Frankly, heroin is pretty good as a social lubricant,” he said.

As the debate wound down, Tiger tried to strike a compromise.

“I think we owe it to ourselves to not look at this as Thou Shalt or Thou Shalt Not,” he said.

All four researchers agreed that excessive drinking should be discouraged, no matter what the circumstances. Heavy alcohol use led to an estimated 88,000 deaths in the United States each year from 2006 to 2010, according to the Centers for Disease Control and Prevention.

They also conceded that sending any public message about drinking could be tricky, given that 60 percent to 80 percent of the adult US population already reports alcohol consumption.

“Who would be eligible to start drinking?” Saitz asked.

The annual Bicknell Lecture is named in honor of William J. Bicknell, founder of the SPH department of global health, who died in 2012.

Lisa Chedekel can be reached at chedekel@bu.edu.