Damn the Risks, Pour Me Another Glass
Why I don’t plan to stop drinking alcohol.
IS A GLASS OF WINE WITH DINNER going to increase your chance of getting cancer or another serious illness? For the past few years, we’ve been deluged with studies and news accounts suggesting that the answer is yes. This week, the USDA reinstated a caution in its dietary guidelines about limiting alcohol.
Note: This is the Trump administration. No sane person seeking guidance on a health matter would look to their science-trashing witch doctors. At the moment, they appear to be whipsawed by industry interests and other constituencies. But who cares? They forfeited credibility the minute Robert F. Kennedy Jr. was appointed.
The Trump clown show to one side, even if the federal government were staffed only by science-respecting people, we’d still have a problem when it comes to recommendations like whether or not to have that glass of wine, because our society is not good at evaluating risks. Not at all. For example, most parents drive their kids to school or walk them to the bus stop every day. They don’t permit their 8- or 10-year-olds to go to the corner shop by themselves or take a city bus. Why? Because they believe, wrongly, that if kids are left on their own there is a serious risk of kidnapping. In reality, stranger abduction is incredibly rare (abduction by non-custodial parents is another matter). The chances that a child will be snatched by a stranger are about 1 in 720,000. And yet we’ve created a world of constant supervision based on the mistaken belief that kidnapping is somewhat common. There are costs to this—kids get less exercise when they are bused or driven to school, they are less likely to acquire a sense of autonomy and mastery of their surroundings when they are chaperoned everywhere, they are less likely to develop the social skills that arise among kids when no adult is present to mediate, and more.
The “stranger danger” phenomenon is a matter of misinformation (largely fueled by sensationalist media). Evaluating the risks of alcohol is admittedly a closer question. Unlike kidnapping, the risks of which have been wildly inflated, there is good evidence that alcohol consumption is linked to disease and premature death. The question is: How much alcohol is too much? Is the current recommendation that “No amount of alcohol is safe” reliable? I have doubts.
The anti-alcohol messages have been pounded home. People magazine proclaimed “One Drink a Day Raises Cancer Risk, Study Finds.” The Philly Voice headlined “No Amount of Alcohol is Safe to Drink.” Futurism’s headline on a story about risk was headlined “Experts Warn of Link Between Drinking Alcohol and Getting Cancer.” And the New York Times advised that “Even a Little Alcohol Can Harm Your Health.”
Let’s start with the fact that all of these studies are observational, not randomized controlled trials. That’s not a flaw, it’s just reality. You can’t do RCTs on things like diet over the course of decades because you can’t put one group of people in one lab and give them exactly one glass of wine a day for twenty years and another group in another lab and give them five glasses of wine a day and then see what happens. You have to rely on people’s reports of what they consumed.
And people lie. Some lie knowingly, but others, perhaps a larger number, lie inadvertently. Especially in a matter like drinking, where less is considered healthier and morally superior to more, people tend to underestimate or misremember how much they’ve imbibed. A Canadian study that compared people’s reported drinking with their actual purchases found that they underreported their wine consumption by 38 percent, their beer intake by 49 percent, and their spirits consumption by 66 percent. A doctor once told me that he asks patients how much they typically drink in a week and makes a mental note to double it. It’s not intended as an insult, just an acknowledgement of human nature.
But if these studies don’t account for the likely underreporting of drinking—and most do not—then the conclusion that “even one drink a day raises cancer risk” is probably wrong. Many, perhaps most of the people who said they drank seven drinks a week may have had ten or fourteen. And those who said they had fourteen probably had much more. Most of the bad effects of drinking, all of the studies acknowledge, come from those who consume a lot more than one drink a day.
There is also the matter of relative versus absolute risk. Press accounts of scientific research often say things like “[X] doubles your risk” of cancer. That’s a measure of relative risk. But the reality could be that your risk rose from 1 in 100, to 2 in 100. That’s a doubling of the risk, but not nearly as scary when understood in context. If drinking a glass of wine per day increased your risk of cancer from 1 percent to 2 percent, would you be willing to chance it? Considering how much I enjoy wine, I would. And again, due to underreporting, it’s not even certain that that risk calculation is accurate.
There are other things about the way people lead their lives that the headlines don’t capture. For example, there is evidence strongly suggesting that binge drinking is more harmful to health than steady daily consumption. Yet the studies often fail to distinguish between someone who drinks seven glasses of wine over seven days and someone who drinks seven glasses on Saturday night. It matters. And many of the “alcohol-related deaths” that studies list are clearly the result of drunkenness: like car accidents, falls, and homicide.
So I’m going to continue to enjoy that delightful sound of a cork popping out of a bottle, swishing the beautiful crimson elixir around a globe-shaped glass, inhaling the aromas of fruit and earth and spice, tasting the subtle interplay of sweet and tannic, and feeling the warm sensation in the belly that alcohol always delivers. Even if there’s a small increased risk, it’s worth it to me.