For the many and the one

Those who enjoy occasional “adult beverages,” as I do (wine preferentially in my case), need not desist in the aftermath of the recent study spawning headlines. The risks of alcohol did not suddenly shoot up; we did not suddenly discover risks we did not know about before; and the risks reported are not suddenly in the gamechanging zone.

I am not writing to recommend you drink alcohol to lower your health risk. Any level of alcohol is dangerous to your health for the simple reason that alcohol is alcohol. The ill effects of excess over time are well known. So, too, are the potentially calamitous effects of acute use. The reason alcohol is universally dangerous to health is that excess on even one occasion, in someone who does not drink excessively in general, could prove lethal. That could be true at a fraternity initiation; that could be true on any given highway. You likely also know that alcohol generally increases cancer risk somewhat, and breast cancer risk perhaps in particular.

So, yes, alcohol is dangerous to your health. But as David Spiegelhalter at the University of Cambridge observed, the level of driving associated with the least risk is also zero. Aaron Carroll in the New York Times noted that there is no entirely safe level for dessert.

There is still one important clarification to append, however. Drinking alcohol, moderately, judiciously, and responsibly can still actually lower your overall health risk — depending on who you are.

Let’s say that alcohol raises the risk of “bad outcomes” by, on average, 10 percent, and let’s apply that to a hypothetical population of 100 people. Let’s also note that the new study actually did only describe the associations between alcohol intake and health outcomes in populations of people; it did not, and could not, examine variations at the individual level.

One way to get an average “bad outcome” level of 10 percent is for everyone’s risk to go up by about 10 percent: (10 percent X 100 percent ) = 10 percent . This would be the scenario in which zero alcohol is safest at the population and individual level alike.

But another way to reach that same “average” risk increase is the one that is likely closest to reality. Alcohol increases health risks quite a lot in some, less in others, not at all in others still, and actually lowers health risk in a few. Coverage of the new paper seems to have people believing that last item was precluded now, but it’s not.

So, for instance: alcohol could increase risk 50 percent in 20 members of our hypothetical population; increase risk 10 percent in 30 members; not affect risk in 20 members; reduce risk 5 percent in 20 members; and reduce risk 20 percent in the remaining 10.Let’s be clear, I am making these numbers up for purposes of illustration, not proposing these exact effects. Here is the resulting equation: [(50 percent X 20 percent ) + (10 percent X 30 percent ) + (0 X 20 percent ) — (5 percent X 20 percent) — (20 percent X 10 percent )] = 10 percent .

In words rather than numbers, risks at the level of the population can be, and generally are, a mix of quite varied risks among different individuals. If you are at low risk for the many potential alcoholrelated pathologies, have risk factors for cardiovascular disease, and drink moderately and responsibly, there is the same potential for net health benefit now as there was before the new paper and the attendant media coverage of it. Really.

There are both safer and more reliable ways of reducing cardiovascular risk. I am simply saying that if you drank sensibly and responsibly before the recent news cycle because it was a source of pleasure in your life, the latest news cycle dispenses no new reason to stop. If you thought your moderate drinking might actually lower your risk for heart disease, you are as right about that now as you were a week ago.

Personally, I think truly fine wine is among the rare, reliable indications that there could be intelligent life down here. But I drink it judiciously to avoid the hazards of excess, and for pleasure — not to reduce my health risks. It might do that, but that would be a bonus.

Pleasure itself is important to health; if you raise a glass to the limitations of population-based epidemiologic studies, I suggest you toast to that. As they say in the old country: L’chaim.