We read with interest the article by Tolstrup et al. and we commend
them on this important and large piece of work. The study is a worthwhile
endeavour and for the most part we agree with their interpretation of the
findings.
Given that the potential implications of this paper are enormous, we
feel it is important to highlight and reaffirm some of the limitations and
challenge some of their complex methods concerning non-drinkers. The
authors state - non drinkers may include formal alcoholics and have not
clarified this key piece of information. Non-drinkers may also include
certain professions such as drivers, full time carers and nurses as well
as abstainers for religious or cultural beliefs. Similarly patients on
medications such as warfarin and older psychotrophic drugs or sedatives or
those who incur palpitations worsened by alcohol are less likely to
consume alcohol or to volunteer a history of such. Given this was a
prospective survey study - if the issue regarding alcohol consumption was
an apriori question, such key data should have been collected.
Furthermore the non-drinker group is an unignorably smaller group
then expected by chance suggesting there are important differences in
behavioural choices at play here. Since no account is documented as having
been undertaken to elucidate these baseline differences, important
confounders could not have been adjusted for in multivariate analyses.
Given this and the critical nature of this paper in terms of
influencing alcohol choice - in particular for those who are current and
lifelong non-alcohol drinkers, we would state that the authors might have
presented a more accurate picture having completely removed non-drinkers
from their analyses. By not having done this - the paper could be
misrepresented by alcohol distributors, producers and manufacturers to
state that some alcohol is better for you than none - which is a statement
which to the best of our knowledge has never been proven in a carefully
designed prospective randomised controlled trial using previous lifelong
abstainers and a non-alcoholic placebo.
Rapid Response:
Comparison against non-drinkers worth removing
We read with interest the article by Tolstrup et al. and we commend
them on this important and large piece of work. The study is a worthwhile
endeavour and for the most part we agree with their interpretation of the
findings.
Given that the potential implications of this paper are enormous, we
feel it is important to highlight and reaffirm some of the limitations and
challenge some of their complex methods concerning non-drinkers. The
authors state - non drinkers may include formal alcoholics and have not
clarified this key piece of information. Non-drinkers may also include
certain professions such as drivers, full time carers and nurses as well
as abstainers for religious or cultural beliefs. Similarly patients on
medications such as warfarin and older psychotrophic drugs or sedatives or
those who incur palpitations worsened by alcohol are less likely to
consume alcohol or to volunteer a history of such. Given this was a
prospective survey study - if the issue regarding alcohol consumption was
an apriori question, such key data should have been collected.
Furthermore the non-drinker group is an unignorably smaller group
then expected by chance suggesting there are important differences in
behavioural choices at play here. Since no account is documented as having
been undertaken to elucidate these baseline differences, important
confounders could not have been adjusted for in multivariate analyses.
Given this and the critical nature of this paper in terms of
influencing alcohol choice - in particular for those who are current and
lifelong non-alcohol drinkers, we would state that the authors might have
presented a more accurate picture having completely removed non-drinkers
from their analyses. By not having done this - the paper could be
misrepresented by alcohol distributors, producers and manufacturers to
state that some alcohol is better for you than none - which is a statement
which to the best of our knowledge has never been proven in a carefully
designed prospective randomised controlled trial using previous lifelong
abstainers and a non-alcoholic placebo.
Competing interests:
None declared
Competing interests: No competing interests