Intended for healthcare professionals

Clinical Review

One for the heart

BMJ 1997; 315 doi: (Published 20 December 1997) Cite this as: BMJ 1997;315:1664
  1. Richard Doll, emeritus professor of medicinea
  1. a Clinical Trial Service Unit and Epidemiological Studies Unit, Radcliffe Infirmary, Oxford OX2 6HE


“An ounce of whisky, please Sister,” or was it half an ounce or two ounces? I cannot remember now, but I know that I prescribed some tentatively after having sought the ward sister's opinion when I was called to my first patient with lobar pneumonia as a newly qualified house physician in 1937.

There was nothing else to prescribe unless oxygen was needed. In the 19th century alcohol had been prescribed for many debilitating conditions, but its medicinal use was dying out except for people who were terminally ill, and there was certainly no idea that it might be of any use in preventing disease. Some people must have seen Pearl's report in 1926 of a U shaped relation between mortality and the consumption of alcoholic beverages, but it was totally ignored by the medical profession.1

The situation began to change soon after the second world war, with reports of an unusually low prevalence of coronary artery disease in patients found to have cirrhotic livers at necropsy.2 3 Necropsy series were, however, subject to many biases, and these reports excited little interest. Even in the 1970s, when case-control studies of people with and without myocardial infarcts4 and cohort studies of people with different personal characteristics5 began to report a reduced relative risk of myocardial infarction in people who drank small or moderate amounts of alcohol in comparison with non-drinkers, scant attention was paid to them. The belief that alcohol was bad for health was so ingrained that the idea that small amounts might be good for you was hard to envisage, and it is only in the past 10 years that cardiologists and specialists in preventive medicine have begun to take it seriously.

Prophylactic value of alcoholic beverages

The evidence for a beneficial effect is now massive.3 6 7 It …

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