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All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h384 (Published 10 February 2015) Cite this as: BMJ 2015;350:h384

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Re: All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts

It is good to see even the slightest support for the seemingly hopeless effort of making science prevail when commerce decides otherwise. But one small concern with this article was the reference to the association of lower mortality among older light drinkers in western nations as the 'protective effect'. This is what is in question and I am not sure we can appear to endorse that formulation or seemingly take it as a given, in an article that adds further doubt to the validity of the proposition.

The alleged causality beneath the association is of course not the subject of the study. But it cannot be assumed as established particularly because 'abstainers' are such a small minority in the countries where the studies are conducted over and over again (and highlighted in the mass media). This renders the ‘abstainer’ group abnormal to start with – and not only in ways controlled for in our traditional list of potential confounding factors.

The idea that alcohol is good for the heart is now widespread. If it indeed is, and we want to consume alcohol as a medicine, we should seek to take the minimal dose at the cheapest price. A generic medicinal alcohol should be allowed on the market if the medical profession is honestly convinced that a little alcohol is good for us (or at least for elderly westerners). And the profession should tell us whether a teaspoon a day is enough or not for the presumed benefits. Doctors should not collude with the alcohol trade to make us swig unnecessarily large quantities of expensive branded commercial beverages in the belief that we are taking medicine

Refs:
Knott CS, Coombs N, Stamatakis E, Biddulph JP. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015;350:h384

Competing interests: No competing interests

14 February 2015
Diyanath S Samarasinghe
Associate Professor in Psychological Medicine
Faculty of Medicine, Colombo, Sri Lanka
Kynsey Road, Colombo 8, Sri Lanka