Intended for healthcare professionals

Rapid response to:


International regulation of alcohol

BMJ 2008; 337 doi: (Published 07 November 2008) Cite this as: BMJ 2008;337:a2364

Rapid Response:

A balanced approach needed for regulation of alcohol: "Do not throw out the baby . . . "

To the Editor:

The editorial by Room et al on international regulation of alcohol(1)
gives a somewhat unbalanced appraisal of alcohol use in our societies.
The consumption of alcoholic beverages is a part of the lifestyle of
people in many cultures around the world and, when consumed moderately and
responsibly (as it is by the large majority of the population), is
associated with considerable health benefits. Protective effects
associated with regular, moderate drinking have been shown especially for
cardiovascular diseases, which continue to be the leading causes of death
throughout the world.(2-7) Further, moderate drinking is associated with
much lower risk of diabetes and its complications.(8-11) For most,
moderate alcohol intake can be an important component of a "healthy
lifestyle," one that also includes not smoking; avoiding obesity; getting
regular exercise; and consuming a diet high in fruits, vegetables, whole
grains, and limited amounts of red meat. Even among individuals
who follow the other four components of a healthy lifestyle listed above,
the addition of moderate drinking provides considerable additional health

Attempts to control alcohol misuse should be highly focused so that
they do not achieve lower rates of abuse at the cost of reducing benefits
among the majority of people who consume in a healthful fashion. Abraham
Lincoln, the sixteenth president of the US, stated it well when he said,
"It has long been recognized that the problems with alcohol relate not to
the use of a bad thing, but to the abuse of a good thing."(13)
Interventions that result in a decrease in moderate, responsible drinking
among the middle-aged and elderly populations in areas where
cardiovascular diseases, diabetes, dementia, and other diseases of ageing
are common could have a negative impact on the public health.

R. Curtis Ellison, MD
Professor of Medicine & Public Health

Yuqing Zhang, MD
Professor of Medicine & Public Health

Institute on Lifestyle & Health
Boston University School of Medicine
761 Harrison Avenue, Boston, MA 02118, USA


1. Room R, Schidt L, Rehm J Mäkelä P. International regulation of
alcohol. BMJ 2008;337:a2364

2. Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of
alcohol consumption and risk of coronary disease in men. Lancet

3. Kannel WB, Ellison RC. Alcohol and coronary heart disease: the
evidence for a protective effect. Clinica Chimica Acta 1996;246:59-76

4. Doll R. One for the heart. Br Med J 1997;315:1664-1668

5. Sacco RL, Elkind M, Boden-Albala B, at al. The protective effect
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6. Djoussé L, Gaziano JM. Alcohol consumption and risk of heart
failure in the Physicians’ Health Study I. Circulation 2007;115:34-39

7. Bagnardi V, Zatonski W, Scotti L, La Vecchia C, Corrao G. Does
drinking pattern modify the effect of alcohol on the risk of coronary
heart disease? Evidence from a meta-analysis. J Epidemiol Community
Health 2008;62:615-619

8. Koppes LL, Dekker JM, Hendriks HF, Bouter LM, Heine RJ. Moderate
alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of
prospective observational studies. Diabetes Care 2005;28:719-725.

9. Koppes LLJ, Dekker JM, Hendriks HFJ, Bouter LM, Heine RJ. Meta -
analysis of the relationship between alcohol consumption and coronary
heart disease and mortality in type 2 diabetic patients. Diabetologia

10. Fan AZ, Russell M, Naimi T, Li Y, Liao Y, Jiles R, Mokdad AH.
Patterns of alcohol consumption and the metabolic syndrome. J Clin
Endocrin Metab 2008. (Published ahead of print, doi:10.1210/jc.2007-2788)

11. Beulens JWJ, Kruidhof JS, Grobbee DE, Chaturvedi N, Fuller JH,
Soedamah-Muthu SS. Alcohol consumption and risk of microvascular
complications in type 1 diabetes patients: the EURODIAB Prospective
Complications Study. Diabetologia 2008;51:1631–1638.

12. Mukamal KJ, Chiuve SE, Rimm EB. Alcohol consumption and risk for
coronary heart disease in men with healthy lifestyles. Arch Intern Med

13. Lincoln A. Talk to Washington Temperance Society of Springfield,
Illinois, February 22, 1842, as published in

Competing interests:
From the Faculty of the Institute on Lifestyle & Health at Boston University School of Medicine, whose surveillance of the scientific literature is partially supported by funds from organizations related to the beverage industry.

Competing interests: No competing interests

13 November 2008
R. Curtis Ellison
Professor of Medicine & Public Health
Yuqing Xhang
Boston University School of Medicine, Boston, MA 01701, USA