How Australia decided there is no good to drinking

In 2009, Australia issued new guidelines - replacing those from 2001 - for the consumption of alcohol through the government’s National Health and Medical Research Council. The 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol (keep this title in mind) halved the acceptable levels of consumption for men from four to two glasses of alcohol daily (the level for women remained at two glasses).

In 2010, the United States issued a draft - through its Department of Agriculture - of Dietary Guidelines for Americans, which is reissued every five years. The group responsible for the alcohol section (PDF 323KB) was headed by epidemiologist Eric Rimm of Harvard Medical School, where he is a co-director of the Health Professionals Follow-Up Study. This “prospective” research project has tracked groups of doctors’ and nurses’ health outcomes and drinking for decades.

The two sets of guidelines differed rather substantially. The American guidelines assert: “the lowest mortality risk for men and women [occurs] at the average level of one to two drinks per day, [and] is likely due to the protective effects of moderate alcohol consumption on CHD [coronary heart disease], diabetes and ischemic stroke as summarized in this chapter.”

This is a rather bold statement - that people who have a couple of drinks daily live the longest - a position for which the US alcohol group found strong evidence.

The Australian guidelines beg to differ. According to the FAQs (PDF 454KB) addressed to the public which accompany the formal document, “Recent scientific evidence suggests that any potential health benefits from consuming alcohol probably have been overestimated. Any benefits are mainly related to middle aged or older people and only occur with low-levels of alcohol intake of about half a standard drink per day.”

The US Dietary Guidelines also answer a FAQ about potential cognitive benefits this way, “Moderate evidence suggests that compared to non-drinkers, individuals who drink moderately have a slower cognitive decline with age”. The Australian guidelines FAQs make no mention of such long-term mental advantages from drinking, even though the body of the Guidelines document (which most people are unlikely to read) states that “light to moderate alcohol consumption may protect against cognitive impairment and dementia in older adults” and lists 12 studies as references.

The two sets of guides for people’s drinking thus offer different impressions of the benefits of alcohol. At a minimum, this suggests that there is quite a bit of leeway in the conclusions professionals arrive at from the same research - or at least in the emphasis they place on such findings. And alcohol is a primary example for such differences in interpretation. What can explain them? We might first look towards cultural differences between America and Australia. Yet both countries are so-called temperance cultures - ones with long histories of proselytising against alcohol (as opposed, say, to Italy, Greece, Spain, Hungary, Belgium). So culture-wide attitudes towards alcohol don’t offer a good explanation for differences in the two guidelines.

In prior editions, the American Guidelines were more anti-alcohol than the Australian. The 1990 edition, for example, declared that drinking alcoholic beverages "has no net health benefit, is linked with many health problems, is the cause of many accidents, and can lead to addiction. Their consumption is not recommended." This point of view was revised modestly in the 1995 edition by these two declarations: "Alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history," and "Current evidence suggests that moderate drinking is associated with a lower risk for coronary heart disease in some individuals".

What a furore these statements - literally lost within a swirl of information about alcohol’s negative impacts in the American document - created! Opposition to the inclusion of such cultural and health claims was led by legendary segregationist (and teetotaller) Senator Strom Thurmond. The statements were maintained nonetheless in the final version, leading to the even further-reaching claims proposed for the 2010 edition. But these have led to a whole new furore from public health and anti-alcohol advocates in the States. Plus ça change, plus c'est la même chose.

The Australian Guidelines have already provoked their own tempest in a teapot. Writing on an Internet listserv for alcohol epidemiologists to which I belong, one member of the Australian authorship committee, Professor Robin Room of the University of Melbourne, declared he was strongly opposed to the wording of the recommended level of drinking of a "half a standard drink per day" in the FAQs - which is, after all, how most Australians are to learn how much they should be drinking. Room also questioned the inclusion of FAQ answer: "Young people (up to 18 years of age) are advised not to drink alcohol at all."

Although the American alcohol recommendations are not home free yet, it does seem remarkable that Americans might reasonably be offered guidelines that drinking moderately will help them to lead longer lives of greater mental acuity, while Australians already have guidelines that give them no reason to suspect this. The title of the Australian guidelines, indicating that its purpose is “to reduce health risks from drinking alcohol,” conveys the meaning that the only way to approach drinking is as a negative experience, one to be avoided if possible.

It’s funny how science gets filtered on its way to reaching the public due simply to the composition of boards of people charged with interpreting research, and that warring groups of respected scientists can debate the most basic aspects of public health recommendations. In the process, Australians are to believe for most of the next decade, judging from the time between the last two sets of alcohol guidelines, that there are no benefits worth considering when thinking about their drinking.