The benefit of alcohol in moderation

Small amounts of alcohol were held to be beneficial in the 19th century, bu t the idea died out. Scientific evidence that moderate amounts prolonged li fe, published in 1926, was ignored. Further evidence accumulated from the e arly 1950s but the belief that alcohol was only harmful had become so ingra ined that the idea has been taken seriously only since the early 1980s. Now , the evidence that small amounts reduce the risk of vascular disease by ab out a third and reduce total mortality in middle and old age is massive. Al ternative explanations for the observed inverse relationships have been rul ed out and beneficial effects have been shown to be biologically plausible. The reduction in mortality is mainly attributable to ischaemic heart disea se and cerebral thrombosis, but some other diseases may also contribute to it. The increasing mortality with larger amounts is attributable to many ca uses that have long been recognized. The optimum level varies with sex and age and may be zero under about age 45 years. The benefit is directly due t o ethanol and the extra benefit attributed to wine is due to the pattern of drinking. Public policy needs to take account of medical and social effect s other than mortality and will vary in different communities depending on background patterns of injury and disease.