
All cause mortality and the case for age specific alcohol consumption guidelines - JeremyNT
http://www.bmj.com/content/350/bmj.h384
======
forloop
At the bottom of the page:

~~ What is already known on this topic ~~

\- It is unclear from existing evidence whether the protective effect of
moderate alcohol consumption is both real and applicable to older populations

~~ What this study adds ~~

\- When compared with self reported never drinkers, protective associations
were largely limited to women drinkers aged 65 years or more

\- Little to no protection was present in other age-sex groups

 __*

I'm not a woman over 65, and I doubt the majority of people on HN are either.
The study is still useful, though, since it indicates what not to do for
health promotion! Drink alcohol.

Edit: not much markdown works... boo.

~~~
shamney
where does it show that moderate alcohol consumption is bad for health
promotion??

------
shamney
"In summary, the study is grossly underpowered to convincingly prove a
plausible protection, and they have committed the cardinal sin of saying that
non-significance is the same as 'no effect' in a study lacking sufficient
events, in this case, deaths in non-drinkers. Maybe epidemiological studies
should include power calculations, which make sure there is a reasonable
chance of detecting a plausible effect, and which became standard in clinical
trials after too-small studies were being used to claim that drugs did not
work."

[http://understandinguncertainty.org/misleading-
conclusions-a...](http://understandinguncertainty.org/misleading-conclusions-
alcohol-protection-study)

------
jakobegger
Looking through this study it becomes clear that any positive effects of
alcohol consumption is probably based on wishful thinking rather than
statistical evidence.

They do mention one important point: most studies consider non-drinkers a
homogenous group. In this study, they show that a lot of the seemingly
positive effect evaporates when former drinkers are removed from the study. I
wonder what would happen if they also removed people from the study who don't
drink alcohol because of health reasons.

~~~
aidenn0
More like "the number of lifetime teetotalers they could find was so small
that there was insufficient data to measure an effect"

------
sandworm
I'd be interested in reading a study of drinking patterns beyond simple
measurement of total consumption.

Every study I read measures volume over a time such number of units per week.
But there is a difference between downing a bottle of wine in one hour every
saturday night as opposed to a single glass every night. Perhaps a study based
on peak blood alcohol level during the week rather than total consumption?

The OP study seems to have dealt with older people. Retirees, without jobs,
might have many 'average' days resulting in a steady daily drinking pattern.
Most of the younger drinkers I know go for extended periods without drinking
(weekdays) only to get hammered come the weekend. Is this worse? Maybe multi-
day dry periods give your system a rest and that is better than a daily
pattern? I don't know.

It's all moot to me. I don't drink, which for a non-muslim non-mormon canadian
means people often think I'm a recovering alcoholic. I'm not. I just don't
like drinking. It;s not fun.

~~~
aetherson
These total-factor mortality studies tend to be over large populations and
long time-periods, so it's difficult to administer a test protocol like "check
their blood alcohol many times a week and find a peak."

It seems almost certain that intensity of drinking has some effect on total-
factor mortality, if only because if you get blind drunk you're more prone to
accident than someone who drinks only to being buzzed or less.

~~~
sandworm
That's why I am so interested. I could see how getting blind drunk once a week
might actually reduce total mortality. Perhaps those who get blind drunk only
occasionally under planned conditions have fewer accidents than those who
drink regularly and therefore spend more time under the influence.

I agree that a measurement protocol would be difficult. But the OP was based
on self-reporting. They could ask "Have you, in the last week, ever been above
the legal driving limit?" or "What is the most you consumed in a single
sitting this week?"

------
anovikov
So 20 units per week is about 0.5L of scotch. I drink about that much, or even
a bit less, and most people think i am a drinker. Is that level of consumption
actually safe?

~~~
DanBC
This isn't medical advice: UK recommended limits are 3 to 4 units per day,
with some days alcohol free and don't save the units up.

You're drinking towards the upper range of that, but still described as
"reduced risk" drinking. "Increased risk" drinking is between 3 to 4 units per
day (so around 28 units a week) and 50 units a week. Over that and you're at
"high risk" drinking. [http://www.nhs.uk/conditions/Alcohol-
misuse/Pages/Introducti...](http://www.nhs.uk/conditions/Alcohol-
misuse/Pages/Introduction.aspx)

You might want to make sure you have a couple of alcohol free days spread out
in the week. You might want to make sure you're not regularly drinking more
than that half liter of whiskey each week.

The NHS has a huge amount of information:
[http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholhome.aspx](http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholhome.aspx)

------
marincounty
"Two samples were used, each utilising a different variable for alcohol usage:
self reported average weekly consumption over the past year and self reported
consumption on the heaviest day in the past week"

I started to question the study a when I saw self reported.

I would really like to get to the bottom of this is # of drinks a day and
health. What is the true number of drinks/day that cause damage? I vaguely
remember Checholvakia study that made the partipiciants bring back the cork,
so the researchers knew they drank the alcohol, and didn't sell the bottles.
But even then--they could have poured out the liquor? I gave a weird feeling
no drinks/day is best? I should be dead--yes--antidotal.

------
SixSigma
Direct healthcare costs estimated to account for £3.5bn by 2011-12 ($4.1bn;
€3.6bn) of annual National Health Service expenditure in England.

Meanwhile :

Health problems associated with being overweight or obese cost the NHS more
than £5 billion every year. [1]

[1] [https://www.gov.uk/government/policies/reducing-obesity-
and-...](https://www.gov.uk/government/policies/reducing-obesity-and-
improving-diet)

~~~
ojbyrne
I suspect that alcohol consumption is a significant contributor to obesity.

------
k2enemy
A little off topic, but their site makes it really hard to figure out what BMJ
stands for. I clicked around until I saw a picture of an old medical journal
with "British Medical Journal" on the spine. On the ten or so pages I tried,
that phrase never appears.

~~~
duncanawoods
I think its a pseudo-acronym, like BP and KFC, where the mission extends the
original goal so that it becomes rebranded without standing for the original
name anymore.

I doubt you will find the original name of the other two on their sites
either. If there is one thing that motivates marketers, its expunging an
obsoleted brand from history...

------
whiddershins
Basically, though, it's at the point of debating positive effects (if any) of
drinking alcohol. Because there is no evidence of a negative effect.

For most Americans, I believe this concept: that drinking probably is not bad
for you, would be considered pretty radical.

~~~
linearb2
What? It's radical because it's not true. Every large-sample longitudinal
study into alcohol consumption has found an inverse correlation with
mortality. Ignoring all questions about liver and cardio risks or benefits,
alcohol is carcinogenic in a dose-dependent way.
[http://www.medscape.com/viewarticle/824237](http://www.medscape.com/viewarticle/824237)

------
maerF0x0
So the TLDR is if youre >= 65, decrease alcohol consumption. If you're <65
optimal range is 15-20 units per week, better if it's even consumption per
day.

"One unit of alcohol is about equal to: half a pint of ordinary strength beer,
lager or cider (3-4% alcohol by volume); or. a small pub measure (25 ml) of
spirits (40% alcohol by volume); or. a standard pub measure (50 ml) of
fortified wine such as sherry or port (20% alcohol by volume)"[1]

So in short: have 2 weak pints of beer xor 1 strong pint of beer xor 150ml of
13% wine.

Can someone confirm,refute this understanding of the text.

[1]:[http://www.patient.co.uk/health/Recommended-Safe-Limits-
of-A...](http://www.patient.co.uk/health/Recommended-Safe-Limits-of-
Alcohol.htm)

~~~
losvedir
Did you read the article? The whole point seems to be the opposite of this.
There was some small benefit to drinking alcohol to women over 65, none in
other groups.

~~~
circlefavshape
Not none

"Among younger men, the range of protective effects was minimal, with a
significant reduction in hazards present only among those who reported
consuming 15.1-20.0 units/average week (hazard ratio 0.49, 95% confidence
interval 0.26 to 0.91) or 0.1-1.5 units on the heaviest day (0.43, 0.21 to
0.87)"

A hazard ratio of 0.49 means your chance of dying is _halved_. That seems like
a very significant benefit to me. As a comparison in this study the hazard
ratio for all-cause mortality for engaging in a very high volume of exercise
is 0.65
[http://www.hivdent.org/_nutrition_/2011/PIIS0140673611607496...](http://www.hivdent.org/_nutrition_/2011/PIIS01406736116074962.pdf)

(the 95% confidence interval for the exercise study is much narrower though)

------
not_that_noob
I'm sorry, but this is one research result I won't drink to.

