Your Health

Just what the doctor ordered

Some years ago while working in England, I discovered that I was allowed to pre- scribe whisky as medicine for hospital patients.

Thanks to a 19th century regulation, when a dose of alcohol was the standard (and often the only) treatment for many debilitating diseases, hospital doctors in England were allowed to write prescriptions like "RX Whisky 30 ml. per os nocte".

I have even recommended it as better than "sleeping tablets" for patients the night before major surgery.

But the medicinal use of alcohol has been out of fashion for years. Says Sir Richard Doll, emeritus professor of medicine at Oxford University, "The belief that alcohol was bad for health became so ingrained that the idea that a small amount might be good for you was hard to envisage."

It has only been during the last decade that doctors have started taking the beneficial effects of alcohol seriously.

One pointer in this direction was the observation made at post-mortems that heart disease was seldom found in patients with alcoholic cirrhosis.

Later, several researchers found that middle-aged people who drank small amounts of alcohol had a reduced risk of getting heart attacks.

Today, the evidence of alcohol's beneficial effect is massive.

The facts still need refinement, but in broad terms they are clear: In middle and old age, a small amount of alcohol (between one and four drinks daily) reduces the risk of premature death.

One important study of middle aged British doctors showed those who drank 2 to 3 units of alcohol daily had the lowest mortality - a "unit" being half a pint of beer, one glass of wine or a single 'shot' of spirits.

It doesn't matter whether you drink beer, wine, whisky or arrack - the benefit comes from the ethanol content rather than any special characteristics of these drinks.

Ethanol increases the levels of HDL ("good") cholesterol, slightly reduces LDL ("bad") cholesterol, and diminishes the blood's tendency to form clots. These all lessen the risk of circulatory diseases - especially heart attacks and strokes.

The effects of ethanol on blood constituents last less than 24 hours, and this is reflected by the fact that the risk of suffering a heart attack is diminished for 24 hours after consuming alcohol.

It is important to understand the difference between taking small amounts of alcohol regularly (which can be good for you) and putting a good booze every Friday night (which has been shown to be bad for you and those around you). One study found a sevenfold increase in fatal heart attacks among those drinking more than five bottles of beer in a single session.

Research is still needed to ascertain whether the benefits of alcohol apply to different age, sex and ethnic groups. At present we know that alcohol consumption is unlikely to produce any reduction in mortality in those under 45 years.

The Greek philosopher Plato 2000 years ago apparently knew all this - he is said to have forbidden the use of wine in people under 18 years and intoxication in those under 40. After that age, he advised them to take pleasure in wine - "intoxication being calculated to put heart into the elderly!"

Our increased awareness of alcohol's benefits raises as many questions as it has answered.

How do governments (which make money by taxing liquor on the one hand and then have to spend money to cope with alcohol-related violence and liver diseases) balance the risks and benefits ?

Public health policies cannot be the same in different countries - the prevalence of heart disease (which can be reduced by alcohol) and the incidence of accidents and violence (which are known to increase with the availability of alcohol) vary in different parts of the world. Suddenly making alcohol available to alcohol-starved societies would obviously create problems of its own. Policies good for one society and in one era might be disastrous in another place and time.

So the bottom line for those over 45 is that a small amount of alcohol each day can reduce the risk of getting a heart attack.

Of course it is worth remembering the cautionary words of my colleague Derek - "What doctors thought was bad for you is now actually good for you - but it may not be good for them to tell you in case you do it too much."

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