The Daily - How Bad Is Drinking for You, Really?

Episode Date: July 5, 2024

Midway through one of the booziest holiday weekends of the year, we re-examine our love-hate relationship with alcohol.Susan Dominus, a staff writer for The New York Times Magazine, gets to the bottom of the conflicting guidance on the benefits and risks of drinking.Guest: Susan Dominus, a staff writer for The New York Times Magazine.Background reading: Research has piled up debunking the idea that moderate drinking has any health benefits.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday

From The New York Times, I'm Natalie Ketro-Eff, and this is The Daily. Midway through one of the booziest holiday weekends of the year, we re-examine our love-hate relationship with alcohol. Today, my colleague Susan Dominus on how bad, or not, drinking is for you. It's Friday, July 5th. So you and I are both here to discuss our relationship to alcohol, a topic that I think endlessly fascinates us because for the past several decades, we've gotten conflicting guidance on the benefits and risks of drinking. And you, Sue, you decided to finally get to the

bottom of it. Thank you. Well, I tried. I mean, I think a lot of people do have a lot of confusion. I know that I feel that way. My friends and I are talking about it all the time. And I was very happy to have the opportunity to actually look at it journalistically. I'm curious what it was that made you head down this journalistic path. You know, about a year ago, I have a dear friend and I kept saying to her, hey, let's, you know, get together for a drink. How's next Tuesday? And she was like a little bit of these him. And finally, we ended up going for a walk, at which point it became clear that she was not avoiding me, but she was avoiding going for a drink. And she was somebody who didn't drink a ton. She was

like a once a, you know, maybe a drink with dinner every night person. And she was trying to go to zero. She was doing this because she had been hearing reports on podcasts, headlines, that alcohol was much more dangerous than previously understood. And she just kind of got freaked out, to be honest, and stopped pretty much altogether. Yeah, I saw those same headlines, some of them in our newspaper. They were hard to miss, even if you were trying to miss them.

Yeah, I think that's true. And I guess I just thought, is it so bad that you need to stop drinking altogether? Is it really even that bad that you need to stop having your one drink a night if that brings you joy and relaxation at the end of a stressful workday? I just felt like it was sort of bizarre that we didn't have an answer to that question. And I realized that it was not a question I could answer just by looking at the news right now. I think some of the confusion that we have actually

starts because of research that was being published in the 90s. And back then, the news was alcohol might actually be good for you. There has been for years the belief by doctors in many countries that alcohol, in particular red wine, reduces the risk of heart disease. Now it's been all but confirmed. There was all this research that suggested that drinking red wine

had a protective effect on heart health. Right, I remember that. Yeah. There was famously an episode of 60 Minutes. The wine has a flushing effect. It removes platelets from the artery wall. In which Morley Safer holds up a glass of red wine and says that researchers are finding that this is actually good for your health. So the answer to the riddle may lie in this inviting glass. It was news that was really convenient for people.

They really wanted to hear that good news. Supposedly drinking red wine is supposed to be good for me. And so I don't feel so bad if I have more than one glass. Oh, I believe that's why I drink it. I'm 61 years old. And wine sales, red wine sales in the U.S. apparently went up something like 40% over the course of the following year. And this is, by the way, right at the moment.

I think I became a legal drinker in 1991. So for my generation, this was an incredibly influential study. I actually have a friend who told me that he worried at one point that he wasn't drinking enough red wine to get those health benefits because he wasn't much of a drinker and he felt guilty about it. I love that. Hello. Hello. Can you hear me? So while I was reporting this out, I called a researcher in Canada named Tim Stockwell, who has studied alcohol's effects on the body for years. And he was really excited

about this research at the time. So I kind of embraced it, really. I thought, isn't this great? We don't have to tell a really negative story and say, it's all bad for you. Tim was convinced that basically the research was clear, that this was settled science. And he even chastised in a commentary published in Australia's leading medical journal people who were still denying these health benefits as sort of tin hat conspiracy theorist types. I likened people who were skeptics of the health benefits of alcohol to members of the Flat Earth Society and to people who doubted that men had been on the moon. But clearly that's not the end of the discussion, right? I mean,

the narrative starts to change at some point. For Tim, that really started to change not long after he published that commentary, when he got a call from another researcher named Kay Middleton Fillmore. She sounded a bit upset that nobody would fund her work on doubting the protective effects. I heard her out. Who told him that she had a lot of doubts about this research that he thought was so sound. The idea there were sick quitters. So Fillmore focused on how the data had been categorized in these studies. And she told him that they often included a category of people called abstainers, people who didn't drink, but that this category also included a group of people who drank and stopped.

And they didn't take into account the fact that many of the people in this group likely stopped because they were ill. In fact, Tim calls them the sick quitters. So you have this group of non-drinkers that actually includes a number of former drinkers and actually number of former drinkers and actually potentially sick former drinkers. That's exactly right. And when you include them in a data set with other non-drinkers, it actually makes people who drink moderately look really healthy in comparison. And this creates the illusion that a moderate amount

of alcohol is beneficial. I have to admit, the part of me was intrigued, just there was intellectual curiosity. And Tim was unconvinced, but was open-minded enough to be curious about whether he was wrong about all of this. And the two of them actually started collaborating together. And I got totally into it. I remember spending hours and hours and hours.

They ran the numbers, and they came out in 2006 with really different results. And they showed that most likely Fillmore was right. And when you did indeed rearrange the data so that the former drinkers were in a different category, the protective effect of moderate alcohol consumption basically disappeared. This kept pinching myself. You know, have we really got this right? And to Tim, this was super surprising.

So suddenly this settled science is very unsettled. Yeah. Boy, did we get commentaries. And it lit a bit of a fuse. And not surprisingly, the alcohol industry is not so excited about these findings. And they push back. One very specific thing was a call for a meeting where researchers were invited and Kay Fillmore was invited. A symposium was gathered that was partly funded by an alcohol industry group.

And the result of this meeting was to produce a document which basically summarized all the evidence and concluded that there were definitely benefits from drinking alcohol. And they published a summary of the events afterwards, and they concluded that actually, moderate alcohol consumption did have beneficial effects. And Kay was mad. She felt like banging her shoe on the table in the meeting because she kept saying, no, I don't agree. That's wrong. So there was a lot of resistance. And we kept getting criticism. People say, you got this wrong. You should have done that. So each time we'd go back and get more studies.

So Kay Fillmore, Tim's research partner, actually passed away in 2013. But Tim continued on with the research into the health impact of alcohol. And in 2023, he and his colleagues published a massive, massive study. It was the most comprehensive, the largest study. I think we had close to 5 million individuals represented. Which found that not only does drinking moderately not have protective effects on your health? But in fact, it increases your risk of all-cause mortality, which is to say dying of pretty much anything, could be a car crash, could be disease. And that's true for women when they drink even just a little bit less than

two drinks a day. And for men, that's true at just about over three drinks a day. So the idea was that no amount of drinking is good for you. That's the most important takeaway. And at not such high levels, you do start to see this increased risk. I mean, it kind of sounds like we're going from alcohol in the beginning being portrayed as essentially a health food, to now it being a public menace? Yes, I think one can interpret it that way. And it certainly felt that way, obviously, to a lot of people when they read it. Many, many cancer doctors always did disagree with the idea that alcohol could be protective. It was always known that drinking increased your risk of breast cancer, of esophageal cancer in very real ways.

But I think that was underappreciated by the public. Like, lots of surveys always found that that information was not penetrating the same way that, like, red wine is good for your heart had penetrated. So this was now switching the public messaging pretty dramatically. Right. And this time, for whatever reason, their warnings about alcohol seem to have actually landed a little harder in the public consciousness. I mean, I'm thinking about your friend, for example, about myself and a lot of people I know who are now wondering what to do with that information. Yeah, that is for sure. You know, I was curious to hear what Tim thought about all this and how he was thinking about it how he thought we could be thinking about it i kind of thought that tim was going to have the

zeal of the convert you know that having been somebody who had reassured everyone that alcohol was just fine for them in moderation that now he was going to kind of go to the other extreme and be very finger wagging about how bad alcohol was for you and basically tell me that I shouldn't drink at all. But in fact, do you not drink at all anymore or is it very occasional for you? Oh, I just, I'm a light drinker. I'm always astonished how I'm prepared to have 10 minutes of pleasure to feel a little rubbish for several hours the next day. And yet we all do it. It was really interesting when I got into it with him and tried to talk to him about how he understood the risk. One of the things I believe is that we should find ways of helping people grasp the scale of the risk and how it compares with things they can get their head

around. What I learned was really a much more nuanced picture. We'll be right back. Sue, this new, nuanced picture of drinking, it sounds potentially very appealing. Tell me what it looks like. Well, I've been thinking a lot in my reporting about how to help people understand risk in a way that is not abstract, in a way that they can grasp and apply to their risk in a way that is not abstract, you know, in a way that they can grasp and apply to their lives in a meaningful way. And there are several different ways that you can think about risk. So, for example, we often talk about how a certain behavior

might increase your risk of a poor health outcome by a certain percent or by a certain factor. risk of a poor health outcome by a certain percent or by a certain factor. And so what does that look like in terms of alcohol? Let's say I drink six drinks a week, which I kind of do, versus someone who has a drink or two a week. Tim told me that by having those six drinks, I've increased my risk of dying prematurely from some alcohol-related cause by a factor of 10. Wow. Compared to someone who just has like a drink or two a week. Now, that sounds really dramatic. Like, whoa, I'm increasing my risk of dying from some, you know, alcohol-related cause by 10 times.

Right. But even still, it turns out that if I drink those six drinks a week, the risk I was facing of dying from an alcohol-related cause was still quite low. On average, that lifetime risk is like 1%. So for me, at this stage in my life, my risk of dying generally is pretty low, knock on wood. And so really any incremental added risk on top of that is going to be quite low as well. Okay, if I'm getting this right, if you drink six drinks a week, you are 10 times more likely to die from any alcohol-related cause than someone who drinks less, which sounds bad. But in reality,

that just brings your risk up to 1% total. So you're still relatively unlikely to die from those causes. That's right. Now, that number, when you apply it across the population, it really is meaningful because if many, many people's risk of dying goes up by a factor of 10, that is a lot of people dying.

But on an individual level, some people might still find that number reassuring. And there's other ways to think about it on an individual level, too, to think about risk that way. Tim told me that you could also look at risk in terms of trying to figure out the amount of time that, for example, drinking a certain number of drinks might shave off your life on average. Like, what is drinking due to life expectancy? Okay, that seems like a great question, and I, for one, really want to know the answer. Basically, he told me that for people who have

about two drinks a week, they're going to lose, on average, less than one week of their life. For people who have around seven drinks a week, they're going to shave maybe two and a half months off the end of their life. Now, when you get to five drinks a day, now you're talking about upwards of two years of lost life. All these things, to be sure, are averages. So, you know, it's not like you can take that information and go to the bank. You could be the person who loses many more years of life or weeks of life or months of life, but this is the average. Right. And I mean, if you're someone who's a more casual drinker, you're drinking, okay, seven drinks a week. That's a, you know, a glass of wine every night with dinner, maybe. We're talking about two and a half months of life shaved off here. I'm wondering, Sue, what you thought

when you heard that? I was like, great. I was extremely relieved. I thought, I'm not going to, like, no, I'm just not going to worry about this. If I want to reach for a glass of wine, I'm going to. It's just not something I need to think about in this kind of way. I mean, that's kind of what I was thinking, too. Yeah, I understand that. I mean, again, when you take those weeks and you apply them across a population, that is many, many, many, many years of lost life across the population. But for you individually, maybe a population, that is many, many, many, many, many years of lost life across the population. But for you individually, maybe it's not that bad. And that's how I started to think about it until I started to really dig into my own relationship to alcohol. What were

the benefits of it for me? What were my own other risks? You know, risk is very individual. And I myself know already that I am at increased risk for breast cancer because of my family history. So given that I already have an elevated risk of breast cancer, and we know that alcohol consumption is linked to increased risks of breast cancer, do I want to compound whatever risk I already have that's higher than I would like it to be? That actually doesn't make that much sense to me personally. And obviously, alcohol is very addictive. You never know if you're going to become the person who suffers from an alcohol addiction. And obviously, that is something that ruins many people's lives. Right. So you're saying that obviously, alcohol is not the only risk that we have. And we kind of have to look at it in context of all the other health risks we have as individuals, which might really complicate things. It's not just those, say, two and a half months off your life that we're talking about here.

It's complicated. And it gets even more complicated if you go beyond thinking about the risks of alcohol to yourself, but if you think about it in terms of the collective harms. So we know that alcohol consumption is highly associated with all kinds of social ills, with sexual assault, domestic violence, dangerous driving. Obviously, alcohol is present in a shockingly high percentage of these kinds of incidents. And even when you have not that much alcohol, like let's say you have a drink or two, you know, you are more likely to make that dangerous left turn or, you know, not to notice that the baby has a marble in her mouth. So it's not just the risk that you pose to yourself, but also what is the increased risk of your harming someone else? At this point, it sounds like you're trending pretty negatively toward drinking. I mean, I can go there all the way. You know, I clearly have thought through what those negative

outcomes are from drinking. But I also, as I've been reporting this piece, have really had a lot of conversations with people about how, you know, alcohol is not just a negative cultural force. Just a couple of nights ago, I was talking to some friends who are both doctors, and they were really encouraging me to remember the friendships that have come over, you know, a few drinks. I mean, certainly many, many romances may never have gotten off the ground without a drink or two. One friend of mine pointed out to me that like alcohol actually has played a pretty big role in like lots of historic international diplomacy. And that's because it helps people lower their inhibitions. And that can be bad, but can also mean leaving behind some of your worries or it can make you more open to something

new or to connecting, you know, there's the drink after work. I remember in my 20s being in a work environment that was, we're not in a great place. There wasn't a lot of bonding going on. A lot of people were new and young. And one night we all went out and everybody had a drink together. And like, obviously things can go very wrong in those kinds of situations. But in this case, I actually do think it kind of changed the office dynamic

for the better going forward. Right. I mean, there's the long summer days by the pool, the long holiday weekends with friends, the karaoke. Yeah, I think that is exactly right. I mean, also, you know, for some people, really fine wine, I mean, this is not me, I can't tell the difference among any of them, but really fine wine represents for some people the height of what human civilization can produce. You know, there's just this absolute appreciation for the taste of wine. So, Sue, you've gone on this pretty big journey here. It sounds like you have weighed your individual risks against these collective harms. You've looked at the idea that alcohol has some benefits in your life. Where does all of this land for you? You know, I didn't feel like, okay, I must abstain altogether forever. But I did end

up resolving to drink less. I, you know, I'm a drink at night kind of person, and I definitely resolved to cut back. And yet I am surprised to find it is hard to cut down on my drinking. For example, not too long ago, I ended up at a party and it was like a really hot night and I had resolved not to drink because I'd had a drink the night prior. But when I got there, I actually could not find a non-alcoholic beverage. And it's a million degrees out. There's only wine and mixed drinks available. Like, what are you going to do? I had a drink.

And at the same time, I think part of why I didn't resist even further was that it was a party. And I was a little bit nervous. And I felt a little bit better with that drink in my hand. Yeah, your plan to drink less in that moment sounds like it ran squarely up against both practical realities and social conditioning, centuries of social conditioning around how we interact with each other. Yeah, and I started to see drinking as almost something that was quite, when people reach for a drink at a party, for example,

it's a sign that they are looking to connect, you know, that they're looking to let down their guard, that they're looking to enjoy the socializing that's happening there. And when people reach for a drink, that's another way of saying, like, I want to be in this moment with you and turn off the part of my brain that is worrying or self-conscious. And then you think, okay, but like, wouldn't it also be great if we could all somehow be comfortable enough in our skins to be able to have those moments, to let down our guards, to be our most relaxed selves without a drink? Yeah. It's like, on the one hand, seeing someone reach for a drink,

it kind of points to their vulnerability, their desire to connect in that moment. And on the other hand, should we all just be investing more in therapy maybe than drinking? It's probably better foropening, Sue, about your reporting here is that it gives us an answer to this question that's been asked and unanswered for so long that's been nagging at us. And that's, what is the price of the pleasure that alcohol gives so many of us? And do we want to pay it? And do we want to pay it? Well, for one thing, I think I've come to understand that this really is a pretty personal decision that people have to make kind of for themselves, almost on the order of like, how do people think about money or saving or spending?

And everybody also has different tolerance for risk. So, I mean, for me personally, I started out this reporting partly because I just had this like general vague bad sense whenever I was reaching for a glass of wine. But now I feel, in a funny way, a little bit more in control of that choice. Thank you so much, Sue. Oh, my pleasure. Thanks for having me on the show. We'll be right back. Here's what else you should know today. Here's what else you should know today. President Biden spoke to a group of Democratic governors on Wednesday, telling them he was staying in the race, but needed to get more sleep, work fewer hours,

and avoid events after 8 p.m. The meeting with the governors was intended to reassure more than two dozen of Biden's most important allies that he's still in command of his job and capable of mounting a strong campaign against Trump. Several governors were disappointed there wasn't more discussion about whether Biden should continue in the race, even though none of them directly told Biden that he should drop out. And Britain's Labour Party won a landslide victory in the UK election on Thursday, ousting the Conservative Party that has been in power for the last 14 years.

It was the worst defeat for the Tory party in its nearly 200-year history. Many voters said they were fed up with the government because of a struggling economy, increasing dysfunction within the public healthcare system, and a rise in immigration. The new prime minister, Keir Starmer, has promised a fiscally prudent center-left government, quote, in the service of working people. Today's episode was produced by Stella Tan and Diana Nguyen, with help from Alex Stern. Thank you. and Dan Powell, and was engineered by Chris Wood. Special thanks to Alice Callahan. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderly. That's it for The Daily. I'm Natalie Kitcheroff. See you on Monday.