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A contextually and scientifically flawed British medical paper released on Feb. 24 could frighten women away from moderate alcohol consumption and — ironically — cause many of them to die prematurely of cardiovascular disease.
The sensational article, based on the study “Even moderate drinking affects women’s cancer risks,” made global headlines by warning that:
“Drinking just a glass of wine a day increases women’s risk of breast cancer, as well as several other types of the disease, a new study concludes. The research, carried out among more than a million UK women, says that alcohol accounts for 5,000 cases of breast cancer every year.
ARTICLE, PAPER OMIT VITAL INFORMATION
Both the syndicated newspaper article and the actual medical paper omitted the vital scientific fact that scores of peer-reviewed studies, published over the past 20 years agree unanimously that people who consume alcohol in moderation live longer than either abstainers or heavy drinkers.
This longer life span, according to the research, comes from a 30 to 50 percent drop in deaths from cardiovascular disease — the number one killer in the developed world.
Moderate consumption is usually defined as one drink per day for women and one or two for men.
UNETHICALLY GLARING OMISSION
The most glaringly unethical omission appears near the end of the article — written by syndication staffers of BMJ Publishing Group, a company which also owns the British Medical Journal.
Under the headline: “What does this mean for me?” the article states:
“Just about everything we do has risks. We can’t avoid risks altogether, but knowing about them can help us make decisions we are comfortable with. It’s been clear for some time that alcohol is a factor in women’s risk of getting cancer, especially breast cancer. This latest study puts some figures on that increased risk. You may find that this helps you decide whether you are happy with the amount of alcohol you drink.”
Of course, valid behavioral decisions need to be based on a consideration of all risks and benefits. By raising the question of what this study’s finding’s meant for individuals, they raised the obligation to provide context regarding overall death rate by failing to present their study in context, this article only frightens readers without informing them.
FACTUALLY INACCURATE AND UNWARRANTED CONCLUSION
In addition, the article’s statement that: “It’s been clear for some time that alcohol is a factor in women’s risk of getting cancer, especially breast cancer….” is false.
Actually, it has NOT been clear. Research does not support this conclusion at all. In fact, the research over the past 20 years has all been equivocal, with some studies — like the current one — finding a connection and many others not.
The Framingham Heart Study and the U.S. Women’s Health Study are among those finding no connection.
Unlike the extensive body of research consistently finding the connection between moderate consumption and longer life, no such consensus has emerged with regard to cancer.
LIES, DAMNED LIES AND STATISTICS
The syndicated newspaper article, based on work published in the BMJ’s Journal of the National Cancer Institute, aptly illustrates Mark Twain’s adage that there are three kinds of falsehoods: lies, damned lies and statistics.
Like it or not, all the data available on health and moderate alcohol consumption are based on statistics and a discipline known as epidemiology. The connections between smoking and lung cancer, high cholesterol and heart disease and other now-well-known phenomena were first made through epidemiology.
TEASING TRUTH FROM STATISTICS
As the cigarette companies persuasively argued for decades, statistical indications are not conclusions on which personal health decisions can be made. It’s one of the few truthful statements they ever made.
But how do you know if a conclusion can be reasonably warranted? Epidemiologists offer three solid indicators:
1. Is the data consistent from study to study? Do the vast majority reach the same outcome?
2. Is there a valid physiological, biochemical or other scientific mechanism which could explain the phenomenon and outcome?
3. Does a “dose-related” pattern emerge? An effective medicine, aspirin for example, shows a small effect when small amounts are taken, a better effect when more is taken and then negative side effects when too much is taken. This shows a direct connection between the data and the phenomenon being investigated.
THE CANCER LINK FAILS THE THREE-STEP TEST
The article currently making global headlines, along with others looking for connections between cancer and moderate alcohol consumption fails the three step test.
The body of studies are equivocal, no plausible physiological mechanism has been established and no does-related phenomenon has been established.
In fact, the “no safe level” of exposure conclusion from the study seems to put women’s moderate alcohol consumption into the same category as cigarette smoking and nuclear waste.
IS THE MODERATE CONSUMPTION-BREAST CANCER LINK A STATISTICAL ARTIFACT?
Some data suggests it is an artifact resulting from the education and socio-economic patterns of women’s alcohol consumption.
This is the conclusion of a team of Veterans Administration physicians lead by Dr. Randall P. Harris, M.D., Ph.D., of the American Health Foundation. In a chapter on breast cancer and moderate consumption, my 1992 best-seller, The French Paradox and Beyond, I reported:
“Their logic goes as follows:
(1) Alcohol consumption increases linearly with education. Only 39 percent of women with less than nine years of education call themselves drinkers; that rises to about 70 percent for women with 16 years of education.
(2) Well-educated women most often postpone pregnancies, often into their late 2Os and 30s; less-educated women frequently have children in their teens.
(3) Breast cancer risk increases as the onset of the first pregnancy is postponed.
Therefore, the increased risk of breast cancer may be due to the postponement of pregnancy among educated women — who tend to drink more and postpone pregnancy - and not to alcohol consumption (which is perhaps only indirectly and not causally related).
Supporting this hypothesis is the fact that almost all of the studies which showed a positive relationship between alcohol and breast cancer showed the highest risk among thin drinkers.
This is at odds with general data that shows obese women to be at higher risk for breast cancer. The explanation? Highly educated women (who drink more and who postpone their first pregnancy) tend to be thinner than less-educated women. Thinness, then, is also indirectly (but not causally) related to breast cancer.
However, thinness could be related in another way. The same amount of alcohol consumption would produce a higher level of blood alcohol in thin women than in those who are larger, thus accentuating the effects of alcohol.
Science simply has no conclusive answer on these hypotheses.
ENTIRE FRENCH PARADOX BOOK ONLINE FOR FREE
After four printings and more than 100,000 copies sold, The French Paradox and Beyond is out of print. Astonishingly, none of the book’s conclusions have been overturned by science in the years since it was first published.
Indeed, the evidence has grown stronger for the cardiovascular effects, and new research has shown even more positive effects of moderate consumption, including those for Alzheimer’s, osteoporosis and more.
The book is free, but still under copyright. If you use portions, I ask only that you credit the source and provide a link to it (http://www.french-paradox.net/) to allow others to use it as a resource.
Part 2: Study of UK Cancer-Moderate-Consumption Paper Shows Fundamental Flaws In Data, Sample Selection, Methodology
A NOTE: Most of the author’s courses in college consisted of math, physics, biology and other sciences. The author, Lewis Perdue, is on a first-name basis with both the science and the mathematics associated with this and similar studies. He graduated with distinction from Cornell University. He finds junk science offensive.
Further, Perdue does not make wine, sell wine or have any connection to any company selling wine or any form of beverage or product containing alcohol. And rather than cozy up to the industry, he spent most of the 1990s angering many in the wine business with his persistent reporting and does not plan to alter that behavior.
Posted by lperdue on Feb 26th, 2009
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