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Critique 167: What determines a person’s belief that “alcohol is heart-healthy?” — 22 July 2015

This paper, based on data from more than 5,000 adults participating in an internet-based survey, sought to determine what were the perceptions of subjects on the relation of alcohol to heart disease, and how these perceptions resulted in particular behaviors related to alcohol consumption. Partricipants for the survey were recruited by a variety of methods, including announcements “in the lay press, promotional events, word of mouth, social media, e-mail, and clinic visits.” While the goal of the study is commendable, the results of any such survey obviously depend on many social and cultural factors of the people who respond to the survey; it was not a random sample of the population used in this analysis. This is critical because an interpretation of the data requires an understanding of the population surveyed.

Forum members had other concerns about this paper, including the specific survey questions regarding the perceptions of alcohol effects. For example, the key question asked in the survey was “Do you believe alcohol is good for your heart?” Forum members pointed out that it is obvious to nearly everyone that this cannot be answered without quantifying the amount of alcohol or the pattern of drinking. They consisdered that a more appropriate quesiton might be something such as “Do you believe that the moderate consumption of alcoholic beverages can benefit your heart?”

The authors make statements such as “Participants perceiving alcohol as heart healthy consumed 47% more alcohol.” This may sound alarming until it is revealed that the observed difference was from a baseline of 0-3 to 1-5 glasses of wine/week and from 1-7 to 2-8 total drinks/week. These higher amounts are not ‘alarming’ at all, and in fact fall within usual guidelines for “sensible drinking.”

Forum members were particularly upset that the authors misquote a number of scientific papers to support their claim that even low levels of drinking increase the risk of certain diseases. The authors also use such misrepresentations of data to justify their concerns that current guidelines for alcohol consumption may not be appropriate. Forum reviewers found it especially disturbing that the peer review process by the journal failed to uncover such misrepresentations of data.

The authors repeatedly give the impression that they are against any amount of alcohol consumption. They do not comment on the consistent findings in almost all well-done prospective studies indicating that moderate drinkers live longer than abstainers. Further, statements by the authors that suggest that people who think that alcohol is heart healthy are misinformed does not stand up to scientific data, which indicate that moderate and responsible drinking is associated wtith better health and longevity.

It is interesting that the report indicates that older, higher-income, and more highly educated subjects are more likely to consider alcohol to be heart healthy than younger and less-educated subjects. While a question was asked by the investigators as to whether or not the responder’s perception of the health effects of alcohol influences their decision to drink or to not drink, the specific responses to this question are not presented in the paper. It remains unclear to what extent beliefs about alcohol’s potential health effects relate to alcohol use or, more importantly, to alcohol abuse.

Overall, Forum members thought that the idea behind this study was of interest, but emphasized that it is important to collect data based on a random and well described sample of the population if one is to provide significant and understandable results. Further, the report is compromised by what appears to be a deliberate misrepresentation of the prior scientific literature to support the authors’ contention that alcohol is not healthy; there are a number of obvious errors that should have been detected during the review process by the journal. In the opinion of the Forum, the most reliable result from these analyses relates to where people obtain their information regarding alcohol and health: it does not come from physicians or scientific publications, but primarily from the lay press.

Reference: Whitman IR, Pletcher MJ, Vittinghoff E, Imburgia KE, Maguire C, Bettencourt L, Sinha T, Parsnick T, Tison GH, Mulvanny CG, Olgin JE, Marcus GM. Perceptions, Information Sources, and Behavior Regarding Alcohol and Heart Health. Am J Cardiol 2015; pre-publication. http:// dx.doi.org./10-1016/j.amjcard/2015.05-029. For the full critique of this paper by members of the International Scientific Forum on Alcohol Research, please click here.

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