Getting beer into perspective

As my friend and colleague, Michael Lewis, is wont to say: 'There is nothing so disgusting as a drunken brewer.' I would go further, for the state of drunkenness is neither pretty nor conscionable in anybody. It is socially unacceptable, ugly and dangerous.
Stuttaford (1997) tells of how medical students memorise the various stages of drunkenness: 'dry and decent, delighted and devilish, delinquent and disgusting, dizzy and delirious, dazed and dejected, and dead drunk'.
Excessive consumption of alcohol can be fatal. At the very least it can lead to an unfortunate lack of inhibitions. Most extensively publicised of course are the incidences of drunken driving. There is no question that consumption of alcohol and driving do not mix. The legally permitted levels of alcohol consumption vary considerably between countries. The safest option is to avoid alcohol completely when intending to drive. Interestingly, alcohol appears to play a part in 15% of fatal crashes in the UK where the legal drinking age is 18, but more than 30% in the US where the legal drinking age is 21 (Barr 1999).
There is ample evidence that drinking any alcoholic beverage to excess is harmful. However, so too is the overconsumption of any dietary component or the pursuit of many activities to excess.
It is a fact that drunkenness has been around for millennia (Roueche 1960). The Chinese Shu Ching from about 650 BC said that:

Men will not do without kiu (a beer made from millet or rice). To prohibit it and secure total abstinence from it is beyond the power even of sages. Here, therefore, we have warnings on the abuse of it.
The Mongolian chief, Genghis Khan, stated:
A soldier must not get drunk oftener than once a week. It would, of course, be better if he did not get drunk at all, but one should not expect the impossible.
Such pragmatic approaches sit uncomfortably with a good many people. However, in a mature and far-sighted society, it is only by confronting these issues that rational and realistic solutions and practices will emerge.
It is relevant at this point to consider statistics concerning drunkenness and instances of drink-related driving. Table 1.4 highlights that the current situation in the UK is far healthier in respect of all drunkenness offences than 25 years ago. Furthermore, the number of drivers involved in accidents that register above the legal limit for alcohol
has remained around 2% of the total number involved in accidents since 1990 and is half the level of 25 years ago (Table 1.5). Incidentally, Skynet Webmagazine in May 2002 reported how the use of a mobile telephone (even a hands-free phone) presented a greater risk during driving than the consumption of up to two drinks. This should not be construed as an acceptance of even moderate alcohol consumption before driving - zero intake will always be the best option for those intent on such an activity - but rather highlights that there are other even more potent dangers that do not attract the same focus or emotion.
Alcohol, though, raises passions to an extent wholly unlike most other components of the diet. It is anathema to some that a broad kirk within the world of medicine should be alerting society to the bene ts to be had from including alcohol in the diet in moderation. Moderation should surely be the byword for all parts of our menu.
Lord D'Abernon, editor of the early twentieth-century study championed by the British Medical Research Council, Alcohol: Its Action on the Human Organism, exclaimed:
Alcohol is an ungrateful subject. Most people who are interested in the subject are already partisans on the one side or the other, and no body of impartial opinion exists which is ready to be guided by scienti c inquiry. The majority of those who would give any attention to original work on the subject would do so less to gain knowledge than to nd arms and argument to support their preconceived opinion. Roueche (1960)
Current evidence about lighter drinking and health suggests that:
(1) The case is now quite strong that, for persons, at risk of coronary heart disease, there is an optimal amount, not just a safe amount of drinking.
(2) This bene t of alcohol operates by reducing the risk of the commonest kind of heart disease - coronary heart disease.
(3) We cannot yet de ne precisely the optimal amount of alcohol but that it is below 3 drinks per day.
(4) It doesn't seem to matter what type of alcoholic beverage is taken.
Subsequent research from Klatsky's laboratory and various other researchers have re ned these statements, but their fundamental accuracy is unchanged.
Another major player in the eld has been Dr Norman Kaplan from the University of Texas Southwestern Medical Centre, who wrote in the American Heart Journal:

I nd nothing wrong or unhealthy about my current practice - a beer or two after a heavy tennis game or a glass or two of wine after dinner...
One last argument sometimes used against all alcohol consumption is that, even if moderate alcohol consumption is healthy, physicians cannot condone it because this condones heavier use and may even encourage those who now drink in moderation to become addicted abusers.
Dr Kaplan certainly hits the nail on the head, for there are so many who cannot seem to recognise that it is possible, indeed the norm, to consume alcohol in moderation. It is no more reasonable to advocate the elimination of alcohol consumption than it would be to lobby for the elimination of football because some people deliberately set out to critically injure opponents, or the avoidance of prescription medicines because some people overdose.
Aspirin in regular small doses is a lifesaver. In excess it can be a killer. The same applies to alcohol. A dear friend of mine takes an aspirin a day to counter the risk of heart disease. He is roundly applauded for his conscientiousness and it is implicit that he would never take more than his prescribed ration. The evidence is increasing that a pint or two of beer per day may be just as ef cacious. Rather fewer people would approve if he swapped his aspirin for the beer, despite the fact that the beer has nutritional value absent in the aspirin. And, whereas everyone will naturally assume that he will know not to get heavy-handed with the aspirin, some will just as automatically assume that he won't know when to put down the bottle of booze.
Preventing reasonable-minded folk from drinking to their customary moderation is just as illogical as banning chocolate because some people pig out on it, or dispensing with kitchen knives because there is an occasional person predisposed to insert them into friends and neighbours.