The politics of drinking
             January 13, 2025

Whatever happened to the J-shaped curve?

This article first appeared in the Propel Info newsletter on April 28. 2023

At the fag-end of the 19th century, when the temperance movement in the UK was about to reach its zenith, a Dr Joseph Mortimer Granville wrote to The Times declaring that, on the contrary, people weren’t drinking enough. Abstinence and moderation were, in fact, making them ill.

His letter was unearthed a few years ago by geographer-of-drink James Kneale, who speculated that Granville was courting controversy to win friends and drum up business, like an early celebrity medic – and he did subsequently put his name to adverts for port wine. Kneale, by the way, does not believe that Granville did what he is most famous for, which is inventing the vibrator.

The idea that alcohol might be good for you didn’t go away though. From the 1970s, it has circled around research that suggests taking a certain amount of drink is protective against heart disease – presented graphically as a J-shaped curve in which the left point of the J are abstainers who are dying younger than those who drink – but not too much.

That theory is fiercely contested, and a thoughtful article by science journalist Tim Requarth in American online magazine Slate this week wonders whether the curve has been flattened for good by growing evidence of the link between drinking and some cancers.

The culprit here is not alcohol itself but acetaldehyde, a chemical produced by the body as a by-product of metabolising alcohol, something that humanity’s ancestors evolved to do some ten million years ago to enable them to eat rotting fruit on the forest floor. At least according to the ‘drunken monkey thesis’, which sounds good to me.

So, while scientists might accept the J-shaped curve applies to heart disease, its benefits are outweighed by the cancer. That view lies behind Canada’s decision earlier this year to not only tighten its recommended drinking guidelines, but to assert that because alcohol/acetaldehyde is a known carcinogen, there can be no safe level of alcohol consumption.

This was already the World Health Organisation’s position, but Canada’s move caught the headlines. You can spend a lot of time and effort picking apart the data behind this. In short, it remains contested. I’m not going to go there, but I’ll make some general points.

My first thought is that the ‘no threshold’ argument, if you really mean the tiniest amount is dangerous, seems daft. Alcohol is present in all kinds of daily foodstuffs, from bread to fruit. You can’t avoid it. It also sounds like a bad position for the medical profession to take. I do think guidelines can be helpful when someone is damaging their health by drinking too much and needs to cut down. Telling them the only hope is to abstain completely is not going to play well.

And the risk for moderate drinkers of contracting alcohol-related cancer is very small. Requarth points out that, “if 143 middle-aged men drink once a day, there might be, in the near-term, one additional death”. Bad luck, of course, if you’re that one. But it puts the argument into perspective.

A bigger problem with epidemiological studies is that they rarely take into account social contexts. We know nothing about the behaviours behind the numbers, the way people drink. Health is not just about what you put into your body, and assessing the impact of drinking goes beyond chemical reactions. We are not lab rats.

And we know that social interaction is vital to our well-being. Going to the pub is a healthy thing to do. The interesting puzzle is, does that have to involve alcohol? Can we remove it and get the same benefits? Now that would be an anthropological question, as Father Jack might say. It must be significant that where human beings began to live in settled communities, around 10,000 years ago, we also find evidence of brewing and of places where people could gather, much like a pub.

Perhaps we have always known that our essential society with others – conversation, a bit of singing and dancing – is lubricated by a drop of some mild, disinhibiting, psychoactive substance. And it seems to me that the social benefits make for a better argument than a purely medicinal one when it comes to defending drinking against those who would curtail our pleasures.

I just don’t think the battle for the J-shaped curve is winnable any more than Joseph Mortimer Glanville’s quackery. Claiming that booze is medicine can perhaps win you friends, but how are you going to get people, each of whom react differently to it, to take the precise dosage required? Arguing about alcohol without understanding drinking as a social activity is going to get you nowhere.

Phil Mellows, April 28, 2023

Previously:

Whatever happened to the J-shaped curve?

No beef, but….   

Folk devils and nitrous oxide

The joy of loitering

The return to the local

Larry Nelson and the challenge of trade journalism

What we'll be losing if pubs disappear

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