 Why do we not see the corporate interests of the alcohol industry as clearly as we see those of the tobacco industry? Well, the alcohol industry has waged a sophisticated and successful campaign of the last few decades undermining perceptions of the extent of alcohol-related harm to health by framing the argument as a balance of benefits and harms. Yes, alcohol may be an intoxicated carcinogen increase in cancer risk, but what about reducing heart disease risk? Policymakers hesitate to introduce effective alcohol policies or even to support the addition of warning labels for fear they might undermine or contradict any possible health benefits of alcohol use. After all, alcohol consumption clearly raises HDL, the supposed good cholesterol. But sadly, as I've already explored, HDL is no longer considered protective, based on part of so-called Mendelian randomization studies where having a high HDL your whole life doesn't appear to help. Whereas a lifelong reduction of bad cholesterol, LDL, just thanks to luck of the draw genetics, does indeed decrease heart disease risk. So the boost in HDL from alcohol may not matter. And if you look at subclinical markers of atherosclerosis like the thickening of the wall of your crotted arteries in your neck, those that abstain from alcohol completely seem to be at the lowest risk. And the same with coronary calcium scores, where in general the lower the alcohol consumption, the lower the risk. And alcohol bumps our blood pressure up a bit as well, which would be expected to raise, not lower our cardiac risk. So where do we get this idea that alcohol was good for us? From the famous J-curve. Check it out. If you follow large populations of people over time in general, the more people drink, the higher their risk of dying prematurely. The lowest risk, those who tend to live the longest, were not those who drank zero, the abstainers, but those who drank moderately like one drink a day. That's why you get some folks recommending that physicians should counsel lifelong non-drinkers to take up the habit. I'm sure there are statin drugs, but alcoholic beverages don't require a prescription or far cheaper, and certainly more enjoyable. Is moderate drinking really protective? Or is there just something about people who abstain completely from alcohol that puts them in a higher risk category? The reason we suspect something fishy is going on is that abstainers seem to be at higher risk of a whole swath of diseases, including, ironically, liver cirrhosis. Compared to lifelong abstainers, those who have never touched the stuff, men and women drinking a little appeared to have less liver cirrhosis. Wait, what? How could a little drink be linked to lower rates of liver cirrhosis? Well let's think about it. What makes more sense? That drinking led to less liver cirrhosis, or liver cirrhosis led to less drinking? In other words, reverse colonization, the so-called sick quitter effect. If you look at studies of smokers, sometimes you see higher mortality rates among those who quit smoking compared to those who continue smoking. Why? Because the reason they quit smoking is because they got sick. So of course, sick people die more often than less sick people. That's why when you classify someone as a non-smoker in a study, you have to make sure they're a lifelong non-smoker, not just a non-smoker since last Tuesday. Yet unbelievably, that's not what they do in most alcohol studies, where instead they misclassify former drinkers as if they were lifelong abstainers. And look, individuals with poorer health are more likely to cut down or stop drinking completely, thereby making current drinkers look good in comparison to those who drink zero. Some of the abstainers are just abstaining because they got sick and stopped. OK, so what if you went back to all those studies and corrected the misclassification, separate out the former drinkers from the lifelong abstainers? We didn't know until now. They indeed found drinker misclassification errors all too common, plaguing three quarters of the studies, and when they controlled for that, the J-curve disappeared. The death versus alcohol relationship became more consistent with a straight line, you know, linear dose response, meaning more alcohol, more death, no protection at low levels of consumption. So no apparent benefit of light to monitor drinking after all when you use better comparison groups. Although these results are not what the majority of drinking adults made desire to believe, the public deserves to hear and to read in a more complete and balanced detail the ever-growing evidence that drinking alcohol is very unlikely to improve their health.