The conflict between public health goals and the temperance mentality

Objectives. The prevailing view today is that alcohol consumption is unambiguously a social and public health problem. This paper presents evidence to balance this view. Methods. Evidence of beneficial effects of alcohol against coronary artery disease is examined, together with cultural reasons for resistance in the United States to the implications of this evidence. Results. Alcohol use reduces the risk of coronary artery disease- the major cause of heart disease, America's leading killer-even for those at risk for such disease. Moreover, recent research indicates that alcohol continues to reduce risk at the higher levels of drinking measured in general populations. However, with consumption of more than two drinks daily, these gains are increasingly offset by greater mortality from other causes. Conclusions. Educators, public health commentators, and medical investigators are uneasy about findings of healthful effects of drinking. A cultural preoccupation with alcoholism and the negative effects of drinking works against frank scientific discussions in the United States of the advantages for the cardiovascular system of alcohol consumption. This set has deep roots in American history but is inconsistent with public health goals.