Should Doctors Prescribe Alcohol to Adults?

There's no more emblematic standard of good health in the United States than the food guide pyramid. Often seen printed on cereal boxes and taught in school, it's widely recognized if not well followed. The pyramid advises Americans to eat lots of grains and fruits and vegetables, some meat and dairy, and a small amount of fat and sugars. One day soon, it may advise adult Americans to have a drink of beer, wine, or spirits every day as well. The idea isn't as radical as it may seem. Policymakers at the U.S. Department of Agriculture and Department of Health and Human Services are reconsidering their stance on alcohol—which in the past has consisted of mentioning the possible health benefits of alcohol while emphasizing the adverse effects—as they update the U.S. dietary guidelines. Now, with the policy experts talking ever more seriously about endorsing moderate drinking for adults, is it time for physicians to consider selective prescription of alcohol for patients?

One third of U.S. adults abstain from alcohol, according to a Gallup poll, and as a result they miss out on the health benefits of alcohol. Epidemiologic evidence from more than 100 papers over the past 3 decades has shown that moderate alcohol consumption helps prevent heart disease, the leading killer in the United States (710 000 deaths annually). Other health benefits include reduced risk for ischemic stroke, peripheral vascular disease, dementia, diabetes, and osteoporosis. Of course, alcohol can also be dangerous. Alcohol is linked to more than 100 000 deaths every year, from accidents to liver disease to violence to stroke. Some studies have linked it to an increased risk for breast cancer in women. Alcohol abuse among teenagers is a major concern, and alcoholism afflicts more than 8 million adults. Furthermore, some people appear to be genetically predisposed to …