title: Ought low alcohol intake to be promoted for health reasons?
abstract: There is increasingly widespread acceptance that alcohol taken in moderation by the population aged 35 years or older reduces the risks of ischaemic heart disease and all-cause mortality. Ten causal criteria are used to evaluate the scientific evidence for a protective effect of low alcohol intake on ischaemic heart disease. Inferences for public policy are then assessed using the principles of beneficence, non-maleficence, justice and autonomy to support a framework of nine ethical considerations: intervention versus causation; effect modification by gender, smoking, biogenetic and other factors; inappropriate adoption of recommendations; competing hazards between atherosclerotic disease and cancer; opportunity cost; equity of access; the value system used to judge outcomes; the degree of social influence warranted; and consent and responsibility. We conclude that in the absence of more adequate scientific knowledge and informed community debate it is unethical to promote low alcohol intake as a preventive health measure.
authors.affiliation: Department of Public Health, University of Western Australia, Nedlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Holman
authors.forename: D R
authors.initials: DR
authors.lastname: English
mesh_terms: D000428:Alcohol Drinking; D001315:Australia; D004992:Ethics, Medical; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D017202:Myocardial Ischemia / Q000517:prevention & control*