International Journal of Epidemiology 2002;31:1287-1288
© International Epidemiological Association 2002
Book Review |
Bacchic Medicine. Wine and Alcohol Therapies from Napoleon to the French Paradox.
Harry W Paul. Amsterdam, New York: Editions Rodopi, 2001, pp. 341, US$28, EUR 30 (PB) ISBN: 90 420 1111 4; US$75, EUR 80 (HB) ISBN: 90 420 1121 1.
I looked forward to reviewing this book because the title suggested that it would be taking a critical look at not only the history of wine and alcohol as therapeutic agents, but also at the current and widely accepted (‘established’) view that alcohol in moderate amounts is positively beneficial to health in general and to the cardiovascular system in particular; a view about which I have serious reservations. I had expected to be informed about the past but not entertained, and so I was pleasantly surprised to be presented with a well balanced story, told with a sharp eye, on the social, political and scientific aspects of both past and present endeavours in this field. This contribution to the Wellcome Series in the History of Medicine is written with learning, with humour, with some sarcasm and not a little irony (I did not know that academics did irony!). The author is a professor of history (Florida), with a special interest in the development of science in France, and he presents a highly readable analysis of the machinations of all those involved in the pursuit of the ‘truth’ about alcohol in general, and wine in particular, in relation to health and disease. You will get the measure of the man from his story of the role of wine in popular (folk) medicine and it is difficult not to rise to the shock quality of phrases such as ‘Wine occupied a position of considerable significance within the therapeutic arsenal of popular medicine; it was nearly as important as shit, and was indeed often used as a vehicle for this valuable item of popular materia medica’. Wine as a symbol of blood seems poor stuff by comparison.
From the popular to the professional therapeutic modes of the 19th century in France and Germany, where alcohol and opium became pleasant and efficacious substitutes for purging, vomiting and bleeding. Specific wines were given for specific purposes and with due regard to the temperament and social standing of the patient, but overall, red wine remained, as it does today, the favourite of the medical profession and even in the 1800s, doctors played a critical role in fostering a highly positive image for the consumption of red wine.
Throughout the 19th century there was fierce debate in France and Britain regarding the medical reputation of alcohol and it was not until the end of that century that alcohol therapy came to be regarded as ‘one of the great errors in the history of medicine’. The emphasis then shifted from the role of alcohol in therapy to an issue we are still debating, namely the effect of light to moderate drinking on health. For those with no awareness of the long history of the current debate and whose knowledge of the literature is limited to recent publications, it will be highly educational to read about the past! French and British wine therapies are dealt with in entertaining detail and it is refreshing to know that the English doctors essentially agreed with Louis Pasteur that the English working class should be persuaded to drink pure and pasteurized wine, thus adding a good food to their diet.
For at least 100 years the issue of whether wine is good or bad for the health of the drinker has been keenly debated in scientific, industrial and political spheres with considerable overlap in these several areas of activity by the participants. The attempts to establish the scientific basis for an ancient remedy have been hard fought with considerable support for the superiority of wine over beer or cider and certainly over spirits. Research reporting the beneficial effects of moderate wine drinking were well covered in the medical and popular press, while reports dealing with negative aspects of alcohol consumption received little attention. Nothing seems to have changed! The role of the medical profession in all this was not beyond reproach and doctors have always been prominent among the privileged consumers of good wines, and the organizers of societies designed to promote the virtues and benefits of wine drinking have never been short of vigorous medically qualified supporters.
We come to the past 50 years and the increasing scientific evidence for the role of wine as an antiseptic and bactericidal agent and, in the 1950s, the discovery of flavonoid phenolics (polyphenols) in red wine. On to the use of wine in treating hypertension and heart disease and then to the possibilities of preventing the development of atherosclerosis by regular wine consumption. It is intriguing to realize that the scientific studies on the effects of wines’ constituent elements preceded the later epidemiological studies supporting the protective effects of alcohol in general and wine in particular. There is a vigorous, balanced but brief review of the ‘French paradox’, enlivened by the information that ‘only 28% of French men and 11% of French women drink wine regularly and only half French adults drink wine at all’!
The payoff for a reviewer is the opportunity to ride their own hobby horse. I enjoyed this book but was aware of the absence of any comment on the methodological biases in epidemiological studies evaluating the effects of alcohol or wine on health and disease, such as the changes that take place in an individuals alcohol intake with the passage of time and the factors determining such changes e.g. increasing ill health and medication. Such a process leads to an accumulation of ill health among non-drinkers in particular, with relationships between alcohol intake and morbidity/mortality showing linear positive relations in younger subjects and U-shaped curves only in older subjects. In choosing a baseline group for comparisons, no amount of adjustment or even stratification can take adequate account of such changing behaviour, particularly when only one point in time is used for classifying alcohol intake.
There is no doubt that each type of alcoholic beverage contains different constituents with differing effects on a wide variety of physiological, biochemical and hormonal systems and thus each will be found to have some effects specific to itself. However, one suspects that alcohol itself will be the key determinant of outcome of drinking, and that in the long view the ‘protective’ effect of light or moderate intakes of wine or any other alcoholic beverage will pale into insignificance in the overall aetiology of any disease.
Anyone interested in the ‘alcohol story’ should read this book for pleasure and enlightenment and everyone working in this field should do so to prevent them from thinking that they have found something new!
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