A 100,000 feet View?

A just released study on global alcohol usage and morbidity and mortality has just been released by Lancet. The general conclusion seems to be:

Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

Namely the world should stop drinking. This is a global study and it uses a multiplicity of previous studies and it even acknowledges its own deficiencies. Namely:

First, the available studies have assessed the risk of alcohol use by relying on external meta-analyses, which do not control for confounding in the selection of the reference category within constituent studies. This approach is problematic because of the so-called sick quitter hypothesis, which emphasises the importance of reference category selection in correctly assessing risk among drinkers, along with other confounding study characteristics such as survival bias...Second, previous studies have used sales data to estimate population-level alcohol stock. Researchers have noted the benefit of using sales data instead of survey data for quantifying alcohol stock available within a location.However, sales data still have bias because of consumption by tourists and unrecorded consumption from illicit sales, home brewing, and local beverages  ...Third, previous studies have assumed zero as the counterfactual exposure level that minimises harm. Within a comparative risk assessment approach, a counterfactual level of consumption that minimises harm is required to estimate population attributable fractions.

In many ways this study has in my opinion weaknesses. Namely the simple one of co-morbidity issues. For example in many countries drinking and smoking are typically done together. Thus how does one separate the two effects. Second, as with all such studies the mechanism for the putative disease is missing. As we better understand cancers we better understand causes. Hypermethylation, oxidative stress, etc are but a few. What is alcohol? Then there is the issue that alcohol in the US is not alcohol in third world countries. The list goes on.

Although this is of interest, its generally over-broad presentation delimits its applicability in my opinion.