The only clear-cut message regarding alcohol and health, then, is that all heavy drinkers should reduce or abstain, as should anyone with a special risk related to alcohol, such as a family or personal history of alcoholism or preexisting liver disease. Beyond that, however, the potential risks and benefits of alcohol are best evaluated on a case-by-case basis. Cardiovascular surgeon Roger R. Ecker and I constructed an algorithm that can help health practitioners and their patients decide how much--if any--alcohol is right for a given individual [see box on opposite page].
In short, health professionals should provide balanced, objective guidelines regarding their patients' use of alcohol, and such advice needs to be tailored to each person. I believe that it is possible to define a clear, safe limit for alcohol consumption that would offer a probable benefit to a select segment of the population. The ancient Greeks urged "moderation in all things." Three decades of research shows that this adage is particularly appropriate when it comes to alcohol.
ARTHUR L. KLATSKY is a senior consultant in cardiology and an adjunct investigator at the division of research at the Kaiser Permanente Medical Center in Oakland, Calif. A graduate of Harvard Medical School, he headed the medical center's division of cardiology from 1978 to 1994 and directed its coronary care unit from 1968 to 1990. Since 1977 he has been principal investigator of a series of studies of the link between drinking alcoholic beverages and health. His 1974 Annals of Internal Medicine article [see More to Explore, on page 29] was the first published epidemiological report of an inverse relation between alcohol drinking and coronary disease; it was cited in 1995 by the National Institute on Alcohol Abuse and Alcoholism as one of 16 seminal articles in alcohol research. His most recent honor was the Morris Collen Lifetime Achievement Research Award by Kaiser Permanente in 2004. Klatsky has completed six marathons and in 1990 climbed Mount Kilimanjaro.