The alleged health benefits of wine depend on who funded the research

Every week or two we seem to get another published article telling us about some potential health benefits of wine. Sadly, these articles often contradict each other, as I have already written about myself (for a list of posts, see The effects of alcohol on the human body).

Recently, Adrian Chiles wrote a strongly worded opinion piece about this topic for The Guardian newspaper: Drinking alcohol is bad for you — end of. Ignore the headlines that claim otherwise. Here, I will supplement his words with some ideas that he did not specifically cover.

First, I will start by quoting Chiles at length, because it is important to emphasize his ideas. He wrote:

It’s amazing how easy it is to persuade us that what we want to be true is true. Consider a typical headline to a story covered with great enthusiasm by many major news organisations this week: “Moderate alcohol consumption may lower stress, reduce heart disease risk, study finds.” Enthusiastic drinkers, drowning in a dark sea of health warnings, will cling on to such words as stricken sailors might hold on to the hull of their capsized boat.

They will turn a blind eye to the facts of the story, although even the headline itself, with its “may” and its “study finds”, suggests this scientific revelation isn’t quite the slam dunk we might be hoping for. Once the study’s methodology and conclusions are outlined, it’s clear that the whole thing falls into the category of quite interesting, rather than this changes everything. But who needs that level of detail? If I’m so minded, there’s as much information in the headline as I’m ever going to want or need to support my long-cherished pet theory about drinking. “I knew it! I told you so! Drinking helps me deal with stress, ergo it eases the strain on my poor ticker, therefore I’ll live longer and more happily.” I’ll file this fact away along with that one about red wine being good for you, as good as a health drink.

On the other side of the argument, to counter all this, the public health lobby takes an ever more severe position. The World Health Organization is now saying that when it comes to alcohol consumption, there is no safe amount that does not affect health. While this might be technically true, it also has an absurdity to it. As David Spiegelhalter, then professor for the public understanding of risk at Cambridge University, pointed out when England’s chief medical officer said something similar in 2018: “There is no safe level of driving, but the government does not recommend that people avoid driving. Come to think of it, there is no safe level of living, but nobody would recommend abstention.”

My contributed addition in this current post is to point out a publication by Su Golder & Jim McCambridge: Alcohol, cardiovascular disease and industry funding: A co-authorship network analysis of systematic reviews.

They studied a set of 60 published reviews concerning cardiovascular disease (CVD) and alcohol, written by a total of 231 unique authors. There were 14 reviews undertaken by authors with histories of alcohol industry funding, including 5 that were funded directly by the alcohol industry itself. The remaining 46 had no such funding identified.

Their conclusion was:

Nearly a quarter (23%, 14/60) of systematic reviews undertaken on the impact of alcohol on CVD had a known connection to alcohol industry funding. These formed distinct co-authorship subnetworks within the literature. [An example is shown above, where each point represents an author and the lines represent who they worked with.] All reviews by authors with histories of alcohol industry support identified a health protective effect of alcohol, whereas those with no known history of support were approximately evenly divided, with 54% (25/46) concluding there was evidence of health protective effects.

The reviews associated with the industry were more likely to study broader CVD outcomes, as opposed to more specific CVD outcomes such as hypertension or stroke, had a higher number of included studies, and were more influential, being more likely to be cited by others. ... Over time the proportion of systematic reviews on CVD and alcohol authored by those with histories of funding by industry has declined, and there has been an increase in reviews more likely to conclude there is no evidence for cardio-protection.

The citations data attest to the enduring influence of the idea that alcohol may be good for the heart within scientific communities, as well as having a hold on public and policy perceptions of alcohol. This idea has been assiduously promoted by the alcohol industry, for whom it looks clearly important to political strategies. This study demonstrates that there is a need not only to resolve the long running controversy, but also to pay attention to the actions of the alcohol industry in influencing the science. It is striking how little we know about a subject that does such large and growing damage to global health.

So, there you have it. Who funds the research has a big influence on what the published results will be. Quite possibly, you do not bite the hand that feeds you, even in academia! Anyway, as Adrian Chiles noted: You can often ignore the headlines, but don't ignore the details.

Wine packaging will change

My wife and I went to do the weekly shopping yesterday morning, and part of the process was to take the recyclable packaging with us to the supermarket. Here, out in the car-park, there are large individual bins for: paper packaging, plastic packaging, newspapers / magazines, clear glass, and colored glass, plus a small container for batteries. Inside the supermarket entrance, there are machines to accept PET drinks bottles and aluminium cans, for which one has paid a deposit, which must be reclaimed (the money will be deducted from the supermarket bill).

For us, Sweden has long had this sort of recycling arrangement, where shopping, which generates packaging, is associated with recycling that packaging. Almost all other products can be taken to specialist recycling centers (called återvinningscentraler), where there are huge industrial-sized skips. There is a skip for clean landfill (soil, concrete, etc), one for metal, one for wood, etc. We also have two curb-side bins per household, to put out fortnightly, one for non-recycling and one for organic matter (ie composting).

Interestingly, the European Union is in the process of wisely adopting roughly this Swedish scheme of recycling. This emphasizes just how important recycling is in the modern world. We should therefore be asking ourselves what the wine industry is doing to take an active part in this particular part of society.

The leading role of the Nordic countries (Sweden, Denmark, Norway, Iceland, Finland) has actually been acknowledged within the wine media. For example (Can the Nordic monopolies turn the drinks world green?): *

Scandinavia’s five alcohol monopolies have launched a joint program to combat climate change.

Across all of these regions, there is a high consumer awareness of environmental issues, and recycling rates are over 90%, rising to 98.2% for the nature loving Norwegians. Finland’s recycling rate has been encouraged by a deposit-refund system (10 cent to 40 cent depending on the size). The return ratios are with cans at 97%, PET-bottles 90% and glass bottles 98%.

Historically, until the late 1990s, the Nordic monopolies had their own refund systems on wine bottles that were then cleaned and refilled. The cheap, low–quality wine they contained, and the packaging model, went out of fashion, but there are now suggestions that it might be revived. According to Maritta Iso-Aho, Alko’s Communications Director: “All means are on the table, and we have discussed the possibility to re-introduce the concept.”  But the the discussions are evidently still only in the very early stages.

Clearly, the major issue here is the wine bottles. There is a high environmental cost to making them in the first place, and also a high cost to recycle and re-make them. The massive temperatures needed for both making and recycling glass bottles mean that they have what is called a Large Carbon Footprint (The problem with wine bottles). Indeed, the glass represents a huge percentage of the wine industry’s global carbon footprint (Assessing the carbon impacts of wine production), and we have long known this (The environmental cost of a bottle of wine).

The re-filling of bottles, as discussed above, is an obvious way forward for the wine industry, although it has rarely been tried. However, the recent London Wine Fair was to focus on sustainability, with bottle reuse scheme and education sessions, as a first data-gathering step. Unfortunately, there seem to be many objections that have been raised, as discussed by Australian Grape & Wine, for example, with regard to proposals by Australian state governments and territories to extend container deposit schemes to include glass wine bottles (We need to change the narrative around container deposit schemes).

In terms of manufacturing, rather than re–using, there are several current ways of moving forward (6 wine trends impacting climate change and consumer taste), including the two most obvious ones:

• Trend #1 — More light–weight wine bottles
• Trend #2 — The growing use of alternative wine containers

The first one, making wine bottles using less glass (ie. lighter weight), is an obvious strategy. For a discussion, see: Lighter wine bottles don’t affect quality and are better for the planet.

For the second one, most people think of bag-in-box and aluminium cans, when considering alternative wine containers to glass, but there are other packagings available. I have reviewed this topic before: How do so-called alternative wine packagings compare? For another discussion, see: Alternative wine packaging: thinking inside the box.

The carbon emissions of all of these various alternatives are compared in this graph, which should make the ultimate environmental situation clear to you.

The main issue for we consumers, of course, is the quality of the wine put into these containers. Sadly, in terms of alternative packaging, there has been considerable discussion about: Is the wine industry ready to utilise alternative packaging?

There seem to be two camps when it comes to alternative packaging in wine. One believes change is not just inevitable, but essential, the other is still firmly of the view “if it ain’t broke ...”.

The former camp argues the wine industry needs to act if it is to be in tune with growing consumer demand to buy products that are sustainable,  environmentally healthy and help cut carbon emissions. Wine brands need to adapt with these concerns in mind.

In the latter camp are those who can’t yet see the reason to change a supply chain, dominated by glass packaging, that has worked well for so long, and is so entrenched in established wine drinkers’ modus operandi.

This is a recurring theme in the alternative packaging movement, that it is the major retailers that hold all the cards and it is up to them to take the plunge to effect change. Andrew Ingham explains: “Wine doesn’t lead, it waits. It waits for the retailers to tell them what they want, and then it responds, It’s such a shame that getting a supermarket listing is the bottleneck to innovation and change”.

This last conclusion seems to me to be very sad, actually. More optimistically, much of the wine industry has already gotten used to screw-caps, so they can probably get used to other things as well.

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* I have discussed before the seemingly endless American tendency to call the Scandinavian (government-owned) retail stores “monopolies”: Why are there wine monopolies in Scandinavia? A bigger problem, if there is one, seems to be the three-tier system of alcohol distribution and sales in the USA (The American wine media has failed their audience).

The psychology of tasting wine

Last week I looked at a published review of The effects of alcohol on the human body, and this week I thought that I should move on to our psychology. This encompasses how much effect our minds have on what we perceive, independently of what is actually there. After all, there are probably far more studies of outside factors on our purchasing and tasting experiences of wine than of any other food or beverage.

So, what we need here is some sort of published review of the topic, which I can then summarize for you. The publication I have chosen for this purpose is from 2020: Wine psychology: basic & applied (by Charles Spence).

To quote some of the important points from the text:

     This review paper highlights how basic cognitive research can help understand, and thereafter modify, the way in which people respond to wine. The emerging body of research has led to a growing awareness of just how much a wide variety of cognitive and perceptual factors ... influence the wine–drinking experience, both in wine experts and regular consumers alike.
     Wine is a complex, culture–laden, multisensory stimulus, and our perception / experience of its properties is influenced by everything from the packaging in which it is presented through the glassware in which it is served and evaluated.
     The perception of wine itself, and the wine–tasting experience more generally, have been shown to be influenced by everything from the weight of the wine bottle through to the sound made by its closure and the glass from which it is drunk, and on to the wine’s visual appearance and the multisensory environment / atmosphere in which it happens to be consumed.
     Researchers working in a diverse range of disciplines from marketing to sensory science, and from cognitive neuroscience to packaging design and economics, have started to become increasingly interested in the consumer’s response to wine, be it in terms of the latter’s purchase behaviour or their perceptual response on tasting a wine.
     A growing body of experiential wine research now demonstrates that a number of contextual factors, including everything from the colour of the ambient lighting through to background music, can exert a profound, and in some cases predictable, influence over the tasting experience.
     Sonic seasoning — that is, the matching of music or soundscapes with specific wines — in order to accentuate or draw attention to certain qualities / attributes in the wine, such as sweetness, length, or body, also represents a rapidly growing area of empirical study.

Not unexpectedly, the review paper also notes that:

No matter whether one is talking about the impact of colour, glassware, packaging, branding, label design, closure type, pricing, or perceptual expertise, there is just so much more research in the world of wine than in any of the world’s other more popular drinks such as, for example, coffee, tea, beer, or water.

Indeed, it has been claimed (by Gordon Shepherd) that drinking wine “engages more of our brain than any other human behaviour”. This is, of course, a reference to sensory perception and its interpretation, not to any inherent intellectual characteristics of wine drinkers!

In this sense, it is particularly stressed that the context, or situation / atmosphere, in which a wine is drunk can have a notable effect on the actual tasting experience. Some of you may know this as the Provençal rosé paradox, in which a wine that tastes great while on holiday often tastes much less enjoyable when sampled again afterwards at home. In a similar vein, there can be significant differences between bottles of the same wine; and, because wine is usually in a slow state of change, it is next to impossible to replicate exactly the conditions of any previous formal study (such as an organized wine tasting).

Apparently, much of the current study of the psychology of wine tasting seems to revolve around two things: lighting and music. For example, based on a particular published experiment:

The results revealed that the wine was rated as tasting significantly fruitier under red than under green lighting.

Perhaps more interestingly, there is also:

an emerging body of laboratory research documenting first that people intuitively match basic tastes, such as sweet, sour, bitter, and salty with particular musical attributes, and thereafter that playing music (or soundscapes) with matching or mismatching sonic properties can influence people’s ratings of the taste / flavour of a variety of foods.

A different review article, (Multisensory experiential wine marketing) delves further into the topic of music and wine, which sounds fascinating (no pun intended!):

The pairing of wine with music goes back a long way, starting out with commentators at first merely just using musical metaphors in order to describe the wines they were writing about. In recent years, however, this area of interest has morphed into a growing range of multisensory tasting events in which wine and music are paired deliberately in order to assess, or increasingly to illustrate, the impact of the latter on people’s experience of the former. Initial isolated small-scale and often anecdotal reports of music supposedly changing the taste of wine have since evolved into large-scale experiential, experimental, events.

On the other hand, this idea (from the original article cited above) may surprise you:

The research clearly shows that if the taster does not know which wine glass they are evaluating a wine in / from [then] the glassware seems to make little difference to the taster’s experience. However, as soon as the latter become aware of the nature of the glass from which they are tasting, the glassware can suddenly make a huge difference to the tasting experience.

So, the psychology of tasting wine is complex, and you therefore need to get the conditions right. That is, to put it formally, this: “might also make one wonder how much of what goes on in, and is written about, the world of wine is some kind of social construction based on expectations rather than necessarily reflecting a genuine perceptual effect”. It might also make us wonder about the pronouncements of so-called experts, which I will look at in a later post (Part 2 of this post can be found here: The psychology of wine tasting, part II).

The effects of alcohol on the human body

Every other week there seems to be another report about alcohol consumption and one or more of its effects on the consuming organism, especially if that organism is a human being. This has resulted in most countries banning alcohol consumption by people under a certain age, for example, or sometimes even by all residents. Over the years, I have looked at this topic a number of times in this blog:

• Wine and health — why is there so much argument, pro and con?
• Why we are never going to know whether wine is good for us, or not
• Health and the wine drinker, yet again
• Wine and health is never a simple topic

The problem is that each medical study is actually quite limited in its scope. The end result of this is that the conclusions from these studies often seem to contradict each other, since they are all talking about slightly different things. This is not only annoying, it is actually unhelpful for the rest of us. One good summary of the recent history of the general topic of wine and society is: Pour one out.

However, I thought that in my post I might write about the most comprehensive scientific study ever undertaken involving alcohol effects. This sort of study is called a meta-analysis, and it tries to combine all of the data from all of the known published studies into one giant dataset, and then see what general conclusions might be drawn.

For medicine, this approach is taken globally by what is called the Global Burden of Disease Study. As they themselves claim:

The Global Burden of Disease (GBD) provides a comprehensive picture of mortality and disability across countries, time, age, and sex. It quantifies health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities eliminated.

The GBD has been going for the past three decades (The Global Burden of Disease Study at 30 years), and it has become more and more ambitious:

The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes ... The latest iteration provides assessments of thousands of outcomes for diseases, injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries.

For our purposes here, the most recent publication looking at the effects of alcohol appeared back in 2016:

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

There are 514 authors who contributed to the publication, based on “694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use” (you should be very very impressed by this!). From all of this, they “produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol–attributable deaths and DALYs [disability-adjusted life-years]”.

You can read the paper for yourself if you want the details, but the conclusions are clear (see the graph above):

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 ... Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% of age–standardised female deaths and 6.8%  of age–standardised male deaths.

There are lists of different medical conditions associated with increasing alcohol consumption — one of these, which you may not have thought of, is illustrated in the graph below. Nevertheless, the bottom line is clear:

The level of alcohol consumption that minimised harm across health outcomes was zero standard drinks per week.

Now, you might not like this conclusion, especially as it does seem to contradict those studies reporting apparently protective effects of small amounts of alcohol consumption. Indeed, a more recent meta-analysis (2023) does report such a thing (Association between daily alcohol intake and risk of all-cause mortality: A systematic review and meta-analyses):

This systematic review and meta–analysis of 107 cohort studies involving more than 4.8 million participants found no significant reductions in risk of all-cause mortality for drinkers who drank less than 25 g of ethanol per day (about 2 standard drinks compared with lifetime nondrinkers) after adjustment for key study characteristics such as median age and sex of study cohorts.

That is, less than 2 drinks per day did not increase health risks. So, I guess this contradiction means that we still don’t know anything consistent about small alcohol effects, and maybe we never will.*

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* The issue here seems to be that combining data from different studies has all sorts of technical (data–analysis) issues arising from different biases in the original data:

Mounting evidence suggests these associations might be due to systematic biases that affect many studies. For example, light and moderate drinkers are systematically healthier than current abstainers on a range of health indicators unlikely to be associated with alcohol use — eg, dental hygiene, exercise routines, diet, weight, income; lifetime abstainers may be systematically biased toward poorer health; studies fail to control for biases in the abstainer reference group, in particular failing to remove “sick quitters” or former drinkers, many of whom cut down or stop for health reasons; and most studies have nonrepresentative samples leading to an over-representation of older White men.