Thursday, February 4, 2021

The Medicinal Use and Misuse of Alcohol


During Prohibition, you could buy whiskey legally with a doctor's prescription. Many years ago, I posted the picture above and it prompted a correspondence with a medical student who was also a whiskey fan, who wrote the following on the medical use of alcohol, what we know, and what we don't.

"Up until the 1980s, alcohol was given by I.V. to (of all patients) pregnant women as a "tocolytic," to help relax the uterus and stop contractions during premature labor. It was titrated to the slurred speech of the woman! It is hard to believe that it took until the 1980s for the medical world to realize that it also caused respiratory depression in neonates. 

"I consider this to be one of the more absurd uses of 'medicinal' ethanol use in history, despite the fact that it did in fact relax the uterus. Other uses have certainly been better thought out. The early anesthesiologists gave ethanol (before the advent of ether) to the wounded in the Civil War during emergency surgery. This was probably whiskey and was moderately successful. Ingested alcohol is actually a pretty good anesthetic, the problem being the amounts needed to reach an adequate blood concentration sufficient for surgery tend towards the lethal. 

"Another interesting use of alcohol in the hospital is its administration in the event of a methanol or ethylene glycol (anti-freeze) overdose. Ethanol reverses the toxic effects of those other poisons, preventing blindness, and liver and kidney failure. 

"My understanding is that during Prohibition, when physicians wrote prescriptions for whiskey, these tended to be for other reasons. I'm guessing the practice centered on the idea of whiskey as a 'general tonic,' a 'constitutional' of some sort. Perhaps even an early psychiatric medicine? Which would be interesting because of what we now know about the physiology of alcohol's depressive effects on the central nervous system. 

"What I find so interesting about all this is that humans have known for a long time that alcohol has a medicinal use, but we've often been very mistaken in our understanding of the physiology. This is a fascinating chapter in the history of medicine, not just in the history of whiskey. 

"Numerous papers have been published in journals such as the New England Journal of Medicine about the health benefits of moderate alcohol consumption. Wine gets all the publicity in the lay press, but every paper unequivocally states that the form of the alcohol one ingests makes no difference. Reductions in heart attacks are well documented, as are reduced rates of strokes, as well as reduced cognitive decline and dementia in the elderly. There has even been some work on the antioxidant effects of spirits, but the funding of these papers renders some of their conclusions questionable. 

"While the scientific understanding of alcohol's effects is expanding, it is still based primarily on outcome studies rather than on biochemical experiments. Animal models are useful only up to a point. Most conclusions thus far about the salubrious effects of alcohol are based on controlled, double-blind randomized population studies. Those conclusions are pretty darn solid, but when it comes to the hypothesized mechanism of actually how alcohol induces its effects, no one really knows, other than to say that there is something 'anti-atherogenic' about alcohol. Which is kind of like defining a horse as a horse. No shit. 

"I wonder what effect the anti-alcohol movement has had historically on developing our scientific knowledge of alcohol. An analogy is the debate about stem-cell research. Politics and moralists have our scientists hog-tied while the rest of the world moves forward with life-saving insights and technologies. The medical understanding of alcohol is one of the many casualties of American theocracy, one of the great ironies in our history." 


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