Here’s a simple question: Is moderate drinking okay?

这是一个简单的问题：适度饮酒可以吗？

Like millions of Americans, I look forward to a glass of wine—sure, occasionally two—while cooking or eating dinner. I strongly believe that an ice-cold pilsner on a hot summer day is, to paraphrase Benjamin Franklin, suggestive evidence that a divine spirit exists and gets a kick out of seeing us buzzed.

像数百万美国人一样，我期待着在做饭或吃晚餐时喝一杯葡萄酒——当然，偶尔也会是两杯。我坚信，在炎热的夏日里，一杯冰镇的皮尔森啤酒（Pilsner，一种淡啤酒），借用本杰明·富兰克林的话来说，是一个暗示性的证据，表明有神灵存在，并且乐于看到我们微醺。

But, like most people, I understand that booze isn’t medicine. I don’t consider a bottle of California cabernet to be the equivalent of a liquid statin. Drinking to excess is dangerous for our bodies and those around us. Having more than three or four drinks a night is strongly related to a host of diseases, including liver cirrhosis, and alcohol addiction is a scourge for those genetically predisposed to dependency.

但是，和大多数人一样，我明白酒不是药。我不会把一瓶加州赤霞珠葡萄酒等同于液态他汀类药物。过量饮酒对我们的身体和我们身边的人都有害。每晚饮酒超过三到四杯与多种疾病密切相关，包括肝硬化；而对于那些有酒精依赖遗传倾向的人来说，酒精成瘾更是一种祸害。

If the evidence against heavy drinking is clear, the research on my wine-with-dinner habit is a wasteland of confusion and contradiction. This month, the U.S. surgeon general published a new recommendation that all alcohol come with a warning label indicating it increases the risk of cancer. Around the same time, a meta-analysis published by the National Academies of Sciences, Engineering, and Medicine concluded that moderate alcohol drinking is associated with a longer life. Many scientists scoffed at both of these headlines, claiming that the underlying studies are so flawed that to derive strong conclusions from them would be like trying to make a fine wine out of a bunch of supermarket grapes.

如果说反对大量饮酒的证据是明确的，那么关于我晚餐小酌葡萄酒习惯的研究则是一片充满困惑和矛盾的荒原。本月，美国卫生局局长发布了一项新建议，要求所有酒精产品都附带警告标签，指出其会增加患癌风险。大约在同一时间，由美国国家科学院、工程院和医学院发布的一项荟萃分析则得出结论，适度饮酒与长寿有关。许多科学家对这两个标题都嗤之以鼻，声称其基础研究存在严重缺陷，从中得出确凿结论，无异于想用一堆超市的葡萄酿造出上等葡萄酒。

I’ve spent the past few weeks poring over studies, meta-analyses, and commentaries. I’ve crashed my web browser with an oversupply of research-paper tabs. I’ve spoken with researchers and then consulted with other scientists who disagreed with those researchers. And I’ve reached two conclusions. First, my seemingly simple question about moderate drinking may not have a simple answer. Second, I’m not making any plans to give up my nightly glass of wine.

我过去几周一直在仔细研读各种研究报告、荟萃分析和评论文章。大量研究论文的标签页把我的网页浏览器都弄崩溃了。我和研究人员交流过，也咨询过一些与这些研究人员观点不一致的科学家。最终我得出了两个结论。首先，我关于适度饮酒这个看似简单的问题，可能并没有简单的答案。其次，我目前不打算放弃我每晚的那杯葡萄酒。

Alcohol ambivalence has been with us for almost as long as alcohol. The notion that booze is enjoyable in small doses and hellish in excess was captured well by Eubulus, a Greek comic poet of the fourth century B.C.E., who wrote that although two bowls of wine brought “love and pleasure,” five led to “shouting,” nine led to “bile,” and 10 produced outright “madness, in that it makes people throw things.”

人们对酒精的矛盾态度几乎与酒精本身的历史一样久远。公元前四世纪的希腊喜剧诗人欧布罗斯（Eubulus）就很好地捕捉了酒精小酌怡情、过量伤身的观念。他写道，尽管两碗酒能带来“爱与欢乐”，但五碗酒会导致“叫喊”，九碗酒会引发“怒火”，而十碗酒则会彻底导致“疯狂，因为它会让人乱扔东西”。

In the late 20th century, however, conventional wisdom lurched strongly toward the idea that moderate drinking was healthy, especially when the beverage of choice was red wine. In 1991, Morley Safer, a correspondent for CBS, recorded a segment of 60 Minutes titled “The French Paradox,” in which he pointed out that the French filled their stomachs with meat, oil, butter, and other sources of fat, yet managed to live long lives with lower rates of cardiovascular disease than their Northern European peers. “The answer to the riddle, the explanation of the paradox, may lie in this inviting glass” of red wine, Safer told viewers. Following the report, demand for red wine in the U.S. surged.

然而，到了20世纪末，传统观念强烈倾向于认为适度饮酒有益健康，尤其是选择红酒时。1991年，哥伦比亚广播公司（CBS）记者莫利·萨弗在《60分钟》节目中制作了一期题为“法国悖论”的专题报道。他在节目中指出，法国人饮食中摄入大量肉类、油、黄油和其他脂肪，但他们的寿命却比北欧同龄人更长，心血管疾病发病率也更低。萨弗告诉观众：“这个谜团的答案，这种悖论的解释，可能就藏在这个诱人的红酒杯中。”该报道播出后，美国市场对红酒的需求激增。

The notion that a glass of red wine every night is akin to medicine wasn’t just embraced by a gullible news media. It was assumed as a matter of scientific fact by many researchers. “The evidence amassed is sufficient to bracket skeptics of alcohol’s protective effects with the doubters of manned lunar landings and members of the flat-Earth society,” the behavioral psychologist and health researcher Tim Stockwell wrote in 2000.

每天一杯红酒如同药物的观念，不仅仅被轻信的媒体所接受。许多研究人员也将其视为一个科学事实。行为心理学家兼健康研究员蒂姆·斯托克韦尔（Tim Stockwell）在2000年写道：“所积累的证据足以将那些怀疑酒精保护作用的人，与质疑载人登月者和地平说（相信地球是平的理论）的成员归为一类。”

Today, however, Stockwell is himself a flat-earther, so to speak. In the past 25 years, he has spent, he told me, “thousands and thousands of hours” reevaluating studies on alcohol and health. And now he’s convinced, as many other scientists are, that the supposed health benefits of moderate drinking were based on bad research and confounded variables.

然而，如今，Stockwell本人，可以说也成了“地平论者”（这里比喻他不再相信之前普遍接受的观点）。他告诉我，在过去的25年里，他花费了“成千上万个小时”重新评估关于酒精与健康的研究。现在，他和其他许多科学家一样，坚信适度饮酒所谓的健康益处是基于糟糕的研究和混杂变量（指那些可能影响研究结果，但未被充分考虑或控制的因素）得出的。

A technical term for the so-called French paradox is the “J curve.” When you plot the number of drinks people consume along an X axis and their risk of dying along the Y axis, most observational studies show a shallow dip at about one drink a day for women and two drinks a day for men, suggesting protection against all-cause mortality. Then the line rises—and rises and rises—confirming the idea that excessive drinking is plainly unhealthy. The resulting graph looks like a J, hence the name.

所谓的“法国悖论”有一个专业术语，叫作“J曲线”。当你在X轴上绘制人们的饮酒量，在Y轴上绘制他们的死亡风险时，大多数观察性研究显示，女性每天大约一杯酒、男性每天大约两杯酒时，死亡风险会有一个轻微的下降，这表明适量饮酒对全因死亡率具有保护作用。随后，曲线会不断攀升，证实了过量饮酒显然对健康有害的观点。最终形成的图表看起来像字母J，因此得名。

The J-curve thesis suffers from many problems, Stockwell told me. It relies on faulty comparisons between moderate drinkers and nondrinkers. Moderate drinkers tend to be richer, healthier, and more social, while nondrinkers are a motley group that includes people who have never had alcohol (who tend to be poorer), people who quit drinking alcohol because they’re sick, and even recovering alcoholics. In short, many moderate drinkers are healthy for reasons that have nothing to do with drinking, and many nondrinkers are less healthy for reasons that have nothing to do with alcohol abstention.

斯托克韦尔告诉我，J型曲线理论存在许多问题。它基于对适度饮酒者和不饮酒者之间有缺陷的比较。适度饮酒者往往更富裕、更健康、社交更活跃，而不饮酒者则是一个混杂的群体，其中既包括从未饮酒的人（这些人往往更贫穷），也有因生病而戒酒的人，甚至还有正在康复的酗酒者。简而言之，许多适度饮酒者之所以健康，是出于与饮酒无关的原因；而许多不饮酒者之所以健康状况不佳，也是出于与戒酒无关的原因。

When Stockwell and his fellow researchers threw out the observational studies that were beyond salvation and adjusted the rest to account for some of the confounders I listed above, “the J curve disappeared,” he told me. By some interpretations, even a small amount of alcohol—as little as three drinks a week—seemed to increase the risk of cancer and death.

蒂姆·斯托克韦尔和他的同事们剔除了那些无法挽救的观察性研究，并对剩余的研究进行了调整，以排除我上文提到的一些混杂因素。他告诉我，“J型曲线消失了”。根据一些解读，即使是少量的酒精——每周饮酒量少至三杯——似乎也会增加患癌症和死亡的风险。

The demise of the J curve is profoundly affecting public-health guidance. In 2011, Canada’s public-health agencies said that men could safely enjoy up to three oversize drinks a night with two abstinent days a week—about 15 drinks a week. In 2023, the Canadian Centre on Substance Use and Addiction revised its guidelines to define low-risk drinking as no more than two drinks a week.

J曲线的消失正深刻影响着公共卫生指导方针。2011年，加拿大公共卫生机构曾表示，男性每晚最多可以安全饮用三杯大份的酒，每周有两天禁酒，即每周大约15杯酒。然而，到了2023年，加拿大物质使用与成瘾中心修订了其指南，将低风险饮酒定义为每周不超过两杯酒。

Here’s my concern: The end of the J curve has made way for a new emerging conventional wisdom—that moderate drinking is seriously risky—that is also built on flawed studies and potentially overconfident conclusions. The pendulum is swinging from flawed “red wine is basically heart medicine!” TV segments to questionable warnings about the risk of moderate drinking and cancer. After all, we’re still dealing with observational studies that struggle to account for the differences between diverse groups.

我担心的是：‘J曲线’的终结催生了一种新的普遍看法——即适度饮酒存在严重风险——而这种看法也是建立在有缺陷的研究和可能过于自信的结论之上的。舆论的钟摆正在从那些有问题的‘红酒基本就是心脏药！’的电视节目，摆向关于适度饮酒与癌症风险的、值得商榷的警告。毕竟，我们面对的仍然是观察性研究，它们难以充分解释不同群体之间的差异。

In a widely read breakdown of alcohol-health research, the scientist and author Vinay Prasad wrote that the observational research on which scientists are still basing their conclusions suffers from a litany of “old data, shitty data, confounded data, weak definitions, measurement error, multiplicity, time-zero problems, and illogical results.” As he memorably summarized the problem: “A meta-analysis is like a juicer, it only tastes as good as what you put in.” Even folks like Stockwell who are trying to turn the flawed data into useful reviews are like well-meaning chefs, toiling in the kitchen, doing their best to make coq au vin out of a lot of chicken droppings.

在一篇广为流传的酒精与健康研究分析中，科学家兼作家维奈·普拉萨德写道，科学家们仍然以此为依据得出结论的观察性研究，饱受一系列问题的困扰，包括“旧数据、劣质数据、混杂数据、定义模糊、测量误差、多重性、零时点问题以及不合逻辑的结果”。他精彩地总结道：“荟萃分析就像一台榨汁机，它的好坏只取决于你放入的原料。”甚至像蒂姆·斯托克韦尔这样，试图将有缺陷的数据转化为有用综述的人，也像一群善意的厨师，在厨房里辛勤劳作，竭尽全力想用一堆鸡粪做出法式红酒炖鸡（一种美味的法国菜肴）。

The U.S. surgeon general’s new report on alcohol recommended adding a more “prominent” warning label on all alcoholic beverages about cancer risks. The top-line findings were startling. Alcohol contributes to about 100,000 cancer cases and 20,000 cancer deaths each year, the surgeon general said. The guiding motivation sounded honorable. About three-fourths of adults drink once or more a week, and fewer than half of them are aware of the relationship between alcohol and cancer risk.

美国卫生总署署长关于酒精的新报告建议，在所有酒精饮料上增加更“醒目”的癌症风险警示标签。这些主要发现令人震惊。卫生总署署长表示，每年约有10万例癌症病例和2万例癌症死亡与酒精有关。这一指导动机听起来是高尚的。大约四分之三的成年人每周饮酒一次或更多，但其中不到一半的人了解酒精与癌症风险之间的关系。

But many studies linking alcohol to cancer risk are bedeviled by the confounding problems facing many observational studies. For example, a study can find a relationship between moderate alcohol consumption and breast-cancer detection, but moderate consumption is correlated with income, as is access to mammograms.

然而，许多将饮酒与癌症风险联系起来的研究，都受到许多观察性研究面临的混杂因素问题的困扰。例如，一项研究可能会发现适度饮酒与乳腺癌的检测之间存在关联，但适度饮酒与收入相关，正如获得乳腺X光检查的机会也同样与收入相关。

One of the best-established mechanisms for alcohol being related to cancer is that alcohol breaks down into acetaldehyde in the body, which binds to and damages DNA, increasing the risk that a new cell grows out of control and becomes a cancerous tumor. This mechanism has been demonstrated in animal studies. But, as Prasad points out, we don’t approve drugs based on animal studies alone; many drugs work in mice and fail in clinical trials in humans. Just because we observe a biological mechanism in mice doesn’t mean you should live your life based on the assumption that the same cellular dance is happening inside your body.

酒精与癌症相关最公认的机制之一是，酒精在体内分解成乙醛，乙醛会与DNA结合并损害DNA，从而增加新细胞失控生长并形成癌性肿瘤的风险。这一机制已在动物研究中得到证实。但是，正如普拉萨德（Prasad）所指出的，我们不能仅凭动物研究就批准药物；许多药物在小鼠身上有效，但在人体临床试验中却失败了。仅仅因为我们在小鼠身上观察到一种生物学机制，并不意味着你就应该假设同样的细胞“舞蹈”（cellular dance，此处指细胞活动）也在你的体内发生，并以此作为生活依据。

I’m willing to believe, even in the absence of slam-dunk evidence, that alcohol increases the risk of developing certain types of cancer for certain people. But as the surgeon general’s report itself points out, it’s important to distinguish between “absolute” and “relative” risk. Owning a swimming pool dramatically increases the relative risk that somebody in the house will drown, but the absolute risk of drowning in your backyard swimming pool is blessedly low. In a similar way, some analyses have concluded that even moderate drinking can increase a person’s odds of getting mouth cancer by about 40 percent. But given that the lifetime absolute risk of developing mouth cancer is less than 1 percent, this means one drink a day increases the typical individual’s chance of developing mouth cancer by about 0.3 percentage points. The surgeon general reports that moderate drinking (say, one drink a night) increases the relative risk of breast cancer by 10 percent, but that merely raises the absolute lifetime risk of getting breast cancer from about 11 percent to about 13 percent. Assuming that the math is sound, I think that’s a good thing to know. But if you pass this information along to a friend, I think you can forgive them for saying: Sorry, I like my chardonnay more than I like your two percentage points with a low confidence interval.

我愿意相信，即使没有确凿证据，酒精也会增加某些人患某些类型癌症的风险。但正如美国卫生总监（surgeon general）的报告所指出的，区分“绝对风险”和“相对风险”非常重要。拥有一个游泳池会大幅增加家里有人溺水的相对风险，但实际上，在自家后院游泳池溺水的绝对风险却幸运地非常低。同样地，一些分析得出结论，即使是适度饮酒，也能将一个人患口腔癌的几率提高约40%。但考虑到一生中患口腔癌的绝对风险不足1%，这意味着每天喝一杯酒会使普通人患口腔癌的几率增加约0.3个百分点。卫生总监报告称，适度饮酒（比如每晚一杯）会使患乳腺癌的相对风险增加10%，但这仅仅是将患乳腺癌的终生绝对风险从约11%提高到约13%。假设这些计算是准确的，我认为这些信息是值得了解的。但如果你把这些信息告诉朋友，我想你可以原谅他们会说：“抱歉，我更喜欢我的霞多丽葡萄酒，而不是你那点带低置信区间的两个百分点（的风险增幅）。”

Where does this leave us? Not so far from our ancient-Greek friend Eubulus. Thousands of years and hundreds of studies after the Greek poet observed the dubious benefits of too much wine, we have much more data without much more certainty.

这给我们带来了什么启示呢？我们离古希腊朋友欧布鲁斯的观点并不遥远。在古希腊诗人观察到过量饮酒的那些可疑好处数千年、数百项研究之后，我们有了更多的数据，却没有获得更多的确定性。

In her review of the literature, the economist Emily Oster concluded that “alcohol isn’t especially good for your health.” I think she’s probably right. But life isn’t—or, at least, shouldn’t be—about avoiding every activity with a whisker of risk. Cookies are not good for your health, either, as Oster points out, but only the grouchiest doctors will instruct their healthy patients to forswear Oreos. Even salubrious activities—trying to bench your body weight, getting in a car to hang out with a friend—incur the real possibility of injury.

经济学家埃米莉·奥斯特（Emily Oster）在她的文献综述中总结道，“酒精对你的健康并非特别有益。”我认为她说的可能没错。但生活并非——或者至少不应该——是为了避免所有带有丝毫风险的活动。正如奥斯特指出的，饼干也对你的健康无益，但只有最刻薄的医生才会要求健康的病人戒掉奥利奥饼干。即使是那些有益健康的活动——比如尝试卧推与自己体重相当的重量，或者坐车出去和朋友玩——也存在受伤的真实可能性。

An appreciation for uncertainty is nice, but it’s not very memorable. I wanted a takeaway about alcohol and health that I could repeat to a friend if they ever ask me to summarize this article in a sentence. So I pressed Tim Stockwell to define his most cautious conclusions in a memorable way, even if I thought he might be overconfident in his caution.

对不确定性抱持理解固然很好，但它不那么令人印象深刻。我希望能找到一个关于酒精与健康的精辟总结，以便朋友让我用一句话概括这篇文章时，我能复述给他们。所以我追问蒂姆·斯托克韦尔（Tim Stockwell），请他用一种令人难忘的方式阐述他最谨慎的结论，即便我当时觉得他可能对他所持的这份谨慎有些过于自信了。

“One drink a day for men or women will reduce your life expectancy on average by about three months,” he said. Moderate drinkers should have in their mind that “every drink reduces your expected longevity by about five minutes.” (The risk compounds for heavier drinkers, he added. “If you drink at a heavier level, two or three drinks a day, that goes up to like 10, 15, 20 minutes per drink—not per drinking day, but per drink.”)

他说：“男性或女性每天喝一杯酒，平均会缩短约三个月的预期寿命。”适度饮酒者应该记住，“每喝一杯酒，都会使你的预期寿命减少大约五分钟。”（他补充说，对于饮酒量更大的人来说，风险会累积加剧。“如果你每天喝两到三杯，这种风险就会上升到每杯酒减少10、15、20分钟——注意不是按饮酒日计算，而是按每杯酒计算。”）

Every drink takes five minutes off your life. Maybe the thought scares you. Personally, I find great comfort in it—even as I suspect it suffers from the same flaws that plague this entire field. Several months ago, I spoke with the Stanford University scientist Euan Ashley, who studies the cellular effects of exercise. He has concluded that every minute of exercise adds five extra minutes of life.

每次饮酒都会让你减寿五分钟。这个想法可能会让你感到害怕。就我个人而言，我却从中获得了极大的慰藉——尽管我怀疑这种说法也存在着困扰整个研究领域的同样缺陷。几个月前，我与斯坦福大学的科学家尤安·阿什利（Euan Ashley）进行了交流，他主要研究运动对细胞的影响。他得出的结论是，每运动一分钟，就能增加五分钟的寿命。

When you put these two statistics together, you get this wonderful bit of rough longevity arithmetic: For moderate drinkers, every drink reduces your life by the same five minutes that one minute of exercise can add back. There’s a motto for healthy moderation: Have a drink? Have a jog.

把这两个统计数据放在一起，你就会得到一个关于寿命的奇妙粗略计算：对适度饮酒者来说，每喝一杯酒会减少你生命中的五分钟，而每一分钟的运动可以帮你把这五分钟补回来。这有一个健康节制的格言：喝一杯？那就去慢跑一下吧。

Even this kind of arithmetic can miss a bigger point. To reduce our existence to a mere game of minutes gained and lost is to squeeze the life out of life. Alcohol is not like a vitamin or pill that we swiftly consume in the solitude of our bathrooms, which can be straightforwardly evaluated in controlled laboratory testing. At best, moderate alcohol consumption is enmeshed in activities that we share with other people: cooking, dinners, parties, celebrations, rituals, get-togethers—life! It is pleasure, and it is people. It is a social mortar for our age of social isolation.

即使这种计算方式也会忽略一个更重要的方面。把我们的存在仅仅简化为一场计算得失分钟的游戏，这无疑是剥夺了生活的活力。酒精不像维生素或药片那样，我们可以在洗手间的私密空间里迅速服用，然后通过受控的实验室测试进行直接评估。往好里说，适度饮酒与我们和他人共享的活动密不可分：烹饪、晚餐、派对、庆祝、仪式、聚会——这便是生活本身！它关乎愉悦，也关乎人际。在我们这个社交孤立的时代，它还是一种社会粘合剂。

An underrated aspect of the surgeon general’s report is that it is following, rather than trailblazing, a national shift away from alcohol. As recently as 2005, Americans were more likely to say that alcohol was good for their health, instead of bad. Last year, they were more than five times as likely to say it was bad, instead of good. In the first seven months of 2024, alcohol sales volume declined for beer, wine, and spirits. The decline seemed especially pronounced among young people.

卫生局局长的报告中一个被低估的方面是，它其实是在追随，而非引领着全国范围内远离酒精的趋势。就在2005年，美国人还更倾向于认为酒精对他们的健康有益，而不是有害。而去年，他们认为酒精有害而非有益的可能性是之前的五倍多。在2024年前七个月，啤酒、葡萄酒和烈酒的销量均出现下滑。这种下降趋势在年轻人中尤为明显。

To the extent that alcohol carries a serious risk of excess and addiction, less booze in America seems purely positive. But for those without religious or personal objections, healthy drinking is social drinking, and the decline of alcohol seems related to the fact that Americans now spend less time in face-to-face socializing than any period in modern history. That some Americans are trading the blurry haze of intoxication for the crystal clarity of sobriety is a blessing for their minds and guts. But in some cases, they may be trading an ancient drug of socialization for the novel intoxicants of isolation.

鉴于酒精伴随着过度饮用和成瘾的严重风险，美国酒类消费的减少似乎完全是积极的。但是，对于那些没有宗教或个人异议的人来说，健康的饮酒是一种社交行为，而酒精消费量的下降似乎与美国人现在面对面社交的时间比现代历史上任何时期都少这一事实有关。某些美国人正在用清醒的清澈明晰来取代醉酒的模糊迷雾，这对他们的心智和身体来说是一种幸事。但在某些情况下，他们可能正在用一种古老的社交媒介，换取孤独带来的新型“迷醉品”。