One of the fathers of the "French Paradox" believes the time has come to "ban" the expression his research team published in the mid '80s.
One of his countrymen, whose work helped make famous the paradox of having a high saturated fat diet and lower than expected death rate from heart disease nearly a decade ago on "60 Minutes," says that attributing a low rate of heart disease to daily consumption of wine or other forms of alcohol is wrong.
A growing number of French health researchers have news for the rest of the world: It is myth that the French are healthier than most everyone else because they drink. In truth, the French are drowning in the grape and paying a hefty price for it.
"There is no scientific consensus today over the protective effect of alcohol," says Dominique Gillot, France's secretary of state for health. "The link between the quantity of alcohol consumed and increase of risk of diseases, particularly cancer, is, on the other hand, scientifically validated."
The fact is that according to data from the world's largest study of heart disease, conducted by the World Health Organization (WHO) during the past decade in 21 countries with 10 million men and women, French heart disease statistics appear to have been underestimated and the "French Paradox" overestimated. France's rate of heart disease is actually similar to that of neighboring Italy, Spain, and southern Germany — lower than many countries in the world, but hardly as remarkable as reported in
the 80s and early 90s.
The French drink one-and-a-half times more per capita than Americans and their death rate from liver cirrhosis is more than one-and-a-half times greater than that in the United States. According to WHO, France has the sixth highest adult per capita alcohol consumption in the world. (The U.S. ranks 32nd.) Alcohol may be involved in nearly half of the deaths from road accidents, half of all homicides, and one-quarter of suicides, according to the French equivalent of the U.S.
Institutes of Health. And while coronary heart disease may be less pervasive in that country of 60 million people than in many others, it is still the number one cause of death.
Within the past year, several other revelations have highlighted this little-publicized, other side of French drinking:
- According to the first French economic study of its kind, France is more like the U.S. than Americans might realize in that alcohol also ranks first — above tobacco — in its cost to society. Tobacco takes more of a toll than alcohol in the rest of Europe, Canada and Australia.
- The high premature death rate of French men is largely due to alcohol abuse. It is nearly double the premature death rate of French women, and the magnitude of the difference is the highest in Europe, according to the French government's most recent report on health.
- French youth, who can legally drink at age 16, prefer beer and distilled spirits to wine and have increased their consumption five-fold since 1996 in part because 12- to 14-year-olds are drinking and binge drinking. This has led to a new government "War Against Drugs" that includes alcohol.
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The French Paradox. Even in English the expression sounded romantic to 33.7 million Americans who first heard it in a report by Morley Safer on "60 Minutes" in November 1991. Although the French eat fatty foods and smoke more than Americans, said Safer, "if you're a middle-aged American man, your chances of dying of a heart attack are three times greater than a Frenchman of the same age. Obviously, they're doing something right — something Americans are not doing... Now it's all but confirmed: Alcohol — in particular red wine — reduces the risk of heart disease."
Within four weeks, U.S. sales of red wine rocketed by 44 percent. American Airlines reported being unable to stock enough red wine to meet demand. By February 1992, a Gallup poll showed that 58 percent of Americans were aware of research linking moderate drinking to lower rates of heart disease. According to the poll, consumers had returned to drinking levels not seen since the mid-'80s. Although beer remained the preferred drink of Americans, wine preference increased from 22 to 27 percent.
Five months after the 1992 poll, "60 Minutes" re-broadcast the "French Paradox" segment. Sales of red wine shot up 49 percent over the previous year. Safer was honored in France with a special "communication" prize from LVMH Moët Hennessy-Louis Vuitton.
During the next few years, the Wine Institute lobbied officials of the U.S. Department of Health to reflect studies confirming the "60 Minutes" side of French drinking in
the U.S. Dietary Guidelines, which the industry subsequently used to market wine as a health elixir. Food and Wines from France, which promotes Gallic products overseas, placed full-page newspaper ads announcing that French consumption of fatty food was counteracted
by drinking French red wine.
"[Health] announcements are increasing consumption more than anything else," said Stephanie Grubbs, marketing manager for Robert Mondavi Coastal, in Impact magazine in 1997. That same year, three out of four readers in the January Consumer Reports on Health survey believed that moderate red wine consumption is more beneficial than drinking beer or liquor.
Recently, the San Francisco-based Wine Institute helped some California wineries get permission from the Bureau of Alcohol, Tobacco and Firearms (BATF) to add a label referring consumers to the federal dietary guidelines to learn the "health effects" of alcohol. But anyone who actually sent for the document would discover that the government's advice on alcohol is mostly cautionary.
Inflamed by the belief that the wine industry was using the label to make it appear that the government was suggesting Americans drink for their health, Senator Strom Thurmond (R-SC), whose daughter was killed by a drunk driver, recently won a battle for the BATF to hold hearings on whether the "health effects" label can legally be affixed to every wine bottle. They're scheduled to take place in a number of U.S. cities in
late spring.
Today the Wine Institute touts its product on its website with studies and press releases. One quotes David Pittman, Ph.D., researcher at Washington University in St. Louis: "In societies such as France, Italy, Spain and Portugal, where wine and overall alcohol consumption is higher than in the United States, they just don't have as many alcohol-related problems such as drunk driving and underage drinking."
That would be news to France.
The world view that the French are able to control their drinking habits is untrue, according to Pierre Kopp, professor of economics at the Sorbonne. Kopp recently released the first French study estimating the cost of legal (alcohol and tobacco) and illegal drugs. Kopp estimates that alcohol costs France $18.5 billion (U.S.) each year. Drinking is responsible for nearly 53 percent of overall social costs of alcohol, tobacco and illegal drugs, he reports. (Annual cost to the state is $14.3 billion for tobacco and $2 billion for illegal drugs.)
But even these high alcohol economic cost figures are underestimated, cautions the researcher, because he left out alcohol-related crime and accidents, which comprise some of the largest costs to society in the United States. Kopp focused on public and private money spent on medical treatment, lost productivity, absenteeism, uncollected taxes, unpaid health contributions, and preventive measures.
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"Consumption is exceptionally high and the final bill is extremely heavy. Alcohol accounted for 42,963 deaths in France in 1997."
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When "60 Minutes" introduced the French Paradox to America, Morley Safer featured only one French scientific authority — Serge Renaud, a trendsetter in alcohol research who still maintains that "there is no doubt that a moderate intake of wine (one to three glasses per day for a man) is associated with a 30- to 40-percent reduction in mortality from all causes." In its first issue of the new millennium, the prestigious British journal Lancet noted in a short profile of Renaud that his enthusiasm for alcohol and the French Paradox is hardly unanimous today among his French peers. In fact, at least two of the scientists instrumental in early French Paradox research today disagree with Renaud's belief in the central role of alcohol in a lower coronary heart disease rate.
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What's new for both men is the MONICA Project established by centers around the world to MONItor trends in Cardiovascular diseases and relate them to risk factor changes over a 10-year period. Established in the early 1980s by WHO, its final data were highlighted last September at the European Society of Cardiology in Barcelona. De Lorgeril reported there that the WHO data were 75 to 90 percent higher than France's statistics for coronary heart disease deaths.
The cardiologist said he scrutinized alcohol-related deaths and found that French men, "who drink too much," have the highest rates of liver disease and — by far — more upper gastrointestinal cancer, and were more likely to die in accidents, by suicide, or as a consequence of crime than men of other nationalities. While men in Sweden can expect to live 76.5 years on average, a French man's average lifespan, said de Lorgeril, is 74.1 years.
Dr. Ian Graham, a professor of epidemiology at Trinity College in Dublin, said that de Lorgeril's statistics suggest that the lower rate of coronary deaths in France are due "to competing causes of death" — many more French men might die early from alcohol-related causes before they have the opportunity to die of heart disease.
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In 1998, a pharmacist who is a director at the French counterpart of the U.S. National Institute of Health handed then French Health Minister Bernard Kouchner a report that had the effect of "a sort of a bomb." In what has become known as the Roques Report, Bernard Roques classified drugs on the basis of their danger to the public rather than their legal status. Based on scientific data, alcohol took first place along
with heroin and cocaine; tobacco took second place with amphetamines and LSD; and marijuana was in the third, least dangerous group.
[...]
Written by Hilary
Abramson; edited by James F. Mosher; copy edited by Pam
Glenn
Copyright 2000 Marin Institute for the Prevention of Alcohol
& Other Drug Problems
The original article from which the above excerpts were taken can be found on the
Marin Institute: Preventing Alcohol Problems web site at
www.MarinInstitute.org/NL2000.html.