Those of you who have been reading my blog since its previous address may remember my EtAOK post. Without reposting it, a quick summary is that despite its many ill effects and the huge cost it creates within society, alcohol (a.k.a. EtOH) is consistently and preferentially ignored throughout medical education. I like to therefore call it Et-AOK because despite the huge medical burden it places on society, since most doctors seem to enjoy drinking more than the average individual it is passed off as being totally OK, or EtAOK.
We all know smoking is bad. It causes cancer of many kinds. It causes significant decrease in lung function. It causes birth defects. It even carries a surgeon general's warning that using the product will cause these problems.
Alcohol can cause cancer, specifically hepatocellular cancer and stomach cancer. Alcohol can cause you to die from just about any organ system failing. Alcohol is the #1 cause in America of birth defects. Nobody seems to care.
Not only does alcohol cause all these things, it also causes a lot of trauma. You might remember my ER rotation posts "Life Lessons" and "Chief Complaint". A lot of those people also came in with pretty notably elevated blood alcohol levels. Anyway, the whole reason for me revisiting this post is I spotted this article in the news today. You might notice a few things about this guy. Like his use of a mixture of "stupid stuff" right before inserting the snake in his mouth. A poisonous western diamond back rattlesnake. Into his mouth. Because it was a "nice snake". Not that this one case report among many would change the fact that in medical school you will hear more about "the beneficial effects of drinking one glass of red wine daily" than anything other consequence of drinking alcohol.
Oh yeah, and this case is double awesome because it's anesthesia related because his tongue was so swollen as to totally occlude his airway requiring an emegency trach.
[update 1]: Who could ask for such luck in a single day?! Not just one story of inibriated madness, but two. This one is the story of a 54 year old drunk man who got in trouble with the law for throwing an onion at his 27 year old wife. I'm sure there's more than one story of "night's I can't remember" in that family. Your first clue might be that when the man was his wife's age she was but an embryo.
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3 comments:
G,
You've certainly shown us many of the bad things EtOH can do (and goodness knows we've all seen its horrible end-stage effects). That leaves me two questions for you.
a) Most of these are people who abuse or are dependent on EtOH, consuming large quantities. Can you point out similar bad outcomes from more moderate intake (ie, the 1 glass of wine per day that we hear about being cardioprotective?)
b) Do you believe it is possible to use EtOH without abusing it? Is it possible, in your mind, to get more benefit than harm from this substance?
A) Similar bad outcomes can come from people with low levels of aldehyde dehydrogenase. Like asian women. And the "cardioprotective" effect is really just an antioxidant effect -which you can get from other less intoxicating substances like pomegranate or grape juices.
B) I believe some people can use it without abusing it, although most people abuse it at some point in their life - like while they are still underage and techinically shouldn't even have access to it. I do NOT think the benefits ever exceed the risk. Aside from "cardioprotection" from one specific beverage which actually has nothing to do with the alcohol, what other benefit is there?
1) People with low levels of EtOH dehydrogenase are more prone to easy intoxication, nausea, vomiting, and facial flushing, but I was not aware that this made them more prone to HCC, cirrhosis, pancreatitis, Wernicke-Korsakoff's, or the other terrible effects of end-stage alcohol abuse.
2) This review article http://www.ncbi.nlm.nih.gov.ezproxyhost.library.tmc.edu/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15006418&ordinalpos=15&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
would seem to suggest that "chronic ingestion of small quantities of ethanol" acts through many varied pathways on the heart (mostly in animal models) to protect it from ischemia independent of changes in blood pressure, lipids, or other risk factors. It seems that the effects are greater than simply antioxidant free radical scavenging alone.
3) While there are quite a few articles on different antioxidant compounds and myocardial protection, I only found 3 on grape seed polyphenols and 0 on pomegranate. I don't know precisely what antioxidants are found in different fruit juices, so I couldn't really compare the names ("wogonin, baicalin, baicalein, catechin and procyanidin B2" in one article) to any specific source. I did see one promising review on selenium compounds and their antioxidant effects.
4) In psych, I see people addicted to all manner of substances, from the legal to the illegal to the why-the-heck-would-you-abuse-THAT?. I doubt I'll ever recommend to a patient that they START consuming alcohol in order to protect their heart--after all, alcoholic beverages are full of calories in addition to everything else. If I have a patient who drinks a bit more than I think is necessary, but I think they can "cut down", then I might bring up the 1-2 glasses of wine thing. If I have someone who is clearly abusing or dependent on alcohol, I would of course recommend treatment and future abstinence from alcohol. Period. Therefore, my opinion is, until someone shows me that drinking alcohol is BETTER than diet changes, exercise, etc, in preventing heart disease, then I will not routinely recommend it. EtOH is a very dangerous drug, probably more dangerous than marijuana which is illegal.
However, I do not see truly moderate use as a problem for most people. I've never really gotten the message from my attendings that "it's okay for us to drink, but not the patients." I have, however, seen so much damage from alcohol abuse, that I think I've gotten the message. I don't think our school tried to sugar-coat the truth about alcohol.
If you think that drinking in our class is a problem (which it may be), then perhaps it could be suggested by a group to class officers that there be less drinking at class functions?
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