Pearl, Raymond -- Alcohol and Longevity

An historical study on the relationship between alcohol consumption and mortality; possibly the first significant scientific effort to report beneficial effect of moderate consumption.

Pearl, RaymondAlcohol and Longevity New York: Alfred A. Knopf, 1926. 273 pp.

(This review was originally published in the newsletter of the Wayward Tendrils, a society of wine book collectors. E-mail address: tendrils@jps.net.)

by Ronald F. Unzelman, MD

Biologist Raymond Pearl (born Farmington, New Hampshire, 1879; died Hershey, Pennsylvania, 1940) was a fervent advocate of the scientific method and was an early exponent of the application of statistics to study biology and medicine. Graduated from Dartmouth in 1899, he received a Ph.D. from the University of Wisconsin in 1902, and was associated with the Institute for Biological Research at Johns Hopkins University from 1918 to 1940. He authored numerous articles and books in his field and was the center of a prohibitionist storm of non-scientific criticism because of this report. For sixty years the medical profession ignored Pearl's elegantly presented conclusion that a small to moderate amount of alcohol consumption was not bad and indeed was beneficial to health. Only recently has the medical community at large acknowledged this information.

Professor Pearl's interest in the effect of alcohol on duration of life originated from one of his biological experiments on chickens designed to test the effect of alcohol on progeny. He noted chickens that were administered alcohol "far outlived their untreated brothers and sisters." Now this was during a time of anti-alcohol hysteria in the United States which led to Prohibition. The ingrained belief was that all alcohol was unhealthy. As the consummate biological scientist he came to a logical, although controversial, conclusion: "These experimental results regarding the effect of alcohol upon longevity were so widely different from the commonly held opinions on the subject as greatly to excite curiosity to investigate the problem with adequate human material."

His human material was originally collected to study the factors involved in the etiology of tuberculosis. Field workers, trained in biology and social work investigation, and able to speak a variety of foreign languages, conducted extensive personal interviews of family members in Baltimore, MD, to record the "environmental situation, habits of life, health history, racial stock, anthropological characteristics, exposure to tuberculosis, etc. of all the members of the family." Amount and type of alcoholic beverages consumed were corroborated by the independent testimony of at least two other persons acquainted with each individual. This meticulously collected information from 3084 men and 2164 women aged 15 to 99 years represented data from a fairly homogeneous, white, working class population of a large American city.

There is a lot to admire about the setup and presentation of this study which separates it from contemporary investigations:

1. Presented in full-length book form which allowed the literate exposition of background and full elaboration of results and explanation that modern editorial policy restricts to abbreviated medical staccato jargon.

2. Alcohol intake recorded by trained observers, not a self-questionnaire; confirmed by independent observers and collected without the bias that this was an "alcohol" study, i.e. accurate data!

3. But a statistical wrinkle I keenly appreciated was Dr. Pearl's decision to define categories of drinking by effect, contrary to modern inquiries that compare inconsistent quantitative amount categories.

A. Heavy class of drinkers defined as "those persons who are positively known to have been in the habit of getting drunk."

B. Moderate drinker defined as using alcohol in forms of beer, wine or spirits, but never enough to become intoxicated. His moderate steady category equated to a very English "daily pint or two of beer, or a daily bottle of claret, or a few glasses of whiskey."

Contemporary investigators and various national guidelines have yet to agree on a single definition of a moderate amount of alcohol intake. Pearl explains his simple reasoning, "surely it is in accord with common usage to call a person who gets drunk a heavy drinker. Also it is common usage to call a person who drinks a little but never gets drunk a moderate drinker."

Pearl's actuarial method to compare mortality was to develop life tables. This was similar to the technique used by life insurance companies of his time; a person leaves the "exposed to risk group" only upon death. Life table functions can be expressed as expectation of life (in years), survivorship (number of survivors out of 100,000 starting together at age 30), death rates per 1000 life years exposure (mortality rates) and "the most basic and trustworthy life table constant" age specific death rates.

He concludes: "the highest expectations of life throughout are experienced in the moderate steady group, in the case of both males and females." Professor Pearl's scientifically developed life tables demonstrate clearly the first J-shaped mortality curves in which heavy drinkers fare the worst and moderate drinkers live longer than abstainers. He quaintly pronounces "the results are unquestionably novel."

Raise a glass of wine — now that we have rediscovered wine as a healthy mealtime beverage — to this long-neglected pioneer scientist who had the fortitude to publish his logical, but "politically incorrect," conclusion based on a considerable mass of objective data.

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