Wine, Medicine, and Risks to Health

Here is a bit of poetry, familiar to admirers of Keats:

O, for a draught of vintage that hath been
Cool’d a long age in the deep-delved earth,
Tasting of Flora and the country green,
Dance, and Provençal song, and sunburnt mirth!
O for a beaker full of the warm South,
Full of the true, the blushful Hippocrene,
With beaded bubbles winking at the brim,
And purple-stained mouth;
That I might drink, and leave the world unseen,
And with thee fade away into the forest dim

And here, by contrast, are some quite recent specimens of anti-poetry:

And finally, though the list could be extended by many examples:

I kept coming back to these headlines while reviewing some bioethical literature on the medicalization of risk and the rise of preventive medicine. The most recent entry in this emerging body of criticism is Paul Scherz’s interesting and provocative book, The Ethics of Precision Medicine: The Problem of Prevention in Healthcare. Scherz’s book is his second to address this topic, and he and Farr Curlin (my co-author on The Way of Medicine) have also co-edited a special issue of the journal Christian Bioethics on the topic.

Scherz, Curlin, and others argue that contemporary medicine has moved in recent decades to an overwhelming focus on the identification and mitigation of risks to health. You can see this if you have been to your primary care physician recently for your annual checkup: an increasing amount is geared towards discovering your medical risk profile—focused, preferably, on risks for which there are pharmaceuticals that you can be prescribed in order to reduce your risk as low as possible.

Your physician no longer treats you for the illnesses you do have, but for the ones you might have at some point in the future. And once you have been “diagnosed” with some treatable risk factor, such as high cholesterol, you will now constantly be in treatment—consigned to one or more forms of medicine in perpetuity. Even surgery is not out of the question for those whose genetic profile suggests the possibility, for example, of breast or ovarian cancer. And, of course, you will need continued monitoring to ensure that your risks remain within the correct parameters.

This new domination of your life, day in and day out, by attention to and care for risk to health makes it seem as if health is the only good that matters. Reduction of risk to a minimum approaches being a full-time job. A similar reduction was seen in our public approach to the COVID-19 pandemic.  The risks to health posed by the virus swamped concern for many other goods, including sociality, work, and children’s education.

Covid is effectively over, but the paradigm of risk reduction and a single-minded attention to health lives on in the realm of preventive medicine.

And it lives on in the recent scare tactics concerning wine. Proponents of what seems to be a new form of socially mediated prohibition, such as the University of Colorado’s Cancer Center, almost certainly overstate the risk to health of alcohol—is it really a “leading cause of cancer”? But then the single-minded focus on risk to health squashes concern for the real goods associated with wine, such as conviviality and hospitality (to say nothing of relaxation and enjoyment).

My sample headlines, and many others, display as well a neglect for the associational qualities that make wine so delightful: the way in which wine can bring one back to a particular place, a dance, a song, a jest. And the authors of these articles are indifferent to the way that wine can allow us, at least temporarily, to leave the world and our troubles behind—sometimes alone, sometimes “with thee.” Too much of that deliberate forgetting of one’s care is undoubtedly irresponsible; some degree of it, on occasion, can make life somewhat more bearable.

These benefits, to say nothing of the livelihood of those who make and sell wine, would be lost if the relatively low risk of moderate drinking to health were the only consideration relevant to the question of whether to drink or not. The Los Angeles Times opinion piece in particular brought me near to despair. That the Body and Blood of our Lord should be reduced by half, and Christ’s connection to wine, from the very first moments of his public ministry to his last, should be effaced, is a monstrous suggestion. Was Christ at Cana unjustly putting the wedding guests at risk of cancer? It is an absurd proposition.

 Critics of the medicalization of risk argue that the new medical paradigm fails to recognize the potential health dangers that “treating” risk can lead to, as medications and surgeries pile up upon one another. The side effects of these treatments are often not well-known, and the variety of drugs a patient might be taking can interact in unforeseen ways. 

Moreover, and in sharp contrast with the person-to-person care by a physician for an individual sick patient, the medicalized risk paradigm can lead to depersonalization when individuals are known primarily as instances of a statistically modeled population.

The new antagonism toward wine and other forms of alcohol seems similarly de-personal to me. It neglects the way that wine, at its best, functions in relationships: at a family meal, a wedding, a couple celebrating their anniversary, and the Eucharistic feast. And it treats what should be an individual decision—to drink or not—entirely in terms of a statistical approach to alcohol’s health risks.

Two further features seem to me to connect the work of Scherz and Curlin to the great wine scare of 2024-5.

Over the course of that period (which still continues), it seemed like every time I looked at The New York Times I saw headlines about the dangers of alcohol, about the “sober-curious,” about “dry January,” and, of course, about the Surgeon General’s warning about alcohol and cancer. 

The effect on me—mild but real, and clearly vividly felt by others—was anxiety: anxiety manifesting in suspicion, a suspicion of wine. Eric Asimov is the wine writer for the Times and a wine lover if ever there was one. But he too felt the chill of this anxiety, subjecting his daily wine drinking practices to heightened scrutiny and defense. It might seem inflationary to say it, but I felt myself becoming alienated from wine, as if it was something out to get me.

Scherz makes similar claims about preventive medicine: the focus on risk moves the anxiety and alienation of illness—the sense that one’s body has betrayed one, and that more betrayal is in store—to the realm of experienced health.  I feel nothing wrong with me, but my risk profile encourages me to think of my body as flawed, as containing within itself the seeds of its own destruction. By contrast, Curlin argues in an essay in Christian Bioethics that a truly Christian approach to risk must be attentive to Christ’s warning:

Therefore do not be anxious, saying, “What shall we eat?” or “What shall we drink?” or “What shall we wear?” For the Gentiles seek after all these things, and your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness, and all these things will be added to you. Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble. (Matthew 6:25–34; ESV)

One can also see parallels with the way that the quantification and medicalization of risk becomes tied up with efforts at large scale social control. When Covid-era slogans such as ‘If anyone is unsafe, everyone is unsafe,’ or ‘No acceptable losses’ were taken seriously, their goals could be accomplished, if at all, only by extraordinarily comprehensive and intrusive governmental measures—measures backed by social sanctions, such as scorn and shame, that were often extremely uncharitable and ill-conducive to civic friendship.

The goals of the Surgeon General’s intervention likewise will require greater efforts at social control if they are to be realized. Noah Rothman, writing in National Review, argues that knowledge of wine’s risks can hardly be expected to change people’s behavior—such knowledge is already “baked in” to our choices. Rather, the intent is to drive up the price of alcohol as, in order to “compensate for the additional cost imposed on manufacturers and to offset the losses associated with negative perceptions of their products, producers boost prices.” More expensive wine means fewer overall consumers.

This seems like more than mere “nudging.” And the opportunities for control could extend further. My health plan requires me to testify that I do not smoke in order to avoid higher premiums. Will my alcohol consumption face similar scrutiny?

So, what to do? Well, if one drinks, one should drink virtuously: at the right times (usually with food), with the right people (friends, although sometimes also with enemies), and in the right way—not too much, not too often, not before driving and so on. These are familiar folkways of drinking, responsive to the various risks of wine and other alcohol, not just those related to cancer.

Virtue is needed also to prevent the excesses of risk management. We must not be overwhelmed by concern for health to the point where we fail to live our lives with a full and reasonable orientation to all the goods of the human person. We must strive to overcome anxiety in the face of life’s uncertainties. We should not abandon care for the body, but that care should be rooted in the larger framework of our personal vocation:the particular life to which God has called us, but one which for all of us must be a life of service.  As Curlin notes, “Those who are busy with serving God and their neighbors are less susceptible to the lure of preventive medicine strategies that would turn their lives into one long provision for the flesh.”

Discernment of the place of both wine and medicine in one’s life is needed; such discernment should neither ignore nor unduly elevate the role of risk in a well-ordered life.

Image by New Africa and licensed via Adobe Stock.