CORK Bibliography: Alcohol, Therapeutic Use

10 citations. January 2003 to present

Prepared: March 2010

Appel JM. "Physicians are not Bootleggers": The short, peculiar life of the medicinal alcohol movement. (review). Bulletin of the History of Medicine 82(2): 355-386, 2008. (101 refs.)

This essay seeks to chronicle the effort of physicians to secure the right to prescribe beer, liquor, and other alcoholic beverages to their patients for medicinal uses during the Prohibition era. A review of the medical literature and popular press from the period 1920-26 reveals that the physicians who lobbied for the right to prescribe alcohol and, ultimately, took their claim to the United States Supreme Court, were not uniformly antiprohibitionists attempting to circumvent the Eighteenth Amendment. Instead, this coalition of physician activists, led by John P. Davin and Samuel W. Lambert, included both supporters and opponents of prohibition. Their attitudes on the therapeutic value of beer and liquor also varied widely. Yet what united these men and women-and what defined their movement-was opposition to state interference with the practice of medicine and an increasing concern with the federal government's role in the regulation of their profession. The defeat of their efforts, presaging the passage of the Sheppard-Towner Act in 1921 and the extension of veterans' health benefits in 1924, marked an important step in the development of antagonism between the medical community and the federal government during the mid-twentieth century.

Blondell RD; Dodds HN; Blondell MN; Looney SW; Smoger SH; Sexton LK et al. Ethanol in formularies of US teaching hospitals. (letter). Journal of the American Medical Association 289(5): 552, 2003. (3 refs.)

The authors of this letter examine the use of ethanol in hospital formularies for therapeutic purposes, particularly in treating alcohol withdrawal. The evidence for supporting this practice is weak. The present study was conducted to examine the frequency of ethanol use for patient care in major American teaching hospitals. An 18-item questionnaire was completed by 116 U.S teaching hospitals. These results were seen: Ethanol was dispensed within the prior 12 months at 83 (72%) of the responding hospitals: 45 dispensed both oral and IV ethanol; 20 dispensed only IV ethanol; 18 dispensed only oral ethanol. Physicians had used ethanol to prevent or treat AWS in 62 (75%) of the 83 hospitals where ethanol was dispensed. Among the 65 sites reporting IV ethanol use, 45 (69%) indicated that physicians were permitted to order IV ethanol for AWS. Of the 63 facilities where oral ethanol was dispensed, it was used for AWS in 44 (70%). Estimates for the number of patients treated for AWS within the prior 12 months ranged from 1 to 50 (mean, 8) with IV ethanol, and from 1 to 200 (mean, 17) with oral ethanol. Alcoholic beverages were also used for "patient courtesy" at 38 hospitals, sedation at 10, stimulation of appetite at 6, and for other reasons at 25. Ethanol continues to be dispensed by hospital formularies at more than two thirds of major US teaching hospitals, despite the lack of published evidence for its effectiveness.

Hay K. Medicinal effects of alcohol? (letter). Canadian Family Physician 50: 224-224, 2004. (0 refs.)

Hodges B; Mazur JE. Intravenous ethanol for the treatment of alcohol withdrawal syndrome in critically ill patients. (review). Pharmacotherapy 24(11): 1578-1585, 2004. (24 refs.)

Critically ill patients with alcoholism are at greater risk of morbidity and mortality from alcohol withdrawal syndrome than are patients without alcoholism. Benzodiazepines are considered the drugs of choice for the prevention and treatment of alcohol withdrawal syndrome, but some studies have suggested that intravenous ethanol may be as effective as those agents, as well as being less sedating. We evaluated the evidence regarding the use of intravenous ethanol for the prevention and treatment of alcohol withdrawal syndrome in critically ill patients in order to determine its role in this patient population. Because of the paucity of well-designed clinical trials, and because of intravenous ethanol's questionable efficacy, inconsistent pharmacokinetic profile, and relatively narrow therapeutic index, routine use of this drug is not recommended in critically ill patients who have alcohol withdrawal syndrome or are at risk for it.

Holt MP, ed. Alcohol: A Social and Cultural History. Gordonsville VA: Berg Publishers, 2006. (Chapter refs.)

This edited volume deals with an array of topics that shed light on the social and cultural history surrounding alcohol. With 13 chapters it is organized into three sections. Alcohol has long played an important role in societies throughout history, and understanding its consumption can reveal a great deal about a culture. It examines how drink has evolved in its functions and uses from the late Middle Ages to the present day in the West. This book discusses a range of issues, including domestic versus recreational use, the history of understanding of alcoholism, and the relationship between alcohol and violence, religion, sexuality, and medicine. It looks at how alcohol sheds light on issue of class, gender and place. Drawing on examples from Europe, North America and Australia, this book provides an overview of the many roles alcohol has played over the past five centuries.

Lieberman B. The power of positive drinking: Are alcoholic beverage health claims constitutionally protected? Food and Drug Law Journal 58: 511-520, 2003. (81 legal refs.)

The Competitive Enterprise Institute's (CEI's) 1996 lawsuit challenging the federal government's policy regarding alcoholic beverage health claims was dismissed, without prejudice, on procedural grounds. See CEI v. O'Neill, No. 96-2476 (D.D.C. June 18, 2001), appeal dismissed, CEI v. O'Neill, No. 01-5241, 2002 WL 1359478 (D.C. Cir. May 10, 2002). Summary: It seems almost too good to be true that moderate consumption of alcoholic beverages substantially reduces one's risk of contracting heart disease, but a wealth of published studies have shown it to be an accurate statement. ... In its 1993 Industry Circular, entitled Health Claims in the Labeling and Advertising of Alcoholic Beverages, ATF conceded that "there is currently a growing body of scientific research and other data that seems to provide evidence that lower levels of drinking decrease the risk of death from coronary artery disease." ... ATF sponsored a survey, conducted by DHHS' Center for Substance Abuse Prevention (CSAP), which tested the consumer impact of the proposed directional statements, including whether they would confuse consumers about the risks of drinking or obfuscate the message in the mandatory health warning statement. ... The agency conceded that "the regulations make it difficult to present a substantive health claim (for example, one involving cardiovascular benefits associated with moderate alcohol consumption) on an alcohol beverage label, because of the level of qualification and explanation that would be necessary to set forth the risks associated with such consumption." ... The agency has not demonstrated, to the satisfaction of First Amendment commercial speech scrutiny, that such health statements are misleading absent the now-mandated disclaimers.

Sandler M; Pinder R, eds. Wine: A Scientific Exploration. London: Taylor and Francis, Inc., 2003. (806 book refs.)

The science of wine, its protective medical effects, and its making are discussed. The authors note that wine has been made since Neolithic times. The beneficial effects of wine were also well known by the ancients. Modern issues were first noted in 1979 with the publication of a paper related to the relationship between cardiac mortality and the consumption of wine. The authors suggest that red wines, particularly Merlot and Pinot Noir, may have greater protective effect than white wines, perhaps as a result of higher concentrations of polyphenols in the reds. Chapter headings in this volume include: (1) drinking wine; (2) the history of wine as a medicine; (3) archaeology and the origins of wine production; (4) saving the vine from Phylloxera: a never-ending battle; (5) wine and heart disease: a statistical approach; (6) wine, alcohol and cardiovascular diseases; (7) wine flavonoids, LDL cholesterol oxidation and atherosclerosis; (8) resveratrol: biochemistry, cell biology and the potential role in disease prevention; (9) grape-derived wine flavonoids and stilbenes; (10) modern biotechnology of winemaking; (11) the identity and parentage of wine grapes; (12) wine and migraine; (13) wine: protective in macular degeneration; and (14) antimicrobial effects of wine. Many figures and tables are included.

Sattar SP; Qadri SF; Warsi MK; Okoye C; Din AU; Padala PR et al. Use of alcoholic beverages in VA medical centers. Substance Abuse Treatment, Prevention, and Policy 1: article 30, 2006. (11 refs.)

Background: Benzodiazepines are the first-line choice for the treatment of alcohol withdrawal syndrome. However, several hospitals continue to provide alcoholic beverages through their formulary for the treatment of alcohol withdrawal. While there are data on the prevalence of this practice in academic medical centers, there are no data on the availability of alcoholic beverages at the formularies of the hospitals operated by the department of Veteran's Affairs. Methods: In this study, we surveyed the Pharmacy managers at 112 Veterans' Affairs Medical Centers (VAMCs) to ascertain the availability of alcohol on the VAMC formularies, and presence or lack of a policy on the use of alcoholic beverages in their VA Medical Center. Results: Of the pharmacy directors contacted, 81 responded. 8 did not allow their use, while 20 allowed their use. There was a lack of a consistent policy across the VA medical centers on availability and use of alcoholic beverages for the treatment of alcohol withdrawal syndrome. Conclusion: There is lack of uniform policy on the availability of alcoholic beverages across the VAMCs, which may create potential problems with difference in the standards of care.

Sotos JG; Blondell RD; Dodds HN; Sexton LK. Ethanol in hospital formularies. Journal of the American Medical Association 289(18): 2361, 2003. (11 refs.)

This letter to the editor, and reply, concern research by R. D. Blondell, et al. (JAMA, 289[5]:552, 2003) that found that ethanol is still in the formularies of most U.S. teaching hospitals. They suggest that ethanol is ineffective in treating alcohol withdrawal syndrome, and thus are concerned that having ethanol in a hospital formulary "may send the implicit message that alcohol is an appropriate remedy for illness." In fact, recent practice guidelines cite ethanol as a treatment of methanol poisoning. Ethanol may also be used in treating ethylene glycol poisoning. In reply, it is stated that although methanol and ethylene glycol themselves are not highly toxic, they are converted to metabolites that are (i.e., formaldehyde and formic acid, or glycoaldehyde and glycolic acid, respectively). In addition to gastric decontamination, supportive care, and hemodialysis in selected patients, the treatment strategy for these poisonings is to block the initial step in their metabolism by inhibiting alcohol dehydrogenase, which converts the alcohol to an aldehyde. Fomepizole is the only treatment approved by the U.S. Food and Drug Administration for methanol and ethylene glycol poisoning, and there is clinical evidence to support the recommendation that it should be the first-line treatment. Traditionally, intoxicating intravenous (IV) doses of pharmaceutical-grade ethanol have been used as an alcohol dehydrogenase inhibitor, but the evidence to support this practice is limited. IV ethanol should not be used for the alcohol withdrawal syndrome; benzodiazepines are the treatment choice.

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