Key concerns include: Abstainer bias: some non-drinkers in comparison groups were former heavy drinkers, artificially inflating their risk and making moderate drinkers look protective by comparison Residual confounding: moderate drinkers tend to have higher incomes, better diets, stronger social networks factors that independently reduce disease risk Lifestyle entanglement: epidemiology struggles to disentangle wine from Mediterranean diet, social cohesion, physical activity, and other variables A 2014 briefing by Blakely & Wilson (Public Health Communication Centre, University of Otago) summarized it clearly: There may be a benefit for cardiovascular disease prevention from moderate alcohol use but its true benefit may be overstated by our current best evidence due to unresolvable biases. Their bottom line: heavy use is clearly harmful, binge drinking is clearly harmful, cancer risk increases with any exposure, cardiovascular benefit is plausible but likely overstated, and the net public health burden of alcohol remains net negative across populations
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