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MELVIN KONNER MD

Science / Medicine : Study on Alcoholism Shows the Roots of Sexism Are Seriously Flawed

February 19, 1990|MELVIN KONNER MD | Editor's note: This is the second column by Dr. Melvin Konner, who teaches medical anthropology at Emory University in Atlanta. His column will appear every other week.

One of the subtlest and most consistent forms of sexism, found in cultures throughout the world, is that men are supposed to drink and drink hard, whereas women are supposed to drink demurely and discreetly, if at all. Among rural Mexicans, Hopi Indians, Samoans and other Polynesians, African Bantu, and modern-day, bar-frequenting British, Americans and Soviets, men sit together in time-honored ritual and match each other drink for drink. Although alcohol consumption is down in the United States, drinking and all the behavioral problems it causes are still common, particularly in young men, who may measure manliness by how much they can drink.

Of course, a sloppy drunk is not considered macho. But a man who is a man should--in a chauvinist culture--keep pace with other men and still be able to talk and fight skillfully. As for women, the more traditional the culture the more they are likely to be excluded from the circle of hard drinkers. The woman who can drink like a man is seen as a rarity, and a man should be able to drink a woman under the table--a position from which she is not likely to exert much influence over the opinions of her fellow drinkers.

Size is part of the story. A 100-pound woman taking one drink for every two put away by a 200-pound man will, all else being equal, have the same size bolt of consciousness-blunting elixir hit her brain. But we now have research to prove that there is more at work than simple weight difference. The implications of this work tell us much about the source of this sexual stereotype and the misguided interpretations by numerous societies.

If our hypothetical small woman does keep up with her doubly hefty male companion, she will have far more wooziness to deal with. And if both walk the same straight line at the close of the bout, it is she who is the real macho hero, because the two bodies handle booze so differently, putting her at an enormous disadvantage.

The new evidence comes from an elegant study published in the New England Journal of Medicine in January. The authors, a binational team of physicians led by Mario Frezza, conducted their work in Trieste and New York. They began with two established observations. First, women seem to develop cirrhosis of the liver more easily than men. Second (and harder to explain by any cultural factor) after an equivalent oral dose of ethanol--the active alcohol in wine, beer, and spirits--women have higher blood levels than men. Since intake in such studies is always corrected for body weight, size is not an issue here.

Consider the conventional picture of what happens when a slug of bourbon or chardonnay gets swallowed. The blood rapidly absorbs the ethanol from the stomach itself and from the intestines. The ethanol flows throughout the body, including the liver and the brain. From then on, the liver is in a race against time to detoxify the alcohol before too much gets to the brain. The liver's main tool is an enzyme called alcohol dehydrogenase; it oxidizes ethanol to a harmless substance known as acetaldehyde. Ninety-eight percent of the stuff can be safely transformed in this way, at a rate of roughly one standard drink (or one four-ounce glass of wine, or one 12-ounce can of beer) every 90 minutes or so, for a 170-pound man. Meanwhile, the brain gets its peak ethanol hit about an hour after the drink goes down the hatch.

Enter Prezza and his colleagues with their very sensible question: If women have higher blood levels right from the start, could this have something to do with the stomach? The results were striking.

In all 20 men in the study, but especially in the nonalcoholic men, the rate of stomach enzyme activity was markedly higher, and the concentration of ethanol in the blood markedly lower. The two measures were correlated, strongly suggesting that the stomach enzyme difference was the explanation of the differing blood levels. With intravenous injection as a control condition, the peak blood levels in the two sexes were similar. But with oral intake, the nonalcoholic men reduced their peaks by about half, whereas the 23 women reduced their peaks by less than 30%. Over time, the exposure of the brain to ethanol was much greater in the women than in the men, and this was clearly attributable to stomach enzyme activities at least 70% higher in men.

We hear a great deal about the dangers of alcohol, not least to the child growing inside a pregnant woman. We must now recognize that, for biological reasons, women will have much higher blood levels of the stuff, even after adjusting intake for smaller size. The ancient machismo of the drinking contest thus rests on a true biological sex difference. Does the reality of this difference make women inferior? Obviously not. But cultures throughout the world have noted the sex difference in boozing capacity and interpreted it in a way that demeans women. It goes to show how tenacious we have been in coloring sex difference chauvinistically. Sexism and boozing are bad habits, and the sooner we abandon both, the better off we'll be.

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