Whiskey

Is it acceptable to drink alcohol in outpatients?

Twelve years ago, I made a career move from being a biomedical scientist with teaching and training responsibilities to being a teacher. I’ve been sifting through paperwork from my biomedical science days and as these documents go as far back as 1979, there are some real gems.

We are all told that alcohol is bad for us, especially in excess. Reflecting back often means that we judge what was happening then by the standards of today. So, has there ever been a time when drinking alcohol was acceptable in a hospital?

In 1976, a paper was published in a respected scientific journal, Acta Endocrinologia. Scientists had found that whisky (perhaps of Scottish origin, judging by the spelling) was a potent stimulant for secretion of the hormone calcitonin. Calcitonin, produced by the thyroid gland, is an important regulator of calcium and phosphate, as it inhibits the action of cells that are responsible for releasing mineral ions from bone.

In normal, fasting subjects, whisky stimulation only causes a very small rise from a baseline of less than 80 ng/l. In patients with a predisposition to develop medullary carcinoma of the thyroid can show an increase of greater than 1000 ng/l following whisky ingestion – indicating an increase in the mass of the cells responsible for secreting calcitonin.

So, what happens? The subject is asked to fast for a minimum of four hours and then gives a sample of blood. The subject then drinks 50 ml of whisky and waits fifteen minutes, then gives a second blood sample. Calcitonin levels are measured on both samples.

It was suggested in the original article that the whisky wasn’t directly responsible for the release of calcitonin, but stimulated the release of gut hormones that were already known to be stimulators of calcitonin.

So, if we fast forward 50 years, would we still be using the whisky stimulation test? Of course, the answer is no. The increase in mass of the cells responsible for calcitonin release would be seen by ultrasound examination, a biopsy would be taken, and the tissue examined under a microscope.

My conclusion is that the diagnostic testing of 2020 is far more reliable than that of 50 years ago, but possibly not as much fun.