For the last few days, CNN has run a story for New Year’s Eve revelers about how to deal with the hangover the next morning, caused by drinking too much alcohol the night before. (You can find one of their versions of the story here, and no doubt similar stories appeared on hundreds of broadcast news outlets – it is a favorite.)
The reporter pointed out that we do not understand what causes a hangover. By this she actually meant we do not understand the biological steps on the causal pathway from heavy drinking to hangover, which is an important distinction. We clearly know that the drinking causes the hangover. Also, there is pretty good evidence that some of the symptoms, particularly headache, are caused or exacerbated by dehydration so drinking a lot of water while imbibing (or pounding back a lot before falling asleep) helps a lot.
The critique I want to focus on is about the most emphatic piece of advice in the story, that the “hair of the dog” approach (which is to say drinking a bit in the morning – I am not sure if that idiom is universal) is bad because it merely makes you feel better. I will set aside her common nonsense (“alcohol is a ‘toxin’ so drinking more of it must be bad for you”) until I am stuck on a slower news day. I will focus instead on the interesting false dichotomy between “curing” a hangover and feeling better. A hangover is not cancer or a serious infectious disease, where diminishing the symptoms does not eliminate the core problem. The reason a hangover is bad is because it makes us feel bad, so for all practical purposes the symptoms are the disease. The bloody mary in the morning (or beer or even bourbon if you are not into froofy drinks) that “merely” makes us not feel the hangover has, as far as we can define it, eliminated the hangover. (As an aside, even for cancer, an intervention that eliminates pain and nausea is a great benefit in itself that should not be ignored, though it may do nothing to cure the cancer.)
This is not to say that binge drinking to the point that it causes a hangover is harmless. But, as the reporter should have known — given that she reported that we do not fully understand the causal pathway — we do not have any reason to believe that the hangover itself, treated or not, represents any real ongoing harm. A moderate amount of alcohol with breakfast is no more harmful than it is when you do not have a hangover. Perhaps not so good for productivity, but there is no reason to believe that it increases the real harm of the recent binge. Also, for some people the treatment works and for some it probably does not, but each individual drinker can probably figure this out (expanding on this point is a topic for another day).
This reminded me of a wind turbine case I worked on recently in New Zealand (no easy links to the particular case, but some of what I have written on the topic is here), where one of the main arguments by the industry’s consultants was that what residents suffered due to nearby wind turbines was not a disease but just a collection of symptoms. The first response to that is that “symptom” in this case is short for “symptom of a disease” so there must be a disease there somewhere, whether we know what to call it or not. But the deeper response is that for many conditions (it makes no difference whether we call them a disease or not), the symptoms are what matter. A superficial scrape or minor burn can be described in terms of tissue damage, but what really matters to people is that it hurts – get rid of the pain and whatever remains during the healing process is just invisible biology at work. Some headaches represent underlying conditions that need to be fixed, but most are just about the pain, so Tylenol does not “merely treat the symptom” – it cures the condition.
So, in the case of the hangover and for many other cases, it is nonsense to draw a distinction between feeling better and being better. The problem is that most health reporters have committed that cardinal journalistic sin of getting too close to their subjects, the medics and researchers, reporting what the subjects care about as if it were what the audience should think or care about. Those who focus on disease as an epistemic object in itself can easily forget that what ultimately matters is what is experienced by what they call “the patient” (who the rest of us call “people”). I am reminded of a Robert Wood Johnson Foundation conference I went to during my postdoc, a mix of physicians who were learning to be researchers and scientists learning about health topics. During one remark from one of the medics, related to a talk about some medical condition that caused pain, he joked “as background for you non-physicians, I should mention that pain is a bad thing.” One of my social science colleagues immediately shouted out from the audience (with speed that I envy to this day), “I think the physicians are the ones that need to be taught that.”
EP-ology 