Medicine: Out in the Open

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Ethanol has a harmful effect on nearly every organ in the body. Chronic heavy drinking increases the risk of myocardial disease and high blood pressure. Alcohol eats away at the stomach and intestines, causing bleeding in some drinkers. Alcoholic males may experience shrunken testes, reduced testosterone levels, and even impotence. Sustained drinking sometimes disrupts women's menstrual cycles and can render them infertile. Among expectant mothers, drinking can produce birth defects and is a major cause of mental retardation in American children. Even the immune system's efficiency is reduced by alcohol. Studies are under way to determine whether heavy drinking might cause AIDS to surface more quickly in infected carriers.

But alcohol takes the worst toll on the liver, where most of the ethanol in the bloodstream is broken down. Because alcohol is so high in calories (there are 110 calories per jigger of 90-proof liquor), the liver metabolizes it instead of important nutrients, a phenomenon that can lead to severe malnutrition. The high caloric content of ethanol also causes fat to build up in the liver, one of the earliest stages of alcoholic liver disease. This is frequently followed by scarring of the liver tissue, which interferes with the organ's task of filtering toxins from the blood. The slow poisoning leads to other complications, including cirrhosis, an often fatal degeneration of the liver that affects at least 10% of all alcoholics and is especially hard on women. "They die of cirrhosis earlier than men, even though they consume less alcohol," says Judith Gavaler, an epidemiologist at the University of Pittsburgh Medical School.

This year studies at the Harvard Medical School and the National Cancer Institute reported that even women who drink moderately may have a 30% to 50% greater chance than nondrinkers of developing breast cancer. Heavy drinking among men and women alike has been linked to cancer of the liver, lung, pancreas, colon and rectum. In October a team led by Dr. Charles Lieber, a leading alcoholism researcher at the Bronx Veterans Administration Medical . Center in New York City, reported that it had isolated a possible link between alcohol and cancer in humans. The culprit appears to be a member of the family of enzymes called cytochrome P-450s. In the presence of alcohol, the cytochrome can turn certain chemicals in the body into carcinogens.

Despite the medical recognition of alcoholism as a disease 21 years ago, there is still uncertainty over its legal status as an illness. Michael Deaver, the former aide to President Reagan who is on trial for lying to a grand jury about his lobbying activities, is arguing that he was not responsible because he is an alcoholic and his drinking at the time impaired his memory of events and facts. In the past the so-called alcoholism defense generally has not been very successful, but it has worked on occasion in perjury cases.