Strange Brew 

Will there ever be a cure for alcoholism? And why is wine tycoon Ernest Gallo spending millions trying to find out?

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As a public policy matter, industry critic Andrew McGuire argues, the government could do other, more cost-effective things to reduce the impact of boozing through education, restricting marketing promotions, and raising taxes on alcohol. Studies have shown that making booze more expensive reduces its consumption, according to McGuire, executive director of the San Francisco-based Trauma Foundation, which, among other things, examines the role alcohol plays in creating trips to emergency rooms and morgues.

Alcohol companies -- including Gallo's -- have opposed tax hikes because, well, they would reduce consumption of their products. Instead of taxation, McGuire says that industry executives have long used the red herring of scientific research into the causes of alcoholism to keep regulators off their backs. The effect: It puts the spotlight on the user instead of the dealer. "As long as policymakers look for a Holy Grail of research to solve alcohol-related problems," McGuire says, "then they'll always be dumping money into a pit that has no bottom.

"They are never going to find the Holy Grail."TTo an extent, McGuire is right. Don't expect the Gallo Center to breed a Brave New World of alcohol-resistant humans if it discovers the exact genes behind alcoholism. For all the hope for new drug treatments, researchers at Gallo concede that whatever they come up with, it won't be a silver bullet that forever eradicates the plague of alcoholism from the earth.

Alcoholism is a very tricky thing. Gallo Center gene-expert Kirk Wilhelmsen says that each new discovery raises complicated issues. Take, for instance, the finding that biological processes associated with alcoholism also are associated with learning and feeling pleasure.

"I've been asked many times if we'd treat alcoholism [by trying] to eliminate it from the population," Wilhelmsen says. "I think that may be a catastrophic idea. Alcoholism is a subversion of the normal biology of our reward system. The things that make us have sex and procreate and learn and fight and do all these things related to survival, those are the same processes subverted by alcohol. If you shut down that system completely, it may be a pretty sad world. And, in fact, if you were to say, 'I'd like to eliminate all the alcoholics in the world,' then you would eliminate some very clever and bright people."

Wilhelmsen's equivocal view begs the question: So then what's the point of this costly Manhattan Project? "What we're doing," he explains, "is trying to understand the biological process and sort it out and take it apart so that we can understand what drives what; how the cells work; how they communicate; how this reward system works so that we can tweak it the right way. It may be that there won't be one pill that treats everyone coming out of this, but maybe we'll learn that there are fifteen types of alcoholics or twenty types of alcoholics. And then the idea would be to sort out what kind of therapy to give to each one of those."

And even if Gallo researchers do come up with new drug treatments, they say that future patients should combine their drug therapy with some kind of psychological therapy or twelve-step program -- for even though we now know that there is a strong biological component to alcoholism, there is clearly also a social and psychological component.

This isn't to say that Gallo and other researchers in the field are not going to produce major medical breakthroughs, says Dr. David Smith of the Haight-Ashbury Free Clinic. Smith argues that hoping for a silver bullet for alcoholism is wrongheaded. Alcoholism is not an acute disease, but, like diabetes, a chronic one that requires both ongoing medical treatment and behavioral modification.

Perhaps the most crucial product of this kind of research, Smith says, won't be a pill -- it will be the promise that alcoholism may finally move onto the treatment map of primary-care physicians. Smith says that most medical doctors now think they can't do anything for an alcoholic because they can't prescribe anything. Thus they often don't even ask their patients how much they drink each week, reducing the potential for early intervention.

Aside from drug treatments, Gallo Center leaders are hoping to use their findings to develop a diagnostic blood test for alcoholics. Smith says if physicians could administer the blood tests, they also would be more likely to screen their patients for drinking problems. "They [researchers at Gallo] are studying the things we need to know," says Smith, "and the reward, if they're successful, will be astronomical."

So, exactly what can we expect from the Gallo Center at the end of its five-year Manhattan Project in 2003? Kirk Wilhelmsen concedes that it would be "optimistic" to say they will actually have helped market a new drug that can be prescribed by then.

"The goal posts are to have drugs that are in trials and that are targets. I think that's possible. I don't think we're going to be able to point to a drug that's advertised in Reader's Digest."


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