By now, it is a familiar litany. Study after study suggests that alcohol in moderation may promote heart health and even ward off diabetes and dementia. The evidence is so plentiful that some experts consider moderate drinking — about one drink a day for women, about two for men — a central component of a healthy lifestyle.

But what if it’s all a big mistake?

For some scientists, the question will not go away. No study, these critics say, has ever proved a causal relationship between moderate drinking and lower risk of death — only that the two often go together. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy.

“The moderate drinkers tend to do everything right — they exercise, don’t smoke, eat right and drink moderately,” said Kaye Middleton Fillmore, a retired sociologist from the University of California, San Francisco, who has criticised the research. “It’s very hard to disentangle all of that and that’s a real problem.”

Some researchers say they are haunted by the mistakes made in studies about hormone replacement therapy, which was widely prescribed for years on basis of observational studies similar to the kind done on alcohol. Questions have also been raised about the financial relationships that have sprung up between the alcoholic beverage industry and many academic centers, which have accepted industry money to pay for research, train students and promote their findings.

“The bottomline is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a “gold standard” kind of study,” said Dr Tim Naimi, an epidemiologist with the Centers for Disease Control and Prevention.

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