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Tuesday, February 7

The WOSCOTCH trial

A double-blinded study into the effects of single-malt scotch
- Dr. George Burden

The WOSCOTCH, or West of Scotland Scotch Trial, is a prospective double-blinded study designed to determine if and to what extent the regular intake of single-malt scotch whisky affects the incidence and severity of cardiovascular and cerebrovascular disease.

Other trials that have addressed this issue include the HOOTCH, MRSIP, LOOPED, and 4F studies. No previous trial, however, has studied the special properties of single-malt scotch as opposed to other ethanol-containing beverages, and for this reason WOSCOTCH was initiated.

The principal investigators included the renowned cardiologist Dr. Glenn Fiddich, ably assisted by research assistants John Walker Ph.D. and James Beem M.Sc. Several days of intense negotiations resulted in the agreed upon acronym of WOSCOTCH. The rest of the study's parameters were worked out over lunch.

Volunteers for the trial were solicited through advertisement in the Glasgow Times. Approximately 1,373,000 responses were obtained, predominantly male and between the ages of 19 and 103. An attempt was made to recruit whisky-naive subjects but only three were found and it was decided to abandon this particular aspect of the protocol.

A second obstacle was getting subjects to agree to be in the placebo group. A compromise was reached when it was agreed that the placebo would be overproof Demerara rum instead of mineral water.

Test subjects were randomised to several different intake levels of single-malt whisky or placebo, with ranges of 1 to 3 ounces, 4 to 8 ounces, 9 to 16 ounces, 17 to 26 ounces, and 27 to 52 ounces of distilled spirit daily.

The decision as to which single-malt scotch to use for the study was handled by closeting the principal investigators in a room in an unspecified private club. Over a gruelling 24-hour period, 250 whiskies were sampled by these hard-working gentlemen before a decision was made to purchase the Glenlipid distillery for provision of study materials. It was voted unanimously that the decision would be reviewed on a semi-weekly basis in case a whisky more suited to study purposes should make itself manifest.

The trial was to last one year, at which time a comparison of cardiovascular morbidity and mortality would be made between the placebo and study groups. One thousand of the volunteers were enrolled in the active treatment arm and 1,000 in the placebo arm. The medication and placebo were dispensed each evening by trained ethanol technicians at the Dog and Whistle Pub.

The active treatment group received their medication at room temperature and unmixed with any other substance. Those who requested ice were immediately withdrawn from the study in disgrace. Administration was closely monitored by clinical investigators who are to be commended admirably for their selflessness in personally assuring the quality of the active treatment medication, as well as the placebo.

Participants were followed regularly to assess cardiovascular and cerebrovascular health. Several problems were encountered in this component of the trial.

In approximately 57% of the 17 to 26 ounce group, and 83% of the 27 to 52 ounce group, it was impossible to obtain a history from the test subject. In 17% of these cases the cause was the fact that the investigator was incapable of taking a coherent history.

Physical exam was also problematic with frequent diagnosis of ataxia and dysarthia in the higher intake levels of both placebo and treatment groups, as well as in the investigators themselves. This appeared to be a temporary phenomenon, having resolved by the following morning in the vast majority, though many were found to have replaced their symptoms with dehydration and cephalgia at this time.

At least 23 study participants were erroneously declared deceased, only to reappear the following evening for their usual treatment, much to the surprise and annoyance of the study co-ordinator who had declared them dead.

After one year and careful tabulation of results, it was determined that those ingesting single-malt scotch at all quantities had lower rates of heart disease and stroke at levels that reached statistical significance. Overall mortality and morbidity failed to decrease, however, mainly due to higher levels of motor-vehicle mishaps and other accidental forms of injury.

Divorce rates also tended to be higher, both in study participants and in investigators. Liver enzymes of both the study and placebo groups tended to be higher than in the general population, though no worse than in those taking "statin"-type drugs for high cholesterol.

It was the overall recommendation of investigators that the trial be continued indefinitely.

Alternatively, a new study called WOSCODT, West of Scotland Study on Delirium Tremens, might be feasible at discontinuation of the WOSCOTCH Trial.

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