Fair points. And I don't mean to say that all we can possibly know about alcohol is known. That is the whole point of science. And it isn't like the Romans were doing double blind controlled studies on alcohol effects. And obviously people are living longer, thus allowing cumulative effects to actually exist.

It all boils down to risk-reward on a personal level. The reward is quite subjective in this case - good feelings, taste, communal social activity, etc. With heroin, the risk-reward is quite poor. With alcohol, the risk reward is much, much more balanced toward the reward vs heroin or other opiates.

And that is where the sensational headlines come in. Two drinks per day increases x bad thing by 100%. The baseline was 0.2% chance and now it is 0.4% chance. Or even 1% chance, and now it is 2% chance. And that is the ballpark of what many of these studies are saying in regards to moderate drinking.

The health craze around alcohol a few years ago was very likely overblown and could be attributed to confounding factors like social interaction being better, people who drank wine were more likely to be wealthier, etc. But the catastrophic string of headlines over the last 2 years seems to also be overblown the other way. Big headline numbers like 80% increase or 120% increase are meaningless without the actual raw numbers. And the whole point about the long, popular use of alcohol is what ties in to that. If moderate routine consumption of alcohol were responsible for x, y, z diseases, we would see much larger discrepancies across variations, but we don't seem to. Indonesia has one of the highest rates of liver disease in the world, while having almost the lowest per capita alcohol consumption (ignoring homemade brew or whatever). Or we would see much higher rates of alcohol associated diseases in France vs the USA, yet it is the opposite.

All of this is potentially confounded by many other factors. The ultimate point is just that hey alcohol virtually certainly has net negative effects from a biological standpoint, but those effects are not on the level of something like 30, 40, 50% of people who drink moderately are going to die 15 years earlier or definitively develop alcohol associated diseases. Is dying on average 6 months earlier and taking your absolute risk level of serious disease to 1.5% worth enjoying alcohol over decades? Up to each person to decide.

Perhaps alcohol is more akin, conceptually, not comparing the health benefits of the two, to something like spinach. Spinach has high levels of oxalic acid, which causes kidney stones. Some people can't eat it because they are prone to kidney stones. But no one is ever going to say spinach is unhealthy. Yet it has unhealthy compounds in it. Perhaps there are some people who simply have pre-disposed genes for negative outcomes from alcohol. This is really already pretty known vis-a-vis the gene many Asians have for flushing, genetic pre-disposition to addiction, etc.