Clearly drinking alcoholic beverages is not a good idea, both from the religious as well as the medical point of view. I will restrict myself to the medical aspects of alcohol consumption. However, it is important to point out that in Pakistan it would seem that more people die from drinking ‘boot leg’ alcoholic drinks contaminated with poisonous additives rather than regular commercially available alcoholic beverages.

Why do people drink alcohol in the first place? Throughout human history people have been consuming alcoholic beverages. So I suppose there must be some enjoyment in the consumption of alcohol that has allowed it to continue to be a part of human diet. In Pakistan, when we hear or read about people who drink, the picture is almost always that of a person who is ‘drunk’ and not in his senses. Yes, it is almost always a ‘he’ and not a she.

Having lived in the United States for more than three decades, I can vouch for the fact that most people that drink alcoholic beverages do not get drunk every time they drink. There are drunks but they are few and most of them are addicted to alcohol and are called alcoholics. Alcohol consumption at even a moderate level does however impair the ability to drive. ‘Drunken’ driving is a major cause of auto accidents in the US though more recently it has been overtaken by ‘texting’ while driving.

Some fifty years ago when I was in medical school, our professor of ‘Pharmacology’ (study of medicines) described the effects of alcohol on people in four stages that he called the four ‘double Ds’. The first stage was ‘dizzy and delightful’, and then came ‘drunk and disorderly’ followed by ‘dead drunk’ and finally there was the ‘danger of death’. Most people drink to stay in the first stage but usually end up in the second one. From a medical point of view, moderate alcohol consumption removes inhibitions, allows ideas to flow more freely, and that can be a pleasant ‘lubricant’ for social interaction.

There is an ongoing debate in medicine whether moderate drinking has any health benefits. Moderate drinking is defined as two glasses of wine for men and one glass of wine for women once a day. Sadly, even in this matter women have not been able to achieve parity. There might be some health benefit to moderate drinking but we as physicians are reluctant to recommend any drinking since few people stop at the second glass.

The bad effects of alcohol consumption beyond moderate drinking can be divided into the immediate and the long term effects. Immediate excessive drinking also called ‘binge drinking’ is dangerous since it can lead to the dead drunk and even the danger of death stage as mentioned above. Also being drunk is associated with traffic accidents and violence.

Spousal abuse in countries where alcohol is freely available is often blamed on excessive alcohol consumption. However, in Pakistan spousal abuse happens quite frequently even without alcohol being involved.

Long term alcohol consumption in excessive amounts will damage the liver and eventually destroy it completely. This is the commonest cause of death in chronic (long term) alcoholics. In Pakistan, the commonest cause of liver damage is not alcohol but infections with the viruses that cause Hepatitis B and Hepatitis C. These infections are reaching epidemic levels in many areas of Pakistan.

The reason why I started thinking about alcohol is the association between ‘wine’ and Urdu poetry. And the fact that some of the best poets were imbibers of alcohol in different forms. That said, more often than not drinking and drunkenness are used as metaphors for the means to achieve the mystical state of gnosis. There are poets that also talk of drunkenness in the actual physical sense. From a historical perspective there have been excellent poets that never drank and excellent poets that did.

For this reason it is difficult to say that alcohol actually improved the quality of poetry composed by those poets that did drink. But then let us see what Urdu poets come to mind before others. Ghalib, Faiz and Faraz are without doubt the most famous and beloved poets that we can name, imbibers all. There is a story probably apocryphal that somebody once asked Ahmed Nadeem Qasmi, a major Urdu poet and a contemporary of Faiz, as to why he (Qasmi) never became as famous as Faiz. Qasmi said, because I do not drink. But Qasmi did make it into his nineties.

As a physician the question that came to my mind was why some poets literally drank themselves to death at an early age while others drank heavily but escaped the havoc of alcoholic liver damages that killed many of their contemporaries. For this discussion I will restrict myself to poets in the last century that were known to be heavy drinkers. However, one important medical point needs to be made that liver damage is more common in heavy drinkers that do not eat a proper and nutritious diet.

Of the heavy drinking poets and authors that died at a relatively early age there is Meeraji who died at the age of thirty seven, Akhtar Shirani who died in his early forties as did Asrarul Haq Majaz, Chiragh Hassan Hasrat who died in his early fifties and Saadat Hassan Manto who also died in his early fifties. Interestingly, all these deaths are clustered in the years immediately after the partition of India. Why that time period?

Perhaps alcohol was freely available and was reasonably inexpensive during the last days of the Raj. And perhaps because Muslims were living among Hindus and Sikhs who did not have any religious bans on alcohol so there was no societal condemnation of alcohol consumption as there is now in Pakistan. Whatever the reason, many Muslim poets drank openly and often well into the early years of Pakistan. Yet many of these heavy drinkers made it into their seventies and even eighties.

Let me take the example of Faiz Ahmed Faiz. Faiz made it into his seventies and based upon most reports died after suffering a heart attack. He had suffered a heart attack earlier on that he survived and even wrote about. In my opinion it was chain smoking that caused most of Faiz Sahibs medical problems. He was also a heavy drinker but his frequent and often multiyear incarceration in different Pakistani jails dried him out and managed to repair any liver damage he might have suffered.

Also, Faiz unlike the other poets that died early had a day job and could not remain drunk all the time. Of all the famous drinking poets, Josh Maleehabadi made it into his eighties. He was a disciplined drinker and only drank for a certain time during the day.

The last famous drinking poet from Pakistan was Ahmed Faraz who perhaps like Josh limited his drinking time. Faraz died in his seventies from problems unrelated to his drinking. Why we do not have any major poets coming up now? I don’t think that has anything to do with the availability of alcohol.