Wine and heart disease sometimes seem as present as death and taxes - especially the possibility that a drink a day contributes to heart health. The latest news is that the relationship is not quite so simple as some would have us believe. Hilary Abramson is a journalist living in San Francisco who writes publications for The Marin Institute for the Prevention of Alcohol and Other Drug Problems.

"Johnny Carson [who underwent quadruple heart bypass surgery last year], has some advice for David Letterman [who is recovering from a quintuple bypass]: "'Drink more red wine.'

"That's the message Carson left for Letterman while he was in the hospital." -- Associated Press

In 1991, "60 Minutes" aired a segment on the "French Paradox." It seemed the French -- contrary to all the rules -- enjoyed a diet high in saturated fat with a much lower than expected death rate from heart disease.

The program credited the drinking of red wine. Within a month, red wine sales had rocketed upward 44 percent.

By 1995, the U.S. Dietary Guidelines, the cornerstone of federal nutrition policy, no longer referred to the "drug effects" of alcohol -- the third leading cause of death in the United States. Instead, it noted "Current evidence suggests that moderate drinking is associated with a lower risk for coronary heart disease in some individuals."

And in 1999, the Bureau of Alcohol, Tobacco and Firearms (ATF) approved two statements on wine bottle labels telling consumers how to obtain information on the "health effects of wine consumption." One suggested seeing the family doctor, the other referred to the Dietary Guidelines.

This drew such a strong negative response from public health professionals that the bureau held public hearings in Washington, D.C. and San Francisco in May.

Partly for this reason, the issue of alcohol and health is being re-examined, both here and in France -- where some of the researchers who first announced the Paradox now say that if alcohol does help lower the rate of heart disease, it is only one of many complex lifestyle factors.

In fact, use of alcohol is so damaging that the French government recently launched a public health campaign that includes alcohol (and tobacco) in its "War on Drugs."

This is in sharp contrast to the U.S. government, which ignores alcohol in its $1 billion media campaign to discourage kids from using illegal drugs. U.S. Surgeon General David Satcher and other public health officials agree the only label that belongs on alcohol is a warning label.

Even moderate use of alcohol has risks for some drinkers, says Satcher, who refers to studies showing links with such problems as migraine headaches, seizures, poor sleep, and cancer of the rectum, esophagus, and breast.

But what of the studies showing some benefit? Many public health advocates charge that most such studies would probably have remained obscure except for the $13 billion American wine industry's using them as the centerpiece of its marketing strategy.

Authors of some of the most cited studies stand by their conclusions. For example, Dr. Arthur Klatsky, whose work is often mentioned, is convinced that there is a positive relationship between "good" cholesterol and a small amount of alcohol.

"But," he adds, "you should never give one-size-fits-all advice about drinking.

"It has to be on a one-to-one basis with a doctor who knows the patient's history and alcohol. There are a lot more effective ways to prevent heart attacks....I don't think a bottle of wine or any other alcohol is the place for the word 'health' unless it's the health warning, because of the multitudinous risks with alcohol."

Another much-cited researcher, Dr. Carlos Camargo says, "Drinking alcohol for the heart isn't like taking chemotherapy for cancer. It isn't that kind of drug." Arguing against the "health effects" label, Camargo says the wine industry focuses too much on the benefits of moderate drinking "an obvious and self-serving attempt to promote alcohol sales."

John De Luca, president of the Wine Institute that represents about 500 wine companies, calls the label "an educational tool." So deeply does he believe in the alcohol/ heart disease studies, he told the ATF panel, that the Wine Institute is granting $150,000 to the National Stroke Association to distribute the new Dietary Guidelines to about 50,000 doctors.

Meanwhile, in France, some key researchers think the "French Paradox" has collapsed in the face of data the largest-scale investigation of heart disease ever conducted, overseen by the World Health Organization, during the past decade in 21 countries with 10 million men and women. It found the rate of heart disease in France is actually similar to that of Italy, Spain and southern Germany - lower than many countries, but not as remarkably low as first reported.

Heart disease remains the number one cause of death in France. The French drink 1.5 times more alcohol per capita than Americans and their death rate from liver cirrhosis is more than 1.5 times greater than that in the United States. Indeed, awareness of the problems presented by alcohol emboldened public health officials to win a fight to retain the strongest law controlling alcohol advertising in Europe and perhaps anywhere.

Pierre Kopp, professor of economics at the Sorbonne, claims that alcohol costs France $18.5 billion every year, more than tobacco and illegal drugs combined. These are conservative estimates, Kopp says, because they ignore alcohol-related crime and accidents.

And Dr. Claude Got, a director of the French equivalent of the U.S. National Institute on Drug Abuse, says that a proper public health stance would focus on behavior that is relatively risk free, like quitting smoking, eating a low-fat diet, exercising regularly, losing weight, and taking baby aspirin.

"Man is not only a heart," he says, and the rewards of using alcohol are offset not only by higher rates of cirrhosis, but by "road accidents, violence, hypertension, and nervous diseases produced by alcohol."

(The bureau will accept written or e-mailed comments until September 29 -- ATF, P.O. Box 50221; Washington, D.C. 20091-0221; ATTN: Notice No. 892. E-mail: nprm@atfhq.atf.treas.gov.)