Which presidential candidate will make you drink more?

I was a debater in high school. At great personal expense to my social life I went out and spoke instead of participating in sports or art or music or whatever as an extracurricular activity. For some of you who know me but didn’t know that, I bet some puzzle pieces are falling into place.

My debate teacher was well respected and had a great depth of experience with judging debating. He had a regular story about the worst debate he had ever judged. The resolution, or what was being debated, was “better dead than red”. For those of you who did sports in high school rather than debating, any resolution is essentially meaningless and can be interpreted in any fashion you would like. The above resolution could have been a debate about the merits of communism versus capitalism; it could have been a debate about whether we should force parents to vaccinate their children against their will;  it could have even been about how terrible tomatoes are and how we would be better off if we didn’t eat them.

Instead though, the debaters in the “worst debate of all time” defined the resolution as whether it was better to be aboriginal or dead. The debate team that opposed the resolution settled on the argument that death was horrible but that it was only slightly worse than being aboriginal. The team in favor went with the similarly racist argument that, no, living as an aboriginal person was horrible for reasons including that they were drunk all the time and that they didn’t work. Death was obviously preferable. The second speaker on this team did eventually decide to go with the reasonable argument that a lot of why aboriginal Canadians have had so many social and economic problems have been as a result of systemic oppression. But then he went back to defend his partner’s points on the drunkenness and crime and all of that. It sounds like something out of a piece of Ku Klux Klan literature rather than a high school debate.

It’s hard to compare anything to it. As they were teenagers at the time I guess we have to give them the benefit of the doubt. Nevertheless, it seems like an obtuse and tone-deaf debate to have when you are (most likely) a white male, (most likely) come from a household that has an income in the six figures, and (most likely) are wearing a suit jacket with some prep school crest on it. True to stereotype, most debaters were white-male prep-school educated, knobs when I was debating. I was, of course, the only exception.

The closest that I have come to witnessing a similar debate though (and this is in the crudest sense as it’s difficult to get anywhere close to this “worst debate of all time”) was several weeks ago when I watched the brouhaha in St. Lou-ha-ha, the melee in Missouri, the federal debate fisticuffs between Hillary and Donald. A candidate running for president had to publicly deny sexually assaulting women, disavowed on record something their running mate said, and then threatened to lock up their opponent. And Hillary was there too. It was a debate that wouldn’t have been out of place in a banana republic.

I am under no illusion that I will have any effect on the outcome of this presidential contest. Most of the people who read this blog are Canadian and are therefore ineligible to vote in an American election. I am not going to convince any Americans that I know who are voting for Hillary to switch their allegiance.  I am not going to convince any Americans I know who are voting for Donald because most of these people are stuck scratching their lobotomy scars when I use polysyllabic words like banana.

So I have nothing to contribute to this debate. But what I can do is address the obvious question: who will cause you to drink more if elected president? We have a perfect testbed for this question, which is to see how much the candidates cause us to drink during the final debate which occurred two weeks ago in Las Vegas.

To test this question, I recruited one healthy male volunteer of legal drinking age into this experiment.  In the interest of anonymity, we will call him by his initials, SS. SS has a prodigious brain and an even more prodigious liver and so could spare both in the interest of the scientific method. I also purchased a police-grade breathalyzer which makes this blog post, by far, the most expensive in Strange Data history. I had attempted to run this experiment on the previous debate in St. Louis, but the first breathalyzer I purchased seemed to function as a random number generator rather than an accurate test of blood alcohol content. I had to reschedule until Amazon shipped the new one.

Good old-fashioned American debate drinking games have been a staple of the socially awkward college student since debates were televised. They’re as American as apple pie or failed gun control legislation. Most of the normal drinking game rules are based upon the script that regular American politicians follow. This pabulum forms the basis of all political drinking games because it seems like most American politicians (but really all politicians) can’t get through a speech without speaking all of these terms. I chose the following terms or concepts as the foundation of the drinking game rules:

• "middle class"
• "small businesses"
• A promise of tax cuts 
• The “I’m a regular joe, not a politician” story 
• Accusing an opponent or the establishment of being “Washington insiders"
• “The children are our future” anecdote

These would be the terms that I would expect from a regular election cycle where the candidates weren’t universally hated and scandal plagued. This is not the case this year. So to add to these terms were several specific to the discussion (I use that term loosely) that has been occurring around the candidates this year. These “wildcard” terms include:

• Any affair/sexual impropriety talks
• Emails/Wikileaks talks
• Stamina/health/fitness talk
• China – they’re taking our jobs
• Mexico or how to build a free wall
• Tax returns

Mentioning any of these twelve concepts earned one drink (which I measured in a one-ounce shot glass). The drink would be earned on a per-thought basis. For example, a candidate who said “middle class” repeatedly during the same line of argument would earn themselves one drink. An opposing candidate who replied to that line of argument though would also earn themselves a drink. A candidate who mentioned one of these terms, then switched topics, and then switched back to the term in question would earn themselves two drinks.

I chose these twelve terms for two major reasons: they’re fairly objective and they’re discrete, so it’s easy to measure drinks. In previous elections I have used drinking rules like, “if the candidates speak over the moderator, drink until they stop”, which makes it difficult to measure alcohol intake. I have also used drinking rules like “if the candidate tells a lie then drink”, which is a subjective rule at least in real time (and wouldn’t you be drinking constantly?). But to the above objective drinking rules I added one that is more subjective: if a candidate says something that makes my jaw drop, finish a drink. To accurately gauge alcohol intake for SS I used a measuring cup to record these finished drinks.

As this is a blog that’s nominally about health and medicine, I guess I should talk about something health-related. Your liver is an organ that loves you dearly. It loves you so much that it will help clear any alcohol in your blood out of your body so that this alcohol does not kill you. I once heard from an intensive care doctor that all you really need to live is a small bit of brain and your liver. Everything else can kind of be replaced and although you will have a poor and uncomfortable life, you will live.

The way that alcohol enters your body (usually) to get to your liver is by drinking it. It goes in your face. It then is dumped by the esophagus into the stomach where about 20% of it is absorbed via the stomach lining. The stomach then dumps it into the initial part of the small intestine – the duodenum – where the remaining 80% is absorbed. Any food in the stomach delays gastric emptying and uptake of alcohol, which explains why people do not feel as intoxicated as quickly when they drink and eat.

Alcohol gets absorbed into the blood and then is transported via the portal blood system directly to the liver where that organ gets first crack at ridding you of it. This is called the first pass system and it is why orally ingested drugs (that are cleared by the liver) are usually less potent than those given directly by intravenous. This first pass system occurs both in the liver and at the interface between the gastric mucosa and circulation system. The liver itself continually purifies blood flowing through it so that any alcohol that does not get cleared through first pass will be purified on further passes through the portal system.

From the liver’s circulatory system alcohol disseminates into the bloodstream. It then exerts its effects on the brain and gives the feelings of intoxication. Alcohol continues to circulate throughout the blood and is processed by the liver every time it passes through the portal vein system. The biochemical mechanism for this process in the liver is a conversion by the enzyme alcohol dehydrogenase into acetic acid and then into carbon dioxide and water. It is during the processing by alcohol dehydrogenase that a coenzyme is required; this rate limits the conversion so that at sufficiently high quantities of alcohol in the blood, the liver will metabolize and excrete alcohol at a constant rate. Once you hit saturation you can theoretically predict blood alcohol content (BAC) and the excretion of alcohol by the following equation:

Blood alcohol content (BAC) is then a factor of the volume of alcohol consumed (v), the strength of the alcohol (z), the proportion of alcohol absorbed (a – which is presumed to be one under “normal” experimental situations), alcohol density (d – equal to 0.789g/ml), mass of the subject (m), and a conversion factor that is a product of the water content of a person’s tissues (r). The excretion rate is a factor of the time since consuming alcohol (t) and a coefficient that has been estimated from previous experiments (B – about equal to 13.3 g/dL/hr).

As we have an ability to predict BAC, we can then estimate the tolerance that SS has to alcohol. There are several ways to classify tolerance in alcohol ingestion. One way in particular classification separates how the alcohol acts on the body and how the body acts on alcohol. Functional tolerance relates to how sensitive the brain is to the intoxicating effects of alcohol – it is how the alcohol acts on the body. Increasing functional tolerance is why alcoholics can drink quarts of vodka and not slur their words. This is a difficult thing to measure accurately as BACs will still be high despite behaviour that suggests otherwise.

What we can measure a little bit more accurately though is dispositional tolerance. Dispositional tolerance is how the body deals with alcohol. A liver that is chronically exposed to alcohol can clear the same amount of alcohol at a quicker pace.  Since we have a way to estimate the theoretical BAC of SS and we will also have empirical estimates of BAC through the breathalyzer we can then check his relative dispositional tolerance to alcohol. If the log of the ratio of empirical BAC to predicted BAC is above zero then SS has higher dispositional tolerance than the average person. If the log of the ratio of empirical BAC to predicted BAC is below zero then SS has a lower dispositional tolerance and is a lightweight.  

So some logistics. BAC breathalyzer measurements were taken at six minute blocks and all drinks taken during a block were attributed to the beginning of that block. The debate itself lasted about 90 minutes but the total time we assessed the BAC for SS was 114 minutes. A scribe/referee counted drinks and I went back after the debate with a transcript and checked the count to ensure accuracy. SS fasted prior to the session and did not otherwise consume alcohol during the experiment. In honor of America we chose an American beer that had an alcohol content of 4.8%. It was the weakest beer in my fridge.

So first of all, what were the subjects of discussion (again – using that term loosely) that earned the most drinks during the debate? The following graph shows that, on a per-drink basis, Clinton and Trump talked about China and Mexico a lot. Tax cuts were also a big subject of discussion during the economic portion of the debate. True to form, Clinton made SS drink on the stereotypical politician talking points like “middle class” or “small businesses”. True to form, Trump mainly made SS drink during the wildcard portion of the debate while discussing the Wikileaks scandal and making vaguely racial remarks. He was one mad hombre.

 

On the topic of jaw-drops, there were four in total during this debate. Clinton called Trump “Putin’s puppet”, which made Trump’s face look like it was about to burst from all the blood flowing to it. One for Clinton. Trump accused Hillary Clinton and Barack Obama of personally organizing a riot in Chicago during one of his rallies. Then he refused to say that he would accept the results of the election. Two jaw-drops for Trump. The moderator, Chris Wallace, also got a jaw-drop for casually mentioning that the candidates (because they hate each other so much) could not agree to closing arguments at the end of the debate. Kudos to Chris for getting on the board.

On a who-will-make-you-drink-more basis, we have conflicting results. In terms of number of drinks, Clinton won. In terms of volume of drinks, Trump won, mostly on the back of his jaw-drop drinks.  Like the tortoise and the hare, Clinton was slow and steady, and Trump was all over the place. This tie-of-sorts seems consistent with their leadership styles.

 

Over the totality of the debate, SS consumed about 1700ml of beer. His peak BAC occurred at the 96^th minute at the end of the debate, thanks to Chris Wallace and his loud mouth. This peak level was 0.102 g/dl.  The other BAC peak was a 0.099 g/dl reading in the 48^th minute after a flurry of affair and sexual impropriety talk and then Trump accusing a sitting US president of organizing a riot.

 

It turns out that, at least relative to the Widmark prediction, SS clears alcohol well at high levels but is a lightweight at lower levels of consumption. As the debate continued into the 50th minute and the volume of beer increased dramatically the ratio of measured to predicted BAC dipped below zero. His liver was lazy at the beginning of the debate but started to kick into higher gear as the night wore on and more outlandish things were said.

 

So I guess we’ll give this contest to Trump as he did make SS drink the highest volume of beer. It’s a pyrrhic victory for the Donald but at least it’s a victory. Winston Churchill once said that you can always trust the Americans to do the right thing after exhausting all of the alternatives. I never thought one of those alternatives would be a presidential candidate who was a woman-groping, race-baiting, anti-intellectual, but here we are.  I wish I had more of a profound ending to this post but it’s hard to be profound when you have to affirm that these attributes are disqualifying for a leader. But the Americans will do the right thing. That, or my liver will be working a lot harder over the next four years.