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        The politics of drinking

November 5, 2012



Scientific veil slips from the face of medical temperance

At the risk of boring everyone, I’m returning to the subject of my previous diary, Prof Klaus Makela’s paper dismissing cost-to-society calculations of alcohol harm as a waste of time. Twitter friend and public health researcher Claire Harkins is to blame, steering me towards the debate that’s followed Makela’s essay.

What’s most striking about this is that it has attracted input from some of the biggest names in alcohol research, people who’ve had a major influence on current policy. And to sum up the majority view in the vaguest possible way: Makela makes some good points, but this is the best we’ve got.

Jurgen Rehm notes that ‘cost of illness’ studies, as they are usually called, are  increasingly requested by governments and decisionmakers” despite the flaws. “Frankly, I do not know of a better way to summarise the social impact of alcohol consumption.” “Those deciding on policy priorities, if the decisions are to be ‘evidence-based’, want to see concrete evidence, which at some point is usually reduced to a single common metric,” adds the respected veteran Robin Room before toying with the notion that researchers might refuse to do such studies.

Of course, it being their stock-in-trade, the alcohol researchers themselves have an interest in raising the profile of the drink question, something that brash societal cost figures do very effectively.

But it’s Thomas Babor, who makes perhaps the most candid contribution, appearing to agree that such studies are “not scientifically credible” but “serve other functions” contributing to a “well-planned paternalism with a human face”. “In a democracy, politicians and policymakers often need to be shamed into doing the right thing, and costs to society have the ability to shame, blame and even defame… It is the simple, single monetary figure that captures public attention more than anything else.”

So much for evidence-based policy. It is astonishing that Babor of ‘Babor et al’, authors of the indispensable scientific textbook of medical temperance, Alcohol: No Ordinary Commodity, should declare a practice “not scientifically credible”, but go on to advocate its use in the name of “doing the right thing”.

My coinage ‘medical temperance’ originally sought to characterise the public health lobby as an ideology that could not usefully be termed ‘neo-prohibition’, because it stopped short of that. It also identified the medical discourse in which its arguments were almost exclusively framed.

But, as has been pointed out to me, there is an echo here of a moral position underpinning the science, and it’s this that Babor seems to make explicit in his defence of cost-of-alcohol studies.

The veil has slipped.

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