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Preventative health debate: in defence of liberty and diversity

The problem with the preventive health movement is the refusal to accept a basic trade-off of Western society — that liberty is at times more important than maximising community welfare.

I was most pleased to see a detailed response from two prominent members of the preventive health industry to my piece on Monday about how deep the regulate-and-tax instinct runs in those who are paid to tell us what is good for us. A few minor things …

Which schools are “removing alcohol from school-based events because they acknowledge that the normalisation of alcohol influences the drinking behaviours of young people”? Perhaps readers can tell us their experience on this. More to the point, do Thorn and Jones seriously think schools should be made to do so? Should the majority of parents be dictated to by a minority of obsessives with an urge to impose their views on others, using the convenient figleaf that it’s “for the kids”?

If so, why not make schools ban the consumption of junk food at fetes? Make them knock off the sausage sizzle — what sort of example does the consumption of those little bags of fat set? The logic goes further. Make sure the second-hand book stall has nothing anyone could object to, for fear a child might pick it up. Ban carny rides and the jumping castle, for fear a kid could be injured. That’s the remorseless logic at work here: once it’s OK to ban one thing, it’s OK to ban everything that someone objects to as dangerous, because you can’t be consistent and say no.

The president of the AMA said “if we start digging out the evidence about when people should be exposed to alcohol it’s actually 25 years of age, not 18”. Sounds like a case for lifting the legal drinking age to me. As for the claim that half of adult Australians support lifting the drinking age, the relevant National Drug Strategy survey question Thorn and Jones linked to wouldn’t pass muster in the most biased polling: asking if people support measures to reduce excessive alcohol use, after literally dozens of questions about the negative effects of drug and alcohol consumption — seriously?

And, alas, Jones still hasn’t produced any evidence that Australian kids frequent group buying sites. A stat from a US site about 18-34 year olds just doesn’t cut it, unless she wants to go beyond the AMA and lift the legal drinking age to 35.

Australia does not rank “about the same” as European countries in terms of alcohol consumption, unless you think a 30% difference is “about the same”. The data Thorn and Jones quote and link to shows Australia on 10 litres per capita per annum. Austria is well over 13, the Czech Republic over 16, Denmark over 13, France well over 13, Germany nearly 13, Ireland over 14, Italy 10.7, the UK over 13.

And Thorn and Jones appear to have missed my point about the 18th century. I suggest they have a look at how responses to the Gin Craze were predicated on confining women to reproductive roles and depriving them of economic opportunities as much as any high-minded middle class concerns for the poor. As for Hogarth, how about Visit to the Quack Doctor?

And “bingeing by young people is a modern phenomenon”. Where’s the evidence for that? And what about the greatest Australian binge drinking phenomenon of all, the six o’clock swill, a direct product of social control efforts by minorities?

Suddenly, a regular part of the social rituals of people around the world is a mysterious and disturbing phenomenon that requires more study (funded by taxpayers, natch) and warnings.”

But the most revealing part of the response is the language of Thorn and Jones. The “middle class” apparently has a “new obsession with wine”. Everything the preventive health industry disapproves of has to be medicalised into some sort of psychological or social dysfunction, even if it’s a tradition embedded in human culture for thousands of years.

Take the lastest wheeze from the industry. This week, yet another taxpayer-funded study was wheeled out by some preventive health bodies to attack what they called “pre-loading”. That’s the simple act of going to your friends’ place before going out at night and having a drink while you’re there, often while getting ready to go out. Suddenly, a regular part of the social rituals of people around the world is a mysterious and disturbing phenomenon that requires more study (funded by taxpayers, natch) and warnings. The media release concluded with the inevitable demand for tax rises on alcohol.

As more than a few people on Twitter pointed out when I linked to it, the media release could have been written by the very industry the preventive health industry opposes, the pubs and clubs, anxious to make people spend more on their premises rather than at home.

The same logic of medicalisation extends to women. “Women’s drinking” is apparently a problem per se. Thorn and Jones defended the case I cited in my original article, in which GPs were urged to interrogate all women about their drinking. For the preventive health industry, simply being female is a kind of medical condition that predisposes them to harms that require extra surveillance, intervention and regulation. Just like their eighteenth century antecedents, the preventive health industry can’t help but see women through the prism of reproductive control.

The broader point is this: Western societies have always accepted that there is a trade-off between individual liberties and maximising community welfare. We could put CCTV on every lightpole and in every house and cut the crime rate dramatically, but we accept that our liberties as adults are more important. We could ban every form of risky activity, from skydiving to eating bad food, and reap economic advantages, but we accept that our liberties as adults are more important.

But the preventive health industry doesn’t accept that. A lot like the corporations it routinely rails against, the industry reduces citizens to consumers and workers whose only value lies in maximizing their economic value through precious QALYs. And where it is unable, or doesn’t dare to propose, banning things, it proposes to tax them out of reach. And all funded by taxpayers. In this sense, the preventive health industry is just another sector of the economy looking to make a buck from us.

Human diversity and a willingness to take different paths through life aren’t a problem to be medicalised.

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  • 1
    Sean Baker
    Posted Thursday, 22 November 2012 at 2:10 pm | Permalink

    Enough you pretentious pofertje:
    ‘social élites anxious to impose control on what they disapprove of.’ Are you pretending not to be part of the social élite, or to criticise it from within?
    On another point, do you think women appreciate you telling them what conversations they should or should not be having with their treating doctor, and their ability to speak out if they feel they are being interrogated? Infantilise much?
    You’re pleased to see the detailed response from the prominent members of preventive health, yet you can’t seem to play the people, rather than the ball - I note you only responded directly to some of their points and evidence.
    Is this really about such lofty ideals of truth, justice and the Australian way, or grotty half admitted desires for things to be exactly as they are because that’s the way we like them?

  • 2
    james.kite
    Posted Thursday, 22 November 2012 at 3:25 pm | Permalink

    I think you may need to take a step back and have a look at your articles on this, Bernard. You’re beginning to sound like Miranda Devine.

    I agree Jones’ and Thorn’s response to your original piece was weak but you don’t sound much better. Your shrill paragraph about the slippery slope of banning things is especially flawed: you can take your “logic” the other way and say we shouldn’t ban anything because people should be free to do whatever they want. Why not, for instance, allow people to purchase assault rifles? And while we’re at it, we may as well allow them to do so without having to obtain a license or having to register the weapon. And then let’s make it ok for people to carry their assault rifles where ever and whenever they like. Too far? But surely everyone will choose to do the right thing, Bernard?

    Yes, there are some who work in preventive health who would like to take things too far. But that is true of every industry and slamming the whole profession as ivory tower elites with nanny state intentions is neither helpful nor fair. By all means, critique proposals made by those in preventive health, but a little perspective is required.

  • 3
    John Bennetts
    Posted Thursday, 22 November 2012 at 4:03 pm | Permalink

    Nice stir, Bernard. I can see that you are enjoying getting a discussion started.

    You also are having a bit of fun at the expense of certain “experts”. Well done on that score. Expert opinion should be challenged thoroughly before being accepted and acted on.

    I still don’t know what the primary objective is. As a regular purchaser of top shelf wines, I pay a disproportionate amount of WET (Wine Equalisation Tax). If, as seems possible, your objective is to have this tax levied on the alcohol content of booze rather than its price, then I must agree with you. My dollars will go much further.

    If, however, your primary goal is for a free-for-all in a completely deregulated alcohol market, then I disagree.

    Precisely what is it that you are after, Bernard? A good argument or a good social outcome?

  • 4
    tinman_au
    Posted Thursday, 22 November 2012 at 4:07 pm | Permalink

    I can understand a (relatively) new development like assault rifles being regulated, but something that’s been around for 10,000 years? I think after 10k years of society living with it, the rules we currently have are probably about right as a balance between “healthy and happy”.

  • 5
    james.kite
    Posted Thursday, 22 November 2012 at 4:32 pm | Permalink

    Make it swords then, tinman. People used to be able to walk around with swords in their belts. We can’t do that anymore. Is that a bad thing?

  • 6
    drsmithy
    Posted Thursday, 22 November 2012 at 8:44 pm | Permalink

    I still don’t know what the primary objective is. As a regular purchaser of top shelf wines, I pay a disproportionate amount of WET (Wine Equalisation Tax). If, as seems possible, your objective is to have this tax levied on the alcohol content of booze rather than its price, then I must agree with you. My dollars will go much further.

    Not so good for those of us whose preferred tipple is top-shelf Scotch, however. We’ll be getting screwed even more obscenely than we already are.

    Precisely what is it that you are after, Bernard? A good argument or a good social outcome?

    One would hope Bernard’s objective is to try and find the _real_ problem(s). The sheer number of countries with cheaper, easier and more common access to alcohol, but lacking the violence and binge drinking, make it clear to anyone who has a passing acquaintance with critical reasoning (or lacks a wowser authoritarian agenda) that alcohol is not the root cause.

  • 7
    drsmithy
    Posted Thursday, 22 November 2012 at 8:47 pm | Permalink

    Make it swords then, tinman. People used to be able to walk around with swords in their belts. We can’t do that anymore. Is that a bad thing

    Please, tell us more about how a sword (or an assault rifle) is comparable to a tinnie of XXXX.

  • 8
    Kfix
    Posted Thursday, 22 November 2012 at 8:50 pm | Permalink

    Bravo Bernard. Thorn and Jones never even address the question of whether it’s appropriate to ban or regulate just because there may be some negative aspect to a behavior - they simply assume this and concentrate on lists of studies showing some negative effect or other. At least someone is speaking up.

    And Sean Baker, you need to study logic. Bernard’s desire for doctors not to treat being a woman as a condition is in no way equivalent to telling women what they can or can’t talk about. That’s a cheap and lazy straw man you are hacking at with james.kite’s sword.

  • 9
    Kfix
    Posted Thursday, 22 November 2012 at 8:54 pm | Permalink

    drsmithy, maybe a tallie of XXXX could do some damage in the wrong hands?

  • 10
    Sense Seeker
    Posted Thursday, 22 November 2012 at 11:21 pm | Permalink

    Bernard, have you got an alcohol problem? What a silly rant. If I want to read about “taxpayer-subsidised” this or that and hinted-at conspiracies to make the lives of ordinary Aussies miserable, I wouldn’t be reading Crikey, thank you very much.

  • 11
    slickrichard
    Posted Friday, 23 November 2012 at 8:19 am | Permalink

    Thank you Sean and James. Bernard is way out of his depth on this one. As a medical student and frequent reader of Keane I’m shocked that he’s ignored and even ridiculed the incredible importance of preventative medicine and public health. It is nothing but plain offensive to compare the preventative medicine ‘industry’ (funny, I’ve never heard of this) to some of the other self-interested lobbying bodies in our society. Public health bodies ask for bucks from taxpayers because initiatives aimed at improving the health, disease-free lifespan and thus quality of life of members of our society costs money. Already in my three years of medical school I’ve seen too much of the devastating effects that alcohol has on individuals and families, biologically, psychologically and socially. Alcohol (and tobacco) are now a major factor in a truly scary proportion of hospitalisations, many of them for horrible chronic and incurable conditions. For those who think that people will simply do the right thing with alcohol (to protect their children from the harmful effects, for example), only need to stand outside any one of Sydney’s major hospitals and (perhaps with gas mask fitted) see how mums and dads with their young children at hip care to observe the suggestion/plead not to smoke around nsw health centres. Perhaps this no smoking policy at the doorstep of our centres, where people are incredibly being treated for and dying from diseases causes by smoking has gone too far? Using Mr Keane and his supporters’ similar straw man tactics (as if the cake stall, kebab shop and pizza kitchen wasnt enough already), maybe we should be opening up a bottle shop or two and a pub inside our hospitals where the friends and relos can forget their troubles outside of visiting hours? To argue that since prohibition of something doesn’t work, therefore any attempt at regulation to improve health is evil is simply ridiculous and commits some basic logical errors. Please just be a little more rational and think outside of your own head everyone who has jumped on the BK bandwagon (that’s not Burger King).

  • 12
    drsmithy
    Posted Friday, 23 November 2012 at 10:57 am | Permalink

    Using Mr Keane and his supporters’ similar straw man tactics (as if the cake stall, kebab shop and pizza kitchen wasnt enough already), maybe we should be opening up a bottle shop or two and a pub inside our hospitals where the friends and relos can forget their troubles outside of visiting hours?

    Hospital patients and visitors - at least in private hospitals - can already get alcohol with their meals if they want it (if it doesn’t conflict with their treatment, of course).

    To argue that since prohibition of something doesn’t work, therefore any attempt at regulation to improve health is evil is simply ridiculous and commits some basic logical errors.

    No-one is arguing there should be no regulation.

    The argument being made is that _more_ regulation (or taxation) is not required.

    If alcohol were even a tenth as dangerous as prohibitionists would have us believe, humanity would have died out millennia ago.

  • 13
    Jim Moore
    Posted Saturday, 24 November 2012 at 2:28 am | Permalink

    Sense Seeker. I think the answer is yes. BK is battling with demons and losing, judging by the poorly written arguments in these articles. Throw out scientific research and base decisions on anecdotes?! No thanks, keep your blood-letting and leeches away from me witchdictor’

    And BK, schools were set up specifically to make sure kids aren’t dumber than their parents. That science and education are now pointing out the truth, that alcohol is a poison that should be banned from commercial sales, only worries those with a vested interest in preserving the status quo, and that includes alcoholics currently in denial.

  • 14
    Rohan
    Posted Sunday, 25 November 2012 at 4:48 pm | Permalink

    …truth, that alcohol is a poison that should be banned from commercial sales, only worries those with a vested interest in preserving the status quo, and that includes alcoholics currently in denial.”

    Because that’s a terrific argument and all.

    Bernard will be so disappointed that he’s been dropped off the list for your next Spirulina party.

  • 15
    drsmithy
    Posted Sunday, 25 November 2012 at 4:52 pm | Permalink

    That science and education are now pointing out the truth, that alcohol is a poison that should be banned from commercial sales, only worries those with a vested interest in preserving the status quo, and that includes alcoholics currently in denial.

    This is just like the “all sex is rape” argument you get from some radical feminists, and worthy of the same level of credulity.

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