Intended for healthcare professionals

Rapid response to:

Editorials

International regulation of alcohol

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2364 (Published 07 November 2008) Cite this as: BMJ 2008;337:a2364

Rapid Response:

Draconian public health intervention versus personal freedom

There is an extraordinary lack of balance in many proposals by medics
for
changes to government policy designed to improve our health. And there is
a
selective attitude to evidence in justifying such policy ideas.

The call for international controls and much more stringent
constraints on
the sale of alcohol are just the latest such proposals.

The political objection to measures of this type is that they treat
the
population like a bunch of children who cannot be trusted to make
responsible informed decisions for themselves. So the ruling class must
make
technocratic decisions about what is good for them. So we heavily restrict

smoking, impose increasing prices and decreasing availability on alcohol,
render whole classes of drugs completely illegal and spend a fortune
attempting to restrict their supply.

Some people think that we should trust the population to be
responsible and
adult in their choices. And we should respect the choices even when they
are
bad for the individual who makes them (but impose constraints where those
choices impact other people). Letting people make their own choices and
face
the consequence is good for people even if its bad for public health in a
narrow sense. Not trusting people is, ultimately, dangerously
totalitarian.

The philosophy that people can't be trusted to make the "right"
health
choices colours the use of evidence. Yes it is true in a narrow sense that

sudden increases in price constrain the amount people drink (it could
hardly
not be true when people have finite incomes) and strong restrictions on
supply also constrain consumption. But price and supply constraints are
very
poor explanations of the differences in consumption between different
countries. If high price and tight constraints were good predictors the
french
would all be drunken hooligans and the norwegians would all be sober
puritans.

England recently attempted a big relaxation of its licensing hours.
Surely this
should have led to an enormous increase in consumption and damage. What
actually seems to have happened is a slight decline in consumption and a
similar amount of antisocial behaviour but much less concentrated in time.

Apparently people are perfectly capable of constraining their own
consumption and don't need the government to do it for them. This
represents a very powerful argument against the need to impose strong
constraints on supply and undermines the implication of the
epidemiological
"evidence".

Apart from anything else, most people don't suffer harm from alcohol.
But
the restrictive policies proposed will affect everyone. Why should any
government constrain the whole population to reduce the harm to a few?

Even if the epidemiological and public health arguments for further
restricting alcohol were sound, there would be strong philosophical and
political argument for leaving things alone and letting people make their
own
decisions.

Competing interests:
Enjoys larger volumes of alcohol
than recommended by doctors

Competing interests: No competing interests

24 November 2008
stephen black
management consultant
london sw1w 9sr