Distortions: The false dichotomy strategy of the public health industrial complex

In waging a campaign against a legal industry, it is good to paint them as evil. We saw this with the temperance movement in the 19th and early 20th centuries, and again with Big Tobacco in the mid to late 20th. I was at an academic conference once where a scholar introduced an anti-alcohol campaigner as being “on the side of the angels” which I, an adamant non-smoker, thought was more than a little un-scholarly and biased. The history of tobacco control is complex, but to argue that someone is on the side of the angels seems to me to be ignoring that complexity. It’s good versus evil.

Indeed, we see “Big” placed in front of any industry we want to characterize as out for profit to the detriment of public well-being: Big Pharma, Big Tobacco, Big Sugar (I know it’s also a band; sorry guys). Good us versus evil “Big” industry.

How about “Big” Public Health? I’ll come back to that.

This post is inspired by an extended essay in the Toronto Star published on 5 March 2023. It is by Kieran Leavitt and I spoke with him at length when he was researching the piece. Our conversation ranged across many aspects of the issue and Kieran demonstrated himself to be insightful, thoughtful, and not afraid to push back, three things I really enjoy about talking to good journalists.

Of course, it’s the Toronto Star, so there is an editorial bias towards neo-prohibitionism. The Star was formed as a voice for progressive reformers in late 1800s, and one of the causes it espoused was prohibition. It still does, although it might not recognize the direct connection. It breaks, as I say, on the side of prohibition.

Thus, Kieran’s article gives more time to the arguments of the neo-prohibitionists, who characterize this as a battle between their enlightened science and the corruption of the liquor industry, where the “class one carcinogen” argument is not questioned or contextualized, and where the anti-tobacco success is presented as a model for the ravages of alcohol and its hoped-for demise.

This can be seen in the way anti-alcohol forces characterize the other side. To them it’s all about a big business making money notwithstanding the harm of their product. Big Tobacco. Big Pharma. Big Alcohol. This is exactly what the temperance movement was saying 150 years ago.

John Bengough, a political cartoonist who published the satirical magazine Grip, was also an ardent prohibitionist and left us with some great cartoons characterizing the attitude.

The problem with this Big Alcohol versus the “angels” of Public Health is it is a false dichotomy. Along with people who make money directly from the alcohol trade, there are many people who look askance at many of the increasingly shrill proclamations of the anti-alcohol establishment.

(I don’t want to make this about me (but it is my blog) suffice it to say that people think I have some kind of financial arrangement with the alcohol industry. They give me no money for these words, but I do have an arrangement: I give them money for their products. It’s called commerce.)

Those of us who have found ourselves speaking out in opposition to the highly distorted evidence and overly temperate (though immoderate) recommendations of the CCSA face the sort of derision that the temperance movement saved for their opponents 150 years ago: we are shills for the industry, or somehow corrupted. We cannot possibly be speaking truth to their power.

Now, I don’t want to use this blog to flog my books, but it is increasingly clear to me that what is going on here is a direct parallel with the battle waged between “Wets” and “Drys” at the end of the 19th century. The temperance movement was strong, united, organized and strategic. They were united through a network of evangelical churches with deep experience in pushing for social change (many had roots in abolitionism, which of course was a very good cause and a success). They had a cohort of passionate speakers (paid by donations to the cause) and could organize petitioning campaigns, marches, rallies, and back politicians who supported them. They were loud and persistent.

The “other side” was a disconnected network of opponents. This was before the sort of mass lobbying organizations we see for industry. Brewers and distillers might work together on some issues, but from my research there was nothing near the mass organizational power of temperance. Along with those who had a financial interest in booze there were many well meaning thinkers and writers who saw the limits to the arguments of temperance. For example, when temperance people argued that removing liquor from the landscape would elevate the morality o the people, some replied that true morality is not found in having your choices limited but rather being equipped to make good choices.

This opposition to the temperance industrial complex benefited from politicians who were smart enough to know that temperance was toxic. Numerous examples of dry legislation failed because people wanted their booze. In places that had voted themselves dry, worse drinking was often the result: it’s hard to hid barrels of booze, but a few bottles of whisky slip into the coat pocket or bag.

There was a third side, however, which is why I call this a false dichotomy: there were many people who didn’t chime in. They didn’t vote in plebiscites, they didn’t march in parades, they didn’t vote for “temperance” politicians on that one issue. Had they been fired up about temperance, they would have done. For them, temperance wasn’t a major issue. And the odds are, they knew they would still be able to get their hands on booze.

That is why this is a false dichotomy. The Public Health Industrial Complex (Big Public Health) consist of those who have built their careers and make pretty decent salaries researching and advocating against alcohol (and characterizing it as the “next tobacco”). They think that if you oppose them you must be embedded in the industry. They assume they are the only ones with the best interest of the public at heart, and anyone who opposes them is beholden or duped by King Alcohol. They can’t imagine that everyday people recognize that drink is not such a scourge, that for many people it enhances their lives in innumerable ways, and that changing a recommendation from 10-15 drinks per week to 0-2 is such an extreme recommendation that it cast doubt upon the whole public health industry.

What they also can’t imagine is that those evil grasping capitalists, including like small batch distillers, your local brew pub, family owned wineries, and craft cider makers, are actually just as concerned as everyone else in making sure people don’t get injured or hurt by their products, and in maintaining social order. Nobody profits from chaos, although let’s be sure: some industries, including the neo-prohibitionists, benefit from playing on the fear of social disaster.

Sadly, the acolytes of Big Public Health press on, drawing from the anti-tobacco playbook but addressing a recreational product that was not nearly as carcinogenic as tobacco. It is a disappointing but entirely expected strategy, and sadly, zealousness blinds them to the actual harms they may be doing.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s