Wednesday, 5 November 2014

Warning: contains warnings

Some piece of work who writes for the Sydney Morning Herald wants warnings, lots of warnings!

Watching the social media footprint of the AMA's Alcohol Summit last week...

Warning: this article is based on the author following a hashtag of a conference she didn't attend.

...gave one clear indication – if we are thinking obesity and its social harms, don't blame the fat person. Make sure the world we live in makes it possible to eat less, move more, know where calories come from.

Because it is absolutely impossible to eat less, move more and know where calories come from in the world we live in, right? Don't blame the sinner, blame Big Food.

The author then expresses her outrage about the lack of calorie counts on wine bottles. As it happens, I agree with the Daily Mash that it is not unreasonable to expect to see calorie information discretely displayed on products that we eat and drink. It is only information, after all. The only danger is the slippery slope. If the public health racket sees calorie counts as a warning, it might only be a matter of time before they decide to add an actual warning ('this product can cause diabetes, gangrene, amputation' etc.). And if people continue to drink wine - which they will - the warning will turn into a disturbing photo and when that doesn't work, the bottle becomes one big graphic warning. That, of course, is exactly what happened with cigarettes.

Elizabeth Elliott, professor of pediatric medicine at Westmead Children's Hospital ... says that the decline in smoking rates is a model for what she hopes will happen with alcohol in Australia.

"We have done it with smoking, we can do it with alcohol."


Yeah, we know. We kinda saw this coming, to be honest with you.

So it's a matter of health. But it's also a matter of safety. Why don't bottles have warnings about pregnancy? Why don't they mention the safe number of drinks to have each week? Or the fact that your decision-making might be impaired if you drink and drive?

Why don't we have warnings on kettles telling people that they might scold themselves? Why don't matches have warnings about burning your house down?

Because warnings can only be justified if they tell you things you don't already know. They also need to stand some chance of changing your behaviour as a result.
 
Risks which are universally recognised do not require incessant government-mandated messages. Do people really drive drunk or get plastered when pregnant because they think it is safe? I doubt it, but even if I am wrong there are plenty of ways to impart warnings without plastering them on the side of every product all day long. The message about drink driving was not transmitted on the side of beer cans, but in public service announcements and through other conduits, including schools.

One of the problems with the public health lobby (and the author of this article) is that they assume people are morons who engage in risky behaviours because they are unenlightened. Hence they write patronising sentences like this:

And folks, let me explain, four or five drinks a night, every night, is not recommended.

This condescending attitude (from somebody who has followed a conference on Twitter) easily evolves into I-know-best authoritarianism...

Here's the real challenge. Haber explains that popular measures are ineffective alone and effective measures are often unpopular. He knows price hikes work but even small ones make consumers unhappy.

For Australia, maybe a little unhappiness is a good thing.

What a little charmer she is.

There are real problems with the current mania for warnings. For a start, the warnings are not always true. In Britain, there are currently two warnings on alcohol packaging. Neither of them are evidence-based. In fact, they are evidence-free.
The first tells you, by way of a picture, that pregnant women shouldn't drink alcohol. Whilst it is true that pregnant women shouldn't drink very much alcohol, there is vanishingly little evidence that modest, occasional consumption harms the foetus. Like many of the things 'public health' says, the message is a Noble Lie designed to scare women off alcohol altogether. Their concern is, as someone said yesterday, that "a small amount can lead to more drinks". In other words, because some women might not know when to stop, all women should be lied to.

The second warning tells you not to regularly drink more than 3 or 4 units of alcohol a day if you are a man. This factoid was famously "plucked out of the air" in the 1980s when doctors were asked to come up with safe drinking guidelines. They decided to err on the side of caution and another Noble Lie was born. The original evidence-free guess wasn't even about daily drinking. It gave a weekly guideline of 28 units a week, but the public health chancers feared that people might drink their weekly 'allowance' all at once and they so arbitrarily split it up into seven daily segments, thereby introducing a sub-lie to the larger fib.

The thinking behind Noble Lies is that they can't do any harm and they might do some good. The trouble is that they do, in fact, do harm. In the case of the zero tolerance approach to drinking in pregnancy, it can make women stressed and unhappy not to be able to touch a drop of alcohol for nine months. Paternalists don't care about that ("maybe a little unhappiness is a good thing"), but they should care that, as was reported last month, the scare stories are making some women so panicky that they have abortions:

Warnings over drinking, including media reports last month that one episode of binge drinking could cause lasting damage to a child’s mental health and even harm school results, have led to BPAS “regularly seeing women so concerned they have harmed their baby before they knew they were pregnant, they consider ending what would otherwise be a wanted pregnancy”, the advisory and abortion service said.

At the other end of the scale, you have people who see so many warnings that they ignore them all. This has been the story in California, a state that is run by risk-averse neurotics, for years. California puts out cancer warnings about licorice and coffee. It narrowly voted down proposals to put diabetes warnings on fizzy drinks. There are plans to put warnings on petrol pumps. As David Henderson says, if the government cries wolf too often, people can't tell real threats from tiny risks.

The point about the original warnings on cigarettes is that they (a) were true, (b) marked out cigarettes as an unusually dangerous consumer product, (c) persuaded many people who needed persuading, (d) informed people of a meaningful threat, and (e) had a meaningful impact on consumer behaviour.

Many of the current wave of warnings meet none of these criteria. They merely add to the noise of fear and hysteria that reasonable people block out.

13 comments:

Sue Wilson said...

Public health does not try and deter people from participating in many other risky activities such as skiing, DIY, rugby, gardening, driving a car, riding a bike, walking down the street, going abroad on holiday, woodworking, mining, keeping birds as pets etc etc. It could be argued that these things are activities that consume calories and so the risks are balanced, or even outweighed, by the benefits. But nicotine, alcohol and food all also have benefits. Maybe the harms do outweigh the benefits at a population level but the thing about individuals is that we give different weightings to risks and benefits.
What a sad world it would be if we all had to behave the same way

Jonathan Bagley said...

Sue is right. The Public Health Industry displays its true, puritanical colours by never commenting on very dangerous pastimes such as skiing, and horse riding; although there have been concerns about middle aged men killing themselves on motorbikes,
http://www.dailymail.co.uk/femail/article-2319082/Third-men-admit-having-midlife-crisis-splurging-motorbikes-plastic-surgery-new-wife-make-feel-young-again.html,
possibly because of the "she's half your age" aspect. Tut, tut, a little too much enjoyment going on there.

Will Shetterly said...

Is there a name for the dogooders who want warnings on everything? I was just the other day thinking about Tipper Gore's crusade to put warnings on rock music in the US.

BrianB said...

"The point about the original warnings on cigarettes is that they (a) were true, (b) marked out cigarettes as an unusually dangerous consumer product, (c) persuaded many people who needed persuading, (d) informed people of a meaningful threat, and (e) had a meaningful impact on consumer behaviour."

You might want to rethink these arguments a little, Chris.

You sound as if you've crossed over to the dark side.

nisakiman said...

@BrianB

My thoughts exactly. I would have thought that a far more 'unusually dangerous consumer product' was the automobile, with it's combined dangers of potential for sudden death and the toxic fumes it emits. No warnings on the sides of those yet, though.

JohnB said...

Let’s consider the “health warning” Smoking Kills

1.
The bulk of the evidence against smoking is statistical in nature. Even if we accept that the statistical evidence has been reasonably acquired and free of errors and confounders – which it’s not, there are very definite rules governing how statistical information is disseminated. These rules are routinely violated, mangled, abused, butchered by antismoking activists. Moralizing zealots use a particular, exaggerated, highly-inflammatory language, e.g., “kill”, “death”, “poison”, “toxic”. It targets an emotional reaction.

Consider the following:
10 Outrageous Claims Made By The Temperance Movement
“All of these things were taught in schools as scientific fact. Educators like Mary Hunt crusaded to get temperance views and “science” into the curricula of the public schools—and in many cases, they succeeded. Hunt was the driving force behind the Scientific Temperance Instruction Movement, and although they met resistance at first, the WTCU made sure that their members and supporters were in key roles within the education system.”

http://listverse.com/2014/01/05/10-outrageous-claims-made-by-the-temperance-movement/

There was nothing “scientific” about the Scientific Temperance Department. And Temperance groups were as rabidly anti-tobacco, making all manner of baseless claims about the deleterious effects of tobacco use. Then there was the far more influential Eugenics (medically-aligned) Movement that was also rabidly anti-tobacco/alcohol. Concerning baseless claims about tobacco and alcohol, the Temperance and Eugenics Movements sang from the same hymn sheet. This tells us much about how moralizing zealots operate. They believe they have a definitive world view that all must abide by. So, when all of the populace does not do as told, the zealots become more hysterical in their claims attempting to “convert” the non-conformers. The only thing important to moralizing zealots is getting people to do as they’re told. The rhetoric quickly degenerates into terrorizing, through baseless, highly-inflammatory claims, the populace into conformity.
Honestly depicting statistical information doesn’t have sufficient “terrorizing” value for zealots.

JohnB said...

2.
I can point you to a document (see Godber Blueprint) that instructs activists not to use statistical information, but to use such terms as “kill” which go far beyond the implications of the underlying data.

Working Papers in Support of the 8th World Conference on Tobacco or Health: Building a Tobacco-Free World
March 30 – April 3, 1992

Buenos Aires, Argentina
(excerpts)

Use strong direct wording such as
Smoking kills
Smoking is addictive
Smoking causes lung cancer
Smoking causes heart disease
Smoking damages your lungs
Smoking harms the fetus
Smoking hurts your children
Don’t use statements that condone any
form of smoking, imply only a chance
of contracting disease, or attribute the
statement to a third party . Don’t use :
“Don’t smoke too much for health’s sake . ”
“Smoking may cause……
“According to the government . . . . .”

(p.14)
Consider skull and crossbones or other
strong visual displays .

(p.15)

We’re not dealing with facts here. It’s activism. It’s the standard deterioration into the vocabulary of moralizing zealotry. It’s the production of [baseless] generalized slogans for terrorizing effect.

And there’s a theme in the inflammatory propaganda. Zealots will cast doubt on the integrity of ingredients of a target with a view to evoking revulsion, e.g., alcohol is made from excrement. They will contrive an ever-growing list of diseases and character failure that will afflict the partaker. And for the non-conformer, the diseases will produce a slow, horrible, agonizing death. This is the typical repertoire of the moralizing zealot. The goal is to condition (brainwash) the populace into conformity through aversion, revulsion, and outrage. The moralizing zealot rationalizes this unethical, abominable conduct as for the “greater good”.

This particular document makes for interesting reading. It’s all “how to do activism” exploiting medical authority:
http://legacy.library.ucsf.edu/tid/hoc28a99

JohnB said...

Consider the warning label “Smoking Harms Unborn Babies”. The statistical associations between smoking women and particular problems in newborns is confined to a few percent of deliveries to smoking women. Further, the role of smoking in these problems is highly dubious in that it is such a poor predictor for these problems. The vast majority of deliveries to pregnant smokers are comparable to pregnant nonsmokers. But you would never guess this from the label above which implies that smoking harms all babies.

This inflammatory nonsense comes from the late-1970s. Look at the Godber Blueprint, the framework for the current crusade. Here’s an insight into how antismoking fanatics/zealots/extremists “reason”:

“Donovan’s most interesting remarks related to smoking and pregnancy. He admitted that he couldn’t explain how or why smoking harmed the fetus but suggested that, instead of worrying about such fine points, women be told that all unborn children of smoking women will be hurt. Donovan urged every participant to go back to their countries and publish estimates of the lethality of smoking and pregnancy based on the number of pregnant smokers. He urged this as an effective method to get women to stop smoking. 1979 (p.14)”

This is the sort of inflammatory trash that has been fed to the public for the last 30 years. Facts don’t matter. All that matters to antismoking fanatics/zealots/extremists is what needs to be said repeatedly to terrorize folk into antismoking conformity.

Consider, too, “Children are harmed by exposure to secondhand smoke”. Again, the implication is that all children exposed are harmed. There is no evidence to support such a claim. These outrageous claims promote the idea that exposing children to SHS is reckless and irresponsible. It even has an application for nonsmokers - allowing your children to be exposed to SHS is reckless and irresponsible.

It has to be remembered that this inflammatory, social-engineering trash is coming from Public Health. Obviously Public Health has no regard for mental and social health: Manipulating the masses into deranged belief – an assault on mental health (with detrimental social health ramifications) – does not register as a health issue in medically-monopolized Public Health.

JohnB said...

There’s one set of risk factors that the medical establishment doesn’t want to know about – iatrogenesis. Public Health has become the political-activist arm of the medical establishment. It protects medical interests – ideological, political, and financial. Go ask any of the Public Health con artists how much effort they have expended in reducing/eliminating iatrogenesis? Or how many 5-star conferences on iatrogenesis (like the Tobacco Control conference in Moscow recently) they’ve attended?

Background on iatrogenesis and the [lack of] attention it attracts by the medical establishment:
http://f2cscotland.blogspot.com.au/2013/07/dangers-to-life-and-public-health-lobby.html

The latest on iatrogenic effect:
http://www.newsmaxhealth.com/Headline/medical-errors-malpractice-doctors/2014/08/26/id/590884/

Christopher Snowdon said...

BrianB,

The warnings said 'smoking may be hazardous to your health'. Do you dispute that?

A lot of people didn't believe that smoking caused lung cancer. Since it does, it's fair to say that they needed persuading. Unless you dispute that smoking causes lung cancer.

Does this make them unusually dangerous as everyday consumer products. I'd say so. Certainly enough to justify the (relatively mild) warnings of the time.

Nisakiman,

Au contraire!

http://blog.greenlaker.com/2010/06/california-curiosity-prop-65-warning.html

nisakiman said...

Heh! Ok Chris, cars have warning labels! Not quite like a packet of fags, but close enough. :)

A lot of people didn't believe that smoking caused lung cancer. Since it does, it's fair to say that they needed persuading. Unless you dispute that smoking causes lung cancer.

Actually, I do dispute that smoking causes lung cancer. I think that smoking is quite likely to exacerbate any susceptibility to lung cancer, and those that are genetically predisposed to LC probably shouldn't smoke. But actually, without any extenuating factors cause LC? There is no evidence for it. Only epidemiology, which is statistics, and you know as well as I do what they say about statistics.

How many laboratory animals have died trying to prove that smoking causes LC? And all in vain. And what about the demographic anomalies? There are too many of them. And what about all the lifelong smoker centenarians? They give the lie to the statement "Smoking causes lung cancer" all on their own, without all the other items.

So yes, I do dispute that "smoking causes lung cancer". Although I have no particular issue with "smoking can be hazardous to your health", because patently in some circumstances it can. I don't think we need it written on the pack, though.

Christopher Snowdon said...

"The point about the original warnings on cigarettes is that they
(e) had a meaningful impact on consumer behaviour. How did you quantified this ? I can't imagine people quitting smoking because of some small print on the side of the pack 'smoking may be hazardous to your health'. That's a meaningless statement that could describe almost anything from eating fish to taking a taxi. Actually I think it was the first level on the slippery slope which lead to present day insanity with plain packs and all the other warnings you talk about in your post.

Christopher Snowdon said...

Sorry not to have seen your reply earlier, Chris, but I assumed my posting hadn't gone through - well, given that blogger totally crashed my PC when I pressed 'post', it was a fair assumption!

Anyway, you asked:

"The warnings said 'smoking may be hazardous to your health'. Do you dispute that?"

Not that particular one, no, although I would prefer it to be preceded by "Statistics suggest that ..." for total honesty.

But are you saying that this one message was all that was printed on cigarette packets? How about: (some paraphrasing)

"Smoking harms you and those around you"

"Smoking ages your skin"

"Smoking causes erectile disfunction"

All lies, but the biggest lie of all is the simple, universal one:

"Smoking Kills"

Not to mention, of course, the fraudulent black lung (yes, I know the images came later, but old habits die hard).

So I do dispute that the warning messages are true - they are using a typical propagandist's rhetorical distortion of known facts, which is repeated and repeated until it becomes received wisdom. But received wisdom isn't truth, except to the religious.

The success of such propaganda is demonstrated in your next paragraph, when you say:

"A lot of people didn't believe that smoking caused lung cancer. Since it
does, it's fair to say that they needed persuading. Unless you dispute
that smoking causes lung cancer."


Well, since there is (still) no robust scientific explanation of just how smoking 'causes' lung cancer, then I am forced to admit that I do indeed dispute presenting this hypothesis as bald fact. Does that make me a "denialist"?

If you had said "Some studies suggest that there is a strong statistical relationship between smoking and lung cancer", then I couldn't disagree. But that wouldn't help with the cause of re-education now, would it?

I know your intransigent view on this matter, Chris, but I think you defer too much to epidemiology - ironic given how much you rail against it's application to other areas of life. But there is little doubt that the anti-smoking rhetoric has been couched in such hyperbolic language that any real educational message has been drowned out. Only pure propaganda is left, and the truth may or not be contained in that. I think not, or, at least, I am highly sceptical.

But I have to say that I feel you have distorted your own argument by applauding and parrotting the anti-tobacco lobby. I mean, if you accept that your quoted health warning ("...may be hazardous to your health") is true (and all of the other reasons for supporting), then surely you must concede that it would be just as valid to place such warnings on alcohol and many other consumer products - including e-cigs - which seems to be the opposite to what you actually are arguing.

As I said, you may want to rethink your arguments. I somehow suspect that you won't, though.