Alcohol advice and the noble lie

This, from by Julian Baggini in the Guardian, is rather good....

Want the truth about alcohol? You won’t hear it from the government 

.. For some time, studies repeatedly produced graphs with a J-shaped curve, showing both abstinence and excessive consumption associated with the worst health outcomes, with moderate drinkers enjoying the best health. It was only in January 2016 that the Department of Health revised its guidelines and claimed the best evidence now suggested that there was no “safe” level of alcohol consumption and every glass increased cancer and heart disease risk.

These new guidelines have been contested, but whether they are right or wrong, the point is that for years people who looked at the data repeatedly found the J-shaped curve, but no official source ever recommended the lifestyle it pointed to: one of moderate drinking. Changes in evidence don’t change the general tenor of anti-alcohol advice, they merely change how forcibly the authorities dish it out.

Why should this be so? One reason is that we like to think in clean, clear categories of good and bad. With our puritanical Protestant history, alcohol has always fallen on the dark side of this divide. So when the truth turns out to be complicated, rather than accept this maturely, we refuse to acknowledge the good and carry on as though it were all bad.

This is doubtless true, and there is more religious influence in the 'public health' crusade against alcohol than most people realise, but the 'no safe level' rhetoric is taken directly from the anti-tobacco campaign. Whilst the government has never recommended moderate drinking to teetotallers, it has only recently shifted towards an implicit message of total abstinence. This is because they are copying the anti-smoking movement in both messaging and policy.

Aside from the pure moralising, a more understandable but no less erroneous reason for refusing to recommend any consumption of intoxicants is fear of the slippery slope. Even if 21 units of wine a week does turn out to be healthy, 21 bottles of wine is not. Similarly, drug use can slide into drug misuse. Give a green light to moderate drinking, so the fear goes, and heavy use is sure to follow.

This paternalism might be benign in intent but it is malign in effect. If it is to have any credibility, health advice must be consistent with the evidence, not gerrymandered to anticipate its potential misuse. Sadly, however, health advice almost always goes through the distorting filter of officials anticipating behaviour change.

Again, this is true. Health authorities do not trust the public with information. But simplistic and misleading advice is not just about influencing the behaviour of people. It is about influencing the behaviour of government. The minutes of one of the alcohol review meetings says that it is ‘important to bear in mind that, while guidelines might have limited influence on behaviour, they could be influential as a basis for government policies’. 

When I wrote about this in 2016, I concluded that: 'Influencing government policy is the real aim of the game. They don’t trust us to handle accurate information. As a result, we can no longer trust them to give us it.' That is pretty much the conclusion Baggini comes to...

Health advice too often follows the principle of the noble lie. Rather than being told the plain truth, we are told what the authorities believe will lead us to behave properly, when “properly” means not just in the way that is most prudent for ourselves, but what is seen to be morally appropriate. This means that whatever the truth about healthy drinking or drug-taking is, we can’t trust government health advice to provide it. When the best current scientific evidence meets moralising paternalism, it is truth that starts to bend.

 Do read his whole article.