[caption id="attachment_11123" align="aligncenter" width="960"] Brought to you by The Centers for Disease Control[/caption] This little gem about America's modern prohibitionists came out last month, but I didn't want to harsh your rum buzz with yet another example of how joylessly unrealistic, controlling, and contemptuous American bureaucracy is. Of course, The Centers for Disease Control (the subject of this little screed) would likely argue that I'm some kind of baby-killer for not rushing their message out as swiftly as possible. You see, they want you to know that no woman of child-bearing years should drink any alcohol at all, unless she is on full-time, passive birth control. From The Atlantic—Protect Your Womb from the Devil Drink:
Julie: Olga, did you know that 3.3 million women in the U.S. are “at risk of exposing their developing baby to alcohol?” Well, their hypothetical babies at least. This number represents the women aged 15 to 44 who are “drinking, having sex, and not using birth control,” according to a report The Centers for Disease Control and Prevention released on Tuesday. In an effort to prevent fetal alcohol syndrome, the agency says doctors should “recommend birth control to women who are having sex (if appropriate), not planning to get pregnant, and drinking alcohol.”Here's the report from the CDC, so you can read this piece of Chinese lead- and talc-filled pablum for yourself. If you can't stomach longish articles that look like Carrie Nation took over the USAToday, I'll digest it for you.
- There is NO SAFE AMOUNT OF ALCOHOL CONSUMPTION during pregnancy, from making the Beast with Two Backs, all the way until the sweating, screaming, and well-coached breathing. (And really not until you finish breast-feeding, but that's another publication for another day) ((You are breast-feeding your baby, right? Right? Right?!?!))
- There is a whole raft of scary, permanent problems that a baby might have. A large number of these can be caused by (among other causes, known and unknown) any alcohol consumption during any point of pregnancy.
- A post-pubescent, pre-menopausal woman can become pregnant if she, get this, has sex.
- Ipso facto, all fertile women must choose between drinking, or The Pill or an IUD. (Or condoms. But let's be honest with ourselves, if you are a boozer, how careful are you always going to be about condoms?)
On an individual level, pregnancy is an exercise in abstinence. Women are told to give up not just alcohol, but caffeine, too. And seafood and lunch meat and soft cheeses. And sometimes, things that are much harder to go without. Jane Marie wrote a heartbreaking essay in Cosmopolitan about going off her depression and anxiety medication while pregnant.It is a bit brutish to demand that a woman who wishes to go about her life to give up sensible recreational lifestyle choices (e.g. sex... or Pegus), or to endure a range of side-effects, agonizing negotiations, or other dangers. But asking people to make draconian personal choices against their own wishes to prevent low-order-probability events is just one of the brutish services modern government provides! And get this: I am fully aware that brutish (by this definition) advice is often necessary, and indeed a good thing. Fathers like me, with daughter's like mine, often issue "brutish" advice about subjects quite close to this. One difference is that if an individual issues such "guidance" to a young woman or women publicly, a Twitter mob of persons allergic to contrary viewpoints will form and declare the Earth a Safe Space, where said individual is not welcome. Other differences are the time-testedness of the advice, the recognition of human nature in the thought process, and the order of magnitude of the probabilities.... The science here really is dubious. It's what happens when you combine patrician public policy with scientific endeavor. Science loses... or is co-opted, which is worse for Science. First off, yes: All evidence is quite clear that some level of alcohol consumption, at some points in a child's development, can have deleterious, even devastating consequences. What is, however, far from remotely certain is how low that level of consumption is, and a which points in the timeline, and how great the risk actually is. (One in a hundred? One in a million?) As but one example, there is evidence showing an improvement is natal outcomes with mothers who drink low amounts of alcohol during parts of pregnancy over those who teetotal. (Danger! Correlation is not causation!) My point here is that there is conflicting good science on the subject. It is dishonest and to no small degree self-deluding to act as if there evidence sufficient to support such an absolutist conclusion as the CDC puts forth here. While the CDC release does not use the term, it is clearly informed by the all-too common term, "There is no safe level of X." With the exception of supertoxins like Plutonium, this phrase generally has come to mean, "we don't actually know for sure what the minimum safe level is, only that there is some level that is not safe. So to be conservative, let's just say the level is zero. Better safe than sorry." To adopt this as rigorous scientific method, we would be forced to also put forth public policy based on there being no safe level of crossing the street. If you base life decisions on pronouncements like there being "no safe level of crossing the street", the little Jimmy will not be allowed to walk the two blocks to Billy's house on Saturday. Jimmy's mom will instead have to schedule a playdate for next weekend. The upshot of this is that Jimmy will be safe from the terrifying risk of walking down the street while eleven, but the cost of this safety is that there is now be a near certainty that he will be living in Mom's basement and working for the Martin O'Malley campaign when he is 24. It is simply not possible for human beings to avoid all risks in life, and any attempt at doing so usually ends badly. An honest accounting of risks, and an honest disclosure of the uncertainties about those risks, is going to be more helpful to people in determining what risks to take, and how often. The human mind works fairly consistently, especially en masse. Tell people that something is too dangerous to do at all, something they really like doing, and they are going to do it anyway. Having decided to do it anyway, they will justify this by not believing you. And once they don't believe you, many will take this as license to seriously ignore your advice.... And if this disbelief is easily justified by their own experiences and by facts in evidence, they will conclude not only that you are wrong, but that you are liars. And they will place an assumption upon you that any other advice and/or edicts you may issue are also likely untrue. And they won't be happy about it. Think I'm wrong? [caption id="attachment_11126" align="aligncenter" width="360"] The horrible, inevitable consequence of telling people that the sky is green for long enough....[/caption] So, why do public health advocates employ absolutist solutions so often? Are they truly so risk-adverse that they genuinely believe their own advice? I doubt it. In a recent speech, Christopher Snowdon of the British think tank Institute of Economic Affairs addresses this endemic dishonesty, using general alcohol consumption issues as his focus. I think it is an excellent piece, not least because much of his thinking mirrors my own as outlined above.... He suggests there are two reasons, neither of which are a true belief in the advice offered. The first thought process he describes in terms of teacher's setting homework expectations.
...the teachers told us that we would be expected to do three or four hours of homework a night. ... I doubt that any of us were so conscientious. Speaking personally, I recall half an hour being the average, perhaps up to an hour on occasion. Looking back, I think the teachers knew that we wouldn’t do three or four hours. I think they would have been very happy if we did one or two hours. They were doing something that behavioural economists call ‘anchoring’ — putting an unrealistically high number in our minds in the hope that we would settle for a lower number, but that the number would still be higher than the number we would have come up with if left to our own devices. If they had said we should do an hour, we might have settled for 20 minutes. If they had said half an hour, we might have settled for ten minutes.The second motive he proposes is bureaucratic, rather than health motivated. Put in terms of this CDC missive, the number and intensity of women drinking while pregnant or actively trying to become pregnant has been declining over time. That this can be attributed to the efforts of the public health community is indisputable, and to the extent that we recognize it as a public good, should be celebrated as a success. But bureaucracies are generally loathe to brag about real successes (though they certainly tout illusory successes when they are failing at root jobs). Why? Because if they admit to having fixed a problem, the rest of the government will say, "Awesome! Now we can give your money to spend on some other problem that isn't fixed, or even (I'm laughing so hard I can barely type here) just not spend that money at all." Conversely, if you change your metrics, from "don't drink if you are trying to become pregnant" to "don't drink if you could possibly become pregnant", suddenly you have three and a half million women added to your population of people with dangerous drinking habits. Three and a half million is a crisis! Better give them more money.... I'll propose a third motive as well: the clever, incremental totalitarianism of the bureaucratic state, in this case, the Prohibitionist wing. When we ended Prohibition, we didn't end the prohibitionists. We just taught them better tactics. First, they came for the college students, and I did nothing. Because, screw those punks. Then, they came for the fertile women, and I did nothing. Because I am not a fertile woman. And so on. Finally, the CDC is being a bit naive about some of the rather elemental relationship between booze and pregnancy. Bill McMorris at the Federalist writes this:
Forgive me for taking this personally, but I wouldn’t be here if not for the invention of Irish whiskey. My two children wouldn’t be here if not for Pinot Noir. We’re a good Catholic family. The only form of birth control we use is my physique, but, like every other method of birth control short of abstinence, it is not 100 percent effective (Baby No. 3 is due in July). Evidently we are child-abusing monsters.In my case, I am reliably informed that in my case, my nativity can be put down to the invention of the Stinger.... Regardless, I am not suggesting women go on The Drinking Man's Diet, be they fertile or not. There is a connection between drinking and pregnancy outcomes. The connection gets stronger with greater consumption, likely curving up in more than just a straight line. The advice our physician gave my wife and me was to be careful about the calendar when actively trying to get pregnant, and abstain once we succeeded. In the latter stages of the pregnancy, a smallish glass of wine on most days would likely have a higher chance of being beneficial than being harmful. Pregnancy is hard, people. There is the weight gain. The weariness. The sexual insecurity. The crankiness. The worries about the future... And guys, if you think it is hard, the women have it even worse!abc