Thursday, March 25, 2010

Ninny state? [updated]

Last year, the healthists tried coining a new phrase: "ninny state". Noticing that folks were starting to push back against their various interventions into folks' personal lives, and that the term "nanny state" was on the rise, they figured the problem was in branding rather than in their meddling. And so they started saying those opposed to "nanny state" interventions were supporters of a "ninny state" and argued that their fellow travelers ought also make extensive use of the same term. Apparently they came up with this bold new strategy at a public health conference in Australia. Said healthist-extraordinaire George Thomson,
"There's a need to reframe public health activity as stewardship that protects people. We need to emphasise the advantages of the strong state, the state that protects," he told the conference. But the public health community, delving into alien territory, acknowledges it needs some help from the country's top advertising brains in coming up with catchy counter-phrases.
Yup, some clever ad-men to help them come up with ways of marketing the term ninny-state, that's just the ticket.

And so I found it pretty damned funny when Doug Sellman opened his latest salvo against Roger Kerr in today's Christchurch Press by calling Kerr a proponent of the ninny state, then went on to whine about alcohol industry advertising campaigns. So it's ok for Sellman's bunch to look for ad-men to help them with their propaganda, in addition to the millions spent already by governments on public health campaigns demonizing alcohol, but it's not ok for the alcohol industry to advertise their products? Interesting.

They really do need some better branding though. The term "ninny state" does not Google very well at all. The first hits I get on it suggest the term is far more used to describe the implementation of nanny state policies by ninnies, or when the objects of nanny state attention so internalize the preaching that they start advocating it themselves (ninnies then being the micro to the nannies' macro); articles going back to 2005 have it as an alternative description of paternalistic government policies.

It's doubly funny when Sellman implies civilization itself is at stake when "ninnies" advocate rolling back his preferred regulations:
These democratically agreed restrictions and controls are what many of us refer to as "civilisation", the result of 200 years of social development in Western democracies.
Recall, of course, that very good argument can be made that the brewing of alcohol helped give rise to "civilization" thousands of years ago. Personally, I'd put modern civilization as going back a bit farther than two hundred years in the West and I'd note the rather decent contributions made in the mid-East a thousand years ago (and also a couple thousand years prior to that) and in China going even farther back, but that's a bit beside the point; Eurocentrism is the least of Sellman's problems.

Sellman says that Kerr's argument consists of naught but cobbled-together assertions about alcohol that ignore his preferred "facts" about alcohol. Of course, Sellman isn't exactly above ignoring facts he finds inconvenient. He says Kerr ignores that there are 700,000 "heavy drinkers" in New Zealand. Well, there's good reason to ignore that number: it's pure nonsense. Utter rubbish. The only way to get that number is by counting up any woman whose consumption totals more than 20 grams of alcohol per day on average and any man whose consumption exceeds 40 grams. That's less than 2 pints of standard 5% beer for a bloke, and less than a pint for a lady. Complete nonsense. The only measure on which it can start making sense is if health is the only thing that anyone anywhere values. The very best existing evidence suggests that mortality risk is minimized for men somewhere around one standard drink per day and for women somewhere around half that, but moderate drinkers start facing increased health risk, relative to teetotalers, at around 25 grams per day for women and just over 40 grams per day for men. So Sellman's "heavy drinkers" are folks who have just barely started drinking at levels where they see increased risk relative to non-drinkers.

But let's stick with Sellman here and have health as the only permissible goal. The very best evidence suggests that overall mortality risk is minimized at consumption of a bit over half a standard drink per day (average for men and women), and yes these numbers have never-drinkers separated from former drinkers as reference group. Relative to these very moderate drinkers, teetotalers have about a 16% increased risk of death. Should we be forcing non-drinkers to take their daily dose and whinge endlessly about the risks of under-drinking? If not, then the 16% increased risk isn't worth worrying about, right? If it's only risks over 16% that are worth worrying about, mortality risk (relative to teetotalers) is only 16% higher for folks drinking just under 60 grams per day (eyeballing from the graph): the cutoff for "high risk" drinking for men. So why count men drinking more than 40 grams, Doug? Is it so you can get a bigger number? You should be careful: when the numbers get too big, folks start being a bit skeptical. And 700,000 heavy drinkers in a country of just over 4 million people is obviously nonsense. Most folks will run a mental tally of their friends, counting up the ones that would fit a common-sense notion of heavy drinking, and find 700,000 utterly implausible.

Further howlers:

Contra-Sellman, New Zealand society is hardly "organized in such a way as to maximise heavy drinking and therefore alcohol profit." We have fairly high alcohol taxes in place already - taxes high enough to counterbalance any plausible external costs imposed by alcohol abusers; anti-alcohol public service announcements aren't exactly scarce; the police can lock folks up for being drunk and disorderly; you can't buy spirits at the supermarket; bartenders can be in legal trouble if they continue to serve obviously heavily drunk patrons.... We may not have your preferred set of heavy regulations, but things are hardly set up to maximize heavy drinking. It's hard to imagine the mindset that reckons the current slate of fairly restrictive alcohol regulations is the result of the government being entirely in the pocket of the alcohol lobby.

But the most irritating bit is Sellman's concluding comment:
Which state - "ninny" or "nanny" - is likely to encourage individual responsibility? The answer is neither. Highly restrictive "nanny state" families are prone to producing emotionally stunted children with no initiative, but laissez-fair "ninny state" families with no clear rules or regulations often produce out-of-control children. The answer, of course, lies in the middle ground.
For Sellman, the state is parent, trying to bring up its citizen-children with just the right amount of freedom, with himself providing sage advice about where that sweet spot lies. What a ninny.

Update: Doug Sellman responds in comments, below.

5 comments:

  1. That last paragraph is bizarre.

    Is he really using the very metaphor from which the term 'Nanny state' comes from?

    ReplyDelete
  2. Dear Eric
    Four points.in response to your entertaining piece about my article on the ninny state and alcohol -
    1. I don’t think we are going to progress thinking about the damage that alcohol is doing to New Zealand by engaging in further ninny/nanny talk. But Roger Kerr’s previous fatuous comments about “nanny state” regulations needed a response.

    Rational discussion about alcohol begins by recognising it as a Class B equivalent drug (High Risk to Public Health) and then formulating the best regulatory controls on it to minimise the harms using the international scientific literature. The current excessive commercialisation of alcohol is not helping advance civilisation in New Zealand – there is just too much harm occurring, both from heavy drinking and “passive drinking”. 70,000 physical and sexual assaults each year is a large burden to bear.

    2. The figure of 700,000 heavy drinkers in New Zealand is not based on the figures you quote. It is based on NZ household research using the Alcohol Use Disorders Identification Test (AUDIT), a widely used World Health Organisation developed instrument for detecting heavy drinking. Yes, it’s a large number alright - the total population of Wellington and Christchurch combined. We are a country featuring a heavy drinking culture, where too many have been brain washed to think “life can’t be enjoyed without alcohol” and “social events aren’t proper events without being wasted”..

    3. I’m not sure if you’ve read the reviews of Jackson et al in the Lancet 2005 and Chikritzhs et al in the Drug and Alcohol Review 2009, but the (cardioprotective) benefits of alcohol you write about are now seriously questioned. If you want to take drugs (alcohol), I would suggest you do it simply to enjoy the artificial positive feelings you seek, as I do intermittently. We aren't benefiting our health though. The neurotoxic, carcinogenic, depressigenic, sexually impairing and aggressigenic nature of this drug are unfortunately not well enough known for consumers to make fully informed choices and the alcohol industry goes out of its way to keep these things hidden from its customers.

    4. I don’t see the state as “parent”, although it can certainly perform parental functions if we collectively want it to. As a psychiatrist I was extrapolating a principle from families in trouble.

    Like you in economics Eric, I’m aware of the difficulty of understanding complex systems, but even more so when trying to change them. We just have to get on with our jobs and provide the government (our collective mind) the best information we have to try and solve the problems confronting us as a society. That’s all I’m trying to do.

    I'm happy to send you copies of those two articles if you'd like.
    Cheers
    Doug

    ReplyDelete
  3. 1. If it's equivalent to class B, that would seem good argument for reducing the regs on anything equivalent to class B to match the alcohol regs, not the other way round. Most folks are able to incorporate alcohol into very normal lives very successfully. Alcohol equivalent to hash and morphine though? Really?

    2. I was following BERL's figures, which I'd thought had picked up from there, but I can double check. BERL's figures only have numbers approaching 700K when including men drinking more than 40 grams and women more than 20 grams per day. It is wholly implausible that 700K New Zealanders -- that's 1/6 for the population as a whole, including children -- have a serious drinking problem.

    3. I've read those papers. Jackson makes a big hubub about potential confounds that are entirely answered by the metastudy I'd linked. Chikritzhs figures that low levels of drinking are unlikely to do much on the cardio side. I care a lot less about cardioprotection than about overall mortality, and the J-curve there is massively well established in the literature. The metastudy I've linked (Castelnuovo) has dozens of studies on drinking and overall mortality rates, split by all kinds of potential confounds. Is there a more recent metastudy out there, or is there a particular problem with the one I'm citing? 'Cause I don't see much in Jackson that's not answered in it. All the worries about former drinkers confounded with never-drinkers - doesn't make much difference. All the worries about omitted health behaviours biasing things -- can't make much difference (only tiny differences in J-curve effects between studies that have no other health behaviour covariates and ones with lots of them, so potential for omitted variable bias to be causing big problems is limited). Maybe there's some other omitted variable bias, but the burden of proof given the weight of evidence for the j-curve ought to be on the side seeking to disestablish the curve.

    4. I can't see how your last paragraph can be read other than as I read it, but I'll take your word for it.

    ReplyDelete
  4. For those interested, an online version of the WHO test appears to be here. I can totally believe that that test would show 1/6 having a hazardous drinking problem - the threshold is too low. It still says I'm ok, but it doesn't take much tweaking to put it into hazardous range.

    Start by having a perfectly healthy one pint per day 5 days per week (again, this is less risky than teetotalling). 2 standard drinks. Add in less than one time per month when you have 3 pints in a session (6 standard drinks). Add in less than one time per month that being tired the next morning impairs your job performance a bit, add in less than one time per month that you've some regret from the night before (heck, I've plenty of non-drinking related regrets...), and you're hazardous by their standard. You've a total score of 8 - hazardous.

    ReplyDelete
  5. Great article, Eric. I went to the annual Porritt lecture at Whanganui Hospital last week where Doug Sellman spoke about the nature of addiction and then promoted his hobby horse, Alcohol Action. To me his plans for higher taxes and stopping young people of voting age from purchasing liquor smacked of Nanny writ large. The Business Roundtable paper written by the late Roger Kerr noted that Prof Sellman had described individual responsibility as a 'tired old mantra'. In his lecture he scoffed at the concept of free will. So obviously we are all slaves to our neural circuitry, and no-one is responsible for their actions. By his logic, all people imprisoned for violent crimes released immediately.

    Good point you make about the class B drugs - if alcohol is still legal and sold over the counter, so should morphine, amphetamine and Valium.

    ReplyDelete

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