Wednesday 4 July 2018

Interesting take on evidence-based policy

The anti-alcohol folks are pushing for stronger and mandatory warnings on drinks about the dangers of alcohol consumption during pregnancy. 

This bit was particularly interesting:

Baddock argues attempts by the alcohol industry to promote measures to reduce FASD have been ineffective and rather seek to debate the evidence.

The NZMA submission urges decision-makers to be aware of, and pre-empt, industry counter-arguments to public health measures such as mandatory labelling.

Baddock says a standard alcohol industry tactic has been to cite lack of evidence as a reason not to do something, which has been used by others such as the tobacco industry to "thwart and delay" public health measures like plain packaging.

"It's not just alcohol. I think any industry tends to be resistant to anything mandatory that might affect their sales."

However, she is hopeful the alcohol industry will "come on board" with mandatory pregnancy warnings. 

"I would love to see the alcohol industry put up their hand and say FASD is a real problem and we need to be helping reduce the harms done [by alcohol]." 
Traditionally, the status quo has some weight. Those proposing changes to the status quo have to provide some evidence that the change will be beneficial - that the gains will exceed the costs. In areas where evidence on gains and harms is hard to come by, we can look to international evidence - or run trials.

It is a bit odd to pre-emptively say (my paraphrase): "Hey, we don't have any evidence that our policy proposal will do any good. We ran some focus groups suggesting that people don't pay much notice to current labels, but we have no particularly good reason to expect that mandatory labeling will change real-world behaviour in the cohort we should be worried about. But anybody pointing out the absence of evidence - we're going to pre-emptively say that they're industry shills."

Another fun bit - the anti-alcohol people worry that messages like 'it's safest not to drink while pregnant' might strengthen beliefs that light drinking in pregnancy is harmless.

Here's Emily Oster on that. She included a nice section on alcohol in her review of all of the evidence on the dos and don'ts during pregnancy.
There exists no large (or even small) randomized trial about drinking during pregnancy; such a thing is never likely to exist. This is not unique to drinking, of course – there are no large randomized trials of Tylenol usage in pregnancy, either, just a lot of large observational studies. And some women will read the existing evidence and still choose to abstain. But there is a growing body of data suggesting that, if women choose to have a glass of wine, there is no evidence they are harming their baby.

Telling women that an occasional glass of wine is more harmful to their baby than heroin or cocaine is misleading and may also be potentially dangerous. It surely would not be supported by the vast majority of the medical establishment. Focusing on punishing and shaming women who choose to have an occasional glass of wine during their pregnancy also takes away important focus from helping women who are struggling with truly problematic drinking and the social problems that often come with it. 
So they're worried that people might draw the correct conclusion from the labeling - that heavy drinking during pregnancy is a very very bad idea, but a glass of wine every other day is going to be fine.

Again - the anti-alcohol people will not be happy until they have incrementally gotten us to alcohol plain packaging. It's salami-slice tactics, exactly the same as used in the push against tobacco,  incrementally piling on restrictions until the only thing allowed on the packaging is warning labels and small-print indication of the manufacturer.

No comments:

Post a Comment