Unhealthful News 194 - Public health terrorism, Pennsylvania date rape edition

In my last post I wrote about (and plan to revisit) a pseudo-public-health campaign to vilify the common practice of parents co-sleeping with their infants, which might cause a net increase in risk when done properly, but might not, and the net effect is clearly very close to zero.  I pointed out that this type of destructive extremist behavior by nanny-state actors seems to trace to anti-tobacco extremism emerging, since the 1990s, as the tail that wags the dog of public health.

Chris Snowdon recently posted a scathing takedown of an extreme (which is not to say rare) commentary that argued that since society has accepted policies that deny people the freedom to use tobacco, therefore government should take the same action with regard to other health-affecting choices.  Not every health affecting choice, of course -- just the ones that a certain ilk of people does not approve of.  As Snowdon has argued at length, this is one of the dangers of allowing an exceptional set of actions (government restrictions on free choice) to deal with an "exceptional" problem (the high risk from smoking).  Granting such exceptions to the ethical standards of free Western society almost inevitably creates a situation where extremists want to use the same tactics to deal with any similar phenomenon that they declare to be a problem.

A related but slightly different concern about such disregard for ethical public policy, beyond curtailment of personal autonomy via prohibitions, is curtailment of autonomy via manipulative messaging.  The worst of this, along with simply lying, is emotional violence that is designed to hurt people (for their own good, of course) and usually harms orders of magnitude more people than it causes to behave differently.  The most obvious example is the disturbing, often gory graphics on tobacco packages, which proponents have managed to trick everyone into calling "graphic warnings", even though they are most certainly not.  (A warning communicates accurate information that is not already known for the purpose of facilitating better informed decision making.  The tobacco graphics fail the "communicate information", "not already known", and often the "accurate" bits.)

The authors of the anti-co-sleeping campaign clearly drew inspiration from (and maybe even apprenticed in) the lavishly funded anti-smoking emotional violence campaigns which adopted a mentality of "say/show anything that might accomplish the goal, regardless of whether it is true or what damage it does."  In the case of the anti-co-sleeping, the damage includes the problem that it is impossible to offer advice about how to safely co-sleep (specifically, don't do it when you are under the influence of mind-altering drugs, legal or otherwise).  When the over-the-top message that co-sleeping is as bad as putting baby to bed buried in covers and cuddling a large sharp knife, there is not room to say "but if you do, make sure to...."  Further damage comes from making some of the many co-sleeping parents feel bad about their choice based on incorrect information.  And for any parent whose child died while co-sleeping the message might as well be "nyah nyah, you were an idiot, you deserve to be grieving for the rest of your life".

Fortunately there are very few such parents.  But, a lot more women have suffered date rape, and that is a lot of nasty flashbacks resulting from this (pictured) anti-drinking message that depicts a disturbing image of the legs and half-removed clothes of a young woman lying on what appears to be the floor of an low-quality institutional bathroom.  The guilty organization in this case was the Pennsylvania Liquor Control Board, which pulled the ad after one day following an outcry by rape victims and advocates.  At least that agency does not claim the mantle of "public health" in their title, though it is kind of annoying that the state secures for itself a monopoly over liquor and wine sales, and this agency that is the monopoly seller is using the profits for nasty messages like this.  (Fortunately there is something of a free market for beer and, for those of us living in the southeast of the state, there is the state of Delaware, home of low price booze, only a few minutes away -- something that seems even more worthwhile given this fiasco.)

Is our state liquor monopoly an extremist "anti" organization that is just trying to twist women to their agenda.  Well if you go to their webpage that is linked from the rape graphic, you will find such statements as:

Heavy drinking is usually defined as consuming an average of ... more than 1 drink per day for women

Also you will find such demonstrates of knowledge as:

...binge drinking is a pattern of alcohol consumption that brings the blood alcohol content (BAC) level to 0.08% or more. This pattern of drinking usually means 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.

For most men and most drinks, less than 3 drinks in 2 hours is enough to get above 0.08%.  My personal favorite, though, was:

The more alcohol you consume, the more intense the effects 11.

What makes it funny is that "11" there is a reference note.  They felt the need to cite to some FAQ at the CDC website to make that claim.  For amusement value, this just edges out this one, in their list of "myths":

MYTH: Alcohol is an aphrodisiac.  Alcohol reduces inhibitions and may stimulate your interest in sex...

But apparently that does not mean it is an aphrodisiac or anything.

In short, the PLCB behave like the typical pseudo-public-health nannies when it comes to this messaging, both in terms of the message and the intelligence with which it is delivered.  On the website, their message is the usual scattershot collection of claims about how terrible a behavior is; date rape risk is a minor part of the arguments they heap on.  So why do they emphasize that in their graphic?  Because it evokes visceral horror among many women, more so than does the threat of choking to death in one's sleep or dying in a car crash.  The action being taken is ostensibly one of communication and warning, not prohibition or regulation.  But the act is actually designed to terrify the audience, through creating fear and other emotional reactions to a memorable image, into being less likely to drink, regardless of whether they might make that decision based on a rational calculation of the risk.  Even setting aside the practical problems with this (e.g., those most likely to be terrified are those who are already most cautious), this is not a legitimate role for government or anyone supposedly acting in the public interest.

In contrast with the anti-co-sleeping message, where the advice is not actually supported by the science, it is undoubtedly true that less drunkenness will result in less rape.  But that does not justify a tactic that is designed to provoke as much reaction as possible (even if it is paranoid overreaction).  As with the anti-co-sleeping message and tobacco, the prohibitionist approach makes it impossible to offer useful harm reduction advice.  This is particularly striking since the text accompanying the graphic is actually addressed not to the victim, but her friends ("when your friends drink, they can end up making bad decisions...that leave them vulnerable....").  So here's a thought:  If you see your friend drinking about to pass out, do not let her go unaccompanied toward the bathroom with a man she just met.  Even better, the message could be "as with a designated driver, make sure someone in your group has the job of guarding against such occurrences (and avoid fraternity parties entirely)."

And speaking of that man, the ad campaign did not acknowledge his existence  Due to the apparent lack of a perpetrator and blaming the booze, the rape can only be seen as the victim's fault entirely.  The outrage about that is probably what got the ads pulled in a day, as reported by the Philadelphia Inquirer and via the Associated Press, though the stories also tell us of the outrage the victims of date rape expressed about having that imagery forced on them.  It is tempting to say the news reports were good, because they report the complaints and the sensible outcome.  But thinking about it more, the stories failed the basics of news reporting.  There was no inquiry into what possessed those idiots to create this in the first place, or to think it was acceptable.  The report is about one battle, without realizing that it is part of a war.

Returning to the message, why did the PLCB not offer advice about how to avoid date rape even when you are drinking?  Because they do not actually care about date rape.  Their mission was just to discourage drinking, by any means available.  The typical current behavior of "public health" told them that exploiting the existence of date rape was ok.  Yes, they folded when someone insisted that it was not ok, but their willingness to fold may have been because they were not quite as committed as the extremists are; the funding for the effort comes from the profits of the agency's liquor stores, after all.  It is not difficult to imagine the extremists (the Milwaukee public health unit in the co-sleeping case, most everyone in the business in the case of tobacco, and quite a few in the anti-alcohol groups) arguing that the importance of their cause justifies terrorist tactics, blaming the victim, and causing flashbacks for thousands of previous victims.

I do not want to imply there is some huge divide between these tactics and direct government control over people's actions.  Indeed, the prohibitionists depend on disinformation and emotionally violent messages to create the social situation where they can impose policy-enforced restrictions on behavior.  Demonization and abuse of smokers would not be possible if a couple of generations had not been "taught" how evil they are and how they really all just want to quit but are too weak to do so without "help".  But the two bits should not just be lumped together, if for no other reason because the messaging approach is commonly practiced by ostensibly respectable people.  As a real and credentialed public health person, I am more bothered by them than by the prohibitionist extremists that they empower and cover for.  It is like the southern "gentlemen" in Washington for over a century talked about states' rights and such to provide cover for lynchings and other acts of racism that they pretended to not support.  There are always thugs out there for any cause; there are not always credentialed, skilled, and apparently respectable propagandists making it possible for them to act.