Should the right to sell alcohol belong only to states? According to a new study by a 12-member group of public health professionals, chosen by the director of the Centers for Disease Control and called the “Task Force on Community Prevention Services,” the answer is hell, yes, because government control means fewer stores, which means fewer sales, which means less drinking.
To understand the task force’s thinking one needs to step into the neo-prohibitionary world of public health.
According to Deborah Cohen, a scientist at the Rand Corporation, and Tom Farley, the current New York City health commissioner, we have all been told a fairy tale about the follies of Prohibition. Far from a failed experiment in social engineering, it was, they say, a brilliant success. From 1920 to 1933, America dried out en masse and public health improved dramatically — deaths from cirrhosis of the liver, they note, dropped by 50 percent.
They argue that this gain was much bigger than the negative impact of the black market and gangsterism, and that repeal came about not because there was a populist rejection of paternalism, or even a mass longing to drink legally, but because the wealthy wanted a tax on alcohol to mitigate the effects of income tax.
In their 2005 book, “Prescriptions for a Healthy Nation,” they write: “Prohibition taught us that if we tighten up the availability of alcohol, people will drink less and be healthier. It also taught us that a total ban on drinking causes our society more problems than we are willing to bear. It didn’t teach us about the effects (good and bad) of all the policy options between a total ban and an unregulated free market, which are exactly the options we ought to be thinking about.”
In other words, the goal of public health should be to push the most restriction one can get away with, because, as Cohen and Farley argue, the real problem is not the hardened drinkers or the addicts, it’s the moderate consumers: “When everyone is drinking ‘moderately,’ it gives license to a few to get drunk,” they write. “The more acceptable drinking is among friends and neighbors, the more people will become alcoholics.”
Moreover, because there are so many so-called moderate drinkers who drink more than Cohen and Farley think is appropriate, the damage they do to themselves and to others in absolute numbers is worse than that done by the much smaller group of hardened drinkers. In other words, the fundamental problem of public health is mathematical: When the majority is a little bit bad, they are, in sum, more damaging to society than a minority being very bad.
Cohen and Farley pursue this line of reasoning across the field of public health. They call it curve shifting, but environmental utilitarianism might be a better way of describing it: the greatest good is that which has the greatest impact on the greatest number. Regulation and restriction should target the middle, not the extremes.
The CDC-appointed task force, meanwhile, bases its conclusion on single distribution theory, which argues that there is a close mathematical relationship between average or normal drinking and the prevalence of problem drinking. Thus, if you reduce the overall amount of alcohol available and reduce the average consumption, you get at the problem consumption, too. If you combine this with Cohen and Farley’s claims for the benefits of curve shifting, alcohol restrictions make some sense. The moderates stop being secretly immoderate and in doing so exert a drag on excessive consumption.
From the task force’s report, you would think that no one had found problems with the way the single distribution theory has worked in practice in the 50-plus years since it was proposed. You would be wrong. One recent study, conducted by the National Bureau of Economic Research and funded by the National Institute on Alcohol Abuse and Alcoholism, found that hardened drinkers, far from being tethered to their moderate counterparts, were the least responsive to increased alcohol pricing. They just kept on chugging. If this is true, why would heavy drinkers respond to decreased availability? In fact, according to government data, they don’t. The states that still control alcohol sales don’t, on average, do any better at reducing alcohol harm than the states where alcohol sales are privatized.
And the task force isn’t the only one neglecting awkward data in an effort to save us from ourselves.
Let’s go back to Cohen and Farley’s claim about Prohibition’s triumph in reducing deaths from cirrhosis. It fails to account for the fact that the cirrhosis death rate was in decline just as Prohibition started.
Given that it takes years to develop the disease, fluctuations in the age distribution of the population because of immigration and deaths from the Spanish flu pandemic in 1918 explains most of the decrease during Prohibition, says economic historian Jeffrey Miron, and not the restriction on alcohol.
The devil isn’t always in us; but in public policy, it’s often in the details.
To understand the task force’s thinking one needs to step into the neo-prohibitionary world of public health.
According to Deborah Cohen, a scientist at the Rand Corporation, and Tom Farley, the current New York City health commissioner, we have all been told a fairy tale about the follies of Prohibition. Far from a failed experiment in social engineering, it was, they say, a brilliant success. From 1920 to 1933, America dried out en masse and public health improved dramatically — deaths from cirrhosis of the liver, they note, dropped by 50 percent.
They argue that this gain was much bigger than the negative impact of the black market and gangsterism, and that repeal came about not because there was a populist rejection of paternalism, or even a mass longing to drink legally, but because the wealthy wanted a tax on alcohol to mitigate the effects of income tax.
In their 2005 book, “Prescriptions for a Healthy Nation,” they write: “Prohibition taught us that if we tighten up the availability of alcohol, people will drink less and be healthier. It also taught us that a total ban on drinking causes our society more problems than we are willing to bear. It didn’t teach us about the effects (good and bad) of all the policy options between a total ban and an unregulated free market, which are exactly the options we ought to be thinking about.”
In other words, the goal of public health should be to push the most restriction one can get away with, because, as Cohen and Farley argue, the real problem is not the hardened drinkers or the addicts, it’s the moderate consumers: “When everyone is drinking ‘moderately,’ it gives license to a few to get drunk,” they write. “The more acceptable drinking is among friends and neighbors, the more people will become alcoholics.”
Moreover, because there are so many so-called moderate drinkers who drink more than Cohen and Farley think is appropriate, the damage they do to themselves and to others in absolute numbers is worse than that done by the much smaller group of hardened drinkers. In other words, the fundamental problem of public health is mathematical: When the majority is a little bit bad, they are, in sum, more damaging to society than a minority being very bad.
Cohen and Farley pursue this line of reasoning across the field of public health. They call it curve shifting, but environmental utilitarianism might be a better way of describing it: the greatest good is that which has the greatest impact on the greatest number. Regulation and restriction should target the middle, not the extremes.
The CDC-appointed task force, meanwhile, bases its conclusion on single distribution theory, which argues that there is a close mathematical relationship between average or normal drinking and the prevalence of problem drinking. Thus, if you reduce the overall amount of alcohol available and reduce the average consumption, you get at the problem consumption, too. If you combine this with Cohen and Farley’s claims for the benefits of curve shifting, alcohol restrictions make some sense. The moderates stop being secretly immoderate and in doing so exert a drag on excessive consumption.
From the task force’s report, you would think that no one had found problems with the way the single distribution theory has worked in practice in the 50-plus years since it was proposed. You would be wrong. One recent study, conducted by the National Bureau of Economic Research and funded by the National Institute on Alcohol Abuse and Alcoholism, found that hardened drinkers, far from being tethered to their moderate counterparts, were the least responsive to increased alcohol pricing. They just kept on chugging. If this is true, why would heavy drinkers respond to decreased availability? In fact, according to government data, they don’t. The states that still control alcohol sales don’t, on average, do any better at reducing alcohol harm than the states where alcohol sales are privatized.
And the task force isn’t the only one neglecting awkward data in an effort to save us from ourselves.
Let’s go back to Cohen and Farley’s claim about Prohibition’s triumph in reducing deaths from cirrhosis. It fails to account for the fact that the cirrhosis death rate was in decline just as Prohibition started.
Given that it takes years to develop the disease, fluctuations in the age distribution of the population because of immigration and deaths from the Spanish flu pandemic in 1918 explains most of the decrease during Prohibition, says economic historian Jeffrey Miron, and not the restriction on alcohol.
The devil isn’t always in us; but in public policy, it’s often in the details.