Citation: Fillmore, K.M. and Roizen, R., The new manichaeism in alcohol science (Commentaries on McCreanor et al.'s "ICAP and the perils of partnership"), Addiction 95:188-190, 2000.
This editorial1 is the latest installment in a recent campaign to marginalize beverage industry involvement in alcohol science.2,3 The campaign arguably derives chiefly from a quarter-century-long shift in alcohol epidemiology's master paradigm -- from the alcoholism paradigm (which problematized the alcoholic drinker, not the beverage) to a public health paradigm (which views alcohol consumption through a risk-factor idiom). To the extent that the latter paradigm is therefore inherently anti-alcohol, partnerships between public health and alcohol producers and their agents can only be disinformational and counterproductive -- resulting in what Babor et al.2 disparagingly termed "liquorspeak". More than a few important questions are raised by this editorial and the campaign it reflects -- some of which we sketch below.
Is the public health paradigm as implacably anti-alcohol as this editorial's argument implicitly requires? The scientific jury, for example, is still out on whether moderate drinking has life-extending benefits (e.g.4-7). In any case, how monolithic is the public health paradigm in alcohol science? Substantial sectors of alcohol science continue to conduct research in the tradition of the alcoholism paradigm -- including etiological, diagnostic and treatment effectiveness studies (e.g.8-10). Additionally, alcohol science's multi-disciplinary character means that it is crisscrossed with paradigms from many disciplines -- anthropology, sociology, psychology, economics, pharmacology, etc. In what sense, therefore, is it appropriate that the public health paradigm's anti-alcohol sensibility should define the entirety of alcohol science's relationship to the industry? Similarly, how does the editorial's argument accord with the notion that the public health paradigm may in fact have fallen on hard times in recent years -- whether due to nagging unresolved empirical problematics, perceived incompatibility with our era's neoliberal political zeitgeist, or increasingly apparent theoretical limitations? Such problematics doubtless contributed, for example, to Rehm et al.'s11 recent call for refocusing epidemiological attentions on drinking patterns-thus, ironically, suggesting a research direction also advanced by ICAP12 and criticized on that account in the editorial.
Does the editorial build on a credible (if implicit) philosophy and sociology of science? The editorial suggests a naive objectivism -- contrasting a putatively purely disinterested, well-meaning public health camp with a distorting, profit-driven industry- sponsored camp. The largest patron of mainstream alcohol-related public health research is the state, with its own strongly competing interests with respect to alcohol.13 Hence, state-funded alcohol research is by no means immune from the influences of extra-scientific cultural-political factors14-15 and the fruits of such research are subject to the state's selective and self-serving use.16 Moreover, and obviously, the state has no crystal ball by which a complex idea such as the public's health (still less the public's good) may be best defined. How sound, in turn, is the editorial's seeming assumption that beverage industry leadership has no interest in minimizing alcohol-related problems? -- a disposition on their part that might hasten the day the alcohol industry would travel down the road taken recently by the tobacco industry. On a deeper level, how would the editorial's authors make room for Sylvia Noble Tesh's17 shrewd observation that any effort to engage in preventive public health activity inevitably involves a substrate of "hidden arguments" about human nature, society's ideal structure and the legitimate sources of human knowledge?
Harry Hascell Moore -- a key figure in the launch of mainstream science's interest in alcohol in the late 1930s in the US -- described the formation of a bipartisan (i.e. Dry and Wet) advisory committee for the then-fledgling Research Council on Problems of Alcohol in the following words: "We seem to have succeeded in persuading the lion and the lamb not only to lie down together ... but to work together."18 Moore's positive lion and lamb allusion contrasts sharply of course with Hawks' negative use of the same metaphor as quoted in the editorial. This rhetorical difference bespeaks the quite different social contexts and social purposes of alcohol science in the two eras. Moore's comments reflected his era's preoccupation with cultural conflict surrounding alcohol in the United States -- when modern science was offered as disinterested, objective and knowledge- accumulating institutional medium for achieving a new social consensus on alcohol. The rise of the public health paradigm has effectively eclipsed that cultural-level focus and, indeed, has thrown fresh fuel on such conflict's fires by re-politicizing the alcohol problems social arena and the role of alcohol science therein. Ironically, even a climate of re-politicization may nevertheless suggest the wisdom of a welcoming disposition toward industry's participation in research and policy discourse. What better way, after all, to ensure that public health science does not fall prey to its own ideological commitments and policy partisanships?
KAYE MIDDLETON FILLMORE & RON ROIZEN
Department of Social and Behavioral Sciences,
University of California,
Box 0612, Laurel Heights,
CA 94143-0612, USA