The return of prohibition

America in the early twentieth century was a weird place. Progressive puritans ran amok. The Anti-Saloon League held the whip hand over politicians. Schools were forced, by law, to teach “Scientific Temperance Instruction”, a warped doctrine which asserted that alcohol was an instantly addictive poison that was dangerous even in the smallest of doses. 

America got even weirder after 1920 when it became illegal to buy a drink anywhere, but at least that was repealed thirteen years later and the Americans learned some lessons from it. 

Those lessons are now being unlearned. The number of Americans still alive who have even the dimmest memory of Prohibition has dwindled to a tiny rump. Even Joe Biden isn’t old enough to have what modern Progressives call “lived experience” of it, and it shows. One of his last acts in office has been to give the green light to the de facto prohibition of cigarettes by authorising the FDA to take nearly all of the nicotine out of them. Some will say that this doesn’t amount to prohibition because products that look like cigarettes will still be available with traces of nicotine in them. But even under actual Prohibition it was legal to sell beer so long as it had less than 0.5 per cent alcohol, derisively known as “near beer”. 

The non-smoking teetotaller Donald Trump may yet come to the rescue and stub out Biden’s attempt to create a legacy for himself by banning cigarettes, but the direction of travel is clear. In the USA, as in Britain, the puritans are winning and prohibition is no longer a dirty word.

Alcohol is next. After the collapse of Prohibition, the temperance lobby spent decades licking its wounds and reinventing itself. The Anti-Saloon League became the American Council on Addiction and Alcohol Problems. The United Kingdom Alliance for the Suppression of the Traffic in all Intoxicating Liquors morphed into the Institute of Alcohol Studies. The International Organisation of Good Templars changed its name to Movendi International. They all transformed themselves into “public health” groups because if you want to ban something these days, that’s where the action is.

A hundred years ago, it was the “tobacco people” who were warned that they would be the next target of the prohibitionists (and the Anti-Cigarette League duly obliged). Today it is the other way around. The neo-temperance lobby is working from the blueprint of the tobacco prohibitionists. 

Two weeks ago, the US Surgeon General called for cancer warnings on alcoholic beverages. Alcohol consumption has been linked to several types of cancer, most of them quite rare, but cancer is not the biggest risk associated with drinking. Why didn’t he suggest liver cirrhosis warnings? If he is only worried about cancer, why did he not call for health warnings on sausages and bacon? And if he is only interested in informing the public, why did he not call for labels saying that moderate drinking reduces the risk of all-cause mortality by 16 per cent, as a landmark report from the National Academies of Sciences, Engineering, and Medicine had confirmed only weeks earlier?

The answer, of course, is that he was consciously imitating the anti-smoking lobby whose first big win after the 1964 Surgeon General’s report on smoking was to get cancer warnings put on cigarettes. He was also trying to give booze some bad publicity after the National Academies report had once again reminded people that there are health benefits from moderate drinking.

These people hate the health benefits of moderate drinking and are doing everything they can to erase them, first from the public consciousness and then from the scientific literature. The aim is to introduce a rebooted form of Scientific Temperance Instruction in which alcohol is seen as an addictive poison that can never be consumed safely. There is too much evidence that alcohol is benign and even healthy when consumed sensibly for this to happen overnight, but the process goes on, year after year, of steadily reducing drinking guidelines, casting doubt on the science and parroting the line that there is “no safe level” (another slogan borrowed from the anti-smokers). 

Yesterday saw another brick in the wall with a report from the US Interagency Coordinating Committee on the Prevention of Underage Drinking which had very little to do with underage drinking and a great deal to do with portraying alcohol as deadly from the first sip. It claimed that people aged between 15 and 20 who have one drink per week are at risk of an “alcohol-attributable death”. The odds were only 7 in 100,000, but the magnitude of risk doesn’t matter in the cult of “public health” where anything is fair game if it saves one life on a spreadsheet.

Even if the claim were true, there is no way the authors could know it from survey-based observational epidemiology (which is all they had to hand). The number of 15-20 year olds who consume exactly one alcoholic drink a week must be vanishingly small and even if epidemiologists could get hold of them, they wouldn’t necessarily admit it because it is illegal to buy alcohol until you are 21 in the USA.

In short, the figure is made up. It is make believe, a figment of the imagination. Or, to use the authors’ technical term, it is “cause-specific modelling”. There is no reason to publish a statistic that is based on nothing, that is meaningless to individuals (since the risk is infinitesimal) and that has no policy relevance (since under-21 year olds cannot buy alcohol) other than to hammer home the ideological message that there is no safe level of alcohol and that alcohol is the new tobacco.  

It will be a slow and incremental process, but do not underestimate the scale of their ambition. Last year, an editorial in Lancet Public Health — titled “Why is alcohol so normalised in Europe?” — complained that “alcohol use remains deeply embedded in European society” and said that “it is crucial to dissociate alcohol from cultural traditions”. 

The persistence of a practice doesn’t justify its continuation—just because it has been ingrained in society for generations doesn’t mean cultural norms cannot change. As demonstrated with tobacco, cultural norms can and do shift over time.

Just before Christmas, the British Medical Journal published an article in which the authors complained that the festive season is “filled with events that exemplify the normalisation of alcohol in our culture [and] is a reminder of the need for action.” They described the Tobacco and Vapes Bill, which will eventually prohibit the sale of all tobacco products, as “a good start” and urged the government to “rapidly follow up the Tobacco and Vapes Bill with equally bold and radical action to address alcohol harm.” 

When the Surgeon General raised the prospect of cancer warnings on wine bottles, Professor Timothy Rebbeck from Harvard T.H. Chan School of Public Health could see which way the wind was blowing and, judging from his interview with USA Today, he liked it.

Whether labels are in alcohol’s future or not, Rebbeck said it’s only the beginning. When the first surgeon general’s report on smoking came out in 1964, he said it took decades for public health officials to come up with a plan to end smoking that included strategies such as limiting advertisements, banning cigarettes in public places, taxation and economic incentives.

“It took time for people’s mindset to change and it’s going to be the same for alcohol,” he said.

You can’t say you haven’t been warned.