Addiction Research and Theory, August 2010; 18(4): 389–391.
Reply to Commentaries
Civil war in alcohol policy: Northern versus southern Europe
The attitudes of Room and the alcohol public policy field he represents are well-captured by his slighting reference to John Tierney’s consistently well-written pieces in the New York Times addressing conflicts of interest. Room (2010) simply dismisses Tierney – a wellinformed and acute observer of the scientific scene writing for the most influential American newspaper – on the grounds: ‘‘Mocking quotes from newspaper science writers should not deflect us . . .’’.
Room thinks it obvious that readers should simply endorse his refusal even to consider the thoughts of an opinion leader in a venue read by millions of people. Tierney (2010) addressed exactly this Olympian perspective:
Another reason [for disdain for non-academic-style funding] is a snobbery akin to the old British aristocracy’s disdain for people ‘‘in trade.’’ Many scientists, journal editors and journalists see themselves as a sort of priestly class untainted by commerce, even when they work at institutions that regularly collect money from corporations in the form of research grants and advertising.
This same disdain characterizes Room and his colleagues’ attitudes towards data and cultural perspectives on alcohol that contradict their own. As I noted in my original piece, the European Comparative Alcohol Study (ECAS) found more consumption but fewer problems – even less alcohol-related mortality – in Southern Europe than in Scandinavia. The ECAS team, led by Room, largely ignored this key finding of their study. While condescending to incorporate Allamani’s summary in the ECAS volume, Alcohol in Postwar Europe, Room and the Scandinavian team simply reasserted that alcohol was bad and its consumption must be reduced – as they have tried to do for decades in Scandinavia.
Unfortunately, for this policy approach, as I described in my piece, Room and Scandinavian colleagues’ recent research has found the exact opposite of what their model predicts – a result about which Room makes no mention in his commentary! That is, Bloomfield et al. (2010) found self-reported alcohol problems reduced in Scandinavian areas where taxes were lowered and limits on returning residents’ carry-home alcohol quota were removed, a decline not found in a control region (Northern Sweden) where such change was delayed.
Room and colleagues’ ability to ignore countervailing information, evident in his sneering dismissal of ‘‘newspaper science writers’’ and the collective disregard for Allamani’s comments in the ECAS volume – indeed, for the basic findings of the research itself – is captured by Allamani’s (2010) experiences as a Southern European researcher: ‘‘it is not often that southern European viewpoints about the culture of drinking are taken into account in a serious way.’’ He details not only how Northern Europeans have chosen how to study and interpret the Southern experience with alcohol, but how public policy in the South was then built on these Northern views!
Ironically, there is no more eloquent description of this iatrogenic process of imposing external controls than one authored by Room (1988) for a UC San Diego conference, ‘‘Evaluating Recovery Outcomes,’’ in which we both participated:
In comparing Scotland and United States, on the one hand, with developing countries like Mexico and Zambia, on the other hand, in the World Health Organization Community Response Study, we were struck with how much more responsibility Mexicans and Zambians gave to family and friends in dealing with alcohol problems, and how ready Scots and Americans were to cede responsibility for these human problems to official agencies or to professionals. Studying the period since 1950 in seven industrialized nations . . . . [when] alcohol problem rates generally grew, we were struck by the concomitant growth of treatment provision in all of these countries. The provision of treatment, we felt, became a societal alibi for the dismantling of long-standing structures of control of drinking behavior, both formal and informal.
What is most fascinating about Allamani’s comment is his detailing of how Italian culture has actually taken the drinking bull by its horns, influencing it (for instance, in re cirrhosis) through deep but informal cultural mechanisms: ‘‘We were also convinced that preventive measures were often affected by the decrease in consumption, rather than the reverse.’’ Beyond this, he brilliantly discusses the different ways in which Northern and Southern European scientists approach the topic of drinking, to wit, local researchers ‘‘could not isolate the issue of drinking from everyday life.’’ This statement actually stands as a beacon to the integration of drinking, culture, and community in both the science and policy of drinking. Such integration is not a limitation, but instead will be the major thrust of the science of alcohol use in this century.
Room does no better in dealing with my discussion of disclosure, where he is disingenuously minimizing. He writes as if the issue were merely wanting ‘‘to know and take into account the source of funding for a piece of research.’’ I accept such disclosure (which I have provided here). My argument is with approaches like McCarthyism or the Hollywood blacklist, where involvement with the alcohol industry (as was once true for Communistic political involvements) even years earlier can ruin a person’s chances for publication, employment, or non-industry funding for later research. The editors of Addiction are clearly angling for this state of affairs, as noted in Gmel’s (2010) caustic comment, ‘‘The Good, The Bad, and The Ugly,’’ quoted in my piece, but which Room typically ignores.
There is no better conclusion from this discussion than Allamani’s exquisite final statement: ‘‘The quality of aims and method, and the clarity of results, should determine the acceptability of a paper, not an a priori fear or distrust of those who are funded by non-public sources.’’ Of course, Allamani has a horse in this race. Since government research funding is minimal in Southern Europe, Allamani describes how industry sources have underwritten major research – the only possibility available. But why would Room and his Northern European colleagues care about that?
Throughout his commentary, Room does not seem to have taken much time to read and think about my positions. At the beginning of his comment, it is not clear whether he intends to tar me with the brush of thinking like outdated early scholars on alcoholism (whom I critique – as I do Room and his colleagues – for their neo-Temperance attitudes), or because I am too radical in rejecting Room’s ‘‘soft constructivism’’ (a delightful image). In re the former, while Room consigns me to the past century, his own horror stories of industry influence on the NIAAA are from 1976 and 1984.
On the complex topic of what science comprises, I will unfortunately have to be brief. Room has consistently misunderstood the influence of culture and cognition on addictive phenomena (as outlined in my book, The Meaning of Addiction). This is a common problem, because humans are so culture-bound – indeed, that is the subtext of my article. But Room fundamentally misunderstands the nature of science – just as modern (largely American) neuroscience does by reifying PET scans as embodying the nature of addiction. Thus he misconstrues my statement that ‘‘there is no conclusive science . . . ’’ to mean that I am discarding the idea of objective science altogether.
Instead, my writing recognizes the essential cultural relativity of scientific conceptions about alcohol’s nature and effects. The entire purpose of my work is to show how inferior is the work Room endorses by the criteria of empirically falsifiable theory. My goal is to make the best possible scientific statement, which must incorporate cultural context. Unfortunately, whereas a cross-cultural scientific model of alcohol use and effects is possible and desirable, the field has failed to pursue one. This failure is due partly to the culturally approved acceptance in America of a purely neuroscientific, albeit delusional, explanation for addiction, along with Room et al.’s internationalistic disregard of cultural variations in the meanings of alcohol and the experience of drinking. Room and colleagues justify this disregard (although he spends little time defending it here) by a premature, pseudo-scientific claim to having established propositions of universal validity. And his and colleagues’ research has now vitiated the very basis for such claims, a result they struggle to explain (Room et al. 2009).
Allamani A. 2010. Behold the sun’s heat, which becometh wine. Addiction Research and Theory 18(4):386–388.
Bloomfield K, Wicki M, Gustafsson N-K, Mäkelä P, Room R. 2010. Changes in alcohol-related problems after alcohol policy changes in Denmark, Finland, and Sweden. Journal of Studies on Alcohol and Drugs 71:32–40.
Gmel G. 2010. The good, the bad and the ugly. Addiction 105:203–205.
Room R. 1988. Commentary. Program on Alcohol Issues. Evaluating recovery outcomes. San Diego, CA: University Extension, University of California, San Diego. pp 43–45.
Room R. 2010. A blast from the past – Temperance as the source of all our troubles. Addiction Research and Theory 18(4):383–385.
Room R, Osterberg E, Ramstedt M, Rehm J. 2009. Explaining change and stasis in alcohol consumption. Addiction Research and Theory 17:562–576.
Tierney J. 2010. Corporate backing for research? Get over it. New York Times, January 26.