A story of Marriage

A man lost his job for watching pornography on his work computer. He explained that he is struggling to overcome a “porn addiction.” He has been married to his fat, deaf wife for about twenty years. They don’t have a conventional relationship, he said. They are “not intimate in any way.” She’s way too good for him. They are in counseling to help him overcome the “addiction.” He has no friends. But he has grown closer to his church group. Is this what marriage is like?

Graphic labels on cigarettes packages

Forcing cigarette companies to put graphic warning labels, including health warnings, pictures of diseased organs, and the 1-800-QUIT-NOW number, on cigarette packages, is a violation of the First Amendment, according to a recent and totally correct ruling by the DC Circuit (pdf).

You might wonder why this is so, since cigarette companies are already required to put warning labels on packs, while alcohol manufacturers have other warning labels, and all makers of packaged food are required to list ingredients, calories and so forth. The legal reasoning behind this regulation is that the government had a legitimate interest in making sure that consumers are accurately informed about the contents and risks of the food, beverages and cigarettes they consume.

Now, there is nothing in the Constitution restricting the ability of government agencies to campaign against smoking, taking the public stand that the risks of smoking outweigh its benefits. The libertarians among us might think that this is not a proper use of the power and money of the state, but the libertarians among us are often disappointed. However, the state still does not have the right to force any individual or company to express a certain opinion. The federal district court and DC Circuit agree that graphic labels and the QUIT NOW message go beyond informing consumers about health risks and amount to discouraging smoking. (In fact, the FDA made no secret of the fact that it hoped the labels would nudge people to quit.) This "ideological" message is one the government cannot force a company to send.

The Companies contend that, to the extent the graphic warnings go beyond the textual warnings to shame and repulse smokers and denigrate smoking as an antisocial act, the message is ideological and not informational. “[B]y effectively shouting well-understood information to consumers,” they explain, “FDA is communicating an ideological message, a point of view on how people should live their lives: that the risks from smoking outweigh the pleasure that smokers derive from it, and that smokers make bad personal decisions, and should stop smoking.”

No one doubts the government can promote smoking cessation programs; can use shock, shame, and moral opprobrium to discourage people from becoming smokers; and can use its taxing and regulatory authority to make smoking economically prohibitive and socially onerous. And the government can certainly require that consumers be fully informed about the dangers of hazardous products. But this case raises novel questions about the scope of the government’s authority to force the manufacturer of a product to go beyond making purely factual and accurate commercial disclosures and undermine its own economic interest—in this case, by making “every single pack of cigarettes in the country [a] mini billboard” for the government’s anti-smoking message.

The so-called "warning labels" are not really warning at all, the Court held, but propaganda. Some convey no relevant facts, and others might be deceptive: an image of someone smoking through a tracheotomy hole might give the inaccurate impression that a tracheotomy is a common result of smoking.

Many of the images do not convey any warning information at all, much less make an “accurate statement” about cigarettes. For example, the images of a woman crying, a small child, and the man wearing a T-shirt emblazoned with the words “I QUIT” do not offer any information about the health effects of smoking. And the “1-800-QUIT-NOW” number, when presented without any explanation about the services provided on the hotline, hardly sounds like an unbiased source of information. These inflammatory images and the provocatively-named hotline cannot rationally be viewed as pure attempts to convey information to consumers. They are unabashed attempts to evoke emotion (and perhaps embarrassment) and browbeat consumers into quitting.

I find myself saying, as often before, thank God for the First Amendment. Cigarette companies in other countries are already forced to use graphic "warning" labels. Now, if only we still had the Fourth, Fifth and Sixth Amendments...

New DSM addiction disorder criteria

Among the millions of people who will be diagnosed with an addictive disorder in the new DSM are many whose lives will be derailed by their substance use, leading to car accidents, suicide, brain damage, sexual trauma...The new criteria will allow clinicians to intervene at an earlier stage in the addiction cycle, when relatively brief and inexpensive treatments can prevent more serious problems from escalating. Psycho-education, psychotherapy and group support should be available for people who seek treatment early on. Who would argue that it’s better to wait until the substance use escalates before treatment can be initiated?

Who would argue against early intervention? I would. There are costs to substance abuse treatment: big financial ones, the cost of limiting people's autonomy, and the risks of teaching someone who may never (yet) have experienced addiction that he probably will get addicted and will be powerless to stop it. Not to mention teaching that if a person continues to use drugs or alcohol, he's no longer responsible for his behavior.

I mean, imagine a bunch of typical 20-year-old drinkers sent into AA. They probably fit the diagnostic criteria (since the definitions of "binge drinking" and "heavy drinking" keep being revised downwards!), but does anyone think that such drinkers would benefit from a treatment program? In fact, we know that most young people who use drugs or alcohol heavily will age out of such heavy use naturally. In most cases, no intervention is necessary: and treatment programs have a terrible record of success. To call for early intervention drug and alcohol treatment is like calling for surgery to treat the common cold. We know it doesn't work for most people, it's expensive, and it does serious harm to the people subjected, in many cases involuntarily, to treatment.

Oh, and ignore the first sentence. As my astute readers will have noted, horror stories are totally irrelevant when talking about early intervention. For every person who will have serious problems with a substance, there are hundreds who fit the criteria for early intervention but will never have serious problems.