Monday, January 25, 2010

Michael Keane, and harden the fuck up fatties ...


First a confession.

I was once a Coca Cola addict. Not the sugary stuff, but the pure chemical-laden hit you got from diet coke. Oh it was a pure rush, of the kind that has now turned the younger generation from ordinary soft drink towards the kind of rush you get from the cans of Humungous Red Direct to Your Brain Bull this and Gigantus Green Surge that. It's got so you can't find a decent old fashioned sugar hit in a deli fridge these days.

I guess the habit, the addiction, the disease, call it what you will, harkens back to the good old drug laden days of my youth. Not that I ever smoked. Or at least inhaled. Oh well, Bill Clinton never had sex either.

No I'm talking about coca cola mixed with those shiny little pink tablets you could extract from the middle of cough pills, before they got wise and banned the things, along with sudafed in its useful form (you can take your current sudafed and shove it, no hit potential, and worse totally useless when it comes to actually clearing noses). Mix a couple of those with coke, and it was like a whack of speed without the teeth grinding.

Worse, the system shovelled coke at me like there was no tomorrow. Even now, head down any supermarket aisle and you could find 24 packs of cans reduced to fifty cents or less a can, or bottles so huge that you could turn yourself into a bloated fat thing within the week.

Walk the street and you'd find some kindly shop owner - who himself had cheated and bought his supplies from the supermarket - handing over a hit of coke at a solid discount.

How did I kick the habit? Well it wasn't easy. It helped that the corner store supplier decided to bump up the price. And then as the bloating and the fattening kicked in, vanity took hold. I went cold turkey, but for weeks I felt a dizzying sense of hunger and desire, and even now I can hear the siren song when I see a can. Fortunately the last time I tasted it - once you get off it, your body regains discrimination and discernment - the stuff tasted vile. Full of chemicals and brown muck. What the world needs now are detox clinics for coke addicts (no, not the Australian television stars' kind of coke, the dangerous liquid coke).

Is it any wonder that in the United States obesity is on the rise? And in Australia? And you don't have to look too far for evidence, or graphs, or charts, even if the chart below (Overweight and obesity in Australia) is a little old:



Which is why it's quite strange to read the righteous Michael Keane and Lifestyle-altering strategies more likely to reduce liberty. Keane is having an anxiety attack about the proposed taxing of harmful lifestyle products:

There are increasing calls to regulate and tax many supposedly harmful lifestyle products, such as fatty foods, soft drinks and even video games, under the guise of public health imperatives. It is relevant to scrutinise the ethics of the principles used to justify what amount to public health-inspired government lifestyle mandates.

Well fair enough. I know that video games don't hurt my health unless I play them forty eight hours straight, and then I notice the walls seem to bend in peculiar ways as they hide aliens from my ray gun on the fortieth level.

But what about smoking? Surely it's a good thing that smokers are treated like pariahs and taxed up the wazoo, as a way of helping them break their addiction, before they end up with emphysema, and can't walk two steps, like my father before his lungs killed him.

The first point to make is that previous public health campaigns for things such as clean air and water differ fundamentally from those currently being discussed. The key difference is that no one chose to drink water that contained faeces; on the other hand, alcohol, hamburgers and even cigarettes bring utility as well as harm. What value is an exciting night out with friends, or the experiences gained from episodes of heavy alcohol consumption, or simply the experience of feeling relaxed for an evening? It is illegitimate to present a one-sided equation of harm unbalanced by utility. What is a harmful outcome to some might be an optimal balance to others.

Well sure cigarettes can bring utility. But what's that got to do with taxing them? They make sure that hookers pay income tax for providing utility as well.

And of course it's not just choice when it comes to cigarettes, is it? A bit like sex really. They're addictive, or at least the nictone is, though I also buy the argument that they're socially addictive as well (self-image, something to do with the hands, imagining a career as a nineteen forties film noir movie star, women tough-looking and Jean Seberg cute and ready to blow smoke at men).

To ignore addiction when talking about choice - don't start me on the pleasurable addictive qualities of wine and chocolate - is surely a nonsense, in much the same way as prattling on about choice when it comes to the pleasures of having high fructose corn syrup in your soda (or sugar or chemicals or caffeine). Or for that matter the potent pleasure of salt and oil and grease and fat and flour in hamburgers (yes a recovering soda addiction goes with burger addiction).

You don't have to look very far for evidence that such foods are addictive, and before you know it, you're kissing cousins with diabetes and such like illnesses.

Well Keane's not into that kind of whimpering and loose talk about addictions. No, it's harden the fuck up fatties:

The next issue relates to who should make the decision about whether something represents an overall net positive or negative for the individual. A central committee? No; in order to balance the infinite considerations in making such harm-benefit calculations, our society is built on deferment to the fundamental ethical principle of autonomy.

Would that include the fundamental right to drive as pissed as a parrot on the wrong side of the road as a way of exercising my fundamental ethical principle of autonomy? You know, like Marlon Brando in The Wild One? Or a goose waving a flag around and talking about the central committee, as if that could keep a Russian from a bottle of vodka or fermented potato scraps?

Because Keane can see where this is heading, and it's all to do with paternalism and taxes, as if enough damage hasn't already been done to the tobacco industry by taxing it up the wazoo, when all they were doing was offering the consumer choice:

In a recent article in The New England Journal of Medicine, a group of academics attempted to justify a public health-inspired tax on soft drinks. Within medical academe the ideological pendulum seems to be returning towards that of paternalism (the informed doctor taking responsibility for the uninformed citizen). Thus the authors argued that people couldn't make a free choice to purchase a soft drink because most of the population doesn't have the capacity to understand what it is doing.

This necessitates the extraordinary premise that people have no realisation that consuming junk food in excess might be bad for their health. People know that too much junk food or booze or too much smoking is bad for them. Some people make irresponsible choices.

Yep, harden the fuck up fatties. Tough titty addicted smokers.

But what if, just if, some people actually knew that they were making irresponsible choices, but couldn't break the cycle of addiction? Does anyone really know fat people who just love being grotesquely overweight, shovelling down soda and burgers and shit food as if there's no tomorrow, smoking away like chimneys determined to die, and given the likely effects on health, chances are there will be a considerable foreshortening of the number of tomorrows and dead chimneys all around.

If just one side of the equation (all the harmful outcomes) indicates that people can't make sensible choices, then, by definition, we have branded large swaths of our community as lacking the capacity to make the basic autonomous lifestyle choices expected of adults. Is an average person able to consent to open-heart surgery but not to purchase a soft drink?

Well can I just timidly put my hand up and say here's one adult who's been incapable of making the basic autonomous lifestyle choices expected of an adult? Does the goose really think that the addicted always has a choice in these matters? Well yes in the harden the fuck world of the libertarian, but tell that to the average sucker with cash in the paw roaming the supermarket aisles.

And is the average government, able to tax anything that moved, being quite sensible in wanting to tax a soft drink, perhaps as a way of funding open-heart surgery, but in fact funding anything it might desire that might improve society at large? What the fuck's so noble or free about being able to shovel soda down your throat in twenty ounce servings? Say one thing for the cinemas, with their pricing, I can enjoy a soda free night at the movies. Which just might help my level of leptin (Fat, sugar 'addiction' linked to obesity).

Scientists have found evidence that fat and sugar may be addictive, possibly explaining why many obese people just can't get enough junk food.

The area of the brain that moderates eating behaviour is influenced by the blood's level of leptin, a substance secreted by fat cells.

However, a study by a psychologist at New York's Albert Einstein College of Medicine has found that rats fed high-fat diets take only three days to lose their ability to respond to leptin.

Oh there's more, lots more of this scientific stuff, but then we knew all that about tobacco in the fifties. Only it didn't suit the tobacco industry to publish their findings so that the rest of us might know.

Is it deeply cynical of me to suggest that in fact many people find it hard to do the sensible rational thing, and instead of Spockian logic, head off to the nearest supplier of crap for a comforting round of self-abuse? And is there any harm trying to keep grog intake to a civilised level, or even making vices a little more expensive. We're not talking about banning here - banning never works - but just the making of vices a little more expensive, so that choices might be nudged in the right direction.

Admittedly it's hard to argue that preventing a drunken thug being violent or a morbidly obese person from having a heart attack isn't worth a few cents extra in taxation per drink or hamburger.

Which won't of course stop me from getting on the grog, or having a soda and burger if I want one. But a tax is hardly a libertarian moral crisis of the first water, unless you're a member of the alcohol game or the soft drink industry, but that momentary lapse, that temporary weakness in his rhetoric, tells us Keane is just moving in for the kill:

But it is a bedrock legal and societal principle that we consider differently those who cause harm to others and those who make choices that harm themselves. Crucially, there is a real possibility that taking action against harmful consumption under a public health imperative may end up causing more overall harm.

Bedrock! Crucially!

And don't you just love the "may". That's a crucial bedrock 'May".

Because after all the right to drink soda is intrinsic to our self-esteem and the worthiness of civilisation. Where would America be without McDonalds - the cheesemakers of our time - did you know countries with McDonalds never go to war with each other, except in the Balkans - or the way Coca Cola carried United States culture into the most vile communist countries in the land.

The public health view tends to promulgate a culture of abrogation of personal responsibility. "I drove when I was drunk because of my alcohol disease; society failed me."

Funny, where I come from, if you get pissed and you drive and you have an accident, you're under the hammer. But the notion that someone can - with the wave of a hand - overcome their 'alcohol disease' provides a singularly sanguine assessment of the way people can exercise choice.

Thus, even if increased regulation does not cause a major impediment to people's freedom, failure to address the relevant complex societal, philosophical and ideological questions may prohibit a more effective resolution to the problem.

My god, and I thought it was just Chairman Rudd who talked this kind of blather. And what relevant complex, societal, philosophical and ideological questions might addiction involve? And can we now look forward to the licensing of marijuana, which taken in moderation, is no more addictive or destructive than some other legally allowed drugs of choice?

Admittedly, many lifestyle indulgences increase costs to the health system. But as every act or behaviour can ultimately be related to health, this argument can be used to regulate every decision we make. In a third-party payer system, there is an irreconcilable conflict between healthcare costs and liberty. More and more you are likely to see well-meaning ideological lobby groups (as well as mercenary rent-seekers) justify restrictions of free choice and association on the basis of "healthcare costs".

Ah yes, the rent seekers. Well meaning ones.

Well we know what that's code for. And no it doesn't involve talk of landlords charging rent, and capitalists charging interest for their capital. In the new fashion the concept of rent-seeking, on which capitalism is based, is now attributed to governments and bureaucrats.

But back to the main argument. Ain't it grand when people talk about the dangers of taxing liberty in the name of taxing sodas and burgers.

Except of course in the case of takeaway foot outlets, for example, where GST already applies to:

any food that is supplied for consumption on the premises
hot takeaway food
prepared meals
bakery products
confectionery
snack foods
ice-creams
biscuits
flavoured milks
soft drinks


So then we're not arguing about the concept of a tax, as the man said to the hooker when they got down to discussing the price of services, we're just talking about the size of the tax, and whether soft drinks and such like might be singled out for a little attention. Just like cigarettes. Just like alcohol.

Forcing a citizen to undertake an action against their will for the "greater good" of healthcare-cost reduction is a wholly unethical position. No person can be ethically compelled to participate in a health program against their will. The lack of the ability to opt out of paying the alcopops tax reinforces the political nature of the tax.

So we drop taxes on tobacco and alcohol? I mean alcopops contain alcohol, and they peddle the stuff to the young in a form which should be taxed more highly simply because they offend good taste, a decent palate and anyone with a sense of decorum and aesthetics. In fact, we could use that argument to start loading up taxes on the young in all sorts of areas - starting with dress sense.

I keed, I keed.

Public health advocates often point to the detainment of reckless carriers of infectious disease as an example of the ethical basis of depriving someone of their liberty for the greater good. However, in these cases society detains the individual at fault. We don't put a lockdown on the rest of the community as well.

There are existing methods to deal with lifestyle-related harm. Harm involving violence must be addressed through the criminal system; failure to punish the individual while lamenting the violence as a public health issue may lead to devastating emotional distress to the victim.


So we make it a crime to manufacture and sell soft drinks to the public? Drive it underground, and bring on the prohibition years for coca cola? Oh yes, for the creation of public obesity, all the coke executives and burger manufacturers are given ten years under the three strikes and they're gone rule.

Or did I miss a step in the logic there? What existing methods should we deploy? Soda drinker's Anonymous, with twelve steps to give up the fizz, six steps for dropping off burgers, and I think at least twenty steps to abandon the magical allure of a nice dark chocolate?

Harm that reduces an individual's success in life must be seen as tolerable in order to preserve freedom. Harm that increases healthcare costs needs to be addressed by targeting with increased charges those who use the increased healthcare services.

And pray how might that be done? By demanding to know the eating habits of anyone who presents with diabetes, and if they admit to drinking soft drinks, and otherwise carrying on in ways that put them in the way of disease, either deciding not to treat them or charging them double for their folly?

Finally, the actual objective data to demonstrate the likely marginal reduction in harm to society from implementing lifestyle taxes is sparse and far from conclusive.

Sure, tell that to the next fat drunk clutching a burger and a restorative soda as you see them waddle down the street. So let's all keep eating shit and getting fatter and fatter. Where's the harm in that, as opposed to maintaining an unwinnable war on drugs while allowing other kinds of junk food drugs to flood the market place.

God help me, I'm no prude and have many vices, and share in many addictive habits, but I swear to god the lack of logic in some of these libertarian tracts makes me want to howl at the moon, or get out a nice bottle of red and get on the piss for the night. It might not cure my addictions, but it makes the world seem fuzzy and nice ...

(Below: go on, you know you want it, and thanks to Michael Keane it's tax free and haven't you always admired Homer Simpson as a sturdy example of libertarian thinking? Listen to the guy in red).


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