Healthy Debate

Jacob Sullum's "What the Doctor Orders" (January), the most important critique of governmental public health activities we have seen, should be assigned reading in every school of public health. We plan (with REASON's permission) to reprint Mr. Sullum's article in a special issue of our health magazine,Priorities, along with commentaries from several public health leaders and, hopefully, a rejoinder by Mr. Sullum. We think the special issue will encourage public health activists to consider the extent to which government health promotion programs can both threaten and enhance individual liberty.

We concur with Mr. Sullum that people engage in various health-compromising behaviors for pleasure, utility, or convenience. Howe ver, we don't think this means people, especially children, are necessarily prepared to accept the risks associated with their lifestyles. People tend to succumb to social pressure and impulse in adopting health-compromising lifestyles and then justify the ir actions by rationalizing about them. This is hardly the libertarian ideal of self-directed, reasoned decision making. Choices made by neglecting likely negative consequences may give some people a sense of "freedom," but how free can someone be who choo ses chronic self-destruction?

Educational initiatives that deemphasize mere propaganda and help people learn to make carefully reasoned lifestyle choices may offer more genuine personal freedom than is provided by the simple opportunity to indulge in bad habits without government inter ference. For example, national dialogue about Surgeon General's reports on smoking has led tens of millions of Americans to modify their lifestyles and improve their lives. Would Americans actually feel more free or live more fully if government stopped addressing lifestyle and health issues altogether?

William M. London
Director of Public Health
Elizabeth M. Whelan
President American Council on Science and Health
New York, NY

Jacob Sullum's outstanding feature on the public health establishment's imposition of values in the guise of science reminded me of a revelatory conversation I had not long ago. I had been out drinking with a friend, and the bar we were in was unpleasantly smoky. Later that night, my friend was complaining about the residual stink we had absorbed from the bar, and she said that smoking should be banned. I suggested that might be a bit excessive, but she explained her position: "I don't want to have to pay for medical care for all the people who get sick from smoking."

"Neither do I," I replied, "and that's a great reason not to socialize health care."

"But I believe in socialized health care," she responded, although she was visibly uncomfortable with the implication. Responsibility for the conse quences cannot long be kept separate from control over the conduct. Wherever the cost of an activity is spread among the public, decisions that were previously private choices made by individuals for themselves are transformed into public decisions made by the political majority for everyone. Freedom gives way to coercion.

When an individual's behavior imposes significant costs on others, fiscal responsibility--and fairness--require that others have the power to regulate that individual's behavior. And of c ourse, regulation inevitably reflects the values of the regulators, not the regulated; indeed, if they converge, regulation is hardly necessary. To wit: My friend and I had been drinking, an activity that imposes costs on others as surely as smoking does. But she didn't advocate banning drinking, because she places a value on that activity, whereas she doesn't understand why anyone would place a value on smoking.

In a free society, the voluntary assumption of risk is a wellspring of progress and pleasure. In a collectivist society, as Mr. Sullum reports, it is a crime. This simple, quotidian anecdote vividly illustrates the eternal truth that whenever government extends an open hand, you can be sure that its other hand is nearby--in a closed fist.

Jeff Bucholtz
Santa Monica, CA

Jacob Sullum's piece hit the target. The health care elite want to substitute absence of "premature death" for freedom as the primary American value. These fanatic crusaders are willing to forsake scientific virtue in their ques t to achieve that goal.par A comprehensive 84-page analysis of CDC-funded research appears in "Guns and Public Health: Epidemic of Violence or Pandemic of Propaganda," in the University of Tennessee Law Review, 1995. The article is written by two professors at Harvard Medical School, a professor at Columbia Medical School, a professor of biomathematics, and a criminologist. They conclude: "The anti-gun health care advocacy literature...prostitute[s] scholarship , systematically inventing, misinterpreting, selec ting, or otherwise manipulating data to validate preordained political conclusions....[these authors] all too often feel no compunction about asserting falsehoods, fabricating statistics, and falsifying references to counterfeit support for [their anti-gun agenda]."

The result is junk scholarship under the disguise of injury prevention. As that thorough study demonstrates, the health care advocacy literature regarding this public policy issue is fraught with partisan departures from scholarly inquiry. That is why, unlike true scholars, the CDC-funded doctors routinely refuse to make their data sets available to other scholars for comparison and evaluation.

Joseph Olson Professor of Law Hamline University St. Paul, MN

Jacob Sullum responds: I thank Mr. London and Ms. Whelan for their kind remarks, but I have to say that their notion of freedom gives me the willies. In a free society, individuals constantly make choices that seem foolish or short-sighted to observers with different tastes and prefere nces. Personally, I do not perceive enough benefit in smoking to justify the risk. But I'm sure a lot of smokers would have a hard time understanding why I enjoy bungee jumping. By saying that individuals who defend their "health-compromising lifestyles" a re simply "rationalizing," Mr. London and Ms. Whelan imply that such choices are inherently irrational and that people who make them must be ignorant, stupid, or crazy.par It's true that people sometimes regret decisions to engage in risky behavior. People ma ke mistakes in every area of life. In this respect, the smoker with lung cancer resembles the woman who spends her life in a loveless marriage or the retiring CPA who wishes he had become an airline pilot. All three have made decisions that were hard to re verse, with consequences that are now permanent. If people are free only to make careful, reasonable, fully considered choices that they will never regret, they are not free at all.

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