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Alcohol, pregnancy, experts, and evidence

In the United States, the Centers for Disease Control recently released a new advisory regarding the use of alcohol during or around pregnancy. According to the CDC, any drinking by women ‘who are pregnant or might be pregnant’ constitutes ‘drinking too much.’ The primary reason for the label is the risk of a fetus developing Fetal Alcohol Syndrome, although Sudden Infant Death Syndrome (SIDS) and miscarriage were listed as well. The range of the recommendation is rather wide – the CDC targeted any woman who might be or become pregnant (so, any sexually active woman capable of becoming pregnant). The recommendation has been widely criticized.
A number of commentators noted the shaky evidential basis for the advisory. Regarding Fetal Alcohol Syndrome, for example, there is a lot we do not know regarding the amounts of alcohol that are dangerous, and it has been suggested that genetics might play a role in propensity to develop the Syndrome. Regarding SIDS, some evidence suggests the link between alcohol and SIDS is moderated by parents co-sleeping with infants after abusing alcohol – but the advice offered by the CDC did not flag this indirect (potential causal) link.
Writing in the LA Times, the philosopher Rebecca Kukla also emphasized the contributions such messages make to creating a culture of shame surrounding women and pregnancy (here). Writing for Time, Darlena Cunha argued that the CDC advice is overly paternalistic, and discriminates against women (here).
I do not wish to justify the CDC. I rolled my eyes like many others when I first heard of the recommendations. But here’s a question: why might the CDC release such an advisory? I could imagine someone thinking like this. Well, there should be higher awareness of potential damages of alcohol on a developing fetus. The CDC has the function of alerting the US public to various health risks, and is something of a trusted source as it fulfills this function. But people will not base their decision on the CDC alone. They will be biased in their assessment of evidence, and they may also rely on the first bit of pseudoscience to pop up on Google. So we should come out forcefully, in the hopes that our voice will count for more than a more moderate recommendation might. This way, perhaps we will do more good. (Imagine trying to convince your kids not to run out into the road. You might scare them out of such a behavior by emphasizing the very unlikely but goriest possible outcome.)
Of course, I have no idea how the CDC reasoned nor what led to the nature of the advisory they released. What I want to ask is whether institutions we trust to deliver evidence-based advice ought to reason in this way.
Arguably, they should not. We want our experts to be experts, not to be another source of bloviating rhetoric in the public sphere. Evidence-based experts have the credibility they do because they know the evidence. It seems plausible, then, that our experts should fulfill their function in a certain way. They should pay attention to the way their messages are framed. Their messages should be framed in a way that respects people’s autonomy over their own health choices, and that treats decision-makers as reasonable individuals capable of weighing relevant evidence. Doing so would presumably lead to a more moderate message – one that, in this case, emphasized the potential links between alcohol use and fetal alcohol syndrome, that admitted just how much we do not know regarding this question, and that stressed potential reasonable responses to the existing evidence. Importantly, this can be done without overstating the case, without ignoring the nature of the risk (as seems to have happened regarding the alcohol-SIDS link), and without ignoring the amount of risk associated (as seems to have happened regarding the alcohol-Fetal Alcohol Syndrome link).
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4 Comment on this post

  1. You only have to ask the experts in the field of FASD and alcohol and pregnancy to know that we do know quite a bit about the link between alcohol and pregnancy and the amounts that cause harm. You mentioned genetics as being a factor about which we know little. This is the very reason that abstinence is the only way to prevent FASD or any harm to an unborn child. Every women is different which means that its impossible to say that 2 drinks are safe. They may be safe for one but not the other. The CDC are acting on the best knowledge of the time and it is good advice. Fifty percent of pregnancies are unplanned therefore many people drink before they know they are pregnant. Many people I know who have done this have regretted it once they realise that their child’s behaviours and issues are as a result of those few drinks. The child may not show any problems at all but no one will ever know how many IQ points the child doesn’t have because of those few drinks. Don’t ignore this advice – there are far too many people who wish this advice was around when they were pregnant.

  2. Alcohol is a level one carcinogen and a depressant drug. Addictive and known to cause cancer. It kills millions and ruins tens of millions of families. Any advice not to consume it seems reasonable. It is a persons choice tho harm themselves. Harming others is selfish.

  3. The CDC putting out this advisory to pregnant women regarding the use of alcohol during pregnancy is reasonable, at least the way I see it. No matter how “wide” the range of the recommendation is, it is reasonable and they would not have put it out there unless they were concerned. I do not know the statistics when it comes to this issue, but even if there is a chance that something negative could result in an infant such as SIDS or Fetal Alcohol Syndrome, tells me that the CDC was not in the wrong by any means when putting this advisory out. We all know very well that drinking alcohol while pregnant is bad and should not happen, even though it does. As far as women that are sexually active and could possibly become pregnant, perhaps they should drink either but a majority of women are not going to follow that. With that being said, the CDC of course recommends that women who could even possibly become pregnant should not drink alcohol and I don’t think it is right for us to say that the CDC is wrong in any way when it comes to advising these women not to drink alcohol. It does not take an expert to advise that the use of alcohol is bad for these women, and the way I see it, whether or not their babies could potentially be affected, they probably should not drink just to be safe. After all, that is what the CDC is all about, being safe. They want to try to prevent infants being born with any kinds of defects, and they are there to help. It may seem like they are judging and discriminating against women to some, but I would be confident in assuring that is not something that they would do on purpose. In the book “Ethics in Human Communication,” there are practical principles offered by ethicist Deni Elliott. The one that I would like to present for this case is as follows: Recognize needs and interests held in common, such as avoiding harm or preserving the environment (Elliott, Deni p. 235 “Ethics in Human Communication”). The part of that principle that simply says “avoiding harm” is something that tells me why the CDC put this advisory out, and are being ethical in doing so. From what I have read and understand, there is nothing unethical from their advisory message, as they are legitimately concerned for the well being of infants. I only see ethical information when viewing for myself what the CDC is doing here, which is only for the good.

  4. It would actually be a requirement for everyone to have knowledge of the CDC-recommendations. If so we might assume that this could be a tool to reduce FASD largely in the future. I would prefer to see CDC as a global organization so that everyone can take notice of their clear definition about the dangers of alcohol. There are far too many parents and adults who have to carry the long life burden of FASD throughout their lives. For example, there are far too few children with FASD who can imagine the problems that still await them in the future.
    I would advice not to ignore the recommendation of the CDC about one drop of alcohol being one drop too much. It would be wiser to accept that there is no safe amount of alcohol in combination with pregnancy or even pre-conception or while breastfeeding.

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