Since posting my rant on the now age old debate about paternalism (or as the people over in USA are calling it: Nanny State) versus public health, I have been reading a lot more about the Soda wars and it emerges that now it is way more hotly debated than ever before.
Following in the steps of Mayor Bloomberg, Mississippi Senator Tony Smith has authored a bill that mandates that the government cannot dictate what the people can or cannot eat. Besides doing away with any prohibitions on portion sizes, it is also against the mentioning of calories per served bit on the menu. The New York Daily News believes that the state Governor is about to sign off on the bill making it a law, well, that effectively bans bans.
The bill is receiving enthusiastic support from, erm, Big Food (not that I meant the pun), for obvious reasons. But, wait, there’s more. The author of the bill, Sen. Smith has a massive conflict of interest to report. He owns this thing called a Stonewall’s BBQ, which, I believe is a chain of food stores. So, if Bloomberg had his way, he might have been up against severe financial constraints. Prophylactic self-preservation, or advocacy for autonomy? You decide!
The problem with the legislation being authored by Senator Smith is that it is a dead end for any legislative advocacy against obesity. Now I have not read the exact bill being passed through the system, and most of my understanding of its contents are through second or third hand reports from news sites, but still, what I read did not sit well with me. This piece of law would effectively kill off any and every attempt at regulating obesity in the state.
And anyway, a person with such massive conflicts of interest should not have been even involved in the law-making process in the first place. It just goes to show that it is indeed money that makes the world go round!
What is interesting to note is that, with a self-reported prevalence of obesity in adults pegged at almost 35% (BRFSS, 2011), Mississippi is one of the most obese states in the States. And it may be possible that the actual numbers are a tad higher because self-reporting may give rise to a lower estimate. Senator Smith writing such a self-serving ban on bans makes me wonder whether there may be something in Dr. House saying “Patients are idiots” (and extrapolating it to “People are idiots”) and thus redeeming Mayor Bloomberg’s law in the eyes of autonomy advocates like myself!
Image and Stats sourced from the CDC.
The paternalism which dictated the passing of the Bloomberg-Soda-bill also rankled my conscience. However, Dr. Aaron Carroll presents a counterpoint on the JAMA Forums that is very interesting to note (please note that he, like me, is not all hung up on the idea that Bloomberg had it right by calling to cut the size of certain sugary drinks):
When I first expressed my belief that the soda ban would do little to reduce obesity as an actual policy, because there were still plenty of ways to consume calories in New York City, many expressed a belief that the law was more of a symbol than an intervention. By bringing to light and focusing on the unhealthy nature of sugared beverages, the ban might have encouraged many people to choose on their own to consume less of them.
if Mayor Bloomberg wanted to take a symbolic stand against obesity and make people aware, then the whole brouhaha over this issue has indeed been a giant success. Its ripples have reached as far as India, where me and my colleagues mill around and discuss paternalism and public health over healthy, calorie-limited, size-restricted beverages while we are doing our daily jog on the treadmill. Or not.
Image Credit: SodaHead
But, in all seriousness, I agree with Dr. Carroll, when he says:
Martyring the attempt to ban unhealthy beverages has brought even more attention. The repeal might do just as much good as the policy itself.
In my last post on this Soda Wars issue, I expressed the fact that I was confused whether curbing some certainly-alienable individual rights for the sake of the greater good was a completely ethical and desirable step. I was torn. Being an ardent advocate for patient autonomy, I had wanted the same freedom of choice to spill over in public health policy-making as well. However, in this matter, I am ready to take a stand. The Anti-Bloomberg Bill hides a sinister financial conflict behind the façade of individual autonomy. It puts a stalemate to all discussions and legislations to combat a complex socio-political issue. It stymies all the progress made by the martyring of Bloomberg’s Soda Bill. It effectively neuters the legislative route of public health policy-implementation. At the risk of sounding anti-civil-liberties, I must end by saying that this makes Bloomberg’s Bill look way more acceptable an alternative.
Image credit: SocioEcoHistory
Bloomberg Meme: He actually wanted to pass a bill that would limit the noise levels in earphone to avoid ear injury in adolescents. The adolescents, of course, were not too thrilled.
Anti-Bloomberg Bill: Most of my understanding of the contents of this bill is from secondary and tertiary sources as I have not read the original bill. If there are any inconsistencies in the interpretation, that may be due to the loss in transcription through several levels of blogging and analysis. Do let me know if I have got any aspect of this bill wrong.
Balance: Obesity is a public health menace and as a trainee in the field, I believe we must strike a balance between the extremes that the two sides have taken on this issue. Policy-making is sometimes the fine art of striking a compromise, a balance between the desired and the acceptable. Pushing legislation on people that they are not ready to accept is not going to make things better.