Constructing the book series
The origin of the book series can be traced to an ICAP meeting in September 1995 at which
Drinking Patterns and Their Consequences was conceived. This book provides a list of its “editorial advisory group” and “external review panel” [
13], an insight into the generative process not found in most other books in this series. These bodies were made up of academics and industry representatives - many of whom would go on to contribute to other books in the series as authors and/or editors. Perhaps most notable was the membership of former senior employees of the US National Institute of Alcohol Abuse and Alcoholism (NIAAA) Leland Towle and Loren Archer.
Several books were the product of conferences or meetings. The structure of
Alcohol and Pleasure (1999), edited by Grant and Stanton Peele (a psychologist who argues against the medicalisation of addiction), mirrors that of the 1998 conference on which it was based (with, for example, ‘rapporteurs reports’) [
15]. Academics associated with ARISE (Associates for Research into the Science of Enjoyment), a front group for the tobacco industry [
23] were heavily involved in this conference, with David Warburton (University of Reading), the leading figure in ARISE, on the International Advisory Board for the conference and subsequent book, to which ARISE associated authors contributed four chapters [
24‐
27].
Other books in the series owe their origins to ICAP organised conferences or meetings.
Moonshine Markets (2004), edited by Alan Haworth (University of Zambia) and Ronald Simpson, the former VP of Corporate Scientific Affairs at Seagram, is described as the “outgrowth of a meeting the International Center for Alcohol Policies (ICAP) hosted in 1999, which brought together public health experts from developing countries to identify research topics of particular interest to these countries” [
28].
Corporate Social Responsibility and Alcohol (2005), edited by Marcus Grant and Joyce O’Connor (National College of Ireland), is described as the product of a conference organised by ICAP and the National College of Ireland in 2002, though: “At least a third of the material included in this volume was commissioned after the conference, and many of the papers included were significantly rewritten to reflect our focus on the theme of corporate social responsibility” [
29].
Expressions of Drunkenness (2010), the final volume in the series, edited by Anne Fox, an consultant with close ties to the alcohol industry [
30], and Mike MacAvoy, the former chief executive of the SAPRO DrinkWise Australia, was the product of a workshop held in Paris in 2007.
The role of ICAP in shaping the ‘form’ of the books in the series is most obvious when they are the product of meetings and conferences they have arranged. ICAP’s roles in the design of other volumes is clear in other ways, including the role of ICAP employees such as, Marjana Martinic, Eleni Houghton, Jennifer Kast, and Daniya Tamenderova in editing or authoring material across the series. For example,
Learning About Drinking (2001), edited by Houghton and Anne Roche (Flinders University), was the product of an ICAP-led initiative described as follows:
“The book is the result of a careful process of international consultation. In 1997, ICAP commissioned four papers by social scientists from Latin America, Australasia, South Africa, and Europe to capture their perceptions of how youth in those cultures learned about drinking alcohol. Each consultant was asked to focus particularly on the role of family, peers, culture, and religion. They were also asked to consider the effect more formal policies and programs have on learning about alcohol. These papers were discussed at a meeting held at ICAP in February 1998, which the four consultants attended, together with other education specialists and a representative from the alcohol beverage industry. Shortly after that meeting, a fifth paper on China was also commissioned. [...] Following the recommendations of the meeting, experts in relevant fields were invited to contribute chapters to this book. The five commissioned papers were made available to them all as source material and remained an important anchor point during the process of drafting, revising, and finalizing the chapters” [
31].
This extract demonstrates the layers of influence that ICAP employed to shaping the contents of the book, laying bare both some of the work, and obfuscations, involved. The book chapters, contributions to the ‘constitutive forum’ [
32] of alcohol science, are the result of a process in which the alcohol industry was closely and continuously involved.
Dwight Heath’s ‘Drinking Occasions’ (2000) - the only sole-authored book in the series and one of only two which is not an edited collection - was explicitly the result of an ICAP “consultancy”. Heath, a leading anthropologist on alcohol at Brown University, had contributed to all three earlier books in the series.
Shifting paradigms in science and policy
The intentions behind the book series vis-à-vis the existing state of alcohol science are set out clearly in the closing paragraph of the concluding chapter (written by Grant and Eric Single, of the Canadian Centre on Substance Abuse/University of Toronto) of the first book in the series:
“In this book, the authors have attempted to provide a strong rationale for a paradigm shift from per capita consumption toward drinking patterns as a more effective basis for measuring and assessing alcohol-related problems and for more effective policy and prevention approaches […] The main purpose of this book is to contribute to the process of establishing and giving credibility to the concept of drinking patterns as a basis for alcohol policy” [
33].
Similarly, Grant’s Preface to
Alcohol and Pleasure states that “the principal factor [in deciding to organise the conference upon with the book was based] was the sense that the time had come to turn a new page in the long story of alcohol and society” [
34], while in his Foreword to
Drinking Occasions, the book series is presented as a coherent intellectual programme: “The first three volumes in this ICAP series on Alcohol in Society are multiauthored volumes dealing with shifting paradigms in alcohol studies” [
35].
The early books are thus self-conscious interventions in the realm of science, ambitiously designed to change the terms of the debate – to move alcohol science and policy onto the ground preferred by ICAP. This took advantage of the under-development of the study of drinking patterns [
36] and the rise of harm reduction ideas for drugs in the preceding decade [
37, for a thoughtful discussion of the relationship between alcohol control and harm reduction, see
38], which had ready applications to alcohol [
39]. Attention to drinking patterns, i.e.
how people drink alcohol, is compatible with attention to
how much they drink. Reducing overall alcohol consumption in order to reduce alcohol harm is not, however, in the interests of the industry [
40]. The explicit purpose of the ICAP book series was to shift the paradigm in alcohol research from a focus on reducing consumption to making drinking patterns the central object of scientific and policy attention. In this, ICAP was directly engaging with unresolved scientific issues, predicated on clear understanding of the policy implications.
The narrative that ICAP research on ‘drinking patterns’ was shifting the paradigm in alcohol science is one that flows through the early books in the series. For example, the Introduction (subtitled “Drinking Patterns and Policy Development”) to
Alcohol and Emerging Markets states that “There is now widespread support” [
41] for the propositions set out in
Drinking Patterns and Their Consequences, which was published the previous year. Similarly, the Introduction to
Moonshine Markets by Haworth and Simpson [
42] contains a section on “Patterns of Drinking”, referencing three specific chapters in
Drinking Patterns and Their Consequences; those by Dwight Heath [
43], by Amelia Arria (Johns Hopkins University) and Michael Gossop (National Addiction Centre, UK) [
44], and one jointly authored by Wilson Acuda (University of Zimbabwe) and Barton Alexander (of Coors Brewing Company) [
45].
A focus on the harms caused by alcohol in much of the public health literature provides a target for ICAP. Roche laments in
Learning About Drinking that, “Comparatively little has been published about alcohol that has not been written from the perspective of its negative consequences” [
46]. In
Alcohol and Pleasure, Grant’s ‘Conclusion’ remarks that:
“Although the existence of beneficial effects is generally recognized, little attention has been paid to them within the public health context […] Even more modest than research on benefits is any existing attempt to describe beneficial patterns of drinking” [
47].
The attempt to bring attention to the benefits of drinking involves a critique of the entire public health approach to alcohol, not just that of alcohol science.
A focus on drinking patterns and the benefits of drinking were two key themes for ICAP. Bringing the two together allows claims such as “much drinking is either entirely or virtually harm free” [
33], a line in the first book repeated verbatim in the ‘Introduction’ to the second,
Alcohol and Emerging Markets, [
41], and a sentiment that is a significant focus of the third,
Alcohol and Pleasure. A shift from population level approaches to a primary focus on ‘drinking patterns’ is a move that restricts attention to certain kinds of drinking and drinkers and admits consideration of harmless or even beneficial drinking. Many of the books include references to epidemiological claims that alcohol protects against heart disease, claims which rest on population level research, in which industry has been prominent [
48]. However, the claims to the benefits of drinking extend well beyond the biological, the product of ICAP’s recruitment of anthropologists and sociologists. This is one example of the kind of “balance” that ICAP proposes; moving attention from harms to benefits. Grant writes in his ‘Foreword’ to Heath’s
Drinking Occasions: “Having spent a quarter of a century working on alcohol policy issues, I am amazed at how little attention has been paid to the characteristics of the vast majority of drinking occasions, namely those which lead to feelings of subjective well-being and social cohesiveness. I see this book as an important contribution to this sorely neglected area” [
35].
The power of this kind of narrative is that it can be seen as perfectly reasonable, drawing attention to a real limitation in the literature, even while being mobilised strategically with other arguments. For example, descriptions are coupled to prescriptions, such to promote ‘responsible’ drinking, that are not well rooted in research [
49]. As the concluding line of
Learning About Drinking has it: “If beverage alcohol is an enjoyable part of life for most adults, one should not be shy about encouraging responsible drinking and fully exploring mechanisms and pathways by which that may be achieved” [
50]. That weaknesses in the science have led to poor alcohol policy is the key claim that runs through the ICAP books series.
Alcohol public health science presented as a weary ideology
The per capita consumption paradigm is often dismissed as being less than scientific, despite the longstanding scientific consensus. Grant, Houghton, and Kast write in their ‘Introduction’ to
Alcohol and Emerging Markets that, “the days are long gone when it was enough to mouth the words “less is better” as if they were some kind of religious mantra encapsulating divine truth.” [
41]. Grant’s ‘Afterword’ to the same book contains the passage:
“In a sense, this is the book which I would have liked to have issued as a WHO report. It is intended to contrast with other publications which address alcohol problems in the developing world from particular ideological perspectives” [
51].
The ICAP intellectual programme is presented as being particularly suitable for low and middle income countries, which have been a major focus of industry expansion, in contrast to high income countries with saturated markets [
52,
53]. Grant writes here as if the existing paradigm was in the process of being swept away, with the alleged narrow “ideological” focus made redundant:
“…as I worked on […
Alcohol and Emerging Markets] I got the sense of a new way of looking at drinking patterns and alcohol problems. There seemed to be a groundswell of scientific energy that acknowledged all the excellent research traditions of the past, but wanted to find a quite distinct approach to alcohol research that better fits the real needs and priorities of the developing world. What emerges is an impatience with the weary preoccupation with per capita consumption figures that often obscure more than they reveal” [
51].
The framing of drinking patterns as a practical, pragmatic approach, explicitly or implicitly contrasted with the ‘ideological’ approach of the existing consensus, recurs throughout the series. In Grant and Single’s concluding chapter to
Drinking Patterns and Their Consequences we have: “If less is always better (as the single-distribution approach assumes) then abstinence would logically be best of all. Harm-reduction measures, by contrast, presume that drinking will take place” [
33]. Harm reduction is presented as “simply neutral regarding the long-term goal of interventions, which are pragmatic rather than ideological in their orientation. […] It is essentially a practical rather than idealized approach” [
33]. Such themes draw on an intellectual hinterland of the development of earlier influential harm reduction ideas in respect of illegal drug use, which around this time were also being explored in relation to alcohol [
39].
The authors close with: “A shift from a focus on overall consumption to patterns is therefore not merely of theoretical value. It represents a new pragmatism, which can lead to alcohol policies rooted in the interests of the individuals and communities they are intended to serve.” [
33]. Society’s interests are presented as being advanced by this approach, whilst business interests play no explicit part in the narrative. In
Alcohol and Emerging Markets, Grant, Houghton, and Kast write: “This book is intended to focus attention on the best available information from some other parts of the world, in order to highlight the importance of developing policies that are based on reality rather than ideology.” [
41]. Similarly, Grant closes
Alcohol and Pleasure by saying that the book:
“contribute[s] to a public policy that values education and information, that recognizes the autonomy of individuals and communities, and that rises above worn-out ideologies. The challenge is to build a scientifically sound approach that also will be of practical utility in making people’s lives healthier, of higher quality, and more pleasurable” [
47].
Who could disagree with ICAP’s ‘pragmatic’, ‘practical’ and ‘scientifically-sound’ approach if we take their framing of the public health consensus at face value; as divorced from reality, ‘ideological’, ‘worn-out’, and making knowledge claims no more scientific than ‘religious mantra’?
Offensive and defensive varieties of balance
Where books are not explicitly positioned as part of a programme to overthrow the paradigm, it is often suggested that their purpose is to provide
balance. Sometimes, this is expressed in essentially defensive ways, a shield against anticipated criticism. Grant introduces
Drinking Occasions by writing that while the book, “does not dwell upon drinking problems, […] It is therefore appropriate to acknowledge, here in the foreword to the book, that its intention is not to ignore or minimize the adverse health and social consequences of irresponsible drinking” [
35]. Grant appears to be anticipating attacks on the legitimacy and purposes of the book:
“…it does not ignore alcohol related problems. What it does is put them in context. In any assessment of the place of alcohol in society, due weight must be given to the burden of disease and disability associated with it. But weight also needs to be given to its significant contribution to personal and social well-being. This book is intended to help balance the evidence” [
35].
Calls for ‘balance’, in conjunction with the dismissal of population level approaches, sometimes takes a more ‘offensive’ form. In the ‘Rapporteur’s Report’ in
Alcohol and Pleasure, Cynthia Chasokela (Zimbabwe Ministry of Health) and Eva Tongue (International Council on Alcohol and Addictions) write: “A conference consensus seemed to accept the role of a public health sector that develops and disseminates a neutral and scientifically well grounded body of health information” [
54]. The implication is that existing information provided by the public health sector is neither neutral (what does ‘neutral’ mean with regard to alcohol harms) nor scientifically well-grounded. Chasokela and Tongue suggest an answer to why this may be: “Often, public health approaches are impeded by cultural baggage – such as the remnants of temperance traditions in some societies – that undermines the development of sound policies and the communication of scientific information about beverage alcohol” [
54]. ‘Balance’ is required to counter the hidden moral agendas that shape public health research and policy making, agendas that need to be exposed in order to conduct better science and make better policy. As with other material used strategically by ICAP, such content can be seen to have some substance; for example, valuing health or welfare over other concerns does necessarily involve implicit judgements.
This appeal to ideas of ‘balance’ is not limited to intellectual approaches, but extends to ‘balancing’ the voices present in the debate. In their ‘Introduction’ to
Alcohol and Emerging Markets, Grant, Houghton and Kast admit that:
“There are many reasons why those with a commitment to reducing alcohol-related problems might distrust the beverage alcohol industry […] No doubt there will be those who object to the inclusion of the industry perspective on ideological grounds, but we hope there will be many more who see it as expression of willingness to engage in a common mission where nobody, finally, has a monopoly on best practices” [
41].
They continue, appealing to the reasonable reader “to judge for themselves the relative merits of an approach which includes the perspective of the beverage alcohol industry and an approach which excludes it. At the very least, it is to be hoped that scientists and scholars will always feel free to publish where they wish” [
41]. This appeal is a defensive invocation of academic freedom, anticipating criticism of scientists’ engagement with the alcohol industry.
The claim is made that alcohol regulation is most effective when it is ‘balanced’, which is understood as “a balance between government regulation, industry self-regulation, and individual responsibility. And, in turn, what that requires is that all should be open to points-of-view other than their own” [
41]. Evidence of
effective regulation is largely absent from this narrative. The message discipline is impressive, as in for example Gaye Pedlow’s (Diageo, previously in PR at British American Tobacco) chapter in
Alcohol and Emerging Markets which advances that, “alcohol policies need to be based upon an objective understanding of available research on alcohol use and misuse, and should aim to create a reasonable balance of government regulation, industry self-regulation, and individual responsibility” [
55]. ICAP narrative is that the shortcomings of science and policy are in part the product of the exclusion of industry. Hurst Hannum (Tufts University) argues in his ‘Conclusion’ to
Corporate Social Responsibility and Alcohol that this is an ethical imperative: “Being ethical and acting responsibly means being honest, transparent, consistent, and tolerant of those with different values. Only with such tolerance can there be mutual respect among those with different viewpoints” [
56]. He goes on to say: “Adversarial relationships between the stakeholders only serve to weaken initiatives” [
56]. Opposing industry involvement in policy making, as has been a key recommendation of WHO [
57], is thus framed as morally problematic. Hannum, it should be noted, was the author of the ‘special commentary’ in Alcohol and Alcoholism that introduced the ICAP-supported ‘Dublin Principles’ to the wider alcohol research community [
5].
As the series develops, the tone of these book’s position
vis à vis the public health consensus becomes more moderate. By
Swimming With Crocodiles (2008), which coincides with the development of the WHO global strategy on alcohol [
58], the tone is more conciliatory. Discussing ‘stakeholder asymmetry’, Mark Leverton (Diageo) and Keith Evans (Drug and Alcohol Services, Australia, who was later revealed [
59] to have worked as a consultant for ICAP in their efforts to shape alcohol policy in southern Africa) write: “Compounding this dichotomy is the perceived incompatibility between population-level measures related to alcohol and an emphasis on more targeted harm reduction. In fact, the two approaches are perfectly compatible” [
60]. This is altogether less antagonistic than the material in the earlier books, and is reflected in more under-stated opposition to population-level measures by industry actors including ICAP’s successor organisation, the IARD [
61]. Population-level approaches are no longer attacked as such, outright opposition to them is muted, and the emphasis is on involvement in policy making as the prize now to be won. Notwithstanding the failure of high-level attempts to shift the paradigms governing science and policy, involvement in policy making provides a key pathway to influence in national policy making, that has been pursued successfully [
62].