Philosopher Mary Midgley (1992: 3) observed: ‘As the gap between professional science and everyday thinking widens, it gets increasingly hard to work out in what sense most of us can be said to be thinking scientifically at all.’
This occurred to me on reading the title of an article by Leppo et al (2014: 512): ‘“Why take chances?” Advice on alcohol intake to pregnant and non-pregnant women in four Nordic countries.’ The authors report that not only have the governments of Denmark, Finland, Norway and Sweden advised pregnant women to completely abstain from drinking alcohol, they also make the general point that in attempting to manage uncertainty there is a move away from the ‘estimation of risk’ in favour of what they describe as ‘a wider socio-cultural push towards broader employment of the precautionary principle’ (PP).
But where exactly does a ‘why take chances?’ approach arising from a ‘wider socio-cultural push’ towards the PP fit into a medical culture that is dedicated to proven scientific methods of risk evaluation and where the concept of evidence-based medicine is actively promoted? Leppo and Hecksher (2010: 7) acknowledge that when Denmark and Finland adopted their total abstinence message, their policy was ‘not, however, based on research evidence pertaining to the harmfulness of a small-to-moderate alcohol intake during pregnancy but rather on the principle of precaution.’
In her report on a London conference on maternal autonomy held in April 2016, Murphy (2016: 371) cited a review of UK policy ‘which stated that recommendations to abstain from alcohol during pregnancy demonstrated “a new approach to risk based on seeking to make uncertainty certain”’. Such certain uncertainties, one could argue, rival the then US Secretary of Defense Donald Rumsfeld's February 2002 ‘known unknowns’ reply during a press briefing.
Certain uncertainty was evident in the recent position paper from the European Board and College of Obstetrics and Gynaecology (EBCOG, 2016: 100) on alcohol and pregnancy. Having made clear that it supports the consensus view that women should ideally abstain from alcohol during or when planning pregnancy, the EBCOG then states: ‘That being said it has to be understood that there is limited evidence that drinking small amounts of alcohol in pregnancy causes harm to the baby.’
The PP comes from the German idea of ‘Vorsorgeprinzip’, requiring governmental foresight in preventing the development of environmental risks and dangers. Its first international use was in the text of the 1985 Vienna Convention for the Protection of the Ozone Layer. But the PP has spread beyond its environmental origins to find expression in health care. The appeal of the PP to some may stem from the way it can take an ordinary notion of possibility, and lead it down the philosophical garden path where it can be introduced to ‘logical’ possibilities, where anything can happen ‘in theory’, but is not possible in the real world. Perhaps part of the reason for the ‘wider socio-cultural push’ towards the PP can be attributed to our tendency to merge what is logically possible with what is practically possible—as a result of which, the PP does not always appear coherent.
Midgley (1992: 38) confirms that experts do not always agree, even with access to the same facts: ‘Views about facts never stand alone. They are always shaped by background world-pictures… [which] are themselves not value-free; they are always more or less dramatized.’
Peterson (2007: 6) cites critics of the PP, with one describing it as ‘too vague to serve as a regulatory standard’, and another saying that once a risk of a certain mag nitude has been identified, preventive measures become mandatory, so ‘as virtually every activity is associated with some risk of nonsignificant damage, it seems that the precautionary principle can therefore be used to prohibit every human activity’.
In the context of alcohol in pregnancy, it is tempting to assume that the more data that accumulate from research into the topic, the easier it will be to advise pregnant women on alcohol consumption. However, with the PP hovering in the background, Peterson (2007: 7) suggests that more information is not always better when drawing up a risk assessment: ‘Briefly put, the motivation is that a decision maker faced with too much information might be unable to see the wood for the trees.’
It seems that it is not quite enough to acquire a stock of knowledge about alcohol and pregnancy. The question of the extent to which their relationship is deemed to be safe relies on our interpretation of this knowledge. Our answer to the question will be what we think, but it will be determined by how we think, and it seems that our ‘wider socio-cultural push’ towards the PP will be hard to resist.