After serving in various city, county and state offices over the past decade, San Diego County Supervisor Susan Golding says she has learned that "it's impossible for government to protect all people from themselves at all times."
"But government can give people a chance to behave more intelligently, or in a more informed manner," Golding adds.
Toward that end, Golding has proposed an ordinance that would require businesses selling alcohol in unincorporated areas of the county to post signs warning pregnant women of the potential dangers of drinking alcohol.
The proposal, to be heard Tuesday by the Board of Supervisors, has generated a public debate that is similar, though more civil and much less acrimonious, to that heard for years in legislative battles over cigarette smoking regulations.
Golding and other advocates, including many doctors and health care officials, hail the proposal as a means of combatting widespread public ignorance about medical evidence linking birth defects to even moderate drinking during pregnancy.
However, critics, led by alcoholic beverage producers, decry the proposed regulation as merely another unnecessary governmental intrusion into business and individuals' personal affairs. And, just as the tobacco industry has persistently disputed studies detailing the risks associated with smoking, alcohol producers contend that medical evidence on the effects of small amounts of alcohol on a fetus is inconclusive.
Medical experts in the field of "fetal alcohol syndrome"--the third leading cause of birth defects in this country, covering a range of disorders related to maternal alcoholic consumption--acknowledge that light to moderate drinking may not pose a risk to all pregnant women. But the fact that research has shown that drinking clearly leads to birth defects in some, they emphasize, is sufficient reason to abstain from alcohol, including beer and wine, during pregnancy.
"The research isn't specific enough to say that if you drink this much, it's probably going to cause that problem," Golding explained. "But it is specific enough to say that drinking during pregnancy is potentially quite harmful.
"We also know that this is the only birth defect that is 100% preventable. All we're trying to accomplish with these signs is to educate people about the potential danger. What they do with that information is up to them."
Under Golding's proposal, restaurants, bars, grocery and convenience stores and other establishments selling alcoholic beverages would be required to post 5 1/2-by-8 1/2-inch signs stating, "Pregnancy and alcohol do not mix. Drinking alcoholic beverages, including beer and wine, during pregnancy can cause birth defects."
That phrasing is an amended, somewhat milder version of the wording contained in Golding's original proposal last fall. The changes, including eliminating the word "warning" at the top of the sign, were made primarily to alleviate concerns of restaurateurs, as well as beer and wine makers.
"Seeing the word 'warning' in big letters would have made it seem like you were walking into a toxic dump or some kind of danger zone," said Paul McIntyre, executive director of the San Diego Restaurant Assn. "That's contrary to the kind of atmosphere or tone restaurants try to create."
The signs would be located in restaurant restrooms and affixed to cash registers or located in a spot visible where sales occur in liquor and grocery stores. Originally, county officials considered placing the signs in business entrances, but changed their mind after restaurant owners complained that the signs would clutter entryways--a lament also heard from grocery store representatives--and probably would not be well read there.
"We're already regulated so much that another sign by the entrance would have been just another nuisance to us and something else for customers to ignore," said Bob Lubach, owner of Lubach's Restaurant and president of the local restaurant association. "People seem to do more reading in the restroom than anywhere else, so if you're trying to reach the greatest number of people, that's probably the best place to do it."
Because of the changes in the signs' phraseology and location, the San Diego Restaurant Assn., which initially opposed the measure, has, in Lubach's words, "made a 180-degree turn" and now is "enthusiastic about being an educational tool" on the possible dangers posed by drinking during pregnancy. The proposal also has drawn strong support from the March of Dimes, the local chapter of the National Council on Alcoholism and other groups dealing with birth defects and alcoholism.
Opposition to Golding's proposal is led by the Distilled Spirits Council of the U.S. (DISCUS), which has opposed similar alcohol warning laws adopted in other cities, including New York City, Los Angeles, Philadelphia, Washington, D.C., and Columbus, Ohio. While such laws carry potential economic consequences for alcoholic beverage producers, that factor is almost never cited by opponents in their campaigns to block the regulations.
"They don't want to be in the position of saying, 'We want to sell beer and liquor to pregnant women,"' said Rick Kritzer, the Columbus Health Department's alcoholism prevention coordinator. "They prefer to say these rules really aren't necessary or the medical evidence isn't clear."
Indeed, the Spirits Council's basic strategy here has been to raise questions about the accuracy and findings of the medical studies linking birth defects to alcoholic consumption during pregnancy.
"It is not known what specific dose level of alcohol might generate birth defects," the group stated in a position paper submitted to the supervisors. "There is no substantive evidence that light or moderate drinking by pregnant women is harmful."
DISCUS officials also argue that some birth defects attributed to fetal alcohol syndrome actually could have been caused by other factors, including poor nutrition, smoking, drugs and stress. In a hearing last month, a DISCUS representative told county officials that fetal alcohol syndrome is caused only by chronic consumption of more than 45 alcoholic drinks per month.
Those arguments, however, are contradicted by more than 2,000 studies over the past 15 years that have proved that alcoholic consumption during pregnancy can harm a developing unborn baby, according to county health officials and experts in the field. The possible birth defects include facial disfigurations, small head and body size, mild to moderate mental retardation and lesser learning disabilities. Drinking during pregnancy also has been linked to an increased likelihood of stillbirths and spontaneous abortions.
While the risk of those defects is greatest among heavy drinkers, some studies have demonstrated that dangers exist even at low levels of consumption--as low as one alcoholic drink per day.
Dr. Kenneth L. Jones, an associate professor in UC San Diego's Department of Pediatrics and a leading researcher on fetal alcohol syndrome, flatly states that there is no "safe level" of drinking during pregnancy. A 1980 report by the U.S. surgeon general reiterated that point in advising women not to drink any alcoholic beverages during pregnancy.
" . . . It is clear that not all infants prenatally exposed to the same amount of alcohol will be affected to the same extent," Jones said in a recent medical journal article. "It would, therefore, seem naive to consider that there exists a 'safe' amount of alcohol for all pregnant women. What may be a 'safe' amount for most women might well be devastating for another woman's unborn baby. Therefore . . . total abstinence from alcohol is the best policy throughout pregnancy."
Based on national estimates that fetal alcohol syndrome is found in one to three births per thousand, researchers believe that between 28 and 84 babies affected by it are born annually in San Diego County. As many as 200 babies suffering from less severe defects traceable to alcoholic consumption by their mothers also are born here each year, they add.
According to county health officials, the cost of treating infants born with fetal alcohol syndrome could be as much as $500,000 a year, with the long-term treatment costs totaling millions of dollars.
"These signs might help not only to prevent some personal tragedies, but also could reduce a huge financial burden that eventually is going to be borne by society," Golding said.
To accomplish that goal, Golding says, her proposed ordinance must help to overcome widespread misconceptions concerning the relative risks of hard liquor, beer and wine during pregnancy, as well as about drinking levels during pregnancy.
"Most people realize that excessive drinking of something like gin or vodka isn't a good idea, but they generally don't think of beer or wine the same way," the supervisor noted. "The message we have to get out is that any drinking of any type of alcoholic beverage can cause birth defects."
Tom Wright, administrative director of the San Diego chapter of the National Council on Alcoholism, argues that the signs also could "give women some ammunition to say 'no' if they get any pressure to have a drink or two."
Skeptics, though, have questioned whether signs on restroom walls or cash registers are the most effective way to transmit that educational message. Restaurateur Lubach, however, argues that restrooms are "one place where you're going to be able to catch most people's eye sooner or later." In addition, a Gallup Poll conducted in New York City one year after the posting of warning signs there found a 14% increase in the public's awareness of the risks involved in consuming alcohol during pregnancy.
Moreover, Golding also plans to request that the signs be placed in county buildings and health clinics, and hopes that schools, doctors' offices and other businesses will voluntarily display the signs. The ordinance would affect about 700 businesses in the unincorporated areas of the county, but Golding said that she will encourage other cities in the county to adopt similar laws covering more than 3,600 other local outlets in incorporated regions.
The county will pay the estimated $1,000 cost of printing the signs, and county health officials will check compliance during their regular inspections of restaurants and other businesses that sell food and drink. Fines for failure to post the signs would range from a maximum of $50 for a first offense to $250 for a third or subsequent offense within a year.
Well aware of the limits of any governmental attempt to regulate drinking or individuals' other personal habits, Golding characterizes her plan as "just a way of passing out some simple advice that people can heed or ignore."
"There not only is a limit to what government can do, but also a limit to what it reasonably should do in an area like this," Golding said. "If we can get people to give a second thought to taking that first drink or the next one, we'll have done about as much as we can do. We can't stop people from drinking. We can only tell them why they shouldn't."
National Council on Alcoholism official Wright agrees, but frames the issue differently.
"If in all of San Diego this saves just one baby, we'll have been successful," he said. "If that's all we accomplish, how could anyone say it wasn't worth it?"