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Prohibition

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Tona Hangen, Prohibition, Journal of American History , Volume 99, Issue 1, June 2012, Pages 374–377, https://doi.org/10.1093/jahist/jas127

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With their three-part documentary on Prohibition, Ken Burns and Lynn Novick turn the rise and fall of the Eighteenth Amendment into a cautionary tale about metastasizing single-issue politics in America. Perhaps as expected, the films hit their stride when talking about the late 1920s, with tommy-gun wielding gangsters, bootleggers, and speakeasy patrons battling earnest federal enforcers for the soul of the nation. But the films brood far more than they sensationalize, ultimately making the story of Prohibition not only more expansive but also much more serious and less rollicking than it might be.

The “noble experiment” (a term attributed to Herbert Hoover) of Prohibition was enacted to protect American families and society from the pernicious and widely acknowledged effects of alcohol consumption. While saluting these laudable intentions, Burns and Novick cast Prohibition as not only a “notorious civic failure” but, even more damning, also as a violation of the American character itself. Although Prohibition was in effect only from 1920 to 1933, its roots tapped into the early years of antebellum reform and it had lasting effects on American culture, politics, and law. Prohibition takes in an ambitious sweep of more than a century, starting with the beginnings of the temperance movement in the 1820s.

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The Darker Side of Prohibition

During Prohibition, industrial-grade alcohol cost hundreds of American lives. The Coolidge administration encouraged its circulation.

When we think of Prohibition, the cultural touchstones of the Jazz Age come to mind: gangsters and molls, feather boas, glittering headpieces, and of course, bathtub gin. Sourced by shadowy bootleggers, noxious homemade moonshine killed or blinded hundreds of Americans. But that’s only half the story. What we once considered criminality run amok, was in fact inextricably tied to a willingness at the highest levels of American government to sacrifice the lives of those considered worthless degenerates.

Throughout the Prohibition period from 1920 to 1933, some forms of alcohol were still available for purchase. Prescription alcohol—to treat bronchitis and other conditions—was one. Industrial-grade alcohol—designed for use in paints and floor thinners—was another. Although it was undrinkable, industrial-grade alcohol was often stolen and resold by criminal syndicates to be used in cheap liquor. The Coolidge administration effectively encouraged the practice as a way of discouraging illegal consumption, by giving tax breaks to industrial-alcohol manufacturers who “denatured,” or poisoned, their supply.

The week of Christmas, 1926, almost a hundred people died from the effects of drinking industrial alcohol. Hundreds more died in subsequent years. They were drinking a substance that, thanks to government intervention, had been intentionally but unnecessarily rendered fatal.

For many in Coolidge’s administration, this was hardly a problem; in fact, in some cases it was seen as beneficial. It did, after all, get drunks off the streets expediently.

But for Charles Norris, New York’s medical examiner, it was just another example of the dark side of Prohibition’s would-be moral certainty. Writing for The North American Review in Christmas of 1928, Norris condemns America’s “essay in extermination” wrought by Prohibition.

“In a word,” Norris says, “wood alcohol is not ‘poison liquor’. It is simply poison. If it gets into liquor, the liquor is poisoned. So these Americans died not of poison liquor but of poisoned liquor. Who poisoned it?” He denies that it is “The Government.” Nevertheless, he sees the ubiquity of wood alcohol poisonings as “a serious indictment of Prohibition before the court of public opinion.” Addicts’ access to unsafe alcohol accelerates an existing danger: “Death by alcoholism means death by excess drinking of alcohol, encouraged and accelerated more or less by sundry poisons put into active service by our benevolent Government.”

Norris is something of a moderate when it comes to his views on Prohibition. He’s at once keen to stress that “these denaturants were originally added to the alcohol under Government control and connivance.” But (perhaps due to his governmental position) he is tactful in his assignation of blame. “But let us not blame the Government too harshly. Something must be added to grain alcohol to prevent its being all drunk away and thereby denied to legitimate industry and business.” Rather, Norris blames the system itself: a moral philosophy of prohibition that drives the drunk and the desperate toward noxious materials the government is perfectly willing to let them consume.

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Norris reveals how New York of the 1920’s viewed certain populations as disposable. By entering the sphere of immorality, alcoholics, in the eyes of the Coolidge administration, forfeited their right to life. It’s telling that, even in death, there are two rules: one related to “respectable drunks” and one for the degenerates.  As Norris writes, “Private physicians will rarely make such a report and expose their deceased customers to the indignity of a post-mortem examination, [but] will prefer to ascribe death to other “natural causes” when they can, in the case of clients in good standing or society.”

Norris’s essay reminds us that moral outrage over perceived danger—and a concern for the reality of human life—don’t necessarily go hand in hand. Especially when those lives lost are not “in good standing” in the society in which they live.

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Prohibition Benefits and Detriments Essay

Detriments of prohibition, benefits of prohibition, works cited.

The arguments by John Gordon Cooper (1872-1955), “Prohibition is a success” (1924) and “Prohibition is a Failure” (1926) by William H. Stayton (1861-1942) will form this summary paper. Cooper in his arguments portend that prohibition should be upheld with much important consideration as much as the other parts of the constitution. Thus is because disregarding the Eighteenth Amendment that prohibits the intoxicating liquor remains a basic and fundamental part of the constitution and as such cannot be given less consideration.

The effectiveness of prohibition as advanced by the author includes a number of well illustrated points that stand to support his arguments. First, prohibition is effective in that it has increased drinking and intemperance throughout the whole nation. Secondly, prohibition drastically led reductions in the levels of violations in that it was obeyed by bootleggers and moonshiners after the war time. This is demonstrated in its active role in the reduction of bribery and smuggling in the intoxication beverages to the thoughtless and the indifferent. In analyzing the effectiveness of prohibition, Cooper underlines the fact that it saved the nation millions of dollars from unscrupulous businessmen who had the intent to employ their act of bribery and graft to hoodwink the law enforcers into supporting their acts. This entailed enlisting the support of corrupt politicians while making use on continuous propaganda to portray the good face of law and order. Prohibition ensured that these illegal business dealings were reduced or remained under control and surveillance. According to Cooper, the opponents of prohibition formed alliances with corrupt politicians thus subjecting the whole country into unending propaganda aimed at law and order and a sober and decent America; unfortunately this propaganda was able to increase due to the leniency of the courts and petty fines practically licensed the bootleg trade and the law’s delay made conviction impossible in many cases.

While prohibition was effective in the reduction on the consumption of illegal and intoxicating liquor, nevertheless, it completely failed in the total elimination of the consumption of these liquors. This was due to the rampant levels of corruption and the inability by the law enforcement authorities to effectively institute and ensures that the prohibition provisions are upheld. In addition the above, police statistics reveal that there was a recorded increase in the number of arrests for drunkenness from the year 1920. This in fact is denoted by the author as the year in which the constitutional prohibition was recognized. While the general aim of the legislating prohibition was aimed at reducing the drunkenness by consumption of illegal liquor, taking such as fast and drastic action was not appropriate. This figure is well demonstrated by the National Commission on Marihuana and Drug Abuse (1) in stating that “The Bureau placed the consumption of alcoholic beverages at 73,831,172 gallons, or 0.6 gallon per capita in fiscal year 1930 as contrasted with 166,983,681 gallons or 1.7 gallons per capita in 1914”.this increase in the consumption of alcohol was the reason behind the consequent increase in the number of arrests.

The failure of prohibition has generated the greatest level of corruption within the most critical departments of the government that has led the general population into wondering on the effectiveness of the government in protecting them. The integrity of the government has thus been put into question because of the reverberating effects of the failure of prohibition. This is due to the inability to protect the law and uphold this section of the constitution with all the executive and legislative requirements it deserves. Furthermore, the enforcement of prohibition has burdened the government as a result of resources needed to enforce the law.

The first two benefits of prohibition as detailed by Cooper include the reduced death rate and the America’s increased prosperity. Statistics provided by Commission on Marihuana and Drug Abuse (3) illustrates that prohibition has reduced the rate by 873, 000 in the first four years. In this connection, crime levels have come down in that even though many people are continuously arrested, the charges preferred are not directly linked to drunkenness. In the analysis of the increased prosperity, large amounts of dollars that formerly destined to the saloon have been adequately used to buy a whooping seven million cars that have been domestically manufactured thus translating to a robust manufacturing sector. This is because approximately three billion dollars have been channeled from the destructive uses to more constructive uses that are beneficial to the economy.

In addition to the above, Pletten (2), in giving support to Cooper’s assertion that prohibition was a success that reiterates that “Bottom line, notwithstanding the mismanagement and politicization, Prohibition was a success, despite the many efforts to sabotage it.” The benefits of prohibition are not limited to the above mentioned but have extended to the increased number of people joining the stock market as investors and those acquiring enterprises. In summary, the man remains the greatest benefactor from prohibition. This is because there has been noted increase in the volumes of earnings and levels of productivity that are products of prohibition.

National Commission on Marihuana and Drug Abuse. History of Alcohol Prohibition. 2009. Web.

Pletten, Leroy J. Prohibition Was A Success – Here is the evidence. 2010. Web.

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• v.96(2); Feb 2006

Did Prohibition Really Work? Alcohol Prohibition as a Public Health Innovation

Jack s. blocker, jr.

The author is with the Department of History, Huron University College, University of Western Ontario, London, Ontario.

The conventional view that National Prohibition failed rests upon an historically flimsy base. The successful campaign to enact National Prohibition was the fruit of a century-long temperance campaign, experience of which led prohibitionists to conclude that a nationwide ban on alcohol was the most promising of the many strategies tried thus far. A sharp rise in consumption during the early 20th century seemed to confirm the bankruptcy of alternative alcohol-control programs.

The stringent prohibition imposed by the Volstead Act, however, represented a more drastic action than many Americans expected. Nevertheless, National Prohibition succeeded both in lowering consumption and in retaining political support until the onset of the Great Depression altered voters’ priorities. Repeal resulted more from this contextual shift than from characteristics of the innovation itself.

PROBABLY FEW GAPS between scholarly knowledge and popular conventional wisdom are as wide as the one regarding National Prohibition. “Everyone knows” that Prohibition failed because Americans did not stop drinking following ratification of the Eighteenth Amendment and passage of its enforcement legislation, the Volstead Act. If the question arises why Americans adopted such a futile measure in the first place, the unnatural atmosphere of wartime is cited. Liquor’s illegal status furnished the soil in which organized crime flourished. The conclusive proof of Prohibition’s failure is, of course, the fact that the Eighteenth Amendment became the only constitutional amendment to be repealed.

Historians have shown, however, that National Prohibition was no fluke, but rather the fruit of a century-long series of temperance movements springing from deep roots in the American reform tradition. Furthermore, Americans were not alone during the first quarter of the 20th century in adopting prohibition on a large scale: other jurisdictions enacting similar measures included Iceland, Finland, Norway, both czarist Russia and the Soviet Union, Canadian provinces, and Canada’s federal government. 1 A majority of New Zealand voters twice approved national prohibition but never got it. As a result of 100 years of temperance agitation, the American cultural climate at the time Prohibition went into effect was deeply hostile to alcohol, and this antagonism manifested itself clearly through a wave of successful referenda on statewide prohibition.

Although organized crime flourished under its sway, Prohibition was not responsible for its appearance, as organized crime’s post-Repeal persistence has demonstrated. Drinking habits underwent a drastic change during the Prohibition Era, and Prohibition’s flattening effect on per capita consumption continued long after Repeal, as did a substantial hard core of popular support for Prohibition’s return. Repeal itself became possible in 1933 primarily because of a radically altered economic context—the Great Depression. Nevertheless, the failure of National Prohibition continues to be cited without contradiction in debates over matters ranging from the proper scope of government action to specific issues such as control of other consciousness-altering drugs, smoking, and guns.

We historians collectively are partly to blame for this gap. We simply have not synthesized from disparate studies a compelling alternative to popular perception. 2 Nevertheless, historians are not entirely culpable for prevalent misunderstanding; also responsible are changed cultural attitudes toward drinking, which, ironically, Prohibition itself helped to shape. Thinking of Prohibition as a public health innovation offers a potentially fruitful path toward comprehending both the story of the dry era and the reasons why it continues to be misunderstood.

TEMPERANCE THOUGHT BEFORE NATIONAL PROHIBITION

Although many prohibitionists were motivated by religious faith, American temperance reformers learned from an early point in their movement’s history to present their message in ways that would appeal widely to citizens of a society characterized by divergent and clashing scriptural interpretations. Temperance, its advocates promised, would energize political reform, promote community welfare, and improve public health. Prohibitionism, which was inherently political, required even more urgent pressing of such claims for societal improvement. 3 Through local contests in communities across the nation, liquor control in general and Prohibition in particular became the principal stage on which Americans confronted public health issues, long before public health became a field of professional endeavor.

By the beginning of the 20th century, prohibitionists agreed that a powerful liquor industry posed the greatest threat to American society and that only Prohibition could prevent Americans from falling victim to its seductive wiles. These conclusions were neither willful nor arbitrary, as they had been reached after three quarters of a century of experience. Goals short of total abstinence from all that could intoxicate and less coercive means—such as self-help, mutual support, medical treatment, and sober recreation—had been tried and, prohibitionists agreed, had been found wanting. 4

For prohibitionists, as for other progressives, the only battleground where a meaningful victory might be won was the collective: the community, the state, or the nation. The Anti-Saloon League (ASL), which won leadership of the movement after 1905, was so focused on Prohibition that it did not even require of its members a pledge of personal abstinence. Battles fought on public ground certainly heightened popular awareness of the dangers of alcohol. In the mass media before 1920, John Barleycorn found few friends. Popular fiction, theater, and the new movies rarely represented drinking in positive terms and consistently portrayed drinkers as flawed characters. Most family magazines, and even many daily newspapers, rejected liquor ads. 5 New physiological and epidemiological studies published around the turn of the century portrayed alcohol as a depressant and plausibly associated its use with crime, mental illness, and disease. The American Medical Association went on record in opposition to the use of alcohol for either beverage or therapeutic purposes. 6 But most public discourse on alcohol centered on its social, not individual, effects. 7

The only significant exception was temperance education in the schools. By 1901, every state required that its schools incorporate “Scientific Temperance Instruction” into the curriculum, and one half of the nation’s school districts further mandated use of a textbook that portrayed liquor as invariably an addictive poison. But even as it swept through legislative chambers, the movement to indoctrinate children in temperance ideology failed to carry with it the educators on whose cooperation its success in the classrooms depended; teachers tended to regard Scientific Temperance Instruction as neither scientific nor temperate. After 1906, temperance instruction became subsumed within more general lessons on hygiene, and hygiene classes taught that the greatest threats to health were environmental and the proper responses were correspondingly social, not individual. 8

By the time large numbers of voters were confronted with a choice whether or not to support a prohibitionist measure or candidate for office, public discourse over alcohol had produced a number of prohibitionist supporters who were not themselves abstainers. That is, they believed that it was a good idea to control someone else’s drinking (perhaps everyone else’s), but not their own. A new study of cookbooks and etiquette manuals suggests that this was likely the case for middle-class women, the most eager recruits to the prohibition cause, who were gaining the vote in states where prohibition referenda were boosting the case for National Prohibition. In addition to the considerable alcoholic content of patent medicines, which women and men (and children) were unknowingly ingesting, women were apparently serving liquor in their recipes and with meals. In doing so, they were forging a model of domestic consumption in contrast to the mode of public drinking adopted by men in saloons and clubs. 9

Self-control lay at the heart of the middle-class self-image, and middle-class prohibitionists simply acted on the prejudices of their class when they voted to close saloons while allowing drinking to continue in settings they considered to be respectable. Some state prohibition laws catered to such sentiments when they prohibited the manufacture and sale of alcoholic beverages, but allowed importation and consumption. 10 A brisk mail-order trade flourished in many dry communities. Before 1913, federal law and judicial decisions in fact prevented states from interfering with the flow of liquor across their borders. When Congress acted in 1913, the Webb–Kenyon Act only forbade importation of liquor into a dry state when such commerce was banned by the law of that state. 11

WHY NATIONAL PROHIBITION?

At the beginning of the 20th century, wet and dry forces had reached a stalemate. Only a handful of states maintained statewide prohibition, and enforcement of prohibitory law was lax in some of those. Dry territory expanded through local option, especially in the South, but this did not mean that drinking came to a halt in towns or counties that adopted local prohibition; such laws aimed to stop manufacture or sale (or both), not consumption. 12 During the previous half-century, beer’s popularity had soared, surpassing spirits as the principal source of alcohol in American beverages, but, because of beer’s lower alcohol content, ethanol consumption per capita had changed hardly at all. 13 Both drinking behavior and the politics of drink, however, changed significantly after the turn of the century when the ASL assumed leadership of the prohibition movement.

Between 1900 and 1913, Americans began to drink more and more. Beer production jumped from 1.2 billion to 2 billion gallons (4.6 billion to 7.6 billion liters), and the volume of tax-paid spirits grew from 97 million to 147 million gallons (367 million to 556 million liters). Per capita consumption of ethanol increased by nearly a third, a significant spike over such a short period of time. 14

Meanwhile, the area under prohibition steadily expanded as a result of local-option and statewide prohibition campaigns. Between 1907 and 1909, 6 states entered the dry column. By 1912, however, prohibitionist momentum on these fronts slowed, as the liquor industry began a political counteroffensive. In the following year, the ASL, encouraged by congressional submission to its demands in passing the Webb–Kenyon Act, launched a campaign for a prohibition constitutional amendment.

The best explanation for this decision is simply that National Prohibition had long been the movement’s goal. The process of constitutional amendment in the same year the ASL launched its campaign both opened the way to a federal income tax and mandated direct election of US senators (the Sixteenth and Seventeenth Amendments), seemed to be the most direct path to that goal. 15 Its supporters expected that the campaign for an amendment would be long and that the interval between achievement of the amendment and their eventual object would also be lengthy. Ultimately, drinkers with entrenched habits would die off, while a new generation would grow up abstinent under the salubrious influence of prohibition. 16 ASL leaders also needed to demonstrate their militance to ward off challenges from intramovement rivals, and the route to a constitutional amendment lay through state and national legislatures, where their method of pressuring candidates promised better results than seeking popular approval through a referendum in every state. 17

Once the prohibition movement decided to push for a constitutional amendment, it had to negotiate the tortuous path to ratification. The fundamental requirement was sufficient popular support to convince federal and state legislators that voting for the amendment would help rather than hurt their electoral chances. The historical context of the Progressive Era provided 4 levers with which that support might be engineered, and prohibitionists manipulated them effectively. First, the rise in annual ethanol consumption to 2.6 US gallons (9.8 liters) per capita of the drinking-age population, the highest level since the Civil War, did create a real public health problem. 18 Rates of death diagnosed as caused by liver cirrhosis (15 per 100000 total population) and chronic alcoholism (10 per 100000 adult population) were high during the early years of the 20th century. 19

Second, the political turbulence of the period—a growing socialist movement and bitter struggles between capitalists and workers—made prohibition seem less radical by contrast. 20 Third, popular belief in moral law and material progress, trust in science, support for humanitarian causes and for “uplift” of the disadvantaged, and opposition to “plutocracy” offered opportunities to align prohibitionism with progressivism. 21 Concern for public health formed a central strand of the progressive ethos, and, as one historian notes, “the temperance and prohibition movements can . . . be understood as part of a larger public health and welfare movement active at that time that viewed environmental interventions as an important means of promoting the public health and safety.” 22 Finally, after a fleeting moment of unity, the alliance between brewers and distillers to repel prohibitionist attacks fell apart. 23 The widespread local battles fought over the previous 20 years brought new support to the cause, and the ASL’s nonpartisan, balance-of-power method worked effectively. 24

The wartime atmosphere during the relatively brief period of American participation in World War I played a minor role in bringing on National Prohibition. Anti-German sentiment, shamelessly whipped up and exploited by the federal government to rally support for the war effort, discredited a key antiprohibitionist organization, the German-American Alliance. A federal ban on distilling, adopted to conserve grain, sapped the strength of another major wet player, the spirits industry. 25 But most prohibition victories at the state level and in congressional elections were won before the United States entered the war, and the crucial ratification votes occurred after the war’s end. 26

In sum, although the temperance movement was a century old when the Eighteenth Amendment was adopted, and National Prohibition had been a goal for many prohibitionists for half that long, its achievement came about as a product of a specific milieu. Few reform movements manage to win a constitutional amendment. Nevertheless, that achievement, which seemed at the time so permanent—no constitutional amendment had ever before been repealed—was vulnerable to shifts in the context on which it depended.

PUBLIC HEALTH CONSEQUENCES OF PROHIBITION

We forget too easily that Prohibition wiped out an industry. In 1916, there were 1300 breweries producing full-strength beer in the United States; 10 years later there were none. Over the same period, the number of distilleries was cut by 85%, and most of the survivors produced little but industrial alcohol. Legal production of near beer used less than one tenth the amount of malt, one twelfth the rice and hops, and one thirtieth the corn used to make full-strength beer before National Prohibition. The 318 wineries of 1914 became the 27 of 1925. 27 The number of liquor wholesalers was cut by 96% and the number of legal retailers by 90%. From 1919 to 1929, federal tax revenues from distilled spirits dropped from $365 million to less than $13 million, and revenue from fermented liquors from $117 million to virtually nothing. 28

The Coors Brewing Company turned to making near beer, porcelain products, and malted milk. Miller and Anheuser-Busch took a similar route. 29 Most breweries, wineries, and distilleries, however, closed their doors forever. Historically, the federal government has played a key role in creating new industries, such as chemicals and aerospace, but very rarely has it acted decisively to shut down an industry. 30 The closing of so many large commercial operations left liquor production, if it were to continue, in the hands of small-scale domestic producers, a dramatic reversal of the normal course of industrialization.

Such industrial and economic devastation was unexpected before the introduction of the Volstead Act, which followed adoption of the Eighteenth Amendment. The amendment forbade the manufacture, transportation, sale, importation, and exportation of “intoxicating” beverages, but without defining the term. The Volstead Act defined “intoxicating” as containing 0.5% or more alcohol by volume, thereby prohibiting virtually all alcoholic drinks. The brewers, who had expected beer of moderate strength to remain legal, were stunned, but their efforts to overturn the definition were unavailing. 31 The act also forbade possession of intoxicating beverages, but included a significant exemption for custody in one’s private dwelling for the sole use of the owner, his or her family, and guests. In addition to private consumption, sacramental wine and medicinal liquor were also permitted.

The brewers were probably not the only Americans to be surprised at the severity of the regime thus created. Voters who considered their own drinking habits blameless, but who supported prohibition to discipline others, also received a rude shock. That shock came with the realization that federal prohibition went much farther in the direction of banning personal consumption than all local prohibition ordinances and many state prohibition statutes. National Prohibition turned out to be quite a different beast than its local and state cousins.

Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. They rose after that, but generally did not reach the peaks recorded during the period 1900 to 1915. After Repeal, when tax data permit better-founded consumption estimates than we have for the Prohibition Era, per capita annual consumption stood at 1.2 US gallons (4.5 liters), less than half the level of the pre-Prohibition period. 32

Prohibition affected alcoholic beverages differently. Beer consumption dropped precipitously. Distilled spirits made a dramatic comeback in American drinking patterns, reversing a three-quarters-of-a-century decline, although in volume spirits did not reach its pre-Prohibition level. Small-scale domestic producers gave wine its first noticeable, though small, contribution to overall alcohol intake, as wine-grape growers discovered that the Volstead Act failed to ban the production and sale of grape concentrate (sugary pulp that could be rehydrated and fermented to make wine). 33

UNINTENDED AND UNEXPECTED CONSEQUENCES

Unexpected prosperity for wine-grape growers was not the only unintended consequence of National Prohibition. Before reviewing other unexpected outcomes, however, it is important to list the ways in which National Prohibition did fulfill prohibitionists’ expectations. The liquor industry was virtually destroyed, and this created an historic opportunity to socialize rising generations in a lifestyle in which alcohol had no place. To some degree, such socialization did take place, and the lessened consumption of the Prohibition Era reflects that. Although other forces contributed to its decline, Prohibition finished off the old-time saloon, with its macho culture and links to urban machine politics. 34 To wipe out a long-established and well-entrenched industry, to change drinking habits on a large scale, and to sweep away such a central urban and rural social institution as the saloon are no small achievements.

Nevertheless, prohibitionists did not fully capitalize on their opportunity to bring up a new generation in abstemious habits. Inspired and led by the talented writers of the Lost Generation, the shapers of mass culture—first in novels, then in films, and finally in newspapers and magazines—altered the popular media’s previously negative attitude toward drink. In the eyes of many young people, especially the increasing numbers who populated colleges and universities, Prohibition was transformed from progressive reform to an emblem of a suffocating status quo. 35 The intransigence of the dominant wing of the ASL, which insisted on zero tolerance in law enforcement, gave substance to this perception and, in addition, aligned the league with the Ku Klux Klan and other forces promoting intolerance. 36 Thus, the work of attracting new drinkers to alcohol, which had been laid down by the dying liquor industry, was taken up by new hands.

One group of new drinkers—or newly public drinkers—whose emergence in that role was particularly surprising to contemporary observers was women. Such surprise, however, was a product of the prior invisibility of women’s domestic consumption: women had in fact never been as abstemious as the Woman’s Christian Temperance Union’s activism had made them appear. 37 Women’s new willingness to drink in public—or at least in the semipublic atmosphere of the speakeasy—owed much to Prohibition’s achievement, the death of the saloon, whose masculine culture no longer governed norms of public drinking. The saloon’s demise also made it possible for women to band together to oppose Prohibition, as hundreds of thousands did in the Women’s Organization for National Prohibition Reform (WONPR). 38

Public drinking by women and college youth and wet attitudes disseminated by cultural media pushed along a process that social scientists call the “normalization of drinking”—that is, the breakdown of cultural proscriptions against liquor. Normalization, part of the long history of decay in Victorian social mores, began before the Prohibition Era and did not fully bear fruit until long afterward, but the process gained impetus from both the achievements and the failures of National Prohibition. 39

Other unintended and unexpected consequences of Prohibition included flourishing criminal activity centered on smuggling and bootlegging and the consequent clogging of the courts with drink-related prosecutions. 40 Prohibition also forced federal courts to take on the role of overseer of government regulatory agencies, and the zeal of government agents stimulated new concern for individual rights as opposed to the power of the state. 41 The bans on liquor importation and exportation crippled American ocean liners in the competition for transatlantic passenger service, thus contributing to the ongoing decline of the US merchant marine, and created an irritant in diplomatic relations with Great Britain and Canada. 42 Contrary to politicians’ hopes that the Eighteenth Amendment would finally take the liquor issue out of politics, Prohibition continued to roil the political waters even in the presidential seas, helping to carry Herbert Hoover first across the finish line in 1928 and to sink him 4 years later. 43

WHY REPEAL?

All prohibitions are coercive, but their effects can vary across populations and banned articles. We have no estimates of the size of the drinking population on the eve of National Prohibition (or on the eve of wartime prohibition, which preceded it by several months), but because of the phenomenon of “drinking drys” it was probably larger than the total of votes cast in referenda against state prohibition measures, and many of the larger states did not even hold such referenda. So Prohibition’s implicit goal of teetotalism meant changing the drinking behavior of a substantial number of Americans, possibly a majority.

Because the Volstead Act was drafted only after ratification of the Eighteenth Amendment was completed, neither the congressmen and state legislators who approved submission and ratification, nor the voters who elected them, knew what kind of prohibition they were voting for. 44 The absolutism of the act’s definition of intoxicating liquors made national alcohol prohibition a stringent ban, and the gap between what voters thought they were voting for and what they got made this sweeping interdict appear undemocratic. Nevertheless, support for prohibition in post-ratification state referenda and the boost given to Herbert Hoover’s 1928 campaign by his dry stance indicate continued electoral approval of Prohibition before the stock-market crash of 1929.

Historians agree that enforcement of the Volstead Act constituted National Prohibition’s Achilles’ heel. A fatal flaw resided in the amendment’s second clause, which mandated “concurrent power” to enforce Prohibition by the federal government and the states. ASL strategists expected that the states’ existing criminal-justice machinery would carry out the lion’s share of the work of enforcement. Consequently, the league did not insist on creating adequate forces or funding for federal enforcement, thereby avoiding conflict with Southern officials determined to protect states’ rights. The concurrent-power provision, however, allowed states to minimize their often politically divisive enforcement activity, and the state prohibition statutes gave wets an obvious target, because repeal of a state law was easier than repeal of a federal law or constitutional amendment, and repeal’s success would leave enforcement in the crippled hands of the federal government. 45 Even if enforcement is regarded as a failure, however, it does not follow that such a lapse undermined political support for Prohibition. Depending on the number of drinking drys, the failure of enforcement could have produced the opposite effect, by allowing voters to gain access to alcohol themselves while voting to deny it to others.

Two other possible reasons also fall short of explaining Repeal. The leading antiprohibitionist organization throughout the 1920s was the Association Against the Prohibition Amendment (AAPA), which drew its support mainly from conservative businessmen, who objected to the increased power given to the federal government by National Prohibition. Their well-funded arguments, however, fell on deaf ears among the voters throughout the era, most tellingly in the presidential election of 1928. Both the AAPA and the more widely supported WONPR also focused attention on the lawlessness that Prohibition allegedly fostered. This argument, too, gained little traction in the electoral politics of the 1920s. When American voters changed their minds about Prohibition, the AAPA and WONPR, together with other repeal organizations, played a key role in focusing and channeling sentiment through an innovative path to Repeal, the use of specially elected state conventions. 46 But they did not create that sentiment.

Finally, historians are fond of invoking widespread cultural change to explain the failure of National Prohibition. Decaying Victorian social mores allowed the normalization of drinking, which was given a significant boost by the cultural trendsetters of the Jazz Age. In such an atmosphere, Prohibition could not survive. 47 But it did. At the height of the Jazz Age, American voters in a hard-fought contest elected a staunch upholder of Prohibition in Herbert Hoover over Al Smith, an avowed foe of the Eighteenth Amendment. Repeal took place, not in the free-flowing good times of the Jazz Age, but rather in the austere gloom 4 years into America’s worst economic depression.

Thus, the arguments for Repeal that seemed to have greatest resonance with voters in 1932 and 1933 centered not on indulgence but on economic recovery. Repeal, it was argued, would replace the tax revenues foregone under Prohibition, thereby allowing governments to provide relief to suffering families. 48 It would put unemployed workers back to work. Prohibitionists had long encouraged voters to believe in a link between Prohibition and prosperity, and after the onset of the Depression they abundantly reaped what they had sown. 49 Voters who had ignored claims that Prohibition excessively centralized power, failed to stop drinking, and fostered crime when they elected the dry Hoover now voted for the wet Franklin Roosevelt. They then turned out to elect delegates pledged to Repeal in the whirlwind series of state conventions that ratified the Twenty-First Amendment. Thus, it was not the stringent nature of National Prohibition, which set a goal that was probably impossible to reach and that thereby foredoomed enforcement, that played the leading role in discrediting alcohol prohibition. Instead, an abrupt and radical shift in context killed Prohibition.

LEGACIES OF PROHIBITION

The legacies of National Prohibition are too numerous to discuss in detail; besides, so many of them live on today and continue to affect Americans’ everyday lives that it is even difficult to realize that they are Prohibition’s byproducts. I will briefly mention the principal ones, in ascending order from shortest-lived to longest. The shortest-lived child of Prohibition actually survived to adulthood. This was the change in drinking patterns that depressed the level of consumption compared with the pre-Prohibition years. Straitened family finances during the Depression of course kept the annual per capita consumption rate low, hovering around 1.5 US gallons. The true results of Prohibition’s success in socializing Americans in temperate habits became apparent during World War II, when the federal government turned a more cordial face toward the liquor industry than it had during World War I, and they became even more evident during the prosperous years that followed. 50 Although annual consumption rose, to about 2 gallons per capita in the 1950s and 2.4 gallons in the 1960s, it did not surpass the pre-Prohibition peak until the early 1970s. 51

The death rate from liver cirrhosis followed a corresponding pattern. 52 In 1939, 42% of respondents told pollsters that they did not use alcohol at all. If that figure reflected stability in the proportionate size of the non-drinking population since the pre-Prohibition years, and if new cohorts—youths and women—had begun drinking during Prohibition, then the numbers of new drinkers had been offset by Prohibition’s socializing effect. By 1960, the proportion of abstainers had fallen only to 38%. 53

The Prohibition Era was unkind to habitual drunkards, not because their supply was cut off, but because it was not. Those who wanted liquor badly enough could still find it. But those who recognized their drinking as destructive were not so lucky in finding help. The inebriety asylums had closed, and the self-help societies had withered away. In 1935, these conditions gave birth to a new self-help group, Alcoholics Anonymous (AA), and the approach taken by these innovative reformers, while drawing from the old self-help tradition, was profoundly influenced by the experience of Prohibition.

AA rejected the prohibitionists’ claim that anyone could become a slave to alcohol, the fundamental assumption behind the sweeping approach of the Volstead Act. There were several reasons for this decision, but one of the primary ones was a perception that Prohibition had failed and a belief that battles already lost should not be refought. Instead, AA drew a rigid line between normal drinkers, who could keep their consumption within the limits of moderation, and compulsive drinkers, who could not. Thus was born the disease concept of alcoholism. Although the concept’s principal aim was to encourage sympathy for alcoholics, its result was to open the door to drinking by everyone else. 54 Influenced by Repeal to reject temperance ideology, medical researchers held the door open by denying previously accepted links between drinking and disease. 55

Another force energized by Prohibition also promoted drinking: the liquor industry’s fear that Prohibition might return. Those fears were not unjustified, because during the late 1930s two fifths of Americans surveyed still supported national Prohibition. 56 Brewers and distillers trod carefully, to be sure, attempting to surround liquor with an aura of “glamour, wealth, and sophistication,” rather than evoke the rough culture of the saloon. To target women, whom the industry perceived as the largest group of abstainers, liquor ads customarily placed drinking in a domestic context, giving hostesses a central role in dispensing their products. 57 Too much can easily be made of the “cocktail culture” of the 1940s and 1950s, because the drinking population grew only slightly and per capita consumption rose only gradually during those years. The most significant result of the industry’s campaign was to lay the foundation for a substantial increase in drinking during the 1960s and 1970s.

By the end of the 20th century, two thirds of the alcohol consumed by Americans was drunk in the home or at private parties. 58 In other words, the model of drinking within a framework of domestic sociability, which had been shaped by women, had largely superseded the style of public drinking men had created in their saloons and clubs. 59 Prohibition helped to bring about this major change in American drinking patterns by killing the saloon, but it also had an indirect influence in the same direction, by way of the state. When Prohibition ended, and experiments in economic regulation—including regulation of alcohol—under the National Recovery Administration were declared unconstitutional, the federal government banished public health concerns from its alcohol policy, which thereafter revolved around economic considerations. 60

Some states retained their prohibition laws—the last repeal occurring only in 1966—but most created pervasive systems of liquor control that affected drinking in every aspect. 61 Licensing was generally taken out of the hands of localities and put under the control of state administrative bodies, in an attempt to replace the impassioned struggles that had heated local politics since the 19th century with the cool, impersonal processes of bureaucracy. Licensing policy favored outlets selling for off-premise consumption, a category that eventually included grocery stores. With the invention of the aluminum beer can and the spread of home refrigeration after the 1930s, the way was cleared for the home to become the prime drinking site.

LESSONS FOR OTHER DRUG PROHIBITIONS

Perhaps the most powerful legacy of National Prohibition is the widely held belief that it did not work. I agree with other historians who have argued that this belief is false: Prohibition did work in lowering per capita consumption. The lowered level of consumption during the quarter century following Repeal, together with the large minority of abstainers, suggests that Prohibition did socialize or maintain a significant portion of the population in temperate or abstemious habits. 62 That is, it was partly successful as a public health innovation. Its political failure is attributable more to a changing context than to characteristics of the innovation itself.

Today, it is easy to say that the goal of total prohibition was impossible and the means therefore were unnecessarily severe—that, for example, National Prohibition could have survived had the drys been willing to compromise by permitting beer and light wine 63 —but from the perspective of 1913 the rejection of alternate modes of liquor control makes more sense. Furthermore, American voters continued to support Prohibition politically even in its stringent form, at least in national politics, until their economy crashed and forcefully turned their concerns in other directions. Nevertheless, the possibility remains that in 1933 a less restrictive form of Prohibition could have satisfied the economic concerns that drove Repeal while still controlling the use of alcohol in its most dangerous forms.

Scholars have reached no consensus on the implications of National Prohibition for other forms of prohibition, and public discourse in the United States mirrors our collective ambivalence. 64 Arguments that assume that Prohibition was a failure have been deployed most effectively against laws prohibiting tobacco and guns, but they have been ignored by those waging the war on other drugs since the 1980s, which is directed toward the same teetotal goal as National Prohibition. 65 Simplistic assumptions about government’s ability to legislate morals, whether pro or con, find no support in the historical record. As historian Ian Tyrrell writes, “each drug subject to restrictions needs to be carefully investigated in terms of its conditions of production, its value to an illicit trade, the ability to conceal the substance, and its effects on both the individual and society at large.” 66 From a historical perspective, no prediction is certain, and no path is forever barred—not even the return of alcohol prohibition in some form. Historical context matters.

Bone Dry Forever! This sign on a St Louis street at Prohibition’s onset illustrates the widely held belief that the liquor ban would be permanent.

Source. Missouri Historical Society, image SNDC 7-08-0022.

Seized distilling equipment early in the Prohibition Era reflects the artisanal scale to which the production of beverage alcohol was reduced.

Source. Chicago Historical Society, image DN-0072348.

The Federal Prohibition Bureau, led by Roy Haines (left), was chronically underfunded by Congress and harrassed by officials of the Anti-Saloon League, such as O. G. Christgau (right).

Source. Chicago Historical Society, image DN-0079835.

Prohibition fostered increasing consumption of nonalcoholic beverages, such as fruit juices and carbonated drinks, the latter symbolized by this A&W Root Beer stand in Madison, Wisc, in 1931.

Source. Wisconsin Historical Society, Image 18489.

Acknowledgments

Tom Pegram and Ted Brown provided helpful comments on an earlier version of the article.

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Essay on Prohibition

The views of people on prohibition have always been different. A controversy has been raging for the last few centuries about the usefulness and efficacy of Prohibition. Prohibition implies banning of drinking by the Government.

Those who are opposed to prohibition have their own arguments to support their views. The lovers of wine find nothing wrong in drinking. According to them, Hindu Mythology is replete with names of gods and demons who drank Soma’ and Sura’ respectively. They further say that the Russians have been taking Vodka’ and even the English are not against drinking.

They contend that wine is used in the religious rituals of the English and that it has become a second nature with them to drink. They even go to the extent of saying that during the British rule in India drinking became a mark of gentility with the people to drink and those who did not were considered backwards in civilization.

The opponents of Prohibition argue that life is full of miseries and sorrows and that it is a ring of dejection. According to them, there is no other way to forget their worries except by drowning their sorrows in a cup of wine. Even some state governments of India of the post-independence era imposed prohibition only to withdraw it later on.

Maharashtra, Gujarat, Andhra and Haryana had bitter experience on this issue. This speaks, according to the lovers of wine, of the uselessness of prohibition because it deprives the states of a big part of revenue coming from excise and custom of liquor.

Some argue that drinking is a personal matter and any prohibition amounts to suppressing individual liberty. Moreover, they point out, that the more prohibition exerted itself, the greater will be the popularity of drink. Illicit sale and smuggling of wine have raised its fangs in the states where prohibition was imposed.

But those who oppose prohibition do not realise the: drowning of sorrows in a cup of wine is a temporary escape from ironic; tragedies stresses and strains of life. They should not forget that habit is second nature. Habit is the first cobweb, then a cable.

We weave a thread of it every day, and at last, we cannot break it. The supporters of prohibition are of the view that revenue from custom and excise of liquor should not be earned to the moral and economic detriment of unfortunate individuals and their families.

The advocates of individual liberty should not forget that liberty is not licensed. It is not a curtailment of an individual’s liberty to prevent a man from drinking that results in the ruin of his family and very often leads to his personal physical, mental, moral and material ruin.

The evil effects of drinking are obvious. It ruins discriminate discrimination between good and evil. It switches off the control of reason and conscience, and makes one blind with passion. It engenders an irresistible craving for wine, women and wealth.

It makes a man completely imbecile, besides ruining his finances family and his family. It incapacitates the brain and imagination and breaks down a man’s morale and will-power. It overstrains the nerves, shatters the lungs and the heart, thereby bringing the person who indulges in it to premature death.

Apart from this, the habit of drinking is a great social evil too. It degenerates and perverts society. A man under the influence of liquor fails to distinguish between wife and daughter.

His judgement fails ments falter and he loses all sobriety. It has cost many promising People dearly S.T. Coleridge, Marlowe, singer Prince Sehgal, etc., fell victims to the evil of drinking.

Prohibition implies complete abstinence from wine. Gandhi. Morarji Desai and social reformers of India wanted prohibition to be enforced in the country so that the poor classes like the knights of the broom, the washermen, the cobblers, the unskilled labourers, drivers, professional soldiers and others might not ruin themselves by drinking liquor.

But the job is not that easy. It cannot be a success as long as people are illiterate and poor. The government must realise that the people are still groping in the dark. They cannot tell good from evil, right from wrong. The spread of education can alone broaden their mental horizon.

Since our education system is itself defective, it cannot be expected to deliver the good. There is strong need of awakening in the masses. Changes in the education system be brought about to suit the purpose. Healthy diversions, cultural activities and love for life are very essential before the cup of wine is snatched from the lips.

Prohibition is a social problem. The economic conditions of the people will have to be improved. Labour laws will have to be enacted to lessen the physical strain of the workers. Sources of amusement and recreation will have to be provided.

Honest administration vigilantly guarding against smuggling and illicit distillation is a must. Work and ideals of success and prosperity will have to be made available to every individual to achieve freedom from want, worry, fear and frustration. Social conscience will have to be awakened against the custom of drinking on days of festivals and other occasions of festivity.

If the above mentioned steps are taken both by the government and the Social reformers with courage and will-power and that too in right earnest, there is no reason why is reason why the people of India will not be healed of this evil of drinking.

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The Anti-Abortion Endgame That Erin Hawley Admitted to the Supreme Court

Somewhat lost in the debate around abortion pills and oral arguments that took place at the Supreme Court in FDA v. Alliance for Hippocratic Medicine on Tuesday was one deeply uncomfortable truth: The very notion of what it means to practice emergency medicine is in dispute, with anti-abortion doctors insisting upon a right to refuse treatment for any patient who doesn’t meet their test of moral purity. Indeed, the right asserted is that in the absence of certainty about which patients are morally pure, the doctors want to deny medication to all patients, nationwide.

In public, the plaintiffs in this case—a group of doctors and dentists seeking to ban medication abortion—have long claimed they object to ending “unborn life” by finishing an “incomplete or failed” abortion at the hospital. But in court, they went much further. Their lawyer, Erin Hawley, admitted at oral argument that her clients don’t merely oppose terminating a pregnancy—they are pursuing the right to turn away a patient whose pregnancy has already been terminated . Indeed, they appear to want to deny even emergency care to patients whose fetus is no longer “alive,” on the grounds that the patient used an abortion drug earlier in the process. And they aim to deploy this broad fear of “complicity” against the FDA, to demand a nationwide prohibition on the abortion pill to ensure that they need never again see (and be forced to turn away) patients who’ve previously taken it. This is not a theory of being “complicit” in ending life. It is a theory that doctors can pick and choose their patients based on the “moral distress” they might feel in helping them.

It should come as no surprise that the same judge who tried to ban mifepristone in this case, Matthew Kacsmaryk, has also attempted to legalize anti-LGBTQ+ discrimination in health care nationwide. This is the ballgame: weaponize subjective religious beliefs against secular society to degrade the quality of care for everyone. If you can’t persuade Americans to adopt hardcore evangelical views, exploit the legal system to coerce them into it anyway.

Alliance for Hippocratic Medicine is at once embarrassingly frivolous and existentially important. Don’t let the jokes about how silly the Comstock Act seems , or how speculative the theory of standing is, get in the way of taking a serious look at the claims on offer. The plaintiffs say they are terrified that one day, a patient may walk into their emergency room suffering complications from a medication abortion prescribed by some other doctor. This patient may need their assistance completing the abortion or simply recovering from the complete abortion, which these plaintiffs deem “complicity” in sin. And they say the solution is either a total, nationwide ban on mifepristone, the first drug in the medication abortion sequence, or a draconian (and medically unnecessary) set of restrictions that would place mifepristone out of reach for many patients. (The U.S. Court of Appeals for the 5 th Circuit ruled to reinstate those restrictions at their behest.)

It is a twisted line of logic, one that should never have reached the Supreme Court in the first place. But it is also a product of the court’s past indulgence of outlandish claims about moral “complicity.” As was made plain in the oral arguments and briefing, activist doctors are no longer satisfied with personal conscience exemptions already granted under state and federal law; they now insist that nobody, anywhere, should have access to the abortion pill, in order to ensure that they themselves won’t have to treat patients who took one. At a minimum, they say, they should be able to radically roll back access to the pill in all 50 states to reduce the odds that one of these handful of objectors might someday encounter a patient who took it. This extremist argument lays bare the transformation of the idea of “complicity” from a shield for religious dissenters to a sword for ideologues desperate to seize control over other people’s lives and bodies.

At oral arguments, several justices pressed Hawley, who argued on behalf of Alliance for Hippocratic Medicine, with an obvious retort: Why can’t her clients simply refuse to treat these hypothetical someday patients on the grounds that they cannot help end the “life” of a fetus or embryo? After all, federal law guarantees doctors the right not to have to provide an abortion if doing so is “contrary to his religious beliefs or moral convictions.” Justices Amy Coney Barrett and Brett Kavanaugh secured assurances from Solicitor General Elizabeth Prelogar, early in the arguments, that under no circumstances could the government force any health care provider to ever participate in an abortion in violation of their conscience. Justice Elena Kagan asked Prelogar: “Suppose somebody has bled significantly, needs a transfusion, or, you know, any of a number of other things that might happen.” Would the plaintiffs object to treating them? Prelogar said the record was unclear.

Hawley, who is married to far-right Republican Sen. Josh Hawley, then approached the lectern and cleared up any confusion: Yes, she insisted, treating a patient who has undergone a medication abortion violates the conscience of the plaintiff physicians even if there is no “live” fetus or embryo to terminate anymore. “Completing an elective abortion means removing an embryo fetus, whether or not they’re alive, as well as placental tissue,” Hawley told Kagan. So the plaintiffs don’t object just to taking a “life.” They also object to the mere act of removing leftover tissue, even from the placenta.

Of course, these doctors must remove “dead” fetal tissue and placentas all the time—from patients who experienced a spontaneous miscarriage. By their own admission, the plaintiffs regularly help women complete miscarriages through surgery or medication. Those women they will gladly treat. Other women, though—the ones who induced their own miscarriage via medication—are too sinful to touch. Before the plaintiffs can administer even lifesaving emergency treatment, they need to know the circumstances of this pregnancy loss: Spontaneous miscarriages are OK; medication abortions are not.

Justice Ketanji Brown Jackson, too, zeroed in on this admission. She told Hawley that she had thought the objection was to “participating in a procedure that is ending the life [of the fetus].” Hawley told her no: Any participation in an abortion, even through the indirect treatment of a patient without a “live” fetus, violated the doctors’ conscience. So, wait. What about “handing them a water bottle?” Jackson asked. Hawley dodged the question, declining to say whether helping a patient hydrate would constitute impermissible complicity in sin.

All this is reminiscent of Little Sisters of the Poor , a case about a Catholic charitable group that was afforded an exemption from the Affordable Care Act’s contraception mandate. The Little Sisters were asked to check a box signaling to the government that they could not comply with the mandate, at which point the government would step in to cover their employees. But the Little Sisters refused, viewing this action—the checking of a box to opt out of coverage—as “complicity” in abortion because it would in turn trigger government payment for contraception (which they viewed as abortifacients). The Supreme Court and the Trump administration ultimately indulged the Little Sisters’ claim .

Here, we have emergency room physicians asserting that they will not participate in lifesaving medical intervention unless they approve of the reason for the pregnancy loss. Presumably, if the pregnant patient is an unwed mother, or a gay or transgender person, the doctor would be similarly complicit in sin and decline service. Seen through this lens, since one can never know which sins one is enabling in the ER, each and every day, a narrow conscience exemption becomes a sweeping guarantee that absolutely nobody in the country can ever have access to basic health care, let alone miscarriage management. (Of course, these plaintiffs might focus only on one set of “sins” they see as relevant.) In a country effectively governed by Kacsmaryk and his plaintiff friends, a gay person suffering a stroke could be turned away from any hospital because of his sexual orientation, all to spare a doctor from a glancing encounter with prior sin. As Tobias Barrington Wolff, a professor of law at the University of Pennsylvania Law School, put it to us in an email, this unbounded view of complicity “is part of enacting the social death of people and practices you abhor, which in turn can contribute to the material death of people and practices you abhor.”

One of the most exhausting lessons of post- Roe America is that being “pro-life” definitively means privileging the life of the presumptively sin-free unborn—or even their “dead” remains—over the life of the sin-racked adults who carry them. This is why women are left to go septic or to hemorrhage in hospital parking lots; it is why C-sections are performed in nonviable pregnancies, at high risk to mothers; it’s why the women who sued in Texas to secure exceptions to that state’s abortion ban are condemned by the state as sinners and whores . And it’s why—in the eyes of the Alliance for Hippocratic Medicine — it is a greater hardship for a physician to “waste precious moments scrubbing in, scrubbing out” of emergency surgery, as Hawley put it, so long as they don’t believe that the emergency warrants their professional services, than it is for a pregnant person, anywhere in the country, including in states that permit abortion, to be forced to give birth.

At oral argument, Hawley explained that her clients have “structured [their] medical practice to bring life into the world. When they are called from their labor and delivery floor down to the operating room to treat a woman suffering from abortion drug harm, that is diametrically opposed to why they entered the medical profession. It comes along with emotional harm.” The emotional harm alleged here is that unless these doctors approve of the specific circumstances of the ER visit, they violate not only their own medical preference but also their religious convictions. But they will never truly know enough about the sins of their patients to be able to shield themselves against being a link in a chain of subjective lifelong sin. And to be a doctor, especially an emergency physician, should be to understand that your patients’ private choices and spiritual life are not really open to your pervasive and vigilant medical veto. This deep-rooted suspicion of patients deemed insufficiently pure for lifesaving treatment didn’t begin with the availability of medication abortion. It will assuredly not end there.

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The War on Drugs is Also a War on Pain Patients

Related articles.

In a recent New York Times essay, a professor of anesthesia and pain management recently protested the Drug Enforcement Administration's opioid manufacturing quotas and micromanagement of doctors treating their patients' pain. At a time when DEA S.W.A.T. teams frequently raid doctors' offices for "inappropriate" prescribing, the professor's essay demonstrated boldness. Unfortunately, the professor's reform proposals were much less bold.

In a March 22 opinion  column  in the  New York Times  entitled “The DEA Needs to Stay Out of Medicine,” Vanderbilt University Medical Center associate professor of anesthesiology and pain management Shravani Durbhakula, MD, documents powerfully how patients suffering from severe pain—many of them terminal cancer patients—have become collateral casualties in the government’s war on drugs.

Decrying the Drug Enforcement Administration’s progressive tightening of opioid manufacturing quotas, Dr. Durbhakula writes:

In theory, fewer opioids sold means fewer inappropriate scripts filled, which should curb the  diversion of prescription opioids for illicit purposes  and decrease overdose deaths — right? I can tell you from the front lines that that’s not quite right. Prescription opioids once drove the opioid crisis. But in recent years opioid prescriptions have significantly fallen, while overdose deaths have been at a record high. America’s  new wave  of fatalities is largely a result of the illicit market, specifically  illicit fentanyl . And as production cuts contribute to the reduction of the already strained supply of legal, regulated prescription opioids, drug shortages stand to affect the more than  50 million people  suffering from chronic pain in more ways than at the pharmacy counter.

Dr. Durbhakula provides stories of patients having to travel long distances to see their doctors in person due to DEA requirements about opioid prescriptions. However, despite their efforts, they find that many of the pharmacies do not have the opioids they require because of quotas. She writes:

Health care professionals and pharmacies in this country are chained by the Drug Enforcement Administration. Our patients’ stress is the result not of an orchestrated set of practice guidelines or a comprehensive clinical policy but rather of one government agency’s crude, broad‐​stroke technique to mitigate a public health crisis through manufacturing limits — the gradual and repeated rationing of how much opioids can be produced by legitimate entities.

In the essay, Dr.Durbhakula does not question or challenge the  false narrative  that the overdose crisis originated with doctors “overprescribing” opioids to their pain patients.

Unfortunately, Dr. Durbhakula’s proposed policy recommendations would do little to advance patient and physician autonomy. She would merely transfer control over doctors treating pain from the cops to federal health bureaucracies and let those agencies set opioid production quotas. For instance, she claims, “It’s incumbent on us [doctors] to hand the reins of authority over to public health institutions better suited to the task.”

No. The “reins of authority” belong in the hands of patients and doctors.

Dr. Durbhakula suggests that “instead of defining medical aptness, the DEA should pass the baton to our nation’s public health agencies” and proposes that the Centers for Disease Control and Prevention and the Food and Drug Administration “collaborate” to “place controls on individual prescribing and respond to inappropriate prescribing.” She elides the fact that these public health agencies will “respond” to doctors or patients who don’t comply with their regulations by calling the cops.

To be sure, Dr. Durbhakula has good intentions. But replacing actual cops—the DEA—with federal health agencies that can order those cops to arrest non‐​compliant doctors and patients is like rearranging the deck chairs on the Titanic. True, her proposed new pain management overlords would have greater medical expertise, but they would still reign over doctors and patients and assault their autonomy. And, as we  learned  during the COVID-19 pandemic, they will not be immune to political pressures and  groupthink .

While her policy prescriptions may be flawed, Dr. Durbhakula deserves praise for having the courage to point out that the war on drugs is also a war on pain patients. Alas, courageous doctors are in short supply these days. Most doctors keep their heads down and follow the cops’ instructions.

After I read her essay, I wrote the following (unpublished) letter to the editor of the  New York Times :

Dear Editor— Kudos to Dr. Durhakula for speaking out against the Drug Enforcement Administration’s intruding on doctors’ pain treatment (“ The DEA Needs to Stay Out of Medicine ,” March 22, 2024). As my colleague and I explained in our 2022 Cato Institute white paper, “ Cops Practicing Medicine ,” for more than 100 years, law enforcement has been increasingly surveilling and regulating pain management. The DEA maintains a schedule of substances it controls, and it categorizes them based on what the agency determines to be their safety and addictive potential. The DEA even presumes to know how many and what kind of controlled substances—from stimulants like Adderall to narcotics like oxycodone—the entire US population will need in future years, setting quotas on how many each pharmaceutical manufacturer may annually produce. The DEA restricts pain management based on the flawed assumption that what they consider to be “overtreatment” caused the overdose crisis. However, as my colleagues and I showed, there is  no correlation  between the opioid prescription rate and the rate of non‐​medical opioid use or opioid addiction. And, of course, as fear of DEA reprisal has caused the prescription rate to drop precipitously in the last dozen years, overdose deaths have soared as the black market provided non‐​medical users of “diverted” prescription pain pills first with more dangerous heroin and later with fentanyl. Researchers at the University of Pittsburgh School of Public Health found that overdose fatalities have been rising  exponentially  since at least the late 1970s, with different drugs predominating during various periods. Complex sociocultural, psychosocial, and socioeconomic forces are at the root of the overdose crisis, requiring serious investigation. Yet policymakers have chosen the lazy answer by blaming the overdose crisis on doctors treating pain. When cops practice medicine, overdoses increase, drug cartels get richer, and patients suffer. Sincerely, Jeffrey A. Singer, MD, FACS Senior Fellow, Cato Institute

When cops practice medicine, overdoses increase, drug cartels get richer, and patients suffer.

Reprinted with permission. Dr. Singer's original piece can be found here on the Cato Institute website

View the discussion thread.

By Jeffrey Singer

Jeffrey A. Singer, MD received his BA from Brooklyn College and his MD from New York Medical College. After completing his surgical residency and receiving Board Certification he began a private practice as a general surgeon in Phoenix, Arizona and became a Fellow of the American College of Surgeons. He is a Senior Fellow at the Cato Institute in Washington, DC, serving in the Department of Health Policy Studies. He is also a Visiting Fellow at the Goldwater Institute in Phoenix, AZ. His principal areas of scholarship are health care policy, drug policy, drug prohibition, and harm reduction. Dr. Singer has been practicing medicine for more than 30 years.

Latest from Jeffrey Singer :

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Press Release

FDIC Makes Public February Enforcement Actions

No Administrative Hearings Scheduled For April 2024

For Release

WASHINGTON — The Federal Deposit Insurance Corporation (FDIC) today released a list of orders of administrative enforcement actions taken against banks and individuals in February 2024. There are no administrative hearings scheduled for April 2024.

The FDIC issued six orders in February 2024. The administrative enforcement actions in those orders consisted of one order to pay civil money penalty (CMP), two consent orders, one prohibition order, one combined prohibition order and order to pay a CMP, and one order terminating consent order.

To view orders, adjudicated decisions and notices and the administrative hearing details online, please visit the FDIC’s Web page by clicking the link below.

February 2024 Enforcement Decisions and Orders

FDIC: PR-21-2024

Home — Essay Samples — History — Prohibition — Prohibition Dbq Questions And Answers

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Florida Court Allows 6-Week Abortion Ban, but Voters Will Get to Weigh In

The Florida Supreme Court found that the State Constitution’s privacy protections do not extend to abortion. But it also allowed a ballot question on whether to expand abortion access.

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By Patricia Mazzei

Reporting from Miami

• April 1, 2024

The Florida Supreme Court overturned decades of legal precedent on Monday in ruling that the State Constitution’s privacy protections do not extend to abortion, effectively allowing Florida to ban the procedure after six weeks of pregnancy.

But in a separate decision released at the same time, the justices allowed Florida voters to decide this fall whether to expand abortion access. The court ruled 4 to 3 that a proposed constitutional amendment that would guarantee the right to abortion “before viability,” usually around 24 weeks, could go on the November ballot.

Read the Florida Supreme Court’s Ruling on the Abortion Ban

The Florida Supreme Court overturned decades of legal precedent in ruling that the State Constitution’s privacy protections do not extend to abortion, effectively allowing Florida to ban the procedure after six weeks of pregnancy.

The rulings encapsulated, in a single state on a single day, how the country has grappled with the abortion issue since the U.S. Supreme Court overturned the Roe v. Wade decision that recognized federal abortion rights in 1973.

The conservative-leaning court found 6-1 that a 15-week abortion ban enacted in 2022 was constitutional. That ruling — in response to a lawsuit brought by Planned Parenthood, the American Civil Liberties Union and several abortion providers — will allow a six-week ban enacted last year to take effect by May 1.

“Based on our analysis finding no clear right to abortion embodied within the Privacy Clause, Planned Parenthood cannot overcome the presumption of constitutionality and is unable to demonstrate beyond a reasonable doubt that the 15-week ban is unconstitutional,” Justice Jamie R. Grosshans wrote in the majority opinion.

In paving the way for the six-week ban, the court cemented the rapid transformation of Florida, once a destination for women seeking abortions in the American South, into a place with restrictive policies akin to those in surrounding states.

But allowing the ballot measure gave supporters of abortion rights a chance to continue their national campaign to preserve access to the procedure by giving voters the opportunity to directly weigh in on the issue. Ballot measures in favor of abortion rights have already succeeded in several states, including Ohio and Michigan.

Read the Florida Supreme Court’s Ruling on the Constitutional Amendment

The Florida Supreme Court allowed voters to decide this fall whether to expand abortion access, ruling 4 to 3 that a proposed constitutional amendment that would guarantee the right to abortion “before viability,” usually around 24 weeks, could go on the November ballot.

“This is a historic day in the fight for abortion access in Florida,” said Lauren Brenzel, director for the Yes on 4 campaign that put forth the ballot measure. “No longer will decisions about abortion be left between politicians disconnected from the realities of everyday Floridians’ lives.”

Abortion rights groups in about 10 states are trying to put measures on the ballot to secure access; Florida is the largest of those states.

Historically, many women from Southern states with tighter restrictions on abortion have traveled to Florida for the procedure. They will now have to seek abortions much further away, perhaps in Virginia or Washington, D.C. Few women realize that they are pregnant at six weeks, and backers of abortion rights say the stricter ban, once effective, will amount to a near-total prohibition.

In its ruling allowing the six-week ban to take effect, a majority of the justices argued that past abortion cases had been wrongly decided based on an overly broad interpretation of the State Constitution’s privacy clause — an argument similar to the one the U.S. Supreme Court made in overturning Roe .

The privacy clause in the Florida Constitution states: “Every natural person has the right to be let alone and free from governmental intrusion into the person’s private life.” The Florida Supreme Court first ruled that it applied to abortion in 1989; in 2012, voters rejected an amendment that would have exempted abortion from constitutional privacy protections.

But on Monday, a majority of the justices said that voters did not understand the privacy clause to extend to abortion when they added it to the State Constitution in 1980, citing among other things the public and legislative debate at the time.

Justice Jorge Labarga, the lone dissenter, noted that the ruling would have far-reaching consequences.

“The impact of today’s decision extends far beyond the 15-week ban at issue in this case,” he wrote. “By operation of state statute, the majority’s decision will result in even more stringent abortion restrictions in this state.”

The justices narrowly approved the ballot measure, saying it complies with Florida requirements that it be clear and limited to a single subject. Those who dissented argued in part that the language in the ballot question is too vague and could lead to years of further litigation.

Neither of Monday’s rulings was a surprise: The seven-member court has moved to the right politically, with Gov. Ron DeSantis, a Republican, appointing four of the justices. But while the court had a Monday deadline to rule on the abortion measure, it faced no similar timeline to rule on the abortion ban.

By issuing both rulings on the same day, the court gave abortion opponents a sought-after decision narrowing privacy protections. But by also allowing a ballot measure to expand abortion access, it gave those groups little time to celebrate.

Immediately after the court ruled, opponents and proponents of the ballot measure accused the other side of being extreme, previewing their likely campaign messages.

Republican lawmakers who supported the 15-week and six-week abortion bans argued that the ballot measure would allow abortions late in pregnancy. Abortions after 21 weeks are extremely rare and usually follow severe medical diagnoses.

“This is not about government’s interference with abortion but about allowing abortion until the moment of birth,” said State Senator Erin Grall of Vero Beach, who sponsored the six-week ban.

Ms. Brenzel countered that it was the lawmakers who were out of step with a majority of Floridians. Public opinion polls have suggested that most Floridians believe abortions should be legal in most cases.

And Danielle Tallafuss, a Central Florida resident who had an abortion at 22 weeks after learning that her fetus had a life-limiting heart condition before the state restricted the procedure, said women should be able to make the decision to terminate a pregnancy with their doctors.

“My heart has been in turmoil since the Supreme Court overturned Roe v. Wade and Florida’s passage of a 15-week abortion ban,” she said. “Today I am filled with hope that residents will be able to vote in November to give abortion access back to the women of this state.”

An earlier version of this article incorrectly described the breakdown of the Florida Supreme Court decision that allowed an abortion measure on the November ballot. The justices ruled 4 to 3; they were not unanimous.

How we handle corrections

Patricia Mazzei is the lead reporter for The Times in Miami, covering Florida and Puerto Rico. More about Patricia Mazzei

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FAQ about Affordable Care Act Implementation Part 66

April 2, 2024

Printer Friendly Version

Set out below is a Frequently Asked Question (FAQ) regarding implementation of certain provisions of the Affordable Care Act (ACA). This FAQ has been prepared jointly by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at https://www.dol.gov/agencies/ebsa/ laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/aca-implementation-faqs and http://www.cms.gov/cciio/resources/fact-sheets-and-faqs/index.html ), this FAQ answers a question from stakeholders to help people understand the law and promote compliance.

Prohibition on Lifetime and Annual Limits and Annual Limitation on Cost Sharing

Public Health Service Act (PHS Act) section 2711, as added by the ACA, generally prohibits group health plans and health insurance issuers offering group or individual health insurance coverage from imposing lifetime and annual dollar limits on essential health benefits (EHB), as defined under section 1302(b) of the ACA. (1) Under the ACA, self-insured group health plans and large group market plans are not required by PHS Act section 2707(a) to offer EHB; however, to the extent these plans cover EHBs, they must comply with the annual and lifetime prohibitions under PHS Act section 2711. Final regulations implementing PHS Act section 2711 provide that, for plan years beginning on or after January 1, 2020, a plan or issuer that is not required to provide EHB must define EHB, for purposes of the prohibition on lifetime and annual limits, in a manner consistent with an EHB-benchmark plan selected by a State in accordance with 45 CFR 156.111, including coverage of any additional required benefits that are considered EHB consistent with 45 CFR 155.170(a)(2). (2)

PHS Act section 2707(b), as added by the ACA, provides that non-grandfathered group health plans, including non-grandfathered self-insured and non-grandfathered insured small and large group market health plans, shall ensure that any annual cost sharing imposed under the plan does not exceed the limitations provided for under ACA section 1302(c)(1). (3) Under ACA section 1302(c)(1), an enrollee's cost sharing for a plan year for EHB is limited. This annual limitation on cost sharing also applies to non-grandfathered health insurance coverage offered in the individual and small group market through the EHB requirements of PHS Act section 2707(a). The Departments have previously issued FAQs addressing the annual limitation on cost-sharing. (4)

In the proposed HHS Notice of Benefit and Payment Parameters (NBPP) for 2025 (proposed 2025 NBPP), (5) HHS proposed to amend 45 CFR 156.122 to codify that prescription drugs in excess of those covered by a State's EHB-benchmark plan are considered EHB. Because they are EHB, benefits for those prescription drugs would be subject to EHB protections, including the annual limitation on cost sharing and the prohibition on lifetime and annual limits, unless the coverage of the drug is mandated by State action and is in addition to EHB pursuant to 45 CFR 155.170, in which case the drug will not be considered EHB. HHS stated this policy in the preamble to the 2013 Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation Final Rule (6) and the final HHS NBPP for 2016, (7) and therefore HHS was of the view that this policy was clearly understood by issuers. However, comments received in response to the EHB Request for Information (8) issued in 2022 included a significant number of requests from interested parties to clarify the applicability of this policy in rulemaking, particularly as it relates to some plans in the individual, small group, and large group markets that have developed programs to provide coverage of some drugs as "non-EHB," outside of the terms of the rest of the coverage. After consideration of comments on the proposed 2025 NBPP, HHS is finalizing the amendment to 45 CFR 156.122 in the final HHS NBPP for 2025 (final 2025 NBPP) with respect to issuers of non-grandfathered individual and small group market plans that are subject to the requirement to provide EHB.

Some commenters on the proposed 2025 NBPP stated that the final rule should make clear whether this policy applies to large group market and self-insured plans. The Departments are issuing this FAQ to address the applicability of this provision in the final 2025 NBPP to self-insured group health plans and large group market plans for purposes of the prohibition on lifetime and annual limits under PHS Act section 2711 and the annual limitation on cost sharing under PHS Act section 2707(b).

Q: Does the policy in the final 2025 NBPP, which provides that prescription drugs in excess of those covered by a State's EHB-benchmark plan are considered EHB, apply to large group market coverage and self-insured plans defining EHB for purposes of the prohibition on lifetime and annual limits under PHS Act section 2711 and the annual limitation on cost sharing under PHS Act section 2707(b)?

As explained in the preamble to the final 2025 NBPP (issued contemporaneously with this FAQ), the proposed 2025 NBPP primarily addressed the application of this policy with respect to issuers of non-grandfathered individual and small group market plans subject to the requirement to provide EHB. The final 2025 NBPP does not address the application of this policy to large group market health plans and self-insured group health plans. The Departments understand the questions raised by commenters with respect to large group market health plans and self-insured group health plans and intend to address the applicability of this policy to those plans in future notice-and-comment rulemaking. Specifically, the Departments intend to propose rulemaking that would align the standards applicable to large group market health plans and self-insured group health plans with those applicable to individual and small group market plans, so that all group health plans and health insurance coverage subject to sections 2711 and 2707(b) of the PHS Act, as applicable, would be required to treat prescription drugs covered by the plan or coverage in excess of the applicable EHB-benchmark plan as EHB for purposes of the prohibition of lifetime and annual limits and the annual limitation on cost sharing, which would further strengthen the consumer protections in the ACA.

• The provisions of PHS Act section 2711 apply to both non-grandfathered and grandfathered group health plans and group or individual health insurance coverage, except the annual limits prohibition does not apply to grandfathered individual health insurance coverage. See 45 CFR 147.140(c)(1).
• 26 CFR 54.9815-2711(c)(2), 29 CFR 2590.715-2711(c)(2), and 45 CFR 147.126(c)(2).
• The provisions of PHS Act section 2707(b) apply to all non-grandfathered group health plans, including non-grandfathered self-insured and non-grandfathered insured small and large group market plans.
• See FAQs About Affordable Care Act Implementation Part XII (Feb. 20, 2013), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-xii.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/aca_implementation_faqs12 ; FAQs About Affordable Care Act Implementation (Part XVIII) and Mental Health Parity Implementation (Jan. 9, 2014), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-xviii.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/aca_implementation_faqs18 ; FAQs About Affordable Care Act Implementation Part XIX (May 2, 2014), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-xix.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/aca_implementation_faqs19 ; FAQs About Affordable Care Act Implementation Part XXI (Oct. 10, 2014), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-xxi.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/downloads/reference_pricing_faq_101014.pdf ; FAQs About Affordable Care Act Implementation Part XXVII (May 26, 2015), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-xxvii.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/downloads/aca-faqs-part-xxvii-moop-2706-final.pdf ; FAQs About Affordable Care Act Implementation Part 31 (Apr. 20, 2016), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-31.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/downloads/faqs-31_final-4-20-16.pdf ; FAQs About Affordable Care Act Implementation Part 40 (Aug. 26, 2019), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-40.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/downloads/faqs-part-40.pdf ; FAQs About Affordable Care Act Implementation Part 46 (Jun. 4, 2021), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-46.pdf and https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/downloads/faqs-part-46.pdf ; FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 55 (Aug. 19, 2022), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-55.pdf and https://www.cms.gov/files/document/faqs-part-55.pdf ; and FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 60 (Jul. 7, 2023), available at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-60.pdf and https://www.cms.gov/files/document/faqs-part-60.pdf .
• 88 FR 82510, 82601 (Nov. 24, 2023).
• 78 FR 12833, 12845 (Feb. 25, 2013).
• 80 FR 10750 (Feb. 27, 2015).
• 87 FR 74097 (Dec. 2, 2022).