Conclusion Overreach in Alcohol and Pregnancy Article: The Authors Reply

Dear Editor,

In her recent letter to the Journal of Studies on Alcohol and Drugs editor, colleague Sarah Roberts (2016) judges that we might have overreached our conclusion in a recent article (Alshaarawy et al., 2016). She wrote:

“Telling all women who have sex with men to vigilantly check for pregnancy as a way to avoid possible (although not yet clearly documented) health effects from alcohol use during the month they become pregnant seems to be more in the line of using public health as a justification for controlling women’s behavior than following public health principles of evidence-informed interventions and using the least restrictive means necessary to accomplish public health goals” (Roberts, 2016, p. 668). We offer the following responses.

• (1) As for “telling all women” anything, what we wrote was this simple conditional statement: “If alcohol-attributable health effects on the fetus are found as early as Month 1 of the pregnancy, women who drink might be advised to use pregnancy test kits after every sexual encounter that might give rise to a conception” (Alshaarawy et al. 2016, p. 275).

• (2) Ours was a conditional statement. Our sentence starts with the conjunction “if” to convey this conditionality.

• (3) We chose the modal verb form (“might”) to convey our uncertainty, including our uncertainty about what anyone should do.

• (4) Our non-imperative statement makes clear that we have not engaged in “telling all women who have sex with men” to do anything. It’s not something we would advocate, any more than we would advise use of a pregnancy test kit before and unless the test has acceptable sensitivity and specificity.

• (5) We thank Dr. Roberts for publicizing our work, and we thank the JSAD editor for the chance to respond to the charge that we have overreached.

We encourage readers to take a look at the evidence presented in our article, to read what we actually wrote, to consider the implications, and to judge for themselves whether we have overreached or tried to use “public health as a justification for controlling women’s behavior,” (p. 668) as Dr. Roberts thinks we have done. (We do not plead guilty as charged.)

Conflicts of Interest and Source of Funding

There is no conflict of interest to disclose. This work was supported by Michigan State University, the National Institute on Drug Abuse Grants K05DA015799 and T32DA021129 to James C. Anthony, and the National Center for Complementary and Integrative Health Grant K99AT009156 to Omayma Alshaarawy. The content is the sole responsibility of the authors and does not necessarily represent the official views of Michigan State University, the National Institute on Drug Abuse, National Center for Complementary and Integrated Health, or the National Institutes of Health.