Diagnosing foetal alcohol spectrum disorder in children can be fraught with issues.
It's not the doctor's fault, really. Attention deficit hyperactivity disorder has become quite an acceptable label to paste on children these days. Everyone knows about the prevalence of ADHD; it seems to explain so much about the behaviour of young boys, in particular; and, most particularly, it locates the source of the problem in the child. Parents, and society, are absolved of any responsibility.
But what if the problem is something else? What if, as a doctor, you're aware that the young mother may have indulged in binge drinking - not a lot, you understand, just a bit - during her pregnancy? What if the mother (who loves and adores her child absolutely, of course, that's not in doubt) may not have been aware she was pregnant in the early stages and got more than a bit tipsy? Do you reach for the label foetal alcohol spectrum disorder?
Because if you do, things change. For a start, the doctor is blaming the mother for the child's mental condition. It implies, no, asserts, she drank during pregnancy, when the National Health and Medical Research Council now recommends strenuously a mother shouldn't. But the other effect is that you rip away the few props of government support that are available.
As well as that, you probably can't be completely certain of your diagnosis. There's not a lot of information about FASD, whereas everyone's heard about ADHD. So what are you going to do? There's no question really. But the ramifications are enormous.
For a start this really suits the alcohol industry and that's a big consideration if you're a politician. The tobacco industry is big, but gambling and alcohol … well, that's where the real money is. You take on Goliaths such as that at your peril. Drinking is utterly entrenched as part of our way of life. It is our culture. It would be un-Australian to criticise someone relaxing with a stubby or two on the weekend. But of course, that's not what we're talking about, but it's not the way we, as a country, drink either.
It's easy for any Australian to slot themselves into the relevant advertising clip. If you're true blue, with lots of mates, you're out having fun with a stubby in your hand. Or perhaps you're a sophisticated connoisseur enjoying a glass of bubbly under a huge marquee in the countryside. The power of advertising is such that it's hard to imagine any social activity that isn't lubricated, in some way, by alcohol. That's fine, but there is a dark side.
What isn't advertised is binge drinking that continues until people have become literally ''legless''. Children sculling hard liquor until they vomit. Groups of people who are utterly determined to drink themselves into oblivion on a bender that will continue for hours. The binge. And this is the problem. Binge drinking has somehow - again - become an acceptable part of Australian culture. And the industry isn't keen on being challenged.
When the NHMRC changed its warning to urge expectant mothers to avoid alcohol completely, Sydney's Daily Telegraph ran a story pillorying the doctors' advice. Unsurprisingly perhaps, significant sections of the industry appear unwilling to accept even this simple warning.
The apoplectic reaction of distillers seems to suggest the medical profession were engaging in an all-out assault on the Australian way of life. Yet all it was attempting to do was inform mothers that if they drank when pregnant, their children risked significant brain damage. Evidence suggests this is concentrated in the frontal lobes of the brain.
This can result in cognitive deficits and inability to concentrate and co-operate with others - similar symptoms to ADHD.
The chairman of the parliamentary committee that investigated FASD, Graham Perrett, notes that in severe cases the physical appearance of sufferers can actually change. ''I was looking at some early photographs of convicts,'' he says, ''and you could see it. Thin upper lips and eyes that looked just that little bit too close together. And a smooth, flat run instead of a groove between the upper lip and the nose.''
Perrett holds Moreton, the most marginal Labor seat in Queensland. He came to most people's attention last year when in early February he threatened to resign if Kevin Rudd didn't stop destabilising Julia Gillard. He has two chances of being returned after the next election; Buckley's and none. Perhaps that's why he's prepared to do something about this issue.
''I have a seven- and a four-year-old and the advice we received as a couple was that the odd drink didn't hurt,'' he says.
But now, he says, the best medical advice has changed. ''Medical thinking has evolved - it's not just don't get drunk, it's don't drink.''
Perrett is not the only MP who is seriously concerned about this issue. Dr Sharman Stone is the member for the rural Victorian seat of Murray. She sees the cost of binge drinking and the terrible human toll particularly among the indigenous communities in her electorate. She has been a driving force, alerting her colleagues to the human, as well as financial costs of, the problem.
The committee that investigated the problem wasn't, as you might expect, looking into the medical or economic ramifications of this issue. The professionals appear to have dropped the ball when it comes to the abuse of alcohol in the community. Instead, the Standing Committee on Social Policy and Legal Affairs was left to make the 19 crystal-clear recommendations that stand at the end of the brief but horrific report. The report was tabled last year. The government hasn't indicated when, or how it will act to implement any of these suggestions, despite the obvious need for urgent action.
Of course, the difficulty is that doing something would require taking on the status quo. That's something no government wants to do in an election year, particularly when it means making an enemy of an industry that has deep pockets and is indelibly marked as being utterly Australian. And what's a bit of brain damage, here and there …
Nicholas Stuart is a Canberra writer.