Posts tagged with Coercive Healthism

Earlier this month, the House of Commons Science and Technology Committee lived up to its name, and beamed a professor into one of its hearings. G’day Gilmore was down under, in the land of amber nectar and rich red shiraz, and by a miracle of technology he was also present in Westminster. Asked by the committee Chair whether he could hear those stuck in good ol’Blighty, G’day assured him that he could. ‘Yes, Chairman, very clearly thank you,’ he said. It was probably the clearest statement of the day.

The occasion was the taking of oral evidence by the STC in the matter of alcohol guidelines, and as ever the troupe of temperance tut-tutters headed up by G’Day were in on the act.

One of Dr No’s retired medical friends, not teetotal, but almost, inherited an adequate wine cellar, mostly reds, from a relative. Given a science backed consensus that small amounts of red wine would be good for him, he decided not to dispose of the cellar on favourable terms to Dr No - Dr No is always happy to help an old friend out - but to indulge in a spot of self prescribing: ℞ vinum rubeum, 1-2 glasses nocte.

Elsewhere, an old biddy friend of Dr No’s mother, bereaved last year, has taken to keeping a bottle of sweet sherry in with the tea cosies, and of an evening she warms her soul as she dozes in front of the television with a tipple or two. Not so long ago, a grandad patient of Dr No’s asked: ‘No harm in an evening sharpener? Just scotch and water, you understand.’ Dr No knew it would be a large tumbler, and a generous slop, but still he answered ‘not at all’ - and didn’t even caution against excess. This chap had survived the not only the horror of Burma in the Second World War, but the long years of following memories as well, and the last thing he needed was a ticking off from Dr No.

Storms of protest have greeted recent ‘leaks’ that NHS trusts plan to shoo existing smokers and fatties off waiting lists, and ban new and returning entrants until they have done time in a get fit quick boot camp. Herr citizens who fail to comply vill be sent down ze salt mine, and the key (but not their matches and crisps) thrown away.

These variants of health fascism are in fact nothing new. IDS style poor law conservatism always reckons those who have fallen on hard times have somehow managed to pull a fast one, and health fascism is the natural sibling of poor law conservatism. Those who cannot work will not get benefits; and those who will not fix their habits will not get NHS health care. Scattered amongst the protest comments on blogs and in the media is more than enough serves-the-bastards-right why-should-we-pay-for-their-healthcare invective to make Dr No’s toes curl.

Two old stories by a curious but telling coincidence made it into the top news last week. One re-ignited the ADHD isn’t bad parenting or poor diet, it’s an illness (and genetic to boot) debate; the other reminded us just how determined Big Pharma can be when it comes, as they say in financial circles, to helping us grow our GDP. The theme which unites these two stories is medicalisation – that tendency to transform the vagaries of human nature into ‘real’ illnesses.

As a medical student, Dr No was greatly impressed by a particular surgeon. This surgeon was that rare thing, a surgeon whose mind was even sharper than his scalpel. He taught Dr No perhaps the most important surgical lesson of all: that surgery is not about how to operate – any competent surgeon can do that – it is about when to operate; and it is fidelity to that decision that distinguishes the great surgeon from the average surgeon. That same great surgeon taught Dr No much else, often in the vernacular, and none more certain than that which holds that the only sure-fire way to advance one’s medical career is to apply regular and consistent negative pressure at the anus of one’s superiors.

‘The only function of public health,’ JK Galbraith might have said, ‘is to make cranial osteopathy look respectable.’

Such a thought occurred to Dr No as that tiresome quango, the National Institute for Health, Clinical and Anything Else Anybody Will Pay Us For Excellence dumped not one but two unwelcome coils of public health ‘guidance’ on an unsuspecting public this week. One was old hat – salt and saturated fat are bad for you, flogged into new life in NICE’s inimitable way (‘Tens of thousands of lives could be saved, and millions of people spared the suffering of living with the effects of heart disease and stroke, simply by producing healthier food says new NICE guidance’). The other was something altogether different. Pregnant women who smoke, NICE declared, can’t be trusted to tell the truth, and so the truth must be forced out of them, if necessary by coercion:

Warning: post contains economics. Some readers may find themselves bored silly. In such cases, Dr No recommends taking a tea-break and returning to the post only when the sense of boredom has completely dissipated.

Economists are keen on a concept known as elasticity. There appear, from Dr No’s primitive researches on the matter, to be a disconcerting number of elasticities in economics. Naturally enough, economists dress all these elasticities up in hieroglyphics, but inspected through the lens of common-sense, economics stands revealed as a study of rubber bands, albeit rubber bands that drive economic activity, but rubber bands nonetheless.

Another voice has been added to the hue and cry for a minimum price for alcohol. Within days of Rubber Duck stepping down from his CMO post, the better to quack his favourite message, NICE, the National Institute for Health, Clinical and Anything Else Anybody Will Pay Us For Excellence, has jumped on the wagon. Voluminous guidance, published earlier this week, recommends a raft of measures that, NICE says, will ‘significantly decrease alcohol consumption’ if implemented. A top tip for government is to make alcohol ‘less affordable by introducing a minimum price per unit’. There was much talk of growing tides of unassailable evidence. Dr No began to fear he was now King Canute, alone on the beach, his once half full glass now half empty. Until, that is, he heard an interview on the Today programme. Suddenly the glass was half full again.

That smuggest of colleges, the Royal College of Physicians of London, already infamous for its part in the MMC/MTAS disaster, has of late been cozying up ever more closely to the Department of Health, and its chief pongo, Sir Liar Liar Pants on Fire Donaldsong. Earlier this week it moved still closer, issuing an right-on report damning callous smokers who kipper their kids.

The report, featuring a cover photo of a prole caught in the hideous act of kippering a bairn, contains shocking figures and urgent recommendations in bountiful supply. Passive smoking, it estimated, caused children over 300,000 UK GP consultations and almost 10,000 hospital admissions every year, at a cost to the NHS of about £23.3 million. An alarming list of childhood illness caused by passive smoking includes old favourites such as asthma and wheeze (22,000 extra cases) and middle ear disease (120,000 extra cases), as well as the reliable media magnets meningitis (200 extra cases) and cot-death (40 extra deaths).

Dr No’s mother, a fit 80-something year old, recently attended an ophthalmology clinic, on the advice of her optician, and was told – out of the blue, by a nurse – she hadn’t even seen a doctor - that a bed had been arranged for her to come in two days later to have her cataract removed. The nurse was most put out when Dr No’s mother – who knows her mind very well – said she had no intention of coming in for an operation she neither knew about, nor did she need. Yes, she does wear reading glasses – but otherwise her eyesight is fine.