Taking on the ‘health crusaders’
Ifirst came across Barbara Ehrenreich, the American writer and radical activist, when, as a medical student in the Seventies, I read For Her Own
Good, her devastating critique of the absurdities of “expert advice to women”, much of it from doctors. She has since produced a stream of spirited polemics and political analysis, particularly focusing on the plight of low-paid workers. Her 2010 book Smile or Die (subtitled “How positive thinking fooled America and the world”) exposed the fatuity of the promotion of happiness as a goal of public policy. In her latest work, Natural
Causes, published this month, Ehrenreich turns her attention to the “epidemic of wellness, the certainty of dying and killing ourselves to live longer”, issues at the centre of healthcare controversies on both sides of the Atlantic. Now 76, and a survivor of breast cancer (the subject of a celebrated personal account), Ehrenreich is irked by her peers’ obsession with lifestyle and diet and medical check-ups. As she says: “I don’t want to make the pursuit of health a major life project.”
The main targets of her ire are the healthy lifestyle crusaders, such as Jamie Oliver, who attribute the higher mortality of poorer people to their affinity for junk food and cigarettes. She believes that the war on smoking has turned into a “war against the working class”, reflecting middle-class “pity and contempt” for those on lower incomes.
Noting the rising death rates among poor white Americans from alcohol, opioid addiction and suicide, Ehrenreich insists that “the class gap in mortality will not be closed by tweaking individual tastes”. True to her radical roots, she advocates measures to relieve poverty, clean up the environment and improve access to medical and mental healthcare and the reform of occupational health.
What has nutritional science done for us?
A growing number of medical authorities, including BMJ editor Fiona Godlee, GP campaigner Dr Rangan Chatterjee and tele-doc star Michael Mosley, are demanding the reform of the medical school curriculum to include training in nutritional science.
According to graduate students Kate Womersley and Katherine Ripullone, writing in the BMJ last year, “nutrition is at the cuttingedge of scientific discovery” and “medical students need to understand the role of diet in health promotion and disease prevention”.
But what has nutritional science done for us? Since the clarification of the role of vitamins many years ago, it is difficult to think of any significant contribution.
What are the “evidence-based lifestyle interventions” in which students need to be instructed? For years, doctors have told fat patients to eat less and exercise more, evidently to little effect. Current health promotion policies amount to repeating the same old homilies in a triumph of wishful thinking.
In fact, dietary regimens for disease were what doctors recommended in the millennia before scientific medicine came up with effective treatments.
Take peptic ulcers. From the days of Hippocrates until about 30 years ago, patients were condemned to a vast range of different dietary recommendations and restrictions (not to mention drastic surgical procedures), all largely ineffective. Following the development of acid blockers such as cimetidine, ranitidine and omeprazole, all these diets (and operations) were promptly abandoned, to the relief of doctors and patients alike.
We’re docs, not cops
The plight of Albert Thompson, the pseudonym of a 63-year-old man denied treatment for prostate cancer because of his inability to produce a passport after 44 years’ residence in the UK, reveals the impact of measures to restrict eligibility for NHS care introduced under the 2014 Immigration Act.
If hospitals and GP surgeries enforce these regulations, patients will be reluctant to present with medical problems, with inevitably damaging consequences.
I recall that similar attempts to press doctors into policing the immigration system in the Eighties were successfully resisted.
A new campaign, Docs Not Cops, has been formed to challenge the discriminatory character of the demand for passports, noting that so-called “health tourism” accounts for less than 0.3 per cent of the NHS budget. Under the slogan “Patients, Not Passports”, Docs Not Cops insists on the principle that patient need should be the sole criterion for access to NHS care.