The Doctor's Surgery

Many doctors have a pile of old journals in their study, accumulated in the vain hope of keeping up with the latest medical advances.

The pile silently reproaches them and occasionally provokes them into a frantic but unavailing effort to catch up by working their way through it.

I made one of my periodic feeble efforts the other day and came across an opinion article that claimed that health is not the absence of disease. Alarm bells began to ring at once: this is the beginning of the slippery slope towards health totalitarianism.

The World Health Organisation defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity’ (emphasis added).

I am not sure, then, that I have ever met a healthy person and, if I were to do so, I am not sure that I should like him or her.

Be that as it may, the WHO’S definition would justify almost anything in the name of public health, from the banning of habits to the enforcement of them.

The author of the article quoted above was a consultant in the treatment of patients in intensive care – by definition desperately ill – who was drawing attention to his own inability to live a healthy life. He therefore realised that he was not so much a health as a disease professional, because he did nothing to promote health as defined by the WHO. He was a picker-up of smashed shards rather than a potter who made pots.

A statement like that made by the WHO is not false just because you don’t like its corollaries, but I began at once to think of arguments against health totalitarianism. For example, I consider myself healthy though I have two illnesses necessitating drug treatment to keep them in check.

Of course, someone might say that if the treatment holds the illnesses in check, then I am no longer diseased, but the fact is that if I stopped taking the pills, the diseases would return and one would eventually kill me.

We should stop worrying about what health really is and take heed of Aristotle’s sage advice that more accuracy should not be demanded of words than their subject matter permits. I therefore do not believe that we need, as the author of the article suggests we do, to ‘develop a new breed of doctors who can concentrate on function rather than malfunction’, and who would ‘deliver’ – horrible managerial word (see Words and Stuff, page 64) – ‘a fusion of exercise, physiology, occupational medicine and nutrition’. Part of health is taking it for granted, not straining after it.

What else did I learn from my foray into the pile of journals? There had been an epidemiological study in China suggesting that those who ate an egg a day had an 18 per cent lower risk of dying of heart disease than those who never ate an egg – though whether this was because healthier (and wealthier) people ate eggs, or because those who ate eggs were healthier (and wealthier), the study could not say.

I was unable to discover from the report whether people who did not die of heart disease lived longer than others; after all, heart disease is not the only cause of death. I could not discover, either, for how long you had to eat an egg a day for the effect to exert itself, or how large, in absolute rather than relative terms, the effect was. These gaps make it difficult to know whether or not people should eat an egg a day for the sake of their health.

My advice, then, is to eat an egg a day if that is what you want to do. I also strongly advise you to be healthy and wealthy.