Fw: The Tyranny of Health

[Russell Grinker]

>Review
>The Tyranny of Health: doctors and the regulation of lifestyle by Michael
>Fitzpatrick
>Routledge,  October  2000 , 208pp,  pbk £9.99, hbk £35.00
>
>It has become  almost  a commonplace  to  note  that  though we  live
>longer  and  healthier  lives, we  are also more  concerned  about  our
>health  than ever  before. Whilst many  commentators  have  written on
>different aspects of this paradox ,  there has until now been no
>satisfactory  survey  of the whole. Fitzpatrick gives us, from his
>perspective as a GP, the most penetrating  analysis  yet published of the
>rise of the New Public Health, and of its dangers for patients, doctors and
>the relationship between them.
>
>Fitzpatrick  presents   a history of the way  that health has become a
>major personal and political  topic,  by looking at  the different health
>scares of the last few years,  the  screening tests  and 'healthy  living'
>recommendations that  have been introduced  and accepted in spite of
>dissenting  academic  criticism   We are all familiar with instructions  to
>eat  healthily  (just why  is it five or six portions of fruit or
>vegetables  per day anyway?),  drink a certain number of units of alcohol a
>week, take exercise , and subject  ourselves to screening  tests  of
>dubious  efficacy . However , it is only when we are confronted by the
>whole panoply of  measures that we realise how  far things have gone and
>how   rapid  the pace of change has been. The result is that we now
>tolerate,  if not actively seek  out,  a level of  interference in our
>personal  lives which  would have been unthinkable  even ten years ago.
>
>How to  explain  the astonishing success of the new public  health  amongst
>doctors and the public?  A cynic would say that there is a straightforward
>financial motive for many doctors'  enthusiasm for these measures, and
>though there is some truth in this, it is not the most important part of
>the story. Fitzpatrick provides  an excellent  account  of the gradual
>process by  which the medical profession  has  lost confidence in itself,
>as the old arrogance  has been replaced by  acute  self doubt. The crisis
>of modern medicine  is graphically  illustrated by the volte face of the
>BMA in its attitude to alternative medicine: from a defiant defence of the
>'demonstrable and reproducible benefits' of orthodox medicine  in 1986 to a
>posture of 'abject  relativism' in response to 'complementary ' approaches
>only seven years later .
>
>Fitzpatrick  also consider s  why health has become such a public concern
>over the last  decade  or so. This section is short and thus appears
>somewhat schematic  but does provide the basis for further work. Many
>commentators  have  noted that the ending of the   Cold War  has thrown up
>massive  problems  for the old ideologues of the West, as the initial
>triumphalism rapidly  evaporated to be replaced by  a general feeling of
>stagnation.   Fitzpatrick notes that  '[c]hanges in society now appear no
>longer to be the result of conscious  or planned human activity , indeed
>things appear to be out of control'. At first sight this may seem
>exaggerated,  but  then think of the almost  mediaeval suspicion with which
>GM food has been greeted.  In these  circumstances, any  hope of achieving
>progress  in society  is just not on the agenda , and the retreat  to
>narrow  concerns about  health is understandable. It is also understandable
>that the government  should take advantage of concerns about health to
>strengthen its grip over an increasingly fragmented society   The result ,
>as Fitzpatrick puts it, is that 'when health becomes the goal of human
>endeavour  it  acquires  an oppressive influence over the life of the
>individual'.
>
>In the short term, the trends identified in The Tyranny of Health are
>likely  to get worse . Only last week a distinguished  cancer specialist
>was advocating that men over 50  (a category in which I have recently
>acquired a vested interest) should abstain from sexual intercourse  and
>thus cut their risk of cancer  of the prostate .  Indeed the  prostate
>looks set to become  the organ of the decade,  although  I fear that until
>we have acquired our own distinctive  ribbon  we cannot  compete with  the
>other cancers.
>
>How then to reverse  the tyranny of health ?  Fitzpatrick recognises that
>this book is very much a preliminary  work , but it does lay  the basis for
>future work which should be aimed at  defining the links between, on the
>one hand,  the tyranny of health and the crisis of medicine, and on the
>other, the stasis of the new  world order.  The medicalisation of  life and
>the politicisation of  medicine should both be resisted,  for as he puts it
>'[i]n the absence of a forceful movement  from  below, medical intervention
>becomes  a vehicle of government  policy, not politics writ large, but
>politics on a small scale, petty,  intrusive and moralising'. Fitzpatrick
>is certainly  not against  the idea of doctors being involved in the
>politics of health , but he emphasises  the importance of maintaining
>clear boundaries.  Doctors should reassert their autonomy  from the state
>and  '[d]octors who aspire to a wider political role, would be best advised
>to pursue this, not in their surgery, but in the public sphere. At a time
>when health has become such a political issue, he insists that 'the first
>responsibility  of a doctor  as a doctor is to provide medical   treatment
>for individual  patients'.
>
>On first inspection, this book appears similar to Petr  Skrabanek's  The
>Death of Humane Medicine (1994).  But Skrabanek's' critique,   though often
>perceptive, was  that of a   cynical,  detached  libertarian,. Mocking  his
>gullible  medical  colleagues  and expressing a certain contempt  for the
>general public, his approach  was  ultimately sterile. In contrast,
>Fitzpatrick's  is a much more serious  work. It is  a major  contribution
>to  our  ideas of health and disease  at the begining of the 21st century,
>which deserves to be considered alongside  contributions by  writers such
>as Susan Sontag and John Berger .