Fw: The Tyranny of Health

Russell Grinker grinker at mweb.co.za
Tue Oct 10 01:54:34 PDT 2000

>The Tyranny of Health: doctors and the regulation of lifestyle by Michael
>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as the old arrogance has been replaced by acute self doubt.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
>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 .

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