Healthism is a vile habit: It is no longer enough simply to be well; we are exhorted to pursue an impossible and illiberal cult of perfection

Bryan Appleyard
Tuesday 20 September 1994 23:02 BST

DR JOHN Harvey Kellogg, inventor of the corn flake, hated masturbation. In his zeal to diagnose and extirpate this vile habit, he listed 39 symptoms of the solitary vice and suggested a number of painful methods of suppression in both boys and girls.

Dr Kellogg feared that the human race was decaying through physical and moral degeneracy and wished to devise a healthy lifestyle that would produce 'a higher, purer and nobler type'. His abiding conviction was that disease was 'a consequence of some wrongdoing on the part of the individual'.

His innovative approach to breakfast apart, Dr Kellogg was, most people would now agree, a nut. But he was also what the late Petr Skrabanek called a 'healthist'. In his excellent book The Death of Humane Medicine and the Rise of Coercive Healthism, published this week, Skrabanek explains that Kellogg believed in health as a positive virtue to be energetically pursued by the right- minded and, consequently, how he viewed sickness as, if not a vice in itself, then at least as the inevitable outcome of vice.

Quite crazy, you might say, but Skrabanek's thesis is that the healthism of morbid dingbats like Kellogg lives on; there is a straight line of descent down to the prevailing medical ideology of today.

Is he right? Are those who would seek to treat perfectly healthy bowels and hearts with fibre, jogging and polyunsaturates no more than the anti-masturbation bozos of our day? Is Virginia Bottomley, not to put too fine a point on it, mad?

Well, masturbation may be off the agenda, just, but there can be no doubt that we regard disease and death as the outcome of misguided actions, and insist that those actions - rather than the disease - should be suppressed.

Martin Kettle of the Guardian, for example, writing about research conducted by Professor Rod Griffiths, West Midlands public health director, concludes that men are not being looked after. Government should do something to stop men dying of the things that, these days, men seem to die of: suicide, driving fast cars, heart attacks and prostate cancer. The answer, says Kettle, lies with men themselves, 'but since we know that men won't solve these problems by an unprovoked change of attitude, there is surely some public responsibility to do more on the provocative front'.

This is the typical healthist leap of logic which has transformed the practice of medicine. No longer is health a normal state of equilibrium and no longer are doctors those to whom we turn only when this equilibrium is disturbed.

Instead, our entire life, even in the complete absence of sickness, is implicated in the pursuit of more perfect health and greater longevity. We must not smoke or hang around smokers, drink too much, eat fat, breathe summer air in the cities, pursue dangerous sports and, of course, we must exercise to recapture some aboriginal state of fitness. Doctors have become the priests of this new cult of endless aspiration. They screen, check and warn the healthy, upbraid the sick and lecture us all on the multiple errors of our ways. Everything can be, as Skrabanek puts it, 'medicalised', every act can be shown to have health implications and can, therefore, form part of our lifestyle dossier being compiled by whatever recording angels inhabit healthist heaven.

This is not merely irritating. At a time of radical thinking about the funding of health care, it can also be dangerous. Smokers have been refused treatment, a development that opens up all kinds of possibilities. Will heart surgery be restricted only to those who work out or will emergency treatment after a car crash be offered only to those with a clean licence? Will insurance cover be denied to those whose lifestyles are deemed to be too wilfully unhealthy?

Skrabanek has two arguments against healthism. First he insists that this kind of pressure and coercion amounts to a fascistic imposition on the lives and freedom of individuals.

And, secondly, he points out that most of the healthist assumptions are either not proven, wrong or highly biased. For example, he says that screening - a central doctrine of healthism - has been found to have no health benefits, but that this finding has been suppressed. And he regards the caring of the healthists as a hypocritical cover for crude authoritarianism.

'As healthism is driven by power,' he writes, 'rather than by concern for the welfare of fellow men, it is devoid of any moral principles.'

These are serious charges. For if he is right and the healthists are guilty of rigging the evidence and of scaremongering on the basis of inconclusive research, then clearly they are no better than the Victorian anti-masturbators, abusing science in the name of a personal distaste and puritanically meddling in lives of which they disapprove. And, up to a point, he certainly is right. The big argument in favour of Skrabanek's case is that we obviously do place too much faith in medicine. In terms of prolonging our lives, it can do little.

The simple reality of the modern world is that, thanks largely to a series of elementary public health measures, notably effective sewage systems, we have achieved an enormous increase in longevity. In comparison with these measures, medicine has so far done little and, most doctors agree, is unlikely to do much in the future.

But this new longevity has, effectively, 'caused' a massive increase in illnesses of old age - dementia, cancer, heart disease - and it is this increase that has been used to justify the impositions of the healthists. In addition, advances in medical technology and theory have widened the definition of disease so that, for example, we regard ourselves as ill if we are found to have a high cholesterol level, even though we might otherwise be symptom-free.

In short, the healthier we get, the more scope there is for getting sick, and the more resources we pour into health care, the more money we shall have to find to pay for the consequences. This was not understood at the inception of the National Health Service when it was thought, logically enough, that the total cost would diminish as people became healthier.

Skrabanek can only be right to identify the switch from what he calls 'humane medicine' to a positive pursuit of health as a fundamental change in the function of medicine. He is also right that the limitless promises offered by this change are largely unfulfillable.

And, finally, he is right to point out the implications for freedom. Anything can be medicalised and anything, therefore, can become an excuse for group pressure on the individual in the name of communal virtue, money or the supposed impact on others. Plus, of course, there will always be Kelloggs and Kettles, keen to deprive others of their pleasures.

But the philosophical position from which Skrabanek mounts his assault is, I think, weak. His attitude is that of radical individualism, a rugged libertarianism. We should start from the position that we do what we like and the health industry should start from the position that what we do is none of its business. Skrabanek accepts that this may be lightly qualified, but not, as it is being at the moment, systematically changed so that the communal obsession with health is allowed to subvert the principle of individual liberty.

This is weak because it does not really confront the problem of knowledge. Clearly, a scientist in possession of overwhelming evidence that smoking and cancer are linked would be crazy or irresponsible to suppress that evidence on the basis that it was none of his or her business. The existence of such knowledge changes things, it changes us and demands our reluctant attention.

We may wish to be free of its consequences, but, having known, we cannot unknow; the tobacco can never taste quite so sweet again. Imagine, says Leontes in The Winter's Tale, a cup in which there is a spider. A man may drink and, not noticing the spider, think nothing of it . . .

'. . . but if one present

Th'abhorred ingredient to his eye, make known

How he hath drunk, he cracks his gorge, his sides,

With violent hefts. I have drunk, and seen the spider.'

That is the real problem of health care, the problem of our awful knowledge. This lies far beyond the attitudinising of libertarians and healthists. You cannot unsee the spider and there are now millions of spiders and thousands of doctors pointing them out. Skrabanek is more right than wrong, Kellogg was a nut and Bottomley is a pain. But, alas, with Leontes we have all drunk and seen the spider.

The Death of Humane Medicine and the Rise of Coercive Healthism by Petr Skrabanek is published by the Social Affairs Unit at pounds 12.95.

(Photograph omitted)

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