Bad Habits

This is the outline text of Peter Marsh's lecture to the Institute for Cultural Research at the King's Fund, London, November 17 2001.



Part 1

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In Praise of Bad Habits – Part 1

ICR Lecture – November 17th 2001

In the Western world we live in an age that is, by all objective criteria, the safest that our species has ever experienced in its evolution and its history. We are healthier than any of our predecessors have been. We live on average considerably longer than even our immediate progenitors. Today, the infant death rate is less than 6 per 1000 live births. Just a hundred years ago the figure was 150. Even in the late 50s four times as many children died in their fist year of life than they do today. Our diet, contrary to all the 'anti-junk food propaganda', is not only the most nutritious but also the most free from potentially dangerous contaminants and bacteria that we have ever consumed. Despite the class divisions which remain within our society, and which reflect themselves in the health gap between the rich and the poor, we have, as Harold Macmillan once famously said, 'never it had it so good' when it comes to a lack of objective risks to our lives and to our well-being.

At the same time we have, ironically, come to fear the world around us as never before. In the absence of real risks, we invent new and often quite fanciful ones. The better off in our society, who have the least to really worry about, are most prone to this novel neurosis of our age – fearing instant death from the contents of their dinner plates, unless chosen with obsessive care, and 'unacceptable' physical decline from failure to follow every faddist trend recommended by their personal fitness trainers. We fear that our children are constantly in danger from strangers – despite the fact that the vast majority of child abuse occurs within the family – and feel compelled to ensure their safe arrival at school by transporting them in people carriers – while at the same time decrying the depletion of fossil fuels and 'unacceptable' levels of environmental pollution – and we wonder why our children are getting fat. In this constant state of irrational fretfulness we start lose our faith in anything which looks like science – preferring to put our faith in the 'Emperor's Clothes' of homeopathic and other forms of 'complementary' medicine, while withdrawing children from rational and safe vaccination programs aimed at preventing an epidemic of measles following irresponsible scare mongering in our newspapers.

Our flight from rationality is evidenced in other panics which currently preoccupy us. The development of biotechnology, for example, which holds real promise for the eradication of famine in much less fortunate parts of our planet, is resisted by the fit and well-fed for fear that we shall release Frankenstein's monster – despite the fact that Americans having been eating this stuff for over a decade without a single ill-effect. As the extremists among them plan their activist campaigns using mobile phones, they see no irony in trying to convince us all that the aerials and masts which facilitate such coordinated action will fry our brains – and particularly our children's brains – again despite the absence of any real evidence for such beliefs. They are the same people that once argued that steam trains would asphyxiate all their passengers if they travelled at more than thirty miles per hour, and that dangerous electricity could leak from uncovered light fittings. The trouble now is that people believe them.

It is in the context of this post-rational era that the notion of 'lifestyle correctness', founded largely on narcissistic health ideals, has come to shape the direction of people's lives in ways which once characterised the power of formal religions. In place of faith in the creeds and tenets of the established church, we now follow slavishly the equally false promises of the health promotion professions – those who would have us believe that if we lead the 'good' life we will have unending life and beauty.

This comparison between the pursuit of health and the search for God has been noted by a number of social commentators, including, for example, the Australian academic Deborah Lupton. In her book The Imperative of Health she argues:

"In this secular age, focusing upon one's diet and other lifestyle choices has become an alternative to prayer and righteous living in providing a means of making sense of life and death. 'Healthiness' has replaced 'Godliness' as a yardstick of accomplishment and proper living. Public health and health promotion, then, may be viewed as contributing to the moral regulation of society, focusing as they do upon ethical and moral practices of the self."

While the new religion of health enables many people in our society to gain a sense of moral worthiness, it also provides a valuable means of censuring deviants – those new outcasts in a world where the concept of 'zero tolerance' has somehow become a 'good thing'. (The currency of this term alone, in my view, is sufficient to illustrate the extent to which we have lost the moral plot.) People who are unwilling to succumb to what the late Petr Skrabanek (a renegade Czech medic) described as 'Coercive Healthism' – those among us with 'bad habits' – are the new outcasts in this increasingly fearful and intolerant world. It is, in the words of the East London GP Michael Fitzpatrick, the Tyranny of Health which now surrounds us.

Michael Fitzpatrick's recent book called The Tyranny of Health: doctors and the regulation of lifestyle is one which I strongly urge everybody to read. He works in Hackney and is a man who is in daily contact with the sick, and sometimes with the dying. Increasingly, he is also in daily contact with the 'worried well', people who have been driven to fear the very world they live in by unfounded scares and inappropriate health promotion. And now he regularly encounters people who blame themselves for their own illnesses – those who have been persuaded that they are sick only because they have failed to lead the lifestyles which what he sees as an increasingly authoritarian government has prescribed for them.

His simple message is: "Doctors should stop trying to moralise their patients and concentrate on treating them", and he enlists the help of the microbiologist Renee Dubos to reinforce his point. Dubos commented in his book The Mirage of Health, written way back in 1960:

"In the words of a wise physician, it is part of the doctor's function to make it possible for his patients to go on doing the pleasant things that are bad for them – smoking too much, eating and drinking too much – without killing themselves any sooner than is necessary."

And that, for Fitzpatrick, is the real job of the General Practitioner – not meeting 'lifestyle education' targets set by the state. Nor refusing to treat those who have allegedly brought ill health upon themselves. His job is that of the doctor, not the priest.

Fitzpatrick's complaint, like that of Skrabanek who feared what he called the 'Death of Humane Medicine', reminds us very much of Bernard Shaw's tirade against the medical profession made in 1909. In a speech to the Medical-Legal Society he berated the arrogance of the profession in invading the civil rights of individuals that would not be tolerated in any other area. In his conclusion he remarked:

"The last thing I want to say to you is this: You must have the medical profession socialised because medical men are finding themselves more and more driven to claim powers over the liberty of the ordinary man which could not possibly be entrusted to any private body whatsoever."

Nationalisation of the health service was not, however, seen as the all-important issue here. Shaw added that even in these circumstances "not for a moment do I suggest that the doctor should have any power to coerce the patient even for his own good."

Shaw upset more than a few medics with his forthright views on the role of their profession. And few doctors then, as now, aligned themselves with his dictum that health is not something which should be pursued for its own sake. Shaw said:

"Use your health, even to the point of wearing it out. That is what it is for. Spend all you have before you die."

Shaw's line here reflects very much an old Russian proverb which, if you visit our humble SIRC office in Oxford, you will find displayed as you enter. It translates simply as "If you don't drink, and you don't smoke' you will die healthy."

A similar sentiment was also, and perhaps most famously, expressed by Samuel Langhorne Clemens, better known as Mark Twain. In his 'autobiography' he commented:

"There are people who strictly deprive themselves of each and every eatable, drinkable and smokeable which has in any way acquired a shady reputation. They pay this price for health. And health is all they get out of it. How strange it is. It is like paying out your whole fortune for a cow that has gone dry."

It was Mark Twain, of course, who also urged us to be careful when reading health books. "You might", he warned "die of a misprint."

A hundred years on and we seem to have ignored all of these rather wise and liberal views, despite the clear evidence available to us of healthism's negative consequences at both individual and societal levels. If we go back a little further into history, to the French Revolution say, then we start to see the origins in modern Europe of the very forces against which Shaw, Twain and many others have railed.

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