THE TYRANNY OF HEALTH: DOCTORS AND THE REGULATION OF LIFESTYLE

Michael Fitzpatrick is a GP who works in Hackney – 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 an increasingly authoritarian government has prescribed for them.

This a powerful book. It is written with true feeling, sometimes bordering on despair. It is as much a crisp analysis of the decline of libertarian values among the political left as it is a damning critique of the basis of health provision in Britain. For example:

"The left's endorsement of the government's Aids campaign, following earlier feminist approval of the mass removal of children from parents in Cleveland, signalled the radical movement's abandonment of its traditional principles of liberty and opposition to state coercion. While most conservative commentators loyally defended government policy, only a small group of free-market radicals was prepared to advance a, rather limited, defence of individual freedom against the authoritarian dynamic revealed in the government's health policies."

This is strong stuff, and it will win him few friends among the chattering classes who have now almost entirely succumbed to reach-me-down prescriptions for every aspect of their daily lives, whether they be to do with 'safe' sex, smoking, drinking or the perils which lurk inside genetically modified foods. But Fitzpatrick is used to this. He has already experienced the narrow intolerance shown by the 'new' left when his earlier book, Truth About the Aids Panic, suggesting that the generation of this panic was essentially an attempt to regulate sexual behaviour, was shunned by radical bookshops.

This book is much broader in its scope, challenging received wisdoms on everything from health screening to drug 'treatment'. Some of his criticisms are by no means new. The late Petr Skrabanek, a renegade medic from Bohemia who worked for most of his life in Dublin, also warned about 'moral panics and health scares'. Skrabanek's book The Death of Humane Medicine and the Rise of Coercive Healthism was a seminal work which laid bare the authoritarian undercurrents evident in much of what passes for modern health promotion and the politically motivated abuses of epidemiology. But Fitzpatrick is quick to note the limitations of what, in Skrabanek's case, was a critique from a right-wing libertarian standpoint:

"[Skrabanek] further commented that 'simple minds, stupefied by the sterilised pap of television and the bland diet of Bowdlerised culture and semi-literacy, are a fertile ground for the gospel of new lifestyle.' Though this revealed the author's patrician contempt for 'the masses', seriously compromising his claims to advance a humanist perspective, it did little to explain the rise of health promotion in the particular context of Western society in the 1990s."

Fitzpatrick proceeds to argue that the reason for the rapid rise in prescriptive health promotion in the 1990s was the State's attempt to increase its apparent legitimacy after periods of social instability and insecurity. Through the complicity of the medical profession arose increased scope for government intervention in private life which was, perhaps perversely, welcomed by a majority seeking the security of ready-made lifestyles and codes of conduct. He stops short, however, of seeing in this trend some very unsavoury historical parallels. The work of paediatrician Hanauske-Abel, for example, which compared the modern-day convergence between the interests of the medical profession and the interests of the state with that which occurred in Nazi Germany, receives no mention. In an article in the BMJ Hanauske-Abel wrote: "Contextual analysis of events during the summer of 1933 in Germany may not just improve an understanding of the past but may also help to assess the present and near future. Developments within medicine and society during the past decade, particularly in North America and Europe, may found another convergence of previously separate political, scientific and economic forces." But perhaps that is just a bit too scary.

In his conclusion to the book Fitzpatrick returns to his blunt message that "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:

"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." (The Mirage of Health, 1960)

Fitzpatrick's disenchantment with the new left, as represented by Tony Blair's Labour Party, and its seeming inability or desire to resurrect its historical roots and values, is one which we, the directors of SIRC, having similar roots in the socialist tradition, personally share with equal regret. The very word 'libertarian' has now become synonymous with right-wing, free-market positions, having been discarded by the left as a 'redundant' concept. And we also share with him the same grave doubts about the political agendas which underlie much of what passes for benign, caring health 'advice'. The Tyranny of Health expresses with great clarity and precision the growing sense of unease that many people, both inside and outside of the medical profession, are beginning to experience.

The Tyranny of Health: Doctors and the Regulation of Lifestyle: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119546/