Wednesday, 2 June 2010

The Church of Health

Any lingering doubt that the medical profession sees itself - and is increasingly seen by the public - as fulfilling the ancient role of the priesthood should be dispelled by today's news that NICE wants doctors routinely to ask patients about their alcohol consumption. Anyone registering with a new doctor, or even just updating their medication, will be asked up to ten "screening questions" reports the Telegraph.

The reason cannot simply to identify hardcore alcoholics and other problem drinkers, whose problems will often be obvious and, in any case, might well lie. Rather it will provide an opportunity for doctors to dish out unsolicited advice and reinforce the official line that anyone drinking more than the arbitrary weekly limit is in danger of imminent death.

Alex Deane of Big Brother Watch said

This is typical nanny statism from a bullying, increasingly authoritarian organisation. We are entitled to have a drink when we want one. Doctors are there to heal us, and can keep their opinions about lifestyles to themselves unless asked – after all, we pay the tax which pays for the health service.

Which is true as far as it goes. But it's worth noting the response of Professor Eileen Kaner, who worked on the guidance and told the Telegraph that "research has shown that, as long as the questions are asked alongside others about lifestyle and they are delivered in a non-judgemental way, then patients do not mind." Prof Ian Gilmore, President of the Royal College of Physicians, agreed. "We have a long way to go to get to a point where people get fed up with being asked," he declared. Indeed. Only appeals to security are accorded greater public deference than the claims of health.

The days when GPs were people you went to see when you were ill are long past. Indeed, many doctors actively dislike people suffering from minor ailments clogging up their surgeries. One group - funded, it's true, by makers of over-the-counter drugs but supported by the BMA - complained that treating coughs and colds was costing the NHS £2 billion every year. As well as taking up GPs valuable time when they could be compiling data on alcohol consumption or prescribing anti-cholesterol drugs to perfectly healthy 50-year olds. Today's ideal is the non-patient patient, someone who is never ill but is nevertheless a regular and obedient client of the NHS.

Similarly, the clergy would like to see people every Sunday, regardless of whether or not they've been committing any sins. Primed by pharmaceutical companies, they dispense pills like communion wafers.

Centuries ago, rulers sought to bolster their credentials by gaining the support of powerful clerics, who were bought off with large endowments for their cathedrals and monasteries. Today, they promise not to reduce spending on health. Once, government banned or restricted things (adultery, alcohol) because of moral objections rooted in religion. Today they seek to ban or restrict things (drugs, alcohol) on medical grounds. It was I think Nigel Lawson who described the NHS as our true national religion - but he meant no more than that people believed in its perfection or at least moral sanctity despite all evidence to the contrary. It has more recently acquired the sense of infallibility and didactic mission of, say, the Catholic Church. Convinced of the rightness of its own teachings, the health establishment has enthusiastically embraced the opportunities for bossiness and interfering provided by the Nanny state.

It is not to the individual who happens to be sick that doctors are now supposed to owe their loyalty, but to society as a whole. In fact, public health policy depends for its effectiveness on the co-operation of millions of healthy people who could lead perfectly decent lives without seeing a doctor more than once or twice a decade. Hence the medical establishment has pushed for mass-screening (of little benefit to low-risk individuals, at risk of false-positives) and demanded ever-more draconian measures against smoking, drinking, obesity, cars or anything else that can be shown to have a statistical link with ill-health. Such campaigns necessarily acquire an absolutist character, for it is impossible to eliminate either risk or illness. There will always be more lectures to be delivered, more guilt-feelings to induce.

Leaving aside the contrast between religion's emphasis on the unseen world, the concerns of the Chruch of Health and the Church of Christ have much in common. There's a similar fascination with regulating people's sex lives, for example. Doctors like bishops have clear ideas about how people should behave in bed - a phenomenon seen not only in campaigns against sexually transmitted desease but, more insidiously, in the tendency to categorise declining interest in sex as a medical condition. Both cults stress the importance of indoctrinating the next generation. Religion and Healthism both seem convinced that the world is getting steadily worse and is in need of salvation. The church preaches against sin; so do doctors - drinking heavily or not exercising are made to seem not just injurious to one's physical health but morally compromising too.

Unfortunately, while religion can offer eternal life the medical industry can only offer a temporary postponement of inevitable death. But they claim to be working on that, too.

Unlike religion, of course, medical scaremongering claims to be evidence-based. But the statistics used to back up claims of, say, an obesity "time-bomb" often turn out to be highly questionable or at least loaded. Yet they are almost always reported unquestioningly, as though they were holy writ, as though the mere fact that a medical expert has anathematised something is reason enough to ban it, or at least regulate it. Of course, I do not underestimate the importance of scientific or medical evidence in public debate. Far from it. But such evidence is all-too-rarely treated in the media as evidence should be, questioned and verified. Rather, it is taken on trust. Medical claims are often deferred to in the way that religious claims once were. It says so in the Bible. It says so in the Lancet.

NICE, a body set up to absolve ministers from making controversial decisions about rationing expensive drugs, now wants to give moral and spiritual guidance to the nation via a network of local doctors as pervasive as that once run by the church. It is the New, Interfering Church of England.

Of course, there are differences. Anything you told a priest was covered by the unbreachable seal of confession. Anything you tell a doctor is protected theoretically by patient confidentiality. But it will be written down and, if present plans do not fall victim to the cost-cutting act, will be uploaded to a giant database accessible by potentially millions of NHS operatives. Don't worry, though, your data will never be misused and there are strong safeguards to keep it secure. You can believe in Health.