The Medicalisation of Everyday Life

Glossy magazines told stories about couples with relationship problems who went to their GP, and the GP didn’t understand their problem (the first paragraph of any medical story in the media). Then they went to the specialist, and he didn’t help either. But then they went to a private clinic. Here they did blood tests - hormone profiles, esoteric imaging studies of clitoral bloodflow - and then they understood. The solution was in a pill, but that was only half the story, and the diagnosis was almost more important: she had a mechanical problem. Rarely was there a mention of any other factors, that she was feeling tired from overwork, that he was exhausted from being a new father, or finding it hard to come to terms with the fact that his wife was now the milky mother of his children, and no longer the nubile sex vixen he first snogged on the floor of the student union building to the sound of Don’t You Want Me? by the Human League in 1983.

This is because we don’t want to talk about these issues, any more than we want to talk about social inequality, the disintegration of local communities, the breakdown of the family, the impact of employment uncertainty, changing expectations and notions of personhood, or any of the other complex, difficult factors that play into the apparent rise of antisocial behaviour in schools.

This wishful deafness to the clamour of reality reaches its purest form in our newfound obsession with food, as if it was the most important lifestyle risk factor for ill health, as if every technical detail should be devoured and acted on, for the promise of eternal zest. From the Daily Mail’s ongoing project to divide all the inanimate objects in the world into ones that either cause or cure cancer, to daytime television’s obsession with the healing power of this week’s magic berry, there is no end to this material. Should you believe it? No. I have demonstrated time and again how these claims are flawed in their own specific cases. But something more interesting is being ignored in the background.

The World Health Organisation’s Commission on the Social Determinants of Health reported this week, and it contained some chilling figures. Life expectancy in the poorest area of Glasgow - Calton - is 28 years less than in Lenzie, a middle-class area just eight miles away. That is a lot less life, and it isn’t just because the people in Lenzie are careful to eat goji berries for extra antioxidants, and a handful of brazil nuts every day, thus ensuring they’re not deficient in selenium, as per nutritionists’ advice.

People die at different rates because of a complex nexus of interlocking social and political issues including work life, employment status, social stability, family support, housing, smoking, drugs, and possibly diet, although the evidence on that, frankly, is pretty thin, and you certainly wouldn’t start there.

But we do, because it’s such a delicious fantasy, because it’s commodifiable and pushed by expert PR agencies, and in some respects this is one of the most destructive features of the whole nutritionist project, graphically exemplified by figures such as Dr Gillian McKeith PhD. Food has become a distraction from the real causes of ill health, and also, in some respects, a manifesto of rightwing individualism. You are what you eat, and people die young because they deserve it. You hear it from people as they walk past the local council estate and point at a mother feeding her child crisps: “Well, when you look at what they feed them,” they say, “it’s got to be diet, hasn’t it?” They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 80. You deserve it. Not like them.

Genuine public-health interventions to address the social and lifestyle causes of disease are far less lucrative, and far less of a spectacle, than anything a lifestyle magazine editor or television commissioner would dare to touch.

There is no glamour in “enabling environments” that naturally promote exercise, or urban planning measures that prioritise cyclists, pedestrians and public transport over the car. There are no votes, it seems, in reducing the ever-increasing inequality between senior executive and shop-floor pay. When do you ever hear about elegant ideas like “walking school buses”? Somewhere near you, a softly spoken public-health official has probably tried to interest your local paper in a story on them; presumably the latest urgent food-fad news left no space.

We love this stuff. It isn’t done to us, we invite it, and we buy it, because we want to live in a simple universe of rules with justice, easy answers and predictable consequences. We want pills to solve complex social problems like school performance. We want berries to stop us from dying and to delineate the difference between us and the lumpen peasants around us. We want nice simple stories that make sense of the world and if you make us think about anything else more complicated, we will open our mouths, let out a bubble or two, and float off - bored and entirely unphased - to huddle at the other end of our shiny little fishbowl eating goji berries.

[Ben Goldacre]
Bad Science, extract can be found here

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This is about people feeling like they’re out of control, and people’s reaction to unalterable fate. It’s about superstition, really.

People who work in professions where they believe they have no control over the outcome tend to be the most superstitious. Examples include coal miners, who perform all kinds of rituals before going underground, because the mine might explode. They see this as outside of their ability to do anything about it. Sports people are also very superstitious and again, this is because they believe they have no control over the outcome of the game.

If we believe we believe we have no control over an outcome, we tend to be superstitious. If we have no firm foundation of belief, we go a little crazy. All you have to do to control people is confuse them a little bit, and, as they flap about searching for truth, guide them where you want them to go.

What all the health scares have actually done is confused people into believing they have no control over their lives or their own well-being. And THAT’s why they believe popping pills can cure everything, including “syndromes” that don’t actually exist. In past societies, they might have performed a rain dance, or made a poultice out of eggs, chicken feathers and tar. Now we take a gelatine-coated pill. But there’s no real difference.

In some ways, medical doctors are guilty of propagating this. Doctors make no effort to explain WHY a pill works. Most doctors don’t even explain what they’re prescribing. Instead, from the patient’s point of view, they’re given a magical ticket, that they present to a shaman (a chemist), who then gives them magical food they must swallow that clears up their strep throat or make them stop feeling so depressed. They may as well touch wood every hour, or take a pill full of fish oil…

Doctors should work harder to explain what they’re doing, even if the patient is resistant (and I realise that most are) That should be part of a diagnosis session—an essential element of bedside manner. “You must understand what I am telling you.”

Once that’s done, people will be more resistant to quack cures, and made-up illnesses, because they will feel they are in control.

This is the big difference between now and 50 years ago. 50 years ago we felt we knew what was what. If you had a cold, you drank lemon and whiskey, and stayed in bed. You walked daily and ate an apple a day because “it’s good for the constitution”. We had a definite idea of what was good for us, even if sometimes it was off the mark. Nowadays we have no concrete idea of what’s good for us. One report says wine will slowly kills us. Another says that a glass a day will stop us dying of a heart attack. One report says fast food will kill us. Another says that a Big Mac a week is actually good for us. MMR jab? Good for our kids. Bad for our kids. Confusion reigns. Doctors sit idly by, smug in their ivory towers, with their head in order, and baffled as to why everybody elses’ head isn’t in order.

The bigger picture is about the nature of humanity, and how we respond to knowledge (and the lack of it). This is perhaps one of the biggest issues of our time as we have more and more knowledge, thanks partially to the Internet, but also thanks to the fact we’re living in a sci-fi universe when pretty much everything is possible.

[John Smith]
http://www.badscience.net/2008/09/the-medicalisation-of-everyday-life/

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Dissemination of Information

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