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Overeaters, smokers and drinkers: the doctor won't see you now
Macleans ^ | April 18, 2006 | NICHOLAS KOHLER AND BARBARA RIGHTON

Posted on 04/25/2006 9:20:47 AM PDT by USFRIENDINVICTORIA

At issue: health care for patients with self-destructive vices -- overeating, smoking, drinking or drugs. More and more doctors are turning them away or knocking them down their waiting lists -- whether patients know that's the reason or not. Frightening stories abound. GPs who won't take smokers as patients. Surgeons who demand obese patients lose weight before they'll operate, or tell them to find another doctor. Transplant teams who turn drinkers down flat. Doctors say their decisions make sense: why spend thousands of dollars on futile procedures? Or the decision is the product of frustration: why not make patients accountable for their vices? {snip} But in a health system with more patients than doctors can treat, where doctors have discretion over whom they'll take on, some say it's inevitable that problem patients will get shunted aside in favour of healthier, less labour-intensive cases.

So here's the question: if people won't stop hurting themselves, can they really expect the same medical treatment as everyone else? Health care in Canada is supposed to be about equal treatment for all comers. [snip]

Doctors across the country told Maclean's of colleagues who would not take "unhealthy patients" -- smokers, drinkers and the obese -- because caring for them would be too complicated, and too much of a burden for their already overcrowded practices. Such patients might, in other words, take longer to treat, reducing the number of patients a doctor can see and bill for. The consequence is an entrenched tendency to choose the gym-goer, the moderate connoisseur of red wine and the non-smoker. Says Dr. Edward Schollenberg, the registrar of the College of Physicians and Surgeons of New Brunswick: "The idea that smoking or drinking or excess weight impacts on your health care is just the way the world is.

(Excerpt) Read more at macleans.ca ...


TOPICS: Canada; Culture/Society; Government; Miscellaneous; News/Current Events
KEYWORDS: healthcare; publichealthcare; socialengineering; socialism
Navigation: use the links below to view more comments.
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This is an excerpt from Macleans -- Canada's dead-tree answer to Newsweek.

When the public health care monopoly was introduced in Canada, the deal was equal treatment for everyone. Now, we see that some people are more equal than others. We've gotten used to waiting lists, and other more subtle forms of rationing. Now, we're seeing flat-out social engineering.

This is an excerpt; because I'm not sure about the rules for posting from Macleans. The whole article is available on line at the link & is worth reading as a cautionary tale about socialized public health care monopolies.

1 posted on 04/25/2006 9:20:50 AM PDT by USFRIENDINVICTORIA
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To: USFRIENDINVICTORIA

Doctors should have the right to refuse patients just as business owners should be able to turn away potential customers.


2 posted on 04/25/2006 9:25:40 AM PDT by ConservativeMind
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To: USFRIENDINVICTORIA

Ah, socialized medicine. Always so good.


3 posted on 04/25/2006 9:26:09 AM PDT by wizardoz
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To: USFRIENDINVICTORIA

They're not going to have many patients if they turn down Canadians who drink.


4 posted on 04/25/2006 9:27:06 AM PDT by dead (I've got my eye out for Mullah Omar.)
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To: fanfan

Ping.


5 posted on 04/25/2006 9:27:52 AM PDT by Springman
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To: USFRIENDINVICTORIA

I guess this means that homosexual AIDS patients will go to the back of the line. /sarc


6 posted on 04/25/2006 9:27:52 AM PDT by garv
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To: Cathryn Crawford

ping


7 posted on 04/25/2006 9:29:17 AM PDT by Sir Gawain
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To: ConservativeMind
Doctors should have the right to refuse patients just as business owners should be able to turn away potential customers.

In a free market certainly, but medical care is socialized in Canada.

They've forced people into an system where they're denied medical care. And there are no other options in the country.

8 posted on 04/25/2006 9:29:45 AM PDT by dead (I've got my eye out for Mullah Omar.)
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To: ConservativeMind

''Doctors should have the right to refuse patients just as business owners should be able to turn away potential customers.''

... and the first people they should refuse to treat are lawyers and politicians.


9 posted on 04/25/2006 9:30:50 AM PDT by Lexington Green (Politician - Lawyer - Journalist.... when you lie for a living)
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To: ConservativeMind

The problem is, we have a health care monopoly. If doctors within the system won't treat them, there is no where else for these patients to go.

This would be comparable to your HMO refusing to treat you, after you've been making payments your whole life. If an American HMO tried that on a wholesale basis, it would quickly lose its client base to competitors. Canadians don't have any alternative to the public monopoly.


10 posted on 04/25/2006 9:31:42 AM PDT by USFRIENDINVICTORIA
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To: USFRIENDINVICTORIA

"Transplant teams who turn drinkers down flat."

If the transplant is for a liver that the person ruined by drinking it's no shock. Same thing happens here in the U.S.


11 posted on 04/25/2006 9:31:47 AM PDT by Bikers4Bush (Flood waters rising, heading for more conservative ground. Vote for true conservatives!)
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To: garv
"I guess this means that homosexual AIDS patients will go to the back of the line."/sarcasm

and, the elderly should be shuffled far, far back in the line since we all know its all down hill for them anyway...../sarcasm

12 posted on 04/25/2006 9:32:14 AM PDT by cherry
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To: USFRIENDINVICTORIA
Guess after they (the doctors' offices) get through the gene marker screening (DNA) for hereditary diseases, HIV+ folk, drinkers, smokers, overeaters, workaholics, drug abusers, mentally handicapped, physically handicapped, sex addicts, insomniacs, caffeine addicted, diabetics, hypertension afflicted, and the folks that already are sick to send to the back of the line, being a doctor in Canada will be a breeze, right?
13 posted on 04/25/2006 9:35:15 AM PDT by RSmithOpt (Liberalism: Highway to Hell)
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To: dead
Socialized medical care = rationed medical care.

Soon, rationing will be by government guidelines and edicts.

Then, the sad commentary will be:
First, they came for the drug addicts. But I didn't use drugs, so it didn't matter to me.
Next, they came for the drinkers. But I didn't drink, so it didn't matter to me.
Then, they came for the obese. But I wasn't obese, so it didn't matter to me.
Then, they came for the weak and unproductive. But I was afflifted by neither, so it didn't matter to me.
Then, they came for the elderly. But I'm only 50, so it didn't matter to me.

14 posted on 04/25/2006 9:35:50 AM PDT by Mad_Tom_Rackham (A Liberal: One who demands half of your pie, because he didn't bake one.)
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To: USFRIENDINVICTORIA
That makes sense. However, in the light of such potential behavior from the State, we must seek a more healthy life as insurance against asinine policies.

We can greatly limit the problems we would need to bring to a doctor. As conservatives, such a "can-do" attitude should already be a part of each of us.
15 posted on 04/25/2006 9:37:34 AM PDT by ConservativeMind
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To: garv
"I guess this means that homosexual AIDS patients will go to the back of the line. /sarc"

Your /sarc tag indicates you already know the answer to that one.

In addition, a BC Human Rights tribunal has ruled that the health care system must pay for "sexual reassignment surgery" for transsexuals.

http://www.tgcrossroads.org/news/archive.asp?aid=688
16 posted on 04/25/2006 9:37:43 AM PDT by USFRIENDINVICTORIA
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To: garv

I guess this means that homosexual AIDS patients will go to the back of the line."

They have priority...


17 posted on 04/25/2006 9:38:57 AM PDT by Paisan
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To: garv
I guess this means that homosexual AIDS patients will go to the back of the line. /sarc

Have you ever got that right! (The sarcasm, I mean)
Still and all, what if the patient is an overweight, cigarette smoking Muslim? Or an overweight sot of a queer? Will/can they be denied treatment?

18 posted on 04/25/2006 9:40:09 AM PDT by yankeedame ("Oh, I can take it but I'd much rather dish it out.")
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To: USFRIENDINVICTORIA

The more health care becomes an individual responsibility, the better.


19 posted on 04/25/2006 9:45:27 AM PDT by JmyBryan
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To: Springman; GMMAC; Pikamax; Former Proud Canadian; Great Dane; Alberta's Child; headsonpikes; ...
Thanks for the ping, Springman.

Image hosting by Photobucket

20 posted on 04/25/2006 9:45:42 AM PDT by fanfan (FR is the best/biggest news gathering entity in the whole known history of the world. Thanks Jim.)
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To: USFRIENDINVICTORIA

bump


21 posted on 04/25/2006 9:48:45 AM PDT by Freee-dame
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To: ConservativeMind

"Doctors should have the right to refuse patients just as business owners should be able to turn away potential customers."

Not if they're taking government money. You seem to be under the delusion that this is the free market we're talking about. :)


22 posted on 04/25/2006 9:49:39 AM PDT by dljordan
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To: USFRIENDINVICTORIA

bttt


23 posted on 04/25/2006 9:51:08 AM PDT by shield (A wise man's heart is at his RIGHT hand; but a fool's heart at his LEFT. Ecc. 10:2)
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To: fanfan

You're welcome. BTW, what are the taxes on Cigs and booze in Canada?
If you know.

The US and state Gov. make more on them than the producers!!


24 posted on 04/25/2006 9:51:46 AM PDT by Springman
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To: Bikers4Bush

"If the transplant is for a liver that the person ruined by drinking it's no shock. Same thing happens here in the U.S."

There is a shortage of livers (and other organs) for transplanting. They should go to people who won't abuse them.

However, what should we do when (if) the technology for growing new organs is perfected, and there is no longer a shortage? In the U.S. drinkers would probably be able to get insurance, if they paid a large premium. Rich boozers could just pay all the costs out of pocket. Canadians have no alternative to the public health monopoly (except to travel to the U.S. for the services).


25 posted on 04/25/2006 9:51:46 AM PDT by USFRIENDINVICTORIA
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To: USFRIENDINVICTORIA

Yep, but by god don't you dare tell an Illegal Alien he can't have free Health Care.

Racist pigdogs.

/sarc


26 posted on 04/25/2006 9:52:58 AM PDT by Leatherneck_MT (An honest man can feel no pleasure in the exercise of power over his fellow citizens.)
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To: RSmithOpt

But half of the things you mention directly relate to the part of the article that stated "This is an issue of behaviour and choice," . . . "People can choose to alter their behaviour, can choose to go to the gym more often -- these are choice things."


27 posted on 04/25/2006 9:55:27 AM PDT by synbad600
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To: Springman

"Sin taxes" (taxes on booze & tobacco) are much, much higher in Canada. Cigarette smuggling from the U.S. is a big business.


28 posted on 04/25/2006 9:59:19 AM PDT by USFRIENDINVICTORIA
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To: Springman
In addition to federal and provincial sales taxes, alcohol in Canada also is subject to an excise, or "sin," tax at both levels. The average total tax on alcohol in Canada is 83 percent, as opposed to 44 percent in the U.S., according to the Association of Canadian Distillers.

Source

29 posted on 04/25/2006 10:01:14 AM PDT by fanfan (FR is the best/biggest news gathering entity in the whole known history of the world. Thanks Jim.)
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To: USFRIENDINVICTORIA

There are other ways the monopolies restrict access. My father in law (who by the way, was active, non-smoker, healthy eater) contracted colon cancer in his early 50's. Because he would not submit to chemo, the doctor refused to give him any other care. The same thing happens stateside, or course, but here it is easier to switch doctors.


30 posted on 04/25/2006 10:02:10 AM PDT by sittnick (There is no salvation in politics.)
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To: Springman
In Canada, between 63 and 79 per cent of the price of a package of cigarettes is tax. In New York, by comparison, the tax on cigarettes is 38 per cent.

Source

31 posted on 04/25/2006 10:03:53 AM PDT by fanfan (FR is the best/biggest news gathering entity in the whole known history of the world. Thanks Jim.)
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To: USFRIENDINVICTORIA
Awwwwww, man!
I'm so bummed out!

You mean to tell me it's not just smokers any more?
Who'da thought?

< /sarc >

32 posted on 04/25/2006 10:05:54 AM PDT by Publius6961 (Multiculturalism is the white flag of a dying country)
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To: USFRIENDINVICTORIA

Drinkers and smokers get no care, but the chronically non-productive still get everything free, yes?


33 posted on 04/25/2006 10:07:38 AM PDT by thoughtomator (That new ring around Uranus is courtesy of the IRS)
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To: USFRIENDINVICTORIA
Cigarette smuggling from the U.S. is a big business.

A guy that I knew got arrested on his third trip with a RV filled with cigs. They confiscated the camper and threated him with 10 years. He rolled on his cananadian accomplices and got nothing but an official "never come to Canada again". The real kicker is...It wasn't his RV, so he got off with nothing.

34 posted on 04/25/2006 10:07:43 AM PDT by Dosa26
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To: Mad_Tom_Rackham
It seems you've learned the lessons of history very well.

The Terri Schiavo case was a wake-up call to me. The so-called "right-to-die" has been morphed into the "right to euthanize". Canadians worry about the effects an aging population will have on our health care system. I fear that we've already seen the solution.
35 posted on 04/25/2006 10:08:37 AM PDT by USFRIENDINVICTORIA
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To: ConservativeMind
"Doctors should have the right to refuse patients just as business owners should be able to turn away potential customers.

... and everyone should have the right to choose whom they associate with socially or business wise, but...
That is now bigotry, profiling, discrimination or meanspiritedness and forbidden by by law

36 posted on 04/25/2006 10:09:24 AM PDT by Publius6961 (Multiculturalism is the white flag of a dying country)
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To: ConservativeMind
"Doctors should have the right to refuse patients just as business owners should be able to turn away potential customers."

Doesn't that violate the Hippocratic Creed - to save lives?

Ooops! I forgot. They'll willing kill babies via abortion.

Ah, just think of all the money they WON'T be making. These are just the folks they can have a field day with!

37 posted on 04/25/2006 10:10:59 AM PDT by nmh (Intelligent people recognize Intelligent Design (God) !)
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To: USFRIENDINVICTORIA

A terrifying situation. Next, doctors won't accept patients over 80. Or 70. Or 55. Doctors with waiting lists might decide to work only on pretty women. Canada seems crazy to me.


38 posted on 04/25/2006 10:11:24 AM PDT by Veto! (Opinions freely dispensed as advice)
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To: ConservativeMind
We can greatly limit the problems we would need to bring to a doctor. As conservatives, such a "can-do" attitude should already be a part of each of us.

Unfortunately, the New Deal has made self-sufficiency a punishable offense

39 posted on 04/25/2006 10:15:04 AM PDT by tacticalogic ("Oh bother!" said Pooh, as he chambered his last round.)
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To: cherry

You may thinnk it's sarcasm, but that is actually happening in the Netherlands.

And in the good old USA

http://worldnetdaily.com/news/article.asp?ARTICLE_ID=49888


40 posted on 04/25/2006 10:18:53 AM PDT by chesley (Liberals...what's not to loathe?)
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To: nmh
Doesn't that violate the Hippocratic Creed - to save lives?

Unfortunately....those that abide by that oath are a dying breed. More and more are going into the profession for the $$ and prestige......not because they have compassion for their fellow man.

41 posted on 04/25/2006 10:22:32 AM PDT by LaineyDee (Don't mess with Texas wimmen!)
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To: Lexington Green


... and the first people they should refuse to treat are lawyers and politicians.

---

With rare exceptions, I do refuse. Harrius, M.D. (internal medicine)


42 posted on 04/25/2006 10:24:33 AM PDT by Harrius Magnus (Enemy #1 = The Leftist holy trinity of multiculturalism, moral equivalence and relativism.)
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To: Veto!; USFRIENDINVICTORIA; fanfan
"Canada seems crazy to me"

... and when it comes to the ever politically correct proponents of what's become a socialist medicine "industry" up here, don't forget to add 'hypocritical'.

Obesity & homosexual practices are both plainly health hazards, but don't hold your breath waiting for any government sponsored media blitz, like the anti-smoking campaign, targeting fat fagots!

Where are the tobacco-like taxes on donut shops & bath houses ?!?!
43 posted on 04/25/2006 10:25:32 AM PDT by GMMAC (Discover Canada governed by Conservatives: www.CanadianAlly.com)
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To: USFRIENDINVICTORIA

Canadians have two health care systems, one in Canada and one here in the US.


44 posted on 04/25/2006 10:28:11 AM PDT by VOATNOW1
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To: ConservativeMind
Doctors should have the right to refuse patients just as business owners should be able to turn away potential customers.


That pesky Hypocritical oath might get in the way of that
45 posted on 04/25/2006 10:30:23 AM PDT by calljack (Sometimes your worst nightmare is just a start.)
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To: USFRIENDINVICTORIA
In Praise of Bad Habits

In Praise of Bad Habits

ICR Lecture - November 17th 2001

In this lecture I will try to do 3 things. First, I want to present a perspective on the level of concern (some might say 'obsession') with dietary, health and lifestyle correctness that characterises contemporary Western societies, and the UK and the United States in particular. This pursuit of novel, narrow concepts of so-called 'health' and 'fitness' has led us to create new outcasts - those who fail to conform to the increasing catalogue of prescriptions for what is 'best for us' - those who, contrary to the advice of self-appointed arbiters of modern rectitude, persist with 'bad habits'.

Secondly, I want to argue that this zeitgeist of 'health' has some unfortunate and unsavoury historical predecessors, which might serve as warnings to us. The forces which lie at the root of what I will refer to as 'healthism' might be rather less benign than we have been led to believe.

Thirdly, I want to argue that a number of trends evident in our cultures run counter to what we might take to be our evolutionary heritage. The idea that we should seek to remove all risks to our lives and to our bodies, avoiding what previously might have been seen as pleasurable or 'fun', might prove to be 'unsustainable' - leading to patterns of living for which our stone age brains are simply not yet designed.

In case this should seem to preface a simplistic, reductionist or neo-Darwinist account of the human condition, I should also declare from the outset the philosophical framework, if that is not too grand a term, in which my remarks will be made. At the Social Issues Research Centre we have been trying, not wholly successfully I must admit, to revive a perspective which seems to have all but disappeared in recent years - that of a left-of-centre, libertarian position. The word 'libertarian' has largely been high-jacked by the extreme political right - particularly in America - while the left has moved increasingly towards lifestyle coercion and what has aptly been described as 'focus group fascism' - if Mr Blair's focus groups think something is 'bad', then let's ban it in pursuit of easy populism - a rather novel approach to democracy.

All of this is a great pity. And we seem to have moved a long way away from John Stuart Mill who, in his essay On Liberty, said:

"Neither one person, nor any number of persons, is warranted in saying to another human creature of ripe years that he shall not do with his life for his own benefit what he chooses to do with it. All errors he is likely to commit against advice and warning are far outweighed by the evil of allowing others to constrain him to do what they deem his good."

I find nothing in this original concept of 'liberalism' that is incompatible with a just and caring society, which believes in redistribution of wealth and support for its least advantaged members. And I say all this because I am fed up with being labelled as a 'conservative' by right-on, middle-class, self-appointed guardians of what passes for political correctness these days. I'll just get that off my chest ...

I should also, I suppose, based on previous experience of floating some of the points in this lecture, issue a health warning. In the way that a humble packet of peanuts now has a label which says 'Contains Nuts' - just in case we were unaware of that fact - and an electrical screwdriver has a sticker which warns 'Do Not Insert in Ear' - this lecture may contain statements and arguments which may give rise to intellectual and psychological distress. Your statutory rights are not affected by this warning.


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.

The transformations in public health philosophy in revolutionary France were founded on the ideology that instruction in diet and lifestyle were the keys to ensuring the eventual compliance of the French people. It was, therefore, perhaps no accident that the head of the first ever government public health department in Europe, established in 1798 - the year of the Revolution itself - was none other than one Dr. Guillotin - more familiarly known as the inventor of an efficient decapitation device - the guillotine.

Commenting on this period of history Petr Skrabanek notes:

"It is a paradox that the Age of Enlightenment, which destroyed the false certainties of religious dogmas and freed man from superstition, forged, at the same time, new chains for the enslavement of man, by regarding him as a machine, governed by materialistic and deterministic laws."

Elsewhere in Europe in the 18th century other types of coercion in health policy were beginning to develop. In Germany for example, many medical journals included in their titles the term Medizinalpolizei,(medicine police), and later Gesundheits-Polizei (health police). The medical historian George Rosen has argued that the concept of medical police was part of a broader political force which sought to secure greater wealth for the merchant classes and the aristocracy by ensuring that workers were sufficiently fit for their semi-slave roles.

This trend, according to Paul Weindling at the Wellcome Unit for the History of Medicine led to more far-reaching consequences:

"Medicine was transformed from a free profession, as it was proclaimed by the German Confederation in 1869, to the doctor carrying out duties of State officials in the interests not of the individual patient but of society and future generations."

This convergence of state and medical interests was also reflected in Britain in the rise of the eugenics movement in the early 1900s, following publications by Francis Galton and others. The philosophy enshrined the belief that the quality of human stock could be improved, as in the case of other animals, by preventing the reproduction of those of lesser quality while encouraging propagation of the superior variety. The term 'social hygiene', which quickly followed the development of eugenic ideology, incorporated notions of genetic selection with concerns for sanitation, diet, personal lifestyle and child care. While previously ill-health had been seen as an unavoidable misfortune, it now became (at least in part) the result of bad habits.

The fact that such dangerous philosophies were seen as persuasive by health reformers was due in large part to the pressures to achieve 'national efficiency' prior to the First World War. From the point of view of Charity Commissioners and the medical profession, the number of 'undeserving' poor in society had become unacceptable and radical steps were needed to reduce such a burden in times of economic recession. The eugenic ideology, therefore, found favour across the political spectrum, with 'left', 'right' and 'new liberals' all in agreement that control of breeding and lifestyles was a legitimate role for the State.

These patterns of convergence of the state and medical professions were the direct precursors, according to some historians, for the ultimate expression of lifestyle and health prescription which lay at the heart of the philosophy of the Third Reich. And comparisons between contemporary healthism and that which developed in Germany in the 1930s are, I'm afraid, so striking that they cannot be ignored. The philosophy of Gesundheit ist Pflicht - health is duty - initially took on forms that are disconcertingly familiar in modern health trends.

The implications of such parallels have been highlighted by the New York professor of paediatrics, Hartmut Hanauske-Abel, who has provided us with some of the most cogent arguments against contemporary trends towards health 'intervention' in an article in the British Medical Journal in 1994 on German medicine and National Socialism in the 1930s. He had previously published a similar article in the Lancet in 1986 As a result, the German medical authorities withdrew his sub-licence to practice emergency medicine. It was only restored to him after a decision by the Supreme Court.

Hanauske-Abel is highly critical of his predecessors in Germany and of the active role they played in furthering the aims of the Third Reich. He argued that, far from German doctors being corrupted by Hitler's regime, they were ahead of the regime in advocating policies on eugenics. While this accounts for his lack of popularity among the German medical profession, his argument that what is happening in the profession today has many striking similarities with the early 1930s has resulted in even greater hostility.

His arguments are detailed and sometimes complex. But the core of his thesis, based primarily on analysis of documents published in 1933 in German medical journals, is to do with two types of convergence. The first of these is the one I have already noted between the state and the medical profession. Doctors were no longer in the business of diagnosing and treating ailments but of inculcating in their patients a narrow philosophy of health - what today we would benignly refer to as health promotion, but which has its roots in fundamentally illiberal and dangerously authoritarian political ideologies.

The second type of convergence with which Hanauske-Abel was concerned was that of political convergence - the virtual eradication of political opposition, resulting in a single area of consensus regarding all aspects of state control and intervention. I am not normally prone to alarmism - but, it seems to me that we now live in what might be described as a 'post-politics' decade. There is no real political debate in Britain, as we saw in the run-up to the last election - just an uncomfortable sharing of a right-leaning, centrist position. Even when thousands of tons of bombs rained down on what little was left of Afghanistan in the so-called 'War Against Terrorism', as we sought to oust one band of murdering thugs by arming and supporting an equally bloodthirsty band of zealots, voices of dissent amongst those claiming to be the people's representatives were so muted and faint that they were hardly audible. It is particularly in times of economic decline, as witnessed in 1930s Germany, that such forms of political convergence can have calamitous effects.

Hanauske-Abel concluded his BMJ article by saying:

"Contextual analysis of events during the summer of 1933 in Germany [The year Hitler rose to power] 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. … These forces may not be as demoniacal as those in Germany in the summer of 1933, but only by approaching their next alignment with great caution can we avert a conflagration".

OK, this may sound rather over-dramatic - and that is what I felt when I first read the article. And I am certainly not suggesting that medics and health professionals are involved in a sinister neo-Nazi conspiracy. I am not saying that at all. But the more I examine the intolerance which our society extends to those it deems as exhibiting 'bad habits', the more I am reminded of those concepts of 'racial hygiene' 'health purity' and of the 'duty' to conform to the state's concept of 'healthy living' - it's an uncomfortable feeling. And it is this 'discomfort' with historical reminders that is evident in Germany today. It has been suggested, for example, by George Davey Smith - an epidemiologist at Bristol University - that one of the reasons many Germans continue to smoke cigarettes in apparent defiance of extensive anti-tobacco campaigns is because of reminders of the Nazi past. For Hitler, tobacco was a 'genetic poison' and the anti-smoking campaigns that he personally instigated were allied directly to the promotion of Aryan superiority. The stance taken by Goebbels on coffee was very similar. And the memory of these lingers on.

Patterns of convergence similar to those occurring in 1930s Germany are also evident in the role of supra-governmental groups such as the World health Organisation, which force quite narrow Western concepts of health into the agendas of developing countries - hence seat-belt wearing campaigns in Mozambique where the main form of transport is the water buffalo and cart. And Deborah Lupton again notes that under the prevailing discourse of 'healthism', the pursuit of health has become an end in itself rather than the means to an end. For the WHO, health has become reified to the extent that it is defined by them as 'a state of complete physical, mental and social well-being' - a phrase which, given the points I have just raised might be seen as having sinister overtones. As David Seedhouse, Director of the National Centre for Health and Social Ethics in New Zealand has noted:

" ... in pluralistic societies any claim to know objectively the constituents of a worthwhile life must at the very least be treated with caution."

Seedhouse argues that the whole notion of 'well-being' should be dropped from the WHO mandate. Not only is the concept too vague to be used as a measure of the effectiveness of health promotion, it smacks very strongly of the 'we know what is best for you' philosophy. Robert Downie and his colleagues, in one of the 'bibles' of health promotion used by WHO activists, show that they are clearly exponents of this paternalistic role. They note that 'well-being' can be viewed in one sense as a subjective judgement made by individuals about their own physical and mental states. Ordinary mortals, however, as opposed to health promoters, may have 'illusions' about their own well-being - they are not 'feeling great' at all. They say:

"Subjective well-being ... may be spurious and may arise from influences which are detrimental to an individual's functioning or flourishing and/or to society."

From this standpoint, the large lady in Polynesia, who is culturally valued because of her size and weight, and lives a contented and long life as a result, is deluded. Her Body Mass Index (BMI) of over 30 is contrary to the WHO's 'objective' measure of well-being - she is 'obese'. She must, therefore, be 'encouraged' to become a more 'normal' size despite the fact that this will inevitably make her less culturally valued, and probably quite miserable. There is also no real evidence that she will live any longer either.

For Seedhouse and others, the concept of 'objective' well-being, which is at the core of the WHO philosophy, consists of nothing more than unfounded prejudice. It provides a 'cover' for health promoters whose real " ... intentions and preferences", he suggests, " are becoming too obvious."

Let me now just return to the issue of risk, before I work towards the final theme of this lecture.

At the core of all healthism is a concern to eradicate risk in people's lives. On the surface this appears to be a liberal, caring aim and is robustly defended by those in the health education and promotion fields. Risk, however, as the anthropologist Mary Douglas and others have pointed out, is now both a politicised and a moralised concept. Risk is now the secular equivalent of sin. In this sense exposing oneself to risk, when other options are available, is to act in a sinful manner.

But there is a further issue here, and that is to do with the (often arbitrary) definition of risk. Which particular aspects of lifestyle are to be defined as risky/sinful, and to which segments of society will 'persuasion' be applied for the 'good of society as a whole'? These are not abstract questions for they raise yet another insidious component of healthism - its culturally divisive nature. Risk determination is undertaken by a relatively small, white, middle class elite group in Western society - scientists and health professionals. These are people who, in the main, do not smoke, drink to excess or engage in promiscuous sexual activities. They have low-fat and low-sodium diets and tend to be over-represented in the gymnasium and aerobic exercise groups. (They might, to some people, also appear phenomenally dull.)

Engaging in risk - smoking, drinking, creating the possibility of sexually transmitted diseases, eating fat, sugar, salt and avoiding too much exercise - is characteristic of a different strata of society - the poor and marginalised, the working classes, ethnic minorities and 'deviant' groups. When the proponents of healthism are urging changes in lifestyle in order to achieve, in their terms, 'well-being', they are advocating changes for others much more often than they are for themselves. In this sense they are essentially moralists seeking to stigmatise specific members of society.

Charles Rosenberg, Professor of the History of Science at Harvard, emphasises this point crisply:

"Cultural values and social location have always provided the materials for self-serving constructions of epidemiological risk. The poor, the alien, the sinner have all served as convenient objects for such stigmatising speculations."

The point about healthists is that they have what Mary Douglas calls a "sense of individual control over social forces." Because of their relatively privileged positions they feel that they have a personal stake in the culture to which they belong, and therefore wish to adopt lifestyles to maximise such benefits. But, as the writer David Shaw points out in his book The Pleasure Police, in a somewhat less academic manner than Douglas and her colleagues:

"... poor people - the starving, the jobless and the homeless, whether here or abroad, with children or without - are not the ones demanding bans on smoking, silicone breast implants or oily popcorn in the local movie theater ... No, the alarmists - the Cassandras who see death where'er they look - tend to be people with higher than average education and socio-economic status ... who want to be absolutely sure they live long enough to enjoy it, except that they're so busy worrying that they don't have the time, energy and appetite to enjoy anything - and, in the process of trying turn their personal anxiety into public policy, they are also depriving the rest of us of much pleasure we should be able to take from life."

The demonising of risk-takers has identifiable social and cultural functions which, in my view, run quite counter to positive forces which lie at the very roots of our evolution. We have attained the benefits of a safe and civilised world precisely because our ancestors were risk-takers. From an evolutionary psychology perspective the cognitive structures which shape our reasoning and our relationship with our environments - our natural competences - have been moulded not by our development in the mere 200 years of industrialised living but over the millions of years since the arrival of the early hominids. Our modern skulls, suggest, Leda Cosmides and many others in the 'Evo Psy' field, house stone age minds - brains not yet adapted for the rapid transition from hunter-gatherer communities to the technological sophistication of the 21st century. Natural selection is a very slow process - there have not been enough generations for it to reorder our neural circuits to come to terms fully with our progress.

I am aware of the limitations of evolutionary perspectives, and I reject the notion that by identifying what has existed in our past we can determine what ought to be pursued in the present and in the future. Such shallow and untenable reasoning lies at the heart of many sexist, racist and elitist dogmas. It is, however, unlikely that we have been able simply to cast off what might loosely be described as 'in our nature' over the mere 1% of our evolution which has been characterised by organised agriculture and so-called 'civilised' living. And there is ample evidence, I would argue, that the desire to take risks, and experience the frisson of excitement which accompanies such activity, is still 'wired in' to the cortical structures which direct our lives. We can seek to regulate risk-taking, in the way that we regulate equally natural desires for sex, dominance and pleasure. But I do not think that we can sustain a 'safe' society - one in which risk is the equivalent of sin - for very long.

When our society becomes too safe, we feel compelled to put risks back into our lives. Consider for a moment bungee jumping. Only in the context of recent shifts in contemporary living could such a mindless activity come to be considered attractive - something which people will pay to do - leaping off bridges and towers to be rescued from the inevitable fate of gravity by an elastic cord! What we have here is a clear example principle of risk homeostasis - in times of objective safety, we act more recklessly - a phenomenon also quite apparent in more humdrum aspects of our daily lives. We make cars 'safer' with seat belts, air bags and automatic braking systems. As a result people, and men in particular, drive them faster and with less regard for potential mortality. And all of this is based, in my view, on our evolutionary heritage - achieving a comfortable balance between the enervating experience of complete safety and the heart-stopping fear of one risk too many - a level of physiological and psychological arousal which first tempted early man out of his cave to find food, and thus to feed his family and ensure the survival of his genes, but inhibited acts of sheer hubris in front of a sabre-toothed tiger.

It is this sense of balance - the essential ingredient of our success as a species, and one which is so often expressed in what are now defined as 'bad habits' - that we are now in serious danger of losing. We need some bad habits, I suggest, in order to retain our subscription to the human race.

There is, of course, another sense in which our pursuit of health, as defined in terms of longevity, might prove to be unsustainable. It is already becoming apparent that having a large sector of society in 'retirement' - past the stage of productive input into the economy - has its drawbacks. The notion of the state providing financially for its elderly, for example, is fast disappearing. The scale of the pension swindles conducted by recent governments makes Robert Maxwell seem quite amateurish. We simply can't pay people to live out their extended lives with any degree of dignity without a radical re-shaping of state fiscal policies. And that, given the converged political world in which we now live, is unlikely to be achieved. Talk begins again of voluntary euthanasia, assisted suicide … but let's not go down this depressing road again.

Maybe the way we resolve the dilemma is to redefine morality - for morality, after all, is always founded on expediency and adaptation. Could smokers become admired because of the selfless way in which they shorten their lives? Could the English breakfast - the heart attack on a plate - be re-cast as the food of saintly people who will, if we are to believe all the current health dogmas, quickly and economically drop down dead from a surfeit of cholesterol. Who knows?

Let me finish with something from my old chum Desmond Morris, who turns out to be an even longer-standing friend of Pat Williams [chair]. Over a leisurely and congenial lunch in Oxford, which involved rather more than the recommended 3 units per day of alcohol, we persuaded him to write an article for publication on our web site to do with food and eating from a zoologist's perspective. We thought he would dash off a witty and interesting piece about lions and their taste for wildebeest, or something like that. Instead, what he sent me was a moving account of his mother's death, which had occurred a short time before. The title was 'A little bit of what you fancy'. In it he said:

"It was a meal to make a food faddist swoon away in horror. My mother was piling her plate high with a greasy, fatty, fry-up of a mixed grill and tucking in with gusto. When I say 'with gusto', I mean she was eating with the urgent pleasure of a predator at a kill. Although she was born during the reign of Queen Victoria, she was more in tune with the robust food pleasures of the eighteenth century, when a feast was a feast, and nobody had heard about health foods, diet regimes, or table etiquette that demanded you chew each mouthful 32 times before swallowing."

"Watching her in action and trying my best to match her appetite, I glibly remarked that if she kept ignoring the words of wisdom of the health gurus and diet experts, she would die young. This may sound like a cruel thing for a son to have said to his mother, but the fact that she was in her 99th year at the time of the meal in question, helps to put my remark into perspective."

After some eloquent attacks on the pontificators and what he terms the 'diet fascists', and after calling attention to Man's omnivorous nature, Desmond returns to the story of his mother:

"When my mother was dying (just in time to avoid putting the Queen to the trouble of sending her a telegram, as she expressed it) I asked her if there was anything she wanted, 'A gin and tonic' she whispered. I had to feed it to her through a straw. 'If you've got to go, you might as well go with a swing' she said. And where food and drink is concerned, you might as well stay with a swing."

That, for me, is more than sufficient reason to argue that bad habits are, indeed, of value - that they make us human.

46 posted on 04/25/2006 10:31:14 AM PDT by metesky ("Brethren, leave us go amongst them." Rev. Capt. Samuel Johnston Clayton - Ward Bond- The Searchers)
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To: Veto!
A terrifying situation. Next, doctors won't accept patients over 80. Or 70. Or 55. Doctors with waiting lists might decide to work only on pretty women. Canada seems crazy to me.

----

It's already happening in the U.S. of A., and before you go and blame the doctor, take a look at the CMS (specifically, Medicare, the old and disabled) website -- they are slowly implementing "pay for performance" simultaneously with declining reimbursement rates. 3 of my 5 partners no longer take Medicare patients. Few realize the economics of health care, that when a government payor controls 50 % of a service field, we are already long onto our way of socialized medicine. Doctors are, in large part, government subcontractors. Unlike other federal employees, we are not unionized. Many just choose not to take the lower rates and greater paperwork hassle (ie increased overhead) of contracting with the Gubmint. I can't wait until I'm busier, when I can drop Medicare faster than a greasey turd.
47 posted on 04/25/2006 10:33:56 AM PDT by Harrius Magnus (Enemy #1 = The Leftist holy trinity of multiculturalism, moral equivalence and relativism.)
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To: metesky

What's ICR?


48 posted on 04/25/2006 10:36:39 AM PDT by Publius6961 (Multiculturalism is the white flag of a dying country)
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To: USFRIENDINVICTORIA
Canadians don't have any alternative to the public monopoly.

Do you not have the ballot box?

49 posted on 04/25/2006 10:38:00 AM PDT by dagogo redux (I never met a Dem yet who didn't understand a slap in the face, or a slug from a 45)
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To: garv
I guess this means that homosexual AIDS patients will go to the back of the line. /sarc

Ha ha?
Give it a shot; see you in jail.

The best way to nurture contempt for laws generally, is to pass laws like "if you ask that question, you go to jail".
None of these doctors, presumably all intelligent, will ever, ever ask this question or address this glaring and egregious inconsistency:

Indeed, why not apply the same criterion to perverts?

50 posted on 04/25/2006 10:40:09 AM PDT by Publius6961 (Multiculturalism is the white flag of a dying country)
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