Health, Lifestyle, Environment: Countering the Panic
Social Affairs Unit, London, 1991
ISBN 0 907631 44 4
Introduction by Sean Gabb
Note: Early in 1991, I was persuaded to do some editing work for The Social Affairs Unit. This book was my biggest project, and it involved more work than I expected. Some of the essays were fully written out and needed only moderate editing. Many were corrupt transcripts of what were often rambling conference speeches, and these needed to be rewritten. This was in the days before the Internet, and I had to spend days in various libraries, checking facts and pulling out quotations.
What I most enjoyed was reconstructing and then trying to source the Latin phrase Timor mortis conturbat me. I suspected at first it was a misquotation of a mediaeval trochaic tetrameter. I rearranged it as Timor mortis me conturbat, and spent days in the library attached to Westminster Cathedral, reading through hundreds of lines of devotional verse. Eventually, I discovered by accident that it comes from a Roman Catholic service for the dead and reads in whole Peccantem me quotidie, et non poenitentem, timor mortis conturbat me. Quia in inferno nulla est redemptio, miserere mei, Deus, et salva me. This was of absolutely no importance to the work as a whole, and I had no reason to suppose the author who quoted it could even read Latin. But tracking the quotation down cheered me no end.
I was never given a copy of the finished work, so have no idea how much of my work was left as I supplied it. I do not know if my footnote about the Latin survived. But here is my Introduction. Though it is detached from the essays it was meant to summarise, it seems good enough to publish as it stands. Since I am summarising what others have written, or what I wrote on their behalf, I will not say that I agree with every word of this Introduction. But I am, of course, in general agreement with it.
The purpose of this book is to examine the misuse of science in the public health debate. We are told, on allegedly scientific grounds, that our modern way of life is uniquely unhealthy; that unless we change it ‑ or let it to be changed for us ‑ we shall continue to die earlier than we need from various unpleasant illnesses. On why we are so unhealthy opinion may seem divided. Some point to our diet, showing how this has departed from the natural simplicity which we used to know, and which is still known elsewhere in the world. Others point to the environment, lamenting how our industries have poisoned it, and how it in turn is now poisoning us. But on where the final blame is to rest opinion is unanimous. In an unregulated market economy, consumer safety is said to come second behind the pursuit of profit. The chief proposed cure for this is government intervention in one form or another.
Now, these claims are untrue. They are made against the manifest burden of the evidence. In the first place, we are not uniquely unhealthy. Those of us now alive in the West are, on the whole, the healthiest people who ever lived. All the great scourges of the past have been overcome. We no longer live in the shadow of plague and famine. We are not infested with parasites. Our teeth are sound, our bodies large and strong. Almost invariably, we survive our infancy, and, overwhelmingly, our youth and middle age. We need only look around to see this. Or we can find it in the population tables. In 1850, life expectancy at birth among the English working classes was about 37. By 1900, this had risen to 50. Today, it is just below 73, and is confidently expected to rise still further. In 1976, there were 300 centenarians in the United Kingdom. In 1986, there were 3000. Much the same is reported for the other Western democracies.
In the second place, we owe these benefits entirely to the rise of industrial capitalism. During the past 200 years, first in England, then throughout the West as a whole, there has been a rational application of science to production. The result has been an immense and continuing increase in living standards, and therefore of health and life expectancy. Wherever the coordinating role of market pricing has been rejected, and the fundamentally irrational policy of central economic planning adopted in its place, living standards have at best crept forward. More often, they have on the whole declined.
These facts are notoriously true. Yet, every day, we see them flatly denied. Instead of rejoicing in the fruits of scientific and industrial progress, many of us now support what Bob Browning calls
strong new secular religions whose characteristics include opposition to economic growth, industrial technology and competitive capitalism.
Of course, there is nothing mysterious in this. We are richer and healthier than our ancestors. We and our descendants face the most intoxicatingly splendid future. We are, even so, the same human beings that have always existed. If for different reasons, we are still moved by fear and ignorance; and there are still special interests groups willing and able to take advantage of these passions. Let us look more closely at what is happening.
Timor mortis conturbat me ‑ the fear of death disturbs me. Ever since we learned as a species to think, this fear has oppressed us. We are alive. We are surrounded by all the good things of the world. One day, though, we shall be dead. Our bodies will rot away; and whether anything will detach from our corporeal selves, and continue independently, we have no certain means of knowing. Until recently, it was usual to hope for an afterlife. Now, throughout the West, the Judeao‑Christian tradition on which hope largely rested is in decline, and the search is on for some other source of comfort. Not surprisingly, perhaps, we tend to look for this in the medical sciences: if there must be a final hour, it might at least be put off.
Yet, while our lives have indeed been extended, our fear of death has not diminished. Rather, it has increased. The less directly familiar we grow with death, the more it seems to worry us. We live, says Professor Peter Berger, in a “cultural climate of pervasive anxiety”. Just hint a danger in something ‑ that it may give us cancer, or a heart attack, or whatever ‑ and the Western public will fall into a state of hypochondriacal terror.
Nor is the public able to separate sense from nonsense in matters of health. That would require an understanding of scientific fact and reasoning that is for the most part absent. Not only the general public, but also the well‑educated and those who determine the content of the media, are simply ignorant. Mathematics and the natural sciences are a closed book to them. According to Mark Mills,
something like 60 per cent of the [American] population thinks that dinosaurs and people lived at the same time…. About half the population doesn’t know that an electron is much smaller than an atom. A quarter of the population does not know that the earth goes around the sun, nor half the population how long it takes the earth to go around the sun.
People believe in the most improbable things ‑ in “lucky numbers”, in the paranormal, in flying saucers, in anything wonderful and capable of arousing lively passions. When told that something may be bad for their health, they scarcely ever ask how bad, but pass straight on to accepting the need for action. There was, for example, a certain risk involved in living next door to Three Mile Island during the whole course of the nuclear failure there. This was cried up in all the media as something uniquely horrible, and was generally accepted as such. Yet the statistical risk of death was exactly the same as a canoeist runs every six minutes. Perhaps people fear cancer more than they do drowning. Certainly, few have paused to compare the various risks.
The Exploiting Interests
There is no single group of beneficiaries from the great health panic of our time. It can be turned to the support of so many interests, sometimes acting in concert, sometimes against each other. But these do seem to fall under two broad headings. First, there are the medical puritans, or those haunted by what H.L. Mencken called the “fear that someone, somewhere, may be happy”. No one nowadays talks with a nasal whine about seeking the Lord, or puts linen drapes around table legs. But the underlying substance of puritanism remains the same in every generation: all that ever changes is the form. J.R. Johnstone and Chris Ulyatt find it sad but amusing to draw out the continuities. There has always been a minority of doctors and medical campaigners ready to condemn pleasure as unhealthy. A century ago, they made the world unhappy by dwelling on the alleged horrors of the commonest sexual peccadillo ‑ how it could bring on every condition from catarrh to insanity. Today, with God and the old morality out of fashion, they must find some new means of making our blood run cold. Accordingly, they declaim against smoking and drinking and eating too heartily, passing on every fact and half‑fact that comes their way.
Second, there is what has been called the New Class. In every Western country, to a greater or less degree, there is now a large section of the middle class by which economic status, though still important, is desired far less ardently than power. Admittedly, as Irving Kristol observes, there have always been such people among us. The difference is that, in the past, they contrived to serve us in various useful ways ‑ by joining the armed forces, or going out and ruling an empire. Today, these options are closed, and it is us, their fellow citizens, on whom they must in some way impose themselves. The interests of this New Class are served by taking up any ideology that is at once likely to prove popular and to expand the administrative and regulatory functions of government.
The articulation of health scares is exactly this. It allows its advocates to announce ‑ and to believe ‑ themselves to be working solely for the public interest. It impresses the public. Above all, it impresses the authorities. At a time of escalating health budgets, any concentration on prevention as opposed to cure is likely to be welcome. And, to quote Bob Browning again,
[i]f there is one universal theme in worldwide public interest health campaigns which distinguishes them from conventional health care campaigns, it is the almost total emphasis on what they call preventive rather than curative action. The official slogan of the World Health Organisation is now the somewhat utopian “Health for All by the Year 2000”.
He notes the increasing tendency of economists, sociologists and lawyers to determine health policy rather than doctors. He notes also the linked tendency to replace the sober and detached language traditionally associated with scientific reasoning with a strident activism. The declared ends of this “advocacy science” is less the advancement of knowledge than a heavier weight of controls on what can be produced or sold.
After an examination of the main American campaigning bodies, he concludes ominously:
They want (perhaps demand is a better word) to see the traditional separation of church and state reversed and their values established as official state ideology. Opposition views and lifestyles are seen as sinful. Many have no use for the tolerance that has been a keystone of liberal democratic societies.
The Sincerity of Most Health Activism
We must not, however, assume that self‑interest is incompatible with idealism. It is not. Those who most benefit from health and environmental programmes do usually believe in their own absolute rightness. They are the products of the youth culture of the 1960s and ‘70s. They have never wanted for anything, and so have never seen fit to praise or even appreciate the wonders of universal affluence. As Irving Kristol observes, they are drenched in
the intellectual and ideological impulses, the anticapitalist, antibourgeois, antimodern impulses of the 19th and early 20th centuries.
While they may use rational means, their ends are too often expressed in the vague, mystical language of neopaganism. It really is to them an artical of faith that progress is bad for humanity and for the environment which sustains us. If they were just cynical manipulators, their power would be all extension and no base. Their strength ‑ and, thus, their danger ‑ lies in their utter sincerity.
True and False Public Health Education Distinguished
Nor must we condemn every attempt at public health education as reactionary propaganda. We must simply be careful to distinguish true from false. This done, Dr Digby C. Anderson is even indifferent to whether the educators are funded by the government or by the market. Indeed, prior to taking up his present position, as Director of the Social Affairs Unit, he produced one of the first British textbooks on public health education. For him, the criterion is whether or not the educators seek to impose their lessons on an inattentive public. He sees true health education as
families, intermediate community agencies and schools giving children at school information about behaviour‑related diseases, encouraging them to think about the values involved in approving or rejecting certain behaviour and developing their capacity to take decisions and the responsibility for them. In the health care field, it means helping doctors and others to communicate effectively with their patients in the treatment of actual and in warning of conditions at risk. But most important of all, health education also occurs spontaneously when there is free public debate about health and behaviour (editor’s emphasis).
Anderson has no objection to educators who accept that they are dealing with free and responsible beings. But he is implacable opposed to those who go about calling for legal and administrative controls, and a monopoly of the right to educate the public.
As a typical instance of coercive education, he draws attention to the Report published in the July of 1991 by the British Department of Health’s Committee on Medical Aspects of Health Policy. Described by the Minister presenting it as “the most comprehensive of its kind in the world”, this sets various targets to be achieved before the end of the century. There is, for example, to be a 30 per cent reduction in coronary heart disease. Fewer cigarettes are to be smoked. Less fatty and other disfavoured sorts of food are to be eaten.
How is all this to be achieved? By mass publicity campaigns, and by regulation. The Report lays down specific recommendations of how many calories and nutriants we require, depending on age and sex. The Health Education Authority has been asked to simplify tese recommendations into healthy eating guides, and even a cookery book. The Government is also to campaign for new European Community regulations on food labelling so that consumers may be better informed of what their food contains.
But, what if millions of British consumers prefer to ignore these recommendations? How then are the health targets to be achieved? Supposing they continue to eat as much sugar as before, or smoke as many cigarettes. Are they to be coerced? “Either the target is a pious and empty hope or it is indeed coercive” Anderson says.
Turning to the stated means of reaching the targets, these are bound to be inefficient. They cannot take account of the immense diversity of consumers. We have different health needs and different pleasures. Advice suitable for some is not suitable for all. Those who cannot handle alcohol are unlikely to be helped by campaigns that treat all, including the moderate majority, as prospective alcoholics. Labelling requirements will simply reflect the obsessions of the activists, rather than genuinely inform the public. Advertising bans, even if they have their desired effect, will establish a precedent for the suppression of other forms of speech.
Real health education requires debate and a diversity of views. What passes under that name nowadays has various truer descriptions ‑ paternalism, nannyism, consumer‑socialism, even food leninism. But, whatever we call it, it is not education.
The Scientific Justifications
The main scientific support of health activism is a debased epidemiology. Before about 1950, this largely a matter of studying the patterns of infectious diseases. Given careful observation and interpretation, solid results were possible. But the elimination of most infections has required the epidemiologists to find some new activity. Professor Petr Skrabanek observes how they have turned instead to looking for associations between the principal modern killers ‑ heart disease and cancer ‑ and some particular behaviour or mode of living. Unfortunately, these associations are nearly always ambiguous. Even where not based on wishful thinking or statistical incompetence, the findings often indicate risks too small to worry about. Not surprisingly, given that there are so many epidemiologists, all doing the same sort of thing, their advice can on the whole be confusing.
Thus, depending where we look, we are told that a third of all cancers are caused by diet, and that 70 per cent are so caused. We are told that coffee makes women both sexually inactive and sexually active, and that it causes and does not cause heart disease. We are told to drink decaffeinated coffee to be on the safe side, and that one of the chemicals used in decaffeination causes cancer. The list is endless. At the last count, there were 246 risk factors identified for coronary heart disease.
Uncertainty has not stopped the epidemiologists from lending their support to the health activists. With their blessing, we are lectured on the evils of tobacco and alcohol and fatty foods. The claims are set before us in plain and lurid English. The ambiguities and reservations are left behind, at best, in the scientific literature
Take, for example, the case for the existence of “passive smoking”. This has been amazingly successful. Some time around the beginning of the 1980s, Peter Berger attended an international conference on smoking and health. He was told by one of the anti‑smoking activists of the goal to “make smoking an activity engaged in by consenting adults”. At the time, the anti‑smoking cause was a minority concern. Today, and largely because of the fears raised by the various passive smoking claims, that goal has largely been reached.
Yet Johnstone and Ulyatt look in some detail at the epidemiological evidence, and find it at best “circumstantial and incomplete”. One of the main studies cited is that of the Japanese reseracher T. Hirayama. He investigated the relative incidence of lung cancer in the non‑smoking wives of smoking and non‑smoking men, finding a higher incidence in the wives of the latter. Since their publication in 1981, his findings have been one of the main supports of the campaign for restrictions on smoking in public and for higher taxes on tobacco. It has regularly been cited in the mass media as all the conclusive proof that could be ever required. In fact, it was quickly demolished in the scientific press. It was shown how Hirayama had made the most surprising statistical blunders ‑ how, indeed, his own data could be used to show that lung cancer was commoner in unmarried women than in the non‑smoking wives of smokers!
Of course, the health activists seldom tell outright lies. They more often manipulate information in ways that will make the public think it has been told what it has not. Peter Finch examines this misleading use of statistics by the health activists. He shows how maximum response is ensured by the careful choice of language. Invariably, relative risk is emphasised rather than absolute.
Take again, for example, the claim that non‑smoking wives of smoking men have a 30 per cent higher chance of contracting lung cancer than non‑smoking wives of non‑smoking husbands. Assuming its truth ‑ undoubtedly a large assumption ‑ this is alarming. But look at the same fact from another direction. The annual death rate from lung cancer among the second group of wives is 6 per 100,000. Among the first group, it is thought to be 8 per 100,000. There is, indeed, a 30 per cent higher relative risk. But the absolute risk is about 1 in 50,000 ‑ much less alarming.
Unfortunately, it is the alarming facts that are accepted. For, as said, most people are incapable of following a scientific argument. They are neither able to understand the ambiguities and reservations implicit in what the health activists tell them, nor often willing to try to understand them. By not objecting to the distortions made by the health activists ‑ by going so far as to sanction them ‑ epidemiologists are contributing to an erosion of scientific standards among themselves and of rationality throughout society at large.
The Particular Campaigns: Food
That our diet is rich in poisons is one of the most alarming claims made by the health activists. We are told that our liking for fatty or sugary foods explains why so many of us die from heart attacks. This is the prevailing nutritional wisdom. “It has” says Dr James Le Fanu,
been around for the better part of twenty years. It has been endorsed by countless expert committees, is believed in and promoted by virtually every doctor, and in popular culture it has the same status of self evident veracity as the common belief that smoking is harmful to health.
Yet these claims derive from the most slender base of scientific fact. Until the 1960s, the exact opposite was believed with equal certainty. Since the studies of Sir John Boyd Orr in the 1930s, the orthodox view of a healthy diet had been one rich in fat, low in fibre. More animal protein was held to be the answer to all our nutritional problems. Bread and other high carbohydrate foods were despised as empty calories.
Now, this change of view stemmed from no corresponding fresh discovery in the science of nutrition. All the fundamentals had been discovered by the 1930s; and while our knowledge since then has deepened, it has not been revolutionised. Instead, neither then nor now, were the orthodox dietary guidlines based on good empirical evidence. The change was one more of fashion than of understanding.
Much was said in the 1930s about a supposed crisis of malnutrition among the working classes. This, it was proclaimed by the scientific and political establishment, could only be ended by increasing their consumption of animal proteins. Certainly, children in state schools tended to be smaller than those of the same age in the public schools, and this was attributable to differences in diet. But there was only a slightly higher incidence among the former of anaemia, rickets and the other diseases of malnourishment. Despite their supposedly poor diet, they were suffering no real ill‑effects.
By the 1960s, fears of mass malnutrition had receded. Instead, the talk was of an immense rise in heart disease. This was linked to the consumption of animal proteins, and the old dietary campaign was thrown into reverse. Yet, again, the evidence was far from certain. Le Fanu draws attention, among much else, to the similar fat consumption of Americans and Swedes, and to their wholly different patterns of heart disease ‑ and, very strangely, how Swedish immigrants soon conform to the American pattern even without varying the amount of fat consumed in their diet. The rise and subsequent fall in the incidence of heart disease among Westerners coincided with a rise and fall in the consumption of animal proteins, but to a wholly disproportionate extent. He concludes that “coronary heart disease must primarily be an unexplained biological phenomenon in which fat consumption or a high cholesterol (caused by defective genes) and cigarette smoking may have an additional but not determinant role”.
Le Fanu ascribes the popularity, each in its time, of the two main sets of dietary guidlines described above not to the subtlety of their scientific base ‑ for their was none ‑ but to wider movements of fashion. In the 1930s, depression and poverty were responded to with calls for the working classes to be allowed to share the eating habits of the upper classes. By the 1960s, the rising belief among part of the intellectual elite that prosperity was harmful was reflected in calls for an ascetic diet.
The Particular Campaigns: The Environment
But, of all the claims made by the health activists, none alarm more than those concerning the environment. If they tell us that cigarettes or butter will put us into an early grave, we can give both up and hope that our bodies will take notice. What can we do, though, if we believe the very air and soil around us to be poisoned? There is little room here for individual action. For the most part, we cannot even know that we are in danger. We cannot see or taste the poisons. Their effect is cumulative, and only becomes apparent when nothing can be done to avoid it. The best solution might seem to be a secular version of Pascal’s wager. If we give into the health activists, and let them cripple the economy with anti‑pollution laws, the rate of progress will at least decline; but we may all live longer. If we leave things alone, we shall grow richer, but may not live to enjoy it. Yet, once again, if looked at calmly and with all the relevant knowledge, the alarms simply evaporate. Repeatedly, those who raise them show a disregard for scientific practices and a selective use of statistics that is a disgrace to the intellectual leaders of our technological civilisation.
Look, for example, at the Love Canal scandal of the late 1970s. This New York State housing development was found to have been sited near a chemical waste dump. The media were at once filled with allegations that the residents were afflicted with higher rates of Hodgkin’s disease, rectal cancer and asthma. All the residents were bought out with public money. The Federal Superfund programme for cleaning up toxi waste sites was a direct result of the incidents.
Yet, as Aaron Wildavski shows, the studies on which these allegations were based were not at all rigorous. In one, a group of residents was invited to fill in a questionnaire about how unhealthy they felt: they were not medically examined; nor were their answers checked against those given by people living elsewhere. Subsequently, it has been found impossible to prove that so much as a cold resulted from living near the chemical waste. None of the wastes was ever found in air or water samples. The houses are now being refurbished for new residents.
Even so the Superfund programme has continued, it budget having risen from an initial half billion dollars to more than $10 billion. Much of this ‑ as might be expected ‑ goes on the salaries of the programme’s legal staff.
Again, look at the campaign against Alar, a growth retardant used to increase orchard yields. This was denounced by, among others, Ralph Nader and Meryl Streep as a carcinogen. Figures were produced out of thin air to show how many children died each year from drinking apple juice containing it. There was a mass panic throughout the United States. Eventually, a Federal ban was imposed on its use.
Yet no evidence was ever produced to show that Alar definitely was a carcinogen. Even granting the claims that it was, one apple tainted with it would have had less than half the carcinogenic potency of a glass of chlorinated tap water. Compared with the natural poisons that plants develop as a protective ‑ and which in many cases our own defences overcome ‑ Alar was nothing. The panic was wholly unjustified.
Wildavski applies the same deflationary analysis to claims about Somatotropin, asbestos and Agent Orange. In every case, he finds the same pattern of exaggerated or unfounded allegations of harm, the same calls for government regulation ‑ or, at least, the spending of government money. He sees an entire movement of “progressive scientists” and their allies, dedicated to showing how what they call corporate greed is subjecting ordinary people to unjustified risks of painful or fatal illnesses. Anyone who dares question their findings or methodology is denounced as an apologist for big business.
There is something depressingly familiar about the health and environmental scares. They are the latest specific instances of a tendency that can be observed throughout history. Our surroundings change, Inside, we remain the same. Today, we panic when someone from a pressure group tells us how the glazing on parcel string will invariably give us skin cancer. Four centuries ago, our ancestors believed, on the same quality of evidence, that a few old women could ride on broomsticks and make the crops fail. There are the same apocalyptic warnings, the same invitation to suspend all rational judgment, the same hysterical denunciations of the sceptics.
Even so, there are grounds for optimism. For all its vagaries in the short term, the human mind does show a long term bias in favour of the truth. To the few men of common sense who witnessed the withcraft mania, it must have seemed that the human race had gone permanently mad. Yet the mania did steadily subside. In one generation, it was the required orthodoxy: to doubt it was to risk charges against oneself. In the next, it was merely a universal belief against which the sceptics could argue unmolested. In the next, it was believed only by the common people, the educated classes having liberated their minds of the superstition. At last, it was a belief abandoned by all but children and the unbalanced. There is no reason why we should not one day look back on the health activists with the same contempt as we now look back on King James I and Matthew Hopkins.
But that is a hope for the future. Today, we are living through the first generation of the mania, where to doubt is to be suspect. As Irving Kristol says,
we have some deep problems. It’s not just a question of educating the people: who’s going to do the educating? We can educate a few, but since they [the health activists] control the universities ‑ by now, the high schools as well ‑ it’s not so easy to educate large numbers of people. I think we are fighting a defensive action, a holding action. Our advantage is that they cannot succeed in governing in a way to satisfy ordinary men and women…. On the other hand, there they are. The laws have been passed, the institutions set up, the rules made: and I think our experience of the past ten years under quite conservative administrations indicates the difficulty of rolling back the wave.
A holding action may be all that is now possible. But there is no reason for despair. As in the past, the truth will in the end prevail.
© 1991 – 2017, seangabb.
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