by
Michael Fitzpatrick GP (MD)
2001

reviewed by Mira de Vries

Fitzpatrick wins me over right away with nail-on-the-head statements like:

The government’s public health policy is really a programme of social control packaged as health promotion.

Medicine has become a quasi-religious crusade against the old sins of the flesh.

While resources are poured into projects that use health to enhance social control, real health needs—especially those of the elderly—are neglected.

Only an epidemiologist could believe that data based on ‘selfreported’ levels of alcohol consumption can provide a useful basis for quantitative studies.

Such is the degradation of medical ethics that it is now considered virtuous for doctors to take on the role and responsibilities of the police and to subordinate the best interests of their patients to the dictates of government drug policy.

The invention of new disease labels—such as ‘attention deficit hyperactivity disorder’ in children or diverse forms of addiction in adults—reflects the trend to define a wider range of experience in psychiatric terms.

The propaganda of addiction finds a ready resonance in a society in which people are all too ready to accept a medical label for their difficulties.

There is ... a marked tendency for vulnerable people to develop an ongoing dependence on therapy, which is as likely to confirm their inadequacy as it is to enable them to overcome it.

Parenting projects are likely to weaken parental authority still further.

He asserts that the government (he never mentions the industries that pull the government's strings) peddles health and longevity. But, he posits, if you eat right and moderately, take plenty of exercise, and don’t smoke, you are likely to prolong your life only marginally, maybe by a few months. Who wants to live long, anyway? Most of the elderly people Fitzpatrick sees in his medical practice in an underprivileged borough of London live in poverty and loneliness. “[I]t may well be the case that an old person’s enjoyment of a cigarette, a cream bun and a bottle of Guinness is more important to them than the extra few weeks they might spend in a life of miserable abstinence.”

It is a fallacy that we can stay healthy until we die. Old age unavoidably brings infirmity. Ironically, today most people would rather drop dead suddenly while still in the best of health than first have to go through a period of illness. In former times such a death would have been considered a terrible scourge, depriving the person of advanced warning that it’s time to wrap up affairs and take leave of loved ones.

Citizens are bullied by the government into fearing cancer, heart disease, cot (crib) death, aids, and melanoma from sunbathing. In reality we have no proof that behavior (other than refraining from smoking, which is already well-known) can reduce our chances of being stricken with cancer or heart disease, or prevent crib death. Aids, contrary to the hype, is rather rare in England, and one’s chance of contracting it remote. Most melanomas appear on unexposed areas, such as the inside of the thighs.

So far so good, but reading on, my enthusiasm for Fitzpatrick's position is tempered. I agree with Fitzpatrick’s ridicule of fear mongering up to a point. Inflating the risks of various diseases and the efficacy of measures to reduce the risks only serves the wrong parties, those who benefit financially and socially from our fears.

But then Fitzpatrick goes a step too far. He also ridicules fear of BSE, the 3rd generation contraceptive pill, and the measles vaccine. He misses the point that the public has been deceived by industries and the government that purports to regulate them by exposing us to risks we have not chosen, nor even known about, such as: feeding cows an inappropriate diet, withholding information about the harmful side effects of drugs, and adding poisonous mercury as a preservative to baby vaccines in order to save refrigeration costs. He claims that pregnancy and abortion are far more dangerous than the pill, and that not vaccinating children could cause a "return of measles" (a childhood illness that was usually almost trivial in otherwise healthy and well-nourished children). Now Fitzpatrick is doing the fear mongering. He also denies the risks of passive smoking, as though we should all stop whining and breathe whatever anybody blows our way.

Then follows a long diatribe disparaging British and other politicians, as though these developments would not have occurred if the rival candidate or opposing party had been elected. Fitzpatrick is pretty clear on medicine, but he is totally confused about political dynamics. He blames government interference in health care on -- capitalism and free markets! He even becomes lyrical, mentioning “The unchallenged ascendancy of the capitalist system.” He doesn’t seem to grasp what the terms capitalism and free markets mean. They are about absence of government interference, exactly the policy he endorses regarding medicine. Perhaps when it comes to diagnoses, he should stick to his stethoscope.

Towards the end of the book, the author begins to somewhat regain my confidence. He acknowledges that physicians have always welcomed state licensing because it strengthens their position of dominance, while at the same time they resent it for interfering with their professional autonomy. They want it both ways.

Then there's another strange statement: “Traditional physicians ... were forced to compete with diverse unscrupulous practitioners.” Why would competent and conscientious physicians have to worry about competition, particularly from frauds? A well-regarded doctor is likely to be plagued by more demand for his services than he can provide.

Fitzpatrick further defines: “a quack is a practitioner who tries to please his customers rather than his colleagues.” If that is true, then please give me a quack.

The Tyranny of Health is available in paperback and as an e-book.