Layer 73 A Dose of Reality

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There’s an excellent article in yesterday’s G2 called A Dose of Reality. Ben Goldacre writes a regular column for the Guardian called Bad Science, which is also the title of the book he’s just published.

http://www.badscience.net/2008/09/the-medicalisation-of-everyday-life/#more-784

It’s well worth going to the website to read this extract, from which I’ve extracted the following:

When people introduce pseudoscience into any explanation, it’s usually because there’s something else they’re trying desperately not to talk about. Alternative therapists, the media, and the drug industry all conspire to sell us reductionist, bio-medical explanations for problems that might more sensibly and constructively be thought of as social, political, or personal. And this medicalisation of everyday life isn’t done to us; in fact, we eat it up.

For over five years now, newspapers and television stations have tried to persuade us, with “science”, that fish-oil pills have been proven to improve children’s school performance, IQ, behaviour, attention, and more. As I have documented with almost farcical repetitiveness in this paper, these so-called “fish-oil trials” were so badly designed that they amounted to little more than a sham.

You might step away from obsessing over food just for once and look at parenting skills, teacher recruitment and retention, or social exclusion, or classroom size, or social inequality and the widening income gap. Or parenting programmes, as we said right at the beginning. In fact, Durham’s GCSE results, where the “trial” was performed, improved far more in the year before the fish-oil pills were introduced, after a huge input of extra funding and, more importantly, extra effort from local teachers and the community. But the media don’t report stories like that: because “pill solves complex social problem”, even if it’s not true, is a much better angle.

This fish-oil story is a classic example of a phenomenon more widely described as “medicalisation”, the expansion of the biomedical remit into domains where it may not be helpful or necessary. In the past, commentators have portrayed this as something that doctors inflict on a passive and unsuspecting world, an expansion of the medical empire; in reality, it seems that these reductionist biomedical stories can appeal to us all, because complex problems often have depressingly complex causes, and the solutions can be taxing and unsatisfactory.

The pharmaceutical industry is in trouble: the golden age of medicine has creaked to a halt, the low-hanging fruit of medical research has all been harvested, and the industry is rapidly running out of new drugs. So the story of “disease mongering” goes like this: because they cannot find new treatments for the diseases we already have, the pill companies have instead had to invent new diseases for the treatments they already have.

Recent favourites include social anxiety disorder (a new use for SSRI antidepressant drugs), female sexual dysfunction (a new use for Viagra in women), the widening diagnostic boundaries of “restless leg syndrome”, and of course “night eating syndrome” (another attempt to sell SSRI medication, bordering on self-parody) to name just a few: all problems, in a very real sense, but perhaps not necessarily the stuff of pills, and perhaps not all best viewed in reductionist biomedical terms. In fact, you might consider that reframing intelligence, loss of libido, shyness and tiredness as medical pill problems is a crass, exploitative, and frankly disempowering act.

In the media coverage around the rebranding of Viagra as a treatment for women in the early noughties, and the invention of female sexual dysfunction, for example, it wasn’t just the tablets that were being sold: it was the explanation.

The solution was in a pill, but that was only half the story, and the diagnosis was almost more important: she [supposedly] had a mechanical problem. Rarely was there a mention of any other factors, that she was feeling tired from overwork, that he was exhausted from being a new father, or finding it hard to come to terms with the fact that his wife was now the milky mother of his children, and no longer the nubile sex vixen he first snogged.

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

This wishful deafness to the clamour of reality reaches its purest form in our newfound obsession with food, as if it was the most important lifestyle risk factor for ill health.

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

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

But we do, because it’s such a delicious fantasy, because it’s commodifiable and pushed by expert PR agencies. Food has become a distraction from the real causes of ill health, and also, in some respects, a manifesto of rightwing individualism. You are what you eat, and people die young because they deserve it.

Genuine public-health interventions to address the social and lifestyle causes of disease are far less lucrative, and far less of a spectacle. What glossy magazine focuses on how social inequality drives health inequality?

There is no glamour in “enabling environments” that naturally promote exercise, or urban planning measures that prioritise cyclists, pedestrians and public transport over the car. There are no votes, it seems, in reducing the ever-increasing inequality between senior executive and shop-floor pay.

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