July 2014 – Outsider Insight

How disease-mongering turns patients into customers

The closest thing modern Britain has to a unifying state religion is universal admiration of the beloved National Health Service or NHS for short, although its remit has expanded considerably since its early days when it aimed to provide essential healthcare to all irrespective of income. As a proportion of national wealth NHS spending has risen from 3.5% in 1960 to over 9% now, that's over 18% of government spending. The fastest rise occurred in the frenetic spending spree of the early years of the new millennium, indeed as recently as 2000 it accounted for just 5% of a smaller GDP, see UK Public Spending . And yet perversely many attribute the failings of the NHS to cutbacks rather than misplaced priorities, crippling bureaucracy and an obsession with targets. As a result of the pervasice tickbox culture millions of older and vulnerable patients are given immune-system-suppressing flu vaccines whether or not they want them or address any of the real medical issues a patient may have, while many real life-threatening diseases are either misdiagnosed or go undetected. It must seem ironic that elderly patients are left in death pathways, while younger NHS customers receive cosmetic surgery such as breast enhancements to combat the perceived curses of low self-esteem and depression. The growing number of clinically obese adults may be entitled to expensive gastric bands because their addiction to high-fat foods is allegedly beyond their self-control, while old people die in freezing homes because their neighbours could not be bothered to check. We have the technology to keep people technically alive in a semi-vegetative state until they are brain dead and to appease any perceived physiological inadequacy. Gender realignment treatment used to be a rather extreme measure, eligible for public funding only in rare cases of genuine hermaphroditism. Nonetheless, as surgical techniques improved many, clearly unhappy with their anatomical gender, opted for private sex change surgery. One Iraqi-born millionaire even underwent two gender reassignment operations, and many others have suffered from greater emotional turmoil because of dissatisfaction with the outcome of their life-changing surgery than they ever had when they felt trapped in the wrong body. Yet despite widespread public scepticism of its effectiveness, this invasive surgery is now available on the NHS and to suggest otherwise is now deemed transphobic, a term coined on the back of homophobic. Another growth sector is the murky domain of mental health. According a Nuffield Trust report, mental disorders cost the English NHS £12 billion in 2010, more than double the total spend on cancer. A longer term but welcome trend since mid 20th century has been longer life expectancy and a greater survival rate from diseases that would until recently have been irredeemably terminal, so one way or another health spending has risen in most wealthy countries.

The last European elections even saw the emergence of a new party, the National Health Action Party (NHA), which fielded candidates only in the London region. It has a very active campaigning team both online and among London-based NHS staff. They not only oppose privatisation, but also all cutbacks in NHS spending. This stance appeals to a large cross-section of left-leaning public opinion. However, their simplistic analysis has one small flaw. Government spending on healthcare has increased dramatically since 2001 and has continued to grow even under Conservative and Liberal Democrat alliance. The figures are publicly available. In real terms UK healthcare spending doubled from 2000 to 2010 and has continued to grow very modestly since, currently some £130 billion or 18% of public expenditure or 9.1% of GDP. To be honest this is largely in line with healthcare spending in countries with comparable living standards. But mileage or rather value for money varies. The USA has the highest level of healthcare spending in the world, but yet many much poorer countries have a higher life expectancy. Most notably Cuba and the US have the same mean life expectancy, but in US dollar terms US healthcare spending is astronomically higher. In the US an estimated 100,000 people die every year of inappropriate prescription medication, competing with Unintentional Injuries and Alzheimer's disease for the fifth most common cause of death.

Clearly if we expect our health service not only to cope with the challenges of an ageing population, but also to meet growing demand for lifestyle medicine (cosmetic or performance-enhancing treatment), we must be prepared to pay for it. The recent rise in lifestyle medicine, especially cosmetic surgery, has transformed beauty and wellbeing from gifts of nature into commodities. As a result fairly average imperfections, from misaligned noses and teeth, undersized breasts, balding hair, erectile dysfunction, once considered just unfortunate facts of life, are now treated as major causes of depression and prime targets for medical intervention.

That means we need to decide as a society which categories of healthcare we should socialise and which categories are best left to personal discretion (or in my humble opinion actively discouraged as they destroy social cohesion by emphasising the power of money to transform one's body beyond essential medical need). Certainly if someone endures a tragic accident or succumbs to a debilitating disease, it seems very unfair for their prognosis to depend on their bank balance or ability to pay into a generous health insurance scheme. Socialised healthcare means if you fall victim to injuries or illness beyond your reasonable control, then society as a whole will pick up the bill. However, by redefining physiological imperfections and emotional distress as illnesses, the multibillion pound medicalisation business has significantly boosted healthcare costs. As these costs spiral out of control, we risk throwing the proverbial baby away with the bath water. We all need essential medical care at times in our life. If we are generally healthy, this may mean just regular checkups with the odd vaccination (another controversial topic) and for women a short stay in hospital to give birth. Natural human diversity means we are not all blessed with perfect bodies or physical performance potential.

However, socialised medicine also requires social cohesion and solidarity among the different groups within society. While we delegate responsibility to medical professionals, at all times they must serve our needs, not those of disease-mongering pharmaceutical multinationals or invasive state apparatuses. We should not become mere customers or guinea pigs for medical experiments, but be empowered patients, who just want an honest diagnosis and impartial evaluation of medical options. If we expect others to subsidise our healthcare, then we have a responsibility to look after ourselves as best we can. If I decide to engage in a high risk activity for my own pleasure, it seems reasonable that I take out additional insurance. Why should others foot the bill for expensive restorative surgery, if some daredevil motorcyclist decides to jump over 10 double decker buses ? The point is as medical technology evolves, we must clearly define genuine medical needs, otherwise we will just sleepwalk into the collapse of the National Health Service as we knew it and healthcare will be just a profit-making business. Indeed this is already happening albeit underwritten by taxpayers and banks. As Professor Allyson Pollock reminds us "Virgin landed a £630 million contract for community mental healthcare, with no previous experience, while RBS, Serco and Carillion, to name but a few, are raking in billions in taxpayer funds for leasing out and part-operating PFI hospitals, community clinics and GP surgeries. A private company now runs an NHS hospital. US private medical companies are now involved in the privatisation process, such as HCA and United Health. HCA is in a joint venture with University College Hospital London, where it provides cancer treatment, but only for those who can pay. Both New Labour and the current Conservative/Lib-Dem coalition have turned the NHS into a front for a rapacious biomedical business.

Twitter Mob: Don’t Blame the Users

How lobbies have turned consumer groups into victims

Twitter does not exactly lend itself to critical analysis. I doubt many people have changed their minds on anything after reading a mere 140 character tweet. Such short messages tend to reinforce existing prejudices and opinions and often build on concerted advertising and awareness-raising campaigns. You can tweet a link to an article, but usually only those sympathetic to your cause will read it. Twitter also encourages conformity as nobody wants to be unpopular or offend their virtual friends. It's fine to support widely publicised causes, but not to voice views that others may easily misinterpret. When issues are simplified, many will readily interpret any divergence from the mainstream view as an act of tribal betrayal, like a crowd of Glasgow Rangers supporters spotting a loner wearing a Celtic scarf.

As I often take nonconformist stances, I've grown used to the devious tactics employed by seasoned opinion leaders, such as dismissing any embarrassing evidence against their case as mere conspiracy theories. However, another very effective tactic is to champion the rights of consumer groups to consume the very product or service that some dissident suggests may harm them.

By this logic, nobody could have ever exposed the harmful effects of cigarette smoking simply because millions of consumers enjoyed, or rather believed they enjoyed, this product. Smoking relieves stress and helps people befriend other smokers. It often serves as a great socialising tool and an act of defiance against an increasingly invasive nanny state. Indeed there is much evidence suggesting nicotine acts as an antidepressant, which might explain why so many smokers find it so hard to quit. This vice may be a little outmoded today, but fifty years ago non-smokers had to tolerate smokers at work, in their extended family, neighbourhood and in many public spaces like pubs, cafés and public transport. Some would complain, but generally had to keep quiet in many everyday social situations. Indeed some would have to claim to suffer from a special medical condition to persuade a friend to refrain from smoking in their presence. Yet as evidence mounted that smoking has all sorts of nasty side effects, smokers began to quit and non-smokers became much more proactive in reclaiming smoke-free areas. More recently smokers have been turned into outcasts, often having to escape outdoors on cold rainy days to indulge in their filthy habit.

Fast forward to the 21st century and antidepressants are not only a multi-billion pound industry, just as tobacco was, but they are actively endorsed by celebrities and state-sponsored healthcare institutions as the primary treatment for the growing number of people who feel stressed or depressed. Yet as smokers, alcoholics and recreational drug users know, mind-altering chemicals may offer you a temporary escape from your melancholy, but they come at a huge price in terms of long-term ill-health and some rather unpleasant neuro-psychological side effects. This change of public opinion, from the largely psycho-social model of emotional distress to the mainly biological model, is largely the result of a four decade long campaign to associate in the public mind a chemical imbalance with people's nonfunctional states of mind. Human feelings have been medicalised, although there remains scant proof of a link between natural serotonin levels and state of mind. Many substances we ingest can affect our natural mood-regulating compounds (serotonin, dopamine, norepinephrine and epinephrine). It should come as little surprise that many diagnosed with clinical depression, anxiety disorder, bipolar disorder, OCD etc.., have a bad diet and have indulged in booze and other recreational drugs. Often bad lifestyle choices arise from a downward spiral of emotional insecurity and a tendency to seek solace in anything that turns your mind away from the immediate cause of distress. As our expectations for higher material goods and personal achievements grow, so does our sense of inadequacy and isolation, when we fail to reach these goals. We are not all blessed with perfect athletic bodies, excellent hand-eye coordination and extraordinary musical talent. We will not all be premier league footballers, Olympic medalists, world-famous pop singers, TV celebrities or fashion models. Most of us are fairly average with relative strengths and weaknesses, but our current obsession with status symbols turns minor personal deficits into medical conditions that require treatment. How personality traits develop has long eluded neurologists. Why are some people so gregarious with an upbeat and ebullient disposition, while others have a more reclusive, independent and sobre character and tend to reflect on events and observations in greater detail? If worrying about things were so bad, then why would such instincts evolve in the first place? In essence worrying is about caring about yourself and loved ones. If we didn't worry about anything, we would lack motivation to try harder. Most creative types need plenty of time for introspection. As we obsess more with image and social networking, detailed analysis can fall by the wayside. While some may be enhancing their social status through better presentation and socialisation, others prefer to build a better life through hard work and contemplation. However, in the age of industrial automation and outsourcing, many lack the motivation to make or even repair things themselves. In today's perverse world, a non-productive lawyer not only earns more than her cleaner, but also more her car mechanic and all the other manual workers who helped make her lifestyle possible. Yet many higher-earning professionals in the burgeoning hot-air sector succumb to work-related stress and even depression.
There may be a good argument for short-term medication to wean people off junk food and booze or simply to get the out of bed in the morning, but little evidence that the any pre-existing chemical imbalance caused them to make bad lifestyle choices. Millions now believe antidepressants are essential medication for anyone whose relative lack of cheerfulness or bad moods cause others so much distress. We have thus wished away the underlying causes of depression in our incessant drive to promote mandatory bubbliness, i.e. where we all feign happiness through fake smiles and frequent giggles ? Casual observations would suggest offices have been transformed from relatively sombre places of work into comedy workshops. 50 years of TV satire and now endless YouTube gags have had their effect on the collective psyche. Yet, we are not all born actors. If you fail to take part in mandatory amateur theatrics, your jovial teammates will soon write you off as a loner. Whereas 50 years ago a lack of practical skills could prove a handicap in all but the most privileged families, today it is a perceived lack of social skills that sets many at a distinct disadvantage. Social anxiety, here in its literal non-psychiatric sense, is a prime cause of social alienation, leading to a lack of self-worth, a sense of inferiority and inevitably melancholy.

Handing out free antidepressants to address social alienation is like distributing morphine tablets to combat tooth decay. They may temporarily alleviate unpleasant symptoms, but they fail to address the root causes of the problem and may have very nasty adverse effects with prolonged use. Suggesting that opposing state-subsidised mass-medication of unhappiness offends the unhappy is like accusing an opponent of hydraulic fracturing of condemning the elderly to freezing homes in winter (the elderly would be the first to suffer from polluted tap water). These quick fixes are simply not the solution.