HEALTH THREAT

Theodore Dalrymple, a medical writer,

says that medical journalism is bad for you

1 HESITATE to bite the hand that feeds me, but I doubt that it will take much notice of my ingratitude.

The hand in question is that of the press, which has a virtually limitless desire for articles about medical matters. As far as my own career is concerned, I have had the good fortune to be in the right place at the right time, for the demand is a com- paratively recent one. A generation or two ago, newspapers and magazines ignored medical matters almost completely.

Nowadays hardly a news bulletin is broadcast into the ether, hardly a newspa- per is pushed through a letter-box, without carrying its quota of medical stories. I once estimated that an assiduous reader of the Daily Telegraph alone would read about 2,000 articles concerning health and medicine every year (a few written by me). An employee of the BBC once told me that there had been a directive that every major news bulletin was to carry a health item. And last Sunday, for example, two newspapers had headlines on their front pages likely to promote health scares. The Mail on Sunday led with the news that ter- minations of pregnancy might increase the risk of women subsequently suffering from breast cancer; while a newspaper of oppo- site ideological slant, the Observer, informed its readers that consumption of soya products had been 'linked to' breast cancer and brain damage.

I do not suggest that these newspapers are any worse than any others in this respect, but the fact is that both these sto- ries were highly speculative and therefore deeply irresponsible. It is perfectly possible, likely even, that both stories will come (from the scientific point of view) to noth- ing, but the readers will be left with a residue of anxiety that will not be allayed even if — as is most unlikely — the newspa- pers subsequently publish retractions. I remember many years ago that it was sug- gested that eating green potatoes was the cause of spina bifida and, though the theory was subsequently disproved conclusively, I still cannot look at a green potato without thinking of that condition.

Medical stories in our newspapers seem to fall into two categories: the dire-threat story and the miracle-cure story. The dire-threat story informs us of a hitherto unsuspected environmental poison or, increasingly, of incompetent or downright murderous doc- tors (the medicalisation of our newspapers being perfectly compatible with bitter hatred of the medical profession); while the mira- cle-cure story seeks to persuade us that immortality or, more importantly, skin with- out wrinkles is just around the corner, thanks to a little light genetic engineering. The reader's pendulum therefore swings between baseless anxiety and false hope.

There are three conditions necessary for this wretched situation to develop. First, there must be a fund of speculative science about statistical associations between envi- ronmental factors and disease (coffee caus- ing cancer of the pancreas, etc.). The fact is that if you examine enough diseases and enough environmental factors, some of them will be statistically associated; and however many times we are told that statis- tical association does not imply causation, there is an inherent disposition to think that it does. If we are told that heart attacks are associated with low levels of selenium in the blood, and brazil nuts contain a lot of sele- nium, it follows — psychologically, if not logically — that eating brazil nuts will pre- serve us from heart attacks.

Second, there must be a press that is ready to disseminate, magnify and exag- gerate the findings of speculative science. This we most defmitely have: the medical journals are trawled through regularly by staff on newspapers searching for intima- tions of the elixir of life or of a horseman of the apocalypse.

Third, and finally, there must be a popu- lation that is increasingly concerned about its health, despite the fact (or is it because of it?) that it is the healthiest population of humans ever to have existed.

It is the cultural meaning of the medicali- sation of our press that most worries me. Does it not imply a narrowing of our mental horizons, so that what might happen to our bowels or our feet is of more interest to us than what has actually happened in the larg- er world? Is this not a sign of our increasing solipsism, narcissism and egomania, which is all too regrettably of a piece with a culture of innumerable individual rights? Modern over-concern with matters medical is a symptom of cultural, spiritual and moral impoverishment. It is, of course, a develop- ment to which I have contributed for pecu- niary advantage.

Not long ago, an American magazine sent me seven volumes, each a memoir of illness, for review. The magazine could, of course, have sent me many more such memoirs, for the genre is a rapidly expanding one, and new examples are published every day. Indeed, it is now possible in some American university departments of literature to take courses in writing about illness.

Presumably publishers do not publish books without a public to buy them, and therefore the demand for such books must have increased. Who, then, reads them, and why? The same people, I assume, who read all those articles in newspapers about dis- eases they'll never get, hazards they'll never encounter and cures they'll never need.

But why? I suspect it has very little to do with a desire for genuine medical informa- tion, such as a person with diabetes or who is about to undergo a colostomy might seek. Rather, it is a matter of burgeoning self-importance. The health pages persuade us that what happens to tiny little us migraine, arthritis, constipation, or whatev- er it might be — is at least as important as a civil war on the other side of the globe that has so far cost a million lives. Indeed, it is a fair bet that the problem of food allergy alone has occupied more space in our newspapers in the past year than all the civil wars in Africa combined.

Not many years ago it would have been considered reprehensible for a person to be self-obsessed to the extent of wishing to read mainly, or even only, about what might hap- pen to himself. But this is now a general trait, though whether it was caused by or has merely been reflected in our newspapers I am uncertain (I suspect that the relationship is dialectical). Whatever the answer, the medicalisation of our press is a symptom of a deep and regrettable mental involution.

The interest in medicine is also a sign that we live in a demotic, if not a democrat- ic, age. We know in our hearts that each of us will be ill at some time in our lives, indeed sick unto death. By telling us that what must happen at some time to each and every one of us is worthy of public attention, the health pages of our newspa- pers tell us that our lives are significant. And, in the absence of religious belief, only public acknowledgment of our suffering can give any transcendent meaning to it.

Should our newspapers, then, carry no medical items whatsoever? I concede that if there were an outbreak of bubonic plague in Glasgow or cholera in Bolton it might be worth a mention — say a small paragraph; likewise an indisputably proven cure for Alzheimer's. The rest should be silence. But, in the meantime, I sit back and wait for com- missions. No one will listen to my recom- mendations, thank goodness.