Wednesday, January 09, 2008

Britain: Despite all this stuff about well clinics, there's no evidence that government campaigns alter behaviour

By Mick Hume

Say what you like about the nanny state, but I do think it's a bit much when the Prime Minister takes it upon himself to make our new year's resolutions for us. In his message to mark the 60th year of the NHS, Gordon Brown resolves that we will all live healthier lives ? stop smoking, drink less, exercise more. As a reward, the health service will still treat us should our personal regime inexplicably fail and we fall sick. This generous offer is to be made in a patient's contract spelling out "the rights and responsibilities associated with entitlement to NHS care".

Some protest that this could mean smokers or the obese being denied healthcare. But such "ethical rationing" is already happening. Mr Brown's plans for a more "personal and preventative service" involve a bigger risk to us all. They mark the next step in an unhealthy trend, begun under Margaret Thatcher and accelerated under Tony Blair, to make it a role of the NHS to send people to the Naughty Habits Step.

Where the "old-fashioned" health service merely treated the sick, today's NHS seeks to beat well people into shape as clean-living citizens through advice and guidance. As Michael Fitzpatrick, an East London GP, observed when such contracts were first proposed, they involve "a major shift of general practice away from the treatment of patients who are ill towards the regulation of the lifestyles of the population".

Despite this being the age of "evidence-based" medicine, nobody can provide proof that such government drives to alter behaviour improve public health. Yet the authorities press on regardless, seeking a magical cure for an ailing political class that hopes to reconnect with people around "ishoos" of personal health. Politicians who have no clue how to change society for the better are reduced to cajoling us to sort ourselves out.

These unwieldy plans can only further undermine the efficiency of the health system, the role of doctors as clinical professionals ? and most importantly, the autonomy of individuals. They turn the purpose of healthcare on its head. As Ren‚ Dubos wrote in 1960, "it is part of the doctor's function to make it possible for his patients to go on doing the pleasant things that are bad for them ? smoking too much, eating and drinking too much ? without killing themselves any sooner than is necessary". There must be more to life than healthy living. Amid the talk of rights and responsibilities, one that gets ignored is the individual's right to make the "wrong" choices.

The other fact often missed out is that we already live longer, healthier lives than ever before. So why not leave us alone to enjoy it? Modern clinical care is capable of wonders, and the health service should stick to that. How about an alternative, informal contract for the 60th anniversary of the NHS: we promise to come to you when we are sick, if you will pledge only to try to cure what ails us


Eat your heart out, food freaks

US fast-food giant McDonald's is selling more burgers in Britain than at any time in the 34 years since it opened its first outlet here, The Times said Monday, quoting company figures. The newspaper said there were more than 88 million visits to the "golden arches" in Britain in December 2007 alone, up nearly 10 million on the previous 12 months and the equivalent of about 320,000 more each day. The findings follow a study by pollsters Synovate in conjunction with the BBC published January 2, which suggested that Britons are now the world's biggest fans of fast food, just ahead of Americans.

McDonald's UK chief executive Steve Easterbrook was quoted as saying that the fast-food business had stalled in the wake of recent British government initiatives to target a growing obesity epidemic with healthy eating schemes. But he said in an interview: "This is one of our strongest years for 20 years, and we feel pretty confident about the momentum we have built up."

McDonald's has changed its menu in recent years, cutting salt, sugar and trans-fats in its products and offering healthier alternatives such as porridge, fruit smoothies and chicken wraps.

But The Times said about 90 percent of sales in Britain were still for traditional fast-food fare like burgers, french fries and ice-cream while more than two million children's "Happy Meals" were sold each week in November 2007.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:
"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."
So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

"What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!


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