Читать книгу Panic Nation - Stanley Feldman - Страница 11

BY MICK HUME

At the start of the twenty-first century, we in the West enjoy higher standards of living, health and diet than at any moment in history. But you would be hard pressed to know it, from the miserabilist tone of much public discussion of the human condition.

At another time, the fact that people in a society lived far longer, healthier lives than their ancestors might reasonably have been thought a cause for some celebration. Today, however, we often appear unhealthily obsessed with looking on the dark side of life and worrying about our health. Even where no major health problem appears evident in the present, there is a veritable epidemic of experts on hand to assure us that we are only storing up problems for the future, warning of the threat of supposed ‘time bombs’, be it the ‘ageing time bomb’, the ‘obesity time bomb’, the ‘mobile-phone time bomb’ or whatever. As yet, these alleged health time bombs have failed to explode as predicted – remember the epidemic of heterosexual AIDS that was supposed to kill countless thousands in the UK, or the epidemic of vCJD (‘human mad-cow disease’) that was meant to leave behind up to half a million dead? Yet it seems there is always another ‘time bomb’ of one sort or another allegedly waiting in the wings to get us. In the same way, in recent years the government chief health officer has appeared to be suffering a bad case of ‘epidemicitis’, at various times describing the country as being in the grip of an epidemic of everything from flu to smoking.

Look at the list of current health panics and concerns that are addressed in this book. They cover a range of issues so wide that it might seem as if no part of the human physique or psyche has been left untouched by a huge wave of fresh diseases and disorders. Everything from our cholesterol levels to our intake of such everyday items as salt is now not only put under the laboratory microscope, but is highlighted in the daily news headlines as a potential health risk.

The list of health risks with which we have to contend grows longer almost by the day. It is well captured in the following A-to-Z (well, A-to-X, anyway) list of everything that, at least according to certain epidemiologists, is supposed be capable of causing cancer today:

Acetaldehyde, acrylamide, acrylonitrile, abortion, agent orange, alar, alcohol, air pollution, Aldrin™, aflatoxin, arsenic, arsine, asbestos, asphalt fumes, atrazine, AZT, baby food, barbecued meat, benzene, benzidine, benzopyrene, beryllium, beta-carotene, betel nuts, birth control pills, bottled water, bracken, bread, breasts, bus stations, calcium channel blockers, cadmium, captan, carbon black, carbon tetrachloride, careers for women, casual sex, car fumes, celery, charred foods, chewing gum, Chinese food, Chinese herbal supplements, chips, chloramphenicol, chlordane, chlorinated camphene, chlorinated water, chlorodiphenyl, chloroform, cholesterol, low cholesterol, chromium, coal tar, coffee, coke ovens, crackers, creosote, cyclamates, dairy products, deodorants, depleted uranium, depression, dichloroacetylene, DDT, dieldrin, diesel exhaust, diet soda, dimethyl sulphate, dinitrotoluene, dioxin, dioxane, epichlorohydrine, ethnic beliefs, ethylene acrylate, ethylene dibromide, ethylene dichloride, Ex-Lax™, fat, fluoridation, flying, formaldehyde, free radicals, fruit, gasoline, genes, gingerbread, global warming, gluteraldehyde, granite, grilled meat, Gulf war, hair dyes, hamburgers, Heliobacter pylori, hepatitis B virus, hexachlorobutadiene, hexachlorethane, high bone mass, HPMA, HRT, hydrazine, hydrogen peroxide, incense, infertility, jewellery, Kepone™, kissing, lack of exercise, laxatives, lead, left handedness, Lindane™, Listerine™, low fibre diet, magnetic fields, malonaldehyde, mammograms, manganese, marijuana, methyl bromide, methylene chloride, menopause, microwave ovens, milk hormones, mixed spices, mobile phones, MTBE, nickel, night lighting, night shifts, nitrates, not breast feeding, not having a twin, nuclear power plants, NutraSweet™, obesity, oestrogen, olestra, olive oil, orange juice, oxygenated gasoline, oyster sauce, ozone, ozone depletion, passive smoking, PCBs, peanuts, pesticides, pet birds, plastic IV bags, polio vaccine, potato crisps (chips), power lines, proteins, Prozac™, PVC, radio masts, radon, railway sleepers, red meat, Roundup™, saccharin, salt, selenium, semiconductor plants, shellfish, sick buildings, soy sauce, stress, strontium, styrene, sulphuric acid, sun beds, sunlight, sunscreen, talc, tetrachloroethylene, testosterone, tight bras, toast, toasters, tobacco, tooth fillings, toothpaste (with fluoride or bleach), train stations, trichloroethylene, under-arm shaving, unvented stoves, uranium, vegetables, vinyl bromide, vinyl chloride, vinyl fluoride, vinyl toys, vitamins, vitreous fibres, wallpaper, weedkiller (2-4 D), welding fumes, well water, weight gain, winter, wood dust, work, X-rays.

Or perhaps, to put it more succinctly, being alive can give you cancer.

Not so long ago, few would even have been aware of the existence of many of these issues, never mind worrying about them. Yet somehow our forebears seemed to survive perfectly well in blissful ignorance, their lifespan lengthening from generation to generation, despite often pursuing lifestyles and diets that would now be considered dangerously irresponsible.

So let us stand back from those headlines for a moment and ask ourselves, how could it be that many people now apparently feel threatened by so wide a range of new health risks? How could it be that so many different dangers suddenly appear to be menacing our society at the same time – and, moreover, at a time when as a society we are in such a state of rude public health?

It seems clear that this divergence between the facts of our longer, healthier lives and the perception of such varied and rising risks to our health cannot be explained by the specifics of any particular issue. It is not the details of our salt intake or of our cholesterol levels that make so many people open to these sorts of health concerns today. Rather, there must be some broader, overarching trends at work in our culture and society that can lend new weight to the fear of previously unimagined risks.

In order to grasp what is going on here, we must first come to terms with the broader spirit of the age.

For a start, we are faced today with a powerful cultural aversion to risk. Health risks that might have once have been brushed off as acceptable or negligible are now elevated into important issues of public concern. Thus ‘passive smoking’ – the inhalation of the smoke from other people’s tobacco – has recently become the subject of a major health crusade across the West, despite the questionable evidence of the real effect of environmental tobacco smoke on public health, and the fact that fewer people now die of smoking-related diseases than in the past. In a climate where there no longer seems to be such a thing as an acceptable level of risk, many other minor health risks can be used to spark major overnight controversies.

Where health risks are concerned, it seems the orthodoxy now is always to assume the worst-case scenario to be the most likely one, however far-fetched. Humanity has always faced risks, and there has always been a debate about how to manage them. Today, however, unlike in the past, risk is seen not as something we can handle or perhaps even turn into opportunity, but as something that we suffer from and must be guarded against.

The assumption that we cannot cope with risk and uncertainty reached a new level when the British Medical Journal came out with the argument that the word accident should henceforth be banned, since such incidents were really avoidable if we took the proper precautions. Not only, it seems, is there no longer any such thing as a manageable risk, but it is apparently no longer acceptable to suggest that accidents will happen.

Underpinning this heightened desperation to avoid or limit risk is another powerful theme of contemporary culture: the notion of human vulnerability. Once the widespread assumption might have been (based on some sound historical evidence) that humanity could survive more or less whatever was thrown at it, that the resilience that had taken us from the caves to something approaching civilisation was pretty well indomitable. Today, the opposite tends to be assumed.

The default setting for the human condition is now widely seen as being a state of vulnerability and victimhood. The autonomous individual who stands on his or her own two feet appears to be an endangered species. Instead the assumption is that we are pretty pathetic specimens who must need professional intervention and advice to protect us from the problems of everyday life. We are a society on the couch, under the supervision of the therapeutic state.

The overwhelming fear of risk and the sense of humans as near-powerless victims of life have not only stoked irrational health panics but have helped to create an unhealthy attitude to health and illness in our society.

First, it means that there is a tendency to medicalise many of our problems, to redefine personal issues and characteristics as medical afflictions requiring professional intervention. Thus, everything from childish mischief making to shyness can now be labelled as a syndrome or a disorder, and drugs or treatment prescribed. This process of medicalisation has the effect both of relieving people of responsibility for their lives (how can those suffering medical conditions be blamed for the symptoms?), and of making them even more obsessive about health issues.

Second, as Dr Michael Fitzpatrick – GP and author of The Tyranny of Health – has argued, these trends have created a climate in which it is now deemed perfectly normal for us to be ill rather than well, and where health has been turned from something we took for granted into the goal of life for which we must self-consciously strive:

In the recent past, health was regarded as the normal state of affairs and illness was considered an exceptional departure from normality, a transient state through which the patient passed… At the same time, illness has lost much of its stigma and even confers a series of socially approved identities – ‘person with HIV/AIDS’, ‘cancer survivor’, ‘sufferer from stress’, ‘victim of bullying’ – confirmed by patient organisations, celebrity sponsorship, soap opera story lines, autobiographical accounts and other forms of media coverage.3

Who is responsible for bringing about this unhealthy state of affairs? It is common to blame outbreaks of irrationality and health panics on stupid members of the public, now sometimes known as ‘the worried well’, who are whipped up into a moblike frenzy by ‘the meejah’. The media certainly play a key role in setting the public mood. But it is important not to underestimate the extent to which these problems emanate from the top of society downwards – starting with the government and the political class. They have done more than anybody to worry the well.

Since the panic about a SARS epidemic gripped the world in 2003, the New Labour government’s policy towards issues such as bioterrorism or SARS in the UK has been based on the principle of ‘organised paranoia’. That memorable but little-known phrase was coined at the time by Geoff Mulgan, then the head of the powerful Downing Street Performance and Innovation Unit. Mulgan was speaking at a conference entitled ‘Panic Attack: interrogating our obsession with risk’, organised by the online magazine spiked at the Royal Institution in May 2003. He had a wry little smile on his face when he used those words. But he definitely was not joking.

Mulgan suggested that, through elevating this organised paranoia into a principle informing policy planning, the government hoped to become better at spotting new risks such as SARS, BSE and bioterrorism ‘before they become evident’. But how exactly do the seers and oracles of Whitehall hope to identify a potential risk before it has even become visible? By gazing into a crystal ball, perhaps?

Almost, it seems. The modern political equivalent of the crystal ball is the ‘what if?’ scenario, and this is increasingly becoming the stuff of policy-planning discussions on both sides of the Atlantic, especially post-9/11. It means that policymakers dream up fantasy disasters (what if a terrorist infected with SARS crashed a petrol tanker into a nuclear power station?), and then try to plan to deal with these hypothetical crises.

The reaction to SARS became a powerful symbol of what is wrong. Here was a new but relatively minor epidemic that, in a sane society, would demand a serious response from the medical and epidemiological authorities.

In our apparently less-than-sane society however, officials from the World Health Organisation (WHO) downwards treated SARS as a cross between the Black Plague and a bioterror attack, quarantining entire cities and damaging whole economies. Meanwhile people across the world could be seen walking around wearing useless paper masks, a sort of modern equivalent of the medieval amulets used to ward off evil. The SARS panic turned into an outstanding example of the cure being worse than the disease, the panic causing more damage in the real world than any fantastic ‘what if?’ scenario is likely to.

Mulgan’s remarks should serve to remind us that the suffocating safety-first spirit of the age comes from the top down. Major political academic and scientific institutions now appear to be obsessed with risk management/avoidance, and infected with the outlook of organised paranoia. The worst fear of those in authority is now to be accused of not taking sufficiently stringent precautions to ward off some potential, or even hypothetical, threat to public health.

The watershed in this came with the BSE/vCJD crisis of the 1990s. The authorities were widely – and arguably unfairly – blamed for not doing enough to foresee and forestall that disaster for British farming. The Phillips Report into the disaster advised that the government should in future adopt a strict ‘precautionary approach’ at the hint of any potential public-health problem. Even though the apocalyptic predictions about a vCJD epidemic on which the Phillips approach was based proved entirely unfounded, the precautionary principle has been institutionalised in government policies ever since. It essentially dictates that a lack of hard evidence about a possible risk is no excuse for postponing official intervention and public-health warnings.

The impact can be seen in something like the government-backed Stewart Inquiry of 1999 into the safety of mobile phones, which established that there no evidence of a health risk – but then concluded that, regardless of the evidence, we should all adopt a precautionary approach to using the things anyway. In 2005, the official UK Food Standards Agency launched a high-profile PR campaign around the alleged risk posed by the Sudan 1 food dye. The presence of traces of the banned colouring in some processed foods (so minute that anybody would need to eat a supermarket full of the stuff to suffer so much as a stomach ache), became the pretext for ordering the recall of millions of pounds’ worth of perfectly edible food. Every expert knew there was no real risk of harm to public health; one put the risk of eating some of the contaminated processed food on a par with smoking one cigarette in an entire lifetime. But they went ahead and banned it anyway, threatening shopkeepers with prison for selling safe food, just as a precaution.

The authorities’ hope is that taking pre-emptive action will reassure the public and forestall future health panics. The result, however, is often the precise opposite. In the risk-conscious climate discussed above, overblown precautionary measures only confirm many people’s suspicions that there is a real problem. And self-conscious government attempts to show that it is doing something can only lead to escalating demands for it to do more.

It is possible to see how this works itself out in relation to the avian-flu issue as it has developed in the UK over the past couple of years. For its part, the New Labour government has tried to hold the line against hysteria and appear reasonable, issuing a consistent ‘don’t panic’ message. But it has been repeatedly outbid by opposition politicians, experts, campaigners and media voices accusing it of complacency or a cover-up, and demanding more and more precautionary measures. In this, it lies at the heart of government policy on everything from food dye to mobile phones, and by emphasising the need to reduce risk. Now, fearful of being accused of not intervening enough to prevent a potential threat to public health (almost the most serious charge a politician can face these days), the government’s response is to up the ante further, to try to demonstrate that it is fully prepared.

There have been many official appeals to remain calm and attempts to put the risk of bird flu in perspective (such as the chief scientist’s assessment that, even if avian flu did infect our poultry population, the odds of anybody in Britain contracting it would be about 100 million to one). But these would be far more convincing if they were not accompanied by reports of the government’s plans to deal with a hypothetical devastating pandemic. These measures include plans to close schools, reportedly to keep the predicted number of deaths among children down to 50,000 instead of 100,000 (that should reassure the parents); plans to dig ‘plague pit-style’ mass graves to accommodate the countless thousands of expected corpses; and plans to give GPs and medical staff armed escorts to beat off the predicted mobs of vaccine-hunting people. It is worth recalling that these are government measures designed to deal with a pandemic to be caused by a strain of the H5N1 subtype of the bird-flu virus that could pass easily from human to human – a strain that does not actually exist anywhere in the world, and may never do so. That is organised paranoia in action. If headless-chicken syndrome were to catch hold of the country in relation to bird flu, the infection will have spread from the top of the body politic downwards.

The confusion over bird flu confirms how the creeping spread of the politics of fear and the rise of risk-aversion makes our society easy prey to any panic in matters of personal health. We have reached the point where we often seem to live in a sort of Chicken Little culture, in which many are predisposed to panic about the sky falling in every time an acorn falls on their head (or a trace of nut appears in their food). Although the sky is not falling on our heads yet, some who should know better do seem to be suffering from clouds on the brain.

There is a crying need for a sober and rational presentation of the facts about health today, to counter the entrepreneurial scaremongers and the professional panic merchants. This book is the place to start. Ultimately winning the arguments, however, will also require waging a culture war against the miserabilist spirit of our times, which provides such a fertile environment for the spread of sick ideas about health, risk and humanity.