Broccoli fights cancer, says the British Journal of Cancer. This worries me because I remember vividly that once upon a time, circa 2001, broccoli was carcinogenic. Back then, it contained acetaldehyde, which was A Bad Thing Of Some Kind, and quite prominent in health stories until we forgot about it. Luckily, I don’t use deodorant or incense, but phone masts, bacon and the rest of the fashionable carcinogens will probably get me if I live long enough.
Or they will if the endless health scares in the press are to be believed. But despite their repetitive, contradictory and medically tenuous nature, people pay attention to these lists of absurd things that are supposedly bad for you. They even act upon them — randomly banning bra underwiring or broccoli from their lives — while remaining resistant to constant, consistent and proven advice to eat, drink and smoke less and exercise more. Why?
Ben Goldacre, who as well as being a doctor, writes a column entitled Bad Science, says the lure of the health scare story for the media lies in that fact that during the “golden age of medicine, miracle cures and sinister hidden scares really were being discovered.” Now, “we move ahead by small incremental understandings of large numbers of modest risk factors, but journalists haven’t found a way to write about that, so every fractional research finding has to be crowbarred into the ‘miracle-cure-hidden-scare’ template.”
The basic problem is that we’re so healthy. As Catherine O’Leary, a doctor working in Kent points out: “Medicine has made tremendous strides in curing diseases with antibiotics, in treating illnesses such as heart disease and depression, and in preventing illnesses such as diarrhea, measles, small pox and now, possibly, heart disease that people are less accustomed to ill health all around them.”
For this reason, she thinks that “ill health, mental or physical, has developed a significant stigma that people are anxious to avoid — especially if this may convey a loss of status.”
On the other hand, people might be bothered about their health, but they don’t want to stop doing things they like.
O’Leary explains that, in her experience, heavy drinkers are aware of the risks but are so “passionate not to be deprived of drink” that they hide the habit or avoid doctors entirely. Smokers are often in a simpler form of denial.
“I frequently encounter smokers who are concerned for their health, but who won’t discuss their habit,” she says, even after she shows them a calculator on her computer screen that displays the enormous effect smoking has on life expectancy.
“It only has a small effect in the success I have getting them to quit.” she says.
Kieran McCafferty, a renal doctor working in central London, says that people want a scapegoat: “They don’t want to exercise, because they’re lazy, but they want to say, ‘But I stopped using deodorant!’, which is like giving up chewing gum for Lent.”
McCafferty also says that health scares are so powerful because most of them relate to cancer. Patients are more likely to die of heart disease, but they can understand and accept a blood clot blocking a vessel and killing them. It doesn’t feel as personal as something growing inside the body.
“With cancer,” he says, “your body has turned against you.”
His experience of telling patients they have serious illnesses bears this out.
“People react really well when I tell them they’re going to have to go on dialysis,” he says, “even though the life expectancy is about three years. They react much worse when it’s prostate cancer with an expectancy of closer to 10 years.”
The maverick scientist James Lovelock, whose Gaia hypothesis that the Earth should be examined as a single, self-regulating system, says that our biggest problem as a species is that we cannot understand risk. He gleefully points out that, in the vast majority of cancer cases, oxygen and time are the main factors. Fuel from the food we have eaten reacts in our cells with oxygen we have breathed in to build energy packages that can be carried around the body. There is accidental leakage from these billions of reactions. Some of this leakage is in the form of highly reactive molecules containing oxygen. Most of these are mopped up by safety systems, but not all. And over the course of our increasingly long lives, some of these products of oxidation can damage our DNA, causing cancer. There is a deeper truth in what he’s saying: In the end, the world will get us somehow.
Lovelock says that our inability to grasp that concept, combined with a dysfunctional belief that something is “good” if it’s “natural” and “bad” if it’s a “chemical,” distort our view of the health risks that surround us. It’s easy to see how our current unease about the chemical, industrialized world around us fuels popular health scares. Lovelock blames misunderstandings caused by the science-illiterate media.
As Goldacre explains: “Few things can make a doctor’s heart sink more in clinic than a patient brandishing a newspaper clipping.”
But this doesn’t mean the public is stupid, he says.
“Only those who have never met the full range of people in their community will ever claim that,” he says.
O’Leary agrees. Patients might enjoy reading unlikely tales about a man regrowing his finger with pixie dust made of pig intestine, but this doesn’t mean they believe it. Her patients are not worried about deodorant or broccoli. But they do want body scans or have read about new drugs, “the vast majority of which have not got beyond the experimental.”
These are serious concerns that get to the heart of the fundamental issue with healthcare provision, which is the allocation of scarce resources as medical science discovers increasingly brilliant ways of mitigating the effects of illness.
The problem is, we’re going to die. When Richard Dawkins had his entertaining dig at scientifically risible homeopathy last year, he found that what helped patients was receiving old-fashioned “care.” People want to feel someone is on their side.
On Monday I tried to count how many times the private healthcare company Bupa used the word “feel” in one of its animated adverts in the UK. A woman portrayed as a bouncy little animated circle didn’t “feel” great. Then she went to a nice, clean Bupa surgery, which made her feel relaxed or similar, and the nice, friendly doctor made her feel important and cared for, which made her feel better, and there was some more stuff, all of which helped her feel reassured, and that felt great. The narrative was imprecise, and I am not sure she was ill, but she definitely wanted to feel better.
I’m not sure how many “feels” there were in the end because I felt dizzy.
Clever Bupa. It offers medicine, but also the chance for people to “feel good.” Health scares about small things give us the illusion of control over something big that frightens us. They offer exactly the same thing as Bupa’s ads: a problem and a solution.
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