The Death Of Human Medicine

THE DEATH OF HUMANE MEDICINE

T HE DEATH OF
HUMANE MEDICINE
AND THE RISE OF
COERCIVE HEALTHISM
P etr Skrabanek

THE SOCIAL AFFAIRS UNIT

© T he Social Affairs Unit 1994
A ll Rights Reserved

British Library Cataloguing in Publication Data
A c ataloguing record of this book is available from
t he British Library
I SBN 0 907631 59 2
R eprinted 1995 (twice), 1998

TO PAULSACHET

The views expressed in this book are the author's own,
not those of the Social Affairs Unit, its Trustees,
Advisers or Director

B ook production by Crowley Esmonde Ltd
T ypeset by Rowland Phototypesetting Ltd, Bury St Edmunds, Suffolk
P rinted and bound in Great Britain by
S t Edmundsbury Press Ltd, Bury St Edmunds, Suffolk

Contents

The Author

7

Preface
Robin Fox

9Foreword
Acknowledgements

11
13

Part One: Healthism
1 T he rise of healthism
2 A fter Illich
3 Before Illich
4 H ealth for sale
5 ' Anticipatory' medicine
6 U nhealthy obsession with health
7 'Positive health' and its promotion
8 G reen healthism
9 T hanatophobia and the medicalisation of death

15
17
23
29
31
37
41
51
53

Part Two: Lifestylism
1 R ecipes forlongevity
2 F itness craze
3 F oodism
4 T he wages of sin
5 T he demon drink
6 D amned tobacco

57
71
78
99
111
119

5

D EATH OF HUMANE MEDICINE
Part Three: Coercive Medicine
1 F rom theory to practice
2 Coercive altruism
3 T he doctor as agent of the state
4 T otalitarian medicine
5 P regnancy police
6 Lifestyle surveillance
7 T he Stakhanovite worker
8 G enetic tyranny
9 The war on drugs
10 Autonomy

137
139
146
152
157
161
167
171
176
184

Notes and References

195

6

The Author

P etr Skrabanek died on 21st June 1994 from an aggressive
p rostatic cancer at the age of fifty three. The manuscript of
The Death of Humane Medicine was completed a few days
b efore his death.
B orn in Czechoslovakia he acquired a doctorate from
C harlesUniversity and worked as a forensic toxicologist. He
h ad almost finished his medical studies when in 1968, whilst
h e and his wife, Vera, were in Ireland, the Russians entered
P rague. They decided to remain in Ireland and Petr enrolled
in the College of Surgeons medical school and qualified at
t he Society of Apothecaries.
A fter house officer posts he worked in the field of neurotransmittersand became an authority on Substance P. He
j oined the Department of Community Health in Trinity College, Dublin in 1984, initially in a temporary capacity, aided
by a grant from the Wellcome Foundation. He was subsequently appointed as a lecturer, then senior lecturer and
finally associate professor. He was made a fellow of the
college and a fellow of the Royal College of Physicians of
Ireland.
H is last book, Follies and Fallacies in Medicine, w ritten
with James McCormick, has been translated into Danish,
D utch, French, German, Italian and Spanish.

7

Preface

W ho is this viper in the bosom of medicine, this Bluebeard?
O ne of the smartest moves in my working life was to make
t he acquaintance of Petr Skrabanek.
H is story is remarkable. In 1968, when Russiantroops
i nvaded Prague, he and his wife Vera happened to be on
holiday in Dublin. They opted to remain in Ireland, where
t hey brushed up their English with the aid of a copy of Ulysses
( Petr later became an international authority on the works
of James Joyce). To his Czech qualification as a toxicologist,
P etr added an Irish medical diploma; and by the mid-1970s
he was .gaining attentionthrough a series of critical and witty
l etters in The Lancet, a ddressed from the endocrine unit of
a C atholic hospital. Increasingly his sharp pen was directed
at population medicine and the apostles of lifestyle - those
w ho preached the fallacy of cheating death. Among public
h ealth doctors and epidemiologists, Skrabanek became a
n ame that aroused strong passions; so it was all the more...