In the preface to this remarkable book Dr. Fitzpatrick describes breaking into the house of an elderly couple during a bitterly cold February. The couple had succumbed to a combination of infection and hypothermia. While waiting for the ambulance, Fitzpatrick, a primary care physician working in a blue collar Borough of London, England, found an untouched leaflet describing the dangers of anonymous sex and the virtues of condoms. This leaflet had been distributed to 23 million homes in the UK, around half of which contained either an elderly couple or an old person living alone. At this moment Fitzpatrick reflected upon the absurdity of the "everyone is at risk" campaign and the motives of a government that did little to prevent the elderly from freezing to death and yet enthusiastically supported "healthy living".
The conclusion that Fitzpatrick reaches will surprise and enrage both those who agree and disagree with his view. The author is nothing if not blunt stating, "the governments health policy is really a programme of social control packaged as health promotion." In an era when social institutions are increasingly discredited (think Congress, the Senate or any other political institution), irrelevant (e.g., unions) or ignored (e.g., religious proscriptions against premarital sex) the government has seized upon personal health as a means of reconnecting with society and regulating and supervising people's lives.
At first glance Fitzpatrick's contention might be viewed as absurd and eccentric but think about it, how many aspects of your life are affected by concerns about health? Do you feel guilty driving to work when you might walk? Do you eat salad when you would prefer a steak? Do you miss out on a Friday night excursion so as to not have a drink or to avoid a smoky atmosphere? Medical jurisdiction over lifestyle extends into the home, the workplace, our schools and neighborhoods. This might not appear coercive but combined with endless screening programs of increasingly intrusive nature and daily announcements regarding another necessary alteration to keep us healthy and the insidious regulation of life becomes more apparent.
This might all be forgivable if it were the case that these changes in lifestyle were of benefit but Fitzpatrick explains they are not. With the exception of smoking there is very little evidence that the proposed adoption of a "healthy lifestyle" will have any noticeable benefit to the individual. For example, changes in diet to reduce cholesterol will increase the life expectancy of an average 65-year-old man by between 2.5 and 5.0 months. If you are younger than this, the benefits are so small as to be incalculable. Essentially your odds of having a heart attack under the age of 65 are very small; if you start a diet of muesli and skimmed milk while avoiding all fatty food your risk will be reduced to very, very small. When stated like this many might choose to live happily, if a little more riskily, eating bacon and drinking whole milk rather than existing "safely" on a boring diet.
Fitzpatrick's bottom line is that people need less moralizing when they are well and more health care when they are ill. Doctors should retreat from the moral sphere and return to helping people live their lives, as long and as healthily as possible, with their vices that make life happy and livable.