Essay:On medicine

The dentist's morality

A clever child of five already sees through the dentist's morality. To the dentist, as explained by the colorful posters in the dentist's office, the world is full of delightful and pleasant things to eat. These, the dentist condemns as Bad for Your Teeth, therefore evil. There are also various disciplines varying from extremely unpleasant to mildly annoying; but these things are Good for Your Teeth, therefore virtuous.

A child of five can already see that the dentist's morality represents a sort of tunnel vision. A perverse set of priorities. A crabbed and miserly approach to life's rich pageant. To accept the dentist's morality is to make your goddamn teeth the enemies of your happiness.

The chief problem with medicine, and, more importantly, with medicalized popular culture in the United States, is that it has come to accept a version of the dentist's morality writ large.

The magic regimen

Everybody dies. Moreover, everybody dies "of" something. For reasons I don't pretend to understand, filling in the blank with "old age" on the cause of death form isn't allowed, even if it seems the simplest explanation. So the organ that gave out, the heart, lung, or liver, is identified as the cause of death. And if that's what kills people, the idea comes into play that if we can just keep that organ from failing, all the people who died with that box on the form checked would still be alive and well. This doesn't even make mathematical sense, but it's the way human minds work, so people are going to think this anyways.

The current medical ideology seems to me to show a basic lack of charity. It tells the sick and suffering that it's all your fault. You didn't live right. Now you're paying for it. And I get to be angry at you for it, because I am being taxed for your failure to shape up. I cannot reconcile this belief system with the most basic notions of charity.

"Cancer" is almost always old age. "Heart disease", likewise, is old age. Most people who die of "pneumonia" have actually died of old age. It's not a matter of them not being old age; it's just that science has that many pigeonholes to identify which organ or system gave out first. It may be the case that your genes have programmed you to die at 45. Once you pass childbearing age, you're mostly invisible to Darwin. And for someone confronting the reality that their life is approaching its end at 45, we have more important and less rude things to tell them than "you might have lasted longer if you'd taken up jogging."

But suppose for the sake of argument that it's true that there existed a magic regimen of life that guaranteed that you'd never contract heart disease, or chronic lung inflammation, or dementia, or stroke, or any of the various ailments that are accepted answers in that blank on the form. Those who suffer and die from them can be told that it's their own fault for failing to stick to the program.

Do you really want to live in a world where it's socially acceptable to say shit like that? Because it's the cornerstone of the "prevention" culture. People are constantly saying, or at least insinuating, the notion that it's your fault you got sick for not living right.

Medical moralism ought to be an outrage, at least against etiquette. It isn't improving anybody's quality of life or making people happier. It breaks the Golden Rule.

Public-healthism is the new racism

Healthism is an excellent substitute for racism. We get to blame the poor when they suffer from the illnesses of old age; it's all their fault for not living right, after all. If you believe this, it supports your resentment of taxes that support them. If they had made 'healthy choices' they wouldn't need public assistance, or so the argument goes. And of course 'fitness' is a quite acceptable proxy for your willingness to suffer for conformity.

There is literally nothing more diagnostic of white privilege than this belief system. Who buys organic food, and worries about GMOs? Who does yoga this side of India? Who shops at Whole Foods?

Slenderness is a useful proxy for your willingness to suffer for conformity. 'Health' has replaced wealth in the old Calvinist ethos, as a sign of God's favor that demonstrates your entitlement to lord it over your neighbors. So state-sponsored 'health' initiatives increase elitism, classism, and social tension much more effectively than they achieve any of their nominal goals. At minimum, this gives rise to a reasonable suspicion that the stated goals are not the real ones.

Dieticians

I've always viewed the dietician's approach to food, measuring this and counting that, with the same mix of incomprehension, pity, and contempt as any other kind of mental illness.