As we continue to drown under a tsunami of over-regulation,
I was horrified to read proposals to regulate the food industry like the
tobacco industry. There is a basic
problem in this approach. Regulation only has a limited worth. We have
seemingly regulated the way in which MPs claim their expenses. We have also
aspired to regulate the banks in the wake of the credit crunch which so nearly
brought this country to bankruptcy.
The regulation of the tobacco industry is a cautionary tale
of what happens when the state attempts to interfere with freedom of choice. For
all the regulation and increased taxation, the incidence of new smokers taking
up the habit has barely changed. The prevalence of people smoking as a
proportion of the population has gradually dropped but not by nearly as much as
originally intended. It proves that people will make their own minds up and
make their own choices accordingly. The best way to effect a change at the end
of the pipeline is to concentrate our efforts at the other end of the pipeline.
If you have ever been to your local hospital and seen people shivering to death
with a fag in one hand and a drip stand in the other, you should question why
that happens. It is very easy to sit in judgement and condemn those smokers for
the effects of their unwanted smoke on everyone around them. That rather misses
the point though. Smoking is an addiction. If those same smokers had received
more structured health education at primary school level and beyond, the
chances of them choosing to take up the habit would be considerable reduced. Although
the increased tax revenue is enticing at a time when the NHS faces ever more
challenging financial pressures, the amounts generated don’t correlate with the
commensurate cost of treatment.
To seek to regulate the food industry in the same way would
only yield the same results. Education both at school and in the home are the
real key. If education is delivered in a focused, structured way, people will
be better placed to make more informed decisions regarding their own health in
the future. That must include both the children and their parents though. That
is a considerable challenge but is the only way in which lasting progress will
be made.
The food industry is very powerful and more than happy to
supply our weaknesses – if we let it. This entire argument revolves around
choice. On the one side lie the supermarkets with their demanding shareholders.
That probably includes you and me if we have any pension provision or shares of
our own because investment in the supermarket sector has been seen as a safe
bet. Here lies the big dilemma. Whether or not we like it, we are all at least
partially reliant on the continued growth of the food sector which contributes
so adversely to our own health outcomes through a cynical attempt to drown us
in a vast choice of high glycaemic index foods and cheap alcohol. If we follow
the best available advice and shun our devotion to these high sugar foodstuffs and
cheap alcohol in favour of home cooked food made from fresh base ingredients,
our health outcomes will be so much better. Our pension pots might not be quite
so big but our sense of wellbeing will more than make up for that. We might not
even be able to afford to drive everywhere thus making us use our legs for
transport again. This can only have a positive impact on our health outcomes. It
is only when we make our own food and become more judicious about what we
choose to eat that we become the master of what goes in it. Ergo, if we want to
adopt a healthier diet, it is down to us to make that happen. Just as with
smoking though, there will be those whose addiction to high sugar, processed
foods will already be too great to address. While we may not be able to make
much progress with those at the end of the pipeline, we can certainly make
great strides at the other end – if we want to.
My worry is the power of the food industry. They remain
highly influential in the corridors of Westminster and it can be argued with
some justification that the government would now find it very difficult to extricate
themselves. What we really need is stronger government. A government with the morality
to say no to an industry which does so much damage to the health of the nation
would have an enormous effect on the NHS.
Yesterday, I listened to a prominent member of Her Majesty’s
Opposition highlighting the importance of an NHS which remains free at the
point of access for every man, woman and child. She went on to claim how our
European neighbours are incredulous that we can sustain such a system. So am I.
I am utterly agog that we can continue to offer a free NHS to everyone with
nowhere near enough effort being made to address the biggest drains on it. If
we are going to let the food industry carry on as it is, the burden on our NHS
is just going to get bigger unless we focus on consumer education. Much is
being done but the real work still lies ahead of us. We all want the NHS to
remain free, but are we all happy to play our part in that?
Let us also be clear about something else. Nobody lives for ever
but everyone should have access to the best possible quality of life in their
later years. At present, this is not being addressed adequately. A number of
recent studies have highlighted sub-standard nutrition for our elderly and a
growing trend for the older members of our society to turn to alcohol for
comfort. In short, we have become far too insular as a society with a growing
tendency to sit back and just rely on the state to provide for us when the
going gets a bit tough. The concept of a family or the wider community providing
for their own is becoming less and less likely with both continuing to prefer the pursuit of wealth and pleasure.
This is a huge problem which is sadly getting much worse.
It is not the food industry which we need to regulate. We
need to re-educate ourselves. If we begin to value our health more, we will
make better life choices in terms of our diet and exercise. If we can achieve
this, the supermarkets can place as many unhealthy items as they like on their
shelves and we will be better equipped to calmly walk past them. Preferably, we
won’t even find ourselves in the supermarket as often because a big key to
community regeneration are the struggling high streets. A return to the high
street is not just achievable. It is also necessary to reclaim our communites
which have become so decimated by years of corporate greed. The arrival of
social media has been a real boon with people more inclined to engage with one
another again.
There are signs that people are beginning to
eschew the supermarkets but the reasons why are not so clear. The popular view
is that the supermarkets became too greedy and people reached a tipping point
above which they were no longer prepared to pay. The alternative view is that
people are beginning to think more about what they eat and how much they eat.
The true answer is not yet obvious but I sincerely hope the latter is true. With
news that a supermarket price war is upon us, people need to resist the false
economy of some transient discounting. Once the supermarkets have lured us back
over their threshold, they have us where they want us and spend huge amounts of
money placing the unhealthy foods in the most strategically attractive places.
That is where they make the most profit and those are the foods to which we
become most easily addicted. It is cynical and nasty and has sustained the
growth of an enormous industry. But we all still have the choice to say no and
think again about how much we value our own health.
I completely agree, this is about re-educating ourselves. That way, the next generation will reject the temptations of junk food. However, I really must stress, as a patient who is advocating for others, medicine must also look at it's own doorstep. Just how much training do GPs get on nutrition and deficiency states? Why are the tests for B12 and thyroid for example so poor? Why is the cut off for b12 deficiency so much lower here than in, for example, Japan? If you know anything about food, you will know that the iron content in spinach is nowhere near what it was thirty or forty years ago. Common deficiency states are the root of much chronic illness. The body survives on good nutrition yet the tests to discover deficiencies are routinely refused or plain old inadequate.
ReplyDeleteWhen pharma is involved in continued education for medics (indeed, their influence is everywhere, not just continued) then it's easy to see why they put the focus on drugs to mop up symptoms of ill heath, not deficiencies that can be resolved by better diet and supplements.
Hi Lorraine, the education regarding nutrition at medical school is, I would say, adequate but not a great deal better than that. In addition, there is surely now a strong argument to suggest that healthcare professionals also have to take responsibility for the health choices they themselves make. Without putting too fine a point on it, there are too many people working in healthcare who are just poor adverts for health promotion. On a recent placement, I was in a clinic assessing the eyesight of patients with advanced stages of diabetes. One patient was asked why he hadn't sought dietary advice to control his condition. He had but the person giving him the advice was, in his words, even fatter than he was! It's hard not to have some sympathy with his stance that he wasn't go to take advice from someone who was even worse than he was? As for B12 levels, it is something about which my understanding is fairly basic at this stage in my career but I find your points very interesting.
ReplyDeleteAlistair thanks for replying, sorry I didn't see it sooner. I wonder how best to push for improved nutritional education at medical school? This article in yesterday's Telegraph is worth a read. If the soil where you live is, for example, selenium or iodine deficient, it matters not a jot how good your diet is. It's only as good as the food you consume and that is dependent on the soil it's grown in. http://blogs.telegraph.co.uk/news/judithpotts/100289892/the-need-for-research-into-the-role-of-supplements-and-their-correct-usage/?utm_source=dlvr.it&utm_medium=twitter
ReplyDeleteThere are current plans for a national curriculum for all medical schools. It might have been reasonable to suppose that for such an important subject, this was already in place - not true. Whether or not sufficient time will be given for such an important area as nutrition is not yet clear. But it most certainly needs to be! For my induction day as a Junior doctor in North Wales, the BMA, the Medical Defense Union and Medical Protection Services collectively provided a buffet "lunch" consisting of a stack of Domino's pizzas complemented with fizzy drinks. And these are the people who will become the health decision makers of tomorrow. Scary!
ReplyDeleteAm pleased plans are afoot, shall watch that with interest! This is such a fundamental health issue, to ignore or demote it's importance is, I truly belive, medical negligence. I totally agree with you that the health providers must lead by example, with a caveat. Last year I attended out of hours for a hematoma in my arm thanks to a careless blood draw at my surgery. The lovely nurse who was dealing with me was breathless, obese and fairly ill looking. She took my details and when I told her I had Graves, hypothyroidism and hypoparathyroidism, she asked how I was feeling. After explaining the nightmare back to good health, she told me she was also hypothyroid and barely able to function yet doctors said her thyroid was noraml because the TSH said so! I asked how much thyroxine she took, what her T3 levels were, her iron, b12, D status (crucial for converting the T4 to T3 as you will know) and she said no idea, no one would test it. She was now on all the polypharmacy I used to take - beta blockers, PPIs, sleeping pills, amitriptyline, antidepressants, tramadol etc.
ReplyDeleteThis is a travesty of modern medicine. We knew how to treat this disease a century ago, and used the same porcine insulin, successfully, right up until the synthetic T4 came on the market in the sixties. Shortly after this levothyroxine as standard, we aquired new 'diseases' of ME, CFS, Fibromyalgia...I firmly believe, and research is coming to back my up, that diabetes type 2 and breast cancer are linked to this in women. The clinical evidence is just not there for safety and efficacy of T4 only replacement. MHRA, EMA and NICE are woefully short of it despite the Goldacre era of EBM.
A long way for saying, fat, fair and forty must be addressed again because the obvious is staring medicine in the face and it can't see it for arrogance. The arrogance of saying, we have that one sewn up. One little pill a day, easy to treat thyroid disease.
Correction. Obvioulsy we didn't use porcine insulin for thyroid patients! Porcine thyroid I meant. Of course, it does have parallels with the way porcine insulin was deemed old fashioned and taken out of use to ill effect.
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