Yves here. Readers might argue that Richard Murphy’s contention, that medicine is too far outside the political discourse, does not apply to the US, where who should get and who should pay for “gender affirming care,” the use of vaccines, and RFK, Jr’s MAHA all show that medicine is very much part of the political debate in the US.
I beg to differ. First, the hot-button issues in the US, even though they have health impact, are still a different flavor of Jay Gould’s saying, “I can hire one half of the working class to kill the other half.” These are divisive topics which conveniently divert attention from much more basic problems, like the grotesque overpricing of US medical care due to its profit drive, how many policies, from Obamacare to a lot of Medicare Advantage plans, are overpriced Band-Aids that don’t deliver when patients really need them, to the resulting crapification. How many ordinary citizens realize that electronic health records worsen care by making medical histories harder to read and distracting doctors by (often) requiring data entries while the patient is in the room?
And don’t get me started on MAHA. While the objective is estimable, RFK, Jr’s priorities seem too much in line with those of wealthy health fetishists rather than ordinary and low-income Americans. Admittedly, RFK, Jr. does plan to get what amounts to junk food out of public school menus.
But promoting raw milk, liberalizing dietary supplement regulation, and getting suspect additives out of prepared foods may be beneficial (I beg to differ on raw milk ex very strict regulation and disagree on dietary supplements) but still don’t tackle core issues. How about food deserts? A lot of neighborhoods don’t have enough affordable fresh veg and decent quality meats and fish for residents to regularly prepare simple meals on their own. How about Mayor Bloomberg’s fetish, sugary drinks? Why isn’t RFK, Jr, after one of the scourges of the poor (and too many of the middle class) high fructose corn syrup? And while we are at it, aspartame, the FDA’s most controversial food additive approval evah, and also the one that has continued to get far more complaints than any other? Instead, he’s been touting beef tallow deep fries (and why is deep fried ever a good idea!?!?)
Richard Murphy continues on his theme of how neoliberalism is bad for mental heath, as are profit/convenience driven diets, and that these are regularly omitted in health care policy discussions. If nothing else, he is continuing to bring attention to the fact that modern societies are suffering from ever-worsening mental health crises and high levels of obesity, which are for the most part being ignored.
One of the themes in the piece below is the desire of UK officials to treat people as more or less homogeneous, when they are anything but. That has become widespread in the US, with behaviors that were once seen as tolerably normal now pathololgized and medicated. The poster child is rambunctious boys. In many cases, more activity, as in more recess and walking to and from school, would dampen down a lot of this behavior. So too would a few more years of growing up. But most parents accede to pressure to drug them up.
In a bit of synchronicity, a new post on Aurelien’s Substack, The Man Who Nearly Woke Up, seems germane. I have to admit I was initially bothered by it, since the central character was simply not believable: a man on his last day of work, leaving a job where no one would miss him and to which he had no attachment, with no passions, no interests, and no plans for how to occupy the rest of his life. Someone so compliant should have at least had fear or anxiety as a motivator.
But this tale made sense, at least to me, reframed as an account of the ideal white collar worker in a big organization, willing to take on any role, even an awful one, if it had sufficient pretenses of being a career-positive move and garnering some respect internally. This is the thin gruel neoliberals hope we will all swallow.
By Richard Murphy, Professor of Accounting Practice at Sheffield University Management School and a director of the Corporate Accountability Network. Originally published at Funding the Future
UK ministers are claiming ill health is over-medicalised in the UK. It isn’t. It’s under-politicised instead. It’s neoliberalism that is making us ill, but they refuse to recognise that fact.
This is the audio version:
This is the transcript:
Medicine is under-politicised in the UK at present.
I think many people will be surprised to hear me say that because what they’re used to hearing is Wes Streeting, our Health Secretary, saying that medicine is over-medicalised at present, particularly when it comes to mental ill health.
Well, he’s right to an extent and again, I think most people will be surprised to hear me say that. But the reason why he’s right is for reasons that he does not understand.
Like most Labour ministers, he’s out of his depth when he talks about medicine.
The fact is that the reason why we have so much mental ill health at present, is that we are not talking about the politics that is creating that ill health. And that’s what I mean when I say that we are under medicalising medicine at present. We live in a country where ill health is being created by the choices that politicians are making.
Just look at the recent example of the government deciding that it’s going to cut benefits for the most disabled people in our society.
Is that going to reduce depression?
Is that going to reduce anxiety?
Is that going to put people into a position of work because suddenly they’re liberated – as the minister’s claim – to go out there and do a job that they never realised they could do before?
No, of course it isn’t going to do any of those things.
It is going to increase stress.
It’s going to increase anxiety.
It is actually going to increase disability, and it’s going to remove the right of many people to get to work because they will not have the funding that they need to do so. Everything is almost the opposite of what Wes Streeting says when it comes to health, and this is true more generally.
We have a massive medical problem with obesity in the UK. I’m old enough to remember when people were smaller than they are now. Let’s be quite blunt about this. Average waist sizes in the UK have increased by three or four inches over the last 40 or so years. My memory that people were slimmer when I was younger is not false. It’s absolutely true. We are simply bigger now, and there is no genetic explanation for this.
There is an argument in medicine, of course, about nature versus nurture. The neoliberals want us to think that it’s all about nature. They say every problem that we have with regard to medicine simply requires us to examine the genome in ever greater depth until we find the answer to the problem that they’re looking for, which will be another drug.
And look, we can see that with regard to obesity – ozempic, and wegovy – they are the answers apparently to the problem of obesity, but actually they aren’t.
They suppress the desire to eat. They actually also suppress the desire to live. They suppress the desire for sex. They suppress the desire to go to work. They are creating mental ill health in their own rights because that’s what they do. They suppress. So, therefore they are not an answer to anything in the long term, except they do make a lot of profit for the medical industry. It’s already thought that one in ten people in the UK might be on one of these drugs, many of them privately prescribed.
And this is not an answer to our medical problem. Our medical problem is caused by the failure of our government to ensure that we have safe food to eat.
We are fed with ultra-processed food, which is so packed with sugars that are so addictive that we so overconsume those foods that we end up overweight as a consequence.
But not just overweight, because the same sugars that create the addiction also create pain in our bodies because we are too big as a consequence of eating them.
They create problems with regard to our mental ill health because they give us short term dopamine hits and then deep crashes. They create further problems.
And yet our government is doing nothing to stop this because they will not stop the pursuit of profit. They won’t deal with the problem of obesity because it is about profit making in the first case, by selling ultra processed foods, and in the second case by selling drugs to tackle it, which in the end will create more problems all of their own.
There’s a fentanyl problem in the USA. We thankfully don’t have anything like that in the UK. My prediction is we will have an ozempic and a wegovy problem in due course because they in turn are drugs prescribed in the first instance for good reason, but with long-term and deeply dangerous effects.
I suspect, and I’m deeply worried about this, that there’s another dimension as well. I am well aware of the problems of neurodivergence that about 30% of people in the UK suffer from. They just are simply not fitting into the expectation of what normality is, as is defined by our politicians, as is defined by the 70% of the population who are neurotypical, and as is also defined by our economic philosophy.
Remember, neoliberal economics assumes that we are homogenous human beings. It says there is nothing different between you and me, and I promise you there is. I’m not saying that’s a problem. I don’t want to be you, and you don’t want to be me. What we want is to be ourselves with all those little idiosyncrasies that make us up and I hope make us appealing to those who know us and maybe even love us.
But the point about it is, that is not what the government assumes we are. We can see it in their policy. We can see that they think we are one and the same. All of us are, for example, they say willing and able, whatever our circumstances, to go out to get work because apparently we all get our dignity through work, even though very clearly that’s not true and very clearly, it’s not true that we are all able to work.
So, this assumption of homogeneity is fundamental to the problem that we face with medicine because we are simply different. We don’t want to be forced into boxes.
Ask most people with neurodivergence whether they want to be neurotypical, and they’ll say no, because they enjoy being who they are. But that is not acceptable to a medical system, which is seeking to put people in boxes.
This is where the danger lies in almost everything that we are looking at.
And it is reinforced again by the world around us. We are told what we must want. Advertising does that all the time.
We are told what is typical by that advertising, even though quite clearly a lot of the advertising will completely miss the point with us.
And we recognise that we are not typical.
We recognise that we are not wanting to be one and the same as everyone else.
And this comes down to the curse of neoliberal economics. We are simply seen as economic units. We are not even seen as functioning human beings.
And again, this is so clear from what Labour is talking about when it talks about disability.
They don’t talk about the fact that we need to care for people. They talk about the fact we need to get people back into the workplace. We only exist if we work according to Labour.
They say they exist for the sake of working people, but the majority of people in the UK don’t work. They’re young, they’re old, they’re carers, they’re sick, or whatever else it might be.
Why should we assume there is this complete uniformity of you and that as a result of this uniformity being imposed upon us by our politicians, by our economists, by our companies in the UK, that we should all be the same because we must all consume the same products and look alike?
This pressure to be uniform is making us anxious, depressed, and ill in a world that is not made for people to be stereotypes, but instead to be individuals.
And this is where Wes Streeting is wrong. If he wants to take medicine forward – if he wants to actually de-medicalise so many of these conditions – he has to change the political environment around them by recognising that some people can’t work in the same way as others and some people don’t want the same thing as other people might.
We have differing skills.
We have differing opportunities.
We have different strengths.
We have different weaknesses.
All of those things are real Wes Streeting.
When you build a medical system that recognises that there is no one such thing as a standard human being then you will build a medical system that reflects the fact that that is the reality of the people we are. And then you’ll treat us as individuals, and then you’ll find a cure to our problems. But so long as the economy treats us as this homogenous being, we’re in deep trouble.
What can you do about this? I think that’s a really good question and one I like to ask often.
Well first of all, learn about this. Understand that advertising is forcing you into a box in which you don’t want to be put.
Understand that you may not be neurotypical. You might have ADHD; you could be autistic. You may have issues with regard to mental ill health, which are not of your choosing, but which have been imposed upon you.
And don’t blame your parents or people around you because they didn’t nurture you wrongly.
The economy nurtured you incorrectly.
So again, let’s take this out of a blame game, except for the fact that profit is what is destroying mental ill health in this country.
Instead, let’s begin to talk about how it is that we can think about ourselves as individuals, as people who are different and value those differences and respect them.
This is a task we can all undertake because it’s about us and it’s about how we relate to other people and how we look at other people and how we understand them.
And that is really key.
I don’t want to be you.
You shouldn’t want to be me.
We should respect our differences and actually nourish and cherish them.
But we don’t live in a world that does that. And that’s why we live in a world where there’s far too much mental ill health, and as a consequence, too much physical ill health.
Wes Streeting is a million miles away from realising that this is the case. He thinks that there’s a problem with the over-medicalisation of health in the UK. No, there isn’t. There’s a problem with the under-politicisation of health in the UK, because politics has not recognized the cause of the ill health we have. When we do that, we’ll all get a lot better.
Richard is (IMNSHO) correct, but there are so many other issues to unpack here, many of which have been shown in good peer-reviewed literature for years if not decades.
Yes mental health might be over-medicalised but it is DEFINITELY under-politicised. Offering up the more likely true underlying explanation (neoliberalism, as he touches upon) is verboten. I’ve referred before on here to one of the top health economists under Blair EXPLICITLY publishing that we are entitled to three-score years and ten. Then go die. (I’m only gonna put links here to anything I’ve not said before on NC since 3 links tends to trigger the trip-wire and my comment will disappear down a hole). Adam Smith in his Theory of Moral Sentiments backtracked somewhat on the specialisation thing, recognising that this might not be good for an individual human’s mental health if they are treated like a cog in the machine. Plus I rue the day we changed the name of the dept from “Personnel” to “Human Resources”.
We aren’t homogeneous. True but yet again verboten to say this. Microceconomics doesn’t like this, particularly when it comes to variances and higher moments of the statistics. As soon as we acknowledge that a person might vary in their response on 2+ occasions then we open a Pandora’s Box that traditional economics cannot solve. That’s why phenomena like the n-of-1 trial were invented (which, again, I’ve mentioned). Yet again, can’t talk about those, because it raises nasty questions and requires INCREASED politicisation as to whether we should be doing more of these trials and in which areas to establish how and under what conditions a particular human might be inconsistent in their response.
A further note on treating people as individuals. As I think more on this, I increasingingly think that ship sailed around the turn of the century. NICE here in the UK explicitly works from models by my former colleagues based on the average patient. The idea of a multimodal distribution is anethema and I can’t see any pressure to change this. Because that would open yet another Pandora’s box concerning segmentation of the population with different groups treated differently since their needs are so different.
The anti-disability stuff by Labour is just plain nasty. As someone who has never claimed any state benefit and whose family haven’t, but who now are desperately trying to get disability benefits to stay afloat, long past the point where at least one one of us was eligible, this is insulting and evil by Labour.
Finally, just in an attempt to forestall links to the study I wanted to skewer this Guardian nonsense article, which some might be tempted to use in attempts to get beyond economics (in fact these methods are practically all rooted in economics). These articles should not even be dignified with discussion if you understand that numbers that have mathematical operators like averages should have certain properties (most of the happiness results require cardinality which is Math 101). This study, along with the one recently claiming collapse in mental health among the young, are based on demonstrably nonsense premises. It doesn’t mean the general conclusions are wrong – merely that those quantitative conclusions using these methods are “not even wrong”, unfalsifiable, since you can’t look into a person’s head and disprove that his/her “4” today is twice as large as her “2” yesterday.
Some of us actually used methods that are falsifiable about Australian quality of life (not happiness) and about QoL over the life cycle, putting out our stuff back in 2010, way before COVID or any “recent” explanations. Trouble is, unless you get out of your particular academic silo, you won’t see that stuff……but this comes back to Richard’s point….that the Political Economic regime still reigns supreme.
“…I beg to differ. First, the hot-button issues in the US, even though they have health impact, are still a different flavor of Jay Gould’s saying, “I can hire one half of the working class to kill the other half.” These are divisive topics which conveniently divert attention from much more basic problems, like the grotesque overpricing of US medical care due to its profit drive, how many policies, from Obamacare to a lot of Medicare Advantage plans, are overpriced Band-Aids that don’t deliver when patients really need them, to the resulting crapification…”
Thank you, that sums up the most expensive so-called health-care in the world, with the poorest health outcomes in the OECD (and even some developing countries). https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
And the ACA Obama/Romney Care is another giant subsidy to the insurance rackets. I consider it kleptocracy and extortion, although most people would dismiss that out of hand.
The UK appears to be setting the NHS up to fail by a thousand cuts, with an intent to make full privatization easier for the public to swallow. From the outside, it seems over time both L and C governments have done “backdoor” privatization of some health services. Still, the NHS remains hugely popular in the UK
https://www.youtube.com/watch?v=nW-bFGzNMXw&ab_channel=Mith
When both major parties (like Ds and Rs in the US) support privatization (empty rhetoric aside), how can the NHS be saved, and even strengthened?
Sorry, wrong link above, the YT was a response to reducing people to numerical economic units.
The link intended was
https://www.health.org.uk/press-office/press-releases/nhs-remains-our-biggest-source-of-national-pride-but-public-are-worried
In terms of NHS support, yes people clapped and banged their pots in support for it a few years ago. But as someone who has literally presented to the top bods in Whitehall (2009) as well as in more recent years “worked at the coal face” doing audio-typing when oncology, urology and plastics all went below critical numbers of admin workers during COVID infections, my latter experience was particularly worrying.
Stories are getting out about gross misconduct of NHS Staff: I saw similar examples so I have no reason to believe these are made up. The most egregious example was in urology: audio-typing is female dominated and I got a shift job basically because althought not a trained typist, I could type fast due to 20+ years in academic health services research and I knew a lot of medical terms so could hit the ground running. We males all know prostate cancer and its “physical test” are not popular. Witnessing a bunch of women in an open plan office of typists and secretaries in oncology sharing “funny” (extremely personal) details of individual male patients horrified me. When asked to work some more weeks I promptly said “no thanks”.
Basic levels of professionalism have been eroded over 3 decades. Nepotism was rife. I got the job because my sister was a senior secretary and just told the boss of all the oncology admin staff that I could type fast and knew a lot of the lingo! These stories are percolating out. I’ve heard on the grapevine people learning things about their diagnosis via routes that are most NOT how they should have been told. Standards in admin are appalling, but since these people are paid no more than someone at LIDL whaddya expect?
The erosion in trust and confidence in the NHS has been a calculated plan over 3 decades and we’re perilously close to a level where people decide it isn’t worth saving. Which isn’t so far from the shenanigans going on against public organisations in the USA.
I have all kinds of things about this article – but one little aside I would like to say about things like BEEF TALLOW FRIES…….
If anyone else has ever worked in fast food or fast casual, please chime in. I did as a very young person and I have the scars to prove it. The tallow fry thing is a huge distraction – we have to rethink much more about our commercial food production – tallow fries are a microscopic part of the problem.
As an FYI – in order to make the french fries really crispy and crunchy, they are cut from potatoes, then placed in gigantic vats of sugar water, with serious amounts of sugar. In my day, one of the evening jobs was cutting usually 200 lbs of potatoes into fries, then dumping them into these vats of sugar water and hauling them into the walk in refrigirator – where they would marinate in the sugar for 3-5 days. Nowadays, this is all done at a distribution center – and all the outlets get are bags of fries they just dump in the fryer. But the process is largely the same. These things are hideously bad for your health no matter what they are fried in. Americans demand a certain texture and color to their french fries and that is how it is done. Just another FYI – potatoes are obviously a root vegetable. And just like onions, carrots, etc potatoes will concentrate all the organic chemicals they are exposed to in the flesh of the roots. So if you are eating commercially grown potatoes – you are eating lots of chemicals too.
There is a way to do this in a much more healthy manner – it just takes a lot of work and I am not sure how it would ever scale.
First, grow your own. Potatoes are among the easiest of all vegetables to grow and produce huge yields.
Yukon Gold will work just about anywhere in the USA. The seasons are different – but that is what gardening is all about. We have ours in large gigantic metal cattle feeder containers with large holes on the bottom. We have too many moles – and have to do that or the moles will eat them all. Right now this very week, I am preparing the eyes for planting from last years’ crop. We do our own amendments to the soil – completely and wholly organic in every way. True organic potatoes require potash ( and I have found the best way to do this for potatoes is potash tea – take your ashes and put them in big vats of water and leave in the sun for a week – then pour onto your potato plots. Plants like carrots and rhubarb seem to really enjoy the dregs after you have dumped the tea. Potatoes also require some degree of compost – we use our cow manure and our Lomi-burned table scraps – and I always stick a bunch of crunched down egg shells – a) for the phosphorus – and b) to kill the grubs. After really getting this down, you will have all the potatoes you can handle. As I tell the 4H kids all the time – just a few years of practice and you will have it. Humans have been doing this for millenia.
In the fall, we have all the potatoes we could ever use for the year – and much more.
Slice them into French Fries ( or hash browns ) place them in gallon freezer bags – cover them with a bit of olive oil and salt – and then freeze them.. Do not worry about peeling them – the peels make the fries much better. We had 180 gallon freezer bags this year. We give a lot to the neighbors. And if you want mashed potatoes – these do just fine as well – all year long.
Get a rotissirie air fryer like this one – https://www.goodhousekeeping.com/appliances/a62567210/air-fryer-with-rotisserie/ – the very first one listed – the Instant – is the one we use. Put the fully frozen bag into the rotissirie – and then cover that with olive oil and salt. About 20 minutes later, you will have the best and most crunchy fries ever. No deep frying, no chemicals, no PFUAs, no nothing.
We do not do this in our society because it is hard work ( not much Netflix for me and my family all summer) and so many do not have any kind of place to do this. And because this kind of approach would be literally impossible to scale and distribute without a bunch of chemicals, etc……This approach with family gardens was how my grandparents and their generation did it with potatoes and so many others – and they did not seem to be burdened with near the health problems I see all around me today. Our health care system and what it is overburdened by is a direct reflection of how we have chosen to live our lives in our world today.