Philip Lee is Conservative MP for Bracknell and, we are told, a part time GP. Dr Lee naturally takes a lively interest in the future of the NHS but I can't help wondering if his suggestion about people who get ill due to inappropriate "lifestyle choices" has more to do with his political aspirations than his medical concerns. Lee reckons that people who smoke or eat doughnuts and get sick as a result ( I had not realised that the cause of illness could be pin pointed with such accuracy, but I'm not a medical man) should be denied free prescriptions. Bound to be a big hit with Tory backwoodsmen. You have to peel back the layers a bit here before getting to the real heart of the matter.
First of all, not everyone gets free prescriptions anyway. Just about everything that befalls human beings is due to a "lifestyle choice", if that's what you want to call it, because living is a pretty dangerous occupation. Sure we can and perhaps should, make healthy choices but some of us have more choice than others and, let's be honest, we are not all equally endowed with choice making ability. The unspoken assumption is that it is the long term unemployed, larger drinking, deep fried underclass who are mainly at fault here but the truth is that nothing is as unhealthy as work. Dr Lee might bring his undoubted diagnostic ability to bear on just how much sickness is created in the production of his mobile phone for example and he might also consider the huge legacy of poor health that will result from long work days spent in front of a computer screen.
Look, the more responsibility we take for ourselves the better and there could be no bigger enthusiast for healthy exercise, fresh air and decent grub than me, but that responsibility is both an individual and a collective one. We are responsible for ourselves and for each other. If we want people to make healthy choices we need to educate them to do so but we also need to realise that to a very large extent and for the majority of people "lifestyle" is not really a matter of choice at all.
Philip Lee could make a bigger contribution by helping his patients rather than trying to score brownie points with his chums at Millbank.
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Curtailment of therapy based on judgements of lifestyle have been doing the rounds for some time - many proposals were made under the last Labour Government too. Most of my experience has been with transplant surgery and the regular cry concerned liver transplants for alcohol abusers. I recall an audience in Brasil where I was questioned about a Brasilian playboy who had drunk his way through two livers and was on his way to the UK for another. Should the UK give him one, even if he was prepared to pay? It meant one less liver for UK patients. But once life-style is established as a reason for therapy curtailment we are on a slippery slope. Almost all disease has a life-style component. Insufficient exercise, too much exercise, over eating, under eating, unhealthy diet, working too hard, being idle, too much sex, not enough sex, living too far away from work or living too near your workplace, are all contributory factors in the assessment of disease. So for this reason I published guidelines on organ transplantation which stressed that priority should be given to an ability to cooperate with the post operative therapy, and that doctors should not make therapeutic decisions based on speculations about life-style. Of course some doctors argued that alcohol abusers might not be able to cooperate. But that really is a matter for case by case assessment. It seems our Tory doctor is not really familiar with the problem. But then, I learnt early on in my career that GPs were not that well informed about medical decision making. Their job is to treat the sick, not lecture on how to live. As for education about healthy life-style - that is fine, but not from politicians and legislators.
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