Dirk Campbell July 2015
|I have just been reading one of those rare books whose central concept seems so important and so universally applicable that one wonders why no-one thought of it before. It is a very simple observation and, like gravity and evolution, very obvious in retrospect; one realises that it has actually been around for ever but not previously identified. The observation in question is that all living systems possess a capacity, for which there is no word in the English language, for self-strengthening in response to stress or impact. This capacity goes beyond resilience, which is merely the ability of a system to retain its integrity. The book is by Nassim Nicholas Taleb, author of Black Swan (nothing to do with the ballet movie but a book about the profound effects of the unexpected) and because there is no term for its central concept he has been forced to coin one: ‘antifragility‘. (The title of the book is ‘Antifragile’.) It’s not a good word, because it references its opposite; it’s like calling strong ‘anti-weak’, or weak ‘anti-strong’. But until someone comes up with a better word it will have to do.|
Antifragility is central to life and is thus relevant to all areas of human concern, but none more so than health. Our bodies have a remarkable capacity for self-healing and self-strengthening, a mechanism imperfectly understood by biologists, who rely on testable and repeatable experiments, and this attitude carries through into pharmacology and thence into the pharmaceutical industry. Big Pharma exerts a huge influence on the medical profession because of the enormous sums of money it makes and can therefore spend on marketing its drugs, thereby eclipsing other, cheaper, more common-sense options such as trusting the body’s immune system (an antifragile function) and allowing short-term non-damaging conditions to run their course without medical intervention.
The systems we create are not antifragile, unfortunately. They are at best resilient, but usually not even that. Our health service, like all our other services (education, defence, police, transport, energy, waste disposal and so on) can only be kept going by regular infusions of money drawn from an increasingly fragile and vulnerable economy. The government’s best solution to this problem is to sell the services off to private enterprise, but this only kicks the can down the road if you’ll excuse the cliché, because private enterprise is just as dependent on borrowing as government, and it is forced to pay its top executives huge salaries into the bargain. The way they get round that problem is to avoid paying UK tax, of course, to which government perforce turns a blind eye, because if it didn’t the service concerned would become far too expensive to the consumer, and the apparent benefit of privatisation would be lost.
Conventional wisdom has it that our services would work perfectly if we spent enough money on them. Government always boasts about how much money has been spent on hospitals, new drugs, doctor training and so on as if this were the main consideration in the provision of health care. Quite apart from the questionable nature of this belief is the rather glaring fact that Big Pharma exists primarily for the purpose of making money rather than health, in the same way that the food industry, the weapons industry and the oil industry all exist primarily to make money. This way of working is fine until resources run out, when it becomes no longer feasible. The Transition project is about recognising this inevitable downturn and preparing for it in advance.
So what can we do about health? I would like to mention here that societies we regard as primitive have no medical industry and no health insurance, only the knowledge of plants that grow around them and the security of their community. It’s a way of life that worked perfectly well for all humanity for millennia – because that’s how we all were before the economic growth imperative took over (Lawlor 1991, Quinn 1992). Also, these ‘primitive’ communities are happy. They have not the fear of disease and death that we have (Everett 2008). We are nowadays told to regard childhood diseases such as measles, mumps, whooping cough and even influenza as potential killers, but they are much less lethal statistically than the poisions we put into ourselves, particularly tobacco and alcohol (WHO 2011), not to mention the many other dangers we knowingly create, climate change being the main one, because that’s where the financial growth is. And that’s what government and big business require of us.
Our culture teaches us that disease and death are enemies to be fought and overcome when actually there could be no life at all without death as its counterpart – a fact well understood and accepted in ‘primitive’ societies. Our health services talk proudly of ‘lives saved’ as if this were some kind of permanent achievement instead of a temporary postponement. In fact, although life expectancy is increasing for us in the affluent world, cancer incidence is on a steep upward curve. In 1900 cancer death rates were one in 1500 in the USA. Today it’s three times that despite all the hugely expensive medical technology and chemicals that have been developed (New England Journal of Medicine 2015). We need a more sensible attitude to health: one that accepts disease and death as natural; one that includes the sick and dying as part of the community instead of an unpleasant thing to be sectioned off; one that listens to the messages of disease and death instead of blocking our ears and hoping they will go away.
So where does all this leave us, if we are to divest from government-supplied ‘free’ health care and invest in local health provision? First of all we should invest in information. I don’t mean trawling hundreds of internet sites for self-diagnosis, though there’s nothing intrinsically wrong in that; I mean educate ourselves and our community about what standard health care promises – such as freedom from common childhood illnesses – and what it actually achieves, namely a huge increase in childhood allergies and chronic conditions (smartvax.com) which place further strain on an already overstretched service. Many conditions that people go to the doctor for today are self-limiting: colds and flu are good examples. No-one dies of these conditions unless they are already in bad health. The idea that infections make us stronger if we allow them to run their natural course, and we are in good health in the first place (Taleb 2015) is impossible for the medical profession to admit, firstly because of the tiny minority of exceptions, and secondly because of the stranglehold that Big Pharma has over it. Deaths from measles only occur in cases of Vitamin A deficiency (McTaggart 1991), but doctors are not allowed to acknowledge this because the government has decreed that all the world shall be immunised at an early age, providing huge profits for the pharmaceutical industry and building up immune problems for the population in later life, which will require treatments that provide even huger profits for the pharmaceutical industry.
I am not a particular advocate of alternative healing – I have seen it work, though not very often – but I am saying that we must change our attitude to health provision because the system we have become accustomed to can’t last. And if that means more reliance on traditional wisdom and less on expensive pharmaceuticals, so be it. Also we will have to convert from a ‘cure it’ to a ‘prevent it’ attitude. As Taleb points out, our bodies are capable of responding magnificently to certain kinds of acute stress, including disease, as long as they have not already been incapacitated by continuous low level stress, intake of toxins and physical inactivity. Our bodies are designed by evolution to be exposed to uncomfortable experiences, even extremes from time to time, as this makes them more robust. Doctors all know this and most of the ones I know in Lewes are very sporty for this reason. I would go further and state that we have in Lewes a tremendous reservoir of knowledge and wisdom in our doctors. Ideally placed, in fact, for the formation of an LHS (Local Health Service) that can be both effective and leading, challenging the orthodox correlation between good health and money. I venture to say that we would benefit from better information and a better attitude towards disease and death, and I question the standard rhetoric about ‘war on disease’ which assumes that somehow the human body is ‘in league with the enemy’ rather than being our ally. Because if it is a war, it is a war that can never be won.