EBTL.050817

To Your (Spiritual) Health

If you are a regular reader of the Guardian (which I am not), or spend much time reading about the politics of clinical trials (which I do), you have probably heard of Ben Goldacre. Goldacre is a British physician and science writer who holds a post at the Centre for Evidence-Based Medicine at Oxford, and who for almost a decade wrote a St column called Bad Science, which he has spun out into several books. He writes well, has a quick wit, and while I sometimes find the rhetoric of his crusade against “bad science” sort of frustrating and tiresome, I can’t help but feel a sense of kinship with someone I see as a fellow complicater (a 2014 collection of his writing is titled I Think You’ll Find It’s a Bit More Complicated Than That). He can, at times, come across as a typically smug scientific triumphalist, as in his crusades against pseudoscience and various alternative therapies (I personally have a bit more time than he for alternate modes of knowledge-making), but he is nevertheless no stranger to the complexities of evidence production. He is also a driving force behind the AllTrials and OpenTrials campaigns, which together have been advocating—with surprising, if achingly slow, piecemeal, success—for a research culture/infrastructure that would ensure that all clinical trials are centrally registered and fully report their methods and results, and for such material to be available to all researchers in a collaborative, open database.1 You may be surprised to hear that no one is keeping track of the research conducted on drugs and other medical treatments that may or may not be approved for human use. The fact is, there are several such registries, but in spite of registration being mandatory in many countries, it seems people don’t really use them.2

Anyway, Goldacre comes to mind because it appears that the sort of do-gooding, new-leaf-turning, care-of-the-self jibber jabber that typically reaches fever pitch around January 3 every year has become a steady, unceasing drone in my social circles of late (perhaps it is called being in one’s middle thirties?). As someone who has perpetually (or at least regularly) miserable health and for whom nothing in particular in the way of diet, exercise, vitamins, regular blood work, or homeopathic hoozlewazzle has ever made any difference, and who has by profession become rather intimate with the maelstrom of contingencies, fine-tunings, and epistemically rationalized fudgings that undergird the production of all scientific knowledge (not just the pseudo-scientific kind), I find the Ouroboros of everything-bad-is-good-for-you/everything-good-is-bad-for-you that fuels the endless peripeteia of health advice pretty obnoxious. And so it was nice to stumble across a British Medical Journal article of Goldacre’s from around Christmastime a few years back wherein he takes lightly to task the kind of research (and subsequent marketing) that supposes to justify such things as chocolate and red wine consumption:

Moderate red wine drinkers, we are specifically informed, come out better on all kinds of health measures, and nobody wants to ruin Christmas by mentioning confounding variables again (like how moderate red wine drinkers hang out at home with their friends eating salad and talking about their posh jobs and stable social support). A fairytale science story must be simple, reductionist, and mechanistic. Red wine is good for you because it contains life-giving molecules, like antioxidants. And nobody wants to spoil Christmas—for the whole family—by mentioning that the antioxidants story is one of the great unspoken non-starters of twentieth century medical research… Only a malevolent Scrooge-like figure, mumbling over his glass of tap water in the corner, would dare to point out that if you are going to pore over a biochemistry textbook, and pick pathways out at random, then you can prove anything you like… And that’s when you might start to think, well now, perhaps people who eat fresh fruit and vegetables are, just like the people who drink red wine in decorous moderation, living healthily in all kinds of ways. Much like the people who buy vitamin pills. Lusty walks around country mansions. Cycling to work. That kind of thing.3

The article is flippant, but draws on a large body of research concerning not only the fuzziness of any conclusions about the real health effects of wine per se, but also the limitations of a style of evidence production that so many of us put great faith in without knowing much of anything about how it works. Goldacre’s is a well-needed, if sure to go unheeded, intervention, as much so now as it was in 2007. One need only look to this Christmas headline from the Montreal newspaper L’Express: “Le vin rouge prévient du vieillissement, c’est scientifiquement prouvé” (“Red wine prevents aging, it’s scientifically proven”), which cites an article from the journal Nature that turns out to have nothing specifically to do with red wine, or even with human beings.4 While Goldacre’s piece is more about marketing and bad science journalism (or science-indifferent health journalism), by ending on an implied note of just drink it, goddammit, he also hints at something that concerns me about this whole phenomenon.

That is, the normalization of a moral economy wherein such things as chocolate and wine need to be justified by their ostensible health benefits, as guilty pleasures redeemed, while the structure of spiritual blackmail remains perfectly intact. It is an economy wherein our health and the maintaining thereof take on a personal moral valence—the individual sits at the centre of a constellation of “lifestyle choices,” and the story of their good works are believed to be writ on and in the body, like a modern-day vindication of The Picture of Dorian Gray (for the story was not so much about Gray being protected from aging by his painted proxy, but from the literal, corporeal degradation of his flesh that was thought to be the just and inevitable consequence of his depravity). If you will pardon my hyperbole, at its worst this facilitates the blaming of the disease-ridden poor for not exercising and for eating too many Junior Bacon Cheeseburgers, and at its less extreme it still constitutes the selling of our pleasures back to us as (health) virtues. That is a calculation I don’t much care for. If you are going to drink and gourmandize and gorge, at least do so because it is the stuff of life, not because it is supposed to hold forth the promise—but not even the promise! Only a probabilistic, anonymous, statistical implication, an association!—of some extension of your otherwise miserable existence. Or, if you are going to lard yourself and your drinking in quasi-medical justifications, at least have the good aesthetic sense to go grander. Rustle up a rationale with a little more pizzazz: do so on the basis of old-wives’ tales or epigrams from doomed novelists, humoral medicine, the doctrine of signatures, or just to keep your skeleton from jumping out your damn mouth in search of some less feeble flesh.