By A. Enzo. Baptist Bible College and Seminary.

In the past cheap fildena 100mg overnight delivery, however safe 100 mg fildena, the state had intervened in industry and services; now (as it tried to retreat from some of its earlier commitments) it stepped up its interference in personal and family life buy fildena 25 mg without a prescription. The left’s endorsement of the government’s Aids campaign discount fildena 25 mg with amex, following earlier feminist approval of the mass removal of children from parents suspected of sexual abuse in Cleveland buy generic fildena 25mg line, signalled the radical movement’s abandonment of its traditional principles of liberty and opposition to state coercion. While most conservative commentators loyally defended government policy, only a small group of free-market radicals was prepared to advance a, rather limited, defence of individual freedom against the authoritarian dynamic revealed in the government’s health policies (see Chapter 5). Until the early 1990s, politics and medical practice were distinct and separate spheres. Some doctors were politically active, but they viii PREFACE conducted these activities in parties, campaigns and organisations independent of their clinical work. No doubt, their political outlook influenced their style of practice, but most patients would have scarcely been aware of where to place their doctor on the political spectrum. Systematic government interference in health care has since eroded the boundary between politics and medicine, substantially changing the content of medical practice and creating new divisions among doctors. Thus, for example, the split between fundholding and non-fundholding GPs in the early 1990s loosely reflected party-political allegiances as well as the divide between, on the one hand, suburban and rural practices, and on the other, those in inner cities. Despondent at the wider demise of the left, radical doctors turned towards their workplaces and played an influential role in implementing the agenda of health promotion and disease prevention, and in popularising this approach among younger practitioners. Allowing themselves the occasional flicker of concern at the victimising character of official attempts at lifestyle modification, former radicals reassured themselves with the wishful thinking that it was still possible to turn the sow’s ear of coercive health promotion into the silk purse of community empowerment. Reflecting the wider exhaustion of the old order throughout Western society, an older generation of more conservative and traditional practitioners either capitulated to the new style or grumpily took early retirement. In 1987 I co-authored The Truth About The Aids Panic, challenging the way in which the ‘tombstones and icebergs’ campaign had grossly exaggerated the dangers of HIV infection in Britain, causing public alarm out of all proportion to the real risk (Fitzpatrick, Milligan 1987). Though the central argument of this book was rapidly vindicated by the limited character of the epidemic, it received an overwhelmingly hostile response, particularly from the left. Radical bookshops either refused to stock it or insisted on selling it with an inclusion warning potential readers that it might prove dangerous to their health. In public debates I was accused of encouraging genocide and there were demands that I should be struck off the medical register. My argument that safe sex was simply a new moral code for regulating sexual behaviour provoked particular animosity from those who took the campaign’s disavowal of moralism at face value. Not only does moralism not need a dog collar, in the 1990s it was all the more effective for being presented through the medium of the Terrence Higgins Trust, once aptly characterised as the Salvation Army without the brass band. Given the pressures of full-time general practice, intensified by the various government reforms and campaigns, this project took rather longer than intended and, in 1996. This was rejected by the Department of Health on the grounds that the proposed project was not ‘in the interests of medicine in a broad sense or otherwise in the interests of the NHS as a whole’. The fact that I was obliged to carry on working on this project in the interstices of the working day has meant that it has taken rather longer than anticipated. This has, however, enabled me to take into account the accelerated development of some of the trends of the early 1990s in the period since New Labour’s electoral triumph in 1997. The scope of government intervention in personal life through the medium of health has expanded—into areas such as domestic violence and parenting—and it has become more authoritarian— notably in the programme for maintaining heroin users on long-term methadone treatment. Yet the remarkable feature of New Labour’s public health initiatives is that they have provoked virtually no criticism either from the world of medicine or from that of politics, from any part of the political spectrum. The collapse of both the old left and the new right gives New Labour unprecedented authority to push forward both its authoritarian public health policy and its ill-considered programme of ‘modernisation’ in the health service. Whatever the fate of Tony Blair’s subordination of the NHS to electoral expediency, it is time to expose the deeper processes of the medicalisation of life and the corruption of medicine. In relation to my earlier dispute with the Department of Health, I would like to acknowledge the support of Diane Abbott, Mildred Blaxter, Gene Feder, Michael Neve, Peter Toon and Tony Stanton. In relation to this book, I am especially grateful to Mary Langan for assistance in many areas and to my medical colleagues Matthew Bench, Tricia Bohn, Gabriella Clouter, Chris Derrett, Janet Williams and Fayez Botros. Thanks are also due to Toby Andrew, Jennifer Cunningham, John Fitzpatrick, Liz Frayn, Heather Gibson, John Gillott, Sally Goble, James Heartfield, Brid Hehir, Gavin Poynter, Mark Wilks. I am particularly thankful to Mick Hume, the x PREFACE courageous editor of LM magazine, where many of the ideas developed here first appeared. I also pay tribute to all the staff and patients at Barton House Health Centre to whom this book is dedicated. Michael Fitzpatrick April 2000 xi GLOSSARY OF ACRONYMS ADHD Attention Deficit Hyperactivity Disorder Aids Acquired Immune Deficiency Syndrome ASH Action on Smoking and Health BMA British Medical Association BMJ British Medical Journal BSE Bovine Spongiform Encephalopathy (aka Mad Cow Disease) CHD Coronary Heart Disease CJD Creutzfeldt-Jakob Disease (also nvCJD: new variant CJD) CMO Chief Medical Officer DHSS Department of Health and Social Security DoH Department of Health ETS Environmental Tobacco Smoke (inhaled by passive smokers) GMC General Medical Council GP General Practitioner HIV Human Immunodeficiency Virus ME Myalgic Encephalomyelitis (aka Chronic Fatigue Syndrome) NHS National Health Service NICE National Institute of Clinical Excellence PHA Public Health Alliance RCGP Royal College of General Practitioners RCP Royal College of Physicians RCPsych Royal College of Psychiatrists UNICEF United Nations Children’s Fund WHO World Health Organisation xii 1 INTRODUCTION We live in strange times. People in Western society live longer and healthier lives than ever before.

Rhaiadr Jones and his wife and orthopedic surgeons generic 50 mg fildena fast delivery, giving encouragement were appointed manager and matron buy 50 mg fildena visa, and thereby and moral support to cripples and their parents the Cripples’ Training School gained the services during long months and years of treatment purchase fildena 50 mg online, have of a first-class financier and a devoted woman purchase fildena 50 mg otc, devoted their lives and given whole-time service discount fildena 25 mg line, who have applied themselves to this task. They college was established for the training of crip- were inspired by Agnes Hunt because she worked pled children, of whom no less than 90% have with them; she herself attended the clinics and made their own livings. Let us hope and believe that this Twenty years later, the Disabled Persons’ spirit of devotion, which has been maintained for Employment Act was passed by the government a full generation, will not be dispelled, or even of this country, and the Disabled Persons’ dimmed, by the reforms of hasty planning. Of the one million It was in 1927 that Sister Hunt succumbed to disabled who are now registered in Great Britain, the stimulation of Robert Jones and agreed that a high proportion have been trained to take their the problem was not yet solved. It was not enough place in the open labor market and have proved to search out cripples and arrange hospital and themselves to be no less efficient than their able- after-care treatment. Those few whose disabilities be taught not only the joys of normal recreation were so grave that they could not have been but also the responsibilities of normal work. A expected to compete in the open market have retraining scheme was necessary. She wrote: “I been engaged in the sheltered factories of the collected four boys, already training in the boot Disabled Persons’ Corporation, the trade name of and blacksmith’s shops, and two girls from which is “Remploy. Loyes’ College for informed them that they were ‘The Shropshire Training and Rehabilitation of the Disabled, Orthopedic Training School for Cripples. As this was more than Crafts’ School, Chailey; the Lord Roberts’ I could tell them the meeting adjourned. Institute for the Deaf; and the Duchess of Port- “Before you could say ‘knife’we had one hundred land’s Training College for the Disabled, Not- and fifty names on the waiting list: and not even tingham. Where were they to be realize, when they were appointed solemnly as a housed and fed? How would the hospital forerunners of a great reform in resettlement of committee take this new venture? With Miss Sankey, who is well remembered Cross in 1918, and was created a Dame of the as a superb after-care superintendent, Miss Hunt British Empire in 1926—the highest honor that moved into the Derwen, which was to become the can be awarded to any woman in this country— Cripples’ Training College. There was an early was responsible for important advances in pre- stage when, after being granted £50 by the com- ventive treatment, the creation of an orthopedic mittee, “we also annexed some unconsidered hospital, the organization of an after-care system, trifles from the hospital. Shortly before she died, she asked and wrote: “Ten shillings for leather and two days herself to name the essential qualities of a nurse of man’s time at three pounds ten shillings a week and replied: “Common sense, gentleness, kindli- plus 5 per cent profit equals—? Eventually I put ness, and the power of giving hope and joy to x which I had been told meant an unknown quan- those who are suffering. He cures most in whom William was diligent as a boy, and at the age most are confident”? Most were confident in of 14 went with a bursary to Glasgow University, Agnes Hunt. Afterwards he spent enjoy life despite disability; at the age of 81 she a short time in Edinburgh, and finished his died as she had always been—cheerful, brave, medical training at St. Later he started a school of anatomy in rather than by precept, and the decision of history Covent Garden, which soon acquired consider- may well be that the greatest of all her contribu- able reputation by reason of the facilities he tions was her own life. In 1770 he transferred the school to Great Windmill Street, where a building had been Reference erected with lecture theater, dissecting rooms, and museum. He had already been elected physi- The quotations in this appreciation are from This is my cian–accoucheur at the Middlesex Hospital and Life by Agnes Hunt (Blackie & Sons, Ltd. Rhaiadr Jones anatomy, and he lectured upon it to the end of his for access to many unpublished documents. He was elected a Fellow of the Royal Society, to whose transactions he contributed a paper “On the Structure and Diseases of Articulating Cartilages. In early life he had none of the studious habits of his elder brothers, both of whom went to a university, one studying medi- cine and the other law. Being the youngest, and favored by his mother, John was somewhat undis- ciplined. He was averse to schooling of any kind but gave early evidence of the thread of his pecu- liar genius when he rambled in the woods, watched ants, bees, birds, and tadpoles, and pestered country folk with simple questions on natural history. Until the age of 20 his mind remained fallow and untroubled, but on the verge of manhood he woke from slumber and for the next 45 years worked so prodigiously in the pro- duction and study of scientific material in medi- cine and biology that the like of him has not been seen again.

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