books

An Intelligent Person's Guide to Medicine By Theodore Dalrymple Publisher: Duckworth. ISBN:07156 29735.138 pages.£12.95.

This book is a nice size; short with a pleasant type-face, making it easy to read.

Otherwise there is virtually nothing to recommend it.

A 'post-politically correct' ramble (did we blink and miss something - did health achieve political correctness? ), it has all the superficial attraction of Private Eye's satirical column A Doctor Writes.

Thus, taking us rapidly through the Protestant work ethic, virtue, and the meaning of life, Dr Dalrymple asserts that good health is not the precondition of a worthwhile life, but merely one good among many.

There is no 'right' to health.

'People who pursue their health for its own sake are rather like the hi-fi enthusiasts who used to devote themselves to the technical specifications of their apparatus, but never actually listened to music.'

As a result, Dr Dalrymple castigates the 'health zealots' who tell us 'we should set our hearts racing for a certain period of time every day'.

Though personally a passionate anti-smoker, the good doctor confesses: 'I admire people who disobey doctor's orders.'And this leads to the central theme (if there is one): that government should not interfere.

The 'British Minister for Public Health' is wrong, for example, to suggest that today's children might die early because of their diet (too little fruit and vegetables), when the American experience shows that junk food increases life expectancy.

The government should not fund condoms for prostitutes and needle exchanges in prisons: there is no public duty to save people from the harmful consequences of their own illegal conduct.

This reminded me of the local GP who, faced with setting targets for tackling HIV, seriously declared that the answer was to reduce the local gay population.

More systematically, the author believes that healthcare services are not the major determinant of the health of any population, and that the NHS has done nothing to reduce the inequalities in health between rich and poor.

His solution? Private provision.How is it that 'the market' is never referred to in the medical journals except as a term of abuse and scorn, and references to Cuba are almost always favourable?' (Note to author: please send me these journals. ) But, and this is telling, Dr Dalrymple says: 'The relationship of doctor to patient is not that of shopkeeper to customer.'

He wants to know how a health minister can say that patients nowadays expect to be treated like customers when 'just as a parent should know how to say no to its child, so a doctor should know how to say no to a patient'.

In other words, there is one rule for healthcare generally, another for the doctor individually. 'Doctor knows best.' (Quote, unquote. ) Worse, the writer sees himself as a 'medicine man' (using only male gender pronouns). The female half of the human species merits a dozen specific mentions: pregnant, mother, prostitute, battered wife, 'foible', 'helpless victim' and, of course, nurse.

Female health and fitness enable the author to air two prejudices at once.

The only thing worse than running is, 'time spent at a fitness club... whose gym has a large, long window that gives on to the street, through which the passer-by can witness scores of women pedalling furiously on wheel-less bicycles and walking with grim determination on treadmills that produce nothing except sweat.'

do not the men catch the eye of the watching author? Or should the women be producing something else?

This book is not intelligent, nor a guide, nor much about medicine. But for those of us who believe in public health, it is always worth being challenged. If we disagree, we must demonstrate better arguments of our own.