Theodore Dalrymple on Negligence and Unaccountability
2019-08-08 · Guest: Theodore Dalrymple (Retired psychiatrist and author) · 51:49
Critique of the New England Journal of Medicine
Bob Zadek interviews retired psychiatrist and author Theodore Dalrymple about his book, False Positive, which critiques the New England Journal of Medicine for its shift from technical medical reporting to biased social and political commentary. They discuss the “medicalization” of human behavior, specifically how addiction, obesity, and criminality are increasingly framed as diseases to shift responsibility from the individual to the collective. Dalrymple argues that while medical journals have immense authority, their foray into epidemiology and social policy often relies on weak correlations and serves to expand the administrative state’s reach over personal life.
Topics: Medicalization of behavior, New England Journal of Medicine, individual responsibility, epidemiology, addiction, obesity, criminal justice reform, public choice theory, correlation v. causation.
Speakers:
- Bob Zadek - Host
- Theodore Dalrymple - Retired psychiatrist and author
- Caller (Michael) - Obstetrician
- Caller (Michael) - Psychologist
The Power of Experts [00:17]
Bob Zadek: Hello everyone, welcome to the Bob Zadek Show, the longest-running live libertarian talk radio show on all of radio. Thank you so much for listening this Sunday summer morning. We are always the show of ideas, never once the show of attitude.
One of the conceits of the progressive politicians and followers in the United States, if not around the world, is this blind, unyielding faith in the power of experts—in the fact that there are a cohort of experts in the country, in the world, who know better than we do how best we should organize our lives. That is why the progressives always seek to increase the power of government, not per se because they are hungry for the power (but of course they are), but because it is good for all of us. We are simply not competent to run our lives, and therefore it is good policy to have us cede power over our lives to those who are more competent than we are. That, of course, is a theme we have discussed on my show often over the many years that I’ve been broadcasting.
One of the sub-cohorts of experts is, of course, the medical profession. There’s lots—and we may not be aware of it, but we will very shortly in this show—how much of our power over parts of our lives not directly related to medicine we have ceded to doctors and the medical profession at large, simply because we presume, or they would have us believe, that they know better than we do.
The New England Journal of Medicine [05:42]
Bob Zadek: This morning’s show, we’re going to do an interesting examination with our guest. One of the leading medical publications is the New England Journal of Medicine. It is read by many, if not most, doctors. What appears in the New England Journal of Medicine is often taken as gospel. If not taken as gospel by doctors, it is of course given great weight because doctors do not have time to do research themselves, and therefore, as is the case in any other profession, we need help in practicing our craft as good as we would like, and we resort to publications such as the New England Journal of Medicine.
The question is two questions: Is the medical profession’s faith—shall I say blind faith—in the New England Journal of Medicine, is that well-founded, or is that harmful to the medical profession? But far more importantly, is it harmful to the rest of us? Why do we care? Well, we do care because the policies—not medical, but sociological and political—which find their way into the New England Journal of Medicine and therefore become gospel among doctors and ultimately to all of us, is often wrong. Where the New England Journal of Medicine takes positions that are non-medical in their content or in their effect.
Theodore Dalrymple, this morning’s guest who is joining us from his home in France, has written a fascinating book called False Positive, where Theodore has taken the trouble and the time to examine 12 months of publication of the New England Journal of Medicine just to see what’s going on between the cover and the end page of that journal every week for a year. What he has found is shocking and astonishing, as you will see, and it goes well beyond mere medicine. It creeps into social policy, criminal justice reform, and the like. It represents once again where the experts, the self-appointed experts, are taking control surreptitiously, but sure as anything, taking control of aspects of our lives simply because they are appointed experts. To share with us his research and his study of 12 months of the New England Journal of Medicine and the shocking effect upon all Americans, if not all citizens of the world, I’m happy to welcome Theodore Dalrymple to the show. Theodore, welcome this morning.
Theodore Dalrymple: Thank you very much. Thank you.
Bob Zadek: Now, you are a retired physician. You have written two dozen, perhaps one or two more than two dozen books, all well-received. The most recent one is False Positive. What was it that prompted you to conceive of this book? Was there some event that caused you to perk up and get curious about the journalism in the New England Journal of Medicine, and what caused you concern to write an unusual and extraordinarily important book such as this?
Theodore Dalrymple: Yes. Well, if I might start with a slight correction, it’s every week, not every month, so it’s 52 issues.
Bob Zadek: Oh, thank you. Thank you.
Theodore Dalrymple: Yes. Well, I have a French nephew who was a medical student, and he had an examination which he failed in how to read medical literature, which is a very good idea—he’s a medical student in Paris—and it’s a very good idea that there should be an examination to show whether people can read something critically, because we don’t read things very critically. He asked for my assistance, and I thought I would think of a few rules for him. Then I thought, well, I’ll look in the New England Journal and see how much of the New England Journal is actually not error-free, but fairly good. I must say I was surprised at how often I found very simple errors. In addition, the medical journal has a lot of social commentary, and it is a little like reading Pravda. I don’t mind having anyone’s opinion, but one felt, or I felt over many weeks or months, that I was reading some kind of orthodoxy which was actually never challenged in the pages of the journal.
Bob Zadek: So what happens is you start with a journal that is a technical journal written for a technical audience, practicing physicians and the like. That journal, having now achieved a certain stature, which it does have, and perhaps subject to what we discover in this show, that’s well-deserved stature—let’s assume that for the minute, at least that’s how it’s perceived. Once it achieves that status, it gets to a level that it is speaking the truth, it is speaking orthodoxy. It then expands, takes advantage of that position to lecture us, scold us, and opine on matters well beyond their area of expertise, but remaining cloaked in this aura of authority that they’re an authority, that it’s the New England Journal of Medicine, and therefore they are to be believed somewhat blindly.
The Haiti Cholera Outbreak [09:59]
Bob Zadek: What are some of the examples, if you can, to help our audience understand how far from the practice of medicine the New England Journal of Medicine wanders, and in your opinion, how off are they when they leave their comfort—what should be their comfort zone—of pure medicine? Give us some examples so the audience can understand how pervasive and how important these mistakes are to Americans and the world.
Theodore Dalrymple: Well, there can be large things and small things, and sometimes the small things are more revelatory than the big things. So the very first item in the book relates to an article which actually is quite good about the cholera epidemic in Haiti and the hope of a new cholera vaccine. It says, the article says, that cholera was unknown in Haiti until 2010, until it was brought to Haiti in 2010, and then it continues with the article. Now, it seems to me that anyone of the most minimal curiosity would say, well, if there was no cholera in Haiti until 2010, it might be worth a mention how it got there. Because after all, it’s a 19th-century disease. Haiti has lots and lots of diseases of its own, as anyone who knows Haiti will understand.
The reason that it wasn’t mentioned—this is my surmise—was because it was brought by Nepalese peacekeeping troops. They came from Nepal where there was a cholera epidemic, and when they arrived in Haiti, their sewage was poured directly into the water supply of a large part of the country. As a result of that, nobody knows how many people died, but between 10,000 and 80,000, and about possibly 10% of the entire population suffered from cholera. So it’s an interesting question. And then, of course, there is the question as to why the origin of this epidemic was not mentioned. The answer to that seems to be that the journal itself, together with the CDC, The Lancet (which is another very important journal), and the World Health Organization conspired for quite a long time to prevent it being known that the peacekeeping troops had brought cholera to Haiti. Of course, they didn’t do it deliberately; no one would accuse them of that. But it was something that they wished to hush up. I’m afraid the New England Journal didn’t cover itself in glory in this episode. So I concluded that actually they didn’t really want anyone to dwell too much on where it came from and why the journals and various other organizations hadn’t mentioned where it was.
Epidemiology and Air Pollution [13:00]
Theodore Dalrymple: Another very important aspect, another very important thing to realize, is how many of the papers are epidemiological in origin. That is to say, they examine the distribution of diseases through populations. They’re highly mathematical; not one in a thousand doctors understands the mathematics. They draw very large conclusions from very doubtful information.
So that, for example, one that I give is that epidemiologists looked at the all-cause death rate from the pollution of the air, found a correlation—that is to say, there’s some correlation between the level of pollution and the overall death rate in a population—and then concluded that the levels of pollution in the whole of the United States should be altered, the permissible levels of pollution ought to be altered, in order to take into account this correlation that they had, in order to produce equality of outcome in all areas of the United States. Without any realization of just how difficult and expensive this would be, without realizing that the logic of this is not to allow any pollution at all, because nobody would say that any pollution is good. Nobody likes pollution. They didn’t see the difficulties, they didn’t see the logical fallacy. I mean, it’s a very, very elementary thing that correlation is not causation. So just because two things are correlated…
Bob Zadek: And what was the thesis as to the article? It surprised me when I learned from your book about this being a topic. It seemed to me that the whole area of air pollution is so much beyond the competence of doctors to either do something about it or to understand it. It all relates to physical science and chemistry and simply other disciplines that doctors bring little more to the table than anybody else. So didn’t it surprise you that even the topic itself would be appearing in the New England Journal of Medicine?
Tobacco and Lung Cancer [14:55]
Theodore Dalrymple: Not entirely. Because if you take the question of cigarette smoking, for example, and lung cancer—this was actually the Nazis who first discovered it, but we don’t talk about that—the epidemiologists early in the ’50s correlated the death rate from cancer of the lung and cigarette smoking. They discovered something which was actually important, and there was a plausible explanation as to why smoking should cause cancer, and they were doctors who did it. So this kind of research is common.
The problem is, of course, that the correlation between smoking and lung cancer and the causation of it was pretty clear. I mean, it was a strong one, a very strong one, in fact. But the same logic has increasingly been applied to factors in the causation or the alleged causation of disease which are weaker and weaker and weaker and harder and harder to prove. So what is originally a perfectly reasonable way of proceeding has now extended so that every week we get badgered about what we should eat or what we shouldn’t eat based on studies like this with very weak correlations and without real explanation as to why the correlation should exist. So it’s really an extension of a method which originally is useful and can still be useful, but is obviously capable of great misuse and over-interpretation and a badgering of the population. Many of these correlations, of course, turn out not to be reproducible. I remember in 1972, for example, there was an alleged correlation between green potatoes and spina bifida when pregnant mothers ate green potatoes. Even now, people can’t agree as to whether this is a real causative correlation or not. Most people think that it isn’t, but there are some who still maintain that it is. Now, the point about that is that if you can’t even decide a relatively simple thing like that, it’s very difficult to give hundreds and hundreds of recommendations. And we’re still badgered, at least I think we’re badgered, by recommendations as to what we should do on the basis of weak correlations. So I think in a way, the cigarette or tobacco smoking and lung cancer, that was a kind of triumph, and people are always trying to repeat it, but unfortunately extending it far beyond what is reasonable.
Medicalizing Criminal Behavior [19:19]
Bob Zadek: A very powerful part of your book—and I should mention that the book is interesting in that the topics themselves were not topics that you selected because you felt they were important topics; you were driven by the topics which were presented by the articles in the journal as you read them. So the book is an interesting potpourri of almost independent essays based upon the article you happened to have read and wanted to comment upon in the journal. You spent some time and in some very persuasive and interesting writing on, of all things, criminal law and criminal behavior. Now, that’s a topic that one would say, “What in the world is that doing in the New England Journal of Medicine? Of what interest is it to a general practitioner in the Midwest to see an article on the behavioral sciences and on criminal justice?” But you have a fair amount of time in the book devoted to the topic of criminal law, and there’s a phrase I’d like you to help our friends out there understand. I think I’m either paraphrasing or quoting when I say you observed in more than one article that criminals are treated as ill, and the ill are treated as criminals. That resonated with me because that phrase has been the topic of many shows that I have done on the area of drug legalization, on the area of wholesale incarceration for a long period of time (at least in my opinion) of criminals, the high incarceration rate in the United States. All of those are, to me, non-medical facts that had to be resolved by society. But tell us what you have learned and what you had concluded about the journal in its comments on this link between criminal behavior and illness, or illness and criminal behavior.
Theodore Dalrymple: Well, you see, if you take the epidemiological view of things and you look at illnesses through the lens of risk factors, so that, for example, let us say diet: if you have the wrong diet, then you get a disease. Because you can—I mean, there’s a contradiction here—but anyway, because you can change your diet, if you don’t change your diet and then you get the disease, you are in some way responsible for getting the disease. However, when someone acts criminally, he is said to be suffering from a disease and needs treatment. There’s a therapeutic attitude towards criminality, which I disagree with.
Actually, I was a doctor for a long time in a prison in Britain, and a lot of criminals in my view have half-adopted this attitude of regarding themselves as ill, as not being agents, but in the grip of something. So that, for example, they might say that they are addicted to stealing cars just because they do it over and over again and find it exciting. They use a medical term, “addiction,” for what they do. They regard themselves as really the vectors of forces rather than people who have agency. Of course, they don’t—this is a subtle thing because they know in their hearts and between themselves that this is nonsense, but they get rewards for presenting themselves as if it were true. If you repeat a lie over and over again, it becomes true.
Addiction as Choice or Disease [21:46]
Theodore Dalrymple: I was particularly interested in the question of addiction. In the prison in which I worked, heroin addiction was the most important one. It is presented everywhere by doctors as a medical illness pure and simple. Now, there are medical aspects to it, clearly; there are very important medical consequences to taking heroin, not the least of which is death. But I argued, or argue, that it is not a medical condition in itself. There are physiological aspects to it; there’s no doubt about that. Addiction is a genuine physiological phenomenon. But addiction to heroin is clearly not just an illness in the way that, say, rheumatoid arthritis is an illness or Parkinson’s disease is an illness. It’s not something—it’s not something that happens to you; it is something that you do.
And if I don’t mind me going on a little longer, I’ll give you some reasons for thinking this. In Britain, at any rate, the average length of time that people take heroin intermittently by injection before they become physically addicted to it is 18 months. So they’re taking it 18 months before they become physically addicted. In other words, this is something that does not just fall on them out of the sky. In order to inject heroin, they have to know where to get their heroin, they have to know how to prepare it, how to inject it. Injecting yourself is not something that most people want to do as a pleasure, so that you have to overcome inhibitions. Heroin has unpleasant side effects which you have to learn to disregard. In addition, before any of this starts, people know now—heroin addiction has become so widespread that everyone knows what the consequences are. So far from it being something that happens to you, I argue that it’s something that some people want. It’s a very peculiar thing. I can’t understand why anyone wants it. I suppose there’s an element of self-dramatization, a lack of meaning in their lives, and so on, an antinomian attitude to society. But it can’t be just presented as something that happens to you and is straightforwardly a misfortune. And yet, that is the attitude of the National Institute on Drug Abuse, and it has adopted more or less as an orthodoxy in the New England Journal—but not in the New England Journal alone. It’s in other journals and in general in the leaders of the medical profession, though perhaps not among the foot soldiers of the medical profession.
Bob Zadek: Now, there is a reason, a somewhat sinister but human reason, why the approach of the medical profession to something like drug addiction might be different than the approach of society at large. We’ll talk about that motivation, sometimes called public choice, sometimes called greed, when we come back. I’m speaking this morning with Theodore Dalrymple. Theodore has written an important, interesting book, readable to everybody out there, called False Positive, where Theodore has examined 52 issues of the New England Journal of Medicine and has found both mistakes in the journal—that’s not necessarily a headline—but has found, which was more shocking to me, where the journal wanders well beyond the orthodox practice of medicine and starts to opine on and offer what appears to be expert opinion on social policy well beyond their area of expertise. Lots more to follow, including why we are adversely affected by that when we come back. We’re going to take an incredibly short break. We’ll be back in 30 seconds. Please stay tuned.
[Break]
Responsibility in Criminality [31:40]
Bob Zadek: Welcome back to the Bob Zadek Show, the longest-running live libertarian talk radio show on all of radio. As we are proud of saying, the show of ideas, never ever the show of attitude. This morning we are speaking with Theodore Dalrymple. Theodore has written over two dozen books. He is a retired practicing physician. He writes for the Manhattan Institute. His most recent book, False Positive, examines 52 issues, one year of issues of the New England Journal of Medicine. He examines them in the first instance for errors in their reporting, which he was able to find. The fact that there are errors in a publication is sort of assumed; nobody is perfect, and why would we care, and perhaps we don’t all that much. However, the important thesis which Theodore points out in False Positive is that not only are there errors, but the errors are in areas where perhaps the New England Journal of Medicine ought not be offering an opinion at all, such as, as we said before the break, in the area of criminal justice, opioid addiction, drug addiction, euthanasia (which we perhaps will get into), and air pollution and the like—areas that might surprise us that a journal such as the New England Journal of Medicine is opining on.
Now, before the break, Theodore, we were talking about the overlap between criminal behavior and whether and the medical sciences. How much of criminal behavior is the result of bad actions, simply criminal behavior itself because somebody is greedy and wants somebody else’s property, wants to harm somebody? How much of that is pure criminality that has to be punished? That, after all, as libertarians, we believe that’s the essential purpose of government: to protect us so nobody hurts us or takes our stuff. But then it spills over, because you can get into the areas of causation. Somebody perhaps is more likely to suffer in criminal—to become a criminal based upon environmental issues, based upon areas of early-stage parenting by parents, based upon a bad home life and the like. And so when you start to try to figure out where personal responsibility ought to stop and where it becomes an illness in the broad sense, that’s where my head kind of starts to explode. Because after all, the likelihood that I, with my middle-class upbringing, might succumb to criminal behavior is probably much less than somebody in a different environment. So how does one sort out intellectually where illness in the broad sense has something to contribute to criminal behavior, or do we care? Is it just people have to play the hand they’re dealt? I have great difficulty enunciating a principle that I am totally happy with.
Theodore Dalrymple: Well, I think the enunciation of the principle that everyone has to deal with the hand he is dealt is very important, because if you try to equalize that, what you’re arguing for is a society that would make North Korea seem like a haven of freedom. You can’t equalize the hand that people are dealt, but it’s still necessary to demand of people that they keep within certain limits. I dealt with this problem every day for years and years in the prison in which I worked. And if I can just give you an example: a man came to me, he was a burglar. Actually, in England, you have to be pretty incompetent or a very frequent burglar to be caught by the police because our police don’t do very much, actually. But anyway, he was in for burglary again, and he said, “Doctor, do you think my burgling has got anything to do with my childhood?” So I said, “Absolutely nothing whatsoever.” And he was very surprised by my response because he has been taught to believe that his behavior is simply a kind of physical response to circumstances. And I said, “Well, it’s really quite simple. You want things that you don’t want to work for, you’re lazy, and you’re not very clever.” And instead of being very annoyed, he started laughing, as they always did when you went through this, when I had this kind of conversation. They were not annoyed; they laughed, and in a way they were quite relieved because they didn’t have to pretend anymore. Now, it is certainly true, however, that people like that do have horrible—often have terrible—childhoods. And you can talk about it. You can talk about the childhood and everything like that, but without implying that you are now making an excuse for them. So you can talk about it quite openly, but you mustn’t give the impression that I am now finding the buried psychological treasure that without any effort on your part will stop you doing whatever it is that you’re doing. Because there isn’t any technical thing that doctors or others, psychologists—psychologists are even worse than doctors—can do to help that person. What they need is a Socratic dialogue rather than therapy.
Medical Journals and Social Policy [37:29]
Bob Zadek: I have two comments on what you just said. I was smiling as you were talking because I flashed back to American pop culture, specifically the song “Officer Krupke” in West Side Story. I invite, when the show is over, I invite everybody to listen to the words of that song and you will hear exactly what Theodore has just said. And Theodore, it’s quite interesting because we have a caller on hold, and I believe the caller is a psychologist, so I’d be interested in hearing his point of view. Michael, good morning, welcome to the show.
Caller (Michael): Thank you. I am not a psychologist, I am an obstetrician.
Bob Zadek: Oh, I had a different Michael. Okay, good morning, Michael.
Caller (Michael): Congratulations on a fascinating show and the guest’s opinion, with which I agree 100%. I just would like to comment one thing that the guest and everybody else has to be careful. Just like when we started dealing with AIDS/HIV, started in San Francisco with Kaposi’s sarcoma and so forth, we did not judge the social behavior of the people who were carrying or involved with it. We just went ahead and looked for remedies. The New England Journal of Medicine published many studies on the remedies of HIV and how do we mitigate it, rather than deal with who gets it. The same goes for gonorrhea and syphilis. We don’t judge that it’s more common among sex workers; we try to find the proper cure. So we have to limit our criticism to what extent do we want a medical journal to go and tell me exactly how cholera was introduced into Haiti. Let’s just focus on the narrow issue of cure that belongs to medicine. And that’s why my criticism of the logic of the guest when he said the dogs did not bark, they did not tell us how cholera was introduced into Haiti, and really that’s not the topic that we need to focus on. We need to focus on the cure. There is political correctness in the New England and every other journal, but in this case, I think they should focus on the medical part. I would like to hear his opinion.
Theodore Dalrymple: Well, with regard to AIDS, of course, he’s absolutely correct that we should try and find the cure—well, we have almost found the cure. But it is also important to find out how the disease spreads. It’s not just that we cure, but we also want to know how the disease spreads so that people can have the information to alter their behavior accordingly to reduce the risk of their getting the disease. So I don’t think it’s either/or. And if, for example, people had denied that having unprotected sex promiscuously in gay bars, if they had denied that this was a way in which it was propagated, I don’t think you would be doing your patients very much good. Similarly with the case of cholera, you do want in future people to be careful about moving troops from—and it is a medical problem—with troops infected with cholera. You do want people to think about these things. And in fact, the role of the New England Journal had not been merely not to be interested in it, but actively to deny the truth. And if it hadn’t been for a French bacteriologist and epidemiologist, this truth would have been covered up. And I’m not saying that we should dwell on it to the exclusion of anything else, but it does seem to me a matter of medical interest.
Sympathy vs. Accountability [43:01]
Bob Zadek: We have another caller, another as it were Michael on the phone, and this other caller who we’ll take in a second is the Michael who is a psychologist who I thought the first Michael was. Michael, good morning, welcome to the show and what’s on your mind?
Caller (Michael): Good morning, Bob. Thank you for introducing me. Hi, Theodore. I agree with everything you said, Theodore, and I’d like to add something about addiction. One of the clearest distinctions between a disease and an addiction is that you normally don’t decide to have a disease. But with an addiction, say to heroin, you make a decision. You decide to shoot up, and then when you stop, you decide not to stop. But this is not true of disease. So an addiction is more of a cognitive process, even though I agree with you there’s the brain is involved, so there is brain physiology there. But I wanted to just add that.
Theodore Dalrymple: Can I just add something that I would like to make clear is that because something like addiction is willed, if you like—somebody chooses, particularly chooses to be a heroin addict—it doesn’t mean that you withdraw all sympathy from them. Because if someone is partly responsible for his own downfall, that doesn’t mean to say that you don’t sympathize with him. After all, we’re all partly responsible for our own unhapppiness. I doubt that there’s anybody listening who is not responsible in some way for his own unhappiness. But we do have this tendency now to say that we would sympathize only with people who are not responsible for their conditions, and if they’re responsible for them, we won’t sympathize with them, we won’t try to help them. And I think that’s a very wrong attitude.
Caller (Michael): Yeah, I agree with that. And as part of the sympathy for people who have addictions is teaching them how to get over addictions, teaching them they’re not powerless, they’re powerful. They decide to shoot up and they can learn how not to.
Theodore Dalrymple: Exactly. Of course, it can—the problem is, of course, that it can be very difficult because by the time they realize that they want to change, they’ve done so much damage to their life that it is extremely difficult. They may have alienated their family, their community, and so on and so forth. Alcoholics who decide at the age of 60 to stop drinking actually face a pretty bleak future if they’ve ruined their lives, they don’t have a family, and so on. So I’m not suggesting it’s an easy thing to do, but I don’t think that disguising the truth from them is compassionate.
Bob Zadek: Thank you so much, Michael, for being a listener and for your call this morning.
The Obesity Epidemic [45:11]
Bob Zadek: Theodore, another area where you commented because of an article in the New England Journal of Medicine, and it’s another crossover area where you wonder how much is personal responsibility and how much is medical. You shed a lot of light on the area of obesity. Tell us briefly what the thesis in the New England Journal of Medicine was on obesity and why you felt that they were spilling over into an area of simply behavior and it was not a medical issue.
Theodore Dalrymple: Well, obesity is obviously a very complex matter. The epidemic of obesity, not just in the United States but everywhere in the world—or most places in the world, not quite as bad as in America, but pretty bad in many places. And of course, the fact is that overeating and eating things which lead to obesity is very common. And the problem then becomes, well, what do you do? Do you say to people, “You’ve done this to yourself and therefore we’re not going to help you”? Do you make them pay extra for health insurance because of it? Do you make other people pay for health insurance because of it? Do you force them, if you like, or encourage them to eat different things other than by a process of information? Do you make it difficult for them to obtain certain foods which are very bad for them? Who has the responsibility for doing this? I don’t have a very clear doctrine of this, but I think the question must be—these questions must be asked.
Bob Zadek: And what did you find? Where did you differ from what you read in the journal? What was their thesis and how would you criticize it?
Theodore Dalrymple: Their thesis was more or less that, a bit like addiction, obesity is a disease and that’s it. There’s nothing else. And therefore we treat it just as a disease, and when you’ve got a very fat patient, you, if necessary, you do an operation to make him less fat and so on. And there’s simply nothing else to say or do. You mustn’t even mention that actually, to put it very crudely, it’s a condition of overindulgence.
Individual vs. Collective Responsibility [49:19]
Bob Zadek: The journal is purely a medical condition, and therefore there is once again there is somebody who is a victim. We have discussed many times on the show the victimization of bad behavior, so that people who behave badly are more victims rather than actors in what they are doing. Once you label it a disease, you have relieved them of any responsibility. It’s sort of not their fault; it has nothing to do with them. The cause is existential, and therefore they are simply have to be treated, which means the cost of their own actions is now absorbed by society. And in making that observation, Theodore, you remind us of a very important point: that once society is led to believe that bad behavior is the result of an illness, what happens is, because of the way society is organized, that means that the bad behavior, or the cost of fixing that problem, is now absorbed by all of us, and the responsibility becomes a collective responsibility rather than an individual responsibility. So the effect—and you point this out in your book—the effect of achieving the labeling of bad behavior as an illness is that the responsibility and the cost is transferred from the individual to the collective. And that’s fascinating to me because that’s where a discussion of the New England Journal of Medicine spills right over into libertarian concerns.
Now, Theodore, we only have a couple of minutes left. What is your advice, what is your conclusion that Americans at large ought to take away from your book and from this transfer, this change in labeling of bad behavior from behavioral to medical? We only have a minute left, Theodore.
Theodore Dalrymple: Yes. Well, I think the first thing is self-examination to see how far one does it oneself, because it’s very easy to do it and it’s very convenient to do it, because it’s not just we absolve others, we absolve ourselves. And it’s a human temptation to do that. As soon as we’ve done something wrong, at least as soon as I do something wrong, I tell myself, “Oh, it’s not really me, it was the circumstances.”
Bob Zadek: This is Bob Zadek, thanking Theodore Dalrymple for joining us for an hour this morning from France. Please read his new book, False Positive. It’s a wonderful read. You will learn a ton and you will see the profession of medicine entirely differently. Thanks so much, everyone. I’ll be back again next Sunday.