Mark Greaves

Spectator debate: Can we trust health advice?

Spectator debate: Can we trust health advice?
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It was a close fight. Both sides at Tuesday night’s debate at IET London seemed to accept that trust in official health guidelines was running low. And, among the 200 or so members of the audience, that was certainly the case: a show of hands requested by the evening’s chair Andrew Neil at the start suggested most were ‘wary or distrustful’ about advice.

The sceptics not only had the audience already on their side, but were offered a gift earlier in the day, when NICE showed how badly judged official advice can be — by choosing sun-starved February to stipulate that we should apply six to eight teaspoons of cream for every 30 minutes in the sunshine.

Dr Ellie Cannon, The Mail on Sunday columnist, stepped up first, offering a compelling defence of health guidelines, not by sticking up for NICE or Dame Sally Davies, the Chief Medical Officer, but by championing a seagull named Sid, the mascot for a skin cancer awareness campaign in Australia.

Sid the Seagull, according to Dr Cannon, had a massive effect in diminishing the prevalence of skin cancer, helping to turn a population of avid sun worshippers off sunshine. (It was so successful, in fact, that a lot of Australians are now vitamin D deficient.)

Another health awareness drive, the ‘back to sleep’ campaign, helped reduce the incidence of cot death by about two thirds in just four years, she said.

This was clearly impressive stuff. Public health authorities, for just a few minutes, seemed like they deserved a fair bit of credit. But it didn’t last long.

Before the real sceptics was Dr Christian Jessen, who, sitting on the fence, said the public shouldn't take advice at face value, but should 'question everything'. Like good French food, he said, it all depended on the source. He suggested patients faced with, say, the option of surgery should take the same approach as his dad did when buying a car or a television — checking all the reviews, seeking a second or third opinion.

A robust case against health advice came from Dr Michael Fitzpatrick, author of The Tyranny of Health, who cited wildly hysterical predictions about the outbreaks of swine flu and mad cow disease.

The latter, he recalled, was predicted to kill anything between 100,000 to half a million people – in the end the mortality rate never rose above a handful of people a year. ‘Rather than a reluctance to scaremonger, there’s a yearning for it,’ said Dr Fitzpatrick.

Dr Max Pemberton, Spectator Health editor, agreed that politics sometimes got in the way of the evidence, with officials wanting to ‘be seen to be doing something’. But he argued that reliable health advice was being undermined by the media giving space to ‘nutters and naturopaths’ as much as to experts in the field. Celebrities muddied the waters too, with Gwyneth Paltrow warning against eating bread and Jamie Oliver, a cook, telling people what’s healthy.

It led to an atmosphere where conspiracy theorists picked apart everything, and dismissed authoritative guidelines on the basis of their own random anecdotes – ‘my grandma had cream every day of her life washed down with a cup of lard and she lived to 107’. Actually, he said, official health advice was a lot more solid than people gave it credit for.

That is, as long as it reflected the evidence. For Dr Richard Harding, a member of the 1995 government advisory group on sensible drinking, this was certainly not the case on alcohol, where the evidence of harm had been ramped up and the benefits downplayed. In 1972, he explained, evidence that abstinence from alcohol was a key risk factor for coronary heart disease was actually suppressed by the National Institutes of Health, the US government agency. (A memo reasoned that encouraging drinking would be ‘socially undesirable in view of the major health problem of alcoholism that already exists in this country’.)

For the reputation of public health officials this seemed like a heavy blow. Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs, continued the attack. Official guidelines were not just a skewed reflection of the evidence, he argued, but were deliberately manipulative. Draconian advice on alcohol and sugar was as disingenuous as teachers telling pupils they needed to do three hours of homework a night, while actually being happy if they worked for half an hour. Behavioural economists, he said, call it ‘anchoring’. He explained: ‘By reducing the number [of units] to such an implausible level we tend only to exceed it two or three times,’ he said.

Adults, he said, deserve accurate information. ‘They don’t trust us with the information therefore I don’t think we can trust them to give it,’ he said.

His argument didn’t quite win the day, however. At the end of the debate Andrew Neil asked again for a show of hands. This time the ‘don’t knows’ came out on top. Neil summed up: ‘Your indecision is clearly final.’

The Spectator health debate was held in association with the IEA. Click here to view the photo gallery.