A plea for the progress of serious thinking about health!

Clinton E. Betts Assistant Professor School of Nursing, Faculty of Health Sciences, McMaster University
I most certainly agree with the reviewer comments cited by the authors in the text of their paper; The paper is timely and can be potentially useful for health policy makers (p. 1032). However, timely in this case is a bit of an oddity. In response to a recent critique of progress that I had written (Betts, 2005) a rather noted philosopher, who is kind enough to review scholarly work for me from time to time, asked me; I would think that this language [of Progress] is pretty hollow now. Do your colleagues really believe it? The point is, that serious thinkers have not believed in Progress since well perhaps since Nietzsche (1990) suggested that; Mankind surely does not represent an evolution toward a better or stronger or higher level, as progress is now understood. This progress is merely a modern idea, which is to say, a false idea. (p. 4), over a century ago. Though, certainly since Ivan Illich gave the term iatrogenesis a whole new meaning. And yet virtually all of our social and political institutions, particularly those of health and welfare, are founded, perhaps even premised on the idea of Progress. One wonders then, why it has taken so long for many of us, who generally consider ourselves to be health practitioners of one kind or another, to catch on to this serious problem of Progress? Could it be that we have subscribed so heavily to a technorational science model, again particularly in the health and welfare industry, that all of our, so highly advertised, critical faculties have become stuck in a paradigm of delusion? Indeed, in a recent article by Roy (2005), a chemist by the way, aptly titled in my view; Scientism and Technology As Religions he claims that; Scienceand-technology is the most powerful force under human control; hence, scientific fundamentalism is the most dangerous. (p. 836). Of course Roy isnt the first to suggest that techno- rationalism (or scientism) may well constitute a religion of sorts, in fact, once again a century ago, Nietzsche claimed something similar, as have many others. In fact, more recently, Schaler (2002) has proposed that health itself had indeed become a religion, with the medical profession as a priestly caste. (p. 67). Those of us who do the work of healthcare (be it diagnosis, intervention, education, promotion and what not) must now begin some serious thinking, or at any rate begin to pay attention to some of the serious (anti-modern if you will) thinking that has characterized the 20th century. Perhaps we might begin with a question of the profoundest sort that has already, and again recently, been proposed by Joseph Heath (2004); Is it possible to emulate many of the attractive features of western societies, while avoiding the social pathologies? (p. 665-6). While I do agree with the authors claim that; Public health needs to be more passionate about health issues associated with human progress and adopt a health promotion stance. (p. 1033), we must also be careful for at least two reasons. The first concerns what both Fitzgerald (1994) and Fitzpatrick (2001) refer to as The Tyranny of Health, while the second is perhaps best summed up by Ulrich Beck regarding his theory of reflexive

modernity (or second modernity); Due to the close link between institutions that depend on one another to exist, it can be assumed that processes of change and transformation in particular parts of the structure will trigger problems in other parts (the side-effects of side-effects) (Beck & Lau, 2005, p. 533). Indeed, side effects are the order of the day, and nothing happens without them happening. The problem then, for those who claim to be engaged in the fixing of problems, is which side effects are good and which are bad. Or put differently, which are acceptable and which are not. Moreover, these are socio-political and socio-cultural issues of value, and they are anything but scientific. Finally, in the spirit of the authors well put claim that; public health has to become more assertive and politically aware (p. 1033), with, perhaps, a continuing attention to Foucault, let us begin a plea for the progress of serious thinking about health, rather than maintaining the modern course of unhealthy Progress. References Beck, U. & Lau, C. (2005). Second modernity as a research agenda: Theoretical and empirical explorations in the meta-change of modern society. British Journal of Sociology, 56(4), 525-557. Betts, C. E. (2005). Progress, epistemology and human health and welfare: What nurses need to know and why. Nursing Philosophy, 6, 174188 Fitzgerald F. T. (1994). The tyranny of health. N Engl J Med, 331, 196-198. Fitzpatrick M. (2001). The tyranny of health: Doctors and the regulation of life style. Routledge: New York. Heath, J. (2004). Liberalization, modernization, westernization. Philosophy and Social Criticism, 30(5-6), 665-690. Nietzsche F. (1990) The Anti-Christ (tr. R.J. Hollingdale). Penguin, New York. Roy, R. (2005). Scientism and technology as religions. Zygon, 40(4), 835-844. Schaler, J. A. (2002). Moral Hygiene. Society, May/June, 63-69

Published December, 13 2005 as a Rapid Response to Chio, B. C. K., Hunter, D. J., Tsou, W. & Sainsbury, P. (2005). Diseases of comfort: Primary cause of death in the 22nd century. Journal of Epidemiology and Community Health, 59, 1030-1034. Available at: http://jech.bmjjournals.com/cgi/eletters/59/12/1030#427