Any Who Style Themselves Experts in “Public Health” Must Be Derided as Lunatics or Executed as Tyrants
How can any man have specialist authority in something as expansive as "the health of the public"?
It was best presented perhaps by the distinguished doctor who wrote the article on these matters in that composite book which Mr. Wells edited, and called “The Great State.” He said the doctor should no longer be a mere plasterer of paltry maladies, but should be, in his own words, “the health adviser of the community.” The same can be expressed with even more point and simplicity in the proverb that prevention is better than cure. Commenting on this, I said that it amounted to treating all people who are well as if they were ill. This the writer admitted to be true, only adding that everyone is ill. To which I rejoin that if everyone is ill the health adviser is ill too, and therefore cannot know how to cure that minimum of illness.
This is the fundamental fallacy in the whole business of preventive medicine. Prevention is not better than cure. Cutting off a man’s head is not better than curing his headache; it is not even better than failing to cure it. And it is the same if a man is in revolt, even a morbid revolt. Taking the heart out of him by slavery is not better than leaving the heart in him, even if you leave it a broken heart. Prevention is not only not better than cure; prevention is even worse than disease. Prevention means being an invalid for life, with the extra exasperation of being quite well. I will ask God, but certainly not man, to prevent me in all my doings.
But the decisive and discussable form of this is well summed up in that phrase about the health adviser of society. I am sure that those who speak thus have something in their minds larger and more illuminating than the other two propositions we have considered. They do not mean that all citizens should decide, which would mean merely the present vague and dubious balance. They do not mean that all medical men should decide, which would mean a much more unbalanced balance. They mean that a few men might be found who had a consistent scheme and vision of a healthy nation, as Napoleon had a consistent scheme and vision of an army.
It is cold anarchy to say that all men are to meddle in all men’s marriages. It is cold anarchy to say that any doctor may seize and segregate anyone he likes. But it is not anarchy to say that a few great hygienists might enclose or limit the life of all citizens, as nurses do with a family of children. It is not anarchy, it is tyranny; but tyranny is a workable thing. When we ask by what process such men could be certainly chosen, we are back again on the old dilemma of despotism, which means a man, or democracy which means men, or aristocracy which means favouritism. But as a vision the thing is plausible and even rational. It is rational, and it is wrong.
It is wrong, quite apart from the suggestion that an expert on health cannot be chosen. It is wrong because an expert on health cannot exist. An expert on disease can exist, for the very reason we have already considered in the case of madness, because experts can only arise out of exceptional things. A parallel with any of the other learned professions will make the point plain. If I am prosecuted for trespass, I will ask my solicitor which of the local lanes I am forbidden to walk in. But if my solicitor, having gained my case, were so elated that he insisted on settling what lanes I should walk in; if he asked me to let him map out all my country walks, because he was the perambulatory adviser of the community—then that solicitor would solicit in vain. If he will insist on walking behind me through woodland ways, pointing out with his walking-stick likely avenues and attractive short-cuts, I shall turn on him with passion, saying: “Sir, I pay you to know one particular puzzle in Latin and Norman-French, which they call the law of England; and you do know the law of England. I have never had any earthly reason to suppose that you know England. If you did, you would leave a man alone when he was looking at it.”
As are the limits of the lawyer’s special knowledge about walking, so are the limits of the doctor’s. If I fall over the stump of a tree and break my leg, as is likely enough, I shall say to the lawyer, “Please go and fetch the doctor.” I shall do it because the doctor really has a larger knowledge of a narrower area. There are only a certain number of ways in which a leg can be broken; I know none of them, and he knows all of them.
There is such a thing as being a specialist in broken legs. There is no such thing as being a specialist in legs. When unbroken, legs are a matter of taste. If the doctor has really mended my leg, he may merit a colossal equestrian statue on the top of an eternal tower of brass. But if the doctor has really mended my leg he has no more rights over it. He must not come and teach me how to walk; because he and I learnt that in the same school, the nursery. And there is no more abstract likelihood of the doctor walking more elegantly than I do than there is of the barber or the bishop or the burglar walking more elegantly than I do. There cannot be a general specialist; the specialist can have no kind of authority, unless he has avowedly limited his range. There cannot be such a thing as the health adviser of the community, because there cannot be such a thing as one who specialises in the universe.
Source: Eugenics and Other Evils published in 1922