Heroes Not Zombies

The BMJ “views and reviews” section often contains the journal’s most thought-provoking and interesting content. This last week included a review of John Wesley’s 1747 text called  “Primitive Physic: Or, an Easy and Natural Method of Curing most Diseases”.
You might know of Wesley as the founder of the Methodist Church and a prolific hymn writer, but I’m guessing that, like me, you didn’t know he’d written anything on health. I was struck by two features. First of all, in recommending particular drugs or treatments he says this –

I have purposely set down (in most cases) several remedies for each disorder; not only because all are not equally easy to be procured at all times, and in all places: But likewise the medicine that cures one man, will not always cure another of the same distemper. Nor will it cure the same man at all times. Therefore it was necessary to have a variety. However, I have subjoined the letter (I) to those medicines some think to be infallible

You’d be surprised how many people haven’t quite sussed out this wisdom! In this current regime of “Evidence Based Medicine” and Clinical Guidelines the strong impression is often conveyed that there are two kinds of medicines – those that work and those that don’t. In fact, if Wesley’s methodology were to be followed the authors of “evidence based guidelines” would be sorely tempted to mark all their recommended drugs with a “l” for “infallible”! When it comes to health care and available treatments we would do well to heed Wesley’s “ Therefore it was necessary to have a variety”.

The second feature was a scan through his “rules” for healthy living – read them in more detail here

Pretty much what he’s saying is take exercise (in fresh air), drink plenty of water, eat enough to feel well but no more, have a mixed diet with a ratio of meat:veg of about 2:3, and avoid processed food as much as possible (OK, for him processed was seasoned, spiced, pickled etc – but the point was still to eat as much unprocessed food as possible). Finally, abstain from alcohol, (tea and coffee if you have bad “nerves”), go to bed early, get up early and have a regular rhythm to your sleep habit. Sound familiar?
I was just at a Medical Update seminar in BMA House in London and lecturer after lecturer advised – stop smoking, drink more water, take regular exercise and don’t eat till you get obese as the key ways to reduce risks of a huge range of diseases. Indeed, in the very same issue of the BMJ is an article about trying to persuade women to adopt healthier lifestyles pre-conception and how the vast majority don’t change their behaviour after such “education”. We don’t get it do we?
Who doesn’t know that to smoke, drink alcohol to excess, avoid all exercise and eat till you’re obese might not be good for your health? It’s over 260 years since Wesley preached his message (and I bet you can find plenty of older writings preaching exactly the same things). It doesn’t work. It’s not that the lifestyle doesn’t work. It’s the preaching the lifestyle that doesn’t work. People don’t choose to smoke, to get drunk, to eat till they get fat to get diseases. And they’re not going to choose not to smoke, not to get drunk or to change their eating habits for some statistical possibility of future health.
Throughout history the greatest health benefits have never stemmed from a targeting of individuals, they’ve come from social, economic and political interventions. Isn’t it time we started to apply a bit more effort and resources to housing, town planning, public transport, the industrialisation of the food supply, and socio-economic inequality? You never know – might just have a greater impact than preaching healthy lifestyles.