the perversion of choice

Iona Heath, past president of the UK Royal College of General Practictitioners and an early supporter and advisor for our Selling Sickness conference, wrote a column in the 31 October 2009 BMJ titled: The Perversion of Choice.

She began by describing how the 2009 edition of the National Health Service Constitution established “a new right to choice and to information to support that choice.”

However, she went on, devastatingly, to claim that “the reality is that only state sponsored choices are supported” and to wonder if “the [NHS] rhetoric seems more and more designed to provide a fig leaf of respectability to cover the naked pursuit of a policy agenda that [contributes to] the crudest expression of market forces.”

Although Dr. Heath’s column focuses on wrongheaded new policies in general practice medicine, her analysis goes to the deepest heart of the “Selling Sickness, 2013” call to challenge disease-mongering. Medical science and public health are being perverted by practices designed and fulfilled, both knowingly and unknowingly, to serve market forces that prioritize the new, the costly, the corporate-sponsored. The rhetoric of “choice” is used in a superficial, mechanistic, and sometimes even cynical way to disguise policies with socially hazardous consequences. The noble “right to choice” must be unpacked, alas, as too often just a Madison Avenue slogan, one that the public and professionals cannot hear or use uncritically.