Friday, July 23, 2004


"Four learning-disabled students sued the organization that administers the medical school admission test, alleging they were denied extra time to take the exam in violation of California's disability laws. The discrimination lawsuit, filed Monday in Alameda County Superior Court, argues that students who have trouble reading can learn to practice medicine if they receive enough time and a distraction-free setting in which to complete the Medical College Admission Test.

"Without accommodations, I really can't show what abilities I have," said plaintiff Brendan Pierce, 28. Pierce, who has dyslexia and attention deficit disorder, graduated from the University of California, Berkeley, in 2000 with a psychology degree and has completed premedical courses at Mills College. He said he's always done well in school, having been given extra time on his exams since junior high."

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So you want to be given a doctor who can't read very well and who has attention-deficit disorder? I think I would be suing the Association of American Medical Colleges if they DID allow such a person to pass their tests


The term 'nanny state' is a misnomer for the current form of authoritarian government. The concept of the 'therapeutic state' better captures the distinctive character of public health under New Labour. The target of government measures aimed at changing a wide range of behaviours deemed to be unhealthy is the individual citizen who has internalised a sense of personal inadequacy and responsibility for health. Though government intervention is more coercive and intrusive than in the past, it is mediated through a range of 'caring' professionals and its authoritarian character is obscured. Nanny is a straw person, the counsellor is the personification of the therapeutic state.

A nanny state is one that is authoritarian but paternalistic, bossy but benevolent. Nanny forces the children to eat their greens and to take their medicine, but it is only for their own good. In some respects, the British government during the Second World War behaved in this way, imposing food rationing, media censorship, restrictions on travel, blackouts, etc. Emergency measures to contain epidemics, from smallpox and cholera in the nineteenth century to SARS in the twenty-first, involve restrictions on civil liberties, such as quarantines, to limit the wider threat to society. Regulations to reduce death and injury on the roads - speed limits, breathalyser tests, seat belts, motor cycle helmets - are more familiar examples of 'nanny state' initiatives.

Nanny state measures tend to be imposed collectively and temporarily, justified by exceptional circumstances, such as war or pestilence. If, like driving regulations, they are introduced with long-term effect, this requires convincing evidence that they achieve the desired benefits (which was rapidly produced). It is worth noting that, even when these conditions have been fulfilled, there has often been considerable popular resistance to such measures. Though the nanny state has generally been able to rely on support from doctors and other professionals for its policies, it has also had to resort to coercive powers to enforce compliance with regulations introduced to enhance public welfare.

The most striking contrast between today's therapeutic state and the nanny state of the past is the absence of popular opposition. On the contrary, opinion polls reveal substantial majorities in favour of measures currently under discussion, such as bans on smoking in public places and restrictions on advertising of 'junk food'. Where is the campaign to uphold the rights of smokers in pubs and restaurants? Have we seen demonstrations demanding the right to eat junk food or indulge in binge drinking?

It is also striking that whereas the health benefits of quarantine or seat belts are clearly evident - even to those who defy them - those associated with current policies are dubious and contentious. For example, the dangers of passive smoking have been the subject of academic debate for more than 20 years. The current consensus that banning public smoking will save up to 1,000 lives a year is a triumph of propaganda over science. At least there is some evidence in this area: in relation to the health benefits of advertising bans and food-labelling regulations there is none at all.

The apparently unstoppable momentum of the campaign for a ban on public smoking reveals the key dynamics of the therapeutic state. Not only is it supported by non-smokers, but a majority of smokers also approve of a measure which will prevent them from pursuing this traditionally convivial activity in pubs, clubs and restaurants. This reflects the fact that many smokers have internalised the way in which smoking has been re-conceptualised in the public health campaigns of recent years. Up to the 1990s, smoking was generally regarded as a bad habit, if one that provided some respite from the cares of work and family life. This view of smoking was confirmed by the fact that, in response to mounting publicity about the link between cigarettes and lung cancer from the early 1960s onwards, several million people abandoned the habit. Furthermore, most did this without the benefit of any professional intervention....

When smokers confessed that they welcomed bans on public smoking as a further measure to protect them from themselves, the public health zealots recognised the triumph of their bleak ideology. The stage was set for the leaders of the British Medical Association to march to Downing Street bearing aloft a banner in the form of a supersized cigarette packet carrying the legend 'Passive Smoking Kills'. If the nanny state is a paper tiger, the therapeutic state is a much more formidable adversary, not least because so few even recognise it as an enemy.

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