11 v I)r. Perr Skrubinek
When in 1974 the American
Psychiatric Association declared that
hoMOSCXU21itV -as no longer a
disease. the new consensus -as the
result of a vote among the members.
Similar ly. if a group of religious func-
tionaries were to cast a vote an
wlicther homoscxualim is still a sin.
the majority could give their assent
and the consensus would be upheld.
It would be a mistake to equate such
consensuses .;ih a democratic deci-
sion. us demos has no say in the
m.aters. Neither is anyone the wiscr
hen a corscns-un: is rru-cht-1
,:onsensus conferences on health
issues are a rcc,:nt phenomenon.
Since 1977. the Nation2l Institute% (If
Health in the VSA have organized
almost 100 consensus conferences. at
a cost of about $10 million. Most
doctors are unaware of what these
conferences were about and in many
instances the practice of medicint
has been unaffected. As rccommcn-
i d2tions from consensus conclaves are
issued ex cathedra. -ithout any
reference to original data. lawyers
may use them in malpractice suits
against doctors who have not
followed them. The careful sclec-
tion of participants guarantees a I
consensus. A token dissident.
coopted to maintain the scmbl2ncc
of impartiality. is. us a rule. not gi% cn
;;.-cc to ruffle -.hz If the
consensus report. Yet the very need
foi consensus stems from a lack of
consensus. Why make in issue of
agreeing on barricthing that everyone
(or nearly everyone) takes for
granted' In s6ence, lack- of consen-
sus does not bring about the urpc to
hammer out a consensus by assem-
bling participants whose dogmatic
views are well known and who
welcome an opportunity to have
them reinforced by mutual backslap-
ping. On the contrary, scientists are
pmvidcd with a strong impctu-. to go
back to the benches and do more
experiments.
Unccrtainty in medicine. as in thcol-
ogy. is intolerable and a cnnscnsu.%
conference. like a synod (if bishop%.
is convoked tn settle the matter. A
"n, cs"m pie , as :he rcp-n- !!f the
National Cholesterol Education
Program Expert Panel on detection.
evaluation and crcaernent of high
b
lood cholesterol. issued b, a
commirrectifthinvcxperrs.1 -1-herc
is strength in numbers and it silences
thc'critics. Among' 'many recommen-
Dr Skrabanrk is Senior Lecturer at thr Deparmient
of Communirr HeaN, TriYiA- College JWical School.
C litiversily of Dublin. His most mcent book, The
Follies and Fallacies of. Vedicine. crimen L-tfh
James
McCormick, L-as published in 1989 h.r Tan-agon
Prrss. Glasgow. The Axeriran version is due fo
appear in
Fall 1990 (Pitimetheas Pras).
4 WMAIATOW I"TH & CCVLDP-M
C)
0 N
Ln
BAT IndustrieS doeUrnent for Province of BritiSh
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ditions. rhis rep-off crodomma diet For nc%%:
lfv%c.hjtc rclirion%hip with pickjgcd and
adtcrti~cd with slogan%
hich there is rocir A %-rap (jfc%-idcnt c
medicine: thc% drcurn alunic -Atcrna- that have a
wicntific ring---cornpor.
;
chit it is c:jpjhlc of,:hanging the risk ri,c,"
but the, pu~ chmugh the mr-L I
crizcd dii-onsis. automated choles.
. form coronar%; heart disease.
(if d% ing for **health check%.- *rhc finuncial
teral measurement. the latest phar-
but them i!b ccas(inihic c%idencc that
exploitation (if the worried-well and maccuticul
breakthroughs. And other
it does not. The Agreement on of the Dick vi hom
doctor% cannot core quick technological fixes for
human%'
dictur, treatment And on the is no longer %erhally
denounced by ills And wtocs. The risks (if ncu
tech-
meaning (if "high- chtilesterol is the ]cider% of
the profession: it is the noingies arc nor
c,aluated: And since
ichic,cd hy An old Chincc ccomcn- order of the
diy. Mi mukc it easier there is no c%iduncc of
risks it is
,us method crroploycd in settling the for
-consumers - to opt for buying is3,umcd chic there
is e%-idcrwc of no
,juc,cion if the length (if the health.- the
-product- is nearly risks. When finally the risks
can no
Fmpcro- .% no%c. k-% Richard
" longer he ignored and cxcccd the
no unc %;is
Fcvnmar. recalled. -inLIc hcncrics by a wide
margin. a new
alloncd to see the Emperor's face. Fushinn take,.;
civet. It took o%cr tcn
chi% precluded direct measuremcnc, years for
neonatologists to question
hUC A cii-c-us could still he U nce rt aii rity
ii-hy o,er MOCK) premature babies in
reached hv going Arnund the
, incubators b=mc blind. The cause
Asking experts on the
kingdom and
in of the blindness was retmicntal fibro-
ength of the Fmpcror's nose what plasia induced by
the routine use of
the% th-kchi it might be and by a,-c,- oxygen. The
possibility that some-
medicine
iging all the answers. Since the ,
thing so good and natural as oxygen
number of questioned imperial as in could become a
leading cause of
rhinosophiscs was rather large. the childhood
blindnc%- did not cross
standard error of the mean was very anyone*s mind
for a long time. It is
theology
low. And the precision of the estimate ,
easy to he disc wich hindsight. But
-as good. s what about the "prudent" diet.
recommended by expert.- A ho claim
.',Icdic2l fashions comi chat if ingested daily it
would
intolerable.
nou that the world has become a 1 conquer the
number one killer-
global village. they reap hccarombs coronary heart
disease- Surely it
or, ictims. People have developed a could do no
harm. or could it-
/41'r PH =.,/A
bro-hialpirow.oiria
1.1 /W1 JoFAIAT IM
.xrt,e, h-d.
%
e*
C:)
Ln
BAT Industries document for Province of British
Columbia 23 April 1999


particularly dramatic example their surplus of dry
tokimmed milk and inability to buv it, that is, in
plain
of a non3ensus consensus until supplies dried up.
Alternative language. povcrcy.s
affecting the health and lives protein mixtures
included corn-sny.
of millions of starving people milk. whc-.tc-wv
blend. fish protein
h WHO and
C1,
1
c
'Ile F
6 in the developing world was concentrates or even
by products of
.c
'
l,u aI
Ag I u (- Organization
the 'great protein fiasco."2-3 The nylon
indu.,try.2 At Jorhar in Assam. i dce. it
necessary to cs!,c,.-
'curve." if that is the word. for India.
single-cell protein pilot plant b1c cxpc"s and
committees to
hunger and starvation is unlikciv to
I was manufacturing protein from i delibcntc on
new estimates of
be found by quizzing experts. who I of gas oil.4 A
United -6
substrate I -cncrgv and protein requirements.
would consider the obvious answer. Nations
advisory committee The latest fashion is growth
monitor.
more of the staple food. as unscicn- proposed $400
million 10-year ing. using scales and plotting the
tific. Thus. when in the early fiftics. program
for p(oduction of fish- results on a graph paper.
The expcn.
the WHO's experts wrongly conclud. protein in
India and similar projects diture on suitable
scales alone Gir
ed that kw-ashiorkor India was estimated
was "the most at $21 million.7
serious and wide- -Starving children
spr,!---d nutritionul
3 are unhkcN to
disorder known to benefit from ha%ing
medical and nutri. 10 their dying plotted
tional scicncc."Z an an inaccurate
wrongly imputed growth chart. One
the prim ary cause does not have to
of k,,,ashirokor to pay experts to learn
protein deficiency. A
that what these
and -rongly postu- children need is
lated that there was breast milk of prop-
2 'world protein crly n.,urished
gap." the scene was mothers.
set for a solution of
a non-problcm. A
In the developed
special commission world. experts arc
of expert. the producing reams of
Protein Advisorv "c commended
Group. was to "help dictary 2110w2nCCS"
WHO to advise for energy. protein.
Food and Agri-
calcium. or vita-
cultural Organiza- mins. As many
tion and UNICEF experts produce
on the safety and manv different
suitability for
recommendations.a
human consump- concern was
rion of new protein c x p re ss I: d b v
foods-and has another group of 13
evolved into a experts from an
major force in the A afild rwrkmr ~rdiml aimfiv.
at a ~atktr-d-hildefinw i. (Wk.
n suit-
r
i
ti
fight to close the o
za
o
gan
ablv abbreviaecd as
protein gap."! Instead. they opened were
launched in 14 different coun- EURONLTS. that
something should
a gate to fruitless (and costly) 3
tries.
I be done about it: "it is surely time for
endeavors. Experts speculated tha an attempt 2t a
Lonscnsus.-8 I have
the alleged world shOft2ltc Of Pmtcin It took
nearly thirty years to iSCOv- no idea -hat is my
energy require-
could be remedied by new foods " that the cause of
hunger and star- ment and I don't give two hoots
cr
obtained from bacteria. algac. yeasts. vation is
not failure of world produc- about it. Neither
does my neighbor
protozoa an fungi.4 The Unitcd rion of protein but
-.cafcirv of food nor anyone I know. I am
privileged
States used to dump on the poor due to
mal-distribution of siaple food chat I can cat
when I am htinKry. But
6 AlEfthrask ~""` 6 GIALOPmor
C)
"7
-4
-J
-4
(71
BAT Industries document for Province of British
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then. experts have to cat too and
being art expert is a lucr3tive way of
carning one's bread.
Consensus experts do not put any
cost on their recommendations since
everyone would li%c longer and who
am we to put a price on human life?
Money, spent on one crusade will not
be available for other. more efrective
uses. For this very reason it would
be unwise for a singic-causc cnthusi-
ast to delve to deeply- ocher experts
could cheat him out of his budget.
To make their case. the consensus
experts Ace tempted to inflate the
importance of their cause by jumbo-
jet statistics. This is done by
enumerating how many lives would
be lost. which otherwise would be
saved if the experts goc hold of the
money. in the next 10. 20, 50 years.
in a population of 100. 200. 500
million. As such numbers Arc large.
and become larger by multiplication,
they can be expressed suitably as the
number of jumbo icts crashing in the
national airspace daily. These statis-
tical massacres stun both politicians
and the public. Once the bandwagon
starts moving downhill the prestige.
power. and credibility of the experts
are at stake. Various ruses must be
employed to suppress. dismiss. or
distort new information which uiider-
mines the premises of the consensus.
here have been Coo Many
disasters of good intent" in
T the history of medicine and
people should tcmper.their
faith in expcrt3--particutarly
when they see them coming in
drovcs-with their own informed
skepticism. After alL it is the public
who will. carry the cost both physical-
ly And financially. William Siivcrmsn
pointed out that the ultimate test of
any medical innovation should be-
Is life any sweeter? -Criticism must
come from sceptics in the communi-
ty if we arc to separate 'halfway'
technical solucions from solid claims
of improvement in general wclfafc*9
Knowing that someone is eager to
sell you a cholesterol number, and
keep the proceeds of the lottery,
could put off even the hardened
gambler.
The oldest consensus among the
vendors of health. and Other traders
along the valley of the shadow of
death, was thar people want to be
deceived and should be pleased
accordingly. In the past. mountc-
banks were distinguishable from
their more respectable colleagues at
least in 2PPC2f2nCC and manners. if
noc by the effectiveness of their
cures. Nowadays. the con,
medicine and its "alternatives is an
ominous foretaste of the ultimate
consensus that all will be healthy by
the year 2000. with the WHO bless-
ing. provided they don't die by then.
cat plenty of fibre. and promise never
to use their reason again. 0
I The Expert Panel Report ofthe
National Cholesterol Eductfion Program
on detection. evaluation and treatment of
high blood cholesterol in Adults. Amb
InrernMed I"S. 148: 36-0.
Z,%[cLaren DS. The great protein flasco.
I incer 1974: ii: 93.%.
3 Tracey SIV. From Panglos to
P2 nphobiz Pitfalls in the Path of
Responsible Prediction. 513Mh 1985; M
Z9 _3z.
4 TSnncbauM SR. Mateles Rl. Single
cell protein. Sci-L lournal 1968.4 (No.
5):87.9Z. .
S Anon. Poverty. minutrigion. and world
supplies. (Editorial.) I-Anc-et M7. ii:
4,974sq.
6 Anan. Energy and protein requirements
revisited. (Fditorial.) 1-2nm 191115; ii-
1279.IzW.
7 Anon. Growth monitoring: Intermediate
technology or expensive luxury.
(Editorial,) Lancet 1985: ii: 1337-133&
8 Haurmt JGAJ. et al. Recommended
dictm allo-ancm for Eumpe. I ancet
I 9ft ii: I ZZo.
9 Silvcrman WA. Neonatal pediatrics at
the century mark. Pmo Riol %led 19M
3 L- 159-170.
U.N. REPORT LINKS
WORLD POVERTY TO
LACK .OF FREEDOM
A May I report approved by ft Unbd Nations
1311"bWant ftgrammo =91n. what Irse
market a6mcas have bw sWq for years:
ft wows oxxwm am sloo the low
",I Tftht#=D~V8WWAWWI991.
p- ops, ~ by a Im of c, - i I and drml-
optrat a19" dl - P by the UNW. lonrej.
INN & 'Human Ffeedorn kXW 10
the relative freedom existing In countries.
While no surprise to free markstoors. the
skws M" nor" Www* shock
pocirThirdWorldcountriss. Thomson, mainy
of them ended up at the Ix & of In Human
P*n 11- him-
seem to have unleashed the creatilve ener.
gm of the people-4ndl ro hrA 14 lo am
higher *#W 0l income rd social progroW
the UNOP's repcirl estWishes a dau link
MtWW S=Wnk and pAW ! dC This
is an Insight Me American and U.N. policy
makers shculd flind insItuclift. One of ft bed
ways to promote, plitk:al heacb. around the
world Is to encourage the growth of Ira*
mark" and Irn trade.
The Roporl's -Scoreewd. The Human
F. Indox mossm countries ,, "
I* how they respect a " IN of righm Thesis
include: tie V% Io MW at horna w4 abrood.
b essocials, and Mom* peeokft shd to
speak end write in indigenous torquagav, ft
hodom from forcid V4 child WW. UVI.
cow punishment arhul saw- of proper-
IV, bid consorsho of the pM the, lagal right
to express one's nabonslity, lo an opon trial,
and to a JudidW pmoou ft assumas adefen-
dint innocent und proven pW. and ft right
to freedom of religion, and to decide the
number of one's of-spring wow governmen-
III interference.
Countries were graded on a scale of 0 to 40---
40 mprosonliq the highest WWI Of hodom.
The mnkkW were of the situations in 1US.
Sweden and Donmatit top ths list each with
Mras of 39: Belgium, France. and West
Germany (a I was known who the measurs-
ments were taken) swo 35. Next come
Canada and SwlUarland with 34 and the,
Uuted SWA with 33. BnUn and Japan score
32. On the low vid of tho scale, kK has a
zera, b1lowed &A* by Lbya wdh a 0n$ Wd
China with a two. V*~ and CUM
be; Sold MW and Kuwait wore, a 3h and
an eight, rospodyely. Bangladesh gets a
ww, kwqa an eight, v4 HaN a nine. The
wows largest: doenocracy India. a 14.
1 lu ftm D"Okpi" Alpwt 1991 is ral-
Ali korn Oxford Liniversly Press, Now York Cily.
BAT Industries document for Province of British
Columbia 23 April 1999