Monday, November 08, 2010

Dr. Tom Farley-Run for Our Lives

There is a fascinating and revealing profile of  NYC Health Commissioner, Dr. Tom Farley, in yesterday's NY Times-and the piece manages to magnify some of those traits that we have seen in the good doctor that, frankly, scare us to death. Farley really is out to run our lives-but only in our best interests, of course: "In his sparsely furnished office in Lower Manhattan, Dr. Farley is Clark Kent, smiling mildly behind his glasses, his plain gray suit hanging on his wiry 6-foot-2 runner’s frame. But in public health, he is fast emerging as Superman, able to reframe public debate in a single op-ed article about whether poor people should be allowed to buy Cokes with food stamps. He has urged what he calls curve shifting, an overhaul of human behavior toward healthier living. But to do this, he says, the entire cultural landscape must be changed to make bad choices harder and good ones easier, even if it has to be engineered by the government."

Think about this for a minute-"curve shifting," and overhauling human behavior, "towards healthier living." This is the kind of  world view (and Weltanschauung is the more appropriate synonym in the friendlier German version of the term) that has set off the libertarians-and those pundits who see the face of fascism in this urge to compel people to live healthier lives.

Is the comparison unfair and overwrought? We don't think so, at least not totally-and consider who Farley himself views as a role model for his excursion into behavior modification: "In a chapter called “Humans Behaving Badly,” Dr. Farley writes admiringly of the reward-and-punishment system of behaviorist theory. “B. F. Skinner would have predicted that health education programs directed at individuals would fail,” he writes. “He would have proposed (he did propose) that if we really want to change how we behave, we must change the environment in which we live.”

But it is precisely the philosophy of Mr. Skinner-someone who believed in "operant conditioning" so much that he enclosed his own children in a box invented to study and control how folks can be made to behave better. In doing so, Skinner is heir to an entire anti-democratic and, yes, proto-fascist tradition that begins with Plato's musings in the Republic-as J. L. Talmon pointed out so many years ago. Behaviorism, as practiced and preached by Skinner, was the attempt to meld psychology and science to an ancient philosophical tradition that held the mass of people in contempt.

It is, therefore, no accident that Farley finds inspiration in Skinner: "Now that science has beaten back infectious diseases like cholera, influenza and polio, public health is largely reimagining itself to fight chronic diseases like obesity, hypertension and high cholesterol. Dr. Farley, in turn, has made it his mission to foment not the next revolution in drugs, vaccines or germ-fighting, but lifestyle changes that offer New Yorkers the implicit promise of living forever — or at least longer. Promoting behavior change, Dr. Farley likes to say, is the 21st century’s equivalent of 19th-century advances in sanitation, and “Prescription for a Healthy Nation” heralds that agenda."

And it is also no surprise that when someone like Tom Farley finds that his zealotry is contradicted by scientific evidence, it is the science that gets the boot-as it did with the fraudulent anti-soda advertising campaign: "But recent revelations about the health department’s internal debate over its antisoda campaign have underlined complaints that Dr. Farley’s more lifestyle-oriented crusades are based on common-sense bromides that may not withstand strict scientific scrutiny. The Times reported last month that Dr. Farley, in a series of e-mails, overruled his chief nutritionist and others who had raised concerns about the accuracy of the campaign, “Pouring on the Pounds.” It features a YouTube video of a young man guzzling a glass of soda as goopy fat runs down his chin. The ad warns that drinking a can of soda a day “can make you 10 pounds fatter a year,” without any disclaimer that people gain weight differently."

This is what happens-and it did with the second hand smoke evidence-when ideology begins to infect clear thinking-and the ideologues are given the power to act out their inner most wishes, science be damned! "Dr. Michael Alderman, editor of the American Journal of Hypertension and a professor at the Albert Einstein College of Medicine, said reducing sodium on the scale that Dr. Farley was recommending could lead to good and bad physiological changes. “It’s an experiment; we don’t know what’s going to happen,” said Dr. Alderman, who is an unpaid adviser to the Salt Institute, a trade group. “Should we do a randomized clinical trial on 10,000 people like we always do? Or should we just impose it on millions of people?”

We know where Farley comes down on this-after all, he imposed his calorie posting experiment on millions of New Yorkers without a scintilla of scientific evidence that it had any efficacy whatsoever. And Dr. Alderman goes on to make this telling point: "He said that other inadequately tested interventions, like postmenopausal hormone therapy and low-fat diets, had backfired, adding, “There’s almost a law in this world, when you do things without solid scientific evidence, there are unintended consequences.”

One of those consequences-and we're not sure that it is unintended-is to deprive people of the right to make their own choices; an elitist strain of thought that gets its American legs in the Progressive Movement's war against populist democracy in the last century-and the view that survives to this day concerning the fear of populism's "paranoid style;" and the irrationality that is perceived to animate populist impulses in the Tea Party movement.

In this context a public health ideology, promoted by an educated, well-meaning elite, is designed to take control over how people behave so that we can condition them to live their lives in a manner that best suits their overall interests. But once this takes hold, there is no end to the road that it will take us on-or the unintended consequences it will visit upon us.

So, when it comes to Dr. Farley's prescriptions, we can see-unlike most prescriptions written by doctors-that his are written quite clearly. They provide us with an ominous view of a future where all aspects of our lives are routinely and intimately controlled by the experts in operant conditioning-with all of the democratic air sucked out of the system in the name of healthier living