The ecstasy of sanctimony

“The ecstasy of sanctimony,” says Philip Roth, is “America's oldest communal passion [and] historically perhaps its most treacherous and subversive pleasure.” The Brits too can be overwhelmed by sanctimony, which Chambers defines as “affected or simulated holiness.” This week's BMJ has accounts of outbreaks of sanctimony on both sides of the North Atlantic.

Britain has been engulfed by a media debate on how the NHS handled a 94 year old woman with a head wound (p 306). What exactly happened is never likely to be clear, but her family says that it found her after three days still in casualty, in the same clothes, and caked in dried blood. They smelt neglect and contacted both the media and the local member of parliament—who happened to be Ian Duncan Smith, the leader of the Tory opposition and a man badly in need of a higher profile and some political victories. Without having checked the case with the hospital, he raised the case on the floor of the House of Commons in prime minister's question time. Rather than say he would “look into the case,” which might have been wise, the prime minister surged to the defence of the hospital, stating that Duncan Smith had got his facts wrong.

For the next four days the airwaves and presses were full of accusation and counteraccusation. The patient was a racist. The hospital consultant was a Labour stooge. The Tories were denigrating public servants. Labour was Stalinistically stifling the truth, trying to hide its appalling failures with public services. Anybody who entered the debate was likely to emerge smeared and bruised. Everybody lost, except perhaps doctors at large who now find themselves defended rather than attacked by the government. “The forces of conservatism,” as the prime minister famously described us, suddenly seem to be needed to deliver reform in the NHS and win the next election for Labour.

It's hard to extract much wisdom from such a mess, but one message is that “those who live by the sword shall die by the sword.” So be careful with trying to manipulate the media and public debate.

The sanctimonious orgy from the United States concerns an attack on the sacred blood test for prostate specific antigen (p 255). The editors of the Western Journal of Medicine (which is part owned by the BMJ) argued in the San Francisco Chronicle that the test should not be used in mass screening—not, most readers will judge, a controversial statement. But the authors were immediately overwhelmed by accusations, abuse, and personal threats. They would be responsible for hundreds of thousands of deaths—“geriatricide” on a huge scale. The University of California, which employs the two authors, has been asked to fire and silence them. So much for free speech and the American constitution.

The moral: beware of attacking screening, the modern panacea. The National Cancer Institute might bear this in mind as it disseminates its conclusion that mammography does not save lives (p 255).