Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting them on Wednesdays to coincide with the schedule of his old BMJ column. We hope you enjoy them.

One of the most absurd, as well as potentially sinister, definitions known to me is that of health according to the World Health Organisation: a state not merely of the absence of illness, but of the actual presence of complete physical, mental and social well-being. I have only to re-read it for my own complete mental well-being, and therefore my health, to break down.

The young German novelist, Juli Zeh (born 1974), spotted the totalitarian implications of this definition and used it as the opening sentence of her dystopian novel, The Method, recently published in English.

In the new state imagined by Zeh, existing some time in the middle of this century, health as defined by the WHO has become the ideology of the state – all other ideologies, religious, social, political and economic having failed miserably. Like many dogs today, citizens of the new state are implanted with a chip under their skin; they are obliged, under pain of prosecution, constantly to monitor their blood pressure and biochemical parameters. They are not permitted to stray beyond the limits of areas that have been bacteriologically sanitised, and if they do so they are punished. The death penalty having been abolished, the worst penalty to which they are subject is the vita minima, the minimal life, which is a state of suspended animation under freezing conditions.

The protagonist of the book, Mia, a bacteriologist, is in rebellion against the supposedly beneficent dispensation that is called simply The Method. There is no leader of, no personality cult in, The Method; but it is opposed by a shadowy, and probably fictitious, terrorist organisation called the PRI, the People’s Right to Illness, of which she is eventually accused of being a member.

The Method’s ideological justification is succinctly summarised at Mia’s first trial for having consumed illicit substances such as caffeine and tobacco, and for not having turned in her regular blood pressure and biochemical results. The judge asks her:

What would happen if you fell ill?

To which Mia answers:

I’d see a doctor.

The judge then asks:

Who would pay for the doctor?

Mia replies that she would pay, but the judge then asks whether, if she could not do so, society would let her die. The answer, of course, is No, though Mia is silent; and the judge then says:

Good sense dictates that society should look after your health in times of need. By the same token, the onus is on you to ensure such circumstances do not arise.

This gives The Method the locus standi to interfere in absolutely everything, to make claims to a right of surveillance that even the most totalitarian regimes hitherto have not made. And all supposedly (and plausibly) in everyone’s best interest, that of his health.

The book makes uncomfortable reading for doctors who are apt to suppose that their own goal, the health of the population in general and that of their patients in particular, is the highest ethical goal possible, and that everything else should be subordinate to it. Juli Zeh’s book is a reduction ad absurdum of public health as the highest good. I suppose the question her book raises is one of the nature of slippery slopes: must every slippery slope be slid down to the bottom, or is it possible for humanity to call a halt when it has slid down far enough?

Opinions differ.