A Japanese Physician Questions “Health-First” in the Era of COVID-19

An Informed Choice Not to Choose

As we are embroiled in the current COVID-19 infodemic—a flood of information that includes both accurate and inaccurate details to sift through—perhaps the principle of always divining correct information is itself a fallacy. We also have the option to ignore information, says the physician Ōwaki Kōshirō, who presents a bold challenge to the commonly accepted wisdom.

Ōwaki believes that advocating health literacy to discern correct from false information is based on the world view of health professionals, the media, and other experts. Falsities that are circulating outnumber truths in far greater volume than experts realize. It may seem preferable to reach the truth, but there is a high risk that people will believe bogus information instead. Rather than fretting incessantly over which answer is true or false, he states, we should have the option of choosing neither.

According to Ōwaki, even scientific rationale, or so-called evidence, is no guarantee of certainty or efficacy. Put simply, conclusions vary wildly depending upon the value given to statistical data, and researchers can interpret data according to the position they aim to prove.

Ōwaki considers information itself to be like a pathogen. Its spread can encourage anxiety, leading to panic. Believing health-related rumors can actually damage your health. “To protect your health, it’s important to distance yourself from the sea of information. Sometimes it’s best to turn off your television, or close that browser window.”

Varied and flexible strategies are needed to vaccinate ourselves against panic. Naturally, the underlying reason for being influenced by information is a fear of infection. But Ōwaki wonders if we are sacrificing our lives because of undue concern about avoiding infection and staying healthy.

Excessive Trust in Preventive Medicine

When he was an undergraduate medical student, Ōwaki felt uneasy about the emphasis on living a long, healthy life, as well as the inordinate expectations placed on medicine.

“Doctors are not necessarily always correct. I felt that we needed to address people’s unquestioning belief in medicine, and to more boldly affirm that they are likely to die from disease at some stage or other.”

These beliefs formed the basis of his book, Kenkō kara seikatsu o mamoru (Protecting Our Lifestyles from “Health”). In it, he questions the excessive confidence placed in preventive medicine to tackle lifestyle-related diseases and cancer, attacking it as “superstition.” One example he cites is assumptions about purines and cholesterol. We are cautioned to avoid beer, due to the gout-causing purines it contains, and to pay close attention to what we eat in order to minimize our cholesterol intake. In fact, though, beer does not contain high levels of purines, and significantly more cholesterol is synthesized within the body than is absorbed from food. Ōwaki points out that denying oneself beer or being paranoid about foods will not have significant efficacy in preventing disease.

He had nearly finished his book before the COVID-19 pandemic struck. Although most of the content is based on his prepandemic ideas, it raises questions about the emphasis on health and safety that has been exacerbated by the novel coronavirus.

Unease over New Lifestyles

Protecting Our Lifestyles from “Health” was published in June, followed, in July, by Ōwaki’s translation of The Death of Humane Medicine and the Rise of Coercive Healthism by the late Petr Skrabanek, a Czech-born physician and author. Ōwaki describes his own book as a commentary on Skrabanek’s work.

Skrabanek claimed that so-called “healthism” was akin to a religion. On the basis of that “faith,” modern medicine has often intervened in people’s health without sufficient consideration for their lifestyles and happiness. Healthism monitors the population and is used politically as a means to conceal acute social problems. His assertions cut deeply into the connections among health, medicine, and politics.

Owaki’s translation of Skrabanek’s work.

According to Ōwaki , the “new lifestyle” advocated to combat COVID-19 is exactly the kind of one-track thinking described by Skrabanek—an approach that requires people to endure hardship for the sake of health. He is uncomfortable with the lack of concern that the meticulous control exercised over people’s lives, with no certainty of the outcomes, might be more serious in itself. A grim issue it raises is harassment of infected persons. “The belief that carelessness causes infection of the individual and of others leads to condemnation of those infected for their negligence,” says Ōwaki.

But infection is not necessarily the result of careless behavior. For example, people may need to go to crowded places due to circumstances beyond their control. It is prejudiced to censure those who fall ill, saying they should have been more careful, while ignoring the existence of myriad unidentified factors.

“With COVID-19, nobody can be sure about anything. There is no clear medical basis for infection countermeasures, and in Japan, there is no legal basis. Although penalties are not imposed, when the Japanese government implores people to be cautious, citizens conduct surveillance on one another. It is difficult to effectively restrain this mutual surveillance. This recently led to the rise of self-appointed ‘coronavirus police.’”

The Perspective of Protecting Lifestyles

In the end, we are left with no option but to live with uncertainty—and with the virus—in a world where ambiguities abound.

“COVID-19 will not vanish, even if we develop vaccines and treatments,” notes Ōwaki. “We will continue to suffer instability while attempting to balance economic activities, health, safety, and lifestyle. That’s why I believe we need to accept a degree of risk to protect the quality of our lives.”

Ōwaki reminds people that COVID-19 is not as severe a threat as smallpox or plague bacillus. “For example, although infection comes with the risk of death in the worst-case scenario, if everybody changes their lifestyles due to that fear, we abandon cultural traditions built up over centuries. Placing value on our lifestyles requires us to tolerate a degree of risk. We must not forget that life entails risk.”

The previously imposed restrictions have been relaxed to prioritize the economy. But if fear of additional waves of infection rises, the situation might change.

“The response to COVID-19 is being governed by the general mood, so I want to keep an eye on that.”

The Upshot of Mutual Surveillance

Ōwaki was inspired to write his own work during the four years he spent translating Skrabanek’s book, but did not intend to refute modern “healthism” from a medical perspective. His intention, he says, was “to remind people of common things they had forgotten without realizing.”

During our interview, he referred to works by great thinkers of the past, including Michel Foucault’s Discipline and Punish, Samuel Butler’s Erewhon, and Ivan Illich’s Limits to Medicine.

“These writers cautioned that doctors would brainwash people, for their own ends, to behave in certain ways. They warned that it would lead to situations where people are convinced that they act of their own free will, when they are actually coerced into mutual surveillance.” Ōwaki believes that we now risk creating such a society.

“Erewhon depicts a dystopia where illness is punished as a crime. Similarly, health supremacism​ is just a step away from totalitarianism.”

In his book, Ōwaki dedicates a chapter to the health controls and horrific eugenics pushed by Nazi Germany and Imperial Japan. This may seem extreme to some readers, but he insists that we must not forget the lessons of history. The Nazis took a strict approach to the harm caused by tobacco and alcohol, and some alcoholics were sent to concentration camp​s to set an example. This was based on the belief that a healthy populace would strengthen the country. Ōwaki wonders if there are some similarities in what is taking place around us today.

His book quotes Japan’s first minister for health and welfare, Kido Kōichi, who, in 1938 proclaimed that “All citizens must understand that their bodies do not belong only to them, but also belong to the nation. . . . they should train and strengthen them for the nation.” Today, Article 2 of the Health Promotion Act, passed in 2003, states that “Citizens shall deepen their interest in and understanding of the importance of healthy living habits, maintain an awareness of the state of their health throughout their lives, and strive to improve their health.” Both Kido and today’s law state that health is achieved through effort, and its maintenance is the responsibility of citizens.

“Don’t Get Sick” Is a Curse

After Ōwaki graduated from medical school, he worked at a publishing house and for a medical information website precisely because he wanted to reexamine the reality of medicine from a distance. Three years ago, he began working as a physician to learn in the field of clinical medicine while utilizing his career experience.

He says that a large proportion of patients are elderly, presenting him with many opportunities to contemplate how we should approach the aging society and questions of illness. “We must keep questioning the pursuit of a long life burdened with numerous health problems, and considering how we can sustain society as a whole. Even if we desire a long and healthy life, people always become ill. Although you may distance yourself today from the wretched lives of sick people, tomorrow, it might be you.”

He therefore advocates an approach of enjoying life even if you become ill and worn-out.

“I hope to encourage people to do what they want with their health. I want to turn health from a religion into a fad. Experts may want us to verify everything against the facts, but we should not become overly concerned. For example, even if evidence suggests that regularly eating nattō helps prevent disease, the actual efficacy is tiny. You should eat it because you like it. That’s good enough. Similarly, you shouldn’t get bothered unless things are especially harmful. I want people to adopt the good bits as they please, eating whatever they wish, as their personal fad.”

Ōwaki’s ultimate message is to enjoy life by freeing yourself from the “curse” of trying not to get sick.

(Originally published in Japanese on November 2, 2020. Interview and text by Itakura Kimie of Nippon.com. Banner photo © Nippon.com.)