Heart Beat: "Then out spake brave Horatius, the Captain of the Gate: To everyman upon this earth, death cometh, soon or late..."
Broadly speaking, the words in Macaulay's Lays of Ancient Rome hold good today. There are certainly no examples otherwise in the medical literature. Some examples are given in religious literature but I feel ill qualified to comment on these.
The reason that I am talking about this at all is recent reading and musing about "lifestylism". A healthy lifestyle, I would say at the outset, is a good thing in every way and pretty well everybody knows this.
Trouble is that we're free spirits and we don't always do what is good for us. We also realise, or should realise, that even the most exemplary lifestyle, whatever that may be, does not bestow immortality.
However, the impression is constantly given and reinforced by State agencies that if certain poisons are avoided e.g. tobacco, alcohol, drugs, and we all exercised and did not eat too much, so-called lifestyle diseases would diminish and perhaps disappear, thus sparing us unnecessary suffering and death and saving the health services incalculable amounts of money.
I did some thinking about this clear but simplistic theory. I have read recently that smoking, active and passive, accounts for about 7,000 deaths a year in the Republic. (How anybody knows this for sure is beyond this feeble brain.)
I myself heard it stated on the Late, Late Show a few weeks ago that the currently fashionable bogey of obesity would within 10 years be the biggest killer in the State.
Let us therefore assume that 9,000 fatties will die each year. Throw in another 5,000 whose heart disease is caused by incorrect diet and another 5,000 whose deaths are brought about by drugs or excess alcohol. HIV/AIDS, which may have a lifestyle component and risky physical activities like stepping out your front door, would surely account for another couple of thousand and lest I be accused of wilful blindness I must not forget the few thousand who are killed by the medical profession each year.
Now, if we could stop all this happening, we would have achieved a Tír na n-Óg with loads of comely maidens dancing at the crossroads, a population explosion requiring lots of one-off houses in the countryside and no more squandering of money in the health service.
Sadly, however, it does not really work like that. People will continue to get sick, need medical services and hospitals and even have the temerity to die. All of the campaigns against smoking, drinking, obesity etc are not going to alter this fundamental fact.
There is another equally fundamental fact. The eventual cause of death for the individual will probably be more expensive for the State than what you may have stopped him from dying from in the first place. The situation arises that you may prolong life, but it is fallacious to assume that you will save money.
I am briefly going to divert here to make a declaration. I am not now and never was a cigarette smoker. I tried smoking a pipe several times but apart from a propensity to burn holes in my tie and shirt I never really got going. I do confess with no apologies to a nightly cigar late in the evening when I am reading. I hope this does not portend an early doom but I am weak and this is something I enjoy.
I personally feel that smoking, particularly heavy cigarette smoking, is bad for you and I would be surprised if there is anybody in Ireland who does not know this. Education and logic are the ways to reinforce this, not exaggeration and prohibition.
It has long been taken that non-smokers wind up paying the bills incurred by the reckless smokers. In 1997 a study was published in the New England Journal of Medicine which did not find that smokers had higher lifetime healthcare costs. This was not part of the premise of the initial tobacco legislation. Sadly, like lots of other things it is not borne out by the facts.
This is all theoretical but it does have consequences. Often perhaps more money is expended on what are really well-meant efforts than is justifiable by any tangible result. The US has a Department of Alcohol, Firearms and Tobacco (remember Waco). This almost paramilitary-like force spends little of its time and efforts on tobacco.
We have the Office of Tobacco Control and we are about to have smoke-free pubs. We also, I respectfully point out, have these inconvenient patients on trolleys and many of our acute beds shut.
It was with some frustration also that I noted another group who are going to advise on obesity. All this costs money, which should be going to the coalface. I was heartened to see Fiona O'Malley's response to this; the death of common sense has not finally occurred.
People make lifestyle choices, often bad ones, but free ones and we have to live with one another. By all means, let us talk, debate and educate but compulsion and prohibition in lifestyle matters have little place in a free society.
• Maurice Neligan recently retired as a leading cardiac surgeon.