Dr Christian Jessen: "The word 'exploitative' drives me mad"

Helen Lewis talks to Dr Christian Jessen about Twitter diagnoses, self-promotion and the best of the NHS.

Dr Christian Jessen lives an odd life. Quite regularly, people send him photos of their diseased body parts; others seek medical advice from him on Twitter, which he retweets with his response in capital letters before the question. So: “IT’LL KILL YOU IN AN HOUR OR TWO. @DoctorChristian how poisonous exactly?”
 
Dr Christian, as he prefers to be known, is the presenter of Channel 4’s prime-time hits Embarrassing Bodies and Supersize vs Superskinny. In the former, members of the public air their piles, warts and assorted deformities for the benefit of a grateful nation; in the latter, an overeater and an under-eater swap diets for a week in the “feeding clinic”.
 
Both shows have millions of viewers. As a result, Jessen is now our best-known telly doctor (and he is a real one, unlike Gillian McKeith and her internet PhD). But where a previous generation had Robert Winston talking through his trustworthy moustache about the miracle of life, Dr Christian is more likely to go to Magaluf, strip down to his pants and give everyone a pep talk about genital warts.
 
The big question is –why? Why would anyone submit to showing off their bunions, never mind their STI, on national TV? “Sometimes, they’ve been trying for ages to get help and they haven’t been able to get it,” he tells me over juice and pastries at a hotel in London. “Some of them are very political. Some of them are [saying]: ‘I want to promote my condition because I’ve had it long enough and my GP doesn’t seem to understand what it is.’”
 
Isn’t there an element of the freak show? “The word ‘exploitative’ drives me mad. These people have watched the show – it’s been going on for, what, seven series now?”
 
No one can accuse him of not practising what he preaches. He’s spoken about having a hair transplant and his struggle with body dysmorphia, which makes him see a puny weakling in the mirror, when he actually looks more like He-Man. Once, asked on Twitter if he’d ever had an STI, he simply replied: “YES”.
 
Hearing from so many people about their problems, he has a clear perspective on the health service. “The NHS is really, really good at dealing with acute problems, emergencies, major illnesses like cancers. Where it’s not so good is [treating] your ingrowing toenail, your small hernia, your haemorrhoids . . . But what other way is there of doing it, really?”
 
He certainly doesn’t think that the NHS should refuse treatment to immigrants, as some right-wing papers have suggested. “What I like about the NHS – and this is a contentious issue – is that if you’re a poor, African woman with HIV and you know you’re going to die in your country and your children are going to die, if you scrape the money together to get [here], they’ll look after you.” He pauses and flashes a wry, if expensively maintained, smile. “I don’t think we can afford to, but that’s a different issue.”
 
Unlike most doctors I have met, Dr Christian is unafraid of the internet and how it has changed patients’ expectations. He loves to tweet, despite the British Medical Association’s worries about the medium, and in one series of Embarrassing Bodies, people used Skype to consult him. He thinks that video calls could be a scalable solution for those who find it hard to visit their doctor in person (“Most GP questions are: ‘Should I worry? Shouldn’t I?’”).
 
He also doesn’t mind when patients turn up having researched their condition on the web. “I don’t sigh. Well, sometimes I do. Patients come in and they go, ‘Doctor, you gave me these tablets and I’ve just seen that according to the latest trial data they’re not necessarily the right ones.’ That can only be good for us.”
 
Medicine Man: unlike many other doctors, Jessen has embraced the internet. Photograph: Phil Fisk/Camera Press.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 19 August 2013 issue of the New Statesman, Why aren’t young people working

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Is TTIP a threat or an opportunity?

TTIP offers potentially huge opportunities to both Europe and the US - we should keep an open mind on what the final agreement will mean.

Barack Obama made it abundantly clear during his visit to the UK that if Britain left the European Union then it would be quite some time before we would be able to negotiate a trade deal with the United States. All the more reason to examine carefully what the Transatlantic Trade and Investment Partnership (TTIP) will mean for the UK. For Labour this is especially important because a number of trade unionists and Party members have expressed concerns about what TTIP could mean.

The economic worth of such a partnership between the European Union and the US has been questioned and it has been frequently stated that TTIP could give multinational companies unprecedented influence and undermine the British NHS.

With regard to the economic benefits of TTIP there are few that would argue that there are no economic gains to be achieved through the partnership. The question is to what extent economic growth will be stimulated. On the positive side the European Commission has argued that an agreement could bring economic gains of between €68 billion to €119 billion per year to the EU (0.3% to 0.5% of GDP) and €50 billion to €95 billion (0.2% to 0.4% of GDP) to the US. For Britain, this means that an agreement could add up to £10 billion annually to the UK economy.

On the negative side, a study commissioned by the European United Left/Nordic Green Left Group in the European Parliament has maintained that TTIP would bring only “limited economic gains”. These gains have to be weighed, it was argued, against the “downside risks”. Those risks have been identified as coming from the alignment of standards in areas such as consumer safety, environmental protection and public health.

These are important concerns and they should not be quickly dismissed. They are made all the more important because the existence of already low tariffs between the EU and the US make the negotiations to reduce non-tariff barriers to trade all the more significant.

There are a number of areas of concern. These include food standards and the regulation of GM crops and the worry that the EU’s focus on applying the environmental precautionary principle might be weakened. The European Commission, which has a responsibility for negotiating TTIP on behalf of the EU, is however acutely aware of these concerns and is mindful of its legal responsibility to uphold, and not to in any way weaken, the agreed legal standards to which the EU adheres. A concern has been expressed that irrespective of what European law may say, TTIP could undermine those standards. This I find difficult to accept because the ‘rule of law’ is absolutely central to the negotiations and the adoption of the final agreement.

But the EU is mindful of this concern and has brought forward measures which have sought to address these fears. The latest proposals from the Commission clearly set out that it is the right of individual governments to take measures to achieve public policy objectives on the level that they deem appropriate. As the Commission’s proposal states, the Agreement shall not affect the right of the parties to regulate within their own territories in order to achieve policy objectives including “the protection of public health, safety, environmental or public morals, social or consumer protection or promotion and protection of cultural diversity”.

Of course, this is not to suggest that there should not be vigilance, but equally I believe it would be wrong to assume the theoretical problems would inevitably become reality.

The main area of concern which has been expressed in Britain about TTIP relates to the NHS and the role of the private sector. Under the Investor-State Dispute Settlement (ISDS) provisions investors would be able to bring proceedings against a foreign government that is party to the treaty. This would be done in tribunals outside the domestic legal system. If a Government is found to be in breach of its treaty obligations the investor who has been harmed could receive monetary compensation or other forms of redress.

The concern is that the ISDS arrangements will undermine the ability of democratically elected governments to act on behalf of their citizens. Some have maintained that measures to open up the NHS to competition could be made irreversible if US companies had to be compensated when there is a change of policy from a future Labour Government.

In response to these concerns the European Commission has proposed an Investor Court System. This would be based on judgements being made by publicly appointed and experienced judges and that cases would only be brought forward if they were precisely defined. Specifically, it is proposed that cases would be limited to targeted discrimination on the basis of gender, race or religion, or nationality, expropriation without compensation or the denial of justice.

Why, you might ask, is there a need at all for a trans-national Investor Court System? The reason in part lies in the parlous state of the judicial systems in some of the relatively recent EU accession countries in Eastern Europe. To be frank, it is sadly the case that there are significant shortcomings in the judiciary of some countries and the rule of law is, in these cases, more apparent than real. It is therefore not unreasonable for investors to have an international framework and structure which will give them confidence to invest. It should also be noted that there is nothing proposed in TTIP which contradicts anything which is already in UK law.

We need to remember too that this is not only about US investment in Europe, it is also about European investment in the US. No US-wide law prohibits discrimination against foreign investors, and international law, such as free trade and investment agreements like TTIP, cannot be invoked in US courts. The Investor Court System would therefore benefit European companies, especially Small and Medium Sized Enterprises. 

It is of course impossible to come to a definitive conclusion about these provisions because the negotiations are ongoing. But it would surely be unwise to assume that the final agreement would inevitably be problematic.

This is especially true regarding the NHS. Last year Unite the Union commissioned Michael Bowsher QC to provide an opinion. His opinion was that “TTIP does pose a threat to a future government wishing to take back control of health services”. The opinion does not express a view on whether TTIP will “force” the privatisation of the health service (as some have claimed) and Bowsher admits that much of the debate is “conducted at a rather speculative level” and he has been unable to produce any tangible evidence to support his contention about future problems. On the other hand, it is the case that there is nothing in the proposed agreement which would alter existing arrangements for compensation. There are of course many legal opinions which underpin the view that existing legal arrangements would continue. While I accept that it is theoretically possible for the Bowsher scenario to occur, it is nevertheless extremely improbable. That is not to say that there ought not to be watertight safeguards in the agreement, but let us not elevate the extremely improbable to the highly likely.

A frequently heard criticism of TTIP is that the negotiations between the US and the EU are being conducted in ‘secret’.  Greenpeace, for example, has strongly sought to make this a central part of their campaign.  Although the Commission publishes EU position papers and negotiating proposals soon after they are tabled, it is impossible to see how complex negotiations of this kind can be practically conducted in public.  However, I believe that the draft agreement should be made public well before the final decisions are taken.

Once the negotiations have been concluded, the draft agreement will be presented to the European Council and the European Parliament, both of which have to agree the text. The European Council is, of course, made up of representatives of the governments of the EU and the European Parliament is democratically elected. Both Houses of the British Parliament will also debate the draft and there will need to be parliamentary approval of the agreement.

Transparency and democratic scrutiny are two things which there cannot be too much of. But, in practical terms, it is difficult to see how there could be more of either without making it nigh on impossible to secure such a complex agreement. Unite, of which I am a member, and others are quite right to express their concerns about TTIP, but let’s not exaggerate the potential difficulties and let’s not assume that the worst case scenario will always come about. TTIP offers potentially huge opportunities to both Europe and the US, and we should therefore at least keep an open mind on what the final agreement will mean.

Wayne David is the Labour MP for Caerphilly and is Shadow Minister for Political Reform and Justice. He is a former Shadow Europe Minister and was a junior minister in the last Labour government.