If people can make themselves healthy, should we blame them for getting sick? That is the question raised not only by broadening acceptance of the idea that people should assume some responsibility for their health, but also by the exciting new trend towards patient empowerment.
Of course, the list of "good behaviour" can get tiresome. But the question of personal responsibility is arising more and more. "Don't blame me for being fat!" said Lizmari Collazo at the recent Medicine X conference at Stanford University, where a group of researchers, doctors and caregivers met to discuss the new world of patient-generated health. To his credit, organiser Larry Chu also invited a group of patients.
The conference discussed what is now becoming accepted wisdom. Rather than just reform health care, we should also figure out how people can maintain or regain their own health. They need to eat right, stop smoking, drink less, and exercise and sleep more. And they should avoid too much stress, monitor their vital signs and share bio-data.
Statistically, this works. People who do these things are healthier on average.
And, yes, society's institutions should help them to do this. Schools should provide nutrition education (and healthy lunches). Businesses should encourage their employees to be healthy by providing discounts on insurance, offering team sports, and the like.
But suppose this fails. Suppose that, despite all blandishments, someone gets diabetes through some combination of behaviour and genetics. Should they now be blamed for developing diabetes and raising health-care costs? Or can they blame their parents or the state for their inability to be healthy?
Sometimes such things are simply bad luck. It is important to remember that statistics are about generalities: for every 100 people who are 90 per cent likely to be healthy, 10 per cent will be unhealthy - and it may or may not be their "fault". Yet we seem to be heading towards a world in which self-anointed saints and blamers face off against supposed sinners and suspects.
To be sure, it is worthwhile to foster healthy behaviour. But how far do we want to go? I suspect that different societies, cultures, employers and governments will come up with different answers.
In practical terms, though, we would be wise to listen to Collazo's plea: "I am not a fat blob, having [unhealthy] English breakfasts, who gave herself diabetes. I am a human, and I have dignity."
We should remember the old saying: hate the sin, not the sinner. We can attempt to stop diabetes without rejecting diabetics, and to eliminate obesity without demonising the obese.
Nowadays, people have more choices - and more opportunities to make the wrong choices - than ever before.
In the end, we need to acknowledge the outliers - the people who got diabetes by chance, not by fault. They may be a minority but, for the sake of human dignity, we must allow every one of them to claim that statistical anomaly, even as we support each of them in trying to follow the path that statistics indicate could help them to lead healthier lives.
Esther Dyson, CEO of EDventure Holdings, is an active investor in a variety of start-ups around the world. Copyright: Project Syndicate