No One Is Coming

Why physiological rights will not be defended by any of the guilds that surround them, and why the defence must be legal.

The physiological deficit is present, documented, biologically consequential. The tests that would name it are not run. The nutrients that would correct it are not prescribed. The advice that would restore it is not given. Who will defend the person in whom the deficit sits?

Not from the medical community

Physicians are trained to respond to diagnosis, not to deficit. What is not on the diagnostic list is not on the therapeutic list. The medical community has spent forty years being taught that restoring what the body no longer produces is the paradigmatic error of a pre-scientific medicine. The founding exemplar of that lesson is the Women’s Health Initiative, and its reading has been thorough. A physician who names a physiological deficit outside of a listed disease is a physician who has departed from the standard of care. The economic architecture reinforces the training. Consultations are billed for diagnoses. Deficit is not a diagnosis. Restoration is not a treatment. The defence of the physiologically deprived person will not come from the profession that has been formed not to see them.

Not from the wellness industry

The wellness industry sells hope. It cannot sell a right. A right is universal, owed, and enforceable; a wellness product is optional, purchased, and personal. What the industry offers is the depoliticisation of the physiological question. The person who is missing magnesium becomes a consumer who might choose to try a magnesium supplement, and the failure of a public institution to have identified and corrected the deficiency becomes a private matter of consumer preference. The industry benefits from the framing. Its revenue depends on physiology remaining a matter of individual optimisation. The defence of a right requires that the individual choice frame be transcended, which is the frame the industry lives inside.

Not from the nutritionists

The nutritionists are accredited by curricula built on national dietary guidelines. Those guidelines are constructed with, and in many cases directly written by, the food industries whose products the guidelines endorse. A nutritionist who publicly names what the balanced diet does not deliver risks the professional recognition without which the practice cannot exist. The frame of the profession is that the balanced diet is sufficient, that supplementation is at best insurance, and that the person who is missing something has probably not been eating well. The profession is not organised to answer the question of what the balanced diet cannot provide in principle. The defence of a physiological right requires that question to be answered.

Not from the pharmaceutical industry

Bioidentical hormones are not patentable. Naturally occurring nutrients are not patentable. Peptides that the body already produces are, at best, marginally patentable in specific formulations. The pharmaceutical industry has no structural incentive to defend the restoration of what the body would produce on its own if given what it needs. Its incentives run in the opposite direction: toward the patented analogue, toward the pharmacologically active modification, toward the compound that can be exclusively licensed and priced to recover a development cost. A right that centres on what the body already knows how to make will not be defended by an industry whose economics require that what is sold be new.

Not from public health

Public health is calibrated to the population and to the manifest deficiency threshold. Its instruments (the recommended dietary allowance, the fortification target, the public advisory) are averaged and floor-set. They are designed to avoid the frank historical deficiency diseases: scurvy, pellagra, rickets, beriberi. They are not designed to name the intermediate zone in which a person is neither frankly deficient nor optimally supplied, and in which most of the disease of the modern industrialised population is generated. The language of public health is the language of recommendation, not of entitlement. A recommendation can be issued without an obligation of enforcement. A right cannot.

Not from the universities

Research funding follows industry priorities. To publish on what the industries have not decided to test is to publish outside the well-lit corridor in which the citations accumulate and the tenure decisions are made. A young researcher who systematically investigates conditionally essential nutrients, individual variability in requirements, or the therapeutic use of doses above the recommended intake is a young researcher whose grant applications will be scored below those of peers investigating the currently fashionable question. The university produces knowledge along the axes that the funding structure rewards. The defence of a physiological right requires knowledge along axes the funding structure does not reward.

Not from the science communicators

The popularisers, the health journalists, the skeptics, the debunkers, the mythbusters, the fact-checkers of medical claims: this group has positioned itself at the extreme centre of the discourse. Its stance is a stance of neutrality, and the neutrality is claimed as its virtue. In practice, the reference point against which claims are measured is the current consensus of the scientific institutions. What the institutions endorse is treated as established. What they have not addressed is treated as non-existent. What they have marginalised is treated as debunked. The extreme centre does not exit the frame of the institutions it reports on. Its reputational survival requires that it not exit. Defending a physiological right requires exiting the frame: naming what the institutions have not named, requiring what the institutions have not required. This is the operation the extreme centre is professionally incapable of.

Only jurists can break this silence

The list could be extended. Insurers reimburse what medicine codes, and code nothing else. Patient associations are often financed by the industry whose products treat the disease around which the association organises. Professional boards enforce guidelines and sanction deviation. In each case the reasoning is the same. The actor is either economically dependent on the frame that produces the invisibility, or professionally trained to reproduce it, or reputationally positioned to defend it.

What remains?

The jurist works in a category the medical community does not use. A right is not an evidence-graded recommendation. It is an entitlement. It does not require, before it can be defended, that the scientific institutions have finished measuring the deficit or that the pharmaceutical industry have found a way to profit from its correction. It requires that the person be entitled to the physiological substrate of their own health, and that the entitlement be given legal effect. The right to food, in the international instruments where it appears, is such an entitlement. Its operationalisation into specific physiological rights, the right to adequate magnesium, adequate potassium, adequate B vitamins, adequate omega-3, adequate bioidentical hormones when the body has ceased producing them, is a legal move.

The jurist is the only actor whose professional survival does not require deference to the guilds that produce the invisibility. The jurist can name what the guilds have not named, because the naming does not depend on the guilds’ consent. The defence of physiological rights will come from law, or it will not come.