London, April 23: The people of Bihar, some of who are among the poorest in the world, are in some ways happier than Americans, the richest in the world.

The Americans make themselves miserable by worrying unnecessarily about their health, according to an astonishing paper published in the prestigious British Medical Journal.

The author, Dr Iona Heath, a general practitioner in Kentish Town, north London, quotes the economist Amartya Sen to back up some of her arguments and says that there is an unhealthy relationship between doctors, politicians and pharmaceutical companies.

Her central thesis is that pharmaceutical companies have a vested interest in making the rich worry about what more they should do to prevent illness. In the process, millions are persuaded to become virtual hypochondriacs, she seems to be suggesting.

Heath has been chairwoman of the ethics committee of the Royal College of General Practitioners since 1998 and was previously vice-chairwoman of the college.

It is just as well she did not stretch her research to Bengal where some people are happiest telling others about their illness, real or imagined. Perhaps she would have concluded that doctors and pharmaceutical companies make money by over prescribing, judging by what she has to say in the BMJ.

Heath?s conclusion? ?It seems that the more people are exposed to doctors and contemporary health care, including the rhetoric of preventive care, the sicker they feel.?

In her paper, entitled ?Who needs health care?the well or the sick??, she makes the point: ?Shifting drug spending from the worried well in developed countries to those with treatable disease in poorer nations will benefit the health of everyone.?

Heath attacks ?investment in health care, especially when it is driven by the interests of pharmaceutical companies?.

She says: ?The emphasis on preventive care damages patients in rich countries by tipping them towards misery. This process is built on a foundation of fear and is fanned by economic and political pressures. A fraction of the spending on preventive medicine in rich countries could make a huge difference to the health of poorer nations.?

She explains: ?Amartya Sen has compared people living in Bihar, Kerala and the United States. Bihar is the poorest state in India, and Kerala is the state that has invested most heavily in education and achieved the highest rates of literacy. Predictably, life expectancy is lowest in Bihar and highest in the United States, with Kerala?s falling between the two but much closer to the United States.?

?However, the rates of self-reported illness are paradoxical: low in Bihar, where the low expectations of health are disturbing, and enormously high in the United States, which is equally disturbing but for different reasons,? she goes on. ?Kerala combines the greatest longevity and the highest rate of self reported illness of all the Indian states.?

Heath finds her answer in English literature: ?George Eliot thought these questions the core of research and, describing the young Dr Lydgate in Middlemarch, she wrote, ?He wanted to pierce the obscurity of those minute processes which prepare human misery and joy... that delicate poise and transition that determine the growth of happy and unhappy consciousness.??

Heath says: ?Health has become the over-riding contemporary virtue, and the measure of health care in rich countries has become, to a great extent, the simple prolongation of life. Doctors are exhorted to use preventive technologies to try to ensure that everyone lives as long as possible. The danger is that the achievement of longer and, by all objective measures, healthier lives, may result in those lives being increasingly dominated by feelings of illness and fear.?

The drug companies, especially in the West, will not like her allegations: ?The political and financial power of the multinational pharmaceutical conglomerates continues to grow, and they supply money and resources to both clinicians and researchers. We urgently need to move away from bullying of patients by doctors, of doctors by politicians and, I suspect, of politicians by multinational corporations.?

Heath says: ?Only a minority of most populations are sick at any one time; the majority are healthy. It is clearly in the interest of the pharmaceutical industry that this majority should be persuaded that they need to take action to remain healthy by being screened and taking preventive medicine.?

She gives the damning example of Britain: ?Seventy per cent of the UK population is taking medicines to treat or prevent ill health or to enhance well-being. How can this level of medicine taking be appropriate in a population which, by all objective measures, is healthier than ever before in history? As the overall health of a population increases, more money can be made from selling healthcare interventions for the healthy majority than for the sick minority. In rich countries, more money is now invested in research into the prevention of disease than into its treatment.?

She poses a philosophical question that is deeply relevant for a city such as Calcutta with its ingrained culture of illness. ?As doctors, are we simply interested in postponing death? Should we not also be interested in reducing rather than fanning the human burden of fear and in emphasising rather than undermining health??

Is there some validity in Heath?s thesis?

This is, of course, anecdotal evidence but an Englishwoman who works in a south London general medical practice told The Telegraph: ?Dr Heath is absolutely correct.?