'Why rewards work better than nannying'

The public is being urged to take more responsibility for its health to cut smoking and drinking and take more exercise.

But in this week's Scrubbing Up, Professor Richard Ashcroft, a bio-ethics expert at Queen Mary, University of London, warns that will-power is often too weak.

Health Secretary Andrew Lansley told the doctors' union, the British Medical Association, it was time for people to take more responsibility for the health of themselves and their families.

Lansley argued that if we want to see people eating healthier diets, smoking less, and taking more exercise, then an approach based on lecturing people, supervising what they eat, and banning things would fail - unless people's behaviours changed too.

He was not saying - as conservatives (small c) often do - that it is none of the state's business what people eat.

Quite the opposite: he was explicitly arguing for the state having a role in changing how people behave.

What motivates

What Mr Lansley was doing was arguing that we need to look at the ways we try to encourage healthy eating, giving up smoking, etc.

Do they work? Or do they sometimes achieve the opposite of what we intended?

But politicians who advocate patients taking greater control of their own healthcare fail to understand what really motivates people.

It's all very noble, but recent behavioural science research challenges the idea that people are rational decision-makers where their personal health is concerned. People are not always in full control of their behaviour.

A prime example is smokers. Despite knowing the damage their vice causes, the instant fix they get from a cigarette overrides any consideration for long-term wellbeing.

The problem is not really that we all have things we like, and knowingly eat or drink, which aren't all that good for us.

A little of what you fancy

Most of us know that a little of what you fancy does you good, and most of the time we're right.

Sometimes we'll knowingly "trade off" different goals we have: I want that ice cream, and I want lose weight, and right now I choose the icecream, knowing that the plan to lose weight is taking a hit. But that's a conscious choice, even if I regret it later.

The problem is that often we make these sorts of choices unconsciously, or make mistakes. Or our commitment to our goals is weaker than we think. Or - hardest of all - our will is weak.

In other words, it isn't just that I trade off icecream against weight loss in favour of icecream now. It's that I do so systematically.

My behaviour is shaped by forces I don't know about, don't understand, and even when I do, I find hard to resist or control.

A lot of this is about getting better informed, but health education is only part of the story.

Some health information campaigns are very compelling - think of the anti-smoking campaigns which use children talking about their parents' lung cancers. But the evidence that they work is weak.

And they rarely have the seductive appeal of the campaigns of the tobacco and alcohol industries. Health campaigns are rarely about pleasure and enjoyment, and they are rarely cool.

But even when I get 'clean' information that isn't intended to bias my choices one way or another - my habits and thought processes are just as important, if not more important, than what I know.

Lecturing people fails both because no one likes to be hectored, and because people don't necessarily learn from it. And they have other sources of information as well.

Usually what drives me is circumstance, habit and short term reward. So the trick is to find ways to rewire my habits, change my circumstances, and make the rewards pull me in ways I want to go, and not in ways that are harmful to me. And that's hard.

It is also hard to see how getting industries which have an interest in getting me to buy their (harmful) products in increasing quantities can be trusted with promoting health education and health behaviour change at the same time.

With government advertising budgets being slashed and the Change4Life scheme being handed over to the private sector, this is a serious concern to many working for public health.

The sting in the tail of Mr Lansley's tale is that "personal responsibility" might be what's at the root of the problem, not the solution.

'Give out statins with junk food'

Fast food outlets should consider handing out cholesterol-lowering drugs to combat the effects of fatty food, say UK researchers.

Taking a statin pill every day would offset the harm caused by a daily cheeseburger and milkshake, the Imperial College London team said.

It would only cost 5p a customer - similar to a sachet of ketchup.

But the British Heart Foundation warned an unhealthy diet does more harm than just raising cholesterol.

Writing in the American Journal of Cardiology, Dr Darrel Francis and colleagues said it was about reducing harm in the same way that people who smoke are encouraged to use filters and those who drive are told to wear seatbeltsA junk food diet has a wealth of unhealthy consequences beyond raising cholesterol”

End Quote Professor Peter Weissberg British Heart Foundation

They took data from trials of almost 43,000 people to calculate whether the statins could override the effects of eating a junk food diet.

A statin a day can neutralise the risk of cardiovascular disease linked to a daily intake of a 7-oz cheeseburger and a small milkshake, they calculated.

The researchers said there could be no substitute for leading a healthy lifestyle, including eating a good diet, but that a complimentary statin would be at least one positive choice among a sea of negative ones.

For those only eating junk food once a year, an annual one-off statin dose would have little effect, but for those who partake more regularly it would have a greater opportunity to neutralise that risk, they added.

Heart risk

Statins are already taken by millions of Britons to reduce the risk of suffering a heart attack or stroke by lowering levels of bad cholesterol in the blood.

They are thought to be fairly safe, although some experts have raised concerns about side-effects.

One low-dose statin - simvastatin - is available in a low dose to buy from the pharmacist.

"Importantly, even partial adherence to statin therapy conveys a mortality benefit, suggesting that statins do not need to be taken daily to have some protective effect," said Dr Francis.

Cattle 'cloned from dead animals'

Cloned meat - from lab to plate

Some of the cattle cloned to boost food production in the US have been created from the cells of dead animals, according to a US cloning company.

Farmers say it is being done because it is only possible to tell that the animal's meat is of exceptionally high quality by inspecting its carcass.

US scientists are using a variety of techniques to assess which animals have exceptional qualities.

These attributes include meat quality, productivity or longevity.

These exceptional animals are cloned to be used as breeding stock, with the aim of raising the quality of herds on beef, dairy and pig farms in the US.

There is a long tradition of resurrecting dead animals for cloning - Dolly the sheep being a case in point.

The head of the leading US animal cloning company has said that European farmers will fall behind the rest of the world unless they are allowed to use such techniques to improve the productivity of their livestock.

The aim of livestock cloning is to clone the best animals to produce the best beef.

But some cattle farmers believe it is impossible to pick the best quality animals until their meat has been properly analysed.

That is why there are cloned bulls here that have been produced from the cells taken from the carcasses of dead animals.

Brady Hicks of the JR Simplot company in Idaho said his organisation was among many that had tried out the technique successfully.

"The animals are hanging on a rail ready to go to the meat counter," he told BBC News.

"We identify carcasses that have certain carcass characteristics that we want, but it's too late to reproduce the genetics of the animal. But through cloning we can resurrect that animal."

These "resurrected" animals are then bred with naturally born cows. The next step is to see if their offspring - whose meat can be sold to consumers in the US - have the same qualities as the grandparent from which the cells were originally taken.

Ranchers at the Simplot company also clone from live animals that are particularly productive or fertile.

The driving force behind the project is the head of the company, Scott Simplot, who firmly believes that cloning can be used to improve beef production. His stated aim is to raise the standard of the great American steak.

"The notion behind what we are doing is to find that animal that created that great steak - and once we have it, we want to reproduce it," he said.

"So (if we are successful), every time we have a steak at a restaurant it will have that memorable taste."

But the idea is not to everyone's taste. The leading whole food chain in the US, Whole Foods Market, has banned the sale of products of cloning.

According to its global vice-president, Margaret Wittenberg, although meat and milk from cloned animals has been allowed to go on sale in the US, most Americans have never heard of it.

"A lot of customers in the United States are oblivious of it," she said.

"You don't hear about it in the media. And when you do tell people about it they look at you and say 'you're kidding! They're not doing that are they? Why would they?'"

Ban bid

Mark Walton, president of the leading US animal cloning company, ViaGen, says livestock farmers have a very good reason to use his services.

He says scientists in many countries are trying to find ways of using the technology to boost production and quality.

Cloning is not used by livestock farmers in Europe, and there are moves by some members of the European Parliament to ban it altogether. Mr Walton believes that would be a mistake.

"If I were a European farmer and my competitors in the US, China and South America were using the technology, I'd be concerned about losing all access to it," he said.

It is early days for cloning in US agriculture. There are only a thousand clones in the one hundred million-strong American cattle herd.

The idea is to pick the best animals and use them to breed from. ViaGen charges cattle farmers $17,000 to clone an animal.