Disease is no democrat. As 2020 has demonstrated. This year has made us all part of a vast data-collection project that will, when computed, reveal Covid-19’s favourites and perfect victims, its disproportionate wrath. We already have the preliminary findings.
Black Britons and poor Britons have suffered the most. This could be a propensity of the Coronavirus, but it might simply be a function of the contemporary United Kingdom, where living in the richest areas of the country buys you almost 19 more years of life than if you lived in the most deprived. If the Victorian researcher Charles Booth were to rise from the grave to draw us some new poverty maps, he’d still need all those different coloured inks.
One ailment, though, maintains a reputation for discriminating against the wealthy. Gout makes big toes swell painfully and cartoonishly. It causes chalky nodules called tophi — often compared to crustacean eyes — to balloon from knees and knuckles. It hurts. (“Like walking on my eyeballs,” reported the Regency cleric and humourist Sydney Smith.) The condition occurs when excessive amounts of uric acid in the blood cause crystalline needles of salt to gather in the joints and surrounding tissues. Its raw materials are purines — chemical compounds thickly concentrated in seafood, meat and alcohol — which helps to explain why gout gained its status as “the disease of kings.”
“Gout,” concluded Thomas Sydenham, one of the founders of British clinical medicine, “kills more rich men than poor, more wise than simple.”
Three centuries later, that’s no longer the case. The last big British study found that prevalence of gout in the population had increased by over 60% between 1997 and 2012. (Wales and the north-east of England were particularly afflicted.) In US, the “gout therapeutic market” is valued at $1847m, and a report released last month projected it might reach $3820m by 2027.
Thomas Sydenham might have looked at these figures and seen a strange and painful kind of social progress; a pathological levelling-up. In his day, only the wealthy could afford to surfeit on lampreys, pate and port. Perhaps, in 202o, cheap meat, cheap booze, the Iceland prawn ring and the two-metre long Aldi pig-in-a-blanket have made gout a disease to which anyone can aspire.
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