Scribblings and blether and haver

March 2020 reading list

Better late that never, here’s the March reading list. Just in time for the end of April. It all coincided with full COVID-19 busy-ness so has had to wait a while. Here are the books for the past month:

Recommendation of the Month

Looking back this is not an easy choice for this month and there are some fine books here. Heimat is a graphic novel and not the kind of book I would have picked up, if it hadn’t been an Orwell Long List book, but I thoroughly enjoyed it. Both books by Bloodworth were excellent and I particullarly liked the short punchy nature of The Myth of Meritocracy. Last month I read Myers’ memoir of Northern Ireland Watching the Door and Say Nothing is the perfect companion — it’s easy to see how it won the Orwell Prize. I wasn’t sure I would like Permanent Record and I was completely won over by Snowden. A close runner up for my recommendation this month is The Line Becomes a River which tells of the experiences of Cantú, a border guard patrolling between Mexico and the USA. It is beguiling, haunting and humanises the struggles at the border. Rather wonderful.

However, if recommendations are based on how many times I actually tell people about a book then McGreal hits the spot in American Overdose. You can read the comments and quotes° I picked out. It’s obviously a cliché to suggest ‘all doctors should read this’ but it has been a very powerful stimulus for me while working in clinical settings of dependence and substance misuse. I’ll keep on recommending it to anyone who stands still long enough within earshot.

The Growth Delusion by David Pilling

This book is about GDP. Gross Domestic Product. It might not seem like the most auspicious of topics but Pilling pulls us along into a fascinating journey through economics, climate change, and happiness. GDP is a single number that has come to dominate our lives in a staggering way. It is the embodiment of the ‘economy’. Whatever that is. Pilling explores this and, near the end, describes this single number as “trying to squeeze a frog into a matchbox”. He reminds us that the economy is just an invention, it isn’t real in the sense of being tangible. It’s a relatively modern way of conceptualising some of the activities of our society.

He discusses alternatives to the GDP like the Genuine Progress Index° and the Happy Planet Index° (not widely used, he tells us, due to tendency for it to make world leaders laugh). He considers the environmental impacts of growth and how we might take them into account. He describes how two separate processes came up with the same number for the overall wealth of the world, somewhat spookily as he says, with the value of $33 trillion. He asks: should we be describing the planet’s resources in money terms at all, does it legitimise the destruction of deep time resources?

He gets into happiness and, so inevitably, discusses Bhutan and its Buddhist influenced approach. Parenthetically, they still don’t seem that happy on most measures but that might be because they are just so darn poor they still have to raise themselves up to that basic level.

There is one rather wonderful quote about growth: “Only in economics is endless growth seen as a good thing. In biology it is known as cancer.” This can stand along Greta Thunberg’s angry: “fairy tales of eternal growth” rebuke° to those that can’t spot the internal flaw of growth-orientated capitalism.

Pilling talks about the “deaths of despair” and I’m very aware of how much I see those in my routine clinical work — the deaths due to suicide, drug addiction, and chronic liver disease. It was economists Anne Case and Angus Deaton who first talked about this and I’ve ordered their new book, Deaths of Despair and the Future of Capitalism° that has only just been published. What strikes me is that this concept has, potentially, enormous power to change how people view these problems and might influence how we tackle them.

This book is in my Orwell Long List 2019 series of posts.°

American Overdose: The Opioid Tragedy in Three Acts by Chris McGreal

For me, there wasn’t any getting over the sheer of horror of this book. It unflinchingly portrays the drug industry in all its absolute criminal neglect. Looming large is Purdue Pharma who built their business up from the humble origins with the Sackler brothers into a billion-dollar corporation. They shamelessly manipulated the research, the researchers, the clinicians, and federal agencies who should know better. Oxycodone was a drug that simply didn’t have good evidence but they managed to create a movement, the ‘epidemic of pain’, that compelled doctors to prescribe. The pill mills in counties like West Virginia churned out prescriptions at an alarming rate. Far faster than any single doctor could even write them.

Eventually, many of those doctors and others who organised those clinics faced some kind of retribution but often it was minor, few did any jail time, and they all ended up significantly enriched. None more so than Purdue Pharma but many other pharmaceutical industries were quick to jump on the bandwagon. Their influence went far and wide and deep. Apparently independent institutions were taking hefty payments from the industry. And Americans died in their hundreds and thousands.

This particular sordid story has a long tail as well. Even if the prescription opiates have eased back many people have already been led into opiate addiction and this is fuelling increases in heroin use. It will be another generation before this is back to any kind of balance and in the meantime people die, families are bereaved, children are taken into care, societies are irrevocably disrupted. I’m very involved in the clinical management of substance misuse and we’re all deeply concerned about the death rates from drug poisoning in the UK yet we barely register as a tremor compared with the seismic disruption from opioids in the USA.

There is much to raise alarm: the misrepresentation of the NEJM letter by Porter and Jick that was misrepresented, cited for years, to make the case and drive for opioid prescribing; the lobbying and pernicious influence of the pharmaceutical industry on governments; the complicity of state organisations with corporate entities and the revolving door as regulators took up lucrative consultancy posts; the manipulation of drug trials and “enriched enrolment”; and the scumbag doctors who flagrantly breached professional values to amass fortunes. When it comes to anger, it’s difficult to know where to start.

Some selected quotes:

“The crude calculation is that prescription painkillers have claimed more than a quarter of a million American lives, although there are good reasons to believe the toll is higher because of under-reporting and stigma.”

“In England and Wales, opioid prescriptions have doubled over a decade, driven by the dispensing of tramadol. Two million Britons have taken a painkiller that was not prescribed for them. Deaths involving opioids have more than doubled since 2012 in England and Wales, driven by a surge in heroin use.”

“The US consumes more than 80 percent of the world’s opioid painkillers yet accounts for less than 5 percent of its population.”

“The congressman had other examples: a Kentucky doctor who prescribed more than 2 million pills to 4,000 patients over 101 days, and the physician who saw 133 patients in a day in an office without electricity and was prescribing OxyContin and Viagra to teenage boys until the feds locked him up for twenty years.”

“The FDA continued to allow OxyContin to be widely prescribed for moderate pain. “We were ignored,” Congressman Rogers told me. “They just listened to us, smiled, waved good-bye.””

“The White House estimates the crisis has cost the United States $1 trillion because of the demands on health care, policing, the courts, and lost jobs and productivity and is likely to cost half that amount again over the next few years. The epidemic costs West Virginia alone more than $8 billion a year, about the same as the drug industry makes from opioids.”

“In 2017 the New England Journal of Medicine posted a rare warning note over the online version of the Porter and Jick letter whose misrepresentation had been a foundation of the campaign by the opioid ideologues: “For reasons of public health, readers should be aware that this letter has been ‘heavily and uncritically cited’ as evidence that addiction is rare with opioid therapy.””

“John Brownlee, the former federal prosecutor in Virginia, regarded Purdue Pharma as a criminal enterprise.”

“But they were drowned out as the American medical system was hijacked by a mix of bad science and corporate money. The result was a lost decade—the years between the unequivocal warnings from those grappling with the early impact of mass prescribing of opioids and the CDC stepping up to the plate—in which the epidemic could have been contained and hundreds of thousands of lives saved.”

This book is in my Orwell Long List 2019 series of posts.°

Hired: Six Months Undercover in Low-Wage Britain by James Bloodworth

This book details Bloodworth’s experiences as he tours through various low paid jobs in England. He starts working in an Amazon warehouse in the Midlands where he works as a ‘picker’ with a GPS tracker and under near constant surveillance. The work is gruelling, walking many miles per day. It’s also apparent that there are few employment rights. The workers are issued with ‘strikes’ for minor offences, even being off sick for genuine reasons, and once they reach six they are sacked. It is mostly staffed by European immigrants. Few can stick it for any length of time.

Then he comes to Blackpool to work as a carer for CareWatch. Again, it’s incredibly low paid work and exhausting with unreasonable demands and little training. Next down to South Wales where he spends time working in a call centre for Admiral, speaking to people in the old mining communities that no longer exist. He comes back to London to do a spell as an Uber driver.

This is Orwell’s The Road to Wigan Pier for the 21st century and the gig economy. Bloodworth doesn’t spare any time in gouging the myth of ‘be your own boss’. It almost feels like it is verging on some Orwellian pastiche in its descriptions, especially when he lingers on the descriptions of the accommodation and the hard scrabble lives of people in low quality accommodation and gig economy wages. Like Orwell, he is scrupulous about the money, offering detailed figures on the incomings and outgoings. The reality of how much one can earn and how the costs of daily living soon fritter it away. The outsourcing of work to agencies adds to this pressure with pay often being late, or wrong. And, of course, when it is wrong people are underpaid.

Bloodworth doesn’t spend much time dwelling on the health implications but there is an interesting digression into this during his time working for Amazon. Despite the physical element to the work he puts on weight and feels unhealthy. His accommodation makes it hard to cook and he slips into comfort eating at McDonalds, drinking beer regularly (though probably not beyond recommended limits), and smoking. I’d also be willing to wager that the areas of the towns in which he stayed there is a high density of takeaways outlets, fried chicken shops etc. They will be particularly obesogenic. I’m reminded of the idea of the all-consuming cognitive bandwidth toll that this poverty places on people.

People don’t like migration in the general but in the specific they are usually unfussed. They fret about migrants taking their jobs, taking benefits, clogging up the NHS but only when they don’t link this to the people they know. Those ones are usually regarded as perfectly OK, somehow the exception to the rule. They are no longer part of the out-group, they are the in-group, and people will perform cognitive contortions to make this work. This is something we all do as humans, it’s not some special quality of people in poverty. We all carry that bias with us all the time.

Hired is not a cosy read and it’s an uncomfortable insight into the hardship of hard-working people trapped in work environments without rights and with very few options.

This book is in my Orwell Long List 2019 series of posts.°

In Extremis: The Life of War Correspondent Marie Colvin by Lindsey Hilsum

I sense there is a mythologising of Colvin that occurred during her lifetime and has certainly intensified since her death. Her website° states she was “the greatest war correspondent of her generation” and pays tribute to her achievements. That’s understandable and it doesn’t dwell on any moments of personal unhappiness or any self-destructive behaviour that brought those plaudits. We have to celebrate her work and life but did it have to come at such an appalling cost to the individual? Is being the greatest war correspondent about being the person who runs the biggest risks?

Hilsum does a very good job of presenting the facts and we’re left to fill in the gaps. Her admiration and love for Colvin shines through but this is no hagiography; Colvin’s flaws are left open for examination. There has clearly been much introspection about the role of the war correspondent in past years but this book should certainly generate plenty of discussion amongst journalists. I would hope that this is a topic that is debated regularly. How close must one be to “bear witness”? From my perspective, as a doctor involved with vulnerable people, it’s difficult not to listen to this book and be appalled at the pathology on display.

We need to talk about alcohol. Early in the book it’s very apparent from Hilsum’s descriptions that Colvin was using alcohol spectacularly. She offers descriptions of Colvin being drunk at key moments, not filing copy in time, flouting the advice of editors and bosses. It made me wince to listen to someone who seemed to need help and was often desperately unhappy. It all rather depends where one let’s one lens fall — Colvin had more moments of joy and intense pleasure than most people can imagine. Yet, there is a lingering note of regret here.

I listened to the audiobook and it was narrated by the author, Lindsey Hilsum. This always makes me nervous. Hilsum has written a very fine book but the qualities of professional narrators aren’t to be under-estimated. In the end, it works out just fine, if lacking some of the seamless qualities of the top narrators, but the hint of an American accent when Hilsum reads quotes from Colvin made me twitch a little.

The thought that kept running through my head was how Colvin was allowed to go back time and time again. It’s not as if Colvin was a model professional when not overseas; the impression I was left with was that she was drowning rather than waving. I found it difficult to conceive how any reasonable employer could send a person with serious mental health problems and severe PTSD back to a conflict zone. Repeatedly. Times change and I’ve no doubt that much of this stems from Colvin’s forceful personality but, in terms of duty of care, it feels hard to defend. Hilsum does cover this a little at the end: “There are those who blamed her editors for her death. She should have been taken off the road years ago, they said.”

Much of this biography is taken up with the personal details of Colvin’s life and that, to me, felt important. The reporting from war zones is punctuated by her rather jet-setting, somewhat hedonistic lifestyle, and Hilsum makes extensive use of Colvin’s diaries to flesh out Colvin’s emotional state. Colvin was a passionate, if not always objective, witness to many horrors but Hilsum offers a more rounded picture than the image of the journalist-warrior striding across the landscape in search of truth. It’s compelling and inspirational but it’s tinged with sadness.

This book is in my Orwell Long List 2019 series of posts.°

A note

I’m keeping it simple and focused on the writing but I have added a few tags for some themes.

Email if you want to get in touch: scribbles@euanlawson.com

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Why We Get the Wrong Politicians by Isabel Hardman

This is another book that feels like it doesn’t have a name that entirely reflects the content and is just a little too click-baity but that shouldn’t stand in the way of what is a very lively and informative read. Hardman does cover a lot of ground and it’s a largely sympathetic portrayal of our politicians. Quite rightly, it doesn’t hold back from criticising them when needed — particularly when considering sexual harassment within the establishment. Hardman has been a political journalist for many years and she is exposing the systemic problems rather than taking a tilt at the individuals.

Initially, Hardman ventures back into the shocking selection processes to which all the parties subject prospective candidates. The financial and personal costs are hugely punitive with little chance of success in even the best circumstances. These go a long way to explaining why we get the ‘wrong politicians’. They are arduous and damaging to the individuals. Inevitably, that selection pressure will have an impact on those that do make it through.

The book is also very good at pulling back the parliamentary curtain and covering the processes of the Commons and Lords for primary and secondary legislation. The functioning of the chambers along with the role of select committees are detailed and how MPs can interact with these. Hardman uses this to expose how little time MPs, our supposed legislators, get to spend doing the job one might think they are in Parliament to do: scrutinising and refining existing and new laws. Hardman makes it clear just how the system is stacked against any tendency to voice an opinion. Any attempt to do so will quickly result in career-ending confrontations with their party.

And, if you are ever thinking of standing for parliament she details the stresses, the god-awful hours and the abuse that MPs receive. It is dismal. You may have little sympathy, and goodness knows there are plenty of villains and rogues, but it serves no useful purpose to have a system that is so very dysfunctional. We have enough difficulties with disproportionate representation as it is but, as ever, it seems that money and privilege are crucial to selection and survival as an MP. I don’t know if it was Hardman’s intention but she ends up presenting a compelling case for reforms at all levels.

This book is in my Orwell Long List 2019 series of posts.°

Orwell Long List 2019

out of 15 books read.

I have, rather belatedly, given the 2020 list will likely appear next month, embarked on a small project to read, reflect, and write about all the books on the Orwell Long List from 2019. There are 15 of them and I will add links and (ticks) as I get through them. They are tagged ‘Orwell Long List 2019’ as well.

 

February 2020 reading list

A quiet month here on the blog, especially notable when the last post was January’s reading list… I’ve been busy enough reading and here are the books for the past month:

  • Watching the Door: A Memoir 1971-78 by Kevin Myers
  • Pills, Powder, and Smoke by Antony Loewenstein
  • How to Have Impossible Conversations by Peter Boghossian and James Lindsay
  • Still You Sleep by Kate Vane°
  • The Socialist Manifesto by Bhaskar Sunkara
  • Rose’s Strategy of Preventive Medicine by Geoffrey Rose
  • Utopia for Realists by Rutger Bregman
  • Mindf*ck by Christopher Wylie
  • Why We’re Polarized by Ezra Klein
  • The Growth Delusion by David Pilling

I’d have to say that my top recommendation from this month would almost certainly have to be Mindf*ck by Wylie. The importance of the Cambridge Analytica story can’t be under-estimated and I’m very relieved to have stepped back from Facebook et al. Watching the Door was remarkable. I learned plenty from Impossible Conversations, though I don’t think the format is ideal for audiobook as it would be better to absorb the book over a longer period. Bregman was excellent and thought-provoking and Klein’s Why We’re Polarized opened up another window to see our current political landscape. If you are a fan of Ha-Joon Chang (I am) then Pilling’s The Growth Delusion is similarly excellent and you’ll never listen to broadcasters talk about GDP again without shouting at the television or radio.

January 2020 reading list

Nothing too complicated about this. Here are the books I’ve got through in January 2020. As usual there is a mix of audiobooks, ebooks, and good old fashioned hardcopy.

I’ve provided some links above when I’ve written something about them. I don’t use Amazon or affiliate links so click away with impunity. These span some seriously varied genres so it is hard to nominate a favourite. As a general rule, the ones I write about are usually the ones that have had most impact. The book I’ve found myself recommending the most and talking about has been Narconomics. I was shocked by Catch and Kill and I loved reading Tilman again after many years away from him. I think I would read a shopping list if it was written in Chang’s wonderfully accessible style and Bliss’s book was instructive in showing how science can be written with a wonderfully human, sidelong gaze.

Narconomics by Tom Wainwright

Narconomics has been on my reading list for a long time now and I’m sorry I didn’t get to it sooner. It’s a sharp analysis, informed and informative, and I took a tremendous amount away from it. It reinforced some important points around the global drug market. Wainwright covers in some detail° the expense and largely futile policing of the drugs trade. In an early example, he takes us through the economics of destroying large amounts of the coca crop and how this has almost no impact on the final price for the consumer. Until then the policy of destroying the source of the drug seems to be entirely logical yet Wainwright dismantles it so comprehensively you are left wondering how you ever believed it in the first place.

The concept of the hard drugs market as being relatively inelastic is an important one. Reductions in supply don’t necessarily shift demand. Attacking the supply-side of the industry has very little impact, particularly in early links of the chain. Interestingly, one of the biggest changes in heroin use, in one case study, was the large-scale adoption of heroin assisted treatment in Switzerland. In effect, it reduced the market, but it also took out the low-level dealers with dramatic reductions in overall usage.

It is also worth reiterating an important point about the drugs debate. It is important to acknowledge the difference between decriminalisation and legalisation. The countries where drugs are used (UK, USA etc) are keen to lay the blame for the problem on the supply side with Johnny Foreigner. We need to be mindful that a half-baked decriminalisation could result in unintended consequences. It will not necessarily have the same effect as full legalisation and regulation. The murders, the deaths, and all the misery inflicted through the organised crime networks that supply the drugs may continue depending on the exact nature of the changes. Decriminalisation may work for the drug-consuming rich nations while entrenching violence and poverty in the drug producing and transit countries.

The move towards cannabis legalisation continues. Wainwright also explores this using economic principles and the often complex, not always intuitive, impact it can have on drug markets. There is a fascinating opportunity with legal cannabis production to ensure it is socially just. Handing over the industry and the profits to corporate regimes would be a mistake – try this article in The Correspondent° for more on empowering people through Big Marijuana.

Catch and Kill by Ronan Farrow

Harvey Weinstein is appearing on television regularly as his trial continues. He looks broken and frail, a shell of a man, but I find it easy to harden my heart and watch, with grim satisfaction, some semblance of the justice process playing out. Before reading this, I understood the gist of the story but I hadn’t read exhaustive accounts in the mainstream media. In Catch and Kill°, Farrow lays it all down for inspection.

In some ways, the pictures of Weinstein now remind me of a few hard men I met when doing prison medicine. Only they weren’t hard men any more. They were weakened, spent, and preyed upon. They had meted out some violence in their time and were now, in their turn, feeling the threat. The difference is that Weinstein is facing appropriate legal actions and not some extra-judicial beating. And perhaps my biggest emotion when seeing Weinstein looking so elderly is one of regret. It has taken too many years and too many victims to get to this stage.

Catch and Kill portrays Weinstein as a predator and a man who deserves to face the full weight of the justice system pressing down on him. The book grimly details Weinstein’s modus operandi and Farrow’s dogged, if not plain obsessive, pursuit of the story. Farrow’s descriptions of the establishment, “the great white predators”°, closing ranks is enough to make you retch. Farrow also records in the book how he was trailed and investigated by a shadowy Israeli security company, a “private Mossad”, employed by Weinstein. NBC do not come out of it well. Actually, very few do. Perhaps only the women who went through it and the ones who were able to steel themselves to resist, to tell their story. And, Farrow as well, he certainly went through the wringer.

One small point, but it needs to be mentioned. I listened to the audiobooks and I have no idea what the producers were thinking of in letting Farrow do the accents. You will read many reviews commenting on it. The only thing I can say is that they did, as the book went on, grate less and less, and the story is too compelling, too astonishing, to even consider sacking it. Don’t let it stop you reading this important book.

The Ascent of Nanda Devi by HW Tilman

There are few figures in the 20th century with as remarkable a story as HW Tilman.° He will be well known to anybody who has spent time working through any of the rich literature we enjoy on mountains and exploration. Inevitably, it won’t be long before your attention is drawn to the books of Tilman and his co-explorer Eric Shipton.° They are a justly famous pairing, though less celebrated beyond adventurer circles, whether armchair or active. I was going to write ‘sadly’ there, but given the style in which they went about their lives, there seems little to regret.

I remember, with great excitement, when the seven collected mountaineering exploration books by Tillman were published in the 1990s. The larger volume still sits on my bookshelf but the very size of it does somewhat restrict its use. As handsome a volume as it is, it’s not easy carting around 900-odd pages worth of hardback book.

I was delighted to discover that the Tilman (and Shipton) books have now been made available as individual volumes and also as e-books. So, I was able to enjoy The Ascent of Nanda Devi (1937) on my Kindle. I can scarcely add to the fine words that have been written about Tilman. He has a thoroughly laconic style, much imitated by would-be literary mountaineers, and famous enough in the 1950s to have helped inspire the parody, The Ascent of Rum Doodle

On the front of the new book it states: “I believe we so far forgot ourselves to shake hands on it” quoting Tilman’s self-parodying line on reaching the summit. It’s a delight.

January Debrief — The Political Doctor

My Debrief for the January 2020 issue is available on the BJGP website.° It was an odd one to write and it already feels like a long time ago. The lag with monthly publication always leaves me slightly disorientated when articles are published. I’m working ahead and, suddenly, something written many weeks in the past bobs back up. This one was particularly unusual as I wrote it in the feverish week before the general election and it was published a couple of weeks after.

I was determined to write something political but I didn’t want, with this particular article, to be overtly partisan. Not that I have a problem with that. I don’t think you’d have to dig too far back into my writings to determine where my loyalties lie but I figured the timing was critical here. I hesitate to invoke the imagery of a party to characterise the election campaign but further comment in the BJGP might have been about as welcome as being offered the previous night’s leftover cold kebab while nursing a brutal hangover. All that said, there has been an interesting reaction to it and it seems to have struck a note with a few people.

For those of the left-leaning persuasion, it’s tremendously easy to lurch into apathy, if not outright despair. Personally, I plan to find ways to dig in and get more involved. The responses I’ve had suggest I’m certainly not alone. Get in touch if you want to talk about it.

On Immunity: An Innoculation by Eula Bliss

This is a sensitive exploration of immunity and vaccines that occasionally digresses and certainly doesn’t follow the main thoroughfares of the scientific highways. It’s more like a version that takes the scenic road, meandering through the countryside, ending up at the same destination, but offering a very different experience for the traveller.

Reading the reviews on Amazon is an uncomfortable experience as it serves a very pointed reminder that the anti-vax sentiment is very much alive and kicking. One review stuck with me, suggesting that Bliss didn’t quote any papers or research, though the reviewer may well have been an anti-vaxxer who simply didn’t like Bliss’ viewpoint. Actually, I think On Immunity is very rich in scientific detail, it’s just wearing it in a very different style. Bliss couldn’t have written a book° like this without the depth of research she has done, it’s a rich vein amongst many other layers, not all of them familiar to those of us whose time is spent reading a certain type of dry academic article.

Here are just a selection of passages I highlighted:

“Having virtually invented a paid profession and being almost exclusively available to the rich, doctors were suspect to the working class.”

“When he taught me [Bliss’s father] to drive, he gave me this advice from his own father: you are responsible not just for the car you are driving, but also for the car ahead of you and the car behind you. Learning to drive all three cars was daunting, and inspired an occasional paralysis that plagues driving to this day.”

“As early as 1840, I learned, a doctor observed that vaccinating only part of a population against smallpox could arrest an epidemic in full.”

“The concept of a “risk group,” Susan Sontag writes, “revives the archaic idea of a tainted community that illness has judged.””

“Killing germs, rather than washing them away, reminded him of the Crusades, when an abbot who was asked how to tell the faithful from the heretics replied, “Kill them all—God will know his own.””

“But risk perception may not be about quantifiable risk so much as it is about immeasurable fear.”

“Our fears are informed by history and economics, by social power and stigma, by myths and nightmares.”

“Intuitive toxicology is the term that Slovic uses for the way most people assess the risk of chemicals.”

“But most people prefer to think of substances as either safe or dangerous, regardless of the dose.”

“But the use of natural as a synonym for good is almost certainly a product of our profound alienation from the natural world.”

“But vaccines are of that liminal place between humans and nature—a mowed field, Berry might suggest, edged by woods. Vaccination is a kind of domestication of a wild thing, in that it involves our ability to harness a virus and break it like a horse, but its action depends on the natural response of the body to the effects of that once-wild thing.”

““Probably the worst thing that ever happened to malaria in poor nations,” Rosenberg writes, “was its eradication in rich ones.””

“It spelled “munity,” from the Latin munis for service or duty. “Munity is what you are really writing about,” a colleague would say to me.”

“The debate over vaccination tends to be described with what the philosopher of science Donna Haraway would call “troubling dualisms.” These dualisms pit science against nature, public against private, truth against imagination, self against other, thought against emotion, and man against woman.”

“That croup, the kind that was frequently fatal in a short time, was caused by diphtheria and has virtually disappeared in this country since the introduction of the diphtheria vaccine in the 1930s. My son had viral croup, once distinguished from diphtheria by the French with the term faux-croup. While diphtheria kills as many as 20 percent of the children who contract it, faux-croup is rarely fatal.”

“The wise practice of waiting and watching is hard to sell, in part because it looks a lot like doing nothing.”

“The purpose of heroic medicine was not so much to heal the patient as it was to produce some measurable, and ideally dramatic, effect for which the patient could be billed.”

“Childbed fever, as puerperal sepsis was called, was spread by doctors who did not wash their hands between exams. But doctors blamed it on tight petticoats, fretting, and bad morals.”

“Autonomy is usually imagined as the alternative to paternalism. But in what is sometimes called the “restaurant model” of medicine, the paternalism of doctors has been replaced by the consumerism of patients.”

“And the doctor, who was a father in the paternalistic model, is now a waiter.”

““Where there is trust, paternalism is unnecessary,” the philosopher Mark Sagoff writes. “Where there is no trust, it is unconscionable.” And so we are caught in a double bind.”

“measles has killed more children than any other disease in history”

“Until the results of a small study are duplicated by a larger study, they are little more than a suggestion for further research.”

“Immunity is a shared space—a garden we tend together.”

Bad Samaritans by Ha-Joon Chang

I’ve read a number of books about economics in the past year or so. They have, undeniably, been written by economists who would self-identify as left wing and who are, on various levels, putting forward arguments to refute neoliberalism.

In a recent Debrief column for the BJGP° I wrote that doctors did, often, regard themselves as being beyond politics. Economics has also tried to pull off this sleight of hand. Economic is no more apolitical than medicine. The notion that the free market is currently unrestricted in some pure form, outside the interference of politics, doesn’t stand up to any reasonable scrutiny. We don’t let industries pollute indiscriminately and we have abolished child labour – both are fundamentally political decisions, made by society, for the greater good and the boundaries of the free market are always set in one place or another.

I’ve read the Chang books slightly out of order and I’ve just read Bad Samaritans.° This one puts forward his myth-busting approach to economics, so well exemplified in 23 Things They Don’t Tell You About Capitalism° and puts it in the context of the developing nations which is Chang’s main interest. I find Chang to be lucid and compelling. We castigate developing countries who dare to suggest economic policies that we ourselves used to nurture our own infant industries°, and we strong-arm them into accepting a free market approach that will continue to enrich us more than anyone. It’s hard to shake a lurking outrage, if not shame, when our hypocrisy is so grimly exposed.

Strava update for 2019

Here, apropos of not all that much, are my Strava stats for 2019. I’m fairly diligent about recording all my activity on Strava and I find it a convenient way to monitor how much exercise I’m getting. I’m no longer indulging in the social media side of it at all. Over the past 5-6 years I’ve hit around 250-270 hours each year and that’s evenly spread over the months. I’m almost tediously regular. I rarely have single activities that are particularly long but I am super consistent. And, no matter how hectic life gets I can almost always get something in. Measuring it keeps me honest and if I have to have a lighter week or two, or I have a quiet month, I just try to lift it back again a little.

This works for me incredibly well. I don’t go through any binges of exercise and I simply have no prolonged periods without any exercise. I no longer have to go through that pain of trying to get back into running when I’ve laid off for a few months. Doing half as much, on a consistent basis, month upon month, is something most people could manage. It’s surprising how little will work if you can just keep doing it, week in week out, building the habit, accumulating the benefits.

Around 200 hours is running and most of the rest is made up of weight training. I’ve done a minsicule amount of cycling in the past year. That is, on reflection, the one thing I’d like to do more of in 2020. I do go up hills for most of my exercise and my elevation stats reflect that. However, I’d add that I don’t go up them very quickly. The main benefit is that it probably helps with my leg strength and I think it makes me less injury prone. I also get to enjoy a nice view…

December 2019 reading list

Here are the books I’ve got through in December 2019. There are certainly more than usual as there are several shorter volumes here. And, I had some leave as well so I hared through a few more then.

I’ve provided some links above when I’ve written something about them. I don’t use Amazon or affiliate links so click away with impunity.

Darkness Visible: A Memoir of Madness by William Styron

This is only a short book but it is a harrowing tale of one man’s plunge into the abyss of depression. I picked it up via a comment in Christopher Hitchen’s autobiography. Styron spends quite a bit of time emphasising just how utterly inexpressible depression is as a disorder. How the language doesn’t exist and the words just don’t match up to the horror. Styron himself is quick to point out that an individual experience is just that, unique and idiosyncratic, but I’m certain there will be some deep resonances for many people in this slender volume.

I should add that the doctors don’t fare well yet Styron is admirably restrained, even generous, in his descriptions. Styron is right to highlight the complexity of predisposing factors and triggering events but the iatrogenesis of the benzo prescribing is very ugly and I blush to read of it. Some of the medical perspective is of its time as Styron’s depression, so starkly painted in Darkness Visible°, affected him in the 1980s. Much of it remains frighteningly pertinent.

Some selected quotes:

“The most honest authorities face up squarely to the fact that serious depression is not readily treatable.”

“Frighteningly, the layman-sufferer from major depression, taking a peek into some of the many books currently on the market, will find much in the way of theory and symptomatology and very little that legitimately suggests the possibility of quick rescue.”

“The intense and sometimes comically strident factionalism that exists in present-day psychiatry—the schism between the believers in psychotherapy and the adherents of pharmacology—resembles the medical quarrels of the eighteenth century (to bleed or not to bleed) and almost defines in itself the inexplicable nature of depression and the difficulty of its treatment.”

“This is to say more specifically that instead of pleasure—certainly instead of the pleasure I should be having in this sumptuous showcase of bright genius—I was feeling in my mind a sensation close to, but indescribably different from, actual pain.”

“Nonetheless, for over seventy-five years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.”

“Bloody and bowed by the outrages of life, most human beings still stagger on down the road, unscathed by real depression. To discover why some people plunge into the downward spiral of depression, one must search beyond the manifest crisis—and then still fail to come up with anything beyond wise conjecture.”

“I used alcohol as the magical conduit to fantasy and euphoria, and to the enhancement of the imagination.”

“Alcohol was an invaluable senior partner of my intellect, besides being a friend whose ministrations I sought daily—sought also, I now see, as a means to calm the anxiety and incipient dread that I had hidden away for so long somewhere in the dungeons of my spirit.”

“I couldn’t rid my mind of the line of Baudelaire’s, dredged up from the distant past, that for several days had been skittering around at the edge of my consciousness: I couldn’t rid my mind of the line of Baudelaire’s, dredged up from the distant past, that for several days had been skittering around at the edge of my consciousness: “I have felt the wind of the wing of madness.””

“But never let it be doubted that depression, in its extreme form, is madness.”

“The madness of depression is, generally speaking, the antithesis of violence. It is a storm indeed, but a storm of murk.”

“Over two years before my siege, an insouciant doctor had prescribed Ativan as a bedtime aid, telling me airily that I could take it as casually as aspirin. The Physicians’ Desk Reference, the pharmacological bible, reveals that the medicine I had been ingesting was (a) three times the normally prescribed strength, (b) not advisable as a medication for more than a month or so, and (c) to be used with special caution by people of my age.”

“Then, after dinner, sitting in the living room, I experienced a curious inner convulsion that I can describe only as despair beyond despair. It came out of the cold night; I did not think such anguish possible.”

“Much evidence has accumulated recently that indicts Halcion (whose chemical name is triazolam) as a causative factor in producing suicidal obsession and other aberrations of thought in susceptible individuals. Because of such reactions Halcion has been categorically banned in the Netherlands, and it should be at least more carefully monitored here.”

“While my own carelessness was at fault in ingesting such an overdose, I ascribe such carelessness to the bland assurance given me several years before, when I began to take Ativan at the behest of the breezy doctor who told me that I could, without harm, take as many of the pills as I wished.”

“More or less the same can be said for Art Therapy, which is organized infantilism.”

“It is of great importance that those who are suffering a siege, perhaps for the first time, be told—be convinced, rather—that the illness will run its course and that they will pull through.”

“A tough job, this; calling “Chin up!” from the safety of the shore to a drowning person is tantamount to insult, but it has been shown over and over again that if the encouragement is dogged enough—and the support equally committed and passionate—the endangered one can nearly always be saved.”

“To most of those who have experienced it, the horror of depression is so overwhelming as to be quite beyond expression, hence the frustrated sense of inadequacy found in the work of even the greatest artists.”

The Gentle Art of Tramping by Stephen Graham

It may be approaching the centenary since its publication but this small hardback book from 1926 is a treat. One shouldn’t place aesthetics over content when it comes to a book but Bloomsbury have got the package just right. The woodcut style cover and the heft of the hardback amplify the wonderfully rebellious nature of the content. It is, quietly, subversive and if you are ever struck with a smouldering desire to get outdoors then Graham will rekindle your fire.

Here are selected quotes from The Gentle Art of Tramping°:

“The tramp is a friend of society; he is a seeker, he pays his way if he can. One includes in the category ‘tramp’ all true Bohemians, pilgrims, explorers afoot, walking tourists and the like. Tramping is a way of approach, to Nature, to your fellow man, to a nation, to a foreign nation, to beauty, to life itself. And it is an art, because you do not get into the spirit of it directly — you leave your back door and make for the distant hill. There is much to learn, there are illusions to be overcome. There are prejudices and habits to be shaken off.”

“From day to day you keep your log, your daybook of the soul, and you may think at first that is a mere record of travel and facts; but something else will be entering into it — poetry — the new poetry of your life, and it will be evident to a seeing eye that you are gradually becoming an artist in life.”

“Of all tramping the most delightful is in the mountains; the most trying is along great highways.

“Mountain walking is really much less tiring because: first of all, there is no dust, then there is more contrast and mental distraction, and last, not least, one’s feet hit the earth at varying angles, employing more muscles.”

“The freedom of speech and action and judgement it gives you will breed that boldness of bearing which, after all, is better than mere good manners.”

“The less you carry the more you will see, the less you spend the more your will experience.”

“The best companions are those who make you freest. They teach you the art of life by their readiness to accommodate themselves.”

“For tramping is the grammar of living. Few people learn the grammar — but it is worthwhile.”

On Tthe Trespassers’ Walk: “It takes you the most extraordinary way, and shows what an enormous amount of the face of the earth is kept away from the feet of ordinary humanity by the fact of ‘private property.’

“The world is large enough, or is only too small, as takes your fancy or speaks your experience. But blue sky by day and fretted vault of heaven by night gives you the foil of the infinite, making your petty exploit a brave adventure.”

“Life is a like a road; you hurry, and the end of it is grave.”

“Lord Chesterfield’s Letters to his Son and Arnold Bennett’s How to Live on Twenty-four Hours a Day are of little value to us. We will not read in our baths, nor memorise French verbs while we fry. Or we will, if we like, but not upon the compulsion of filling time.”

“Tramping is straying from the obvious. Even the crookedest road is sometimes too straight. You learn that it is artificial, that originally it was not made for mere tramping. Roads were made for armies and then for slaves and labourers, and for ‘transport’. Few have been made for pleasure.

“After a long tramp it is nice to see a book which has been clothed with pencillings. It records in a way the spiritual life of the adventure, and will recall it to you when in later years you turn over the page again.”

“It is well to take a book that you do not quite understand, one that you have nibbled at but have found difficult.”

“So also man’s life. We think of it in length of years. But that in a way is an error. Life is not length of time, but breadth of human experience.”

“Self-expression is life.”

“A thought recorded, one that is your own, written down the day when it occurred, is a mental snapshot, and is at least as valuable at the photographs you may take on your journey.”

“Yesterday’s thought is worth considering again, if only as the stepping-stone of your dead self.”

“The personal diary, however, that daybook of the soul, is not meant for other gaze.”

“It is in description tht the keeper of a diary becomes artist. All description is art, and in describing an event, an action or a being, you enter to some extent into the joy of art.”

“You are more than the mere secretary of life, patiently taking down from dictation, more than life’s mere scribe; you become its singer, the expressor of the glory of it.”

“No farmer objects to your walking alongside his corn fields or across his pastures. It is people who enclose but do not farm who have most prejudice against strangers.”

“It will soon strike you when tramping that the word infinite does not always mean the same: there are grades in infinity and measures of the immeasurable.”

Understanding colour blindness

I was talking about colour blindness again today. As I said, it’s a topic that I’m prone to going off on. I’d been drafting some rough ideas and a few paragraphs for the book° on the train down to London and I had been thinking about how other people perceive colour blindness.

And, interestingly, this was the turn the conversation took. The two people I was speaking to are intelligent and perceptive yet it was just incredibly challenging for them to get a handle on what it’s like to be colour blind. I showed them the picture in the last blogpost — and, of course, they both saw the number and I was able to explain what I saw. Just a mess of red-brown-green blobs. (I almost feel like I need a new word for this kind of shade as to me, it’s just a single colour with varying shades.) I also pulled up one of the early chapter drafts, provisionally titled Everyday annoying shit and was able to point out some of the problems colour blindness can cause.

It would be good in the book to make it a guide for people to try to get a feel for how it is to be colour blind. Mostly, it doesn’t feel like anything of course but the world does just stump us in some funny little ways. With 1 in 12 men affected, there are very few people out there who don’t know others who are colour blind. One often sees, in any description of colour blindness, photographs that have been altered to take out red hues or green hues. Pictures of market stalls of fruit seem very popular for this. I’ve no idea if these work, they don’t for me, for obvious reasons, but they seem to lack a reality and an essential quality that tells you about the lived experience. If I can capture a little of that I’ll be happy.