Scribblings and blether and haver
A slow start to the month as I read less, unusually, while on leave than I do at home. That’s the power of habit for you and the physical exertions and privations of camping (minor though they are) meant I spent less time curled up with a book. However, I came back with renewed enthusiasm. I also caught up with a couple of books that were part read. It is satisfying to finish these up — piles (virtual or not) of half-read books are not good for one’s mental wellbeing. Here’s the August list.
Smallpox: The Death of a Disease by DA Henderson
I came to this book after reading Polio: The Odyssey of Eradication by Thomas Abrahams last month. Given that smallpox is, so far, the only disease we’ve succeeded in eradicating it is referred back to frequently. This is an enjoyable read, enlightening around the tactics, but it does get a bit ‘listy’ at times with endless WHO epidemiologists and personel poppping up repeatedly.
Bothy Tales by John Burns
Easy, fireside reading to make one yearn for a day on the hills. This is, and I don’t mean this disparagingly, something more of a palate cleanser for me. I’m not keeping any notes, I’m just immersed in the vicarious experience of being in the Scottish mountains.
Morality by Jonathan Sacks
This is good stuff and I was particularly pleased to read it as it annoyed me at points. Quite severely, in fact, but it’s good to avoid too much confirmation bias. I have copious notes that I need to translate. There were, for me, a couple of major shortcomings. In areas which are not his own experience he relies on secondary sources — much the same books I have read myself in recent times. He seems particularly prone to a failure to differentiate between association and causation. His views on drugs and substance use are dismally biased and lacking any credible evidence base at all. It’s much stronger on the philosophical side and when he stops dragging everything back to religious examples, the latter half of the book is very good and keeps getting better.
This is an Uprising by Mark Engler and Paul Engler
The Englers take us through the topic of non-violent resistance. If you are planning to get involved in any future social campaigns it’s vital reading. Even if that’s not on your agenda I found it incredibly instructive to understand how movements we do hear about regularly have worked and may find traction in the future.
Into the Wild by Jon Krakauer
At the heart of this story is the tale of Chris McCandless who walked into the Alaskan wilderness and starved to death a few months later. Krakauer weaves in other tales and his own experience. It’s sensitive, well written, and a very fine piece of longform journalism.
Tribe: On Homecoming and Belonging by Sebastian Junger
Junger crams a lot of wisdom into a slim volume. It’s easy to understand how Jonathan Sacks quotes from this book: suicide, social isolation, PTSD, the nature of war and rampage killings. Damn, it’s good.
Austerity’s Victims: Adults with a Learning Disability by Neil Carpenter*
Another damning indictment of the policies of the austerity decade and Carpenter lays out the impacts for many of the 900,000+ adults with learning disabilities in England. It’s not pretty reading.
Man’s Search for Meaning by Viktor Frankl
This scarcely needs introducing. Frankl was a psychiatrist who survived Auschwitz and Dachau who went on to develop logotherapy. Jonathan Sacks referred to it and I realised I had never read it. In fact, weirdly, I had barely heard of it and somehow it was hardly on the fringes of my awareness — somewhat like Richard Smith and Elizabeth Gilbert.° It’s not a book that needs my endorsement but it is a short read — as an audiobook it was fantastic.
Invisible Women: Exposing Data Bias in a World Designed by Men by Caroline Criado Perez*
I have written about this book before° and I couldn’t bring myself to completing the audiobook. This month, I finished off with the Kindle version for the last third that I hadn’t yet read. I just found this a hard book to get through and I’m still puzzling why. It might be because Criado Perez let’s her (understandable) anger creep in but it’s not just that — her fury at the demonstrable gender bias means that for all the brilliant data exposed she often over-interprets or uses the data to buttress a wider point about gender discrimination where it just doesn’t hold. If you are going to use data as the main plank of your argument I’d argue it is critical that you stay within the limits of interpretation of the data or you hugely weaken your point. This remains an incredibly important book but CCP just doesn’t quite nail it.
The Good Ancestor by Roman Krznaric
This is all about taking the long view and thinking about generations ahead. Krznaric (pronounced kriz-narik according to his website) covers the short-termism of the modern world and then added all sorts of tools and ways of thinking of the future beyond even our own life spans. He presents the moral case and offers practical examples. Of course, the climate emergency is the obvious area in which we need long-term thinking but there are many others as well. I have dozens of notes and it might be my book of the year thus far. More to come on it.
*Part read earlier this year and finished this month.
An interesting bunch this month and, for the first time in a while, a book I just could not get along with at all. Here’s the July list.
- What If? by Randall Munroe
- Narco Wars by Tom Chandler
- The Windrush Betrayal by Amelia Gentleman
- Dopesick by Beth Macy
- Wind, Sand and Stars by Antoine de Saint-Exupéry
- Some Kids I Taught and What They Taught Me by Kate Clanchy
- How to Think Like a Roman Emperor by Donald Robertson
- The Elements of Eloquence by Mark Forsyth
- Polio. The Odyssey of Eradication by Thomas Abraham
- The Obstacle is the Way by Ryan Holiday
- Hope in Hell by Jonathon Porritt
Comments and Recommendation of the Month
I typed the initial draft of this post in early July, having read the first couple of books on the list and as I neared the end of The Windrush Betrayal by Amelia Gentleman and Dopesick by Beth Macy. At that point, I’d have been astonished if another book could better Gentleman’s effort and I wrote about it back then.° I was listened to the audiobook, read by Gentleman herself, and it was, by turns, leaving me breathless with rage and often close to tears.
I am still prone to shouting at the TV, but I know I am just another madman howling at the moon.
That said, I need to be clear that I am still prone to shouting at the TV, but I know I am just another madman howling at the moon. Yet, as I get older it is impossible to miss the fact that, on a regular basis, the politicians we despised have popped up again in a more human role, having sloughed off the party political skin. Michael Portillo and Ed Balls spring to mind as particularly polarising politicians who have been rehabilitated. No, I suspect Cameron, Rudd and May don’t express any regret because that is, at its heart, how most people behave. We rationalise, we dissemble, we justify and we very rarely admit to ourselves, much less anyone else, that we were mistaken.
Yet Gentleman’s account in The Windrush Betrayal is absolutely damning. The callous behaviour of the politicians, the willingness to de-humanise, is laid bare. At its toxic core, this is, obviously, a book about racism and, importantly, it demonstrates how racism can become systematised. The government machinery, reduced to its heartless efficiencies, exposes the horror of market-driven outsourcing pursuing its sightless, amoral aim. It’s a template for the despots and the malignant. The government created a hostile environment, that could do nothing else but ingrain racist processes. Even worse, they made us all complicit by getting the NHS, GP surgeries, the landlords, and the employers to do the work.
I did read Clanchy as soon as I had heard it won the Orwell Prize° and it is a wonderfully insightful book. It’s more uplifting than The Windrush Betrayal and Clanchy’s background as English teacher, novelist and poet, mean that the literary swirls through it. Which never does any harm, I suspect, when it comes to book prizes. For me, it’s not quite as urgent or as critical as The Windrush Betrayal which I would rate above it.
And, as I mentioned it at the start, I had better follow through and deliver… I could barely muster the strength to finish The Obstacle is the Way which didn’t work for me on any level. I found it superficial and unengaging. I read it shortly after finishing How to Think Like a Roman Emperor — another book following the vogue for Stoic philosophy. In HTTLARE, Robertson weaves in modern psychology and facets of CBT to the story of Marcus Aurelius. I’m happy to recommend it highly if you want to explore that niche.
I am red-green colour blind and I’m well aware of my general inability to distinguish red particularly well. In particular, I often miss subtler shades of pink. Apart from a tendency to wear inappropriate shirt and tie combinations it’s hardly life threatening. Or so I thought.
However, it is perhaps rather more than an inconvenience that blood is red. People that are colour-blind may be unable to spot early signs of blood loss. And as any fule kno unexpected blood rings big fat alarm bells for the Big C.
Colour-blind people (the vast majority being men) can’t pick up some of the early signs of disease when it involves spotting colour changes in bodily fluids.
The study also looked at the histology and the non-colour blind had 69% with superficial disease and the rest had invasive bladder cancer. The colour-blind group had 42% with superficial disease and 58% with less favourable histology. This is statistically significant (p<0.01).
There is sound logic to back up these findings. Colour-blind people (the vast majority being men) can’t pick up some of the early signs of disease when it involves spotting colour changes in bodily fluids. So they are presenting later with more advanced disease. Not good. However, this is a small study — only having 21 cases of bladder cancer in colour-blind men limits how far I would want to rely on the findings.
Colour-blindness is treated as nothing more than an evolutionary oddity; good for teaching the basics of X-linked inheritance° but of no clinical significance. Yet, it might have a little more impact than you think.
Katmawi-Sabbagh, S., Haq, A., Jain, S., Subhas, G., & Turnham, H. (2009). Impact of Colour Blindness on Recognition of Haematuria in Bladder Cancer Patients Urologia Internationalis, 83 (3), 289-290 DOI: 10.1159/000241669°
I have been musing on my own personal cricketing failings and I have always suspected that I am handicapped by being colour blind. Think about it. How do you fancy spotting a red ball on a green background with an inability to tell red and green apart? It turns out the medical literature has already considered the issue of colour blind cricketers and is there to back up my plaintive pleas.
There is an expected prevalence of around 8% in the male population for colour-vision deficiency. Of course, an incidence of 8-9% means there is likely to be one colour blind player in every team. Previous studies quoted have suggested rates as low as 4% in first class county cricketers. One study° looked at 293 cricketers from seven cricket clubs in Melbourne. They found that 8.9% had colour-vision deficiencies but only 6.7% played at the highest level within those clubs. However, that reduction in those playing at the highest level is statistically significant.
This could lead one to the conclusion that being colour blind is holding some cricketing men back. This study also looked at some other interesting areas which might prove useful for the village cricket bluffer and will provide ample ammunition to mount a robust defence of any mishaps.
The batting average in those with mild colour-vision deficiencies was 28.3 and those with severe deficiencies was 18.8.
The batting average in those with mild colour-vision deficiencies was 28.3 and those with severe deficiencies was 18.8. (Sadly, the authors report this was not statistically significant but don’t let that stand in the way of your bar-room thesis during the match post-mortem.) It was also noted that those with colour-vision deficiencies rather prefer fielding close to the batter. This might prove a highly useful piece of hard medical evidence for those that find galloping around a boundary rope somewhat wearing. The authors have included some technical explanations which will help beat back any naysayers.
A further hypothesis is that cricketers with abnormal colour vision will have greatest difficulty when fielding in the outfield where the angular size of the ball is small and the ball may often be seen against grass or surrounding foliage. The ball subtends about 12 minutes of arc for a fielder close to the batsman and three to five minutes of arc for a fielder near the boundary. It is known that all observers with abnormal colour vision, even those with a mild deficiency, have difficulty seeing red objects in natural surrounds. For these reasons cricketers with abnormal colour vision should prefer to field close to the batsman. Botham was a brilliant slip fielder…
W.H. Ponsford (pictured) was known to be colour blind but he has the 6th highest average in first class cricket° in the history of the game. He doesn’t always make the lists because he never met the 20,000 run minimum that is often applied. He also scored over 400 twice in first class innings. Only Brian Lara can match that.
Rather amazingly 42% of men in this study did not know they had any colour-vision deficiency. So the next time you shell a dolly at long-off perhaps you ought to toddle down to your GP and do an Ishihara test.° Being colour blind could provide some convenient excuses.
Harris, R., & Cole, B. (2007). Abnormal colour vision is a handicap to playing cricket but not an insurmountable one Clinical and Experimental Optometry, 90 (6), 451-456
I finished the last hour of Amelia Gentleman’s The Windrush Betrayal this morning as I ran on the western fringes of the Howgills. I was coming off Arant Haw and down towards Seat Knott. It is not very summery at the moment. The baking hot drought days, mid-lockdown, of April and May, are receding in the memory.
It was barely 12°C and I managed with a cotton T-shirt and shorts but there was no lingering. I had to, incongruously, wear a pair of gloves with the scanty running kit, an affectation usually reserved for Premier League footballers, but an essential one as my stiffening blood vessels aren’t letting warmth get to my extremities in quite the way they did. There was a stiff breeze, unusually more easterly, maybe with a hint of south, compared with the usual prevailing westerlies. It’s curious how the wind, something that we wouldn’t normally pay much mind, becomes so startingly evident when out running. The easterly push meant, despite my efforts to lift the pace, that I was engaged in something of a struggle to get up the hills. The playful breezes at house level are rather more persistent higher up and I had to lean in, work hard. I was glad to reach the summit at 606m and turn my back to the wind.
The other problem with the wind is that I can, when it really starts roaring, have difficulties hearing the audiobook but I was still picking it up just fine today. The Windrush Betrayal hasn’t been an easy listen because it is so emotive. It is enraging. A horror story of institutional racism, the hostile environment of May, Cameron and Rudd. The stories of lives devastated had me in tears. I often wonder if some politicians’ cheeks are touched with any blush of shame. I doubt it. Not because I regard them as unfeeling monsters but because it is just not within human nature to admit to mistakes. More likely, they rationalise it, build the fortifications around their own personal story. Gentleman touches on this as she interviews Rudd and she recounts how May expressed personal sorrow, clumsily as ever, but never apologised for the hostile environment policy. That remained inviolate, reasonable; it was simply the unfortunate collateral damage she regretted. (Though, again, Gentleman points out this only came when it became clear public opinion was firmly with the Windrush generation.)
They tell of injustices through gritted teeth, not wanting to let their emotions intrude.
As I was running down, I thought how disappointed I would be if Gentleman’s book doesn’t win the Orwell Prize. A little unfair as I have yet to read any of the other five on the list beyond Gentleman and Perez. I thought, if they can best these two then they really will be worth the effort. My timing is impeccable, as it turns out, as it spurred me to check the site and the Prize was being announced today. Not long to wait to find out. As it happens Amelia Gentleman didn’t win — it has gone to Kate Clanchy for Some Kids I Taught and What They Taught Me. An unanimous decision according to Stephanie Flanders. I have it on my Kindle and plan to start immediately.
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Well it was a much better month than May and I found my groove again. There are some real gems here that would have me enthusing in any given month. I’ll try to tackle them individually with posts in the coming weeks. Here’s the June list.
- Don’t Be Evil by Rana Faroohar
- You Talking to Me by Sam Leith
- Parliament Ltd by Martin Williams
- Our Final Warning by Mark Lynas
- How to Survive a Plague by David France
- The NHS at 70: A Living History by Ellen Welch
- The COVID-19 Catastrophe by Richard Horton
- Humankind: A Hopeful History by Rutger Bregman
- You Are Not Human by Simon Lancaster
- The Art of Statistics by David Spiegelhalter
- The Candy Machine by Tom Feiling
- Unpopular Essays by Bertrand Russell
Recommendation of the Month
Don’t Be Evil is a good run through of the problems at Google and Facebook. You Talking to Me hops through the formal discipline of rhetoric, something that I’m not very familiar with at all but I enjoyed. Parliament Ltd is damning of many politicians and the whole parliamentary process. There is a lot to be cross about but, weirdly, I found Williams’ scathing tone about politicians slightly irritated me. It’s clear he has a very low opinion but I wasn’t always sure it was entirely fair to daub all politicians with this particular brush at all times.
Our Final Warning is a bleak read but not to be ducked. How to Survive a Plague is a fairly long book but uplifting despite the desperately long list of victims. One of the big players at the time of the HIV epidemic was none other than Anthony Fauci. He doesn’t always come out of it well. The NHS at 70 is rather short and somewhat superficial. The COVID-19 Catastrophe by Horton is brutally honest, again relatively brief, but packs a punch.
You Are Not Human was excellent and made me think deeply about metaphor and how we use it, unthinkingly, all the time. Humankind is very good as well and this book, plus Utopia for Realists, make Bregman one to keep close. The Art of Statistics does a manful job of tackling some complicated stats. It’s not my first rodeo when it comes to looking at these but my head was swimming at times. The Candy Machine is another book covering the horrors of the ‘War on Drugs’.
My favourite book this month was Unpopular Essays by Bertrand Russell. I picked it up because of a recommendation in Bregman’s book. For some reason, the life and works of Russell have passed me by. I could barely have told you who he was, much less anything about his books. It was wonderful to read these essays from a different period but be entertained and stimulated. And knowing there is much to read of Russell’s yet is always a lovely feeling — reminiscent of that thrill when you find an author you love and there is a long backlist to work through. I’m not certain I’ll be delving into all his past academic works but there are plenty of essay collections to enjoy.
Here it is, the May reading list. It was a little bit impacted by COVID-19 as I did, just ever so slightly, lose my focus and I was finding it harder to concentrate. Some of these are, as a result, more varied and rather less academic.
- Proust and the Squid by Maryanne Wolf
- The Lost Decade by Polly Toynbee and David Walker
- Stolen by Grace Blakely
- Draft No.4 by John McPhee
- Bad Blood by John Carreyrou
- Hypersanity by Neel Burton
- The Secret Barrister by Anon
- Steve Jobs by Walter Isaacson
- So You’ve Been Publicly Shamed by Jon Ronson
- Detectives in the Shadows by Susanna Lee
- Good Cop. Bad War by Neil Woods
Recommendation of the Month
I was looking foward to Proust and the Squid and I was disappointed. The second half of the book is heavily weighted towards people with a specific interest in autism and I was crushed by the level of detail. It didn’t work for me at all. The Lost Decade was good but a bit of a grind. It was also almost impossible not to read everything as if it was asterisked — any talk of economic and social impact now being looked through the COVID lens. Stolen was good, more strident and militant than I was expecting. Draft No.4 started slow but had some great advice about writing longer form work. Bad Blood was gripping, a page turner, and an astonishing indictment of the Silicon Valley startup culture.
A well-resourced criminal justice system is the absolute bedrock of a fair society and it is failing.
Jon Ronson’s book was diverting enough and it certainly encouraged me to stay off Twitter. Detectives in the Shadows is an academic discussion of the hard-boiled hero but very much has an American sensibility. And Good Cop, Bad War details Neil Woods’ experiences as an undercover cop.
As I write this, I realise that it wasn’t a superb month. Ultimately, if I had to pick a book to recommend then I think The Secret Barrister edges it over Stolen. You may never be involved with it, woe betide you if you are, because a well-resourced criminal justice system is the absolute bedrock of a fair society and it is failing. We spend a pitiful amount on it and the relentless drive for more savings is a deep wound in our democracy. Legal aid has been slashed and we’ve been suckered with the PR about the undeserving. Median income of barristers in 2012-13 was £27,000 — though, some do of course, earn large sums at the upper end, most don’t. Read the book, but if that’s too much for you then check out The Secret Barrister FAQs.°
Here’s the April reading list. I’m catching up after a busy COVID-19 period so haven’t written about these individually.
- Criminal by Tom Gash
- The Last Crossing by Brian McGilloway
- Why I’m No Longer Talking to White People About Race by Reni Eddo-Lodge
- The Rule of Law by Tom Bingham
- I Will Never See the World Again by Ahmet Altan
- Deaths of Despair and the Future of Capitalism by Anne Case and Angus Deaton
- Airhead by Emily Maitlis
- Truth to Power by Jess Phillips
- Pale Rider by Laura Spinney
- We Should All Be Feminists by Chimamanda Ngozi Adichie
- Winter Hours: Prose, Prose Poems and Poems by Mary Oliver
- Other Minds by Peter Godfrey-Smith
- Crippled by Frances Ryan
- Poverty Safari by Darren McGarvey
Recommendation of the Month
I can still come up with a book of the month to recommend. Or at least I think I can. There are several very strong candidates on this list. Crippled by Frances Ryan is very powerful but it is very heavy on numbers — not usually a problem for me but I found myself just dizzy with it. It’s a book I will refer back to in the future but it’s not quite as readable as others. Spinney’s Pale Rider had been popping up repeatedly in Amazon’s recommendation algorithm and, given the pandemic, it seemed churlish to avoid it any longer. It is a little uncany reading it when one compares our current circumstances an experiences. The Rule of Law was more technical than I had expected and I can see why this is essential reading to those in the profession or closely related ones, but it felt less accessible than I had hoped. I thought Other Minds was tremendous, I listened to the audiobook and it was captivating. Poverty Safari has won multiple awards and plaudits for good reason and, like Why I’m No Longer Talking to White People About Race, will make you change how you think about you engage with discussions about their central topic — poverty and race. In the end, I’ll recommend Deaths of Despair because it is a lesser known book and I read it in hardback just a few days after its release. It is an unflinching summary of the so-called ‘deaths of despair’ in the USA.
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:
- Hired by James Bloodworth°
- American Overdose by James McGreal°
- In Extremis by Lindsey Hilsum°
- The People Vs Tech by Jamie Bartlett
- The Myth of Meritocracy by James Bloodworth
- Moneyland by Oliver Bullough
- The Joy of Work by Bruce Daisley
- The Lines Becomes a River by Francisco Cantú
- Say Nothing by Patrick Radden Keefe
- Heimat by Nora Krug
- Permanent Record by Edward Snowden
- Criminology: A Very Short Introduction by Tim Newburn
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 within earshot who stands still long enough.
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.
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 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.
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 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.
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.
- Why We Get the Wrong Politicians by Isabel Hardman° ✅
- The Growth Delusion: The Wealth and Well-Being of Nations by David Pilling° ✅
- Hired: Six Months Undercover in Low-Wage Britain by James Bloodworth° ✅
- American Overdose: The Opioid Tragedy in Three Acts by Chris McGreal° ✅
- In Extremis: The Life of War Correspondent Marie Colvin by Lindsey Hilsum° ✅
- The People Vs Tech: How the internet is killing democracy (and how we save it) by Jamie Bartlett ✅
- Moneyland: Why Thieves And Crooks Now Rule The World And How To Take It Back by Oliver Bullough ✅
- Natives: Race and Class in the Ruins of Empire by Akala
- The Line Becomes A River by Francisco Cantú ✅
- A Certain Idea of France: The Life of Charles de Gaulle by Julian Jackson
- Bad Girls: A History of Rebels and Renegades by Caitlin Davies
- Nightmarch: Among India’s Revolutionary Guerrillas by Alpa Shah
- Our Boys: The Story of a Paratrooper by Helen Parr
- Say Nothing: A True Story of Murder and Memory in Northern Ireland by Patrick Radden Keefe ✅
- Heimat: A German Family Album by Nora Krug ✅
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.
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.
- Bad Samaritans by Ha-Joon Chang°
- The Road to Wigan Pier by George Orwell
- On Immunity: an Innoculation by Eula Bliss°
- The Ascent of Nanda Devi by HW Tilman°
- Catch and Kill by Ronan Farrow°
- Essayism by Brian Dillon
- You Are What You Read by Jodie Jackson
- The Red Market by Scott Carney
- Narconomics by Tom Wainwright°
- Beast by Matt Wesolowski°
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 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.
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.
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.