Scribblings and blether and haver

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.°

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.°

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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.

Purple skies and pink elephants

I do love talking about colour blindness. You can’t be in conversation with me too long before I’ll raise the topic and I suspect most of my work colleagues know about it. They are very generous about making accommodations when we are in presentations, or standard setting sessions, or just looking at documents. Yet, it’s also apparent some of them don’t necessarily understand it particularly well.

I have written a couple of articles on Blokeology: there’s one on late presenting bladder cancer° and another on colour blind cricketers.° And in Episode 053 I spoke to Kathryn Albany-Ward who runs the Colour Blind Awareness website.° Over the early months of 2020 I’m going to turn my attentions to a short book on colour blindness. As well as covering some of the basic science I’m going to touch on some of the interesting wrinkles around this common condition. With 8% of men affected it’s not that niche. It’s much less common in women — just 0.5% of them are affected — but we all know plenty of people who are colour blind. It is another matter whether they know it themselves of course. Doubtless I will discuss that.

At the moment I’m just planning a slim volume. I have an outline and it may come in with as little as 20-25,000 words but I may digress and it could be more like 35-40,000. That would be satisfying as it will feel more like a complete, if trim, book. So, that’s the aim and I’m getting my 2020 plan in early. I’ll post updates, and perhaps some excerpts, in due course. The working title is, as you might have guessed, Purple Skies and Pink Elephants, though that’s likely to change. It stems from my direct experience: it’s a standing joke that I refuse to accept the existence of the colour purple and pinks look very grey to me. I always thought elephants were pink. I was shocked to find out that’s not true.

The image is an example of an Ishihara plate. My daughter tells me that she can see the number 74. I can’t see anything, it’s just a blend of dots with no discernible pattern at all. She tells me the numbers are in green and the surrounding dots are varying shades of dark red and browns. I look at it and I’m not honestly sure I know what colour most of the dots are at all. I think I can tell some of the light greens with confidence but after that I’m stumped. They could be dark green, red, brown, orange… who knows?

The pleasure of unexpected snow

It was, completely unexpectedly, and rather joyfully, snowy today. I stumbled out of bed in the half-light and was surprised to see snow nestling, Dickensian style, on the skylight window. Maybe I just hadn’t really been paying attention to the forecast.

It wasn’t freezing outside and underneath it was rather muddy but the dogs were ecstatic to be out, frolicking around, and it was the puppy’s first experience of snow. Both dogs ended up with mutiple globes of snow dangling from the back of their legs.


This is the track that takes you up to Winder from Howgill Lane. Dead ahead is the the Nab, not much more than a flank with a pseudo-summit that leads up to Arant Haw. I trudged up Winder today. No running for me as my right knee is unhappy with life, aching like hell and with some tenderness on the medial joint line that has sprung up out of the blue. I didn’t tweak it and it didn’t even start hurting during a run. It all just kicked off a few hours after a gentle run on the flat. Odd. I’m hoping it’s trivial and it just needs a few days to calm down. In that regard, the snow is entirely welcome as walking doesn’t feel like such as drag when you are in the snow and any real running isn’t an option in any case.


The odd half light of snow is so hard to capture. I almost always prefer black and white in any case (it’s a colour blindness thing°). The view is south east from the summit of Winder — the trig point is just out of shot on the left — and the Frostrow Fells are the first line of lower hills with Dentdale sitting just in behind.


And, of course, this is the wider summit view. Behind the trig point is one of those 360° observation points that maps out the horizon and allows you to spot and identify all the surrounding hills and landmarks.

The winter days are more or less at their shortest now and the dark mornings have been pressing in. The December solstice is in a few days. I also have in mind the sinusoidal curve of day length — there isn’t much change at this time of year and it will be a few weeks before the length of the days starts to shift significantly and we feel the difference. Yet, it’s always a good time when we pass through the solstice and a weekend morning with snow is a welcome bonus.

Men Explain Things to Me by Rebecca Solnit

This is a slim volume, made up of seven essays, by Solnit. The first, and most well known, is the 2008 titular essay that, while not using the term itself, helped inspire the recognition of ‘mansplaining’. The key passage, summing up the concern, is here:

“Yes, people of both genders pop up at events to hold forth on irrelevant things and conspiracy theories, but the out-and-out confrontational confidence of the totally ignorant is, in my experience, gendered. Men explain things to me, and other women, whether or not they know what they are talking about. Some men.”

It’s never going to be comfortable, as a man, reading these essays but Solnit’s feminism is inclusive. Solnit talks about that term ‘mansplaining’ and how she is not super-keen on it, with suggestions of an inherent male flaw, rather than recognising it is an inappropriate behaviour. Near the end, in the essay Pandora’s Box and the Volunteer Police Force she says:

“I think the future of something we may no longer call feminism must include a deeper inquiry into men. Feminism sought and seeks to change the whole human world; many men are on board with the project, but how it benefits men, and in what ways the status quo damages men as well, could bear more thought.”

I’m wholeheartedly on board with this but one is always treading a fine line. There is an ever-present risk that flagging problems for men in culture looks like it is, again, ignoring women. And this is a recurring theme in Solnit’s essays – the invisible women (the title, of course, of Caroline Criado-Perez’s book on the gender data gap). Yet, if men engage in a discussion about feminism, we have to be hyper-aware of the risk of falling into the trap of explaining, of mansplaining. This doesn’t have to be a major problem, most of the time we just need to do a bit more listening, and a little less talking. Which is almost certainly good advice for life generally.

I don’t believe we (men, I mean) so should be in the slightest bit concerned about feminism. Certainly not the movement Solnit advocates. A couple of her quotes to illustrate:

“Feminism is an endeavour to change something very old, widespread, and deeply rooted in many, perhaps most, cultures around the world, innumerable institutions, and most households on Earth — and in our minds, where it all begins and ends.”

“Like racism, misogyny can never be adequately addressed by its victims alone. The men who get it understand that feminism is not a scheme to deprive men but a campaign to liberate us all.”

Letters to a Young Contrarian by Christopher Hitchens

I have highlighted a remarkable number of passages in this book and it still feels like it glanced off the surface, like some wayward missile with too low a trajectory and too much speed. With Hitchens at his best they rush at you with tremendous velocity and force.

At other times, in other essays, I simply can’t parse Hitchens. I don’t have the classics background or the deep knowledge of the literature to cope. Letters to a Young Contrarian° is accessible and because of the nature of the book it is a generous seam to mine for Hitchens quotations. It’s a book, and they are increasingly rare, in my ‘read again’ pile.

Here are my selected quotes:

“There were many who retained the unfashionable hope of changing the world for the better and (which is not quite the same thing) of living a life that would be, as far as possible, self-determined.”

“The essence of the independent mind lies not in what it thinks, but in how it thinks.”

“The term “intellectual” was originally coined by those in France who believed in the guilt of Captain Alfred Dreyfus. They thought that they were defending an organic, harmonious and ordered society against nihilism, and they deployed this contemptuous word against those they regarded as the diseased, the introspective, the disloyal and the unsound.”

“It may be that you, my dear X, recognise something of yourself in these instances; a disposition to resistance, however slight, against arbitrary authority or witless mass opinion, or a thrill of recognition when you encounter some well-wrought phrase from a free intelligence.”

“To be in opposition is not to be a nihilist. And there is no decent or charted way of making a living at it. It is something you are, and not something you do.”

“You must feel not that you want to but that you have to. It’s worth emphasising, too, because there is a relationship, inexact to be sure but a relationship, between this desire or need and the ambition to rely upon internal exile, or dissent; the decision to live at a slight acute angle to society.”

“This would be idiocy in its pejorative sense; the Athenians originally employed the term more lightly, defining as idiotis any man who was blandly indifferent to public affairs.” “

“On Sigmund Freud’s memorial in Vienna appear the words: “The voice of reason is small, but very persistent.”

“George Orwell said that the prime responsibility lay in being able to tell people what they did not wish to hear.”

“Conflict may be painful, but the painless solution does not exist in any case and the pursuit of it leads to the painful outcome of mindlessness and pointlessness; the apotheosis of the ostrich.”

“Oriental religions, with their emphasis on Nirvana and fatalism, are repackaged for Westerners as therapy, and platitudes or tautologies masquerade as wisdom.”

“Pyotr Kropotkin might have been rather a rarefied anarchist but he had a point when he said that if only one man has the truth, that’s enough.”

“Our standard for these things is subject to its own Gresham’s Law:° not only does it recognise the bogus but it overlooks and excludes the genuine.”

“The fish rots from the head in such matters”

“This depressing discovery need not blind us to the true moral, which is that everybody can do something, and that the role of dissident is not, and should not be, a claim of membership in a communion of saints.”

“the human race may be inherently individualistic and even narcissistic but in the mass it is quite easy to control.”

“The socialist movement enabled universal suffrage, the imposition of limits upon exploitation, and the independence of colonial and subject populations. Where it succeeded, one can be proud of it.”

“Fatalism and piety were the least of it; this was cynicism allied to utilitarianism. Don’t let yourself forget it, but try and profit also from the hard experience of those who contested the old conditions and, in a word or phrase, don’t allow your thinking to be done for you by any party or faction, however high-minded.”

“The crucial distinction between systems, he said, was no longer ideological. The main political difference was between those who did, and those who did not, think that the citizen could—or should—be “the property of the state.””

“Populist authoritarians try to slip it past you; so do some kinds of literary critics (“our sensibilities are engaged . . . ”) Always ask who this “we” is; as often as not it’s an attempt to smuggle tribalism through the customs.”

“Joseph Heller knew how the need to belong, and the need for security, can make people accept lethal and stupid conditions, and then act as if they had imposed them on themselves.”

“In some ways I feel sorry for racists and for religious fanatics, because they so much miss the point of being human, and deserve a sort of pity. But then I harden my heart, and decide to hate them all the more, because of the misery they inflict and because of the contemptible excuses they advance for doing so.”

“Irony, says Czeslaw Milosz in his poem Not This Way, is “the glory of slaves”: the sharp aside and the witty nuance are the consolation of the losers and are the one thing that pomp and power can do nothing about.”

“There are times when one wants to hold society’s feet to the fire, and to force a confrontation, and to avoid the blandishments of those who always call upon everyone to “lighten up” and change the subject.”

“Dante was a sectarian and a mystic but he was right to reserve one of the fieriest corners of his inferno for those who, in a time of moral crisis, try to stay neutral.”

“However, you should get and read Joe Sacco’s cartoon-history Safe Area Goražde°, to which I was honored to contribute an introduction.”

“The high ambition, therefore, seems to me to be this: That one should strive to combine the maximum of impatience with the maximum of skepticism, the maximum of hatred of injustice and irrationality with the maximum of ironic self-criticism.”

“Never be a spectator of unfairness or stupidity.”

“Seek out argument and disputation for their own sake; the grave will supply plenty of time for silence.”

“Suspect your own motives, and all excuses. Do not live for others any more than you would expect others to live for you.”

Missing the Anthropocene point

The advert on the back of Private Eye this week features a watch from the company, Christopher Ward. The watch is the C65 Anthropocene and it comes in at £995 in its cheapest version.° Apparently: “Inspired by the Scottish Opera’s ‘Anthropocene’, this 300-piece limited edition integrates the production’s icy wilderness setting into its very design.” Well, let me speak plainly: what a load of absolute bollocks. For a start, and this is mostly an aside, this is the kind of pretentious imagery that makes me want to gouge out my own eyes.

But it’s worse than fluffy PR hype. Let’s be clear, high-end luxury watches are about blatant consumption and excess. Ironically, Christopher Ward’s thrust is that they are, in fact, affordable when compared with the ultra-oligarchal end of the market. It’s a marker of how far we’ve distorted consumption when spending £1000 on a watch is positioned as reasonable. The main headline for the advert is Product of the environment. Yes, like everything is of course, and that’s rather the point isn’t it? We wouldn’t be in the Anthropocene if we hadn’t pursued our boundless ambition to produce from the natural resources we have at our disposal.

Apparently 5% of the price will go to conservation charities and this virtue-signalling is currently commonplace in the premium watch market.° We should call it out for what it is: cynical marketing that flags the rank hypocrisy of manufacturers. I don’t qualify as an environmentalist, I understand that there are many changes I still need to make to my life to help with sustainability, and doubtless there are many luxury goods I have that I could forego. However, I’m still sufficiently grounded in reality to recognise that conflating expensive watches with environmentalism is vomit-inducing fakery and naked deceit.

More on email – geeking out with MailMate

One of my basic beliefs about email is that the key to success is to be online for the minimum possible time. You treat it the same as a physical mailbox. You wouldn’t stand beside your letterbox doing the work that was received in the letters. You have to treat it as a collection point. Get in, get out. Do the work. Go back later. Preferably just once or twice a day. You are still communicating fast compared to the old snail mail but you can achieve some balance with competing demands on your time.

The most heinous email crime one can commit is to work out of one’s inbox when it’s still hitched to the open streams of the internet. This approach drives my views on the apps I use to manage my email. The ability to work offline is essential and makes browser-based email a bit of a loser. It was just three weeks ago when I was bemoaning° this missing feature and I’ve just discovered a rather wonderful email app for Mac, MailMate.° It also has a lightning fast structure and even allowing for some initial set up it is going to save me a lot of time.

Just to reiterate: you can’t take care of the work that comes into your inbox if you are forever pausing to look at the next email as it pings. As well as the evidence around the cognitive impact, it’s a psychological torture device. A bit like working in certain branches of medicine, say emergency medicine, where the work never stops flowing in. You never get to the end of the work, the doors never close, but at least you do get to the end of your shift. With email people don’t even have a virtual clocking off time. They just plough on, wondering why they are so stressed.

Back to MailMate. It has a spartan appearance and you have to write your replies in plain text and Markdown – though the app handles HTML incredibly well and styles the outgoing emails as needed. I realise this will scare some people off but it is straightforward. The developer also makes a compelling case.° And, really, how many emails do you send with anything more than very occasional smear of italics or bold? MailMate does only work for IMAP so if you are locked into the Microsoft Exchange structure then it won’t help. My university email sits within that dreary walled garden but I do have other accounts where I have some more freedom.

MailMate allows you to toggle individual accounts and I have also discovered, and this is wonderfully helpful, that when the email account is offline, you can still send email. MailMate doesn’t block access to the SMTP server and you can still send out. This is completely fantastic. It’s always been a problem that when you collect the email you have to turn it back on again to send – more emails trickle in and, inevitably, you are back on the email dreadmill. I’ve tried to hack all kinds of solutions for this and MailMate just bakes it in.

I made a couple of tweaks to how it works for me. There are good instructions at the site but there’s a potted summary in the next two sub-headings.

Turn on your app in an offline state

If you turn Outlook to offline and close it then it will, when re-opened, still be offline. No problem there. It does mean you have to remember to do it each time – and I have conditioned myself to make it a habit. MailMate also allows you to tweak the preferences to ensure it always starts offline. I highly recommend this. If you have to grab a file or check the wording of an email for another piece of work you don’t get subjected to your inbox again if you left the app with it still online. It does involve a little bit of work in MailMate and you’ll have to go into the Terminal but it’s simply a matter of cutting and pasting a single line of code to change the default. Restart MailMate once you’ve done it. Easy. Here’s the code to type into the Terminal:

defaults write com.freron.MailMate MmInitialOfflineStateEnabled -bool YES

How to add a global shortcut key that toggles all accounts online and offline

This is the keybindings functionality that MailMate makes it easy to access. Go to the MailMate app in the Finder and right click. Open Package Contents. Then go to Contents/Resources/KeyBindings. I duplicated the Gmail plist file and called it Gmailextra. I then added this line of code under the ‘Only in MailMate’ section of the file:

"~@o" = "toggleOnlineStateOfAllAccounts:";

That now means that Option-Command-o will toggle the online state of all the accounts. Then, you simply type Gmailextra into the Preferences panel in the app:

And, that’s it. The app is now automatically offline when you open it. You can use Option-Command-o to turn everything off and as soon as you have them downloaded then flip to offline again with the same keyboard shortcut. Rinse and repeat.

Happy days.

06 Dec 2019 EDIT: I just updated my MailMate to the new version. The plist file with my Gmailextra settings disappeared in the update so my keyboard shortcut to toggle all accounts on/off was broken. I added it again, as per my own instructions, and all is well.

Left and right: Click bait book titles

There is not much doubt that click bait book titles are in vogue. They tend to be provocative, Buzzfeed inspired, and just like standard click bait they don’t necessarily reflect the content of the actual book. My most recommended book this month is James O’Brien’s How to Be Right… in a world gone wrong.° O’Brien is a radio chat show host on LBC° and he’s very left wing. Unusual in the world of ‘shock jocks’. His book is brilliant at walking through the arguments people use to ram home their points around race, migration, Islamophobia, feminism and, of course, Brexit. He carefully and comprehensively demolishes them and shows us how to do it too. His techniques will, naturally, work for any political position and he is incredibly ineffective at pushing people further to justify their position. In all the examples in the book they quickly fall apart. It is compelling.

He uses transcripts (or recollections of them) in the book and it works brilliantly in audiobook form. I have a slight fear of authors reading their own work. Audiobook narration is not easy and butchering it can destroy the experience. This is one where I’m happy to report the opposite. I can’t imagine this book working without O’Brien’s voice as he narrates his work and recreates the debates with the angry callers. I’m still not that keen on the title. It isn’t really about being right in the sense of besting someone. It could be argued it is about being ‘right’ in the sense of ensuring one’s arguments are robust, coherent and consistent with one’s experience and the evidence available. O’Brien excels in deconstructing opinions that can’t meet these criteria. (It is possible my enjoyment of this book is a form of bias as well – O’Brien’s views are a very close fit with my own.) I’ll be listening again in the near future.

Signalling to Facebook

If you want to move a little further away from Facebook and Mark Zuckerberg then you may wish to consider giving up WhatsApp. It was acquired by the Big F in 2014 and they paid a cool US$19 billion.

The best alternative I have found is Signal app.° It is an open source project that is supported by grants and by donations. There is no profit motive and it’s there to support the users. It works beautifully on my old iPhone, has an Android app, and the desktop app works well too. It was one of WhatsApp founders, Brian Acton, who set up the Signal Foundation and developed Signal after he left WhatsApp in 2017. In fact, it’s the end-to-end encryption technology of Signal that provides the privacy backbone in WhatsApp.

I don’t feel that concerns about my privacy are that great. I don’t have any concerns that the government is going to hack me. And, as Signal makes clear, WhatsApp is very secure – though it does attract more hackers’ attention than other platforms. I just think Facebook’s completely dominance of this market is damaging. Facebook is, in this article from Wired°, “a monopsonist of media attention”. I’m hoping Elizabeth Warren gets her wish and breaks up Facebook. Meantime, I’m just doing my bit to break out of the Facebook stranglehold and Signal makes it an easy decision.

Home visits and GPs

There is just one story that is getting bandied around in GP circles this week. It’s the Kent Local Medical Committee (LMC) motion,° debated at the national meeting, that home visits should be removed from core contract work.

Now, I’ve little sympathy for the heart-tugging nostalgic view of general practice that is peddled by dewy-eyed traditionalists. But, really, what on earth were they thinking? It takes about 30 seconds to spot the flaws in this suggestion. It fragments care, disrupts continuity, and it wages its effect on the most vulnerable people in society. It throws the housebound, disabled, and terminally ill under the bus. Did we learn nothing from the 2004 contract when we gave up out of hours care? The splintering of primary care into separate pockets damages services and will always have a disproportionate impact on the most needy.

I’m all for radical thinking and I appreciate that GPs are hard-pressed but this is so desperate I wonder if it is incredibly Machiavellian. Bear with me, I’m trying to be charitable. Maybe it’s actually a clever way of highlighting how parlous the situation is, that GPs would even countenance such a policy. It might yet have that effect, and things are undeniably hard, but this doesn’t seem conspiratorial. It has cock-up written all over it.

Taking notes on audiobooks

Audiobooks are big business. I’ve been listening to a lot of them this year and the combination of my regular driving commute and running means I get through them quickly. I’ve developed my own system for taking notes when reading and it’s an important part of my reading process. I’ll detail that another time but here’s my immediate problem: how do you capture notes and thoughts when listening to an audiobook?

It’s straightforward if you are sitting down and listening as you can keep a notebook handy. However, one of the attractions of audiobooks is that they are consumed while you are doing other things. Usually I’m driving but I have started listening when out for a walk or sometimes a run.

So, I’ve been mulling over the possibilities.

Just use your usual system

Stop what you are doing and make a note using your preferred medium. Not very handy when engaged in some activity but I do fall back on this when I can.

Dictating notes

It’s an audio medium so using audio to record notes has some logic. There are some options here. You can use the phone that is playing the audiobook to record a voice memo. It may involve hitting some buttons if you don’t have a plan. I’ve never been happy to try this when driving as any fiddling with buttons is almost certainly not legal and definitely unsafe. It can be done without a massive fuss when out walking although it is disruptive when running.

So a no-hands system is needed. I have tried keeping a dictaphone in the car and I have found it quite straightforward to use for the occasional quick note. It does involve fiddling with a device (so isn’t really no-hands), though with mine I can do this without even looking at it. Being safe is clearly the priority. For complete hands-free safety then Siri (or equivalent) could be the way forward. It is possible to set up Siri to open an app like Bear and one can just dictate directly into that. (Although I have discovered that when CarPlay is enabled then Siri won’t allow it.) Alternatively, it is even easier to get Siri to open a voice memo and speak your thoughts. I use the voice memo option as I think it reduces any temptation to look at the screen. The voice memo is also super-easy if you are out walking or running with headphones that have a microphone.

Make a bookmark

It is possible in some audiobook apps, and the Audible one does this, to press a button and make a bookmark. I use the Bound app for iOS° for DRM-free audiobooks as it has a bookmark function. This is just the digital audio equivalent of turning over the corner of a page and you have to come back later and re-listen to the section and take any notes. This is quick and easy but I have found that I’ve been rubbish at going back and re-listening.

None of these are hugely easy and they often risk additional distractions. As well as the obvious safety concerns I also find it jolts me out of my reverie – both from the book and the activity. More and more I’m not worrying about notes and treating audiobooks as a different experience to reading. I’m not trying to replicate the note taking. If that truly bugs you then you could stick to books that might not need any notes or just let them wash over you. Fiction is the obvious example where you’re less likely to want to take notes. I realise this is unsatisfactory but if I genuinely have an insight while listening to an audiobook then I’m finding it sticks with me long enough to get captured later.

A passing thought on the D-word

What is it about the verb “to die” and the word “death”? In recent weeks and months I find myself more and more distracted by the inability of our journalists, politicians, or anyone on the media, to state plainly that someone has died. They have, more often than not, ‘passed away’. I heard a DJ on Radio 2 do it earlier in the week and, this evening, I even heard the newsreader on BBC 5 Live refer to a ‘passing’ to avoid using the word, death.

We are tiptoeing around death. There seems to be a self-imposed ban, a moratorium, if you will, on the D-words. I don’t want to over-play it but is it related to our increasing need to cure every ill, our inability to tolerate any ailment? We can’t face our own mortality in an age of individualism. Death is a dirty word. I spent part of the afternoon re-reading a Belgian paper, which will be published this coming week in BJGP Open, that extends the debate around euthanasia and dementia. Belgium and the Netherlands are two countries who have already enacted legislation. Yet, how can we possibly have a sensible conversation in the UK about death and one’s right to choose, to exercise control, if we’re unable to even speak its name?