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

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

Here are just a selection of passages I highlighted:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

• Men Explain Things to Me by Rebecca Solnit°
• Everyday Socialism (Fabian Society) edited by Rachel Reeves MP
• Cold Fear by Mads Peder Norbo
• Letters to a Young Contrarian by Christopher Hitchens°
• The Missionary Position by Christopher Hitchens
• And Yet…: Essays by Christopher Hitchens
• Why Marx Was Right by Terry Eagleton
• Let It Snow by Nigel Bird°
• Where Good Ideas Come From by Steven Johnson
• Time and How to Spend It by James Wallman
• The Gentle Art of Tramping by Stephen Graham°
• WTF by Robert Peston
• Darkness Visible by William Styron°

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.

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.”

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.”

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.

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?

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.

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.”