Scribblings and Blether

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Fall by Andrew Preston

Robert Maxwell is not a person that is well known these days but readers of a certain age will remember his relentless presence in the media until his death in 1991. This is a fascinating and compelling insight into the man. You would be hard-pressed to describe him as likeable. He is now best remembered as the owner of the Daily Mirror who was a criminal, stealing the pension fund as he tried to prop up his failing empire, and condemning many people to financial hardship and despair. As a media mogul he makes Rupert Murdoch look like a pillar of moral rectitude.

Maxwell was born into grinding poverty, fought in the Second World War, was a Labour MP, a spy, a billionaire entrepreneur, a raging egomaniac, and destined to die in mysterious circumstances on the brink of the collapse of his business. His youngest daughter, his unabashed favourite, is Ghislaine Maxwell. You may have heard of her.

I hadn’t known Maxwell had been an MP and been awarded a Military Cross. I certainly didn’t know he was alleged to have been involved in the extra-judicial execution of a German civilian. Preston also describes an episode where Maxwell, who was by then an officer, machine-gunned German soldiers after they surrendered, describing how the British soldiers grumbled it wasn’t fair.

Maxwell had a major role in the post-war development of scientific publishing. According to this biography he recognised the potential to monetise what was essentially free — knowledge. Many would argue that is still going on with large corporations profiting from the work of academics while restricting access to that same research with paywalls. Maxwell became the UK and US distributor for Springer-Verlag and his fortune was built on the company Pergamon Press (which had started life as Butterworth-Springer). In 1991 Elsevier bought Pergamon and it continues as in imprint.

Elsevier is incredibly profitable with annual operating profits approaching £1 billion in recent years. And much of those profits, though not all, are built on publicly-funded research. This Guardian Long Read covers in some detail the background to Maxwell’s publishing business, his recognition of the opportunities, and the ongoing challenges faced by scientific publishing. Meanwhile, Elsevier continues to print money science.

8 May 2021 Scribbles Books
Bowland Tower bike pic 7 May 2021

April 2021 reading List

A good month and a dozen cracked off. As ever, these are in the order they were finished. If I had to pick one to recommend then it would be Failures of State and there are some notes on that.

Okwonga’s book, One of Them, is a slim volume, very readable, and damning. There is perhaps a risk with it that it’s simply a reinforcing book — if you have a problem with Eton and the private school system then there will be much here to bolster your beliefs. Otherwise, I’m not sure it will change minds.

Wright’s book is not quite as radical as the title might suggest but How to Be an Democratic Socialist isn’t nearly so catchy. It is a brilliant overview of all the ways one might oppose the current system without necessarily calling for a full-blooded revolution.

  • Failures of State by Jonathan Calvert and George Arbuthnot
  • Woke: A Guide to Social Justice by Titania McGrath
  • Free Speech And Why It Matters by Andrew Doyle
  • The Art of Disruption by Magid Magid
  • Pryor Convictions by Richard Pryor
  • A River in Darkness by Masaji Ishikawa
  • The Inimitable Jeeves by PG Wodehouse
  • How to Be an Anticapitalist in the Twenty-First Century by Erik Olin Wright
  • Nicotine by Gregor Hens
  • Crack House by Harry Keeble with Kris Hollington
  • Anti-Social by Nick Pettigrew
  • One of Them: An Eton College Memoir by Musa Okwonga
1 May 2021 Monthly Reading List Scribbles

Failures of State by Jonathan Calvert and George Arbuthnott

I finished this book a couple of weeks ago but it is one that has stayed with me. You know how it is — your mind keeps drifting back to a book, it won’t quite let you go. This is one of those. It is all the more remarkable when you consider it is recounting events that we’ve lived through, or at least most of us have, in recent months. A lot has happened.

I’m not quite sure where to start with my outrage. There are so many avenues down which it can be channelled. Perhaps my greatest disgust is reserved for the repetitious nature of the mistakes. Pandemics are not common and we can allow a certain latitude. Yet the abject refusal to recognise the inevitable and to vacillate while people died is unforgivable. One of the bleakest passages is the description of the clandestine Sunday evening rendezvous with the prime minister” with four academics in September as Johnson considered a circuit breaker. Following the science? Read it and weep. Three academics put the case for a more liberal approach. They don’t come out looking good. The fourth academic advising Johnson and Sunak, Professor John Edmunds, if he re-iterated the advice in a co-authored Sage report, would have been recommending an immediate two-week circuit break. (He declined to report to the authors what he said in the meeting.)

The political bunfighting continues but the COVID situation is widely held to be brightening. As long as you are myopically squinting at the UK and that you don’t care too much about the rest of the world. At the time of writing the WHO is pointing out that the pandemic is a long way from over, indeed it is accelerating”. The situation in India is horrendous. But it surely can’t be any secret that the problem of unchecked infection will come back to stalk us in the form of variants?

I’ve picked out some of the quotes I highlighted with some comments.

The initial response

Those months in early 2020 were excruciating as we waited to go into lockdown. It was perfectly obvious it had to happen and the delay seemed inexplicable. Meantime, the infection was spreading and that, of course, means that the death toll will have been ticking up. It was initially quiet and easy to be lulled into a complacency but it was baked in. Calvert and Arbutnott are scathing about the early response and Johnson’s efforts.

He did not attend any of the first five meetings of Cobra, the key national crisis committee that commanded the UKs response to the pandemic. The first Cobra meeting Johnson attended was on 2 March and by then the virus had already firmly gained its foothold in the country. As many commentators would point out after our first article: this was an extraordinary dereliction of his duty as a prime minister, which would have enormous consequences.

A study by Southampton University has shown that 190,000 people flew into the UK from Wuhan and other high-risk Chinese cities between January and March and were allowed to travel across Britain at will. The researchers estimated that up to 1,900 of these passengers would have been infected with the coronavirus — guaranteeing the UK would become a centre of the subsequent pandemic.

In fact, according to the analysis, there were only three occasions in the last 10 years when a prime minister, who had been in Westminster, had skipped a Cobra meeting.

The lack of action was described by Doris-Ann Williams, chief executive of the British In Vitro Diagnostics Association, which represents 110 companies that make up most of the UKs testing sector. Amazingly, she said her organisation did not receive a meaningful approach from the government asking for help until 1 April — the night before Hancock bowed to pressure and announced a belated and ambitious target of 100,000 tests a day by the end of that month.

As part of 26 key recommendations from Cygnus, the NHS was told it needed to make urgent and drastic improvements, which would have to be paid for with money the government was advised to specifically ring-fence for that purpose. That did not happen.

There was also a critical lack of laboratory testing capacity. According to Martin Hibberd, a professor of emerging infectious disease at LSHTM, a key reason for that had been money. The NHS had moved away from using its own laboratories in the years before the pandemic and had increasingly farmed out its work to privately owned facilities in an effort to cut costs.

The herd immunity fallacy

We lost valuable time at the start of the 2020 as the herd immunity fallacy played out. While few would dispute that the CMO and CSO are people of integrity the sense is that they have grown into their roles. One wonders how hesitant and how diffident they were at the start; and for all the denials there seems to have been a strong flirtation with herd immunity in many who were looking at the early signs.

One well-known senior Conservative confided: I had conversations with Chris Whitty [the chief medical officer] at the end of January, and they were absolutely focused on herd immunity. The reason is that with flu, herd immunity is the right response if you haven’t got a vaccine.’

Whitty denies that he has ever been an advocate of herd immunity other than as part of a vaccination programme. But herd immunity was a view that appears to have infected the government.

The concept of herd immunity is toxic politically because it effectively means that the weakest in society — the ill and the elderly — are left to perish.

Herd immunity was a dangerous experiment with no proven upside, but Johnson’s government was willing, nonetheless, to try it.

Since herd immunity was self-defeating, the government’s strategy of delaying the introduction of measures to suppress the virus was a calamitous miscalculation.

The Domoscene conversion

Dominic Cummings had initially favoured the government’s delay-and-mitigate approach, but he changed his mind. Dominic himself had a conversion,’ a senior Tory said. The Domoscene conversion’, as it became known, was said to have happened at an earlier meeting with scientists.

It is difficult to imagine a man who could be much more reviled in public life than Dominic Cummings after his Barnard Castle. There can be few who were genuinely persuaded by his performance in the Rose Garden on Downing Street. This caught my eye at the time as it is a reminder that our Dom is very much his own man. There is little likelihood that he can ever be rehabilitated in the public’s eye but some on the left may find themselves cheering him on and he is catnip for the commentariat. And, given his apparent willingness to hang Johnson out to dry, any testimony he offers to a future inquiry will be box office. We’re going to be hearing a lot of Cummings for a good while to come.

The NHS was overwhelmed

Most people think we got away with it and we coped. The NHS weathered the storm. Yet, when the system gets overwhelmed it wouldn’t typically collapse in a televisual way.

Downing Street was anxious that critical care units should not be visibly overrun as they had been in Italy, Spain and China, where patients in the city of Wuhan were photographed dying in corridors. So a veil of secrecy was now placed over Britain’s hospitals. The publication of critical care capacity figures was suspended, which meant nobody outside the corridors of power would be able to tell whether hospitals were being overrun, and a general ban was imposed on information being passed to the media without sign-off from central command. The NHS management had shifted to a war footing.

There may well have been efforts to downplay the scale of the problem but one graph is revealing. It’s difficult to shift away from this — logical reasons for this drop, other than a form of rationing, are very thin indeed.

This is a compelling image. That drop down to 6% involves a staggering amount of loss, grief, and pain. It also screams of the missed opportunities. If anyone, like the government, ever tells you that ICUs weren’t overwhelmed then remember this dismal curve. Thousands of decisions were made that meant people weren’t sent to ICU who otherwise would have been.

The evidence was buried away in data collected from 65,000 people who were admitted to UK hospitals with the virus up to the end of May and that had been analysed by the Covid-19 Clinical Information Network (Co-Cin), which reports to the Sage advisory committee. This data produced by the Co-Cin team is the government’s best record of how patients with the virus were treated in hospitals during the outbreak. Overall, it showed that just one in six Covid-19 patients who lost their lives in hospital during the first wave had been given intensive care treatment. This suggests that of the 47,000 people who died of the virus inside and outside hospitals, an estimated 5,000 — just one in nine — received the highest critical care, despite the government claiming that intensive care capacity was never breached.

In the middle weeks of March, 13 per cent of that age group admitted to hospital with the virus were given an intensive care bed. By the start of May, that figure had more than halved and was down at 6 per cent.

In October we had revealed evidence that access to intensive care had been rationed in hospitals across England, which had led to patients being denied life-saving ventilation. This had sparked an intemperate reaction from Professor Stephen Powis, the NHS national medical director, who claimed our story was untrue’ and was deeply offensive’ to health service workers. Powis was adamant that even at the height of the pandemic there was no shortage of ventilators and intensive care.’ The consortium’s findings suggest he was very badly informed.

The Inquiry will come

The government is in no rush for an inquiry. It is, obviously, an entirely political decision. There may be a skimpy argument that we are still fighting through and now is not the time. There is certainly some credibility in recognising that the pandemic has a way to go. You don’t have to be over-cynical to feel that the government is unlikely to come out well from an inquiry and they are delaying the moment. It will be much easier to bear the political cost if lives have returned to normal and people are focusing on getting back to the quotidian concerns of family, work, and leisure.

History is unlikely to be kind to Johnson and his government’s stewardship of Britain’s response to the pandemic.

Weatherby and Abrahamson believe that Johnson’s conduct could also amount to the criminal offence of gross negligence manslaughter’, although they believe it is unlikely that the Crown Prosecution Service would take up such a case. That may change, they note, if further evidence emerges at a future public inquiry.

28 April 2021 Scribbles

March 2021 Reading List

One to read: It has to be In Control by Jane Monckton-Smith - terrifying but helpful in equal measure.

  • The Things They Carried by Tim O’Brien
  • Elegy for Mary Turner by Rachel Marie-Crane Williams
  • A World Without Email by Cal Newport
  • Brutally Honest Guide to Microstock Photography by Alexandre Rotenberg
  • The Rookie by Stephen Moss
  • A Promised Land by Barack Obama
  • In Control: Dangerous Relationships and How They End in Murder by Jane Monckton-Smith
  • A Short History of Drunkenness by Mark Forsyth
  • How to Write Funny by Scott Dikkers
1 April 2021 Monthly Reading List

February 2021 Reading List

One to read: Not an easy choice this month with 5-6 contenders. Jews Don’t Count is short, accessible, and I came away with a much improved understanding of anti-semitism.

  • Our Bodies, Their Battlefield by Christina Lamb
  • How to Blow Up a Pipeline by Andreas Malm
  • Jews Don’t Count by David Baddiel
  • Why Running Matters by Ian Mortimer
  • The Assault on Truth by Peter Osborne
  • Extraterrestial by Avi Loeb
  • What Money Can’t Buy by Michael J. Sandel
  • Bullshit Jobs by David Graeber
  • Streets of Dublin by Joe Houghton
1 March 2021 Monthly Reading List

January 2021 Reading List

One to read: I learned more from Revolting Prostitutes than I care to admit.

  • First You Write a Sentence by Joe Moran
  • The Precipice by Toby Ord
  • Revolting Prostitutes by Molly Smith and Juno Mac
  • Crack: Rock Cocaine, Street Capitalism, and the Decade of Greed by David Farber
  • Storyworthy by Matthew Dicks
  • Violent Borders: Refugees and the Right to Move by Reece Jones
  • Drug Use for Grown Ups by Carl L. Hart
  • No Fixed Abode by Maeve McClenaghan
  • Labours of Love by Madeleine Bunting
1 February 2021 Monthly Reading List

December 2020 Reading List

One to read: The audiobook of Black and British is sublime. The narration by Kobna Holbrook-Smith (who reads Aaronvitch’s fabulous Rivers of London series) is just perfect. It’s a long one at over 24hrs but I didn’t want it to end.

  • The End of Everything (Astrophysically Speaking)
  • Black and British: A Forgotten History by David Olusoga
  • The Great Pretender by Susannah Cahalan
  • Beyond the Red Wall by Deborah Mattinson
  • On Inhumanity by David Livingstone-Smith
  • Going Dark by Julia Ebner
  • This Is Not Normal by William Davies
1 January 2021 Monthly Reading List

November 2020 Reading List

One to read: Brian Deer could be the dictionary definition of tenacious, if not obsessive. The Doctor Who Fooled the World is superb.

  • Wake Up by Piers Morgan
  • For Small Creatures Such as We by Sasha Sagan
  • The Future of British Politics by Frankie Boyle
  • The Rules of Contagion by Adam Kucharski
  • The Tyranny of Merit by Michael J. Sandel
  • The Doctor Who Fooled the World by Brian Deer
  • Conscious by Annaka Harris
  • The Idea of the Brain by Matthew Cobb
  • Blind Descent by James M. Tabor
1 December 2020 Monthly Reading List

Wake Up by Piers Morgan

Now it is no great shakes to declare that 2020 has been full of surprises, few of them in truth that pleasant. If there was one person I didn’t think would feature in my writing around medicine and politics and books it was Piers Morgan. Like many, though by no means all, I’ve been a long subscriber to what could be called the Hislop School of Thought. The Private Eye editor and HIGNFY panellist has a particular enmity for Piers Morgan and, frankly, it didn’t seem that unreasonable. That said, I’ve always been wary about hating’ celebrities, or politicians for that matter, as we never know these people, not truly.

Piers Morgan has come over as a raging egotist, a Trump apologist, and shameless self-promoting narcissist. Yet, looking back there have been clues. There’s the Youtube video of him in the cricket nets gamely being peppered by Brett Lee’s fast bowling. He took it, cracked rib and all, with impressive courage. Chapeau. I also read Emily Maitlis’ book Airhead earlier in the year and Piers Morgan appears in there, a friend of Maitlis, and the portrayal hints at the decency of the man. I seem to recall, though don’t quote me, that she also mentions Morgan’s assertion that he regards himself as a feminist. He was also the editor of the Daily Mirror. Now, like any tabloid, particularly in that era, it was hardly a bastion of moral rectitude. But, there was the matter of the vociferous opposition to the Iraq War from Morgan and colleagues, a good moment for him and the Mirror.

Anyhoo, back to the politics and medicine. Perhaps then it shouldn’t come as quite such as surprise that he has been the surprise hero of the COVID-19 pandemic. He has, with considerable gusto, thrown himself into holding the British Government to account. To be fair, given the vacillation, the u-turns, and the sheer agonising ineptitude this should be more in line with shooting fish in a barrel. Yet, it has been largely beyond the media. Not so Piers.

He describes himself as a liberal and the book is an extended rant against illiberal wokery”. Now, I don’t agree with him about several arguments within the book and it is all too easy to hear Morgan ranting in sections. He does have a very valid and real point about cancellation culture. It’s difficult to reconcile free speech with the no-platforming approach. For some of the most despicable hate speech mongerers there will be legal grounds for this but one feels it should be held in reserve and deployed in only the most egregious of cases.

And, he is on the side of the angels, well Obama, here as well. Personally I’m less certain this is about wokery, as he characterises it, and more about polarisation. Morgan’s wokery’ is just one manifestation of the divisive nature of social discourse. In some ways Morgan is resisting the polarisation, not letting himself get dragged to either extreme. It is an impressive example of self-confidence, possibly mildly pathological, and those torrid forces tugging at his ego have resulted in him coming across as vaguely unhinged as he has raved about men wearing papooses or vegan sausage rolls.

I took a bit of a deep breath before reading this book, thinking it might be one to puncture my filter bubble. In the end, not so much. I was worried it would provoke some visceral reaction, deepening my own bias. It has, in many ways, given me a tremendous amount of pleasure. It’s all too easy to read books that simply confirm one’s bias. It turns out I almost certainly have more in common with Morgan than we are apart. Arguably, Morgan is now an unusual beast, someone who has not gravitated to an extreme pole, holding liberal views from decades past, but not letting himself be pulled further. The political tectonic plates are shifting but I suspect Morgan has barely budged an inch even as the ground under him has been rent. He has, in 2020, found his mojo again and, to borrow a slightly grim phrase, he is having a good’ pandemic. Which is good for him. And as it turns out it’s pretty good for us too.

Morgan ranting about it is just intolerant and it’s even vaguely bullying; a quality that is often not too far away with our Piers.

Let me finish on a sidenote and say a few words about vegan sausage rolls to hark back to Morgan’s days of petty irrelevance. I don’t actually know what Morgan’s beef is with them but I suspect the problem is the lack of the beef’, well pork. Often it is when plant-based food tries to imitate meat products that it often goes wrong. The thing is, many of us have grown up with sausage rolls, they are a comfort food. Yes, I could eat something completely different but that roll of pastry with a salty tasty smear running down the middle is good. For me, it is just as good, in fact even better, than the meat version. I get the same fatty salty flaky warmth and comfort without the dead animals. Win-win.

Morgan ranting about it is just intolerant and it’s even vaguely bullying; a quality that is often not too far away with our Piers. He does, to his credit, acknowledge this in a few places in the book. I’m not sure his day-to-day behaviour has improved with this self-awareness and insight. I still see him regularly calling out some muppet on Twitter by citing his own follower count. Morgan might be putting in an unexpected bid for national treasure status but the planet-sized ego is still capable of eclipsing and undermining his own arguments. The book is well worth the read though.

19 November 2020 Scribbles

Back on Twitter

It is has taken me a while but I have rejoined Twitter. It is a somewhat painful process after deleting it all a couple of years ago. I was first on Twitter in 2009, I think, and had a few followers but I am now rebuilding from scratch. I’d be very happy to engage with you there. I am @euan_lawson.

15 November 2020 Scribbles

October 2020 reading list

Here is my reading list for October 2020 and I hope it highlights some books you may be tempted to try for yourself. There is no ranking here and they are simply presented in the order in which I read them.

For anyone who spends any time thinking about evidence to help with decisions (and you should) then Science Fictions by Stuart Ritchie is the obvious choice this month. Just because there are flaws in the way evidence is presented doesn’t render it all useless—but it is more important than ever to be able to make those judgements.

Eating Animals by Jonathan Safran Foer

I found this a slightly disjointed book, not entirely focused, and I’m not sure I was that keen on Foer’s style in certain sections. It is undeniably compelling. I found the argument that Foer put forward irresistible. This is partly as Foer doesn’t try too hard to persuade us—a good technique for doing exactly that but I didn’t feel I was being played. Will it stop you eating meat? Quite possibly. If you are mostly plant-based and wobbling then this book may well tilt you over the edge.

On Fire by Naomi Klein

This is a collection of essays and other writing from Klein, the Canadian author and social activist, including speeches to various organisations. There is a little repetition but mostly I found that they hang together beautifully. She is writing from a left wing liberal viewpoint but Klein’s recent efforts have been to put those politics in the context of the climate emergency. I find it difficult to listen to her and be anything other than utterly persuaded.

Science Fictions by Stuart Ritchie

This could be regarded as a disheartening book but I prefer that we make some clear-headed appraisals of the evidence with which we are presented. It is a tremendous introduction to meta-science, the science of science. This is not quite as navel-gazing as it sounds. As Ritchie puts it:

If science is the process of exposing and eliminating errors, meta-science represents that process aimed inwards.”

Publication bias, p-hacking, data dredging are all here. Not to mention outright fraud and overblown hype. If we don’t minimise and eliminate these we’re never going to come to the right decisions as our science will be tainted.

Against the Grain by James C. Scott

Scott explores the earliest civilisations and I’m a bit of a sucker for these pre-historic excursions but I was a little disappointed. There are some interesting notions—for example, the mutual inter-dependence between barbarians and those dwelling in the walled cities and the role of slave trades. There are also the well known problems of disease in these societies, unknowable for those at the time, in moving from hunter gatherer to city lifestyles. Yet, I found the book hard work and it just never grabbed me.

The Most Good You Can Do by Peter Singer

I’m trying to remember how I got put onto Singer. I think it was Jonathan Safran Foer as Singer leapt into prominence for his 1970s book, Animal Liberation. He is a philosopher and not afraid to ask some hard questions. You will think differently about charitable giving, indeed how you live your life, after reading this book. I’ve long felt a resentment at the emotional heart-string tugging that goes into your typical appeal from charities. Singer offers an alternative: effective altruism. There is a TED video (natch) if you can’t find the time for this book.

Left Out by Gabriel Pogrund and Patrick Maguire

Corbyn does not come out well of this telling of the recent Labour psychodrama. But few do here. My overall sense was of a lot of people behaving abysmally. It’s difficult to avert one’s eyes and stop reading, but it’s the same uncomfortable sensation one gets witnessing a car crash. Pogrund and Maguire dwell on the Corbynmania but all too often he appears passive, utterly unsuited to the demands of leadership. It also offers plenty of insight into the ongoing anti-semitic debacle with Jezza. All the indications suggest he is an honourable man who has devoted his life to many worthy causes. His very sense of self revolves around this anti-racist self perception. This is the trap; he seems unable to fathom how he could be considered anti-semitic and Labour find themselves trapped in a doom-loop.

Consider Phlebas by Iain M. Banks

I read Banks’ contemporary fiction back in the 1990s and I got up to A Song of Stone (1997) before tailing off. One has to be a little careful about memory but I have a vivid recollection of going through several of them while ensconced in various Kathmandu cafés in 1996 while on my medical elective. (Spent at a small cancer hospital in Bhaktapur.) I’m not sure why I never took to his science fiction but I had a sudden desire to take on this first book in the Culture series. And it is a towering achievement, a fitting memorial, one of many he has left us, to a man who died too early at the age of 59.

How Fascism Works by Jason Stanley

A short book but one that deserves to be kept near at hand for reference as various malignant political forces try to bend society to their will. This is no historical tome, though it references past processes with inevitable reference to the Nazis. I read this just before the vote but now we are through the US Presidential election and reflecting on the Trump administration, among others around the world, it’s easy to pick out the scenarios being played out before our eyes. There is an argument that it will add more to polarisation but I found it sufficiently nuanced to reach beyond that.

1 November 2020 Monthly Reading List Scribbles

September 2020 reading list

As it happened I got through just eight books this month though one at least was something of a beast. However, given I took on the editorship of the BJGP that’s not too bad. Here’s the September list.

The books

Carpe Diem Regained by Roman Krznaric Very good. I came to this after reading Krznaric’s new book The Good Ancestor and I’m inclined to go through his back catalogue. In this one he takes the whole concept of carpe diem — first expressed by Horace — and applies it to modern life. There is some interesting crossover here with Storr’s book Selfie and the nature of individualism.

Crashed. How a Decade of Financial Crises Changed the World. No less than 25½ hours for this audiobook and I have mixed feelings. If nothing else it has made it clear to me just how complex the global financial system and its inter-linked cogs have now become. The best bits are when the political angles are explored and the hardest bits are endless technical details about bonds, credit swaps etc. I just let them wash over me and it is one of the advantages of audiobook.

The Ghost Map by Steven Johnson I read Johnson’s book about ideas and creativity last year and you can see the germ of that book in here. This is a rather wonderful exploration of Jon Snow that goes well beyond the simple tale of the Broad Street pump handle and highlights how hidebound we all become when it comes to our opinions. The contortions performed by the establishment to hold onto the miasmic theory of disease are almost comedic to our modern sensibilities. However, it was a deadly serious business and Snow was a remarkable individual.

Selfie by Will Storr Another excellent book by Storr who is a compelling writer. It isn’t laser focused and there is much of Storr’s personal experience in it - no bad thing - resulting in a very readable, occasionally funny book. There are also many insights into the cult of self, of personality, which is engulfing us. He reminds of Ronson in his long form style, only a little more academic, with a slightly more melancholic edge.

MBS by Ben Hubbard One of the reasons I wanted to read this was because I am a Newcastle fan. The Saudi takeover of Newcastle hasn’t, at the time of writing, yet happened but it is still possible it will get resuscitated. There is plenty to deplore about Mike Ashley but he is not in the same league as Mohammed Bin Salman. This is far from a hatchet job and Hubbard covers some of the liberations in Saudi society - women now being allowed to drive. There is, of course, much on Khashoggi and his dark, brutal murder.

The Future We Choose by Christiana Figueres and Tom Rivett-Carnac I didn’t get a great deal that was new about this but it is a good summary of the climate concerns we face, the options we have for developing a society to cope, and it manages to strike an optimistic tone.

The Prime Ministers by Steve Richards I was concerned this book might be a little too concerned with the topic of leadership and veer off into expansive conclusions about how to lead’ using the experiences of PMs as fertile ground for handy anecdotes. Not a bit of it. It’s a political book that gives a precis of each of these PMs and the struggles they faced, concentrating on their characters and their reactions. Very good.

A Little History of Philosophy by Nigel Warburton Another gem that skips across the major branches of philosophy with a light touch. It is accessible and it is engaging. What more could you want?

1 October 2020 Monthly Reading List Scribbles

August 2020 reading list

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.

The books

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 lets 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 is an incredibly important book but for me it’s not as good as it could be and 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.

1 September 2020 Monthly Reading List Scribbles

July 2020 reading list

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 sometimes wonder what politicians think when they read these books. Do David Cameron, Amber Rudd, Theresa May, feel any sting of shame at all? Most probably not. And, not because I believe they are heartless psychopaths. I try hard not to judge the personal qualities of people on the news and in the media as we can’t really know these people and labelling them as such doesn’t help.

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.

16 August 2020 Monthly Reading List Scribbles

Late presenting bladder cancer and colour vision

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.

A good example is blood in the urine. I doubt I would miss frank gross haematuria but a red-green colour deficiency makes it easy to miss an elegant pink tinge in my urine. This simple study° from some urologists in Preston took 200 male patients with bladder cancer and assessed them for colour deficiency using an Ishihara° plate test. They found 21 blokes (10.5%) had red-green or complete colour blindness’. The presentation at diagnosis was frank haematuria in 74% of the non-colour blind versus 62% of the colour blind (non-significant).

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°

15 August 2020 Colour Blindness

Colourblindness and cricket

WH Ponsford

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. (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

15 August 2020 Colour Blindness

The Orwell Prize winner 2020 goes to…

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.)

Amelia Gentleman narrates it well and the story includes moments of personal reflection too, where she had doubts and anxieties. These were welcome, there are times when the forced objectivity of journalists feels, well, forced. They tell of injustices through gritted teeth, not wanting to let their emotions intrude. The Orwell Prize rather exemplifies the need for political journalism to have a viewpoint, to have a stance, though it is perfectly possible to over-egg this. Going to far is, perhaps, one of the reasons I found Caroline Criado Perez’s book, Invisible Women, a much harder listen. Her understandable frustration and anger at the demonstrable injustice and bias manages, just at points, to lessen the raw power of the data bias. (In fact, I still have a couple of hours left on that book to finish as I had, unusually, given up on it.)

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.

9 July 2020 Scribbles

June 2020 reading list

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.

1 July 2020 Monthly Reading List Scribbles

May 2020 reading list

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.

I liked Hypersanity but it was a little patchy. The Secret Barrister takes us through the abject running down of the criminal justice system in the past decade. I’m not quite sure why I picked up the Steve Jobs biography, possibly as a consequence of reading Bad Blood and the hero worship of Jobs by the main player, Elizabeth Holmes. Neither of them come out particularly well.

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.°

1 June 2020 Monthly Reading List Scribbles

April 2020 reading list

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.

1 May 2020 Monthly Reading List Scribbles

March 2020 reading list

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

Recommendation of the Month

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

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

1 April 2020 Monthly Reading List Scribbles

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.

19 March 2020 Orwell Long List Scribbles

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.”

18 March 2020 Orwell Long List Scribbles

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.

17 March 2020 Orwell Long List Scribbles