This is by way of a personal note, but I figure that as nobody is making anybody read this, here goes anyway.
I’d like to say thank you to friends (no names, no blushes). Some of whom I haven’t met, some of whom are new and some of whom I’ve known for what seems like forever.
Friends who have hung around whilst I worked out that tunnels do come to an end. Friends who have gone out of their way to include me in things. Friends who have coped with my inward looking state.
New friends who have come along and accepted me with my all too obvious baggage. Friends who have made me laugh. Friends who have welcomed me into their homes on significant days.
Friends: my thanks.
I’m not going to take the historical parts of the site offline. One day I will be able to read them myself. For the moment they can rest. Need to rest.
I am looking forward to life in a way that I haven’t been able to do for a very long time. A very very long time.
And, dude: flip!
“Rights” are a slippery concept. It is both a useful and a problematic term. Useful, because used with caution it gets across an idea that we seem to have a fair amount of common ground about. Problematic, because once you start trying to get specific the idea falls apart.
I can’t remember the academic jargon for this now, but I don’t believe in inalienable rights that have descended upon us from somewhere else. I believe that “rights” are human constructs. However that doesn’t make the idea less useful, nor does it much affect the way the word gets used outside of the rarified atmosphere of the philosophers’ debating society.
Enough preamble…I think that most discussions about rights start in the wrong place. I don’t just mean the old debate about rights *and* responsibilities, although that is often still a missing component of any discussion as well. What I mean is best explained by example:
Most discussions about rights start off with somebody saying that they have, or ought to have, a right to do something. As in “my right to vote”, or “it’s my body. I have a right to do with it as I wish”.
Because, when you get down to it, “right” used in this way is meaningless – in the sense that there is no list written on tablets of stone (or held in binary form by some magic combination of electricity and silicon if you prefer). If you say “I have a right to do x” and I say “no you don’t” the conversation doesn’t have anywhere to go.
If, on the other hand, you start off by saying “what right do you have to stop me doing x?” then the debate becomes more meaningful. Because I don’t have a right to stop you voting then if I do so then it becomes very obvious that we are dealing with a power relationship. If I wish to stop you drinking alcohol then I have to find a way of justifying my action. You may not have a “right” to drink, but I certainly don’t have a right to stop you either. In fact I don’t have a right to interfere with your life at all. If I wish to do so I need to find a way of legitimising my actions through some other argument.
A neat illustration of this has recently cropped up in South America:
Argentina’s supreme court, presented with a case about youths arrested with a few joints, ruled last week that such behaviour did not violate the constitution. “Each adult is free to make lifestyle decisions without the intervention of the state,” it said.
The state admits that it has no right to stop people smoking marijuana. The basis of a whole swathe of state activity just disappeared. Pop.
Now, the people of Argentina may get together and decide that the smoking of marijuana needs to be controlled in some way for the benefit of the people of Argentina as a whole – or maybe only in cases where the smokers are deemed through age not to be fully responsible for their own lives. But it will need to be explicit and argued back and forth. Existing laws need to be changed because they have been built on an implicit assumption that the state has the “right” to interfere and now the state has accepted that it doesn’t.
This is very pertinent to the argument about assisted suicide (euthanasia). People argue that they have a right to decide how to die. This is not helpful. Ask the question the other way around – what right do you have to stop me choosing when or how I die?
Just like the marijuana story, asking the question this way around doesn’t assume that therefore the activity ought to be allowed. It merely makes clear what is being argued about. If society decides that assisted suicide should remain illegal then it needs to find convincing arguments why that should be so (mental capacity to decide might be one. As might exploitation of people in an unequal relationship). But it behoves the prohibitionists to create, and win, the rational argument. Whereas we live in a society where there are a whole load of things, like marijuana, that are prohibited for irrational reasons.
For more on the liberalisation of drugs in South America read this Guardian article.
(Comercial T-Shirt available here)
The British NHS is mealy-mouthed about homeopathy and even runs some hospitals with homeopathy in their title (although it is difficult to determine how much homeopathy that they currently do).
Some homeopaths say sensible things:
The Royal London Homeopathic Hospital is run by doctors who are also homeopaths and who treat conditions such as hay fever and rheumatism. They are also furious that some homeopaths are making these false claims about malaria.
The hospital’s Director Peter Fisher told Newsnight “I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.”
And others don’t:
The Nelsons adviser told the researcher that the homeopathic compounds would protect her. “They make it so your energy doesn’t have a malaria-shaped hole in it so the malarial mosquitos won’t come along and fill that in.”
Both quotes from this BBC programme.
The problem being that homeopathy isn’t held to the same standards as other products. For some reason, whatever the law says, we seem to have exempted the alternative therapies from the same scrutiny that, say, a bottled water manufacturer, or a sports drink company, has to endure.
The Society of Homeopaths has recently issued a press statement which contains the following section:
Chief Executive, Paula Ross says, “this is just another poorly wrapped attempt to discredit homeopathy by Sense About Science. The irony is that in their efforts to promote evidence in medicine, they have failed to do their own homework. There is a strong and growing evidence base for homeopathy and most notably, this also includes childhood diarrhoea”
The whole statement is online including references (although the provided link wasn’t working when I tried it). It is quite a clever press release.
The release is response to a story that the BBC was running based upon some statements from the World Health Organisation (or, at least, senior figures within it). The WHO seems to have been responding to the pressure group named by the Society of Homeopaths. There are a variety of WHO professionals quoted here. The quotes include:
Joe Martines, on behalf of Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO: “We have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children…Homeopathy does not focus on the treatment and prevention of dehydration – in total contradiction with the scientific basis and our recommendations for the management of diarrhoea.”
Does. Doesn’t. Does. Doesn’t.
Ben Goldacre has some good stuff to say about using evidence selectively in the field of homeopathy.
In recent years there seems to have been the blurring of a useful distintion. Even the NHS link at the top of this piece refers to homeopathy being “a type of complementary and alternative medicine (CAM)” Complementary seems to me to mean “in addition to” as against the “instead of” of alternative. There are a number of complementary therapies, especially manipulative and educational ones, that are widely used and supported within the medical profession (you could argue that Physiotherapy, which is present in every acute hospital, started that way). New ones get tested from time to time and the results get included in premier medical journals. Lumping complementary together with alternative is not helpful.
Although the medical profession is conservative (and believe me, doctors who are not conservative can be scary), it is my experience that they do actually want to do good. If there is convincing evidence that some unexpected benefit accrues from a practice not hitherto considered then, albeit with lag that can sometimes seem regrettable, medicine encompasses that idea. It becomes mainstream. Practices that fight to maintain their status as “alternative” have failed to convince medical professionals.
So, remember that:
Homeopathy is a complete system of medicine, suitable for everyone.
Source on the Society of Homeopaths’ front page.
Hill of the timid birds (Beinn Enaiglair), and another Corbett.
Really quite a lot of the day (and eight hour circle from Braemore Junction) was spent walking across rough ground – mostly heather moorland – as the tracks marked on the Ordnance Survey maps proved to be elusive.
Early on in the walk there was a very obvious and maintained vehicle track which went roughly in the same direction as the path we were looking for. We followed it for a while and it was quite hard to give it up and set off across the heather, for giving it up meant both hard work and admitting that we didn’t exactly know where we were or which direction we should be going in. However, the hillwalker’s bête noire of losing height laboriously gained finally won out and we turned.
Lesson learned….I hope.
Although collectable (by those who want to, which of course I don’t), Beinn Enaiglair doesn’t seem to be heavily visited. It might get a few enthusiastic visitors keen to get an extra tick after climbing the nearby, and higher, Beinn Dearg, but as it works as a super walk in its own right it seems a pity that the tracks are faint. The views are stunning – from the loomy Beinn Dearg in one direction to Loch Broom and the sea in another. All round in fact. Top spot.
There are indications that the landowner doesn’t much appreciate walkers. And, of course, lower numbers of walkers mean fading tracks which mean yet lower numbers of walkers. However, to quote the text which appears on OS maps:
In Scotland, everyone has access rights in law over most land and inland water, provided access is exercised responsibly. This includes walking, cycling, horse-riding and water access, for recreational and educational purposes, and for crossing land or water. Access rights do not apply to motorised activities, hunting, shooting or fishing, nor if your dog is not under proper control. The Scottish Outdoor Access Code is the reference point for responsible behaviour, and can be obtained at www.outdooraccess-scotland.com or by phone your local Scottish Natural Heritage office.
The Access Code is available from here.
(Munros 1, Corbetts 3, Grahams 1)
Britain has a Supreme Court. Or at least it will have in October this year. We are currently rather between courts as the predecessor body is no more. It is a very British idea that constitutional change this significant just sort of happens quietly in the background. It isn’t quite going to be supreme in all regards (there is, as ever, a partial, but only partial, exemption for Scotland), but even so…fancy separating out the judiciary from the legislature. Whatever next? An elected head of state :-)
The last case heard by the law lords in their old guise as members of the second chamber of parliament was the case brought by Debbie Purdy (or here). It was a momentous decision on which to end, not just because of Ms Purdy’s story, but because the ruling states (speaking loosely) that people have a right to know whether a law is going to be enforced. This seems to be the sort of thing that the highest court in the land ought to get involved in.
Assisting somebody to commit suicide is illegal and carries a long jail term, yet there have been at least a hundred cases recently in which people have clearly and openly assisted in a suicide without there being a prosecution. Many of these cases have been very high profile. As far as I am aware nobody has doubted the facts of the cases, many (all?) of which have been subject to a police investigation.
The UK system contains an odd get out for the crown prosecutors in that not only do they have to consider the likelihood of getting a conviction but also whether the prosecution would be “in the public interest”. That’s all very well for the prosecution service, but it leaves people not knowing about their personal position. Public interest is an after the fact decision. It can’t help guide action.
So if you were in the position of wanting to do something that was clearly against a law but which didn’t ever seem to get prosecuted wouldn’t you feel a bit stressed about it?
I happen to think that current law is wrong, but I think even more strongly that having a law that is not enforced is stupid. It leads to a disrespect for laws and damages society. In this particular case, I also think that putting people through the uncertainty of an after the fact judgement by a bureaucrat is cruel.
On the wider question of assisted suicide, I note that the Royal College of Nursing has now changed its stance of opposing a change in the law. It is now neutral on the question (and why it thought it had a view in the first place is beyond me, but let’s not go there). Attitudes are changing. The current position is untenable. I hope, for everybody’s sake, that a good balanced compromise is reached soon.
The recent outbreak of celebration around the anniversary of the first moon landing reminded me that we human beings think that we are soooooo clever. Hubris, in a word. And ok, collectively, we have done some pretty amazing things, but to pick a selection of links that have crossed my net gateway this week:
- We have a very poor (and hotly disputed) understanding of what makes us tick. If anybody knows where all the rational actors are hiding please see me after the show.
- We’ve only just worked out that you don’t have to be human to have a sense of self (also, video). Who knows what other things we will eventually find out about our dumb friends.
- We’ve only just noticed 350 species in one region of the world – and not just bugs, beasties and small green things either, but 11 Kg mammals too.
The fact that we are working on such questions is a good thing. The fact that these questions remain there to be worked upon is less good.
Um, so what is this post about? See the top of the sidebar.
I think that the British National Health Service is one of the great achievements of British society. It is a great civilising force, and the ultimate insurance policy.
It is, however, appalingly badly run. I say this as someone who spent a decade running a chunk of it.
My most recent brush with it indicated that some of the problems that seemed to be very old news back in 1990 still exist. Sloppy administration…complete lack of concern for the patient as a functioning human being…non existent information flow…
These problems persist despite the fact that the individuals involved can be (and were in my recent example) kind and helpful. They persist despite the fact that they frustrate the hell out of the clinical staff. They persist despite the fact that good people work extremely hard. They persist despite the fact that other industries face similar problems and have largely solved them.
When an industry could look with envy to say, oh, the airline industry for its customer service record, and go on doing so for decades. Indeed for the gap not to shrink, but get bigger. Then, I think, the reasonable question is ‘why?’.
There are some unique features to public healthcare that will always mean that there is a conflict between quality and quantity. Anything that is free at the point of delivery will get over used. Given finite resources this means that there will always be a pressure to cut corners to produce more, because the demand is usually expressed in quantitative terms. I think that the NHS has got pretty good at dealing with that particular problem. It can’t be made to go away, but it can be kept within bounds.
A more significant problem is that given the choice between a new form of therapy or an expansion of an existing service and, say, a better environment or a new computer, the pressure is always on to put off the support costs and spend on the clinical costs. To continue with the airline example that’s like putting planes in the air at the expense of getting them cleaned or maintained. At the margin the decision to put off support expenditure in favour of clinical expenditure always seems right. However the cumulative effect of those marginal decisions can be disastrous.
I’ve been out of the NHS long enough now to not know how that balance is currently viewed. I suspect that it varies back and forth over time.
But the real problem with the NHS is that the incentives are all to pot. Even when I worked there I could see that we were not concentrating on the right things. Systems that I assumed would exist when I joined in about 1990 not only didn’t exist, but still don’t.
I’d like to claim that my bit of the NHS was sorted out under my watch, but no. And whilst I was a part of team that worked long and hard, too much of that work was aimed at dealing with the facts of public ownership – the regime changes, the incessant target settings, the control hierarchy that needed to find something to do, and the treacle-like decision process.
It almost felt like I was being kept deliberately busy in order to make sure that I didn’t make any improvements.
Lots of good able people. Lots of genuine effort. Terrible outcomes.
The NHS is the ultimate producer led organisation. In my time there nobody had any incentive to think through what it might be like to be a patient. From my recent experience that is still the case.
What characteristics lead it to be that way? Monopoly (by licence) supplier. Enormous employer (between a million and two million employees depending on how you count). Understandably mixed objectives (OK, so you define a good health outcome…). Political confusion about the difference between ensuring that something is available and actually supplying it. Political interference (politicians can only say no in the generality. In the specifics they will always say yes).
The result is pretty inevitable.
I wish I knew what the answer was. I don’t see any health system that stands head and shoulders above the rest.
My post here isn’t about the way to fund healthcare, but the way to supply it. If you would like to read an excellent article about funding healthcare then this recent NYT article by Peter Singer is recommended. The author isn’t a journalist and the article is a very considered piece.
I love this story. And it is so ‘in our time’.
Receive bad service from a big corporation. Spend a year seeking compensation. Write a song and produce a video. Get millions of hits in a few days. See the corporation squirm.
The story care of The Guardian. Direct to the video.
You broke it, you fix it. Way to go.
I’ve also walked up Meall Fuar-mhonaidh, which is a Graham. In my defence I note that “Meall Fuar-mhonaidh may not be well known by name”.
It is a lovely walk with views of Loch Ness. A hill, yes, but not a mountain. “This is easy as hill walks go”.
Read more here (the source of those quotes).
(Munros 1, Corbetts 2, Grahams 1)
Walking on Saturday – a whole genuine Corbett (Beinn Loinne). A glorious sunny day. Almost too hot, and definitely too insect ridden to stand still. Not teeny midges (the sun deals with them), but gigantic horse type flies. The sort where you can both feel and see the cut as the first chomp happens.
Not having to battle against the wind and the rain left time to ponder on some of the great questions in life like “what is that large and obvious bird over there?” and “why don’t I have any idea what plant is creating this carpet of yellow flowers?”. A reluctance to stop meant that observations were of the more sweeping kind and thus I ended the walk with insufficient details to track down either the bird or the flower. I’d even like to know more about the biting fly but observations of that were more swatting than sweeping.
I started feeling guilty about not knowing more about the environment that I was walking through. Ditto its flora and fauna. Upland bog (which might have been too difficult to pass through on anything other than the end of a summer dry spell). Not an environment that many people tend to live in, but not completely unvisited by me over the course of my life.
Over the length of the walk I came to an accommodation – whilst I’d like to know more about that place, both in general and in the specific, actually life is crammed with things that I’d like to know more about. Unlike, say, the golden-era-times-gone-past shepherd who might have known the uplands in a lot of depth, modern man jets about and dips into many many more environments and situations. My total knowledge of the environment is probably greater, but only a small fraction of it is allocated to the Scottish uplands.
Learn more, yes. Feel guilt, no.
(Munros 1; Corbetts 2, Grahams 0. Damn, I’m counting)
