1: “The reason for the bite is crystal clear: it’s there for scale, so that a small Apple logo still looks like an apple and not a cherry.”

2: How Germany’s contact tracing system for covid-19 works.

3: Economic downturns tend to reduce gender inequality, but the one associated with covid-19 has disproportionately affected women.

4: There are four national anthems without lyrics.

5: Over the last month, I’ve received 3,100 work emails.

6: I heard on the radio this morning that Romans painted eyes on their ships because they believe the gods would protect ships with eyes on them. And it made me think: was this the real reason? Will people in two millennia look back at our time and say that we printed crossed-fingers on all lottery tickets because we believed it brought luck (as opposed to it just being a brand)? There are so many things in life which start as superstition but become traditions which are completely divorced from the original beliefs.

7: The Normal People TV series was better than the book. I know people say you can’t compare the two, but I’m doing it anyway.

8: A loose lock meant that I got to peek through a crack in the door into the southwest tower of the Tyne Bridge:

9: Balancing rocks really seems to have become a trend these days. I know this makes me sound grumpy, but I’m not really a fan: there’s something that feels entitled about taking a shared area of natural landscape and putting a personal ‘project’ on it rather than leaving it how it was found.

10: Citizens of Monaco are called Monegasques.

11: “Uncertainty is a natural state for clinicians and scientists; a reality that politicians seem unable and unwilling to grasp. This contrast plays out sharply when politicians claim to be ‘following the evidence’ in their response to covid-19. How can the evidence be so certain that it should be followed? Isn’t it better to accept uncertainty, communicate that uncertainty clearly to the public, but provide a convincing rationale for policy informed by, not following, the best available science and evidence?”

12: When I’m asked to give talks about antimicrobial resistance, I sometimes mention the issue of incorporating antibiotics into ships’ paint to prevent the formation of a biofilm on the hull which allows barnacles to attach. This initially seems like a ridiculous use of a precious resource, but the issue is actually a bit more subtle than it first appears: barnacles create surprisingly high levels of drag, increasing fuel consumption and carbon dioxide emissions from the ship far more than you might first imagine. I was therefore delighted to learn of the invention of HullSkater, which is basically Roomba for ship hulls.

13: What’s the difference between music and language?

14: “As disaster strikes, ‘baseball caps appear atop politicians’ heads like mushrooms after a rain,’ Jerry Ianelli wrote, in 2017, for Miami New Times. Ianelli called the disaster hat ‘performative folksiness.'”

15: I missed the news a couple of months ago that Renzi Piano’s replacement for the Ponte Morandi in Genoa has been structurally completed, less than two years after the shocking and tragic collapse.

16: It seems that Instagram’s artificial intelligence can’t reliably distinguish photos of naked people from photos of paintings or statues, even when backed up by 15,000 human reviewers. This is a bit of social media controversy which has been around for years, but has hitherto completely passed me by.

17: Solar panels in space generate more energy than those on Earth because our atmosphere reflects or absorbs over half of the solar energy reaching the planet. This topic popped into my head for no clear reason this morning, and the magic of the internet meant that clarification was only a click away. What a time we live in.

18: “The painful conclusion is that Britain has the wrong sort of government for a pandemic—and, in Boris Johnson, the wrong sort of prime minister. Elected in December with the slogan of “Get Brexit Done”, he did not pay covid-19 enough attention. Ministers were chosen on ideological grounds; talented candidates with the wrong views were left out in the cold. Mr Johnson got the top job because he is a brilliant campaigner and a charismatic entertainer with whom the Conservative Party fell in love. Beating the coronavirus calls for attention to detail, consistency and implementation, but they are not his forte.”

19: The OED defines “suspend” as “to debar temporarily from participation in something.” Today, I’ve seen the BBC using the construction “permanently suspended” for the first time, which seems like a significant moment of change in the use of that word.

20: Food is all about salt, fat, acid, heat… and Samin Nosrat, who is impossibly endearing.

21: “You often cannot innovate before the world is ready.”

22: Grief and paperwork come as a package in the US healthcare system.

23: “My experience of being a person is a continual act of becoming, of creation. If nothing else, you continually have to be another day older. To instead focus on the things that are never going to change—from the day that you are born—is like locking yourself in a room.” That struck a chord with me, which was an interesting and arresting experience because it was said by Lionel Shriver, whose opinions are usually diametrically opposed to my own.

24: What advice on covid-19 social distancing can be given to sex workers?

25: The last episode of The Good Place is almost as good as the last episode of Six Feet Under.

26: “In what may be the first known case of its kind, a faulty facial recognition match led to a Michigan man’s arrest for a crime he did not commit.”

27: Beautifully scented designer alcohol hand gel is a mainstream thing now.

28: This profile of Richard Horton gave me some new insight into his response to covid-19.

29: Midwifery is marginalised in the USA.

30: Fukushima serves as a reminder of the long-term consequences of major incidents on mental health. I worry that the response to covid-19 in the UK suggests we haven’t learned that lesson.

1: Alan Bennett had open-heart surgery in Spring 2019 and the news completely passed me by.

2: A paucity of Papal patience provides problematic publicity for a Pontiff preaching peaceful pacifism to pious pilgrims.

3: Norovirus probably causes about two-thirds of care home outbreaks of gastrointestinal disease.

4: Fewer than 20% of schools in Texas teach children about safe sex. Texas is among the States with the highest teen pregnancy rate. Any connection is disputed by conservatives.

5: I’m reading Matt Haig’s Reasons to Stay Alive at the moment, and there’s a line advocating for greater ‘mood literacy’ which I found a rather lovely turn of phrase. It reminded me of this blog post advocating examination of one’s own response to the outside world to better understand one’s mood. Both taught me something about self-examination.

6: One of the room booking systems at work requires me to “invite” a given room to attend a meeting. I’ve now learned through bitter experience that rooms can decline invitations… which felt a little humiliating, even if it does open up a whole new seam of entertaining insults (e.g. “that meeting sounds so pointless that even the room declined the invitation”).

7: Populist ‘knee-jerk’ reactions in politics are commonly discussed and clearly dangerous. I’ve been reminded today by an article on the lack of legislation around in vitro fertilisation research in the USA that the opposite—a complete failure to react because issues are complex and divisive—can be just as dangerous.

8: Merely possessing a placebo analgesic, without even opening it, has been shown to reduce pain intensity.

9: The average age of a BBC One viewer is 61. If one considers that a problem, as the BBC seemigly does, then I suppose one might conclude that removing children’s programmes from the channel was not the right approach.

10: The Royal Botanic Garden Edinburgh is only a short walk from the city centre and is a great place for a winter stroll. The uphill walk back to the city centre is a touch more tiring.

11: Over the past decade, the proportion of the UK’s electricity generated from wind and solar power has increased from 2.4% to 20.5%. The proportion from coal has fallen from 31% to 2.9%. (As reported in Positive News, though the specific article isn’t online.)

12: Aspiring comedians often go on ‘introduction to stand up’ courses. I’d never thought about these sorts of courses existing, but of course they do.

13: More than half of Luxembourgers speak four languages. The best-selling newspapers in Luxembourg have articles in two languages. This makes me feel inadequate.

14: In the 1990s, John Major mooted renaming Heathrow airport after Churchill, while Lindsay Hoyle and William Hague fancied naming it after Diana.

15: I have long known the North East is an outlier for antibiotic prescribing in primary care, but hadn’t fully realised until a meeting today that the North East isn’t an outlier for antibiotic prescribing in secondary care.

16: I was surprised to read that a survey suggested that only one in three people on the UK knows the standard VAT rate is 20%, and one in ten knows the basic rate of national insurance is 12%. But then, on reflection, my own surprise surprised me, because I don’t really know how or why I know those figures myself. I’m sure there are plenty of similar figures on which I’d have no idea myself!

17: Since last September, Monday to Friday, the City of London Magistrates’ Court has been filled by Extinction Rebellion defendants from around the country.

18: The developers of Morecambe’s Central Retail Park have “put an extraordinary amount of effort into stylising the car park” including quirky themed artworks, sculpted steel waves and effigies of seabirds diving for fish.

19: In the US, a broadly similar amount is spent on treatment for back pain ($88bn) and treatment for cancer ($115bn).

20: Office for National Statistics Travel to Work Areas are an interesting way of dividing up the country.

21: Civil servants in China cannot ordinarily be dismissed. One wonders what Dominic Cummings makes of that.

22: Over 70% of 12- to 14-year-olds in China are short-sighted. The Communist Party has set targets for reducing that, leading to some slightly strange practices in schools, including compulsory twice-daily eye massages and dressings-down for those whose sight worsens over time.

23: It’s not a public health emergency of international concern.

24: Blinded trials are not always best. I remember having to write an essay or answer an exam question on this topic at some point in the past, but haven’t really thought critically about it in years.

25: The attendance fee for the 2020 World Economic Forum in Davos is 27,000CHF (£21,400). I will never complain about medical conference registration fees again!

26: Luxury branded homes—as in, “I live in a Bulgari residence” or “I’m in the Porsche apartments”—are now a thing. Is it possible that this is a global conspiracy to see how far the definition of “gauche” can be pushed?

27: “We fill our days with doing laundry, replacing our brake pads at the auto shop, or making a teeth-cleaning appointment with the dentist, in the expectation that everything will be fine. But it won’t. There will be a day that kills you or someone you love.”

28: “To err is manatee. A manatee might mistake a swimmer’s long hair for shoal grass and start munching away, oblivious to the attached figure. To err is baby elephant, tripping over her trunk. To err is egg-eater and moonrat and turnstone and spaghetti eel, and whales, who eat sweatpants.“

29: Pulmonary tuberculosis can be detected in babies by doing PCR tests on faecal specimens. Sensitivity of the test varies according to the exact methods used, and this is an active area of research.

30: It’s a public health emergency of international concern.

31: The TV series Love Island has an unexpectedly innovative business model which involves selling items seen on the show via the app which viewers download to vote for contestants.

1: It feels great, if a little anticlimactic, to finally be able to delete “Locum” from my email signature.

2: The North Shields Fish Quay has really smartened up since Wendy and I last visited. It would be nice to live somewhere with a river view, if only it didn’t have to be near a river.

3: Going to Ikea for the 10.30 Sunday browsing opening time isn’t a successful crowd avoidance strategy.

4: Barriers between healthcare organisations can make simple things—like arranging urgent vaccinations—more difficult than they ought to be. Perhaps someone should invent some sort of national health service which provides care based on need rather than budgets, contract provisions and organisational mission statements.

5: Telling patients that they look far too young to have donated blood 61 times makes them want to go back and donate again as soon as possible to receive more flattery.

6: Sometimes, people who use irritating business chatter do actually understand what they’re on about.

7: Business planning isn’t my bag.

8: Th Guardian Daily app doesn’t work properly on Kindle tablets.

9: Loud Christmas music in coffee shops makes settling down with a coffee and a good book difficult. Headphones and white noise on Spotify are an imperfect and antisocial solution.

10: It’s not easy being green: should I buy second-hand books and support the planet or new books and support the author?

11: Durham County Council has meeting rooms with quite spectacular coastal views in Seaham:

12: Dementia friendly parking spaces are now a thing… at least in Hemlington:

13: “At this time of year, it is not uncommon for viruses including influenza and norovirus to circulate in schools. The risk of infection can be reduced by practising good hand hygiene, particularly after using the toilet, after using a tissue to catch a cough or a sneeze, and before eating.”

14: Our TV needs re-tuning. Broadcasts are moving away from the 700MHz band of frequencies to free up spectrum for mobile data instead. Given the profitability of mobile data services and the proliferation of home broadband (especially in the context of PSTN switch-off), I wonder how long over-the-air television broadcast have left?

15: Arguments opposing the Public Libraries Act 1850 included a Conservative view that people “have too much knowledge already” and that “the more education people get the more difficult they are to manage.” In fairness, I suppose people now carry the sum of human knowledge in their pockets and do have a tendency to be rebel against authoritarian control, so perhaps he had a point.

16: The TLS has relaunched with a rather stylish new look. Dr Brian Klass’s comparison of politics in Trump’s America and that in Brexit Britain through the medium of cheese was a particular highlight of this issue for me.

17: Coffee shop Christmas music irritates Wendy even more than me. It’s depressing, or so I’m told.

18: A replacement wing mirror for a 2009 Aygo costs less than £50. I was expecting a much bigger bill after someone completely snapped mine off (and didn’t leave a note!)

19: The brand new Sunderland medical school has some impressive facilities.

20: Colleagues at Middlesbrough Council taught me that routine air quality monitoring still uses diffusion tubes fixed to lampposts; people have to go up in cherry pickers to change the tubes every month.

21: Research into treatments for interstitial lung disease includes a lot of discussion about disease taxonomy and the problem of lumping and splitting: considering diagnoses with the same underlying pathology together (lumping) or as distinct entities (splitting).

22: Cleveland Fire Brigade taught me about their Stay Safe and Warm free one-hour response service for boiler breakdowns where they lend people emergency electric heaters.

23: A wet and dreary Saturday can be a good prompt to light the fire and relax at home.

24: I didn’t know that Sheffield had a hybrid tram-train system until I read this Wired article.

25: Purdah rules can be really annoying sometimes, especially when I’ve done a lot of work to prepare for a meeting I’m no longer able to attend.

26: I thought I learned the etymology of the word “syndrome” after it was featured in a lecture. Yet after thinking about it for a while, the suggestion that it was derived from words for “before” and “diagnosis” didn’t ring true, so I looked it up in the OED online. The lecture version was thus proven to be completely wrong, so I suppose I learned not to take the content of lectures on trust.

27: Only a decade late to the party, I learned that Ecosia—the search engine that plants trees—is a thing.

28: People really don’t know what I do all day. This month, in my health protection role, a meeting of vascular surgeons has invited me to talk about knife crime, a univeristy course has asked me to teach about rural medicine, and a meeting of intensivists has invited me to present on recreational drug toxicology. They may be disappointed at me turning down their kind invitations, but they’d be far more disappointed if I accepted given that I know naff all about any of those topics.

29: Via Lana Greene’s column in 1843, I leaned of the German word “Multioptionsgesellschaft”. It was apparently coined by Peter Gross, a Swiss sociologist, in the early 1990s. It refers to a world swamped by choice, which feels very current: I frequently open Netflix for something to watch and close it a few minutes later with the resignation of not being able to decide.

30: I heard a snippet of a radio programme in which an older person was being interviewed and the subject of loneliness among the elderly came up. The interviewee suggested that while lots of attention has been paid to loneliness recently, too little has been paid to the loss of solitude for many other older people, such as those in care homes. I’d never heard that point made before, and I suspect it will stick with me: solitude is something very important to me.

Ten years ago today (eleven by the time this is published), I learned that I had passed my medical school finals and became a doctor. It doesn’t feel like it was a decade ago.

At work, I recently happened to have a meeting with someone I worked with as an F1 doctor but haven’t seen since. It felt like we worked together a month ago rather than a decade. I still occasionally say “hi” in the street to the porter who used to comment on my “Bird’s Custard” colour tie as an F1. And yes, somehow my F1 year was long enough ago that ties weren’t yet banned in hospitals.

I think the Simon of ten years ago would be amazed to find that I’m now working in public health. I didn’t enjoy the occasional public health bits at medical school, and I wasn’t even really aware that it was it’s own specialty until I came to pick a career path. Public health always struck me as worthy, dull, and far removed from anything that actually had any measurable impact on patients.

It was only after a serendipitous run of F1 hospital rotations that I started to see the point. My first job was in upper gastrointestinal surgery, a subspecialty involving seriously brutal surgical interventions to treat cancers with very poor prognoses. My second job was in stroke medicine. My third was in gastrointestinal medicine, a speciality in which a large proportion of the patients had end-stage liver disease as a result of alcoholism.

I think it’s impossible to go through that sequence and not feel slightly despairing: hospital medicine comes too late for most of these patients. Their lives very often cannot be pieced back together: as one particularly insensitive consultant used to regularly say, for those patients “the party’s over”.

The most effective treatment for these patients would be to rewind time and tackle their problems before they were ill. This initially pushed me towards General Practice, until I realised (late) that this was the point of Public Health. My realisation of this came so late that I didn’t really know what public health doctors did all day, but stuck in an application to the specialty anyway… as well as general practice.

After long essay-style application forms, written exams and half-day intensive interviews known as “selection centres”, it somehow came to pass that I was offered places on both the GP and public health training schemes. I had 48 hours to decide between a familiar career path and one which sounded fascinating but that I barely understood. In truth, I hedged: I went with public health because general practice always under-recruits, and I was pretty confident that a re-application to GP would be successful in 12 month’s time if public health turned out to be awful.

I was also put off by the obsession with portfolios in General Practice. My experience of clinical portfolios was that doctors were judged too much on their ability to write and present evidence rather than on their practice of medicine. I was, even if I say so myself, great at presenting portfolios of glowing assessments as a Foundation Doctor, but this felt a bit flat. It seemed to me that people in public health were known by results and reputation, and I liked that idea. I’m not so sure that was an accurate assessment of either speciality, but it certainly played a part in my decision-making at the time.

Leaping into public health felt brave at the time, even if it seems like hedging in retrospect: no end of people were telling me that I’d be “wasted” in public health and that my skills with patients meant that I’d be a fantastic GP. Some of this was subfusc whispers in my ear, some was formal written feedback, some was mildly paternalistic advice. Only a minority were enthusiastic. Luckily, once I set my mind on something, I’m pretty strong-willed.

Public health wasn’t awful. I mean, it had its moments: within weeks of me accepting a place, the coalition Government announced an intention to move public health outside of the NHS. This may have been the right decision, but it was terrifying for me as an NHS doctor to know that my NHS career path had been cut off just as it was beginning.

As I progressed through my training, I came to really enjoy health protection, the part of public health which deals with outbreaks and other biological, chemical and radiological threats to the population. I liked the combination of clinical-style short-term pressure, thoughtful balancing of risks, and the close association with clinical colleagues (and occasionally patients). I wrangled the system to spend almost half of my training in health protection placements, and since 2016 I’ve been a consultant in health protection. It is—by far—the most enjoyable and rewarding job I’ve ever done, in which I’m surrounded by a brilliant team who never give anything less than their best.

So, in career terms, I could not be further from where I thought I’d be ten years ago. But I also couldn’t be happier with the choices I’ve made. I don’t really know that there’s a lesson in that.

Someone once told me that the most important thing in career planning is to do what you enjoy and collect certificates along the way. Delayed gratification is rarely worth it in career terms: the gratification might never come. But its hard to ever regret doing something you enjoy, and collecting certificates provides tools to make a “leap” to something else when the first thing stops being fun.

I don’t know whether that’s good advice or not, but it roughly correlates with my experience over the last ten years. Let’s hope that I’m still enjoying things as much ten years hence – whatever I’m doing then!

The picture at the top is obviously my own. It was from my graduation which was, of course, a little later than the day I found out I’d passed.

In this morning’s Monocle Minute, there was a fascinating bit about a public health measure in Pakistan which had completely passed me by:

Pakistan’s Punjab province has taken an intriguing step to discourage its citizens from chugging too many cans, demanding that brands such as Red Bull and Monster remove the word “energy” from their packaging and replace it with “stimulant”. The move comes from the scientific advisory panel of the Punjab Food Authority (PFA), who ruled that the word was misleading. The PFA decided that the drinks do not provide people with nutritional energy per se, rather that the caffeine, taurine and guarana merely stimulate drinkers.

I think there is much to be done around the regulation of food packaging, as it often seems pretty misleading. But most of what I’d thought about previously was around claims about the “healthiness” of foods and claims about calorific content. In fact, I’ve had previous publications ranting about both the food industry and the public health response on the latter point, but don’t have any clear answers of my own to offer. I’d never really thought about the connotations of “energy” drinks as a name, so I think the story above is a really interesting development and I’ll be intrigued to see whether it spreads more widely.

Sometimes, even those of us in public health miss public health developments in our own country. I only recently because aware of the fact that liquid laundry detergent capsules are now packaged in opaque containers not because of changing consumer preferences but because of very sensible European legislation, designed to reduce their attractiveness to children.

That’s a public health legislative win by anyone’s yardstick… and while most had realised the packaging had changed, no-one in my office was even aware that the legislation existed. It’s amazing how much public health measures can pass by even those of us working in the field – we perhaps don’t do enough to celebrate public health achievements that aren’t badged like that.

A year or so ago, my friend James O’Malley wrote a great article revealing that Fuller’s pubs had gone sugar-free on soft drinks – years before the Soft Drink Levy came into force. This was a voluntary public health measure by a private business. Wouldn’t it have been great if, say, Public Health England or the Faculty of Public Health had seized on this as an example of responsible action and praised the chain – rather than simply ignoring it? Just a thought.

The photo at the top is a cropped version of this photo posted to Flickr by Mike Mozart. I’ve edited and re-used it above under its Creative Commons licence.

A couple of news stories I’ve read lately have made me think about our approach to regulation of advertising.

First, there was this story by Travis M Andrews in The Washington Post about the portrayal of smoking in shows made for streaming services:

Among the vices often embraced by streaming services and avoided by broadcast television is tobacco in all in its forms … A study compared seven popular Netflix shows to seven popular broadcast shows. In this sample, it found Netflix’s shows featured characters smoking almost three times as often as those produced by broadcast networks like NBC, ABC and CBS.

Now, we could spend all day poking holes in this ‘study’, but the thought is still going to fester: it does seem like there might be more smoking in these shows than in those on broadcast TV.

Second, there was this BBC Trending story by Branwen Jeffreys and Edward Main about YouTube stars being paid to encourage kids to cheat on school assignments:

YouTube stars are being paid to sell academic cheating, a BBC investigation has found. The BBC Trending investigation uncovered more than 1,400 videos with a total of more than 700 million views containing EduBirdie adverts selling cheating to students and school pupils. In some of the videos YouTubers say if you cannot be bothered to do the work, EduBirdie has a “super smart nerd” who will do it for you.

This isn’t so obviously related to health but does highlight an issue with inappropriate advertising within online streams which are typically seen by children and young people.

Both of these stories made me reflect on the work that has gone into restricting advertising of harmful products such as cigarettes and energy dense foods, and how the fruit of that work might be lost if legislation doesn’t keep up with changing media consumption habits.

For example, there are no regulations around the portrayal of smokers on streaming shows, whereas broadcast shows must comply with Ofcom’s rules, including Rule 1.10:

Smoking must generally be avoided … unless there is editorial justification.

There seems to be non-stop debate in the media press about whether TV ads or online ads are more ‘impactful’, with the conclusion usually predictable according to who has funded or published the work. But it does seem increasingly clear that many people (including me) are now watching more streamed content than broadcast content, and that this is more common among younger people.

It’s hard not to worry that the slow pace of legislative change might cause us to unintentionally slide back to an era of lesser regulation of what is actually seen despite strong evidence of harm. We really mustn’t let that happen.

The photo at the top was posted on Unsplash by Tina Rataj-Berard and is used here under the Unsplash licence.

I recently finished reading Don Bartlett’s translation of A Death in the Family, which is the first volume of Karl Ove Knausgård’s radically honest autobiography. It took me a long time to get through this book (around three months) because I found it so intense that I had to read sections at a time, interspersed with other books. Nonetheless, I thought it was a masterpiece.

Roughly halfway through, Knausgård writes:

There is no one who does not understand their own world. Someone who understands very little, a child, for example, simply moves in a more restricted world than someone who understands a lot. However, an insight into the limits of understanding has always been part of understanding a lot: the recognition that the world outside, all those things we don’t understand, not only exists but is also always greater than the world inside.

This caused me to reflect for quite a long time and stimulated a couple of thoughts to jot down here.

The description of people understanding their own world and being restricted to the world they understand is fascinating. I think there are lessons in that formulation for public health. People frequently make choices which are, by any objective measure, bad for them: smoking, refusing vaccinations, drinking a G&T while blogging. But taking action which is objectively harmful isn’t necessarily irrational, and we often forget that.

If someone’s understanding of their world is that vaccinations cause harm to children, then refusing vaccination is a rational choice in line with their understanding. Their understanding is wrong, but they are acting rationally within the limited world in which they move. If we are to effectively influence the behaviour, then we need to inhabit the world to understand the rationality of the choices people are making. Unpicking the reasons for the incorrect understanding and setting about correcting it is likely to lead to greater success than lecturing people.

At work, there is a sign in the lift which reads “Could you have taken the stairs?”. The answer for me is invariably “no”—I only take the lift when I’m unable to take the stairs—and every time I see the poster I get mildly annoyed at its accusatory tone. It also seems unlikely that it changes anybody’s behaviour, given that it is only seen after someone has decided not to take the stairs. It’s a poster that doesn’t have any effect on anyone’s understanding, nor does it expand anyone’s worldview.

I realise this is a fairly incoherent ramble (see also the reference to drinking and blogging), but I suppose my point is that public health interventions should try to be less preachy and more practical.

In professional life, it isn’t uncommon to hear people imploring other people to ask questions if they don’t understand something. “There are no stupid questions” and “If you’re thinking it, someone else is thinking it too” are commonly heard refrains. And yet, professionals often remain frightened to ask questions which they think might reveal a degree of ignorance.

A few years ago, after a particularly tense meeting which had featured the world “I really don’t understand what you’re talking about”, a former supervisor gave me a one-to-one aside of valuable advice which they said it had taken many years to learn: “If someone is coming to talk to me and is so poor at pitching what they say that I can’t follow it, it is my professional responsibility to politely challenge that by asking them to explain themselves. It solidifies my reputation as someone who is engaged, intelligent and listens to what people say.”

This made me pay much more attention to my own and others’ reactions to people asking questions. The first thing I noticed was the frequency with which, when challenged, people often weren’t able to explain their waffle. This is useful because it helps people to make a value judgement about the rest of what someone is trying to tell them. The second thing I noticed was that when people could explain, they were usually happy to do so, and altered the rest of their ‘pitch’ to a more appropriate level. The third thing I noticed was that my respect for the person who asked the question generally increased.

This completely changed my perspective, and I now regularly ask questions which I’d previously have thought might make me look stupid. This took an effort at first, of course, but now comes naturally. Sometimes the questions I ask are bloody stupid and I should know better—but rarely, and when it does happen, it at least gives people a laugh. I don’t know if it’s bolstered my reputation, but it has certainly meant that there are lots of things I now understand that would have otherwise passed me by.

“An insight into the limits of understanding has always been part of understanding a lot”.

I took the photo at the top of this post at Charles de Gaulle airport. It is a chandelier, which has absolutely no relevance to the content of the post. I just thought it was quite pretty.

Last week, I read this remarkable story about a new cruise ship by Oli Franklin-Wallis in Wired, and have been thinking about it ever since:

Symphony of the Seas – which, on its maiden voyage from Barcelona in March 2018 became the largest passenger ship ever built – is about five times the size of the Titanic. At 362 metres long, you could balance it on its stern and its bow would tower over all but two of Europe’s tallest skyscrapers. Owned and operated by Miami-based cruise line Royal Caribbean, it can carry nearly 9,000 people and contains more than 40 restaurants and bars; 23 pools, jacuzzis and water slides; two West End-sized theatres; an ice rink; a surf simulator; two climbing walls; a zip line; a fairground carousel; a mini-golf course; a ten-storey fun slide; laser tag; a spa; a gym; a casino; plus dozens more shopping and entertainment opportunities.

Cruise ships mean two things to me.

Earlier this year, I went on a ‘mini-cruise’ from Newcastle to Amsterdam aboard a DFDS ship. The journey was an overnight 15 hour or so thing, so certainly not equivalent in any way to spending weeks at sea on the world’s biggest cruise ship. The rationale for this was that I fancied a last-minute break and couldn’t find a cheap flight from Newcastle, so went on a cheap boat instead, spent a day in Amsterdam, and took a cheap flight from there. This worked remarkably well, and I’d do it again.

This was the first time I’d been on an overnight boat since our annual family camping trips to France when I was a child. Prior to going, I’d sort of thought in the back of my mind that I might be the sort of person who might one day enjoy a proper cruise. This experience put me off.

The ship was lovely, and I was particularly impressed by the cabin. I had expected a pokey bunk-bedded hovel but was actually rewarded with a fairly large space which looked not unlike a Travelodge room, with an en-suite bathroom. The food on board was also much higher quality than I would have expected. But I am somebody who likes to wander—and even with only 15 hours on the ship, I was itching to get off and explore. Exploring the ship felt a bit constrained.

It was silly of me not to realise this in the first place. Wendy and I ruled out going to an idyllic holiday resort last summer for the sole reason that it was located on a main road along which walking was not advised, so we couldn’t ‘go for a wander’ without catching a bus or taxi somewhere first. I hadn’t really clocked that ‘going for a wander’ wasn’t really a go-er on a ship.

While the Symphony of the Seas is ridiculously bigger than the ship I was on (it’s more than twice as long and can take four times as many passengers across twice as many decks), I still think I’d feel ‘cooped up’ pretty quickly. So I don’t think I’ll be going cruising anytime soon.

My other relationship with ships is professional. One of the more esoteric parts of my role as a Consultant in Health Protection is that I am the designated Medical Officer for a number of ports. This gives me certain legal responsibilities relating to ships and the health of their crew—most of which are thankfully delegated to people much more expert than me. But just imagine how complex an outbreak of norovirus or Legionnaire’s disease could get on a ship as huge as Symphony of the Seas. I was fascinated to read in Oli’s article about some of the steps taken to mitigate the risks:

“The level of hygiene is extreme,” Yrjovuori announced, as we passed a hand-washing station. Though ship-wide outbreaks of sickness make the news at least once a year, the total number of passengers who fall ill is a fraction of one per cent. But close quarters enable outbreaks, so sanitation regulations at sea are stringent. Every part of the ship, from lift buttons to the casino’s chips, are sanitised daily; interior materials have to stand up to the high level of chlorination from the constant cleaning. Rubbish is frozen in vast storage containers to slow bacteria growth and is only removed in port.

Fascinating stuff… perhaps we could even try and replicate some of it on land!

The pictures in this post are my own from the above-described ‘mini-cruise’ adventure. The pictures in the Wired article are a great advert for the power of print, looking far more arresting as double-page spreads than as on-screen images.

The link between the two articles in this 2D is health and economics. It’s a reasonably weak link, granted… but it’s a link nonetheless!

The first article I’d like to recommend is this long and thoughtful interview with Bill Gates by Ezra Klein of the Washington Post, which carries the arresting title “death is something we really understand extremely well”. He talks through some of the financial decisions his Foundation makes, and the economics of disease eradication. I found it quite fascinating.

The second article is really rather different. For Priceonomics, Alex Mayyasi gives a history and economics lesson to explain why articles in scientific journals are, more often than not, behind a paywall. He argues, too, that the system needs to move on and develop in the 21st century. As someone who spends a disproportionate amount of time whining about medical journals and their paywalls, I found this detailed blog post very interesting and informative.

2D posts appear on alternate Wednesdays. For 2D, I pick two interesting articles that look at an issue from two different – though not necessarily opposing – perspectives. I hope you enjoy them! The picture at the top of this post was uploaded to Flickr by Howard Lake, and has been modified and used under Creative Commons licence.

Regular readers will know I’m a fan of infographics, and I thought this was was particularly powerful (though clearly more “graphic” than “info” – what’s with that 50% reduction “graph”?). Still, it’s a powerful message – 100,000 new donors needed in the next few weeks. Sign up to give blood today.