A few things I’ve been thinking about this week. The second post of a pair, which may or may not become a series, inspired by Jonathan Rothwell.

There’s a bit in Paul Beatty’s book The Sellout which says

That’s the problem with history, we like to think it’s a book—that we can turn the page and move the fuck on. But history isn’t the paper it’s printed on. It’s memory, and memory is time, emotions, and song. History is the things that stay with you.

I don’t think we’ll ever again speak of that first COVID-19 lockdown in the UK without mentioning illegal parties at Downing Street. They made no difference to any of us at the time—we didn’t know they were happening—but we all feel the gut-punch now.

Parties pale into insignificance compared to the unfathomable loss of life, a blow we have not yet collectively absorbed. Perhaps we can’t absorb it while continuing to grieve more COVID-19 deaths in the UK each day than terrorism has caused in the century to date; a Lockerbie of life lost each day.

But that insignificant image has such emotional weight that it will stay with us, and—I suspect—become a prominent dark thread in the tapestry of the history of the pandemic in the UK.

Wendy and I enjoyed dinner at Hibou Blanc for the first time this week. Neither of us could remember the word hibou from French lessons, which is not at all unusual. Neither of us looked it up out of curiosity before we went, which is very unusual.

Over the last couple of years, I’ve come to think that public health agencies, and probably healthcare providers, should disengage from (e.g.) Twitter. We have ample evidence that most social media is harmful to the public’s mental health. As agencies charged with improving health, we shouldn’t be driving people to engage with something we know to be harmful for many.

This week, I changed my mind. I would have always said that it is crucial that public health messages reach people; it’s self-evident that social media allows us to do just that. It’s a weak argument to suggest that people stick around on social media for the public health messages, so engagement with these sites isn’t really promotion. The risks of the small degree of acceptability conferred by the appearance of trusted organisations are almost certainly outweighed by the benefits of reaching people who would otherwise not see relevant messages.

I’m not sure what made me ponder these issues this week, but it’s an issue on which I’ve entirely changed my view, almost overnight, based on no new evidence.

Inspired by Jonathan Rothwell, here are a few things I’ve been thinking about this week. This may turn out to be one of those things that never appears again, or may turn out to be a regular thing.

The Waste Electrical and Electronic Equipment (WEEE) regulations mean, in broad terms, that anyone selling electronic goods has to pay for environmentally friendly disposal at the end of the product’s life. My top tip is to take any electrical recycling to Currys, as they accept all of it without question and without purchase, and it’s generally less hassle than trying to get to a council recycling site.

The practical implementation of WEEE regulations isn’t perfect, and a lot of equipment still ends up in landfill. However, it is a reasonable baseline standard of the sort of environmental responsibility we should expect: you produce it, you fund safe disposal of it.

It seems strange to me that we don’t have similar regulations for product packaging. Why, for example, can food manufacturers get away with selling products in non-recyclable single-portion packing and not have to fund safe disposal? How is it societally acceptable to sell stuff with the expectation that it will be used for a few days, then buried underground for thousands of years?

As a public health doctor, I’m as much an advocate for the value of vaccination as anyone. Yet, it’s hard not to think that we’ve lost any sense of subtlety and nuance in discussion of anything COVID-19 vaccine-related.

Asking sports stars to publicly disclose their medical history to compete in a tournament is uncomfortable. There is reasonable uncertainty about whether an unvaccinated doctor is better or worse than no doctor. Mandating vaccination inevitably hands a megaphone to those choosing to resist, with predictable negative consequences.

The balance between personal choice and public protection will always be delicate and ethically complex, even moreso in countries with tax-funded healthcare. Balancing those risks is basically my professional role, every day, across myriad health threats (though I’ve no real say on COVID-19 measures).

None of this is black and white; except the fact that almost everyone will benefit from a course of COVID-19 vaccination.

My car insurance was due for renewal just after Christmas, and I moved to a new provider who promised to beat my renewal quote and to provide an Amazon voucher on top. I automatically assumed that the voucher was a workaround to the new Financial Conduct Authority (FCA) rules which prevent people who are renewing policies being charged more than existing customers.

I expected that January would see a slew of voucher offers for people switching providers. When this didn’t happen, I investigated further. It turns out that I am entirely wrong: the FCA rules require insurers to include incentives for new customers in their calculations.

The fourth in an occasional series of posts listing things I’ve enjoyed on the web recently.

As the lock rattles

This is a bit of a cheat because I read it in the paper LRB rather than online. John Lanchester’s article on the pandemic is well worth reading for both its detailed analysis and its snark about our wholly unable Prime Minister.

It isn’t always possible to draw a straight line from someone’s personal life to their public works. Johnson’s private life is his business. But one thing you can say about a man responsible for at least nine pregnancies by at least four different women is that he is prone to wishful thinking. That wishful thinking is the common theme in the government’s failures from spring 2020 to autumn 2020 to now. Johnson doesn’t want certain things to be true, so he acts as if they can be ignored. That strategy has worked for him in domestic politics. It was at the heart of his advocacy for Brexit. But it doesn’t work in economics, and it doesn’t work in dealing with a pandemic.

Lanchester’s discussion of the topic on the LRB podcast is also worth a listen.

Things fell apart

I listen to quite a lot of speech radio, but without wanting to disappoint Auntie, I have been a bit of a BBC Sounds refusenik. It’s a stupidly named service with a hard-to-navigate app that has never seemed relevant to my life.

Yet, when searching for something completely unrelated online recently, I discovered that Jon Ronson had made a radio series for BBC Sounds, which has also had an edited run on Radio 4. The series began in November, and despite being a fan of Ronson’s work and therefore presumably within the target market, the Beeb’s marketing didn’t reach me until after it had finished, but the whole series remains available.

Once I knew it existed, I enjoyed this series. Each episode investigates the ‘origin’ of a particular aspect of the ‘culture wars’, which sounds tedious, but with Ronson’s gentle humour and humanity, it becomes a collection of interestingly strange and moving tales.

Not a drill

The relationship of the USA to guns is one that always feels difficult to grasp from a British perspective. This chilling Atlantic article from Nicole Chung describes her experience of a receiving a text from her 13-year-old daughter in the middle of the morning telling her that she is sheltering at school as there is an active shooting threat.

I was in high school when Thurston and Columbine happened, which means I was in high school before it occurred to me that I could be shot in my school. This knowledge is something that American schoolkids of all ages live with now. My 13-year-old has been participating in shooter drills since she was 3 years old—though when she was younger, her teachers couched them in vague, less frightening terms. I remember the day she came home from preschool and told me, “We practiced what to do in case someone is in the school who shouldn’t be.” She described her teacher locking the doors, turning off the lights, and herding all the students into a small bathroom, where they were told to sit still and stay “very, very quiet.” “It was hard. We weren’t very quiet,” she admitted.

This is one of those articles that just stopped me in my tracks.

Clinical negligence reform is an ethical and financial necessity

Ian Kennedy’s suggestion for reform of the NHS approach to clinical negligence, as published in Prospect, is clear and convincing.

The crux of the approach is this: we should separate the needs of the patient from the conduct of the professional/institution.

I’d struggle to mount a convincing argument against.

‘Daddy isn’t coming back’: surviving my partner’s suicide

There isn’t a line in Manuela Saragossa’s FT story that isn’t worth your time, but this one particularly spoke to me:

The meds were to treat schizoaffective disorder, a combination of schizophrenia and bipolar, the worst of both terrible worlds. In Steve’s case, his illness manifested as persistent delusions, mania and depression.

“It’s just in your mind,” I would tell him, uselessly, after an episode, once the volume had turned down on the recurring, persecutory thoughts that tormented him. “My mind is all I have,” he would rightly reply.

This is a moving and direct account of living with a partner with severe mental illness, and coming to terms with his untimely death. In another universe, I’m a psychiatrist: I came very close to applying for specialty training in psychiatry, before opting for public health. I don’t think I would have been all that good at it, in retrospect.