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Medicine and mandates

They say that history doesn’t repeat itself, but it rhymes.

This morning, I’ve been reading two articles where it strikes me that there is a particular resonance in the themes.

The first is Florence Sutcliffe-Braithwaite’s remarkable account in The London Review of Books of the NHS infected blood scandal: ’We’ve messed up, boys’. This is the first thing I’ve read about these events that allowed me to grasp the totality of the tragedy. It’s a remarkable piece of writing, even by the exceptional standards of the LRB.

The second is Devi Sridhar’s editorial in The Guardian Weekly about the way politicians used scientists in the response to the COVID-19 pandemic. This isn’t quite such a must-read, and I don’t entirely agree with Sridhar’s views but fully support her conclusion that we ought to reexamine the power and independence of Government advisors. This discussion has been bubbling away in public health circles since the creation of Public Health England, which many saw as reducing the independence of scientific advisors.

Doctors and politicians both have essential parts to play in the management of public health crises. Crises require both technical expertise and democratic oversight. Doctors sometimes tend to dismiss the role of politicians by thinking that only technical decisions have weight. Politicians sometimes ignore expertise, preferring their own views or feelings about the right path. The balance isn’t easy to get right, and both doctors and politicians are eminently capable of getting things wrong.

There’s much to ponder in Sutcliffe-Braithwaite’s piece, of which this is only a very minor part. Yet, when reading the two essays in sequence, the spectre of the problematic relationship haunts both crises.

This post was filed under: Health, Politics, Post-a-day 2023, , , , .

The juice was neither cold nor hot. It caused no pain.

I can’t recall having previously read Colm Tóibín’s 2019 moving account of his testicular cancer. You can also listen to him reading the piece at that link.

The whole essay is quite wonderful, and it feels a bit wrong to pick out specific bits, but on my most recent reading, I was particularly struck by this passage:

In the end I phoned the hospital. The nurse could not have been kinder, but since there was no pain, no precise problem, she did not seem to know what to say. Feeling bad was part of chemo, so the fact that I felt bad was not news. Eventually, I found that I couldn’t explain what I felt and we ended the conversation. A few minutes later, she called back and said I should come over to the hospital and pack some things with a view to staying for a few days.

It made me think firstly about the difficulty of articulation. As humans, how many times have we all thought “there’s just something not quite right”—but been unable to describe, even to ourselves, exactly what is wrong?

And secondly, it took me right to the mind of the nurse. As a doctor, it transported me to all those times when my gut feeling has said something’s wrong, and after a bit of soul-searching, I’ve made a bold decision in response.

This post was filed under: Post-a-day 2023, , .

Slag in the vestibule

In an old LRB diary, Patrick McGuinness makes an observation about loquacious train announcements:

In Europe what you hear on trains is minimal and informative: you get told your destination and the stops as they approach. In Britain it’s a relentless patter of pseudo-information aimed at pseudo-customers by people running a pseudo-business. You don’t ‘read’ the safety instructions, you ‘take some time to familiarise yourself with’ them. Your belongings must always be ‘personal’, and in case you were wondering, as you neared your ‘station stop’, what to do with them, you are ‘advised to remember to take them with you’. The train is also the only place outside a Classics course where you’ll hear the word ‘vestibule’. That’s OK, it’s nice to hear it again, but they spoil it by saying ‘vestibule area’.

He’s wrong about ‘vestibule’: you can also occasionally hear it in our house, where Wendy and I sometimes playfully use the word to refer to our porch. It’s even what we call the porch in our smart home setup.

This is an anatomical joke: there are many vestibules in the body, which are generally small spaces leading to larger spaces. The anatomical features retain a metaphorical connection to the original Latin vestibulum, the small enclosed room at the entrance to a house… otherwise known today as a porch. But I’d never thought about it enough to realise that we were re-creating the metaphor in reverse.

You’re also possessed of a pair of vestibulocochlear nerves. We occasionally misappropriate the word as an adjective meaning ‘in the porch’—‘Who turned the vestibulocochlear light off?’ There ain’t no humour like anatomical humour, amirite?

Musing on this today, however, made me wonder about the connection between a ‘vestibule’ and a ‘vestry’ in a church. I first wondered if it was maybe a similar metaphorical thing, in that the ‘vestry’ is the area in which one prepares before entering a church. Or perhaps the connection is ‘vesting’, as in donning or doffing clothes.

So I fired up the OED.

As it turns out, they seem to be unrelated, or at least both existed in Latin. As I’ve mentioned, vestibule comes from vestibulum, which retains its meaning today. The history of ‘vestry’ is less certain. It seems to come from the ‘vestments’, from the Latin vestīmentum—clothes. However, it’s not clear if that’s a direct thing—because it’s where the garments are stored—or a metaphorical thing, ‘vesting’ in the sense of endowing someone with something, like ‘investment’.

A ‘vestry’ in the church sense is also sometimes called a ‘revestry’ or a ‘vestiary’—some sources suggest that ‘vestry’ is just a corruption of ‘vestiary’. Interestingly, Wikipedia seems to prefer ’sacristy’, which I would have said was specifically Catholic, but very much isn’t.

The OED provides a whole separate meaning of ‘vestry’: the rubbish associated with a mine, which I think I’d probably naturally refer to as ‘slag’. I would never have previously imagined featuring those two words in the same sentence.

The image at the top of this post was generated by Midjourney.

This post was filed under: Post-a-day 2023, , , .

Requisitioning ice cream vans

A couple of weeks ago, I made passing mention of the 1984 BBC drama Threads, the chilling one-off film that dramatised the aftermath of a thermonuclear explosion in the UK.

I know I’ve already recommended one article from the latest LRB, but Florence Sutcliffe-Braithwaite’s essay on Britain’s preparations for nuclear war during this period is well-worth a read.

The advice given to medical staff ran from the ridiculous to the sublime. Staff at ‘casualty collecting centres’ were told to siphon off patients whose deaths seemed inevitable to a holding area, though they mustn’t describe these patients as ‘moribund – expecting to die – but expectant, meaning expecting to get away to hospital as soon as possible’. A lecture on nursing after an attack warned: ‘There will be no place for grumblers.’ The government contemplated requisitioning ice cream vans, using their chiller cabinets to store blood and medicine.

I particularly liked the description of local Government push-back against national Government:

When the radicals on the South Yorkshire Fire and Civil Defence Authority were forced by the Thatcher government to make plans for nuclear war, they responded by publicising plans so detailed and lurid that they functioned as anti-nuclear propaganda. Protect and Survive advised readers, grimly enough, that ‘if anyone dies while you are kept in your fallout room’, you should ‘move the body to another room in the house. Label the body with name and address and cover it as tightly as possible in polythene, paper, sheets or blankets.’ The South Yorkshire plan warned that ‘the bag should not be too tightly sealed, as pressure of the gases produced by a body decomposing is likely to rupture the bag and the resulting smell is likely to create unnecessary offence.’

Wither any national Government that forgets that local Government has democratic legitimacy, too.

The image at the top of this post was generated by Midjourney.

This post was filed under: Post-a-day 2023, , .

What’s in a drag race?

Ru Paul’s Drag Race has become such a cultural phenomenon that I think it’s impossible not to have watched at least some of it at some point. Wendy and I certainly watched a season or two years ago, though didn’t stick with it, as it wasn’t really our kind of thing: a bit too forced, a bit too formulaic (every episode is essentially the same), and perhaps a bit too exploitative (in the way that most reality television feels a bit exploitative). I’ve never understood the strength of feeling about the show, or what about it drives such a devoted following.

If you feel similarly, then I’d encourage you to read Mendez’s excellent essay in the latest London Review of Books. As so often with the LRB, it gave me a wholly new perspective.

This post was filed under: Post-a-day 2023, , .

Rabid Barbie discourse

In the final paragraph of an article about the recently released Barbie film that I happened across on The Verge, Charles Pulliam-Moore referred to “the rabid Barbie discourse”.

In my sheltered world, there has been very little “Barbie discourse” at all. The venerable New York Times published an opinion piece by Andi Zeisler:

For the past 64 years, Barbie has been at the center of countless debates about who women are, who they should be, how they look and what they want.

I mean, really? Has it?

I’m sure we’ve all seen occasional articles about Barbie’s freakish body proportions. There have been many articles over many years promotion the brand’s diversification of the doll line with new models representing different professions, skin tones, disabilities, and so forth. And humorous cultural references to the Barbie line are quite pervasive: see Malibu Stacy in The Simpsons. Even I indulged on this blog, albeit 17 years ago.

In the 1990s, the London Review of Books published an article on Barbie by Lorna Scott Fox, with possibly the most quintessentially LRB opening I’ve ever I’ve read:

‘Barbie can be anything you want her (yourself) to be!’ Thus the sales pitch for a plastic toy that in most people’s minds simply represents the essence of bimbo-ness. But what if the big hair and tacky costumes were actually vehicles of patriarchal and racial hegemony, while also enabling a potentially subversive network of reappropriative authorial narratives?

“But really,” I thought, “it’s just a toy. Surely, this can’t really spill over into ‘rabid Barbie discourse?’”

I underestimated, as a quick web search for ‘rabid Barbie discourse’ revealed. The top result—from the website of a newspaper that has been publishing for more than two centuries—was a news article using words like ‘enraged’, ‘insane’, ‘woke’, ‘wild’, ‘bonanza’, ‘heaven’, ‘banned’, ‘feminist’, ‘patriarchy’, ‘mean-spirited’ and ‘cynical’ in discussion of a promotional popcorn container. The container was pictured no less than fifteen times in the article.

And honestly: that’s where I realised that this ‘rabid discourse’ was—like anything rabid—best avoided.

The image at the top of this post was generated by Midjourney.

This post was filed under: Post-a-day 2023, , , , , , , .

The worth of a life

Last week, the news paid open-ended attention to the loss at sea of the Titan submersible and its wealthy crew. Days earlier, the plight of 750 people, many of them children, on the sunken Adriana didn’t even make the top story on the bulletins I saw.

Ours can’t have been the only sofa in Britain on which the comparison was made with dismay.

On the LRB Blog, Michael Chessum suggests:

The mass drowning of migrants does not meet the media’s criteria for a human-interest story because the victims have been dehumanised. Centuries of racist conditioning have led us to this point, but there is a new strategy at work, too. Donald Trump and Suella Braverman have an air of performative stupidity, and it comforts the liberal commentariat to believe that the far right’s spell in power is a blip. But their project is deadly serious and for the long term. Trump’s ‘big, beautiful wall’ and the UK government’s plan to deport asylum seekers to Rwanda would have been unthinkable twenty years ago. The core narrative of the nationalist right, that migrants and foreigners are to blame for falling living standards, now dominates the mainstream. It feeds popular demand for the militarisation of our borders.

I’m not certain that I fully agree: I think there’s an element to which the loss of life of migrants has become normalised and ‘expected’, whereas the Titan story was unlike any story we’ve heard in recent years. Yet, the balance of coverage—not to mention the relative willingness of nation-states to spend money on each rescue effort—did feel like an upsetting new low to me.

Twenty years ago, Aaron Sorkin tried to shock us by including a ballsy line in the fourth season of The West Wing making the case that, from the President’s perspective, ‘a Kundunese life is worth less than an American life.’1

These days, it’s no longer the shocking subtext: it’s beamed into each of our homes in full technicolour, so routine that it no longer attracts on-air comment.

  1. Equatorial Kundu is one of Sorkin’s most successful fictional countries, originating in The West Wing, making a cameo in The Newsroom, escaping the Sorkin universe in iZombie, and turning up in any number of fictional exercises and assignments. Qumar never quite caught on in the same way.

This post was filed under: Media, News and Comment, Post-a-day 2023, , , , .

The rich list

I’ve never ventured into a branch of Home Bargains (or ‘Home and Bargain’ as it was called when I was growing up in its home county). But this neat fact from Andrew O’Hagan’s latest in The LRB was startling nonetheless:

Sales at Home Bargains (‘Top Brands. Bottom Prices’) have increased by £3.4 billion. Home Bargains has nearly 600 stores throughout Britain and the company’s owner, Tom Morris, enjoys the excellent designation of being the richest Liverpudlian in history. For fans of Paul McCartney, it’s depressing to find that there’s a lot more money in disposable toilet wipes than there is in writing ‘Love Me Do’.

Well, then.

This post was filed under: News and Comment, Post-a-day 2023, , .

AI is not a single entity

There’s a typically brilliant piece by Liam Shaw on the LRB blog right now about the recent use of an AI tool to assist in the discovery of an antibiotic: abaucin.

There is much important detail in Shaw’s blog which was missing from most of the media coverage on this topic. Most crucially from a health perspective, this antibiotic is likely to be useful only in topical applications (onto the skin) whereas the majority of harm from the single species the antibiotic treats—Acinetobacter baumannii—is from sepsis. It is a significant discovery, but mostly in the sense of being a staging post on the long road of development, rather than as an end in itself.

Shaw is also specific about the techniques used, and their limitations:

As well as powerful neural networks, the machine learning model depends on the existence of carefully collected data from thousands of experiments. It’s still a vast screening project, just not as vast as it would be without the AI component: it uses the data to find the best ‘ready to use’ molecule from the available options.

The discovery of abaucin shows that AI is helpful for the early stage of winnowing down the vast space of chemical possibility, but there’s still a lot to do from that point onwards.

This is useful because it feels like we are in a moment where ‘AI’ is used to refer to myriad things, and using the term on its own is not very helpful. It feels akin to the early 2000s, when a whole group of technologies and applications were referred to as ‘the Internet’ (always capitalised) as though they were a single entity.

It’s notable that the abaucin study didn’t refer even once to ‘artificial intelligence,’1 but used the somewhat more specific term ‘deep learning.’

When so many technologies, from large language models to recommendation engines to deep learning algorithms to theoretical artificial general intelligence systems are all condensed into two letters—AI—it doesn’t aid understanding. I’ve spoken to people this week who have interpreted the headlines around this to mean that something akin to ChatGPT has synthesised a new antibiotic on request—an understandable misunderstanding.

When scientists are warning about AI threatening the future of humanity, they aren’t talking about chatbots—yet you’d be hard-pressed to discern that from breathless headlines that refer to anything and everything as simply ‘AI’. In just a handful of days, even the well-respected BBC News website has published articles with headlines referencing ‘AI’ about drone aircraft, machine learning, delivery robots and image generation: all entirely different applications of a very broad class of technology.

If we’re to have sensible conversations about the ethics and regulation of AI technologies, I think there’s much to be done to try to help the public understand what exactly is being discussed. That ought to be the job of the news. Currently, it feels like we’re stuck in a cycle of labelling things as ‘AI’ as a strategy to garner attention, leading to conflated ideas and complete misunderstanding.

The image at the top of this post was generated by Midjourney, whose idea of the appearance of a human brain seems sketchier that I might have imagined.

  1. Though, in fairness, the press release did.

This post was filed under: Media, News and Comment, Post-a-day 2023, , , .

On the lumbar extension machine

This post was filed under: Post-a-day 2023, , .

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