Of scepticism, jet-packs and living to a thousand

I’ve spent a very pleasant evening in the company of the Sceptics in the Pub London, where the speaker was Dr. Aubrey de Gray, Chief Scientific Officer with the SENS Foundation. In brief, de Gray (Wikipedia article) set out the work of the SENS foundation which, as I understand it, looks at ageing as a disease which it then sets out to cure as a problem of regenerative medicine. While that is the primary aim, it has the effect, if successful, of increasing both quality and quantity of life; that is to say, making something approaching immortality not only possible but desirable.

De Gray set out a paradigm whereby metabolism causes damage, and damage then causes pathology. In this model, gerontology attempts to intervene in the first step – problematic because of the great complexity of metabolism – and geriatrics intervenes in the first step – problematic because damage has already caused pathology and is at best palliative. He sought to reverse accumulated damage before it became pathological.

Initially, this would allow for an extension of the useful human lifespan by perhaps thirty years. Once that first step was accomplished, refinements in technique would allow, excepting being hit by cars and so on, to continue for arbitrarily long periods, through the possibility of increasingly eficacious treatments before the eficacy of repeated cycles of previous treatments lost eficacy.

You can get a flavour of his speech from this TED talk.

Broadly, I would raise three problems with de Gray’s plan.

Firstly, the scientific. I can’t assess his science, but a number of people there raised fairly substantial problems with his paradigm and with the conclusions he drew from it. That is probably one for the peer reviewed papers.

Secondly, the technological. The very long, four-figure lifespans suggested depended not just on continuing improvements in the (speculative) set of technologies, bit that those improvements happened faster than people died because of a loss of eficacy as described above. The examples de Gray cited in support of his position were the motor car and the aeroplane. Unfortunately for him, the equally plausible alternative of the jet pack was raised: theoretically possible, desirable even, and can be turned into a prototype that can fly for half a minute, but can’t be turned into a production model (because the amount of fuel that can be loaded onto a human is finite and less than what’s needed for useful flight). Another example would be power from nuclear fusion, which has been ten years away for fifty years. It is a prediction based on little more than fiat.

Thirdly, the socio-economic. In answer to a question from yours truly about the cost of the treatments, de Gray was quick to observe, thousand-year life spans would have major effects on world society, meaning that we could throw much of traditional economics out of the window. If we do that, though, we throw political economy out of the window. Thus, de Gray’s assetion that the state would pay for its citizens to have these treatments is distinctly problematic as the state, as we know it, would not necessarily sill exist. Even if we accept that the state still exists in a recognisable form and that it makes economic sense for states to pay for these treatments, it does not follow that they will pay for them. As de Gray thought equality was a major issue, it’s worth going into at slightly greater length.

The basis from which de Grey works is that regenerative medicine is medicine like any other, albeit with remarkable effects. As we know from the current debate in the US, there are plenty of people who see taking money from them to pay for the healthcare of others as morally wrong. There are also plenty of countries that would like to provide comprehensive healthcare, but cannot afford it. De Grey provided no explanation of how we would roll out this treatment when we cannot at the moment give people with economic potential very cheap drugs – say, hydration salts for diarrhea – that would have similar economic benefits to the de Grey treatments but at vastly lower costs per dose. From the point of view of the state, it doesn’t matter whether a day’s work is done by a thirty-year-old or a three hundred and thirty-year-old. Given that states do not have to provide pensions or old age healthcare now, and that the mechanism by which they will be convinced to do so is absent, it seems as reasonable to conclude that arbitrarily long lives will remain the province of the wealthy as to conclude that we will enter this brave, new world. A nightmare scenario would be lots of people having access to these treatments but not making the necessary lifestyle changes. If we kept dropping kids every twenty or thirty years over a thousand year life, we’d very quickly overpopulate the planet.

I hope that de Gray’s science is more thorough than his statecraft.

Of course, if de Gray is right, I look forward to seeing you at the February 2317 meeting of Sceptics in the Pub London – assuming someone hasn’t already booked the room.

xD.

The American Health Service

The proposals in the US at the moment seem to be ranging between extension of a non-exclusionary scheme like Medicare to anyone that wants it on the one hand and public health co-operatives on the other. Whether that would be a single co-operative for the US, one for each state or many more remains to be seen.

It is clear that what is not being proposed is the American Health Service. In the former case above, the state commissions a lot of healthcare; in the latter case, co-ops pool risk, presumably remaining competitive even if they have to take everyone because they don’t have to make a profit. Neither of these cases has the key feature of the state actually owning the hospitals and employing the doctors (although Medicare does pay for the bulk of residency training in the US).

According to the 1951 Census, the population of England & Wales was 43,744,924 while the population of Scotland was ~ 5,100,000 according to the GRO*. In other words, when the NHS was set up, the population was just south of fifty millions, the great bulk of whom were covered under the National Registration Act 1939. The Labour government had a strong majority in Parliament, a charismatic advocate in Nye Bevan and a mandate for action. Plenty of people from all sides of the political spectrum supported implementing the Beveridge Report in some form (though not as comprehensively as the NHS would be).

The US population today (according to the US Census Office’s Population Clock ) is 307,196,354. That’s six times larger and spread over fifty polities that have differing healthcare systems. Moreover, the design of the US constitution makes it very hard to implement big changes and Obama is not providing the leadership on the issue that one might want.

I believe it was Nye Bevan who said that he thought Britain should remain a unitary state because it was the easiest way to achieve socialism but that the USA should remain a federal system because it was the easiest way to achieve socialism there (note to wingnuts: it was the leader of a party affiliated to the Socialist International who was feted so often in the US). For socialism, read systemic change: the drive to reducing carbon emissions was and is stalled at the federal level while real progress is made by some of the states. Similarly, it might be better for healthcare to be delivered by the states. Two states, Massachusetts and Minnesota, have compulsory insurance with subsidisation for the poorest, while New Jersey has a variation on the theme. They could be expanded. Some parts of the US remain resolutely conservative; they are going to be very hard to convince. There is no particular reason that their objections should stand in the way of, ahem, more enlightened parts of the country having better public healthcare provision. Nota bene that this is not quite the same as the left-right split. Minnesota, for instance, has two Democratic senators, but did have a split delegation, and has a GOP governor.

A brief end-note. There have been lots of anecdotes about the excellent/appalling care/death sentence received/imposed by the healthcare systems/death panels of the US/UK. In the period April 2008 to April 2009, the NHS saw five million emergency admissions. That works out at around one every six seconds, over the entire year; add to that everything else the NHS does and you have a lot of doctoring going on. I’m guessing the figures for the US are proportionately higher. In both systems, there will be examples of outstanding care and examples of poor care. Judging the entire system on one case is illiterate.

xD.

* – It is now 50,431,700, according to the ONS mid-2005 population estimate, while the population of the UK as a whole is 60,209,500.

The Citadel

The polemic of Obamacare and the nature of the NHS continues. There is a really important contribution to be made by Dr A. J. Cronin, a doctor of some note. Dr Cronin died in 1981, and the contribution is not scientific, but moral. It is not a paper, but a novel, called The Citadel.

I am not going to try to summarise the book; the plot is simple enough, but it is the experience of the author and the emotion he expresses that make the book worthwhile. It is the anger expressed at a system where the rich buy doctors’ time that they do not need while the poor die. It is a book that helped Labour win the ’45 election and helped the founding of the NHS.

It is available from Amazon in paperback and there are four English-language and two Italian film adaptations. The 1938 version is listed in The New York Times Guide to the Best 1,000 Movies Ever Made.

xD.

Conservatives for Patients’ Rights ‘Faces of Government Healthcare’ video

Conservatives for Patients’ Rights (CPRights) have a video up decrying government healthcare.

The NHS has its problems; no-one would say that it is perfect. However, it does a pretty damned good job and it does so regardless of someone’s ability to pay. While we don’t see the faces of private healthcare – or those who can’t afford it – it strikes me that there are some missing faces in the video; those who are happy with the NHS. There’s rather a lot of us.

The first face is Kate Spall, who says ‘if you have cancer in the UK today, you are going to die quicker than any other country in Europe’. The largest, pan-European, cohort-based study on cancer survival is EUROCARE. EUROCARE runs into the same problem that any other systematic review of cancer survival rates in Europe is going to; there are different recording systems between (and sometimes within) countries and some countries don’t keep records at all (the UK is pretty good; adult coverage in Germany is about 1.4%).

Nevertheless, the EUROCARE research suggests that Ms Spall is wrong.

Tables to show life expectancy of fatal cancer cases against % cured patients for country, age and date of diagnosis
Tables to show life expectancy of fatal cancer cases against % cured patients for country, age and date of diagnosis

While we are towards the bottom of the table, we are not at the bottom. In any case, this study does not take account of factors such as smoking, drinking, diet and so on. More information is on the latest results page.

A brief search on BBC News shows Ms Spall’s interest in cancer; her mother died from a rare form of kidney cancer. She managed to have Nexavar provided, even though “the drug, which can cost up to £40,000, is not a cure, but can help some patients”. Now, while my greatest sympathies are with Ms Spall, £40,000 is a lot to spend on a non-cure. Perhaps, in terms of QALYs, it was worth it; however, part of her objection was that the drug was available in some English health trusts. While I would certainly agree that there is not enough democratic involvement in NHS trusts, one of the effects of choice is, necessarily, variation. This seems like a poor choice – if you’ll excuse the pun – of ‘face of government healthcare’.

Next up is Katie Brickell. Despite asking for one at 23, Ms Brickell wasn’t given a smear test; by that time, she had contract cancer of the cervix. Again, my heart goes out to Ms Brickell, but this was a fluke. The evidence suggests that the smear test provides no benefit before about 25. If everyone were going in for a test whenever they were worried and there was no consideration about whether the test was appropriate, a lot of money would be needlessly spent on a lot of needless procedures.

Angela French says that it’s hard to get hold of new, expensive drugs on the NHS. Quite why this isn’t the case in the USA at the moment or, indeed, in any system that doesn’t have an unlimited budget is beyond me. Dr Karol Sikora makes the same point; quite why it is any less heartbreaking when a poor person in the US with insufficient insurance cannot afford a given drug is, again, beyond me.

The rest of the people featured are Canadian; I’ll leave them to one side as I don’t know enough to comment on the situation there. I would just note that no-one in the US is proposing a UK-style health service; rather, they’re going for different ways of amending insurance-based policies. The only system that exists like that at the moment is healthcare for the armed services which is, er, pretty good.

xD.

Meanings of words

Listening to the rather wonderful Fry’s English Delight reminded me of a post on the rather wonderful F Word Blog. A dimwit MEP by the name of Roger Helmer doesn’t believe that homophobia exists. Mr Helmer, whose blog has the strapline ‘Straight Talking’, says

In psychiatry, a phobia is defined as an irrational fear. I have yet to meet anyone who has an irrational fear of homosexuals, or of homosexuality. So to the extent that the word has any meaning at all, it describes something which simply does not exist.

This is the kind of English up with which I will not put. Firstly, the word phobia is used outside of the psychiatric context. A rabid dog is sometimes described as hydrophobic because of its fear of water – different to that described in the DSM – and a symptom of meningitis is often described as photophobia. Unless Mr Helmer is insisting that every tin can he buys is entirely Sn, he can sod right off.

Beyond that, the meanings of words change. Paedophilia comes from the Greek ????, child, and ?????, which best translates as ‘brotherly love’ (as in Philadelphia, the city of brotherly love). It was originally coined to differentiate from pederasty which definitely meant sexual love. I could use Helmer’s logic to say that we don’t need to worry about paedophiles, but those damned paederotes. It would be as pointless as Helmer saying that he is not a homophobe but a antibivirist – words change their meaning.

xD.

Suicide and the public interest

In a post on her website1, Nadine Dorries MP makes a series of contentions concerning the law on assisting suicide that I believe to be mistaken.

The first contention is that the 1961 Suicide Act clearly and unambiguously “states that those who aid, abet, counsel or procure someone else’s suicide, can be prosecuted and punished with up to 14 years in jail.”

That is true; however, section 2 (4) of the Act says that

no proceedings shall be instituted for an offence under this section except by or with the consent of the Director of Public Prosecutions.

Indeed, the case made by Purdy and the instructions to the DPP revolve around this section. As I understand it, the contention, which the Law Lords supported, was that article 8 of the European Convention on Human Rights, as Lord Neuberger of Abbotsbury said,

entitle[s] her [Purdy] to be provided with guidance from the Director as to how he proposes to exercise his discretion under section 2(4) of the 1961 Act

The second contention is that “clarification of the existing law can only mean one thing: assisting suicide is illegal and prosecutable with up to 14 years in jail.” In other words, the instruction to the DPP means that the law can only be clarified in one direction, which would increase the probability of a prosecution (and, so, limit the number of instances of people travelling to Dignitas). Again, that is simply not true. That is one possible outcome; however, on the basis of what reasons not to prosecute in these cases that the DPP (and his predecessor) has published, it seems equally likely that the public interest will not be seen to favour any tightening of the implementation of the law.

The CPS list a series of factors in the Full Code Test that will make a prosecution more or less likely. One of the points made in the ruling is that being an accessory to suicide is the only crime of aiding, abetting, counselling and encouraging where the principal is not guilty of a crime, suggesting that (at least possibly) those points may not be appropriate.

Ms Dorries, in the third contention, suggests that any deviation from more prosecutions would be the creation of new law (“Keir Starmer cannot change this law without a vote in Parliament. He can only define policy one way and that would be for the law, which has until now been quietly passed over by the authorities, to be paid due attention in each and every case”). This is simple rubbish. It seems worthwhile to quote Viscount Dilhorne, quoted by Lord Hope of Craighead in the ruling:

“In 1951 the question was raised whether it was not a basic principle of the rule of law that the operation of the law is automatic where an offence is known or suspected. The then Attorney-General, Sir Hartley Shawcross, said: ‘It has never been the rule in this country – I hope it never will be – that criminal offences must automatically be the subject of prosecution.’ He pointed out that the Attorney-General and the Director of Public Prosecutions only intervene to direct a prosecution when they consider it in the public interest to do so and he cited a statement made by Lord Simon in 1925 when he said:

‘… there is no greater nonsense talked about the Attorney-General’s duty than the suggestion that in all cases the Attorney-General ought to decide to prosecute merely because he thinks there is what the lawyers call a case. It is not true and no one who has held the office of Attorney-General supposes it is.’

Sir Hartley Shawcross’s statement was indorsed, I think, by more than one of his successors.”

Ms Dorries’ fourth contention is that the legalisation of assisted suicide will be the first step towards state-assisted suicide. I say that it is not the first step but the same thing. If it is legalised in the UK, it will like as not be available, at least for some people, with state support. If nothing else, there will be heavy state regulation and oversight. I see no difference in the two instances other than an attempt at implying that the NHS is going to start bumping off people who have no family. Ms Dorries evidently has a low opinion of doctors if she thinks they will routinely tell people to die because they’re holding up a bed; indeed, the possibility for doctors to do that now to the relatives of someone in, say, a persistent vegetative state exists in practice through the similar device of a DNR.

The fifth contention is that “the first job of Parliament is to protect the majority and the vulnerable”. This is rot; those are two jobs which could well be, and often are, at odds with one another.

The sixth contention is that those who want to change or clarify the law on assisted suicides might be better off “to let sleeping dogs lie”.

The idea of jury nullification is not new; it would be a stone-hearted jury that convicted Omar Puente of helping his wife to die. Indeed, one of the factors in the Full Code Test against a prosecution being brought is the likelihood of a conviction. That, at best, is an unknown, particularly if any weight is given to recent polls on the subject.

Ms Dorries might do well to remember a line by Abraham Lincoln:

“The best way to get a bad law repealed is to enforce it strictly.”

I have not dealt with whether there should or should not be a change in the law; I have merely pointed out what I believe to be mistakes in Ms Dorries’ reasoning. Given her stance on abortion, her stance on assisted suicide is of no surprise. For the record, I would probably be in favour of relaxing the law on assisted suicide.

The text of R (on the application of Purdy) (Appellant) v Director of Public Prosecutions (Respondent) is on the House of Lords website and the (very short) Suicide Act 1961 is on the OPSI website.

There is a certain irony on the last ruling by the Lords of Appeal in Ordinary in the House of Lords, thanks to the creation of the Supreme Court, is on assisted suicide.

xD.

1 – No comments or trackbacks mean it’s not a blog, just a regularly updated website.

PS – One of the pitfalls I have fallen into, blogging-wise, is not doing enough research. However, I’m not an MP and not running a campaign on this issue, unlike Ms Dorries. Indeed, the article she links to in the Daily Mail, talking about a Bill she is to propose to make it clear that a prosecution must be brought in all cases of assisting suicide, shows that many of the contentions she makes in the article on her website are flawed. I’m prepared to accept that I’m wrong on the detail, but I think I am right in saying that the situation is rather more complicated than Ms Dorries would have us believe. To the lawyers (there’s at least four) who read this blog – I appreciate corrections!

U2 can B sh1t

Every generation gets to change the world

sings Bono in a new advertisement.

Is the U2 singer leading a new campaign to feed the hungry and clothe the naked? Will he lead us into a world without the scourge of war? Can Bono take us into this new, golden age?

No. He’s trying to sell us a BlackBerry.

Worse than the cynical move from providing politicians at international fora credibility and cool to pushing mobile email in the same messianic terms is the sheer God-awfulness of the saccharine-sweet lyrics and their total detachment from anyone’s reality.

The song in question is ‘I’ll go crazy if I don’t go crazy tonight’ by U2 and I think it is a subliminal attempt to make people buy BlackBerries hiding a subliminal attempt to make people convert to Bonoism.

The advert is here; below follows the video.
Continue reading “U2 can B sh1t”

When points mean passports

I’ve become a bit enured to being called a war-mongering baby-eater when I knock on a door to ask someone to vote for Labour. Usually, people listen politely and occasionally offer you a cup of tea, but you do get the odd snipe.

Imagine the scene when an aspirant British citizen knocks on a door to canvass for their party of choice. Not only will they be associating themselves with politics, they will be opening up their motives to criticism. “You’re only doing this to get a passport”.

Phil Woolas wants a points-based system for awarding passports, with points available, inter alia, for canvassing for political parties. That would only add to the scepticism over the motives of those involved in politics.

If we say that Britishness is behaving like people in Britain, the problem is that being a member of a political party, let alone door-knocking for one, is an increasingly un-British thing to do.

There is also, apparently, no limitation to which parties, present or future, are allowed. maybe taking part in our civic life does include campaigning for the Official Monster Raving Looney Party or the Church of the Militant Elvis, but I don’t think that’s what Woolas had in mind. I might set up the ‘immigrants campaigning to get rid of this stupid immigration points system, but only in a thoroughly British way’ party.

It’s not obvious what British values means, either. I would rather not have a hereditary monarchy. Were I an aspirant citizen, would that be sufficiently un-British? Would campaigning for Scottish independence be un-British? Are Sinn Fein kosher?

There will be also be points for going to live in areas of depopulation. Yes, you too can be British by living where the British don’t.

Of course, Woolas might be trying to make immigrants be model Brits, in which case I would advise him to look at the plank in his own eye before the speck in his brother’s. I know plenty of non-citizens resident in the UK who are model citizens, fully engaged with community and civic life. I just don’t want their motives to be quesioned.

Posted by Wordmobi

We hate to say we told you so…

On some routes, bendy buses are a good idea. Despite it being relatively quiet because of the school holidays, people want the bendies back on the 507.

But we did. Repeatedly.

I rather doubt this will have much electoral impact as lots of the people on the 507 are coming from outside the Greater London area.

In other bus news, which I hadn’t heard about, East Thames Buses has been sold to Go Ahead. Both the sale and the fact that the only news outlets which carried the story, other than Mayorwatch, seem to have been Socialist Worker and Investors’ Chronicle, neither of which I read, bothers me.

Neil William’s template Twitter strategy

Neil Williams (blog, Twitter) has drafted a template strategy for Government departments wanting to use Twitter; find it on the Cabinet Office’s Digital Engagement Blog or on Neil’s website as a PDF. It’s a good document – you have to bear in mind that this is for civil servants – and could be a good starting point for anyone with a brand to manage. It’s worth reading and I do hope that various people in HMG take it on board, particularly how useful it is as a conversational tool – I’ve had questions answered by MoD over Twitter in a matter of a couple of minutes and replied to a few things from Paul Drayson, Tom Watson and others.

I really like a particular idea that Neil has – departments live twittering their own press conferences and so on. That would be a real ‘value-added’.

A little while ago, I put all the regional and departmental RSS feeds that the COI’s News Distribution Service provide onto Twitter. The full list is here; I’m really pleased that Neil has listed me as an unofficial aggregator of government content, and more than a little flattered.

xD.