Some Random Thoughts for the Next Posting

I had an insight into the way that I write articles. Recently I needed to write a paper to be presented at a conference in Cape Town. It became apparent my best modus operandi is to begin on Monday; write furiously for three days, each day starting by reading what I have already written; and then on Thursday and Friday I go back and edit. So the lesson is not to try to start an article in midweek but to save up and get on with it on a Monday. What I have not yet learnt is the best way to do the reading other than at the gym.

At the end of May I went to the conference mentioned where the paper was to be presented. The conference  was organised by the Center for International Governance Innovation, my new employer in Canada, and the American Political Science Association. It was on the future of South Africa and what Nelson Mandela’s legacy might look like.

I traveled from Durban a day before the meeting. I went up to Greyton, about two hours drive from Cape Town, in the Overberg mountains. I spent a night with Tim Quinlan, who worked for many years at HEARD as my deputy. Greyton is really beautiful and I much enjoyed the calm small town feel of the place. I’ve posted a couple of pictures of my stay with this blog. The question is, could I and would I want to live there and while it is great to visit I honestly do not think it would work in the longer term as it does feel very isolated.

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The conference itself was fascinating, and I came away uncertain as to what the future of South Africa looks like. There were a number of criticisms of Mandela. Three stuck in my mind. The first was allowing Winnie to get away without answering for the murder of Stompie Moeketsie in 1991. She was convicted of kidnapping and being an accessory to assault, and sentenced to six years in jail, but this was reduced to a fine and a two-year suspended sentence on appeal. Second, was taking money for elections which allowed a culture of corruption to take root. Thirdly and of course, closest to my heart, not picking up on the threat that HIV posed to South Africa. We worked hard though. The meeting began with a dinner on Friday, on Saturday and Sunday we met from 9 am to 6 am and then had working dinners. Yet another weekend gone! I now need to complete my chapter.

Back in the UK there were a few small wins. We went to the beach, and although it was far too cold to venture into the water the dog had a good run. On the way back to Norwich we stopped at a garden centre and bought some pond weed and water plants. The pond was cleaned a month ago and looked very bare. There will be many happy frogs.

I mowed the lawn and it took nearly two hours. The first challenge is getting the lawn mower to start; it should never be taken for granted that it will indeed fire up with the pull of the cord. It was extremely satisfying when, on this occasion, it started first time. The grass was not too thick, but I still filled  nearly half of the garden waste bin. This activity was instead of going to the gym and it was probably nearly as good the work out as I would have had there. I put in my Zen Player, wore a headband to keep it on and listened to the BBC news.

The dog came out to help, which means her biting at the wheels and waiting for me to throw tennis balls for her. I was also joined by a friendly robin that perched on a nearby branch and talked to me, and a thrush that followed the mower to see what edible goodies I might be turning up. It was actually a rather pleasant and productive way to spend a couple of hours.

Just over six weeks ago we (HEARD) were asked to undertake a study for the Global Fund for AIDS, TB and malaria. The question posed was: how should resources be divided between the three diseases before being allocated to countries? This was asked by the Board. An earlier question: Should resources be divided between the three diseases before being allocated?, was not on the table. We were asked to work to a tight timeline to develop a formula to try  address this question. I put together a team of five staff members led by Catherine Sampson who has joined us for a year and who is a Peace Corps volunteer.

 We were sent a series of dates on which various things had to be delivered and we succeeded in doing the work. There were three groups invited to be involved in the work the others being from the USA and UK respectively. I was delighted to learn we had been the only group that had succeeded in making the technology of video conferencing work for all the meetings, and we were also the only ones to stick to the deadlines we were given. It was a real learning experience for us all and I was delighted by the way people stepped up to the mark.


Ben Goldacre, Bad Pharma: How Drug Companies Miss Doctors and Harm Patients, Fourth estate, London 2012, 430 pages

Ben Goldacre hates sloppy and misleading science, ‘Bad Science’ was the title of his first book. It took a bit of time for me to get into this book, but once I did I really enjoyed it and was almost sorry it came to an end. Although I have to say that it peters out rather than ending with a bang. This may be because he is writing for primarily a British audience and finishes by setting out various things that patients, doctors and the community can do to respond to the mis-selling of drugs. It is an excellent book which describes how  deals? go wrong in the development and selling of drugs. There is a detailed explanation of how trials are carried out and why they so often don’t tell us what we need to know.

What is missing from this is an understanding of the difficulty of publishing null results. This goes beyond science broader research and public community. It then takes us into human psychology and an understanding of what makes us tick. We want news that is interesting and grabs our attention. When it comes to medicine we want to know what will work. The problem is healthcare is a form of market failure. When people are sick, they want to get better right now. Healthcare professionals need to be gatekeepers. It also means that they need to be more honest about what medicine can and can’t do.

We, as a society, need to be accepting of the concept of a ‘good death’, and that will take some psychological leaps. This is a book that should be read by every scientist and social scientist as well as the public who want to be informed about drugs and drug companies. My biggest criticisms are his lack of understanding of economics and an unwillingness to engage with this, but perhaps that is the subject of another  bigger book; secondly one has to ask who ultimately benefits from the pharma industry and why they do it. Given that most pharmaceutical companies are publicly listed it seems that we mislead ourselves willingly.

Stephen Grosz, The Examined Life: How We Lose and Find Ourselves, Chatto and Windus, London 2013, 225 pages.

This is the story of the experiences and learning of a psychoanalyst. Grosz was born in the USA but practices in London (how he got there would, in itself be an interesting tale). The book is divided into six parts: beginning; telling lies; loving; changing; and leaving. This style of the book for case studies of patients to be presented to illustrate points. Each is extraordinarily well written and extremely readable. There are some deeply interesting people, a professor who at age 72 realises  he is gay and wants to negotiate his relationship with his wife and family.

The book does not tell us the outcome for all patients out there on many lessons in it. The back cover says ‘this book is about our desire to talk, to understand and be understood. It is also about listening to each other, not just words but the gaps in between. What I am describing here isn’t a magical process. It’s something that is part of our everyday lives-we, we listen’.

This is a book for every therapist and everyone who goes for therapy. It is also a book for anyone who wants to have a better understanding of themselves and others and how we interact, or so often fail to. It is not very long but I was really sorry to come to the end of it, it could be twice the length and just as readable. There are no solutions in it: that is the point we have to look within ourselves. What I did find rather interesting is that we learn how each of the patients was affected and in many cases damaged by their parent’s and upbringing. It would be interesting to have had parents psycho analysed, did they know what effect they were having on their children? Even more important is, do we understand what we are doing to our kids at the moment. That is something I battle with all the time. An answer is to have two funds for our children: one for college and the other for analysis.

Andro Linklater, Measuring America: How the United States was Shaped by the Greatest Land Sale in History, Harper Collins, London 2003, 312 pages

Perhaps one of the most striking differences in flying across large parts of the United States or Canada or Europe is the way the landscapes are  regulated. In Europe human habitation tends to follow the contours, rivers and other natural features. In the USA the grid dominates. This book is about how the land was surveyed.

I picked up a copy at a secondhand bookstore and have to say I found it deeply fascinating. The significance of the measuring was that it allowed private property to dominate, unlike the feudal system of Europe and the United Kingdom. This in turn shapes the North American psyche. Clearly they went hand in hand but one that could not have happened without the other.

The author describes the measurement systems, not just for length but also wakes and liquids. At the core of the distances was the chain, a length of linked metal bonds devised by one Edmund Gunter, a clergyman who issued instructions on how to do this in 1623. He had first used the chain in about 1607 to measure the estates of the Earl of Bridgewater. I can remember ‘chaining’ the sports field at Waterford school as part of a geography lesson. A chain is 22 yards long which is the length of a cricket pitch. This last fact has no significance in the USA. Measuring has to do with politics, commerce and fairness. Politics determine what distances and measures are used, commerce demands certainty and consistency.