All posts by Keith

I’m a controversialist and catalyst, quietly enabling others to develop by providing different ideas and views of the world. Born in London in the early 1950s and initially trained as a research chemist I retired as a senior project manager after 35 years in the IT industry. Retirement is about community give-back and finding some equilibrium. Founder and Honorary Secretary of the Anthony Powell Society. Chairman of my GP's patient group.
sexuality, thoughts

Why Monogamy?

I’m dipping into (“reading” is too organised a concept for my random excursions) This Explains Everything: Deep, Beautiful and Elegant Theories of How the World Works, edited by John Brockman. This is a collection of almost 150 short essays written in response to the Edge question of 2012: What is your favourite deep, elegant, or beautify explanation?
The answers cover the spectrum from particle physics through psychology to the social sciences. Authors include luminaries like Susan Blackmore, Leonard Susskind, Stephen Pinker, Carl Zimmer and Jared Diamond as well as a whole host of people I’ve never heard of.
One essay I read last evening stood out for me, and I am naughtily going to reprint it here in its entirety.

The Overdue Demise of Monogamy
Aubrey de Gray
Gerontologist; chief science officer, SENS Foundation; author, Ending Aging
There are many persuasive arguments from evolutionary biology explaining why various species, notably Homo sapiens, have adopted a lifestyle in which males and females pair up long-term. But my topic here is not one of those explanations. Instead, it is the explanation for why we are close — far closer than most people, even most readers of Edge, yet appreciate — to the greatest societal, as opposed to technological, advance in the history of civilization.
In 1971, the American philosopher John Rawls coined the term “reflective equilibrium” to denote “a state of balance or coherence among a set of beliefs arrived at by a process of deliberative mutual adjustment among general principles and particular judgments.”* In practical terms, reflective equilibrium is about how we identify and resolve logical inconsistencies in our prevailing moral compass. Examples such as the rejection of slavery and of innumerable “isms” (sexism, ageism, etc.) are quite clear: The arguments that worked best were those highlighting the hypocrisy of maintaining acceptance of existing attitudes in the face of already established contrasting attitudes in matters that were indisputably analogous.
Reflective equilibrium gets my vote tor the most elegant and beautiful explanation, because of its immense breadth of applicability and also its lack of dependence on other controversial positions. Most important, it rises above the question of cognitivism, the debate over whether there is any such thing as objective morality. Cognitivists assert that certain acts are inherently good or bad, regardless of the society in which they do or do not occur—very much as the laws of physics are generally believed to be independent of those observing their effects. Noncognitivists claim, by contrast, that no moral position is universal and that each (hypothetical) society makes its own moral rules unfettered, so that even acts we would view as unequivocally immoral could be morally unobjectionable in some other culture. But when we make actual decisions concerning whether such-and-such a view is morally acceptable or not, reflective equilibrium frees us from the need to take a view on the cognitivism question. In a nutshell, it explains why we don’t need to know whether morality is objective.
I highlight monogamy here because, of the many topics to which reflective equilibrium can be usefully applied, Western society’s position on monogamy is at the most critical juncture, Monogamy today compares with heterosexuality not too many decades ago, or tolerance of slavery 150 years ago. Quite a lot of people depart from it, a much smaller minority actively advocate the acceptance of departure from it, but most people advocate it and disparage the minority view. Why is this the “critical juncture”? Because it is the point at which enlightened thought-leaders can make the greatest difference to the speed with which the transition to the morally inescapable position occurs.
First let me make clear that I refer here to sex and not (necessarily, anyway) to deeper emotional attachments. Whatever one’s views or predilections concerning the acceptability or desirability of having deep emotional attachments with more than one partner, fulfillment of the responsibilities they entail tends to take a significant proportion of the twenty-four hours of everyone’s day. The complications arising from this inconvenient truth are a topic for another time. In this essay, I focus on liaisons casual enough (whether or not repeated) that availability of time is not a major issue.
An argument from reflective equilibrium always begins with identification of the conventional views, with which one then makes a parallel. In this case, it’s all about jealousy and possessiveness. Consider chess, or drinking. These are rarely solitary pursuits. Now, is it generally considered reasonable for a friend with whom one sometimes plays chess to feel aggrieved when one plays chess with someone else? Indeed, if someone exhibited possessiveness in such a matter, would they not be viewed as unacceptably overbearing and egotistical?
My claim is probably obvious by now. It is simply that there is nothing about sex that morally distinguishes it from other activities performed by two (or more) people collectively. In a world no longer driven by reproductive efficiency, and presuming that all parties are taking appropriate precautions in relation to pregnancy and disease, sex is overwhelmingly a recreational activity. What, then, can morally distinguish it from other recreational activities? Once we see that nothing does, reflective equilibrium forces us to one of two positions: Either we start to resent the temerity of our regular chess opponents playing others, or we cease to resent the equivalent in sex.
My prediction that monogamy’s end is extremely nigh arises from my reference to reproductive efficiency above. Every single society in history has seen a precipitous reduction in fertility following its achievement of a level of prosperity that allowed reasonable levels of female education and emancipation. Monogamy is virtually mandated when a woman spends her entire adult life with young children underfoot, because continuous financial support cannot otherwise be ensured. But when it is customary for those of both sexes to be financially independent, this logic collapses. This is especially so for the increasing proportion of men and women who choose to delay having children until middle age (if then).
I realize that rapid change in a society’s moral compass needs more than the removal of influences maintaining the status quo; it also needs an active impetus. What is the impetus in this case? It is simply the pain and suffering that arises when the possessiveness and jealousy inherent in the monogamous mind-set butt heads with the asynchronous shifts of affection and aspiration inherent in the response of human beings to their evolving social interactions. Gratuitous suffering is anathema to all. Thus, the realization that this particular category of suffering is wholly gratuitous has not only irresistible moral force (via the principle of reflective equilibrium) but also immense emotional utility.
The writing is on the wall.
____________________
* A Theory of Justice (Cambridge, MA: Belknap Press, 1971).

Friends with benefits. Or just friends. Or just benefits. Where’s the problem?
As one of my university friends used to observe: why should sex not just be an expression of friendship; we have sex just because we’re friends and feel like it; no more, no less? How is this actually different from having a drink, listening to records, or playing tennis together?
I’ve always struggled to see why anyone has a problem with this.

natural history, photography

Weekly Photograph

This week a photograph from the archives; it was taken in October 2011.
I see a Green Woodpecker going through the garden a couple of time most years. But this guy (yes, probably male) was on our next door neighbour’s lawn and back then this was the third or fourth time I’d seen him visiting over a period of 2-3 weeks. One day I watched him for 45 minutes, quartering the same area repeatedly, so it must be very rich in ants. Taken at a range of 20-25 yards from the study window with my biggest lens and still this is a small crop from the middle of a frame.

Click the image for larger views on Flickr
Green Woodpecker
Green Woodpecker
Greenford, October 2011

words

NHS Communications

Every week someone somewhere in the NHS sends out an email bulletin called NHS Networks News. It is intended to provide a channel of useful information and articles on the happenings in the NHS for clinicians and similar. For some reason I seem to be subscribed, so I see a copy.
And each week this email starts with a short piece called “Editor’s blog”. Sometimes it is useful. Sometimes it is humorous. This week’s was undoubtedly supposed to be humorous. But in actual fact all it has done is highlight the appalling levels to which the NHS culture and NHS communications have sunk, because it is far closer to the truth than I think the anonymous author realises, as you’ll know if ever you have tried reading any NHS documentation. (Although the same is equally true of most corporate cultures.)
Just for your edification, I shall reproduce here the full item.

The gas and air principle
All NHS staff must learn a second language before they can be truly proficient communicators: they need to be able to speak NHS.
In the latest in our occasional series of tutorials, we offer further tips for the aspiring NHS speaker.
Verbs
In most languages, verbs are “doing” words. In NHS they are “actively considering” words. Saying that you will “do” something may make you appear brash or over-confident. Acceptable alternatives include “aim to”, “take steps toward” and “formulate a vision and strategy for”.
When you have practised each of these, you can use them together to convey the desired nuance or level of obfuscation.
So while “aiming to tackle the causes of health inequalities” could still be mistaken for a commitment, “aiming to take steps towards formulating a vision and strategy for tackling health inequalities” avoids the risk of embarrassment and disappointment when nothing happens, but demonstrates very strong active consideration.
Nouns
In English, nouns – or naming words – denote a person, place or thing. In NHS, nouns are used to create the impression of something tangible.
For example “stakeholder” is a useful term meaning someone who is not involved and you have no intention of involving, but who cannot be ignored. A patient is a good example of a “stakeholder”.
When you have mastered “stakeholder”, you can start to introduce “ownership” into your everyday conversation. Here are a few phrases to practise, with English translations in brackets.

  • “I’m going to give you ownership” (“It’s your problem now”)
  • “We don’t have ownership” (“Nothing is our fault”)
  • “We are working with stakeholders to establish full ownership” (“No one knows what’s going on”)

Adjectives
Adjectives in English are used to describe things, usually to make them clearer. Adjectives have a slightly different role in NHS, which is to make statements more emphatic. Simple ones to start with include “key”, “core”, “vital”, “meaningful”, “strategic” and “high-quality”. In NHS it is mandatory to use at least one of these words in front of any noun.
“Increasing” is among the most useful adjectives in NHS. Describing all problems as “increasing” helps to explain why they continue to get away from us despite the steps we have taken to formulate a vision and strategy for aiming to solve them.

Putting it all together
Once you have grasped the different parts of speech, you will soon be ready to try out your new skills. Here are two superb examples of written NHS, taken from a report published this week by the Local Government Association* and Public Health England. Don’t be disheartened if your first attempts are not up to this standard.
“A history of joint working has ensured that health issues are built into planning policies. Healthy urban planning is now high on the council’s priority agenda and a toolkit is being developed to embed health issues further into planning.”
“A number of partnerships and a strategy involving a parallel inter-linked range of initiatives have been set up to tackle the increasing problem of alcohol misuse in the city. Pioneering use has been made of the council’s traditional functions in the service of health. Involving the public and service users has been a key component.”
Note how the sheer density of each sentence creates a sense of meaning without allowing any actual meaning to escape. This is the effect you should aim for in your own written and verbal communications.
All of which leads us to the first rule of NHS, known as the gas and air principle: the purpose of words is not to bring ideas to life but to render them unconscious as swiftly and safely as possible.
(*Not an NHS organisation, but an accomplished NHS speaker in its own right.)

Oh dear! If it wasn’t quite so true it would indeed be amusing.

uncategorized

Oddity of the Week: Larks & Owls

Seriously, though, people vary in the times they like to sleep and wake—this has been the case throughout history. What’s new, however, is the recent discovery that the tendency toward being a lark or an owl is genetically determined in a similar way to the tendency to have blue or green eyes. The gene that governs sleep/wake predisposition is called Period, or PER for short. Like the gene for eye color, it comes in two different types (let’s call them PERI, which causes people to have larkish tendencies, and PERo, which causes them to have owlish tendencies). You probably know that we have two copies of all our genes, which means we have two copies of PER as well. The trick, however, is that these copies don’t have to be the same: If you have two copies of PERI, you’ll be a lark. If you have two copies of PERo, you’ll be an owl. But if you have one copy of each (which is what 50 percent of the population has), you’ll be somewhere in between. This works for eye color too, by the way: If you have two copies of EYE-COLORg, you’ll have green eyes. Two copies of EYE-COLORb you’ll have blue eyes, and a copy of each you’ll have brown eyes.
From Penelope A Lewis, The Secret World of Sleep (2013)

current affairs, medical

Transforming the NHS

1 Comment

As regular readers will know, transforming the NHS so that it can provide excellent healthcare to people in the UK at an affordable cost is something which has exercised my mind for a long time (see, for example, here and here). And I am involved, at a local level, in trying to help unlock this.
Now don’t get me wrong. Many parts of the NHS are excellent. In an emergency they generally work brilliantly, at least in the short-term. And many of the doctors and nurses care deeply about looking after the patients.


However whenever I walk into any NHS hospital, clinic or office** there are several things which immediately strike me:

  • the obscene level of waste
  • the absence of appearing professional
  • the number of staff who seem to spend their lives wandering around doing little or nothing
  • the appalling environment
  • the apparent lack of both money and the will to put any of this right.

And that is despite the fact that the NHS should already have shed-loads of money to do everything we would want it to do if it used it wisely.
The other day I had to visit a local private hospital, and the contrast with the NHS was almost as stark as it has always been. No, it wasn’t perfect. For a start it was far too hot, but it was clean and looked professionally welcoming. Yes, there were plenty of staff around, and they all appeared to be doing something with a purpose. You had a degree of confidence that everyone knew what they were doing and why and that they cared about their patients.
This is more what the NHS should be like. But how to get there?
I keep thinking about this and here’s my three step plan for the paradigm shift which the NHS requires, from top to bottom.
Step 1. Get someone at the top who can successfully run a large, quality, profitable corporation and who is able and willing to tell the politicians to butt out and stay out. Someone like Richard Branson, or perhaps Alan Sugar (no, I don’t care that you dislike them; they’re good at what they do). Someone who will have a vision of how the organisation should be and will implement it regardless of push-back from any level — if you aren’t going to do the job, get out.
Step 2. Tackle the appalling level of waste. This includes finding efficiencies — improved ways of doing things — at all levels. And that means everything from reducing bloated layers of managers and administrators, through cupboards full of medical supplies which have to be thrown out because they go out of date while other departments can’t order the very same thing, to turning down the heating.
Yes, really! Turn the heating down! NHS hospitals, clinics and offices are always far too hot; when people who are usually cold tell me it’s too hot then you really are wasting money! Just this one thing could save the NHS millions.
And while you’re saving money, fix the buildings: even if you can’t build new hospitals (because of time, money or space) you can at least make the ones you have into a habitable environment. Fix the leaks etc. Stop the draughts. Buy some paint. Because they will save you even more money in the long run.
Do those two things and you will start to see a culture change. But to complete the paradigm shift you need to do something just as fundamental the the outlook and attitude of all the staff — from the most world renowned consultant surgeon to the lowest lavatory cleaner. So that means …
Step 3. Everyone needs to take on board four basic beliefs and habits:

  1. Cherish the patients. They are why you are doing what you do. They’re not just important they are your whole raison d’être. They deserve the best.
  2. Put yourself in the other person’s shoes, whether they’re a consultant, GP, patient, nurse, administrator or ancillary worker. Think what effect things will have on them. And then treat them as you would like to be treated.
  3. Work as a single team. Everyone is equal but everyone has different skills. It doesn’t matter if you’re a patient, the most renowned surgeon or the ward cleaner, everyone has an important role which has to be valued as important to the patient’s recovery. (And part of that means valuing people and paying them decently.)
  4. Be empowered. If it is right and needs doing, do it. This has to come from the top by giving everyone freedom (not bullying), and it has to come from the bottom with people grasping that freedom. Unless there is an over-riding reason not to do something, just do it.

No, I don’t pretend it will be easy. That’s why you need the right person, with the right attitude, at the top. Without that one person it will never work because the politicians will keep meddling and the all the vested interests will see the top as weak and keep playing their own games. And then the patient (remember him/her?) is forgotten.
Yes, initially there will be a lot of scepticism and probably a morale hit. But as time goes on, as it begins to work and people start to buy-in, morale will increase and you’ll win lots of crusaders.
But it will take time. I went through this in a multi-national corporation in the 1990s and it took the best part of a decade, lots of head-banging, a lot of people being retrained and several rounds of redundancies for those who couldn’t or wouldn’t adjust. So I’ve seen it done; I was looking up from the bottom wondering WTF was happening; after a couple of years the penny dropped and I too changed. I know it can be done.
So David Cameron and Jeremy Hunt, do you have the balls to do this?
I’m not holding my breath.
____________________
** This also applies to some GP surgeries although most are better as they are small stand-alone businesses which have to keep afloat.

personal

Five Questions, Series 5 #4

We’ve got to question 4 of the Five Questions in Series 5 that I posed at the beginning of the year. (OMG, a month of the year has gone already!)


Question 4: Give me the story of your life in six words.
How about this as a fair summary:
Working class, eccentric thinker who underachieved

I didn’t get where I am today by achieving anything other than mediocrity.
OK, yes I did well academically by most people’s standards: reasonable first degree, a masters, then a doctorate (by the skin of my teeth!). But I failed dismally as the academic I wanted to be and left after a year.
I was destined to be a top consultant technician in a large IT company, but allowed myself to drift from job to job. I realised towards the end of my career that I could have achieved much more so-called success if I had put my mind to it. But I hadn’t and I realised I really didn’t want it, although I would have liked the status, the money and the pension. And that, from the outside looks like under-achievement because the early academic promise should have taken me much further than it did.
Unfortunately this just reinforced my internal mental self-portrait as a loser, an image which seems to have been instilled in me in childhood. It became an ingrained self-fulfilling prophesy. But of course it’s bollox. Intellectually I know it is.
But changing one’s internal self-image is damn hard. I’ve managed to get a long way from being a miserable, negative, “they’re all out to get me” git of a loser, as my father was, and as I was set to become. But so far I haven’t managed to shift the internal “loser” self-portrait.
No wonder I’m depressive.
Bah! Humbug!

amusements, people, photography

Weekly Photograph

This week’s photo was taken last October when Noreen and I travelled on the paddle-steamer Waverley from London (Tower Pier) to Southend. This guy was one of the passengers. He was totally oblivious to me sitting on deck less than 10 feet away taking his photo. I don’t know how he was warm enough in just a t-short at 9AM on a cold foggy morning. I ask you, what does he look like?!

Click the image for a larger view

Plonker
River Thames, October 2013

quotes

Quotes

Another in our series of interesting, thought-provoking or humourous quotes recently encountered.
It has proven surprisingly difficult to work out how many sheets of A4 the average goatskin can produce.
[@ianvisits on Twitter]
Challenges cannot possibly be good or bad. Challenges are simply challenges.
[Carlos Castaneda]
Less and less is done until non-action is achieved. When nothing is done, nothing is left undone.
[Lao Tzu]
There are basically two types of people. People who accomplish things, and people who claim to have accomplished things. The first group is less crowded.
[Mark Twain]
The whole modern world has divided itself into Conservatives and Progressives. The business of Progressives is to go on making mistakes. The business of the Conservatives is to prevent the mistakes from being corrected.
[GK Chesterton]
A man’s bookcase will tell you everything you’ll ever need to know about him
[Walter Mosley, born 1952]
In expanding the field of knowledge we but increase the horizon of ignorance.
[Henry Miller, The Wisdom of the Heart (1941)]
It is a very sad thing that nowadays there is so little useless information.
[Oscar Wilde (1854-1900)]
Beware of false knowledge; it is more dangerous than ignorance.
[George Bernard Shaw (1856-1950)]
For lust of knowing what should not be known,
We take the golden road to Samarkand.
[James Elroy Flecker (1884-1915), The Golden Journey To Samarkand]
It’s because someone knows something about it that we can’t talk about physics, it’s the things that nobody knows about that we can discuss. We can talk about the weather; we can talk about social problems; we can talk about psychology; we can talk about international finance … so it’s the subject that nobody knows anything about that we can all talk about!
[Richard Feynman (1918-88)]
… and at the very bottom, a world of caverns whose walls are black with soot, a world of cesspools and sloughs, a world of grubs and beasts, of eyeless beings who drag animal carcasses behind them, of demoniacal monsters with bodies of birds, swine and fish, of dried-out corpses and yellow-skinned skeletons arrayed in attitudes of the living, of forges manned by dazed Cyclopses in black leather aprons, their single eyes shielded by metal-rimmed blue glass, hammering their brazen masses into dazzling shields.
[Georges Perec, Life: A User’s Manual]
If you’ve ever tried counting yourself to sleep, it’s unlikely you did it using the square roots of sheep. The square root of a sheep is not something that seems to make much sense. You could, in theory, perform all sorts of arithmetical operations with them: add them, subtract them, multiply them. But it is hard to see why you would want to.
[Matthew Chalmers, “Reality Bits”, New Scientist, 25/01/2014]