Notes from the Panopticon

The Sharks and the Jets

The last few weeks have given an insight into the silly, testosterone-fuelled, adolescent nature of our political class. With the smell of an election in the wind, they spent the time braying at each other, calling each other chicken, and striking menacing poses.

Neither side felt particularly confident, so the poses were particularly nauseous and infantile. But they were not unusual. When will politicians grow up and behave in a way that earns respect instead of behaving like gangs of louts?

The press does not help – journalists stand about and egg the idiots on.

And we're supposed to take elections seriously.

MMR Vaccine: Truth and Consequences

All other knowledge is hurtful to him who has not honesty and good-nature ~ Michel Eyquem de Montaigne-Delecroix (1533–1592)

This article was prepared before the current measles outbreak was announced. It is even more relevant now.

The MMR (measles, mumps and rubella) vaccine has been routinely administered to most one-year-olds in the US since the early 1970s. It was widely introduced into the UK in 1988. Ten years later, in February 1998, thirteen doctors based at the Royal Free Hospital in Hampstead published a report in the Lancet, alleging that the vaccine was linked to the development of inflammatory bowel disease and autism. (The same research team had already suggested in 1995 that MMR was associated with Crohn's disease, although this claim had quietly been abandoned.) The new report was based on a finding that eight out of twelve children referred to the hospital had suffered from sudden onset of developmental disorders very soon after the administration of the vaccine.

The Guardian, at the time, stated that: "A medical study suggests today that there could be a link between the measles, mumps and rubella vaccine (MMR) given to children in their second year of life and inflammatory bowel disease and autism … They also found that the behavioural changes in the children which are typical of autism, such as forgetting the basic language they had just learned, began within days of their MMR vaccination".

Report discredited

The doctors' report was discredited by the investigative journalist, Brian Deer, who commented that: "even a superficial examination of the report revealed crude errors, inconsistencies and omissions which might properly have been challenged by the Lancet's editor". Instead of such careful scrutiny, The Royal Free Hospital was quick to promote the report through a press release, a video news release and a press conference.

Deer's investigation, published in a Sunday Times special report and a Channel 4 documentary programme, revealed that Dr Andrew Wakefield, who fronted the study, was receiving payments from Richard Barr, a solicitor who was trying to bring a case (financed by the British Legal Aid Fund) against the vaccine manufacturers. The children cited in the doctors' report, were in fact associated with Barr and his action.

Undermined confidence

The effects of the controversy were to undermine confidence and to drastically reduce the uptake of the MMR vaccination. Between 1995, when information began to appear suggesting that the MMR vaccine was implicated in bowel disorders, and 1998, when the paper was published alleging the link with autism, the uptake of the vaccine fell from 92% (close to the World Health Organisation's recommended level of 95% for the protection of a population) to 88%. It hovered at about this level until 2001 when the case was taken up by the media with a sustained attack on the vaccine.

By 2003, the level of uptake had fallen to around 80%. By then, 12% per year of young children had been put at risk by a scare which proved to be unsubstantiated. And it took until 2005 to bring the uptake rate back to 84%, which is better but still more than 10% below the World Health Organisation's recommended level.

Harm done to the nation's health

It is difficult to assess the harm which this has done to the nation's health.

The chart below, showing the incidence of the three diseases, looks dramatic; incautious journalists might jump to the conclusion that we are in the grip of a mumps epidemic caused by the MMR debacle. They would be wrong. The rise in mumps cases is mostly in the over-15 age group – a group who (as children) were too young to benefit from the introduction of MMR. This is the normal type of epidemic which occurs from time to time and which blanket vaccination is designed to prevent.

There has also been a smaller – but still significant – rise in cases in the under-15s, which probably did result from the MMR boycott. With an epidemic among teenagers and young adults (for whom MMR was not available), and with parents avoiding MMR, young children are being exposed to mumps with no protection against catching the disease.

The second chart shows the infection rates of the other diseases in a little more detail by cutting off the top of the graph and the mumps spike. It shows that there was very little effect on infection rates during the problem period. Epidemics come and go, and luckily there has been no significant outbreak of measles or rubella during the period, as there was with mumps. However, the low level of immunisation has put children and unimmunised adults at risk, in the same way that young adults are currently at risk of catching mumps.

Dangerous diseases

All three diseases are dangerous and can cause serious long term consequences:

• mumps can cause sterility
• rubella can cause birth defects in babies whose mothers are infected during pregnancy
• measles can cause death; in 2006 an uninoculated thirteen-year-old (with an underlying lung condition) was the first child to die of measles in the UK for 14 years

Children who missed out on the MMR are growing up vulnerable to these diseases. More than 3000 of them have already fallen victim to mumps.

So how did we get here and what can we learn? The government, faced with the problem of falling confidence, did not handle the situation well.

Loss of trust

The first and most serious problem was that it had lost the trust of the public. This is not a problem peculiar to the MMR crisis. But it does show how important it is for a government to show itself to be honest and open. Without trust, it cannot carry out its job properly. Here are some factors which led to this disintegration of trust:

• The handling of the BSE crisis by the previous Conservative government which undermined faith in official scientific advice.
• The disastrous strategy used in the 2001 foot-and-mouth outbreak which led to the closure of the countryside and pyres of burning carcases – how could people trust a government that let things get so out of hand?
• The failure to address the growing menace of hospital acquired infections – most people knew someone who was affected.
• The failure to demonstrate that the huge additional resources which were being poured into the NHS were making a difference – this had a disastrous effect on NHS staff morale and undermined public trust further.
• The style adopted by ministers and officials when questioned about their policies and actions; this had become mealy-mouthed and defensive.
• The failure of Tony Blair to say whether his son Leo had been given the MMR. This undermined confidence in government advice and was a particularly crass version of the "do what I say not what I do" attitude. Blair should have known better. He was a father of a young baby and was dealing with a public fearful for the health of their children and had been given a unique opportunity to demonstrate confidence in the advice of government scientists – an opportunity which he flunked.

Richer parents

In addition, faced with a potential public health disaster, the government failed to try an alternative strategy. Instead of insisting that it was MMR or nothing, they could have offered separate inoculations, an option chosen by many richer parents (including the Blairs? – a later leak suggested that Leo had been given the MMR but by then it was too late). Offering an alternative to MMR, with a carefully-reasoned explanation of why the government felt it was right to choose the three-in-one, would have been so much more reassuring than the "we know best approach" which put thousands of children at risk.

Of course the government were not the only culprits. The more drama-driven elements of the press were all too keen to spread doom-laden predictions over their front pages, to ferment fear and insecurity in their readers. And we must remember who started the whole debacle. Scientists who do not follow proper procedure undermine respect for all scientific research.

And so children were put at risk by a three pronged failure:

• Shoddy science
• A hysterical press
• A mistrusted government

Luck may run out

There is a risk that the whole can of worms will be reopened now that Dr Wakefield and two of his colleagues (Professor John Walker-Smith and Dr Simon Murch) face a hearing before the General Medical Council. They will be questioned about the conduct of the research that underpinned their report. Let us hope that lessons have been learnt and – equally importantly – that no efforts are made to reignite the fears. So far we have been lucky, with only a limited impact from reduced immunisation. Luck may run out.

The terrorist and the rubberneck

Neither a man nor a crowd nor a nation can be trusted to act humanely or to think sanely under the influence of a great fear." Bertrand Russell

Fight!

When I was at school and in the playground, it was amazing how – from time to time – there would be a sudden murmur which would grab everyone's attention. "Fight!" And suddenly, as if from nowhere, a great magnet would pull everyone into a milling circle around a couple of boys, inevitably boys, fighting.

The audience had no effect on the protagonists who continued to lay into each other. There was a buzz of excitement in the crowd and the noise level would rise. Eventually the teachers would turn up. They would push through the excited children who were jostling and straining to get a better view, grab hold of the combatants and pull them apart.

As they fought their way into the centre, they would try to disperse the crowd with fatuous injunctions. "Off you go, there's nothing to see here". Clearly there was something to see. Why else would we be there?

These sorts of remarks are also made by the police trying to clear bystanders or control crowds when there has been an accident or a fire or someone is taken ill in the street.

Magnetic effect sells newspapers

It is the magnetic effect of these occurrences that sells newspapers and glues us to our television screens: terrorist events, natural disasters, major accidents, abductions, wars. The effect is visceral.

No doubt there is a psychological explanation for the power of the reaction. We slow down to see what we can of an accident on the motorway. We are drawn to the crowds of a football match; we have to see the latest film; and when true drama unfolds we are sucked in to the spectacle. The instinct to join in, to be part of the crowd, is the same in all these examples and television, in particular, ensures we can indulge our ghoulish tastes.

Ruthless exploitation of raw feelings

This instinct is used to manipulate us and is the raison d'être of news coverage in all media. And because media empires enrich themselves by feeding this appetite, they are only secure when they have enough material to excite their audience. They are driven by the imperative of maintaining income. And they are ruthless in exploiting our raw feelings in order to do so. Because of this, they distort reality.

Multiple deaths in a spectacular train wreck or air crash are therefore more exciting than the 3,201 deaths and 28,954 injuries sustained in a typical year on British roads. This is almost 62 deaths a week, 9 deaths every single day. Compare this with an average of 23 rail passenger deaths per year over the last 12 years. In terms of passenger miles travelled, the rate of death on the roads is about eight times as high as on rail. But train crashes grab the headlines and our attention.

Thrill factor

The thrill factor would not matter so much if it did not damage the political process. The government has its agenda distorted by the barrage of attention focused by the media and is tempted to legislate by knee-jerk reaction. Even if it avoids this trap, it invariably wastes millions of pounds on public enquiries.

These usually end in a whitewash, or in vague conclusions, or they are simply ignored because the moment has passed. At the same time, MPs are diverted from screening legislation on less flashy subjects as they too are sucked into the media driven frenzy. As a result, less than satisfactory legislation goes through without sufficient scrutiny.

The government, anxious to wrest back control of the agenda, attempts to manipulate the news itself. This process – that takes up an increasing part of its time and attention – has come to be known as spin.

As a result of spin, perspective is lost, priorities are distorted and the government loses our respect.

Terrorist atrocities

So far, I have used everyday examples to make my point. But things get even more out of hand when there is threat of war or terrorism.

On 9 September 2001, when terrorists flew planes into the twin towers, the Pentagon, and attempted to attack another location just over 3000 people died. In the same year, the number of people who died on US roads was 42,196. The 9/11 death toll represented just three and a half weeks of road casualties. It also compares with an average of 2000 general aviation deaths each year in the USA in the 1990s. And, interestingly, ten times as many American die from gunfire each and every year (almost 30,000).

But the drama and newsworthiness of 9/11 cannot be denied. Rubbernecking went into overstretch. Not only that, but it was easy for politicians and the media to stimulate fear in the population.

In response to the attacks of 9/11, the US embarked on two wars. So far in Iraq it has lost 3400 soldiers and in Afghanistan 319. So the cost of this response in American lives has now surpassed the number of people killed in the attacks. In terms of money the cost of the 9/11 events was calculated at $27 billion (loss of life, property etc. etc.). The financial cost of the response in the Iraq war alone passed $378 billion in March 2007.

At least 63,000 deaths

Perspective and priorities go out of the window when policy is built on a visceral reaction to a dramatic event. If we add a minimum estimate of the number of Iraqis killed (60,000 is the lowest estimate – other estimates, also from reputable sources, put the figure in the hundreds of thousands), the numbers become stark:

• terrorist action: 3000 deaths,
• American reaction: 63,000 deaths (minimum estimate)

This represents a factor of over 20:1. But it is not an exceptional ratio. Between 1968 and 1981, Palestinian terrorists killed 284 Israeli civilians. Yet between 1968 and 1975 (a shorter period), Israeli retaliation killed 3500 Arab civilians in Lebanon, Jordan and Syria (a factor of over 12:1). And the vast majority of these casualties, on both sides, were bystanders. Civilians not combatants. People like you and me.

Add to this the huge cost of mounting the war and the terrifying instability that has been exacerbated in the Middle East. Then think back to the event that started the ball rolling – the initial 3000 deaths on the East Coast of the USA. Just one tenth of the number of deaths from gunfire tolerated each year. We can now see how effective the hijacking was; how our rubbernecking helps the terrorist to do his work.

Puppets in the White House

It was child's play for the designers of the 9/11 attacks to pull the strings of their puppets in the White House. With minimal expenditure of their own resources (a US commission estimated that the cost to the terrorists of mounting the 9/11 project was half a million dollars, one 756,000th of the cost of the Iraq war so far), the terrorists have created a mayhem from which only they and their allies have benefited. They have finally achieved what they have been trying to accomplish for so long: open civil war in the Middle East. And they could not have done it without the help of George Bush.

Perhaps it would have been better if our teachers were right, if they had been able to persuade us, as kids in the playground, that there was nothing to see. Perhaps we should wean ourselves off acting on gut instinct when something dramatic happens. We pay a high price to feed our addiction to real-life drama.

Image credits:

farm.tucows.com/_archives/2005/12/9/

images.twiet.nl/world_trade_center.php

Campbell on TV

Where men are the most sure and arrogant, they are commonly the most mistaken ~ David Hume (1711-1776)

In the television version of his diaries, Alistair Campbell revealed far more than he intended. The three things that I took away from the programmes were:

• Campbell is a vain and deeply disturbed individual who should never have been entrusted with such power
• Tony Blair's poverty of judgement in picking his friends places Campbell in the company of other star choices (Bush, Berlusconi, Blunkett, Mandelson, as well as Cherie's indispensable confidente, Carole Caplin)
• A large part of Labour's (and Blair's) failure to engage the public in positive aspects of its policy agenda was because of Campbell's paranoia and exclusive focus on danger.

His strategy wreaked havoc because, instead of deflecting attention and cooling the impact of events, his actions poured petrol on the flames. His uncontrolled ill-temper and contempt for those who opposed his views enraged his victims who, in turn, sought every opportunity for revenge.

A telling moment was when he showed sympathy for John Prescott and the notorious egg/punch incident. Clearly, Campbell would have done the same, but more restraint is required of a Deputy Prime Minister or Chief Press Secretary.

The culmination of Campbell's career was his involvement in the dodgy dossier, the Gilligan incident, the death of Dr David Kelly, and the Hutton Inquiry fiasco. Campbell had drawn his friend Blair into territory where it was impossible for him to win. Whatever Blair said, whatever he did, he would not be believed. Campbell was his Svengali and he wrecked any moral authority Blair might have had.

The style of the diary is self-serving and pathetic, as shown by the empty note of sympathy for Dr Kelly's widow. But Blair chose to listen to him and, even after Campbell resigned, said that he would telephone him every single day. Campbell was his crutch, so indispensable that Blair insisted that he attend cabinet meetings. He needed Campbell in the same way that Cherie needed Caplin. Hole in the head comes to mind.

Blair and Campbell were a double act, although it is difficult to decide which was Laurel and which was Hardy. It is easy to imagine Campbell muttering "another fine mess you've got me into", but it was Campbell who sexed up the dossier (whatever Hutton concluded). Neither man had the innocent charm of Laurel and both shared the self-importance of Hardy. Their performance would have been comic if it had not been tragic.

Campbell's role in politics was a sorry episode which did much to undermine trust in public life, and in the men and women who populate that world. A sad story of a talented but flawed man, driven by a need to succeed in achieving narrow goals, diminished by an uncontrollable urge always to be right.

Picture credit:

www.weirdwildrealm.com/f-laurel-hardy.html 

The art of the blog: a reply to Polly Toynbee’s article in The Author based on her Bagehot Lecture

…it behoveth him to have a vigilant eye to the proceedings of great princes, and to consider seriously of their designs ~ Sir Walter Raleigh (1554 –1618)

Before I started to publish this blog, I asked a friend for comments. She was very upset by what she read, believing it to be carping and critical. I took her comments to heart and have softened my tone and moderated my language. At the same time, she berated me for not voting because she believes that voting is the right way to take part in the democratic process. My opinion of political parties, however, is unchanged. Based on their behaviour and their attitude to the electorate, my feeling remains – a plague on all your houses.

Instinctive sympathy for the political process

My friend directed me to an article in The Author magazine by Polly Toynbee, "The art of the column", which I read with interest. Toynbee offers two golden rules for columnists:

• "If you are going to try to explain the world of politics to the world outside you need to have a strong instinctive sympathy for the political process and for the politicians who face the very difficult task of getting anything done"
• Spend … "a good long time as a reporter first … both a general reporter and a specialist in some particular subject … for politics is not about the miasma of Westminster … it is about policy and the real world."

Attack on the blogosphere

Toynbee's attack is on colleagues who are "overtly and strongly opinionated" and on the "alternative Rory Bremner voice (that) has become mainstream". She says there is a risk that the style of the blogosphere, its "unmediated sound and fury" coming from "unknown sources with unknown intentions", is "forcing conventional columnists to shout louder, to take up contrarian postures for the sake of it."

Towards the end of the article, she provides some good advice, referring to "the skill of crafting a column with a beginning, a middle and an end, a coherent argument, at least three facts that readers won't know, and information gleaned from talking to the leading players in the case."

Once you have gutted what Polly Toynbee is saying, it comes down to "clear off you amateurs and leave the job to us professionals, you contaminate us". And maybe she has a point. Tony Blair was an amateur when he leapt straight into the job of Prime Minister – and look how we, and more tragically the people of Iraq, have paid the price. This is despite the fact that Blair was ably assisted by Alistair Campbell, a professional journalist who had passed through Polly Toynbee's career development mill. Yet it was only at the end of Blair's career that one glimpsed how much he had done for Northern Ireland and how admired he was in Sierra Leone. With a professional journalist at his side, how did he fail focus public attention on these not inconsiderable successes?

Two objections

I have two greater objections to Polly Toynbee's position:

• First, she turns inclusion in the cosy, inward-looking, elitist world that is professional politics into a virtue for the columnist. How would she cope if the BNP, UKIP or an extreme Islamic party became mainstream? (Not out of the question – let us never forget how quickly the Nazi Party took power in Germany in the 1930s).
• Second, she places emphasis on the moderating effect of working for a newspaper, its editor and its publisher . My thoughts may come from an "unknown source", but I can assure her that I have never worked for Robert Maxwell, Conrad Black or Rupert Murdoch.

On one point I must agree with her – "… if you fail to be entertaining no-one will read you. It takes bravado to go out there and tell the world what you think." Finding readers is many, many times harder in the blogosphere. The blogger does not have the benefit of passing traffic as Toynbee does from the comfort of her newspaper column.

But even without readers, I benefit from the process of writing. With its discipline, I clear my thinking and there is always the faint chance that some passer-by may read and be interested in what I say. I have no illusions.

Incandescent fury

My original motive for starting to blog was an incandescent fury at having to live in a country led by the shallow and inconsequential Tony Blair, whose mindless actions led to the deaths of tens of thousands in Iraq and the erosion of civil liberties and the right to free speech at home. Only fundamental constitutional reform will protect us from another leader of his ilk: simultaneously besotted by his own convictions and propelled into knee-jerk policy-making by a hysterical and hostile press. I am heartened that Gordon Brown sees a need for constitutional reform and I now watch and wait for a better future.

Smell of competence

Polly Toynbee's article, and my friend's original criticism, have made me focus on what I can bring to the party. I want to do better than Richard Littlejohn who sees his job as "sitting at the back and throwing bottles". I try to look at what people do and not at what they say. For example, my wife and I have often argued about the merits of Gordon Brown. Whatever criticism was made against him, I was unable to get away from the fact that he has run the economy much better than any Chancellor in the twentieth century. He just smells of competence. His first days as prime minister feel right too. I will not make a firm judgement until the honeymoon period is over – I am only too well aware that politicians are masters of the finesse. I could not care less about his performance in Prime Minister's question time. For the moment he is making the right noises. If he follows through with liberating policies, with opportunities for better, freer lives, and if he doesn't view the public as potential criminals who need to be watched or as children unable to look after themselves or to make their own choices, I shall breathe a sigh of relief.

I am however, cautious about his reputation for bullying, autocracy and bad temper. But again, his willingness to give up power, first to the Bank of England and now to the Commons, belies this reputation. And if his bad temper was the result of watching the moronic antics of the Blair/Campbell double act, I am inclined to sympathise.

Unnoticed in the stalls

I find I have digressed but hope the diversion has strengthened my defence of blogging. I have one big advantage over Ms Toynbee and other political columnists – I am sitting here and watching from MY vantage point. I might not have a front row seat, but from up here in the gods I occasionally spot things – juxtapositions of actors, things happening off stage – that may go unnoticed in the stalls.

One more point: in democracy, no-one is an amateur. We all pay our taxes or receive our benefits, we all have a right to vote (or in my case not to vote), and we can all have our say, despite Blair's efforts to stifle free speech. The internet has yet to settle but it has the potential to be massively democratising, to become a moderator of the power of the cosy elite to which Ms Toynbee is privileged and proud to belong.

And finally, to show that I have been paying attention, here are three facts that are not well known. In the 2005 general election:

• For every 96,482 votes, the Liberal Democrats won one seat
• For every 44,306 votes, the Conservatives won one seat
• For every 26,031 votes, Labour won one seat

So what is there to sympathise with? To my mind, these figures – alongside other weaknesses – seriously undermine the legitimacy of the political process.

I have slipped in a few harsh words here and there to satisfy Ms Toynbee's prejudice against bloggers.

Picture credits:

www.safecom.org.au/lawrence03.htm

www.lboro.ac.uk/.../pages/07-commending.html