Why all medical advice is wrong

When I first wrote this post it was in a spirit of cynicism following panicked and incoherent responses to the COVID-19 epidemic. Now that the Chief Medical Officer has taken a hand, I see that has changed, and actual science and common sense are to prevail.

This is not enough for many commentators, who seem quite indignant that the best cure for a headache is to cut the patient’s head off and that anyone opposing that obvious course is either negligent or malicious.

I add these paragraphs, and the link below to the press conference, to acknowledge that in Britain at least there is now a sensible, principled response.

Why all medical advice is wrong, first draft:

In the individual case it is wrong –

  • Because doctors know that although the science is proven beyond doubt, the patient’s descriptions of himself and his symptoms are not.
  • Because diagnosis is an art, not just a science, relying on unreliable interlocutors and ambiguous signs;
  • Because patients do not speak in medical language;
  • Because a physician prescribes drugs but the body shapes its reaction around diet, and the two cannot be separated;
  • Because different metabolisms react in different ways;
  • Because patients do not follow to the letter the advise they are given.

Public legal advice is wrong –

  • Because it is given in general terms but the patients are individuals;
  • Because it cannot possibly say everything which should be said;
  • Because they don’t want to offend people who need to be offended on occasion for their own good;
  • Because overgeneralisation even unto dishonesty is the only way to get a message across to the public;
  • Because telling them everything would cause everyone to hide at home and no work would get done. Then we would all starve, which is unhealthy;
  • Because the alerts are written by civil servants, not medical experts.

My advice is wrong –

  • Because I am not a medical expert and am barely ever ill myself so don’t rely on anything I say; but at least I admit that.

I can be forgiven some cynicism. If you remember the MMR triple-vaccine scare, which still has not faded away, there was a lot of Public Health material to convince parents that the triple-jab is safe, as it is for most children. But I read the leaflets and also the background research papers and found discrepancies. I found out-and-out lies in the government material (no, the Danish study did not show that single jabs are identical in effect to the triple-jab as single jabs were not available in Denmark). The advice though was there to make a change in behaviour, not to tell the whole truth. That would be too complicated. The material was wrong but the conclusion was true, for most children.

Now we have the new Wuhan pneumonia, ‘COVID-19’, and the initial advice, before the experts on epidemics got hold of it, was not even coherent. That is unsurprising as the data is not available. There is a twofold thrust: to prevent the spread of the new disease by limiting the opportunities for infection, but also to stop panic and keep people going into work.

Thankfully, that has been taken in hand now in Britain, and practicality prevails in the new advice. It is not so abroad, where publicly pleasing panic measures seem to be preferred, defying the science and quite probably doing more harm than good.

Our own nation, being not so incontinently emotional, the panic buying is real in places, but mainly as a reaction to others emptying the shelves. That cannot last, as long as there are workers available to refill the shelves when the panic calms down. I hope.

A worrying thing is when a phrase becomes a buzzword, and that coming phrase is “self-isolation”. Now, in Italy we are told, everyone has gone home and stopped work (but these are Italians – will we even notice?) In Britain the dynamics are different. As the phase comes into the collective consciousness, it becomes a thing-to-do. Hang-on though: self-isolation is meant to be for those with a real risk of having been infected, not as a protection for that person but to stop him becoming a source of onward infection. Just going to bed for a fortnight and then emerging weakened into society ready to be infected is worse than useless. It may be hard to telling someone who has got it into their head that this is the thing to do. Until there is a proven vaccine, which will take months to develop as it is a living organism, the only way to stop yourself, ultimately, from being infected is to contract the disease and get through it, if you can survive it.

Let us pray that the reliable analyses are correct and that this is just another disease fatal to many but otherwise washing over the population like all the recent contagions, leaving a legacy of immunity in the population against future outbreaks. We shall see.

This is all meat to the Extinction Rebellion mob, who must be positively rejoicing at the idea that mankind is about to be wiped out as their prophetess has predicted. However getting people to stay in bed for weeks on end is not going to reduce the population – quite the contrary in fact.

Link to the press conference on 12 March 2020:

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Sir Humphrey’s logic

We used to swear by the Civil Service, and now we swear at it. Ministers must still work with their civil servants, but can they understand them? Just as importantly, can civil servants understand ministers?

It seems a unique relationship, but not quite. There are analogies. at least to how the relationship between minister and mandarin show work.

We have all seen Yes Minister, and those who have been in Whitehall testify that it is more of a documentary than we would hope. (The writers had a group of inside informants and much of what happened on screen was a reflection of what was actually happening, incredibly.) The world it portrays has senior civil servants confident that they are the actual government, the permanent class who go on, while politicians come and go and are at best an annoyance. That seems to be genuine too.

Be fair to them: the civil servants are professionals who are faced with amateurs. What is a professional to do? He is the one who knows how things work, who sits where and how they will react, and what happened last time, but in come the amateurs insisting they are in charge and wanting to change things without knowing how they are set up in the first place. Any action is taken in the knowledge that in a year or a week that bumbling amateur will be out and a new man will be in with different ideas, ready to unwind all the changes.

Reshuffles are bad enough, but when there is an election it may force a thorough-going change in direction and the put-upon mandarin will be called upon to reverse all the hard work done before. In that case, there is every motivation to hold back and ensure that anything done can be reversed. That does not sit well with the political thrust to radical change. Clashes are inevitable.

John Redwood wrote recently of how he helped Margaret Thatcher to get her reforms through a reluctant Civil Service and, if I read it correctly, the biggest factor of retardation was reluctance to release any powers of the state, and consequent loss of wonted control, which is why the 1980s privatisations were so painful to do, forced to go Act by Act instead of a single Privatisation Act.

In the recent years of political chaos and serial general elections, the impermanence of political direction was a reality and the Civil Service had to carry the ship of state on an even keel with little help.

In a democracy, the Civil Service cannot be autonomous and the two sides cannot work without each other. The relationship is like that of client and accountant or client and solicitor: the professional may be tempted to think that he can work without his client, but his whole purpose is to fulfil the client’s requirements.

If an entrepreneur goes to his solicitor and asks for something impossible or illegal, the solicitor is under a threefold duty; which firstly is to advise that the proposed course as described cannot be done. Some will stop at that point thinking their duty done, but it has not been. The second limb is to analyse the client’s actual requirement, the position he or she wants to reach, and find a way to achieve it which is possible and legal. The third is to get on and do it.

The accountant or the lawyer may know the intimate detail of his own field better than the client, but the purpose of his field is to serve his client, who knows his or her own needs better that the accountant will. Just as some accountants or lawyers think they have done their bit as gatekeepers by saying ‘no’ when it comes to a limit of the possible, so may some senior civil servants, but in both cases that is wrong: the mandarin’s duty is to understand the minister’s requirement and carry it out, maybe not in the way that is requested as that might be impractical or illegal, but to fulfil the actual requirement and motivation.

The Civil Service though is a monopoly and has all the bumbling inefficiencies of a monopoly. An entrepreneur can fall out with his accountant and go to another. Therefore each practice keeps itself efficient and provides tight service to keep its clients happy. Each firm too will watch what others do and imitate best practice, so that all are steadily improved. That does not happen in Whitehall: a minister cannot just ring a rival firm of mandarins to give a better quote or which has a more specialist practice. It would be better if they could.

In the meantime, we have a dynamic relationship of political and administrative spheres, which is not working well in all ministries, through misunderstandings, timidity and reluctance.

It does take a skilled professional to read his client’s mind and interpret what is the actual end to be reached, but that is the job. It is not meant to be easy, but if you can only handle easy, Sir Humphrey, you should not be there.

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What is less known is the reply Aetius sent

Aetius Dux britannis salutem:

I do not know which of you wrote that letter, but I send this reply in the earnest hope that you will insert it somewhere appropriate. A grex of disgruntled woad-dodgers looking to betray their own country is not going to impress me. I am not playing your game. In fact, I will copy this letter to King Vortigern and let him put you where you should be, which with the wild beasts is in the arena, if you still have those.

Forty years ago Britannia left the Empire, and things have changed a but since then. We have moved on even if some Romano-enthusiasts like you refuse to do so. Get with the rest of your nation, for goodness sake.

The last lot of Britons I saw called me a ‘Hun-loving Moesian bastard’, before I hanged them. Let’s be clear about this: we East Europeans work hard to do the jobs you lot turn you noses up at, and if we can slaughter Franks and Saxons, so can you, you lazy stulti.

You had your Britanniae exitus – we asked you three times to reconsider and three times you killed the magistrates sent to give you the protection of the iron boot of Rome on your necks. You have never been part of the Roman Project. You never stopped speaking Welsh and we never accepted any of you unwashed savages in our ranks.

Britain is finished, forever. Gaul, Raetia, Illyria, Moesia – these are the places with a future, but Britain post exitibus is nothing, and will never amount to anything. Your name will be forgotten.

As for your ‘groans’, this idea that the Saxons are going to take over your island and destroy you culture, well it sounds like the old Celtic Replacement conspiracy theory to me.

Now, the Picts – no one nose who there are these days. They’re not going anywhere.

The Scotti: I’ve advise you to let them in. They will pour south, so just let them take charge of everything important, leave them to it and they’ll get it running smoothly again. It’s only the ones left in the north you need to worry about, if they think they’re the only Scots on God’s green Earth. The Hibernii too: you know they have a coming-of-age ritual, that every youth reaching manhood has a bag packed ready to move to Britain. You’ll learn to love them, even if the favour is not returned.

And the Angles and Saxons swarming over the sea – they’ll never amount to much.

Tomorrow I have a battle to fight over at the Campis Catalaunicis, but after that, be assured that I will pay a great deal of attention to ignoring you.

Ualete et i in malam crucem.

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To Aetius thrice Consul, the groans of the Britons

Gildas, in the 6th century, tells us that a generation after Britain had left the Roman Empire, a plea was sent to Rome to return and rescue the Britons from incoming hordes:

“To Aetius thrice Consul, hear the groans of the Britons

The barbarians drive us to the sea, the sea drives us to the barbarians; between these two means of death, we are either killed or drowned.”

The Romans, however, could not assist them, and in the meantime the discomfited people, wandering in the woods, began to feel the effects of a severe famine, which compelled many of them without delay to yield themselves up to their cruel persecutors, to obtain subsistence.

Flavius Aetius was the senior general commanding in Gaul and Hispania, and the effective ruler of much of the Western Empire. Britannia had left the Empire long since and been abandoned. He did not respond.

Who wrote the letter he does not say. This was in about 450 AD, forty years after the legions had been expelled from Britannia. Aetius had other things on his mind at the time, such as suppressing numerous invasions and rebellions, and the little matter of confronting Atilla the Hun as he invaded Gaul with the largest invasion force in Roman history. The Britons only ever thought of their own position. How little things change.

What was this island, cut off from the Empire? It had been conquered as a public relations exercise by Claudius and while towns and roads and coloniae were built, much of Britannia remained a wild frontier for the three and half centuries of occupation. It was the one province of the West which never spoke Latin but kept its own language. It was the one province of the Roman Empire from which no native ever rose to become a leading general or magistrate. When the legions withdrew and the last Roman magistrates were expelled, the Celtic Iron Age seems to have resumed as if nothing had happened in the meantime.

It was a fertile land and one defended only by the soldiers of a distant Empire, and increasingly not even by Romans but auxiliaries, and when even these withdrew then there came other Britons, untamed Britons, and from across the sea came tribes of untamed Germany

Was this letter to Aetius written by a king or a faction? Gildas is unclear, but the wording he gives is in the style of an oration recounted by Tacitus, which is to say made up for effect. (Not that I would knock a Tacitus oration: Solitudinem fecerunt, pacem appelunt – brilliant) Nevertheless, whatever its words and from whomever it came, the letter was written, as a plea for Rome to ride to the rescue.

Perhaps it was the ultimate Remoaner moment. Are we to expect a faction of die-hard pro-Europeans to write, forty years hence, a similar letter to a leader of the European Empire, and what will they find?

The letter Gildas describes, the Groans of the Britons, was addressed to the closest commander of an empire dying as it stood. No answer came, but there was none in truth who could answer, for those who wrote the letter were appealing to the dream that was Rome, and no more than a dream. The Empire they called to was already dead.

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Where is the text, Boris?

A negotiation starts with a document. Whoever slams their document on the table first is winning all the way through, if he can just keep it on the table. That document is the basis of the agreement to come, and though it may be cut about, covered in red ink amendments, sworn at, had appendices nailed on and provisos enough to sink a trawler, it is the chassis on which the agreement is built. Its basic definitions are the pre-conceptions, the bones on which it grows, and its structure the structure of the deal.

Where is the text? The British text must be on the table in Brussels on Day 1.

Mrs May’s team were hopeless:  they just waited limply for the Europeans to suggest things and, as they had no ideas of their own, they had to go along with them.  We saw the result, and the House of Commons spewed it out of their mouths. This time it matters, as this time we are not looking at a year-long transition but a trade treaty which may last for generations.

Before the negotiating text there must be the Heads of Terms, and we have these in the form of the Political Declaration, which is why it is so important. The text must follow that framework and if it does so there can be no complaint of reneging on the deal.  We have seen the Europeans backsliding on their word already, trying to add into their position elements which were specifically removed from Mrs May’s surrender version of the political declaration.  They cannot be trusted to produce a text. However there is a wrinkle or two in that: more later.

The political declaration is very good: it is not comprehensive we can’t quite say ‘yeah, that’ and leave it to go no further, but it provides enough of a skeleton to build a very well-set body upon.

Long before we got to this stage the Brexit-bearing thinktanks had been working up to this moment, saying they have a text in embryo. Very well – let us slam that text on the table.

The pre-match sparring has been done, the taunts and feints. The teams are gathering. MI6 I hope has done what needs to be done as the other side have (but that idiot from the DGSE was too obvious, Monsieur). The places are set around the table (with the sun shining in the British delegation’s eyes in the afternoon and the wobbly chairs etc) but the meetings are on.

So where is our text?

The noise from Brussels and Paris should remind Whitehall of a few lessons learnt over the last forty years of negotiating with the European institutions, but which they incomprehensibly (and incompetently) seem to forget every time. Brussels haggles the way you should:  to win a cow they ask for the herd.  It is a British curse that our Foreign Office wallahs misunderstand and hand over the whole farm.  It is not to be wondered that the European politicians push at the envelope, beyond the terms of the Political Agreement, as they might just get away with it, and if not, bien, that is where you have to start. No one should be riled but they should understand this for what it is.

Even so, we need to get out text down first.

For one thing, our people will be better at writing a text. Anyone who has had the misfortune to have to wade through a European Union text will know how awful it is – long screeds of political preambles beginning “whereas” and then straight into jargon that begins to depart from commercial reality from page 1 (or, after those preambles, page 23).

The British delegations always had a reputation for common sense and plain speaking: deploy those now or we will be knee-deep in fluff searching for any substance. That indeed is how to hide the horrors: bury them in fluff. Fluff cannot be argued with but can be filled with Trojan horses, and eventually after wading through endless, meaningless words your counterpart starts agreeing things just to get rid of it, and that is where you win. It is unprincipled, timewasting, dishonest, thoroughly European, and devastatingly effective.

The British drafting technique is rather different: define your basic precepts, say what you mean and leave it at that. On such a structure there is no perch to add ambiguity and political blind-sides and it can all be wrapped up in a couple of months. I have done more complicated deals in less time.

It is traditional at this point to wish the team good luck, but it is not about luck. I hope that they will understand if my wish is more blunt: “Get on with it.”

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