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On the British National Health Service imbalance between lethargic diagnosis and really rather good actual treatment of serious medical conditions

Yesterday I sent out a mass email to a list of my nearest and dearest, as many of them whose names I could remember, telling them that, just before Christmas, I had been diagnosed with lung cancer, and you know, pass it on. I said how bad I thought it was, and it does indeed seem rather bad. And I said what they could all do to cheer me up. Basically, tell me and tell the world what a clever fellow I have been over the years, and what their favourite writings and activities of mine have been. This process is now well under way, and a very gratifying boost to my morale it has already been, morale when faced with cancer being, I surmise, a rather big deal, maybe even a life-saver. My thanks to all those who have already communicated with me along those lines, and long may that process continue.

I put the entire text of that email up at my personal blog, and should you now wish to, you can read it there.

What else to say? Many things, not least that this diagnosis has concentrated my mind wonderfully on what really matters to me. During the last few years, I have found myself writing more and more about trivia and esoterica, of the sort that intrigues me but lacks general appeal, at my various personal blogs, rather than trying to grab the world by the ears here at Samizdata. Although I promise nothing, I now feel that this is liable to change. My life now looks like being too short to be postponing the final bits of ear-grabbing that I now want to try to get done, before I depart. Famous last words are hard to contrive, but some rather more impressive ones than would have happened had I merely died suddenly now seem worth attempting.

I’ll make a start by writing about a phenomenon I have become very aware of during the last few days and weeks, which is the imbalance between the effectiveness of Britain’s National Health Service when it comes, on the one hand, to the diagnosis of a disease, and on the other hand, to the treating of it.

Basically, the NHS does the first very inefficiently and in particular very slowly. But, it does the second really rather well, often just as well or better than the private sector, and often with the exact same equipment and staff.

My understanding of this contrast may be distorted by the fact that I am now being treated, at the expense of the NHS, at London’s Royal Marsden Hospital in the Fulham Road, which has a global reputation for its cancer treatment. But, in not a few of the sympathetic emails I have received from friends and relatives, this same story has recurred, of slow and unsatisfactory NHS diagnosis, then followed by a vigorous, urgent and targetted response to the problem, once that problem was properly understood.

The email which explained this best came from my sister, who was an NHS General Practitioner for all of her working life until she retired.

The problem faced by the NHS in diagnosis is that the NHS is confronted on a daily basis with an ocean of complaints about aches, pains and general misfortunes which can be anything from very serious to hardly counting as real medical problems at all. NHS general practitioners provide a service which stretches all the way from trying to spot something like my lung cancer, to just lending a sympathetic ear to a person who is being tormented by her husband or children, or just generally feeling glum and run-down. The service is free at the point of use. If you are having a miserable life and could use some pills to take the worst of the sting out of that life, and if you would positively welcome waiting in the queue at the doctor’s, thereby enjoying a little moment of blessed relief from the disappointments or even torments of the rest of your life, well, you would visit your doctor, wouldn’t you?

The National Health Service doubles up as a sort of National Friendliness Service. At which point, how is the doctor supposed to decide who he or she should spend serious time with, in this vast and varied queue, and whom he or she should shove to the back of the queue? How is the doctor supposed to spot the serious medical cases, in among the vast throng of the merely unhappy and unfortunate? I’m not blaming these NHS doctors for their problem. They’re doing their best. It’s just that their best is liable not to be that good.

So it is that the NHS takes a huge amount of time to identify the serious cases, such as mine is. A pain in your pelvis, you say? Quite bad, you say? Well, I suppose you could have a test, towards the end of next month. Maybe an appointment with a bone doctor, in January? Would the 21st be convenient? Our budget is rather limited, as I am sure you realise, and time slots soon get taken.

Faced with this interminable process, while my aches and pains gradually got that little bit worse as the weeks went by, I eventually sought the informal help of medically expert friends. Who immediately advised me to go private to find out what the problem was. Sounds like it’s serious, they said. They recommended a trusted private sector GP, who talked my sufferings over with me on the phone within about one hour, and immediately steered me towards an esteemed colleague. I put myself in this colleague’s hands. I did not and still do not have any private medical insurance scheme. Nevertheless, for the price of a cheap second hand car, I then learned the bad news of what was happening to me in a matter of days. In no time at all, or so it now feels, I began to be treated at the Royal Marsden, for the immediate threat to my spine, which is just next to where the tumor is.

I soon realised that what I had paid for was not just a diagnostic expert, but also an advocate for me, within the NHS system. That advocate could lay out the evidence in front of the NHS. Look, this is serious. Treat this, and you won’t just be chucking money at nothing. You will be curing or at the very least seriously treating a serious condition.

I am not trying to make a partisan political point here. I know I know, NHS equals socialism, yah boo hiss. But I think the distinction is a bit more subtle than that. As I say, the serious treatment of serious conditions bit of the NHS seems, if my experience and that of other emailers to me in recent days is anything to go by, to work rather well.

I think the distinction concerns what in other contexts is referred to as “moral hazard”. It is one thing to exaggerate an ache or a pain in order to have a nice little conversation with a nice doctor and to get hold of a few prescription anti-depressants or some such thing, without having to part with any money you do not have because payday is not until tomorrow. But people don’t fake lung cancer merely to get the sympathetic attention of a doctor. I mean, how would you even do that?

I was persuaded by two dear friends in particular that there was almost certainly something or other seriously wrong with me, and I was willing and could afford to reinforce my question with a stash of quite serious cash. I bought my way to the front of the diagnosis queue, and I do not apologise for this one little bit. I bought my way past various merely unhappy and somewhat discomforted people, and well done me. I now have a fighting chance. It turned out that I did indeed need serious medical attention and I needed it fast. My one big regret now is that I did not start waving my money around sooner.

As I say, it was the way that this original surmise of mine was so strongly confirmed by the experiences of others that made me sure that this was something worth me writing about, at the internet outlet I have at my disposal that will reach the greatest number of potential readers. What I’m saying is: Learn from me about how to throw money, in particular, at the diagnosis stage of a potential illness. If your problem proves to be no big problem and is easily corrected, well, fine, you’ve checked it out. Panic over. But if it is a serious problem, chances are you don’t want to be wasting time, and if you have the money, you should spend it and save the time.

Another way of explaining this is to point out that testing for things like cancer can get decidedly expensive, if it is to be done well. Soon after consulting my private sector diagnostic expert, I had about three different tests, each of them costing well over a thousand quid each. It makes no sense to give tests like that to people who are merely unhappy with their lives and their lot in life, and are telling you they have a tummy ache merely to get a little bit of your attention.

Or to put it yet another way, I look forward fondly to the time when such tests get much, much cheaper. Cancer care itself, I have been learning, is massively better than it was even a few short years ago. Well, likewise and one day, I’d like to think that instead of spending half an hour on some unwieldy and expensive space age contraption at the Marsden, there will come a time when all those complaining of bodily misfortunes, however slight, can just step through a gadget no more complicated than an airport metal detector. If the hit rate for serious conditions is a mere one per two hundred, or some such number, well that’s fine. Cheap at the price.

And don’t get me started on Brunel, which is the Marsden’s even space-agier device which has been giving me my first doses of actual treatment. Brunel is really something.

Like I say, my treatment looks like it’s state-of-the-art.

If this blog post saves or merely prolongs just one life, then good. Mission more than accomplished. This has not been that important a posting, and I certainly claim no originality for it. I’m sure many others have noted the same things as I have just been noticing. But, maybe for just one reader or friend-of-a-reader, it just might be the straw, so to speak, that saves one human camel’s back, if you get my drift.

This posting has been written in some haste, hence its rather excessive length. Brevity tends to take longer, I find. Also, I dare say there’s the odd typo or two, which I will correct as and when I or anyone else spots them. But I am sure you understand my haste. I have lots more things I want to say here before I make my exit, and it looks now like I have far less time to waste than I had earlier been supposing.

45 comments to On the British National Health Service imbalance between lethargic diagnosis and really rather good actual treatment of serious medical conditions

  • […] Not much here today, what with yesterday’s dramas, but I have just ripped off a Samizdata piece, based on my recent medical experiences, entitled On the British National Health Service imbalance between lethargic diagnosis and really rather good …. […]

  • Suburbanbanshee

    The problem is that a lot of people in the UK apparently think that waving around money is wrong, and that being pushy about increasingly more serious health problems is wrong, and that it’s totally okay to die and only find out what was wrong with you in an autopsy, which will be carried out on your still-unburied body in a year or so. I don’t even know that many people in the UK, and yet at least three people I know have reacted this way to serious health problems, or the health problems of their parents or grandparents.

    The really horrifying one was when an acquaintance was coming to Boston as a guest at a science fiction convention, and happened to mention this mysterious thing going on with his parent or grandparent or whoever. And Boston is full of doctors and hospitals, and a lot of specialists belonged to this convention committee, so they offered to comp the family members’ airfare as well as the guy’s, and sponsor a little medical tourism, no problem. And they just wouldn’t. And of course the family member died before they got any serious testing by the NHS, and it was something that could have been treated pretty easily when the medical tourism was offered.

    I hate it. I don’t know how people can count themselves expendable like that. And now, under lockdown, I’ve seen a lot of US people doing that to themselves, and I hate it even worse.

  • Shlomo Maistre

    Brian – as a longtime Samizdata reader, I can say your writings have always struck me as charmingly direct, matter-of-fact, and affable. I am terribly sorry to hear of your diagnosis. I suspect that, if your writings are any indication, you are an extremely genuine person and great friend so you will have plenty of loving friends reaching out to you.

    I – a mere stranger – have always very much enjoyed learning from your writings over the years – both from the content as well as from the tone. And many more years ahead. G-d Speed.

  • APL

    Brian Micklethwait: “I look forward fondly to the time when such tests get much, much cheaper.”

    There is the possibility that these things aren’t already much cheaper as a result of the monopolistic and restrictive practices of the NHS.

    Anyway, very sorry to hear your news Brian. I hope and prey your NHS treatment is successful.

    It’s probably inappropriate, but the internet suggests panacur may have therapeutic effect on some cancers.

    Of course, no double blind randomised trials have been conducted.

  • Alex

    Very sorry to hear of your illness Brian. I have enjoyed your posts and photos and hope your treatment goes well.

  • Nick

    Dear Brian,

    Many thanks for your writings over the years. They have found their way over to Australia and have been much appreciated. A good GP is worth their weight in gold, and can be a better diagnostician than even the fanciest machines. The system they work in is a different matter and the NHS Blog Doctor, Dr Crippen, laid bare the failings of the NHS in regard to general practice at length before being cancelled. My personal thoughts, while not as well written as yours, are here http://bit.ly/2NlHz7a

    All the best for your upcoming treatment, medical science can work miracles in some cases and I hope you have all the luck you need. I look forward to your further posts.

  • Michael Jennings

    Having had experience of both the Australian and British medical systems, it is the British GP system and the system of referrals to specialists I find the most frustrating.

    In Australia you make an appointment to see a GP, see the GP the same day, see the GP, pay the bill and walk out. If there is a need for a referral to a specialist the doctor gives you a piece of paper, you call the specialist’s practice and make an appointment, you see the specialist and pay his/her bill on the way out. The government then reimburses you a majority of the fee. (Doctors often waive the copayment for patients who can’t afford it and there are also clinics in public hospitals for people who can’t afford it).

    In Britain you may have to wait weeks to see a GP. Once you do you can only see a specialist if you can convince the GP that there is a case for you to see a specialist, and the GP has a financial incentive to not make too many referrals. Then you spend time on a waiting list. Then a few months later you will see a specialist in a hospital clinic.

    From that point – at least in London teaching hospitals – the care will be world class. But getting to that point is a struggle. If you go to A&E (ER for Americans, Casualty for Australians) in an emergency you will get excellent hospital care right away. Emergency care is something else the NHS does well.

    Having medical friends is extremely useful, not because they can help you jump queues (they can’t) but because they understand the system. There are certain things that will get a GP to refer you if you say them, and medical friends will tell you what to say. But going to a GP consultation with a prepared script has its dangers too.

    Another thing that is interesting about the Australian system is that the amount of money that the government reimburses for a particular service (the “scheduled fee”) is fixed, but the total fee that the doctor charges is not. So the copayment (the difference between the two) is larger for the best doctors. Price signals thus exist. This is good. Also, the act of paying a bill when you leave the doctor’s surgery makes it clear about who the customer is – the patient rather than the government. Receptionists in Australian doctors surgeries are generally polite and friendly, whereas GP receptionists in Britain often behave like they received their customer service training in Smolensk in 1982.

  • Barry Sheridan

    Very bad news Brian, I sincerely hope you can conquer this dreaded disease. As for shame about spending money on getting to the head of the queue, there is definitely no need, it is necessary. Regrettably Britain will not levy a basic charge to see a GP, this would filter out some of those who really have no requirement to see a doctor.

    Keep positive, it helps.

  • Clovis Sangrail

    Brian, my very best wishes for a successful treatment.

  • First of all. Eff Cancer. Good luck with the treatment, here’s hoping it pays off.

    Second I admit to not always noticing which Samizdatista wrote which post but I can say that I have generally read and appreciated the ones of yours that I recall. I may even have linked to them here and there.

    Thirdly – regarding the NHS and private medicine – this article by my friend Tom Knighton is probably relevant: https://tomknighton.substack.com/p/thank-god-for-relatively-free-market

  • Natalie Solent (Essex)

    Brian, I am so sorry to learn this news. I will indeed try to find a way to say what a clever fellow you have been over the years, and what an interested and therefore interesting fellow, and what a humane and clear-thinking fellow, and what a fellow in the sense of friend. But so much of what I now believe came from a seed you planted that I am overwhelmed. Continuing the garden metaphor, I can’t say that this flower or that tree came from you because you have been planting and watering all the time. But I will tease out one thought. When I first came across your writings in the 1980s as a recovering socialist, what I absorbed from them was that respect for other people as equals means respecting their liberty. Not, as I had previously thought, doing them (my) good, but letting them find their own good. And your many posts simply expressing your delight in the fun things free people make and do were a joy.

  • Paul Marks

    I wish you a full and speedy recovery Sir.

    You have done great work for liberty over the years. I hope you are still here to do more work for liberty in the years to come.

  • John B

    The NHS is a cost centre. Unlike private, it cannot recover cost of what it produces, nor make a surplus/profit to reinvest and be an incentive for new investment. The more it does, the more its cost, the faster it uses its budget, the less it can do. Built in is do less, do things more slowly to eke out the budget. For private enterprise, the more it does, the more its revenue, the more it can do and expand. The incentive is increased patient throughput, attract more business. Quick diagnosis attracts more business, the exact opposite the NHS wants or indeed can handle. .

    All resources are scarce and must be rationed somehow. The options are: rationing by price, rationing by quota, rationing by wait list. The first is fairer because only those who really need it will pay the price, whereas ‘free’ attracts many who have no need and those who do don’t get it. That some may not be able to afford care in a private system (well we have charities) is the trade off for a better service for all. Little point in something being ‘free’ for the ubiquitous ‘poor’, if they can’t get it. And what is fair about dying from lack of treatment so everyone with trivial complaints can be seen, to serve a political imperative.

    (We can see this ethos now: anyone can suffer and die to ensure resources are free for CoVid cases, for the sake of politics.)

    The NHS rations by wait list, thereby pushing treatments down the line into the next budget period. Slow diagnosis is part of this. It offers the possibility that the patient will die (maybe of something else), go private or just put up with their condition.

    Those who think slow diagnosis is deliberate and thus the suggestion is cynical, might like to consider it is baked into NHS culture and operating procedure for decades, so it does not requires a conscious thought, it is just what is.

    It’s free, stop complaining, be grateful, do as we say,,, around this, NHS culture has evolved. It won’t change until it loses its non-contestable monopoly and people are given choice in a competitive market for health care insurance and provision.

  • John Lewis


    As an occasional poster but regular lurker I have enjoyed and appreciated your writings for many years.

    May I add my name to those wishing you all the best.

  • You’re a good and sensible writer, Brian. Keep at it.

    My cancer was very different in behavior to yours. I didn’t know anything was wrong, or even different, until suddenly OH MY GOD! Went in to the emergency room (at a hospital on my insurance network). They did all kinds of tests, including CAT and MRI scans, and made an immediate appointment for me with an oncologist. In two weeks, the damn thing was gone. The recovery was rough, but it’s been years now and nothing has come back. (I got regular CAT scans for five years to be sure.)

    As Michael Jennings says, if you start in the Emergency Room things happen much more rapidly. But you have to have an emergency first. You didn’t. I have no idea what would have happened, if the onset were gradual and I had to see my primary doctor — it depends on the doctor, I guess. Here in the USA you sometimes are able to choose the doctor. That can help a lot.

  • Snorri Godhi

    Brian: I am saddened. I am not much of a spokesperson, but i trust that i speak for all of us when i say that you must not give up hope. You owe it to us not to give up hope.

    Brian asks us to tell him you what a clever fellow he has been. I could honestly say that i have read all his posts with interest, but i feel the need to be more specific.

    I had meant to read Mancur Olson’s The Rise and Decline of Nations, but there are a lot of books that i mean to read. It was Brian’s praise of the book that pushed me to actually read it.

    I had never heard of Emmanuel Todd before Brian wrote about his ideas.

    I had seen the movie, Margin Call, and was favorably impressed, before Brian wrote a positive review of it; but i could not possibly have said what was impressive about it as well as Brian did.

    This is not much of a list, but it is meant only as a modest addition to what others will say. A less modest addition would not be sincere.

  • Paul Michaels

    Brian I was truly aghast to read your post this morning. I only met with you a few times, usually when I visited with Chris Tame, sadly another victim of this disease that stalks our species. I well remember you speaking out against some dumb statement made by Peregrine Worsthorne at a talk in London back in the 1970’s. While I don’t remember the exact words you used they must have hit target judging by the reaction of said Worsthorne, to say he was annoyed and without a reposte was obvious.
    My sincere hope is that you can overcome this, using any and all means within your reach, with my sincere best wishes…

  • Shlomo Maistre

    As Michael Jennings says, if you start in the Emergency Room things happen much more rapidly. But you have to have an emergency first. You didn’t.

    Interesting. Across the pond here in the USA, you can go to the emergency room for anything and they cannot turn you away. I suppose this is different in America than in the UK.

  • Myno

    I mostly lurk, but the lurking is especially fruitful on Samizdata, and Brian, your contributions have injected a needed human element that grounds us all in the individual consequences of liberty. Many thanks for your articles through the years, and best of fortune as you do battle. We’ll be looking forward to many more of your contributions to come.

  • Fraser Orr

    Brian I add to the other commenters here in letting you know how much I have enjoyed (and plan to enjoy) your writings here. I wish you all the best with your treatment, and I’d remind you that many things that ten years ago were considered a death sentence are now considered a manageable condition. I hope your disease is one such case.
    However, I think you were making a substantial and interesting point, but I wanted to add one thing that is important. I actually write software for medical devices including diagnostic equipment like the CT scanners and X Ray machines. There is a trade off in these machines between the harm they cause and the information they provide. For example, when XRaying a spine doctors would like to use a higher dose of radiation to get a clearer picture of what is going on, however, that radiation is, in itself, damaging. So there is a trade off between the two that is really nothing do do with money. So this does indeed exacerbate the point you make between delaying testing to save both money and the damage the test might do, verses the need for earlier testing to get treatment earlier.
    I wish you well in your future journey, and I am glad for you that you can be treated at such an excellent center for medicine.

  • staghounds

    Thank you for what you’ve done, now get well!

  • Behind Enemy Lines

    Best of luck, Brian, from someone who’s been reading and enjoying your work since near the beginning of Samizdata. I’ve learned from friends in recent years that cancer treatment has improved in every dimension. Beyond that, please allow me to repeat Paul Marks:

    Paul Marks
    December 30, 2020 at 1:49 pm

    I wish you a full and speedy recovery Sir.

    You have done great work for liberty over the years. I hope you are still here to do more work for liberty in the years to come.

  • Mr Ed

    Best wishes Brian, hoping that you pull through. I remember going to one of your Friday evening talks in the early 1990s and Paul Marks told me that one hand grenade in the room would have wiped out libertarianism in Britain. You have kept the flame alive and migrated it into the internet age, also adding a fascinating wider perspective on so many aspects of life.

    Just remember in your dealings with the NHS that the people treating you have certain duties, such as:

    13G Duty as to reducing inequalities

    The Board must, in the exercise of its functions, have regard to the need to—
    (a) reduce inequalities between patients with respect to their ability to access health services, and

    (b) reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.

    But they don’t have a specific duty to make you better. Around 20 years ago, my aged Estonian refugee neighbours were both in hospital, one of our neighbours was upset by how they were in different hospitals and insisted that she knew a consultant who could pull some strings to get them re-united, I immediately thought of ‘blat‘, the Soviet-era Russian word for influence or contacts in a bureaucratic system.

  • Really sorry to hear this, Brian.

  • Andy Janes

    Hi Brian.

    We met a few times at various Libertarian Alliance and Libertarian Home events in London over a decade ago. I have been reading Samizdata for nearly 20 years (though don’t comment much) and have always enjoyed your posts and insights.

    I’m very sorry to hear your news and hope you make a speedy recovery.


  • Robert

    Brian – I’m very sorry to hear this news, and hope you can make a recovery.

    I don’t know you well at all, but I’ve had the pleasure of meeting you and talking with you a few times at Simon’s Libertarian Home meetups at The Rose And Crown, The Two Chairmen, and various other pubs around London.

    One thing I admire about you is that you manage to combine your convictions with a fair minded appreciation of the complexity of the world. We see this in your post above, where you give a very fair account of the strengths and weakness of the NHS, but are also unapologetic about using private healthcare when it made sense. Too many people, of all political views, get this balance wrong, and either hold onto their convictions by taking an overly simplistic view of things, or acknowledge the compexity of the world, and use that as an excuse not to hold any firm views about it.

    As I said, I don’t know you well, and in the weeks and months ahead it will be those closest to you who will do all the work of helping and supporting you – I wish them and you all strength in the trial ahead. I’ll be in the crowd, one more voice cheering you on, and singing your name: “There’s only one Brian Micklethwait!”

  • Schrodinger's Dog


    I’m so sorry to hear of your diagnosis. My thoughts are with you and I am, of course, hoping for the best.

  • Christian Moon

    Thanks for writing this and everything else over the years, Brian. You will be in our prayers as you bear what you have to bear.

  • MadNumsimatist

    Been going through similar hoops since May for my prostate. Finally have an MRI booked for the end of January, but I have a feeling it will be cancelled. Basildon is a Covid designated hospital, if so, I am going private.

    Just searched and between £200 and £1,000. I would not have thought of it without this post. Thank you for sharing and advising, and hope to read many more your posts next year, and the years thereafter.

  • Surellin

    Best of luck, Brian. You are an inspiration in many ways, even here in Utterly-Anonymous-Town-In-Random-Midwestern-State, USA.

  • David Farrer

    Brian, I am so sorry to read this news. I recall the first time we met when Chris introduced you as the new assistant manager at the Alternative Bookshop. I would often come in and see you hunched over your little black and white Osborne computer. You assured me that computers were the future – I’d only just accepted that it was OK for men to operate typewriters… But the LA publications poured forth with you as publishing boss. By far the biggest LA expense was for paper, envelopes and postage.

    You and Chris would ask me to write something for the cause, but I refrained because I didn’t have a degree and all proper writers did! But “you’re earning more with your professional qualification than we graduates”, Chris would say. Eventually I signed up with the OU and got a First. That gave me so much pleasure and I’d never have undertaken the task had you and Chris not encouraged me to write. Years later I met Michael Gove and then James Naughtie at the Edinburgh International Book Festival and they were both readers of my Micklethwait-inspired scribblings. Make of that what you want! Another reader was Iain Macwhirter, political writer for the Glasgow Herald. I gave Iain a stash of LA publications and went on and on about the Austrian School. A few weeks later Iain was introducing the historian Niall Ferguson to a large audience at the Book Festival and spent the first ten minutes talking to him about Mises and Hayek!

    The EU was something you and other comrades went on and on about. We went to bed early last night – no Hogmanay this year – and just before eleven o’clock I woke up in time to hear the grandfather clock strike. I nudged Pam and told her that we’d left the European Union. I’ll be having a wee dram shortly.

    So, what I am saying is that your influence has spread far and wide. With a name like Micklethwait I’d guess that you are really a Viking. Tough fighting folk. Keep up the tradition.

  • Johnathan Pearce

    Brian, I am going to write a specific posting on Samizdata about the writings of yours I liked and the impact you have had on me personally. It was good to see you in person the other day – talking over the doorstep to be correct with these rules – and I detect there is a lot of fight in you yet.

    I think your analysis of the NHS referral process is spot-on. The NHS has the flaws of centralisation and its funding model, but there are many excellent people working in the system today. I have had my own troubles with a dodgy knee and the process of diagnosis and follow-up is exactly as you have described it. I intend to try and circumvent the bureaucracy how I can.

  • Brian, in your Normblog profile you observed:

    “My favourite bad idea, so to speak, is the belief that the truth is obvious. Believe that and you land in a heap of trouble. Just for starters, neither you nor anybody else have any excuse for not recognizing the truth at once, or for ever changing your mind about it. If you disagree with someone, you have to be right (because you have no excuse not to be) and they have to be evil (ditto). Mayhem.”

    You wrote this almost fourteen years ago. I don’t suppose a week goes by without my being reminded of it. Congratulations, and good luck.

  • iowaan

    i, too, am sorry for your trouble.

    Know that you have reached many more than you suspect, and that you have helped, or at least pointed in a better direction, many.

  • Quentin

    Best wishes for a speedy recovery.

  • Brian Micklethwait (London)

    From December 30th, through the 31st and into January 1st 2021, I suffered an internet and email outage. Luckily nobody seems to have feared that I might have snuffed it right there. But that did mean that my thanks for all these kind comments are somewhat belated. Although actually, waiting for the comments to stop before joining in does make sense.

    One of the best bits of advice I have had since my Announcement came from a much loved school friend, the father of my first GodDaughter. He is no libertarian, but he said: If you are asking others to tell you what you’ve done well, do the same for yourself. What do I think have been the central threads of how I have thought about things, and set about doing things? I hope I can manage something along exactly such lines.

    If I do manage such a thing, I am already sure that it will refer to what Peter Briffa, about three comments above this, was kind enough to quote me saying, about the badness of the idea that The Truth Is Obvious.

    I have not tended to regard myself as a particularly friendly sort of person, rather shouty if anything. I have had some very undignified yelling matches with people over the years, and I have always been very fond of the sound of my own voice. But I think you can see how being a good intellectual host, as I have tried to be with my libertarian meetings over the years, would have been a whole lot harder to make work if my background assumption was that, what with The Truth Being Obvious, I was obviously right about everything and all who saw things differently were equally obviously evil idiots. Because you see, these idiots were not just failing to see the Truth. They were deliberately turning their backs on it. There The Truth was, staring them in the face. They were ignoring, even denying it. That’s not just stupid, it’s evil.

    Try running an intellectual social event if that’s what you think of everybody else present.

    This Truth Is Obvious (I might want to add the word “always” to that) idea is seldom something that people explicitly spell out, in exactly such words. Rather do they think and feel and argue without ever examining that false assumption that they are unthinkingly assuming to be true.

    I associate this style of thinking in particular with the worse sort of Randians, the ones I think of as Rand-roids. I still wince at the memory of the colossal row I had with a Randian ex-friend, who triggered me, near to the end of one of my Friday meetings, at just the time when the evening should have been at its most convivial. I just lost it completely.

    Rand constantly referred to “evil” people who “refuse” to face facts. Well, sometimes that may be what’s happening. There definitely is such a thing as intellectual corruption, being wrong on purpose. But far more often it is just that someone else is seeing things differently to the way you do. Personally I think that “objectivism” is incoherent nonsense. But if you think otherwise, that makes neither of us evil. We merely disagree about the complicatedness and unobviousness of the world.

  • Snorri Godhi

    I would like to ask Brian — if he is not too busy — whether he is familiar with Popper’s essay that makes pretty much the same point about The Truth not being Obvious.

    I think that the essay is On the Sources of Knowledge and Ignorance, and that Popper used the word Evident instead of Obvious. At the moment, i cannot check.

    From what i heard, it seems that Popper did not follow his own advice in his personal life; and i must admit that i did not follow his advice even after reading his essay. I got better at it after reading Taleb: he made me realize that i do not need to be sure to be right to be confident that somebody else is wrong.

    Later, after reading Harry Frankfurt’s theory of Bullshit, i improved on that position: I do not need to be sure that i am right to be confident that somebody else is bullshitting. And that is important, because it helps me avoid being gaslighted. (And thus, the theory of gaslighting also comes into play.)

  • Snorri Godhi

    OK, I found Popper’s essay online, and the way he frames it is that it is wrong to assume that The Truth is Manifest.

  • Brian Micklethwait (London)


    I am not familiar with Popper’s essay, because it is literally decades since I read any Popper. But when I did, which was when I was a teenager, he was a major influence. I read him at Cambridge U when I was supposed to be studying architecture. Popper, Hayek, a seasoning of Mises, David Friedman. Bingo. That’s how libertarianism kicked in for me, or that’s how I now recall it. (The architecture was also part of that process.)

    And what is more, I am certain that what Popper said about this influenced me, and that I then made the idea my own, or thought I did. And then handed it on in my version to the likes of Peter Briffa. So yes, Popper was almost certainly the one who got me started thinking like this.

    I too have heard that Popper was something of a shouty dogmatist if you got up close and personal with him. But people who by temperament are inclined to this or that bad habit are not necessarily to be criticised for putting the notion that people generally need to do better than this, and to be very explicit about it.

    Advice is often very revealing, about the person giving it. My advice about what you should do in some particular circumstance could very well reflect the fact that if I am in that position, I need to be taking that particular bit of advice myself, whereas others would do the smart thing automatically and not need to obsess a bit about this or that principle that they should be carefully following. I think Popper dug deep into the mechanisms of intellectual toleration, at least partly because these habits of thought didn’t come all that naturally to him. He had to have that advice at the front of his own mind, when the argument was a really serious one and he needed to be at the top of his game. I think this does him credit. No he should not have been like that with family and friends, but at least in his intellectual work he said better than he did, and maybe even said it all the better because he was in some sense berating himself.

    I connect all this in my mind with how Popper emphasised that at the heart of civilisation lies the idea that we are not our ideas. We are not our opinions. You can respectfully criticise someone’s beliefs or ideas, without attacking them personally. I believe you are mistaken, rather than The Essence of Your Being Is Wicked Because Wrong. This was the kind of thing Popper said about the Ancient Greeks, was it not? They started this sort of intellectual civility, where your self is separated from your thoughts and opinions. The beginnings of science, in other words, that idea being foundational even as many other Ancient Greek ideas about science have been set aside.

    It would be very peculiar if someone like Popper, who put the procedures of science at the heart of his thinking, did think that the truth is obvious. You could almost define science as the study of that which is not a bit obvious, but which turns out to be true nevertheless. If it was all obvious, there’d no need for science. We could all just suck it up at a glance.

    I also connect, in my mind, this kind of thinking with the fact that both my father and my two grandfathers were trial lawyers, or Barristers as we Brits call such persons. Law court practice is all about the fact that, time and again, the truth may be quite different from what it at first seemed to be. And to get close to the truth, you need a couple of clever chaps like my grandads to argue about it (which I believe they actually did quite a few times), and explain why, although it sure looks like this miscreant did it and and should be incarcerated at once with no bullshit equivocation, actually, there just might be another way of looking at things.

  • Snorri Godhi

    Brian: I very much appreciate your reply.

    I am not familiar with Popper’s essay, because it is literally decades since I read any Popper. But when I did, which was when I was a teenager, he was a major influence. I read him at Cambridge U when I was supposed to be studying architecture.

    That reflects my own experience to some extent. I read The Logic of Scientific Discovery 3 times in my first year at university. But it did not impact my academic studies: it only impacted the time i could spend chasing skirts. Since i was awfully bad at the latter, it did not really matter.

    This also reminds me of a quote from David Hume that i found on wikipedia:

    while [my family] fanceyed I was poring over Voet and Vinnius, Cicero and Virgil were the Authors which I was secretly devouring.

  • Snorri Godhi

    Popper’s essay.
    With apologies for not linking to it earlier.

  • Brian Micklethwait (London)

    This is the the review I did, back in 2012, of Margin Call that SG was kind enough to mention in one of his earlier comments. I just re-read it. It stands up pretty well, I think.

  • I only want to say, get well soon Brian. I have lost too many friends this last year already and fear another very close one is soon to leave us. I’d rather you kept writing in your inimitable style for a very long time indeed.

  • Brian Micklethwait (London)

    Me too. Thanks Dale.

  • I will add my thanks to the many Brian has received. Some of Brians’s many posts I have praised, some I have disputed (what I could call my very first post here – actually posted by Natalie after a long talk we had – was a response to one of Brian’s posts), but I value the latter no less than the former, sometimes even more.

    Brian may or may not already know the story of how, long ago, when Natalie worked in the Private Finance Initiative of the UK Treasury, she was deputed to receive two visitors who had come to advocate some very mildly free-market/libertarian ideas. They arrived with a pamphlet authored by Brian. “Brian Micklethwaite?”, said Natalie, recalling a pamphlet they had not brought but she had read, “Is that the Brian Micklethwaite who wrote ‘In Defence of Mercenaries’?”

    Seeing the alarmed look on their faces, she hastened to assure them that this was no discommendation from her. The startled libertarians left with a (sadly, erroneous) impression of Brian’s fame among, and acceptability to, civil servants.