We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.

Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]

A heretic speaks

Madeline Grant of the Institute of Economic Affairs has a guest spot in the Times. Presumably when they invited her they had an inkling of what sort of guest she would be. You really ought to buy a copy of the Times or electronic equivalent to read the whole article, but I hope that the following excerpts will give the general picture. She is metaphorically sitting with her boots on the coffee table, fag in one hand, her host’s vintage port in the other, keeping the party both appalled and entertained:

Let’s stop kidding ourselves about the NHS

… our public services are on track to become a Leviathan health provider, with only a few other minor functions attached. You might argue that this cycle of increased spending simply reflects Britain’s ageing population, but it hides some growing dangers.

Voltaire quipped in the 18th century that “where some states possess an army, the Prussian Army possesses a state”. Like Prussian military might, the NHS has embedded itself in our national psyche, consistently topping opinion polls of Britain’s best-loved institutions. Its cult status is spread on social media by people sharing personal tales and using hashtags such as #TheNHSsavedmylife, as if a publicly-funded service doing its job was somehow remarkable. Then there was the bizarre worship of the NHS at the 2012 London Olympics opening ceremony. Foreign visitors here, often with far superior health systems at home, regard our NHS mania with bemusement.

We could learn a lot from other countries. Australia offers free health cover for everyone but encourages citizens to top up these costs wherever possible. Most Australians are covered for all in-patient care and about three-quarters of GP care. The majority buy “top-up” insurance to meet the shortfall, while the state subsidises insurance premiums. Though public spending on health accounts for 9.3 per cent of Australian GDP compared to Britain’s 9.8 per cent, it outperforms us on almost every measure, including, most importantly, patient outcomes.

Sadly, given our worship of the NHS, it will be politically difficult to incorporate cost-sharing elements. But let’s at least admit that our centralised model is an international outlier and not, as is often claimed, the “envy of the world”. Even in Sweden, which the left regards as a socialist Valhalla, personal spending accounts for 16 per cent of total health expenditure, compared with 9 per cent in Britain.

Increased funding for the NHS must go hand in hand with reform of a system which favours bureaucrats over frontline staff. Despite a growing shortage of nurses, the number of managers on the payroll had risen by almost a quarter in four years. Our health service lags behind others in the uptake of new technologies — a report last year revealed it was “the world’s largest purchaser of fax machines”.

There are facts and figures a-plenty in the article, but long after they are forgotten I will remember that line about the fax machines. Sometimes a single dramatic example that encapsulates an issue can do more to change opinion than a page of statistics.

Yet another medical serial killer

Niels Högel: German ex-nurse admits killing 100 patients

A hundred victims, and it is not even the BBC’s top story.

Towards the end of the last century I visited a very nice elderly couple, the husband of whom was a retired doctor. I noticed a flyer or newsletter sitting on their kitchen table with a heading something like “Doctors against gun violence”. At that time Dr Harold Shipman had fairly recently been arrested and the sheer number of his victims – more than two hundred – was beginning to emerge. I could not help thinking that, given that the number of people Shipman had killed by medical means exceeded by a great margin the death toll of the two largest shooting mass murders that had then occurred in the UK, Dunblane and Hungerford, maybe there was scope for a rival pamphlet called “Gun owners against medical violence”. The thought remained unspoken, of course, and a good thing too. I was not usually so flippant about mass murder even in thought: after the Dunblane massacre of primary schoolchildren I had thought about Thomas Hamilton’s victims almost every day for two years or more. Shipman’s victims did not haunt me to nearly the same extent. The same seems true of the general public. No doubt much of that was because Shipman killed the old not the young. It is not that people do not care about elderly victims, but the instinct to protect children and thus to consider the murder of a child the worst of crimes is bred in the bone. But that does not entirely explain it. Another British medical serial killer, the nurse Beverley Allitt, did target babies and children, by giving them overdoses of insulin and potassium. She murdered four children between the ages of seven weeks and eleven years and attempted to murder several others. One of those she failed to kill, Katie Phillips, was left permanently brain damaged by her attentions. This was after Katie’s twin sister Becky had already been murdered by Allitt. Yet her deeds seem almost forgotten now.

Maybe it is time for that long unspoken thought to get an airing, and for better reasons than to keep score in competitive shroud-waving. I have come away from Wikipedia shocked at how many such“angels of death” there have been, how long they have got away with it, and how high their number of victims has been. Almost more chilling than the death counts is their uncertainty: Donald Harvey, United States, 57-87. Arnfinn Nesset, Norway, 27-138+. Charles Cullen, United States 35-400+. There are plenty more on that list. And it can be practically certain that there are yet more who appear on no list, because they are still killing now.

Justin Trudeau’s finest hour

It wouldn’t kill us to give credit where credit’s due:

Canada becomes second country to legalise recreational cannabis, reports the BBC.

I expect crime to fall – and the sky not to.

I also expect that some Canadians have already got over-excited and done some stupid things over the last couple of days, and more will follow.

One of the many bad effects of prohibition of cannabis and related drugs was that it led users to wrongly deduce that because these substances are not nearly as harmful as was claimed in order to justify the ban on them, then they must not be harmful at all. One of the saddest experiences of my stint as a teacher was to watch a colleague use soft drugs to slowly paddle himself towards dementia in his mid-thirties.

Prohibition of drugs did not stop him getting them, did it? When something does not work it is good to stop doing it as America did in 1933 and Canada has now. Let us rejoice at an outburst of sanity.

Edit and save?

While we follow the soap operas at Westminster, Brussels and Washington other things happen in the world. Some of them will have effects that may still reverberate when the names “May” or “Merkel” or “Trump” have become no more than answers to pub quiz questions. Harry Phibbs, writing in CapX, has depressing news:

Anti-scientific EU rules are hindering work to save millions of lives

Let us consider another EU imposition. It is a rule that inhibits our contribution to the fight against malaria. According to UNICEF this disease is “the largest killer of children” on the planet. That agency estimates that malaria kills one child every 30 seconds, about a million a year. Most of those children are under five years of age, with 90 per cent of cases occurring in sub-Saharan Africa. Research suggests that while the number of deaths has fallen since 2010, in the last couple of years progress has stalled.

The good news is that a gene editing application has been developed which could eradicate malaria. It is called CRISPR — Clustered Regularly Interspaced Short Palindromic Repeats — and is considered “cheaper, faster, and less error-prone than any gene editing technology that came before it”. It could help preserve endangered species, improve welfare for farm animals — and save the lives of millions of children. The idea is to make mosquitoes immune to the disease.

But

In July, the BBC reported that the “European Court of Justice ruled that altering living things using the relatively new technique of genome editing counts as genetic engineering.” It added that “scientists who work in the areas of gene editing and genetic modification warned that the ruling would hold back cutting-edge research and innovation.”

Denis Murphy, professor of biotechnology at the University of South Wales, said the EU rules would “potentially impose highly onerous burdens on the use of genome editing both in agriculture and even in medicine, where the method has recently shown great promise for improving human health and well being.”

I must be honest here. As I read that article, mixed in with the genuine sadness and anger I felt about the way the EU’s restrictions look likely to hinder the development of a technique that could have alleviated large amounts of human suffering, I also felt a certain ignoble exhilaration. The European Union is being as bad as I always said it was. I had found a devastating answer to “Name me one bad thing the EU does, then!” It is possible that partisan passion is blinding me to the good reasons the ECJ might have had for caution. Ecosystems are complicated. Messing about with them has a habit of going wrong. Think of the introduction of rabbits to Australia or Mao’s attempt to eradicate sparrows from China.

One of the skipped-over paragraphs from Mr Phibbs’ article that I covered with the word “But” is this one:

“The team began with just two edited males, designated mosquitoes 10.1 and 10.2, into which the drive was inserted. After two generations of cross-breeding with hundreds of wild-type mosquitoes — and in mosquitoes, two generations can pass in less than a month — they produced 3,894 third-generation mosquitoes, of which 3,869 (99.5 percent) had the resistance gene. Just two mosquitoes were able to spread the trait to thousands of progeny — and malaria resistance along with it.”

The speed of that geometric progression scares me. Once started, the spread of these gene-edited mosquitoes could not be easily reversed.

But maybe it does not scare you, and you know more of genome editing than I do. My knowledge of biology is that of an attentive reader of pop science. Can any of you tell me more about this subject? Is the EU being as bad as I always said it was?

When the pot is boiling over, try turning down the heat

I am told that one of the ways Libertarians irritate normal people is by their attitude that there is a simple answer for so many of the political dilemmas that vex society.

Suck it up, normies, there is. There is certainly a simple answer for the political dilemma about which the Times is asking in this Readers’ poll: “Should everyone who identifies as female have access to women-only spaces?” The rubric says,

The government is consulting on a reform of the Gender Recognition Act. Currently the law allows people to gain legal recognition for a change of gender, but some transgender groups say the process is bureaucratic and intrusive and are pushing for a change that will allow anyone to freely choose their gender.

This is opposed by a number of women’s rights groups, which say the change would give men access to female-only spaces such as lavatories and changing rooms, putting women in danger.

The equalities minister, Penny Mordaunt, will consider whether to reform the law after the consultation ends on October 19 — but as The Sunday Times reports, many Conservative MPs are opposed to any change.

What’s your view?

You doubtless want to hear the result of the poll. I will tell you by and by, but for now I will exercise my freedom to irritate, and reiterate that the simple answer to the political dilemma is to take politics, in the sense of laws voted into existence by MPs like Penny Mordaunt and then enforced by the police and the Equalities Commission and suchlike, entirely out of the equation. Freedom of association for all! But what about bad people? What about Nazis? Yes, them too. If Nazis own or legitimately hire a space to do their Nazi stuff in, leave them to it. Don’t want to hire your hall to Nazis? Then don’t. Want to boycott any premises that lets Nazis in – or any that keeps Nazis out? Then do so.

Between groups of people who are not bad but among whom there are differences of opinion, try negotiation. It doesn’t have to be a million separate negotiations for every individual village hall or public lavatory, or for every women’s sporting competition or Brownie pack; there are such things as organisations and organisational policies. Not that there is anything wrong with having a great many separate local deals. This is called “subsidarity”.

Many fear that this radical strategy would give free rein to the worst instincts of the people. I don’t get it. To get into the habit of settling disputes by meeting the other party and peacefully trying to reach a compromise sounds a great deal more likely to give free rein to the best instincts of the people. Humans are nicer when not being threatened. Conversely when they suspect that in their relations with another group that, as the saying goes, “if you give them an inch they’ll take a mile” – then they won’t give an inch.

The other day I read this post from Econlog entitled “Tradeoffs Between Immigration and Reduced Freedom of Association”. Key quote:

The more that people’s freedom not to associate with others is reined in, especially when those others are people of different races, the less likely they are to favor immigration and, even if they never favored immigration, the more likely they are to be outspoken opponents of immigration.

Race is not the only category this applies to. Have you noticed how people who five years ago would have thought a transwoman was a lady from Transylvania now see transsexuals and/or transgender people as a threat? Have you also noticed how discussion of this issue is another pot beginning to boil over to use the metaphor of my earlier post. So far the lid is being held down. One word out of place on this topic can get you into trouble. But the pressure keeps rattling the pot, with jets of steam coming from such unlikely members of the Vast Right Wing Conspiracy as users of Mumsnet, members of the Labour party and Lesbians at a Pride march.

I voted “No” in that Times poll. As so often with me and polls I did not agree with the premises of the question. Other people freely choosing the gender is none of my business. I do not support or oppose a change in the criteria for legal recognition for a change of gender; I support tearing up all the laws on this subject and setting them on fire. Still my answer to the question “Should everyone who identifies as female have access to women-only spaces?” was closer to “No” than “Yes”.

5,068 votes have been cast so far in the poll. 97% of them were “No”. Of course it is a self-selecting sample from readers of one newspaper. Do not read too much into it. But you probably should read something into it. That is a strikingly high level of disapproval of a Conservative government’s proposed policy from the readers of a Conservative-leaning newspaper.

Samizdata quote of the day

We’ve a new little report, piece of scientific research, telling us that cheese and red meat are good for us. This in entire opposition to everything governments have been telling us about diet for decades now. This telling us that government is a seriously bad way of doing anything.

Sure, of course, humans are wrong, most humans are wrong a lot of the time. The problem with government being that when that wrongness gets propagated by our rulers it becomes the established fact. Meaning that we’re all affected by it, there is none of that natural variability of error which protects some and harms others. We all become subject to the error that is

Tim Worstall

Food science vs government

Terence Kealey has a policy analysis on the Cato Institute entitled Why Does the Federal Government Issue Damaging Dietary Guidelines? Lessons from Thomas Jefferson to Today. I found this from a comment by ‘Bloke in North Dorset’ from Tim Worstall’s blog.

It is a very good document. It begins with a history lesson on government food advice. In 1953 people were having heart attacks so the government had to Do Something about it. Ancel Keys said it was caused by eating too much fat. But science is never that easy.

As Yerushalmy and Hilleboe pointed out at the 1955 WHO seminar, and as they expanded in their 1957 paper, the data thus suggested the citizens of poor countries (who largely ate vegetables, including starchy vegetables such as maize/corn, rice, and potatoes) didn’t die much of heart disease (but they were vulnerable to other diseases); while the citizens of rich countries (who ate a lot of meat, which includes much fat) died largely of heart disease (but were protected from other causes of death).

The document explains how understanding gradually increased but that even today the relationships are not fully understood. Adding government to the debate was not helpful.

On being challenged on the incompleteness of the science, Senator McGovern said “Senators do not have the luxury that the research scientist does of waiting until every last shred of evidence is in,” which is the opposite of the truth: research scientists are at leisure — and are perhaps even obligated — to explore every possible hypothesis, but senators should not issue advice until every last shred of evidence is in, because they may otherwise issue misleading or even dangerous advice. As they did in 1977.

In fact the government advice was out of date for 60 years:

Although by 1955, within two years of originally proposing it, Keys had abandoned the dietary cholesterol hypothesis, for another 60 years the federal government continued to warn against consuming cholesterol-rich foods. It was only in 2015 that its Dietary Guidelines Advisory Committee classified high-cholesterol foods such as eggs, shrimp, and lobster as safe to eat: “cholesterol is not a nutrient of concern for overconsumption.”

This 60-year delay shows how asymmetrical the official science of nutrition can be: a federal agency can label a foodstuff dangerous based on a suggestion, yet demand the most rigorous proof before reversing its advice.

This is the sort of thing that comes from applying the precautionary principle. But taking precautions turns out to be risky action.

To Mark Hegsted’s question in his introductory statement to the Goals — “What are the risks associated with eating less meat, less fat, less saturated fat, less cholesterol?” — we can now reply that if, in consequence, people were to follow his advice and eat more carbohydrates and more trans fats in compensation, the risks are of precipitating early death from atherosclerosis. Irony of ironies.

The document describes multiple causes of the disconnect between the real understanding and the public policy. Scientists are not perfect:

The popular view is that scientists are falsifiers, but in practice they are generally verifiers, and they will use statistics to extract data that support their hypotheses. Keys, for example, was not a dishonest man, he was merely a typical scientist who had formulated a theory, which — by using poor statistics — he was able over the course of a long career and many publications to appear to verify.

And the government makes things worse:

Governments may be institutionally incapable of providing disinterested advice for at least four reasons. First, the scientists themselves may be divided, and by choosing one argument over another, the government may be making a mistake. Second, by abusing the precautionary principle, the government may be biasing its advice away from objectivity to risk-avoidance long before all the actual risks have been calculated. Third, because of public pressure, it may offer premature advice. And fourth, its advice will be distorted by lobbying.

I imagine that much of the story described here, at least the science history part, is well understood in retrospect and uncontroversial. Its lessons might be applied elsewhere. What currently controversial science suffers from poor statistics and is being distorted by government involvement, I wonder?

Samizdata quote of the day

That there are now more overweight humans than starving humans is one of mankind’s greatest achievements.

Damien Counsell has said it many times. Good for him.

“If a nurse didn’t like you, you were a goner”

Remember the mockery that Sarah Palin got for her prediction that state health care might result in “Death panels”?

She was wrong about a few things. There is no need for a panel of bureaucrats to decide when it is time to stop treating old people and those with Downs syndrome. That can be done more conveniently by the doctors and nurses. And while we’re at it, why confine ourselves to stopping treatment? Would it not also reduce the burden on the NHS and its employees to become a bit more proactive and actively shorten these useless lives?

This article by Dominic Lawson about the Gosport War Memorial Hospital scandal is one of the most powerful I have ever read.

Last week’s monstrously belated report on the Hampshire hospital’s treatment of its patients in the 1990s revealed that at least 450, and probably more than 650, had been killed — sorry, had had their lives shortened — as a result of a policy of attaching them to syringe drivers pumping diamorphine. Diamorphine is medically indicated only when the patient is either in the severest pain or terminally ill, because its notable side effect, when large doses are consistently administered, is respiratory failure. Injections of diamorphine — in 30mg doses — were Dr Harold Shipman’s chosen method of dispatching his patients. But the numbers at Gosport exceed the tally of Britain’s most prolific mass murderer.

You may be thinking, no need for that sort overblown rhetoric. Surely this is a case of misplaced mercy, of overdoing the pain relief? That is what I thought too. It is why I had not paid much attention to this story until now. More fool me. Read on:

The report, led by James Jones, the former Bishop of Liverpool, reveals that only 45% of those administered terminal quantities of diamorphine were said to be in pain. And in 29% of cases their medical notes give either no reason, or no comprehensible justification, for the lethal dose (most died within a couple of days of being attached to the pump).

(Emphasis added by me, as it is in all the excerpts I quote in this post.)

Even that is not the worst. Read on further:

The ones most likely to get the treatment appeared to be not the sickest, but the most “difficult”. As the stepson of one of the victims remarked: “If a nurse didn’t like you, you were a goner.” This was clear from the testimony of Pauline Spilka, an auxiliary nurse. After the local newspaper in 2001 reported the complaints by relatives of Gladys Richards, (whose life had been “shortened”), Spilka went to the police. In an interview with Detective Chief Inspector Ray Burt of the Hampshire constabulary, Spilka said: “It appeared to me then and more so now that euthanasia was practised by the nursing staff. I cannot offer an explanation as to why I did not challenge what I saw at that time . . . I feel incredibly guilty.”

Spilka was especially troubled by the fate of an 80-year-old patient (his name is redacted) whom she described as “mentally alert and capable of long conversations . . . able to walk . . . and to wash himself”. He was, however, “difficult”. She told the policeman that this patient was “always making demands” and that “I remember having a conversation with one of the other auxiliaries [Marion] . . . we agreed that if he wasn’t careful he would ‘talk himself onto a syringe driver’.”

So it came to pass: “One day I left work after my shift and he was his normal self. Upon returning to work the following day, I was shocked to find him on a syringe driver and unconscious. I was so shocked and angered by this that Marion and I went to confront the ward manager.” They were told to put a sock in it. Nursing auxiliaries are at the bottom of the chain, without any medical qualifications. What was their word worth, against that of the formidable (and formidably well connected) Dr Jane Barton

Whereas a word from Dr Jane Barton was literally enough to sentence a woman to death. Lawson continues:

Perhaps the most upsetting case — at least, as the father of an adult with Down’s syndrome, I found it so — was that of 78-year-old Ethel Thurston, admitted with a fractured femur. She was described in the report as having “learning difficulties [and] the mental capacity of a 10-year-old”, though she “once held down a job in a bank . . . and had been able to travel across London independently”. The nurses’ notes took a different tack: “Willing to feed herself only if she feels like it . . . her behaviour can be aggressive.”

On July 26, 1999, Dr Barton made her recommendation: “Please keep comfortable. I am happy for nursing staff to confirm death.” Happy? The following then appears in the nursing notes: “Syringe driver started diamorphine 90mg. Midazolam 20mg.” These huge doses were administered at 11.15am. At 7pm a nurse confirmed Miss Thurston’s death.

Samizdata quote of the day

Even for The Guardian managing two logical fallacies in the one editorial is pretty good going. But that’s what they achieve in this one on funding the NHS. They manage both to get the Keynesian – and by extension, modern monetary theory – idea of deficit financing wrong and also the implications of the National Health Service being the efficient manner of organising health care. Actually, this is such a misunderstanding that I suspect it’s been written by Aditya Chakrabortty

Tim Worstall

Other ways of providing health care

Whenever I have attempted to discuss health care, I am always told about how the US health system fails people. I am sure that this is some combination of untrue (my own experience of US health care was walking in unannounced, paying $100 and being seen and fixed straight away) and unfair. US health care is not wholly private or even very free-market at all, and suffers a high level of regulation. But I do not understand enough about the details.

I occasionally hear good things about other health care systems, such as Australia’s method of having people pay and then possibly having the government refund them. While I can understand that it will be hard to convince people that anarcho-capitalist health care is best, it is interesting in the UK that no changes to the structure of health care at all will be considered. Private companies must not be allowed to make a profit! Such profit can only be gained from killing patients.

However the IEA have recently made an interesting strategic decision to counter-attack the knee-jerk reaction that the only alternative to the NHS is US-style health-care. What if the NHS and the US system are both weird and there are other sane and functional systems in the world? Kate Andrews has appeared on the BBC pointing this out. Guido covered it. Kate Andrews wrote a piece for the Spectator. All this is to publicise the IEA report Universal healthcare without the NHS.

One thing they keep pointing out is that the NHS ranks in the bottom third of the world’s health care systems in terms of outcomes. That will need a lot of repeating if anyone still thinks it is the envy of the world.

It is also, perhaps, a much more effective strategy than attempting to convince people of the benefits of free markets up front. “Let us try to learn something from nice country X” does not require breaking down as many mental barriers as “please abandon a lifetime of carefully cultivated opinions about the unfairness of capitalism”.

Our god requires sacrifices

Tim Worstall says that Hayek’s much-derided argument that government health care would make us serfs of the state is supported by an astonishing piece by Nick Cohen which appears to argue that so it would, and so it must. Part of me hopes that Cohen, who has often been one of the more principled voices on the British Left, is writing tongue in cheek or trying to provoke a reaction. But the commenters nearly all seem to take it quite seriously and only berate him for not going far enough.

Here’s the piece from Cohen: “Saving the NHS means forcing us to change the way we lead our lives”.

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

Speaking as a base creature myself, I do not believe it would be a healthy future at all to be ruled by people with such contempt for me.

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

No fast-food outlet would be allowed within a one-mile radius of a school. Agricultural subsidies for fat and sugar would be abolished. Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

A commenter called “erikus” put their finger on what all this was reminding me of:

Stardate 21327.5. Captain Picard & the crew of the Enterprise arrive at a world where the local inhabitants are suffering the apocalyptic consequences that fell upon them after they tried to re-engineer themselves in order to meet the expectations they believe are placed upon them by the institutions that were created by their ancestors and which they’ve come to regard as sacred & inviolate.

Picard’s final speech: ‘They killed themselves for this. They died because they believed that they had to sacrifice themselves in order to preserve in perfect form the institutions left to them by their ancestors: Institutions that were themselves originally created with one simple purpose: To preserve their lives:

We must remember that the institutions that we create exist for our well-being & that once we begin to worship them & think their well-being transcends that of our own, they lose their reason for existence.’