The Lanyard – Billy Collins

This is the first part of a dispatch originally published on 8 November 2010. (Google Translate may help if it look Greek to you)

Γεια σας φίλοι μου, μια ωραία ημέρα του,

Granite is a crystalline rock believed to have formed as a result of mega-convection cells in the earth’s mantle. Like convection in a pan of heated water, but on a much much larger scale and much much slower. As the body of molten rock rises- like one of those lava lamps- surrounding rocks are absorbed into it. As the molten mega-bubble rises it begins to cool. Crystals are formed, their eventual size depending on the rate of cooling. Near the “contact zone” chunks of rock that have not been fully molten and absorbed end up having a much finer grain size. These are known as xenoliths (Greek= foreign rocks).

If through movements in the earth’s crust the granite “dome” reaches the surface, it is subjected to weathering and erosion. Mainly water and oxygen in the atmosphere begin to break down and alter the rocks. Quartz crystals end up as sand, feldspars end up as clay minerals etc.  Xenoliths are more susceptible to weathering than granite. Xenoliths end up as hollows at the surface. They end up as water holes.

North of Yuendumu there is a hill that white pioneers in a fit of extraordinary imagination called “Rock Hill”. This is Wakurlpa, which consists of granite. On Wakurlpa there are two parallel narrow wanari (water holes), they are the handle of a kuriji (shield).

http://www.youtube.com/watch?v=gPqrTaVXJhI

One of the reasons I studied geology is that it would give me the chance to travel to foreign places. I’m a self confessed xenophile.
English Spell-check does not  recognise xenophilia, but has no problem with xenophobia or necrophilia. Fancy that.

On 4^th.November, The Australian published an article headed “Exiled group of Aborigines to leave damage”.  It included the following:
“…Chief Superintendent Fred Trueman confirmed a number plate had been stolen and another car damaged.

“There is no evidence to suggest that anyone >from the Yuendumu group is involved,” Chief Superintendent Trueman said.

Despite the Yuendumu people staying in a block surrounded by cyclone fencing, staff have raised concerns about catching scabies and head lice from the children.”To ensure (police) staff and recruits did not contract these conditions, (police) took the precautionary measure of establishing a separate mess hall for those from Yuendumu,” he said….”

It is my understanding that the children often go swimming at the nearby beach. The police staff are scabiephobes and headlicephobes. Head lice and scabies are saltwaterphobes.

I recall comedian Alexi Sales talking about personalised numberplates. He thought they were a bit of a wank. The plates were rather expensive, so he could not afford a set. Instead he changed his name by deed-poll. He changed it to GMX-427.

I can’t recall any Warlpiri Yuendumu people suffering from numberplatephilia.

A co-author of the article in the Australian rang me, I guess to see if I would give her some more scintillating information to titillate her audience with. When she mentioned “the riot”, I said I objected to her calling it that. A “riot” brings to mind uncontrolled anarchy; what happened in Yuendumu quite clearly was not. She got defensive: “The police are calling it a riot. People have been charged with rioting. What are journalists meant to do?” she repeated it, like some Indonesian plurals.  I thought of several suggestions, but bit my tongue.

Colin Powell told the UN that Iraq had chemical factories on the back of trucks.  What were journalists meant to do?
http://www.youtube.com/watch?v=IYBA9JD5oW4

Mal Brough told us that there were paedophile rings on Aboriginal communities.  What were journalists meant to do?

I’m telling you the cow jumped over the moon.  What are journalists meant to do?

School Holidays Series Part One
by Quentin Cockburn

It’s something about school holidays.  I like to think that being at home with the kids during holidays as distinct with being at home at any other stage of the year is precious.  Perhaps the only precious thing is not being ‘deaded’ by the routine of getting up and off to school.  During holidays we like to think that this “special time” will reinforce some intrinsic bond, and hope deep down that holidays will not be compromised by money, and the inescapable feeling that lots of it is what you need to have some fun.  There’s roughly three categories for kids in the twenty first century.  There’s the organised, totally organised school holiday.  My son Jasper has a friend, of sporty persuasion in which every second is calibrated with attendance at sports clinics, footy camps, athletics, competitions, meets, and the parent’s sole function is to co ordinate the events and drive thousands of kilometres in search of “compulsory organised fun”.  Invariably it instills as “fun” competition, routine, failure and winning.  Preparation for the life “outside”.  Then there’s the more standard, the realisation in spite of the anticipation that holidays, like war, can more often than not be boring.  Telly, fish and chips, DVD’s, Nintendo’s and shopping with the odd excursion to Melbourne and more shopping.  It’s a holiday spent safely inside.  The final category, the traditionalists see holidays as an existentialist take on life in general.  Going nowhere, nothing planned, minimal parent presence, and left to your devices, mucking about with friends.  Being outside most of the time, doing the things you’re not supposed to do.

You see, it’s a dilemma for kids these days.  I’ve said it before but the spike in teenage suicides is all our fault,  we’ve so cosseted the growing up experience and made it safe that there’s nothing to do.  I know you’ll be repelled by the “in my day”, but let’s take a cold hearted analytical look…  What did we do?  And how did it keep us from the mind numbing boredom and segway into Drugs?  (Every Parents worst nightmare!!!)  We built things from scraps gleaned from the tip, (Banned).  We made great fun of fireworks, (Banned).  We rode around all day on bikes without helmets, bakes, lights, (Banned).  We tinkered around with old cars and drove into trees in paddocks, (Banned).  We went swimming in creeks and lakes without supervision, (Banned).  When we go a little older we bought ciggies, (Banned), and grog, (Banned), and did silly things like fire air rifles, (Banned).  Lit fires, (Banned) and made explosives (Banned).  Went on hikes without telling anyone where we were off to, (Banned), and Hitchhiked, (Banned) after seeing bands under-age( Banned).  Explored sewers, (Banned).  Destroyed derelict buildings, (Banned), and wandered down mine sites with candles and torches. (Banned)

Can’t find an outlet for simple fun, improvised fun, unstoppable fun like burning tyres and letting them roll ablaze down hills.  We’ve crafted a generation or two stuck in boredom, doing what the most neurotic of us have crafted for them. T o shop, be good, and avoid DANGER.

The only recreation prescribed to our kids is to obsess about fashion, reality TV and consume.

As a counter we are building a Dalek. To drive round Bendigo, and anoint the most sinister over-designed spaces, (the mall) with a bit of science fiction counter reality.

On walks amidst the mine sites, (there are still plenty in Bendigo) the generational favourites of throwing rocks, pilfering and “quiet vandalism” still hold true.  Building things from stuff gleaned from roadside collections, are the few “outlets” for a creative and restless spirit.  They all involve kinetic, physical and chemical energy, that’s non compulsory and more fun.  The message is eternal, keep it simple.  Be fit, and enjoy one anothers company.  For tomorrow one amongst us may become a banker.

TRAINEE  BANKER

After Dr Nortin Hadler’s plea that we as citizens involved in our health system speak up and take responsibility Quentin Cockburn in today’s post deplores the dis-empowering aspects of being referred to as ‘Clients’.

I HATE that word client.  It is detestable.  It reminds us all that we as citizens have been robbed of dignity, reduced to being mere consumers, to units on a bar chart somewhere.  Our worth as individuals, as participants within a society is marginalised to management speak shorthand.  It denies us the most basic dignity.  It denies us our society.  To be referred to as clients takes away any power we might have had.

The corruption began about twenty years ago.  Now it is unstoppable.  There is a code implicit in being referred to as a client.   It is patronising.  There is no reciprocity in the ‘client’ arrangement.  We are encouraged, as “clients” not to be actively engaged in any political, social, and reform process.  Ours is to just consume.  Leave the big picture to focus groups and the fiefdom of upper and middle management.  Clients are now nothing more than “ Designated Lesser Persons”.   Collectively we are prisoners.  As “clients’ we are told what is good for us by those who bought us the GFC, with ‘A wisdom beyond question’.  Like a church, they have certainty on their side, and it’s evidence based.  Go ask the scientologists, unlike ‘mainstream’ religion they can support their beliefs with ‘FACTS’.

I believe, (and this proves a little bit of history goes a long way), the mis -use of client is rooted in the tradition of the Greeks and Romans.  A democracy based upon the assumption that there’s an impenetrable layer between the rulers and the lesser orders.  They developed a prototype version of democracy.  In Greece, the citizens, (some ten percent of the population), were granted voting rights, participation in decision making and the rest of the population were slaves.  With citizenship came responsibilities, to pay taxes, serve on the military when called upon, and suicide if your faction or strategies were bested by any putative Hannibal.  I think the best description of the sort of Graeco-Roman rites of passage comes with Robert Graves’ ‘Count Belesarius’.  He describes Constantinople at its height, torn by factions, and all the panoply of power and corruption we associate with pre selection in contemporary politics. The finale is of Belasarius after political and military success, having his eyes taken out as a member of the wrong faction and for valuing principle above politics.

The point being; as a citizen the individual had a stake in power and the discretion to act upon principle. There are no ‘principles’ in being designated a “client”, other than to be subjected to power.

‘Client’ used to establish an agreed, paid, participatory exchange, (usually professional) between an individual and a professional.  Invariably for white collar services.  For accountants, lawyers, engineers, and consultants.  Other users of services, non professional, invariably government, were described as  ‘inmates, wards, prisoners, homeless, destitute, delinquents’, the list goes on and on. It describes an involuntary arrangement, whereby the government forces an individual to endure an incarceration, or period of prescribed isolation or treatment.  It’s partly a draconian ideal prefaced upon the activity being activated to ensure a subject’s personal welfare, and benefits to the state.   Since when did a prisoner become a client?  Since when, did a poor bastard in a psychiatric institution become a ‘client’?  And since when did some miserable bastard stuck on Manaus island became a ‘client’?  There is no reciprocity, there is no exchange beyond the power of the state or instrumentality to brutalise and coerce.  It is a corruption of the rights of individuals to exist, (even bad ones) as free and equal citizens.  It is Thatcher’s enduring legacy. To ensure that our community becomes to all intents and purposes ‘impotent’.

So when next you’re being pinioned by a burly host of Public Transport Safety Officers for failing the Myki test, you’re being bludgeoned to death on Manaus Island, or your sentence has been increased courtesy of unpaid parking fines give thanks to the fact that as a “valued client” your standing in the community is virtual. And your power to enforce change minimal, as client assumes subservience, almost derogatory, because that’s how they do things in the ‘Church of Clientology’.  They have an acronym for it, You may have heard it,  as a ‘Designated Lesser Person’ ; DLP.

In researching Dr Nortin Hadler for our posts last week (here and here) PC came across the following review in the New England Journal of Medicine (2008).  Guessing that this journal is on few of our readers lists and feeling concern for the future of the Australian Health System we have reprinted it here.  

The Corrosion of Medicine: Can the Profession Reclaim Its Moral Legacy?
By John Geyman. 344 pp. Monroe, ME, Common Courage Press, 2008. $24.95. ISBN: 978-1-56751-384-4

Worried Sick: A Prescription for Health in an Overtreated America
By Nortin M. Hadler. 353 pp. Chapel Hill, University of North Carolina Press, 2008. $28. ISBN: 978-0-8078-3187-8

Health care reform is back — at least rhetorically. These two books suggest that both Democrats and Republicans are missing the boat, or perhaps rearranging deck chairs on a ship that is already listing. Both parties’ presidential candidates trust private insurers and pay homage to the technical virtuosity of America’s doctors and hospitals. But John Geyman blames insurers and their corporate brethren for the country’s health care woes, whereas Nortin Hadler sees a medical establishment that has pushed interventionism to the brink of assault. The authors of both books analyze why our exorbitantly expensive medical efforts yield such mediocre results — but on very different levels.

Geyman focuses on financing policies and the corporate takeover of medicine. Longtime readers of the Journal will have encountered this theme, starting with Arnold Relman’s classic 1980 editorial on the incipient threat posed by the “medical-industrial complex.” Geyman marshals a quarter-century of meticulously referenced evidence to argue that market-driven care is driving inexorably toward dominance by large corporations whose priority is their bottom line. Investor-owned insurers, hospital chains, and drug companies have warped the priorities and practice of medicine. Too many doctors have gone along, seduced by drug company handouts, research funding with implicit strings attached, and insider profits from joint-venture specialty hospitals and the like. These lucrative liaisons have left the profession weakened and demoralized.

Geyman’s literary voice arises from his unusual professional and political trajectories: from country doctor to academic department chair and prominent journal editor, and from longtime Republican to president of Physicians for a National Health Program, a group that advocates national health insurance. His book is packed with ideas, outrage, and data — for example, death rates at investor-owned hospitals are 6% higher than the rates at nonprofit hospitals, and yet treatment at investor-owned hospitals costs 3 to 13% more. Overhead for private insurers is four times that of Medicare. The number of medical administrators has grown 18 times faster than the number of physicians during the past quarter century. Every year, more than 18,000 American adults die because they lack health insurance. Geyman’s book reads like a carefully prepared grand rounds — complete with charts and graphs — presented by a passionate advocate and scholar.

Geyman prescribes universal insurance that is set up like traditional Medicare, with funds collected through taxes and paid directly to doctors and to nonprofit hospitals, nursing homes, and other such institutions. By eliminating private insurers, simplifying reimbursement, and proscribing ownership of health care institutions by investors, such a program could save perhaps $300 billion annually on bureaucracy and profits — enough to cover the 47 million uninsured persons and to improve coverage for most other Americans.

Hadler, a rheumatologist and occupational medicine specialist, concentrates on medical decisions. He indicts doctors for peddling fake diseases and promising false cures, and he also indicts patients for refusing to accept the normal infirmities of age and the inevitability of death. Like many contrarians, he sometimes overstates his case, but the case is often a strong one.

Hadler offers a withering critique of the invasive treatment of chronic stable coronary artery disease, echoing the view that has long been advocated by noted cardiologist Bernard Lown. The single-minded focus on opening (or bypassing) narrowed arteries relies on an oversimplified model. Most acute occlusions do not occur at sites with previous high-grade stenoses; stenotic lesions often stimulate the development of collateral circulation that attenuates their danger; and modern medical management often stabilizes plaques. Moreover, randomized trials have shown that few patients with chronic stable angina benefit from mechanical intervention — apart from the 3% of patients with left main coronary artery disease.

Hadler also takes on screening for breast, colon, and prostate cancer, which has not been shown to decrease all-cause mortality but does increase radiation exposure, surgeries, and worry. He criticizes tight glucose control, prefiguring the unexpected results of a recent randomized trial. Unfortunately, he sometimes stretches his case — for example, minimizing the evidence that supports control of moderate hypertension.

Hadler mostly blames our cultural predilection for medicalizing discomfort for America’s hyper-interventionist system of medical care. He mentions, almost in passing, the financial winners in the $88 billion industry that exists to care for patients with coronary artery disease, and the political and commercial pressures that members of that industry have exerted to invent, maintain, and publicly fund the interventionist paradigm. Although Hadler focuses on clinical decisions and Geyman focuses on financing policy, they concur that physicians, wittingly or not, have abetted the corruption of healing. Moreover, both sound a hopeful note — doctors have the knowledge, power, and moral obligation to reject the false coin of commerce and technological hype and to reassert the primacy of the patient.

Steffie Woolhandler, M.D., M.P.H.
David U. Himmelstein, M.D.
Cambridge Hospital, Cambridge, MA 02139

by Quentin Cockburn
Gerard Henderson, The Australian and typical Radio National listener

In an attack on the artifice of left-leaning literary conferences, the ABC, and David Marr, Gerard Henderson concludes;

“Conferences where almost everyone agrees with almost everyone else are invariably boring.  They also have the effect of distorting reality as the inner-city Left dismiss as bigoted the “they” who happen to live in suburban and regional Australia’.

He writes for the Australian, where, and I quote, “where almost everyone agrees with almost everyone else’. He and Marcia, Noel, and big Brother Rupert.

I’m worse.  A Radio National listener.  Henderson rails against ‘taxpayer funded literary festivals’.  An anger felt that we the taxpayer were forking out and subsidising this left cabal.  He must go apoplectic on the taxpayer funded return of $880 million to Rupert.  On David Marr and Cardinal Pell, He fumed, ‘No other view was heard”.  True Gerard.  In short-hand code; they’re all dead.

He’s quite right.  Right wingers are not thinkers, they’re reactionary bastards.  Full of hate and punishment.

He loathes Marr.  Funny, his loathing actually makes me like him.  A collective of “right -minded’ people,?  Southpark nailed it, “a smug”.  Henderson points to Morrie Schwartz and his stable.  Lefty protagonists and then lists them all, (like Schindler, he likes lists).  He belabours the fact these leftist sympathisers, bleeding hearts, public subsidised neophytes, Burnside, Archer, Leunig, etc, talk amongst themselves, and the literary festivals are ‘like with like’!

Couldn’t agree with him more.  I hate writers festivals.  Writers festivals are what you get when the forum for public ideas have become utterly Murdocked!!   We have writers festivals because few people can bother reading stuff that challenges them.  I’m proof of this!  Could only manage the first paragraph of Bob Carr’s biography.  I grew up in the outer suburbs.  I don’t want to think, and society in general can go get fucked!!

Who would pay to hear Andrew Bolt?  Who would want to listen to Robert Manne?  It’s bad enough enduring the sameness of the Monthly, without having to turn to the daily dross of the Herald scum and the Australian.  Who wants local when you can global – Murdoch’s, sexualised purient filth.  We as consumers want certainty, The divine, (now the Catholic Church is so diminished) entropy of slow birth over the open grave.

But I am a typical Radio National Listener.  It’s a wide audience.  It brooks a plurality of input.  The right like to think of Radio National listeners as all the same.  The same group think of Asians as amorphous.  They deny them difference, because that would change their worldview; like global warming, finite resources and greed.  It would endanger their sense of hyper paranoid insecurity.  Boisterous nationalism, border protection, all xenophobia as Adolf will tell you is insecurity.  Good thing we have Gerald at the Sydney Institute to temper this.

But though I listen I cannot condone, all of Radio National.  What is that misquote from Descartes?  Why then should I like Geraldine Doogue.  Ron Casey should have landed her that left hook and left Normie alone.  And ‘Life Matters’?  To wallow in a soup of slushy, self indulgence.  My nadir, Rachel Cohn, and ‘The Spirit of Things’.  Oh! How I would like to crucify her.  But I uphold their right to annoy me, to make me in mid stream, get up and turn the radio off.  I hate the music programme,  it’s so Sydno-centric.  Though I confess an enduring love for Amanda Vanstone.  All of this I prefer to the Orwellian certainty of the Murdoch; his banal, de-valuing Evil Empire,

That’s why we don’t have ‘righties’ at writers festivals because we already know what they will say.  We already know that they are strong on punishment, coercion, fear and delusions of certainty.  And we know that writers festivals talk ‘like with like’, but with 85% of Australia media owned by Morloc, where else can they disseminate thinking?  It’s banned in Schools, Universities, and Parliament.  Like Caxton’s original printing press, it is rarer by the minute, and exists beyond the odd Morrie only on the ethernet.  That my dear friend is all we have.  As a punishment I would test anyone to endure fully a writers festival.  I imagine the audience to be almost as bad as an Art Gallery opening.  More boring than Womad, or the collected musical works of Paul Kelly.  The pompous pretentious, preening, smug, wankers, (just like myself).  Occasionally though, in amongst their latte, machiattos, non lactose skinny, vegan organic machiolattos, fattened superannuation portfolios, and inflated self importance, an offering of truth falls out.  From Murdoch, the offering is just the certainty of fear and punishment.

Today’s dispatch was first published 1 November 2010.  

Bonjour mes amies,
Megan Stack in her book ‘Every Man in This Village is a Liar’ writes: “…But in Jerusalem I learned that good intentions and lofty ideals are among the most dangerous tools of all in a war, because they blind people to what they’re doing…”
A more famous book has the following: “…Father, forgive them, for they know not what they do. (Luke 23:34)….”
http://www.youtube.com/watch?v=RTQL42onK08

The International Geophysical Year (IGY) was held in 1958 during a lull in cold war tensions. China and Taiwan were the only “major” nations that didn’t take part.

In 1961 a group of U.S. backed Cuban exiles staged the Bay of Pigs invasion, a failed attempt at toppling the Castro regime.

In 1962 there was a stand-off between U.S.A. & the U.S.S.R. over Soviet (U.S.S.R.) missiles on Cuban soil, that nearly unleashed World War III.
http://www.youtube.com/watch?v=kHD5nd3QLTg

In 1967 at the beginning of an exploration effort that would soon lead to the now (financially) notorious Australian “nickel boom”, newlyweds Frank and Wendy were based in Norseman (Western Australia).
Also based in Norseman at the time were an American (U.S.A.) couple. The husband, a Geophysicist, had been involved in precision mapping during the IGY. The wife told us in a “can you believe it!?” tone of voice, that they had discovered that Cuba was 10 miles from where they thought it was. When Wendy and myself didn’t react in an “oh my god!!!” way, she exclaimed: “What if we have to bomb Cuba?!!!!” Vraiment quelle horreur!!!

I’ve got a mental picture of planes dropping their bombs ten miles out to sea (hopefully where there were no innocent schools of fish).

I also ponder:  What if Baghdad or Beirut or Grozny or Sarajevo or the Twin Towers had been 10 miles from where it was thought they were?

An Amnesty International  website reports that in 2009 there remained 240 detainees languishing in Guantanamo Bay on Cuban soil.
http://www.youtube.com/watch?v=aDdQnGHtHok  [Cuba- “Libertad desde mi Tierra”… Freedom out of my land (Soil)…]
http://www.youtube.com/watch?v=6rRJP8rVg-4

If anyone decided to bomb Cuba these days, they wouldn’t miss.

I’ve mentioned before that what is happening to the Warlpiri of Yuendumu bears no comparison to such disasters and atrocities as the Armenian or Rwandan genocides, the Kampuchean killing fields or that abomination that was the Holocaust.

No one that I’m aware of has ever rued that they didn’t know where exactly Yuendumu was, in case it became necessary to bomb it. If such a necessity arises, they won’t miss.

Many good intentions and lofty ideals are expressed aimed at protecting Aboriginal children and women. Reconciliation has been replaced as a lofty ideal with Closing the Gap.

The authorities have been blinded to what they’re doing.

In 2008, barely a year into the Intervention, a long time white resident of a nearby community told me: “This was a good little community but it is unravelling under this pressure”. At the time I thought “At least Yuendumu is holding together”. Now, I’m not so sure. About half the Aboriginal population is gone.

Contrary to what officials keep saying, school attendance is down (In Yuendumu from around 80 students a day to around 30 to 40 students  a day).

The boiling frog.

Killing them softly ——– with good intentions and lofty ideals.
http://www.youtube.com/watch?v=dpNdMIAnKko

They’ve been blinded to what they’re doing
http://www.youtube.com/watch?v=3ZJ-kLKut9E  I was blind but now I can see….
http://www.youtube.com/watch?v=8_qyHRH4kOc

A bientot,
François
http://www.youtube.com/watch?v=fgRzOBzVgBE
http://www.youtube.com/watch?v=86wME5d_yZM

Australia’s much lauded health system is under threat, so Passive Complicity looks at the American model and finds it wanting.    Here is a further extract from Nortin M Hadler’s  2013 book The Citizen Patient (UNC Press)

Health in general, and good health in particular, does not lend itself readily to easy understanding because it has many components and reflects so much that is our humanity.   In that regard it is similar to other hard-to-define concepts, such as “love” and “job satisfaction”.  Many elements contribute to health, only some of which are defined and all of which display enormous individuality.

That being the case, what do we mean by “health care”, the “health-care system” and “health-care reform”?    These and many similar terms are no longer the language of policy; they have become common parlance.   They all presume that good health will result if we prevent bad health.  Further, if “bad” health surmounts our defenses, we can call on trained professionals whose job it is to identify and try to fix the diseases and disorders that render health “bad” so that “good” health will re-emerge.  I (Dr Nortin Hadler) am a man of this cloth.  I am trained, experienced and committed to this strategy.  I am also convinced that this strategy encompasses but a small component of health care, and an exclusive focus on it perverts the health-care system and diverts the goal of rational health-care reform.  I am writing this book to recruit the reader to this expansive, perhaps radical, and certainly iconoclastic view.

This is not to say that a strategy of prevent-treat-cure is worthless.  To the contrary it is my life’s work.  It is what we think of when we exalt “medicine”.  However it is a strategy that demands an exquisite moral compass.  It is a strategy that must have no agenda other than to benefit the individual patient.  If the process that serves the strategy becomes the goal, the patient is placed at risk of becoming the excuse rather than the beneficiary.  The more the process is valued and rewarded for its own sake, the greater the personal price paid by the patient.  I argue that this dialectic is approaching the extreme in America and thereby setting precedents around the globe.

This is a counterintuitive argument in a country wont to flaunt its medicine as the “best in the world”.  It becomes a compelling argument when one critically examines the process from the perspective of the patient enmeshed in the health-care system, not from the perspective of the system that promulgates the process.

Dr Hadler is looking to change the question from “What’s good for me?” to “What’s the best way to organise health care so that I can have more confidence it will deliver what’s good for me?”  Hadler goes on to explore the costs of health care where in America it consumes almost 20% of GDP, the conflicts of interest where medical schools are often funded by industry players – drug companies, devise manufacturers, hospitals, – such that the medical schools are thought of as ‘loss centres’, where faculty deans regularly have positions with these companies, where the companies sponsor research and conferences.   Over half the spending on ‘health’ goes ‘into the pockets of “stakeholders”  without advantaging a single patient”.

PC will bring more of this at a later date.

Passive Complicity takes a look at western Health Care, starting with some thoughts of Nortin M Hadler, whose 2013 book The Citizen Patient (UNC Press)  forms the basis of this and tomorrows posts.

This book ‘examines the modern doctor-patient relationship and the many perversities that characterise the American “health-care system”.’  Hadler wrote this ‘in order to enable ….. enlightened Citizen Patients’ to drive-health care change.

A necessary first step in devising a rational solution to our national health-care problem is preparing all patients to take responsibility for assuring that whatever is being said or offered or done will really be to their benefit. If “health care” and the system that underpins it were intrinsically trustworthy, patients could relax, secure in the knowledge that whatever happens to them has a salutary benefit-to-risk ratio.  Sadly, we know that this is not the case; in fact the present health-care system is structured to frustrate that security.

Any discussion of “health care” must necessarily begin with a discussion of “health”.  What do we mean by “health”?  One can enjoy “good” health or suffer “bad” health.  Is “bad” health no more than the absence of “good” health?  Is there a continuum between “good” and “bad” health?  Can either be objectified reliably?

Good health is not the absence of symptoms; all of us will suffer symptoms repeatedly, symptoms that give us pause without compromising our belief that we are basically well.  Episodes of backache, headache, heartache, “colds”, “flu”, and much more are predicaments for which most of us are a match most of the time.  Despite such predicaments, we can remain in good health.

Nor is good health the absence of disease.  If we define disease as pathology, as abnormalities in our anatomy or physiology, by midlife all of us harbour diseases – and I mean important diseases.  Some of these are so commonplace as to be part of the course of life: gray hair, bunions, degenerative changes in the spine, hardening of the arteries, some forms of cancer, and the like.  Some are lying in wait to smite our good health.  Some are contenders for the ultimate smiting, the cause of our demise.  Most will still be lying in wait on that fateful day.  Despite our diseases we can remain in good health.

Health is not a purely scientific construct; the components of health that can be quantified and studied systematically barely scratch the surface of what most of us mean by good health.  Science is no match for individuals perceptions of well-being, for the temporal component of well-being, or for the vagaries of the social construction of well-being.  A century ago, obesity indicated good health, while today it’s generally considered to indicate bad health, even though we know that it is the correlative socioeconomic status that influences health far more than heftiness itself.  A century ago orgasms were considered bad for you; today, their absence is considered something that merits treatment.

To be continued…