Britain is far more corrupt than we think

Mary Dejevsky in The Independent

Within Britain, there is a widespread view – seriously dented neither by the MPs’ expenses saga nor by the newspaper phone-hacking scandal – that this is not a corrupt country. It might not be quite as squeaky clean as Scandinavia, but it is nothing like – let’s see, who shall we offend? – Italy or Spain. As for Russia or China, well, we can strut the moral high ground – can’t we? – certain of our superiority.

Incorruptibility is part of our national self-image. But we flatter and deceive ourselves. Over the past few weeks, The Independent has exposed private investigators who routinely break the law, digging for dirt on behalf of commercial clients. The techniques – phone hacking and “blagging” – are the same as those for which journalists have been hauled before the courts and pilloried by public opinion.

If there seems to be a slight edge to our reports, how could there not be? On present evidence, law enforcers would appear to take a dimmer view of journalists applying these illegal methods, or buying them in, than it does of business people and lawyers who do the same. That, at least, was the message from the Serious Organised Crime Agency, which initially instructed MPs not to name the companies commissioning such services on the grounds that it could “undermine their financial viability” by “tainting them with… criminality”.  Yesterday, however, there was a change of heart and Soca supplied the Home Affairs Select Committee with a list of a list of 101 names of people and organisations who have hired private investigators. The committee’s chairman, Keith Vaz, is now deciding whether to publish them.

Strictly speaking, blagging – obtaining information by deceit – can succeed without a partner. The offence is all on one side: no money or favour changes hands. But this is not the only way in which information is obtained. As with journalists and the police or others who hold  sensitive information, it is now known that money or favours have changed hands. And in these cases, those who sell are as culpable as those who buy. There has to be a market for the transaction to work.

The sellers might not see themselves as corrupt, merely as individuals exploiting an opportunity, or enjoying a perk of the job. That such practices may not always have been recognised as corrupt does not make them less so. It just means we are more adept than some of our neighbours at not calling things by their proper names. A gift for euphemism is something else that defines our national character.

If journalists and private investigators were the only ones under investigation, and the only commodity changing hands was information, we might just be able to file it away and argue that Britain has a very limited and very specific corruption problem. But this is not true, either.  In banking, we have had the rigging of Libor, the key lending rate, by individual bank employees for personal gain. As corruption goes, this comes close to the top of any list because  greed compromised a major pillar of the financial system – in a global financial centre which was built largely on its word being its bond.

A few steps further down we have claims of corrupt behaviour by British companies abroad. Only last week accusations were made against employees of a British company in China, GlaxoSmithKline. According to the Chinese, other pharmaceutical firms are also in the frame – for allegedly bribing doctors to prescribe their products. It is not, of course, that paying backhanders, or “doing as the natives do”, was unheard of in the operations of UK companies outside Britain. But the Bribery Act of 2010 made it expressly illegal, and it comes to something when it is the Chinese authorities doing the exposing and British companies that find themselves in the dock. The reputational damage flows only one way.

Again, it might be just possible to winkle out a “British” exception and claim that this sort of corruption reflects the malign influence of “foreigners” rather than any home-grown proclivity. But such complacency is challenged by the latest “global corruption barometer” compiled by Transparency International. Published earlier this month, its findings show not only that the perception of corruption in Britain has increased markedly over the past two years – not surprising, giving the prominence of the phone-hacking scandal – but that in the same period one person in 20 claims to have paid a bribe to a public official for services as diverse as health, justice and education.

A first instinct is, naturally, to question these conclusions. A second would be to surmise that those who admitted paying a bribe were at the margins – newcomers, perhaps or illegal migrants. But that would be too easy an escape. As with journalists and police, corruption is a transaction. There must be takers as well as givers. But I find it credible, too, because of a mini-brush of my own. When posted abroad more than 10 years ago, I checked that my husband, if he became non-resident, would have to pay privately for his (expensive) Parkinson’s medicine. The doctor, a locum, said yes, that was so. Then he paused, and – as I read it – implied, no more, that a deal could be struck. I left, but a possibility was there. 

And this is where corruption begins. Not with GSK in China, but with crimes left unpunished, names left unnamed and the prosaic minutiae of daily needs debased. If the Serious Organised Crime Agency is telling MPs – our representatives – what we the public may and may not know for national commercial reasons, the UK is on a slipperly slope indeed.

Soldiers as teachers why not as doctors?

by Archie Bland in The Independent

In its wisdom, the Government has decided to give members of the Armed Forces a fast-track route into teaching. The plan, long in the making, will give former troops the chance to teach even if they don’t hold a university degree, and I'm all for it, but I don’t think the Government is going far enough. Yes, we need a military ethos in our schools. But what about our hospitals?

Think about it. Schools will benefit from the military values of leadership, discipline, motivation and teamwork, as David Laws and Michael Govehave argued, but you know where else those values would be useful? The chaotic world of hospitals! OK, so not all soldiers have an education in medicine. But they have the right values. And the right values are much more important than the right qualifications.

The image of infantrymen moving from the military’s theatres of operations to the hospitals’ operating theatres is not the only one available to demonstrate how absurd this proposal is, how insulting to teachers and children, and how profoundly anti-intellectual, with its contempt for the idea that knowing about things might be a necessary prerequisite for teaching them. And these other modest proposals make still clearer the rationale for the Government’s pursuit of this particular wheeze. Imagine, for instance, that teachers were to be fast-tracked into combat units because of their capacities to work hard, manage people and deal with stressful situations. Or try to picture charity workers getting teaching jobs without a degree because a philanthropic ethos might be just as worth instilling in our children as a military one. Any such suggestion would be greeted, rightly, with puzzlement.

And yet with the military it’s different. This plan is based on an American example – with the difference that in America, 99 per cent of participants already had a degree – and in recent years we’ve been edging closer to the American model of unthinking glorification of our Armed Forces. When soldiers and sailors behave well, their exploits are used as evidence of military nobility. When they behave badly, they are seen as bad apples, and we rarely ask whether their wrongdoing might in fact be the product of a poisoned culture.

I suppose this squeamishness is understandable: ever since the invasion of Afghanistan, we’ve been engaged in brutal conflicts that cost most of us very little, and a few of us a great deal. We owe those few. But squeamishness, and a heavy debt, are not a sensible basis for policy making. So, although it feels frankly treacherous to say so, here goes: a military culture is appropriate for the front line, but not for the classroom, where independent thinking should be considered essential. Soldiers might be brave, and well-disciplined, but if they aren’t well qualified that probably won’t be enough to make them good educators. Teachers are doing something really difficult. And children? Children are not the enemy.

The placebo effect is present in every medical intervention

The western concept of an autonomous self does not account for how a doctor's beliefs can influence the patient's health

• 
• • Philippa Perry
  • guardian.co.uk, Thursday 21 March 2013 14.32 GMT

'A contributing factor of the effectiveness of the placebo is the reputation, charisma and convictions of the doctor administrating it.' Photograph: Stockbyte/Getty Images

A recently published study declared that 97% of 783 GPs admitted that they had recommended a sugar pill or a treatment with no established efficacy. This is not a scandal because a placebo is an effective, proven intervention that stimulates our bodies' own capacity to heal itself.

The placebo effect is present in every medical intervention, not just those procedures, such as sugar pills, where the placebo effect is the only known agent at work. To understand exactly how it works would be the equivalent of understanding in full how our mind influences our physical heath, and I expect we still have plenty more to discover in that area.

The concept of the self being an autonomous being is a deeply held belief in western civilisation, but we affect each other all the time. If our doctors wholeheartedly believe that the treatments they are giving us have every chance of working, we are more likely to believe it too. I don't know if this is the effect of mirror neurons or quantum physics, but it happens. It's not that the doctor is just a technician treating our disease, but is also a person who influences us. Bedside manner is more than an optional add-on luxury. If a doctor's influence makes us feel more positive about our health, it will make us more optimistic, and our optimism has a direct effect on our health. For example, research has shown our expectations about recuperation or complications significantly serve as self-fulfilling prophecies for how we recover after surgery.

In 1955, the inventor of the double-blind design form of testing, Henry K Beecher, discovered that 35% of patients found satisfactory relief from a placebo. It is thought that a contributing factor of the effectiveness of the placebo is the reputation, charisma and convictions of the doctor administrating it, as these affect a patient's belief system. In Beecher's study, this might have been missing, because the dispenser of the drug would have known that the drug might just be a sugar pill – so this 35% may be a conservative estimate of the efficacy of placebo.

These days, when testing the placebo effect, we can get the MRI scanner in on the act. Tor D Wager conducted a study in 2004 with a placebo cream he told the subjects would take away pain. He then inflicted pain on them and watched them in the scanner. Those who had been given the cream (the control group had nothing) showed "placebo effect patterns" in the prefrontal cortex. This part of the brain activates when anticipating pain relief and triggers a reduction of activity in pain-sensing areas of the brain. Wager suggests that this interplay within the prefrontal cortex may also trigger a release of pain-relieving opioids in the midbrain.

So when you look your toddler in the eye and kiss his boo boo better, you are probably setting this process into play. You could say, "let me trigger a reduction in your pain sensing brain activity", but "mummy kiss it better" works fine.

Your five worst medical nightmares

From a doctor amputating the wrong leg, to a woman given the wrong baby, hospital treatment does not always go to plan. Luckily, though, mistakes are rare

One unhappy patient … Kenneth Williams in the 1967 film Carry on Doctor. Photograph: ITV/Rex Features

It sounds like a classic nightmare – waking up during an operation to find you can't move. But that's what happened to one patient, Sarah Newton. "I was trying to scream. I tried to wiggle my toes desperately hard but I couldn't move anything." Thankfully, "accidental awareness", as it is known, is rare. A survey from the Royal College of Anaesthetists says it occurs once in every 15,000 operations under general anaesthetic, or 153 times in 2011 – and is usually brief and painless. But what of our other medical terrors?

Wrong site surgery

Usually the cause is a catastrophic series of administrative errors, such as when Dr Rolando Sanchez, a Florida surgeon, was told by a nurse that he was amputating the wrong leg of his patient just as he finished cutting through it. Luckily, with only 70 incidents recorded by the NHS in the year 2011-12, it is extremely unusual.

Wrong patient surgery

Never mind the wrong limb. How about operating on the wrong body? Sometimes there may be a mix-up over two people with the same name. Or similar procedures. The reality may not be as scary as it sounds – recently a patient in Cambridgeshire was given another patient's lens during eye surgery, although this was soon corrected. Plus there were fewer than 10 incidents reported in the UK during 2011-2.

Retained instruments

Leaving surgical instruments inside patients occurred 161 times in 2011-12. Often it's a sponge, which can lead to serious infections. The risk arises in emergency surgery, and in surgery on obese patients, but it is still very unlikely to happen to you.

Baby mix-ups

Despite being a common storyline in films or stories, there are few documented cases of mothers sent home with the wrong baby. But you have to ask: how would they know? In Romania in 2008, Cristina Zahariuc noticed because the daughter she was sent home with turned out to have a penis. Despite a few awful stories, the risk will be lower now that most babies stay with their parents immediately after birth.

Being treated by an impostor

Well, it has happened. In September 2011, 17-year-old Matthew Scheidt was convicted, of impersonating a physician's assistant in Florida. He dressed wounds, attended surgery, examined naked patients and even administered CPR. While New Zealander Richmal Oates-Whitehead treated victims of the 7 July 2005 bombings in London, despite not being medically qualified.

Ferdinand Waldo Demara managed fairly well when he conducted a series of major operations by speed-reading textbooks during the Korean war. And a man called Gerald Barnes even managed to impersonate a doctor, and be convicted of it, five times. Thankfully pretenders do tend to get caught.

Wave a banknote at a pundit and he'll predict anything

Of course it is outrageous to jail scientists for honest errors, but it is legitimate to hold them to some account

• 
• • Simon Jenkins
  • The Guardian, Thursday 25 October 2012 19.30 BST

Illustration by Satoshi Kambayashi

On the evening of 5 April 2009, Luigi Guigno of L'Aquila in Italy was phoned by a sister terrified by tremors under their village. He told her not to worry. Government experts in "the forecasting and prevention of major risks" had just been on the news declaring there to be "no danger" of an earthquake. They need not go out into the street. A few hours later an earthquake struck and Luigi, his pregnant wife, their son and 300 others were crushed to death.

This week a local judge jailed six of the scientists, not for failing to predict the quake but for giving what he regarded as reckless reassurances. He fined them £6m and disbarred them from public office. World scientists condemned the verdict as inquisitorial and medieval. Britain's Lord May said it ignored the basic nature of scientific inquiry. Luigi's relatives disagreed. A local official said simply: "Some scientists didn't do their job."

When a forester fails to predict that a tree might fall and it kills someone, he is arrested. The same goes for a train mechanic who fails to repair a carriage, a cook who poisons a customer and a builder whose house collapses. They didn't mean to kill, but they failed to forecast what might ensue from their defective expertise.

Why does the same not apply to the professional scientists, experts and pundits on whose predictive genius so much of our life depends? The answer is that they claim protection, either through (usually weak) self-regulation or by pleading Lord May's fifth amendment, that the nature of scientific inquiry exonerates them of harmless mistakes.

This week agriculture ministers were left floundering by conflicting scientific guidance on bovine TB and badgers. Transport ministers were humiliated by statisticians failing to predict revenue on the west coast railway. The Totnes MP, Sarah Wollaston, called attention to the hysterical 2009 swine flu "forecast", which panicked Whitehall into blowing £500m on dubious Tamiflu, whose test results it refused to disclose.

Yesterday we were told that the nation was recovering from a second "dip" in a recession, which its forecasters had failed to predict. This is despite government economists being served by ever more powerful computers and mathematical models. No one, to the best of my knowledge, has been called to account for this failure.

Science has rarely enjoyed greater status. Schools are in thrall to it. Broadcasters grovel at its feet, with hours of programmes devoted to children gazing adoringly at scientific researchers, depicted as funny, garrulous, lovable role models. Science has taken the place of religion in a cocoon of uncritical certainty. Those who claim the title "scientist", be it natural or social, expect to combine the immunity of diplomats and the infallibility of popes. Science is merging into scientology.

Of course, Lord May is right, that academic inquiry must proceed uninhibited by risk from error. That is what universities are for, and why they should stay independent of the state. But the Italian geologists were not doing research: they were paid to apply their expertise to keep the public safe. They were not researching, but advising. They failed catastrophically.

The truth is that there is one law for the officer class and another for the poor bloody infantry. When experts trained to detect seismic phenomena fail, their fraternity does not criticise or review their work, but treats them as innocent and relieves them of blame. If an ordinary worker miscalculates the risk, if trains crash, trees fall, rivers are polluted or foodstuffs rot, he goes to jail. The difference is not in class of error but in class of person.

Since the dawn of time, people have craved prediction against uncertainty. They have paid soothsayers, witchdoctors, stargazers and palmists. They ask journalists at parties: "Who is going to win the American election?" and seem cheated if the reply is "I just don't know."

Some people are paid to forecast. Their job is to make assertions about the future, assessing likelihood over a spectrum of certainty. When a scientist says this or that "will happen", we expect it to have greater credence than if he had merely gazed into the entrails of a sacred goose.

The worst offenders are meteorologists. A Devon entrepreneur, Rick Turner, declared last month that he would sue the Met Office for inaccurate and "persistently pessimistic" forecasts, which had cost his region millions of pounds in lost revenue. I hope he wins. The gloomy Met Office, seemingly in the pay of the outbound tourism trade, is reckless with other's people's livelihoods. The weather on the Welsh coast this summer was not ideal, but it bore not the slightest resemblance to the daily "forecast" of it on the radio. The sun shone for far more hours than it rained, yet the forecast kept people away in droves. And there was never any hint of correction or apology.

Prediction matters to people. If the variables are too great, science should shut up, rather than peddle spurious expertise. But you can wave a banknote in a pundit's face and he will predict anything you like. Of course, it is outrageous to jail scientists for honest errors, but it is not outrageous to hold them to some account. When did Lord May's Royal Society last inquire into a scientific scandal? Journalists, like bankers, are getting hell these days for their mistakes. Why let seismologists off the hook?

Closed drug trials leave patients at risk and doctors in the dark

 

Drug companies can hide information about their drugs from doctors and patients, perfectly legally, with the help of regulators. We need proper legislation

We need muscular legislation to ensure that all information about all trials on all currently used drugs is made available to doctors Photo: Alamy

By Ben Goldacre

8:13PM BST 25 Oct 2012

34 Comments

This week, Daily Telegraph readers have been astonished by revelations about the incompetent regulation of implantable medical devices. This paper has clearly demonstrated that patients are put at risk, because of flawed and absent legislation. But many of these issues apply even more widely, to the regulation of all medicines, and at the core is a scandal that has been shamefully ignored by politicians.
 

The story is simple: drug companies can hide information about their drugs from doctors and patients, perfectly legally, with the help of regulators. While industry and politicians deny the existence of this problem, it is widely recognised within medical academia, and meticulously well-documented. The current best estimate is that half of all drug trials never get published.
 

The Government has spent an estimated £500 million stockpiling Tamiflu to help prevent pneumonia and death in case of an avian flu epidemic. But the manufacturer, Roche, continues to withhold vitally important information on trials of this drug from the universally respected Cochrane Library, which produces gold-standard summaries on medicines for doctors and patients. Nobody in the Department of Health or any regulator has raised a whisper about this, though Roche says it has made “full clinical study data available to health authorities around the world”.
 

In fact, while regulators should be helping to inform doctors, and protect patients, in reality they have conspired with companies to withhold information about trials. The European Medicines Agency, which now approves drugs for use in Britain, spent more than three years refusing to hand over information to Cochrane on Orlistat and Rimonabant, two widely used weight loss drugs. The agency’s excuses were so poor that the European Ombudsman made a finding of maladministration.
 

Even Nice, the National Institute for Health and Clinical Excellence, plays along with this game. Sometimes chunks of its summary documents on the benefits and risks of drugs are redacted, because data has only been shared by companies under unethical “confidentiality agreements”. The numbers are blacked out in the tables, to prevent doctors seeing the benefits from a drug in each trial; and even the names of the trials are blacked out, as if they were code names for Russian agents during the Cold War.
 

This is a perverse and bizarre situation to have arisen in medicine, where decisions are supposed to be based on evidence, and where lack of transparency can cost lives. Our weak regulations have been ignored, and if we don’t act quickly, the situation will soon get much worse. The European Medicines Agency’s sudden pledges of a new era of transparency are no use: it has a track record of breaking such promises. We need proper legislation, but the new Clinical Trials Directive, currently passing through the European Parliament, does nothing to improve things.

Are you glazing over at the mention of European directives? This is where it all went wrong. Sunlight is the best disinfectant, but these issues have been protected from public scrutiny by a wall of red tape, while the people we trust to manage these complex problems have failed us. Regulators have lacked ambition. Politicians have ignored the issue. Journalists have been scared off by lobbyists. Worst of all, the doctors in medical membership bodies, the Royal Colleges and the Societies, even the patient groups – many of them funded by industry – have let us all down.

This must change. We need muscular legislation to ensure that all information about all trials on all currently used drugs is made available to doctors. We need the members of patient groups and medical bodies to force their leaders to act. And we need EU medicines regulators to be held to public account, for the harm they have inflicted on us.

Ben Goldacre is a doctor and author of 'Bad Pharma’ (4th Estate 2012)

Doctors' basic errors are killing 1,000 patients a month

The Independent 13 July 2012

Almost 12,000 patients are dying needlessly in NHS hospitals every year because of basic errors by medical staff, according to the largest and most detailed study into hospital deaths ever performed in the UK.

The researchers from the London School of Hygiene and Tropical Medicine and colleagues found something went wrong with the care of 13 per cent of the patients who died in hospitals. An error only caused death in 5.2 per cent of these – equivalent to 11,859 preventable deaths in hospitals in England.

Helen Hogan, who led the study, said: "We found medical staff were not doing the basics well enough – monitoring blood pressure and kidney function, for example. They were also not assessing patients holistically early enough in their admission so they didn't miss any underlying condition. And they were not checking side-effects... before prescribing drugs."

In one case a middle-aged man who had a cyst on his neck removed developed an infection. He was treated with antibiotics but medical staff did not realise he was not responding until it was too late and he died.

In another case, a 40-year-old obese woman was in hospital for three weeks while doctors investigated symptoms including vomiting and weight loss before discovering she had ovarian cancer. She was never given preventive treatment for blood clots – a risk of prolonged bed rest – and died of a clot on the lung.

The study was based on analysis of 1,000 deaths at 10 NHS trusts during 2009. Previous estimates have suggested up to 40,000 deaths a year are caused by errors in care but these have been based on international studies and have not directly linked the errors with the cause of death.

Dr Hogan added: "Hospitals must learn from careful analysis of preventable deaths and make every effort to avoid [them]."

Most of the patients who died were elderly and frail and suffering from multiple conditions. But some were in their 40s and 30s. More supervision by senior consultants was required to ensure junior doctors carried out proper assessment on admission and liaised with GPs and social services.

International evidence suggests one in 10 hospital patients suffers harm as a result of errors in their care, ranging from short-term effects from a wrong prescription to severe harm resulting from an operation on the wrong limb.

But the new study, published online in BMJ Quality and Safety, found errors of omission were more frequent than active mistakes.

Dr Hogan said: "The NHS in the future is going to have to look after very frail elderly patients as their numbers increase. Our systems are not robust enough to ensure we avoid harming them."

The authors say the quality of hospital care should be assessed on the basis of harm caused by errors, rather than on deaths. "If 95 per cent of deaths in hospital are not due to preventable poor care, the scope for hospitals to demonstrate reduction in their mortality rate is limited," they say.

A Department of Health spokesperson said it was an important study which revealed a picture of preventable deaths.

"Patients have a right to expect the very best care from the NHS. Any preventable death in hospital is unacceptable and we expect the NHS to ensure patients receive high-quality, safe and effective care. We know that data like this can help hospitals to improve services," said the spokesperson.

Man who died of dehydration was killed by hospital neglect

Neglect by medical staff led to a man dying of dehydration in a hospital bed, a coroner has ruled. Medical staff at St George's Hospital in Tooting, south London, did not give Kane Gorny vital medication to help him retain fluids. The 22-year-old, who was a keen sportsman, even phoned police from his hospital bed as he was so desperate for a glass of water, the inquest heard. Deputy Coroner Dr Shirley Radcliffe told the hearing: "A cascade of individual failures has led to an incredibly tragic outcome."

She recorded a narrative verdict at Westminster Coroner's Court and said Mr Gorny had died from dehydration contributed to by neglect. Dr Radcliffe said: "Kane was undoubtedly let down by incompetence of staff, poor communication [and] lack of leadership, both medical and nursing."

James Stevenson, the solicitor for Mr Gorny's family, said they were "devastated by the number of missed opportunities" to prevent his death.

The power to say no

Pritish Nandy
02 January 2012, 09:18 PM IST

Share on Hotklix

Share on Messenger

Share on StumbleUpon

Share on Yahoo Buzz!

Share on Digg

Share on Reditt

Google Bookmarks	Newsvine
Live Bookmarks	Technorati
Yahoo Bookmarks	Blogmarks
Del.icio.us	ApnaCircle
inShare

4

My worst failing is my inability to say No. This year I intend to correct that. I will clearly and unequivocally say No when I want to. Not a Maybe or a Perhaps; a straight, categorical No.




For people like me it’s not easy. We were brought up being told that No is impolite, rude, and politically incorrect. There are nicer ways to turn down a request. You can gently fob it off. Or procrastinate. Or do what my friend Husain, the painter, always did. He said Yes to everything and promptly disappeared. Poof! People have waited for him to inaugurate an event in London while he went off to New York for a party. No, Husain never allowed a commitment, any commitment to burden him. He happily failed each, knowing fully that he will be forgiven for his indiscretions. He blamed it on his poor memory. But memory had nothing to do with it. Insouciance did.


My friend Mario was identical. He did hundreds of cartoons for me when I was editor, but never on time. Give Mario a deadline and you could be sure he will miss it. He completed every assignment but in his own time. I remember he once came to me with a cartoon so late that I had forgotten what it was for. But no, he never said No. He was always polite, always proper and agreed to any deadline I set him because he knew he would not have to keep to it. We decided to do a book together, of naughty limericks, largely based on Indian politics. I waited three years for him to complete the drawings. By the time they were ready, I had lost the manuscript. (We didn’t have computers in those days and typescripts were easy to lose.)


I smoked my first cigarette at 7 because I couldn’t say No. I downed my first whisky at 9, smoked grass at 11, all because I couldn’t say No. Luckily I found it all quite boring and so, by the time I was 16, it was all over and I was ready to take on life on my own terms. Minor addictions have never distracted me since. I listen to Vivaldi, read Dylan Thomas, try to figure out why Damien Hirst is such a vastly over rated artist. I can spend all day listening to Mallikarjun Mansur and marvelling at his genius if only I can say No to a million silly, irrelevant commitments I pick up, for people I barely know.


My father died because he couldn’t say No to a doctor, a family friend in Jabalpur who convinced him that prostrate surgery was the easiest thing on earth, and he could do it in his own nursing home. By the time I heard of it and rushed there, he was already in a coma from which he never recovered. We finally pulled the plug on him. My mother lost our family home in Kolkata because she couldn’t say No to her landlord, who requested her to give up her decades old tenancy because his family had grown, needed more space. Even before she packed up her meagre belongings and came to me here, the landlord had sold off the house. Yes. Life makes suckers of us all. Especially those prone to saying Yes.


I was reading the cover story in a news magazine recently which argued that the most important thing you can tell your doctor is No. Most people suffer because they say Yes and get lumped with medication they don’t need, tests that are not necessary, and surgeries they could have done without. This is true at the dinner table as well, or in a restaurant. The more often you say No to the lip smacking food there, the better your health will be. The day we can say No to all the candidates when voting, the quality of our politicians will improve.


Life is a honey trap. Everyone’s waiting for you to say Yes. The moment you do, you are entrapped by absolute, arrant nonsense, breathtakingly packaged, aggressively promoted, seductively laid out in front of you, and completely irrelevant to your life or well being. The wise man says No. The fool succumbs. 2012 is my year to say No. An emphatic, easy No. Like Eric Bana told his handler in the last scene of Spielberg’s masterpiece, Munich. If a patriot who risked his life hunting down terrorists can say that, so can you and I.

Socrates - Requiem for a wise man!

 

Nirmal Shekar

AP Former Brazil's soccer player Socrates

The Socrates persona was as contradictory as it was compelling

HE was a hard-drinking, chain-smoking free thinker grappling with the higher reaches of truth passed on to posterity by Friedrich Nietzsche and Karl Marx in an awesome Victorian auditorium of a Rio de Janerio University.

He was a head-banded, flamboyant young man with curly brown locks unlocking the splendour of Brazilian country music to an entranced audience.

He was a fiery-eyed left-wing activist, a Che Guevara-type radical spouting slogans while leading a student march to restore democracy in his country.

He was a professional paediatrician hugging sick children at a UNICEF health camp with the missionary zeal of a Mother Teresa.

Socrates Brasilero Sampio de Souza de Oliviera, who passed away on Sunday in Brazil, was all of these…and more. He was one of the most gifted players produced by the greatest of soccer-playing nations, Brazil, in the post-Pele era.

Rebel with a cause

A rebel with a cause, Socrates had a stupendous ability to combine stardom with creative ability on the field. His one-two passing symphony with his team-mate and friend Zico had a Mozartian magnificence.

As the eldest of a middle-rung government official's 10 sons, as a brilliant young medical student, Socrates was intensely in search of an identity in the fragmented world of the late 1970s.

“I am not a footballer. I am a human being,” he screamed at mediapersons early in his career, apparently fed up with their one-track line of questioning. It was the cry of a man trying to free himself from the chains of a media-manufactured image, the struggle of a very intelligent human being trying to shake off a straitjacket.

It is this protean quality that set Socrates apart from some of the most brilliant players of his era. Deeply rebellious against the over-ordering of life, on and off the football field, he was quintessential nonconformist.

“He would sing a song and all of us wound enjoy it. Then, almost suddenly, Socrates would go into a shell, an impenetrable shell of his own. We knew him, yet we did not know him,” said a team-mate of his when Socrates was playing for the Sao Paulo giant Corinthians.

 

Multi-faceted persona

To be sure, it would take more than an average footballer to have come to terms with Socrates' multi-faceted personality. For, the Socrates persona was as contradictory as it was compelling. He was a man in search of individual freedom in an age ruled by conformity and organisation, both in and out of football.

If you ever saw a cold-blooded master of life's capriciousness — someone with knowledge of Nietzsche's amor fati — then you can picture Socrates striding back nonchalantly after missing a crucial penalty in a World Cup semifinal against France in Mexico.

It is not as if Socrates was an incurable eccentric with a finger on the self-destruct button. He loved the game as much as he loved anything else in life. But he knew sport was just sport, not a matter of life or death. He would have been more devastated by the death of a child in a Rio health facility than a missed World Cup penalty.

 

Doctor for the poor

Never one to beat around the bush, Socrates admitted early in his career that it was for big money that he temporarily abandoned his life as a doctor to become a footballer. “As a footballer, I get much quicker to the financial stability I need to be what I want to be: a doctor for the poor,” he said.

On the field, he was a master. With Zico and Falcao, he was part of a midfield that was rarely matched in the entire history of the game. So confident were these men about their own skills that they ignored their defensive weaknesses as a resurgent Paolo Rossi of Italy claimed a hat-trick to dump them from the 1982 World Cup.

He made his presence felt in the 1986 World Cup too, but soon the game was up for Doc. But another one, perhaps more rewarding — serving the poor as a doctor and becoming a sagacious commentator on television — began.

“Life is not about quantity. It is about quality,” Socrates said over 30 years ago. By modern standards, he died young.

He drank his way to his grave, like so many other sportspersons. But the difference is, he was a wise man who did know exactly what he was doing. It was his hemlock.

Medical Errors - Eighth Leading Cause of Death in the US

According to the Institute of Medicine, between 690,000 and 748,000 patients are affected by medical errors in the US every year and between 44,000 and 98,000 die from them. Even this low ball estimate makes medical mistakes the eighth leading cause of death worse than breast cancer, AIDS and motor vehicles accidents. It also makes medicine far more error prone than high-risk fields. For commercial aviation to take the same toll in the US as medical errors do, a full-up 747 would have to crash every three days, killing everyone on board.

More troubling is the medical profession's traditional response to these disturbing statistics, which has largely involved evasion, obfuscation, minimisation, defensiveness and denial....

"Observing more senior physicians, students learn that their mentors and supervisors believe in, practice and reward the concealment of errors. They learn to talk about unanticipated outcomes until a mistake morphs into a complication. Above all they learn not to tell the patient anything."  - Nancy Berlinger in After Harm.

Extracted from Being Wrong by Kathryn Schulz