Turkey regresses

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For many years Turks were very pro-Western. Indeed, they considered themselves part of the West. But, maybe, partly because the EU members baulked at Turkish EU membership and the cultural upheaval it might cause, Turkey is undergoing its own cultural upheaval, where the authorities are insisting on ethnic, religious and historical distinctness from the West. Secularism fades as the number of religious schools rises. Evolution is disappearing from the curriculum, and the objective in schools is to raise “a pious generation”. The Turkey of Kemal Ataturk is disappearing, and the country is sliding back into xenophobia and chauvinism. Rapprochement with a newly resurgent Russia is threatening NATO.

An historian once postulated that religions have surges and fall-backs. Islam surged under the Prophet, of course, fell back during the later middle ages, had a surge (into Western Europe/ Vienna) in the 17th Century, fell back under Western colonialism, and has been surging back with a vengeance recently, maybe under the threat of technologies it cannot combat. For whatever reason, the fact is that, hidden from our sight there are tens of thousands of Turks who passionately support and defend pluralistic democracy. There is a dicotomy in Turkey between the modern West of the country and the mass of Anatolia, which never really accepted the changes Kemal Ataturk made. Two countries, really.

I remember a conversation with a young Turkish businessman on a plane trip. He told me that he and his friends bought into Western ways in toto. His English was perfect and he loved visiting London. But, he said, travel a hundred miles east of Istanbul and it is like time travel back into the 13th Century.

What are we doing to support these educated, Westernised Turks (who haven’t been bullied or arrested)? Trump will do nothing – he is frightened of moslems; terrorists, don’t you know.
We should offer them a safe home in the West – they would be an economic asset.

Are American men in crisis?

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According to some commentators, American men are in crisis. For Democrats declining workforce participation rates, rising suicide rates and increasing drug use are symptomatic of an economy that is too weak and rigid to offer men the opportunity they need to thrive. Republicans prefer to focus on social causes of men’s woes: the rise of feminism, the decline of the man as the chief breadwinner, the decline of marriage and family responsibility, and a culture that increasingly insists masculinity is ‘toxic.’

It’s certainly the case that the ever-radical nature of modern-day feminism can make the notion of men as victims taboo. Too often it is assumed that because women have faced gender discrimination on a scale and intensity that men haven’t, men cannot face particular challenges of their own. America ought to be mature enough to recognise that both men and women face different hardships. Starting arguments on which is the more oppressed sex isn’t helpful when trying to make good policy.

It’s also the case that many American men feel purposeless and lost in the modern world. With the decline of traditional manufacturing and resource extraction jobs, men often find it hard to navigate the new economy. Being unable to provide for their families can rob a man of his pride. American men are more likely to commit suicide, more likely to be involved in a crime, more likely to take drugs or abuse alcohol, and are certainly far more likely to be addicted to porn. The 2016 presidential election had an unusually large gender gap, and for good reason. Trump spoke to the men who feel uneasy with the direction America is headed. Conversely, Hilary Clinton was the archetype of the sort of woman who loves modern America: wealthy, college educated, socially liberal, feminist, at ease with America’s ethnic transformation.

Having said that, the conservatives who seek to blame feminism and/or liberalism as the primary causes of men’s plight are deeply mistaken. Empowering women does not come at the expense of men. Female labour force participation rates have risen considerably over the past fifty years, yet men’s wages continue to increase unabated. American feminism, at least outside the most radical college campuses, does not view masculinity as evil, so long as it does not come at the expense of women’s freedom.

Rather, men are suffering from a lack of personal responsibility. Increasingly, they blame women for unsuccessful marriages or failed relationships, instead of self-reflecting at their own faults. They turn to substance abuse and junk food, instead of taking responsibility for their own health. And rather than re-educating themselves to adapt to the modern economy, they drop out of school or college, and then blame politicians for changes to the economy beyond anyone’s control. Due to the increasing importance of knowledge-based services, and the increasing number of highly educated, career-orientated women, men can no longer simply be mediocre at school, and then expect the jobs and the women to come to them. It takes time, effort and forward planning to be successful. And partly thanks to the #metoo movement, old-school chivalry is making a comeback.

I understand that some social and economic changes America has experienced haven’t been to men’s benefit. But the men’s rights movements, and other right-wing phenomena that make men out to be hapless victims of middle-class feminism, are completely deluded. American men ought to take responsibility, work hard, be courteous and respectful, and seize the opportunities the modern world affords. And with a bit of determination, they can build careers, relationships and families to be proud of.

Over-diagnosis in medicine

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Sometimes it can be better to do nothing.

Some in the American medical profession are concerned about the dangers of overzealous medicine. There has been a trend towards detecting health problems too early, convincing healthy people they are sick, and treating them too aggressively.

The latest research, published in December in the Journal of the American Medical Association, is a pointer. It found that in US hospital regions with high rates of CT scans – which are typically ordered to check the lungs and abdomen – many more kidneys are removed. Doctors can see the kidneys too, and often stumble on innocuous cancers that are never going to bother the patient. 1 in 50 of those who undergo the surgery die within a month.

With biomedical companies designing ever more tests, such as breath-tests for cancer, the problem is only going to worsen. A person who presents with, say hoarseness of voice, gets a CT scan that finds a minor tumor somewhere else in the body, which might merit close watching over a period, but is promptly removed in unrelated surgery.

Cancers can grow quickly and some slowly; some even vanish on their own. There are the cancers, which have already spread before tests notice them, and cancers that can be treated before they spread if caught early – and cancers that never spread at all. A new test (liquid biopsy) will tell you that you have cancer, somewhere, but can’t tell you where. This then poses question, ”How many fruitless tests will you have to go through to find the growth that may never do you any harm?”

Take breast cancer: some doctors think mammograms are over-used. Screening in the US has found many non-progressing breast cancers, but has helped very little in catching fast-progressing cancers early on. Among 1000 women who are screened every year for a decade from the age of 50, roughly one will avoid death through breast cancer, more than 500 will have at least one false alarm and 10 will be treated needlessly. Meanwhile, women are naturally anxious as they wait for a biopsy and about the risk of undergoing chemotherapy for a cancer that is basically benign. (Based on an article by Wendy Glauser, New Scientist)

There is a temptation to blame the medical profession alone for over-diagnosis. After all, they have, in America (in contrast to Europe), a heavy financial incentive to treat as much as possible. But the truth is more complicated. Many (not all!) patients, too, want to treat every condition they are subject to. A huge part of Medicare expenditure is given over to treating a small number of rich, old people to keep them alive, come what may. It must be hard to say “no”. Do people want doctors to deal just with pressing, acute problems, or use the modern power of medical technology to search diligently for something, anything, wrong? I fear – the latter. And up go the premiums!

Epicureanism and how to treat others

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A propos my comments on Judge Kavanagh and how a gentleman could have replied to the sexual allegations, I fear drop-dead insensitivity seems to have spread from small, powerful groups of badly brought-up human beings to other parts of the population.

Yesterday, I received a phone call asking me to spend 15 minutes on a hospital survey. I have just undergone a major piece of surgery, am continuously exhausted, still in pain, rely on my wife for mostly everything, and have had less than 12 hours sleep in the past week. Would I take a survey on the hospital experience?

NO!

Now had the survey-taker started off, “I gather you have had a major operation at X Hospital. I’m so sorry. I hope the operation has been a success, you were well treated and are starting to feel a bit better. I wonder if you are up to helping us with a survey that might make the hospital experience better for everyone? If not, I understand”. Had the woman started off in this vein I would have cooperated. But I told her, ”This is not your personal fault, but it is too early, I have no perspective on the experience, am not in good shape, and I consider the timing premature, if not insensitive. No, thank you.”

What has this to do with Epicureanisnm? EMPATHY! plus sensitivity and an understanding of how to handle people tactfully, not bludgeon them and get their backs up. This no longer seems to be understood in some quarters, which is why we have to fight back against the people who are 110% invested in themselves alone, and their objectives, and have little time for working out how real human beings feel and how to win them over.

“Taking back control” in Britain

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The endless battles over Brexit mean that few politicians are “seriously engaged” in thinking about “how the world might look after our departure”. It’s time they started. “Simmering resentment with the power of Whitehall” could well ensure that it becomes the next target of “a growing urge to take back control”. In terms of taxes, the UK is by far the most centralised country in the Western world: only about 5% of tax revenues are raised locally, compared with nearly three times that amount in France, and a near 50-50 split in Canada and the US between federal and municipal taxes. Campaigners want change, arguing that “true local power requires the devolution of tax and spending to go hand in hand”, and that local government should also be handed “substantial regulatory control”. At present, local discretion over policies, from land planning to public health, is minimal, “and the ability to liberalise, rather than tighten, rules is almost non-existent”. No wonder we are seeing a “popular rebellion against opaque and concentrated political power”: we need “a new constitutional deal within the United Kingdom”. (Mark Littlewood, The Times, August 2018)

Amen to that! The rot started with Thatcher, who objected to a local democracy that diluted her power. Since her time things have become steadily worse, until it is barely worthwhile standing for local councils because they have no influence. The power has passed to the rich and the corporations, and to a giddying succession of incompetent Whitehall ministers.

It is.time for the people to seize back control. Unfortunately, assuming that Brexit goes through (this week’s Salzburg EU meeting suggests the real threat of “no deal”, mainly over the status of Northern Ireland), it is more likely that an extremist right-wing Tory cabal will attempt to seize power and centralise even further. The British people expressed dissatisfaction with the status quo in the Brexit referendum. Unfortunately they were voting on the wrong issue with the wrong government in charge. The problem isn’t Brussels; it is London.