Drugs, part 1: can we trust Big Pharma?

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Seeking to replace Warfarin as a blood thinner, Duke Clinical Research Institute ran a trial that ended with approval of the drug Xarelto. However, later the blood testing device malfunctioned. Duke did further tests and published a letter in the New England Journal of Medicine saying that the problems with the machine did not affect the trial results. The data from these results would have allowed a comparison with the device’s readings, but were suppressed. Meanwhile, 5000 lawsuits have emerged that claim patients have been harmed by Xarelto, and the European Medicines Agency found the machine to be highly inaccurate. This case has caused a change in the way that journal articles are published. Authors are now required to disclose their outside financial interests and the role drug companies, in this case Johnson & Johson and Bayer, played in the articles’ publication.

Can we trust these drugs and the companies who sell them, and, in America, pour mega-dollars into TV advertising? I myself am taking a certain drug, and only found out on the internet that it is implicated in damage to kidneys, bone fracture and even memory loss. Yes, you have to make a judgment as to whether the beneficial effects of a drug on an immediate medical condition outweigh the possible side effects, but it makes you wonder whether it’s worth taking anything at all. The old saying holds: caveat emptor.

The cost of pharmaceuticals can be ridiculously high, even for drugs developed twenty or thirty years ago.  It is one thing in Europe, where there is only effectively one purchaser per nation (the National Health Service in the UK); the monopoly buyer in this case has real power, and this is just what American Big Pharma fears and spends money on resisting at all costs (“socialised medicine”).

No, in my opinion we cannot. blindly trust the pharmaceutical industry. The profit motive seems to come first before the health of the public.  The  horrendous spread of opioid dependency, which is doing untold damage in the US, is a case in point.  Actions taken by the industry to limit the problem have been too little, too late. “Free enterprise” run riot.

( The writer used to work for an international pharmaceutical company.  At the time the industry referred to itself as “the ethical pharmaceutical industry”.  I guess most of it was ethical at the time, or tried to be, although salesmen offering business gifts to doctors always seemed to me to be a dubious practice. Today, the ethics of the industry seem ever more muddied).

 

 

 

 

 

The lessons of history – known and learned, or cast aside?

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This last Sunday marked  the centenary of the Battle of Passchendaele – one of the bloodiest of World War One.   Officially known as the Third Battle of Ypres, Passchendaele was fought between 31 July and 6 November 1917 in the West Flanders region of northern Belgium. About 275,000 Allied troops and 220,000 Germans died.   In a very moving ceremony, shown on television, Prince William joined the King of Belgium in laying wreaths at the Menin Gate in Ypres.  The gate – which stands where British troops marched when heading to the battlefields – is covered with the names of 54,391 British dead who have no known grave.

The slaughter of that unbelievable number of young men has left its indelible mark upon the historical memory of most Europeans, regardless of which side their nations were on in the brutal, cruel and senseless First World War, and later, the equally destructive Second World War that grew out of the policies of revenge adopted after the First war.  It was to prevent such disasters happening again that those nations joined together to form the European Union.

A hundred years later the British Prime Minister, Teresa May,  also laid a wreath on behalf of  a British government that, one hundred years later, almost to the day, is leaving the EU and thus helping once again to destabilize Western Europe, not to mention Great Britain.  Is she capable of connecting the dots?  Has she any grasp of European history or the endless, futile wars that have plagued it? Does the irony of what she is so intent on doing register with her, do you suppose?

Attitudes towards gay rights in Britain

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Generally speaking, Britain is a socially liberal country, at least relative to the rest of the world. So most people assume the country is one where being openly gay is accepted. We have gay marriage, unlike much of the rest of the Europe and most of the rest of the world. Britain’s isn’t a country where socially conservative religions are particularly prominent, Northern Ireland notwithstanding. The UK is home to a plethora of charities and NGOs like Stonewall or Amnesty International, who help defend gay rights around the world. Recently, the government wants to enhance Britain’s reputation for tolerance by making it easier to change your gender, thus hopefully establishing the nation as a haven for the transgendered.

However, the reality is more complicated. YouGov, one of the few polling agencies to accurately predict the 2017 election, conducted a poll on people’s attitudes to gay rights. http://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/ox04ln7wgb/PinkNewsResults_170724_Sexuality_W.pdf. They asked three questions: whether you approve of gay men becoming parents, whether children should be taught about gay relationships at primary school, and whether gay sex is natural. On all three questions, a majority of people gave the gay-friendly answer (excluding the don’t knows.) But there were some interesting caveats.

The first was support for gay rights by party affiliation. On all three questions, Conservative voters bucked the nationwide trend and generally opposed gay rights. This suggests that by passing gay marriage and now by extending transgender rights, the Conservative Party has largely acted against the wishes of its supporters. Now that isn’t necessarily a bad thing- the party badly needs younger and more liberal voters if it wishes to regain its majority. But it does mean that for now, a significant proportion of Conservative MPs will not hold gay-friendly views, even if they can’t translate such attitudes into public policy. Therefore, if as a gay Briton, you don’t believe that the fight for gay rights has been won, it may be safer not to vote for your local Conservative MP- as a precaution if nothing else. It’s also worth pointing out that Labour and Liberal Democrat voters support gay rights emphatically, suggesting that there aren’t very many socially conservative ‘Blue Labour’ people out there.

The second cleavage in public opinion was the Leave-Remain Brexit divide. Remain voters were far more gay-friendly than Leave voters. Now I’m not suggesting that all Leave voters are homophobes, but YouGov’s data certainly suggests that they are more likely to be. I think this is largely due to Remain voters being more liberal across the board. Remain voters, myself included, value individual freedom very highly. Conversely, Leave voters value social cohesion, a strong sense of identity and collective sovereignty above individual liberty. For some who supported Leave, gay people don’t fit into their preconceived notions of what being British involves. This also suggests that nostalgia for an earlier time played a key role in driving the Leave vote. Nostalgia is generally expressed more by social conservatives, because Britain in the past was a more socially conservative country. Many who voted Leave don’t like what modern Britain has become. Part of this is for economic reasons; they miss the secure, well-paid blue collar jobs that are a rarity now. But they also like Britain’s past social makeup: the gendered nature of the labour market and household, the relative ethnic homogeneity, and of course, the lack of prominence given to homosexuality.

Another interesting divide was the gender divide. Now this wasn’t as stark as the party affiliation or Leave-Remain divide. But the fact is, men are more likely to oppose gay rights than women. Growing up as a young boy in Britain, I remember that being called ‘gay’ was the worst insult you could be called. I even cried once when someone called me gay. For some reason, male homosexuality seems offensive to a lot of men. It is perceived as a threat to traditional notions of masculinity. Some men don’t like how camp the stereotypical gay man is, or how gay men seem to find it so easy to talk to women. It may also be the case that men are simply more intolerant than women, at least overtly. Go to any far-right rally or march, and it will be overwhelmingly male. Conversely, go to any protest against environmental degradation or income inequality, and the chances are it will be majority female.

The widest division found in the poll was the generational divide: young people are far more in favour of gay rights than their elders. I don’t find this surprising at all; the old grew up in a time when people weren’t taught about gay relationships at school. It’s encouraging that attitudes have improved over time, and as the young replace the old, they will continue to do so. But it’s important to remember not to alienate the old, whether it’s in public policy or the culture. This doesn’t mean being homophobic at all. But it does mean being patient and courteous to the elderly when challenging any attitudes they may still hold. It means explaining to them what homosexuality is and how gay and lesbian people live, rather than shouting at them and accusing them of being bigoted. Like everyone else, the elderly are products of their time. I think more people ought to consider that.

In my opinion, the most interesting contrast was the attitudes between the relatively well-off and the less fortunate. The richer respondents to the poll were generally very enthusiastic towards gay rights, whereas the working class participants were more divided. The class divide on gay rights has all sorts of implications. It means by emphasising their social conservatism, the Conservative Party will always have at least some working class support. Equally, by being very progressive, the Liberal Democrats are unlikely to shake off their reputation as a middle class party. Unfortunately, the poll at least somewhat confirms the stereotype that exists amongst the middle class, that the working class are less tolerant. It may be that social conservatism is partly a product of material hardship; when people are struggling economically, they are less likely to believe that those who face social discrimination are really struggling. Hence, social conservatives are less likely to believe that homophobia, sexism, racism and xenophobia are widespread. But there’s cause for optimism here. If we can improve the living conditions of the working class, we may also be able to diminish opposition to liberalism at the same time.

The only other breakdowns in support for gay rights measured in the poll were regional and in terms of sexuality. In the case of the latter, gays, lesbians and bisexuals were emphatically in favour of gay rights, obviously. In the case of the former, London and Scotland were the most gay-friendly, the Midlands and Wales were generally the most hostile. There was a very slight North-South divide, with the South being more liberal, but nothing statistically significant.

Overall the poll is a reason for optimism. Britain is a country where the gay and lesbian community is generally welcomed and accepted, and that isn’t likely to change anytime soon. But the poll also implies that socially conservative Britain is deeply alienated from and disillusioned with wider society. It found that older people, poorer people, Conservative voters and men were more opposed to gay rights; these were the same groups that voted for Brexit, hence the relative lack of enthusiasm for gay rights amongst Leave voters. However, as I explained with the elderly, the solution is not to insult people or exert a sense of moral superiority. These people face some severe challenges that many of the rest of us are far less likely to experience. Older people are often economically vulnerable and physically in poor health. Poorer people obviously face a tougher time than the rich. Men die younger and commit suicide at higher rates than women. As a society, we must address these issues, rather than pretend they don’t exist by dismissing people as homophobes. Or else, social conservatism and right wing populism will persist for decades.

Best of the Week #9

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If you’re anything like me, you’re probably a very opinionated person. You will have views on all sorts of things, from the best flavour of ice cream to the true meaning of life. Now having such a vast array of opinions can be fun. It makes you a more interesting person, because you’ll have a unique perspective on things. It gives you something to discuss with others. It makes you more intelligent, as having strong opinions requires a lengthly and time-consuming thought process, where you spend time consuming and analysing information. Unless your opinions aren’t well thought out, in which case having them can make you seem ignorant or arrogant.

Like many of us, Epicurus was certainly opinionated. But he also believed that a pleasurable life derived from an absence of stress and conflict. On occasion, holding an expressing opinions can be a very fraught affair, in which neither you nor those you talk to come away having enjoyed themselves or learnt anything. The problem with society, particularly in polite and respectable circles, is that we are expected to have opinions on everything, however ill-informed our judgement really can be.

Which brings me to this week’s article, written by Lara Prendergast https://www.spectator.co.uk/2017/07/why-must-i-have-a-strong-opinion-about-everything/. For Prendergast, her position as online editor of The Spectator means she is expected to have opinions on all of the topics her magazine covers. But in reality, it isn’t reasonable to expect her (or anyone else) to hold definitive views on such a vast array of subjects. Particularly if you pride yourself on your judgements being based on a great amount of evidence and reasoning, not mere assertion. Nowhere is this more true than in the academic world, where professors and lecturers are expected to know a great deal about their specialist field, but far less about anything else. It wouldn’t be reasonable to ask an economist their views on international relations, even if the economist had some interest in the subject. Even within subjects this principle applies; a 20th century British historian could not be expected to analyse the fall of the Roman Empire.

The importance of withholding an opinion has increased in recent years. Prendergast gives two reasons. The first is that the world has become more complicated, with issues being commonly discussed that didn’t even exist a few years ago. Now we are expected to hold views on everything from driverless cars to 3D printing. For the older generation, this can seem daunting. The world isn’t just becoming more complicated in terms of science and technology, but also in terms of social change. As the world becomes more globalised, we are expected to hold views on other cultures, religions and races, even if we’re totally unfamiliar with them. If you asked me about the experience of black people in Britain, I wouldn’t have the first idea.

The other problem with giving an opinion is the simultaneous rise of political correctness and hyper-partisanship, with has increased the social penalties for expressing the ‘wrong’ opinion. Social conventions about acceptable and unacceptable speech have always existed; many religious societies have long been intolerant of what they consider to be blasphemous views. But in modern society, political correctness has been secularised. If you say that abortion ought to be completely unregulated to a group of Republicans, or that illegal immigrants ought to be deported en masse to a group of Democrats, you can expect a harsh and occasionally violent backlash. If expressing a view will cause conflict, it may be better to just not express the view at all.

Prendergast comes to a few conclusions, all of which I agree with. People are encouraged to express opinions too hastily, when the priority ought to be learning the facts. Social media has created intellectual bubbles where people are used to only hearing opinions that concur with their own, so any that runs contrary to what they usually hear seems inflammatory. However, none of this means that opinions are bad. Like Prendergast, I love expressing and hearing different perspectives- it’s a large part of why I contribute to this blog. But at the same time, we ought to be refrain from giving our judgement more often. Opinions should be reserved for situations where they will be heard respectfully, by people well-informed enough to give a proper response to them. No one has the right to demand to go unchallenged, regardless of the situation. Opinions should also be only given when they can be properly explained. One of the pitfalls of social media, especially Twitter, is that this often isn’t the case. Moreover, out of politeness, the person who started the conversation on a topic ought to be given the last word. This is just so that discussions can be ended as genially as possible, instead of everyone fighting to get their say long after it should have ended.

 

Eight Epicurean counsels

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Epicureanism was never meant to be a dry academic philosophy. In fact, it is best kept away from academia, where, as usual with philosophy, long words render it dull, if not incomprehensible. Rather, it is a vital way of living that seeks to free men and women from a life of unhappiness, fear and anxiety. It is a philosophy for the practical-minded with common sense. While Epicureans have written scholarly works, they have always been most interested in explaining Epicureanism in a manner simple enough for anyone to understand and remember:

1) Don’t fear God.
2) Don’t worry about death.
3) Don’t fear pain.
4) Live simply.
5) Pursue pleasure wisely.
6) Make friends and be a good friend.
7) Be honest in your business and private life.
8) Avoid fame and political ambition.

I would add: think of others; be polite and considerate; try to see the other point of view; meet others half way, if possible. Take the smooth and pleasant road, as free from stress and conflict as possible. But don’t be put upon!