Monthly Archives: April 2018

ONLY THE LONELY KNOW THIS FEELING’S AINT RIGHT…

Can loneliness trigger off disease? And if so what form does it take?

Sometimes it is self-imposed, especially when a wife or partner of many years is no longer there. Depression of a rare kind takes over for which no practical reason is fully justified. A new liberty of movement often turns to seclusion, whereas in normal circumstances it should create new horizons rather than social isolation.

Loneliness, it seems, raises the risk of a heart attack by more than 40 per cent; a major study published recently also suggests that social isolation can increase the chance of a stroke by 39 per cent and premature death by up to 50 per cent.

The analysis is based on the health records of 480,000 Britain’s making it the largest study of its kind. Those who already have cardio-vascular problems were far more likely to die early if they were isolated, suggesting the importance of family and friends in aiding recovery. The research team, which included British academics, said lonely people had a higher rate of chronic diseases, were smokers and showed more symptoms of depression.

Christian Hakulinen, the University of Helsinki academic who led the study, concluded that having few social contacts was a risk factor for early death, particularly among those with pre-existing cardio vascular disease. ‘The message is that if we target the conventional risk factors then we could perhaps reduce the cardio vascular disease among those who are isolated or lonely,’ said Dr Hakulinen. ‘It is also important we show that those who are socially isolated might have a worse prognosis after a heart attack or stroke.’

Scientists from University College London and Finland traced the 480,000 Britain’s aged 40-69 for 7 years. Social isolation was associated with a 43 per cent higher risk of first time heart attack when age, gender and ethnicity were factored in. Other life styles and socio-economic factors were taken into account; this explains 84 per cent of the increased risk, suggesting the lonely and isolated were most vulnerable to well-known risks. Similarly, social isolation was associated with a 39 per cent heightened chance of a first time stroke, but the other conventional risk structures accounted for 83 per cent of it. The results were similar for loneliness and risk of first time heart attack or stroke, according to the study, published in the medical journal Heart.

Those who already have cardio vascular problems were 50 per cent more likely to die if socially isolated and still a quarter more likely to die once known risks had been accounted for. More than half of all people aged 75 in Britain live alone and more than a million are believed to suffering from chronic loneliness.

Helen Stokes-Lampart, who chairs the Royal College of GPs, said; ‘Loneliness could have a devastating impact on long term health.’ She said: ‘The reality is that loneliness and social isolation, particularly for older people, can be on a par with terms of its impact on health with suffering from a chronic long term condition as this study shows, increased the likelihood of developing serious conditions such as heart attacks and strokes. On the frontline, GPs are, our teams report, seeing patients on a daily basis whose underlying problems are not primarily medical but who are feeling socially isolated or lonely. As well as being distressing for patients, loneliness can also have a real impact on General Practice and the wider NHS at a time when the whole system is facing intense resource and workload pressures.’

The College said it was working with charities, the community and voluntary groups to draw up a manifesto to present to government to tackle loneliness.

Loneliness, as well as social isolation, as I said at the outset of this piece, are tantamount to a disease whether self-imposed or due to personal circumstances and, as such, are not to be taken likely.

No Longer With Us

SIR DOUGLAS BLACK

Douglas Black is one of Britain’s most respected medical figures. Born in Scotland in 1913-2002 he rose to become professor of medicine at Manchester University, a post he held for nearly twenty years. In the early 1970s he was chief scientist at the Department of Health and Social Security, and from 1977-80 he chaired the Research Working Group on Inequalities in Health, which resulted in the publication of the controversial Black Report. He has published extensively in medical journals and was president of the Royal College of Physicians from 1977-83.

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I interviewed him in 1997. Here is what he told me then.

You were a son of the manse and grew up in Scotland. How far did these two factors influence and shape the man you became?

Being brought up in Scotland gave me the accent you can hear, and being a son of the manse gave me the twin advantages of poverty and culture. My father’s salary peaked at £300 a year, but we had plenty of books. There was no television, thank heaven, and we didn’t even have a radio, so I was able to read and think.

Did you ever think of following your father into the church?

Not really. This was not from any aversion to the church at all, but just that my father was rather keen for me to become a doctor and I had a fairly strong scientific streak. Being Scots, I had C. P. Snow’s two cultures embedded in me – my subjects in the higher school certificate were English, Latin, physics and chemistry.

I assume your family were Church of Scotland … did the Presbyterian ethic stay with you throughout your life, would you say?

Very much so. I’m firmly adherent to the so-called Protestant work ethic, but I’m very ecumenical in my outlook. I mean, anyone who’s seen patients and mixed in the world could hardly be a narrow-minded adherent of one particular sect, but I still think that religion means something. Like anyone else in this day and age I’m puzzled by the conflicts between cosmology as revealed by science and ‘truth’ as revealed in the Judaeo-Christian scriptures – or the Koran, if it comes to that.

When you qualified as a doctor, the National Health Service was not yet in place. What are your chief memories of medical practice at the time?

I qualified in 1936 and so I had twelve years before the NHS came in. Four of these years were spent in the Royal Army Medical Corps as a biochemist – not that I knew much about biochemistry, but that’s where I was put, and I went where I was told. What I remember about general practice was – to put it dramatically – you could have young people coming in with lobar pneumonia, and one in five would die. Nowadays you would expect one hundred per cent of them to walk out of hospital, but before antibiotic medicine it was a different story. Some people talk about complete conquest of infection, but that of course is nonsense. At the moment we are bedevilled by at least two infections – BSE, to give the topical one, and the terrible AIDS business. Bacteria and viruses often just jump ahead. The other striking difference between then and now was access. In the old days only rich people could buy good treatment, not always as good as they thought they were buying, but they could still buy it. Poor people could go to the voluntary hospitals as they then were, and again get pretty reasonable treatment, but the poor middle class was greatly disadvantaged because they could not afford specialist fees, and stubborn pride – certainly in Scotland – kept them from soliciting charity.

Were you a young idealist then? Did you want very much to make your mark and improve conditions?

Very much so, both medically and socially. I wanted to practise good medicine, and also to investigate the leading edge of medicine. My own research field was body fluid, because someone told me when I was a medical student that the body was sixty per cent fluid, so I thought, well, that’s for me. I’m an opportunist and a pragmatist.

Since you started out the medical world must have changed beyond all recognition. Have all the changes been improvements, would you say?

The improvements far outbalance the non-improvements. The National Health Service was a tremendous success for the first twenty-five years and shrewd people celebrated its twenty-fifth birthday not knowing what was going to happen thereafter. The incursion of market values has made very big changes. Whilst market values are tremendously important in other areas, for example in publishing, I think in medicine it’s a shade different. I’m not being idealistic or starry-eyed here, but I would say that health is so important to people that there shouldn’t be an additional financial barrier placed on top of the disability of illness.

Would you say there is a need nowadays to remind ourselves of the founding principles and values of the National Health Service? Do you think we have perhaps moved too far away from the original concept?

Yes. The NHS has been reorganized four or five times since 1973 and no service can stand up to that. It’s so disruptive. What has happened is that a somewhat artificial system of contracts has been introduced to govern all transactions which used to be quite informal. And doctors have been made to think very much more about finance. While it’s good that doctors should know what they’re costing the public, it’s bad if they have to think of money first.

Doctors traditionally maintain a professional detachment from political and social issues. In your own case, did you feel a responsibility, a duty perhaps, to go beyond the mere medical issues involved, or is it more the case that you think medicine cannot be isolated from other social issues?

My favourite answer to almost any question is both. I’ve got a built-in social interest, not a strongly political one, but one which just makes me feel for the poor. That’s part of being Scots, I think. My spontaneous interest was strongly reinforced when I worked in the Department of Health for a short period as chief scientist, and I was asked to get a working party together to study the relationship between social class and health. I found that social class is really not a particularly good indicator of poverty because there are those in social class 1 who are struggling quite hard, and conversely in social class 5 you can get people who are unskilled but who have the Midas touch. That made me take a much more structured interest in these problems.

You are perhaps best known for the Black Report into inequalities in health-care which had considerable political impact in 1980. You established beyond doubt the links between social deprivation and ill health. Were you surprised by your own findings, or had you always expected as much?

What we discovered was not particularly surprising, since we have records going back to the last century showing that poor people have shorter expectation of life and experience more ill health than people who are substantially better off. That’s of course something that anyone could see just by looking, but it was in the middle of last century that it was put on a quantitative basis by a man called Chadwick. Our particular contribution was to produce such a mass of statistics that it’s now an unassailable fact that poverty and ill health are linked. That doesn’t actually mean that poverty inevitably causes ill health, though it can do, just as ill health can lead to poverty. But we were able to argue quite strongly that there was evidence of poverty causing ill health, and the simplest evidence for that was that often the children of working-class people, manual labourers in particular, experience illness that accompanies them throughout their lives. It’s unlikely to be due to their being weaklings, forcing themselves to be poor; it’s more likely the other way round, though it’s contentious.

Is it true that Mrs Thatcher tried to suppress your report and would not accept your recommendations on the grounds that they were too expensive to implement?

The formal evidence we have is that Patrick Jenkin, then Secretary of State for Health, wrote a foreword to the report in which he admitted just that. It’s then conjecture whether Mrs Thatcher herself had anything to do with it, bearing in mind that it is unlikely that any secretary of state in her government would come out with such a potentially contentious statement without first having secured her complete backing. There may even have been dirty tricks, because our report came out in a dull cover in a pretty tatty condition. My friend Peter Townsend later brought out a shorter version in Penguin which had tremendous sales throughout the world. Some years later the Health Education Council brought out a further report called ‘The Health Divide’, and quite remarkable events attended its appearance. A press conference which had been arranged was cancelled by the Director General. There were strong denials that ministers had in any way tried to influence the abandonment of the press conference, but it seemed to me that the very strength of the denials implied they were untrue.

No one really disputes the association between poor health and poverty, but what exactly constitutes poverty in your view? Is there a minimum standard above which the term poverty no longer applies?

In this country there is of course no poverty approaching the extremes of third world poverty, which is accompanied by extreme morbidity and mortality. In Britain you get some people who are pretty destitute and others who are pretty affluent, so there is a graduation. A definition of poverty is rather elusive, partly because there’s a tendency to think that if someone has a television set, he is not experiencing extreme poverty. The official definition is actually when someone has resources of less than half the average wage.

But poverty is such a relative term. I mean, there must be a difference between what we now call poverty and what you yourself observed growing up in Scotland in the 1920s…

That’s right. As a working doctor in Scotland I saw people at the outpatient clinic in bare feet and woollen long johns which they wore because their houses were so cold. But to some extent these conditions are coming back, as you can see from the number of people sleeping in doorways.

Would you also allow that there are some people who sleep rough through choice? They’re healthy enough, but they perhaps don’t want to work, or are not disciplined enough to work.

I think that’s true. It’s difficult to know to what extent they are prey to circumstances and to what extent they lack motivation.

Did you distinguish between poverty and deprivation in your report? Which is more closely associated with poor health?

In a way deprivation is easier to define than poverty, because it’s not purely economic, it’s also cultural – lack of education and lifestyle factors which are linked with poverty, but are not of course a necessary part of it. For instance, it’s paradoxical that people in social class 5 on the whole smoke more than people in social classes 1 and 2, but it may be their only consolation, their way of escape.

Doesn’t the question of what can or should be done about inequalities in health remain an ideological one which can only be decided by politicians?

It has ideological components, that’s for sure. I mean, the degree to which people want to do something about inequality depends on their political set of mind. But it’s a blurred picture. For example, it’s not the case that all socialists have nightmares about poverty and all conservatives never give it a thought; it’s much more complex than that. May people in the Conservative Party are deeply unhappy about the relationship between poverty and health and the extent to which poverty has been recreated.

You have been critical of both Labour and Tory administrations of the health service. Although Labour were sympathetic to the principles of the NHS they were guilty of what you call ‘doctrine socialism’ with regard to private practice. Under the Tories you suggested in 1988 that the National Health Service was threatened by ‘monetarist and managerial dogma’. Where are we as regards political approaches to the NHS today?

A lot of this is about power and who makes decisions. To me there have been two shifts of power which are a direct result of reforms. One shift has been from the professionals – doctors, nurses, biochemists – to the managers. Of course the health service needs management just like any other comparable enterprise, and I’m totally in favour of strengthening management wherever that can be well done. The second very considerable shift of power has been from a service centred on hospitals to a service centred on family doctors and other people. There are strong elements of good in that because, after all, more people see their family doctor than are ever going to need to go into hospital. But where it’s not so much of a good thing is that general practitioners, instead of producing clinical arguments in favour of their patients being admitted to hospital, now have a financial stick with which to belabour the hospitals, and I’ve seen some very bad consequences of this. Sometimes hospitals literally run out of money with only a month or so to go, and conversely there is sometimes a budgetary surplus which leads to all sorts of unnecessary expenditure for its own sake. The annual budget has big problems.
How do you view the National Health Service today?

It’s not as good as it was ten years ago. I don’t think it’s as bad as the reforms might have made it, because we’ve still got the people who are reasonably dedicated to the original objectives of the health service. My major worry is that if the market forces continue and increase, then recruitment to the health service will bring in a different kind of person.

In an article in the British Medical Journal three years ago you wrote that the recurrence of monetarism over the last dozen years has revived evils that should have been relegated to history. What are the evils you were thinking of?

I can be just as rhetorical as any politician when I’m writing a rather popular article, but the sort of evils I had in mind were unequal access to health care and an increase in the disadvantages of poverty and unemployment, two of the huge changes in the past twenty years.

In the same article for the BMJ you quoted John Ruskin who said: ‘Above all a nation cannot last as a money –making mob; it cannot with impunity go despising literature, despising science, despising art, despising nature, despising compassion, and concentrating its soul on Pence.’ This is quite strong stuff. Do you really believe our priorities are quite wrong, that we have lost our souls to money-making?

That’s a rhetorical statement in a rhetorical article followed by a rhetorical question. No, we haven’t lost our soul, though I think we’ve damaged it.

There appears to be a class factor in the use of tobacco and the quality of diet, and the amount of exercise taken. Isn’t the answer – in part at least – better education leading to prevention? Or is that a pie-in-the-sky approach?

It’s a very important approach, but it’s certainly not one that ranks tremendously high in efficiency. To give a very concrete example, the Royal College of Physicians has produced four reports on smoking in general, and a further one on smoking among young people. But there are more young women smoking than ever, and also more young children. So education is not the only answer.

Where do you stand on the question of medical treatment for those who refuse to help themselves – by continuing to smoke, for example?

We should treat them as well as we possibly can to the limit of our resources. I’m against any kind of moral sanction on so-called self-induced illness. One sometimes feels the temptation, but it’s one to be resisted. No we’re not there as judges, and we’re not there as padres; we’re there as doctors, and our job is to do the best we can for an individual. Of course by doing the best for the individual, we may be acting unfairly to the rest of society. But when I was in clinical practice, the basic principle was just take the case in front of you and not to worry too much about the hinterland…very reprehensible.

Do you think we are moving in the general direction of making medical treatment conditional upon responsible behaviour in the patient?

I doubt it. I think that some of my fellow puritans would want to do that, but I’m not so convinced of the veracity of my own attitudes that I would want to impose them on anyone else, either by implication or exhortation.

You regard yourself as a puritan, rather than a liberal?

I’m not against liberalism as such, but I think it has to be balanced by responsibility. There has to be a balance between liberty and libertarianism, between rights and duties. Nowadays rights have been elevated to such a huge extent, and duties have become rather neglected. For example, when you enter marriage you are not only entering a career of great enjoyment and promise, you’re also undertaking some obligations. I think the emphasis has to some extent fallen away from the obligations.

As a doctor – setting aside any moral principles you might have – are you in favour of the current relaxed attitudes towards sex…I’m talking about safe sex, of course.

I’m afraid I’m a dyed-in-the-wool puritan. I can’t justify Puritanism, but I just can’t help thinking that on balance extra-marital sex does more harm than good. Sex is a good thing, I agree with that all right, but I also think it has to be controlled to some extent.

Are there any moral absolutes in the practice of medicine?

If you think about it, there are none at all – even if you consider something like ‘Thou shalt not kill’. If I had someone with a disseminated cancer and he got a lobal pneumonia, I’d be only too happy to let him die from the pneumonia. Philosophers say that that’s no different at all from taking a syringe of potassium and pushing it into a vein and killing in that way…I can only say that it feels very different. I myself have never actually given a lethal injection, but I have some sympathy with people who do it in cases of intractable pain that they can’t otherwise relieve, even though I think it’s a very slippery slope that doctors shouldn’t go down.

When I interviewed Baroness Warnock she said that she did not believe in the sanctity of life at all costs, and that compassion was the single moral absolute. Would you agree?

No, I wouldn’t agree. I’m not a believer in absolute moral dogmas at all. When I have to formalize it, I’m a situation ethicist; in other words, I believe that the facts of a given situation are so preponderant over moral principles that one shouldn’t have absolute moral principles. In the case of the man with pneumonia who’s riddled with cancer and in unbearable pain, I’d let him go. I think that’s compassion, but I don’t make that an absolute, otherwise I wouldn’t be inclined to condemn lethal injection.

Would you agree that developments in medical science are now so rapid that they happen before our moral thinking is ready for them?

Yes, and it’s almost inevitable, because as soon as some apparently worthwhile medical discovery is made, everyone wants to apply it that week. Science runs and ethics comes plodding along behind it, and that’s probably not how it should be in an ideal world.

Since it is undoubtedly true that things which people scarcely entertained as possibilities are now actualities, and assuming this trend continues, isn’t it going to challenge the whole moral fabric of our society?

Yes, of course it is, but I think that the challenge should be directed at the scientists and doctors themselves.

What sort of ethical restraints, if any, should be placed on doctors?

Most important is the judgement of their peers in a moral climate. It’s very difficult for outside people to know what doctors are doing, let alone come to a judgement of whether it’s right or wrong. Obviously the extreme case is easy; it’s the marginal case that’s always the difficult one.

On the question earlier this year of whether or not a woman should be able to use her dead husband’s sperm, you wrote to The Times supporting her case. You said amongst other things that the woman was a victim of ‘corporate tyranny’ and that ‘people banded together are capable of follies and excesses beyond what the same people acting as individuals would perpetrate on other individuals’. This was a reference to the Human Fertilization and Embryological Authority. First of all, what in your view is the alternative to such an authority, which is there to safeguard standards and to see that the rules are implemented?

It so happened that I was on the original committee which was the Voluntary Licensing Association. My experience of the work of the VLA made me very watchful for the future of the statutory licensing authority. It seemed to me they were applying general principles too rigidly to particular situations. That’s really the germ of my idea that there might be such a thing as corporate tyranny.

Well, how can this corporate tyranny be avoided? What would you replace it with?

I’m not generally an advocate of centralization, but I think I would feel happier with a central committee on ethics which would have a general surveying function, and which as specific cases arose could call in the appropriate experts to acquaint them in depth with the medical aspects. That would be a better long-term solution than a whole lot of ad hoc committees, each of which might become too narrowly focused on its own neck of the woods.

As regards the woman in question and the issues arising from her case, do you think that women have a right to have children, come what may, provided medical science can provide them with the means?

It’s not a universal right – I wouldn’t go as far as that – but unless there are strong contradictory circumstances, I think the woman is the best judge as to whether she should have a child or not.

You obviously believed in the case of Diane Blood that the authority in their decision had caused her undue stress and hardship. But haven’t we also a duty to consider the implications for a child born in these circumstances? Can we be absolutely sure that it is morally right for the child to be brought into the world in this way – not only fatherless, but using the sperm of its dead father?

It is difficult to exclude remote possibilities, but if we come to the evidence in this particular case she said that the husband wanted a child, and it’s not an unreasonable thing for a husband to want. What is the disadvantage to a wanted child of having lost one parent? Pretty small I would say.

But I’m talking about the psychological effect of being born from the sperm of a dead father…

Well, it might worry many people, but it certainly wouldn’t worry me. Maybe I should explain why I wrote the letter. There was perhaps a reasonable case to prohibit the use in this country, but when the authority then became so determined in their opposition as to preventing her going abroad, I regarded that as a step too far in pursuing an attitude about which I feel they shouldn’t have been one hundred per cent certain. But I have learned something since that worries me, and that is that the sperm was taken by rectal stimulation. That strikes me as being distasteful. It doesn’t mean that it’s necessarily immoral or wrong, but it is distasteful.

But aren’t you also morally offended, if only by the very unnaturalness of it?

No. I’m a kind doctor, and it seems to me that the advantages to Mrs Blood of having a baby outweigh a hypothetical psychological disadvantage based on imagination – this business of the dead father. I mean, it is an aesthetic worry, not a moral worry. I’ve always tried to distinguish between things that are aesthetically wrong, morally wrong and illegal, because they are each different. They can be the same in so far as a lot of illegal things are also immoral and distasteful. But there are things which are distasteful which are perfectly legal.

Coming from someone with your views, there is surely a contradiction there…

Yes, I’m a contradictory chap.

Well does the time factor play any part here? Would you feel happy if the same woman wanted to use her head husband’s sperm after, say, ten years? Would there be a stage where it would be viewed as a morbid obsession with the past unlikely to benefit the resultant child?

That question could only be properly answered by meeting Mrs Blood and having a talk with her and coming to some kind of a view about her psychology.

There is much talk at present of genetic engineering and cloning. With such possibilities, do you ever get a sense that Huxley’s Brave New World is closer than we think?

It depends how close you think it is. Huxley’s Brave New World involved the universal use of drugs to make people feel better, and something like that is not too far beyond the horizon. But I don’t think there ever will be human clones because prohibition by government will prove to be sufficient.

People in general react very passionately to such issues, whereas doctors are renowned for their dispassionate approach to medical ethics. Is it mainly a question of knowledge and ignorance here, that is to say that the vast majority of lay people are deeply ignorant of the facts?

No, I think it goes far beyond ignorance. It’s the doctor’s real dilemma in a way. You have to maintain your professional detachment, otherwise you get so emotionally involved that you can’t really provide the kind of help the patient needs. The patient introduces all the emotion that is required, and if any were lacking, the relatives would introduce still more. So I think one has to keep one’s professional cool. That doesn’t mean that one mustn’t. You’re no sort of doctor if you fail to do that, and appreciate what an illness is doing to a person – that’s a necessary component of medicine, but you mustn’t get so carried away by total sympathy for patient and relatives that you don’t give them the best medical advice possible. Old-fashioned paternalism is out, even though I’m something of an old-fashioned paternalist myself. It is very difficult to be detached. Many patients have caused me great sorrow and I’ve taken actions that I have had cause to regret, but it wouldn’t really have helped the situation very much if I had, you know, gone mad.

You were president of the Royal College of Physicians from 1977-83. What were your responsibilities there, and did holding that office enable you to achieve certain goals?

I have a hedonistic approach: if you’re enjoying a job, it’s at least possible you may be doing well, whereas if you don’t enjoy what you’re doing it’s almost certain you’re doing it badly. I tremendously enjoyed my six years at the college. My main responsibility was to supervise professional standards in the interests of patients, a very worthwhile objective.

Where do you stand on the question of attitude of mind being able to influence health and illness? And are you a believer in alternative medicine?

There’s inevitably an interaction between body, mind and soul, and psychosomatic conditions are certainly rife. There’s no doubt that attitude of mind plays a big part. To answer the second part of your question, one really has to approve of anything that’s going to help patients, and undoubtedly many patients are greatly benefited by alternative medicine in all its various forms. I have a twofold difficulty with it: first, that the burden of scientific proof is often difficult to obtain, and secondly, nature itself is a very good doctor, so a lot of the good things which happen may not necessarily be due to the alternative medicine but rather the healing power of nature. There are some areas where getting an actual operation done is terribly important, acute appendix being the most straightforward example, so I would say that people should obtain an informal medical opinion before they go off to alternative medicine if they feel really ill. Apart from that, it’s not for me to condemn it.

Do you think that in our more secular society we are increasingly less able to come to terms with the fact of our own death? In the old days people felt themselves to be in God’s hands…

I’m certainly against prolonging life that’s past its purpose, as it were. I’ve had to think about this a lot in the last year or two because I’ve been chairing college committees on brain-stem death and also on the persistent vegetative state. I certainly think that there are some states of life that are worse than death. The decline of religion may have made people stick more to this terrestrial life, but like so much else, it’s a mixed non-blessing.

How do you feel about your own mortality?

Not much in the way of fear, though when I wake up in the morning I recognize that as a blessing. I once gave a lecture in which the opening paragraph recalled Joseph Addison’s essay about a crowd of people crossing a bridge which ends in a series of broken arches and is also perforated by trapdoors through which some of them fall into the flood below. Some of them clamber precariously from one arch to another, but in the end they all fall. That’s very much the sort of picture you get of life as a doctor. There’s a tendency in my profession to think that illness is something that happens to other people, but when you get to my age you have to recognize it’s going to happen to you.

If you look back over your own lifetime, do you think society is more chaotic now, in the sense that the old certainties have been eroded, and material improvements in our standard of living, for example, have perhaps led to a corresponding decline in other areas?

Yes, I do. I once wrote a paper called ‘Dead Sea Fruit’, and I think perhaps we’ve experienced some of that. So many of the things that blossom brightly with promise have turned to ashes. In the 1960s we were promised universal happiness, but it hasn’t quite worked out that way.

 

TO INFINITY AND BEYOND…

What appears to be an African desert is a sensational picture of the surface of Mars. You might have thought this surface is one you would expect a Bedouin tribe to wander across with their camels. But the eerie landscape is much farther from home than the Sahara. The view is actually around 60 million miles away – or an eight-month rocket trip – to the surface of the magical Mars.

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The image of the red planet taken by NASA’s Mars Rover has been digitally white balanced so the rock appears as it would under our sky. Ground temperatures on Mars vary widely between day and night, fluctuating between 3c (37.4f) to -91c (-131.8f). The atmosphere is about 100 times thinner than Earth and is 95 per cent carbon dioxide. Despite its extreme differences to Earth, the landscape of Mars is made up of familiar geographical features such as ice-caps, volcanoes, clouds and canyons.

The mountain ridge in the background is 50 miles from the Rover’s camera – which took 16 pictures shortly before northern Mar’s winter solstice, when clear skies provide a sharper view of distant scenery. Together, the photos form a panorama that takes in Yellowknife Bay where in 2013 the space mission found evidence of an ancient lake with all the basic chemical ingredients for alien microbial life.

To the south is the Clay Unit which is the mission’s next destination, after observations from orbit detected clay minerals there. The site from which the images were taken three months ago sits 1073 ft. above the landing spot on the floor of Gale Crater where the rover touched down in 2012.

Ashwin Vasavada, of NASA’s jet propulsion lab in California, said: ‘Even though curiosity has been steadily climbing for five years this is the first time we could look back and see the whole mission laid … the vast plains of the crater floor stretch out to the spectacular mountain range that forms the northern rim of Gale Crater.’

All I can say is what an amazing picture of Mars! The younger generation will no doubt have the opportunity to see the marvels of this planet as well as others which we are yet to be discovered. The thing I regret in old age is that my time is now limited and I envy those who will live and see within the next hundred years the enormity of The Creation and what lies beyond it. Lucky buggers…

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I will be taking a break from the 11th – 25th April and not posting on my blog. I will resume on my return.

 

The Unbeliever

Last night we marked the launch of Ogg Boytchev The Unbeliever at Hatchard’s in Piccadilly.

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Here what I said during a short address to introduce the author to an enthusiastic crowd of well- wishers.

Oggy Boytchev made a dramatic escape from behind the Iron Curtain in Bulgaria in January 1986. A few months later he joined the BBC World Service in London as a newsreader for the Bulgarian Section, before moving into mainstream journalism. He became John Simpson’s producer and accompanied him on dangerous undercover assignments around the world. In 2014, Quartet published Oggy’s book about his adventures with Simpson, simply entitled Simpson and I recalling their time together.

John Simpson wrote about the book: ‘I think it’s excellent – exciting in places, funny in others, and very thoughtful. I found the book delightful and a hugely valuable check to my own memories’

Today, we are assembled here to celebrate the publication of Oggy’s latest work, a highly topical thriller which I’m told is based on a true story.

It’s December 1963. It’s a decade since the death of Joseph Stalin and a year since the Cuban Missile Crisis. Nuclear war feels imminent. In Sofia’s Great Ceremonial Hall of the People, Alexander Ivanov, a low-profile UN diplomat turned spy, is on trial for treason and espionage, accused of selling secrets to the CIA. He has become an international media sensation overnight.

Facing death by firing squad, Alexander has been offered a way out: make a full confession –exposing and humiliating the Americans – and his life will be spared. The communist propaganda machine will do the rest. But what if all is not as it seems? What if Alexander has become a pawn in a power play beyond his control?

The Unbeliever is a gripping panoramic account of Cold War paranoia and intrigue spanning four decades, told through the life of one extraordinary – and real – spy

Oggy is a talented story teller who deserves your recognition. I believe that we should encourage him by asking people to buy more than one copy of his book to give to friends who I am sure would appreciate this gesture. Simpson and I is still available and certainly worth buying if you haven’t already done so. It can be ordered through Amazon or directly from Quartet, whichever you choose.

We would certainly be delighted if you were to do so. Authors and independent publishers depend on people like you who keep us dedicated to what we do. The colour of your money is always our most encouraging factor. Thank you!

No Longer With Us

I was reminded by my very alert secretary nicknamed Amazon, that on 24 July last year I wrote a piece about Melissa Sadoff’s book, Woman As Chameleon, under the heading ‘A More Innocent Time?’ Reading the piece again when sexual harassment is the topic of the moment, I think it is worth a peak for those who missed my blog at the time. It is now obvious things have changed dramatically since then. Women are taking the reins everywhere – they can’t do worse than men – and men are deservedly relegated.

Here what I wrote on this occasion  regarding her book, which Quartet published in 1987.

The recent brouhaha about the sexual antics on various TV programmes reminded me of a time, not that long ago, when a suggestion that wives sucked their husbands’ toes was ridiculed as if we had faced the end of civilization.

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The book’s publication  provoked a response that was never intended (though that ancient adage about no publicity is ever that bad does apply in the publishing trade). The hilarity arose partly because of its subject and partly because of the identity of its author, who happened to be married to David Stevens, then the press baron of Express Newspapers who had been created a life peer as Lord Stevens of Ludgate. Melissa Sadoff, as she called herself, possessed an inherited family title from central Europe and was, formally speaking, Melissa, Countess Andrassy. The book she had written was Woman as Chameleon: or How To Be the Ideal Woman. It was the very antithesis of feminist doctrine, aiming to teach women ways to keep their marriage exciting by pampering their man and acceding to his every wish and whim. Melissa was flamboyant in her views and Lord Stevens gave the impression of taking his wife’s attentions in his stride. She described the treatment she gave him in rather embarrassing detail, which opened up an opportunity for the critics to have a field-day in leg-pulling. ‘Grovel’ of Private Eye immediately dubbed Melissa ‘Countess Undressy’ and claimed to have suggested the book after hearing her speak about her husband’s ‘Ugandan preferences’. He was able to quote her verbatim for his own purposes.

‘There is nothing,’ she says, ‘that can be called perverse between husband and wife so long as it relates to the husband’s need and the wife’s willingness to do it.’ I have advised her to put it all on paper with a view to publication in book form. I tell her that my friend the seedy Lebanese parfumier Mr AttullahDisgusting could well be interested, as he is currently obsessed by all aspects of the Ugandan situation.
Two weeks later ‘Grovel’ followed through with the latest development:

As I suggested, the Countess Undressy . . . is to write a book of Ugandan hints, which will shortly be published by the swarthy Lebanese sex-fiend Naim Attullah-Disgusting. The ‘Countess’ will not mince words when she describes how she sees the duties of a wife. ‘Always kiss your husband’s body, starting from his toes,’ she writes. ‘After kissing his toes and sucking them, proceed to kiss every inch of his legs . . . ‘She should then perform the oral act. Many women feel an aversion towards this form of sex . . . Women who feel this way need to be asked what they would prefer – to have their husband go to a prostitute for such a service?’ (What’s the oral act? © Norman Fowler ’87) (That’s enough filth. Ed.)

The launch for Woman as Chameleon was held on 10 February, with ‘Londoner’s Diary’ of the Evening Standard citing the toe-kissing routine before asking ‘a pale, nervous and uncomfortable’ David Stevens, ‘Well, does she always?’ He had to confess that he hadn’t yet read the book, and didn’t intend to do so till he’d sifted through the reviews. ‘Otherwise I might be embarrassed.’

The nearest the party came to being risqué was when Jubby Ingrams’s (the daughter of Richard Ingrams, and who worked at Quartet) shoe was removed from her foot by an admirer with a view to kissing her from the toes upwards. Ms Sadoff rushed over to intervene. ‘No,’ she cried with a Transylvanian lilt. ‘It must be the other way round.’

Henry Porter in the Sunday Times ‘Notebook’ judged David Stevens to be ‘rather more reticent about his home life’ than was his wife.

I would estimate that this book . . . is going to cause considerable embarrassment to Mr Stevens . . . None the less, he has taken steps to purchase the serial rights if only to keep it out of the hands of the Daily Mail group, which naturally was keen to enhance his discomfort by publishing extracts like this: ‘Become your husband’s own prostitute . . . if your husband is in his study, workroom or garage in the wintertime put on a sexy slip, wrap yourself in a coat, slip on suspenders, black stockings and surprise him wherever he may be.’

Unfortunately the fun and games of the press diverted attention from the rest of the book, which threw many a light on relationships, friendships, motherhood and divorce, with sound philosophical reflections. Melissa was of Hungarian origin, a talented concert pianist and an accomplished hostess. She was perhaps a shade over the top in her enthusiasm, but being an eternal optimist her heart was in the right place. In retrospect, I believe she deserved more praise for the book than she ever received. Throughout the merciless lampooning from Private Eye and the barrage of snide sarcasm aimed by the rest of the press against the book, which inevitably earned the displeasure of the feminist lobby, she remained in control and outwardly unaffected by it all.

Her husband, despite the newspapers’ determination to embarrass him, was extremely supportive. He did not seem to be in any way phased by the teasing of friends over the rumpus caused by some of the book’s intimate passages. Sadly, only two years later, Melissa died when she got up in the middle of the night to eat a peach and choked on the stone. I was in Los Angeles at the time and was woken to hear the dreadful news. It left me feeling very emotional. I had grown to like Melissa immensely. Her colourful personality and boundless zest for life were her enduring strengths and ensured she could not be easily forgotten.

Melissa was always entertaining, with something of interest to say. I interviewed her in 1987 two years before she died  and here is the substance of what she told me.

 

THE EARLY INFLUENCES

Melissa Sadoff: My grandmother and mother probably showed me what the feminine woman is. They delighted in being lovely women and emphasized making a man’s life very pleasant and charming.
I thought carefully about what I wanted even as a very young girl, and would simply ask for things and get them. Our family was a male-dominated family, but I had an equal voice. I was single-minded and determined, very. I always knew I was going to be a writer, and started reading when I was five. I was writing little pieces of prose when I was nine or ten, and always wrote my own cards at Christmas and birthdays, and particularly for Mother’s Day and Father’s Day, and when I was thirteen I had already started writing philosophical essays. I always wanted to be famous, not for the sake of being famous, but for the sake of leaving something to humanity after I died. If I had been a man, I probably would have been some kind of crazy general ore war leader, even though war is not in my heart at all. But I think I would have been quite a determined man.

ADVANTAGES AND DISADVANTAGES

Melissa Sadoff: The more I’ve read history, the more I’ve read literature, the more I’ve felt that a determined woman, in all cultures, through all history, could achieve what she wanted. Even in Roman history, you had women leaders, women queens. There were quite well-known priestesses in Greek society. We know that Egypt had queens, Cleopatra and Nefertiti. It’s not just the social position they were born in, but a woman who was determined could always achieve what she wanted – for example, Joan of Arc. Which woman, even today, would lead an army dressed as a man, and there she was, she did it, she was a friend of kings. So I never felt that a woman as an individual was restricted, although I would say the that the rules, regulations and laws in certain cultures didn’t allow the mass of women their freedom.
In some societies, maybe many societies, women are still discriminated against en masse, but that is changing. It has been changing for a long while. It is a slow evolution, but it is getting up speed and it’s getting more and more straightened out. I personally have not suffered discrimination, but not because I had any advantages. When I was about five years old, we were thrown out of one home, in Hungary. When I was seven years old, we were thrown out of Yugoslavia. We did not have a chance to take even the little dolls – at that time probably the most important thing to me. When you couldn’t take sentimental possessions, never mind material possessions, that should create a tremendous complex in a human being. When you are seven years old and you see a dead body hanging off a tree, with all the insides out, that is not an advantage, that should create a tremendous disadvantage. When I realized at about thirteen or fourteen that, due to different political philosophies, people mistreat each other very badly, I was shaken into reality from my romantic, idealistic world. It should have left me cynical, it should have left me bitter, and quite insecure. I had the same ability or inability to cope with my problems as all of us do. The difference is that many of us do not think about our lives. We do not realize how long we live, we don’t ask ourselves what we want to achieve in that life, we don’t ask ourselves how we can cope with our own problems without going to psychiatrists, without asking for all sorts of help, without becoming alcoholics or drug addicts. We don’t ask ourselves whether we can solve our own problems. And very often we can.
I still say that, as long as a woman is very feminine and knows what she wants, and tells it honestly, she is going to get everything she wants, whether it is a career or children or whatever.
Women may have problems with their cycles, things like that, but even though there are times and reasons and physical causes for a woman to react that way, it annoys me when you hear women saying, oh dear, I can’t get up in the morning too early, and if I do I have to have a cup of coffee immediately, and my cigarette, and I can’t talk to anybody before noon. I could say the same thing. But I wouldn’t, it’s a waste of time. I would say that is a negative approach. If I have to get up very early in the morning, I do. I am going to be pleasant, and I’m going to speak to people before noon. Why not? We are sophisticated human beings. We are no longer animals, to react in such natural ways and say we cannot cope with this, that or the other. We have a brain in our head and we should use it.

SEXUALITY

Melissa Sadoff: We’re prompted to believe that, to have exciting sex, you have to make love all the time. First of all, much as we would want it, or our imagination would want it, you can’t do it physically, simply because there are other things to do. By the time any man comes home at night, he is half-exhausted if not completely exhausted, he is not in a very good mood to perform. And if a woman has an ordinary or average life, she is not ready to hop into bed either. So if a woman is clever and creates romantic situations, such as a weekend away or visiting her husband in the office, if she can seduce her husband in different circumstances and situations, she can keep that going and really kindle his imagination.
Most men do not equate sex with love. Women do. But even a man can be a victim in a strong, clever woman’s hands. Let us say it starts with a flirtation, then leads to an affair, then the woman, the other woman thinks, this could really become something of a much more permanent nature and she likes the whole idea. She can trap him without difficulty. I don’t care who the man is, he will think this is the greatest love he ever had in his life. So it is possible for a clever woman to change men’s minds and therefore, what was in the beginning just a flirtation, an affair, can become a love.
It is not the speed and quantity of sex that matters, it is the quality. Making love every ten days is much better than making love every day and not knowing what this is all about.

MOTHERHOOD

Melissa Sadoff: Rearing a child is probably the most important for a woman, but I would rather give that love to a man. I chose my vocation. I would be much more interested in making a man happy than a little child. Having said that, I have had happiness in children as well, but I did it because I love them, not because I really chose them.

RELATIONSHIPS

Melissa Sadoff: I prefer men if the women are not educated. I don’t mean educated in the sense of university degrees, but educated in life. I have met many wise old women who were not educated at university, but they were utterly, utterly interesting to talk to. They had been through the university of life, they were wise, they were very intelligent – maybe not academic, but intelligent – and I like interesting women. If a woman speaks to me only about washing machines and the price of butter and where the children go to school, I don’t enjoy that type of woman at all.
I love a man who, no matter how much he loves to work, knows the seductive side of life and can combine the pleasures of life with work. I also like a man who treats a woman like a woman.

DIFFERENCES

Melissa Sadoff: I think men and women are completely different, not just visually, not just biologically, but our brain is different. We have the same type of nerve centre and so forth, but our reflexes, our emotions will be different. If a man is confronted by a prowler, his natural instinct would be to stand up and fight. A woman’s natural instinct would be more or less to run away and scream. It is just a natural reaction. We’re not sophisticated enough yet to say we have a brain in our head and we are going to use it. We allow the brain to use us and tell us what to do.
A man needs several women, many women, not only for a short span of time, but throughout his lifetime. I come back again to how different we are, mentally and biologically. Women need a romance and need one man, maybe. They would probably never change that one man if there is no good reason to do so. A man, no matter how loyal and how much he loves his wife, in my opinion – particularly an intelligent man who is well travelled, who knows life such as life is, full of exciting projects and exciting adventures – that man would need a different woman every year, every six months, who is to say, maybe every month. I cannot find anything immoral or amoral about it.
Our sexual needs are different, totally. A man needs to be stimulated all the time, so does the woman. However, unless she is a nymphomaniac, she would be very happy to be stimulated only by one man. As long as she is in love with him, and she can be in love with him for ever and ever, as long as she has that romantic image of the man, she will be faithful to him as long as she lives. However, no matter what she does, unless she really is superb, she is not enough, she is going to start ageing eventually. It is so silly of us women to think that a man doesn’t enjoy beauty, doesn’t enjoy excitement, doesn’t enjoy youth. There are all sorts of women. Some are much sexier than others. If a man is a real man, he will fall under the charms of this other woman. We would have to be all-round women, or what I call women for all seasons, to please a man forever, and even that would be very difficult.

 

A ONE NIGHT STAND IS NOT NECESSARILY ABHORENT TO WOMEN

The dating game is being unmasked as sex bridges the gap in its inception between men and women. Previously the sexes would see things rather differently, despite the fact that women are more likely to regret sleeping with someone too soon, while men regret not doing so in general. But it transpires that women can be as content as men when it comes to no strings sex, a study suggests, as long as they make the first move and the person they are sleeping with is good in bed.

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A woman’s misgivings fade somewhat if the night of passion is their idea, according to researchers. They wake up with regrets the morning after if the sex was bad – but not so much if they enjoyed it. A study of almost 800 people to determine why women regret casual sex more than men, found feeling pressurised into it a key reason. Women feel much less regret if they initiate the encounter while men care less about who makes the first move.

Lead author Dr Leif Edwards Ottensen Kennair, from the Norwegian University of Science and Technology, said women’s greater reluctance to have no strings sex may be due to their human evolutionary past. He said: ‘Women in the past had a lot more to lose from having sex with a non-committed partner as if they got pregnant the man could walk away at no cost to anything but his reputation while she could be left to bring up the child. We know today that women are more worried than men about pregnancy, sexually transmitted infections and their reputation.’

Women may also regret a one-night stand more because they are less likely to climax, according to the research. Put simply, men tend to have a better time during sex which cancels out some of the more unpleasant feelings such as shame and guilt.

The psychologists interviewed 750 people about their last no strings sexual encounter. Around half of women said they regretted it – compared with about a third of men. To find out why, they asked participants how much they enjoyed the sex, whether they had an orgasm, and how much they worried, felt immoral or felt pressure.

The study group were also to rate their agreement to the statement ‘I was the one to take the initiative.’ The results showed men and women regretted having sex if the sex was bad, the other person sexually incompetent or they experience worry or disgust. Each factor is more important for women than for men. Women felt less regretful if they made the first move but this had no impact on whether men felt regret or not.

Study co-author Professor David Buss, from the University of Texas, said: ‘Women who initiate sex are likely to have at least two distinguishing qualities. First, they are likely to have a healthy sexual psychology being maximally comfortable with their own sexuality; second, women who initiate have maximum choice of who they have sex with.’
The study, published in the journal Personality and Individual Differences, found disgust was the biggest cause of regret over a one night stand. This could be disgust over the type of sex, someone’s hygiene or the act of having sex outside a relationship. The authors conclude: ‘Women’s greater worry and lower levels of sexual gratification partially explain why women regret casual sex.’

I don’t believe it has ever been easy to define sex and its consequences. However, what is beyond doubt is that men in general can attain orgasm easier than women whatever the circumstances. Women take more time to reach a climax, as opposed to men to whom the act is more mechanical and as such, less complicated.