Values and beliefs

A theme that has run through numerous posts on my blog has been aspects of my beliefs and values. For many years I've thought a great deal about these important but intangible matters. The first time I can recall thinking consciously about my own values and being aware of a significant change was when I was doing research for the UK Royal Commission on Medical Education in the late 1960s. Some of the questions in the surveys of medical students and established general practitioners and consultants probed these intangible but important personal attributes, and prompted me to think introspectively about my own beliefs. I've been sweating over a chapter in my memoirs on values and beliefs, trying to find the right way to express my thoughts. This post isn't the place to display a preview of this troublesome chapter but I'll mention a few examples.

When I was a teen ager and a medical student, like many of my classmates I was typical male chauvinist. Until my year, the cohort or graduating class of 1949, there had never been more than one or two women in a class which in those days in Adelaide averaged 30 to 40. There were 60 graduating students in my year, and 15 of them, 25%, were women.  We called them "girls" and resented their presence among us. 

The responses to the RCME survey questions revealed many ways in which women faced greater obstacles than men to pursuing their chosen career. They had to overcome much discouragement by their parents and school teachers, and bias against them by selection committees. To get into medical school they had to be determined, highly motivated, and usually academically superior to their male contemporaries. It's not surprising that women got the largest share of gold medals, prizes and distinctions, and were more likely than the men to graduate with honours. But the surveys of students and graduates from 25 of the 26 medical schools in the UK in 1966 showed that despite their academic superiority, discrimination against women persisted after graduation: women graduates were often passed over for the best internship and residency positions. In addition to the hard facts revealed in survey responses, many women wrote comments that revealed the obstacles and discrimination they faced. My sense of justice and fairness was outraged and easily trumped what remained of my male chauvinism. Almost literally overnight I converted and became a feminist, eager to help correct this uneven playing field and make life more equitable for women doctors. That's a long story I've told more fully in my memoirs, and it illustrates how values can change under the influence of evidence.

Changes in attitudes and values regarding crime and punishment may have responded to other stimuli. As best I recall, my belief in the death penalty for murder and harsh punishment for crimes like rape and sexual assault faded slowly rather than being overturned suddenly, until the last vestiges were dispelled by unequivocal evidence that several alleged murderers had been wrongly convicted.  My tolerance for people of equivocal gender identity was a more slowly developing change. How did this value change come about? I suppose it was influenced by opinion leaders in the media and by evidence that was presented in scientific articles - and personal friendships with gay and lesbian colleagues.  Nowadays I believe that tolerance of gender ambiguities is one of the indicators of a mature civilization, and rejection of the death penalty and other harsh punishments is another. In the USA, intolerance of LGBTQ people is widely prevalent in the right-wing states where gun ownership is part of religious beliefs (along with the obscene distortion of the teaching of Jesus about the virtue of poverty and the evil of wealth: the religious right wing has a strong belief in the 'virtues' of wealth and greed as well as gun ownership). It's easy to get angry about these weird aspects of the American way of life. I won't dwell on this further, just finish by saying that my kids seem grateful that Wendy and I decided to settle in Canada rather than the USA, and resolutely resisted all seductive invitations to move south of the 49th Parallel. I'm still wrestling with the words and phrases needed to express these thoughts tactfully in my memoirs. Professionally my lines of communication almost all flow north-south rather than east-west, I probably still have more American than Canadian friends, I've been president of two American national associations and vice-president of a third one, I've been awarded the highest distinction, the gold medal, of the American Public Health Association, and I've been described as an 'honorary American'; I hope what I've written here doesn't hurt the feelings of my American friends. I am pretty sure most of them share my values anyway: that's why they are my friends.

Reconciling aspirations and reality

Our last year in Edinburgh, 1969, was a time for coming to terms with reality. I had quite a high profile by the beginning of that year. I had been principal investigator for almost all the research I'd done for the Royal Commission on Medical Education, had published many original articles that had been widely praised and discussed and I had taken several initiatives that led to other publications. I'd presented results of my work at important national meetings in the UK and at international meetings and seminars in Australia and the USA. I was getting attractive invitations from universities and research groups in USA, Canada and elsewhere in UK, but not from Australia. I'd been passed over when I applied for the foundation chair of community medicine at Monash University in Melbourne, which had gone to a well connected professor of medicine who had no experience and no track record of community-based research in epidemiology. I'd been informed in quite unmistakable language that I would not be promoted from top-of-the-scale senior lecturer to reader (= associate professor) at the University of Edinburgh. Early that summer I'd been invited to present a paper at a think-tank at Airlie House, near Dulles Airport, just outside Washington DC. This proved to be at least in part a pretext to enable  several senior people at Harvard Medical School and Harvard School of Public Health to consider me for a challenging cross-appointment that would link the medical school to the school of public health. After the Airlie House meeting I flew to Boston, met the deans of Harvard Medical School and the School of Public Health, was offered and provisionally accepted the cross appointment. But I had many misgivings. Accepting this position meant migrating back to the USA, where we would have to find a place to live perhaps 2 hours commute away, and this time, unlike my previous post at the University of Vermont, we would have to concede and assume that the USA would be our permanent home, would have to become American citizens with all that this entailed. 

I had received another invitation, to become a professor of epidemiology and community medicine at the University of Ottawa. Almost as an afterthought I flew from Boston to Ottawa, where I'd been booked into the rather down-at-heel but picturesque old colonial Bytown Inn. I arrived in late afternoon of a hot summer evening. I'd already eaten, so I strolled up to Parliament Hill, then over to the Rideau Canal and south beside the Canal to somewhere near where I live now, on the corner of Queen Elizabeth Drive and First Avenue, where as dusk began to fall, mums and dads sat quietly chatting on their front verandas while their kids played street hockey. I had an epiphany. This would be a better place to raise our children than some far distant outer suburb of Boston. These didn't look like the kind of people who would keep a loaded handgun in their homes!  Canada hadn't gotten involved in the ruinous Vietnam War. Canada had a parliamentary democracy, not the corrupt pseudo democracy of the USA where political decisions usually depended on which special interest group bought the most favours from elected office-holders.     

Harvard is one of the most prestigious universities in the world and it was a rare distinction to be invited to join the staff. But there were drawbacks. The position was funded by 'soft money' - I would have to raise money to pay my own salary as well as the salaries of the team of researchers I would be expected to recruit. I was fairly confident that I could do this. I was full of ideas, unanswered questions about determinants of the quality of medical care both in hospital-based and community-oriented practice. (Even now, almost half a century later, some of these questions haven't been answered by studies using validated evidence). More troubling was the harsh reality of academic politics that had defeated previous efforts to build a secure bridge between the medical school and the school of public health. 

Ottawa University medical school was young, established in 1945 and undistinguished, to put it mildly. To call it mediocre was to flatter it. Turning this inside out, it had nowhere else to go but up. It had tremendous possibilities, a small medical school in a large city with two large hospitals meant rich resources for teaching, for staff-student interaction, in both languages too. I had the track record the medical school was seeking, clinical experience and impressive training and experience in epidemiology. I was ideally qualified to lead the department of epidemiology and community medicine with its combination of research focus and family practice. But we loved life in Edinburgh, so didn't want to think about leaving this lovely old city.

Wendy and I agonized over the decision for as long as we dared. Both Harvard and Ottawa  wanted my decision within a relatively brief time, 2 or 3 weeks as near as I can recall after many years. It was the most difficult decision we've yet faced and while we were deliberating over it we thought of little else, talked about little else.  

Preaching to the choir

On Tuesday morning August 13 I took the train to Kingston, where David met me. We drove to his home for a light lunch, then David drove Charles, John and me to Waterloo, where I gave my annual rabble-rousing talk to the new class of MPH students. This annual event is always one of the highlights of my academic year. The MPH Class is a roughly 50-50 mix of youthful health sciences graduates and mid career public health workers - nurses, physicians mostly, many who have worked for MSF, Oxfam, IFPA, etc, in developing countries and the world's trouble spots. As in previous years it was refreshing to find them very responsive, able to engage in vigorous interactive dialogue, so that rather than having to talk at a sea of faces (about 80 altogether) I engaged with them all in a splendid discussion of changing values and health-related behaviour.

The previous evening I joined David and his three young adult kids, and Peter's partner Sylvie Spraakman for dinner at an excellent restaurant where a helpful table server took the photo at the head of this post. From L to R, Peter, Charles (formerly Christina) John, Sylvie, me, David.

While I was rabble-rousing with the MPH class, David met with several of his colleagues, with whom he is spending his sabbatical year. Then we had a quick lunch and set off on the drive back to Kingston  using the toll road north of Toronto to avoid the traffic congestion crossing the city, which would almost certainly have delayed us long enough to miss my train back to Ottawa from Kingston. It was all a very pleasant interlude.

Hiroshima

The news that an entire Japanese city had been obliterated by a single bomb on August 6, 1945 reached us in Adelaide quite soon after the event, and was soon followed by the news that a second atom bomb had been dropped on the city of Nagasaki with equally widespread death and destruction. Members of my medical student class had studied physics recently enough to comprehend the nature of these immensely powerful bombs. I remember our discussion one August day in 1945 in the students' hut where we had lunch and some of us played cards (I'd played cards too for a while but stopped when they began playing for money). We understood without being told that atom bombs had changed our world forever. John Hersey's account of the devastation in Hiroshima occupied an entire issue of the New Yorker a year later on August 31, 1946 (I still have my copy) and Albert Einstein's eloquent words about a "New Manner of Thinking" had considerable impact too. Today is the 68th anniversary of that world-changing event. It's a sad comment on our information-overloaded times that the anniversary passed without notice this year; and I saw no little paper boats carrying candles in the pond beside the Canal a couple hundred meters south of my condo, where they have been a mute tribute to memory of the dead in previous years. Technology has changed the world almost beyond recognition during my lifetime. Atom bombs and other nuclear weapons are the most ominous technological change - in the Epilogue to the First Edition of Public Health and Human Ecology (1986) I dreaded their possible imminent use; 10 years later in the Epilogue to the Second Edition  I wrote more hopefully that the danger of a nuclear holocaust had receded. But it hasn't altogether vanished, and never will unless a cadre of wise statesman and women who love humanity more than illusory "victory" in a nuclear war agree to destroy stockpiles of nuclear weapons all over the world. There seems absolutely no chance that anything of this sort will happen in my lifetime.

J K Rowling's ear

Karen Trollope Kumar told me about Harry Potter and the Philosopher's Stone which she'd heard about from her English relatives, before it was published on this side of the pond, so I bought and read it before the publishing juggernaut began to roll. It was great fun to read, laugh out loud funny in places, and, I thought, spot-on accurate in capturing the way English school children were talking in the 1980s and early 1990s. Rowling's ear for demotic speech is the most impressive feature of The Casual Vacancy, an excellent novel about small town politics infested with a large cast of unlikable characters. Most of the school children are especially unpleasant, but Rowling has captured the way they talk, including the way they use obscenities, with consummate skill. She's done it again in The Cuckoo's Calling, a pseudonymously written whodunnit with a tough guy private detective, Cormoran Strike, who lost a leg in Afghanistan and is saved from bankruptcy by a wealthy childhood acquaintance who pays him well to find evidence that a sister's recent suicide was murder. Like J K Rowling's other books, the strength of this one rests on the smart, pungent dialogue, liberally seasoned with the meaningless obscenities that punctuate almost every conversation in pubs and public transport in London. Perhaps Cormoran Strike will reappear in more books still incubating in J K Rowling's fertile brain. I hope so: he has considerable potential, and so does his temporary office help Robin Ellacott, who will become a permanent fixture I hope.