Christmas weathers and moods

One year when I was a schoolboy I remember a neighbourhood sweepstakes about Christmas Day weather: would it break 100 on Christmas Day? That's 100 degrees Fahrenheit, the old scale we used in Australia in those far off prewar days. It was an even-money bet, almost half the time it did, although the really hot weather didn't arrive until after New Year. There must have been more to that sweepstakes than just yes or no to the simple question: the winner would have been the one who made the nearest guess to the actual temperature. Nonetheless, the sort of weather they've had in Adelaide this December didn't happen in the 1930s: in the middle of December there were five days consecutively with temperatures over 40 Celsius in my home town, Adelaide.  That's unprecedented, and a rather convincing bit of empirical evidence to add to all the rest, that climates are changing, that the world is getting warmer. This year the Adelaide forecast is for 39 C on Christmas Eve and 37 C on Christmas Day, with rain - not a very pleasant combination. My son David and his wife Desre are there, renewing connections with his aunt and uncle (my brother Peter) and his cousins and their kids - and cousin Kate's grand-children. His cousin Anne dropped in on us in Ottawa a few years ago but he hasn't seen the other Adelaide relations since 1968, when he was 9 years old. The Adelaide branch of the family is large, rather noisy, the nearest we have these days to a Victorian or Edwardian extended family. My brother has four children, an array of grand children, and three great grandchildren. There are to be several festive meals at different cousin's homes over the 4 days the Canadian contingent will be in Adelaide. I hope the weather is kind to them. I'll be with them all in spirit and wish I could be there in the flesh.

Jenny, Anne, David and Peter Last, Adelaide, Dec 24, 2015

Here in Ottawa we seem certain to have a green Christmas this year, our first really green one, with above-zero temperatures,perhaps a little drizzly rain, as we are having today.

It sets me thinking about weather and moods I've known at other Christmases around the world. There've been Christmases in Adelaide when it wasn't searingly hot, just pleasant, although for sheer perfection, nothing comes close to two or three we had in New Zealand. In Scotland it was still dark when we got the kids out of bed about 8 am, and dark again by 4 pm, very short, gloomy sort of days but not very cold: we never had a White Christmas in our five Edinburgh years although we could see snow on the Pentland Hills south of our home, but we did once in London, or rather with our friends Hazel and Bill Wheeler who lived in Surrey on the southern outskirts. There was a hard frost overnight that froze their pond, and gentle feathery snowflakes in the afternoon and early evening, just enough to cover the ground and decorate the trees. There wasn't enough to make a snowman and we were all too snug by the fireside to bestir ourselves anyway, kids as well as grown-ups. That was the Christmas when we had a small miracle. We were too poor to afford a Christmas tree that year but Wendy brought a dead tree branch indoors, we stuck it in a bucket of sand that we watered a little bit so the branch would stand upright, and decorated it with milk bottle tops that we pressed on the pointed end of our lemon squeezer to turn them into little bells, silver, red or gold, depending on the quality of the milk in the bottle. When we got back from our brief break at the Wheeler's home in Surrey, our bare, dead tree branch had burst forth in little green leaf buds - it wasn't dead after all, just dormant, and it had been warm enough in our house for it to come  to life in a premature spring. Ten years earlier during my first experience of Christmas in London, I was a house officer (junior physician) at Hillingdon Hospital at Uxbridge, Middlesex on duty on Christmas Day, mouth sore after having a tooth extracted a day or two before, heart sore because I'd just been dumped by my girl friend of the time and unhappy, but happy by the end of the hospital festivities, patients as cheerful as possible, and nurses very affectionate. I suppose I've had only one really unhappy Christmas, in 2010, six weeks after my beloved Wendy had died. That's not a bad track record after all these years.

Climate change - 2: Health impacts

Climate change has several kinds of impact on human health. as well as on the health and survival of domestic and other plants, and domestic and other animals.

Climate change includes both rising average ambient temperatures and increased frequency and ferocity of weather extremes. Both have direct and indirect effects on health. They also have important effects, mostly adverse, on food crops and on animals, including marine animals that are staple parts of human diets. In short, climate change seriously threatens food security. 

Weather extremes -- droughts, floods, violent storms -- have obvious effects on human health. Hurricane Katrina which struck New Orleans and the Mississippi delta in 2005 caused about 2,000 deaths and displaced several hundred thousand people.  But it was only a Category 3 hurricane by the time it made landfall. Several more severe storms have hit the southern USA and Mexico since 2005, but most have struck unpopulated regions.  Hurricane Sandy (2012) caused tremendous property damage along the New Jersey and adjacent New York coasts but relatively little loss of life. Similar severe storms in other parts of the world with less efficient disaster preparedness, e.g. south China, can lead to far greater numbers of deaths, injuries and infrastructure damage. Droughts and floods disrupt food crops and are a serious threat to food security. The effects of extreme weather are most pronounced in regions where the people are poverty-stricken, can't afford air conditioning, have flimsy huts rather than solidly built homes, or are crowded in shanty towns on flood plains. 

Many insect species flourish in warmer weather. These include insect vectors of diseases that have great public health importance, particularly the varieties of mosquitoes that carry malaria and dengue. Epidemiologic surveillance and monitoring habitat of insect vectors have revealed that the range of vectors has extended further into previous temperate zones and higher altitudes that in the past have been free of malaria and dengue (and other vector-borne diseases).  Nairobi, Harare, Kampala, and other large cities in the East African highlands are outside the range of vectors for malaria and dengue, but as the climate gets warmer these dense human settlements will become vulnerable. Some ecological relationships between vectors, pathogens and people are complex. For instance, Lyme disease is spread by ticks that feed on deer which normally are not in contact with humans; but as affluent suburbia extends further into rural regions, humans and wild deer become more likely to be in closer contact. Hence the risk of Lyme disease is increased.  Other ecosystem disruptions also occur. For instance, marine species such as salmon and mackerel reproduce successfully within a narrow temperature range. As sea surface temperature rises there are many disruptive consequences, among which collapse of marine species such as mackerel may be relatively minor in the grand scheme of things. But it is a calamity for predators (seabirds, dolphins, etc) that feed on mackerel, as well as a serious loss of seafood for humans.

Rising temperature in inland freshwater lakes and rivers accelerate reproductive cycles of micro organisms, including pathogens. The ecological consequences are complex, and include an increase in waterborne diseases -- cholera, diarrhea, parasitic infections. The South American cholera epidemic that began in the early 1990s and lasted over 10 years was started when the cholera organism was introduced by ships trading from the Bay of Bengal. It was facilitated by a symbiotic relationship between the cholera vibrio and other freshwater organisms, notably zooplankton. This epidemic caused over half a million cases and almost 100,000 deaths. Persistence of the epidemic was fostered by interaction of the cholera vibrio, marine zooplankton, and the warmer water temperature of river estuaries along the Pacific coast of South America. A southward fluctuation of the El Nino tropical Pacific Ocean current made those coastal waters unusually warm, thus enhancing survival of the cholera vibrio and increasing the risk of infection. Warmer weather also leads to proliferation of allergenic grasses and weeds, and is responsible for rising prevalence of asthma and hay fever.

There are many other health-related consequences of rising environmental temperature. For instance, riots and civil disturbances occur more often in hot weather than cold, which tends to encourage people to stay indoors to keep warm, rather than congregate in unruly crowds. on city streets These social disturbances tend to cause deaths and injury of those who take part. The moral of this story: avoid crowds and eschew demonstrations in hot weather. 

There is much more I could say, but this is probably more than enough for casual readers. There's plenty more available for anyone interested. See, for example, 

Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health in Lancet July 15, 2015

Climate change

Everyone is talking about the unseasonably warm weather in this corner of North America. It's the same story in other parts of the world. In the southern hemisphere it's extremely hot in my home town of Adelaide. Current temperatures two weeks before Christmas are in the 40s.  This is not unprecedented but it is highly unusual to have sustained extreme heat as early in the summer as this. It is almost certainly attributable to global climate change. There are already serious consequences for human health and wellbeing, and soon there will be more. 

Climate change first appeared on my radar in the early to mid-1980s. I spoke about global warming and the greenhouse effect with graduate students and at public health meetings from 1987 onward. I was invited to speak to ministers of health of Commonwealth nations at their biennial conference in Nicosia, Cyprus, in 1987. My first published paper on the implications of atmospheric changes for public health appeared in the  Canadian Medical Association Journal in 1989. It attracted attention, and soon afterwards I was invited to write a comprehensive review for the trend-setting Annual Review of Public Health. In that review article I focused on two human-induced changes in the atmosphere, rising carbon dioxide concentration caused by combustion of carbon based fuels, and depletion of the ozone layer in the stratosphere caused by several ozone destroying substances such as freon.

The potential harm to all forms of life on earth from rising levels of ultraviolet radiation due to destruction or attenuation of the protective stratospheric ozone layer was readily recognized even by ultraconservative right-wing politicians like Margaret Thatcher, UK prime minister, and she, along with other world leaders, signed the Montreal Protocol (1987), aimed at restricting production and release into the atmosphere of ozone-destroying substances. The danger to all forms of life from exposure to high concentrations of UV radiation has been fended off, at any rate for the time being.

Reaction and responses to the equally grave threat to the stability of life-supporting ecosystems from global climate change has not been so unanimous nor as effective. Wealthy and powerful interest groups in the carbon fuel industries, i.e. oil and coal, and transport industries have fought determined rearguard actions to maintain the status quo.  They have had support from many quarters, for example the Australian media mogul Rupert Murdoch, and several influential members of the US Congress.  Several global conferences convened under the auspices of the United Nations have been little better than fiascos. So it is gratifying that all the world's nations gathered in Paris in early December 2015 achieved a rare show of unanimity in recognizing the gravity of the threat to global life-supporting ecosystems from rising atmospheric CO2 concentration and resolved to reduce, perhaps eventually to eliminate use of carbon-based fuels. It remains to be seen, of course, whether the resolutions voted into effect in Paris actually lead to effective action by all nations, especially China and India. These two large nations rely on large quantities of low grade coal to generate most of their energy.  In China it powers the high speed rail network that the Chinese have built in recent years. 

I summarized the impact of global warming on individual and population health most fully in a chapter in the 2nd edition of my book Public Health and Human Ecology (1997). The impacts are all adverse. Prolonged heat kills large numbers of people, an estimated 50,000 in the widespread European heatwave of 2003. Wendy and I were in Edinburgh when that heatwave began (I was there for the convocation where I received the honorary degree of Doctor of Medical Science).  We stayed in the posh and prestigious North British Hotel, but it had no air conditioning, so it became very uncomfortable.  It was even hotter in London, although at least the Domus Medica of the Royal Society of Medicine, my London 'Club', is air conditioned. But it was very oppressive out of doors. The Eurostar train that we took from London to Paris is air conditioned too, thank goodness, and so was our hotel in Paris, although inadequately. We sat a while in a park in the Marais, but abandoned our plans to stay a week in Paris to sample its many charms yet again. Instead we escaped after 2 days on the TGV to Geneva where the Cornavin Hotel, my favourite there, is air conditioned. But outdoor patios of restaurants aren't, so there too it was oppressively hot. It's easy to understand why so many died of heat stroke and heat exhaustion. Most were old and frail, or young and ailing. Wendy and I were in our late 70s then, and we found it hot enough to be distressing.  

Since 2003, just as in the preceding 100 years, global average temperatures have continued to rise, in parallel with rising atmospheric concentrations of CO2. The rising global temperature has thawed polar and alpine ice-caps, exerting maximum effect at high latitudes: ambient temperatures have risen higher near the poles than anywhere else. I last flew over Greenland in August 2011 and saw for myself the dramatic impact of global warming on this large ice-covered island. It's no longer ice-covered, at any rate in late summer. Far below our plane as we flew over at 11,000 meters, we could see vast pools of melt-water everywhere; and the seas to the east and west of Greenland were dotted with innumerable icebergs, calved off the glaciers that run down to the fiords and drain into the sea along the coasts of Greenland. All that melting ice is coming from above sea level, so it is contributing to rising sea levels. So are even larger volumes of melt water from the land mass of Antarctica. The IPCC reports estimate that sea levels around the world will rise by at least a meter before 2100. In addition to rising concentrations of CO2 the atmosphere is being burdened by large quantities of methane, released from frozen bogs and from permafrost as this thaws. Methane is an even more powerful greenhouse gas than CO2, so it accelerates global warming. Most of the IPCC scientists say privately that the sea level will rise by much more than a meter, but even that modest rise will gravely threaten many small island states, e.g. the Maldives south of India, Kiribati and others in the Pacific, as well as low lying coastal regions of south China, Japan, India, Bangladesh, Holland, Miami and much of south Florida, the Mississippi delta, London and East Anglia and many other parts of the world. The habitat and food-growing regions of several hundred million people are at risk. Soon there will be many millions more environmental refugees. 

I'll say more about the implications for food security, and about the direct and indirect impact of global warming on human health in another post.

Trumpeting

When he first surfaced over my horizon a few years ago I thought Donald Trump was a loud-mouthed, empty-headed buffoon. At that time, he was obsessed with the belief that Barack Obama was not born in the USA and therefore was not eligible to be president of the USA.  In retrospect and in view of his current pronouncements, this obsession would seem to have its roots in a racist belief that non-European people are unfit for high office. Cautiously observing his increasing appeal to all that is worst about the masses and their reaction to demagogues, I am becoming more than a little alarmed. His ignorant ravings have done nothing to erode his appeal to the masses -- if anything, the reverse.

He reminds me more of Hitler every time I see and hear him speak in the sound bites that appear on my TV screen whenever I turn it on. We didn't have TV in 1938-39 when Hitler's face and speeches dominated our newsreels in the 'shorts' that preceded the main feature
 at the movies. Trump's mannerisms resemble those of Hitler's that I remember from those long-gone days. 

There is one interesting difference.  Hitler was very clear about his demands and his political agenda. Trump isn't. Apart from a proposal for a wall between Mexico and the USA, and perhaps one between Canada and the USA, and an edict (or whatever it takes) to keep all Moslems out of the USA, I have no clear notion of Trump's political platform. I wonder if he has actually defined his platform yet. I get an impression that he has a list  of undesirable people and events but is less sure of what he actually wants to do in the event that he achieves the Republican nomination for President of the USA, and the even more unlikely event (I hope!!) that he gets elected.

There have been dystopian fictions about a fascist takeover of the United States. I fervently hope life isn't going to imitate art, but Trump is unquestionably a fascist demagogue, as intelligent, cool-headed clear thinking Americans instantly see. It worries me, however, that there are increasing proportions who perceive him as the saviour who will restore the USA's lost greatness.  How he proposes to go about achieving his ill-defined and undefined aims is troubling.  A demagogue who develops or invents his cause or causes  and his policies and political agenda after the fact of being identified as a national leader is a truly terrifying prospect.

America has undoubtedly lost much of its former greatness, I believe as a direct result of a misplaced national hubris.  Thucydides knew it well, understood it, and eloquently described its tragic consequences in his history of the Peloponnesian War, fought between Athens and its adversaries more than 2000 years ago. Aspiring leaders of America and other countries should be required to read Thucydides as a condition of running for office. One of the signs of decline from greatness is the lack of merit demonstrated by aspirants for high political office. This is manifest emphatically in the dozen or more who seek the Republican nomination, most of all in the worst of them all, Donald Trump.  

Periodic madness

I attribute the phrase 'periodic madness' to John le Carre, the nom de plume of the British writer David Cornwall. It's a useful descriptor. Bouts of periodic madness have gravely damaged the American psyche and the body politic. Obvious examples include the Civil War, in which about a million young men died, Prohibition, which fostered gangsterism, the concepts of 'manifest destiny' and American exceptionalism, which absolves the USA from obligations held in common by other civilized nations, especially in wartime. 

When Wendy and I lived for a year in Burlington, Vermont in 1964-65, we saw several manifestations of 'periodic madness' that persuaded us to turn our backs on the American variant of 20th century civilization. I've mentioned these in previous posts on this blog.  They include strident militarism and a paranoid view of the USA's place among the community of nations, which was displayed in the early 1960s in the Vietnam War. Americans saw this as a conflict between the (good) forces of Capitalism and the (evil) forces of communism. Even now, half a century after it ended, many of them apparently continue to believe this distorted, misguided view of the reality, which was a war of liberation of the Vietnamese from French colonial rule. The French were decisively defeated when the fortress of Dien Bien Phu was overrun by the Viet Cong. But American 'advisers' were already operating in Vietnam. Instead of embracing Ho Chi Minh as a fellow spirit of George Washington, American policy makers saw him as an agent of the mythical communist hordes that sought to convert the world to their evil system. They expended huge amounts of American blood and treasure opposing the irresistible urge of the Vietnamese people to control their own destiny. The Vietnam War ended and so did the Cold War. But America found other adversaries, notably in the Middle East. Perhaps 'periodic madness' is the wrong phrase to describe this feature of the American psyche: it's not periodic but perpetual madness.

One constant feature is violence, commonly lethal violence. This week there was another mass shooting: fourteen people at a pre-Christmas party in a disabled people's centre in California were slaughtered by a young married couple who had a baby a few months old. They left the baby with relatives, put on body armour and used large calibre assault rifles, weapons of war that have no possible civilian use. The man was American-born, has an 'Arab' name, and acquired his wife in what sounds like an arranged marriage while visiting Saudi Arabia last year. Several aspects of this mass shooting are unusual and puzzling. The unanswered questions about it will doubtless soon be answered. This might have been a terrorist attack. None of the other mass shootings in the USA this year - 355 according to the Daily Beast, an 'average of one a day' according to the NY Times - is associated with international terrorism, although some, for instance one a week ago, were associated with another manifestation of madness in the body politic, an attack on a Planned Parenthood clinic, a rather common form of domestic terrorism in the USA. Many Americans seem to believe it's OK to destroy facilities and terrorize, even kill staff of family planning clinics, because every foetus has the right to live. Nurses and doctors who help women with reproductive problems on the other hand, apparently don't have a right to life, according to this warped view. Political reactions to this latest mass shooting have been the same as to all the others: condolences and prayers for the bereaved, and total silence on possible legislative or regulatory measures that might be adopted as ways to reduce or control this mindless and preventable loss of life. 

A late bloomer

Let me call her Mrs McKnight. Doris McKnight. She was a little wisp of a woman, 60ish, nondescript, mousy, soft-spoken when she spoke at all, which was seldom. Her great burly husband spoke for her, barging into my consulting room ahead of her, telling me about her symptoms, usually in a rather patronizing way, belittling her problems, giving her little opportunity to speak for herself. His name was ... no, I'll keep him anonymous. I'll call him Vern. I doubt if he ever read a book in his entire life.  Doris made up for this. By the time I met her she'd worked her way through all the classics in the municipal lending library and sometimes diffidently asked for my suggestions about what she should read next. Doris was in pretty good shape.  Mild high blood pressure was her only overt reason for seeking medical surveillance, and like so many fair-complexioned Australians, she had some hyperkeratoses on her scalp and arms, the thickened skin spots that are the consequence of a lifetime's exposure to too much ultraviolet radiation, and precursors of skin cancer.

Then Vern died suddenly, probably of a cerebral haemorrhage. He left their affairs in a horrid mess. Doris tidied the paperwork, paid the arrears of income tax, rearranged her home, sold the car that she couldn't drive, turned the garage into a workshop, and set about fulfilling her unrealized dreams, turning these into exquisite reality. 

Doris had always wanted to do something with her hands.  She began with plasticene but it dries out, crumbles away and loses its shape. She graduated pretty quickly to pottery, and invested in a kiln. She began making little pottery flowers arranged in elegant sprays and wreaths, and decorative abstract figures on teacups and teapots. She spent hours painting these, honing another skill, teaching herself which colours best blended or contrasted with others. Then she graduated to human figures, whimsical leprechauns, demure fairies, lecherous satyrs, naughty little boys and prim school girls. Her irrepressible sense of humour bubbled up around all her figures. She sold them at fairs and the 1950s equivalent of farmers' markets. She did quite well: her little 'human' figures especially commanded very good prices and she was businesslike enough to recognize this, charged appropriately, and, I suspect, didn't bother the tax authorities with details of her cash transactions.

I got to know her in the last 2 or 3 years that I was in practice in Adelaide in the 1950s and regretted leaving the practice more because of her than almost any other patient I cared for.  She bloomed late, but luxuriantly, an inspiring example of all that is best about the human spirit. 

How I edit

In the late 1950s my medical career and my literary life began to merge in pleasing ways -- pleasing to me as a writer, pleasing to readers who fed back to me the fact that the stuff I wrote was easy and even enjoyable to read and was educationally useful. I began to feel that I was doing what I was meant to do with my life. I consciously set about sharpening the skills I was developing. Medical journals were not only hospitable to the stuff I was writing; their editors began to ask me to pass judgement on other people's articles: I became a peer reviewer. That further transformed my life, bringing me into closer contact with the complex problems of scientific editing. I had a mission in life. I began mobilizing my professional expertise and my literary skills to the same worthwhile end.

The next step plunged me into the wonderful world of editing. At the University of Edinburgh, two senior staff members, Reg Pasmore, a physiologist, and Jim Robson, an internal medicine specialist, invited me to edit the 'community medicine' section of the massive multi-volume Companion to Medical Studies they were compiling. This covered everything a medical student needed to know: the basic preclinical subjects, anatomy, biochemistry and physiology, the bridging disciplines, pathology, microbiology, immunology, pharmacology, the clinical sciences, medicine, surgery, obstetrics and gynaecology, psychiatry, and my specialty, community medicine, or public health.  At first I innocently thought my task as a medical editor was to improve the prose in the texts that authors sent to the textbook I was editing: to tighten, clarify the language. I was taken gently in hand by the two editors in chief, who explained my role and responsibilities to me. 

'Literary' editing was part of the task but it mattered less than factual correctness. First and foremost, was the text scientifically accurate, truthful, valid? Scientific writing covers a wide spectrum. Almost all scientific writers aim to present the truth as they understand it. They may grasp only part of the truth, may use inappropriate statistical tests to demonstrate that their findings are true, or - rarely - may seek to deliberately deceive readers. The most important quality required of a good editor is possession of a built-in crap-detector. At the far extreme of bad medical science writing is scientific fraud. It is rare but its impact can be devastating because it can do great harm. A scoundrel fabricated false evidence purporting to show that the measles, mumps and rubella (MMR) vaccine caused autism. His motive was that he had a financial interest in a company that made a competing vaccine. The fraud was soon exposed, but many otherwise intelligent young parents continue to resist getting their infants immunized against measles, mumps and rubella, and often by extension other preventable infectious diseases because publication of the fraudulent paper in a prestigious medical journal left a permanent memory stain on the vitally important public health procedure of immunizing infants against infectious diseases. Gross fabrication and deliberate fraud are rare but minor examples are common. That is why possession of an effective crap-detector is such an important quality of all editors  of scientific books and journals. I'll say more about this in a future post.

Other skills are required when editing scientific books. How and where does the text I am editing fit into the big picture, the entire discipline? Is it concordant or discordant with other parts of the book, other aspects of the body of knowledge in that domain? Are all chapters at the same intellectual and professional level? (Once I had the troublesome task of telling an eminent specialist that his contribution might have been OK in the New York Times Sunday magazine but was below the level required by advanced postgraduates aiming to enter that specialty).  Other things editors must detect include plagiarism, including self-plagiarism, i.e. publishing the same chapter in two or more different books. Rather often I sought second and third opinions, inviting other experts to review the MSS submitted by the expert who'd been invited to write the chapter. This is part of the peer review process which is so valued by scientific editors. I discovered that I had a talent for medical editing. 

A problem arises in domains of biomedical science where uncertainty persists, for instance about which theory of causation best fits the facts, for example in coronary heart disease; or which treatment regimen is the most likely to control a potentially lethal disease such as breast cancer. In those situations the best approach is to present summaries of each point of view - with supporting factual evidence of course.  Pasmore and Robson were fortunate to have in Edinburgh an eminent authority on radiotherapy and an eminent breast surgeon: they were able to offer chapters by both in the Companion to Medical Studies, and leave it to readers to decide. I learnt a great deal from Reg Pasmore and Jim Robson about the art and expertise of editing. The search committee seeking an editor in chief for the massive US reference textbook of public health and preventive medicine evidently had me in the cross-hairs and might have consulted with Reg Pasmore or Jim Robson.  Perhaps that's why I, a non-American, was invited to be editor in chief of this fat volume now eponymously known as 'Maxcy-Rosenau-Last' Public Health and Preventive Medicine. 

My successful completion of that task established my reputation, and led to other editing tasks, some even more challenging. I edited the Canadian Journal of Public Health for 11 years, Annals of the Royal College of Physicians and Surgeons of Canada for 9 years, networked with editors of other medical journals and learnt a great deal about the unique problems they faced. I got deeply immersed in compiling and editing technical dictionaries, starting with the Dictionary of Epidemiology, which was in many ways the most enjoyable professional work I ever took on. I was co-editor of several other technical reference books, ranging from Stedman's Medical Dictionary and the Oxford Dictionary of American English, to several encyclopedias, notably the MacMillan Encyclopedia of Public Health. All these tasks, some of them pretty large, occupied the first 12-15 years after I officially retired from the active staff of the University of Ottawa. I am among the most fortunate of people, to have had the opportunity to do such enjoyable and worthwhile jobs over such a long period of my professional life.           

Beatrice and Sidney

I picked up A Victorian Courtship by Jeanne MacKenzie (Oxford: OUP 1979) in the early 1980s, in Oxford after OUP published the first edition of the Dictionary of Epidemiology or in London. I forget which.  It vanished in my bookshelves which have an uncanny ability to conceal as well as to reveal books. Happily it survived the ruthless pruning that accompanied our move from a house to an apartment. Its spine caught my eye last week. I opened and began to read it. It's a slim little book, about the courtship of Beatrice Potter, youngest of 9 daughters of a prosperous North Country industrialist, and Sidney Webb, the little Cockney who wooed and won her. They were a power couple I'd love to have known, left of centre intellectual movers and shakers. They founded the London School of Economics and the weekly New Statesman, and were prominent Fabian socialists. Beatrice and Sidney Webb were married for more than 50 years and accomplished an enormous amount of good in Britain and the world. They and their work deserve to be better known by all of us. This book helps to make them better known.

Beatrice Potter (1892) shortly before her
marriage to Sidney Webb

Sidney and Beatrice Webb en route
to the Soviet Union, 1932

I've often wished for time travel so I could converse with many people I'd love to have known but couldn't because they lived before my time. Mary Wollstonecroft, for instance, and Jane Austen, and Samuel Johnson. Sidney and Beatrice Webb's lives overlapped with mine, so it would have been possible in theory for me to have met them, if I'd gone to London a few years sooner, and moved in the same circles.   (Beatrice lived 1858-1943 and Sidney 1859-1947). But I didn't go to London for the first time until 1951, and didn't enter that magical circle of left-wing intellectuals until 1961. Perhaps it bends truth a little to say I 'entered' that magical circle: I was always on the fringe, and the circle had fragmented by the early 1960s. But I knew well, and networked with some of the surviving members throughout the 1960s, first in London then in the second half of the 1960s from my base at the Usher Institute of Public Health at the University of Edinburgh. My mentor Jerry Morris was a disciple of the Webbs, and his friend Richard Titmuss at the London School of Economics was their principal apostle. I sat at Titmuss's feet too, and learnt much from him, notably how to reinforce and apply in my own professional life, his (and my) values of equity, altruism and social justice. These were the Webb's values too, of course. I did my best to pass on these values in all my contacts with students, in many of my published papers and in Public Health and Human Ecology, and even managed to smuggle hints into some entries in the Dictionary of Public Health.

Like most young women of her time, Beatrice Potter had no formal education, but was self-taught. Long before the concept was 'invented' as an exciting innovation in medical education, she was applying problem based learning in her work as a rent collector in tenements owned by her family in the slums of East End London. She taught herself sociology, applying the concepts and theories of Herbert Spencer. She worked with Charles and Mary Booth on their monumental study of work and poverty, teaching herself more social science as well as economics and statistics. Sidney Webb too was largely self-taught. When these two scholars met - two student researchers attempting to figure out how society and communities worked, how and why some were 'healthy' and functioned smoothly and successfully while others did not - it was a true marriage of two first class minds in search of solutions to oppressive problems that hampered progress towards a more ideal civilization in late Victorian and Edwardian England. 

Beatrice was able to deploy some of her family wealth pursuing research aimed at diagnosing the ills of that society, and poured more of that wealth into the research and educational institution that became the London School of Economics. This occupies a huddle of buildings near the junction of Kingsway, Aldwych and the Fleet Street end of the Strand. (Whenever I was in London in the 1960s, 70s and 80s I used to beat a path to the LSE, specifically to the Economist Book Shop whence I usually staggered away, my briefcase bulging and weighed down with exciting treasure obtainable nowhere else). 

Sidney Webb's wooing and winning of Beatrice Potter depended on his letters to her. In those times before telephones became ubiquitous, generations before email, the internet, Facebook and the other fast-track features of life in the early 21st century, communication between two young people who were attracted to each other relied heavily on letters.  They weren't all that young, moreover: Beatrice was well into her 30s and Sidney a few months younger.  It took a while for them to overcome the constraints of their times, and their letters seem stiff and formal, compared for instance to those between Wendy and me. Nevertheless few exchanges are as captivating as the letters back and forth between Sidney Webb and Beatrice Potter, judging by the samples in this small book. 

Beatrice had at least one really kooky idea (two, if you count the infatuation she shared with Sidney for Soviet Russian communism as practised by Stalin). She believed that women should adopt cigarette smoking as a sign of their equality with men: "Let men beware of the smoking woman. I would urge earnestly on the defenders of Man's supremacy to fight the female use of tobacco with more sternness and vigour than they have deployed in the female use of the vote. It is a far more fatal power. It is the wand with which the possible women of the future will open the hidden stores of knowledge of men and things and learn to govern them. Then will women become the leading doctors, barristers and scientists. And a female Gladstone may lurk in the dim vistas of the future."  It's happening and gaining momentum - although she would have deplored Maggie Thatcher and her policies even more than I do!  

There's much more I could say about this fascinating couple, especially about Beatrice. I haven't even mentioned her emotional relationship with the powerful statesman Joseph Chamberlain. The Webbs richly  merit a biopic.  I hope someone at the BBC or elsewhere sees this post and seizes the suggestion.   

Equality and equity

As an Australian with Y chromosomes I was born a male chauvinist and remained true to the associated beliefs and values through my school and university years. I believed that males were inherently superior to females in all respects. It was a belief that seemed as immutable as belief in the law of gravity.

Imperceptibly this belief began to be eroded, at first so subtly, so insidiously that I can't date the onset of doubts about the natural superiority of males. In retrospect I think the first onset of doubts may have arisen when I began seeing sick people. One would have to be as thick as two planks to fail to notice that women and girls withstood suffering and sickness, chronic unremitting pain, devastating loss, with courage, phlegmatic calm, philosophical insight, a sense of humour and constructive foresight, rarely equalled by their male consorts. Reluctantly also I had to concede that there were women who could out-perform me on every criterion it's possible to measure. Being married to Wendy played an important role in the slow and steady process of conversion, or enlightenment.  I owe to Wendy the erosion and ultimate obliteration of my sense of the natural superiority of males (and the sense of entitlement that accompanied it).

Ultimately hard facts that came to light when I was doing research for the UK Royal Commission on Medical Education in the early 1960s impelled my conversion from male chauvinist to card-carrying feminist. I "came out," so to say, and I had facts and figures to back me up. These were published in one of the papers that summarized the results of meticulous research projects I did with help from Gillian Stanley and others. (Stanley GR, Last JM, "Careers of Young Medical Women." Brit J Med Educ, 1968, 2:204-209, and Appendix 19, Report of Royal Commission on Medical Education. Cmnd 3569; London: HMSO, 1968, pp 320-396).

Conditions have been improving for the female half of the human race since long before the 1960s, although obviously there is a long way to go before we achieve genuine equity between the sexes in all the nations and cultures of the world. Karen Trollope Kumar and I summarized some persistent appalling facts in a background paper for a WHO conference on "Women, Health and the Environment" in Bangkok in 1997. By then it was possible to use official demographic statistics from very large populations in both India and China to reveal the devastating distortion of the naturally occurring sex ratio of male:female births by the selective abortion of female foetuses. That distortion has led to large cohorts of men who have no marital partner, with consequent insoluble social problems.

All of this bad news has been put in a more cheerful, more positive and hopeful perspective by the enlightened actions of Canada's new prime minister, Justin Trudeau.  He has selected a cabinet with equal numbers of women and men. (When asked "Why?" he had a simple conversation-stopping answer: "It's 2015!")  Today I watched the swearing-in ceremony and was enormously impressed by the range, depth, and diversity of experience of the new cabinet. Collectively they have tremendous potential.  If they fulfill only half their promises, it will be a spectacular success. I know and have worked with one member of the new cabinet, Kirsty Duncan PhD, and have great respect for her expertise and ability; she and I were in the vanguard of scientists studying the causes and effects of climate change in the 1980s.   She and Catherine McKenna, my local member, new minister for environment and climate change, are safe hands and minds to manage this urgent problem.    

Sunshine in Canada (A VERY POLITICAL POST)

WARNING: A VERY "POLITICAL" POST!

It's too soon to rejoice, and the Liberal Party has a history of failure to fulfill election promises. Nonetheless I feel cautiously optimistic. The Harper government's objective was never clearly defined but seems to have been to cut costs by reducing taxes and the size and influence of the national government. The Treasury Board tightly controlled the flow of money so funds allocated remained unspent. Military Service pensions and benefits were not delivered, nor were allocations to First Nations, enabling the government to boast that they had balanced the budget. If funds voted by their own government had been disbursed they would have had a deficit of several billion dollars. They governed with a unique combination of paranoid fear, austerity, and deceit.  They did terrible damage to Canada's international reputation and standing among the enlightened nations. For these reasons and others set out below I believe the Harper government was the worst for 100 years. It's good to be finished with them. 

In February of 2015 I compiled a list of reasons why I would never support the Harper government, and strongly believed that no enlightened intelligent person would. Here are my reasons:

Why I don't support the Harper conservatives (Compiled February 2015)

1. Ideology, not evidence, determines political decisions; strong anti-science bias

The Conservative Party of Canada is one of the most scientifically ignorant, politically inept sets of political leaders on earth. They are worse than ignorant. They are willfully obscurantist, hostile to science, blindly blundering about, rejecting evidence in favour of their narrow ideology. They have abdicated from international discussions of the most urgent policy issue confronting humanity, the critically urgent problem of climate change and what to do about it. 

2. Lack of vision

The Harper Conservatives have an extraordinarily narrow vision of Canada. Indeed they are without vision. Stephen Harper sees Canada as an ‘energy superpower’ but only considers petroleum fuel as the source of this energy. Moreover, the fuel is very ‘dirty’- bitumen or tar that requires costly, energy-intensive refining. Further, while he seeks to maximize consumption and combustion of oil, Harper has no time or patience with conservation of energy. He has even less time for sustainable energy, for solar, tidal and wind power. This directly contradicts traditional conservative philosophy.

3. Profligacy

Among the gifts left to Harper by the previous Liberal government, along with a large fiscal surplus, was a program of subsidies for enhancing energy efficiency by improved home insulation. Among the first act of the Harper Conservatives was to cancel this program.

4. Fiscal irresponsibility

Another immediate act was irresponsible tax cuts that eliminated the healthy surplus inherited from the previous government. These tax cuts were, of course, very popular with the most short-sighted portion of the electorate. These were truly acts of a visionless government, that called to my mind the biblical saying, “Where there is no vision, the people perish.”  

5. Governs on ‘divide and rule’ principle

Nations run best on collaborative teamwork. The concept of collaboration is alien to the Harper government which functions on a ‘divide and rule’ principle, setting one ethnic or interest group against another. There are many examples of this obtuse behavior. One that is more harmful than most is Harper’s refusal to attend meetings of first ministers of the provinces and territories.

6. Partisan policy in Israel-Palestine dispute

For many years before the Harper government came into office, Canada had a high international reputation based on its record of impartiality and altruism, particularly in the Israel-Palestine dispute. The Harper government has destroyed this reputation. It has sided unequivocally with Israel, boasting that it is Israel’s best friend, needlessly making an enemy of Islam.

7. View populace solely as taxpayers

The Harper government sees the people of Canada first and foremost as taxpayers. Newborn babies, indigent single mothers, old people dying of cancer or dementia are not primarily taxpayers, although they have well defined needs for health and social care. Every Harper government action boasts of an accompanying reduced tax burden. You get what you pay for. I don’t mind paying more for better quality, for example of CBC radio and high quality postal services.

8. Hostile to women’s reproductive rights

The Harper government is unfriendly, to say the least, towards women’s reproductive rights. Some years ago they denied charitable status to the International Planned Parenthood Federation, Family Planning Canada, and several similar NGOs. They withheld approval for the so-called ‘abortion pill’ for over 2 years, longer than any other drug ever submitted for approval in Canada, longer than any other nation. 

9. Mean-spirited and vindictive

The Harper government is mean-spirited and vindictive, for instance targeting altruistic non-governmental organizations that promote concern for the environment. These are seen as enemies, presumably because they disapprove of government policies that are very destructive of environments. These have been subjected to costly and needless audits by Canada Revenue Agency.

10. Attacks on Parliamentary Budget Office and Elections Canada

The Harper government’s way of doing politics relies on hatred and contempt for political adversaries. These adversaries include the permanent civil service. Civil servants are regarded and portrayed not merely as enemies of the CPC, but enemies of Canada – a complete distortion of reality. They have adopted the same attitude to impartial agencies such as the Parliamentary Budget Office and Elections Canada.  The aim seems to be to emasculate or neutralize democratic infrastructure that threatens them by telling the unvarnished truth.

11. Hypocrisy and empty gestures

Examples of this include Harper’s very public ‘apology’ for the atrocities committed during the residential schools fiasco. It was an empty gesture because nothing whatever was done to follow up and make amends for the parlous plight of First Nations people: no move to ameliorate the plight of people on reservations where living conditions are deplorable, outright refusal to establish an inquiry into the root causes of conditions that have led to over 1200 missing and murdered women and girls. 

   

12. Use of omnibus bills rather than parliamentary debate

The Harper government repeatedly bypasses democratic debate by using ‘omnibus budget bills’ as a way to change laws without submitting these laws to formal parliamentary debate.

13. Lemming-like rush towards extinction (opposite of sustainability)

The actions of the Harper government take all life in Canada towards extinction. I wouldn't mind in the least if the Harper government became extinct. But it makes me angry to think of them carrying bright children with them to extinction, children who manifestly could run Canada and the world a great deal better than they have.  In the interests of life in Canada and life on earth, we must get rid of this bunch of scientific ignoramuses who have been mismanaging our lovely part of the habitable world for far too long. 

14. Narrow, ideologically based economic policy

Economic policies are very narrow, based on resource extraction rather than sustainable diversification. In early 2015 we see the adverse consequences as oil prices collapse.

Economic policies are ideologically based, as in dismantling of National Wheat Board, which ensured stability of income for farmers. Taxation relies on 'boutique' tax cuts for targeted segments of the population.

15. Mediaeval approach to crime and punishment

Crime must be punished. That's far more important than preventing crime. More and bigger prisons, harsh sentences, are the solution. If they could get away with it, they would restore the death penalty.

16. Miserable mean-spirited management of refugee resettlement (because they are Muslim?)

 Refugees are viewed as potential or even actual terrorists. If possible, keep them all out "None is too many" which was the prewar government policy towards Jews fleeing the Nazi regime in Germany, is the covert policy of the Harper conservatives. 

A few additional reasons to reject Harper and all he stands for: 

Our flag: Not even $50K for 50^th anniversary paid for from Museums’ budget, versus $400K for War of 1812 when Canada didn’t even exist                                                                                              

False and misleading erection of phantom ‘terrorist’ enemies – stoking fires of ‘national paranoia’

Delay, delay, delay help for distressed Muslims (e.g. Syrian refugees, Al Jazeera journalist)

During the election campaign, Harper and his crony Jason Kenney added a further reason. A woman, just one of two women in the past decade, wanted to wear her niqab (face veil) during her citizenship ceremony.  Harper declared that he would prevent this, if necessary by special legislation. If an ordinary Canadian had made such a statement, couched in language that was an implicit incitement to violence, there would be a strong case for prosecution under legislation against racist hate speech. That the prime minister of Canada should say such a thing, not once as a slip of the tongue but repeatedly, in my view disqualifies him from holding any public office.  

Why and what we write

We write because we have something to say, something to sing, a poem, a story, an item of news, a mathematical formula with predictive power, a theory of how the universe works, that we want to share with others. We feel an irresistible compulsion to share our thoughts, our ideas, with other people. 

By 'we' I mean all humans, everyone, but especially those of us who believe we have something worthwhile, important, beautiful, aesthetically pleasing, that we are impelled to share with others. 'Others' vary in number from our nearest and dearest to all of humankind. 

We began doing this before writing was invented. Balladeers, story-tellers, wandering minstrels, tribal elders and sooth-sayers were talking to the rest of their tribe or clan millennia ago, singing songs, telling stories, relaying the history of their people. Homer, the blind poet, sang the story of the siege of Troy which probably mixed a historical record of real events that happened to real people with the magic and myths of interventions by the gods.  The Iliad, Homer's tale of the siege of Troy, of Achilles, Agamemnon, Helen and Paris, Priam, Hector, Odysseus, the rest of the heroic band of Greeks and Trojans and the Olympian gods and goddesses, dates back, we believe, to long before those who told the tale had written records. It was passed on orally, perhaps for centuries before it was written down, and preserved in perpetuity as one of the greatest of all timeless classics. 

I discovered that I had worthwhile things to say to my professional peers and students aspiring to join our ranks, possessed the ability to express these in language others enjoyed reading as much as I enjoyed writing them down. I could summarize and condense complex concepts into simple generalizable principles. In 1977 I started work as editor in chief of a massive comprehensive reference textbook of public health and preventive medicine. When it was published in 1980, that book had 1926 pages, plus 25 pages of 'front matter' - title page, table of contents, preface, list of contributors and their affiliations. The book attracted praise from many quarters. The praise I appreciated most was for the introductory chapter in which I pulled it all together, summarized the complex and occasionally confusing 'big picture' in an overview devoid of technical jargon, 6 pages a grade school child could understand, about the scope, aims, methods and scientific basis of public health. Here is a sample:


"The ways to preserve and improve health are discussed at length in later chapters. In summary, the methods are to keep the environment safe, to enhance immunity to infections, to behave healthfully, to eat wisely and well, to have well-born children, and to care prudently for the sick." 

Whether I'm writing about tangible things or abstract concepts it's important that I, the writer, and all my readers, give the same meaning to every word in the text. There is no place for Humpty-Dumpty in my kind of writing. Remember what Humpty-Dumpty said to Alice: "When I use a word it means just what I choose it to mean - neither more nor less." That's not to say I reject ambiguity always and forever. Even in the Dictionary of Epidemiology - a dictionary, forsooth - my editorial team and I felt obliged to leave a little wiggle room, a little uncertainty, or two alternative meanings, for an occasional technical term. We also had to recognize that the same technical word or phrase could occasionally mean something entirely different in two (or more) unrelated scientific domains in which its use had evolved independently. But that's a rather arcane discussion for another time and place, not for this post on this blog.   

In this post I'm discussing my own writing, and it would be easy to get carried away, to run on for far longer than the most patient reader would wish. Time to quit while I'm ahead.

Why I write

George Orwell's essay Why I Write was published in an obscure, short-lived English literary magazine in 1947. It was reprinted in (I think) an Australian literary magazine a year or so later, and that's where I must have read it. It made me think for the first time about why I had this odd compulsion to arrange my thoughts in what seemed to be an orderly manner, and set them down on paper.  I remember trying to set down my reasons why I wrote. I wish I still had the two or three badly typed pages I managed to produce as my answer when I was in my early 20s, but like nearly everything I wrote in those days, it hasn't survived. 

Orwell spent a few pages describing how he wrote, and on what topics - fact, political polemics, infrequently fiction, though later works, his two most famous, most timeless books, Animal Farm and 1984, are classified as fiction. He seems to have found it difficult to address the question in the title of his essay, because he flits around it like a bee buzzing from flower to flower and his reasons are sometimes buried almost shamefacedly in paragraphs about something else. At one point in the essay he tries to compile a list of reasons: egoism; aesthetic enthusiasm; to store facts for posterity; political purpose. But he gets distracted, and this essay, which could have been a valuable contribution to literary scholarship, is in the end a rather frustrating, rather inchoate, rather annoying and disappointing mess. I suppose that's one reason I tried to write my own essay on the matter in 1948 or thereabouts. Other collections of essays that I formerly possessed, by E M Forster, Aldous Huxley, Arthur Koestler, half a dozen other 'public intellectuals' of the 1930s, 1940s, 1950s, are long gone, not part of my shrunken downsized library, so I can't check; but I don't recall any other writers or thinkers who addressed the question, and stated their reasons for writing.

My reasons then included desire to clarify complex concepts and ideas, to explain, perhaps to simplify these concepts and ideas by expressing them in my own words, and not insignificantly, the pleasure I got from writing. These reasons are implicit, sometimes explicit, in much of my professional writing. Among my books, I've edited a massive reference textbook of public health and preventive medicine, compiled and edited technical dictionaries of epidemiology and of public health, and co-edited an encyclopedia of public health and a 'Companion' to Medicine in the 'Companion' series published by Oxford University Press. I wrote large parts of all these books, even the encyclopedia, to which I contributed more than my fair share. Working on all of these and other books and articles, and writing editorials for journals I edited, gave me immense pleasure, partly because of collegial relationships with other editors and authors, but mainly because it was such a pleasure to do all that writing. I've always been chuffed to get feedback from readers who say it's a pleasure to read what I've written, more enjoyable than many other textbooks and works of reference because I wrote with a lively style that kept readers awake.

Until recently I've always been able to find exactly the right word, the appropriate phrase, the rounding off paragraph to sum it all up. Alas, as I enter my 90th year I find all this no longer falls trippingly off my tongue, it's no longer there at the surface of my mind, waiting to be plucked and used to the best purpose. Now I must often search, sometimes in vain, for the needed words and phrases. These, no doubt, are signs of declining intellectual vitality that I must accept and make the best of, smiling bravely through unshed tears as I lament the ravages of time.  No, correction: I don't lament them at all, I acknowledge and accept them, thankful to be here still after all these years and insightful enough to recognize my limitations.

And I can add another reason to my list of reasons Why I write: It's the perfect therapy.

What would you do?

A devoted couple in their early to middle 80s confronted a crisis of accumulating health problems.  I'd known that elderly couple almost all my life. He was my favourite cousin, about 5 years younger than I; and I'd known her for more than 70 years. They'd had a marvellous life. Thanks to lucky real estate deals and other sensible investments they were very wealthy. They could afford to pay for all the domestic help and personal nursing care they needed. In their early to middle 80s, they were as in love as they had been when they married more than 60 years ago. They looked back on full lives that had been enormously pleasurable. One of the highlights of their lives had been a three-year yachting cruise around the world, during which their daughter had paired off with a man from Chile, a nephew of the dictator Augusto Pinochet. One of their sons had fallen for a French girl, married her, and settled in France. Their other son wasn't quite so fortunate: he'd been caught with marijuana in Greece, and despite high-priced legal counsel with good arguments, he'd spent several months in the slammer in Corfu. That was one of the few clouds on their horizon,apart from the fact that two of their three children settled far away on other sides of the world after they married.

Now things were going wrong.  He had become forgetful and unable to care for himself as dementia held him in its increasingly relentless and clammy grip. She'd fallen victim to mesothelioma, an intractable malignancy caused by exposure many years earlier to trace amounts of asbestos, the amount that might be shed by a fraying insulated oven mitt or a barbecue apron. Mesothelioma can't be treated. The malignancy hits the lining of the lungs, sometimes the lining of the gut; but it can't be cut out, can't be treated with radiation or chemotherapy.  Their daughter's marriage had broken down so she had come home from Chile to live near her parents in Queensland in a prosperous suburb of Brisbane. As the mesothelioma advanced and her vitality wilted away, and her husband became increasingly dependent, forgetful and childlike, she and I exchanged several emails. She didn't confide her intentions to me, but I can vividly imagine the thoughts she must have had as she considered their options. I was saddened but not surprised when my brother phoned me with the news that they had taken their lives. They used exhaust fumes from their car engine, so the cause of death was carbon monoxide poisoning. My brother, a devout Christian and a retired physician, expressed disapproval of their decision - her decision I suppose - to end their lives together in this way. He'd have preferred the option of palliative care for her, and longterm care for him - care in uncomprehending solitude without his loving wife beside him, because her prognosis was for a rather brief and painful terminal illness, whereas he might have lived for 10 more years. Years ago Wendy and I talked about several scenarios for the end of our lives. One scenario resembled the reality of the fate that befell my cousin and his wife, and they took - or she took - the same decision we'd have opted for in those circumstances. I wholeheartedly support their decision to die together. I picture them in their car, locked together in a final loving embrace: they were an amorous couple who had no inhibitions about expressing their love for each other when in the company of another loving couple like Wendy and me.

They had enough free will and autonomy to decide their own fate, just as Wendy and I would have when we were still together side by side, and I retain, should circumstances arise to justify it. They and I would strongly support physician assisted suicide. Our Supreme Court has decreed that this ought to be the law of the land. It will be, if the next government of Canada is sensibly chosen in the imminent elections. If circumstances arise in my life to make continuing existence unbearable, it would be comforting to know that this option would be available. I wonder how readers of this blog would decide should they face a situation like that of my cousin David and his wife Judy.  Would they opt for Judy's action? Or would they be in favour of my brother Peter's solution? It's an important question that merits debate by all thoughtful people in a society where the fate that overtook my cousin David and his wife Judy occurs increasingly often. In any event, David and Judy live on with a fondly affectionate place in my memories. (The photo shows Judy, Wendy and David at Gordonbrook sheep and cattle station in northern New South Wales, near Grafton, in 1987).

Judy, Wendy and David,
Gordonbrook, near Grafton, NSW, 1987

Values

For many years I discussed values with groups of medical students, occasionally with others such as nursing students, two or three mind-blowing times with combined groups of medical and nursing students. Naturally those discussions focused on health-related values - cleanliness, personal hygiene, fastidious food-handling, consideration of the needs of others where tobacco smoking, noisy behaviour, socially disruptive conduct were concerned. We also talked about fundamental values associated with family formation, cohesiveness and dissolution, which have obvious implications for health. I reported to students my own experience of growing up in a broken home, reared by a divorced mother in an era when divorce was rare and stigmatizing, in contrast to the present time in which separation and divorce are commonplace and socially acceptable. We talked too about Canadian values, respect for human rights and dignity, tolerance, acceptance of social and cultural diversity.  I passionately believe in all the rights embodied in the Universal Declaration of Human Rights (the UN Charter) and the Canadian Charter of Rights and Freedoms.  When I was younger and stronger I would have been prepared to fight to defend these rights. I've supported Amnesty International financially for more than 40 years and rely on this organization and others like it to fight for me now.

I was appalled and disgusted with the blatantly cynical conduct of prime minister Harper, whose fondness for divisive political tactics has reached a new low in exploiting the worst of xenophobic - Islamophobic - impulses with regard to wearing the niqab. A woman - just one woman - wants to wear a niqab when she takes the oath of Canadian citizenship. She will, of course, have removed the niqab and duly identified herself to requisite officials before the citizenship ceremony. I believe she has the same rights as all other Canadians to dress in a manner she finds culturally comfortable during this rite of passage. To deny her this right is to deny everything Canada stands for. It would be the ultimate denial of Canadian values.  It is typical of Stephen Harper - a divide and rule leader - that he would inflame this and make this one woman's wish into an election issue that over-rides all other issues in importance. It speaks volumes about the emotion-driven thought processes of many people than opinion polls reveal the influence this otherwise irrelevant episode seems to be having on voting intentions. I weep for Canada if this becomes the deciding issue in the election.