Pandemic influenza

It's been a busy week so far. Yesterday morning I was invited to give a keynote address to open a two-day national workshop on pandemic influenza, convened by the Public Health Agency of Canada. I chose to widen the scope to talk about pandemics in general and to consider some broader issues than control of pandemic influenza. It was a very interesting workshop, which included the perspectives of the World Health Organization, the UK and the USA. Here is the text of my opening talk, which seemed to find favour with many participants who spoke to me afterwards and at the dinner last night.

Historical and other aspects of pandemic disease

The struggle for supremacy between mankind and infectious microbes has fascinated me since I was a medical student nearly 70 years ago. Pandemics are an aspect of this struggle, in which, for a time, microbes gain the upper hand. The world’s population passed 7 billion in October 2011. A crowded world is heating up, its infrastructure is deteriorating, and millions are restlessly moving. UNHCR reported 47 million refugees in 2010; at least that many or more migrated from rural to urban areas. Every year about 200 million migrate internationally, and 600 million or more travel internationally by air. Future pandemics are a certainty, probably soon, perhaps due to new pathogens. Some pandemics have affected the course of history and probably will again in future. Difficult moral and ethical issues can arise in epidemic and pandemic disease control.

Ancient fears and superstitions

A large outbreak of an often mysterious disease that strikes people down seemingly at random has always been a terrifying phenomenon. Such events were explained in ancient times as god’s punishment for the people’s sins, the work of the devil or evil spirits, probably summoned by malign individuals like witches, or those perennial scapegoats, the Jews. Someone had to be blamed and punished, so witches were burnt at the stake, Jews were driven out of the community. Pandemics, even localized epidemics, still have the power to awaken atavistic fears among ignorant and superstitious people, as they did in the Middle Ages. People look for scapegoats, try to find someone to blame. They turn to fundamentalist aspects of faith, make sacrifices to appease vengeful evil spirits or the wrath of god. The economy suffers, hurting those who worship Mammon.

An Adelaide GP’s perspective on the 1958 Asian influenza pandemic

My experience as a GP (family doctor) in Adelaide in the 1958 pandemic of Asian influenza shaped my career. In June 1958, I was 8 1/2 years out of medical school, 4 years in general practice in Adelaide. Asian influenza reached Australia in early winter, in June. In Melbourne, the eminent virologist Macfarlane Burnett (later a Nobel laureate) headed the Walter and Eliza Hall Institute at the University of Melbourne and working with Frank Fenner at the Commonwealth Serum Laboratories, began preparing a vaccine. Small quantities of the vaccine reached Adelaide in July, and were given to highest priority public officials, including ambulance attendants, emergency room staff, police (but not GPs). In July, August, early September, my partners and I worked nonstop. We did a lot of house calls in those days; during that pandemic I did up to 30 house calls on many days, as well as seeing patients in my office. Public service radio announcements urged people with flu symptoms to avoid public places like hospital emergency departments (but not GPs’ waiting rooms!). Worldwide deaths in the 1957-58 influenza pandemic were over 2 million. The pandemic struck close to home. It killed two young health professionals I knew very well: a nurse in the maternity department of the hospital where I did most of my obstetrics, and an ambulance driver with whom I played golf. Both had flu vaccine a few days earlier…

In October after the pandemic receded I fell critically ill with a non-bacterial pneumonia. I and my doctor thought for a few days that I would die. I had a daughter aged 10 months and my wife was pregnant with our second child. It was a career changing experience. During my convalescence I thought deeply about what to do with the rest of my life: I decided to leave general practice where I was happy, financially secure, and I’m told, was regarded as a good doctor. Instead I decided to train in public health sciences, especially epidemiology, with the aim of keeping people healthy rather than waiting for them to get sick. That career change brought me to Ottawa 42 years ago.

Pandemic diseases in historical perspective

The outcome of many wars has been determined more by pathogenic micro organisms than by military strategy, tactics, bravery, or superior weapons. The plague that afflicted Athens at the end of the first year of the Peloponnesian War (426-425 BCE) was described in detail by the historian Thucycides, who was there and got the plague, but fortunately survived it. It was not a pandemic but a localized epidemic, probably louse-borne typhus. The next historically memorable epidemic (or pandemic) was the plague of Justinian, emperor of Constantinople; this afflicted the Empire of Byzantium in 541-542 CE, and was probably bubonic and pneumonic plague.

The Black Death, bubonic, pneumonic and septicemic plague devastated Asia Minor and all of Europe in 1347-1350. That pandemic killed up to 30% of the people of Europe and may have set back the advance of civilization by several hundred years. That was followed in 1485 by the first wave of a mysterious contagious disease called the sweating sickness (or ‘sweats’). This caused severe epidemics in Britain and Europe until 1551, after which it disappeared forever. We have no idea what this was. It might have been a variety of influenza but contemporary accounts don’t sound like influenza. Several medieval epidemics of smallpox and typhus were widespread pandemics.

Influenza and cholera are the best known among lethal pandemics in the past 200 years, a period during which we have had good clinical and statistical records, and increasingly good microbiological and immunological tools. This combination has removed much, but not all, of the superstition, hysteria, ‘fear of the unknown’, victim-blaming and stigmatizing that often occurred during lethal outbreaks of contagious diseases in earlier times.

Cholera has swept across the world in seven pandemic waves since the early 19th century; the seventh cholera pandemic seems to be subsiding now, apart from sporadic outbreaks in Haiti and refugee communities in Africa; but no doubt we haven’t seen the last of cholera.

Influenza

Hippocrates (4th Century BCE) described a disease that sounds very like modern influenza and several writers described outbreaks in Europe as early as 1580. The first European occurrence that we can confidently call pandemic influenza was in 1830-1833. A pandemic in 1880-1882 invaded Europe from Russia. About the same time there were influenza epidemics in China and India. The first truly global pandemic was the ‘Spanish’ Influenza in 1918-1919. This attacked predominantly young people (born after 1882) and had a case fatality rate of at least 2% in people aged under 40. Estimates of worldwide deaths vary from 20 to 100 million. It certainly killed more than all killed in the Great War of 1914-18.

Several potentially catastrophic pandemic waves of influenza have fizzled out or been aborted since 1976, most recently swine (H1N1) and avian influenza (H5N1) which had a higher case fatality rate. We can’t know for certain, but strain-specific vaccines and other counter-measures like isolating and killing infected domestic poultry flocks may have aborted or prevented what could otherwise have become major pandemics possibly with high case fatality rates.

Since its onset in the early 1980s, the HIV/AIDS pandemic has killed about 35-40 million people, but the epidemiology, natural history, and control measures for HIV/AIDS are so different from other pandemics that they require separate discussion, and I won’t go into details. The threat remains real from outbreaks of new and emerging pathogens that could be natural or man-made.

Pandemic disease as a war weapon

In North America and in Australia in early colonial times, blankets used by smallpox patients were given to indigenous aboriginal tribes with the deliberate aim of infecting them with smallpox. These were genocidal acts of biological warfare. About 300 years earlier, the spectacular success of the Spanish invaders against the Aztec empire in Mexico was due less to their guns and steel swords than to the viruses of measles and smallpox that they brought with them; the Spanish invaders were resistant to these viruses but the Aztecs were not, and were decimated. The Spaniards did this unwittingly, but during the plague of Justinian a thousand years earlier, corpses of plague victims were catapulted into besieged cities in Asia Minor with the deliberate intention of starting a plague epidemic. Infected corpses have been dropped down wells to contaminate drinking water since biblical times, so this is an ancient aspect of military tactics. In World War II, the Japanese experimented with plague, and Winston Churchill’s government experimented with anthrax among other organisms, rendering an island near the entrance to the Firth of Forth unfit for human occupancy– it was still “Off Limits” when I worked at the University of Edinburgh in 1965-69. Other nations also experimented with highly contagious pathogens, and no doubt continue to do so. A terrorist group or a small, weak nation with malice aforethought could severely damage a larger, wealthier, well-armed nation, using biological weapons. My son had 30 years in the Canadian forces and worked among other things on security threats to Canada; he told me that NDHQ (like the CIA and NSC in USA) takes this threat seriously – although they haven’t taken the Canadian people into their confidence about this. (The public might be more cooperative with pandemic control measures if they knew about such threats).

Pandemic disease in food crops

The famine in Ireland in 1845 was man-made but it was potentiated by potato blight, a fungus disease that wiped out the harvest of potatoes upon which Irish peasants and city people depended for their survival. One reason I deplore the infatuation of agribusiness with genetically modified food crops such as corn is that these monocultures could be terribly vulnerable; they might be susceptible to invasion by virus, bacteria or fungus which could destroy in one blow the food crops of an entire region. This nightmare scenario is less likely to occur if we encourage biodiversity, avoid monoculture and genetically modified food crops. This biological reality seems to be better understood in Europe than in USA and Canada. However, I don’t really know what I’m talking about here. These may be the ravings of an old man in the process of losing his marbles, so ignore me, or heed me as you wish.

Living in harmony with pathogenic organisms

The laws of evolutionary biology dictate that we can never win a war against pathogenic organisms using antibiotics and anti-viral agents. Micro organisms have generation times of minutes or less in favorable conditions, so resistant strains rapidly evolve. History and headlines every day tell us that humans have never yet learnt how to live in harmony with enemies of our own kind. But we have learnt and continue to learn how to live in harmony with many of our microbial enemies. Safe food and water, kitchen hygiene, vaccines, sera, antibiotics, window screens, bed nets and condoms have enabled us to co-exist with an increasingly wide range of pathogens. Recent genome studies offer great promise of future developments, including creation of non pathogenic strains of dangerous pathogens that could “out-breed” the pathogenic varieties, and genetically enhanced resistance to pathogens like common cold viruses.

Studies of blood group frequencies in countries around the world as long ago as the 1960s demonstrated striking differences; the occurrence of sickle cell anemia in regions where malaria had long been endemic is further evidence to support the hypothesis that regional impact of epidemic, endemic and pandemic disease in previous generations led to these differences in genetic makeup: it is caused by the impact of these diseases on particular genotypes. Plague, smallpox and influenza epidemics in particular appear to have had considerable influence on the genetic make-up, including blood group frequencies, of populations in Southern and Western Europe, Egypt and the Middle East, and India. All this was known about the time Crick and Watson discovered the DNA molecule. Since DNA analysis was perfected, further studies have enlarged our understanding of relationships between genetic makeup and susceptibility or resistance to many diseases, including those such as influenza that have the capacity to cause pandemics. Medical science will surely develop techniques of gene transplant or transfer, or other ways to manipulate the human genome so as to enhance herd immunity to specific viruses, enabling populations to live in harmony with pathogenic micro-organisms that caused devastating epidemics in earlier times.

What happens when we relax mass vaccination?

Paralytic poliomyelitis, measles, diphtheria and whooping cough epidemics occurred when mass vaccination broke down after the USSR collapsed. Small, localized outbreaks have occurred in unimmunized sub-groups such as members of the Dutch Reform Church who have religious objections to vaccines. Cases of measles, rubella and mumps occurred when parents withheld their infants from MMR and other vaccines after the scoundrel Wakefield published a paper, later shown to be fraudulent, claiming an association between MMR vaccination and autism. As formerly common infectious diseases of childhood become vanishingly rare, sporadic cases and even epidemics will return if herd immunity falls below the critical level, which can be calculated for each of these diseases, using mathematical models developed many years ago by Norman Bailey (since refined by others). One of our best defenses against epidemics is maintenance of herd immunity. This can become a challenge when the risk of an adverse reaction associated with each specific vaccine approaches (or exceeds) the risk of acquiring the disease, raising ethical dilemmas about balancing risks and harms against benefits.

Ethical and moral concerns

Fear of contagion is a variation on the theme of fear of the unknown. We think of it as an out-dated emotion but it occurred during the SARS epidemic in Toronto in 2003. ‘Contagion’ (suspected contagiousness) is stigmatizing, harmful, potentially lethal: being Chinese in Toronto during the SARS epidemic could have led to being burnt at the stake if it had happened in medieval times. These sentiments were detected on talk radio in Toronto in 2003. Epidemic control officers have a moral or ethical obligation to dispel these irrational emotions by educating the public, being open and truthful. During the SARS epidemic I was asked by the CBC to give many interviews, the aim being to educate the public and eliminate the tendency to stigmatize groups suspected of disseminating the SARS organism (at that time the nature of the organism was unknown). On one memorable morning I gave 14 separate interviews to 14 breakfast radio programs from St John’s to Victoria, White Horse and Yellowknife. The questions were much the same each time but probably correctly, the CBC producer wanted live programs aimed at the local audience, rather than a single nation-wide interview. The aim was to inform and educate, to avoid the moral problem of stigmatizing the innocent. The World Health Organization didn’t help: WHO officials should have known better: their travel advisory cost Toronto $35M/day in lost business.

The procedures of epidemic control, surveillance, locating cases, notifying, isolation, quarantine, raise ethical challenges. Surveillance reminds us of George Orwell’s 1984, that Big Brother is watching; identifying and notifying cases is potentially stigmatizing. Isolation restricts freedom of cases. Quarantine denies freedom to contacts of cases. The question pandemic control officers must ask is “How can I eliminate the risk that control measures cause harm to anyone?” Other troubling questions arise when we use the “police powers” of public health.

Philosophical considerations

One purpose of history is to help make informed guesses about the future. A few months before I graduated from medical school in 1949, I wrote a gloomy essay about future prospects for humanity. One theme I explored was what I perceived as an alarming, unsustainable population increase. In 1949 the world’s population was 2.4 billion, increasing by 20 million/year. In October 2011, the world’s population passed 7 billion, and it is increasing by 75 million/year. Demographers, agronomists, security analysts in the CIA, and other experts, agree that the world can’t sustain such increasing numbers; the population is projected to reach 9-10 billion by mid-century; at the same time we are losing agricultural land to urban sprawl, soil erosion, desertification, sea level rise, climate change; and the oceans, formerly the source of 30% of human protein needs, are depleted and polluted. Are we about to hit Thomas Malthus’s wall? Is the irresistible force of population growth hitting the immovable object of declining global resources? This is happening now in parts of the world. It is responsible for the increasing number of environmental refugees, from 5 million in 2005 to 47 million in 2010. Wait a wee while and one of the Four Horsemen of the Apocalypse will bring you down. What’s your preference? War? Famine? Pandemic Disease?

Perhaps we should welcome rather than take counter-measures next time a pandemic strikes. That would be one way to reduce the surplus population.

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Today I had to miss the second part of the workshop on pandemics to attend a U of O function at which my presence was almost mandatory; this had to do with plans for the period from now to 2020 and beyond, to which I've already contributed in a miniscule way. I was very happy to hear from a bright young man in the Development Office about the ways in which the U of O is encouraging and promoting transdisciplinary activities and groups, helping to break through the watertight compartments that sometimes block communication among disparate groups and individuals in the scholarly community.

Bah! Humbug!

At this time of the year I feel really sorry for the people who work in shopping malls, in the few surviving department stores, and this year for the first time even in the neighbourhood book shop. How can they endure hour after hour of carol music? They deserve extra wages for the hardship. I love many Christmas carols but the versions chosen for endless repetition as background to the shopping spree the vendors hope for, are chintzy schlock. Today I heard far worse. A so-called ballad singer was inflicting on CBC Radio's audience her souped up versions of It Came Upon a Midnight Clear, Away in a Manger, Come All Ye Faithful, and Stille Nacht (Silent Night) with her horribly out of tune high and low notes and thumper-thumper instrumentation. If she had come within reach I'd have cheerfully garrotted her. Then there are Christmas lights. Sure, they brighten the long nights, but increasing numbers of people leave their twinklies on for months, until daylight saving summer time begins in April if not longer.

Climate and human health

The latest issue of the British Medical Journal to reach me had a report of a conference in London last month on the health impact of expected climate change in the next 50 years, in the lifetime of my grandchildren. This was attended by leading experts on public health, climate science, agronomy, entomology, strategic studies, food science. It makes grim reading. The consensus is firmer than ever that in the absence of immediate action to reduce carbon dioxide emissions, there will be a 4-5 degree C increase in average global temperature by 2060, increased frequency and ferocity of droughts and floods, and sharp decline in productivity of all the world's grain-growing regions. This will lead to hunger, starvation, famine, massive refugee movement and widespread conflicts. More than half the world's population will be living in regions where mosquito-borne diseases occur. Our government denies the need to do anything about these predictable dangers, indeed is doing all it can to prevent any steps towards mitigation of climate change at the conference now in progress in Durban, South Africa. The smugly complacent woman columnist in our national newspaper as usual finds a dissenting voice among the climate scientists and quotes this triumphantly: don't worry, be happy, all those experts are wrong, here is a scientist who says all is well and the observed rise in global average temperatures over the past quarter century, the increased number of extreme climatic events, the melting polar and alpine icecaps are "normal events" and just passing trends. Even more frightening, smart-arse engineers and others assert that they have a solution, just load the upper atmosphere with a bit of sulfur dioxide or other stuff to reflect solar radiation back into space and bring the temperature down that way, while continuing to load the atmosphere with more greenhouse gases. The economy, so say the investors, is more important than survival of grain crops, life-supporting ecosystems, even humans, so long as we can continue with business as usual, continue to "grow" the economy, continue to make profits. A species that acclaims such sentiments doesn't deserve to survive, and won't.

Memory, speech and balance

On September 2 2005, Wendy and I had a tasty meal and a bottle of Chianti with my second cousin Nick Potter and his wife Toni, at an Italian restaurant in Canberra. It was a special occasion, because I brought Nick into the world in 1959 and hadn't seen him since he was a baby. As we stood to leave at the end of the evening, I felt a sudden peculiar sensation inside my head and knew instantly that I had experienced a small bleed into my brain. I had difficulty forming words, and my balance was unsteady. These symptoms persisted, and to some extent, still persist more than 6 years later. Magnetic resonance imaging when we returned to Ottawa confirmed that I had multiple small infarcts in my basal ganglia. What slowly became apparent was that the small brain-bleed had impaired my short-term memory and wiped out some of my long term memories, including ability to understand and speak German, Italian and French. The memory loss is quite extensive, as I realize when I read Wendy's diaries: she often describes events and people of whom I have no memory whatsoever. I am thankful that the bleed was not more extensive. At least it didn't cause partial paralysis or more serious speech disorder than slight hesitancy and a frequent, not always successful, search for the right word when I'm speaking. As for balance, I don't try even to balance on the bottom step of my little ladder, I leave to my kids any tasks that require use of the ladder.

Surprising statistics

Narcissist that I am, this morning I looked at the statistics on this blog. I'm surprised about the identity of some visitors (average 20-30/day, also a surprise; I thought my jottings were mostly for my own benefit, a form of therapy, and that only a few family members looked at it). I greet my visitors collectively and reveal no identities, though now I know some that previously I didn't. I'm flattered and won't let this knowledge inhibit what I say in my posts.

Is physics wrong after all?

When I left school about 68 years ago, I had absorbed just enough physics and mathematics to understand how these two domains of scholarly activity related to each other to explain why things happen in the way that they do in our universe. This is (or maybe was) the universe according to Einstein. Over the decades since those far off and long ago school days, I've tried to stay, more or less, abreast of advances in physics. Not, alas, the mathematical basis of the physics of the very large, astrophysics, or the very small, particle physics, but at least abreast of the observations, and thence the comforting way the mathematical theories support these observations. I could understand how and why the atom bomb worked, because E = MC squared. C is the speed of light in a vacuum and nothing can exceed the speed of light. Now something has. It has been observed twice, because no one believed the original observation, which came from CERN, the European theoretical and observational physics laboratory on the border between Switzerland and France near Ferney, a sort of suburb of Geneva. The physicists who observed particles traveling faster than the speed of light are associated with the Large Hadron Collidor, and their second set of observations of particles traveling faster than the speed of light confirms their earlier observations, and overturns our 100-year old understanding of physics according to Einstein. I've got no idea what this means, nor do any of the physicists, apparently. Like other observations, such as the fact that the expanding universe is expanding much more rapidly than it ought to be to conform with the conventional mathematical theory, it suggests that much remains unknown about the basic fabric of the cosmos. Sometimes I think that if I were starting my career rather than ending it, I would like to work at the growing edge of physics, or better still, at the interface of physics and molecular biology. I have a feeling that the next generation of physicists might make some surprising discoveries at that interface.

Unrest all over the place

People, mostly young people, are objecting to the status quo in many parts of the world. In Syria several thousand have died so far in the past 8-9 months in what originally appeared from here to be a bloody one-sided battle to suppress them, but lately has seemed more like an armed insurrection or possibly a civil war. In Egypt, especially in Cairo, there have been a few deaths and some bloody heads and bruised bodies. In the USA and here in Canada there have been a few bruised bodies and bloodied heads as police dismantle camps of the "Occupy" movement that has spread widely from its origins in Lower Manhattan. The aims of this movement may be a tad fuzzy, but the reason for it is clear enough to me: if I were younger, I'd be out there supporting them myself. Educated 20-somethings can see little or no hope that they will be able to fulfill their aspirations, achieve income and positions comparable to those of their parents. To a large extent their parents' and grandparents' generation are to blame for this, or rather their anonymous investment advisers and pension plan managers are. They are responsible for dismantling industries in USA and Canada, shifting them to China, Mexico, India where large labour pools were waiting, and employers didn't have to contend with pesky occupational safety or environmental laws and when somebody got injured on the job, they could be "let go" - discarded and replaced without any fuss. Then there's the problem of criminal bankers and financiers who looted prosperous industries, stripped assets and destroyed whole sectors of the economy along with the jobs therein; and of course in the USA this included sub-prime mortgages, which meant that tens or hundreds of thousands of families became homeless when the mortgages were foreclosed. No doubt some of the "Occupiers" come from that background. What sickens me about this is that the American bankers and financiers who did this have destroyed their nation's economy, poisoned the well so there's unlikely to be an economic recovery any time soon, paid themselves huge bonuses; and the legislators they bought rigged the tax system so they pay less tax than people with much lower incomes. And none of them went to jail. It's a cruel world that doesn't deserve to survive. I hope the "Occupy" movement generates enough outrage to put an end to this soon, and that the wicked get their just deserts, preferably while I'm still around to relish the spectacle.

Speaking to a new generation

Once again this afternoon I felt a bit like the Eiffel Tower - everyone wanted their photo taken beside me. It happened after I spoke to the scientific staff of the Public Health Agency of Canada. Not all of them, about 30-35 I think. This took place in a fine new building on the very familiar campus of government buildings on Tunney's Pasture, just west of downtown Ottawa, where I have spent innumerable hours over the past 42 years. Looking over the audience, I didn't see a single familiar face. Twenty years ago I knew every one of them in the equivalent section of Health Canada, was on first-name terms with almost all. Now there has been a generation change - all those old friends have retired, some have died. After I'd spoken to them, a talk with which they seemed well pleased, at least a dozen people took out their cell phones, not to yack to somebody or other, but to use them to take my photo with each of them, sometimes several together, standing beside me. I asked a couple of the more handsome among them to email a copy to me, but none have done so as yet. If any do, I'll add a picture to this post.

At last we may begin to get some wintry weather. For weeks now we've had delightfully sunny days and temperatures in the teens, often high teens; but today the thermometer fell to low single figures and there were a few flurries in outer suburbs of Ottawa. Whatever else Wendy wrote about in her diaries, she invariably mentioned the weather. By this date we'd had our first snowfall, often more than just one snowfall, almost every year that I've so far read (I'm up to 1987 now, and my memorably productive sabbatical spells in Canberra and Sydney. We had our 30th wedding anniversary in Sydney, at a splendid sea food restaurant that, to my surprise, evidently did not impress Wendy as much as it did me. But I'm happy to report that she enjoyed that all-too-brief sojourn in Oz as much as I did.

Missing Wendy

Wendy died a year ago today. in retrospect, I can see that for at least 5-6 months, my mourning and grieving were indistinguishable from a rather severe clinical depression. Joining a couple of groups, a Tai Chi class and Ottawa Independent Writers to widen and deepen my acquaintance networks, was my self-prescribed treatment to help lift me out of this state of mind, and to some extent these worked. But nothing I've yet found can overcome the terrible loneliness which I often feel. My children are very good to me. Rebecca and Richard provide at least one and sometimes two meals every week either at their place or mine. If at their place, Jonathan drives me out to their home in Britannia. David phones me almost every evening to talk about matters great and small, world affairs or the latest events in his department at the Royal Military College in Kingston. Last weekend, Jonathan drove us both to Kingston to visit briefly with David and Desre, and to attend Doug Gibson's book launch - he was the senior editor of a major Canadian publishing house and in retirement he has written a splendid book of anecdotes about the personal quirks of some of the distinguished authors whose work he edited and published.

My conversational skills have never been strong, and one of the consequences of my solitary life nowadays is that I am becoming almost inarticulate in the company of others. I think I can hold my own on paper as well as ever. I've just finished preparing a paper by invitation for the Public Health Agency of Canada and both I and my handlers in PHAC are satisfied that this is up to my usual standard. But in conversation, I'm sure I have fallen off sadly.

Eco-troubles

The world is beset by economic troubles that have dominated news reports on TV, radio and print media for months. Much less discussed in the media are the demographic and ecological stresses that are ultimately responsible for at least part of the economic trouble the world is experiencing. For at least twenty years perhaps much longer, depending upon definitions, indicators and methods of measurement, humans have been extracting ecological goods and services from the planet at a faster rate than the planet can produce these goods and services - and two prominent components of the goods, carbon-based fuels and prime agricultural land, are non-renewable. Our 'free market' economy is based on the untenable premise that perpetual economic growth is desirable and possible. As I've said elsewhere, perpetual economic growth is no more possible than perpetual motion, the fanciful dream of the scientifically illiterate. We have reached 'Peak Oil,' where the cost and difficulty of extracting and refining this most convenient portable source of energy exceed the economic benefits of its use.Yesterday the International Energy Agency, a rather obscure United Nations agency, released a report stating that energy use is out-pacing energy production. I haven't seen a clear statement about loss of agricultural land to desertification, urban sprawl, sea level rise, soil pollution, but world food reserves have shrunk from about 100 days 40 years ago to less than 20-25 days last time I looked. Smart-aleck scientists say that the short-fall can be made up by hydroponic crop production; but I think that is another fanciful dream, like the unachievable fanciful dream, carbon capture and storage. Nobody is connecting the dots. The blunt truth is that there are too many people. We passed 7 billion last month. An increasing number of the 7 billion, optimistically projected to be 9 billion by 2050, face a miserable lot in life, as well as consuming their portion (I won't call it a share) of the planet's finite resources. Humanity has hit the wall, the irresistible force of human reproduction has hit the immovable object of finite planetary resources. The Public Health Agency of Canada has asked me to open next month a meeting of pandemic control specialists with a few remarks about the history of pandemics. I plan to say a little about the history, and also offer my forecast for the future. I hope for the sake of the future of life on earth that this future will include fairly soon a major pandemic or two that will reduce the surplus population by at least one order of magnitude. That seems to me to be the least undesirable of the Four Horsemen of the Apocalypse. Two other Horsemen, famine and war, would be much worse, more disruptive, although it remains to be seen how avoidable they ultimately are.

An anniversary today

On November 9, 1969, I arrived in Canada as a landed immigrant; so today is my 42nd anniversary as a Canadian. Three weeks later I went back to Edinburgh to help Wendy with the final clearing up of our wonderful home at 5 Greenbank Crescent on the south side of Edinburgh, and escorted Wendy and the kids from there to Ottawa, via London and Montreal. We arrived in Montreal just as a snow storm began and were on the last late afternoon flight before both airports (Montreal and Ottawa) were shut down by what turned out to be a brief but disruptive storm, the first of that winter. Our little family had our first night in Canada in the comfort of the Lord Elgin Hotel. Somewhere on that journey, probably on the frantic dash along an endless corridor from the immigration desk to our departure gate, Rebecca got separated from her precious Teddy Bear, a disastrous start to her life in Canada but she got over it as quickly as she replaced her lovely Edinburgh accent with harsh Ottawa Valley speech.

This anniversary has brought another warm sunny day to celebrate the event. Another celebration is the annual Massey Lectures which are on CBC radio this week. This year the subject is "Winter" and the speaker is Adam Gopnik, a public intellectual, a Montreal man now living in New York and writing for the New Yorker. In my opinion Gopnik is a rather light weight Massey lecturer; it's a pity that CBC couldn't get someone of more substance for this 50th anniversary of the Massey lectures.

I know what a Zamboni is; I can pronounce Etobicoke and Temagami; in January I wear a toque, not a sun-hat. But I have to confess that in January I would prefer to live where I'd wear a wide-brimmed hat while watching the batsman lift a slow ball over silly mid-on and the umpire signals six. All the same, having lived in Canada for almost half my life, and for several years longer than I lived in Australia, I am Canadian, or at any rate more Canadian than anything else.

Offenses Against Nature

Today, two days into standard (winter) time, is glorious; warm sunshine, temperature was 17 C early this afternoon, but blustery, strong north-west winds. At mid-day joggers were jogging in shorts and T-shirts. I went for a walk, as brisk as I can manage these days, and didn't know whether to laugh or to cry at the sight of two diesel powered little tractors, their cabs encased all around in transparent plastic and glass, their drivers wearing ear protectors. These expensive machines, $50K apiece or possibly more, were scurrying about on the lawns in the little park beside Patterson's Inlet off the Rideau Canal, leaf-blowers working overtime as they tried vainly to blow the yellowing fallen leaves into tidy heaps, while the gusting gales blew the leaves back faster than the machines could tidy them into heaps. Nature is untidy, let's face it. The air pollution from the diesel engines, and the noise pollution from their engines and from the leaf-blowers attached to them, were offensive, disgusting crimes against the environment. I think a few families with teen-aged children equipped with rakes could have had a lot of fun and got this job done more efficiently and more quickly and without the cost, noise and air pollution the National Capital Commission inflicted on this neighbourhood today. I found the entire proceedings a profoundly disturbing metaphor for a lot that is wrong with society today. Here were our tax dollars being squandered on a pointless exercise that was in every way an affront to how nature handles the process of death and renewal. If fallen leaves are allowed to lie where they fall, they nourish the land as they rot away into humus. It's untidy to behold compared to a nice neat lawn, I suppose, as some see it anyway; but if the seasons unfold as they usually do in these parts, the neat lawns will soon be buried under winter snows anyway, so what's the point of it all? These unnecessary diesel powered little tractors were using non-renewable resources and creating unpleasant noise and air pollution - and adding to the atmospheric burden of carbon dioxide - to what end? To tidy an otherwise untidy-looking little bit of parkland for a few days, possibly for a few weeks at most. I wonder whether a society that has such values as this deserves to survive.

Recent and current reading

Here's a partial list of what I've been reading lately, and am still reading in several cases; I have that habit, some call it good, others call it bad, of reading many books simultaneously:

Wendy's diaries. I'm up to 1985; sometimes these diaries make me laugh, sometimes they make me cry

Cloud Messenger draft #2 by my friend Karen Trollope Kumar; a beautifully written account of Karen and Pradeep's courtship and marriage and their subsequent 10-11 years in the foothills of the Himalayas. A clever blend of lyrical travel writing, insightful descriptions of Indian family life, intimate glimpses of Karen's own family, and her endurance of horrific events including murder and a major earthquake. I hope she can persuade Penguin to publish this!

Ragnorak, or The End of the Gods, A S Byatt's retelling of the Norse sagas, a beautifully written and quite brief account that skillfully blends the "Twilight of the Gods" saga with modern, apocalyptic thoughts about collapsing ecosystems and the implications of this for the future of life on earth.

Victoria Nicholson's Singled Out, social history about the 2 million women in Britain with no mate because of the slaughter of the Great War of 1914-1918. Sad, and not as good as Nicholson's later book, Millions Like Us.

Margaret Atwood's new collection called In Other Worlds, mainly elegant essays on science and speculative fiction, dystopias, etc.

The Cat's Table by Michael Ondaatje

Sex and Samosas by Jasmine Aziz

Oliver Sacks's latest, In the Mind's Eye, about the onset of his own blindness, among other things

The Emperor of Maladies, a scholarly study of the social and cultural history of cancer by an oncologist; I'm enjoying this and taking it slowly.

Articles and reviews in The Guardian, Walrus and New York Review

Ill Fares the Land, by Tony Judt, probably the best of the books about the present age of greed and widening economic gaps between the haves and the have-nots. Most appeared as essays in NYRB. Tony Judt's history of Europe since the end of the 1939-45 world war, called simply Postwar, is the best history of this period I have ever read.

Several thrillers by Henning Mankell, translated from Swedish -- far better than the 3 massive door-stoppers by Stieg Larsen about Lizbeth Salander, although these had their moments.

Several charming books by Alexander McCall Smith, about Bertie, the gifted 6 year old who lives with his appalling mother Irene and inoffensive father and baby sister at 44 Scotland Street, Edinburgh; and the other series about Elizabeth Dalhousie and the Edinburgh in which she lives with her lover Jamie who becomes her husband, and her baby son Charlie, not forgetting Brother Fox who frequents her garden and walks along the top of the garden wall. I've just finished the latest of the latter series on my Kobo e-reader, The Perils of Morning Coffee. I don't know how he does it, churning out several books a year, all of them good to excellent. Like many who know and love Edinburgh, I'm addicted to Alexander McCall Smith's books set in Edinburgh

Curiosity, by Joan Thomas, a Winnipeg writer; this is a splendid novel based on the life of Mary Anning, the barely literate village girl from Lyme Regis who founded the science of paleontology and an imagined love affair with Henry de la Beche who drew excellent pictures of some of her discoveries in the chalk cliffs that were full of fossils.

Three books about "The Big Questions" in physics, mathematics and philosophy that I picked up as remainders. Excellent way to get up to speed again in these three domains. I've posted remarks about some of these books on my blog

There are quite a lot more that I've read in the past few months, and many that I've reread wholly or partly, including Winnie the Pooh, Pride and Prejudice, Richard Feynman's essays and Charlotte's Web.

What a weird mixture! I spend a lot of time reading. It's much more rewarding than TV. I'm sure I'd be able to add lots more if I stopped to think.

Missed signals

HELLO
Hi is such a simple word,
A greeting, however fleeting
To acknowledge another being.
Ignored and unresponded,
It becomes a rebuff.
A hurt, Enough to bruise the heart.
Trust and affection turn shy,
I ask why?
Perhaps he didn't hear.
Was too near exhaustion to reply,
Preoccupied with boyhood dreams.
But still I cry.

This sad little poem slipped through the cracks when we were assembling Wendy's poems and stories for the book of her Selected Works - although if I had found it I don't think she would have let me include it in the book. I came across it among her old letters. Reading her diaries (I'm up to 1985) I've seen her complaints about my behaviour fall off to become quite rare by the early 80s; by then we had become a smoothly functioning team, and our lives had become more relaxed. Our nest was empty, our social life less frenetic and stressful, very enjoyable overall in fact. We had some wonderful European holidays, often tacked on the end of my interesting assignments for WHO in Geneva or at the Karolinska Institutet in Stockholm. Also, from about the mid-1980s we managed to get back to New Zealand and Australia at least once every year until 1999, always, until our second visit in 1999, without a dent in our savings: my fare was paid by some agency or other,and frequent flyer points paid Wendy's way. (I paid both our air fares that second time in 1999 so we could take part in the 50th anniversary celebrations of my graduation from medical school). Nonetheless, it's unbearably sad to read her complaints to her diary about my shortcomings. I suppose I can take comfort that these complaints were few and far between, only 2 or 3 in 1981 and 1982, only once each in 1983 and 1984. If only I'd known, if only I'd picked up those signals of distress while she still lived! I suppose these signals balanced out though: there were rare occasions when she tried my patience to breaking point. Perhaps there aren't many married couples who survive living together at close quarters for 54 years without a blemish - an angry word, tears, even almost coming to blows once or twice. But those blemishes got fewer and fewer as the years passed. I don't remember any in our last few years together. I hope her diaries when I get to those last few years will confirm my memories.

Singled Out

My mother was the youngest of a family of ten siblings. Two of her sisters were my maiden aunts, Auntie Ollie and Auntie Doris. I had never thought much about why they never married until a few weeks ago when I read Singled Out, Virginia Nicholson's social study of the 2 million women left unmarried in Britain by the slaughter of their husbands and potential husbands in the Great War of 1914-1918. It's a sad book, sad like unrequited love. I don't think it is nearly as good as Virginia Nicholson's Millions Like Us, her subsequent book about the women who went to work to fill gaps left in the labour force when men departed to fight again in the second world war in 1939-45. Nicholson's sources were mostly still alive and available for interview when she wrote about their roles in the war of 1939-45, but most of the women left single by the slaughter of the Great War were dead or too old to be interviewed, so although she tries her best, Singled Out lacks much of the intimacy of Millions Like Us. She has to write about unfulfilled sexual desire mostly by inference and guesswork, compensating a little perhaps by excessive emphasis on flamboyant lesbians like Radclyffe Hall. It's a good book, worth reading, but it would have been better if it had been written 30 or 40 years sooner, and if the sad and lonely women she writes about had been free of inhibitions and able to speak and write frankly about their plight.
...................................
Now I am reading the second draft of Cloud Messenger, Karen Trollope Kumar's excellent memoir of the years that she and her husband Pradeep Kumar lived and worked in the Himalayan foothills, in 1985 to 1997, eleven years altogether because she came back to Canada for the birth of her second child. Karen writes beautifully. This is a fascinating blend of lyrical travel writing, perceptive social and cultural insights, intimate glimpses of family life in India, medical care under conditions much less lavish than customary in Canada, and crises that tested her fortitude to the utmost. One more draft, perhaps, and this book will be ready to send into production.

Housework

My cleaning lady, Sue Ng, has had to take time off to help her sister in Toronto care for their aged father (he's nearly 100, and objects to being put in a 'home' for the elderly). As I'm going out tomorrow evening, I decided not only to do the weekly washing today as usual, but also to stuff and roast the chicken I got at the supermarket yesterday. On the whole I coped with the double load of housework on the same day, and there's enough left over for me to have cold chicken and stuffing for several more meals over the next few days. However, the stuffing wasn't up to its usual delicious best, and when David Skype-phoned me this evening, he explained why: Wendy would have bought the spices before she fell ill, so they are probably over 3 years old. I noticed an absence of aroma when I added the spices to the breadcrumbs, chopped onion, etc, and that explains why my stuffing tasted so bland. Ah well... I've been reading more of Wendy's diaries lately, and although remarks about what she regarded as culinary disasters occur less often then they did in earlier years, she occasionally still found grounds for self criticism even when we had been married over 25 years - but I'm happy to report that she more often had reason to be gratified with her successes. No matter how hard I try I'll never achieve her excellence, but it's good to try from time to time, and it makes a pleasant change from prepared meals zapped in the microwave, and from grilled steak or chops, which are about my usual level of culinary artistry.

Canada writes

I have just submitted my second entry in this year's Canada Writes literary competition. Both are entries in this year's short story competition. The conditions are procrustean: the story must be no more than 1500 words and no less than 1100 words. Part of me can understand why these rather peculiar restrictions on length have been set; but they would automatically disqualify almost every one of Alice Munro's stories, and almost all of the stories by all other great and distinguished short story writers living and dead. The other conditions are understandable. The story must not have been published previously or posted on a website or blog. Both the stories I have submitted were first written in modified, more primitive, form more than 65 years ago. I don't think I have broken or even bent the rules. And I won't post these stories on my blog, even though I know they don't stand a remote chance of winning a prize. I may have a better chance in the literary non-fiction competition which opens in December. I have entered one of Wendy's stories as well, her memoir, "The Smile" in the short story competition after editing it down from 1900 to just under 1500 words; I was rather perplexed about this, because it's true story that would fit equally well in the non-fiction category. But it reads like a short story. Maybe I'll enter it also in the literary non-fiction category as well, when this opens in December. I've got several of my essays lined up waiting to enter as soon as the competition opens. Wish me luck! The prizes are large enough - first prize is $6000.00 - to attract professional writers, so I don' think I have a chance. But you never know. It's worth a try.

Sex and Samosas

Last Sunday afternoon, Sachiko Okuda took me to Jasmine Aziz's book launch. It was held in the East India Company, an elegant and excellent Indian restaurant, attended by about 100 of Jasmine's friends and family members. Sachiko and Jasmine were two of the participants at the Writers' Workshop in Pembroke a few months ago. Here they are with me at the book launch.
Now I've read the book, Sex and Samosas, from cover to cover, which beats reading excerpts on Jasmine's blog. I think it is a very good, well written book. It describes a young woman's journey from miserable overweight and low self-esteem to self-confident athletic fitness, and a most appropriate happy ending. It begins and ends with two sex parties, parties where women can buy sexy underwear, perfumed and flavoured oils and unguents, lubricants and sex toys, learn something about their own bodies, and have a lot of fun while getting a little loosened up by liquor. There are some raunchy, lurid sex scenes but it's worth reading for other reasons as well. It provides a poignant victim's perspective of ways that school girls can be cruel to a classmate whose skin pigment, hair, dress, and diet differ from the mainstream in that school. This is not emphasized but sketched lightly in the background. Also sketched are accounts of some ways in which cohesive Indian extended families are cohering, yet mixing and blending into the multicultural mosaic that makes Canada such a wonderful, exciting country to live in and belong to. In many places, including several of the raunchiest sex scenes it's laugh-out-loud funny. Good descriptions of the unique ecstasy of sexual pleasures are very rare in literature and fiction. This book contains one of the best descriptions of what an orgasm feels like, that I've ever read. I hope all those who read my blog will read Sex and Samosas too, and recommend it to all their friends. You can get a copy at amazon.com
(The photo at the top of this post was taken at the annual Ottawa Book and Craft Fair a few weeks later. I wanted to put it at the end of this post but the software program put it at the top and I'm not savvy enough to know how to shift it).

How long should we live?

Today would have been Wendy's 86th birthday.

A theoretical physicist was talking on the radio about the future: the future of computing, use of quantum computers, the future of nanotechnology, the concept of parallel universes (which are theoretically possible and might exist for all we know); and the future of human life spans. That’s when I wrote him off as a crackpot, because he asserted that theoretically humans could live forever. Whether he meant selected humans or all humans wasn’t clear, but either concept flies in the face of biological, not to mention demographic, realities as I understand them. We all die, some early in life, some after many decades – all in accord with the biological reality of death and renewal. Ideally, our decomposed bodies recycle in the biosphere into other living creatures, although inventive and sometimes misguided or perverse people have developed many ways to preserve (as opposed to commemorating) the dead. We can have ourselves preserved – or our bodies anyway – by various forms of embalming. Jeremy Bentham and Lenin come to mind; we can be encased in bronze, as in a bizarre and intermittently funny film by the Dutch-Australian film maker Paul Cox. There are limitless variations in styles of monuments to the dead, many like the pyramids and the ornate cemeteries in Rome, Milan, Malta, Havana implying or making explicit a belief in life after death; others like funerary urns are probably more often intended to be decorative ornaments that gratify the living than commemorate the dead. What about eternal life? The idea shrivels my marrow. At age 85, I look back on a wholly satisfying life that has been immensely pleasurable; the 55 of these years that I shared with Wendy were much more than merely pleasurable. But even if Wendy had not departed this life eleven months ago, I’ve had just about enough. She and I talked about life expectancy a few times; we both felt we had already lived as long as we could have wished when we last talked about this, driving home from the clinic where the neurologist Pierre Bourque had given us her diagnosis of ALS, or motor neuron disease. We were both then just short of 85, and were reassured by what Pierre told us about how her disease would probably progress in the coming months. It did indeed evolve much as he said it would, with progressively more pronounced weakness, longer and longer periods of sleep, but no pain and no deterioration of her mind. Now that Wendy has gone and I’m on my own, I no longer feel that I have much incentive to go on indefinitely. Like many others who reach this age, I’ve seen many others die who were my friends, acquaintances and about my age or younger, and as my father once said to me when he was about the age I am now, it’s easy to get very lonely as friends and colleagues die off all around me. I’ve always been inclined to be a ‘loner’ so being alone for a greater portion of my life than formerly doesn’t trouble me much. I find plenty of ways to keep myself busy and amused. My apartment is full of books to read, and to reread – mostly to reread: I get more pleasure from rereading familiar and much loved books than from starting something new. But I often do start something new, though I confess that I start many more than I finish. And I’ve got quite a lot of writing to do, 3 chapters to write in Public Health and Ecology, the reincarnation of Public Health and Human Ecology, this time with two co-authors rather than all on my own as before. Then I want to finish off as well as polish my memoirs, submit a few pieces for the CBC’s annual literary contests, and if I’m still going strong after all that, assemble, edit, and publish some of the stuff I wrote over the 30-odd years that I edited various medical and public health journals. All that should be enough to keep me off the streets and out of mischief for a few years.

Thanksgiving 2011

It wasn't easy to find suitable autumn colours to illustrate this post, but just below my balcony the late afternoon sun caught the golden leaves of a little maple tree. The hot sunny weather felt more like high summer than well into the autumn, and the leaves are slow to turn this October for the same reason. In past years I've often photographed the brilliant colours in our neighbourhood from our balcony and from ground level, always around this date. This year the combination of mild days and frosty nights hasn't happened; the day temperature dipped briefly a week ago, but so far this year we haven't had a frost; and this Thanksgiving weekend we have had a virtual heatwave. Yesterday Rebecca and Richard held a delightful family feast for David and Desre and Jonathan and me. It was warm enough for us to eat this out on their patio at dusk, and all around us others in that neighbourhood were having their feast out doors on their patios too. We exchanged greetings with Rebecca's next door neighbours; it was all very cosy and collegial, a small but delightful Thanksgiving feast. Today has been another hot day of blazing sunshine, and conditions have been similar all over the northern hemisphere. Last week temperatures in the southern half of England were in the low 30s and thousands of people went swimming in the sea. It's just another harbinger of the relentless advance of climate change or global warming, and by rights it should make us all tremble. But I think instead most people will feel as I did strolling in our little park, grateful for small mercies.

statistics don't lie, or not often anyway

It was a pleasant surprise to find the University of Ottawa ranked among the top 200 universities in the world in the latest Times Higher Education Supplement. The U of O, a former religious college of the Oblate order, became a public secular university after the 1939-45 world war, in order to attract government funds then being disbursed to universities. I was attracted here in 1969 by the opportunity to build a new department of epidemiology in a university that was then mediocre (if even that) and was then still sufficiently dominated or haunted by its religious catholic origins to have men of the cloth occupying all but about 2 or 3 of the top managerial positions. It had nowhere else to go but up. The faculty of medicine in 1969 ranked last among the 16 medical schools in Canada on objective criteria such as research funds awarded in competitions and performance of its graduates in national qualifying exams. At a faculty "retreat" in 1976 one after another of my fellow heads of department lamented our lowly status. When my turn came to speak,I pointed out to my colleagues that we had some real advantages: we were a small medical school in the nation's capital, rich in governmental and non-governmental resources including many that are relevant to medical research, in a city large enough to offer our small classes very rich clinical experience; class sizes were small enough so everyone knew everyone else; we were (and are) a bilingual school. Our downtown campus is less than a kilometer from Parliament Hill. (This helped to attract me to Ottawa but as the faculty of medicine expanded, the new Health Sciences Centre had to move to new Health Sciences Campus, 4 Km south). I said "retreat" was the wrong word to apply to our brainstorming session: we should have called it "advance" - we had nowhere else to go but up. I've seen the U of O go up steadily and increasingly rapidly during the years I have been here. Now we rank about 3rd or 4th nationally on objective criteria such as research funds attracted, 1st or 2nd in national qualifying medical exams, we are moving steadily upward in global rankings like the Times Higher Education Supplement, we have a downtown campus of handsome, although rather crowded buildings.
Looking over the league table of world universities, it's clear to me that like isn't always being compared to like. Caltech (the California Institute of Technology) is in top place although it is not a "full-service" university; I know the London School of Economics is not; Harvard, Oxford, Cambridge, the University of Edinburgh, all are "full-service", the Ecole Normale Superior in Paris probably is not. The criteria on which the rankings are based include output of original research (based on original articles in top quality peer reviewed journals, original monographs, research facilities and funding) staff-student ratio, facilities such as libraries, etc. Probably I need to study the criteria used in the rankings a little more fully, but on the face of it, they seem valid, and I know they are taken seriously by people like university presidents. So as a long-time staff member (over 41 years and counting) I'm pleased and proud.

Steve Jobs

It's as though he had been a head of state,or a crowned monarch. The death a few days ago of the co-founder of the Apple empire has generated more comment and commemorative paragraphs of poor prose than any other death since Princess Di's untimely and messy departure from this life. How many of the innovative products of Apple Macintosh were actually his brain-children is not clear to me. I came late to the world of Macintosh, Apple computers, iPhone, iPad, i-this, i-that; indeed the only Apple product I possess is the MacBook Pro laptop on which I'm pecking out this post. But I do love this elegant little laptop, which is far superior to the PC products I've stuck to for the past quarter century or more. It's actually a sensual pleasure to use it, whereas there was always an adversarial relationship between me and the succession of PCs I worked with - or against. Another thing I'm aware of is the elegant design of the Mac, the pleasurable way it does what I want it to do (most of the time anyway; it's my own fault, not the laptop's, that I have trouble operating the track pad occasionally). It's so elegant! Consider the way the power cord attaches when I need to recharge batteries. A magnet! Why didn't IBM or Microsoft think of that? I understand the magnet, like the aesthetically pleasing appearance of all the Apple products, was Steve Jobs' idea. Yet he was a software designer by profession, a dropout withal, but a genius nonetheless. I suppose he merits the many accolades he's attracted, perhaps even the "stop the presses" actions of Time magazine, which pulled its current cover and many inside pages in production to replace these with a fulsome eulogy. But I'm sure we will see his like again. Probably Apple has a dozen clones of Steve Jobs already on board.

Occupy Wall Street

A nascent movement that hasn't been getting much attention up here in Canada is the interesting development that began in Lower Manhattan and has spread to other US cities - Chicago, San Francisco and several more so far. A small but increasing number of people have been camping in a park close to Wall Street, peacefully and quietly demonstrating against the dishonesty and financial excesses of dealers, brokers and high rollers both in Wall Street and in the big banks. The blatant arrogance and greed of these folk has begun to outrage more and more of their victims. I've heard two thoughtful commentators compare this movement to the riots that scarred London and several provincial cities in England last summer - social scientists who have studied the rioters have discerned a common thread running through the motivation of the predominantly youthful mobs, disillusion with the prevailing economic system and hopelessness and helplessness about their predicament - the rioters were 'have-nots,' expressing their anger against the 'haves,' who over recent years have systematically devised schemes to enrich themselves and impoverish everyone else. The 'Occupy Wall Street' movement is more gentle, more polite, entirely non-violent, entirely law-abiding. This hasn't stopped the police from harassing and arresting large numbers, nor from applying (illegally) some harsh enforcement methods such as use of pepper spray against non-violent resistors. I think the police may come to regret this gratuitous use of force: they may have misjudged the depth of anger and resentment of the many millions whose good jobs have been exported to Mexico, China, Bangladesh, etc, and whose homes have been and are still being foreclosed. Labor unions in the USA are weak and mostly ineffectual, but Occupy Wall Street has the support of at least one union so far, largely symbolic perhaps but it's a start. It seems pretty certain now that the recession will deepen, more jobs, more homes will be lost; and in the grip of another bout of the USA's periodic madness fomented by the Tea Party supporters they elected, the US Congress and state legislatures will not enact legislation to raise taxes to pay for urgently needed infrastructure repair and maintenance, apparently preferring to maintain high unemployment rates. These right wing legislators don't use the word of course but they are behaving in ways that have created a kleptocracy, replacing the failed democracy of the USA. Lobbyists tell elected congress how to vote, electors are ignored, so there is widespread cynicism, fewer and fewer even bother to vote. I am so thankful that Wendy and I rejected the USA as a place to settle permanently! I hope our children and grandchildren are grateful for our decision!

Signs of the times

Google has added some new features (maybe they were always there, unnoticed by me).One of these is statistics. My blog had 24 visitors yesterday, 294 last month, and since I started it in February 2010, it's been "visited" 7079 times - not,I'm sure, by 7079 different people perhaps no more people than the two dozen who looked at it yesterday. Even 24 seems a lot to me (in this intrusive age when no one has a private life anymore, no doubt this includes snoops from sundry secretive government agencies).
* * *
Earlier this afternoon while I was walking in a quiet place beside the Canal, I heard honking geese overhead. At first I couldn't see them, then far above, almost out of sight was a large V-formation, perhaps 100 strong, purposefully heading south. They may have been snow geese, because squadrons of Canada geese stay here nowadays until late November or even later in the year; but the geese whose habitat is the high Arctic set off on their migration earlier. I've heard many blue jays lately too, presumably also passing through on their way south.Today is supposedly our last really warm day and by the weekend we will be down to single figures. A week ago when I looked out the west windows I saw hardly any autumn colors but today there are many red, orange and yellow trees even if the predominant color is still green. In past years I've often taken photos of the autumn colors when they are at their best, usually in the second week of October. This year they may be at their best a little later, judging on present indications. And I may not yet be entirely passe, over the hill, yesterday's man: I've had two more invitations to talk to students and others in the past week. That's another sign of the times I suppose, a sign that a new academic year is under way - and a morale booster too, of course. It's great to feel wanted and needed.

An 85th Birthday

Today is my 85th birthday. I slept in a bit later than usual, was still in bed when the 8 am news came on my bedside radio, soon rudely interrupted by an appalling racket of power drills in the next door apartment where renovations are taking place. Then the phone rang, and at the other end was brother Peter, phoning from Adelaide. He sounded pretty spry and brought me up to date with family news. My email too when I switched it on after breakfast, was replete with birthday greetings, including Peter's and a lovely note from Dodie Ziemer in Melbourne. I really do feel 85, still mobile, 20/20 vision thanks to successful cataract surgery and no major life-endangering diseases, but a handful or more of irritating relatively minor impairments that collectively remind me I am no longer young. I can't walk as briskly as once I could but at least I can walk, which is more than some my age can do. My reward for paying dues for half a century is honorary life member of the British Medical Association, so I get the BMJ every week; it's the only medical journal I read now. although I skim half a dozen others and occasionally read something in one of them. For the past few years it seems that hardly a week goes by without the obituary of a former friend or acquaintance in the UK; altogether I worked there for almost 10 years and one way or another, I had a large network of professional colleagues and personal friends, far more than I've acquired on this side of the pond. I remember several old people including my father, saying that old age gets lonely as friends and contemporaries die, in his case leaving him the sole survivor of a once large circle. I feel a bit like that sometimes, although as a lifelong 'loner' I may be less troubled by this than many other people. I have my books and the radio, and occasionally look at something other than news and weather reports on TV. David is laid low by a respiratory infection that has incapacitated many of the staff and cadets at RMC, but today I had lunch with Rebecca, Richard and Jonathan, to celebrate this milestone. I miss Wendy's little doggerel verse that used to be a consistent birthday ritual; once at least it was a real poem, preserved forever in print in the book of her Selected Works, and I still have many cards with other, briefer verses. I miss Wendy, and wish we were together. Even now, more than 10 months after her death, the wound is still raw, as I discovered when I had this thought about her yearly birthday verses and the sad realization that there will be no more of these cheery verses.

The Cat's Table

Wendy and I went from Adelaide to Liverpool, England by sea in 1961, and came home from Rotterdam to Adelaide by sea in 1962; then in 1964 we sailed from Sydney across the Pacific, through the Panama Canal to Kingston, Jamaica, Veracruz Mexico, and on up the eastern seaboard of the USA. All three voyages were on freighters that carried 12 passengers. Rebecca and David were both toddlers when we went to England in 1961, David not much more than a toddler when we came home in 1962; Jonathan wasn't even there in 1961 or 1962 and was just over six months old when we left Sydney in 1964. So he has no memory of any of our sea voyages; Rebecca and David have only fragmentary memories. I've been reading with delight Michael Ondaatje's new novel, The Cat's Table, about the sea voyage of a 9-year old boy in 1954 from Columbo to London via Aden, the Red Sea, the Mediterranean and on to Tilbury Docks in London. It's a vividly evocative description of the hare-brained fun and adventures that the boy, Michael and two other boys his age, got up to on the 3-week voyage. It made me realize how much our kids missed by making their much longer and potentially more exciting, more adventurous voyages when they were too young to get up to any mischief or engage in any of the sorts of adventures that Michael, Ramadhin and Cassius indulged in during their voyage on the passenger liner Oronsay. Our three had only handfuls of passengers with whom they could interact, but closer relationships with officers and crew. And yet, I dunno... maybe it's as well our kids were too young. I'm not sure Wendy and I would have survived unscathed if our kids had been 9 or 10 years old... The Cat's Table is a delightful book, more accessible than some of Ondaatje's other novels, eminently readable, and with some memorable characters among the passengers and the ship's company.

Caravaggio

On Friday of last week I took Jeff House and Fiona Stevens to the exhibition of paintings by "Caravaggio and his followers" at the National Gallery. There were a lot more followers than works of Michelangelo di Caravaggio, but he was well represented by a selection of a dozen or more of his sacred and profane works. The latter are more interesting, paintings of common people: gypsy fortune tellers, card-sharps, pick-pockets, soldiers, riff-raff of the gutters of Renaissance Rome, with expressive faces, vivid movements captured like stop-motion photographs. The sacred paintings included St Francis of Assisi in a ragged, patched cloak, Christ's body being lowered from the cross, Abraham about to cut his son's throat until the angel points out the convenient ram. It was a very well spent morning. So today I rented a DVD called Caravaggio. It turned out to be a surreal version of his life story, with vividly evocative close-ups of some of his paintings, anachronistic touches like cigarettes and toques, a typewriter on which an art critic is painstakingly hunt-and-peck typing savage comments on Caravaggio's latest profane masterpiece, and the sound-track of a steam train when there is a love scene on the screen. It was weird, but worth seeing. Just barely: the set piece cinematography captured Caravaggio's style very well, and it was worth seeing for this, but not for any other reason. It would have been incomprehensible if I hadn't so recently learned a lot about this brilliant innovative artist.

Fiona and Jeff drop into Ottawa

I'm very pleased with the weather gods who turned on spectacular late summer, rather than early autumn days, and cool fall nights throughout the visit to Ottawa by my old friend Jeff House and his wife Fiona, whom I also know, but less well. I was very chuffed that Jeff and Fiona came all the way from San Francisco mainly just to see me, it appears. Fiona has an elderly courtesy aunt here so she too had an incentive to make this visit. They saw Ottawa almost at its absolute best (perhaps a dash or two more of autumn colours would have achieved absolute perfection, but fall is late this year, another sign of climate change I suppose). The visit wasn't long enough for all the exchange of news and views I would have liked but it was certainly way better than no visit. I first met Jeff some time towards the end of the 1970s, soon after I had been appointed editor in chief of Preventive Medicine and Hygiene, the venerable American textbook first published in 1913, edited by Milton Rosenau; he saw the book through six editions then handed it on to his friend Kenneth Maxcy, who was based at Johns Hopkins School of Hygiene and Public Health in Baltimore. Maxcy in his turn passed the torch to Philip Sartwell, who was not a good editor. The dissatisfied publishers asked the Association of Teachers of Preventive Medicine to select a new editor; ATPM struck a search committee and chose me, which was a shocking surprise to everyone, especially me. I first met Jeff when he was senior medical editor at Oxford University Press. We seemed fellow spirits and a few years later when the IEA selected me to compile and edit the Dictionary of Epidemiology, Jeff and I became firm friends, drawn to each other by many shared interests. We used to meet annually at least once at a major epidemiology or public health meeting, and over the years he made several tactful suggestions about ways I could do better in my editorial role. Our shared interests include literature, the arts more generally, and politics, as well as the making of good books. I wish Jeff and Fiona were my neighbours instead of living 3000 or more miles away. Now they have set off on their way home to San Francisco and I'm kicking myself that I forgot to get out my camera on any of the occasions that they were here in my home. Just to close the circle on my digression into the matter of that big public health textbook: I used my editorial role in many innovative ways, one of which was to change the name from Maxcy-Rosenau Preventive Medicine and Hygiene to Maxcy-Rosenau Public Health and Preventive Medicine. I wrote about my reasons for the name change, and later in the 13th edition, the publishers honoured me, adding my name to the book's eponym: now it's called "Maxcy-Rosenau-Last" - and perhaps soon Bob Wallace's name will be added too; or maybe the eponym will be dropped, maybe the great monster will become an e-book. Sic transit gloria mundi. (Fiona took the photo at the top of this post with her cell phone. I could kick myself for forgetting to get out my digital camera! I missed several splendid photo ops.)

9/11 + 10

I've lived in and visited several nations afflicted with chronic terrorist attacks by organized, aggrieved groups, and know enough about others to feel reasonably confident about an observation and conclusion. In all but one nation, these attacks are regarded as serious outrages against the public order, but life goes on as near normal as possible, and the necessary security against future attacks is a minor annoyance. The exception of course is the USA, where a single attack ten years ago, admittedly a dramatic and horrible attack that killed several thousand and destroyed two iconic skyscrapers seems to have induced a permanent and fundamentally harmful change in the American psyche and way of life. The IRA attacks in Britain, ETA's in Spain, the Tamil Tigers in Sri Lanka, the Kurdish separatists in Turkey, all lasted for decades and I think all killed and maimed more people, but for the affected nations and their people, life has gone on more or less normally. I came back to North America from a brief visit to Greece and Turkey and went straight on to the USA in November 2004. The contrast was glaringly obvious. The USA has become the Paranoid States of America. The paranoia seems to me to have become greater as time passes, reaching a crescendo as the 10th anniversary of the outrage approaches; and it has affected Canada's present leader who remarked a few days ago that the greatest threat facing Canada is "Islamicism", whatever that is. The remark understandably has made Canadian Muslims nervous, and stigmatized them withal. But this is a trivial distraction compared to the disruption of American life by the aftermath of that attack on the twin towers of the World Trade Center on September 11, 2001. The Department of Homeland Security has become a massive money-eating monster with intrusive tentacles that touch millions. Air travelers meekly empty their pockets, remove their coats and their shoes to go through the security station between the check-in desk and the departure lounge. I wonder how many know that shoes are are removed also before entering a mosque. Many thousands are on a secretive "No-Fly" list which is Kafka-esque in its operation. Once on this list, even mistakenly as seems to have been quite common, the sentence and the stigma are life-long. I don't think we should be commemorating what 19 men with box-cutters brought about that day. And for good measure, a pox on Homeland Security.

Hard Labour

September 3 is one date that always gives me a little frisson of ... what? Not nostalgia, but 72 years ago it was the date on which the world, even my schoolboy world, changed forever. I will never forget the quavery old man's voice of the British prime minister Neville Chamberlain coming over the short wave radio that Sunday night as he told us, all over what was then the British Empire,that we were now at war with Germany. We were at the home of my Auntie Katie that evening, along with a balding Jewish refugee newly arrived in Australia from Europe, and I watched as tears ran down his face, the first time I ever saw a grown man cry. Later we drove that man part way home, to where he could get a tram into Adelaide. It was a cold night of scudding clouds that intermittently hid and revealed the sparkling Southern Hemisphere stars, jewels in the bright girdle of the Milky Way. I felt apprehensive that night as we all did I think, very unsure of what was to come, how long it would last, what would be the outcome. Nowadays this particular weekend signifies something else altogether: it's the Labor Day holiday weekend in USA and Canada, the transition from summer holidays to the start of the new year for schools, colleges, universities. Next week my diary is cluttered with welcoming events for new classes, most of which I can safely ignore, though I do want to attend a couple. For years I used this weekend for my private purpose of taking stock of what I had accomplished, what remained to be done before the end of the year. It's the same story this year I suppose. For months I was mourning Wendy, slowly emerged from that state around the middle of the year, began to pick up the pieces of my life and move on. My labours aren't done: I committed long ago to write 3 chapters in Public Health and Ecology, a new book to be published by Oxford University Press, that is a linear descendant from my solo effort, Public Health and Human Ecology. For the past few weeks I've been diligently pecking away at the first of my chapters, and today I began to work on the second of them, the chapter on philosophical, moral and ethical foundations of public health. This is actually the last chapter in the book, one I enjoy writing and talking about because it explains why we do what we do in public health practice, why it matters, what some of the moral and ethical challenges are, and how we can confront and respond to these challenges.

Millions like us

The subtitle of Millions like us, by Virginia Nicholson, is "Women's lives in war and peace 1939-1949." I was 12, about 3 weeks short of 13, when World War II began on September 3, 1939, and an 18-year old second year medical student when it ended in 1945. I grew up in Australia of course, far away from the air raids, blitzkrieg, invasions, occupations, Nazi oppression, subjugation, the Holocaust; it all came closer after December 7 1941 and the lightning fast advance of the Japanese as far as Papua-New Guinea, the bombing of Darwin, midget submarines in Sydney Harbour. I grew up among women because most of the men were in uniform fighting in war zones far away. Some of my cousins and other close female relations had experiences very like those described in this excellent book. It is social history of a high order, a beautifully constructed synthesis of Virginia Nicholson's own writing and excerpts and quotations from the diaries, letters, memoirs, jottings of large numbers of women in all walks of life, all classes of the conspicuously stratified British society, all of it evoking the dramatic dislocation of the lives of women and girls by the total war between the aggressive forces of the Nazis, fascists of Germany and Italy, later Japan too, and those opposing aggression, Poland, France and Britain to begin with, Britain alone for about 18 months from May 1940 until December 1941, when the reluctant US forces joined the fight, tipped the balance, and with the insane Nazi assault on the USSR bringing the Soviet Union into the war on our side, the tide slowly turned in favour of the Allied forces. No other history of that tumultuous period focuses on what happened to the millions of British women whose lives were turned upside down by the 1939-45 world war and its aftermath. I think this is an excellent book, first class social history, very readable, sufficiently scholarly to be taken seriously. I've read Virginia Nicholson's social history of the subset of people she calls Bohemians who lived on the margins of respectable society in France, Germany, Britain in the early 20th century. She has written another book of social history called Singled Out, which is about the 2 million British women left unmarried because of the slaughter of their husbands, sweethearts, potential husbands, in the suicidal war of 1914-1918. After Millions Like Us, this has moved up to second place on my list of books to read. If you haven't read Millions Like Us, add it immediately to your reading list. I recommend it without reservations.

Afterthoughts about Edinburgh and Epidemiology

Tangible reminders of my brief interlude in Edinburgh are a definite dip in my bank balance (I didn't stint on expenses, traveled in comfort); a 2012 calendar with fine photos of Edinburgh; firm handshakes, likely for the last time, with old friends from many countries; and a few stimulating and memorable talks. It's unfair to compare this IEA/WCE with any of the previous meetings because I was absent without leave from enough to count as a part-timer. On balance, I thought it was probably the best organized IEA congress I've ever attended, and a few plenary talks were outstanding. Passing judgement from Australia without having attended, Colin Butler criticized lack of vision about the future, but I think several talks I heard were all about future implications, notably the two opening plenary lectures by George Davey Smith on how we can cope with implacable limitations of epidemiological science and Raj Bhopal on the consequences of the ethnic transformations produced by the massive migrations of recent generations of humans. Very few epidemiologists seem even to be aware of this dramatic demographic, social, and economic phenomenon, but its reverberations are likely to shape the course of human affairs for many generations. I'd like to be beginning my career now rather than ending it: I can see limitless scope for research along frontiers of several disparate disciplines and branches of scholarly activity. I think it's fascinating, for instance, that so much of the greatest literature in English being written at present emanates from writers whose roots are in the Indian Subcontinent (although most are part of the diaspora). Why is this? I notice too that leading scientists, scholars, surgeons, engineers, have names that reveal their ethnic origin in that same region, or in SE or East Asia, although they may have grown up and been educated in UK, USA, Sweden or Germany. I'd like to be a population geneticist 100 years from now as the genes mix and mingle more, and try to trace genetic traits that have contributed to this flourishing of excellence. I'm sure it comes back to the fact that human progress, like the origin of species, thrives on diversity. There will be wonderful opportunities to observe and study this in the next 100 years. That's a grand prospect, some compensation for all the troubles facing humans and other living creatures in our over-populated and polluted planet. I hope the young comers were listening carefully, and heed what Raj Bhopal was saying at the Edinburgh World Congress of Epidemiology.

"I'll go no more a-roving..."

Well, not until next time anyway. This afternoon as I climbed out of the tiny ten-seater Saab airplane that brought me back from Waterloo, that tune popped into my head as I realized that for the first time I can remember in many years I have no future travel whatsoever in the file folder in my desk drawer that I reserve for travel plans. I should have: at first I accepted a wedding invitation to fly out to St Andrews-by-the-Sea in New Brunswick where my friends Pat Huston and Bob Clark will marry the day after tomorrow. Then Pat gave me an opportunity to back out when I told her it would be my third flight out of Ottawa in 2 weeks, so I gratefully made my excuses and won't fly to St John New Brunswick tomorrow. It would have been one trip too many. As it was, I flew to Waterloo yesterday afternoon, took grandson Peter Last and his lady friend Sylvie Spraakman out to a rather costly but excellent dinner last night, had a sleepless night because my jet lag finally caught up with me, spoke for almost 2 hours to the new intake of MPH students at Waterloo this morning, and flew back to Ottawa this afternoon. While I was in Waterloo last night, I had an email from Gilles Paradis, inviting me to perform for his class at McGill next month, but the dates he wants me coincide with the visit to Ottawa of my friends Jeff House and Fiona Stevens, so I turned Gilles down too. Everyone says my interactive chat to the new MPH intake this morning was a success, and I felt pretty good about it too, but I was glad when it was over. Now I can focus on the report Raj Bhopal asked me to write about the RCPE online collection of historically important works on epidemiology and public health, and on licking into final shape the chapters I must write for Public Health and Ecology, which is a lineal descendant of Public Health and Human Ecology, the book I am most pleased and proud about among all I've written and edited. Back to that MPH Class: It's worth the trip to Waterloo for my annual dose of optimism about people and the future. This year, like others in the past, the class of about 70-80 is predominantly female and predominantly made up of experienced public health workers aiming to upgrade their skills, perhaps to leap over a salary bar too. I made enough provocative remarks to stimulate a vigorous interactive discussion that led seamlessly into the theme for the second half of the morning, 'The future of public health' -- of which unfortunately I missed the first half because I was kidnapped by a TV interviewer, and asked among other things for my opinions about the future. I'd have preferred to listen to the views of others, especially the two very bright and capable women (both public health physicians) who conducted that session. I understand that my interview is to be posted on the Waterloo MPH website so I'll post the URL on this blog when I get it.

Greenland Ice-melt

My flight home to Canada had one worth-while bonus, making up for the problem that cut out the electronics of the in-flight movie system, which deprived us of the chance to watch any of the 120 or more movies on the menu. We flew over Greenland, well north of the southern tip of the island. The clouds had lifted so I had an unobstructed view from 10 Km above as our plane crossed the island. I have two views of Greenland in a deck of slides on "Human Health in our Changing World", a satellite image showing the extent of summer ice-melt in 1992 and 2002, and a photo from a passenger plane window in September 2005 of small islands off the southern tip, all just bare black rock with a few skiffs of snow on high tops of some of them. What I saw was even more dramatic evidence of global warming. There was much bare black rock where years ago I remember snow at this time of year. I saw many very large lakes of melt-water,which I know from articles I've read, are draining into the sea; and all along the coast were glaciers with their noses in the sea, which was flecked with innumerable icebergs scattering far to the south and west, all adding water to the sea from well above present sea levels. Greenland ice-melt is one of the main contributors to sea level rise which is happening at an increasing rate, will raise the sea level by at least a meter before 2100 (the most conservative estimate) and by a great deal more, 5-7 meters if worst-case scenarios occur. Those who deny climate change and global warming should be made to observe Greenland late in the summer. I was seeing it earlier than late summer. The evidence and the effects of melting ice will be more obvious in 6-10 weeks from now. And this hasn't even been a hot summer in Greenland.

The promise of youth

In an earlier post about my impressions of Edinburgh, I boasted about feeling like the Eiffel Tower because so many people wanted to have their photo taken with me. An extremely well known IEA member, a past president, said to me, rather enviously I thought, that no one at this meeting had asked to be photographed with him. I spoke to most of these photographers, asked them why they wanted my photo now that I'm so far over the hill, no longer the editor of the Dictionary of Epidemiology or of major textbooks of public health. Without exception, all I spoke to had used the Dictionary (or one of the 14 or 15 translations); several said it was their most essential educational tool, not only used by them, but one they urged their students to use too. Some of my editorial comments on definitions struck responsive chords too. Remarks like this make all the effort worth while. I hope all the collaborators and contributors to the Dictionary read this: they share in the praise: I could never have done this alone. My lasting impression of talking with all these photographers is of enthusiasm for epidemiology, and for public health sciences in general. This makes me feel very good. All the hard work, enjoyable for sure, has been worth it.
Somewhere, perhaps in the Royal Scottish Museum, I saw a print of that wartime poster, "Is your journey really necessary?" I think my journey was well worth while, even if strictly speaking, not necessary. Conversing with enthusiastic young comers and those of my old friends who had made it to the Congress was rewarding and enjoyable; seeing the little bits of Edinburgh that were all I could manage in my debilitated state made it worth while too. So did the visit to the Royal College of Physicians of Edinburgh and its library, and the little gathering there of people who love books, especially old books. Most of all, the worldwide collegiality, mingling for a few days with this gathering of like-minded people, made all the stresses and strains of the journey very well worth while. I'm sure I'll have more thoughts about the XIXth World Congress of Epidemiology, so don't be surprised if I post more on this experience.