Seasonal letter and Annual Report

For the record, here's this year's Seasonal Greeting e-letter, which went out in batches of 20-30 to several hundred friends scattered about the planet. Because I relied mainly on the electronic memory of my iMac to identify the targets, some people got several copies and others didn't get one. If you are in the last group, you can read it here if you are interested.

Dear Family and Friends

Am I lazy, or super-efficient? Whichever, this e-letter is going to relations and friends in New Zealand and Australia. I’ve pasted my ‘Annual Report’ in this email.

Are all you Kiwis excited or perplexed about choosing  a new flag?  Too bad Janet Wendy isn’t still here to weigh in with her views! I remember talking about flags with her, her brother John Wendelken, and several others years ago, long before you got as far as choosing between several alternative designs. Way back then we would have preferred flags for both NZ and Oz without the union jack but with well known and easily recognized symbols like a boomerang for Oz and a silver fern for NZ

Winter is heading our way, but so far it hasn’t been too bad: no snow, but cold enough to make me wish I was back in Sunny South Australia.

Seasonal greetings, and Love and best wishes to you all,

John

Annual Report, 2015

I’ve had a quiet year of vicarious pleasure, enjoying my progeny’s experiences.  Jonathan advanced the plans for his ecologically sustainable off-grid home; David and Desre traveled most recently to Finland, and will be in Adelaide over Christmas; Rebecca and Richard continue to make delectable jams and pickles, and Rebecca’s garden draws praise from everyone.  My three grandsons are all doing well, Charles in Victoria BC, Peter in Toronto, and John in Halifax, Nova Scotia - scattered literally from coast to coast. 

I prefer to avert my eyes from the wider world. Looking back from my 90^th year, I don’t think there’s been a day of my life when the whole world has been at peace. Terrorist atrocities have lacerated Paris, glorious city of some of my happiest memories; and the Middle East is a festering mess. In Canada a bright spot is replacement of the dreadful Harper by young Justin Trudeau and a government that shows promise of being enlightened and progressive. 

These days I seldom venture beyond the city limits of Ottawa, this year just twice, a flying visit to Karen and Pradeep Kumar in Hamilton, with an excursion to the Shaw Festival Theatre where we saw a splendid production of Pygmalion; and I attended a stimulating writers’ workshop at Arnprior, where I fine-tuned the story described below. 

Writing has been my main activity.  I’ve been writing a story for children in the 9-12 year old age range. This departure from all my previous literary efforts has been great fun.  The story is derived from one I made up in 1962 when we were on a cargo ship carrying 12 passengers, returning to Australia after a year in London. About halfway between the Red Sea and the Western Australian coast we ran out of books to read to our two toddlers, Rebecca and David. They didn’t want Wendy and me to read yet again from Winnie the Pooh, Wind in the Willows, Charlotte’s Web, or The Magic Pudding. They said they were tired of all these. Wendy and I were fed up rereading these books too. So I made up a story to tell them. I’d forgotten this until I was reminded by reading Wendy’s diary for 1962. When I began to write the story down, the characters came to life in my head and took over. The heroine is the parrot who once sat on the shoulder of Long John Silver, the villainous pirate in Robert Louis Stephenson’s adventure story, Treasure Island. She is a brilliantly coloured Australian rosella. I named her, and the story, Gloriana, the poets’ name for Queen Elizabeth, Good Queen Bess, and gave her a very long life span: in the early 1930s, time of my earliest memories, she is rescued from a pawnshop at Port Adelaide by 9-year old twins. Gloriana is old enough to have learnt human speech, and tells the twins she knows where the pirates’ treasure is buried.  There’s a road trip through interesting parts of eastern Australia to a little island off the Great Barrier Reef. Gloriana and the twins are pursued by 3 villains who had tried to extract directions to the treasure by getting Gloriana drunk, and want to try again. Writing this has been more fun than anything else I’ve ever written.  About a dozen children have read a first draft of the story. One said he thought it was boring, but all the others said they enjoyed it, several said it’s exciting and they want to read it again after I’ve polished it a bit. I’ve spent the last few months polishing.

I’ve kept my blog going too, writing about once a week on whatever catches my fancy.  You can see this at http://lastswords.blogspot.com

I hope it’s been a good year for you, that you enjoy Christmas, Hannukah, Diwali, the solstice, your own private festival, whatever, and that your future is happy and bright.  

Yours ever, 

John

Fifteen Dogs

One evening the Olympian gods Apollo and Hermes were quaffing ale at the Wheatsheaf Tavern in Toronto.  They were chatting about the nature of humanity. Apollo argued that humans were neither better nor worse than other creatures such as fleas or elephants. Hermes spoke in favour of human languages and wondered what it would be like if animals had human intelligence. Apollo wagered a year’s servitude to Hermes that animals – any animals – would be even unhappier than humans if they had human intelligence. The gods were near a veterinary clinic, so they chose 15 dogs who happened to be there overnight as subjects of their experiment, the means to the end of settling their wager.

The dogs ranged in size and breed from Atticus, a Neapolitan mastiff to Athena, a teacup poodle; large dogs also included Bella, a great Dane, Rosie, a German shepherd, Frick and Frack, nasty-natured littermate Labradors – a nice touch, that, to make friendly, lovable Labs the dogs with the most unpleasant dispositions – and Majnoun, a spayed black poodle. Benjy, a smart beagle who kept his wits about him, survived where others fell by the wayside. Later, Benjy described the brutal violence and murder among the dogs when they fell out with one another, and between dogs and humans, when talking about it with Majnoun.  The violence, murder and other unpleasant deaths take place mostly “off camera” so to say. There were several mutts, notably Prince who was the deepest thinker in the original pack, composed poetry, and continued to think, reflect, and compose poetry after he was expelled from the pack.

If I were to enter such a wager as that of Apollo and Hermes I would choose to demonstrate or refute it on a species less diversified than dogs, which have been selectively bred by their human companions to produce a truly astonishing range of visible variation within the species classified as Canis, the dog. Cattle would serve the purpose quite well and are much less diversified. There is equally or greater variation in personality and prevailing mood even among dogs of the same breed, which I suppose we could legitimately liken to races of mankind – although the visible differences among breeds of dogs are orders of magnitude greater than those between human races. Such a diverse collection as the fifteen dogs in the veterinary clinic that night the story begins could never form a cohesive pack and the prospects for this were further eroded by the sharp personality differences among the dogs.  Andre Alexis implies that these differences followed their adoption of human characteristics.  From what I know about dogs and their diversity, I think Alexis is wrong about this, but it’s a picky point and I wouldn’t argue about it.  The difference soon led to exile for Prince and a brutal death for several others, leaving only Atticus, Bella, Rosie, Benjy and Frick and Frack as survivors. Then Rosie was attacked and killed by another pack of dogs. The murderous gang led by Atticus thought they had killed Majnoun too, left him for dead on a road in High Park, but he was rescued by a kind human couple, Miguel and Nira, and nursed back to health and strength.  Nira renamed Majnoun Lord Jim, or just Jim, and a close bond soon developed between the woman (who worked at home as a copy-editor) and the dog. All dog lovers will recognize this bond, a spiritual, philosophical, emotional bond that is indescribable and incomprehensible to those who do not love dogs.  I had such a bond for some years with Helen, a gentle dachshund bitch and still look back on that loving relationship (which I had good evidence was mutual) with strong feelings of abiding affection bordering on love.

Most of the dogs who survived the early blood-letting died off from other causes such as taking poisonous baits, and the final sections of the book describe the fate of the longest lived and most “human” – the clever and cunning beagle Benjy,  the poodle Majnoun, and the poet-mutt Prince, who all have long and in the case of Majnoun and Prince, largely happy lives.  But did they die happy? Majnoun surely didn’t, alone, starving in a locked empty house after his humans failed to return from a weekend excursion, killed in a traffic crash presumably; the fate of Prince is more equivocal; probably he was happy, even though blind and deaf. Certainly he was loved and cared for until he was gently put to sleep in a veterinary clinic.  But Prince, and Benjy, and even Majnoun to an extent, survived for varying periods on their own, without human companions with whom they bonded and formed mutually supportive relationships. Andre Alexis meditates a little on the nature of the mutually supportive relationship between humans and dogs, but wisely stays clear of in-depth discussion: had he gone into this in depth, his book would have grown to twice its size, or more.

There is much more in this small novel. There are reflections on the nature of bonding between dog and human, on the differences – essential survival traits – between human and canine sentiments; and casual remarks about the ways in which Toronto is such a ‘livable’ city.  So far I’ve read it only once.  It’s a book that cries out to be reread, an easy task because it is such a small book.   I’m looking forward to rereading it.  

This is a truly worthwhile novel, a beautifully crafted little story written with great empathy by a dog lover.  It richly deserved the Giller and Writers’ Trust awards it has already received.  I think it will win more awards before its day is done.

Taking stock

Looking back over a long life I continue to be thankful that I've lived through such an exciting era of discoveries and improvements to the human condition. But it's also been a time of bloody wars in which increasing proportions of those killed and maimed have been infants, small children, and the elderly -- innocent bystanders. We face huge environmental challenges, notably from climate change. The UN Conference in Paris offers hope, if the world's nations and their leaders keep their promises.

Forget gloom and doom. It's the first day of a new year, a time for optimism, time to reflect on all the good things that have happened in my lifetime. I summarized the medical and health-related good things in the Epilogue to the second edition of my book, Public Health and Human Ecology (1997). We can prevent or cure many diseases that were invariably fatal when I was a medical student almost 70 years ago. Financial barriers between sick people and the care they need have been obliterated in most advanced nations. Even in the USA where fierce resistance to tax-supported medical care persists, the barriers have been reduced. The medical profession which was almost exclusively restricted to white men in suits until almost half a century ago, has been feminized and has become culturally diverse; students are admitted to medical school on the basis of talent, not connections to the rich and powerful. Perhaps related to this new diversity, there is increasing concern about the moral and ethical foundations of the health care system. I view this with particular interest.  Of my various contributions to advances of medical science and practice in my lifetime, I am especially pleased and proud about this. 

Beyond medical practice and its scholarly aspects wherein I've spent the past half century and more, advances and changes for the better are even more spectacular. The device I use to tap out these posts on my blog is an excellent example. When I post it, it instantly enters the public domain, and the facts about readers that I glance at occasionally, tell me the readers reside all over the world. (This fact pleases me immensely. Occasionally I get feedback from readers and this pleases me even more, especially when they disagree with my dogmatic statements). So I am grateful for the spectacular advances in information technology in recent years. Faxes and photocopiers were briefly exciting but soon superseded by email, scanning, Skype, and the mysterious cloud about which I'm still  mildly suspicious. What will come next, I wonder? Holograms, 3-dimensional facsimiles? Smellograms? The "Feelies" that Aldous Huxley creepily mentioned in Brave New World? Or  something as incomprehensible to me, and as unpredictable, as the first photocopiers were when I saw them in 1960. 

Air travel has improved too, despite the discontents of heightened security, inedible plasticized food, being herded like cattle in abattoirs (a deliberately unsettling simile) and airline schedules that are often a suggestion rather than a factual statement. David and Desre left Sydney on New Years Eve and thanks to longer-haul intercontinental aircraft than in 2006 when Wendy and I last flew that route, and the International Date Line, arrived in Vancouver before they'd left Sydney. The 747 on which Wendy and I flew in 2006 had to refuel in Honolulu, which meant undergoing the torture and endurance trials of Homeland Security for a couple hours in the middle of the local night when we were worse afflicted by jet lag than any other time in my memory. 

Some advances in technology haven't yet entirely caught up with each other. For instance, CBC hasn't resolved the issue of content between its on-air channels. Yes, I'm aware of the great variety available on line, but even with a top-of-the-line iMac I'm reluctant to load one part of it with opera or classical music while I type my literary masterpieces (or whatever they are) on another part. The better, pragmatic reason  for reluctance is that the avaricious accountants in Bell Canada would charge an arm and leg and several pounds of flesh for the doubtful privilege of listening to the obscure opera their scholarly announcers seem to enjoy. I've gone back a few "generations" in music technology, back beyond on-line on-demand music, beyond CDs, to vinyl LPs.  I'm so happy I kept my collection of LPs, despite the temptation to put them out in a garage sale. I have classical music, opera, jazz, blues, and voice recordings, some quite rare and hard to get, perhaps not obtainable at all now.  I had to invest in a new turntable, which has a CD player and USB drive slot as well as the hardware to play my beloved LPs. My cup doesn't quite runneth over: I need to wire it up to a pair of auxilliary speakers. When I've done this, my turntable -- old technology to be sure -- might turn out to be the best investment I've made for many years.

I could go on. There's much more. But you get the picture. Happy New Year, Felice anno nuovo, et cetera.

 

Christmas weathers and moods

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

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

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

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

Climate change - 2: Health impacts

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

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

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

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

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

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

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

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

Climate change

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

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

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

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

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

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

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

Trumpeting

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

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

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

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

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

Periodic madness

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

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

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

A late bloomer

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

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

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

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

How I edit

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

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

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

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

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

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

Beatrice and Sidney

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

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

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

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

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

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

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

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

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

Equality and equity

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

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

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

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

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