Author: jamescalumcampbell

Matt Hancock, secretary of state for health and social care, has published a report, The future of healthcare: our vision for digital, data and technology in health and care.  This sets out plans for a fully digitised NHS.  The paper record is gone, history.  Data will be cloud-based, many consultations will be virtual, and internet connectivity will be high speed.  Matt Hancock wants to make the NHS a world leader in digital tech innovation.   “NHSX” – “a specialist bridge between the worlds of healthcare and technology” – is due to be launched next month.

The reaction of the Royal College of General Practitioners to the proposed initiatives has been, I would say, lukewarm.  Fix the basics first, is the broad message.  What is the point of having your head in the clouds if the computer keeps crashing and it can’t even print out a prescription?

I read about this in Insight, a quarterly publication for members of MDDUS, the Medical and Dental Defence Union Scotland, quarter 2, 2019.  In the same issue I also read about a new British Medical Association survey which has found that eight out of ten doctors are at substantial risk of burnout.  The BMA surveyed 4,300 doctors and found that more than a quarter of them had received previous, formal diagnoses of mental conditions, and four out of ten said they were suffering from psychological or emotional distress which affected their work, training or study.

I wonder if Mr Hancock is familiar with the biochemical concept of the “rate-limiting step”.  You have a series of biochemical reactions – say the Embden-Mayerhoff Pathway that converts glucose to pyruvate, prior to its conversion and insertion as Acetyl-CoA into another pathway, the Krebs Cycle, critical in energy production.  All of the reactions take place at a certain rate.  In any such sequence there is a specific reaction that will be slower than any of the others.  The entire process can only function at the speed of its slowest component.  We had to learn these pathways by heart at Med School.  They are very beautiful entities, but to be honest, intimate knowledge of them doesn’t have much direct application to clinical practice…

…except in one way.  Things they don’t tell you at Med School: in the emergency department I became aware of the fact that the processing of a patient through the system is usually governed by a rate-limiting step.  It pays to identify, early on, what that step might be, and set it in motion.  For example, if you realise the patient will need a specific investigation that will take time, order the investigation early.  Don’t wait until you’ve done everything else because you will waste time.  The rate-limiting step will dictate the shortest possible length of time within which your patient can be managed.

Consider now the current waiting times experienced by patients in the community.  It is well recognised that many patients requesting a GP appointment may have to wait for a fortnight before they are seen.  Imagine they have a neurological problem necessitating referral to an NHS neurology out-patients clinic.  It is well recognised that they may need to wait for six months, or even a year.

Consider now the contribution of Mr Hancock’s “super-fast broadband” towards shortening the duration of the rate-limiting step.  It is evident that digital technology’s potential to ameliorate the inertia of the NHS is negligible.

We have to remind ourselves, constantly, of what Medicine is.  What does Medicine attempt to achieve, and what are its procedures?  What, if you will, is the Embden-Meyerhoff pathway of the medical consultation?

It never varies.  I should say, it should never be allowed to vary.  The patient meets the doctor in an environment that is quiet, secure, and confidential.  The rituals of courtesy are observed.  Then the doctor asks the patient what the problem is, and then he sits still and listens intently.  Under no circumstances should he emulate the interviewing techniques of Andrew Marr or Fiona Bruce or Jonathan Dimbleby or Emily Maitlis.  He must be completely quiet, and receptive, so that he steps into the patient’s shoes. For a moment, he becomes the patient.  This act of empathy, the taking of the medical history, very often turns out to be the consultation’s rate-limiting step.  It is always, without exception, its most important component.  It has got nothing to do with a computer, a smart phone, a manager, or a Health Secretary.

Medicine is an intensely human activity.  The medical consultation, with the medical history at its core, is the essence of what any medical practitioner with direct patient contact does.  Get the medical consultation right, and all else will follow.  I should translate this into practical, workaday terms.  A full-time GP should offer something like 20 to 25 consultations per day (fifteen minute appointments) to a maximum of 100 consultations a week.  Down south, the RCGP needs to tell that to Mr Hancock.

To give you an idea of how desperate they are down south, last night I got an emailed job offer from a GP recruiting agency for a locum (5 day working week) for the month of July on the south coast.  Remuneration: £27,650.

I said no.

Dominic Raab wants to prorogue Parliament.

Prorogue?

Isn’t it funny how these obscure words turn up all of a sudden, and everybody starts to use them as if they are in common currency and familiar to everybody?  Mr Blair resiled, and continues to resile, nothing.

Chambers: prorogue v.t. to prolong (obs.): to keep from exertion (Shak.): to discontinue the meetings of for a time without dissolving. – v.t. prorogate to prorogue: to extend by agreement, in order to make a particular action competent (Scots law). – n. prorogation.  (L. prorogare, -atum – pro, forward, rogare, to ask.)

Incidentally, while leafing through Chambers to find prorogue, I got side-tracked, as you do, and came across phratry (a social division of a people, often exogamous) and then phrontistery (a thinking place).  Aldous Huxley used to impress dinner guests with the breadth of his conversational topics, until they realised he had been browsing Encyclopaedia Britannica.  But I digress.  The phratry should be outraged that Mr Raab dare prorogue the phrontistery.

Boris, being a Classics scholar, would presumably be familiar with the etymology of such words.  He has a reputation for cleverness.  His absence from the Channel 4 debate on Sunday night might indeed be put down to cleverness rather than reticence.  With respect to the tenancy at No 10, everybody seems to think Boris is a shoo-in.  I’m not so sure.  You only need to look at the other occasions over the past 80 years when the Tories have replaced their leader, either as Prime Minister or Leader of the Opposition.  The crown seldom, if ever, falls to the front runner.  Even the appointment of Theresa May herself in 2016 surprised many of her colleagues.  Mr Cameron resigned because with respect to Brexit he’d backed the wrong horse.  But then so had Mrs May, albeit in a lukewarm fashion.  So her succession didn’t really make any sense.  Events have shown that to be so.

Then in 2005 the front runner had been David Davis, but he lost the contest on the basis of a single lacklustre speech to the party conference, while a young and relatively unknown David Cameron, speaking without notes, was confident and smooth and articulate.

Then in 1990 the frontrunner had been the colourful, mace-wielding Michael Heseltine, but he lost to John Major, a son of music hall performers, who had a meteoric rise through the Foreign Office and No 11.

After Edward Heath lost the two elections of 1974, the Tories looked around for a suitable successor.  Margaret Thatcher was widely seen as a stalking horse who would wound Mr Heath before somebody else moved in for the kill.  But to everybody’s astonishment she beat Heath in the first round.  And back in 1965 when Heath himself assumed the mantle, it was not he, but Reginald Maudling who had led the opinion polls.

Sir Alec Douglas-Home might well be seen as the archetypal unexpected Tory successor.  The charismatic front runner in 1963 was Quintin Hogg.  But the Tories had been rocked by the Profumo scandal and no doubt felt they needed somebody entirely dependable, Establishment, and colourless.

Harold MacMillan succeeded Anthony Eden in 1957.  The front runner this time was Rab Butler.  And although Eden himself had long been the heir apparent to Churchill, it might be argued that he was past it even before he finally reached No 10.  The night Winston gave a farewell dinner to the Queen and the Duke of Edinburgh at No 10 in 1955, he apparently said to a private secretary, “I don’t believe Anthony can do it.”  Eden’s tenure was short.  He was destroyed by ill luck, ill health, and Suez.

Churchill’s own succession in May 1940 was greeted by a large part of the Conservative Party with dismay.  The great man himself writes most eloquently, at the end of Volume 1 of his 6 volume History of the Second Word War, The Gathering Storm, of the famous occasion he and Lord Halifax met with Chamberlain to decide whom the King should send for.  But, as Nicholas Shakespeare has pointed out in Six Minutes in May (Harvill Secker 2017) WSC’s account may not be entirely accurate.  The subtitle to that book is “How Churchill Unexpectedly Became Prime Minister.”

A couple of years ago somebody asked Boris if he’d like to be PM and he replied in his bluff way that if the ball happened to squirt out of the back of the scrum in his direction he might be minded to pick it up.   I think such imagery speaks volumes.  Understatement, the Oxbridge litotes tradition, is alive and well.  Success must be effortless, or at least must appear to be effortless.  Boris does not cast himself as one of the pack.  That would be vulgar, altogether too plebeian.  Besides, he’s probably afraid – he certainly should be – of the forensic debating ability of Rory Stewart, and he must be hoping like hell that Stewart gets knocked out in the next round.  They say the premiership is Boris’s to lose.  Perhaps this is why he is walking on egg shells.  The weight of history since the Second World War suggests that to be handed the position of front runner in the race for No 10 is to be handed a poisoned chalice.  Maybe Boris has studied his history and taken George Santayana’s advice to heart, that those who cannot remember the past are condemned to repeat it.

The Germans, as ever, have a good word for it.  Vergangenheitsbewältigung.

Coming to terms with the past.

A pub quiz question:  Who was the first Briton ever to address the US Congress?

Winston Churchill?  Well, that would be a reasonable guess.  Harry S. Truman described him as “a real Limey.  He made a very good speech, and then we all walked around and shook his hand.”   In his address, the person in question expressed the belief that the future of civilisation lay principally in the hands of the English-speaking peoples.  Now that was one of Winston’s themes.  He took great pains to forge a trans-Atlantic alliance.  If anybody, it was he who invented the “Special Relationship”.  Only this week, President Trump described the Special Relationship as “the greatest alliance the world has ever known.”  Of course Winston, half American himself, knew that there was an element of humbug in all this.  Lend-Lease, the relinquishment of imperial naval bases in return for a fleet of obsolete destroyers, was like getting blood out of a stone.  In the film Darkest Hour there is a recreation of a trans-Atlantic telephone call between Churchill and Roosevelt, in which the President, hobbled by a suspicious and isolationist Congress, gives the PM the bad news that he can’t supply the UK with matériel.  “But we’ve paid for it!” protested the PM, “with the money we borrowed from you…”

It looks like the UK is making that transatlantic call again, cap in hand.  It’s going to be a great deal.  Fantastic deal, believe me.  Everything is on the table.  Including the NHS.  And a lot more besides.  But President Trump is the world’s greatest ad-libber.  He just makes it up as he goes along.  Somebody whispered in his ear that the NHS was not on the table, so five minutes later, it came off again.  Inconsistency never appears to trouble the President.  He used to be critical of the MMR vaccine, and then when measles returned to the US with a vengeance, he told all the moms to make sure their children got the shots.  I could imagine Andrew Marr playing him a whole reel of film in which he expressed dubious opinions he subsequently reneged on.  Mr Marr did something like this with Nigel Farage.  It tends to lead to an unseemly playground spat.  “But you said…”  “No I didn’t.”  “Did.”  “Didn’t.”  Mr Trump would look Mr Marr in the eye and tell him it was all fake news.

But is it really appropriate to compare a putative 2020 UK-US trade deal to a Lend-Lease agreement in 1940?  Surely we were in a much greater pickle 80 years ago.  And it was a completely different world.  We have grown blasé about the prosperity and the creature comforts we now enjoy.  The first Briton to address Congress also anticipated the modern world with uncanny prescience:

Broad highways crowded with automobiles threaded the remotest lands, and overhead great air-liners carried week-end tourists to the wilds of Africa and Asia…  The globe… was full of pleasure-cities where people could escape the rigour of their own climate and enjoy perpetual holiday.

In such a world everyone would have leisure… Everybody would be comfortable, but since there could be no great demand for intellectual exertion everybody would be also slightly idiotic.          

Incidentally, I thought Mr Trump spoke very well in Portsmouth.  He read President Roosevelt’s prayer on the eve of D-Day most eloquently.  And Mrs May was even more impressive.  She read a love letter from a soldier to his wife.  You might not associate prayer with the President, just as you might not associate the expression of strong emotion with the PM.  Maybe they were both able to convey something powerful precisely because the emotion was not theirs, but belonged to somebody else.

I thought it strange that the Russians were not invited to the D-Day commemorations.  Mr Lavrov evidently thought so too, although Mr Putin said he was busy enough, and not at all put out.  Considering the appalling price Russia paid on the Eastern Front, and considering also that the principal powers of the Grand Alliance were Britain, the USA, and Russia, it does seem a strange omission.  Of course it can’t be accidental, and must have everything to do with the current strained relationship between east and west.  Who knows what is going on in the higher diplomatic echelons?  But is it not better to seek détente and reconciliation when you have the chance?  Is it not, in fact, better to jaw-jaw than to war-war?

That first Brit to address Congress evidently thought so.  Himself ostensibly apolitical (that rules Winston out), he moved in the highest political circles in the 1930s.  He had the ear, and the confidence, of both Stanley Baldwin and Ramsay MacDonald on one side of the Pond, and on the other, of President Roosevelt.  He could see that Europe was heading for catastrophe and he looked for a way out.  He brokered with President Roosevelt the idea of a summit, involving the United States and the great European powers, including the Fascist dictators.  President Roosevelt would chair the summit, which could be held in some neutral venue such as Geneva.  President Roosevelt was key.  He was really the One Big Man in the Show.

That’s the sort of rather archaic description Richard Hannay gives to Constantine Karolides, the Greek Premier in The Thirty-Nine Steps.  Which rather gives the game away.  The first Briton to address Congress was John Buchan, when, as Lord Tweedsmuir, he was Governor-General of Canada.  I learned this from the new biography by his granddaughter, Ursula Buchan, Beyond the Thirty-Nine Steps (Bloomsbury, 2019).  The summit never happened.  As described in Janet Adam Smith’s earlier biography (Rupert Hart-Davis, 1965), John Buchan suggested it to the then British PM, Nevil Chamberlain, but Chamberlain dismissed the idea without even telling his foreign secretary, Anthony Eden, and instead went off to Berchtesgaden to deal directly with Herr Hitler himself.

On the 6^th February 1940, John Buchan suffered an intracranial event from which he did not recover.  He died on 11^th February.  If he had survived, his Canadian term of office would have come to an end in September of that year.  The Canadians had wanted him to stay on, but his granddaughter thinks he might have had his eye on the post of ambassador to the US.  He was not to know that in May 1940 Chamberlain would be succeeded by Churchill, and that the man he might have considered likely to become PM, Lord Halifax, would eventually become the ambassador in Washington.  Buchan seems to have been rather wary of Winston, as a close friend of Baldwin might well have been, but he was certainly not alone in that.  He was not to know that in 1940 Winston would have his finest hour, far less that that they were both presiding, unwittingly, over the dissolution of the British Empire.

I much enjoyed Ursula Buchan’s book, and its evocation of a world I recognised, but which no longer exists.  I wonder who the next Briton to address Congress will be.  Boris?  Andrea?  What will they say?  I don’t think they should echo Buchan’s remark about the civilising pre-eminence of the English-speaking peoples.  It would be good, on the other hand, if they followed Buchan’s footsteps, headed ‘Down North’, and addressed the Québécois in French.  Yesterday, after all, was Pentecost.  Crack cocaine aside, who is surrounded by a mighty wind, touched with tongues of flame?  Who, in fact, is the One Big Man (or Woman) in the Show?

It’s not looking good.

Minded to put the current political impasse out of my mind for a bit, I went on Saturday night to the Glasgow Royal Concert Hall, where The Royal Scottish National Orchestra closed their season with a bang, several bangs, in a scintillating performance of William Walton’s Belshazzar’s Feast.

In Babylon Belshazzar the King made a great feast…

To a thousand of his lords.

Why a thousand?  This reminds me of Edgar Allan Poe’s nightmarish story, The Masque of the Red Death: 

It was… while the pestilence raged most furiously abroad, that the Prince Prospero entertained his thousand friends at a masked ball of the most unusual magnificence. 

It’s really the same, archetypal story.  An enormously rich and powerful potentate turns his back on the misery of his people and throws a huge, decadent and opulent bash in honour of various false gods, for a bunch of sycophantic hangers-on.  The revelry is arrested at its height by an omen or augury which strikes terror into the hearts of the assembly, and this is followed rapidly by a devastating visitation, and annihilation.  In the Poe story, the visitation comes in the form of a masked infiltrator, the personification of the Red Death.  In the biblical story of Walton’s Oratorio, to the accompaniment of Walton’s deadly chilling music, the visitation comes as a vision:

And in that same hour, as they feasted

Came forth fingers of a man’s hand

And the King saw

The part of the hand that wrote.

And this was the writing that was written:

“MENE, MENE, TEKEL UPHARSIN.”

“THOU ART WEIGHED IN THE BALANCE

AND FOUND WANTING.”

So on Saturday I didn’t, after all, escape from political realities.  I thought of Westminster, and inevitably I thought, “Thou art weighed in the balance, and found wanting.”  Wanting – not because Westminster has made a wrong decision, and opted to go down the wrong path; wanting – not because Brexit might be a bad idea, or even a good idea; but wanting, because, with respect to Europe, Westminster has done nothing at all.  Wanting, because it doesn’t matter how elegant your consultation is, how revealing your history, how conscientious your examination, how probing your investigation, how accurate your diagnosis, and how wise your formulation, it all comes to naught if you fail to write a prescription.  Wanting, because people are beginning to wonder whether the privileged route to power of the ruling class – the fields of Eton, PPE at Oxford, a research post somewhere in the bowels of Whitehall, selection, candidacy and, at last, a seat on the green benches, is of any use whatsoever to anybody.  Wanting, because those who strut the corridors of the Palace of Westminster with a sense of importance and entitlement and even of Destiny have failed to notice they are no longer relevant.  All the acres of wordage of doubtful intent have come to nothing.  The racing driver Sir Jackie Stewart once said that there are many people who can open a deal, but very few who can close one.  How true.  The members are lost in a catacomb of labyrinthine proportions.  Turn on the radio at any time of the day or night and you will be exposed to the same word salad –  brexitmeansbrexitnodealisbetterthanabaddealirishbackstopsinglemarketcustomsunioncliffedgewtorulessoftbrexitbrinonorwaycanadapluscontrolofourborderssovereigntynewtradedealschlorinatedchickenborisnigel… like the crazed ravings of a critically unwell patient, toxic, febrile, and delirious.  When somebody, in whatever walk of life, realises he has reached the end of the road, run out of options, and that the game is up, we may echo Daniel 5:5-31 in saying, “He’s seen the writing on the wall.”  But the trouble with Westminster is that they haven’t yet seen the writing on the wall, even though it is there.  Westminster fits the archetype: the fall of the Roman Empire, the illimitable domination of Darkness and Decay over the castellated abbeys of Prince Prospero – happy and dauntless and sagacious – sounds like Rory Stewart.  The collapse of Babylon:

In that night was Belshazzar the King slain

Slain!

And his Kingdom divided.

I’m rather fond of Walton’s Belshazzar.  It is scored for colossal forces: Baritone solo, two choruses, a very large symphony orchestra, organ, and two additional brass bands.  Sir Thomas Beecham didn’t think much of it and it is said that he encouraged Walton to throw in the brass bands and enjoy himself because he’d probably never hear the work performed again.  There is an element of farce about Belshazzar.  Perhaps there is something innately farcical about any depiction of decadence.  That element of farce has also slipped over into reality of the machinations in Westminster.  Part of the richness of the farce resides in the fact that the players can’t see the writing on the wall.  They are players in a Whitehall Farce and they don’t know it.  There is for example something farcical about the fact that – at time of writing – there are thirteen declared contenders for the position of Prime Minister.  This reminds me of a blockbuster “sword and sandals” movie I once saw, of Spartacus vintage, depicting the collapse of the Roman Empire.  Not long after Nero made his horse a Senator, the position of Roman Emperor came up for grabs, and while there were lots of eager contenders, the hero of the film and his beloved joined hands and escaped the throng, left the city, and lived happily ever after, deep in the Etruscan countryside.  The film’s hero and heroine had realised that the climb up the greasy pole, to the prize at the top, just wasn’t worth the candle.

When is a dog-eared three shilling and sixpenny Penguin paperback worth £56,250?

When it’s Sir Laurence Byrne’s annotated copy of D. H Lawrence’s Lady Chatterley’s Lover.  It was part of the collection of the late Stanley J Seeger, and it has recently been sold to an overseas buyer.  But its export abroad has been halted by the government, to see if somebody can match the price and keep the volume in the country.  It is said to be “a witness to history.”

I was a bit snooty when I heard about the £56,250 price tag.  “A collector,” I remarked, “with more money than sense.”  But we all have our weaknesses.  Mine is for first edition Ian Fleming books.  I haven’t looked at the collection for a while so let me take an inventory.  It gets better as it goes along:

Casino Royale: one pan paperback and one hardback Penguin Vintage Classics.

Live and Let Die: hardback Cape 2^nd impression 1954 – no dust jacket.

Moonraker: Pan paperback.

Diamonds are Forever: Thriller Book Club first edition with dust jacket, good condition.

From Russia with Love:  Jonathan Cape, first edition, no dust jacket.

Dr. No: first Book Club edition with dust jacket.

Goldfinger: Jonathan Cape reprint with dust jacket.

For Your Eyes Only: Jonathan Cape first edition, no dust jacket.

Thunderball: Cape, first edition with dust jacket.

The Spy Who Loved Me: Cape, second impression with dust jacket.

On Her Majesty’s Secret Service: two Cape copies, one first edition and one second impression, both with dust jacket.

You Only Live twice: Cape, first, with D.J.

The Man with the Golden Gun, two Cape copies, both first, both with DJ.  And a first American edition (the American Library) in perfect condition.

Octopussy and the Living Daylights: two Cape copies, both first, one with dust jacket.

In addition, I have a Cape first edition Thrilling Cities with dust jacket, in perfect condition, and first Cape editions of John Pearson’s Life of Ian Fleming and Kingsley Amis’ James Bond Dossier.  Chitty Chitty Bang Bang and The Diamond Smugglers are paperbacks.  In Moonraker, when Bond takes on Drax who cheats at cards, by cheating at cards, he first consults Scarne on Cards.  I have a beautiful hardback edition, with dust jacket…  So it goes on.

So, strictly speaking, I’ve got half the Bond canon in first edition.  Any time I go into a second hand bookshop I have a look for one, but they are getting rarer, and I don’t expect to come across a Casino Royale or a Moonraker.  I picked up most of my first editions for a song, at a time before they really became collectors’ items.  I often wonder, if I did come across a first edition Casino Royale, immaculate in its dust jacket, retailing for £10, would I snap it up, or would I say to the vendor, “Do you realise this is worth £10,000?”

Which brings us back to Lady C.  Why is Laurence Byrne’s besmirched copy so valuable?  The value of an antique often resides in its pristine state.  Hornby Dublo train sets are sought after, and if they are in fine condition within a well-preserved box, the value skyrockets.  But Sir Laurence’s copy of Lady C isn’t even a hardback, let alone a first edition.  Why is it so valuable?  I can answer in one word.

Provenance.

The Crown prosecuted Penguin Books over Lady C in 1960, under the Obscene Publications Act, and lost.  It was a pivotal moment not just in English Law, but in English History.  It was the end of an era, ushering in the Swinging Sixties.  The case against Penguin now seems rather quaint.  Mervyn Griffith-Jones for the prosecution made his famous remark about wives and servants.  Perhaps Sir Laurence scribbled it down on the dog-eared margin.  Even then, it must have sounded to those in the public gallery absurdly patrician and hopelessly out of touch.  Bernard Levin sat through the entire trial.  It gradually became apparent to him that it wasn’t really the book at all that was on trial, nor the publisher Penguin, nor the author D. H. Lawrence.  It was Connie Chatterley herself who was in the dock.

But it’s funny to find Lady C, in a sense, back on trial.  Is that paperback worth all the fuss and the money?  In the world of Lit Crit, F. R. Leavis was and perhaps remains Lawrence’s most avid champion.  When, in his 1962 Richmond Lecture, Leavis carried out his hatchet job on C. P. Snow, saying that, far from being a novelist, Snow didn’t begin to know what a novel was, Leavis chose, by way of example of a great novelist, D. H. Lawrence.  But in his book D. H. Lawrence, Novelist (Chatto and Windus, 1955), Leavis considers Lady C to be a minor work.  He called it a worthy “hygienic undertaking” to redeem physical sex from the charge of obscenity.  But he thought that such an enterprise could not be anything other than an offence against taste.

Just as Leavis did a hatchet job on Snow, so did Bertrand Russell attack D. H. Lawrence.  In the second volume of his autobiography, Russell rejected vehemently Lawrence’s mystic “blood” philosophy, which he later came to consider led straight to Auschwitz.

I’m not impressed by the provenance motive.  A Fender bass guitar is a Fender bass guitar.  But if it was owned by Elvis, it becomes a relic.  How much can it be worth?  In one sense it is worth whatever somebody is prepared to pay for it.  Yet in another sense it doesn’t matter how much it goes for, it’s still a Fender bass guitar.  There is nothing in the provenance that stops it being just a bass guitar.  You could call it “priceless” but you might as well call it “worthless”.  We often use the word “priceless” in a hyperbolic way to mean that some commodity is, or would be, extremely expensive.  Similarly, we might call a piece of intellectual property, like wisdom, “invaluable”.  So, paradoxically, “invaluable” means “valuable” and “priceless” means “pricey”.  Even a programme as venal as the Antiques Road Show sometimes recognises that, in respect of good taste, some items ought not to be priced.  With respect to an heirloom of personal significance to a family, the expert says, “You’d never sell it.”  The owner looks a little taken aback; this is news to him!

Sometimes when I flick on the telly at lunchtime for the one o’clock news I catch the end of Bargain Hunt, in which two teams of two, each with the aid of an expert, compete to buy and sell three ancient items of dubious value, plus or minus “the bonus buy”.  The losses seem generally to outweigh the profits, which in either case are pretty modest, and nobody, least of all the BBC, gets hurt.  “Join us for some more bargain hunting, yes?”  They link arms and kick an imaginary football.  I worry at this point that somebody is going to do their back in.

“Yes!”

This I feel should be the spirit in which “provenance” is viewed.  I like to think that if my second impression copy of John Lennon In his own Write (Jonathan Cape, 1964) happened to bear the draft lyrics of No Reply, in the author’s hand, on the inside cover, I’d say to any prospective buyer, “It’s beyond price.  You can’t afford it.”

We also sometimes use the word “priceless” to mean “hysterically funny”.  Somebody says to you, “That Penguin paperback went for £56,250”, and you reply, “That’s priceless.”

 

Thumbing through a copy of J. K. Galbraith’s book on the 1929 Wall St Crash in Waterstones on Saturday I was amused to read that Galbraith had searched in vain in a US airport for the same book, and had, rather self-consciously, approached the book seller.  “Er, looking for a book on the financial crisis by a guy I think named Galbraith.”

“What’s the title?”

“The Big Crash.”

“Not the sort of title we’d have at the airport, sir.”

Also on Saturday I got this yellow flier from the SNP through my door.  Stop BREXIT: Vote SNP.  In 2014 Scotland voted to stay in the UK, and then sent 56 SNP MPs (out of a total of 59 MPs) to Westminster.  Then in 2016 the UK voted to leave the EU.  Scotland, as it happens, voted to stay in the EU, but as she had already voted to be a “region” of the UK this mattered not one whit.  This predicament is, I venture to say, peculiarly and particularly Scottish.

Then on Saturday evening I went to the RSNO, in preference to watching Eurovision.  Hong Kong, America, Finland, and England were represented, almost as cosmopolitan as Eurovision.  If Australia can be in Eurovision, then I think Japan should join in.  They would be contenders.  Surely Japanese reality TV and Eurotrash are closely aligned.

Then in The Sunday Times I came across a fantastic mixed metaphor.  Mrs May was writing to persuade her Parliamentary colleagues to vote for a yet-once-more revamped Withdrawal Agreement Bill (the WAB).  Her pitch – Withdrawal Agreement Bill will be a bold new offer to MPs – was rather hard to find: outside lane, Page 13.  But on the front page, next to a charming picture of the Duchess of Cambridge, The Sunday Times was giving notice of the ERG’s determination to vote down the WAB: “If (Mrs May) loses she has surely trumped her own ace and will have to fold…The WAB is toast.”

And one more gem I heard on the radio from a political pundit: “My crystal ball is broken, going forward.”

What are our options?

1. The WAB is passed, and we leave the EU “in an orderly fashion.”
2. The WAB is not passed and Parliament once more attempts to reach consensus in finding another deal. However the EU reminds Westminster that the WAB is the only deal in town.
3. Mrs May resigns and a new Prime Minister enters No. 10. But this of itself does not alter the impasse.
4. A General Election is called and the new Prime Minister is returned, or a new new Prime Minister takes over. But this again of itself does not alter the impasse.
5. Parliament gives the nod to a “People’s vote”. Since the WAB is toast, and since it had been the only deal in town, this can only offer two options:
6. Either we revoke Article 50 and stay in the EU, or…
7. …We crash out.

On Thursday I intend, if spared, to vote in the European Parliament Election.  It will certainly be the strangest election in which I’ve ever exercised my franchise.  Many of the UK candidates, while they are in it to win, don’t ever wish to take their seats.  Their preoccupation is more with Westminster than with Brussels.  It is Mr Farage’s avowed intention to break up the Westminster two party system.  Polls suggest his Brexit Party is the front runner.  If they do well, Mr Farage intends to demand that his party form an integral part of the team negotiating the UK’s exit from the EU.  He will be in a better position to push for a hard Brexit.  He wants to leave under WTO rules.  On the other side, some of the parties, for example the Lib Dems and the SNP, are campaigning to stop Brexit and stay in the EU.  When the 2016 referendum result was announced, a lot of democratically-minded politicians said, “We’re all Brexiteers now.”  Both the Conservatives and Labour voted to trigger Article 50.  But it appears that Tory and Labour are both being eclipsed in this argument, as the prevailing points of view become more polarised.

Maybe there was never any possibility of a fudge.  Maybe leaving the EU really is like a divorce.  You can’t be married just a wee bit.  You’re either in or you’re out.  Ah yes, but who gets the house, the contents, the car, the white goods, the CDs etc?  Well, leave it to the lawyers.  At least it would be cathartic.  So here are three predictions:

1. We crash out on Halloween.
2. The next Prime Minister will be called Jeremy.
3. There will be a very significant alteration to the constitutional arrangements within these islands.

There is one other possibility.  And considering that the UK came last in Eurovision, we should be alert to it.  There hasn’t been much attention paid to the effect all this is having in Continental Europe.  Those occupying the Westminster Bubble are inordinately narcissistic.  We continuously hear that the EU will come back to us, cap in hand, begging for trade.  But the EU must be concerned for its own integrity.  If the Brexit Party does well, and the returned members take their seats in Brussels, their remit will be to create mayhem.  The EU must be well aware of this and I expect they are already workshopping certain scenarios.  There is always the possibility that we could be expelled.

For an object lesson on how not to chair a television panel discussion programme, look no further than Question Time (Thursday May 9^th, BBC 1).

A chairperson should be like a football referee.  In a well officiated football match, the referee is invisible.  He has probably had a word with the respective team captains as the coin is tossed, and set down the rules of engagement.  Observe the rules, he says, and I will not impede the flow of play.  For that reason he might let an infringement pass, albeit temporarily, to see if an advantage to the other side accrues.  He won’t penalise bad play; only foul play.  If he has an opinion as to a team’s performance, and how it might be improved, he keeps it to himself.  He may be invisible, but he has clout, in the form of yellow and red cards.  Therefore the players should behave themselves.  The fans on the terraces take all this for granted.  They would be indignant if the referee showed bias towards one side, and flabbergasted if he took possession of the ball, and ran with it, like Sir Stanley Matthews, the Wizard of the Dribble.  What would such an intervention signify?

Anarchy.  If the referee behaves badly, the players will do the same, and then the bad behaviour will spill on to the terraces.

Anarchy pretty much describes Thursday’s Question Time.  On the panel: Amber Rudd, the Work and Pensions Secretary, Jonathan Reynolds, Shadow Economics Spokesman, Anna Soubry of the newly formed Change UK Party, Nigel Farage of the newly formed Brexit party, and entrepreneur and Labour donor John Mills.  Four questions were asked, three of them Brexit-heavy.  I paraphrase:

1. After a week of great come-backs, will Theresa May do the same in getting her Brexit deal through Parliament?  

“You’re thinking of the footie?” enquired Fiona Bruce.

“Maybe.”  And maybe that’s what brought my football analogy to mind.  It wasn’t long before Ms Bruce got on the ball, the first of many unscheduled and redundant interruptions.  She abandoned her detached position above the battle and stepped into the heat and dust of the arena.  But isn’t that what the other panellists are there to do?  Frankly it’s a bit of an affront, that she should steal their thunder.  If somebody is spouting humbug, somebody else on the panel will be sure to take them to task.  The trouble with the chairperson stepping into the fray is that she will lose perspective.  Actually she lost perspective, thrice, when she failed to understand a question from an audience member, when she forgot to ask Nigel Farage Question 2, and in Question 4, when she failed to understand the meaning of an exchange with Mr Farage, following yet another of her interruptions.  Once she had entered the arena, the match was no longer being refereed, and it is hardly surprising that panel members began to talk over one another, exchanges became strident and bad-tempered, the audience felt free to howl with derision, and to shout out without invitation, despite the fact that their heckling could not be clearly heard on air.  Ms Bruce tried to rein in the assembly, reminding people that the Brexit debate had become toxic, but by then she had lost all authority, and her intervention made not one whit of difference.  And we were still on Question 1.

2. Would a change of Prime minister break the deadlock? 

The trouble with a football match that has gone out of control is that the spectators are no longer interested in the finesse of the Beautiful Game, but only in how down-and-dirty it can get.  For the record, Amber Rudd thought the Conservative Party should hold its nerve, Jonathan Reynolds wanted a General Election, Anna Soubry fears Boris as a possible successor, John Mills thought Mrs May should quit ASAP and a successor should attempt to renegotiate a better deal with the EU.  Mr Farage wasn’t asked.  So…

3. Should Theresa May and Jeremy Corbyn be worried about the Brexit Party?

… So he answered Question 2 when asked Question 3.  He hopes the PM stays PM for as long as possible because the more she makes a hash of it the better the Brexit Party will do.  I think it was self-evident that Mrs May and Mr Corbyn should be very worried about the Brexit Party.  Love him or loathe him, Mr Farage is a formidable political performer.  He shares with Mr Trump an ability to make a connection, and to hold an audience, perhaps even to mesmerise it.  His answers may well be simplistic and pat, he might for all I know have made it all up on the back of an envelope, but the mainstream parties can’t seem to find a way to challenge him and to undermine his arguments.

4. How can the falling GP numbers be revived?

Thank goodness for a non-Brexit question.  It had been all over the news that day.  England and Wales used to have 66 GPs per 100,000 population, and now that number has fallen to 60.  Actually in Northampton, from where the programme was going out, the number was 55.  As for the question itself, I can’t think any of the proposed solutions were terribly original.  The usual tropes: train more doctors; practise in a different way; put more money in; recruit more; go to the pharmacist.  The most eloquent and coherent statement came from an Italian doctor in the audience who was a local GP.  She described how the critical problem in General Practice today is not one of recruitment, but of retention.  Doctors are leaving the UK in droves, because they are so unhappy.  Half way through her statement, Ms Bruce opined, “I can hear from your voice that that upsets you.”  First a referee, then a player, and now a commentator.

Of course, question 4 is not really a non-Brexit question.  Everything concerns the place of the individual in a community, a society, a nation, a state, a continent, and a world.  Nobody in the panel had apparently stopped to wonder what is making the medical profession so unhappy.  What are the doctors trying to escape from?  The toxicity of Question Time?

Mr Farage said about the European elections on May 23^rd, “I’m trying to win.  I want to break up the two party system.”  Anna Soubry and Nigel Farage agree about one thing, that politics is broken.  But I think if anybody was satisfied with the way Question Time went, it would have been Mr Farage.  He might well have rubbed his hands together with glee.  A good night’s work!

Well, Gavin Williamson, erstwhile Defence Secretary (of all people) turned out to be the leak.  At least according to Mrs May.  It was like something out of Tinker Tailor Soldier Spy.  He had to go.  Yet he protesteth his innocence vociferously.  He swore on the life of his children.  That reminded me of the time Mr Gummer got one of his kids to eat a hamburger on telly during the Mad Cow Disease crisis.  I think they should keep the kids out of it.  Don’t swear on anything or anybody.  As Our Lord said, let your yea be yea and your nay be nay.

Mr Williamson’s last act as Defence Secretary was to meet with the submariners at Faslane.  But by the time they held the controversial service at Westminster commemorating 50 years of Trident, Penny Mordaunt had taken over.  She had been Secretary of State for International Development, and her place (it’s a bit like trying to solve Rubik’s Cube) was taken by Rory Stewart.  It’s not that long since Mr Stewart took over the prisons, swearing to sack himself if he didn’t solve the drugs and violence crisis.  That pledge seems no longer to pertain.  Meanwhile, John McDonnell the Shadow Chancellor is telling us that Mrs May herself is a mole, leaking confidential information from the Tory-Labour meetings trying to find a path to Brexit.  But there’s no readily available means of sacking Mrs May, much to the chagrin of Iain Duncan Smith.

I’ve never been able to understand cabinet reshuffles.  How can you head up a department for a few months and then jump ship and head up another?  How can you possibly master each brief?  At least the civil service can keep things ticking over while you’re trying to mug the stuff up.  Look at Stormont!  No government for more than two years now.  And life – well, with one very notable exception – goes on.  I can contrast that (I’m sure you can too) with my (your) own professional experience.  If I didn’t turn up for work, either in the Emergency Department or the General Practice Surgery, even for one day, there would be pandemonium.  Harms would ensue; some of them might be fatal.  This was why I and my colleagues would often, no doubt ill-advisedly, drag ourselves into work when we felt like death, because we didn’t wish to place an intolerable burden on our already overstretched colleagues.  The idea of not turning up for two years?  Well, after about three days, as we say north of the border, I would have got my jotters.

Back at Faslane, the safes in the nuclear subs hold the Prime Minister’s “letters of last resort.”  You can read about them in The Silent Deep, The Royal Navy Submarine Service since 1945 by Peter Hennessy & James Jinks (Allen Lane, 2015).  When the balloon goes up, big time (as becomes apparent when Radio 4 ceases to broadcast,) three submariners read the PM’s letter to find out what to do.  In the broadest terms, I suppose this must be an order either to retaliate, or not.  But I wonder if this is nothing more than a piece of propaganda, all part of the bluff-and-grope strategy of a nation state wishing to appear belligerent and slightly unbalanced.  You could hardly conjure a modus operandi less democratic than to have the PM in the isolation of Chequers take a decision, over a Ouija Board for all we know, about how to bring the world to an end full of bangs and whimpers.  Apparently she doesn’t need to run it by anybody or even let anybody (the three submariners aside) know her decision.

But to return to the porous National Security Council, I’ve heard it suggested that Mr Williamson was indeed the leak, only he doesn’t know it.  I imagine political journalists are rather adept at extracting information from people.  They are not so much constructing a story from scratch, as filling in missing pieces of a jigsaw.  They might interpret an involuntary facial tic as a nod and a wink.  I know, again from my own professional life, how easy it is inadvertently to betray a confidence without noticing.  When people go phishing, you have to be on the highest alert.  Fortunately I was assisted in this by my appalling memory for names.  I could remember the lesion, but don’t ask me who it belonged to.

When Mr Williamson swore on the lives of his children, somebody phoned the Jeremy Vine Show on Radio 2 to say that that proves he did it.  But I don’t think you can draw any conclusions from it one way or another.  Personally, I think it was the tarantula.

I devoured the latest Ian McEwan, Machines Like Me, subtitled And People Like You (Jonathan Cape, 2019).  I’m a McEwan fan and I’ve read the whole canon.  Mind you, his books are a little like Chinese meals.  There is no satiety.  After The Children Act I waited impatiently for the next one, and here we are.  They made a film out of The Children Act, and I will hazard a guess, two guesses, that they will make one out of Machines Like Me, and that Ben Whishaw (Q in the Bond movies) will play the machine.  Just a hunch.

I’m not quite sure why I admire McEwan, because I seldom find his characters simpatico, and I would have no wish to meet them or move among them, in their metropolitan environment.  Yet his books are page turners, and this latest is no exception.  It’s a vision – dystopian to my mind – of where Artificial Intelligence might take us.  It concerns an android, Adam, so sophisticated as to pass for Homo sapiens.  McEwan elects not to place Adam in the future but back in the 80s, but the 80s of an alternative universe in which Britain has lost the Falklands War, Tony Benn is leader of the Labour Party, the Beatles have reunited, and Alan Turing, an establishment elder statesman, is alive and well.  This backdrop, at once familiar and totally unrecognisable, provides a zany lop-sidedness against which Adam’s existence becomes almost believable.

Alan Turing is another reason why Machines Like Me could end up in film.  Benedict Cumberbatch played him in a film largely concerned with his decryption work during the war at Bletchley Park, The Imitation Game.  The thesis of The Imitation Game is that if you are interacting with an intelligence whose mode of expression suggests consciousness, then there is no reason to suppose that consciousness is absent.  You might say that Machines Like Me is an exploration of all that such an assumption might imply.

Do you suppose Adam the android goes AWOL?  As in Mary Shelley’s Frankenstein, Stanley Kubrick’s 2001, and Robert Harris’ The Fear Index, that’s generally what such creations do.  If he does, we should hardly be surprised.  Already such events are happening in reality.  It now seems highly likely that two recent near identical disasters in civil aviation were caused by a computer taking control of the aeroplane and flying it into the ground while the pilots were unable to do anything about it.  In aviation, when the gremlins start to act up, the captain takes control and flies the aeroplane.  This side of the Pond he says, “I have control,” and on the other side, “My aeroplane.”  What a shock to make that statement only to find that the real captain of the aircraft is not in the cockpit.  In any walk of life, when the systems begin to malfunction, you must have a way of shutting them down while still being able to carry out your basic tasks.  Under no circumstances should you allow Adam to disable his own Kill switch.

These events were shocking enough, but even more shocking was the insouciance of the reaction from some quarters.  There was no recognition of the fact that these events were not like other civil aviation disasters caused by pilot error, mechanical failure, bad weather, bad ground to air communication or more likely, a multifactorial concatenation of circumstances, a combination of all of the above.  In its sinister aetiology, this was of a different order.  Yet our capacity for forgiving machines their vagaries seems inexhaustible.

Our love affair with IT and AI in 2019 is just like our love affair with the automobile circa 1964, around the time Dr Beeching ripped up the rail system.  Once we were gridlocked we came to regret that, and I believe once our cyber systems pack in, not necessarily because they are hacked, but just because they are too damned complicated, we will similarly rue the day.  I don’t care for this Brave New World.

Last week, the National Security Council met to discuss whether the Chinese telecoms firm Huawei should be involved in building the UK’s 5G phone network.  That Mrs May favours Huawei, apparently against the advice of some ministers and officials, has been leaked.  Who leaked it?  MI5 might be called upon to seize mobile phone and email records.  There is a certain irony in the National Security Council’s assessing whether or not Huawei’s systems might be “secure”, while the council itself is as leaky as a sieve.  That could have come straight out of a novel by Ian McEwan.

Good Friday: wrote to The Herald, a response to a letter from a General Practitioner.  The vexed topic: Assisted Suicide.  His was a nuanced letter, carefully stated and well expressed.  This was no surprise, as the writer is a regular contributor to the paper.  I know him.  We went to the same medical school, and greet one another at RSNO concerts.  So while my response expressed an opposing point of view, I hope I was polite and courteous.  It occurs to me that it would be best to extend that similar level of courtesy to people I don’t know.  There’s nothing to be gained from cheap point scoring.

But why write to the papers?  I can think of a few reasons, perhaps worth rehearsing, why not to write:

1. You might not be published. This can be disappointing, particularly if you’ve put some care and effort into the composition, you are pleased with the result, and feel you have a point worth making.  I used to be crestfallen when I got rejected, but I’m much more philosophical about it now.  It’s no big deal.  Bernard Levin used to remind himself that his carefully crafted articles for The Times were wrapping the fish and chips that night.  Sometimes I’ve regretted writing something and hoped to goodness it wouldn’t get published.  Naturally on these occasions such sinful follies appear in print the very next day.
2. You might be published, but in an abridged, edited form. I used to have Beethovenian tantrums about this, and imagine myself seizing the editor by the throat and ranting: “Don’t change a word!”  But again I’m more relaxed about it now, so long as the essential meaning isn’t distorted.
3. When you write, particularly on a contentious issue, you are sticking your head above the parapet, so people are liable to take pot shots at you. It pays to check for ripostes and rejoinders the next day: “Dr Campbell needs to wake up and smell the coffee.  Can he really be so naïve as to imagine…?  I won’t be making an appointment at his surgery any time soon…”  And so on.  It doesn’t do to be too thin skinned.  And remember, you’re not checking for injuries to the amour propre, rather looking for counterarguments that again need to be rebutted in an ongoing debate.  Some of the comments are liable to be “robust”, but at least The Herald won’t publish anything downright offensive.  If you want the offensive stuff, go on line.  I once did.  Never again.  I can’t say I’m liberated from all that junk because I was never entrapped.  I don’t really understand why young people get dragged down by online abuse.  Just Log Off.  Easy for you, you old codger, I hear you say.  You’re past it anyway.  You have no idea of the pressures…  Well I don’t accept that.  And I’m impatient with those who mentor the young, who feel constrained to say that there are good sides too to social media.  No there aren’t, not if somebody is driving you to despair.  Switch the bloody thing off and crush it under foot.  But I digress.  Back to reasons for not writing to the papers.
4. You, in turn, might find that it is you yourself who are the intemperate and loud-mouthed bully. When I find myself spluttering indignantly into my cornflakes over some piece of (to my mind) arrant nonsense, I remind myself that it pays not to fire off a quick broadside, but to take time out for reflection in silence.  I remind myself of the words of Oliver Cromwell (I’ve said this before but it’s worth repetition) “I beseech you, in the bowels of Christ, think it possible you may be mistaken.”  So order your thoughts, and compose yourself before composing your piece.  Don’t be mean and sarcastic, avoid the “argument ad hominem”, and address the issue, whatever it may be.  If you are only writing to vent your spleen, maybe it would be better to maintain a dignified silence.  I once made a pact with myself never to write to the paper unless I had something positive and constructive to contribute.  Unsurprisingly, the frequency of my correspondence diminished.
5. There is the ever present possibility that you sound like a barrack-room lawyer. You have no time for nuance; your arguments are pat.  A statement of the bleedin’ obvious, mate.  Or, as we say north of the border, story’s endit, pal.  This I fear.
6. You might make a mistake. It might be trivial, or it might be serious.  Either way, it is liable to be pounced upon.  I remember once, in a letter whose content I’ve long since forgotten, invoking the Writ of Habeas Corpus.  Next day: “Habeas Corpus won’t do Dr Campbell any good north of the border.  He means ‘The Protection gin Wrangfu’ Imprisonment Act’…” or some such.  Clever dick.
7. You might make an error of judgment. You might unconsciously betray a prejudice that goes against the current zeitgeist.  We live in a Pharisaic age.  “Dr Campbell should hang his head in shame…”  I particularly dislike the “hang his head in shame” imagery.  People who hang their heads in shame are defendants in a show trial.  Their belts are removed so they have to hold their trousers up while standing in the dock.  They are clearly guilty.

So.  Plenty of reasons not to write to the papers!  Why on earth would you ever do it?  It’s simply the creative impulse.  You conjure an idea that you want to share, and you try to express it as succinctly and coherently as you can.  Mindful that column inches are at a premium, you go through your draft and cut out all the deadwood, all the clichés and redundant expressions, the self-indulgences, and the purple prose.  You murder your darlings.  Then you read it through once more and think, “Am I going to regret this?”  But, taking the long term, isn’t it true that you always regret the sins of omission more than the sins of commission?

So you take a deep breath and press “send”.