Study 329 is the most famous clinical trial of all time – see Study329.org. The only trial with two diametrically competing versions of what happened in print at the same time.
And its 329 years since the Battle of the Boyne, which effectively ended 50 years of upheaval that began with a clash between the then King (Executive), Charles I, and Parliament. This clash now seems to many pundits, commentators and experts to be echoed in the current clash between the British Executive (King Boris) and UK Parliament playing out this week. Will Boris get the chop, the way Charles did?
The Battle of the Boyne secured the reign of King Billy, the price of which was a triumph of Parliament. This Battle is celebrated every 12th of July in Northern Ireland – the marching season – when towns are bedecked in Orange regalia and pavements painted red, white and blue. It has become a symbol of Protestant triumph, even though the year before King Billy had made an alliance with Catholic Austria.
This Battle set the scene for the later partition of Ireland, in 1922, into Cis-Ireland and Trans-Ireland – with Trans-Ireland designed to be tribal. There would be a Protestant majority, which was initially around 55% to 45%, but is now closer to 52% to 48%.
The 2016 Brexit referendum has since produced the exact same split in England. And a descent into the same tribalism. Two groups marching past each other, unable to find common ground. We’re all Nor’n Irish now.
This is not just a story local to the Western European Archipelago; the United States has been intensely and increasingly tribal for the last 30 years at least. It may not be entirely unconnected to the WEA story, in that broadly speaking the WASPs are on one side facing off against the others.
The original WASPs were a bunch of Puritans, some of whom figured on leaving England and setting up a less sullied polity in America, while others stayed put but figured on purifying England (of European influence).
The Forgotten Man
On all sides now, everyone seems to feel forgotten or overlooked and is busy asserting an identity, increasingly an individual one with a bodily focus – such as neurodiverse or transgender.
When campaigning Trump pitched it in terms of the forgotten man – that too many of us now feel enmeshed in the tentacles of a Deep State, which he promised to roll back.
The Deep State is largely a set of rules, regulations, a bureaucracy. One that cuts numbers into people’s arms and processes them without ever paying heed to who they are. It is growing. It encroaches on our lives more and more, facilitated by the internet which requires us to tick innumerable boxes before we can access anything.
Europe is a domain of regulations par excellence. It’s where rule by rules began. But exiting Europe won’t mean exiting regulations. It will mean a double-dose of regulations – those Britain requires and those Europe requires. And the grip of regulations will be no less in Britain than in Europe.
In both Britain and Europe anyone who gets injured by a drug or a vaccine will be forgotten. There is no greater chance of access to clinical trial data in Britain than in Europe. The people who have done most to push for access to trial data have been recent European Ombudspersons – a Greek man and then an Irish woman.
Because there is no access to trial data, if you are injured by a drug in Britain or Europe, your identity is not that of a citizen or a consumer, or even as a patient as it once was. Your identity now is as a loser. And not even other losers like the company of losers. Neither Trump nor Johnson have ever shown a scrap of interest in losers.
I Daniel Blake
It took 50 years for England to find a middle ground after the stand-off between Charles and Parliament. It was a shaky middle-ground – unlike America and Canada, which were as WASP dominated as Britain through to the 1960s, the British prime minister for instance still cannot be a Catholic.
In Norn’ Ireland, there are hints of voters beginning to endorse a middle ground, over a century after the difficulties became formally entrenched. The priest-ridden, Rome dominated South meanwhile has become one of the most liberal states in Europe.
America shows just the opposite – the loss of common ground – and a sense that the descent into division may have a long way to run before it bottoms out and people begin to find a way back.
Ken Loach’s movie I Daniel Blake speaks to these issues. It shows a decent man trapped in and ground down by an impersonal bureaucratic apparatus. No one in the apparatus is able to engage with any of the people they see. The horror grows steadily and leads to a blow-out. Blake doesn’t pick up a gun and spray bullets around the place. He has a stroke.
This would have struck a chord ten or twenty years ago but no-one now gives a fuck about the English working class. They are beyond forgotten. The problem our rulers now have is that the same impersonality is encroaching on middle class or upper middle class folk in their dealings with their banks, the government, the education and health systems and increasingly everything else.
Everything works, sort of, provided nothing goes wrong. But once you hit a snag that requires discretion to sort out, the system can’t cope. It calls on you to do the administration to sort your own problem, while often making the problem impossible to solve because there is no tick box that corresponds to just what has happened to you. We are left screaming in impotent rage “I David Healy would like to speak to a human being”.
What we have here is government by algorithm and process. Every process is made up of bunches of algorithms – If X, then Y.
Around 1990 – 300 years after the Boyne , giving drugs became algorithmic – as a consequence of EBM and pharmaceutical companies persuading doctors and governments to treat risk factors as though they were medical disorders – If your cholesterol is high, given X, if a rating scale score is high, give Y etc.
Except drugs are not algorithms. They are chemicals whose safe use depends on information and discretion and giving the same information to Catholics, Protestants, Jews and Muslims. And even with the information, drugs defeat algorithms – you should not be consuming 5 or more algorithms or you will die earlier, end up in hospital more often and have a worse quality of life.
Drugs and the injuries they cause may point a way forward. Everyone should have access to all the data behind any drug they take and very very few of us should be on 5 or more drugs.
But drugs don’t come without doctors. So very very few of us should be seeing 3 or more partialists (specialists) because each partialist will want to chuck drugs at us and many will get staggeringly nasty if we demur.
Until recently the ideal was to have a family doctor, a generalist, with occasional recourse to a specialist. The problem now is that its increasingly difficult for any of us to have a family doctor – we may go to one clinic but will see a different doctor each time and this is just as bad as being fed to partialists.
The logic extends one step further. We probably need to limit the number of processes in our lives. I’ve no idea what the optimal number is but it would seem self-evidently true that the greater the number of processes we are exposed to, no matter how intelligible the elements of these process are, unless meaningful discretion (oversight) is built into the system, the riskier for all of us.
Macrocosmically this is obvious. The environmental problems we now have is at least in part because too many things are happening automatically without anyone in a position to take stock.
Its not just the injuries drugs and processes can cause, its the passivity they induce. A thermostat means that we don’t have to get up and adjust the heating. This can be convenient and useful from time to time. When it becomes automatic it contributes to a passivity, just as all remote controls do. And to an impersonality even impersonal killing as in death by drone.
We need Citizen’s Assemblies and Co-operatives rather than, or at least to supplement, government by regulation.
PS This evening in Parliament the British Executive got defeated by a group termed the Rebel Alliance (largely not from Eton) – the tally being 300 votes for the Executive and 329 for the Alliance.