I don’t really have much contact with the medical profession, mercifully. I haven’t been to see a doctor for over 10 years. And when I did used to see them, it was almost always only to get the sleeping tablets that I’ve long since replaced with far more effective whisky.
The result is that I’m now observing the medical profession from a distance – through binoculars, as it were. And recalling my experience of them over the years.
And the odd thing, in my recollection, is that none of those that I encountered in one surgery or other were particularly antismoking. They would ask me just once whether I smoked, and thereafter never mention it again. I remember one – a rather attractive woman doctor who I always liked visiting (because, well,… she was rather attractive) – even telling me, 30 years or so ago, that the roll-ups I smoked didn’t really count as cigarettes, because it was the manufactured ones that were the real problem.
And yet it’s the medical profession that is very largely the source of antismoking fanaticism. There was the very first one I ever encountered, the grim and humourless Dr W (who remains for me the personification of the antismoking zealot). But there was also Dr Richard Doll, and Doctor George Godber, and Doctor Gro Harlem Brundtland, and now UK CMO Dr Sally Davies, and WHO Director General Dr Margaret Chan. There are plenty more of them.
And here’s what seems to me to be the principal difference between them: It is that all the doctors that I encountered in surgeries and hospitals were hands-on, practising doctors meeting patients face-to-face every day of their working lives. And all the antismoking zealots whose names I’ve just mentioned are or were administrators of one sort or other. They’re doctors who, at some point after becoming qualified as doctors, ceased practising medicine. Dr W became a district health officer. Doll became a researcher. Godber became a CMO like Sally Davies. And Brundtland became a politician as well as becoming another WHO director general like Chan.
Or, to put it another way, the practising doctors that I encountered were the front line troops at the cutting edge of some war, and the administrators were the general staff officers in their chateaux miles behind the lines, poring over their maps. Their experiences of the war were completely different. And so was their thinking. For the front line soldiers, the war was bullets singing past them, and shells exploding around them, men dying beside them. For the general staff, the bullets and shells and casualties appeared as numbers in reports and requisitions. And the maps over which they pored were models of battlefields over which they moved toy soldiers and guns and aircraft.
And, pursuing this analogy further, “lifestyle medicine” or “evidence-based medicine” are examples of medical strategic thinking about How To Win The War: You win it not by treating sick people, but by preventing them from getting sick in the first place (as a consequence of smoking cigarettes, drinking beer, and eating chocolate chip cookies). And these new medical strategies seem to have taken over the high echelons of the medical profession in much the same way as a sudden enthusiasm for cavalry or artillery – or whatever the latest weapon is – periodically overtakes military strategic thinking – and which the poor bloody infantry in the front lines never have the faintest clue about.
Furthermore, the war planners in their headquarters never have to actually practically implement their plans. It’s not them who will have to usher smokers out onto the streets outside Dorset hospitals. It’s not them who will have to tell smokers on park benches to put out their cigarettes. It’s not them who is going to have to tell grieving relatives that, no, you can’t smoke here. They get other people to do that.
And furthermore, these administrative doctors – the researchers and CMOs and director generals – are often surrounded by people who come from outside the medical profession. Like Deborah Arnott or Linda Bauld or Stanton Glantz, most of whom probably wouldn’t be able to apply a sticking plaster to a bleeding cut, never mind operate to remove an inflamed appendix, and yet who feel able to lecture hospital administrators on the need to drive smokers out onto the streets.
And so I’m beginning to think that the medical profession consists of lions – the courageous front line soldiers – led by donkeys – the administrative general staff far behind the front lines. Which is how the historian Alan Clark described the British army in WW1.
And the same probably applies in other disciplines. In climate science, it would appear that models of reality – computer simulation models – have replaced reality in the minds of many climate scientists. And it has even become necessary for them to change reality – by adjusting temperature records, for example – to bring reality into line with the models.
But in the end it’s always the practical realists in the front lines who must necessarily win out over the dreamers and planners and theorists and modellers in their remote headquarters behind the front lines. For either the new strategy or new weapon actually works, or it doesn’t. And if it doesn’t work, it will eventually be discarded, even if some awful cost has to be paid before the lesson is learned.
Of relevance, (H/T Rose) is this report:
…figures uncovered by the Telegraph, show that the nine main health quangos are now employing 628 officials on salaries of at least £100,000.”
They include 93 taking home more than Theresa May’s £149,440 salary – up from 48 at their predecessor bodies three years earlier.
Among the highest paid is the NHS deputy medical director, earning around £225,000 a year.
and this one too:
“Dame Sally Davies CMO: £205,000 – £210,000”, well she can certainly afford the tax on a packet of cigarettes but she is not doing as well as Harpal Kumar CEO of Cancer Research UK who was getting £240,000 a year and that was back in 2015.
Of course the generals in their headquarters were always paid far more handsomely than the infantry in the trenches.