The limits of the market

Here is the review on antimicrobial resistance, considering drug resistant infections which could set back medicine a hundred years. Hip operations would be too risky, if someone might die from a resistant infection after. It is commissioned by the UK Government and partly funded by the Wellcome Trust. It collects evidence of how market failure inhibits development of antimicrobials- generally known as antibiotics- and the economic effects of a failure to contain resistant organisms.

Some resistance develops from insufficiently regulated generic manufacturers in the third world not putting sufficient quantities of active ingredients in pills, or using cheaper less effective alternatives; or even not making the pills properly soluble in the patient’s gut. Because the immune system attacks transplanted organs it needs to be suppressed, so making transplantees more vulnerable to infection.

Here is the industry declaration on resistance (pdf), signed at the World Economic Forum in Davos by 85 companies and nine industry associations in the pharmaceuticals business. They want the law changed, so that “the pricing of antibiotics more adequately reflects the benefits they bring”.

I love the change in language. The “pharmaceuticals” are “antimicrobials”, because of course humans are “biotic”, though the commonly used word is used to journalists. “Antimicrobials” is more accurate but also distances the cognoscenti from the laypeople. I also love the term “New Drugs for Bad Bugs” (ND4BB), a programme of the European Commission.

The review estimates the cost of total antibiotic failure as £100 trillion over thirty years, so continuing resistance would be a great benefit. I do not want that to be the cost to users. The company which patented the last effective antimicrobial could hold humanity to ransom- or even, restrict the treatment to the wealthiest, under precise, controlled conditions, so no microbe would become resistant. However the declaration also commits to making antimicrobials affordable in the third world.

It calls for the removal of incentives to prescribe higher volumes of antibiotics. The more you sell, the more you make- but that increases resistance. It calls for alternatives, such as vaccination and improved diagnostic tests for resistant infections, and for more judicious use of antibiotics in farming. Improved hygiene also inhibits transmission of infection. It admits that new valuation mechanisms and commercial models to make antibiotic research benefit everyone do not yet exist- we stand ready to work with payers and policymakers on new valuation mechanisms and commercial models that specifically address the unique challenges of this market.

A competitive market model has not brought the new antibiotics needed to combat resistant strains, and cannot protect us. We need ways of collaborating for the good of all, to prevent resistance. The human organisations so far created for co-operation for the common good are democratic governments and inter-governmental organisations. Only democratic governments can prevent the exploitation of new antibiotics, or the wrongful use of existing antibiotics, for unjust gain.

Cezanne, Les joueurs des cartes

Joy and Sorrow

I love M’s enthusiasm. He really enjoyed something, and thinks we should do it again. Well, we shall, next year (“we” is a larger group than just the two of us) and he wanted to find out about it immediately.

F brought us a cake. Possibly not GBBO winner, but perfectly acceptable iced sponge. She started apologising for it, including the fact that she had sliced it unevenly. I appreciated the generosity: F is sweet, and easy to be with. I wondered at the apologies. I would be sad to think she is in a permanent state of nerves, worried that her good deeds were not good enough, hurt that we had not eaten all her cake; though not all of us wanted cake. I want to reassure her, to appreciate her, to be clear in my own mind that she is thereby reassured and no longer worried. I want to fix her.

F met [impressive person]. “What did you think of her, then?” I asked.

“She’s quite intense” she said. Next day F was apologising again, unsure whether she should have said that woman is “intense”. “Well, she is intense,” I said. I wonder how much F had been worrying about that remark, how much worry is a part of her life…

[Impressive person] had poked M with a stick, and M was bothered. He wanted to know what the Rules were, so he could understand the rights and wrongs of the situation IP had described to him. As a lawyer, I want to use the rules for my benefit: I don’t want a lawyer who tells me what I can’t do. I hire a lawyer to tell me how I can do what I want, as JP Morgan said. And I have strong, conflicting feelings about that situation: I feel we should all get along; and at the same time that the wrong result was reached. Arguably I should be neutral. I wonder how possible it would be, though, to persuade M of a particular interpretation of rules, point him at my adversary, and retire, to giggle and gloat.

I was sitting in the Quaker meeting thinking on these things. I wish she would be less… I wish he would be more… I wish he would not do things like… I really would like to gather them as a hen gathers her brood under her wings; and they would not be gathered or fixed. Well of course not. Neither would I, in the same situation. And any of them, even F with her worry, would be lessened if I could mould her as I wish. Life may mould her.

Perhaps this is part of Khalil Gibran’s experience, it is only that which has given you sorrow that is giving you joy. My recollection of that quote was poor, and googling it I found this.

The Earth is filled with the glory of God, as the waters cover the sea, I thought. Note the change of tense from the hymn, which quotes Isaiah. I was hard at my exercise, accepting the paradox: horrible and beautiful; pain and delight; surrender and control; joy and sorrow.

Cezanne, Medea

The Hard Problem

What is “consciousness”? In an evolved human being, is there any space for altruism? The Hard Problem by Tom Stoppard deals with such questions, in a blisteringly intellectual way. At the National Theatre, between scenes The Well-Tempered Klavier plays, with flashing lights symbolising neurons and dendrites. At one point, characters debate whether a machine can be conscious. Yet rather than arid it is beautifully warm, with the most delightful heroine, and a vile, hedge-fund billionaire villain. I bought a copy, and reading it see more complexity in its structure.

Can altruism evolve? Yes. It could be sexual selection: men are drawn to women who are self-sacrificing. (Where would that put me?) It could be a by-product: a genetic variation gives you particularly efficient kidneys, say, but also makes you kind. It could be that genuine altruism exists in outliers, genetically programmed, as an effect of having more canny subjects who do favours in expectation of reward. It could be the evolution of groups, which I understand EO Wilson has advocated.

Some things are not altruistic. A mother’s self-sacrifice is in the interests of her reproduction. Rose of Sharon in The Grapes of Wrath, cited by the heroine Hilary, bears her child still-born, and the book ends with her breast-feeding a starving man. After such a crushing blow, Rose might be doing something to make her feel life has meaning.

The Hard Problem is not evidence for altruism. As a character says in the first scene, “Don’t cite works of fiction”. But it is evidence of our desire to believe in kindness for its own sake. The villain profits hugely from the crash of 2007, encouraging irrational exuberance then betting the other way at the right time. He funds The Krohl Institute for Brain Science– is that an altruistic act, or just something which amuses or interests him? Would either explanation make him more or less “good”? There is a series of actions in the play, about which we, and sometimes the characters, speculate on their level of altruism.

I am delighted to see a lesbian couple, played straight as it were- they are just a normal couple who bicker a bit and love each other, living together easily. In lesbian Love, a woman does what she imagines her desired one would want, who is revolted; much of the “generosity” is a way of getting sex.

I want to believe in altruism, particularly in my own; unless I am altruistic I have no understanding of myself, and I may merely be broken.

Paul Cézanne - Nature morte avec du lait et des fruits

National Theatre

It is not true that “in my weakness is my strength” or “We can be at our most powerful when we are vulnerable“. Rather, we are powerful when our vulnerability cease to matter to us, either to correct or disguise. When I delight in my vulnerability it ceases to frighten me.

Without a series of coincidences- petty ones, bus late, that sort of thing- I would not have been on the South Bank on Wednesday, or had the experiences I had. If I had realised the theatre ticket Mona was offering was for a 45 minute interview with Anthony Sher I would not have bothered. If the bus had been on time I would have had my mobile phone- ask, if you really must- and not have tried to contact her by borrowing one. First I tried in the train. The woman opposite was typing furiously on her lap-top, with precise hand-written notes; I read, “£1.6m”. She had her business face on, but was very sweet when I said “excuse me”. But her mobile had ceased to work. The man beside me had no signal, but leant me his when he caught one. We had a brief conversation about mobiles. Nearing the station, she stood up, and I noticed she was trembling.

In the National Theatre, I did not notice Mona, so keen was I to borrow a mobile. The first I asked said she had specifically switched her phone off for the theatre, and the second showed hers was on the blink. You have to take the battery out, apparently. She could not remove the SIM. Then we stared at a line crawling across the screen for an age. With no signal inside, I took the phone outside in the rain, and Mona chased after me. She had been talking “to two old women- women my age”. An hour later, she said, “I have two messages- oh, they’re from you”.

I did not ask Sher my question, about his role as a psychic transsexual. Mona’s question was that she had noticed aspects of his Falstaff in his Willy Loman, and wondered how he laid down a role before starting a new one. It is not a problem, he said, nothing he had ever even considered. She tried to ask a follow-up, speaking over the interviewer, and later was going “yeah…yeah” as if we were at a table with him, rather than in an audience. At first I was embarrassed, but before the couple in front looked round disapprovingly I had decided Mona was my friend, and I would support her. Perhaps she was not used to the strong painkillers.

Sher played Falstaff as a ruthless, homeless alcoholic. His charm was part of the complexity of the character- Shakespeare writes human beings. Sher’s comment which has hurt me was that the fantasist Loman has a strong will: I do not know what to do with my strong will, either.

Mona had tickets for the play, but not one for me- but not for that night, either, she had the day wrong. I got a ticket. I have at last embraced Disabled status, which got me a £34 discount, without needing any evidence or explanation.

Paul Cézanne - Nature morte avec pommes et pêches

MP on Iraq

Paul Cézanne, The card playersWhen arguing, stick to your strong points. From what he misses out, Mr Sawford’s argument for bombing Iraq is very weak indeed. I emailed him on the day of the vote, and he wrote to me dated 6 October. He has posted much of his argument on his website. He says six key conditions were met:

There is a just cause for action on humanitarian grounds and the grounds of national interest, as the instability caused by the overthrow of the democratic state of Iraq means it could become a haven and training ground for terrorism directed at the UK.

Humanitarian bombing. Who’d have thought it? The rhetorical triple is good- just… humanitarian… national interest- three words to push my buttons- but how might bombing promote stability in the Failed States Index’s 11th most unstable state?

Paul Cézanne, bathers, in partIS have shown they could not be negotiated with. Well, so has the US, with drone strikes. Who can negotiate with death from the air?

The UK is responding to the request of the democratic state of Iraq. I can’t find how inclusive it is of the Sunni minority, but the BBC says it is not.

The aims of the mission are clear: international military air power is supporting the Iraqi army and the Kurdish Peshmerga in their ground campaign against IS, and the use of air power is accompanied by training and resources to support their efforts. Are the aims achievable? Are those forces capable of withstanding IS?

There is broad support for action, with all 28 EU member states, the Arab League, and a regional coalition of Jordan, the UAE, Bahrain and Saudi Arabia and Qatar supporting the action. In 2010, Saudi Arabia bought $60bn worth of aircraft from the US. Why isn’t it flying these missions? Sales continue. Ask Google. It appears Saudi Arabia is bombing Syria instead: so much for Britain not bombing Syria.

The action is proportionate, with the UK now committing a limited number of Tornado aircraft as well as continued surveillance.

Paul Cézanne, bathersI emailed, and asked three questions this does not address.

What are the chances of success?

What are the costs of the action?  Flying the Tornados and firing their missiles costs money, as does repairing the damage on the ground, and is there a risk that IS will have surface to air missiles?

In what way is this military action better than doing nothing at all? Will not more Muslims be made militant by seeing their co-religionists bombed? Might IS left alone become as good a government as we might expect in Iraq after further bombing? Is there anything which might produce stable, peaceful states in Iraq and Syria?

Hooray for Youtube. This charming song has lived with me for decades.

MP bothering

The house with the cracked walls, Paul Cézanne

I have never contacted my MP about a personal difficulty, but I emailed him twice recently, about TTIP and Iraq. He replies in a reasonable fashion, with standard paragraphs put together by an assistant.

My Tory father used to bemoan “ratchet socialism”: under each Labour government more power would be arrogated to the State, and Conservatives would not undo it. TTIP seems to ensure ratchet capitalism. A Tory government could put health services out to tender. A Labour government could not then bring those services back into State provision without opening itself up to claims to compensation under Investor-State Dispute Settlement. It would be a restraint of trade legally indistinguishable from nationalising the Suez Canal. The UK government will not seek to exclude health services from the scope of TTIP.

The TUC wants to exclude ISDS from the treaty. Frances O’Grady’s inclusion of this possibility in a consultation exercise is not such a great achievement as she suggests.

Dispute settlement procedures are the wrong target. Without them, a treaty becomes a pious hope, broken with impunity. The previous Labour government in Australia under Julia Gillard promised to exclude ISDS from future trade agreements, but this carries risk to Australian commerce as well: If Australian Paul Cézanne, Seated peasantbusinesses are concerned about sovereign risk in Australian trading partner countries, they will need to make their own assessments about whether they want to commit to investing in those countries.

That Labour government also promised the Government will not support provisions in trade agreements that constrain our ability to regulate legitimately on social, environmental or other similar important public policy matters. Such as plain packaging of cigarettes, a social policy matter. Philip Morris Asia argues that the Australian law is in breach of its intellectual property rights. Was it foreseeable that such a challenge could be made to a public health initiative?

Though the case started in 2011, it is not yet resolved. Pleadings, submissions and evidence are kept confidential on the orders of the Singapore tribunal. Justice will not be seen to be done.

What does Mr Sawford say? “I am worried that ISDS would give corporations the power to sue our government if they thought that a national law would hurt their profits.” What sort of national law? Is this a treaty which would allow no restraint of trade at all? In the EU, a “single market”, there is a great deal of restraint of trade: Champagne must be made in Champagne, and Melton Mowbray pork pies in Melton Mowbray. In the EU, there are procedures for such restraint across the whole market. The parties seek to bridge the gap between their respective approaches: perhaps this is the high water mark of such restraint, and the US will veto any further law.

Might there be such procedures under TTIP? The State of Play document from the Commission does not tell me. On most provisions, including dispute settlement, the parties are still negotiating.

My MP’s letter echoes concerns about TTIP without helping me understand what it might do. This document from the EU says it is Wonderful. Should I trust it?

The inner critic II

https://i1.wp.com/upload.wikimedia.org/wikipedia/commons/0/0c/C%C3%A9zanne%2C_L%27Hiver.jpgI lie, of course, because I am ashamed. I do not want to avoid the CAB, as it is my way of meeting people, having an interest, exercising my altruism. I want to avoid having my buttons pressed. The problem is the strength of my inner critic.

The paid job I had at Swanston CAB was poorly planned. I was supposed to advise parents at Children’s Centres about their benefit entitlement. The CAB thought the Children’s Centres would be eager to refer the parents, and the parents would be eager to see me. The Children’s Centres thought the CAB would refer clients whom I would see at the Centres, so bringing new clients to them. The parents showed indifference, mostly, and one support worker was deeply hostile- think of incident, rage and cry a bit, put it back in its box- so I saw far fewer clients than was expected.

Making an effort to see it positively, I can say: it got me to this beautiful place, six  months’ paid work, and I did some good for some clients. I had not really made an effort to publicise my services before, and I had that challenge. (At one show, with stalls for various services for the parents, few parents actually turned up, but that was not my fault.) I had to form relationships with the children’s centre workers, with varying results: I choose to think that with Lucy more important than with that hostile worker.

Seeing it negatively, as I did, I found it a failure, which was a judgment on me. My failure. That is the inner critic, which sees me as a bad and generally useless person. Just as the internalised transphobia is reinforced by the few transphobic people I meet, my inner critic is reinforced by the occasional harsh judgment of me by others. The problem is that as my inner critic is so fierce, I find it hard to differentiate those negative judgments of others according to whether they have value or not. Each feels like a complete rejection of me, and I react angrily and imperceptively. My judgment meets my angry denial, where I would be better to see things as they are, and feel and respond appropriately to this situation not past situations. And my inner critic disregards any hurt I feel at this as inappropriate, again stupid and useless.

I had the Minute of Disunity of Quakers, and my appeal against it, to deal with at the same time.

Now, I have been volunteering. I wrote about how I find it now, and over the last six months I have been thinking of how I can fit in there- do as I am told, basically, rather than formulate my own arrogant way, as there is only room for one way. Accept that. Now, I think, reduce my fierce reaction to criticism, because it is not a reaction to the real world. Find my own current emotional reaction. See clearly. Something I need to practise.

Lying

https://i2.wp.com/upload.wikimedia.org/wikipedia/commons/9/9e/C%C3%A9zanne%2C_L%E2%80%99Automne.jpgAs I practise, I grow more adept at lying.

I have not been going to the office. H will think badly of me for this, or worry about me, or tell me how she would behave, or what is in my interests. I don’t think badly of myself for this. I could argue, and put my case, and hear her worries. I fear that she will not come round to my view. Instead, I first said that I had been that day, then later that it had been boring with nothing worth talking about, and then made up a generic story about the kind of problem I see there and say that it happened.

Or, I would phone my father if I had anything to relate to him which I was proud of, and which I thought he would see the reason for pride. I would like contact occasionally, but do not want to go naked into it.

Perhaps I could trust them. They wish me well. I do not want to disappoint, or I do not want to hear disappointment in their voices, or something. Disappointment is all very well, but expressing it while speaking to me is a judgment, which I do not want to hear. Go judge someone else.

Eventually, I might tell that generic story in the same way as if it had really happened. Though telling genuine stories, I would be thinking it through, for my own benefit, and bouncing my thoughts and feelings off my friend. Telling a made up story feels sterile, but finding one to do that with might make it completely credible.

I do not know if I am doubted. One tends to believe what others say. I would rather be able to say what I felt, and be heard and accepted. I do not feel that I am, though I do not know how clear that is a perception of others. What is the judgment, exactly?

“One just has to keep building higher and higher fences,
to show one can jump them.”

I rather like that attitude. I can see the attraction. I have just been so frightened for so long that it is not mine, and I cannot see what challenge I might enjoy or keep to. I want things to be quiet. I do not want challenge.

A trans woman I met said that she had a rare genetic condition whereby she had two X  chromosomes, but an “SRY inclusion factor” on one made her develop male sex characteristics. She also told me that at school she had blown up the bike sheds with home-made explosives, and that she had acquired written evidence of having been sacked because of her transition which netted her a large settlement. A woman I met at university, unable to get her degree, told me that she was doing an Open University history degree, and had been told “she was likely to get a First”. A man who I met during a summer job as a pool attendant told me that he had been in the SAS, and that his former girlfriend tried to inveigle professional secrets from him, as she was in the National Front. In each case, it was the accumulation of stories which made me doubt them, and after I noted their unlikelihood. The tip might be, make your lies credible.

Natural Law

https://i2.wp.com/upload.wikimedia.org/wikipedia/commons/e/e5/C%C3%A9zanne%2C_L%27%C3%89t%C3%A9.jpgI assert in the Equal Marriage debate that heterosexual marriage is in no way affected by recognition of gay marriage: not individually, and not as a whole. But perhaps Flavius’s is. He asserts it will be damaged by the statutes on equal marriage. How might that be?

Part of the problem is that we use words differently. He says that heterosexual sex is “natural”, and I agree. It bonds two people together, and may have the potential for conception. I say homosexual sex is natural. He says, “You can’t seriously believe that it’s natural for a man’s sex organ to be inserted in another man’s rectum?” and I hear the distaste in his words. He finds the thought horrible, harmful, and unnatural.

Well, yes, I do, as it fulfils the purpose of sex to bond people, and it happens. He also thinks that people hurting each other or themselves is unnatural, which begins to show what “natural” might mean to him: in accordance with God’s purposes for humanity, in accordance with our good. But I still see the good which comes from two gay people bonded together as a couple, which he does not see.

How will the redefinition of marriage hurt him, individually? Fiddling with marriage and the family with a redefinition will create chaos:  a host of confusing new laws to accommodate the new definitions, the intrusion further of the State into the affairs of the Church, and the dissolution of familial bonds as an entire generation will grow up with the idea that something as basic and immutable as the family can be arbitrarily redefined at will.

That is, people will not have his moral boundaries. Gay men will not try to marry women in an attempt to make themselves straight; instead, they will find partners they can love physically as well as in friendship. I think that benefits them, and those gay men who have tried marrying women then formed gay relationships agree. I think it is “natural” in his sense, in accordance with God’s will for our good.

How might it hurt him, then? This is my attempt, rather than his: he might meet people who disagree with him. He might see gay couples, and people- even Catholics- who believe that they are properly married. His moral view will be challenged. This will cause him such distress that he cannot bear it.

Or, he genuinely cannot conceive that others might see the Good differently from how he sees it, let alone that they might have as much right to decide what is good for them. Humanity finds Good by trial and error- we have tried Mao’s Cultural Revolution, and it is not a Good end, and we know that now. To me, Good and Truth are indeed one and eternal, but we cannot know them, only grope towards them. So his idolatry of his Magisterium prevents him from making any progress towards knowing what is truly Good.

My religion

https://i0.wp.com/upload.wikimedia.org/wikipedia/commons/9/93/C%C3%A9zanne%2C_Le_Printemps.jpgMy religion is practice, not dogma.

On Sundays I go to the meeting house. T drives me, and we chat. About fifteen or twenty people gather, and chat deeply and joyously. I kiss cheeks, and have two or three good hugs.

I sit in silence in the meeting room. The last time I went in, I was assailed by the holiness of it. Or- I am aware that I have different states of awareness or attention. I may sit with my thoughts chasing their tails, thoughts I have thought before, or I may be in a state where my senses seem heightened, that I can hear a pin drop, I can see wonder and beauty in the grain of the bench. It is “holy”- it seems to facilitate in me altered states which I value. My teacher Amrita writes of silence.

I notice the other people as they come into the room. As I worship with most of them regularly, talk to them, see them in action, I know and value them. I take pleasure in their presence and being.

I may watch the clock for the hour, and think, and- sometimes my thoughts seem to move in a new or useful direction. This may be “inspired”. There are a number of stories about how this might happen. It is the Holy Spirit, moving me, as St Paul says giving words to my inarticulate feelings. Or, it is my unconscious mind, and things drift into consciousness. Sometimes I feel moved to speak this to the Meeting, and sometimes what I say has had particular meaning for others, or what they say has been where I am. Two Friends spoke of resisting this prompting to speak, and being unable to- our Quakerly sobriety lives with vibrant hearts and charismatic Movement.

Then we chat over coffee.

S says that she needs to talk of these spiritual matters, and is so delighted that she has found people who understand what she means. I joined when I felt driven from my Anglican church, when I could no longer worship disguised as a man, and found I was accepted among Quakers.

I join in with the organisation, as assistant area meeting clerk and now member of Nominations Committee.

What of dogma and doctrine? I have certain experiences, chiefly these senses of holiness or inspiration, which I choose to label with the term God. That may mean any number of things, between the evolved consciousness of this human being in a random universe through some sort of collective unconscious, race memory exhibited in instinctive behaviour, or all-powerful eternal Creator. Sometimes one idea of God seems to fit better than others: for I see in part, and understand in part, and a false understanding may help me to a truer perception.

The Virgin Birth is a story. I do not need to know if it was true in the sense that “Henry VIII had six wives” is true, for I see its beauty. I have words and stories, stimulating and provoking me, to my behoof.