I arrived in Boston last night (and yes before you say it another working weekend) to attend a meeting where I am discussing viruses and MS. A topic close to my heart. Boston was gridlocked as a result of several anti-Trump protests. My taxi driver and US colleagues have post-election blues. What is happening in the US is not too dissimilar to what happened in the UK post-Brexit. In fact I have still have the ‘Brexit Blues’.
On Thursday night my wife read me Aaron Sorkin’s open letter to his daughter. Whilst she was reading it I realised that herein lies the problem. Sorkin’s letter and its tone is arrogant and self-obsessed. My epiphany is that Sorkin, and his attitude, is the problem. The arrogance of ‘the haves’ is why we have Brexit and Trump. The race to the top, and the race to the bottom, largely driven by the effects of globalisation, have disenfranchised large sections of society. Social mobility is stagnant and the wealthy and highly-skilled have taken over the asylum to make sure their offspring stay on top. In London, the wealthy game the system that makes it very difficult for children from poor families to climb the ladder. Falling living standards coupled with low job satisfaction and limited prospects has fuelled the discontent of the ‘have-nots’. Democratic protest via the ballot box has now delivered us to this point. In the past we would have had civil unrest and militant revolutions. If we don’t take these democratic protests, delivered via the ballot box, seriously the next forms of protest won’t be so benign.
We need to go back to first principles, reassess things and reconsider how we want to live our lives and how we want our society to work. I am not a politician but I realise that I need to seriously consider how each of my decisions and choices affect others, particularly those less privileged than myself. The fourth arm of our Brain Health Challenge is wellness. Although this is rather a ‘soft’ part of the challenge, it has, in view of recent events, become the most important aspect of the challenge. At the heart of wellness is our interaction with society and our environment. How do my decisions, about the way I live, cascade through society and affect the environment?
Do I really want to support an uberised world? As a Londoner one of the most satisfying things you can do, particularly when you are tired, harassed, or when it is raining, is to hail a black cab. I agree it is a luxury, but why not? The other night my wife and I were out at dinner celebrating our anniversary (we have been together 35 years) when we decided to call a cab. When we went onto Uber the closest Uber car was a minute from the restaurant; we were literally in the middle of colony of Uber ants. As we hadn’t yet paid our bill we decided to call a black cab via Hailo. Hailo is one of the many Apps available to call a black cab, or traditional hackney London cab, which was developed in response to Uber. The closet black cab on Hailo was 4-5 minutes away so we booked it. Despite Hailo quoting a fixed-price, derived by some cloud-based artificial intelligence (AI) engine, our Cabbie put on his meter. I would like to think he did this out of habit. When we finally got home the metered price for the ride was almost double the price we had negotiated via the Hailo app. Most people would have said great you got a good deal. But had we? As cabbies incomes have dropped, I am sure the quality of their lives have deteriorated and they have become more dissatisfied with their lot and society at large. I am sure cabbies, as a group, are more likely to have voted Brexit. And that’s the rub.
London cabbies and their battle with Uber may be a soft target, but the same story is being played out in the recreation, retail, service, education and health sectors. As we devalue jobs and services in the name of efficiency are we not destroying what we value most? Do people with MS really want to be managed by an App, or a robot, driven by artificial intelligence, or do they want a human with compassion and empathy to share the journey with them? What type of healthcare system do we want? What type of society do we want to live in?
It is a great tragedy that the xenophobes, racists, misogynists, anti-gays and other lobbyists have high-jacked the Brexit and Trumpist agenda. At the heart of the issue is need. Just as Maslow defined a hierarchy of needs modern society has a hierarchy above these that makes it work. Ambition and aspiration are as important a driver today as were in the past. Unless we can reignite the sparks that have made our societies so successful we will regress. I suspect we are regressing already, things don’t feel the same anymore.
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| Maslow’s hierarchy of needs (picture from Wikipedia) |
I agree that it is time for bold and brave political leadership that addresses the needs of the ‘have-nots’, but the real task at hand is with us as individuals. Next time you make a choice ask yourself how it is going to affect society at large, particularly those at the bottom of the pyramid. I for one am grappling with how can we keep the human element alive in the NHS. People with MS and their families need HCPs with empathy, or at least compassion. At the moment both these fundamental attributes that underpin caring healthcare are evaporating. Any suggestions would be helpful, these issues need to be debated and widely discussed.
Despite his protests we gave our cabbie the largest tip we have ever given a cab driver; we simply paid him according to his metered rate. Rather than feeling like we had missed a trick, we felt happier and more liberated than we had in a long time.
CoI: Up until now I live a charmed and very privileged life.
Re. People with MS and their families need HCPs with empathy, or at least compassion.This is so true, I gave this as feedback to a mental health service over a year ago. Even if a HCP doesn't agree with want the patient is saying the HCP needs to still show empathy and compassion.
Congratulations Prof G and your anniversary.
Thanks. It is also our 30th wedding anniversary this week. We were hoping to take a break to celebrate and reflect, but unfortunately work commitments have put that on hold.
Prof G I think you should become a politician.
Re: "Prof G I think you should become a politician."Anyone who works in healthcare soon realises how political it is. The main driver of poor health is poverty, even in developed, or rich, nations.
Have you ever looked at the photos of the British soldiers in the trenches in World War 1? 100 years later, if they were here, they wouldn't recognise England. You may be a big fan of multi-racial, multi-cultural societies, but no one asked the indigenous population. The idea that mixing everyone up has not resulted in the harmony that the idealists expected. I suspect that you left South Africa for this reason (now one of the most violent societies in the world). The coming decade will see the rise of popularist right wing parties in France, Germany and eastern European states. Who is too blame? The politicians who ignored the white working class (often Christian) indigenous citizens. By the way, these are my observations not my views. It doesn't take a genius to work out why things are going badly wrong.
fascism (noun)an authoritarian and nationalistic right-wing system of government and social organization.synonyms: authoritarianism, totalitarianism, dictatorship, despotism, autocracy.
I feel the same: the so-called 'efficiency' savings of privatised services are made through cutting staffing costs – hence our pensions crisis, zero-hours contracts and low wages.The ghost of Thatcher still haunts us.
Re: "…The ghost of Thatcher still haunts us."Global trends are bigger than one politician, but she played her part. This is about the impact of neoliberalism and globalisation.
"The idea that mixing everyone up has not resulted in the harmony that the idealists expected."And with that, you show that you have fallen for the typical rhetoric spouted by those puppet masters who stir the unsatisfied masses so well. The angry, the unfortunate, the uneducated enter the blame game so readily. It's easier than addressing the real societal issues which certainly take longer than a goverment term of 4 years to fix. Vote for me – I'll get rid of the immigrants – it will all be better then. Except it won't – because they are not the problem. And closing down borders denies both history and the realities of our shared world, in which we all need to work together.
I agree totally with your view on retaining the human element. The ability to engage with other people is essential to our well being. This approach creates a problem in our society, it costs a lot of money. Everyone has to create a model that is as cost efficient as possible and it is human beings who are often the most expensive element. As a result everyone is creating solutions using computer technology. These solutions are cutting down on the chance for experts to engage with people who are seeking their advice or help.People seeking advice or help are often the very ones who do not have the money to pay for a solution that allows human interaction. I like your comments but how many of us have the cash to splash?This is lifeg, it is a tricky problem. Do you have a workable solution?
The question is how do we get everyone to focus on humanism? How do we get back on top of the agenda?
Can you please provide evidence that focusing on humanism is the answer to the problems you have formulated?
I was reading on the BBC about occupational therapists have a vital role to play in supporting older people to maintain and regain their independence. The Cardiff OT pilot saved some patients seeing doctors, reducing pressure on hospitals. I just wondered if pwMS do access OT's beyond adaptions to homes and equipment. Such as falls training, skills development and psychotherapy?
Re: "…I just wondered if pwMS do access OT's beyond adaptions to homes and equipment."Not easy when we have them in limited supply. I am going to suggest a creative solution. Why can't OTs spread their skills and services more widely using the unemployed, or underemployed, workforce? This is what the NHS wants is to do.
One will tread carefully here, bros, because one is most likely on probation for one's past polemics vis-a-vis the crapness of the very new DMTs that keep Don Giovannoni clocking up air miles.Don Giovannoni is actually right in his understandings of why the screenwriter Aaron Sorkin's open letter is why the rest of us are voting the way we are. Heck, seeing Katy Perry and Miley Cyrus — both of whom come from entrenched Republican families, and make crap music that says nothing meaningful — shed their collective fake tears over Hilary's loss, made me wanna high-five the Trump voters. These parties and celebrities know nothing about how the real world works, and thus, don't know us.America is hurting, as is Blighty. Here, the richest got a tax-cut, yet the disabled got a bedroom tax. It is baffling. In America, they have undervalued their workers by bringing in workers from Mexico who will work for less pay and in worse working conditions. The same thing has happened here as workers from poorer Mediterranean countries and Eastern European territories, prove more tempting to greedy capitalists.Don Giovannoni is mad if he thinks that emerging technology won't out price him in his job. Blimey, he's an old guy now so maybe he'll be less effected, but his junior doctors are gonna get whacked by new tech. Look how they've capitulated to the Tories and called off their strike. The Government holds the Aces now. The doctors have no fight.Dear Americans, I am with you. Much like us, you've been lied to, misinformed and used by those in power. You've endured austerity while they've ascended. They've made a monkey out of you. Get angry. Get real angry. You have nowt to lose.Peace out, homies.
Love, love, love you Dre.You are so right. We have been used. Brexit needs to happen immediately. Posh people don't get us but we have democracy on our side.
I'm not sure that I get you, Dre. Are you really a Brexiter? Why? You're a lefty, right?I get what you're saying about disingenuous celebs and politicos, though. Be careful, though, as your words my cause rioting 😉
What–a–load–of–guff.
Re: "…vis-a-vis the crapness of the very new DMTs…"Show me the data? You can't make a statement like that without showing us the evidence to support the statement. Or may be this is a hypothesis that needs to be tested? If that is the case any suggestions on what experiment you would like to run?
Gavin GiovannoniMonday, November 14, 2016 8:26:00 am"The question is how do we get everyone to focus on humanism? How do we get back on top of the agenda?"Show me the data, please. You can't make a statement like that without showing us the evidence to support the statement. or may be humanism is a hypothesis that needs to be tested? If that is the case, any suggestions on what experiment you would like to run?Ps. I agree that humanism is important and should be driving the world… but I understand that my view is open to debate and there is no consensus on the issue.
There are many problems and Prof. G has hit quite a bit of it on the button, "globalization."While the actionable term globalization only came into the average person's light in the last 15-20 years the truth is globalization began as Russia came apart. Literally. The "players" were already at it before then but it was not as actionable.In respect to Trump most Americans do not realize what has happened.They were given a reality media TV show by a man who is very good at reality media. He dominated the media .vs. the media performing actual focused reporting. New bombastic statements, rhetoric and crud came out so rapidly and continually that is what was reported upon.He demonized many.On the other side of the coin there is no way he could or would have had any chance had he not. He did not tackle issues, political policies, any of it. Instead, he used the media and the world essentially.He and his team are either quite smart in at least as getting into office or the media/populous is quite dumb.If he is that smart in looking ahead of the curve then the globe is in for a new USA.If however his personality is so injected into policy and media then the world may well have become a much and I do mean much more dangerous place.One of my concerns is that of Russia and the USA. If these two entities were to cozy up that now represents a military capability that no nation on the planet could even consider standing against. None.There are serious dangers there as well as a significantly more rapid track *IF* globalization stays on the table.The current globalization "view" is that the USA is in the car. We dont drive it but we are in the car. Russia was "dealt out" of the car as the USSR came apart. They were promised the glory's of democracy, money, resources, help towards a more capitalistic life. For a rather short term it happened. Then, it didnt. Instead, The Asian Pacific / European nations got goodies (more so Asia). Russia has been attempting "deal itself" back in to globalization. Once one of the two superpowers they were dealt out.If the USA and Russia deal in, look out.The problem happening across the westernized societies world… There are people who think. There are people who think they think. There are people that want others think for them while they stay entertained.This is not strictly a USA matter. Westernized nations have been in a situation of "Be careful what you ask for you just might get it." This due to people who live in a fog of "Entertainment is bliss" .vs. being active towards societies. Same reason people w/ disabilities, poverty and more suffer in comparatively wealthy nations.While folks often lay blame at the feet of governments the truth is we get the governments we elect and as people who choose not to be active in governance / decisions actively all is fine… Until its not.History is a fine teacher yet some 95% of the people in the world know little to nothing of it be it globally or within their lands.People who carry water buckets and struggle for basics in small villages in Africa know more of their history than those in developed countries.
I strongly believe that quality shift in medical services is impossible without replacing (at least some) humans with machines. And it is not all about cost optimisations.We see that contemporary deep learning neural networks outperforming humans in many different tasks and areas right now. I can’t understand why medicine should by any different.
Vasy I agree with you. I am all for innovation and improved quality, but it needs to be woven into a system of care that recognises our social needs.
Hi Prof G, looks pretty futuristic, but I do believe this kind of transformations are inevitable (unless we start a nuclear war or something)Healthcare in 2030: goodbye hospital, hello home-spitalhttps://www.weforum.org/agenda/2016/11/healthcare-in-2030-goodbye-hospital-hello-home-spital
Dear Prof G,Thanks for flying coach and spending the weekend away from your family again. Hell is getting on an aircraft and turning right. Been with my shrink 5 years, Wednesday morning was the first time her professional face just wasn't there. All of NYC was in shock, never heard the city as quiet – just no noise. Here is a remarkable piece from a rubbish site, written before the election:http://www.cracked.com/blog/6-reasons-trumps-rise-that-no-one-talks-about/So just heard that he plans to spend the weekends in NYC; what a great spend of my tax dollars.
Thanks Aidan for the comment. I did turn right, but still managed not to fly coach.
I often turn left and still end up in coach…I guess that happens when you enter by the rear door:-)
It's fairly sickening to have working class bigots such as those commentinabove to generalise about the indigenous Christian populations of the U.K. Not every working class person thinks like you some of us have the class consciousness to recognise a fascist by stealth type argument and didn't vote Brexit. As for nothing to lose – we have a return to naked racism and my black/brown/non Christian working class neighbours, friends and colleagues are losing already to the manipulation of the right.
Successful empires have always been open to all and welcome immigration and diversity. Its the mixing pot that drives creativity. It when you close them up that they wither and die.
Can you give me examples of such successful open to all welcome immigration and diversity empires?The Roman Empire? The British Empire? The Russian empire? The Mongolian empire? The Ottoman empire?Seriously, which one was successful open to all, welcoming of immigration and diversity? (Unless diversity means slavery…)Look, it's true that Britain conquered the world and built up it's empire in a prolly one of the most non violent ways. But hardly open to all and welcome immigration and diversity….
"… it's true that Britain conquered the world and built up it's empire in a prolly one of the most non violent ways…"That is totally delusional nonsense! For example, the Opium Wars!!! Non-violent???
I suffer from MS and read this blog as much as I can.Nonetheless, I was pro-Brexit, pro-Trump and pro-Le Pen, etc…Friends categorise me as "alt-right".I hope that's OK? Do you think it's my MS putting these evil ideas in my mind, or is it just contrarian geo-political awareness?
Re: "I hope that's OK?"Of course it is okay; over half the population in the respective countries voted like you. This blog is inclusive, and not exclusive, provided you obey some simple civil, common-sense, rules. The purpose of this post is to address the causes of the divisions so that we can address them and study their impact on the management of MS and health in general.
Thank you. The majority of readers (assuming a representative sample of UK/US readership) are naturally of a different view.But they suffer or treat MS.I read the Spectator for politics – and will never expect a column on MS there.Perhaps we should stick to what we know best?
Apologies, I think my last email is out of order.Sorry for being rude.Thanks for all the good work you do for us.
Dear professor Gio, there's a link in one comment that twkes the reader to ccsvi central. You are accused of selling drugs. The idiots at ccsvi central have no idea how NICE or the NHS works and neither, seems does Dr Dre. Words can not describe my scepticism as regards ccsvi, it's a money stream for interventional radiologists. There is more than one that will 'open' veins that have no constrictionsMrs Beal is not a neurologist or a doctor. She is a massive pain in the neck though.
Prof G are you telling us that you are a Brexit/Trump sympathiser?
Re: "Prof G are you telling us that you are a Brexit/Trump sympathiser?"No. I am just trying to make sense of the position we find ourselves in. I could cry foul and state that the democratic process is flawed and let’s have a rerun of the referendum and US elections. I could do an ‘Aaron Sorkin open letter’ and pen a much poorer ‘Brexit/Trump Lament’, but this will get me nowhere. Or I could analyse the situation and see if we can bring society together to address the needs of everyone. Unfortunately, the educated/privileged, such as Aaron Sorkin and myself, have forgotten that the position we find ourselves in is not the default position. It has taken time, education, etc. to arrive here and we have many options; for example we can move something one commentator already referenced when he/she referred to my South African roots. In comparison the less privileged have no options. The question I am asking is how we progress from here so that we don’t let this rift divide our society further and impact on our health and wellness. I am beginning to realise that the issue is really about education and sharing. How do we deal with the current global trends that continue to wreak havoc on modern democratic society that we have so carefully built over centuries? I have no answers except to ask you as an individual to question how you want to live your life and in what society you want to live in and how these choices impact on your wellness. But as one commentator said I should probably stick to what I know.
Is the answer alternative minimum income? I think this is the only real alternative, for example the largest type of job in the US is driver. Approx 17 percent of the workforce works as a driver, you do not need a crystal ball to see that technology is going to have a major impact over the next few years on this section of the economy.
"The question I am asking is how we progress from here so that we don’t let this rift divide our society further and impact on our health and wellness."Is the question 'how do you move on from society's inherent unfairness to a state where the haves and the have nots are co-existing peacefully and lovingly?' The rift between the privileged and the non privileged already exists and is and has been divisive for a long time. Revolutions have been borne out of such rifts. The only difference between now and 1000 years ago is even the poor are now more comfortable then they were 1000 years ago: for whatever that's worth.I agree the issue is sharing. Without some hefty resource allocation world wide, the rift is going to continue to grow and widen (some call this rift 'Americanisation'). The version of democracy born in Athens thousands of moons ago has nothing to do with the world we live in today and is bursting at the seams.I want to live in a society where people with MS have a voice, are not bullied by their doctors and have access to understanding, empathy and real care. People with MS can be vulnerable. Doctors have power and ego. Can we deal with that rift first? As a doctor, it's something you do know about and have direct expertise on.
Income based issues are simply a hot spot. Want people activated? Talk money and the haves and have nots. Point blame and yield solutions or rhetoric. Either way, response is invoked.This, I fear, is much much bigger than income.Understanding the casual American mindset is important here. It can be summed up in three letters as the primary paradigm. "Own"Apply that word to literally anything and you have the American mindset.America is also the most charitable nation in the world throughout history.Without the concept of "Own" it could not be.Money is not the only item in the equation of "Own."In fact, there are hundreds if not thousands.The issue in America (and elsewhere) is "Own" is feeling a whole lot more like "Owned"… Again, many different aspects not only financially.That all said and done… Even if Mr. Trump had 8 years in office that is not enough time to flip around decades upon decades of mounting stacks of plates.However, conflict can.I'd not be surprised a bit to see within the up and coming times to see events result in marshall law in the USA resulting in no elections.
Yes, Sorkin is so arrogant, so clearly "we" deserve the ire of those poor rural voters left behind by the system. They just couldn't help electing a fascist who hired a virulent anti-Semite as his propagandist, the poor dears. They suffer so, despite being backwards, violent uneducated hatemongers who have driven my kinds of people out of their parts of the country for years. It was the only way to get our attention on their health crisis and poor employment, even though Obama tried to improve the health system and their Republican governors blocked it, even though Clinton and Sanders were working together on education costs and the wage gap.Please have a care how you phrase these things in the future. Sorkin has always been a patronizing git, but the people who voted Trump would gladly have us all pay with our lives. I've heard about our arrogance in the face of economic insecurity before…
ChicagoAnon how do you want to live you life? Forget Trump, Clinton, Saunders, Sorkin, etc. for a moment. This is about you and your fellow man. Remember wellness is a 'philosophical construct' about how you interact with society and your environment; and your God if you are that way inclined.
There's no appeasement with those who would kill you, Dr. G. My grandparents and their kin learned it the hard way. I did my good faith, I voted for the candidates who would save these folk, give them healthcare, fix Flint's water, build roads. It's irrelevant because it has nothing to do with economics. Economic anxiety? We've heard that before…
Exactly and I might add, make it actionable within society instead of simply behind "these four walls"America's vote turnout was 119 million people of a nation of 320+ million.Already 20 years back it was said by many that the USA was ripe for exactly what has happened.Perhaps The Donald was paying attention.Echo's of 1939 were talked about on a program on HBO with economists and others around the globe.In the USA, somewhere in the last 60 years the paradigm changed. Instead of it being one of working towards a better future for children and indeed the world it shifted to "Me, My and I" which is completely unsustainable no matter the nation.
Dear Gavin,Re: People are right to be angry Last week's US Presidential election result was a global wake-up call. Whether in the US or the UK, people are feeling left behind – marginalised by an economic system that makes them work harder for less, while hoovering up ever greater rewards for a small elite. People are right to be angry. Our political and economic system is delivering rising inequality and falling living standards. Young people today find it harder to get a home of their own, harder to find good secure jobs, and are landed in lifelong debt simply for wanting an education. Older people see their children and grandchildren struggling, their libraries and community services cut, their friends’ social care get worse. They’ve seen politicians privatise what were once our collective assets, and they are paying the higher bills and higher fares as a result. If we, as socialists, don’t step forward and offer solutions, then into the vacuum step the merchants of hate and blame. They see the problem, but instead of offering solutions to make people’s lives better, they offer someone to blame. The Tories do the same. They have opened the door to UKIP and fanned the flames of fear. The Tories pretend to understand people’s problems, but offer nothing but someone to blame. Meanwhile, the economy is slowing again. People’s pay still hasn’t recovered from the last recession and housing costs have soared. The Tories are cutting schools’ budgets, have slashed social care and have put the NHS into its worst crisis. It’s time for our party – half a million strong, with more members than all the other UK parties combined – to get out there to tell people why a Labour government matters. Our party doesn’t have the benevolence of the press barons, it doesn’t have the donations of billionaires, so please speak to your fellow party members, trade unionists and friends and ask them to take part in our National Campaign Day on Saturday 26 November. Yours sincerely Jeremy Corbyn MPLeader of the Labour Party
Prof G getting air time from Corbyn is impressive; well done. You may yet prove me wrong about politics.
Re: "Prof G getting air time from Corbyn is impressive"Not at all. They have bots that search the web and post comments whenever they think they are getting an audience. Do you really think an MS Blog is on Labour's reading list.
Don't listen to that Windbag 6:34 Vote for Meeeeeeee!Theresa May MPLeader of the Conservative Party
Jeremy Corbyn MP – It probably would have been nice if you acknowledged something about MS in your speech (political rant?).I think it's fair to say that people with MS also don't have the benevolence of the press barons or the donations of billionaires, so rather than shameless seeking money on a medical blog for political agendas: perhaps your time here could be better spent telling people with MS how you will improve their lives. I wonder if that's why Labour party is losing touch with its constituents? Labour Politician: Me me me me I can heal the world, we are the best, we can do it all, give us money support us, we'll help everyoneNeedy person: how are you going to help me Mr MP?Labour Politician: me me me me me vote for me gimme money me meme mememememeNeedy person: *walks off shaking his head*Labour Politician: I just don't understand: why are people no longer listening to us?
Prof. G you must he a Labour party member. I got exactly the same email from JC.
"I for one am grappling with how can we keep the human element alive in the NHS."Not everything is about money. I had a really helpful consultation with a GP the other day. She really listened to my concerns and addressed them. She talked to me human-to-human, without airs and graces, and without making me feel like just another patient to get out the way. The consultation took very little time, but the benefit of talking to a knowledgeable medical professional who obviously cares was remarkable.