It’s easy to despair in the face of our species’ (homo sapiens: ‘wise man’) apparent unwillingness to recognise environmental constraints. The facts of life on planet Earth have been laid bare to most of us by now. We cannot go on consuming as many of us do in the West indefinitely, especially with populations in developing countries increasingly adopting our lifestyles.
Denial is the default, including by chipping away at the edges of an incontrovertible proposition that humans are out of balance with nature; but also in terms of how we satisfy our desires individually – sure a little more won’t do any harm. There is always some excuse or other available to avoid taking responsibility for our actions.
Pope Francis previously described a dysfunctional relationship with Mother Earth:
This sister now cries out to us because of the harm we have inflicted on her by our irresponsible use and abuse of the goods with which God has endowed her. We have come to see ourselves as her lords and masters, entitled to plunder her at will.
Russia’s brutal invasion of Ukraine ought to bring this serious imbalance home to us. Underlying the aggressive posturing in response – and crazed talk of no-fly zones that could precipitate nuclear war – is a hard-nosed recognition that European countries will continue to purchase oil and gas from Russia. So, how should conscientious individuals respond to the impasse?
Ludwig Wittgenstein’s statement comes to mind: ‘Whereof one cannot speak, thereof one must be silent.’ In moments of crises holding back from holding forth is often appropriate.
The reflection required is also facilitated by viewing Bob Quinn’s short (16 minutes, 48 seconds) film ‘Bog Graffiti’, which mostly wordlessly documents the co-existence of his art work and nature on land he has regenerated in Conemara. The unspoken context is climate change. Another of the old masters, pioneering electronic music composer Roger Doyle provides a score that artfully integrates the elements.
Art in nature in Bog Grafitti.
Bob Quinn explained the concerns animating the film in a 2019 blog post:
The desertification of the Sahara happened suddenly.
Six thousand years ago northern Africa had as temperate a climate as Europe, had two lakes as big as Munster. It was fertile enough to support a settled agricultural population and their gods. There were fauna too, antelope, rhinoceros, hippopotamus, crocodile roaming as freely as the human animals.
Over a couple of centuries – the blink of a geologist’s eye, according to a computer simulation (Milutin Milankovic Medal, 2005) – a combination of local vegetative and atmospheric changes in the area (recorded in deep land and sea cores) caused a local climate event – the Sahara event.
It should not surprise us. During another of this planet’s many interglacial warming periods , alligators thrived at the north pole; there are fossils to prove it.
A blindspot of our species is that we confuse weather with climate. Humans do not cause destructive climate events; we accelerate and intensify their frequency. Unexpected change follows unregulated ‘progress’: our cars, our holiday flights, our excessive consumption.
Present climate change is, like politics, global but people experience it in local terms: a drought in one place, a tsunami in another, forest fires here and there. Tough luck on poor people, faraway. It couldn’t happen here?
Alas, homo sapiens is all the one, seven billion of us, all on the same tiny planet, as voracious and unthinking as mice sailing on a ship of cheese.
The film puts on a display of the natural world, from bees to butterflies, in all its glory, and gore. A poignant moment is the sight of a bat writhing in agony in a pool of cooking oil. At least we are a little more aware now that the bat may yet have its revenge, over humankind at least.
A bat fails to recover its flight in ‘Bog Grafitti’.
Filmed in 2019 at a point when – prompted by a certain teenager from Sweden – many of us were facing up to the challenge of climate change, it is appropriate perhaps that the scenes in the film are seen through the eyes of a young girl – Bob Quinn’s granddaughter Sasha May Quinn. She seems destined to inherit this Garden of Eden, but as we see in the film, storms are moving in – interspersed with scenes of motor cars, cattle marts and aeroplanes demonstrating the excesses of consumption. It begs the question: what will remain for the generation to come?
Bog Graffiti is the work of a master craftsman teaching us what we know already in our hearts but generally fail to acknowledge in our conscious actions. The film ends with the Latin motto: ars longis, vita brevis ‘skilfulness takes time and life is short,’ which originates in a Greek text, Aphorismi written by the Father of Medicine, Hippocrates.
Appropriately perhaps, the lines following from that text state: ‘The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.‘ Thus, art such as Bob Quinn’s can impart a lesson, but it remains to be seen whether we take this on board in our actions and deeds.
The HSE, and health care access more generally in Ireland, has never been under such scrutiny as has been the case in recent times. From the handling of the pandemic to the chaos witnessed during last year’s cyber attack, we now face recent revelations about utter confusion in the handling of funds and a recruitment crisis, exposed in leaked tapes published by the Business Post.
HSE CEO Paul Reid also admitted in a recent News Talk interview how, particularly recruitment issues, were “not going to be solved in one year.”
It is reasonable to assume that addressing structural dysfunctions in health services will take time, but we often forget the real impacts, and often irreversible damages on our most vulnerable members of society, caused merely by the passage of time. This applies especially to the treatment of complex conditions requiring a multi-disciplinary approach.
A most striking example is the effects on those children awaiting treatment for Spina Bifida/Hydrocephalus, and their parents.
We recently spoke to Amanda Coughlan Santry, the co-founder of the parent-led advocacy group Spina Bifida & Hydrocephalus Paediatric Advocacy Group, which has been active since 2017. It raises awareness around the lack of access to care for children affected by the condition, and actively engages with the institutions to address what seems one of the worst failings by the State in contemporary Ireland.
Amanda, along with other parents Una Keightley, Stefania Opinto, and Orlaith Maher Lalor, joined us for an in-depth interview which we hope can draw further attention to the current situation.
The group have recently launched a website www.sbhpag.comin which sixty-nine children’s stories are presented. Here one can discover the scale of the challenges surrounding their access to treatment.
We heard of children being left on waiting lists for surgeries for over a year for treatments, which in other European countries are urgently attended to. There have been years of complaints, which went for the most the most part unanswered and, most distressingly, in the last few months, parents of children in pain, have felt compelled to refuse to leave A&Es for days on end until their children were treated.
Daniele: Can you tell us more about this condition?
Amanda: Spina Bifida is described as one of the most complex conditions compatible with life; a baby’s spine and spinal cord does not develop properly in the womb, causing a gap in the spine. Spina bifida is a type of neural tube defect. The neural tube is the structure that eventually develops into the baby’s brain and spinal cord.
Most people with spina bifida can have surgery to close the opening in the spine. But the nervous system will usually already have been damaged, which can lead to problems such as weakness or total paralysis of the legs, Urological, Bowel and Renal issues.
Many babies will be born with or develop hydrocephalus which is a build-up of fluid on the brain. This requires a V.P or a shunt to drain the excess fluid from the brain into the abdomen or the heart.
There are about approximately 550 children under 18 living with Sb/Hydro in Ireland. Ireland has one of the highest rates of neural tube/SB birth rates in the developed world.
Daniele: Can I ask you for a little bit of context to give an idea of the extent of the services needed?. What are the types of care that your children need?
Amanda: Our children need proactive care and what they are receiving is often reactive care via emergency intervention. This is often too late and results in long term damage and loss of function. These children need timely access to care particularly in relation to Orthopaedics, Urology, Ophthalmology, Neuropsychology and Neurosurgery.
Daniele: How are these types of care being delivered in Ireland and is the capacity in the health service enough to address the scale of the problem in Ireland?
Amanda: Currently the care in Ireland is sporadic, chaotic, under-funded & under-resourced. Some children have access to a Multidisciplinary Spina Bifida Clinic, others do not. There is no clear pathway of care for children living with Hydrocephalus alone. An annual MDT SB clinic is international best practice. We estimate 85% of SB children are not receiving this and the percentage is higher in children born prior to 2009.
Daniele: I gather that the waiting times are causing actual daily pain and suffering. If someone breaks a bone or a dislocation, he gets treated in a fairly short time. How’s that different from the pain that your children suffer? And what happens if you go to the A&E?
Amanda: I know of a child that received her surgery last month because the mother took the drastic measure of taking her daughter to accident and emergency and refusing to leave. She dug her heels in the A&E in Temple Street, until she was admitted. And once she was admitted sat for two and a half weeks before the child had her surgery.
In that process, the CEO of the National Children’s Hospital Group, Joe Gannon, subsequently wrote to one of the politicians in government who had been trying to fight for this child’s case, and told the politician that she was currently an inpatient and that she was going to have her surgery on the 17th of January.
He made it sound that it was a planned admission and that she had been given a date and they had come in.
Actually what happened is that the mother refused to leave until her daughter’s medical needs were met and also the child did not have her surgery until a week later. The mother is very grateful to all the doctors involved as they all told her that she was doing the right thing not to leave and were very supportive. She was supported in that sense by us as well but she should have never had to take such a drastic step.
We’ve had another number of families that have had to do this since last September.
Another mother went in on a Saturday with her son, who had dislocated hips for four years, the child is six, and she refused to leave until they were admitted. And once they were admitted, they couldn’t see the surgeon because he wasn’t there. They refused to leave and sat there for 10 days until their child had the surgery.
Daniele: How did your organisation come into being?
Amanda:We’re all parents of children with spina bifida or hydrocephalus that came together to advocate for better services for children, under the age of 18, living with Spina Bifida/Hydrocephalus in Ireland.
Our group was formed in 2017 and have been trying to work in a proactive and collaborative manner with all relevant stakeholders since then.
My own son was one of the children failed, he sat on a waiting list from 2014 to 2016, and by the time he’d seen a spinal surgeon in 2016, we were told it’s too late.
So my son lives with inoperable scoliosis and he cannot be helped by this campaign or anything else but I wanted to do something to stop this from happening to other children. Una Keightley was one of the very first to come on board when we formally launched the paediatric advocacy group.
Daniele: Una Keightley, what pushed you to take a more proactive role in dealing with the issue?
Una: I suppose it did become quite apparent that no matter how many letters you wrote, like what Amanda had said, the situation didn’t improved. She wrote to everyone, she had highlighted it. And it just really concerned me. And I’m a health care professional. I’m a radiation therapist and it was just unbelievable to me that this was going on. And I suppose at that stage my child was younger when we came together. Once we talked to more and more parents we realized that people were actually lodging complains but they were going nowhere.
So we started to proactively inform the powers that be and Children Health Ireland asking them to do something about it.
Amanda: There is a cohort of children born prior to 2009 who had no access at all to this to the Spina Bifida team in Temple Street Hospital because there was no urologist on that team. So it was decided it was safer to leave the children in Crumlin Hospital and move them at a later stage. A urologist didn’t come onto the team at Temple Street until 2014, and the children were never moved. So a lot of our children were receiving inadequate services are no service at all.
We highlighted this problem in 2018 with the CHI board. In that meeting, they asked us, our advocacy group, to go back to the families and identify whether they felt that they weren’t receiving a timely access to services or any services at all. So we did, which was a big job being undertaken because we’re volunteers.
There was also a cohort of families who thought that their children were being treated but many other that did not.
Una: In the beginning of 2019, we gave Children’s Health Ireland a list of 133 families and children who felt that they weren’t receiving a proper service. There was then so many e-mails back and forth between Amanda and CHI. We asked them: When can we meet? What are we going to do about this? And the answers were like: “We’re verifying the list.” “We are analysing the list.”
We have screen shots of these emails.
That one way communication continued for probably 18 months until, after March 2020 they just ignored us.
Entering 2021 we felt we had to do something but, on top of that, I need to say that I suppose a lot of parents were fearful. If they talk out, maybe the care standard that would be provided to their child would be diminished. Now, I wouldn’t have that fear, and I don’t think any of us would.
It was then when we decided to publish online our children stories. Which is something that distressed us greatly but we felt we were left with no choice.
We had requested to meet the Minister ever since he took up office. He wouldn’t meet us. The Minister for Children wouldn’t meet us. The Minister for Disability wouldn’t meet us. Nobody would take up and highlight what was happening to these children. So the parents as a group decided that we were going to have to do something fairly drastic to get their attention. So that’s what we did.
Daniele: I have noticed an increase in media attention to the issue in 2021, also thanks to your campaigning. Are you hopeful that increased scrutiny could move things in the right direction?
Amanda: Yes, people now view our children as the vibrant individuals they are as opposed to a number on a list or a medically complex child that is unrelatable. The support received initially from media, County Councils, and local representatives across all 26 counties has been immense. This has stemmed from the proactive and
drastic measures taken by the Paediatric Advocacy Group and the families to highlight the failures in care for their beloved children.
People have been shocked by the current state of medical neglect that has
been inflicted by the Irish state on our children. They are not willing to allow a further generation of children to be failed and to turn a blind eye to the historical neglect that has been allowed to happen.
Daniele: After years of campaigning, countless letters to TDs and local councillors, you have finally met with Minister Donnelly along with Spina Bifida Hydrocephalus Irelandand other stake holders last February in relation to the abnormal waiting times that are now in place for paediatric orthopaedic treatments. Plans have been presented and funding – as much €19 million that the HSE made available to CHI –, albeit with little information on the specific break down. The Minister also set some clear goals, including to limit the waiting time to four months at first with the aim for this to be reduced to zero, and to provide a number of additional treatments. What’s the reaction from you and your organization to these pledges?
Amanda: There aren’t many details released yet, and there is still a draft in formation. What they told us is that they have ring fenced €19 million for children with spina bifida, but also to children with scoliosis.
They have also said that clinically no child should wait for more than four months for surgery. So that is very ambitious and while we’re glad about these pledges, we’re not blindly trusting. There’ve been promises made before not only to us, but to the scoliosis advocacy groups as well. So yes, the funding is great, but we need to see that the funding is going to make a real difference in these children’s lives.
One of the government target is to “treat an additional 107 Spina Bifida cases” but we don’t know how they come up with that particular number. There is no database within CHI of how many children are living with the condition. So how do you come up with a number if you don’t know how many children you’re treating, do you know? So we’re a little bit dubious about it and we don’t want to be tied to that number. What we want is to fund and to reach as many children as possible.
Daniele: Did the Minister agree to regularly update your organisation while they endeavour to deliver these pledges?
Amanda: We do have a commitment from Stephen Donnelly and Children Health Ireland, to regularly engage with us and we do now have a contact with one of the Minister’s special advisers. So if an issue comes up or we want to speak to Donnelly, all I have to do is give the special adviser a ring and he will relay any information and if need be we speak to the Minister directly. So that’s the promise we have. So we are we’re optimistic and he seemed very genuine when we spoke to him. But don’t intend to take the pressure off until this gets sorted. We intend to stay very, very focused.
Daniele: Are there any kind of league tables or other international comparisons that can be drawn on?
Una: It would be difficult because we have such a high rate compared to a lot of the world. What we do know is that in Ireland it is not the expertise that is missing but proper funding and organization. Cases are picked up in pregnancy here more than they are in other countries, probably because the stenographers are looking for them due to the high incidence.
Daniele: What kind of challenges are you dealing with as mothers and what are the support needed for families at large?
Stefania: My daughter’s name is Aurora and she’s just turned three. From her birth in February 2019 until August 2019 she was in hospital as she was born with Hydrocephalus.
I found out about that on my 26 week scan here in Ireland and to be honest with you I didn’t know what it meant so I had to do my own research. They didn’t explain to me exactly what it was. So I had to go back to Italy, and I went to the hospital in Genoa to try to get different opinions.
Once she was born, here in Ireland, she needed to go straight for surgery because there was too much pressure on the brain because of these fluids. And so we got transferred first to Temple Street, and after two weeks to Crumlin.
I just want to clarify that doctors and nurses were fantastic to me, to my husband and to Aurora. She wouldn’t be here if the surgery hadn’t been successful.
Having said that there definitely gaps in the communication between the two hospitals. They were relying on the parents to get the information, which is not ideal because I’m not a doctor and that created frustrations and fears.
When our daughter was released from hospital we were pretty much left to our own devices. She had just one appointment in Temple Street during her first year. And after that, I’ve been told that I needed to wait another year. Initially I thought that such a long time between visits was just because she’s doing well but It’s not the case. There was lots of information that I had to get elsewhere, and not from the professionals. In terms of psychological support for parents, we were very much left on our own. So you either cope and become resilient or probably you’re not going to make it mentally. I’m grateful I found this group and that these ladies became my source of knowledge.
Una: In terms of the financial support as well, like. Many of us received no financial support because our husbands or partners were too high earning So although your child has very high medical care needs – you could have a child who’s on oxygen 24 hours a day – you won’t get one penny from the government.
Orlaith: In my case, my daughter is 20. We were under a multi-disciplinary team but with only three consultants in it. And after 2008, Crumlin finished up its spina bifida clinic. We then ended up being spread over four hospitals which don’t share files. So as Silvana said earlier, it is up to the parent to bridge the gap.
When she was born she was very ill for the first four and a half months. We lived in the hospital paying for parental accommodation.
I had my dream job. I worked in the Irish Times and I was part of the first team to ever bring in supplements into a broadsheet newspaper. I went on carer’s leave and eventually ended up leaving my job.
There was no support for children with hydrocephalus. It’s not considered an intellectual disability. So, you know, you’re very much left on your own. My husband had a good job. I’ve never received Carer’s allowance after the first four or five months that we spent in hospital with her.
When my daughter was seven they took away her medical card. In this country, when the medical card is taken away, your medical hardship scheme is directly attached. So a lot of the equipment you need you have to pay for it yourself.
At nine she had three failed shunts, and two brain bleeds ending up spending nearly four months in Beaumont Hospital. I had to pay for my parking every day, for my accommodation and my food. Thousands of euros. I can’t claim back anything on that. And we still had to pay our bills and our mortgage.
There’s a lot of stress around dealing with the child that’s sick and sure, you’re not failing your special child as you’re doing the best you can. On top of that, you’re fighting for everything. You’re fighting for therapy, you’re fighting for access to care, you’re fighting for basic things like my daughter’s incontinence and the allocation of nappies. It compounds into a heavy psychological weight. It’s not the disability alone, it’s the lack of support; the lack of access to timely care and that constant heavy worry all the time. They need help. I can’t get them help. I can’t force my appointments. I can’t force the consultant to do this or that. My daughter has now aged out of paediatrics and there’s no transition pathway. So now my job is going to my GP all the time. She had her first orthopaedic appointment in five years two weeks ago, and that took 16 adult consultants to refuse her before we got that orthopaedic consultant. So there’s lots of stress on you all the time.
Here in Ireland, we have great nurses, we have great doctors, and I wouldn’t made it without them, but they’re not resourced and there doesn’t seem to be a willingness to accept we have such a high rate of these cases and that it needs to be invested in.
Amanda: In the space of 18 months, my son went from needing care to becoming completely inoperable. For the first couple of years. He had a lot of appointments. Then it that stopped.
My relationship with my partner deteriorated and broke down, very early on due to the stress and the strain of trying to care for a very medically vulnerable child. I suddenly became a single working mother with two children, one with massive medical need and not financially supported by the state. I worked full time, paid a huge amount of rent. I’ve subsequently remarried and have gone on to have other children. Thankfully, my husband came into this with an open eyes.
We wouldn’t change our children, what we would do and what we want to do is to change the services for them. They can become independent within their capabilities, and live their lives to the fullest without the need to be in pain or to have their parents struggling and fighting for services.
Daniele: Over the last two years of pandemic, and with the HSE coming under cyberattack, your stress levels must have been almost unbearable. Having said that it is quite evident that these dysfunctions were there prior to these. How have you coped?
Amanda: I’ve spoken to numerous families about this and we acknowledge that the pandemic and the cyber-attack happened, It was very scary and nobody had to protect our children more than we did.
But what happened in the pandemic? The small amount of services and extra curriculum activities that our children were receiving stopped.
Physiotherapists, occupational therapists were all redirected to COVID services and we understand the need for that. But there was also a huge recruitment drive by the HSE up thousands of health care professionals, like myself were ready to help but weren’t called up.
We know now that during the pandemic, orthopaedics accident where less frequent so why weren’t our children’s needs met within this timeframe when obviously there was the space to meet them given the cessation of extracurricular activities?
As parents, we would call the pandemic and the cyberattack, the new great excuse for not giving us an appointment.
Our children didn’t just freeze their conditions for two years or three years. You know, they continue to deteriorate.
Stefania: My daughter Aurora, she has malformation of her ribs and she has never seen an orthopaedic surgeon in the last 3 years.
It’s not that the doctors aren’t aware. Her Cardiologist took her case to his heart and did his best to advocate within Crumlin Children Hospital and he really fought for me but it’s not his job to organize a better multidisciplinary care structure.
Daniele: That would be the job of the administration I presume. To conclude, how do you think Irish society perceives disability and how can awareness be promoted?
Amanda: Irish people generally would be viewed as very laid back and positive.
Therefore, there is an element that “disability cannot happen to me!”. It is only with an ageing population, inaccessible public transport, inaccessible housing, and educational facilities that the message is relayed to the ordinary person about how vast the inequality is between the non-disabled & disabled communities in Ireland.
Over the last few decades Ireland has become a more diverse nation. Our children are exposed to more languages, ethnicity and religions than has ever been present on this island.
These are the children of a new and inclusive Éire and as such, they do not have the same prejudices and intolerances as those who have gone before them. Our children living with disabilities are accepted by their peers and integrated more within society.
It is deeply distressing for us that the relevant stakeholders within government and the Irish health care system, have not adopted the same attitude and continue to treat our children like second class citizens.
In two hundred years doctors will rule the world. Science reigns already. It reigns in the shade maybe – but it reigns. And all science must culminate in the science of healing – not the weak, but the strong. Mankind wants to live… to live. Joseph Conrad, The Secret Agent (1907), p.263
This article charts the origins and development of what often appears to be a strawman conspiracy theorist over the course of the COVID-19 pandemic, especially through “fact checker” initiatives operating at the behest philanthrocapitalism. This appears to have insulated regulatory agencies long prone to capture from adequate journalistic scrutiny, leading to a groupthink amidst an effective censorship of alternative, and scientifically valid, assessments of the danger posed by COVID-19, and the optimal humanitarian response.
Losing Our Grip?
In May, 2020, veteran Guardian journalist John Naughton explored the origins of Plandemic a “documentary” video ‘featuring Dr Judy Mikovits, a former research scientist and inveterate conspiracy theorist who blames the coronavirus outbreak on big pharma, Bill Gates and the World Health Organization.’ Naughton relates how the video migrated from mainstream social media into the dark recesses of the Internet.
As he put it: ‘The cognitive pathogen had escaped into the wild and was spreading virally.’ Ultimately, the New York Times ‘traced it back to a Facebook page dedicated to QAnon, a rightwing conspiracy theory, which has 25,000 members.’ All this Naughton said: ‘confirms something we’ve known since at least 2016, namely that conspiracy theory sites are the most powerful engines of disinformation around. And when they have a medical conspiracy theory to work with, then they are really in business.’
In May, 2020 The Atlantic’s Jeff Goldburgannounced that conspiracy theorists were winning, and that America was ‘losing its grip on Enlightenment values and reality itself.’ Thus a 2014 study estimated that half the American public ‘consistently endorses at least one conspiracy theory,’ a proportion that had risen to 61% by 2019, suggesting the Internet was accelerating the trend. Another survey indicated that 60% of Britons were wedded to a ‘false’ narrative.
Adjudicating on the falseness, or otherwise, of a narrative is not always, however, a straightforward exercise. Indeed, it will be argued that justifiable concerns around recent impugning of expertise have been weaponised to create another layer of disinformation over the course of the COVID-19 pandemic.
The “wild-eyed” conspiracy theorist – often referred to as “members of the tin foil hat brigade” – has become a widely derided figure. This appears to be a belated response to so-called “post-truth” accounts, associated with supporters of Donald Trump in the U.S. and proponents of Brexit in the U.K., dismissive of expertise. This challenged a board consensus around such issues as the importance of mitigating climate change. But in confronting genuine disinformation it appears that many on the left, in particular, failed to interrogate vested interests during the pandemic.
“Totalizing Discourse”
Charles Eisenstein defines conspiracy myths as ‘a totalizing discourse that casts every event into its terms.’ He traces these overarching explanations – relying on observed phenomena only insofar as these fit with a preordained pattern – to the first century Gnostics, who believed that ‘an evil demiurge created the material world out of a pre-existingdivine essence.’
The “totalizing” nature of such an approach has previously been dismissed by Karl Popper since ‘nothing ever comes off exactly as intended.’[i]Oliver and Wood(2014) identify three facets to an approach that has traditionally pointed to Freemasonry –an “illuminati” – Jews and Jesuits, and, in more recent times, intelligence agencies such as the CIA, KGB, MI5 or Mossad:
First, they locate the source of unusual social and political phenomena in unseen, intentional, and malevolent forces. Second, they typically interpret political events in terms of a Manichean struggle between good and evil … Finally, most conspiracy theories suggest that mainstream accounts of political events are a ruse or an attempt to distract the public from a hidden source of power (Fenster 2008)
In her seminal 1951 text The Origins of Totalitarianism, Hannah Arendt identifies such a tendency as a precursor to mob rule, describing how a conspiracy theorist ‘is inclined to seek the real forces of political life in those movements and influences which are hidden from view and work behind the scenes.’[ii]
Yet certain conspiracy theories in our time, such as suggestions the U.S. invaded Iraq in 2003 in order to plunder oil resources rather than decommission weapons of mass destruction, or that the fossil fuel industry deliberately sowed confusion over climate change, remain plausible, even if we lack clear documentary proof.
A problem lies in how individuals with minimal academic attainment treat conspiracies as objective truths rather than conjectures based on circumstantial evidence. The likelihood of a conspiracy is often portrayed as “beyond reasonable doubt”, as opposed to “on the balance of probabilities.” A formally educated observer may be repelled by an insistent approach that does not allow for reasonable doubt.
The intuition relied on by confirmed conspiracy theorists thus generally fails to acknowledge uncertainty, and lacks scientific or historical rigour. Yet these accounts may still occasionally yield insights when empirical methods fall short. After all, suspicions raised by conspiracy theories are often vindicated. Rather than dismissing out of hand such ‘magical thinking’, it is useful to consider these as unproven hypotheses, and not necessarily untrue, simply because an individual is overstating a case.
For example, over the course of the COVID-19 pandemic increasingly persuasive evidence has emerged of a laboratory leak – perhaps from so-called ‘gain of function’ research – giving rise to the pandemic. But in February, 2020 The Lancet published a letter from a number of prominent scientists who ‘strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin.’ This had a chilling effect on the scientific debate during the early stages of the pandemic.
Notably also, the ‘father of economics’ Adam Smith opined that ‘People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.’[iii] Smith’s portrayal of commercial calumnies is reflected in a question posed at a medical conference in 2018 by a Goldman Sachs executive: ‘Is curing patients a sustainable business model?’
Previously, a succession of pharmaceutical scandals led Ben Goldacre MBE to take a sympathetic view of so-called “anti-vaxxers”, who are now consistently conflated with “conspiracy theorists”: ‘I think it’s fair to say that anti-vaccine conspiracy theories are a kind of poetic response to regulatory failure in medicine and in the pharmaceutical industry. People know that there is something a little bit wrong here.’
Similarly, Tom Jefferson – editor of the Cochrane Collaboration’s acute respiratory infections – in an interview with Der Spiegel in 2009 in the wake of the Swine Flu pandemic-that-never-was pointed to shadowy pharmaceutical forces: ‘Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur.’
UNESCO’s World Trends Report 2018.
Journalism Under Threat
An assumption of malevolent or self-serving – cui bono? – motivations (particularly concerning a Big Pharma industry with a shameful record of distortion and manipulation) is almost a prerequisite for being an investigative reporter. Stories don’t drop out of the air. Unless a journalist assumes wrongdoing – in essence a conspiracy theory – there would be no reason to begin digging.
The key distinction between genuine journalism and conspiracy theorising is that proponents of the latter tend to blurt out their “findings” without marshalling supporting evidence, with the Internet providing anonymity as required. This, however, makes such accounts easy to ridicule to the detriment of journalism with an evidential basis.
Journalists have long been deflected from investigating large corporations. In a recent memoir the great American journalist Seymour Hersh fumes at how in the late 1970s The New York Times shut down his attempt to investigate corporate America ’when confronted by a gaggle of corporate conmen.’[iv]
This challenge has increased significantly in the wake of the Internet. After the “Original Sin” of free online publication, the number of American journalists fell from 60,000 in 1992 to 40,000 in 2009, a pattern seen across the world. As revenues diminished, workloads increased. Cardiff University researchers recently conducted an analysis of 2,000 U.K. news stories, discovering the average Fleet Street journalist was filing three times as much as in 1985. To put it another way, journalists now have only one-third of the time to do the same job.[v]”
“Fact Checkers”
Over the course of the pandemic a strawman conspiracy theorist appears to have been consciously developed to deter valid journalistic interrogation, in particular, through so-called “fact checking” initiatives. It has reached a point where, as Charles Eisenstein observes: ‘“Conspiracy theory” has become ‘a term of political invective, used to disparage any view that diverges from mainstream beliefs. Basically, any critique of dominant institutions can be smeared as conspiracy theory’
In the absence of adequate journalistic scrutiny during the pandemic corruption has been rife. The executive director of The British Medical Journal Kamran Abbasi described ‘state corruption on a grand scale’ that is ‘harmful to public health’ Abbasi observes how the pandemic ‘has revealed how the medical-political complex can be manipulated in an emergency—a time when it is even more important to safeguard science.’
This also occurred in the context of unregulated social media, where companies set their own rules. In March, 2020, having previously styled itself ‘the free speech-wing of the free-speech party’, Twitter moved to address concerns around conspiracy theories. In future it would be: ‘Broadening our definition of harm to address content that goes directly against guidance from authoritative sources of global and local public health information.’
Nonetheless, free reign was given to “click-bait” alarmists such as Eric Feigle-Ding on Twitter, who saw his following mushroom from just two thousand to almost a quarter of a million. Angela Rasmussen, a Columbia University virologist, identified a pattern: ‘He tweets something sensational and out of context, buries any caveats further down-thread, and watches the clicks and [retweets] roll in.’
Twitter did not act alone in upholding an apparent orthodoxy that often lapsed into an extremism that deterred legitimate questioning. Google took unprecedented steps to erase material violating ‘Community Guidelines’: ‘including content that explicitly disputes the efficacy of global or local health authority recommended guidance on social distancing that may lead others to act against that guidance.’
Initially at least, Facebook adopted a more laissez faire approach, although users who had read, watched or shared ‘false’ coronavirus content received a pop-up alert urging them to go the World Health Organisation’s website. In November, 2021, however, the editors of the British Medical Journal sent an open letter to Facebook in response to “fact checkers” undermining their investigative report into ‘a host of poor clinical trial research practices’ at Pfizer’s original vaccine trial.
Thus, the approach of the social media giants was bolstered by an unprecedented journalistic effort to “factually” repudiate conspiracy theories during the pandemic; notwithstanding how ‘uncontested facts—things that are ascertainable, reproducible, transferable and predictable—tend to be elusive.’
Preparations for the “fact-checking” initiative began in January, 2020 when a global #CoronaVirusFacts Alliance, comprising more than one hundred “factcheckers” around the world, described as ‘the largest collaborative factchecking project ever,’ was launched by the Poynter Institute, ‘when the spread of the virus was restricted to China but already causing rampant misinformation globally.’ It said that the WHO had classified the issue as ‘an infodemic — and the Alliance is on the front lines in the fight against it.’
From March 2020, with the support of these “fact checkers”, outlets such as Reuters responded to an anticipated wave of conspiracy theories, taking particular care to address allegations against Bill Gates. He has been described as ‘the world’s most powerful doctor’ despite not having earned a medical degree due to the Gates Foundations being the second largest funder of the WHO, after China. This included allegations that he had apparently planned the pandemic, and wanted to commit genocide through vaccines.
For example, on May 30, 2020 a BBC article purported to defuse claims the pandemic was ‘a cover for a plan to implant trackable microchips and that the Microsoft co-founder Bill Gates is behind it’; although it acknowledged Gates had said that ‘eventually “we will have some digital certificates” which would be used to show who’d recovered, been tested and ultimately who received a vaccine,’ and also referenced ‘a study, funded by the Gates Foundation, into a technology that could store someone’s vaccine records in a special ink administered at the same time as an injection.’
Front building of the Bill and Melinda Gates Foundation in Seattle.
Gates Foundation
When it came to outlandish conspiracy theories around COVID-19 all roads led to Bill Gates and his $47 billion philanthropic Bill and Melinda Gates Foundation – besides a personal fortune of $115 billion, and growing, as of October 2020.
For many of world’s population under stay-at-home orders the pandemic was viewed through a digital prism – often at a remove from morbidity or mortality itself. At that stage, Gates’s 2014 Ted Talk ‘The Next Outbreak. We’re not ready’ seemed almost prophetic.
He opined: ‘If anything kills over ten million people in the next few decades it is most likely to be a highly infectious virus rather than a war.’ The failure of Western governments to prepare for such an eventuality seemed to have been laid bare – in particular the Presidential administration of Donald Trump, who according to a Cornell University study ‘was likely th\\e largest driver of the COVID-19 misinformation “infodemic.”’
Gates’s main reference point appears to have been the Spanish Influenza (H1N1) outbreak of 1918 – the Ur-pandemic of modern times – that led to up to fifty million deaths, many of them young men in their prime, at a point when the global population was approximately two billion. In contrast, the infectivity and severity of SARS-CoV-2 ‘are well within the range described by respiratory viral pandemics of the last few centuries (where the 1918–20 influenza is the clear outlier).’
Neil Ferguson
“Scientific Groupthink”
In March, 2020, Imperial College’s Neil Ferguson told the New York Times the ‘best case outcome’ for the U.S. was a death toll of 1.1 million, rising to 2.2 million in a worst case scenario, a projection that has proved wildly inaccurate. Yet, alternative, and scientifically valid, assessments of the danger posed by COVID-19, and the optimal humanitarian response to the challenge were virtually ignored in legacy media at the time. Thus, an Oxford University paper, which included Sunetra Gupta as an author, countered what the New York Times described as the ‘gold standard’ Imperial modelling underestimated immunity from prior coronavirus infections and posited a far lower infection fatality rate.
But in March, 2020, the Financial Timeswarned that Gupta’s group’s modelling was ‘controversial and its assumptions have been contested by other scientists.’ Implicitly, the Financial Times was accepting the “gold standard” Imperial paper.
Moreover, in November, 2020 an article in the Scientific American describes how Stefan Baral, an epidemiologist and associate professor at Johns Hopkins Center for Global Health, wrote a letter about the potential harms of lockdowns which was rejected from more than ten scientific journals (and six newspapers) in April, 2020. Baral recalls, ‘it was the first time in my career that I could not get a piece placed anywhere.’
The article also recalled that, ‘highly anticipated results of the only randomized controlled trial of mask wearing and COVID-19 infection went unpublished for months.’ The authors concluded that the ‘net effect of academic bullying and ad hominem attacks has been the creation and maintenance of “groupthink”—a problem that carries its own deadly consequences.’
In the absence of access to authoritative, diverging scientific accounts, opposition to lockdowns could easily be dismissed as being the preserve of conspiracy theorist cranks associated with “anti-vaxxers” and even a “far-right” fringe.
“Screen New Deal”
Apart from offering pharmaceutical companies the huge financial incentive – grasped within open arms – of developing a vaccine for universal application, lockdowns and social distancing measures also brought soaring profits for major technology corporations. Moreover, restrictions provided a testing ground for the Gates Foundation’s long advocacy of technological approaches in education.
In May, 2020 Naomi Klein identified collusion between state and Big Tech interests in what she described as ‘A Screen New Deal.’ She referred to New York Governor Mario Cuomo’s courting of Google and the Gates Foundation: ‘Calling Gates a “visionary,” Cuomo said the pandemic has created “a moment in history when we can actually incorporate and advance [Gates’s] ideas … all these buildings, all these physical classrooms — why with all the technology you have?” he asked, apparently rhetorically.’
Remote learning technology permitted extended school closures around the world, despite the chance of death from COVID-19 being ‘incredibly rare’ among children. Researchnow suggests many students made little or no progress while learning from home, and that learning loss was most pronounced among disadvantaged students. As a consequence, up to 20,000 children in the U.K. went missing from school rolls during the pandemic. Nor is it apparent that teachers faced any greater risk compared to the wider population in fulfilling classroom teaching.
Media Funding
Popular consent on a global scale for lockdowns, particularly from those identifying on the left, seems to have been manufactured through vast ‘philanthropic’ funding of journalism, in particular of publications associated with progressive outlooks.
By June 2020, the Gates Foundation contributed $250 million to journalism, which according to Tim Schwab in The Columbia Journalism Review, ‘appears to have helped foster an increasingly friendly media environment for the world’s most visible charity.’
A theme of ‘we are in this together’ inhibited criticism and enquiry. This quiescence has been criticized by the Greek socialist Panagiotis Sotiris who wrote: ‘What is missing here is something that used to be one of the main traits of the radical left, namely, an insistence that science and technology are not neutral.’
Tim Schwab calculates that $250 million had been devoted to journalism by the Gates Foundation for the six months up to June, 2020,. Recipients included BBC, NBC, Al-Jazeera, ProPublica, National Journal, The Guardian, Univision, Medium, The Financial Times, The Atlantic, The Texas Tribune, Gannett, Washington Monthly, Le Monde, and the Center for Investigative Reporting, as well as the BBC’s Media Action and The New York Times’ Neediest Cases Fund.
Schwab adds: ‘In some cases, recipients say they distributed part of the funding as subgrants to other journalistic organizations—which makes it difficult to see the full picture of Gates’s funding into the fourth estate.’
As a result, he says:
During the pandemic, news outlets have widely looked to Bill Gates as a public health expert on covid—even though Gates has no medical training and is not a public official. PolitiFact and USA Today (run by the Poynter Institute and Gannett, respectively—both of which have received funds from the Gates Foundation) have even used their fact-checking platforms to defend Gates from “false conspiracy theories” and “misinformation,” like the idea that the foundation has financial investments in companies developing covid vaccines and therapies. In fact, the foundation’s website and most recent tax forms clearly show investments in such companies, including Gilead and CureVac.
The Gates Foundation’s pivotal role in funding global health has long raised concerns. In 2008, Dr. Arata Kochi, the former head of WHO’s malaria programme argued the Gates Foundation was undermining scientific creativity in a way that ‘could have implicitly dangerous consequences on the policymaking process in world health.’ He worried that Gates-funded institutions – including Imperial College London (MRC Centre for Global Infectious Disease Analysis) – were adopting ‘a uniform framework approved by the Foundation,’ leading to homogeneity of thinking: ‘Gates has created a ‘cartel,’ with research leaders linked so closely that each has a vested interest to safeguard the work of others. The result is that obtaining an independent review of scientific evidence (…) is becoming increasingly difficult.’
GAVI, the Vaccine Alliance, is the most obvious example of the Gates Foundation’s engagement. GAVI has successfully immunized large numbers of children, but been criticized by other NGOs for inadequate funding of health system strengthening.
One of GAVI’s senior representatives reported that Bill Gates often told him in private conversations ‘that he is vehemently ‘against’ health systems (…) he basically said it is a complete waste of money, that there is no evidence that it works, so I will not see a dollar or cent of my money go to the strengthening of health systems.’
As of 2017 only 10.6 percent (US$862.5 million) of GAVI’s total commitments between 2000 and 2013 had been dedicated to health system strengthening, whereas more than 78.6 percent (US$6,405.4 million) have been used for vaccine support. Doctors Without Borders (MSF) states that, while GAVI has helped to lower prices of new and underused vaccines for eligible countries, the cost to fully immunize a child was 68-times more expensive in 2014 than it was in 2001.
According to long-time Gates critic James Love, Gates ‘uses his philanthropy to advance a pro-patent agenda on pharmaceutical drugs, even in countries that are really poor.’
Safe Treatment?
This article makes no bold claims regarding the efficacy of any treatments, but the overwhelmingly negative reaction of legacy media to research pointing to the efficacy of the off-patent drug Ivermectin suggests that vested pharmaceutical interests wished to undermine public confidence in any scientific arguments regarding its efficacy.
In June, 2020, a laboratory study demonstrated it was ‘an inhibitor of the causative virus’ (Caly, 2020). Later, a Systematic Review, Meta-analysis that included twenty-four randomized controlled trials said: ‘Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin.’
In a predictable example of “fact-checking” where an outlandish claim is used to discredit a compelling hypothesis, the Poynter Institute quoted a social media post ‘rating’ the claim that Ivermectin basically ‘basically obliterates’ as ‘false.’
The Guardian’s dedication to discrediting the meta-analysis also suggested vested interests were at work, and contrasts with a failure to report on the British Medical Journal’s account of a whistle blower alleging serious data integrity issues during Pfizer’s vaccine trial.
It should hardly be controversial – let alone dismissed as a conspiracy theory – to argue that the weight of evidence points to a ‘Gates-Approach’ lying behind ongoing adoption by most Western governments of unprecedented suppression measures in support of universal vaccination – notwithstanding potential treatment alternatives – leading to the introduction of vaccine passports, as Gates “predicted” in April, 2020. This also occurred alongside a familiar ‘rhetoric supportive of ‘holistic’ health systems.’
It is now clear that consent for lockdowns, especially in the Anglophone world, was manufactured through wildly inaccurate epidemiological assessments of an infection fatality rate of 0.9% in the notorious Imperial College paper. This estimate has since been adjusted to 0.2% (available on the WHO website), a figure which Joffe argues is likely ‘a large over-estimate.’
It is also clear that globally mortality statistics for COVID-19 have been systematically exaggerated. This manipulation can be traced to a WHO document from April, 2020 entitled ‘International Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death’. It set out strict rules for the registration of COVID-19 deaths, which differ fundamentally from registration for other causes. The guidelines define a COVID-19 mortality as ‘a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma).’
For most people COVID-19 is a virus that poses little danger. Prior to the arrival of a vaccine, a U.K. study from October, 2020 found 76.5% of a random sample who tested positive reported no symptoms, and 86.1% reported none specific to COVID-19. Moreover, an article from Peter Doshiin the British Medical Journal in September, 2020, stated: ‘At least six studies have reported T cell reactivity against SARS-CoV-2 in 20% to 50% of people with no known exposure to the virus’; apparently vindicating Sunetra Gupta’s “controversial” paper, over which the Financial Times cast doubt.
A “totalizing” discourse of a COVID-19 conspiracy theory identifies a preordained plan being set in motion by malicious actors, wherein the pandemic culminates in a dangerous vaccine being foisted on a brainwashed population. This might lead to an assumption that such vaccines invariably give rise to severe adverse reactions that are systematically covered up. Such an account does not demand evidence as events are simply unfolding “as planned.”
In reality, however, events rarely follow a preordained pattern, and even in circumstances of regulatory capture state agencies are never entirely bereft of integrity. Moreover, such accounts divert attention from probing interrogation of the efficacy of vaccines and the desirability of universal uptake of a medication that does not block transmission, especially one rushed to the market, and which may cause unforeseen adverse reactions.
It is also apparent that public perception of the efficacy of vaccines has been distorted by the media’s reporting of relative risk reduction, as opposed to absolute risk reduction, which is just 0·84% for the Pfizer–BioNTech vaccines.
Moreover, importantly, in January, 2021, Peter Doshi and Donald Light in the Scientific American objected to the undermining of ‘the scientific integrity of the double-blinded clinical trial the company—and other companies—have been conducting, before statistically valid information can be gathered on how effectively the vaccines prevent hospitalizations, intensive care admissions or deaths.’
This came after Pfizer pleaded an “ethical responsibility” to unblind its trial and offer the vaccine to those who received a placebo. The authors argue that ‘there was another way to make an unapproved vaccine available to those who need it without undermining a trial. It’s called “expanded access.” Expanded access enables any clinician to apply on behalf of their patient to the FDA for a drug or vaccine not yet approved. The FDA almost always approves it quickly.’
In terms of any actual conspiracy or contrivance to raise prices along the lines of tendencies that Adam Smith pointed to among gentlemen of commerce, the role played by Bill Gates has been, doubtless, more complex than many conspiracy theorists allow for. However, in circumstances where a billionaire with a history of monopolistic aspirations promotes an agenda aligning with his financial interests it should come as no surprise that colourful theories abound; especially with many journalists seemingly inhibited from enquiring into his Foundation’s activities.
Indeed, ironically, the aforementioned Guardian journalist John Naughton recently described Gates while Microsoft CEO as having acted like ‘a mogul who is incredulous that the government would dare to obstruct his route to world domination.’ Does such a leopard ever change his spots?
Sadly, the amplification of the outlandish claims of conspiracy theorists by so-called “fact checkers” could be causing reputational damage to genuine expertise, and allow demagogues reliant on angry mobs to say: “I told you so.” The propagandist role of “fact checkers” has undermined genuine investigative reporting, much of which already occurs on the margins.
In the early stages of the pandemic especially, difficulties in reporting were compounded by deficits in scientific understanding among overworked journalists in precarious employment, who were encouraged to justify unprecedented lockdowns as a form of social solidarity. The assumption that by “following the science” a journalist is adequately performing his or her role is a dangerous fallacy, which does not take account of how diverging scientific arguments may be concealed.
In the absence of sufficient independent journalism, and amidst censorship of alternative scientific opinion, troubling questions remain unanswered as the pandemic draws to a close. Perhaps we will never know the full story. Nonetheless, it is vital that adequate cost-benefit analyses (including with access to full trial data) are conducted on all pharmaceutical and non-pharmaceutical interventions in future.
Feature Image (c) Daniele Idini: The Burning of “the Witch of Winter” in Cardano al Campo, Lombardy, Italy.
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[i][i] Karl Popper (1972). Conjectures and Refutations, 4th ed. London: Routledge Kegan Paul. pp. 123–125.
[ii] Hannah Arendt (1951) The Origins of Totalitarianism, 1951, p.140
[iii] Adam Smith, The Wealth of Nations, book 1, chapter 10, par. 2).
Environmentalist Erik Stokstad once remarked that ‘H2O – is there any other molecule so vital, and so problematic, for people?
The UN estimates that around 1.2 billion people, or 20 per cent of the world’s population, live in areas where the limits of sustainable water use have already either been reached, or breached. It is high time the issue sits as a priority on the global agenda. There may still be enough for us all, if only we can keep it clean and share it.
In 2017, 5.3 billion people used a safely managed drinking-water service (i.e., one located on-premises and free from contamination)
6.8 billion people used at least a basic service. Basic service is an improved drinking-water source, within a round trip of 30 minutes, to collect water.
785 million people lack even a basic drinking-water service, including 144 million people who are dependent on surface water.
About 2 billion people use a drinking water source contaminated with faeces.
Contaminated water can transmit diseases such as diarrhea, cholera, dysentery, typhoid, and polio. Contaminated drinking water is estimated to cause 485 000 diarrheal deaths each year.
By 2025, half of the world’s population will be living in water-stressed areas.
In the least developed countries, 22% of health care facilities have no water service, 21% no sanitation service, and 22% no waste management service.
Water use has been increasing globally by about 1% every year since the 1980s. This is due to population growth, socio-economic development and changing consumption patterns. Global water demand is set to rise at a similar pace until 2050, accounting for an increase of 20-30% above the current level of use with increased demand from both industrial and domestic sectors.
About two billion people live in countries experiencing high water stress, and four billion people experience severe water scarcity for at least a month every year.
Water stress is defined as the ratio between water withdrawals (i.e., domestic, agricultural, and industrial water uses) and available renewable water supplies.
Water scarcity means scarce availability (i.e., physical shortage) due to the failure of institutions to ensure a regular supply or due to a lack of adequate infrastructure. Safe drinking water and sanitation are basic human rights, indispensable to sustaining healthy livelihoods and fundamental to maintaining the dignity of all human beings.
International Human Rights law obliges states to work towards achieving universal access to water and sanitation for all, without discrimination, while prioritizing those most in need. Fulfilment requires that services be safely available, physically accessible, equitably affordable. Water availability depends upon the amount of water physically available, and also how it is stored, managed and allocated to various users.
It, therefore, relates to surface water and groundwater management, alongside water recycling and reuse. Water management for smallholder family farmers needs to consider both rainfed and irrigated agriculture. Approximately 80% of global cropland is rainfed, and 60% of the world’s food is produced on rainfed land.
The 2019 UN-Water initiative called ‘Leaving No One Behind’ suggested how improvements in water resources management and access to water supply and sanitation services are essential to addressing various social and economic inequities. Water scarcity is entwined with environmental protection, poverty alleviation and promoting development; globally more than 2.5 billion people live in the most abysmal standards of hygiene and sanitation.
Wastage of water and absence of regular clean water supply is evident not only in burgeoning metropolises but also in huge rural regions. The mighty Colorado river, North America, seldom meets the sea. One-third of the US and one-fifth of Spain still suffer from water stress. Central Africa’s Lake Chad, supporting thirty million-plus people has already shrunk to one-tenth of its former size, the negative contributory factors include inter alia climate change, drought, poor management and overuse.
South Asian woman carrying water on her head, 2016.
India
In India accessibility to drinking water has increased considerably over the last decade in particular. However, around 10 per cent of the rural and urban populations still don’t have access to regular safe drinking water.
The available annual utilizable water in the country (surface as well as ground) stands at 1100b cubic meters.
World Bank data shows that the total cost of environmental damage in India amounts to 4.5 per cent of GDP and of this 59 per cent results from the health impact of water pollution!
Another cause of anxiety is that unsatisfactory availability of safe drinking water. Though water contains organic and inorganic impurities, the main source of diseases are the organic impurities that enter into the water through the soil from cesspools, through manure, or through sewers emptying their contents into the rivers – from which many cities, in particular, get their drinking water supply.
Additionally, inadequate home piping systems including unclean water tanks, improper drainage, and waste disposal systems, also contribute to impure or contaminated water. Again, the presence of excessive inorganic matters (iron, lead salts, etc.) leads to diseases like constipation, dyspepsia, colic, paralysis, and kidney disease, sometimes resulting in death. Dangerous bacteria produce deadly diseases of jaundice, cholera, typhoid, diphtheria, kidney problems, nervous system problems and even lead to an increased risk of cancer.
Contrary to popular perception, the hardness of water is not a risk to health so long it does not contain disease-causing pathogens and bacteria. Especially, during summer and rainy seasons, the position goes from bad to worse, as water-borne diseases become rampant. The extreme heat and humid environments are favourable to bacteria. The immediate need is thus to invest in timely, reliable, proven and advanced water purification systems[xiv] that guarantees the public safe and pure drinking water at all times.
Efforts to enhance drinking water supply must move at a greater speed so as to cover all of the villages in the developing bloc with adequate potable water connection and supply.
Technology plays a vital role in terms of meeting people’s basic needs in a sustained manner. Naturally, protecting freshwater reserves, watershed development, chemical treatments following the safety norms, tackling the arsenic and fluoride contamination, among others, could offer rich dividends.
Strategies for Managing Water
The former Secretary-General of the United Nations Ban Ki-moon once said:
we need to begin thinking about better strategies for managing water – for using it efficiently and sharing it fairly. This means partnerships involving not just governments but civil society groups, individuals and businesses.
This is a realistic approach, which is not achieved by hiding in conference rooms and observing world water day.
Responsibility lies with both government and the private sector, and involves: checking the unrestricted exploitation of groundwater; encouraging planned urbanization; optimisation of use; restricting the flow of effluents from industrial units to the rivers, with stricter governance.
We must nurture new scientific knowledge in order to understand the evolution of water systems that involve the relationship between man and nature. But also integrate local knowledge into scientific research to address user needs, and put in place more effective mechanisms to translate scientific knowledge into societal action.
The challenges of addressing the water-food-climate-change-nexus could be mitigated if collaborative approaches are taken up, which depend on political will, market mechanisms and innovative technology.
For example, market forces could work well under a cap-and-trade approach similar to those applied to carbon dioxide. Creating mechanisms for market forces to play a role in the management of scarce water could be a major leap forward.
Developing an inclusive institutional structure to establish multi-stakeholder dialogue and cooperation is essential to ensuring equitable access to sustainable water supply and sanitation services.
When governments’ roles are geared towards policy setting and regulation, the actual provision of services is carried out by non-state actors or independent departments. Well-functioning accountability mechanisms help institutions with sufficient capacity fulfil their mandates to monitor and enforce the obligations of the service providers.[xvi]
Girls of squatter settlement in Dharan collect water from river.
Towards a Sustainable and Efficient Water Resource Strategy
Every year, several millions of people die from drinking contaminated water. To help address these challenges related to freshwater, scientists in many disciplines are applying new tools and techniques. One way has been to understand the impact of climate change on water quantity and quality and predict future needs and threats. Another way has been to explore making use of water—for drinking or industrial purposes—from sources that are otherwise considered unusable.
An emerging area is the ecological impact of activities related to the energy industry such as fracking or carbon sequestration. Other researchers are trying to increase the efficiency of farms and factories – the biggest consumers. Water scarcity already poses a great threat to economic growth, human rights and national security.
Deforestation of the Madagascar Highland Plateau has led to extensive siltation and unstable flows.
A Global Phenomenon requiring Local action – a ‘Glocal’ focus for the road ahead!
Water recycling and finding better ways to remove salt from seawater could be of key importance. Population growth could cause global demand for water to outpace supply by mid-century if current levels of consumption continue, according to a recent study.
Periods of increased demand for water – often coinciding with population growth or other major demographic and social changes – were followed by periods of rapid innovation of new water technologies that helped end or ease any shortages.
Using a delayed-feedback mathematical model that analyses historic data to help project future trends, some studies have identified a regularly recurring pattern of global water use in recent centuries. Based on this recurring pattern, researchers from Duke University predict a similar period of innovation could occur in the coming decades.
There is thus an immediate need to invest in a reliable, proven and advanced water purification system that guarantees the public – in both rural and urban areas – safe and pure drinking water at all times.
State of the art technology must be extensively made use of in a time-bound manner to protect the triple bottom (planet, people, profit)[i] from threats emanating from various forms of pollution.
PROACTIVE over REACTIVE use of water technologies
It is worth noting that companies are proactively taking initiatives and are stepping up steadily. One company called Ecolab intends to further leverage lot and machine learning to enhance its proactive services to ensure water is conserved and available to both businesses and the communities they operate in.
They have provided their service to about 40,000 customers in more than 170 countries around the world to maximize available resources. There is a positive impact on process efficiency too.
Hopefully, the next-generation 3D TRASAR technology reduces reuses and recycles water. The technology can not only monitor the water usage at a customer’s site and alert us should it get out of control, but it can also take remedial actions based on the stress levels on the systems, and induce chemicals or reduce water usage to maximize the life of the asset and minimize usage.
People collect clean drinking water from a tapstand in the town of Ghari Kharo, in western Sindh Province in Pakistan.
Population Growth
Population growth puts strain on the per capita availability of water. In the developing world, efforts to enhance drinking water supply must move at a greater speed so as to cover all of the villages with adequate potable water connection/supply.
New technology should play a bigger role in such a context to meet people’s basic needs in a sustainable manner. Naturally, protecting freshwater reserves, watershed development, chemical treatments following the safety norms, tackling the arsenic and fluoride contamination, among others, could also offer rich dividends for private companies.
Water limits are close to being breached in several countries, while food output has to increase by up to 100 per cent by 2050 to sustain a growing world population, according to the United Nations.
We must holistically manage water and energy usage. Further efforts must be intensified to maximize the use of technology in order to proactively conserve water and improve performance in water-intensive industries.
A progressive, realistic plan should therefore focus on:
(A) improving data collection on the location and types of water resources.
(B) promoting water-saving farming technologies.
(C) developing sewage treatment facilities alongside water projects.
(D) establishing a national monitoring body and a new legal framework for the sector.
As we can’t expand in a quantitative sense, we have to expand by using our water more carefully.
Feature Image: Abandoned ship near Aral, Kazakhstan.
In the controversy surrounding the leaking of a confidential document by then Taoiseach Leo Varadkar last year, a key point has been missed regarding whistleblower Chay Bowes’s motivations. As an insider and former head of the VHI Homecare division Bowes gained significant insights into the operation of the Irish health system, especially the HSE. This interview probes into the obstacles he faced in attempting to deliver an effective model of community care away from overcrowded hospitals. He argues the HSE perpetuates dysfunction to the benefit of the private system.
Chay Bowes first interfaced with medicine through the Irish Army Medical Corps in 1988. This stoked a passion for healthcare which led him to take up a job as a phlebotomist, where he encountered an older generation of hospitals, such as St James’s, where he worked with elderly patients in the country’s public health system.
This experience coloured his view of the health system as it evolved to become, as he puts it, ‘more focused on financial outcome rather than patient outcome,’ and led him to set up his own company, focused on clinical work in people’s homes.
He had found that general hospitals tended to be ‘Victorian constructs, where we put all the sick people who are susceptible to infections, so that they can mix with other sick people.’ He concluded ‘that much of what happens in the hospitals doesn’t really need to happen there, and a huge volume of those patients could be treated at home in a cheaper and safer holistic fashion.’
After the dismantling of small, community hospitals Bowes observed ‘pressure building on the larger general hospitals to become the catchall for all kinds of diseases and complexities,’ and that this ‘contributed to the ongoing perpetual dysfunction which is today what we call the HSE.’
Taking out a bank loan, he purchased a van to move around the nursing homes, taking blood samples. By that stage he had observed thousands of elderly arriving into hospital in taxis and ambulances for routine blood samples. There they were catching flus and colds, so he said to himself: “why don’t I develop a system to treat those people out in the community?” This was back in 2004-2005, but he was told that’s not how things are done.
Undeterred, he decided to take an extended leave of absence from the hospital to set up a service doing these blood tests in the community, which proved very successful. The only limitation was that he was working alone.
At that point, he expanded his service to give vaccinations in the community too and took on a few employees. The first company evolved into another, leading to a contract with the HSE in 2007 worth €14 million. That business was focused on patients with chronic obstructive pulmonary disease and chest diseases. Its rationale was to keep various types of patients in the community, who were repeatedly being admitted to hospital with lung diseases.
‘So, they didn’t go into a hospital, where people tend to get sicker, particularly those with lung diseases. It also helped these patients,’ he says, ‘that their social networks were intact.’ Soon there were two hundred working for the company.
Resuscitation room bed after a trauma intervention.
Tara Healthcare
At that point he brought Dr. Gerry McElvaney on board, ‘a really patient focused guy,’ he says, ‘who was highly intelligent and super-committed to doing things differently.’
Together, they pushed forward with what became Tara Healthcare. When patients were surveyed, he says, ‘ninety-eight percent preferred to remain in the community under our scheme rather than go into hospital: all the data was saying that this was a much safer.’ It was also cheaper to deliver, and the patients’ families were delighted to remain with their loved ones.’
He argues that they had created a perfect example of how a community-based scheme could be delivered cheaper with better patient outcomes, and where staff were really happy too, as they could get out of the acute hospitals.
However, he encountered, ‘an incredible level of scepticism around innovation in Irish healthcare.’ In one case, he says, there was a hospital in Dublin, which ‘wouldn’t send patients to this new service, because they didn’t like our medical director because he came from another hospital group. Professional rivalry is rife in Irish Medicine, sometimes to the detriment of patients.’
HSE Logic
Time and again he was met with the perverse HSE logic of ‘it’s doing really well, so let’s shut it down and send all these patients back into the hospital.’
The HSE’s reaction to the Financial Crisis of 2008 was just like its dysfunctional approach to COVID-19 he argues. They closed his operation down because hospitals ‘which were in perpetual crisis wanted us to move this service into their area.’ A senior HSE figure told him directly that ‘“what you’ve done in Dublin is almost too good. Everyone’s going to want it. They’re going to want it in Galway. They’re going to want it in Limerick” So, they wouldn’t fund it because they were already funding the dysfunction.’
The agency funds the dysfunction to a certain level of service with tens of billions of euros. And when something outside of the system comes along and demonstrates efficacy, financial viability, and good patient outcomes, that’s irrelevant because they still have to fund the dysfunction. It’s like trying to repair an airliner in mid-air – you don’t want to land because it could expose the rottenness of the system.
So, we sent the patients back to hospital, further highlighting the dysfunction of the HSE at the time. They had to pay us a penalty for terminating the contract prematurely, which cost them more than running it for the subsequent two years.
Working for the HSE he found innovation was met with suspicion: ‘the hospitals want to hold onto patients because without patients occupying beds, they can’t justify their budgets.’
And because budgets are pinned to occupancy and the size of the facility, hospitals seemed slow to manage overcrowding at the cost of lesser funding.
Fair Deal?
He argues that we should ‘evolve to a place where we simply don’t treat people with certain uncomplicated infections in hospitals, like in Canada and Australia.’
Now, he says, the only fast track for vulnerable patients is into a state or private nursing home, which is excessively expensive, ‘or their home is taken from them in what the government very cynically calls a Fair Deal:
someone works all their life, pays taxes, builds a home for their family, and contributes to the state and to society. But when they get ill, go into a nursing home or require dignified care the state wants to take their home from them to pay for that care.
Moreover, despite earning huge praise from patients, peers and when he presented the scheme to the NHS in the UK, he found the HSE ‘were always finding fault with what we were doing.’
‘I became used to that,’ he says ‘and very quickly realized the only thing the Irish public system does very well is perpetual dysfunction. It manages to procure massive budgets from the State, and despite this consistently overspends,’ despite ‘terrible outcomes for patients.’
He suggests that it takes ‘a concerted effort to continually do health as badly as we do in Ireland’, a system of public health, ‘with such huge budgets for such a small population.’
He says it is important to question why, given a very small and young population, ‘half of that population pays out of pocket expenses, approaching €2 billion, for private health insurance.’ He reckons this is ‘to protect ourselves from the dysfunction of the public system.’
🚨A record 908,519 people in Ireland are now on some form of a public hospital waiting list to be treated or assessed by a consultant. Meanwhile Gov lacks meaningful action on addressing capacity deficits #CareCantWait @DonnellyStephen @mmcgrathtdhttps://t.co/8ye5e4DoWw
‘It’s a very simple problem,’ he says, ‘too many of the same actors are involved in the public and private systems.’ The analogy he uses is of two separate doorways in a clinic: the public and the private:
You knock on the public door, and say, “Look, doc, I’ve got a terrible hip. It’s really hurting me. And he goes: “Yeah, you need a relatively simple, hip replacement, but it’s going to be probably three, three and-a-half years, because the system is overloaded.”
But the doctor adds unless of course you’ve got health insurance. So you say, “OK, I’ll go and get health insurance.” But by this stage you are too old to avail of this. But what are you going to do now, as your hip is only going to get worse?
You’ve been to the first door, where you met the doctor in the public system about the hip, who we’ll refer to as Dr Jim. Then you go ten feet down the corridor and knock on the door. “Who’s there? Why it’s Dr Jim again!’” And you say “Hey, Dr Jim, you just told me that you couldn’t fix my hip for three years.” and he responds: “not exactly. I can fix it if you pay me via your insurer.”
In a country of five million people, we have almost one million people waiting for care of one sort or another in a public system, which is one of the best funded systems in the developed world.
And, Bowes says, ‘it just so happens that the man running the show, Paul Reid, has no specific health care experience, for example. The UK’s NHS employs around 1.4 million people to serve a population of nearly 67 million. Its CEO Simon Stevens is paid €210,000 a year, while Ireland’s HSE employs around 102,000 people with a population of only 4.9 million, Reid is astoundingly paid over €426,000 a year.’
We have hundreds of people who work for the agency on long term sick leave. The dysfunction runs into every fractional part, IT, training, resourcing, recruitment, and services. The dysfunction is almost at a cellular level. But again, we are consistently told that we can’t land the jumbo jet to fix it, because if we do that, what will happen?
COVID-19
When COVID-19 landed, Bowes says, ‘with the stroke of a pen, we bought up every single private bed in the State. This occurred despite people saying since the foundation of the State, “Oh, you know, you can’t publicize the private, it would never work, but it was done overnight because the will existed.’
Health policy in Ireland, he says, reflects:
the laissez faire attitude of a class of people who are running the medical system, advising the agency and the legal system. They of course all have health insurance. I don’t know anybody who served on the board of the VHI or any doctor working in the system who doesn’t have private healthcare. I myself have to admit that I took out private health insurance purely because I know how difficult it is to access care via the public system. It’s sad but true and I am lucky enough to be able to pay, unlike more than 50% of the most needy In our society who cannot.
‘Irish People’ he says are dying ‘for the lack of basic diagnostic care.
Bowes muses on how: ‘The further up the pyramid you go around a health product in Ireland, the less you hear about the patients. And when you get to the board level, patient outcomes are in some way superfluous to the real issues, which are profit and the market.’ He argues that there ‘isn’t a single private provider in the country here’ which ‘isn’t preoccupied with profit.’
He says:
We’re happy to ostensibly starve a public system and propagate a private system which is absolutely predatory on the dysfunction in the public system. And in many, many cases, the people providing the care in the public system also have been or currently are providing care in the private system.
That’s our medieval, dysfunction and immoral system. It’s actually, and I don’t use this term lightly, an apartheid system. We have a segregated, apartheid system in health care. It simply isn’t based on needs of the patients. Ok, obviously, if someone’s at death’s door, they’re going to get seen, but I’m talking about this grinding dysfunction, where both sides are nodding to each other as they pass each other in the night, knowing that it’s so wrong. It’s so wrong. There are super doctors out there, super surgeons, super nurses and staff operating in the health system. It’s definitely a case of lions being led by donkeys.
Really encouraged by response of a leading figure in Irish culture over the past 50 years. "Daniele's interview with Fr.McVerry is classic. Cassandra is rapidly becoming the most important vehicle for ideas in the land." ***@danieleidiniph1@BowesChayhttps://t.co/7N1bz38X77
Bowes muses ‘I have no problem with doctors wanting to make a decent living. You’ve got to pay people appropriately. But now we’re flooding the system with locums from overseas who are often poorly trained and have poor English and patient interaction skills .’
And points to another ‘incredible dysfunction, which is again, state sponsored.’
We train more doctors than any other country of our size in the world, but we export them to Australia, New Zealand and the UK. It costs the state a significant amount to train these guys, and then they can just catch a plane to Bondi Beach. Of course, we can’t force people to work here – no more that we can force a health care worker to take a vaccine – but there are ways to incentivize the system, and develop better methods of training doctors, because we still use the archaic Leaving Cert as the basis for deciding who we train as doctors.
He also wonders:
How is it that while we train more doctors than anyone else that we are importing more doctors and nurses than anyone else? Countries like the Philippines, India and others are being bled of their precious nursing and medical staff to come to Ireland to look after our sick. There’s something wrong, right? But in the Irish system nothing changes. No wants to take on the vested interests. No one wants to take on the big personalities in health care and medicine. The political nexus between medicine, law and politics in Ireland is so tight because of insular practices and local allegiances trumping national welfare with some of the biggest political donors and influencers being waist deep in the sector.
He wonders ‘Who’s going to challenge the vested interests and speak out for vulnerable patients? The CEO of the HSE? Absolutely not. The past CEOs of the HSE seem to be only good at one thing, which is saying, “We’re trying…” But they walk out at the end of the end of their contracts with a big pension and usually into guess where? Yes, you guessed it, the private sector.’
He reveals how ‘a former CEO of the agency said to my face that he was the most powerless man in the health system.’
Image (c) Daniele Idini
Dysfunction Funds Profit
Bowes wonders:
How can you operate a business with a hundred and twenty thousand employees and seem to be powerless to sack people for not delivering, or in many cases simply doing their job wrong? Where’s the accountability in that system?
How can you amalgamate numerous health boards which are operating as satellites into a single “dynamic entity” and nobody loses their job? Not one manager is made redundant. Not one of them is even sanctioned.
How can a health system pay out tens and tens of millions in malpractice claims for egregious malpractice and incompetence in both governance and clinical care? For essentially killing women who are pregnant by denying them an abortion? By condemning young women to terrible life ending illness by failing to diagnose their cancers? How can you pay out these tens and tens of millions again and again, year after year, and nobody is sanctioned for it? How does that work?
It works because the dysfunction funds profit, and that profit is harvested by vulture funds, by private hospitals and private investors, by their legal advisors, some of whom don’t even pay taxes in this country, and who pays the price? The citizens that languish on public waiting lists accruing ill-health because they can’t pay for treatment. The man with the simple requirement for treatment, he’s invisible to the system, he is superfluous to the profit motive.
The poor he says have no bargaining power because:
the bargaining power is money and influence, and the people who have the influence to change the system are receiving huge salaries to manage and essentially perpetuate dysfunction. Again, the private system predates on the mismanagement of the public system. If it functioned there would be no need for a private system, right? Therefore, you have to wonder, who does the current dysfunction benefit? It’s an easy one: the private providers. But nobody who is of the machine is working against it. No one in Leinster House is saying to the CEO of the HSE: “What are you doing for your four hundred grand? We’ve got less intensive care beds per capita than Lithuania or Latvia. Two years into a pandemic, we still don’t have a dedicated COVID hospital which is just insane.
Apparatchiks of a state system who’ve worked, like Paul Reid in state jobs are seen as a safe bet. They’re nominated in as managers, managers of dysfunction, gatekeepers for their political sponsors and marked for future cushy roles on the private side of the wall.
Image (c) Daniele Idini.
Perpetual Crisis
He adds that ‘things like this mysterious and much vaunted “Cyber Attack”, which apparently “destroyed the abilities of the system” seem to be a perfect excuse to deflect from the internal failures of HSE management and external incompetence of its political masters.’
Bowes says: ’what I know, and anyone that has worked in the system knows, is that there was and is no viable system to attack.’ The HSE have ruminated for decades on the implantation of an electronic patient record: they have spent millions evaluating, re-evaluating, procrastinating, and failing to implement a viable solution.
Months after this “Attack”, you’re still running Windows 1998. Somebody needs to be held accountable.
But, he says: ‘the Minister doesn’t talk to the to the HSE, the relationships between the “Three Masters” of Health are utterly flawed, the Department of Health is cumbersome and cautious, the HSE is a lumbering leviathan with no real direction other than self-preservation, and the Minister is preoccupied with surviving a potentially career ending stint in the mire of the Irish Health system.’
Consider this, with such a huge annual Health budget and such poor outcomes for patients alongside such terrible value for money, the dysfunction and paying for it becomes central to the rational of the organisation. They actually need this dysfunction. Without the dysfunction, they’d be screwed because there would be an open accounting of what we’re doing in a system which is delivering horrendous results.
He also criticises Stephen Donnelly’s policy of giving more money to the National Treatment Purchase Fund, which sends public patient overseas for treatment, arguing that ‘this is not the same as a really equitable national health system where everybody gets treated on the basis of need.’
He says that people could argue that in a free-market economy if someone wants to purchase health insurance it’s up to them: ‘However, that’s different to paying almost half a million a year to a CEO to perpetuate a dysfunctional system.’
He says the HSE is only interested in crises, ‘in things like COVID’ and saying ‘but COVID is why the system is screwed, or we’re dealing with the cyber attack, which has caused this perpetual dysfunction, which is, you know, all entirely untrue.’
His conclusion is ‘the managers, architects and political apologists for the segregated and morally bankrupt system have done an exceptional job of screwing the Irish people out of their tax dollar and their rights to health and dignity. I’m not sure they are capable of doing anything else. It’s time to demolish and rebuild.’
I loved working for the NHS (National Health Service), especially as it was configured in Bradford, West Yorkshire. Bradford was a health action zone, and probably still is due to its high level of social deprivation. This meant it got more funding for health and social initiatives.
Darndale, Dublin or Moyross, Limerick would be areas with similar issues. The practices in Bradford were large and covered virtually everything except performing major surgeries and delivering babies, meaning there was an eclectic mix of health professionals, all under the same roof. This was referred to as a ‘primary care team’. A team?
After completing my undergraduate training in Dublin I arrived under the impression that being a GP was essentially a solo effort, a bit like being a snooker player.
In his own eyes the GP is the hero, even if in Ireland he is a failed consultant in other people’s view. Not so in the NHS, and certainly not in Bradford, where GPs were part of a multidisciplinary team approach to the provision of health services. Each person was a cog in wheel that contained management, administration, nursing, occupational therapy, physiotherapy and community pharmacy services. They even held meetings, spoke to each other civilly and advice flowed in various directions. How radical!
On a wider scale, local practices provided many of the out-patient services traditionally provided by hospitals including cardiology, neurology, rheumatology and chronic disease management; they even carried out minor surgery and endoscopies. GPs were encouraged to upskill to become what they called ‘GPs with special interests’ or GPSI (pronounced Gypsy). All of this occurred in close proximity to their patients and in familiar surroundings. These practices were based in large urban centres, although I would imagine it would have been difficult to replicate this model in rural areas with widely dispersed populations.
Unemployed outside a workhouse in London in 1930.
Beveridge Report
The NHS emerged in a society with a different history to Ireland’s. The 1942 Beveridge report highlighted that urban poverty was widespread in the U.K., as George Orwell’s account in The Road to Wigan Pier bears testament. One can get all misty-eyed about Beveridge’s recognition of the plight of the working class; the reality was a fear that workers’ poor health would impact on profits, and might turn revolutionary.
Nevertheless, the post-War drive to correct some of these deficits lay behind the birth of the Welfare State, including the establishment of the NHS in 1948. This was strenuously resisted by the medical profession, much as the profession in Ireland, along with the Catholic Church, were resistant to Noel Browne’s Mother and Child Scheme. More latterly the mere mention of ‘Sláintecare’ induces apoplectic rage among certain members of the ‘caring’ profession.
This may seem naïve, but I fail to see what’s wrong with a universal health service, ’free at the point of entry from the cradle to the grave’, paid for out of taxation revenue and borrowings; this is a service that encourages the utilisation of all health-related services in a country, public and private, for all citizens, based not on ability to pay, but need. But apparently this isn’t a good idea.
I have come across many ideas that were thought not to be good ideas in my twenty-seven years of practice, but few had credible reasons for their outright rejections. Chronic disease management, i.e. diabetes, heart failure, COPD or renal failure should be undertaken by a person known to the patient – i.e. a GP – living in close proximity to where they live.
‘Too Busy’
This has been the bread and butter work of GPs in the U.K. since the 1990s, but apparently in Ireland during the 2000s this wasn’t a good idea, because we were ‘too busy’. Doing what I wonder?
Integrated services would allow GPs to order investigations directly. In Ireland at present, if, for example, a chap without health insurance injures his knee playing Sunday football and his GP thinks it could be a torn cartilage, he will have to wait up to two years to see an orthopaedic surgeon. He is then put on a waiting list for perhaps another year, until finally he has his MRI scan and discovers he has a torn cartilage.
By that time, however, he is no longer playing football and is twenty kilos overweight, having spiralled into an unhealthy lifestyle. To add insult to injury he will receive a letter from the hospital asking if he wishes to remain on the waiting list for his knee operation, by which stage he might as well get in the queue for a knee replacement.
Big Pharma
Nowadays, it’s not a good idea to refuse to meet pharmaceutical reps when they call to the practice. Having trained in Bradford – where none of the practices or the training scheme’s educational events gave access to reps – I thought that it was reasonable to turn them away. We didn’t meet reps selling toilet rolls or coffee, so why meet representatives of multibillion dollar pharmaceutical corporations? Such companies spend more on advertising and marketing than research because they know how it works.
Alas, we dopey doctors assume they are sharing their scientific data with us whilst buying us lunch, giving us pens (with names of drugs emblazoned on them), stationary, wall clocks, mugs etc. So, they do share ’their’ science, the bits of their research that shows their product in a good light, not the science or the research warts, or heart attacks, and all.
A cosy world of Irish general practice featuring golf, rugby and tweed had been frozen in time until 2008. The GMS contract which began in 1970s paid well, but we still had our ‘privates’. In other parts of the English-speaking world ‘privates’ usually refers to one’s genitalia, but in an Irish GP setting this refers to the paying customer.
In some practices private patients are given preferential access to appointments. Invariably, this will involve nothing more than prescribing an antibiotic for a cold. Such patients usually have their own cardiologist or several oncologists they refer to using their first names. However, from 2008 onwards when the International Monetary Fund invaded Ireland and took control of the purse strings, the government of the day unilaterally took 35% off the GMS contract payments. Then the privates became more important, but these patients were increasingly hard up too with the world’s economy in a mess.
The next few years for me remain a blur. My recollections arrives through the haze of mental illness and stress brought on by a Celtic Tiger mortgage, business partnership shenanigans, and yo-yoing emigration-immigration, amongst other adventures.
Image (c) Daniele Idini
Pandemic
Fast forward to 2020 and the unknown quantity that was the Sars-CoV2 escape from Wuhan’s virology research centre – known as the Wuhan Wet Market dose to some, depending on your trust in media, governments and power elites.
Then the WHO advised GPs via august bodies such as the Irish College of General Practitioners to do nothing, as there were no treatments despite it being a deadly pandemic. Furthermore, we didn’t even need to see patients. We locked our doors, sat by the phone, ‘stayed safe by staying apart,’ among a litany of other trite statements.
It was heartening to note on some well-known GP websites that some practitioners were one step ahead of WHO/HIQA/NPHET insofar as they immediately sensed a threat to ‘the privates’. Not as an unwanted symptom of a Sars-CoV2 infection, but as a result of the hatches being battened down. How could the privates access their GPs and more importantly pay them?
The unelected and widely disrespected government with its GP-trained Taoiseach knew instinctively what to do. More accurately Leo Varadkar knew what to do. He found the answer to this most perplexing question and saved the day. Make everyone private. GMS patients ringing up resulted in a fee, privates ringing up resulted in a fee from the government.
So the gravy train sloshed its merry way through the pandemic. An entire profession was bought, and continues to be bought by vast sums of money for examining patients that one is already being paid for, vaccinating all and sundry against influenza, Sars-CoV2-twice or is it three times, who knows, who cares, the money spigot is stuck on maximum flow.
Money that was not available up to 2020 is now flowing like goodies from the proverbial cornucopia. This has bought compliance with ways of treating people that run counter to the codes of practice of any good doctor.
Practices are now treating patients like lepers, creating nonsensical plastic barriers, one way passes through surgeries, discouraging unvaccinated patients, disrespecting patient autonomy, and offering a paternalism reminiscent of the Victorian era. But worst of all is a refusal to treat patients in the early stages of Sars-CoV2, regardless of how medically vulnerable they may be because of ignorance and hubris.
This is what buying a profession produces.
Image: Daniele Idini.
Eau de BS
Born and reared in a working class Dublin area with a healthy disrespect for all authority, I have always been a contrarian. That disrespect has served me well. So, when I hear people in authority asking citizens to pull together or to do deeds for the good of the nation I instinctively smell eau de BS.
Supposedly for the good of the nation, we are creating a society that is comfortable with meaningless segregation based on vaccination status that is supported by the medical profession. We even have the prospect of hospitals taking young people off transplant lists and families being refused access to a dying loved one in a care home. Now we are witnessing a clamour for a dubiously effective pharmaceutical product to be inflicted on children as young as five.
The medical profession has allowed one of the highest levels of trust to be stolen by greedy fools who use it to ensure people think that their products can also be trusted. The medical profession has become avaricious, self-serving, vindictive, patient-averse, opinionated and authoritarian, and is failing to foster the doctor-patient relationship.
I fear that relationship which is the bedrock of general practice has been irrevocably damaged. What need then will there be for GPs if artificial intelligence can deliver the information in an up-to-date, rational, non-judgemental and timely fashion in the comfort of anyone’s home?
It seems that when this older generation pass into retirement, a tech savvy generation will not want what they never really had: a genuine doctor-patient relationship.
Featured Image: Aneurin Bevan talking to a patient at Park Hospital, Manchester, the day the NHS came into being in 1948.
As an immediate disclaimer, I am a doctor training to be a general practitioner in Ireland and am a member of the Royal College of Physicians of Ireland. I have worked in the local hospital emergency department and Covid assessment hubs as well as a general practice surgery during the pandemic and have seen very unwell patients suffering with Covid-19 and the after-effects of same. I have friends who have lost parents and grandparents and understand the devastating effect that the virus has had on their lives. I absolutely do not underestimate the seriousness of this disease. I am fully vaccinated and recommend that patients are vaccinated should they so wish. I am vehemently against the concept of vaccine mandating and passports. I fully support the right to protest and detest the concept of censorship by large technology companies. I feel that in the current climate of extreme opinions on this topic, I must state all the above. I have no expertise in infectious diseases, public health or epidemiology. Like most doctors, regardless of whether they choose to admit it or not, my understanding of statistics is limited. Hence, I do not offer any opinion in this regard.
The Doctor in Society
The Covid-19 pandemic has been an ever-present part of our daily lives for over a year. There is little left to say that has not already been said in relation to the correct management of the virus on a national and international level. It appears – from the approaches of different countries around the globe – that it is impossible to reach anything approaching universal agreement on the best manner of protecting vulnerable people from the disease, while simultaneously protecting vulnerable people who also have suffered terribly because of the restrictive measures that governments have felt it necessary to enact in our societies. Hence, the purpose of this essay is not to provide an opinion as to the approaches adopted, but to discuss and examine some ethical considerations and the implications of our decisions.
We should first consider the role of a doctor in society. John Berger wrote in A Fortunate Man, a seminal book on the life and work of a dedicated general practitioner in rural England, that ‘like an artist, or like anybody else who believes that his work justifies his life, Sassall – by our society’s miserable standards – is a fortunate man.’[i]
Certainly, as a vocation, medicine is endlessly interesting and the care of people when they are unwell is incredibly rewarding, despite its demands. There is an intimacy between a doctor and his patient that is intangible and key to a successful therapeutic relationship. We occupy a privileged position in people’s lives as we often meet them when they are at their most vulnerable and most in need of help.
Note the deliberate use of help as opposed to treatment. I use this word purposely because treatment in the general sense is not always appropriate when trying to improve a patient’s condition. Berger continues that a good doctor can be recognised as someone who ‘meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognises them’. You’ll notice that the recognition does not include intelligence, curiosity or diligence, although these are all welcome attributes.
Ethical Pillars
Another important aspect of being a decent doctor in the true sense of the word is to regularly consider the four ethical pillars of medical practice. These are autonomy, justice, beneficence and non-maleficence. Acknowledging and adhering to these principles allows us to help and treat patients in a humane manner and should allow doctors to recognise the limits of our ability to protect people. This is an important point to emphasise. As physicians, we often see ourselves as lifesavers or life-preservers, but this is often not the case and creates unrealistic expectations for both the doctor and patient.
Our primary function is to prevent unnecessary suffering and death where possible and to try to consider the effects of our treatments not just on the patient, but on the patient’s family and wider community. Beyond the above, we are capable of little else, which is in of itself, no mean feat.
A significant risk in the practice of medicine is that in the search for ‘progress’, our hubris means that we are trying to cheat death on behalf of the patient with ever-increasing numbers of interventions, with often dubious effects on patients’ quality and quantity of life.
This is often apparent in the field of oncology. For example, a recent paper published in JAMA in November 2020 examined the clinical trial data available on treatment outcomes of all novel cancer drugs approved for the first time between 2000 and 2016.[ii] 92 novel cancer drugs were approved by the FDA for 100 indications based on data from 127 clinical trials. Despite the enormous cost of both developing and treating patients with these drugs, the median absolute survival benefit was 2.4 months.
This requires emphasis. 2.4 MONTHS of median survival.
This is simply staggering and reflects that we may have lost our way in the medical community, approving medications for use without fully appreciating the implications of this decision i.e., if this person receives x drug at x cost, what effect will this have on the healthcare system as a whole? Does treating patients in this manner, with often experimental medications, benefit society as a whole or the pharmaceutical industry? This may require a ‘hard heart’ as described by Jim Stockdale in Thoughts of a Philosophical Fighter Pilot. The correct decision for the many is often the hardest on the few.
Progress in Medical Science
It goes without saying that it is essential to strive for progress in science and medicine. This should not require stating as I am in awe of the advances made every day in medical science. It is, however, equally essential to recognise the fundamentals of health and the requirements for same. The UN defines health as not just the absence of disease, it is a state of complete physical, mental and social well-being. Can we say, as doctors, whose role it is to help restore and maintain health, that any of our patients are healthy in the context of the events of past year? Are we striving to help our patients to be healthy or are we only treating their diseases as they develop? There is a subtle but significant difference.
Ivan Illich, the philosopher, wrote extensively about the effects, both good and bad of doctors and medicine on not just the individual but on society in general.[iii]3 He recognised the amazing large-scale innovations in public health that have given us access to good food, safe water, sewage disposal etc, but he also recognised the potential for medicine and the medical profession to cause significant harm. The focus of his arguments relate to the adverse impact of medicine on society. His principal argument being that the medical profession was eroding the individual’s capacity to accept suffering and more importantly, the capacity to die one’s own death.
As previously mentioned, our duty is to ameliorate suffering where possible and allow patients to suffer and die with dignity when this is appropriate. Our attempts to do more has the potential to lead to catastrophe, both physically and psychologically, because it can permanently remove a patient’s perception of control over their own being. Prominent examples include the current opioid epidemic in the US and benzodiazepine addiction issues here in Ireland. All developed under the guise of attempting to alleviate suffering, but instead mutating to continue to cause devastation to this day.
Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased over six times since 1999.[iv] Most of these deaths are attributable, unintentionally or not, to the medical profession. This is a sad reality. Simply because a treatment decision is well-intentioned does not protect the doctor or the patient from unintended circumstances.
Hence, I would advocate where at all possible, conservative or ‘light touch’ medicine, promoting patient empowerment and autonomy. Where possible, I suggest promoting the ideal of health provided by William Landen: ‘To ensure good health; eat lightly, breathe deeply, live moderately, cultivate cheerfulness and maintain an interest in life’.
Latter-day Clergy
Physicians should be an occasional addendum to life; instead, we have increasingly assumed the role previously held by the clergy. This is not a positive development. Although the medical profession has not asked for this endowment, it has accepted it without significant resistance or understanding of the spiritual nature of the role. Many physicians are not consciously aware of the transference, creating further patient dependence and maladaptive behaviour patterns, creating the class of people known to doctors as ‘heart-sink’ patients. Medicalisation of existential angst manifesting as vague abdominal pain serves neither the doctor, the patient, nor society in general.
Public health is an extension of medicine that is remarkably important but often ignored at a societal level. It has been defined simply as the science and art of preventing disease and is tasked with the promotion and protection of the health of entire populations. This is a gargantuan task and is arguably much more important than the other, more visible fields of medicine. While the aims of public health medicine are admirable, it would be easy to deduce that multiple aspects of modern public health, beyond the basics mentioned previously, had been failing miserably up to the onset of the pandemic.
Levels of both child and adult obesity as well as type 2 diabetes are increasing year on year, chronic disease continues to over-burden every western healthcare system and smoking rates remain stubbornly high globally. All these issues, created by the cultures of excess and consumption that we inhabit, are likely to worsen in the years ahead, with multiplicative effects on successive generations in Ireland to the point where it is expected that our life expectancy and more importantly, healthspan, will decrease in the years ahead.[v]
I mention this to illustrate the point that people rarely behave in a rational manner. This is especially evident at a population level. Therefore, one could logically decide in a public health capacity, to intervene in increasingly intrusive ways to ultimately improve the health of the population, through restriction of access to unhealthy pastimes and products. This would presumably entail banning cigarettes, alcohol, highly processed junk food and all other manners of potentially unhealthy choices. This would reduce the burden on our hospitals in both the short and long-term and allow improved access to care for a happier, healthier population.
For example, the government of Bhutan has banned all sales of cigarettes in their country, with excellent health effects to date. The Prime Minister of Bhutan took the decision because he stated that it was the right thing to do for the health of the country’s citizens.[vi]
However, it would be argued vociferously that any such decrees would impinge on an individual’s rights to individual choice, not to mention the enormous loss in tax revenue to the State from the sale of such items. The Irish government is estimated to generate two billion euro a year in tax revenue from the sale of cigarettes alone. Interestingly, it is estimated that we spend the same amount on the management of smoking-related diseases in our healthcare system, thus negating this as an argument against banning cigarettes.
If this were indeed implemented in Ireland, and more particularly in the case of alcohol, there would be immediate cries of excessive intervention in the private lives of the citizens of the State. This would be a perfectly reasonable argument in the absence of a state of emergency, such as we find ourselves in over the course of the past fifteen months.
It must be stated that the effects of cigarettes and alcohol are not limited to the individual. Anyone who argues this has not had to wait for an outpatient appointment in an overcrowded cardiology or respiratory clinic for three years. One should remember though, that there has been a healthcare and trolley ‘emergency’ in Ireland since Mary Harney announced one twenty years ago and there has been no improvement whatsoever in the annual crisis figures, with increasing amounts of the State budget allocated to the attempted provision of healthcare. In 2018, the Irish state spent €22.5 billion on the healthcare system, which equates to 11.4% of Gross National Income (GNI).[vii] People blame the healthcare system but the system, while dysfunctional, may not truly be to blame. Perhaps, as a society, should we shoulder some of the responsibility?
State Interventions in Pandemics
Thus, after thinking about some of the arguments that could be made for state intervention in the lives of its citizens, I think it is important to consider the various ethical approaches that could underpin our ongoing approach to the pandemic.
A utilitarian approach was initially adopted by the UK government, aiming for the concept of achieving herd immunity to maximise the collective interest. As is commonly known, this was quickly abandoned as the healthcare system came under increasing strain. This approach is not without precedent, and I do not refer to the management plan decided upon by the Swedish government.
In 1968, the world was struck by an influenza pandemic known as the ‘Hong Kong flu’, killing approximately 4 million people globally, according to the Encyclopaedia Britannica. A paper published in The Lancet examined the response to the 1968 pandemic and noted that the British government was extremely passive in its approach.[viii]
Fearing that the press would have a field day if it issued a prominent warning about the pandemic, it left it to local medical officers of health to decide on the most appropriate course of action. Interestingly, publishers were also reluctant to risk stoking public fears, ‘a reflection perhaps of heightened anxieties due to the Cold War and the launch of Sputnik, as well as greater respect for medical experts and deference to authority’. This approach undoubtedly led to many deaths and interestingly, affected people under the age of 65 more than the elderly.
It can certainly be argued that the fabric of British society was maintained at the time, possibly for the greater good in terms of long-term ramifications. Contrast this with the media response to the pandemic today. The Guardian newspaper is one of many which has a live ‘coronavirus update’ section on its website for the past year. Does the information provided serve the individual or the advertisers paying for space?
Ireland’s Kantian Approach
By way of comparison, Ireland seems to have adopted a Kantian approach to the management of the pandemic. It is unclear whether this is by accident or by design. In an interesting paper by Gerard Delanty, he quotes the philosopher Jurgen Habernass, the world’s leading political philosopher.[ix]11 He stated that ‘the efforts of the State to save every single human life must have absolute priority over a utilitarian offsetting of the undesirable economic costs’. This equates to, in layman’s terms, ‘lockdown first, ask human rights questions later.’
While Kantian ideals are superficially attractive, I worry that the implications of following such an approach will have long-term repercussions. One can argue that that the degree of government overreach into the lives of its citizens is deontologically unacceptable and that multiple human rights violations have occurred in this country and may occur again in the near future.
A report commissioned by the Irish Human Rights and Equality Commission in 2020 stated that ‘not only is Covid-19 more than a public health crisis, but it is also arguably the most significant set of human rights and equality challenges that Ireland has ever faced’[x]12 The report highlights multiple areas of concern regarding the State’s and NPHET’s issuing and maintenance of emergency powers. Principally, these included the blurring of the boundaries between legal requirements and public health guidance, the potential for emergency measures and their enforcement to disproportionately affect certain disadvantaged and more vulnerable groups and the lack of human rights and equality expertise in the decision-making structure put in place to tackle the pandemic, or in the systems that implement and scrutinise these decisions.
These are significant issues that have not been acknowledged or addressed by the Government or NPHET. This should be of significant concern as it belies the seriousness of the situation. I must stress that I do not suggest that NPHET or the government are made up of morally ambiguous people. They are not the real issue. I honestly believe that they are decent people working hard in the most extraordinary circumstances that we have witnessed in most of our lifetimes. It is in this ‘state of exception’ however, that we must be at our most fierce in the assiduous monitoring and protection of our civil liberties.
Overreach?
Giorgio Agamben, the Italian philosopher, has warned repeatedly against the implementation and continuation of emergency powers as a normal paradigm of government.[xi] He questions the imposed limitation of freedom in a desire for perceived safety and security and has previously discussed this issue in his examination of the surveillance powers afforded to the US government after the events of 9/11. He warns against fear and stresses the importance of society guarding itself against any form of extreme government, regardless of perceived benevolence.
Matthew Crawford, the philosopher cum motorcycle mechanic, also warns against the culture of ‘safetyism’, describing a cycle whereby ‘the safer we become, the more intolerable any further risk becomes’ and that ‘once emergency powers are passed, they are seldom relinquished.[xii]’
Do we genuinely believe in Ireland that we are immune to benevolent autocracy? Has the question even been asked in the public domain here? Does the absence of questioning and discussion not demonstrate the lack of any public intellectual discourse that might be useful to allow individuals to consider their own ethical responsibilities in a pandemic?
By corralling people in their homes, the State has acted as a helicopter parent, pacifying us with off-licences and pandemic unemployment payments. The decision was made that people were not trustworthy enough to consider their fellow man and behave accordingly.
Anti-lockdown campaigners have repeatedly pointed to the relative ‘success story’ of Sweden in its approach to the pandemic. Perhaps, it has nothing to do with the manner of the imposition of the restrictions but to do with how seriously the population took the virus and were satisfied to adhere to advice from the public health authorities. There was reciprocal trust between the State and its’ people. Because essentially, that is the difference between the population groups.
I would ask people to ignore the behaviour of the virus and instead to consider how people in different countries behave on an individual basis. In Japan, lockdowns have not occurred as they are deemed illegal. However, anecdotally, they take virus very seriously and take what could be regarded as excessive personal risk avoidance i.e., wearing hazmat suits in airports when travelling (this was witnessed recently in Charles de Gaulle Airport in Paris).
Again, I must re-state that I do not believe that lockdown decisions in Ireland were made with ill-intention. They were made to ostensibly protect the vulnerable in society i.e., the elderly. By and large, despite some nursing home and hospital scandals, this has been effective and a healthcare system, bloated and over-burdened for decades, has avoided a presumed disaster. These are the benefits of the most prolonged and nominally if not practically, the most stringent lockdown measures in Europe.
The Law of Unintended Consequences
However, one should also consider and cite the law of unintended consequences i.e., that the actions of governments always have effects that are not anticipated. Hence, it would be unrealistic to assume that our seventeen months of restrictions will have no harmful side-effects. Unfortunately, the vulnerable in society are still those who have and will suffer the most.
Elderly patients, the focus of our concern, have deconditioned before my eyes over the course of the three lockdowns enacted here and many of my colleagues are reporting similar experiences. Loss of muscle and bone strength has a direct impact on the morbidity and mortality of an elderly population.[xiii]
Physically active older adults (≥60 years) are at a reduced risk of all-cause and cardiovascular mortality, breast and prostate cancer, fractures, recurrent falls, ADL disability and functional limitation and cognitive decline, dementia, Alzheimer’s disease, and depression. They also experience healthier ageing trajectories, better quality of life and improved cognitive functioning. Inactivity over the past seventeen months will have dreadful ramifications for a significant proportion of the people that we have sought to protect.
They spend their time with their families in a state of anxiety, fearful of becoming unwell but also guilty at the burden placed on their families. Loneliness and social isolation have increased dramatically. This will have multiplicative effects in the years to come as there is a strong body of evidence to demonstrate that cognitive decline and mortality rates are doubled among people who suffer because of isolation and loneliness.[xiv]
The ESRI now predicts that tens of thousands of people will permanently lose their jobs, and that up to 250,000 will remain unemployed at the end of 2021[xv]17. Perhaps many of these jobs would have been lost because of the pandemic and not the restrictions, but the negative societal impact of such job losses on people in lower socioeconomic groups cannot be overstated, further worsening inequality and poverty.
In Ireland, the lockdown has been an inconvenience for the middle class, but I state without hesitation, that the longer this persists, the more devastating the blow will be to the vulnerable in society and the more difficult it will be to recover.
Socioeconomic Status
Socioeconomic status has a much more significant impact on health status than medicine and medical care. To provide a stark example, In England, the gap in life expectancy (LE) at birth between the least and most deprived areas was 9.4 years for males and 7.4 years for females in 2015 to 2017; for healthy life expectancy (HLE) it was 19.1 years and 18.8 years respectively.[xvi] This is in one of the richest countries in the world, with a socialised healthcare system lauded and envied globally. It is essential that we remember this fact if we wish to strive for a decent society. I stress again that lockdowns and continued restrictions will affect the most deprived in our own society and further widen the gap of income inequality.
Finally, the effect of state intervention must be considered on the most vulnerable cohort in society, our children. Lockdowns have been demonstrated to have increased the number of adverse childhood experiences suffered by vulnerable children.[xvii]
The common argument in favour of lockdowns is that their adverse effects are not multiplicative. I would argue the opposite. The longer these measures remain in place, the larger the long-term effects on children. A study in Oxford demonstrated that children had essentially learned nothing over the course of the pandemic year through Zoom.[xviii]. It is estimated that 100,000 children did not return to school in the UK after the most recent lockdown or were defined as ‘severely absent.’[xix] When will disadvantaged children regain the educational ground that they have lost and what will be the effect of this life on their adult lives?
The government tells us to stay safe and hold firm, slogans that signify nothing except a lack of imagination. They asked that the citizens of the State protect the health service by adhering to stay at home guidelines, which were enforceable by law. The question must be asked why the State has not applied the same urgency to the trolley and hospital bed crisis, which has been present annually for at least twenty years?
How many poor people have died unnecessarily because of over-crowding or inequitable access to healthcare services? Why was the Cervical check scandal allowed to unfold? Why the Mother and Baby Home scandal? Why are we building a behemoth Children’s Hospital that is arguably not suitable for purpose and will be by its’ finish, the most expensive hospital in the world? Why does this occur while there are 193,600 children living in poverty in Ireland,[xx] considering the wealth that this country currently generates. One should ask is the state truly worried about its citizens or its systems of ‘care’? There is a significant difference.
Viktor Frankl
Finally, we should consider the role of the individual in this pandemic. Victor Frankl, the famous neurologist and founder of logotherapy, wrote about the nature of life and its meaning in the context of his experiences as a prisoner in Auschwitz and his subsequent return to society.
In Man’s Search for Meaning and Yes to Life, he explores the themes of meaning and his own treatment of patients with severe mental illness. In summary, his own severe despair, which often afflicted him, only served to convince him further of its meaning and the importance of finding meaning in life.
This does not necessarily mean happiness as this is a more modern obsession. We have no right to happiness in the modern sense. Life does not expect you to be happy or sad or any other emotional state. Life simply is. Within these confines, which are as limited or limitless as you choose, what you emotionally feel during this period is your interpretation of the experience, nothing more or less.
Tragedy constantly stalks us and will visit at various points during our lives, regardless of external environmental factors. As a result, negative visualisation is a concept that the Stoics advocate. Marcus Aurelius wrote of putting his children to bed at night and imagining them dying. This was not done in a sociopathic sense, but to remind him of the precious time that he had with his children, to value this time and to appreciate that they may be taken from him at any point.
Perhaps, societally, we could improve our lot by engaging in this thought process more often, not to upset us but to improve our appreciation of what we have now and to steel ourselves against the difficulties that we may face in the future. It encourages difficult thinking and bravery. It may often be easier to retreat to the arms of someone/something else to make decisions for you but is this the correct decision? This pandemic is an external, unfair devastation but I believe that our society, as imperfect and flawed as it is, can adjust and limp forward. I trust in people to make the correct decisions for themselves at this point in the pandemic.
In Summary
I repeat my claim to no expertise on the management of a pandemic. As a doctor, I am asked to assess people’s problems, both medical and otherwise on multiple occasions throughout my daily work. While I am required to make my decision with relative confidence where possible, key to being a decent physician is to constantly consider that I may be wrong in my treatment decision and that my differential diagnosis remains broad.
I believe that at this point, ongoing and future mandated restrictions are likely to be more harmful than beneficial to society and that we should carefully consider the course that we plot and what we value in life. Safety should not be valued above all else and iatrogenesis has terrible implications for health. I write this on a day when NPHET has recommended to government that indoor dining should be restricted to people who are fully vaccinated only. Is this what we have become?
[i] Berger J. A Fortunate Man: the story of a country doctor. London: RCGP; 2005
[ii] Ladanie A, Schmitt AM, Speich B, et al. Clinical Trial Evidence Supporting US Food and Drug Administration Approval of Novel Cancer Therapies Between 2000 and 2016. JAMA Netw Open. 2020;3(11):e2024406. doi:10.1001/jamanetworkopen.2020.24406
[iii] Illich, I. (1975). Medical nemesis: The expropriation of health. London: Calder & Boyars.
[iv] Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020.
[v] Woolf SH, Schoomaker H. Life Expectancy and Mortality Rates in the United States, 1959-2017. JAMA. 2019;322(20):1996–2016. doi:10.1001/jama.2019.16932
[vi] Ugen S Bhutan: the world’s most advanced tobacco control nation? Tobacco Control 2003;12:431-433.
[viii] Honigsbaum M: Revisiting the 1957 and 1968 influenza pandemics The Lancet 13–19 June 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247790/
[ix] Delanty, Gerard (2020) Six political philosophies in search of a virus: critical perspectives on the coronavirus pandemic. Discussion Paper. London School of Economics, London https://www.lse.ac.uk/european-institute/Assets/Documents/LEQS-Discussion-Papers/LEQSPaper156.pdf
[x] Irish Humans Rights and Equality Commission, https://www.ihrec.ie/documents/irelands-emergency-powers-during-the-covid-19-pandemic/
[xi] Stephen Humphreys, Legalizing Lawlessness: On Giorgio Agamben’s State of Exception, European Journal of International Law, Volume 17, Issue 3, 1 June 2006, Pages 677–687, https://academic.oup.com/ejil/article/17/3/677/2756274
[xiii] Hwang, T., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M. (2020). Loneliness and social isolation during the COVID-19 pandemic. International Psychogeriatrics, 32(10), 1217-1220. doi:10.1017/S1041610220000988 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306546/
[xiv] Hwang, T., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M. (2020). Loneliness and social isolation during the COVID-19 pandemic. International Psychogeriatrics,32(10), 1217-1220. doi:10.1017/S1041610220000988
[xvi] Office of National Statistics, https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2015to2017/
[xvii] Per Engzell, Arun Frey, Mark D. Verhagen Learning loss due to school closures during the COVID-19 pandemic Proceedings of the National Academy of Sciences Apr 2021, 118 (17) e2022376118; DOI: 10.1073/pnas.2022376118 https://www.pnas.org/content/118/17/e2022376118
[xviii] ‘Kids can’t catch up if they don’t show up’ The Centre for Social Justice, https://www.centreforsocialjustice.org.uk/library/kids-cant-catch-up-if-they-dont-show-up?utm_medium=email&utm_source=CampaignMonitor_Editorial&utm_campaign=LNCH%20%2020210628%20%20House%20ads%20%20JO+CID_c144dc407b002e4fa6548baa2389bf59
The bacterium streptomyces avermitilis was discovered by Satoshi Omura at the Kitasato Institute in Japan in conjunction with William C. Campbell at MSD (Merck, Sharpe and Dome) in the early 1970s. From this compound the medicine Ivermectin was developed. Ever since, it has proved a wonder drug for the treatment of parasites in humans and animals.
Most of these infections occur in Africa and Latin America, but it was nevertheless a lucrative drug for MSD. Nonetheless, in 1987 they provided the drug to the world free of charge as the Kitasato Institute gave up rights to any further royalties from its sale. This was an exceptionally generous gesture as it was a $1 billion per year product, and had been for several years. Its extensive and widespread use in humans has been described by Chris Whitty, Chief Scientific Advisor to the British government throughout the COVID-19 pandemic as ‘a drug with a good safety profile’, with a serious adverse drug reaction rate of 1/800,000’
Another paper says ‘Ivermectin was generally well tolerated with no indication of associated CNS (central nervous system) toxicity for doses up to 10 times the highest FDA approved dose of 200mcg/Kg’. In a nutshell, it is a safe drug, in use for a long time, and the nuances of clinical usage are therefore known to many physicians.
A recent paper from India using ivermectin as a preventative used 15mg on average, twice per month at a cost of $1.20 per month in healthcare workers resulted in a 72% reduction in infections. In a recent online enquiry to a wholesaler in India I was offered 100 x 3mg tablets for $12. Yet remarkably this same dose in Ireland would cost €100 per month.
As is well known by now, in early 2020 the WHO alerted the world to a pandemic virus that apparently emerged out of China, a virus for which there was no known treatment available and which was most dangerous in elderly patients with underlying conditions.
The illness presented with cold-like symptoms that after a period of between five and eight days could develop into severe respiratory symptoms, requiring hospitalisation and sadly in some cases leading to death.
The Irish College of General Practitioners stated in their guidelines to general practitioners in April 2020: ‘Clinicians should be aware of the potential for some patients to rapidly deteriorate one week after illness onset’ (members access only: https://www.icgp.ie/speck/properties/asset-Interim Guidance for General Practitioners).
The same document lists those conditions and age groups in which this is a possibility. It goes on to state that ‘no medications have shown any therapeutic benefit on the progress of Covid-19 pneumonia.’
This advice has not been updated since April 2020. So ‘do nothing until the patient turns blue’ appears to be the invaluable advice from a national body sixteen months into this crisis. However, in the spring of 2020 if you were unfortunate enough to find yourself in a nursing home your blue pallor would not summon the arrival of a flashing blue light, but instead you would receive midazolam and morphine, both respiratory depressants, whilst you awaited the Grim Reaper.
GPs were discouraged from examining their patients. Even the use of the stethoscope was deemed unnecessary. Shades of blue were everything. The ‘do nothing’ approach is still supported in the guidelines issued by HIQA in February 2021, despite over forty studies demonstrating the efficacy of ivermectin in the intervening period.
HIQA Advice
HIQA currently advise that ‘individuals do not prescribe or use interventions for the treatment of COVID-19 that do not meet the necessary minimum criteria’, but don’t outline what these criteria are.
They go on to ensure that ‘practitioners are not criticised for not prescribing these interventions.’ This latter is a somewhat curious statement if a body is so confident that their evaluation of the evidence is above reproach.
Yet William C. Campbell co-discoverer of Ivermectin with Satoshi Omura – with whom he shared the Nobel prize – in a speech to the Royal Irish Academy in April 2020 stated: ‘there is the possibility that a safe dosage of Ivermectin might reduce the rate of viral replication in the mammalian body, or affect the virus in other ways that might be revealed by further research.’
Ivermectin (IVM) bound to a C. elegans GluClR.
Fortunately for some Irish patients, a few brave GPs looked beyond this island for guidance. Asking doctors to do nothing, and specifically indicating certain actions that they should not take, is a restriction that disconcerts many experienced doctors, if not being a downright interference in the doctor-patient relationship.
As GPs in the community we deal with people who are part of a family within a social setting. We are therefore cognisant of many features of health – which outsiders might consider superfluous to the ‘science of medicine’.
Now I laugh each time someone juxtaposes those words, especially when I consider the absolute chaos that is general practice’s interaction with people. At the end of some consultations, I’m lucky to be able to spell my own name correctly, let alone apply the cold, steely, rational logic of science to solving any problems.
But no matter how chaotic or complex, or even futile, medical interventions may be, one must never vanquish a patient’s hope. Even when close to death, hope – if not for further life at least for a peaceful death – is something the GP can bring to the situation.
So who are these people in the ICGP or HIQA to say to GPs that there are no treatments available for their vulnerable patient who develops a SARS-CoV2 infection; to say ‘well let’s wait and see, and sure if you turn blue we’ll get an ambulance’?
We won’t visit or examine you, and you won’t be coming to our surgeries, but we’ll look after you by proxy. So why were we as doctors advised to do nothing? Not even to try a cheap, effective and safe drug, if only to elicit the placebo effect?
Criminal Charges
In India WHO’s chief scientist Dr Soumya Swaminathan is facing criminal proceedings brought by the Indian Bar Association for disseminating disinformation about ivermectin and its effectiveness as a preventative and early treatment for SARS-CoV2 infection.
Should those in HIQA who made recommendations to Irish doctors not face similar charges? Is this not a case of wilful blindness?
In the USA two distinct groups of doctors-intensive care physicians lead by Drs Pierre Kory and Paul E. Marik set up the FLCCCA (Front Line Covid Critical Care Alliance), and community-based physicians led by Professor Peter McCullough of Texas A+M University, in conjunction with AAPS (American Association of Physicians and Surgeons), devised protocols in their respective fields using Ivermectin and other medications, deemed ineffective by the WHO.
https://www.youtube.com/watch?v=dEmOCWOZPk8
Their rationale was based on medical ethics and a professional desire to give their patients a fighting chance against this condition. They have faced vilification and attempted sanctions, as have doctors in Ireland who were simply trying to help their patients. And some patients even had the temerity to get better.
I’m not sure what irked the Medical Council of Ireland more, the survival of the patients despite being given a HIQA/WHO proscribed substance, or some previous impotence at not being able to impose their second hand thoughts on all members of the medical profession.
There is no money in helping patients as the current system is set up. One makes more money merely by ascertaining how ill someone is by using the phone. Even if these medications do nothing beyond the placebo effect why has there been a concerted effort to block the use of what has already been shown to be a relatively low risk intervention?
Meta-Analysis
The most recent Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines by Laurie, Bryant et al in the American Journal of Therapeutics found a 62% reduction in death in a meta-analysis of fifteen RCTs. It concludes:
Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally.
The WHO’s own assessment of seven trials showing an 81% risk reduction was diminished in significance because of ‘imprecisions’ resulting in the WHO falling short of recommending the use of ivermectin. Fudge, fudge and more fudge.
Let’s cut to the chase here with this and perhaps many other substances. There are powerful vested interests steering advisory bodies away from the evidence, buying up integrity and burying it in a deep dark place.
The current vaccines are deemed to be the only safe and reliable treatments. This is ironic given that these products are all still in phase 3 trials, and safety data will not be fully available until late 2022 at the earliest.
The fact is that emergency use authorisations (EUAs) issued by the FDA in America and the EMA in Europe are contingent on there being no other treatments available in a public health emergency deemed to be effective. This is about money, vast sums of money. It is about wilful blindness at the highest echelons of the WHO, national governments and so called scientific advisory bodies.
It is about conflicts of interest, and the damaging and intellectually limiting dependency that science has placed on large corporations, and it would seem that now governments are in the same stranglehold.
As it is often said, the first casualty of war is truth. Clearly this also applies to pandemics, where body counts mean money, power and influence. And as in war inflation of body counts has always been good for business. Death may evoke much front of camera hand wringing but behind the scenes there is even more palm rubbing and back slapping.
Confusion and fear are to be expected in novel situations where experience is limited; this should fade as understanding grows. Such is the natural cycle. When governments employ behavioural psychologists to induce fears in order to control and coerce the population, however, we have to question their motives and methods.
Initially we were advised that a zoonotic virus crossed species: horseshoe bat to pangolin and then to humans, via the food chain. Ghastly images were shown nightly of a range of exotic creatures that Chinese people – portrayed in somewhat xenophobic terms because of their, to us, foreign tastes – supposedly enjoy consuming. This outbreak witnessed sagacious, and wealthy, heads knowingly saying ‘I told you so.’
And apparently we can expect much more, and worse, in the future because of the ways in which we live and eat. Last year any question of whether it could have come from any other source was shot down as absurd by dubious fact checkers, and freighted with conspiracy theory fairy dust.
This despite Wuhan containing a level 4 BSL laboratory, and three members of its staff being hospitalised in November 2019 with coronavirus-like respiratory symptoms. Furthermore, this same laboratory was conducting gain of function research into coronaviruses, through a grant form EcoHealth Alliance, an organisation funded by U.S. National Institutes for Health. This type of research using viruses was banned by the Obama administration as being too risky.
Weaponising
This same research is not far removed from the process of weaponising a pathogenic organism. So why did NIH fund this laboratory to carry out this type of research, and who else knew of the potential risks, and incentives, for finding a novel infective agent and researching possible treatments and vaccines?
The first we in the West learnt about any of this came from the videos on TV and social media of people dropping dead in the street – in hindsight clearly not coronavirus cases – and the Chinese locking down it citizens. Next there was Italy, with coffins being carted away by military trucks.
These were all carefully orchestrated publicity stunts, but who was responsible? Who decided to broadcast uncritically these sensational images? The world took note, a pandemic was declared and governments around the world, almost uniformly, imposed harsh and unprecedented restrictive measures on their citizens.
In Britain the initial plan was to protect the vulnerable, through cocooning, whilst awaiting herd immunity in the young. But there followed a swift turnaround in the face of public outcry. In Europe only Sweden resisted the clamour to lockdown and was pilloried in the international media. ‘Sweden has become the World’s Cautionary Tale’ declared The New York Times in July, 2020.
The British government’s approach was strongly influenced by the epidemiological modelling of Imperial College’s Professor Neil Ferguson, of previous forecasting fiascos. For example, he predicted three to four million deaths from Swine Flu in 2009, which ultimately resulted in less than 300,000 global fatalities.
Ferguson’s Imperial paper predicted 500,000deaths in the U.K. in an unmitigated scenario, and on March 20th, told the New York Times that the ‘best case outcome’ for the U.S. was a death toll of 1.1 million, rising to 2.2 million in a worst case scenario. As of June, the U.S. has seen just over 600,000 deaths, and the U.K. 127,945, in circumstances where the attribution of death to Covid-19 is often deceptive.
Further doom and gloom laden scenarios was provided by Professor Christian Drosten, head of the institute of virology, Charite university hospital, Berlin, while alternate modelling provided by Professor Michael Levitt, Stanford University and Nobel laureate was ignored.
Dorsten’s main contribution to this story is his paper ‘Detection of 2019 novel corona virus by real time RT-PCR’ outlining the basis for the widely used Drosten-PCR test that has been criticised for multiple errors, and the haste with which it was published. This test is now the most widely used diagnostic test for Sars-CoV2.
This is despite its invenor Kary Mullis’s – Nobel laureate for chemistry for his work with PCR – stating unequivocally ‘it doesn’t tell you if you are sick’.
There are a number of criticisms of the Drosten method in that he reportedly developed it using partial genetic sequences provided by the Chinese, in conjunction with sequences from other corona viruses. Furthermore, the test which according to Kary Mullis is a quantitative test, is not reported to clinicians this way.
Instead a qualitative result ‘detected’ or ’not detected’ is reported without giving the cycle threshold, even after the WHO suggested physicians should be given this figure. The significance of the cycle threshold harks back to Kary Mullis’s ‘it doesn’t tell you if you are sick.’ Even Dr Anthony Fauci of the NIAID (National Institute of Allergy and Infectious Diseases) has stated that at ct values of greater than 35 it is unlikely that any live virus is present in the patient.
Why then did Irish laboratories use ct values as high as 45? And why did we go from testing inpatients with PCR, knowing the false positive rate, to the community setting and especially the asymptomatic, given asymptomatics are often ‘false positives’, leading to an inflated ‘case’ count.
One has to wonder if the state’s spending of an estimated €400 million on PCR testing has been a case of noses in the trough not wanting to avoid the public smelling the coffee. Who were the people with vested or conflicted interests in this issue?
Churchillian Speeches
Most Western governments, including Australia and New Zealand, paraded their respective Prime Ministers before the cameras to make speeches of Churchillian gravity, implicitly likening the threat of Sars-CoV2 to World War II. Leo Varadkar even paraphrased Churchill in his first speech to the nation -’never will so many ask so much of so few,’ before imposing unprecedented draconian lockdown measures, based on fear.
Along the way we have heard words of caution from notable academics including Stanford Professors John Ioannidis and Jay Bhattacharya, as well as Professor Sunetra Gupta of Oxford University. But these voices were hardly ever heard on Irish mainstream media.
These authorities cautioned that measures would disproportionately hurt the poor and vulnerable; that severe illness was mainly confined to a recognisable cohort, and that there was no evidence for the efficacy of lockdown measures.
Nobody listened. Instead the government closed schools, prevented people from earning a living, stopped all cultural and sporting activity, prohibited religious worship and confined travel to within five kilometres of home.
For months elderly people languished alone in nursing homes and hospitals, some dying alone; women gave birth without their partners; funeral rites were severely curtailed, as basic civil rights were completely ignored in response to an illness with an estimated infection fatality rate of 0.05% for anyone under the age of seventy years.
Every night the state broadcaster became the government’s harbinger of doom with the recitation of nightly death tolls. What purpose other than ratcheting up of fear did this serve?
Through the diligent questioning of Michael McNamara TD, however, we know that the reported mortality figures included anyone testing positive in the previous twenty-eight days with a PCR test, no matter what their underlying condition. Deaths unassociated with Sars-CoV2 were obviously irrelevant.
They turned out to be very relevant as the CSO annual death figures of 6.4 per 1000, which were little different to previous years, and even less than 2013. Why then, when death figures dropped, did reporting switch to the spurious concept of ‘cases’, defined by a positive PCR test? Why did the Irish government shamefully enlist the services of RTE in terrifying the nation, and why did the state broadcaster acquiesce? Answers on the back of a postcard…
Disproportionately Affected
The message ‘we are all in this together’ was a big lie. The disease disproportionately killed people over the age of eighty, especially those in nursing homes, many of whom were needlessly infected after being transferred to hospitals with testing withdrawn at the height of the pandemic in spring 2020. The obese, those with diabetes, chronic heart and lung diseases are also disproportionately affected.
Some people find it hard to believe that when Care Home residents were in the greatest need for testing and diagnostics, testing service was pulled from the entire sector for 3 weeks, to preserve test supplies for the general public. Most died in Homes many/most were not tested. pic.twitter.com/EFi8XsRqER
These pre-existing morbidities are more prevalent among lower socioeconomic groups in society. So we were clearly never all in this together.
Civil servants, including politicians and the medical profession, those working in IT and for media corporations, could easily work from home, but nearly half a million people had to stop work for the duration, especially those in the tourism and hospitality sectors. These are mainly young people, and like children, most would only have been mildly effected by the virus. So why were they forced to suffer unnecessarily?
Moreover, why did small retail outlets have to close for months on end, while off licenses and fast food chains were deemed essential services?!
States of Fear
The kind of Propaganda devised by Sigmund Freud’s grandson Edward Bernays who infamously made it fashionable for women to smoke, was evident in the government’s manipulation of the figures, and the media’s delivery. Bernays wrote in Propaganda (1928) ‘The conscious and intelligent manipulation of the organised habits and opinions of the masses is an important element in democratic society.’
A host of celebrity scientists appeared, many with Conor McGregor levels of empathy, only better elocution, a gentler demeanour and less tattoos. Trite experiments were undertaken on popular TV shows, where we found dour funereal forecasts from infectious disease experts, who were invariably wrong in their predictions, and inane squeaking from a misplaced neuroscience.
This is a brilliant blog post which should be ready by every journalist covering Covid-19. It takes aim at several ubiquitous experts who have made wildly inaccurate predictions and who have not been held to account for those predictions. https://t.co/1QgEahaxfH
All of these ‘experts’ sang in unison. Dissenting voices were heard briefly and infrequently. Some lost their jobs merely for disagreeing with the bull-in-a-china shop approach taken by the HSE/NPHET/government.
In her new book States of Fear Laura Dodsworth outlines how the UK government used behavioural psychologists, probably via their Nudge unit, to control the population through the deployment of carefully selected ‘experts’ and repetitive messaging on news broadcasting.
This was substantiated in the recent testimonies by Dominic Cummings, the former chief adviser to Boris Johnson. ISAG were also familiar with scaremongering techniques, as intercepted emails highlight their tactic of targeting and discrediting individuals, and keeping fear ramped up as a tool in their ZeroCovid campaign.
To quote Bernays again ‘there are invisible rulers who control the destinies of millions. It is not generally realised to what extent the words and actions of our most influential public men are dictated by shrewd persons operating behind the scene.’
Using this sinister playbook, between them NPHET, ISAG and the government managed to sow a level of fear, suspicion and division in society that may take years to unravel.
Flatten the Curve?
Despite all the hype around flattening the curve to save the health service at the beginning of the pandemic, and the use of draconian measures to do so, alas nothing was done to treat patients at home.
Several readily available, cheap and relatively safe products, were hypothesised to have positive benefits in the early stages of a Sars-CoV2 infection, but there were systematic efforts to steer physicians away from these.
The ICGP guidelines for GPs on the treatment of early Sars-CoV2 amounts to do nothing, and wait for patients to get better, or if they fall really ill send them into hospital. Some doctors in the USA lost their licenses for prescribing these medications, and others in Ireland faced censure by the Medical Council.
According to physicians like Peter McCullough, Professor of Medicine at Baylor University, Texas in conjunction with AAPS (The association of American Physicians and Surgeons), and separately Dr Pierre Kory of FLCCCA (Front Line Covid Critical Care Alliance) Sars-CoV2 was empirically treatable, especially in that first week before the patient became very unwell.
https://vimeo.com/560523610
So, despite a concerted effort to vilify them, they treated their patients. Why did Irish GPs, save for a few, fail to do so?
In doing nothing did many patients needlessly died? With our widespread application of lockdowns and our disregard for focused protection measures, as advocated by the Great Barrington Declaration (which has garnered 850,000 signatures, including 43,000 from medical practitioners) coupled with our refusal to at least try and treat patients, have we done a great disservice to our patients?
Perhaps one of the main reasons for the concerted campaign to ensure that no other treatments were deemed suitable for the early treatment or prevention of the disease was the FDA criterion for an EUA (emergency use exemption). No such exemption would have been granted to a product in such an early stage of development, without animal or human study data, except in what are deemed to be extraordinary circumstances.
€26 billion – the amount Pfizer expects to earn this year after producing the first Covid-19 vaccine – might buy a lot of scientific validation, and political influence.
The undue haste with which these vaccines have been rolled out demands sceptical enquiry, especially in relation to two particular cohorts: pregnant women and children. As clinicians we generally exercise extreme caution in these groups.
So why is it that for a condition with an overall IFR of 0.15% have we discarded this caution? Linking vaccination status to the right to work, travel, attend cultural and sporting events is divisive, coercing those who wish to exercise a degree of caution and/or exercise autonomy over their health.
Without the questionable concept that is asymptomatic spread, there is no justification for vaccinating anyone in low risk groups, and certainly no justification for using bully tactics.
Despite all these glaring questions, there has been a deafening silence from the medical profession in Ireland, and those that have spoken out have been quickly silenced. Is this how we are going to deal with complex issues in future? Adopting binary, categorical approaches without nuance leaves no room for debate.
RTE have paid lip service to the notion of an informed debate, hosting Martin Feeley and then later pitching Professors John Lee and Sunetra Gupta into debate with hand-picked stalwarts.
Moneybags
In Ireland today scepticism is viewed as a contagion to be eradicated, with compliance seen as the perfect state of health. As a nation we must ask: why have so many been so quiet; why has fear replaced reason, and groupthink taken over once again?
One must question the role of doctors ‘stuffing their mouths with gold’ as Aneurin Bevan put it in relation to British doctors at the inception of the NHS. A quick look at the 2019 PCRS payments to GPs shows a healthy €85 million in government expenditure. This, however, mushroomed to over €200 million for the same period in 2020.
Some were clearly making a killing during the pandemic. And whose idea was it to advise doctors not to see patients face-to-face during the pandemic? If a doctor won’t see you who will?
Further to this windfall will be vaccination payments at a cool €60 per patient. Is it any wonder GPs want everyone vaccinated?
There may even be boosters for variants required for everyone on the planet! The media should be asking the question: who is benefitting from this Monty-Pythonesque situation?
Certainly any government with the slightest authoritarian bent, which it transpires appears to be most Western ‘democracies’. It really is worrying how little opposition there has been to Chinese-inspired lockdowns, with opponents dismissed as a far right fringe – even by the apparently left-wing opposition – despite the obvious damage these policies have done to the poorest, who were also least protected by the measures.
Why did so many European governments fall into line so quickly, when even a passing familiarity with EU politics would indicate that it can take years for Member States to agree on the number of legs that the average cow possesses?
If you intuit that something is just not right, and baulk at jingoistic phrases like ‘the new normal’ and ‘build back better’ ask yourself cui bono or ‘who benefits’, and don’t let the fear of being labelled a ‘conspiracy theorist’ dissuade you from asking reasonable questions.
4,915. And rising. This number can only increase or, at best, stay the same. It can never go down. Of all the innovations that governments and media around the world have come up with, seemingly independently of each other, during the ongoing Covid period perhaps the most insidious is the daily running total of deaths.
I have often wondered what purpose this number serves. At a time when we are frequently told by the media and government to ‘follow the science’, what could be more unscientific than a figure which, even when nobody is dying, looms above us as a warning that danger is ever present and nothing has improved.
But take the number of people who are unemployed, a figure that has reached terrifying proportions without any sophistry or assistance from behavioural scientists. In fact, a lot of effort is expended on massaging this number downwards from the actual amount to levels more palatable for public consumption.
But imagine that we calculated the number of unemployed by concocting a total of all those who have been laid off – jobs that have died – at any time and for any duration, during the past thirteen months? Or since unemployment began, a running total of all the people who have been unemployed ever?
What function would that number serve? Might it help prevent future unemployment? Might it better inform us of the skills and training required for our workforce? Might it be useful for analysis and reporting? As Frankie Howerd used to say, “Nay, nay, and thrice nay.” I wager any civil servant who proposed such an idea would soon be on their way to early retirement, and be about as popular with politicians as a Garda on breathalyzer duty outside Leinster House.
Yet that’s exactly what we do with the running death total (and its near twin the running case total) for Covid. If the purpose of this number is to show where we currently stand amidst the ebbs and flows of the pandemic, then surely a monthly or a weekly total would do the job better. We could then, as we do with the unemployment figure, compare this month to last (or this week to last) and judge which way we’re going. Are we moving steadily forwards? Are we tumbling hopelessly backwards? You get the idea.
Why haven’t we ever had a running total of deaths from cancer, heart attacks or diabetes? If we’d started even a year ago, these numbers would be at impressive levels now. Cancer and diseases of the circulatory and respiratory systems certainly dwarf the Covid tally.
Surprisingly, Worldometer hasn’t tried to do something like this. To many of us, Worldometer is the central hub of running Covid death totals. Currently, it trumpets a formidable 593,148 deaths for the United States, a daunting 127,570 for the United Kingdom and, as mentioned at the start, a not inconsiderable 4,915 for Ireland.
But what do these frightening numbers refer to? Well, they refer to the number of Covid-19 deaths. So what’s all the fuss about? The fuss is over what constitutes a Covid-19 death. So what is meant, exactly, by a Covid-19 death? Here is where it starts to get a bit complicated.
Some doctors expressed concern about what they felt would give a misleading picture of causes of mortality. These rules, they said, were unprecedented and would lead to the over-reporting of deaths from Covid-19 and the under-reporting of deaths from other causes. Their warnings went unheeded and, for the most part, unreported. There was no place for prudence and common sense amid the frenzy and hysteria of the early days of the pandemic.
Even CMO Tony Holohan acknowledged in April last year: ‘Clinically, the “index of suspicion” for the disease would be “a good deal higher” than would normally be the case for flu.’
Since then numerous medical professionals have added their voices to this dissenting chorus. The latest Patrick O’ Connor is coroner for Mayo and public information officer of the Coroners Society of Ireland. O’Connor has expressed his discomfort at official reporting of Covid-19 deaths in this country: “I think numbers that are recorded as Covid deaths may be inaccurate and do not have a scientific basis”, he said earlier this month.
Let’s take a look at the International Medical Certificate of Cause of Death (MCCD). For this section I am indebted to Dr. No, the author of the ‘Bad Medicine’ blog, for his succinct explanation of how the MCCD works and how, in practice, the WHO guidelines affect this process. I recommend his article about this if you want a more detailed understanding of the topic.
The MCCD was introduced by the WHO in 1948. Its purpose was to create an international standard for the recording of deaths and to describe the sequence of events which led to a death, rather than just the immediate cause (as was common in many countries at that time).
Frame A (above) is the most important part of the MCCD. It is here that all significant information about a death is recorded. As you can see, Frame A has 2 boxes. Box 1 is for recording the cause of death, Box 2 is for recording contributing conditions. Box 1, the cause of death box, has four lines: the first line records the immediate cause of death, the remaining lines record any conditions which led to the immediate cause of death, with the last line containing the underlying cause of death. The idea is to record the sequence of events which led to the death.
To give an example. A person with diabetes dies from a heart attack, which was caused by heart disease.
So the first line in Box 1 contains ‘Myocardial Infarction’ (the clinical name for a heart attack) because a heart attack was the immediate cause of death. The second line contains ‘Ischaemic Heart Disease’ (the clinical name for heart disease) because this is the underlying cause of death. This is the condition which initiated the sequence of events which culminated in the person’s death: the heart disease led to a heart attack. The remaining lines in Box 1 are left blank because this person had no other conditions which contributed to the sequence of events leading to their death. Diabetes is recorded in Box 2 because this is a contributing condition, rather than being a part of the sequence of events which led to death. This death will be registered as ischaemic heart disease (or simply heart disease) because this is the underlying cause of death.
Another example. A person dies from internal bleeding due to a ruptured artery as the result of a road traffic accident.
The first line in Box 1 contains ‘Internal Bleeding’ because this is the immediate cause of death.
The second line contains ‘Ruptured Artery’ because this is what led to the internal bleeding.
The third line contains ‘Road Traffic Accident’, as this was the underlying cause of death: it was a road traffic accident which initiated the sequence of events that led to the death. In this instance, Box 2 is left blank as there were no contributing conditions. So, the road traffic accident led to the ruptured artery which led to the internal bleeding. This death will be registered as a road traffic accident.
“clinically compatible illness”
The WHO’s guidelines define a Covid-19 death as “a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma).” This is an extremely vague definition and one which allows for a rather broad interpretation of what can be considered a Covid-19 death.
As can be seen from the HSE’s website or that of the UK’s NHS, there is a large overlap between the symptoms of Covid-19 and those of any number of other respiratory conditions or Influenza Like Illnesses (ILIs). Any of these other conditions can be considered a “clinically compatible illness”. You will note that Covid does not have to be confirmed: a “probable” case is sufficient for inclusion as a death. As Dr. No puts it, “If it looks like Covid-19, it is Covid-19.”
The guidance goes on: “A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19.” This is very important. What physicians are being told here is that, when they have identified a Covid-19 death (using the loose “if it looks like Covid” definition), then regardless of any pre-existing conditions which may have triggered severe Covid-19, the death must be registered and counted as a Covid-19 death. This goes against all conventions for identifying the cause of death.
So how does this relate to our MCCD form? Well, in our earlier examples of somebody dying from a heart attack and somebody dying in a road traffic accident, there should be no difference in the way the deaths are recorded. In fairness to the WHO, they are quite clear in their guidance that these two types of death should not be recorded as Covid-19. (Unfortunately, this has not stopped overzealous authorities around the world from registering heart failure, motor accidents, suicides and murders as Covid deaths).
However, when it comes to most other types of death, we start getting into murky waters. Take the example of a person who dies from pneumonia, caused by immobilisation, which itself was caused by multiple sclerosis.
In this case, the underlying cause of death is multiple sclerosis. Why? Because multiple sclerosis led to immobilisation which led to pneumonia. So this death will be registered as multiple sclerosis.
Now, let’s imagine this person had tested positive for Covid-19.
Notice anything strange? Because of the WHO guidelines, the underlying cause of death is no longer multiple sclerosis, but is instead Covid-19. Multiple sclerosis (and immobilisation) gets moved to Box 2, it’s now been relegated to a contributing condition. This death will be registered as Covid-19. Remember the WHO said in their guidelines “A death due to Covid-19 may not be attributed to another disease and should be counted independently of pre-existing conditions.”
@apoorva_nyc quoted the potential false positive rate at between 43% and 90% in August.
I would assume one major issue is that we are misdirecting treatment and prevention efforts from the most infectious to the non-infectious. https://t.co/LORjMJx6pu
So here we have the case of an unfortunate individual whose multiple sclerosis, over many years, caused them to become immobile. Immobility, sadly, can lead to pneumonia which, especially for the aged and/or immunocompromised, often results in death. However, because of the WHO guidance, the presence of a positive PCR result alone means that all of their medical history, the entire chain of events which led up to the person’s death, is cast aside and replaced by the misleading explanation of Covid-19.
But the issue goes even deeper. You’ll recall that the WHO’s definition of a Covid-19 death includes “probable” cases as well as “confirmed” ones. Our final example describes an individual who dies from acute respiratory distress syndrome (ARDS), caused by pneumonia, which itself was caused by chronic obstructive pulmonary disorder (COPD).
As you can see, the underlying cause of death is COPD, which led to pneumonia, which led to ARDS. This death will, of course, be registered as COPD.
But what if this person had had contact with someone known to have Covid-19 or even with a person suspected of having it? Here’s what would happen to the MCCD:
The underlying cause of death is now ‘suspected Covid-19’, which, in the figures we see on the nightly news and in the vast majority of statistics made available by governments, is treated in exactly the same way as a confirmed Covid-19 death. The WHO’s clinical coding instructions insist that it is, so long as the deceased had “contact with (a) confirmed or probable case.” The COPD which caused this person’s pneumonia is cast aside, no longer considered to have played a part in the sequence of events that led to their death.
This is absurd. Yet this is how deaths around the world are now being recorded and registered. If somebody is dying of heart disease, liver disease, respiratory disease, cancer, dementia or any other terminal illness, and they have a positive PCR test or have simply been in contact with somebody suspected of having Covid, their death is now registered and counted as a Covid-19 death. Any pre-existing condition, no matter how serious and no matter what part it played in their ultimate demise, is moved to Box 2 of the MCCD and not recorded as the underlying cause of death. The WHO guidelines state, in the section entitled “Comorbidities”, that “if the decedent had existing chronic conditions…they should be reported in Part 2 of the medical certificate of cause of death.” Conditions which for more than seventy years, since the introduction of the MCCD form, have been understood as underlying causes of death, are now rebranded as contributing factors. All to make way for the mighty Covid.
Massive Inflation
The result is a massive inflation of the numbers of Covid-19 deaths. As Patrick O’Connor, the Mayo coroner, says, when speaking about terminally ill patients, “If they prove to be Covid positive in a test, it is that (Covid) which is recorded as the principal cause of death — even though that person may have been terminally ill with a short life-expectancy prior to such testing.” And, as we have seen, a test is not even necessary, as the WHO’s guidelines instruct physicians to include “probable” with “clinically compatible” illnesses in the tallies.
Even before the WHO issued their guidelines on 16th April last year, Italian authorities had been using a similar method to register Covid deaths, with 88% of patients there (up to March 20th, 2020) having at least one comorbidity and many having two or three. In addition to hugely inflating the number of deaths from Covid-19, this bizarre way of counting also distorts the mortality rate of the disease, making it seem far more deadly than it actually is.
In 2020, a total of 73,444 people died in England and Wales with Covid-19 recorded as their underlying cause of death. In response to a freedom of information request, on 29th March 2021, the UK’s Office for National Statistics revealed that only 9,400(12.8%) of that number were recorded without pre-existing conditions.
Interesting but not a surprise. In Ireland we counted all deaths, in all settings, suspected cases even when no lab test was done, and included people with underlying terminal illnesses who died with Covid but not of it.
On July 3rd last, Ireland’s then acting Taoiseach, Leo Varadkar, tweeted, “In Ireland we counted all deaths in all settings, suspected cases even when no lab test was done, and included people with underlying terminal illnesses who died with Covid but not of it”, revealing that the numbers of Covid-19 deaths in Ireland were vastly exaggerated and in no way reflected the lethality of the disease in this country.
Although the complete death statistics for 2020 have not yet been made available for Ireland, in April, 2021 Kildare coroner Professor Denis Cusack published a report analysing deaths in that county during the pandemic. Of 230 deaths recorded with Covid-19 as the underlying cause, 228 (99.13%) had pre-existing conditions.
Fewer than 1% Died Without a Comorbidity
I would have thought that this was a significant finding, that fewer than 1% of the people who died from Covid-19 in County Kildare did not have comorbidities. But, like anything else that doesn’t fit in with their campaign of terror against the Irish people, the Irish media was having none of it. While both RTE and The Irish Times gave coverage to Professor Cusack’s report, neither had anything to say about the 99.13% of Kildare’s Covid dead who had pre-existing medical conditions. Nor was there a mention of the average age of death in this cohort being 82.2 years of age. Both news services instead chose to focus on selected aspects of the report which they used to support the ‘lethal virus’ narrative they have long pushed. Is this censorship? Maybe it’s just extremely poor journalism.
The running total of deaths is one of the pillars that supports this whole charade. The narrative of a deadly pandemic would never have worked without the impression of huge numbers of fatalities, countless lives ‘lost to Covid’. The unprecedented changes in the way deaths are counted allowed this to happen. You would imagine such a fundamental change, one which has had such a colossal impact on every man, woman and child on the planet, would be widely reported and discussed. Yet it is almost impossible to find a mention of it anywhere in the mainstream media.
There needs to be an urgent investigation, on a global scale, to find out how the Covid pantomime was allowed to happen. And we need one in Ireland, to determine who knew what and when, and exactly who has benefitted.
Walk-in Testing Centres
The current narrative being spun in Ireland is that we are close to ‘finding a way out’ of lockdown and that, if we behave ourselves, we might be permitted some limited freedoms during the summer. This is hardly surprising. We’re coming to the end of coronavirus season, which means it’s so much harder to inflate ‘cases’. And because mortality rates in the Northern Hemisphere are typically at their lowest during the summer months, it’s not as easy to attribute huge numbers of deaths to Covid-19. It was the same last summer.
But the government has been preparing for this. Already, there are 5 walk-in testing centres in operation in Ireland, with many more planned – a perfect way to boost the numbers and keep us on our toes for the summer months. And, of course, the government reserves the right, at any moment, to slap us all back into lockdown.
At the same time, it has been made abundantly clear that whatever limited freedoms we might be permitted will be contingent on mass vaccination and, before long, vaccine passports and digital identity. And don’t forget, coronavirus season comes around again in September. But, as we have seen, the lethality of this disease, for which we’ve radically changed the way we live and have forsworn so much of our freedom, has been blown out of all proportion by the fraudulent way in which deaths are registered.
We suffered under austerity for a decade. It’s hard to believe that the same politicians who decimated our health service, causing untold hardship and death, now want to protect us. Do we trust they are spending our money honestly and wisely? How much is being spent on mass vaccination, testing, tracing, the vaccine passport infrastructure? And what is the cost of the Covid period to our economy? The whole circus makes a mockery of the years of austerity and of every person who suffered because of them.
Cost to our Health
Then there is the cost to our health. Many have lost their lives because of this deception, but you don’t see a running total of their deaths on the news every night. How many have died due to a lack of primary health care, which has been sidelined and neglected, sacrificed at the altar of Covid? How many cancelled surgeries and missed screenings? What about those in urgent need of treatment who were too frightened to attend a hospital? And those who were turned away before they even reached a hospital, because Gardai at a checkpoint deemed their need not sufficiently urgent?
The mental health of our nation has taken a nosedive, not due to Covid but because of lockdowns and other unwarranted sanctions against our people. Loneliness, depression and despair have all taken their toll. The US Centres for Disease Control and Prevention (CDC), hardly a radical anti-lockdown stronghold, has estimated that one third of all excess mortality in the United States during 2020 was due to reasons other than Covid-19.
We’ve been deceived. When important facts are left out of a narrative in order to foster a misconception, we call it lying by omission. We have been lied to by politicians, public health officials, wealthy media barons and the stooges who write for them. And we have paid a terrible price. In the twilight of our freedom, it’s time for us to stand up for the truth.
If this were indeed implemented in Ireland, and more particularly in the case of alcohol, there would be immediate cries of excessive intervention in the private lives of the citizens of the State. This would be a perfectly reasonable argument in the absence of a state of emergency, such as we find ourselves in over the course of the past fifteen months.
Ireland’s Kantian Approach
Overreach?
Physically active older adults (≥60 years) are at a reduced risk of all-cause and cardiovascular mortality, breast and prostate cancer, fractures, recurrent falls, ADL disability and functional limitation and cognitive decline, dementia, Alzheimer’s disease, and depression. They also experience healthier ageing trajectories, better quality of life and improved cognitive functioning. Inactivity over the past seventeen months will have dreadful ramifications for a significant proportion of the people that we have sought to protect.
The common argument in favour of lockdowns is that their adverse effects are not multiplicative. I would argue the opposite. The longer these measures remain in place, the larger the long-term effects on children. A study in Oxford demonstrated that children had essentially learned nothing over the course of the pandemic year 
In Summary
