Humble Pie and Drawn Swords

One of the biggest rewards for any writer is knowing that the end product of hours spent slaving away in a draughty garret is actually being read by someone. I was therefore heartened to receive feedback from two eagle-eyed readers a couple of weeks ago, who noticed that Henry V (1386-1422) could not possibly have been responsible for the Apothecaries Act of 1815 without, as one put it, receiving divine intervention. How right you are, and you have my apologies for a spot of poor editing. What I had intended to convey was that, in order to suppress the quacks, Henry V issued a variety of decrees which ultimately became enacted, during the reign of George III, in the form of the Apothecaries Act of 1815.

Having now returned from an evidently much needed vacation, I am reminded of the words of Alfred, Lord Tennyson, who wrote ‘For man is man, and master of his fate’. Sadly, his optimism would seem misplaced today when it comes to the fate of doctors, with another of his lines being more apt: ‘So all day long the noise of battle rolled’. So it would seem from the recent headlines in the medical press. For example, GP Business informed us that Andrew Lansley is ‘launching his charm offensive’; surely a multi-layered contradiction in itself.

Elsewhere we are told that the Secretary of State for Health says ‘GPs have an ethical duty to cut costs’. Now, of course we understand that finance needs to be considered, but for us medical chaps that rather awkward ethical duty to treat patients keeps cropping up and getting in the way, Mr Lansley; but I guess that isn’t a concern that troubles you too much, as long as the budget breaks even. Whilst we accept the need for transparency in the way tax-payers money is spent, I am equally sure that tax payers do not want to be sold short when it comes to receiving the best treatment for their illness. If what I can offer my patients doesn’t equate to what I would find acceptable for a member of my family, then I am not fulfilling my primary role as the trusted physician. It is no coincidence Mr Lansley, that, when placed in alphabetical order, patients come first, physicians next and politicians last; and thus it should be so in terms of providing care.

Whilst I have been away, it has also been decreed that ‘practices must provide online booking by 2015’. Now, that is one where I am sure the proven ability of the NHS to come up with suitable computer software and associated security will not be found wanting. I jest of course. Seeing is believing, but I wouldn’t hold your breath just yet.

That the Department of Health has agreed to a 20% rise in GP training places by 2015 is obviously good news at face value. Nonetheless, it will take a further four years for those doctors to come out of the system as fully-fledged GPs. At present, the number of GPs is down to 1999 levels. With 8% of GPs leaving the NHS in 2010, 22% now being over 55 years, and consultations set to rise to 433million per year by 2035, there may be light at the end of the tunnel in terms of training, but it is still presently a very dark place at the coal-face, and that needs to be promptly addressed to avert a significant manpower crisis. So, unless something is done now to attract trained GPs back into the NHS, or to stop us older ones from running with the remnants of our sanity for the exits earlier than necessary, the current national shortage of GPs will continue for the next decade.

The one delightful piece of news ironically comes from an obituary for a paediatrician in the USA, who only retired at the age of 103. She died in April at the grand age of 114, which lends a hearty boost to my much-publicised intention to hold a 120^th birthday party in January 2080. Keep that date in the diary; though at this rate, I may have to couple it with a retirement party. 

(First published in the Scunthorpe Telegraph, Thursday, 7^th June 2012.)

Time to Decriminalise Drug Addiction?

Just the word ‘addict’ is enough to conjure up a negative impression in many people’s minds. Precede it with the words ‘book’, ‘telly’, or ‘exercise’ and it softens the perception. However, try ‘drug’ or ‘alcohol’ instead and the negativism drops off the chart. In western society, drug addicts are often perceived to be amongst the worst members of society, with alcoholics not that far behind. For many people, the concept invokes images of seedy squats, down-and-outs, crime, prostitution, discarded needles, HIV, hepatitis, wasted lives, early deaths…the list is endlessly dismal. Such people are perceived by many to be untrustworthy as employees and undesirable as neighbours.

However, what if your neighbour happened to be the author Jack London, famous for his books ‘The Call of the Wild’ and ‘White Fang’, who rewarded each 500 words written with an alcoholic drink; or the writer Robert Louis Stevenson (of Jekyll and Hyde fame), addicted to hashish, opium and cocaine, and who thought wine was ‘bottled poetry’? Alternatively, consider the poet Dylan Thomas, the mind behind such invocative poetry as ‘Do not go gentle into that good night’, and who rather pertinently said that ‘an alcoholic is someone you don’t like, who drinks as much as you do’. Then there was Aldous Huxley, the author of the classic ‘The Doors of Perception’, which was written whilst under the influence of the psychotropic drug mescaline. The list is endless, and includes the likes of poets and writers such as Thomas de Quincey, Lord Byron, Percy Bysshe Shelley, John Keats, Charles Dickens, Edgar Allen Poe, Samuel Taylor Coleridge, and Sir Arthur Conan Doyle, all of whom were addicted to the opium and alcohol mixture known as laudanum.

Now, not for one moment do I want anyone to believe that I am condoning the misuse of drugs and alcohol. Many of the aforementioned famous personalities died of illness brought on by addiction. My point is to illustrate that our perception of whether or not the addiction is generally acceptable depends on whom the person is, and how they deal with their addiction. For example, the controlled use of alcohol is accepted by most people in our society; being drunk in the city centre on a Saturday night is not acceptable to most. With some notable exceptions (such as the late Amy Winehouse), what also differentiates the acceptable from the unacceptable is the availability of money. Drugs tend to be expensive; mainly because of their illicit status. This in turn fuels the negative spiral of people turning to crime and dropping out of acceptable society to fuel their addiction. To compound the issue, in many areas the most successful rehabilitation centres are only available to the wealthy.

Drug addiction, as anthropological research has shown, has always been with us. It is equally true to say that it will never disappear, and it is not just a problem associated with the young. According to some studies, illicit drug use in those over 50 years has increased by a factor of ten since the mid-1990s. In London, for example, one in ten over-sixties regularly uses cannabis. Other drugs featured in these studies of the older population include cocaine, ecstasy, LSD, amphetamines, and tranquilisers.

Additionally, throughout the world the criminalisation of drugs is causing hardship in, and destruction of, whole countries; many of which are in South America. As a result, global initiatives are now taking place to consider drug policy reform. There is a very rational, public health argument for decriminalising drugs, and substituting litigation with appropriately resourced treatment for addicts. Increasingly, doctors are calling for evidence-based policies in respect to drugs. The evidence in respect to the potential health-gains for society is out there; we now all need to suppress our prejudices and encourage our politicians to effectively engage in this important debate.

(First published in the Scunthorpe Telegraph, Thursday, 31^st May 2012)

Time for More Compassion

All professional bodies have codes of conduct, expounding the ethical principles that underpin the manner in which its members are expected to act. For doctors, the code comes in the guise of a document called Good Medical Practice, published by the General Medical Council (GMC). Likewise, the House of Commons produces a guidance code for Members of Parliament, Funeral Directors have theirs, and the Press Complaints Commission operates a Code of Practice for newspapers. In Addis Ababa, Ethiopia, where the World Congress on Public Health recently took place, there was a publically displayed list of Principles of Ethical Public Service, listing integrity, loyalty, transparency, confidentiality, honesty, accountability, serving the public interest, exercising legitimate authority, impartiality, respect for law, responsiveness and leadership as pre-requisites for service. In America there is even a Code of Practice for Columnists. The interesting thing is that nowhere in these documents appears the word ‘compassion’.

The Oxford English Dictionary defines compassion as ‘sympathetic pity and concern for the sufferings or misfortunes of others’. In turn, ‘sympathy’ is the feeling of pity and concern for the affected person or people; it is showing that one understands their plight.

However, Kamran Abbasi, editor of the Journal of the Royal Society of Medicine, recently expressed the opinion that ‘compassion isn’t even a dirty word in the NHS…with clinicians too preoccupied with targets, efficiency drives, and restructuring to care for their patients’ (JRSM 105, p. 93).

Yet, according to a survey by the GMC, compassion, kindness and empathy are qualities which people feel are important and should be portrayed by doctors. Why then, do so many codes of practice leave out such important values? Is it that you can train people to act with all the principles expounded in the Addis Ababa example above, but cannot enforce a quality that comes from deep within one’s own personality?

The Dalai Lama, the Tibetan Buddhist spiritual leader, recently wrote on the social network site Twitter (@DalaiLama) that ‘even our personal virtues, such as patience and our sense of ethics, are all developed in dependence upon others’. He said ‘fear, hatred, and suspicion narrow your mind - compassion opens it’. In his view, ‘once you realize that compassion is useful, that it is something really worthwhile, you immediately develop a willingness to cultivate it’.

To those who are religious and profess their faith in their daily lives and actions, the concept of compassion is real and becomes second nature. Many would agree that compassion helps in effectively communicating with others. Such action can also be self-rewarding for, again in the words of the Dalai Lama, ‘if you become more concerned for the welfare of others, you will experience a sense of calm, inner strength and self-confidence’.

Of course, self-reward is not principally what serving humankind is all about. However, nobody should object to a free dose of the ‘feel-good factor’, and if it means that the behaviour that earned the reward is more likely to be repeated, then who should complain about that? The sad part about all this is that ‘tender loving care’ or TLC as it was often known, is no longer seen as an appropriate form of treatment on its own. Indeed, it is often completely lacking, even when every other treatment has been exhausted.

Even in the 21^st century, nobody has all the answers, and there is no cure for all ills. Compassion is often the most valuable tool left in the armoury and it should be deployed more frequently and effectively by all healthcare workers. It is also a tool that should be honestly wielded by everyone in public service (politicians take note), and indeed, by all of us in our daily interactions with each other. That said, it is not something that can be learned or fabricated; it needs to be felt. The starting point is to search deep inside oneself, find that hidden quality, and then bring it to the surface. The entire world would be a better place if we all put compassion into it.

First published in the Scunthorpe Telegraph, Thursday, 24^th May 2012.

Quote of the Day

'Not all those who wander are lost.'
J.R.R. Tolkien

Beware a Secretary of State Bearing Gifts

Today, I would like to remind you of a tale from Greek mythology. It concerns the city of Troy; a city that did in fact exist and whose ruins can still be seen today in northwest Turkey. Troy was the centre of the Trojan Wars, which occurred somewhere between 1200 to 1400 B.C. About that time, the ruling Royal family of Troy was King Priam and Queen Hecuba, and they had a beautiful daughter called Cassandra. Unfortunately for her, Cassandra had the power of foresight. I say ‘unfortunately’, as on many occasions nobody was prepared to believe her. One of her disregarded prophesies was the destruction of the city of Troy; something which indeed took place (remember the story of the Trojan Horse?). In modern times, the term ‘Cassandra Syndrome’ is used to describe the malady affecting those who disbelieve predictions of doom until the events actually occur.    

Now, on no account am I suggesting that I can be compared with an attractive lady of royal parentage. However, I do feel that I am one of a growing band of doctors who have the power of prophesy (solely, it must be said, in relation to the future of the NHS) but have up to now been largely ignored. I can almost hear you yawn at this stage, and I appreciate that it may be a little tedious, but I make no apologies for returning again to the subject of the new Health & Social Care Act. Please read on, because I have a job for you all to undertake.

The fact is that, although the Act has been passed by Parliament, the detail has still to be implemented. In this respect, we can all be influential and potentially alter the destructive power of this Trojan Horse that now stands at the gates of the NHS.

There are two major issues for us. The first is to save the ‘National’ in the NHS. In an attempt to form a shared vision of the future of the NHS, the Royal College of General Practitioners (RCGP) is trying to encourage the adoption of a set of ten ‘core values’, against which the Act will be implemented. These values are: greater involvement of GPs in shaping NHS care, a UK-wide agreement on free NHS services, integration of health and social care, reduced bureaucracy and increased efficiency, patient empowerment, respect for patients’ beliefs and valuing diversity, patient involvement in shaping NHS services, encouraging innovation, promotion of public health, and cutting inequalities.

The second major issue stems from one of these values; that is the need for a national approach to public health. Under the new Act, public health services are moving from the umbrella of the NHS to the local councils. With no disrespect to my local authority colleagues, there is a widespread concern that councils are ill-prepared for this change, especially at times of epidemics. Already, we have seen a diminution of national advertising campaigns (last year’s influenza vaccine campaign suffered as a result, and we had a higher death rate from influenza than most other European countries). The fear is that, with more decisions of this nature being taken locally, will the public be as well informed of major health risks as in previous years? Sometimes, national leadership is the most effect way to get a message across.

So, your task, readers one and all, is to join me, along with my colleagues at the RCGP, and start to question how the Act is being implemented. Talk to your doctors, question your MPs, attend local council meetings, get involved with patient participation groups, write letters to the newspapers; in essence, take control of the future of your NHS. Please do not become victims of the Cassandra Syndrome. The Secretary of State for Health has delivered a modern day Trojan Horse to the doors of the NHS; don’t accept it as the gift he likes to pretend it is. Look to see what lies beneath and neutralise its threat now before it is too late and the NHS becomes your Troy.

(First published in the Scunthorpe Telegraph, Thursday 26^th April 2012)

Welcome to the new NHS

Austerity and rationing: two words which are strongly reminiscent of Second World War years. However, add to them the phrases postcode lotteries, cut-backs, and year-on-year savings and one is rapidly brought into the modern day. A further phrase, the ‘Nicholson Challenge’, is one more familiar to those working within the National Health Service; nonetheless, it has the power to impact upon us all. For the NHS, the Nicholson Challenge is a descriptive phrase that sums up the biggest ‘efficiency drive’ in its entire history.

By the year 2015, the NHS is expected to have found at least £20 billion in savings. At present, that means reducing budgets by 4% per year. In an organisation that is already struggling to meet demands for health care for an increasingly aged population, incorporate the latest treatments, allow access to new drugs, and extend provision of trained staff (e.g. consultant cover at weekends), the savings are not easy to come by. To a great extent, that has been a driving force behind the new Health and Social Care Act; the remorseless reduction in administrative personnel (by closing Primary Care Trusts) and the drive to increase the managerial input from GPs.

‘Putting GPs in the driving seat’ may seem like a catchy, vote-winning strap-line to the latest reforms; in reality, it is ‘GPs in the firing line’. Those difficult decisions about whether a new drug or service can be offered to patients will now need to be taken by your GP through an organisation called the Clinical Commissioning Group (CCG). Many patients will understandably think that is good on the grounds that doctors are supposed to act in the best interests of the patients. The problem for GPs is that, in today’s austere financial climate, restrictions on prescribing have probably never been so great, and they are going to get worse. As a professor of public health research and policy recently told a conference of doctors, ‘you haven’t got any idea what is coming your way; it’s goodbye to professional autonomy’.

The latest news from the Department of Health is that the 4% efficiency drive will need to continue beyond 2015, which means a downward pressure on GP drug budgets for a decade. It is therefore understandable that CCGs greet the arrival of new drugs with dismay rather than clinical excitement. The situation is not helped by the NHS Constitution stating that ‘patients have the right to drugs recommended by NICE for use on the NHS, if your doctor says they are clinically appropriate’. Unfortunately for GPs, NICE (the National Institute for Clinical Excellence) makes its decisions on the grounds of drug effectiveness, not whether the NHS budget can afford it.

One recent example has been paraded widely in the national press. Dabigatran is a new drug that may offer an alternative to warfarin therapy for conditions such as deep vein thrombosis. In many ways, this would offer several advantages to patients and doctors. However, the price tag is steep. It has been estimated that its use will force drug costs up by 20% (£10 million pounds per year in some areas of the country). Set against the need for 4% savings, such a threat to the drug budget is causing widespread alarm, and CCGs are desperately looking at local prescribing policies in order to restrict the use of dabigatran.

The Health and Social Care Act may be here and GPs may well be in the driving seat, but the NHS is on a one-way track; attempts to turn it are equally likely to derail it and now that will be the doctors’ fault, not the politicians’ doing. The danger of failure is the imposition of large corporations in providing commissioning support, with private control of prescribing and referrals; welcome to US-style medical care.

There can be little doubt left that, as GPs, we are now firmly placed between that proverbial ‘rock and a hard place’.

(First published in the Scunthorpe Telegraph, Thursday, 12^th April 2012)

Is the NHS now on Death Row?

At the time you read this column it will be just over one month since the Health and Social Care Bill was passed by the House of Commons. It may be that the Queen has since added her signature and this badly thought-through piece of legislation has taken its place within the laws of our land, despite the collective opposition of most senior health colleges and organisations. Castigated by many for my early, publicly expressed opposition to the proposals, I am now metaphorically deafened by those who have awoken too late in the day to the reality of the destruction to the integrity of our National Health Service that this political axe now threatens.

However, we are where we are and, as with all previous NHS upheavals, those who are already tasked with providing the majority of the health care in this country will roll up their sleeves and try to make a silk purse out of a sow’s ear. I speak, of course, of the General Practitioners; those without whom the foundations of the NHS would simply crumble. I say that, not because I am a GP, but because it is a fact that 80% of health care is performed in General Practice. We are, in effect, the front line of the health service.

That said, it will probably come as no surprise to you if I say that the front line is under siege. The pressures on general practices around the country are already overwhelming, and the bad news is that it is about to get worse. If you have difficulty in getting an appointment to see your GP, thank the government for the mess they have created for us all. Not only are GPs already having to spend many more hours per week in running the health service (not forgetting that the Government shamelessly started to dismantle Primary Care Trusts even before the Bill was passed by Parliament), but a lack of investment in General Practice has left it in a perilous state, with smaller practices facing the potential prospect of closure, and larger practices having difficulty in recruiting new doctors as partners or associates. Even locum doctors are a fast disappearing commodity.

Across the country, an additional man-power crisis is looming. 10% of GPs are over the age of 60. In London, the figure rises to 38%, and in the West Midlands it is around 17%. Coupled with that, many GPs in their 50s are looking to an earlier retirement than previously planned; mainly as a direct result of the effect of Government policies on workload, reduction in primary care funding, excessive taxation and unwarranted meddling with pensions. However, recruitment to general practice has been flat since 2010 (running at a ‘growth’ of 0.2%). With the deepest of respect you, as patients, can complain all you like to our practice managers, and we as doctors can say ‘sorry’ as often as you can stand hearing it. However, without significant re-investment and the instigation of an immediate policy for creating more GPs, the situation is only going to go from bad to worse. As it is, general practice as you know and desire it to be is not presently sustainable for the longer term. In truth, the cynics amongst us wonder if that is really the Government’s ulterior motive. The Secretary of State for Health has now won his way; the question is at what future cost to the health of us all?

(First published in the Scunthorpe Telegraph, Thursday, 5th April 2012)

Reminiscences on a Train

It is raining.

Flecks on the glass become droplets,

coalesce into rivulets, turn horizontally

and gather pace as

the train outraces the rain.

The shower becomes a downpour,

then a storm. Spouts of water

bounce off passing streets; torrents 

gush from downpipes, overpowering gutters, 

converting roads to rivers. And 

with each moment the scenery changes;

the years roll back, until I sense the

cold, biting wind of a Yorkshire dale;

your hood-framed face smiling through

a curtain of dripping water.

I hear, too, the wind raging around

a cliff-top cottage on Lundy Isle,

as you sip wine by candlelight;

and I sense the humidity as you shower

outside amidst the heat of a Maldivian storm.

With every cloudburst, the dust

of the years is washed away, revealing

memory after memory until the

scene settles on two stone steps

within a Lincoln doorway, framing

an umbrella,

and two people, twenty years younger;

and I know the intensity of that

rain-soaked moment when

I knew.

© Copyright Robert M Jaggs-Fowler 2011

Growing up is hard to do

I think the line ‘growing up is very hard to do’ was part of the lyrics from the song ‘Heart of Gold’ by The Kinks (a 1960s London rock band, for those who think history is anything that happened before 1980). If having an octogenarian father who believes he is a perpetual teenager wasn’t enough proof of that proclamation, three recent conversations most certainly proved the point.

The most recent involved a professional conversation with an eighty year old lady, who declared upon leaving my consulting room that there was nothing wrong with her that a young man couldn’t fix. Unfortunately for that particular spirited lady, the local NHS budget doesn’t presently run to the provision of such therapies; at least not at present, but who knows what may be round the corner with the new Health and Social Care Bill?

Reversing in time, the second conversation was one overheard in a village pub in the Yorkshire Dales last week. Please picture two octogenarian men, both wearing cloth caps and tweed jackets, sitting at a small wooden table, and each supping a pint. In walks a third such character, with a profusion of hair protruding from beneath his cap and obscuring his collar.

           

‘You need a haircut, George.’

           

‘I had one last September,’ came the reply.

‘Just how old do you think you are?’

‘76 next birthday.’

‘Ah, a mere youngster. That’ll explain it then.’

However, those two conversations just added to what I had already perceived closer to home one month ago. The occasion was dinner with a friend, who is normally a respectable, suited, high-powered business man. For the sake of clarity, he is in his forties and I am in my fifties. We were dining in a rather splendid establishment in East Yorkshire when the conversation turned to an ‘App’ called ‘Foursquare’ that one can download for mobile telephones and other such devices. It allows the user to ‘check-in’ to wherever they are. This in turn allows their friends to keep track of their whereabouts. Points are gained for every ‘check-in’, and there is a table ranking one’s friends in respect to their week’s activity. In addition, if you have checked in the most times to a particular location, you become the ‘Mayor’ of that establishment; a fact that is then made known to the entire electronic world via Twitter, Facebook and any other social networking facility available. It is rather pointless and somewhat childish. It is also exceedingly good fun, and had us both near to hysterical laughter; especially when my friend discovered that I am now the Mayor of the Elsham Railway Crossing and also the Barton Recycling Plant.

Traditionally, 18 is considered to be the age we become adults. However, a survey by the financial company Scottish Widows concludes that we are more and more delaying taking on the roles and responsibilities of adulthood. Apparently, half the population didn’t feel like responsible adults until they were 25. More intriguingly, 49% of those who don’t presently feel like a grown-up think they will never do so.

The population of our country may be an ageing one, but it would seem that there is proof that the aged are getting younger, in mind as well as in body. As Bernard Baruch (American presidential adviser) wrote in Newsweek in 1955, ‘To me old age is always fifteen years older than I am’. It would appear that his concept has firmly crossed the Atlantic.

(First published in the Scunthorpe Telegraph, Thursday 29^th March 2012)

The Book of Genesis Guide to Pensions

I recently set myself the challenge of reading the entire Bible in preparation for a Master’s degree in Spirituality, Theology and Health.  Of course, I have read it through before; twice in fact; once when I was in my teens and again in my twenties. Thereafter, I have only dipped in and out according to need or the time of year. This time I am aided by a version called the Bible in One Year, which neatly divides it into 365 manageable chunks.

The first thing that struck me as I commenced my literary marathon, apart from being reminded of the difficulty presented by certain Hebrew names, is that Old Testament characters lived to an astonishing age. For example, we are told that Adam lived 930 years and Noah managed 950 years. Abraham only managed 175 years, but that is still fairly good going by today’s standards. Theologians will no doubt be able to explain this in scholarly terms. However, having read the latest dietary advice from HM Government, I have developed a theory of my own; but more of that later.

There is an old saying that proclaims ‘you are what you eat’, and we increasingly have the evidence to support such a bold statement. Few of us now cannot know that we should avoid unsaturated fats, reduce our cholesterol intake, increase dietary fibre, eat at least five portions of fruit and vegetables per day, moderate our alcohol consumption, and stop smoking if we hope to live to a healthy old age. It seems that the maxim ‘an apple a day keeps the doctor away’ is no longer enough for the modern era.

The latest exhortation from Westminster is that many of us still eat too much red meat. Of course, red meat has featured in the British diet for generations. Roast beef, lamb shank, steaks, sausages, bacon, burgers; they all feature high on the communal list of our nation’s favourite dishes. Changing such entrenched habits can take a lifetime. However, the truth is, not to do so can also cost a lifetime. The evidence is mounting, and in today’s parlance, carnivores are not cool.

The proof is in a paper recently published in the Archives of Internal Medicine. Researchers studied 100,000 people over a 28 year period. In so doing, they came to the conclusion that every 3oz of red meat eaten each day increased the risk of dying from cancer by 10% and heart disease by 18%. Processed meat holds even greater risks: for every two slices of bacon or one hot dog, the risk rises to 16% in respect to cancer and 21% for heart disease.

Scientists have for a long while studied what is generally known as the Mediterranean Diet, and have shown that this may well hold the secret to good health and longevity. Rich in fish, chicken, beans, nuts, fruit and low-fat dairy products, the Mediterranean diet does not contain a high percentage of red or processed meat; which brings me back to the Book of Genesis.

We know from the Bible that the diet of 4,000 years ago was typically composed of fruit, grains and fish; the ‘fatted calf’ was a precious commodity and as such was only killed on religious feast days and for other special celebrations. In essence, the likes of Adam, Noah and Abraham followed an ancient version of the Mediterranean Diet. Now, Biblical scholars may well show that there are disparities in the way they measured and recorded time in those days. However, one thing is for certain, the health of our early ancestors certainly seems to have prospered in the absence of a diet rich in red meat. It has just taken us a long while to remember that fact. So, if the Government wants us all to change our habits, perhaps the pension companies should also be warned to adjust their actuarial tables and take into account the Old Testament effect.

(First published in the Scunthorpe Telegraph, Thursday, 22^nd March 2012)

Space

It all started when I looked up to a clear night sky this week and was captivated by the proximity of Jupiter and Venus; two very bright planets surrounded by a myriad of small stars in a black sky of nothing much else. That led me to thinking about the subject of space, both in terms of the universe, and also at a more down-to-earth level in respect to the space between us as individuals; that ‘area of unoccupied ground’ as the Oxford English Dictionary describes it.

Space is very important; it gives structure and meaning to things. For example, without the small spaces between these words, you would not be able to easily read what I have written. Art galleries use space to display their works of art in a manner which can be appreciated; small objects often have a vast area between them and the next artefact, and this emphasises the beauty or intricacy of the item concerned. We also see space utilised in public, often with large garden areas, squares or parkland around important buildings in order to accentuate the grandeur of those buildings.

As individual human beings we also have a need for space. Whether it is the space around your favourite chair at home, your desk in the office, the nominated area of the car-park with your name on it, or that bit of the beach temporarily claimed for your family, we cherish those defined areas and easily become perturbed if something happens to erode that personal territory.

For humans, psychological spaces are equally important. Most of us understand that ill-defined distance that needs to be kept between two strangers if we are not to appear threatening to, or to feel threatened by, the other person. Being invited into that personal space is a sign of accepted friendship and increased intimacy. A hug or a kiss requires crossing that no-man’s land between you; a process which, in its infancy, is often a highly charged moment whilst each person weighs up the other person’s reaction to the apparent intrusion.

However, the opposite is also true. When people are too tightly bound to each other, it is possible for one or both to feel constrained and restricted; we speak of ‘breaking free’ from a relationship, or use phrases such as ‘I need some space’. It is notable that the dictionary also defines space as the ‘freedom and scope to live and develop as one pleases’. In ‘The Prophet’, the Syrian writer Kahlil Gibran, considering the subject of marriage, said ‘let there be spaces in your togetherness’. Just as with trees in a forest, human beings need space to grow and develop within a relationship. We also need space to be seen as the individuals we all are; just as with the objets d’art in the art gallery, or important public buildings.

Yet, though space is important, it can also work against us and cause social divide. The act of inviting someone into your space can be an important act of friendship. Such actions can even help to break down barriers between cultures and communities, and help to remove a sense of isolation that people often feel in the most crowded of places. Reaching out to someone from a different culture or social background, making contact across that psychologically dividing space, can have a profound impact and change lives for the better. ‘I was a stranger and you welcomed me’ wrote St Matthew in the Bible (chp.25, v35).

So, just a few moments of staring into a night sky led to several hours of re-evaluation as to how I see and treat the space around me. Do I have enough personal space to psychologically grow, and do I allow sufficient space around others that they might do likewise? Am I too protective of my space, erecting barriers to keep people out of it? Do I do enough to welcome people into my space? These are important questions if harmony is to exist within our lives and relationships. Space may be an area of emptiness, but I suggest that it is also one of our most valuable commodities, being worthy of our respect and consideration.

(First published in the Scunthorpe Telegraph, Thursday, 15^th March 2012.)