Don't send a doctor to do a politician's job

from the department of radical-wheelchair-ectomy

NICE logo in 2000 (C.E.) (source: archive.org)

(source: https://www.nice.org.uk/)

Somewhere between ~2001 and 2016 NICE morphed from being about "clinical excellence" to "health and care excellence".
At its inception, NICE was the British
medical establishment's co-option of the evidence-based medicine movement, which believed that medical treatment should be based on the best available (scientific) evidence, rather than, say, the doctor's personal experience or the blandishments of the last drug rep they'd seen. Very good.

At the heart of the approach was the systematic review of available studies on any clinical topic. This is a limited paradigm. Although one of the purposes of a systematic review is to identify avenues of future research, the problem remains that all the world is not a clinic, and so not all questions are amenable to study by methods available to the clinician.

Public health is different. Controlled experimentation is difficult, and is much more likely to be based on ecological study (i.e. non-experimental observations). And policy prescription based on it will be prone to all kinds of perverse effects, political compromise and subversion, partial implementation, and general motherfuckery. Put it this way: you can trust doctors to identify and quantify the scale of health problems; but you certainly can't rely on them to solve them alone.

The latest NICE guidance, on air pollution, which kills about 30,000 people each year in both the UK and France, was interpreted both as "anti-motorist" by the right-wing press, and a recommendation to remove traffic-calming speed bumps. Of course it says no such thing, and I saw it as my immediate duty to subvert this:

.@Telegraph Fixed that for you. Where do I send the invoice?

HT @carltonreid pic.twitter.com/8dkAiMpcLU

— Douglas Carnall (@JuliuzBeezer) December 1, 2016

I don't like the NICE guidance for a different reason. A medical perspective of society is inevitably conservative: there is no social critique, no examination of the source of the problem, which is motor exhaust fumes of the ever-increasing numbers of motor vehicles on the roads. This is accepted as inevitable, or, if it is not, the authors of the report seem to have been unable to summon the courage to say so.

Well done if you can be bothered to comment on their advice:

My comments going into the NICE air quality guidance consultation, potential to damage our ability to get good cycling infrastructure built pic.twitter.com/EbrLIzShYB

— Tom Bailey (@TyneTom) December 1, 2016

Maybe they'll tweak it. But the guidance will be ineffectual without a clear overall demand for motor traffic reduction. Instead NICE contents itself with describing the existing evaluations of "clean air zones" as being of poor quality, and takes comfort in the forthcoming tighter Euro-6 standard for emissions with nary a mention of the VW scandal, nor the successful lobbying of the motor manufacturers to postpone tightening the regulations. So let's look elsewhere for solutions. The growing political recognition in Paris of the injustice of the present situation is heartening:

#Paris: 50% of the public space is reserved for cars which represent only 13% of journeys https://t.co/kixvhHUU7C pic.twitter.com/gR3OEql3w6

— Mohamed Mezghani (@MedMezghani) December 1, 2016

If memory serves, about 7% of trips to central London are made by car, so both cities are in roughly the same ballpark. But the less densely populated suburbs where providing frequent public transport is difficult, are a more difficult problem. It is an acute irony that moving out to the suburbs for a better lifestyle is poisoning everyone left behind. 30,000 dead! It's not quite the first day of the Battle of the Somme, more like a couple of 747s crashing each week of the year. And it dwarfs direct death from road trauma.
Any policy that does not address the overuse of the private motor car as a central issue in better urban air quality is doomed to ineffectiveness. Yet for all its claim to scientific excellence, NICE seems to consider a frank statement in favour of this treatment to be so radical as to be unworthy of evaluation. Ho hum!

Presumed liability for cyclists too?

I had an exchange with Bob Davis of the Road Danger Reduction forum earlier today about presumed liability in cycle-pedestrian crashes. The Blogger interface makes embedding tweets a bit of a fag compared with Storify, so I made this.

Lamentable Corbyn-basher refuses debate

I felt moved to offer a comment below this blogpost, which claims Jeremy Corbyn is "unelectable" because of his positions he has struck in the past on matters Irish:

Classifying Corbyn's statement that he would commemorate all those who have died in the cause of Irish independence as "support for the IRA": just a tad crude? Would there have been a Good Friday agreement without the left's recognition of the justice of the republican movement?
Of course, that doesn't stop anyone misrepresenting Corbyn's views in the way that you suggest. But it would still be a misrepresentation. The English electorate may well be ignorant enough to find such over-simplification attractive; but that is hardly a recommendation. Fortunately the electorate has other sources of information than admen's billboards these days.
Neither would participating in a "minute of silence" (however convened) be equated with endorsement in most reasonable people's minds: politicians should pause for reflection more often!

I'm posting it here under the rule that it is rejected comments that are most interesting (the site, a standard WordPress design, is purportedly open to comments, but only one suspiciously unctuous comment has actually made it to below the line. Ho hum!). 

Update 28/11/16: Nice example of how anyone can get caught up in a minute of silence.

Shock troops of the carbon liberation front

I get these YouTube genre crazes from time to time. One example: US truckers' dashcam footage. Allie Knight has an appealing personality, so it's nice to tune in to her doings for a while. Otherwise I just pick a road trip, and mix some music of my own choosing over the top.

Indiana Jack
Allie Knight

Obesity epidemic caused by sedentary living not diet

from the what-made-you-think-you-could-stop-using-your-legs? department

I took out a subscription to the London Review of Books a few years back, in the hope that some of its literary excellence would rub off on my translations. And to have something to read in the bath. My attitude to it is generally one of respectful awe at the elegant mastery of the canon displayed therein, but when finance specialist John Lanchester strayed into an ill-founded discussion of the current obesity epidemic, I quite naturally composed this grumpy letter to its editor. Unsurprisingly rejected, for its ill-tempered criticism of both the writer, and the editor who sent him thence, and its slight inaccuracy (he mentions inactivity twice, not once), it appears here, in suitable obscurity.

John Lanchester laments the ill effects of the general increase in occidental adiposity, but sadly, as is all too common of articles in the genre, he mentions 'inactivity' as a factor only once, discusses it not at all, then lapses into a contentious and unsystematic review of possible dietary factors.
But the average Briton walks on average eight miles per day less than they did fifty years ago. In 1949, fully one-third of all miles travelled using a mechanical mode of transport were by bicycle: by the year 2000 only 1-2% were [1].
It's quite simple. The scales do not lie. If you eat more calories than you burn off, you gain weight; if you eat less than you burn off, you lose weight. What's more, the relative error of the hypothalamic mechanisms that produce the sensation of satiety is greater when energy requirements are low.
I realise I sound like some ruthless P.E. teacher when I tell people to get out of their bloody cars and start using their legs again, but that is what is required. As for those poor little underage prisoners strapped into car seats everywhere they go, never getting to explore their world for fear of getting knocked down, I weep for them.
It is disappointing indeed that Lanchester aimed so wide that he missed an obvious target by a mile: the re-examination of the Fordist mode of revictualment represented by the private motor car and the supermarket car "park".

Rearranging the urban furniture

from the because-we-need-the-space-for-other-things department
The Bristol Traffic blog, which claims to be about "getting around Bristol", obviously got off on the wrong foot when it was named "bristolcars", so I suppose it was hardly surprising that it failed to publish this comment, beneath a post there regretting "the war on the motorist." They are, of course, under no obligation to publish any remark of mine, though their unwillingness to debate their ideas is duly noted. As ever, I offer it here instead:

"The car is a victim of its own success. Car ownership over the last twenty-five years has continued to increase linearly—see this RAC report for example on: Car ownership in Great Britain According to the RAC, there were 20 million cars on Britain's roads in 1991; by 2007 there were 26 million, with considerable growth in two- and three-car households. Whilst these might at first sight be considered figures in support of your argument for more parking and roads, the problem in town is that space is limited and choices have to be made. If every trip into the centre of town were to be made by car, congestion would rise. Consider the graphic attached to this tweet

La ciudad que queremos #transportesostenible vía @elpais http://t.co/wbTZQf2ec2 pic.twitter.com/lnaz3fg0HZ

— ViveLasPalmasGC (@ViveLasPalmasGC) August 18, 2015

which illustrates the amount of road space needed by 48 people using various transport modes: a car, the bus, walking, or a bike. It is clear that cars occupy a vast amount of urban space—and the faster they move, the more they need. This high requirement for space is to the detriment of all other modes, and choices have to be made. Presenting this as a war on the motorist is to fail to understand the impossible demands of the mode for urban space in any streetscape conceived before the 20th century. A streetscape designed for the car looks like Los Angeles, not Bristol, and if you want a city like Bristol to work for everybody, car use has got to be limited in some way."

Elisabeth Carnall 17 July 1935 — 23 December 2015

Sad to report that my mother died recently. Apologies for the delay in announcing this, and any distress that may have been occasioned if you thus heard the news by a tortuous route. 

All who knew her personally are most cordially invited to her Memorial Meeting 2.30pm Saturday 30 January 2016, Quaker Meeting House, Victoria Terrace, Edinburgh.

Donations to Edinburgh Peace and Justice Centre (online possible via PayPal button top right of that page). 

Memories and messages to d@bzr.bzh