Tickling the English

by Dara O Briain

  With kind regards,

  Simon Frackiewicz

  I was not turning down an offer like that. This time we drove down early in order to meet Simon at his shop in the plaza.

  I was under no illusions that I needed glasses. About a year previously, I had convinced myself that it was time for spectacles when a distant road sign looked blurry one day.

  ‘Ah well,’ I thought, ‘I’ve had a good innings. At least I’ll look distinguished.’

  I walked into a Specsavers and, while I waited for the consultation, I tried on a forest of eyewear. I was really getting into it too. I had a pair all picked out. I was quite looking forward to the new, distinguished me.

  Then the optician, who had lenses an inch thick, invited me into a room to run the tests. It turned out I had nearly perfect vision. Good news for me, of course, but the optician didn’t seem very happy. To the half blind, it must have seemed like I was mocking him. He practically spat the results out at me. You’d think I’d gone to have a prosthetic arm fitted before going, ‘Oh wait, what’s this in my sleeve?! Sorry!’ I was the first person to be thrown out of Specsavers for having Münchausen’s syndrome.

  Yeovil town centre was deserted. Only the optometrist was open, and Simon was there to greet us. A younger man than I expected, he was clearly not from the West Country.

  ‘No, I’ve lived in a lot of places, although, interestingly Yeovil is the first place I’ve lived that wasn’t in that book Crap Towns.’

  ‘Where else have you lived?’

  ‘Croydon, Liverpool, Reading, Islington…’

  And then he paused, and looked relieved for having found his way eventually to Yeovil.

  Then we did an unnecessary eye-test. For a nerd like myself, it was just fun to play with the machines. I had wanted to ask a lot of questions in Specsavers, but had been discouraged by the increasingly tense vibes coming from the myopic and jealous optician. Excitingly, I discovered that things had moved on in the world of eye-testing. That chart, for example, with all the letters, is now randomly generated by a computer so that people can’t memorize the bottom rows. They’ve also got rid of all the easy letters; it’s now just a cloud of E’s, H’s, M’s and W’s.

  ‘What else is new?’ I asked Simon.

  ‘We can also take a photo of the inside surface of the eye,’ he offered. ‘It’s called Digital Fundus photography.’

  ‘Why would I want to see that?’

  ‘Well, we use it to check for possible loss of sight because of diabetes, or to monitor glaucoma or tumours.’

  I nodded sagely.

  ‘Sometimes you can tell other problems though. If you know where to look, you can get an indication of high cholesterol. Or systemic hypertension. High blood pressure. Just from looking at the blood vessels in the eyeball. You can tell there might be a problem if they look wriggly.’

  And he showed me an eyeball with big, thick, happy veins, and then, by contrast, an eyeball where the veins were narrow and struggling.

  ‘Wow. That must be awkward news to break. They only came in for some glasses.’

  ‘Yes. Well, I try not to be the one to break the news. It shouldn’t come from me. This’ – he says, pointing at the eyeball on the screen – ‘is only an indicator. I usually just recommend that they go and see a doctor as soon as possible.’

  I sat behind a complex machine, rested my chin and forehead on a support, and the flash went off a couple of times.

  I returned blinking to my seat.

  ‘We’ll just get this up on the screen then,’ said Simon, and suddenly here’s a picture of my eyeball, all red and unearthly and with blood vessels, I couldn’t help noticing, as narrow as spider’s legs.

  ‘So how does that look?’ I asked.

  There was a really long pause as Simon weighed up the best answer.

  ‘You should probably check with your GP.’

  Eastbourne Congress Theatre

  2 lawyers

  1 carer

  1 student of film, television and radio

  1 clarinet teacher:

  ‘To what ages?’

  ‘From eight to seventy-five years old.’

  ‘When are they going to let that seventy-five-year-old leave school? He must really creep out the eight-year-olds. I bet they always pick him last at play time.’

  A pleasant visit to the south coast, only briefly marred by the difficulties of getting a pizza delivered to the theatre. There’s usually only a small window to get some dinner, between the soundcheck and the curtain coming up and, if we aren’t near any shops, this involves phoning out and then directing the delivery boy to the back entrance in a way that sounds disturbingly like grooming:

  ‘No! Come to the back of the theatre!’

  ‘I’m not sure about this.’

  ‘It’s perfectly safe. Just bring the food all the way round the back of the building and wait there. By the skip. I’ll be along in a minute.’

  ‘Can I not just bring the food to the front?’

  ‘NO! I’m sorry… I didn’t mean to sound angry. Please come. I’ll give you more money.’

  Amidst the usual mixture in the audience was the light and shade of uncovering the lawyers (a solicitor and barrister together – this is like finding sheep farmers and cattle farmers at the same hoe-down; but they all get booed like panto villains by a noisy crowd) and then a full-time carer. There really is no line of attack on a full-time carer – unless, of course, you want to look like a complete prick in front of your crowd. Once they’d spotted this loophole, though, the entire room was at it.

  Anyone ever interrupt a crime?

  ‘I once saved a woman who was having an overdose,’ said one man.

  ‘Impressive. What did you do?’

  ‘I brought her home and put her into the lounge.’

  ‘I’m sorry. Did you just say “lounge”?’

  ‘Yes. I brought her into the lounge.’

  Well, firstly, who has a lounge? And, secondly, who brings home junkies and puts them in a lounge?

  Surely a lounge is just too twee for the sudden arrival of a twitcher. A lounge is for maiden aunts and smoking jackets and string quartets.

  Although, to be fair, I’ve always wondered what use a chaise longue is. Too slopey for a chair, too hard for a bed. But, now that I think about it, just right for the propping up of tripped-out junkies before you slam a hypodermic filled with adrenaline into their breastplate. That’s one way to bring the cello recital to a crescendo.

  I asked the man’s wife about this event and she said, ‘I know nothing of this.’

  ‘Well, I’m not surprised,’ said I, ‘you were off your head on heroin at the time.’

  The most notable thing about the show was returning after the interval to a stage covered in flyers for Petula Clark, all of which had ‘Save the DGH!’ written on the back. The entire audience seemed to be supporting the campaign to preserve the local District General Hospital, and not have it move somewhere else. It’s not a campaign I felt I should get too involved in, partly because Petula Clark seemed to have the celebrity angle covered, but mainly because they gave no indication of where the DGH was going to end up.

  Britain is rightly proud of the NHS. It stands as an example to the world of how to socialize medical care. One of the intermittent pleasures of living here is seeing an injured American after treatment, waiting for a bill, until you explain to them how it works. Honestly, it gives you quite the glow. It’s almost worth injuring an American just to see their bewildered and happy face at the end of the process.

  Of course, it’s an organizational mess. It’s the world’s third largest employer, after (and I think this is wonderful company to be in) the Chinese army and the Indian state railway. How well managed do you think the Indian state railways are? Do you think they wanted all those people sitting on the roof? I’m guessing the Chinese army has a really strict disciplinary structure but, other than how to deal with absenteeism, I’m not sure how many lessons ther
e are to learn from it. So the NHS has very few organizational peers on whose experience it can draw.

  From the outside, it seems to exist in a continuous flux, endlessly attempting to transform itself according to altered government policy and novel administrative philosophies. The same departments are renamed and reorganized. Hospitals become trusts, GPs become one-stop clinics, clinics become super-clinics, doctor training gets longer and then shorter, power is divested and re-invested, quotas are imposed and lifted. District general hospitals get moved. Possibly to somewhere that really needs a hospital, possibly not.

  There’s no correct answer, of course. All this constant reorganizing feels sometimes like getting a small boy to distribute the raisins in Christmas-cake mix, and then watching him get his head wrecked by the challenge of mixing them just right. Mix it again! No, wait, there’s more on the left side now. Mix it again!

  Amidst the swirl of conflicting results and studies, and tortured metaphors, let’s look at just one piece of data which, to me, sums up everything you need to know about the English and their attitude towards health. The life expectancy is the silver bullet here.

  Life expectancy in Britain is about seventy-nine years. This is bang on the average for industrialized countries. It’s a little lower than some, obviously, like Finland, or Macau, or Jersey but, here’s the real stunner: it’s forty years higher than it was two centuries ago.

  In two hundred years, medicine has doubled our time on the planet. For all the talk of childhood obesity, or MRSA, or cancer remission rates, this country has, demonstrably, never been healthier. NEVER BEEN HEALTHIER.

  You can’t imagine how much fun it is to present that fact to an English audience. It’s like when you throw a ball for a dog, but you don’t actually throw the ball and just palm it. And the dog stares in the direction the ball should have gone and looks confused, then looks back at you and then to where the ball should be. It’s a glorious piece of cognitive dissonance. An English crowd isn’t built to accept good news like that.

  England is the only country in the world that would welcome the news of the longest life expectancy in human history with the headline ‘Pensions Timebomb!’

  (This was even more fun before the credit crunch, when you could, with justification, say ‘Never healthier… and never richer’. That really wrecked their heads.

  ‘But there are poor people…’

  ‘Of course, but are they poor like the medieval poor? Who’s living in mud now? Where are your Dickensian slums?’

  ‘But there’s poverty…?’

  ‘Yes, and there are still people who need help. But poverty comes with free education and universal healthcare now. Can you not even give yourselves credit for that?’

  No, clearly not.)

  So they point to Finland and say how much better the healthcare is there.

  A couple of points to bear in mind about life expectancy. You should only worry about a differential if there is any way you would ever move to Finland, Jersey or Macau and, frankly, what with selling one house, buying another and changing all your money into kroner or whatever, it would be a lot less effort to just cut down on your cheese intake. Complaining about the marginally better cancer remission rates in Sweden is exactly the kind of behaviour that will stress you into an earlier grave anyway.

  There is no bad news in the average health tables which you couldn’t counteract with a few lifestyle changes.

  Luckily, for the English, we all have to die, and thus, something has to kill us. The numbers have to add up to 100 per cent. If we cure one disease, something else has to fill in the gap.

  If they cured cancer in the morning, the English papers would lead with ‘Heart Disease on the Rise!’ Very few nations are so obsessed with their own unhealthiness as the English. In a recent EU study of twenty-eight European countries that I came across, one in twelve people (8 per cent) from the United Kingdom said that they would generally describe their health as ‘bad’. This put the UK in the top ten for perceived ‘bad’ health, with only Portugal, of the western European countries, having a higher proportion. By comparison, only 3 per cent of people in Ireland said they had bad health. In the same survey, slightly more than one in three people in the UK (34 per cent) said that they had a long-standing illness or health problem. This puts the UK fifth in Europe, behind Estonia, Lithuania, Finland and Hungary. By comparison again, only 19 per cent of Irish people said the same thing.

  Poor things, lie down, you must be feeling weak. You’re not actually weak, of course. The life expectancy is longer in the UK than it is in Ireland, longer by 0.8 of a year. I hope that, after I die, you spend the following ten months telling yourselves what a surprise it was that I went first, since you’ve been the sick one all this time.

  Here’s another interesting thing to note:

  Almost one in four English claims to have suffered from an allergy of some kind. This is compared to one in sixteen Irish people. A survey of British GPs in 2006 revealed that three-quarters of the doctors surveyed believed that their patients’ food intolerances were entirely in their minds. Another poll of patients found that one in five people had found out about food intolerances from a celebrity interview in a magazine or on television.

  Or we could just take the word of the GP I met in Belfast who told me:

  ‘The main problem with the NHS is the 99 per cent of the patients who aren’t sick.’

  Bath Theatre Royal

  1 children’s nurse

  1 civil engineer

  1 project manager for a mobile-phone company

  1 photographer:

  ‘What do you shoot?’

  ‘It’s mainly nuns and pigs.’

  So where can they go, these not-sick people? Well, they used to go to Bath.

  In 1676, Thomas Guidott, an Oxford-educated doctor, published ‘A Discourse of Bathe, and the Hot Waters There. Also, Some Enquiries into the Nature of the Water’. (Today it would be called Aqua Magic: Five Steps to a Fabulous You.) He maintained that large numbers of people had been cured of a wide variety of ailments by taking the mineral waters at Bath, both through drinking the water and bathing in it. His follow-up book, The Register of Bath, detailed hundreds of further miracle cures, including lameness and sterility. By a lucky coincidence, Dr Guidott actually ran a medical practice in Bath, and was one of the chief beneficiaries when the ideas in his book became fashionable.

  Another Bath resident, Dr William Oliver, published Practical Dissertation on Bath Water in 1707. A large number of similar works by other mineral-spring-adjacent medical researchers emerged at around the same time. The aristocracy rushed to take the waters at Bath, with Queen Anne making frequent visits to the spa town. Catherine of Braganza, the wife of King Charles II, popularized the mineral springs at Tunbridge Wells. It’s obvious to us now that, outside of the placebo effect, there was no medicinal benefit to any of this. Indeed, in July 1665, the diarist Samuel Pepys noted the negative effect the waters had on an acquaintance: ‘It seems her drinking of the water at Tunbridge did almost kill her before she could with most violent physique get it out of her body again.’ What the craze for mineral spas, and the later craze for seawater bathing, did demonstrate was the English elite’s capacity for hypochondria (Daniel Defoe described Bath as ‘the resort of the sound, rather than the sick’), their enthusiasm for new health fads, and their ability to exert a profound influence on the way people thought about their own health. That never went away. Three centuries later, Princess Diana did wonders for the colonic-irrigation industry while, in May 2006, Prince Charles gave a speech to the World Health Assembly in Geneva arguing for increased use of homeopathy and other alternative therapies.

  Sixty years on from the birth of universal medical care, there are more than fifty thousand practitioners of complementary or alternative medicine in the United Kingdom but only fifty-eight thousand GPs. The annual alternative-medicine spend is thought to be at least £2 billion and possibly up to £5 billion. Around six million
Britons use complementary or alternative therapies each year. On this basis, given the massive advances in medical understanding since the eighteenth century, it’s possible that a certain medical gullibility may be an unexpected national characteristic in itself.

  Medicine versus quackery is one of the long-running battles for the soul of this country. Is Britain the land of William Harvey, Alexander Fleming, Joseph Lister and Florence Nightingale, or the land of drinking spa water, aromatherapy and homeopathy? This divide is obvious, even within the healthcare system. The Royal London Homoeopathic Hospital has been funded by the NHS since 1948, and the NHS has been spending up to £500 million a year on alternative therapies in recent years. However, in November 2008, the government’s chief scientific adviser, John Beddington, told MPs that he could see no scientific evidence that homeopathy worked and he would look into its funding through the NHS.

  There are those who take a benign view of homeopathy, who speak of the positive benefits of simply giving patients time and attention. Fine, but it’s still just water and sugar cubes pretending to be medicine.

  The tooth fairy is nice; it brings a lot of joy and comfort to a large section of the population at a time of medical distress; but I wouldn’t spend £500 million of public money on it.

  It would be a small victory for the Harvey and Fleming side of the national character if the NHS could shake itself free of this nonsense. One of the central theses of Peter Clarke’s history of modern Britain, Hope and Glory, is that the British people traded in their empire abroad for a new empire at home – I suppose you could even call it an empire of health and welfare. In all the criticism of the National Health Service, the English sometimes forget the extraordinary fact that they have created an institution at their heart that says, ‘If you are sick, we will look after you.’ Flawed as it is, there is still something dignified and impressive about the NHS. Indeed, I defy any English person to watch the section on the National Health in Michael Moore’s film Sicko and not get a lump in their throat. Of course, being English, they will probably then rush to get the lump checked at the GP’s, then put some arnica on it to be on the safe side.