International Lymphoedema Framework – Uganda Framework

There is excitement in the world as the ILF begins an epidemiological (for those of you who do not understand that word, let Coco stand alongside you) study to ascertain the prevalence of lymphoedema in Uganda.

It is well known that lymphatic filariasis is endemic in tropical countries, alongside other mosquito borne diseases, but the real extent of the problem and its expression among the people is not properly understood.

Lymphatic filariasis is only one of the causes of lymphoedema in East Africa, all of the other causes, whether primary or secondary are also present, though the mix will be different than in Europe, and other parts of the world.

The International Lymphoedema Framework, through its chairman, has provided funding for the study which will be lead by Dr Arthur Bagonza of Makerere University in two districts in the village regions of Uganda.

Basic training in the identification of three stages of progression of the disease has been completed in Kampala this week and the lead field workers are ready to take the tool out into the field to complete their survey. Dr S Narahari of the IAD, India, and Professor Christine Moffatt will act as referees to confirm or vary the stage assessments made by the field workers.

The survey will assess the numbers and proportion of individuals in the community affected together with the impact of the disease upon the quality of life of the sufferers. The results will be used to inform the Ministry of Health, who have given their unqualified support to the study, in the allocation of resources to combat the problem and relieve the suffering.

Dr Arthur with Dr Alfred Mubangizi, Assistant Commissioner Health Services – Vector Borne and Neglected Tropical Diseases, Ministry of Health with the rest of the team who attended the inaugural meeting.

The Ugandan framework, lead by Dr Arthur Boganza and Lydia Kabili, is a newly formed framework within the International Lymphoedema Framework and benefits from a longstanding relationship with Prof. Linda Gibson and Makerere University.

Debate and dogma

Debate is valuable. Debate and disagreement are necessary in science. Debate is dangerous.

Three statements and it may surprise you, or else it may not, that these statements are not incontrovertible; indeed, they provoke as much controversy as these:

Dogmatism is valuable. Dogmatism is necessary. Dogmatism is dangerous.

Why should this, that debate is dangerous, be?

Often it may arise because reputations or careers are at stake. If the foundation of your life is that science which says A is true and another comes along and asks the question: How do you know A is true? Have you considered this set of data? Does it not suggest that A may not be true in all circumstances? then from your perspective the very asking of the question is a personal challenge not a scientific one.

So in a very simple case, you may notice that if you pump 1 kilocalorie of energy into 1 kilogram of water its temperature rises by 1°C (A is true). If therefore you conclude that when you pump 110 kilocalories in its temperature will rise by 110°C, you may be disappointed unless you also increased the pressure under which you heated the water to at least one and half atmospheres. Change of state effects would disrupt the thermal elevation – you may even lose enough water in trying to do so for the espresso that you would have had in order to recover from the falsification of your paradigm had you not the change of state occurred. A is not always true, or if it is true it is true only in specific well-defined circumstances, and so your understanding must be improved. You may want to hold onto your idea that A is true, but the data is against you, or is it? Look again. You may think that you must now say A is not true, but the actual position may be that A is not true only under certain, perhaps clearly defined but perhaps not, conditions.

We should note here, though it is not our main point that it is folly to base our paradigm of life upon our own transient scientific understanding of the way the world works. We are here speaking of derived paradigms, not underlying paradigms which we shall address shortly.

Scientific methods and historical analysis

Now our understanding of the relationships between heat, temperature, pressure and water is quite well understood. We are dealing with a simple (but it is a three body problem) molecule with well (is that really so?) understood properties. Experiments may be easily defined and conducted in well controlled ways, and repeated indefinitely by unrelated individuals who will, within the limits of observable experimental measurement, always obtain the same results, but our understandings elsewhere are not quite so clear. Experiments may not be possible or, if they are, controls may be difficult to impose. We may not know or even understand all of the factors which may influence the outcome. When Rutherford fired his artillery at a sheet of little more than tissue paper he expected nothing other than to punch holes in it. The data obtained however required a rethink. Some of the artillery shells, alpha particles, bounced back off the thin film of gold leaf.  Whilst Rutherford was able to describe what was happening, a proper theoretical understanding of what was taking place would not be available until several years later.

We not only require then data, which Rutherford had, but we need a robust framework within which that data may be interpreted. The old ideas of phlogiston and æther were abandoned when it was found that they could no longer explain the data that became available. Now however in the presence of the hypotheses concerning the warping of space one may wonder: how can something which is the lack of existence of anything, ie emptiness, be warped. Does not this suggest the presence of a substance, an æther, which is presently yet undetected, in that emptiness which is the thing that is being warped? That however is not a discussion for this article.

When we being to look at things rather more complex than water, though they are structures in which water is a major component, and indeed the symptom if not the cause of the problem, such as a biological machine, driven itself by smaller complex biological components, with its own messaging, delivery and disposal systems some of whose functions overlap and which are mutually dependent upon each other as well as upon the other components of the machine whose efficient function is also required for the maintenance of the systems of communication, we may have to acknowledge that our understanding of the behaviours of this system is somewhat less than our understanding of the behaviour of water. We are also faced with the fact that we cannot design experiments to perform on these machines, for that would be unethical, which would allow only one part to function whilst holding the others in stasis. We are therefore left with only the possibility of RCT (randomised controll(ed) trials) and clinical observation. These may result in significant quantities of data, from which tentative conclusions may be drawn until we have a robust theoretical framework from which explanations may be drawn and predictions may be made.

In some circumstances we have to resort to forensic analysis of the data which has many useful, indeed valuable, techniques associated with it, where there is no possibility of repetition of a single one time event, in order to understand it. Now I need say no more here than that forensic examination is simply another word for guess work in which the actual solution after all the possible explanations have been considered and shown to be wanting is the ‘impossible’ explanation. Darwin left this teasingly in his hypothesis concerning origins laying down clearly the grounds on which his hypothesis must be tested and leaving later generations to show the wantonness of his hypothesis.  Mendel began this work and it has continued in many guises to the present day with perhaps greater and greater skill being shown than of which Darwin ever dreamed in the elaboration of the hypothesis in the vain hope that somehow it may be possible to avoid the consequences of a failure at the quite simple test that he proposed. The resultant edifice is not even built on sand, it is built upon the impossibility of two mutually exclusive requirements existing at the same time, not to mention the uncountable (though not in the mathematical sense of the word) number of violations of the principle that change must only take place in simple single steps.

The possibility then must be left open that whatever conclusions we draw may be falsified by another set of data drawn from a different RCT or set of observations in other circumstances.

Contemporary events

In recent days we have heard many say that you must follow the science, but the science has been inconclusive and contradictory. At times the message drawn from this has been inappropriate and non sequitur. For example to say that acquiring immunity from a particular disease will protect others is patently untrue . If I have immunity from say TB then I am more likely to carry the disease unknowingly and therefore become a greater danger to those whom I meet who have no immunity. We only need to think of the case of Mary Mallon to understand this. I am being more socially responsible by not acquiring immunity, for then I would know when I were ill and could take appropriate steps to protect others. There are many other things that could be said both about the messages drawn in respect of the recent global infection and the quality of the data on which they are based, again however this article is not the place for that discussion.

Underlying paradigm

A second reason perhaps for debate being seen as dangerous is that it not only challenges the conclusions drawn from the data but undermines the paradigm which lies behind the specific interpretations of the data. The paradigm is held dearly by those who hold it, for they have an abhorrence, which some are not afraid to display, towards alternative paradigms within which alternative understandings of the data may be held, and which each can yield contrastingly different conclusions than the opinions generally held.

The hostility to any alternative view, even if it can be supported by rigorous mathematical calculations using the same data and mathematics that the majority view use, leads to a stifling of debate and ultimately to a stagnation of science. The silencing of those whom you see as your opponents in science is detrimental to progress.

It is exceedingly important in science that you recognise those who disagree with you as being honest scientists. None of us are infallible, and none of us have a perfect understanding. Archimedes was wrong. Pythagoras was wrong. Galileo and Copernicus were wrong. Einstein and Bohr were wrong. Only two of us were right, and I cannot remember who the other one is.  Of course I jest, but you, dear reader, know what I mean.

It is not, at least from a scientific perspective, wrong to hold different underlying paradigms for to hold a paradigm is necessary in order to offer interpretations of data, but we cross the line when we say that our interpretation is the only valid one.

The correct position – to encourage debate

Every true scientist lays down a challenge for every other scientist: This is my hypothesis A is true, disprove it if you will, please. His delight is, and if not is, it should be, that you take up that challenge. If every other scientist does not rise to the challenge then no progress will be made and we shall do nothing more than promulgate the same false ideas with which Galileo agonised. It is not until we have demonstrated that A cannot be false that we have any real certainty that A might be true. The scientist must live dangerously, expecting that every one else will wish to prove him wrong and in failing to do so demonstrate that he might be right.

Conclusion

Debate is valuable for it is the life blood of progress. Debate and disagreement are necessary in science for we do not have a complete and perfect understanding. Debate is dangerous for it challenges our well beloved but imperfect understandings of how things are and may require us to change.

The corollary ‘Dogmatism is valuable. Dogmatism is necessary. Dogmatism is dangerous.’  has also been demonstrated in this short article. It is left as an exercise to the reader to deconstruct and reconstruct the article appropriately.

International Lymphoedema Framework

I have just returned from the International Lymphoedema Conference 2023  #ILF which was held in Nottingham. It was a wonderful scientific, medical and therapeutic conference for any who would have any interest at all in lymphoedema in its many and varied forms. Much of the science went over my head, especially when presented by the Dutch, but it was still possible to detect some conflicting hypotheses and the robust debate among and between the participants. Such debate demonstrates a very healthy environment for the development of sound science based upon real-world evidence. Among the participants were the #theila the International Lipoedema Association whose stall was well worth the visit. What has lipoedema to do with lymphoedema? You may well ask, but I shall offer no explanation here for fear of misleading you, save to say that those who know know. Do visit their websites:
International Lymphoedema Framework
International Lipoedema Association

ILA Stall

More pictures from the conference – password required – here

More may be read about the involvement of ILA in the conference here. Note especially the engaging discussions: Thought-provoking discussions led to a deeper awareness of the challenges faced by the lipoedema community. It is a well thought out understatement indeed.

How to distract your auditor’s comprehension

When the message is weak, what do you do?

The answer of the preacher is often: Shout! but there is a better way

The ubiquitous presence of punctuated, percussive sound waves emanating from the large black boxes carefully positioned around the auditorium at 64hz or thereabouts in the modern age, but not only so but also in many ancient cultures, is an essential element of the many shared experiences of groups of individuals in our divers communities. It dulls the senses and raises the ire so that any criticism which may attend the auditor is directed solely at the manner of the presentation and not at the content thereof.

How different is the approach of those who wish to provide not only entertainment in a shared experience which is felt in the body, but also an enlightenment of the mind where such manipulation of that which so easily distracts us from what is important, that is the content of the presentation.

There are many who would dull our minds in order to persuade us to accept the message presented to us. So, scam telephone calls, email and text messages represent some of the worst excesses of this, and what will they be like when AI starts to generate them? How long do we have to wait before the scammers voice sound just like that of your friend who is being impersonated? Hot on the heels of such as these are those who would sell you their quack solutions to health, housing, communication and transport problems. It will only cost £xx/month but you do not hear increasing at 4% + inflation each year for the next ten years during which you are locked in, having to pay the full amount if you wish to get out early.

Then we have religious quacks: Do this and live!. It may be true, but you still have to answer for what you have done and in any event you are actually unable to do this Moses said: Their foot shall slip in due time. Be aware of the siren voices that would silence the only message that matters. There is only one name given among men by which we must be saved.

Coupled with the distractive sonic vibrations an attempt was made to provide a cathedral like oracular experience by means of beams of light in the otherwise darkened room, as if streaming through stained glass windows on a bright summer’s day. What a contrast all of this is with the buildings of the Reformers who thought that the lecture theatre was much more commodious to the reception and understanding of the message. In the light of such a place we are able to read the text for ourselves, to review it and take notes of what has been said. Such a context for the delivery of the message is much more fitting and provides a much greater probability that the message will be received and understood for the benefit of both the orator, the auditor and the clients of the auditors.

All of this was designed to create the right ambience for what was then to be presented to us from the dais. We were treated to an inspirational [an adjective that the marketing world would ascribe but not Coco] talk about how to live with stress and other issues in the world. Paul takes this up when writing to Timothy, where he says: For bodily exercise profits a little, (1Tim 4:8) but then points him to what really matters: godliness is profitable for all things, having promise of the life that now is and of that which is to come. (1Tim 4:8) It was interesting, perhaps entertaining, but for all the efforts to provide techniques, promote a proper understanding of self worth, Coco considers missed the mark ignoring what really matters as set out by the apostle.

Godliness with contentment is great gain.

Total energy consumption

One cannot but be impressed with the work of Greene and his students, not just at winning the Queen Elizabeth Prize for Engineering, but for the 40% improvement in the efficiency of solar cells that resulted from the application of their work. The report may be read here: https://www.bbc.co.uk/news/science-environment-64553915 (Queen Elizabeth Prize: Solar team wins prestigious engineering award)

We are also provided with an impressive graph which appears to show that in 2021 solar production of electricity was nearly 50% of that provided by coal. Closer inspection reveals that not all is well with this graph. The percentages do not add up to 100. Something is missing, and most of the missingness can be filled by oil and nuclear, nearly 14% in 2010 falling to 10% in 2021. I am aware that the graph runs to 2022, but I have to restrict my comments to 2021 not having additional data for 2022.

It looks good, but is it?

The second problem we have is that it does not take into account the increase in consumption of electricity since 2010. In 2010 total production was roughly 21TWh, increasing by 25% to 28TWh in 2021. The graph shows nice falling lines for coal and natural gas, which are of course big carbon dioxide producers, as if we are reducing our dependence upon them. If we apply the 25% increase in consumption to the graph however all of the lines tend upwards.

The real problem however is that we appear to be looking solely at electricity consumption. This rather distorts the issues, giving a false impression of how well we are doing in our progress towards the combat of the factors that influence unwanted climate change. A different analysis can be seen if we look not only at electricity consumption, but at the energy costs of electricity production. Coal then comes in at 36%, solar at only 4%. For coal you get out in electricity about one third of what you put in. When you factor in other uses of power, such as transport (shipping, petrol and diesel vehicles, etc) then the picture yet quite different as you may see in the graph below.

Quite a different picture when total energy costs are factored in

Given that the figures behind this have been compiled by BP if there is any bias in them at all it is likely to be in favour of fossil fuels, rather than the other way round, but I have assumed there is no bias. Solar costs are about 3TWh for 2021. Coal is about 44TWh. There is quite a good discussion on https://ourworldindata.org/electricity-mix explaining why we need to look at the production costs of the power we use not just at the power we consume.

The good news is that renewables, which consisted of only 14% of total energy use in 2010 in 2021 consisted of 17%, and increase of 45%.  This mitigated the increase in fossil fuel use, but we still managed to increase out consumption of fossil fuels by 12%.

Let me add in closing that the BBC graph is accurate. It describes precisely what it claims to describe. It could make a nice marketing tool for an electricity supply company that wanted its customers to feel good about buying from them, but it does not provide the information we need to assess where we are in our efforts to decarbonise energy production.

Summary figures:TWhTWh
World20102021
Fossil fuels121480136018112%
Other sources1901927691146%
Total140500163709117%
Fossil fuels86%83%
Other sources14%17%
Detailed figures may be obtained from the data set available at https://ourworldindata.org/electricity-mix

Transplants

An abuse of a great need for a political point

When editors see an opportunity…

Whilst I do not wish to down-play the agony of those who wait for an organ transplant and the grief of those whose loved ones do not receive one in time, it is a little ingenious to use organ transplant resources in the anti-cognitive-racism game that is presently being played out in the UK and probably elsewhere with perhaps more ferocity. I also understand that headlines must be catchy if they are to draw the attention of the prospective reader, so when I saw the headline ‘Black patients wait up to six months longer for organs’ (BBC News) (or more fully on the article itself ‘Organ transplants: Black people wait up to six months longer, NHS figures show’ my interest was aroused.

I hope those who saw the headline read it, as though the headline hints at racism thereby suggesting endemic racism is present, the facts mentioned in the article belie that accusation. White skinned people wait on average 488 days, whilst black skinned people wait 735 days. That does suggest an imbalance of some kind, but the cause of that imbalance is not the colour of the skin but the relative sizes of the pools of organs available. If we ignore any overlap in the pools of organs from black skinned and white-skinned people, the pool for black skinned is proportionately half the size of that available for white skinned people (the article is however slightly thin on the ground for this assertion, but let it be for now), therefore, on the basis of a non-rigorous calculation I would expect to see waiting days for white-skinned people to be only 50% that of black (mathematicians, please correct me), but the actual waiting time is around 66% suggesting that proportionately speaking black-skinned people have shorter waiting times taking into account the pool of resources available.

Curiously, which is why I suggest that there is covert racism behind the article, there is also a reference in the article to the waiting times of Asian people being 650 days, but no further information is given. Given that Asian people wait up to three months longer (longer than what we might ask) why do they not come up for greater attention in the article?

The article does go on to speak of better things, the benefits of transplants, some of the results, and the schemes available and is to be commended for that, but we do not need to use a race card to advertise such things.

Do we?

When darkness falls upon the mind

Exposing the truth

Three rather interesting short articles on the BBC, the first clearly shows how seriously we should take Critical Race Theory.

Lack of ethnic diversity among egg and sperm donors
Richard Drax: Jamaica eyes slavery reparations from Tory MP
Chimamanda Ngozi Adichie: Author warns about ‘epidemic of self-censorship’

The fault, and cause, of a shortage of resources in a minority culture is clearly to be attributed to the dominant culture for whom the greatest of opprobrium is to be reserved. The particular shortage is of the shortage of the two essential elements in the making of a human being, and though the answer is of course a mother and a father that is not what they mean, they focus purely on the biological elements, eggs and sperm derived from a minority culture in the UK. It is described as a lack of ethnic diversity by the HFEA. In this instance the minority culture highlighted was West Indian, and by inference Afro-Caribbean. Common sense may find a different and more plausible cause and dismiss the suggestion of fault and blame altogether.

The second also takes us to the Caribbean, and in particular to the island of Jamaica, whose government joining arms with Barbados is considering seeking reparations from the current British owner of a plantation for the treatment of slaves before 1833. The grounds of the case may rest in Critical Race Theory or Identity Politics – as these are mercurial concepts I leave it as an exercise for you, dear Reader, to make the correct assessment. The article does not say whether reparations will also be sought from those who made their fortunes and built their kingdoms in West Africa from the enslavement of those who were taken by sea to the Caribbean or overland to the Middle East. I dare say any law firm which takes up the case will be kept busy for many a day, whether or not their solicitors benefited from the education they received at the institutions which were established or funded out of wealth derived from estates established long before 1833.

The third article reports on an author who, seeing through all of this nonsense, speaks of an epidemic of self-censorship and the inability to ask questions because of a fear of asking the wrong sort of questions. This author speaks of a place for valid criticism, which is essential if there is to be meaningful debate, but of no place for an ugly, violent backlash against those who speak a view which is contrary to your own. The aim of debate is not to silence but to convince. Where would we be without the progressive Hypothesis-Antithesis cycle which leads to greater understanding and better hypotheses? But in Cancel Culture the Antithesis must not be spoken. What progress can be made? The proponents of Darwinian evolution have successfully cancelled academic examination of their stories, despite Darwin’s own warnings to them that his hypothesis would fail in the absence of certain conditions, one of which remains absent, a second of which has been strongly overturned. This cancellation has turned biological science into a blind alley seeking to prove that which cannot be proven and failing to pursue enquiries which will yield beneficial results.

It is good to see their willingness to expose, albeit perhaps unwittingly, the short falls, indeed perils, of that which has taken deep root in a society which, in its post-modernist thinking (if thinking is a post-modernist activity), has lost its moorings, Critical Race Theory, Identity Politics, Cancel Culture and a host of other ‘critical’ theories which are no more nor less critical than the sledgehammer used of the builder to demolish* a wall. How we need to return to the law of the Lord which makes men wise.

Look at how King David spoke of it: Restoration – pursuing the right paths. Making wise – enabling us to understand the vast universe in which we live. Rejoicing – do we not when we look at all of the marvels of nature: the stars, the galaxies, the cosmos, the depths of complexity in the living cells, the molecular machines that keep us alive. Enlightening – revealing the secrets of the universe to us. Enduring – they are not fickle, they are unchanging, we can rely on them. Righteous – they provide the grounds on which human society can flourish.

The law of the Lord is perfect, restoring the soul;
The testimony of the Lord is sure, making wise the simple;
The statutes of the Lord are right, rejoicing the heart;
The commandment of the Lord is pure, enlightening the eyes;
The fear of the Lord is clean, enduring forever;
The judgments of the Lord are true and righteous altogether.
More to be desired are they than gold,
Yea, than much fine gold;
Sweeter also than honey and the honeycomb.
Moreover by them Your servant is warned,
And in keeping them there is great reward.
Psalm 19

*The oxymoron is deliberate. Builders do not demolish, they build. In true Critical Language Theory style as set out by Lewis Carroll so long ago: builder “means just what I choose it to mean—neither more nor less”.

Health Care or Profit

I am astonished. I find myself in agreement with a sociologist. ‘The market in health care is not a means of achieving competitive efficiency but a pseudo-market for creating private value at public expense.’

But I suppose agreement comes in that he is speaking to the least favourite part of my education in accounting, economics. Now when a sociologist speaks to economics one would wonder whether you need to find a pinch of salt, but then you already know that you need more than a pinch when you read any of my comments on economics, so my agreement with the man does not lend any support to what he wrote.

However little I understand economics, the use of words like competitive efficiency and pseudo-market, or even market on its own let alone any pseudosity about it, are warning signs of the first degree.  As an aside, if you know what a warning side of the second degree is you are at least one step ahead of me; please share your thoughts. The conclusion however stands up to all the scrutiny of the much less glamourous side of accountancy. If a service is provided by a non-profit organisation then it will, all other things being equal, cost less than an organisation that is set up for profit. This is an obvious conclusion for there is one significant cost within the organisation set up for profit which is not in the non-profit organisation. That additional cost is not taxation it is the return to the owners of the organisation. That return may be in the way of dividends or the super-profit of the owner being the amount in excess of the wages he would have been paid had he been employed by the organisation.  

Of course not all other things are equal, and the inequalities in the other things will drive the cost up or down. The costs of raw materials are likely to be different for the greater purchasing power of the National Health Care System (NHCS) should be capable of procuring raw materials more cheaply than the other organisations. Staff costs may be different in the other organisations for several reasons:

  1. The other organisations will not be bound by the national agreements of the NHCS;
  1. rates may be higher as a consequence of the expectation of staff that working for a private organisation should be remunerated at a higher rate then working for the NHCS
  2. rates may be lower as a consequence of the transfer of the pension costs away from the NHCS
  3. Base staffing levels within the NHCS may be kept lower if an other organisation is providing staff. The risk of having more staff than can be usefully employed is passed over to the other organisation.
  4. The other organisation will wish to be compensated for taking on the staff level risk.
  5. Where base staff levels are inadequate, the NHCS becomes dependent upon the provision of staff by the other organisation who are then able to charge a premium for the staff they provide.

On balance I would consider that it is likely that staff costs will be greater when taking into account a value for each of these factors, notwithstanding that in some local cases the costs may be lower. I am sure there are economists out there who will point out that I have missed many other factors which influence the cost as not all things are equal.

I cannot but then agree, though I say it with a heavy heart being on the purer side of the spectrum of scientists, with the sociologist that the market in health care is a means of creating private value at public expense.

Or, as the man on the Clapham omnibus might say: Those who wish to make a pretty penny out of health care will relish the thought of its privatisation. If we wish to retain our NHS then efforts to privatise any part of it should be resisted.

The sociologist is Robert Dingwall. In https://www.socialsciencespace.com/2022/11/the-covid-pandemic-in-france-a-review/ he is reviewing two books which analyse the response in France to the presence of Covid-19 in the population, and draws interesting comparisons with the UK’s response.  I commend it to you.

SARS

I normally think that when a thing is referred to by the initial letters of its proper name there is no need to add an S to pluralise it. The plural S is hidden behind the initial capital letter. So we have, for example, OS. You would not ask how many different OSes are there? You would ask how many different O(perating) S(ystems) are there. The plural s is hidden. There are exceptions of course but these prove the rule for the combination of the initial letters has become a noun in itself which does not describe the same thing as the string of words describes, so though we refer to LASER, if we have two sources we shall speak of having two lasers.

I should also like to make a further exception in response to a suggestion by a Western oligarch that one country become an special administrative region of another country. I shall refer later to this as the Type B proposal. That other country is well known for its SARS which were first identified there about twenty years ago. Much effort is put into the elimination of these SARS for they are quite dangerous things. The effects that they have on the people of that country are quite severe and if left uncontrolled would have serious adverse social and economic consequences, so the (dis)benefits of these SARS must, so we are led to believe, be curtailed at all costs.

The truth of these remarks would of course be clearly seen if the doctrine behind this suggestion were pressed to its logical conclusion, and it was proposed that the other country should become a special administrative region of the one. The objective of the underlying doctrine would be equally achieved. I shall refer to this as the Type A proposal.

Both proposals are the logical outcome of the foundational doctrine held by the other country, so why would not a Type A solution be acceptable to it? Is it a fear that it, as a SAR, would go the way of all other SARS?

Unvaccinated?

The BBC have run an analysis ‘Unvaccinated’. It is available for eleven months.

https://www.bbc.co.uk/iplayer/episode/m0019g27/unvaccinated

‘Covid-19 is on the rise again in the UK. After multiple lockdowns and more than 197,000 deaths, experts are warning we’re now entering a fifth wave of the pandemic. So why are around four million adults in the UK still yet to receive a single dose of the vaccine? In this timely, eye-opening investigation Professor Hannah Fry seeks to understand why so many remain unvaccinated against Covid-19.

To fully explore this complex and deeply divisive debate, Hannah brings seven unvaccinated participants together under one roof to unpack long-held opinions, beliefs and fears that have prevented them from getting the vaccine. Together, they meet leading experts, confront the latest science and statistics to emerge in the field, and dissect how misinformation spreads on social media. At the end of the experiment, each contributor is asked if what they have learned has changed their mind, and whether they will now take up the vaccine.‘

If this is the same Professor Hannah Fry as in the Mathematics of Cities at the UCL Centre for Advanced Spatial Analysis, then it seems to Coco that she brings the regimen of mathematics into disrepute. The study, which is designed to fully explore the complex and deeply divisive debate over whether to submit to vaccination or not, is hardly a scientific study, even by the standards of the least rigorous of the psycho-social , so-called, scientific disciplines. There is no parallel study to explore the opinions, beliefs and fears of those who have submitted to vaccination; no meeting of the vaccinated to discuss the contrary evidence and no question put to each of them whether with their greater knowledge they now understand the issues better and in the light of that would have refused the vaccination.

Whilst the setting, if the headline picture is of the location for the event, is quite pleasant, and certainly appears to be less ‘clinical’ than other centres used for similar, but quite different and putatively malicious, purposes, the description provided above suggests that this is nothing less than an attempt at re-education. It is an entirely one-sided, one-way effort to persuade individuals to change their views.

Coco is disappointed, but not astonished nor surprised by the BBC but disappointed, and astonished at UCL.

Just for the avoidance of doubt, this is not in itself a discussion of the reasons for and against vaccination. As mentioned above, the issues are complex; the science, such as it is, behind the modern vaccines is young; the language used to code biological systems is only partly and inadequately understood. There are many uncertainties. There are also complex social issues around our responses to threats, especially where there is a mixture of real, only perceived, and illusory threats some of which are propagated by those with special interests which are not fully aligned with the interests of the actual or potential patients.

E&OE