Bishop Hill Why do good intentions in the public sector lead to evil?
Jan 3, 2015 Climate: Sceptics NHS The tactic of demonising dissenters from the global warming orthodoxy has a long and dishonourable history now, and I'm sure that readers scarcely need me to recount the instances of bad behaviour that have made it to the public record. I was struck by the parallels between these stories and the experiences of Professor Joseph Meirion Thomas, a cancer surgeon who had the temerity to write a series of articles questioning certain aspects of the way health services are run in the UK.
The resultant Twitter storm would have looked entirely familiar to BH readers, with GPs and nurses all over the country flinging vulgar abuse at the good professor. This probably all falls under the heading of "free speech" (although also under the heading of "bad manners"), but as ever with these things there were less reputable ideas floating around, with one GP trying to organise a complaint to the General Medical Council and, in a painful echo of Andrew Dessler's contemptible behaviour during the Bengtsson affair, a GP from Fulham asked if the professor was "unwell". A letter describing Meirion Thomas as "vile" and "evil" was circulated to doctors in the area where the professor worked.
Also familiar were the attempts by those at the head of the relevant institutions to retaliate: Dr Maureen Baker, chair of the Royal College of General Practitioners called for Barnardo's to refuse a donation from Professor Meirion Thomas. An email from one Professor Azeem Majeed of Imperial College, was sent to his employers, asking them to dissociate themselves from the articles and insinuating that local doctors would stop referring patients if he was not dealt with. The result was a fortnight's gardening leave and then a gagging order being imposed.
It's interesting to see Prof Majeed's attempts to defend himself on his twitter feed:
@Azeem_Majeed it was the kind of questions -which could even be seen as covertly veiled threats- though wasn't it?! @spectator @Freddygray31
— ndeaks (@ndeaks) January 1, 2015
He clearly has no idea that he has done anything wrong. His mind seems to struggle with the idea that his implied threats might have overstepped the mark.
Of course Majeed probably believes that Meirion Thomas's complaints are wrong or misguided; he probably believes that he is doing the right thing in trying to get him silenced. But why does a mere difference of opinion over the views of a middle manager in the NHS end up in a situation where we are discussing freedom of speech and what many would take to be outright fascism? I can't remember anything like this when working in big businesses in my younger days. In fact it's hard to imagine a business having anything other than a passing interest in the views of a middle manager of one of its suppliers.
What is it about the public sector that makes differences of opinion among well-meaning people lead to evil?
Reader Comments (106)
It's an attitude of mind, we're doing good for mankind anyone who suggests otherwise is the devil incarnate, It's another example of a religious belief.
'What is it about the public sector that makes differences of opinion among well-meaning people lead to evil? '
They are being paid to uphold bad laws. Kinda like climate change troughers.
Any way of sending an e-mail to Imperial College asking why Prof. Azeem Majeed is employed there (despite his attempted bullying of others)?
Send the fire back on them; enough adverse comments and the pressure goes back onto him. He won't be fired but having to defend himself before a Board of politically correct namby pambies will remind him that he isn't the centre of the universe.
there seems to be an endemic mindset in health services that if you make a mild - or even constructive - criticism it is a foul Slander and you must be condemned to the outer reaches. There is also an immediate tendency to impose a gagging order. Interestingly the Welsh have, as I recall, forbidden the imposition of such gagging orders.
The problem is partly that many senior consultants have not caught up with modern life. No longer are they regarded as God - we have all got access to the Internet and more and more of us are doing our own research into our illnesses. This is actually a Good Thing but resented by senior consultants who trained inthe James Robertson Justice era. Sadly our chief executives of the various establishments DIDN'T train in that era!
"But why does a mere difference of opinion over the views of a middle manager in the NHS end up in a situation where we are discussing freedom of speech ...."
Freedom of speech has been eradicated in the UK.
‘A racist incident is any incident which is perceived to be racist by the victim, or any other person.’ - pause and consider the implications of that final phrase.
Or/And, we have this incitement to waste police time:
https://twitter.com/policescotland/status/549955567960465408
The need of people to be told what to do, think, act, etc., by other humans is not old. The earliest I've tracked it back in the written records is 1 Samual Chapter 8 (a quick read). In the milleniums since 900 BCE, little has changed.
I question well-meaning" in "well-meaning people" - being polite is not necessarily well-meaning
The are a number of pyschological "types" involved in climate "scientist"
There are the green misanthropists who hate all things man
There are the diehard environmentalists who hate technology and wish to return to medieval times
Academics who see a gravy train
Academics and civil servants who are incompetent and fear their work will be exposed as nonsense -wasn't Michael Mann made lead author before he had even finished his PhD? Think of all the pretend Nobel Laureates who have appeared in climate science - I suspose they think it makes up for their lack of ability
Lets face it, the growth in climate "science" and academics has not been matched with a growth in ability.
I've just stolen a great meme
- "Weez patrolling the comments sections to fight a conspiracy of those nastiz, nastiz deceitful deniers"
... hang-on is that Gollum's ring you are wearing ?
- Anyone know if anti-denier crusaders patroling blogs have had special training ? cos I see the same strange MO again and again
There have been several instances recently of inane comment being blown out of all proportion. However, everyone must remember it is not the law itself that has changed but the medium. The rule of thumb that you do not state in a public place anything that you would not shout across a crowded room is still true, the difference is that Facebook, Twitter or comment threads such as this means that the audience is far bigger than in the past and more than often hostile. The Supreme Court however, needs to look at the issue of freedom of speech, whistle-blowing and the fact that you do not have the automatic right NOT to be offended. Persons such as former Apprentice stars may well be seen as a warrior of the freedom of expression in future as against rabid exhibitionists. Literally, people are now being jailed for what would have been casual or crude comments in the pub.
I always have a little laugh when warmists use the 'if your doctor said' routine. My reaction is 'you trust your doctor?' The only way to get prompt treatment now is to work out what you've got and walk your GP through it. If not actually tell them point blank. Specialists like Meirion Thomas are in a different league and usually know exactly what they're doing but most GPs and lower ranking hospital staff are largely useless. There was a sneery bit of research that said women who self diagnose are wrong 20%-25% of the time which ignored that they had a far greater success rate than GPs.
Over the last 15 years I've had far more experience with medical people than I ever wanted to which is why I truly believe that professionals (private and public) need contant, agressive, external monitoring. The more the gripe and try to avoid it, the more bad practice they're engaging in.
The threat of losing your job because you want to make it better (organisation wide). That was as I remember a recent quality thrust in UK, well fairly recently. Apart from Industry, quality requirements were placed on the Civil Service and would include the NHS.
In such processes a champion was (should be) identified.....so we have one here with the right qualifications and experience. Don't think the quality circles have been working...for a long time..?
And you would be forgiven for thinking any GP/Specialist would be very polite and giving. That's part of the training is it not?
Clearly much of the untrained, inexperienced want to use the likes of Twotter to show just how weak they are. Unfortunately, the more senior want to get into it also and not for a good.
Classic case of "Political Correctness", carried to its logical extreme.
Behaviour in the public sector is better explained by ruthless self interest than 'good intentions'.
Thank you. I find this behaviour offensive as well as detrimental to good science. I hadn't tied it specifically to the public sector but there does seem to be a correlation. Perhaps job security feeds the arrogance, and perhaps in some cases it also feeds on the adulation of impressionable undergraduates. Perhaps there is a selection bias in that, in the current climate, humility is not a successful lifestyle choice. My personal Bete Noir is Brian Cox, whose reiteration on television some time ago that 'the science is settled' struck me as the dumbest remark ever by a physicist. He lies at the opposite end of the spectrum to giants like Plank and Feynmann. I call him the Professor of Self-Righteousness.
I am reminded that the phenomenon is not entirely new. Martin Rudwick's outstanding books on Geohistory in the 19th Century tell us that relationships between leading proponents of alternative geological hypotheses were apt to be acrimonious. But of course they lacked Twitter et al, the ideal media for the pretentious and the infantile.
Come now. It took the medical 'authorities' ~1400 years to acknowledge the errors in Galen's Anatomy.
As a civil servant I noticed that the ethos of the civil service changed post 1997; it changed from being there to serve the public to being there to be served BY the public. The nannying, the hectoring, councils spying on people, the cavalier attitude to the public's concerns, managers' latest dimwit policy fads implemented without any local consent/approval and the belief that the public HAVE to be led and told what to do. Frightening really; and so Orwellian.
I would think assuming intentions, good or bad, is a fallacy.
Jeff T
With regards to managers, I think the whole rise of "managerialism" - as in thinking you can manage using MBA theory alone rather than learn and educate yourself empirically in the field you are responsible for - has led to a whole host of bad managers. The UK system of paying them more than workers at the coal face frequently leads to a false sense of knowledge resulting in cock ups and then if anyone says anything, innuendo, falsehoods and bullying result in that person getting fired. As if being a manager makes you smarter.
Troughers is definitely a good name for the behaviour. Whether the managers involved are aware of what they are doing or it is a kind of group think is another matter.
My candidate would be the collectivist herd instinct. It seems to be being force-fed by social media too, which I suppose shouldn't surprise us - after all, what are Twitter et al for if not to reinforce herd behaviour? I assume that is why they are so loved by SJWs.
This particular case is made worse because the mythology of the NHS exacerbates the already astronomically high self-esteem many medical professionals seem to enjoy.
The GMC comes out of this well, telling complainants that the good doctor had no case to answer as he was entitled to freely express his views.
The behaviour of his employer, Royal Marsden, is a disgrace in requiring him to sign a gagging order as a condition of his continued employment.
But, arguably, far worse is the failure of successive governments, despite lots of warm words, to put in place robust measures to stop the NHS (and other other public bodies) persecuting critics from within their own ranks and whistleblowers. If governments had acted properly, a gagging order would not have been an option for Royal Marsden.
One of the best - and most upsetting - pieces of journalism I read last year was this Graun article on whilstleblowing.
'There were hundreds of us crying out for help': the afterlife of the whistleblower. Whistleblowers speak out because they feel they have to, often at great personal cost. But years later, do they think it was worth it?
Steve
I think it is unfair putting real (and great) scientists like Planck and Feynman in the same sentence as Brian Cox. What has Brian Cox ever done except rake in cash from the BBC for doing naff documentaries.
Re: Trefor Jones
> Literally, people are now being jailed for what would have been casual or crude comments in the pub.
The day Liberty, Amnesty or any of the other so called "Human Rights" organisations take up the case of somebody being prosecuted for an offensive tweet or gagged for having the 'wrong' opinion is the day I will donate money to them.
Article 10 of the Human Rights Act 1998 states:
An argument could easily be made that prosecuting somebody for something they say infringes article 10. This is especially the case since much of what is now considered offensive, by the professionally offended, changes on a daily basis making it nearly impossible not to offend.
Why is it that nannystate poopers are always on indefinite assignments have lifelong careers never need to switch jobs to another country etc?
Are they just "better" people, or do they just THINK THAT OF THEMSELVES
Like for like they are 10x better paid as well, for the majority doesnt do crpa.
I am reminded of this article by Gerald Warner. Number One Priority for 2015: Make Political Correctness History
The public sector indeed provides great examples of group think in support of dogmas and policies that are, let us say, somewhat lacking in evidence. "Peer-reviewed science" on diet and nutrition on the one hand, and climate on the other, is flawed largely because it is tied to the public-sector gravy train. The status quo will predictably be defended, dissent will be punished, etc.
On the other hand, the idea that the private sector is less caught up with second-order debates, more focussed on what counts, or simply more honest, can only go so far. Pfizer alone provides several examples of pushing products that may or may not do more harm than good, simply to maximize profit. To say the least, corporations expect their employees and "partners" to sing from the same songbook. It may be worth noting that doctors are invariably part of a campaign to push supposedly beneficial drugs.
Taking a step back, boomers have problems with health care. They are getting old, and it is natural for them to become concerned with even small changes in physical well-being. They generally want their lives to be extended--but with some degree of comfort. Even the fears about climate are tied to personal, physical well-being: what's going to happen to me? Yet it's possible that there has been no really big breakthrough in health since before the boomers became the Establishment. The big vaccines, antibiotics, insulin, all go back some way. So how do health organizations, in the public or private sector, justify their size and budgets? It may be rational for them to disengage a bit from actual evidence--and then turn on those who stick to evidence.
Some recent relevant headlines:
1) There is no evidence to support the practice of Ob/Gyn's in making every woman submit to a pelvic exam (there's a good chance this is mostly theatre to support the idea of expertise). There is no doubt a link to all the stories questioning the effectiveness of existing cancer screens. The deeper story here may be that little is known about how to prevent serious diseases, or even how to identify them in early stages.
2) Two-thirds of cancers may be caused by random mutations in stem cells--"bad luck"--leaving only one-third for a combination of lifestyle/environmental/genetic factors. To say the least, huge organizations exist and carry out fund-raising on the assumption that at least half of all cancers are caused by lifestyle/environmental factors, setting even genetics to one side.
3) Professor Thomas's story as discussed above: he pointed out that female GPs are likely to put in fewer hours, and see fewer patients, than their male colleagues; the public sector pays for training all these people; it may not be the most effective use of tax dollars to train female GPs. One can see how this evidence-based observation could evoke rage. Even more interesting: he suggests that the public are getting used to the idea of seeing a real specialist; GPs in general don't seem adequate except as a screen to identify which specialist you should see; there are quicker ways to get a referral to a specialist, including ER's; this becomes a very inefficient use of public resources.
Elderly patients clamouring for better health care; a system, whether public or private sector, that is not exactly over-flowing with solid, evidence-based answers. One result is something close to truth squads.
I like the comment by TinyCO2 above: it is funny when warmists say we should trust the experts just like we would trust a doctor. If for some unfortunate reason you see a lot of doctors, you are not likely to gain more and more confidence that they all really know what they are doing.
There are so many possible balls in play here it is hard to know which ones might be relevant.
Vested interests need not necessarily be financial ones and an attack on the GP system will be seen by some GPs as an attack on them personally. There are all sorts of reasons for this. GPs in the UK are exceptionally well-paid by European standards; there is among some of them a lurking guilt at the outcome of their negotiations with the Blair government that resulted in a massive increase in their pay for working shorter hours.
SandyS has a point about the "religious" aspect. The whole of human history tells us that mankind needs some form of belief system whether it is one God or many gods or a god-substitute.The modern age is (arguably) the most irreligious we have ever had, in the traditional sense, and it is worth remembering the quote ascribed to Chesterton that "when a man stops believing in God, he doesn't believe in nothing, he believes in anything".
This may be the organisation he works for, especially if it is one which, like the NHS or perhaps even Greenpeace, lays claim to some higher and "holier" objective than simply making and selling widgets at a profit and which thereby gives him a sense of "vocation". He is, as Andrew says, "well-meaning".
In other circumstances the "faith" may be amorphous — political activity is a bit out of fashion these days but political correctness certainly isn't, then there's feminism and a variety of other -isms that enable the "believer" to think well of himself.
The stronger his commitment to the organisation or the philosophy the more sharply he will react against anyone who implicitly or explicitly criticises it. Paradoxically this is most likely to happen when sub-consciously he recognises the flaws in the organisation (or philosophy or hypothesis in the case of science — not confined to climate thought that it is the area we have most to do with here) but is either too committed to accept them or feels that he is too ill-equipped to change anything, which explains the level of frustration/anger which results.
I don't think I'm saying anything new here. As far as I know this is relatively basic psychological stuff that I learnt 50 years ago. The difference is the explosion in (a) atheism which has left many people in need of a different sort of firm ground on which to stand,and (b) the means of communicating the anger/frustration to a wide audience instantly.
I suspect that is another fruitful area of study by the psychologists who should be able to say how many of those (named and shamed by the Mail) who may have half-agreed with Meirion Thomas until they saw what their colleagues were saying and ended up joining the lynching party.
'What is it about the public sector that makes differences of opinion among well-meaning people lead to evil? '
Inherent cultural Marxist collectivism!
"What is it about the public sector that makes differences of opinion among well-meaning people lead to evil? "
It's quite simple. When you are on the side of the angels anyone who doesn't agree with you must automatically be the devil.
That's it.
According to the DM, one of Prof Meirion's sins was to write that
This is obviously testament to the fact that the NHS has an appalling record of recovering costs from patients who are not entitled to its services.I once took this up with a consultant who was giving me a health check. I suggested to him that it would surely be of immense help to the NHS if all patients were billed for their healthcare - and that those who were exempt would merely remit their bills to the DoH (whatever....it could as easily be their home surgery/GP).
The advantage of this was that a) non-exempt patients would have to pay, recovering tens of millions; and b) exempt patients would get a better picture of the cost of the NHS to society - because, at the moment, they think it's 'FREE'! (and it's not)
I understand that it would have a cost to do this but then, so would any billing system dreamed up to catch 'healthcare tourists'. But this bit of admin would pay for itself in recovered fees.
The consultant thought it was a crap idea, but seeing as he was a proctologist, I guess he was influenced.
It would have been nice to read exactly what the Prof. said to rile the GP establishment but although the piece is supposed to be on the Mail's abomination of a website, neither of two articles link to it and the search facility is inspired by the adage of the drunk and the street lamp. The Royal Marsden was the place of my first post graduate employment.
Then it was a world centre of excellence for cancer treatment and, I suppose, 50 years on, still is.
Hence the suggestion that patients be not referred there reveals a mentality which regards cancer sufferers as suitable cannon fodder in an internecine war. This suggests that, whatever he said, has substance.
diogenese2
I'm inclined to agree with your assessment, certainly as far as Azeem Majeed is concerned. His "I only asked questions" defence is disingenuous, to say the least. How what he said could be interpreted as anything other than a threat ("shut this bastard up or we'll stop sending you patients") mystifies me.
Of course he could just be another loudmouth like Frozen Warning; I'm afraid my view is that everything said on Twitter should be ignored. As an example of "Anti-Social Media" I don't see how it could be improved upon.
But it's all of a piece with what I said above. "The Patient" is to be protected at all costs since that is the purpose of the NHS as such as Majeed see it. Patients as individuals are expendable. Casualties of the fight to keep the NHS pure. Collateral damage.
"differences of opinion among well-meaning people": ooh, you are a tease, Bish.
@ SandyS
It's an attitude of mind, we're doing good for mankind anyone who suggests otherwise is the devil incarnate, It's another example of a religious belief.
No it is not. It is an example of the attitude of people who have turned their back on God, made the NHS into an idol that must be worshipped, and do not believe they will ever have to account for their actions to a Supreme Being.
The response of the medical 'professionals' in this case has actually made Professor Joseph Meirion Thomas' points more believable. Instead of asking to be able to publish a rebuttal of each point made (surely easy if the points were so misguided), the medical community questions his sanity, his expertise, threatens his employers, sends insulting messages to his friends and colleagues. The only conclusion one can make from this is that they have no defence against his points.
The paragraph above changing medical to climate scientists and the professor's name to one of many who have queried AGW, could be precisely the same, with the same conclusion.
I don't know that it is solely public 'servants' that react like this. However, I would agree that it does appear to be more prevalent in jobs where the money and support for the individuals' employment is largely sourced from the government such as in academia and NGOs and in this case health services in UK.
They're all part of the same retarded mindset, the leftist fools. To them free speech is a given: for them alone.
I worked in the public sector for a few years before retiring and my wife worked in the NHS as a MedSec: suffice it to say the public sector is bad and the NHS worse BUT if you haven't witnessed it from within you really won't understand how bad it is. Yes Minister! barely scratched the surface: corruption is rife at all levels and outright lies are passed up to "responsible" ministers.
Talking of free speech:-
http://www.breitbart.com/london/2015/01/03/if-calling-the-scots-jocks-is-a-racist-crime-then-western-civilisation-is-over/
http://www.bbc.co.uk/news/world-australia-30664760
Talking public sector monopolies the BBC on the latest Australian bush fires.
BBC News trying to pin them on Climate Change but the usual they don't say when they started recording bush fire occurrences and those making the claims.
@TinyCO2
Here's a possible response to the "if your doctor said" argument.
If your doctor said that you were going to develop a life-threatening fever on the basis of a computer model that couldn't even explain your current symptoms, would you accept that?
If he said it was an average of 100 computer models that all made different assumptions about human biology and which all failed to replicate your actual medical history, would that be any better?
If your doctor then insisted that you must immediately undergo radical surgery with a huge risk of dangerous complications, would you agree to it? And if you were then assured that 97% of doctors would say the same thing, what would you think about the medical profession in general?
Tribalism and political correctness are not limited to the public sphere, nor to health care and climate change.
The great leveler is broad dissemination of facts and knowledge enabled by the internet. Despite all the disinformation and ad hominem sniping the net also enables, it allows sunshine disinfectant to illuminate what PC tribes prefer to keep hidden in the dark.
As here, or with Prof. Begstom*, or countless other examples.
[Bengtsson?}
As if I'm watching a society in decline. I hope " as if".
we should not have a public sector providing services of all sorts
only policing and regulation is warranted and should be provided by industry experts on short term assignments
and an army and spook office
no education, health, and all sors of charities and quangoes that turn out to be parking places for buddies of the residing elected scum.
a first strep could be to restrict public service contracts to 2y max
do not preach mobility to others , do it yourself.
are you listening, bbc??
You can find the original article by googling the following:
site:www.dailymail.co.uk meirion thomas
and it turns up as the first search result
http://www.dailymail.co.uk/debate/article-2840252/Why-fear-GPs-NHS-s-problem-not-solution-surgeon-J-MEIRION-THOMAS.html
@Graeme No 3
These are the details for Imperial's Head of Legal Services: Milena Radoycheva, Head of Legal Services, m.radoycheva@imperial.ac.uk.
The College Secretary and Registrar is John S Neilson, j.neilson@imperial.ac.uk.
"Honi soit qui mal y pense"
Evil be to he [who} evil thinks
The attitude of those who would suppress dissenting opinions is very old, summed up in the Inquisitor's formula: "Error has no rights."
The first premise is that you are wrong (as proved by the fact that you express a different view than mine).
The second premise is that your wrong opinion might be injurious to society if it were allowed to stand.
The corollary is that your opinion should be suppressed by any means necessary. (Be grateful that suppression no longer involves a threat to burn you alive.)
This has been the usual attitude to dissent in every human society as far back as we know. It is not at all special to the modern public sector; its most vicious modern exponents cut the heads off dissenters in the name of religion.
So "why public sector?" is the wrong question. More to the point is "how can we prevent the gradual roll-back of the extraordinary enlightenment insight that it is beneficial to society to allow people to express opinions that might be wrong?"
Prof Thomas is not a whistleblower. If he was, he would have given specific and precise details of events leading to patient harm. He made a bunch of generalisations, many of which are the opposite of the truth. For example, GP Surgeries have been way ahead of hospitals (both nhs and private) in their use of IT. His solution for asthma (more specialist nurses) is another bad idea. GPs deal with 2 problems in 10 minutes; their nurses take 15 minutes to deal with 1 problem (a third of the productivity) and frequently require GP input where clinical judgement is required. The solution would drive down quality while driving up costs.
And this is really nothing to so with public sector vs private sector. The Royal Marsden depends in part on GP referrals for its income. He slagged them off. It's not surprising he was censured. If an investment banker slagged off his institutional clients in the media, I bet his bank would fire him.
The idiots who complained to the GMC about him are dead wrong. But then so is he. And so is your assertion that this is a public sector problem. You are really suffering a lapse in judgement over this story.
While the gag itself is entirely typical of the bureaucratic fascism oozing over the world these days, there is one factor the Majeeds of this world always forget. Those of us with no prior knowledge of the story will read it and immediately think, "Ah, they've shut him up. Clearly what he's saying is true and they don't like the light being shone on it."
Thank you, Prof. Meirion Thomas. The concerns you raised have now been officially confirmed, and you have done us all a service in drawing attention to them. And, btw, I say that as someone whose recent experience with the NHS has been truly appalling, so it doesn't surprise me one bit.
The problem largely dates back to the Blair years, GP contracts gave GPs huge salaries and lots of empowerment over doctors employed within hospitals. The result is that GP medical practitioners, who frequently have little medical knowledge above that of senior registrars in hospitals, are earning up to 100 times as much as them for far less hours.
Hardly surprising then, that they react in this way, when a senior colleague questions their cushy jobs.
I have just complained to http://www.asa.org.uk/ about a WWF advert featuring polar bears and claims that ice will disappear and they will not be able to feed. If others also complain when they see this then there might be some effect.
I wouldn't assume good intentions.
Andrew