Europe, I used to think, was essentially a clockwork, engineering operation where public opinion in the form of the tabloids is nothing so much as a wrecking operation. I remember when I first came to Brussels how amazed I was at the intricate structure of decision making: it was an immense flow chart diagram and everything seemed so immensely logical and rightful in its place. Commission proposed –parliament amended. With help of impact assessments; this went on to the council of minsiters, who represent the nation states after input from the committee of the regions and the European social and economic committee. The lobbyists and civil society also had their input arrows; there was Coreper, the nation states’ embassies to the EU,and the flow chart was slightly amended for second readings and what was known as conciliation, where the institutions failed to agree. It’s not that underneath this political structure there weren’t people; the people’s needs came in through impact assessments, ruled by the gods of utility. But there was no politics. It seemed a liberation. There were differences, but the system was designed to create the best of all possible worlds for homo europeanus.
And coming back to London and picking up the bleeding redtops was a shock to my Brussels-refined sensibilities: the mastheads were dipped in blood and opening the pages was like prising apart the jaws of a rottweiler. There were jokes about Europe when they bothered to write about it all, but the joke was in the vulgarians, and you do not answer a fool according to his folly.
But never mind, Europe would continue to work for them, supervise them, be an invisible guiding hand, while the masses made bad jokes, feasted on their roasts.
How does it all work? It’s the basic question. And the more I learnt about the subtlety of decision making, the way it took all sides into account, the more I got to admire the officials working bit by bit on this institution, which grew and grew better, so that decisions flowed not only more smoothly but ran Europe better. The acronyms and special jargon started to make sense, and were not there as a gratuitous obstacle to mark exclusivity –unless that rule apply to all specialist activity, including say engineering or medicine. But was necessary because of the fine honed and abstruse nature o fdecison-making.
And people said: who could say that Europe didn’t deliver: it broke down barriers to trade and movement of peoples, brought democracy to its eastern marches, raised the bar of environmental and safety standards and thus stimulating technical innovation –legislation being the driver. Whereas nation states were caught up in their petty concerns, so that roads through border areas were of poor quality, the visionaries of DG transport funded schemes that would link Athens and Stockholm, Warsaw and Lisbon, by motorways, and the whole continent by a high speed railway network, the trans Europe express. It funded abridge between Sicily and the mainland, Sweden and Denmark. There were large sums of money to bring researchers and universities together so that there would be no Chinese walls, no duplication, The bane of a Europe of40 odd nation states with their narrow blinkers on. For the consumer and expat there were low international call charges, cheap European flights, and no Spanish death duties as the most recalcitrant nationalists – the bloated, St Georges flag-draped ,mono lingual expaiateinthe southern Spain railing about ”Europe” were the biggest beneficiaries of reforms: better, fairer Spanish bureaucracy, free cross-border healthcare for ageing mother and cheap flights down to Malaga for the teenage grandchildren. .
When the people said ”What has Europe ever done for us”, the reply would be: “Watch the life of Brian”/
One of the pleasures of working in Brussels, in the European parliament, was watching the parade of nationalities: The name plates on the doors brought curiously to mind star trek in its heterogeneity: Vlasak and Lipietz, Jaatteemaki, Konya-Hanar: The European parliament was a demonstration of diversity, on show every night at nationality themed nightly receptions as the pop of champagne corks echoes around the parliament’s many lobbies, like gunfire on a night on the trenches many years ago. The idea it homogenising seemed ridiculous; for here the television set and the American TV series was surely the enemy.
I have friends of all nationalities, and the most difficult to make contact with –but ultimately the most rewarding, have been the French, because their perspectives are just so different, yet so compelling. Many times we discussed the British attitude to Europe, and they brought up the parallel of the national profession: the French, the fathers of Europe, are a nation of engineers. (Only the British tabloids and their benighted readers think they are a nation of cooks and lovers) The British are a nation of warriors and traders…or perhaps pirates. (often the same thing) . The French carefully design Europe like a grand projet, a TGV, an ariane espace or an Airbus 380 of political construction. The British just see gimlet eyed opportunities, and their pirate ships kept in port by the suffocating technocratic inevitability of it all. They approached the whole thing with a cynicism of experience rather than the analytical mind fired by idealism – the approach, as any scientist or engineer knows, leads to progress. My French friends note British euro-scepticism and ask: where is your space programme. And why trains crawl at snails pace once they reached the Kent side of the channel tunnel. The train metaphor is often used for European integration or more generally progress, and it is an apt one, for the French equate technology with politics. .
There have been times when I have hated the British, with their fat-rumped insular righteousness, but the longer I spend in Brussels the more I have come to see that they are right. Behind the flowcharts, the position and policy papers, the smooth seminars that create a consensus, the different inputs from different institutions all leading inexorably to the right decision, I have come to see people –bureaucrats, individuals fighting turf wars, advancing their careers and that of their friends. Instead of a multilateral system based on different institutions, the council of ministers –national governments –reigns supreme, supported by acolytes in the national press. I have seen huge inefficiencies: the court of auditors failing to sign off the accounts for the14th year running, the voices from scientists at conferences who have told me that European science and technology spending – the biggest science budget in Europe, and its second largest item after agriculture –is all a waste of money, and they wouldn’t touch it with a bargepole for all the conditions laid down by ignorant bureaucrats.
I have re-read my Hayek, about the dangers of centralisation and a command economy, and east Europeans like Vaclav Klaus, the Czech president, are forever and rightly warning about the dangers of the EU turning into the EUSSR. We have been here before, they say. As the EU starts extending itz competences to culture and sports, Stalin’s chilling phrase about engineering the human soul comes to mind. Engineering might be a good thing; but social engineering ,if the 20th century is any guide, is not .And society is not a machine: it’s too complicated to try and make it one.
So my feelings about the EU are undergoing a change, and I am a lot less positive than before, and getting less do. The motto of the more intelligent Tory MEPs that ”We like Europe, but that the European Union” seems to ring ever more true.
But there are moments when I still think back to those early days five years ago: the snow is patterning your hair but it has melted as it touches the cobbles of the spire-infested grand place, giving a sheen in the gaslight. You have just emerged from a smoky estaminet with some gravelly words of Leonard Cohen ringing in your ears. Soon you will be hitting the pillows. And tomorrow you will goto the building with the gardens and the big atrium,, and along with the girls and boys in suits clutching files under their arms, together make the world a better place.
Monday, November 19, 2007
Hard to engineer a better world
Europe, I used to think, was essentially a clockwork, engineering operation where public opinion in the form of the tabloids is nothing so much as a wrecking operation. I remember when I first came to Brussels how amazed I was at the intricate structure of decision making: it was an immense flow chart diagram and everything seemed so immensely logical and rightful in its place. Commission proposed –parliament amended. With help of impact assessments; this went on to the council of minsiters, who represent the nation states after input from the committee of the regions and the European social and economic committee. The lobbyists and civil society also had their input arrows; there was Coreper, the nation states’ embassies to the EU,and the flow chart was slightly amended for second readings and what was known as conciliation, where the institutions failed to agree. It’s not that underneath this political structure there weren’t people; the people’s needs came in through impact assessments, ruled by the gods of utility. But there was no politics. It seemed a liberation. There were differences, but the system was designed to create the best of all possible worlds for homo europeanus.
And coming back to London and picking up the bleeding redtops was a shock to my Brussels-refined sensibilities: the mastheads were dipped in blood and opening the pages was like prising apart the jaws of a rottweiler. There were jokes about Europe when they bothered to write about it all, but the joke was in the vulgarians, and you do not answer a fool according to his folly.
But never mind, Europe would continue to work for them, supervise them, be an invisible guiding hand, while the masses made bad jokes, feasted on their roasts.
How does it all work? It’s the basic question. And the more I learnt about the subtlety of decision making, the way it took all sides into account, the more I got to admire the officials working bit by bit on this institution, which grew and grew better, so that decisions flowed not only more smoothly but ran Europe better. The acronyms and special jargon started to make sense, and were not there as a gratuitous obstacle to mark exclusivity –unless that rule apply to all specialist activity, including say engineering or medicine. But was necessary because of the fine honed and abstruse nature o fdecison-making.
And people said: who could say that Europe didn’t deliver: it broke down barriers to trade and movement of peoples, brought democracy to its eastern marches, raised the bar of environmental and safety standards and thus stimulating technical innovation –legislation being the driver. Whereas nation states were caught up in their petty concerns, so that roads through border areas were of poor quality, the visionaries of DG transport funded schemes that would link Athens and Stockholm, Warsaw and Lisbon, by motorways, and the whole continent by a high speed railway network, the trans Europe express. It funded abridge between Sicily and the mainland, Sweden and Denmark. There were large sums of money to bring researchers and universities together so that there would be no Chinese walls, no duplication, The bane of a Europe of40 odd nation states with their narrow blinkers on. For the consumer and expat there were low international call charges, cheap European flights, and no Spanish death duties as the most recalcitrant nationalists – the bloated, St Georges flag-draped ,mono lingual expaiateinthe southern Spain railing about ”Europe” were the biggest beneficiaries of reforms: better, fairer Spanish bureaucracy, free cross-border healthcare for ageing mother and cheap flights down to Malaga for the teenage grandchildren. .
When the people said ”What has Europe ever done for us”, the reply would be: “Watch the life of Brian”/
One of the pleasures of working in Brussels, in the European parliament, was watching the parade of nationalities: The name plates on the doors brought curiously to mind star trek in its heterogeneity: Vlasak and Lipietz, Jaatteemaki, Konya-Hanar: The European parliament was a demonstration of diversity, on show every night at nationality themed nightly receptions as the pop of champagne corks echoes around the parliament’s many lobbies, like gunfire on a night on the trenches many years ago. The idea it homogenising seemed ridiculous; for here the television set and the American TV series was surely the enemy.
I have friends of all nationalities, and the most difficult to make contact with –but ultimately the most rewarding, have been the French, because their perspectives are just so different, yet so compelling. Many times we discussed the British attitude to Europe, and they brought up the parallel of the national profession: the French, the fathers of Europe, are a nation of engineers. (Only the British tabloids and their benighted readers think they are a nation of cooks and lovers) The British are a nation of warriors and traders…or perhaps pirates. (often the same thing) . The French carefully design Europe like a grand projet, a TGV, an ariane espace or an Airbus 380 of political construction. The British just see gimlet eyed opportunities, and their pirate ships kept in port by the suffocating technocratic inevitability of it all. They approached the whole thing with a cynicism of experience rather than the analytical mind fired by idealism – the approach, as any scientist or engineer knows, leads to progress. My French friends note British euro-scepticism and ask: where is your space programme. And why trains crawl at snails pace once they reached the Kent side of the channel tunnel. The train metaphor is often used for European integration or more generally progress, and it is an apt one, for the French equate technology with politics. .
There have been times when I have hated the British, with their fat-rumped insular righteousness, but the longer I spend in Brussels the more I have come to see that they are right. Behind the flowcharts, the position and policy papers, the smooth seminars that create a consensus, the different inputs from different institutions all leading inexorably to the right decision, I have come to see people –bureaucrats, individuals fighting turf wars, advancing their careers and that of their friends. Instead of a multilateral system based on different institutions, the council of ministers –national governments –reigns supreme, supported by acolytes in the national press. I have seen huge inefficiencies: the court of auditors failing to sign off the accounts for the14th year running, the voices from scientists at conferences who have told me that European science and technology spending – the biggest science budget in Europe, and its second largest item after agriculture –is all a waste of money, and they wouldn’t touch it with a bargepole for all the conditions laid down by ignorant bureaucrats.
I have re-read my Hayek, about the dangers of centralisation and a command economy, and east Europeans like Vaclav Klaus, the Czech president, are forever and rightly warning about the dangers of the EU turning into the EUSSR. We have been here before, they say. As the EU starts extending itz competences to culture and sports, Stalin’s chilling phrase about engineering the human soul comes to mind. Engineering might be a good thing; but social engineering ,if the 20th century is any guide, is not .And society is not a machine: it’s too complicated to try and make it one.
So my feelings about the EU are undergoing a change, and I am a lot less positive than before, and getting less do. The motto of the more intelligent Tory MEPs that ”We like Europe, but that the European Union” seems to ring ever more true.
But there are moments when I still think back to those early days five years ago: the snow is patterning your hair but it has melted as it touches the cobbles of the spire-infested grand place, giving a sheen in the gaslight. You have just emerged from a smoky estaminet with some gravelly words of Leonard Cohen ringing in your ears. Soon you will be hitting the pillows. And tomorrow you will goto the building with the gardens and the big atrium,, and along with the girls and boys in suits clutching files under their arms, together make the world a better place.
And coming back to London and picking up the bleeding redtops was a shock to my Brussels-refined sensibilities: the mastheads were dipped in blood and opening the pages was like prising apart the jaws of a rottweiler. There were jokes about Europe when they bothered to write about it all, but the joke was in the vulgarians, and you do not answer a fool according to his folly.
But never mind, Europe would continue to work for them, supervise them, be an invisible guiding hand, while the masses made bad jokes, feasted on their roasts.
How does it all work? It’s the basic question. And the more I learnt about the subtlety of decision making, the way it took all sides into account, the more I got to admire the officials working bit by bit on this institution, which grew and grew better, so that decisions flowed not only more smoothly but ran Europe better. The acronyms and special jargon started to make sense, and were not there as a gratuitous obstacle to mark exclusivity –unless that rule apply to all specialist activity, including say engineering or medicine. But was necessary because of the fine honed and abstruse nature o fdecison-making.
And people said: who could say that Europe didn’t deliver: it broke down barriers to trade and movement of peoples, brought democracy to its eastern marches, raised the bar of environmental and safety standards and thus stimulating technical innovation –legislation being the driver. Whereas nation states were caught up in their petty concerns, so that roads through border areas were of poor quality, the visionaries of DG transport funded schemes that would link Athens and Stockholm, Warsaw and Lisbon, by motorways, and the whole continent by a high speed railway network, the trans Europe express. It funded abridge between Sicily and the mainland, Sweden and Denmark. There were large sums of money to bring researchers and universities together so that there would be no Chinese walls, no duplication, The bane of a Europe of40 odd nation states with their narrow blinkers on. For the consumer and expat there were low international call charges, cheap European flights, and no Spanish death duties as the most recalcitrant nationalists – the bloated, St Georges flag-draped ,mono lingual expaiateinthe southern Spain railing about ”Europe” were the biggest beneficiaries of reforms: better, fairer Spanish bureaucracy, free cross-border healthcare for ageing mother and cheap flights down to Malaga for the teenage grandchildren. .
When the people said ”What has Europe ever done for us”, the reply would be: “Watch the life of Brian”/
One of the pleasures of working in Brussels, in the European parliament, was watching the parade of nationalities: The name plates on the doors brought curiously to mind star trek in its heterogeneity: Vlasak and Lipietz, Jaatteemaki, Konya-Hanar: The European parliament was a demonstration of diversity, on show every night at nationality themed nightly receptions as the pop of champagne corks echoes around the parliament’s many lobbies, like gunfire on a night on the trenches many years ago. The idea it homogenising seemed ridiculous; for here the television set and the American TV series was surely the enemy.
I have friends of all nationalities, and the most difficult to make contact with –but ultimately the most rewarding, have been the French, because their perspectives are just so different, yet so compelling. Many times we discussed the British attitude to Europe, and they brought up the parallel of the national profession: the French, the fathers of Europe, are a nation of engineers. (Only the British tabloids and their benighted readers think they are a nation of cooks and lovers) The British are a nation of warriors and traders…or perhaps pirates. (often the same thing) . The French carefully design Europe like a grand projet, a TGV, an ariane espace or an Airbus 380 of political construction. The British just see gimlet eyed opportunities, and their pirate ships kept in port by the suffocating technocratic inevitability of it all. They approached the whole thing with a cynicism of experience rather than the analytical mind fired by idealism – the approach, as any scientist or engineer knows, leads to progress. My French friends note British euro-scepticism and ask: where is your space programme. And why trains crawl at snails pace once they reached the Kent side of the channel tunnel. The train metaphor is often used for European integration or more generally progress, and it is an apt one, for the French equate technology with politics. .
There have been times when I have hated the British, with their fat-rumped insular righteousness, but the longer I spend in Brussels the more I have come to see that they are right. Behind the flowcharts, the position and policy papers, the smooth seminars that create a consensus, the different inputs from different institutions all leading inexorably to the right decision, I have come to see people –bureaucrats, individuals fighting turf wars, advancing their careers and that of their friends. Instead of a multilateral system based on different institutions, the council of ministers –national governments –reigns supreme, supported by acolytes in the national press. I have seen huge inefficiencies: the court of auditors failing to sign off the accounts for the14th year running, the voices from scientists at conferences who have told me that European science and technology spending – the biggest science budget in Europe, and its second largest item after agriculture –is all a waste of money, and they wouldn’t touch it with a bargepole for all the conditions laid down by ignorant bureaucrats.
I have re-read my Hayek, about the dangers of centralisation and a command economy, and east Europeans like Vaclav Klaus, the Czech president, are forever and rightly warning about the dangers of the EU turning into the EUSSR. We have been here before, they say. As the EU starts extending itz competences to culture and sports, Stalin’s chilling phrase about engineering the human soul comes to mind. Engineering might be a good thing; but social engineering ,if the 20th century is any guide, is not .And society is not a machine: it’s too complicated to try and make it one.
So my feelings about the EU are undergoing a change, and I am a lot less positive than before, and getting less do. The motto of the more intelligent Tory MEPs that ”We like Europe, but that the European Union” seems to ring ever more true.
But there are moments when I still think back to those early days five years ago: the snow is patterning your hair but it has melted as it touches the cobbles of the spire-infested grand place, giving a sheen in the gaslight. You have just emerged from a smoky estaminet with some gravelly words of Leonard Cohen ringing in your ears. Soon you will be hitting the pillows. And tomorrow you will goto the building with the gardens and the big atrium,, and along with the girls and boys in suits clutching files under their arms, together make the world a better place.
Bruges group meeting
I attended a Bruges group conference this weekend, at King’s College. The people were all over the age of sixty: sellotaped glasses, walking sticks, that sort of thing. A constant refrain was the call for speakers to speak up – bellowed from various corners of the room. The man behind me fell asleep, spoke in his sleep, and snored, before being woken up.
The Bruges group is highly eurosceptic; its patron is one M Thatcher. but John Redwood, the only MP present, at least had some interesting things to say. He said he voted against the EC in the referendum in 1975 because he had read the treat of Rome which talked of ever closer political union; he would have voted for good relations and a free trade agreement with the other countries “but that was not on offer”. He described the current EU as a threat to democracy. He said he, as Welsh secretary, had sat in on about 20 meetings of the council of ministers and that the way decisions were made was a disgrace to democracy. “We met in private, there were no opportunities to vote the legislation down, no one asks ‘Is your new law necessary”. Ministers were stressed by “arbitrary deadlines” set up by unelected bureaucrats; “thousands of laws” are passed in this way, he said..”And you cannot correct, amend of repeal these laws.”
He said the British parliament was packed with “eurofederalists”, and that the public was apathetic. He urged his audience to engage their friends and begin a letter-writing campaign to MPs.
He also urged unity between the different factions within Euroscepticism: “Sick of factionalism, splintering into ever smaller groups as people compete to hold on to the true faith. The Tories were on board and would vote for a referendum and “Eighty percent of the public are on our side.”
“Nobody under the age of 50 has been able to vote on the future of the EU. The EU has changed enormously since 1975. People are given referenda on whether they want regional assemblies or small town mayors, but not on whether they approve of this new Europe.”
He has a point.
Another speaker, Marc Henri Glendinning of the democracy movement, talked about how the referendum vote would be won. They would be distributing leaflets to 150 target constituencies; and holding a mock referendum in a key constituency. Overseen by the electoral reform society. “ He said the pro referendum side needed 85 MPs to switch sides – they already had 230 comprising Tories and Welsh nationalists and a few labour and Liberal MPs. “Over 400 will vote against a referendum, but 185 of those are MPs in constituencies with fewer than 5,000 majority. “And these could be persuaded if their electorate felt strongly. If we can break 30 LibDems we could persuade the new liberal leader to back the Tories.”
“Winning the right to a referendum is necessary but not sufficient.” In others words it was just the beginning. He also urged linking up with pro referendum groups in other countries, and that this was not a Little Englander issue but about the people against the oligarchic elites that rule Europe.
He is right.
They need thousands of pounds though, despite the backing of the owner of rubik’s cube. “Are there any rich widows out there,” he said, surveying his audience.
“Speak up,” bellowed the man behind me.
Another speaker said - rightly again - that British ministers and civil servants go native when they go to Brussels, intoxicated by being effective members of a cabinet that rules 500m people. Instead of representing the UK in Brussels, they came back with new found loyalty to their chums in Brussels and start representing Brussels in the UK.
That, too, is correct.
That said, the conference degenerated a bit after that.
Christopher Booker – who has written books on fiction – compared the EU to Sauron’s Mordor and the constitutional treaty to the evil ring that corrupted its wearer and controlled the bearers of the lesser rings owned by elves, dwarves and men. He intoned the inscription that great fictionalist JRR Tolkien said was inside the Ring:
“One Ring to rule them all, One Ring to find them,
One Ring to bring them all and in the darkness bind them
In the Land of Mordor where the Shadows lie.”
He said this melodramatically, in all seriousness, and no one laughed.
And then Ruth Lea, an economist and former treasury official, who had said sensible things about the need to renegotiate the relationship with Europe along the lines of the Swiss relationship to the EU – a respectable position, with a case for it – then let herself down by denying that global warming was a plot by the EU to accrete more powers. This prompted some interest among the audience, and later, as I left, I heard the whipless MEP Roger Helmer talking in his best bedside voice to a number of oldies. “Well, you know, most of the new Tory candidates deny climate change.”
The Bruges group is highly eurosceptic; its patron is one M Thatcher. but John Redwood, the only MP present, at least had some interesting things to say. He said he voted against the EC in the referendum in 1975 because he had read the treat of Rome which talked of ever closer political union; he would have voted for good relations and a free trade agreement with the other countries “but that was not on offer”. He described the current EU as a threat to democracy. He said he, as Welsh secretary, had sat in on about 20 meetings of the council of ministers and that the way decisions were made was a disgrace to democracy. “We met in private, there were no opportunities to vote the legislation down, no one asks ‘Is your new law necessary”. Ministers were stressed by “arbitrary deadlines” set up by unelected bureaucrats; “thousands of laws” are passed in this way, he said..”And you cannot correct, amend of repeal these laws.”
He said the British parliament was packed with “eurofederalists”, and that the public was apathetic. He urged his audience to engage their friends and begin a letter-writing campaign to MPs.
He also urged unity between the different factions within Euroscepticism: “Sick of factionalism, splintering into ever smaller groups as people compete to hold on to the true faith. The Tories were on board and would vote for a referendum and “Eighty percent of the public are on our side.”
“Nobody under the age of 50 has been able to vote on the future of the EU. The EU has changed enormously since 1975. People are given referenda on whether they want regional assemblies or small town mayors, but not on whether they approve of this new Europe.”
He has a point.
Another speaker, Marc Henri Glendinning of the democracy movement, talked about how the referendum vote would be won. They would be distributing leaflets to 150 target constituencies; and holding a mock referendum in a key constituency. Overseen by the electoral reform society. “ He said the pro referendum side needed 85 MPs to switch sides – they already had 230 comprising Tories and Welsh nationalists and a few labour and Liberal MPs. “Over 400 will vote against a referendum, but 185 of those are MPs in constituencies with fewer than 5,000 majority. “And these could be persuaded if their electorate felt strongly. If we can break 30 LibDems we could persuade the new liberal leader to back the Tories.”
“Winning the right to a referendum is necessary but not sufficient.” In others words it was just the beginning. He also urged linking up with pro referendum groups in other countries, and that this was not a Little Englander issue but about the people against the oligarchic elites that rule Europe.
He is right.
They need thousands of pounds though, despite the backing of the owner of rubik’s cube. “Are there any rich widows out there,” he said, surveying his audience.
“Speak up,” bellowed the man behind me.
Another speaker said - rightly again - that British ministers and civil servants go native when they go to Brussels, intoxicated by being effective members of a cabinet that rules 500m people. Instead of representing the UK in Brussels, they came back with new found loyalty to their chums in Brussels and start representing Brussels in the UK.
That, too, is correct.
That said, the conference degenerated a bit after that.
Christopher Booker – who has written books on fiction – compared the EU to Sauron’s Mordor and the constitutional treaty to the evil ring that corrupted its wearer and controlled the bearers of the lesser rings owned by elves, dwarves and men. He intoned the inscription that great fictionalist JRR Tolkien said was inside the Ring:
“One Ring to rule them all, One Ring to find them,
One Ring to bring them all and in the darkness bind them
In the Land of Mordor where the Shadows lie.”
He said this melodramatically, in all seriousness, and no one laughed.
And then Ruth Lea, an economist and former treasury official, who had said sensible things about the need to renegotiate the relationship with Europe along the lines of the Swiss relationship to the EU – a respectable position, with a case for it – then let herself down by denying that global warming was a plot by the EU to accrete more powers. This prompted some interest among the audience, and later, as I left, I heard the whipless MEP Roger Helmer talking in his best bedside voice to a number of oldies. “Well, you know, most of the new Tory candidates deny climate change.”
Tuesday, November 13, 2007
Should immigrants be tested for TB?
hould Britain test all immigrants for TB? It’s a disease almost eradicated in the native population. Yet several hundred thousand immigrants a year come, many from countries where not only active TB rates are higher in the UK, but where up to a third of the population has latent TB. That is to say they have been infected, have a few hundred of the rod-shaped bacteria in their lungs contained by their immune systems: they are asymptomatic and non infectious. In ten percent of cases, however, these latent carriers go on to develop full blown TB.
Statistically that’s about three thousand arrivals a year who will eventually develop the disease . It wouldn’tbesobad ifalthese cases were of normal TB, which is easy and cheap to treat, inconvenient mostly for the patient, who has to endure a six month cocktail of antibiotics even after he has begun to feel well.
But about 2-3percent ofTB cases these days are multidrugs resistant (MDR) – the result of por drugs compliance further back in the transmission chain – and this TB is expensive and massively inconvenient to treat, susceptible only to second line drugs which are expensive, take a long time to work and have terrible side effects. There are periods when these MDR TB patients have to be kept in isolation chambers, seen to by a phalanx of doctors and nurses. The cost of treating such a patient has been estimated at £250,000 for a three year programme, and statistically Britain should be seeing about 60-80 MDR patients a year (3% of the 3,000 TB cases), as indeed it does.
To get an idea of what treatment for MDR is like, I spoke to one of few native Brits who did catch it – while in hospital (a depressingly common route), from another patient with active MDR:
Paul Thorn was a young HIV positive nurse treated for his HIV in an open ward at Westminster and Chelsea hospital in 1995 when a Brazilian came in, coughed up his sputum – the standard test – and, because the nurses failed to take precautions, infected the others. Six died. Paul survived –by enduring a painful three year course of chemotherapy, part of that period spent in an isolation room in hospital. He sent me a copy of his diary of the period.
“For some time experts had been predicting that it was only a matter of time before an outbreak of TB/MDR-TB occurred in such a way. Three months after exposure to the deadly bacteria, I was told of the outbreak. My health had already been deteriorating prior to my knowledge of the exposure. During that time the bacilli multiplied slowly in my lungs without me knowing. My slowly advancing chest pain and breathlessness were finally explained. Then without warning I lost my liberty and found myself locked away from society in a negative pressure isolation room so that I didn’t infect anyone else.”
Paul couldn’t leave the room – “you might not get out alive”, one doctor told him - and his contact with visitors was restricted. He found himself being visited by a succession of doctors and nurses in masks, and was given medication that made him woozy, confused and angry. When his story appeared in the media; he started getting letters of support – but also critical letters, asking why the taxpayer should pay for he mistakes owning to his lifestyle choice, since HIV exacerbated his condition.
But things got better: by October 1995 he was putting on weight, and had started a fitness routine.
When he was set free, he had to comply with several conditions: Though he was sputum negative and therefore very unlikely to be infectious, he still had to be careful. His doctors told him:
“You should sleep in a single room with the door closed at night, and should spend the majority of your time inside. It is relatively safe for you to go out for short periods assuming you will not be in close contact with anyone for longer than quarter of an hour or so. This means you will not be able for example, to go to restaurants, clubs, or use public transport. The flat should be properly ventilated. You will need to comply with daily direct observed therapy and will be advised to attend our out-patients' clinic once monthly. You should have no new social contacts and should not have contact with anyone who is HIV positive or otherwise immuno-compromised. You should also not have any contact with pregnant women or children."
Over the next three years Paul lost a lot of friends. His MDR TB course continued, a daily dose of five drugs taken under supervision at his local medical centre, under the internationally recognised standard of DOTS treatment, for which he says he was glad. “These drugs represent really powerful chemotherapy. I was vomiting, my lips became numb, I became paranoid because the drugs seemed through my brain membranes. I would have stopped taking the drugs.” He never did though- thanks to the support of his consultant – and now speaks regularly at conferences as well as having published a book on how to survive TB.
There are several hundred individuals being treated in the above manner, in a lowokey way, in centres in London, Liverpool and elsewhere – under John Moore Gillon at the east London; under prof Peter Davies at the Liverpol cardiothoracic centre. Though invidious to question the dedication of staff or the determination to be cured of MDR patients, Paul did admit that he was often tempted to quit: to walk out and disappear into the community, with his uncured MDR.
It’s not that easy catch someone else’s TB, you have to spend hours in their company in an environment saturated with cough droplets, so catching it on the tube is unlikely. But there have been outbreaks – in Leicester, London, in the former a school, among former residents of a squat, from where it rippled out to 67 friends, relatives others. These have not been any multidrugs resistant outbreaks, yet.
The MDR treatment bill in the UK may only run into the tens of millions of pounds a year – these are the decisions policy-makers have to make all the time. Prof Davies does not think screening worthwhile = for a start the detection test s for MDR are complex and beyond the capabilities of embassy staff, at least until electronic kit becomes available, Then it raises the questions: if immigrants, why not all visitors? Students, tourists, temporary workers, since they could equally well –albeit at lower risk – be carriers. .No other country has gone down that route, ever..
But it’s worth awareness raising. Paul told me of one case in West London where a GP took a year to diagnose his patient with TB, having done tests for cancer as well as the usual respiratory diseases. Prof Davies blamed the drugs companies for pushing asthma drugs in the medical journals, with their slogans aimed at doctors “Cough..Think asthma” The drugs firms have long found it more profitable to invest in such western world ailments than in TB. (Though that is slowly changing.)
For while it must be a surprising fact to many that not only is disease associated with Victorian “romantic” death not eradicated but is the world’s second biggest infectious killer, it remains overwhelmingly disease of poor countries. Perhaps greater awareness will put pressure on efforts to reduce the scourge in the poor world - and thus preventing it from striking in the rich one.
Statistically that’s about three thousand arrivals a year who will eventually develop the disease . It wouldn’tbesobad ifalthese cases were of normal TB, which is easy and cheap to treat, inconvenient mostly for the patient, who has to endure a six month cocktail of antibiotics even after he has begun to feel well.
But about 2-3percent ofTB cases these days are multidrugs resistant (MDR) – the result of por drugs compliance further back in the transmission chain – and this TB is expensive and massively inconvenient to treat, susceptible only to second line drugs which are expensive, take a long time to work and have terrible side effects. There are periods when these MDR TB patients have to be kept in isolation chambers, seen to by a phalanx of doctors and nurses. The cost of treating such a patient has been estimated at £250,000 for a three year programme, and statistically Britain should be seeing about 60-80 MDR patients a year (3% of the 3,000 TB cases), as indeed it does.
To get an idea of what treatment for MDR is like, I spoke to one of few native Brits who did catch it – while in hospital (a depressingly common route), from another patient with active MDR:
Paul Thorn was a young HIV positive nurse treated for his HIV in an open ward at Westminster and Chelsea hospital in 1995 when a Brazilian came in, coughed up his sputum – the standard test – and, because the nurses failed to take precautions, infected the others. Six died. Paul survived –by enduring a painful three year course of chemotherapy, part of that period spent in an isolation room in hospital. He sent me a copy of his diary of the period.
“For some time experts had been predicting that it was only a matter of time before an outbreak of TB/MDR-TB occurred in such a way. Three months after exposure to the deadly bacteria, I was told of the outbreak. My health had already been deteriorating prior to my knowledge of the exposure. During that time the bacilli multiplied slowly in my lungs without me knowing. My slowly advancing chest pain and breathlessness were finally explained. Then without warning I lost my liberty and found myself locked away from society in a negative pressure isolation room so that I didn’t infect anyone else.”
Paul couldn’t leave the room – “you might not get out alive”, one doctor told him - and his contact with visitors was restricted. He found himself being visited by a succession of doctors and nurses in masks, and was given medication that made him woozy, confused and angry. When his story appeared in the media; he started getting letters of support – but also critical letters, asking why the taxpayer should pay for he mistakes owning to his lifestyle choice, since HIV exacerbated his condition.
But things got better: by October 1995 he was putting on weight, and had started a fitness routine.
When he was set free, he had to comply with several conditions: Though he was sputum negative and therefore very unlikely to be infectious, he still had to be careful. His doctors told him:
“You should sleep in a single room with the door closed at night, and should spend the majority of your time inside. It is relatively safe for you to go out for short periods assuming you will not be in close contact with anyone for longer than quarter of an hour or so. This means you will not be able for example, to go to restaurants, clubs, or use public transport. The flat should be properly ventilated. You will need to comply with daily direct observed therapy and will be advised to attend our out-patients' clinic once monthly. You should have no new social contacts and should not have contact with anyone who is HIV positive or otherwise immuno-compromised. You should also not have any contact with pregnant women or children."
Over the next three years Paul lost a lot of friends. His MDR TB course continued, a daily dose of five drugs taken under supervision at his local medical centre, under the internationally recognised standard of DOTS treatment, for which he says he was glad. “These drugs represent really powerful chemotherapy. I was vomiting, my lips became numb, I became paranoid because the drugs seemed through my brain membranes. I would have stopped taking the drugs.” He never did though- thanks to the support of his consultant – and now speaks regularly at conferences as well as having published a book on how to survive TB.
There are several hundred individuals being treated in the above manner, in a lowokey way, in centres in London, Liverpool and elsewhere – under John Moore Gillon at the east London; under prof Peter Davies at the Liverpol cardiothoracic centre. Though invidious to question the dedication of staff or the determination to be cured of MDR patients, Paul did admit that he was often tempted to quit: to walk out and disappear into the community, with his uncured MDR.
It’s not that easy catch someone else’s TB, you have to spend hours in their company in an environment saturated with cough droplets, so catching it on the tube is unlikely. But there have been outbreaks – in Leicester, London, in the former a school, among former residents of a squat, from where it rippled out to 67 friends, relatives others. These have not been any multidrugs resistant outbreaks, yet.
The MDR treatment bill in the UK may only run into the tens of millions of pounds a year – these are the decisions policy-makers have to make all the time. Prof Davies does not think screening worthwhile = for a start the detection test s for MDR are complex and beyond the capabilities of embassy staff, at least until electronic kit becomes available, Then it raises the questions: if immigrants, why not all visitors? Students, tourists, temporary workers, since they could equally well –albeit at lower risk – be carriers. .No other country has gone down that route, ever..
But it’s worth awareness raising. Paul told me of one case in West London where a GP took a year to diagnose his patient with TB, having done tests for cancer as well as the usual respiratory diseases. Prof Davies blamed the drugs companies for pushing asthma drugs in the medical journals, with their slogans aimed at doctors “Cough..Think asthma” The drugs firms have long found it more profitable to invest in such western world ailments than in TB. (Though that is slowly changing.)
For while it must be a surprising fact to many that not only is disease associated with Victorian “romantic” death not eradicated but is the world’s second biggest infectious killer, it remains overwhelmingly disease of poor countries. Perhaps greater awareness will put pressure on efforts to reduce the scourge in the poor world - and thus preventing it from striking in the rich one.
Sunday, November 11, 2007
The accidental war
The second world war remains a bit of a taboo in Brussels, as was evident when the Poles insisted on dredging it up at the recent summit, when they said they ought to be given council votes on the basis of a population of 66m, which would have the number of inhabitants in their country had not a certain war started by a certain nation raged over their territory.
The second world war is taboo, but it's also been an axiom that the Germans were wholly at fault, and that the west fought a good war. Totalitarianism followed totalitarianism, so the cold war melded seamlessly with the second world war. Both fights were supposedly "good fights".
Yet these days absolute good and evil is no longer anything secular Europeans believe in. So it may be that AJP Taylor, the most controversial and most popular British historian of the last century, deserves to come into fashion again.
He rejected the standard narrative that westerners imbibe with their mother's milk: that the second world war was caused by Hitler and his totalitarian dictatorship, and that it might have been avoided has it not been for the policy of appeasement which only served to whet his appetite. The lesson learnt – that dictators must never be appeased, as they will be encouraged – has had amazing traction in western, especially American, foreign policy ever since.
AJP Taylor had, when the Origins of the Second World War was published in 1961, had a distinguished career as a fellow of Magdalen and a number of highly regarded books under his belt. His telly don period was yet to begin.
The book set off a storm, and probably cost him the regius professorship of history at Oxford, which went to his archrival Hugh Trevor Roper, who comdemned his theory for every available sin.
Trevor Roper, later responsible for the Hitler diaries fiasco, by the way, said that Taylor’s evidence was unreliable; he distorted documents by selective citation and dismissed those he didn't like by claiming they didn't count. Taylor, he said, contradicted himself repeatedly and drew conclusions at variance with his evidence. Many other historians of the time agreed. Yet the book continues in 2007 to sell well, especially to undergraduates.
Taylor’s thesis was that Hitler was not evil demon but rather on ordinary German, perhaps even just an ordinary European, politician. He was not bent on European or world domination, but was just playing the European power game, as all statesmen of the time were: their motives were simply to maximise the gains of their country without resorting to the kind of war that whose damage would negate any gain. Chancellor Stresemann, the “good German” of postwar myth, who wanted to follow a peaceful path, had exactly the same plans to dominate eastern Europe as Hitler did, one way or another. Inasmuch in that Hitler did have a personal characteristic it was dithering opportunism: Whereas others saw a demonic genius bent on dominating Europe by masterfully pulling all the strings because he had a carefully laid out plan, Taylor saw only an ordinary politician who let events fall into his lap and asked how he might benefit from them.
Nations’ interests were eternal, and leaders were not motivated by ideology in their pursuit of that. Whereas others saw in Mein Kampf a blueprint for worldwide domination, Taylor heard the confused beerhall chatter of the twenties put between hard covers, and rated it what it said as unimportant. .
Whereas some saw the Hossbach memorandum of 1937 as a timetable for war, Taylor saw it as a document typifying the intrigue and machinations of the Nazi system of government - but these were red herrings that other post-war historians, setting up the war as defensive white hat allies versus Nazis ideologically bent on world domination, had mistakenly pursued.
The important things were Germany's interests in dominating eastern Europe, Russia's fear of invasion from the west, Italy's dream of a new Roman empire in the Mediterranean, the tradition of non European intervention in British foreign policy so that Britain could concentrate on dominating the rest of the world instead, all were more important, in the international pursuit of power, than spreading the doctrines of Marx or Nietszche, exporting the Concentration camp or the swastika. True, in wicked acts “Hitler outdid them all” – partly because the context of war allows wickedness to flourish – though it must be remembered that it was the British who invented the concentration camp ad the Belgians who carried out racial cleansing in the Congo.
Not that leaders were unimportant; they made all the difference, usually by being tripped up by bit part players and smaller countries while in pursuit of their national interests. So history was in one sense predetermined; in another accidental..
This Europe was one where events were brought about by the unimportant characters, and few of the big name leaders got what they wanted, even when they knew it: the weak and second rate made things happen, puppets and puppet masters changing places. It was Papen and Hindenburg who thrust power on Hitler because they believed he could control them. Schusnigg brought about the collapse of Austriai when he invaded the headquarters of the Austrian nazis.
The second world war was started by the machinations of the Polish foreign minister, who refused the reasonable German request to Danzig, a German city and inveigled the British on to the side after tabloid British opinion decided something “must be done” before bowing out. The mutually negating settlement that became known as the second world war ended with both nations’ relative eclipse and the rise of the USSR and America, which had never been a part of the European power system.
AJP Taylor came to the project after wondering why the debate about the origins of the first world war still raged while the origins of the second were surrounded by complacency: Hitler's absolute personal wickedness, and the evil of totalitarian nazism, were the received wisdoms that closed off the debate. When researching the book he discovered that the Versailles revisionists were wrong to blame the unfair treaty for the next war, and that while all powers had interests, Germany was the indeed the dynamic, expansionist element in European policy, as France had been the century before, and the other powers were trying to constrain it.
The struggle for power between nations in fact described the EU today, and one wonders: could the state of affairs of competing states in 1930s Europe been brought to the identical situation of competing and prosperous states today without the second world war and the holocausts in all senses that it produced?
Was the second world war, in fact, a bit of an accident? Brought about by the Poles.
The second world war is taboo, but it's also been an axiom that the Germans were wholly at fault, and that the west fought a good war. Totalitarianism followed totalitarianism, so the cold war melded seamlessly with the second world war. Both fights were supposedly "good fights".
Yet these days absolute good and evil is no longer anything secular Europeans believe in. So it may be that AJP Taylor, the most controversial and most popular British historian of the last century, deserves to come into fashion again.
He rejected the standard narrative that westerners imbibe with their mother's milk: that the second world war was caused by Hitler and his totalitarian dictatorship, and that it might have been avoided has it not been for the policy of appeasement which only served to whet his appetite. The lesson learnt – that dictators must never be appeased, as they will be encouraged – has had amazing traction in western, especially American, foreign policy ever since.
AJP Taylor had, when the Origins of the Second World War was published in 1961, had a distinguished career as a fellow of Magdalen and a number of highly regarded books under his belt. His telly don period was yet to begin.
The book set off a storm, and probably cost him the regius professorship of history at Oxford, which went to his archrival Hugh Trevor Roper, who comdemned his theory for every available sin.
Trevor Roper, later responsible for the Hitler diaries fiasco, by the way, said that Taylor’s evidence was unreliable; he distorted documents by selective citation and dismissed those he didn't like by claiming they didn't count. Taylor, he said, contradicted himself repeatedly and drew conclusions at variance with his evidence. Many other historians of the time agreed. Yet the book continues in 2007 to sell well, especially to undergraduates.
Taylor’s thesis was that Hitler was not evil demon but rather on ordinary German, perhaps even just an ordinary European, politician. He was not bent on European or world domination, but was just playing the European power game, as all statesmen of the time were: their motives were simply to maximise the gains of their country without resorting to the kind of war that whose damage would negate any gain. Chancellor Stresemann, the “good German” of postwar myth, who wanted to follow a peaceful path, had exactly the same plans to dominate eastern Europe as Hitler did, one way or another. Inasmuch in that Hitler did have a personal characteristic it was dithering opportunism: Whereas others saw a demonic genius bent on dominating Europe by masterfully pulling all the strings because he had a carefully laid out plan, Taylor saw only an ordinary politician who let events fall into his lap and asked how he might benefit from them.
Nations’ interests were eternal, and leaders were not motivated by ideology in their pursuit of that. Whereas others saw in Mein Kampf a blueprint for worldwide domination, Taylor heard the confused beerhall chatter of the twenties put between hard covers, and rated it what it said as unimportant. .
Whereas some saw the Hossbach memorandum of 1937 as a timetable for war, Taylor saw it as a document typifying the intrigue and machinations of the Nazi system of government - but these were red herrings that other post-war historians, setting up the war as defensive white hat allies versus Nazis ideologically bent on world domination, had mistakenly pursued.
The important things were Germany's interests in dominating eastern Europe, Russia's fear of invasion from the west, Italy's dream of a new Roman empire in the Mediterranean, the tradition of non European intervention in British foreign policy so that Britain could concentrate on dominating the rest of the world instead, all were more important, in the international pursuit of power, than spreading the doctrines of Marx or Nietszche, exporting the Concentration camp or the swastika. True, in wicked acts “Hitler outdid them all” – partly because the context of war allows wickedness to flourish – though it must be remembered that it was the British who invented the concentration camp ad the Belgians who carried out racial cleansing in the Congo.
Not that leaders were unimportant; they made all the difference, usually by being tripped up by bit part players and smaller countries while in pursuit of their national interests. So history was in one sense predetermined; in another accidental..
This Europe was one where events were brought about by the unimportant characters, and few of the big name leaders got what they wanted, even when they knew it: the weak and second rate made things happen, puppets and puppet masters changing places. It was Papen and Hindenburg who thrust power on Hitler because they believed he could control them. Schusnigg brought about the collapse of Austriai when he invaded the headquarters of the Austrian nazis.
The second world war was started by the machinations of the Polish foreign minister, who refused the reasonable German request to Danzig, a German city and inveigled the British on to the side after tabloid British opinion decided something “must be done” before bowing out. The mutually negating settlement that became known as the second world war ended with both nations’ relative eclipse and the rise of the USSR and America, which had never been a part of the European power system.
AJP Taylor came to the project after wondering why the debate about the origins of the first world war still raged while the origins of the second were surrounded by complacency: Hitler's absolute personal wickedness, and the evil of totalitarian nazism, were the received wisdoms that closed off the debate. When researching the book he discovered that the Versailles revisionists were wrong to blame the unfair treaty for the next war, and that while all powers had interests, Germany was the indeed the dynamic, expansionist element in European policy, as France had been the century before, and the other powers were trying to constrain it.
The struggle for power between nations in fact described the EU today, and one wonders: could the state of affairs of competing states in 1930s Europe been brought to the identical situation of competing and prosperous states today without the second world war and the holocausts in all senses that it produced?
Was the second world war, in fact, a bit of an accident? Brought about by the Poles.
Del ponte flies in
As Europe went about its business – the usual boring chemicals directive, postal services and constitutional verification stuff – an avenging angel slipped into Brussels.
International Criminal court prosecutor Carla del Ponte is trying to make up for one of the most obscene episodes in modern EU members’ history: the failure to act decisively during the Yugoslav war, until the Americans came in, the culmination of which barbarism was the massacre of Srebrenica in July 1995.
Although the enclave was guarded by Dutch soldiers under a UN mandate, the UN’s uselessness neither exonerates the Dutch commanders on the ground for ejecting the Bosnian men who had sheltered in the UN base to their certain deaths from the vicious Serb army outside, nor the EU in its passivity in the war leading up to the climactic outcome of the first genocide on European soil since 1945.
Del Ponte, the Swiss prosecutor who once dealt with Russian and Italian mafia, came to talk to journalists to mark her eight years as the chief prosecutor for the International Criminals Tribunal in the Hague, dealing with war crimes carried out in the former Yugoslavia. The multilingual lawyer her opponents have called everything from “La Puttana” to “the unguided missile” is as impressive and attractive a sixty-year-old woman as I have ever seen, and her zeal at bringing the big fish who have still eluded her to justice is undiminished.
She was accompanied by the commissioner for enlargement, Olli Rehn, who is crucial in determining whether Serbia gets to join the EU or not, and it was not quite clear whether they were singing from the same hymn sheet, playing a bad-cop cop good-cop routine, or whether Rehn’s relative emollience towards Serbia evident at the meeting suggests the EU is actually contemplating letting Serbia getting away with some of the trappings of membership without handing over the butcher of Srebrenica, general Ratko Mladic, and his boss, Bosnian Serb republic ex-President Radovan Karadzic.
Last year Rehn suspended membership talks for Serbia for the antechamber of the EU, the Stabilization and Association agreement, on Del Ponte’s recommendation because of stalling in handing over particularly Mladic, who is still believed to be in Serbia. (Karadzic’s whereabouts are less well known). Earlier in June however he announced that talks would start again, though Del Ponte was adamant that the association agreement – which Croatia, Macedonia and Albania have already signed, Croatia even an EU candidate – should not be completed until Serbia had done its bit. Croatia’s chief war criminal Ante Gotovina was arrested in a hotel in Tenerife after a cock up involving his wife’s careless use of her mobile phone. It was in December 2005, by coincidence two months after Croatia, having already signed the ASA, began its serious EU entry negotiations. Gotovina was accused of being accomplice to 150 deaths during operation storm in 1995, which drove thousands of Serbs out of Croatia; regarded as a war hero by many Croats, his arrest was unpopular. The Kosovo Albanian chief war criminal suspect Ramush Haradinaj has also been sent to the Hague and – in a recent coup – two of the five remaining chief suspects on the Serb side, just in this last month.
Del Ponteis right that it’s essential not to let up now and let the two biggest war criminals slip away before negotiation with Serbia pass their first stage. Croatia did sign the ASA before Gotovina was apprehended, but Gotovina’s crimes are not in the same league as Mladic’s Srebrenica.
Ever since Luxembourg’s foreign minister Jacque Poos announced in 1991 that Europe’s hour (as a foreign actor) has come and nothing happened, the EU’s record in the Balkans has been inglorious. There are some Serbs and their western sympathisers such as the academic John Laughland that raise a number of arguments against being too harsh on Serbia: at least accord it the ASA status granted to Croatia in anticipation of a handover of Mladic who until at least 2002 was actively protected by the nationalist prime minister Kostunica. That would be deeply wrong.
The EU has never let in countries which have had a recent war and then not atoned for it. (As Germany did). Many in Serbia (and Croatia) are caught in nationalist mindsets and find the war justified. It is dangerous to let wolves into the sheep’s lair; and the EU must set out a marker by insisting by giving no ground to what on balance is the worse side, and its war criminal heroes.
The EU failed to stop the war, but it mustn’t let one inglory be followed by another by being soft on the Serbs – again. Del Ponte understands that, it’s not clear whether Rehn and his coterie of EU officials in DG enlargement do.
International Criminal court prosecutor Carla del Ponte is trying to make up for one of the most obscene episodes in modern EU members’ history: the failure to act decisively during the Yugoslav war, until the Americans came in, the culmination of which barbarism was the massacre of Srebrenica in July 1995.
Although the enclave was guarded by Dutch soldiers under a UN mandate, the UN’s uselessness neither exonerates the Dutch commanders on the ground for ejecting the Bosnian men who had sheltered in the UN base to their certain deaths from the vicious Serb army outside, nor the EU in its passivity in the war leading up to the climactic outcome of the first genocide on European soil since 1945.
Del Ponte, the Swiss prosecutor who once dealt with Russian and Italian mafia, came to talk to journalists to mark her eight years as the chief prosecutor for the International Criminals Tribunal in the Hague, dealing with war crimes carried out in the former Yugoslavia. The multilingual lawyer her opponents have called everything from “La Puttana” to “the unguided missile” is as impressive and attractive a sixty-year-old woman as I have ever seen, and her zeal at bringing the big fish who have still eluded her to justice is undiminished.
She was accompanied by the commissioner for enlargement, Olli Rehn, who is crucial in determining whether Serbia gets to join the EU or not, and it was not quite clear whether they were singing from the same hymn sheet, playing a bad-cop cop good-cop routine, or whether Rehn’s relative emollience towards Serbia evident at the meeting suggests the EU is actually contemplating letting Serbia getting away with some of the trappings of membership without handing over the butcher of Srebrenica, general Ratko Mladic, and his boss, Bosnian Serb republic ex-President Radovan Karadzic.
Last year Rehn suspended membership talks for Serbia for the antechamber of the EU, the Stabilization and Association agreement, on Del Ponte’s recommendation because of stalling in handing over particularly Mladic, who is still believed to be in Serbia. (Karadzic’s whereabouts are less well known). Earlier in June however he announced that talks would start again, though Del Ponte was adamant that the association agreement – which Croatia, Macedonia and Albania have already signed, Croatia even an EU candidate – should not be completed until Serbia had done its bit. Croatia’s chief war criminal Ante Gotovina was arrested in a hotel in Tenerife after a cock up involving his wife’s careless use of her mobile phone. It was in December 2005, by coincidence two months after Croatia, having already signed the ASA, began its serious EU entry negotiations. Gotovina was accused of being accomplice to 150 deaths during operation storm in 1995, which drove thousands of Serbs out of Croatia; regarded as a war hero by many Croats, his arrest was unpopular. The Kosovo Albanian chief war criminal suspect Ramush Haradinaj has also been sent to the Hague and – in a recent coup – two of the five remaining chief suspects on the Serb side, just in this last month.
Del Ponteis right that it’s essential not to let up now and let the two biggest war criminals slip away before negotiation with Serbia pass their first stage. Croatia did sign the ASA before Gotovina was apprehended, but Gotovina’s crimes are not in the same league as Mladic’s Srebrenica.
Ever since Luxembourg’s foreign minister Jacque Poos announced in 1991 that Europe’s hour (as a foreign actor) has come and nothing happened, the EU’s record in the Balkans has been inglorious. There are some Serbs and their western sympathisers such as the academic John Laughland that raise a number of arguments against being too harsh on Serbia: at least accord it the ASA status granted to Croatia in anticipation of a handover of Mladic who until at least 2002 was actively protected by the nationalist prime minister Kostunica. That would be deeply wrong.
The EU has never let in countries which have had a recent war and then not atoned for it. (As Germany did). Many in Serbia (and Croatia) are caught in nationalist mindsets and find the war justified. It is dangerous to let wolves into the sheep’s lair; and the EU must set out a marker by insisting by giving no ground to what on balance is the worse side, and its war criminal heroes.
The EU failed to stop the war, but it mustn’t let one inglory be followed by another by being soft on the Serbs – again. Del Ponte understands that, it’s not clear whether Rehn and his coterie of EU officials in DG enlargement do.
Two speed Europe
Variable geometry, which some call a two speed Europe, could be coming into vogue again, judging by predictions from a number of grand figures at an EPC think tank conference held in Brussels just after the new reform treaty was agreed by leaders.
What two-speed Europe means is that a core group of countries forge ahead with legislation that ties their countries ever closer together. The outer ring meanwhile lives with the policies it has signed up to in the extant EU but goes no farther. Participation in core Europe will remain voluntary.
What’s not to like? Well, the British don’t like it, fearing that they will be in the outer ring and therefore lose influence. But it’s actually deeply un-British to complain about this: it is one thing not to want a “superstate” to dictate terms to you; quite another to interfere with other countries’ wish to decide their own arrangements, if that’s what they want to do – and Britain isn’t being excluded. Countries, like individuals, have freedom of association too.
The European Policy Centre is a bellwether of Brussels opinion, and it’s interesting that several speakers, Peter Sutherland, chairman of BP and regular Brussels commentators, Antonio Vitorino, a former commissioner and Portuguese prime minister, and Antonio Missiroli, the director of research at the EPC, all predicted the variable geometry would be coming into more frequent play. Last time it was on the cards was after the failed summit in December 2003, when – as at the summit two weeks ago – the issue was a squabble over voting weights. Soon-to-join Poland didn’t want to give up its favourable position in the council of ministers earnt at Nice in 2000. (It finally agreed to a change 2 weeks ago) Talks were deadlocked; the summit collapsed and out of a general sense one feels of the morass faced by future European decision-making, Jacques Chirac, the president, wheeled out his plan B, the idea of a two speed Europe led by a pioneer group with Germany and France at its heart. The requirement for this as I then remember was that eight countries had to sign up for Chirac’s plan-B to become reality, and I remember doing the arithmetic with a young Czech girl journalist over a cigarette break outside the Czech delegation’s room in the Justus Lipsus building. Luxembourg and Belgium were givens, of course; but Hungary and Greece had just announced they would agree to sign up, and Austria. And the Czech republic she added, relying on inside information from the Czech camp. I remembered my sense of disappointment, but she shrugged and said; “You know, we like England. But we just don’t want to be on the outside.”
The Chirac plan, which was soon abandoned, was heavily criticised by British commentators who said the threat amounted to bullying tactics and that the Berlin Wall, which had just come down, was about to be re-erected between new and old – an argument that examplified unreasonable British huffing and puffing, since no exclusion of new members would be taking place.
So what’s the new deal about? Here is research director Missiroli: “Some degree of “variable geometry” will be inevitable in an expanding EU. While this would not necessarily result in a ‘two-speed Europe’, there would be a centre of gravity, with ‘core’ members participating in all key common policies and varying groups of countries involved in only some of them. The planned new treaty is deliberately permissive in this respect as it includes considerable possibilities for both opting in or out and implementing enhanced cooperation.”
In fact, a lot of this is happening already, and to an extent it ‘s only being given a name. Already, some EU countries opt out of the euro, the Schengen agreement or EU defence policy.
In the new treaty Britain has an opt-out on justice and home affairs, and the charter for fundamental rights. Possible future examples of variable geometry include giving new members such as Turkey long derogations before being allowed to enter the common labour market; in fact it might be the only way to keep enlargement, one of the EU’s most lauded achievements, on track, since France is committed to a referendum on the subject of Turkey and will probably say no unless the country is kept at some sort of arms length. The Turks will probably rather settle for an attenuated membership than none at all.
So far so relatively uncontroversial. But there is an ambiguity in discussions in Brussels on whether variable geometry as is happening and will continue to do so, and a two speed Europe as posed by Chirac and subject to the eight nation minimum vote, are quite the same thing. What I suspect Chirac really painted was a grand vision of a single, core framework of shared and psychology and intent, not about opting in or out a la carte this policy or that. And that, once a two speed Europe is in place, insiders could move at a much more rapid clip than currently, totally changing the face of Europe as we know it: a core Europe shorn of annoying dilettante latecomers who, since entry, are forver upsetting the original federal vision of the core Six’s founders. Britain will almost certainly be outside, for better or for worse, and maybe that’s the way the country wants it.
What two-speed Europe means is that a core group of countries forge ahead with legislation that ties their countries ever closer together. The outer ring meanwhile lives with the policies it has signed up to in the extant EU but goes no farther. Participation in core Europe will remain voluntary.
What’s not to like? Well, the British don’t like it, fearing that they will be in the outer ring and therefore lose influence. But it’s actually deeply un-British to complain about this: it is one thing not to want a “superstate” to dictate terms to you; quite another to interfere with other countries’ wish to decide their own arrangements, if that’s what they want to do – and Britain isn’t being excluded. Countries, like individuals, have freedom of association too.
The European Policy Centre is a bellwether of Brussels opinion, and it’s interesting that several speakers, Peter Sutherland, chairman of BP and regular Brussels commentators, Antonio Vitorino, a former commissioner and Portuguese prime minister, and Antonio Missiroli, the director of research at the EPC, all predicted the variable geometry would be coming into more frequent play. Last time it was on the cards was after the failed summit in December 2003, when – as at the summit two weeks ago – the issue was a squabble over voting weights. Soon-to-join Poland didn’t want to give up its favourable position in the council of ministers earnt at Nice in 2000. (It finally agreed to a change 2 weeks ago) Talks were deadlocked; the summit collapsed and out of a general sense one feels of the morass faced by future European decision-making, Jacques Chirac, the president, wheeled out his plan B, the idea of a two speed Europe led by a pioneer group with Germany and France at its heart. The requirement for this as I then remember was that eight countries had to sign up for Chirac’s plan-B to become reality, and I remember doing the arithmetic with a young Czech girl journalist over a cigarette break outside the Czech delegation’s room in the Justus Lipsus building. Luxembourg and Belgium were givens, of course; but Hungary and Greece had just announced they would agree to sign up, and Austria. And the Czech republic she added, relying on inside information from the Czech camp. I remembered my sense of disappointment, but she shrugged and said; “You know, we like England. But we just don’t want to be on the outside.”
The Chirac plan, which was soon abandoned, was heavily criticised by British commentators who said the threat amounted to bullying tactics and that the Berlin Wall, which had just come down, was about to be re-erected between new and old – an argument that examplified unreasonable British huffing and puffing, since no exclusion of new members would be taking place.
So what’s the new deal about? Here is research director Missiroli: “Some degree of “variable geometry” will be inevitable in an expanding EU. While this would not necessarily result in a ‘two-speed Europe’, there would be a centre of gravity, with ‘core’ members participating in all key common policies and varying groups of countries involved in only some of them. The planned new treaty is deliberately permissive in this respect as it includes considerable possibilities for both opting in or out and implementing enhanced cooperation.”
In fact, a lot of this is happening already, and to an extent it ‘s only being given a name. Already, some EU countries opt out of the euro, the Schengen agreement or EU defence policy.
In the new treaty Britain has an opt-out on justice and home affairs, and the charter for fundamental rights. Possible future examples of variable geometry include giving new members such as Turkey long derogations before being allowed to enter the common labour market; in fact it might be the only way to keep enlargement, one of the EU’s most lauded achievements, on track, since France is committed to a referendum on the subject of Turkey and will probably say no unless the country is kept at some sort of arms length. The Turks will probably rather settle for an attenuated membership than none at all.
So far so relatively uncontroversial. But there is an ambiguity in discussions in Brussels on whether variable geometry as is happening and will continue to do so, and a two speed Europe as posed by Chirac and subject to the eight nation minimum vote, are quite the same thing. What I suspect Chirac really painted was a grand vision of a single, core framework of shared and psychology and intent, not about opting in or out a la carte this policy or that. And that, once a two speed Europe is in place, insiders could move at a much more rapid clip than currently, totally changing the face of Europe as we know it: a core Europe shorn of annoying dilettante latecomers who, since entry, are forver upsetting the original federal vision of the core Six’s founders. Britain will almost certainly be outside, for better or for worse, and maybe that’s the way the country wants it.
Africa's economic partnership agreements
Peter Mandelson, the EU Trade commissioner, was the target of spitting rage last week from MEPs who called him an aggressive bully who engaged in blackmail. The reason was his ideas how to revise EU-African trade. He says it will bring prosperity to Africa. His detractors fear it will make Africa poorer, and subject to greater European control.
For decades the Lomé and Cotonou agreements allowed African countries privileged non-reciprocal access to European markets, without having to open their own to the juggernaut of European commerce. Lomé and Cotonou were good deals, especially for African farm products. Brazil and other efficient agricultural producers chafed at the high tariffs that kept European farmers sheltered; African farmers, far less efficient, were able to ship their goods unhampered in.
But this is now set to change. Because of new WTO rules that disallow non reciprocal trading agreements between regional blocs, the arrangement is due to be replaced by what is effectively a free trade agreement dismantling African barriers that protect their fragile markets and turns Europe and Africa into what looks a free trade area where all producers compete on equal access terms. Mandelson says this is a chance for Africa to turn the page.
Nearly all duties on agricultural and industrial products from Europe would be eliminated under the deal, and African governments would allow European investors free access to invest in any sector of their economies. African consumers would get cheaper products and firms would have access to cheaper spare parts and machinery.. Good in theory - except the story is more complicated, just to take one particular area of tension: farm products, say Mandelson’s critics.
Under the much-criticised common agricultural policy, European farmers will maintain their massive amounts of direct price support; they are well organised and united, and possess the infrastructure to impose their goods on Africa. Africa, whose farmers get little money from their states, will be flooded with European food. According to Paul Goodison, a trade expert at the European Research Office, many African farmers will be put out of business, and Africa will be denied that food security which every rich country arranges for itself by keeping enough farmers on support to make themselves self sufficient at a famously high cost.
“European farmers are not competitive on the world market, and Africa offers them an outlet for their goods,” said Goodison. “But under the new agreements, it will be cheaper for a food processing plant in Senegal to buys its tomatoes from Europe than from a local farmer, struggling with poor technology, poor roads and access to markets. In South Africa, with which Europe has already concluded a trade agreement, there are processing entrepreneurs who turn into simple import agents because it’s more economic.”
The consequence, said Mamadou Chissikho, head of the west African peasant movement ROPPA, at a conference of left wing NGOs in Brussels which featured agriculture as a big issue, will be an exodus of peasants to the squalor of the cities – and increased pressure of immigration into Europe. “It has to be questioned whether the EU has a joined-up Africa strategy at all,” said Giles Merritt, Secretary-General of the Friends of Europe think-tank in Brussels.
And yet the commission and its supporters says the EU’s motives are good. “It is a mistake to paint the European commission as the bad guys,” said Fredrik Erixon, director of the European Centre for International Political Economy in Brussels.
Supporters of the EPA agreements say the EPAs (four, one for each region of Africa, on top of one each for the Caribbean and Pacific developing countries) will promote sustainable development, contribute to ending poverty and integrate Africa into the world economy. In repeated speeches, Mandelson points out that Africa’s share of world trade is falling, and that Africa needs both “trade and aid” to prosper. The European Commission’s DG Trade points out that after 30 years of trade under current bilateral agreements, sub-Saharan African states and the other members of the ACP (African, Caribbean and Pacific) group of developing countries exports just a few basic commodities, most of which fetch lower prices than they did thirty years ago.
The commission says old recipes have not promoted diversification or competitiveness. And that they are no longer compatible with WTO rules on non discrimination and have been successfully challenged.
The EPAs are meant to change the relationship between Europe and Africa, from one built on preferential tariffs – an eroding lifeline – to one that builds lasting and more efficient markets for Africa.
One commission official close to Mandelson said: “The preferential tariff regime is based on old colonial relationships but keeps Africa locked into selling a few basic commodities to its former colonisers. African producers will diversify and become more competitive when exposed to foreign competition.” The emphasis is on helping Africa, not benefiting Europe.
Further, to give African producers time to adjust, there will be a long phase out of tariffs on European products. “Mandelson has spoken of 15 – 25 years.” This is pushing the envelope with international opinion in order to favour Africa, as the WTO norm is ten years, said the commission official. There is also the possibility that agricultural products will retain their tariffs indefinitely if African countries so want it. WTO rules allow a discretionary 10 percent of trade in a free trade agreement to remain behind trade barriers. Since African agricultural imports from Europe make up 13 percent of its total EU imports, and Europe proposes to open its entire market to African producers, the aggregate will come under 10 percent of total EU-African trade. “They can keep all tariff if they agree agriculture is so important that this is the area they want to exempt.”
Last week, at a conference in Brussels, the deputy secretary general for DG Trade, Karl-Friedrich Falkenberg, expressed exasperation at the NGOs and African representatives in Brussels who spread the word of the negative consequences of EPA on agriculture.. Falkenberg told an audience of diplomats and officials that “NGOs have got it wrong on agriculture”.
Yet the commission has some convincing to do. Agriculture is anyhow not the only issue.
Goodison said that behind all the “bullshit” was a strongly pro-European business agenda. The commission was not interested in helping Africa per se, but, after the market access negotiations were sealed, wanted to sign a number of other agreements on the so called Singapore issues relating to investment protection, transparency in government procurement and competition policy. The EU has not managed to push these through the WTO, but if it signs these agreements with Africa, it can then go to the WTO and say here is a 104 nation bloc – the ACP countries plus the EU – who want these reforms, and they will mostly benefit the EU. Africa does not have the infrastructure to cope with this legislation.
What happens next will be decided behind closed doors in Brussels and in African capitals. Mandelson is busy jetting around the world, and meeting African negotiators in Brussels. For practical purposes a deal has to be sealed by the end of October, beginning of November, so that customs officials can be ready for the new regime come the end of the waiver on 31 December. But the amount of development assistance the EU will be granting on top its regular aid commitments to help losers adjust is far from clear. And the Lagos Guardian has reported inside sources that say the west Africans will not sign up to the agreements by then. Sir John Kaputin, secretary general of the ACP group of states, said: “We are not happy with the negotiations as they are.” As for East Africa, while local analysts say the Kenyan government sees “EPAs as the only way forward”; there are problems with configurations in regional trading blocs that may hold up a final deal.
Peter Mandelson told the European parliament’s trade committee in mid September – when MPs described his uncompromising attitudes - that negotiations were on the edge “and whether this is the edge of a cliff or of success the next few weeks will tell”. If Africa doesn’t sign the EPAs, the least developed countries, the LDCs, will fall back into the relatively generous Everything But Arms regime, with non reciprocal tariff free entry to Europe (same as before in fact), but the richer developing countries in Africa could be in trouble on December 31st.
Namibia for instance would see a sharp percent rise in tariffs, up to 140 percent, on its beef exports, according to Erixon. One commission insider said: “Cocoa and fish products from Ghana, horticulture from Kenya, bananas from Cote D’Ivoire and Cameroon. These are the products that will face export difficulties.” Mandelson has said he won’t compromise: it’s EPAs or nothing.
In the high stakes game, no one is laying all their cards on the table right now, but Goodison predicts that there will be some kind of interim agreement of market access that satisfies the WTO demands by 31 December, and would save the high value exports. In addition, the EU would seek to negotiate binding settlement mechanisms that would expand the EU’s agenda over Africa regarding investment protection, competition policy and other so called Singapore issues - in the years ahead.
However the agriculture issue is resolved, whether the Singapore issues will be in Africa’s interests is a matter of dispute.
ENDS
For decades the Lomé and Cotonou agreements allowed African countries privileged non-reciprocal access to European markets, without having to open their own to the juggernaut of European commerce. Lomé and Cotonou were good deals, especially for African farm products. Brazil and other efficient agricultural producers chafed at the high tariffs that kept European farmers sheltered; African farmers, far less efficient, were able to ship their goods unhampered in.
But this is now set to change. Because of new WTO rules that disallow non reciprocal trading agreements between regional blocs, the arrangement is due to be replaced by what is effectively a free trade agreement dismantling African barriers that protect their fragile markets and turns Europe and Africa into what looks a free trade area where all producers compete on equal access terms. Mandelson says this is a chance for Africa to turn the page.
Nearly all duties on agricultural and industrial products from Europe would be eliminated under the deal, and African governments would allow European investors free access to invest in any sector of their economies. African consumers would get cheaper products and firms would have access to cheaper spare parts and machinery.. Good in theory - except the story is more complicated, just to take one particular area of tension: farm products, say Mandelson’s critics.
Under the much-criticised common agricultural policy, European farmers will maintain their massive amounts of direct price support; they are well organised and united, and possess the infrastructure to impose their goods on Africa. Africa, whose farmers get little money from their states, will be flooded with European food. According to Paul Goodison, a trade expert at the European Research Office, many African farmers will be put out of business, and Africa will be denied that food security which every rich country arranges for itself by keeping enough farmers on support to make themselves self sufficient at a famously high cost.
“European farmers are not competitive on the world market, and Africa offers them an outlet for their goods,” said Goodison. “But under the new agreements, it will be cheaper for a food processing plant in Senegal to buys its tomatoes from Europe than from a local farmer, struggling with poor technology, poor roads and access to markets. In South Africa, with which Europe has already concluded a trade agreement, there are processing entrepreneurs who turn into simple import agents because it’s more economic.”
The consequence, said Mamadou Chissikho, head of the west African peasant movement ROPPA, at a conference of left wing NGOs in Brussels which featured agriculture as a big issue, will be an exodus of peasants to the squalor of the cities – and increased pressure of immigration into Europe. “It has to be questioned whether the EU has a joined-up Africa strategy at all,” said Giles Merritt, Secretary-General of the Friends of Europe think-tank in Brussels.
And yet the commission and its supporters says the EU’s motives are good. “It is a mistake to paint the European commission as the bad guys,” said Fredrik Erixon, director of the European Centre for International Political Economy in Brussels.
Supporters of the EPA agreements say the EPAs (four, one for each region of Africa, on top of one each for the Caribbean and Pacific developing countries) will promote sustainable development, contribute to ending poverty and integrate Africa into the world economy. In repeated speeches, Mandelson points out that Africa’s share of world trade is falling, and that Africa needs both “trade and aid” to prosper. The European Commission’s DG Trade points out that after 30 years of trade under current bilateral agreements, sub-Saharan African states and the other members of the ACP (African, Caribbean and Pacific) group of developing countries exports just a few basic commodities, most of which fetch lower prices than they did thirty years ago.
The commission says old recipes have not promoted diversification or competitiveness. And that they are no longer compatible with WTO rules on non discrimination and have been successfully challenged.
The EPAs are meant to change the relationship between Europe and Africa, from one built on preferential tariffs – an eroding lifeline – to one that builds lasting and more efficient markets for Africa.
One commission official close to Mandelson said: “The preferential tariff regime is based on old colonial relationships but keeps Africa locked into selling a few basic commodities to its former colonisers. African producers will diversify and become more competitive when exposed to foreign competition.” The emphasis is on helping Africa, not benefiting Europe.
Further, to give African producers time to adjust, there will be a long phase out of tariffs on European products. “Mandelson has spoken of 15 – 25 years.” This is pushing the envelope with international opinion in order to favour Africa, as the WTO norm is ten years, said the commission official. There is also the possibility that agricultural products will retain their tariffs indefinitely if African countries so want it. WTO rules allow a discretionary 10 percent of trade in a free trade agreement to remain behind trade barriers. Since African agricultural imports from Europe make up 13 percent of its total EU imports, and Europe proposes to open its entire market to African producers, the aggregate will come under 10 percent of total EU-African trade. “They can keep all tariff if they agree agriculture is so important that this is the area they want to exempt.”
Last week, at a conference in Brussels, the deputy secretary general for DG Trade, Karl-Friedrich Falkenberg, expressed exasperation at the NGOs and African representatives in Brussels who spread the word of the negative consequences of EPA on agriculture.. Falkenberg told an audience of diplomats and officials that “NGOs have got it wrong on agriculture”.
Yet the commission has some convincing to do. Agriculture is anyhow not the only issue.
Goodison said that behind all the “bullshit” was a strongly pro-European business agenda. The commission was not interested in helping Africa per se, but, after the market access negotiations were sealed, wanted to sign a number of other agreements on the so called Singapore issues relating to investment protection, transparency in government procurement and competition policy. The EU has not managed to push these through the WTO, but if it signs these agreements with Africa, it can then go to the WTO and say here is a 104 nation bloc – the ACP countries plus the EU – who want these reforms, and they will mostly benefit the EU. Africa does not have the infrastructure to cope with this legislation.
What happens next will be decided behind closed doors in Brussels and in African capitals. Mandelson is busy jetting around the world, and meeting African negotiators in Brussels. For practical purposes a deal has to be sealed by the end of October, beginning of November, so that customs officials can be ready for the new regime come the end of the waiver on 31 December. But the amount of development assistance the EU will be granting on top its regular aid commitments to help losers adjust is far from clear. And the Lagos Guardian has reported inside sources that say the west Africans will not sign up to the agreements by then. Sir John Kaputin, secretary general of the ACP group of states, said: “We are not happy with the negotiations as they are.” As for East Africa, while local analysts say the Kenyan government sees “EPAs as the only way forward”; there are problems with configurations in regional trading blocs that may hold up a final deal.
Peter Mandelson told the European parliament’s trade committee in mid September – when MPs described his uncompromising attitudes - that negotiations were on the edge “and whether this is the edge of a cliff or of success the next few weeks will tell”. If Africa doesn’t sign the EPAs, the least developed countries, the LDCs, will fall back into the relatively generous Everything But Arms regime, with non reciprocal tariff free entry to Europe (same as before in fact), but the richer developing countries in Africa could be in trouble on December 31st.
Namibia for instance would see a sharp percent rise in tariffs, up to 140 percent, on its beef exports, according to Erixon. One commission insider said: “Cocoa and fish products from Ghana, horticulture from Kenya, bananas from Cote D’Ivoire and Cameroon. These are the products that will face export difficulties.” Mandelson has said he won’t compromise: it’s EPAs or nothing.
In the high stakes game, no one is laying all their cards on the table right now, but Goodison predicts that there will be some kind of interim agreement of market access that satisfies the WTO demands by 31 December, and would save the high value exports. In addition, the EU would seek to negotiate binding settlement mechanisms that would expand the EU’s agenda over Africa regarding investment protection, competition policy and other so called Singapore issues - in the years ahead.
However the agriculture issue is resolved, whether the Singapore issues will be in Africa’s interests is a matter of dispute.
ENDS
Overseas development institute seminar
The senior scientist was quite emotional. He believed in the ways that solved the global food crisis in the postwar period: airlifts, green revolutions, mass feeding programmes with US agricultural surpluses supported by grain state senators like Bob Dole and George McGovern. It was in the spirit of grand collective action of the second world war. And, he asked, where are the great figures of today who can fight world undernutrition whose numbers, to one’s chagrin, have stagnated at around 800m people in recent years? Where are the new Churchills in the wars against hunger, the new Marshall plan for food distribution?
The occasion was an Overseas Development Institute seminar in London, and the man was the former chief of the policy affairs service of the World Food Programme, John Shaw; he’s served the organisation for 30 years. It was World Food Day, and he was launching a book.
There was a sense of disagreement from the audience. Collective action was of its time.. But today’s solution could not be about identifying a problem and throwing all global resources at it, not least because there is no collective political will to do so. It was noted that George McGovern came a cropper when he relaunched his programme in the late 1990s.
For things were simpler then: today, there are no massive food surpluses, jus transient ones. While hundreds of millions of people don’t get enough food, obesity is he fastest growing problem in the west. Tim Lang, an audience member who is a well-known professor of food policy, spoke about the distortions of the food industry – the trade patterns, the food miles, the advertising of sugars and sweets, the consignment of at least the next two generations in the rich world to the consequences of poor nutrition. The west is increasingly exporting its bad nutritional habits to Africa: biscuit and pasta and other cheap confectionery products replacing manioc. In fact, five percent of black Africans are obese. So it’s not just about maldistribution of food, but malconsumption.
There was a feeling that democracy is a solution, quoting Amartya Sen’s argument that India had not had any famine since it became one. And that supermarkets with their just-in-time distribution systems which shut out a lot of exporters were part of the problem. The poor agriculturalists who make up much of the world remain under monetised, hey cannot sell their way into wealth. Tim Lang’s presence was a reminder of the dangers of scientific farming – he has written much on he subject.
“productionism” that was about efficiency, state support, intensification, appeal to consumers, cheap prices and the equalling of quantity with well being.
If today’s intensive agri-industry does neither the west nor the developing world any favours, what is the solution? Nutrition is a subject that is very hard to interest ministers in, said the head of the ODI, Simon Maxwell. Part of the complexity is that so many areas of policy impinge on food production, and it’s a global, hard-to-get your head around issue. And there are time pressures too: climate change, said a panellist, will lower agricultural yields, farmland will increasingly be set aside for bio-fuel production, and agriculture, dependent on oil for transport and production, could be crippled by energy shortages.
There have been recent food riots in India and Mexico. In the end, there was audience and panellist consensus that the institutions of the post-war era – the Food and Agricultural Organisation, the World Bank, the UN – were not up to the task of the persistent challenges of hunger coexisting with obesity within a modern global agri-0business structure. What should come instead, no one knows.
The occasion was an Overseas Development Institute seminar in London, and the man was the former chief of the policy affairs service of the World Food Programme, John Shaw; he’s served the organisation for 30 years. It was World Food Day, and he was launching a book.
There was a sense of disagreement from the audience. Collective action was of its time.. But today’s solution could not be about identifying a problem and throwing all global resources at it, not least because there is no collective political will to do so. It was noted that George McGovern came a cropper when he relaunched his programme in the late 1990s.
For things were simpler then: today, there are no massive food surpluses, jus transient ones. While hundreds of millions of people don’t get enough food, obesity is he fastest growing problem in the west. Tim Lang, an audience member who is a well-known professor of food policy, spoke about the distortions of the food industry – the trade patterns, the food miles, the advertising of sugars and sweets, the consignment of at least the next two generations in the rich world to the consequences of poor nutrition. The west is increasingly exporting its bad nutritional habits to Africa: biscuit and pasta and other cheap confectionery products replacing manioc. In fact, five percent of black Africans are obese. So it’s not just about maldistribution of food, but malconsumption.
There was a feeling that democracy is a solution, quoting Amartya Sen’s argument that India had not had any famine since it became one. And that supermarkets with their just-in-time distribution systems which shut out a lot of exporters were part of the problem. The poor agriculturalists who make up much of the world remain under monetised, hey cannot sell their way into wealth. Tim Lang’s presence was a reminder of the dangers of scientific farming – he has written much on he subject.
“productionism” that was about efficiency, state support, intensification, appeal to consumers, cheap prices and the equalling of quantity with well being.
If today’s intensive agri-industry does neither the west nor the developing world any favours, what is the solution? Nutrition is a subject that is very hard to interest ministers in, said the head of the ODI, Simon Maxwell. Part of the complexity is that so many areas of policy impinge on food production, and it’s a global, hard-to-get your head around issue. And there are time pressures too: climate change, said a panellist, will lower agricultural yields, farmland will increasingly be set aside for bio-fuel production, and agriculture, dependent on oil for transport and production, could be crippled by energy shortages.
There have been recent food riots in India and Mexico. In the end, there was audience and panellist consensus that the institutions of the post-war era – the Food and Agricultural Organisation, the World Bank, the UN – were not up to the task of the persistent challenges of hunger coexisting with obesity within a modern global agri-0business structure. What should come instead, no one knows.
Warch out, America knows everything
If Americans are from Mars and Europeans are from Venus, as the writer Robert Kagan once put it,
D-66 – named after the summer of love year when it was formed - represents much of what is best, most emblematic about Europe. The Dutch social liberal party may only capture 2 percent of the Dutch electorate, but its voters are post-materialistic, urban, young, highly educated, secular, and comprise a high proportion of women. This profile couldn't be more different from the materialistic , middle aged, male, small town, nationalistic, poorly educated American person of faith who makes up the bedrock of president Bush's support, and support for his "War on Terror". I didn’t say there was a difference in waistlines.
It is not surprising that these two world views will clash if given a rare chance. Not violently, that's impossible, but in this case over the civil liberties of European citizens and travellers. Europeans’ civil liberties is an issue close to the hearts of D-66’s internationalist and youthful politicians. It’s somewhat less close to the hearts of aforementioned American patriots, especially when there is a “War against terrorism” to be won. Unfortunately it has also become a war against tourism.
D-66’s member of the European parliament is Sophia int’veldt, an auburn-haired, youthful history graduate aged around 40 who speaks five languages and has all those traits attributed to her voters, who was given the responsibility to monitor the EU-US passenger name records agreement, up for negotiation this summer. We had a long conversation where she gave me the benefit of her views on the subject.
As a justice and civil liberties issue, the transfer of passenger details from airlines to the US immigration authorities for analysis is not an issue over which the European parliament has co-competence. Yet. It will be once the new constitution in disguise becomes law in 2009. Then, the EP will have what is known as co-decision powers on justice and home affairs, an equal say compared to the European commission and the council of the EU member states’ justice ministers and home secretaries. It represents a considerable, perhaps the most considerable, formal shift in powers to a new institution in the new treaty: justice and home affairs issues after all lie at the heart of sovereignty. Yet the way int’veldt tells it, this empowerment in two years time is important, because it will actually be a dilution and a check on a vast amount of powers currently concentrated on the commission’s justice directorate, powers that have de facto if not de jure accreted informally and slowly over the years, especially on transnational issues such as terrorism – a concentration of unmonitored power that the Americans, wanting to get things done, have learnt how to exploit. Or to put another way: when it comes to a single telephone number for Europe, there is already one, in justice and home affairs. Franco Frattini, the commissioner in charge of such things.
Int’veldt says; “Frattini is a nice man, not particularly liberal, not particularly conservative. But the powers he has would go to anyone’s head. Terrorism is one of those transnational issues where is a vacuum in responsibilities, and here the commission – without quite having a European competence for it, has stepped in to take responsibilities.” Some governments are either keen on terror legislation themselves (because they are convinced, wrongly, that their peoples are) and benefit from playing the time-honoured game of pushing stuff through Brussels rather than national parliaments; other countries either don’t know what’s going on in Brussels, or dare not exercise their veto.
The picture for European private individuals is a slightly worrying one. Admittedly it is being facilitated by the commission, a European body. And it is not as bad in disregard for international norms as the Geneva convention denial seen over Guantanamo bay or Abu Ghraib, but it’s motivated by it’s in the same spirit of unilateralism as those two administration low points and entirely consistent with the pull out from the Kyoto treaty further back, the torpedoing of NATO, or the rejection of the international criminal court.. The original treaty, signed in May 2004, was about the US customs and immigration having access to the passenger name record (PNR), created on each booking, so as to get people’s addresses, credit card numbers , travel history, and travel companions as an adjunct in the fight against terrorism. As one security expert told me recently: “The advanced passenger information record tells you who you are. The PNR is much more interesting for the authorities: it tells them what you have been doing.” It allows law enforcement theoretically to find out terrorists, say, who have shared phone numbers, used the same credit card for bookings or who have travelled with each other. The information could in exceptional cases be used by other authorities and even other countries. The data could only be kept for 3.5 years, and would eventually be supplied on a case by case basis – from the airlines – known as push – rather than on a pull basis.
At the time the no fly list and the selectee list (which either stopped the person from flying or put them through enhanced security procedures, and was a few thousand names. There was no provision for the right of European citizens to inspect files on them or correct them if they had been stopped from flying and they thought there had been mistaken for someone else of similar name.
Up to the point when the new agreement was negotiated a few weeks ago, many things had happened in the security field. The passenger watch list, the widest dragnet comprising all intelligence reports gleaned from the widest possible and therefore least reliable sources, had grown to nearly half a million names; from this list, the no fly and selectee lists are drawn; the former is estimated at 30,000; the latter a larger number but classified and shifting. Further there were a growing number of anecdotal reports about the hassle endured by travellers both to and within the States, related to general rudeness as well as to a growing number of misidentifications where people, some quite prominent, were being mistaken for terrorists of same or phonetically resembling names. These individuals included Edward Kennedy, a US marine returning from Iraq, an Emmy-winning TV correspondent and outspoken critic of the Bush administration. Further, on the European side there was concern about the American authorities’ trustworthiness when it emerged that the Americans scored also for avian flu risk – not in the original protocols - and that the original promises contained get-out clauses that allowed for huge leeway in cancelling the modest guarantees the European Union had been given about what was done with their travelers’ data. The rumours that Americans were illegally scanning intra-European flights for terrorists and the fact that most of them were still surfing European airline records freely, having still not implemented the push system, did not help relations.
Most damagingly, there was the revelation in November last year that the US was using a parallel security system, originally used for determining the security risk of cargo, to create a data base of suspects far wider than anyone thought possible: in fact, using not only PNR information but an unspecified amount of other factors – at one point it was rumoured the DHS used passengers’ credit ratings and employment histories – to determine whether passengers were a security risk: every visitor – and that means you too - is scored for potential to do terror or cause nuisance to the United States. That represents a big difference to the system as supposed as implemented; which used PNRs as a auxiliary tool to determine terrorist suspects already on the watch list further connections. This hitherto unknown system made everyone a suspect. There was no recourse to correction insight into people’s files (whether American or European), and the scheme went ahead despite congress specifically voting against appropriations for schemes that profiled travellers as well as stopping a programme called secure flight for domestic travel over privacy redress concerns.
Perhaps it was because European airlines feared that they would be denied landing rights if EU governments refused to allow information on European travellers be read by US authorities – the usually profitable Atlantic air travel business is in trouble as it is – having dropped by 15% since 2000, falling even last year, partly because of the perception of tighter security controls. May be it was the commission’s eagerness to implement an intra European PNR monitoring scheme with extensive data mining operations of its own.
Anyhow, the agreement concluded between the US and the EU at the end of June is possibly worse from European citizens’ perspective than the 2004 deal.
Data will now be retained for up to an astonishing 40 years, not 3.5. There was no mention of the ATS system, or complaints about abuses. No restrictions how the info would be distributed, even to other US friendly countries. (Israel? Uzbekistan? ) The letter of intent has no legal basis, as before. And there is no talk of congressional approval that would bind the US to its commitments. There is redress for PNR mistakes – the privacy act is now extended to non US citizens – but as America’s main terror fighting mechanism is the scrutiny-free ATS, that doesn’t seem to matter. The push system is to be implemented, but there are still caveats which make it effectively akin to the much wider pull system. It’s as if the powers that be were unconcerned about Europeans’ privacy.
What would the consequences have been if European airlines refused to forward CRS PNR data. Of course, much of this information would still be available on US servers. But such a political act of insubordination might have consequences: ban on landing rights, a cancellation of the open skies agreement that allow US and EU airlines to fly all over each others territories, with much commerce to be gained. The EU might be punished by a draw down of commercial and other relations, eventually.
There is an argument that the EU has a far stronger hand than it thinks. That the US needs the EU as much as vice versa.
But it was clearly not evident at the negotiations. And one wonders in what other areas Europe’s surrender to America will be manifested: America is united and determined while Europe is fragmented and weak: the nation states for various reasons have given up their competences, but the EU political mechanisms are not strong enough to withstand US pressure, if even people like Frattini were willing. The Europeans don’t believe they are fighting a war, there is no single (rogue, many believe) administration, and there is no common European public opinion that could be swayed either away, Europe is divided and conquered by the US (an issue never spoken of whereas Russia’s games are often complained about). And no one knows what goes on in Brussels anyway, a single one-stop-shop godsend for America wanting to strike favourable deals.
D-66 – named after the summer of love year when it was formed - represents much of what is best, most emblematic about Europe. The Dutch social liberal party may only capture 2 percent of the Dutch electorate, but its voters are post-materialistic, urban, young, highly educated, secular, and comprise a high proportion of women. This profile couldn't be more different from the materialistic , middle aged, male, small town, nationalistic, poorly educated American person of faith who makes up the bedrock of president Bush's support, and support for his "War on Terror". I didn’t say there was a difference in waistlines.
It is not surprising that these two world views will clash if given a rare chance. Not violently, that's impossible, but in this case over the civil liberties of European citizens and travellers. Europeans’ civil liberties is an issue close to the hearts of D-66’s internationalist and youthful politicians. It’s somewhat less close to the hearts of aforementioned American patriots, especially when there is a “War against terrorism” to be won. Unfortunately it has also become a war against tourism.
D-66’s member of the European parliament is Sophia int’veldt, an auburn-haired, youthful history graduate aged around 40 who speaks five languages and has all those traits attributed to her voters, who was given the responsibility to monitor the EU-US passenger name records agreement, up for negotiation this summer. We had a long conversation where she gave me the benefit of her views on the subject.
As a justice and civil liberties issue, the transfer of passenger details from airlines to the US immigration authorities for analysis is not an issue over which the European parliament has co-competence. Yet. It will be once the new constitution in disguise becomes law in 2009. Then, the EP will have what is known as co-decision powers on justice and home affairs, an equal say compared to the European commission and the council of the EU member states’ justice ministers and home secretaries. It represents a considerable, perhaps the most considerable, formal shift in powers to a new institution in the new treaty: justice and home affairs issues after all lie at the heart of sovereignty. Yet the way int’veldt tells it, this empowerment in two years time is important, because it will actually be a dilution and a check on a vast amount of powers currently concentrated on the commission’s justice directorate, powers that have de facto if not de jure accreted informally and slowly over the years, especially on transnational issues such as terrorism – a concentration of unmonitored power that the Americans, wanting to get things done, have learnt how to exploit. Or to put another way: when it comes to a single telephone number for Europe, there is already one, in justice and home affairs. Franco Frattini, the commissioner in charge of such things.
Int’veldt says; “Frattini is a nice man, not particularly liberal, not particularly conservative. But the powers he has would go to anyone’s head. Terrorism is one of those transnational issues where is a vacuum in responsibilities, and here the commission – without quite having a European competence for it, has stepped in to take responsibilities.” Some governments are either keen on terror legislation themselves (because they are convinced, wrongly, that their peoples are) and benefit from playing the time-honoured game of pushing stuff through Brussels rather than national parliaments; other countries either don’t know what’s going on in Brussels, or dare not exercise their veto.
The picture for European private individuals is a slightly worrying one. Admittedly it is being facilitated by the commission, a European body. And it is not as bad in disregard for international norms as the Geneva convention denial seen over Guantanamo bay or Abu Ghraib, but it’s motivated by it’s in the same spirit of unilateralism as those two administration low points and entirely consistent with the pull out from the Kyoto treaty further back, the torpedoing of NATO, or the rejection of the international criminal court.. The original treaty, signed in May 2004, was about the US customs and immigration having access to the passenger name record (PNR), created on each booking, so as to get people’s addresses, credit card numbers , travel history, and travel companions as an adjunct in the fight against terrorism. As one security expert told me recently: “The advanced passenger information record tells you who you are. The PNR is much more interesting for the authorities: it tells them what you have been doing.” It allows law enforcement theoretically to find out terrorists, say, who have shared phone numbers, used the same credit card for bookings or who have travelled with each other. The information could in exceptional cases be used by other authorities and even other countries. The data could only be kept for 3.5 years, and would eventually be supplied on a case by case basis – from the airlines – known as push – rather than on a pull basis.
At the time the no fly list and the selectee list (which either stopped the person from flying or put them through enhanced security procedures, and was a few thousand names. There was no provision for the right of European citizens to inspect files on them or correct them if they had been stopped from flying and they thought there had been mistaken for someone else of similar name.
Up to the point when the new agreement was negotiated a few weeks ago, many things had happened in the security field. The passenger watch list, the widest dragnet comprising all intelligence reports gleaned from the widest possible and therefore least reliable sources, had grown to nearly half a million names; from this list, the no fly and selectee lists are drawn; the former is estimated at 30,000; the latter a larger number but classified and shifting. Further there were a growing number of anecdotal reports about the hassle endured by travellers both to and within the States, related to general rudeness as well as to a growing number of misidentifications where people, some quite prominent, were being mistaken for terrorists of same or phonetically resembling names. These individuals included Edward Kennedy, a US marine returning from Iraq, an Emmy-winning TV correspondent and outspoken critic of the Bush administration. Further, on the European side there was concern about the American authorities’ trustworthiness when it emerged that the Americans scored also for avian flu risk – not in the original protocols - and that the original promises contained get-out clauses that allowed for huge leeway in cancelling the modest guarantees the European Union had been given about what was done with their travelers’ data. The rumours that Americans were illegally scanning intra-European flights for terrorists and the fact that most of them were still surfing European airline records freely, having still not implemented the push system, did not help relations.
Most damagingly, there was the revelation in November last year that the US was using a parallel security system, originally used for determining the security risk of cargo, to create a data base of suspects far wider than anyone thought possible: in fact, using not only PNR information but an unspecified amount of other factors – at one point it was rumoured the DHS used passengers’ credit ratings and employment histories – to determine whether passengers were a security risk: every visitor – and that means you too - is scored for potential to do terror or cause nuisance to the United States. That represents a big difference to the system as supposed as implemented; which used PNRs as a auxiliary tool to determine terrorist suspects already on the watch list further connections. This hitherto unknown system made everyone a suspect. There was no recourse to correction insight into people’s files (whether American or European), and the scheme went ahead despite congress specifically voting against appropriations for schemes that profiled travellers as well as stopping a programme called secure flight for domestic travel over privacy redress concerns.
Perhaps it was because European airlines feared that they would be denied landing rights if EU governments refused to allow information on European travellers be read by US authorities – the usually profitable Atlantic air travel business is in trouble as it is – having dropped by 15% since 2000, falling even last year, partly because of the perception of tighter security controls. May be it was the commission’s eagerness to implement an intra European PNR monitoring scheme with extensive data mining operations of its own.
Anyhow, the agreement concluded between the US and the EU at the end of June is possibly worse from European citizens’ perspective than the 2004 deal.
Data will now be retained for up to an astonishing 40 years, not 3.5. There was no mention of the ATS system, or complaints about abuses. No restrictions how the info would be distributed, even to other US friendly countries. (Israel? Uzbekistan? ) The letter of intent has no legal basis, as before. And there is no talk of congressional approval that would bind the US to its commitments. There is redress for PNR mistakes – the privacy act is now extended to non US citizens – but as America’s main terror fighting mechanism is the scrutiny-free ATS, that doesn’t seem to matter. The push system is to be implemented, but there are still caveats which make it effectively akin to the much wider pull system. It’s as if the powers that be were unconcerned about Europeans’ privacy.
What would the consequences have been if European airlines refused to forward CRS PNR data. Of course, much of this information would still be available on US servers. But such a political act of insubordination might have consequences: ban on landing rights, a cancellation of the open skies agreement that allow US and EU airlines to fly all over each others territories, with much commerce to be gained. The EU might be punished by a draw down of commercial and other relations, eventually.
There is an argument that the EU has a far stronger hand than it thinks. That the US needs the EU as much as vice versa.
But it was clearly not evident at the negotiations. And one wonders in what other areas Europe’s surrender to America will be manifested: America is united and determined while Europe is fragmented and weak: the nation states for various reasons have given up their competences, but the EU political mechanisms are not strong enough to withstand US pressure, if even people like Frattini were willing. The Europeans don’t believe they are fighting a war, there is no single (rogue, many believe) administration, and there is no common European public opinion that could be swayed either away, Europe is divided and conquered by the US (an issue never spoken of whereas Russia’s games are often complained about). And no one knows what goes on in Brussels anyway, a single one-stop-shop godsend for America wanting to strike favourable deals.
Fantasies and folliws in medicine
Petr Skrabanek
Petr Skrabanek, a professor of public health at Trinity college Dublin and Lancet editorialist, was one of the great iconoclasts In the beginning of Fantasies and Follies in Medicine he announces that he suffers from scepticaemia, a generalised condition to which a course at medical school will invariably confer lifelong immunity. He examined poor thinking in medical science, had fun with doctors’ authority, and as a result this superb book seem to have been slightly neglected by the profession.
Fantasies and Follies begins with a chapter on placebos, and he slides into a disquisition on what doctors do. They are not scientists. And here we have the delicate subject of uto suggestions. The placebo effect works: the physician’s belief in the effects of his treatment and the patient’s faith in his physician exert a mutually reinforcing effect which nearly “always results in an improvement and sometimes in a cure.” But as a rule discussions of the placebo effect concentrate the gullibility of patients and ignore that of physicians. He quotes Platt wryly observing that the frequency with which placebos are used is an inverse relation to the combined intelligence of physician and patient.. He then asks: if therapy is beneficial why should scientists, envious of the results, accuse doctors of using placebos. But the magic only works, like the monarchy, if no light is let in upon the practice. Which is maybe why his books ought to be unread after all.
He writes: since much of the success of medicine depends on the placebo effect it is puzzling that medical textbooks have little to say on the subject. But surely, as he must know, it is not puzzling at all. Sir Douglas Black, he writes, a past president of he RCP, estimated that only 10 percent of diseases were significantly influenced by modern treatment. Or Sir George Pickering, who said that in 90 percent of patients seen by a general practitioner the effects of the outcome are unknown or there is no specific remedy to the symptoms. Though doctors prescribe drugs with active compounds, it has been estimated that up to half of modern-day prescriptions have any effect on the diseases for which they have been ordered: positive results are a folie a deux affecting doctors and patients alike.
He spells out the difference between science, which is inherently anarchic and subversive of authority, and the practice of medicine. And here he quotes Oxford academic Iain Chalmers, discussing the various authoritarian strategies to prevent inquiry into the placebo effect: “It is because the scientific method actively fosters uncertainty that it must invariably be subversive of authority. If these authorities are to be successful propagandists for their diverse practices and causes then they, unlike scientists, need the self confident certainty that they know what is good and bad. Searching questions about how they know are only unsettling, they serve to complicate the simple messages which are such an important component of their work.”
In chapter two his project becomes clearer: his enemy is not authority in medicine, but poor thinking in science. If the desire to take medicine is what distinguishes men from animals, man’s need for explanations of his raisons d’etre to explain why we are born and die are even more characteristic.. Doctors and healers since time immemorial have flourished because neither they nor their patients tare able to distinguished between association, cause and effect. He compares irrational polypharmacy of the modern age with blood letting of the past, and laments that “learning from experience means nothing more than learning to make the same mistakes with increasing confidence”.
Any layman reading science papers should take a primer in his expose of the fallacies of logical reasoning before believing the latest media scare – journalists especially. In Dublin, writes Skrabanek, the density of television aerials was strongly associated with infant mortality, not because television was lethal to infants but because density of aerials reflected poor housing, overcrowding and misery. In the personal relationship between physician and patient where a a situation arises that the patient feels better, cause and effect may not matter, but when faulty causational logic is applied to science you have junk science.
Skrabanek, who died in 1994, was accused in the medical press of taking payments as a consultant to Phillip Morris, a factor probably contributing to his obscurity today. One section of his book deals with how relative risk is misinterpreted. His example might be out of date, but the principle still holds: in 1995, the committee on safety of medicines wrote to all British GPs informing them that taking newer contraceptive pills doubled the risks of thrombosis. In the next few months abortion rates increased by 10 percent; with an unquantifiable number of unwanted pregnancies carried to term. Yet the absolute risk, beyond earlier contraceptives, seems to have been about 10-15 per 100,000 woman years of use, the increased mortality rate would be one per 1 million woman years, As he writes: “Life itself is a sexually transmitted disease with 100 percent fatality, and living it to the full means balancing reasonable and unreasonable risk.” It is probably attitudes like that, and the principle of relative risk carried over to lung cancer, that endeared him to the tobacco industry.
But his distinction between medicine and science surely still holds true: just recently the researcher John Ioannides published a paper which has since become rather well known “Why most Published research findings are false”, which operates in Skrabanek territory. In essays published elsewhere, Skrabanek takes issue with the near random play if epidemiological associations: supposed findings that do not reflect links with the outside world but are constructed by epidemiologists’ methods of examining data and reporting results.
Despite the cloud of tobacco industry associations, I intuit that Skrabanek was essentially just sceptic: Bohemia from where he escaped to Ireland after the Prague spring has one he strongest traditions of freedom and dissenting thought in Europe: surrounded and over-run by authoritarian empires, whether Prussian, Habsburg, Nazi or Communist, the Czechs much more than other Slav peoples sought refuse in scepticism, doubt – and in humour. If answering from the grave, Skrabenek would no doubt say he wrote in the tradition of Vaclav Havel. Havel opposed communism, whereas Skrabanek cast his eye over the nature of medical authority, careful to distinguish its merits from its demerits.
He was a jazz lover, chess player and bon viveur, loved by generations of Trinity students, his greatest love his Czech wife, who escaped from Prague with him.
His books remain available for download on Trinity College’s website.
Petr Skrabanek, a professor of public health at Trinity college Dublin and Lancet editorialist, was one of the great iconoclasts In the beginning of Fantasies and Follies in Medicine he announces that he suffers from scepticaemia, a generalised condition to which a course at medical school will invariably confer lifelong immunity. He examined poor thinking in medical science, had fun with doctors’ authority, and as a result this superb book seem to have been slightly neglected by the profession.
Fantasies and Follies begins with a chapter on placebos, and he slides into a disquisition on what doctors do. They are not scientists. And here we have the delicate subject of uto suggestions. The placebo effect works: the physician’s belief in the effects of his treatment and the patient’s faith in his physician exert a mutually reinforcing effect which nearly “always results in an improvement and sometimes in a cure.” But as a rule discussions of the placebo effect concentrate the gullibility of patients and ignore that of physicians. He quotes Platt wryly observing that the frequency with which placebos are used is an inverse relation to the combined intelligence of physician and patient.. He then asks: if therapy is beneficial why should scientists, envious of the results, accuse doctors of using placebos. But the magic only works, like the monarchy, if no light is let in upon the practice. Which is maybe why his books ought to be unread after all.
He writes: since much of the success of medicine depends on the placebo effect it is puzzling that medical textbooks have little to say on the subject. But surely, as he must know, it is not puzzling at all. Sir Douglas Black, he writes, a past president of he RCP, estimated that only 10 percent of diseases were significantly influenced by modern treatment. Or Sir George Pickering, who said that in 90 percent of patients seen by a general practitioner the effects of the outcome are unknown or there is no specific remedy to the symptoms. Though doctors prescribe drugs with active compounds, it has been estimated that up to half of modern-day prescriptions have any effect on the diseases for which they have been ordered: positive results are a folie a deux affecting doctors and patients alike.
He spells out the difference between science, which is inherently anarchic and subversive of authority, and the practice of medicine. And here he quotes Oxford academic Iain Chalmers, discussing the various authoritarian strategies to prevent inquiry into the placebo effect: “It is because the scientific method actively fosters uncertainty that it must invariably be subversive of authority. If these authorities are to be successful propagandists for their diverse practices and causes then they, unlike scientists, need the self confident certainty that they know what is good and bad. Searching questions about how they know are only unsettling, they serve to complicate the simple messages which are such an important component of their work.”
In chapter two his project becomes clearer: his enemy is not authority in medicine, but poor thinking in science. If the desire to take medicine is what distinguishes men from animals, man’s need for explanations of his raisons d’etre to explain why we are born and die are even more characteristic.. Doctors and healers since time immemorial have flourished because neither they nor their patients tare able to distinguished between association, cause and effect. He compares irrational polypharmacy of the modern age with blood letting of the past, and laments that “learning from experience means nothing more than learning to make the same mistakes with increasing confidence”.
Any layman reading science papers should take a primer in his expose of the fallacies of logical reasoning before believing the latest media scare – journalists especially. In Dublin, writes Skrabanek, the density of television aerials was strongly associated with infant mortality, not because television was lethal to infants but because density of aerials reflected poor housing, overcrowding and misery. In the personal relationship between physician and patient where a a situation arises that the patient feels better, cause and effect may not matter, but when faulty causational logic is applied to science you have junk science.
Skrabanek, who died in 1994, was accused in the medical press of taking payments as a consultant to Phillip Morris, a factor probably contributing to his obscurity today. One section of his book deals with how relative risk is misinterpreted. His example might be out of date, but the principle still holds: in 1995, the committee on safety of medicines wrote to all British GPs informing them that taking newer contraceptive pills doubled the risks of thrombosis. In the next few months abortion rates increased by 10 percent; with an unquantifiable number of unwanted pregnancies carried to term. Yet the absolute risk, beyond earlier contraceptives, seems to have been about 10-15 per 100,000 woman years of use, the increased mortality rate would be one per 1 million woman years, As he writes: “Life itself is a sexually transmitted disease with 100 percent fatality, and living it to the full means balancing reasonable and unreasonable risk.” It is probably attitudes like that, and the principle of relative risk carried over to lung cancer, that endeared him to the tobacco industry.
But his distinction between medicine and science surely still holds true: just recently the researcher John Ioannides published a paper which has since become rather well known “Why most Published research findings are false”, which operates in Skrabanek territory. In essays published elsewhere, Skrabanek takes issue with the near random play if epidemiological associations: supposed findings that do not reflect links with the outside world but are constructed by epidemiologists’ methods of examining data and reporting results.
Despite the cloud of tobacco industry associations, I intuit that Skrabanek was essentially just sceptic: Bohemia from where he escaped to Ireland after the Prague spring has one he strongest traditions of freedom and dissenting thought in Europe: surrounded and over-run by authoritarian empires, whether Prussian, Habsburg, Nazi or Communist, the Czechs much more than other Slav peoples sought refuse in scepticism, doubt – and in humour. If answering from the grave, Skrabenek would no doubt say he wrote in the tradition of Vaclav Havel. Havel opposed communism, whereas Skrabanek cast his eye over the nature of medical authority, careful to distinguish its merits from its demerits.
He was a jazz lover, chess player and bon viveur, loved by generations of Trinity students, his greatest love his Czech wife, who escaped from Prague with him.
His books remain available for download on Trinity College’s website.
Game of chicken
Is there blackmail over vaccines in threat that never went away?
Knowing the day of your death, as someone said, would certainly focus your mind. So it is with avian flu, the big non catastrophe of the last years. Experts and officials are certain that the pandemic will strike one day – the question is, when.
The effects could be devastating. Based on the 20 percent incidence and 0.5 percent mortality of the Spanish 1918 flu, there could be tens of millions of deaths, mainly in the elderly and vulnerable. Unlike normal seasonal flu, this will also strike the tropics – Africa, South-East Asia. And these countries are woefully underprepared. There has been an enormous expansion of scientific research into bird flu vaccines in the last few years: 70 percent of patents being applied for in the last year alone. But there are matters of production capacity and cost that severely question the ability of the developing world to pay for it. Rich countries have advanced purchase guarantees with the large drugs firms to buy the so called pre-pandemic drug in the event of a outbreak. Poor countries have to make do with charity, and reduced prices. GlaxoSmithKline has just announced a donation to the World Health Organization of 50m doses of their vaccine, with promises of an arrangement of tiered pricing for the rest of developing country needs. This is all well and good, but Asian health officials are sceptical as to whether help will always be forthcoming or effective.
For a start, a 50 million dose earmarked war chest will only go so far in the developing world; and though intelligent targeting of key workers and the vulnerable (perhaps less the vulnerable in callous Africa) is inevitable, there will be huge political problems in decisions to distribute the drugs: In a pandemic that can cross the world at the speed of a jumbo jet, delays due to squabbles are fatal. As for tiered prices, will they be low enough to be affordable? The example of tamiflu, the anti viral drug taken after any outbreak, is not encouraging: a dose sells in the west for $16, in India, where wages are $1 a day, for $14. GSK have not yet set out a price but promise that their vaccines will be affordable.
Officials from one Asian country badly hit with avian flu have hinted that they are prepared to use their biggest means of leverage:: the genetic material necessary for the production of vaccines culled from the millions of poultry slaughtered in their countries where avian flu in birds is endemic. At the moment, this information has been given freely to the WHO’s reference laboratories on the same basis as seasonal mutating flu virus information has been given for the last fifty years.
But now Asian officials are contemplating starting to “sell” the virus information. The legal situation is a bit unclear, says one UK patent official, but under the international biodiversity convention which says a country’s plants are its “ownership”, viruses could fall into that category. Even if international patent court cases ruled against Asian countries’ legal right to knowledge of constantly mutating virus varieties, their officials can just withhold them. And without virus information, there can be no vaccines.
This is a drastic step, but Asian officials say that there is a lack of trust between their government and he WHO as to whether they will get something back. Current global production capacity is 600m units, enough for rich countries, way short of global population needs.
Because WHO bureaucracy works slowly and by consensus, such “blackmail” may not be effective on an international political scene. Another way forward is where countries affected by avian flu cut deals directly with the vaccine manufacturers. The drugs firm Baxter already has good relations with Indonesia, having promised to donate 2m vaccines. Officials refuse to say there’s any quid pro quo for Baxter’s generosity, that they give virus information on an exclusive basis, but it’s also known that Baxter is one of the few drugs firms with the advanced drugs facilities that can take the wild version of the virus directly from the source, avoiding the need to have the virus’s safety risks genetically modified through the WHO’s reference laboratories. This opens the way to an interesting possibility: While Indonesia gets its drugs guaranteed, there are also certain commercial advantages for Baxter: bypassing the reference labs speeds up the process of bringing to market the most up-to-date vaccines by several weeks, giving the firm an edge over its rivals.
Leverage exercised in such a way, while it might be some good news for the Asian countries where the precious avian flu viruses are present, is likely to leave Africa even more marginalised. Even if Africa were to get its fair share of vaccine, no one has even talked about delivery systems. One African expert said: “We are not well prepared.” Africa’s death toll could be the equivalent of a decade’s worth of AIDS deaths.
One “consolation”, if you could call it that, is that the current vaccines, against the H5N1 species of the virus, will only work if the mutation that causes the pandemic is within the H5 family: Health experts say the disease which may break out anywhere on the planet tomorrow may well not be H5; in that case, an effective vaccine against a new strain will take months to develop while the pandemic rages. For that period at least, rich and poor would be affected equally.
Knowing the day of your death, as someone said, would certainly focus your mind. So it is with avian flu, the big non catastrophe of the last years. Experts and officials are certain that the pandemic will strike one day – the question is, when.
The effects could be devastating. Based on the 20 percent incidence and 0.5 percent mortality of the Spanish 1918 flu, there could be tens of millions of deaths, mainly in the elderly and vulnerable. Unlike normal seasonal flu, this will also strike the tropics – Africa, South-East Asia. And these countries are woefully underprepared. There has been an enormous expansion of scientific research into bird flu vaccines in the last few years: 70 percent of patents being applied for in the last year alone. But there are matters of production capacity and cost that severely question the ability of the developing world to pay for it. Rich countries have advanced purchase guarantees with the large drugs firms to buy the so called pre-pandemic drug in the event of a outbreak. Poor countries have to make do with charity, and reduced prices. GlaxoSmithKline has just announced a donation to the World Health Organization of 50m doses of their vaccine, with promises of an arrangement of tiered pricing for the rest of developing country needs. This is all well and good, but Asian health officials are sceptical as to whether help will always be forthcoming or effective.
For a start, a 50 million dose earmarked war chest will only go so far in the developing world; and though intelligent targeting of key workers and the vulnerable (perhaps less the vulnerable in callous Africa) is inevitable, there will be huge political problems in decisions to distribute the drugs: In a pandemic that can cross the world at the speed of a jumbo jet, delays due to squabbles are fatal. As for tiered prices, will they be low enough to be affordable? The example of tamiflu, the anti viral drug taken after any outbreak, is not encouraging: a dose sells in the west for $16, in India, where wages are $1 a day, for $14. GSK have not yet set out a price but promise that their vaccines will be affordable.
Officials from one Asian country badly hit with avian flu have hinted that they are prepared to use their biggest means of leverage:: the genetic material necessary for the production of vaccines culled from the millions of poultry slaughtered in their countries where avian flu in birds is endemic. At the moment, this information has been given freely to the WHO’s reference laboratories on the same basis as seasonal mutating flu virus information has been given for the last fifty years.
But now Asian officials are contemplating starting to “sell” the virus information. The legal situation is a bit unclear, says one UK patent official, but under the international biodiversity convention which says a country’s plants are its “ownership”, viruses could fall into that category. Even if international patent court cases ruled against Asian countries’ legal right to knowledge of constantly mutating virus varieties, their officials can just withhold them. And without virus information, there can be no vaccines.
This is a drastic step, but Asian officials say that there is a lack of trust between their government and he WHO as to whether they will get something back. Current global production capacity is 600m units, enough for rich countries, way short of global population needs.
Because WHO bureaucracy works slowly and by consensus, such “blackmail” may not be effective on an international political scene. Another way forward is where countries affected by avian flu cut deals directly with the vaccine manufacturers. The drugs firm Baxter already has good relations with Indonesia, having promised to donate 2m vaccines. Officials refuse to say there’s any quid pro quo for Baxter’s generosity, that they give virus information on an exclusive basis, but it’s also known that Baxter is one of the few drugs firms with the advanced drugs facilities that can take the wild version of the virus directly from the source, avoiding the need to have the virus’s safety risks genetically modified through the WHO’s reference laboratories. This opens the way to an interesting possibility: While Indonesia gets its drugs guaranteed, there are also certain commercial advantages for Baxter: bypassing the reference labs speeds up the process of bringing to market the most up-to-date vaccines by several weeks, giving the firm an edge over its rivals.
Leverage exercised in such a way, while it might be some good news for the Asian countries where the precious avian flu viruses are present, is likely to leave Africa even more marginalised. Even if Africa were to get its fair share of vaccine, no one has even talked about delivery systems. One African expert said: “We are not well prepared.” Africa’s death toll could be the equivalent of a decade’s worth of AIDS deaths.
One “consolation”, if you could call it that, is that the current vaccines, against the H5N1 species of the virus, will only work if the mutation that causes the pandemic is within the H5 family: Health experts say the disease which may break out anywhere on the planet tomorrow may well not be H5; in that case, an effective vaccine against a new strain will take months to develop while the pandemic rages. For that period at least, rich and poor would be affected equally.
Friday, November 09, 2007
TB tests for all.....
Should Britain test all immigrants for TB? It’s a disease almost eradicated in the native population. Yet several hundred thousand immigrants a year come, many from countries where not only active TB rates are higher in the UK, but where up to a third of the population has latent TB. That is to say they have been infected, have a few hundred of the rod-shaped bacteria in their lungs contained by their immune systems: they are asymptomatic and non infectious. In ten percent of cases, however, these latent carriers go on to develop full blown TB.
Statistically that’s about three thousand arrivals a year who will eventually develop the disease . It wouldn’t be so bad if all these cases were of normal TB, which is easy and cheap to treat, inconvenient mostly for the patient, who has to endure a six month cocktail of antibiotics even after he has begun to feel well.
But about 2-3percent of TB cases these days are multidrugs resistant (MDR) – the result of pooor drugs compliance further back in the transmission chain – and this TB is expensive and massively inconvenient to treat, susceptible only to second line drugs which are expensive, take a long time to work and have terrible side effects. There are periods when these MDR TB patients have to be kept in isolation chambers, seen to by a phalanx of doctors and nurses. The cost of treating such a patient has been estimated at £250,000 for a three year programme, and statistically Britain should be seeing about 60-80 MDR patients a year (3% of the 3,000 TB cases), as indeed it does.
To get an idea of what treatment for MDR is like, I spoke to one of few native Brits who did catch it – while in hospital (a depressingly common route), from another patient with active MDR:
Paul Thorn was a young HIV positive nurse treated for his HIV in an open ward at Westminster and Chelsea hospital in 1995 when a Brazilian came in, coughed up his sputum – the standard test – and, because the nurses failed to take precautions, infected the others. Six died. Paul survived –by enduring a painful three year course of chemotherapy, part of that period spent in an isolation room in hospital. He sent me a copy of his diary of the period.
“For some time experts had been predicting that it was only a matter of time before an outbreak of TB/MDR-TB occurred in such a way. Three months after exposure to the deadly bacteria, I was told of the outbreak. My health had already been deteriorating prior to my knowledge of the exposure. During that time the bacilli multiplied slowly in my lungs without me knowing. My slowly advancing chest pain and breathlessness were finally explained. Then without warning I lost my liberty and found myself locked away from society in a negative pressure isolation room so that I didn’t infect anyone else.”
Paul couldn’t leave the room – “you might not get out alive”, one doctor told him - and his contact with visitors was restricted. He found himself being visited by a succession of doctors and nurses in masks, and was given medication that made him woozy, confused and angry. When his story appeared in the media; he started getting letters of support – but also critical letters, asking why the taxpayer should pay for he mistakes owning to his lifestyle choice, since HIV exacerbated his condition.
But things got better: by October 1995 he was putting on weight, and had started a fitness routine.
When he was set free, he had to comply with several conditions: Though he was sputum negative and therefore very unlikely to be infectious, he still had to be careful. His doctors told him:
“You should sleep in a single room with the door closed at night, and should spend the majority of your time inside. It is relatively safe for you to go out for short periods assuming you will not be in close contact with anyone for longer than quarter of an hour or so. This means you will not be able for example, to go to restaurants, clubs, or use public transport. The flat should be properly ventilated. You will need to comply with daily direct observed therapy and will be advised to attend our out-patients' clinic once monthly. You should have no new social contacts and should not have contact with anyone who is HIV positive or otherwise immuno-compromised. You should also not have any contact with pregnant women or children."
Over the next three years Paul lost a lot of friends. His MDR TB course continued, a daily dose of five drugs taken under supervision at his local medical centre, under the internationally recognised standard of DOTS treatment, for which he says he was glad. “These drugs represent really powerful chemotherapy. I was vomiting, my lips became numb, I became paranoid because the drugs seemed through my brain membranes. I would have stopped taking the drugs.” He never did though- thanks to the support of his consultant – and now speaks regularly at conferences as well as having published a book on how to survive TB.
There are several hundred individuals being treated in the above manner, in a lowokey way, in centres in London, Liverpool and elsewhere – under John Moore Gillon at Bart’s; under prof Peter Davies at the Liverpol cardiothoracic centre. Though invidious to question the dedication of staff or the determination to be cured of MDR patients, Paul did admit that he was often tempted to quit: to walk out and disappear into the community, with his uncured MDR.
It’s not that easy catch someone else’s TB, you have to spend hours in their company in an environment saturated with cough droplets, so catching it on the tube is unlikely. But there have been outbreaks – in Leicester, London, in the former a school, among former residents of a squat, from where it rippled out to 67 friends, relatives others. These have not been any multidrugs resistant outbreaks, yet.
The MDR treatment bill in the UK may only run into the tens of millions of pounds a year – these are the decisions policy-makers have to make all the time. Prof Davies does not think screening worthwhile = for a start the detection test s for MDR are complex and beyond the capabilities of embassy staff, at least until electronic kit becomes available, Then it raises the questions: if immigrants, why not all visitors? Students, tourists, temporary workers, since they could equally well –albeit at lower risk – be carriers. .No other country has gone down that route, ever..
But it’s worth awareness raising. Paul told me of one case in West London where a GP took a year to diagnose his patient with TB, having done tests for cancer as well as the usual respiratory diseases. Prof Davies blamed the drugs companies for pushing asthma drugs in the medical journals, with their slogans aimed at doctors “Cough..Think asthma” The drugs firms have long found it more profitable to invest in such western world ailments than in TB. (Though that is slowly changing.)
For while it must be a surprising fact to many that not only is disease associated with Victorian “romantic” death not eradicated but is the world’s second biggest infectious killer, it remains overwhelmingly disease of poor countries.
Statistically that’s about three thousand arrivals a year who will eventually develop the disease . It wouldn’t be so bad if all these cases were of normal TB, which is easy and cheap to treat, inconvenient mostly for the patient, who has to endure a six month cocktail of antibiotics even after he has begun to feel well.
But about 2-3percent of TB cases these days are multidrugs resistant (MDR) – the result of pooor drugs compliance further back in the transmission chain – and this TB is expensive and massively inconvenient to treat, susceptible only to second line drugs which are expensive, take a long time to work and have terrible side effects. There are periods when these MDR TB patients have to be kept in isolation chambers, seen to by a phalanx of doctors and nurses. The cost of treating such a patient has been estimated at £250,000 for a three year programme, and statistically Britain should be seeing about 60-80 MDR patients a year (3% of the 3,000 TB cases), as indeed it does.
To get an idea of what treatment for MDR is like, I spoke to one of few native Brits who did catch it – while in hospital (a depressingly common route), from another patient with active MDR:
Paul Thorn was a young HIV positive nurse treated for his HIV in an open ward at Westminster and Chelsea hospital in 1995 when a Brazilian came in, coughed up his sputum – the standard test – and, because the nurses failed to take precautions, infected the others. Six died. Paul survived –by enduring a painful three year course of chemotherapy, part of that period spent in an isolation room in hospital. He sent me a copy of his diary of the period.
“For some time experts had been predicting that it was only a matter of time before an outbreak of TB/MDR-TB occurred in such a way. Three months after exposure to the deadly bacteria, I was told of the outbreak. My health had already been deteriorating prior to my knowledge of the exposure. During that time the bacilli multiplied slowly in my lungs without me knowing. My slowly advancing chest pain and breathlessness were finally explained. Then without warning I lost my liberty and found myself locked away from society in a negative pressure isolation room so that I didn’t infect anyone else.”
Paul couldn’t leave the room – “you might not get out alive”, one doctor told him - and his contact with visitors was restricted. He found himself being visited by a succession of doctors and nurses in masks, and was given medication that made him woozy, confused and angry. When his story appeared in the media; he started getting letters of support – but also critical letters, asking why the taxpayer should pay for he mistakes owning to his lifestyle choice, since HIV exacerbated his condition.
But things got better: by October 1995 he was putting on weight, and had started a fitness routine.
When he was set free, he had to comply with several conditions: Though he was sputum negative and therefore very unlikely to be infectious, he still had to be careful. His doctors told him:
“You should sleep in a single room with the door closed at night, and should spend the majority of your time inside. It is relatively safe for you to go out for short periods assuming you will not be in close contact with anyone for longer than quarter of an hour or so. This means you will not be able for example, to go to restaurants, clubs, or use public transport. The flat should be properly ventilated. You will need to comply with daily direct observed therapy and will be advised to attend our out-patients' clinic once monthly. You should have no new social contacts and should not have contact with anyone who is HIV positive or otherwise immuno-compromised. You should also not have any contact with pregnant women or children."
Over the next three years Paul lost a lot of friends. His MDR TB course continued, a daily dose of five drugs taken under supervision at his local medical centre, under the internationally recognised standard of DOTS treatment, for which he says he was glad. “These drugs represent really powerful chemotherapy. I was vomiting, my lips became numb, I became paranoid because the drugs seemed through my brain membranes. I would have stopped taking the drugs.” He never did though- thanks to the support of his consultant – and now speaks regularly at conferences as well as having published a book on how to survive TB.
There are several hundred individuals being treated in the above manner, in a lowokey way, in centres in London, Liverpool and elsewhere – under John Moore Gillon at Bart’s; under prof Peter Davies at the Liverpol cardiothoracic centre. Though invidious to question the dedication of staff or the determination to be cured of MDR patients, Paul did admit that he was often tempted to quit: to walk out and disappear into the community, with his uncured MDR.
It’s not that easy catch someone else’s TB, you have to spend hours in their company in an environment saturated with cough droplets, so catching it on the tube is unlikely. But there have been outbreaks – in Leicester, London, in the former a school, among former residents of a squat, from where it rippled out to 67 friends, relatives others. These have not been any multidrugs resistant outbreaks, yet.
The MDR treatment bill in the UK may only run into the tens of millions of pounds a year – these are the decisions policy-makers have to make all the time. Prof Davies does not think screening worthwhile = for a start the detection test s for MDR are complex and beyond the capabilities of embassy staff, at least until electronic kit becomes available, Then it raises the questions: if immigrants, why not all visitors? Students, tourists, temporary workers, since they could equally well –albeit at lower risk – be carriers. .No other country has gone down that route, ever..
But it’s worth awareness raising. Paul told me of one case in West London where a GP took a year to diagnose his patient with TB, having done tests for cancer as well as the usual respiratory diseases. Prof Davies blamed the drugs companies for pushing asthma drugs in the medical journals, with their slogans aimed at doctors “Cough..Think asthma” The drugs firms have long found it more profitable to invest in such western world ailments than in TB. (Though that is slowly changing.)
For while it must be a surprising fact to many that not only is disease associated with Victorian “romantic” death not eradicated but is the world’s second biggest infectious killer, it remains overwhelmingly disease of poor countries.
Thursday, November 08, 2007
Airport gripes
The contrast does seem odd. I was on my way to a conference of the world’s top airline security executives. But first there was the obstacle course via humiliation and pandemonium at Stansted, possibly the world’s worst airport. I was reminded of what one complaints website said, talking of “Biblical scenes that were Stansted’s queues” and saying: “The armed police must be there to stop us lynching airport staff.”
When I arrived at Charleroi I sped quickly into Brussels, walked in to the town’s most luxurious hotel, the Conrad, walked up the registration desk, hadn’t pre registered but flashed my presscard, was greeted with a smile and the words “We will have your badge ready in a minute. P lease go ahead right in”. And was inside a room full of the world’s top security experts from airlines, airports and aviation organisations within thirty seconds..
I had a daypack with me and so, concludingly, it is much easier to blow up a conclave of top air executives (perhaps from the Passengers’ Liberation front) than it is to blow up a planeful of lowly leisure travellers on a discount flight.
I found top officials hugely unhappy, with the situation. The first official who spoke said – and this was after Glasgow: “There’s too much security in airports these days, more than passengers stand for. They would willingly take extra risks for less inconvenience but are not consulted.” A panellist explained why: “Every time there is a new outrage politicians have to be seen to do something. So they impose new security restrictions on airports and passengers. They take the credit, but don’t pay the price: 25-40% of airport costs are now security. Ultimately it is the passengers who pay through their ticket prices, or putting up with the departure lounges turned into shopping malls: if airports were not able to cross subsidise from retail profits, ticket prices would be much higher.”
Over lunch, one official, Pekka Salo, deputy head of security at Finnair, said; “Security at airports ought to become less of an issue now that you just blow people up with a carbomb or on the metro. But flying is an iconic fear among passengers, and airports are easy to pick on. You don’t see governments going to the association of nightclub owners and saying: what security measures have you implemented outside your nightclub?”
Salo also complained about the “placebo security” – meaning pseudo security measures imposed at haste after some outrage that do very little to improve real security and whose sole beneficial effect, if it even manages that, is to reassure passengers. “Take the ban on nail clippers and nail files. That’s stupid. Because airside you can easily get hold of eating knives in one of the many airside restaurants that are more dangerous than that. Or what if someone can do karate….” His real fears concerned “airport workers lending terrorists their access cards.”
The ban on liquids came in for some criticism. Dr Michael Kerkloh, the CEO of Munich airport, summarised the regulations that see thousands of litres of duty free liquid being poured out daily at his and other European airports in purchases belonging to transit passengers coming from outsider the EU and going to an onward destination within Europe: “Bullshit.” In the sardonic words of another safety official: “It’s only because airports want to sell passengers their whisky twice.” Bernard Liim, director of international relations and security at the ministry of transport in Singapore, said that some airports in Asia even confiscated duty frees on final arrival, “when you have arrived, and you will travelling home by car, final destination, and are no danger to other passengers.” Shaking his head, he said: “There is a lack of harmonisation on these issues.”
The problem is set to get worse unless better solutions are found and a proper debate is carried out, it was agreed. Even Gunther Maschnigg, the head of safety at IATA, which has to be circumspect and conservative, said: “There is much better security but also much, much more frustration, since 9-11. There have been many stopgap measures. Air travel is growing, in some countries 10-20 percent annually. By 2020 there will be 80 percent more air travel globally. The current system of security cannot adapt.”
To me, it seems that the debate has to start by separating out security that doesn’t work from real security. Then – the trade-off between real security and inconvenience has to be measured, a question for politicians, the public and experts.
Apart from the nailfile ban, placebo measures would surely include uniformed and armed police at airports. According to an Israeli security expert these only serve to reassure the public – and provide scouring terrorists for the first likely targets. Much better would be undercover armed guards. Another placebo measure is arguably the US no-fly list, whose reassuring-sounding 140,000 names to keep the homeland safe include many superfluities, deficiencies and anomalies: the list includes the 9/11 hijackers and Saddam Hussein, and several international statesmen with whom the US has diplomatic relations, including Evo Morales, the president of Bolivia. US journalists looking into this story were told “The CIA and various government agencies just took all their names on their computers and dumped them on to this list.”
Some genuine terrorists with common names, such as Robert Johnson, a 62-year-old black man convicted of plotting to bomb a movie theatre in Toronto, since deported to Trinidad. cause their innocent namesakes boarding a plane any amount of trouble. CBS’s Sixty Minutes recently interviewed a dozen Robert Johnsons, innocent all-Americans: businessmen, a politicians, soldiers, a football coach, all of whom had enormous troubles get on flights, sometimes interrogated for hours after the check-in agents who are obliged to call the alert if just a name similar or identical to one on the no-fly list flags up. The system is as crude as that. Sometimes they are even strip searched. A spokeswoman for the US Terrorist Screening Center just said that society and anyone named Robert Johnson has to pay for security.
The problem is – many real terrorists are not even on the list: for instance the original eleven British suspects recently charged with plotting to blow up ten commercial airliners with liquid explosives, even though they had reportedly been under surveillance for more than a year. Nevertheless, the list continues to monitor “terrorists” at every check-in because it gives American public opinion – legislatprs ad public - the reassurance of security.
But there are effective further security measures that can indeed be put in place. At the conference, Ramesh Anon, an Israeli security expert, talked tough. “We need to stay one step ahead of the terrorists, who will always find our weakest point. We have to have a global standardisation or terrorists will find the softest target.” He suggested more prior screening of travellers – background checks after ticket purchase – and more armed undercover air marshals on every flight. Other Israeli experts have recommended security booths on the single approach roads to the airport, accompanied by speed bumps, as at Tel Aviv airport, which would have stopped the Glasgow airport incident. .
But Tel Aviv airport has a fraction of the passengers (and car traffic) of Heathrow and Chicago, and is the rest of the world able or willing to take the admittedly successful security measures Israel imposes on airline traffic and employ it as the global solution to the growing worldwide air travel industry ? Travelling back, I caught the Eurostar.
When I arrived at Charleroi I sped quickly into Brussels, walked in to the town’s most luxurious hotel, the Conrad, walked up the registration desk, hadn’t pre registered but flashed my presscard, was greeted with a smile and the words “We will have your badge ready in a minute. P lease go ahead right in”. And was inside a room full of the world’s top security experts from airlines, airports and aviation organisations within thirty seconds..
I had a daypack with me and so, concludingly, it is much easier to blow up a conclave of top air executives (perhaps from the Passengers’ Liberation front) than it is to blow up a planeful of lowly leisure travellers on a discount flight.
I found top officials hugely unhappy, with the situation. The first official who spoke said – and this was after Glasgow: “There’s too much security in airports these days, more than passengers stand for. They would willingly take extra risks for less inconvenience but are not consulted.” A panellist explained why: “Every time there is a new outrage politicians have to be seen to do something. So they impose new security restrictions on airports and passengers. They take the credit, but don’t pay the price: 25-40% of airport costs are now security. Ultimately it is the passengers who pay through their ticket prices, or putting up with the departure lounges turned into shopping malls: if airports were not able to cross subsidise from retail profits, ticket prices would be much higher.”
Over lunch, one official, Pekka Salo, deputy head of security at Finnair, said; “Security at airports ought to become less of an issue now that you just blow people up with a carbomb or on the metro. But flying is an iconic fear among passengers, and airports are easy to pick on. You don’t see governments going to the association of nightclub owners and saying: what security measures have you implemented outside your nightclub?”
Salo also complained about the “placebo security” – meaning pseudo security measures imposed at haste after some outrage that do very little to improve real security and whose sole beneficial effect, if it even manages that, is to reassure passengers. “Take the ban on nail clippers and nail files. That’s stupid. Because airside you can easily get hold of eating knives in one of the many airside restaurants that are more dangerous than that. Or what if someone can do karate….” His real fears concerned “airport workers lending terrorists their access cards.”
The ban on liquids came in for some criticism. Dr Michael Kerkloh, the CEO of Munich airport, summarised the regulations that see thousands of litres of duty free liquid being poured out daily at his and other European airports in purchases belonging to transit passengers coming from outsider the EU and going to an onward destination within Europe: “Bullshit.” In the sardonic words of another safety official: “It’s only because airports want to sell passengers their whisky twice.” Bernard Liim, director of international relations and security at the ministry of transport in Singapore, said that some airports in Asia even confiscated duty frees on final arrival, “when you have arrived, and you will travelling home by car, final destination, and are no danger to other passengers.” Shaking his head, he said: “There is a lack of harmonisation on these issues.”
The problem is set to get worse unless better solutions are found and a proper debate is carried out, it was agreed. Even Gunther Maschnigg, the head of safety at IATA, which has to be circumspect and conservative, said: “There is much better security but also much, much more frustration, since 9-11. There have been many stopgap measures. Air travel is growing, in some countries 10-20 percent annually. By 2020 there will be 80 percent more air travel globally. The current system of security cannot adapt.”
To me, it seems that the debate has to start by separating out security that doesn’t work from real security. Then – the trade-off between real security and inconvenience has to be measured, a question for politicians, the public and experts.
Apart from the nailfile ban, placebo measures would surely include uniformed and armed police at airports. According to an Israeli security expert these only serve to reassure the public – and provide scouring terrorists for the first likely targets. Much better would be undercover armed guards. Another placebo measure is arguably the US no-fly list, whose reassuring-sounding 140,000 names to keep the homeland safe include many superfluities, deficiencies and anomalies: the list includes the 9/11 hijackers and Saddam Hussein, and several international statesmen with whom the US has diplomatic relations, including Evo Morales, the president of Bolivia. US journalists looking into this story were told “The CIA and various government agencies just took all their names on their computers and dumped them on to this list.”
Some genuine terrorists with common names, such as Robert Johnson, a 62-year-old black man convicted of plotting to bomb a movie theatre in Toronto, since deported to Trinidad. cause their innocent namesakes boarding a plane any amount of trouble. CBS’s Sixty Minutes recently interviewed a dozen Robert Johnsons, innocent all-Americans: businessmen, a politicians, soldiers, a football coach, all of whom had enormous troubles get on flights, sometimes interrogated for hours after the check-in agents who are obliged to call the alert if just a name similar or identical to one on the no-fly list flags up. The system is as crude as that. Sometimes they are even strip searched. A spokeswoman for the US Terrorist Screening Center just said that society and anyone named Robert Johnson has to pay for security.
The problem is – many real terrorists are not even on the list: for instance the original eleven British suspects recently charged with plotting to blow up ten commercial airliners with liquid explosives, even though they had reportedly been under surveillance for more than a year. Nevertheless, the list continues to monitor “terrorists” at every check-in because it gives American public opinion – legislatprs ad public - the reassurance of security.
But there are effective further security measures that can indeed be put in place. At the conference, Ramesh Anon, an Israeli security expert, talked tough. “We need to stay one step ahead of the terrorists, who will always find our weakest point. We have to have a global standardisation or terrorists will find the softest target.” He suggested more prior screening of travellers – background checks after ticket purchase – and more armed undercover air marshals on every flight. Other Israeli experts have recommended security booths on the single approach roads to the airport, accompanied by speed bumps, as at Tel Aviv airport, which would have stopped the Glasgow airport incident. .
But Tel Aviv airport has a fraction of the passengers (and car traffic) of Heathrow and Chicago, and is the rest of the world able or willing to take the admittedly successful security measures Israel imposes on airline traffic and employ it as the global solution to the growing worldwide air travel industry ? Travelling back, I caught the Eurostar.
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