Kung Fu Panda, the 2008 cartoon hit, provides the basic co-ordinates for understanding the ideological situation I have been describing. The fat panda dreams of becoming a kung fu warrior. He is chosen by blind chance (beneath which lurks the hand of destiny, of course), to be the hero to save his city, and succeeds. But the film’s pseudo-Oriental spiritualism is constantly undermined by a cynical humour. The surprise is that this continuous making-fun-of-itself makes it no less spiritual: the film ultimately takes the butt of its endless jokes seriously. A well-known anecdote about Niels Bohr illustrates the same idea. Surprised at seeing a horseshoe above the door of Bohr’s country house, a visiting scientist said he didn’t believe that horseshoes kept evil spirits out of the house, to which Bohr answered: ‘Neither do I; I have it there because I was told that it works just as well if one doesn’t believe in it!’ This is how ideology functions today: nobody takes democracy or justice seriously, we are all aware that they are corrupt, but we practise them anyway because we assume they work even if we don’t believe in them. Berlusconi is our own Kung Fu Panda. As the Marx Brothers might have put it, ‘this man may look like a corrupt idiot and act like a corrupt idiot, but don’t let that deceive you – he is a corrupt idiot.’
The British Medical Journal depicted the Health and Social Care bill with a picture of Frankenstein’s monster on the front cover with ‘Bill’ on his forehead. They called the reforms “mad” and defended the use of the word,
We needed a word to communicate the sense of the government’s proposed reforms as being “mentally disordered or deranged; insane; resulting from or caused by madness; extremely and recklessly foolish” – the Chambers dictionary definition of the word “mad.” We were trying to be accurate, not clever.
Andy Cowper writes the Health Policy Insight blog has probably contributed more analysis to, and has more detailed knowledge of the NHS reforms than any other individual. His posts are full of scathing, mockery, and mild-expletive-laden-ire.
Scourge of homeopaths and the Daily Mail, Ben Goldacre’s response to Lansley’s presentation of medical statistics was titled ‘Andrew Lansley and his imaginary evidence’ but he made sure, as always to avoid politics,
I’m not in favour of, or against, anything here: all health service administrative models bore me equally.
There is an inherent danger here of not seeing the wood for the trees. In his excellent essay, Dehumanized: When math and science rule the class, Mark Slouka quotes Dennis Overbye,
Nobody was ever sent to prison for espousing the wrong value for the Hubble constant.
The arguments that really matter to people are moral, not scientific. They are about justice, equality, rights and wrongs. A close reading is better than a brief glance and good science as a foundation is self-evidently better than bad science, but we have to be able to extrapolate from facts about facts to implications for people and policy.
The government’s recent attempt to justify the reforms on the basis of health outcomes are a post-hoc distraction: in July last year I wrote, “Extraordinary changes require extraordinary justification backed up by extraordinary evidence” There was no extraordinary justification or evidence in the white paper. The references provided would have embarrassed a first year undergraduate.
As the Lancet reported in October, the justification is clear:
“The White Paper’s proposals are ideological with little evidential foundation. They represent a decisive step towards privatisation that risks undermining the fundamental equity and efficiency objectives of the NHS. Rather than “liberating the NHS”, these proposals seem to be an exercise in liberating the NHS’s £100 billion budget to commercial enterprises” Lancet Oct 6th 2010
We need nerds. I am very grateful for people like Andy and Ben who pick over documents of extraordinary size and complexity to explain the detail to those of us who are fully occupied with our work and families.
There are a handful of people looking at the bigger picture and one of the best is Richardblooger who writes the excellent evidence-to-policy blog, Conservative Policies Dissected.
But we all need to go beyond the trees and look at the woods to see that the pronouncements on the NHS from politicians of all parties are absurd, and whilst we mock, they hide like Berlusconi behind a façade of buffoonery while the savage process of dismantling the NHS goes on.