“The further a society drifts from the truth, the more it will hate those that speak it.” George Orwell
The doctor-patient consultation has much to do with the determination of truth. First a true history needs to be taken – symptoms need to be listened to and interpreted carefully. False beliefs of what symptoms may represent need to be corrected as doctor and patient seek to come to a shared understanding of the true nature of their condition. Once a reasoned explanation of what is going on has been agreed upon, normality needs to be distinguished from pathology if the over medicalisation of life, so beloved of pharmaceutical companies, is to be avoided. And once a consensus of what is true has been established it needs to be acted upon accordingly – an honest discussion needs to be had as to what a course of treatment, pharmacological or otherwise, may genuinely have to offer. The truth of whether a course of antibiotics will benefit that troublesome cough, how much help an antidepressant will really offer somebody with depression or to what extent a patient’s cancer will respond to chemotherapy needs to be determined and explained to the patient based on the available medical evidence rather than either the wishful thinking of patient/clinician or the exaggerated claims of pharmaceutical companies. But in an increasing postmodern world, where no absolute truth is held to exist, and some truths are more convenient for some to hold than others, such certainty seems harder to define. Truth, it seems, is terminally ill and languishing on an outlying ward whilst a DNAR form is being hurriedly completed by those who will benefit most from its death. Truth is in need of some urgent intensive care. Coming to that shared consensus within the consultation is, therefore, becoming more and more problematic.
On January 2nd 1891 a 12 year old boy called William died. A little under four years later, on December 13th 1894, his brother Ernest followed suit. He was just 9 years old. You won’t have heard of them – indeed I wonder if anyone alive today remembers that either of them ever even existed. Yet a gravestone in a Lincolnshire churchyard testifies to the fact that they did – it stands in memory of the truth that once they were both very much alive. The gravestone reminded me that those I have no knowledge of were no less real for my ignorance of them. I am glad it was there for me to read.
It’s good to visit graveyards from time to time – and not just to visit the graves of those we have known and loved. It’s helpful to be reminded of the countless generations of people who have gone before us, and to remember that all have died having once lived, not so very differently to us. To forget them does not alter the reality of their once vibrant lives but, by ignoring their former existence, we are diminished ourselves.
We make a mistake if we think we are more important that those who have gone before us.
We make a mistake if we arrogantly imagine that how we see things today is inevitably so much more sophisticated than how our predecessors saw things in the past.
And we make a mistake if we forget that one day we too will die and lie forgotten by those who live on. We, and what we reckon, will be considered of little importance by the strangers who will one day walk amongst our gravestones.
A few miles away from that village churchyard is Lincoln Cathedral. There the invitation again goes out to remember more of those who have died. The heavy stone slabs confirm that death is no respecter of persons. Even the great and the good, rich enough or considered important enough to have their lives commemorated in such grand surroundings, know what it is to die tragically young. Selina Newcomen died on 15th January 1725 aged 29. Just six weeks later, on 25th February, her eight month old son, John, joined her in the grave.
A third graveyard lies within Lincoln Castle, a few hundred yards away from the cathedral. In the 19th century, the castle housed a Victorian Prison. Here the gravestones are less auspicious. Rising no more than a few inches above the ground, the stones are engraved with just the initials of the person whose grave they mark – along with the date on which they were executed. Priscilla Biggadike was hung at 9am on December 28th 1868 for the murder, three months earlier, of her husband, Richard. He had been poisoned with arsenic. She maintained her innocence right up to the point of her execution. Fourteen years later, Thomas Proctor, a lodger of the Biggadike’s at the time, confessed on his deathbed to having committed the murder. Ironically, just a stone’s throw away, Lincoln Castle holds a copy of the Magna Carta of 1215. Famously it promises to deny or delay right of justice to no one. On this occasion however, a misrepresentation of what was true ended in an awful injustice. When truth is absent, something important dies.
Discerning the truth is fundamental if right decisions are to be made, if justice is to prevail, if sensible actions are to be taken.
But for some the truth is sometimes inconvenient.
In his book ‘The Book of Laughter and Forgetting’ the Czech writer, and Nobel Laureate, Milan Kundera wrote, ‘The struggle of man against power is the struggle of memory against forgetting’. His point was that we need to fight to keep remembering what is true because there are those who would have us forget the truth, if indeed we were ever allowed to know it in the first place. Controlling what is believed to be true, controls those who believe it.
Throughout history the rich and powerful have always wanted to control what is remembered, so as to paint a version of events favourable to themselves. Some have used their wealth to buy the silence of those who know the truth, others have used their power to threaten and intimidate those who they do not want to speak. It is no different today. Hollywood has recently been rocked by the news of how one rich and powerful man sought to silence the women he assaulted by paying them large sums of money to sign ‘Non-Disclosure Agreements’ or by threatening them with career failure if they ever opened their mouth and spoke of what he had done to them.
Pharmaceutical companies are sometimes guilty of similar misrepresentations of the truth. Not only do they encourage us to interpret normality as disease, they would also have us believe that their drugs are more effective in producing satisfactory endpoints than they really are, imaginatively misrepresenting data and applying gagging clauses to those who undertake their research lest results of that research is unfavourable for the drug’s marketability.
If something is not said, it is soon forgotten, and what is not remembered is soon no longer believed – no matter how true it actually was. Truth then dies – it ceases to be important.
It is not only a version of history that powerful people want to manipulate. The notion of truth itself is something that some would like to see die – and be left with no memorial stone to mark its passing. Truth can indeed be inconvenient – it gets in the way of allowing us to do what we want. This wish, to see truth conveniently disposed of, is not a new desire – it’s been around for millennia. Nearly 2000 years ago Pontius Pilate, perhaps himself drawing on Plato, asked one who claimed to bear witness to the truth the question ‘What is truth?’ In the 19th century Friedrich Nietzche coined the term ‘Perspectivism’ and, presumably failing to notice his own internal inconsistency, asserted that ‘There are no facts, only interpretations’. And today we have so called ‘alternative facts’. Some, the rich and powerful, claim that these alternative facts, with no objective evidence to support them, have as much validity as facts that are objectively verifiable. Others just shout down, vilify and ridicule any opinion contrary to their own – ad hominem arguments being preferred to reasoned argument. The only thing that is true, it seems, is that there is no truth.
In ‘The Eighteenth Brumaire of Lois Bonaparte’, Karl Marx wrote: ‘Men make their own history; but they do not make it just as they please; they do not make it under circumstances chosen by themselves, but under circumstances directly found, given and transmitted from the past. The tradition of all the dead generations weighs like a nightmare on the brain of the living.’ Marx’s point is that nobody stands outside of history – everyone, even the most progressive of thinkers, is influenced by the particular historical context they find themselves in. The thinking of those in the past was, without doubt, not without error but we are foolish if we think it was completely false. If we try to think in new ways, without drawing on the wisdom of the past, we ourselves will make mistakes influenced as we are by the time in history we find ourselves. We will make mistakes in the conclusions we draw, different mistakes, certainly, from those that have gone before us, but mistakes none the less. Novel ideas of the nature of reality are unlikely to be reliable. Truth matters – and it is best discerned standing on the shoulders of those who have thought before us rather than dismissing that body of understanding as irrelevant and out of date and trying to start afresh. C.S. Lewis advised that at least every fourth book one reads should be from an era prior to our own. He wrote, “Every age has its own outlook. It is especially good at seeing certain truths and especially liable to make certain mistakes. We all, therefore, need the books that will correct the characteristic mistakes of our own period. And that means old books.’
And it means old ideas too. That’s why we need to remember those who have gone before us – and learn from them. Those old and long retired GPs may not be talking out dated nonsense after all. Perhaps they are wiser than we would like to think. Perhaps we should listen more attentively to the advice they might have for us. If only we would ask it of them.
But still there are those who want to redefine truth for us, and make it fit modern sensibilities. If as is sometimes said, truth is the first casualty of war, then it would seem we have a fight on our hands – that the battle has been raging for a while. We must not uncritically buy in to the spirit of the age – uncritically believe what we are told. To do so will spell disaster. If we lose the notion of truth, then what place the news? Will there be any point in switching on our televisions at 10 o’clock each evening? And what will we hear if we do?
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THE SWEN AT TEN – A DAILY ROUND UP OF ALL YOU NEED TO FEEL
For those who find any meaning in arbitrary concepts of time: It’s 10pm on Senseday, the 38th of Imaginary, 2084 – here are the perspectives.
Our main story tonight is the inauguration of Liarnel Thump as the new President of the renamed ‘United Provinces of the Relevant World’. President Thump takes up his position after declaring himself as the populace’s undisputed choice of leader following his claiming a 98% approval rating amongst ‘right thinking’ people. Under new legislation that states that supporting evidence is no longer required before attesting such a claim, Thump’s taking power will proceed unopposed. Outstanding criminal charges against the President will not be considered since, as there is no such thing as right and wrong, crime is no longer considered a meaningful concept in a progressive society such as the UPRW. Those who have accused Mr Thump of ‘violating their personal space’ have been instructed to ‘feel differently about it’. Furthermore since it has long been felt by those in power that only the powerful can lawfully own property, those who assert that they have such a thing as personal space are open to a charge of larceny since they have no right to deny any space, personal or otherwise, from others. Legal teams are considering how ‘the unimportant’ might be charged with wrong doing in a blame free society where the concept of wrong is not recognised. Early indications are that the poor, the weak and the easily oppressed will be made exempt from immunity to prosecution to ensure the smooth running of society for those of significance. Similarly mental illness will no longer be acceptable. In a society that is deemed entertainment rich and where a fun filled future is considered guaranteed, low mood and anxiety will be classified as deviant emotions and those displaying such unhelpful and negative attitudes of mind will be subject to incarceration.
Former Prime Minister, Tony Blah, renewing his role as an envoy for peace today urged the government to support military action in response to the alleged chemical attack in Syria. He said people needed to remember that, just because no evidence was ever found that Saddam Hussein had weapons of mass destruction, it didn’t alter the fact that he undoubtedly had the capacity to launch a nuclear attack on western targets within 45 minutes. Meanwhile President Putout maintained that no chemical attack ever took place in Syria and the very idea that it did was as ridiculous a notion as Russia ever using chemical agents against its own citizens. ‘Besides’, Putout added reassuringly, ‘believe me when I say to you, you know we Russians love our children too.’
Health news. Jeremy Stunt has promised to deal decisively with the fact that lazy overpaid doctors are the cause of the undeniably high mortality that inevitably befalls those who are admitted to hospital on a Sunday. With the news that 53% of those who merely visit patients at the weekends are now injured by doctors larking about on the wards, Stunt announced that he would act with the same care and diligence he applies to his personal financial concerns to ensure doctors would work longer hours for less pay. He also confirmed that 5000 new family doctors would be available a week next Thursday.
Dr Frank Trueman’s appeal at the National Court of Personal Opinion came to a premature close this morning when the former family ‘doctor’ refused to swear, on a copy of Judge Expedient’s Shopping List, to tell the post truth, the whole post truth and nothing but the post truth. The guilty verdicts passed against him for having exhibited Unlove and behaving in an Unaffirming manner therefore remain. Last month Dr Trueman was found guilty of these crimes by a jury of his more enlightened when he insisted that Twiggy Silthlike was dangerously underweight and should be refused the bariatric surgery that she, believing herself to be obese, desired and, therefore, demanded as her human right. The court had agreed that Miss Silthlike had suffered great harm from Dr Trueman’s assertions and agreed with her view that to be defined by her BMI of 15.4 was ‘personally limiting’. The court further agreed that her belief that she was overweight was one that she had an inalienable right to hold. ‘I will not allow my nutritional status to be determined on an arbitrary mathematical calculation related to my height and weight’ Miss Silthlike had said in a statement whispered from her bed of restricted consciousness at the initial hearing six weeks ago. Leading surgeon, Mr Dai Cutting, who subsequently performed the stomach bypass surgery, said he was proud to have acceded to his patients wishes and had no regrets over the consequences that had resulted from the procedure. Speaking on Miss Silthlike’s behalf, the family lawyer assured the public that, although her parents had been upset by suggestions that Twiggy’s failure to attend the hearing in person indicated that she may now be biologically challenged, they were comforted that Twiggy had previously stated that she would never desist from identifying as ‘alive’. Dr Tom Foolery, Chair of the National College for General Acquiescers, distanced the professional body from the beliefs of Dr Trueman. He assured the public that today’s young GAs were trained to wholeheartedly agree with their clients ideas, to reassure them that all their concerns are unfounded and to completely meet their every expectation.
In other health related stories, the annual conference of those with a Chronic Obstructive Pulmonary Disposition took place today. It was described by those attending the event as a wonderful coming together of those on a journey of discovery seeking out the benefits inherent in living with alternative lung functionality. Hundreds packed the Assembly Rooms in Battersea to hear Toby Acco, self-appointed Professor of Respiratory Medicine at Neverton University, deliver the keynote address entitled ‘How to be happy with your haemoptysis’. Delegates then coughed, spluttered and wheezed their way through motions seeking to redress the balance resulting from the negative reporting of the consequences of smoking in years gone by. On hearing that no studies in the last thirty years had shown an association between COPDisp and cigarette consumption, a prankster, who had managed to slip past security, asked if this might be because ethical approval for such studies had not been granted in recent times for fear of upsetting smokers were a link to be proven. The question remained unanswered as the imposter was escorted from the hall. Outside the venue, a small gathering of the far right ‘Smoking may not be 100% good for you Party’ demonstrated. As she was dragged from the scene by police, one militant said that she was just a little concerned that, what with all the oxygen cylinders on display, the constant stopping to light cigarettes may pose a risk, not only to those who were smoking but also to those pushing the wheelchairs to the specially designated ‘Fume Rich Spaces’ that had been constructed for the use of those attending and provided by the pharmaceutical company, Gloxo who, along with their sister company, Cigarettes-R-Us, have been stalwart supporters of the conference for many years. A spokesman from London Fire Service dismissed the concerns of the protestors as trivial compared to the dangers inherent in denying an individual the right to do as they jolly well pleased and said that the bigotry displayed by those remonstrating had no place in modern Britain.
The Science Society of Camford Univeristy has been expelled from membership of the leading university’s Student Union. The Society has a reputation for insisting on reasoned argument and the application of logic as a basis for seeking to understand the universe. President of the Student Union, La La Littlethought, stated that such old fashioned views were no longer accepted in advanced institutes of education especially one with such an excellent reputation as Camford. The Science Society had been allowed representation at the Freshers Fair but only if they were prepared to share a stand alongside other organisations holding outmoded outlooks on life. Ms Littlethought confirmed that since The Science Society had felt unable to share space with The Flat Earth Society, and had therefore absented themselves from the event, they could no longer be considered a university approved organisation. A statement released by the Student’s Union press office concluded, ‘It’s such a shame that members of Science Society can’t accept that theirs is just one of many equally valid ways weak minded people choose to look at the world. They ought to consider homeopathy.’
Sport – and it’s now only three weeks till the Olympic Games. This will be the third games to be played since it was universally agreed by members of the International Olympic Committee that competitive sports are unhealthy pastimes since taking part in such activities can encourage the deluded belief that some people are better at some things than others. The IOC have announced that there will be a new event taking place at these games with ‘Watching grass grow’ being introduced alongside the already very popular ‘Waiting for paint to dry’ and ‘Considering one’s navel’. Tickets are still available for all three events. The IOC reassured the public that they were not planning the reintroduction of medals at the forthcoming games since it was felt that to reward one person’s performance over another would go against the fundamental Olympic principal that everybody is equal at everything. It was confirmed however that certificates of attendance would be issued to all participants along with a complete set of commemorative fridge magnets.
Australia have been awarded the cricket fair play award.
In entertainment news, Greenwood Studies have announced that a film version of the popular TV series ‘The Y Files’ is to begin production in the New Year. Who will play investigators Mully and Sculder in this new feature length version has yet to be announced but the producers have confirmed the tag line for the movie remains, as for the television show, ‘The truth is in You’.
This week’s National Referendum Result – after 27 years of being rerun weekly, today’s referendum has finally yielded a result in which a majority of the 13 people who voted elected that day should no longer follow night. The government confirmed that there would be no further referenda on the matter and that they would now act to enforce the new policy as soon as possible. Verity Doubtful is favourite to chair the cabinet committee responsible for implementation after her successfully delivering the ‘Black is White’ initiative last year.
And finally this evening, extreme weather has left vast areas of Bangladesh under water. Tens of thousands are dead and millions are without food and shelter. Some are suggesting that this is a false news story and of course Bangladesh is only a third world country but still, let’s keep our fingers crossed, bless them.
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Truth matters. When everybody decides on their own version of what is true based on nothing but what we feel on a matter, no opinion can be challenged as wrong and we all make ourselves out to be gods. It is inherently self-centred and sooner or later we will insist on others dancing to our tune. Society becomes fractured and directionless as no common values are held to be true by all and no distinction exists between the trivial and the important. The result is that those who are rich and powerful, those who can impose their version of reality on others most effectively, become tyrants with no means of being restrained.
The struggle today is to remember that some things are true and some things are not – no matter what the wisdom of the world tries to buy or bully us into believing. But it’s more than that – truth doesn’t need to be just remembered, it’s needs to be upheld. The notion that there is no such thing as truth, has survived infancy, made it to adulthood and is now enjoying comfortable middle age. Perhaps we can’t know everything fully, but some things we do fully know – and certainly more fully than is sometimes claimed. The truth is out there.
This is particularly true for doctors. We need to take responsibility for determining, as far as is possible from our training and experience what is true and relaying this honestly to our patients – even when that truth is unpopular with our patients or indeed inconvenient to ourselves. Of course there will be occasions when there are differences of opinion and when these occur they will have to be resolved honestly, and amicably, based on a thorough assessment of the available evidence. And it’s not only in our dealings with patients that we need to stand up for the truth – we also need to stand up to our political leaders. We need to ensure that no one believes the false reports of what underlies the current crises in the NHS – reports that some are perpetuating as they seek the demise of this much loved institution.
As professionals we have responsibilities to act professionally – we must speak the truth. If we are not known to be truthful, we cannot expect to be trusted. And when trust is lost the profession falls.
It was Aeschylus who wrote ‘In war, truth is the first casualty’. We live in a day when truth is under fire, when contrary opinion is ridiculed and reasoned argument is silenced with a raising of an angry voice and a dismissive wave of the hand. Truth must not die and become something that only once existed – an idea that is fondly remembered. We need to take care of truth, seek it out and visit it often. We need to nurture it and allow it to flourish. And we need to speak truth too. Because the truth, like a young life, is precious. And precious things are worth holding on to.
I sat in another churchyard – on a bench placed there a decade or so ago in memory of a girl in her early teens who had died. She had been killed when a driver, his judgement impaired by alcohol, had recklessly raced his car at excessive speeds and hit her whilst she walked home from the park one Sunday afternoon. It was a criminally stupid act with tragic consequences. In front of me was her grave. On it were some fresh flowers. I’m glad somebody remembers her – but I wish she’d never died at all.
Some musings 