Category Archives: General practice

Brexit: We are all more susceptible to persuasion than we like to think.

I was a young doctor. I had it in my power to help this guy. So I did.

He was a drug rep. Sitting opposite me in my consulting room. Half a century – most of a lifetime – ago. He had been waiting outside for much of my morning surgery, as reps used to in those days, hoping I would see him before I started on my paperwork and visits. As usual it had worked – me being too soft-hearted to say no and send away a fellow human being with a wasted morning.  ‘There but for the grace of God’, and so on…

So there he was, and as well as laying out his samples and his glossy leaflets and his free-lunch offers, he was telling me a personal tale of woe. It may have been his idea of a novel pitch, but something about his demeanour struck me as genuine and it got round my usual defences big time. I remember it went something like this:  company cutting down on reps – prescribing figures in his patch down – in danger of losing his job – children at home – wife…

So.  I had an impulse to help him. To my utter shame as a rational scientific doctor, from that day and for a long time afterwards I changed the routine medium strength painkiller I prescribed to one of the preparations he had been pushing. I mean promoting.  Paramol 118 was the name of the drug. A nicely packaged mixture of good old paracetamol and dihydrocodeine. The latter a mildish opiate in widespread use at the time under the trade name DF118. So it was a perfectly legitimate preparation of well-established ingredients likely to be effective in one of the commoner clinical indications – pain control.

I should explain that in those days long ago, before limited prescribing lists, National Institute for Clinical Excellence (NICE), generic substitution, and even before NHS prescription charges, the doctor’s clinical freedom was regarded as sacrosanct. We general practitioners (GPs) could write prescriptions for any approved drug that we liked. The pharmacist would dispense it without question and the NHS would reimburse them.

The point of this story is that it taught me a valuable lesson – it made me realise how easily my judgement can be influenced.  I am not proud of that, but I am proud of the fact that I acknowledged it and took steps to protect myself.  I made it an inflexible rule that I never saw reps, so the receptionists told them that and they never sat all morning waiting in hope. I never went on drugs company lunches, in fact I never had had time for them anyway, and with one exception I never went on ‘freebies’. The one exception was when a local company, Merk, arranged for a glider flight at the local airfield, Lasham, which was irresistible and remains a sensational memory. Most particularly, I never allowed reps to set up their stalls in the corridor while I was a course organiser on the Wessex GP Training Scheme.

None of this was particularly popular. The most respected GP colleagues would tell me confidently that they never allowed themselves to be influenced as I had been. But somehow I always doubted that the average of four thousand pounds per GP per year that the pharmaceutical industry was spending in those days, was entirely wasted, even on them. The fact that in subsequent years my prescribing costs were the third lowest in Hampshire (something I had to work out for myself from the tables we were sent) added to the feeling that I was right about this.

The moral of this story is that we are much more open to influence than we like to think. We now know that the various organisations seeking to influence the 2016 EU referendum used social media to target voters in a way which was vastly more sophisticated than anything employed against the judgement of doctors like me in the 1970s. We know that a foreign power, Russia, used similar techniques to achieve the same objective. By analysis of millions of stolen social media records, yielding frighteningly-detailed personality profiles, both identified people who were likely to be persuadable. Arguments were chosen that were likely to strike a chord with these individuals. (In the same way that my rep, years ago, struck a chord with my human sympathy). They then bombarded each of these people, in a way which was hidden from general sight, with messages of prejudice, hatred and misinformation. What’s more, they subsequently claimed credit for swinging the result of the referendum and precipitating the expected withdrawal of the UK from the EU.

So, when I read people saying that they think it unlikely that these campaigns of targeted propaganda had a significant effect on the result, still less that they cast the validity of the result into serious doubt, then I remember the respected colleagues who were so sure that the pharmaceutical industry was wasting its money in trying to influence their magisterial clinical judgement.

 

 

 

To Reykjavik for the Nordic Congress of General Practice

Back home now after a week in Iceland. Primarily for The 20th Nordic Congress of General Practice, a huge event with 1,500 delegates in the magnificent new Harpa Conference Centre and Concert Hall for which I and four fellow GPs ran a workshop on the subject ‘Doctors as Social Activists’. Link to my presentation

Views of the astonishing Harpa conference centre

I was describing my efforts since retirement to challenge organised climate change denial. Link to my presentation

1,500 Nordic GPs coming out for coffee break from one of the plenary sessions in the main hall

This was the very opposite of a freebie because we paid all our own expenses and discovered, having dutifully followed the advice to book flights and accommodation well in advance, that all five of us would have to pay the £700 registration fee for the conference.

This was on top of Reykjavik being, with Tokyo, currently the most expensive capital city in the world, even without the devalued pound, so that everything – food, trips, entrance to exhibitions, goods in shops – was more than twice as expensive as at home. Nonetheless, Lesley and I gritted our teeth, tightened our belts (I lost 3½ lbs on the trip) and took the opportunity to see something of this fascinating country and its admirable people.


Apart from the conference we were lucky to be in Reykjavik for Iceland’s National Independence Day (from Denmark : 1944). In spite of a cold wind and intermittent downpours, the atmosphere was festive and friendly. We felt it a real privilege to be there. We heard the President give a speech and then an actress gave a beautiful recital of a poem in Icelandic. Then there was a parade to the fair-ground around the lake, where there were circus acts and the world’s oldest strong-man competition.


The houses and buildings in Reykjavik were extraordinarily varied, often brightly painted, and quite a few had large murals painted on them.


The famous Hallgrimskirkja cathedral dominated from the top of the city, It was striking outside, although the concrete was currently under repair – testifying to the extreme harshness of the climate. The inside was serenely beautiful, with the most magnificent modern organ I have ever seen, being played while we were there.


We were unlucky with the weather, but we shared a car for a day out to the Snaefellsjoekull National Park north of the city, and took a coach trip around the ‘Golden Circle’ on our last day – our only really sunny day.

The Golden Circle is very much a tourist route but you see the junction between the American and the Eurasian tectonic plates (separating at about a centimetre a year) at the Þingvellir National Park, the magnificent Gullfoss Falls, and the geysers at the Haukadalur Geothermal Area.

Everywhere you see beautiful blue lupins, apparently a recent, deliberate introduction to stabilise and enrich the soil (lupins of course being nitrogen-fixers) which are proliferating at an incredible rate and seem to be broadly welcomed.  You can see them in the foreground and in the hills in the picture bottom right above. We were told that the country was 85% covered by trees when the Vikings arrived, but they cut them all down for fuel, housing and ships.

 

One thing which surprised us was the sheer size of the country – more than 300 miles East to West and 200 North to South. So we only saw a small part close to Reykjavik.

And this yellow door was the entry to our little room, with its blind to make it dark when it ought to have been night.

A tribute to Robert M. Pirsig

This is a photograph of author and philosopher Robert M. Pirsig taken by Ian Glendinning at Chester, England on 7th July 2005

Talking in some depth about things that seem important – by J A R Willis


This article appeared in the December 2000 issue of Medical Humanities in the series Medicine through the Novel.  It is repeated here as a tribute to one of my greatest inspirations – Robert M. Pirsig – who died two days ago (24 April 2017)


‘Unless you are fond of hollering you don’t make great conversations on a running cycle. Instead you spend your time being aware of things and meditating on them. On sights and sounds, on the mood of the weather and things remembered, on the machine and the countryside you’re in, thinking about things at great leisure and length without being hurried and without feeling that you are losing time.’ (p 17 of 416)

The gentle voice is incredibly familiar, heard now for the third time, a voice that seems to have got itself into my deepest being. Continue reading A tribute to Robert M. Pirsig

Old talks that still seem relevant

I am still working out how best to use this site.

Although it got several likes, which were much appreciated, I think my Sea Monster and the Whirlpool address is much better placed on its own page rather than here on the chronological blog. So I have moved it to its own page, tidied up the formatting and added some of the slides. That lecture, which I gave as the keynote on ‘Science’ to the 50th Anniversary Symposium of the Royal College of GPs, attracted thousands of hits when I posted it on my first website www.friendsinlowplaces.co.uk and was largely responsible for me coming up as the first ‘James Willis’ on Google for several years a decade or so ago – not bad for what is a fairly common name.

I have now added another talk which meant a lot to me and which I still believe said something important. Professionalism – Red and Grey – discussing the meaning of that confusing word and arguing that we need to restore respect for its more subtle, but ultimately more fundamental, colour. Flavour, if you like. Of course, I would love to receive comments, contributions and discussion. To this end, I have appended the complicated Venn diagram of the two aspects which I and my colleagues developed at the time – you can see that it is very much work in progress. If you are intrigued, have a look at the talk itself.

Red Grey chart