Why did I get such great healthcare in America?

Over the past year or so I’ve had first-hand experience of the American healthcare system. Having only really known about US healthcare from a UK perspective, my experience caused me to update some of my expectations. This post formed out of some mindless wondering while in a waiting room and is a way to condense and clarify what I learned.

The gist of why I ended up seeing a bunch of American doctors is that my left eye started moving slower than my right eye and, while it could have been caused by a bunch of serious things, it turned out to be an unusually mild case of a super rare auto-immune disease. I’m fine, so we can guilt-free move on to what I learned about the system here. My care started in the UK with the NHS and then shifted into the US, giving me the chance to compare both experiences. Obvious caveat: my experience is mine alone and I have pretty good health insurance, lots of people in the US are not so lucky and will not have this same experience.

Quality of care

Hands down, the US “wins” on quality of care, both in terms of speed and thoroughness.


It took 3 months to get my first US neurologist appointment, with no referral. The wait time to see a neurologist in the UK is currently over a year (although I actually saw a neurologist within 2 hours on the NHS as they thought I might have a brain tumour). After the first US appointment, I saw 5 different types of neurologist within a month: a general neurologist, movement-specialist neurologist, neuro-opthamologist, neuro-oncologist and neuro-geneticist. In all it took just 6 weeks from seeing the first doctor to getting a clear diagnosis, despite being one of just 300 people in the whole USA to have my particular disease. I was impressed.


In addition the the incredible number of specialists I saw (one of whom was Deputy Dean of the Yale School of Medicine), I got a crazy number of tests and scans. I had 2 MRIs, an X-Ray, 2 sets of blood tests, a nerve-conductivity test, an electromyography study and a PET scan. I also eventually had my entire genome sequenced at Yale. In the UK, I had an emergency CAT scan and an MRI, again when they thought I had something serious, but there is no way I can see myself having had anything like these tests on any timeline, and yet they ended up being essential to working out what I had. BTW the nerve-conductivity test involves being literally electrocuted to test the speed of nerve signals in your arms and legs. It sucks.


So yeah, as you’d expect, the US stuff was expensive. It cost just shy of $30,000 to get my diagnosis, with all but $300 of that paid for by my insurance. My treatment, 1.5 pills taken each day, costs a cool $100k per year, also paid for by insurance. I have no idea what my UK care cost, because no patient ever knows that in the NHS, but suffice to say it was way cheaper. The medicine I take here is also available for free on the NHS and costs the UK government roughly £3k/year/patient for the exact same medicine that costs my insurance $100k.

Why did I experience such great healthcare?

The clearest change in my perspective is that I’ve seen what fantastic health care looks like and I wish we provided that in the UK on the NHS. What’s less clear to me is why I had such better care here. For example, why did I see so many specialised doctors so quickly? One obvious reason would be that the US has more doctors than the UK but nope, they actually have slightly fewer doctors per capita than in the UK (2.7 per 1,000 residents vs 2.8). Perhaps US doctors use their time more efficiently and so can each see more patients but in my experience, each doctor had way more time to spend with me than in the UK. Nice for me, but it does not suggest higher efficiency.

Two explanations then come to mind. One is that the US has more specialists, even if they don’t have more doctors in general. A quick Google search backs this up: there are just 5 neurologists per million people in the UK versus 12 in the US. So the UK may have slightly more doctors but way fewer specialists.

The other explanation is that UK doctors experience higher demand than their US counterparts: the UK has about 4.5 doctor visits per capita per year, versus just 2.7 in the US. Possible explanations include the number of uninsured or underinsured people in the US who simply can’t afford to see doctors, and the UK having an older population. Assuming the same pattern applies to neurologists, that means that there are twice as many neurologists per capita in the US, facing about half the demand, resulting in about 4x more neurologists per patient. This very neatly fits my own experience: seeing a neologist in 3 months vs 12 and having appointments of about 1-2 hours versus 0.5 hours.

Why exactly there are so few neurologists in the UK is not immediately obvious. The difference does not seem to be driven by relatively better pay for neurologists in the US. The average UK neurologist earns 89% of the average doctor’s salary, little different to the average US neurologist, who earns 85% of the average US doctor’s salary. My best guess is that a focus on salaries ignores the centrally planned nature of the UK’s NHS: even if doctors face the same economic incentives to be specialists or generalists, the NHS is so dominant that it can actively choose to recruit more generalists without having to incentivise this by increasing their salaries.

As for why I had so many more tests done in the US, and so quickly, the answer seems pretty simple: the US just has way more scanning machines. The UK has 6 MRI machines per million residents vs 38 machines in the US. While the UK has just 54 PET scanners in the whole country, the US has 2,500, or about 10x more per capita. So if you have 5-10x more scanning machines per resident, and those residents are about half as likely to go to hospital in the first place, it’s no surprise you can provide way more scans, faster.

Of course, this is just one level of the explanation: why is the supply of healthcare so much higher in the US in the first place? The obvious explanation is there is so much more money being spent. The spending argument likely applies most strongly to the equipment side of things: an MRI scanner should cost about as much in the US as in the UK, and so more money means more scanners. It seems to apply less on the labor side, since US doctors earn more than twice as much as UK doctors, which might explain why the US has 5x more MRI machines but only 2x more neurologists.

Going much deeper than this will require a pretty detailed knowledge of healthcare systems that I simply don’t have. Perhaps I will dig into it more but for now, it’s been interesting to do this shallow dive. The US has a much higher supply of healthcare to meet a lower demand than the UK does, and so I saw way more neurologists and scanning machines, way faster. I think many people in the UK know how crazy expensive US healthcare is, but few will know just how good it is, for those with insurance. I remain convinced of the NHS’ principle of free care for all, I am certainly not keen to see a private system in the UK. But perhaps we should consider spending way more on the NHS: American-quality care for all would be a something to aspire to.

Is blockchain really a “truth machine”?

I’ve recently been reading some excellent blogs and appreciating the value of thinking “out loud” in blog form. I thought I’d resurrect this old site and post semi-regularly to challenge myself to clarify my thinking.

I am currently some 20% through The Truth Machine; a book about the blockchain’s potential to bring trust and credibility not just to finance, a la Bitcoin, but to just about anything. The book’s authors argue that blockchain’s ability to record an uneditable ledger can help restore trust in the global finance system, as broken by Lehman Brothers’ dodgy accounting, or in developing shared facts across society, as threatened by Trump and his Fake News bogey man. I got the book because I feel very skeptical of the application of blockchains to anything in the real world and this seemed like the book to convince me otherwise. So far, I remain a skeptic. Here’s why:

An absence of verifiable fact is often only a tiny part of most problems

The authors zoom in on dodgy accounting practices at Lehman Brothers as a key cause of the financial crisis and the leftwing (Occupy) and rightwing (Tea Party) protests that followed. They point to the UNHCR’s delivery of food aid to Syrian refugees using biometric verification on blockchain as a major advance in support to refugees. But the 2008 crash was due to way more than dodgy accounting practices at one bank: what about sub-prime mortgages and cheap credit? They seem to have contributed much more to the crisis. And much of the accounting “dodginess” was due to genuine difficulty in valuing many assets: the fact that a blockchain can make an immutable record of the risk that a particular family in Florida will default on their mortgage does nothing to assure us that the risk calculation was ever actually accurate. For the Syrian refugees, reduced food aid fraud is, sure, nice, but not remotely as important getting their kids back into school or ensuring access to clean drinking water, the kinds of essential but boring things that have little to do with cryptography.

Where verifiable facts are needed, they often won’t change minds

There are cases where verifiable facts would make a difference. Take COVID-19 vaccination safety and efficacy, for example, or whether Bill Gates personally created the pandemic. Verifiable truth in those cases could literally save lives. But people don’t follow anti-vaxx beliefs because of a lack of verifiable facts to the contrary, they follow them for a million other reasons, including because those beliefs suit their personal prejudices. Somehow using a blockchain to show someone that COVID vaccines were properly tested is not going to change their minds anymore than showing them a New York Times article will. After all, you say that the blockchain is infallible, but isn’t that exactly the kind of thing an elitist globalist in the pocket of Big Pharma would say?

Blockchains will reach most people via fallible middle men

If I buy 0.5 Bitcoin using Binance, I am trusting Binance to buy Bitcoin for me. Like most people, I have no idea how to verify that they really bought Bitcoin or just created a fake account that says I own Bitcoin. Regular people will interact with blockchains via these kinds of trusted, fallible intermediaries, not dissimilarly to how we use banks or newspapers today. Sure, the blockchain may be infallible, but a fake website can use the fake content of a non-existent blockchain to convince me of whatever they want and, like most others, I won’t really know the difference.

Perhaps I’m missing something, and I hope the remaining 80% of The Truth Machine will get me there, but I remain unconvinced that the blockchain can really fix all that many of physical the world’s problems. Sure, it can do fully digital stuff well, like encrypt messages or digital money transfers, but so far in the book, the real world applications look like a nerdy hammer in search of a nail.

Just Because a Comedy is Set in a Famine Doesn’t Mean it Can’t be Funny

This was published in The Independent

Who could laugh at one million people starving to death? This is one side of the argument currently exploding in tweets and Facebook comments over Channel 4’s announcement of a new sitcom based in the Great Irish Famine, called ‘Hungry’.
A petition against the show has already managed some 34,000 signatures, calling for the show, of which not a single episode has yet been made, to be cancelled. If you ever needed proof that tens of thousands of people are incapable to seeing past a headline and thinking for themselves, this is it.

The petition’s signers, it seems, have never seen a TV comedy. No, mass-starvation is not funny. No, the forced migration of a million people is not funny. But what kind of show are people expecting? Do we really envision an entire sitcom where starving Irish people point to their emaciated bodies and, what, a studio audience bursts into giggles? Will we see blackened, withered potatoes pulled from the diseased ground accompanied by whoops of canned laughter?

The offence junkies have failed to see the difference between comedy about the Famine and a comedy set during the Famine. The difference is crucial, and has been key to so many successful comedies. The slaughter of the First World War wasn’t funny and yet Black Adder Goes Forth, set in the trenches, was. The Holocaust couldn’t be further from humour and yet Life is Beautiful, set in a concentration camp, was very funny. Northern Ireland’s sectarian “Troubles” weren’t funny and yet the TV comedy Give My Head Peace, which featured characters who are members of Belfast terror groups, was.

These shows managed more than just humour. By never denying or masking the terrible realities of their characters’ situations, these comedies succeed in showing humanity against a backdrop of inhumanity They never diminished the unfolding tragedy, but highlighted it.

Take Life is Beautiful. We smile at a Jewish father’s attempt to convince his small son that their concentration camp is really a fun summer camp. This is hardly a crude Holocaust joke; humour is used to convey the tragedy of love and innocence when faced with evil. The humour makes the tragedy starker, not trivial. There is no reason for the same not to work with the Famine.

But this is all to take the petition to Channel 4 at face value. There is likely another, more political agenda of the complaints. It may suit a minority of Irish people to feel that “The English” hate us; to paint an image of The Englishman as a cruel Lord in his distant castle. It feels nice to be the victim.

But colonial England left Dublin long ago. Today they give us their highest points in Eurovision and vote our accent as sexist on Earth; the anti-Irish point just doesn’t stand anymore. In any case, the show has been conceived by a Dubliner, something which the petition has failed to mention.

The show has only just been commissioned. If it really is a series of jokes mocking starvation then trust me, I’ll be straight to the front of the complaints queue, but I strongly doubt it.

To find humour in even the most tragic circumstances is a great human trait and something the Irish pride ourselves on. I hope we haven’t lost that.

The Only Surprising Thing About Northern Irish Racism Is The Surprise

To say that Northern Ireland has come a long way since its sectarian civil war is a cliche but it’s worth saying: we’ve come a long way. The soldiers no longer patrol the streets. The curfews no longer empty the streets at night. The bombs no longer tear through shopping centres and flesh. The Northern Ireland of my childhood has rebranded as the land of the Titanic and Game of Thrones, Liam Neeson and Snow Patrol. But a look at headlines coming out of the country today gives good reason to doubt things really did change for good.

Would you trust a Muslim to do your shopping for you? That’s a genuine source of debate right now as the First Minister Peter Robinson publicly defends comments by an evangelical pastor who said that Islam was “the spawn of the devil” and “satanic” and that when it came to Muslims, “I don’t trust them”. Fine, let the Good Reverend say that. We’ve heard this bigotry echo in holy walls before only it was about Catholics, or it was Jews, or still today, homosexuals. If you don’t like his recycled message of hate, don’t attend his services. A very different problem is the First Minister’s defence of the pastor. Unlike the church, I can’t just up and leave the country; I’m stuck here and I’m stuck here represented by this man whether I like it or not. A politician can never represent every one of his constituents’ political views but he must surely give them equal moral value as human beings. When our First Minister vilifies an already vilified minority as untrustworthy, we all do.

As she spoke out in defence of Northern Ireland’s Muslims on local TV, Anna Lo, an Alliance Party politician, choked back tears. Lo, the first East-Asia-born politician ever elected in the UK, had just announced that morning that she would not seek reelection because of the racist abuse she had suffered in the past year. The abuse came about because she supported Belfast City Council’s decision to fly the Union Flag only on royal occasions and not everyday at the City Hall. The decision provoked mass protest and rioting and Lo, one of many politicians to support the flag decision, was singled out for vicious racial abuse on social media and her party’s offices were petrol bombed. She was, she said, scared to walk in the streets for fear of racial taunting or worse.

Perhaps the only strange thing in all of this is that we bother to act surprised. In a country built on petty division between Catholic and Protestant, is more division really that unexpected? We are sending a message to our children from birth that what really matters in this world is your tribe and those who share your tribe. We do more than send them this message; we scream it at them. We scream it at them in their tribal schools that tell them “it’s best to keep away from those Others”. We scream it at them from the violent murals and tattered flags on their streets that tell them “from here to there is ours but go no further”. We scream it at them with their very names that mark them as “ours” or as “theirs”, that brand Podraig and William like cattle from rival farms. We scream it at them until we are blue in the face and then we act surprised that they actually listened. We scream it at them until their hearts turn deaf.

Behind the racial abuse of Lo, behind the mistrust of Muslims, lies the ugly truth that while the civil war may have ended, the divisions and mutual suspicions that fuelled it live toxically on. We must ask ourselves; did we stop the killing because it wasn’t getting us anywhere or did we stop the killing because we learnt to value the lives of others as we do our own? Is peace, if that’s what we have, simply more convenient than war or is it a precious gem to be treasured and fought for daily? To look at many of our leaders today is to see a class who think that reverting to the rhetoric of the past is a useful tactic to have to hand, not a moral regression.

Following #IStandWithAnna on social media is to see the countless many who do understand peace. The many who understand that peace is not merely the absence of war but the constant rejection of tribal devision and the building of friendships across divides. It is they who must scream back even louder at the sirens of division and wage peace. It is they who know that to fail to stand for Anna or for our Muslim friends is to pave a path to the past. The real line-in-the-sand in Northern Ireland is not between Catholic and Protestant or Nationalist and Unionist but between those who see tribes and those who see shared humanity. It’s time we got louder.

Secret App: A Masquerade Ball In Your Phone

It’s often said that in the Internet Age there is no more anonymity but this is only half true. Yes, thanks to Facebook I’ll know that that girl from my old English class in Year 12 has just broken up with her boyfriend and is playing Taylor Swift on a tear-filled triumphant loop on Spotify but the internet has also opened up so many ways to be completely expressive and yet completely anonymous. Take Twitter. While my own handle is @roryfenton (Hint: follow me. I’m lonely), many of the people I follow use anonymous accounts. @LetterOfNote shares interesting letters written by famous and not-so-famous hands. @IAM_SHAKESPEARE (“Willy Shakes”) fills my timeline with accidental innuendos from Shakespeare’s plays (today’s include “His youthful hose, well sav’d, a world too wide” from As You Like It). These don’t, however, represent the bulk of anonymous tweeters. Less interesting or humorous are the countless accounts set up to anonymously abuse other Twitter users. When you see someone like Lenny Henry told to “EFF OFF BACK TO *insert misspelt African country*”, there’s a good chance that was sent from an anonymous account, possibly set up just to send that tweet. To exaggerate a little, it seems we’re stuck with either arseholery on anonymous Twitter or Too Much Information on nonymous Facebook. Yes I made the word “nonymous” up.

Into the fray steps new app Secret, aiming to provide an anonymous platform for users to share their biggest secrets with friends. Launched just weeks ago, I decided to try it out. I first heard about the app when it shot to fame after a Nike employee posted that the company was about to fire its Fuel Band staff. I say “Nike employee”, it could have been absolutely anyone because Secret is anonymous in extremis. Loading up the app for the first time you enter your email address but create no username or handle. When you post a “secret”, it is not linked to any particular user, not even to a pseudonym. You can publish “I like Steve” and immediately after “I have mixed feelings about Steve” with no way to tell it was the same person saying both.

Unlike Twitter, you can’t choose whom to follow. Your Secret friends will be automatically added using your iPhone contacts (an Android version is en route) so, short of actually asking them, you’ll never know which of your friends are populating your timeline. If you like a post (a “secret”), you can swipe right on it to “love” it just like a “like” on Facebook and you can comment too. Commenters are identified by little symbols beside their comments (such as a blue ship or a yellow flower) so you can have conversations on a secret and keep track of who says what but when you comment on another secret, your symbol will change, keeping your identity hidden.

When you love a secret, that secret will appear on your friends’ timelines, enabling secrets to go “viral” like a tweet being retweeted and until you reach ten friends using the app (I currently have an embarrassing 5) you can’t tell if a secret was posted by a friend or simply loved by them.

The app itself is one of the nicest apps I’ve ever used. Secrets come with the text itself (limited to about the length of a tweet) and a background, which can be a photo or just a colour. The result is a timeline that looks much neater than the clutter on either Facebook or Twitter, with text appearing in larger font. When I first got Secret my Secret-using-friend count stood at 1 so I had a timeline with a total of 5 secrets in it, none too exciting, mostly slagging off engineers. I decided to dive in and share my first secret: “I spent at least one hour of everyday for the past two weeks watching Graham Norton YouTube clips and now there are none left”. I gave it an orange background because that’s Graham’s colour. The fact that I’m sharing this “secret” in Felix gives away that I’m not all that ashamed of it; it wasn’t, really, a proper secret. Nonetheless within an hour my 21st Century need for sanitised human contact was satisfied by a pity love from that one friend and a simultaneous pity comment- “approved”. Thanks one friend. Happy with my first attempt at secretting, I invited a load of my phone contacts (they receive anonymous emails from Secret itself) and tucked myself into bed to dream-up new scenes for Graham Norton.

Upon waking, I opened up Secret to find my friend count had swollen to 3 friends. This three-fold increase actually had a huge impact on the number of secrets I could see, as not only did my friends’ secrets enter my feed, so did those they had loved. I could now get an idea of just what kind of thing people were posting. A typical “secret” is wildly removed from TV chat show addictions. Gentle reader be warned: Secret contains a *lot* about sex. Nothing especially explicit and seldom sweary, just people being really honest about their likes and dislikes. Of course, this could really just be representative of the kind of people I’m friends with- your timeline will be unique to your friendship group.

I decided to follow suit and send out a slightly saucier second secret, one I certainly won’t put in Felix. This one was a proper secret, enough to make me Google “secret app security” before posting it with all the caution of a mother duck setting her little baby duck on the pond for the first time. It was at this point, if I say so myself, I became a bit of a Secret Super Star. Extending well beyond my three friends, within an hour my secret had been loved by 20 different people and attracted approving and shocked comments respectively from a red cat and green bottle. I set my phone aside to do some revision (and, let’s face it, scrape the barrel of Graham Norton clips) to find my 20 loves now stood at 50 as I tucked myself again into bed, feeling smug. Bedtime for Rory is just early evening in the States, where the app is most popular. While I dreamily planned the interactions in a fantasy interview between Graham and Elvis, my secret sped down the zipline of friend-to-friend connections across the Atlantic and as I groggily opened the app that next morning, it had been loved by over 250 people. That’s 250 people who were sufficiently moved by my tale of smut that they moved a finger the full width of a phone screen in loving admiration. Red Cat and Green Bottle had now been joined by ten other friends, including a disapproving blue bicycle helmet. Helmets, eh?

Being, as I am, a Massive Big Deal, this wasn’t my first experience of Going Viral as last month I managed 500 retweets on what turned out to be the first photo of the UK’s first married same sex couple outside Islington Town Hall (seriously, @roryfenton, do it). Being Secret-viral, however, is a very different thing. I couldn’t help but be pleased that so many people were loving something I’d done and yet it was something I was far too embarrassed to actually tell anyone about. I took a screen shot of the wild number of notifications I’d racked up and tweeted it boastfully but without the content of the actual secret, nobody cared. In boasting about my Secret success, I was getting Secret all wrong; the whole point is the anonymity. In providing pure anonymity while among friends, the app works like the perfect masquerade ball where the fun isn’t in working out who everyone is or who has the most exciting disguise but in being completely and utterly open, throwing caution to the wind and just standing there in your brilliant, ugly, faceless, truthful nudity. In boasting about attracting so much “love” I was desperately grasping at identity, at a way of standing out. To fully do Secret is to fully let go of the self. It’s fucking deep.

As I got more and more immersed I started to notice two different categories of secrets. First, there are the secrets that aren’t really “secrets” at all but jokes of the “I’m secretly Batman” type. Funny, yes, but nothing that couldn’t be posted to Twitter. The second non-sexy category is something I really wasn’t expecting: there are some incredibly honest, highly private posts that you simply would never see on Twitter or Facebook. “I’m going to hurt someone on Thursday and I can’t help it but I feel so terrible”, for example, posted by someone about to break up with their boyfriend/ girlfriend elicited dozens of comments with advice and personal experience from other people who been through the same thing. “I’m worried my taste in porn conflicts with my gender politics” started a very frank, erudite debate on feminism and pornography between friends that could only have happened anonymously.

I am just over a week on Secret and I’m utterly hooked. When someone posts something highly personal to Facebook, it can feel fake, as if they are seeking attention or passive aggressively getting at someone else. On Secret these possibilities are stripped away as people fully, honestly expose a part of themselves in search of advice or maybe just the knowledge that someone knows their truth, albeit not whose truth it is. On Twitter I can follow anyone in the world and in turn be followed by anyone. With Secret, I know that I am hearing from friends and their friends which adds a weight and proximity to what they say. When I post a secret I could be receiving sincere advice from my best friend or a stranger on the other side of the world connected to me by a complex web of mutual acquaintance- I can judge advice on content alone. “I have chronic depression that once became so severe that I took several weeks of absence from work while I sought treatment. I told my boss and coworkers that I had mono. I didn’t want to deal with the stigma”. When was the last time someone opened up to you like that? Someone did to me, 5 minutes ago, on Secret. A friend of a friend. The secret has no comments (what could you possibly say?) but loves. Hundreds of them. Letting that person know that even if they don’t want to be named, people care. And as that person uses Secret they will see from others that they are not alone. Anonymity among friends is a powerful thing.

With fewer Batman jokes and more openness, Secret has enormous potential. It is wonderfully therapeutic to be so open and with fewer friends than fingers, each secret can be properly appreciated. The fact that only one secret fits on the screen at a time adds to this. If I were the app’s developer, I would keep “love” but stop telling people how much love they’ve received. That would stop the occasional jokey attention seeking and bring the level up to just letting stuff go. I look forward to seeing where Secret goes over the next months and years. It has found something very special that no other social network has quite managed. Give it a go.

And if you’re wondering, my viral Secret currently has over 450 loves #BigDeal #HashtagsOnlyWorkOnTwitter #ThisIsANewspaper #GodINeedToGetOutMore

This Article Will Make You Hate Articles That Tell You How To Feel

Written for Huffington Post.

There’s something strange about the way we treat emotions; they have become products to be bought and sold. It was a visit to an American Pentecostal church that first got me thinking about this. The differences with the mass of my Irish Catholic upbringing and this service couldn’t have been starker. I’d never seen anyone roll around the floor speaking in tongues before; soon I’d seen four of them. But more surprising than this was the way that the pastor spoke about Jesus. Jesus, we were told, would make you feel great. You know that feeling when you slurp down a cold Coke on a hot day? Jesus is like that times a thousand. Believing in Him makes you feel just swell; a refreshing, ice cold Diet Christ.

I’m not religious but this seems a strange interpretation of the Christian message. This god-turned-man who shook Jerusalem to its core, who made the lame walk and the dead breath again, who faced unimaginable torture, humiliation and ultimately death for the sake of people he had never met and yet loved, he will make you wriggle around on the floor like a drunk seal attempting sit-ups, spewing meaningless noise in front of your children and peers in a fit of infantilising, self-pleasing nonsense. The Messiah, served up like a pill to be popped. Would you like fries with that?

I’ll leave religion to the religious but this desire to focus on emotional outcome as a product, regardless of content, is to be found in abundance throughout the secular world. “I wanted my kids to be able to feel proud of me as their mum”, says the actress in the TV ad. The ad, it turns out, is for teeth whitening but that doesn’t really matter. It could be for a car or a holiday or a new generation of Pokemon, what is really being sold is the feeling of your children being proud of you. Want that feeling? Buy that feeling. Pay in monthly instalments for that feeling.

Nowhere has this trend been more extreme than in the “click bait” articles now swarming social media. “What This Boy Has To Say About Family Is The Most Moving Thing You Will Watch Today [VIDEO]”, essentially, “click here to feel moved”. More extreme click bait go so far as to offer a running commentary on how your emotions will change while watching the embedded video: “At 0:22 you’ll wonder where he’s going with this, at 1:45 you won’t believe your eyes and by 3:43 you’ll be fighting back tears”. This blow-by-blow breakdown sterilises the content, eliminating the potential for unexpected emotions to creep through. Someone has already digested the content for you, just open your beak and let UpWorthy vomit video clips directly down your grateful gullet. Chewing is so last century.

Perhaps worst of all is how the emotions salesmen make irrelevant the actual product they claim to be selling. In selling us the emotions their product will give us, they switch attention from the product to the users. To an extent, this is perhaps harmless. It may be true that we are more likely to buy a new pair of running shoes based on how good their TV ad made us feel, rather than how much faster or more comfortably they will make us run, but at least no one gets hurt in the process, and you do get some shoes. Watching this approach in the charity world is a different matter. When it comes to helping others, our focus must be on the recipient of that help; their wants and their needs. Now look at the charity industry. Two years and two weeks ago we had #Kony2012 aiming to raise awareness of the Lords Resistance Army in East Africa. It did this with a 30 minute video that featured one Ugandan child and two Ugandan politicians. It also featured dozens of white American activists, in particular the campaign’s director and his adorable toddler son. Facts (such as the fact that the LRA hasn’t been in Uganda for a decade) were sidelined in place of images of these activists pumping their fists in the air and rushing about smiling. Had it been made for UpWorthy, they might well have said “by 2:34 you’ll hear about a country you’ve never heard of that’s poor, at 5:42 you’ll see the cutest American kid with the coolest dad and want to hug them both so hard, at 12:36 you’ll hear about child soldiers but don’t worry, it’s from the perspective of the cool American dad, at 25:17 you’ll see lot’s of people who look just like you and are having loads of fun, at 31:02 you’ll share this with your friends on Facebook #SOMETHINGNEEDSTOBEDONE and feel great about how you saved those kids, and by 33:40 you’ll have forgotten all about it”.

Kony2012 was a massive failure. The video targeted emotion, not conscience, and people got the thrill of “doing something” from just sharing the video and forgetting about it. When we make charity about ourselves and how we feel, rather than about those we are purporting to help, we don’t help. This is why ‘voluntourism’ is so popular, despite being so obviously ineffective. Spending thousands of pounds to send an untrained gap year student to travel to Africa and teach English for a month, rather than provide a qualified, local teacher who would earn a thousand pounds in a year, would never happen if our concern was those we claim to be helping. Our concern is how great and heroic our student gets to feel, and that’s who we end up funding.

Let’s press refresh. Emotions are important, they’re human. Sometimes they make things unbearable, other times they’re the only things keeping us going. We kill all of this if we degrade emotional responses to the status of a product. We should buy stuff, do stuff and help people on the basis of what those things are or what those people need. If they make you feel good afterwards; great but be prepared for the possibility that they won’t. Don’t click on the next article that tells you everything about how you’ll feel after clicking and nothing about what it actually contains. Think for yourself and feel for yourself and at 36:52, or whenever the hell you want, you’ll be a normal human being again.

How To Look Good Dead

(I wrote this for the New Humanist magazine)

I was told once that the best way to know a city is to get lost in it. I can’t say if this is a universal truth but with my truly terrible sense of direction I’ve had plenty of chances to put it to the test. It was just this Monday that I made my favourite finding to date. Bumbling around the mean streets of Chelsea, lost and late for a lecture, I took a shortcut through Brompton Cemetery and turned a five minute shortcut into a 30 minute stroll, stopping at the most interesting graves, walking around the different mausoleums and ensuring I was more than fashionably late for that lecture.

The cemetery houses the mouldering great and the decaying good of 19th and early-20th century London and long ago reached capacity. But what made me pause in the place was not so much the architecture of the various stone monuments as gaining a snapshot of how people had chosen to have themselves, or their loved ones, remembered. To sum up one’s life in the space of a gravestone, perhaps the length of a tweet, is surely impossible and yet something must be written. It was looking at the different attempts at this “summing up” that grabbed my attention for so long and got me thinking about how and why people pick certain graves. For those of you considering dying at some stage, here’s my handy cut-out-and-keep guide to choosing your grave. After all – if you get it wrong, you won’t get get the chance to change your mind.

The first consideration when choosing your final resting place is surely location. Residents of Brompton Cemetery clearly had this in mind by picking the leafiest, poshest area in the city. One of the saddest aspects of death is surely its democratic nature – it takes us all and treats us as if we were the same. By buying a really swanky location for your grave you ensure that future generations will know just how loaded you were. If you wouldn’t be seen dead outside of SW, make sure you aren’t.

Now after a long, hard life don’t you deserve to decay in style? Cemetery chic is very much in for when you go under but choosing that perfect tomb isn’t quite as simple as keeping up with latest from the Milan catwalk. You’ll want a timeless classic, something that endures through the ages but is still totally “you” and stands out. This absolutely means that the traditional “rounded rectangle” gravestone is a no-no. Nothing says, “I really wasn’t that much” like a miserable rounded rectangle – it’s the jeans and t-shirt of the grave world and darling, you deserve better.

Not all budgets stretch to it but a tasteful, life-sized statue of an angel is a great way to express yourself and something many Brompton residents have given their seal of approval. Another really great investment that we at the New Humanist can’t get enough of is a roof. Remember, your hair still grows after you die and you certainly don’t want it getting wet. A classic choice is the mausoleum, a small house to keep you nice and dry during those winter months and really leave your mark on the landscape.

Lastly we come to the tricky part – what to write? This has to be the most personal part of the grave experience – just how can you leave that perfect final message to the world? Never fear, we at the New Humanist have some great tips to make your epitaph an epictaph. Remember that the ideal gravestone is a permanent business card; you want to make sure that people know just who’s worm-gobbled remains they’re walking past. Include any titles you may have like Sir, Lady and so on. I saw one person in Brompton who went so far as to mention their Oxford MA and the barrister firm they worked for – take an up-to-date CV to your local stone masons and see what they can do with it.

Once you’ve made it clear just who you were, how will you find those choice sentences that really encapsulate your life?

This could be quite a challenge but luckily there’s a handy, one-size-fits-all solution to that; a Bible quote. Nobody wants to run the risk of having people disapprove of their choice of epitaph. By choosing a quote from the Bible, even if you don’t believe in it in the slightest, you shield yourself from criticism and ensure you blend in nicely with the other Bible quotes on your neighbours’ graves. Sorted.

So there’s my guide to How To Look Good Dead, allowing you to remain fashionable right up to the end and beyond. By following these simple rules you really can take all of the hassle out of dying and finally begin to look forward to it.

But let’s say, for the sake of argument, that there’s another approach to death and another take on the Brompton Cemetery. The stoneworks today are giving way to the chisel-like wind and rain of a century, the carved statements of self-importance rendered increasingly illegible with passing years. The cemetery remains, as any other cemetery, a field of buried, indistinguishable skeletons; a congress of ex-people. It was this truth that, for me, held the real power of the Brompton Cemetery. The utter absurdity of so much of our existence is laid out in its coarse, stone-carved nudity. The gaping disconnect between the pompous monuments and the anonymous skeletons beneath them could well serve as a stark reflection of our own lives.

Our obsessions with collecting accolades and positions simply for keeping up appearances seem just as foolish as keeping a roof over our graves. What use is there in limiting our existence for the sake of the approval of others?

One final suggestion, next time you’re out and about in the city: get lost.

What The LSE’s Apology Means For Free Speech

It’s been a long road. Yesterday evening, in a victory for free speech, the Director of the London School of Economics apologised for intimidation of the university’s Atheist, Secularist and Humanist Society at their Freshers Fair. Promoting their society at the October fair, the society’s President and Secretary, Abhishek Phadnis and Chris Moos, were surrounded by 8 security guards, at the request of the students union, for refusing to remove t-shirts showing the popular cartoon Jesus and Mo. When they eventually did put on jumpers, the were assigned a guard each to follow them for the rest of the day.

As President of the National Federation of Atheist, Humanist and Secular Student Societies I’ve written before about the challenges many of our members face when legitimate criticism of religion is slammed and shutdown as “offensive” or even “racist”. Yesterday’s statement represents an important step forward in the fight for free expression on UK campuses for our member societies. Its significance will be felt beyond the LSE by universities and students unions across the country who resort too quickly to censorship in the face of religious sensitivities. To truly understand the significance of yesterday’s statement requires an understanding of just why it happened.

The decision of the LSE’s Director to review events on the day, going against the actions of his staff and students union, was a very mature and doubtless politically difficult one that should be applauded but it didn’t take place in a vacuum. The apology followed over two months of press coverage, public outcry and legal pressure.  The press coverage was unanimously against the LSE’s attempted censorship with comment pieces in every broadsheet. This was important, as part of the reasoning behind the intimidation was concern about potential outcry from religious students- we’ve shown that we will make a fuss too. A university concerned about its reputation will take note of that.

But I believe our most powerful and effective argument wasn’t reputational but legal. We are indebted to pro bono legal advice from David Wolfe QC, who helped the LSE ASH in drawing up their formal complaint, with input from no less than 3 professors of law. The 15 page document sets out in no uncertain terms the legal responsibilities of universities to ensure the freedom of expression of their students and to what extent this freedom can and cannot be curtailed. It took weeks to draft and makes very clear that the LSE got its decision wrong. We also made clear that we would, if necessary, take the matter to court. It was very likely this pressure that secured yesterday’s apology, after 6 weeks of consideration by the School.

The impact of this has already been felt elsewhere. I attended a meeting last week at another London university, the students union of which had told its Atheist Society they couldn’t criticise Christianity in their posters, using a bizarre interpretation of the Equality Act as their justification. The society stuck to their guns and, bolstered by the legal assurance already secured at LSE, argued the case that their free expression was being curtailed. The union backed down.

Universities will have paid close attention to the LSE’s behaviour. It is clear that the case for free speech has been made and won. While not quite a judge’s ruling, a more subtle precedent has been set; freedom of expression does not bow down to religious sensitivities. Well done to Chris and Abhishek for sticking to their principles and taking this to the end. Here’s hoping no more students have to.

Aid’s Scientific Revolution

There is probably no other question in economics that evokes such strong emotions and creates such a clear divide between left and right. To the left, the world’s poor are caught in a poverty trap; without the minimum resources to help them help themselves, they will never break out of this cycle. Aid, then, is clearly needed as a big push to kick things off. To the right, aid encourages dependency, distorts markets and props up nasty regimes – keeping the poor in their place. There is no sign of either side winning this battle. But subjecting individual aid projects to robust statistical analysis through randomised controlled trials (RCTs), modelled on medical trials, could provide a way out of the ideological mire.

So what is aid? Aid can come in many forms – such as military aid to help a country fight terrorists, or budgetary aid sent with no strings attached to bolster a government’s finances, or the cancelling of historic debts. Here we focus on a more altruistic form of aid – that sent to help the world’s poorest with little expectation of benefit to the donor, for example direct financing of mosquito nets or primary schools.

The moral cause for wishing to alleviate world poverty is a clear one. That one billion people live on this planet on less than a dollar a day while so many of us live in luxury is surely a moral outrage. The philosopher Peter Singer has compared such inaction to standing by a lake as a child drowns. Surely, he reasons, no person would give a seconds thought to diving in? Practically speaking, of course, giving aid is complex and costly yet the principle, he argues, is the same.
This metaphor succinctly encapsulates the argument for aid – that only immediate, decisive and potentially painful action, essentially diving in, can help the poor. The clear implication of Singer’s reasoning is that the solution is to get actively involved – but what if modern aid offers our metaphorical child little more than a faulty life ring? Or worse, what if aid actually helps to drag her down? This is the real question in the aid debate. This goes beyond rock concerts and emotive advertisements; is the obvious solution the right one?

Diving In
Many would say yes. These aren’t just rock stars and actors – distinguished professors of economics such as Columbia’s Jeffery Sachs see aid as an essential way of unlocking the economic potential of the poor. In his book The End of Poverty, Sachs points to farming as an example of this – if farmers are donated fertiliser, they can massively increase their harvest, which in turn gives them money to be able to buy their own fertiliser next year, thus creating a virtuous cycle. For Sachs, the farmers are caught in a poverty trap (unable to buy the fertiliser they need to progress) and without an aid-based kick-start (free fertiliser) they will never escape from poverty. Sachs sees this poverty trap model applying to many other areas of development – sick, poor people cannot afford medicine, but whilst they are ill they are unable work, meaning that they get even poorer. But aid also has a larger role to play. It can help small, cash strapped democracies stay on their feet and provide for their people’s basic needs. It can also kick-start basic infrastructure such as roads and schools.

Sufficiently compelled by this call to action, I headed off with some other Imperial College students last year to witness just this type of aid – designed to kick-start economic progress – in rural Kenya. Herdsmen, caught by a severe drought, were encouraged to take up fishing. A British charity subsidised nets and boats for the fledgling fishermen, with the idea that the subsidies could be gradually reduced as the economy took off. Each boat would take ten fishermen and each fisherman supported around ten dependents, meaning 100 people were helped by just one boat. It seemed to be the perfect project.

Unforeseen Consequences
There are, however, powerful arguments against this kind of help. On a nationwide scale, the large and sudden influx of foreign money makes the local currency rise in value, suffocating exports. This was best documented in Holland when the manufacturing sector contracted, following the discovery of natural gas in 1959, earning the phenomenon the name Dutch disease. Furthermore, money given to poor country governments needn’t necessarily end up going to infrastructure or healthcare. According to Paul Collier of Oxford University, 40% of African military spending is funded by aid, unbeknownst to the donors. It is certainly no secret that the poorest countries often have the nastiest regimes.
Aid can also undermine democracy, making poor countries accountable to donors, not to their citizens. The old American maxim of ‘no taxation without representation’ too often works in reverse – no representation without taxation. When poor countries rely on foreign funds and not taxes from local people and businesses, the need to be accountable to citizens is reduced and corruption and inefficiencies can more easily set in. Somaliland provides an excellent counter-example – not recognised as a country by the international community, it cannot receive aid and in fact has seen significant improvements in accountability and reduced corruption as citizens demand more for their taxes. And lastly, we cannot forget the ethical implications of aid recipients relying on public services provided by politicians in wealthy countries for whom they cannot vote.

The Truth Lies in the Data
Where does this leave the Kenyan fishermen? They lack a mature manufacturing sector so that shouldn’t be an issue. But how could the other factors affect them? It is here that we get to one of the biggest problems with aid – the lack of good data on its effectiveness. In truth neither the left nor right perspectives can offer a good evaluation of such a program without first gathering data. This was exactly what we did in Kenya.

Through interviewing 200 of the fishermen, we were able to gain a clearer picture of how the subsidies were impacting the local economy. The results were surprising; the perfect picture offered by aid evangelists was found to be murky at best. Investment in boats turned out to be not only a surprisingly ineffective way of catching fish – as opposed to just tying nets to rocks and leaving them – but was also heavily biased in favour of the relatively rich fishermen who could afford to pay the unsubsidised half of the price. However, we also found that investment in nets, especially targeted at the poorest, was a very cost effective way of helping out, with nets paying for themselves after two months. This was not only interesting, it was also very useful. The data enabled the charity to refocus its efforts, saving valuable donations and improving the quality of life for the fishermen.

Our research is part of a bigger shift in the aid debate – its scientific revolution. In seeking out quality data, we were able to get to the heart of the issue. The apex of this is the use of randomised controlled trials (RCTs), in the style of medical trials, on aid projects. The idea is simple. Half of a population is given a form of aid (nets, extra teachers etc.) while the other isn’t. Those who do and don’t receive the aid are chosen at random and in such a way that they cannot affect each other so that the impact of the aid can be clearly demonstrated. Essentially like any lab experiment. The idea is simple and common sense to any science student but it is having a significant impact on a hitherto opaque world.

The world before evidence-based medicine is hard to imagine – quack doctors of varying credibility combined folklore and pseudoscience to propose cures for just about any illness. Today, trials form the basis of medicine. Think of the 1991 discovery that folic acid reduces incidence of spina bifida, as a result of which 10% of the world’s flour is now fortified with the acid and thousands of such birth defects have been prevented. This same process is gradually taking place in aid. RCTs in Uganda have found that providing food in schools won’t increase enrolment, but it does boost attendance. RCTs across Africa have found that charging even a nominal fee for a malaria bed greatly reduces their use, contrary to the intuitive view that people only value what they pay for. Aid is experiencing its own scientific revolution.

The pioneers of this field are undoubtedly Professors Abhijit Banerjee and Esther Duflo of MIT’s Poverty Action Lab, who have been working in this area since the Lab’s founding in 2003. In their 2011 book Poor Economics, they outline the results of their RCT work. Their findings agree with neither left nor right, they simply find out what works. A new student union project at Imperial College called The African Development Project is dedicated to doing just this; involving science and engineering students in the evaluation of aid projects.

The potential of RCTs is very exciting indeed. They can provide no magic bullet – far too many such cures have been proposed in the past – but they do provide a way to go beyond the ideological warfare and change the aid debate for the better. Beyond simple moralising and abstract philosophising, scientific trials offer perhaps the most effective approach yet to understanding and tackling poverty. Its message is simple: find out what works, and then fund what works.

Exhibition Ode

This being my last of an excessive six years at Imperial, I can’t help but wonder, with more than a little panic, just how different life will be outside of the academic bubble. Excactly how I’ll gel with a world of 9-5s, responsibility, mortgages and early nights is uncertain. One thing I do know is clear: I’ll never again get to live in South Kensington. More precisely, I’ll never again get to live beside Exhibition Road. I’ll miss it.

Visiting London from Belfast with my family as a child, I would always insist on a visit here. In every way a future Imperial physicist, it was the Science Museum that leapt out for me and would fill up my precious London hours; a vast warehouse of discovery and invention – with whole rockets and World War II aeroplanes, hands-on exhibits and guided tours. I wanted to work there. I wanted to live there, or nearby. I ended up doing both.

Actually working at a museum; that’s a lot of fun. I spent a few months as a volunteer guide in the Science Museum’s 1001 Inventions Gallery (which looked at science during the Islamic Empire), mostly hovering around the display on numbers. Did you know that the numerals we use today were drawn so that the number of acute angles each has corresponds to the number it represents? Think of chubby, rounded zero. Or  the number one with its slanted cap. I imagine I bored the hell out of the hundreds of school kids who passed through, but it was an awful lot of fun.

Heading down the road from College, taking care to avoid the ever-earnest Mormon missionaries, gives a drive-by viewing of one of the finest buildings in London, the V&A. But this beauty is a war veteran ­– take a closer look and you’ll see that her newly restored side has ugly lumps missing, wounds inflicted by German bombers in World War II and left by restorers in memorial.  To get to know the museum, the ideal would be to spend whole days walking around, but for the exam-pressed Imperial student I offer the most convenient way to get to know the museum – my patented Study and Toilet Tour.

It is a little known fact that the V&A contains the National Art Library, a huge collection of mouldy old leather-bound books in plush surroundings with 100 desks for studying, open to all and free of charge, complete with comfy leather chairs, old fashioned desk lamps and a view of the museum’s large quadrangle. You can feel like you really did get into Oxbridge. Now for my Toilet Tour; go to this library to study instead of Imperial’s and take a map. Every time you want a toilet break, chose a different toilet on any floor you like and take your time walking there. I count eight toilets in all – it won’t be long before you’ve covered the entire museum, from the incredible collection of statues on the ground floor to the British Galleries on level 4. And lunch in the museum’s café is accompanied by a live pianist on Saturdays so you’ve no reason to leave the place at all, really.

Then we have the Natural History Museum, a temple to Darwinism and the natural world. The millennium old Giant Red Wood segment is worth catching, with the history of the last 1,400 years marked using its growth rings as a timeline. You’ll find it in the main entrance hall, a few floors up. Not forgetting the Darwin Centre – apparently if you flash your Imperial card, smile politely and imply you’re some kind of expert, they’ll let you in to see their giant squid. Now there’s a sentence that I never expected to write.

Exhibition Road is now pedestrianised, with the traffic/pedestrian distinction blurred and speed limits kept to 20 mph, much to the annoyance of drivers. Until two years ago, it was just a regular road, with none of those fancy benches and ‘Boris Bike’ stations. I’m glad for its makeover, because the truth is that it is more than just a road.

For such a busy part of Central London it’s pretty amazing to have places where you can sit in complete silence. For such an affluent part of the UK, it’s nice to have such a variety of people walking around. We lucky devils get to live here, for now. Make the most of it.