You don’t know ME

Today is ME Awareness Day. Many people have heard of ME, but the chances are that, unless you have ME, or are a carer for a person with ME (PWME), you do not really know it for the brutal debilitating effect it has. It wastes people’s bodies, fogs their minds and it can crush their spirits.

You might not really know ME because it is very difficult to diagnose. Often people with other fatigue conditions may be lumped in as ME patients. The key criterion for ME, in my opinion (other opinions are available) is Post Exertional Malaise (PEM). In other words you have only a certain limited amount of energy. If you go beyond that, you suffer PEM, which is not just taking a bit longer to recover, it is a crash that can last for weeks or more.

You might not really know ME because you do not understand what it actually does. Making it synonymous with “Chronic Fatigue Syndrome” is one of the worst misnomers ever. It is not just feeling a bit tired, it is not just feeling exhausted. Think of the worst flu you’ve ever had. Now think about feeling like that all the time. Think of constant stomach pain. Think of constant migraine. Think of headaches coming and going. Think of there never being an end in sight. Not everyone has these symptoms all the time; they are variable. But you never know when one is going to strike.

Another reason you might not really know ME is that you don’t see it. If people with ME are not stuck in bed (where you can’t see them) with their face fifty shades of ill, they might be sitting outside. And you don’t know that they can only walk ten yards. The illness is invisible, and PWME pay the same penalty as all the other people with invisible disabilities: people don’t believe they’re ill.

And you don’t really know ME if you think it is curable. It is not. Sometimes people get remission, which is fantastic for them. But many people never do, and all the cures that are touted as being 100% effective, well, they aren’t. Sometimes people get better after a “cure”. All the evidence suggests that it was random, or that they were one of those who had something other than ME in the first place. It also enables people to say that some cures have no side effects so it can’t hurt to try them. Wrong. One case among many: two sessions of acupuncture resulted in two weeks of deep illness. (And please don’t even think of saying, ah, that’s all the bad stuff coming out.)

The lack of robust scientific evidence for much of what happens in the ME world is a big problem, because it enables people to make all sorts of claims that cannot be challenged. If people claim something they really need to say what the evidence for it is rather than saying there is no evidence against it.

You really don’t know ME if you still think that the obvious things which work for other people work for people with ME. Just exercise your way out of it: recipe for disaster. What you think intuitively must work does not. It takes a good deal of attention to your own thinking process to accept that what seems like common sense to you just doesn’t work for people with ME. When they hit that wall that you cannot see, they crash, and there is no genuine way in which they can exercise their way past it.

Another reason you really don’t know ME is that nobody really knows ME (apart from those who have it). Scientific knowledge of ME is still in its very early stages. It is a complex and difficult condition to research. There is nowadays a great deal of work going on but it is like a giant jigsaw in which people are occasionally placing random pieces which don’t yet connect up in any meaningful way. There are many lines of research which look “promising”. No promise has yet borne fruit. It may well be that in ten years time, we will understand what causes ME and we will have cures for it. I have a hope, a desperate hope, that that is so. That will depend on scientists continuing to find more and more pieces of the jigsaw until patterns start to emerge, But we are only at the beginning of that process now. Going into detail about this is very difficult to do in a rational way. The research strands that are taking place are so disparate and disconnected at this stage that the simple way to summarise them is a list, a very long list. I will not do that here, but refer you for further information to Science for ME, which has a massive archive. 

Another reason that you don’t know ME may be that some people have a vested interest in not telling you the truth. This is contentious, and I will be clear here that I am giving you my opinion and that other opinions are available. But many very much better versed people than me share my opinion. Some people would have you believe that ME is a psychological condition and can be cured by strategies such as cognitive behavioural therapy and graded exercise. A subset of those people equate ME with false beliefs, and posit that people can be cured by changing their beliefs. This stems partly from what is called the biopsychosocial model of illness which originally attempted to combine biological, psychological and social environmental explanations of illness so that a holistic portrait of the subject could be constructed. It is not a very good model and, once it entered mainstream thinking, it suffered perversion from commercially vested interests. In other words it was used to emphasise the “psycho” bit so that the focus was put on the subject’s beliefs and thought patterns at the expense of both biological and environmental factors. This was too useful to insurance companies looking for ways to reduce their claims bills to be ignored. And to people like Iain Duncan Smith, looking to punish ill people for being ill.

ME is a perfect playground for the biopsychosocial model because so much about the illness cannot be proved. The most prominent example of this approach is the PACE trial of 2005-2010, a five million pound examination of the effectiveness of treatments such as CBT and graded exercise for PWME. The architects of the PACE trial were highly experienced, skilled academics and scientists with international reputations, or, as I prefer to call them, snake oil salesmen (they were mostly men). PACE’s purported results – that CBT and GE were effective - are still robustly defended by its champions. But their methods and their findings have been dismantled with varying degrees of elegance and destructiveness by statisticians, clinicians and other academics and practitioners from all over the world. The most comprehensive demolition has been by David Tuller: see his Virology blog. An account of the PACE trial and the controversies surrounding it can be found at Mepedia. I won’t go into detail here, but just to give a flavour of the quality of the trial and its amendments, it was possible to emerge from the trial in a worse condition than you went in, and still be deemed “cured” (not just “improved” but actually “cured”).

Why would people defend a trial with such obvious flaws? I cannot see inside the minds of those who do, but I suggest a combination of arrogance, defence of reputation, commercial interest in particular outcomes and professional closing of ranks.

(Note: I do not believe that CBT is useless. It can be an effective tool for managing the condition and getting the best one can out of life within the limits ME imposes. But it is not, and never will be, a cure. As long as powerful people tout it as a cure, it is very difficult to advocate its use for what it can be used for.)

More than that, so many professionals disbelieve it that they regularly investigate parents of children who have it for child abuse or neglect. I can only state in the strongest terms that that should not be.

In a nutshell, it is a condition that, whatever you see on the outside, ruins life for those who suffer from it. It causes pain and extreme lethargy. It is also limiting because of an extreme lack of energy combined with the possibility of post exertional malaise. There is not yet a clear scientific explanation, not even a reliable method of diagnosis, but there is much research going on. A condition misunderstood and disbelieved by ordinary healthy members of the public and, shamefully, by many clinicians and researchers. A condition that takes away people’s ability to live their lives, to follow their hobbies or their desires. A condition that leads to millions being missing from the everyday lives of their friends and peers, and missing in fact from their own lives. #millionsmissing

What should we do with the Palace of Westminster?

First published on Liberal Democrat Voice.

The Houses of Parliament currently function as the location in which Parliament expresses and exercises its sovereignty. It seems obvious that they no longer fit that function well: archaic logistics, terrible accessibility, lack of office and meeting space, and chambers designed perfectly for the cheap game show otherwise known as PMQs, but not for deliberation or wise governance.

Soon the buildings are to have a very expensive makeover during which time MPs and Lords will have to decamp. Perhaps we should make the decampment permanent. Build a site suitable to house the legislative body of a modern democracy.

Some argue that such a building should be outside London. That is a separate debate. But whether it is in London or not, it then leaves open the question of what we should do with the Palace of Westminster. My suggestion is that we should bear the cost of the refurbishment, and then turn them into the home of an Institute for Democracy.

One of the many lessons of Brexit, whichever way it goes, is that we desperately need a way of re-engaging the mass of citizens with the democratic process. People in every region and in every section of society feel, and are, disenfranchised. We can, and should, argue all we like for reform of the voting system and other formal and administrative tinkering, but it will take more than that to re-enfranchise many ordinary citizens.

An Institute for Democracy can have many functions and many forms. One of the possible forms is the holding of regular citizens’ assemblies, in which people from all over the country are randomly selected for invitation to an assembly which may last for several days, in which they learn about, discuss and debate one of the many issues about the way we are governed. Attendance at the assembly might be treated like jury duty, with the assemblees paid for their expenses and their time, and employers and others required to allow them to attend. The chambers of the two Houses can be retained for the purpose of holding plenary meetings of the assemblies.

This would be, in my mind, the main activity of the Institute, but I can envisage many others. It can hold seminars, conduct research, act as a library and a repository for material and data about democracy. It will still be a tourist attraction, and can also attract income from sponsors, sales and hosting events.

Given the catastrophic effect Brexit has had and is still having on our democratic processes, the Institute needs to be set up and to start to do its work well before the Palace is refurbished. It could start immediately, and hold assemblies in all of the different regions in whatever remains of the UK. I would hope that it would continue to do that, one of the biggest problems about the social and economic shape of
our country being the enormous weight attached to London and the south east. The Palace would form a magnificent centre piece for the Institute, but never its only home.

I suggest that this should become Liberal Democrat policy.

Glyndimandias

Seen near Glynde

Glyndimandias

I met a traveller from a Sussex land,
Who said—“Two vast and pointless trunks of stone
Stand by the road. . . . Near them, on the earth
Half sunk a ticket kiosk lies, whose shattered frown,
And wrinkled schedule, and lack of mirth,
Tell that its attendant well those coupons read
Which yet survive, stamped on these lifeless things,
The hand Supreme that mocked them, and the Artwave that fed;
And on the pedestal, these words appear:
My name is Glyndymandias, King of Kings;
Look on my Ticket Prices, ye Mighty, and despair!
Nothing beside remains. Round the decay
Of those colossal Posts, boundless and bare
The lone and level downs stretch far away.

With apologies to Percy Bysshe Shelley.

Why I am a Liberal Democrat

The LibDems recently ran an essay competition on the theme "What  it means to be a Liberal Democrat today". Results of the competition are not out yet, and I have no idea when they will be. Here is my effort, for what it is worth.

________________________________________________

I am a Liberal Democrat because I have a sense of justice. Justice means everybody getting a fair chance without the playing field being tilted against them throughout their lives. Justice does not mean everyone being treated the same all the time. Equality before the law is a sine qua non, but equality before the law requires different treatment, e.g. those who cannot afford representation should get legal aid. Those who can should not. My sense of justice is Biblical as much as it is political, though I accept it will not be for everybody. The Old Testament justice of Amos “Let justice roll on like a river and righteousness like an ever flowing stream”. Justice is so much more than equality before the law: it demands that we treat everybody as we would wish to be treated ourselves. Thus the two most important fibres in my being, the political and the religious, are intertwined.

Liberal democracy involves a lifetime of effort levelling the playing field. We come into a world with a tilted playing field. We make the effort to level it. But the effort does not end once the field is level because in our world the most influential currency is money, and money is magnetic. Wherever it is, it attracts more. If we leave the playing field alone, it will gradually tilt again as those with money use their power to accumulate more. So we need to work constantly to keep the playing field level. It is not just about fairness, it is also about effectiveness. Wealth used for the benefit of all benefits the wealthy too (some of the wealthy realise this). Wealth redistributed to those who have no work keeps them fit and alert and best able to contribute when work does come their way. Wealth redistributed towards those who will never be able to work means we care for those less fortunate than ourselves. Hence my implacable opposition to the poisonous policies and practices of the current Department for Work and Pensions.

The second most influential currency is information, which is crucial for the exercise of power. Information is light which we shine into the murk of both states and corporations to find out how they are affecting us. Without information we are not free, so being a Liberal Democrat means a concern for the freedom of information everywhere and in every form. People must be free to communicate with each other everywhere and about anything, provided it does not harm other people. But people in power hide information as obsessively as they hide money. So liberalism involves a permanent struggle to uncover information and set it free.

I don’t aim for a small state. I aim for an effective state. Size and effectiveness are not necessarily correlated. I want a state that is strong when I need it to be and otherwise leaves me alone. At the same time I want a society that encourages other people to be all that they can be, but to leave me alone if I am not affecting them. Regulation is a necessity; without it markets and social relations would not be peaceably ordered. Too much regulation is problematic, but so is too little – as we discovered in 2008. I want a smart state, one that is strong enough to counter balance prevailing global forces, and at the same time nimble enough to deal with rapidly changing circumstances. The Home Office’s leaden footed response to legal highs is a perfect example of how not to respond to change.

So the state needs to be smart, which entails that the people need to be smart. We need an active concerned and involved citizenry to keep the state tuned to our needs rather than to the needs of those in power. Liberalism also involves realism. I am realistic enough to know that we will never have an entirely active and involved citizenry. The forces of individualist consumerism are too strong for that. But we need a certain minimum, and everybody should at least have the chance, which means we need an education system in which people learn how to be smart. The system we have at the moment teaches one thing and one thing only – how to be measured. It is a tribute to the indomitability of the human spirit and to the professionalism and creativity of our teachers that most of our pupils leave the system with their character intact.

Ultimately, liberalism, like any political philosophy, is about character. Liberalism includes generosity of spirit. I do not envy those who are richer than me, provided they have earned it, which is by no means always the case. I do not scorn those who are poorer than me, because they did not bring it on themselves. They just live in the wrong part of the playing field, the one that I am constantly working to level up. Liberalism involves being always conscious of the rest of the world, not just the bits of the UK that go beyond my comfortable environment, but the entire world. Being internationalist means we won’t forget that our comfort depends on the discomfort of many others.


Liberalism is not an easy creed. It involves a tolerance for complication, an appetite for the convoluted practice of listening to every point of view and working to accommodate all of them. By and large political philosophies are based on either fear or hope. The politics of fear is easy. You point and shout. Liberalism is founded on the politics of hope, which is hard, hard work. We do not have the Daily Mail to expound our beliefs. We have Focuses. Which have to be delivered. So we pound the pavements. Activism gets you fitter. Not only have you got the message out, but you’ve taken your health into your own hands as well.

Moussaka

A friend recently posted a Facebook update, as she often does, about what she was cooking. It was moussaka and it included potatoes. I replied firmly that a moussaka cannot have potatoes in it. She replied with the BBC recipe from which she got it. I was not prepared to take the BBC as authoritative (on more or less any topic these days), so I held my ground and we had a bit of an exchange about it. Various other people weighed in, including one who made the point that recipes do develop over time. Which I knew to be true. And, to be honest, it has always been a slight surprise to me that what I regard as authentic moussaka has rice with it. Not chips, although they serve that now in most Greek resort centres. Ugh.

Anyway, I decided to research it, and rapidly discovered, to my surprise, that moussaka is a relatively modern invention. And an actual invention. I found several sources for this, but the best in my view is this feature in The Atlantic. It revolves around Nicholas Tselementes, a Greek chef of the early twentieth century, who had considerable international experience. He thought that Greek cooking had become too Turkish during the long period of Turkish occupation, and he set out to de-Ottomanise it. The moussaka that we know today was part of his response. He took out a lot of the spiciness, and incorporated a certain amount of French influence (though not garlic, which he apparently despised). His cookbook, published in the 1920s, contained recipes from many places, and those he considered to be the important Greek ones. He has a whole chapter on moussaka, and includes a number of variants, including moussaka cooked with courgettes or artichokes or..... potatoes (the horror, the horror).

So I sit corrected on the topic of potatoes in moussaka. And as was said in the Facebook conversation, cooking does develop, in this case quite deliberately. I know that: I'm English. Our national dish (apart from curry and pizza - enough said) is fish and chips. Chips from America; battered fish brought here by Jewish refugees in the eighteenth or nineteenth century. And the moussaka that we know today is a multicultural, though primarily European, melange. So I will accept that moussaka can be made with potatoes.

The next issue is the rice, which to me always felt a bit Middle Eastern, rather than Balkan. Again, I'm wrong in terms of cultivation and usage. Rice has been cultivated in Greece since at least classical times. Definitely pre-Ottoman.

Despite my discoveries I will stick to my idea of what a proper moussaka is, for primarily personal reasons. When I thought about it after discovering Tselementes, I realised that for me moussaka is not a recipe but an experience. In my secondary years and at university I studied classics. I learned Greek. I enjoyed Greek stuff. I enjoyed particularly the discovery of the Kebab Cellar in Cambridge (sadly no longer there). And I enjoyed going to Greece, allegedly to study the monuments. Moussaka for me is about being warm and carefree, and to get that feeling it can't have potatoes in it.

It has to have a Greek salad with it. (Greek salad is any veg you like, as long as it has olives and feta cheese in it.)

It also has to have retsina with it.

Baklava afterwards is OK, but I'm not too bothered about that - I'm usually too full and too drunk by then.

And for preference to be preceded by taramasalata and pitta bread. Not hummus. (Taramasalata seems to be Greek in origin by most accounts, but the tarama... bit derives from Turkish...)

Is there a liberal case for not raising the speed limit?

When Philip Hammond announced that he was in favour of raising the motorway speed limit to 80 mph, my instinctive reaction was “That's stupid”. The immediate reaction was based on his reasons for doing it, the most prominently quoted of which, at the beginning at least, was that so many drivers on motorways exceed the limit anyway, that we may as well raise it. On that basis I look forward to him repealing the law on using mobile phones in cars and also voting for the legalisation of cannabis. No? No, I didn't think so.

His other key reason makes marginally more sense in that both cars and roads have become safer since the limit was set. Both fatalities and serious accidents have reduced significantly and steadily over a long period, and so it makes sense to look at whether the limit is still appropriate. So I thought I should, rather than nurturing my own prejudices, look at what the liberal arguments are for and against raising the speed limit.

One of the issues I think is that the argument for raising the speed limit is quite simple, whereas the argument against has to be put in a more complex way. The argument for is that people should not be prevented from doing what they want to do unless it harms someone else. If it does harm someone else then in order to come to a decision on what to do, you have to consider the relative harms of restricting the rights of person A, the doer, or person B, the done to. The main issues you have to deal with are that people get killed and that there is a cost to the environment. The figure for last year, 2010, is that, with our modern safer cars and roads we managed to kill 118 people on our motorways. Even if you accept the argument that speed kills (lots of people don't – but more of that later) presumably those 118 were killed by a probable maximum of 113 perpetrators (there were 113 accidents). These figures are from the DfT. One might say that the other millions of motorists should not be prevented from doing what they want because of the consequences caused by a very small number of people. On the environmental issue, you either ignore it or you try to come up with an argument that says the gains in time saved etc are worth the environmental costs. I don't plan to spend much time on the environmental argument, because I'd like to concentrate on the human angle and the rights angle.

To look at the other side – the case for not raising the speed limit, I think there are two key issues. First of all the principle of freedom is clear – if I want to restrict other people's freedom I need a good reason. Secondly, the reasons should be based on evidence rather than doctrine. Problems arise of course when the evidence is equivocal. Then the skills of weighing it and interpreting it come to the fore.

So, first of all, let us visit the evidence. The debate is about freedom versus life and limb (leaving the environment aside for the moment). My right to travel at what speed I like against other people's right to remain alive and unharmed. So the evidence must show how many people are killed and injured, how many of those accidents are preventable, and whose fault they are.

In terms of deaths and injuries on our roads, the trend has been firmly downwards for many years. To take a sample year pretty much at random, in 1990 5217 people were killed and 60,000 injured seriously on our roads. In 2010 the corresponding figures were 1850 and 20803. (Note: 1850 is a revision in the latest version of the 2010 figures released by the DfT.) The collection of these figures has been challenged in that a study in 2006 found discrepancies in police reporting and hospital admissions, suggesting that the method of police reporting, on which the official figures are based, was reducing the actual number. This is now acknowledged in the DfT's annual summary. But the reporting effect is minimal. So, yes, our roads are a lot safer than they were. Does that mean they are safe enough? In the announcement something was made of the fact that our roads are among the safest in Europe. That claim has been examined by fullfact.org and shown to be broadly correct, if a little disingenuous. Now, that is not an evidential claim. It's a comparative claim, and it is open to us to say “So what?” I'm not that impressed by the fact that our roads are safer than Romania's. I'd rather they were safer still. The fact that our roads are safer than other people's means nothing when we still managed to kill nearly 2000 people on them last year. So I'm discounting that comparison for the purpose of deciding what a liberal response should be.

Part of the context of this is that motorway driving is considerably safer than driving on other roads. Motorways make up less than 1% of our road network, yet take 19% of the traffic. Even so, 5% of last year's fatalities happened on motorways. So by comparison with other roads, they are very safe. But that still does not necessarily mean that they are safe enough. The next thing to check is whether speed is a contributory factor in deaths and injuries on the motorways. The evidence here needs to be divided into two parts. Does speed contribute to accidents happening? And does speed contribute to the severity of the consequences if an accident does happen? The evidence for the first question is that it makes a limited difference. There is a problem here in that the safety of cars has increased in such a way that people get the impression that they're perfectly safe to drive at high speeds because the car will protect them. Road, tyre and braking technology have also increased to the point where it is much more rare for a driver to lose control of a car at high speed. But that does not mean that it does not happen. A significant number of deaths are in single vehicle collisions – in other words, a vehicle colliding with a tree or failing to negotiate a bend. I have no data for the proportion of such accidents on motorways as opposed to other roads. It is almost certainly a lot less, but equally certainly it does happen. The safety of new cars and roads is only relative. The higher the speed, the longer the reaction distance needs to be to allow for safe braking even with new technology. And driving at least two seconds apart is an activity that seems to have escaped a lot of British drivers. (I will come back to driving habits later.) Overall the WHO estimate that 1 km/h decrease in travelling speed would lead to a 2–3% reduction in road crashes.

Looking at the consequences of accidents the evidence is much stronger. Many studies demonstrate that increases in speed cause great increases in severity of impact. The WHO paper referred to above estimates “For car occupants in a crash with an impact speed of 80 km/h, the likelihood of death is 20 times what it would have been at an impact speed of 30 km/h.”

It seems clear from this evidence then that raising the speed limit from 70 to 80 would cause a small increase in accidents and a significant increase in the proportion of fatalities and serious injuries resulting from such accidents. This is admitted by the DfT, whose initial analysis indicates a 1% increase in deaths, according to the Guardian.

This still leaves open the question of what we should do. Millions of motorists used our motorways in 2010. Only 113 of them, at most, killed somebody, and only 668 caused serious injuries (injuring 798 people). Does a few people getting it wrong give us reason to restrict everybody's liberty? I think that there is an argument for that. Here we leave evidence behind and move into the realm of consequence, principle and practice.

A lot of people assume that those who cause fatal and serious accidents are different. They are idiots, bad drivers, unlike the rest of us who are good drivers. But there is little indication that those who cause such accidents really are different – they are not boy racers, they are not serial offenders, they are not all travelling at egregious speeds that nobody sensible would ever consider. They are ordinary drivers, just like most of the rest of us, but their luck ran out. We might more legitimately think that some are a bit sillier than most of us, but even if we assume that, can we assume that the way we behave has no effect on them? We have in this country a culture of driving badly. We do not recognise it as such, but if you consider the common driving behaviour, it is difficult to escape that conclusion. Most people do not think of speeding as a crime, far from it. Large numbers of people think that they have a right to break the speed limit. This applies to people who regard themselves as law abiding in every other way. I once said to a room full of pensioners that we are all law breakers. There was instant disapproval. I asked for a show of hands of people who had never broken the speed limit. “Oh, that's not the same thing”, they said. I have one eye on Question Time as I'm writing this. The usual audience – the kind of solid upstanding citizens who are actually interested in politics. Good people, who think through and about issues. If I asked in that studio right now how many drivers could, hand on heart, say they had never broken the speed limit, I doubt that any would be able to do so. It has become routine; it is part of our driving culture. We assume that speeding is OK, which is one reason why Philip Hammond is raising the issue – he assumes it too. In his case, I think he has an idea that, given that people are travelling at 80 now, if you raise the speed limit to 80, they will continue to travel at that speed. I think their perception is not that they are travelling at 80, but that they are travelling at speed limit plus 10%. If the limit is raised, then the limit plus 10% will be raised commensurately.

Another indication of the kind of driving culture we have in this country is the way use our car horns. The meaning of sounding a horn, in the Highway Code, is “I am here”. The meaning of the horn, as used by most of us, is “I am angry with you”. The overall culture is one of a general selfishness, and a great carelessness. We work on the basis that we can get into our cars and then not pay attention till we get to our destination. We do not value awareness of what is going on around us. This is why so many of us think it's OK to use a mobile while we drive. “1/5 of UK motorists admit accessing social networking sites on their mobile phone while driving.” and many more will phone or text with. Many of us will travel at the fastest speed we can, or for the law abiding, at the stated speed limit pretty much regardless of the weather, road or traffic conditions. Varying our speed to suit the conditions does not come naturally to many of us. The culture will not change because the speed limit is raised. All it will do is assimilate the new limit into its way of thinking. (Work carried out in the United States confirms this.)

My general point here is that the driving culture is made by all of us. When people get killed on the roads most of us can quite rightly say we did not kill anyone. But it is wrong to draw from that the conclusion that we can escape responsibility for the cumulative effect of the things that we do. We determine and preserve the culture that enables the few who drive so carelessly and at such speeds that they do kill people. The speed limit as such isn't the problem: it's the way we drive that results in so many deaths and so many serious injuries. But the speed limit is a factor, because it is part of the equation people use to determine the speed at which they will drive. I doubt that the way we drive is going to change (I would like it to, very much, but I am not optimistic) so any decision made about speed limits has to take that into account.

In summary, my argument is:
- evidence shows that increasing speed causes small increases in the likelihood of accidents happening, and significant increases in the consequences of accidents, in terms of deaths and serious injuries.
- life has value, although we drive as if it does not - although the bulk of motorists are not directly responsible for deaths or injuries, the majority of us maintain a culture in which people are encouraged to drive selfishly and carelessly
- it can therefore be justified, on a liberal basis, to restrict everybody's freedom to drive at speed, in order to allow as many people as possible the freedom to live.

A more positive liberal approach would be to work on educating people about good habits of responsible driving, awareness, and the need to protect the environment. An even more liberal approach would be to get them out of their cars and onto more frequent and more reasonably priced trains and buses. But I only meant to discuss the speed limit.

Buteyko

Following the post in which I confessed to bearing joint responsibility for the financial ills of the NHS, I have taken up Buteyko.
Buteyko was a Russian physiologist, trained in scientific method, which was the first thing that made his ideas more attractive to me than some of the less scientifically based ways of doing things. In the course of his work he noticed that people with a variety of chronic conditions all had low levels of CO₂ in their bodies. He devised a breathing method which he hoped would help people elevate their CO₂, and he discovered that when it worked properly, people's conditions either disappeared or at least ameliorated. So it's now a method taught by practitioners in various places around the world. The Wikipedia article on Buteyko is quite high quality.

Like all these things they have a long list of conditions that they claim to have success with. Among them were high blood pressure and cholesterol, so I thought what the heck let's give it a go.

The treatment involves five two hour sessions spaced over five days, and then a month of follow up by telephone. The follow up is genuine - I know other people who have done it and who have had hours of conversation on the phone to sort out what they are doing. A one off price covers all that and a reunion meeting after the month is up, and participants can do the course again free of charge. Again, that sounded like a very fair deal, unlike some who will charge by the hour for an unlimited number of sessions, and leave you with the feeling that it's your fault if it didn't work.

An interesting feature of the course is that it is run by a woman who lives locally, Martha Roe, but backed up by a man who lives in Thailand, Christopher Drake. He joins the sessions via Skype video, and will also do telephone calls to people with more complex problems than Martha feels able to deal with. Hooray for new technology. They share a website, and Martha has her own as well.

The method involves breathing less. It sounds, shall we say, counter intuitive, but there is a logic to it. We use only a proportion of the oxygen we breathe in, so if we breathe in less, we don't starve of oxygen, we just use more of what is in each breath. We breathe in air with approximately 21% oxygen in it. We breathe out approximately 17% - 19%. If we didn't, mouth to mouth resuscitation wouldn't work (that's my excuse anyway). And if we breathe less, we lose less carbon dioxide. It's all connected to the brain's respiratory centre, which is what controls the feelings we get when we need to breathe according to the level of CO₂ it perceives, and the idea is to retrain it to trigger the breathing response only at higher levels of CO₂.

To do that we learn what are called pauses, and very shallow breathing (VSB, there had to be a TLA in there somewhere). The pauses can be quite unpleasant, and you look a right tit when doing them. A pause is holding your breath for a specific length of time, and as the length gets longer you do distractions - these are bodily movements which have the function of distracting the mind from the need to breathe. Sounds stupid but it works - I can add up to 20 seconds to the length of the pause by jerking up and down. Not something to be done in public. I got a very quizzical stare from the cat last night after a particularly flamboyant set of distractions.

Does it work? it can take a long time, but I did my course last week, and I've been doing the method for ten days now. I have seen two things happen. From the first day I did it, I have been sleeping better. I've been unwell for the last four months, and for the whole of that time my sleeping pattern hasn't changed, but I've been waking up feeling completely unrested, having great difficulty forcing my body out of bed, and taking at least an hour after getting up to get my brain in gear. But since day 1 of Buteyko, I have woken up feeling as if I've had a night's sleep. That alone was worth the price.

Has it had an effect on my blood pressure? I bought my own monitor a few days before starting Buteyko and so far I have detected a very slight downward trend since starting the course. It's difficult to tell at the moment, partly because I have been using the monitor experimentally - after coffee (adds 10 points), during indigestion (adds 20 points), after exercise (ye gods), and so on, and I haven't tracked it under stable conditions. But there is a hint of downward movement, which I hope will continue. Maybe I'll be less of a burden to the NHS in a while than I am at the moment.

Among other things we've been told that Buteyko can change the way you breathe when you sing, and can change the way you use your voice. So we are considering a Buteyko choir, Buteyko ventriloquism, and of course, the Buteyko dance, which would be a kind of punk / Goth rendition of the distractions. I can see it being a big hit at the Brighton fringe next year.

And, on a more serious note, evidence based medicine should be taking a good look at Buteyko. The evidence is that it works. It doesn't work for everybody, but neither do pills. A properly conducted scientifically based study should show that many people can avoid long term costs and long term invasion of their bodies by drugs and other techniques. Maybe the NHS will come to embrace Buteyko. On my limited experience so far, that would be a good thing.