Reflections of his 87-year-old sister in ‘Lock-down’ – and after
Covid and Biology – Mary Bliss
If this epidemic had occurred 150 years ago it might have gone unnoticed; partly because it would, at least initially, have affected fewer countries; but mainly because targeting the old, unfit or ill, who would have already died, or be dying, their deaths would have been considered natural, or inevitable. Children and young people, being largely spared, would not have had to endure their present privation on behalf of their elders. [1] Life would have continued more or less as normal.
Indeed, this may have happened, who knows how many times? It is only the more deadly plagues like the Black Death, which killed one third of the population of Europe, [2] which are recorded in history.
Are we a sick world? In many countries nowadays it is almost a crime if anyone, including new-borns, is allowed to die naturally from disease or age. It is not realized what a dangerous concept this is. Death is as much part of life as life itself. Although some cyanobacteria appear to have been living and dividing unchanged, for example, in stromatolites, [3] since the early epochs of the planet, more complex plants or animals need to renew or reproduce themselves periodically. This is usually a sexual process by which they swap genes with another of the same, or very similar, species. The result is a new individual which combines characteristics of, but differs from, both parents, who subsequently age and die. Mutations, genetic changes caused by mistakes in nuclear division, or damage due to outside causes, for example, radiation, (sometimes useful but more often deleterious), are also randomly incorporated or eliminated in the sexual reproductive process.
A virus is a simple organism which cannot live outside a host cell. It does not have genes but only a core of nucleic acid which depends on mutation to change its behaviour. But viruses, too, can combine and create and spread new variants as shown by Covid-19 today. [4]
Hosts and parasites have battled with each other since life began. [5] New pathogens are constantly being produced which blindly target new hosts. Continual change, causing fresh modes of attack by disease and new modes of host defence, is the arms race of life. Thinking creatures like ourselves may try to modify it, for example, by vaccines or treatment, but relief is likely to be only temporary. New challenges are constantly arising. The replication, and hence mutation, rate of a virus is virtually infinite compared with that of a human being.
But besides being enemies, viruses and bacteria are also, not only friends, but the very stuff of which we are made and cannot live without. [6] We employ mitochondria, unrelated micro-organisms in our cells to enable us to move and otherwise function; and, like all animals depend on some form of life, plant or animal, for food. Only plants can manufacture food from inorganic materials using energy from the sun, but to do this they too depend on semi-independent organisms, chloroplasts, in their leaves. In life, alliance is as vital as war.
Evolution
Dissatisfaction with modern thinking is reluctance to accept biology, especially evolution. We have scarcely moved on from the horrified comment of the bishop’s wife following the publication of ‘The Origin of Species’, “Well! If we are descended from apes, let it not be generally known!’ Physics, astronomy, palaeontology, physiology we can assimilate and use, but biology, like advances in astronomy in the old days, is fiercely resisted. We don’t want to know. Whether this will do us more harm personally than accepting that the earth travels round the sun, rather than the sun round the earth, did to free thinkers in the past, remains to be seen. Heretics today may be less likely to be burnt, but they certainly lose their jobs; [ 7 ] and there is plenty of killing going on as the world becomes more exposed and polarised. But the greater danger is to our species.
If we recognise evolution at all it is because we like to think we alone can control it. Even Huxley, Darwin’s popular supporter, thought that ‘purposeless evolution had produced a man…capable of directing (it)’; [ 8] but this is impossible. Living things continually change their make-up and behaviour but only evolution determines whether for better or worse. It will deal with us automatically whatever we do. Our populations will either survive and flourish; or die out – with, to me, the greater sorrow, the loss of all we have learned about ourselves and the universe, our arts and joys. We are likely to accelerate our demise by trying to avoid it. Growing big bodies was eventually fatal to the dinosaurs; only the smaller species, our birds, survived. Growing big brains will probably exterminate us much more quickly. Harari [ 9] points out that a human predecessor, Homo Erectus, survived for around two million years in Asia before becoming extinct, but doubts if, with our present way of life, we will manage another thousand.
We should understand the need for ageing and death
The principal victims in this pandemic are unhealthy individuals supported by medical science. It is estimated that between 15% and 30% of the UK population today suffers from multi-morbidity. [10] They are mainly elderly, but also younger patients with genetic or acquired conditions. Genetic illness is frequent in modern societies, mainly due to resuscitation of new-borns with genetic defects, the usual, unconscious death of which is nature’s way of preserving the health of populations.[11] The commonest acquired cause, after smoking, is probably obesity. [12] In the past only the richest members of society could afford to be obese, but now-a-days in well off countries it more often afflicts the poorest, including immigrants and ethnic minorities who suffer from social discrimination. [13] Their constitutions may also not have had time to adapt to different ways of life and diets – or infections, such as Covid-19. For reasons not yet known, in the USA and UK, ‘Negros’ tend to develop more serious illness, with higher death rates, than other ethnic minorities and ‘Caucasians’. [14]
It pleases me to think that families in poor parts of the world, for example, Africa, may be less at risk from the virus because their populations are likely to be younger, slimmer and, with minimal health services, have fewer unfit and elderly subjects. [15] But children in developing countries are dying too, from war, starvation and disease exacerbated by world ‘Lock-down’. [16]
Elixir of life
The quest for the elixir of life has preoccupied Homo sapiens, and possibly other human species, since they became the first animals to anticipate death. It has been pursued in various ways: by providing food or armies to be buried with the dead to nourish or fight for them in another existence; belief in an afterlife of heaven for the deserving; reincarnation; by building monuments, from obituaries to pyramids; and by chemical experiments.
Beginning in the 19th century, and powerfully encouraged in the 20th, scientists and doctors believe they may at last be able to achieve the impossible. Armed with artificial teeth, eyes and hips, pace makers, anaesthetics, antibiotics, hormones, ACE inhibitors, calcium channel blockers, anti-coagulants, steroids, statins, anti-inflammatory drugs, antimetabolites, pain killers of all descriptions, immunoglobulins, immunosuppressants, vaccines and transplants (soon to include xenotransplants, [17] which risk transferring pig viruses to humans [ 18]) they feel omnipotent. As Hamilton observes, hospitals now vie with cathedrals on city skylines. [11] Already doctors are playing with the genes in somatic (body) cells, including those involved in senescence; [19] soon they hope to include the germ line which gives rise to our children, allowing them to fashion human beings as they wish. [20]
Lawyers and politicians jump on the band wagon for gain, glory or personal benefit. Health tourism is popular. Demagogues who refuse to hand over the reins of power have been kept going into their nineties to the detriment of their countries. So far, there has been little effect on the actual process of ageing by which, from the age of 30 or earlier, by 80 years we lose up to 30% of the working substance of our bodies, including muscles, bones and brains. [21]
Relatively little thought is given to who will pay for longevity and its expensive needs. [22] And apparently almost none (2020), or only belatedly (2021) [23], to children – if children are still necessary? [24]
Ensuring that kids are fed; outlawing even mild physical chastisement, [25] (common in the mammalian world), as well as demonstrations of affection from persons responsible for them; and preventing injury in municipal parks; seems to about summarise governments’ interest in them (2020). Paying teachers the same as doctors never seems to be on any agenda (hence the continued support for private schools by parents who can barely afford them).
Covid – 19
This is the world on which Covid-19 has pounced. It doesn’t matter where it has come from.[26] Pathogens are everywhere. We need to think of ourselves as a battery farm, or a supermarket with most of its goods beyond their ‘sell-by’ date. Both invite infection, and that is what we are seeing. Our only real hope is to ‘learn to live with it’ – as advised by the man in the street.
If I believed in God, I would say it has been sent by Him to warn us. Quite a kind warning. For all the statistics we don’t understand, [27] this virus is not very deadly. Compared with other infections, eg. polio, measles, ubiquitous tuberculosis, it is perhaps unique in sparing children almost completely. [28] Although we can’t be sure about long term effects, [29] with current treatment, it has an infection – fatality rate of between 0.5 – 2.4 and 2.1 – 2.4, [ 30] (depending on the date and source of the data), [29] mainly in the very elderly; [27] and it has greatly stimulated the development and deployment of vaccines. [31]
Children
Nevertheless, the losers are the children: [23] often overweight, ‘locked-up’ in bedrooms, with only a phone – and its messages – for company, dependent on ‘virtual’ rather than actual experience at a crucial period in their lives; deprived of the exploratory play of childhood and the freedom of adolescence; deprived of proper schooling [ 32 ] and the competition of comrades, with only discredited ‘AI’ algorithms to reward achievement [33] – all in order to protect older parents and grandparents. The loss of critical school years is now, belatedly, becoming apparent (2022). It is affecting especially countries with a poor or unequal standard of education at the outset, where it may have eliminated the last chance of betterment for pupils and their families for a generation. [34]
Some of these children and young adults may also die. Around 1 in 5 children in Britain are already saddled with obesity when they start school. [35] Obesity is difficult to reverse [36] and predisposes to diabetes and other ailments, including Covid-19.
I can’t recall a single fat child when I was at school in the 1940s. What has happened? The manufacturers of convenience foods are usually blamed, but should they be?
Could it be the Pill?
I remember as a medical student sitting on the steps of University College, London, with other students, male and female. A young man sighed, ‘If only there was a Pill!’ And in less than 5 years there was! In 1963, as Germaine Greer triumphantly claimed, it caused ‘The Second Sexual Revolution’. [37] The first was due to the essential, brave, but, in her opinion, incomplete, battle of the Suffragettes.
It is the Pill which has allowed women to take their place beside men in almost every aspect of human life. The reason for the Suffragettes’ diffidence was obvious. Women could not behave like men without at least a risk of becoming pregnant, which, if they were unmarried, would still have been condemned by society. Most unmarried mothers of that period felt obliged to give their babies for adoption. Provided the modern woman knows what to do and is willing, the Pill has changed all that. It allows her to expect to be able to mix with men in virtually any occupation; to indulge herself, and men, in apparently ‘free sex’ when they feel like it; to claim an equal right to earn a man’s wage; to put off childbearing for as long as she wishes (only our descendants will know the result of that: Aristotle thought the best ages for creating healthy children was 18 years for women and 37 for men). [38] Women can avoid procreation altogether, but, if necessary, claim paid maternity leave. They can co-habit with a man without marriage if she, or he, prefers; and, married or unmarried, expect him to share equally in household management and child rearing, to the extent that he can also claim ‘paternity’ leave.
Again, we need to think about biology. What is the purpose of ‘marriage’? It is not confined to ourselves, but is common in many animals and birds. Even if they are not monogamous, males frequently oversea harems; and Homo sapiens men have, as far as we know, usually helped to provide food and offered some form of protection for their wives and children. But in these days of the working woman the obligation in the marriage contract is diminished: ’Let them and the State pay!’ It is a pity, because it makes fathers less able to enjoy their children.
Mothers and fathers
Children need to feel themselves supported, loved and valued above all else in their parents’ lives. This does not mean continual surveillance or presents; but the provision of food, particularly by the mother, is fundamental (as it is in almost all animal interactions). [39] For a child, that means somebody making breakfast, packing a lunch box if their school does not have a cooked lunch, providing a snack to welcome them when they come home, and an evening meal. All this is difficult to do ‘part time’. Caring for children of all ages is a full-time job. Anything less than this commitment, however it is accomplished – most commonly by unremitting hard work – affects children’s behaviour and development. [39]
You can’t look after children if you are a soldier away at a war, [40] and their father can’t do it properly without you. Grandma might, but in Westernised countries today is usually too old. As for the state… they might as well be ‘in care’. And what about a home for the family? DINKs – couples with ‘Double Income and No Kids’ – can buy houses, but raise prices so that mothers have to work so that the family can afford even a flat. The father as the only earner helped to keep ordinary house prices stable. And what else? It belonged to him. He was there, the head of it. Whether he was a good or bad father, that was his role, accepted as such by his wife, and above all by his children. All children need role models. Single parents can rarely provide this for either boys or girls.
Most educated women today need to work, not only for money, but for social life and wellbeing. They should be encouraged and supported so long as what they do, and is expected of them, is not at the expense of their family and children, if they have them. Maternity leave is a step forward, but paternity leave is not a substitute. Today it is common to see fathers pushing baby buggies but they seldom seem to talk to their charges – but, I have to admit, neither does a mother rivetted to a phone, with an older sibling vainly trying to attract her attention…
Society, mainly feminists or young or hypocritical men who like sprinkling their work with ‘shes’ rather than ‘hes’, should stop complaining about too few female ‘Chief Executives’, [41] or women’s ‘lowly paid jobs’.[42] Apart from those ‘whose … skills have atrophied’, [42] most mothers know what their children need. Mothers who want to remain at home with their children may be depressed by criticism from other women that ‘they are letting the side down’. [43] It is probably easier to combine bringing up a family with being a Chief Executive than as a social worker or cleaner. Men can help, but should preferably be the fathers of the children. With effort, a stepfather or partner can come to regard unrelated children as his own; at the other end of the scale, children can be candidates for all kinds of abuse. Step mothers appear more natural, but may still be hard for both parties to accept.
Free love
What about ‘free love’? Can love ever be ‘free’? Must it always entail obligations, and what is it for? Pleasure? Cohabitation? Security? Marriage? Happiness? Most young people today would put ‘children’ last.
The notion that we have a ‘right’ to ‘free love’, that we can’t be healthy without it, is spurious. Sex for its own sake, without concomitant interests, easily results in satiety. This is probably the main reason for the appeal of homosexuality today, gay and lesbian. ‘Gay pride’ and ‘same sex marriage’, (sometimes involving hapless ‘children’), are manifestations of the insecurity felt by those who have abandoned everything for ‘love’. Gay marriage is an insult to children and families that marriage between men and women has been designed for millennia to protect. Homosexuality should not be condemned. It can be a driver for great good in human affairs, but there is danger in extolling sexual licence to the extent of irresponsibility, especially on TV which the general public regard as their authority. Parents are much less willing to let their children roam and explore than in the past.
Gender
Bored, hungry and anxious children will turn to comfort food and drink. Boys who do not have a father to compete with are likely to replace him with gangs and drug heroes. There seems to be a conspiracy not to recognise the effect that the disruption of the biological family has had on both sexes. It is easy to see. Not only are children fat (or too thin) and often burdened by illness, but they are excited and bewildered by discussion about ‘gender’. [44] All young girls, and probably boys, fret about their appearance and try to conform to the prevalent ideal; but, unless medically indicated, never before have they had to confront questions about ‘gender change’. [45] How Western trained doctors, or any doctor, can agree to provide puberty blockers, or operations more mutilating even than ‘FGM’, (universally condemned in the modern world), [46] to normal children is incomprehensible to me. Binding babies’ feet, shaping heads, and even castration in the past were less horrific.
Depression is common in children world-wide today. [47] [48] The West’s dealing with their children may seem less harsh than China’s where working parents may be separated from them for years [49], but is it?
Women
Feminist extremists like to claim that men are unnecessary. This is not to say that women will not do almost anything to attract their attention. In my grandmother’s day, this meant conforming as far as possible to a standard of physical beauty, putting up one’s hair, playing down intelligence, and bathing machines. Today it is more likely to involve jumping out of aeroplanes, playing football or training to become an engineer – whilst wearing hair dangerously long to emphasise femininity! Women like to show they can do anything a man can do.
Nevertheless, suicide in young women is rising. [50]
Over millions of years the sexes have evolved, as in all animals, different roles with different aptitudes. Evolution promotes division of labour. This has generally meant the female taking on the lion’s share of the work of producing and caring for offspring – but Homo Sapiens’ men help. Women are as likely to be attracted by a man who can understand a mathematical equation, is a stimulating companion, can design an aeroplane or a washing machine (and make them), or make money or mend a car – as by a ‘hunk’. Intellectual ability in man is an important sexual attribute. (Although I enjoy making them, I prefer art works by men). It is probably the main reason for our large brains. The sexes have traits in common, inherited from their parents, but differences are wired in their genes even before they are amplified by sex hormones. Women’s abilities are more general, mainly based on their family and environment. Today they are often keen activists and committed governors – of schools – and 2022, countries! The latter is not surprising as they have always governed households – and men.
If women wish to study subjects like science, they usually have to work harder than men to understand them (as even Greer admits). But they do, and to the benefit of their children if they have them. An educated mother is a boon. I was a doctor and my mother was a doctor, and I would not have wanted anything else. Rather than pretend that differences between men and women don’t exist, we should understand and honour them. There is no question of ‘superiority’ or ‘inferiority’; the sexes depend on each other. They are one, and must have the same opportunities for education. Current expansion of education for women is proving decisive for the prosperity of nations. [51]
Men
Men have set us aside from other animals, for better or for worse. Men are philosophers, creators and engineers. It is they who have given us our religions and governments, imagined our sagas, ploughed our fields, built our cities, furnished our bathrooms, put us on the moon and sent vehicles to Mars They have established the whole fabric of our lives, including, today, the Internet. The reason women feel they ‘can manage on their own’ is because men have provided so many helpful devices in the work place and home that being female no longer seems a handicap – we don’t notice it. But it is one thing to be a traveller, another to have designed the ship, the rocket and the return. Although we have to acknowledge that we don’t have the strength of men, today even the job of battle can be done by women, but is that what we are for?
Equal opportunities
Generally, men and women perform best in the society of their own sex. Thought is inhibited by sexual awareness, (although stimulated, sometimes to great heights, by frustration). It is likely to be still more so in the present ‘me too’ culture. (Being plain, I enjoyed ‘wolf-whistles, and I am sure other women did too. The kill-joys are killing women as well as men.) Mixing the sexes should not be statutory in work or play. It can be terrifying. I once attended a week’s Equal Opportunities Course run by London’s Hackney Council, obligatory for their staff at the time. Managers, from nurses to engineers, were being exhorted to hire similar numbers of men and women. A builder asked, ‘So what do I do when she freezes half way up a ladder?’ Still more worrying, Heads of local schools were encouraged to employ equal numbers of ‘homo’- and ‘hetero-sexual’ teachers to ensure that children acquired a ‘balanced view of sexuality’.
Attending this seminar of perhaps forty people was a lively middle aged black lady. Apropos of the builder’s complaint, we were discussing physical differences between men and women which might affect their suitability for different jobs. I was trying to explain about hormones which are responsible for the development of secondary sexual characteristics in adolescence, when she suddenly interrupted me, shouting, ‘Hormones! What are hormones? I never heard such rubbish in my life!’ I was surprised, and just said, as depreciatingly as I could, that they were chemicals produced by the body that caused the changes which turned boys into men and girls into women. Her face collapsed and she almost looked as if she was about to cry when she said, ‘It is all very well for you! You have had a private education, but I was at school in Hackney. How do I know about such things?’. I felt extremely sad.
War
We are an aggressive species. War is waged by men, although encouraged, and now a days often aided, by women. Perpetual competition within and between tribes, races and nations, probably little different from that of all animals, and plants, except that it involves our brains, has made us what we are. So far as we can tell, war (and cruelty which does seem to be specific to us) has been ubiquitous in our history. The strategy and cooperation needed to win wars with our relatively feeble physique is an additional factor which is likely to have contributed to the selection of our big brains.[52] It has been essential to the development of the higher faculties in the arts and sciences. The price has been death, misery, ruin and famine, but probably worth it.
But war has never been so sophisticated and dangerous as it is today. I am thankful that how it is dealt with in the future is not likely to concern me. Better understanding of the causes of racial differences should help.
As with the sexes, people with different needs, living in different circumstances, have evolved special physiques and skills. Do schools teach children that tropical races have dark skins to protect them from excessive sunlight, just as northern races with less of it have light skins to ensure that they can make enough vitamin D to make strong bones? If not, why not? Both are beautiful, as fashion and the arts demonstrate. Biologically, we prefer faces that look like our own. We feel most comfortable in the company of others of the same race and culture whom we can understand and who understand us. This is natural, but not essential. We are all Homo sapiens. We need to discover and respect people with differing ideas and talents [53] rather than claim that we are ‘all the same under the skin’ and must conform to a Western model. [54]
In tropical climes with an abundance of food and minimal need for shelter, probably the main natural threat during our development has been from infectious disease, for example, malaria, which still kills around 600,000 people a year, including 80% children. [ 55] Only the fittest may survive. We marvel at the fitness of natives in rural Africa surpassing any efforts by Western trainers. But it is a physique which, like that of many other Indigenous people, may be ill adapted to a changed environment, for example, caused by increased affluence or migration, exposing them to new illnesses.
In cold countries where first requirements are for shelter and clothing, as well as food, the development of pioneering abilities are essential.
In the modern world where people of different evolutionary backgrounds must inevitably mix, variability in skills and attitudes may be stark and lead to much misunderstanding. Instead, we should celebrate them. Better education would help, but needs to happen fast. Today, the mix of races, clash of ancient civilisations and beliefs, global accusations about the origins of Covid-19 and its variants [26] and loss of land and livelihood are causing increasing, terrible outbreaks of violence. Misogyny, inflamed by the current disparagement of men, may play a part.[56] We must also learn not to be offended. A Jewish GP I used to know described how in the street one day a black friend walked past him. He turned and caught him saying, “Hey! What’s the matter? You didn’t say, ‘Hullo’!” “Oh, I am sorry Doc,” he said, “I didn’t recognise you! You white fellas all look alike!” A point of view which we need to understand.
Religion
Religion is important. It has helped to lead us from superstition to a better understanding of ourselves. Faith should be respected, not abused. Religions which bind tribes and nations together encourage war, but promote self-sacrifice and are usually based on family life, marriage and children. [57] [58] They may serve the biology which they reject better than the ill understood ideas of ‘liberal’ secularists. I have frequently felt happier in the company of a truly religious person than in that of an atheist like myself. One can share something of their devotion and hope, even if not believing in it.
Religions also provide a moral compass, something we all need, especially children – even if it is only an unconscious sense that what we do may affect others. Religions can cause untold atrocities, as recently evidenced in Canada, [59] but have been the building blocks of civilisation.
Politics
Once a year, window cleaners, three brothers, come to clean my windows. While his brothers do the work, the eldest likes to have a political discussion. On their first visit, in 2016, he held forth about immigrant youths groping women in Cologne Station; and, for the first time, I realised that Britain was likely to lose the forthcoming Referendum. A year later, after Trump had been elected President of America, I asked my cleaner what he thought of him. He said, “I like Trump. He says what he means.” He does, even if he says, and means, something opposite half an hour later. He says what many people in America, including some immigrants (even if unwelcomed by him), [60] and probably most of the world, thinks, and would like to say, too.[61] ‘Political Correctness’, like religious dogma, stifles thought and action. Practices, crueller than ‘free speech’, can flourish under its banner; for example, loss of university jobs for suggesting that men are generally better mathematicians than women, or similar observations.[62] This seems to me to be the underlying appeal of populist parties like America’s Republicans, who don’t care, and don’t want to know, liberal niceties about race, sex, gay marriage, ‘LGBTQ+’ or ‘Health and Safety’. It may even support dictatorships within democratic communities like the EU, for example, in Poland and Hungary, in defiance of the law.[63]
This year, June 2021, my cleaner began immediately about the demise of General Practice. We agreed that, since Covid-19, it seems to have become little more than a government tool for organising screening programs and vaccination. He had a mother-in-law with a colostomy dying of cancer being looked after by his wife at home. Their GP wouldn’t visit her. I have found that many of the sons, and especially the daughters, of refugee friends, want to be doctors. Their problem is that not knowing enough about British traditions they may feel bound to rely, perhaps more than older doctors, on NHS ‘policy’ in their management of patients. Will compassion and personal responsibility, the hall mark of the doctor, ever be restored? In any case, this may not help the profession. Owing to ill-considered mandates during the pandemic which have inevitably affected the way general practitioners work, one third of English GPs are planning to retire within 5 years, including one in six younger than 50. [ 64 ] Their proud boast of being ‘generalists’ looking after whole families, rather than ‘specialists’, concentrating on single patients, has been lost, and with it their traditional role in the community.
He said that nurses, for all the hype on TV of their being ‘rushed off their feet, were not much better, as many of them were too overweight to do their job properly – an observation with which I sorrowfully agreed.
He had had a painful ear but no doctor or nurse would look at it (‘you can’t look in your own ear’), but merely ordered further courses of antibiotics. He said, mightn’t this make you sick? He had come to rely more and more on homeopathy and health food shops. We agreed that they might be less likely to do harm, and that extra time spent listening to customers and trying to help them, (for whatever reason), might do good.
Litigation
In the 1980s, I attended a medical lecture by an American doctor – I can’t remember on what subject – in which he said, “We in America have a disease called ‘Litigation’; like all diseases it is catching, and you will catch it too.” We have. Lawyers, as much as doctors, are responsible for our management of Covid-19. Are we really desperately worried about the fate of 90-year-old women in nursing homes who have terminal dementia and can no longer recognise their families? Or are we more concerned about what the media will say, (especially if we are a prime minister), if we don’t vaccinate ‘ancients’ as a priority? Or worse, if their families are encouraged to sue us? These are questions which doctors and lawyers cannot discuss, but, for the sake of survival or profits, must abide by the rules. Remuneration for misadventure is a run-away process which, unless we can break free from it, may end up destroying us. Already, lawyers are sharpening their claws, and those of the families of Covid victims, on their prospects.
We must take back personal responsibility. I do not mean current injunctions about ‘shared decision making’ in medicine, designed to protect doctors and hospitals from litigation; but real requests for help. Most patients want advice from their doctors, who, after all, usually have more knowledge and experience of their situation than they do. They do not want their agonised question, ‘What would YOU do, Doctor, if you were me?’ met with a cold stare. Although, as Harari [9] stresses in his book, Homo Sapiens’, (although not in his subsequent books), there is no scientific basis for human ’rights’, if we are to make use of them, a ‘right to decide for ourselves, as adult men and women’, following as much information as the doctor, aided if necessary by trained councillors, (not just hospital ethics committees or lawyers), feel able to give, is surely as important as current ‘rights for women’? This is probably what motivates most ‘anti-vaxxers
Covid 19 – follow up
When I began to write these reflections in the early 2020s, the pandemic was rushing upon us with astonishing speed. Nobody knew how it was going to turn out; the news was all about death, shut downs in China, overwhelmed hospitals, lack of ventilators in Italy. People were frightened, and politicians bewildered by something not in their briefs.
Nevertheless, the first breakdown of the illness which I saw – from China – showed me immediately that it was not as bad as all that – was, in fact cheering, in that it was the top row, the 90 year olds, and a lesser extent the one below it, people in their 80s, (which includes me), who had suffered almost all the mortality. [65] The age groups below that had only a smattering of deaths; and below 50 years, almost none at all! It looked like a miracle – and the picture has not changed substantially since, despite the development of ‘variants’ which, although more infectious, do not seem to be much more deadly. A more recent study which separated deaths depending on whether they had occurred in nursing homes, ICUs or ‘medical wards’, and which included the most up to date treatment, gives a similar but more detailed picture. [ 66] It confirms that it is the unprecedented age of much of the world’s population and accompanying illnesses, which primarily underlies this pandemic. Now-a-days, with greatly improved medical and technological support, ‘elderly people’ are older and frailer than ever so it is not surprising that they are the principal victims of the Covid virus. But I was surprised by the world’s lack of interest in the immunity of children compared with its outrage about the deaths of 90 year olds. If the concern had been mainly on behalf of nurses it would have been more understandable – and indeed, many older or less fit health workers have caught the disease and died. They deserve memorials. But in the West at least, the most vociferous criticisms have concerned the ‘neglect’ of already mortally ill patients. It is very depressing. I found myself instinctively supporting those rulers who, either with thought, as in Sweden, or without, like Bolsonaro in Brazil, (or even Trump or Johnson in the early days) hoped to ‘carry on as usual’.
Anyway, world lock-downs took off and the skies emptied.
I did not feel I could comply. This was partly because at the age of 85 I felt I had had my ‘innings’, and that I was past the ‘three score years and ten’ that my Biblical – but not religious- upbringing had taught me was the human life span. All except one of my grandparents had died at around that age. Therefor it seemed reasonable to me to risk death. Legally, I had the excuse that I needed to continue to visit my younger son and his wife, both of whom have learning difficulties. With the best will in the world, they could not manage masks (worn below their noses), social distancing, shopping on-line or by kind neighbours. They rely on the corner shop. My son continued to travel several times a week in empty buses and trains, to help me throughout this period. Because of taste changes, (metallic), lasting around three months in 2020, I think that I, and probably they, caught the virus, but none of us was ill. We have all since had at least three vaccinations.
It was my relationship with neighbours and friends that was difficult. As an apparently fit and active 80 year old, I did not feel particularly vulnerable; but many of my contemporaries, undergoing the latest treatments for cancer, heart and immune diseases, and on a plethora of drugs, were more compromised. I kept away from them as they wished, but this did not prevent them from regarding me as a ‘vector’ and a menace to society. I did not blame them, although I missed their company; but when it came to expressing my thought about the pandemic, I was in a dilemma. I felt it would be cruel to show my feelings even to my closest friends. However, having tried to describe them as dispassionately as possible, now that the initial panic is over, and most of us are still alive, as well as vaccinated, and the laws have been modified, I have not been able to resist asking a few to read this essay to see what they think of it.
Most have not commented. A few have suggested helpful amendments. But mainly, perhaps as I intended, the majority seem to have failed to realize the depth of my anger towards what I regard as the selfishness of our generation. At least at the beginning, we seem to have forgotten about our children altogether even though, if they had continued their lives normally, there would have been little danger if they had caught the illness – as many may have done. The authorities seem to have been unconcerned about what the prohibitions must have meant for them, or their parents, telling them it was for ‘Grandma’.
What about her – or Grandpa?
I have been regarded as a healthy old woman – despite my refusal, so far, to put my name down for a hip replacement and the fact that I can only walk a hundred yards, painfully, with a stick. That I can no longer calculate, including giving change; have difficulty in orientating myself even in a familiar place; can no longer read a map – or remember it the moment after I have looked at it; that I can’t think of names, or even ordinary words, or spelling; or why I have laboriously climbed upstairs to do something I can’t remember, may be hardly noticeable even to myself. But it is not the same as being young. I sometimes have to get up four to six times at night for the toilet; I have poor balance; I have difficulty standing up or sitting down; doing anything on the floor is agony. I have constipation, flaking nails, moles, tender patches of skin, a hairy chin, poor stamina, dribbling, clumsiness. When I was a geriatrician, I never properly appreciated the near impossibility of my patients to deal with intricate hearing aid batteries. My greatest gratitude is for cataract surgery which has restored my sight to almost childhood acuity. I don’t think I am depressed, but real and foolish worries keep me awake by going round and round in my head. Sweeping the kitchen floor with a broom is painful due to thin skin on my hands, and the Hoover is too heavy.
Do I need a Home Help, or a Carer?
If age is kind, cancer is waiting to snatch us. Some of my readers may be pleased to learn that it has now snatched me (2022)!
Eighty year olds who escape these infirmities must be rare. But rather than ’fighting them’, (a popular medico-political term), should we not regard them as aids to reconciling ourselves to oblivion? We like to think or ourselves, however poorly, as still ‘needed’; but, as a revered colleague who died of motor neurone disease was fond of saying, ‘None of us is indispensable’.
Dispensable – but missed?
Longevity
Leaving aside the question of who is to pay for it, [ 67 ] indulging in longevity can only cause limited harm. We may certainly enjoy it, despite Dr Johnson’s observation that ’Life protracted is protracted woe’. We will all die eventually and our children, with a different variety of chromosomes, will take over. Trying to stay alive, by one means or another, is unlikely to prosper. Dolly, the sheep, engendered from a somatic cell of her mother, thus avoiding sex, did not survive for long, and it is to be hoped that other similarly engineered animals and humans won’t either. They could be more hazardous to our future than robots. Plants may be more tolerant, but they, too, have not evolved elaborate processes for cross-fertilization for no reason, probably mainly for defeating parasites. In the end, genetic engineering may be forced to resort to artificial meiosis, randomization, which has proved to be so important, inside and outside the laboratory – but can Nature be bettered?
Genetic engineering
Our obsession for preserving embryos and new-borns with known or unknown bad mutations, the mantra of ‘Right to Lifers’, and designing faultless babies, is more serious than hankering after longevity for ourselves, and could destroy our species.
Bill
I need my brother, a generous and humorous man, and a great lover of Homo Sapiens, to explain and criticize what I have been trying to say. By the time of his death in 2000, aged 63, he probably understood life on this earth better than anyone – except God. Bill was never sure about Him. He was certainly not religious in any accepted sense, but he always refused to allow himself to be called an ‘atheist’. He agreed with Lermontov who said we should not claim certainty about things which we do not ‘know’ (in his case Astrology and Predestination). Therefore, as we are unable to understand the universe, and what lies beyond, we cannot say that God does not exist. Bill did not think highly of me for disagreeing.
‘Technosuperlife: its forerunners and lies’
Bill thought that scientists and other thinkers had a duty to warn governors about dangers which they foresaw might harm us. His last words are contained in a paper entitled ‘Technosuperlife: it’s forerunners and lies’, which he was due to read at a Symposium of the John Templeton Foundation in February 2000. [68 ] Because of his illness and subsequent death, it was not delivered (although possibly read?) at the meeting. It has not been published, mainly because it is disliked by Bill’s fellow scientists as much as by the few members of the public who may have heard or seen it. It is part of that ‘Don’t want to know’ category which I mentioned at the beginning of these Reflections. However, although only twenty three years have passed since Bill wrote it, many of his predictions, which included a ‘pandemic,’ are more relevant today than they may have seemed then: for example, a current proposal that all British babies should be genetically screened at birth. [69] This can only lead to the life-long treatment which he dreaded, and which has already begun.
Meiosis
Bill’s message is that if we ignore evolution or try to interfere with it, we are likely to condemn Homo Sapiens to an accelerated extinction in the next few hundred years. The crucial factor, as he sees it, will be the loss of the benefits of meiosis, the mixing of parental genes which occurs in sexual reproduction, which Bill regarded as the most important – and surprising – development in the history of life on this earth. It provides the child with a new combination of genes to combat attack by parasitic diseases (which similarly mix genes,) and other environmental threats, and helps to deal with ‘mutations’: changes in the structure of the genes themselves, ‘good’ or ‘bad’, depending on whether they favour survival or the opposite, by randomly preserving occasional useful mutations and helping to eliminate much more frequent adverse ones. Although the embryo may die during this process, either at an early stage as a miscarriage, or later as a neonate or young child, it is critical for ensuring that the population remains healthy. If it is prevented, by preserving the lives of affected children and encouraging them to breed, Bill estimates that, at the likely rate of one bad mutation per year per individual per generation, in 300 – 500 years every civilized genome will have accumulated an average of at least 10 bad mutations and will be unlikely to function without the help of a ’Techno-Superlife’, involving ‘computers, information technology, media enthusiasm, medical technology and drugs’. [70 ] Poor countries which cannot afford this care, may fare better; but with our almost complete dependence on the ‘Planatory Hospital’, our individuality will be lost. We will have come to resemble chloroplasts and mitochondria in plants and animals, whose lives have been wholly subsumed by that of their hosts. We will no longer be Homo Sapiens. Even if nothing bad has happened in our own germline during this time, or we hope to protect our family by remaining childless, ‘(our) extended family at the distance of cousinship…or (all) (our) descendants at the level of great grandchildren’ are unlikely to escape the deleterious effects of even phenotypic treatment, eg, spectacles [ 71 ]; let alone somatic – or germline – CRISPR Genome Editing targeting defective genes. So far, the former has resulted in only mild improvements in somatic (body) disease [ 72 ] and the latter has been barely attempted for the ‘germline’ which gives rise to our children. It is unlikely to be able to treat the 4000 or so currently known genetic defects, and still less mutations in the 100,000 genes and their millions of dependent structures (proteoformes) [73] on our 23 chromosomes which we have scarcely begun to identify and understand.
Lies
So are our advisors being honest when they claim to be able to do these things? The advance of science in the 20th century has, not surprisingly, caused a decline in religious belief to the extent that the role of the priest has frequently been overtaken by that of the doctor. The activities of priests have not caused much harm, and have undoubtedly helped sufferers by providing comfort and reassurance; but those of modern doctors, who act like priests when they claim to know what ought to be done on the grounds of expertise, are a different matter: ‘You ought to save your sick baby by hospital intensive care, and we will try to make sure that you do save it.’ This may be at variance with the beliefs and instincts of the parents, so that laws have had to be devised to encourage compliance. [ 74 ] The result can be a lifetime of misery for the patient – “No more needles!” – and disruption of the family, [ 75] – but in 300 years will we care? Probably the best way to prevent such a tragedy is for families to have to pay for the help which their dependent members need. At present such a proposal would be political dynamite, but it could save us nevertheless.
Are we worth saving?
Homo Sapiens is worth saving for as long as possible. Not only are our brains, and what we can do
with them, unique in the Solar System, but possibly in the Universe itself. It will be tragic if we allow arrogance [ 76] to cause our extinction earlier than necessary. We tell ourselves that our motives for preserving the lives of defective babies are ‘mercy’ and ‘respect for life’, and, if we are religious, ‘souls’, but are they more likely to be just because we can? The babies themselves cannot know what is happening to them. As Mark Twain has put it, he was not ‘incommoded’ by lack of life before he was born any more than he expects to be when he is dead.
Parents, or family members nearest to the child, not professionals, need to decide what should be done.
Illness
Twain’s observation also applies to those of us who are trying to postpone death by means of modern therapy. Here I am conscious of an irony: earlier, I suggested, fancifully, that the pandemic could have been sent by God to warn us about the effects of our over medicalized lives. Now, aged 87, I am in the throes of it myself. Not pleasant, but inevitable. Serves me right!
Mary Bliss 17.03.2023
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Ageing Issues 