The Pharmaceutical
Journal Vol 266 No 7131 p84
Most men, if they are being honest, would admit to having a collection of odd
socks pushed into the corner of a drawer in the bedroom. I am certainly no exception.
When our daughters were small, we had, for some years, a “sock bag” filled with
odd white socks (obligatory at their prep school) for which the matching socks
never did reappear. Likewise, most people will be aware that a dropped piece
of bread and butter will usually fall butter side down, that ropes (and women’s
gold or silver chains) will unaccountably knot themselves, and that one’s holiday
destination is always at the bottom left hand corner of the Ordnance Survey
map, necessitating the purchase of three more maps to get complete coverage
of the holiday area. These are examples of the well-known Murphy’s Law, which
basically can be stated as “if it can go wrong, it will”.
Many people, particularly scientists, take a dim view of Murphy’s Law and assume
that it is simply an old wives’ tale. However, this is not so. Murphy existed,
and so does his Law. Edward A. Murphy (1918-90) was a graduate of West Point
and served in the US Air Force during the 1939-45 war. After the war he became
research and development officer at Wright-Paterson Air Force Base near Dayton,
Ohio, and was involved in a project to test the effects of rapid deceleration
on human beings using a rocket sled. A harness equipped with strain gauges had
been developed to measure the forces on the volunteers in the tests. After some
apparently successful runs, the records showed that the test had somehow failed
to work properly. Examination of the harness showed that it had been wired up
incorrectly. Murphy observed, ruefully, that if it was possible for a technician
to make a foul-up, then that was the way that things would be done. This was
the basis of what came to be known as Murphy’s Law. Murphy later went on to
become involved in the development of pilot escape systems for high speed military
aircraft and the Apollo space missions, and considered his “law” to be a good
maxim for safety. Subsequently, the concept of “defensive design”, in which
one tries to foresee and counteract the effects of human blunders, has become
widely used in areas where safety is paramount.
Sadly, Murphy’s Law tends often to be seen as a rather trivial interpretation
of the general cussedness of the world around us. However, it is possible to
demonstrate that the law has real validity. Take the phenomenon of dropped buttered
bread landing butter side down. Some years ago, on a television programme about
Murphy’s Law, a rather silly experiment was carried out, in which the audience
threw slices of bread and butter into the air to see which way they landed.
Not unexpectedly, the result was similar to that of tossing a coin, ie, 50:50.
However, few sane, rational people throw buttered bread into the air, except
as food for the birds. What usually happens is that the bread is dropped from
the table. A little thought will show that there are several forces acting upon
such dropped bread, including a forward momentum and the acceleration due to
gravity. These forces will have the effect of making the bread turn end over
end, so that in free fall the bread would tumble. However, the distance from
the average breakfast bar or table to the floor is usually just enough to enable
the bread to complete slightly more than half a turn, thus allowing it to land
butter side down. In an elegant evening discourse at the Royal Institution a
couple of years ago, Robert Matthews gave rational explanations for many of
the Murphy’s Law effects,1 including tangled ropes,
odd socks and the carrying of an umbrella when it fails to rain (and vice versa).
There has also been a full mathematical explanation of the odd socks effect.2
Thus, Murphy’s Law has a basis in fact, and is not just a trivial issue suited
only to be treated as a joke.
There is a special case of Murphy’s Law, which one can call the Law of Unintended
Consequences. This is called into play when one attempts to do something, only
to achieve the precise opposite. For instance, firebreaks in forests often fail
to work because the clearance of trees allows the growth of smaller, herbaceous
species that when dry may burn more readily than mature trees. Efforts to protect
important meadows containing rare plants by banning cattle from grazing were
frustrated when the plants on which the cattle grazed over-grew the whole area
to the exclusion of the species that were supposedly to have been protected.3
Doubtless, colleagues will know of many more examples in which a well-laid plan
was frustrated by the Law of Unintended Consequences. This law, like the more
general Murphy’s Law, needs to be heeded.
Much thought currently is being given to the future of our profession. Our President,
in her address to the British Pharmaceutical Conference last year, hailed the
government’s pharmacy strategy as “a watershed for the profession”.4
Indeed, it may well turn out so to be. In the same speech, the President urged
the swift implementation of the Crown report to allow pharmacists to become
prescribers. However, she also made an indirect reference to “pain” to be felt
by pharmacists who had invested their lives in the National Health Service,
which some have interpreted as a veiled threat to their businesses. If such
pain were to be felt, not only could some pharmacists lose everything that they
have worked for over many years, but the supply of both medicines and advice
to patients might be severely disrupted. No amount of e-commerce will make up
for the loss of a local community pharmacy within return pram-pushing distance
of people’s homes, particularly for those who have no transport, let alone a
home computer. We might, thereby, in our efforts to move into a New Age for
pharmacy, reduce rather than enhance the level and quality of pharmaceutical
service to the poorest and weakest members of the public, not to mention the
adverse effects on the livelihoods and retirement prospects of some of our colleagues.
Is this what we really intend? Unless we are very careful, such things could
come about under the Law of Unintended Consequences.
As regards pharmacist prescribing, yes, nurses now have the right to prescribe
and many pharmacists wish to emulate them. However, serious doubts are now being
raised over nurse prescribing.5 When a person of
such eminence in the field of prescribing studies as Professor Hugh McGavock
emphasises his grave concerns, then we should take his comments very seriously.
Should they not also apply to pharmacist prescribing? Before we rush headlong
into the brave new world envisaged by the government plan, let us remember stories
about babies and bathwater, and the various laws of the cussedness both of material
things and of human nature.
Madam President, beware! The ghost of Edward Murphy is looking over your shoulder.
John Wilson is a pharmacist, based in Arnold, Nottinghamshire,
who has retired and works part-time