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PJ Online homeThe Pharmaceutical Journal
Vol 275 No 7375 p614
12 November 2005

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Onlooker

Virtue of the divided mind more
Time for NHS reform more
Climate change and flooding could force Venice to sink into legend more


Virtue of the divided mind

Hunter-gatherersWe sometimes hear a great deal about the benefits to be anticipated from concentrating the processes of thought and attention. In guiding the activities of our children we often resort to the need to pay attention and urge them not to allow any distraction. School teachers in particular use “Pay attention” as a favourite phrase when things are getting out of hand. Yet when it comes to serious study and the need to assess evidence and reach an important decision, the temptation to adopt tunnel vision, and therefore to ignore great tracts of relevant information, may be less desirable than at first appears.

Concentrating on selected aspects of a problem and ignoring the overall shape of the enquiry and the interactions between its various parts is something that politicians practise ad nauseam. They tend to do so deliberately, hoping to avoid awkward questions to which they have no answer. This means that they cannot use lateral thinking or adopt a holistic attitude towards a problem. Inevitably, this narrows their outlook on life.

It is believed, and I suspect with good reason, that the female mind takes into account more factors than the male one. The comment has been made that a woman is able to do many things at the same time, such as caring for a child, preparing a meal and cleaning the kitchen.

If you think about this, you will realise that it probably represents an evolutionary process. In the early days when humans were hunter-gatherers it made sense. Armed with spear or bow, the hunter made his way through the wilderness in the track of the game that would provide a life-saving meal. His attention was wholly absorbed in following the spoor and stalking his prey. He could not think about anything else till his objective had been reached. The woman, by contrast, was concerned with meandering along and keeping an eye open for edible or medicinal plants by the wayside. Her attention had to be constantly wandering as she progressed. She did not dare concentrate her mind on one aim, as the simple hunter could do.

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Time for NHS reform

An editorial in The Lancet for 8 October maintains that the health service as we used to know it has disappeared. The health secretary has promised to continue with plans to introduce “market-based contestability”, meaning competition, into primary care. Many health workers have strongly opposed this idea, which involves bringing venture capital into the various branches of the service.

What was once a single NHS is becoming increasingly decentralised with a proliferating network of providers and independent treatment centres. Hospitals are to be built and financed by private money, with private surgical clinics and diagnostic services. It is, however, agreed that changes in the NHS are overdue, and underfunding for decades has demoralised medical staff working in outdated buildings with inadequate equipment. Across the UK there are inequalities in access to services, and the application of research results to practice has been delayed. Incentives for change and improved practice have been few.

Attempts at reform through administrative changes and inspections have proved ineffective. A report from the King’s Fund has found no improvement in care from current incentives. The service is becoming increasingly fragmented and the governing principles of universality and equity call for close attention. Incentives are too few to encourage continuous improvements in care, and counter-incentives impede the necessary changes.

Unfortunately, ideology rather than evidence has moved the minds of the Government, and studies of the effects of the reforms have not been made. Pending evidence of benefit, some think that the programme of privatisation should be halted.

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Climate change and flooding could force Venice to sink into legend

Travellers in Italy, and poets in particular, have waxed lyrical over the ancient city of Venice. Shelley talked of “a peopled labyrinth of walls, Amphitrite’s destined halls” and Byron described a situation “where Venice sate in state, throned on her hundred isles”.

There is today consternation over the distinct possibility that, given our climatic threats affecting the whole globe, Venice might sink into legend. Attention has been concentrated recently on the fate of New Orleans but many other coastal cities are facing disaster. Flooding in Venice has been a problem since the Middle Ages, and the accelerating rise in sea level attributed to global warming has turned a sporadic nuisance into a looming menace.

A discussion of this situation, published in Science for 23 September, describes some of the activities and investigations now focused upon the problem. Venice not only calls for attention in terms of its own plight but also offers a wealth of evidence that can be turned to good effect elsewhere. The city and its lagoon have become a model system for the complex interaction between the physical, biological and urban processes operating in a marine setting.

The record of Venetian sea-level changes through the years is claimed to be the most comprehensive in the world. Researchers have also been trying to account for the observed steady sinking of Venice through a combination of moving continental plates and the compression of sediment. Records indicate that the sea level in the Middle Ages was even higher than today, while during the Roman empire it was some 1.5m lower. It is disconcerting to find that sea levels in the vicinity of Venice have risen rapidly over the past 50 years.

Even without global warming, Venice is prone to flooding. One reason is that it was built only two metres or so above the water level at the time. Another reason is that, because the lagoon is situated at the narrow end of the Adriatic, swells generated by storms in the Mediterranean produce a build-up of water in the lagoon, sometimes doubling the volume of water on Venice’s doorstep. If it were not for the northward drift of Atlantic storms over the past 40 years — an effect also linked to global warming — the state of Venice now would be even more parlous.

Climate change and flooding are not the only factors that trouble Venetians. The art and architectural treasures of the place are calling for further protection and restoration.

There are also environmental threats to the surrounding lagoon, which supports a bustling seaport industry and protects Europe’s largest area of wetland. Fortunately, the Venice lagoon is the most closely studied in the world, yet it presents a singularly complex array of urgent problems to be overcome.

Venice’s population has fallen from 150,000 in the 1950s to 64,000 today, and its prosperity depends on 14 million tourists every year and on port traffic. Effort must be made to encourage more younger residents, otherwise the distant prospect is depressing.

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