What to do about the many crazy cyclists?

I’m all in favour of cycling. It’s very much the best way to get around, good for the person and the planet. I’ve been cycling in London for 50 years and still most weeks cycle into Central London. But now I find that I’m at more risk from other cyclists than I am from cars, taxis, or buses. Cyclists in London seem to be out of control.

Fifty years ago cyclists were few and far between in London (although much commoner 20 years before that), but now it’s like being in the Tour de France if I cycle during the rush hours. When I stop at a red light, which I always do, I feel like the fossil that I am. Unless there is a stream of traffic crossing ahead when cycling would be suicidal, I’m usually the only one to stop. The other cyclists go straight through the lights. They also cycle on the pavements, across zebra crossings with pedestrians on them, and the wrong side of traffic islands. Other cyclists, many of them on electric bikes, cut inside you and across you as you cycle. I’m usually one of the slowest, but people in Lycra often going above the 20 miles per hour speed limit race each other. The biggest risk takers may be those on electric bikes delivering food who are unrecognisable with their heads and mouths covered. Most of them seem to cycle without lights, an indictment of their employers.

The law is confusing for cyclists. Some traffic offences apply only to drivers—for example, speeding or using a mobile phone—while others apply to cyclists as well—for example, obeying traffic signals. Some laws—like requiring lights on the bike (which many don’t have)—apply specifically to cyclists. There was no need to require cyclists to obey the speed limit when the minimum speed limit was 30 mile per hour and bikes were heavy. Now in London and other cities the speed limit is often 20 miles per hour, and bikes have become ever lighter and faster.

The Ask the Police website says that “Cyclists are required by law to act responsibly. It is a criminal offence to ride a cycle either dangerously or without due care and attention whilst on a road. It is also a criminal offence to ride a cycle in a public place or road whilst unfit through drink or drugs.”

In 2016 there were 26 convictions for dangerous cycling in England and Wales, 63 convictions for careless or inconsiderate cycling, and two convictions for cycling under the influence of drink or drugs. Clearly the conviction rate is extremely low: I stand a good chance of seeing 60 cyclists jumping the lights in one journey across London. I can well see that the police have better things to do than prosecute cyclists for dangerous, careless, or inconsiderate cycling. Cyclists know that they are most unlikely to be stopped by the police, and if they are stopped they are likely to be spoken to not prosecuted.

The main victims of crazy cycling is likely to be cyclist themselves, but others can be seriously harmed. No charge was brought against a cyclist who was cycling at 29 miles per hour around Regents Park and collided with an elderly woman who died two months after the collision. Although the speed limit was 20 miles per hour, the cyclist was not breaking the law because speed limits don’t apply to cyclists. 

In 2017 Kim Briggs was killed by a cyclist in central London. The cyclist was convicted by a jury of “causing bodily harm by wanton and furious driving,” but he was cleared of manslaughter. Her husband, Mathew Briggs, is now campaigning for a new offence of causing death by dangerous cycling.

What is the answer? The obvious answer is for cyclists to calm down, obey the law, and keep within the speed limit even if not legally required to do so. That seems to me to be highly unlikely to happen in London. Another answer may be greater enforcement of existing laws by the police. Perhaps a relatively small increase in prosecutions might have a deterrent effect. It seems obvious to change the law to require cyclists to obey speed limits, and a new a new offence of causing death by dangerous cycling may well come, particularly if there are more deaths (as there are likely to be). The extreme step of requiring cyclists to be licensed seems very unlikely.

My guess is that nothing will happen until there are more deaths caused by cyclists or other road users, particularly pedestrians, complain more loudly as the craziness of cyclists increases.

Because I was strongly taken to task by other cyclists when I published a blog along these lines before, I need to repeat that I strongly support cycling and am well aware that cyclists are the most vulnerable group on the roads. https://blogs.bmj.com/bmj/2019/09/11/richard-smith-time-to-regulate-cyclists/

An exhibition of powerful, spiritual, charcoal drawings of heads

Frank Auerbach created his remarkable series of charcoal drawings of heads by making a drawing of the sitter, largely erasing it, and then drawing it again. He might do this 40 or 50 times, a process of destruction and re-creation. Through this process he achieved drawings with great intensity. He often attacked the paper so hard that he punctured it. Many of the 20 or so heads in the Courtauld Gallery exhibition have clearly visible patches, but they add not subtract from the intensity of the pictures. Some too seem to have marks of water. The pictures are mostly black and white, one at least more white than black, but some have a few lines of colour, making them feel both deeply considered but also spontaneous.

The pictures are of only a few people: himself; Stella West (“EOW”), his partner at the time; Leon Kossoff, a fellow and now equally distinguished artist; Gerda Boehm, his cousin who seemed to serve also as a mother; Julia Wolstenholme, who later became his wife;  and Helen Gillespie. All apart from Gillespie were important in his life. He drew 10 pictures of West, and four of them hang along one wall, working powerfully together. West must have been constantly sitting for him, and Boehm sat for him weekly for 20 years beginning in 1961.Se

Auerbach did the drawings at the beginning of his career soon after the war. He had left Berlin as a child, and his parents died in the Holocaust. It was a time when people were recovering from the horrors of the war and asking questions about the meaning of existence. Auerbach could hardly afford paint, one of the reasons he may have concentrated on charcoal. The exhibition also includes a few paintings, and it’s clear how the paintings—of Kossof and West—developed from the drawings. Auerbach sees drawings to be just as important as paintings.

Nobody smiles in the pictures, and almost everybody looks down. Mostly the heads are bigger than life-size and fill the picture, although some have some upper body. A self-portrait included a hand, but it was only roughly drawn, not important. The people look haunted, melancholic, stoical, and solemn, but dignified and intensely alive. The result is pictures that feel spiritual. I thought of madonnas, but I also thought I may have spotted a halo and a crown of thorns. I was reminded as well of the heads on Easter Island.

I was very glad that I went to the exhibition, and I was almost tempted to buy the book of the exhibition—but we have far too many art books, most of which we never look at and probably never ever will. No matter where you live in the world you can see the exhibition, through a virtual tour. https://virtualtour.courtauld.ac.uk/frank-auerbach/ I recommend it.

As I went round the exhibition I jotted down notes on my phone (see below)

Worked and reworked.

Rubbed out. Started again 50 times.

Looking down

No smiles

Kossof’s bulging head

Drawing almost destroyed

Water marks

Destruction and creation

Scarred

Haunting

Religious

Madonnas

Colour shocks

Broken down to elements

Head bursting out

More white than black

A monster?

Solemn but not dead

Gerda Boehm, a cousin but more mother. Sat for him weekly for 20 years.

Disintegrating and reintegrating

Monumental, not sketches

Poise, dignity

Flashes of red, dynamic, strong lines

Pink added at the end

Deeply considered but also spontaneous

Is that a halo?

Emerging from the dark only to enter again

Dead and alive

Mostly head, rarely body

Hands more like sticks than human hands

Patched paper important

Ten heads of EOW Estelle West

Stoic but melancholic

Mostly bigger than life sized

Present and absent

Running our fingers over the head

Is that a crown of thorns?

Nobody looks up, nobody smiles

A chance to discover what it’s like waiting to be executed

Chidiock Tichborne wrote the poem below in the Tower of London in 1586 while waiting to be executed. He was 23. As I read the poem again yesterday morning I was—for a moment–in the Tower with him.

A Roman Catholic he joined the Babington Plot to assassinate Elizabeth I, but a double agent exposed the plot. On 20 September 1586 he was disembowelled, hung, drawn, and quartered.

Only three poems by him survive, and the one below, by far his most famous one, was included in a letter to his wife. All the words in the poem are monosyllabic, part of its power.

Elegy for himself

My prime of youth is but a frost of cares,
My feast of joy is but a dish of pain,
My crop of corn is but a field of tares,
And all my good is but vain hope of gain;
The day is past, and yet I saw no sun,
And now I live, and now my life is done.

My tale was heard and yet it was not told,
My fruit is fall’n, and yet my leaves are green,
My youth is spent and yet I am not old,
I saw the world and yet I was not seen;
My thread is cut and yet it is not spun,
And now I live, and now my life is done.

I sought my death and found it in my womb,
I looked for life and saw it was a shade,
I trod the earth and knew it was my tomb,
And now I die, and now I was but made;
My glass is full, and now my glass is run,
And now I live, and now my life is done.

How could a radio broadcast on self-examination have avoided creating misperceptions?

Earlier this week I listened to a radio broadcast in which a woman in her 20s with breast cancer described how she examined her breast and found a lump. She is now being treated for breast cancer. The interviewer, an older woman, interviewed her gently with empathy. There was no challenge, as there would have been to a politician, and the result was misleading and probably harmful messages.

The peg for the interview was the death from breast cancer of Kris Hallenga, the founder of CoppaFeel!, a breast awareness campaign. Hallenga was clearly a remarkable woman full of pazazz and humour. As the website of CoppaFeel! says: “In 2009 Kris was diagnosed with secondary breast cancer at the age of 23, after being turned away from her GP for over a year. By the time she was diagnosed, it was terminal. Kris’ ambition was for no one else to find themselves in her position and so CoppaFeel! was born, to ensure breast cancers are diagnosed early and accurately.” https://coppafeel.org/

The broadcast wanted to pay tribute to Hallenga’s life and achievements in a sensitive way and interviewing a young woman with breast cancer naturally seemed a good way to do so. In the context of the death of one young woman from breast cancer and interviewing another young woman with breast cancer, how could the interviewer do anything but let the young woman tell her story and conclude with the message that all women, including women in their 20s, should examine their breasts regularly?

It seems self-evident that examining your breasts regularly is a good thing to do. How could it not be? But, as all doctors know, many things that seem obviously beneficial can actually be harmful, and evidence suggests that that is the case with breast self-examination, particularly in young women.

One obvious problem with the broadcast was that hearing about two women who developed breast cancer in their 20s inevitably gave the impression that this was common. In fact, it’s extremely rare. In the UK there are on average in a year two cases of invasive breast cancer in every 100 000 women aged 20-24 and 11 cases for every 100 000 in women aged 25-29. There were no cases of what Cancer Research UK calls “breast carcinoma in situ” among women aged 20-24 and one case per 100 000 women in women aged 25-29.

As I’ve blogged before, breast carcinoma in situ or ductal carcinoma in situ (DCIS) is a confusing condition that may or may not progress to invasive cancer. https://blogs.bmj.com/bmj/2011/09/07/richard-smith-communicating-with-patients-about-ductal-carcinoma-in-situ/  A graph of age-specific incidence looks very odd because it has a big spike at age 50-54 while invasive breast cancer incidence rises progressively to peak at age 65-70. Breast cancer, like most (but not all) cancers is a disease of older people (men get breast cancer as well). Breast carcinoma in situ peaks at age 50-54 because women in Britain are routinely offered mammography at age 50, and breast carcinoma in situ is diagnosed mostly by mammography. Very few women in their 20s will have a mammogram, explaining the almost non-existent cases of breast carcinoma in situ in women in their 20s.

Many, even most, people in Britain think that breast cancer is a disease of young women rather than old women, largely because of the great attention paid to young women, particularly celebrities, who develop breast cancer. This week’s broadcast would have strengthened that misperception and it wouldn’t have been insensitive of the broadcast to state that cancer in woman in their 20s is extremely rare.

But the bigger misperception was to encourage young women to regularly examine their breasts. This is the conclusion from the Cochrane Library systematic review of breast self-examination: “Data from two large trials do not suggest a beneficial effect of screening by breast self‐examination but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. At present, screening by breast self‐examination or physical examination cannot be recommended.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387360/

In other words, lives are not saved by breast self-examination but a lot of women will have biopsies without benefit and naturally the finding of a lump will make women anxious, particularly as many people think that cancer leads to death. It’s a matter of false-positives, a signal (the examination) that something is wrong when it isn’t. False positives will be particularly common in women because true-positives, the signal (the examination) that something is wrong when it is are vanishingly rare because hardly any women in their 20s develop breast cancer.

How could the broadcast have avoided promoting these misperceptions? One option would have been not to have had the broadcast at all, and that probably would have been the best option. Another option would have been to interview after the young woman a doctor knowledgeable about breast cancer who could have corrected the misperceptions, but that would have cast a cloud over Hallenga’s work. Silence is often the best option.

A beautiful short story of 52 words. It might be entitled: “A man goes to the doctor”

The poet Silva had asked his doctor to draw a circle on the exact location of his heart. Of course, Silva, after visiting the doctor, arrived home, took off his shirt and shot himself in the centre of the circle: that’s why he’d sought the anatomy lesson, to commit an efficient suicide.

I took this story from Reputations by Juan Gabriel Vásquez.

Structure is everything, and David Nicholls has a gift for it

When I teach on writing a scientific paper I emphasise that structure is everything. Get the structure right and all else can follow easily. Plus editors can fix words, but it’s hard to fix structure. Scientific papers have a standard structure: IMRAD standing for introduction (why did we do it?), methods (what did we do?), results (what did we find?), and discussion (what might it mean?). Authors know it, and readers know it: everybody knows where they are. You can see from that brief account of the structure that the discussion is the hardest part of the paper to write, and with a friend I once proposed a standard structure for the discussion part of a paper.

What’s true for scientific writing is, I think, true of all writing: structure is everything. Readers need to know where they’ve come from, where they are, and where they’re going. Some novels have a structure almost as standard as scientific papers, one reason why detective novels are popular: something horrible happens; suspects are lined up; a clever detective solves the crime. Ulysses, perhaps the greatest novel in English, has an extraordinarily complex but well worked out structure following Homer’s poem and using different styles of writing. Even some poems—think, Dante’s Inferno with the circles of hell—have a transparent structure.

David Nicholls, an author who is currently riding high, has a gift for devising structures. One Day is a novel that follows the relationship of a couple who meet as students on the same day year after year. I read the novel in part because the students met at Edinburgh University, where my wife and I met. I enjoyed the novel but enjoyed more the television series.

Now Nicholls has published a novel, You Are Here, constructed around the Coast-to-Coast walk, a walk of almost 200 miles that I have done twice. The novel even includes maps. I loved the walk both times and remember the journey well. I often quote the broad outline of the walk: “From the Irish Sea, through the Lake District, across the Westmoreland Plateau, over the Pennines, down the Yorkshire Dales and then across the Vale of York and the North York Moors to the North Sea.” That’s the structure of Nicholls’s novel, with an interlude of a journey from Herne Hill (where my grandparents lived) to Battersea past the end of our road. How could I resist the novel?

Built on the ready-made structure is a love story. Will a divorced woman and a broken-hearted man, both around 40, manage to get together? Kurt Vonnegut warns authors about writing a love story—“because then all the readers care about is whether the girl gets the boy?” But I did care, and the witty dialogue is Nicholls’s other strength in addition to structure. I enjoyed the book greatly, and it was the easiest of reads, which I mean as a compliment not a criticism.

Nicholls was interviewed on the radio about the novel, and the interviewer observed that the book read as if it had been written to be filmed. With the witty dialogue, the wonderful views, and the smattering of sex, it’s all there for another successful series. I doubt that we’ll have to wait long. Plus the Coast-to-Coast devised by Alfred Wainwright https://richardswsmith.wordpress.com/2023/12/26/a-biography-of-a-fell-loving-curmudgeon-inspires-the-thought-of-a-last-hurrah/ is now the most popular walk in Britain, and the walk will sell the book and the book the walk. Everybody’s a winner, except that some of the path is already severely eroded.

I realised that I had read (or I thought I had read) one other novel by Nicholls, Us. I couldn’t remember anything about it, but I found my “review” on Goodreads, which reads: “I stopped reading this after 20%. It had a stale, uninspiring feel after Trollope. I’ve reverted to Henry James.” Oh dear, but then when I looked to see about the structure of the novel, I found that it included a Grand Tour, again a ready-made structure. I realised as well that I had watched the television version and enjoyed it a little.

Quotes I took from the book:

The risks involved in romantic love, the potential for hurt and betrayal and indignity, far outweighed the consolations.

Marnie noted his face, which had something old-fashioned about it, a kind of crumpled nobility, like someone leading a doomed expedition.

‘I suppose the main thing I feel now, and I want you to remember I’ve had a drink or two, is that I would have liked to have loved someone. You know, mutually, and for a period of time, and at that time of life, when you’ve got so much of it.

The stories we tell about ourselves are never neutral: they’re shaped and structured to create an impression,

For the moment she felt content, not because she’d spoken but because she’d been listened to.

Running parallel to the reality of her marriage was a phantom version of her twenties in which she’d been more ambitious, studied, travelled, taken risks, said yes.

If you wanted to get a man to talk with real emotion, you should ask him about his father.

The health research system needs to achieve environmental sustainability and fund more research into environmental destruction and health

We have known for four years that the NHS accounts for around 5% emissions of greenhouse gases, but we don’t know the carbon footprint of the heath research system. The research community has been slower than the NHS to develop a plan to get to net-zero, but the past week has seen two important steps forward: 25 research organisations have signed a concordat “to reduce and eliminate our own negative environmental impacts and emissions and achieve the transition to sustainable practices” https://wellcome.org/what-we-do/our-work/environmental-sustainability-concordat#about-the-concordat-ac54 ; and the first of what will be a series of meetings was held on “Research Outputs in Environmental Sustainability.”

Research systems are complex, including funders, universities, research institutions, regulators, industry, societies, publishers, individual researchers, and many more. Unlike the NHS there is no unified leadership, hence the need for a concordat, which was described at the meeting as “the seed for regulation.” As well as committing the signatories to eliminating environmental impacts, the concordat commits them to “ensure research and innovation continues to play a critical part in understanding how our planet is changing.” Funding has until very recently been hard to win for research on environmental destruction and health and findings ways to reduce that destruction and the harm it causes. The NHS net-zero plan makes it clear that a great deal of research and innovation will be needed to get the NHS and other health systems to net-zero. Research will also be needed to get the research system itself to net-zero.

The signatories to the concordat include the National Institute for Health and Care Research (NIHR), UK Research and Innovation (UKRI), and the Wellcome together with 10 universities. Funders hold a great deal of power in the research system (no funds, no research) and are beginning to require researchers when submitting grant applications to include information on environmental impact. How, people asked, will they trade off clinical benefit, cost, and environmental impact? The criteria that will be used to make the trade-off are nor clear, and nor are their agreed methods for measuring the environmental impact of research. Eventually, it was agreed, funders will have to stump up to develop a tool for measuring environmental impact. Representatives of funders did say that they will be willing to pay more to reduce environmental impact. Eventually funders might have carbon budgets just they have financial budgets and will be obliged not to exceed their carbon budget, forcing some difficult decisions.

As for the NHS, much of the carbon footprint of the research system will result from procurement—purchasing machines, agents, transport, food, and much more. The NHS is steadily stepping up what it requires from suppliers. Might research institutions be able to come together to use their purchasing power? Similarly, might they come together to lobby government? Academic institutions are jealous of their independence, and Imperial, Cambridge, and Oxford, three big research universities, have not signed the concordat.

Again as in the NHS, there are many pockets of innovation, but there are not good ways of sharing learning. People asked the funders to be willing to fund networks to share learning, and some networks—for example, on measuring and reducing the carbon footprint of clinical trials—already exist.

One message that was emphasised at the beginning of the meeting and then largely forgotten was the importance of including patients, research participants, and citizens in developing programmes to reduce the environmental impact of research. NIHR in particular has led the way with ensuring that patients are involved in every part of the research process, and they must be part of achieving environmental sustainability as well.

The leaders of the research community may have been slow to wake up to the importance of environmental sustainability in research, but when ending the meeting Professor Sir John Iredale, honorary consultant physician and former executive chair at the Medical Research Council, UKRI (who did a good job of chairing the meeting, encouraging candour) emphasised the need for immediacy and system wide change.

My conversation with Nigel Farage in a dream

The context is that Nigel Farage is working for a small organisation that I head. He has rung me up to talk about a meeting within the organisation. I wasn’t at the meeting.

Farage: People in the group don’t listen to me. They don’t seem to like me. They don’t respect me.

Me: What do you expect me to do?

Farage: Talk to them. Tell them to listen to me.

Me: Have you told the group how you feel?

Farage: No.

Me: Will you?

Farage: No.

Me: Don’t you think that you expressing how you feel to the group would be better than me talking to them? Don’t you think that me talking to them could make group dynamics worse not better?

Farage: No.

Me: Do you understand my thinking?

Farage: No.

Me: Will you reflect on what I’ve said?

Farage: No.

Here the dream ended, but it was a dream that made sense, seemed like the waking world. There was nothing surreal: no gorillas or flying saucepans appeared. Inevitably I’ve not remembered the dream exactly, but I think I’m close. My main memory is of Farage keep saying no, and, of course, his whole fame is built on no. (If you don’t know, he was the effective (if not formal) leader of the No Campaign in Britain’s referendum to leave the European Union.)

Does the dream mean anything? By definition it can’t reveal anything about Farage, but does it reveal anything about me that I didn’t know? I don’t think so, although I can detect in the dream elements of other issues on my mind. Perhaps a psychoanalyst would tease out something. I’ll never know, unless one reads this and tells me.

The impact of Oxford and Cambridge on Britain: mostly adverse?

Most of Britain’s prime ministers and many of its leaders in all sections of society went to Oxford or Cambridge Universities. The influence of those two universities on Britain is huge, but has it been benign or malign?

I’ve already written a blog about an essay by the journalist Simon Kuper, an Oxford graduate himself, in which he argued that Oxford is responsible for the current lamentable state of Britain. https://richardswsmith.wordpress.com/2019/06/27/is-oxford-university-the-cause-of-the-downfall-of-britain/  Oxford, he said, teaches you to talk confidently about a subject of which you know little, not how to get things done.

Today in Robert Skidelsky’s marvellous biography of Maynard Keynes I’ve been reading about the Apostles, the secret club of the cleverest students at Cambridge, and I’ve been left thinking that the ways of the club may also have had an adverse effect on Britain.

The club was founded in1820 and was “more like a family than a club.” They met every Saturday where a “moderator” would read a paper that would be discussed by members (including “embryos,” new members, and “angels,” dons who had been Apostles) speaking from the “hearthrug.” Between meetings the Apostles spent most time with each other. “Their discussions were full of in-jokes, personal allusions, private meanings. Their talk was spiced with blasphemy and sexual innuendo, much as it had been at school.”

The Kantian jokes was the club was “real” and the rest of the world “phenomenal.” “What this meant was that the world outside was regarded as less substantial. Less worthy of attention than the society’s own collective life.” Members of the club felt superior. Most of the members “combined great cleverness with great unworldliness.” They were, writes Skidelsky, “a product of a very English reaction to industrial life, based on the cult of dead languages, chivalry, moral utopias, and the rejection of commercial careers.” The whole university “saw itself as a world of learning and beauty set in a land of barbarians and philistines.”

Tennyson, Bertrand Russell, and G E Moore were all members as were Lyton Strachey and Leonard Woolf, who recruited Keynes. In his turn Keynes recruited Wittgenstein, who left almost immediately, thinking it ridiculous. Guy Burgess, Anthony Blunt, and two other Soviet spies were also Apostles. Women were admitted only in the 1970s.

The Apostles had a great influence on Keynes, giving him, writes Skidelsky, “the opportunity, incentive, and justification for becoming the person he wanted to be.” A friend who went to Cambridge (but was not, as far as I know, an Apostle) thinks Keynes the greatest Englishman, and he certainly had great worldly achievements, rather undermining my argument that Oxford and Cambridge have had an adverse impact on Britain. But many of the traits exemplified by the Apostles—a sense of superiority, disdain for non-Apostles, and a celebration of unworldliness—have not served Britain well, especially when put alongside the misplaced confidence installed by an Oxford education.

Why it’s horrible being a tourist

I’ve read this in Helen Garner’s novel The Children’s Bach https://richardswsmith.wordpress.com/2024/04/21/a-short-highly-original-novel-that-includes-excellent-advice-on-how-to-write/ and thought that it expresses so well the horror of being a tourist in remarkably few words that I’ve given it a blog on its own.

“What do tourists do? They walk, they stand, they look, they buy. They fumble for money on buses, not knowing whether to pay the driver or the conductor. They visit famous monuments, fountains, old houses full of stone and shutters and anachronistic lace. They notice that the day without duty passes with the slowness of a dream. They know that their existence is without point. They envy those who go arm in arm, who have a home to go to.”