Cicero on friendship

For Cicero friendship, “with the exception of wisdom,” was the most important thing in the world, as he lays out in his Treatise on Friendship. I have taken these quotes from his treatise and arranged them to make Cicero’s argument. I have much enjoyed my communion with a man dead for 2000 years.

The value of friendship

You might just as well take the sun out of the sky as friendship from life; for the immortal gods have given us nothing better or more delightful.

Now friendship may be thus defined: a complete accord on all subjects human and divine, joined with mutual goodwill and affection. And, with the exception of wisdom, I am inclined to think nothing better than this has been given to man by the immortal gods. There are people who give the palm to riches or to good health, or to power and office, many even to sensual pleasures. This last is the ideal of brute beasts; and of the others we may say that they are frail and uncertain and depend less on our own prudence than on the caprice of fortune. Then there are those who find the “chief good” in virtue. Well, that is a noble doctrine. But the very virtue they talk of is the parent and preserver of friendship, and without it friendship cannot possibly exist.

What can be more delightful than to have someone to whom you can say everything with the same absolute confidence as to yourself?

[Many of the] things desirable in the eyes of some are regarded by very many as worthless. But of friendship all think alike to a man, whether those have devoted themselves to politics, or those who delight in science and philosophy, or those who follow a private way of life and care for nothing but their own business, or those lastly who have given themselves body and soul to sensuality—they all think, I say, that without friendship life is no life, if they want some part of it, at any rate, to be noble.

Components of friendship

[A friend] will be entirely without any make-believe or pretence of feeling; for the open display even of dislike is more becoming to an ingenuous character than a studied concealment of sentiment. Secondly, he will not only reject all accusations brought against his friend by another, but he will not be suspicious himself either, nor be always thinking that his friend has acted improperly. Besides this, there should be a certain pleasantness in word and manner which adds no little flavour to friendship. A gloomy temper and unvarying gravity may be very impressive; but friendship should be a little less unbending, more indulgent and gracious, and more inclined to all kinds of good fellowship and good nature.

Friends talk truth to each other, no matter how painful that might be

It is true that to give and receive advice—the former with freedom and yet without bitterness, the latter with patience and without irritation—is peculiarly appropriate to genuine friendship, it is no less true that there can be nothing more utterly subversive of friendship than flattery, adulation, and base compliance.

There are people who owe more to bitter enemies than to apparently pleasant friends: the former often speak the truth, the latter never.

Now, if on a stage, such as a public assembly essentially is, where there is the amplest room for fiction and half-truths, truth nevertheless prevails if it be but fairly laid open and brought into the light of day, what ought to happen in the case of friendship, which rests entirely on truthfulness?

If a man could ascend to heaven and get a clear view of the natural order of the universe, and the beauty of the heavenly bodies, that wonderful spectacle would give him small pleasure, though nothing could be conceived more delightful if he had but had someone to whom to tell what he had seen.

Virtue is an essential component of friendship

We mean then by the “good” those whose actions and lives leave no question as to their honour, purity, equity, and liberality; who are free from greed, lust, and violence; and who have the courage of their convictions…[and] to the best of human ability they follow nature as the most perfect guide to a good life.

Seeing that a belief in a man’s virtue is the original cause of friendship, friendship can hardly remain if virtue he abandoned.

Nature has given us friendship as the handmaid of virtue, not as a partner in guilt:

Cicero is generous in defining virtue, nobody can be perfect

Such men as these are good enough for everyday life; and we need not trouble ourselves about those ideal characters which are nowhere to be met with.

Fewer people are endowed with virtue than wish to be thought to be so.

Other essential components of friendship

Now, what is the quality to look out for as a warrant for the stability and permanence of friendship? It is loyalty. Nothing that lacks this can be stable.

[Also essential is] “respect”; for if respect is gone, friendship has lost its brightest jewel.

Politics and friendship don’t go well together (I think of Michael Gove stabbing Boris Johnson in the back)

It is not in human nature to be indifferent to political power; and if the price men have to pay for it is the sacrifice of friendship, they think their treason will be thrown into the shade by the magnitude of the reward. This is why true friendship is very difficult to find among those who engage in politics and the contest for office. Where can you find the man to prefer his friend’s advancement to his own? And to say nothing of that, think how grievous and almost intolerable it is to most men to share political disaster. You will scarcely find anyone who can bring himself to do that.



A tale of the power of accents and unintended consequences

“It is impossible for an Englishman to open his mouth without making some other Englishman hate or despise him,” wrote George Bernard Shaw in Pygmalion, a play in which a poor girl is taught to speak “proper.” With a posh accent you might be despised as a “toff” or “stuck up”; a cockney or strong regional accent might show that you are “common,” or a “lout” or “slut”; and a “BBC accent” can be despised as “boring.”

I heard on the radio the other day that a quarter of people in Britain think that they have been discriminated against because of their accent, while four out of five employers say that they pay attention to accent when hiring people. A barrister with a cockney accent is more unusual than a black, female barrister, and a friend with an upper class accent was dismissed as unsuitable to be a television doctor because “too posh”: posh accents are acceptable on television only in wine experts and eccentrics.

As I listened to the radio, I thought back to being a child and our mother not wanting us to develop strong cockney accents. The oldest two of us went to a primary school in Rotherhithe where everybody was a cockney. Interestingly now I stop to think of it, neither of our parents had cockney accents despite being brought up in South London. (How did that happen I wonder?) It was a question of whether home or school would dominate our accents.

In an attempt to tip the balance away from cockney, my mother would have us say “thirty thousand feather round a thrush’s throat” ( “firty fasand  fevvers rand a frush’s froat”); “how now brown cow” (“ aw naw brawn caw”); and “the rain in Spain stays mainly on the plain” ( “the rine in Spine sties minely on the pline.”) Hazel, my mother, was not a snob, but I think she recognised that having cockney accents would limit our choices.

She had moderate but luckily not complete success. I have a distinctly London voice, but it’s only mildly cockney. Indeed, I’m often taken for Australian, which is, I think, because the Australian accent is a thin veneer over cockney, the accent, I suspect, of many of the criminals first shipped to Botany Bay. But my accent is more common than that of most doctors. And I can speak cockney: I speak it when I get into a black cab to be sure that they know I know my way and won’t be tempted to up the fare by taking me a longer route.

But luckily my mother failed with my brother, who, although he can manage a middling accent, is known as a cockney comic and has even been offered the part of Sid James, the quintessential cockney comic. Rather than boosting my brother’s career, any success by my mother in curtailing his accent would have worked against him.

Should the first rule of medicine be not “Do no harm” but rather “Be kind”?

Wordsworth wrote in Tintern Abbey that the “best portion of a good man’s life” are “His little, nameless, unremembered acts of kindness and of love.” I understood  this thought better when I read American lawyer Ken Schwartz’s account of his time in hospital with a lung cancer that eventually killed him: “moments of exquisite compassion” from some health staff and “simple human touch . . . made the unbearable bearable.”

But I know of no better account of the impact of “unremembered acts of kindness” than I read this morning in Oscar Wilde’s De Profundis, written while he was in prison. Before you read the brief passage below it is worth knowing some of the context. Wilde, the great writer and wit of the 19th century, was imprisoned  for sodomy and gross indecency. He was brought very low in prison, and many of his friends deserted him. One person who stood by him was Robbie Ross, an openly gay journalist who had been Wilde’s first male lover and later went with Wilde into exile and became his literary executor. It is Ross who raises his hat to Wilde.

“Where there is sorrow there is holy ground. Some day people will realise what that means. They will know nothing of life till they do,—and natures like his can realise it. When I was brought down from my prison to the Court of Bankruptcy, between two policemen,—waited in the long dreary corridor that, before the whole crowd, whom an action so sweet and simple hushed into silence, he might gravely raise his hat to me, as, handcuffed and with bowed head, I passed him by. Men have gone to heaven for smaller things than that. It was in this spirit, and with this mode of love, that the saints knelt down to wash the feet of the poor, or stooped to kiss the leper on the cheek. I have never said one single word to him about what he did. I do not know to the present moment whether he is aware that I was even conscious of his action. It is not a thing for which one can render formal thanks in formal words. I store it in the treasure-house of my heart. I keep it there as a secret debt that I am glad to think I can never possibly repay. It is embalmed and kept sweet by the myrrh and cassia of many tears. When wisdom has been profitless to me, philosophy barren, and the proverbs and phrases of those who have sought to give me consolation as dust and ashes in my mouth, the memory of that little, lovely, silent act of love has unsealed for me all the wells of pity: made the desert blossom like a rose, and brought me out of the bitterness of lonely exile into harmony with the wounded, broken, and great heart of the world. When people are able to understand, not merely how beautiful —’s action was, but why it meant so much to me, and always will mean so much, then, perhaps, they will realise how and in what spirit they should approach me. . . .”

Perhaps the first rule of medicine should not be “Do no harm” but rather “Be kind.”



Whom to trust on old age: Matt Hancock or Cicero?

The Manifesto of the Conservative Party promised us all five more years of healthy life by 2035. At the launch of the strategy for healthier longer lives from the All Party Parliamentary Group for Longevity,  Matt Hancock, the Secretary of State for Health, urged the audience to stop thinking of the growing proportion of elderly people in the population as a problem and recognise it as a boon, the result of success.

At the part of the meeting I attended nobody mentioned that life expectancy has stalled in Britain and even fallen among some groups. Nobody mentioned that most evidence does not support the much desired “compression of morbidity” (whereby people live long, healthy lives and fall quickly into death): instead, we seem to be spending longer periods in poor health and unable to live independently. Hancock did produce as evidence that the Conservative promise can be achieved the fact that people in people in some places already have healthy lives that are more than five years longer than people in other places. He talked about “places” rather than income and failed completely to acknowledge the intractability of the problem of difference in life expectancy between rich and poor.

At the age of 67 soon to be 68 (no presents, please) I’m interested in old age. When I was at medical school you were old at 60. Then it became 65 with the “old-old” beginning at 75. Am I old? I have a strange condition that I’ve called the Dorian Gray syndrome: “the central feature of the disease is the conviction–indeed, the knowledge–that you are the youngest person in the room when you are actually the oldest or one of the oldest.” But a week ago I ran the 5 km of the Park Run, did a personal best, came second (of two) in my age group, and have spent the past week hobbling rather than walking because of damage to my knee. “There’s no fool like an old fool,” my wife reminded me, urging me to stop running so far.

Even if I’m not old now I soon will be, and so I have turned not to Matt Hancock or the All Parliamentary Group for Longevity but to Cicero for advice on old age. Cicero did not reach old age by today’s standards in that he was beheaded by Mark Anthony’s supporters at age 63. His head was exhibited in the Forum in Rome, and Fulvia, Mark Anthony’s wife, is said to have repeatedly stabbed his tongue with a hatpin in vengeance for his power of speech.

But I have no doubt that Cicero will give better advice on old age than Matt Hancock, and I suggest that his short Treatise on Old Age should be recommended reading to all medical students and doctors. Cicero agrees with Hancock that old age can be delightful: ”The arms best adapted to old age are culture and the active exercise of the virtues. For if they have been maintained at every period—if one has lived much as well as long—the harvest they produce is wonderful, not only because they never fail us even in our last days (though that in itself is supremely important), but also because the consciousness of a well-spent life and the recollection of many virtuous actions are exceedingly delightful.”

Cicero sees four reasons why, against Matt Hancock’s plea, people may see old age as miserable: “I find that there are four reasons for old age being thought unhappy: First, that it withdraws us from active employments; second, that it enfeebles the body; third, that it deprives us of nearly all physical pleasures; fourth, that it is the next step to death.” He then addresses each in turn.

There is no reason he suggests for the old to withdraw from active employment, and he might be impressed that three men close to 80 are competing to be the next president of the modern-day Rome, the United States. “The great affairs of life are not performed by physical strength, or activity, or nimbleness of body, but by deliberation, character, expression of opinion. Of these old age is not only not deprived, but, as a rule, has them in a greater degree.” (Some of the Amerucak electorate will, I suspect, disagree.)

Cicero is not in favour of retiring to the golf course. “Old men [please read “men and women” for “men” throughout] retain their intellects well enough, if only they keep their minds active and fully employed. Nor is that the case only with men of high position and great office: it applies equally to private life and peaceful pursuits…. Is it not rather the case with all these that the active pursuit of study only ended with life?” Indeed, for the old Cicero writing his treatise was a great pleasure: “To myself, indeed, the composition of this book has been so delightful, that it has not only wiped away all the disagreeables of old age, but has even made it luxurious and delightful too.”

To guard against the enfeeblement of old age Cicero recommends that “Active exercise…and temperance can preserve some part of one’s former strength even in old age.” He is very modern in urging us to think of aging as illness or disease: “We must stand up against old age and make up for its drawbacks by taking pains. We must fight it as we should an illness. We must look after our health, use moderate exercise, take just enough food and drink to recruit, but not to overload, our strength. Nor is it the body alone that must be supported, but the intellect and soul much more. For they are like lamps: unless you feed them with oil, they too go out from old age.”

He advises study and continuing labours: “The man who is always living in the midst of these studies and labours does not perceive when old age creeps upon him. Thus, by slow and imperceptible degrees life draws to its end. There is no sudden breakage; it just slowly goes out.”

The third worry about old age, the waning of physical pleasures, Cicero sees positively because: “No more deadly curse than sensual pleasure has been inflicted on mankind by nature, to gratify which our wanton appetites are roused beyond all prudence or restraint. It is a fruitful source of treasons, revolutions, secret communications with the enemy. In fact, there is no crime, no evil deed, to which the appetite for sensual pleasures does not impel us. Fornications and adulteries, and every abomination of that kind, are brought about by the enticements of pleasure and by them alone….For pleasure hinders thought, is a foe to reason, and, so to speak, blinds the eyes of the mind.”

Cicero is “thankful to old age, which has increased my avidity for conversation, while it has removed that for eating and drinking.” He doesn’t want wine, women [or men], song, and games, and wisely he observes “my contention is that not to want is the pleasanter thing.”

The final argument against old age is the closeness of death, but, observes Cicero, “who is such a fool as to feel certain—however young he may be—that he will be alive in the evening? Yes, you will say; but a young man expects to live long; an old man cannot expect to do so. Well, he is a fool to expect it. For what can be more foolish than to regard the uncertain as certain, the false as true?”

Death is a good thing not to be feared because it brings either oblivion or happiness among old friends. (He doesn’t mention hell, a concept brought to full power by Christianity.) “All things that accord with nature are to be counted as good. But what can be more in accordance with nature than for old men to die? Just as apples when unripe are torn from trees, but when ripe and mellow drop down, so it is violence that takes life from young men, ripeness from old. This ripeness is so delightful to me, that, as I approach nearer to death, I seem as it were to be sighting land, and to be coming to port at last after a long voyage.”

Cicero makes no reference to any condition like dementia, nor does he mention loneliness. Few lived long enough in his time to develop dementia, and the Mediterranean diet probably helped those who did live long enough. Loneliness was also unknown. Cicero concludes: “End of life is the best, when, without the intellect or senses being impaired, Nature herself takes to pieces her own handiwork which she also put together. Just as the builder of a ship or a house can break them up more easily than anyone else, so the nature that knit together the human frame can also best unfasten it.”

Matt Hancock made no mention of death in his speech—there are no votes in death. And scanning the All Parliamentary Group’s report I can find no mention of death. The chances of achieving five more healthy years for all by 2035 seem to me tiny, but what we can be sure of is that annual deaths will increase by some 30% by 2050—and, God willing, I will be one of them.


An enchanting novel that celebrates Russia

It’s easy to see why A Gentleman in Moscow by Amor Towles, a “literary novel,” has sold over a million copies: it begins well, finishes well, is full of twists and turns, and enchants like a Tchaikovsky ballet. We sense that Towles loves Russia and its culture but at the same time is not blind to it many faults.

Beginning at the time of the Revolution and ending with Khrushchev in power, the novel lightly tells us the history of Russia, extending back to the time of the czars. On the first page we learnt that the “gentleman,” the Count, is placed under house—well, hotel—arrest for the rest of his life. The Metropol Hotel, still one the finest hotels in Russia, is at the very centre of Moscow close to the Bolshoi Theatre, Red Square, the Kremlin, and the Lubyanka. And all of Moscow passes through the hotel. There could be nowhere better to set a novel that celebrates Russia and Moscow.

The Count returned to Russia from Paris at the time of the Revolution, when most aristocrats were headed in the opposite direction. He is not, it’s clear, a normal aristocrat, although he has all the attributes of a gentleman—perfect manners, a deep knowledge of food, wine, dress, literature, art, music, and history, and is able to speak several languages. But it is employment in the hotel, unexpected “fatherhood,” and relationships that keep him alive in the hotel for 50 years.

I took several quotes from the book (below) and was led to compose tow blogs, one of which is largely a section from the book.


All poetry is a call to action.

Imagining what might happen if one’s circumstances were different [is] the only sure route to madness.

Life will entice, after all.

But every period has its virtues, even a time of turmoil. . . .

But in a period of abundance any half-wit with a spoon can please a palate. To truly test a chef’s ingenuity, one must instead look to a period of want. And what provides want better than war?

Fatima was fluent in the floral codes that had governed polite society since the Age of Chivalry. Not only did she know the flower that should be sent as an apology, she knew which flower to send when one has been late; when one has spoken out of turn; and when, having taking notice of the young lady at the door, one has carelessly overtrumped one’s partner. In short, Fatima knew a flower’s fragrance, color, and purpose better than a bee.

A gentleman should turn to a mirror with a sense of distrust. For rather than being tools of self-discovery, mirrors tended to be tools of self-deceit.

“If only I were there and she were here,” she sighed. And there, thought the Count, was a suitable plaint for all mankind.

Fate would not have the reputation it has if it simply did what it seemed it would do.

“Then came the Age of Iron—and with it the steam engine, the printing press, and the gun. Here was a very different trinity, indeed. For while these tools had been developed by the Bourgeoisie to further their own interests, it was through the engine, the press, and the pistol that the Proletariat began to free itself from labor, ignorance, and tyranny.”

From bells to cannons and back again, from now until the end of time. Such is the fate of iron ore.

Our friends who should overestimate our capacities. They should have an exaggerated opinion of our moral fortitude, our aesthetic sensibilities, and our intellectual scope. Why, they should practically imagine us leaping through a window in the nick of time with the works of Shakespeare in one hand and a pistol in the other!

For as sunrise leads to sunset and dust to dust, as every river returns to the sea, just so a man must return to the embrace of oblivion.

And that is just how it should be. That sense of loss is exactly what we must anticipate, prepare for, and cherish to the last of our days; for it is only our heartbreak that finally refutes all that is ephemeral in love.

They spoke of the once and the was, of the wishful and the wonderful.

Since the beginning of storytelling, he explained, Death has called on the unwitting. In one tale or another, it arrives quietly in town and takes a room at an inn, or lurks in an alleyway, or lingers in the marketplace, surreptitiously. Then just when the hero has a moment of respite from his daily affairs, Death pays him a visit. This is all well and good, allowed the Count. But what is rarely related is the fact that Life is every bit as devious as Death. It too can wear a hooded coat. It too can slip into town, lurk in an alley, or wait in the back of a tavern.

As I’ve said to you before, we and the Americans will lead the rest of this century because we are the only nations who have learned to brush the past aside instead of bowing before it. But where they have done so in service of their beloved individualism, we are attempting to do so in service of the common good.”

After all, Medea, Lady Macbeth, Irina Arkadina—these were not roles for the blue-eyed and blushing. They were roles for women who had known the bitterness of joy and the sweetness of despair.

Montaigne’s maxim that the surest sign of wisdom is constant cheerfulness.

Moscow 1922



Russia’s four great contributions to the West (and the World)

In the bar of the Metropol Hotel in the centre of Moscow in the early 20th century a boorish German complained to a Brit that “the only contribution the Russians had made to the West was the invention of vodka.” He challenges anybody in the bar to name three others. In A Gentleman in Moscow by Amor Towles’s, Count Alexander Ilyich Rostov—recipient of the Order of Saint Andrew, member of the Jockey Club, Master of the Hunt—takes up the challenge.

“Number one,” said the Count, adding a pause for dramatic effect: “Chekhov and Tolstoy.”

“With Chekhov and Tolstoy, we Russians have set the bronze bookends on the mantelpiece of narrative. Henceforth, writers of fictions from wheresoever they hail, will place themselves on the continuum that begins with the one and ends with the other. For who, I ask you, has exhibited better mastery of the shorter form than Chekhov in his flawless little stories? Precise and uncluttered, they invite us into some corner of a household at some discrete hour in which the entire human condition is suddenly within reach, if heartbreakingly so. While at the other extreme: Can you conceive of a work greater in scope than War and Peace? One that moves so deftly from the parlor to the battlefield and back again? That so fully investigates how the individual is shaped by history, and history by the individual? In the generations to come, I tell you there will be no new authors to supplant these two as the alpha and omega of narrative.”

[Number two] “Act one, scene one of The Nutcracker.”

“You laugh, mein Herr. And yet, I would wager a thousand crowns that you can picture it yourself. On Christmas Eve, having celebrated with family and friends in a room dressed with garlands, Clara sleeps soundly on the floor with her magnificent new toy. But at the stroke of midnight, with the one-eyed Drosselmeyer perched on the grandfather clock like an owl, the Christmas tree begins to grow. . . .”

“As the Count raised his hands slowly over the bar to suggest the growth of the tree, the Brit began to whistle the famous march from the opening act. “Yes, exactly,” said the Count to the Brit. “It is commonly said that the English know how to celebrate Advent best. But with all due respect, to witness the essence of winter cheer one must venture farther north than London. One must venture above the fiftieth parallel to where the course of the sun is its most elliptical and the force of the wind its most unforgiving. Dark, cold, and snowbound, Russia has the sort of climate in which the spirit of Christmas burns brightest. And that is why Tchaikovsky seems to have captured the sound of it better than anyone else. I tell you that not only will every European child of the twentieth century know the melodies of The Nutcracker, they will imagine their Christmas just as it is depicted in the ballet; and on the Christmas Eves of their dotage, Tchaikovsky’s tree will grow from the floor of their memories until they are gazing up in wonder once again.”

“Third,” said the Count. Then in lieu of explanation, he simply gestured to the Shalyapin’s entrance where a waiter suddenly appeared with a silver platter balanced on the palm of his hand. Placing the platter on the bar between the two foreigners, he lifted the dome to reveal a generous serving of caviar accompanied by blini and sour cream.”


How World War III will start, destroying humans and the planet

“People want war. I feel it. People are thirsting for blood. They have come to hate others and want now to kill them. People are bored. The right-wing leaders in Poland are worse even than those in Hungary. A madman is running America. Putin needs war to stay in power. Israel will explode.”

My elderly Polish friend is in apocalyptic mood. But before he concludes his argument with a flourish, he has carefully explained to me how World War III will start, a nuclear war that this time will finish the human species. His explanation comes from reading a novel written by a retired general and evidence that supports the plot of the novel.

“It will be a war over collapsing resources brought about by climate change,” I suggest.

“Maybe, but I don’t fear climate change like I fear war. I am wary of fears that become fashionable. Climate change will take time. War will come soon.”

The novel suggests that Estonia will be the trigger for the war. It is like Ukraine in that the people in the East of the country, about a quarter of the population, speak Russian and want to join Russia. The Estonian government will stop them, prompting Russia to invade. The difference between Estonia and the Ukraine is that Estonia belongs to NATO, which will have to respond.

NATO conventional forces are far superior to Russia’s, says my friend, but the Russians have invested heavily in tactical nuclear weapons, small bombs that will destroy just individual towns. It will be forced by the NATO response to use them. NATO hasn’t invested in tactical nuclear weapons and will be forced to respond with bigger bombs.

That will prompt all nuclear powers—China, India, Pakistan, Israel—to use their bombs before bombs are used against them.

Soon after he read the novel, my friend read about the Russians bringing tactical nuclear weapons to the border with Estonia. Then he visited Poland and to his astonishment saw a huge poster of two fighter jets swooping together with writing that says “Poland defends Estonia.” The Poles, he says, hate the Russians with a deep, visceral hate.

I wasn’t wholly convinced. I still think that war is more likely to be sparked by battles over diminishing resources caused by climate change or the inevitable war, as identified by Thucydides, that arises when one superpower (this time China and the US rather than Athens and Sparta) takes over from another.

Whichever way it might come war is coming.

PS. After my apocalyptic conversation I attend the launch of Britain’s “strategy for longer lives.” The Tory manifesto promises “five more years of healthy life” to everybody, as the Secretary of State for Health reminded us. His main message is that we mustn’t talk gloomily of the “aging of the population” but positively of “healthier longer lives.” Nobody mentions that life expectancy has stalled and even fallen for some in the past two years. Nor does anybody point out that the much hoped for “compression of morbidity” has little evidence to support it and much against it. The Secretary uses the fact that wealthier people already enjoy five years more healthy years than poor people as evidence that the manifesto promise is possible. In some sense this is true, but it fails to acknowledge the intractability of the problem of inequalities in health, which have got worse not better in the many decades that people have been talking about responding to them.

For me the Secretary of State is living in a fantasy world and my Polish friend in the real world. But the Secretary is young, and we are old.