Quotes from Proust XXXII: Happiness is really useful to us in one way only, by making unhappiness possible


As for happiness, that is really useful to us in one way only, by making unhappiness possible. It is necessary for us to form in happiness ties of confidence and attachment that are both sweet and strong in order that their rupture may cause us the heart-rending but so valuable agony which is called unhappiness. Had we not been happy, if only in hope, the unhappinesses that befall us would be without cruelty and therefore without fruit.

In reality every reader is, while he is reading, the reader of his own self.

Time in which, as in some transforming fluid, men and societies and nations are immersed,

Oblivion is at work within us, and according to its arbitrary operation they [the people we know] evolve.

Roger Bacon on ignorance and peer review

The Franciscan philosopher Roger Bacon (c1214-1294), who some regard as the father of modern science, argued in his great text Opus Majus that there were four sources of ignorance.

  1. Frail and unsuited authority
  2. The influence of custom
  3. The opinion of the unlearned crowd
  4. The concealment of our ignorance in a display of apparent wisdom

I must confess right away that I didn’t read this in the Latin of Opus Majus but in the English of Bertrand Russell’s History of Western Philosophy. It’s important that I confess this as I’m taking Russell as an authority (or at least a reliable messenger), which Bacon criticised, and because I haven’t and couldn’t read the original Latin https://richardswsmith.wordpress.com/2016/07/29/why-i-regret-not-learning-latin/  –and Bacon was a strong proponent of learning languages and studying the original texts.

When I read Bacon’s four causes of ignorance I thought immediately of peer review. It’s clear to me that Bacon would have dismissed peer review.

Roger Bacon

Firstly, peer review depends entirely on “frail and unsuited authority.” It has no evidence base in the scientific sense of experimental studies demonstrating its effectiveness. It’s important because authorities say it is, and those authorities are, I suggest, “unsuited.” They are unsuited because they may be distinguished physicists or biochemists but they have not studied and experimented with peer review.

Secondly, peer review depends wholly on custom. It may not be as old as people think, but it is “the way we do things around here” in deciding on which grant proposals will be funded and which papers published where. And there are now huge vested interests: profits made, jobs provided, and reputations built. Bacon thought that concealment of our ignorance in a display of apparent wisdom was the main source of ignorance, and T S Eliot would agree: “In order to arrive at what you do not know/You must go by a way which is the way of ignorance.” But custom–the way we do things here–runs the failure to recognise, and even celebrate, ignorance a close second.

Thirdly, the “unlearned crowd”–editors of journals, authors of Scholarly Kitchen, publishers of profitable journals, and sadly most scientists–insist that peer review must be central to science.

Fourthly, scientific authorities conceal their ignorance in a display of apparent wisdom. I can’t claim to know everything about peer review, but I have been following evidence on peer review for nearly 40 years. That evidence, as I’ve written many times, https://breast-cancer-research.biomedcentral.com/articles/10.1186/bcr2742  fails to show effectiveness (and I accept that absence of evidence of effectiveness is not the same as evidence of absence of effectiveness) but does show that peer review is slow, expensive, something of a lottery, inefficient, wasteful of scientific resource, poor at detecting error and fraud, prone to bias, and anti-innovatory. Yet when I present this evidence to the learned–as I have done at the Royal Society, UNESCO, and other theatres of supposed wisdom–it is dismissed with anecdote: “I’ve had many papers improved by peer review.”

I’m sure that if Roger Bacon were to return from the grave he would condemn peer review outright.

What have I achieved in six years of teaching?

Yesterday as I flew home from teaching in Amsterdam for the last time I wondered what I might have achieved in six (or perhaps it’s seven) years of teaching.

Twice a year at the Royal Tropical Institute (KIT: Koninklijk Instituut voor de Tropen) I have taught about non-communicable disease (NCD) on the “tropical doctors’ course,” and once a year I’ve taught students on the health and development course.

Most of the students on the tropical doctors’ course are young Dutch doctors, but there have been some from other countries and some nurses and other clinicians. Many of them have worked or will work for Médecins Sans Frontières, and they are selfless and inspiring. Their clinical skills are supplemented by surgery, and the course does its best to prepare them for responding to all health problems in low and middle income countries and refugee camps.

The course has been running for many years, and on the wall are pictures of earlier generations of students–all men in suits with big moustaches. Now more than half the class are women. Until the year before I began there was no teaching on NCD, and it had been taught just once or twice by Jaime Miranda, a Peruvian friend. At the time he was doing a PhD at the London School of Hygiene and Tropical Medicine, and it was easy for him to cross to Amsterdam and teach. Once he returned to Lima it was impossible, and he suggested that I take over.

There had been no teaching on NCD because it wasn’t thought to be an important problem in low and middle income countries; and before the 1980s it wasn’t. In my teaching I show a graph of causes of death in Matlab in Bangladesh: in1986 NCD accounted for 10% of deaths, but by 2006 it was 80%, a very rapid transition. A pandemic of NCD is sweeping through low and middle income countries, so it became essential to have something about it in the course.

Similarly it needed to be included in the health and development course, which lasts a year and is attended by students from a wide range of low and middle income countries but mostly from Subsaharan Africa. The students are a mixture of doctors, nurses, pharmacists, and officials from health ministries. They are older than those on the tropical doctors’ course and usually harder work to teach; but the last class I taught yesterday had about 30 students and was especially responsive. There was one student– a woman doctor from Tanzania of about 35–who, even in the short time of the class, I felt sure will become minister of health if not prime minister in Tanzania.

When I started I felt vulnerable teaching the young doctors: not only have I never worked as a doctor in a low and middle income country I have worked as a doctor seeing patients for only two years ( and even then being essentially as assistant to “real doctors”). But I was told that didn’t matter: I wasn’t teaching them clinical skills but rather opening their eyes to the importance of NCD and giving them information on its prevalence and courses and discussing both global and local responses to the problem.

Teaching is, I believe, a branch of the entertainment industry. Nobody learns when bored. I’m also a great believer in the quote that I thought came from William Butler Yeats that “Education is not the filling of a pail, but the lighting of a fire.”  But I learn from Quote Investigator that Socrates is said to have said to millennia earlier: “Education is the kindling of a flame, not the filling of a vessel.” In fact there is no evidence that either made the quotes attributed to them, but Plutarch did write: “The mind is not a vessel that needs filling, but wood that needs igniting.” Whoever said or wrote it, I believe it strongly. I’m also keen on the phrase “All teach, all learn”: the students know much that I don’t know. I work too on the principle that the students already know much of what they need to know, and that it’s my job to help tease it out of them.

I’ve never had any training as a teacher, but this set of principles means that in six hours of teaching I try never to talk for more than 10 minutes at a time, and I mostly succeed. I encourage interaction and laughter, so I have to think a lot of my feet–and I am, I believe, performing rather like my brother, a stand-up comedian. It’s fun but tiring. On the tram to Amsterdam Centraal after my day’s teaching I sit like a zombie, staring out of the window. Once at Schipol I need a beer, even though it may not be 5 O’clock. I’m left hugely admiring of teachers who teach day after day. How do they manage it?

But what have I achieved? I’ve flow many miles, consumed much carbon, spent hours interacting with students, had great fun, and shared the 150 slides on my Powerpoint some 20 times. But is the world any better? Will the students be more effective because of my teaching? Will suffering be relieved, deaths averted, health created? I find it hard to believe that that will be the case.

But it could be. The nature, duration, and style of my teaching make it hard to know. I haven’t taught the students a skill that they can retain all their lives and use to great benefit. I haven’t filled buckets (I haven’t tried to), but could I have lit fires, fires that will burn and transform. I’ve taught around a 1000 students, surely I must have lit at least one fire.

I think of yesterday’s Tanzanian doctor when we discussed how low and middle income countries, which have only embryonic health systems, have the opportunity to develop health systems that will be more sustainable than those we have in high income countries. I presented some ideas, and her thoughtful questions showed that she was very taken by the ideas. Perhaps she might feed that small flame, and the consequence might be a more sustainable health system in Tanzania.

A young Dutch doctor was taken by my talk about climate change being the number one health problem and asked to  be connected to doctors I know who are leading the way on environmental sustainability. I connected her, and who know what the consequences might be. Perhaps nothing, or perhaps a vibrant movement in the Netherlands that will contribute to real change.

Teaching is a privilege and a pleasure, and I enjoy it. As we discussed last night at dinner, we can all remember teachers who had a big impact on us: I think of Nigel Ballantyne, Len Morey, Mr Eliot, Bryan Mathews, John Munro, Stephen Lock, and there are more. Perhaps somebody will remember my teaching.

I think back to a dismal teaching session in Kumasi, Ghana. In the evening we ate dinner outside, and I expressed my dissatisfaction to the dean of the medical school who sat next to me. “But who knows,” he said, “you may have planted an acorn that will grow into a great oak tree.”


Quotes from Proust XXXI: A book is a huge cemetery in which on the majority of the tombs the names are effaced and can no longer be read.

A whole heap of verbal concepts and practical goals which we falsely call life.

It is only while we are suffering that we see certain things which at other times are hidden from us/

Real books should be the offspring not of daylight and casual talk but of darkness and silence.

A book is a huge cemetery in which on the majority of the tombs the names are effaced and can no longer be read.

Quotes from Proust XXIX: Thanks to art, instead of seeing one world only, our own, we see that world multiply itself

The uniqueness of the fashion in which the world appears to each one of us, a difference which, if there were no art, would remain for ever the secret of every individual.

Thanks to art, instead of seeing one world only, our own, we see that world multiply itself and we have at our disposal as many worlds as there are original artists, worlds more different one from the other than those which revolve in infinite space, worlds which, centuries after the extinction of the fire from which their light first emanated, whether it is called Rembrandt or Vermeer, send us still each one its special radiance.

Howard Hodgkin: portraits filled with memories and associations and just sometimes figures

Howard Hodgkin’s paintings are instantly recognisable: it’s the colours (lots of characteristic orange, blue, and green), brushwork, arcs, spots, and painted frames or frames painted over. His portraits are as strong as any of his paintings, but, particularly in his later ones, you struggle to see even the hint of a figure.

Walk with Andrew

In his exhibition at the National Portrait Gallery, I was amused by a painting commissioned by a couple to celebrate their 20th wedding anniversary; unusually they posed for him, but despite the posing they ended up as simply entwined brush strokes. I’m sure, however, that they weren’t disappointed.


When Hodgkin painted a portrait he painted not a recognisable face or figure but an impression, a collection of memories and associations. There were initially marks recognisable as faces or other parts of bodies, but they mostly disappeared as his style developed.

I’m reading a biography of Picasso, and Cubists–long before Hodgkin–would include in the portraits what were little more than hints of people and then build the picture around them, usually with a restricted palette. But I don’t think that they were explicitly painting memories and associations of the people, although they perhaps were unconsciously. What else could they paint?

Hodgkin said that the more delicate and transitory the memory he was painting the more he needed to surround it with a dark, thick, strong boundary or frame–to protect it. You could see that in his painting of absent friends at the beginning of the exhibition.

Absent friends

Several of the paintings were erotic, and you could clearly see that they were. In Bed in Venice reflects the rich colours, warmth, and luxury of Venetian palazzos and the green of the canals with the couple on the right hand side.

In bed in Venice

Another painting was of what he called “a moment of unclothed sensuality,” and his picture of David Hockney emerging from a  swimming pool seems to have a phallus at the centre–and is that green fountain around the phallus water he’s shaking off or an ejaculation? Chicken didn’t like the symmetry of the painting.

Moment of unclothed sensuality


The exhibition included one self-portrait in which a ghostly Hodgkin peered through a curtain of spots, but Old Man Listening to Music, a large painting and one of the last he painted, is surely a self-portrait. Famously Hodgkin agonised over paintings, constantly changing them, which is surprising as they look both fresh and spontaneous. But he said that late in life he began to do all the painting and repainting in his head before he put brush to canvas. As I looked at Old Man Listening to Music I thought how hard that must be and what an extraordinary visual memory he must have had.

Listening to music

Hodgkin died just before the exhibition opened, and so the exhibition is a summary of more than 60 years of painting portraits. Will his work stand the test of the time? I think so.

The most Romantic death?

What might be the most Romantic death? Perhaps to die in battle, unhorsed, sword in hand, fighting for the most noble (or perhaps most hopeless) cause? Byron, that greatest of Romantics, died, I thought, fighting the Turks on behalf of the Greeks; in fact, I discover from Wikipedia, he died of sepsis after a bungled operation, perhaps one of the most unromantic deaths.

Keats died of tuberculosis, at the time a Romantic death, but now just squalid. Shelley drowned through being an incompetent sailor. Wordsworth died of old age, and Coleridge died of heart failure possibly contributed to by his opium addiction.

James Dean dying in a car crash might be a contestant, but he died not in a race but in a clumsy crash.

Glenn Miller didn’t die but disappeared, which has a definite Romantic twang.

To die in the arms of your lover seems a remarkably unromantic death when you think of all the embarrassment and form-filling that must follow.

Plus a Romantic death must surely be out of doors and involve action. Robin Cook, the Labour politician, died walking the Scottish hills, which seems to me an excellent and Romantic death.

But my favourite Romantic death comes from a cheesy film I watched past night, What We Did On Our Holiday. Billy Connolly (dying in real life of Parkinson’s disease) plays a reprobate grandfather who once played football for Scotland: “I rose and headed the ball into the net, my own net.” He lives in a most beautiful part of Scotland where the mountains reach the sea with his uptight, awkward son and his depressed daughter-in-law. His other son lives in London with three young children and is getting divorced after an affair with a Para-Olympian.

The London couple, trying to hide their divorce, travel to Scotland for Connolly’s 75th birthday. As preparations are underway for an extravagant event that Connolly is not looking forward to, he takes his three grandchildren to his favourite beach, a most beautiful place, deserted with a view of distant islands and mountains. He lets the children drive the Land Rover and run amok. At one point they bury him, and he pretends to be dead. We, the audience, think he’s dead, but he’s not. He tells the children how he has cancer and how he would like a Viking funeral, set adrift in a burning boat. The children love him and listen hard.

When the children return from splashing in the sea Connolly looks dead again. They think he’s playing, but this time he’s really dead. They decide that they must honour him with the Viking death he wanted. They pull together a raft, haul him onto it, erect a ragged sail, cover him in petrol, set fire to him, and push him out to sea. We watch him drift out blazing towards the mountains.


That’s my top Romantic death so far–to die on a beautiful beach playing with your grandchildren and then drift on fire out to sea. Can you beat it?