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When payment falls due

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Congratulations!!  You just failed the Marshmallow Test… and your failure was entirely predictable.

The Marshmallow Test is a psychological experiment devised in the 1970s by psychologist Walter Mischel, a professor at Stanford University, to measure deferred gratification in children.  The test was simple enough.  A child would be sat at a table on which was placed a marshmallow.  The child was then told that the researcher had to leave the room for a minute, and so long as the child didn’t eat the marshmallow the researcher would give them a second one when they returned.  Simple enough you might think.  All the child has to do is to resist eating the marshmallow for a minute and he/she will be rewarded.  Except, of course, very few children are able to resist.

It turns out that just ten percent of children have the ability to resist; and this result turns out to have profound implications.  That ten percent turn out to be over-represented in the top educational grades, the best paid jobs and the most stable relationships.  And things do not get any better with age.  Most adults, given a choice between a small box of chocolates today and a large box next week, choose the small box.  The consequences of this are truly devastating.  As I explain in my book The Consciousness of Sheep:

“We simply cannot connect with the fact that it is the same me who will get to enjoy a large box of chocolate next week if only I can resist the temptation of a small box immediately.

“This experiment has important consequences for all of humanity.  It highlights a key reason why so many people stay stuck in unpleasant situations simply because they will not put effort into making change.  Again, we all ‘understand’ this at a cognitive level.  For example, we know that someone who is in a poorly paid and/or stressful job would be better off taking up a night school or distance learning course than, say, going to the pub in an attempt to unwind.  Nevertheless, adult education is struggling to recruit students while pubs are full of people complaining about their jobs!

“To most of us, our future selves are complete strangers.  Indeed, we are often more caring about our present friends and relatives than we are about our future selves.  And if our future selves are strangers, is it any surprise that we offer them no greater support than we would to a stranger today?  It is not that we wish them harm.  But – let’s be honest – how many of us would give up a small box of chocolate today so that someone else can have a large box next week?

“Of course, many of the issues facing us are so much greater than who gets chocolates.  An adult will not educate themselves so that a stranger can get a better job.  A drunk will not turn down a drink so that a stranger will be spared a hangover.   A smoker will not turn down a cigarette so that someone else does not get cancer.  And none of us will leave our cars at home or turn down holidays abroad so that strangers do not have to cope with economic collapse and climate change.”

This is not solely the product of culture – although the media, politicians and advertising companies exploit it mercilessly.  We are hard-wired to stay focused on the here and now; and for good reason.  With the exception of the relatively few decades that advanced industrial civilisation has been around (and even then only for a minority of humans) life has been so short and brutal that few have had the luxury of contemplating the future.  If there is food today it must be consumed or stored because surely there will be famine tomorrow… and if not famine, then plunder at the hands of someone bigger and stronger.  Wiser pre-industrial societies aligned their culture to overcome this tendency by obliging members to consider the effect of their actions and decisions on future generations.  But advanced capitalism is designed to let it rip.

So here’s a very topical question: should we allow people whose nature and culture operate in this way to make policy decisions in response to a global pandemic?

The story we have told ourselves (in the same way as fat people convince themselves they will begin dieting tomorrow or that smokers promise to quit next week) is that our decisions are being made by scientific experts whose understanding is based on a long-term overview of the situation.  Politicians (they would have us believe) are merely “following the science.”

This was likely true to a large extent back in February.  SARS-CoV-2 was an entirely new entity which, according to the worst case scenarios, could kill millions while leaving many more incapacitated for weeks at a time.  Faced with this prospect, politicians had to somehow balance three potentially competing needs; to:

  • Keep deaths and incapacity to a minimum
  • Prevent healthcare services being overwhelmed
  • Avoid an economic meltdown (particularly where critical infrastructure is at risk).

The difficulty with this is that each requirement operates on a different time-scale.  Protecting the healthcare system is immediate and short-term.  There are limited specialist staff, beds and equipment.  And as these are rapidly used up in the face of an exponentially increasing caseload, the need and public demand for action becomes impossible to resist.  And so, various versions of lockdown and border controls were implemented across the developed world in March and April.

Avoiding an economic meltdown, in contrast, is a long-term matter.  Various ameliorative measures such as the UK furlough scheme and the USA stimulus cheques worked to temporarily delay job losses; but only at the cost of states engaging in unrepayable borrowing while central banks pushed interest rates into negative territory.  There is a limit to how long this can continue before a financial system already fatally weakened after 2008, collapses entirely.  Because while the banking and financial sector of the economy often appears entirely detached from the “real economy,” ultimately the former depends upon the continued growth of the latter.  But with even officially measured unemployment beginning to spike upward already, there is bound to be an unpleasant reckoning in the coming months – particularly if Covid-19 waves continue unabated.

This contradiction between the short-term goal of maintaining the healthcare system and the long-term need to maintain the economy, rapidly became overlaid by various agendas.  While the UK government began with (but denied) a herd immunity strategy, metropolitan liberal opponents quickly built the narrative that this meant “putting the economy ahead of people’s lives.”  This fitted in with the broad reaction of a British public which turned out to be far more risk-averse than decision makers initially thought.  Far from demanding our freedom, a majority of Brits were ahead of the government and the media in demanding the imposition of most oppressive lockdowns possible.  The narrative has become so ingrained today that earlier this month when MPs questioned the wisdom of the current drift toward a second lockdown were accused by the Health Secretary of “wanting to let the virus run wild and take hundreds of thousands of lives.”

This, however, is where the various agendas which are currently driving policy obscure a genuine and far from settled public health debate.  Excess deaths in 2020 are going to be much higher than the previous five year average.  But the reason for this is not (or at least, not directly) to do with Covid-19.  The majority of the excess deaths are the result of the delays and cancellations of routine testing and treatment of non-Covid-19 illness.  Ed Conway at Sky News provides some heart-rending personal examples of this:

“Consider the story of Adrian Rogers, a scaffolding supervisor in his 40s, who was diagnosed with stage 4 bowel cancer in 2018.

“The cancer had spread to his liver but the initial courses of chemotherapy were promising – so promising that the tumours on the bowel stopped growing and what had looked inoperable suddenly looked like it might be treatable.

“Adrian was scheduled to have a life-saving operation to remove 70% of his liver at Manchester Royal Infirmary in early April.

“Then came lockdown…”

Adrian Rogers became another statistic.  His operation cancelled, chemotherapy put on hold.  His cancer is now considered terminal.  Just one of the thousands of premature and arguably preventable deaths caused by the response to Covid-19.  As Private Eye’s MD [practicing GP Philip Hammond] explains:

“Of the 30,260 ‘excess’ deaths – that is, above the five-year average expectation – in private homes since March, less than 1 in 10 is attributed to Covid-19… Each week 12,000 people die in the UK, many from conditions more treatable or preventable than Covid.  It could be that thousands have died from cardiac conditions at home who might have been saved in hospital.  We do few post-mortems, especially at the moment, so we will never know for sure (a lucky escape for the government).  But many consultants are anxious about reductions in the cancer and cardiac events reaching hospital…”

Remember that the UK government is trailing public opinion here.  While the government’s instinct – as witnessed by Chancellor Rishi Sunak’s “eat out and spread the virus” scheme in August – has been to return the economy to normal operations as quickly as possible, the majority of the UK public continues to favour lockdowns, even if it affects them directly.  Many on the political left also support lockdown measures (and the state-funded mitigation schemes) because they further erode the neoliberal consensus of the past four decades.  A return to austerity and “market forces” is going to be much harder now that the public has seen how quickly the government can create new currency and intervene in the economy.

Ultimately, this means that both sides are currently playing ping-pong with the government’s third competing need; to keep deaths and incapacity to a minimum.

Having said that government can be forgiven for over-reacting back in February when little was known about Covid-19, the same cannot be said now.  Despite the various cock-ups (some might say criminal negligence) of government in the early days (such as sending infected people into nursing homes or failing to provide adequate PPE to frontline health workers) the death rate from Covid-19 has proved to be far lower than the early modelling suggested.  Moreover, as effective treatments become available, far more of those unfortunate enough to end up in intensive care are surviving to tell the tale than was the case in the spring.  Meanwhile, the risk of dying from a range of non-Covid conditions has grown dramatically as a result of cancelled treatments, lack of community services and the severing of social support networks.

Concern about the longer-term public health impact of the response has resulted in a call for a return to what has been labelled a “herd immunity strategy.”  Most famously – because of the hostile media response to it – was the Great Barrington Declaration:

“Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.

“Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.”

The media (who clearly have an agenda of their own) chose to focus on the handful of idiots who signed it under amusing false names than the three esteemed scientists who wrote it.  One of the authors, Dr Sunetra Gupta (a professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modelling of infectious diseases) has recently responded to media and political criticisms in an article for Unherd:

“It is important to bear in mind that the attainment of the herd immunity threshold does not lead to disease eradication. Instead it corresponds to an equilibrium state in which the infections lingers at low levels in the community. This is the situation we tolerate for most infectious diseases (like flu which kills 650K people every year globally). The situation can be vastly improved through vaccination, but it is very difficult to eliminate the disease even with a good vaccine…

“The Great Barrington Declaration… suggests that we exploit the feature of this virus that it does not cause much harm to the large majority of the population to allow them to resume their normal lives, while shielding those who are vulnerable to severe disease and death.

“Under these circumstances, immunity will build up in the general population to a level that poses a low enough risk of infection to the vulnerable population that they may resume their normal lives. All of this can happen over a period of six months, and so this Focused Protection plan does not involve the permanent segregation of the vulnerable from the rest of the population.”

Less publicity was given to the long list of practicing GPs who signed a letter to Health Secretary Hancock earlier this month warning against further lockdown measures:

“A total of 30,260 excess deaths have occurred in private homes since March but less than 1 in 10 are due to Covid-19.

“The pandemic has resulted in an inflation of acute cardiovascular deaths, most of which did not relate to Covid-19.

“There is a concerning signal that child suicide death rates in the UK increased during lockdown and amongst those reported after lockdown, restriction to education and other activities, disruption to care and support services, tensions at home and isolation appeared to be contributing factors.

“The older shielding population with multiple long-term health conditions, (the very group whom restrictions were aimed at protecting) experienced higher levels of depression, anxiety and loneliness compared with those who were not shielding and were more likely to be less physically active than usual.

“These are but a sample of the myriad harms, both logged and latent, that need to be balanced with ongoing restrictions and infection control.

“Covid deaths alone can no longer be used as the unilateral measure of harm. Public health goes beyond deaths and ICU beds.

“We do not wish to undermine the seriousness of pandemic management but the wider harm to babies, children, young people and adults of all ages can no longer be ignored.”

This is a debate that a society capable of thinking ahead would have had right at the very beginning of the pandemic.  In short, the question we failed to ask back then was; “what does victory look like?”  That is, is the aim to entirely eradicate SARS-CoV-2 in the same way as smallpox was eradicated – a process that took 21 years?  If not, then what is our measure of success?  The development of a vaccine?  Until now, nobody has developed a vaccine against a coronavirus, and the record for developing a vaccine of any kind – against mumps – is four years.  And as professor Gupta points out, most vaccines act only to keep the spread of disease to a minimum.  The development of successful treatment packages is probably the most realisable victory condition.  Hospital deaths have fallen significantly since the spring as understanding of the disease and the development of new treatments has improved.  But the real game-changer will be an understanding of preventative measures (such as avoiding vitamin D3 deficiency) together with the approval of non-hospital early treatments (ideally over-the-counter, but at least via a GP prescription).

Because we have been unable to define an end state for the pandemic, we are stuck in a dangerous state of denial in which concerns about the long-term public health consequences of the response are aggressively dismissed as putting private profit ahead of people’s lives. 

There is a reason why the region where I live has among the worst health outcomes in Europe.  It is because economic decay going all the way back to the 1930s, and exacerbated in the 1980s, guarantees earlier incapacity and premature death from a range of otherwise preventable diseases such as cancer, stroke and heart disease.  The average male in Merthyr will be disabled before he reaches 60 and will be dead before reaching 75.  An average male in affluent leafy West Oxfordshire can expect more than 85 disability-free years of life.  That is the difference that the economy makes.

As with long-term health considerations, there is an economic reckoning appearing on the horizon.  Large swathes of the national economies of the developed states never recovered from the crises of the late 1970s and early 1980s.  Many more places fell into decline in the aftermath of the 2008 crash.  In the UK today, only London and the archipelago of top-tier university towns managed to generate some growth in the decade after 2008.  But even here, by the end of 2018 the beginnings of a slowdown were evident.  Our response to the pandemic (both the official response and our collective behaviour changes) has served to accelerate the pace of decline.  And the longer we artificially strangle the flow of currency through the economy, the nearer we bring the day when the entire UK economy – no longer supported by the export of North Sea oil and gas – goes into freefall.

This, too, is something that a government and people capable of forward thinking might now take steps to ameliorate.  Trapped in short-term and often politically-driven Hell, however, all we can do is sit back and watch with morbid fascination. 

In the global pandemic version of the Marshmallow Test, we’ve already lost; and payment will soon be due.  Decisions made for short-term reasons on the basis of inadequate understanding back in the spring of 2020 condemn us to an economic catastrophe in 2021 and a public health nightmare for years to come.  It should go without saying that if we cannot manage to process time over the relatively short duration of a pandemic, our chances of doing anything to mitigate resource depletion or even dent the destruction of the human habitat are pretty much zero.

As you made it to the end…

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