Granny Not

Guernsey McPearson

The women there do all they ought;

The men observe the Rules of Thought.

They love the Good; they worship Truth;

They laugh uproariously in youth;

(And when they get to feeling old,

They up and shoot themselves, I'm told)

Rupert Brooke

I must confess to some ignorance here. I know, I know, that's not a usual weakness of GMcP's but even my knowledge has its limits. You will, of course, have recognised the lines as coming from Rupert Brooke's wonderful and witty poem, The Old Vicarage Grantchester. Identifying that is not the problem. The question is what exactly did he mean by the Rules of Thought? Note the use of the capitals. It is almost as if he is referring to some well-known system. (On the other hand Good and Truth are also capitalised, so perhaps not.) But what can it be? Could it be a famous work of the 19^th century. I refer, of course, to that treatise of 1854, by George Boole (1815-1864), An Investigation Into the Laws of Thought on Which are founded the Mathematical Theories of Logic and Probabilities. If so, then these good men of Grantchester were clearly well-equipped to understand that queen of sciences, statistics, in which logic and probability go hand in hand. Boole, is of course, the mathematician after whom Boolean algebra is named and is thus considered a pioneer of computing. He would no doubt be astonished to discover where it has all led. What would he make of the fact, for example, that thanks to the sort of mathematics he was expounding, you can view a video on You Tube at http://www.geevideos.com/watch/1144219132/forgotten-genius-george-boole-part-2/ in which a certain Mike Salter, head of Applied Electronics at Lincoln College (Boole was from Lincoln)expounds on the merits of this forgotten genius.

Which reminds me, did you know that there are 10 kinds of statistician? Those who understand binary and those who don't? (This is my only joke, I am afraid, and is stolen from that incomparable writer, Mr Christopher Brookmyre.)

However, much as I am attracted to the passage quoted by its reference to logical thinking, it is actually that last line that provides my reason for quoting it. Yes, folks I am going for a double whammy. Having offended just about everybody by questioning the wisdom of the Pangean Pharmaceutical Agency (PPEA) in forcing pharmaceutical sponsors to have paediatric evaluation plans, PEPs, (see Suffer the Little Children, SPIN, passim) I am now going to put the case for ageism in medicine. That is to say I am going to argue that it is perfectly rational to use age as a ground for discrimination in determining health care priorities.

Now at this point I feel it is appropriate to digress to some science fiction. I have in mind a rather cheesy film of the 1970s called Logan's Run. The Logan in question is played by Michael York, and is a so-called sandman in a future dystopia in which people are killed when they reach the age of 30 know as 'lastday'. Those that refuse to collaborate in their own destruction are known as runners and are hunted down and killed by the sandmen. The film of course is a load of tosh but on the plus side it does feature gorgeously pouting Jenny Agutter and has now achieved quite a cult following

This sort of activity, killing individuals just because they are old, is called senilicide. (See http://www.funnyordie.com/videos/2383 for a video on this theme.) Thirty is perhaps a bit young for a society to choose as the limit to follow-up, to put it statistically, but in the original novel on which Logan's Run was based the snuff limit was set even lower. It has been a feature of various works of fiction. For example Tom Robbins's Jitterbug Perfume features a king, Alobar, who balks at the usual fate of kings of his tribe that they should be killed as soon as they show the first grey hair. Senilicide is even, famously, supposed to have been practiced by what used to be called Eskimos but are now usually referred to as Inuit. Once grandma's teeth had worn out she was no longer able to soften up the seal skins properly by chewing them, and so just a burden on society. So it was a case of off to the nearest ice floe and cast her adrift.

I hope that you all appreciate what you get in this column, not only statistics and drug development, but literature, cultural criticism and anthropology.

Now why I am discussing this? Well actually, for once it has nothing much to do with Pannostrum, except of course that since the elderly are amongst our best customers company policy is dead set against senilicide, if I can phrase it thus. Furthermore, many of our top managers are positively senile. In fact I think that whether considered from the point of view of who we are or what we do, it can safely be said that Pannostrum is pro wrinkly.

No, for once I am picking up on a wider cultural theme. I have my antennae out everywhere of course and it was the recent fuss north of the border (ancestral home of the McPearson clan) that I am referring to. The head of 'The Caledonian Pill Board' (which recommends what medicines Scots should have reimbursed to take with their porridge and haggis), has had the temerity to suggest that Caledonians should have a debate on whether, given that healthcare budgets are finite, they should prioritise medicine for the young. All the chap was asking for was a discussion, but the press has been full of letters virtually accusing him of having suggested that one should drag the elderly out of the care homes line them up and shoot the lot of them.

Now, when discussing this, people often invoke some principle of equality, such as 'the elderly should get the same standard of care as the young'. But what does this mean? Consider two persons suffering from the same disease, one young the other old. We have decided that they should have the same standard of care. Does this mean they should have the same sums of money spent on their health care? But other things being equal the older person is likely to need more care. Should we spend to try and achieve the same outcome? But this might be impossible and other things being equal the younger patient is likely to have a greater expectation of future years of life. On the other hand given that the older patient has already lived longer the total expectation of life will be greater than that of the younger patient. In fact it is only to the pea-brained that it is even obvious what equity with respect to age means.

My standard thinking on this involves the observation that ethical dilemmas cannot be solved at the point of sickness. I give you an example. I understand from various documentaries that appear on television that many of the young of Great Britain have summer holidays on the Island of Ibiza where they spend much of the early part of every evening pouring alcohol down their throats and much of the later part expelling it. Furthermore, they seem to have no interest in the local culture, making no attempt to learn Spanish, let alone Catalan or visit the Phoenician settlement of Sa Caleta but instead trying to find willing partners for casual sex. Tut tut! It's worse than a PSI conference dinner.

Now, consider the spending priorities of UK limited. It's a disgrace. I give you one lager lout about to make an online payment for his annual holiday to Playa d'en Bossa and a little old grandma in need of a hip replacement. She's been waiting for that for a while because we haven't built enough hospitals and employed enough orthopaedic surgeons or theatre nurses. We could change our system of taxes so that the young could not afford holidays and use the money to treat the elderly. Put that oaf up against grandma and see who wins. He probably supports Arsenal or Chelsea and shouts Ing-er-land at internationals. He swills lager in public from a can while belching and effing and blinding. Grandma on the other hand is in the WI. Why, the woman almost certainly makes scones. It is, as the Ibiza set would say, a no-brainer. Grandma wins every time. We should tax the young and use the money to treat the elderly better in the NHS.

However, looking at the issue on what the philosopher John Rawls referred to as the original position, this choice is perhaps not so logical. You are about to start your life. What sort of a society would you like? One in which you get holidays when you are young but may find that healthcare is rationed when you are old or one in which it's work, work, work and no fun but when you are 75 you get a guaranteed hip replacement?

I was getting quite excited about this theme the other evening and as usual when this was the case was giving Mrs McP the benefit of my thoughts. She rather cuttingly replied that I was no longer in the first flush of youth and ought to watch out what sort of society I wished for. I replied that of course that wasn't the point but I stuck by my principles and she had my full permission to shoot me when I got senile.

Thanks, dear, she replied. But if I ever think I need your permission to do something, it will be a sign that I am senile and you can shoot me.

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