This week, the second session of the year, and there were nine of us including Sophie the dog. We started in a way we often do. First we went round and said what we’d been thinking about for the last two weeks; and we talked about some of the things that this sparked off. And then we talked about a topic which Ben had brought in.
In our first round of discussions, the topic of who we are and what makes us who we are came up. One of us said that life in Red Lodge was settling back down into its routines after the holiday. Another of us said that he had been thinking about how who we are depends on who we are with, which led us to ask ‘Who would we be if we were stuck on a desert island, all by ourselves?’ We wondered whether we really do depend on others around us to make us who we are, or whether it is possible to be yourself in spite of it all. And bearing in mind that Red Lodge routines are settling back down, we wondered how routines affect who we are. Do they make it more difficult, or easier, to be ourselves?
Some people like to be disliked. They seem to thrive on it. Especially on the internet. One of us mentioned aggressive littering, which he had seen in New Earswick village. Some young people, he said, had been deliberately dropping litter in front of an old lady, and then were very aggressive to her when she confronted them about it. We talked about the way in which people, especially young people, might want to find out who they were by trying out being destructive, and so learning what they are comfortable with and what not. One of us mentioned that he had once cut the head off a daffodil just to do something destructive, and then afterwards had paused and realised he had not been happy with what he had done. The group asked whether he had been alone at the time, and he said that he had, which we thought was interesting as destructive acts seemed to be more common from people in a group.
We talked about bankers giving back their bonuses, and how the general public mind seemed to be inconsistent: first they wanted him to give it back, and then they said they didn’t think he should have had to. We suggested that the huge salaries paid to the very rich might show a mind-set which is not so very different from that of the young people dropping litter in a group. There’s peer pressure in both examples, since the rich want to be making as much as their peers. And we thought of the World War I generals throwing away the lives of young soldiers like litter, as shown in the recent adaptation of the novel Bird Song.
And then we set to talking about the story that this picture illustrates. Here’s the question:
Suppose we had a medicine that might be a lethal poison, but might be able to save many lives. Would it be alright to test that medicine on someone beforehand, and risk their life, if thereby we might save many other lives?
We quickly decided that it was not ok to do this unless the person it was to be tested upon agreed to it. Even if that person was a prisoner or a very bad person themselves. One of us pointed out that this story was no different from the actual story of Porton Down, the famous UK medical military research centre. When he had been in the Navy, many fellow servicemen had volunteered for experiments at Porton Down. Documents recently released under the fifty-year rule had revealed that some of those people had been exposed to radiation during research on the effects of nuclear war. Before, we’d said that if the experimental subject agreed to it, it was ok to test a drug on them. But if you didn’t know what the effects would be, could you really agree to it? Can you knowingly agree to something when you don’t know what you’re agreeing to? (Well, we said, you can knowingly agree to take a risk.)
We remembered the great drive to find a cure for the common cold in the 1950s, when many people had gone to Porton Down to test out new cold jabs. You got three weeks holiday and a payment. Some of us in the group had done the tests, as the family needed the money. We mentioned that today we know that there is no cure for the common cold: yes indeed, but maybe we only know this — or maybe the public only knows this — because of the Porton Down experiments, since not so long back people thought that you got a cold from actually being in the cold.
We said we respected scientists who did experiments on themselves, who shouldered the risk themselves. Ben mentioned that John Charnley, who pioneered the NHS hip replacement, had experimented on himself (see the last line of the long extract below); and we tried to think of some more.
Today’s main puzzle
Ben then put the story of the prisoners and the possibly dangerous drug in a different form. He drew some pictures to illustrate. The pictures below are borrowed from a website called Advocatus Atheist: they are very good and I hope the person who made them doesn’t mind me using them here.
Imagine there is an out-of-control train heading down a track and will surely crush four people tied to the track unless you do something. Luckily, there is a branch line just ahead of the train, and if you pull the lever you will divert the train onto the branch — but unluckily, there is also a person tied to that track! Is it right to pull the lever, and so sacrifice the one for the four?
Well, we mostly said it would be right to pull the lever and save the four for the one. But what if the option was not whether you should divert the train, but whether you should push someone onto the track and so stop the train?
In both cases, we kill one for four. But it feels like the first one is right and the second one wrong. Why do we think they are different? Well, there’s a lot to say about these sorts of puzzles, apparently. But we didn’t say it: someone immediately pointed out that the right thing to do would be to throw yourself onto the track, and that brilliant point pretty much wound things up (though someone else also added that in the first case if you mishandled the points you could derail the train).
More next time!
PS I didn’t realise it at the time, but the reason why we raised the question about who we are and what is our identity, was because I had been telling O.K., a new member of the group, about a discussion we had had in the group a long time ago. I had told this person about what Arnold had replied to this question, and it had stuck in O.K.’s mind. Then he raised the topic when it came to talking about what had been making us thing. So Arnold’s thoughts are still with us, even though he no longer is. And the other topic was based on a picture that T.I. had done as a poster for the group, even though T.I. has left the group and gone on to find work. So I like to think that there were two more people present at the group today than were physically sitting round that table in Red Lodge.
From the London Review of Books, ‘It’s Already Happened’, by James Meek Vol. 33 No. 18–22 September 2011
One dark Sunday afternoon in February 1982 Jill Charnley waited at the wheel of a car outside a hospital in Mansfield. Through the storm she saw her husband bustling towards her with a plastic pail containing the haunch of a woman who’d just died. ‘Down the road he came with a triumphant smile on his face and this bucket with a hip in it. He put it in the boot of the car. I remember saying: “My God, I hope we don’t have an accident, if they look in the boot of the car to see what’s there …”’
John Charnley, Sir John as he was by then, managed to restrain himself from dissecting the specimen, preserved under formalin, until the next day. The dead patient’s hip was, in a way, as much his as hers. It was implanted in 1963, one of the world’s first successful total hip replacements, performed by Charnley using a hip of his own design. ‘This is truly a marvellous climax to my series of more than 70 cases,’ he wrote in his journal, referring to post-mortem examinations he’d already done on his early patients. To have his prototype hip work smoothly inside someone for almost 20 years and still be, as he described it, in perfect condition, gave him joy.
The first generation of NHS surgeons were front-line surgeons in a literal sense. In 1940, aged 29, Charnley went to France as a military medic with the makeshift flotilla evacuating British troops from Dunkirk. ‘He didn’t expect to survive,’ his widow told me. ‘The boat he was in was bombed or shelled. I remember him saying to me that was the point when he believed he’d been saved for a purpose.’
The foundation of the NHS in 1948 coincided with a golden era in the struggle against infectious disease. In postwar Britain, orthopaedic surgeons earned their spurs in hospitals built in the countryside as sanitoria, designed to deal with the bone and joint problems caused by tuberculosis and polio. But the incidence of these infectious diseases was dropping. Casting around for new raisons d’être, the bone doctors fastened on arthritis.
Up to this point, the options for people with a dodgy hip were limited. Basic human actions – walking, getting up, sitting down – require smooth movement of the femoral head, the ball-like top of the thigh bone, against the cup-like socket in the pelvis known as the acetabulum. When it works as evolution made it, it is because socket and head are sheathed in a smooth layer of cartilage that secretes a natural lubricant called synovial fluid. Inflammation, fractures and swelling make the hip jam and chafe like a rusted-up hinge. The result is immobility and pain. By the 1950s, it was becoming fairly common to cut off the degraded top of a patient’s thigh bone and replace the femoral head with one made of metal or ceramic. Other surgeons focused on the acetabulum: they lined damaged hip sockets with cups made of steel, chrome alloy or glass. What was missing was total hip replacement, a reliable way of replacing both head and socket. It had been tried in the 1930s, with the two parts made of metal, but it had never really worked.
Charnley charged at the problem with zeal. A grammar school boy from Bury, he was a charismatic dynamo, a brilliant explainer given to anger when thwarted. He was so obsessed with bone growth that he got a colleague to cut off a piece of his shin bone and regraft it, just to see what would happen. (He got an infection and needed another, more serious operation.) Imbued with technocratic patriotism he carried a torch for the British motor industry and saw parallels between car and human engineering. Jill Charnley remembers him roaring down to London in his Aston Martin – ‘a brute of a car, a good engineering car’ – to visit her. He told her he was redesigning nature, and illustrated his theories with ball bearings from the British Motor Corporation’s new Mini.
They were married in 1957 and Jill moved into his medical digs in Manchester, where the wallpaper had a bone motif. Keen to avoid the communal dining-room, with its clientele of fusty bachelor surgeons, she tried the kitchenette. ‘I went in and opened the first cupboard,’ she said. ‘I was literally showered with old bones and all sorts of screws and bits and pieces.’
‘Oh Lord, yes.’
After noticing that a patient with a French-made acrylic ball fitted to the top of his thigh bone gave off a loud squeaking whenever he moved, Charnley realised that a complete hip replacement would work only when the head was firmly held in place and when materials were found that mimicked the low-friction, squeak-free movement of a natural hip joint.
His first attempt was a steel ball, smaller than the usual prostheses, attached to a dagger-like blade that was pushed through the soft core of the thigh bone and held in place with cement, like grout round a tile. For the socket, he used a Teflon cup. He put the experimental hip in about 300 patients. It was a disaster. After a few years tiny particles of Teflon shed by the cup caused a vile cheesy substance to build up around the joint. The blade came loose in the bone. Pain returned. Each one of the Teflon hips that Charnley had so laboriously put into his patients had to be removed and replaced. He did the work himself. His biographer, William Waugh, quotes one witness as saying the sight of Charnley going to each operation was ‘like observing a monk pouring ashes over his own head’. Punishing himself further, Charnley went around for nine months with a lump of Teflon implanted in his thigh to observe its effects.