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Theodore Dalrymple on Elite Medical Journals and the Criminal Underclass

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Theodore Dalrymple on Elite Medical Journals and the Criminal Underclass

10 Blocks podcast June 26, 2019
Health Care
The Social Order

Anthony Daniels (known to readers as Theodore Dalrymple) joins Brian Anderson to discuss Daniels’s quarter-century of writing for City Journal and his new book, False Positive: A Year of Error, Omission, and Political Correctness in The New England Journal of Medicine.

“Theodore Dalrymple” first appeared in the pages of City Journal in 1994 with an aptly titled essay,The Knife Went In,” which recounted conversations he had had with violent felons during his time as a physician in a British inner-city hospital and prison. Since then, Daniels has written nearly 500 articles for City Journal. Selections of his essays have been compiled in the books Life at the Bottom: The Worldview That Makes the Underclass (2001) and Our Culture, What’s Left of It: The Mandarins and the Masses (2005).

Daniels’s latest book, False Positive, brings a critical eye to one of the most important general medical journals in the world: The New England Journal of Medicine. Daniels exposes errors of reasoning and omissions apparently undetected by the Journal’s editors and shows how its pages have become mind-numbingly politically correct, with highly debatable arguments allowed to pass as if self-evidently true.

Audio Transcript

Brian Anderson: Welcome back to the 10 Blocks podcast. This is Brian Anderson, the editor of City Journal, and I'm very pleased to welcome on the show today Anthony Daniels, known to our readers by his pen name Theodore Dalrymple. A retired physician who once practiced in a British inner-city hospital in prison, Tony is one of the English-speaking world's great writers, most original writers. He was once described by Arts & Letters daily as the Orwell of our time, and Peggy Noonan calls him the best doctor-writer since William Carlos Williams. His work has appeared not only in City Journal, but in multiple publications, ranging from The Wall Street Journal to The New Criterion to National Review. He's the author of at least two dozen books, one of which we will discuss today. Tony's here in New York and we're happy to have him on 10 Blocks. We’ll take a quick break and we’ll be back with Theodore Dalrymple after the music.

Brian Anderson: Hello again, everyone. This is Brian Anderson, editor of City Journal. Joining us in the studio is Anthony Daniels, better known to our readers as Theodore Dalrymple. We gave a longer introduction at the start of the show, but he’s written nearly 500 articles, short and long, for us since 1994, and it’s an honor to finally have him on the podcast. Tony, your new book looks at the fields of medicine and health through the lens of the New England Journal of Medicine. The book is called False Positive: A Year of Error, Omission, and Political Correctness in the New England Journal of Medicine. Perhaps you could describe what led you to write this book and how you proceeded?

Anthony Daniels: Well, I started-- I was inspired, if that's the word, to write it by a request from my French nephew, who's a medical student in Paris, who had an exam on how to read medical papers, medical literature, medical journals, and I gave him a few rules of thumb-- and he passed the exam. And I thought, well, I would look at the Journal, follow it more closely than usual to see how far my rules of thumb were obeyed in the Journal. So what I did is I just took a Journal, every week's Journal, and selected something from it, not quite at random-- it had to be something that was interesting to me-- and examined what it said, both the social commentary and the more scientific papers.

Brian Anderson: I think our readers would be interested in the social commentary side. You would assume a journal of medicine is going to be focusing on medicine, but often it spilled over into a kind of political correctness.

Anthony Daniels: Yes, that's true. There are lots of examples of that. For example, I mentioned a letter from the Netherlands about the glories of euthanasia in the Netherlands. And the author proudly stated that 92% of the 6,000 people who are euthanized, or encouraged to commit suicide by their doctors, 92% of them had serious medical conditions. Now, if I were editor of the New England Journal, I would say, 'well, what about the other 8%? Let's have a bit of clarification there.'

Brian Anderson: Right.

Anthony Daniels: But it wasn't even a question. And I suspect-- I can't prove-- it's because of an approval, a desire to make euthanasia look good.

Brian Anderson:  What other areas do you cover in False Positive where you do see this kind of errors, or emissions, or bracketing of important information, which does seem to have a kind of political subtext?

Anthony Daniels: Well it infects quite a lot, even the more technical things. For example, there was a paper about air pollution, the relationship of air pollution and total death rates in the United States, and it was a very large study-- it looked at a population of 60 million people, so it wasn't a tiny study, and it was extremely sophisticated in some of it's statistical manipulations. And what it found is that there was a relationship. The more polluted the air, the higher the death rate. And as is very often the case in such a paper, they concluded that the relationship was causative, as a statistical association is causative. And then this paper recommended changing the air of a very large part of the country without thinking about the cost, but also making this fundamental error that statistical association is causation. Now, I don't believe that the fact that they recommended changing almost everything was as a result of what they found. I think that was the starting point for them, probably. And if you looked at statistical association of air quality, you could probably find an association with, say, murder or illegitimate birth, but you wouldn't say that the air quality caused murder or illegitimate birth.

Brian Anderson: Right. Yes, that's making a pretty big leap. This year, 2019, marks a quarter century of writing for City Journal, where you've explored some of these themes that you're looking at in False Positive. You've written this regular quarterly feature for us, 'Oh, to be in England;' some of your earlier books are compilations of City Journal essays. One recurring current in this work is to look at what might be called criminal or underclass behavior. I'm thinking of some of your more chilling stories, one you did in 2015 called "Into Darkness," or one the next year "It's Your Fault I Killed." And, really, this theme goes back to your very first essay for City Journal "The Knife Went In." What has drawn you to look at what many people would find to be a morbid subject, of criminal behavior, self-destructive behavior?

Anthony Daniels: Well, first of all, it's actually statistically quite important because there's a large portion of the population actually living like this. But it's philosophically of interest because one of the explanations of ill behavior, if you like, is a kind of mechanical one. People have certain experiences and they react to them in a certain self-destructive way, as if their behavior was that of a billiard ball being impacted by another billiard ball. So, fundamentally, I suppose the underlying theme is that this is a wrong way to conceive of social problems and of human problems. There is almost always, not 100%, but almost always agency. Agency is extremely important. You don't deny that things are more difficult for some people than for others, but if you deny the agency of people, then you begin to treat them as objects rather than as subjects.

Brian Anderson: It's dehumanizing.

Anthony Daniels: It's dehumanizing. So, to give you an example, the idea-- and this is a medical example-- that heroin addiction is an illness which just strikes you out of the blue, like perhaps Parkinson's Disease strikes you out for blue, is completely false. And, to my mind, obviously false. But if you take the view that it is just an illness, then first of all, the person who suffers it has the reasonable expectation that the doctor will cure him of it without really any effort on his own part. But it also means that, theoretically, at any rate, you could do extremely nasty things to a person just because you're saying he's really an object, he can't do other than he does do. And not only is this horrible, but it's completely unrealistic,

Brian Anderson: We've seen a turn to this in recent positions in the law enforcement community, certainly among left-wing attorneys general, who are increasingly being appointed American cities. There's a big push now to decriminalize lower level infractions, and also a kind of return to the 70s idea that even violent criminals are really just reacting to their environment, this billiard ball idea that you mentioned. Your forthcoming essay in City Journal is looking at this kind of mindset in England, and maybe you could say a bit about what's going on there with regard to crime.

Anthony Daniels: Well, there's been a very strong current in British intellectual circles that criminality is akin to an illness, and therefore it's wrong to treat it as something that people have any control over. And of course this becomes a self-fulfilling prophecy. In England, the leniency of our criminal justice system. . . Precisely, I think because of our tendency to sociologize everything, to say that people are not agents-- because of an unhappy childhood, or whatever it is that you say it is, inequality or whatever it is-- this actually promotes criminality because it's a fairly obvious thought that actually what happens to you, what the results of crime are to you, can affect whether you commit it or not. This is something that is denied. It's as if criminals didn't have thought processes like us, they're completely different from people like us. But they're not different from people like us, on the whole. There are one or two exceptions, of course, but it's not true grosso modo. And if you look at the British criminal justice system-- in Britain, there's constant propaganda about how we have the highest rate of imprisonment in western Europe, and the, the measure is per head of population. But that's an absurd measure. It's actually per crime committed. And if you look at the difference between Spain and Britain, for example, we have roughly the same number of prisoners per head of population, but in Spain there are six times as many prisoners per violent crime, with the not-surprising result that there is much less violent crime in Spain than in Britain.

Brian Anderson: Over here, again, to turn to the American context, there is a lot of talk about the plague of mass incarceration. So there is a push to release what are, supposedly, nonviolent criminals back into the streets. The reality is that a lot of these prisoners are not nonviolent-- in fact, most prisoners have committed very serious felonies in America-- and I remember you saying once that, given the number of crimes that the typical criminal commits before he's finally incarcerated, the jails should be even more filled with people, right?

Anthony Daniels: Yes. And actually, in Britain, at any rate-- I can't speak for the United States-- should be there for longer. It's very curious how people say that prison doesn't work because a high proportion of prisoners when they come out commit offenses again, and I don't think I've ever seen anywhere in a British publication this might indicate that actually they should be in prison for longer. Another very obvious consideration, which is completely beyond the British intellectual class, is that the number of victims of crime is very much greater than the number of perpetrators. So each perpetrator actually creates large numbers of victims, and therefore it's not kind to people who live in criminal areas where there's a lot of criminality not to deal properly with the criminals. We deal with criminality as if it is a benefit received by the poor instead of what it is, one of the great hardships of being poor.

Brian Anderson: That's right, because the poor people in America are certainly the disproportionate of victims of crime.

Anthony Daniels: Yeah. And this seems to me so obvious a consideration that I don't understand how intellectuals can't or won't grasp it.

Brian Anderson: Another debate that's been cropping up that you've written on, I think in an illuminating way is that over the legalization of drugs; there is a significant push in the United States for legalizing cannabis now, not just for medical purposes but for recreational purposes. But there is starting to be a pushback on that because there is significant evidence that this might not be such a good move from a public policy standpoint, or from a public health standpoint. Maybe you could talk a bit about that.

Anthony Daniels: Well, one of the arguments for legalization is that the harm of taking what are currently illicit drugs is entirely, or largely from the illegal status, and that if you could just go down to your drugstore and buy a little cocaine, for example, for yourself, or whatever it is that you want, and it was treated like chocolate or some other commodity, there would be no ill consequences. But actually, what we have seen in the United States, and where I think there has been a kind of scandalous failure to recognize it until very recently, is that the consequences of taking opioids, even when they are prescribed perfectly legally, have been catastrophic. So it is not true that the consequences of widespread drug use, the ill consequences, are solely or even largely caused by the illegality. There is, of course, another argument, which is a very libertarian argument, that everyone should be allowed to put into his own body anything that he likes. But once you've said that-- and I think most people would say, well, there has to be some control over alcohol, and so on and so forth-- the question isn't whether there should be any control or not, but where that control actually is. And you can have it more liberal or less liberal as you like, but I really don't think it's conceivable, as I've indicated, that you could just go down to your drugstore or your convenience store and say, 'well, I'd like a little cocaine' or 'I'd like some PCP, or angel dust' or 'fentanyl' or whatever. It just doesn't seem to be very realistic.

Brian Anderson: Not yet. You've written an enormous amount on culture for us.

Anthony Daniels: Yes.

Brian Anderson: In particular, you've been drawn to the works of Shakespeare, and I wonder, what is it in Shakespeare, particularly among the greats of literature, that seems to resonate so much with you?

Anthony Daniels: Well, I think Shakespeare is actually unique. Of course I can't say that there's nothing like it anywhere else because I haven't read everything else. But it's the only body of work that seems to me as extraordinary in a special way. If, for example, you read the speeches of Richard II, or hear them, it's not merely that you look at and sympathize with someone who has fallen from a high position-- who, incidentally, is not a good person. There's no suggestion that he's a fallen hero. He's perhaps an average person with weaknesses, and you see how far he falls. But the extraordinary thing is, at any rate for me, is that when you read it, you actually become Richard II. You are Richard II. And this happens over and over and over again. John Gross, who was a wonderful, a great critic who knew more about English literature than anybody I've ever met, points out about Shylock, in his wonderful book about Shylock, Shylock scraped speech, you know, "Hath not a Jew eyes," and that kind of thing. He says that you can read it a hundred times and it never loses it's impact. And I've actually tried reading it many times straight over, and it's true. If you read it the 20th time, the 100th time, the impact on you is as great as the first time. And I don't think there's anything quite like that. There's almost no human situation that Shakespeare hasn't thought of.

Brian Anderson: I think you're going to have a book-length treatment of Shakespeare pretty soon. We've got enough of those essays, we could probably turn them into a book pretty soon.

Anthony Daniels: All right. Oh, well I must do some more.

Brian Anderson: Yeah, they've been great. Just a question on your own method of working. What is your typical day like? You're an incredibly productive writer; you don't seem to suffer from writer's block. You can often deliver very sharply done short editorials for us on things that are going on in the news. I'm just curious, how do you spend your days these days? You're not practicing?

Anthony Daniels: I'm not practicing. I couldn't do it now, but I used to go work and be a doctor, and I'd be on duty at night, and then I'd also write three articles a day. I couldn't do that now. I don't suffer from writer's cramp, it's more like writer's diarrhea. Anyhow, I find the best time to write is immediately. I get up, and I often, now, spend a couple of hours in bed writing. My wife very kindly brings me coffee, and maybe some toast. I can't really write more than four hours at a time unless someone calls me and offers me some money.

Brian Anderson: That's always a motivation. So are you doing any kind of consulting with prisons?

Anthony Daniels: No, not anymore. That's all over.

Brian Anderson: Well, that covers a range of topics here, Tony. It has been a remarkable 25 years. I hope we can do another 25 years.

Anthony Daniels: Unlikely, but I hope so, too.

Brian Anderson: You never know with all these medical innovations. I want to thank you very much, and good luck with the new book. The new book, again, is called False Positive, it is out from Encounter imminently. We love your writing here at City Journal and I'm very proud to be publishing it.

Anthony Daniels: Thank you very much, and I'm very grateful to you.

Brian Anderson: One last announcement: we've created a new email address for the show, so if listeners want to get in touch and drop a comment or share an idea, you can now email us directly at podcast@city-journal.org, so that is podcast@city-journal.org. Thanks very much for listening, and thanks again, Tony.

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